LOS ANGELES (AP) — Picketing began Wednesday morning at Kaiser Permanente hospitals as some 75,000 health care workers go on strike in Virginia, California and three other states over wages and staffing shortages, marking the latest major labour unrest in the United States.

Kaiser Permanente is one of the country’s larger insurers and health care system operators, with 39 hospitals nationwide. The non-profit company, based in Oakland, California, provides health coverage for nearly 13 million people, sending customers to clinics and hospitals it runs or contracts with to provide care.

The Coalition of Kaiser Permanente Unions, representing about 85,000 of the health system’s employees nationally, approved a strike for three days in California, Colorado, Oregon and Washington, and for one day in Virginia and Washington, DC.

The strikers include licensed vocational nurses, home health aides and ultrasound sonographers, as well as technicians in radiology, X-ray, surgical, pharmacy and emergency departments.

Doctors are not participating, and Kaiser says its hospitals, including emergency rooms, will remain open during the picketing. The company said it was bringing in thousands of temporary workers to fill gaps during the strike. But the strike could lead to delays in getting appointments and non-urgent procedures being rescheduled.

It comes amid unprecedented worker organising — from strike authorizations to work stoppages — within multiple industries this year, including, transportation, entertainment and hospitality.

Wednesday’s strike is the latest one for the healthcare industry this year as it continues to confront burnout with the heavy workloads — problems that were exacerbated greatly by the pandemic.

Unions representing Kaiser workers in August asked for a $25 hourly minimum wage, as well as increases of seven per cent each year in the first two years and 6.25 per cent each year in the two years afterward.

They say understaffing is boosting the hospital system’s profits but hurting patients, and executives have been bargaining in bad faith during negotiations.

“They’re not listening to the frontline health care workers,” said Mikki Fletchall, a licensed vocational nurse based in a Kaiser medical office in Camarillo, California. “We’re striking because of our patients. We don’t want to have to do it, but we will do it.”

Kaiser has proposed minimum hourly wages of between $21 and $23 next year depending on the location.

Since 2022, the hospital system has hired 51,000 workers and has plans to add 10,000 more people by the end of the month.

Kaiser Permanente reported $2.1 billion in net income for this year’s second quarter on more than $25 billion in operating revenue. But the company said it still was dealing with cost headwinds and challenges from inflation and labour shortages.

Kaiser executive Michelle Gaskill-Hames defended the company and said its practices, compensation and retention are better than its competitors, even as the entire sector faces the same challenges.

“Our focus, for the dollars that we bring in, are to keep them invested in value-based care,” said Gaskill-Hames, president of Kaiser Foundation Health Plan and Hospitals of Southern California and Hawaii.

She added that Kaiser only faces seven per cent turnover compared to the industry standard of 21 per cent, despite the effects of the pandemic.

“I think coming out of the pandemic, health care workers have been completely burned out,” she said. “The trauma that was felt caring for so many COVID patients, and patients that died, was just difficult.”

The workers’ last contract was negotiated in 2019, before the pandemic.

Hospitals generally have struggled in recent years with high labour costs, staffing shortages and rising levels of uncompensated care, according to Rick Gundling, a senior vice president with the Healthcare Financial Management Association, a nonprofit that works with health care finance executives.

Most of their revenue is fixed, coming from government-funded programs like Medicare and Medicaid, Gundling noted. He said that means revenue growth is “only possible by increasing volumes, which is difficult even under the best of circumstances.”

Workers calling for higher wages, better working conditions and job security, especially since the end of the pandemic, have been increasingly willing to walk out on the job as employers face a greater need for workers.

The California legislature has sent Democratic Governor Gavin Newsom a bill that would increase the minimum wage for the state’s 455,000 health care workers to $25 per hour over the next decade. The governor has until October 14 to decide whether to sign or veto it.