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Health Care Workforce Plans Taking Shape For Legislative Session

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Hospitals and nursing homes struggle to find nurses and certified nursing assistants amid a workforce shortage as traveling nurses fill the void. 

Behavioral health providers face difficulty filling entry-level positions, some of them paying less than the $20-an-hour offered at Kentucky Fried Chicken restaurants in Bend.

COVID-19 has accelerated the pace of retirements and departures from the health care field amid exhaustion and burnout as the pandemic approaches the two-year mark. 

In the upcoming short, 35-day legislative session, Gov. Kate Brown and Oregon lawmakers are floating a variety of bills intended to address the dire situation head-on, both for short-term and long-term needs. The proposals, if they win approval, would drive Oregon’s efforts to rebuild its health care workforce and the economy over time as the state exits the pandemic. 

The ideas — and high-profile proposals — run the gamut. Health care is one of three industries tapped for growth potential in Brown’s $200 million workforce development blueprint, called Future Ready Oregon 2022. Lawmakers will propose an incentive program for behavioral health providers so they have more cash to recruit and retain employees. Another bill would give nursing students better access to on-the-job internships. Oregon Health & Science University wants more money to recruit a wider pool of diverse students.

There’s money to spend. Between federal one-time COVID-19 relief dollars and better-than-projected state revenues, Oregon lawmakers anticipate between $1.5 billion and $2 billion of additional funding for the remainder of the 2021-2023 budget cycle. Brown wants to put at least  half a billion into state reserves so lawmakers can tap it in future downturns. There also are other items on her priority list, like affordable housing, child care and education.

Here’s a look at what’s in the mix: 

Governor’s Workforce Proposal: Brown’s workforce proposal is a $200 million plan that looks for ways to grow Oregonians in the health care, construction and manufacturing industry. It’s specifically aimed at underserved communities and populations, including rural areas, people of color, women, veterans and formerly incarcerated people.

The money would go toward a variety of efforts, like apprenticeship programs, community colleges and local workforce boards and youth programs. 

At this point, there’s not a breakdown of how much money would go toward each industry. That depends on local priorities, since community-based organizations would play a role in seeking funding and starting pilot projects. Lawmakers also are interested in including more industry sectors in the package, Brown said Tuesday at The Associated Press preview of the legislative session.

“The goal is to give Oregonians the tools and the resources, and frankly to create career pathways in ways that are sustainable and create jobs that provide a living wage,” Brown said, adding that conversations with lawmakers will continue.

The full scope of the proposal’s potential boost to health care is unclear. Still, potential avenues to invest in the health care workforce run throughout the proposal. For example, community colleges play a key role in homegrown nurses and other health care workers in Oregon. 

“Community colleges are an important part of the nursing workforce but also broadly the health care workforce,” said Kevin Mealy, spokesperson for the Oregon Nurses Association, in an interview. “By building up all the classifications of health care workers — your CNA’s, your technicians — you’re able to lift the burden from nurses and doctors as well. If you have talented people on the health care team, everybody is able to work to the top of their scope.”

OHSU Workforce Proposal: Brown said she supports OHSU’s proposal to increase the number and diversity of the medical school’s clinician graduates. The school is requesting $45 million this session. Of that, $20 million would be a permanent increase in OHSU’s direct education appropriation and $25 million would be a one-time influx of money for scholarships that would be matched with philanthropic efforts, according to the university’s request. 

The request is the foundation of OHSU’s “30-30-30” plan, which has the goal of growing clinical health care program graduates by 30% and increasing the diversity of students to 30% — both by 2030.

The proposal would allow OHSU to graduate more than 2,000 additional clinicians by 2030, according to university estimates. This includes nurses, clinical psychologists, physicians, physician assistants, public health leaders and nutritionists.

Behavioral health workers: Lawmakers are also putting together a proposal to help behavioral health providers attract and retain workers, from specialized clinicians to entry-level caregivers. The proposal would give providers loans for needs, including recruitment and retention bonuses and other incentives, like child care incentives. The money would be dispersed as loans, but they would be forgivable if providers demonstrate the money was used for its intended purpose.

The funding amount isn’t concrete yet, but it could be upwards of $200 million. It comes as providers have struggled to fill positions and competed to hire the available employees. In some cases, it’s led to the closure of facilities or programs. 

“Behind the scenes, we are trying to scope it out,” said Rep. Rob Nosse, D-Portland and chair of the House Behavioral Health Committee. “There’s a lot of back-and-forth going on between the advocates and the agency and the fiscal people.”

Nosse is working on the details with Sen. Kate Lieber, D-Beaverton and co-chair of the house joint budget committe’s subcommittee on human services.

“We are struggling to hire people for these incredibly important jobs,” Brown said. “And from a historical perspective, the care sector has relied on the backs of Black and brown and Indigenous people and women to provide this care, and it hasn’t been typically paid in such a way that will provide good wages to be able to afford housing, invest in retirement, and, frankly, send kids to college.”

The work is a short-term bridge as the state continues to work on long-term needs in the behavioral health system, such as better reimbursement rates for providers.

“We are going to have to make those structural changes, and that is going to need to take time,” Brown said. “In the short term, it’s incredibly important that we make investments in pay, both to hire and retain our behavioral health workforce. We are seeing the workforce leave, frankly, to go on to other better paying jobs.”

Nursing Workforce: Rep. Rachel Prusak, chair of the House Committee on Health Care, has said she will pursue a bill intended to bolster the state’s health care workforce of nurses, whether for hospitals, long-term care facilities or other settings. The proposal is the product of a workgroup that gave input from the health care industry, nurse advocates and other groups. 

The bill directs the Oregon State Board of Nursing to give a nurse internship license to qualified nursing students. The goal behind that is to get more nursing students into the field for hands-on clinical experience and supervision from qualified nurses.

The bill allows out-of-state nurses to work in Oregon for up to 90 days in any setting with a need. Currently, out-of-state nurses are usually only allowed to work in Oregon for up to 30 days, and only in critical care units. That rule, however, is waived due to the pandemic. The goal behind that change is to encourage more nurses to seek a permanent Oregon license and settle down in the state for a career.

The bill also provides funding for the state nursing board to participate in a wellness program that would provide free counseling services to nurses. 

The bill also establishes a committee to work on long-term solutions to the workforce crisis. 

Mealy, with the nurses association, said one key need is adequate pay for nursing faculty. Possible solutions include tax credits for faculty or student loan forgiveness, Mealy said.

Plenty of Oregonians want to be nurses and the pandemic has highlighted the role they play alongside other health workers. But schools typically turn down more than 50% of applicants because they don’t have enough teachers.

“There’s simply not enough teachers to teach them,” Mealy said. “That’s the pinch in the pipeline.”

For example, OHSU had 1,780 applications for its registered nurse program in 2019 and admitted 446, according to a school report.

For bachelor’s degree programs in nursing, Oregon schools had 5,178 applicants and admitted 1,083, an acceptance rate of 21%, according to an Oregon Center for Nursing report.

Community colleges also get flooded. Lane Community College has two to three times the number of applicants compared to open slots, according to an Oregon Public Broadcasting report. 

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.

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