Do NOT piss off the nurses.
Do NOT piss off the nurses. Justin Sullivan/Getty

A Washington state bill that garnered major media attention across the country is officially headed to the Governor's desk.

SHB 1155, which was approved by the Legislature on Wednesday, will require hospitals and other healthcare providers to give nurses and techs uninterrupted meal and rest breaks. This might not sound controversial, but after Republican Senator Maureen Walsh—who opposed the bill—argued on the Senate floor last week that nurses don't need breaks because they're sitting around playing cards, the story caught fire. Walsh's statement was widely shared among nurses (#nurselife meme accounts were going nuts), and she quickly became public enemy number one among people who wear scrubs. Her office got thousands of calls, emails, and letters, including over 1,700 decks of playing cards that were sent to her office in Olympia.

It's not hard to see why nurses were so pissed about her comments. Nurses typically work 12-hour shifts—often on their feet. A few minutes to eat some yogurt and take a break is hardly some kind of luxury. But here's the thing: Maureen Walsh wasn't talking about all nurses. She was talking about a very specific hospital setting, and this, largely, got lost in the media translation.

Here's what actually happened: Walsh, who didn't plan on supporting the bill in the first place, was in favor of two amendments tacked on by Republicans that were actually meant to derail the bill entirely. One would have required a maximum of eight-hour shifts, which would completely upend the profession, and another would have exempted a number of small, rural healthcare centers called critical access hospitals from complying. Walsh, whose own mother was a nurse, supported this exemption. During debate on the Senate floor last week, she said:

I understand helping with employees and making sure that we have rest breaks and things like that, but I also understand that we need to care for patients, first and foremost. And by putting these types of mandates on a critical access hospital that literally serves a handful of individuals—I would submit to you those nurses probably do get breaks. They probably play cards for a considerable amount of the day. But the reality is this bill does not apply to critical access hospitals.

Please support this amendment and help out some of these under-served areas in the state that have these critical access hospitals that, frankly, we’re being told may not be able to survive if they have to comply with these types of mandates. Please support this amendment.

Walsh has since apologized, but at the risk of pissing off a whole lot of nurses myself, she's kind of got a point. Rural hospitals can be agonizingly slow. I talked to a nurse who worked at a community hospital in rural Washington, and she told me that while she didn't play cards during her shift, she did watch two full seasons of a PBS show on the Civil War in the first month. This isn't because she's lazy or incompetent; rather, the few patients she saw were usually asleep. There's only so many times you can organize the supply closest, and her shift was mostly an exercise in trying to stay awake.

Obviously, the nurse's experience is just anecdotal, so I called North Valley, a rural hospital in Tonasket, Washington (population 1,032). The nurse manager there told me that while her hospital supports paid breaks, there's another section of SB 1155 that could, in her words, "kill" them.

"We're not opposed to the breaks," she said. "The challenge is what's happening with on-call." That's the other provision of this bill that saw opposition from hospitals because SBH 1155 will also prohibit mandatory pre-scheduled on-call shifts, a practice that often forces nurses and techs to work overtime. Hospitals do this to save money because they can rely on on-call staff instead of just scheduling more nurses. The nurse manager I spoke to, as well as hospital lobbying groups, say their concern is that relying on regularly scheduled shifts instead of on-call nurses will triple the hospital's staffing costs, but, according to the Washington State Nurses Association (WSNA), they can probably afford it.

"The total net income (surplus) for Washington’s 40 critical access hospitals is $208,657,776, with an average surplus of $5,216,444 per hospital," said the WSNA in a statement. North Valley isn't quite that loaded, but their average profits over the past four years are still over $1.5 million annually. While it's true that hiring in rural areas can be difficult, they've got the money to do it.

"Nurses in these facilities want these protections and did not want to be left out of the bill," Jennifer Muhm, a spokesperson for WSNA, told me.

Ultimately, the two controversial amendments that Maureen Walsh supported were scrubbed from the final bill. Nurses will not be required to work 8-hour shifts, and rural hospitals will not be exempted (they will, however, be given two additional years to implement the new changes). Spokane Rep. Marcus Riccelli, who sponsored the bill, said in a phone interview that he's very pleased that, after five attempts in the state legislature, a bill guaranteeing nurse breaks has finally passed. "It won't matter if you go to a hospital in Dayton or Spokane or Seattle," he said, "Patients and workers will get the same protections."

As for why this bill passed with bipartisan support when it's failed to make it out of the Senate five years in a row, Maureen Walsh may have something to do with it. Her comments may have been distorted as the story spread online, but she galvanized healthcare workers en masse. They didn't just call Walsh's office and their own legislators, they showed up in Olympia to lobby—and, on Wednesday, to see their rest break bill pass.

Sen. Walsh, however, was excused from the vote.