Oregon lawmakers have the chance to make historic improvements to healthcare, thanks to the collaboration of labor and hospital management. 

On March 28, the state hospital association of and three healthcare unions unveiled a sweeping compromise over a hotly contested safe staffing bill. Oregon Nurses Association (ONA), Oregon Federation of Nurses and Health Professionals (OFNHP), and Service Employees International Union Local 49 (SEIU) worked with the Oregon Association of Hospitals and Health Systems (OAHHS) to draft an amendment to House Bill 2697, a bill lawmakers introduced at the unions’ request. It comes after months of negotiations between the unions and the hospital association at the urging of Representative Rob Nosse, the bill’s main sponsor. Nosse used to work as a union rep at ONA, and as a legislator has been a longtime advocate of setting minimum staffing levels 

“It’s pretty impressive. I’m proud to have been in the room,” said OFNHP steward and Kaiser Permanente physical therapist Nicole Brun-Cottan. “I think there is really clear acknowledgement there is a problem, and it’s going to take everybody to fix it.” 

ONA proposed the bill as its top legislative priority this session; OFNHP, SEIU, and Oregon AFSCME endorsed it, too. 

‘A little bit of flex’

Originally, hospital executives opposed the bill, saying it would set impossible-to-meet standards in statute during a nationwide healthcare staff shortage, threaten hospitals with “expansive, excessive” penalties, and unfairly burden rural facilities. The amendment resolves those concerns by creating the flexibility to adjust ratios locally if workers and management agree, and including a provision for limited deviations from the statutory ratios that would help in unexpected cases like a car crash or mass casualty event. 

The amendment also switched enforcement from an audit-based system to a complaint-based system, and it changed the fine system to lower some penalties and include warnings first.

HB 2697 would make Oregon the first state to establish statutory nurse-to-patient ratios and the first with ratios for certified nursing assistants. The ratios apply to multiple units of the hospital, including the emergency department, intensive care, and labor and delivery rooms. It also creates comprehensive staffing plans that include professional, technical, and service health care workers. Those workers get a stronger voice in staffing decisions with their own advisory committees. 

If passed, advocates say it will set the high-water mark for safe staffing across the county. Labor leaders have called it a game-changer and an important first step of fixing the staffing crisis. 

It would take effect Sept. 1, 2023, with nurse-to-patient ratios starting June 1, 2024, and new staffing committees for other workers starting Dec. 21, 2024. 

Financial penalties and fines for hospitals would not begin until June 1, 2025. 

Retain, recruit, review

Advocates say HB 2697 is a staff retention bill at its heart. Oregon has more registered nurses per capita than California, but many leave the field due to stress and burnout. Inadequate staffing is a leading cause for that. 

“We are hemorrhaging nurses out the back door of the hospital far faster than we can bring them in,” testified ONA Director of Government Relations Paige Spence at a hearing on the bill. 

Spence said clinicians expect the bill to boost recruitment, too, because healthcare workers from elsewhere will want to work in a state with minimum staffing laws. Several former nurses testified they would come back to the bedside if staffing improved. 

The measure is one piece of a larger package of bills that includes investments of nearly $40 million into staffing training, recruitment and retention programs.

Safe staffing may come to Washington too

Washington state lawmakers this session are also considering a safe staffing bill that was the product of union-management collaboration. Senate Bill 5236 would create staffing committees to determine how many nurses to assign to each patient care unit. The plans would be due to the state by January 2025 and put in place six months later. The bill establishes fines for hospitals that don’t comply with their plan. Nurse union leaders, hospital executives, and some state senators drafted the measure together. SB 5236 passed the Washington Senate with a 35-13 vote on March 6 and had been assigned to a House committee as of press time.