Hospitals and Nurses Disagree Over How Many Patients Each Nurse Can Juggle

Two powerful forces battle in Salem over staffing ratios.

Bill of the Week: House Bill 2697

This bill, which would require nurse staffing ratios, is among the most hotly contested health care bills of the session.

The Oregon Nurses Association is a powerful voice in Salem, while the state’s 60 hospitals, represented by the Oregon Association of Hospitals and Health Systems, are pillars of communities across the state. The prospect of staffing ratios has them at loggerheads.

Nurses say COVID-19 decimated their profession, particularly hospital-based nurses. For their part, the hospitals say they face perilous financial conditions that would worsen under mandatory staffing.

“The minimum staffing required by the bill will further constrict hospitals that are already experiencing a capacity crisis,” Jennifer Gentry, Providence Oregon’s chief nursing officer, testified Feb. 28. “The net impact is that fewer individual patients can be served in Oregon hospitals.”

Chief sponsors: State Reps. Rob Nosse and Travis Nelson (D-Portland) and Sens. James Manning (D-Eugene) and Deb Patterson (D-Salem).

What it would do: Establish minimum staffing ratios for nurses and nursing assistants. In hospitals, for example, nurses could be assigned to care for one to six patients, depending on the unit and severity of patients’ conditions. Although nurses and hospitals currently collaborate on staffing, the bill sets specific ratios and includes two provisions to put some teeth in the quotas: Nurses could sue if hospitals fail to meet specified levels, and the Oregon Health Authority could levy fines of $10,000 a day for noncompliance.

Problem it seeks to solve: Nurses and hospitals agree there is currently a shortage of nurses in Oregon. Nurses left their jobs in droves over the past three years for a variety of reasons: unsafe working conditions, overwork, and a lack of child care. That led hospitals across the state to pay itinerant nurses two or three times what they pay staff nurses.

The Oregon Nurses Association say insufficient staffing burns out nurses and imperils patients. The union argues there are enough trained nurses in the state to meet demand—and adds that they won’t come back to work unless hospitals agree to staffing ratios.

“I have been working on safe staffing legislation since 2001,” testified Bruce Humphreys, an ONA member from Bend. “And while we have made progress, our currently staffing law does not provide enough enforcement incentive to make hospitals in Oregon take staffing seriously.”

Who supports it: The Oregon Nurses Association and its organized labor allies. Nosse, the chair of the House Committee on Behavioral Health and Health Care and a former nurses’ union employee, says the bill should fix a long-festering problem. “We’ve tried for the past 25 years to have staffing committees work this issue out,” Nosse says, “but we really don’t have it worked out.”

Who opposes it: The Oregon Association of Hospitals and Health Systems. Several of its members testified at a Feb. 28 public hearing on the bill. They noted that California, which long ago put staffing levels into statute, is also suffering a nursing shortage. (Research from California shows more staffing improves nurses’ working conditions. Results on patient outcomes are mixed.)

Adding new mandates with expensive penalties would rob hospitals of flexibility without making the situation better, hospitals say. “We agree the current nurse staffing law is not working, but we cannot support HB 2697 as currently written,” says Lisa Goodman, a spokeswoman for the association. “We need a new law that supports the hospital workforce, preserves access to care, and acknowledges the dynamic, local environment of hospitals and the staffing shortages they face.”

The hospitals and the unions are now negotiating furiously behind closed doors to find a compromise.

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