More than 2,100 registered nurses at Seattle Children’s Hospital voted Monday to authorize a strike, setting up a potential first work stoppage in the institution’s 118-year history.
The overwhelming vote came after 32 bargaining sessions failed to produce a contract both sides could accept. Electronic voting concluded at 1 p.m., with nurses sending a clear message: the hospital’s latest offer doesn’t meet their needs.
Now the Washington State Nurses Association has the authority to call a strike with 10 days’ notice, though both sides say they’re still committed to reaching an agreement.
The dispute centers on money, staffing, and workplace safety, with each side presenting starkly different narratives about what’s fair and what’s financially possible.
Seattle Children’s says it offered wage increases averaging $10.62 per hour, a 17.4 percent raise over the contract term. Less experienced nurses would see increases up to 23.8 percent under the proposal.
The hospital also points out it pays 100 percent of the employee-only healthcare premiums for nurses working at least 24 hours per week, something “only a few hospitals in the Puget Sound region” do.
“Seattle Children’s is committed to being a leader in total compensation in the Puget Sound region,” a hospital spokesperson said. But the hospital “must also prioritize financial stewardship in the face of potentially devastating economic headwinds, including significant federal and state cuts and taxes.”
The hospital estimates tens of millions of dollars in negative financial impact in fiscal year 2026 alone, growing to hundreds of millions over five years from state and federal taxes and funding cuts.
The nurses union sees things differently.
The WSNA says Seattle Children’s nurses are paid below market rates compared to other West Coast pediatric hospitals. A 17 percent raise doesn’t close that gap if you’re starting from behind, the union argues.
Beyond wages, nurses want improvements in staffing that would help recruit and retain experienced clinicians for hard-to-fill roles like night shifts and behavioral health units.
The union says many nurses lack sufficient sick leave and are sometimes forced to work while contagious, creating patient safety risks.
The WSNA has also filed unfair labor practice complaints alleging the hospital engaged in actions that could violate federal labor law during negotiations, though specifics of those complaints haven’t been made public.
“Nurses at Seattle Children’s are vital members of the team and play an important role in providing the highest level of care to patient families,” the hospital spokesperson said, emphasizing the hospital’s commitment to continued negotiation.
A federal mediator has been involved in the bargaining, with the hospital’s own updates describing “incremental progress in some areas of contract talks.”
But progress hasn’t been enough to prevent the strike authorization vote, which the union described as “a last resort after prolonged talks.”
The context surrounding these negotiations makes both sides’ positions more understandable, if not reconcilable.
Seattle Children’s laid off 154 employees in November, about 1.5 percent of its workforce, according to Washington’s Employment Security Department. The hospital also eliminated 350 open positions.
Hospital administrators cited reduced state and federal funding as the primary reason for the cuts, the same financial pressures they now cite in contract negotiations.
Changes to Medicaid reimbursements under federal legislation enacted earlier this year have sparked concerns across healthcare systems in Washington. Reduced spending and reimbursements could force cuts to services or staffing at hospitals serving low-income patients.
Seattle Children’s treats all children regardless of families’ ability to pay, making it particularly vulnerable to Medicaid cuts. “Total compensation for nurses must be balanced with preserving Seattle Children’s ability to care for all children in the region,” the hospital said.
From the nurses’ perspective, financial pressures at the corporate level shouldn’t translate to below-market wages and unsafe staffing ratios at the bedside.
Two weeks after the November layoffs, nurses held rallies seeking safe working conditions, adequate staffing, and better pay. The strike authorization vote represents an escalation of that pressure.
If nurses do strike after providing 10 days’ notice, Seattle Children’s would face difficult decisions about maintaining operations at one of the region’s most prominent pediatric care centers.
The hospital would likely bring in temporary replacement nurses, an expensive proposition that would undercut the argument about fiscal constraints. Replacement nurses typically command premium rates, and the costs of recruiting, credentialing, and training them add up quickly.
A strike would also create risks for patients with complex medical needs who can’t easily be transferred to other facilities. Seattle Children’s serves as the regional referral center for the sickest pediatric cases across Washington, Alaska, Montana, and Idaho.
Parents of children with cancer, heart conditions, or other serious illnesses would face uncertainty about whether their child’s care team would be available or whether procedures might be delayed.
The 118-year history without a strike speaks to a traditional relationship between the hospital and its nursing staff. Breaking that history would signal how far apart the two sides have drifted.
Both the WSNA and Seattle Children’s say they remain willing to negotiate even as labor pressure increases. The strike authorization gives the union leverage but doesn’t make a work stoppage inevitable.
The 10-day notice requirement provides a window for last-minute agreement. Sometimes the reality of an impending strike concentrates minds and produces compromises that seemed impossible during regular bargaining.
