Oregon House Passes Bill Regulating Nurse Staffing Levels For Pandemics

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Oregon House lawmakers on Friday passed a bill that puts more oversight in place for hospital nurse staffing plans during long-term emergencies like the COVID-19 pandemic. 

House Bill 3016 aims to guide nurse safety and staff needs at hospitals during national and state emergencies. Opposed by some hospital systems, the bill passed 32-17 on a party-line vote in the Democratic-controlled House and now goes to the Democratic-controlled Senate. 

The legislation would change hospital nurse staffing plans during an emergency. Currently, hospitals can suspend nurse staffing plans and legally don’t need to follow them when an executive order from the governor declares a state emergency. Those staffing plans stay suspended until the executive order is lifted and the emergency ends. The suspension of nurse staffing plans during the yearlong pandemic spurred the legislation, amid concerns about staffing shortages and burnout among frontline health care workers.

The bill’s aim is to give hospital nurses a voice during long-term emergencies that force changes to normal routines and staffing plans. A number of Oregon hospital systems oppose the bill, however, saying they need flexibility during a pandemic or other emergency.

Under the bill, hospitals that deviate from nurse staffing levels during an emergency must develop contingency plans and crisis care standards. The bill aims to address issues like staff shortages and overtime and give employees a voice when staffing levels need to change amid emergencies. A hospital would need the approval of its nurse staffing committee when it deviates from its regular nurse staffing plan for more than 90 days. Each hospital’s nurse staffing committee is composed of a mix of nurses and administrators. The bill also requires hospital administrators and staffing committees to meet within 30 days of emergency to start collaboration on staffing plans.

Bill Would Give Nurses A Voice During Pandemics

“Nurses are the backbone of the healthcare industry and work endless hours, even risking their lives to care for Oregonians most affected by the COVID-19 pandemic,” said bill sponsor, Rep. Rob Nosse, D-Portland, in a statement.“HB 3016 ensures that nurses will have a voice on staffing during a disaster or a pandemic so they can advocate for the quality care patients deserve.” 

The bill builds upon thes state’s past work to address nurse staffing levels in hospitals and give employees a say in the process. In 2015, Oregon lawmakers passed Senate Bill 469, which requires each hospital to establish a nurse staffing committee to develop a hospital-wide staffing plan adequate to meet patient needs. That legislation also put in place the 12-member Nurse Staffing Advisory Board, which gives the Oregon Health Authority advice about how to administer and enforce staffing plans. The authority also has the ability to conduct surveys and work with hospitals on plans to correct deficiencies.

“This legislation is crucial to the wellbeing of both our healthcare workers and patients,” said Rep. Rachel Prusak, D-Tualatin/West Linn, and a nurse practitioner. “I’ve been on the frontlines of healthcare during this pandemic and when I say this is a matter of life or death, I’m not exaggerating. Nurses bear the majority of patient care, making our voices indispensable when it 

comes to planning staffing needs and safety requirements.” 

The 15,000-member Oregon Nurses Association labor union has said the bill is necessary so that staff committees have a voice during long-term emergencies. 

“One of the most important lessons we’ve learned during COVID-19 is that hospital administrators need to come together with nurses to collaborate on safe staffing levels during an emergency,” said Travis Nelson, a registered nurse and a member of ONA’s Cabinet on Health Policy, in a statement after the House vote. “Oregon’s nurses are leading our pandemic response while providing outstanding care to patients on the frontlines. We know firsthand what our community needs to stay safe and how to avoid the harm that comes when there aren’t enough nurses to care for the people counting on us.”

Hospitals Say Current Process Works Well

Hospitals have voiced concerns that the bill would remove their flexibility to make nimble decisions during long-term emergencies.

 In prior testimony to lawmakers, the nurses association said that without any changes, nurse staffing plans are suspended during an emergency until an executive order declaring the emergency over. 

“At the time, no one envisioned a pandemic that could keep an executive order in place for a year or more,” Deborah Riddick, director of government relations for the Oregon Nurses Association. “We now know different and need to update the law to ensure collaboration on a flexible, facility-based contingency plan is developed by nurses and administrators. Our nurse staffing committees are a national model that should be utilized, especially during times of crisis to ensure predictability and efficiency in process.”

Several hospitals oppose the bill, including Columbia Memorial Hospital, an independent non-profit facility in Astoria. Judy Geiger, the hospital’s vice president of patient care services, told lawmakers that Columbia Memorial’s nurse staffing committee met weekly during a COVID-19 surge to monitor staffing and made collective decisions about when to start meeting again if the patient census rose. 

“This process worked very well,” Geiger wrote to lawmakers. “We do not need a law to assure that this happens. The mechanism is already in place. This bill is very worrisome. During a state of emergency, we need more not less flexibility to get the job done and care for patients. As we respond to COVID-19, many regulations have been streamlined to reduce barriers to care and to assist in quickly addressing the immediate needs of our patients.”

Corvallis-based nonprofit Samaritan Health Services, which has five Oregon hospitals, also voiced concerns about the bill, saying hospitals need to adjust rapidly during acute crises.

“Attempts to force unnecessary collaboration on a problem that is difficult itself to identify would create an additional and unnecessary barrier between caregivers and leadership,” the provider told lawmakers. “We focus as a team on providing the best staffing and care plans and are already working together to determine how to best meet the needs of our community.”

Salem Health also voiced concerns for similar reasons. The Salem provider told lawmakers it took steps during the pandemic to give employees a voice, such as pulling nurses into daily incident command huddles to get their feedback. 

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.

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