Fight over hospital safe-staffing standard continues in Legislature

OLYMPIA – A safe-staffing standard for hospitals is one step closer to becoming a reality in Washington state.

A bill that would require hospitals to implement safe-staffing standards, including strict ratios, passed a House of Representatives panel Friday. It still needs to pass the full House before going to the Senate.

The bill has highlighted the divide between hospitals and their workers. Hospitals have come out against the bill despite support from many of their nurses and employees who say they need safe-staffing standards to ensure better patient care.

Although it passed out of the House committee, legislators acknowledged there is still work to be done on the bill.

“I do think it has the potential to really get to a place where we can really have some teeth in showing our nurses that we protect them and care about them and at the same time making sure hospitals have what they need to keep going,” Rep. Lillian Ortis-Self, D-Mukilteo, said during the meeting.

Along with restricting overtime and expanding meal and rest breaks, the bill outlines per department what the staff-to-patient ratio should be, and hospitals would be required to follow them. It follows a similar plan that’s on the books in California.

For example, the bill says there should be one registered nurse to three nontrauma or noncritical care patients, and one nurse per one trauma or critical-care patient. In intensive care units, one registered nurse should have one to two patients, depending on their stability.

It also outlines the number of patients assigned to direct care certified nursing assistants. It ranges from one nurse to eight patients in intensive care units to one nurse to 50 patients in cardiac monitoring units.

The Washington State Hospital Association has pushed back on the staffing ratios, claiming it would force many hospitals that are already short-staffed to turn away patients. Hospital leaders also say they could not flex their staff, as they currently are to accommodate the surge in patients, under staffing ratios proposed in the legislation.

The ratios would force hospitals to hire more staff, but leaders argue that ratios alone cannot bring more nurses to hospitals.

“Ratios will not create more nurses,” Taya Briley, vice president of the Washington State Hospital Association, told reporters this week.

The nursing shortage in Washington predates the pandemic, and a recent survey of the association’s member hospitals found a need for 6,000 additional nurses in the state.

Part of the existing workforce is contemplating leaving the industry.

Unions, representing nurses, nursing assistants and other health care workers working in hospitals 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.

Nurses and health care workers argue having safe-staffing standards in place would help them provide better patient care. Currently, hospital staff work long hours without many breaks. Among those surveyed by the unions, 84% reported feeling very or somewhat burned out.

That leaves fewer nurses taking care of more patients, Sacred Heart Medical Center registered nurse Clint Wallace told The Spokesman-Review earlier this month.

“I think it’s easy for everyone to understand,” Wallace said. “Taking care of less patients is easier than taking care of more patients.”

The bill requires a hospital’s staffing committee to create a staffing plan to comply with the standards set out in the bill. It also creates additional accountability measures by giving the Department of Labor & Industries the power to regulate the committees and its staffing plans.

If a hospital does not create a staffing plan that meets the requirements in the bill or violates its staffing plan, it would be subject to a fine of $10,000 a day for a hospital or $100 a day for rural hospitals, small hospitals and certified sole community hospitals.

During unforeseeable emergency circumstances, hospitals can deviate their staffing plan but should have staffing committees to develop contingency plans for those cases. Under the bill, “unforeseeable emergency circumstances” is defined as “any unforeseen national, state or municipal emergency” or “when a hospital disaster plan is activated.”

The bill that passed out of the committee Friday delays the effective date until Jan. 1, 2023. Hospitals have until Sept. 1, 2023, to establish their staffing committees .

Rep. Eileen Cody, D-Seattle, said the bill gives hospitals a delay so they are not implementing these new rules during a pandemic. Cody, a former nurse, said health care workers need a sign that things will get better after the pandemic.

“Nurses are looking for guarantees that life is going to change,” Cody said. “They can’t go on like this.”

Next stepsThe bill passed 4-3 out of the House Labor and Workplace Standards committee on Friday. It still needs to pass in the full House and the Senate before becoming a law, and lawmakers said there are still negotiations happening on the bill.

Though the bill has Spokane Republican Rep. Mike Volz signed on, Republican leaders have said they do not support the ratio proposal.

House Minority Leader J.T. Wilcox told reporters Tuesday there needs to be more funding for education and getting nurses into the field to begin with. Senate Minority Leader John Braun agreed there needs to be more done to get health care workers in the field and retain them.

Braun called the staffing standards proposal a “very problematic bill.”

“Nothing about this bill fixes the problem in front of us,” he said.

Volz said he signed onto the bill because he heard from a number of constituents who work in hospitals.

He said he has concerns about how rural hospitals may be affected by this bill, but both he and prime sponsor Spokane Democrat Marcus Riccelli have said they will look at how to treat smaller hospitals under this proposal.

“I’m in a position that I can help with the solution rather than just sit back, rather than being passive,” Volz told The Spokesman-Review earlier this month.

Leaders in both parties have said finding a way to address the staffing crisis facing the health care sector is a priority. Other ideas being discussed this session focus on both long-term and short-term retention.

The state hospital association does support an investment in nursing education to increase the pipeline of new nurses into the state’s system.

Gov. Jay Inslee’s proposed budget would invest $6 million to fund grants for nurses willing to train students and $8 million to support grants for low-income students wanting to become nurses. Additionally, it would spend more than $3 million to create a pilot program that would improve the work environment in long-term care facilities.

“We need more nurses,” Inslee told reporters Thursday. “It’s pretty simple.”

Democratic leaders pointed to possible changes in credentialing and licensing requirements to allow more nurses to get into the field in the future. Rep. Pat Sullivan, D-Covington, said the budget team is looking at how to address the issue in the short term and long term.

Cody, chair of the House Health Care and Wellness committee, said she is working this session on a number of bills that would look at education, specifically getting more teachers in the field. One of those ideas is expanding loan forgiveness for nurses who decide to teach, getting hospitals to commit to increasing the number of students they can take and improving clinical training, Cody said.

“We need more faculty to be able to give more slots,” she said.