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Saundra Sorenson
Published: 28 February 2023

Registered nurse Tammie Cline described sleeping in her car after 12-hour shifts with no break left her too exhausted to walk from the driveway into the house.

“You’ve spent two additional hours trying to catch up on your charting,” she said.

“You mentally and physically cannot keep up.

"That’s why nurses are leaving the bedside.”

tamarah cline 180Tammie Cline, RNThe experience was less a personal anecdote than a common experience among frontline healthcare providers, Cline, who serves as president of the Oregon Nurses Association, said. Cline spoke during a roundtable last week to bring awareness to the hospital staff shortage crisis, and to introduce state legislation to set and enforce mandatory staffing minimums in hospitals.

“I’ve been a registered nurse for nearly 20 years, and I know what it’s like to be burned out and not get breaks, not get vacations, and have to deal with awful staffing,” Rep. Travis Nelson (D-Portland), a registered nurse and former vice president of the Oregon Nurses Association, said.

“It’s part of the reason why I left the bedside nearly 10 years ago.

"I also know what it feels like to have a patient die – a patient with a spouse, a patient with children, a patient with loved ones – and to know that they died in part because I didn’t have the support that I needed as a nurse. That was a heartbreaking experience, and it’s an experience that continues to live with me to this day.”

rob nosse introRep. Rob Nosse (D-Portland)travis nelson 2022 introRep. Travis Nelson (D-Portland)Nelson cosponsored House Bill 2697 with Rep. Rob Nosse (D-Portland), chair of the state House Committee on Behavioral Health and Health Care.

“HB 2697 includes some common sense provisions that will require minimum numbers of staff on units needed to provide safe patient care, they’ll create some ironclad protections for rest and meal breaks, and will create financial consequences, penalties for hospitals, when they don’t follow our laws,” Nosse said.

A Crisis, Not A Shortage

Legislators and nurse advocates took aim at the narrative that there is a nursing shortage in Oregon or nationally. Not so, they said; heavy patient-to-nurse ratios lead to poor outcomes for both. Nor is the crisis the result of the pandemic, although the pressure from treating COVID cases brought many of these issues to light, they agreed.

“I have no doubt people are dying because of insufficient staffing,” Nelson said.

Oregon Health Authority Patrick Allen said as much in September when testifying in support of a $40 million additional funding request for hospitals. He explained that statewide, 700 people on average are either waiting for hospital beds or stuck in them awaiting discharge because of the severe staffing shortage–and that Oregonians have most certainly died waiting for care.

“Let’s think for a moment about what happens when a unit in a hospital doesn’t have enough staff,” Cline said. “First, patient care suffers. Nurses who take care of more patients than is safe report constantly that they are unable to perform their care duties. Nurses who care for more patients are more likely to experience medication errors.

“We see increased patient mortality, more pressure ulcers, more infections, more cases of pneumonia, longer hospital stays, more hospital readmissions, more respiratory failure and more preventable deaths.”

A vast majority of nurses in Oregon have reported experiencing “severe burnout,” with even more characterizing their work lives as “dangerously stressful,” Cline said, referring to a recent survey by the Oregon Center for Nursing. A national survey found that 15% of nurses have contemplated suicide.

“It’s a work environment crisis as much as it’s a staffing crisis,” Noose said.

“Nurses and other frontline healthcare workers simply will not continue to work under these conditions.”

The issue is exacerbated by an industry-wide practice of failing to enforce meal and rest breaks, Cline said.

“Data from St. Charles Bend Hospital in Oregon is truly astonishing,” she said. “The number of reported missed and meal breaks at St. Charles alone has grown 50% in the last two years, to more than 5,000 hours of missed bathroom breaks and lunch breaks (in a year), just at one hospital.”

Enforcement & Penalties

The legislative solution, as Nelson and Nosse have proposed, is to create staffing oversight committees in each hospital and to introduce considerable fines to hospitals that don’t comply with staffing plans.

Under HB 2697, the  OHA would be required to audit every hospital in the state once every three years. The OHA would also create an online portal where staff could report staffing plan violations, and maintain a website to post each hospital’s staffing plan.

Penalties for violations would include fines of $10,000 for each day the hospital was understaffed – meaning, out of compliance with the hospital staffing plan submitted to the OHA – and $200 in restitution to staff members for each missed rest or meal break. The bill also grants the OHA the ability to suspend a hospital's license if the hospital fails to correct violations.

HB 2697 also outlines acceptable staffing minimums in each hospital unit. Though some negotiation is allowed on a case-by-case basis and as allowed under approved staffing plans, in general, nurses are assigned a maximum of one to two patients in emergency or acute care settings, including the Intensive Care Unit. Patient limits are as high as four in oncology or medical-surgical units, five in psychiatric care and six in postpartum units.

Noting studies that show nearly a third of working nurses nationwide intend to quit by the end of the year, Noose said, “These problems, as we have heard, are only going to get worse unless we put statutory protections in place.”

A Tool For Retention

Nelson noted that the state currently has 17,000 more active registered nurse licenses than before the pandemic, and that many of those licensed professionals have left the field.

Creating healthier workplaces with manageable patient loads would go far in bringing many of those nurses back to the bedside, he argued.

“I think that this staffing bill is also a nurse recruitment and retention bill,” Nelson said. “I think that if we pass this bill in Oregon, we will see nurses from across the country come to Oregon…Nurses have left, and the reason they’ve said they’re leaving is because of short staffing. I think if we pass this, and nurses see that there is meaningful change that will hold employers accountable, we’ll see a lot of nurses come back who are sitting on the sidelines right now. That’s what I’m hearing from my friends, from colleagues from nurses across the state.”

Cline, who left Good Shepherd Medical Center in Hermiston months ago after more than 20 years of service, agreed. She argued that with workplace improvements, even rural hospitals would be able to maintain higher staffing levels.

“Most nurses that are leaving the bedside in these rural areas are vested in their communities. That is where they live, that is where their families live, that is where they want to be. So I have talked to my colleagues, and they will return to the bedside if they feel safe being at the bedside.”

The House Committee on Behavioral Health and Health Care will hold a public hearing on HB 2697 Tuesday at 5 p.m.

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