Hospitals and nurses unions have signed a landmark agreement on how to address differences about staffing ratios — and move ahead.

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Whether government should impose mandatory ratios of nurses to hospital patients has been bitterly controversial in many states, including Washington.

Nurses have argued that staffing minimums are necessary for safe patient care, but hospitals have countered that legislation is too blunt an instrument and could force them to close emergency rooms and other units.

Monday, hospitals and nurses unions in Washington signed what they called a first-in-the-nation, landmark agreement on how to address these differences and move ahead.

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Breaking a five-year stalemate, the two sides pledged to support legislation that would require every hospital to create a unit-by-unit, shift-by-shift nurse-staffing plan. The plan would be set by a nurse-staffing committee; at least half the members must be registered nurses who regularly care for patients.

For the patient wondering why no one is responding to that call button, another part of the legislation may provide some answers: Both the staffing plan — which will show the staffing for each shift for each unit — and the nurse schedule will be posted in a public area and must be available to patients and visitors who request it.

Under the agreement, hospitals and nurses also decided that hospitals should report nurse-staffing levels when they report medical errors, and will ask the Department of Health to revise its reporting forms.

“We know there are preventable errors and preventable harm done to patients every day” and that low nurse-to-patient ratios have been linked to adverse events, said Anne Tan Piazza, spokeswoman for the Washington State Nurses Association, which represents 15,000 registered nurses.

“We have an interest in ensuring that there is adequate and appropriate nursing staff at the bedside to assure safe patient care.”

The agreement sets the stage for nurses to have “more real decision-making power” about staffing, said Chris Barton of SEIU (Service Employees International Union) Healthcare 1199NW, which represents about 22,000 health-care workers across the state.

Previous attempts to solve the nurse-shortage problem with legislation didn’t work, said Cassie Sauer, spokeswoman for the Washington State Hospital Association. “It was a winner-take-all atmosphere,” she said. “This is too complicated an issue.”

The agreement, announced Monday in Olympia by Gov. Christine Gregoire, was negotiated with the help of the William D. Ruckelshaus Center, of both the University of Washington and Washington State University.

In addition to pledging to support the bill now moving through the Legislature to establish hospital-staffing plans, hospitals and nurses agreed to establish a steering committee to continue working together through the Ruckelshaus Center.

Carol M. Ostrom: 206-464-2249 or

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