Approximately 250 doctors, nurses, and physician assistants at all eight Legacy Health hospitals across Oregon and Washington filed union authorization cards with the National Labor Relations Board last week, per a press release from the Oregon Nurses Association.

“Legacy Health has received a petition for representation from the Pacific Northwest Hospital Medicine Association on behalf of hospital-based providers,” said a statement from Legacy issued Monday morning. “We respect our providers’ rights to determine union representation through processes overseen by the National Labor Relations Board.”

Eduardo Serpa tells Oregon Business that when he began working as an internal medicine doctor at Legacy Salmon Creek Medical Center four years ago, Legacy administrators were better about listening to workers’ concerns.

---

---

Now that’s changed, says Serpa, who spoke with OB in his capacity as a member of the PNHMA, which already represents hospitalists in Sacred Heart Medical Center in Springfield and which is serviced by the Oregon Nurses Association.

“There has always been great collaboration historically, between the providers and the administrators [at Legacy], and I always felt like our voice was heard. Over the last few years, though, we’ve seen more unilateral decision-making out of the administration and changes to how we deliver care,” Serpa says. “One of the biggest concerns as health care providers, when we work these seven-day stretches, is keeping away burnout. I think the pandemic really showed us that the priorities we had of putting patients first, the hospital second, and ourselves third, is just not a sustainable practice.”

The news comes on the heels of a merger announcement between Legacy and Oregon Health and Science University, which was a point of contention during the negotiations with the Oregon Nurses Association. ONA members voted to authorize a strike against the healthcare system before reaching a tentative agreement last week.

---

---

Serpa says the news that Legacy, which posted $172 million in losses in its 2023 fiscal year,  was being purchased wasn’t a surprise to him or many of the people he works with, but that maintaining bargaining power is increasingly important to providers moving forward. 

“Any change that might be perceived from being acquired by OHSU, we want to be a considerable part of that discussion and really pursue that equity through deliberation as a union,” Serpa says.

The health care providers will meet in the coming weeks to confirm details and schedule an election date. If approved, they will join nearly 700 Legacy nurses and mental and behavioral health professionals represented by the ONA, which has more than 16,000 members across the state.

---

---

Kevin Mealy, communications manager for ONA, says that the NLRB has been approving unions more quickly in recent years, and says the organization could return the decision in a matter of weeks.

The filing follows a flurry of union activity across the state, notably in the health care sector  – including strikes at Providence Health Systems in Portland and Seaside this summer and a strike authorization vote at Oregon Health and Science University in September. In July, 57 employees at Legacy’s Unity Center for Behavioral Health in Portland filed for union recognition with the National Labor Relations Board, voicing concerns about staffing and safety.

Last year 15 health care providers — including doctors and nurse practitioners — at four Eugene-area clinics announced plans to file for union recognition in partnership with the PNHMA. It’s unclear how many Oregon doctors belong to a union, but PNHMA says it has 200,000 members nationwide, and ONA says U.S. physicians are increasingly drawn to unions as “health care systems have become larger and more corporate.”

---

---

Mealy says the growth in union activity among Oregon health care workers is part of a larger movement of organizing around the country. He says President Biden’s visit to Michigan to stand with workers striking against the big three automakers last week was a sign of increasing momentum for the labor movement, and that Oregon workers are setting an example for the rest of country.

“I do think this is a historic moment. ‘Historic’ is an often overuse term, especially these days, but seeing elected officials stand together with active unions is a crystallizing moment in this growth of union activity that we’ve seen over the past few years, and certainly healthcare workers are leading the way in Oregon and across the country,” Mealy says. “We’ve seen renewed healthcare organizing and different types of professions that haven’t traditionally been union-profession positions. And it goes the other direction, too. We’re seeing Starbucks workers organize. I think there’s a new wave of unionism coming because people see a union as a way they can have a voice at work, and make work better for them, and for the people they serve.”

Medford Mayor Randy Sparacino wasn’t surprised by his city’s standout income growth.

According to data from the 2022 American Community Survey released in mid-September by the U.S. Census Bureau, the median household income growth in the Medford metropolitan statistical area increased by 23% during the 2019-2022 cycle, compared to a statewide increase of just 5.7% during the same period.

Income growth in the area — which includes all of Jackson County — was the 37th fastest in the country, outpacing 91% of other U.S. metros. The growth pattern also extended to other Oregon cities, with Bend and Grants Pass also seeing gains.

Sparacino says Medford’s expanding leisure and hospitality sector, as well as an influx of in-migration among retirees and people fleeing more expensive metros, are partly behind the city’s strong income numbers.

“Pretty much all across the service industry, they’re raising their baseline to get people that come through the door and apply for jobs. Locally, we’ve seen a lot of significant expansion in the service industry with regard to additional hotels and restaurants, and they have almost all increased their baseline in annual wages,” Sparacino says. “Years of wildfire smoke are having an impact, but over the course of the last two years, the travel has actually gone up. We’re seeing a recovery in our tourism — a turnaround since the pandemic.”

During the inflationary cycle that began in 2019, leisure and hospitality, trade, transportation and utility workers have consistently received wage gains that have outpaced the declining dollar, with leisure and hospitality jobs seeing the largest gains. In the leisure and hospitality sector, worker compensation grew at an annual pace of 9.1%  between June 2021 and June 2022. Wages have gone up 6.5% in the sector, even after adjusting for inflation.

Medford Chamber of Commerce president Eli Matthews says the American Community Survey results are the fruit of years of work by the chamber and Travel Medford, the city’s tourism office, which have focused on creating tourism-related projects, including wine tours, children’s sports events and the state’s first-annual major-league cornhole tournament to the city since 2012.

He also mentioned Asante Health Systems, which he says attracts seniors and health care sector jobs to Medford.

“We’ve seen tremendous growth in the last 10 years in travel and tourism for Oregon. It’s over $15 billion industry, and it’s one of the driving factors down here,” says Matthews. “We’re projecting real good growth year-over-year. Through the pandemic, we were fortunate to get a lot of people who wanted an exodus from the larger cities. But the truth is travel, tourism has always been one of our driving successes here.”

Regional state economist Guy Tauer, who conducts workforce and economic research for Coos, Curry, Jackson and Josephine County for the Oregon Employment Department, tells Oregon Business that Medford’s eye-catching survey results may contain a lot of statistical noise.

“This survey is not similar to a Census where it’s counting everyone. When the sample sizes are larger, the margin of error is smaller,” says Tauer, who adds the Medford income will need to show continued growth and expansion for him to consider the upward growth a real trend. Purchasing power in Medford, for example, rose 6.7% according to the survey, but the results were not outside the survey’s margin of error. The survey also excluded proprietary income received by self-employed individuals and unincorporated business owners.

“I would say this is headed in the right direction, I just think you just have to read the survey with caution. If you’re trying to get to the bottom of ‘why did incomes go up?’ It’s hard to say,” says Tauer.

---

---

Tauer says the Medford MSA’s growth numbers fell back to earth when adjusted for inflation, but still showed some statistically significant signs of growth during the 2019-2022 cycle. Average earnings in the Medford MSA increased 3.7% even after adjusting for inflation while inequality levels (calculated by the GINI coefficient) held steady, and remained lower than the national average. The amount of households with income between $100,000 and $149,999 also jumped from 14.9% to 18.4%, all statistically significant gains, according to Tauer.

In his article analyzing the survey data, Oregon state economist Josh Lehner pointed out that the positive income gains in southern Oregon have reversed a decade of decline. Over the last 10  years, regional growth in southern Oregon didn’t pick up until mid-to-late cycle, and the ground lost during the 2008 financial crisis housing that was not fully regained by the time the pandemic hit. Using a multi-year average, Lehner found “Medford’s relative income position compared to the statewide numbers hasn’t been this strong since the mid-2000s.”

With eight new hotels currently in development in the city and surrounding area, the Rogue X community center to host indoor sporting events slated to open this year, and steady population growth from people coming to the Medford MSA, Matthews says the city is well-positioned to continue its growth into the future.

“Compared to California, it’s far easier to have that quality of life, and your dollar will go a lot farther in southern Oregon. Our median home price right now is $401,000. In California, it’s literally triple that. There are over 220 days of sunshine, and you literally drive 20 minutes and you’re out enjoying all sorts of beautiful nature, rivers and lakes,” says Matthews, who adds that the chamber is still planning ways to grow. “The one thing we’re lacking here in Medford is a spot to hold larger, formal, conferences and meetings. So that’s one of our other goals that we’re going to achieve here shortly.”

Genesis Financial Solutions, a Beaverton-based financial services company which services credit cards and lending to consumers and suboptimal credit, announced this week that it has rebranded as Concora Credit. The rebrand features a new website, and comes after a year of forming business partnership with retailers looking to service lower-credit customers.

Jason Tinurelli, chief marketing officer at Concora Credit tells Oregon Business over email that the name Genesis Financial Solutions was not performing as well as desired. “As a company, we are 20 years old and have helped millions of people access credit, but our name and branding were not breaking through in the market. We took rebranding as an opportunity to stand out with our name, branding, and ‘Do More’ tag line,” says Tinurelli.

Genesis Financial Solutions was founded in 2001, and specializes in subprime consumer credit and student loans, and work with merchants, retailers, educational institutions and healthcare providers to offer credit to customers with FICO scores between 300 and 689 — scores considered subprime by most financial services providers.

---

---

In March of this year, Genesis partnered with Michigan-based Gardner White to become the primary servicer of the furniture retailer’s secondary credit program, which offers revolving credit lines of up to $6,000 and deferred interest programs for customers with lower credit scores.

In May,  the company partnered with the Texas-based Upbound Group Inc, owners of lease-to-own furniture retailers Rent-A-Center and Acima, to issue its credit cards  to consumers. The Upbound Group reported $979.16 million in quarterly revenue in June, an 8.6% year-over-year decline.

In addition to the partnerships with Upbound and Rent-A-Center, Tinurelli says Concora Credit has two businesses it is looking to expand.

“The Mastercard programs are big and well-known, and we want to continue to expand those markets. On the Private Label Credit Card side, we want to continue growing with Upbound while adding other retailers and healthcare services where a second-look credit card program makes sense to help them do more business,” says Tinurelli.

The company’s credit cards will also be rebranded. According to the release, Concora’s headquarters will remain in Beaverton.

A previous version of this article said Concora Credit issued credit cards. The cards are issued by banks. Oregon Business regrets this error.

Forty-five members of United Auto Workers Local 492 at the Stellantis Parts Distribution Center in Beaverton have joined 5,600 workers at 38 parts and distribution centers in an expanded strike against Detroit automakers.

The work stoppage began after UAW President Shawn Fain announced the strike on Facebook Live Friday. The Beaverton workers join 13,000 other workers who began strikes last week at Ford, GM and Stellantis assembly plants across the country. Fain invited President Joe Biden to join striking auto workers during the announcement, an invitation the president accepted. 

The UAW has been in negotiations with Ford, General Motors and Stellantis – a Dutch multinational automotive manufacturing corporation formed from the merger of Fiat Chrysler Automobiles and the French PSA Group — since June 2023. Workers began striking on Sept. 15 but have not seen sufficient movement to meet demands, which include wage increases and end to differential pay for temporary workers.

---

---

Members of the Ford assembly plant in Portland are not on strike for now. Ford avoided additional strikes this week by meeting some of the union’s demands, according to Fain .

“This is an important time for our industry. As our country makes a needed transition to a green economy we have a historic opportunity to raise autoworkers standards instead of lowering them,” Local 492 President Rob Perdue said in a press release. “Unfortunately as the Big Three corporations expand into EVs they’re using it as an excuse to slash wages and undermine standards that generations of UAW workers have fought for and won. That needs to stop for all of our sake.”

“We’re planning to stay out as long as we need to win a fair contract,” Jill McCambridge, UAW Benefits Representative at the UAW Local 492, said in the release . “We’re done accepting wages that don’t keep up with the cost of living, and we’re done tolerating a two-tier system for temporary workers. The companies we work for are making record profits so it’s time to share with those of us who do the work every day.”

---

---

Last week, Stellantis announced layoffs, which a company spokesperson attributed to the United Auto Workers strike.

A representative from Stellantis respond to request for comment with the company’s own press release, stating: “We question whether the union’s leadership has ever had an interest in reaching an agreement in a timely manner. They seem more concerned about pursuing their own political agendas than negotiating in the best interests of our employees and the sustainability of our U.S.”  

They did not address questions about layoffs at the Beaverton plant.

Yet American schools and libraries — including those in Oregon — are facing an intense culture war that jeopardizes this progress. The debate centers around protecting and serving youth while upholding constitutional rights and promoting high-quality literature and fresh, independent voices. In recent years, a political movement has emerged to challenge and cancel books, displays and events in schools and public libraries ostensibly on grounds of child welfare and parental rights. Last year the number of attempts to ban or restrict books in the U.S. reached a 20-year high. While challenges are lobbed from different political sides, PEN America reports that the vast majority of materials targeted for removal feature LGBTQ+ characters and/or characters of color, or they cover sensitive topics like race, racism, LGBTQ+ identities or sex education. Some groups fueling the censorship crusade have been associated with extremist organizations and anti-government groups. Conservative legislators in various states have enacted measures to make it easier to restrict access to content and even impose criminal penalties on library staff. Thankfully, recent federal court rulings have overturned and blocked censorship attempts in Texas, Virginia and Arkansas, emphasizing the significant First Amendment protection to which all are entitled — including minors. 

Yet, while the core principles of free expression that define our nation have strong protection in the legal system, we must not take them for granted. Proactive awareness, resistance and rejection of censorship are imperative both for our individual liberty and economic future. In today’s marketplace, forward-thinking business leaders recognize that a diverse and inclusive workplace is not just a moral imperative but also a strategic advantage. Soft skills like teamwork, emotional intelligence and crosscultural understanding are now reported by Forbes to be more valuable to employers than technical expertise alone. Studies show that companies with diverse teams outperform their competitors financially.

Reading widely and thoughtfully cultivates those invaluable character traits that are essential for leadership roles. A study in the journal Reading Research Quarterly (2014) found that students who read diverse literature were more likely to demonstrate increased empathy and perspective-taking abilities compared to a control group. The American Library Association’s report, “Why Diversity Matters,” highlights the positive impact of varied literature on youth’s cognitive and affective development and how it fosters empathy, understanding and critical thinking.

---

---

A Puritanical restriction of reading choices risks hindering the development of these essential soft skills in students by instilling fear of reading and of challenging ideas. Literature that tackles sensitive topics encourages open dialogue and helps students become well-rounded individuals with the capacity to embrace different viewpoints. By nurturing empathetic and culturally competent individuals, businesses ultimately gain a labor pool with a deeper understanding of the world, greater flexibility and adaptability.

Rather than retreating from challenging conversations, a more productive approach lies in providing diverse reading options. A robust selection of classic, contemporary, popular and emergent literature allows students to explore different narratives with guidance from parents and educators, promoting an appreciation of language and storytelling and a love of reading, ultimately increasing resilience and competence in their interactions and relationships. One argument being made is that the materials being challenged are considered “pornography,” and therefore, this content is harmful to minors. But that characterization — and reader maturity — are highly subjective. These are assessments best left to individuals and their parents — not the government. Societal standards and norms change over time, often led by artistic expression in the marketplace. 

Just as Elvis’ then-outrageous dancing now looks innocuous, classic books by writers such as Chaucer, Hemingway, Steinbeck and Vonnegut — that were once considered scandalous — are today known as important pieces of literature. And the Constitution requires that works are evaluated on literary merit as a whole, not merely by provocative passages taken out of context. Furthermore, respected therapists contend that the moral panic associated with children and awareness of sexuality is unfounded — and actually may increase children’s vulnerabilities to exploitation and abuse. For example, denying youth the pursuit of factual knowledge about their bodies discourages them from seeking professional and researched materials on the topic, or from discussions with parents and trustworthy adults. As Bronwyn Davies of the University of Melbourne has said, “What is dangerous, more than anything else, is the withholding of knowledge from children — the deliberate construction not of innocence but of ignorance.”

The battle for youth access to diverse literature in schools and libraries has profound implications for the future of our workforce and society. 

We invite business leaders to join us, along with supporters such as Parents Defending Schools & Libraries (PDSAL.org), to champion the preservation of freedom of expression and advocate for nurturing a generation of employees equipped with empathy, critical thinking and adaptability. By protecting the sovereign right to read, together we can shape a more inclusive and prosperous future.

Perry Stokes is co-chair of the Oregon Library Association Intellectual Freedom Committee (OLA IFC), a standing committee empowered by the OLA Board to educate and support the value of intellectual freedom, and to help provide public oversight of any potential violations of the First Amendment in Oregon libraries.

Click here to subscribe to Oregon Business.

For former Oregon Department of Corrections director and Oregon Community Foundation CEO Max Williams, fixing Oregon’s Drug Addiction Treatment and Recovery Act through a ballot measure is the least best option.

The former Republican state legislator says he would prefer lawmakers address what he sees as “system deficiencies” in the state’s 2020 drug decriminalization Measure 110 during a legislative session.

In a conversation with Oregon Business, Williams pointed to Washington state as a successful example. In May, the state legislature passed SB 5536, which made drug possession and use criminal misdemeanors; it also allocates millions more in funding for addiction treatment and recovery services.

But Williams says that given the often-unpredictable results of Oregon legislative sessions, his organization — called the Coalition to Fix and Improve Measure 110 — has filed two voter initiatives with filed with the Oregon Secretary of State’s Office to act as a backstop.

---

---

He says when he initially met with allies wanting to amend 110, there was talk of repealing the measure altogether. He says the part of the measure that works — using cannabis taxes to fund recovery and treatment efforts — will stay intact, and should be expanded to include funding from other sources. But he says decriminalizing hard drugs takes away the state’s method of handling drug-addicted individuals who are unable and/or unwilling to get help on their own.

The campaign already has $700,000 raised from high-profile donors like Columbia Sportswear CEO Tim Boyle, Nike founder Phil Knight and real estate developer Jordan Schnitzer.

Williams says if the state has the ability to arrest and detain individuals for drug possession, that also means it can mandate treatment earlier on in a person’s addiction cycle. He says the ability to mandate treatment is an important tool to help in addiction recovery and combat the state’s ongoing fentanyl crisis. The drug, which Oregon authorities seized 2 million doses of in 2022,  has surpassed methamphetamine as the most frequent cause of drug overdosing deaths in the state – which increased 41% last year.

“We are just sort of letting people stay in that space where they will eventually suffer an overdose, which is a tragedy for them and their families, or they commit a crime serious enough where they get a felony and have to do a longer jail or potential prison sentence and these tools can’t help them,” Williams tells OB. “We should intervene in these earlier steps of possession and use so that we can help move people in the right direction before they commit the more serious crimes. That’s not how people necessarily want to talk about it, but from my time in the Department of Corrections, for lots of people I worked with, a series of events led them into the system, and it was in the system where they got an opportunity to get cleaned up and make decisions about change.”

---

---

A 2014 study published in the Journal of Substance Abuse Treatment 160 participants “under various levels of criminal justice supervision” in an outpatient substance abuse treatment program. Researchers that while those who were referred by court mandate demonstrated less motivation at entry, but were more likely to complete the six-month treatment program than those who entered it voluntarily.

Under Measure 110, possession of hard drugs remains illegal, but possession of small quantities of certain drugs is a civil violation comparable to a traffic ticket. Police can hand out $100 citations for drug users, that come with a card referring to an addiction treatment hotline; those who call the hotline can have the $100 fee waived. In May 2017, 1,483 people were arrested on drug possession charges in Oregon. In May 2022, that number declined to 176.

The program has had lackluster results; cited individuals rarely follow up for treatment on the hotline, or show up in court.

In June the Oregon legislature passed a bill that criminalizes possession of small quantities of fentanyl, rolling back part of 110.

---

---

Both versions of the measure the coalition is considering re-criminalize possession of lethal drugs like fentanyl and methamphetamine and mandate treatment for “drug-dependent persons” convicted of or charged with drug possession or certain misdemeanor property crimes.  They also create a discharge diversion procedure for offenders who meet very specific criteria: to qualify for diversion, a defendant must have no other criminal charges pending, have not been convicted of drug manufacture or delivery within the last five years, have not have taken part in a drunk driving or drug diversion program within the last year, have not taken part in a drug diversion program or have been on probation for a drug misdemeanor charge within the last five years, and must not have a criminal history that includes two person-related felonies. They also establish record expungement procedures for offenders who successfully complete rehabilitation. Both measures also criminalize use of controlled substances in public.

One version of the measure stops there, while the other also stiffens penalties for dealing and manufacturing drugs, and transfers Measure 110’s grant program, funded by cannabis taxes and currently standing at $302 million from the Oregon Health Authority to Alcohol and Drug Policy Commission and directs the ADCP to fund evidence-based prevention programs.

“We think that the Alcohol and Drug Policy Commission has been an underutilized resource,” Williams says. “It doesn’t make sense to have one commission with a strategic plan about our long-term addiction needs in Oregon over here, and a separate group of people who are making decisions about how these important and critical resources are being managed as they go out to community over there. We think that there’s an opportunity to merge both of these things in one place. The governor directly appoints the members of the Alcohol and Drug Policy Commission, so this puts this squarely in the governor’s basket to pick to choose people who can serve on ADPC who have a mix of backgrounds and experience necessary.”

Willams says his organization prefers the lengthier bill, but which bill will make it to ballot depends on the titling process by the Attorney General’s office. He says he has been in contact with Rep. Rob Nosse (D-Portland) about a potential legislative fix. Nosse confirmed he had spoken with Williams, and that he assumes and hopes they will talk more. He says he discussed both versions of the bill with Williams, and that the process of addressing Measure 110’s consequences is “an evolving thing.”

“Max [Williams] is very engaging and being a former legislator and corrections department head and a lawyer, he knows a lot about this topic.  My hope is that he and his clients will work with us legislators to figure all this out as there are likely unintended consequences for what he and his funders want to accomplish,” Nosse told OB over email. “My hope is the legislative process will surface all that, and help bring him along to a series of solutions to the challenges our state is facing because of P2P, Meth, and Fentanyl.”

---

---

According to Oregon Health and Science University and the ADPC, Oregon currently has a 49% capacity gap of treatment services, and the state ranks 50th in the nation for access to addiction treatment. According to the Oregon Health Authority, approximately 8,400 people have received treatment from services funded by Measure 110.  

An August poll found slightly more than half of Oregonians support of a repeal of Measure 110, with more than 64% supporting repealing parts of the law. Lawmakers across the state have already begun reacting to the potential shortcomings of the measure. In October, state legislators will go on a fact-finding mission to Portugal, which decriminalized drugs in 2000, to look for ways to curb addiction.

Williams is skeptical as to whether the Portugal trip will yield any substantial lessons for Oregon legislators. He says the addiction support infrastructure is already built in Portugal, that the money from Oregon’s cannabis tax is still insufficient to treat the state’s addiction problems, and that more funding will have to be found by state departments and the state legislature, especially as the state’s cannabis industry contracts.

“Even with even with those dollars, there’s insufficient infrastructure. It’s not enough to cover it and so if you’re serious about addressing the ravages of drugs and addiction in the state, you’re going to have to make more of an investment,” says Williams, who adds that he is hoping the legislature will address the issues with before either of his group’s measures make it to the ballot.  “It’s my hope that they will take this up. I think we have the potential to get a better product through that process. But again, forecasting the legislature has become increasingly difficult over the last 20 years and we just don’t feel like we just sort of stand by and take our chances.”

Erica Swartz wasn’t surprised by the wide margins of this week’s strike authorization vote against Oregon Health and Sciences University.

What was surprising, according to Swartz and to leadership in the Oregon Nurses Association, was what preceded it: OHSU’s August announcement that it intends to merge with Legacy Health Systems.

Swartz, who works in the pediatric oncology department at OHSU and as co-chair of the hospital’s staffing committee, says the merger announcement — exactly one week after nurses declared an impasse in their ongoing contract negotiations with OHSU — took nurses by surprise and has created uncertainty and mistrust between nurses and management. When the merger was announced, OHSU nurses and management had been engaged in bargaining since December of 2022 over safe staffing levels, compensation and other issues.

---

---

Nearly 3,000 nurses at OHSU voted to authorize a strike against the health care provider Monday: 95% of those who participated in the vote favor a strike, and 96% of union nurses at the hospital voted.

ONA spokesperson Kevin Mealy told Oregon Business that in April, the ONA bargaining team asked OHSU’s chief financial officer if the hospital aware of any major acquisitions on the horizon, and that nurses were told no.

“[That] was in April and in August, they announced this merger with Legacy so obviously that was already in the making. I think the other piece behind that is there’s a little issue of trust, in this particular discussion, but also more broadly,” Mealy says. “If you weren’t as open about that merger at that point, then we definitely want a backstop or something written in the contract that we will have a role, and not just the CFO or someone else from the executive suite saying ‘Yeah, you’ll have a say; we’re very interested in your input.’”

---

---

Sara Hottman, associate director of media relations at OHSU, told Oregon Business over email that OHSU notified members of the merger once the letter of intent was finalized in August. Now OHSU and Legacy Health are in the due diligence phase of the nonbinding letter of intent, and she says they expect to have a definitive agreement by December of this year. Hottman provided an FAQ about the merger, but did not directly address Mealy’s claim about the CFO’s April comments.

Swartz says she has questions about how her future at the company will look under the combined health care system which OHSU has not yet answered, and could impact the delivery of care to patients.

“So far, OHSU has provided no information to us about how our work environments may change,” Swartz says. “At the bargaining table we have been asking for a memorandum of understanding, which is management agreeing with us that if and when the merger happens, they will return to bargaining and work it out with us if our working conditions were to change. They have not been willing to do so, and have expressed sentiment that it is their administrative right to do as they see fit.”

---

---

Mealy says that while the ONA is still “cautiously optimistic” about the merger but that in general, health care mega-mergers lead to fewer services and higher costs for patients. According to a 2023 literature review by the health care research nonprofit KFF (formerly known as the Kaiser Family Foundation), a growing body of evidence shows that consolidation in health care provider markets has led to increases in prices without clear evidence of increases in quality.

The quality of care at hospitals acquired during recent waves of consolidation either got worse or stayed the same, according to a 2020 study led by Harvard Medical School published in 2020 issues of the New England Journal of Medicine.

Mealy says having a front-line voice during the process of merging the two healthcare systems means patients and workers will have an advocate as the healthcare systems go about the restructuring process.

“I think there’s a sense that having a frontline voice during that merger process, looking at the details and how we work through combining two different systems with two different sets of standards and ways of working, is going to be very important to make it successful and  something that’s actually good for patients and nurses, as opposed to what we’ve seen across the board, which is that mergers haven’t delivered what they promised.”

The nurses’ contract expired June 30, and the two sides have now completed the required 30-day cooling off period after the impasse declared in August. The union is required to give OHSU 10 days’ notice before calling a strike.

A research and outreach unit at the University of Oregon’s College of Education has announced a partnership with Irish voice tech startup SoapBox Labs, to integrate the company’s dialectical artificial intelligence technology into the university’s assessment tool.

A press release accompanying the announcement said UO plans to integrate SoapBox Labs’ technology into CBMskills, a program which pairs with easyCBM, the platform the College of Education uses to measure the progress of entry-level readers. SoapBox Labs’ system can accurately assess children based on their own unique speech patterns, accents, and dialects, leading the company to win tech certification nonprofit Digital Promise’s Prioritizing Racial Equity in AI Design product certification in 2022.

The announcement follows two other recent SoapBox Labs collaborations with educational publishers Scholastic and Imagine Learning.  Gerald Tindal, director of behavioral research and teaching at the University of Oregon, said in the press release the incorporation of SoapBox Labs’ technology into CBMskills “[A]llows us to much more effectively and precisely unpack where students are struggling, so we can intervene more strategically and more quickly.”

---

---

“This partnership underscores our commitment to revolutionizing language and reading development through technology, and together with the University of Oregon, we’re continuing to leverage voice technology to help teachers and students,” Martyn Farrows, CEO at SoapBox Labs, said in the release.

UO’s College of Education launched, easyCBM, 15 years ago to assess acquisition of reading skills and inform educators’ interventions to support struggling students. Since its release, the program has been used to deliver eight million education assessments, according to UO. CBMskills is a voice-driven assessment platform which records and assesses timed reading passages to track student’s learning progress in order to identify and intervene with struggling readers.

Using the SoapBox language engine, the assessment tracks a student’s progress through timed reading passages, making it easier for educators to accurately and specifically identify where students are making mistakes in oral language proficiency. For example, a child who skips words or sentences but pronounces the words correctly may have a visual processing problem rather than a reading problem. If a child regularly replaces an “R” with an “lL,” an articulation disorder may also be present. The type and frequency of errors can be highlighted through a voice-enabled learning tool, enabling more personalized instruction and faster intervention.

The College of Education’s behavioral research and teaching division plans to onboard an additional 10,000 teachers with CBMskills by the spring of 2024, according to the announcement.

I just finished reading Adrian McKinty’s thriller novel The Island, as well as a 1997 study of the Senate filibuster by Sarah Binder and Steven Smith called Politics or Principle? Filibustering in the United States Senate.

What are you watching? 

There are a lot of good TV shows out there, but I especially enjoy watching the dramas The Lincoln Lawyer and Yellowstone, as well as comedies, including Ted Lasso and Jury Duty.

What are you listening to? 

On long drives in Oregon, I often listen to The Daily podcast.

What is your must-have gadget? 

I call it the “Lion Hunter.” It’s a chemical-free weeding tool that resembles a pogo stick, and I use it to remove dandelions from my yard by twisting them out of the ground.

---

---

What are your hobbies/interests?

I enjoy home and yard-improvement projects. Over two decades, I’ve renovated most of the house. I’m also a native Oregonian, so hiking trails — both old favorites and new discoveries — as well as jogging, paragliding and tennis.

What was your childhood or earliest ambition?  

To make the world better. I wasn’t sure what form that would take when I was growing up, but it’s been the honor of my lifetime serving Oregonians. 

Where is your favorite place to vacation?   

The Oregon Coast is where I go to unwind and spend time with family and friends.

What is your biggest extravagance?

My wife and I had been talking about taking a vacation together in Italy for years. We originally planned to go on our 10th wedding anniversary, but we didn’t make it. Last year we finally got to go and celebrate our 30th anniversary in Italy, and we had a wonderful time.

What motivates you to come to work?   

The core place I come from is that ordinary people need a champion. I am absolutely thrilled when I can pass legislation that helps tackle climate change, advances LGBTQ+ equality or strengthens the four foundations for the success of our working families: good health care, quality education, decent affordable housing and good-paying jobs.  

---

---

Who is your professional role model?   

Oregon Senator Mark Hatfield. I learned the ropes of public policy as an intern in his office, where I had a front-row seat to seeing how a good policy can help millions of people and how a bad policy can hurt millions of people. Sen. Hatfield also taught me just how important it is to have an Oregon voice on the Appropriations Committee, so the needs of our state are always well represented when important federal funding decisions are being made.

What ambitions do you still have?   

I have many goals, including hiking the whole Pacific Crest Trail, biking across America and patenting an invention.

Click here to subscribe to Oregon Business.

“I got tired of being poor,” she says with a laugh. 

Though she was highly motivated, Summer’s dream nearly derailed at the last minute. It wasn’t failing grades, illness or outside pressures that put her graduation from Portland Community College’s rigorous two-year nursing program in jeopardy. 

The threat to Summer’s diploma was coming from inside the house. 

In April 2023, shortly before Summer was set to graduate, Lisa Sanchez-Navarro — the director of Portland Community College’s program — resigned her position. That started the clock ticking: Administrators had just 15 days to find a new director and have them approved by the Oregon State Board of Nursing (OSBN) — or shutter the program. 

After a lot of shuffling and searching, and an extra 15-day extension, PCC administrators hired Cynthia Backer as interim program Dean of Nursing. With an approved director in place, Summer and her cohort of new nurses could get their diplomas and start their nursing careers. 

“The Oregon State Board of Nursing works closely with all of the colleges,” says Janeen Hull, PCC’s dean of academic & career pathways for healthcare & emergency professions. “They would never leave students hanging.”

Yet nursing students, nursing educators, hospitals and ultimately everyone seeking health care in Oregon are all in danger of being left hanging. Nurses are in desperately short supply, but fully qualified nurse educators are really hard to find. In fact, though her résumé is long, even Backer does not meet the full qualifications set by OSBN to become a permanent hire. Finding a permanent candidate to meet those full standards will be challenging. 

“The pool of qualified nurses who want to work in education is small,” Hull admits. 

---

---

The nursing shortage, nursing-educator shortage and connection between the two is old news. The American Association of Colleges of Nursing (AACN) has been highlighting the issue for over two decades, according to an article in American Nurse. Written by Susan Bakewell-Sachs, OHSU School of Nursing dean, along with two other contributors, the article calls the problem behind the nurse-faculty shortage a “matter of great and growing concern.”

A sticky web of interconnected issues — burnout, lack of clinical and lab space, uncompetitive pay for nurse educators, and a fair dose of institutional misogyny — drives this crisis. The COVID pandemic accelerated the pace. And while this is a nationwide problem, Oregon has been hit particularly hard. The state produces the third-fewest nursing school graduates per capita as compared to the rest of the country, according to a study by the Oregon Longitudinal Data Collaborative (OLDC). 

Statewide, stakeholders hunt for coordinated solutions, but the prognosis is unknown. The nursing and nursing-educator crisis has festered for a long time. Can this finally be the moment of change? 

It is not that people do not want to become nurses. Just like Summer, plenty of good candidates dream of starting down this path. For this year’s fall class, Portland Community College alone had 400 well-qualified applicants to their program, according to Hull. The program, however, could only accommodate 32 of them — that is, 8% of total applicants. 

Numbers across the state are a little better, but not much. The OLDC study found that 6,800 qualified people applied to programs in 2020, but only 23% were accepted. On the national level, there were 91,038 qualified nursing applications left on the table in 2021. 

---

---

The fact that most registered nursing programs in Oregon have enough qualified applications and regional jobs to double enrollment is heartening, even as the profession evolves into something more complex. The job has certainly changed from when Backer was in school: “We were trained to give back rubs, help people eat and do bed baths,” she says. “People go into nursing for heartfelt reasons, but there has definitely been a change in expectations.” 

Expectations for nurse educators have shifted as well. The job demands they keep up with an ever-expanding body of health care knowledge, even as textbooks lag behind. 

“You can’t just teach to the book,” says Backer. “Teachers need the most current, online resources and access to real world examples.”

They also need to know how to teach. That means successfully communicating information to a diverse set of students with different learning styles. (Nursing students often need a fair bit of hand holding, Summer says. “We were neurotic,” she says, “and in a state of panic all the time!”)

But anxious students and high expectations are just add-ons to the root causes of the nurse/nursing educator shortage. The biggest problems are a lack of clinical space where students practice and a huge disparity in the pay a teacher can make as compared to a nurse working in the field. 

The situation is no better at private colleges and universities. 

“We absolutely do not have enough nurse educators,” Dean Casey Shillam, School of Nursing & Health Innovations, University of Portland, says.

Even if there were an abundance of educators, the lack of clinical space squeezes the nursing pipeline to a drip. These clinical placements are required for all students. To get them, the schools must foster individual relationships with healthcare placement sites. This forces a competition between the programs where the students are the losers. The longitudinal study found that 95 percent of nursing programs had an individual or cohort denied placement from 2016 to 2020. 

Securing clinical space has always been difficult. The pandemic made it worse. “Placements in off-campus professional practice, hospitals, and community-based, long-term care has all diminished because the health systems are not functioning,” says Shillam. “They have no capacity to take students.”

But perhaps the biggest barrier to becoming a nurse educator is money. Low nursing educator pay is the standard across the nation. According to the latest Nurse Salary Research Report issued by Nurse.com, the median salary across advanced practice registered nurse roles is $120,000. By contrast, AACN reported in March 2022 that the average salary for a master’s-prepared professor in schools of nursing is $87,325.

Payment structures widen the disparity. Nurses are paid hourly; nursing educators draw a salary. That means any extra work outside the contract — like prepping courses, attending orientations or reassuring anxious students — is unpaid. 

Oregon has one of the largest pay gaps between nursing faculty and registered nurses, according to the OLDC study. This makes it easier to lure even the most dedicated faculty away. 

“Even if nurses want to get into academic nursing, the health systems are so desperate for clinicians that they are offering nurses their dream jobs, and I’m losing faculty,” laments Dean Shillam. She reports losing four faculty members this year alone to positions that she admits make her a bit envious. “They are landing fully remote telehealth jobs or working just three days a week in patient intake, receiving full benefits, and making one and a half times more.”

---

---

Why is nursing-educator pay so low, particularly when compared with what medical educators — the professionals who teach doctors — make?

Medical education is supplemented by Medicare. Nursing is not, answers Dean Shillam. And why is that? “Because physicians have more influence in Medicare funding decisions and nursing doesn’t have the same level of influence and impact in how nursing education could be equitably funded.” 

So the nursing-education system is built on the underlying expectation of unpaid labor. Shillam is not ready to call this situation straight-up misogyny but will admit that “historically, physicians were predominantly male and have driven these policies, whereas nurses were predominantly and still are majority female.”

Structural inequities aside, Oregon’s nursing schools and legislators are working to find a solution. 

PCC is expanding its programs, adding options like Certified Nursing Assistant and Licensed Practical Nurse to its course list. These easier-to-
obtain certifications make nursing accessible to students who need to start their careers sooner. The move will hopefully ease labor shortages while giving students a stepping stone to the next level. 

PCC is also opening a brand-new, state-of-the-art nursing education simulation lab at its Sylvania campus. This larger space, filled with sophisticated equipment like simulation mannequins, will make room for another cohort of students, bumping up PCC’s class size from 32 to 40. 

Oregon Health & Science University is hard at work implementing its 30-30-30 plan. Funded in March of last year, the $45 million investment aims to increase the number of clinicians graduated by 30% and increase student diversity by 30% by the year 2030. The money includes an extra $20 million per year to expand class sizes and a one-time $25 million to kick-start the OHSU Opportunity Fund. This money will go to tuition assistance, loan repayment and other resources needed to recruit and retain a more diverse class of learners. 

“We have nurses who are interested in advanced degrees and thinking about taking education coursework that would allow them to teach,” says OHSU’s School of Nursing Dean Bakewell-Sachs. “The 30-30-30 plan is seeking to meet workforce needs for nurses and other professions and seeking to establish a long-term solution.” 

The Opportunity Fund, according to Bakewell-Sachs, is about “building the workforce of the future. We want to align workforces to mirror society. If we increase the diversity of our students, we want to have faculty to align with that as well.”

OHSU also established the Oregon Nursing Education Academy to expand the ranks of preceptors and clinical nursing faculty. This program hopes to train a total of 63 faculty and 92 preceptors from Oregon, Idaho, Washington and Alaska by the fall of 2026. The program is designed for nurses who already have a bachelor’s degree or higher in nursing. 

Nurses that graduate with an associate’s degree from community colleges are already pretty well incented to get their bachelor’s degree. “That’s where the upward mobility is,” explains Hull. “Certain hospitals only want to hire nurses with a bachelor’s.” 

Summer, the recent graduate from PCC, is already planning for hers. She’ll start working as a nurse in telemetry while taking OHSU bachelor’s-level classes online. 

The recently passed SB 523 aims to make it easier and less costly for future community college graduates to get their bachelor’s, particularly for students in rural areas. “The bill tries to capture students who wouldn’t continue on or [would] do it through an out-of-state, for-profit option,” explains John Wykoff, deputy director of the Oregon Community College Association. “This cost-effective option should be more attractive to students.” The program could also help keep rural students in rural communities, where the need is greater. 

But the bill does not wow PCC’s Hull. “I haven’t explored what SB 523 would mean for us,” she says. “I can’t even find enough instructors for our associate’s program.” 

---

---

None of these efforts, however, address the pay disparity between educators and practitioners. The OLDC study analysis found that increasing wages by $6,139 for nine-month nursing faculty would incent and entice instructors. The report stresses that schools should collaborate on pay increases statewide to avoid creating competition between programs. 

Where that money would come from presents another issue. Proposed legislative action, HB 3323, would create a stipend for nurse educators. Hull was a bit more excited about this bill. “Washington state already does something like this. It could be a possible solution.” The bill, however, was still in committee when the House adjourned in June.  

Backer at PCC suggests that some face-to-face recruiting with nurses could help sway them over to teaching. “I see nurses at hospitals that are so good with students,” she says. “We should seek these people out and show them why teaching is a worthy career. We need to advertise to them, let them know it can be fun.”

As far as finding more clinical space, Backer suggests looking for new opportunities outside of hospitals. “What about addiction clinics or homeless shelters? They have to be places where the student is getting nursing experience.”

While these are all good steps forward, fixing the nurse/nurse-educator shortage will be an uphill battle. Burnout among current nurses is extremely high. About 100,000 registered nurses left the workforce during the past two years due to stress, burnout and retirements, and another 610,388 reported an intent to leave by 2027, according to a study released by the National Council of State Boards of Nursing and reported by the American Hospital Association. 

Perhaps this is because of a system that needs nurses yet undervalues their contributions. 

“The system values doctors because hospitals can bill for their work,” Summer says. “They see nurses as a money-suck even though we are essential for patient care.”

Still, Summer holds a lot of admiration for the nurses who helped her along the way. She would like to teach eventually, saying it is on her long-term trajectory. But she’s come across so many nurses suffering from compassion fatigue that she wonders. 

“I chose nursing because I can keep learning. There are a lot of fields to go into, and you can’t do bedside forever,” she says. “Teaching would be a great trajectory. They just need to be paid more.”

Click here to subscribe to Oregon Business.