Labor disputes made healthcare headlines in 2018, with nurses demanding better staffing ratios from chains Tenet and Community Health Systems, nonprofit systems University of California Health and Kaiser Permanente and a handful of smaller independent hospitals.
Fights over the ratio of nurses to patients fueled strikes, rallies and even a midterm ballot initiative in Massachusetts, but it wasn't the sector's sole labor battle in 2018. The year saw heated collective bargaining negotiations, hospitals busting union activity and big struggles over benefits and wages for service workers.
Staff shortages and medical benefits are two primary pain points for mental health professionals at Kaiser's San Francisco Medical Center, and 4,000 of them kicked off a five-day strike this week after six months of contract negotiations. Members of the National Union of Healthcare Workers plan on demonstrating at Kaiser facilities up and down the state.
The skirmish is far from the first strike at Kaiser this year. The nonprofit health system has been the target of several union-organized demonstrations.
Union membership across all industries has been trending downward for the past four decades, and healthcare is no exception. The Union Stats database reports that the percent of unionized hospital workers has dropped from 22% in 1983 to 15.2% in 2017.
Organized labor in the the healthcare industry — within hospitals specifically — is markedly different from other sectors, considering hospital unionization wasn't federally legal until the '70s. The majority of private sector hospital workers were excluded from collective bargaining rights for nearly three decades until the National Labor Relations Act was amended in 1974. Once those workers were brought into the fold, the percentage of hospitals with collective bargaining agreements increased from 3% in 1961 to 23% in 1976.
Strikes followed. The Federal Mediation and Conciliation Service, a government agency that mediates negotiations when a contract is within 30 days of expiring, routinely publishes data on work stoppages it was unable to prevent dating back to 1984. According to the agency's data, healthcare and social assistance have had the fourth-most work stoppages (mostly strikes and lockouts) of all industry categories, trailing manufacturing, construction and retail.
Hospitals have seen some of the largest strikes in the past decade, including a one-day, 23,000-workers strong hospital strike in California in September of 2011 that resulted in a four-day lockout for 6,000 Sutter nurses.
Here's a month-by-month breakdown of the hospital strikes and pickets that made headlines in 2018.
California protests dominated early 2018. The year kicked off with UC nurses picketing at eight of the system's locations on Jan. 25. The nurses, represented by National Nurses United founding member California Nurses Association (CNA), demanded "safe staffing, patient protections and retirement security," Maureen Berry, a UC nurse, said in a statement.
The informational picket followed over eight months of bargaining negotiations. California was notably the first state to mandate nurse-to-patient staffing ratios in 2004, but nurses across the state haven't been satisfied with wages and benefits.
Days later, about 100 CNA nurses picketed at Dignity Health's St. Mary's Medical Center in San Francisco, citing concerns about staffing strains at the height of flu season.
UC picketing picked back up again in early February, this time held by roughly 70 cafeteria, custodial and a mix of patient care workers at UC San Diego's Thornton Pavilion in La Jolla. Organized by UC's largest employee union, the American Federation of State, County and Municipal Employees (AFSCME) Local 3299, workers demanded a new union contract offering market-competitive wages. One union official told the San Diego Union-Tribune that some employees can "barely afford to feed their families."
On Valentine's Day, more than 1,000 healthcare workers represented by Service Employees International Union-United Healthcare Workers West (SEIU-UHW) began picketing at hospitals owned by Kaiser Permanente over what the union purported to be plans to cut wages, outsource warehouse jobs and relocate others.
A Kaiser Permanente spokesperson told Becker's Hospital Review that the claims were "loud, false criticism and wage misleading attacks." The protest continued into March.
Nurses at Ascension-owned Borgess Medical Center in Kalamazoo, Michigan, held what would be the first healthcare union action to occur outside of California in 2018. On March 5, more than 150 Michigan Nurses Association members rallied in protest of the St. Louis-based hospital operator's plans to eliminate nursing positions at Borgess. Ascension, which owns five hospitals in southeast Michigan, cut 250 jobs in that state by the first of the month and a total of 500 by mid-March.
That's right around the time Pennsylvania nurses and technologists represented by SEIU Healthcare PA began picketing at CHS-owned hospital Wilkes-Barre General. Those workers, many of whom traveled from First Hospital in Kingston and Moses Taylor Hospital in Scranton (two other CHS properties in the state) for the rally on March 15, protested high staff turnover and shortages, mandatory overtime and expired contracts at all three hospitals.
Simultaneously, CNA nurses in the midst of contract negotiations with St. Joseph Hospital, Eureka organized a protest against what union reps called "chronic understaffing" at the California hospital. St. Joseph's had been in compliance with that state's staffing standards, per the California Department of Public Health.
Two days later, 300 AFSCME members picketed Minneapolis-based Hennepin Healthcare over contract negotiations. Workers protested the hospital's proposal to cut performance-based raises and benefits for workers — salt in the wound after Hennepin spent $220 million building its new Hennepin Healthcare Clinic & Specialty Center.
Contract disputes dominated the month, starting with Oregon nurses picketing at Providence Medford Medical Center and followed by a one-day strike launched by Massachusetts Nurses Association members at Greenfield-based Baystate Franklin Medical Center on April 11.
On April 18, frustrated SEIU-UHW technicians protested Tenet-owned Hi-Desert Medical Center in Joshua Tree, California. The union claimed its contract was not equal to contracts negotiated at other Tenet properties in California. A day later in Chicago, SEIU members rallied for better pay for front-line workers at Illinois Health and Hospital Association facilities.
At Detroit Medical Center's Huron Valley-Sinai Hospital in Michigan, more than 100 members of the fledgling Professional Nurses Association of Huron Valley-Sinai Hospital (an MNA affiliate) held an informational picket on April 25 calling for safe staffing ratios. The union made staffing its flagship issue in bargaining for its first contract at Huron Valley-Sinai Hospital.
Back in Pennsylvania, roughly 360 SEIU nurses and mental health professionals working under expired contracts at Moses Taylor and First Hospital organized a one-day strike on April 29. Strikers were barred from work the following day.
On May 2, SEIU-UHW members set the stage for what would be dozens of statewide protests in California, starting with Kaiser's South Sacremento Medical Center. Workers for the hospital giant demanded fair wages and job security in the face of outsourcing and cuts.
Following the Kaiser protest, nearly 10,000 service workers at UC Davis in Sacramento began a three-day strike that brought 29,000 nurses, case managers and other union healthcare workers to the picket line. Strikers demanded job security and better pay for custodial, groundskeeping and security workers.
On the other end of the country, New York-based nurses and emergency medical service workers at Stony Brook University Hospital followed suit by protesting over unfair wages, high turnover and increased hours.
Earlier in the month, nurses represented by the Pennsylvania Association of Staff Nurses and Allied Professionals picketed Pottstown Hospital, owned by Reading, Pennsylvania-based Tower Health. Union nurses, who were in the middle of contract negotiations with Tower, cited unsafe staffing levels and burdensome on-call policies.
Pennsylvania nurses also closed out the month with a one-day strike at Wilkes-Barre General, the third CHS-owned hospital in the state. Nurses cited unsafe staffing levels and mandatory overtime.
June was the calm before the storm, with 150 nurses and hospital workers at Washington state's Providence Regional Medical Center Everett holding lunchtime pickets early in the month over minimal staffing levels and long hours without breaks. The nurses, represented by United Food and Commercial Workers Local 21, had been working under an expired (but extended) contract since October 2017.
With the summer swelter came a windfall of union activity. While July started with CHS reaching an agreement with SEIU nurses at First Hospital in Kingston, Pennsylvania, the rest of the month saw a flurry of strikes and rallies across the country.
The storm started in Oregon, where Kaiser nurses rallied for better nurse-to-patient ratios, before sweeping east to New York. On July 10, SEIU members at Catholic Health's Mount St. Mary's Hospital in Lewiston, New York, picketed over staffing levels for nurses, lab technicians and service workers.
Two days later, downstate in Elmira, Communication Workers of America members hosted a rally for nurse staffing legislation. That same day, union nurses picketed at Osceola Regional Hospital in Florida with similar staffing demands.
July 12 also saw 1,800 nurses represented by the Vermont Federation of Nurses and Health Professionals Local 5221 launch a three-day strike against UVM in Burlington after demanding 10% more in pay raises than the hospital was willing to offer.
Later in the month, over 2,400 United Nurses and Allied Professionals members at Rhode Island Hospital and Hasbro Children's Hospital in Providence began a three-day strike that resulted in a prolonged lockout for nurses, technicians and therapists.
Picketing also took place at HCA-owned hospitals MountainView in Las Vegas and Corpus Christi Medical Center in Texas, part of a campaign organized by the National Nurses Organizing Committee to pressure the Tennessee-based hospital operator into addressing high turnover and understaffing.
The month came full circle with a nurses rally in Harrisburg, Pennsylvania, where union nurses delivered petitions in support of safe staffing legislation in that state.
About 300 Michigan union nurses and their supporters kicked off August with an informational picket at McLaren Macomb, one of seven McLaren Health Care hospitals. Workers in the midst of contract negotiations demanded wage increases and safe staffing ratios, as well as preventative measures against workplace violence.
Back in Pottstown, Pennsylvania, nurses, technicians and service workers picked up their fight against Tower Health by picketing for safe staffing and better working conditions at Pottstown Hospital. Coincidentally, the hospital is a former property of CHS, which owns three other hospitals in the state where safe staffing has been a hot button issue for nurses.
September was relatively quiet, save for continued protests against Kaiser in Oakland. Early in the month, more than 1,000 SEIU workers took to the streets to protest job cuts at the health system. The rally ended with a confrontation with law enforcement and a statement from Kaiser reassuring the public that it is "growing and adding jobs."
Nurses in western Pennsylvania have been battling UPMC for collective bargaining rights for years, but the health system is infamous for weeding out organizers and cracking down on collective action. The system is a constant target of the NLRB for civil rights violations. Still, about 50 nonunion workers, with organizing support from SEIU, managed to strike in early October for their right to form a union and simultaneously launch a political action committee called People Over Profits, which is "aimed at building power for working people in Pittsburgh and shaping a future that puts community before corporations."
Mid-month, 200 Kaiser employees delivered some tens of thousands of employee-signed petitions to executives at the health system in Oakland and Pasadena, demanding an end to the organization's job cuts and outsourcing.
With two months left in the year, a three-day strike across California brought 2018's union activity full circle when an estimated 39,000 workers represented by AFSCME and UPTE-CWA picketed UC's five academic hospitals across the state.
A week before Thanksgiving, 35 nurses at the University of Illinois Hospital and Clinics went on strike after demanding better job protections and wages. A few days later in Ohio, more than 100 nurses and SEIU supporters in Lorain held a silent rally after contract negotiations with Mercy Health soured.
The month closed out with another strike in Pennsylvania, when more than 300 nurses at independent community hospital Indiana Regional Medical Center launched a one-day strike over contract negotiations. The nurses found themselves in a week-long lockout after the hospital paid a temp agency $1.5 million for a week's worth of replacements, an action threatened when the strike was authorized in October.
December - 2019
Aside from planned demonstrations at Kaiser facilities this month, there are a number of potential strikes on the horizon — at least according to online postings from healthcare temp agencies and staffing crisis management firms.
As of publishing, U.S. Nursing Corporation has posted action alerts for potential openings in Oregon in anticipation of a nurse strike in "Fall 2018" and an expected two-week opportunity in New York sometime in January or February. HealthSource Global Staffing, another temp agency for healthcare workers, is currently recruiting for potential strikes in New Jersey, California and New York.