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🗞️ Ballots at the Bedside: Federal Labor Board Orders Union Elections at Tenet Hospital in Northern California

NLRB Region 32 has directed two union elections at a Tenet Healthcare hospital in San Ramon, CA, allowing roughly 136 technical and professional employees to vote on joining an existing SEIU-UHW bargaining unit covering seven California hospitals.

onthelaborfront

onthelaborfront

— 5 min read
🗞️ Ballots at the Bedside: Federal Labor Board Orders Union Elections at Tenet Hospital in Northern California

A federal labor official has ordered two union elections at a Northern California hospital, setting the stage for a potential expansion of union representation at a Tenet Healthcare facility in the San Francisco Bay Area.

Christy J. Kwon, the regional director of the National Labor Relations Board's Region 32 office in Oakland, issued a decision on April 2, 2026, directing simultaneous secret-ballot elections at San Ramon Regional Medical Center, a 123-bed acute care hospital in San Ramon, California. Voting is scheduled for April 15. The elections follow petitions filed by Service Employees International Union-United Healthcare Workers West, known as SEIU-UHW, a California-based healthcare union that represents workers at hospitals and clinics across the state.

The union is seeking to fold two new groups of workers into a bargaining unit it already represents at seven Tenet hospitals across California. The first group, roughly 75 employees, includes respiratory care practitioners, anesthesia technicians, cardiovascular technologists, radiologic technologists, surgical technologists, and ultrasound technologists. The second group, roughly 61 workers, includes clinical lab scientists, clinical pharmacists, physical therapists, occupational therapists, speech and language therapists, social workers, and clinical dietitians.

The legal vehicle for the effort is an Armour-Globe self-determination election, a procedure established in NLRB precedent dating to the 1940s that allows an incumbent union to bring unrepresented workers into an existing bargaining unit. To do so, the union must show that the employees share a sufficient community of interest with the current unit and constitute a distinct, identifiable segment of the workforce. Ms. Kwon found both requirements satisfied for each group.

San Ramon Regional Medical Center, a subsidiary of Dallas-based Tenet Healthcare, pushed back on both petitions. The hospital argued that the voting groups were not coherently defined, lacked a meaningful community of interest with the existing unit, and that additional outpatient employees should be required to vote alongside the proposed groups. Ms. Kwon rejected each argument.

A central legal question was whether the elections would run afoul of the NLRB's Health Care Rule (29 CFR § 103.30), a regulation established in 1989 that limits acute care hospitals to eight designated bargaining unit types, partly to prevent the proliferation of bargaining units in hospital settings. Ms. Kwon ruled that Armour-Globe elections fall outside the rule's reach because they enlarge existing units rather than create new ones, a distinction the courts have endorsed.

The technical employees petition produced a notable side dispute over whether cardiovascular technicians and anesthesia technicians qualify as "technical employees" under federal labor law. Tenet argued they do not. Ms. Kwon disagreed, finding that both roles require specialized training, certification, and the exercise of independent clinical judgment, placing them squarely within the technical employee category.

The professional employees petition raised its own complications. Ms. Kwon added the hospital's physician assistant to the voting group over the union's objection that the individual may not actually be a Tenet employee, ruling that the question of her employment status was better resolved after the election. She also excluded Registered Nurse First Assistants from the professional group, finding that they remain licensed registered nurses and belong in a separate bargaining unit category. Because the professional workers would be joining a unit that includes non-professionals, they will receive a two-question "Sonotone ballot," first asking whether they consent to inclusion in a mixed unit, and then whether they want union representation at all.

The decisive factor in the community of interest analysis was the degree to which the petitioned-for workers are functionally woven into the daily operations of the existing unit. Transporters bring patients to technical workers for imaging and return them to their rooms afterward. Pharmacy technicians stock the medications that professional and technical workers draw on throughout their shifts. Distribution technicians fill the supply orders that those workers generate. In a finding that ran through both decisions, Ms. Kwon concluded that the groups do not merely share a workplace but depend on one another to complete the same chain of patient care.

The elections unfold during a period of notable labor activity across Tenet's California hospital network. Earlier this year, roughly 3,000 registered nurses at six Tenet facilities, represented by the California Nurses Association, ratified a new three-year contract after a one-day strike in October 2025 and months of bargaining past an expired agreement. The SEIU-UHW campaign at San Ramon involves a separate group of workers and a different union, though the two efforts reflect continued labor activity at Tenet's California facilities.

Key Points

  • NLRB Region 32 directed two Armour-Globe self-determination elections at San Ramon Regional Medical Center, a Tenet Healthcare facility, scheduled for April 15, 2026
  • SEIU-UHW seeks to add roughly 75 technical employees and 61 professional employees to an existing seven-hospital Tenet bargaining unit it already represents under a single collective bargaining agreement
  • The Armour-Globe doctrine permits adding unrepresented workers to an existing unit without triggering the Health Care Rule's restrictions against proliferating bargaining units in acute care hospitals
  • Cardiovascular and anesthesia technicians were confirmed as "technical employees" under federal labor law despite the employer's challenge, based on their certification requirements and use of independent clinical judgment
  • Registered Nurse First Assistants were excluded from the professional voting group on the basis that they remain state-licensed registered nurses; the physician assistant classification was added over the union's objection, with eligibility to be resolved after the election
  • Professional employees will receive a two-question Sonotone ballot, requiring them to separately consent to joining a mixed unit before their vote on representation is counted
  • The hospital failed to demonstrate that outpatient employees it sought to include share an "overwhelming community of interest" with the petitioned-for groups, the legal standard required to compel their inclusion
  • Functional integration, particularly the daily interdependence between transporters, pharmacy technicians, and distribution technicians in the existing unit and the petitioned-for workers, was the decisive factor in the community of interest analysis
  • The bargaining history of the existing multi-facility agreement, which already covers technical employees at five of the six other Tenet hospitals in the unit, supported the appropriateness of inclusion at San Ramon
  • The elections are separate from the California Nurses Association contract campaign at the same facility, which concluded with a ratified agreement in March 2026

Primary Source Author: Christy J. Kwon, Regional Director, National Labor Relations Board Region 32

Primary Source: Decision and Direction of Election, Cases 32-RC-380462 & 32-RC-380903, San Ramon Regional Medical Center, LLC (April 2, 2026)

Primary Source Link: Document uploaded and analyzed directly (NLRB Region 32 official issuance)

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