Community Health & Wellness

New hospital staffing standards aim to ease the burden on health care workers

Posted on August 29th, 2024 By: Conor Wilson

A decade ago, it was difficult to get a full-time position at St. Michael Medical Center in Silverdale, says Aimee Oien, a union rep for the hospital’s nurses and other staff. Turnover was low. Most staff started in per diem or on-call roles.

The last several years — even before the COVID-19 pandemic rocked the health care sector — have been different, she says. Positions across all departments are posted more frequently and remain vacant longer.

“It takes me back to, what can be done to make the hospital stand out? What can be done to make people think of St. Michael over other hospitals?” said Oien, a rep with UFCW 3000. “I’m a firm believer that if you change the working conditions, the people will come.”

Recruiting and retaining staff has become more challenging for hospitals across the state, including on the Kitsap Peninsula. Reports from industry groups and state agencies show major workforce shortages. Hospitals compete for a dwindling pool of applicants.

New staffing law

Hoping to reverse course, state legislators, industry groups and unions collaborated on an expanded hospital staffing law last year that is just starting to take effect.

The sweeping legislation not only gives workers more input on staffing considerations, but strengthens enforcement mechanisms for hospitals that fail to comply with staffing plans or provide timely rest breaks.

By holding hospitals accountable, Oien hopes workers experience less burnout, stay in the industry longer and produce better patient outcomes.

“I don’t see there being any negatives to it,” she said.

UFCW 3000 and other unions say staffing shortages in Washington have reached a boiling point. A survey of union health care workers released earlier this year found that nearly half said they were likely to leave the profession in the next few years. A majority cited burnout and short staffing as reasons driving that decision.

To improve conditions, unions wanted the state to implement strict staffing ratios and limit the number of patients assigned to hospital staff at a given time. Hospitals argued that ratios could limit access to care.

Staffing plans include LPNs, CNAs, more

Washington legislators passed a compromise law in 2023. It expanded the state’s hospital staffing law, but stopped short of implementing minimum staffing standards.

Improvements focus primarily on how hospitals develop their annual staffing plans. The document outlines the number of staff assigned to each unit and what happens if they are out of compliance.

Since the state’s original staffing law passed in 2008, a committee of nurses and administrators at each hospital have collaborated annually on a staffing plan. The new legislation expands those committees beyond nurses to include licensed practical nurses and certified nursing assistants, ER technicians and other staff.

Hospitals were required to form those expanded committees by Jan. 1 of this year. Their first staffing plan under the new law is due to the Department of Health by the start of next year, and annually thereafter.

Darcy Jaffe, senior vice president of Clinical Excellence with the Washington State Hospital Association, said the changes to the staffing committees will bring a greater perspective to the process. As they go through the complex exercise of determining staffing assignments, this method will give each hospital the ability to adapt staffing assignments based on their own needs.

“Taking care of patients is so dynamic, there’s only so much predictability,” she said. “Some states put in a one-size-fits-all approach. We feel that doesn’t give you the opportunity to provide your best care.”

Tracking compliance

Starting next summer hospitals will track compliance with their staffing plans and submit semi-annual reports to the Department of Health. Beginning in 2027, they can face financial penalties if they are out of compliance with those plans more than 80% of the time. The DOH can require a corrective action plan to reach compliance.

The new law implemented a similar mechanism for meal and rest break violations. It requires hospitals to submit quarterly compliance reports. They could face penalties, starting in 2026, if they fail to give workers their breaks.

Maureen Hatton, Healthcare Division director of labor union UFCW 3000, said the law was not passed to negatively impact hospitals, but rather provide accountability and transparency. But whether the law ultimately helps hospital workers will depend on how each hospital uses it, she said.

“It certainly was never meant to punish hospital systems,” she said. “It was trying to fix staffing issues as a whole and to keep communities and patients safe.”

Jaffe said tracking compliance will be complicated and a “big lift” for hospitals.

“We’re grateful to have time to implement this well,” she said. “It’s not going to impact patient care in any way but positively.”

St. Anthony, St. Michael plans submitted

Staffing committees at both St. Michael and St. Anthony Hospital in Gig Harbor have already submitted their 2025 plans, a VirginiaMason Fransican Health spokesperson said. The hospitals’ presidents adopted both. A spokesperson for the Department of Health said they have not approved them yet.

Two years ago, SMMC and its leadership were subject to intense public scrutiny over its staffing shortages, particularly in the emergency department. One now famous instance of a swamped ER nurse calling 911 from inside the hospital drew national press.

At that time, hospital leadership said they had about 300 vacant positions. Currently, St. Michael has 134 jobs posted online, not all health care-related. St. Anthony lists 59.

A VMFH spokesperson said St. Anthony and St. Michael have a retention rate of 85% to 90% in the last fiscal year. That includes a perfect retention rate with their nurse residency program. SMMC has 25 residency nursing students starting at SMMC this month and maintains a strong pipeline of candidates.

VMFH has also employed nursing recruitment and retention committees, both regionally and at St. Michael, the spokesperson said. Those bodies actively review open positions, plan how they will meet hospital needs and work to attract new talent.

Other staffing standards

SMMC President Chad Melton wrote in an email to the Kitsap Sun that the hospital created the staffing plans in alignment with the new law, national standards through the National Database of Nursing Quality Indicators and internal quality and patient safety standing. It based the plans on historical and predicted patient volumes and will always meet the state law requirements, he said.

The hospital continues to prioritize initiatives to develop and retain “future generations of health care workers,” he said. The hospital provides market-based pay, positive work environments and professional development opportunities.

“Our most important indicator today and everyday,” he said, “is ensuring we are staffing to patient needs so we continue to deliver the highest quality, safest care.”

Conor Wilson is a Murrow News fellow, reporting for Gig Harbor Now and the Bremerton-based newspaper Kitsap Sun, through a program managed by Washington State University.