Staffing legislation’s one-size-fits-all approach will increase health care costs and make care delays permanent

February 1, 2022

Two bills currently under consideration by the Washington State Legislature could have dire consequences for Washingtonians’ access to lifesaving health care. House Bill 1868 and Senate Bill 5751 impose rigid staffing standards, raising health care costs and limiting access.

“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, RN, MultiCare Health System. “We share legislators’ desire to continue supporting the health care teams that have been so strained over the last two years. However, this proposal will make the problem worse.”

Hospitals have a current shortage of more than 6,000 Registered Nurses. The Washington State Hospital Association (WSHA) estimates that this bill will require hiring at least an additional 15,000 RNs and certified nursing assistants, increasing health care costs in Washington state by a conservative estimate of more than $1 billion.

Hospitals are staffed 24/7, 365 days a year. Each additional nursing slot on a unit represents at least five additional people. The legislation would intensify competition for nurses and certified nursing assistants across the health care system, meaning staff shortages at other essential health care providers like nursing homes will get worse. The legislation does nothing to increase the number of nurses available in Washington state.

Ratios will also increase costs of care. “The state does not plan to increase reimbursement rates to cover the increased costs,” Lourdes Schoch, RN, Summit Pacific Medical Center said. “Most of our hospitals in Washington are public hospital districts or not-for-profit and are operating with little to no financial margin. We will not be able to absorb these additional costs and hospitals will be forced to increase costs or cut critical services. I’m concerned about what that would mean for people in my community.”

A health care staffing shortage has been developing for many years, with an aging population that is increasing demand for health care services just as a large number of nurses reach retirement age. Washington has not adequately invested in workforce development to replace these nurses. Hundreds of qualified applicants are turned away from nursing schools each year in Washington state.

Hospitals have long advocated for increased investment in nursing and other allied health programs. In 2019, WSHA advocated for state funding to increase pay for nurse educators. The association has also long been a supporter of Washington joining the Nursing Licensure Compact. The compact would allow nurses from 25 states to move to Washington and begin a nursing career here more easily. Nursing unions opposed this measure as recently as last year. Washington’s isolation from the compact is a deterrent to nurses considering relocating or working here.

“We are facing a national health care staffing shortage in the midst of the pandemic. Hospitals are doing everything they can to recruit and retain nurses.” Kristy Carrrington, RN, Providence. “Adding a law requiring hospitals to hire nurses that simply don’t exist does nothing to fix the underlying shortage. We need to work together to address the needs of our care teams rather than imposing rigid staffing standards.”

In a recent statewide poll, more than 50% of Washington residents opposed this rigid legislation. These strict staffing ratios would require hospitals to temporarily shut down services, including emergency departments, whenever they did not have enough staff to meet the state requirements.

Some of the research presented by proponents of the bill does not take into account what is happing on the ground in California, the only state in the country that currently has comprehensive hospital staffing ratios. California’s hospital quality, patient access to critical care, and nurse staffing shortages are worse than Washington’s, as reported by national data. During the pandemic, patients in California have been denied lifesaving critical care. California has among the highest nurse vacancy rates in the country and scores lower than Washington on numerous quality metrics.

“Hospitals have been able to work together to level-load patients and ensure everyone has access to critical services throughout the pandemic,” Mike Martinoli, RN, Ferry County Memorial Hospital said. “I worked in California, and if we were to implement their model here, we would risk turning patients away. In my community that means driving over a mountain pass to the next hospital and not having an ambulance to answer emergency calls while the transport is happening. This bill will harm people I care for in my community.”

Instead of imposing rigid staffing standards and steep administrative penalties, Washington’s hospitals are encouraging legislators to:

  • 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.
  • 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.
  • 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 more easily move here from other states and begin working. The compact is working already in 25 states, with eight more planning to join.

For more information on the bill and to take action in support of patient safety and access, visit:


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