Tens of thousands of Kaiser Permanente healthcare workers in California and Hawaii walked off the job early Tuesday as they urged the nation’s largest not-for-profit medical provider to increase salaries and address staffing shortages.

Up to 31,000 registered nurses, nurse anesthetists, pharmacists, midwives, physician assistants, rehab therapists, speech language pathologists and other specialists are involved in the planned five-day strike.

“We’ve been really clear, our workers are trying to keep up and catch up with the cost of inflation,” said Charmaine Morales, president of United Nurses Assns. of California/Union of Health Care Professionals, known as UNAC/UHCP.

Morales said the union’s request to raise wages a total of 25% over four years was necessary to compensate for the far smaller increases workers received in their 2021 contract negotiations, when they received a 2% raise in the first year. She also said the company neglected to meet with various groups of workers at planned bargaining sessions last week to discuss solutions to short-staffing.

“We need to be able to hire more permanent staff. We’re looking for long-term solutions to staffing burnout,” Morales said.

The union has proposed an internal registry of on-call nurses who are union members, so that the company doesn’t have to rely on contract traveling nurses. Morales said the proposal “didn’t go anywhere.”

As striking workers picketed at facilities across Southern California, Kaiser Permanente called the strike “unnecessary and disruptive” and said the demands would “dramatically increase” its current $6.3-billion annual payroll. The company also insisted that staffing was not central to the union’s demands.

Kaiser spokesperson Candice Lee said in an email that while the union’s “public messaging emphasizes staffing and other concerns, the core issue in this negotiation is wages. That’s the reason for the strike.” Lee said that Kaiser’s staffing ratios meet or exceed all California-mandated nurse-to-patient ratios, and that the company “has been proactive in hiring and retaining staff to ensure we deliver the care our patients expect and deserve.”

The company has called the workers’ request for a 25% salary increase “out of step with today’s economic realities and rising health care costs.” Kaiser’s offer of a 21.5% pay raise would increase payroll by nearly $2 billion by 2029, the company said.

“To support this level of increase, we’re reducing internal costs and optimizing operations. Anything beyond 21.5% will require us to further increase rates for our members and customers, at a time when health care costs are increasingly unaffordable and many of them are having to make the difficult choice to go without coverage,” read a statement on the company’s website.

The company said it has plans to fill in care gaps during the strike, and has hired 7,600 temporary nurses, clinicians and other staff as substitutes. Many of those personnel have worked at Kaiser Permanente before and are familiar with its facilities, Kaiser said. The company also noted that 1,000 of its employees volunteered to be reassigned to work in strike locations.

The union’s collective bargaining agreements with Kaiser Permanente expired Sept. 30. Negotiations between the union and the company over wages and benefits have been ongoing for about three months, although some of the union workers have been in talks since March.

The first day of the strike — which is planned to continue until 7 a.m. Sunday — coincided with the onset of a potent storm that swept across Los Angeles early Tuesday.

Surgical nurse Tonja Sweeney marched with hundreds of others from a nearby park to Kaiser South Bay Medical Center through a downpour early that morning. The crowd of drenched healthcare workers carried signs, and their blue ponchos whipped in the wind.

Sweeney, 54, who has worked at Kaiser Permanente for 20 years, had been on the picket line for hours. “I’m super soaking wet, but it’s OK. We’re advocating for the right things,” Sweeney said.

The Harbor City facility was among 20 sites that were picketed across the state, with most of them concentrated in Southern California. Actions are planned in Hawaii and Oregon later in the week.

Sweeney said she often struggles to manage five patients, particularly if other staff members, such as nutritionists and aides, are tied up. If two patients, for example, are delirious upon waking from surgery, they both need someone to sit by their bedsides, even as a third or fourth patient may need assistance walking to the toilet.

“It’s not easy to walk away from our patients, but if we don’t advocate for them, who will?” Sweeney said. “We’re the people taking care of them. It’s hard but we have to do it.”

Romy Timm, a physical therapist, joined the picket line with other union members on strike.

Timm said problems of short-staffing are prevalent for physical therapists as well, and at least ten of her co-workers in recent years have reduced their work hours to part-time from full-time because it became too exhausting for them to consult with 16 to 20 new patients a week.

“We often work on paperwork through our lunches,” Timm said.

Timm, who for six years worked as an ergonomist for the company, would evaluate workspaces for nurses and pharmacists who had filed requests because they were starting to experience repetitive stress injuries from long hours caring for patients or filling prescriptions, she said.

Demands for higher wages come amid rising healthcare costs. Average monthly premiums for families with employer-provided health coverage in California’s private sector nearly doubled in 15 years. Costs rose from just over $1,000 in 2008 to almost $2,000 in 2023, according to an analysis of federal data by KFF Health News, which is not affiliated with Kaiser. That increase is far greater than the rate of inflation.

Some major medical facilities face other financial headwinds, with uncertainty of federal funding due to impending Medicaid cuts. Facilities including Sharp HealthCare, UC San Diego Health and UCSF Health have in recent months announced plans to cut public health services and conduct hundreds of layoffs.