Having spent 2023 closing its intensive care unit and birth center, Baker City’s St. Alphonsus Medical Center is facing a new challenge heading into the fall: labor unrest.
The Oregon Nurses Association held a rally in the heart of Baker City on Wednesday. Entitled “No More Cuts,” the rally was meant to oppose further reductions in hospital services and to advocate for the St. Alphonsus nurses union as it tries to negotiate higher wages with administrators.
For nurses, the fight for better pay and defending medical services are not mutually exclusive. They accuse St. Alphonsus of failing to recruit and retain the personnel needed to run the hospital, leading administrators to cut services direly needed by the community.
St. Alphonsus did not respond to a request for comment. But current and former hospital staff fear that as negotiations between the union and administrators stall, more cuts could be on the horizon.
Nurses speak out
Megan Nelson said a fellow nurse described working at St. Alphonsus like sitting in a chair.
“It used to feel like you came to work and you were comfortable,” she said “It was like you going home and sitting in your recliner and kicking back. And now, when you come to work, it’s horribly uncomfortable. It’s like sitting in a straight back chair with spikes in it.”
Both Nelson and Alyson Rino are veteran St. Alphonsus nurses and leaders of the union’s bargaining unit. As union leaders, they both said workplace morale has eroded as the hospital cut services and upper management has grown more distant from frontline staff.
On top of all of these developments, the nurses contract is lapsing and the union is trying to fight for better pay.
According to the union, St. Alphonsus nurses make $5 to $10 less in hourly wages than their peers at Grande Ronde Hospital in La Grande, around 45 miles away, and St. Anthony Hospital in Pendleton. Nelson and Rino have not been encouraged by the process.
“Their exact words were, ‘We have a very small bucket to pull from’ when they showed us their wage scale,” Rino said. “And quite frankly, it was insulting. To put it nicely, it was the most disrespectful show of administration that we’ve ever seen.”
For nurses, the issues at stake in contract negotiations and the hospital’s downsizing are intertwined.
In letters to government officials and the media, St. Alphonsus administrators have said the birth center was losing money — $5.3 million over the past 10 years to be exact — but it wasn’t in danger of closing until it faced an acute nurse shortage. When the state decided in June 2023 that one of St. Alphonsus’ temporary nurses did not meet eligibility requirements, the hospital made the choice to shut down the birth center due to lack of staff. That closure officially took place Aug. 26.
Rino and Nelson acknowledged that factors like birth center profitability and nurse shortages are playing out across the country. But the closure of the birth center was also a crisis of St. Alphonsus’ administrators own making, they said.
Years of disinvestment had caused nurses and other medical professionals at St. Alphonsus to seek jobs with new employers, even if it meant commuting to a different community like La Grande.
“This isn’t a failure on the nurses’ part,” Rino said. “This is a failure on leadership’s part. We show up every day and do our jobs and leadership failed to lead us in a proper direction.”
The lack of nurses on staff led St. Alphonsus to rely on traveling nurses, Rino said, who required more money and in turn made hospital operations less sustainable.
Rino and Nelson worry that the hospital will continue to shrink in the future as the cuts make St. Alphonsus less attractive to prospective employees. And each cut will have wider ripple effects in the community.
“Baker’s small. There’s not 70 other nursing opportunities out there for nurses to take,” she said. “There’s only a few. Each cut, whether it employs five nurses or 25 nurses, that’s a huge, huge game changer for the hospital in the community.”
From hospitals to health care chains
Riley Hall was one of the St. Alphonsus nurses who looked for an opportunity elsewhere rather than stay.
He started working for the hospital in 2008, when it was still known as St. Elizabeth Health Services. A year later, the Michigan-based Trinity Health announced that it had acquired the hospital and would add it to a newly created chain of hospitals in Eastern Oregon and Idaho.
Hall said he loved working in Baker City, and the change in ownership didn’t initially result in any major changes in the hospital operations. But he began to notice more differences toward the end of his stint at St. Alphonsus.
There were concrete changes, like outsourcing some services that were done in-house. But it also seemed like local managers were being disempowered in favor of corporate leaders, who were disconnected from issues important to Baker City, Hall said.
Rino and Nelson echoed that sentiment, saying they wanted more respect and collaboration than they were getting from hospital administrators.
Hall left St. Alphonsus and took a nursing job with the Baker School District a year ago, adding that his opinions weren’t meant to reflect the position of the school district. He said working with children was an exciting prospect for him, but he’d also soured on St. Alphonsus, a feeling that’s only grown stronger since the intensive care unit and birth center closures.
The stalled contract negotiations at St. Alphonsus come at a time when health care unions are becoming increasingly active. Nurses have recently gone on strike in Portland and Seaside, and medical professionals who have typically gone unrepresented like doctors and medical technicians have organized their own unions.
Kevin Mealy, a communications manager for the Oregon Nurses Association, said union activism is growing in Oregon health care because of a groundswell of support for organized labor, especially among young people.
But, he said, it also has to do with the changing economics around hospitals. Over the years, many hospitals have morphed from locally controlled health care providers run by religious orders to hospitals that are a part of larger national chains. While those chains might retain their religious affiliation and nonprofit status, the people at the top tend to be “people with MBAs,” Mealy said.
“Increasing corporatization in health systems means that more and more folks are after a good bottom line,” he said. “I think that distracts from what a hospital’s mission is, which is to provide great health care to the local community.”
While Hall might not work at St. Alphonsus anymore, the birth center closure still affects his family: His wife is expecting a baby in February.
He said he and his wife are fortunate; They have a doctor friend in Boise who has not only agreed to deliver their baby, but also put them up in her house ahead of the birth.
But Hall knows that not everyone in Baker County has that type of connection. As the community awaits the result of an expected report from the U.S. Department of Health and Human Services on potential solutions, Hall knows some of the darkest outcomes could lay ahead.
“The only thing we know for sure is there’s going to be fetal or maternal death,” he said. “Somebody is going to die. And you just hope that you don’t know them, or they’re somebody who’s (not) really close to you, which is just about the saddest thing you can say.”