If you’re in HR at a hospital or health system, you are no doubt aware of persistent union activity. The data backs up that observation, but there are still surprises to be had.
More than Nursing Unions Are Growing
Get ready to say goodbye to a common assumption, because this isn’t simply a flurry of nursing unions descending upon hospitals to organize. Rather, data drawn from January 2021 to June 2026 (during which unions filed 1,843 representation petitions), shows that most petitions being filed are not coming from registered nurse (RN)-only units. Instead, anywhere from 57% to 75% of units in hospitals, ambulatory settings, and in skilled nursing and residential care are non-RN in orientation.
Those petitions are being filed by lab workers, tech staff, housekeepers, drivers, and more. This shows that employers who assume that nurses are the main union target could miss important signs that a significant amount of activity is happening elsewhere.
Unit Size Matters
The non-RN numbers aren’t the only place assumptions fall apart. Granted, the sheer number of healthcare representation petitions filed against general medical and surgical hospitals during the first quarters of 2026 and 2024 makes it appear as though representation filings are holding steady at 60 petitions for both years. It would be easy to assume that no change happened, but as with most things involving labor relations, it’s not that simple.
Hidden inside that data point is a more valuable one, which is that, in 2026, those organizing drives revolved around unions that aimed at bargaining units small enough that they could be a single department or shift. Twenty-two of those petitions were for units of 10 workers or fewer, and seven filings involved units of 11 to 25 workers.
The union strategy here is to selectively aim for units that they’ll win, no matter how small, to get their foot in the door at any given hospital. This isn’t a strategy being used by random unions, either. The data shows that the Service Employees International Union, the United Food and Commercial Workers International Union, the International Brotherhood of Teamsters, the Communications Workers of America, and the American Federation of State, County and Municipal Employees are all running the same small-unit game.
Win Rates Should Get Some Attention
It’s true that the union-win rate in the healthcare industry currently hovers above 80%, but it’s also important to remember that this isn’t happening in a vacuum. The healthcare industry is particularly plagued with frustrations, and quite understandable ones at that, around safety concerns, staffing shortages, and an ongoing worker exodus.
Unions feel like they have leverage in this field — and they do — so they’ve been aggressive for that reason. It’s also telling that unions are claiming overall victory when, in large part, these successes have been through organizing microunits, as described above.
That is to say, the high win rate looks less like widespread worker mobilization and more like a targeting strategy, which means HR teams need to watch for small-unit petitions in departments they might otherwise overlook, rather than wait for a hospitalwide campaign to happen.
Kimberly Ricci is a content development writer with LRI Consulting Services Inc. in Broken Arrow, Okla.
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