Stakeholders discussed the impact historic nurse staffing laws passed last year will have on hospitals and workers during the 2023 Oregon State of Reform Health Policy Conference.
Lawmakers passed House Bill 2697 during the 2023 legislative session, which puts minimum staffing levels in place, aiming to make nurses’ work more sustainable while simultaneously improving the quality of patient care. Paige Spence, director of government relations at the Oregon Nurses Association (ONA), discussed ONA’s advocacy efforts in promoting the bill.
“We all knew we needed to come together to improve staffing in Oregon hospitals,” Spence said. “Oregon has had a staffing law for about 20 years. We all agreed the existing staffing bill wasn’t working. One of the major things we did with this bill was expand the staffing committee model to allied healthcare workers. So now you can have wall-to-wall staffing committee structures in acute care hospitals across the state.”
Staffing committees make staffing plans for hospitals. The passage of HB 2697 allows for the addition of two staffing committees in hospitals. One will be for service workers (maintenance workers, custodial staff, and cafeteria workers), while the other will be for professional and technical workers.
The new law also addresses patient coverage for nurses when they take breaks, Spence said.
“Our members report that they do not get their meal and rest breaks all the time. There’s not enough time in the day. So one thing we did was ensure that, with the nurse-to-patient and CNA (certified nursing assistant) ratios, those must be followed even when a nurse goes on a rest break. Built into those ratios is the ability to take rest breaks and have [patient] coverage.”
— Spence
HB 2697 went into effect on Sept. 1 for the purpose of allowing health agencies to start writing temporary rules around staffing ratios. The nurse-to-patient ratios will go into effect in June. The new staffing committees will go online in December. And rule enforcement will begin on June 1, 2025.
“We think we’ve built in enough flexibility that the hospitals shouldn’t be in violation,” Spence said. “We’re high on workforce incentives and making sure there are enough workers at hospital bedsides to ensure that complying with the hospital staffing law is a no-brainer. But in the event it’s not, there will be mandatory enforcement with an escalating scale of penalties that will be levied upon the employer if they are in violation of the staffing plan. And it’s complaint-based.”
The ONA will receive copies of complaints its members file, along with hospital staffing committees.
“So we can all be really accountable to each other, and keep track of what parts of the law have been working and what has been more of a challenge to implement,” Spence said. “It’s now mandatory for OHA (Oregon Health Authority) to investigate complaints.”
While HB 2697 aims to address staffing safety standards, other challenges remain for hospitals, including those related to workforce recruitment and retention. Matt Swanson, political strategist at SEIU Oregon State Council, discussed workforce issues.
“The crisis in our hospitals will not just be solved by some of the regulations we’re putting in place to ensure safe patient care. We also identified, for employers and labor, that we needed to do some other things to ensure that these standards could be realized. Some of that is invested in our workforce. How do we develop, retain, and recruit the best workforce, create good jobs, and scale up those who want to join a provider organization or are interested in moving up within that?”
— Swanson
HB 3396—which requires OHA to provide grants supporting clinical education at hospitals and healthcare facilities and to the Oregon Center for Nursing to work with public nursing education programs to develop programs to recruit and retain nurse educators at institutions of higher education—was also approved by lawmakers last year, and could help with workforce challenges, Swanson said.
“The workforce dollars in House Bill 3396 are quite important, as well as the Oregon Center for Nursing addressing some key shortages in nursing faculty, because we simply can’t train enough people until we add more faculty,” he said. “There are some challenges to that. We’re going to have important work to do to make sure there are programs that can increase the number of nurse faculty.”
Sean Kolmer, executive vice president of external affairs at the Hospital Association of Oregon, discussed HB 2045, which was also approved by lawmakers last year. The bill requires healthcare providers to report the aggregate amount of compensation paid to frontline workers—as wages, benefits, salaries, bonuses and incentive payments—annually to the OHA.
“We want to make sure we’re not preventing our members, in particular, from making necessary investments in the workforce,” Kolmer said. “And if you look at the cost drivers for our members, the majority of those investments are (for) workforce. So we want to make sure that is appropriately accounted for. So that’s essentially what this bill did, is (account) for that.”