The intense care required for Covid-19 patients has exhausted nurses and other health care staff. (Oregon Health & Science University photo)
While most state employees took a day off to celebrate Juneteenth on Monday, managers at Oregon’s Nursing Board processed license applications.
The board has a backlog of more than 2,000 applications. At the end of the month, thousands of emergency licenses will expire.
Throughout the pandemic, the state has issued nearly 9,000 emergency licenses to out-of-state nurses to plug nursing gaps. Nurses need an Oregon license to practice in the state, and about 80,000 are licensed to do so.
The emergency licenses were allowed under Gov. Kate Brown’s Covid emergency declaration which ended April 1. Emergency licenses were extended from April 1 through June 30, giving the nurses with emergency licenses until then to apply for an Oregon license. Most of them work for a temporary agency, the Nursing Board said.
The situation is unprecedented.
“We’ve never really had to bring in a whole lot of people all at once and still try to follow the same kind of regulatory procedures that we’ve always had,” said Jana Bitton, executive director of the Oregon Center for Nursing at the University of Portland.
More than one-third have requested and received their Oregon license, and another 2,000 are waiting for their applications to be processed. Out-of-state applicants are fingerprinted and investigated, ensuring that their license in their home state is current and that they don’t have a criminal record.
In the past, that process took two weeks. The deluge of requests has extended the processing time to two months as Nursing Board staff – and managers – work overtime and on weekends and holidays processing applications.The legislative Emergency Board recently gave the Nursing Board approval to hire two more full-time staff members to process applications. But those positions have not been filled and when they are, the new staff will have to be trained. Even if they were ready by next week, the board will still face a backlog of applications.
That comes during a severe nursing shortage in Oregon.
“The staffing issue in this state for nurses is at a crisis situation,” said Ruby Jason, executive director of the Nursing Board.
The board has no idea how many more nurses with an emergency license will request a permanent one. Jason said applications are still coming in. But there are not likely to be enough to ensure that health care facilities have enough nurses, who perform crucial services such as drawing blood, recording vital signs, administering medications, assessing a patient’s symptoms and monitoring patients after procedures.
“It still doesn’t appear there are enough applicants trying to apply for a license in Oregon to compensate for the severe nursing shortage all over the state,” Jason said.
Shortage affects the entire sector
That shortage is affecting all health care sectors, from long-term care homes to emergency rooms to family care clinics, along with patient care, Bitton said.
“Patients are going to have a delay in care,” Bitton said.
Procedures like colonoscopies that are not urgent could take longer than usual to schedule.
“It might take you two months to get that scheduled, whereas before it would have taken three weeks,” Bitton said.
The shortage can lead to people lingering in hospital beds, she said.
“What happens is if you’ve got somebody in the hospital who should be going to a long-term care facility but can’t because they don’t have enough staff, then somebody comes into the hospital and they need that bed but it’s not available because it’s taken by someone else,” Bitton said.
Kevin Mealy, a spokesman for the Oregon Nurses Association, a union representing nearly 14,000 nurses, said patients are often getting short-changed.
“Patients aren’t getting the same care that they’re paying for or that they had expected pre-pandemic,” Mealy said.
There’s also a risk that overworked nurses could make mistakes.
“I haven’t talked to a nurse yet who isn’t afraid of that,” Bitton said. “They want to take care of themselves. They want to take care of their patients, and they want to take care of their families.”
In 2017, an overworked nurse at Vanderbilt University Medical Center in Tennessee gave a patient a paralyzing medication instead of a sedative before a procedure. The patient died, and the nurse was convicted of felony charges of negligent homicide. She lost her nursing license and this May, she was sentenced to three years probation. After that she will have the conviction expunged.
Nurses burn out
Although Covid hospitalizations have decreased, the pandemic and the demands on health care professionals persist, experts said. Nurses have had to work extra shifts and overtime to try to fill gaps, and they’re often treating patients who’ve delayed care.
“Nurses are working longer shifts with sicker patients and less help,” Mealy said.
Health care companies are also short on certified nursing assistants and medical technicians, causing nurses to perform some of their tasks.
“When you’re doing two jobs at once, you’re going to burn out quicker,” Mealy said.
When the pandemic started, Oregon already faced a nursing shortage, experts said. The past two and a half years have pushed many over the edge, Bitton said.
“A lot of nurses have burned out of the profession, or they’ve moved to take a step back because of just the overwhelming amount of work that they’ve needed to put in.”
That’s led to early retirements and nurses transferring away from bedside care. Jason hopes that many will return to the workforce after taking a break. There is no sign yet that masses of nurses are giving up their profession, Jason said.
“We’re not seeing an increase in people giving up their licenses. In fact, we’re seeing an increase in renewals,” Jason said.In February, the Legislature approved a bill that will allow nursing students under certain conditions to obtain a license and practice, but that won’t take effect until January.
Bitton said the nursing crisis won’t be solved by then, and won’t be solved by a single policy change.
Health care companies that find out-of-state nurses willing to work in the state can obtain an exemption for them for up to 120 days while they’re waiting for their applications to be processed. That will give the board time to work through the backlog, Jason said.
Bitton said the nursing crisis has raised questions about Oregon joining a 39-state nursing compact. Member states agree to accept the nursing licenses from member states. If Oregon joined, nurses from member states could easily work here, but the state would have less information about them.
“From a data perspective, and trying to make sure that we know the demographics of the nurses in the state, the compact is not great,” Bitton said. On the other hand, it would smooth the way for a large field of nurses to work in Oregon. That might make joining worthwhile, Bitton said.
States which pay the least fare poorly in the compact, but states with high pay fare well.
California has the highest pay, followed by Hawaii. Oregon ranks third, Bitton said.
“If Oregon were to join in the compact, we are a little bit of an advantage because we pay a lot,” Bitton said.
She expects the issue to be considered in the next legislative session.
“There needs to be a serious discussion about Oregon joining the compact and the pros and cons of that,” Bitton said.
“It is a mess,” she said of the nursing situation. “We’d like it not to be a mess.”
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