Skip to main content
Subject: Update on House Bill 2697
From: Nurse Manager Jennifer Ballard
To: All Surgical Oncology Nurses at Providence Portland Medical Center
Date: May 16, 2024
Amid tense contract negotiations with Providence Health & Services, the Oregon Nurses Association is levying serious allegations against the hospital network it has long accused of putting profits before patient care. Providence, its nurses’ union alleges, is already breaking the landmark nurse staffing law that passed in 2023 and went into effect earlier this month.
At the time, proponents of the bill said it would improve patient safety and relieve overworked nurses. So one might assume that when the law went into effect this month, nurses would be asked to care for fewer patients.
Not necessarily so.
WHAT DO NURSES SAY?
The May 16 email from a nurse manager at the hospital’s 7S oncology unit says the nurse-to-patient ratio during the daytime for non-critical patients would switch from 1 to 3 to 1 to 4.
“While I wish I could say our staff will stay the same come June 1st,” Jennifer Ballard wrote, “I am sad to report that our ratios/staffing will be changing starting at 0700 on Saturday.”
The reason each nurse was getting an additional patient: House Bill 2697, the 2023 law, required hospitals to end the “buddy system” that led to nurses shouldering a double burden while a co-worker had a meal break.
To comply with the law, Providence created a new role, a “relief nurse,” who could be summoned to fill in during breaks. Providence then reassigned nurses to fill that role, resulting in everyone else being assigned more patients.
Not only is this a subversion of the intent of the law, nurses say, it’s also a direct violation.
The law, as written, doesn’t allow hospitals to just throw out their existing staffing models without nurses’ approval, union officials claim. And, they say, that’s exactly what’s happening all over the state.
On June 4, an attorney for ONA filed an official complaint with the Oregon Health Authority, calling Providence’s tossing out of existing staffing models “a systematic and concerted mass violation” of the nurse staffing law. “Providence’s efforts appear to be designed to increase nurse patient loads in violation of existing staffing plans,” it alleges.
WHAT DOES PROVIDENCE SAY?
In a short statement to WW, a Providence spokesperson confirmed that staffing changes had been made on the “7th floor,” but said it was “in order to comply with the law.”
The spokesperson offered few further details, but the hospital’s trade group has offered a more full-throated explanation of why it thinks the move is legal.
The law is best known for its landmark feature: caps on the number of patients per nurse. For oncology units like 7S, that ratio is four patients to every one nurse.
In a June 7 letter to state regulators, Sean Kolmer, a vice president for the Hospital Association of Oregon, explains the ratio is a “dispute resolution solution” for when nurses and administrators can’t agree on an alternative staffing model.
So, by Kolmer’s logic, without an agreement to staff relief nurses on 7S, the statutory 4-to-1 ratio automatically goes into effect—even though it’s more patients per nurse than the unit staffed prior to the new law’s implementation.
Paige Spence, ONA’s director of government relations, says the hospital association is willfully misinterpreting the law, which she says doesn’t allow hospitals to unilaterally ditch a prior staffing plan. “The law and rules are abundantly clear,” she says. “The hospitals are looking to manufacture a loophole.”
The Oregon Health Authority will have to decide who’s right. It’s currently reviewing hundreds of complaints filed by nurses since June 1, and will begin fining hospitals for violations next year.
WHY DOES IT MATTER?
Short staffing and low pay have led 3,000 Providence nurses to announce they’re walking off the job. The three-day strike begins next week across six hospitals, including Providence’s largest, St. Vincent Medical Center in Washington County. It does not include Providence Portland Medical Center, where the nurses’ contract extends to the end of this year.
At a press conference announcing the strike, Medford nurse Caroline Allison named Providence’s interpretation of the new law as one of picketers’ chief concerns.
“The safe staffing law was intended to solve the nurse workforce shortage crisis and allow us to greatly enhance patient care,” she says. “Instead, Providence has again made the decision to focus on their own bottom line.”