We met for our eighth bargaining session on Wednesday, February 15. This session was incredibly powerful - it was finally time to address our number one priority: safe staffing. This was a virtual session where observers came to watch. We had guest speakers and nurses present on our nurse staffing law, who told powerful staffing stories about how OHSU is willfully violating our contract and state law.

Erica Swartz bravely spoke on behalf of AURN and our nurses across the entire hospital when she said the following to management: “The message being delivered to direct care nurses by administration has been made clear- no matter the data you bring, no matter the proper process you follow and no matter the analysis you’ve done, we will not support your plan if it doesn’t meet our budgetary goals… Imagine how those nurses feel when they hear the OHSU Board of Directors celebrate their financial success, knowing that it is based on saving money, while compromising patient care and the work environment.”

Our staffing presentation took about 90 minutes—so much needed to be said. Some had a hard time sharing their devastating stories and many tears were shed. Afterward, we presented our comprehensive proposal on safe staffing and demanded that OHSU finally turn a corner and make things right. Our proposal encompassed all the elements we need to do our jobs safely and to properly care for our patients. This includes, but is not limited to: safe staffing minimums, staffing plan requirements, acuity tool language, Break Relief Nurses, Proper FTE allocations for ambulatory and remote employees that include coverage for vacations and leave, UBNPC hours needed per unit, better support for our Nurse Staffing Committee members, and much more.

Our ONA Professional Services Director, Matt Calzia presented the history of Oregon’s hospital nurse staffing law, which started in 2001 and was largely improved in 2015. He then went over the required elements. He read reports on OHA violations at OHSU, the six different plans of correction that occurred to attempt to get OHSU in compliance with the law, that started back in 2017, and pointed out how those violations still have not been corrected. He set the record straight and demanded real accountability from the OHSU administration.

Matt Calzia concluded by stating: “The unfortunate reality is the record demonstrates a willful disregard for the law and practices that cannot be denied as anything less than obstruction. OHSU nurses are left with no other options than to present strong contract language to hold accountable a nursing administration who not only disregards the letter and spirit of the law, but far worse, the voices of the frontline nurses who have for years been begging for action.” (Matt's full testimony is available here.)

Next, our Staffing Committee Nurse Co-Chair, Erica Swartz gave a powerful overview of how OHSU is grossly non-compliant with the staffing law. She emphasized how the managers have stated that they can only present a plan that is within their budget, which is a gross violation of the law that does not allow external benchmarks such as budget goals to dictate safe staffing. This led to the committee not approving the unsafe plans because they are not in compliance with the law. Here is the history of where we are at hospital wide with staffing plans:
● 2020 (45 plans due, 44 plans received, 1 approved)
● 2021 (47 plans due, 0 full plans received)
● 2022-3 (48 plans due, 37 plans received, 18 fully approved). That’s only slightly more than 1/3 of OHSU working with an approved plan.

She discussed how some units, like the adult critical care cluster and labor and delivery were able to run successful meal and break relief pilots, yet other units were not afforded this same right. All of this takes a toll regularly on our work lives, along with why we are here - to take care of our patients. In 2022 alone, there were 1,268 staffing variances filed! And we know that those 1,268 variances are only the tip of the iceberg, as we found in our bargaining survey that most nurses are pressured not to file variances or have given up filing them when nothing is done. (You can read Erica's full speech here.)

Thirdly, nurses from every major cluster and area of the hospital took turns sharing about how we are all impacted by unsafe staffing across our entire institution. Nurses told the administration how unsafe staffing impacts everything: throughput, patient outcomes, revenue lost from procedures and surgeries that cannot happen, the ability to eat or use the restroom, our licenses, our mental health, and so much more. Several stories went over patient suffering and untimely death, which we believe was exacerbated by extreme short staffing.

After sharing the background, and our members’ powerful stories, it was time to present our full staffing proposal. We made sure that nothing was left out when it comes to fully addressing the needs we have in order to fully provide safe patient care. You can see a full summary of the proposal below.

Management’s Counter Proposals on Restructures and Resource Nurses

At the end of the day, they responded to our layoff proposal and our resource nurse proposal. Regarding layoffs, they made some changes to the restructure section to say that if management chooses to move nurses to other units beyond floating or temporary/special assignments, that it would require a restructure. They countered our language regarding opportunities to change FTE equitably across shifts would be with employer discretion. We expressed concern about how the COVID Connected Care Center may be impacted by these changes.

They proposed that Resource Nurses would need to provide a minimum of 520 hours each fiscal year and at least two shifts in a two-week period. The AURN bargaining team was disappointed to hear management’s continual demand of nurses to work more. This proposal would remove the flexibility that many of our nurses need. They added holiday language saying that as long as they comply with the UNBPC plan for holidays worked, that will count towards the hours requirement. They do not want resource nurses to be eligible for CNI, however they proposed that nurses would receive a higher percentage differential for those working more hours per pay period. We want to hear directly from Resource Nurses before responding and have already heard some serious concerns from those observing bargaining. Management continues to miss the mark; this is not the era for tradeoffs. Conditions need to be improved, not compromised.

AURN Staffing Proposal Summary:
• Acknowledges that nurses must not be assigned nursing activities that are inconsistent with the Oregon Nurse Practice Act that governs our Nursing Licenses.
• Full agreement that the Hospital Based Nurse Staffing Committee oversees all staffing plans and any modifications to those plans.
• Staffing plans must include a mechanism to measure patient acuity and nursing work intensity and we need nurses on the units to be able to hold majority votes to approve proposals that go to the HBNSC.
• Nurse staffing levels must account for non-nursing ancillary and support staff
• We laid out the exact safe staffing minimums for every major area in the hospital covered by the staffing law.
• For those not covered by the staffing law, some ambulatory and remote employees, we laid out a process that UBNPCs can carry out a data driven, evidence-based process to assess baseline FTE and allocate additional FTE where the professional standards show that is necessary. Our proposal also requires that FTE be allocated to properly provide coverage for vacations and leaves. We emphasized this as a top priority for these negotiations.
• We proposed that management stop violating the law and provide proper meals and breaks coverage for all nurses.
• Creation of Break Relief Nurses like our peers at OHSU Hillsboro and Sacred Heart Medical Center have. Empowering UBNPCs to determine the number and type of break relief positions or assignments needed for their unit, cluster, or groupings of units.
• Proper support and relief from work duties for UBNPC members to make sure staffing plans are in compliance with the law.
• Proper support for our Hospital Based Nurse Staffing Committee members to make sure staffing plans comply with the law, including a 0.5 relief time position for the Nurse Staffing Co-Chair for the extensive amount of their duties.