The Struggle for Better Working Conditions
“Our patients deserve the best, not mediocrity.” This powerful message has been shared across social media by the Oregon Federation of Nurses and Health Professionals (OFNHP), an affiliate of the American Federation of Teachers. This group of about 6,000 healthcare professionals is currently engaged in a contract dispute with their employer, Kaiser Permanente. The issue at hand is not the quality of the staff themselves, but rather the systemic workplace stressors that are affecting both employees and patients.
This ongoing conflict involves addressing some of the most pressing issues in nursing and healthcare—specifically, chronic understaffing, stagnant pay rates, and a lack of control over work schedules. The union has prioritized these demands in their recent return to contract negotiations.
The OFNHP is not alone in this struggle. It is part of the Alliance of Health Care Unions (AHU), which includes 23 unions representing over 60,000 Kaiser workers across multiple states. A significant portion of the AHU membership is negotiating as a single unit, aiming for better wages and conditions on both national and local levels. Strike action has been authorized, and if management does not return to the table by October 14, a nationwide walkout of more than 40,000 employees could occur.
The Pressure on Healthcare Workers
The strain on healthcare workers has intensified due to the stubborn bargaining position of management. This has led the AHU to take its final step. If the strike proceeds, it would be one of the largest labor actions of the year. This year has seen a rise in nurses' strikes and other health care actions, reflecting widespread and worsening issues facing U.S. hospital staff, both at Kaiser and in many medical facilities across the country.
The challenges faced by healthcare workers include low pay, long hours, burnout, and the stresses of the COVID-19 pandemic. These factors have led to severe strain on remaining employees, which in turn increases turnover and perpetuates the cycle.
In 2021, the AHU had also voted to authorize a strike, but it was called off the night before when management returned to the table. A new contract was negotiated, establishing a staffing committee to address shortages and securing a wage increase. However, structural issues remained unresolved, and wage gains from four years ago have been diluted by inflation.
The Impact of Management Practices
Kaiser Permanente has a largely unionized workforce, represented by the AHU and overlapping memberships like the Coalition of Kaiser Permanente Unions. The company has operated under a version of a labor-management partnership since the late 1990s. This arrangement aimed to avoid a strike by providing notable concessions to labor, including organizing rights and benefits, and securing unions a seat at the bargaining table. In theory, this works to the benefit of all involved.
However, sources say that the process has become less cooperative. Over many protestations, Kaiser administrators have continued to maintain practices that hospital employees find untenable. The decision to call for a strike indicates the severity of these feelings.
Brenda Rowe, a histology technician at Kaiser and an OFNHP member, is part of the technical bargaining unit. Her unit has not yet seen their contract expire and is therefore ineligible to join the strike. However, they are actively involved in negotiations for their renewal next year. Rowe emphasized that Kaiser technicians are proud to stand in solidarity with the strikers in their local counterpart bargaining units and with the multi-state AHU as a whole.
The Challenges of Staffing and Scheduling
Chronic staffing shortages wreak havoc on the complex operations of a hospital. All work is interconnected, and when nurses cannot cover as much, it puts more pressure on lab techs, who are also dealing with staffing shortages. This creates a no-win situation.
Kaiser Permanente responded to the union’s charges of staffing shortages by stating that they meet—and often exceed—mandated nurse-to-patient ratios and staffing standards. They added that they continue to hire, adding over 6,300 new employees in 2024, including nearly 4,700 in care delivery and more than 1,600 in Alliance-represented roles.
Neoma Palmer, a physical therapist with a sports-clinic specialty, has been employed at Kaiser for 12 years. She explained that there is short staffing everywhere, and it has been getting worse. She noted that management started to not replace open positions after the end of June, with hundreds of jobs remaining unfilled.
The Financialization of Healthcare
A likely motivator for the newly uncooperative, profit-focused management is the financialization of healthcare, especially after the intrusion of private equity firms. Many institutions have moved to prioritize profit, often by leveraging their assets to reap returns for investors. This can compromise the original service of treating patients.
Palmer mentioned that more and more managers and directors coming in are bean counters with no experience in healthcare. She said that this approach doesn’t work and that the incentives of profit and control seem to be the prime reason behind these changes.
Uncompetitive Compensation
Perhaps the central concern for labor in the negotiations is that Kaiser’s pay has failed to keep up with inflation. In general, Kaiser’s pay runs low compared to other hospital systems, particularly in the Northwest. One of the main goals in bargaining was to be paid fairly and to be paid for all hours worked.
Palmer described how at Kaiser, it's the norm to consistently get in early, stay late, and/or take on extra work, often multiple hours per week. This is done to keep up with workloads and licensing, but also very often out of a desire to provide patients with more attentive care.
The Use of Travel Nurses
While management regularly acts to ease staffing shortages by recruiting extra help, they do so by bringing on travel nurses. These nurses are paid fairly well, and Kaiser outlays considerable funds to make use of them. However, this major expenditure may not be beneficial from the vantage of pure self-interest.
Litts, a registered nurse and shop steward, expressed uncertainty that management is careless enough to place profit over patient welfare. Still, it appears evident that impersonal, structural pressures are acting upon all involved, with or without their willing complicity.
As of now, it would seem that, if management remains intransigent through October 14, a system-wide strike remains the only recourse for the Kaiser staff of the AHU’s member unions, both to protect their own livelihood and to stem some of the deleterious effects that pressure tactics and profiteering have inflicted on the Kaiser system.