Unions and management at Kaiser Permanente have reached a tentative agreement that avoids a strike that was to start Monday at 14 West Coast hospitals and hundreds of more clinics and medical offices. The strike would have been by 32,000 nurses, physician assistants, pharmacists and other health care professionals who are union members. But additional job actions had been scheduled to start the following week that could have expanded the number of strikers to nearly 40,000. In addition, a number of unions not involved in these negotiations had planned sympathy strikes that could have taken another 60,000 workers off the job, making it the largest private sector strike in the nation since 2004. The union said the deal, which still needs the approval of its rank-and-file members, secures the economic package it sought as well as the hiring and staffing promises it said are needed to improve the quality of life for workers and the health care needs of patients. “The Alliance of Health Care Unions fought to preserve a Kaiser Permanente where patients can count on excellent patient care and service,” said Hal Ruddick, the union’s executive director. “This agreement will mean patients will continue to receive the best care, and Alliance members will have the best jobs.” Kaiser management also praised the agreement. “These were challenging negotiations, but this tentative agreement demonstrates the strength of our labor management partnership and the unique success it can achieve when we work together,” said Christian Meisner, senior vice president and chief human resources officer at Kaiser. The deal includes wage increases in every year of the proposed five-year contract. This has been a period of particularly strong worker discontent, both at unionized and non-union workplaces. A record 4.4 million workers quit their jobs in September, according to the Labor Department, and employers are having trouble finding the workers they need to fill job openings. That has helped tip the balance more in the favor of workers than employers. It has prompted unions to flex their muscles in a way not seen in recent years, with a rising number of strikes. Even when unions have reached tentative deals with management, rank-and-file members have sometimes rejected the deal, prompting strikes. So the ratification of this deal at Kaiser is not certain. Members of the United Auto Workers union have rejected two such deals at farm and construction equipment maker John Deere, remaining on strike despite an offer that included a 10% immediate raise, an $8,500 signing bonus and additional raises and bonuses later in the contract. But strikers have argued the company, which had been reporting record profits, could afford even more. The union members there are preparing to vote on what the company has termed its best and final offer.