Hospice, Home Health Nurses Unionize at Oregon’s St. Charles Health System

Nurses at St. Charles Home Health and Hospice in Bend, Oregon, have unionized with the Oregon Nurses Association (ONA) to negotiate for improved working conditions, compensation and other issues.

The home health and hospice provider is part of the St. Charles Health System, a nonprofit that serves communities in Central Oregon. The system also operates four hospitals and several family care clinics, with 4,500 caregivers, more than 350 active medical staff and 250 visiting medical staff.

The push to unionize began in 2020, according to St. Charles Hospice nurse Cherie Iannucci, who helped organize the movement to seek union representation.


The home health and hospice unit had undergone a leadership change, and new management came in with a different set of priorities, Iannucci said.

“Many of my co-workers had left after the new director. She didn’t have the same philosophy or care directives, and when you work in hospice, you get very passionate about caring for your patients,” Iannucci told Hospice News. ”The idea of hospice is to give people comfort at the end of their lives and support them, and that was being taken away from the nurses.”

Nurses were starting to get frustrated, and their attempts to seek redress from the health system were less than fruitful, Iannucci indicated. Moreover, they had not received annual wage increases for at least two years at that point, and their travel reimbursement remained the same, despite rising gas prices.


A top priority for the St. Charles home health and hospice nurses was getting more help to reduce each employee’s caseload. Some nurses had to cover more than 100 miles a day to visit 25 or more patients, Iannucci said. Burnout was also becoming more prevalent among their home health and hospice teams.

St. Charles Health System acknowledged the difficulties associated with travel. Much of the Central Oregon region is mountainous and endures cold winters with snow accumulation, which can affect roads and driving conditions.

“St. Charles is located in an isolated geographic area and we do cover many remote and rural communities with home health and hospice care,” Debbie Robinson, director of home-based care for St. Charles Health System, told Hospice News in an email. “We understand that in the winter driving conditions can be difficult, and we believe in supporting our caregivers to ensure they can reach our patients safely to provide the necessary care.”

After a couple of prior attempts to unionize that did not come to fruition, the nurses’ organizers reached out to ONA.

The union represents more than 15,000 nurses statewide in a variety of health care settings, including some who work in other units within St. Charles Health System and a number of other hospice providers. ONA, established in 1904, is affiliated with the American Nurses Association (ANA), American Federation of Teachers (AFT), the AFL-CIO and the National Federation of Nurses (NFN).

The process of signing with ONA went quickly, according to Iannuci. The nurses had union cards within less than a week after 85% of the 39-nurse team voted to join.

St. Charles did not oppose the unionization, according to Robinson, who acknowledged that other nurses employed by the health system were also ONA members.

“While we don’t think it is necessary and would prefer to work directly with our staff on issues related to employment, St. Charles Health System supports the rights of its employees to organize and be represented by a union,” Robinson said. “St. Charles has a long-standing relationship with ONA. Our teams do our best to work collaboratively with ONA representatives to solve issues whenever possible.”

The nurses’ reasons for seeking union membership reflect issues that others encounter from many health care employers throughout the nation, according to Matt Calzia, director of nursing practice and professional development for ONA.

“It’s similar to what we see elsewhere where nurses and other health care workers are pursuing unionization. It is an erosion of working conditions, and a big part of that is that the health care industry continually demands more from nurses and provides less support, and the pandemic has really, really exacerbated that and accelerated the degradation of the working conditions,” Calzia said.  

Among the nation’s more than 3.05 million nurses, about 230,000 belonged to a union in 2021, according to the U.S. Bureau of Labor Statistics. This was a little more than 20%.

However, conditions exacerbated by the pandemic have the potential to lead more workers to consider seeking representation, Jon Anderson with Husch Blackwell said in a 2020 JD Supra podcast.

After all, Robinson told Hospice News, with the costs and labor shortages that have been exacerbated by the pandemic, “doing more with less is a difficult reality the entire health care industry is facing.”

“The health care industry has been hit hard by the COVID-19 pandemic and its aftershocks. St. Charles, like most health systems in the country, is doing its best to navigate the high level of demand for services with a significant labor shortage,” Robinson said. “The costs of providing care have increased dramatically while reimbursement for services has stayed the same. Yet, we continue to be dedicated to our mission as a nonprofit organization to provide care for all those who need us regardless of their ability to pay. “

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