Nurse Staffing

Project Overview

The William D. Ruckelshaus Center was designated to build and mediate a collaborative forum for the Washington State Hospital Association, Northwest Organization of Nurse Executives, SEIU Healthcare 1199NW, United Staff Nurses Union, Local 141 United Food and Commercial Workers, and the Washington State Nurses Association. These five organizations formed the Nurse Staffing Steering Committee to identify, develop, and promote the use of best practices in hospital nurse staffing to improve patient safety and outcomes, as well as to monitor the implementation of Revised Code of Washington (RCW) 70.41.420 (2008), which called for the creation of hospital nursing staffing committees and collaborative nurse staffing decision making.

Project Description

On February 4, 2008, two representatives from each of the five organizations, Northwest Organization of Nurse Executives
(NWONE), SEIU Healthcare 1199NW (SEIU), United Staff Nurses Union, Local 141UFCW (UFCW), Washington State Hospital Association (WSHA), and Washington State Nurses Association (WSNA) entered into a Memorandum of Agreement (MOA) to address issues related nurse staffing in the state of Washington, including:

Research-based criteria for consideration in hospital based staffing standards.
How facility size, location and work force composition may influence staffing standards.
The effect of nurse staffing standards on patient care, particularly in emergency rooms, and on the patient care delivery team.
The system for health care delivery and its key components for providing safe patient care, such as use of staff teams, work redesign, and technology.
Staffing and its relationship to quality, safety and cost.
Initiatives that promote communication, provide staff support, and increase patient safety.

Engrossed Second Substitute House Bill 3123 (SHB 3123) was mutually supported by the unions, hospitals, and nurse executives, enacted by the Legislature, and signed by the Governor in 2008. The law requires hospital-level committees to produce staffing plans to be submitted to hospital CEOs, and posting of unit-specific plans and schedules in each patient care area.

The Memorandum of Agreement is guiding the ongoing work to examine and recommend further actions to address nurse staffing in Washington state, and potentially other joint proposals for action or legislation. This collaborative effort by hospitals, nurses, and nurse executives is unique in the country as a way of addressing the difficult issues around nurse staffing. The five organizations, with the concurrence of the Governor and the Legislature, are working with the facilitation and analytic assistance of the Ruckelshaus Center. For additional support of the committee the center has also utilized faculty members from Washington State University’s Extension and Intercollegiate College of Nursing Spokane, and the University of Washington’s Evans School of Public Affairs, School of Nursing and the Department of Health Services in the School of Public Health.