Safe staffing bill passes state House, but disagreement continues

OLYMPIA – Proposed requirements for the numbers of nurses and other health care workers on duty in hospitals won support from the Washington state House of Representatives on Sunday.

The bill was amended to lesson possible penalties for violating the requirements, but hospital administrators remain strongly opposed to the concept.

The House passed a bill 55-43 to implement safe staffing standards in hospitals across the state, including nurse-to-patient ratios and fines for hospitals that fail to meet them. Another bill, establishing a loan repayment program for nurse educators in Washington, passed 97-1.

The House passage of the safe staffing standards bill is a win for nursing unions which have pushed for staffing ratios that they say can help ease burn out and improve patient care. Hospital leaders, however, have argued against ratios that they say cannot work unless there are more nurses in the field to begin with.

The bill received some changes before passing, and prime sponsor Rep. Marcus Riccelli, D-Spokane, acknowledged there still is work to be done as it makes its way through the Senate.

Riccelli said on the floor Sunday he thinks there has been “some movement” in discussions between hospital leaders and unions.

“We did improve it,” Riccelli said. “I think there’s some continued efforts as we work to navigate this.”

But hospital leaders in Washington still say they cannot support the proposal.

“These changes don’t fix the bill,” Providence Chief Executive Susan Stacey said in an interview.

The bill requires hospitals to follow staff-to-patient ratios, and outlines, per department, what those should be. The changes made Sunday would increase the ratios originally described in the bill, allowing more patients to be assigned for every one nurse.

For example, in emergency departments, there should be eight patients for every one nursing assistant. In medical-surgical units, there should be five patients for every one nurse.

Hospitals have until July 1, 2024, to submit and implement their staffing plan.

Stacey said having hard ratios make it difficult to adjust when patient condition changes.

Hospitals that don’t follow the ratios could be fined by the Department of Labor and Industries, though the new version of the bill allows for hospitals to deviate from their staffing plans for “good cause.” “Good cause” is defined as situations where compliance is “infeasible” and where allowing the hospitals to deviate “does not have a significant harmful effect on employees and patients.”

The fine given to hospitals that don’t comply with staffing standards is now $5,000 a day, down from the $10,000 a day laid out in the original bill.

“It inflicts a level of government oversight that isn’t really necessary,” said Darcy Jaffe, senior vice president for safety and quality at the Washington State Hospital Association.

Nurses, however, say the accountability is needed to ensure hospitals actually follow the plans their staffing committees laid out.

Hospital leaders also argue the bill won’t put more nurses in the field.

“I just don’t know where all these people are going to come from,” Stacey said.

Nursing unions, on the other hand, argue even more nurses will leave due to burnout and exhaustion if staffing standards are not put into place.

“If we don’t do something to stop people from leaving the profession or leaving the hospital situation we are all going to be in trouble,” former nurse Rep. Eileen Cody, D-Seattle, said on the floor Sunday.

Unions representing nurses, nursing assistants and other hospital workers statewide surveyed their own members and found that almost half are considering leaving the field altogether in the next few years.

The survey, which was done in December, found that short-staffing, lack of pay and workplace safety are among the top reasons health care workers are considering leaving. More than 70% said the top reason for wanting to leave was short-staffing.

“I think it’s easy for everyone to understand,” registered nurse Clint Wallace told The Spokesman-Review last month. “Taking care of less patients is easier than taking care of more patients.”

After Sunday’s passage, a statement from WA Safe and Healthy, a coalition of health care workers, said safe staffing standards “protect healthcare workers from dangerously high patient loads and ensure patients get the timely, quality care they deserve.”

During Sunday’s floor debates, lawmakers brought up concerns with requiring all hospitals, even small rural hospitals, to follow the same ratios.

“In the smaller communities, I am really concerned about the financial viability and keeping those (hospitals) in our communities serving the public,” Rep. Joe Schmick, R-Colfax, said Sunday.

Rep. Mike Volz, R-Spokane, co-sponsored the bill with Riccelli but said on the floor Sunday he would be voting against it. Volz had expressed concerns earlier this session that there was no separate standard for small, rural hospitals.

He said Sunday he looks forward to continued conversations on the bill.

Riccelli said there is still a lot of room for discussion over how to treat rural hospitals and it will be “a good point for us to debate” as the bill continues to make its way through the Legislature.

Hospitals and nursing unions have been meeting in recent weeks with lawmakers to work through this bill.

Ashlen Strong, senior director of government affairs at the hospital association, said those meetings have gone well but said the hospital association “just very strongly disagrees that this would be a solution to the problem.”

Another bill passed Sunday in the House establishes a loan repayment plan for nurse educators. Nurse educators are those who have advanced nursing degrees beyond a bachelor’s degree, teach nursing curriculum and are faculty members for an approved nursing program.

The loan repayment program would be treated similarly to the Washington Health Corps, which helps health care workers repay education loans when they work in areas determined to have shortages.

The hospital association said it supports the loan repayment bill and hopes the Legislature focuses more on the education piece rather than the staffing shortages.