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Understaffed and facing a surge that's overwhelming emergency rooms, hospitals say Kate Brown should change rules.

PMG FILE PHOTO - Oregon hospitals and nurses say they may need a change to state staffing rules to battle a surge in COVID-19 cases.With many Oregon hospitals' emergency rooms and intensive care units packed and overflowing — and a bigger surge in COVID-19 cases considered imminent — hospital officials are urging Gov. Kate Brown to stiffen some rules and waive others, saying it will improve their ability to respond.

HULTBERGSaying the new "crisis" is driven by the more contagious Delta variant, Oregon hospitals want Brown to adopt a tougher policy making health care staff vaccinations mandatory. They also want her to waive rules regarding the minimum number of nurses on any given shift, saying it will increase flexibility in how different units are staffed.

"COVID-19 threatens to push Oregon hospitals and their staff beyond the brink of their capacities," according to an Aug. 12 letter signed by Becky Hultberg, president and chief executive officer of the Oregon Association of Hospitals and Health Systems. "Quite simply, the health care system is in crisis … Hospitals around the state are already struggling with staffing shortages, provider burnout, and capacity challenges stemming from decisions to delay care earlier in the pandemic, lack of staff, and other factors, such as the inability to discharge patients to other appropriate care facilities. An unprecedented COVID-19 surge on top of these circumstances will create a perilous situation for our hospitals and the patients who depend on them. We need you to act with urgency to save lives."

The letter said that many of its recommendations had already been made by the Oregon Health Authority or Brown's own incident management team, set up to coordinate her response.

VAN PELT"We met with the governor, and we did get an acknowledgment that she received a request, and that they are continuing to work through our request. But no formal decisions have been made, at least to us, about where she stands on those particular issues," Andy Van Pelt, the group's executive vice president, told the Portland Tribune.

A spokesman for Gov. Brown, Charles Boyle, said on Wednesday she is "incredibly concerned" about the surge in patients, "which threatens to overwhelm our nurses, doctors, and health care workers … Since the hospitals sent their letter we have been in almost constant contact with the hospital association and many individual hospitals.

 "We have been working in close partnership with the Oregon Health Authority and hospital leaders to make sure health care workers have the support they need to continue treating COVID-19 patients … We are moving fast and effectively to implement a number of (the hospitals") specific requests and we are also moving quickly to leverage other resources within our control. That list includes deploying Oregon National Guard members, nurse strike teams, providing special temporary decompression units to reduce the need for hospital beds, and removing barriers to discharging patients to nursing facilities when they no longer require a hospital level of care. We are working to implement targeted solutions for several other of the hospitals' requests, and we plan to provide a more detailed update in a press conference tomorrow morning."

Easing staffing rules could help because without adequate staffing, hospitals aren't allowed to use vacant beds for patients. Hospitals that {obj:56123:have vacant beds can't use them} — so needed treatment for patients coming in the front door is being delayed.

"We are really facing a crisis of staffing," Van Pelt said. "It looks like to the outside, that there are beds available … but if we don't have staff for those beds, we can't use them.

"ICU isn't just COVID — people are still having car accidents, heart attacks, strokes, trauma, and we need to reserve some of those beds for everyday life events that require it."

Click here to read the full letter

Nurses agree: Crisis is worse

The Oregon Nursing Association issued a statement regarding the hospitals' letter, saying "Staffing shortages happen over time, not overnight. You don't wake up one morning and realize you need 200 more nurses. COVID-19 is snapping a health care system that hospital executives already pushed to its breaking point. Attempting to silence frontline nurses' voices in the care process will only accelerate caregiver burnout and staffing shortages."

Virginia Smith, a board member of the Oregon Nurses Association, told the Tribune that hospitals are right that staff shortages are at the heart of the new crisis. Smith also agreed that the situation was more dire than during previous COVID-19 waves.

But Smith, who works at Providence Willamette Falls Medical Center in Oregon City, said retention bonuses paid by hospitals, as well as hiring, are what's needed to combat the crisis. She said dropping current maximum patient-to-nurse ratios would only hurt patient safety, not help it.

"Once you go over the threshold of what you said your staffing plan is for safe care, then you're no longer providing safe care for any of the patients," Smith told the Tribune. "If you establish an unsafe staffing ratio as the norm, you just keep pushing on it to the point where you have what's called a sentinel event: somebody dies, somebody doesn't get the kind of care that they need."

Van Pelt's take: "We realize everybody is stretched, everybody is overwhelmed. All health care workers, everybody working on this crisis from health care IT folks to data folks to capacity, folks, they're stressed. And none of these are a great solution. But given the environment we're in right now, we need to think outside the box."

Other recommendations in the letter:

• Make it easier to hire out-of-state staff.

• Make changes to speed up hospital discharges

• Do more to shield health care workers and hospitals from lawsuits, a controversial idea opposed by consumer advocates and lawyers.

Van Pelt said hospitals are doing what they can, but await clarity on whether the recommendations will be pursued.

"We've been working with OHA directly, and the governor's Incident Command team on several of those issues. And I think we're all kind of in a holding pattern. I think we're in alignment in terms of where we want to go and recommend, but we're simply just waiting for a formal 'yes' or 'no' from the governor's office."

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