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83rd OREGON LEGISLATIVE ASSEMBLY--2025 Regular Session
House Bill 3985
Sponsored by Representative SKARLATOS
SUMMARY
The following summary is not prepared by the sponsors of the measure and is not a part of the body thereof subject
to consideration by the Legislative Assembly. It is an editor’s brief statement of the essential features of the
measure as introduced. The statement includes a measure digest written in compliance with applicable readability
standards.
Digest: Changes the standards for staffing plans for direct care registered nurses in an ED.
(Flesch Readability Score: 65.7).
Modifies the minimum standards for staffing plans for direct care registered nurses in an emer-
gency department.
A BILL FOR AN ACT
Relating to staffing plans for health care provider entities; amending ORS 441.765.
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) Except as provided in subparagraph (C) of this paragraph, the ratio of direct care reg-
istered 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 regis-
tered nurses assigned to trauma patients may not be taken into account in determining the average
ratio under this subparagraph or subparagraph (C) of this paragraph .
(C) The ratio of direct care registered nurses to patients averages no more than one to
six over a 12-hour shift and a single direct care registered nurse may not be assigned more
than six patients at one time, for patients that:
(i) Are directed to an area within the emergency department designated to provide faster
care to patients with less serious conditions; or
(ii) Are assigned a level four or five on a five-level triage acuity scale using the Emer-
gency Severity Index.
(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 assigned
to no more than six patients, counting mother and baby each as separate patients.
NOTE:Matter in boldfaced type in an amended section is new; matter [ italic and bracketed] is existing law to be omitted.
New sections are in boldfaced type.
LC 4828
HB 3985
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(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.
(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 staffing
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
committee, as applicable.
(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-
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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) Except as provided in subparagraph (C) of this paragraph, the ratio of direct care reg-
istered 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 regis-
tered nurses assigned to trauma patients may not be taken into account in determining the average
ratio under this subparagraph or subparagraph (C) of this paragraph .
(C) The ratio of direct care registered nurses to patients averages no more than one to
six over a 12-hour shift and a single direct care registered nurse may not be assigned more
than six patients at one time, for patients that:
(i) Are directed to an area within the emergency department designated to provide faster
care to patients with less serious conditions; or
(ii) Are assigned a level four or five on a five-level triage acuity scale using the Emer-
gency Severity Index.
(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 assigned
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
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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 staffing
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
committee, as applicable.
(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.
[4]