Picketing began Wednesday morning at Kaiser Permanente hospitals as some 75,000 healthcare workers go on strike in Virginia, California, and three other states over wages and staffing shortages, marking the latest major labor unrest in the United States.

According to the AP, Kaiser Permanente is one of the country’s larger insurers and healthcare system operators, with 39 hospitals nationwide. The non-profit company, based in Oakland, California, provides health coverage for nearly 13 million people, sending customers to clinics and hospitals it runs or contracts with to provide care.

The Coalition of Kaiser Permanente Unions, representing about 85,000 of the health system’s employees nationally, approved a strike for three days in California, Colorado, Oregon, and Washington, and for one day in Virginia and Washington, D.C.

The strikers include licensed vocational nurses, home health aides, and ultrasound sonographers, as well as technicians in radiology, X-ray, surgical, pharmacy, and emergency departments.

Doctors are not participating, and Kaiser says its hospitals, including emergency rooms, will remain open during the picketing. The company said it was bringing in thousands of temporary workers to fill gaps during the strike. But the strike could lead to delays in getting appointments and non-urgent procedures being rescheduled.

It comes amid unprecedented worker organizing — from strike authorizations to work stoppages — within multiple industries this year, including, transportation, entertainment and hospitality.

Wednesday’s strike is the latest one for the healthcare industry this year as it continues to confront burnout with the heavy workloads — problems that were exacerbated greatly by the pandemic.