Oregon Nurses Association pushes for stricter hospital staffing law

The Oregon Nurses Association is pushing for minimum standards that establish how many nurses hospitals need to operate and meet patients’ needs effectively. 

The union, which represents 15,000 nurses, on Wednesday released details of legislation it plans to pursue in the 2023 session. Oregon already has a law that requires hospitals and nurses to develop staffing plans to best meet the needs of patients. 

But the union says the existing law needs a stronger enforcement mechanism and steep fines to hold hospitals accountable when they try to skirt staffing requirements. Staffing standards ultimately are about patients, including their level of medical attention and other care they get such as prompt meals and help to the restroom. 

The push for better hospital staffing comes after a two-year pandemic burned out many nurses who endured in understaffed hospitals where the quality of care deteriorated. 

“We live with the terrible consequences of unsafe staffing levels every single day,” Tamie Cline, a registered nurse and president of the Oregon Nurses Association’s board of directors, said in a press conference. “We are forced to pick up extra shifts and work longer hours without rest or meal breaks. Managers assign us unmanageable and unsafe numbers of patients. We leave work feeling exhausted, physically and emotionally, because we are just not able to deliver the quality of care that our patients, and our communities, deserve.” 

Hospitals have faced nursing shortages for more than two years that have affected patient care, nurses have told the Capital Chronicle. Sometimes the consequences have been dire, with patients dying because of a lack of staff, Patrick Allen, Oregon Health Authority director, told a legislative committee in September.

The trade group that represents hospitals, the Oregon Association of Hospital and Health Systems, has said more needs to be done. But it opposes the proposal and warned it threatens access to patient care and is punitive for struggling hospitals.

“Rather than preserving access to quality health care for Oregon patients, the union’s proposal focuses on new ways to punish community hospitals based on questionable standards, while increasing costs,” Becky Hultberg, president and CEO of the Oregon Association of Hospitals and Health Systems, said in a statement. “Under the union’s proposal, community hospitals will have no choice but to reduce access to services if they are unable to hire enough staff, which is very likely given the severe staffing shortage.” 

Proposal Details 

The proposal, backed by Rep. Rob Nosse, D-Portland and chair of the Interim House Health Care Committee and a former nurses association lobbyist, would set minimum figures for how many nurses should be on different types of hospital units. 

From there, nurses and hospital management would set staffing standards based on factors unique to each hospital, such as the acuity of patients and experience of nurses on staff.

The proposal includes:

• The Oregon Health Authority would be required to enforce staffing plans and could levy fines of up to $10,000 a day. The authority didn’t respond to a request for comment.
• Unions and individual employees could sue hospitals in court for violations.
• Staffing plans would require nurses to have adequate meal and rest breaks.
• Minimum staffing standards in the law would set a floor for hospitals. But hospitals and staff would still be expected to collaborate on a plan that looks beyond the minimum standards. For example, an intensive care unit would have at least one nurse for one or two patients, depending on the patient’s conditions.

Allison Seymour, a registered nurse in Salem and secretary of the Oregon Nurses Association, said the improvements would encourage people to return to nursing who, like her, suffered when workloads were unsustainable.

“I carried the guilt of delays in care and missed care,” Seymour said. “I would go home wondering if my patients were going to survive the night. Unsafe workloads made me feel my license was in jeopardy. I developed overwhelming anxiety trying to juggle an unsafe workload, trying to care for everyone at once with the care they deserve.” 

Workforce Crisis 

The nurses union said the shortage of nurses is about retention amid poor working conditions – not the actual number of licensed nurses in Oregon.

The number of licensed registered nurses in Oregon increased from nearly 63,000 in January 2019 to 80,000 in September, an increase of more than 17,000, according to the Oregon Board of Nursing licensing data. 

Those figures only reflect licensed nurses in all situations, not all those employed. Licensing figures also reflect other factors, such as nurses who keep their license and move to another state or retire and only work part-time.

Still, the rise demonstrates that turnover is at the root of the problem, union officials said.

“Everyone must remember that hospitals are the authors of this crisis due to turnover; we know nurses are leaving the bedside at record rates because they are unwilling to work in unsafe and unsupportive environments,” said Matt Calzia, director of nursing practice and professional development for the Oregon Nurses Association. “Fix the working environment, and you fix turnover.”

Calzia noted that the level of increase is equal to the union’s 15,000-worker membership. 

The nurses union said an increase in staffing will improve patient outcomes, help them avoid life-threatening complications and reduce expensive turnover for hospitals.

Hultberg, with the hospitals association, said the group will propose other solutions to address the workforce needs and benefit patients.

In September, the Legislature’s Emergency Board approved a $40 million request from the health authority and the state Department of Human Services for hospitals that coordinate care in Oregon’s six hospital regions, clinical staff to coordinate patient transfers and money to hire 50 more contract nurses. That money is only a temporary fix and state officials say a permanent solution is necessary so hospitals have adequate staffing and the capacity to treat patients at all levels of care.