2023 Oregon Revised Statutes › Volume : 12 - Public Health › Chapter 441 - Health Care Facilities › Section 441.765 - Staffing ratios for direct care registered nurses.

(1) As used in this section, "unit" means a hospital unit as defined by the chief executive 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 account 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 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 patients, 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 ratio 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 section, 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. [2023 c.507 §6]
Note:
The amendments to 441.765 by section 17, chapter 507, Oregon Laws 2023, become operative July 1, 2026. See section 33, chapter 507, Oregon Laws 2023. The text that is operative on and after July 1, 2026, is set forth for the user’s convenience.
(1) As used in this section, "unit" means a hospital unit as defined by the chief executive 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 account 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 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 patients, 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 ratio 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 section, 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.
Note:
See note under 441.761.