Vigorous union campaigns are taking over Pittsburgh hospitals — and they’re landing major pay and workforce wins

Technical.ly partnered with PublicSource to explore the landscape of work in Pittsburgh — famed for its industriousness and intense union-management conflict and collaboration — as it is pressure-tested by changes in governmental policy, technology and economics.

When UPMC acquired a struggling two-hospital health system in Washington and Greene counties last year, it promised to invest hundreds of millions of dollars into its revitalization. 

State and local elected officials argued the acquisition was necessary to keep the system afloat and save more than 2,000 jobs. But union leaders protested the deal, pointing to a track record of rural hospitals closing after takeovers by UPMC and other corporate owners. 

Despite that pushback, Washington Health System officially joined UPMC in June. It hosted a celebration at the newly named UPMC Washington Hospital that was attended by the healthcare giant’s top executives. In a speech, the hospital’s president, Brook Ward, said employees would gain “pathways to promotions, professional growth and earning potential” under UPMC’s stewardship.   

About eight months later, the hospital’s lowest-wage union workers voted to authorize a strike. They said UPMC had only offered them about 23 cents more per hour — nowhere near enough to offset the rising cost of living for the cooks, housekeepers, unit secretaries, surgical technicians and others in the union. UPMC also wanted to raise health insurance premiums and eliminate paid holidays for part-time staff, among other cuts detailed in a press release from SEIU Healthcare Pennsylvania, which represents the workers. 

“We’re the heart and soul of the hospital — the ones who keep that place running,” said Melissa Duran, an electrocardiogram technician and local SEIU chapter president. “We just want to be able to pay our bills, pay our mortgage, make the car payment and not have to worry about buying groceries right now,” she told PublicSource before the Feb. 3 vote to strike.  

As Southwestern Pennsylvania’s economic heart is transplanted from mills to health care, some of the region’s fiercest organizing battles are now being fought between hospital workers, notably including nurses, and health systems. In Washington, as elsewhere, organizers have notched successes. The union negotiated an average raise of 4% per year, up from the 1% originally offered. Some workers will get as high as 19% over the life of the three-year contract. 

It’s the latest in a wave of recent victories for unionized hospital workers, who say they’re tired of low pay, chronic understaffing and other work conditions they feel are unsafe and unsustainable. Nurses at Allegheny Health Network’s Allegheny General Hospital and West Penn Hospital, and UPMC Western Psychiatric Hospital were able to win unprecedented concessions from their employers over the past year, including double-digit-percentage raises that unions say are already easing the staffing crisis. Nurses across the two rival health systems say they achieved those victories by coming together and sharing bargaining strategies — a kind of worker mobilization that’s never happened on this scale in the region’s healthcare industry.

“From what we have seen, those nurses have done a fantastic job sticking together and fighting for what they wanted,” said Duran. They showed us that “it can be done and it has been done.” 

PublicSource sent detailed questions to UPMC and AHN about hospital work conditions and labor negotiations. UPMC didn’t respond, and AHN provided limited answers, emphasizing its commitment to employees while expressing a preference for direct labor relations.

‘The tip of the spear to lead change’ 

Nurses at Allegheny General Hospital decided to play hardball during their contract negotiations with AHN in 2023 — a time of strikes and nationwide labor unrest. 

“The fact that most hospitals have staffing shortages doesn’t mean that nurses have to accept it,” flight nurse and union officer Annale Yobbi said in an SEIU press release. 

After threatening to strike, they negotiated an average raise of 23% and a starting wage that will reach $40 an hour by the end of the contract, for those with a bachelor of science in nursing — terms the union said would transform the profession in Pittsburgh. They also won better nurse-to-patient ratios in some units and more safety measures to prevent violence.   

Nurses across the region sat up and took notice. “It really started a lot of people talking,” said Kari Xander, a neonatal intensive care nurse at West Penn. 

John Hobdy, a nurse at Western Psych, attended a mass Zoom meeting with AGH nurses that summer. “They told us they wanted to be the tip of the spear to lead change in the Pittsburgh area, and the wage they were asking for was $40 an hour,” said Hobdy, a JNESO local union officer. “I remember people saying that was crazy. 

“And then I saw the change when they got it. And for us, we’re like, ‘Well, these other systems could do it. Why can’t we?’”  

Post-pandemic staffing woes    

Labor militancy, or a willingness to strike, is a response to a nationwide staffing crisis in hospitals. An expert described “a vicious cycle” that’s driving it: Hospitals don’t pay well enough to recruit and retain enough workers, and understaffing makes conditions worse for existing staff, causing some of them to quit. 

“It just kind of went round and round,” said Sara Goodkind, a professor of social work at the University of Pittsburgh. “I do think increasing pay is a really important strategy for disrupting that cycle.”

Goodkind is part of a team of researchers who identified, through surveys and focus groups, the biggest problems plaguing nurses and low-wage hospital workers in the region, including: 

• Risks to patient care due to understaffing and poor worker-to-patient ratios   
• Low pay, inadequate benefits and lack of mental health supports 
• Safety concerns due to violence and threats from patients and families 
• Management styles that devalue workers’ voices and expertise.   

Hospital workers said these problems have existed for decades, but the COVID-19 pandemic made work conditions unbearable for many. Some left the industry altogether. Hospital administrators overloaded remaining staff with patients, but did little to address the root causes of the staffing crisis, they added. 

Advocates say unionizing is one of the few ways hospital workers can build enough power to solve these problems, but noted the relatively low union density in the region’s health systems. The majority of UPMC’s 21,000 nurses are reportedly non-union, and an AHN spokesperson told a reporter in 2022 that 14,800 employees — more than half its workforce — are nonunion. Neither responded to a PublicSource request for updated figures.   

“Despite our being one of the most significant labor hotbeds in the country, if not the capitalist world, the capacity to unionize in the health care industry has been very, very, very much thwarted,” said Ken Thompson, a psychiatrist at the Squirrel Hill Health Center who practiced at Western Psych nearly two decades ago. “People are scared. They want to have a job, and they don’t want to be blackballed.”

PublicSource asked AHN how it interacts with unions or workers who want to unionize. Spokesperson Candace Herrington wrote, “Although we strongly believe that effective labor-management relations can be achieved without the influence of a third party, we also respect the right of employees to consider or seek representation if they feel it’s in their best interests.”

In response to questions about how AHN recruits and retains staff, she wrote that it offers “market-competitive” wages and benefits, flexible work schedules and digital nursing roles for experienced nurses. It also makes “considerable investments” in programs and tech to “improve workplace wellness, reduce burnout, ensure nutrition and hydration, and minimize turnover rates.”

UPMC spokesperson Ashley Trentrock didn’t respond to emailed questions and a phone call. 

Goodkind pointed out that while the pandemic took a heavy toll on hospital workers, it may also have given them more power and leverage at the bargaining table. 

“There really did seem to be very little recognition of just how challenging this work is under the best of circumstances,” she explained. “I think the spotlight that COVID put on hospital workers … was useful in their organizing.”

How hospital workers mobilized 

The AGH union victory kicked off a period of strategizing and coordinating among nurses across Pittsburgh. 

During a series of Zoom meetings, AGH nurses advised other union nurses whose contracts were expiring soon. Be as organized as possible and back up your demands with data, they said. They shared examples of contract language and some even planned to show up to bargaining sessions at other nurses’ hospitals. 

Union nurses at West Penn and Western Psych took those lessons into their own contract battles. Both had serious problems they needed to solve: Xander said West Penn was able to recruit new nurses, but “they were leaving as fast as they were coming.” Some senior nurses had left because their raises were lower than what newer nurses were getting. That poor retention contributed to unsafe staffing ratios, she added. 

“It was starting to become very hard to walk away at the end of your day feeling like you didn’t do everything that you possibly could have done for a patient,” said Xander, who was president of the local SEIU chapter at the time. 

At Western Psych last year, understaffing reportedly caused the hospital to close beds on almost every floor, which meant some patients were placed in units that weren’t equipped for their diagnoses or specific needs.  

Hobdy, who works in a unit for older adults, said he sometimes cared for eight patients at a time — far worse than the one-to-five minimum ratio required by California, one of the few states with safe staffing laws. Research shows the odds of patient mortality jumps by 7% with each patient added to a nurse’s workload.

Experts say the problems at Western Psych reflect the country’s ongoing mental health care crisis, caused by more people seeking treatment, a shortage of providers and an industry that undervalues this kind of care.

‘More Scrubs, Less Suits’

Nurses at West Penn authorized a strike after rejecting a contract proposal from AHN in August. Nurses at Western Psych did the same while negotiating with UPMC in October. 

They held rallies and press conferences over the summer and fall to drum up public support. Xander and Hobdy gave rousing speeches in front of reporters and supporters who waved signs that read, “More Scrubs, Less Suits.” Elected officials backed them, including Pittsburgh Mayor Ed Gainey, County Executive Sara Innamorato, U.S. Rep. Summer Lee and Pennsylvania Lieutenant Gov. Austin Davis.

Their efforts seemed to work. 

After threatening to walk off the job, West Penn nurses reached a deal with AHN during a bargaining session that stretched into the night: An average pay raise of 24%, with all nurses earning at least $40 per hour by the end of the contract. Those with 20 years of experience or more will earn at least $50 per hour — a bid to keep senior nurses on staff. The contract also set safe staffing ratios, including guidelines for the neonatal intensive care unit where Xander works.   

“You don’t see that, I would say, in the average NICU,” Xander said, “so that was something very big that we won in our contract.”  

In the wake of AHN’s concessions but negotiating with a different health system, Western Psych nurses and UPMC were initially as far apart “as you could be from the sun to Neptune,” said Hobdy. Though UPMC officials “were reluctant to move on anything,” he and the other nurses stood their ground on the issues they felt were most important, including poor staffing ratios.  

Each nurse in the room told the officials what was going wrong in their units, said Amy Kenny, a nurse at Western Psych for the past 38 years.

“We made them sit through it all,” said Kenny, who works in a unit for mood disorders, schizophrenia and other types of patients. “It set a tone that we’re not there to play around.” 

The union won concessions it said were unprecedented in the UPMC system: The nurses became the first to be paid more than $40 — a 31% raise over the course of the contract. And a clinical ladder, which offers professional development, will give nurses the opportunity to receive an average raise of 35%, with the highest wages totaling 44% by the end of the contract. 

Higher wages, safer staffing

Labor actions may be easing the staffing crisis in some union hospitals.

The number of nurses at West Penn climbed from 597 in January of 2024 to 675 last month — a 13% increase, according to data provided by SEIU. It attributes the increase to the new contract, which was ratified in September. 

Xander said staffing ratios have improved and nurses have a better work-life balance. “People feel like they’re being invested in, they’re being acknowledged and they’re being respected,” she added. 

The AHN spokesperson didn’t confirm the union’s numbers or its assertion that the contract is a driving force behind improved staffing at the hospital. She said the health system experienced “a significant increase in nursing hires” over the last year, which is the result of “different strategies” it adopted to improve recruitment and retention.

Western Psych nurses said they’re seeing improvements, too. 

The hospital’s turnover rate was 67% from October 2023 to January 2024. It fell to 24% after the new contract was ratified last fall, with just eight employees quitting between October and January, according to data provided by the union. 

“The whole culture in the hospital has changed,” said Hobdy, noting it’s hiring more nurses and reopening some beds. And safer staffing levels are allowing more patients to get fresh air on the patio and recreate in other spaces. 

“Imagine if the other thousands of nurses that work at the other hospitals were to get on board,” added Hobdy, who hopes to see more unionization across the region.

Many of those non-union nurses stand to benefit from a recent UPMC pledge to raise their starting wage by 20% through 2027 — a move that was “responding to pressure from union nurse standards,” according to an open letter to UPMC executives, signed by more than 1,000 union and non-union nurses. It called on the health system to do more to retain senior nurses, among other demands.  

Naomi Edwards, a non-union nurse, was among those who delivered the letter. She joined the Zoom organizing meetings and showed up to rallies to support her union colleagues. 

“We’re very happy for them as we’ve watched them get those things that we don’t have,” said Edwards, who floats among units at UPMC Montefiore and UPMC Presbyterian. “I think the answer is more union and non-union nurses working together to elevate the entire field, to put pressure broadly on these healthcare systems to invest in nurses and patient care.” 

Back in Washington, hospital workers ratified their new contract earlier this month. Duran, the EKG tech, said the union is shifting its focus to making sure UPMC keeps the promises it made during the acquisition, including a $300 million investment over 10 years to improve services and facilities.

As they prepare to hold the healthcare giant accountable, they’re taking advice from nurses who blazed the trail last year: “Don’t give up and don’t give in,” Duran said.