By Kristine de Leon
oregonlive.com
PORTLAND, Ore. — A strike by thousands of frontline health professionals across one of Oregon’s largest health systems could disrupt healthcare services for thousands of patients in the state, which even in normal times has among one of the fewest hospital beds per capita in the nation.
About 5,000 frontline health professionals at Providence Health & Services are slated to walk off the job starting 6 a.m. Friday. The striking workers primarily consist of nurses at Providence’s eight hospitals across the state and six women’s clinics and is expected to be the largest among healthcare workers in Oregon history.
The strike is also the first to include a newly formed union of 70 hospitalists at Providence St. Vincent Medical Center, as well as roughly 80 physicians, nurse practitioners and nurse midwives who staff its chain of six women’s clinics in the Portland metro area. Providence has said the physicians and nurse practitioners have proven harder to temporarily replace than nurses, compounding its potential disruption.
Carolyn Zook, a health studies instructor at Lewis & Clark Law School, said the strike comes at a critical time during the cold and flu season, a period when healthcare systems are already under significant strain. Reduced staffing can further exacerbate challenges in the delivery of care, she said.
“The strike will impact us all, whether or not we use the Providence system for care,” she said. “The impacts will trickle down to other ER rooms and urgent care clinics, which will be busier if the strike goes on… We don’t have a lot of hospital beds and so it definitely puts a strain on the greater system overall.”
Providence officials said its hospitals “will be able to offer key services, but it will not be business as usual” during the strike. The Catholic not-for-profit health system has already started notifying some patients at St. Vincent and the women’s clinics about rescheduling appointments.
St. Vincent is Providence’s largest hospital in Oregon with 523 beds. As of last week, it had about 450 patients admitted, but the hospital said it has been “taking steps to gradually reduce the number of patients” to match the number of hospitalists available.
As of Tuesday, according to the Oregon Health Authority, 93% of the available hospital beds in the six counties of northwest Oregon were occupied. Just 171 beds were available — 40 in intensive care units and 131 for general care.
Lisa Goodman, vice president of communications at Oregon Hospital Association, said the state ranks second to last in the nation for hospital beds per capita, which makes any situation that limits hospital capacity a major concern, regardless of the cause.
“We saw during the pandemic the devastating consequences when hospital capacity could not meet community needs,” Goodman said. “So we know this strike will impact community health and patient access to care, especially in the Portland metro area.”
Tim Heider, spokesperson for the Oregon Health Authority, said hospitals are required to comply with Oregon’s safe staffing rules, which set minimum staff-to-patient ratios, and federal laws that require hospitals to provide emergency care regardless of any labor action.
“Hospitals must have a plan in place to continue providing quality care during a strike,” Heider said. “Hospitals are responsible for planning for this situation and communicating with patients and the community about changes in available services.”
London Russell, a registered nurse who works at the emergency department at Providence St. Vincent said she’s worried about patients and what the lack of hospitalists and nurses at St. Vincent — the third largest hospital in Portland — would mean for patients in the area. She said the hospital has been at maximum capacity over the last two months due to the flu season and uptick in respiratory illnesses.
“When a hospital is at capacity, it affects the emergency department because you can’t admit patients to the hospital,” she said. “And when a hospital is not admitting patients, it puts a burden on other hospitals. It’s like a ripple effect throughout the community.”
But she said Providence managers have left the union workforce with little choice.
“We’re scared because we don’t know how long the strike will go on. Many of us nurses are single moms or breadwinners of our families,” Russell said. “We’re also angry because we still have no contract with Providence and it’s now gotten to this point.”
Providence said it has been in talks with state officials and area healthcare facilities to discuss transferring patients to other hospitals if necessary.
Oregon Health & Science University and Legacy Health each said they have been in planning discussions with Providence, other health systems, state officials and local agencies to minimize disruptions to the healthcare system.
“We understand the strain a strike of this magnitude may place on care throughout the region, and we plan to continue providing assistance where and when we can,” Legacy Health said in a statement.
OHSU said it was not limiting elective procedures to preserve capacity but would continue to monitor the situation. Legacy declined to say.
The university said it hosts a centralized information and coordination center to monitor and track the availability of hospital beds across the state. OHSU said it “will help keep needed services accessible to patients of all ages by coordinating transfers within the Portland metro area and the state.”
Emergency dispatchers have access to hospital capacity data to guide ambulance routing, based on patient needs and available resources. It’s not uncommon for the region’s largest hospitals to reroute incoming ambulances to others because of overcapacity or lack of medical capability.
In a statement, Gov. Tina Kotek said her office has been in regular communication with the Oregon State Board of Nursing, Oregon Medical Board and Oregon Health Authority, who are monitoring the situation.
Kotek said she has urged leaders at Providence and the unions “to stay at the bargaining table – that means all hospital staff, not just physicians.” She added that “every hospital worker deserves a fair contract.”
The strike, driven by unresolved labor disputes, centers on demands for better compensation, improved working conditions and better staffing levels. Officials from Providence and the Oregon Nurses Association have been negotiating nine separate labor contracts that have all expired last year. A rare and recently organized physicians union is also trying to establish its first labor contract with Providence after a year of bargaining.
Zook, who teaches at Lewis & Clark, said these labor tensions underscore deeper issues within the healthcare system that have been brewing for years.
“Even before the pandemic, there was already a nursing shortage and nurses were saying they’re burnt out and that their patient loads were too high,” Zook said. “I think we’re now at this interesting time in history where it’s coming to a head because the workers feel like they can’t give the best care to their patients.”
The Oregon Nurses Association and the Pacific Northwest Hospital Medicine Association — which represents hospitalists at Providence St. Vincent Medical Center — called the open-ended strike last Monday. Federal law requires health workers to issue a 10-day strike notice.
Providence said it was prepared to handle the nurses’ absence and has contracted 2,000 replacement nurses. Vivian, an online job search site for healthcare jobs, showed listings for temporary nurses to work at $7,000 per week during the strike.
Finding doctors to fill in, however, has proven more challenging.
“There is no temporary replacement workforce available for physicians and providers,” Providence said in a statement. “We are doing everything we can to mitigate that, including asking ONA to return to the bargaining tables and passing proposals.”
The Renton, Washington-based health system tried to reopen negotiations with doctors and providers. But the doctors said they would return to the table only if Providence also agreed to resume negotiations with other workers. The health system has maintained it would not bargain in the days leading up to a strike, saying it needed to focus on its contingency plans.
On Wednesday, Providence said it would return to the bargaining table with the nurses “once patient care is stabilized.”
With the strike date fast approaching, both sides face mounting pressure to find a resolution.
Greg Raelson, the director of congressional and public affairs of the Federal Mediation and Conciliation Service, said that federal mediators have been working with Providence and the union to help the two find common ground.
While mediators can’t force either party to return to the table or refrain from activities, like going on strike, they can intervene if the strike poses a public health threat, Raelson said. He added that, on rare occasions, the president has the authority to intervene in a strike that threatens to disrupt public health.
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