End of session report

Thanks to incredible engagement and participation by WSNA members, we had some big wins this session. We appreciate everyone’s commitment to advocating for nurses and patient safety in Olympia this year.

The legislature adjourned Sine Die April 23, the last day of the 2017 regular session. As expected, the legislature adjourned without passing a 2017-19 budget. The governor called the legislature back into two special sessions before a final state operating budget was passed on June 30, narrowly averting a state government shutdown.

WSNA achieved some major policy wins during the 2017 state legislative session, and made good progress on a number of issues and priority budget items — all thanks to the very active participation of so many WSNA members.


Major policy wins

Nurse staffing — PASSED

Staffing continues to be WSNA’s number one priority, and we are pleased that with the help of WSNA members and the WSNA Legislative and Health Policy Council, this year’s staffing bill, HB 1714, was signed into law by Governor Inslee May 8.

This new law creates greater transparency and accountability for nurse staffing plans and hospital nurse staffing committees, and it represents a real step forward in our ongoing work to hold hospitals accountable for staffing so that nurses can deliver safe, high quality care to their patients.

HB 1714 was sponsored and championed by Representative Eileen Cody, RN and received outstanding support from Senator Ann Rivers as it made its way through the Senate. The final bill was the result of many hours of negotiation with hospitals and other nursing unions. WSNA extends special thanks to WSNA member Danielle O’Toole, BSN, RN and WSNA Legislative & Health Policy Council member Justin Gill, BSN, RN for their testimony in support of HB 1714.

The new law increases the transparency of nurse staffing plans in hospitals around the state by amending the current staffing law to:

  • Require hospitals to accept the staffing committee’s staffing plan or to prepare an alternative annual staffing plan that will be adopted by the hospital.
  • Require hospitals to submit the adopted staffing plan and subsequent changes to the staffing plan to the Washington State Department of Health beginning Jan. 1, 2019.
  • Require hospitals to implement the staffing plan and assign nursing personnel to each patient care unit in accordance with the plan beginning Jan. 1, 2019.
  • Allow a nurse to report to, and file a complaint with, the staffing committee any time the nurse personnel assignment is not in accordance with the adopted staffing plan.
  • Allow nurses who may disagree with the shift-to-shift adjustments in staffing levels to submit a complaint to the staffing committee.
  • Require staffing committees to develop a process to examine and respond to submitted complaints, and to determine if a complaint is resolved or dismissed based on unsubstantiated data.
  • Require the Washington State Department of Health to investigate complaints with documented evidence for failure to:
    • Form or establish a staffing committee.
    • Conduct a semiannual review of a nurse staffing plan.
    • Submit a nurse staffing plan on an annual basis and any updates.
    • Follow the nursing staff personnel assignments as adopted by the hospital based on the complaints compiled by the staffing committee that include aggregate data that show a continuing pattern of unresolved violations for a minimum 60-day continuous period. Exceptions include unforeseeable emergent circumstances and documented reasonable efforts by the hospital to obtain staffing to meet required assignments.
  • Require hospitals to submit a corrective action plan within 45 days if the Washington State Department of Health (DOH) finds a violation — and, if the hospital fails to submit a corrective action plan or doesn’t follow its corrective action plan, DOH may impose a civil penalty of $100 per day until the hospital submits a corrective action plan, begins to follow a corrective action plan, or takes other action agreed to by DOH.
  • Require the Washington State Department of Health to maintain public inspection records of any civil penalties, administrative actions, or license suspensions or revocations imposed on hospitals.
  • Require the Washington State Department of Health to submit a report to the legislature by Dec. 31, 2020, on the number of complaints submitted and investigated, associated costs to DOH, and any recommended changes to statute. Requires a stakeholder group including WSNA to review the report before it is submitted to the legislature.

This act expires June 1, 2023.

WSNA is already busy working to collaborate with our members and other stakeholders to ensure a successful enactment of the new law. We will be rolling out a full implementation plan, including templates, best practices and education/training for our nurses and members serving on existing staffing committees.

School nurse supervision — PASSED

On April 20, HB 1346, the School Nurse Supervision bill, was signed into law by Governor Inslee after passing the House and Senate with strong bipartisan support. The long-awaited bill clarifies the authority of a school nurse to address clinical needs of students, including summoning emergency medical assistance and the administration of medications; it also prohibits a non-nurse from supervising, directing or evaluating nursing activities.

It will become part of the Washington Common School Law (RCW 28A.210) and recognizes that nurses are already accountable to the state’s Nurse Practice Act (RCW 18.79 & WAC 246-840-700). The bill, promoted for many years by school nurse Theresa Hutchinson, was successful this year thanks to the work of Hutchison, the School Nurse Organization of Washington, and the Washington State Nurses Association. The House bill was sponsored by Representative Larry Springer, and its Senate companion bill was sponsored by Senator Hans Zeiger. Thank you to SNOW member Lynn Nelson, RN, MSN, NCSN for her testimony on this issue.

The National Association of School Nurses defines school nursing as a specialized practice that “protects and promotes student health, facilitates optimal [student] development, and advances academic success.” School nurses bridge the gaps between health and education and between individual and population health care, addressing the chronic health needs of individual students as well as the prevention and health promotion activities of public health. Washington’s school nurses are registered nurses who practice in the 295 public school districts and serve more than one million students ranging from age three to 21 and whose health needs range from wellness care to the full spectrum of chronic pediatric health conditions. Healthy children learn better; educated children grow up to raise healthier families. School nurses work in both sectors to support the well-being of the children of our state. Many school districts are currently hiring for the 2017-18 school year. For more information about school nursing, contact your local school district or the School Nurse Organization of Washington.

— Katie Johnson, DNP, RN-BC, NCSN, FNASN


Budget priorities

While the legislature had much work to do in order to negotiate a final 2017-19 budget, the chart below shows where WSNA’s budget priorities landed during the regular session. Budget negotiations continued in Olympia as this issue of The Washington Nurse went to print. Go to wsna.org for the latest updates. The legislature again took us up to the brink of a state government shutdown before passing a final 2017-19 biennial budget on June 30. The final budget made strong investments in mental health, gave some critically needed new funding to public health, funded the state employee contracts, and maintained the Health Profession Loan Repayment Program at the same level as the previous biennium.

WSNA priorityBudget amountDescription

Public health funding

$12 million

$10 million to local public health departments/districts

$2 million to the Washington State Department of Health

Funding is to address foundational public health services in the areas of communicable disease and chronic disease and injury prevention

State employee contracts

$618 million

Funding for collective bargaining agreements

DOH Fee-setting Process Study

$56,000

Funding for the State Auditor to conduct a study of the Washington State Department of Health’s fee-setting process for all health professions

HB 1714 – Nurse Staffing Bill

$39,000

Funding for the investigation of complaints for violations of the nurse staffing plan requirements

Thank you to Lynnette Vehrs, MN, RN, chair of WSNA’s Legislative & Health Policy Council, and Katie Johnson DNP, RN-BC, NCSN, FNASN with School Nurse Organization of Washington (SNOW) for their testimony in support of WSNA’s budget priorities.


Policy priorities

Bills marked “Special Session Bill” were still under consideration during the second special legislative session, which began May 23. Look for updates at wsna.org and in the fall 2017 issue of The Washington Nurse.

Balanced billing — DEAD

Much negotiation and stakeholder work took place this session on the balanced billing issue. HB 2114 aimed to protect patients and their families from “surprise bills” when an out-of-network provider delivers health care services at an in-network hospital. WSNA expects to participate in interim work on this issue.

Rest breaks — DEAD

Rest breaks remains a top priority for WSNA, and this year the rest breaks bill moved further through the legislative process than it has before. HB 1715 passed the House 55-42, and had a lively hearing in the Senate Commerce, Labor & Sports Committee. The bill and hearing both received extensive coverage in The Seattle Times. Thank you to WSNA member Danielle O’Toole, BSN, RN for her testimony in support of the rest breaks bill, and to WSNA Incoming Executive Director Sally Watkins, PhD, MS, RN, who also testified on this bill.

Secure medicine return — DEAD

While a strong coalition of partners worked hard on the secure medicine return bill, HB 1047, this year, it ultimately was not brought to the House floor for a vote. A number of local boards of health have passed local legislation creating secure medicine return programs — King County’s being the first in Washington state to be passed and implemented. Thank you to WSNA member Jeremy King, BSN, RN for submitting written testimony on this bill.

Prescription monitoring program — PASSED

HB 1427 addresses our state’s opioid epidemic. It requires disciplining authorities, including the Nursing Care Quality Assurance Commission, to adopt rules establishing requirements for prescribing opioid drugs by Jan. 1, 2019. It also expands access to data in the state’s Prescription Monitoring Program, allowing health care facilities to receive information on provider prescribing. The bill also makes it easier for opioid treatment facilities to be located in local communities. This bill was signed into law by Governor Inslee May 16.


Other bills of interest

Foundational public health services — DEAD

HB 1432 defined core public health services and put into statute the Foundational Public Health Services framework — this bill also set in statute a structure for shared services that would formalize smaller health departments contracting of some services (such as epidemiology) from larger health departments, making the system more effective and efficient. The bill passed the House 86-12, and was passed out of the Senate Health Care Committee with a “do pass” recommendation, but it was never voted out of Senate Ways & Means. Thanks to WSNA members who sent nearly 1,000 postcards on public health funding to legislators this session!

Paid family leave — PASSED

A major victory of the third special session was the passage of the paid family leave bill. SB 5975 was signed into law by the Governor on July 5. This bill creates a paid family and medical leave insurance program that is funded through premiums paid by employers and employees. Twelve weeks of paid family leave benefits are provided to employees after the birth or placement of a child under age 18 or when a family member has a serious health condition or military exigency. Thank you to WSNA member Kaila Tang, RN, for testifying in support of paid family leave!


Student loan transparency and accountability

A number of student loan transparency and accountability bills were introduced this session, and many did gain traction. While most of these bills did not pass the legislature this session, SB 5022 was signed into law by the governor.

SB 5022 — PASSED

SB 5022, the Washington Student Loan Transparency Act, was request legislation from Washington’s Attorney General. It was signed into law by the governor April 27. This bill says that, subject to appropriations, student borrowers are entitled to receive notification about their loans from their post-secondary institution each time a new financial aid package is certified that includes student loans — this means that students will receive information on the total amount of educational loans, the range of payoff amounts including principal and interest, and additional details. This will begin July 1, 2018. Additionally, annual compliance reports to the legislature are required in 2019-2025.

HB 1169 — DEAD

HB 1169, included provisions to establish a student loan debt hotline/website, and required institutions touching the student loan process to notify students of these resources; it repealed provisions allowing suspension of a professional license due to student loan debt (including for nurses); and other consumer protections. This bill passed the House 76-22, and received a “do pass” recommendation from the Senate Higher Education Committee, but it was never voted out of Senate Ways & Means.

HB1440 — DEAD

HB 1440, request legislation from Washington’s Attorney General, created the Student Education Loan Ombuds to provide assistance to student education loan borrowers who file complaints. It also required education loan services to obtain a license from the state Department of Financial Institutions in order to operate in Washington state, and put in place a regulatory structure. This bill passed the House 71-27, but did not receive a hearing in the Senate.

Volk bill — DEAD / STUDY APPROACH

On Dec. 22, 2016, the Washington Supreme Court issued a 6-3 decision in Volk v. DeMeerleer that will have profound and detrimental effects on health care providers and patients. The decision is a troubling departure from the standard for “duty to warn” previously established in Washington and nationally. The Court held that, in the outpatient context, the duty of health care providers to warn potential victims of violence extends to all individuals who may “foreseeably” be endangered by a patient who has made a threat, even if no specific target was identified. This leaves providers with unprecedented responsibility to interpret who to warn.

SB 5800 was introduced in the Senate as a “fix” to Volk. It was voted out of the Senate 33-16, but died in the House Judiciary Committee. When this bill died, a new study approach was created, and included organizations that would be part of a study group which would provide a report to the legislature by Dec. 1, 2017. The University of Washington School of Law received funding in the state budget to conduct this study. WSNA and AAPPN look forward to monitoring the study process.