HB 1868 could be devastating to rural healthcare facilities, communities

Dear Editor,
House Bill 1868, which addresses regulations for nurse staffing, could be devastating to our rural healthcare facilities and communities if it becomes law.
This bill requires the Department of Labor and Industries to “regulate and enforce hospital staffing committees and minimum staffing standards,” according to the bill summary. To achieve this, hospitals would need to maintain specific nurse to patient ratios, and mandate and enforce strict breaks for nurses that could not be interrupted for patient care needs.
Three Rivers Hospital already has a nurse staffing committee. We trust our nursing leadership and staff to make appropriate decisions to meet our organization’s goal of providing the ideal patient experience. Administration supports breaks and lunches for all staff, including in patient care. This bill removes choice from our nurses, who are professionals that should be allowed the flexibility to determine what’s best for their workflows and our patients.
A law like this would strain much larger and more well-staffed hospitals. For non-profit rural hospitals like Three Rivers, the burden of meeting every requirement in HB 1868 would be unsustainable during a time when nurse staffing is already sparse. As of this writing, we have openings for six full-time Registered Nurses and one part-time OR nurse, and we are continually seeking per diem nurses to fill shifts as needed. To fill the gaps in coverage now, our existing staff works together to rearrange their schedules, and we also pay high rates for five traveling nurses. It was already a challenge to recruit nurses to work in rural hospitals, and many nurses across the U.S. have left their profession entirely due to the stress brought on from COVID-19.
We are far from the only hospital experiencing nursing shortages: According to the Washington State Hospital Association, there are about 6,100 job openings throughout the state and not enough students in nursing programs to meet that need. In order to comply with the new law, Washington state hospitals would need an estimated additional 15,000 nurses at a cost of about $1 billion.
If our hospital could not meet the new staffing ratios required, we would have to go on diversion, meaning we’d be forced to temporarily shut down certain services and turn away patients. While there have been occasions we needed to go on diversion in Acute Care and transfer incoming patients to other hospitals due to lower staffing levels, we do not want that to become the norm. This law could also put our community members at risk during emergencies.
We are committed to doing our best for all parties involved in these unfortunate times, and we understand very well the need to help nurses avoid burnout. Our legislators could consider better alternatives. They could increase investment in healthcare education, including adding more slots to nursing programs, increasing pay for instructors, and adding financial support and/or loan forgiveness for nursing students. We are also brainstorming ideas with local and regional partners to resurrect a hands-on nurse education and training program in hospitals, but it could be some time before that becomes a reality.
There is also an issue locally and statewide with patients who no longer require hospitalization but are difficult to discharge. We are asking the state for help establishing long-term care solutions, which would help reduce nurse to patient ratios.
It would also be a tremendous help to allow licensed nurses to move here from other states and begin working more easily. Our legislature did not authorize joining the interstate nurse compact last year, which is working well for the 25 states currently a part of it.
We urge our community members to contact our state representatives over the next week and ask them to reject HB 1868. A one-size-fits-all model for nurse staffing is not the answer. Our priority is our patients and their safety, and this bill, if passed, could negatively affect patient outcomes in our rural area.
J. Scott Graham, Chief Executive Officer
Three Rivers Hospital