Why 22,000 Hospital Workers Are Protesting the Biggest For-Profit Hospital Chain in America

About 22,000 hospital workers who belong to a union called the SEIU (Service Employees International Union) are trying to reach a new work agreement with HCA Healthcare, the largest for-profit hospital system in the United States. They are planning protests at more than a dozen HCA hospitals in California, Texas, Nevada, and Florida The Guardian. The workers want a raise to at least $25 an hour, pay that goes up when the cost of living goes up, paid vacation and sick time, and better protections on the job.

A union is a group of workers who join together to negotiate with their employer as a team. A contract is the written agreement that comes out of those negotiations, covering things like pay, benefits, and working conditions.

The workers' demands come at a time when the company is making a lot of money. HCA reported $6.8 billion in profits for 2025, an 18% increase from the year before. The company also approved a $10 billion stock buyback — meaning it plans to spend that money buying back its own shares from investors, which tends to raise the stock price The Guardian. CEO Sam Hazen earned more than $26.5 million in 2025, about 420 times what the typical HCA employee made ($62,955) The Guardian. HCA employs over 300,000 people in the US and the UK.

The gap shows up in real people's lives. Esther Reyes, who cleans and sanitizes rooms at an HCA hospital in El Paso, Texas, earns $16.80 an hour The Guardian. The SEIU, which has about 2 million members and focuses on healthcare workers, previously won a $15.65 minimum wage for its members SEIU. The new demand for $25 an hour would be a big step beyond that.

Workers also want rules about how many patients each nurse has to care for at once — what hospitals call nurse-to-patient ratios. This matters a lot in Nevada. In 2025, Nevada's Republican governor, Joe Lombardo, vetoed a law that would have limited how many patients each nurse could be assigned The Guardian. Because that law did not pass, the only place workers can fight for better ratios is at the negotiating table.

Jody Domineck is a pediatric nurse who has worked at HCA's Sunrise Hospital in Las Vegas for more than 20 years. She is also an officer in her local union chapter, SEIU Local 1107 The Guardian. Her chapter is one of several trying to turn staffing demands into written rules in the new contract.

These protests are not happening out of nowhere. In March 2026, workers picketed outside HCA's Riverside Community Hospital in California over the same staffing concerns SEIU-UHW. Those same issues are now part of the bigger negotiations across multiple states.

The bigger picture is that the union is trying to connect two things: better pay and better patient care. By arguing that staffing levels affect how well patients are treated, the union is saying this is not just about money — it is about safety. The $10 billion buyback gives the union a strong argument: if the company can afford to spend that much on its own stock, it is hard for HCA to say it cannot afford better pay and staffing. Whether that argument works will depend on how bargaining goes at each hospital, whether HCA agrees to put staffing rules in the contract, and how much pressure the protests create.

The political situation makes things harder. Governor Lombardo's veto in Nevada shows that getting staffing laws passed in Republican-led states is an uphill battle. That pushes unions toward contract-based fixes — but those fixes only apply to hospitals where workers are in a union. Workers at non-union HCA hospitals would not benefit from whatever the SEIU negotiates, which could mean two different sets of rules inside the same company. That split could actually help the union argue that more workers should join, and it could be one reason HCA resists setting a precedent.

People across the hospital industry will be watching how this turns out. Because HCA is so large and so profitable, what happens here could influence negotiations at other hospital chains. If the union wins a real path to $25 an hour and written staffing rules, other workers will likely push for the same. If the union falls short, the real test will be whether it can keep workers fired up and organized across several states at once.