After years of work and attempts at passing through state government, legislation improving working conditions for nurses, caregivers and other hospital staff is on the way to becoming a reality with House Bill 1155.
The bill is designed to ensure hospital staff rest periods and breaks are protected from being interrupted or broken up in such a way that employees are not able to rest or eat a meal. The bill also states that no employee of a health care facility will be required to work overtime and that overtime will be only voluntary. There are exceptions to the rules if a medical emergency demands immediate attention.
HB 1155 was passed by the state House on March 6, with bipartisan support in a 63 to 34 vote. On Wednesday, April 3, the bill was approved by the state Senate Ways and Means Committee and passed to the Rules Committee for a second reading before it is voted on by the Senate.
The Washington State Nurses Association (WSNA), SEIU Healthcare 1199NW, and United Food and Commercial Workers 21, three hospital caregiver unions, actively support the bill. The changes to state law are coming before legislators after years of support from health care workers in the state. Nurses working to the point of fatigue has been a growing problem, the unions said, since they are often interrupted during breaks and can be required to work additional hours on call.
Opposition to HB 1155 comes from concern over unintended consequences created by the policy. The Washing State Hospital Association (WSHA), is opposed to the bill due to negative impacts on smaller, rural hospitals in the state as well as possible limitation on access to care by restricting the usage of on-call employees.
The bill has been supported by many representatives of Eastside communities including Bill Ramos, Lisa Callan, Roger Goodman, Larry Springer, My-Linh-Thai, and Tana Senn. Several Republican representatives in the state voted in support of the bill as well, such as Bill Jenkins of District 16 and Alex Ybarra of District 13.
Nancy Gladsjo, a labor and delivery nurse at Swedish Issaquah and member of SEIU Healthcare 1199NW, has worked in health care for 44 years and has seen the negative impacts that overwork and lack of breaks have produced. Often, she said, nurses don’t get a chance to take a break or end up eating a quick lunch at their desk before getting right back to work, leading to physical pain and mental fatigue for many people in the profession.
“I worked a 12-hour shift (today) — we had four c-sections and four deliveries,” she said. “Not a lot of people get lunch breaks. I got no breaks.”
The issues are only made worse when compounded with the shortage of nurses in the state. Staffing is a huge issue, Gladsjo said, because when a nurse needs a break, their patients must be taken care of by a coworker who already has their own set of patients. One nurse having to take care of double the number of patients for a time is extremely stressful, she said.
With the need to look after many patients, all with unique needs and medications, an alert mind is vital to preventing errors. Gladsjo cited a 2016 John Hopkins University study in which medical errors were found to be the third highest cause of death in the country. She worries that fatigue and stress may play a part in the success of work done in hospitals across the state.
The staffing shortage is also part of why the WSHA opposes the bill. Chelene Whiteaker, senior vice president of government affairs at WSHA, said that requiring uninterrupted breaks would lead to increased costs for hospitals due to the need to hire additional staff. The hiring of staff is projected to be a problem since hospitals may not be able to hire enough to comply with the bill if it becomes law.
This would have more harsh impacts on smaller hospitals as well, since they do not have access to as many candidates. Whitaker said that in rural areas, vacancies for nurses can last several months.
“We believe the smallest, most vulnerable hospitals, Critical Access Hospitals, should be exempt from this bill entirely,” she said.
Whiteaker said that of the 39 Critical Access Hospitals in the State, 61 percent of them had a negative operating margin in 2017.
Beth Zborowski, interim vice president of membership and communications, said that many of the larger hospitals already provide uninterrupted breaks as part of collective bargaining agreements with unions. She also said the data collected by the WSHA from hospitals has shown that “nurses are getting breaks 95-98 percent of the time.”
A nurse for 34 years, Clarise Mahler has worked for the EvergreenHealth Medical Center in Kirkland for the past two decades and spoke to the lack of rest time and overtime requirements she has seen throughout the state as part of her involvement with the WSNA.
Mahler said requiring nurses to be “on call” in addition to their full shifts has led to undue stress, and it negatively impacts their performance at work. With nurses working a full day-shift and also on call during the night, it can be challenging to get a break at any point of their day.
“People work during the day then have to be on call during the evening, then work again in the morning,” she said. “Hospitals have to be accountable to the nurse for their health, hire more nurses, provide better breaks. Without a law behind it, they are not necessarily going to do that.”
Whiteaker said it would be difficult for hospital to call in staff for patients who needed care, but were not in life threatening danger, which would be an exception to the bill. Smaller hospitals don’t staff for every need, such as surgical procedures, 24 hours a day because they rarely need it, she said.
Washington is not the first state to consider stronger regulations around work hours and breaks for people in the health care industry. Seventeen states such as Oregon, California, Illinois, New York, Texas and Alaska have similar protections currently in place for hospital workers.
“States like Oregon and California, they’ve put these laws in place, and they work well for the nurses that work there,” Mahler said. “This law will help us, the people of the State of Washington are helping us, as we have helped them for many years.”
Gladsjo and Mahler were hopeful that HB 1155 would enact positive change and keep people in the profession longer. They said that improved working conditions would help to address the nursing shortage in the state by making the profession a more desirable career path.
WSHA representatives said they did support addressing nurse fatigue and patient care, but oppose 1155 due to their projected consequences. WSHA supported Senate Bill 5344 which also address nurse fatigue, but died earlier in the session.
After being placed on second reading by the Rules Committee on April 15, the bill will be subject to more debate before a third reading and a final vote. If approved by both houses, it will be sent to the governor to sign into law.