On September 17, nurses at the Asheville, North Carolina–based Mission Hospital went union, with the final vote tally 965 to 411. The 1,800 nurses will be represented by National Nurses United (NNU).

Mission Hospital is owned by Tennessee-based HCA Healthcare, the country’s largest hospital corporation, and HCA Healthcare put up a serious fight to defeat unionization. As reported in the Intercept, HCA — which has 184 facilities in the United States and the United Kingdom — hired consultants from the Crossroads Group at $400 an hour to defeat the campaign. This union-busting took place even as staff were overwhelmed with COVID-19 patients, short on personal protective equipment (PPE), and staggering under the weight of HCA’s cuts in staff.

Mission’s nurses had filed for an election in March with 70 percent of the workforce signing union authorization cards, but HCA won delays from Trump’s National Labor Relations Board (NLRB), given the company more time to run its anti-union campaign. As the Intercept notes, HCA has already “received nearly $1.5 billion in coronavirus-related CARES Act grants.” As Jonathan Michels writes in Facing South, the Mission campaign was NNU’s largest labor campaign ever undertaken in North Carolina.