Nearly 5,000 nurses at all eight Providence hospitals across Oregon have returned to work after voting this week to approve new labor contracts, ending a 46-day strike.

Striking nurses at Portland’s St. Vincent Medical Center, Providence Portland Medical Center and hospitals in Seaside, Hood River, Medford, Milwaukie, Newberg and Oregon City voted to ratify new contracts.

The agreements include raises of as much as 42% over three years — applied retroactively in some cases — a new understanding on staffing levels and moves toward a new, union-administered health insurance plan.

In a statement, Providence officials said the new labor agreements “find the balance between caring for our valued caregivers and making sure our hospitals, clinics and services have the resources needed to continue caring for all Oregonians.”

Here’s a look at what the new contracts contain:

Wage increases

The Oregon Nurses Association, which represents the nurses at Providence hospitals in Oregon, said the contracts include wage increases ranging from 20% to 42% over three years.

Scott Palmer, spokesperson for the Oregon Nurses Association, said nurses at all eight hospitals now have market competitive wages, which will help Providence retain and recruit nurses.

The increases vary by hospital.

For example, at Providence St. Vincent, the starting wage for a newly graduated nurse was $46 per hour. Under the new contract, those nurses will start at $55 per hour in 2025, increasing to $57 by 2026. Experienced nurses at the top of the wage scale previously earned $67 per hour. Their hourly wages will now start at $77 an hour, increasing to $81 next year.

Wages are slightly higher at Providence Portland Medical Center. Palmer said the wages at both Portland hospitals are now closer to nurses’ wages at Oregon Health & Science University.

Nurses also had sought increases in paid time off accrual, but there were no changes in the new contracts.

Retroactive pay increases

Many of the striking nurses had been working under an expired contract for months. The labor agreement for nurses at St. Vincent and Willamette Falls hospitals expired in December 2023, while nurses at Milwaukie, Medford and Hood River had been without a new contract since the first half of 2024.

Under the new agreements, nurses at St. Vincent, Willamette Falls in Oregon City, Milwaukie, Hood River and Medford would receive retroactive pay increases covering 75% of the hours worked last year. According to the nurses’ union, the retro pay is calculated based on hours worked, time spent on education, meetings and any paid time off used in 2024.

Union leaders said the lack of full retroactive pay was a major concession in the negotiations. Many nurses had pushed for full compensation for the time worked under expired contracts.

Meanwhile, nurses at Providence Portland and Seaside — whose contracts expired more recently, in December — will get a ratification bonus of $1,750.

New approach to staffing

A key dispute in negotiations centered on working conditions and interpretation of the state’s 2023 hospital staffing law, which requires hospitals meet minimum nurse-to-patient ratios. Nurses had argued hospitals were defaulting to minimum staffing levels without taking case severity into account.

Palmer, the nurses union spokesperson, said nurses’ contracts at all eight hospitals will now require Providence’s staffing plans to account for how sick patients are and how much care they require, though each addresses acuity differently.

At Providence Portland, for example, staffing plans for nursing units will establish minimum numbers of nurses for specific shifts, taking into account the severity of patients’ conditions and level of care and attention they need. At Providence Milwaukie, new language gives supervising nurses the authority to adjust staffing ratios based on patient needs.

Meanwhile, at St. Vincent, the previous contract already took into account patient acuity and level of nursing care required in staffing plans. But language in the new contracts introduces enforcement measures to ensure compliance with staffing guidelines that account for differences in patient acuity and care needs. The contract also includes minimum staffing levels for each shift.

The new contract also includes a provision to assign a nurse to relieve those who take a break.

New health insurance program

Some nurses reported problems with accessing their regular in-network providers and filling prescriptions after Providence switched to Aetna as its third-party health plan administrator in January.

The ratified contracts include a dedicated health insurance navigator to help nurses resolve coverage issues quickly — and a joint commitment from Providence and the union to explore setting up a new employee health plan designed and managed by the union with financial support from Providence.

Some nurses, though, had hoped for a more substantial fix.

Aligned contract expiration

Previously, Providence nurses had contracts with varying expiration dates. Nurses had pushed to align contract end dates to increase collective bargaining power in future negotiations.

Under the new labor agreements, nurses’ contracts at St. Vincent, Willamette Falls, Milwaukie and Newberg would all expire on Dec. 31, 2026. Contracts for nurses and advanced care providers at Providence’s chain of six women’s clinics in the Portland metro area would also expire that day.

“For those of us at smaller hospitals like Milwaukie, this is monumental for us,” said Christie Sowards, a registered nurse and chair of the Providence Milwaukie bargaining team. “Alignment means we actually get a seat at the table and we’re no longer relegated to following whatever larger hospitals negotiate. Our voices will be heard and our needs will be met alongside everyone else’s.”

Nurses’ contracts at Providence Portland and Seaside would expire on Dec. 31, 2027.

Meanwhile, nurses’ contracts at Medford and Hood River would expire on March 31, 2027. And the group of roughly 70 hospitalists and palliative care physicians at St. Vincent would have their labor contracts end on Feb. 8, 2027.