The last time hospital nurses in the Twin Cities and Duluth sought contracts, in 2022, they orchestrated the largest nursing strike in U.S. history. Six years before that, Allina Health nurses held the longest such strike in state history.

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Leaders of the Minnesota Nurses Association said all options are on the table as they negotiate three-year contracts for more than 15,000 nurses at a dozen urban hospitals, because prior contracts have failed to resolve staffing and safety concerns that have worsened. A union press conference Thursday amped up public pressure on ongoing negotiations.

"We are here to care for patients, not to be human shields, and we cannot continue to do this dangerous work" without better protection, said Katelyn Warren, a nurse at Allina Health's United Hospital in St. Paul.

The talks include nurses at the Allina, Children's, Fairview and North Memorial hospital systems in the Twin Cities and the Essentia Health and St. Luke's hospitals in the Duluth area.

Warren said in two years on the job at United, she has been assaulted multiple times. She recalled an incident when available night-shift nurses were restraining a combative patient, and none had a free hand to call security for help. She was kneed in the head and missed time from work.

Better safety training could have helped, along with panic buttons being issued to all nurses, she said. But mostly there weren't enough nurses to handle the situation, she said.

"You cannot tell me that the significant cost of paying for workers' comp or the major turnover [of burned-out nurses] is less expensive than additional staff," she said.

Safe staffing arguably has been the top issue for nurses in contract talks over the past two decades. But each time, they have agreed to contracts without one of their chief demands: fixed nurse-to-patient staffing ratios that they believe will keep them safe and increase their time at patients' bedsides.

A spokesman for the negotiating hospitals wouldn't discuss ratios specifically, but said that the hospital negotiators have been "just saying no" to union proposals that are unlikely to result in agreement or are unaffordable.

"If you look at the financial condition of hospitals, some are starting to kind of recover, year over year, from the pandemic but others are still struggling," said Paul Omodt, the spokesperson for the negotiating hospitals.

The hospitals also are facing substantial potential revenue losses if the federal government makes cuts to Medicare and Medicaid, or if state lawmakers ban the facility fees they charge for outpatient care at affiliated clinics.

The concurrent bargaining at a dozen different hospitals gives the nurses leverage, which they used in 2022 when they coordinated a three-day strike at multiple hospitals, which spent millions of dollars to cover shifts with temporary staffing. They ultimately settled on contracts that increased pay by around 18% over three years and created committees and other mechanisms to address workplace safety.

The nurses almost got the power to help set staffing ratios via arbitration hearings with employers, even for non-union hospitals, a year later through a bill in the Minnesota Legislature. But that proposal was scuttled late in the 2023 session after Mayo Clinic threatened to pull back on investments in the state if the legislation passed.

The negotiations are the first under new union leaders, and amid a lawsuit by a former executive director who alleged the union subjected him to racial discrimination and wrongfully terminated him. First-time negotiations also are underway for nurses who recently joined the union, including those staffing North Memorial Health's Maple Grove Hospital.

Twin Cities nurses have asked for 18% raises over three years and other contract improvements, while the hospitals have offered 6% raises. Union president Chris Rubesch said the nurses are resolved to see progress on staffing this time.

"We're hopeful that hospitals will join us at the table and see the common vision of keeping patient health and safety at the center of these negotiations," said Rubesch, a Duluth nurse. "If they don't, we're prepared to ... take the steps that are necessary."