The Hospital Workers Study

This research is the flagship initiative of the Pittsburgh Wage Study. This research is supported by the Heinz Endowments and the Social Science Research Initiative at the University of Pittsburgh. The main goal of this study is to document the effects of incremental wage increases negotiated through a service union at a local hospital on the lives of hospital workers. We accomplish this with a longitudinal, mixed methods study including annual surveys and in-depth interviews. Explore below to learn more about this study and hospital workers’ experiences.

Research Objectives

What hardships do workers experience under the current wage structure, as well as under the improved wage structure? How does a wage increase address some of these hardships?

How do wage increases affect the following domains:

  • participation in public benefits and community nonprofits;
  • participation in employer benefits;
  • workers’ mental and physical health;
  • workers’ ability to save;
  • participation in family and community life;
  • workers’ feelings about and commitment to their work


Clerical, technical, and service workers in a service union at a local hospital are included in this study. This union covers a wide range of workers. Examples include: unit secretaries; nursing and medical assistants; sterilization, pathology; and cardiac monitor technicians; patient transporters; hospital operators; and physical therapy assistants. This population includes about 1,000 workers. In wave one, 51 workers were interviewed and 165* workers completed surveys. In wave two, 44 workers were interviewed and 257* workers completed surveys. In wave three, 206 workers completed surveys. 

In the spring of 2021, we completed another survey of hospital workers, specifically nurses and service workers from four Pittsburgh city hospitals, to understand the effects of COVID-19 on this frontline workforce. In this survey, 538 workers, including 308 nurses and 230 service, clerical, and technical workers, completed surveys. 

*These numbers reflect surveys with complete data for analytical purposes. Larger numbers of surveys were actually completed.

Research Method

This research uses a longitudinal, convergent, mixed methods design. The quantitative arm of the study includes an annual survey inviting the whole population to participate. The qualitative arm uses in-depth, semi-structured interviews of a subset of the population. The two methods inform each other, confirming or deepening understanding of the other. The first wave of data collection occurred 2016-2017 and analyzed the effect of the first wage two wage increases. The second wave occurred in 2017-2019 and analyzed the third wage increase. The third wave was completed in the spring of 2020. An additional study focusing on both nurses and service workers was completed in the spring of 2021. 


  • University of Pittsburgh, Office of the Provost, Social Science Research Initiative
  • Heinz Endowments

Products from This Research

Academic Articles

Do wage increases help? Wage increases and material hardships among low-wage hospital workers. Woo, Shook, Goodkind, Ballentine, Engel, Kim, & Petracchi. (2022). Journal of Human Behavior in the Social Environment, 1-14. 

Abstract: This study examines whether and how wage increases are associated with hardships experienced by low-wage workers and their strategies to manage these hardships. Data are drawn from a survey of 166 hospital service, clerical, and technical workers at a large hospital in Southwestern Pennsylvania. Following an initial wage increase, workers experienced fewer hardships and used fewer strategies to make ends meet, such as financial support from family and public benefits programs. Hardships decreased more for workers making above $15 an hour. These results suggest that raising the wages of low-wage workers can help reduce the hardships they experience and the need to use a variety of strategies to make ends meet.

Material Hardships, Perceived Stress, and Health among Low-Wage Hospital Workers. Woo, Ballentine, Shook, Engel, & Goodkind. (2022). Health and Social Work, 47(1). 

Abstract: Many service, clerical, and technical hospital workers deemed essential during the pandemic have wages that do not reflect the essential nature of their work and do not earn enough income to cover basic expenses. Thus, many experience material hardships related to food, housing, and medical care. Previous studies have shown strong relationships between material hardships and health; however, they do not fully explain the role of stress as an intervening mechanism. This cross-sectional study analyzes an online survey with 257 lower-wage hospital workers to examine the relationships between hardships and health, and how perceived stress mediates these relationships. Path analysis revealed that financial and food hardships were related to mental health through perceived stress, while medical hardship was directly associated with physical health. These findings add to the evidence that workers’ hardships either directly or indirectly contribute to negative mental and physical health outcomes through perceived stress. Future investigations should further examine relationships among material hardships, stress, and health, and advocacy efforts should focus on raising wages for essential hospital workers.

From Scarcity to Investment: The Range of Strategies Used by Low-Income Parents with “Good” Low-Wage Jobs. Ballentine, Goodkind, & Shook. (2020). Families in Society, 101(3), 260-274. 

Abstract: Low-wage workers have borne the brunt of the changing labor market, including wage stagnation, growing income inequality, and increasingly unstable work environments. Most research on low-wage workers focuses on precarious minimum wage employment; however, some low-wage workers hold jobs earning more than minimum wage with consistent, full-time hours. This study explores strategies parents in these “good” low-wage jobs use to provide for their children, using data from in-depth interviews with hospital workers. We find workers use multiple strategies, which we categorized as scarcity, maintenance, and investment strategies to highlight the distinct types of resources and varying amount of stress associated with them. Finally, we compare the types and number of strategies parents use by hourly wage versus net household income.

Moving Beyond Poverty: Effects of Low-Wage Work on Individual, Social, and Family Well-Being. Shook, Goodkind, Engel, Wexler, & Ballentine. (2020). Families in Society, 101(3), 249-259. 

Abstract: Social work has long been committed to eliminating poverty, which is at the root of many of the social issues and challenges we address. Over 40% of the U.S. workforce makes less than $15/hour, and the accumulating evidence suggests this is not enough to meet basic needs. In this introduction to a special issue about low-wage work, we describe what is known regarding the experiences and well-being of low-wage workers, as well as promising policy and practice ideas to better support working families. We provide an overview of the included articles and conclude with encouragement for social workers to move beyond a narrow focus on poverty and more broadly consider the struggles and well-being of low-wage workers and their families.

Conference Presentations

Kim, S. Poster Presentation. A Latent Class Analysis of Essential Workers’ Hardships: Effects of Wages, Public Benefits, and Demographics. Association for Public Policy Analysis & Management, 43rd Annual Program Meeting, March 2022.

Engel, R., Wexler, S., & Kim, S.  Paper Presentation. Can Workers and Their Families Live on a Living Wage?. Society for Social Work Research, 26th Annual Conference, January 2022.

Woo, J., Engel, R., & Shook, J. Poster presentation. The COVID-19 Impact on the Mental Health of Healthcare Workers. Society for Social Work Research, 26th Annual Conference, January 2022.

Goodkind, S, Hyde, C., Haley, A., Ballentine, K. L., & Allmang, S. Roundtable. Social work’s role in addressing precarious, undervalued work across labor sectors. Society for Social Work Research, 25th Annual Conference, January 2021.

Woo, J., Ballentine, K. L., Kim, S., Shook, J., Goodkind, S., Engel, R., Wexler, S., & Petracchi, H. Poster Presentation. Public vs. private: Do strategies to make ends meet moderate the relationship between financial insecurity and stress? Society for Social Work Research, 25th Annual Conference, January 2021.

Woo, J., Ballentine, K. L., Engel, R., Shook, J., & Goodkind, S. Relationships among Material Hardships, Perceived Stress, and Health among Low-Wage Workers. Paper to be presented at the 66th CSWE Annual Program Meeting, November 2020.

Ballentine, K. L. & Woo, J. Symposium. A qualitative study of work-family interaction among low-income hospital workers with a “high road” employer. Work Family Research Network, New York City, June 2020.

Woo, J. & Ballentine, K. L. Oral Paper. More money? More problems?: Good jobs do not prevent workers’ stress from spilling over to their health. Work Family Research Network, New York City, June 2020.

Ballentine, K. L. Symposium. “I could have been there to help him more”: A qualitative study of work-family conflict among low-wage hospital workers with dependent children. Society for Social Work Research, 24th Annual Conference, Washington, D. C., January 2020.

Goodkind, S., Ballentine, K. L., Wexler, S., Waton, A., Shook, J., & Engel, R. Oral Presentation. The social construction of deserved wage: How do low-wage hospital workers respond to income inequality. Society for Social Work Research, 24th Annual Conference, Washington, D. C., January 2020.

Kim, S., Woo, J, Shook, J., Ballentine, K. L., Goodkind, S., Engel, R., & Wexler, S. Oral Paper. Is $15 enough? Understanding the struggles of low-wage workers. Society for Social Work Research, 24th Annual Conference, Washington, D. C., January 2020.

Ballentine, K. L., MacKenzie, K. & Goodkind, S. Oral Presentation. What happens when the fight for $15 is won? Strategies to cope with hardship among low-wage parents. Society for Social Work Research, 23rd Annual Conference, San Francisco, CA, January 2019.

Shook, J., Goodkind, S., Engel, R., Ballentine, K. L., Wexler, S., Petracchi, H. & Woo, J. Oral Presentation. Raising wages of low wage workers: Does it help? Society for Social Work Research, 23rd Annual Conference, San Francisco, CA, January 2019.

Goodkind, S., Ballentine, K. L., Hill, H., Shook, J., Engel, R. & Allard, S. Roundtable. Studying the Impact of Raising Wages of Low-Wage Workers. Society for Social Work Research, 22nd Annual Conference, Washington, D. C., January 2018.

Research Briefs & Reports

Leaving the Bedside: Findings from the Pittsburgh Hospital Workers Survey

Putting our Lives on the Line: Early Pandemic Experiences from Essential Hospital Workers

Moving Beyond $15: Comparing Hardships among Healthcare Workers Earning Below and Above $20 per Hour

One Year into the COVID-19 Pandemic: Mental Health of Healthcare Workers

Pathways from Hardship to Health among Low-Wage Workers

Raising Wages of Low-Wage Workers: Does it Help?

Public Transit Helps Essential Hospital Workers Get to Work

Can Healthcare Workers’ Family Incomes Support their Families? 

“Without Us the Hospitals Wouldn’t Stay Open”: Essential Contributions of Service Workers

Is $15 Enough? Understanding the Struggles of Low-Wage Workers

Hospital Service Workers & Housing Hardships

Hospital Service Workers & Medical Hardships

Hospital Service Workers & Food Insecurity

Pittsburgh Wage Study Preliminary Report – December 2017


Exploring Multiple Pathways from Low-Wage Work to Work Health: A Mixed Methods Study. Woo. (2022). 

Abstract: Scant research has examined the extent to which both economic and non-economic dimensions of low-wage work determine differential exposures to stress, and the extent to which these stressful experiences pose a threat to worker health. The goal of this dissertation study is to explore multiple mechanisms from working conditions of low-wage work to worker mental health. Informed by a theoretical framework derived from social stress theory, this study utilized concurrent mixed methods to gain a fuller and nuanced understanding of vulnerable low-wage workers.

This dissertation study used both quantitative and qualitative data from the Pittsburgh Wage Study. Health care workers in Pittsburgh, Pennsylvania completed online surveys and/or participated in in-depth interviews. Path analysis and thematic content analysis were used to analyze quantitative and qualitative data, respectively. Quantitative examination demonstrated the significant role of certain working conditions in worker mental health and confirmed the mediating role of stress in the relationships between life stressors and mental health. Qualitative examination revealed four groups of workers, grouped according to the level and source of work-family conflict. These groups suggest that work-family conflict needs to be understood in light of not only work schedules but also other factors that promote or hinder workers’ ability to balance work and life. The qualitative findings provide a fuller and more nuanced understanding of the lack of relationship between work schedules and work-family conflict as revealed by the quantitative analyses, thus illustrating the advantage of employing a mixed-methods approach.

It is essential to see the working conditions of low-wage workers as impacting not only the well-being of low-wage workers, but also the network surrounding these workers. Findings from this study will help inform policymakers and institutions of the need for differential strategies to improve working conditions in support of worker mental health. Implications of these findings are discussed with regard to providing a living wage, alleviating material hardship, improving workplace policies, and helping workers balance work and family responsibilities.