We interrupt this program.....

 From talks of Ecuador, let's go back and visit the US again, for a moment.  I have been here for 4 1/2 months, and just clocked out and approved my timecard for the last time, and handed in my badge at Providence Portland Medical Center.

+++Warning - this addresses the strike.  Because I start out defending the need for the way Providence handled the staffing needs during the strike, it may leave a bad taste that I am defending Providence in general.  For the most part, I am not - please read all before coming to a conclusion.  I think Providence is allowing the accusations of impropriety with their strike labor practice to deflect from the real issues.

For the most part it was a very pleasant assignment.   I was warmly welcomed into the unit, and after a few weeks of covering vacations, random ill calls, and assisting with a new employee (called "caregiver" at Providence) orientation, I was assigned to a pleasant, fast paced observation unit, with very pleasant, proactive, and self sufficient staff.   Since Gabrielle was not living close to this hospital, and I was living with her to give her some coin towards her nursing loans, it was an 11 hour day, 5 days a week, for 4 months straight.  During that time, I got 3 days off to recover from Covid, which I picked up at the Easter Service, not the hospital.  So it was pretty much non-stop.

But with 2 weeks to go, the Providence Portland nurses called a 5 day strike, and I spent my second to my last week surrounded by "strike nurses".  The ONA has villified these nurses calling them "scabs" and using them as "unfair".  The truth of the matter is there were patients in the hospital that needed immediate care.  There well being was not, and should never be, part of the bargaining table.  The ONA suggested the hospital should just gave gotten regular travel nurses and agency nurses instead of the "strike breakers".  I'm not sure how that would have made it better.  Let's assume for a moment that 475 such nurses were hanging out, waiting for their next assignment, and all of them wanted to come to Portland for 5 days to assist with a strike.  Other than being more work for the hospital to negociate and set up all of these people, how would that have been better or "more fair"?  

  There still would have been a bunch of nurse working in the hospital during the strike.  The other issue is that there is at least a 3 week lead time for most regular travel assignments so the 10 day notice was not nearly enough to get regular travel nurses.  Also, regular travel nurses generally work 13 weeks assignments, and may not even be willing to come for 5 days.  I work as a travel nurse.  If I wanted another assignment, that was available long before 10 days before my contract ended.  And if I was 10 days out without a contract, it is highly doubtful I would have picked up a 5 day strike contract, instead of just settling in to one of the numerous less contenious 13 week contract deals that were being dangled in front of me.  The only way I would have done it was if I needed a lot of money, and they were offering it.  That would make me no better than the coordinated so called "strike breakers". Illegeal or not, ill patients needed care, even after the hospital transferred out as many as they could, and immediate patient needs come first, end of story.  Also, the nurses that came were not really "strike breaking" since the ONA had already pre set the days the strike would last.  They were merely working the days there was known inadequate staff, (as pre-determined by the ONA) NOT prolonging the strike to get hungry workers to settle.

So in that matter, Providence is on solid ground, so imagine my surprise when I watched their admin field the world's most pathetic press conference.  The reporter asked her if Providence had indeed broke the law (cause apparently hiring strike breakers is illegal).  Instead of saying, yes, and here is why, and the law likely wasn't written with a hospital in mind, and we did all these other things, too, like cancel surgeries, transfer patients, and go on ambulance divert, but at the end of it all there was patients left that needed care, and we needed to do whatever was necessary to make sure they were cared for, she just danced, evaded -- anything but be transparent.  Eventually, the hospital did admit it hired the "illegal" staff because there was not another good way to get the patients cared for, but it was too little too late, did not go into any detail on how a reguarl travel nurse company operates, what the normal lead time is for hiring nurses from such an agency, and fell pretty flat.

Why, when Providence clearly had the moral high ground in this sliver of the situation, did she not just put an end to it?  And why was the ONA focused on the patients that remained in the hospital with no other options getting the care they needed, "illegeal" or otherwise?  In my mind, it should never be "illigeal" for hospitalized patients denied access for whatever reason to their regular caregivers to receive medical care from appropriately licensed and vetted nurses.  And let me tell you, the nurses I met that came to care for these patients were lovely people, who jumped right in with kindness, proficiency, and grace.

I fear there is an elephant in the room, more than one actually, that no one wants to actually address.  Certainly not Providence leadership, and not the ONA, either.  There is a finite amount of money, and since the pandemic, we have lost a lot of it.   Providence is trying to staunch the bleeding, while still somehow justifying a 10 milion dollar salary for their CEO, and very high salaries for other high level leaders as well.  Likewise, the ONA does not want to admit there is a finite amount of money, the last three nursing contracts in the state in roughly the last year have involved record breaking settlements after a threat to strike, using the hospitalized very patient's LIVES as a bargaining tool, and at some point, fiscal responsibility needs to prevail, and hospitals cannot keep on like this.  Providence, on the other hand, does NOT want to address high leadership salaries.  I'm sorry, y'all are going to have to explain to us peasants why this dude is worth so much more than your most talented neurosurgeon.  I realize that even if he made $0, it probably wouldn't make a dent in the salaries of the tens of thousands of people across many states that work for Providence, but it is leaving a very bad taste in everyone's mouth, so you are going to have to say something - something heartfelt, and transparent, not that dancing we all witnessed in your recent press conference.  At least confirm that published salary is true - although I do understand that his salary was cut to $5 million during part of the pandemic.  The poor dude, how did he survive?  You cannot say you don't have enough money, and yet not mention this.  It is just not making sense to people.

So why Providence Portland?  A line in the sand was drawn at this hospital that was not drawn previously.  The last three recent negociations in the state of Oregon (Kaiser, St. Vincent's, and most recently St. Charles in Bend), where the nurses voted to strike, the hospital kept negociating, and avoided a strike.  This time, they clearly communicated (and followed through) that once a notice to strike was made, they would shift to making sure the hospital could be run in the strike, and resume negociations afterwards.  Why did they not do this previously, at St. Vincent's (a very close similar sized hospital also owned by Providence) just over a year ago ?  I believe the answer lies in simple logistics.

Providence Portland is an inner city hosptial.  St. Vincent's is a bit wealthier, more specialized.  For example, as part of the preparations, all of the infants in the NICU were moved to St. Vincent's.  I have a strong suspicion this could not have happened the other way around - the St. V's NICU is larger and more specialized, and it would have been a lot harder to transfer the fragile babies.  Also, there are more specialized cardiac services, such as the Heart Transplant Program.  I do not see how they could have transferred that out.  My own personal opinion is that if Providence could have figured out a way to get the patient's at St V's cared for, they would have allowed a strike there, as well.  Instead Providence Portland is being "made the example", and with it are coming feelings that somehow Providence does not value them as much as the St. Vincent's nurses.

And so, Providence Portland, and its Covid and poverty weary nurses are paying the price.  What they are asking for - essentially - the same pay and benefits that the nurses at St. Vincent's are getting.  To be treated equally.  If Providence signed an agreement with St. Vincent's that they really didn't feel they could afford, but signed it anyway because they could not care for the patients in the event of a strike, they need to own up to that.  Otherwise, it looks like gross favoritism.

Providence stated that the average RN made about $100,000 a year or even more.  One new nurse, licensed for just a few years, that started in the pandemic with minimal training, and support told me that her taxable salary last year was about $69,000.  So clearly, not everyone is making that, and even if they were, that is not that much to live in Portland, OR, where housing starts about about 500,000, and city and state income taxes are very high.  Just for example, Brian saved $1000/month in Oregon taxes when we moved out of Oregon.  Couple that with nursing student loans, which in many cases are quite a bit higher than I had (even adjusting for inflation) attending a private university, and it is not that much to live on, for a professional salary.  Then there is the whole time off thing.  There is ONE PTO bank, that encompasses sick days, vacation, and holidays, for someone whose profession is very stressful and frequently exposes one to illness (like freaking COVID).  When I added up the days with a newer nurse, a person working at a bank would get more paid time off.  At one point, we also had a bank of days that accrued very slowly, and could not be cashed out, but could be used for FMLA, like to care for an aging parent.  That was taken away, and replaced with short term disability, which has much more narrow ways it can be used.  So there are some understandable gripes.  After three years of stress, more time off is essential for mental health.  We worked when everyone else stayed home, and subjected ourselves to a potentially fatal illness, which for many months, there was no vaccine for.  We watched people die, have prolonged illness, suffer from isolation.  The hospital, although losing money, was full to bursting, and the nurses cared for very ill patients, along side discharge ready stressed out patients with no where to go.  I found it very telling that Providence simply published the average nurses' salary with no comparison to other hospitals, most notably the sister hospital a mere 20 minutes away, St. Vincent's.  These are NOT greedy nurses asking for too much.

And yet, with finite finances, there needs to be realistic and transparant discussions on what can be afforded.  There needs to be equal pay across the board, across the hospitals (I see you, too Seaside!!).  There needs to be some very uncomfortable recognition on part of the nurses that much of the hospital is NOT unionized, and when the hospital is put in an uncomfortable situation of signing a contract that would be difficult to afford, they quietly make cuts in other areas, and non nurses can definetely suffer from that.  Again, an honest and transparent discussion about finances would include high leadership salaries, and Providence's financial rating - once very high, and while still decent is slipping.

I have thought long and hard about what I would do in Providence's position.  Besides address the 10 million dollar salary.  It goes without saying you cannot talk to your employees about a budget and have that left unsaid.  I think I would hire an independent neutral consultant to take a frank look at the company's financial situation, and have a them publish a frank public opinion on fair salaries and benefits based on that, and the regional market as a whole (and certainly include high leadership and CEO salary in that evaluation) What could be reasonably afforded across the board.  We cannot just reasonably and fairly only look at nursing salaries.  

Both sides need to communicate with kindness, realism, and authenticity, not sound bites.  Right now, Providence leadership is evasive, and the ONA is provocative. And for the love of God, and the orginal Sisters of Providence, please take immediate patient care needs out of your discussion.  Their care should be non-negociable.