This article has been updated.
Six months after a new law set staffing minimums at Oregon hospitals, the state’s largest nurses union and its hospitals can’t agree on what it means, even as regulators sift through a pile of new complaints.
Since the law’s staffing requirements took effect in June, the Oregon Nurses Association and its members have filed more than 2,400 complaints against hospitals with the state. Many complaints allege hospitals are sidestepping the law’s requirements. While the Oregon Health Authority has looked into just a portion of the filings, regulators found violations of the law in more than half the 244 investigations completed.
The bill was intended to improve working conditions that nurses say are driving them from the bedside. But the law is off to a rocky start, in part because hospitals and nurses disagree on how the law should be interpreted.
Though there have been rumors of a bill to clarify things, lawmakers and others told The Lund Report. But they are not sure if that will happen.
State Rep. Rob Nosse, a Portland Democrat who co-sponsored the original bill, told The Lund Report he was not surprised by the number of complaints.
In addition to lingering stresses from the pandemic, nurses continue to face challenges caring for Oregon’s houseless population as well as rising use of fentanyl and meth, he said. As hospitals increasingly care for people in crisis, nurses’ jobs have become far more challenging.
“They are mad. They are sick of it,” Nosse said. “It is hard to be a nurse right now.”
Meanwhile, many of the state’s hospitals have not rebounded from the pandemic. They continue to lose money due to increased labor costs and lagging reimbursements from insurance of all types.
“The end goal, instead of just leaving for greener pastures, is to make it a greener pasture where I am."
The Hospital Association of Oregon agreed to support the staffing law as part of a package that included legislation hospitals sought to relieve their financial problems.
Sean Kolmer, executive vice president for the association’, said in a statement that the association wants the law to support staff and patient care as intended. But “the law, as it is being implemented by OHA, is inconsistent with what hospitals agreed to during the 2023 legislative session."
Nurse says workplace effort has been a “mixed bag”
Denise Arnold recalled how her job at Providence Newberg Medical Center changed during the pandemic. Sicker patients needed more care. Colleagues left for less stressful jobs. Her work became increasingly exhausting.
Other nurses leaving for easier jobs made her the most experienced registered nurse in the medical-surgery unit. But quitting, she said, would only add to the challenges faced by her patients and coworkers.
“The end goal, instead of just leaving for greener pastures, is to make it a greener pasture where I am,” she said.
When the nurse staffing law passed, Arnold recalled how she and her coworkers were excited that it would give them more say over how the hospital was staffed.
She served on her unit’s staffing committee set up under the new law to develop per-patient staffing ratios based on patients’ needs and the level of experience of nurses working there. The committees’ membership is split between nurses and management. But she said staff’s excitement evaporated because hospital management ignored nurses’ input.
Instead of using the committee’s work she said hospital management began using its own staffing plan using minimum ratios.
The results were a “mixed bag,” she said. For instance, a night shift nurse on the medical surgical unit would be capped at five patients instead of six. But she said that also meant nurses would not get help from certified nursing assistants.
Disagreement over the law
The staffing minimums were intended to be a floor for how many nurses are assigned to a hospital unit, Paige Spence, government relations director for the nurses union, told The Lund Report.
A majority of hospital staffing plans have been approved by the health authority, Spence said. However, she said some hospitals have instead used that floor as a ceiling and are defaulting to the minimum ratios without what she said is the required approval of staffing committees.
Matt Calzia, a registered nurse who is part of the bargaining unit at PeaceHealth RiverBend in Springfield, told The Lund Report that a hospital might want to default to the minimum ratios because they would require fewer staff than what a staffing committee calls for.
At a July meeting of the state Nurse Staffing Advisory Board, members discussed continuing confusion over the law.
According to a state dashboard, health authority regulators have investigated 244 complaints, finding violations in 61% as of Dec. 16. Civil penalties under the law do not take effect until June 2025.
Spence referred to three complaints where the Oregon Health Authority agreed with the interpretation of the nurses union.
In each of the complaints — which involve St. Charles in Bend, PeaceHealth RiverBend in Springfield and Providence Seaside Hospital — health authority investigators faulted the hospitals for adopting the minimums without approval of their staffing committees.
A spokesperson for St. Charles told The Lund Report in a statement that implementing the law “has posed some challenges due to the complexities of managing staffing based on varying patient needs” and management was working with the authority to “seek further clarity on expectations.”
A spokesperson for PeaceHealth told The Lund Report that the hospital has since secured an approved staffing plan. Providence, which is locked in heated negotiations with the unions over labor contracts and staffing, responded with a statement declined to comment. The statement cited ongoing mediation and Providence's agreement "to not make statements during the duration of the discussions."
Sean Kolmer, the hospital association’s executive vice president of external affairs, told The Lund Report in a statement that Oregon’s staffing law is unique and it will take time to understand it.
He said the use of nurse-to-patient ratios were meant to be used when there was a dispute over staffing in a unit.
“The statutory nurse-to-patient ratios were a clear priority for ONA, and hospitals agreed to them so long as the ratios would be the solution when a nurse staffing committee was unable to reach agreement for a unit where statutory ratios apply,” he said.
Complaints languishing, nurses and hospitals agree
The nurses union and the hospital association agree on one thing.
With only a tenth of complaints fully investigated, Kolmer, the hospital trade group executive, called the pace of investigations unacceptable. Frontline staff deserve timely responses to their complaints, as do hospital management, he said.
Spence said she was “disappointed” that the process of investigating complaints has been so slow.
Health authority spokesperson Erica Heartquist told The Lund Report in an email that it was difficult to predict how many complaints the new law would generate. She wrote that the rate of new complaints has decreased since June as the agency has offered webinars and other resources. The agency has hired seven additional staff since August, bringing the total number of employees dedicated to enforcing the law to 12, she said.
Correction: an earlier version of this article misattributed a statement provided by the hospital association. The Lund Report regrets the error.
