Allina Health nurses at five Twin Cities hospitals voted on Thursday to authorize a second strike — this time until a contract is reached — in a dispute over health benefits, staffing and workplace safety.

While nurses at three voting locations said they will need to find second jobs and cut expenses to counter the loss of pay from Allina during a strike, they also said they believe it was necessary to defend their benefits and press the health system after an initial one-week strike in June didn’t result in a deal.

“Otherwise it was all for naught if we went on strike the first time and we didn’t get anything,” said Becky Auger, a nurse at United Hospital in St. Paul.

Leaders of the Minnesota Nurses Association, the union representing roughly 4,800 Allina nurses, will meet soon to decide when to issue a required 10-day notice before a strike can take place.

A key sticking point has been health insurance; Allina wanted to eliminate four union-backed plans and move the nurses to its corporate plans at a savings of $10 million per year. The savings were predicted in part because the union plans have high premiums but low or no deductibles — giving nurses no financial incentives to make prudent health care expenditures such as using urgent-care clinics rather than more costly emergency rooms.

While Allina executives were braced for a no vote, they were disappointed when talks broke down. Dr. Penny Wheeler, Allina’s chief executive, said Wednesday that Allina made a major compromise to discontinue only two of the union plans, though nurses would have to bear most of the cost increases to keep the remaining plans afloat.

“We know that our nurses would be heartbroken to leave the side of their patients,” she said. “And for what reason? … It’s hard to believe they would strike over this when actually they have another choice.”

The June strike cost Allina $20.4 million.

Preparing to cut back

Nurses from Allina’s Abbott Northwestern Hospital and Phillips Eye Institute in Minneapolis, Mercy Hospital in Coon Rapids, Unity Hospital in Fridley and United in St. Paul said they were thinking ahead to second jobs and lifestyle changes that would be necessary to forgo their regular pay.

A young Unity nurse in her second week on the job said she’d have to “call her parents” for support, while a veteran United mental health nurse contemplated retirement. In between were nurses seeking temporary nursing jobs, catering gigs and other income.

United nurse Doug Schroeder said he has been pulling as many overtime shifts as possible in anticipation of a walkout.

Night-shift nurse Jeannine Vigen and her husband, who both work at Unity, face a total loss of income. Vigen cut use of her car and air conditioning this summer and suffered headaches as she weaned off sodas and caffeinated drinks.

“Normally, night nurses live on caffeine,” she said.

Union officials declined to provide specific results, other than to say the required two-thirds majority was reached against the contract offer to proceed with strike planning.

While workplace safety was her top concern, Vigen said she learned the value of her existing union health benefits that covered her out-of-network emergency care when she fell off a horse crossing a remote ravine in North Dakota.

“Everybody deserves good insurance,” she said.

Others said they were striking because Allina had focused negotiations on health insurance without offering significant trade-offs to increase staffing. The union had relented on demands for nurse-to-patient staffing ratios in recent talks, but nurses exiting the voting locations said they need more support when patients get sicker and demand attention that they can no longer then commit to other patients.

“Just recently I worked a shift when I didn’t have time to eat, drink, pee or take a break” because patient call lights were so frequent, said United nurse Andrea Baldazo, who voted against Allina’s offer even though a strike might make it tough to pay her mortgage.

Last round of talks possible

Nurses from Allina and other Twin Cities health systems went on strike for one day in 2010, then took a second vote for an open-ended strike that summer. However, the nurses and their hospitals reached a compromise deal before the walkout took place.

The last open-ended strike in the Twin Cities involved Fairview nurses and lasted three weeks in 2001. Allina nurses also struck in 1984.

Union officials said they will begin planning for a strike, but expect that federal mediators or Allina might pursue another round of talks before any walkout begins.