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State Senate passes safe staffing standard, in compromise between hospitals, unions

A nurse works inside the pediatric COVID-19 vaccine clinic at UW Medical Center - Roosevelt on June 21, 2022, in Seattle, Washington.    (David Ryder/Getty Images North America/TNS)

OLYMPIA – Hospitals may soon have to follow safe staffing standards, including staff-patient ratios, if a bill that passed the state Senate on Tuesday becomes law.

The bill reflects a compromise between hospitals and nurse unions across the state that have long disagreed over the best way to address workforce shortages. Nurses have pushed for staff-to-patient ratios, while hospitals have said they don’t have the staff to follow the ratios.

The proposal, which passed the state Senate 35-15, is one of many being discussed in the Legislature this year to help address workforce shortages in health care.

The final proposal aims to hold hospitals accountable to their staffing plans, which already exist but unions say are rarely enforced.

“When our hospitals do not play by these rules and provide the protections this bill lays out, they will face corrective actions. They will face consequences,” sponsor Sen. June Robinson, D-Everett, said on the floor. “It’s a really good bill that will provide a balance and strong workplace protections for our health care workers.”

The bill came up last year but had set staff-to-patient ratios. This year’s bill doesn’t have ratios set in statute, but it would still require hospitals to create and follow them 80% of the time, or they’d face fines.

Under the proposal, hospitals have until next year to establish a staffing committee, made up of equal numbers of nursing staff and hospital administration. The committee must approve a staffing plan, which includes the number of nursing staff per patients, and the plan must then be submitted to the Department of Health by 2025.

Hospitals would be required to track how often they are not complying with their staffing plan by having too few nurses working. If they are complying less than 80% of the time, the hospital must report to the Department of Health.

Hospitals can stray from the plans if there are “unforeseeable emergent circumstances,” such as a national emergency or when a hospital disaster plan is activated. But if they are deviating for more than 90 days, they must report to the Department of Health.

Beginning in 2027, the Department of Health and the Department of Labor and Industries can start fining hospitals for failure to follow staffing plans at least 80% of the time.

Hospitals can receive penalties up to $10,000 for every 30 days failing to submit a staffing plan, committee charter or corrective action plan, or, if they don’t follow the corrective action plan they’ve created, $50,000 for every 30 days out of compliance . A corrective action plan would include ways to find additional staff, and actions to improve delays in new services and reductions in hospital beds.

Rural hospitals and hospitals with fewer than 25 beds would not have to follow the reporting requirements.

The Department of Health and the Department of Labor and Industries would investigate complaints for failing to follow staff-to-patient assignments.

Nurse unions have said safer staffing plans are necessary to help address burnout in health care workers.

“We’ve said all along that in order for any staffing plans to be effective, they must be enforceable, otherwise hospital executives will continue burning out their workforce through unsustainable short-staffing,” Faye Guenther, president of UFCW 3000, said in a statement last week. “This amended bill certainly isn’t everything caregivers need, but the inclusion of real penalties and oversight for hospitals that refuse to follow staffing plans is an important first step toward improving safety for health care workers and patients.”

The bill also enforces meal and rest breaks for hospital staff, requiring hospitals to provide reports to Labor and Industries of how often they are complying with break requirements.

If hospitals aren’t complying, the department can impose penalties, from $5,000 for rural hospitals up to $20,000 for hospitals with 300 or more beds.

Hospitals have pushed back on safe staffing standards, saying they don’t have enough staff to follow ratios, and the state must focus on getting more nurses into the field before implementing ratios.

“We all want to support hospital staff and also ensure access to health care for our communities,” Chelene Whiteaker, Senior Vice President of Government Affairs at the Washington State Hospital Association, said in a statement last week. “We are pleased to be able to reach an agreement that recognizes the importance of the voice of staff at the local level, who are best positioned to develop staffing plans that appropriately match the needs of patients with the experience of staff.”

Sen. Mark Mullet, D-Issaquah, said this version of the bill allows each hospital to decide its own staffing plans but gives a “clear incentive” for hospitals to staff up and hire more workers.

The bill passed the state Senate with bipartisan support. Sen. Curtis King, R-Yakima, said he supported the bill because it will help nurses, but he encouraged the Legislature to also think about what can be done to help hospitals.

The bill must still pass the state House of Representatives.

Rep. Marcus Riccelli, D-Spokane, who introduced the bill last year, said the version that passed the Senate was the result of a number of negotiations. Staffing plans have always needed to “have more teeth,” he said, and this bill addresses that.

Laurel Demkovich's reporting for The Spokesman-Review is funded in part by Report for America and by members of the Spokane community. This story can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper’s managing editor.