Sarah Norisada is no stranger to multitasking. In fact, it’s essential to her role as a certified nursing assistant at MultiCare Deaconess Hospital in Spokane.
On a typical day, Norisada will know how stretched she is when she sees how many other nursing assistants are on her floor with her. The assistants evenly divide up the patients, so if the unit is full and staffing is short, Norisada could be caring for more than a dozen patients during a shift.
The strain on the health care profession during the pandemic has been well documented. As health care workers contemplate leaving the medical field for less stressful work, in potentially large numbers, hospital leaders are worried patients will suffer if there are not enough workers to care for them. A group of labor unions will ask the Washington Legislature in the upcoming session to create laws outlining minimum staffing levels and patient-to-staff ratios.
Nursing assistants like Norisada are responsible for a lot of the fundamental patient care. They feed, turn, walk, move, bathe, help with bathroom needs and check on patients. They track patients’ weight and vital signs, as well as how much a patient eats and drinks.
When Norisada has more than a dozen patients during a shift, these tasks get more rushed.
Recently, Norisada was asked to work on a different unit where she had to take care of 14 patients, including six with COVID-19.
COVID patients require more time to care for, because she has to don all of the protective gear before entering their rooms. Additionally, if a patient with the virus moves around but then appears out of breath, Norisada must wait until they are stable before she leaves. In one instance, Norisada was caring for one of the COVID patients and missed another patient who needed to go to the bathroom.
“I couldn’t get to her in time, and she soiled herself,” Norisada said. “It’s very disheartening; they are there for care, and they’re getting rushed care.”
“Band-Aids on gunshot wounds”
There was a shortage of nursing assistants before the pandemic began, but now it’s widespread throughout hospitals statewide. Norisada said on her unit, which has higher-risk patients, the team is good about rotating to give one another lunch breaks on their 12-hour shifts, but a 15-minute break?
“You’re lucky if you get one,” she said, noting that even coming back from lunch can be chaotic. “You come back from a break, and it’s chaos. Breaks are definitely missed a lot.”
It’s been a brutal year for health care providers. The delta variant wave left already exhausted providers beyond burned out, and now, at the near end of 2021, another variant is threatening to overwhelm hospitals this winter.
Health care staffing shortages in Washington predate the pandemic, but many providers believe it’s never been this bad.
Callie Allen, a NICU nurse at Sacred Heart Medical Center, has been a nurse for a dozen years, previously in large hospitals in Utah, and now in Spokane.
“The mass exodus that I have witnessed in the time I’ve been here at Sacred Heart is alarming to me personally,” Allen, who has worked there since summer 2019, said. “I’ve never seen it before.”
Providers are leaving for myriad reasons: jobs in less stressful health care settings, burnout, family moves or taking higher paying traveler positions, to name a few.
As Norisada points out in her role as a nursing assistant, people can make similar wages at less stressful jobs elsewhere.
“If you look at CNA wages and compare it to McDonald’s hiring for $15-$17 an hour? I can go flip burgers for almost the same pay but with less stress,” Norisada said. “And it’s not like CNA work, where anything you do wrong can impact a patient forever.”
As workers leave hospitals, the burden falls on those who stay, and hospitals have had to bring in traveling nurses to fill the gaps. This is a temporary solution, however, as those contracts end and the traveling nurses move on.
“That’s the problem: we can’t keep putting Band-Aids on gunshot wounds, and we’re seeing that now,” Allen said.
Survey results from Washington’s three health care unions that represent nurses, nursing assistants, techs and other hospital support staff show that the past two years have taken a toll on their members.
For the more than 1,000 union members surveyed, 49% of them say they are likely to leave the health care profession in the next few years.
This would be devastating to the state’s health care system. An estimated 6,000 nursing positions are vacant in the state, according to a survey of hospitals statewide from the Washington State Hospital Association.
“Our members are burned out, and a lot of them are considering leaving, and even the ones that are there now are considering leaving the profession because they come to work and they are overworked,” said Jane Hopkins, executive vice president of SEIU Healthcare 1199 NW.
Calling for legislative action
A coalition of health care unions, SEIU Healthcare 1199NW, the Washington State Nurses Association and UFCW 21, is calling on the Legislature to take action.
Health care workers are asking for safe staffing standards or patient-staff ratios to be written into state law, as well as existing rest and break laws to be enforced. Additionally, the unions support the investment in workforce development.
“There’s a certain amount of patients, with minimum staffing standards, that we should have to provide the best care possible; that’s been ignored,” Hopkins, with SEIU Healthcare 1199NW, said.
Hospitals now have staffing committees to determine the ratio of health care workers to patients on each unit. Union members and leaders said that the ratios agreed to are not being enforced.
The result, union leaders say, is that more health care workers will leave the field, according to their survey.
Hopkins said, “Forty-nine percent are saying they are thinking about leaving the profession — that would be catastrophic. … Most of those people said they are doing that because of not having safe staffing levels, that’s scary.”
Codifying an actual staffing standard or ratio in state law has been done in just one other state. California adopted staffing ratios into state law in 1999, although that was no easy fight, said Zenei Triunfo-Cortez, president of the California Nurses Association.
In 2004, when California hospitals had to implement the new ratios, based on the union’s language, Triunfo-Cortez said many nurses came back to work.
“There was an uptick in nurses coming back to the workforce,” Triunfo-Cortez said. “The reason why they left was because of the dire staffing situation in our hospitals, but when they realized ratios were in law that every hospital needs to follow, they all came out of the woodwork and started working again.”
National Nurses United has also pushed for staffing standards to be implemented at the federal level as well.
In California, hospitals opposed the staffing standards legislation at the time, and this tension will likely be mirrored in Washington.
The Washington State Hospital Association does not think staffing standards are the answer.
“We don’t think ratios, like in California, work,” said Beth Zborowski, senior vice president of communications at the association.
She said the association has concerns about a rigid standard in state law but won’t know specifics until there is legislation filed.
The hospital association is supportive of the workforce development investment that unions are also asking for, however.
Lots of solutions to the state’s health care worker shortage will be discussed in the upcoming session. Some of those proposals are more agreeable across hospitals, unions and the governor’s office.
Gov. Jay Inslee, who has proposed several solutions to the health care workforce shortage in his budget, said he is open to the idea of safe staffing standards, acknowledging the stress nurses and health care workers have been under the past two years.
“I think their concerns are legitimate, but I will add that you have to have the financial capability to staff (hospitals and facilities), that’s what I’m trying to solve,” Inslee told The Spokesman-Review.
Allen, at Sacred Heart Medical Center, started at the labor and delivery unit. Short staffing there meant she could have two or three laboring patients, despite national guidelines recommending nurses have one to two patients in labor.
When staffing is short, Allen might not get to help a person in labor as long as she’d like, because she has two other patients going through labor at the same time.
“It’s hard to feel pulled and feel like we can’t give our all to our patients,” she said.
For Allen, safe staffing and allowing team members to take breaks is a part of attracting new nurses to the profession.
“We need actual breaks,” Allen said, “and we need safe staffing ratios so when we come to work we feel that we can safely care for our patients, go home, get rest and come back.”