Advanced practice providers say their concerns aren’t being addressed

August 6, 2025 (Portland, Ore.) - Another wave of union organizing is washing over Legacy Health System as about 120 advanced practice providers (APPs) voted overwhelmingly in favor of unionizing with the Oregon Nurses Association (ONA). The nurse practitioners and physician associates are part of Legacy’s Adult and Pediatric Specialty Departments.

“A patient who interacts with Legacy at any level is likely to receive care from an APP, since we make up about one-third of the providers here. But sometimes it feels like we are a hidden workforce,” said Beth Alston, DNP, FNP-C, MBA at Legacy Health. “We decided to form a union because we are siloed in our work areas and Legacy doesn’t have an organized APP leadership structure where our concerns are taken seriously.”

As they prepare to bargain a first contract with Legacy executives, these APPs will prioritize quality patient care with safety and proper support; input in decision-making that fosters transparency and includes day-to-day operations affecting the providers’ ability to provide safe and effective care; and the development of highly functional teams to increase employee retention and mitigate burnout.

“Demand for advanced practice providers is growing, but our seat at the table has been limited until now. That needs to change so we can advocate for resources to care for patients safely and to the best of our ability,” added Alston.

Tuesday’s vote was the latest in a series of union elections at Legacy. In July, more than 200 resource pool nurses who work in Legacy hospitals in Oregon and Washington overwhelmingly voted to join ONA, following the lead of more than 2,300 nurses at Legacy Emanuel Medical Center, Randall Children's Hospital, and Legacy Good Samaritan Medical Center who voted to join ONA in February. ONA also represents registered nurses at Legacy Mt. Hood Medical Center, Legacy Silverton Medical Center and Legacy outpatient clinics; nurses and health professionals at Legacy Unity Center for Behavioral Health; and advanced practice providers at Legacy hospitals, Legacy-GoHealth urgent care clinics, and women’s clinics.

There are ten ONA-Legacy bargaining units in negotiations for first contracts, which amounts to almost 3,200 frontline healthcare workers. An additional 400 registered nurses from two bargaining units are trying to secure successor agreements. Some of the bargaining units have been negotiating for more than 18 months.

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