An Open Letter to Senator Maureen Walsh

Dear Senator Walsh,

I am a Nurse. This morning I was greeted by a headline that read,

“Senator states that nurses ‘probably play cards for a considerable amount of the day’ in amending rest breaks bill”

Twatwaffle Walsh

Stunned by the headline, I read – and then re-read – the article. I was dumbfounded that a legislator would make such an ignorant statement and thought that perhaps your words were taken out of context . I took the time to locate and watch the video of your speech, given in front of the Washington State Senate. I wanted to be sure that I understand fully what, exactly, you were trying to communicate. You see, because I’m an responsible adult and a professional, I believe that I need to have all of the facts before I weigh in on a subject. As a nurse, I’m guided by the principle of do no harm. Your words make it clear that you don’t share that same standard so allow me to educate you.

Nurses work long hours, most of it standing up even sometimes running to take care of our patients. We rarely have time to eat and sometimes hold our bladder for hours at a time because we simply can’t get a break. We suffer more occupational injury and assaults than any other industry including law enforcement and construction. Many of these problems are directly related to working excessive hours without adequate breaks and by working mandatory overtime. I assure you Senator Walsh, this is no exaggeration; my statements are based in fact. Nurses are chronically understaffed. Despite the lack of adequate staffing, we work diligently to ensure that our patients get the best possible care. We routinely bring staffing issues to the attention of our administrators who constantly respond by bemoaning that they don’t have the resources to hire more nurses. This, of course, is factually untrue.

Here are the facts:

Hospital administrators pull down enormous bonuses- and most are not required to be disclosed to the public. Nonclinical healthcare wages- as in hospital administrators- increased 30% over the last decade to $865 billion (Bryant, 2018). Furthermore, salaries for nonprofit CEOs far eclipsed those for nurses. Over the past decade, salaries for hospital CEOs jumped a whopping 93% (Clinical Orthopedics and Related Research 2018). Average salaries for hospital CEOs skyrocketed from $1.6 million in 2005 to $3.1 million in 2015. In fact, salaries for nonclinical workers are a major factor in skyrocketing national healthcare spending. In 2017, 84 of the largest nonprofit hospital systems boasted total annual profits of $14.4 billion — resulting in a 2.7% operating profit margin (Bryant, 2018). Are you telling me that hospitals can’t afford to hire enough staff to allow nurses to get legally mandated breaks? Please, Senator Walsh, show me that math. Sounds like you’re being played by the lobbyists and that you’ve been too lazy to do your own research. Shame on you.

Hospital administrators justify their hefty bonuses by pointing to their leadership role in achieving patient safety metrics. If they are improving patient safety, why, then are medical errors the third leading cause of death in the US (Hopkins 2016) ? And why is the data on hospital-error associated mortality not routinely reported to the public alongside those bonuses so that we can see how deserved these salaries and bonuses really are? Here’s a hint: they’re not deserved. Hospital administrators are making more than ever before in history while hospital stays are getting more dangerous every single year.

What’s causing these errors, you ask? I guarantee it’s not because the nurses are playing cards Senator Walsh. Allow me to enlighten you.

Numerous studies show a correlation between inadequate nurse staffing and an increase in medical errors, as well as patient infections, bedsores, pneumonia, MRSA infections, cardiac arrest, and accidental death. Fatigue has long been established as a significant contributor affecting the quality of patient care nurses provide. One of the most significant factors that contribute to nurse fatigue is a lack of rest breaks (Rogers & Hughes, 2008). Physical and mental fatigue can impair staff performance and increase the odds of health care error, leading to significant death and disability for patients (Rogers & Hughes, 2008; Witkoski & Dickson, 2010). In a study examining the relationship between health care errors and work breaks, researchers found a 10% decrease in the likelihood of error when nurses were given an additional 10 minutes for their meal and break periods per work shift (Rogers, Hwang, and Scott 2004).

Research suggests that restorative breaks enhance performance and reduce the risk of errors and accidents (Tucker, 2003). Improved performance in nurses leads to an improved ability to recognize critical changes in patient’s conditions. When nurses underperform due to fatigue, it results in failure to rescue. A study published in The New England Journal of Medicine found that the risk of death increased two percent each time a patient was exposed to shifts with below target RN staffing ( Needleman, J., et al. 2011).

Nurses are fierce patient advocates. We know the dangers of unsafe staffing and we’re done playing games with the likes of you. I’m calling your bluff, madam. I can read your hand- you haven’t done your homework, and the stakes in this game are high. If you really care about patients like you so adamantly profess, get your facts straight. The last thing the public needs is ignorant legislators voting on issues that impact people’s lives.

Your house of cards is teetering madam Senator. Educate yourself or resign.


Allison Shuttleworth MSN, RN, CEN

Sources so you can finally do your homework:


* Heather K. Laschinger, et al., “The Impact of Nursing Work Environments on Patient Safety Outcomes,” The Journal of Nursing Administration, 36.5, (May 2006);

* Jack Needleman, et al., “Nurse‐Stafing Levels and Quality of Care in Hospitals,” The New England Journal of Medicine, May 30, 2002.

* American Nurses Association. (2009). Safe staffing saves lives. Retrieved from


* McCluskey P. Partners CEO tops hospital pay list. The Boston Globe. Available at: Accessed April 1, 2018.

* Joynt KE, Le ST, Orav EJ, Jha AK. Compensation of chief executive officers at nonprofit US hospitals. JAMA Intern Med. 2014;174:61–67.

* Himmelstein DU, Woolhandler S. Taking care of business: HMOs that spend more on administration deliver lower-quality care. Int J Healthc Manag. 2002;32:657–667.

* Rogers, A. E., & Hughes, R. G. (2008). The effects of fatigue and sleepiness on nurse performance and patient safety. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (pp. 2-509- 2-545). Rockville, MD: Agency for Healthcare Research and Quality.

* Rogers, A. E., Hwang, W. T., & Scott, L. D. (2004). The effects of work breaks on staff nurse performance. Journal of Nursing Administration, 34, 512-519. doi:10.1097/00005110-200411000-00007

* Tucker, P. (2003). The impact of rest breaks upon accident risk, fatigue and performance: A review. Work & Stress, 17, 123-137. doi:10.1080/0267837031000155949

Written by Allison Shuttleworth MSN, RN, CEN for ExpeditionEd ~ April 19, 2019

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