COVID-19 patients require more hands-on and direct nursing care, with one nurse caring for 1-2 patients. Every bed on this intensive care unit in a Portland area hospital is filled with a patient critically ill with COVID-19 in Portland, Ore., Aug. 19, 2021.

COVID-19 patients require more hands-on and direct nursing care, with one nurse caring for 1-2 patients. Every bed on this intensive care unit in a Portland area hospital is filled with a patient critically ill with COVID-19 in Portland, Ore., Aug. 19, 2021.

Kristyna Wentz-Graff / OPB


Even before COVID-19, the nursing shortage was critical. But nursing unions say the pandemic has created a staffing crisis. Nurses at Kaiser-Permanente have authorized their union to call a strike if staffing and patient care aren’t addressed. We hear more from Joshua Holt, an ICU nurse and chair of the bargaining team for the Oregon Federation of Nurses and Health Professionals. Kaiser Permanente was unable to make a guest available but in a statement called the work of health care providers “nothing short of inspiring,” and expressed hope that a contract agreement could be reached.

This transcript was created by a computer and edited by a volunteer.

Geoff Norcross: This is Think Out Loud on OPB. I’m Geoff Norcross in for Dave Miller. In the midst of a staffing crisis at hospitals around the country right now, thousands of Health Care Professionals at Kaiser Permanente facilities in Oregon have voted to authorize a strike. Members of the Oregon Federation of Nurses and Health Professionals Union voted overwhelmingly in favor of going on strike if they can’t reach an agreement with Kaiser administrators. Joshua Holt is the chair of the union’s bargaining team. He’s also an ICU Nurse at Westside Hospital in Hillsboro and he joins me now, Joshua, welcome to the show.

Joshua Holt: Good morning, glad to be here.

Norcross: Can you tell me what is it that you want from Kaiser Permanente? That so far they have not been willing to give you?

Holt: Sure. For us, the number one issue that we are trying to get in this contract bargaining is increased staffing, to be able to adequately care for our patients and improve the access of Kaiser Permanente members to be able to get the care that they need.

Norcross: Can you be specific, how many more people does Kaiser need to hire to be at the level you think you need?

Holt: The number of people that we need is, it’s a little bit nebulous right? Staffing is a complicated thing, as we talk about the delivery of healthcare, but we have put forward several ideas on how we can create formulas that demonstrate where additional staff is needed that automates the process for the recruitment and retention of employees.

Norcross: How would that formula work?

Holt: For instance, over an extended period of time, if you’re utilizing overtime staff utilization or you have managerial folks performing work normally performed by frontline employees, that over an average period of time you can see, that you don’t have enough employees to provide the work, just as part of the normal course of their duties. That would trigger, automatically, the hiring and recruiting of staff across all of our work sites from the hospitals to Health Clinic X, as well as home health.

Norcross: We’re talking about an issue that was a problem before the pandemic. Can you give us a sense of what hospital staffing was like before March of 2020?

Holt: Prior to March of 2020, we’d been raising the concern of not having enough staff for years at Kaiser, and it seems like administrators have really tried to objectify the kind of care that health professionals provide, down to a spreadsheet where we can look at productivity numbers in terms of the number of patients that are needed versus the staff. As health professionals, we know you can’t really put into a spreadsheet what patients require. Each patient’s care, or each patient, has individualized means based off of their acuity and their complex situation. It’s really difficult to justify the difference in opinion of looking at this formulaic response to staffing as opposed to caring for individuals who are people who need our care. So that has been going on for a long time and how we can reduce that number of staff that is necessary, based off of that spreadsheet, and not provide backfill. When people leave, jobs aren’t being posted, we’re taking months and months to get to that point.

Norcross: How did the pandemic make the situation worse?

Holt: When COVID hit, the patient acuity increased significantly more, as people are sicker and sicker. Honestly, folks are dying at more elevated rates or increased rates in our hospitals and they’re doing so alone, right? That takes a serious toll on the health care workers who are having to be the stand in for family members. Also, people are sick and in this community and not able to come to work as well because they’re dealing with being in this pandemic. The amount of moral distress and injury that our health care workers have seen have caused people to hold on as long as they can. But now, we’re two years into this pandemic almost, and the staffing crisis is exacerbating. And so far, we haven’t seen the employer engage in the problem of healthcare staffing, nurse staffing, to suggest that there is a remedy and that they’re taking the problem seriously. That’s why we are where we are.

Norcross: I understand this is a staffing problem and you’ve laid that out very well, but is it also a compensation problem too?

Holt: The constant fight does involve compensation from our end, it has always been about staffing and how compensation plays a part into staffing. So we believe that our compensation structure is not adequate for recruiting and keeping people here especially, as the market changes to have unprecedented rates, especially for contingent workers all throughout the country becomes the entire country is short staffed. At the same time, Kaiser has exacerbated that problem, by instead coming to the bargaining table and without engaging in the problems that we’re bringing forward, suggesting that we’re significantly overpaid, telling and frankly lying to the community about how overpaid we are, and offering a two tier wage structure that will offer significantly lower wages to new hires that will exacerbate and decimate the staffing situation all across Kaiser Permanente and not just here in the Northwest, but in all eight states where they operate.

Norcross: Kaiser was not able to provide a representative to come on the show, but in a statement they provided us they say: ‘It is important to note that the OFNHP’s recent moves have nothing to do with patient care.’ What’s your response to that?

Holt: That’s the first time I’m hearing that, and that is disappointing. As you have introduced me, I’m the chair of the registered nurses for the OFNHP and I am a critical care nurse and I care very passionately about patient care, as does my entire bargaining unit. The only reason why we are here is because we are desperately concerned about patient care. Nurses don’t get into this business in order to have extreme amounts of money, right? We’re not out there being greedy. We’re saying that we have a major staffing problem and the actions we’re taking are because the employer is not engaging with the problem of our community needs, better access to the care that they are prepaying for, and Kaiser has a responsibility to meet their needs.


Norcross: If you’re just tuning in, we’re talking about the decision by thousands of nurses and other health professionals at Kaiser Permanente to authorize a strike. Joshua Holt is the chair of the bargaining team for the Oregon Federation of Nurses and Health Professionals. Joshua. Another quote, I want to run by you from Kaiser and they say, ‘The vote to authorize a strike by union members is disappointing, especially because our members and communities are continuing to face the challenges of the ongoing pandemic. We strongly believe that differences in bargaining are best worked out at the bargaining table and we have a 24 year history of partnership with our unions that proves it.’ Joshua, what do you take from that?

Holt: There’s an aspect of that that I will agree with. It is disappointing that we are here, that since April, since we’ve been in bargaining, that the employer has not engaged in the problem significantly enough, where we do not need to take a strike authorization vote, what we didn’t need to be asking our members to consider whether or not it is appropriate to walk away from patient care in order to provide the best care that our patients need. We don’t want to be here. We want to be caring for our patients. We’ve been in partnership for 24 years in this unique model in the healthcare industry and in the labor movement. And as far as I’m aware, we haven’t actually asked our members to authorize a strike in nearly 30 years. This isn’t something we routinely do, but in this particular moment our patients need to be treated better than what they’re getting, and that’s why we’re here and that’s what we’re going to fight for.

Norcross: I want to ask you about timing, though, because you can’t deny the circumstances that you find yourself in now, with hospitals severely short staffed and a pandemic that has killed over 4,000 Oregonians. Did you think that, at any point in this process, ‘maybe we should wait until things calm down a little bit before we start pushing the issue’?

Holt: I don’t know many patients who would like us to wait before we fought for better care for them and for their families. When we bargained our contracts previously, and we set the contract expiration, we didn’t plan for a pandemic to be happening in the midst of our contract cycle, three years ago. It is what it is in terms of our contract has expired as of September 30, and we’re in a pandemic. We don’t want to be in a pandemic, and we don’t want to be rising a strike at this point. But the two have aligned and our patients need care and we’re prepared to do everything we need to provide the best care for our patients.

Norcross: I want to choose my words carefully here because I don’t want to suggest for a minute that you’re leveraging the pandemic. But, does the fact that it’s happening now, maybe strengthen your position a little bit?

Holt: The reality is that the industry has objectified nurse staffing and healthcare worker staffing to the extent where the staffing problem is at crisis levels on top of the crisis. Yes, we are in a pandemic. We’re not trying to take advantage of that fact. We just need to be providing better patient care than what we’re offering right now.

Norcross: All right. What’s the next step in the contract negotiation process?

Holt: Our hope is that Kaiser Permanente offers to return to the table, so that we can operate in partnership, and in good faith to land an agreement that is appropriate for the organization, for our union members, and for our community. So far, we don’t have dates that I’m aware of, that are yet scheduled, so that we can meet that need, before we would be considering offering a 10 day notice to stop work.

Norcross: As I understand it, this does not make a strike imminent, but you would have to decide to offer that 10 day notice and then the strike would happen 10 days later if you didn’t get what you wanted. And I’m wondering what you think is going to happen? Do you think you might take that next step?

Holt: We sure hope that Kaiser doesn’t make us.

Norcross: I’m curious what you think people should know right now about the states’ and the country’s ability to respond to the challenges that COVID-19 continues to present, and what people need to know about your profession right now?

Holt: The first thing I would say is broadly, throughout the country, and in our own local area here in Oregon, the pandemic is still raging. Please take care of yourself and your families. And remember good public health measures, wash your hands, get vaccinated, do all the things that we’ve been telling each other over the last two years. As we see a surge after surge and increase after increase, our healthcare workers and our ability to respond to ongoing public health needs, is getting more threatened with each subsequent surge. Please take care of yourself and your families and do what you need to do in order to keep yourself, your health care workers, and our society and communities safe.

Norcross: I’ve heard the term contingency workers and Kaiser has said that their priority is to continue to provide members with high quality, safe, care. And in the event of any kind of work stoppage, the facilities will be staffed by their physicians along with trained and experienced managers and contingency staff. What is contingency staff?

Holt: I think what they mean by that are workers who don’t work directly for Kaiser Permanente, but rather on short term contracts provided by 3rd party agencies. Those contingent workers are especially, right now paying exorbitant rates to fill short term needs, without a commitment to the success of the organization, without a commitment to the success of patient care. We think that, and have thought for a very long time, that healthcare workers directly employed by Kaiser Permanente provide significantly better care than people who come in for a very short period of time and leave after a very short period of time, on to the next place. There’s no longstanding commitment to the highest quality and best service of care.

Norcross: Do you know what it costs the hospital to hire staff like that to replace the nurses and other health care workers who have left their jobs?

Holt: I don’t know exactly what Kaiser is paying, but I know the advertisements that we have seen, we’ve seen five figure weekly take home pay being advertised to meet these needs. These are rates that are unprecedented. I have been a contingent worker in the past, prior to working at Kaiser Permanente. These are rates I have never seen before or even heard about before, and that’s prior to a strike authorization, prior to preparing a strike at any organization, that is just the pay that they are paying to provide a minimum level of staffing in our health sites.

Norcross: Okay, last question. I’m just really curious, since you have been through this pandemic that’s going on 20 months now, and you have been dealing with staffing issues even before that, and now you have this contract negotiation that’s in front of you, which clearly is painful. How are you feeling about your profession right now?

Holt: Thank you for asking. It’s a lot of stress on top of stress and not just for myself, as a chief spokesperson at the bargaining table and the chair of a bargaining unit of nurses as well as a healthcare professional myself. As a profession, we are seeing the kind of stress that we’ve never seen before. Healthcare has always been one, that it has been difficult to come home at the end of the day and clear your head and leave your work at work. But after month after month of seeing some of the most difficult work that we have ever been asked to, being concerned for our families and for our coworkers. It takes a serious toll and honestly, I think many of us are not doing okay. I’m really worried about the mental health of our profession and our industry, as well as our community, as our mental health workers continue to be threatened by similar conditions that we are working in.

Norcross: Joshua Holt. Thank you so much.

Holt: Thank you for your time,

Norcross: Joshua Holt is the chair of the Bargaining Team for the Oregon Federation of Nurses and Health Professionals. He’s also an ICU Nurse at Westside Hospital in Hillsboro.

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