Oregon has 128 long‑term care nursing homes and none provide a registered nurse on site 24/7

# What happened At a town hall in Eugene on Aug. 11, U.S. Sen. Ron Wyden and Oregon lawmakers discussed the shortage of on‑site registered nurses (RNs) in nursing homes and proposed legislation to change that. The Oregon state long‑term care ombudsman, Fred Steele, reported that of the 128 long‑term care nursing home programs in Oregon, none currently provide 24/7 on‑site RN coverage.

# Why this matters Registered nurses perform clinical tasks CNAs cannot: assessments, medical care plans, medication administration and IV treatments. Certified nursing assistants (CNAs) provide daily living support such as bathing, dressing and basic vital signs but are not authorized to carry out invasive or higher‑level medical procedures.

Oregon has mandated CNA staffing ratios—one CNA for seven residents during the day and one CNA for eleven residents at night. Steele said those ratios place Oregon above the national average for CNA staffing and are linked to better resident outcomes. However, those ratios do not replace the clinical functions of RNs.

# Federal context In 2024, the Centers for Medicare & Medicaid Services (CMS) completed a rule‑making process that recommended minimum staffing ratios for nursing facilities nationwide and included a 24/7 RN requirement. The rule was set to phase in over multiple years to give facilities time to recruit and train staff. The Trump administration repealed that rule before it took effect.

Currently there is a widespread practice of having an RN on site for roughly 40 hours per week and delegating clinical tasks the rest of the time. That approach leaves gaps in licensed nursing coverage for the balance of each week.

# State action and politics Oregon passed House Bill 2697 in 2023, which established minimum nurse staffing levels in hospitals but did not apply to most residential nursing homes. State Sen. James Manning, a sponsor of HB 2697, and other legislators signaled interest in amending state law to extend staffing protections to residential and in‑home care settings.

Lawmakers and advocates cited nurse burnout as a contributing factor to staffing shortages, pointing to the COVID‑19 pandemic when nurses worked long shifts and reported high levels of stress and attrition. Steele noted that the phased approach CMS had proposed would have given time to recruit and train more RNs for a 24/7 requirement.

# What advocates propose Sen. Wyden has sponsored the Nurses Belong in Nursing Homes Act, which would establish strict minimum staffing requirements in nursing homes, require a registered professional nurse on site 24/7, and provide funding for ongoing surveys, inspections and enforcement of nursing home staffing rules.

State legislators said they are pursuing parallel changes at the state level to expand minimum staffing laws beyond hospitals to residential care settings that do not fall under hospital licensing.

# Bottom line for families and facilities Families should know Oregon's CNA staffing ratios are stronger than many states, but licensed‑nurse coverage is limited: no long‑term care nursing homes in Oregon reported 24/7 on‑site RNs at the time of the town hall. Proposed federal and state legislation would change that, but implementation depends on funding, recruitment and state law changes.