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Nurses union sees snag with hospital staffing law about to take effect

After pushing for the new nurse-to-patient ratios, the union is concerned by the state's proposed rules dictating how they’ll play out in emergency departments
April 11, 2024

This story has been updated with comment from the Oregon Health Authority. 

Less than a year after the Oregon Legislature approved a hard-fought compromise law dictating staffing levels for nurses and other staff at hospitals, the Oregon Nurses Association is worried that the Oregon Health Authority may be messing it up.

The state agency has been going through the process of drafting rules to  implement a key part of a law, which limits how many patients hospitals can assign to nurses for care at one time.

But on March 20, after an initial set of draft rules were released, the nurses association joined with the Hospital Association of Oregon and the Service Employees International Union to send an unusual set of joint comments that, among other things, requested an additional process to ensure the rules for emergency departments are clear and workable.

Since then, the agency is finalizing the rules and put them out for one final round of public comment. And the Oregon Nurses Association is concerned that because the agency did not heed the joint request, the latest set of rules will leave hospitals and nurses confused about staffing requirements for emergency departments. 

“It’s a huge issue for us,” Paige Spence, lobbyist for the nurses union, told The Lund Report when asked about its concerns. 

The rules pertain to House Bill 2697, a bill lawmakers passed in 2023 in response to burnt-out nurses leaving the profession because of chronically understaffed hospitals. Beginning June 1, hospitals will have to follow patient-to-nurse ratios. 

However, emergency departments have more complicated requirements than other hospital units. The law specifies that an emergency department nurse cannot be assigned more than four non-trauma patients on average over a 12-hour shift and no more than five at a time.

Spence said that calculating that average may seem like a simple math equation, but it's complicated by the question of when a patient is deemed under the care of an emergency department nurse. 

The staffing ratio is measured based on patient records indicating the unit they've been assigned to. 

In real life, however, a patient may be admitted and assigned to a hospital’s intensive care unit — but have to wait in the emergency department under a nurse’s care, said Spence. 

“The practical effect,” she said, “is hospitals won’t know how many nurses they need to staff because you’re not sure who all the ratio applies to in terms of the patients.” 

Enforcement of the new law is based on complaints from staff. Spence said emergency department nurses could be potentially confused about when to complain and when they could decline additional patients. 

The health authority convened an advisory committee last year to provide input on regulations for the staffing law. The committee included representatives of hospitals, unions and government agencies. 

Health authority spokesperson Jonathan Modie told The Lund Report in an email that agency staff had sought wide input from labor unions, the hospital association, the Oregon State Board of Nursing and others. By the time the rules were posted for public comment, there was no "suggested consensus language" on the issue from members of the advisory committee, Modie wrote. 

He added that "these rules will be subject to further amendments in future rulemaking as we all learn more about the application of the new law." 

During a March meeting, members of the committee raised the possibility that Oregon’s nursing standards would complicate the implementation of the staffing law. Speakers pointed out that if a nurse begins treating a patient in an emergency department they’re legally responsible for their care until they are handed off. 

Dana Selover, a health authority manager overseeing the meeting, responded by saying that the law allows but doesn’t require the regulations on emergency department staffing ratios. She said she realized that the regulations might need an update after going into effect. 

Spence said the nurses union does not have a firm answer on how to calculate the average and that it will require further conversations to resolve. 

The Hospital Association of Oregon initially opposed the bill, but supported the staffing law compromise as part of a larger deal with the union

When asked for comment on the regulations and concerns from unions,  Sean Kolmer, hospital association executive vice president of external affairs, responded to The Lund Report in a statement, “We’re committed to working closely with that coalition through the rulemaking process to advocate for rules that will have the effect intended by the law.”

The health authority is planning to hold a public hearing on the rule on April 16 and will accept written comments until April 22. 

You can reach Jake Thomas at [email protected] or via @jakethomas2009.