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83rd OREGON LEGISLATIVE ASSEMBLY--2025 Regular Session
Enrolled
House Bill 3294
Sponsored by Representative NOSSE; Senator PATTERSON
CHAPTER .................................................
AN ACT
Relating to staffing plans for health care provider entities; creating new provisions; amending ORS
441.763, 441.765, 441.791, 441.792 and 441.793; and prescribing an effective date.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 441.765 is amended to read:
441.765. (1) As used in this section, “unit” means a hospital unit as defined by the chief execu-
tive officer of the hospital or the chief executive officer’s designee.
(2) With respect to direct care registered nurses, a nurse staffing plan must ensure that at all
times:
(a) In an emergency department:
(A) A direct care registered nurse is assigned to not more than one trauma patient; and
(B) The ratio of direct care registered nurses to patients averages no more than one to four over
a 12-hour shift and a single direct care registered nurse may not be assigned more than five patients
at one time. Direct care registered nurses assigned to trauma patients may not be taken into ac-
count in determining the average ratio.
(b) In an intensive care unit, a direct care registered nurse is assigned to no more than two
patients.
(c) In a labor and delivery unit, a direct care registered nurse is assigned to no more than:
(A) Two patients if the patients are not in active labor or experiencing complications; or
(B) One patient if the patient is in active labor or if the patient is at any stage of labor and is
experiencing complications.
(d) In a postpartum, antepartum and well-baby nursery, a direct care registered nurse is as-
signed to no more than six patients, counting mother and baby each as separate patients.
(e) In a mother-baby unit, a direct care registered nurse is assigned to no more than eight pa-
tients, counting mother and baby each as separate patients.
(f) In an operating room, a direct care registered nurse is assigned to no more than one patient.
(g) In an oncology unit, a direct care registered nurse is assigned to no more than four patients.
(h) In a post-anesthesia care unit, a direct care registered nurse is assigned to no more than two
patients.
(i) In an intermediate care unit, a direct care registered nurse is assigned to no more than three
patients.
(j) In a medical-surgical unit, a direct care registered nurse is assigned to no more than five
patients.
(k) In a cardiac telemetry unit, a direct care registered nurse is assigned to no more than four
patients.
Enrolled House Bill 3294 (HB 3294-A) Page 1
(L) In a pediatric unit, a direct care registered nurse is assigned to no more than four patients.
(3) Notwithstanding subsection (2) of this section, the direct care registered nurse-to-patient ra-
tio for an individual patient shall be based on a licensed independent practitioner’s classification
of the patient, as indicated in the patient’s medical record, regardless of the unit where the patient
is being cared for.
(4) With the approval of a majority of the members of the hospital nurse staffing committee, a
unit can deviate from the direct care registered nurse-to-patient ratios in subsection (2) of this sec-
tion, in pursuit of innovative care models that were considered by the committee, by allowing other
clinical care staff to constitute up to 50 percent of the registered nurses needed to comply with the
applicable nurse-to-patient ratio. The staffing in an innovative care model must be reapproved by the
committee every two years.
(5) A hospital shall provide for meal breaks and rest breaks in accordance with ORS 653.261,
and rules implementing ORS 653.261, and any applicable collective bargaining agreement.
(6) Each hospital unit may deviate from a nurse staffing plan, except with respect to meal breaks
and rest breaks, including the applicable registered nurse-to-patient ratios under this section, within
a period of 12 consecutive hours, no more than six times during a rolling 30-day period, without
being in violation of the nurse staffing plan. The unit manager must notify the hospital nurse staff-
ing committee no later than 10 days after each deviation. Each subsequent deviation during the
30-day period constitutes a separate violation under ORS 441.792.
[(7) A hospital may not require a direct care registered nurse to be assigned to more patients than
as specified in this section or in the nurse staffing plan approved by the hospital nurse staffing com-
mittee, as applicable. ]
(7)(a) If a hospital nurse staffing committee has adopted a nurse staffing plan for a unit
under ORS 441.762, the hospital shall comply with the nurse staffing plan for the unit and
may not require a direct care registered nurse to be assigned to more patients than as
specified in the nurse staffing plan for the unit.
(b) If a hospital nurse staffing committee has not adopted a nurse staffing plan for a unit
under ORS 441.762, the hospital shall comply with the direct care registered nurse-to-patient
staffing ratios applicable to the unit under this section and may not require a direct care
registered nurse to be assigned to more patients than as specified for the unit in this section.
(8) A charge nurse may:
(a) Take patient assignments, including patient assignments taken for the purpose of covering
staff who are on meal breaks or rest breaks, in units with 10 or fewer beds;
(b) Take patient assignments, including patient assignments taken for the purpose of covering
staff who are on meal breaks or rest breaks, in units with 11 or more beds with the approval of the
hospital nurse staffing committee; and
(c) Be taken into account in determining the direct care registered nurse-to-patient ratio during
periods when the charge nurse is taking patient assignments under this subsection.
SECTION 2.
ORS 441.765, as amended by section 17, chapter 507, Oregon Laws 2023, is
amended to read:
441.765. (1) As used in this section, “unit” means a hospital unit as defined by the chief execu-
tive officer of the hospital or the chief executive officer’s designee.
(2) With respect to direct care registered nurses, a nurse staffing plan must ensure that at all
times:
(a) In an emergency department:
(A) A direct care registered nurse is assigned to not more than one trauma patient; and
(B) The ratio of direct care registered nurses to patients averages no more than one to four over
a 12-hour shift and a single direct care registered nurse may not be assigned more than five patients
at one time. Direct care registered nurses assigned to trauma patients may not be taken into ac-
count in determining the average ratio.
(b) In an intensive care unit, a direct care registered nurse is assigned to no more than two
patients.
Enrolled House Bill 3294 (HB 3294-A) Page 2
(c) In a labor and delivery unit, a direct care registered nurse is assigned to no more than:
(A) Two patients if the patients are not in active labor or experiencing complications; or
(B) One patient if the patient is in active labor or if the patient is at any stage of labor and is
experiencing complications.
(d) In a postpartum, antepartum and well-baby nursery, a direct care registered nurse is as-
signed to no more than six patients, counting mother and baby each as separate patients.
(e) In a mother-baby unit, a direct care registered nurse is assigned to no more than eight pa-
tients, counting mother and baby each as separate patients.
(f) In an operating room, a direct care registered nurse is assigned to no more than one patient.
(g) In an oncology unit, a direct care registered nurse is assigned to no more than four patients.
(h) In a post-anesthesia care unit, a direct care registered nurse is assigned to no more than two
patients.
(i) In an intermediate care unit, a direct care registered nurse is assigned to no more than three
patients.
(j) In a medical-surgical unit, a direct care registered nurse is assigned to no more than four
patients.
(k) In a cardiac telemetry unit, a direct care registered nurse is assigned to no more than four
patients.
(L) In a pediatric unit, a direct care registered nurse is assigned to no more than four patients.
(3) Notwithstanding subsection (2) of this section, the direct care registered nurse-to-patient ra-
tio for an individual patient shall be based on a licensed independent practitioner’s classification
of the patient, as indicated in the patient’s medical record, regardless of the unit where the patient
is being cared for.
(4) With the approval of a majority of the members of the hospital nurse staffing committee, a
unit can deviate from the direct care registered nurse-to-patient ratios in subsection (2) of this sec-
tion, in pursuit of innovative care models that were considered by the committee, by allowing other
clinical care staff to constitute up to 50 percent of the registered nurses needed to comply with the
applicable nurse-to-patient ratio. The staffing in an innovative care model must be reapproved by the
committee every two years.
(5) A hospital shall provide for meal breaks and rest breaks in accordance with ORS 653.261,
and rules implementing ORS 653.261, and any applicable collective bargaining agreement.
(6) Each hospital unit may deviate from a nurse staffing plan, except with respect to meal breaks
and rest breaks, including the applicable registered nurse-to-patient ratios under this section, within
a period of 12 consecutive hours, no more than six times during a rolling 30-day period, without
being in violation of the nurse staffing plan. The unit manager must notify the hospital nurse staff-
ing committee no later than 10 days after each deviation. Each subsequent deviation during the
30-day period constitutes a separate violation under ORS 441.792.
[(7) A hospital may not require a direct care registered nurse to be assigned to more patients than
as specified in this section or in the nurse staffing plan approved by the hospital nurse staffing com-
mittee, as applicable. ]
(7)(a) If a hospital nurse staffing committee has adopted a nurse staffing plan for a unit
under ORS 441.762, the hospital shall comply with the nurse staffing plan for the unit and
may not require a direct care registered nurse to be assigned to more patients than as
specified in the nurse staffing plan for the unit.
(b) If a hospital nurse staffing committee has not adopted a nurse staffing plan for a unit
under ORS 441.762, the hospital shall comply with the direct care registered nurse-to-patient
staffing ratios applicable to the unit under this section and may not require a direct care
registered nurse to be assigned to more patients than as specified for the unit in this section.
(8) A charge nurse may:
(a) Take patient assignments, including patient assignments taken for the purpose of covering
staff who are on meal breaks or rest breaks, in units with 10 or fewer beds;
Enrolled House Bill 3294 (HB 3294-A)Page 3
(b) Take patient assignments, including patient assignments taken for the purpose of covering
staff who are on meal breaks or rest breaks, in units with 11 or more beds with the approval of the
hospital nurse staffing committee; and
(c) Be taken into account in determining the direct care registered nurse-to-patient ratio during
periods when the charge nurse is taking patient assignments under this subsection.
SECTION 3. ORS 441.763 is amended to read:
441.763. (1) Each hospital shall implement a written hospital-wide nurse staffing plan [ for nurs-
ing services ] that:
(a) Meets the requirements of this section and ORS 441.762, 441.764, 441.765, 441.766, 441.767
and 441.768;
(b) Includes any staffing-related terms and conditions that were previously adopted through any
applicable collective bargaining agreement, including meal breaks and rest breaks, unless a term or
condition is in direct conflict with an applicable statute or administrative rule; and
(c) Has been developed and approved by the hospital nurse staffing committee under ORS
441.762.
(2) If the nurse-to-patient ratios in ORS 441.765 apply, the hospital nurse staffing committee:
(a) May consider:
(A) The specialized qualifications and competencies of the nursing staff and the skill mix and
level of competency needed to ensure that the hospital is staffed to meet the health care needs of
patients;
(B) The size of the hospital and a measurement of hospital unit activity that quantifies the rate
of admissions, discharges and transfers for each hospital unit and the time required for a direct care
registered nurse belonging to a hospital unit to complete admissions, discharges and transfers for
that hospital unit;
(C) The unit’s general and predominant patient population as defined by the Medicare Severity
Diagnosis-Related Groups adopted by the Centers for Medicare and Medicaid Services, or by other
measures for patients who are not classified in the Medicare Severity Diagnosis-Related Groups;
(D) Nationally recognized evidence-based standards and guidelines established by professional
nursing specialty organizations, if any;
(E) Differences in patient acuity; and
(F) Tasks not related to providing direct care; and
(b) Must comply with ORS 441.765.
(3) A hospital must maintain and post, in a physical location or online, a list of on-call nursing
staff or staffing agencies to provide replacement nursing staff in the event of a vacancy. The list
of on-call nursing staff or staffing agencies must be sufficient to provide for replacement nursing
staff.
(4)(a) An employer may not impose upon unionized nursing staff any changes in wages, hours
or other terms and conditions of employment pursuant to a staffing plan unless the employer first
provides notice to and, upon request, bargains with the union as the exclusive collective bargaining
representative of the nursing staff in the bargaining unit.
(b) A staffing plan does not create, preempt or modify a collective bargaining agreement or re-
quire a union or employer to bargain over the staffing plan while a collective bargaining agreement
is in effect.
(5) A hospital shall submit to the Oregon Health Authority a nurse staffing plan adopted in ac-
cordance with this section and ORS 441.766 and submit any changes to the plan no later than 30
days after approval of the changes by the hospital nurse staffing committee.
(6) A type A or a type B hospital may vary from the requirements of ORS 441.765 if the hospital
nurse staffing committee of the hospital has voted to approve the variance. A type A hospital or
type B hospital shall notify the authority of the variance through the authority’s website. The no-
tification to the authority shall include a statement signed by the cochairs of the committee, con-
firming that the committee voted to approve the variance. The variance becomes effective upon the
submission of the notification to the authority and remains in effect for two years. A type A or type
Enrolled House Bill 3294 (HB 3294-A) Page 4
B hospital may renew a variance or notify the authority of a new variance as provided in this sub-
section.
SECTION 4. ORS 441.791 is amended to read:
441.791. (1) As used in this section, “valid complaint” means a complaint containing an
allegation that, if assumed to be true, is a violation listed in ORS 441.792.
(2) To ensure compliance with ORS 441.761 to 441.795, the Oregon Health Authority shall:
(a) Establish a method by which a hospital staff person or an exclusive representative of a
hospital staff person may submit a complaint through the authority’s website regarding any violation
listed in ORS 441.792;
(b) No later than 14 days after receiving a complaint, send a copy of the complaint to the ex-
clusive representative, if any, of the staff person or staff persons who filed the complaint;
(c) No later than 30 days after receiving a valid complaint of a violation listed in ORS 441.792,
open an investigation of the hospital and provide a notice of the investigation to the hospital and
the cochairs of the relevant staffing committee established pursuant to ORS 441.762, 441.775 or
441.776, and to the exclusive representative, if any, of the staff person or staff persons filing the
complaint. The notice must include a summary of the complaint that does not include the
complainant’s name or the specific date, shift or unit but does include the calendar week in which
the complaint arose;
(d) Not later than 80 days after opening the investigation, conclude the investigation and pro-
vide a written report on the complaint to the hospital, the cochairs of the hospital staffing commit-
tee and the exclusive representative, if any, of the staff person or staff persons filing the complaint.
The report:
(A) Shall include a summary of the complaint;
(B) Shall include the nature of the alleged violation or violations;
(C) Shall include the authority’s findings and factual bases for the findings;
(D) Shall include other information the authority determines is appropriate to include in the
report; and
(E) May not include the name of any complainant, the name of any patient or the names of any
individuals that the authority interviewed in investigating the complaint;
(e) If the authority issues a warning or imposes one or more civil penalties based on the report
described in paragraph (d) of this subsection, provide a notice of the civil penalty that complies with
ORS 183.415, 183.745 and 441.793 to the hospital, the cochairs of the applicable hospital staffing
committee and the exclusive representative, if any, of the staff person or staff persons who filed the
complaint; and
(f) In determining whether to impose a civil penalty, consider all relevant evidence, including
but not limited to witness testimony, written documents and the observations of the investigator.
(3) A hospital subject to a valid complaint shall provide to the authority, no later than 20 days
after receiving the notice under subsection (1)(c) of this section:
(a) The staffing plan that is the subject of the complaint;
(b) If relevant to the complaint, documents that show the scheduled staffing and the actual
staffing on the unit that is the subject of the complaint during the period of time specified in the
complaint; and
(c) Documents that show the actions described in ORS 441.793 (4), if any, that the hospital took
to comply with the staffing plan or to address the issue raised by the complaint.
(4) In conducting an investigation, the authority shall review any document:
(a) Related to the complaint that is provided by the exclusive representative that filed the
complaint or by the hospital staff person who filed the complaint and the person’s exclusive repre-
sentative, if any; and
(b) Provided by the hospital in response to the complaint.
(5) In conducting an investigation, the authority may:
(a) Make an on-site inspection of the unit that is the subject of the complaint;
Enrolled House Bill 3294 (HB 3294-A) Page 5
(b) Interview a manager for the unit and any other staff persons with information relevant to
the complaint;
(c) Interview the cochairs of the relevant staffing committee;
(d) Interview the staff person or staff persons who filed the complaint unless the individual de-
clines to be interviewed; and
(e) Compel the production of books, papers, accounts, documents and testimony pertaining to the
complaint, other than documents that are privileged or not otherwise subject to disclosure.
(6) A complaint by a hospital staff person or the staff person’s exclusive representative must be
filed no later than 60 days after the date of the violation alleged in the complaint. The authority
may not investigate a complaint or take any enforcement action with respect to a complaint that
has not been filed timely.If multiple complaints contain the same allegations or contain
allegations that are based on the same set of facts, the authority may consolidate the com-
plaints into a single investigation or enforcement action, irrespective of whether the au-
thority has already investigated one of complaints or taken an enforcement action with
respect to one of the complaints.
SECTION 5.
Under ORS 441.791 and 441.792, the Oregon Health Authority shall prioritize
the investigation and disposition of complaints that contain allegations that occur on or after
June 1, 2025, over complaints that contain allegations that occurred before June 1, 2025.
SECTION 6. ORS 441.792 is amended to read:
441.792. (1) Following the receipt of a complaint and completion of an investigation described
in ORS 441.791, for a violation described in subsection (2) of this section, the Oregon Health Au-
thority shall:
(a) Issue a warning for the first violation in a four-year period;
(b) Impose a civil penalty of $1,750 for the second violation of the same provision in a four-year
period;
(c) Impose a civil penalty of $2,500 for the third violation of the same provision in a four-year
period; and
(d) Impose a civil penalty of $5,000 for the fourth and subsequent violations of the same pro-
vision in a four-year period.
(2) The authority shall take the actions described in subsection (1) of this section for the fol-
lowing violations by a hospital of ORS 441.761 to 441.795:
(a) Failure to establish a hospital professional and technical staffing committee or a hospital
service staffing committee;
(b) Failure to create a professional and technical staffing plan or a hospital service staffing plan;
(c) Failure to adopt a hospital-wide nurse staffing plan . [ by agreement or after binding arbi-
tration] Each day in which there is a failure to adopt a hospital-wide nurse staffing plan shall
be considered a single violation ;
(d) Failure to comply with the staffing level in [ the] a nurse staffing plan for a unit that has
been adopted under ORS 441.762 , including the nurse-to-patient staffing ratios prescribed in ORS
441.765, if applicable, [ and] if the failure to comply is not an allowed deviation described in ORS
441.765 (6);
(e) If a hospital nurse staffing committee has not adopted a nurse staffing plan for a unit
under ORS 441.762, failure to comply with the direct care registered nurse-to-patient staffing
ratios applicable to the unit under ORS 441.765, if the failure to comply is not an allowed
deviation described in ORS 441.765 (6). Under this paragraph, failure to comply with the di-
rect care registered nurse-to-patient staffing ratios under ORS 441.765 for a single direct
care registered nurse during the nurse’s shift shall be considered a single violation;
[(e)] (f) Failure to comply with the staffing level in the professional and technical staffing plan
or the hospital service staffing plan [ and], if the failure to comply is not an allowed deviation as
described in ORS 441.775 (12) or 441.776 (12);
[(f)] (g) Failure to comply with the staffing requirements for certified nursing assistants in ORS
441.768 [and], if the failure is not an allowed deviation under ORS 441.776 (12); or
Enrolled House Bill 3294 (HB 3294-A) Page 6
[(g)] (h) Requiring a nursing staff, except as allowed by ORS 441.770, to work:
(A) Beyond an agreed-upon prearranged shift regardless of the length of the shift;
(B) More than 48 hours in any hospital-defined work week;
(C) More than 12 hours in a 24-hour period; or
(D) During the 10-hour period immediately following the 12th hour worked during a 24-hour pe-
riod.
(3) If a staff person at a hospital is unable to attend a staffing committee meeting because the
staff person was not released from other hospital duties to attend the meeting, in violation of ORS
441.762 (9), 441.775 (10) or 441.776 (10), the authority shall:
(a) Issue a warning for the first violation; and
(b) Impose a civil penalty of $500 for a second and each subsequent violation.
(4) A direct care staff person, a hospital professional or technical staff person or a hospital
service staff person, or an exclusive representative of a direct care staff person, a hospital profes-
sional or technical staff person or a hospital service staff person, may elect to enforce meal break
and rest break violations under ORS 653.261 by filing a complaint with the authority in accordance
with ORS 441.791.
SECTION 7.
ORS 441.793 is amended to read:
441.793. (1) The Oregon Health Authority shall impose civil penalties in the manner provided in
ORS 183.745 for a violation listed in ORS 441.792.
(2) The authority may suspend or revoke the license of a hospital, in the manner provided in
ORS 441.030, for a violation described in ORS 441.792.
(3) Each violation of a written hospital-wide staffing plan shall be considered a separate vio-
lation and there is no cap on the times that a penalty may be imposed for a repeat of a violation.
(4) The authority may not impose a civil penalty for a violation of a nurse staffing plan, a hos-
pital professional and technical staffing plan or a hospital service staffing plan if the hospital took
the following actions:
(a) Scheduled staff in accordance with the staffing plan;
(b) Sought volunteers from all available qualified employees to work extra time;
(c) Contacted qualified employees who made themselves available to work extra time;
(d) Solicited per diem staff to work; and
(e) Contacted contracted temporary agencies, that the hospital regularly uses, if temporary staff
from such agencies are permitted to work in the hospital by law or any applicable collective bar-
gaining agreement.
(5) If a hospital nurse staffing committee has not adopted a nurse staffing plan for a unit
under ORS 441.762, the authority may not impose a civil penalty for a violation of a direct
care registered nurse-to-patient staffing ratio applicable to the unit under ORS 441.765 if the
hospital took the following actions:
(a) Scheduled staff in accordance with the direct care registered nurse-to-patient staffing
ratio applicable to the unit under ORS 441.765;
(b) Sought volunteers from all available qualified employees to work extra time;
(c) Contacted qualified employees who made themselves available to work extra time;
(d) Solicited per diem staff to work; and
(e) Contacted contracted temporary agencies that the hospital regularly uses if tempo-
rary staff from such agencies are permitted to work in the hospital by law or any applicable
collective bargaining agreement.
[(5)] (6) The authority shall maintain for public inspection records of any civil penalties or li-
cense suspensions or revocations imposed on hospitals penalized under subsection (1) or (2) of this
section.
SECTION 8.
(1) The amendments to ORS 441.791 by section 4 of this 2025 Act apply to
complaints that contain allegations that occur on or after June 1, 2025.
(2) The amendments to ORS 441.792 and 441.793 by sections 6 and 7 this 2025 Act apply
to violations that occur on or after June 1, 2025.
Enrolled House Bill 3294 (HB 3294-A) Page 7
SECTION 9. This 2025 Act takes effect on the 91st day after the date on which the 2025
regular session of the Eighty-third Legislative Assembly adjourns sine die.
Passed by House June 19, 2025
..................................................................................
Timothy G. Sekerak, Chief Clerk of House
..................................................................................
Julie Fahey, Speaker of House
Passed by Senate June 25, 2025
..................................................................................
Rob Wagner, President of Senate
Received by Governor:
........................M.,........................................................., 2025
Approved:
........................M.,........................................................., 2025
..................................................................................
Tina Kotek, Governor
Filed in Office of Secretary of State:
........................M.,........................................................., 2025
..................................................................................
Tobias Read, Secretary of State
Enrolled House Bill 3294 (HB 3294-A) Page 8