SALEM, Ore. — Ask just about anyone in health care and they'll tell you that these are tough times in the hospital business. The Oregon Association of Hospitals and Health Systems reports that Oregon's hospitals are in their worst financial condition in 20 years — and that's just one side of the equation.
OAHHS reports that, on average, hospitals spent more than they made last year. Median operating margins in 2020 were 4.1%, falling to 3.2% in 2021. By 2022, that had dropped to -2.8%. It goes without saying that negative income isn't a good sign.
Just part of the cost that hospitals must cover is paying their people. According to the group, the average cost of each staff member went up by 26% over pre-pandemic levels. Though OAHHS didn't quantify it, that likely is related to the increasing reliance on contracted labor, like travel nurses, to temporarily address critical staffing shortages.
Those costs are part of what's been fueling what we've been hearing from hospitals about how they are struggling to keep up, even with extra funding provided during the height of the pandemic.
On the other hand, hospital workers — and especially nurses — have told us time and again that they are overworked and burnt out. In a national poll conducted by the American Nurses Foundation, 89% of respondents said their organization had a staffing shortage.
When Oregon nurses have tried to renegotiate contracts through their union in recent years, minimum staffing levels have been a major sticking point. To hear them tell it, nurses don't just want to be fairly compensated — they want a guarantee that there will be enough nurses on a given shift to adequately care for patients, rather than just passing the burden of staffing shortages on to the nurses who are still working.
But hospitals and health care worker unions haven't been able to reach a broad understanding on this point until now. You can perhaps understand why — hospitals are saying that they're suffering financially in part by shelling out for staffing, whether it's for their employees or contracted staff. And nurses are saying that whatever hospitals are doing for staffing now, it isn't near enough.
But a piece of legislation, House Bill 2697, appears to have finally gotten support from both sides after negotiations and compromise. It's working its way through the legislature right now.
Here's what HB 2697 would require for hospital staffing levels:
- Emergency Department: One nurse for one trauma patient. Other nurses in the ER could care for as many as four patients who are not trauma patients.
- Intensive Care Unit: One nurse for every two patients.
- Labor and delivery: One nurse for every two patients if they are not in labor or experiencing complications. This changes to one nurse per patient if they are in labor or having complications.
- Postpartum care: One nurse for every three mothers and babies.
- Operating Room: One registered nurse for one patient.
- Post-anesthesia care: One nurse for two patients.
- Oncology unit: One nurse for four patients.
- Pediatric unit: One nurse for four patients.
An announcement on the amended bill came from OAHHS, the Oregon Nurses Association, the Oregon Federation of Nurses and Health Professionals and SEIU Local 49. The groups began negotiating at the urging of Rep. Rob Nosse, one of HB 2697's chief sponsors
The groups endorsed two additional pieces of legislation as part of the agreement: Senate Bill 1079, which aims to improve hospital capacity by addressing "discharge barriers," and House Bill 2742, which would exempt some workforce-related costs from the state's health care cost growth target.
The agreement also calls for roughly $40 million in investments for health care professional training opportunities, described in a news release from the groups as "building a pipeline of health care workers."
HB 2697 has yet to receive a vote in either chamber of the Oregon Legislature. A House committee has recommended it pass with the most recent amendments, but the bill now sits with the join Ways and Means committee — the lawmakers charged with figuring out how to balance Oregon's budget.