House Bill 2697: Providence advocates supporting both caregivers and patients

Jennifer Gentry, RN
Chief Nursing Officer
Providence Central Division

William Olson
Chief Executive
Providence Oregon

We know you’re hearing a lot about House Bill 2697, a proposal to mandate hospital staffing levels in Oregon. This legislation reflects the frustration and strain the health care workforce is feeling, and we are all feeling it. That said, Providence’s goal is to find a solution that balances the workplace desires of nurses and other caregivers, with the needs of our patients and communities. As proposed, Providence has serious concerns about the impact of House Bill 2697 and we are acting as a resource for any questions Oregon legislators might have.  

First, know that as hospital leaders, we absolutely value the clinical expertise, ingenuity and compassion our nurses and frontline caregivers provide to patients and our communities. Partnership with our nurses to find innovative solutions to unimaginable patient needs and capacity constraints over the past three years has been fundamental to our success. This is the work we need to continue. No legislation should inhibit Providence’s ability to partner with direct-care nurses to find ways to provide care to our community, while improving the work environment for caregivers.

Hospital capacity is already limited in Oregon, and the impact is being felt in all our hospitals

House Bill 2697 mandates ratios by unit for registered nurses and certified nursing assistants, and requires committee approved staffing plans for technical, professional and service staff. The minimum staffing required by the bill will further constrict hospitals that are already experiencing a capacity crisis.

Patients who delayed care during COVID are coming to hospitals with more complex needs, and they require longer lengths of stay. This issue is exacerbated because the lack of community placement leaves patients who don’t meet inpatient criteria in the hospital, after they are ready for discharge to an appropriate lower-level-of-care facility. Today Providence Oregon hospitals have more than 75 patients who are unable to discharge while they wait for a place in the community. This has led to an increase in hospital lengths of stay, ambulance diverts, and boarding of admitted patients in the emergency department. The net impact is that fewer individual patients can be seen in Oregon hospitals. 

The clinically trained workforce needed to meet the requirements of HB 2697 does not exist

Our caregivers are our most valued resource. Over the last three years we have seen experienced nurses leave the profession opting for early retirement and less stressful clinical environments. This has led to workforce shortages in hospitals because we are not able to hire enough nurses to fill the open positions we have now.

Currently, Providence has more than 750 open nursing positions in Oregon. Although there are claims to the contrary, there is no evidence that that minimum staffing required by the bill will improve clinical outcomes or entice nurses back to the bedside. In California, where ratios have been in place for several years, they are experiencing the same workforce challenges.

Legislation that mandates that hospitals hire more clinical staff must be balanced with workforce investments. Developing the nurse pipeline takes time and the nurse workforce is not available in Oregon today to meet the increased staffing needs that would be required per this bill. We need thoughtful, evidence-based solutions that are proven to support and strengthen the health care workforce.  

Oregon must balance patient access with meaningful hospital staffing changes

Mandated nurse staffing ratios have not led to improved patient outcomes in other states. Research is clear that the impacts of mandated staffing ratios in states like California has had no significant change in patient outcomes. Staffing is a very complex issue that is compounded by patient acuity and the knowledge, experience and expertise of the nursing team. Staffing ratios do not consider the patient, nurse, team and organizational factors that are weighed with each staffing assignment, rather they limit the flexibility to rapidly respond to the dynamic needs of patients and communities.   

Providence’s goal in discussions about House Bill 2697 is to balance the needs of our caregivers with the needs of our community. We are asking legislators to join Oregon hospitals in finding a solution that improves the work environment for nurses and ensures people in our communities – our families, friends and neighbors – are able to access the care they need when they need it.