Oregon has become the fourth state to enact a law requiring nurse-to-patient ratios at hospitals, a move praised by labor groups and panned by health systems.
Hospitals in the state will have until Sept. 1 to comply with certified nursing assistant ratios set by the bill signed Tuesday by Gov. Tina Kotek (D). Beginning in June 2025, the Oregon Health Authority will start enforcing other minimum nurse staffing requirements that vary by type of unit and patient acuity and take effect next year.
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“This law lays the foundation that we can build from so we are getting to that point where nurses are being fulfilled in their workplace,” said Matt Calzia, director of nursing practice and professional development with the Oregon Nurses Association, a union representing 15,000 nurses statewide. “We want to provide really high quality care, the care that we’ve been educated to provide.”
Although the law focuses mainly on nurse staffing, it starts the conversation for all healthcare workers to have a say in the staffing of their work environment, Calzia said.
For some facilities, the law leaves much to be desired.
Oregon Health & Science University Hospital, located in Portland, opposed the measure, saying it didn’t address the underlying issues contributing to understaffing and will be hard to implement in the proposed timeline.
In a February letter to lawmakers, the hospital suggested the state focus its efforts on improving reimbursement and clinician wages, investing in healthcare workforce development through loan forgiveness and scholarships, reducing administrative burdens on clinicians and increasing patient access to care.
Nationwide, efforts to establish staffing ratios in various care settings have been met with resistance from organizations like the American Hospital Association and large health systems like Mayo Clinic. They argue that ratios deny nurses the independence to determine their own staffing needs, threaten hospitals financially and create an increased dependence on temporary staff.
In Minnesota, Mayo Clinic successfully rallied against legislation that would have required hospitals to establish committees of nurses, other direct caregivers and executives to set staffing levels for inpatient care units.
Three other states—California, Massachusetts and New York— mandate specific nurse-to-patient ratios, though the latter two only require minimums for intensive care and critical care units. Lawmakers in several other states are pushing for similar measures, and a number of states have policies requiring nurse-led staffing committees at hospitals.
In March, federal legislation that proposes national minimum staffing requirements was reintroduced by Rep. Jan Schakowsky (D-Ill.) and Sen. Sherrod Brown (D-Ohio).
The Oregon law requires hospitals to have a 1-to-1 nurse-to-patient ratio for trauma patients in emergency departments, a 1-to-2 ratio for intensive care units and a 1-to-4 ratio in medical surgical units. Hospitals will also need to ensure certified nursing assistants are caring for no more than seven patients during their day shifts and 11 patients during night shifts.
The ratios must be maintained even when nurses take their meal breaks, meaning nurses no longer will have to take a greater patient load to cover for their peers, Calzia said.
Additionally, the measure requires that by the end of 2024, hospitals establish staffing committees led by service workers, technical providers and professional providers in an attempt to help hospital staff other than nurses adopt safe staffing plans.
Hospitals that repeatedly violate the staffing law could face escalating financial penalties of up to $5,000 per offense, with the Oregon Health Authority overseeing complaint-driven enforcement.
