Unsafe Staffing is at the Heart of Oregon’s Health Care Crisis

(Portland, OR) – Two different reports – a national health care staffing shortage report from the American Federation of Teachers’ Healthcare Division (AFT) and a statewide survey of nurses by the Oregon Nurses Association (ONA) – are unequivocal in their findings: unsafe staffing levels are the primary cause of Oregon’s ongoing health care crisis.

AFT’s Healthcare Staffing Shortage Task Force, which included nurse leaders and representatives from Oregon, Alaska, Connecticut, Washington, Wisconsin, and Montana (among others), published their report on November 16, 2022. The Task Force worked for more than 8 months examining the state of America’s health care workforce.

Among the key national findings were:

• The US is facing a serious decline in the nursing workforce (In 2021, the U.S. Department of Labor Bureau of Labor Statistics (BLS) reported 55,000 fewer registered nurses (RNs) employed throughout the country than in 2020. This was the first decrease in total RN employment in more than five years.)
• Hospitals and health care systems claim the reduction in RNs is largely from retirements, but national demographic data shows the industry is seeing an exodus of nurses under the age of 44 from the profession; a significant reversal of the trend, between 2016 and 2022, of nurses under the age of 44 making up a greater share of the RN workforce.
• Nearly one in four health care workers are likely to leave their professions this year.
• Workplace violence against health care workers is growing and has been made significantly worse by inadequate staffing. Health care workers experience 76% of all reported workplace violence injuries, and the rate of reported assaults grew by 144% in hospitals and 63% in home health agencies from 2000 through 2020.
• Pandemic-related pressures on health care accelerated this trend as the rate of violence in hospitals increased by 25% in one year alone, from 2019 to 2020.
• 61% of nurses believe that COVID-19 stresses have had a negative impact on their mental health and 30% report they received or believed they needed mental health services due to the pandemic. Nearly 50% said the pandemic had negatively impacted their physical health, as well as their relationships with family members (42%) and co-workers (41%).
• More than 70% of healthcare workers have symptoms of anxiety and depression, 38% have symptoms of post-traumatic stress disorder, and 15% have had recent thoughts of suicide.
• Unsafe patient levels are linked to poorer patient outcomes, including higher likelihood of death.

“Health care professionals knew long before COVID-19 that working conditions had been deteriorating for years,” said AFT President Randi Weingarten. “Then came the pandemic. For nearly three years, they’ve worked under unprecedented challenges—while for-profit institutions made record profits. Many health care workers are emotionally exhausted and heartbroken from trying to care for your patients under impossible conditions. Understaffing is the core problem, which leads to other horrible conditions like crushing workloads, mandatory overtime, extended shifts lasting 12 to 16 hours, constant fatigue, worker injuries and skyrocketing rates of violence against healthcare workers, making hospitals one of the most dangerous places in America to work.”

• Click here to view AFT’s full Healthcare Staffing Shortage Task Force Report or an executive summary.

ONA is also reporting the results of our statewide nursing survey, which echoed the findings of the AFT task force report. The survey, conducted across all ONA’s bargaining units and with nurses from 37 hospitals from every corner of the state participating, found that unsafe staffing levels are what is driving Oregon’s nursing workforce crisis.

Key findings from the ONA Safe Staffing Survey include:

• Less than 1% of Oregon’s nurses report that their unit is always staffed appropriately – meaning 99% of units in Oregon’s hospitals are sometimes or never staffed appropriately.
• 50% of nurses report they are caring for too many patients on most of their shifts.
• Oregon patients are negatively impacted by improper staffing. When a unit is short staffed, 78% of nurses say there are delays in responding to patient call lights, 76% say there are medication delays, 72% report delays in providing hygiene and nutrition care, 71% say there are delays in pain assessment and intervention, and 66% report that units that are understaffed result in increased length of stays for patients and delays in discharging a patient.
• 92% of nurses report missing meal and rest breaks, with 42% of nurses reporting that they miss meal and breaks on most of their shifts.

ONA’s survey also asked nurses about Oregon’s current hospital nurse staffing law and how well the Oregon Health Authority (OHA) is enforcing that law. The findings clearly indicate that Oregon’s current law is not working in large part because OHA fails to enforce the law. Specifically, 85% of nurses report that their unit is not being staffed according to Oregon law, and 84% of nurses believe that OHA has been ineffective in enforcing Oregon law.

These failures to enforce the law, combined with consistent and historic unsafe staffing levels across the state have led to a crisis in staffing, but also a crisis in nurse turnover. About 90% of nurse respondents reported that staff turnover in their unit has been high (36%) to very high (54%.) Of those who reported high or very high turnover, 84% report that turnover has had a negative impact on their working conditions and on their ability to provide quality patient care.

• Click here to view results from ONA’s Safe Staffing Survey.

“The evidence, both at the national level and here in Oregon, cannot be ignored,” said ONA President Tamie Cline, RN. “We are in a crisis. That crisis has been decades in the making, and unsafe staffing is at the very heart. If we do not act, Oregon will continue to experience the devastating impacts of a failing health care system. Patients will continue to suffer, sick people will continue to face hours and hours of wait times in the ER, surgeries will continue to be canceled or delayed, and nurses will continue to leave the bedside. Unless the Oregon legislature acts in the upcoming session, this cycle will continue, and nurses and patients will continue to bear the consequences.”

The Oregon Nurses Association (ONA) is the state’s largest and most influential nursing organization. We are a professional association and labor union which represents more than 15,000 nurses and allied health workers throughout the state. ONA’s mission is to advocate for nursing, quality health care and healthy communities. For more information visit: www.OregonRN.org. 

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