Oregon hospitals would face limits on fines for staffing violations

The Oregon Health Authority would cap yearly hospital staffing fines at the smaller of $2,000 per licensed inpatient bed or $1 million. The cap would cover violations of the hospital staffing rules listed in the bill. The no-fine exceptions would cover specified staffing shortfalls. Hospitals would avoid certain staffing fines if they scheduled required staff and completed every listed effort to find replacements. Those efforts cover seeking volunteers, contacting qualified employees available for extra work, seeking daily-hire staff, and contacting usual temporary staffing agencies when their use is allowed. The authority would issue warnings and require correction plans for covered violations. Collected fines would go to the hospital’s local public health authority. The ban on fines would apply to violations occurring before July 1, 2027.

Hospitals would implement committee-adopted nurse staffing plans or use a hospital-wide plan meeting state requirements when the committee has not adopted one. The provisions would cover hospital-wide nurse staffing plans and plans for individual hospital units. Fallback plans would keep previously agreed union contract terms, including breaks, unless a term directly conflicts with a law or state rule. Committee-adopted plans would be written, and the adoption vote would be recorded in the plan. Staffing committees would review plans at least yearly and at other times chosen by both committee cochairs.

Hospitals would follow committee-adopted unit staffing plans or, without one, the state’s limits on patients assigned to each registered nurse. The listed medical-surgical limit would be five patients per registered nurse. Other hospital units would have their own limits. A patient’s care classification, recorded by a licensed medical professional, would determine the applicable state ratio regardless of the unit providing care. Units could depart from staffing plans up to six times during a rolling 30-day period, within periods of 12 consecutive hours. This exception would not cover meal or rest breaks. Charge nurses could take patients in units with 10 or fewer beds. Larger units would need committee approval. Charge nurses would count toward ratios while taking patients.

Staffing committees could approve exceptions to state nurse ratios for certain hospital classes and for care models using other clinical staff. The hospital-class option would cover hospitals classified as type A, B, or C. The care-model option would cover hospital units. A hospital-class exception would require a committee vote and notice to the Oregon Health Authority, with a statement signed by both cochairs confirming approval. A care-model exception would require majority committee approval to try different ways of providing care. Other clinical staff could fill up to 50 percent of the required registered nurse positions. Hospital-class exceptions would begin when notice is submitted and last two years, with renewal allowed. Care-model staffing would need approval again every two years.