WSNA to L&I: Intermittent breaks are not appropriate for nursing

Earlier this year, the Department of Labor and Industries (L&I) began a process of updating its non-binding interpretative guidance, which is published to assist workers and employers in understanding the law. Current state regulations (WAC 296-126-092) allow employers to forgo scheduled rest periods and provide “intermittent” rest breaks where “the nature of the work allows.”

The current interpretive guidance does not address whether the nature of the work of patient care allows for intermittent rest breaks. Some hospital employers have taken the position that rest breaks can be intermittent even though health care workers risk their careers and their patients if they leave a patient without care for even a moment.

WSNA has been actively lobbying L&I to update its guidance to reflect current legal decisions and clarify that intermittent rest breaks are not appropriate for nurses. As expected, the hospital/employer community is strongly opposed to our efforts, in part because they know if they cannot claim that intermittent rest breaks are appropriate, they will need to provide adequate rest break coverage to relieve workers of their duties during a break. This means hiring more staff to care for patients.

As part of our effort to weigh in with stakeholder and worker input, WSNA asked our nurses to voice their concerns. WSNA received over 830 signatures in 72 hours on an online petition urging L&I to update the guidance to reflect that the nature of providing patient care does not allow for intermittent breaks. Each nurse who signed the petition adopted the following statements:

• The nature of nursing does not allow for intermittent breaks.
• As a nurse, I’m required to exercise constant vigilance unless and until I am relieved of patient care responsibilities.
• I believe that being able to receive a real rest break is crucial for the health and well-being of me and my fellow nurses!

In addition, we asked nurses to tell Labor and Industries why intermittent breaks are not appropriate for the job we do as nurses. WSNA received over 700 written comments.

WSNA will continue our efforts to advocate for the change in the L&I policy as the agency works through its process in addition to our advocacy on this issue in the courts and the local unit level via contract negotiations, grievances and arbitrations.

Selected quotes from the petition

• “As nurses we have an obligation to our patients to provide care that calls for us to maintain constant attention to their ever changing health condition. Only by relieving me completely of my patient responsibility can I fully relax, regroup, and therefore truly have a break from my responsibilities.” - RN, Spokane
• “As a nurse, there is always something that needs to be done. Just when a nurse catches up on administering medications, performing assessments, and documenting, various patient needs arise, leading to a constant work flow throughout the day. Without being relieved from patient care duties by another nurse for a full 15 minute break, it is essentially impossible to step away for even a 5 minute bathroom or water break.”- RN, West Richland
• “I can't just step away from my patient and run to the bathroom or grab water, I must report off to another nurse so they can be responsible for the patient while I am gone. This cannot just be ‘intermittently’ done.“- RN, Shoreline
• “Unless another nurse is responsible for your patients and can provide immediate care if needed, then you are still responsible for them. There is no way that it would be safe for me to leave the floor without having someone else keep an eye on my patients, even for just a three minute restroom break or a five minute coffee run.”- RN, Seattle
• “Not having true breaks during the shift takes a physical and mental toll on the nurse. 12 hours of work, eating while charting, getting a coffee on the run and hoping to find time to use the bathroom is the norm for a nurse’s shift in our ICU… Not getting adequate breaks leads to physical injuries and mental fatigue which has a negative impact not only on nurses but also on patients.”- RN, Wenatchee
• “I care for very ill patients. My shift is 12 hours. I need physical/mental breaks that I can count on to enable me to not miss anything important, to be able to respond quickly and accurately.”- RN, Vancouver
• “Nurses are required to watch their patients for the entire shift. They need to be relieved by another nurse for their breaks. Intermittent breaks do not allow the nurses to monitor their patients. That can lead to an event which could be prevented.”- RN, Yakima
• “Nursing is physically, cognitively and emotionally demanding work that requires a nurse to be constantly vigilant. This requires rest breaks that are not interrupted but full rest breaks to insure that the nurse is fully at their best to provide the most professional care that they can provide.”- RN, Tacoma