“We don’t necessarily have the staff to accommodate.”

Those are the words of Shalayna Raso, a Utah nurse and mother of three boys. She, like many women in the healthcare workforce, experienced support and struggles while working through and after her pregnancies. She hopes the Pregnant Workers Fairness Act (PWFA) – a new federal law that impacts the lives of Utah’s 734,000 women in the state’s labor force – will help improve working conditions for her and her colleagues. Women make up 44% of Utah’s workforce. 

Businesses and policymakers have the unique opportunity to support working women like Shalayna who need accommodations during and after their pregnancies. To better understand their experiences, I sat down with Shalayna and discussed what the PWFA might mean for her, her family, and other women like her. 

Background 

Shalayna and her husband live in Eagle Mountain with their three young boys. Both grew up in Utah, studied locally, moved to New York for a few years, and then returned to Utah to be closer to family. Shalayna consistently worked as a nurse through these moves and pregnancies. 

A supportive work environment 

Although the New York nurse community wasn’t as welcoming, Shalayna’s Utah co-workers were very supportive – willing to help and teach her when she started her new position as an acute care nurse. Shalayna became pregnant shortly after moving to Utah and starting her nursing job. She had an overall positive experience with her employer. In her words, her work was “super supportive” and gave her accommodations as she needed. This meant assigning Shalayna as a charge nurse (a shift supervisor that sits at the front and can still have patients) more often and limiting her patient load where possible. Her work also avoided giving Shalayna isolation patients, which have more immediate needs during their stay and require more physical exertion from their assigned nurse. These accommodations helped her have some added opportunity to sit and rest as she progressed in her pregnancy. 

Like Shalayna, many Utah women experienced a level of pregnancy accommodation from their employers before the PWFA. Previous legislation specified that employers with 15 or more employees were prohibited from pregnancy discrimination and were required to provide leave or accommodations. These accommodations were under limited circumstances and only when such accommodations did not incur undue hardship for the employer. For example, the Americans with Disabilities Act (ADA) covered a pregnant worker who contracted gestational diabetes or preeclampsia and who requested accommodations from their employer, like a modified job structure. Or, under the Family Medical Leave Act (FMLA), a woman could take unpaid or paid leave if her pregnancy became too physically burdensome and she couldn’t perform essential functions of her job. 

Pregnancy challenges 

In some situations, however, pregnant workers in various industries have needed additional protection and accommodation over what previous laws provided. This is where the PWFA now applies. Through an interactive process, covered employers must provide accommodations for, and not retaliate against, eligible employees requesting pregnancy-related accommodation from performance limitations. This applies even when the limitations do not rise to the level of disability or when the employee cannot perform essential job functions (as long as these limitations are temporary and accommodation does not incur undue hardship on the employer). An employer is also prohibited from electing maternity leave as the required accommodation for the eligible employee. 

For Shalayna, this added level of accommodation would have ameliorated some of the physical burdens during her pregnancies. Even with her employer’s level of accommodation under previous laws, it was harder for Shalayna to work while pregnant. Physical demands limited her ability to care for her body. For example, being an acute care nurse involves intensive walking, which is more physically demanding since the unit has more square footage and a larger-than-average patient load. She said, “I think the biggest things were the tiredness and exhaustion. … One thing that was super hard … was just as I got bigger, the more walking, you know, the harder that was on my body.” 

The harder it became to move around, the more it impacted the number of patients Shalayna could take on. 

Time pressures also took a toll. It was (and is) typical for Shalayna to be constantly pulled in different directions during her shift – responding to patient call lights, administering medications, assisting nurses asking for help, and time-consuming charting of all patient care and progress. These pressures significantly limited Shalayna’s ability to care for her basic physical needs. She said, “I would plan and specifically not drink enough water, so I wouldn’t have to use the bathroom. I do that sometimes, even now.”

Breastfeeding was also difficult. Shalayna could only pump every six hours – once or twice during her shift – compared to the ideal time interval of every two to four hours. To have enough time, she would have a quick snack and then use her 30-minute lunch to pump. Shalayna was lucky that these extended breaks between breastfeeding periods didn’t affect her milk supply, but other nurse colleagues weren’t as fortunate. According to her, their supplies “tanked.” 

Her hospital’s consistent short-staffing issues also made pregnancy more challenging. When not pregnant, she and other nurses often have as many as six patients. Sometimes, this is after the hospital has used off-duty recruitment via group text chains, available “floating” nurses, and assigned mandatory on-call shifts. So, when a floor was short-staffed while Shalayna was pregnant, it was harder for Shalayna to receive a lower patient load. And sadly, this isn’t a new issue. She said: 

All hospitals have the same problem. … I’m not sure why we’re always short-staffed. I don’t know if it’s scheduling, their algorithm, or their budget, but [staffing shortages] have been an ongoing problem since I became a nurse eight years ago, and it’s definitely not unique [to my hospital]. 

What ideal accommodations look like for Shalayna 

Shalayna’s ideal work accommodations when not pregnant would be one uninterrupted hour total during her 12-hour shift – 30 minutes of continuous lunch and two 15-minute intervals for bathroom breaks and rest. She and other workers typically do not operate in that way, but having those conditions would at least help her have time to eat and to drink more. As for the patient load, her ideal work situation would have no more than four patients – a perfect ratio for her and most nursing colleagues to best meet patient needs. 

If Shalayna were to become pregnant or postpartum again, she would love a lower patient load than she typically has. A lower patient load would help her not feel as rushed and help her take more opportunities to sit and rest. Also, adding to the ideal work conditions described above, Shalayna would also want an hour to pump when postpartum.  

If Shalayna had the PWFA during her past pregnancies, it would have been possible for her to ask for and receive these additional accommodations. And if she did, she would have been protected against any retaliation from her employer in relation to asking for and receiving these accommodations – retaliation that might look like being fired, demoted, not being promoted, or not receiving a raise or bonus. Shalayna, and women like her, can now utilize the PWFA to avoid these situations and better maintain their jobs in situations of pregnancy, childbirth, and related medical conditions. 

Shalayna’s reaction to the PWFA 

For this reason, Shalayna became excited when she learned about the new Pregnant Workers Fairness Act. When referring to the new policies the PWFA provides, she said: 

I like that they have to accommodate my situation. … I think it’s cool that they can’t force you to take leave because I know [my coworkers and I] typically have to take leave for our pregnanc[ies] … it would be helpful if they didn’t have to dig [into leave] prior to pregnancy or giving birth.  

She also likes that her potential physical limitations don’t need to be disabling for her employer to accommodate her. “I can still do pretty much everything, but my body just started to hurt more as I became farther along … if there were things I could do easier but still have my job and be paid, that would be awesome.” 

Conclusion 

Shalayna’s story gives light into a common problem for Utah’s pregnant and postpartum healthcare workers. Although the healthcare industry does make accommodations, the industry can struggle at times to meet the needs of its pregnant and postpartum workforce. The Pregnant Workers Fairness Act (PWFA) may provide an added push the healthcare industry needs to more directly address its workforce needs. With the PWFA in place, policymakers and businesses across all industries have a newfound opportunity to better understand, and collaborate in response to, the many experiences of Utah’s working women – women who in this particular case make up the majority share of Utah’s healthcare workforce.