As staffing crisis worsens in hospitals, legislators look to implement safe staffing standard

OLYMPIA – At Sacred Heart Medical Center, staffing has always been pretty thin, registered nurse Clint Wallace said.

But when the pandemic hit, it didn’t take much for that thin margin to become thinner.

Now, patients stay longer while health care workers choose to leave – due to burnout, early retirement or to become a higher-paid traveler nurse.

Those who stay almost always work overtime without many breaks, and they’re exhausted, Wallace said.

“We are fighting to care for our patients, but at some point we also need to fight for ourselves,” said Wallace, who’s worked as a registered nurse for 21 years.

One solution, health care workers say, is a safe staffing standard.

While COVID-19 cases have put hospitals in a staffing crisis over the past two years, staffing concerns were present even before the pandemic.

“Now that we’re in a crisis, staffing levels are falling off a cliff,” Spokane Democratic Rep. Marcus Riccelli said.

Riccelli, along with Spokane Republican Rep. Mike Volz and 42 other co-sponsors, are hoping to pass a bill to implement a statewide safe-staffing standard.

The bill would follow a similar model in California that regulates hospital staffing ratios, meal and rest breaks, and overtime provisions.

It’s a bill for which health care workers and unions have long advocated, but it will likely see pushback from hospitals.

Staffing ratios

The bill outlines, per department, what the staffer-to-patient ratio should be. Hospitals would be required to follow them, if the bill passed.

For example, in emergency departments, there should be one registered nurse per three nontrauma or noncritical care patients, and one nurse per one trauma or critical-care patient. In intensive care units, one registered nurse should have one to two patients, depending on the stability of the patient, according to the bill.

In less emergent departments, such as a cardiac monitoring unit, the ratio is one certified nursing assistant to 50 patients, according to the bill.

When nurses are taking care of too many patients at once, they get exhausted, which can lead to patient safety concerns, Wallace said.

“I think it’s easy for everyone to understand,” Wallace said. “Taking care of less patients is easier than taking care of more patients.”

New data compiled by UFCW 21, SEIU Healthcare 1199NW and the Washington State Nurses Association found that workplace complaints among members of the three unions nearly tripled since 2019. In 2020, more than 8,600 complaints were filed, compared to the more than 2,800 filed in 2019.

“This isn’t sustainable and cannot continue,” Riccelli said.

Volz said hospital staffing has become a big issue in Spokane, and after hearing from constituents about their concerns, he decided to sign onto the bill.

Staff is burning out, he said, and others are scrambling to fill shifts.

“I’m in a position that I can help with the solution rather than just sit back, rather than being passive,” Volz said.

Taya Briley, vice president of the Washington State Hospital Association, said hospitals are currently taking extra measures to support staff, including extra pay, free meals and wraparound support.

The association supports the measures proposed in the bill but stops short of supporting actual ratios proposed in the safe-staffing legislation.

Briley said the hospital association is still understanding the legislation, but is concerned about the ratios.

“One of the things we’re concerned about with this bill is we know it will restrict the way staff are used to serve our patients,” Briley told reporters on Thursday.

The bill requires a hospital’s staffing committee to create a staffing plan to comply with the standards set out in the bill.

It creates additional accountability measures by giving the Department of Labor & Industries the power to regulate the committees and its staffing plans.

If a hospital does not create a staffing plan that meets the requirements in the bill or violates its staffing plan, it would be subject to a fine of $10,000 a day for a hospital or $100 a day for rural hospitals, small hospitals and certified sole community hospitals.

During unforeseeable emergency circumstances, hospitals can deviate from their staffing plan, but staffing committees are required to develop contingency plans for those cases.

Volz said he had some concerns over the fines listed in the bill, and he may look into ways to “tone them down.” He added he is looking forward to working on it with Riccelli.

“I want this to be a positive and proactive thing,” Volz said.

Meal and rest breaks, overtime restrictions

The bill also clarifies some break guidance for employees, removing certain circumstances in which hospitals could be exempt from meal and rest break requirements.

It also puts restrictions on overtime for health care employees. Pre-scheduled on-call time could not exceed more than 20 hours a week under the bill.

The bill allows for overtime work if there are unforeseeable emergent circumstances, but in an attempt to narrow overtime restrictions, the bill removes a provision from current law permitting overtime work if there are “unforeseen disasters or catastrophic events that substantially affect or increase the need for health care services.”

Overtime work is also allowed if a hospital has used reasonable efforts to obtain and retain staffing. However, reasonable efforts do not include “filling vacancies resulting from chronic staff shortages that persist longer than three months,” according to the bill.

Failing to follow the meal, rest and overtime breaks could result in $1,000 of fines for each violation up to three; $2,500 for the fourth violation and $5,000 for each violation after.

Next steps

The bill is expected to get its first public hearing at 10 a.m. Wednesday, and it will likely see changes before it reaches final passage.

Specifically, Volz expressed concerns over how smaller, rural hospitals are treated in the bill. Volz said they already struggle with staffing and may need to have some exceptions to these rules.

Riccelli agreed they will have to be “very conscious of rural hospitals,” and he was open to hearing how to help them in this bill.

Along with this bill, lawmakers and health officials are looking for other immediate and long-term fixes to the staffing issue.

Gov. Jay Inslee announced on Thursday he was sending National Guard members to hospitals across the state to aid in staffing shortages. He was also pausing nonurgent procedures and implementing ways to quickly move patients out of hospitals and into long-term care facilities, if needed.

“What we really need is a way to recruit and retain nurses so we don’t have to rely on outside nurses,” said Karen Riggan, who works in IV therapy at Sacred Heart.

Long-term, Inslee has proposed investing $6 million to fund grants for nurses willing to train students and $8 million to support grants for low-income students wanting to become nurses. Additionally, his proposed budget would spend more than $3 million to create a pilot program that would improve the work environment in long-term care facilities.

He said Thursday he hadn’t looked at the safe-staffing standard bill, but “it’s certainly worth a consideration to help our hard-working folks.”

Lawmakers have also discussed other bills to help staffing shortages, including allowing Washington to join a national nursing compact, which would allow nurses from other states to practice in Washington without a new license.

That bill was brought to the Legislature in 2020, but did not pass. A new version of that bill has not been filed yet this session.

Editor’s note: This story has been updated to reflect that the bill would require one certified nursing assistant to 50 patients in cardiac monitoring units.