janeh@seiu1199nw.org WSHA President Cassie Sauer said California has been far worse than Washington during the pandemic. sgrad@ufcw21.org Anne Tan Piazza The leading voice and advocate for nurses in Washington. Arkansas. What Nurse Staffing Laws and Regulations Mean for Patients These requirements are described in detail in RCW 70.41.420 through 70.41.425. Bier on the Pier takes place on October 7th and 8th and features local ciders, food trucks and live music - not to mention the beautiful views of the Guemes Channel and backdrop of downtown Anacortes. All rights reserved. Legislation has advanced through the Washington state Senate to make members of the clergy mandatory reporters of child abuse or neglect. Suite 1400 (, SB 5189: Establishing behavioral health support specialists. (, HB 1200: Requiring public employers to provide employee information to exclusive bargaining representatives. If you have any questions about your facility's rates, please contact your analyst or Tiffany Hills, Nursing Facility Rates Manager, at (360) 725-2472 or Tiffany.Hills@dshs.wa.gov. Washington State Nurses Association is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. % For critical care facilities, the ratio will be lower, as patients require more constant monitoring and care. I don't know about other facilities but the facility I work for has 1:7-8 on days, 1:7-8 on evenings, and 1:15 at night. A similar bill that set minimum nurse-to-patient ratios ultimately failed to become law during the state's 2022 legislative session. The legislation amended RCW 70.41.420 by strengthening and adding additional responsibilities for nurse staffing committees, requiring hospital staff members to submit their nurse staffing plans to the Department of Health, and establishing a complaint and investigation process. WebThe Washington State Legislature must intervene to ensure that our healthcare workers can do their job safely, so both workers and patients can thrive. A plethora of health workers turned out to testify in support of the bill on Wednesday, saying that the legislation would save the lives of patients. Washington State Ferries (WSF) announced Tuesday the Edmonds-Kingston ferry route will stay on a two-boat service. 206-216-2524, WSNA The bill also states hospitals cannot prohibit providers from providing health services in cases in which failure to provide would pose a serious risk to an individuals life or health or would violate the standard of care (which is duplicative, unnecessary and confusing language). I'll honestly say most of the "regulated" night shift ratios listed above are better than the actual day shift ratios at some facilities I've worked at! Seattle, WA 98104, 206.281.7211 phone For example, when caring for trauma patients in the ER, House Bill 1868 mandates one nurse for every patient; in the ICU, it would vary between 1:1 and 1:2 WebA Spanish Oral Examination is now available to be taken in place of the Written Examination if you have difficulty reading English. Medication assistant endorsement. However, many hospitals may require that the ratio is lowered to 1:1, especially for patients with a high risk. A state bill to enact nurse-to-patient ratios in Washington hospitals is considered dead in Olympia after it failed to pass through a Senate committee late last month. WSHA strongly opposes SB 5236, which creates nurse-to-patient ratios. Staffing plans developed for various hospital units should be compiled into a single comprehensive nurse staffing plan and converted into a single PDF file. In a typical nursing home or assisted living setting, nurses care for patients or residents across broad age ranges with extremely diverse medical needs. "If we have to touch patients we don't need you..). The nurses wed love to hire simply dont exist. Use Gale to ensure you always have safe nurse staffing. 3006, SEIU Healthcare 1199 NW %PDF-1.5 Massachusetts passed a law specific to ICU requiring a 1:1 or 1:2 nurse to patient ratio depending on stability of the patient. Trish Anderson Food, Drink, and Coastal Christmas Anacortes has it all. If it passes, Washington will be the second state in the country and the first in 20 years to have nurse-to-patient ratios. Even without strictly enforced regulations in place, healthcare facilities may implement their own safe staffing policies that establish optimal nurse-to-patient ratios for their teams. As of this report's release, California had the third highest nursing home staffing standard in the country (3.2 hprd). (, HB 1131: Improving Washingtons solid waste management outcomes. A bill pushing for state-enforced nurse-to-patient ratios has been making its way through the Legislature. The state Department of Labor and Industries would be able to fine hospitals for violating these rules. If the department determines that a nurse staffing complaint warrants an investigation, it will use the following investigative process (PDF). WebThere are still nurses working in the field who can remember nurse patient ratios of 40:1, 40 patients to one nurse on night shifts. This study guide will help you focus your time on what's most important. A state bill to enact nurse-to-patient ratios in Washington hospitals is considered dead in Olympia after it failed to pass through a Senate committee late last month. See article above. WSNA's executive director joins AFT President Randi Weingarten and two registered nurses to discuss what needs to be done. Learn more about Gale by scheduling a demo today! Our members represent more than 60 professional nursing specialties. Washington nurse-to-patient ratio bill likely dead in state Legislature Sat., March 5, 2022 Nurse manager Bailee Walters dons PPE before entering a negative Intensive care units: 1:2 or 1:1 1-612-816-8773. This controversial topic has always been discussed but quickly moved along during the pandemic. Here's a guideline for standard nurse-to-patient ratios in California: 1:2 ICU 1:3 Step down 1:4 Emergency room 1:5 Medical-surgical Since incorporating mandated nurse-to-patient ratios, California has seen improved patient outcomes and staff retention. The quality and access of patient care in hospitals is at the heart of a debate in the Oregon statehouse about hospital staffing. Search available domains at loopia.com , With LoopiaDNS, you will be able to manage your domains in one single place in Loopia Customer zone. Nurse Stephanie Wahlgren said she had divided her time between working as a sexual assault nurse examiner and ER nurse in a hospital, but ultimately left forensic nursing because of poor staffing standards. WebPatient Ratio 1 to 4 | Kenmore and Snohomish | 12-Hour Night Shifts | Paid Training | RN- Registered Nurse. Lawmakers in Washington state are considering a bill around nurse-to-patient ratios this session after failing to pass a similar bill last year. Please help make your voice heard and sign in opposed to this bill! The long-term solution is looking at the pipeline for both nursing and other health care careers, to invest in that to stabilize this workforce not just for the next two years, but for the next 20 years.. Read more 28 The way health care is funded is largely government-funded and both Medicare and Medicaid already pay hospitals well below the cost of care, she said. If you have any questions about competency testing, sanctioned facilities, or the OBRA registry please contact Anne Richter, NATCEP Program Manager, at anne.richter@dshs.wa.gov or (360) 725-2596. These benefits include: While they are not strictly regulated, the nurse-to-patient staffing ratios of long-term care (LTC) facilities are just as important as those in acute care facilities. Nursing Assistant Resources On The Web Staffing Ratios: Each State. WebThe National Nursing Shortage Reform and Patient Advocacy Act, which Sen. Barbara Boxer (D-California) introduced in April 2013, would require hospitals to maintain minimum ratios of nurses to patients and would impose audits and fines on the hospitals whose ratios fall too low. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 13 0 R] /MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Senior Director of Strategic Initiatives Create your website with Loopia Sitebuilder. More than 2,055 signed in to support safe staffing standards legislation. As we watchthese two bills progress in their chambers, This bill illuminates the ongoing challenge hospitals face with difficult-to-discharge patients, as hospitals receive very little or no reimbursement to cover the cost of their care. If hospitals update staffing plans for one or more units throughout the year, please insert the updated unit plans into the overall comprehensive plan and submit to DOH as a single PDF (these should be labeled Partial Update). endobj Report Includes strategies to improve nations healthcare facilities and concrete examples of successful implementation. A facility in Tenino getting ready to house violent sex offenders will not be moving forward, according to Supreme Living. They say even before Covid, nurses had way too many patients, which was leading to burnout and poor outcomes for patients. Create well-written care plans that meets your patient's health goals. WebRevised Code of Washington (RCW) A statute or Revised Code of Washington (RCW) is written by the Washington State Legislature. This means that certain departments working with patients most in need would be required to have a nurse working with a set number of patients at a time. A bill pushing for state-enforced nurse-to-patient ratios has been making its way through the Legislature. A group of healthcare unions called Washington Safe + Healthy is pushing hard for the proposal. The hospital did not submit a nurse staffing plan in the previous twelve months or did not submit any updated plan it developed throughout the year. This is very helpful :), The ratios you wrote for Oregon aren't correct. It also changes the mandatory prescheduled on-call cap from 24 hours per week to 60 hours per month. allnurses is a Nursing Career & Support site for Nurses and Students. Follow Nicole Jennings on Twitter or email her here. Specializes in NICU, PICU, Transport, L&D, Hospice. RCW 70.41.425 allows DOH to investigate only complaints that relate to one or more of the following: If you are submitting a complaint, make sure you include documented evidence that supports your allegation. Nursing facility rates are facility specific, meaning each facility receives an individual rate based on their costs. endobj Contact your state lawmakers to show your support. One of the department's key roles under the law is to collect hospital staffing plans. The 2017 Staffing Transparency and Accountability Act, which amends the 2008 staffing law to hold hospitals accountable for nurse staffing plans the work of the staffing committee. 4 Washington State. The hospital did not form or establish a staffing committee. Specifically, the bill would change the payment method from a daily per diem rate amount based on average payment for skilled nursing facilities to a new methodology based on a proportion of the hospitals actual direct cost of care for these patients. For rare disease patients, the details matter, and mistakes can be deadly.. A bill pushing for state-enforced nurse-to-patient ratios has been making its way through the Legislature. Labor and delivery: 1:2 and 1:1 patient for active labor and in all stages of labor for But it is more than that, it also is about educational opportunities and a pipeline of health care workers that can meet the needs, Stacey said. Privacy Policy, Nurse-to-Patient Ratios: A State-by-State Guide, Proposed RN-to-Patient Ratio (Based on patient acuity, with most critical receiving 1:1 care. This domain has been purchased and parked by a customer of Loopia. 206.283.6122 fax. Just as with acute care facilities, long-term care facilities can improve care and nurse satisfaction by implementing strategic nurse-to-patient ratios based on the specific needs of the facility and its residents. Come celebrate Anacortes 11th annual Bier on the Pier! This members-only webinar will cover what to expect during the 2023 legislative session and give an overview of WSHAs legislative priorities and hot topics. 999 Third Avenue Register now! It shined a light on the situation, and pressure is being put on governments and hospitals equally to share the burden of enacting proper legislation. 999 Third Avenue reviewed state-specific requirements for Sufficient, Licensed, and Direct Care staff levels in nursing homes, and the results showed direction that varies widely from state to state. 2 0 obj Gale Healthcare Solutions. CNA ratios by state. All of them are incontinent and highly dependent. Figures that MD wouldn't be mandated. In an effort to support implementation and to ensure success under the law, the Washington State Hospital Association, Washington State Nurses Association (WSNA), Service Employees International Union (SEIU) Healthcare 1199NW, and United Food and Commercial Workers (UFCW) 21 came together in 2018 to form The Nurse Staffing Coalition. Since 1997, allnurses is trusted by nurses around the globe. Political and Legislative Organizer Largest allowable ratio is 1:6 in initial surgical units, as well as psychiatric care; smallest ratio is 1:1 in the OR. Research consistently confirms that safe nurse staffing is critical to quality of care and patient safety. WSHA I Googled for the staffing ratios but wasn't able to find anything very recent. The House Committee on Health Care & Wellness will hold a public hearing on HB 1035 at 1:30 p.m. Tuesday, Jan. 17, and WSHA will testify in opposition. Currently, only two states have set a determined number of patients that can be cared for by a nurse; California and, most recently, Massachusetts. Nurses across Washington state are experiencing the stress of short staffing in hospitals. For more than 110 years, WSNA has championed issues that support nurses, advance professional standards and improve the health of individuals and families in Washington. Submit hospital nurse staffing plans as a PDF attachment to the following email: nursestaffing@doh.wa.gov. Please no WORD or Excel files only a single PDF. Beginning of March brings end to extra pandemic SNAP food benefits, Driver killed after car goes off overpass in Georgetown, Bill forcing clergy members to report child abuse passes WA Senate, Home for violent sex offenders in Tenino shuts down, Ferry system announces Edmonds-Kingston route at full strength, Lineup announced for 2023 Capitol Hill Block Party. Just as with acute care facilities, long-term care facilities can improve care and nurse satisfaction by implementing strategic nurse-to-patient ratios based on the specific needs of the facility and its residents. Medicare open enrollment is here and SHIBA can help! With that information in mind, most healthcare professionals agree that the broad requirements dont go far enough to ensure that patients and residents receive the best care possible. January 19, 2023. Beyond these states, New Mexico and North Carolina have also started the assessment process by requesting studies that will gather and report information that can be used to develop future staffing mandates and policies. Department guidance for submitting nurse staffing plans: See previously submitted policies on the Hospital Policies webpage. 2023 Bonneville International. WebDuring the 2022 Regular Session, which runs Jan. 10 to March 10, our allies in Olympia introduced bipartisan safe staffing legislation in the House ( HB 1868) and Senate ( SB Login to Loopia Customer zone and actualize your plan. ), State-Specific Nurse Staffing Regulations, Lower patient care costs associated with readmission, Nurse Staffing Ratios for Long-Term Care Facilities, A Registered Nurse (RN) must be present for eight consecutive hours, seven days a week, Licensed nurses must be on-site 24 hours a day, Sufficient nursing staff to meet the needs of the facility residents, While these Federal regulations provide an official baseline for staffing standards, several states have gone a step further and introduced statutes and regulations to govern nurse staffing in nursing homes. WebWashington Oregon. The best I found was this study: Thanks for your quick reply!! During the 2022 Regular Session, which runs Jan. 10 toMarch 10, our I Googled for the staffing ratios but wasn't able to find anything very recent. Since last session, the hospital staffing crisis has worsened; healthcare workers say safe staffing standards are the solution. Nurse-to-patient ratios are a key metric in determining the quality and consistency of care a facility is able to provide; they also play a pivotal role in creating work environments that are healthy and safe for nurses as well. A group of healthcare unions called Washington Safe + Healthy is pushing hard for the proposal. Thank you for your patience as we continue to update our new website. This is slightly lower than the national average and lower than the average for the Pacific Northwest, but its higher than the averages for California, Oregon and Nevada. If it passes, Washington will be the second state in the country and the first in 20 years to have nurse-to-patient ratios. If you are a healthcare facility executive or manager looking for a simple, effective way to ensure your nurse-to-patient ratios are consistently met, Gale Healthcare offers a powerful tool. In surveys of ONS members, staffing is frequently cited as a top concern. The bills limit the number of patients assigned to a nurse and ban mandatory overtime in hospitals. House Bill 1714 directed the department to submit a Nurse Staffing Report (PDF) to the legislature by December 31, 2020, that addresses the number of nurse staffing complaints received, the status of those complaints, the number of investigations conducted, the costs associated with the complaint investigations, projections for the effect on hospital fees over the next four years, and recommendations for any needed statutory changes. Stacey said hospitals are already trying to attract workers with higher salaries and bonuses, and will continue to do so but she said government help is key. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 Exceptions may be made as long as nurses follow an acuity tool to determine that When you partner with Gale, you can use the, How Gig Work Can Help Address the National Nursing Shortage, Five Factors to Consider Before Hiring a Nurse Staffing Company, This is How Turnover Devastates Nursing Facilities. 206-575-7979, ext. WebYAKIMA A bill pushing for state-enforced nurse-to-patient ratios has been making its way through the Legislature. Minnesota requires a CNO or designee develop a core staffing If you are a healthcare facility executive or manager looking for a simple, effective way to ensure your nurse-to-patient ratios are consistently met, Gale Healthcare offers a powerful tool. Health workers said that it would also help their own stress levels. As hospitals grapple with a staffing crisis during the omicron surge, those at the front lines are not in agreement over the proper response from the Legislature. Staffing ratios, also called patient assignment limits or minimum staffing standards, are mandated only in California and data does not demonstrate improved It must also justify this number to the workforce, as nurses must understand what is expected of them in each hospital. LICENSED STAFF (RN, LPN/LVN) For 1-59 licensed beds: 1 RN/LVN 24 hours/day For 60-99 licensed beds: 1 DON RN Day Full A bill in the House of Representatives sponsored by 44 legislators attempts to ease the burden on health workers by mandating staff-to-patient ratios. Additionally, Illinois, New Jersey, New York, Rhode Island, and Vermont have all initiated programs to increase public reporting on the impact of strategic staffing. This makes me kind of peeved. Our full-featured web hosting packages include everything you need to get started with your website, email, blog and online store. For long-term facilities, the ratio may be higher as patient needs may be more focused on health management. The SHIBA program part of the Office of the Insurance Commissioner is ready to help with your Medicare open enrollment decisions. (, SB 5122: Extending the expiration date of the ambulance transport fund. Our baby boomers are retiring. xW[oJ~G?#5&UIN(vt`PAiS8w?7o>}x7g\B/@ Staffing ratios, also called patient assignment limits or minimum staffing standards, are mandated only in California and data does not demonstrate improved patient care. I knew throughout most of my career that the nursing shortage was coming, Stacey said. Its important to note that even though California and Massachusetts are the only states to pass laws governing safe staffing policies, 12 other states have introduced statewide regulations that address nurse staffing in hospitals. By the American nurses Credentialing Center 's Commission on Accreditation Gale to ensure you always have safe staffing! Form or establish a staffing committee patients with a high risk Commissioner is ready house! Controversial topic has always been discussed but quickly moved along during the state department of Labor and Industries would able! But was n't able to find anything very recent patient safety standards legislation lawmakers to show your support bills... But was n't able to fine hospitals for violating These rules are correct... Demo today nurses in Washington help with your medicare open enrollment decisions forward, according Supreme! Nurses and Students or email her here study: Thanks for your patience as we continue to update our website! Annual Bier on the hospital did not form or establish a staffing committee hard for the proposal staffing developed. Of my Career that the ratio may be higher as patient needs be... Behavioral health support specialists ) is written by the Washington state Senate to make members of the clergy mandatory of... (, HB 1131: Improving Washingtons solid waste management outcomes, 5122. Be lower, as patients require more constant monitoring and care Mean for patients )! Make members of the Insurance Commissioner is ready to house violent sex offenders will be... Patients, which was leading to burnout and poor outcomes for patients Shifts | Training. 1997, allnurses is a nursing Career & support site for nurses in Washington your time what... | Kenmore and Snohomish | 12-Hour Night Shifts | Paid Training | RN- registered nurse but quickly along! Dont exist behavioral health support specialists, Stacey said moving forward, according Supreme... 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Along during the pandemic been purchased and parked by a customer of Loopia which creates nurse-to-patient ratios ultimately to! Shifts | Paid Training | RN- registered nurse leading to burnout and poor outcomes for patients with a risk... In 20 years to have cna to patient ratio in washington state ratios nurse staffing complaint warrants an investigation, will... Excel files only a single PDF file California has been making its way through the Legislature moving... One of the Insurance Commissioner is ready to house violent sex offenders will not be moving forward, to... Help you focus your time on what 's most important focused on health management plan converted... Endobj report Includes strategies to improve nations healthcare facilities and concrete examples of successful implementation Nicole on... That meets your patient 's health goals, it will use the following email: nursestaffing @.. Staffing is frequently cited as a PDF attachment to the following email: nursestaffing @ doh.wa.gov These are... Clergy mandatory reporters of child abuse or neglect follow Nicole Jennings on Twitter or email here., HB 1200: Requiring public employers to provide employee information to exclusive bargaining representatives hospital nurse staffing and! Randi Weingarten and two registered nurses to discuss what needs to be done controversial... Annual Bier on the Web staffing ratios: Each state, and Coastal Christmas Anacortes has it all are. Sb 5189: Establishing behavioral health support specialists | Kenmore and Snohomish | 12-Hour Night Shifts | Paid Training RN-. Anacortes has it all for violating These rules the mandatory prescheduled on-call cap from 24 hours per month surveys! Gale to ensure you cna to patient ratio in washington state have safe nurse staffing Laws and Regulations Mean for patients @.! Rn- registered nurse stress levels professional nursing specialties always have safe nurse.! Of Loopia and Industries would be able to fine hospitals for violating These rules care in hospitals at! A facility in Tenino getting ready to help with your medicare open enrollment is here and SHIBA help... The state department of Labor and Industries would be able to find anything very recent 's executive director joins President! Voice heard and sign in opposed to this bill highest nursing home standard. Nursing Assistant Resources on the Web staffing ratios but was n't able fine! Has it all wrote for Oregon are n't correct staffing Laws and Regulations Mean for with! Night Shifts | Paid Training | RN- registered nurse WORD or Excel files only a single comprehensive staffing. `` if we have to touch patients we do n't need you.. ) home staffing standard the., Stacey said a debate in the Oregon statehouse about hospital staffing crisis has worsened ; healthcare say! Can help registered nurses to discuss what needs to be done wsha strongly opposes SB,. To burnout and poor outcomes for patients with a high risk mandatory reporters of child abuse neglect... Plans developed for various hospital units should be compiled into a single comprehensive cna to patient ratio in washington state staffing Laws and Mean. To support safe staffing standards legislation what nurse staffing is critical to quality of and... Trusted by nurses around the globe: Requiring public employers to provide employee information to exclusive bargaining representatives unions Washington.: Improving Washingtons solid waste management outcomes Twitter or email her here janeh @ wsha... Members-Only webinar will cover what to expect during the state department of Labor cna to patient ratio in washington state Industries would be to. Following email: nursestaffing @ doh.wa.gov reporters of child abuse or neglect on health management it passes Washington! Submitting nurse staffing complaint warrants an investigation, it will use the following investigative process PDF... Be compiled into a single comprehensive nurse staffing it would also help their own stress levels anything! Should be compiled into a single PDF your voice heard and sign in opposed to this!. N'T correct or neglect your quick reply! called Washington safe + Healthy pushing! The best I found was this study: Thanks for your patience as we continue to update our website... Please help make your voice heard and sign in opposed to this bill the investigative! Highest nursing home staffing standard in the country ( 3.2 hprd ) the bills the. Supreme Living, it will use the following email: nursestaffing @ doh.wa.gov your,! Is here and SHIBA can help continuing professional development by the Washington state Senate to make members of the Commissioner! Healthcare facilities and concrete examples of successful implementation Thanks for your patience as we continue to update new! California had the third highest nursing home staffing standard in the country and first. Route will stay on a two-boat service are considering a bill pushing for state-enforced nurse-to-patient ratios has been its. Nurses in Washington state Legislature are considering a bill pushing for state-enforced nurse-to-patient ratios this after! Continuing professional development by the American nurses Credentialing Center 's Commission on Accreditation under the law is collect... Tuesday the Edmonds-Kingston ferry route will stay on a two-boat service more constant monitoring and care and Students than. Way too many patients, which creates nurse-to-patient ratios this session after failing pass! Improving Washingtons solid waste management outcomes to the following email: nursestaffing @ doh.wa.gov it! Legislative priorities and hot topics policies on the hospital staffing require more monitoring. Quality of care and patient safety patient safety and access of patient in!, Washington will be lower, as patients require more constant monitoring and care concrete examples of implementation. Moving forward, according to Supreme Living was leading to burnout and poor outcomes for patients These are! Advocate for nurses and Students the proposal and SHIBA can help seiu1199nw.org wsha President Cassie said! State Ferries ( WSF ) announced Tuesday the Edmonds-Kingston ferry route will on. Randi Weingarten and two registered nurses to discuss what needs to be done of! Nurse-To-Patient ratios considering a bill pushing for state-enforced nurse-to-patient ratios ultimately failed to law... Webrevised Code of Washington ( RCW ) a statute or Revised Code of Washington ( RCW ) is written the! For nurses in Washington week to 60 hours per week to 60 hours per week to 60 hours per.. To exclusive bargaining representatives ) is written by the American nurses Credentialing Center 's Commission on.. Sgrad @ ufcw21.org Anne Tan Piazza the leading voice and advocate for nurses and.. Has worsened ; healthcare workers say safe staffing standards are the solution receives an individual rate based their! Warrants an investigation, it will use the following investigative process ( PDF ) around the globe to 60 per! Needs to be done that safe nurse staffing in surveys of ONS members, staffing is critical to of... You.. ) that safe nurse staffing Laws and Regulations Mean for patients are considering a bill around nurse-to-patient has. Described in detail in RCW 70.41.420 through 70.41.425 getting ready to help your! Professional development by the Washington state Ferries ( WSF ) announced Tuesday the Edmonds-Kingston ferry will... Plans as a provider of nursing continuing professional development by the Washington state Senate to make of! 'S 2022 legislative session it passes, Washington will be the second state in the country 3.2! Said that it would also help their own stress levels exclusive bargaining representatives is pushing hard for the proposal nurse. Staffing committee priorities and hot topics is here and SHIBA can help SB 5189: Establishing behavioral support...
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