Healthcare workers rally outside Kaiser Permanente Los Angeles Medical Center in Los Angeles on Friday, October 6, 2023. (Ringo Chiu via AP)

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Keven Dardon has worked at a Kaiser Permanente hospital in Clackamas, Ore., for nearly 14 years. As a patient access representative, he is the first person patients see as they arrive and complete paperwork before their appointments. But October 4, when more than 75,000 healthcare workers at Kaiser Permanente locations across five states and Washington, D.C., walked off the job for three days, marked the first time he had ever been on strike.1

For many years, Kaiser workers, who are unionized, didn’t feel the need to strike. Dardon got involved with the hospital chain’s labor-management partnership, a venue for executives and workers to meet regularly to raise problems with working conditions and come up with solutions, back in 2013. But over the last few years the partnership has been “diminishing,” he said. Executives started making choices that, he felt, ignored employee concerns, particularly when it came to hiring enough staff. His team alone has gone from 60 full-time employees in 2018 to 38 today.2

Kaiser regularly sends out reports about the growth of the company’s patient load and “how they’re gaining all this profit, but we’re not seeing the staffing levels [change],” he said. That became a major issue in the union’s negotiations for a new contract, which started in April. All he and his fellow workers are asking, he said, is for Kaiser to listen to them. “We have the solutions to fix Kaiser’s short staffing crisis,” he said. “We need Kaiser to come to the bargaining table in good faith to be able to work on these issues.”3

In response to a request for comment, Wayne Davis, a Kaiser Permanente spokesperson, noted, “Every health care provider in the nation has been facing staffing shortages and fighting burnout.” He said the hospital chain has hired more than 50,000 people over the last two years, has a turnover rate one-third of the industry average, is “a leader in compensation,” and offers “great benefits,” adding, “Kaiser Permanente remains committed to reaching an agreement that is good for our employees, our members, and our organization, and we will continue to bargain in good faith.”4

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Stalled at the bargaining table, Dardon and other Kaiser frontline healthcare workers in support staff positions, including everything from nurses and therapists to dietary and housekeeping workers, staged the country’s largest-ever strike in early October. It followed an enormous number of strikes in healthcare since the start of the pandemic. There were 76 between January 2021 and April 2022, one of which was likely the longest nursing strike in three decades, at St. Vincent Hospital in Massachusetts. Six of the 19 biggest work stoppages this year have been in healthcare. Healthcare workers, burned out from the demands of the pandemic, nearly universally say increasing staffing so they can better do their jobs is their number one concern.5

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On October 13, after the first full day of bargaining once the strike ended, the unions announced that they had reached a tentative agreement, although they did not release details.6

Driving these strikes is “the corporatization of healthcare,” said Karen Lasater, an associate professor at the University of Pennsylvania School of Nursing, which means “hospitals are more and more focused on making profits.” This trend has emerged as hospitals have rapidly consolidated, which research has found might increase profits but harms patient care. That has created “dissonance,” she said, between what frontline healthcare workers are focused on—doing their jobs well and giving patients quality care—and what upper management is focused on. “As long as profits continue to be their motivation, they’ll continue to squeeze their frontline workers as much as they possibly can,” she said.7

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But, years after the start of a pandemic that not only cost thousands of lives of healthcare workers but also lauded them as heroes and demanded ever more from them, workers “are no longer willing to be squeezed,” she said.8

Keven Dardon loves his job. “I love member interaction, helping people navigate Kaiser systems, helping people with financials if they’re going through hardship,” he said. “That face-to-face contact with members and putting them at ease when they’re in a stressful environment is what I enjoy doing.”9

But it’s become much harder. In the years immediately preceding the pandemic his department started to see “drastic changes,” he said, most acutely in staffing. Then the pandemic exploded everything. Dardon and his coworkers feared for their lives and that they would bring Covid home to their families, dealing with a shortage of personal protective equipment that plagued many hospitals at the time. “While everybody else was locked down and working from home, we actually had to show up to the hospital every day,” he said.10

Not only have they not had a break to process that experience, they are now being asked to do more and more and with less and less. Staffing is even lower than it was in 2019. “That means there’s certain tasks that we can’t complete daily,” he said. Of five check-in desks, usually only two or three are actually open. The emergency department’s check out desk, where Dardon and others take copays, review documents, and offer financial assistance, is closed on night shifts. Dardon is technically supposed to work 36 hours a week, but over the past two years he’s averaged 58 to 60, thanks to picking up overtime to make sure patients are taken care of. “I’m exhausted. I feel burnt out,” he said. “I don’t want to continuously be working myself to the bone.”11

Even with his extra efforts, he’s concerned about what it means for patients. Fewer employees at the check-in desks means patients wait longer to get to their appointments, which can cut the time with doctors short or even require patients to reschedule if they can’t wait 20 or more minutes to get checked in. “It’s very saddening,” he said. Patients get upset, understandably, and take it out on Dardon and his coworkers. “Low morale is very big in our department,” he said.12

Dardon was nervous about the strike leading up to it, never having been on one. But on the picket line he saw “so much bonding and camaraderie and all of us wanting the same goal, all of us voicing how staffing is front and center of our strike,” he said. The community also stood with them. Patients drove by, honking their horns and making heart signs with their hands or giving thumbs up; one put a sign saying she stood with them in her window. “We knew the community had our backs, we had their support,” he said. “They really rallied behind us. It’s a great feeling that you’re fighting and standing up for something that’s meaningful, not just to employees but to the community and patients.”13

Supporters came out in Oakland, Calif., too, where Fay Eastman, a patient care technician in the intensive care unit at Kaiser, was also on strike in early October. As we spoke, cars honked their horns and people cheered in the background. “It is loud,” she said. Workers on strike try to make themselves and their demands as visible as possible; she was on the strike line every day from six in the morning to six at night. She estimated that the crowd numbered about 800 people, including other workers in other unions who came out in solidarity, every day of the strike, despite a heat wave hitting the area. On the Friday we spoke, it was friends and family day, and coworkers had brought their children, including a month-old baby.14

Eastman has worked at Kaiser for 15 years and loves taking care of patients. But she’s also suffered from the same reduction in staffing level that Dardon has experienced. In the years before the pandemic, four patient care technicians staffed the ICU floor, she said. Then it went down to three, then to two, and now there’s just one trying to care for 23 patients. “It’s extremely hard trying to get to every single person because now I’m doing the work of three or four,” she said. It used to take minutes for her to respond to a patient’s call; now it can take her as long as 45 minutes. “That’s bad patient care. I don’t want to provide bad patient care,” she said.15

It’s bad for her, too. Sometimes she can’t get any breaks during her shift because there isn’t enough staff. That can mean choosing between getting a patient to the bathroom or going to the bathroom herself. “Our poor bladders,” she said with a laugh. She at least wants “a break where we could rehydrate, use the restroom, eat a little something and then get back on the floor.”16

“I’m a valuable employee, I know I’m skilled. So don’t treat us like trash,” she said. “We stayed during the pandemic. Value us. We are valuable.”17

But bargaining over solutions to those problems had come to a “standstill” before the strike, she said. “Executives are basically refusing to listen to us frontline healthcare workers.” So when Eastman, who is on the bargaining team, started educating her coworkers about the need to strike, “they were pretty much ready,” she said.18

The Kaiser staff also knew that they would be striking at a historic moment. Eastman and the thousands of other Kaiser workers went on strike while 16,000 Hollywood actors and about 25,000 auto workers were also on strike. In a statement expressing solidarity with striking Kaiser workers, United Auto Workers President Shawn Fain said,19

Whether you work in a hospital, or behind a desk, or on an assembly line, your fight is our fight.20

We all deserve dignity on and off the job. We all deserve a future for our families and communities. We all deserve our fair share of the economy we, as working people, create and run. 21

More than 445,00 workers have gone on strike so far this year, making for the most strikes since 2000.22

“That’s pretty amazing, to be part of history,” Eastman said. “It’s like the year of the strike and I’m happy to be part of it.”23

Both Dardon and Eastman emphasized that while the strike felt worth it, they would have preferred to instead have reached a deal with Kaiser that allowed them to keep caring for patients inside the hospital. On October 7 they went back to that work, ending the strike and resuming their jobs caring for patients.24

Kaiser workers may be able to win concessions on staffing from their own employer. But that’s unlikely to shift the broader problems in the industry. For that, lawmakers need to act. Perhaps, Lasater said, these strikes can not only secure demands at the bargaining table but also wake up Congress and regulators.25

One useful intervention would be to pass legislation mandating safe staffing ratios, which currently only California has done, although New York mandated a ratio of one nurse to two patients in critical care units in June. In some hospitals, nurses can be assigned as many as 10 patients at once. Ensuring that nurses only care for a reasonable number of patients wouldn’t just make their workloads more manageable, but reduce hospital stays, readmissions, and deaths.26

The Centers for Medicare and Medicaid Services, meanwhile, already has rules and requirements hospitals have to meet in order to be fully reimbursed, and it could use the same authority to require hospitals to maintain adequate staff. Because Medicare is the largest hospital payer, “it would be a major motivation for hospitals to change their behavior,” Lasater said.27

Hospitals, of course, could make these changes on their own without government intervention. They could even make smaller but meaningful changes, such as doing away with 12-hour shifts that can drive people out of the profession. But the fact that they haven’t changed anything, Lasater said, makes a case for regulatory and policy change.28

The problem is not, however, a labor shortage, she argues. Plenty of people are getting licensed to be nurses, for example, with 13,000 more in 2021 than in 2019. “Hospitals are in a crisis of their own design,” Lasater said. “They’ve chronically understaffed nurses and other frontline workers.” That has, in turn, driven people from the industry to seek jobs elsewhere that will treat them better. “It’s not because we don’t have nurses,” she said. “It’s because nurses don’t want to work in the conditions that hospitals are offering.”29

Until something bigger changes, “I don’t think we’re going to see an end to these historic strikes year after year,” Lasater said. “Because hospitals don’t have a reason to behave any differently.”30