Strategic priority — quality and safety

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.

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.


  • 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

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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.

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“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