Three-way divide on nurse staffing bill

OLYMPIA — Nurse-patient ratio mandates contained in legislation opposed by the North Olympic Peninsula’s three public hospitals has split the 24th District’s three Democratic lawmakers.

Rep. Steve Tharinger of Port Townsend is for it, Sen. Kevin Van De Wege of Sequim is undecided, and Rep. Mike Chapman of Port Angeles is opposed.

Engrossed Second Substitute Senate Bill (E2SHB) 1868, formerly HB 1868, passed out of the House 55-43 on Feb. 13, with Chapman and two other Democrats opposed and Tharinger in favor.

Van De Wege said Thursday he has reservations about it as it proceeds through the Senate.

Van De Wege is a member of the Health and Long Term Care Committee.

“I agree nurses are overworked and need more breaks and need more staffing,” he said.

“It needs to be negotiated on the local level.

“I’m in favor of some statewide standards, but I hesitate to put a blanket policy across the whole state.”

He will vote on the measure as a member of the Ways and Means Committee, which will consider the legislation.

“I’ll listen to public input, but it sounds like it’s going in the right direction,” he said.

The revised version ( changes ratios of one registered nurse to four patients in medical-surgical units to one for every five patients, and increases the 1:3 ratio in telemetry units to 1:4.

The registered nurse-patient ratios apply to 12 hospital departments. They range from 1:1 for the operating room or patients with complications to to 1:6 for a psychiatric unit.

For certified nursing assistants, ratios increase from one CNA for every seven patients to one per eight for psychiatric units and emergency departments.

The CNA ratios apply to 11 hospital departments. They range from 1:4 for a cardiac unit to 1:13 for a pediatric unit.

It also delays implementation for four years for hospitals the size of Olympic Medical Center in Port Angeles and Sequim, Forks Community Hospital and Jefferson Healthcare hospital in Port Townsend.

Chapman, who admitted he favored the legislation at first after listening to union arguments, said last week he is siding with the hospitals’ point of view — that the healthcare facilities are already compromised by nursing shortages that the legislation does not address and that mandated ratios will cause cuts in services and fewer beds available for patients.

Chapman said he is convinced it’s bad policy after talking with hospital representatives — he, Tharinger and Van De Wege have met with OMC officials in the last few weeks.

Tharinger remains in favor of E2SHB 1868, he said in a text message Friday.

“As usual, I think the hospitals on the Peninsula generally do a good job working on their staffing, but other hospitals need a wake-up call to work in good faith with their staffing committees,” Tharinger said when asked why he voted for the bill.

The legislation includes a conditional prohibition on hospitals using overtime to cover chronic worker shortages.

The proposed law requires the Department of Labor and Industries to regulate and enforce staff-to-patient ratios and amends meal, rest break and overtime provisions.

The daily fine for not adopting a staffing plan by consensus of a staffing committee and for failure to follow the staffing plan is $100 a day for smaller hospitals such as OMC, Jefferson Healthcare and Forks Community Hospital.

Except under certain conditions, employees cannot be required to work overtime, which must be voluntary and cannot exceed 12 hours in a 24-hour period or 80 hours in a consecutive 14-day period.

“The refusal of an employee to accept such overtime work is not grounds for discrimination, dismissal, discharge, or any other penalty, threat of reports for discipline, or employment decision adverse to the employee,” the bill says.

An employee who works more than 12 consecutive hours must have the option to have at least eight consecutive hours of uninterrupted time off from work following the time worked.

The restriction does not apply to any “unforeseen emergent circumstance” or because of prescheduled on-call time not to exceed 24 hours a week.

It does not apply when a hospital documents that it has used reasonable efforts to obtain and retain staffing.

“An employer has not used reasonable efforts if overtime work is used to fill vacancies resulting from chronic staff shortages that persist longer than three months,” according to the bill.

The bill restricts hospitals’ use of mandatory, prescheduled on-call time.

It cannot be used to address regular patient census changes or expected increases among employees who are not reporting for scheduled shifts when a hospital documents it has used reasonable efforts to hire and retain staff.

Reasonable efforts, which must be documented, include seeking personnel from a contracted temporary work agency.

Hospitals must provide uninterrupted meal and rest breaks except in emergencies or in a “‘clinical circumstance,’ as determined by the employee, that may lead to a significant adverse effect on the patient’s conduction unless the employer or employer’s designee determines that the patient may suffer life-threatening adverse effects,” according to the bill report.

E2SHB 1868 is scheduled for a public hearing at 9:30 a.m. Monday before the Senate Committee on Labor, Commerce and Tribal Affairs.

It will be broadcast TVW’s YouTube channel.


Senior Staff Writer Paul Gottlieb can be reached at 360-452-2345, ext. 55650, or at