CERTIFICATION OF ENROLLMENT
ENGROSSED SECOND SUBSTITUTE SENATE BILL 5236
Chapter 114, Laws of 2023
68th Legislature
2023 Regular Session
HOSPITAL STAFFING—VARIOUS PROVISIONS
EFFECTIVE DATE: July 1, 2024—Except for sections 1, 3, and 15, which
take effect July 23, 2023; and section 16, which takes effect June
1, 2023.
Passed by the Senate March 6, 2023 CERTIFICATE
Yeas 35 Nays 13
I, Sarah Bannister, Secretary of
the Senate of the State of
DENNY HECK Washington, do hereby certify that
President of the Senate the attached is ENGROSSED SECOND
SUBSTITUTE SENATE BILL 5236 as
passed by the Senate and the House
of Representatives on the dates
Passed by the House April 6, 2023 hereon set forth.
Yeas 92 Nays 6
SARAH BANNISTER
LAURIE JINKINS
Secretary
Speaker of the House of
Representatives
Approved April 20, 2023 10:12 AM FILED
April 21, 2023
Secretary of State
JAY INSLEE State of Washington
Governor of the State of Washington
 ENGROSSED SECOND SUBSTITUTE SENATE BILL 5236
Passed Legislature - 2023 Regular Session
State of Washington 68th Legislature 2023 Regular Session
By Senate Ways & Means (originally sponsored by Senators Robinson,
Keiser, Conway, Frame, Hunt, Kauffman, Lovelett, Nguyen, Nobles,
Pedersen, Shewmake, Stanford, Trudeau, Valdez, and C. Wilson)
READ FIRST TIME 02/24/23.
1 AN ACT Relating to improving workplace standards for certain
2 hospital staff by expanding staffing committees to include additional
3 nursing staff, modifying staffing committee requirements, and
4 clarifying standards and enforcement regarding mandatory overtime and
5 uninterrupted meal and rest breaks; amending RCW 70.41.410,
6 70.41.420, 70.41.425, 70.41.130, 49.12.480, 49.28.140, and 49.28.150;
7 adding a new section to chapter 43.70 RCW; adding a new section to
8 chapter 70.41 RCW; adding new sections to chapter 49.12 RCW; creating
9 a new section; repealing 2017 c 249 s 4 (uncodified); prescribing
10 penalties; providing effective dates; providing an expiration date;
11 and declaring an emergency.
12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
13 NEW SECTION. Sec. 1. A new section is added to chapter 43.70
14 RCW to read as follows:
15 (1) The department, in consultation with the department of labor
16 and industries, must establish an advisory committee on hospital
17 staffing by September 1, 2023.
18 (2) Appointments to the advisory committee on hospital staffing
19 shall be jointly made by the secretary and the director of labor and
20 industries. Members of the committee must have expertise in hospital
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 1 staffing and working conditions and should reflect a diversity of
2 hospital settings.
3 (3) The advisory committee membership includes:
4 (a) Six members representing hospitals and hospital systems and
5 their alternates, selected from a list of nominees submitted by the
6 Washington state hospital association; and
7 (b) Six members representing frontline hospital patient care
8 staff and their alternates, selected from a list of nominees
9 submitted by collective bargaining representatives of frontline
10 hospital nursing staff.
11 (4) Any list submitted to the departments for the initial
12 appointment under this section must be provided by August 4, 2023.
13 (5) If any member of the advisory committee is unable to continue
14 to serve on the committee the secretary and the director of labor and
15 industries shall select a new member based on the recommendations of
16 either the hospital association for members appointed under
17 subsection (3)(a) of this section or the collective bargaining
18 representative for members appointed under subsection (3)(b) of this
19 section.
20 (6) The advisory committee on hospital staffing shall meet at
21 least once per month until the hospital staffing plan uniform form is
22 developed.
23 (7) The advisory committee on hospital staffing shall advise the
24 department on its development of the uniform hospital staffing plan
25 form.
26 (8) The department and the department of labor and industries
27 shall provide any necessary documentation to the advisory committee
28 on hospital staffing in advance of the meetings to discuss technical
29 assistance so that the advisory committee may consider areas of
30 needed information.
31 (9) The advisory committee on hospital staffing must consider
32 innovative hospital staffing and care delivery models, such as those
33 that integrate on-site team-based care delivery, use of patient
34 monitoring equipment and technology, and virtual or remote care
35 delivery. This includes identifying and analyzing innovative hospital
36 staffing and care delivery models including those explored by
37 national organizations and evaluating feasibility of broad-based
38 implementation of identified models. The advisory committee may
39 consider disseminating this information and analysis.
p. 2 E2SSB 5236.SL
 1 (10) The department and the department of labor and industries
2 must provide the advisory committee on hospital staffing with data on
3 a quarterly basis related to compliance with this chapter, complaint
4 filing and disposition trends, and notification of corrective plans
5 of action plans and adherence to those plans.
6 (11) By December 1, 2023, the Washington state hospital
7 association shall survey hospitals in Washington state and report to
8 the advisory committee on hospital staffing on Washington hospitals'
9 existing use of innovative hospital staffing and care delivery models
10 including, but not limited to, integration of patient monitoring
11 equipment, remote patient monitoring, team-based care models,
12 apprenticeship and career ladder programs, and virtual or remote care
13 delivery models, and any challenges with implementing the models.
14 (12) By December 1, 2024, the advisory committee on hospital
15 staffing must review the report prepared by the Washington state
16 institute for public policy as required by section 15 of this act.
17 (13) After January 1, 2027, when the forms are developed and
18 effective, the advisory committee on hospital staffing may meet if it
19 is determined by the department of health and committee members that
20 such meetings are necessary.
21 (14) No earlier than July 1, 2029, the advisory committee on
22 hospital staffing must discuss the issues related to applicability of
23 RCW 70.41.420(7)(b) (i) and (ii) for hospitals listed under RCW
24 70.41.420(7)(b)(iv). This must include possible data collection
25 options, potential costs, sources of funding, and implementation
26 timeline.
27 (15) The advisory committee on hospital staffing must advise the
28 department of labor and industries on the department's development by
29 March 1, 2024, of a uniform form for reporting under RCW
30 49.12.480(2).
31 (16) This section expires July 1, 2030.
32 Sec. 2. RCW 70.41.410 and 2008 c 47 s 2 are each amended to read
33 as follows:
34 The definitions in this section apply throughout this section
35 ((and)), RCW 70.41.420, and 70.41.425 unless the context clearly
36 requires otherwise.
37 (1) "Hospital" has the same meaning as defined in RCW 70.41.020,
38 and also includes state hospitals as defined in RCW 72.23.010.
p. 3 E2SSB 5236.SL
 1 (2) "Hospital staffing committee" means the committee established
2 by a hospital under RCW 70.41.420.
3 (3) "Intensity" means the level of patient need for nursing care,
4 as determined by the nursing assessment.
5 (((3))) (4) "Nursing assistant-certified" means an individual
6 certified under chapter 18.88A RCW who provides direct care to
7 patients.
8 (5) "Nursing ((personnel)) staff" means registered nurses,
9 licensed practical nurses, nursing assistants-certified, and
10 unlicensed assistive nursing personnel providing direct patient care.
11 (((4) "Nurse staffing committee" means the committee established
12 by a hospital under RCW 70.41.420.
13 (5))) (6) "Patient care staff" means a person who is providing
14 direct care or supportive services to patients but who is not:
15 (a) Nursing staff as defined in this section;
16 (b) A physician licensed under chapter 18.71 or 18.57 RCW;
17 (c) A physician's assistant licensed under chapter 18.71A RCW; or
18 (d) An advanced registered nurse practitioner licensed under RCW
19 18.79.250, unless working as a direct care registered nurse.
20 (7) "Patient care unit" means any unit or area of the hospital
21 that provides patient care by registered nurses.
22 (((6))) (8) "Reasonable efforts" means that the employer exhausts
23 and documents all of the following but is unable to obtain staffing
24 coverage:
25 (a) Seeks individuals to consent to work additional time from all
26 available qualified staff who are working;
27 (b) Contacts qualified employees who have made themselves
28 available to work additional time;
29 (c) Seeks the use of per diem staff; and
30 (d) When practical, seeks personnel from a contracted temporary
31 agency when such staffing is permitted by law or an applicable
32 collective bargaining agreement, and when the employer regularly uses
33 a contracted temporary agency.
34 (9) "Registered nurse" means an individual licensed as a nurse
35 under chapter 18.79 RCW who provides direct care to patients.
36 (10) "Skill mix" means the experience of, and number and relative
37 percentages of ((registered nurses, licensed practical nurses, and
38 unlicensed assistive personnel among the total number of nursing
39 personnel)), nursing and patient care staff.
40 (11) "Unforeseeable emergent circumstance" means:
p. 4 E2SSB 5236.SL
1 (a) Any unforeseen declared national, state, or municipal
2 emergency;
3 (b) When a hospital disaster plan is activated;
4 (c) Any unforeseen disaster or other catastrophic event that
5 substantially affects or increases the need for health care services;
6 or
7 (d) When a hospital is diverting patients to another hospital or
8 hospitals for treatment.
9 Sec. 3. RCW 70.41.420 and 2017 c 249 s 2 are each amended to
10 read as follows:
11 (1) By ((September)) January 1, ((2008)) 2024, each hospital
12 shall establish a ((nurse)) hospital staffing committee, either by
13 creating a new committee or assigning the functions of ((a)) the
14 hospital staffing committee to an existing nurse staffing committee
15 ((to an existing committee)).
16 (2) Hospital staffing committees must be comprised of:
17 (a) At least ((one-half)) 50 percent of the voting members of the
18 ((nurse)) hospital staffing committee shall be ((registered nurses))
19 nursing staff, who are nonsupervisory and nonmanagerial, currently
20 providing direct patient care ((and up to one-half of the members
21 shall be determined by the hospital administration)). The selection
22 of the ((registered nurses providing direct patient care)) nursing
23 staff shall be according to the collective bargaining ((agreement))
24 representative or representatives if there is one ((in effect)) or
25 more at the hospital. If there is no ((applicable)) collective
26 bargaining ((agreement)) representative, the members of the ((nurse))
27 hospital staffing committee who are ((registered nurses)) nursing
28 staff providing direct patient care shall be selected by their peers.
29 (((2))) (b) 50 percent of the members of the hospital staffing
30 committee shall be determined by the hospital administration and
31 shall include but not be limited to the chief financial officer, the
32 chief nursing officers, and patient care unit directors or managers
33 or their designees.
34 (3) Participation in the ((nurse)) hospital staffing committee by
35 a hospital employee shall be on scheduled work time and compensated
36 at the appropriate rate of pay. ((Nurse)) Hospital staffing committee
37 members shall be relieved of all other work duties during meetings of
38 the committee. Additional staffing relief must be provided if
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 1 necessary to ensure committee members are able to attend hospital
2 staffing committee meetings.
3 (((3))) (4) Primary responsibilities of the ((nurse)) hospital
4 staffing committee shall include:
5 (a) Development and oversight of an annual patient care unit and
6 shift-based ((nurse)) hospital staffing plan, based on the needs of
7 patients, to be used as the primary component of the staffing budget.
8 The hospital staffing committee shall use a uniform format or form,
9 created by the department in consultation with the advisory committee
10 established in section 1 of this act and the department of labor and
11 industries, for complying with the requirement to submit the annual
12 staffing plan. The uniform format or form must allow for variations
13 in service offerings, facility design, and other differences between
14 hospitals, but must allow patients and the public to clearly
15 understand and compare staffing plans. Hospitals may include a
16 description of additional resources available to support unit-level
17 patient care and a description of the hospital, including the size
18 and type of facility. Factors to be considered in the development of
19 the plan should include, but are not limited to:
20 (i) Census, including total numbers of patients on the unit on
21 each shift and activity such as patient discharges, admissions, and
22 transfers;
23 (ii) ((Level of intensity of all patients and nature of the))
24 Patient acuity level, intensity of care needs, and the type of care
25 to be delivered on each shift;
26 (iii) Skill mix;
27 (iv) Level of experience and specialty certification or training
28 of nursing ((personnel)) and patient care staff providing care;
29 (v) The need for specialized or intensive equipment;
30 (vi) The architecture and geography of the patient care unit,
31 including but not limited to placement of patient rooms, treatment
32 areas, nursing stations, medication preparation areas, and equipment;
33 (vii) Staffing guidelines adopted or published by national
34 nursing professional associations, specialty nursing organizations,
35 and other health professional organizations;
36 (viii) Availability of other personnel and patient care staff
37 supporting nursing services on the unit; and
38 (ix) ((Strategies to enable registered nurses to take meal and
39 rest breaks as required by law or)) Compliance with the terms of an
40 applicable collective bargaining agreement, if any, ((between the
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 1 hospital and a representative of the nursing staff)) and relevant
2 state and federal laws and rules, including those regarding meal and
3 rest breaks and use of overtime and on-call shifts;
4 (b) Semiannual review of the staffing plan against patient need
5 and known evidence-based staffing information, including the nursing
6 sensitive quality indicators collected by the hospital; and
7 (c) Review, assessment, and response to staffing variations or
8 ((concerns)) complaints presented to the committee.
9 (((4))) (5) In addition to the factors listed in subsection
10 (((3))) (4)(a) of this section, hospital finances and resources must
11 be taken into account in the development of the ((nurse)) hospital
12 staffing plan.
13 (((5) The staffing plan must not diminish other standards
14 contained in state or federal law and rules, or the terms of an
15 applicable collective bargaining agreement, if any, between the
16 hospital and a representative of the nursing staff.))
17 (6)(a) The committee ((will)) shall produce the hospital's annual
18 ((nurse)) hospital staffing plan.
19 ((If this staffing plan is not adopted by the hospital, the chief
20 executive officer shall provide a written explanation of the reasons
21 why the plan was not adopted to the committee. The chief executive
22 officer must then either: (a) Identify those elements of the proposed
23 plan being changed prior to adoption of the plan by the hospital or
24 (b) prepare an alternate annual staffing plan that must be adopted by
25 the hospital.))
26 (b) The committee shall propose by a 50 percent plus one vote a
27 draft of the hospital's annual staffing plan which must be delivered
28 to the hospital's chief executive officer or their designee by July
29 1, 2024, and annually thereafter.
30 (c) The chief executive officer or their designee must provide
31 written feedback to the hos