31,000 Kaiser nurses and health professionals in California and Hawaii set strike date over staffing and pay

The waiting room at Kaiser Permanente’s Baldwin Park Medical Center east of Los Angeles is usually full by midmorning. On Jan. 26, many of the nurses, pharmacists and therapists who staff it plan to be outside instead, lining the sidewalk with picket signs in what could become one of the largest open‑ended healthcare strikes in the country.

Unions representing about 31,000 Kaiser Permanente nurses and other licensed health professionals in California and Hawaii have issued a 10‑day notice for an unfair labor practice strike beginning at 7 a.m. Monday, Jan. 26. The walkout would target nearly 20 hospitals and about 200 clinics operated by the nonprofit health giant, which insures and treats roughly one in four Californians and more than 270,000 people in Hawaii.

Union leaders say they are prepared to stay out as long as it takes to secure safer staffing, higher pay and what they describe as basic respect at the bargaining table. Kaiser says it wants to avoid any disruption, insists its hospitals and medical offices will remain open, and argues it has already offered workers some of the largest wage increases in its history.

At stake is how one of the country’s most influential health systems balances its nonprofit mission, its growing surpluses and a workforce that says thin staffing is putting patients at risk.

Staffing, burnout and a “moral injury”

The strike threat comes from the United Nurses Associations of California/Union of Health Care Professionals, or UNAC/UHCP, which represents registered nurses, nurse practitioners, midwives, physician assistants, pharmacists, nurse anesthetists, physical and occupational therapists, speech language pathologists, dietitians and other professionals at Kaiser facilities.

In a Jan. 15 announcement, the union said its members delivered a formal 10‑day notice under federal labor law for an “unfair labor practice strike” starting Jan. 26. The notice cited “chronic understaffing, burnout, safe staffing levels, timely access to quality care, fair wages and respect at the bargaining table” as core issues.

Union leaders have described the current conditions as a form of “moral injury,” saying caregivers are unable to provide the level of attention they were trained to deliver.

“We are not walking out to make noise. We are walking out because we need staffing that actually protects our patients and stops the moral injury nurses are dealing with every day,”

—a UNAC/UHCP officer said in the strike notice.

The union argues that staffing shortages have lengthened wait times for appointments, forced nurses to take on heavier patient loads and increased the risk of medical errors. It has pointed to crowding in emergency departments, delayed follow‑up visits after hospital discharges and high turnover in specialty areas like intensive care and oncology.

California is the only state with broad, legally mandated nurse‑to‑patient ratios, including a maximum of five patients per nurse on medical‑surgical units and two patients per nurse in intensive care. UNAC/UHCP says Kaiser has contract language that exceeds some of those minimums—for example, staffing medical‑surgical units at four patients per nurse—and contends those standards are not being consistently met.

In Hawaii, where no fixed nurse‑to‑patient ratios exist, lawmakers have been weighing bills that would require hospital staffing committees and baseline standards. Kaiser’s Hawaii operations, which are folded into the strike, sit in the middle of that debate.

Kaiser says its offer is “the strongest” in its history

Kaiser Permanente, based in Oakland, is the nation’s largest nonprofit health system by revenue, with more than 13 million health plan members and dozens of hospitals across multiple states. It is bargaining with UNAC/UHCP as part of a larger set of talks with the Alliance of Health Care Unions, which represents more than 60,000 Kaiser workers.

In a Jan. 16 statement on the latest strike notice, Kaiser said it has been in national bargaining with the Alliance for more than seven months, calling it “the longest national bargaining in our history.” The previous national agreement expired Sept. 30.

Kaiser said it has offered “the strongest proposal in Kaiser Permanente’s history,” including across‑the‑board wage increases totaling 21.5% over four years. Under the proposal, workers would receive 6.5% raises at ratification and again in October 2026, followed by 3%, 2.5% and 3% increases through 2028.

The company also highlighted minimum hourly wage floors of $25.56 for Alliance‑represented workers in California, $24 in Hawaii and $22 in Colorado, Georgia, the Mid‑Atlantic, the Northwest and Washington state.

Kaiser also said Alliance employees already earn, on average, about 16% more than similar positions at other health care organizations, and in some markets as much as 24% more.

Kaiser officials say rising labor costs, expensive new drugs and higher acuity among patients have squeezed operating margins, even as overall revenues and membership have grown. In recent financial disclosures, the organization reported operating revenues in the tens of billions of dollars each quarter and a modest operating margin of less than 1%.

“Profits over patients” or necessary reserves?

UNAC/UHCP has challenged Kaiser’s financial framing with a report released the same day as the strike notice titled “Profits Over Patients.” The union said Kaiser earned $7.9 billion in net income during the first three quarters of 2025 and held an estimated $66 billion to $67 billion in unrestricted cash and investments at the end of 2024.

The report accused Kaiser of amassing extraordinary reserves for a nonprofit, while leaving frontline departments short‑staffed. It also criticized Kaiser’s investment portfolio, alleging ties to private prisons, immigration detention, fossil fuel producers and other industries that, in the union’s view, conflict with a healthcare organization’s mission.

Kaiser has said its reserves are essential to maintain stability, finance capital projects such as new hospitals and technology, and protect against downturns and unexpected shocks. It has not directly adopted the union’s characterization of its investments but has stressed its commitment to community health and affordability.

The financial dispute is unfolding as Kaiser continues an expansion push, including through its Risant Health platform, which acquires and partners with smaller health systems. Union leaders say that growth has not been matched by staffing investments inside legacy hospitals and clinics in California and Hawaii.

A partnership under strain

The looming walkout is the latest in a series of labor flashpoints at Kaiser.

In October 2023, more than 75,000 workers in a separate group of unions staged a three‑day strike in multiple states that was widely described as the largest healthcare worker strike in U.S. history. That dispute ended with a tentative agreement that set minimum hourly wages at $25 in California and $23 elsewhere for those workers, along with 21% wage increases over four years.

Last October, UNAC/UHCP led a five‑day strike involving about 31,000 nurses and health professionals at Kaiser facilities in California and Hawaii. That action, the largest in the union’s 50‑year history, ended without a final contract, though the parties agreed to continue bargaining on pay and staffing.

The current strike notice escalates the conflict by making the walkout open‑ended and framing it as a response to alleged unfair labor practices, not only to economic issues. On Dec. 20, UNAC/UHCP filed a charge with the National Labor Relations Board accusing Kaiser of stalling negotiations, canceling or skipping scheduled sessions and improperly communicating directly with members instead of bargaining through the union.

Kaiser has denied bargaining in bad faith and offered a different account of why talks paused late last year. The company said a union leader made what it considered an inappropriate threat during a private meeting to release damaging information unless a deal was reached, prompting Kaiser to reassess the process. The union has said its communications with members are lawful and part of normal organizing.

Under federal law, healthcare unions must give employers at least 10 days’ notice before striking, to allow hospitals and clinics to prepare and safeguard patient care. The classification of a walkout as a strike over unfair labor practices rather than purely over pay and benefits can also affect workers’ legal protections and reinstatement rights.

Patients face uncertainty as contingency plans roll out

Kaiser has begun notifying patients in California and Hawaii about the potential for disruption. In alerts posted on its regional websites, the organization said hospitals and medical offices will remain open during any strike but warned that some pharmacies may close and that nonurgent appointments and elective surgeries may be postponed.

The system has urged members to refill prescriptions ahead of Jan. 26 and said it may shift some care to telehealth or other locations. During the five‑day strike last fall, Kaiser used physicians, managers and thousands of temporary workers to maintain operations while rescheduling some elective procedures and routing more visits through virtual platforms.

The prospect of an open‑ended walkout has raised concerns among patients who depend on regular appointments for chronic conditions, chemotherapy, dialysis or behavioral health services, especially in regions where Kaiser is one of the only major providers. In Hawaii, where Kaiser serves members across Oahu and several neighbor islands, any closures or reduced hours at clinics and pharmacies could leave patients traveling long distances or waiting longer for care.

A broader test of healthcare labor and nonprofit accountability

The standoff comes amid a nationwide staffing crisis in hospitals and clinics, with surveys showing large majorities of nurses and other workers reporting burnout and saying short staffing is harming patient care. California’s strict nurse‑to‑patient ratio law has been touted by some unions as a model and criticized by some employers as inflexible and expensive.

If UNAC/UHCP secures stronger, enforceable staffing ratios or workload limits at Kaiser, the outcome could influence bargaining at other systems and feed into legislative debates in states like Hawaii that are considering new staffing regulations.

The dispute is also likely to sharpen questions about how large nonprofit health systems use their surpluses and reserves, and what communities should expect in return for the tax advantages those organizations receive.

For now, both sides say they are willing to keep talking. Union leaders are preparing picket schedules from Los Angeles to Oakland to Honolulu. Kaiser is refining staffing plans, contracting with temporary workers and calling patients about possible schedule changes.

Unless they reach agreement in the coming days, tens of thousands of caregivers will step away from the bedsides, pharmacy counters and exam rooms where they spend their days—to argue, from the sidewalk, about what safe care should look like inside.