From Complacency to Victory

I became a nurse in 2006. It was rock climbing and mountaineering that drew me to the profession. One day my climbing partner split his head open, and I had to take him to the emergency department (ED) to get stitched up. And then I had this epiphany: “Look at all these people living in Jackson Hole with great jobs who work as little or as much as they want.” I went straight to nursing school, and an internship in emergency nursing showed me that’s where I belong. I love being there in a person’s scariest moment and reversing their trajectory toward death.

I came to Portland’s Oregon Health & Science University Hospital (OHSU) in 2010, and I’ve been in OHSU’s ED ever since. I’ve always appreciated the Oregon Nurses Association (ONA), but COVID-19 drove me to become very active in the union. ONA was the only entity that cared about frontline workers. While administrators gaslighted us, the union acquired P100 masks from all the welding shops in the Portland metro area to keep us protected.

But the pandemic isn’t the main reason I’m active in the union now. It’s my 18 years of stories: everything from being assaulted to coming to the rescue of my peers. My first assault happened before I came to OHSU. I was a very young and very pregnant nurse taking care of a teen needing psychiatric care. As we were trying to restrain him to a stretcher, he kicked me in my belly. It was one of the most terrifying experiences I’ve ever had. (Fortunately, my baby was fine.) I learned very early that we can’t have real safety without safe staffing.

A couple of years ago, when volunteers were needed for the contract bargaining team, I stepped up for the first time. Bargaining lasted 10 months—from the end of 2022 to September 2023—and it was one of the hardest things I have ever done in a professional capacity. But I enjoyed it because I learned a lot, and we won significant raises and important staffing and safety provisions. Before I share details of what we won, I want to paint a clearer picture of the challenges we faced.

Guns, Assaults—and Short Staffing

When I started at OHSU, it was awful. There was the thinnest staffing that I’d ever experienced, and there were no safety protocols for patients whatsoever. No screening procedure, no metal detector. All entrances to the hospital were open to anyone, anytime. Patients came in with guns. They didn’t necessarily have ill intent; motorcycle and car crashes brought people in with guns strapped to their waistbands or in their purses.

The ED entrance now has a metal detector, but there are other ways to enter the hospital. Not long ago, a patient came into the ED waiting room through a back stairway and entrance that were unguarded and unlocked. He got all the way into the triage treatment area where there were five other patients and announced, “I’m suicidal, and I plan on shooting myself. Here’s my gun.” Our nurse had to immediately intervene to take the weapon. The metal detector has helped a lot—security has confiscated many guns and knives. But unexpected things get through. One patient brought big bottles of accelerant and lit a waiting room bathroom on fire.

To those who haven’t worked in a crowded ED, such things might be unimaginable. To me, they are the expected consequence of failed infrastructure—meaning not having adequate resources, including people and their different specialties, physical space, and supplies to meet the demands of this job.

At OHSU, we have a 31-bed ED for a 650-bed hospital, which is about half the size the ED should be. The hospital is always beyond its capacity, so we also have an ED boarding crisis in which hospitalized patients stay in the ED in hallways or the waiting room—some even beg to sleep in their cars. The consequences are often severe, particularly given the hospital’s prior practice of staffing just one triage nurse for 10 hours of a 24-hour period. For example, I was the lone triage nurse for one shift, and I needed to go to the waiting room to get a patient who had come in with stroke symptoms. Because there’s no way to see into the waiting room from behind the door, I inadvertently stepped right between two men—both also patients—who were fighting. One had crutches, which he had raised like a weapon. Using my loudest “mom” voice to stop the fight, I took the crutches. Then, I was able to leave and go push my panic button, which was back inside the locked waiting room door, around a corner, and under a counter. I should never have been alone in that situation. That fight would not have happened if there had been an additional triage nurse tending to the waiting room.

Unfortunately, that story is not unique. During yet another shift in which the ED did not have enough staff, one nurse was assigned to four separate trauma bays, where we treat our most critically ill patients. I was the charge nurse that day and I was in triage, far from the main ED, covering a break for the only triage nurse. A patient arrived as a trauma activation after a car crash. He was stable and seemed fine. But when he returned to the trauma bay after a CT scan, he got out of bed, rummaged through the room, and found a scalpel. My nurse walked in to check on him and found him waving the scalpel around, screaming. Alone with no code button, the nurse stood in the doorway, found one of our portable phones, and called me. This nurse is a close friend, so I immediately heard the urgency in his voice. I dropped everything and ran. By the time I got there, the patient was sitting in a corner stabbing his own eye with the scalpel. Our public safety officer arrived and stopped the patient by tasing him.

I’ll share one more incident—one that only avoided tragedy because the nurse involved was young and fit. He was covering a break for our psychiatric assignment, and we were terribly overcrowded: there were three filled patient rooms in front of him, a fourth patient on a stretcher behind him, and a fifth patient on a stretcher just outside one of the rooms. A patient exited one of the rooms and attacked the nurse, dragged him to the floor, and hit him. Two consulting physicians (from an outside practice) passed through and just stepped over this struggle—it’s on the hospital’s security video—because they were so desensitized to hospital violence. Thank goodness, our nurse was able to get control of the patient. By the time public safety arrived, the patient was back in the room with the door locked. The crisis was over, but the trauma remained—for the nurse and for the other patients.

The Power of Collective Bargaining

Despite these and many more traumatic incidents, our union had to fight through hundreds of hours of negotiations. Ultimately, we won our strongest contract ever, with wage increases of 15 percent in the first year and 6 percent each of the following two years, plus several new staffing and safety provisions.* By the end of bargaining, the administration understood how unsafe our workplace really is. Tragically, one reason they grasped what we were saying is that while we were bargaining, an unarmed security officer was shot and killed, and two additional staff injured, at another Oregon hospital.

One huge step forward in our contract is an ED staffing grid that lays out how many nurses we must have in every four-hour block of a 24-hour period. When I started at OHSU in 2010, the ED was run with 12 nurses. With this new contract, we range from 24 to 30, allowing a nurse for each trauma bay. In addition, a 1:3 ratio is written in for acute care, along with a guarantee to follow professional standards in other areas and enhancements to staffing plan enforcement.

We also argued for a dedicated, 24/7 public safety presence in the ED instead of shared presence with the rest of the campus because the ED is the epicenter of so much hospital violence. Our administration fought that tooth and nail. They wanted to continue with coverage “as best as possible.” But we didn’t back down, so now we have 24/7 security presence and metal detector screenings in the ED.

Since my first assault on the job, I’ve taken self-defense training, including courses taught by female police officers and courses on how to safely handle a gun. I did this to try to stay safe at work—but I had never had such training offered through work until now. We added de-escalation training, including physical training, to this contract for the first time. It is necessary. If you’re going to be a part of a team of nurses and public safety staff who have to physically control a patient, you need to be very practiced and coordinated to keep that patient and everybody else safe. This physical hands-on training will help all of us work together. It has not rolled out yet, but it is in the works. Importantly, this complements another provision for expanding our Code Green Teams—they respond to immediate safety threats in the hospital.

Another crucial victory is that the administration agreed to a campus-wide safety assessment by a third party. That assessment has happened, but we’re waiting to hear the recommendations. The hospital set aside $10 million for implementation, and the committee that decides how to allocate the funds will be at least 50 percent employees and up to 25 percent nurses chosen by ONA.

Our focus now is implementation—implementation of our new contract and of the staffing law that Oregon just passed (thanks to fierce advocacy by ONA and other unions).^† The law includes accountability mechanisms like fines, but members need to learn what constitutes a missed break, what constitutes a staffing violation, and how to file reports. At ONA’s convention in May, there were sessions on the staffing law so that we could learn more about its intention and enforcement. For example, if a friend covers for you so you can take a break, that’s not a break violation (you got a break), but it could be a staffing plan violation if there were not enough staff members for safe patient care. No one is supposed to be doubling up on patients, even to cover a short break.

To fully reap the benefits of our new contract, we’re doing an internal empowerment campaign to show that workplace violence is not OK and to encourage staff to file reports. Especially in the ED, we encounter violence so often that we become complacent. Through our 10 months of negotiations, we finally got the administration’s attention, so now we must document all incidents—and all staffing violations. We’ve demonstrated our power at the bargaining table; now we have to support each other to file our reports, enforce every detail of the contract, and make OHSU the safe, well-staffed hospital that our patients deserve.

Diana Bijon, RN, has been an emergency department nurse for 18 years and is a member of the Oregon Nurses Association and the Association of University Registered Nurses contract bargaining team at Oregon’s largest hospital, Oregon Health & Science University.

*For a short summary of what we won, see go.aft.org/4xe. To review our contract, visit go.aft.org/pv8. (return to article)

^†To learn more about this staffing law, see “Empowering Nurses in Oregon” in the Spring 2024 issue of AFT Health Care: aft.org/hc/spring2024/cline. (return to article)

[Photos courtesy of Oregon Nurses Association]