Later this spring and summer, tens of thousands of unionized healthcare workers at major hospital chains across the country will get a chance to negotiate what's in their next employment contracts.
The contract discussions come a year after they started working on the front lines of a historic public health crisis that continues to stress hospital resources, emboldening unions like National Nurses United and Service Employees International Union.
Workers have staged protests and informational pickets over what employers were doing to keep employees safe. Many threatened to go on strike and workers at HCA Healthcare and a handful of other big systems actually have in recent months.
While they're expected to bring up longstanding issues the pandemic exacerbated like staffing and pay in collective bargaining talks, a slew of other policies could come up, including those around sick leave, workplace safety requirements and racial disparities.
The largest for-profit hospital chain in the country, HCA faced a number of labor disputes last year, including a weeklong strike among nurses at Riverside Community Hospital represented by SEIU in California, and another threatened in December by those same nurses and others from two Southern California hospitals.
HCA has collective bargaining agreements covering 10,000 nurses in five states up for renegotiation this year, according to NNU. Contracts expire for HCA hospitals in Florida, Kansas and Missouri on May 31, and in Texas and Nevada on June 30.
An additional 2,000 nurses at HCA's Mission Hospital in Asheville, North Carolina, are currently bargaining for their first contract after successfully unionizing late last year in a state with the second lowest unionization rate in the country, according to the Bureau of Labor Statistics.
Union membership among healthcare workers hasn't risen dramatically in recent years, with the rate of those employed in healthcare practitioner and technical occupations who are members of unions hovering around 12% from 2017 to 2020, according to BLS.
But a number of hospitals will negotiate their first collective bargaining agreements this year, including those in Asheville.
Better staffing levels were the main reason nurses at Mission Hospital pushed for a union, Amy Waters, a registered nurse in the pediatric intensive care unit, said.
California is the only state with mandated nurse-patient ratios, or limits on the number of patients a nurse can legally take care of, and temporarily rolled them back in December amid surging COVID-19 cases.
"Our main reason for unionizing was to improve our patient care and have better nursing ratios, and ratios is a word that doesn't really exist anywhere outside of California," Waters said.
HCA did not respond to a request for comment.
Having multiple contracts with large hospital employers up for negotiation around the same time could work to the union's advantage, Rebecca Givan, associate professor in the School of Management and Labor Relations at Rutgers University, said. They'll likely collaborate on public-facing actions to draw attention to the process and garner community support after the pandemic pushed frontline workers into the spotlight.
"Most of these issues, especially the safety issues and the quality issues, really do come down to staffing," Givan said.
NNU has documented nearly 3,000 healthcare workers deaths in the U.S. due to COVID-19 so far, though notes it is likely a drastic undercount. The Centers for Disease Control and Prevention has documented 1,332.
A CDC study of COVID-19 cases by occupation found nurses accounted for 30% of cases among healthcare personnel, despite only accounting for about 15% of the total healthcare workforce.
Other major hospital chains with nurses represented by NNU have collective bargaining agreements up for renegotiation this year, including some in California.
More than 8,000 RNs and healthcare techs at 15 hospitals owned by regional nonprofit giant Sutter will bargain for new contracts when they expire this July, according to NNU. Sutter Center for Psychiatry and Sutter Coast Hospital will do so for the first time after recently unionizing.
And 14,000 nurses at more than 29 for-profit Dignity Health hospitals in California and Nevada also have contracts up for renegotiation this year.
Sutter and Dignity Health did not respond to a request for comment.
At HCA's Mission Hospital, where bargaining has already begun, nurses are prepared to spend close to a year negotiating their first contract, Waters said.
They began their push to collectively bargain following HCA's buyout of the former community hospital in February 2019, according to NNU.
"I think this has brought to light a problem that has existed for a long time in nursing," Waters said. "I still love my job, even though I don't love how I have to do it sometimes. But I think there are a lot of young nurses who are just getting into their careers during COVID and I think they're going to turn and run and never come back."