The Washington State Nurses Association (WSNA) has been fighting for safe staffing for decades. Our 2008 staffing law, updated in 2017, required staffing committees so that nurses and administrators could create safe staffing plans together. But hospital CEOs had veto power, so we ended up with a lot of unilateral decision-making by hospital leaders who claimed they couldn’t afford to follow the committees’ staffing plans.
The results have been deadly. We’ve had sentinel events, where patients died because short staffing forced workers to make impossible choices about how to allocate care. Hospitals claim staffing ratios will mean rationing care, but the reality is that nurses are already making those decisions every day without resources or support—and the staffing committees where they hoped to collaborate on solutions for tough issues are a sham. Nurses were supposed to have a voice, but instead hospital leaders overruled them, keeping staffing dangerously low and leaving nurses frustrated as the spirit of the committee was not being honored. As a result, nurses are traumatized, demoralized, and exhausted.
The first goal of WSNA’s Code Red campaign was to win staffing legislation that mandates nurse-patient ratios and increases enforcement and accountability for hospitals. We’d begun working more closely with fellow healthcare unions SEIU Healthcare 1199NW and UFCW 3000 in 2019, when we passed a bill requiring meal and rest breaks for healthcare workers. Together, in 2022, we formed the WA Safe + Healthy coalition. While our legislation wasn’t successful in 2022, this year one of the main legislators who had stood in our way came to us and to the hospital association seeking a compromise. So we worked with them and our champion legislators to develop new legislative language that closes gaps from prior legislation.
At the same time, WSNA nurses embarked on an all-out advocacy campaign. On our lobby day, 50 nurses met with their state representatives; others testified in the legislature; thousands more sent emails, made calls, and wrote letters to the editors of their local newspapers. Legislators heard us loud and clear. While they wouldn’t agree to ratios, they pushed hospitals to meet our needs in many other areas, and our staffing bill was passed and signed into law in April 2023.
Under the new staffing law, healthcare workers have more power on staffing committees. Any staffing plan must be passed by a 50 percent plus one vote, so it needs healthcare worker support—and CEOs no longer have veto power. The proportion of union-represented workers to hospital appointees is still 50-50, but now CNAs and LPNs can participate alongside RNs, and everyone is paid for their time.
The new law significantly strengthens accountability mechanisms for hospitals. In addition to paying fines, hospitals are now responsible for tracking their staffing, and their compliance reports will have to be signed off on by staffing committee co-chairs, one of whom is a direct care provider. If hospitals are not in at least 80 percent compliance, the Labor and Industries Department and Department of Health will determine a corrective action plan that could include closing down units or requiring hospitals to implement staffing ratios. So in a roundabout way, we may be able to get ratios for noncompliant hospitals. In addition, the complaint process is now easier, and hospitals will have to monitor and follow up on complaints.
Additionally, the law establishes a statewide advisory committee that includes six union representatives, six hospital representatives, and some state officials. This advisory committee, which began work in September, focuses on implementation issues, like how to define a staffing complaint as resolved or unresolved and how to address the staffing problems faced by smaller rural hospitals. It gives our members a voice at the state level, working with the departments and agencies that care about the issues we face.
The rest of the bill will be implemented on a rolling timeline. By January 2024, hospital staffing committees will have to be reestablished to include CNAs, and they’ll have to submit new staffing plans by July 2024. After that, the state can begin checking for compliance.
Many people think that legislative work is finished when you get a bill passed, but that’s not reality. This bill is a major victory for us, but we have a long way to go before our members feel like they have the resources and staff to give patients their best care. We’re going to keep fighting and working to keep the public and our legislators fighting alongside us until that happens. We’re celebrating our successes, but we’re also continuing to hold hospitals accountable.
David Keepnews, PhD, JD, RN, FAAN, is the executive director of the Washington State Nurses Association (WSNA). He has devoted more than three decades to advancing the nursing profession in nursing education and health policy and previously worked as a staff nurse in inpatient psychiatry, psychiatric emergency, and community mental health settings. Katharine Weiss, MPA, is the director of government affairs at WSNA. She has also worked as a policy, research, and politics expert for the Washington State Labor Council, Washington State Health Care Authority, and Community Health Plan of Washington.
[photo: courtesy of WSNA]