Ashley Christensen knows what's at stake Monday when Twin Cities nurses take a strike vote -- for her patients, for her profession and for herself.

That's why the young nurse says she'll do what needs to be done.

"The hospitals have put us in a corner," she said. "The response is fight or flight. We have to fight."

Christensen is one of 12,000 nurses set to vote Monday on whether to authorize an open-ended strike at 14 Twin Cities hospitals, as both sides remain mired in the most contentious nursing contract dispute in a quarter century.

The nurses began voting at 6 a.m. and balloting remains open until 8:30 p.m. They can vote at one of two locations: Park Center High School in Brooklyn Park and the Minnesota Nurses Association headquarters in St. Paul. If at least 66 percent vote yes, they would need to give the hospitals a minimum of 10 days' notice but could strike anytime after that.

The vote follows a 24-hour walkout on June 10. It was the biggest -- and also shortest -- walkout in U.S. nursing history, but it failed to get the hospitals to budge.

"It's important for each side to show how strong they are to test how strong the other side is," said Aaron Sojourner, who teaches labor relations at the University of Minnesota's Carlson School of Management.

Both sides flexed their muscle during the one-day strike: the nurses by making good on their threat to walk and the hospitals by flying in 2,800 replacements and staying open for business.

Now they're raising the stakes.

"This is serious now," Sojourner said. "Everybody has a lot to lose if it comes to a long strike -- the hospitals because of the disruption and their reputation, the nurses who care about patient care, and the public has a big stake, too. Both parties recognize that they have an interest in reaching an agreement before they reach the point of no return."

'No benefit to a strike'

Union negotiators, who last week offered to modify their contract proposal and resume talks, have told members they need a strong strike vote for leverage at the bargaining table. The hospitals have agreed to restart talks, but only on the condition that the nurses agree not to strike before July 31, a condition rejected by the union. No new talks are scheduled.

"There is no benefit to a strike and we saw that on June 10," said Maureen Schriner, a spokeswoman for the hospitals. "We need to have contract negotiations that recognize the reality of the health care environment."

From the start, the biggest sticking point has been staffing ratios. The nurses want set ratios that would limit how many patients may be assigned to each nurse, saying they are stretched to the point that patients are endangered. The hospitals say they want more flexibility to move nurses where they are needed, citing economic pressures.

The nurses also initially sought pay raises of 3.5 percent to 4 percent for each of three years but say that's since been modified. The hospitals propose annual raises of 0, 1 and 2 percent, plus cuts to pension and health benefits.

The last time Twin Cities nurses conducted a major walkout was 1984, the year Christensen was born. The nurses stayed out for five weeks, forcing hospitals to rely on replacement nurses to stay open, before the hospitals capitulated with better working conditions.

The granddaughter of a nurse, Christensen says she's wanted to be a nurse as far back as she can remember.

But when she graduated from nursing school in 2007, none of the hospitals was hiring. Finally, after waiting a year, she got a job at Children's Hospital in Minneapolis.

She says she loves her job, especially when her young patients walk in and recognize her. But she also feels stretched thin and would like more help at the bedside. She sees this as a battle between the bean counters and professionals like her.

"The hospitals are out to get us," she said. "They want to define nursing."

Nurses stress staffing

Like many of the nurses on the picket line last week, Christensen argued it's not about the money.

"We don't really care about the wage increases," she said. "We're really concerned about staffing, about infections and contagious disease."

The nurses' proposal also includes better hospital preparations for emergencies and disease outbreaks such as H1N1.

She knows a strike is risky not just for her patients but for herself. She's not married and doesn't have kids, but there's still rent to pay. Her friends, many of whom are community organizers, support her.

Her family has a lot of questions, she said: "My mom is worried if I'm not getting a paycheck every two weeks [but] she supports everything I do."

The union has posted information on its website on how to manage financially during a strike, including advice on calling banks, utilities and other creditors to work out payment arrangements and on where to get health insurance if coverage runs out before the strike is over.

Aarin Nolte, another young nurse at Children's, just bought a home with her husband. They have mortgage and car payments.

"It's scary being a young couple and not knowing what's going to happen," she said. But her husband, who is also in a union, "supports me." She's also ready to vote to strike.

"We are saying enough is enough," she said. "Come on, work with us. We're tired of this. We want a contract."

Chen May Yee • 612-673-7434