Unions, hospitals clash over nurse staffing legislation


Aaron Kunkler


Debate around a pair of proposed nurse staffing level bills is heating up as supporters and detractors weigh in on the legislation. 

The bills, HB 1868 and SB 5751, would create minimum staffing levels, and remove oversight of staffing committees from the Department of Health and place it under the Department of Labor and Industries. The specific staffing level proposals can be found in previous coverage. Noncompliance with the staffing legislation could result in $10,000 a day fines for hospitals. 


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The bills are supported by Washington Safe and Healthy, a coalition of nurses unions which collectively represent more than 71,000 health care workers in Washington State. 

The coalition commissioned a report by George Washington University, which summarized findings which show that higher nurse staffing levels could lower patient mortality and failure to rescue rates, lead to fewer adverse patient events like hospital pneumonia, reduce lengths of stay, and reduce nurse burnout. 

“Because the continued underinvestment in nursing staff leads to cyclical crises of staff burnout, shortages, and, ultimately, patient harm, this issue is one that state leaders cannot avoid addressing,” the report states. 

There are 14 states, including Washington, which have already implemented nursing staff strategies. These strategies take three main approaches: directly mandating nurse to patient levels; requiring staffing committees that include bedside nurses; and public reporting of staffing levels. California is the only state to mandate minimum nurse patient staffing ratios for all hospital units. The other 13 states have tried softer types of laws. Washington State has both nursing committees and public reporting. 

“A huge body of research, based on real-world data, shows that better staffing levels lead to better patient outcomes, and that safe staffing standards are the best solution to ensure better staffing,” said David Keepnews, executive director of the Washington State Nurses Association in a press release. “This is the way out of Washington’s staffing crisis and toward better quality care.”

The report states that data on Washington showed that while registered nurse hours per patient day increased by 55% in California from 2003 to 2018, they only increased by 6% in Washington over the same period. 

The Washington State Hospital Association issued a statement opposing the bill. It states that there is a current shortage of 6,000 registered nurses in state hospitals, and that by its estimates, the bill would require hiring at least 15,000 more registered nurses and certified nursing assistants.

It could potentially increase health care costs in the state by more than $1 billion. At the same time, the state is not planning on increasing reimbursement rates to cover the increased costs which could make it more difficult for hospitals to operate, the press release states. 

“Imposing these one-size-fits-all requirements will make many of the care delays we’ve seen during the pandemic a permanent feature in Washington State,” said June Altaras in the press release, a registered nurse with MultiCare Health System. 

Instead, the association said the state should focus on investing workforce development to replace nurses. It also advocates increasing payment rates for long-term care systems so patients without medical need can move out of hospitals. 

Further, it says the current staffing model should be strengthened, and the state should joining the interstate nurse compact to allow licensed nurses to more easily move to Washington from other states and start working. 

The House bill was referred to the Finance Committee on Feb. 1, and the Senate bill had a hearing in the Committee on Labor, Commerce & Tribal Affairs on Jan. 31.