Nurses at UW Medical Center – Northwest warn of staffing crisis 

Nurses at UW Medical Center – Northwest say urgent action is needed to improve staffing at the behavioral health facility launched in May 2024.

Nurses have been assaulted, missed rest and meal breaks, and have been left alone with patients with a history of violence.

In June, nurses filed 41 complaints about staffing at the Center for Behavioral Health & Learning, up from 11 in May, 19 in April, and six in March. The complaints have escalated since 32 staff, including 13 nurses, were laid off in April.

The Washington State Nurses Association, the union which represents the 3,122 nurses at UW Medicine Northwest and Montlake campuses, keeps track of complaints, known as assignment despite objections or ADOs. (UW Medicine tracks complaints using a different system, so the number of complaints can vary widely.)

The Washington State Legislature invested $244 million in creating the six-story behavioral health facility on the Northwest campus as part of a new era in caring for patients with mental health needs, according to UW Magazine.

By cutting staffing costs, however, patients cannot get the care they need.

“Our patients are vulnerable. Our staff is committed. But this is not sustainable,” a nurse said in a complaint to the union. “We care deeply about our work, but this isn’t a therapeutic environment. It’s demoralizing…

 ‘We care deeply about our work, but this isn’t a therapeutic environment. It’s demoralizing…’ says nurse working at Center for Behavioral Health and Learning.

Nurses said working with patients with high needs and a history of violence requires “cares in pairs,” meaning two staff go into the patient’s room together. That was the facility’s policy, until recently, when it was downgraded to a mere recommendation, according to nurses in the unit.

“A patient with a well-documented history of physical assaults, both against me (on multiple occasions) and numerous other staff members was recently downgraded from a mandated two-person approach to a ‘two-person recommended’ approach,” said a nurse in a complaint. “In all my years of practice, I have never encountered a facility that ‘recommends’ rather than mandates a two-person protocol for a patient with this level of assaultive behavior."

Numerous complaints talk about the nurse’s station being left unattended with patients seizing items that could be used as weapons, patients going into other patients’ rooms not enough staff to watch halls, and the complexity of patients who need constant monitoring. Patients have also smashed computers on mobile workstations.

“I care deeply about my team and the patients we serve,” said a nurse in a complaint. “We’re doing everything we can to hold things together, to create a safe, healing environment, but we can’t do it alone. We need real support. We need to be heard, and more importantly, we need action.

Below are excerpts from other nurses who filed complaints:

• “I was assigned six patients, including one in seclusion due to significant physical aggression toward staff and other patients…The patient in seclusion required assessments every two hours and additional checks due to ongoing medical concerns. Despite multiple efforts to administer scheduled morning medications to my other patients, I encountered frequent delays…
• “The unit was extremely acute all day, and multiple patients were escalated and behavioral, and staff were constantly working to de-escalate situations, often with no time to rest or recover. The nurse’s station was left empty multiple times, and the halls went unmonitored on several occasions. At one point, during one of these gaps, a male patient entered a female patient’s room.”
• “I was punched twice in the face by a patient while giving medications. There wasn’t enough backup — security took too long to respond. I’ve seen the nurse’s station left empty, hallways unmonitored, and high-risk patients downgraded from mandatory safety protocols to ‘recommendations.’ We’re being set up to fail.”
• “While working in Geropsych, I was expected to cover the breaks of CNAs and a nurse. As an RN, this gave me a total patient load of 18 patients, putting me well above safe staffing. Unit does not have enough CNA staff to break each other, therefore relying on RNs to cover the patient loads of multiple staff.”
• “Most of our patients have behavioral care plans that our psychologists create with interventions/incentives. As floor staff we are supposed to be implementing, however due to not enough staff a lot of times these interventions/incentives are not implemented.”

On July 9, five nurses from both the UW Medicine Montlake and Northwest campuses provided their concerns at the UW Board of Regents meeting.

Along with staffing and safety concerns at the Center for Behavioral Health and Learning on the UW-Northwest campus, the nurses said they need dedicated break nurses and better staffing at both hospitals.

Nurses are calling on UW Medicine leadership to:

• Immediately increase staffing in behavioral health and other units. This includes  nurses, CNAs, and trained security.
• Reinstate and denforce clear, mandatory safety protocols for high-risk patients.
• Provide consistent policy communication and accountability.
• Collaborate with staff to create a truly safe, therapeutic environment.

“In every direction, something is falling apart,” said a nurse working in a medical-surgery unit.  “We're caring for up to 10 patients each, supporting a full unit with just one CNA during breaks, and managing COVID-positive and high-risk behavioral-health patients with no additional resources. We don’t just give meds — our patients need hands-on, time-intensive care. But we’re stretched so thin that we have to choose between charting, feeding, cleaning, or calming someone in crisis.”

The labor contract for nurses at UW Medical Center Montlake and Northwest expired June 30.