St. Joseph's Mission Health
The St. Joseph's building is one of the older facilities belonging to Mission Health in Asheville. Colby Rabon / Carolina Public Press

Thursday’s Mission Hospital nurse union vote in Asheville made national news as the largest health care union victory in the South since 1975.

Hours after what National Nurses United called a “landslide victory,” Mission Hospital’s new owner, HCA Healthcare, sent an email to all employees nationwide thanking them for their role in weathering the COVID-19 pandemic so far. 

“HCA has cared for almost 60,000 COVID-19 inpatients, significantly more than any other health system in the country,” the email read in part.

The Tennessee-based company cut costs at the start of the pandemic, including withholding annual raises and temporarily cutting some salaries. Last week’s email announced the return of those wage levels and raises.

In addition, all full- and part-time workers would also get a one-time bonus, the email from CEO Sam Hazen said. Members of the 19 established bargaining units at HCA were excluded. An HCA spokeswoman said this includes the newly formed unit at Mission Hospital.

The timing of the message was calculated, said Alex Kivett-Kimbro, a nurse in the recovery room at Mission, who was among those spearheading the organization effort.

“I think that’s HCA’s way of showing their divisiveness toward the union,” he said Friday.

A bargaining director with the National Nurses Organizing Committee said she expects the hospital’s executives to be in touch with the union by January to start the contract negotiation process.

Contentious process

The union process at Mission Hospital has been contentious from the start, Kivett-Kimbro said.

HCA spokeswoman Nancy Lindell said HCA would review the vote, for which 965 nurses, or 70%, approved.

“In the coming days, the hospital will thoroughly examine the election process and the manner in which the election was conducted,” Lindell said.

Libby Devlin, national bargaining director for the National Nurses Organizing Committee, said both sides of a National Labor Relations Board vote have a seven-day window in which to review the process.

At the end of that time and if there are no problems, the NRLB will then certify the vote, making the union at Mission Hospital official.

After that, the bargaining unit for the nurses will begin collecting information, Devlin said.

“We are going to want to review what the nurses’ concerns are and the demands they want to make,” Devlin said.

“We need to get some information from the employer about what the status quo is, what current benefits do people have, what current policies are in place at the hospital.”

In the coming few months, perhaps as late as January, Devlin said she expects HCA’s team to reach out to the union to start scheduling bargaining sessions.

“This employer is not a pushover,” she said. “We expect there will be some real struggle there. I will tell you the nurses there are ready to engage in that struggle.”

The union effort began more than a year ago, after HCA made a successful bid for then-nonprofit Mission Hospital and its suite of clinics for $1.5 billion.

Shortly thereafter, the new parent company started issuing cuts, which fueled the desire for a union among nurses even more. Nurses accused the company of poor working conditions, with HCA rejecting those complaints, according to correspondence with the state Attorney General’s Office.

The unprecedented vote in an anti-labor state like North Carolina has received national attention, even attracting the attention of Sen. Bernie Sanders, I-Vermont, who congratulated the nurses for their historic vote via Twitter.

The vote must also send a message to HCA’s top brass, Devlin said.

“The question HCA needs to contemplate is how much do they think they can force onto these nurses?” Devlin said. “They are prepared to stand up in solidarity.”

Throughout the collective bargaining process, federal law says the status quo for pay and benefits must be maintained, Devlin said.

It could take nurses a year or two to ratify a contract, Kivett-Kimbro said.

COVID complications

Earlier this year, the new coronavirus, which causes COVID-19, started circulating.

By March, many hospital companies around the country, including HCA, halted elective outpatient surgeries to prepare for a possible swell of COVID-19 patients who would require acute care.

Those elective outpatient surgeries are the most profitable work most hospitals perform. To compensate for the lost revenue, the company halted annual pay raises, reduced discretionary spending, suspended annual merit increases and cut corporate salaries.

Many workers were told to stay home because of a lack of work, including Kivett-Kimbro. However, hospital workers in that situation were paid 70% of their take-home pay on days they couldn’t work, a policy called “pandemic pay.”

Last week’s email to workers announced an end to the chain’s cost-cutting measures starting in November. Workers who had their pay reduced will get bonuses that equal half of the pay they should have received, and others will also get a one-time bonus.

However, the email read in part, the restoration of pay and other benefits does “not apply to union-represented colleagues” subject to the collective bargaining process.

Kivett-Kimbro said normally nurses receive an annual 2%-3% cost-of-living raise. He said he’s under the impression that those raises for Mission’s nurses won’t happen this year.

“This action underlines the importance of us having a collective bargaining agreement at HCA because they are able to take away anything they want to, and to give whatever they want and answer to nobody but the shareholders and themselves,” Kivett-Kimbro said.

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Kate Martin is lead investigative reporter for Carolina Public Press. Email her at

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  1. Isn’t that illegal? The EEOC says equal pay for equal work. It’s discrimination against one for Exercising their right to organize. Withholding their right to organize or penalizing them for doing so is against the law. Glad to see the union there it was needed 15 years ago. Mission was a “Mini HCA” in the way they operated under Ron Paulus. It may have been a “non-profit” on the books but the exhorbatant salaries paid to him and the board members reflects a different picture. They were the ones profiting. New Nurses would leave after one year and go down the road to Charlotte, Greenville, or Knoxville and make 25-30% more. I don’t blame them. I left too over the cronyism and dishonesty I witnessed in my 11 years there. It’s pathetic now HCA is just as bad. Good for you NNU! Put those money grabbing crooks in their place. Just remember, Mission is the only game in town and you better treat the nurses right. One day One of them may be YOUR nurse!!!

  2. Other articles reporting on the bonuses mention the following. As part of the reduction earlier in the year, Union employees were going to have their 401k matching reduced as they did not take a pay cut. The intended reduction will now not be happening. It appears that this decision reversed some of the previous reductions for all employees, including those in unions.

    Why was this left out of this article?

  3. HCA has a history rich with treating nurses poorly.

    They have gone to a new low with this refusal to give bonuses to nurses who are members of the Union.

    Especially after (and continuing) work during this very serious and deadly pandemic.

    Hopefully the public will support the nurses at that hospital and pressure HCA into giving them their much deserved and earned bonuses.