Washington's hospital system found itself facing financial losses approaching $2 billion by the end of 2022, but health care staffers and executives are hoping next week will bring opportunities for aid.
When state lawmakers begin the 2023 legislative session on Monday, they'll find themselves in the middle of a growing debate between health care unions and hospitals, who, despite agreeing the region's medical staffing crisis is worsening, offer different perspectives about how to move forward.
"Our current system is failing all of us," Jane Hopkins, president of SEIU Healthcare 1199NW, said at a news conference. "There are more than enough of us health care workers who want to be at the bedside, serving our communities and providing our patients the best care possible. But we can't give that level of care under 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 submitted last year. In 2022, the proposal from the unions, or the WA Safe + Healthy Coalition, called for strict ratios requiring a certain number of nurses to be on duty in comparison to the number of patients. Their proposal also called for better enforcement of meal and rest breaks for staffers, and ending mandatory overtime policies, among other policies. The legislation made it through the House, but failed in the Senate.
"We're going back to Olympia for safe staffing standards, because it's the one policy that health care workers have said would help reduce burnout," David Keepnews, executive director of WSNA, 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 Industries, where they'll be "developed through rule-making with input from stakeholders," Keepnews said. More time is also included for hospitals to develop certain workforce development provisions, and for rural, critical access hospitals to meet new staffing standards.
"Our only hope of recruiting and retaining health care workers is to make working conditions in hospitals manageable, and that's 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 differ between units, Hopkins of SEIU said. Because the law, if passed, would require hospitals to hire enough staffers, patients would generally see more nurses, she said.
"[Patients are] going to be seen 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 stood firm in its opposition. Its main concern is that the requirements would force hospitals to stop accepting patients once they hit certain ratios, ultimately leading to worse patient outcomes, said Chelene Whiteaker, senior vice president of government affairs at the Washington State Hospital Association.
"Any time you put something rigid like a ratio into law and require hospitals to follow it, you're going to have unintended consequences," Whiteaker said. "We think ratios are not the solution. I would love to know, 'What happens in a workforce shortage when you can't meet the ratio?'"
It's hard to tell what the true impact of strict statewide staffing ratios would be — in the U.S., only California has implemented comprehensive ratio laws, and hospitals and unions disagree over the long-term benefits they brought.
According to a recent George Washington University report supported by the unions' Safe + Healthy Coalition, there is "strong scientific evidence" that nurse staffing levels are "critical components" of patient safety and worker satisfaction. The report discussed three types of laws generally aimed at regulating hospital staffing: mandating 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 said.
Little recent data is available, however, about how mandatory staffing ratios affect patients.
Hospitals, meanwhile, have a list of other proposals they're hoping lawmakers will consider, aimed at boosting health care staffing.
One bill would have Washington join the Nurse Licensure Compact, a group of 39 states that have agreed to allow nurses to have one state nursing license that allows them to practice in other states that are part of the agreement. Another would require more transparency around travel nursing agency salary 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 requesting funds from the state's general fund, the program would assess, 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 when they treat Medicaid patients, she added. The other option is turning them away.
"Hospitals are a large industry in our state, and there's a little bit of a fear that people think hospitals are too big to fail," Whiteaker said. "We are signaling that we have significant financial concerns."