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Nurses’ Union Bill Would Set Minimum Staffing Levels For Hospitals

Hospital officials say boosting staffing minimums would lead to increased financial losses and fewer staffed beds for patient care.
Nurses at Legacy Health Good Samaritan Hospital in Portland. | LYNNE TERRY/THE LUND REPORT
November 2, 2022

With Oregon’s hospitals still experiencing widespread nurse staffing shortages, the Oregon Nurses Association on Wednesday announced a piece of legislation it says would help solve the problem.

According to the union, the bill would improve upon existing state law by detailing enforceable minimum staffing standards all hospitals would need to follow and allow the state to issue fines for violations. Existing law calls for hospitals, in collaboration with their nurses, to set their own staffing levels by unit based on patient need.

The bill is slated for introduction in the 2023 Oregon legislative session by Democratic Rep. Rob Nosse, chair of the House Health Care committee.

“The situation is dire, and without action, things will only continue to get worse,” ONA Board President Tamie Cline said. “Hospital management has had years and years to do something — and nurses have been calling for change for years and years — but hospitals have refused to act.”

The Oregon Association of Hospitals and Health Systems issued a statement in opposition to the proposed legislation, saying ONA’s plan, but hurt patients by restricting hospitals’ ability to staff beds for care if they can’t hire more nurses. The claim echoes previous warnings from hospitals and health officials that an inability to staff beds was leading to patient deaths

“Oregon’s community hospitals are experiencing a capacity and financial crisis that threatens patient care. Rather than preserving access to quality health care for Oregon patients, the union’s proposal focuses on new ways to punish community hospitals based on questionable standards, while increasing costs,” said Becky Hultberg, president of the hospitals association. “Under the union’s proposal, community hospitals will have no choice but to reduce access to services if they are unable to hire enough staff, which is very likely given the severe staffing shortage.”

Hultberg said the association said it would be presenting “real solutions” to the staffing shortage during the upcoming session that would not come at “the expense of patients.”

Tensions over workplace conditions have boiled up since the start of the pandemic. In January, Legacy Health nurses posted an online petition to raise awareness of their situation. In July a certified nursing assistant sued PeaceHealth, saying he was fired for protesting low staffing. An Oregon Health & Science University manager recently told a nurse to staff with a “fiscal lens,” not just with an eye toward safety, prompting a complaint.

ONA officials say nurse staffing shortages at hospitals existed before the pandemic, but working conditions became untenable as staffing declined and patient populations grew. 

Now nurses are reluctant to join hospitals or leave more quickly because short staffing is expected, ONA officials said. This problem is perpetuated, they said, by the Oregon Health Authority not enforcing current staffing law or responding to complaints. Hospitals are required to report to the state the staffing ratios set for different units and shifts.

ONA’s legislation would set those minimum ratios based on patient need. For example, the draft bill proposes one nurse for every three non-trauma patients in an emergency department, while in a psychiatric unit only one nurse for every five patients would be required.

Oregon would be among the first states to have such provisions. So far only California and Massachusetts have legally mandated nurse-to-staff ratios, and in Massachusetts they apply only to intensive care units.

Other details released Wednesday include how the bill would change enforcement of the law and accountability to the public. 

If passed, the bill would allow health care workers and health care worker unions to file civil lawsuits over violations of the bill, would subject facilities out of compliance with any portion of the law to fines of $10,000 per violation per day, would create an online portal for staffing complaints, would ensure complaints are subject to public records law, and would ban revisions to staffing plans without input from a nurse staffing committee.

It would also make rules around required meal and rest breaks, which are often skipped due to the requirement that another nurse must cover a colleague’s patients if they are to go on break. Hospitals would be fined $200 per missed meal or rest break for direct care staff. 

“Our current nurse staffing law is good legislation that should be working, except for the fact that hospitals consistently and willfully ignore the law and (Oregon Health Authority) consistently fails to enforce it,” said Matt Calzia, ONA’s director of nursing practice and professional development. “This new legislation gives our existing law teeth, and adds new crucial components to address nurse turnover, burnout, and patient outcomes.”

The 2023 session of the Oregon Legislature starts Jan. 17.

You can reach Connor Radnovich at  [email protected] or via Twitter @CDRadnovich.