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News / Health

Washington lawmakers consider bill to require and enforce nurse staffing minimums in hospitals

By Santiago Ochoa, Yakima Herald-Republic
Published: February 28, 2023, 7:37am

YAKIMA — A bill pushing for state-enforced nurse-to-patient ratios has been making its way through the Legislature. If it passes, Washington will be the second state in the country and the first in 20 years to have nurse-to-patient ratios.

Health care workers unions and advocacy groups say the bill will help prevent burnout, lead to better health outcomes for patients and improve working conditions for nurses.

Critics such as the Washington State Hospital Association say the nurse-to-patient ratios would place an unnecessary and untenable burden on hospitals already struggling to retain staff.

Looking at the numbers

The Washington State Nurses Association said in a news release that stronger labor laws would help address the staffing challenges Washington hospitals have been facing for years.

Jane Hopkins, president of SEIU 1199NW, a statewide health care workers union, said one of the contributing factors to the lack of practicing nurses in the field has to do with how they’re treated by hospitals. She said the staffing minimums and changes to overtime and meal policies would be a step in the right direction to getting nurses back into health care.

“People get into this field to feel good about the work that they’re doing. Instead, they feel terrible every day,” Hopkins said.

“Because of short staffing, nurses go to work not knowing if their coworkers are going to show up, or if they will have more patients than they can handle,” she said.

“It is morally wrong that they (hospital administration) are putting profits before patient care and before the care of the workers,” she said. “What we’re asking for is reasonable.”

Recently released results from a 2021 poll by GBAO, a Washington, D.C.-based consulting firm, showed 80% of the 1,148 Washington state health care workers who participated reported feeling burned out by their jobs. About half of the participants said they are likely to leave the health care field in the next few years.

The nurses association pointed out that while there are an estimated 6,100 open nursing positions in the state, the issue is there are about 16,000 licensed nurses in the state not working in nursing, according to data from the Washington Department of Health.

Tim Pfarr, a spokesperson for the Washington State Hospital Association, said those numbers don’t represent the whole picture.

“There is a lot of nuance to that number that the unions have not taken into account. For example, we don’t know how many of them live in border communities and work in Oregon or Idaho or as temporary workers in other states. For example, Oregon has 34,000 RN licensees who live outside of Oregon,” Pfarr said.

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Getting into the details

Senate Bill 5236 would require the state Department of Labor and Industries to regulate hospital staffing committees, staffing plans and minimum staffing standards. The bill also makes amendments to the way overtime is handled by employers as well as compensation for breaks and meals.

Hospitals would have to form nurse staffing committees made up of hospital leadership and nurses in non-managerial positions providing direct patient care. The committee would be in charge of developing and reviewing annual staffing plans.

Staffing plans and staff minimums would be enforced by the state and would give the Department of Labor and Industries the ability to impose civil penalty fees when hospitals fall out of compliance with their staffing plans.

The bill also requires hospitals to provide nurses with uninterrupted meal and rest breaks except during emergent circumstances. Compulsory overtime would be eliminated, except for emergent situations that are broadly defined in the bill’s language.

Critics of the bill, like the Washington State Hospital Association and the Washington Policy Center, said the bill places an unnecessary burden on hospitals that already don’t have enough nurses to meet the bill’s requirements.

Pfarr, the hospital association spokesperson, said the organization is concerned about the bill’s generalized approach.

The bill is “kind of taking a one-size-fits-all approach to the issue of nurses staffing, which changes on a shift-by-shift basis really based on a variety of factors,” Pfarr said. “It could be patient acuity, nurse expertise; it also requires daily adjustments when staff can be sick or be on leave or if the patient census changes.”

Pfarr cited California’s staffing shortages as a reason for opposing the bill. California has had statewide nurse-to-patient ratios in place for almost 20 years and has been the only state to do so. Like Washington, California is facing its own nursing shortage, and Pfarr said that could mean staff minimums are not the solution.

Similar proposals are pending in Oregon, Massachusetts, Connecticut and Minnesota this year.

Hospital association lobbyist Lisa Thatcher, who spoke during a Jan. 17 Senate Labor and Commerce Committee hearing, referenced a handful of hospitals across the state that have stopped emergency, maternity and cardiac services recently. Astria Health hospitals in Toppenish and Sunnyside were on her list.

She said staffing shortages have contributed to the loss in services. Thatcher said penalizing hospitals for not keeping up with mandatory staffing minimums would only serve to exacerbate the situation further.

“Mandatory nurse-patient ratios at all times during the day, during a nationwide nursing shortage will cause more hospital services to close because hospitals will not be able to find the nurses or weather the fines to serve all patients who walk through the doors,” Thatcher said.

Local response

MultiCare Health System, which recently acquired Yakima Valley Memorial Hospital, said in a statement to the Yakima Herald-Republic that the proposed bill “would impose rigid staffing mandates and restrictions on hospital staffing at a time when hospitals across the nation are already dealing with historic workforce challenges.”

“MultiCare is fully supportive of safe staffing. To help ensure our hospitals and other health care facilities have the staff necessary to deliver the care our communities need, we are actively working to recruit and retain employees. We also recognize the reality of our nation’s health care staffing shortage, which is unlikely to improve in the foreseeable future, and are exploring how we can evolve care models to effectively and safely deliver care with the staff resources we are likely to have available to us,” the statement said.

MultiCare is part of a larger group of health care systems in the state that are supporting a package of three bills that seek to facilitate the licensure process for nursing students and out-of-state nurses, develop new staffing models for hospitals and help provide nurses with student loan repayment assistance.

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