In 1984 Mary Scattarelli, a young nurse at Abbott Northwestern Hospital in Minneapolis, took a deep breath, left her patients and walked out.
For five tense weeks, she was one of 6,000 nurses picketing outside Twin Cities hospitals, in what remains the biggest strike in nursing history. To raise money, they held bake sales and car washes, before the hospitals finally capitulated with better working conditions.
In the years since, nursing has been transformed from part-time work to a well-respected career widely regarded as offering the ultimate in job security. Nurses are better educated than ever before, take on more responsibility than ever before and -- at an average of $79,000 for a full-time hospital nurse -- are better paid than ever before.
But now, Scattarelli says, she's ready to walk again.
Fourteen Twin Cities hospitals and their 12,000 nurses are locked in the most contentious bargaining in a quarter century. Nurses will vote this week whether to authorize a strike, which could begin as soon as June 1.
The dispute is occurring amid wrenching changes reshaping the national health care landscape. The nurses say the hospitals want to cut health and pension benefits they've fought years to secure and to change work rules in ways that will endanger patients. The hospitals say they're responding to economic realities -- a tough recession and looming health reform -- and patient care will not suffer.
Whether the nurses strike or not, the underlying story is one of a profession that took decades to come into its own only to run headlong into a major restructuring of the health care system.
"This is an unbelievably stressful time, with an unprecedented need for care and a shortage of money to address it," said Connie Delaney, dean of the University of Minnesota's school of nursing, "and nursing is right in the eye, right in the middle."
The work of nursing has changed dramatically in the past two or three decades. Hospital patients are sicker, partly because better technology is keeping them alive longer. Health insurers have curtailed hospital stays to cut costs.
Nurses are surrounded by technology that takes ever more training to master. Beeping, blinking machines now monitor vital signs. "You go into a room and there's much more complexity," said Alice Swan, associate dean of nursing at St. Catherine University. "Before you might see one IV [intravenous line]. Now you go in and there are three lines running and a monitor on the chest."
Pen and paper have been replaced by computer systems that nurses now use to document everything, from charting a patient's recovery to dispensing medication.
With all these changes, nurses say they desperately need more staff so patients are not endangered. That issue -- staffing ratios -- is among the many jostling for space on the bargaining table. Hospital executives respond that the quality of hospital care in Minnesota leads the nation, and what they need is to be able to move nurses around according to need, not ratios.
"In today's health care marketplace, you've got to be flexible to be where patients need you to be," said Anna Youngerman, a spokeswoman for the hospitals. "Rigidity isn't going to work."
The hospitals themselves have also changed. Metro hospitals, which are nonprofit, have seen a wave of mergers since the 1980s that created giant hospital and clinic groups. These groups -- Allina, Fairview and HealthEast being the three largest -- then expanded further, renovating aging buildings and building new specialty centers as they competed fiercely for patients.
For years, much of this worked in the nurses' favor.
Hospitals couldn't hire nurses fast enough, sometimes before they even graduated from nursing school.
"It used to be that nurses went to work to buy a furnace," said Minnesota Nurses Association President Linda Hamilton, who was a young nurse in the 1980s. "Now nursing can support a family."
Nursing salaries quickly surpassed those of once comparable professions such as social workers, teachers and secretaries. Today, a full-time Twin Cities registered nurse makes $79,000 a year on average. However, the MNA points out that since most nurses don't work full time, the average wage is closer to $62,600.
Then the recession hit. Stung by investment losses, rising charity care and cuts in government programs, metro hospitals lost millions in 2008.
The hospitals laid off 1,700 employees, delayed new buildings and froze salaries for management and nonunion employees, climbing back into the black in 2009.
Hospital openings for nurses dried up.
Then there's health reform. The new health bill focuses on prevention, which could shift even more care outside of expensive hospital settings. Primary care clinics, for example, are busy trying to remake themselves as hubs for preventing and managing chronic diseases.
Back in the early 1980s, hospitals were going through a similar upheaval. In 1983, Medicare introduced a new payment formula, known as Diagnostic Related Groups, to bring order to hospital payments. That, coupled with the advent of managed care, squeezed hospitals financially and laid the groundwork for the 1984 nurse strike.
Since then, 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 issues.
What nurses need to remember, said St. Catherine University's Swan, is that hiring will bounce back. As more people get insurance under health reform and baby boomers age, nurses will be in demand again.
But they may have to look outside hospitals for work, in settings such as clinics, nursing homes and home health care. That's already the case for new nursing graduates.
"What I want is for nurses to have jobs, meaningful jobs," Swan said. But, she adds: "I do think there could be a little denial on the part of nurses."
Others note that the airline and auto industries went through similar convulsions, which ended with big concessions from their unions.
With airlines, "the market said 'I want to fly but I don't want to be paying more and more for a ticket,'" said Maureen Swan, a principal with MedTrend Inc. and a hospital consultant. "It's the same with health care. I want health care but I don't want to be bankrupt. If health care is going to respond, labor is going to be part of the solution. It's not just nurses. It's everybody."
Nurses bridle at comparisons to the auto and airline industries.
"It's not about making cars," said Scattarelli, now 54. "This is about patient care."
Over the years, she said, nurses and hospital managers have solved problems together on numerous occasions, "but it's not looking good this time."
This month, thousands of nurses have tried to rally public support with pre-strike picketing at metro hospitals. They held signs: "Patients before profits." "Millions for buildings, pennies for care." "We won the war in '84."
Sheila Hubbard, a nurse at Abbott Northwestern Hospital, showed up because she's worried about her pension. Now 58, she wants to retire at 62, but proposed pension cuts might jeopardize that plan.
Others feel similarly hard done-by. "They tell us they respect us as nurses," said Eric Tronnes, a nurse on one of the bargaining teams. "But when we need staff on the floor, we have to beg to get another nurse."
Several young nurses admit to being nervous, about the economy, about their place at the bottom of the nursing totem pole.
"It's not about money," said Aarin Nolte, a nurse at Children's in Minneapolis. Her co-worker Ashley Christensen finished the sentence: "It's a power struggle."
Chen May Yee • 612-673-7434