A bargaining unit of around 140 nurse practitioners and physician associates at Legacy Health went on strike Dec. 2. Workers gathered on picket lines at 6 a.m. and remained on strike when this issue went to press later that day.
The unit consists of workers described as “advanced practice providers.” Advanced practice providers have training and responsibilities at a level between a nurse and a physician; nurse practitioner and physician associate are their most common job titles.
Nearly 50 advanced practice providers at two Legacy Good Samaritan and Emanuel hospitals in Portland unionized with the Oregon Nurses Association (ONA) in January 2024 and began bargaining that May. Another 90 advanced practice providers in adult specialties at Legacy facilities in Oregon and Southwest Washington joined the unit in August 2025.
Leigh Warsing, a physician associate in Legacy Emanuel’s trauma unit and a member of the union bargaining team, said she’s seen a steady decline in Legacy’s support for staff over her 10 years at the hospital.
“Over the past decade, we’ve all watched Legacy let outstanding providers walk away,” Warsing said during a Dec. 2 press conference. “They’ve gone to OHSU, Kaiser, and out of state to find places where they are supported and valued, leaving patients with fewer, less experienced providers when they need us the most. That forced exodus of talent falls squarely on the shoulders of Legacy’s administration.”
ONA issued a strike notice Nov. 20. Under federal law, health care workers must give at least 10 days notice before going on strike.
Since the start of the year, more than 2,500 nurses, 100 doctors, and 500 other workers like audiologists and behavioral health clinicians have unionized at Legacy. ONA represents more than 3,500 Legacy workers, including three units of advanced practice providers: the unit now on strike, plus pediatric providers and nurse midwives.
Becky Berman, a psychiatric nurse practitioner at Legacy, said at a Nov. 21 press conference that many of her patients have already gone through a string of providers who have left Legacy. Some have had five or six psychiatric care providers in as many years.
Berman said she’s watched her peers leave Legacy for positions with other health care organizations that offer higher compensation, more support, and the guidance and camaraderie of experienced colleagues.
“Burnout is not solved by a paycheck. More money does not magically give us fewer patients or shorter wait lists,” Berman said. But, she said, competitive pay helps retain workers, which in turn reduces burnout across the team.
ONA is seeking hourly wages from $72.90 to $115.04, with 4.5% raises in the second and third years. Legacy has offered hourly wages from $72.84 to $103.37, with 2.75% raises in the second and third years. The two groups’ proposals also differ over where different positions and departments land on the pay scales.
After ONA notified Legacy that it would be issuing a formal strike notice, Legacy gave an improved compensation offer that removed the lowest pay scale from its previous offer, which would have started at $68.51 per hour, the union said.
Legacy executives and lawyers declined to continue bargaining with the union after the strike notice was issued, saying that it needed to focus on patient care. Providence leadership did the same ahead of the 46-day nurses strike that started Jan. 10. ONA said Legacy’s refusal to bargain was a violation of federal law and pointed to past instances where health care worker unions and employers continued bargaining and averted strikes at the last moment.
“We are a relatively small group of advanced practice providers facing off with a handful of executives who wield the financial reins of a multibillion-dollar healthcare organization. The imbalance is clear,” Rob Brookshire, a Legacy physician associate for more than 22 years, said on the picket line outside Emanuel.
Brookshire said Legacy’s willingness to pause bargaining and bring in replacement workers demonstrated executives’ lack of understanding of the APPs’ work.
“No temporary worker will ever match the care we deliver to our patients, nor the contribution of our combined years of experience,” Brookshire said.
