Oregon nurses union grapples with growing pains, contested election

By NICK BUDNICK/The Lund Report

One of the most powerful health care unions in the state is undergoing what some call growing pains and others say is a crisis in leadership. 

More than 20,000 people in Oregon will start voting next week in a highly contested election for leadership of the Oregon Nurses Association. The election is unusual not only due to the number of contested seats — more than 30 of them —  but for the debate it reflects and the way both sides are making their case.

While most union elections happen quietly and out of the public eye, a large slate of candidates calling itself the Caucus for Powerful Reform, or CPR, has published a website making their case that top union leaders are operating undemocratically and not doing enough to support members and organizing. 

Nurses association members “feel a disconnect between leadership decisions and the realities faced by those on the front lines,” the group’s challenger for president, Gina Ottinger, told The Lund Report.

Meanwhile, an opposing slate of incumbents and allied candidates say the union is on the right track. They have set up their own website under the name Stronger Together Oregon.

“I don’t think that promoting divisiveness and promoting distraction between two groups, I don’t think that’s necessarily how we should be functioning as a union,” Rich Botterill, a Providence Portland emergency room nurse who is running for reelection as board treasurer, told The Lund Report. “They have their opinions. … I think a lot of them can be considered inaccurate or misrepresentations, but that’s not something I want to really get into. As an emergency room nurse, what I will say is the only time I give CPR is when someone is either dead or trying to die. I don’t think that’s the case with ONA right now.”

While debates over union democracy and reform are hardly unprecedented, what might seem surprising is that the struggle for control of the nurses union is happening during a time when it has enjoyed what looks like remarkable success.

In addition to organizing gains, the union’s advocacy has helped make Oregon nurses the highest paid in the nation after factoring in the cost of living. They average $120,470 a year and make almost $2.50 an hour more on average than nurses in the second-ranked state, California, according to an analysis by Becker’s Hospital Review. Only two years ago, Oregon nurses’ pay lagged behind 18 other states.

The association’s Executive Director, Anne Tan Piazza, declined to be interviewed, with a spokesperson saying the union did not want her comments to be viewed as commenting on the pending election. 

Pandemic fueled rapid growth

Founded as a professional organization in 1904, the association bargained its first contract in 1954 and joined the American Federation of Teachers in 2013.

In the last two decades, it’s gone from quietly bargaining contracts behind closed doors to aggressively running public campaigns and embracing the language of progressive social change, mirroring a national shift.

Then came the pandemic. In Oregon, hospitals were swamped with sick people, and patients were dying unattended in hospital hallways. Doctors, nurses and hospitals alike declared that the care they were being forced to provide under stressful conditions often did not meet basic ethical or safety standards. Even after the initial surge eased, nurses were told that they should consider hospital finances when addressing patients’ safety and care needs.

The conditions were highly traumatic for many, sparking anger and burnout and prompting many nurses and doctors to find other places to work. Those that remained working in hospitals increasingly signed up with unions who promised to fight for better working conditions and pay, reflecting a nationwide surge.

From 15,000 members in August 2022, the Oregon Nursing Association has jumped to about 25,000 represented workers today — growth of about 67% in just three years, while expanding its membership beyond nursing professions to include aides, assistants and other staff roles.

Already bearing significant clout in the Oregon Legislature, the union’s growth has, if anything, increased its influence, according to some observers. In the wake of the pandemic, the nurses union drove to passage a variety of laws, including the strongest minimum hospital staffing law in the country. It’s also worked to influence nursing standards nationwide.

State Rep. Ed. Diehl, a Republican from Stayton, said the union’s clout is why efforts to allow nurses from other states to practice here, similar to how other states operate, failed in Oregon. Hospitals’ financial strains are partly due to the union’s influence, he added.

“They have tremendous clout,” he told The Lund Report. “We have the highest nursing salaries in the country and one of the reasons our providers are facing financial challenges is because of that, and because of staffing ratios and other legislation that has been pushed through. It’s raised the cost of health care in Oregon.”

Rep. Rob Nosse, a Democrat from Portland who used to work as an organizer for the union, said he’s not sure the union’s clout has grown, but it’s always been strong. And he said it’s a good thing for nurses to be listened to.

“I have never known the Legislature to not care about what nurses think,” Nosse told The Lund Report, adding that the union’s influence is based on a combination of things. “They have a large membership base, they have a political action committee, they represent a profession that’s super important.”

Union leadership has battled internal labor strife

But even as the union’s membership has grown, the nurses union management has appeared to struggle with the stress of organizing and supporting workers in multiple workplaces at once while working to build clout to counter the largest hospital chains.

That stress peaked late last year as the union called a strike against Providence in Oregon, one that ended up lasting nearly seven weeks and, at the end of it, left many members with mixed feelings over whether union leadership had kept its promises and achieved all that it could.

Not only that, but the union demoted its lead organizers for Providence and Oregon Health & Science University, causing members in both systems to accuse union leadership of punishing its members for seeking better pay. 

The board leading the union’ affiliate at Oregon Health & Science University sent top managers of the Oregon Nurses Association a letter about the demotions in April 2025, expressing “concern that these shuffles may be disciplinary or retaliatory in nature. If this is the case, it is becoming increasingly more difficult to know if this retaliation is toward the Labor Rep or the nurses they are working with,” adding that “ONA leadership continually makes claims to promote a member-led, democratic union yet consistently fails to consult members on decisions that impact their bargaining units.”

The Oregon Nurses Association’s staff have their own union, known as the Union of United Staff. In May, in a complaint to the National Labor Relations Board, it accused the nurses union leadership of committing an unfair labor practice in one of the demotions, which it said was due to trying to organize for better working conditions within the union. Asked for the union’s perspective, leadership declined to comment except to note the complaint was later withdrawn.

In a petition, critics also faulted Tan Piazza’s pay, which far exceeded her predecessor, who made a salary of $164,000 in 2021, records show. Tan Piazza’s salary as of last year was $310,000. 

In response to a petition that backed the union organizers, the nurses association board sent out a letter blasting “distortions” and “misinformation” while defending Tan Piazza’s pay and the union’s general working conditions.

“In the last few years we have attracted experienced staff from other unions due to our compensation packages and workplace standards,” the letter said.

In August, union employees filed another complaint against union leadership with the NLRB. They voted to authorize a strike against the Oregon Nurses Association, and picketed the union outside the Oregon AFL-CIO convention in September. The two sides reached a contract in October, according to the NW Labor Press, after which the complaints were withdrawn.

Self-described reform group arises

This year the self-described reform candidates have organized to challenge just about every seat in the elected union leadership. At the heart of their platform are concerns about the leadership style of the union’s top staff. The challengers’ platform also opposes any health care consolidations, saying the current health care system “needs to be torn down and replaced with true health care for all.” And some of the reformers say that union leadership is claiming credit for victories won by member advocacy on the front lines.

The group’s candidate for president, Gina Ottinger, a staff nurse at Providence St. Vincent Medical Center, told The Lund Report in an email that members want more transparency, inclusivity and responsive leadership.

She added, “Many members are concerned about ONA’s direction because they feel a disconnect between leadership decisions and the realities faced by those on the front lines,” Ottinger said via email. “The concerns stem from experiences where decisions seemed to be made without adequate member input, leading to feelings of exclusion and frustration.”

She was echoed by Duncan Zevetski, a night shift nurse at OHSU and the group’s candidate for vice president. He said a more energized union would protect members better against moves by industry and political headwinds. In a time of federal pressures, ONA needs to be “prepared to take on these challenges and be more forceful in our responses and actions in defending our working conditions and our patients,” Zevetski told The Lund Report via email. “Status quo unions are not prepared for these challenges so we need a change from status quo.” 

Zevetski cited ONA leadership’s support of the since-abandoned Legacy-OHSU merger, which could have hurt some OHSU nurses’ working conditions and opportunities.

“Members were not asked about their priorities or about whether anyone in ONA supported further health care consolidation,” Zevetski told The Lund Report. “Support for that merger with members was not there outside of the desire to see Legacy nurses’ working conditions improve.”

The removal by ONA leadership of its lead negotiator with Providence was another trigger for opposition members, according to Ottinger. “It further delayed implementation of our contract and the standards we fought for. It’s a pattern of behavior by unelected leadership to make decisions without member input and it caused instability in our union.” 

Kara Hayden, a speech-language pathologist at Providence Home, Health and Hospice who is part of the reform group, attributed the push for change to a broader membership that increasingly includes non-nurses as well as a desire to put the union’s clout to good use.

“A lot of us are newer members,” she told The Lund Report, “We didn’t unionize to sit around and let health care happen.”

Unity-focused slate disagrees

The Stronger Together slate, which includes several board incumbents, focuses on unity while promising to support democracy and members in language that is reminiscent of that employed by the Coalition for Powerful Reform. But they don’t criticize the union’s top staffers.

Botherill, the Stronger Together candidate for treasurer, said dissension expressed by critics within the union benefits the hospitals who are resisting the union’s calls for better pay.

“I believe in ONA,” he said. “I believe in the things that we’ve achieved over the last three or four years, and I care very much about the well-being of the nurses, and (the union) is not just nurses anymore, it’s health care practitioners in general. I care about their rights, I care about them not being abused, I care about them not suffering moral injury from being understaffed, I care about maintaining adherence to the staffing laws which, quite frankly, a number of the hospitals, I think, quite intentionally misinterpret to their advantage as much as they can. And I want to build on the foundation that we’ve established as a union.”

He said the Stronger Together candidates that he’s “running with have the experience necessary to take what we have achieved and to build on that in the future… our goal is to become a larger, stronger union,” which he said will benefit patients. “The health care system in this country is a little broken right now.”

Similarly, other candidates in the Stronger Together slate echoed themes of unity while promising growth, openness and responsiveness to members.

Chris Rompala, a nurse at PeaceHealth Riverbend who is running for president, said in his candidate statement, “We all know that we have strength in numbers, and our numbers continue to grow!! But, numbers are just that, unless we are unified. This is of the utmost importance to me, and I will continue to support this through transparency and support throughout our organization.”

Election will run a month

Voting will begin Monday, Jan. 12 and run through Feb. 12. 

Nosse, the state lawmaker who used to work for the union, said he hasn’t been following the election, but generally speaking, he said, “I think ONA is pretty democratic.” 

He said the fact that union members are voting down deals negotiated in part by union leadership is probably a good thing. “In a democratic union, the membership gets to say, ‘Hey, no offense, staff and leaders, but you didn’t get it right.’”

Rep. Travis Nelson, a former vice president of the nurses association board, told The Lund Report that he’s endorsed some Stronger Together candidates he knows, and his impression is the self-described reform slate is driven in part by dissatisfaction among nurses at OHSU, who represents a large portion of the union membership.

“From what I’ve heard, it sounds like the OHSU nurses have not always felt like their voice has been heard, which is why they’re running,” he said. “I don’t know everybody involved, but I know that there’s passion all around and that nurses want to have their voices heard — whether that’s at the bedside or within ONA.”

Managing editor Joanne Zuhl contributed to this report.

• The Lund Report is an independent, nonpartisan, nonprofit, online news source covering health care issues in Oregon and southwest Washington. Editor Nick Budnick can be reached at [email protected].