Rigid hospital staffing legislation currently under consideration by the Washington State Senate will make permanent the pandemic care delays in hospitals large and small across the state.
Hospitals are analyzing the impact House Bill 1868 would have on health care access in their communities if it were to become law. If hospitals are unable to hire enough nurses to meet staffing ratios included in the bill, they will be forced to delay care and may have to eliminate some services.
“The proposed legislation is particularly challenging because the ratios must be met at all times, regardless of the time of day, how sick the patients are, or how much experience the nurses have,” said Darcy Jaffe, RN, Senior Vice President of Safety and Quality at the Washington State Hospital Association. “Stacking a rigid one-size-fits staffing mandate on top of a national health care workforce labor shortage doesn’t make sense and will result in care delays.”
In the Puget Sound Region, MultiCare, Virginia Mason Franciscan Health and Swedish Health Services anticipate the bill would result in a loss of about 730 inpatient beds across 16 hospitals. More than 100 Emergency Department beds would also be closed. Overlake Medical Center in Bellevue anticipates losing 55 inpatient beds due to an inability to meet rigid staffing required by the mandate. The medical center is already recruiting for 148 nursing positions and would need to add an additional 95 full-time-equivalent positions to meet the requirements of the bill. Each bed lost represents a loss of care for hundreds of patients over the course of a year.
“We will do everything we can to avoid closing any services,” said Michelle Curry, RN, Chief Nursing Officer at Overlake. “At a minimum, this bill would make permanent the delayed care delivery that was the result of the pandemic. People should expect hours-long wait times for emergency services and delays in scheduled surgeries to continue.”
Hospitals in Spokane estimate closing more than 180 beds across three hospitals, including beds in psychiatric units and at the region’s children’s hospital. Larger urban hospitals provide critical and specialty care for the many rural communities across the state. Reducing the number of urban hospital beds would limit their ability to take patients from surrounding rural hospitals and fracture the health care system.
“We rely on larger partner hospitals to quickly take transfers of critically-ill patients from our small hospital when they need a higher level of care,” said Dr. Joe Mattern, Chief Medical Officer at Jefferson Healthcare in Port Townsend. “Our care teams are very concerned that this legislation will make permanent the delays and longer transfer times we’ve experienced with bed shortages during the most recent COVID surge.”
One service that is unlikely to survive in rural hospitals is obstetrics. For laboring parents in the communities served by Coulee Medical Center in Eastern Washington and Forks Medical Center on the Olympic Peninsula that would mean more than an hour drive to the next hospital with the ability to deliver a baby.
“The legislature’s desire to address burnout among nurses is commendable but a key component of burnout is moral distress. My hospital will not be able to meet the staffing and on-call requirements laid out in the bill,” said Dr. Jennifer Knox, a family practice and OB doctor at Coulee Medical Center. “I cannot think of anything more distressing than not being able to provide care for mothers and babies from our community and the larger Colville Tribal community we serve. I would encourage lawmakers to reconsider this approach.”
The number of nurses required by the legislation simply don’t exist. In Washington hospitals alone, there are 6,100 open nurse positions and a recent survey of hospitals shows compliance with the new mandate would require hiring an additional 15,000 nurses and certified nurse assistants.
Washington State has chronically underinvested in nurse education programs and hundreds of qualified applicants are turned away from programs in Washington state each year. To develop a long-term sustainable workforce, we need comprehensive investment in health workforce education, including funding additional slots, loan forgiveness programs, increases in instructor pay and financial support for people in nursing school. It takes two to four years to train a nurse and our state is not currently graduating enough nurses to meet the increased needs included in HB 1868. If there are not enough nurses to hire, hospitals will be forced to reduce the number of patients they can care for. This legislation will result in care delays if it becomes law.