ONA and our colleagues from the Oregon Federation of Nurses and Health Professionals (OFNHP), Service Employees International Union Local 49 (SEIU 49) and the Oregon American Federation of State, County and Municipal Employees (AFSCME) reached an historic
agreement on amendments to House Bill 2697 (our safe staffing bill) with the Oregon Association of Hospitals and Health Systems (OAHHS) and representatives from Oregon Health and Sciences University, Providence, and Salem Health. And now HB 2697 has
become Oregon law. Review our walkthrough below to see the details of the law and how it may impact your workplace.
The passing of this law puts Oregon at the forefront of safe staffing laws in the nation.
This is by no means a perfect law, but it is absolutely and without question a game changer for nurses and our allied health care workers across the state. All ONA members understand that during tough negotiations concessions are sometimes
necessary to advance our goals. Our negotiating team did have to make some compromises, but we still achieved historic successes.
The amendments were the result of months of negotiations between the interested parties, at the urging of State Representative Rob Nosse (D- HD42), the main sponsor of the bill.
GROUNDBREAKING GAINS
Minimum Nurse-to-Patient Ratios
Key components of the law include first-in-the-nation nurse to patient ratios in state statute for a wide range of acute care settings, including emergency departments; intensive care units; labor and delivery units; operating rooms; and others. These
ratios are “minimum” because it is the minimum staffing allowed under the law. Facilities can’t increase patient load from the ratios in the law without facing consequences. It is NOT the minimum number of patients a nurse can have. It’s also important
to remember this law is a floor not a ceiling, staffing committees can create staffing plans with even higher standards with their facilities’ needs in mind. It is also important to remember current staffing plans which satisfy the minimum standards
of the new statute will remain in place.
The only time facilities can deviate from the legal ratios is when the nurse staffing committees pursues an innovative care model by including other clinical staff. The model must then be re-approved by the staffing committee every two years.
The units with statutory ratios are emergency departments; intensive care; labor and delivery; postpartum, antepartum, and well-baby nurseries; operating room, oncology, post-anesthesia, intermediate care, medical-surgical, cardiac telemetry,
and pediatric. The ratios apply to patient classification per the medical record. These ratios are:
If you are having difficulty reading it, click the image below to view the graphic in a new window.
It is important to note that the ratio for medical-surgical units begins at 1 RN to a maximum of 5 patients, but tightens down to 1 RN to a maximum of 4 patients on June 1, 2026.
A Special Note on ED Ratios
Emergency department (ED) ratios are more complicated, and possibly more confusing, than any of the other ratios in the law. As a result, it is important to identify that the ratio in the ED is an average throughout the shift. This means that the
ratio is 1:4 as averaged throughout the shift. The standard is 1:4, not 1:5. Also, please note that this ED ratio excludes trauma patients, who are 1:1.
1:5 is the max at any time. But, for every amount of time the ratio exceeds 1:4, and a nurse has had to care for 5 patients at once, this must be offset during that same shift by a nurse caring for only 3 or fewer patients during at least that same
amount of time.
This is the same work that we have been doing collectively for the last ten years. Moreover, we can continue to build on the work that has already occurred.
Wall-to-Wall Staffing Committees
This law also establishes two new staffing committees! One for service workers (like environmental and food services), and the other is for technical providers (such as radiology technicians and ultrasound technicians) and professional
providers (like physical therapists and occupational therapists). These new staffing committees will empower hospitals and workers to adopt staffing plans based on clear and comprehensive criteria which will then be submitted to, and enforced
by, the Oregon Health Authority (OHA). Our health care colleagues will now be able to shape and influence the quality of care they provide right alongside nurses and gain a voice in the crucial decisions made in care delivery. These new staffing committees are a huge success for ONA-represented techs and other health professionals, and ONA is deeply grateful to OFNHP, SEIU 49, and Oregon AFSCME for their powerful advocacy to reach this point.
A key difference between these new staffing committees and the nurse staffing committee is the process that is required if the committee does not approve a plan by majority vote within 60 days of deliberation. When the nurse staffing committee does
not approve the nurse staffing plan, the disputed plan or parts of the plan will be decided by an arbitrator (discussed in future sections) when there are no statutory ratios. In contrast, the new committees will send the disputed staffing plan
or parts of the plan to the hospital or the CEO’s designee for final determination of the plan. The plans are then submitted to the OHA.
This legislation adds a faster process when nurse staffing committees are at an impasse. If the
committee does not adopt a staffing plan for units with no statutory ratio by the 60th day of deliberations, the co-chairs of the staffing committee submit the disputed parts of the nurse staffing plan to OHA, and OHA initiates expedited binding
arbitration. The arbitrator issues their decision within 60 days.
If all staff in staffing committees in a hospital are subject to a collective bargaining agreement, and if all unions to whom these collective bargaining agreements pertain
agree, the committees may combine and meet jointly to streamline planning. This includes the nurse staffing committee.
Enforcement
ONA members know that one of the key failures of Oregon’s health care system is the lack of enforcement by the Oregon Health Authority. Our proposed legislation dramatically increases the enforcement mechanisms needed to uphold the provisions of our
bill. That includes enforcement that is complaint driven, with specific timelines for investigations into those complaints, and clear, unequivocal direction to OHA on its role as the enforcement agency. This is a major shift away from
the ineffective and inefficient “audit and survey” model currently used by OHA. In addition, our law creates a series of financial penalties levied against hospitals who consistently violate the law, putting real teeth into these
provisions (see table below for more detail).
If you are having difficulty reading it, click the image below to view the graphic in a new window.
Rest and Meal Breaks
The safe staffing law puts an end to the “buddy break system!”
This law closes loopholes and creates powerful enforcement mechanisms so nurses can get their meal and rest breaks without compromising patient safety and care by doubling
another nurse’s assignment. The statutory ratios must be maintained even when a nurse gets a break: this means when you go out on a break your patients are cared for so you will not be behind in your work when you get back!
The law has strong enforcement in place for when a nurse or other health care worker misses a break. Hospitals will pay $200 for each missed break when a health care worker files a valid complaint with OHA! Workers may also choose
to file a complaint with BOLI and there is the potential of a civil penalty if BOLI finds a violation has occurred.
Parameters to note are that the worker must file the complaint within 60 days of the missed meal or rest period, and cannot
also file a grievance or a lawsuit pertaining to the missed break. Additionally, this remedy is only available to workers who have a collective bargaining agreement that does not provide for a monetary remedy for missed breaks, or is not at all covered
by a collective bargaining agreement.
Either way, the meal and rest break loopholes are closed, and nurses will no longer be required to double their patient assignments so a colleague can eat during their 12-hour shift!
Prior to this law, OHA has been very slow to respond to or address complaints. Now, OHA must forward the meal and rest break complaints to BOLI within 14 days of receiving them, AND for all complaints, must notify the hospital, the co-chairs
of the relevant staffing committee, and the union, if any, that a complaint has been filed.
Other Important Components
A CNA shall not be assigned to more than 7 patients at a time during the day shift and 11 patients at a time during the night shift. But it is important to note that CNAs will be governed under the new service staffing committee, not the nurse staffing
committee. Adding an LPN will need the approval of the staffing committee.
Units that do not have statutory ratios will have a staffing plan approved by staffing committee, and this legislation adds a faster process when at impasse.
COMPROMISES
As mentioned, this law does include some compromises to address emergent patient care needs and to meet the need for flexibility identified by legislators. Despite the compromises, we are pleased with this bill, and the limitations we were able to put
on these deviations. Compromises include:
Rural Hospitals
The amendments do provide for rural (Type A and Type B) hospitals to receive a two-year variance from the law’s requirements, but only if the nurse staffing committee approves that variance. This concession was made to
address the concerns of some legislators who worried the new regulations would be impossible for smaller, rural hospitals to meet in the required time frame.
(Note: Type A and B hospitals are hospitals with under 50 beds. Type As are located more than 30 miles from another hospital, and Type Bs are less than 30 miles from another hospital.)
Staffing Committee Approval of Different Ratios For “Innovative Care Models”
With approval of the nurse staffing committee, a unit can deviate from the RN to patient ratios (with the addition of up to 50% clinical staff) in pursuit of innovative care models considered by the staffing committee. The model must be re-approved by
the staffing committee every two years.
Limited Flexibility to Meet Emergent Patient Care Circumstances
The amendments do allow for a specific number of incidents, during a limited period, where a unit may deviate from the hospital staffing plans and exceed the nurse-to-patient ratios. This is a concession specifically in response to concerns about emergency
circumstances (such as a new surge in COVID-19 or a mass casualty event). We were successful in limiting the number of deviations and the length of time during which those deviations can occur.
Hospital Setting Only
You may recall that, when we introduced HB 2697, our language included home health settings. The current law only applies to hospital environments. ONA's lobby team is committed to working with our home health and hospice members to try to elevate staffing solutions in the 2025 session.
This law is a steppingstone for all health care workers, and creates a path we can follow for our future goals, like higher staffing standards in home care settings.
IMPLEMENTATION TIMELINE
There are many layers to this law, and because of various needs, implementation takes a little bit of time. It can be frustrating to wait for these exciting changes to take effect, but many of them require more oversight by the OHA which then needs time
to increase their manpower so they can adequately meet those new needs. The implementation timeline is intended to ensure hospitals and staffing committees have sufficient time to prepare for the changes.
If you are having difficulty reading it, click the image below to view the graphic in a new window.
September 1, 2023: The bill takes effect and agencies can begin rulemaking (i.e. the process to make all these wonderful things happen)
September 1, 2023 – December 31, 2023: ONA is at the rulemaking table
January 1, 2024: Deadline for OHA to adopt a system (“rules”) to receive complaints.
June 1, 2024: Nurse ratios take effect
December 31, 2024: Deadline for new staffing committees to be developed.
June 1, 2025: OHA enforcement including civil penalties begins (see enforcement table earlier)
June 1, 2026: Medical Surgical ratio tightens to 1:4
A Message from ONA President Tamie Cline “Thank you.
Thank you for your passionate commitment to your profession, your dedication to your patients, and your love of your communities and families. Your hard work has made this possible, and we are deeply grateful for everything you have done, and continue
to do, to advocate for the highest quality of care for patients and the best working conditions for your colleagues.
If there is one thing I know, it is this: when nurses join together in a common purpose, we are unstoppable. I also want to extend my thanks to our union siblings, and OFNHP in particular. Our solidarity on this bill made the difference, so thank you.
-Tamie Cline, RN, President of the ONA Board of Directors”
