Washington nurse-to-patient ratio bill likely dead in state Legislature

OLYMPIA – After a monthslong debate between hospitals and nursing unions, a bill that would have required hospitals to implement nurse-to-patient ratios died this week in the Legislature.

The bill, sponsored by Spokane Democratic Rep. Marcus Riccelli, would have had to make it out of the Senate Ways and Means Committee by Monday, but it was not voted on. Because nothing is ever truly dead until the end of the session, lawmakers could find a way to revive it by the end of the session next Thursday.

“I’m definitely disappointed that we’re not stepping up for our frontline workers and our nurses,” Riccelli said.

The original bill would have required hospital staffing plans to follow nurse-to-patient ratios, such as eight patients for every one nurse in emergency departments. Hospitals that failed to follow the ratios would have received daily fines by the state Labor and Industries department.

An amendment from Sen. June Robinson, D-Everett, in the Ways and Means Committee would have removed the ratios but kept some provisions surrounding meal and rest breaks and overtime. It would have tasked oversight with Labor and Industries, as opposed to the Department of Health, which has the ability to enforce staffing plans but has not been quick to do so.

The amendment was never brought forth in the committee.

Much of the argument from hospitals was that there were not enough nurses to fill the ratios, meaning they would have to begin cutting care for patients because they did not have enough staff. The Legislature is also addressing some of the issues with the nursing “pipeline” in other bills, such as providing loan forgiveness for nurse educators and creating more nursing slots.

On Monday, Taya Briley, executive vice president of the Washington State Hospital Association, said the association continued to have concerns about the legislation even as it stalled in the Senate Ways and Means Committee.

“We do not think strict nurse-to-patient ratios is the answer for how we move forward in our health care system,” Briley said.

She said it’s important for hospitals to support frontline caregivers and build up the pipeline of nurses. She said the association would like to see the Legislature shift its focus and allocate money to do the latter.

Rural hospital administrators, in particular, voiced their concerns with the legislation, particularly their inability to comply with on-call time limits set for staff in the bill. The ratios would force already strapped facilities in rural places with difficult commutes to hire sometimes double the amount of staff they are already attempting to hire.

Staffing in rural facilities was a challenge long before the pandemic, but hospitals with 25 beds or fewer would have had to evaluate which services they could continue to offer with their existing staff if the measure were to become law, as nurses often work in multiple parts of the hospital.

Ramona Hicks, chief executive officer at Coulee Medical Center, said the hospital’s obstetrics program would be at risk if the bill became law, since their surgical team was on call many more hours than the legislation allowed in the event an emergency cesarean section was needed. Closing this service, she said, would leave their service area in Central Washington, which services the western region of the Colville Indian Reservation, without a hospital that could deliver babies.

But for nurses currently in the field, many say it is still not enough.

“Folks were talking about the pipeline in, but not giving due consideration to the revolving door out,” Riccelli said.

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

The December survey 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 staffing issues.

Jack Sorensen, spokesperson for a coalition of nursing and health care worker unions, said in a statement they were hoping to get the bill out of committee quickly.

“Our health care workers need real solutions to the staffing crisis and resulting burnout,” Sorensen tweeted. “It’s getting worse, and hospital executives have provided no answers.”

Riccelli said he does think parts of the proposal will come back in future sessions. The bill also addressed concerns around meal and rest breaks, overtime and accountability for hospital staffing plans.

Sorensen said unions are “absolutely not done fighting for the safety of health care workers and patients.”

S-R reporter Arielle Dreher contributed to this report.