Twin Cities, Duluth nurses hope strike vote heaps pressure on hospitals

Nurses at a dozen Twin Cities and Duluth hospitals on Monday voted to strike if they can’t agree on a contract, which they insist must include staffing ratios that protect nurses and patients.

Hospital negotiators have refused to discuss staffing ratios, which nurses and their union argued is an unfair labor practice and the pretense for the vote. The result, announced Tuesday morning, does not mean a strike is imminent, but it gives the Minnesota Nurses Association the ability to call one with 10 days’ notice to hospitals.

A long-sought goal of union nurses, staffing ratios are supposed to guarantee enough nurses are available when patients suffer emergencies or just need help getting to the bathroom without falling, said Erika Helling, an intensive care nurse at M Health Fairview Southdale Hospital. She is part of the MNA bargaining committee at the Edina hospital.

“When we limit the number of patients nurses are responsible for, you have better outcomes,” Helling said. “That’s what we’re fighting for. They won’t talk about it at the table.”

Contract talks are happening concurrently for more than 15,000 hospital nurses employed by Allina Health, Children’s Minnesota, M Health Fairview, North Memorial Health and HealthPartners’ Methodist Hospital in the Twin Cities, and by Essentia Health and Aspirus St. Luke’s in Duluth.

The hospitals have opposed the union’s call for rigid ratios, because they can result in costly overstaffing and prevent them from adding or subtracting nursing shifts based on the number of patients but also their illness levels.

Allina in a statement expressed hope for a “sustainable” contract: “Now is the time to focus on reaching agreement and not positioning for a disruptive strike that will not benefit anyone.” A spokesperson for Aspirus, Children’s, Fairview, Methodist and North said their goal is a “fair settlement” as well, but “our hospitals will be fully prepared to care for patients” if a strike occurs.

Calling Monday’s vote on the basis of unfair labor practices is a key procedural step for the union, giving striking nurses federal protection against being fired. Striking purely on economic grounds could put their jobs at risk.

Negotiations have been thorny so far in Duluth, where Essentia filed its own unfair labor practice charges, accusing the union of repeatedly refusing to meet. Essentia clinic nurses and advanced practice clinicians also voted on Monday to pursue strikes if their own negotiations don’t result in contracts.

Nurses have championed staffing ratios in the past, highlighting them in 2010 during a one-day strike and again in 2022 during a three-day strike of Twin Cities and Duluth-area hospitals that was billed as the largest such event in U.S. history.

Each time, the nurses have withdrawn their demands for ratios in exchange for other contract guarantees or improved wages or benefits.

Helling said nurses have the resolve to get ratio guarantees in their contracts, after failing to get them enshrined in state law during the 2023 legislative session. Ratio legislation was scuttled on the final day of that session, after Mayo Clinic threatened to reduce investments in Minnesota over the costly proposal.

“We’re tired,” Helling said. “We’re done.”

Nurses hope ratios could reduce workplace violence in hospitals by increasing supervision of patients and families before crises emerge.

Sixteen patients or hospital workers were seriously injured during physical assaults in Minnesota hospitals in the 12-month period ending last October, according to newly released adverse event data from the Minnesota Department of Health. Before 2020, the state hadn’t reported more than five such assaults in a year.

The state also reported 90 serious injuries and four deaths last year as a result of patients falling in hospitals. Nurses have argued that higher staffing levels and more supervision could prevent some of these events.

“Having too many patients for one nurse, you’re not able to provide the care that you need to for your patients,” said oncology nurse Ariele Smith, who brought her toddler to Southdale Monday to vote for a strike. Some of her cancer patients are overweight and need extra help moving around, she said, while others are coping with terminal illnesses and need emotional support.

The contract talks are taking place amid the backdrop of federal budget-cutting legislation that could cut thousands of Minnesotans from Medicaid and millions of dollars in public support for the state’s hospitals.

Minnesota is hastily applying for a federal Medicaid directed-payments program that could offset those losses and generate an additional $1 billion per year in hospital revenues.