Staffing and pensions are two flashpoints in the contentious negotiations.
Locked in the most contentious contract talks in a quarter-century, 14 Twin Cities hospitals and their 12,000 nurses are bracing for a strike that could start as soon as June 1 and send hospitals scrambling to staff their wards.
The nurses will vote May 19 whether to authorize a walkout.
Nurses say the hospitals are using the weak economy as an excuse to cut pension benefits and change work rules in ways that will endanger patients. The hospitals, which are nonprofit, say that they're merely adapting to economic realities and that patients will be fine.
In 1984, the last time talks imploded for the hospitals group, 6,000 nurses walked out for five weeks in what remains the biggest nurse strike in U.S. history.
Now, as then, the hospitals plan to continue operating and are prepared to hire thousands of temporary replacements. They say they have made contingency plans and already have secured "a number of nurses.'' A California agency has sent e-mails looking to recruit 2,000 replacement nurses at up to $4,770 a week -- three times the typical pay of a Twin Cities nurse.
The nurses, meanwhile, plan to demonstrate outside Twin Cities hospitals this week, hoping to rally public support.
They also have mobilized online, posting copies of contract proposals on the union website, www.mnnurses.org, and updates on Facebook and Twitter. There's even a video of athletes from the Minnesota Timberwolves and the Wild "thanking Minnesota nurses for the work they do!"
"They're proposing to eliminate every gain we've made since the 1984 strike," said Joni Ketter, director of organizing and field operations for the Minnesota Nurses Association.
Trish Dougherty, a hospital spokeswoman, said the employers are seeking necessary efficiencies, not changes in care. "I don't see a crisis of safety in Twin Cities hospitals," Dougherty said.
While posturing is typical in contract talks, economic pressures have intensified in the past few years.
Twin Cities hospitals laid off 1,700 employees during the 2009 recession, causing strains among employees left behind. Hospitals have been squeezed by budget cuts in government health programs, investment losses and increases in charity care. In addition, they face the financial strain of maintaining pension benefits, a crunch that has struck many other industries.
In a sign of rising tensions nationally, 1,500 nurses and allied health professionals at Temple University Hospital in Philadelphia went on strike for 28 days before finally agreeing to a contract last Wednesday.
Since the historic 1984 strike, there's been only one walkout by Twin Cities nurses: in 2001 about 1,350 nurses struck for three weeks at two Fairview hospitals, in part over staffing concerns.
Nursing was once seen as a job for life, and a well-paying one at that. Full-time nurses in local hospitals earn an average of $79,000 a year, not including benefits. But the profession is growing steadily less attractive, nurses say.
Nursing jobs aren't plentiful
Today, with stubbornly high unemployment rates, some doubt that thousands of nurses will walk off the job.
A survey of nurses graduating from St. Catherine University this year found that only 34 percent of those who responded had found jobs.
"Many graduates are going out of state," said Alice Swan, the interim dean of the university's Henrietta Schmoll School of Health in St. Paul. In these times, she said, nurses "may be more willing to cross the picket line."
At the same time, she said there are growing signs that a strike is possible, given the level of nurses' concerns.
Asked if a strike seems likely, on a scale of 1-10, she said: "I'm at a 7.''
At odds over staffing ratios
Jason Bauman, a 26-year-old nurse at Abbott Northwestern Hospital in Minneapolis, admits that many young nurses are nervous about the prospect of a strike. "They're afraid of not being able to support their families," he said.
But Bauman, one of the union organizers, says there are other issues at stake.
"All we really want is safety at the bedside and the tools to continue giving the best care possible," he said. "The employers are crying [about] the economy right now, but this contract is going to be there for three years. We need to address these issues for the future as well."
Nurses say they want the contract to ensure adequate staffing levels. They cite a 2005 medical journal article that said thousands of deaths could be averted if nurses were assigned no more than four patients at a time.
The hospitals say that's unrealistic and that staffing ratios vary among hospital units. In intensive care, the ratio may be one nurse to two or three patients. Elsewhere, it may be as high as one nurse to 10 patients.
More flexibility sought
"We're not proposing cuts to staff," said Dougherty, a former nurse. "We want more flexibility."
Hospitals want the flexibility to reassign nurses among units to meet fluctuating demand. The nurses, who are increasingly specialized, worry that they may end up in units where they have less expertise.
"They [management] really do believe a nurse is a nurse is a nurse," Ketter said.
Dougherty said nurses would be assigned only to areas they're familiar with.
Hospitals also want to raise the maximum number of "low-need" days, when a nurse's shift can be canceled without pay, from three per year to 15.
The hospitals also want to cut their pension contributions for nurses, one of the few groups left with traditional "defined benefit'' retirement plans. They declined to specify the size of the cut, but nurses say it would amount to one-third.
After six weeks of talks, both sides report little progress.
A calling, not just a job
Brenda Gieser, a nurse at United Hospital in St. Paul, was so indignant that she wrote an impassioned defense of the nursing profession.
"I will put myself in harm's way," she wrote. "... I will care for an elderly patient with dementia who needs to be fed, bathed and lifted out of bed. ... I will hold your hand when you are dying."
When she read it aloud at a negotiating session, other nurses cheered. "Many of us are called to this profession," she said last week. "It is absolutely not about money." But if working conditions worsen, she added, "who would want to go into this career?"