Nurses and Doctors Are on Strike at Eight Oregon Hospitals

Six people, dressed for a chilly day, holding ONA "Nurses on Strike" picket signs, shout or sing against a gray Oregon sky alongside a road. One man holds the leash of a dog. Most people in the photo appear to be white women.

Nurses, doctors, midwives, and nurse practitioners have hit the picket lines at eight Providence hospitals around the state, including giant hospitals in Portland and small ones like Providence Seaside. Photo: Jesse Dreyer

Declaring that understaffing had them “running on empty,” 5,000 nurses, doctors, midwives, and nurse practitioners walked off the job January 10 in an open-ended strike at Providence Health and Services, the dominant hospital chain in the Pacific Northwest.

The strikers work at eight hospitals plus women’s health clinics across Oregon. They’re demanding proper staffing, affordable health insurance, and competitive pay that can attract and retain seasoned workers.

“I’ve been with Providence for over 30 years, and I have seen what’s changed,” said medical-surgical nurse Kim Martin at Providence Portland Medical Center. “Providence used to be a nice community hospital, and now it’s venture capital with health care as a side gig.”

The coordinated strike includes workers whose contract just expired and others who have been working without a contract for a year or are still bargaining their first agreement. Management, evidently alarmed by the broad coordination, has tried to split off strikers by negotiating separate agreements. So far it has met a wall of solidarity.

The unions, Oregon Nurses Association and the Pacific Northwest Hospital Medicine Association, are affiliated with AFT. They have filed numerous unfair labor practice charges.

GREED TOOK OVER

Providence is a Catholic hospital system that used to be run by an order of nuns, the Sisters of Providence, but over time, governance has shifted into the hands of the same kinds of business executives who run health care everywhere.

"Corporate greed took over,” said Vicki Knudsen, a 22-year nurse at Providence Medford, in the southern part of the state. “We’ve lost a lot of services for the community. We no longer have oncology, or G.I. [gastrointestinal medicine]. We used to do open-heart surgeries—we no longer do that.”

Safe staffing has been a demand of every recent strike in health care. Oregon recently became the second state after California to pass legislation with required minimum nurse-to-patient ratios; it took effect last June, though no penalties will be levied until this coming June.

Despite the new law, workers said they have been disappointed by Providence’s unwillingness to commit to appropriate staffing plans.

“Our workload has increased, the type of patient we have is more and more complex, but staffing has not increased to keep up with that,” said bargaining team member Lesley Liu, a physician hospitalist at Providence St. Vincent’s.

Nurse unions have fought for staffing ratio laws in Illinois, Minnesota, New York, Washington, Massachusetts and elsewhere, but laws have been defeated or weakened by hospital lobbies.

Providence “benefits greatly financially from being understaffed,” said Robin Richards, an OB-GYN doctor at Providence Women’s Clinics. “I am almost always running behind at the clinic. I would like to think it hasn’t affected quality of care, but it’s getting exhausting.”

“We knew there was a staffing shortage coming two or three contracts ago,” said bargaining committee member Richard Botterill, an emergency department nurse at Providence Portland. “We’ve been saying that for a while, but it seems to be falling on deaf ears.”

PAY LAGS COMPETITORS

Exacerbating the staffing problem is that nurses leave, because their wages are behind those of competing hospitals. Knudsen said: “If you can’t feed your kids, if you can’t put gas in your car or afford your prescriptions, they won’t stay.

“We want to keep the nurses that we have,” she said, “because we know that experienced nurses at the bedside help to lower instances of complications, and patients have shorter hospital stays.”

At Providence Portland, nurses just starting their careers make almost $5 per hour less than they would across town at the Oregon Health and Science University. A nurse with 10 years of experience can make almost $8 an hour more at OHSU.

The disparities are even greater as you get further from the Portland metro area. In Medford, Providence nurses with 10 years of experience are making $16 an hour less than nurses at Medford’s Rogue Regional Medical Center.

The workers’ own health coverage is another issue. Nurses said costs skyrocketed after Providence unilaterally changed their health insurance to a new company, one not accepted by many previous in-network providers.

TRIED TO SPLIT WORKERS

In the lead-up to the strike, Providence claimed in the press that it was ready to reach agreements with some of the harder-to-replace clinicians at Providence Women’s Clinics and Providence St. Vincent’s.

Doctors and clinicians there are bargaining for their first contracts after winning their union elections in May and August 2023. “Providence tried to split off doctors, midwives, and others,” said Botterill. “And they said, ‘No. Negotiate with all of us or none.’”

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However, it was not until today, day five of the strike, that ONA received notice from Providence that it was willing to bargain with all the workers on strike.

“We depend highly on solidarity to be effective,” said Nathan Weiler, an emergency room nurse at Providence Seaside, a smaller hospital on the coast.

“We’ve made it clear we’ll come back to the table,” Boetterill said, “but you do have to do something to show that you want to settle.”

HIGH-ENERGY START

Hundreds of health care workers hit the picket lines the first day with a mix of optimism and sadness.

“The energy was super-high, and at the same time there were a lot of tears,” Knudsen said. “We don’t want to be out there. We’d rather be with our patients inside. But we can’t keep running on empty.”

The union estimates that 90 percent of workers are honoring the strike. Picket lines have had high-profile visitors, including AFT President Randi Weingarten and AFL-CIO President Liz Schuler, in addition to support from other local unions, like teachers and firefighters.

Picketers at Providence Milwaukie, in a suburb of Portland, asked a delivery truck driver on the first day of the strike if he was a Teamster. He said yes, and they informed him of the strike. He turned around and did not make his delivery.

OPEN-ENDED STRIKE

Open-ended strikes are still relatively rare in health care. Unions are required to file a 10-day notice to employers before striking health care workplaces, to ensure arrangements are made for patients, so there is a huge industry for replacement nurse agencies. While scabs are expensive, deep-pocketed hospitals can try to wait the strikers out.

The nurses at Stanford Medical Center in California, represented by the independent union CRONA, had a successful two-week strike in 2022. Communications Workers Local 1133, with members in nursing and support roles, spent five weeks on the line in Buffalo in 2021 to secure staffing language.

To win penalties for staffing ratio violations, 7,000 New York City nurses went out for three days in 2023—but were prepared for longer. After a four-month strike at Robert Wood Johnson University Hospital in New Jersey, 1700 nurses went back to work in January 2024 with new nurse-to-patient ratios. The serious threat of an open-ended strike brought employers to the table with 17,000 Twin Cities nurses in 2023.

Administrators at Honolulu’s Kapi‘olani Medical Center locked out striking nurses for three weeks last fall, until labor and political pressure pushed the company back to the table.

Sarah Hughes contributed reporting to this story.

Gender Pay Discrimination

Jeremiah Wright, a nurse practitioner hospitalist at Providence St. Vincent’s, said the bargaining team discovered that not only were doctors in obstetrics not compensated anywhere near the rates of other Pacific Northwest providers, but that they were also being paid less than the general internal medicine hospitalists, despite having specialty surgical responsibilities.

The OB hospitalists are the doctors who assist with emergency complications during labor and delivery, such as preeclampsia, hemorrhages, or fetal heart rate plunges.

“That became something we thought we should fight for: doctors taking care of high-risk patients should be making equitable compensation with internal medicinists,” Wright said. “They’re the only all-female specialty, and there is some question about imbalance of power that is historical.”

“Our team is all women,” said Shirley Fox, an OB hospitalist physician and member of the bargaining committee. “There’s lots of literature about how overall, the field of women’s health has been underfunded.

“It was interesting to be with internal medicine peers. We were discussing how their pay structure was, and they had a few more bonuses that they could add on to their salaries. We’re actually surgeons with additional training, and working with high-risk patients, and we were getting paid less than internal medicine, which was mind-blowing to us. Hopefully we would get paid a little more, because of our surgical expertise.”

Another piece of disparate compensation stood out: the general hospitalists earn additional compensation, a shift differential for nights and swing shifts, but the OB providers do not.

Instead, since the hospital wouldn’t provide it, the OB department workers elected to dock their own pay 5 percent when they work day shift so that they could internally provide a differential for those working night shifts.

“It frustrates us to know they haven’t been paid a shift differential at night,” Wright said. And when the hospital refused to respond to the union’s proposals for parity across these departments, “it created more solidarity.”