This page is for hospital administrative staff, nurses, and other medical professionals. The page provides actions to take in implementing Engrossed Second Substitute Senate Bill 5236.

Passed in 2023, the bill clarifies labor standards and enforcement regarding mandatory overtime and uninterrupted meal and rest breaks for certain health care workers. It also involves staffing plans, and retaliation protections. Requirements under the law focus on specific medical professionals and facilities.

The new requirements in the law have several milestones involving the Washington State Department of Labor & Industries (L&I). These include:

  • July 1, 2024: Requirements under the law take effect; L&I provides technical assistance to hospital staffing committees to assist in compliance with the law; L&I and the state Department of Health (DOH) reach agreement regarding each agencies role for enforcement and oversight under the law.
  • Oct. 30, 2024: First meal and rest break quarterly reports due from hospitals.
  • Jan. 1, 2025: Final hospital staffing plans due; coverage for mandatory overtime protections expands.
  • July 1, 2025: Hospitals must provide compliance reports.
  • June 30, 2026: Technical assistance expires for hospital staffing committees.
  • July 1, 2026: L&I has the authority to issue penalties for hospitals that exceed the threshold for missed meal and rest periods.
  • Jan. 1, 2027: L&I and the state Department of Health review and approve corrective plans of action related to staffing plan compliance – and require revisions if necessary.

The page also provides links for an employee to file a complaint, and to resources such as the law concerning hospital staffing standards, L&I policies related to the law, and other documents.

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Meal & Rest Breaks for Employees

Who’s Covered Under the Law

Generally, this law covers employees involved in direct patient care at hospitals. The list includes those who are:

  • Employed by a licensed hospital.
  • Involved in direct patient care activities or clinical services.
  • Receive an hourly wage or are covered by a collective bargaining agreement.

Where you work matters

State-licensed hospitals are covered under the law. Those places excluded from coverage include:

  • Clinics or physicians’ offices.
  • Nursing homes.
  • Birthing centers.
  • Psychiatric hospitals.
  • Facilities relying primarily upon treatment by prayer.

Note: Those working in the above professions for the state Department of Corrections are excluded from coverage.

Specific rights under the law

Basic meal and rest break laws cover all employees. For covered health care workers, a meal and rest break can’t be interrupted unless there is a:

  • Specific, unforeseeable emergency. These include: when a local, state, or national government declares an emergency; when a facility activates its disaster plan, or other unforeseen catastrophic event.
  • When a clinical circumstance takes place with a significant, adverse, effect on a patient’s condition.
The following chart shows the minimum number of breaks required, based on shift length:
Shift length Meal periods Rest breaks
4 hours 0 1
8 hours 1-2* 2
10 hours 1-2* 2
12 hours 2 3

* Depending on timing of meal periods. An employee cannot work more than five hours without a meal period.

See the “HLS complaint form” under a separate tab if these rights are violated. L&I will only investigate complaints occurring after July 1, 2024.

Mandatory Overtime Restrictions

Covered healthcare employees are prohibited from being required to work overtime in excess of agreed upon, regularly scheduled, shifts. This page discusses who’s covered, and specific rights under the law.

Who’s covered under the law

Certain healthcare employees are entitled to mandatory overtime protections if they are:

  1. Employed by a covered healthcare facility.
  2. Involved in direct patient care activities or clinical services.
  3. Receive an hourly wage or are covered by a collective bargaining agreement.
  4. Are one of the following:
    • Licensed practical nurse, Registered nurse, or nursing assistant-certified.
    • Surgical technologist.
    • Cardiovascular invasive specialist.
    • Respiratory care practitioner.
    • Diagnostic radiologic technologist.

Note: After Jan. 1, 2025, medical professionals who meet only the first three criteria are covered.

Where you work matters

Among the following facilities covered under the law include the following state-licensed and other facilities:

  • Hospitals.
  • Rural health care facilities.
  • Hospices.
  • Psychiatric hospitals.
  • Department of Corrections facilities.
  • Regulated nursing homes or home health agency.

Note: Healthcare facilities not covered under the law are those that do not operate on a 24-hour per day, seven-day-a-week basis. Also excluded are nursing homes the Department of Social and Health Services operates, and state psychiatric hospitals.

Specific rights under the law

Three types of mandated overtime are prohibited, unless an exception applies (see below):

  • Hours worked in excess of an agreed upon, predetermined, regularly scheduled shift.
  • Exceeding 12 hours worked in a 24-hour period.
  • Exceeding 80 hours worked in a consecutive 14-day period.

Exceptions:

  • Specific, unforeseeable emergency. These include when a local, state, or national government declares an emergency; when a facility disaster plan is activated, or other unforeseen catastrophic event.
  • When the overtime is the result of a prescheduled on-call time.
  • Completing a patient care procedure already in progress, and it could be detrimental if the employee left.
  • When the employer uses and documents “reasonable efforts” to obtain staffing but cannot avoid overtime.

“Reasonable efforts:” In some cases, employers may mandate overtime work when they have made “reasonable efforts” to obtain alternative staffing. The employer must complete each of the following steps before requesting overtime:
1. Seek qualified staff who are willing to volunteer for extra work;
2. Contact qualified staff who have made themselves available for extra work;
3. Seek the use of qualified per diem staff; and
4. Seek personnel from a contracted temporary staffing agency.

See the “HLS complaint form” under a separate tab if these rights are violated.

HLS Complaint Form

Starting July 1, 2024, L&I will receive and investigate complaints from covered medical professionals. The online form focuses on violations of meal and rest breaks or overtime.
L&I will respond generally within seven (7) business days. The message will say an investigation is under way and what additional information is needed.
L&I can file a Notice of Assessment for unpaid wages.

We expect to complete investigations for meal and rest breaks within about 60 business days. Investigations of overtime violations will take about 90 business days.

What you should include

Before you begin filing the complaint, gather the following items:

  • Personal contact information.
  • Employer’s contact information.
  • Supporting documents, or other relevant information, to back your complaint.

Note: It is against the law for a business to fire or otherwise retaliate against an employee who exercises a protected right or intends to file a complaint, or who has discussed potential violations of their rights. File a complaint if you feel you have been retaliated against.

If you believe your rights as a health care worker have been violated, there are three ways you can file a complaint:

Medical Facilities, Hospitals

Health care facilities covered under the law must comply with staffing plans and Hospital Meal and Rest Break Quarterly Reports submitted to L&I. This page covers those requirements, along with technical support available.

Who’s Covered

Hospitals, including state-operated hospitals, are required to meet plan and reporting requirements.

Staffing compliance plan

Under law, Hospital Staffing Committees develop annual staffing plans. Plans consider the following:

  • Patient activity.
  • Intensity level.
  • Nature of care required.
  • Staff experience.

The chief executive officer of a facility must provide reasons if the plan is not adopted. Complaints related to the failure to establish a staffing committee are sent to the state Department of Health.

Complaints related to covered medical facilities not following the staffing plan, or involving shift-to-shift adjustments, will go to L&I.

The requirement to implement staffing plans goes into effect July 1, 2025. Questions about staffing compliance plans should be directed to the state Department of Health.

Meal and rest break quarterly reports

Covered hospitals use the report to document their compliance regarding meal and rest breaks. These forms go to L&I. Hospitals must meet 80 percent compliance in providing meal and rest breaks.

View the reporting form

View the guidance document

Who’s included
Employees to track on the self-report form include a variety of positions – everything from ARNPs to Vascular Sonographer. A complete list can be found on the last page of the “Hospital Meal and Rest Break Quarterly Report Guidance Document.”

What’s tracked
Medical facilities have a variety of reporting categories to track for the report. The list includes:

  • Total breaks required.
  • Total breaks missed.
  • Total breaks successfully taken.

A complete description of the categories, and the formula to determine the percent compliance rate can be found in the “Hospital Meal and Rest Break Quarterly Report Guidance Document.”

When it starts
The first reporting period begins July 1, 2024. Here’s what the schedule looks like. Ongoing quarters will have the same outline.

  • July 1, 2024: Reporting period starts.
  • Sept. 30, 2024: First reporting period ends.
  • Oct. 30, 2024: First quarterly self-report forms due to L&I.

Failure to provide at least 80 percent
L&I will review the compliance reports. Actions can be taken for employers failing to meet 80 percent of the required meal and rest breaks in a quarter.

Until June 30, 2026: L&I will provide technical assistance for hospitals failing to meet the 80 percent standard or failing to file a report.

July 1, 2026: L&I imposes penalties on hospitals failing to meet the 80 percent standard. The penalties range from $5,000-$20,000, depending on the size of the hospital.

A hospital in violation of the standard for three consecutive quarters will be subject to a double penalty amount.

Smaller and more remote medical facilities become covered under the law. The list includes:

  • Certified critical access hospitals.
  • Hospitals with fewer than 25 acute care licensed beds.
  • Sole community hospitals independent of a health system

July 1, 2028: Penalties for smaller and more remote medical facilities take effect for failure to meet the reporting standard.