Skip to main content

A Snapshot of the Nursing Shortage Crisis: The Take from Washington State

June 6, 2023

From time to time, we have attempted to keep our readers abreast of the status of the nursing shortage crisis that has befallen many facilities since the advent of COVID-19. We’ve looked at statistics and reports of strikes and solutions proposed or implemented in various states around the country. Today’s article provides insight on what’s now taking shape in the Pacific Northwest.

A new law has recently passed in the State of Washington that is meant to address the nursing shortage crisis that has plagued several hospitals in the state, especially in the wake of coronavirus pandemic. The push for such legislation came in the wake of feedback from fed-up nurses who have become increasingly vocal about what they believe to be areas of concern in patient care and working conditions.

Trial and Error

The state had previously passed a bill in 2017—years before the COVID event hit the Pacific coast—that required hospitals to form committees to establish safe staffing ratios for different levels of care and respond to related complaints. The law also gave the Washington Department of Health (DOH) limited authority to conduct an outside investigation when hospitals deviated from their plans, failed to submit annual updates, or faced a documented pattern of staffing shortfalls.

According to The Columbian, a local Washington newspaper, public records reveal that at least 185 staffing complaints were submitted to DOH between 2020 and 2022. None of those complaints resulted in fines. Nurses and union representatives say local staffing committees have not provided timely review or meaningful enforcement. Nurses have expressed that they are still taking on too many patients and often missing or having to cut breaks short to care for patients amid the continuing post-pandemic staffing shortages. Around the state, nursing unions have begun to focus on incorporating staffing ratios into hospital contract negotiations. One registered nurse (RN) at a medical center in the Puget Sound area stated:

We tried the staffing committee thing. What we didn’t realize is that it has no teeth.

The medical center made news last October when significant emergency department staffing shortages forced this same nurse to call 911 to request medical reinforcement from members of the local EMS and fire department. Thankfully, hospital officials stated they have since increased the number of registered nurses on staff and stationed a nurse at the emergency department registration desk to more quickly assess and triage patients based on their acuity.

Another RN in an Everett-area facility stated that nurses in the neurosurgery unit had filed approximately 100 complaints involving staffing issues in the first three months of this year. These are simply added to the growing pile of complaints that have yet to be addressed by the hospital’s designated staffing committee.

Moving Toward a Solution

A nurse staffing bill in the 2023 legislative session would have set statewide patient-to-nurse ratios, which is what nurse union members had been seeking. However, the Washington State Hospital Association (WSHA) asserted that rigid ratios could force hospitals to stop accepting patients. As a result of this pushback from the WSHA, legislators passed a compromise bill that leaves many staffing decisions with local committees, though the bill did expand some state reporting and investigative oversight provisions.

Specifically, the new law requires hospitals to report to the state if they fall out of compliance with their staffing ratios 20 percent or more of the time. If that happens, hospitals must submit a corrective action plan (CAP), which could include reducing hospital beds or services or delaying the addition of new services. Hospitals also must start reporting missed meals and rest breaks quarterly to the state; and, starting in July 2026, if 20 percent or more are missed, a fine will be issued, starting at $5,000 for smaller hospitals and $20,000 for the largest facilities. Finally, the new nurse staffing law incorporates new oversight from the state’s Department of Labor & Industries, which will work with DOH to outline how the agencies will balance inspection and enforcement responsibilities.

It remains to be seen how Washington’s new law will impact hospital efficiency, sustainability and patient care. Some nurses remain skeptical, while others are hopeful that this latest legislation contains just the right mix to make a positive difference in their working environment and in overall patient care.

With best wishes,

Chris Martin
Senior Vice President—BPO

Get the Latest RCM News Delivered

Receive practical tips on medical billing and breaking news on RCM in your inbox.

Get in Touch