Questions and Answers on the Lunches and Breaks Rules and Legislation
Last year, the Washington State Legislature had before it a bill to address the issue of Lunches and Breaks for Nurses and Professional Medical Support Personnel. The bill was passed in the State House by a wide margin, but never came up for a vote in the State Senate and failed to become a law. This issue is still very active though, currently being looked at by the Washington State Department of Labor and Industries and likely returning to the Legislature during the 2011-2012 cycle, and so we would like to provide some coherent information on the topic and to answer some of the more common questions you may have.
Question: What is a brief summary of the bill, what it accomplishes and changes?
Answer: The Lunches and Breaks legislation (bill number HB 3024 in the 2009-2010 Legislature) guarantees that Hospitals provide their nursing staff members with uninterrupted 10-minute breaks once every 4 hours worked, and with an uninterrupted 30-minute meal break once during their shift. This changes the current law which allows hospitals to assign nurses short intermittent breaks throughout their shift (5 2-minute breaks, 3 3-minute breaks, etc), or to call nurses away from lunch breaks without cause, or to classify going to a vending machine as an official ‘Lunch Break’.
Question: Which professions are covered under the legislation?
Answer: Registered nurses, licensed practical nurses, surgical techs, radiology techs, respiratory therapists, cardiovascular and pulmonary technologists, and medical sonographers (ultrasound) are covered under the legislation.
Question: How much flexibility are the Hospitals given to implement uninterrupted breaks? Are prescheduled breaks the only option?
Answer: This bill was designed to be extremely flexible. The legislation does not specify at all how hospitals should implement the new rule, and leaves it entirely up to them in coordination with their staffs to find the most efficient and beneficial way to proceed. There are even provisions to allow employees to temporarily choose to take shorter breaks that amount to at least ten minutes in a four hour period if they believe this would work best for their own personal schedules and daily requirements. Prescheduled rest breaks are only one option out of a hundred, and since hospitals are filled with some of the most intelligent and creative people around, a better solution for each individual facility should quickly present itself.
Question: Would nurses be forced to abandon surgeries or patients experiencing a medical emergency?
Answer: No, never. The legislation has very explicit safeguards to prevent this from ever happening, allowing nurses to use their professional judgment to decide whether to go on a break or not, and it also allows hospitals to bring nurses back from a break early if their patients start experiencing a critical situation. Current Washington State Licensing Laws also expressly prohibit nurses abandoning patients in the middle of a surgery or procedure, and this legislation does not change or modify that at all. The whole purpose of this bill is to let nurses rest and stay alert so that their patients’ health is protected; endangering patients is something we would never do.
Question: Suppose something happens during a break or during a day that isn’t a medical emergency but a nurse wants to go back on duty to cover their patient; does this bill allow nurses that option?
Answer: Yes, it does. Here is the important excerpt from the bill dealing with unforeseen and evolving circumstances:
(3) As an exception to the rest break requirement of subsection (1) of this section, an employee may temporarily choose to take shorter rest breaks equivalent to at least ten minutes during each four-hour work period.
(4) Reporting a missed break is not grounds for discrimination, dismissal, discharge, or any other penalty, threat of reports for discipline, or employment decision adverse to the employee.
This was one of the larger points of contention during the bill’s life, and there was a lot of wrong information floating around about this. Many examples were given by opponents of the bill for situations where a nurse wouldn’t be able to leave a break (“When your patient receives devastating news about his or her condition; When a family member you have been waiting to talk to arrives or returns a call; When the woman you have been working with through her whole labor is delivering her baby;” etc), but as the bill clearly reads, the decision would always be in the hands of the nurse. There would be different practices in place at each hospital to ensure that the affected nurses would be able to get the remainder of their break later, but the law would never ban nor punish a nurse for looking after their patients.
Question: What have been the major obstacles to implementing this practice up to now? Hospitals have to understand the benefits to having rested and alert nurses; why hasn’t this already been the standard adopted practice?
Answer: The biggest challenge to implementing this rule has been related to staffing levels at the individual hospitals. Often there simply aren’t enough nurses on staff at any given time to allow one nurse to cover another’s patients for a solid 10-minute block, and often the responsibility has been placed on the nurses themselves to locate their own relief among their coworkers, all of whom have their own patients to care for. This scenario means that even if a hospital has a policy for 10-minute breaks and even makes a good faith effort to fulfill it, logistics and state laws prevent those breaks from actually taking place.
Question: Would this increase costs to hospitals?
Answer: The Washington State Department of Labor & Industries estimates a zero fiscal impact from this new rule, meaning no additional fees or penalties from hospitals. If a hospital doesn’t have enough nurses to cover a given shift, then there would be the additional cost of hiring more nurses, but those costs would be largely or completely made up for by the savings in other areas. Missed breaks and lunches count as nurse overtime, paying one and half times more per hour in compensation; it doesn’t take many nurses missing a few breaks to make up an additional salary. Missed breaks also lead to increased job stress, injuries, and turnover in nurses; the hiring and training process for each new nurse can cost as much as $80,000, and tired overtime employees suffer reportable injuries 61% higher than other employees. These are costly issues that could be better avoided by allowing blocks of time for nurses to rest and regain their focus and composure.
Question: Could this issue be bargained for on a hospital-to-hospital basis?
Answer: This hasn’t been successful in the past and wouldn’t be able to address the root problem. Current Washington State law that allows intermittent meal and rest periods has undermined the intent of contracts to provide uninterrupted meal and rest periods, and this issue truly is about patient safety and should be considered a basic right guaranteed to all professional healthcare providers.
Question: What are the next steps for this legislation?
Answer: As mentioned above, the Department of Labor and Industries is currently debating whether to include this language in the labor statutes, though if this does not go through or if a heavily modified version that removes the important clauses goes through it will likely return to the State Legislature in the 2011 Session and will be supported by the Washington State Labor Council.