Legislature debates WA hospital staffing ratios as health care labor problem steeps

As hospitals grapple with a staffing crisis during the omicron surge, those at the front lines are not in agreement over the proper response from the Legislature.

A bill in the House of Representatives sponsored by 44 legislators attempts to ease the burden on health workers by mandating staff-to-patient ratios.

This means that certain departments working with patients most in need would be required to have a nurse working with a set number of patients at a time. For example, when caring for trauma patients in the ER, House Bill 1868 mandates one nurse for every patient; in the ICU, it would vary between 1:1 and 1:2 depending on case severity, and in pediatric wards, it would be 1:3.

The bill also mandates that hospitals provide uninterrupted rest and meal breaks to all caregivers. Currently, exceptions to this are made for catastrophes and emergency circumstances — into which the COVID-19 pandemic falls.

The state Department of Labor and Industries would be able to fine hospitals for violating these rules.

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Those writing the bill say this is only right for health care workers, who are exhausted after two years of a pandemic.

“Health care workers have moved mountains over the last two years, but they’re burning out,” said Rep. Marcus Riccelli, the bill’s prime sponsor. “These are our heroes, but let’s remember they’re humans first, and they deserve workplace conditions that respect the work they do to help everyone.”

A plethora of health workers turned out to testify in support of the bill on Wednesday, saying that the legislation would save the lives of patients.

Kelly Johnson, a registered nurse at Providence Regional Medical Center in Everett, said she recently called for backup for an unconscious, hypertensive patient in the emergency room, but no one was able to come and help for several minutes.

“This could mean life, death, or permanent changes to someone’s quality of life,” she said. “These are risks associated with inadequate staffing.”

Stephanie Simpson, director of Bleeding Disorders of Washington, pointed out the dangers of forcing workers to multitask too much.

“When a person is overworked, they are not able to tend to all the details,” she said. “For rare disease patients, the details matter, and mistakes can be deadly.”

Health workers said that it would also help their own stress levels. Nurse Stephanie Wahlgren said she had divided her time between working as a sexual assault nurse examiner and ER nurse in a hospital, but ultimately left forensic nursing because of poor staffing standards.

“I am regularly working 18-hour days,” Wahlgren said. “Often this extra work comes at the expense of my family. Because staffing is so bad at my hospital, I miss out on the big moments in my own life, including my son’s birthday and my wedding anniversary.”

But hospital leaders took a very different approach to the bill.

Jennifer Culbertson, chief nursing officer of Swedish Edmonds, said she had seen mandatory staffing ratios when she worked in California — the only U.S. state to have such ratios dictated by law.

“I know firsthand, it makes it impossible to maintain the level of service and access to our hospitals that we currently provide,” she said.

Lisa Morten, HR director at Overlake Medical Center, said moving around more health workers to certain departments would just deplete others because there are not enough workers to go around.

“The nurses we’d love to hire simply don’t exist. … The demand simply exceeds the supply.” Morten said.

During the Washington State Hospital Association’s weekly briefing on Thursday, Susan Stacey, the chief executive of the Providence Inland Northwest Washington service area, said the entire state was about 6,000 nurses short — on top of the shortages being felt around the United States.

“I knew throughout most of my career that the nursing shortage was coming,” Stacey said. “Our baby boomers are retiring. That is a piece of what the folks leaving the health care system is about, is natural retirements.”

WSHA President Cassie Sauer said California “has been far worse than Washington” during the pandemic. She pointed to Los Angeles, where ambulances have been told not to take patients with little chance of survival to hospitals because there is no room for them.

Sauer looks instead to New York, which is investing billions in wages for health workers, as well as education and training for up-and-coming health workers.

“The way health care is funded is largely government-funded — and both Medicare and Medicaid already pay hospitals well below the cost of care,” she said.

Stacey said hospitals are already trying to attract workers with higher salaries and bonuses, and will continue to do so — but she said government help is key.

“We need to continue to look at them and see where is the next step. But it is more than that, it also is about educational opportunities and a pipeline of health care workers that can meet the needs,” Stacey said. “… The long-term solution is looking at the pipeline for both nursing and other health care careers, to invest in that to stabilize this workforce — not just for the next two years, but for the next 20 years.”

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