The Oregon Nurses Association on Wednesday announced details of a bill it plans to introduce in the 2023 legislative session that would mandate certain nurse-to-patient ratios in hospitals.
It would include stiff penalties for hospitals that fail to meet the new standards. And it would allow nurses and their union to file civil lawsuits against hospitals that do not comply.
With hospitals staunchly opposed to the proposal, the debate over the policy will be one of the health care focal points of the upcoming legislative session. A similar proposal that went before Massachusetts voters in 2018 failed after a fierce public debate over the potential cost.
If Oregon were to pass the proposed bill, it would be one of just three states to regulate how many patients can be assigned to a given nurse. California is currently the only state with mandated nurse-to-patient ratios. Massachusetts mandates staffing ratios for intensive care units only.
The draft legislation here comes after months of conflict between the statewide nurses union and hospitals over how to manage staffing shortages, deteriorating working conditions and hospital overcrowding. The problems have persisted — and hospitals have posted steep financial losses — even as COVID-19 hospitalizations have decreased.
In September, lawmakers approved more than $40 million in emergency funding to mitigate staffing and bed shortages in hospitals and long-term care.
Nurse Danielle LaRocco carries an oxygen tank to the room of a COVID-19 patient on the acute care floor at Salem Health in Salem, Ore., Jan. 27, 2022. Some hospitals are feeling the strain due to the recent surge of coronavirus, such as Salem Health, which had had 540 patients, but only 494 beds available.
Kristyna Wentz-Graff / OPB
Rep. Rob Nosse (D-Portland), a former ONA union representative, will introduce the legislation.
At a press conference unveiling the legislation Wednesday, ONA nurses described the personal consequences of having to care for more patients at one time than they could handle.
Systemic short staffing, they say, has made it difficult to take rest and meal breaks during their 12-hour shifts. And they say it is contributing to nurse burnout and high levels of turnover and the risk of violence from frustrated patients.
“Like when a patient tried to stab me over a cold breakfast,” said Allison Seymour, a registered nurse from Salem and ONA’s board secretary who said she left bedside nursing a year ago due to burnout.
“I felt betrayed when I was called a hero,” she said. “Patients were not getting their basic needs met. There were delays in getting meals, delays in going to the bathroom. People weren’t getting baths.”
According to ONA, the turnover rate for registered nurses was 27.1% in 2021.
Oregon law requires hospitals to follow staffing plans they develop in collaboration with their nurses. ONA representatives said that law has not worked during the pandemic, in part because the Oregon Health Authority has been unwilling to enforce it.
“By and large, complaints go completely unanswered,” said Paige Spence, ONA’s director of government relations.
The Oregon Association of Hospitals and Health Systems opposes the proposal and described it as an effort on the part of the union to “punish” community hospitals.
According to Becky Hultburg, president and CEO of the hospitals association, some Oregon hospitals will be unable to hire enough nurses to meet the standards ONA has proposed and would have no choice but to cut their services if the proposal becomes law.
“That means longer wait times in emergency departments, a reduced number of hospital beds, delays in scheduled procedures, and delays in transferring patients from rural hospitals to urban ones when they need a higher level of care,” Hultberg wrote.
The hospital association will propose its own solutions to the workforce crisis in the upcoming legislative session, according to Hultberg. Those include efforts to grow nursing schools by offering a tax credit for nurse educators and incentives for hospitals to provide clinical placements for nursing students. The hospital association will also propose expanding an incentive program for nurses that includes student loan repayments and compensation for moving costs.
The ratios in ONA’s draft proposal vary based on hospital unit and the type of patient receiving care. For example, in the labor and delivery unit, the ratio would be one nurse for one patient during active labor, and then one nurse per six patients (or three mother and baby pairs) during postpartum recovery.
In oncology, the ratio would be one nurse to four patients. In pediatrics, it would be one nurse to three patients.
Leaders from ONA said they based the proposed ratios on three sources: the standards in California’s law, standards in proposed federal legislation, and standards currently followed by some Oregon hospitals.
The standards would only apply to hospitals, and not to nursing homes or other long term care settings, which are also struggling to hire enough nurses and support staff.
Home health agencies would not be required to meet the ratios set out in the proposal, but they would have to create staffing plans in collaboration with nurses.