“We All Feel Less Safe”

On July 4, President Trump signed into law a set of devastating cuts to programs that families depend on—including slashing at least $900 billion from Medicaid¹ over the next decade—to partially offset massive tax cuts for the ultra-wealthy. More than 10 million people are expected to lose health insurance. Already struggling rural hospitals and clinics and safety net hospitals that depend on Medicaid reimbursements to serve low-income communities may have to close. The people who will be most affected are those who can least afford it: Children from low-income families. People with disabilities. Senior citizens and nursing home residents. While communities nationwide rallied in the streets and lobbied Congress to fight the cuts, some hospital systems saw opportunities to boost profits by cutting staff, with little regard for how that might affect patient care.

To learn more about how employer greed and the Trump administration’s authoritarianism are combining to create dangerous conditions for patients and healthcare workers, we spoke with three leaders of AFT affiliates at two PeaceHealth hospitals where staff cuts were made in May. Jodi Atteberry is a patient access representative and referral coordinator in the heart and vascular clinic at PeaceHealth Southwest Medical Center in Vancouver, Washington. She is chair of the Service and Maintenance bargaining unit of the Oregon Federation of Nurses and Health Professionals (OFNHP), and she serves on multiple OFNHP and hospital committees. Dawn Marick, RN, is a nurse on the resource team at PeaceHealth Southwest. She is co-chair of the PeaceHealth Southwest Medical Center bargaining unit of the Washington State Nurses Association (WSNA), co-chair of her hospital’s staffing committee, and an alternate member of the Washington State Department of Health Hospital Staffing Advisory Committee. Amanda Stout, RN, is an ICU nurse at PeaceHealth Sacred Heart Medical Center RiverBend in Springfield, Oregon. She serves on her hospital’s nurse staffing committee and on the executive committee for the Sacred Heart Medical Center bargaining unit of the Oregon Nurses Association (ONA).

–EDITORS

EDITORS: Tell us about your backgrounds. How did you come to work in healthcare with PeaceHealth and to be involved in your unions?

AMANDA STOUT: I’ve been a nurse for almost 16 years, and I’ve been at PeaceHealth RiverBend for my entire career. I first considered nursing because I needed a good job, but it’s been a great match. I had just graduated from the University of Oregon and was going through a divorce with young kids, and I didn’t want to disrupt my family by moving. I discovered that I could take nursing classes at the community college, so I chipped away at the prerequisites, and eventually I got into the nursing program. PeaceHealth RiverBend was the hospital game in town, so that’s where I did my clinicals and where I ended up after graduation. I was a charge nurse and worked nights for many years. Eventually, I wanted to learn more, so I transitioned to the ICU. 

I knew a little bit about unions because my mom was a teacher, so I was happy to join ONA when I started working at PeaceHealth RiverBend. But it wasn’t until several years in, when I discovered that my coworkers and I hadn’t been receiving the correct certification pay (in some cases for years), that I really saw the power of the union. Winning back pay for my fellow nurses and myself felt great, and I started paying more attention and encouraging my coworkers to do so too. One of our stewards worked with me in the ICU and encouraged me to take on more leadership roles, so I became a steward, then a member of the staffing committee and now the executive committee.

DAWN MARICK: PeaceHealth Southwest is something of a family hospital for me. My grandma retired as the surgical secretary from what was then just called Southwest. She wasn’t allowed to attend nursing school as a younger woman because she was married, so when she saw how much I loved caring for people and animals, she encouraged me to pursue nursing. I’m so glad I did. I’ve been at PeaceHealth Southwest for 16 years, and I’ve worked on the resource team supporting various areas throughout the hospital for about half of that time.

It was my former co-chair who suggested I join the bargaining team about eight years ago. That was my first foot in the door as far as union activism. Then I realized we only had one grievance officer, so I jumped into helping with that, and within a few years I was co-chair. I’m also co-chair of our staffing committee. It’s easy to identify problems in our workplace, and I love being part of the solutions as an officer—even though it can be very frustrating.

JODI ATTEBERRY: I got into healthcare because both of my parents worked in this field, and I saw the impact they had. Healthcare isn’t all rainbows and butterflies—it’s helping people get better or helping them transition and making sure they and their families are supported. My dad was a union member. I remember being on the strike line with him one winter when I was a kid. It was cold out there, and I didn’t understand everything, but I knew that we all stood together to fight for what was right.

I’ve worked in many areas of PeaceHealth Southwest in my 27 years here; I’m so proud that we successfully unionized in 2017 and of how strong we have become. OFNHP represents the service and maintenance staff; the technical staff; and the occupational, speech, and physical therapists (referred to as the pro unit), who are bargaining their first contract. One hospital leader told us, “We’ve never had as many grievances and meetings as we have with OFNHP. You guys are relentless.” To me, that’s a sign we’re accomplishing our mission. We’re staying the course and keeping management in check. We work closely with our sister unit from WSNA and with the engineering union. We have seen a lot of bad behavior from PeaceHealth, and we’ve come together to hold the employer accountable for the nasty things they’re doing without regard for patient or staff well-being.

EDITORS: What can you tell us about the layoffs PeaceHealth announced in May?

DAWN: I’m the primary officer in our bargaining unit who handles reductions in force (RIFs). On May 22, I was notified by HR that the observation and same-day surgical overnight units would be closed and that two of our remote care managers would be laid off, affecting a total of 22 nurses. The nurses were notified later that day. In addition, we learned that critical OFNHP members of our care teams would be laid off.

The email didn’t give any rationale for closing those units or eliminating those positions. Based on conversations in staffing committee meetings, the general sentiment from hospital leaders seemed to be that the decision was related to the political climate and concerns about Medicaid and Medicare reimbursement. There hadn’t actually been any changes to reimbursement in Washington state at that point; they were making cuts in anticipation. It was part of a 1 percent reduction that was supposed to be across PeaceHealth, and more than one hospital leader expressed relief that it was only 1 percent.

JODI: We got an email on May 21 that PeaceHealth would be laying off 46 OFNHP members across all three bargaining units, as well as WSNA members and nonunion staff. The eliminated positions included all of the LPNs and unit coordinators in the emergency department (ED) as well as unit coordinators and patient team support (PTS) staff in same-day surgical, social workers, leads for equipment and the supply team on the night shift, mobility aides, and the night shift in the diagnostic imaging library. It was a very disorganized and poorly communicated process. When we went through the job classifications, we saw that on the same day that social workers had been laid off, HR had posted two new social worker positions at the hospital. It was like the hospital’s right hand didn’t know what its left hand was doing.

We got only vague official explanations. Most of the information came through the staffing committee and unofficially from supervisors, who told us that PeaceHealth was anticipating cuts in Medicaid reimbursements and was worried about being financially solvent. Most hospitals are required to have 90 days of ready cash if they receive no reimbursement payments. PeaceHealth has 291 days of ready cash. But this excuse about financial solvency is not surprising if you consider PeaceHealth’s pattern with layoffs in the past. They always happen before the end of the fiscal year (June 30)—and then the executives get their bonuses. Last year, the bonuses were more than $2.2 million. We estimate that the wages for just the 46 OFNHP positions they cut were $1.9 million.

AMANDA: At PeaceHealth RiverBend, we also got an email on May 22 informing us that because PeaceHealth was worried about fiscal health, they were looking at a 1 percent workforce reduction and “streamlining” measures. They said that layoffs wouldn’t include “frontline caregivers” at our hospital—their term for clinicians who provide direct care—and that affected units would have more information by the end of the day. That same email announced that they were filling high-level management positions, which was an odd contrast. There was a lot of confusion and anxiety about who would be losing their jobs.

Later that day, the ICU manager and director sent an email telling us that we would be losing our security team, which is responsible for managing the flow of visitors in the ICU and handling other security concerns. We also learned that the women’s complex would be losing its security. There was no date for the elimination of security beyond “at some point in June,” and we didn’t get any further communication from them despite multiple requests for clarity. Each day we wondered, “Is this the last day that we have security? Are they going to unlock the ICU doors?”

EDITORS: How have these layoffs affected healthcare workers and their ability to provide care?

AMANDA: Our security team’s last day was June 22. Before that, we had security staff for the ICU daily from 8 a.m. to 11:30 p.m. They would come in each morning and get a roster of patients and a list of the nurses and their phone numbers from the charge nurse, and they’d ask, “Is there anything we need to be concerned about?” Sometimes we’d have agitated patients, a tense family situation, or a private patient who needed to be protected. So they would get oriented before visiting hours started.

One of the most important things the security staff did was manage visitor access to the ICU. Visitors at the bedside are extremely important because they can have positive effects on both patients and loved ones,² and we allow visitors most of the time—but we still have to consider safety and our patients’ needs. We have a locked, secure unit, and we don’t allow visitors during morning and night shift changes except under very select circumstances. We only allow two visitors at a time per patient, and sometimes we don’t allow them at all if there are procedures happening or if the patient doesn’t want visitors. So having the security team there to help manage access was huge.

Our security staff was well-known and had a great presence. They helped people who were waiting and anxious to understand the rules and the process. And their presence let people know that this was a space where we maintain respect, where the rules are followed, and where people behave appropriately. The ICU is a stressful environment for everyone. Some visitors don’t think the rules should apply to them, and they try to sneak in or won’t leave when asked. We frequently have patients who are victims of crime or have active police investigations, situations where we need to be especially careful about managing patient information and access. And sometimes patients are agitated or aggressive, and we need security to assist healthcare staff. They were well-trained and always exhibited calm, respectful professionalism, often working to build genuine rapport with patients. They really were a key part of our team.

It’s shocking that PeaceHealth would make these cuts and, from my perspective, potentially endanger our patients and staff in the ICU and women’s complex—two areas where the need for security has recently been highlighted in tragic ways.³ Management’s announcement to us didn’t include any plan to address this major change in our daily operation. When we asked what we were supposed to do, they gave us a form to post the phone numbers of the nurses covering each patient’s room. Now when visitors come, they dial the nurse’s number from the waiting area phone, and the nurse is expected to make the determination and escort visitors in. If they can’t answer the phone, the call goes to the unit phones, and sometimes it gets forwarded to the charge nurse phone, which is used for all kinds of patient care tasks. Every time someone interrupts that, they’re interrupting patient care. If we need security, we now have to call dispatch; they’ll send somebody up from wherever else they’re working, like the ED. So we’re all basically winging it. The nurses are increasingly frustrated, and we all feel less safe.

JODI: Our contracts allow members subject to RIFs to fill open positions in the hospital or to take severance, so about half of the people who were laid off were reabsorbed into other hospital departments. But the folks who stayed and the folks who lost their jobs are all devastated. I have seen a lot of tears from people making these tough choices about what to do with their lives.

The employer has really shown carelessness throughout this process. For example, we negotiated stronger severance packages in impact bargaining, but at no point during that bargaining did PeaceHealth disclose that in order to receive the healthcare benefit continuation, people would have to elect for COBRA, which PeaceHealth would pay a portion of. Instead, people were told at their doctor’s offices that they didn’t have insurance and would have to pay out of pocket. I’ve spent hours on the phone with people who didn’t know how they were going to pay for their surgery or their child’s dental checkup. When we asked HR how this happened, they didn’t have any answers. They just didn’t do what they were supposed to do, and they treated people like they were disposable.

That’s also how they’re treating the staff who are trying to keep these departments running without essential team members. PTSs are certified nursing assistants (CNAs) who work as coordinators in the nursing units and can be an extra pair of hands when needed. The coordinators were the information hub of the ED. They coordinated every single phone call and page for physicians. Instead, management expects the ED techs to cover the eliminated positions. Other staff have similarly been asked to do additional duties on teams where there have been cuts. When we asked management how they expect staff to do all of that additional work on top of their usual assignments, they offered to post a relief position. How is one relief position supposed to fill all of the gaps? They also suggested nurses can perform these tasks—but that’s our bargaining unit work. Nurses should be at the bedside, working in their scope, not sitting behind the desk taking phone calls. Management is using our passion and compassion for patient care and our coworkers against us, and people feel very defeated.

The effect on patients is serious, too. Within the first week without our mobility aides, we had two patient falls that I’m aware of, which is a significant increase. And there is a snowball effect from other cut services, like the diagnostic imaging library night shift. Without that position, you can’t get images pushed through to transfer a patient to another hospital or access images during system downtime for computer upgrades (which typically happens at night). In other departments, it’s the unit coordinators and PTSs who knew the procedures that kept those units functioning during computer downtime, which can last for four or five hours. Cutting staff who know those downtime processes can compromise and delay patient care, with negative outcomes that can include a sentinel event. But all PeaceHealth corporate sees is numbers, and they’re eliminating staff without understanding the effects of these decisions.

DAWN: Our contract language also allows RNs who have been laid off to fill open positions in the hospital, so fortunately we were able to place the RNs who wanted to stay in other departments. But the layoffs still tore apart nurses’ entire professional world. When you work on a unit, you get really close to your team, and it’s hard for that to be abruptly ended.

And it’s not like those units aren’t needed. The same-day surgical overnight unit would hold patients if the surgical floors were full, and they handled pre- and post-op tasks and discharge for patients whose procedures or recovery extended into the night shift. Management assumes that our post-anesthesia care unit nurses will take on those post-op and discharge duties, but that will require training and education because these nurses usually just recover patients and send them to the same-day unit.

The observation unit cared for patients who were expected to stay fewer than 24 hours in the hospital; they prioritized those patients and made sure their imaging and other tests were done quickly so the patients could either be sent home or switched to inpatient status if a longer stay was needed. Now everyone will need to be educated about the difference in priority. We don’t want anyone sitting in the ED for 13 hours waiting for an x-ray or CT when we could have gotten them home.

Closing those two units was bad enough, but we’ve also lost the PTSs, mobility aides, and others who provided vital patient support on multiple units. For example, mobility aides help patients when nurses are triaging patient care, and they make a crucial difference in patients keeping their ability to walk and getting stronger to go home instead of to a facility or community partner. When that staff is taken away, nurses are forced to run from task to task instead of being person focused, and patients notice the difference. If I don’t see my patients often enough to get to know them, I can’t pick up on the subtle changes that tell me they’re having respiratory compromise or that something else is going on. We’re just reactive, and that makes it harder to care for patients and for ourselves. How can we take meal and rest breaks without the support we depend on to make sure patients are safe while we’re off the floor?

Many of our nurses are concerned there will be more reductions. Hospital administrators don’t have to tell us their intentions, but hearing in staffing committee meetings that they were happy it was only 1 percent makes it seem like more layoffs could be coming. That has a terrible effect on morale for everybody, but especially for our early career nurses. As a new nurse, you’re trying to absorb and learn everything and get comfortable in what you’re doing, which can take years—plus you’re worried about student loans and other things. Adding anxiety about job stability makes all of that more stressful.

EDITORS: How are your unions addressing these problems?

DAWN: All of our nurses buttoned up in support of our OFNHP brothers and sisters. Some of the ED staff had worked at the hospital for decades—the most senior PTS had been there for 45 years. That role and expertise were critical to the operation of the department. We need management to know that. And we’re encouraging members in units with reductions to file assignment despite objection (ADO) forms. Those forms go to the WSNA co-chairs, the manager, and our chief nursing officer in real time. We need to know, and we need management to know, how these layoffs are impacting work and patient care.

We’re also taking advantage of the protections in our new staffing law. We were required to submit staffing matrices to the state Department of Health in January, and any changes to those matrices must be approved by 51 percent of the staffing committee. Failure to comply leads to financial penalties. Our previously approved matrices included some of the support staff roles that were eliminated, and when the staffing committee met in July, we had difficult conversations with management about the changes they wanted to make. We voted on one of the areas where the PTSs were cut, and the proposed matrix did not pass. It was a clear statement that we did not think it was a safe decision. Their plan laid off people in positions that they’re required to staff to be in compliance. We have also filed a complaint with the Department of Health for laying off caregivers who were part of submitted matrices without first presenting the plan to the staffing committee for a vote. Of course there are roles that aren’t included in those matrices, like the educators on all our units. There are a lot of staff members who make sure we all have a safe place to work, and the employer could decide to lay them off any time.

JODI: We began impact bargaining right away. We bargained for 21 hours to get additional benefits for our members, including the pro unit and the social workers, whose contract was still being negotiated. We made sure they had a seniority roster and that they would get standard severance and consideration as inside candidates for five months. We’re still sorting out the medical benefit continuation. And we are working with the AFL-CIO to get members help with unemployment and educational opportunities and continuing to meet with the members who elected severance to support them through this horrible process.

We’ve filed grievances for staffing law violations and are working with WSNA to make sure the staffing committee is aware that the people in those eliminated positions are essential to their areas and to the function of the hospital. And we’re continuing impact bargaining for our members who are being asked to take on additional work. PeaceHealth’s mentality is that ED technicians can assist with secretarial duties, but that’s not their role or training, and it’s not what they were hired to do.

In the meantime, I have told my members that we can’t enable PeaceHealth’s gross misconduct by trying to pick up all the slack. This is a problem PeaceHealth created; it’s not OFNHP’s problem to solve. We work to scope, we don’t skip breaks or lunch, and we don’t take on extra work to enable their greed. Something has to give, and it can’t be healthcare workers’ well-being.

AMANDA: We also filed a grievance in mid-June because our contract has provisions that specify a process for this kind of change—including, for example, consulting the unit-based practice committee about safety impacts. If PeaceHealth had come to us in advance, we could have presented a case for keeping security or at least proposed a plan for going forward without them. The grievance included a request for information about security and safety events and related data for the ICU and the women’s complex. We received some information back, and we plan to meet with hospital management soon to discuss it further.

Along with several other people, I also wrote to the director with our questions. I got the impression that he didn’t understand the essential role the security staff played. After the layoff announcement, we asked security staff to log their calls; between 8 a.m. and 4 p.m., the guard would take more than 100 calls. We told management, “This is the work you’re now pushing onto nurses.” It seemed like they had no idea.

Now those calls are being directed to nurses or going unanswered. If our other work is done, we’ll try to step in, but patient care always comes first.

Families are seeing the difference. We have had some families of ICU patients complain, and we’ve encouraged them to contact the hospital’s risk management team or the Oregon Health Authority with their frustrations. Sometimes it takes a long time for a nurse to be able to leave the ICU to bring visitors in. I just tell families the truth: we used to have dedicated staff to do this, but now it’s on the nurses. Many of our patients’ families have been reasonable, but sometimes they are already angry and scared when they come in, so long waits with very little information can lead to trouble. We don’t have trained security guards in the waiting room who can see trouble starting, so when a nurse comes out to get a visitor and walks into something volatile, I have serious concerns that someone is going to get hurt.

Endnotes

1. R. Euhus et al., “Allocating CBO’s Estimates of Federal Medicaid Spending Reductions Across the States: Enacted Reconciliation Package,” KFF, July 23, 2025, kff.org/medicaid/issue-brief/allocating-cbos-estimates-of-federal-medicaid-spending-reductions-across-the-states-enacted-reconciliation-package.

2. L. Dragoi, L. Munshi, and M. Herridge, “Visitation Policies in the ICU and the Importance of Family Presence at the Bedside,” Intensive Care Medicine 48, no. 12 (August 17, 2022): 1790–92.

3. J. Wang et al., “Workplace Violence Experiences of Intensive Care Unit Healthcare Providers: A Qualitative Systematic Review and Meta-Synthesis,” BMC Health Services Research 25 (March 18, 2025): 399; and Associated Press, “Oregon Hospital Security Guard Dies After Being Shot While on the Job,” NBC News, July 24, 2023, nbcnews.com/news/us-news/oregon-hospital-security-guard-dies-shot-job-rcna95886.

[Illustrations by Carole Hénaff]