Union activity in healthcare in 2025 already has seen at least a dozen strikes and 20 hospital-union elections reported as of May 15. This follows a year marked by increasing union elections and fewer strikes at hospitals and health systems, according to the 2025 ASHHRA Healthcare Labor Activity Report.
Becker’s has compiled a collection of information on the largest healthcare unions and strikes, and trends in union activity.
Here are 10 things to know about healthcare and unions:
Union membership trends
1. Union membership rates across industries declined slightly in 2023 to 10% from 10.1% of the total U.S. workforce in 2022.
2. Total U.S. union membership increased from 14.3 million members in 2022 to 14.4 million in 2023. This discrepancy with membership rates is attributed to total employment increasing faster than union membership rates, according to the report.
3. Half of all union members in 2023 lived in seven states: California, New York, Illinois, Pennsylvania, New Jersey, Ohio and Washington. Additionally, 31 states and Washington, D.C., had membership rates below the national average, while 19 states’ rates were above the national average.
Of the 20 hospital-union elections Becker’s has reported on in 2025, California and Pennsylvania accounted for the most, with three elections each.
Union activity data
4. In 2024, both healthcare union elections and union wins — calculated by resolved elections — increased from 2023. There were 356 healthcare elections in 2024, representing a 21% increase from 294 in 2023.
5. The union win rate for healthcare elections decreased slightly, from 87% in 2023 to 86% in 2024. The win rate was at its lowest in 2015 — the earliest available data in the report — when it stood at 75%.
6. California led the nation in union activity in 2024, followed by New York and Oregon. Of the 356 healthcare elections across the U.S. in 2024, 78% occurred in 10 states, including the aforementioned top three: Washington, Michigan, Minnesota, Pennsylvania, Illinois, Massachusetts and Hawaii.
Most active unions
7. The Service Employees International Union — which has 2 million members, according to its website — was the most active union in healthcare in 2024. Last year, the union was responsible for 34% of the union elections that occurred nationwide.
8. Other unions primarily involved in organizing healthcare employees:
- American Federation of Teachers
- International Brotherhood of Teamsters
- American Federation of State County and Municipal Employees
- United Food and Commercial Workers
- International Union of Operating Engineers
- National Union of Healthcare Workers
- National Nurses United
Healthcare strike activity
9. The number of healthcare strikes declined 42% year over year, from 52 in 2023 to 30 in 2024.
So far in 2025, Becker’s has reported on at least a dozen strikes.
10. Of the healthcare strikes that took place in 2024, 18 lasted between one and seven days, and 14 involved 101 to 1,000 employees.
