Taylor Crittenden still feels “righteous rage” when she thinks about her experiences at the beginning of the COVID-19 pandemic.

Crittenden, a nurse at a hospital in Texas, remembers staffing shortages, limitations on personal protective equipment like heavy-duty masks, and long hours as health facilities were being overrun with COVID patients.

“I was impacted by seeing all these people lose their lives,” Crittenden said. “I was also feeling frustrated and quite mad. We just needed more help on the floor. We were the ones in the rooms having these conversations with patients. We were their emotional support and their physical support. And managers and supervisors and directors were nowhere in sight.”

Two years later, Crittenden was among the hundreds of nurses at Ascension Seton Medical Center in Austin who voted to unionize. It was a snapshot of the worker power brewing within the health care industry — led in part by nurses, a workforce dominated by women — that received nearly daily public recognition of its crucial role in keeping people healthy and safe while grappling with realities like reduced resources, increasing burnout and health risks.

Now, as nurses mark the five-year anniversary of the first wave of the pandemic, they’re reflecting on their victories in securing protections but also new emerging challenges. Members of National Nurses United (NNU), the nation’s largest union for registered nurses, spoke with The 19th about their ongoing push for worker protections.

“What we saw during COVID-19, which we still see at this moment, is a radicalization of this workforce — they have to fight not only for the public, but really to protect their very lives,” said Michelle Mahon, director of nursing practice for National Nurses United.

It’s difficult to estimate unionization numbers within the nursing industry, but there were nearly 500,000 hospital nurses represented by unions in 2019. Six years later, that number has jumped to nearly 590,000, according to survey data from the American Hospital Association and internal data shared by NNU.

NNU added that among its membership, at least 10,000 nurses have unionized at more than two dozen health care facilities since March 2020.

Kelly Coward, a nurse at Mission Hospital in Asheville, North Carolina, helped unionize her workplace in September 2020. It was considered North Carolina’s first private sector hospital to unionize. The momentum to organize preceded the start of COVID, when HCA Healthcare, a major company with facilities around the country, bought the hospital in 2019. Staff and residents reported a decline in care, according to NNU, that was exacerbated by the pandemic.

Coward said she and her colleagues faced long hours and diminished resources. She still remembers the chemical smell of the N95 masks that were sterilized and returned to her because there were not enough new ones.

“We did not have what we needed at the beginning of COVID, and during this time, when we’re trying to figure COVID out, nurses are leaving. They’re leaving the bedside,” Coward said. “Some nurses retired early. Some nurses left us to go travel because they could make more money. So we were dealing with all of that, dealing with not enough supplies, not knowing what to do with these patients.”

The union vote brought clarity to the nurses on how they could fight back.

“It’s helped us in multiple ways to stand up to this huge corporation and say, ‘That’s not right. We’re not going to do that,’” she said.

The pandemic laid bare simmering tensions within the nursing workforce about frustrations over low pay, the length of work shifts, growing patient loads and general workplace violence — issues that NNU and others have been sounding the alarm on for years.

“They were being asked to work harder and longer hours, and move from patient to patient, without providing the kind of care that they wanted,” said Kate L. Bronfenbrenner, director of labor education research at the Cornell University School of Industrial and Labor Relations. “Then you have COVID, where nurses were literally dying, and also dealing with much more acute conditions and understaffing.”

Liz Wade has a distinct memory of this. The long-time nurse worked at Providence Saint John’s Health Center in Santa Monica, California, when the pandemic began. Despite reports of health care workers getting sick, management at the time pointed to existing federal guidelines that allowed less protective masks. Several nurses who demanded N95 masks before they would treat a COVID patient were suspended.

Wade, a nurse rep for the union, was at home when her colleagues called about the suspensions. She rushed to the hospital, where she said security attempted to stop her. Management eventually reinstated the nurses amid demands from the union.

“For me, it was an ultimate test of our union to mobilize and shut down the employer’s narrative that we didn’t need PPE,” Wade said. “We did it swiftly, with no deviation from our goal — to provide every nurse at the bedside with the best PPE available.”

In the years following the first wave of the pandemic, headlines began to emerge of new unionization efforts among nurses.

In November 2022, nurses at Ascension Via Christi St. Francis in Wichita, Kansas, voted to unionize. Months later in early 2023, so did nurses at a nearby affiliated hospital. In late 2023, nurses at University Medical Center in New Orleans voted to unionize, making them the first to unionize a private sector hospital in Louisiana.

Jessa Lingel is associate professor of communication and director of the gender, sexuality and women’s studies program at the University of Pennsylvania. In 2022, she co-published research on the gendered assumptions of the nursing profession and its impact on unionization efforts.

Lingel said the imagery of who is a union worker in America is changing. It is one led by women, though data shows men still make up more union members.

“For a long time, images of union members in this country have been dudes. It’s been men — steel workers, dock workers, truck drivers — male-dominated professions,” she said. “But with nurses, you see strategic unionization efforts that are tied to a woman’s profession.”

Lingel said that’s important because any uptick in union membership in recent years has been tied to professions that have more women. That includes service workers within hotels and customer service posts.

“It makes me hopeful for an example of labor activism that is more explicitly feminist but also more attuned to issues of women, issues of people of color, issues of immigrants,” she said.

Lingel’s research was co-written with her sister, Kim Branciforte, a pediatric nurse in Oakland.

When hospitals in the area tried at the height of the pandemic to temporarily roll back its minimum nurse-to-patient ratios — California is the only state with that staffing requirement — the union fought back.

“That was one way that the union really showed up. It was also really helpful to educate newer nurses who have only worked in California and don’t know that the rest of the nation doesn’t have this protection. When people say, ‘Well, what do my dues get me?’ I’m like, ‘They got you these patient ratios,’” she said.

Branciforte said it’s only now, several years into nursing that she feels confident in her work, which includes part-time teaching. She said it’s important that every nurse feels that gradual confidence, which also benefits patients. Without workplace protections, more nurses leave the workforce. That creates staffing shortages, less experienced nurses and worse patient care.

“Who do you want taking care of your child? Somebody who started two years ago, or somebody who’s been doing this for 20 years?” she said.

The union recognition wins have not come without challenges. In several instances, employers have stretched negotiations over initial contracts that can take more than a year. As a result, Crittenden’s colleagues in Austin participated in a historic strike, and then a second, in 2023. Nurses also agreed to strike at Coward’s hospital in the fall of 2024. The unions in Texas and North Carolina have since reached contract agreements with their employers.

Since returning to office, President Donald Trump has taken steps to weaken the labor movement both in private and public workplaces.

In January, Trump fired a member of the National Labor Relations Board, the independent federal agency that resolves labor disputes around the country. In March, a federal judge ruled the firing was unlawful, though the board member’s job remains in question. Trump also fired the board’s general counsel, another Biden appointee.

Bronfenbrenner said private sector employees, including nurses, will need to learn how to advocate for themselves outside of the regular labor board process. That might mean getting their employers to voluntarily recognize future union shops and finding independent arbiters to hold elections.

“They have to make the cost of not recognizing the union greater than the cost of recognizing the union,” she said, adding that nurses remain widely popular. “And if they have density in an industry, that’s easier.”

But the Trump administration is setting up new roadblocks for federal unions that organizers say could have a ripple effect on them. In March, the Department of Homeland Security announced it would cancel a union contract with Transportation Security Administration workers who oversee passenger safety at airports. The move, which impacted at least 45,000 transportation security officers, is being challenged in court.

Last week, Trump signed an executive order aimed at canceling collective bargaining rights from a larger swath of federal employees at more than 30 agencies, including nurses at the Department of Veterans Affairs. At least one union representing federal workers has sued to challenge the executive order.

All of this is playing out amid the backdrop of potential congressional budget cuts to Medicaid, a major health insurance program for low-income Americans.

“We just don’t know the shape of that, but that inevitably is going to mean layoffs, because a lot of health care is funded by Medicaid,” Bronfenbrenner added.

Despite the federal landscape for the labor movement, Branciforte is cautiously optimistic about the future of organizing. She said COVID was a wake-up for a lot of newer nurses to join or form unions, and the months and years ahead could crystallize that.

“The union has been the only effective tool that we have had to get significant change for our patients, for ourselves, and for our families,” she said.