Hospital Staffing

Summary of revised law

In 2023, the legislature passed E2SSB 5236 (PDF) regarding hospital staffing, which amends chapters 70.41, 43.70, 49.12 and 49.28 RCW. The legislation has many requirements for the Department of Health (DOH) and the Department of Labor and Industries (L&I) that will be implemented over several years. Some of DOH’s key roles are to convene an advisory committee, create a hospital staffing form, create a compliance form and to receive these forms from acute care hospitals, and post them online.

DOH has an interpretive statement on RCW 70.41.420 (PDF), which describes the establishment, composition, and responsibilities of hospital staffing committees.

DOH and L&I are working together to investigate and enforce hospital staffing violations. DOH and L&I use different definitions for direct patient care and created a one-page document that outlines the differing definition of “direct patient care” (PDF) based on the context and statutory interpretation and implementation. The legislation also has requirements related to mandatory overtime and breaks. You may learn more about L&I’s policies on its Healthcare Labor Standards webpage and by subscribing to L&I’s GovDelivery distribution list to receive future updates.

Requirements for Hospitals

• January 1, 2024: hospitals were required to have their hospital staffing committees established. 
• July 1, 2024: hospitals submit their hospital staffing committee charter to the DOH. Charters can be emailed to DOH. 
• July 1, 2024: hospital staffing committees must deliver their proposed hospital staffing plan to the hospital's chief executive officer or their designee.
• October 1, 2024: hospitals that are not exempt from RCW 70.41.420(7)(b) adopt written policies and procedures for documenting when a patient care unit nursing staff assignment is out of compliance with the hospital staffing plan.
• January 1, 2025: hospitals submit their final hospital staffing plan to the DOH and then resubmit their plan annually or when updates have been made to the plan. Staffing plans can be emailed to DOH.
• July 1, 2025: hospitals begin implementing and following their hospital staffing plan.
• July 1, 2025: hospitals that are not exempt from RCW 70.41.420(7)(b) document and report to the DOH when the number of patients assigned to nursing staff is higher than allowed by the hospital staffing plan.
• July 1, 2025: hospitals post in a public area on each patient care unit, their hospital staffing plan and any corrective action plan.
• January 31, 2026: hospitals that are not exempt from RCW 70.41.420(7)(b) begin submitting semiannual compliance forms to the DOH. Semiannual reports are due on July 31 and January 31 each year and can be emailed to hospital DOH.

To sign up for ongoing updates regarding hospital staffing, subscribe for updates at the bottom of the page.

To learn more about hospital staffing see the Frequently Asked Questions webpage.
 

How to submit hospital staffing plans

Submit hospital staffing plans via email as a PDF.

Staffing plans must be completed on the hospital staffing uniform form in accordance with RCW 70.41.420 (4)(a).

If you’re having difficulty filling out the form or need technical assistance, you may email DOH for support.

Department guidance for submitting nurse staffing plans:

There are several documents to assist hospitals in filling out their staffing form.

• This is the form that hospitals must use for their hospital staffing plans (PDF).
• This spreadsheet must be used for the staffing matrices and unit information (Excel).
• This document has instructions for completing the hospital staffing form (PDF).
• This document has definitions for the hospital staffing form (PDF).
• This document provides examples for filling out the hospital staffing matrices (PDF).
• This template was created for hospitals that asked for an editable spreadsheet they could use to draft their staffing matrices (Excel), before filling out their final plan on the official hospital staffing form. This is not the official hospital staffing form and cannot be used to submit the final hospital staffing plan.  

Staffing plans developed for various hospital units should be compiled into a single comprehensive hospital staffing plan and converted into a single PDF file. Please no Word or Excel files – only a single PDF.

Once the hospital staffing plan has been submitted, you can check the Hospital Policies webpage in two weeks to confirm that the plan has been posted. Contact DOH by email if you have any questions.

How to submit monthly and semiannual non-compliance reports 

Submit all non-compliance reports via email. 

Beginning July 1, 2025, hospitals that are not exempt from RCW 70.41.420(7)(b) document and report to the department when the number of patients assigned to nursing staff is higher than allowed by the hospital staffing plan.

• Monthly non-compliance report form (PDF).

Beginning January 31, 2026, hospitals that are not exempt from RCW 70.41.420(7)(b) must submit semiannual compliance forms to the department. Semiannual reports are due on July 31 and January 31 each year.

• Semiannual compliance report form (PDF).

There are several documents to assist hospitals in filling out their staffing form.

• Guidance Document Hospital Staffing Compliance/ Non-Compliance Reporting (PDF)
• This document provides examples for filling out the Hospital Staffing Compliance/ Non-Compliance Form (PDF).

If you’re having difficulty filling out the form(s) or need technical assistance, you may email DOH for support. 

How to submit a hospital staffing complaint

Under RCW 70.41.425 the Department of Health will begin investigating these types of hospital staffing complaints on the dates listed.

• January 1, 2024: the hospital did not form or establish a staffing committee.
• July 1, 2024: the hospital did not submit a hospital staffing committee charter.
• January 1, 2025: the hospital did not submit an annual hospital staffing plan on DOH’s form or did not submit any updated plan it developed throughout the year.
• July 1, 2025: the hospital did not implement their hospital staffing plan.
• July 1, 2025: a hospital that is not exempt from RCW 70.41.420(7)(b) did not document and report to the DOH when the number of patients assigned to nursing staff is higher than allowed by the hospital staffing plan.
• January 31, 2026: a hospital that is not exempt from RCW 70.41.420(7)(b) did not submit semiannual compliance forms to the DOH.

When submitting a complaint, make sure to include documented evidence that supports your allegation. Complaints submitted without supporting evidence or data will be closed with the reason code of “insufficient information.” The complainant will be notified that the complaint has been closed and will have the option to submit follow-up data for reconsideration.

Hospital staffing complaints may be submitted by using the department's standard healthcare facilities complaint process.

Hospital Staffing Committee Charters

Submit hospital staffing committee charters by email as a PDF by July 1, 2024.

Charters should be formatted as a PDF and should meet the requirements of subsection 11 of RCW 70.41.420: Hospital staffing committee.

Department guidance for submitting hospital staffing committee charter:

There are two documents to assist hospitals in filling out their hospital staffing committee charter.

• This guidance document contains information for creating and submitting hospital staffing committee charters (PDF).
• This document is a hospital staffing committee charter template that hospitals may use and modify to fit their needs (Word).
• This document is a hospital staffing committee charter template that hospitals may use and modify to fit their needs (PDF).