POINT OF VIEW: Proposed legislation fails to solve problem of nursing care

Jill Buhler Rienstra

Jill Buhler Rienstra

When you live in a rural community and experience a life-threatening accident or illness, you need a finely tuned regional healthcare system to get you the best care as quickly as possible.

A bill under consideration by the Washington State Legislature will place bureaucratic barriers between you and the care you may urgently need, which may have life-threatening consequences for residents of rural communities.

Substitute House Bill 1868, the nurse-to-patient-ratio bill, imposes rigid, one-size-fits-all staffing ratios on hospitals in Washington state. It doesn’t consider clinical discretion: that every patient is different and needs a different level of nursing care. SHB 1868 imposes assembly-line management requirements on your unique care needs and provides no place for thoughtful clinical decision making at the bedside.

This law would require hospitals to hire nurses that are not available with resources that are not allocated — or face fines from the Department of Labor and Industries and/or lawsuits from organized labor.

If you’ve come to our emergency department, your wait was probably relatively short; on average, patients spend around 15 minutes or less before receiving care. A critically ill patient presenting to our ED is seen immediately.

Mike Glenn

Mike Glenn

Our care teams use clinical judgment to balance patient needs, ensuring we provide the best care possible to as many patients as possible. If forced to manage your care by arbitrary staffing ratios rather than clinical judgment, expect wait times to increase to an hour or even several hours just to get back to see a provider.

We do not want to think about a scenario where a critically ill patient cannot receive immediate care.

Worse, if you needed to be transferred to a more specialized hospital, you know this process can take a few hours, and dozens of phone calls, to find a bed and provider that will care for you. Seattle hospitals move mountains to take our patients who need more intensive care.

SHB 1868 has passed through the House of Representatives and is on the way to the Senate. If this bill makes it through the Senate and is approved by the governor, Jefferson Healthcare as a Critical Access Hospital will have four years to implement these changes, while our tertiary care partners only have two.

We are grateful for the additional time, given that the RN labor market in rural communities will be even more competitive as larger hospitals who are able to pay more attract staff who may have been interested in rural healthcare, but the truth is, we will start to feel the effects of this bill as soon as the larger systems begin to have to ration care due to staffing ratios.

We already know how staffing shortages impact our ability to transfer patients out of our ED due to the most recent COVID surge; transfers have taken double the amount of time we would expect if we can find beds at all.

We acknowledge healthcare is going through a huge transition, not a small part due to the COVID-19 pandemic.

Jill Buhler Rienstra

Jill Buhler Rienstra

Managing our community’s response to the pandemic has been an extraordinary challenge for Jefferson Healthcare. We established COVID clinics, nurse hotlines, drive-through vaccination sites and testing centers all while continuing to meet the non-COVID healthcare needs of our community.

We’ve managed a shrinking labor force due to age and pandemic-related retirements, leaves, lack of access to childcare and the healthcare industry’s slice of “the great resignation.”

The result is a statewide shortage of over 6,000 nurses that will continue to cripple access to care and likely need most of the next decade to replenish fully.

This bill claims to prioritize patient care but doesn’t solve the actual problem: a lack of nurses and a limited healthcare workforce pipeline.

We remain committed to safe staffing and a caring work environment.

SHB 1868 does nothing to improve patient safety and does little to improve nurse satisfaction or recruit nurses to the field; we strongly oppose this bill and urge you to learn more and contact our legislators.

We are proud to serve you and this community.


Mike Glenn is the CEO of Jefferson Healthcare hospital in Port Townsend. Commissioner Jill Buhler Rienstra is serving her third term on the hospital’s governing body.

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