As two years of the COVID-19 pandemic have demonstrated, nurses perform heroic work. That work has become even more arduous, with staffing shortages and physical danger being added to the list of difficulties.
Bills being considered by the Legislature warrant thoughtful debate, with questions about whether they will have the intended effect weighed against a desire to improve working conditions.
The need for attention is exemplified by increasing reports of dangerous work assignments. As a recent article in The Columbian detailed, reports to the Washington State Nurses Association by workers at PeaceHealth Southwest have risen sharply — from 32 in 2019 to 302 in 2021.
That is not unique to Clark County. Hospital workers represented by the three largest health care unions filed 8,600 workplace safety complaints in 2021; in 2019, there were 2,685 complaints.
“This is a very real situation,” said Jayson Dick, the union’s director of labor advocacy. “Nurses don’t submit these lightly. These are the assignments that were so bad that nurses felt compelled to file them after a long, grueling shift. These are exactly the kinds of conditions that are driving nurses away from the field.”
According to the Washington State Hospital Association, there is a shortage of some 6,000 registered nurses across the state.
In an attempt to alleviate that, the Legislature is considering House Bill 1868 and its companion, Senate Bill 5751. Rep. Monica Stonier, D-Vancouver, is a co-sponsor of the House bill.
The legislation would mandate nurse-to-patient ratios that advocates say would lower patient mortality rates and reduce nurse burnout. Nurse-to-patient ratios would vary by department, and hospitals would have two years to implement minimum staffing standards.
California is the only state that mandates staffing ratios. A report by a nursing researcher at George Washington University found that staffing in California increased 55 percent from 2003-18; during the same period, staffing increased 6 percent in Washington. “This is the way out of Washington’s staffing crisis and toward better quality care,” said David Keepnews, executive director of the Washington State Nurses Association. “Quite literally, safe staffing saves lives.”
The Washington State Hospital Association opposes the legislation. In a statement, the association argued that staffing mandates would require the hiring of at least 15,000 registered nurses and certified nursing assistants throughout the state, increasing health care costs by an estimated $1 billion.
Hospitals would be subject to fines of up to $10,000 a day for failing to meet the mandate.
Indeed, the nursing shortage is a national crisis that has been exacerbated by the pandemic. “The field continues to struggle with unsafe staffing ratios, moral distress and burnout, lack of support from management and low morale,” Angela Chang of the Johns Hopkins School of Nursing wrote in an opinion piece this week for The Baltimore Sun.
The question is whether legislation will effectively address those issues. Hospitals are reporting difficulty finding qualified candidates willing to take nursing jobs — a situation that will not change under HB 1868. And mandating staffing levels for private businesses is an invitation for unintended consequences.
The coronavirus pandemic has exposed vast shortcomings in American health care. But lawmakers should be leery about trying to plug some of those holes.