Strategic priority — quality and safety

This story was published in the Spring-Summer 2021 issue of The Washington Nurse magazine.

This story appears in Biennial Report of Achievements.

At its core, our work is about promoting behav­iors and practices that positively impact the safety of regis­tered nurses and patients and lead to improved quality outcomes for all residents of Washington. After the coron­avirus pandemic hit our state, much of our focus was on ensuring the safety of nurses and their patients.

Achievements #

  • Success­fully advocated for COVID-19 policies and practices at the state and hospital levels to protect the safety of nurses and patients.
  • Created new Safe Patient Handling and Mobility resources.
  • WSNA advocates on all fronts during COVID-19 crisis

The COVID crisis #

2104 wa nurse covid transparent

The COVID crisis has been going on for more than a year. From the chaotic early days of PPE short­ages and guidance that seemed to change daily, to the winter surge and vaccine rollout, WSNA staff and members have been advocating for what nurses need. We’ve pushed employers, public health officials and elected leaders for a wide range of policies and actions. We’ve lifted up the voices of members in the media and online to make our case. We continue pushing hospi­tals to follow official procla­ma­tions, safety direc­tives and policies put in place to support and protect health care workers — and are filing complaints with the state when they do not.

The vaccine brings hope for an end, but we know our nurses and commu­nity members have not come through this unscathed. As this report goes to press, half a million Ameri­cans have died of COVID-19, including nurses, who have been exposed to and infected with COVID at a much higher rate than the rest of the population.

Critical care and emergency depart­ment nurses are exhausted, and many have left their jobs. Nurses in other units of the hospital are dealing with this virus — as they take care of patients who have COVID and comor­bidi­ties. Still other members have faced furloughs and low census amid the pandemic.

Advocacy with public officials #

From the begin­ning of this crisis, WSNA has been at the table advocating for stronger protec­tions for nurses with the Governor’s Office, our state’s Depart­ment of Health, Labor & Indus­tries, Employ­ment Security, public health officials, state legis­la­tors and our congres­sional delega­tion. Every step of the way, WSNA worked with public officials for inclu­sion of protec­tions for our members.

The results of this advocacy include:

April 10, 2020 — Governor’s Memorandum on Workers’ Compen­sa­tion During the COVID-19 Emergency provides new workers’ compen­sa­tion guidance, including assump­tion that COVID-19 exposure happened on the job, and paid leave during any quaran­tine period.

April 13, 2020 — Governor’s Procla­ma­tion on High-Risk Employees and Workers’ Rights protects high-risk workers from dangerous assign­ments and guaran­tees alter­nate assign­ment or access to accrued leave and unemploy­ment benefits when alter­nate assign­ments are unavailable.

April 2020 - DOSH Hazard Alert from the Depart­ment of Labor & Indus­tries prohibits the use of carcino­genic ethylene oxide in PPE decon­t­a­m­i­na­tion processes.

April 2020 — Used our child­care survey, completed by nearly 1,000 members, to engage public officials statewide to provide child­care options for nurses and other health care workers.

April/​May 2020 — Worked with King County and the City of Seattle to secure free hotel rooms for nurses who feared exposing family members in the absence of acces­sible testing.

May 18, 2020 — Governor’s Procla­ma­tion Reducing Restric­tions on, and Safe Expan­sion of, Non-Urgent Medical and Dental Proce­dures issued, based on recom­men­da­tions from a small workgroup that was led by WSNA Execu­tive Director Sally Watkins and Washington State Hospital Associ­a­tion Board Chair Bill Robertson. Provi­sions include requiring facil­i­ties to:

  • Have appro­priate PPE for workers.
  • If a certain area does have an outbreak, hospi­tals need to be prepared to surge their hospi­tals beds, staff and ventilators.
  • Imple­ment social distancing and strong hygiene measures within their offices and hospitals.
  • Screen patients and visitors for symptoms.
  • Use their clinical judgment for what is consid­ered neces­sary care, using telemed­i­cine when appropriate.
  • Imple­ment policies to protect workers and seek their feedback.

July 29, 2020 — Governor Inslee updates the Procla­ma­tion on High-Risk Employees and Workers’ Rights and extends it through the duration of the current state of emergency.

Sept. 17, 2020 — Hazard Alert from Depart­ment of Labor & Indus­tries and Depart­ment of Health clari­fies steps hospi­tals must take to protect employees and patients from hospital-acquired COVID-19. Provi­sions include:

  • All staff must be trained on COVID-19 proce­dures, infec­tion control proce­dures, how to report a poten­tial COVID-19 exposure, and how to safely don and doff masks, respi­ra­tors and other personal protec­tive equipment.
  • COVID-19-positive and COVID-19-suspected patients must be physi­cally isolated from non-infected persons.
  • Dispos­able respi­ra­tors and proce­dural masks must be replaced daily at the begin­ning of each shift for every employee and immedi­ately upon employee request when soiled or damaged during the shift. Multiple-shift use of dispos­able respirators/​masks is NOT allowed.
  • Employees who enter the room of a patient with suspected or confirmed COVID-19 must follow Standard Precau­tions and use a NIOSH-approved N95 or equiv­a­lent or higher-level respi­rator, gown, gloves and eye protection.
  • Hospital respi­rator proce­dures must ensure that all respi­rator users are medically cleared, fit-tested and trained.
  • PAPRs/​CAPRs may only be used if they are within manufac­turers’ accept­able conditions.
  • Staff are prohib­ited from working or being on the premises if exposed to COVID-19, and all staff who test positive must be excluded from work and isolated according to Centers for Disease Control and Preven­tion (CDC) guidelines.

Dec. 3, 2020 — Governor’s Procla­ma­tion on Non-Urgent Medical and Dental Proce­dures outlines additional require­ments for health and dental facil­i­ties to prevent COVID-19 outbreaks. WSNA success­fully advocated for additional provi­sions for hospi­tals, including:

  • Requiring hospi­tals to provide notifi­ca­tion to staff of high-risk exposure within 24 hours and COVID-19 test results within 24 hours.
  • Requiring random­ized, volun­tary COVID surveil­lance testing in times of non-conven­tional PPE use.
  • Requiring accurate PPE supply and bed capacity reporting to the WA HEALTH database daily and devel­op­ment of a PPE work group to include employees and union representatives.
  • Requiring hospi­tals to follow nurse staffing, meal and rest breaks, and manda­tory overtime laws when providing non-urgent services, proce­dures and surgeries.

Jan. 5, 2021 — Worker Protec­tion Act (HB 1076) pre-filed for intro­duc­tion in the Washington State House of Repre­sen­ta­tives, with input and support from WSNA. The Act gives workers a new way to help enforce the standards Washington state has said are impor­tant, such as meal and rest breaks, wage theft and safety viola­tions. Several WSNA members testi­fied in support of this bill. It was making its way through the Legis­la­ture as this report went to press.

Jan. 6, 2021 — Increasing Worker Protec­tions (HB 1097) bill pre-filed for intro­duc­tion in the Washington State Senate. This bill creates new protec­tions around retal­i­a­tion for reporting unsafe workplace condi­tions. WSNA members testi­fied in support of the bill, which was making its way through the Legis­la­ture as this report went to press.

Jan. 8, 2021 — Estab­lishing Health Emergency Labor Standards (SB 5115) bill pre-filed for intro­duc­tion in the Washington State Senate. This bill provides a number of protec­tions for workers during a health emergency. It was amended on the floor of the State Senate to only apply to the COVID-19 pandemic and not to future health emergen­cies. This bill passed out of the Washington State Senate on Feb. 23 and moved to the House as this report went to press.

Jan. 13, 2021 — Providing Health Care Workers with Presump­tive Benefits During a Public Health Emergency (SB 5190) bill intro­duced in the Washington State Senate. This bill provides presump­tion eligi­bility for health care workers who need to quaran­tine or utilize workers’ compen­sa­tion while out sick with COVID-19 or any disease that is the subject of a declared federal or state health emergency. Senator Jeff Holy (R – Spokane) intro­duced this bill after talking with WSNA members in Spokane. WSNA members testi­fied in support. This bill passed out of the Washington State Senate on Feb. 25 and moved to the House as this report went to press.

WSNA wins major protection for nurses with prohibition on use of carcinogen for PPE sterilization

When WSNA heard that hospi­tals were consid­ering using ethylene oxide, a known carcinogen, to clean face masks, we launched into action to put a stop to this cleaning process.

Nurses at some WSNA-repre­sented facil­i­ties had reported respi­ra­tors and face masks being collected for repro­cessing using ethylene oxide to decon­t­a­m­i­nate. The Food and Drug Admin­is­tra­tion (FDA) has concluded that ethylene oxide is carcino­genic to humans and that exposure to ethylene oxide increases the risk of lymphoid cancer and, for females, breast cancer.

WSNA sent cease and desist letters demanding an immediate halt to the reusing of any face masks, including N95 and other respi­ra­tors, that had been decon­t­a­m­i­nated by the ethylene oxide cleaning process. In addition, WSNA reported this hazard to Labor & Indus­tries’ Division of Occupa­tional Safety and Health.

As a result of our advocacy, the Washington State Depart­ment of Labor & Indus­tries issued a Hazard Alert on April 29, 2020 prohibiting the use of ethylene oxide for cleaning of face masks, including N95s, that included the following directive:

Hospi­tals and clinics are required to use their ethylene oxide (EtO) steril­izer systems for their intended and manufac­turer-approved purposes. EtO steril­izer systems must NOT be used to sterilize masks, respi­ra­tors, PPE or items worn by humans.”

Acting in our communities #

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WSNA distributes thousands of masks to frontline workers

Due to the national shortage of PPE and the lack of effec­tive federal action to secure and produce more, our national union, American Feder­a­tion of Teachers (AFT), donated about 180,000 surgical masks and face shields to Washington state.

WSNA held 10 events in 2020 to distribute these supplies to health care workers, their families and commu­nity members. Our thanks go to AFT for procuring and sending these much-needed masks and face shields to our state.

2104 wa nurse mask up

Mask up” PSAs #

In the begin­ning of September 2020, WSNA ran public service announce­ments (PSAs) on local televi­sion stations in the Tri-Cities, Spokane and Vancouver/​Portland areas to encourage members of the public to mask up.” With the coron­avirus far from under control, and resis­tance to wearing masks emerging in some parts of the state, we felt it was impor­tant to use nurses’ trusted voices to encourage mask-wearing and, we hoped, make a differ­ence in Washington’s efforts to tamp down virus trans­mis­sion and COVID-19 cases.

Advocating in the media #

WSNA lifted up member voices and concerns in the media, earning hundreds of articles that leverage the public’s trust of nurses to win policies that protect and support them. We issued state­ments (often jointly with other health care unions), provided infor­ma­tion and set up inter­views with reporters that spread our message across the state, the nation and the world.

Issues covered lack of PPE, the silencing of nurses and other health care workers, nurse short­ages, furloughs, COVID-19 outbreaks in hospi­tals and nurse burnout.

Review our coverage IN THE PRESS.

Enforcement efforts #

As of the end of 2020, WSNA had filed 19 complaints against 15 hospi­tals with L&I’s Division of Occupa­tional Safety and Health (DOSH) for issues related to lack of PPE, unsafe working condi­tions, failure to follow Governor Procla­ma­tions and failure to follow the September Hazard Alert issued jointly by the Washington State Depart­ment of Health and DOSH. DOSH issued viola­tions at several facil­i­ties highlighted below, including finan­cial penal­ties in instances of serious viola­tion citations.

WSNA members partic­i­pated in the inves­ti­ga­tions, sharing stories of unsafe practices such as being forced to use the same respi­rator for days or even weeks, lack of proper social distancing and venti­la­tion, lack of timely testing and being forced to work after testing positive for COVID.

WSNA filed DOSH complaints for these hospitals:

  • Evergreen Health
  • Grays Harbor Commu­nity Hospital
  • Provi­dence Kadlec Regional Medical Center
  • Multi­Care Good Samar­itan Hospital
  • Multi­Care Tacoma General Hospital
  • Overlake Hospital Medical Center
  • Peace Health South­west Medical Center
  • Peace Health St. Joseph’s Hospital – Bellingham
  • Provi­dence Sacred Heart Medical Center
  • Seattle Children’s Hospital
  • Skagit Regional Hospital
  • St. Joseph’s Medical Center Tacoma
  • UW Medical Center – Montlake
  • UW Medical Center – Northwest
  • Virginia Mason Medical Center

Biennial Report of Achievements

Strategic priority - association vitality

Much of our work in this arena is behind the scenes: strengthening operations and infrastructure. In 2020, the WSNA Board of Directors added a focus on addressing issues of diversity, equity and inclusion in our organization and our work.

Strategic priority - nursing practice

As the professional association for more than 100,000 registered nurses who live and work in Washington state, we are always working to advance nursing practice and ensure nurses’ ability to practice to the full extent of their training and education.