Some 650 nurses at St. Patrick Hospital in Missoula are entering mediation on a union contract a labor leader said will shape the hospital’s ability to care for patients going forward.

“This contract negotiation is really going to be telling on the future of St. Pat’s as we know it,” said Cassidy Dillon, a registered nurse and bargaining team member for the Montana Nurses Association Local 17, in a phone call Tuesday.

The COVID-19 pandemic dealt blows to the healthcare industry, and Dillon said St. Pat’s has been “tremendously affected” since 2020.

First-year turnover rates for nurses are 20 to 30% mainly because the professionals cannot establish roots in Missoula, Dillon said. The health care workers face high property taxes and rising housing costs.

“They have been priced out of Missoula,” Dillon said.

St. Patrick Hospital is part of the Providence system, which operates in 51 hospitals and 1,000 clinics in five states, according to its website.

St. Patrick’s Director of Communications Stacy Rogge said in an email the hospital has been negotiating with the union since Jan. 16, and 12 bargaining sessions are scheduled through March.

“We are glad to be back at the table this week,” Rogge said in an email. She also praised the mediation process ahead. “Federal mediators help find common ground, and having them involved throughout the remainder of the bargaining process will accelerate our path to agreement.”

Dillon said as the Local 17 enters mediation at St. Pat’s on its first contract negotiation since 2020, nurses are hoping the result will be a plan that brings stability to patients for the next 10 years.

In negotiations, she said nurses are focused on recruitment and retention; keeping nurses local; safe staffing ratios; and reducing workplace violence.

To support its industry, the Montana Nurses Association also has pushed for change at the legislature in the past and will continue to do so, said Robin Haux, labor program director for the Montana Nurses Association.

Recruitment and retention

Dillon said nurses want to stay in Missoula, but at least one-in-five leaves in their first year here because of financial constraints.

“If we have nurses constantly coming and going in this revolving door, your loved one isn’t going to have those experienced nurses to take care of them,” Dillon said.

Starting pay for a nurse in Missoula is $31.60, or $65,728 a year based on a 40-hour week.

That’s close to the median household income in the county of $66,840, but it’s much less than starting pay for a nurse at a Providence hospital just a couple of hundred miles away.

For example, a nurse who works in Spokane for Providence Sacred Heart Medical Center earns $41.13 an hour, or 30% more than a starting nurse in Missoula, according to labor contracts.

That amounts to $20,000 more annually in Spokane based on working 40 hours a week.

Dillon said the nurses are precluded from discussing the details of their contract negotiations, but base pay is always a consideration.

Rogge offered another data set.

Citing Becker’s Hospital Review, she said annual hospital nurse turnover rate in December 2023 was 22.5%. However, she said St. Pat’s turnover rate “is much lower” at 15% — and has been improving the last several years.

“Providence St. Patrick Hospital is committed to reaching agreement on a fair contract that will help us recruit and retain the best nurses while staying true to our mission of sustainably serving all members of our community,” Rogge said.

She also said negotiations have been positive and productive so far.

“While many dynamics impact nurse turnover, no one solution can resolve it,” Rogge said. “We are proud of the progress we are making and are committed to focusing on this issue.”

Dillon said St. Pat’s is “pretty good” at listening to nurses about how to fill staffing holes, and it is relying less on expensive traveling nurses than it did in the past. However, she also said local employees have been frustrated about the expenditure on outside nurses.

“Why not take that money and invest in us?” Dillon said is the sentiment among nurses.

She said the current contract negotiation is the most “involved” one St. Patrick Hospital has had in a long time. She said a mediator arrives Wednesday.

“We live to serve our community,” Dillon said. “We want to stay here. We want to continue to better our community. But again, we need Providence to invest in us. And right now, they’re not showing us that.”

Violence against nurses, staffing standards

Patient and nurse safety are also a priorities for the nurses, and the union is advocating for input in staffing ratios in the new contract and may lobby for related legislation in 2025, the nurses said.

Dillon said violence against nurses is prevalent, and it usually occurs when a patient is not of sound mind or delirious and attacks a nurse physically, verbally or sexually. She said nurses and St. Pat’s are updating policies to better protect nurses.

“We’re making headway,” Dillon said.

In an email, St. Pat’s Rogge said the hospital has a record of supporting nurses.

“We have a long history of collaborating with Montana Nurses Association on contracts that advance the nursing practice, are market competitive, and meet the needs of our nurses and our ministry,” Rogge said.

During the 2023 Montana Legislature, lawmakers passed House Bill 590, which requires health care employers to ensure workers who experience violence report incidents to the provider. If the worker consents, the employer must report to law enforcement.

The bill, sponsored by Great Falls Republican Rep. Ed Buttrey, also calls for the Department of Justice to produce an annual report based on reports from health care employers.

Haux said felony penalties exist for attacking police officers, K-9 officers and referees, but not for nurses, although she said the union will take direction from members on how to proceed at the upcoming legislature on any lobbying efforts.

However, she said the Montana Nurses Association may push for another version of House Bill 568, which was tabled last session but would have set nursing-patient standards for hospitals. She said such standards result in better outcomes for patients.

She said ratios and standards vary depending on a hospital’s location — in a rural place versus urban, for example — and based on a department’s needs and patient acuity.

But Dillon said as St. Pat’s addresses those ratios in Missoula, nurses want to be part of the conversation. She said they want to offer more input into safe staffing standards and are asking for it in contract negotiations.

“Patient safety and positive patient outcomes are our primary goals,” Dillon said.