Oregon’s largest nurses union and the hospital industry are gearing up for a push – and potential fight – in the Legislature to bolster the ranks of nurses that have dwindled over the past three years.
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, 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.
Industry Officials Float an Alternative
The Oregon hospital industry wants the Legislature to increase the number of nurses – in part by using state money for incentive programs to help hospitals hire and train nurses.
The Oregon Association of Hospitals and Health Systems, which represents the state’s 62 hospitals, has released details of its proposals for addressing the nursing shortage in a news conference.
The lack of nurses impacts patients, forcing them to spend days in emergency rooms waiting for beds to open or in smaller hospitals when they need a transfer to a larger hospital for specialized treatment.
Hospital industry officials say these proposals would help:
- Senate Bill 485 would add nursing students to an existing program that gives scholarships to health care students. Students can qualify for the program by committing to serve underserved populations, such as rural and low-income Oregonians. Nursing students training to be registered nurses or licensed practical nurses would qualify for scholarships.
- House Bill 2926 would give hospitals funding or other incentives for offering nursing students opportunities for clinical training. Hospitals would get money based on participation. If the bill passes, the Oregon Health Authority would establish the program and determine how much money hospitals could get.
- State tax credits for nurses who teach in nursing programs. Schools sometimes struggle to recruit nurse educators because nurses often can earn more in the field than through teaching.
Hospital officials haven’t determined how much the proposals would cost.
The state’s largest nurses union, the Oregon Nurses Association, has proposed establishing minimum nurse-to-patient staffing ratios in law to fix the crisis. The industry group is opposed to that move, saying it would be too rigid.
Becky Hultberg, president and CEO of the Oregon Association of Hospitals and Health Systems, said in a news conference last week that hospitals agree with the union that the nurse staffing system needs fixes. But she said the minimum staffing standards outlined in the union’s proposal, House Bill 2697, would force hospitals to curtail services and shut down beds.
Andi Easton, vice president of government affairs for the hospital association, repeated that message in testimony to the state Senate health care committee.
“If we are required to have so many providers per patient and you do not have those providers available, your only option is to reduce services,” Easton said.
Finances are another concern. Hospitals also face growing financial pressures and often operate at a loss, Hultberg said. Nearly two-thirds of Oregon hospitals lost money in the third quarter of 2022, she said. During the pandemic, hospitals received millions of dollars in federal funding but that has tapered off while costs for supplies and labor have increased.
Hultberg called for a joint discussion of the issue, saying the hospital association is willing to work with all sides to come up with solutions. She also said she worries that people are getting tired of hearing about the crisis.
“I worry that we have become too used to hearing about long wait times in emergency departments,” Hultberg said. “Or indifferent to the idea that someone can’t get a needed surgery or procedure in a timely manner.”
Paige Spence, director of government relations for the nurses union, told the committee that recruitment and long-term solutions are important, but the group’s goal is to stop the escalating crisis.
By Ben Botkin of Oregon Capital Chronicle
Do you have a story for The Advocate? Email editor@corvallisadvocate.com