Hospitals & Facilities

Healthcare workers in historically nonunionized roles are organizing

Dialysis workers, at-home health workers, and reproductive health workers are just some of those who have expressed increased interest in unionizing.
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SEIU-United Healthcare Workers West walk picket line to strike at Cedars-Sinai Medical Center. Medianews Group/Long Beach Press-Telegram Via Getty Images/Getty Images

5 min read

Workers across several industries—including hotel workers, Hollywood writers and actors, and pilots—have organized and gone on strike in recent months, and healthcare workers are no exception.

In California, for example, Service Employees International Union–United Healthcare Workers West (SEIU-UHW), a union that represents over 100,000 healthcare workers, went on strike at different health systems each week in October, prompting spokesperson Renée Saldaña to dub the month “striketober.”

“Between 2020 and 2022 we had three units go out on strike,” Saldaña told Healthcare Brew. “Now in just this month, we’re having six different unions go on strike. This is definitely a new place that we’re in right now with all of these folks striking at once.”

Saldaña said workers in roles that haven’t traditionally been unionized are organizing or have expressed interest in organizing. These include dialysis workers, at-home healthcare workers, reproductive health workers, and behavioral health workers.

The increased interest in unionizing that Saldaña is seeing is related to how healthcare workers were treated during the height of Covid-19, but she said “it’s even bigger than the pandemic.”

“Unsafe staffing, short staffing, concerns over wages that keep up with the high cost of living in these areas—these were all issues before the pandemic,” Saldaña said. “But what happened was the pandemic exacerbated everything and just made it worse.”

By the numbers: As of 2021, just over 13% of healthcare workers were unionized (roughly 2.4 million people). That number has stayed relatively steady over the last 12 years, according to a December 2022 study from Harvard and the University of Washington researchers. And while no industry-wide research has been published with 2023 numbers yet, healthcare union leaders say interest in unionization has been very high this year.

SEIU-UHW has been organizing workers into the union “at incredibly quick rates,” particularly dialysis workers, Saldaña said. The dialysis industry is “incredibly financially lucrative,” according to Saldaña, and the two largest dialysis providers in the US make billions of dollars in profits annually. SEIU-UHW has organized 24 dialysis clinics in California over the past year, Saldaña said. Before 2022, no dialysis workers in California were unionized.

More than 500 SEIU-UHW dialysis workers in California went on an unfair labor practice strike in September, she added. The workers, from 21 dialysis clinics across the state that are owned by Satellite Healthcare and Fresenius Kidney Care, have similar concerns as the 75,000 Kaiser Permanente workers who went on strike in October, according to Saldaña.

“They want to be able to have more say in their working conditions, safe staffing, and their wages,” she said.

As Republican-led state legislatures across the US move to prohibit or severely limit abortion procedures, reproductive health workers have also expressed increased interest in unionizing, Saldaña said. SEIU-UHW recently organized 550 Planned Parenthood workers in three counties in Southern California.

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Reproductive health workers are “seeing an influx of patients coming into California to access that type of healthcare that maybe they can’t access in other states,” Saldaña said.

More mental health workers are interested in organizing

Behavioral health has been an area of focus for National Union of Healthcare Workers (NUHW), which represents more than 16,000 healthcare workers in California.

“We’re seeing an inordinate increase in behavioral health organizations” showing interest in unionizing, Sal Rosselli, president of NUHW, told Healthcare Brew.

Behavioral health workers are “relatively new” to NUHW, Rosselli said. The union has represented hospital workers since the 1980s, but no behavioral health workers joined until 2010. Now, the union estimates that it has upwards of 5,000 behavioral health members, and since the pandemic, the union has gone from six bargaining units with behavioral health workers to 16 units, according to NUHW spokesperson Matt Artz.

A big issue behavioral health workers have advocated for is staffing, as well as “having sufficient time to provide care for their patients,” Rosselli said. Last year, thousands of behavioral health workers in Northern California went on strike for 10 weeks over claims of high workloads and long wait times for patients to receive care.

“As a result of that strike, we succeeded in getting a guarantee of some significant time for clinicians to deal with not only the patient, but social service agencies that need follow-up with minors, dealing with patients’ families, charting, and coming up with a plan. The patient management time is fundamentally necessary,” Rosselli said.

The bottom line

In early 2023, thousands of nurses in New York City went on strike, citing pay, benefits, and staffing ratios as the primary grievances. The contracts agreed upon as a result of the strike put a great deal of financial pressure on health systems, Michael Dowling, president and CEO of Northwell Health, said in a town hall this spring.

“The cost of the recent agreements that had been reached as part of what was done in the city is in the neighborhood of […] $500 million to $600 million over three years,” Dowling said. “That was not in our budget.”

Nationwide, there have been at least 15 strikes involving 1,000+ healthcare workers each since the start of 2022, according to the Healthcare Financial Management Association (HFMA).“I definitely think healthcare is the ripest industry in the country right now [for labor activity],” Kevin Carr, a partner at Spilman Thomas and Battle, told HFMA.

Shannon Young contributed to this report.

Navigate the healthcare industry

Healthcare Brew covers pharmaceutical developments, health startups, the latest tech, and how it impacts hospitals and providers to keep administrators and providers informed.