A controversial staffing bill for Oregon healthcare facilities has brought the dangers to staff and patients front and center in what appears to be becoming a national trend in nursing negotiations.
“My biggest fear is that I’ll be exhausted and make an error that hurts a patient,” Robert Beck, RN, testified at a recent legislative hearing in Salem. “It’s strange to think something like that happening might end up being my fault.”
The legal risk of making a medication error or causing harm to the patients they dedicated their lives to protect was a recurring theme at the hearing. Knowing they were caring for patients without sufficient staff caused distress and what has been termed moral injury — working under conditions that do not reflect your values or beliefs.
“Nurses in Oregon are desperate,” testified Genee Tennent, RN, from Samaritan Albany (OR) General Hospital. “I think we all have a feeling of dread; that it is only a matter of time before we have a terrible incident.”1
Bridget Lovelace, RN, testifying for the Oregon Nurses Association, described one of the worst nights of her 16-year career. 2
“I had eight patients in the surgical unit on a night shift,” Lovelace said. “All the patients’ needs were very high, and I had no time to do anything but respond to immediate patient issues and pull medications out from the dispensing machine. With this many patients, it was completely impossible for me to give all my patients their medications — to meet the standard of medications being given within an hour of being due. I was angry because of my failure to be able to take care of my patients in a manner they deserved. I was angry because I felt set up to fail.”
Sarah Creson, RN, of St. Charles Medical Center, Bend, OR, did not equivocate in expressing her feelings about the staffing situation.3
“I couldn’t take it anymore,” Creson testified. “I became bitter, burnt out, stressed, and ill more often. It was not sustainable, and I feared for the safety of my staff, my license, and my mental and physical health.”
Provisions Include Right to Sue
The nurses are calling for passage of HB 2697 in the Oregon Legislature, which would require hospitals to establish minimum standards for hospital staffing plans with respect to direct care registered nurses.4 The bill also would require the establishment of technical and service staffing committees to develop written hospitalwide staffing plans. The Oregon Health Authority (OHA) would establish an online portal for healthcare workers to file complaints if a hospital fails to adopt staffing plan. The OHA also would:
- review compliance with hospital staffing plans during in-person site inspections of hospitals and establish a process for developing a plan of correction;
- impose specified civil penalties for failure to implement the staffing plan or correct staffing plan violations;
- post hospital staffing plans and complaints filed against hospitals on a website.
In a controversial provision, the bill would “establish private cause of action for hospital staff and labor organizations,” essentially allowing them to sue hospitals for failure to comply with a staffing plan. These provisions and penalties will force some hospitals to shut down to avoid the penalties and legal liabilities if they cannot find adequate staff to meet the requirements, critics of the bill observed.
“Hospitals across the nation, including our local hospitals, have already reduced services because of an inability to staff beds,” testified Emily Roberts, CEO of Morrow County Health District. “This is reflective of a nurse staffing shortage, not of an unwillingness on the part of hospitals to staff those beds and provide services. It is well documented and well understood that there is a nursing shortage nationally and especially on the West Coast. … Our healthcare ecosystem has never been more vulnerable. Now is not the time to issue regulations that jeopardize our ability to provide services.”5
Hospital capacity already is limited in Oregon because patients who avoided care during the pandemic are coming in for more complex care, said Jennifer Gentry, MSN, RN, NEA-BC, chief nursing officer at Providence (OR) Health & Services.
“House Bill 2697 mandates ratios, significantly higher than we have today, by unit for registered nurses and certified nursing assistants,” Gentry testified. “The minimum staffing required by the bill will further constrict hospitals that are already experiencing a capacity crisis. The net impact is that fewer individual patients can be served in Oregon hospitals. The clinically trained workforce needed to meet the requirements of HB 2697 does not exist.”6
Sarah Horn, RN, the chief nursing officer for Salem Health Hospitals & Clinics began with a sympathetic nod, but ultimately argued the bill is not the right way forward.
“Caregivers across the continuum of healthcare have been asked to do more than was ever imagined,” Horn said. “Long-standing failures of the healthcare system have been exposed, and those at the front line have had to step in and fill the gap. The moral injury, stress, and burnout amongst our frontline teams is real. I am committed to fixing those problems, both at an organizational level and at a state policy level, but they must be fixed at the root cause, as far upstream as possible, not symptomatically. HB 2697 would make things worse, not better.”
Horn argued the bill is not just about nurse staffing and ratios, but a hospitalwide staffing bill that “replaces a nuanced approach to care with a one-size-fits-all staffing model. Mandatory staffing ratios double down on the staffing crisis, and do not allow local community hospitals or nurses and the collective care team the adaptability needed to respond to the community need.”
Morgan Burdick, MSW, BSN, RN, a nurse at Oregon Health and Science University (OHSU) in Portland, recalled holding the hands of dying patients.
“I have cared deeply about the human worth of each one of them, even as some of struggled to get out a full sentence due to respiratory distress to tell me that COVID is not real,” Burdick testified. “We as nurses have been doing the impossible task of being a human Band-Aid on a tsunami of healthcare needs for the past three years.”8
OHSU can provide highly specialized care in part because of the expertise of the nurses providing treatment.
“When we are rapidly hemorrhaging nurses with decades of specialized experience at very high rates, we aren’t able to train and support our new graduate nurses to learn the wisdom and skill lost,” Burdick said.
Noticing a rookie nurse who likely was dealing with her first dying patient, Burdick asked the nurse if she could help.
“With the other nurse’s permission, I helped get the right medications for the woman and called her family to the hospital to say their goodbyes,” Burdick recalled. “We were able to get her comfortable, and she had a peaceful death with her children holding her hands. That is the importance of being able to keep experienced nurses. Nursing school did not teach me the skills I used that day; a veteran nurse did.”
A unit entirely staffed by nurses recently out of nursing school does not leave anyone to teach and mentor their peers into the next generation of skilled nurses. “We need staffing laws to help ebb the tide of nurse exhaustion causing us to seek jobs with a lower risk of injury where we can reliably take our lunch break,” Burdick testified. “It is exhausting to feel like I leave my shift unable to provide the best possible care each of my patients deserve because I’m regularly working on units that are short-staffed.”
REFERENCES
- Tennent G. To the House Committee on Behavioral Health and Health Care in support of HB 2697. Oregon State Legislature. Feb. 20, 2023.
- Lovelace B. To the House Committee on Behavioral Health and Health Care in support of HB 2697. Oregon State Legislature. Feb. 20, 2023.
- Creson S. To the House Committee on Behavioral Health and Health Care in support of HB 2697. Oregon State Legislature. Feb. 15, 2023.
- Oregon State Legislature. HB 2697. 2023.
- Roberts E. To the House Committee on Behavioral Health and Health Care in opposition to HB 2697. Oregon State Legislature.
- Gentry J. To the House Committee on Behavioral Health and Health Care. Oregon State Legislature. Feb 27, 2023.
- Horn S. To the House Committee on Behavioral Health and Health Care in opposition to HB 2697. Oregon State Legislature. Feb. 27, 2023.
- Burdick M. To the House Committee on Behavioral Health and Health Care in support of HB 2697. Oregon State Legislature. Feb. 26, 2023.
A controversial staffing bill for Oregon healthcare facilities has brought the dangers to staff and patients front and center in what appears to be becoming a national trend in nursing negotiations.
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