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Unions, hospitals strike larger deal around minimum staffing compromise

Compromise on nurse-to-patient ratios includes union support for other hospital-backed bills
A health care worker pushes a gurney passed other workers in blue scrubs inside a hospital through a corridor.
Inside Good Samaritan Hospital in Portland. | LYNNE TERRY/THE LUND REPORT
March 28, 2023

A newly announced compromise between Oregon labor unions and the state hospital association over a minimum staffing levels at hospitals includes reduced penalties and more flexibility for management and staff.

And as part of the deal, unions will back other bills on hospitals' wish list.

The outline of the agreement was revealed Tuesday evening in a joint statement issued by the Oregon Nurses Association, the Oregon Federation of Nurses and Health Professionals and Service Employees International Union Local 49 (SEIU) and the Oregon Association of Hospitals and Health Systems. 

The compromise followed months of lobbying, committee hearings and behind-the-scenes talks over one of the most consequential health care bills of the 2023 legislative session. House Bill 2697 was spearheaded by the Oregon Nurses Associa tion, a large and politically active union, as a fix for what nurses and other frontline health care workers have described as intolerable working conditions brought on by the pandemic. 

The unions and the hospital association in a statement described the compromise as making “historic advances towards safe hospital staffing and quality patient care throughout the state” that will “put Oregon at the forefront of hospital staffing laws in the nation.” 

As introduced, the nurses union bill required hospitals to form committees comprised equally of managers and staff to write staffing plans. If the committee came to a stalemate after 90 days of mediation, the hospital would have had to adopt a staffing plan meeting a statewide minimum patient-to-registered-nurse ratio that varied by unit. Hospitals could be hit with $10,000 fines each day they’re below staffing levels, as well as face civil lawsuits from their employees. 

No amendments to the bill had been posted online as of Thursday morning. But testimony provided by representatives from the groups during the Tuesday hearing of the House Behavioral Health and Health Care Committee revealed details about the compromise. 

The amended bill would shift enforcement from the current system of Oregon Health Authority surveys and audits to a complaint-driven process, while making penalties gradually stiffer for each violation and allowing exceptions for smaller hospitals. 

Matt Swanson, lobbyist for SEIU 49, which represents hospital workers and caregivers, told the committee the amended bill means employees will be involved in  “wall-to-wall staff planning” in hospitals. 

“With the passage of House Bill 2697, all workers on the care team will have a clear and resounding voice in hospital staffing,” he said. “New committees for professional and technical workers like respiratory therapists or imaging techs and service workers like dietary environmental service workers and nursing assistants, and many others will now have a voice in safe patient care.”

Swanson said the amended bill no longer allows workers to sue hospitals for violations but requires employers to pay a penalty of $200 to each worker who misses a meal or rest break. Hospitals that don’t adhere to staffing plans agreed to by the newly created committees would be fined $2,500 for the first violation and $5,000 for repeated violations, he said. They could also be fined $500 for not releasing staff to participate on staffing committees. 

Paige Spence, director of government relations for the Oregon Nurses Association, told the committee the amended bill will allow some flexibility for hospitals, particularly those in rural areas. She said staffing committees could agree to allow staff-to-patient ratios to go below the statewide minimums as an “innovative care model” with the addition of licensed practical nurses and certified nursing assistants to the staffing mix. 

Spence outlined the amended bill’s ratios, which she said are based on standards developed by national professional associations. 

They include one nurse for every trauma patient, as well as one nurse for four oncology or cardiac telemetry patients, she said. In emergency departments, the ratio will be one nurse for every one non-trauma patient that will be averaged out over the shift so that a nurse isn’t taking on more than five patients. The legislation will also set staffing ratios for certified nursing assistants. 

The ratios will be phased in beginning in June 2024 and enforcement wouldn’t start until the next year, she said. 

The hospital association had previously warned that the nurses union bill was unworkable and would lead to a cutback in services. Becky Hultberg, the hospital’s president and CEO, expressed gratitude for the compromise in the statement. 

 “The bill supports our hardworking frontline staff and reduces many of the administrative burdens hospitals currently face,” she said. 

Meghan Bours Slotemaker, executive vice president and general counsel for the hospital association, told the committee the amended bill will give hospitals the chance to show they took “reasonable efforts” to avoid civil penalties before they are penalized and they can apply for variances to staffing ratios. 

Andi Easton, the hospital association’s vice president of government affairs, told the committee that as part of the agreement, the labor unions would support legislation spending $40 million to further address staffing shortages. The deal also includes union support for a bill that will allow hospitals to avoid being penalized for not meeting the state’s health care cost growth target as a result of hiring more workers, she said. Additionally, the unions will back legislation intended to ease the discharge logjam hospitals are facing, forcing them to board patients who no longer need hospital care. 

Spence said that workforce development dollars won’t help with the immediate problem of nurses stepping back from the profession. 

“This is a nurse retention bill to keep the nurses who are at the bedside,” she said. “We are hemorrhaging nurses out the back door of a hospital far faster than we can bring them in.”

The bill’s amendments will also set up staffing committees for other hospital care providers including respiratory therapists, psychologists, pharmacists, environmental services workers and others, according to the statement. 

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