"Pittsburgh", by Patrick Kinney, CC BY 2.0
Often still referred to as “The Steel City,” Pittsburgh was once a major hub of steel production, manufacturing, and union power. Beginning in the 1950s, a precipitous decline in steel and manufacturing employment decimated the city and much of the region. Over the last four decades, however, Pittsburgh has rebounded, driven in part by the rise of an “Eds and Meds” economy centered on its universities and health care institutions. Today, higher education institutions, such as the University of Pittsburgh and Carnegie Mellon University, and health care giants, like the University of Pittsburgh Medical Center and Allegheny Health Network, are primary employers in the city and region.
The decline of the steel industry and manufacturing not only wiped out many jobs but also substantially reduced union density. While the rise of the Eds and Meds economy helped spur job growth, the vast majority of new jobs were non-union and many did not pay enough to help workers make ends meet. Many of these jobs also did not provide job security or other workplace protections. Union organizers realized that for Pittsburgh to retain its title as a “union town,” efforts needed to focus on organizing in higher education and health care.
Listening to Hospital Workers: The Pittsburgh Wage Study
Following this renewed emphasis on union organizing, researchers from the University of Pittsburgh (including this post’s authors), in collaboration with the Service Employees International Union (SEIU), launched The Pittsburgh Wage Study to document the experiences and challenges of hospital workers seeking to organize unions and fight for higher wages and job protections. Starting with a group of service, administrative, and clerical workers at one hospital, our study grew to include more hospitals and healthcare professionals. In addition to surveying thousands of hospital workers, we conducted nearly one hundred in-depth interviews and spent many hours observing and speaking with workers at meetings and events to understand the many hardships these lower-wage workers face. Despite the reality that hospital workers provide vital care to the city and region, our findings indicated they were often vastly underpaid and had very little voice in the decisions affecting their work.
We conducted a follow-up survey of Pittsburgh hospital workers in 2022 to help guide the new mayoral administration. We wanted to understand the additional strains and hardships that the COVID-19 pandemic placed on hospital workers. The findings were troubling. We found that high percentages of Pittsburgh hospital workers reported problematic work conditions and mental health challenges, including depression, anxiety, suicidal thoughts, posttraumatic stress disorder (PTSD), burnout, secondary traumatic stress, and stress. At the same time, over 90% said their work felt meaningful and reported moderate to high compassion satisfaction—the satisfaction people experience from helping others through their work—a reminder of how committed they are to caring for patients.
Given these findings, we examined whether being a union member was associated with better work conditions and better mental health and well-being. The renewed emphasis on union organizing in the city and region led to several successful campaigns and a growth in union membership in hospitals in the city. Prior research shows that union membership is associated with higher wages and better benefits, as well as improved health and safety standards. We examined whether these same results were true for hospital workers in our sample, and whether union membership was related to better mental health for these hospital workers.
Photo by ProgressOhio, CC BY 2.0
The Union Difference: Lower Stress, Better Pay, and Stronger Protections
We recently published our findings from this analysis in an article in the Labor Studies Journal titled“ Unionization in Healthcare: Examining Working Conditions and Worker Mental Health Outcomes in Hospital Settings.” Before comparing outcomes, we matched union and non-union workers on who they are, what jobs they do, and their experience to make the groups comparable. We found that union hospital workers were less likely to show signs of PTSD and reported lower levels of stress than non-union hospital workers.
We also found that union hospital workers reported a range of better work conditions. Specifically, union hospital workers reported better pay predictability, less reliance on a second job, and a higher likelihood of working overtime to earn extra money rather than because of pressure from management. Further, union hospital workers reported more access to dental insurance and retirement programs and higher raises than non-union hospital workers. It is important to note that union hospital workers also reported less workplace harassment than non-union workers.
These findings point to the importance of unions for hospital workers. Collective bargaining can set clear, enforceable floors for wages, safety, and harassment prevention. Unions can help secure predictable raises, fair overtime based on choice rather than pressure, dependable benefits, and steadier schedules. Unions can serve as problem-solving partners and strengthen systems to prevent and address workplace harassment, including simple and confidential reporting with timely follow up. In fact, in follow-up analyses, we have found that addressing workplace harassment can lead to lower levels of burnout and secondary traumatic stress and more compassion satisfaction among hospital workers—pointing to harassment as a clear, practical focus for action.
Additionally, unions can work to build support for staff who experience traumatic events and make sure workers can see progress by sharing regular updates on safety, overtime, and access to benefits. They can push for improvements and expand what works. These steps turn the advantages we observed with unionization into everyday improvements in safety, retention, and well-being, and help keep experienced hospital workers where they are needed most.
"Pittsburgh", by Nick Amoscato, CC BY 2.0
Rebuilding Worker Power in the Steel City
There is encouraging news that union organizers in Pittsburgh are making real progress. Over the past four years, 12,000 staff, graduate students, and faculty at the University of Pittsburgh voted overwhelmingly to unionize. Union hospital workers have negotiated strong contracts at several hospitals across the city. In August, nurses at Magee Hospital—part of the University of Pittsburgh Medical Center—became the latest group of healthcare workers in the city to form a union.
Through our work on The Pittsburgh Wage Study, we have helped bring visibility to these campaigns by conducting rigorous research and sharing what we learn. Our interviews, surveys, and time on the ground told a consistent story: hospital workers are carrying a lot and still show up with deep commitment to patients. Unions don’t remove every challenge, but they give workers the tools to make care safer and jobs more sustainable. Lower stress, fewer PTSD symptoms, steadier pay, stronger benefits, and less harassment aren’t abstractions; they’re the conditions that keep experienced people at the bedside.
The story of Pittsburgh’s hospital workers shows that worker power isn’t a relic of the city’s industrial past but a driving force in its future. As health care workers, faculty, and students organize for fair pay, safety, and respect, they are redefining what it means for Pittsburgh to be a union town in the 21st century and strengthening the care system we all rely on.
