Nurses approved a contract Thursday to return to work at five Allina Health hospitals in the Twin Cities, concluding a contentious, nine-month negotiation in which they voted down four prior contract proposals and went on two strikes for a combined 44 days.

While similar to a contract offer the nurses rejected Oct. 3, the latest offer provided enough new financial incentives and guarantees about health benefits to earn nurses’ support — though not without some hand-wringing.

“This was the worst and hardest vote ever,” said emergency room nurse Dawn Marie Sachwitz after voting for the contract Thursday afternoon. “I filled in a circle, erased it, and put in another one.”

More than 4,000 nurses will return to work, starting as early as 7 a.m. Sunday, as Allina rotates out the replacements who were hired from across the country to keep its hospitals open during the latest strike, which started Labor Day.

Allina reported usual levels of inpatient admissions and ER visits, meaning little delay in getting nurses back to work at the five affected hospitals: United in St. Paul, Mercy in Coon Rapids, Unity in Fridley and Abbott Northwestern and the Phillips Eye Institute in Minneapolis.

Announcing the vote results at 9:45 p.m. Thursday, nurse Angela Becchetti said she wished Allina would have arrived at concessions in this contract, such as 24-hour security in all five emergency rooms, earlier.

“This never should have happened — the hard feelings, the strike, none of it,” said Becchetti, a member of the bargaining team for the Minnesota Nurses Association.

Overcoming the emotions and divisions that emerged during the strike will be an important challenge, said Mandy Richards, United’s chief nursing officer. “We [need to] look at what we have in common, and that is to care for our patients and their families in the best way possible,” she said.

Health insurance was the dividing issue during 22 negotiating sessions, as the nurses wanted to maintain four low-deductible union health plans that they viewed as extra protection against the injuries and illnesses that come with their jobs. Allina wanted to phase out those costly plans, which would be subject to a new federal tax in 2020, and move nurses to its corporate plans.

Allina ultimately got its wish, but in exchange guaranteed the benefit levels of its most popular corporate plan through 2021 and provided nurses up to $2,500 over the next five years in their health reimbursement or savings accounts.

The compromise emerged early Tuesday after a 17-hour negotiating session arranged by Gov. Mark Dayton and Lt. Gov. Tina Smith.

“We are grateful this long and painful strike has ended,” they said in a statement Thursday night.

While union negotiators had recommended the three-year contract, other nurses harbored concerns. For some, the financial gains — including 2 percent-per-year raises — were more than canceled out by 44 days off the job.

Cardiac intensive care nurse Brock Clough doesn’t need union health insurance due to his wife’s employment. But the Abbott nurse voted against the contract.

“We didn’t fight this long to get the same deal we could have gotten without striking,” said Clough, who said he worried about the precedent of Allina nurses surrendering the union health plans that other hospital system nurses still receive.

Carol Pilcher, a surgery nurse at Phillips, felt pragmatic in supporting the contract, because she didn’t see Allina giving much more or the public backing a continued strike after the governor’s intervention to urge a deal.

Locking in benefit levels of Allina’s largest health plan through 2021 was the tipping point, she said. “For me, I want something that is set.”

Notice muddies waters

The contract approval occurred despite some midday panic over a legal notice published in the Star Tribune indicating that Abbott was at risk of losing its contract with the federal Medicare program. Nurses opposing the contract seized on the notice as another reason to vote no.

The notice has to do with a medication error that harmed a patient in September and resulted in a federal citation against the hospital, an Allina spokesman said. However, Allina has submitted a correction plan for preventing future errors and, like most hospitals that receive such citations, isn’t in much jeopardy of losing its place in Medicare.

The union declined to provide exact vote results. Only a simple majority was needed.

The protracted negotiation was costly. Allina spent more than $20 million on temporary staffing to keep its hospitals open during the first nursing strike in June, and even more than that to cover the 37 day strike this fall. Since June, more than 200 nurses have permanently left Allina, the union reported.

Allina stated that more than 630 nurses crossed the picket line and returned to work.

Abbott intensive care nurse Marlaine Olson voted yes. She was glad that negotiations resulted in a committee to address the issue of charge nurses being assigned patients and having no time to support line nurses with their patients.

She said nurses came together during the strike, and will be more rigid in enforcing existing contract provisions — which grant them pay for working lunches and allow them to refuse new patients if they believe it jeopardizes their ability to safely manage their patient loads.

“I just feel,” she said, “that we’re stronger now.”