Erika Abdnor: Fixed staffing ratios will make health care problems worse

By Erika Abdnor

Although health care is the most rewarding career, working at a hospital right now is very challenging. We have been working at a breakneck pace for two years, operating at full capacity because of the pandemic, increased severity in illness from deferred care and decreased ability to discharge patients to skilled nursing facilities. This has resulted in canceled surgeries, difficulty in securing inpatient beds for emergency department admissions, and a 50% reduction in our ability to accept patient transfers from other hospitals needing our higher level of care.

Fixed staffing ratios, as proposed in HB 1868, would not solve any of these problems. They would make every one of them worse.

With current staffing levels and challenges in securing new staff members, we would need to close one to two inpatient units to adhere to the staffing ratios for nurses and nursing assistants. This would further increase our hold times in the emergency department, as well as further decrease the number of critical access hospital transfers, we are able to accommodate.

Both cases can be detrimental for the affected patients. The emergency department is so named for a reason: Patients coming to us require immediate care. The emergency department is not designed to provide inpatient care for those requiring admission. It is not out of the ordinary to see an emergency department admission wait 16 hours for an inpatient bed. Deferred inpatient care for excessive emergency department hold times, as well as delays in surgery, have been shown to cause a decline in status, as well as increases in lengths of stay, physical and mental health deterioration, and mortality. Further, high emergency department hold numbers contribute to high saturation and delays in immediate care for new arrivals. Similarly, patient transfers from lower level of care hospitals are necessary to save patients who are declining beyond the capabilities of their current facility. The need to remain at a lower level of care risks further decline for these patients.

We cannot afford to decrease our capacity any further by closing units – nor can every other Washington hospital that would be similarly affected by this bill – for the sake of those who rely on us.

The problem is a shortage of nurses. We are doing everything we can to recruit and retain nurses, but there simply are not enough to fill the massive uptick in demand caused by the pandemic. We are offering sign-on bonuses for new hires, retention bonuses for existing staff and incentive pay for voluntary overtime work. That isn’t enough, and we can’t afford to do more. Due to the equal demand all across the state, a job offer for an applicant is far from a guarantee that the prospective nurse will end up with us. The demand across the country has caused an explosion in compensation for traveling nurses. Many RNs are taking that direction, and hospitals who can’t afford to pay wages high enough to compete are losing their nurses.

Nurse morale is low and is the reason many of us are switching jobs or retiring altogether, there’s no denying that. But in many cases, mine included, it’s not due to being too busy or working overtime – it comes from dedicating one’s life to a career of helping others and feeling like you cannot. Mandated staffing ratios in HB 1868 will let us treat fewer patients. It will decrease our ability to do what we have committed our lives to doing. Nursing during a pandemic is hard enough. The Legislature shouldn’t make it worse.

Erika Abdnor, MS, BSN, has been a nurse for 20 years. She is director of clinical operations at MultiCare Deaconess Hospital.