Concerns over HB1868

National staffing shortages would make compliance with SHB 1868 impossible. Washington’s health care system is facing unprecedented shortages.

An October 2021 survey of Washington’s hospitals estimates an additional 6,100 nurses are needed to meet current hospital staffing needs. WSHA’s analysis of the bill estimates Washington hospitals would need to hire an additional 15,000 to 20,000 FTEs to meet the ratios in the bill. For our hospital, we anticipate needing 15 additional nurses and 6 additional CNAs to comply with the ratios included in the bill.

Why so many staff are needed for ratios

The reason these numbers are so high is because one extra nurse in a nurse-to-patient ratio is not just one extra nurse to hire. Hospitals operate 24/7, and the proposed ratios are in effect 24/7. There are 168 hours in a week. Most full-time nurses work three 12-hour shifts (36 hours) per week, so it takes 4.7 nurses to cover one nurse FTE for the 168 hours in a week. If nurses are working part-time, hospitals would have to hire even more nurses to cover those 168 hours each week. In the last five years, more and more nurses are seeking part-time work.

Forks Community Hospital has worked hard to retain the nurses we have. The last two years have been brutal for everyone working in health care. We are so incredibly grateful to the staff who continue to put their heart and soul into providing life-saving care in the face of this relentless pandemic. FCH has done two retention bonuses to all staff and have a memorandum of understanding to pay incentives for picking up shifts that are identified as an incentive shift.

Nurses leaving hospitals to work for traveler agencies

Despite this, we are losing nurses every day. One traveler agency told us that 55% percent of the traveling nurses they place in hospitals are from Washington state. This means they are leaving our hospital only to be placed back in another Washington hospital. A few months ago, this agency had only 1,000 nurses in WA state, now they have 5,000. Nurses are not leaving hospitals because of the conditions; they are leaving because working as a traveler is incredibly lucrative.


The unions are claiming they need this bill because hospitals haven’t been following their staffing plans for the last two years. Hospitals have faced six surges and canceled non-urgent procedures on and off for the last two years. Times have not been normal. HB 1868 punishes hospitals for caring for Washingtonians during the middle of an unprecedented pandemic.

We simply do not have enough nurses available to meet these ratios. If we are unable to meet the ratios, we will be forced to close the units to additional patients. In some cases, we may not be able to continue to offer the service at all. FCH will be forced to close our after-hours surgery availability which would also force closure of our Labor and Delivery unit. With closure of our Labor and Delivery unit we would stand to lose one of our providers. An additional impact could be the number of patients we would be able to admit to the hospital, let alone finding bed placement elsewhere as those facilities will also be greatly impacted by staffing ratios.

When we reduce services, patients are impacted. We will be rationing care. This means delays in scheduled surgeries (cancer surgeries, heart surgeries, etc.), with urgent and life-saving procedures taking priority; hours-long wait times in the Emergency Department.

Variance process

The variance process is flawed from its inception. If the proponents of the bill thought that hospitals could meet these ratios, they wouldn’t need to put forth this proposal.

The variance says it is for “situations where a hospital can establish that compliance with the minimum staffing standards are infeasible.”

Since the workforce required to meet these ratios does not and will not exist for some time into the future, every hospital in the state would file a variance. There are 105 hospitals that will most likely be seeking a variance.

Hospitals would apply for the variance when they couldn’t hire staff or contract with sufficient traveler nurses to meet the ratios in each unit of the hospital. If a variance was denied, the hospital would still be required to reduce services or close the unit to new admissions to meet the ratios.

The variance process allows the union to challenge the variance even after the hospital showed, and the agency found, that the hospital had “good cause” for not being able to meet the ratios. The department may also revoke the variance with only 30 days’ notice to the hospital. This provides NO certainty for hospital operations or for patients needing services.

Rigid hospital staffing mandates, regulatory fines and increased legal jeopardy do not create more qualified hospital staff. Only ending the pandemic and significant investment in health care workforce education and pipeline development will ease workforce shortages. Please oppose SHB 1868.