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Health-Care Strike Risk Runs High as Hundreds of Labor Deals End

Jan. 24, 2022, 10:00 AM

Hundreds of union contracts will expire in 2022 at health-care facilities from Boston to Sacramento, setting up fights over staff-to-patient ratios, pay, and other safety concerns as beleaguered workers continue to battle the Covid-19 pandemic.

The cluster of expiring labor agreements will force health-care management to reckon with the physical and mental toll the pandemic has had on workers during the worst staffing shortage in memory.

At least 207,000 health-care workers are covered by the more than 400 labor agreements set to expire this year, according to an analysis of federal disclosures and contract settlement data compiled by Bloomberg Law. That figure is a conservative estimate that will only grow throughout the year as more companies report information on expiring contracts to the federal government.

As the agreements expire, medical facilities are contending with rising inflation, an unrelenting pandemic, and workers leaving their jobs at record speeds.

“A lot of people have left the bedside in disgust of how bad staffing is,” said Dana Simon, director of strategic campaigns for the Massachusetts Nurses Association. “They’ve just been left in this disaster with no support.”

The health-care industry is chronically understaffed, and nurses had been pushing for “safe” staff-to-patient ratios long before the pandemic began. But now, workers are demanding better conditions—and managers can’t afford to see their employees strike—giving unions an opportunity to negotiate the best contracts in decades.

If 2020 is any indication, there could be tens of thousands more health-care workers whose employment terms are up for negotiation this year. Many are nurses, but the number also includes nursing home assistants, lab technicians, home-care workers, and others.

Health-care systems with major contracts expiring in 2022 include the University of California (14,600 workers), New York City Hospital Alliance (10,000 workers), and Michigan Medicine (6,100 workers).

Walkouts Likely

Contentious health-related contract negotiations last year offer a glimpse of what may lie ahead. Around 30,000 West Coast Kaiser Permanente employees nearly walked off the job in November, reaching an agreement days before a strike was scheduled to start.

In Massachusetts, nurses engaged in a nine-month work stoppage that ended only after U.S. Labor Secretary Marty Walsh, a former mayor of Boston, mediated a final negotiating session last month. The same union, the Massachusetts Nurses Association, is now in the midst of another contract battle in the seaside towns of Beverly and Gloucester, where labor leaders say 30% of nurses have left since the pandemic began.

“Health care is typically one of the most contentious industries, in terms of impasses and work stoppages during contract negotiations,” Bloomberg Law analyst Robert Combs said. “And that’s not even taking into account all of the added stressors of working in front-line jobs during the pandemic era. It all could lead to a serious ramping-up of labor tensions in the year ahead.”

Worker Demands

Nurses’ wages haven’t kept up with the job’s increasing difficulty during the pandemic, labor leaders say. Better pay is critical for employee retention and recruitment, particularly for health-care facilities in rural areas where it’s hard to attract workers, said Deb Snell, a registered nurse and president of the Vermont Federation of Nurses & Health Professionals.

“Our cost of living just continues to rise, and a lot of our younger staff aren’t staying,” Snell said. “Even some of our older staff are leaving. We’re losing a lot of people to travel right now.”

Hospitals have paid $24 billion more for labor each year during the pandemic, according to the health-care improvement company Premier Inc. Some are struggling to fill lower-level positions because they have to compete for employees with retailers like Walmart Inc. that have raised their wages.

“In 2020, a lot of elective or schedulable procedures were canceled or deferred,” threatening hospitals in rural areas “that were in danger of not surviving,” said Rebecca Givan, associate professor of labor studies and employment relations at Rutgers University who studies the health-care sector.

Hospitals have little incentive to hire more nurses during a shortage, since they don’t generate the kind of lucrative payments from insurance companies that other clinicians do, said David Coppins, CEO of IntelyCare, a staffing platform that directly employs 30,000 nurses. That’s been compounded by the fact hospital executives have been slow to listen to staffing complaints, he said.

“I will say quite confidently that the C-suite in most health systems are still not aware or believe when nurses tell them there’s a few things that they need,” Coppins said.

Unfilled Jobs, Wage Pressures

Across the healthcare and social assistance industry, more than 7% of jobs went unfilled on average in 2021—the highest level of vacancies in the past decade, according to the Bureau of Labor Statistics. Openings peaked at 8.5% in October. Data for December, which could show the Omicron variant’s impact on the industry, hasn’t been released.

Snell represents 2,400 workers at the University of Vermont Medical Center whose union contract will expire this summer. The contract was originally set to expire in July 2021, but the union requested an extension due to the pandemic, a spokesperson for UVM Medical Center said.

Many nurses have taken over “non-nursing duties,” such as stocking rooms and transporting patients, because the facility doesn’t have enough workers, Snell said. Higher salaries, tuition reimbursement, and loan forgiveness would help attract more workers to the field, she added.

Nurses in the union have received a 19.58% wage increase on average over the four-year contract, the UVM Medical Center spokesperson said.

“I’m very concerned” about the possibility of a strike, which has the potential of disrupting patient care, Snell said. The union went on strike in 2018. While UVM Medical Center hired replacement nurses, elective surgeries were canceled.

UVM Medical Center’s staff “have been working incredibly hard to care for our community during a time of sustained high patient volumes, a COVID-19 surge, and a nationwide health care staffing shortage,” said Stephen Leffler, UVM Medical center’s president and chief operating officer.

The facility is “fully committed to working with the union” and to paying competitive wages despite the financial challenges the pandemic has brought on the industry, Leffler said.

Tension between the Massachusetts Nurses Association and the Northeast Hospital Corporation could soon boil over, with nurses at those facilities making 10%-12% less than they would at competing companies, according to the union. Nearly six dozen nurses of the initial 800 have left since the pandemic started—a loss of nearly 2,000 hours per week that has made handling the influx of Covid patients all but impossible, said Simon, the Massachusetts Nurses Association official.

Kaiser Permanente nurses and workers demonstrate outside Kaiser Permanente San Francisco Medical Center in November.
Photographer: Justin Sullivan/Getty Images

Management “recognize[s] the need to adjust wages to better reflect broader market conditions and respect the contributions of our nursing team,” and will continue updating its contract proposal, Kim Perryman, chief nursing officer at Beverly Hospital, said in a statement.

Shifting Power

It’s a similar situation in New York, where one union says staffing vacancies at the WellLife Network, which operates residential care centers for people with disabilities, are nearing 40%. That’s put a strain on the rest of the staff, some of whom are mandated to work 48 hours at a time in round-the-clock facilities, according to the union.

“The shortage is really important, and it’s magnified by not being able to attract people because the wages are so low,” said Warren Pepicelli, an official for UNITE HERE who’s involved in the negotiations.

In a statement, WellLife spokesman Marvin Sperling said the company “has not begun to discuss the economics of the CBA, but anticipates a fair and equitable outcome as we have always had in the past.”

Union demands around working conditions were prevalent long before the pandemic set in.

“Nurses are very committed to providing high quality healthcare,” so understaffing puts “tremendous stress” on them, said Paul Clark, a professor of labor and employment relations who studies nurses’ unions.

Labor shortages across industries in the U.S. have “shifted the power in the employer-employee relationship,” Clark said. “Workers have more power than they’ve had in decades,” which will lead to “a lot of very contentious negotiations” this year. It will also lead to the formation of new unions, more threats of strikes, and better settlements, Clark said.

—With assistance from William Jeremiah

Methodology: Bloomberg Law analyzed data from 458 contracts to estimate the number of health-care workers operating under labor agreements expiring in 2022. Those contracts included 318 contract expiration notices submitted to the federal government and 140 contract settlements from Bloomberg Law’s internal database that mention a 2022 expiration date. Some health-care providers included in the data may have already negotiated new contracts with their workforce.

Many contract expiration notices for 2022 have also not yet been filed. This means the actual number of health-care workers covered by expiring contracts is likely far larger than 207,000.

To contact the reporters on this story: Andrew Wallender in Washington at; Ian Kullgren in Washington at; Allie Reed in Washington at

To contact the editors responsible for this story: Cheryl Saenz at; John Lauinger at