It isn't as tough as California's first-in-the-nation law, but Oregon state legislators have delivered what many are calling a major victory for state nurses by approving a bill that limits mandatory overtime and requires hospitals to adopt staffing plans.
Critics, however, say the bill has lost much of its intended impact because of the various amendments and exceptions that were added on its way through the state Assembly. The state is just the second to pass a minimum nurse staffing law. California passed its law last year, but there is a two-year rule-writing process under way.
Passed by a 44-2 vote in the Senate June 8 after earlier passage in the state House of Representatives, the Oregon bill says the state's 62 acute-care hospitals must work with nurses to draw up staffing plans based on the care needs of patients and nurse specialties. Hospitals also must determine a minimum number of nurses to be on duty for each shift.
In addition, nurses generally cannot be required to work more than two hours beyond a regularly scheduled shift or more than 16 hours in a 24-hour period. Additional nurses are called in when a hospital gets an unexpected surge in patients, but nurses say extra staff isn't always available, so nurses already on duty are forced to work overtime.
Oregon's governor is expected to sign the bill this month, and it would take effect in October 2002.
Backers of the bill say it would help stanch the state's nurse shortage by preventing job burnout. Studies show that nurses typically leave the field after four or five years, opting for less stressful and exhausting professions.
"The bill addresses a primary problem with nurse retention, and that's the practice environment," said Susan King, administrator of professional services for the Oregon Nurses Association, which represents 9,000 registered nurses. "The biggest reason nurses leave or reduce their hours is that they're overworked and, consequently, worry about the quality of care they are able to provide their patients."
The issue first came up in 1999, when the ONA tried to get a law passed prescribing specific nurse-to-patient staffing ratios. But instead, lawmakers asked nurses and hospitals to work together to develop rules regarding adequate staffing levels. Those rules weren't enforceable.
The new law will require the Oregon Health Division to perform random audits to ensure that the provisions are in place and being followed. Violations of the requirements could result in state penalties of up to $5,000 a day or suspension of a hospital's license.
Officials at Sacred Heart Medical Center, a 432-bed hospital in Eugene, Ore., worry that the law will put an extra burden on hospitals already struggling to recruit and retain a full staff of nurses.
"Our primary concern remains whether we can fill all of our (nursing) positions," said Judy Tatman, chief nurse executive of Sacred Heart, where 10% of the 900 nursing positions are vacant. "We're about two hours south of Portland, so we have a much harder time attracting staff than hospitals in the Portland area do."
Tatman, however, points out that the bill also carries some provisions that benefit hospitals.
One amendment, for instance, requires full-time nurses to inform hospitals of any outside jobs they hold. If a hospital discovers that the other job interferes with the nurse's ability to fulfill his or her obligations, it can require the nurse to quit that position.
"Some nurses receive full benefits from the hospital for working 30 hours a week, then work the rest of their time as an agency nurse at another hospital," Tatman said. "We've never been able to inquire about that, but now we'll be able to."
Another clause renders almost moot the bill's stated ban on mandatory overtime. It says a hospital cannot require its nurses to put in overtime-unless it "has made reasonable efforts to contact all of the qualified, on-call nursing staff . . . and is unable to obtain replacement staff in a timely manner."
In fact, the Oregon Association of Hospitals and Health Systems said the bill has been changed so much from its original form that it's now virtually identical to the state staffing rules to which hospitals have been adhering for years.
"When all was said and done, the bill (turned out to be) nothing more than a political statement. There were no real gains for the ONA except for some rhetoric," said Ken Rutledge, president of the OAHHS, the bill's biggest opponent. "This is status quo. If status quo was what the ONA wanted, we wonder why they pursued the bill in the first place."
The bill was first introduced in the Oregon House in May, a week after a new report by the Portland-based Northwest Health Foundation, an independent research group, concluded that the state's nursing shortage has become a public health crisis-one that is compromising patient care, hurting morale and driving up healthcare costs. If the situation continues, by 2010 Oregon won't have a fifth of the registered nurses it will need, the report said.
The nursing shortage is an issue of national concern, with the hardest-hit hospitals canceling surgeries, diverting ambulances to other hospitals and shutting down nursing floors in states such as California, Florida and New York. In a survey of 700 rural and urban hospitals, the American Hospital Association found a shortfall of about 126,000 registered nurses, which accounted for three-fourths of the hospitals' 168,000 job vacancies.
Federal legislation aimed at pulling more people into the nursing profession through grants, scholarships and a nationwide "image campaign" was introduced in Congress in April.