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State investigates nurses' complaints of fatigue during long shifts with no rest

M.O. STEVENS/WIKIPEDIA - Legacy Emanuel Medical Center faces a $277,000 proposed fine, which would be the largest ever in Oregon when it comes to failing to provide meal and rest breaks for employees.More than 4,000 alleged violations of state labor law at Legacy Emanuel Medical Center in North Portland have resulted in a $277,000 proposed fine — the largest of its kind in state history — for failing to provide legally required breaks.

Legacy is fighting the fines issued by the state Bureau of Labor and Industries, known as BOLI, but says it is addressing the issue.

"This is a challenging issue for health care providers everywhere," said Legacy spokesman Brian Terrett. "We've provided BOLI with a considerable amount of information to show our commitment to ensuring that people get their breaks and their lunches while they're on their shift."

The fine is part of a larger crackdown by the Bureau of Labor and Industries, with several hospitals and health care companies under investigation around the state. In March, the state issued $50,000 in proposed fines against Portland Adventist Medical Center.

Adventist, which did not respond to questions from the Tribune, is currently in settlement talks with the state.

"Our agency is committed to ensuring that nurses and hospital staff are treated fairly on the job," said BOLI spokesman Charlie Burr. "We have a duty to enforce meal and rest period protections both for the sake of the individual workers, but also the patients they serve."

Under Oregon law, employers must provide one 30-minute unpaid meal break to anyone working a shift of six hours or more. They must provide two paid 10-minute rest breaks in an eight-hour shift and three such breaks in any shift longer than 10 hours.

Forcing employees in health care facilities to work without breaks adds to fatigue and raises the risk of error and compromised patient care, according to numerous studies.

Legacy's Terrett said the nonprofit health system is telling employees to take breaks. "We know it's better for the employees themselves ... and we know it's important for patient safety to know that our employees are well rested and have the ability to continue to take care of their patients."

"We've done a lot of work with our managers as well as employees," he added. "In fact, all of our screensavers right now are broadcasting the message to take your break and take your lunch."

But Legacy employees, in a dozen complaints to BOLI since 2015, said that despite the messaging, the system is not doing enough to ensure employees have the necessary backup so they can take breaks.

"In my nearly 20 years at this facility, I have been granted approximately two to three 10-minute rest breaks, of which I am due to have three per 12-hour shift I have worked," one employee said in a complaint to BOLI last September. "That's two to three (combined) for the entire 18-plus years."

An operating room employee in November 2015 wrote in a complaint, "Not receiving breaks. Can be stuck without breaks for 8 hours. ... Please help."

In April 2016 a nurse wrote to BOLI, "The nurses do eat during their shift. Unfortunately they are eating in the nurses station next to the tube station where we send patients' blood, urine samples, etc. OSHA violation. They eat in the nurses station because they do not get an actual meal period and they clock out although they are still caring for their patients. ... We work hard and should not have to put our health at risk by eating in the nurses station."

In November 2016, a Legacy employee told a BOLI investigator that if they ask for a break "they are told or made to feel that they are 'not a team player.' "

One employee, speaking on condition of anonymity earlier this week, told the Tribune that the same problems continue.

Susan King, an emergency room nurse who heads the Oregon Nurses Association, said she doesn't have knowledge of the Legacy situation, since nurses there have not unionized.

But she said issues with breaks are occurring at other health care facilities as well, and it boils down to a lack of necessary staffing.

She noted that in Washington, a nurses union there has filed class-action lawsuits against several hospitals. One of them, St. Joseph Medical Center in Tacoma, recently settled for $5 million.

In Oregon, "I think it's an issue statewide, which a variety of nurses and hospitals are concerned about and in some cases trying to remedy," King said. "When you're in a clinical unit where the need for care is ongoing, there never really is a break. ... It is very difficult if you have staff who haven't eaten or haven't gotten off their feet from time to time. If you are mentally and physically fatigued, that doesn't bode well for patients."

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