Oregon hospitals are experiencing drastic staffing shortages, but healthcare professionals disagree on whether minimum nurse-to-patient staffing standards should be implemented.
Members of the House Committee on Behavioral Health and Health Care discussed a bill that aims to implement staffing standards this week. House Bill 2697 would establish minimum standards for staffing plans for direct care registered nurses, and impose penalties for the failure to adopt or comply with these plans.
Hundreds of community members provided written testimony on HB 2697, and the committee heard bill comments from labor and hospital representatives during an informational meeting on Monday, and from community members during a public hearing on Tuesday.
Rep. Rob Nosse (D-Portland), committee chair, said HB 2697 would expand the staffing approach the state has maintained for nurses to other caregivers and staff that work in hospitals, and change the way the Oregon Health Authority handles enforcement.
“It puts ratios in for nurses and other staff based on standards that nurses and various specialties have come to [maintain] over the years,” Nosse said. “I know that this is a very big deal. This is probably one of the most important topics we’re going to wrestle with. Probably, some change is really needed. These employers are vital to our communities, and the people that work there are vital to our communities as well.”
Meg Niemi, president of Service Employees International Union (SEIU) Local 49, testified in support of HB 2697. SEIU represents 80,000 healthcare and property service workers throughout Oregon and Washington. Niemi said unsafe staffing can threaten patient care, staff well-being, and the viability of the healthcare workforce.
“The impact of unsafe staffing, not only amongst registered nurses but across all healthcare organizations, places a significant strain on our communities and the overall viability of our healthcare workforce,” Niemi said. “Current law offers insufficient protection and inadequate enforcement. The current staffing law only protects staff who fall under the Nurse Practice Act, yet numerous studies have shown the importance of team-based care and staffing.”
SEIU Local 49 members have voiced concerns that the staffing crisis is driving morale down, contributing to historic levels of turnover, and creating unsafe conditions for patients and staff, Niemi said.
“In our outreach to our members, they overwhelmingly identify safe staffing as one of their most important issues,” she said. “HB 2697 expands protections to important classifications, in addition to registered nurses. This bill creates minimum standards that include robust staffing ratios for the people who are often the first person to respond to a patient’s needs—the certified nurses aides (CNAs).
Aaron Green, a CNA at McKenzie-Willamette Medical Center in Springfield, also testified in support of HB 2697. He discussed CNA staffing challenges at the medical center.
“When you talk about what we deal with on a daily basis, there’s days we come to work and we could have 36 patients because there’s no staffing ratios for CNAs,” Green said. “That’s an entire floor, and if you’re talking [about] a 10-12 hour shift, you have less than a half hour to spend with each patient to provide all the care they need. It’s not safe, it’s not right. It’s fundamentally impossible to provide all the care a person needs.”
When adequately staffed, most units use nurse-to-patient ratio standards that are similar to those in place at nursing homes, Green said.
“CNAs will have nine patients on a good day, and it allows us the ability to provide the best care these patients deserve,” he said. “Low staffing creates a perpetual cycle of constant turnover. We need to address these staffing shortcomings that have been around for a long time, and at least bring the minimum standard [up] to what nursing homes have to the hospital setting.”
Becky Hultberg, president and CEO of the Oregon Association of Hospitals and Health Systems, testified in opposition to HB 2697.
“We agree with the components of this bill, that we need to find innovative ways to address recruitment and retention, and that the nurse staffing law needs to be modernized,” Hultberg said. “I am confident that together, we can work to address these challenges. But this bill does not do those things. We do not agree with this approach.”
HB 2697 has the potential to threaten access to care for patients in Oregon, Hultberg said.
“This is a hospital staffing bill,” she said. “It is not a nurse staffing bill. It is an attempt to create something that does not currently exist in Oregon or any other state. It replicates what is dysfunctional and broken in the current nurse staffing law, extending it to nearly the entire workforce. It adds a one-size-fits-all approach to staffing, fundamentally changing how nurse staffing works.”
Sarah Horn, chief nursing officer at Salem Health, also testified in opposition to the bill. She said staffing ratios are not a remedy to hospital staffing problems.
“They would only contribute to further healthcare failure,” Horn said. “Studies have shown staffing ratios do not improve patient outcomes, and they will not address the fundamental failures of Oregon’s health system. HB 2697 would make things worse, not better. It will impact the care patients in our communities get at every single level. More than anything, I’m deeply concerned about the impact this proposal will have on access to care all across Oregon.”
Access to care in Oregon has eroded due to staffing shortages and patient needs over the past year, but HB 2697 would only exacerbate the problem, Horn said.
“Mandatory staffing ratios double down on the staffing crisis, and do not allow local community hospitals or nurses in the collective care team the adaptability needed to respond to the community need,” she said. “Mandatory at-all-time staffing ratios ignore unpredicted surges in community need and natural disasters that could force hospitals out of compliance, subjecting them to extreme penalties.”
No action was taken on the bill.