Concerned about patient safety and nurse retention, nurse lawmakers in Washington State and Colorado have introduced legislation addressing staffing issues.

“This bill is trying to drill down to letting nurses have a say in developing some standards,” said Rep. Dawn Morrell, RN (D-Puyallup, Washington).

More than 600 nurses rallied at the Washington State Capitol in support of the Patient Safety Act (HB 1809 and SB 5696). The bill would set minimum staffing standards at acute care hospitals.

“We think the bill is critical for safe patient care and nurse retention in a time of nursing shortages,” said Anne Tan Piazza, government affairs and communication director for the Washington State Nurses Association. “We have evidence that better nurse staffing in hospitals will increase the quality of patient care, and we also know one of the highest reasons nurses leave bedside nursing is their frustration and dissatisfaction with nurse staffing.”

The Service Employees International Union (SEIU) also supports the legislation.

“Patients and their families have a right to know they are receiving safe care. Under this bill, they will have access to the kind of information on which they can make more informed choices about where to seek care,” said Dawn Cutler, RN, a nurse at Providence St Peter Hospital in Lacey and member of the United Food and Commercial Workers International Union Local 141. “With a limited number of patients, nurses know that they have enough time to meet the needs of those patients.”

Morrell knows first hand the importance of adequate staffing. She continues to work as a critical care nurse at Good Samaritan Hospital in Puyallup.

“Nursing keeps me grounded,” said Morrell about why she remains at the bedside. But it concerns her that some nurses give up on the profession too quickly.

“This is a retention bill,” Morrell continued. “I see young nurses who don’t stay in the profession. If you have no control over your workflow and [don’t have] the satisfaction you get at the end of the day of doing a good job, rather than just trying to keep up, we lose them.”

Research by Linda H. Aiken, Ph.D., FAAN, FRCN, RN, at the University of Pennsylvania School of Nursing, and others support the premise that more nurses lead to better outcomes. Morrell has tried for four years to get a staffing bill passed.

Last year, the Washington State Hospital Association considered the staffing bill’s defeat one of its top priorities. Hospital association spokesperson Kristen Peterson said the group has concerns about the 2007 bill. It would like to see a task force convened to address the issue.

Unlike the California staffing legislation, Morrell’s bill does not set nurse-to-patient rations. Rather, it asks the Washington State Department of Health, which licenses and regulates hospitals, to establish standards. Hospitals would have to create staffing committees, at least half comprised of nurses, to develop staffing plans; to submit those plans to the health department; and to post each shift’s plan in the patient care unit.

The legislation also would require hospitals to collect information about skill mix, death among surgical patients, prevalence of urinary tract infections and hospital-acquired infections, patient falls, and other measures, and submit the data to the Department of Health twice yearly.

Adverse health event reports would have to include the number of patients and nursing personnel in the area at the time of the incident. The department would be required to investigate complaints of violations, and hospitals found in violation could face civil penalties of up to $10,000.

In Colorado, Sen. Lois Tochtrop, RN, (D-Thornton) introduced SB 10, which would require hospitals to develop, with input from registered nurses, implement and file with the state minimum staffing levels for each patient care unit in the hospital. The law also would mandate that the facilities make the information available to patients and follow the submitted plan. The state would be required to investigate complaints and impose civil penalties or suspend or revoke a license for violation.

“We support the concept of hospitals having a plan, it should be reportable and that staff nurses should be involved in making decisions about nurse staffing,” said Paula M. Stearns, MSN, RN, executive director of the Colorado Nurses Association.

“This is a transparency bill,” added Patty Stewart, RN, a critical care nurse and volunteer with the SEIU’s Nurse Alliance. “We’re not mandating staffing ratios. We’re just wanting them to put forth a good faith effort to keep with the staffing patterns they deem safe, reasonable and responsible.”

The Colorado Heath and Hospital Association strongly opposed the bill and lobbied heavily to get the current version defeated in committee.

“We’re so opposed, I see red,” said Steven J. Summer, president and chief executive officer of the hospital association. “There is no science behind the issue of nurse staffing measures. There is no uniform way of collecting. There is no indication consumers understand it. It’s not an outcome measure; it’s a process measure. That bill had eight to 10 mandates that would impose enormous costs on hospitals.”