Washington Hospitals, Health Care Unions Split on Best Way Out of Staffing Crisis

Elise Takahama / The Seattle Times

Washington’s hospital system found itself facing financial losses approaching $2 billion through the end of 2022, but health care staff and leaders hope next week will bring the possibility of relief.

When state lawmakers begin the 2023 legislative session on Monday, they will find themselves in the middle of a growing debate between health care unions and hospitals, which, despite agreeing that the region’s medical staffing crisis is worsening, offer different perspectives on how to move forward. .

“Our current system is failing us all,” Jane Hopkins, president of SEIU Healthcare 1199NW, said at a news conference. “There are more than enough of us healthcare workers who want to be at the bedside, serving our communities and providing our patients with the best care possible. But we cannot provide that level of care in unsafe staffing conditions and within the current state of the health care system”.

Hopkins and leaders of UFCW 3000 and the Washington State Nurses Association, which represent thousands of nurses and health care workers in the state, announced their plan Thursday to reintroduce legislation similar to a proposal they introduced last year. In 2022, the proposal from the union, or the WA Safe + Healthy Coalition, called for strict ratios requiring a certain number of nurses to be on duty compared to the number of patients. Their proposal also called for better enforcement of meal and rest breaks for employees and ending mandatory overtime policies, among other policies. The legislation passed the House but failed in the Senate.

“We’re going back to Olympia for safe staffing standards because it’s the only policy that health care workers have said will help reduce burnout,” David Keepnews, WSNA executive director, said during the news conference.

This year’s proposal, unlike last year’s, also includes moving the development of new staffing requirements from the state Department of Health to the Department of Labor and Industry, where they will be “developed through rulemaking with stakeholder input.” interested,” said Keepnews. . More time is also included for hospitals to develop certain workforce development provisions, and for critical access rural hospitals to meet new staffing standards.

“Our only hope for the recruitment and retention of healthcare workers is for working conditions in hospitals to be managed and that is what this bill is about,” Keepnews said. “We need safe staffing standards more now than we did a year ago.”

Patients would also benefit from the proposed staffing ratio requirements, which would vary among units, SEIU’s Hopkins said. Because the law, if passed, would require hospitals to hire enough staff, patients would see more nurses overall, she said.

“[Patients are] it will be viewed in a more efficient way,” Hopkins said.

While many nurses and health care union members have voiced support for legislation around hospital staffing ratios in the past year, the state hospital association has remained steadfast in its opposition. His main concern is that the requirements would force hospitals to stop admitting patients after they reach certain ratios, ultimately leading to worse patient outcomes, said Chelene Whiteaker, senior vice president of government affairs at the Hospital Association. Washington State.

“Anytime you put something as rigid as a report into law and require hospitals to follow it, you’re going to have unintended consequences,” Whiteaker said. “We think ratios are not the answer. I’d like to know, ‘What happens to the labor shortage when you can’t meet the ratio?’

It’s hard to say what the true impact of strict statewide staffing ratios would be—in the US, only California has implemented comprehensive rationing laws, and hospitals and unions disagree about the long-term benefits they brought.

According to a recent George Washington University report supported by the Safe + Healthy Coalition of unions, there is “strong scientific evidence” that nurse staffing levels are “critical components” of patient safety and employee satisfaction. The report discussed three types of laws generally aimed at regulating hospital staffing: setting staffing ratios, requiring staffing committees that include bedside nurses, and requiring public reporting of staffing levels. “Only [staffing ratio] mandates appear to have an effect on hospital practices,” the report states.

However, few recent data are available on how mandatory staff reports affect patients.

Hospitals, meanwhile, have a list of other proposals they hope lawmakers will consider aimed at increasing health care staffing.

One bill would have Washington join the Nurse Licensing Compact, a group of 39 states that have agreed to allow nurses to have a state nursing license that allows them to practice in other states that are part of the the agreement. Another would call for more transparency about travel nursing agency pay rates.

One of the highest priorities, Whiteaker said, is a request for the Legislature to significantly increase Medicaid reimbursement rates to hospitals through a directed payment program. Instead of seeking funding from the state’s general fund, the program would rate or tax Washington hospitals, which would then trigger payments from the federal government, Whiteaker said.

In Washington, Medicaid rates haven’t been updated in 20 years, meaning some doctors lose money treating Medicaid patients, she added. The other option is to remove them.

“Hospitals are a huge industry in our state, and there’s a bit of a fear that people think hospitals are too big to fail,” Whiteaker said. “We are signaling that we have major financial concerns.”