Nurse and Hospital Staffing

A Comprehensive Approach to Implementation and Achieving Safe, Reliable and Effective Care

Washington’s legislature enacted new legislation in 2017 and 2019 impacting hospital nurse staffing and staffing for certain technicians and technologists. House Bill 1155 – enacted in 2019 – makes changes to meal and rest break requirements and the use of overtime and on-call. House Bill 1714 – enacted in 2017 – added new requirements for the development and reporting of nurse staffing plans.

The information and resources below are intended to support hospital leaders and nurse managers in implementing the new laws and achieving safe, reliable and effective care. Additional content will be added to the implementation resources section over the coming months.  

Click on a link below for more information and implementation resources on these nurse and hospital staffing laws:

Uninterrupted Breaks, Overtime and On-Call Law, Enacted 2019

Hospital Nurse Staffing Committee Law Changes, Enacted 2017

Ongoing Hospital Staffing Quality Improvement and Learning Collaboratives

Archived Resources Regarding Staffing Committees

New Hospital Staffing Law – Uninterrupted Breaks, Overtime and On-Call, Enacted in 2019

The Health Care Employees – Meal and Rest Breaks and Mandatory Overtime Act of 2019 (HB 1155) requires uninterrupted breaks for nurses and certain technologists and technicians and makes changes to mandatory overtime and mandatory on-call laws.  

See WSHA’s bulletin and the full text of the final legislation for more specific information on the new requirements, their scope and applicability, and implementation dates. Depending on your facility, requirements go in effect as early as January 1, 2020. 

Implementation Resources

Understanding the Basics

WSHA developed the following initial implementation resources to help support Washington hospitals in complying with the new laws:

  • Webinar content to inform nursing leaders about the new laws and steps to be successful.
  • Bulletin with information on the new law.

Determining Your Hospital’s Compliance Strategy – Policy Playbook

To assist hospital leaders in determining internal policies that need to be developed or changed as a response to this new legislation, WSHA developed a “Policy Playbook.” This resource was developed with significant input from hospital leaders, and includes some potential approaches to consider as hospitals finalize their compliance policies on uninterrupted breaks, mandatory on-call and overtime.

The Policy Playbook is available to Chief Nursing Officers, Chief HR Officers, Lead Legal Counsel and Government Affairs leads at hospitals. If you would like a copy, please email Alicia Eyler.

Communicating Changes to Staff

At the request of hospital leaders, WSHA developed a pamphlet to help hospitals communicate with frontline staff regarding anticipated changes resulting from the new law. Once finalized, the pamphlet will be posted online here.

We encourage hospital leaders to consider how they will communicate policy changes with staff.

Ongoing quality improvement and data collection initiatives

WSHA will be working with the Nurse Staffing Advisory Group in the coming months to determine scope, timeline, and specific strategies for an ongoing data collection initiative to support a quality improvement approach to staffing issues.

Additional Resources

Over the coming months, WSHA will continue to work with hospital members to develop additional tools and resources to help hospitals be successful in continuing to provide access to safe, reliable and effective care under the new law. Updates will be posted to this website. If you have ideas for tools and resources needed, please email Trish Anderson.

Hospital Nurse Staffing Committee Law Changes, Enacted 2017

While hospital nurse staffing committees have been required by state law since 2008, the Patient Safety Act of 2017 (HB 1714) added new provisions in the development of a nurse staffing plan while establishing a formal complaint process. Annually, hospitals must submit plans to the Department of Health (DOH) and provide updates to DOH if the plan changes.

Significant portions of the new law took effect on Jan. 1, 2019. See WSHA’s bulletin, Revised Code of Washington (RCW) 70.41.410 or the full text of the final legislation for more specific information on the new requirements and their scope and applicability.

Implementation Resources – Submitting Your Hospital’s Nurse Staffing Plan

As required by the law, hospitals must submit their nurse staffing plans to DOH by Jan. 1 of every year. Hospitals submitted staffing plans to DOH for the first time in 2019. Upon review of the 90 plus plans on the DOH website and with input from our members, WSHA developed a new DOH submission template to support hospitals in the development and submission of their plans. The aim of this submission template is to standardize the process and make information clearer to the public. We encourage hospitals to use this template when submitting a nurse staffing plan to DOH.

*This template will replace the ‘Sample Attestation Form’ WSHA had recommended for use in submission to DOH in 2019. If you would like a copy, please contact Trish Anderson.

We recommend checking the DOH website a week after you have submitted to ensure the correct plan has been posted under your hospital’s name. For information on how to submit nurse staffing plans, visit the Washington State DOH website or contract Trish Anderson

Additional nurse staffing plan resources:

Archived Resources Regarding Staffing Committees

Forming your staffing committee

Submitting, evaluating, and tracking complaints

Ongoing Quality Improvement and Learning Collaborative

WSHA is taking a new approach to nurse and hospital staffing issues by incorporating this work into our safety and quality portfolio. As part of this work, WSHA will collect quality metrics related to staffing to support quality improvement and supporting learning collaborative model for nurse leaders and managers across the state.

Joining WSHA’s Hospital Staffing Learning Collaborative

Join WSHA and hospital staff to discuss key issues regarding our state’s new staffing laws, share lessons learned and identify strategies to ensure success. These collaborative discussions are tailored toward nurse leaders and nurse managers who are implementing and working under these new laws.

The collaborative is only open to WSHA members. Register for specific learning collaboratives using the links in the sidebar at the top of this page under “related events.” Hospital leadership approval is required prior to being admitted to the collaborative. WSHA staff will follow up on your registration request after confirming with your hospital leadership.

Archived Resources Regarding Nurse Staffing Committees

2018 Coalition Toolkit

As part of its work in 2018, WSHA worked with the Washington State Nursing Association, SEIU 1199NW and UFCW 21 to form the Nurse Staffing Coalition. The Nurse Staffing Coalition developed a toolkit to educate nurse staffing committees about the new law and support compliance – which includes some of the resources below.

Forming Your Staffing Committee

  • Washington state nurse staffing Law (RCW) 70.41.410
  • Nurse Staffing Committee Checklist (Word | PDF)
    Key elements of nurse staffing committees under the 2008 and 2017 law, including composition, primary responsibilities, staffing plan development and implementation of the plan.
  • Sample Nurse Staffing Committee Charter (Word | PDF)
    We recommend that all hospitals have a nurse staffing committee charter describing the roles, responsibilities and processes by which nurse staffing plans are developed and used.

Submitting, evaluating and tracking complaints

  • Staffing Complaint Form (Word |PDF)
    Sample complaint form to help track complaints and data coming to the nurse staffing committee. While tracking and responding to complaints is critical, the process does not replace the need for staff nurses to notify managers or leaders of a potential issue so that efforts can be made to quickly address the situation.
  • Assessing and Evaluating Complaints (Word | PDF)
    Tool to help nurse staffing committees assess and evaluate complaints, including a decision tree outlining the process.
  • Complaint Tracking Tool (Excel)
    Excel form to help the nurse staffing committee track complaints, the resolution and the time frame by which complaints were received and resolved.


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Washington State Hospital Association
999 Third Avenue
Suite 1400
Seattle, WA 98104

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206.281.7211 phone
206.283.6122 fax

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