Q&A: New WSHA Director of Safety and Quality Workforce discusses Washington’s hospital workforce challenges

The Washington State Hospital Association (WSHA) has tapped Gena Ahlawat to serve as its new Director of Safety and Quality Workforce. She will guide hospital leaders in addressing workforce capacity and safety initiatives. Her initial focus will be on implementing nurse staffing committees.

Washington State hospitals are facing serious staffing and financial challenges, often relying on traveling nurses to operate at full capacity. Ahlawat discusses some goals and initiatives aimed at addressing the state’s workforce challenges in this Q&A.

 

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State of Reform: Can you discuss what some of your key goals/responsibilities will be in your new position as WSHA’s Director of Safety and Quality Workforce?

Gena Ahlawat: “Workforce retention and recruitment are high priorities for every industry two-and-a-half years into the pandemic, but especially for hospitals and other health care employers. Our members’ staff have been asked to step up in ways that were unimaginable just a few years ago. They have put themselves and their families at risk to care for patients while dealing with the same child care and other challenges as everyone else. That is why WSHA and its members felt it was necessary to create a position dedicated solely to helping hospitals support their workforce.

Washington State has a nurse staffing committee law that is seen as a model for states across the country. Each hospital in our state has a committee that is comprised of at least 50% direct care nurses. They are generally co-led by nurse leaders in the hospital. It’s a forward-thinking model that acknowledges the complexity and dynamic nature of staffing for patient care in a hospital, particularly addressing the unique aspects of different hospitals and units within those hospitals.

These committees meet regularly to develop nurse staffing plans for the hospital and address any concerns about nurse staffing. Our members have told us the committees are key to the decisions about how best to staff for patient care, and I know that to be true from my own experience co-leading a nurse staffing committee. One of my primary responsibilities in this position is to work directly with hospitals’ nurse-led staffing committees to support their goal of following best practices for operating the committees.”

SOR: Washington hospitals are currently facing many workforce challenges, as well as some financial struggles. What do you believe might be some key areas to focus on to address these workforce issues?

GA: “I was a chief nursing officer here in Washington just a couple months ago, so I know first-hand the workforce challenges hospitals are facing today.

Washington State is not immune to the nationwide nursing workforce shortage. According to the Washington Center for Nursing’s 2021 Nursing Workforce Supply Data Report, which was published a couple months ago, 89% of the roughly 100,000 registered nurses licensed in Washington are working as nurses. Others hold active licenses but are retired, working in other states or other fields, going back to school, or taking time to care for family. Less than 1.5% were unemployed and trying to find work in nursing. 

At the same time, there are around 6,000 nursing job vacancies in Washington hospitals alone. This does not include nursing job vacancies in clinics, surgery centers, public health, or long-term care facilities. We simply do not have enough nurses in our state to fill all of the known vacancies. We absolutely must not only retain our current nursing workforce but also bring more nurses to Washington and invest in educating more nurses.

According to 2022 data from the Bureau of Labor Statistics, Washington State has the fifth-highest RN wages in the country, with a median wage of $96,980. We were recently rated as the number 1 state for nurses to work in a study by NerdWallet. But those factors haven’t brought enough nurses to the state to resolve the shortage. 

The state must do whatever it can to attract nurses to work in hospitals and other health care facilities and expand the number of nursing students in Washington. We would like to see the state invest in a hospital nursing student loan repayment assistance program, provide grants to assist with child care and transportation costs, increase nursing faculty wages and join the 37 other states that have already joined the Nurse Licensure Compact to allow nurses practicing elsewhere to more easily move to Washington State. All of these actions would be helpful.”

SOR: I understand your initial focus will be on the implementation of highly reliable nurse staffing committees. Can you discuss what the role of these committees might be in addressing workforce issues?

GA: “Well-run, nurse-led staffing committees help hospitals retain high-quality nurses because they ensure that nurses have a voice in the way their units are staffed and allow hospitals to maintain flexibility in the way they staff, so nurses have more flexibility in the schedules they work while balancing out the need to provide 24/7 patient care. 

Staffing committees are a locally-driven team approach to staffing that reflects the staffing needs for each unique hospital, and we want to make sure they are effective across all hospitals.”

SOR: Do you have any other initial ideas on how to supplement the state’s hospital workforce at this time?

GA: “We are partnering with the Nursing Commission, the Washington Center for Nursing, and nursing schools to better understand critical gaps in nurse staffing and where we have opportunities to fill those gaps. Further investment in rural nursing and supporting the continuing education of staff who start in positions like nursing and medical assistants to become RNs are proven strategies we want to see expanded. 

Making it easier for out-of-state RNs to practice in Washington is also an important opportunity we are missing out on, so we want to better understand why Washington can’t make the compact work when 37 other states have been able to.

I’ve talked a lot about nurses, but health care workforce challenges go well beyond nurses. We are also working to build workforce pipelines for other members of patient care teams using some of the same strategies.

WSHA’s members have also undertaken a multi-year statewide initiative to spread best practices for staff retention across our member hospitals. As a first step in this effort, nearly 100% of our members have agreed to conduct executive listening sessions with hospital staff to better understand what they are doing well and what can be done to make working in Washington hospitals even better.”

This Q&A was edited for clarity and length.