PORTLAND, Ore. — After 20 years in banking, Richard Botterill sought a career with more purpose. At 52, he enrolled in nursing school. Fifteen years later, he’s an emergency room nurse at Providence Portland Medical Center — and chair of the Oregon Nurses Association (ONA) bargaining unit at the hospital.
Botterill describes his work as a nonstop sprint: stabilizing a patient blinded by mace, diagnosing another for a possible stroke, and treating a third for tachycardia — all within minutes. “Every day is an intense day,” he said. “You’ve got people running from one end of the hospital to the other.”
That pace, he argues, is exacerbated by staffing shortages that threaten both patient safety and worker well-being.
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Battle Over Staffing Ratios
According to Botterill and his colleagues in ONA, Providence Portland is routinely violating Oregon’s nurse staffing laws, even at the risk of accruing fines of up to $5,000 per day.
“They are fighting tooth and nail to prevent what I think is an appropriate level of staffing,” Botterill told the Northwest Labor Press. He pointed to a recent case: 27 patients assigned to just one certified nursing assistant (CNA). The law sets the maximum ratio at seven patients per CNA.
For nurses like Botterill, ensuring safe staffing isn’t just about legal compliance — it’s about protecting patients from harm and preventing burnout that pushes caregivers out of the profession.
The Evolution of Oregon’s Staffing Laws
Oregon has been building staffing protections for decades:
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2001: The state passed its first staffing law, requiring audits of at least 7% of hospitals to ensure they had written staffing plans.
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2015: Senate Bill 469 created nurse staffing committees with equal numbers of direct-care nurses and managers to set unit-level ratios. While collaborative, the law lacked teeth — enforcement was optional.
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2023: House Bill 2697 changed “may” to “shall,” making penalties mandatory. Oregon became the first state in the nation to codify statutory nurse-to-patient and CNA-to-patient ratios.
The compromise law gave hospitals two years to adjust before fines could be applied, with enforcement beginning June 1, 2025. Penalties escalate from a warning to $1,750, then $2,500, and ultimately $5,000 for repeated violations within four years.
Complaints Pile Up
Since enforcement began in June, more than 2,200 complaints have been filed, mostly against four facilities: OHSU, Providence Portland, Asante Rogue Regional, and Sacred Heart Riverbend.
“A lot of hospitals are doing a good job coming into compliance,” said Christy Simila, ONA’s Director of Professional Practice. “Nurses are getting breaks without having to double up patient assignments. But some hospitals are trying to find loopholes to undermine the law.”
Examples of workarounds include:
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Misrepresenting ratios as prescriptive instead of maximums.
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Avoiding CNA ratios by assigning nurses to “tasks” rather than patients.
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Leaving some patients without a CNA altogether.
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Telling nurses they have a two-hour grace period to operate outside staffing plans without triggering a violation.
“These are dangerous practices,” Simila said. “They put both patients and nurses at risk.”
Patient Care on the Line
Botterill, who often works in the emergency department, says the difference between safe staffing and short-staffing is stark. When staff are stretched too thin, ER capacity shrinks:
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Entire assignments may be closed, reducing available beds.
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Wait times stretch to four hours or more; in extreme cases, patients wait eight hours to be seen.
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Overcrowding forces the hospital to go on ambulance divert, meaning emergency vehicles are rerouted elsewhere.
“Patients will leave, either home or to another hospital, or by the time they get back to a room, they’re very grumpy,” Botterill said. “All this translates into poorer care.”
Research backs up his concerns: studies show that each additional patient assigned to a nurse increases the risk of adverse outcomes. For nurses, chronic understaffing drives moral distress and burnout — with about 30% leaving their jobs within the first year.
The Enforcement Challenge
Despite thousands of complaints, the Oregon Health Authority (OHA) has only investigated about 200 cases so far. The slow pace reflects the complexity of gathering evidence, but it frustrates nurses eager to see accountability.
Hospitals, meanwhile, argue that the fines are excessive and that staffing mandates impose unique burdens on rural facilities. But Simila says most hospitals are adapting, and those resisting the law are the exception, not the rule.
A Calling, Not Just a Job
For Botterill, the fight over staffing ratios is deeply personal. “I got into this because I wanted to do something that made a difference,” he said. “Most of the nurses I work with are there because it’s a calling. I love what I do and the people I do it with.”
But unless hospitals comply with the law, he warns, the cycle of burnout and turnover will continue, threatening Oregon’s ability to maintain a strong nursing workforce. Applications to nursing schools remain low, and the profession has yet to recover from the mass exodus during the COVID-19 pandemic.
What Comes Next
The OHA will continue reviewing complaints, issuing warnings, and imposing fines on hospitals that violate staffing laws. Advocates say enforcement is essential to making sure hospitals don’t undermine reforms that took years to achieve.
For patients, the stakes couldn’t be higher: timely care, safety, and trust in the healthcare system. For nurses, compliance means a sustainable career built around the reason most entered the profession in the first place — to care for people when they need it most.
As Botterill put it: “Staffing has a huge impact on the quality of care patients receive. When hospitals resist these laws, they’re not just breaking rules — they’re failing the community.”
