OLYMPIA — A contentious 2022 proposal by state lawmakers to mandate nurse-patient ratios, which passed the House but failed committee muster in the Senate, has resurfaced in new form — without the Legislature setting the ratios.
Hospitals remain opposed to the proposal over a provision that requires set ratios between nurses and patients to be set and regulated by the state Department of Labor and Industries.
Under Senate Bill 5236, staffing committees with 50 percent registered nurses and 50 percent hospital administrators would develop staffing plans for direct-care registered nurses and direct-care certified nursing assistants that must be complied with by July 1, 2027.
The committees, selected at hospitals by Sept. 1, 2024, would develop the plans by July 1, 2025, and submit them to the state Department of Labor & Industries (L&I) for review and adoption.
L&I would establish and adopt minimum staffing standards for RNs and CNAs by Jan. 1, 2027.
As part of SB 5326, hospitals would have to provide employees with meal and rest breaks and eliminate mandatory overtime.
“The staffing standards must be numerical and represent the maximum number of patients a direct care registered nurse or nursing assistant may be assigned, barring unforeseeable emergent circumstances,” according to the bill report at leg.wa.gov.
Senate Bill 5236 was aired out at a Jan. 17 Senate Labor and Commerce Committee hearing, with lines of approval and opposition following a path similar to 2022.
The hearing drew widespread attention, with 2,055 signing up in support of the proposal and about 900 opposed.
SB 5236 is supported by nursing unions, including Service Employees International Union Local 1199, which says nurses are quitting or don’t want to get hired due to poor working conditions caused by caring for too many patients.
Local 1199 is the bargaining unit representing Olympic Medical Center registered nurses and certified nursing assistants.
Port Angeles native and CNA Jena Chamberlin, 27, works 36 hours a week and has been employed at OMC for three years, the Local 1199 member said in an interview.
“We’re shorthanded all the time,” she said.
She said patient rooms are commonly blocked off from use because of short staffing.
“I don’t feel I’m giving the patient the care that I should,” Chamberlin said. “There’s nothing set in stone that says, ‘Hey, you need to have safe staffing by law.’”
Union spokesperson Kenia Escobar said 16,000 licensed RNs live in Washington but are not working as registered nurses, citing state Department of Health statistics obtained by the Washington State Nurses Association and referred to at the hearing.
“The primary challenge that Washington hospitals are facing is not related to the supply of qualified nurses,” the WSNA said in a report, citing escalating turnover rates nationwide due largely to job quality it said would improve with safe staffing levels. “Rather, the challenge stems from difficulty retaining nurses.”
Local 1199 president Jane Hopkins called SB 5236 “really improved” over the 2022 legislation, saying it allows nurses and hospital management to decide what the staffing allocation should look like and that changes will not happen immediately.
“It’s all parties coming together to actually agree on the staffing plan,” Hopkins said.
The proposal has drawn opposition from hospitals, including OMC, Jefferson Healthcare hospital and Forks Community Hospital.
The Forks hospital’s closure of its obstetrics unit Dec. 6 due to staff shortages was cited Jan. 17 by a Washington State Hospital Association spokesperson from among service closures at a half-dozen medical facilities.
“Skilled nursing facilities have closed at least 2,000 beds since the start of the pandemic,” she said. “This is all happening without the passage of 5236 and mandated staffing ratios.”
Mandatory 24-hour ratios will cause more hospital services to close during the ongoing nationwide nursing shortage, she said.
“This is true now, or in four years, when the rule making is to be implemented by the Department of Labor and Industries.”
She also cast doubt on L&I’s “ability to navigate the complexity of the hospital environment.”
Tammy Fellin, legislative director for L&I, responded.
“It is entirely true that we focus more on worker safety than patient safety,” she said.
“It’s also true that expertise exists in the world. And so if the Legislature were to create a process where we could tap into that kind of expertise, the department, as I think everyone knows, is quite familiar with both our enforcement responsibilities where there is a standard that’s been developed as well as a really robust process where we really work with stakeholders to get that kind of expertise.”
Forks hospital CEO Heidi Anderson hopes the OB department can reopen in six months “but this will go longer if we are not able to hire more nurses,” she said in an email. “If the ratio bill were to pass, it would be an indefinite closure along with other critical services.”
There were 40 births at the hospital in 2022, Anderson said.
Asked where pregnant West End women can now go to give birth, she said they have been connected with providers in Port Angeles.
“This bill passing will most certainly close our [obstetrics department] [and] after-hours surgery,” she said. “If the bill passes, we will have to make some hard decisions as to what patient care units are kept open within the hospital.”
Bobby Beeman, OMC spokesperson, also was concerned about putting staff ratios under L&I’s purview and said in an email that ratios could have a negative impact on health care access.
She said salaries were raised for RNs by 7 percent in 2022 and will increase by 6 percent in 2023 and 6 percent in 2024, but that OMC still has 53 openings for RNs.
“These are competitive salaries, yet in the current health care environment, government reimbursement (Medicare and Medicaid) does not support rapidly rising salaries.”
Amy Yaley, spokesperson for Jefferson Healthcare, said in an email the hospital remains opposed to mandatory staffing levels in favor of designing solutions that meet local needs.
“Jefferson Healthcare believes that the partnership between front-line nurses and administration is the best option for designing staffing models that meet both patient needs and employee wellness,” Yaley said.
State Sen. Kevin Van De Wege of the 24th Legislative District, which covers Clallam and Jefferson counties and half of Grays Harbor County, is on the Ways and Means Committee, which doomed the staffing bill in 2022 by not passing it out of committee.
Van De Wege, a Democrat, recently moved from Sequim to Lake Sutherland.
Also a member of the Health and Long Term Care Committee, he said establishing mandatory ratios won’t simply create more nurses and questioned the availability of nurses willing to work on the North Olympic Peninsula.
Rep. Steve Tharinger of Port Townsend, also a Democrat and a 24th Legislative District member of the Health Care and Wellness Committee, praised the bill for its directive to have nurses and hospitals determine on staffing levels.
“We’ll see how this evolves,” he said.
The text of the bill, the bill report and its status are at leg.wa.gov.
Legislative Reporter Paul Gottlieb, a former senior reporter at Peninsula Daily News, can be reached at firstname.lastname@example.org.