Safe nurse staffing

We know, and research confirms, that the care provided by registered nurses has a direct impact on quality of hospital care and patient safety. An aging population, advances in technology and declining lengths of stay have steadily increased patient acuity in hospitals.

Nursing care requires continuous patient assessment, critical thinking and expert judgment, advocating on behalf of our patients 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.

When staffing levels are too low, RNs are frequently forced to compromise the care they give to their patients. Unsafe nurse staffing is a dangerous practice that leads to medical errors, poorer patient outcomes and nursing injuries as well as burnout. Ensuring safe nurse staffing has and continues to be a top priority for WSNA.

The Washington state legislature in 2017 passed the Patient Safety Act, addressing WSNA’s top issue of safe staffing. The bill creates greater transparency and accountability for nurse staffing plans and the work of nurse staffing committees in hospitals.

WSNA worked with other union stakeholders and hospitals on the negotiated bill that builds on the 2008 staffing law to strengthen our staffing committees and increase transparency of hospital nurse staffing plans across the state.

The bill 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.

Read the text of the bill passed by the Legislature.

ESHB 1714: Nurse Staffing

April 20, 2017: Final passage by the legislature.

This bill increases transparency of staffing plan and hospital accountability 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.
• Requires hospitals to submit the adopted staffing plan and subsequent changes to the staffing plan to the Washington State Department of Health beginning January 1, 2019.
• Requires the hospital to implement the staffing plan and assign nursing personnel to each patient care unit in accordance with the plan beginning January 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.
• Allows 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 semi-annual 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 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.
• Requires the Washington State Department of Health to submit a report to the legislature by December 31, 2020, on the number of complaints submitted, 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 on June 1, 2023.

2008 Safe Nurse Staffing Legislation

The 2017 law builds on the 2008 Nurse Staffing Law which includes the following components: Highlights of the law include:

• Each hospital, by September 2008, must establish a nurse staffing committee composed at least half direct care nurses. This committee will develop, oversee and evaluate 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/recommendations on nurse staffing.
• If the staffing plan developed by the staffing committee is not adopted by the hospital, the CEO must provide a written explanation of the reasons why to the committee.
• The staffing information must be posted in a public area and must include the nurse staffing plan and the nurse staffing schedule, as well as the clinical staffing relevant to that unit. It must be updated at least once every shift and made available to patients and visitors upon request.

With the safe nurse staffing legislation in place, every hospital must now begin the important and complex work of creating staffing committees and staffing plans. The passage of legislation was just the beginning of this process. WSNA is committed to providing ongoing support and resources so that the law can have the greatest impact.

For more resources and information for nurses serving on staffing committees or interested in how the committees work, visit Resources and Tools.