Providence nurses and doctors may strike on Friday

The largest healthcare strike in Oregon history is on the horizon. About 5,000 Providence doctors and nurses who work at 8 different hospitals around the state could strike at the end of this week. We’ll get an update from OPB healthcare reporter Amelia Templeton.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. The largest healthcare strike in Oregon history could begin in just two days. Nearly 5,000 nurses and about 100 doctors who work at eight different Providence hospitals around the state have announced their intention to strike starting on Friday, barring an agreement with management. In a brief statement last week, the hospital network said it was prepared to weather a major nurse’s strike, but wanted to return to bargaining with physicians “in the interest of community safety.”

The rhetoric on both sides is ratcheting up. The hospital took out an ad in The Oregonian today, accusing the union of being unwilling to compromise. Meanwhile, Democratic-elected leaders in the state legislature and in Congress have made it clear that they support the nurses and doctors.

Amelia Templeton is OPB’s healthcare reporter. She joins us now with the latest. Amelia, good to see you.

Amelia Templeton: Thanks, Dave.

Miller: I mentioned this would be the largest healthcare strike in Oregon history. Can you just give us a sense for the scale, compared to other recent strikes?

Templeton: It’s about 5,000 workers total. And that’s significant – about 20% of Providence’s workforce here in Oregon.

The closest in recent history was the Kaiser strike, which involved about 4,000 healthcare workers here locally. But it’s not just the number of healthcare workers striking, it’s also the spread geographically. There’s Providence’s flagship hospital, St. Vincent. Also, hospitals in Seaside, Newberg, Oregon City, Medford, Hood River, and a number of women’s clinics.

Miller: This would also be the third Providence nurses strike in two-and-a-half or three years. How do you think that recent history is impacting the decisions of the various sides this time?

Templeton: I think it’s contributed to a sense of escalation. Providence has, historically, said – once the Oregon Nurses Association has indicated that they’re considering a strike and given this 10-day notice – that they can no longer bargain, they have to fully focus on preparing for a strike. I think the Nurses Association has long viewed that as a potentially illegal attempt to sort of intimidate workers out of actually striking. And now, we’ve gotten into a situation where past strikes have been time limited, the Nurses Association has declared this strike indefinitely. So we’ve sort of seen over time ratcheting up. And this is of course also a strike not just involving one or two facilities, but essentially statewide.

Miller: Plus, recent strikes have involved just nurses, right, as opposed to nurses and doctors?

Templeton: That’s right. There are two bargaining units in this strike that are bargaining for their very first contract, and that include doctors and other advanced practitioners. And that, I was told, is not just unique here in Oregon or unusual, but Providence St. Vincent Chief Medical Officer Raymond Moreno said that this is one of the first physician strikes really anywhere in the country.

Raymond Moreno [recording]: Replacing physicians, midwives, practitioners – nobody has any experience with this because this is unprecedented. There have been a few strikes of physicians around the country, resident physicians in one place, emergency physicians in another. But it is not something that anybody has a lot of experience with. It has not happened commonly at all.

Miller: Can you give us a sense of the kinds of jobs that these doctors, these MDs, and nurse practitioners, are doing?

Templeton: Yeah, one of the bargaining units represents hospitalists at Providence St. Vincent Hospital. They sort of supervise care for a majority of the patients there, people recovering from surgery, preparing for the end of life, really anyone who’s not in a sort of the most acute level of care.

And then also there are physicians, OBGYNs, midwives at Providence women’s clinics. They care for a whole range of people who are preparing to give birth, who have other needs related to obstetrics and gynecology.

Miller: Can you describe the different approaches that Providence management has been taking with nurses and with doctors?

Templeton: Yes. So initially, immediately after ONA –

Miller: The Oregon Nurses Association, the nurses’ union.

Templeton: Yes, which I should clarify, officially they represent nurses, but they’re also involved in the bargaining for the two units representing physicians as well in this case.

So after that strike announcement came, Providence said they could no longer continue to bargain, as they have in the past. By the end of the week, however, they came out and said they had managed to hire replacement workers to cover the nursing staff they anticipate will be on strike, but they had not had the same success replacing physicians, and therefore wanted to return to the bargaining table with the two units of doctors that were striking. They did say, essentially, that because they didn’t have anyone to train or prepare, they now had the time to come back to the bargaining table.

Miller: The explicit message there really seems to be, “Nurses, we can temporarily replace you. We’ve done this before, we know how to do it, the folks are out there to hire. But doctors and nurse practitioners, you’re harder to find temporary replacements for.” How did nurses respond to that announcement?

Templeton: I do think they sort of took it that way. And nurses also responded by saying, “We have believed for a long time that Providence is not being sincere when they have refused to bargain after we deliver a 10-day strike notification.” And to the general public, this might not sound that important. But from a legal perspective, Providence could be found in bad faith if they just stop bargaining tactically, as an attempt to try to intimidate their workers out of future strike actions. So if it is in fact not true that they need all of the time to prepare, that could be legally very significant. And nurses have sort of pointed to the statement as an indication that perhaps this was an act of bad faith.

Miller: Bargaining with some members of these workers and not others, it could be seen as a way to kind of take power away from collective action. Has it worked? Did doctors and other advanced practitioners agree to sit down for mediation?

Templeton: The short answer is I don’t know. I had learned from Providence yesterday that women’s clinic doctors and nurses together had agreed to a date at the bargaining table. What I understood about that was not necessarily that it was an indication that they were planning on not participating in the strike, but that they believed they really had an obligation to try to exhaust every possible avenue before letting replacement workers care for their patients – some of whom are people who they’ve been with through this whole long process of getting ready for birth. That meeting was supposed to take place this morning, haven’t confirmed whether or not it actually happened.

Miller: What are the main sticking points, as far as you’ve been able to understand them, in negotiations right now?

Templeton: Depends on who you ask. There have been two very different narratives from Providence and from the unions. I will start with what I have heard from doctors and nurses. They say they’re top issue is staffing, unsustainable workloads and just having to see too many patients. One of the people that I spoke with about this was one of the hospitalists who’s going on strike, Doctor Jahnavi Chandrashekar. She said, essentially, that hospitalists have asked Providence to find a way to cap intake when they become overwhelmed, and that that was the issue that led them to walk away.

Jahnavi Chandrashekar [recording]: When you add one, two, three more patients a day, that has an impact. It’s one thing for that to be one day or one week, where it’s a bad flu season or something like that. But when it’s day after day, week after week, month after month, the effect of that starts to build up. Not only on patients but on providers as well.

Templeton: Other high priority issues I heard about were concerns about healthcare benefits and time off, and then concerns about job security. Providence has recently spun off some of their businesses, they’re trying to spin off the home health and hospice unit, and that has union members concerned.

Providence, I think, agrees that staffing has been a core issue and a sticking point. But they say they believed that they were making headway and were approaching compromises before the strike happened. I think they view this almost as a show of power by the union, and an attempt by the union to show that they can essentially call a statewide strike, and that Providence needs to provide more generous economic compensation.

Miller: We talked about Providence asking doctors to come back to negotiations even as the hospital system has been preparing for a nurse’s strike. What else has Providence said about their strike preparations?

Templeton: They’ve said they do have replacement workers hired. Other sources I’ve spoken to have suggested they have travel nurses who’ve been brought in on two-week long contracts. That’s more or less what we know right now.

Miller: Do the various sides have any bargaining sessions scheduled right now?

Templeton: I don’t know.

Miller: Do you think at this point that a strike is going to happen? We’re talking at 12:17 p.m. on Wednesday – we’re nearing the end of the 10 days, we’re talking about Friday.

Templeton: I think that it’s more likely than not, simply based on how these things have played out specifically with Providence in the past. If negotiations were going to happen to try to avoid this strike, a lot of time has been eaten up over the last week.

Miller: This strike is likely going to be expensive for Providence. You talked about what seems to be two-week contracts for traveling nurses. We’re talking about maybe thousands of those. What could the strike mean for individual nurses? What have you been hearing?

Templeton: Individual nurses are really concerned about the potential for lost wages, first; and second, whether or not their healthcare coverage will continue and for how long. There are nurses potentially involved in this strike who have cancer and are in cancer treatment. There are nurses who are pregnant. So that healthcare coverage issue is really critical.

On the question of the wage issue, I spoke with a labor law expert who said that in this type of strike, nurses do have some legal right to return to their job before the strike is over, if they do so sort of unconditionally. That said, these things get incredibly complicated, and Providence may also have some legal avenues to suggest if they have a contract with replacement workers, that they’re going to honor that contract.

Miller: As opposed to paying two different sets of nurses for one set of work?

Templeton: Yes.

On the healthcare issue, I’ve spoken both with people who are independent of the situation opining, and also with people who are close to the negotiations. And based on the totality of my reporting, I think it’s really unlikely that Providence would cancel its workers' health insurance, if only because it’s a ton of administrative work to do that, and then have to reinstate everybody shortly afterwards.

Miller: More conjecture, it’s your best understanding right now that the strike is going to happen in a day-and-a-half. How long do you imagine it might go?

Templeton: If everybody proves me wrong, I think that would be the better outcome potentially.

I don’t know, it’s really hard to say. There’s nothing that says the strike has to last two weeks simply because replacement workers have been hired for two weeks. You can make arguments there would be benefits to it being shorter. And having covered strikes that lasted five days, the impact of that on everybody is tremendous.

Miller: What kind of impact are we looking at for patient care?

Templeton: That is a million-dollar question. I think both sides are trying to suggest this is going to be really dangerous for patients, and kind of blaming the other side for that. I think getting to the truth of it is a little harder. Providence has said that they have reduced admissions at St. Vincent’s, that not having enough hospitalists there means between 10% and 20% fewer patients total will be able to be in that hospital. And I do think nurses I’ve spoke to are concerned about patients, they’re concerned about patient safety. They’re hoping that hospitals and clinics that aren’t adequately staffed are going to go on divert, so that other health systems in the Portland area that aren’t going through this will be able to absorb some of the difference.

I’ve also reached out to OHA, the Oregon Health Authority, to try to get a clear indication from them as to how seriously they are taking the potential safety concerns of the strike.

Miller: Amelia, thanks very much.

Templeton: You’re welcome.

Miller: Amelia Templeton covers healthcare for OPB.

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