Oregon Passes Minimum Nurse Staffing Ratios Bill

• This summer, Oregon passed a law mandating minimum nurse staffing ratios in hospitals in an effort to combat nurse burnout and protect the safety of patients.
• This bill started taking effect for CNAs on September 1st and will be implemented for all nurses on June 1, 2024.
• Enforcement of these minimum nurse staffing ratios will begin on June 1, 2025, and include fines of up to $5,000 for repeated violations.

Oregon has become the third state in the U.S. to pass a law mandating minimum staffing ratios for nurses in hospitals. Governor Tina Kotek held a ceremonial signing for this bill on August 11th, and it began taking effect on September 1st.

This law has already seen a positive impact. One Oregon nurse and board member of the Oregon Nurses Association, Allison Seymour stated, “I’m thankful to now be one of the many nurses that can return safely to the bedside.” Seymour, like many nurses, felt burnt out from working in the unsafe working conditions caused by understaffed hospitals.

How We Got Here

Passing this bill was no easy feat as Oregon’s nurses and labor unions contended with the hospital association. While one side stated this bill would reduce burnout and save lives, the other said this ball was a threat to access to care and do nothing to solve the state’s nursing shortage.

These testimonies have been going back and forth since the bill’s first public hearing in February. It was only through negotiations and cooperation that this bill was finally agreed upon, with the president and CEO of the Oregon Association of Hospitals and Health (OAHH) committing to positive change.

Oregon’s Minimum Nurse Staffing Ratios

Known as HB 2697, this bill is the first of its kind. While this bill builds upon nurse staffing ratios from other states, it is the first to include such a wide range of care settings.

This bill also established staffing committees for service workers (environmental and food services) and technical/professional providers (radiology technicians, physical therapists, etc.). These staffing committees allow more workers in healthcare settings the power to adopt staffing plans that protect their workers and influence decisions made in care delivery.

The bill itself defines specific titles for the nurses subject to these minimum nurse staffing ratios. These definitions have been detailed below, alongside the ratios for different hospital units:

Definitions

• Charge Nurse: Direct Care RN who coordinates patient care responsibilities among nurses in a hospital unit. 
• Clinical Care Staff: State licensed or certified individuals who provide direct care.
• Direct Care: Care provided by licensed or certified hospital staff within the scope of their license.
• Direct Care Staff: RNs (Including RNs who consult on patient care), LPNs, and CNAs who are routinely assigned to patient care and are replaced when absent. 
• Direct Care: Care provided by licensed or certified hospital staff within the scope of their license.
• Direct Care Staff: RNs (Including RNs who consult on patient care), LPNs, and CNAs who are routinely assigned to patient care and are replaced when absent.

Hospital Units

• Emergency Department: 1 Direct Care RN to 1 trauma patient or 4 patients over a 12-hour shift
• Intensive Care Unit: 1 Direct Care RN to 2 patients
• Labor and Delivery: 1 Direct Care RN to 1 patient in labor, 2 patients otherwise
• Nursery: 1 Direct Care RN to 6 patients (babies counted separately from their parent)
• Mother Baby Unit: 1 Direct Care RN to 8 patients (babies counted separately from their parent)
• Oncology Unit: 1 Direct Care RN to 4 patients
• Post Anesthesia Care Unit: 1 Direct Care RN to 2 patients
• Intermediate Care Unit: 1 Direct Care RN to 3 patients
• Medical-Surgical Unit: 1 Direct Care RN to 5 patients (dropping to 1 to 4 in June 2026)
• Cardiac Telemetry Unit: 1 Direct Care RN to 4 patients
• Pediatric Unit: 1 Direct Care RN to 4 patients

Minimum Nurse Staffing Ratios Compromises and Enforcement

These historic protections for nurses must come with some stipulations, especially considering Oregon is still suffering from a national nursing shortage. For example, this law only applies to nurses in hospital settings.

Another compromise is that rural hospitals may be granted a two-year variance if they cannot gain enough staff in the required time frame. This can only be granted to hospitals that have under 50 beds.

With these compromises, there have also been new enforcement guidelines to ensure hospitals follow the minimum nurse staffing ratios set out in this bill. One major problem this law addresses is nurses missing breaks in order to stop another nurse from having to take on additional patients.

The hospital is allowed one warning for causing a nurse to miss their break, after which they will pay $200 for each missed break that is filed through the Oregon Health Authority. Nurses may also file a complaint with Oregon’s Bureau of Labor and Industries, which may fine the hospital up to $1000 for a violation.

Hospitals are also given a single warning for other violations, such as requiring excessive overtime or failing to establish staffing committees. After which, a fine is occurred for $1,750, $2,500, or $5,000 depending on the number of offenses.

The Bottom Line

Many nurses around the country have been fighting for safe nurse staffing ratios while negotiating with hospitals. Oregon has now taken a proactive step towards protecting the state’s nurses and the patients they care for.

Only time will tell if other states follow Oregon’s lead or find unique ways to combat the nursing shortage that continues to plague our healthcare facilities.

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