Unions, once rare in healthcare, are now targeting hospital employees as potential members. In an industry that has seen an increase in regulations, mergers and acquisitions, rising financial pressures, and changing working conditions, it is easy to understand why discontented employees are being targeted by unions now more than ever. Hospital leaders must look to lessons learned in other organizations to develop strategies that will ensure a successful campaign. In 2003, St. Louis Children's Hospital defeated the Missouri Nurses Association/United American Nurse with a 77% no vote. The authors describe an overview of unionization in healthcare and the strategies they used to successfully win this union election.