As nursing shortage in Oregon continues, legislators plan a remedy

A proposal in the Legislature aims to address the nursing shortage in Oregon, which has put quality care at risk, advocates say.

As many as 350,000 people are hospitalized in Oregon every year, 1.3 million seek emergency room treatment and 13 million are treated as outpatients. 

Nurses are also critical to providing care in medical clinics and long-term care facilities.

Advocates say the lack of nurses can lead to mistakes and poorer quality care.

House Bill 4003 aims to alleviate the nursing shortage by allowing students to treat patients under the supervision of a registered nurse and perform other tasks, giving registered more time to do their job. The proposal would create a nurse intern license for students who’ve had at least a term of nursing instruction and pass a skills test. Supporters say their presence would free up experienced nurses, giving them more time to ensure that patients get appropriate care.

“I think it could be a big help to the nursing workforce, both in terms of education and practice,” Jana Bitton, executive director of the Oregon Center for Nursing, which conducts research and advocates for nurses, said in an email. “It opens up opportunities for workplaces to integrate nurse interns into their staff, which could alleviate staff shortages in some situations.”

The influential Oregon Nurses Association, which represents 13,000 of the 72,000 registered nurses licensed in Oregon, also supports the bill.

“It’s not a panacea but it will provide an on-ramp to the nursing profession and add qualified students to the health care team,” said Kevin Mealy, a spokesman for the association. “Licensed nurse interns can gain invaluable hands-on experience while supporting patients and nurses at the bedside and behind the scenes.”

The proposal won unanimous approval from the House Health Care Committee last week and moved to the Joint Committee on Ways and Means, which decides budget issues. 

Besides creating a new license, the bill would add nurses to a program that provides therapy sessions. The Oregon Wellness Program now offers free, confidential counseling sessions to doctors, physician assistants, nurse practitioners, podiatrists and dentists. The House bill would expand the program to registered nurses. 

The program, which would cost an additional $700,000 to include nurses, offers eight free, one-hour therapy sessions a year with professionals. The program is confidential, which employee assistance programs are not, and appointments are guaranteed within 72 hours. 

Though employer insurance plans cover mental health treatment, there are usually co-pays and it usually takes time to get an appointment.

Nursing educators like Bitton also support the bill because it would also widen the nursing pipeline. In 2018, the Oregon Employment Department said the state would need to add 2,600 nurses a year to replace those leaving and fill new positions created by health care expansion. But in 2019, fewer than 1,600 new graduates entered the workforce. 

“Right now we’re seeing a delay in graduation because of a lack of clinical support,” Rep. Rachel Prusak, D-Tualatin, said in a forum before the session started. Prusak was a nurse for 20 years and has been a nurse practitioner for 14. 

As chair of the House Health Care Committee, she proposed the bill after meetings with nurses, hospital and long-term care administrators and nursing educators. 

“I have watched this really up close,” Prusak said. “It is really personal to me.” 

Idaho and Washington already have nurse intern licenses. Prusak said establishing such a license in Oregon is an easy first step.

“It will be one part of the many things we have to do moving forward,” Prusak said.

The proposal would allow schools to grant credit to students for clinical experience. It also would expand the types of facilities that can use out-of-state nurses on a temporary basis and extend the time they’re allowed to practice in Oregon from one month to three months.

The Oregon Association of Hospitals and Health Care Systems supports the bill, as does the Oregon Primary Care Association, which represents 34 clinics serving low-income Oregonians.

“HB 4003 is a bill that reflects Oregon’s ability to be a leader in health care, and we appreciate that it has clear and predictable steps to start to address the problem,” Andi Easton, vice president of government affairs of the hospital association said in written testimony. “We specifically appreciate the effort to provide a bridge to quickly employing nonresident RNs in good standing in other states to work temporarily in Oregon hospitals.”