The Direct and Indirect Impact of Nurses on Oregon’s Nurse Staffing Law
By Sue B. Davidson, PhD, RN, CNS, ONA Assistant Executive Director Nursing Practice, Education & Research
Since the Oregon nurse staffing statute (2005) and administrative rules (2006) were passed, direct care nurses in the state of Oregon have made incredible efforts to ensure that the statute and rules are utilized.
Here is a list of the nurse staffing processes and activities that are required of Oregon’s acute care facilities, and thus, depend on staff nurses:
- Formation and ongoing work of a hospital nurse staffing committee
- Staff nurse selection/election of representatives to serve on the committee
- Assurance that views and opinions of direct care nurses are heard within the committee’s deliberations
- Development of nurse staffing plans that are based on specialized qualifications of staff, ensure skill mix and competency to meet patient needs, and recognize differences in acuteness
- Notification by staff nurses or others to limit admissions to an assignment, a unit, or a facility if provision of safe patient care cannot be assured
- Approval and yearly evaluation of unit/specialty level nurse staffing plans by the hospital nurse staffing committee
- Definition of agreed-upon shift lengths within a 24-hour time period and within a hospital defined work week
- Documentation of mandatory overtime
Staff nurses have participated in achievement of the staffing law requirements, and consequently, 100 percent of acute care hospitals in Oregon have hospital nurse staffing committees according to Oregon Health Care Regulation and Quality Improvement. Staff nurses have also provided testimony during rule making related to nurse staffing.
But everyone understands that whether a staffing plan is consistent with or based on national specialty staffing standards, or whether it is “home grown” as is the case with many medical surgical units, there are really two realities about nurse staffing plans: what you have on paper is a map to guide you, and on a day to day, shift by shift basis, changes have to be made to accommodate the acuity of these patients, the work load intensity of the nurses, and the amount of patient turnover. This is where the judgment and expertise of staff nurses becomes an indispensable value to nurse staffing.
In Oregon, a group called the Oregon Nurse Staffing Collaborative, consisting of the Oregon Nurses Association and Oregon Association of Hospitals and Health Systems, has been meeting for about four years. This group is structured to mimic the composition of hospital nurse staffing committees by having roughly equal numbers of administrative and staff nurses. In this venue, contributions are made to a shared and expanding knowledge base about nurse staffing through webinars and conferences, research, reports, and one-on-one consultation.
Nurse staffing, aimed at safe patient care, is a process that requires continuous improvement. To that end, direct care nurses in ONA are participating in a workgroup to identify and prioritize potential improvements in the nurse staffing law. When this activity is complete, the ideas will be shared with other groups with interest, investment and involvement in nurse staffing. From this collaboration, an agenda for improvement of Oregon’s Nurse Staffing Law will be set.
As health care reform continues to roll out in Oregon, it is very likely that acute care will undergo change and nurses may have different roles within it. It may mean that staff nurses follow patients as they go home, or that phone consultation is conducted by nurses to check to see that a discharged patient is able to complete their care at home, or that they have needed equipment or medications. What nurses do for this patient in the hospital is dependent on a staffing plan that ensures it can happen. The nurses’ achievement of outcomes for that patient is a nurse’s value-added service, meaning that direct care nurses have contributed to the effectiveness of patient care as well as to the Institute for Healthcare Improvement’s Triple Aim goal to increase the quality of care.