A measure that attempts to ease hospital staffing shortages and improve working conditions is halfway through the Oregon Legislature after nurses, unions and hospitals worked on a compromise for months.
The legislation cleared the Oregon House on a 48-9 vote on Wednesday, June 14, and went to an uncertain fate in the Senate, where a Republican walkout since May 3 has stymied Democrats from the two-thirds majority required for it to conduct business and take votes. The 2023 session is scheduled to end June 25.
House Bill 2697 was easily the most complex of a three-bill package intended to deal with staffing shortages, which were made worse by the coronavirus pandemic. According to a survey last year by the Oregon Center for Nursing, which focuses on workforce issues, 68% of those who responded specified physical and mental exhaustion — largely because of too many patients and not enough staff.
For the first time in any state, the Oregon legislation writes into law specified ratios of nurses to patients in 12 types of hospital units. For example, in the emergency room, nurses are limited to an average of four patients per 12-hour shift — and a single nurse cannot have more than five patients. It also ends the buddy system, under which a nurse yields patients to another nurse who already has assigned patients.
Oregon already has such ratios, which are determined by nurse staffing committees of managers and workers set up under previous laws.
This legislation creates new staffing committees within hospitals, one for service and maintenance workers, the other for professionals and technicians other than nurses.
Rep. Rob Nosse, a Democrat from Portland who leads the House health care panel, said major credit for the legislation goes to those who negotiated it despite initial differences.
“Ultimately, I believe it will provide for better patient care and working conditions,” said Nosse, also the bill’s floor manager. “A lot of compromises were made on both sides by the hospitals and the various unions that represent the workers to get to consensus. Now it’s our job to see their work through and pass this bill. I am optimistic that passage … will bring about better staffing retention in our health care workforce and better patient care.”
The ratios within the legislation do not apply to psychiatric units, including the Oregon State Hospital, where staffing committees must draw up their own plans.
Oregon’s smaller hospitals — known as Type A and B for their Medicaid reimbursement status — can apply for two-year waivers from the Oregon Health Authority. All of the 32 hospitals are outside the three Portland metro counties.
The legislation also sets thresholds for hospital violations of required meal breaks and rest periods, which will be enforced by the state Bureau of Labor and Industries. If the number of violations exceeds six during shifts in any rolling 30-day period, the hospital must pay the worker $200 for a missed break. There is a 60-day time limit for violations to be reported.
Oregon Health Authority will have to write rules for three topics — meal breaks and rest periods, nurse-patient ratios in the emergency room, and the investigation process for complaints — and is empowered to levy penalties starting June 1, 2025.
“This should make the law work better for all sides, including the Oregon Health Authority,” Nosse said.
Nosse said major credit goes to Oregon Nurses Association and Service Employees International Union — Nosse has worked for both — plus the Oregon Federation of Nurses and Health Professionals, American Federation of State, County and Municipal Employees, and the Oregon Association of Hospitals and Health Systems. He singled out Providence Health & Services, Oregon Health & Science University and Salem Health.
“I think the clarity that ratios will bring, with appropriate exceptions, will make the process of figuring out staffing on a unit less contentious and a lot easier,” Nosse said. “I also think it’s a good thing that other members of the care team who do important work but are not nurses will have input into their staffing and be able to work it out with their employer as well.”
In exchange, the hospitals won union support for prior passage of House Bill 2045, which would exempt growth in total employee compensation from an existing law seeking to limit annual increases in health-care costs to 3%. That bill, which the House passed 54-0 in May, also awaits Senate action.
A third bill (House Bill 3396), which awaits a vote in the House, would set aside $27 million for a study of post-hospital treatment once patients are discharged from hospitals.
“I may still not like the strict nurse-to-patient ratios,” said Rep. Charlie Conrad, a Republican from Dexter who opposed the initial version of HB 2697 in the House health care panel. “But I do appreciate the approach the stakeholders have taken in making this bill part of a comprehensive approach, along with the other negotiated components of a workforce package that this House has already passed.”
Rep. Kevin Mannix is a Republican from Salem whose wife, Susanna, is a registered nurse at Salem Hospital run by Salem Health. Though he voted for the bill, Mannix said, lawmakers also must keep funding for hospitals in mind.
“There is a lot of micromanagement here. But it is for good reason,” Mannix said. “We need to ask what it is we can do to bring in the staff they need.”
Rep. Travis Nelson, a Democrat from North and Northeast Portland, is a nurse himself and a sponsor of the bill.
“This bill will provide much needed relief not only for nurses but also all allied health care workers,” Nelson said. “I know many health care workers who have made the painful decision to leave the profession in recent years because they just can’t take it anymore.”
“Oregon is facing a hospital staffing crisis and the heart of the crisis is turnover,” he added. “This is a work environment crisis as much as it is a staffing crisis. Frontline health care workers should not and will not continue working under conditions where management has not provided enough staff.”
