OLYMPIA — In nearly two decades in nursing, Annika Hoogestraat said her work has exposed her to extreme situations.
“We watch people die in front of us and resuscitate them. It can be violent, bloody and gory,” said Hoogestraat, a charge nurse in the cardiac ICU at Seattle Children’s. “You learn to adapt, remove yourself from the situation and go into autopilot, but repeated traumas like that really do take a toll.”
As Washington state health care facilities continue to struggle to recruit and retain workers, a flurry of bills focusing on improving work conditions for nurses is moving through this year’s legislative session. One example, Senate Bill 5454, would provide workers’ compensation insurance coverage for nurses with post-traumatic stress disorders, similar to a 2018 law that allows PTSD worker’s comp coverage for police and firefighters.
The bill’s sponsor Sen. Annette Cleveland, D-Vancouver, said nurses are still facing immense mental health challenges stemming from caring for patients in the midst of the COVID-19 pandemic.
“While many of us believe the pandemic is behind us and have moved on, these individuals continue to see the impacts, every day,” Cleveland said.
The Washington Hospital Association recommended an amendment to the bill to include insurance coverage only for nurses in the emergency department, ICU and flight nurses that cared for patients during the pandemic.
While PTSD may overlap with other mental health concerns, it is a very specific diagnosis for people who may have experienced or witnessed traumatic events. People with PTSD may relive the disturbing event through flashbacks and nightmares, may feel detached from other people, and their symptoms can last long after the traumatic event is over, the American Psychiatric Association says.
Mental health struggles reported by nurses cover a wide spectrum, from PTSD, to workplace burnout, to depression and anxiety. In a February survey of 1,200 nurses done by three state nurse unions, including the Washington State Nurses Association, at least half of the nurses said they are likely to leave the profession in the next few years.
David Jacob Garcia, a registered nurse in a critical access hospital in Sunnyside, Washington, since 2016, said SB 5454 would help with retaining nursing staff. He said he’s seen experienced nurses with five to 10 years of experience leaving the profession in droves.
“It feels like it should be a no-brainer,” Garcia said. “It’s super important for us to be able to expand workers’ compensation for PTSD to make sure that nurses can get the care if they need it.”
Hoogestraat and Garcia said experienced nurses leaving due to burnout and other mental health concerns are being replaced by a large number of new nurses with few people to give them proper training. These new nurses also often turn to travel nurse contracts, which pay significantly more than a staff nursing wage. As hospitals have had to turn increasingly to travel nurses to keep their facilities staffed, it’s also strained their budgets.
Ada Van Landingham, who had been a staff nurse at Seattle Children’s for two years, said she left her staff job and turned to travel nursing contracts because working the night shift wore on her mental health.
Her travel contracts are 12 weeks and she’s able to take a break before signing another contract.
“I worked for 12 weeks, made a lot of money and took a two-week break and traveled to Thailand,” Van Landingham said. “Then I went back to work for another 12 weeks.”
She said as a travel contract nurse, she makes double the amount she made as a staff nurse, but she doesn’t get insurance benefits or paid time off.
“I can take time off to decompress,” she said. “It’s not for everyone, but most of the younger nurses think it doesn’t make sense not to be one.”
Still, while Van Landingham said mental health supports like the PTSD workers’ compensation coverage provided in Cleveland’s bill would be nice, she doesn’t know if it would have been enough to keep her as a staff nurse.
Other bills being considered this session aim to expand the workforce by providing more training opportunities and addressing pay. Bills include efforts to expand nursing school educational opportunities to encourage more people to become nurses, joining a multistate compact to allow out-of-state nurses to practice, and requiring health insurance plans to provide reimbursement equal to what they would provide physicians for the same services.