This article has been updated and expanded to incorporate additional reporting.
Oregon likely is on the brink of the largest health care strike in state history, with more than 4,000 nurses as well as some doctors and other providers across Providence Health’s eight hospitals in Oregon prepared to go out on strike Jan. 10 if the health system doesn’t improve upon the pay increases and working conditons included in its latest contract offer.
The news announced by the Oregon Nurses Association Monday leaves little doubt that a strike is imminent, since Providence has asserted it won’t negotiate after a strike notice is issued.
Here’s a breakdown of what it means.
Why is this important?
The announcement caps off years of labor-management tensions at Oregon’s largest health system, with union members saying the health system is not taking care of patients and workers the way it should. If past is precedent, the strike could disrupt patient care and affect other hospitals around Oregon as well. The announcement follows years of successful organizing drives by the union, and it has repeatedly promised its members that joint action will deliver results.
The strike authorization votes taken across the Catholic health system mean thousands of workers are willing to forgo pay in the hope of forcing better working conditions for them and their coworkers.
Previous strikes called by the union were planned for three or five days to give management a limited taste of what a full-blown walkout would entail. This one, however, will be open-ended and is billed by union organizers as aimed at a systemwide settlement.
Another difference: the nurses union has organized doctors as well, and physicians and advanced practice providers at Providence St. Vincent are expected to join the strike.
How far apart are they?
It depends who you ask. A Providence statement claims the system has offered raises in Oregon that “would give the average, full-time acute care nurse an rate increase of 20% over the life of the contracts, with a double-digit increase in the first year.”
The nurses union, however, calls that statement misleading, adding that “even with the wages that Providence offers, they are still not competitive with other healthcare systems including OHSU. Also, this strike is about more than just wages.”
Providence tends to run behind Oregon Health & Science University, a public teaching hospital and health system, in what it pays nurses. On Nov. 27, the union alerted its Providence Portland nurses that Providence’s wage proposal for the first year of the proposed offer “is now competitive with OHSU, but subsequent year increases remain significantly below OHSU and potentially below inflation.”
Both sides have accused the other of being unwilling to compromise. According to a union spokesperson, “frontline caregivers are striking because of Providence's unfair labor practices, safe staffing, more time with patients, and competitive wages and benefits to recruit and retain more staff.”
Providence responded that the system leadership is proud of its contract proposals, saying they would mean “serious workplace enhancements for represented caregivers, including our physicians.” The system's statement called the union's demands “unreasonable and unsustainable.”
More than pay is at stake
In addition to pay, the union says staffing, health benefits and paid time off at Providence lag those of other systems. The union is seeking guarantees on staffing as well as safeguards against the nonprofit health system contracting out to for-profit firms. That's an increasing concern at Providence, which has outsourced its lab work and is trying to do the same with its hospice and home care.
Dr. Jennifer Lincoln, a hospitalist at St. Vincent, wrote recently on social media that she and her colleagues asked for language “to protect us from Providence outsourcing us to cheaper companies. We even compromised & put in language for exceptions in unforeseen circumstances. They refused – even though another Portland hospitalist contract has this EXACT language.”
How could this affect patients?
In June 2023, a Providence nursing officer described a five-day strike called by the Oregon Nurses Association in Portland and Seaside as “disruptive,” saying that “bringing in a replacement workforce is a very complex and very challenging situation.” This strike will be far larger, likely eliminating the health system's ability to move caregivers between facilities to address gaps. Providence claims it has replacement workers lined up already, but for how long is unclear. According to one union member’s post on Facebook, the open-ended nature of the strike is designed to “make it harder for Prov to plan replacement workers.”
Strikes by health care workers used to be less accepted than in other industries, given provider obligations and the potential effects on patients, experts say. In the past, some unions would even send some health care workers across picket lines to ensure safe patient care.
That’s unlikely to happen in Oregon. Earlier this year a national nursing group’s proposed ethics code called on union organizers to “ensure there is a process in place to care for patients” when a strike is planned, but the provision is expected to be removed after the Oregon nurses union and its counterpart in Washington state objected, saying the onus is on the employer, not the workers fighting for better working conditions.
The locations where the union's members are poised to strike include Providence Portland, Providence St. Vincent, Providence Women's Clinic, Providence Willamette Falls and as well as the system's hospitals in Hood River, Medford, Milwaukie and Seaside. The physicians and advanced practice providers at St. Vincent also will strike, as they were organized by the union under its affiliate the Pacific Northwest Hospital Medicine Association.
How long could it last?
Nobody knows. Providence claims it won't bargain with a union that's on strike. Members of the nurses association can apply for hardship pay to offset a portion of their lost wages, but the extent to which health care workers can sustain that is unclear. Meanwhile, their Providence health benefits could expire by Jan 31 — though the union says it believes the system's coverage obligations would extend at least a month after that.
Contract duration debated, collective clout the goal
The nurses union has long been planning for larger, coordinated action to maximize its clout, and Providence suggests the union has engaged in foot-dragging on some contracts to achieve that. The union, meanwhile, says it seeks to align contracts to expire after two years, in January 2027, for purposes of efficiency because so many issues are shared between work sites.
One nurse, Janny Tan, recently wrote on social media that the union is trying to align contracts with other health systems to also expire January 2027 so "we can bargain with even more power as collective nurses vs corporations." Meanwhile, Providence has pushed some bargaining units to sign three-year deals expiring in December 2027 — which the nurses union has cited as objectionable, telling members such timing “could severely diminish” future bargaining power.
Already, its alignment and growing membership across Providence has increased the union's clout, as one message to members said: “The unprecedented unity among healthcare workers across the Providence system puts us on equal footing with health care executives who seem to be focused only on operating margins and financial results.”
What can Providence afford?
Providence Oregon is part of Providence St. Joseph Health, which operates 51 hospitals across Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington. The nurses union cited the 2024 pay of more than $12 million for outgoing Providence St. Joseph Health CEO Rod Hochman to blast the system for focusing on profits over patients.
The system’s latest financial filing shows Providence Oregon registered losses of $100 million in the 12 months ending September 30, compared to about $4 billion in operating revenue, amounting to losses of about 2.5% for the year. Overall, the multistate system registered about $150 million in operating losses on about $23 billion in revenues in the same time span; those losses were offset by about $400 million in other financial gains.