By Jessica Petro

Across the country, hospitals and health systems are navigating one of the most active and complex labor environments in recent memory. Several high-profile labor disputes have dominated national headlines and caused disruptions to hospital operations.

In early 2025, 5,000 Providence Health & Services nurses in Oregon held a 46-day strike, the largest in state history. On February 20, 2026, nurses and other healthcare professionals at Providence Cedars-Sinai Tarzana Medical Center in California concluded a five-day strike. Also in California and in Hawaii, 31,000 Kaiser Permanente nurses recently ended a four-week strike, while 15,000 nurses across NY-Presbyterian/Columbia, Montefiore, and Mount Sinai concluded the largest nurse walk-out in the city’s history.

Understandably, the growing frequency of these situations is reshaping labor strategies and placing a renewed emphasis on proactive communication, as hospitals and health systems seek to anticipate how escalating labor negotiations may impact patient care and operations.

In the Background

Large, multi-state health systems are no strangers to labor negotiations, but this trend has signaled a broad strategy shift by unions and a departure from pandemic-era camaraderie that many health systems relied on to guide the mediation process.

The onset of COVID-19 presented a somewhat united front for labor groups and their health system counterparts. Amidst the chaos, there was a sense that both groups were working towards the same goal of surviving the surges and rebuilding a system that had experienced devastating loss. While there were certainly outliers, the pressures faced during this time were clear and uniting. Moreover, hazard pay mandates, ARPA funds, and worker bonuses served as morale boosters and well-deserved recognition. But as the healthcare ecosystem has recovered, lingering issues are driving frustration.

Key Issues

What we’re seeing is that labor unions, frustrated with the pace of negotiations, are responding more quickly and more consequentially than in years past. Labor group leaders who may have seen striking as a last resort are increasingly choosing it as an earlier line of defense, despite potential criticism from their membership.

On top of that development, the current federal environment and persistent financial challenges have left hospitals and health systems in a precarious situation. The rising costs of labor, benefits, supplies, and equipment are straining hospital finances, while reimbursement rates are not adequately covering the cost of providing care. Looming Medicaid cuts are also forcing health systems to reconsider how they offer the most essential but loss-generating services.

Union leaders see this reality and have responded accordingly. In recent years, non-wage issues like staffing levels and benefit offerings have been at the forefront of labor unions’ bargaining strategies. Benefits, for example, have become a real concern for members, as many employers work to address rising insurance premiums. In California, Hawaii, and New York, staffing levels and patient caseloads have been cited as major points of contention, pointing to alleged patient safety problems.

What Local Health Systems Can Learn

These national trends serve as important lessons for hospitals and health systems across the northeast.

First, it’s essential to maintain clear and transparent communication with employees at all times – not just during the negotiation process. Building a strong foundation of respect and understanding requires consistency, timely action, and active listening. Health systems can use existing channels to increase communication, as long as these channels resonate with employees and provide ample opportunities for feedback. Over time, employees will know that even if they don’t agree with a policy or update, they will always receive direct information that has their voices in mind.

As negotiations progress, union members may also receive differing messages across multiple channels. When appropriate, health systems should also prioritize sharing straightforward updates about the negotiation process, the system’s priorities, and any next steps. Serving as a steady source of reliable information can counter natural anxiety and dissuade rumors. It can also boost the organization’s credibility as a steward of accurate information. By clearly reinforcing the system’s goals and broadly aligning them with those of the union, you can re-center the conversation on shared interests.

Additionally, the court of public opinion is a major influence on the negotiation process, regardless of a health system’s own external strategy. Across the region, unions often receive wide public support, particularly when their points are framed around safety and quality. Casting the union as the adversary can quickly backfire and erode your institution’s integrity. Moreover, it’s important to remain measured and thoughtful in any public responses to unions and their supporters. Choosing to take the high road can avoid a tit-for-tat situation and will help you appropriately combat misinformation without compromising relationships.

Instead, when speaking publicly about negotiations, keep the focus on shared values, which could be improving operations and safety, supporting employee wellbeing, or maintaining a competitive compensation package. The more a system can point to what both sides have in common, the easier it is to avoid finger-pointing, the ‘blame game,’ and alienating employees.

Why it Matters

Avoiding a strike scenario is not only good for public opinion, but it also preserves vital financial and operational resources that could be reinvested into patients and employees. During a strike, temporary labor and security are significant cost burdens, and lost revenue from canceled or limited services can seriously dent margins and impact patients’ ability to access the care they need. This reality makes it clear that a solid communications strategy is key to mitigating long-term risk and maintaining stability.

In this complex environment, approaching negotiations with transparency, respect, and a clear focus on patient care can better position health systems to navigate turbulence while preserving trust. Above all, a health system must be willing to adapt its playbook to meet the evolving needs of its workforce while holding true to its values and mission.