Hospital Staffing Bill Advances, Threatening Health Care in Washington State

February 16, 2022

Correction Feb. 17, 3 p.m.: The number of states participating in the Nurse Licensure Compact is 39.

Unfortunately, the Washington State House of Representatives passed House Bill 1868 this weekend. While the bill was somewhat modified, its most onerous provisions remain, including rigid ratios that will lead to hospital care delays and increased costs. The bill now moves to the State Senate for consideration. Washington’s hospitals are urging the Senate to oppose the bill to avoid rationing care in our communities.

“The pandemic has been incredibly difficult for everyone working in health care,” said Darcy Jaffe, RN, Senior Vice President of Safety and Quality at the Washington State Hospital Association. “While we share lawmakers’ desire to support health care workers, this legislation would not solve any of the root causes of the strain on our workforce and would make permanent many of the worst parts of pandemic health care, including long delays in care.”

Under HB 1868, if hospitals are unable to meet the ratios, they would be forced to close units to additional patients and in some cases may have to discontinue services entirely. Washingtonians can expect delays in scheduled surgeries; hours long wait times in the Emergency Department; and major challenges for smaller community residents to transfer to a larger hospital when they need complex care.

National staffing shortages would make compliance with HB 1868 impossible. An October 2021 survey of Washington’s hospitals estimates an additional 6,100 nurses are needed to meet current hospital staffing needs – before ratios. Even with the amendments to HB 1868, Washington hospitals would be required to hire at least 15,000 additional nurses and certified nursing assistants to meet the bill’s requirements. Most full-time nurses work three 12-hour shifts (36 hours) per week, so it takes 4.5 full-time nurses to cover a single additional nursing shift 24/7 for a week.

The legislation would intensify competition for nurses and certified nursing assistants across the health care system, meaning staff shortages that already exist at other essential health care providers like nursing homes, surgical centers, clinics, ambulances, dialysis and blood collection would worsen. House Bill 1868 does nothing to increase the number of nurses available in Washington state.

The union proponents of the bill claim that there is not a nursing shortage, only people unwilling to work in hospitals. This is not true. While pandemic burnout is real across health care, there are many other reasons people have left hospital employment, including the current unreliability of childcare and school days and people retiring who initially delayed their retirement at the beginning of the pandemic. Another smaller group of nurses has not left hospital nursing at all, rather they’ve left their local hospital for lucrative work as a traveling nurse in another hospital, due to nationwide shortages.

According to one nurse staffing agency operating here, 55% of the traveling nurses from Washington are being placed in Washington hospitals. This means nurses are leaving their hospital employer to work as a traveler in another Washington hospital. They are not leaving hospital nursing, and the majority are not leaving for other states.

Hospitals are doing everything they can to recruit and retain nurses, including support for childcare, access to mental health services, hiring and retention bonuses, increases in base wages, differential pay for additional shifts, and hiring traveling nurses at great expense to temporarily staff open positions.

“Across the country, hospitals and health care organizations are struggling to staff to the needs of the communities they serve. The Providence family of organizations has been forced to hire traveling nurses to fill critical staffing needs. Typically, traveling nurses add 20% to workforce costs. This has gone up significantly in 2021 where the premium has risen to over 65%,” said Greg Till, Chief People Officer, Providence “This is not a desirable or sustainable approach to staffing. Legislating staffing ratios in Washington state will not solve staffing crisis. It will, however, exacerbate the crippling cost associated with the use of travelers.”

Providence noted that in 2021 they hired more caregivers than ever before. They also invested $220 million to recognize current caregivers and fill open positions across the system, including recognition bonuses for most caregivers, referral bonuses, and market-based adjustments. This is just one example of the investments individual hospitals and health care systems are making in their teams.

Washington hospitals urge legislators to invest in solutions to address the root causes of strain on the health care workforce:

  • Increase investments in health care education in Washington state, including adding more slots to nursing education programs, further increasing pay for nurse instructors, expanding innovative apprenticeship programs, and adding financial and social support for people pursuing a nursing degree. Washington has chronically underfunded education for health care workers. The decline of nursing education slots has been steady since 2017, reducing the ability to meet current and future demand for RNs across health care settings. There are hundreds of qualified applicants turned away every year.
  • Increase payment rates for the long-term care system so patients with no medical need can move out of hospitals and ease the number of patients nurses are caring for. While these patients have no medical needs, their social and mental health needs can be significant.
  • Support and strengthen Washington state’s current nurse staffing committee model that brings together frontline staff and nurse leaders to develop staffing plans at the local level.
  • Join the interstate nurse compact to allow licensed nurses to move from other states and more easily begin working in Washington. The compact has been enacted in 39 states, yet nursing unions opposed joining the compact as recently as 2021.


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