National Nurses United with sign, "Don't Mess With Texas Nurses"
Courtesy of National Nurses United

Austin Nurses Win Largest Hospital Union in Texas

National Nurses United organizers at Ascension Seton Medical Center just delivered a major victory for the Texas labor movement.

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Kellen Gildersleeve, a labor and delivery nurse in Austin, has just helped birth one of the Texas labor movement’s biggest victories in recent memory. Last week, nurses at Ascension Seton Medical Center voted overwhelmingly to join National Nurses United, the largest nurses’ union in the United States. Approximately 800 nurses will be covered by the union, which is now entering contract negotiations with hospital management.

“I’m so excited to be a part of something that’s so historic,” Gildersleeve said. “We have been talking about this for a long time.”

Three years of poorly managed pandemic working conditions, on top of existing staffing issues, became the last straw for Gildersleeve and hundreds of her colleagues at the hospital. Although some of the challenges these nurses hope to overcome are unique to the healthcare field, their victory is a watershed moment for workers in industries across Texas. Union representatives hope their victory at Ascension Seton will inspire more Texas nurses to organize. 

According to Gildersleeve, working conditions at Ascension Seton have deteriorated ever since 2017, when Seton Healthcare Family became Ascension Seton Medical Center as part of a national rebranding by Ascension Health, one of the largest nonprofit hospital operators in the country. She said around the same time, staff-to-patient ratios began dropping, and each nurse had to take on a heavier workload. That trend worsened when the COVID-19 pandemic hit, resulting in a wave of retirements among older nurses and other nurses leaving for better-paying work as travel nurses.

“The pandemic exacerbated issues,” Gildersleeve said. “We had been seeing a decline in our staffing ratios and the number of experienced nurses that we were able to retain long before COVID ever started. And then it just kind of snowballed.”

Ultimately, the hospital’s unwillingness to hire and retain enough people to responsibly handle patient load galvanized the nurses to organize.  

“Whenever staffing is not adequate, nurses do not have the time to advocate for their patients in the way that they were taught,” Gildersleeve explained. “That is going to inevitably cause safety issues, because even experienced nurses with good intuition might miss something if they have to run to answer the next call.”

Ascension Seton’s management did not want to see their nurses unionize, she added. And before they started organizing, some of her colleagues even believed it was illegal to join a union in Texas. That’s a common misconception fueled by the state’s right-to-work law, which means workers don’t have to join the union that represents their workplace. Texas has one of the lowest union membership rates in the country, at less than 4 percent of workers. According to Gildersleeve, hospital administrators further confused the issue by holding mandatory meetings with nurses where they shared their concerns about problems a union—which they painted as a third party—could cause for both workers and managers. 

“Everyone has to admit that in a place down south like Texas, where people tend to be sort of anti-union or they know little to nothing about unions, that it’s even more impressive.”

But ultimately, she said, “a lot of nurses saw through that.”

Two months after filing their petition with the National Labor Relations Board, the nurses voted 385 to 151 to unionize with National Nurses United.

“We’re always thrilled when nurses vote to organize with us,” National Nurses United President Jean Ross said, adding that organizers in Texas have to overcome additional cultural and political challenges. “Everyone has to admit that in a place down south like Texas, where people tend to be sort of anti-union or they know little to nothing about unions, that it’s even more impressive.”

Next, the Austin nurses plan to conduct a survey of their colleagues to find out what issues they want to prioritize. They’ll elect their facility bargaining committee, and then that committee will begin negotiating their first union contract with the medical center.

Ascension Seton Medical Center did not respond to requests for comment. In a statement to the Austin American-Statesman, the hospital said: “Consistent with the ethical and religious directives for Catholic Health Care Services, we respect our nurses’ right to organize themselves through union representation. We are united in our commitment to care for our community and those that we are privileged to serve.”

Ross said in response, “Those are very nice words. And that’s what they are: words. We go by actions. If they want to live up to those words, that’s wonderful. And we’ll notice right away because it’ll be different than any other employer.”


In her experience, every nurses’ union has to fight tooth and nail at the bargaining table, and Ross doesn’t see any signs that Ascension Seton will be any more amiable than other employers.

“They’re just all very, very much the same. Our system is the same. Profit, profit, profit. Profit over patients. Profit over what’s best for the nurses and other health care workers. That’s their main focus. And that’s why we clash,” she said.

“Texas is just a hard state to unionize. And for them to win in Austin, that is big news.”

Even so, union nurses elsewhere—even elsewhere in Texas—have won significant improvements in their workplaces. In 2010, about 2,000 nurses across several hospitals owned by medical giant HCA Healthcare in Brownsville, Corpus Christi, El Paso, and McAllen unionized, marking the last big organizing wave for Texas nurses.  

“It really empowers nurses to be part of the union,” said Sylvia Higgins, a neonatal intensive care nurse at Corpus Christi Medical Center. With each of the four contracts her facility’s bargaining committee has negotiated, they’ve improved working conditions, she said—including pay increases and scheduling more staff where they’re needed. Higgins feels nurses are on equal terms with management now, and that hospital administrators need to listen to their concerns.

As for her fellow nurses in Austin, she said, “I’m so happy for them. Texas is just a hard state to unionize. And for them to win in Austin, that is big news.”

The successful union drive at Ascension comes amid a growing wave of new labor organizing campaigns across the country. Most notably, Starbucks workers have won unions at dozens of shops all over the United States, including several in Texas. Three of the state’s largest newspapers have also recently unionized

But successful union drives in workplaces this large—the union will represent about 800 nurses—are rare in Texas. Many of the biggest unions in the state are in the manufacturing industry—like Gulf Coast refineries and defense contractors in North Texas—and formed during the heyday of organized labor back in the mid-20th century. Since then, large-scale organizing in Texas and the rest of the South have been few and far between. 

“It has been quite a while,” Texas AFL-CIO President Rick Levy acknowledged, unable to recall the last time workers in Texas won a new private-sector union as large as Ascension. As it turns out, just two unions as big as the Ascension nurses’ have been formed in the 21st century, one in 2014 and the other in 2006, according to National Labor Relations Board records. 

The labor movement has evolved since the 20th century to become less industrial and male-dominated. These days, more and more union membership is found in the healthcare industry, and nurses’ unions have become an increasingly powerful part of the movement. In 2020, National Nurses United unionized 1,800 nurses at a major hospital in North Carolina in the face of aggressive union-busting. Earlier this month, 15,000 union nurses in Minnesota staged a three-day strike over understaffing, marking the largest private-sector strike in U.S. history. 

About 17 percent of nurses in the United States are union, though it’s just 2 percent in Texas. That may be changing.

Back in Austin, Kellen Gildersleeve is riding high. The atmosphere at work has already changed for the better, and she’s more eager to go to work. And the response from nurses elsewhere has made victory even sweeter.

“Nurses from all over Texas have been reaching out with messages of support, asking questions,” Gildersleeve said, and she hopes that progress at Ascension Seton and interest at other hospitals go hand-in-hand. “Now we’re just going to be fighting for the strongest first contract that we can get. It’s really essential to set up our success in the future, and hopefully inspire other nurses to follow suit.”