Barring progress at the bargaining table, some 32,000 workers at health care giant Kaiser Permanente are set to walk off the job on Monday, November 15. The workers comprise the Alliance of Health Care Unions, which consists of twenty-one union locals and spans from California to Hawaii to Georgia. Should they strike, they’ll join another Kaiser work stoppage by more than 750 engineers, which began on September 18. The Service Employees International Union—United Healthcare Workers West (SEIU-UHW) says that its members will engage in a one-day sympathy strike with those engineers on November 18, while California Nurses Association members and two thousand of Kaiser’s mental health workers will do the same on November 19.

There are rumors of impending tentative agreements for some of the locals within the Alliance, but neither Kaiser nor the unions have announced any such deals. As to the issues on which the company has dug in its heels, there are several. For one, workers want raises, and the company is offering a mere 1 percent annual raise for the duration of the three-year contract. There are also wage disparities to rectify: Some workers at Kaiser locations in the Inland Empire make 39 percent less than their counterparts in the same positions at Kaiser locations in Los Angeles and Orange County. Further, Kaiser is pushing for a new wage tier that would drastically reduce pay for those hired starting in January of 2023: The company’s proposal cuts their pay by anywhere from 26 to 39 percent.

Finally, there is the issue of staffing. Safe staffing levels have long been a central demand among health care workers, and the pandemic has only exacerbated the issue. When health care facilities don’t have enough workers, they turn to “travelers,” registry workers who travel from one facility to another on short-term contracts. It’s a vicious cycle: Health care workers leave their facilities to become travelers because pay for such work has skyrocketed, while pay for traditional health care jobs stagnates. The problem is so bad at Kaiser that some workers began placing gravestones in an employee locker room, with one for each coworker who had left.

One traveling nurse who recently took a gig at Kaiser explains that while she was there, “We were always short-staffed.” In the TikTok in which she recounts her experience — the video currently has some 10,000 comments — she tells fellow traveling nurses not to work at the company. “There are a ton of amazing clinicians at Kaiser that are being forced into poor patient care by shitty business practices by a company that puts profits before patients at every single turn in the road,” she says.

Kaiser workers say that the company is not backfilling positions that have been vacated — many by staff who left to work as travelers — and that the result is a crunch that leaves workers stressed and patients without adequate care. At one point during the bargaining process, to illustrate the inadequacy of the nonbinding staffing language in the prior contract, members of the Oregon Federation of Nurses and Health Professionals (OFNHP), one of the unions in the Alliance, printed out every short-staffing complaint members had made over the past three years. The resulting document was nine thousand pages.

The Alliance is proposing that the labor-management partnership at Kaiser include staffing committees to oversee backfilling existing positions and hiring for new ones, a structure that would meet on a regular basis and provide workers’ representatives a clear picture of who does and does not work at Kaiser’s sprawling health care facilities that care for some 12 million patients. More specific proposals for filling vacated positions are being negotiated at the local level. But according to workers, the company has been particularly intransigent about this subject, preferring unilateral control over staffing decisions.

While the latest news from the bargaining table suggested significant distance between the two sides on wages — the Alliance wants 4 percent annual raises and no two-tier — it is staffing that may prove the most intractable issue (of course, a two-tier wage system would also exacerbate the problem by driving away potential applicants). Kaiser wants to do as it pleases, and ceding the slightest bit of power over hiring choices to those who must deal with the consequences of those decisions may prove unacceptable to the bosses. As bargaining continues and future tentative agreements are announced, that is the issue on which many at Kaiser are keeping an eye.