HB 2697 Law: Frequently Asked Questions
Please note: Keep that in mind as you review this FAQ, information here is accurate to the best of our knowledge as of July 2023.
Q: Has HB 2697 passed the legislature?
A:Yes!
House Bill 2697 (HB 2697) passed both the Oregon House and Senate in June 2023, and has now become law.
Q: When will HB 2697 take effect?
A: Some components of the law are effective as of September 1, 2023. However, there are a variety of milestones that are implemented at different times. Visit our law explanation page here for a diagram and explanation of implementation timelines.
Q: One of my managers said that HB2697 means our current staffing plan will go away and will be replaced by new ratios; is that true?
A: Nothing in HB2697 forces existing staffing plans to be changed if they meet the minimum requirements in the law. For example: if a telemetry unit currently staffs to a ratio of 1RN:3PTs, there is nothing in the law mandating that the plan must be changed to be 1RN:4PTs. However, if the telemetry unit staffing plan states that the unit staffs for 1RN:5PTs, the plan will need to be adjusted to comply with the 1RN:4PT statutory ratio in the law when they go into effect. Long story short, if your staffing plan is a higher standard than the law, you will not be required to lower those standards or take on more patients because of this law.
Q: Will we still have staffing committees? What will they do now?
A: Yes, the existing staffing committee structure remains in place and now other healthcare workers have a voice in their professional/technical and service staffing committees. The nurse staffing committees still approve staffing plans and staffing committees at impasse now have a process for a legally binding resolution. Staffing committees are now also required to review certain metrics, such as missed meals and rest breaks.
Staffing committees are just as crucial as they were before and have the power to approve staffing plans that are better than the minimum safe standards within the law. This is a floor, not a ceiling and staffing committees will work to set standards appropriate for their facilities.
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. It is also important to remember that current staffing plans that satisfy the minimum standards of the new statute will remain in place.
Q: One of my managers said that, if there is disagreement within the staffing committee and they are at an impasse, hospitals will basically “wait it out” and the ratios in HB2697 will become the standard. Is that correct?
A: This is not accurate. There will be a time-limited and binding arbitration process to settle an impasse with the staffing committee. Units that do not have statutory ratios defined in the law will always have the arbitration process available to resolve any staffing plan impasse.
Q: I heard that ONA and other unions had to make some concessions in this bill; what are those concessions?
A: Yes, the law as passed does include some compromises to address emergent patient care needs and to meet the need for flexibility identified by legislators. The resulting language includes the following compromises:
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 law does 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 (up to 6 in 30 days) and the length of time (up to 12 hours) during which those deviations can occur.
Implementation Timeline
Our amendments establish a reasonable timeline for implementation to ensure hospitals and staffing committees have sufficient time to prepare for these changes. The law, once passed, will take effect on September 1, 2023, to allow time for legislative rulemaking, with the nurse-to-patient ratios beginning on June 1, 2024. It is important to note that the ratio for medical-surgical units begins at 1RN:5PT but tightens down to 1RN:4PT on June 1, 2026. New staffing committees (for service, tech and pro workers) take effect on December 21, 2024. Financial penalties and fines for hospitals will begin June 1, 2025.
Hospital Setting Only
You may recall that, when we introduced HB 2697, our language included home health settings. As amended, the law only applies to hospital environments. ONA's Government Relations team is committed to working with our home health and hospice members to try to elevate staffing solutions in the 2025 session.
Q: I am hearing from friends in the ED that the ratios in this bill are going to make things in emergency departments even worse. Is that true?
A: ED ratios in HB 2697 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 in this legislation 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 always 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.
Staffing committees are just as crucial as they were before and have the power to approve staffing plans that are better than these minimum safe standards. This is a floor, not a ceiling and staffing committees will work to set standards appropriate for their facilities.
Q: Is it true that my hospital will have to pay me $200 for every meal and rest break I miss? How does that work?
A: Yes, but there is a process that must be followed.
First, it is important to note that this safe staffing law puts an end to the “buddy-break system.” The 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.
As a result, 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!
If a health care worker covered under this law has had to miss a break and wants to seek the $200 remedy, they file a complaint with OHA as they would with any other staffing complaint. However, just for meal and rest breaks, it is ultimately the Bureau of Labor and Industries (BOLI) who determines if the $200 is warranted.
Q: I’ve heard from my CNA colleagues that this bill also impacts them and their ratios. How does the bill affect CNAs?
A: For the first time, CNAs will have ratios in hospitals such that 1 CNA cannot have more than 7 patients on day shift and 11 patients on night shift.
Q: Didn’t Oregon already have a nurse staffing law?
A: Yes. Oregon lawmakers passed a nurse staffing law in 2001 which has been amended and updated several times over the years. This law includes several important components, including mandating the creation of nurse staffing committees to oversee staffing in acute care hospitals, requiring that hospitals develop a facility-wide staffing plan and, most recently, providing guidance for staffing needs and nurse safety during long-term emergencies like the COVID-19 pandemic.
What was an effective and useful law 20 years ago is no longer able to meet the staffing crisis we face, in large part because Oregon’s hospital systems have intentionally chosen not to follow the law. Basically, Oregon’s previous nurse staffing law could have been successful, but hospitals refused to follow the rules and the Oregon Health Authority (OHA) has not enforced the laws. That is why the new law prioritized creating stronger means for enforcement.
Q: Does Oregon have enough nurses to meet the requirements of this law?
A: Yes.
First, it is important to know that the minimum staffing standards included in this law are already in place at many hospitals across the state. The minimums in this law close loopholes that hospitals were and are exploiting to have fewer nurses at the bedside. But the law will not dramatically increase the number of nurses needed across the state.
Second, we know that, as of September of 2022, the number of licensed RNs in Oregon was just over 80,000, a dramatic increase in RNs licensed in the state from 2019 where there were just over 62,000. We also know that, of those nearly 80,000 RNs currently licensed in Oregon, 55% of them work in hospitals. That means that there are another 44,000 RNs licensed in the state who are either not currently practicing or are working in non-acute care settings.
Third, we know that nurses are leaving the bedside in droves because of unsafe staffing. Let’s just look at one example: OHSU, Oregon’s premiere medical research hospital. An analysis of OHSU employment data by unit shows a massive turnover problem - a turnover problem that plagues all of Oregon’s hospitals. Between January 2019 and January 2022, OHSU units experienced between 39% and 54% turnover of their RN staff. The reason? Unsafe staffing that leads to burnout, feeling unsafe at work, negative impacts on mental health, and dissatisfaction with their jobs. This legislation directly addresses the core causes of burnout – unsafe staffing – which, in turn, will lead to a reduction in turnover.
The problem isn’t having nurses available, the problem is that the available nurses refuse to work at hospitals that are burning through, and burning out, nurses faster than they can replace them. Now with this law, ratios can safeguard more nurses from burnout, and draw nurses back to the bedside with the expectation of better staffing protections.
Q: How did you determine the safe staffing standards for “nurse to patient” minimums?
A: The nurse-to-patient minimum safe staffing standards were created based on regulations in other states, proposed federal legislation, and an analysis of current staffing practices in Oregon.
We know that the biggest impact on the nursing work environment is the workload of a nurse’s assignment. We analyzed hospital staffing plans and practices across the state and noted that hospitals that staff more closely to the minimums proposed in the law have lower rates of nurse turnover, which is the real nurse staffing crisis in Oregon.
Q: What else will this legislation do?
A: This new law improves the working conditions for and retention of our nurses and healthcare workers to ensure patient safety and improve health outcomes.
For example, ensuring minimum staffing standards are upheld in hospitals would allow nurses more time with their patients so that they can more closely observe them and more quickly respond with lifesaving interventions when needed. Research shows that better nurse staffing is associated with better patient outcomes, increased patient satisfaction, decreased hospital acquired conditions, decreased length of stay for patients, decreased chances for patient readmission, decreased patient mortality, and may help diminish racial disparities.
Higher staffing levels were also associated with a reduction in medication errors, fewer pressure ulcers, less need for restraints, decreased infection, and fewer cases of pneumonia. There was also a 14% decrease in risk for in-hospital mortality for every additional one decrease in patient load over 24 hours.
That means minimum staffing standards save lives, reduce costs, and improve patient care.
