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News / Politics / Clark County Politics

Staffing requirements in hospitals again on Legislature’s agenda

Bill focuses on accountability vs. staff-patient ratios

By Laurel Demkovich, The Spokesman-Review
Published: January 19, 2023, 6:01pm

OLYMPIA — During the peak of the COVID-19 pandemic, hospitals had a shortage of beds.

Now, they have a shortage of staff — a problem that started long before the pandemic but was only exasperated by the continued spike of patients.

“We’re kind of shifting into a situation that is almost even more dire than before the pandemic,” said Christopher Vertefeuille, a certified nursing assistant at MultiCare Deaconess Hospital. “Now we have open beds, but we have no nurses, no aides to take care of those patients.”

Though short staffing was a problem long before the pandemic, Vertefeuille said the response from hospitals since has been “underwhelming.”

A bill making its way through the Legislature would attempt to alleviate some staffing issues by requiring hospitals to adopt safe staffing standards, including assigning certain staff members a set number of patients.

A similar bill last year would have put staff-to-patient ratios in state law. This year’s proposal, sponsored by Sen. June Robinson, D-Everett, focuses more on accountability to hospital staffing committees without having set ratios in statute.

It drew support among nurses and unions who say more workers are needed to keep staff from burning out, but again received sharp criticism from hospital leaders who say they don’t have enough staff to abide by staffing quotas.

Robinson said she’s heard concerns from nurses about staffing throughout her time in the Legislature, but she said she always trusted hospitals to address them.

“And unfortunately, they haven’t,” she said. “It’s just continued to get worse.”

What’s in the bill: The bill would shift the agency charged with managing staffing committees from the Department of Health to the Department of Labor and Industries.

The bill requires that, by September 2024, hospitals have staffing committees. Half of the committee’s members would be nurses and patient care staff, and half of it would be determined by hospital administration. By 2025, each hospital would have to submit its staffing plan to Labor and Industries.

The staffing committee would craft a staffing plan for the hospital, which could include ratios of the number of patients to each staff member.

If a staffing plan is not adopted by the staffing committee, hospitals would be subject to daily fines of $5,000 for large hospitals, or $100 a day for rural hospitals or hospitals with fewer than 25 beds.

Hospitals would only be able to deviate from their plan under unforeseeable circumstances, such as a declared emergency. They would be unable to deviate for more than 90 days without approval of the staffing committee. Labor and Industries would investigate complaints about hospital staffing committees.

Staffing committees already exist in hospitals, but Vertefeuille said there’s no enforcement of them.

“We really don’t have a voice,” he said. “Putting power to the voice of those committees is most important.”

The bill would allow a third party to examine staffing issues, said Alyssa Boldt, a registered nurse at Providence Sacred Heart Medical Center.

“The laws as they stand don’t have teeth,” she said.

But the Washington State Hospital Association argues hospitals won’t meet ratios with the amount of staff right now.

“At the end of the day, a ratio is a ratio,” said Chelene Whiteaker, senior vice president of government affairs. “If you can’t meet it, what happens to the patient you can’t serve?”

Registered nurse Darcy Jaffe, senior vice president of safety and quality at the hospital association, said the staffing plans that hospitals have in place are based on a “typical day,” which doesn’t happen very often.

Hospitals need flexibility to adjust those plans, and this bill would not give them that, she said.

Nurses, hospitals disagree on how to address burnout: Ve rtefeuille said there’s a “mass exodus” because of burnout and safety concerns. The people who have chosen to stay also are experiencing burnout at a faster rate than previous to the pandemic, he said.

Boldt said it’s emotionally draining for nurses who got into the field to provide the best care possible and can now barely keep up with baseline tasks. She said there’s a “vicious cycle” because the likelihood of burnout goes up immensely for the people who stay.

“We go home feeling very defeated and demoralized,” she said.

Supporters of the bill hope that by requiring hospitals to adopt safe staffing standards more nurses and staff who may have left the field because of burnout would come back.

Jaffe said it’s wishful thinking. There isn’t a huge number of nurses waiting to come back into the profession, she added. Instead, hospitals and health care workers need to have conversations about using innovation to care for patients with the amount of staff they have, especially considering the aging population .

Robinson said she understands nurses are hard to hire, but said she has heard from some who say they would come back to work if they had safe staffing standards.

“We’ve got to get a handle on our staffing issues because that is what allows a hospital to function,” Robinson said.

Vertefeuille said he has heard from nurses who are taking care of seven to nine patients at a time .

Boldt said her ideal number of patients would be three or four , though she said the number likely depends on the type of nurse and unit. Having three patients is “very rare” now, she said.

“It’s not the level of care we want to be providing, but it’s what we’re able to do given our staffing resources at the moment,” Vertefeuille said.

Hospital leaders disagree that ratios are the answer.

When a hospital limits the number of patients to staff, there will be major backups, Whiteaker said.

“We’re already seeing backups,” she said. “I think it would be a shock to the public how much more delay there will be in terms of being able to receive care.”

It’s unclear how far the bill will get in the Legislature. Republicans are critical of the plan.

Senate Minority Leader John Braun, R-Centralia, said a ratio would exacerbate the problem of adequate nursing because there aren’t enough nurses to meet the ratios.

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“This is the absolute wrong approach,” he said.

More to address health care concerns this year: Nursing is just one of a number of professions struggling with severe workforce shortages. Legislative leaders in both parties have said addressing workforce issues would be a priority this session.

Robinson said the Legislature is considering how to address the crisis in hospitals. She pointed to helping hospitals’ address financial deficits and improving the nurse pipeline through more access to education.

To help with retention of staff, the hospital association is pushing for a student loan repayment assistance program for nurses, a nursing licensure compact that would allow nurses from other states to move to Washington and immediately start practicing and creating a statewide collaborative to look at hospital staffing.

To help with budget deficits, the hospital association is asking for a Medicaid payment increase as well as help with difficult to discharge patients, such as changes in the state guardianship law, increased funding for post-acute care, or increasing long-term care infrastructure.

The Legislative session ends April 23.