Hospital staffing: Myths vs. Facts

Myth: There are plenty of nurses in Washington State.

Fact: The entire country is facing a nursing shortage. Washington State is facing a shortage of more than 6,000 registered nurses (RNs). Mandated nurse-to-patient ratios would multiply this figure and would likely lead to hospitals closing patient services. Only 1.1% of Washington State nurses are unemployed and looking for work.

Myth: Hospitals are quitting their hospital jobs because hospitals are terrible places to work.

Fact: Among exit interviews, burnout and stressful work environment made up for only 17% of staff departures. The top reasons were relocating for a spouse’s job or retirement.

Myth: Hospitals just need to offer more compensation to fix the staffing crisis.

Fact: Nurses in Washington State are some of the best compensated in the country, earning about $96,000 per year on average. This ranks in the 78th percentile for individual income. The average nurse got a 9% pay increase between 2021 and 2022. NerdWallet ranked Washington State as the top state in the country to work as a nurse in 2022. According to a 2021 survey, 85% of responding hospitals reported offering extra shift bonuses to staff, and 61% reported offering retention bonuses to staff.

Myth: Nurse-to-patient staffing ratios will improve health care quality.

Fact: California is the only state in the country with mandated nurse-to-patient ratios, and it has not been shown to improve patient outcomes. Rather, ratios are likely to lead to hospitals closing services to ensure they stay in compliance, reducing access to services. If an obstetric department closes, patients will no longer be able to deliver at their local hospital. The most vulnerable residents would also be at risk of losing access to the local care on which they rely. Residents from across the state, including Native American tribes, expressed this concern to lawmakers when ratios were proposed in 2022.

Myth: Nurse-to-patient staffing ratios will fix the health care staffing crisis.

Fact: Nurse-to-patient ratios do nothing to address the nationwide shortage of health care workers. They will not reduce the number of job vacancies at hospitals, and if hospitals are unable to staff to the mandated ratio, they will be forced to cut patient services. California is the only state in the country with mandated ratios and has one of the most significant staffing shortages.

Myth: All nurses want nurse-to-patient ratios.

Fact: The largest proponent of nurse-to-patient ratios are nursing unions. Nurses who have worked in California under mandated ratios have testified to how detrimental they can be. Many nurses may not understand the unintended consequences of what ratios would effectively do to their working conditions. Ratios would strip a nurse’s ability to make clinical decisions about their patients, as management would dictate when they take breaks to ensure a proper nurse-to-patient ratio is maintained.

Myth: Nurse staffing in Washington hospitals is haphazard and lacks planning.

Fact: Each hospital develops a detailed nurse staffing plan through a collaborative, inclusive process. In accordance with state law, each hospital has a staffing committee, composed equally of hospital medical staff and registered nurses providing direct patient care. Through a fact-based process, the committee develops an annual patient care and nurse staffing plan, which sets forth and assigns the appropriate staffing for each unit. The plan is based on such factors as the total patient demand, acuity of patients, the mix of skills of nurses on staff and staffing guidelines set forth by national nursing and other health professional organizations.

Myth: Nurses do not get breaks during their shifts, leading to overwork and burnout.

Fact: In fact, nurse do get rest and meal breaks under state law, subject to modifications due to emergencies and the needs of particular patients. Rest breaks must occur at least once every three hours.

Myth: Hospitals are not listening to nurses’ concerns about staffing and workplace issues.

Fact: Hospitals have undertaken a multi-year statewide initiative, Committing Action for Resilient Environments for Patients & Staff (CARE), based on listening sessions held with staff. Some innovations arising from those sessions include providing trauma support services on paid time or paid time off for all staff and participating in a nurse staffing committee best practice gap assessment and learning process to ensure nurse staffing committees are operating optimally.

Hospitals are also piloting staffing and care delivery innovations to reduce nurse workload, including:

  • Team-based care models
  • Increased tele-supervision and remote patient monitoring
  • Robots to fetch supplies
  • Electronic health record systems that cut down on documentation time
  • Programs to grow the skills of CNAs, LPNs, and MAs, so they can practice to the top of their license