By The Herald Editorial Board
Banging on pots and pans won’t be enough; if it ever was.
The covid-era ritual meant to honor front-line health care workers and other first responders during the worst of the covid pandemic was a nice gesture. Yet, even as sincere appreciation remains for those workers — in particular for nurses working in hospitals, skilled nursing facilities and other health care facilities — gestures and thanks won’t provide respite and support for those exhausted by nearly three years of surges in covid patient volumes, aren’t compensating long hours of difficult work and aren’t lending a hand when a shortage of nurses across the state and the nation have driven trained and experienced professionals past breaking points; only to see them return the next day for another 12-hour shift.
The warnings from nurses, locally from staff at hospitals in Snohomish County, have been heard over the past year in reporting by The Herald and other media and in pleas before local government including the Snohomish County Council and the Everett City Council, all to the effect that nurses are burned out, with some leaving their jobs and perhaps the profession, only to add to the staffing hardships. More recently, the warning has deepened to include growing concerns for patient care.
“Why we’re here are unsafe patient ratios in the emergency department” and in other units, said Kelli Johnson, a nurse of 10 years, with six years in the emergency department at Providence Regional Medical Center Everett, during a recent discussion with the editorial board. Johnson and fellow registered nurses Dana Robinson and Trevor Gjendem, acknowledge that their concerns are not unique to Providence’s Everett facilities; it’s a problem common across the state and the nation.
As well, the nurses recognize how the pandemic overwhelmed hospitals and health care facilities, and for its part, how Providence’s management had worked to support the hospital’s health care workers during the pandemic’s spikes.
“Providence was providing incentive to get staff in hospital to cover,” Johnson said. “They paid incentives to get nurses in the door, and nurses felt those incentives matched the risk.” Increasingly this spring, however, the nurses say frustration has grown with a lingering staffing problem and poor communication and transparency, particularly regarding the hospital’s staffing committees, which are supposed to offer nurses an opportunity to share concerns, gather information and propose solutions.
That’s left nurses to seek the help of state lawmakers through consideration of legislation that would set ratios for nurses and patients for specific units in hospitals and skilled nursing facilities.
“There’s nothing in place to hold hospitals accountable in a long-term way,” Johnson said. “The only thing they’re going to listen to is a state law.”
Legislation in this year’s session to set those ratios passed the state House, but stalled in the Senate. The bill, similar to a California law adopted in 2004, is expected to return for consideration when the session begins in January.
Hospitals and others are generally skeptical of the legislation, said two Providence officials in a separate meeting with the editorial board.
There are pros and cons to such ratio mandates, said Kristy Carrington, Providence-Swedish’s new chief executive and Michelle Lundstrom, Providence Everett’s chief nursing officer. Both have nursing backgrounds and direct “bedside” experience with mandated ratios, having worked as nurses under California’s staffing law.
Prior to covid, Carrington said, the outcomes in patient care didn’t show significant differences between California and other states. As well it can be difficult to develop ratios that take into account each patient’s individual needs. During covid, Lundstrom said, California hospitals had ambulances lined up with patients that nurses couldn’t attend to because of the mandate.
More importantly, setting staffing ratios won’t solve the basic problem: a lack of available nurses, especially set against a nursing workforce that is aging, with 55 percent of nurses 50 years or older.
If hospitals and other facilities are unable to hire enough staff, such ratios could force hospitals to leave beds empty or even close units.
“It doesn’t solve the problem that we don’t have enough nurses,” Carrington said.
The nurses disagree, pointing to a large pool of licensed nurses in the state who they say have stayed away from open positions they won’t consider until they have the assurance of safe staffing ratios.
Even so, there’s recognition of a growing shortage for trained nurses, one that is estimated to fall short of needs in the U.S. by 450,000 nurses by 2025, Carrington said.
For local needs, nursing schools, such as that at Everett Community College, are not graduating new nurses at a rate that can meet current demand.
“Everett graduates about 20 to 23 registered nurses a quarter,” Lundstrom said. “I would need about 100 a quarter to get us caught up.”
Discussions are ongoing with Everett and other schools to increase the seats available to students, but colleges, too, are facing their own shortages, namely nursing instructors.
Incentives to address that shortage are among ideas that hospitals and others hope to advance in the Legislature next session, both said.
Hospitals, Providence included, also are coping with nursing shortages elsewhere in health care. Because skilled nursing facilities are seeing the same shortages of nurses, hospitals have been unable to transfer patients who no longer need a hospital’s level of care but aren’t being accepted by skilled nursing facilities.
Of late, Providence has had to provide beds and nurses for about 50 such patients, Carrington said, requiring beds and staff who could be better deployed to serve patients that do need higher levels of care.
The hospital is attempting to make better use of available staff, Lundstrom said, by using more licensed practical nurses, certified nursing assistants and even nursing students for duties that don’t require a registered nurse to perform. Some nurses have balked at the change in duties, she said, accustomed to attending to most of a patient needs and also concerned about the threat to their licenses should something go wrong.
“We’re working with our RNs to get them to let go of the things they’ve always done and deliver care in a different way,” Lundstrom said, and they’ve brought in state officials to ally concerns about licenses.
Hospitals also are asking state lawmakers to consider joining an existing statewide compact, currently including about 39 states, that accepts nursing licenses across state borders and could increase the pool of available nurses.
Still, in the minds of many nurses, state-mandated ratios will be necessary regardless of other efforts.
“If you don’t make sure that nurses can practice nursing safely, then all your other interventions aren’t going to last,” Johnson said.
Legislation regarding ratios as well as other remedies should see more discussion and investigation by lawmakers. But more immediately, Providence and its nurses should continue their own discussions. Carrington described an effort set to start next month that will hold roundtable discussions with groups of nurses — beyond the staffing committees — that can outline issues and consider which can be addressed and their potential solutions and those for which resources are not presently available.
At the same time, the parties participating in the hospital’s unit staffing committees and its steering committee that oversees the unit panels should recommit to transparency and to changes that are achievable. Gjendem noted instances where hospital officials were slow to provide requested information and followed the letter of contract language regarding the committees, rather than their spirit, which limited nurses’ participation.
Providence and its nurses clearly share a commitment to patient care and a concern for the well-being of all staff. The hospital’s nurses — having cared for and protected the lives of patients for three years of a devastating pandemic — deserve the community’s admiration but are most deserving of solutions that fairly compensate them and support their emotional and physical health, allowing them to continue work vital to the community.
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