The quality and access of patient care in hospitals is at the heart of a debate in the Oregon statehouse about hospital staffing.
Oregon unions, which represent rank-and-file nurses, want lawmakers to pass House Bill 2697, which would enact minimum staffing requirements for hospital nurses. For example, a nurse in a hospital’s intensive care unit would be assigned only one or two patients.
Supporters say minimum standards and enforcement are necessary to keep hospitals accountable. The bill would also require hospitals to form staffing committees and staffing plans for other types of workers, such as technicians.
But hospital nurse managers from Portland to rural John Day warn that rigid ratios in law would force hospitals to curtail services and force patients to wait longer for treatment if they didn’t have enough staff. They say the bill is too rigid for individual hospitals.
Both sides of the debate aired their differences in a presentation on Monday in the House Committee on Behavioral Health and Health Care. The committee will hear testimony on the bill on Tuesday.
“This is a very big deal,” said committee chair Rep. Rob Nosse, D-Portland and a chief co-sponsor of the bill. “This is probably one of the most important topics that we’re going to wrestle with.”
Oregon hospital managers and nurses agree that hospitals face a workforce shortage and crisis after a three-year pandemic and burnout sidelined many in the profession. Hospitals often struggle to recruit nurses, especially in rural regions of Oregon. But they disagree on how, exactly, the state should fix the problem.
Kelly McNitt, a registered nurse and director of nursing services at Blue Mountain Hospital in John Day, said House Bill 2697 doesn’t take into account the workforce shortages in rural hospitals and the months necessary to train a nurse to work across all the units of a small hospital. Rural hospitals already face challenges in recruiting, such as a lack of housing and second jobs for the spouses or partners of nurses, McNitt said. Those challenges would make it difficult for hospitals to meet minimum staffing requirements.
“It is a one-size-fits-all model that does not work for rural hospitals,” McNitt said.
Amanda Kotler, senior vice president and Chief Nursing Officer of Asante Health System, which operates in southern Oregon and northern California, echoed that.
“We must recognize the barriers to adequate staffing and the national shortage before imposing regulations on hospitals for compliance that is currently unattainable,” Kotler said.
Kotler said charge nurses, who oversee nurses on the floor, need to have the autonomy to adjust assignments and meet the urgent needs of patients. The bill, she said, would eradicate that ability with the set ratios. For example, she asked, would a nurse already assigned to patients not be able to respond to a trauma that arrives by ambulance?
“These are our biggest fears, especially in rural areas,” Kotler said.
The Oregon Association of Hospitals and Health Systems, which represents all of the state’s hospitals, opposes the bill. Andi Easton, its vice president of government affairs, told lawmakers it “would be devastating to impose these ratios at a time when many hospitals are in dire straits.”
But supporters of the bill warned that standards are necessary to keep patients safe – and ensure their access. They also say the bill allows hospitals to a surge of patients in emergencies by calling in more nurses and reacting as necessary to provide lifesaving care.
The shortage – and need for adequate staffing – includes other areas, said Sarah Curtis, a managed care coordinator at Oregon Health & Science University for patients with neurological needs like epilepsy and Parkinson’s disease.
Curtis’ work involves helping patients get prior authorizations or approval from insurers to cover a service.
“We are chronically short staffed, which causes delays in the process,” said Curtis, also vice president of the American Federation of State, County, and Municipal Employees Local 328, which represents OHSU employees. “Delays can result in patients being canceled or rescheduled often for appointments.”
Curtis added that her colleagues that work with cancer patients have high turnover.
“No one wants to be the one to tell cancer patients they can’t come to their chemo appointment because the authorization is pending,” Curtis said. “The emotional toll of those phone calls is heavy. They work through their breaks and lunches because there’s too much urgent work to be done.”
The staffing shortages lead to missing breaks, which perpetuates the cycle of burnout and decreased patient care, said Tamie Cline, president of the Oregon Nurses Association, which represents more than 15,000 nurses.
“The math here is not complicated,” Cline said. “Going 12 hours without a 15-minute rest break or a lunch break takes an enormous mental and physical toll, which in turn leads to less effective patient care.”
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