Sarah Rice, an Intensive Care Unit nurse at St. John Medical Center, said in her 10 years on the job she hasn’t worked a full week that she’s gotten to take all her allotted breaks.
That’s not a knock against the hospital, Rice said, but a problem within nursing and hospital culture. In what Rice calls a “big win for nurses,” a bill the Washington Legislature passed over hospital industry objections requires hospitals to give nurses uninterrupted breaks.
“Employers tried but couldn’t guarantee us a break,” Rice said. Passed Wednesday, the bill “provides us protection to say, ‘I need to take care of myself so I can take care of my patients.’ ”
Starting Jan. 1, House Bill 1155 will require hospitals to provide uninterrupted meal and rest breaks for licensed practical nurses and registered nurses, with exceptions for emergencies. It also bans mandatory overtime and includes new regulations on overtime and prescheduled on-call time.
Beginning in July 2020, the measure would also apply to surgical technologists, diagnostic radiologic technologists or cardiovascular invasive specialists, respiratory care practitioners and certified nursing assistants.
The new law will affect about 545 staff members employed by PeaceHealth in Longview, including 450 nurses, according to hospital spokesman Randy Querin.
St. John’s Chief Medical Officer Dr. Sheila Lynam said in an email that the hospital is beginning its evaluation of the final version of the measure.
“We have a strong track record of ensuring our nurses and clinical colleagues take breaks, recognizing that break interruptions are not fully preventable in certain patient care situations,” Lynam said in an email statement. “We will partner with our caregivers to determine how we will meet the spirit and intent of HB 1155, empower caregivers to exercise their professional judgment, and continue to provide the best outcomes for our patients.”
For Rice and her coworkers, the measure allows them to give the best care they can, she said. The issue has been a priority for the Washington State Nurses Association union for years. Rice, an association member, said she has been following the issue and lobbied for it in years past. “I reached a point in my career where I felt like I didn’t have the tools necessary to give my all to my patients,” Rice said. “We all know there’s those days where you can’t get away, but they were becoming more frequent and it was hard to take care of myself.”Rice said she and many other nurses at St. John work 12-hour shifts that can quickly turn to 13 or even 16 hours. In her unit, each nurse can care for up to six patients at a time, which can make it difficult to step away for a break, she said.
“The longer we go without break, the more tired and worn down we are,” Rice said. “It can be hard to think critically and catch subtleties in patients. It’s a safety issue.”
The legislation also prevents nurses from being required to work mandatory overtime unless there is an unforeseeable emergency. Nurses and other staff may be required to work prescheduled on-call time as long as the hospital isn’t using it in lieu of scheduling employees to work regular shifts.
Rice said although mandatory overtime is common in nursing, it didn’t happen too much at St. John until recently.
The Washington State Hospital Association was concerned that the measure could have unintended consequences for patients. Requiring uninterrupted breaks could “stifle” relaying patient information among staff members and delay patient care, the statement said.
According to a fiscal note prepared by the state Department of Commerce, the measure will increase costs for hospitals to hire staff to allow breaks and prevent excessive use of on-call time.
The legislation could lead to an increase of public hospital district costs equal to $42.9 million each year to staff the all affected hospitals, according to an analysis by the State Hospital Association.
But the fiscal note said costs for each facility would vary depending on hospital size and number of staff affected.
Now that the measure has passed through several iterations, the association said Thursday it is “much better than the original bill.”
“We remain committed to addressing nurse fatigue and we will continue to work toward solutions that protect access to care in all communities and address the constantly changing needs of patients,” said Cassie Sauer, association president and CEO, in a press release.
The association is concerned that the measure will negatively affect Critical Access Hospitals, which are located in rural communities and have fewer than 25 beds. These hospitals will be subject to the new law July 1, 2021.
The hospital association said will develop an plan to help all Washington hospitals comply with the new law prior it taking effect in January.
Rice said the measure gives hospitals and nurses guidelines of how to work together to help solve scheduling problems.
“We just want to be able to give the best care we can give,” she said. “We just want patients to get quality, safe care. In a perfect world we wouldn’t need laws for that.”