Nurses at Providence St. Vincent Medical Center have voted to reject a tentative contract that their union, the Oregon Nurses Association, had negotiated with the health care giant.

St. Vincent is Providence’s largest hospital in Oregon and one of the busiest hospitals in the metro area.

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The tentative agreement came after eight months of bargaining and the intervention of a federal mediator. ONA had recommended a “yes” vote to its members, but in recent weeks nurses at St. Vincent had been actively campaigning against the agreement.

They voted to reject it by a 4-1 margin.

“Put simply, hundreds of experienced, frontline ONA nurses looked at Providence’s offer and said it’s not good enough,” said Jessica Lobell, a maternity nurse at St. Vincent and a member of ONA’s bargaining team.

Both sides said they will go back to the bargaining table and work with a federal mediator to try to reach a new deal.

If that effort fails, the nurses at St. Vincent could go on strike. The Oregon Nurses Association is required to give 10 days notice before any walkout. The union voted earlier this month to authorize a strike — a necessary prerequisite to notifying the hospital system of a walkout.

Adding to the impact of a potential strike, the nurses at two smaller hospitals, Providence Milwaukie and Providence Willamette Falls, are also in the middle of contract negotiations. In all, more than 2,000 nurses at three hospitals could strike if their demands aren’t met.

“We hope to quickly work through our differences to draft a contract the represented nurses of Providence St. Vincent will approve,” said Jennifer Burrows, chief executive at the hospital. “We are committed to ensuring our valued nurses receive a fair pay and benefits package.”

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The nurses said the initial contract didn’t go far enough to address their main concerns: They are overworked, underpaid, and spending too much out of pocket for their own health insurance.

They said a staffing crisis, driven by low wages, has destroyed workplace morale in a health system that used to have a stellar reputation as a place to work.

Wages at Providence have fallen below the area standard, leading nurses to leave, and Providence to backfill those positions with highly-paid temporary workers.

“When you are doing the same job as the person next to you, but they’re making twice as much as what you are, even though they have less experience and they don’t know your department, that is moral injury,” Lobell said.

“It’s the experienced seasoned nurses who keep the hospital running, and those are the nurses who we are fighting to recruit and retain.”

They painted Providence as a health system that has changed its culture and lost its way as it pursues growth.

Administrators no longer know their nurses’ names or listen to their requests for specific equipment or supplies, according to the nurses.

“For all the crosses and mission statements we walk by in the hospital halls, it’s clear to every nurse that Providence isn’t run by the nuns anymore,” said Virginia Smith, a charge nurse at Providence Willamette Falls and an ONA board member. “It’s a multi-billion dollar business run by corporate executives.”

Providence is the largest health system in the Pacific Northwest and among the wealthiest nonprofits in the region. In Oregon, it manages eight hospitals and more than 90 clinics.

Nonprofit hospitals like Providence St Vincent are required to provide community benefits in order to keep their tax-exempt status.

St. Vincent provided $93 million in free, discounted, and unreimbursed medical care in 2020, the most recent year available in the state’s public data.

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