Nurses and support staff at HCA Healthcare, the largest for-profit hospital chain in the U.S., plan to strike Friday in protest over cuts and concessions the corporation is pushing on front-line health care workers as the coronavirus continues to spread nationwide.

The Guardian and KHN have so far identified reports of 679 front-line health care workers who have died of COVID-19 in the U.S. amid continuing reports of long hours and shortages of personal protective equipment (PPE).

Erin McIntosh, a nurse in the code blue/rapid response department at the HCA-owned Riverside Community Hospital in Riverside, California, for six years, is one of around 1,000 nurses represented by SEIU Local 121RN planning to strike in protest of hospital understaffing during the pandemic, which they say violates California’s nurse-to-patient ratio laws.

“HCA has continuously not upheld their end of the mediation agreement of our nurses staying in ratio,” said McIntosh. The agreement was made in March 2019. “We’re striking June 26 through July 6 because they didn’t want to uphold our mediation agreement.”

Hospital staffs have regularly reused masks and gowns throughout the pandemic, McIntosh explained, creating another layer of stress for health care workers.

“When the pandemic hit, I thought HCA, our hospital, would be revving up the resources, that we would have more resources, more staff, but unfortunately it was the opposite. They started making cuts, and we’re working with skeleton crews,” McIntosh added. “We’re being cut to the bare minimum.”

Job listings for nurses at HCA-owned hospitals in the Los Angeles area were posted in anticipation of the strike actions. HCA reportedly created a unit focused on strike-related labor shortages, offering nurses who appear for shifts during strikes higher pay than they currently receive and free continental breakfast. The company is also seeking to hire labor relations directors in Denver, Dallas, Kansas City and Nashville, Tennessee, and has continued retaining union avoidance consultants in Asheville, North Carolina, amid a union organizing drive at Mission Hospital.

“After thoughtful consideration; the hospital and 121RN failed to come to an agreement and we declined to extend the current agreement,” a spokesperson for HCA told the Guardian in an email. “At this time we believe we are independently making significant progress around the topic of staffing at Riverside Community Hospital and believe that we can support our employees on our own without the influence of an outdated agreement.”

Around the U.S., nurses and hospital workers at HCA have reported understaffing and a lack of resources through the coronavirus pandemic. HCA is currently pushing employees to accept several concessions to pay and benefits — including wage freezes, elimination of 401(k) retirement contributions — and signaling the possibility of layoffs, with non-union employees already forced to accept freezes to annual wage and salary raises.

HCA received about $1 billion in federal coronavirus relief that does not have to be repaid, and over $4 billion in accelerated Medicare payments. The corporation made over $7 billion in profits over the past two years, and HCA CEO Sam Hazen received $27 million in total compensation in 2019, his first year in the position. Hazen and other executives reportedly took pay cuts in 2020, citing the pandemic, but based on his 2019 salary the cut equates to less than 1% of his total compensation.

“Patient safety is not there due to the lack of staffing,” said Xochitl Gonzalez, a certified nursing assistant at Los Robles Medical Center in Thousand Oaks, California. CNAs don’t have mandated staffing ratios, and Gonzalez noted she is currently expected to cover up to 30 patients throughout the day. “They’ve received billions of dollars in federal stimulus relief and they’re still cutting staffing. Managers are doing our work and they’re sending people home, cutting our hours.”

At HCA-owned University Hospital Medical Center in Oakland Park, Florida, nurses with SEIUHealthcare are currently bargaining for a new union contract. The current one is set to expire at the end of July.

Nurses at 19 HCA-owned hospitals around the U.S. are represented by National Nurses United, who also face pressure from HCA to make concessions to current union contracts and have held protests during the pandemic over the lack of hospital preparation and resources to handle coronavirus cases, and the threat of layoffs.

“The federal relief funding should not be a bargaining chip for management,” said Kimberly Smith, a registered nurse at Corpus Christi Medical Center in Texas. “We’re not in negotiations, we have a set contract. For me, it’s set in disbelief and distrust in HCA for trying to change something they already agreed to.”

In Florida, Barbara Murray, a registered nurse at St. Petersburg General Hospital recently protested outside her hospital over the threats of possible layoffs and compensation cuts, even as the current union contract runs until May 2021.

“It’s very frustrating. A lot of days we don’t have enough staff, enough techs,” said Murray. “I’ve been a nurse for 40 years and I’ve seen a lot of changes over time, but the changes aren’t in nurses, we just want our patients to be safe, get well and go home, and we expect our hospital to provide us with what we need to take care of them to get them home safely to their families.”

A spokesperson for HCA told The Guardian there have not been any furloughs or layoffs directly related to the pandemic yet. “We asked our unions to forgo their raises, as well, to maintain continuation pay for their members, and they refused. As a result, while the pay continuation program will continue for most of our colleagues, it will end June 6 for most colleagues represented by a union. While we hope to continue to avoid layoffs, the unions’ decisions have made that more difficult for our facilities that are unionized,” said the spokesperson.

They cited $138 million spent so far on pay continuation programs during the coronavirus pandemic for 120,000 employees, said corporate executive leadership have taken pay cuts between 10% and 30% and said — despite PPE shortages across the nation — HCA Healthcare has provided all hospitals with adequate PPE.