As health systems continue to wrestle with employee burnout, momentum within the healthcare industry to unionize its workforce may be on the upswing.
In 2021, only 13.2% of healthcare workers were unionized, a percentage that hasn’t changed much in the past decade according to the most recent research published in JAMA Network Open.
However, major healthcare labor groups say they are seeing increased interest in union representation from clinicians. This year, the National Labor Relations Board has received petitions for labor representation from groups of clinicians and other workers at more than 200 healthcare facilities.
Related: Burden of enforcing contracts falling on healthcare union members to 'speak up'
Here’s what you need to know about union activity within the healthcare industry.
What is fueling the interest in unions?
The main workplace issues for clinicians include burnout and overworking due to low staffing levels, unsafe working conditions and a lack of adequate training and personal protective equipment.
Many healthcare workers are also upset about low pay rates that prevent them from affording essentials, even after risking their well-being during the pandemic, said Renée Saldaña, spokesperson for the healthcare union SEIU-UHW.
The nationwide average annual wage for registered nurses is $89,010, while for licensed practical nurses it's $55,860, according to data published by the U.S. Bureau of Labor Statistics. And clinicians like dialysis workers sometimes don’t make more than $20 an hour.
Such workers "don't feel like their wages fairly compensate for their expertise and the value that they bring to patients and healthcare facilities,” she said.
How effective are labor organizing efforts at hospitals?
In 2022, the National Union of Healthcare Workers recorded its biggest growth, gaining 1,200 members. Where it used to get word of clinicians at three to four facilities per week looking to join, the union now gets five to 10 leads every day, said Sal Rosselli, its president. Its members are securing larger wage increases than ever due to staffing shortages, he said.
National Nurses United said over the course of the COVID-19 pandemic it organized nearly 7,000 registered nurses at almost two dozen facilities, bringing the total number of RNs it represents to nearly 225,000 members.
The trends are playing out across a number of unions..
The Committee of Interns and Residents, an affiliate of SEIU, has added seven unionized sites this year versus one in 2019. Residents and physicians at one of those sites, the University of Vermont Medical Center, have negotiated their first contract with the hospital, winning wage increases of up to 25% over three years.
Various Service Employees International Union chapters have been successful in organizing different types of employees in the healthcare space, including groups of dialysis workers and security officers in California and home care workers in Nevada.
What are the biggest recent contract wins?
Some of the contracts negotiated in the past few months have included language to significantly improve hospital worker salaries and health benefits, increase staffing ratios and enhance workplace violence protections.
Nurses who are part of the New York State Nurses Association won wage increases in July of more than 37% over a five-year contract with NYC Health+Hospitals.
Clinicians at the Los Angeles LGBT Center ratified a three-year contract requiring the center to pay some employees' healthcare insurance premiums. The agreement also included the implementation of a multi-code emergency communication system and hiring a consultant to evaluate clinic security.
At UCSF Benioff Children’s Hospital in Oakland, members of the California Nurses Association and Caregivers and Healthcare Employees Union secured a 13% pay increase over three years, additional orientation time and educational hours for new nursing graduates, expanded training courses and reimbursement for specialized licensure.
How are nurses advocating for better working conditions?
For some unionized groups, being at the bargaining table has not led to the desired outcomes.
In 2022, tens of thousands of healthcare workers went through with strikes lasting from one day to several weeks. So far this year, more than a dozen strikes were authorized nationwide, many of which were ended or averted by health systems and union members reaching tentative agreements.
Spurred by complaints of unfair labor practices and bargaining in bad faith, more than 85,000 workers in seven states who are part of the Coalition of Kaiser Permanente Unions are conducting strike authorization votes at their respective facilities.
At Cedars-Sinai Marina del Rey Hospital in California, several hundred RNs conducted a one-day strike Sept. 6 over ongoing recruitment and retention issues, as well as management’s alleged demand that nurses waive their right to negotiate education benefits, paid time off and leaves of absence.
Other facilities have taken alternative approaches to striking.
While RNs at Jackson Park Hospital in Chicago turned to informational picketing to speak out about patient safety concerns, clinicians at Providence St. Joseph Medical Center in Burbank, California, protested over the use of artificial intelligence, stating that the technologies cannot replace hands-on care or solve staffing shortages.
How are health systems trying to avoid unionization?
Healthcare workers say systems have tried a number of tactics to keep facilities union-free, from offering more benefits to encouraging union decertification and allegedly engaging in anticompetitive practices.
Although residents and physician fellows at Mass General Brigham, the health system headquartered in Somerville, Massachusetts, unionized in June, organizers reported that their union campaign was initially disrupted earlier this year by a series of emails from facility administrators announcing increases in annual stipends to $10,000 to help with living costs.
Similarly, nurses at George Washington University Hospital in Washington, D.C., and Maine Medical Center in Portland alleged their organizing efforts this year and last were delayed by hospital management removing pro-union signage, implementing mandatory educational sessions on unions and threatening to take away favorable working conditions.
At one Mayo Clinic location in Mankato, Minnesota, nurses and support workers voted to decertify their union groups after receiving assistance from the National Right to Work Legal Defense Foundation, a nonprofit that opposes union membership.
