> How can the change the conditions of their employment without at least the
> threat of striking?
Plenty of ways. The strike isn't the only weapon organized workers have, and there's a ton of creative stuff workers can do when they're in motion. And this can lead to signficant gains. For instance, Tenet workers in 2003 were able to win raises over 4 years of 8%, 7%, 7%, 7% for the RN and Pro units and 6%, 5%, 5%, 5% for everyone else. Raises applied equally to everyone -- no more boss favoritism. Progressive discipline and grievance and arb clauses -- workers no longer "at will" employees. All the other standard stuff in a union contract. Don't know the historical CA standards offhand, but suffice it to say these raises were far above market averages. In Florida, they were literally unprecedented. According to the South Florida Heathcare Human Resources annual wage survey, RNs had been averaging between 3% - 3.3% annual raises, other occupations less. Many service workers with lots of tenure hadn't seen a raise in years.
Standards achieved in other hospitals organized under private election agreements have been similar, but the raises haven't been as large as the first Tenet agreement (but still far above what workers were achieving individually). Don't know the long term care industry as well, but I believe under the much maligned "alliance" agreement in CA nursing home workers earned $2/hr raises. Don't know anything about what multiservice workers (Aramark, Sodexo, etc.) have been able to achieve.