Editorial: Nurses, health care workers need better support

By The Herald Editorial Board

Even after covid’s omicron surge has eased, don’t expect things to quickly return to normal at hospitals in Washington state; or in the nation, for that matter. Even “normal” wasn’t a good situation, with nurses at hospitals and other health care facilities dealing with overtime and increased workload because of shortages of nurses and other health care staff, a problem even before the pandemic.

Covid and its surges — and its toll on life and health — during the past two years have left hospital staff overworked and physically and emotionally drained. While many have stuck it out, others have left the profession, increasing the workload on those who remain.

A survey late last year by the three unions that represent nurses and other health care workers in the state found that 80 percent reported feeling “burned out” after nearly two years of the pandemic. Nearly half surveyed said it was likely they would leave the health care profession in the next few years, with 71 percent among those who had considered leaving saying inadequate staffing at their place of work was the leading reason; another 53 percent cited inadequate pay.

Kelly Johnson, a registered nurse at Providence Regional Medical Center Everett, last week told the state House Labor and Workforce Standards Committee, about recently caring for a patient brought into the emergency department in critical condition who was intubated and unresponsive.

When the patient’s blood pressure dropped dangerously low, “no staff was available to help for several minutes, even after pressing the code staff assist button,” Johnson said. Any delay in timely assistance, Johnson said, can mean the difference between life, death or permanent changes to a patient’s quality of life.

There’s plenty of agreement about the risks presented by inadequate staffing in hospitals.

“We are not in the place we want to be with staffing in hospitals,” said Cassie Sauer, chief executive of the Washington State Hospital Association, testifying during the same House committee meeting.

The disagreement is over how to resolve those shortages, as The Herald’s Katie Hayes reported Monday.

Johnson, other nurses and others in health care, testified in support of legislation — House Bill 1868 and Senate Bill 5751 — that would set minimum staffing levels and standards for hospitals, as well as make changes to state law adopted in 2019 that set standards for meal and rest breaks and overtime provisions. The legislation would also impose significant fines — up to $10,000 a day for hospitals that don’t follow a plan to correct inadequate staffing — and would also allow for lawsuits by employees over violations of rest and meal breaks and overtime provisions.

The problem, Sauer and others representing hospitals and health care facilities said, is they aren’t likely to meet minimum staffing levels if there are not enough nurses available to be hired.

California, others testified during the hearing, is the only state that has such staffing requirements; and it is seeing the same shortages of nursing staff as other states; with no better outcomes for patients.

Currently there are an estimated 6,000 nursing vacancies at hospitals throughout the state. And nursing shortages elsewhere, specifically at the state’s long-term care facilities, are making overcrowding and bed occupancy worse at hospitals.

In December, even before the omicron surge flooded hospitals, Dr. Jay Cook, chief medical officer for Providence Everett, reported that 1 in 6 patient beds at Providence’s Everett hospitals were occupied by patients who no longer needed hospital-level care but remained at the hospital, waiting to be sent to a long-term care facility.

“Our problem is that these vulnerable but not acutely ill individuals occupy inpatient beds and require the same limited hospital staffing needed for other patients with more severe acute medical problems that need our care.”

Short-staffed, themselves, the long-term care facilities are reluctant to admit those patients.

The result, even before omicron, was that Providence had to postpone elective but medically necessary surgeries.

State Sen. June Robinson, D-Everett, who sponsored SB 5751, acknowledges the opposition from hospitals and their administrators, but also pointed to a history of foot-dragging by hospitals on staffing and workplace issues, which covid has now brought to a head.

“They don’t like being regulated in that way,” Robinson told Hayes. “So I think we, as a Legislature, have held off sort of in deference to the hospitals, hoping, assuming they would do the right thing. Years and years go on and it just gets worse and worse.”

Hospitals have set up staffing committees, which include nurses and other employees as representatives. But, Johnson, the Providence Everett nurse, said administrators don’t always listen to their recommendations. Now, they’re looking for stronger regulations that outline how many nurses are required in certain units, including one nurse for every one critical care patient and one nurse for every three noncritical care patients.

However, like the supply chain problem we’re experiencing now with computer chips and truck drivers, there may simply not be enough nurses to go around. And the pandemic and its stresses have left others considering new careers.

Gov. Jay Inslee has, in his supplemental budget proposal, outlined about $17 million in spending to address needs in the health care workforce, including $8 million in grants for low-income students wanting to become nurses, $6 million in incentives for nurses who help to train students and $3 million for a pilot program to improve the work environment of long-term care facilities.

That amount, however, pales against $10 billion that New York’s Gov. Kathy Hochul proposed recently to bolster that state’s health care workforce, including $4 billion to support wages and bonuses for health care workers. Granted, New York’s population is more than twice that of Washington state, but Washington state’s recent revenue forecast — as well as federal pandemic relief aid — should allow for an increased allocation to help strengthen and rebuild the state’s health care workforce.

If lawmakers can settle on a reasonable level of staffing regulation, it should also be matched by a commitment for expanding the availability for education and training in nursing and other health care fields, support and retention of existing workers and involvement of hospital and other facility employees in the decisions that concern their jobs.

Johnson, while seeking passage of the staffing regulation during her testimony, also urged greater collaboration.

“It’s not an us versus them problem; it’s a we (problem) and it requires a team effort,” she said.