The Power of Solidarity

On January 10, 2025, 5,000 frontline caregivers across 11 Oregon Nurses Association (ONA) bargaining units from eight Providence hospitals and six clinics went out on strike—the largest healthcare strike in Oregon history¹—when contract negotiation efforts failed to produce agreements over wages, benefits, and staffing. One of the bargaining units was a group of hospitalists—physicians and advanced practice providers—and marked the first time in Oregon history doctors had walked a picket line. After 46 days, ONA secured a historic victory with agreements that included staffing plans to improve patient safety, substantial wage increases and bonuses to improve recruitment and retention, and stronger benefits.

To learn how ONA members organized to achieve these extraordinary wins, we spoke with leaders of four of the bargaining units represented in the strike. Richard Botterill, RN, is an emergency department nurse at Providence Portland Medical Center, the chair of his bargaining team, and a member of the ONA board of directors. Lesley Liu, MD, is an internal medicine and pediatric hospitalist at Providence St. Vincent Medical Center and a member of the bargaining team. Virginia Smith, RN, is a medical-surgical nurse at Providence Willamette Falls Medical Center, the chair of her bargaining team, and a member of the ONA board of directors. Breanna Zabel, RN, is a medical telemetry nurse at Providence Medford Medical Center, the chair of her bargaining unit, and a member of the ONA board of directors.

–EDITORS

EDITORS: What challenges have you faced with Providence?

RICHARD BOTTERILL: I joined Providence Portland in 2010, when it was still operated by the Sisters of Providence. They were much more interested in community health and in those who were caring for patients. When they retired and St. Joseph Health System came in—and eventually merged with Providence—the sisters’ values supposedly still guided the organization’s approach to healthcare delivery. But you could feel the difference as soon as you walked into the hospital. It was now all about money.

I also noticed a change in ONA in response. Many more nurses got involved and began advocating for change. With new upper management and a new board, ONA’s whole perspective shifted. We became more of a labor-driven and organized union.

In 2023, we were negotiating a new contract, but Providence wasn’t interested in working toward an agreement that would ultimately benefit everyone. So, after conducting a member survey to gauge support for action, we held a five-day limited duration strike in June 2023.² We had tremendous support from the community, including local businesses, other unions, and nurses around the city. We ultimately won some important changes to our contract, like additional RNs to cover meals and breaks, more paid time off, and more competitive salaries—but we knew that we were still going to have to push Providence to follow the state’s new staffing law, which established minimum staffing levels in many units.*

VIRGINIA SMITH: My independent community hospital, Willamette Falls, was acquired in 2009 by Providence, which was growing but still a relatively small organization. They were a “typical” employer that said they wanted a partnership with us. But in 2016 they merged with St. Joseph’s, and our relationship changed.

Having partnered in the past, we were unprepared when, with eight hospitals and eight contract expiration dates, we found that Providence was unwilling to budge on anything—like competitive wages to retain nurses, safe staffing measures, or paid leave after exposure to illness or injury at work. We also had very little coordination between bargaining units.

In 2018, Providence replaced our accrual-based extended illness time with a short-term disability benefit that they claimed was better—but it was a bait-and-switch that made it harder for sick nurses to take leave. We really got the message that Providence didn’t care about us. And we realized that our union needed more internal structures in place to fight for us.

While Richard and I and some other bargaining leaders were starting to develop those structures, the pandemic started, and we really had to organize to address staff and patient safety. As soon as the worst of the pandemic was over, we coordinated to track employer activity and contract expiration. We made sure each bargaining unit had a contract action team (CAT) and a network of stewards. We had members in every hospital initiating conversations, having regular meetings and social gatherings, and building power for escalation.

In my earlier days, we used to say, “Nurses don’t go on strike,” not realizing it was because of our comfortable relationship with our employer. When Providence made it uncomfortable, and then when the pandemic made it very uncomfortable, we realized that we needed to organize so we could do this work safely and protect its future—even if that meant striking.

BREANNA ZABEL: My history with union activism at Providence Medford goes back to 2023, but Medford nurses had been raising concerns, filing grievances, and calling on leadership to listen for years, only to be ignored, dismissed, and pushed further each time.

In January 2024, we began negotiations for our contract, which expired that March. We tried everything. We organized informational pickets and rallies. We came to every bargaining session with real solutions. We filed staffing complaints, met with lawmakers, and rallied our coworkers. But Providence continued to refuse to bargain in good faith, even after we joined five other bargaining units in a three-day limited duration strike with a two-day lockout in June 2024.³

Still, none of that effort was wasted. We built our organizing muscle through CAT membership meetings, community canvassing, and countless meaningful one-on-one conversations with fellow union members. When Providence pushed harder, we didn’t back down. We refused to keep waiting to fight for the care our patients and communities deserve. And that determination helped build the power we needed to lead the largest healthcare strike in Oregon history just a few months later.

LESLEY LIU: The hospitalists at Providence St. Vincent are a new bargaining unit, organized in August 2023. The top issue that led us to organize was staffing. The population in our area has steadily increased over the last 10 years, and we are seeing more and sicker patients, so the workload is much greater. St. Vincent opened an intermediate care unit for patients who previously had been under the care of critical care specialists. We also started taking heart transplant patients after the state university hospital lost its accreditation; our only training was a one-hour presentation from a nurse practitioner. We didn’t feel comfortable taking care of these patients, but we had no say. The decisions were all being made way above us.

There are 21 internal medicine and pediatric hospitalists working on an average day shift, but just four working the night shifts—caring for around 300 patients. We were being put in patient care situations that didn’t feel safe. But we weren’t getting anywhere with our requests for more staff, and people were getting burned out. We wanted to be able to voice our concerns and actually be heard.

After unionizing, the administration agreed to add an extra night hospitalist on weekdays. So now we have five hospitalists working at night, which has helped. But we asked for years, and management didn’t agree to it until we unionized.

EDITORS: Please share more examples of the conditions that galvanized you into action.

LESLEY: As I mentioned, we were concerned about unsafe staffing, especially during swing and night shifts. During one shift, I got called about two patients who were crashing and a third who was dying. At the same time, a nurse called to tell me that another patient had died unexpectedly, and I needed to notify the patient’s wife. As I was giving this person the worst news of her life—and getting more calls that I couldn’t respond to—I heard that I was being paged overhead, which is unusual. It was the nurse, calling back to say the patient hadn’t actually died. I felt horrible. But so many things were happening at once that everything was chaos.

In January 2024, we started bargaining our first contract to address staffing and other issues. By the time the 2025 strike rolled around, we’d been bargaining for a year and were frustrated with our lack of progress. So we ended up coordinating our bargaining with the nursing units toward the end of last year. Going on strike together gave us more power and more voice, and ultimately it helped us come to an agreement on our contract much sooner.

BREANNA: Safe staffing was one of our primary concerns. We’re a smaller hospital, so our medical telemetry unit functions more like a step-down unit. We care for patients who require close monitoring, like stroke patients, those on cardiac drips, and others who are critically ill but not quite ICU-level.

Despite the acuity, my nursing colleagues and I were regularly assigned five of these high-needs patients each. Week after week, we witnessed fatal or near-fatal arrhythmias and responded to full-blown cardiac arrests, with little to no support to help us process the trauma afterward. We fought hard to secure a four-to-one staffing ratio on our unit, and while that was a significant win, some nurses are still assigned five patients, and acuity and intensity often aren’t taken into account. This is not safe for nurses or for patients.

We’re doing everything we can, but it’s a constant struggle to provide the level of care our patients deserve. Our nurse manager hasn’t been a nurse on our floor and doesn’t understand what we’re facing day to day. Yet we’re constantly pushed to do more with less, regardless of the toll it takes on us or our patients.

RICHARD: Having enough nurses has always been an issue for us, and salary and benefits are also a big part of the problem. About seven years ago, we started calling attention during our contract negotiations to the fact that we need to stay competitive so we can attract and retain more nurses. But that had been ignored across the board.

Many staff have stayed despite the challenges we face because we really are family. Everyone supports and covers for each other. But even so, we are often shorthanded, especially as our census has gone up dramatically. We recently expanded our emergency room from 46 beds to 80, and we’re full on any given shift. We typically have dozens of people in the waiting room—with a nearly five-hour wait time to be seen—and we’ve still got ambulances coming in the back door. Many of our beds are used to board patients because other floors don’t have room or staff. The fact that patient care hasn’t suffered says a lot about how our nurses push themselves for our patients—and not much about the support that we’re getting from management.

The summer 2024 strike by the other hospitals in our system helped Providence Portland and Providence Seaside Hospital get the best wage structure we’ve had in a long time when we started bargaining in the fall. But Providence was still digging in its heels with our other units and showing they had no intention of resettling their contracts. At that point, we surveyed our members, finding that over 95 percent of our members wanted to support these other units by joining them in a strike. It’s a testament to the solidarity of our union that even though Providence Portland nurses didn’t stand to get much direct benefit from this action, the vast majority of us were ready to go out on a lengthy strike for our siblings. And we were able to use the salary structure we established in the fall as a model for the other bargaining units.

VIRGINIA: My med-surg unit is 50 beds, and we’re contiguous with the same-day surgery unit. We have a 28-bed ED, but some beds are in the halls—so some patients with broken hips or who are using bedpans have no privacy.

At about 2 a.m. during one shift, we had 26 med-surg patients waiting for beds, but I was already full with 50 patients and another 40 waiting. Two ICU patients came in, but the ICU was also full, so we had to put them in our lobby. I knew they couldn’t stay there, so I moved 10 patients from the ED to short-stay beds—meaning surgeries scheduled for later in the day would have to wait. I mobilized my staff, put my strongest nurses in charge, and we physically moved patients to make rooms available. Those patients didn’t get where they needed to go for another 10 days because our census was so full. We were in a constant state of stress like that for three years.

Before Oregon’s 2024 staffing law, we’d been told for years that the budget didn’t support hiring more nurses. But we’re bursting at the seams with sick people. Now, a year into having the staffing law, my unit is well-staffed. But we still have days when we’re short-handed. So ultimately, we got into this contract fight to make sure our patients have what they need.

And the employer can’t just buy us off with wages. We also need metal detectors at entrances to keep patients and staff safe, and better health benefits. Our insurance is so expensive that I can go get better insurance from Providence in the marketplace for a lot less.

EDITORS: How did you build solidarity internally and communitywide leading up to and during the 2025 strike?

VIRGINIA: We had three contracts expiring in December 2023, three more expiring in the first six months of 2024, and two expiring at the end of 2024. So we knew this was our time to act. We built solidarity across units through conversations about long-term strategy and how these contracts would affect each other.

As we negotiated throughout 2024, we kept up to date on what different bargaining units were experiencing, how the employer was behaving, and how that impacted our union power. When members asked why we weren’t settling, we reminded them what we were fighting for. It took a lot of patience for our bargaining unit members, especially those whose contracts had expired earlier, and a lot of trust in the bargaining teams to continue that slow and steady pressure.

The strike in June 2024 was a test of our power and the employer’s determination to resist. At that point, we had 3,000 nurses working under expired contracts for as long as six months. We didn’t know if we’d have to convince members to take action, but it turns out they were ready to show the employer how much we needed them to care.

RICHARD: Our communication was key to solidarity. We’ve established an environment in which we talk regularly and support each other. So people were talking about the potential for going out on strike long before anything happened. We held meetings leading up to the strike to talk about contracts and strategy. ONA put out weekly and sometimes daily status updates. And there was a lot of support for our bargaining teams. Members knew we’d put in a lot of volunteer hours to work toward a contract because we care about our units.

As far as external solidarity, we had an aggressive publicity campaign to increase awareness about our working conditions, which are patient-care conditions, and we saw very positive support from the community, as well as from nurses at nonstriking hospitals. Some—even from California—came to our rallies and stood on the line with us, and others from even farther away expressed support. Tamie Cline, ONA president and the chair of our board, heard from a friend of hers in Australia who saw the strike on the news there. My sister is a nurse in England and the news was being covered there too. So, a big chunk of the world saw what we did and what was possible, which is huge.

BREANNA: We knew Providence would try to control the narrative with polished statements, paid advertisements, and rehearsed talking points, so we made sure the public heard directly from us. Nurses spoke out about what it’s like to care for too many patients, to experience moral distress, to go home each day wondering if something was missed because we were stretched too thin. They made it clear: this fight wasn’t just about a contract. It was about advocating for the kind of safe, dignified care every patient deserves.

When an informal ONA survey found that 70 percent of Oregonians believed Providence prioritized profits over patients, and a patient survey confirmed that short staffing is a public safety crisis, these gave our fight undeniable weight. We met with city and state elected officials to ask them to intervene. We wrote to Providence’s board and to the Sisters of Providence, canvassed local businesses, and reached out to anyone with the power to demand better. We made it clear that unsafe staffing and nurse burnout ripple through the entire community. We were on the news throughout the strike to make sure our message was louder than Providence’s spin. Many of us were on the line for all 46 days. And when the community saw that we weren’t backing down, they showed up for us. Elected officials, including Governor Tina Kotek, joined us on the line.

We built our solidarity daily, conversation by conversation, with members. We developed trust by meeting members where they were, especially those who were hesitant about union action. Having a genuine interest in people, talking with them about why this fight matters to them, their patients, and their families, is important.

All of our units stood strong and settled together—even the units that had already reached contract agreements. We showed up for each other physically, emotionally, and financially. We donated food, money, and personal hygiene items, picked up strike shifts to help out, and even offered childcare. That’s how we made it through 46 days. And what we gained—solidarity, strength, and a seat at every table—will protect our patients, our profession, and one another long after this contract ends.

LESLEY: I heard someone describe the strike as the best team-building activity imaginable. It was reassuring and powerful to be with so many other people who share your opinions and support your cause. We had a big WhatsApp group that allowed us to share photos, comments, and event details to keep everyone in the loop.

Social media also helped build community engagement. I’m in a Facebook group for women physicians, and physicians from other hospitals and clinics reached out to me and even came out on the line with us. One of our OB hospitalists has a big Instagram following, and she made a lot of posts throughout the strike. And as Breanna mentioned, a few of our elected officials also came out on the picket line with us—two are physicians, and one is a pediatrician who worked at our hospital, so it was powerful to have their support.

EDITORS: Is there anything you would have done differently that may help other unions facing similar situations?

VIRGINIA: I’d like to have had a financial plan in place to provide for all of our members. My husband has two jobs, and he carried us through, but most weren’t in that position. At Willamette Falls, we had seven couples who were both out on the line. They plowed through their savings and took out 401(k) loans, so they were really feeling a financial strain by six weeks.

RICHARD: To that point, I’d want to develop a central database of options, from picking up shifts at other hospitals to finding other work. We have a lot of members who are single parents, and there were bills to be paid.

ONA had strike funds that many districts around the state contributed toward. A team of nurses from all the hospitals worked several long days each week to assess applications for those funds. Implementing an electronic process and a process for determining eligibility would help them move much more quickly and better ensure that all the members who need help can get it.

BREANNA: I’d focus on preparing people emotionally and practically for how hard something like this really is. We were organized and had a plan, but I don’t think any of us fully grasped how much it would take out of us. If I could go back, I’d start building up our hardship resources and emotional support systems sooner. At Providence Medford, we could’ve used a better communication system that could reach members who weren’t always checking social media or email. And I wish we’d built in supports like a mental health check-in table and more wellness volunteers to make this effort more sustainable.

LESLEY: It’s also important to remember that the bargaining team can’t do everything. In my unit, in addition to bargaining, we were expected to rally support, talk to the media, draft letters, and send updates to everyone. It became a huge workload. If I had to give advice to other new units, it would be to organize and solidify the teams responsible for nonbargaining activities. We could’ve used a stronger internal support structure within our group.

I also wish we as a bargaining team had settled on the tentative agreement language for each section as we were working it. We saved it all until the very end, which made finalizing the contract take longer.

EDITORS: What’s next? How will you maintain your solidarity and power?

LESLEY: One huge benefit of the strike is that we have a voice. Now, the administration has to discuss things with us before making changes, which was one of our big objectives. We’re also seeing more organizing from other teams. After the hospitalists unionized, our cardiology advanced practice clinicians followed suit, as did the neonatology nurse practitioners.

I think what’s next is more learning and growing as a union. Getting thrown into the deep end has strengthened our relationship with other Providence bargaining units. I’m not sure we would have had much interaction with the other units otherwise, but now we’re talking to more nurse units as well as other physician units.

RICHARD: We’re also seeing a lot more solidarity with our colleagues throughout Oregon because of what we accomplished. Legacy Health just voted to unionize, which boosts our membership from 19,000 to 23,000. And many other hospitals and clinics are in the process of organizing right now. So we’re going to continue to grow and become stronger.

Of course, Providence is still doing everything possible to fight the 2024 staffing law, including proposing things like monitoring patients through TV screens and cameras mounted on patients’ beds, which conveniently allows management to staff fewer nurses and not adhere to the four-to-one max ratio. We’re interested to see what they’re going to do now that the full weight of the staffing law has gone into effect.

VIRGINIA: We’re a lot stronger now. All the energy, solidarity, and collegiality that we built by standing up to Providence and fighting for what’s right—we brought it with us now that we’re back to work taking care of patients. We’re more aware and determined to not let contract violations slide. We fought for our contract, and it’s up to us to make sure it’s followed.

We’re also connecting with all our members, including the ones who were less engaged and wanted to get back to work and the relative few who eventually crossed the picket line. We want to give everyone a chance to talk through their experiences and continue to build trust and solidarity. Many members got really involved during the strike and are ready for more, so we need to get them plugged into steward training and other opportunities. And it’s important that we take time to celebrate this very hard-fought win, knowing that we are on the right side of this fight for our profession, and that our sacrifice was worth it for our patients.

BREANNA: At Medford, many of our nurses are continuing to stay involved. People are asking how they can become stewards and join committees, and at our last election every position had at least two candidates, which hasn’t happened in a long time. We’re seeing a greater sense of ownership across the board, and we are capitalizing on the momentum of this victory to make our union stronger.

With this strike, we showed that we don’t have to accept burnout, unsafe staffing, or corporate silence. We can organize, and we can win. Now we’re considering how we are going to enforce the contract, hold management accountable, and make sure that this never happens again. That shift was earned through struggle. Now, we get to decide what we build next.

*For more information on Oregon’s staffing law, see “Policies to Achieve Hospital Nurse Staffing Adequacy.” (return to article)

Endnotes

1. L. Anderson and L. Dowsett, “Nearly 5,000 Health Care Workers at 14 Providence Facilities to Strike Jan. 10,” KGW8, December 30, 2024, kgw.com/article/money/business/health-care-workers-strike-providence-health-facilities-january-10/283-3285ef70-0a09-41a3-965e-8bfb382e0a0e.

2. L. Hughes and A. Templeton, “1,800 Providence Nurses on Strike in Portland and Seaside,” Oregon Public Broadcasting, June 19, 2023, opb.org/article/2023/06/19/1800-providence-nurses-on-strike-in-portland-and-seaside.

3. D. Muoio, “Providence Nurses Kick Off 3-Day Strike Across 6 Oregon Hospitals,” Fierce Healthcare, June 18, 2024, fiercehealthcare.com/providers/providence-nurses-kick-3-day-strike-6-oregon-hospitals.

[Photos Courtesy of the Oregon Nurses Association]