Talking Points
STUDY: Oregon Nurse Staffing Law: Is It Working?
Published in March 2012 Journal of Nursing Administration
3/2/2012
ANA supports efforts to evaluate the effectiveness of state laws intended to ensure
appropriate staffing levels.
Oregon was the first state to enact a law (2001) that required the creation of hospital nurse staffing
committees, with direct-care RN input, to determine staffing for each unit and shift.
In order to better understand how well the law was meeting its intent, the American Nurses
Association (ANA) funded the study jointly with the Oregon Nurses Association (ONA).
The study is qualitative, evaluating how the law is perceived, understood and implemented. It is a
first study with limited data and applicability. More studies are needed to determine the effects on
patient safety and outcomes, and nurse satisfaction.
Six other states have passed safe staffing laws requiring staffing committees with direct-care RN
participation, like Oregon’s. More time is needed to collect sufficient data and evaluate results.
The study reveals that nursing leadership greatly influences how the staffing law provisions
are implemented within each hospital.
The Chief Nursing Officer’s view of the staffing legislation and staffing committee is reflected in staff
nurses’ perceptions and the effectiveness of the committee.
Operations of the staffing committees varied among hospitals, including how RNs were assigned to
the committees, how patient acuity factored into staffing decisions, and how minimum numbers of
RNs for each shift were originally established.
The study suggests that stronger enforcement could improve the functioning of hospital nurse
staffing committees and ensure that the law is implemented more consistently and uniformly.
For example, the federal Registered Nurse Safe Staffing Act of 2011 includes enforcement
mechanisms, including financial penalties for violations.
ANA believes any effort to improve nurse staffing is positive. Given the complexity and ever
changing health care environment, ANA prefers an approach that includes the authority of
direct care nurses in determining the staffing plan for each unit and shift.
ANA has long advocated for improving nurse staffing, through development of principles (1999),
federal and state legislative initiatives and the National Database for Nursing Quality Indicators®
(NDNQI®), the database that links RN staffing to patient outcomes.
ANA’s preferred approach promotes adjustable staffing plans that account for patient intensity,
nurses’ skills and experience, available resources and other variables.
ANA supports a bill in Congress that requires a staffing committee to establish an adjustable
minimum number of RNs per unit, based upon assessment of existing conditions.
Previous studies show that higher levels of nurse staffing are associated with better patient
outcomes, lower mortality rates, and lower incidences of nurse burnout or dissatisfaction.
ANA has concerns that a fixed, nurse-to-patient ratio set by law could become a “maximum staffing
level” even when conditions change, such as when patient needs intensify or patient transitions
(transfers/discharges) call for fewer patients for each nurse.