Providence Health & Services is delaying surgical procedures, shuffling patients to free beds and hiring temporary staff as it braces for an impending nurses’ strike.
Nearly 2,000 nurses and allied workers could walk off the job for a five-day work stoppage beginning Monday as months of increasingly bitter negotiations between the health system and the state’s largest nurses union appear to have risen to a bitter crescendo.
The strike would be the first of its kind in more than 20 years and would affect Providence’s hospitals in Portland and Seaside as well as the health system’s home health care and hospice services.
Nurses represented by the Oregon Nurses Association voted overwhelmingly last week to authorize the strike following what union negotiators described as Providence representatives’ unsatisfactory responses during a marathon bargaining session. The union provided Providence with the required 10-day strike notice.
“The union is open to negotiations during the 10-day period, and we’ve always said that,” Christy Youngquist, a registered nurse and negotiator at Providence Seaside, told The Lund Report, a line that other union reps echoed.
Providence administrators have signaled they’re instead focused on minimizing disruptions to patient care during the strike and are pausing negotiations unless the walkout is called off. A statement the health system issued Wednesday afternoon indicated it will resume talks after the strike. It said Providence has already offered the three bargaining units contracts worth nearly $35 million in their first year.
“That figure includes double-digit increases on existing salaries at Providence Portland and Providence Seaside,” reads the statement. “At those facilities, an average annual nurse salary is well over $100,000.”
The strike follows years of tension between the hospitals and the Oregon Nurses Association, which have both warned of dire post-pandemic health care challenges facing the state.
The state’s hospitals have complained of drooping finances made worse by patients they can’t discharge to other settings. Providence, a Renton, Washington-based chain of nonprofit hospitals in five western states, recently reported a $345 million net operating loss for the first quarter of 2023 for the entire health system. Despite the loss, Providence had a $7.8 billion investment portfolio, according to the most recent disclosures.
The politically connected union has taken an increasingly assertive tack with hospitals that it blames for chronic staff shortages that it says are driving nurses from the profession and affecting patient care.
“We are in the middle of a nursing staffing crisis that’s been building over the last five or six years, quite frankly,” Richard Botterill, an emergency department nurse at Providence Portland and union negotiator, told The Lund Report.
He said Providence Portland’s wages have been below the market average for years. While Providence’s offer made some movement on wages, it’s not enough to retain in-demand nurses, he said. He and other nurses say Providence has underinvested in staff, putting patient care at risk.
Oregon hasn’t seen a health care worker strike in over two decades — not since Oregon Health & Science University nurses took to the picket lines in 2001. St. Charles Medical Center in Bend earlier this week reached a deal with nurses who had authorized a strike. But a similar outcome for Providence seems uncertain as Monday draws near.
Krista Farnham, Providence Portland Medical Center chief executive, told The Lund Report she is preparing for a strike on Monday.
“Our nurses are incredible,” she said. “They take great care of our patients and our community. And we will welcome them back on Saturday after the strike. And we are working with them to get to an agreement as soon as possible.”
Providence seeks empty beds at Portland hospital
A strike would have a pronounced effect on Providence Portland Medical Center, a nearly 500-bed hospital that includes an emergency department, surgical services and a maternity unit. The health system issued a statement Wednesday afternoon indicating that people nearby who need life-saving care should still come to the hospital, but others should go elsewhere if possible.
“This is not business as usual, and we need to prepare to take care of our patients. It’s all hands on deck caring for our patients.”
“This is not business as usual, and we need to prepare to take care of our patients. It’s all hands on deck caring for our patients,” Farnham said.
Farnham said the hospital typically cares for 400 patients and 150 emergency department visits, while performing about 100 surgical and other procedures each day.
Hospitals have complained that they are being stuck with patients who require a lower level of care but can’t be discharged because of the lack of beds in skilled nursing or long-term care facilities. There are over 400 patients who’ve seen their discharges delayed, according to the most recent data.
Farnham said that’s why the hospital is taking action now to free up beds by rescheduling all non-urgent surgeries and deliveries while moving patients to other hospitals. That includes babies in the neonatal intensive care unit whom she said Providence is moving to other hospitals in the health system’s network as well as to Legacy Health.
The hospital doesn’t have a specific number of patients it is trying to shift elsewhere, she said.
“Our goal is really to get the number of patients we are taking care of down as much as possible before the strike starts on Monday,” she said.
Farnham also said Providence has been in contact with emergency medical services about the strike. She said Providence Portland Medical Center’s emergency department will be “ready and available” if need be.
Both the American Medical Response, which provides emergency medical transportation in Multnomah County, and the county’s health department issued statements to The Lund Report indicating they’re taking action to prevent the strike from affecting patients who need an ambulance.
But Austin DePaolo, business representative for Teamsters Local 223, said a potential strike could be a problem for patients. DePaolo, whose union represents about 450 paramedics and other emergency workers in Multnomah and Clackamas counties, told The Lund Report that nursing shortages have already meant ambulances have been backed up or diverted from hospitals including Providence Portland Medical Center.
“We are still going to have to bring patients to the ER, but I’m sure they are going to be backed up,” he said.
Already, AMR has been criticized by county officials over its response times, while some cite the county’s rigorous staffing requirements in the name of patient care as a factor in those delays.
Farnham said Providence Portland Medical Center is tapping U.S. Nursing, a temporary nurse staffing agency, to fill vacated positions at the hospital.
“We would prefer not to strike but we have to be prepared,” she said. “We need to take care of our patients during a strike.”
Myrna Jensen, Oregon Nurses Association spokesperson, told The Lund Report that if nurses strike they will have to follow a “a very specific order of operations” to hand off care to their replacement nurse.
“Obviously, if somebody’s right smack in the middle of an emergency, nurses are not going to just get up and leave,” she said.
Hospitals’ reliance on medical staffing agencies during the pandemic became a source of resentment for permanent nurses who complained that their temporary counterparts were paid significantly more. The nurses union has criticized hospitals for spending on staffing agencies instead of investing in permanent staff.
Botterill, the Portland emergency department nurse, said he’d like to see the temporary nurses not cross the picket line, leaving Providence with no option but to come back to the bargaining table.
“I don’t think any of our nurses want to strike,” he said. “But they’ve left us no other option.”
Other units, other concerns
Monday’s potential strike would also affect Providence Home Health and Hospice as well as its Providence Seaside Hospital.
Providence indicated in a statement Wednesday afternoon it will find qualified replacement nurses and other clinicians for the 2,300 home health care patients and 420 hospice patients it serves each day. The service will accept new patients “as the team is able while still maintaining care of existing patients, with a special focus of helping patients discharging from hospitals and transitioning home.”
The health system’s statement also indicated that administrators have rescheduled all elective surgeries at the Seaside Hospital, a 25-bed critical access facility. The hospital has also stopped admitting patients that need a lower level of care.
“We think about our patients first, and this can not be an interruption in care,” Youngquist, the Seaside nurse, said. “Part of this kind of shows that in order for a nurse to walk away from their patients, the situation has to be that bad.”
One of the sticking points in negotiations between the union and Providence Seaside is whether clinic nurses see pay raises equivalent to other providers. Youngquist said clinic nurses like herself face an inaccurate perception that their jobs aren’t as challenging as inpatient nurses. She said that at small hospitals, like Seaside, clinic nurses review X-ray and lab work reports, work on medical triages, cardiology as well as other complex jobs on sometimes very sick patients.
Linda Sheffield, a Home Health and Hospice registered nurse and negotiator, told The Lund Report the union is seeking to improve what she called “below market wages,” the high employee health insurance deductible and better time off.
There are home health and hospice nurses who have not had a vacation in years because they’ve had to use paid time off for sick days.
She said there are nurses in her unit who have not had a vacation in years because they’ve had to use paid time off for sick days.
The statement from Providence said it offered generous packages to all three units that included bonuses of up to $2,500 and a short-term disability program that would cover eight weeks of time off.
The health system said in the statement the total compensation package it offered to Seaside nurses in its last offer is more than $2.3 million for Providence Seaside nurses. The average full-time salary from a Providence Seaside nurse is $118,000, according to the health system’s statement. The latest offer included an 11% average annual wage increase in the first year with 3% in the second and third years.
The statement said Providence offered a “double-digit percentage increase” in total compensation to registered nurses working in Providence Home Health and Providence Hospice, with other health workers seeing pay raises. The unit’s current average hourly rate of pay ranges from $31.15 for a licensed practical nurse to $60.59 for a triage nurse.
Providence, according to the system, offered the biggest compensation package to the roughly 1,300 nurses working in its Portland hospital at more than $30 million in the first year. Providence Portland nurses are paid on average $128,000 and the health system has offered an average wage increase of 12% in the first year and an additional 30 hours of paid time off, the statement asserted.
The Oregon Nurses Association, however, disputed the health system’s figures on wages in a press release. The union responded Wednesday evening saying in a press statement that “Providence has, yet again, completely missed the point.”
“Providence continues to focus exclusively on wages when, in fact, nurses and clinicians are focused on improving patient care, addressing historic unsafe staffing levels throughout the Providence system, and addressing serious patient concerns,” reads the statement.
Clarification: This article has been updated to clarifying Christy Youngquist's role as a nurse.
Jake, can you explain why this process is happening at PPMC and Seaside when ONA and St. Vincent's just went through this? Wouldn't the nurses at PPMC be fine with the St. V's deal? Wouldn't Prov know exactly what PPMC nurses would accept? This seems odd. Thanks!