SILVERTONAPPEAL.COM ❚ WEDNESDAY, JULY 3, 2019 ❚ 3A
OSH
Continued from Page 1A
is squeezed.
The hospital faces a shortage of beds,
which hampers its ability to admit pa
tients who are facing criminal charges
within courtordered deadlines.
Meanwhile, employees face the pros
pect of overtime and doubleshifts to
staff the hospital. That, in turn, can in
crease the chances of fatigue and a po
tential injury.
Hospital officials say that the facility
has taken steps to address the problem
and eliminated mandatory overtime
earlier this year. Now, for example, the
facility rotates employees between
units to cover highneed areas that have
gaps in staffing.
For employees, more is needed to fix
the systemic challenges of shortstaff
ing. But they also know that loosening
the purse strings — and the ability to
add more staff — is not a simple, quick
fix for them or their managers.
Ultimately, that power rests with
state legislators and Gov. Kate Brown.
Rebeka Gipson-King, Hospital Relations Director, unlocks the doors to the cafeteria at Oregon State Hospital in Salem on
June 12. MICHAELA ROMÁN/STATESMAN JOURNAL
Coping with frequent violence
Hospital staff face two sources of vi
olence: Patients who are routinely vio
lent and patients who are infrequently
violent.
In the latter cases, employees are
"very often hurt worse because they
don't see it coming," said Dr. Daniel
Smith, a psychologist at the hospital.
"Nobody goes to work and says, 'I'm
going to get hurt today,'" Smith said.
"Nobody goes to work saying, 'I want to
restrain somebody today.' However,
both things happen."
Staff work with patients from a va
riety of backgrounds. Most patients en
ter the hospital from three broad
groups: those found guilty except for in
sanity in criminal cases and "aid and
assist" patients with pending criminal
charges who need to improve so they
can aid in the defense of their case.
The third main group are patients
who arrive through civil commitments,
which don't involve criminal charges.
The average daily population for the
hospital was nearly 600 in 2018. The
median patient stay was 89 days,
though the length varies depending on
each individual patient's circum
stances.
In 2018, the hospital treated 1,565 pa
tients at its main campus in Salem and a
satellite campus in Junction City. The
two have a combined workforce of
about 2,300 employees.
The majority of patients have un
eventful stays at the hospital. A report
on a fiveyear period at the hospital
showed 62.3% of patients didn't have a
restrictive event, which requires the use
of seclusion, restraints or both.
But the risks remain real, even if the
daytoday odds of an assault are statis
tically low.
"Unfortunately, injuries are pretty
common here," Thoma said. "If you ask
staff, especially that have been around
for a few years, they're going to have a
story about a major injury that they've
had."
Employees and the hospital admini
stration both attribute the rise in inju
ries to more highacuity patients com
ing in to get treated before returning to
court to face criminal charges. Aid and
assist admissions rose sharply in the
mid2018, said hospital relations direc
tor Rebeka GipsonKing.
"At roughly 60% of our admissions,
these patients are admitted directly
from jail and are psychiatrically unsta
ble," she said. "It’s in that first 30 days
following admission where most behav
ioral incidents and restrictive events
happen."
Thoma works on the maximum secu
rity women's unit. She's also vice presi
dent of the Service Employees Interna
tional Union's bargaining unit for em
ployees at the Salem hospital.
"I've personally had some major, per
manently damaging injuries and it's
scary," she said. "It's scary when we get
patients that are incredibly assaultive
to other patients or to staff and worry
about whether or not you're going to
(leave) in an ambulance."
Thoma said she has PTSD from see
ing assaults while working. "One of my
coworkers got stabbed in the neck. It
was only with a golf pencil, but I
shouldn't have to say it was only with a
golf pencil."
Some injuries to employees don't rise
to the level of a worker's compensation
claim.
"Somebody punches you in the arm
and your arm goes numb for a couple
minutes, but you never turn it into a
SAIF claim," Smith said, referring to
Oregon's worker's compensation insur
ance program. "It's only when it's a se
vere injury."
For example, an employee may take a
day off if they are hit by a patient and
then return to work after taking a per
sonal day off. In cases like that, a work
er's comp claim isn't filed.
Serious employee injuries can run
the gamut, though.
"Teeth get knocked out, noses do get
broken, people do get seriously injured
— arms, legs and so on," Smith said.
"They go to the ER and they file a SAIF
claim and then SAIF approves it and it
gets counted."
Overtime and staffing
The hospital needs the equivalent of
102 fulltime employees in Salem to cov
er patient needs beyond what's avail
able from existing resources, records
show.
The calculation includes additional
directcare staff needed after factoring
in things like planned and unplanned
employee absences, training and pa
tients that need additional monitoring.
GipsonKing said it reflects the number
of additional staff needed for optimal
conditions across all units for a 24hour
period.
It also shows why overtime is com
mon and the need for more employees.
"We could hire over 100 fulltime em
ployees and there would still be a need,"
Thoma said. "The hospital runs on over
time. If people didn't sign up for over
time, we wouldn't enough people to cov
er all of our shifts."
Excessive overtime has been a chal
lenge for years at the hospital. A 2015
audit by the Secretary of State's office
flagged concerns about fatigued work
ers.
Challenges persist. Employees who
spoke to the Statesman Journal said
they don't fault management for the
staffing shortage. Getting authorization
for more permanent positions is up to
policymakers.
The hospital's management has
pushed to bulk up its workforce.
The hospital unsuccessfully request
ed turning 66 temporary staff positions
into permanent fulltime jobs so they
can keep more limited duration employ
ees who are trained, boosting the qual
ity of care and safety. That request was
part of the Oregon Health Authority's
budget proposal for the 20192021 bien
nium.
Without a permanent job, temporary
staff leave after 17 months.
"Ultimately, this results in dimin
ished staff and patient safety and pa
tient care," the hospital wrote in its bud
get request.
Gov. Brown didn't include that in her
budget request. Instead, the governor's
budget has focused on increasing the
state's capacity for communitylevel
mental care outside the hospital and
policy changes to open up avenues for
patients better suited for community
level care instead of hospitallevel care.
"With scarce resources, the state fre
quently must make hard choices during
the budget process," spokeswoman Lisa
Morawski said in an email.
The hospital, part of the Oregon
Health Authority, has a workforce of
hundreds.
To put it into perspective, the hospi
tal has 1,019 nursing department staff at
both campuses, a group that includes
nurses, mental health technicians and
clerical and management staff. Its pool
of limited duration staff has about 175
people.
Overtime quickly adds up when fac
toring in planned and unplanned staff
absences.
For example, the hospital can easily
have about 80 unplanned staff absences
on a given day. That's not including fill
ing in for workers with longterm
planned absences like medical and fam
ily leaves.
Overtime problems grew worse when
an Oregon Health Authorityordered
hiring freeze halted the hiring of new
temporary nursing staff in the 20152017
biennium.
The hospital said it was forced to re
sort to more overtime. That snowballed
into bigger problems as limited duration
staff exited: mandatory overtime and
exhausted employees.
It got so bad, in fact, that administra
tors were forced to delay firing nursing
staff with job performance problems to
avoid vacancies.
"We also increased risk related to fa
tigue of our nursing staff who were will
ing to work multiple shifts of overtime,"
the hospital's request said. "In addition,
nursing staff performance issues were
not promptly dealt with if a termination
was warranted because there was insuf
ficient coverage while the position was
vacant."
The hospital says that's no longer the
case.
Facing the problems
GipsonKing, the hospital spokes
woman, said it has not had mandatory
overtime since April 5.
It's made several changes to reach
that point. Directcare staff outside the
nursing department can volunteer for
overtime to cover for mental health
therapists who don't have certified
nursing assistant duties.
The hospital also has more flexibility
in moving staff from one unit to another
to cover needs. On June 2, the hospital
made a permanent change to move staff
across programs and allow them to sign
up for voluntary overtime in the Salem
campus.
That move came after the hospital
temporarily tried it to cover anticipated
staffing challenges during the holiday
season in December and January.
"This was very successful in redis
tributing the overtime to more than just
the people who work on the units with
the highest acuity – so successful that
we just rolled out the change perma
nently on June 2," GipsonKing said.
The hospital stressed it takes safety
and the welfare of its employees seri
ously and conducts staff training on
safe interventions to prevent aggression
and comprehensive risk assessments.
The hospital also does incident de
briefs to explore what to do better next
time an incident happens.
"Just one person getting hurt is not
acceptable, and safety for both patients
and staff is the top priority for OSH,"
GipsonKing said. "At OSH, we treat,
support and protect patients during the
most difficult periods of their lives, pro
viding both a therapeutic and safe place
to recover. We do everything we can to
take care of our staff as well."
For staff, long hours can lead to a
higher risk of accidents on the job.
When staff work a second shift and
have a long, 16hour day, Thoma said,
"you are more likely to make mistakes."
"If you haven't gotten enough sleep or
haven't prepared to work a double shift,
which is 16 hours, then you're more like
ly to make mistakes."
Community mental health care
The hospital also is facing a pressing
need to make structural changes so it
can admit "aid and assist" patients, who
are required to go there within seven
days of a court order.
The Washington County Circuit
See OSH, Page 3B
www.edwardjones.com
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