Thanks to incred­ible engage­ment and partic­i­pa­tion by WSNA members, we had some big wins this session. We appre­ciate everyone’s commit­ment to advocating for nurses and patient safety in Olympia this year.

The legis­la­ture adjourned Sine Die April 23, the last day of the 2017 regular session. As expected, the legis­la­ture adjourned without passing a 2017 – 19 budget. The governor called the legis­la­ture back into two special sessions before a final state operating budget was passed on June 30, narrowly averting a state govern­ment shutdown.

WSNA achieved some major policy wins during the 2017 state legisla­tive session, and made good progress on a number of issues and priority budget items — all thanks to the very active partic­i­pa­tion of so many WSNA members.


Major policy wins #

Nurse staffing — PASSED #

Staffing continues to be WSNA’s number one priority, and we are pleased that with the help of WSNA members and the WSNA Legisla­tive and Health Policy Council, this year’s staffing bill, HB 1714, was signed into law by Governor Inslee May 8.

This new law creates greater trans­parency and account­ability for nurse staffing plans and hospital nurse staffing commit­tees, and it repre­sents a real step forward in our ongoing work to hold hospi­tals account­able for staffing so that nurses can deliver safe, high quality care to their patients.

HB 1714 was sponsored and champi­oned by Repre­sen­ta­tive Eileen Cody, RN and received outstanding support from Senator Ann Rivers as it made its way through the Senate. The final bill was the result of many hours of negoti­a­tion with hospi­tals and other nursing unions. WSNA extends special thanks to WSNA member Danielle O’Toole, BSN, RN and WSNA Legisla­tive & Health Policy Council member Justin Gill, BSN, RN for their testi­mony in support of HB 1714.

The new law increases the trans­parency of nurse staffing plans in hospi­tals around the state by amending the current staffing law to:

  • Require hospi­tals to accept the staffing committee’s staffing plan or to prepare an alter­na­tive annual staffing plan that will be adopted by the hospital.
  • Require hospi­tals to submit the adopted staffing plan and subse­quent changes to the staffing plan to the Washington State Depart­ment of Health begin­ning Jan. 1, 2019.
  • Require hospi­tals to imple­ment the staffing plan and assign nursing personnel to each patient care unit in accor­dance with the plan begin­ning Jan. 1, 2019.
  • Allow a nurse to report to, and file a complaint with, the staffing committee any time the nurse personnel assign­ment is not in accor­dance with the adopted staffing plan.
  • Allow nurses who may disagree with the shift-to-shift adjust­ments in staffing levels to submit a complaint to the staffing committee.
  • Require staffing commit­tees to develop a process to examine and respond to submitted complaints, and to deter­mine if a complaint is resolved or dismissed based on unsub­stan­ti­ated data.
  • Require the Washington State Depart­ment of Health to inves­ti­gate complaints with documented evidence for failure to:
    • Form or estab­lish a staffing committee.
    • Conduct a semian­nual review of a nurse staffing plan.
    • Submit a nurse staffing plan on an annual basis and any updates.
    • Follow the nursing staff personnel assign­ments as adopted by the hospital based on the complaints compiled by the staffing committee that include aggre­gate data that show a contin­uing pattern of unresolved viola­tions for a minimum 60-day contin­uous period. Excep­tions include unfore­see­able emergent circum­stances and documented reason­able efforts by the hospital to obtain staffing to meet required assignments.
  • Require hospi­tals to submit a correc­tive action plan within 45 days if the Washington State Depart­ment of Health (DOH) finds a viola­tion — and, if the hospital fails to submit a correc­tive action plan or doesn’t follow its correc­tive action plan, DOH may impose a civil penalty of $100 per day until the hospital submits a correc­tive action plan, begins to follow a correc­tive action plan, or takes other action agreed to by DOH.
  • Require the Washington State Depart­ment of Health to maintain public inspec­tion records of any civil penal­ties, admin­is­tra­tive actions, or license suspen­sions or revoca­tions imposed on hospitals.
  • Require the Washington State Depart­ment of Health to submit a report to the legis­la­ture by Dec. 31, 2020, on the number of complaints submitted and inves­ti­gated, associ­ated costs to DOH, and any recom­mended changes to statute. Requires a stake­holder group including WSNA to review the report before it is submitted to the legislature.

This act expires June 1, 2023.

WSNA is already busy working to collab­o­rate with our members and other stake­holders to ensure a successful enact­ment of the new law. We will be rolling out a full imple­men­ta­tion plan, including templates, best practices and education/​training for our nurses and members serving on existing staffing committees.

School nurse supervision — PASSED #

On April 20, HB 1346, the School Nurse Super­vi­sion bill, was signed into law by Governor Inslee after passing the House and Senate with strong bipar­tisan support. The long-awaited bill clari­fies the authority of a school nurse to address clinical needs of students, including summoning emergency medical assis­tance and the admin­is­tra­tion of medica­tions; it also prohibits a non-nurse from super­vising, directing or evalu­ating nursing activities.

It will become part of the Washington Common School Law (RCW 28A.210) and recog­nizes that nurses are already account­able to the state’s Nurse Practice Act (RCW 18.79 & WAC 246 – 840-700). The bill, promoted for many years by school nurse Theresa Hutchinson, was successful this year thanks to the work of Hutchison, the School Nurse Organi­za­tion of Washington, and the Washington State Nurses Associ­a­tion. The House bill was sponsored by Repre­sen­ta­tive Larry Springer, and its Senate companion bill was sponsored by Senator Hans Zeiger. Thank you to SNOW member Lynn Nelson, RN, MSN, NCSN for her testi­mony on this issue.

The National Associ­a­tion of School Nurses defines school nursing as a special­ized practice that protects and promotes student health, facil­i­tates optimal [student] devel­op­ment, and advances academic success.” School nurses bridge the gaps between health and educa­tion and between individual and popula­tion health care, addressing the chronic health needs of individual students as well as the preven­tion and health promo­tion activ­i­ties of public health. Washington’s school nurses are regis­tered nurses who practice in the 295 public school districts and serve more than one million students ranging from age three to 21 and whose health needs range from wellness care to the full spectrum of chronic pediatric health condi­tions. Healthy children learn better; educated children grow up to raise healthier families. School nurses work in both sectors to support the well-being of the children of our state. Many school districts are currently hiring for the 2017 – 18 school year. For more infor­ma­tion about school nursing, contact your local school district or the School Nurse Organi­za­tion of Washington.

— Katie Johnson, DNP, RN-BC, NCSN, FNASN


Budget priorities #

While the legis­la­ture had much work to do in order to negotiate a final 2017 – 19 budget, the chart below shows where WSNA’s budget prior­i­ties landed during the regular session. Budget negoti­a­tions continued in Olympia as this issue of The Washington Nurse went to print. Go to wsna​.org for the latest updates. The legis­la­ture again took us up to the brink of a state govern­ment shutdown before passing a final 2017 – 19 biennial budget on June 30. The final budget made strong invest­ments in mental health, gave some criti­cally needed new funding to public health, funded the state employee contracts, and maintained the Health Profes­sion Loan Repay­ment Program at the same level as the previous biennium.

WSNA priorityBudget amountDescrip­tion

Public health funding

$12 million

$10 million to local public health departments/​districts

$2 million to the Washington State Depart­ment of Health

Funding is to address founda­tional public health services in the areas of commu­ni­cable disease and chronic disease and injury prevention

State employee contracts

$618 million

Funding for collec­tive bargaining agreements

DOH Fee-setting Process Study

$56,000

Funding for the State Auditor to conduct a study of the Washington State Depart­ment of Health’s fee-setting process for all health professions

HB 1714 – Nurse Staffing Bill

$39,000

Funding for the inves­ti­ga­tion of complaints for viola­tions of the nurse staffing plan requirements

Thank you to Lynnette Vehrs, MN, RN, chair of WSNA’s Legisla­tive & Health Policy Council, and Katie Johnson DNP, RN-BC, NCSN, FNASN with School Nurse Organi­za­tion of Washington (SNOW) for their testi­mony in support of WSNA’s budget priorities.


Policy priorities #

Bills marked Special Session Bill” were still under consid­er­a­tion during the second special legisla­tive session, which began May 23. Look for updates at wsna​.org and in the fall 2017 issue of The Washington Nurse.

Balanced billing — DEAD #

Much negoti­a­tion and stake­holder work took place this session on the balanced billing issue. HB 2114 aimed to protect patients and their families from surprise bills” when an out-of-network provider delivers health care services at an in-network hospital. WSNA expects to partic­i­pate in interim work on this issue.

Rest breaks — DEAD #

Rest breaks remains a top priority for WSNA, and this year the rest breaks bill moved further through the legisla­tive process than it has before. HB 1715 passed the House 55 – 42, and had a lively hearing in the Senate Commerce, Labor & Sports Committee. The bill and hearing both received exten­sive coverage in The Seattle Times. Thank you to WSNA member Danielle O’Toole, BSN, RN for her testi­mony in support of the rest breaks bill, and to WSNA Incoming Execu­tive Director Sally Watkins, PhD, MS, RN, who also testi­fied on this bill.

Secure medicine return — DEAD #

While a strong coali­tion of partners worked hard on the secure medicine return bill, HB 1047, this year, it ultimately was not brought to the House floor for a vote. A number of local boards of health have passed local legis­la­tion creating secure medicine return programs — King County’s being the first in Washington state to be passed and imple­mented. Thank you to WSNA member Jeremy King, BSN, RN for submit­ting written testi­mony on this bill.

Prescription monitoring program — PASSED #

HB 1427 addresses our state’s opioid epidemic. It requires disci­plining author­i­ties, including the Nursing Care Quality Assur­ance Commis­sion, to adopt rules estab­lishing require­ments for prescribing opioid drugs by Jan. 1, 2019. It also expands access to data in the state’s Prescrip­tion Monitoring Program, allowing health care facil­i­ties to receive infor­ma­tion on provider prescribing. The bill also makes it easier for opioid treat­ment facil­i­ties to be located in local commu­ni­ties. This bill was signed into law by Governor Inslee May 16.


Other bills of interest #

Foundational public health services — DEAD
#

HB 1432 defined core public health services and put into statute the Founda­tional Public Health Services frame­work — this bill also set in statute a struc­ture for shared services that would formalize smaller health depart­ments contracting of some services (such as epidemi­ology) from larger health depart­ments, making the system more effec­tive and efficient. The bill passed the House 86 – 12, and was passed out of the Senate Health Care Committee with a do pass” recom­men­da­tion, but it was never voted out of Senate Ways & Means. Thanks to WSNA members who sent nearly 1,000 postcards on public health funding to legis­la­tors this session!

Paid family leave — PASSED #

A major victory of the third special session was the passage of the paid family leave bill. SB 5975 was signed into law by the Governor on July 5. This bill creates a paid family and medical leave insur­ance program that is funded through premiums paid by employers and employees. Twelve weeks of paid family leave benefits are provided to employees after the birth or place­ment of a child under age 18 or when a family member has a serious health condi­tion or military exigency. Thank you to WSNA member Kaila Tang, RN, for testi­fying in support of paid family leave!


Student loan transparency and accountability #

A number of student loan trans­parency and account­ability bills were intro­duced this session, and many did gain traction. While most of these bills did not pass the legis­la­ture this session, SB 5022 was signed into law by the governor.

SB 5022 — PASSED #

SB 5022, the Washington Student Loan Trans­parency Act, was request legis­la­tion from Washington’s Attorney General. It was signed into law by the governor April 27. This bill says that, subject to appro­pri­a­tions, student borrowers are entitled to receive notifi­ca­tion about their loans from their post-secondary insti­tu­tion each time a new finan­cial aid package is certi­fied that includes student loans — this means that students will receive infor­ma­tion on the total amount of educa­tional loans, the range of payoff amounts including principal and interest, and additional details. This will begin July 1, 2018. Addition­ally, annual compli­ance reports to the legis­la­ture are required in 2019 – 2025.

HB 1169 — DEAD #

HB 1169, included provi­sions to estab­lish a student loan debt hotline/​website, and required insti­tu­tions touching the student loan process to notify students of these resources; it repealed provi­sions allowing suspen­sion of a profes­sional license due to student loan debt (including for nurses); and other consumer protec­tions. This bill passed the House 76 – 22, and received a do pass” recom­men­da­tion from the Senate Higher Educa­tion Committee, but it was never voted out of Senate Ways & Means.

HB1440 — DEAD #

HB 1440, request legis­la­tion from Washington’s Attorney General, created the Student Educa­tion Loan Ombuds to provide assis­tance to student educa­tion loan borrowers who file complaints. It also required educa­tion loan services to obtain a license from the state Depart­ment of Finan­cial Insti­tu­tions in order to operate in Washington state, and put in place a regula­tory struc­ture. This bill passed the House 71 – 27, but did not receive a hearing in the Senate.

Volk bill — DEAD / STUDY APPROACH #

On Dec. 22, 2016, the Washington Supreme Court issued a 6 – 3 decision in Volk v. DeMeer­leer that will have profound and detri­mental effects on health care providers and patients. The decision is a troubling depar­ture from the standard for duty to warn” previ­ously estab­lished in Washington and nation­ally. The Court held that, in the outpa­tient context, the duty of health care providers to warn poten­tial victims of violence extends to all individ­uals who may foresee­ably” be endan­gered by a patient who has made a threat, even if no specific target was identi­fied. This leaves providers with unprece­dented respon­si­bility to inter­pret who to warn.

SB 5800 was intro­duced in the Senate as a fix” to Volk. It was voted out of the Senate 33 – 16, but died in the House Judiciary Committee. When this bill died, a new study approach was created, and included organi­za­tions that would be part of a study group which would provide a report to the legis­la­ture by Dec. 1, 2017. The Univer­sity of Washington School of Law received funding in the state budget to conduct this study. WSNA and AAPPN look forward to monitoring the study process.