How nurses in Washington state got a bill to help with PTSD claims

Nurses deal with many traumatic situations.

But it was one nurse in particular that really got to registered nurse Shawn Mork, a WSNA nurse representative with a background in behavioral health, forensic nursing, and emergency medicine.

This nurse had zipped a staggering amount of body bags during the COVID-19 pandemic and attempted suicide, but was denied a post-traumatic stress disorder claim, Mork said.

Under the law governing workers compensation for nurses, PTSD claims needed to be assigned to one qualifying event.

“Which body bag?” Mork asked rhetorically.

In 2018, a state law allowed police and firefighter post-traumatic disorder claims for job exposure, so why not nurses, Mork wondered.

Mork told WSNA’s Government Affairs team that the law needed to change. The team got to work. They asked first responders how the 2018 bill was working for them. The answer was the bill was too restrictive for people to access — it required having 10 years of service, and the standard of evidence was really high.

“We heard early on if our bill didn’t change some of these barriers, it wasn’t worth fighting for,” said Katharine Weiss, WSNA’s director of government affairs.

WSNA’s Government Affairs team partnered with state senator Sen. Annette Cleveland (D-Vancouver), a former hospital administrator and chair of the Senate Health Care Committee. Cleveland sponsored a bill in 2023 allowing nurses to claim PTSD for work exposure, not just a single event. The bill (SB 5454) became law in May 2023.

The law now states, “there exists a prima facie presumption that post-traumatic stress disorder is an occupational disease” under state law governing industrial insurance (RCW 51.08.140) and it applies to a direct-care registered nurse who has been fully employed in Washington state for at least 90 consecutive days.

Because PTSD can manifest months or years after the trauma, the law says, “the presumption extends to a claimant following termination of employment for a period of three calendar months for each year.”

Ideally, there would be other healthcare professionals added to the bill. But widening the stakeholders takes much longer and it would change the fiscal impact, Weiss said.

As it was, the bill had hurdles.

Some groups wanted to limit the benefits to ER nurses. Another challenge was that nurses who testified in favor of the bill were restricted from disclosing any details of a workplace trauma that would violate a patient’s right to privacy.

“It was pretty tricky to tell their stories, so that patient privacy rights were respected,” Weiss said.

Despite these hurdles, the bill passed on its first introduction — which is uncommon, Weiss said. It also passed without restrictions on what kind of nurses it could affect, how long the nurses needed to be employed, and without standards of evidence higher than the diagnostic criteria listed in The Diagnostic and Statistical Manual, 5th Edition (DSM-5).

The National Institute of Mental Health said it is natural to feel afraid during and after a traumatic situation, but that most people recover from initial symptoms over time. Those who continue with intrusive thoughts that affect work and relationships, however, may have PTSD.

Mork said nurses often reflect and grieve and move on. But many times, they simply cannot move on. They are haunted by nightmares and flashbacks, and can feel numb, detached, and on guard.

“Trauma touches them. They are receptacles of society’s pain,” she said. “Yet, they often feel stigma from co-workers about talking about their emotions and believe they are not a reliable nurse,” she said.

Mork said she has coached many nurses on how there is more strength in mentioning their vulnerability.

“If we’d had this bill sooner, maybe many nurses wouldn’t have left the profession,” she said.

Nurses who have been out of work or working reduced hours because of PTSD may now get the help they need.

“This is good for nurses and good for hospitals,” Weiss said.