More than 1,800 Providence Health & Services nurses and home health workers ended their weeklong strike at 5 p.m. June 23. It was the first major health care worker work stoppage in Portland in more than 20 years.

Experts say nurses unions across the country have been more willing to authorize strikes and to stop work in the last year due to lasting exhaustion from the pandemic and an unwillingness to continue putting up with existing working conditions.

Heronia “Ro” Woodward is a home hospice nurse who works in east Portland. On June 19, along with dozens of colleagues, Woodward picketed outside the small office park in northeast Portland that is the main office of Providence’s home health and hospice team.

Woodward was thinking of her patients.

“So much can happen in just 24 hours,” she said. “A patient can be stable today, and then tomorrow, they are in a pain crisis.”

Providence hired temporary nurses from across the country to keep the hospice team staffed during the strike. So Woodward knew her patients were being cared for. But, she said, the replacement workers don’t know those patients like she does, and she believed they are not getting the same quality of care.

Still, Woodward said the strike was necessary. She said she was standing up both for herself and her patients “so that in the future they get the care that they need, and we get the … I will say the financial recognition and the benefits that we deserve as well.”

A debate over pay, and more

The nurses and home health workers are asking for a wage hike, more time off and double pay if they come in last minute to cover a shift that is short-staffed.

It’s unclear to what extent this strike was part of a calculated strategy on the part of either side, and if so, who should be considered responsible for it.

What is clear is that the Oregon Nurses Association delivered a 10-day strike notice earlier this month after a difficult bargaining session with Providence that had dragged on until 3 a.m. The union hoped the escalation would give them more leverage, and wanted to keep negotiating. That didn’t happen. Providence canceled the remaining bargaining sessions and began preparing to bring in a temporary workforce.

For about a decade before the pandemic, nurse wages and benefits were relatively flat, according to Christopher Friese, a professor of nursing and health management and policy at the University of Michigan. Health care systems were trying to run lean, he said. And unions were more likely to try to reach a quiet deal rather than strike.

He said that’s changed after nurses’ experience on the front lines of COVID-19, in some cases risking their lives and their families’ health to do their jobs.

“Nurses were asked to do the unimaginable — for years,” Friese said. “And so now they’ve had time to think about what they’ve been through and where they were even before the pandemic — and more and more nurses are saying enough is enough.”

That’s been a talking point on the picket line in Portland. Representatives from the Oregon Nurses Association, which represents Providence’s health care workers, say hospitals have under-invested in nursing and that affects patient care. They argue nurses are now handling a post-pandemic population that is sicker, misusing substances more often and harder to treat.

What’s best for patients?

The strike included nurses at Providence’s small hospital and clinics in Seaside and nurses at Providence Portland Medical Center, the health system’s second-largest hospital in Oregon. It also included the 400 or so nurses, social workers and physical therapists with the Providence Home Health and Hospice team. They say the central disagreement in their contract negotiations is over their increasing workload and the problems that it creates for patient safety.

“They have not hired enough nurses,” said home health nurse Peter Gerber. “I’m doing the work of two and a half nurses.”

Gerber has been a home health nurse for Providence for eight years. He cares for people who live in his own Beaverton neighborhood.

“I take care of those people around the corner, down the street who can’t leave their homes,” he said, “who are stuck in bed, who have dementia, who can’t talk.”

Gerber said his normal caseload used to be about 25 patients, which he says is best practice. But over the past year, his caseload has surged as colleagues have left or retired.

“I’m not able to see those patients as frequently as I should to notice the changes in their wounds, in their breathing, to help people stay out of the hospital,” he said.

He’s also expected to meet daily productivity targets. Generally, that means visiting five to six patients a day. An easy patient might take just an hour. But a complicated patient can take up half a day.

If health care workers are feeling newly emboldened to strike, health care systems have an obvious reason to dig in and avoid making concessions during bargaining. Many are losing money and under pressure to try to contain costs.

According to financial statements, Providence Health & Services lost $345 million on its operations in the first quarter of this calendar year, an improvement over its performance last year.

“Hospitals across the country are under siege financially,” Friese said. They’re looking for every opportunity they can to support their budget and that’s appropriate. If hospitals continue to run a deficit, the hospital doesn’t exist.”

Nursing is an obvious expense to consider for executives trying to balance a budget because it can make up around a quarter of a hospital’s expenses.

If you take a broader look, Friese argues, investments in nursing pay off in the long run.

“You have fewer complications, you get patients out of the hospital sooner, you avoid deaths and you actually keep your nursing workforce,” Friese said.