Nurses seek ratio guarantees in new contract as staffing shortages persist
About 22,000 HCA Healthcare workers represented by the Service Employees International Union are in contract negotiations with the company, demanding higher pay, improved staffing levels, and expanded benefits. HCA Healthcare employs more than 300,000 workers in the US and the UK. The union-represented US employees are seeking a pathway to a $25 an hour minimum wage, improved wage scales, and raises that match the increased cost of living. Workers are also asking for paid vacation, sick time, and bolstered work protections. Picket protests are planned at more than a dozen HCA hospitals in California, Texas, Nevada, and Florida.
HCA reported $6.8 billion in profits in 2025, a 17.8% increase from 2024. In early 2026, the company authorized a $10 billion stock buyback program. CEO Sam Hazen received more than $26.5 million in total compensation in 2025, a figure the union said was 420 times the median employee compensation of $62,955.
Esther Reyes, a single mother of three, has worked as an environmental services technician at the HCA-owned Las Palmas hospital in El Paso, Texas, for the past two years on a salary of $16.80 an hour. “Sometimes I need to decide, maybe this month I pay the water bill, then another pay for gas, but most of the time I’m not able to pay for everything,” Reyes said. “I’m struggling. I struggle a lot.”
Reyes said prices have continued to rise while salaries have remained stagnant. “If they gave us the raise we want, it would be a huge blessing,” Reyes said. “I work for my family. I work for my kids. If I don’t get enough for everything, how am I supposed to cover all they need?”
Jody Domineck, a pediatric nurse with over 20 years at HCA Sunrise hospital and medical center in Las Vegas — the largest hospital in Nevada — said staffing shortages affect both workers and patients. Domineck is also secretary-treasurer of SEIU Local 1107. “We also see HCA’s profit reports, and that they are having great returns, and their profit is increasing. Meanwhile, the people doing the work are not being compensated appropriately,” Domineck said. “Our work is how they’re making billions. We are just asking for fair compensation.”
Domineck said staffing shortages persist despite the company’s increased profit. “There’s been multiple studies that show that the more patients you have, the higher the risk is to all patients,” Domineck said. She joined coworkers at a rally around their contract demands outside HCA Sunrise hospital on August 6.
In 2025, Nevada’s Republican governor Joe Lombardo vetoed a bill that would have established safer nurse-to-patient ratios throughout the state. HCA members are now trying to get similar ratio guarantees into their next contract.
Domineck described the personal toll of understaffing. “I personally have had to walk away from a parent when their child was having a procedure, and that parent was crying in the hallway alone,” Domineck said. “I had to walk away from them because I had to see my other patients, and that was one of the kind of moments that broke me, because I, with all of my being, wanted to be there and comfort that parent, but I had to walk away to continue to provide care for the other patients, and those are the decisions nurses have to make when they have more and more patients.”
A spokesperson for HCA Healthcare said a small number of affiliated hospitals are engaged in individual negotiations with local SEIU chapters. “At Sunrise Health System, we value every member of our team and remain committed to reaching a fair agreement through good-faith negotiations,” the spokesperson said in a statement. “While we respect our employees’ right to peacefully demonstrate, portraying this as a patient safety issue is inaccurate. The outstanding issues are about compensation. We believe the best place to reach an agreement is at the bargaining table, and we look forward to continuing negotiations on August 11 and 12.”