WHCA Supports Continuing 24/7 RN Staffing Exception Process

The Washington Health Care Association (WHCA), together with its partner associations, is recommending that Washington continue the exception process for the 24-hour, seven-day-a-week registered nurse staffing requirement that applies to large, nonessential community nursing home providers.

WHCA participated in the stakeholder work group convened under RCW 74.42.360 to review the exception process.

The exception process provides temporary, targeted flexibility for nursing homes that cannot maintain continuous RN coverage despite documented good-faith recruitment and retention efforts. During an approved exception period, providers must continue meeting the federal requirement for 16 hours of RN coverage each day, with a licensed practical nurse covering the remaining eight hours.

Statewide RN Shortage Remains the Root Cause

Nursing homes compete for RNs with hospitals and other health care employers while operating under reimbursement constraints that limit their ability to offer comparable wages.

The statewide mean hourly wage for RNs working in nursing homes is approximately $6 to $7 lower than the mean for RNs across other health care settings. In some metropolitan areas, the difference exceeds $7 per hour. This persistent gap puts nursing homes at a competitive disadvantage when recruiting from an already limited labor pool.

Washington State Employment Security Department projections also identify a shortage of qualified RN labor relative to demand in every workforce development area in the state. The largest gaps are concentrated in the Seattle-King County, Tacoma-Pierce, Snohomish and Spokane areas.

These workforce conditions demonstrate that the fundamental circumstances that led the Legislature to establish the exception process remain in place. Participating stakeholders on the work group agreed that the process should continue.

WHCA’s Recommendations

WHCA and its partner associations recommend that the Department’s report to the Legislature:

• Confirm the findings: Citation and ombuds data show no correlation between exception status and adverse enforcement outcomes.
• Recognize the workforce shortage: Washington continues to face an RN shortage, with nursing homes disproportionately affected by wage competition and Medicaid reimbursement constraints.
• Continue the exception process: The Legislature should preserve the existing process without modification.

WHCA and fellow stakeholders unanimously support continuing the exception process. Available citation and ombuds data show no link between exceptions and poorer compliance outcomes, while statewide RN shortages and nursing homes’ wage disadvantage continue to make round-the-clock coverage difficult.

While DSHS is expected to submit a report on the issue to the Legislature by December 31, 2026. WHCA’s advocacy on Washington’s 24/7 RN staffing exception process appears to have prompted DSHS to reconsider its work to date, and as a result, the report may be delayed. We will keep you updated about the status of this work. In the meantime, WHCA will continue to advocate for the temporary exception process without modification, protecting access to care – especially in rural and underserved communities.