Hospital staffing legislation places patients at risk

March 25, 2019

2SHB 1155 would have many unintended consequences that jeopardize patient care

Washington state lawmakers are currently considering Second Substitute House Bill 1155, which mandates uninterrupted meal and rest breaks for nurses and certain technicians and technologists on hospital staff. It also restricts the use of prescheduled on-call. While it is important for these members of the patient care team to get adequate rest, 2SHB 1155 has unintended consequences that place patients at risk.

2SHB 1155 would force hospitals to preschedule breaks to comply, which could take caregivers away from the bedside at critical times for their patients. By requiring breaks be uninterrupted, the flow of crucial patient information between members of the care team could be stifled, as these nurses and technologists would be legally prohibited from communicating during their breaks unless it were an extreme patient emergency.

Restrictions to on-call could delay important patient care. Only life-threatening emergencies would be exempt from these regulations, and other critical procedures could be delayed, placing patients in emotional distress and at increased risk for complications, which can become life threatening without timely care.

Many patient situations also require diagnostic procedures or imaging to determine whether they are an emergency or not. The restrictions to on-call in 2SHB 1155 would prevent a hospital from being able to call in staff to help do the imaging to determine whether something is an emergency.

While 2SHB 1155 exempts organ transplant procedures from these restrictions, many other procedures could be delayed depending on their severity, including:

  • Bowel obstructions
  • Bone fractures
  • Ongoing treatment and care for burn victims
  • Biopsies and imaging for diagnosing cancer, such as those for breast and colon cancers
  • Surgeries to remove cancerous masses
  • Hernia repair
  • Gastrointestinal procedures to treat diseases like Crohn’s disease
  • Treatments for inflammatory bowel disease
  • Surgery to remove a colon mass
  • Gallbladder surgery
  • Procedures to address certain abscesses and infections
  • Vascular ultrasounds to assess heart conditions
  • Reoperative chest procedures, often performed to treat heart conditions
  • Neurosurgical procedures
  • Urological procedures
  • Gynecology surgeries and procedures – such as to diagnose uterine conditions
  • Complex reconstructive procedures
  • Hysteroscopies, which are sometimes used to determine the cause of repeated miscarriage

Leaders at several Washington hospitals and health systems jointly drafted two letters to lawmakers this week expressing their concerns, specifically regarding how 2SHB 1155 could adversely impact timely access to women’s health care and timely access to surgical services in rural areas.

“We feel very strongly that caregivers should get the rest they need to stay at their best for their patients, but this legal mandate places patients in harm’s way,” said WSHA President & CEO Cassie Sauer. “Not only could it take away key members of the care team when they are needed most, but it could leave patients waiting — sometimes for days — to get the care they need. Health care is evolving, with more emphasis than ever being placed on preventive care to keep patients at their healthiest. Passively allowing a patient’s condition to worsen goes against the very mission of our health care community.”

2SHB 1155 passed the Washington state House of Representatives and is now being considered by the Senate, where it will be considered by the Senate Ways & Means Committee.


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