COVID-19 pushed hospitals into a crisis, with nurses reaching a breaking point as the pandemic dragged on. They also faced surges of other respiratory illnesses like influenza and respiratory syncytial virus, or RSV. Patients paid a price, with long emergency room waits and delayed care while burned out nurses fled the field.
The state’s largest nurses union and hospital industry agree that Oregon needs more nurses but they disagree on how the state should fix the problem. The Oregon Nurses Association, which represents about 15,000 nurses, wants a bill passed this session that would establish minimum staffing standards and levels in law for each part of a hospital, including emergency care and intensive care units.
“We are wanting Oregonians to know that when they walk into the door, they are having way less turnover and therefore experienced care teams at their side who are not burned out, who do not feel unsafe,” said Paige Spence, director of government relations for the Oregon Nurses Association. “The ultimate goal here is improving patient care and patient knowledge that they are able to get better outcomes.”
Nurse staffing is not determined by state law. Rather, nurses and nurse managers are required to work together in staffing committees on plans that establish how many nurses are needed in each part of hospitals.
The Oregon Association of Hospitals and Health Systems, which represents all hospitals in the state, said staffing requirements set in state law would take a wrong one-size-fits-all approach. The group, in a statement to the Capital Chronicle, said that other solutions deserve a look, such as state funding and incentives awarded to hospitals that offer clinical training programs and state tax credits to nurse educators.
Oregon nurses proposal
The nurses union is backing House Bill 2697, which is sponsored by Rep. Rob Nosse, D-Portland, and Sen. Deb Patterson, D-Salem, the chairs of the House and Senate health care committees.
The bill would:
- Require the Oregon Health Authority to enforce hospital nurse staffing plans, with fines of $10,000 a day for violators. The health authority would be required to set up an online portal to receive complaints. Nurses could also sue hospitals in civil court if plans aren’t followed.
- Set minimum standards for hospital staffing. For example, a registered nurse in an emergency department would have no more than three patients without a life-threatening critical condition, or just one critical care patient. An intensive care unit nurse would have one or two patients, depending on their condition. That’s just the minimum, though. Nurses and hospital managers could negotiate stricter standards in staffing plans.
- Establish technical staffing committees in hospitals for other health care workers such as radiography technicians, respiratory therapists and others.
Spence, of the Oregon Nurses Association, said the standards would not apply during crises that send large volumes of patients to the hospital, like natural disasters or mass shootings.
Nosse and Patterson said the nursing workforce shortage is one that will need a variety of fixes, from nurses and hospitals.
Besides the nurses’ proposal, Nosse said that lawmakers will give serious consideration to ideas from industry.
“I’m for sure going to give them a hard look, and then we’ll see how things land with improving staffing,” Nosse said.
Hospital opposition
The Oregon Association of Hospitals and Health System plans to push separate legislation that would also address staffing. The group plans to talk more about its proposals in a press conference on Wednesday.
Lisa Goodman, the association’s vice president of communications, said it agrees that staffing is a problem.
“The staffing shortage is leading to longer wait times for care in emergency departments and for available beds in the hospital, and the bed shortage has forced the transfer of some patients away from their nearest hospital,” Goodman said. “The inability to discharge patients means hundreds of patients every day are not receiving care in the best clinical setting for their needs.”
She said hospitals have faced higher labor costs and suffered financially, leading to cuts that affect patient care.
But she said one solution for Oregon’s 60-plus hospitals, which range from large Portland-area systems to small rural facilities, is a bad idea and could backfire on patients.
“We’re worried this could force some hospitals to cut services if they are unable to meet the bill’s proposed staffing standards, which is a very real possibility given the nationwide health workforce shortage. We need a law that is clear, flexible and creates accountability.”
Goodman said there is “no quick fix” to rebuilding the health care workforce and solutions will need collaboration from people throughout the system.
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