Ensuring safe nurse staffing has been a top priority for WSNA. A growing
body of research confirms what we all know, that the care provided by registered
nurses has a direct impact on quality of patient care and safety.
Nursing care requires continuous patient assessment, critical thinking and expert
judgment, advocating on behalf of our pa-tients, and educating patients and their
families. Those activities are the essence of nursing care and are critical factors
in avoiding preventable complications, injuries and avoidable deaths. WSNA is pursuing
multiple strategies toward accomplishing this goal.
Practice and Education
WSNA has collected and synthesized the evidence-based data on nurse staffing. We
conducted 9 regional workshops in 2007 and an additional 7 workshops across the
state in 2008. These workshops were successful in educating nurses and policy makers
about the important evidence-based impact of nurse staffing on patient safety and
nurse retention and satisfaction.
We also collected over 1200 surveys from staff nurses throughout the State on their
working conditions and concerns regarding adequate nurse staffing and their ability
to take breaks.
Legislation and Coalition Efforts
After the narrow defeat of safe staffing legislation in 2007, WSNA engaged in a
mediated process through the Ruckelshaus Center with the Washington State Hospital
Association, the Northwest Organization of Nurse Executives and other unions on
the critical issue of nurse staffing.
In addition to the jointly supported legislation that passed in 2008, the collaboration
with the stakeholders also includes a Memoran-dum of Agreement with a set of ongoing
projects on collection of nursing sensitive outcomes data, an immediate staffing
alert pilot project, and ongoing education to support the work of the staffing committees.
Collective Bargaining and Outreach
Since the passage of the legislation in 2008, WSNA has been hard at work ensuring
the proper implementation of the new law. We are tracking the progress of the nurse
staffing committees at each of the hospitals where RNs are represented by WSNA.
WSNA is providing ongoing support to our local units and nurses serving on the hospital
staffing committees with materials, work-shops, online information, and staff consultations.
We recognize that passage of the law is just a first step, and we are committed
to ensuring that nurses at the bedside truly have a voice in safe nurse staffing.
Advocacy at the National Level
WSNA, along with the American Nurses Association (ANA) and the New York State Nurses
Association (NYSNA), filed a lawsuit to address RN staffing levels in hospitals.
This has resulted in some major changes within Health and Human Services and the
Joint Commissions’ patient safety standards.
Beginning in July 2009, The Joint Commission’s performance elements will require
that each department or nursing unit must make certain that, when needed, an RN
is immediately available for bedside care. The Joint Commission noted that a registered
nurse is not immediately available if the RN is working on more than one unit, floor
or building at the same time. Despite the fact that the court ultimately dismissed
the lawsuit in January of 2009, ANA, NYSNA, and WSNA were instrumental in working
with The Joint Commission to change its standards to include these fundamental legal
requirements in support of patient care.
As a result of this work, during the summer of 2008, Congress changed the Medicare
law by removing the statutory reference to The Joint Commission, effective July
15, 2010. This means that The Joint Commission will have to apply for deemed status
and be approved by the federal government, just like all other accreditation programs.
Highlights of 2008 Safe Nurse Staffing Law
- Each hospital must establish a nurse staffing committee composed of at least 50%
staff nurses.
- Staff nurses participating on the committee must be on scheduled work time, compensated
at the appropriated rate of pay and relieved of all other work duties.
- The staffing committee is charged with the development and oversight of a nurse
staffing plan for each unit and shift of the hospital based on patient care needs,
appropriate skill mix of registered nurses and other nursing personnel, layout of
the unit, and national standards and recommendations on nurse staffing.
- The staffing committee must conduct a semiannual review of the staffing plan against
patient need and known evidence-based staffing information and respond to staffing
concerns presented to the committee.
- There must be a posting of the nurse staffing plan as well as the actual staffing
level on each unit and shift in a public area and make the information available
to patients and visitors upon request.
- The hospital may not retaliate or intimidate nurses performing duties in connection
with the staffing committee or an employee, patient, or other individual who notifies
the nurse staffing committee or the hospital administration of his or her concerns
on nurse staffing.
