More than 3,000 nurses at six Providence hospitals across the state are set to go on strike for three days next week. In an unusual turn of events, they’re striking in part over the rollout of a law that was hailed just two years ago as a major win for the nurses union and the first of its kind in the nation.
Providence St. Vincent Medical Center, in Portland, Ore., Aug. 2, 2023, is one of the hospitals impacted by the nurses' strike. The 523-bed hospital in Portland’s western suburbs that is Providence’s largest and most profitable hospital in Oregon, according to hospital financial data published by the state.
Kristyna Wentz-Graff / OPB
Economic issues, including annual wage increases and out-of-pocket costs for the Providence employee health care plan, are also in dispute.
Both the Oregon Nurses Association — which represents the striking nurses — and Providence say their negotiations have ended and the strike is set to begin on Tuesday, June 18 at 5:30 a.m. Impacted hospitals include Providence St. Vincent, Providence Newberg, Providence Willamette Falls, Providence Medford, Providence Hood River and Providence Milwaukie.
The strike is large and likely costly. It’s the first that Providence officials said they can remember at St. Vincent, a 523-bed hospital in Portland’s western suburbs that is Providence’s largest and most profitable hospital in Oregon, according to hospital financial data published by the state.
Providence officials said they have hired about 1,000 replacement workers to fill in across the hospitals involved in the work stoppage.
The health care provider hasn’t changed or canceled any services yet, according to the chief executive of Providence Oregon Jennifer Burrows. Patients will get notified by their doctor’s office and the hospital if any existing appointments need to be rescheduled.
Burrows and the union both said that any patient needing emergency care should get it and not worry about the strike.
“If they need medical care, they cross the picket line, no matter what,” said ONA spokesperson Myrna Jensen.
Already, the union and the hospital system are butting heads over the strike’s duration. ONA has called a three-day strike, with its members free to return to work Friday morning. Providence, in a document of talking points shared with OPB, accused ONA of choosing a shorter strike to increase the cost to the health system.
Burrows said staff nurses will not necessarily be asked to return to work as soon as the strike ends. To recruit replacement workers, Providence had to guarantee them five days of wages.
“It will be our replacement workers that are managing patient care in our hospitals until Sunday morning,” she said, though staff nurses may be called to return to work on Saturday or Sunday if Providence doesn’t have enough staff to care for patients.
How a one-time compromise is fueling the strike
The striking workers are asking for higher wages and better health care benefits. ONA says management’s proposal would leave Providence nurses with wages that aren’t competitive with their peers at other organizations, and that the corporation’s health plan for families in particular has high deductibles and high annual out-of-pocket maximums.
Providence executives say they’ve offered nurses a roughly 10% wage increase. They say their employees can choose from several different health insurance plans with varying deductibles.
But the most intense disagreement is over what the nurse’s employment contract will — or will not — say regarding hospital staffing plans.
In 2022, the Oregon Legislature passed a bill with mandatory nurse-to-patient ratios for most hospital units. In an intensive care unit, for example, nurses can be assigned no more than two patients at a time, per the law.
Hundreds of frontline nurses from the Providence Health System, along with their supporters, held an informational picket at Providence St. Vincent Medical Center in Portland, March 15, 2022.
Courtesy of Oregon Nursing Association
That bill amended, but did not replace, an older law requiring hospitals to have staffing plans developed by committees made up equally of nurses and managers.
ONA crafted the 2022 bill and while hospitals initially opposed it, legislators directed the two sides to work together. The version that passed included some concessions to the hospitals, including higher nurse-to-patient ratios in some areas than ONA had initially proposed.
Burrows alleges that ONA is now trying to use the contract to walk back some of the compromises it made to get the bill passed. ONA, meanwhile, says Providence has violated the law — which went into effect June 1 — and is trying to enshrine its “illegal interpretation” in the contract.
At the heart of the dispute is an effort from ONA to preserve the status quo in some hospital units rather than adopting the ratios set by the new legislation. Union representatives said that in some individual hospital units, the nurse-to-patient ratios are better than what the union was able to win in the legislation.
The union’s position is that the ratios in the legislation are a maximum, not a standard. Christy Simila, director of professional practice at ONA, says hospitals should keep staffing plans in place if they exceed the standards in the legislation. Instead, Simila said, in many hospitals, including some Providence hospitals, nurses were told they needed to take the maximum patient assignment once the law went into effect.
“There’s lots of different things that go on in taking care of patients with different needs,” Simila said. “Just assigning the maximum patient load to everybody doesn’t really make sense.”
On June 4, ONA sent a letter to the Oregon Health Authority, accusing Providence of violating the law.
Hospitals, though, interpret the law differently. The Hospital Association of Oregon says hospitals can provide more nurses per patient than the staffing that the law requires, but the ratios were meant to be the default in any situation where nurses and managers on a staffing committee couldn’t come to a mutual agreement on how to staff a unit. On June 7, the Hospital Association of Oregon sent its own letter to OHA, saying it is critical that the legally-defined ratios “serve as the dispute resolution solution.”
Burrows said Providence’s staffing committees weren’t able to come to agreement on ratios for all units by June 1 and, in situations where management and nurses on the committees disagreed, the health system had to indicate to OHA it was complying with the law by submitting a plan using the law’s numerical ratios. She agreed that, in some cases, the ratios set in the legislation aren’t right for every unit, and said they’re open to continuing to work with Providence’s staffing committees to adjust the plan.
Burrows does not, however, want to bargain over it with ONA.
“To now have the union want to dictate that in a contract pulls away the opportunity for the clinical nurses to have a voice in this,” she said.
ONA’s Simila says the union wants to add the language into their contract so nurses could file grievances if the staffing law isn’t being followed.
“It’s another enforcement mechanism that would provide the nurses with a voice and how their units are staffed,” she said. “That’s why it’s ultimately important.”
Correction: A previous version of this story misspelled ONA spokesperson Myrna Jensen’s name. OPB regrets the error.