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Looking Back, Looking Forward
Oregon Nurse Online Summer 2013 Edition
A message from ONA's Executive Director, Susan King, MS, RN, CEN, FAAN

Since the late 1990’s, ONA members have worked to improve patient care in hospitals by addressing nurse staffing. As we have always seen, the data showing the link between staffing and patient outcomes is clear. The evidence showing how Oregon hospitals were failing to adequately staff their facilities was the cornerstone of ONA’s work to enact hospital staffing laws in both 2001 and 2005.

ONA’s work could not have happened without the expert guidance of Sue Davidson who, until her retirement on June 30, was ONA’s Assistant Executive Director of Nursing Practice, Education and Research. Much of her work was focused on hospital nurse staffing, including: creating a robust database of staffing request and documentation forms (SRDFs); meeting with groups of staff nurses and managers to assess staffing conditions; developing of legislative and regulatory policy; and establishing the Oregon Nurse Staffing Collaborative. Sue lent her practice and research expertise to this ongoing issue in order to support direct care RNs and the authority they have under the law. As we move forward, Sue’s guidance and expertise on this topic will be missed greatly. But there is still much to do.

Despite a law that requires hospital nurse staffing to be based on patient need and consistent with national specialty standards, facilities across the state have failed to comply with both the letter and intent of the law and administrative rules. Thus, the energy and time of direct care RNs is focused on preventing inappropriate staffing changes rather than working with their administrative partners to develop good plans. Admittedly, hospitals are currently faced with the possibility of income reductions if we are successful in keeping patients out of emergency departments and preventing unnecessary inpatient admissions. Efforts to tie performance to payment are a reality, even if the economic impact is not yet known. While staffing a hospital is a complicated process, often plagued by uncertainty and unforeseen circumstances, the obligation to patients remains constant for the hospital and the individual nurse.

Across the state, we are seeing a resurgence in directives from finance departments to reduce costs and decrease staffing is becoming common. Use of expensive consultants who propose staffing changes in violation of the law is fashionable again. Members of hospital staffing committees are told that the committee may recommend a staffing plan but they do not have the final authority that the law granted. Department directors verbalize their lack of knowledge about the requirements of the law, including the application of specialty standards. In fact, some departments do not even have the applicable specialty standards as they make reductions in RN staffing. Surgical units continue to use call staff to cover prescheduled off hour procedures, circumventing the limit of 12 continuous hours of work in a 24 hour period.

While there are many actions by facilities that violate the law, enforcement is limited. The department within the Oregon Health Authority that is responsible for enforcement is hard to find by anyone except insiders. There are reports that complaints filed have taken over six months to be investigated and department staff seem reluctant to give advice about the application of the law when questioned.

To be fair, there are a few facilities with successful staffing committees which have continued to develop staffing plans and modifications consistent with the law. Unfortunately, these facilities are not the norm.

Given that the health care environment will be uncertain over the foreseeable future and attempts by facilities to deal with economic factors by reducing RN staff will likely continue, ONA member leaders and staff are preparing for action that will lead to further legislative direction to Oregon hospitals. A workgroup composed of hospital-practicing ONA members, as well as our colleagues from the Oregon Federation of Nurses and Health Professionals, will be developing language and an action plan, with a goal of bringing forward legislative changes in 2015 that will strengthen our nurse staffing law. For ONA members in acute care, submission of reports which detail the work of hospital staffing committees and filing SRDFs when needed will be important as this work proceeds.

We will miss the expertise of Sue Davidson as we embark on this next effort, knowing that her work has made a tremendous contribution to past success. Future success is in our hands. Our patients deserve it.  

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