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I am a lifelong Washingtonian and practice full-spectrum family medicine, including surgical obstetrics and hospital care at a Critical Access Hospital in Northern Grant County.

Coulee Medical Center provides crucial access to healthcare services in an area of very high need, and passage of HB 1868 could have disastrous consequences for a small yet crucial rural hospital that is already straining under the demands of the pandemic.

I work as a hospitalist seven days each month and am the Acute Care Director, and I have personally witnessed and experienced the effects of the COVID-19 pandemic.

Staffing shortages at every level of the facility has trickled down to affect patient care. Provider burnout is a serious problem and is on everyone’s minds as they either navigate it themselves or support their colleagues who are coping with it.

The nurses I work with are phenomenal, and we have in common the desire for a broad clinical skills set, high patient complexity, and commitment to serving our community. Although burnout can surely arise from sheer overwork, it more commonly becomes a problem when caregivers are repeatedly the victims of “moral injury”.

Moral injury is the damage done to one’s conscience or moral compass when that person perpetrates, witnesses or fails to prevent acts that transgress one’s own moral beliefs, values or ethical codes of conduct.

For example, a nurse who has to leave the bedside of a critically ill patient to take a break despite the fact that there isn’t another nurse to take their place while they are gone, thus putting the patient at risk may experience moral injury.

As a provider, not being fully free and unencumbered to provide the care I know patients deserve conflicts deeply with the Oath I took when I graduated medical school.

I am familiar with the desperation one feels when a patient can’t be transferred to a higher level of care due to staffing shortages at other facilities. I experience moral injury that settles into defeated exhaustion when that person dies due to lack of staff elsewhere.

HB1868, as it is written, would surely result in many rural hospitals such as Coulee Medical Center to close entirely, or operate as skeletons of what they currently are.

It does nothing to address the root cause of staffing shortages (particularly in regards to nursing) and will only strongarm care providers into adhering to rules and regulations that are so far removed from our daily reality as to be utterly untenable.

The source of burnout is often not being able to provide the care one believes a patient deserves, and HB 1868 would facilitate that situation many times over across the most sparsely populated regions of Washington State.

Please, take this opportunity to investigate the true causes of nursing and other healthcare provider staffing shortages instead of imposing a regulatory burden that will undoubtedly result in the shuttering of multiple rural hospitals statewide.

Thank you for your time and please do not hesitate to reach out to me. 

Dr. Jennifer Knox

Family Practice OB

Coulee Medical Center