Editor's note: This story was updated on April 24.

Read Advisory Board's take: Why this comment "delegitimizes" the sacrifices nurses make

Last week, Washington state Sen. Maureen Walsh (R) in a speech on the state Senate's floor said nurses at smaller rural hospitals "probably play cards for a considerable amount of the day"—sparking a wave of criticism from nurses and other health care providers, the Tri-City Herald reports. Walsh, who was arguing to exempt small rural hospitals from a bill (SHB 1155) that would require nurses to have uninterrupted breaks, later said she regretted the comment, according to the Herald.

The 4 foundational cracks that are undermining your nurses’ resilience

Walsh's comments

The bill would require nurses and other health care staff, including surgical technologists, in Washington state to have uninterrupted meal and rest periods, except under unforeseeable circumstances. Under the bill, nurses and other staff would receive an additional 10-minute break if their first break is interrupted. The bill also would bar hospitals from addressing staffing shortages by requiring nurses to remain "on call" after their shifts.

The Washington State Nurses Association (WSNA), which backs the bill, said it would prevent health care facilities from using a legal loophole to require overtime and would give health care staff breaks that everyone deserves. 

During debate on the bill, Walsh argued in favor of amending the legislation to exclude smaller rural hospitals from the proposed requirement. She said, "I understand helping … employees and making sure [they] have rest breaks. … But I also understand that we need to care for patients first and foremost." Walsh argued that the requirements could present problems for small rural hospitals "that literally serv[e] a handful of individuals." She added, "I would submit to you that those (small hospital) nurses probably do get breaks. They probably play cards for a considerable amount of the day."

Walsh faces backlash

WSNA, which opposed the amendment, criticized Walsh's comments in a blog post that drove so much traffic it crashed the organization's website on Friday. The group called Walsh's comments "incredibly disrespectful and patronizing."

WSNA wrote, "[N]urses are not sitting around playing cards. They are taking care of your neighbors, your family, your community. And they do read the research: mandatory overtime is bad for patient care and it's bad for your rural hospitals. With all due respect, Sen. Walsh: perhaps it's time for you to put down the cards and pick up the literature."

The comments quickly began trending on Twitter after nurses and other health care providers created the hashtag #nursesplayingcards. One tweet using the hashtag featured the words "Last night's card game" written across a photo of a bloody hospital floor.

— Lyz ©️ 🍀 (@LuckyLyzzie) April 20, 2019

Bruce Lee, executive director of the Global Obesity Prevention Center and an associate professor of International Health at the Johns Hopkins Bloomberg School of Public Health, in Forbes wrote, "Having worked in a number of hospitals and health care settings, I can say that I have never seen nurses play cards at work, even for a moment. I have seen nurses not eat or go to the toilet all day because they were so busy. I have seen nurses stay well beyond their shift times because they were actively caring for very ill patients. I have seen nurses regularly do extra work to compensate for and cope with considerable deficiencies in hospitals and clinics. I have seen nurses covered in blood, urine, and feces because they were trying to help save someone's life. And blood, feces, and urine are not part of any card game as far as I can tell."

Walsh wishes she hadn't said comments

According to the Herald, Walsh since has said she wishes she had not made the comments and they were not intended as malicious. "I was tired," she said, adding, "I said something I wish I hadn't."

However, Walsh said she continues to support the amendment to exempt nurses at small, rural hospitals from the bill. The amendment ultimately was adopted and approved by the state's Senate.

However, the state's House approved the bill without the amendment, which means state lawmakers will have to reconcile the two versions of the bill before it can be sent to the state's governor, USA Today reports (Gstalter, The Hill, 4/20; Lee, Forbes, 4/21; Lam, USA Today, 4/12; Cary, Tri-City Herald, 4/22).

Advisory Board's take

Katherine Virkstis, Managing Director, Nursing Executive Center

Nurses around the world today are working really hard. Across the course of a day (or night), they continuously manage dozens of competing priorities at once, repeatedly triaging the most acute needs, while carefully following multi-step protocols and documenting care provided. And, most of the time, they do this with a smile and a caring attitude that can put patients at ease.

Statements like the one recently made by Senator Walsh threaten to delegitimize the sacrifices and commitments that nurses make for their patients on a daily basis. They also threaten to increase feelings of burnout by telegraphing a message those sacrifices aren't recognized or appreciated.

Burnout among nurses is a real problem. Three out of four nurses report concerns about stress and overwork—and 70% report feeling burned out. These numbers are alarming because, in addition to negatively impacting nurses' well-being, stress and burnout can lead to an increase in adverse patient outcomes, lower workforce productivity, and higher rates of nurse turnover.

To reduce frontline stress and burnout, nurse leaders are striving to build individual nurse resilience through engagement and wellness initiatives. In fact, hospitals and health systems have never been more committed to nurse engagement, retention, and wellness. Despite this commitment, these initiatives alone are not sufficient, because stress and burnout are still increasing.

According to Maslow's hierarchy of needs, individuals can't reach their full potential if they are struggling with basic needs. But in today's health care environment, there are unaddressed needs—or "cracks in the foundation"—undermining nurse resilience and leading to burnout.

So what can hospital and health system leaders do to address the problem? We've identified four of the most pervasive "cracks in the foundation" undermining nurse resilience:

1. Violence and point-of-care safety threats are now commonplace in health care settings;
2. Nurses feel they have to make compromises in care delivery;
3. Staff bounce from traumatic experiences to other care activities with no time to recover; and
4. New technology, responsibilities, and care protocols cause nurses to feel "isolated in a crowd."

To learn more about these cracks—and what strategies you can use to fight them—download our recent report and infographic on the four foundational cracks that are undermining your nurses' resilience.

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Then, be sure to register for our upcoming webconference on June 19th at 1pm ET to learn five ways to make your nurses feel appreciated year-round.

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