Kaiser Permanente employees in Maryland, Virginia and Washington, D.C., voted overwhelmingly to authorize a strike if the company and coalition of unions cannot agree on a new contract by the end of the month.

About 4,000 Kaiser nurses, technicians and medical professionals could go on strike as early as Oct. 1 if a deal isn’t reached.

Workers in Oregon, Washington and Colorado already authorized a strike, and other chapters throughout the United States are now voting on the issue.

If all of the chapters agree to authorize, about 85,000 employees across the nation could stop working.

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The Coalition of Kaiser Permanente Unions and Kaiser Permanente have been in national contract negotiations since April.

The union says Kaiser is not doing enough to rectify staffing issues.

“The biggest issue we have to solve at Kaiser is the chronic understaffing we face in our facilities,” the coalition wrote in a press release. “Eleven percent of coalition positions are vacant and the average vacancy takes 80 days to fill.”

The union also said workers are underpaid and that Kaiser needs to make more of an investment in educating and training future health care workers.

“Many of our health care workers have to have two jobs just to support themselves, or to be able to support their families,” said Linda Bridges, the president of the Office & Professional Employees International Union, Local 2, which represents Kaiser employees in the mid-Atlantic.

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Kaiser’s presence in the Maryland area is relatively small, but has grown in recent years with a recent 222,000-square-foot facility in Timonium.

About 75% of Kaiser’s workforce is represented by unions. Kaiser says strikes are a common bargaining tactic.

“This tactic does not reflect any breakdown in bargaining, nor does it indicate a strike is imminent or will happen at all,” the company wrote in a statement last month. “It is a disappointing action considering our progress at the bargaining table. It does not reflect our commitment to reaching an agreement that ensures we can continue to provide market-competitive pay and outstanding benefits.”