The ‘Second Wave’ Strategy: How Kaiser Workers Escalated a 3-Week Strike
Over 34,000 healthcare workers at Kaiser Permanente across California and Hawaii pulled off something unusual in American labor history—they didn’t throw everything at the wall on day one. Instead, they planned a step-by-step strategy that turned what could’ve been a brief symbolic action into a three-week test of worker power against the nation’s largest nonprofit health system.
The strategy worked like this: 31,000 nurses and other professionals walked out on January 26, establishing open-ended picket lines that forced Kaiser to scramble for backup staff. Then, as management stabilized their initial response two weeks later, approximately 3,000 pharmacy technicians and clinical laboratory scientists joined the walkout on February 9. Union organizers called it their “second wave”—a calculated move designed to pile on more problems right when Kaiser thought they’d weathered the storm.
By February 11, as the strike entered its third week with pharmacy and lab workers maintaining picket lines for three days before their scheduled return, the action had generated sustained media attention, disrupted hospital services, and forced Kaiser to spend an estimated hundreds of millions on temporary staffing. The dispute centers on a gap in money: the union’s demand for a $3 billion investment in wages and staffing over the contract period versus Kaiser’s offer of approximately $1 billion. There’s a disagreement over whether chronic understaffing represents a patient safety crisis.
The Three-Week Timeline
The strike began at 7:00 a.m. Pacific Time on January 26 when the United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP) initiated an open-ended strike at Kaiser facilities in California and Hawaii. The action involved approximately 31,000 registered nurses, nurse anesthetists, pharmacists, physician assistants, midwives, and other licensed professionals.
This wasn’t classified as an economic strike—it was a specific type of strike under the National Labor Relations Act that provides strikers greater protections including the right to reinstatement regardless of whether employers hire permanent replacements. Union president Charmaine S. Morales framed the action as about patient safety rather than wages alone: “Kaiser has committed serious unfair labor practices and because Kaiser refuses to bargain in good faith over staffing that protects patients.”
Kaiser’s response was to maintain normal operations through backup staff—bringing in temporary travel nurses, reassigning managers to clinical duties, accepting volunteers from unaffected facilities, and utilizing contracted professionals. The company announced that all hospitals and nearly all medical offices would remain open, though some outpatient pharmacies and laboratories would temporarily close or operate reduced hours.
On January 29, three days into the nurse strike, leaders from United Food and Commercial Workers (UFCW) local unions issued a formal 10-day strike notice required under federal healthcare labor law. The announcement specified that approximately 3,000 pharmacy and laboratory workers in Southern California and Bakersfield would walk out beginning February 9.
The timing was deliberate. It allowed the initial strike to establish its staying power, demonstrated to Kaiser that the action was sustained rather than symbolic, and positioned the pharmacy and lab expansion to occur at a moment when management had gotten used to the first wave and put backup plans in place but before those measures had stabilized operations.
When the UFCW workers walked out at 7:00 a.m. on February 9, picket lines appeared at Kaiser facilities in Los Angeles, Orange, San Diego, San Bernardino, Riverside, Ventura, and Kern counties. The expansion increased service disruptions beyond what the nurse strike alone had created. While nurses could work with reduced support staff, the absence of pharmacy technicians prevented medication dispensing in affected facilities. The absence of laboratory scientists made it harder to do the medical tests that hospitals need to function and generate revenue.
On February 10, one day after the UFCW expansion began, union leadership announced that pharmacy and laboratory workers would return to work on Thursday, February 12 at 5:00 a.m. The “second wave” would constitute a three-day action rather than an open-ended strike like that of the nurses.
Unions characterized the return as demonstrating strength and successful pressure application, noting that returning to work didn’t end the dispute and workers remained prepared to escalate further if Kaiser refused to bargain in good faith. Critics could interpret the short duration as indicating workers weren’t willing to strike for longer, and Kaiser spokespersons seized on the three-day duration to argue that the strike’s impact was limited and that the company’s contingency planning had proven effective.
The Coalition Behind the Action
The strike represents a coordinated action by the Alliance of Health Care Unions, a coalition of 23 separate unions representing more than 60,000 Kaiser workers nationwide, though the visible action was led by UNAC/UHCP and UFCW locals.
UNAC/UHCP represents more than 40,000 registered nurses and other professionals in California and Hawaii, including optometrists, pharmacists, physical therapists, occupational therapists, speech language pathologists, case managers, nurse midwives, social workers, clinical laboratory scientists, physician assistants, and nurse practitioners. The organization was formed through a 2015 merger, creating one of the largest labor organizations on the West Coast.
Leadership of the strike effort fell to UNAC/UHCP President Charmaine S. Morales, a registered nurse who began her nursing career as a night-shift nurse at Kaiser South Bay Medical Center. Morales is the first woman of color, the first Mexican-American, and the first Filipina to serve as UNAC/UHCP president. She was elected secretary in 2013 and executive vice president in 2016 before becoming president in 2022.
Prior to entering the field, Morales operated a small business. In union communications during the strike, she stated that “Kaiser’s own communications to employees reveal why we are striking” and described union efforts as focused on ensuring that workers had the tools and resources to deliver quality care.
The UFCW participation brought more resources and coverage in different areas. The United Food and Commercial Workers represents approximately 1.3 million members in North America. UFCW materials quoted pharmacy technician Angelica Muro: “We are fed up with being overworked, disrespected, undervalued, and with Kaiser’s illegal attempts to intimidate us out of getting a fair contract.”
The bargaining structure known as the Alliance of Health Care Unions, established in 2018, represented an institutional component of the strike. The Alliance was created to provide coordinated national bargaining power against Kaiser’s multi-state operations while keeping local unions independent and the 23 separate union entities’ distinct membership bases. The 2021 contract negotiations with Kaiser had been the “most contentious national negotiation since the start of the Partnership in 1997,” involving union resistance to proposed two-tier wage structures.
Measuring the Strike’s Effectiveness
Operational Impact
The operational disruption achieved was substantial but not total. Kaiser’s contingency planning, developed over months, prevented the strike from creating a complete system shutdown. Travel nurses deployed to maintain staffing levels, though at approximately two to three times the cost of regular staff wages—a significant expense burden that intensified as days progressed.
Emergency departments continued operating with reduced elective surgery schedules. Some pharmacies and laboratories closed, generating documented patient frustration with lengthy wait times and delayed prescription fills, but these services weren’t eliminated entirely. The operational impact was geographically concentrated in Southern California where approximately 28,000 of the 31,000 striking nurses worked, with Kaiser’s largest medical centers and most significant revenue generation occurring in that region.
Media Coverage and Public Narrative
Media coverage was extensive and sustained over the three-week period. Major newspapers in the state including the Los Angeles Times, San Francisco Chronicle, and regional outlets provided regular coverage. Trade publications including Healthcare Dive, Becker’s Hospital Review, and KFF Health News covered the dispute with attention to staffing implications.
The strike occurred simultaneously with New York City’s largest nursing strike in history, involving nearly 15,000 nurses at multiple hospital systems—a coincidence that provided context and suggested a trend of labor unrest.
Union communications emphasized patient safety, focusing on understaffing that allegedly compromised care quality and contributed to worker burnout and patient wait times. Specific striker testimonies highlighted wage stagnation—one nurse noted experiencing what amounted to a wage decrease when accounting for inflation and housing cost increases in the state.
Kaiser’s counter-narrative emphasized the company’s financial constraints, saying wage demands couldn’t work with affordability and painting the strike as unnecessary given what management characterized as a generous offer. The company framed the union as having abandoned negotiation, emphasized that the strike was disrupting patient care, and argued that the 21.5% wage increase over contract duration was among the state’s strongest nursing contract offers.
Negotiation Progress
Negotiation progress during the three-week period was minimal to nonexistent by union account. UNAC/UHCP leadership stated that Kaiser had “ghosted” the union, failing to schedule new bargaining sessions despite union requests and continued availability.
Kaiser maintained that it had proposed moving to local bargaining tables rather than continuing national negotiations, arguing that the national process had become “gridlocked.” The company stated that 29 of 53 local bargaining units had already reached tentative agreements on local issues, suggesting that local bargaining could produce results.
This disagreement about how to negotiate—national vs. local—became increasingly central to the conflict as the strike progressed. Kaiser filed a federal lawsuit challenging the legality of multi-union national bargaining itself, arguing that the Alliance structure violated labor law and that negotiating with 23 separate unions collectively was unworkable. The union characterized this legal action as union-busting and as evidence of bad faith.
Historical Precedents and Tactical Lessons
The Kaiser strike’s tactics draw from a history of labor conflicts and strike strategy in American labor movement history.
The use of phased escalation rather than going all-in from the start reflects lessons from strike effectiveness research. Research shows that short-duration strikes often fail to pressure employers into substantial concessions because management can absorb brief disruptions through contingency measures.
The 2010 Minnesota nurses’ strike involving 12,000 nurses at 14 Twin Cities hospitals illustrates this dynamic: nurses authorized a one-day strike after negotiations had stalled, choosing a limited duration that would “cause minimal disruption to patients while causing maximum pain to employers” by forcing the hospitals to cancel profitable elective surgeries. However, the employer threat of a lockout and the limited duration meant minimal negotiating power.
The 2021 St. Vincent Hospital nurses’ strike in Worcester, Massachusetts, provides a more complex precedent: the strike lasted 301 days—the longest nursing strike in Massachusetts history—and produced an agreement with modest staffing improvements and only 2% annual wage increases, far below initial demands. The St. Vincent experience demonstrated both the possibilities and limitations of extended strike duration: workers maintained commitment for ten months but accepted outcomes that many characterized as modest gains given the extensive sacrifice.
The choice to expand the strike to pharmacy and laboratory workers rather than immediately involve all unionized Kaiser workers reflects labor movement understanding of hitting weak spots. The 1946 Oakland General Strike, one of the largest general strikes in American history, began with targeted actions by warehouse workers and retail clerks but expanded as other unions joined in support.
Kaiser Permanente strike history itself provided direct precedent. In October 2024, three months before the January 2025 action, Kaiser workers had conducted a five-day strike involving multiple unions and approximately 31,000 workers in California and Hawaii. That October strike demonstrated both that the coalition could mobilize large numbers and that five days of disruption was insufficient to move Kaiser significantly on economic issues. The October 2024 experience informed the January 2025 decision to shift to an open-ended strike classification.
A study of strikes globally concluded that strikes involving these workers don’t increase patient mortality rates, contrary to widespread assumption. However, strikes do disrupt scheduling, delay non-emergent procedures, and create operational strain. The research suggests that hospitals deploy redundant systems for life-threatening emergencies, meaning care continues during strikes, but elective services and routine care face substantial delays.
Strategic Options for Escalation
Geographic Expansion
Rather than maintaining strike action only in Southern California where the concentration of Kaiser facilities creates maximum disruption, expanding organizing and preparation for strikes in Northern California and Hawaii would force Kaiser to manage disruptions in three geographically separated regions simultaneously, making backup staffing more expensive and complicated.
Hawaii is geographically isolated from mainland contingency staffing sources, meaning Kaiser can’t easily shift travel nurses from California to Hawaii. Northern California hospitals, while less central to Kaiser’s revenue than Southern California, still represent significant operational capacity, and involving Bay Area workers would bring the strike into proximity with media centers, political figures, and labor movement leadership concentrated in San Francisco and Oakland.
Patient Safety Campaign Reframing
Launching a campaign across TV and social media with patients telling their stories about harms caused by understaffing and wait times at Kaiser could reframe the strike not as workers wanting “more money” but as workers trying to establish care standards that’ll benefit patients. Creating named patient advocates willing to publicly state that Kaiser’s understaffing is causing their care delays and health risks—and that the strike is justified because workers are fighting for standards that protect patients like them—could shift public perception.
The California RN Staffing Ratio Law (2004), which established mandatory nurse-to-patient ratios in California hospitals, was won through sustained advocacy that framed staffing ratios as patient safety requirements rather than worker convenience. Strike communications that emphasize patient safety and clinical quality achieve better public opinion outcomes than frames emphasizing worker compensation.
Investor and Stakeholder Pressure
Although Kaiser is a nonprofit, it has substantial investments, endowments, and relationships with for-profit entities including venture capital firms. The union could research and publicly identify pension funds held by Kaiser workers, California public employee retirement systems (CalPERS, CalSTRS), and other investors with money in healthcare. Targeting these institutional investors with demands that they pressure Kaiser to settle on terms favorable to workers, or face campaigns to pull investments, could create pressure through customers.
Kaiser Permanente Ventures, the company’s venture capital arm, invests in startups including Abridge (an AI note-taking system for clinicians), creating potential leverage through consumer pressure on companies in which Kaiser invests.
Legislative Campaign for Staffing Transparency
Rather than limiting activity to strike negotiations and media, the union could shift energy to legislative advocacy for California laws requiring public disclosure of staffing ratios, patient outcomes correlated with staffing, and staffing adequacy metrics. If California law required Kaiser to publicly report staffing ratios and patient safety outcomes, the union would gain leverage: Kaiser’s numbers would either prove the union right about understaffing or prove them wrong, and public disclosure would create ongoing pressure.
New York’s Safe Staffing for Quality Care Act (2021) was achieved through combined nursing strike activity and legislative advocacy, with nurses’ strikes creating pressure while legislative allies pushed bills forward.
Sectoral Standards Campaign
Rather than framing the Kaiser strike as unique to one company, positioning it as opening phase of a campaign for statewide or national standards applicable to all employers could reframe the dispute from “What does Kaiser owe its workers?” to “What do all employers owe all workers?”
The Fight for $15 minimum wage campaign (2012-2020s) went beyond individual employers to establish the idea that a $15 minimum should apply economy-wide, regardless of employer. The movement achieved minimum wage increases in cities and states by framing $15 as a standard, not a one-off concession.
What Comes Next
As the Kaiser Permanente strike entered its third week with UFCW pharmacy and laboratory workers returning to work on February 12 while UNAC/UHCP nurses remained on open-ended strike, multiple possible future scenarios seemed plausible.
The most likely near-term development involved continued impasse on the bargaining structure dispute. Kaiser’s insistence on local-only negotiations and its federal lawsuit challenging the legality of multi-union national bargaining were about principles, not money. Unions’ insistence on maintaining the Alliance and pursuing national bargaining reflected strategic positions they viewed as foundational to worker power.
The question of whether other Kaiser unions would join or escalate actions remained open. The Alliance includes 23 separate unions, but the visible strike action came from UNAC/UHCP and UFCW. If additional unions escalated to strike status, particularly ones representing services like environmental services or security, the operational pressure would intensify substantially. However, not all unions shared the same bargaining timelines or priorities, and some local unions had already reached tentative agreements with Kaiser, creating conflicting interests.
The financial sustainability of extended strike action presented constraints. Although union strike funds typically support striking members to some degree, they rarely provide full income replacement, meaning workers faced economic pressure the longer the action continued. Historical strikes demonstrate that worker commitment typically wanes after 4-12 weeks unless significant progress is visible.
Federal regulatory developments could shift the dispute’s dynamics. If the National Labor Relations Board ruled on the unfair labor practice charges filed by unions, finding in the union’s favor could require Kaiser to engage in national bargaining, changing how negotiations would work. Conversely, if the NLRB ruled against unions or if federal courts sided with Kaiser’s position that multi-union national bargaining was unworkable, the unions would face legal obstacles to maintaining their Alliance structure.
The possibility remained that protracted impasse would force compromise settlement. Kaiser and unions might meet in the middle of the $1 billion-$3 billion gap, establishing wage increases somewhere between the 21.5% and 25% figures initially proposed. Staffing ratio and benefit disputes might be resolved through phased implementation or pilot programs at selected facilities.
The strike’s duration and outcome would establish precedent not only for Kaiser’s subsequent negotiations but for the California and national labor movement. A resolution favorable to workers might accelerate organizing and strike activity at competing systems, while a resolution favoring management might suggest limits to worker power and discourage future action.
The dispute over whether $3 billion in worker and staffing investment is “sustainable” or whether Kaiser’s proposed $1 billion in improvements is “generous” reflects disagreements about healthcare money, worker value, and how the company chooses to spend its money. Kaiser’s claim that wage pressures would necessitate raising member premiums or reducing care access contradicts unions’ assertion that the company’s reported $9.3 billion net income demonstrates capacity for both worker investment and member affordability.
Over 34,000 workers determined that their grievances regarding staffing, wages, and working conditions were sufficiently serious to justify risking income, benefits, and employment security through strike action. Their actions generated sustained media attention, disrupted hospital operations in two states, imposed substantial financial costs on their employer, and created precedent for labor activism that others might follow.
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