A strike during the past two days by 18,000 nurses at Kaiser Permanente facilities in northern and central California, including three major Sacramento-area hospitals, was the latest salvo by a powerful union that says it is intent on improving the lot of nurses nationwide.

Strikes and protests took place in 16 states and Washington, D.C., where nurses held a vigil outside the White House on Wednesday. The centerpiece of the action was the California strike against 86 Kaiser facilities in nearly two dozen cities including, Fresno, Stockton and Oakland, on Tuesday and Wednesday.

The California Nurses Association has used such mass walkouts in recent years to pressure Kaiser and other hospitals on a variety of work issues. This week, the group and its umbrella organization, National Nurses United, said they called the strike to bring attention to the dangers nurses face dealing with Ebola cases – and what union leaders say is an erosion of patient care under large health organizations.

Even after two nurses in Dallas were infected by an Ebola patient, many hospitals still lack full-body protective suits and sufficient training to deal with potential Ebola cases, said Rose Ann DeMoro, executive director of the California Nurses Association and National Nurses United.

Kaiser nurses begin two-day strike in Sacramento, Roseville

“Nurses, who have been willing to stand by the patients whether it’s the flu, whether it’s Ebola, whether it’s cancer, are now being asked to put themselves in harm’s way unprotected, unguarded,” DeMoro said at a news conference announcing the actions.

Critics, led by the California Hospital Association, said the strike was really about expanding the clout of an already powerful union, whose members have six-figure salaries, and intimidating Kaiser as it negotiates a new contract. A prior three-year contract between Kaiser and the nurses union expired at the end of August.

“CNA tends to use these strikes as a negotiating tactic,” said Jan Emerson-Shea, vice president and chief spokeswoman for the Sacramento-based hospital association. “They do this all the time. It’s right out of their playbook. You make the hospital pay. ‘If they won’t give us what we want, we’re going to make em pay.’”

Nonunion nurses must be hired to replace those striking and often come from other states, Emerson-Shea said. It’s expensive for hospitals, and the union knows it, she said.

“What they did this time around is use the mask of Ebola,” she said.

All hospitals are prepared to screen and isolate patients with Ebola and other contagious diseases, she said. They will then transfer patients to one of five University of California hospitals, including UC Davis Medical Center in Sacramento, that state authorities have designated to treat confirmed Ebola cases.

The threat of Ebola has receded somewhat in recent weeks. The nurses infected in Dallas have recovered, and no new cases have been diagnosed in the United States in the past few weeks.

Gay Westfall, Kaiser Permanente’s senior vice president of human resources, issued a statement Wednesday saying the company is perplexed as to why the union is striking, since negotiations haven’t even reached the issues of pay and benefits. The strike, Westfall said, could cost Kaiser $24 million a day.

“In the last day or so, the union changed its message and now says that the strike is about ‘staffing,’” Westfall said. “Just as the union’s Ebola message is not sticking because it is not supported by the facts, this new reason for striking by the union also isn’t true. We believe, and our nurses know, that Kaiser Permanente is one of the best-staffed health care systems in California and the nation. Our nurse staffing always meets, and often exceeds, state-required levels.”

In the capital region this week, Kaiser nurses walked off the job, donned red shirts and marched with protest signs at Kaiser hospitals in Roseville, Sacramento and south Sacramento. Although the strike was initially called to protest an alleged lack of Ebola readiness, some nurses said they were mainly marching because Kaiser facilities are understaffed to the detriment of both patients and nurses.

“The strike is about providing adequate staffing for the nurses throughout the 21 medical centers, as well as our call centers, clinics and home health and hospice (care),” said Cathy Kennedy, chief representative for the California Nurses Association at Kaiser Roseville Medical Center.

Kaiser is not hiring enough nurses and has failed to fill about 2,000 vacant positions, union leaders said.

One outside expert said the angry rhetoric between the hospitals and the nurses union fails to capture the more nuanced reasons for the latest strike and others like it in recent years.

“A person who is really cynical would say they’re putting patients at risk to get money,” said Joanne Spetz, a professor at the Center for the Health Professions at the University of California, San Francisco. At least one study has shown that nursing strikes can result in a greater number of patient deaths.

But the nurses union generally pursues changes that are good for both its members and for patients, she said. For instance, a lower ratio of patients to nurses tends to make the nurses’ jobs easier and improve the level of care, she said.

The California Nurses Association has made significant strides in recent years by improving the pay and working conditions of nurses in the state, Spetz said.

The average salary for nurses in California is now about $100,000, and the union helped secure passage of a landmark state law that requires limits on how many patients each registered nurse can treat.

California has more than 300,000 nurses, and about 40 percent of nurses working in hospitals are unionized, Spetz said. It’s a major reason why nurses are better paid and protected on the job than in mostly nonunion states such as Florida and Texas, she said.

Now, National Nurses United is on a push to expand pay, benefits and working conditions to nurses in other states. It seized on the Ebola crisis to help promote its agenda, and staged this week’s labor actions to further its goals, she said.

“There’s a certain amount of ‘flex your muscle a little and bit and show what you can achieve,’” Spetz said. “That’s something that attracts members in other states and gives them broader clout from a national perspective.”

RECENT NURSING STRIKES AND PROTESTS

June 10, 2010: Dozens of nurses walked picket lines outside the UC Davis Medical Center, joining scores of other registered nurses across the state to protest what they decried as chronic violations of the state law requiring minimum staffing levels.

Sept. 22, 2011: Hundreds of nurses walked off their jobs at Sacramento-area Kaiser Permanente hospitals in support of fellow union members protesting management-proposed benefit cuts.

Dec. 22, 2011: About two dozen nurses staged a noon protest outside Sutter Health’s Natomas headquarters over contract negotiations.

Jan. 31, 2012: Kaiser health care workers, joined by nurses, picketed at Kaiser Permanente Sacramento area hospitals, part of one-day demonstrations statewide over stalled labor negotiations.

May 21, 2013: Thousands of employees walked off the job at the UC Davis Medical Center and four other University of California hospitals in a two-day strike involving nearly 13,000 nursing assistants, pharmacists, operating room scrub techs and other workers over medical staffing levels and patient safety.

Tuesday: Kaiser Permanente’s 18,000 nurses in Northern California began a two-day strike, a work stoppage they say is not about pay but about staffing and Ebola preparedness.