At least 40 hospital labor disputes ranging from heated contract bargaining debates to extended strikes occurred in 2018, according to a recent analysis by Healthcare Dive.

Here are the key takeaways from hospital labor disputes in 2018.

Most of the disputes occurred in heavy union or non-“right to work” states.

Based on Healthcare Dive’s analysis, most of the hospital labor disputes that garnered media attention occurred in the Northeastern and Western regions of the U.S.

California had the most labor disputes on the West Coast at 13, while Pennsylvania had the most in the Northeast with seven.

California and many of the states in the Northeast have the highest union participation in the country. New York, which has the highest number of union-affiliated employees in the country at 25.3 percent according to the Bureau of Labor Statistics, had two major disputes this year.

Florida and Texas were the only two states with major labor disputes in 2018 that are not in the top 20 states in terms of union members.

Both states were involved in a potential strike at 15 HCA-owned facilities in September, but the facilities involved reached an agreement in October, according to a National Nurses United press release.

Nurses were involved in the most labor disputes

Out of the 40 healthcare labor disputes listed in Healthcare Dive’s analysis, 21 of them were led primarily by nurses and nurse unions, 18 had a mix of medical and non-medical staff, and one was led by healthcare technicians.

Unsafe staffing, low or uncompetitive wages and lack of benefits were cited as the primary concerns for most of the labor disputes.

July was the busiest month for healthcare labor disputes in 2018

At least eight major healthcare labor disputes occurred in July this year across the country, according to the analysis.

Among those was a three-day strike by workers in Rhode Island against the Providence-based healthcare system Lifespan.

Picketers at MountainView Hospital in Las Vegas, Nevada and Corpus Christi Medical Center in Corpus Christi, Texas, would later vote to approve a strike at 15 HCA-affiliated hospitals in September.

To see Healthcare Dive’s full analysis of labor disputes in 2018, click here.

You can find our strike and protest coverage for 2018 in the list below:

• Union nurses vote to authorize strike at Michigan Medicine (Sept. 21)
• National Nurses United members at 15 hospitals authorize strike (Sept. 5)
• Rhode Island healthcare workers strike begins; Lifespan spends $10M on temp staff (July 23)
• Kaiser healthcare workers plan new round of protests at California facilities (May 1)
• Kaiser proposes change to national labor partnership amid union fractures, continued protests (May 15)