Leaders at hospitals with union representation are approaching labor negotiations in an environment in which familiar issues such as pay and staffing remain central, while AI is reshaping what is discussed at the table.
Healthcare labor activity remains elevated. Becker’s has reported 16 healthcare strikes in 2026. Meanwhile, labor relations consulting firm People Results recorded 51 healthcare strikes in 2025, up from 31 the year before, and found that 62% of union petitions filed in the industry came from six states: California, Washington, Oregon, New York, Pennsylvania and Minnesota.
Against that backdrop, Becker’s spoke with Keegan Fisher, division CHRO for Providence’s North division, which includes the Puget Sound and Alaska markets, and Deborah Visconi, president and CEO of Bergen New Bridge Medical Center in Paramus, N.J., about how they approach negotiations, timelines and what they believe it takes to reach resolution.
Where labor remains a constant
Mr. Fisher, who also supports Renton, Wash.-based Providence’s labor relations team across the system, brings both an operational and enterprise perspective. Providence negotiates more than 100 collective bargaining agreements covering about 40% of its caregiver workforce.
“The reality is that labor within healthcare has been unlike most any other industry, and that’s because the percentage of the workforce that are represented in healthcare has no competitor,” he said. “That is a stark contrast to the country as a whole and other industries.”
For Providence leaders on the West Coast, labor management is an ongoing responsibility. Providence experienced a nursing strike in Oregon in early 2025 that lasted more than six weeks and two nursing strikes in its Southern California market in early 2026.
“I’m grateful to say that 2026 has brought fewer work stoppages for us than 2025, but the principles haven’t changed,” Mr. Fisher said.
Before the contract expires
Both Mr. Fisher and Ms. Visconi said successful negotiations begin well before anyone sits down at the bargaining table.
“One thing I’ve learned is that successful conversations don’t begin when the contract expires,” Ms. Visconi said. “They begin every single day through consistent communication, building trust and creating a culture where employees feel heard and valued. If you only engage during bargaining, you’ve waited too long, and then it becomes a true battle at the table over staff ratios and things of that nature.”
Bergen New Bridge aims to begin contract renewal discussions six months before expiration.
The timeline is often considerably longer for a first contract involving employees who recently voted to join a union. Mr. Fisher said the average time to reach a ratified first agreement in healthcare exceeds 400 days.
“New contracts, those covering caregivers who have recently voted to become represented by a union, will inevitably be more complex, and there is a greater time commitment involved,” he said. “After that first contract, the management team and representatives of the union likely have more to draw upon in terms of experiences and a foundation that will make subsequent negotiations look different.”
What resolution requires
Ms. Visconi said she attended the opening day of Bergen New Bridge’s most recent nursing negotiations to explain the financial pressures facing hospitals, the organization’s role in the community and the need for an agreement that supports long-term financial sustainability.
“I basically laid out: These are difficult times for all of us,” she said. “Everybody has to understand the realities we’re facing as an industry, which includes workforce shortages, rising labor costs and reimbursement pressures.”
As a public safety-net hospital, Bergen New Bridge must balance fiscal stewardship with investment in its workforce, Ms. Visconi said.
“Every dollar we spend is a dollar entrusted to us by the public, by our patients, by our communities,” she said. “Our challenge is balancing fiscal stewardship with investing in our people, because both are essential to delivering high-quality care.”
Mr. Fisher said Providence takes a similar approach. The system focuses on competitive wages, staffing commitments and direct listening efforts throughout the caregiver experience. Providence surveys caregivers three times a year to identify workplace concerns that leaders can address before they reach the bargaining table.
“The better we can do at addressing those, it has made bargaining run more smoothly,” he said. “The number of open issues that need to be discussed at the bargaining table can be more focused, and ideally that will drive forward a quicker path to a ratified agreement that’s equitable for both parties.”
Compensation and what else is at the table
Compensation and staffing remain central to healthcare labor discussions, but Ms. Visconi said the range of issues has expanded.
“Compensation is always up there, but I think there are other things we can provide,” she said. “One thing that came up this time, and this was definitely new, was AI and our use of it.”
Union representatives at Bergen New Bridge initially opposed the use of AI, she said. The parties ultimately reached an agreement that gives union representatives a role in discussions about how the technology is evaluated and implemented.
“We ended up in a place where we said: AI is here to stay, so we need to embrace it,” Ms. Visconi said. “We came up with an agreement that they will have a seat at the table as we start to look at and embrace AI technology. Rather than being against it, they’re now part of it.”
Many of the issues the executives highlighted, including staffing, compensation and AI governance, have also surfaced in recent union contract negotiations.
AI governance has also surfaced in labor agreements elsewhere. For example, the Alliance of Health Care Unions cited AI governance as a gain in 52 collective bargaining agreements ratified at Oakland, Calif.-based Kaiser Permanente.
Ms. Visconi said flexible scheduling and work life balance have also become more prominent in labor discussions.
A new organizing trend: Physicians
Mr. Fisher said one development hospital leaders should watch is organizing among physicians and advanced practice clinicians.
“We have had several physician specialties in certain markets become represented, and that has been a new development that health systems, which obviously employ a large number of physicians and advanced practice clinicians, need to have awareness of,” he said.
At the time he spoke with Becker’s, advanced practice providers at Fred Hutchinson Cancer Center in Seattle were preparing for a union vote with the Union of American Physicians and Dentists. Hospitalists with Providence’s Swedish Medical Group in Seattle had voted earlier in 2026 to organize.
Providence is responding with engagement efforts designed specifically for physicians and advanced practice clinicians. Those efforts include a physician and advanced practice provider advisory cabinet hosted by Providence President and CEO Erik Wexler and a tour in which Mr. Wexler visits the system’s markets to hear directly from employees.
“There is a different requirement within our industry to ensure that we’re addressing the needs of our physicians and advanced practice clinicians,” Mr. Fisher said.
What leaders should carry into negotiations
Ms. Visconi emphasized relationships, credibility and mission as key elements for hospital executives entering negotiations, particularly those doing so for the first time.
“Build the relationship before you actually need it, because trust isn’t created at the bargaining table,” she said. “Know your numbers better than anyone else. Know your labor costs, know the market. You want to be credible when you’re at the table. Remember that negotiations are about interests, not just positions. Listen to what your employees are really asking for.”
She also encouraged leaders to consider solutions beyond compensation, including flexibility, career development, recognition and employee participation in organizational decisions.
“Never lose sight of the mission,” Ms. Visconi said. “Great CEOs don’t negotiate to win the contract. They negotiate to strengthen the organization they’ll be leading the day after it’s signed.”
Mr. Fisher also encouraged leaders to address workforce concerns consistently rather than allowing known problems to persist.
“Are they responding to the asks of their caregivers and their physicians and advanced practice clinicians appropriately, or are they letting known pain points linger?” he said. “I feel like the better we can do as an industry, as healthcare leaders, in addressing that punch list of needs, our caregivers and our providers appreciate that.”
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.