Hospitals are facing greater challenges in providing community care today than ever before. Among the issues we are confronting are:

• Uncertainties about the future of the Oregon Health Plan.

• A shortage of health care workers.

• A growing and aging population.

Providence Milwaukie Hospital, a 77-bed community facility serving the everyday health care needs of the Southeast Portland and Clackamas communities, has an added unique challenge Ñ reaching a labor agreement on a first contract with nurses represented by the Oregon Federation of Nurses and Health Professionals.

The nurses at Providence Milwaukie are dedicated, compassionate people who provide high-quality care. Their efforts directly contribute to the hospital being named one of the 100 top hospitals in the United States by Solucient, a health-care information clearinghouse.

Providence Milwaukie has been negotiating with our nurses for 16 months. On June 11 we entered mediation with a federal mediator. Despite these continuous efforts, the nurses recently chose to hold a one-day strike. During this time, the hospital was staffed with highly skilled, licensed nurses who provided the high quality of care that our patients expect from Providence.

Providence Milwaukie remains committed to bargaining at the table to reach agreement on a fair contract with the nurses. Where we are still far apart, however, is on the issue known as 'agency shop.'

The union wants to require future Providence Milwaukie nurses to either join the union or pay fees as a condition of employment. Providence Milwaukie believes that every nurse should have the right to choose and should not have to pay the union to have a job.

The ongoing labor relations at the hospital do not affect patient care, but other issues do. As the Oregon Legislature works to fix the Oregon Health Plan, tens of thousands of poor and vulnerable people are in limbo, living in fear of losing some or all of their benefits. When that care disappears or is chronically underfunded, the demand on emergency departments rises, physicians struggle to see Medicaid patients and hospitals absorb more unpaid bills.

We have seen our charity care at Providence Milwaukie alone increase 97 percent between 2001 and 2002 Ñ and it is still rising. Add Medicaid shortfalls to charity care, and for the hospital the total cost in 2002 was $3.8 million.

Clackamas County's population increased 21 percent over the past 10 years, further challenging our hospital. Our emergency department was built to handle 15,000 visits a year. Last year we exceeded 21,000 visits. In December we will open a new $9 million emergency department that will have twice as many rooms as our current facility.

As we work to balance the external influences on the hospital, we will continue to recognize the value that our nurses bring to health care and work with them with respect to resolve any differences. Together, we will care for our patients with the same values, compassion and commitment.

Jackie Gaines is an administrator at Providence Milwaukie Hospital. She has been a registered nurse for 23 years. She has two grown children and lives in Clackamas County with her husband.

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