Thousands of nurses at more than 30 Sutter Health and Kaiser Permanente hospitals in Northern California will walk off the job Thursday in what union officials say will be the nation's largest-ever nurses' strike.

More than 23,000 nurses represented by the powerful California Nurses Association – including 17,000 from Kaiser hospitals – are expected to honor the walkout, primarily in the Bay Area but also at Kaiser's Sacramento-area hospitals.

Kaiser officials said they are prepared "to provide high-quality health care and service" during the strike.

The massive one-day strike, engineered by the CNA – part of the National Nurses United superunion – and the smaller National Union of Healthcare Workers, comes as Sacramento-based Sutter Health is seeking concessions from registered nurses at its Bay Area hospitals. The concessions include sharp hikes in health premium and retirement contributions and elimination of paid sick leave and the ability to advocate for patients.

"We're very concerned about Sutter's positions. This is one of the largest, most profitable hospital chains in California," said Charles Idelson, a spokesman for the CNA. "This is not the March of Dimes, this is a corporation and they've taken a very hard line with RNs."

The planned walkout will not affect Sutter's five Sacramento-area hospitals. Sutter General, Sutter Memorial and Sutter Davis hospitals are nonunion. Sutter's facilities in Auburn and Roseville each reached new three-year deals with nurses earlier in the year, said Sutter spokeswoman Nancy Turner.

But "sympathy" walkouts and demonstrations are planned at Kaiser's campuses in Roseville, south Sacramento and Morse Avenue in Sacramento. About 5,300 Sacramento-area nurses are CNA members, said Deborah Burger, a Kaiser nurse in Santa Rosa who is a president of National Nurses United. Burger said she did not know exactly how many nurses in the Sacramento area will strike on Thursday.

The planned action is the latest chapter in the continuing battle between hospitals and nurses over how to split the spoils from one of the few California industries still doing well in these hard times.

From 1999 to 2009, operating revenue at California's hospitals more than doubled, from $31.7 billion to $66.3 billion, state data show.

Hospital administrators have benefited from that increase. Sutter Health's CEO Patrick Fry, for instance, earned about $4 million during 2009, including deferred compensation, tax data show.

And in 2010, Sutter Health saw total income grow to $878 million, compared with $677 million in 2009. The health network posted revenue of $9.1 billion in 2010, compared with $8.5 billion in 2009.

California registered nurses make $88,714 a year on average, excluding benefits, up 20 percent from a decade ago, after adjusting for inflation, according to the California Employment Development Department. That's more than double the inflation-adjusted 8 percent increase in average wages for all Californians during the same period.

Sutter officials said that their Bay Area RNs earn up to $136,000, plus employer-paid benefits and pensions.

Sutter officials said that with rising health care costs and a distressed economy, concessions must be made by labor to keep costs in check.

Turner said Sutter "remains committed … to making health care affordable." She criticized the CNA's proposals and the one-day walkout, saying, "They have very little interest in making health care more affordable."

Jan Emerson-Shea, a vice president at the Sacramento-based California Hospital Association, was more pointed.

"We don't see how taking 23,000 nurses out of hospitals and having them walk the picket line advances quality patient care," Emerson-Shea said. "They're putting access to care at over 30 hospitals at risk. In this economy, when is enough enough?"

Gay Westfall, a Kaiser senior vice president, also expressed frustration at the walkout. "It is disappointing that CNA is asking its members to disrupt patient care and put communities at risk when they have a firm contract in place that runs through 2014," Westfall said.

Kaiser's CNA-represented nurses in Northern and Central California reached a deal with Kaiser effective Sept. 1 that gives a 2 percent wage increase twice a year, a 1 percent annual lump sum payment, and no changes to benefits, for each of three years.

But Kaiser nurses are joining the picket lines in a "sympathy strike," to support Sutter's nurses and some 1,500 hospital workers represented by the National Union of Healthcare Workers, who are negotiating with Kaiser.

The NUHW represents mental health professionals, social workers, marriage and family therapists and workers in optical departments in Northern California. About 30 members in Sacramento are expected to participate in the strike at Kaiser.

The CNA has been aggressive in pursuing its labor demands. Over the past few years, those have focused largely on nurse-patient ratios, pay and retirement benefits.

In 2005, about 9,000 University of California registered nurses were set to strike before a judge blocked the action. The same story played out during 2010.

During 2007, about 5,000 registered nurses did strike at multiple Northern California hospitals. The next year, 4,000 nurses at eight Bay Area Sutter hospitals went on strike.

The California Nurses Association is also expanding fast. During 2009, it spent $61 million, including $4 million on political activities, according to U.S Department of Labor financial filings, up from $15 million in total during 2000.

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