Despite the spin that will come from a variety of sources over the next few days, there are no losers in the tentative contract settlement reached Thursday by the 12,000-member Minnesota Nurses Association (MNA) and 14 metro hospitals. The biggest winners are Twin Citians who depend on the hospitals and their nurses for their health care, often in life-or-death circumstances.

If the three-year agreement is ratified, as the MNA leadership recommends, nurses will receive no salary increase the first year, 1 percent the second and 2 percent the third. The hospitals agreed to drop proposals to cut pension benefits and force the union into a new health insurance plan. Workers in many professions would jump at those terms in today's economy.

For their part, the hospitals avoided a costly strike, fractured labor relations, and a new and unsustainable economic model. Given their already thin profit margins -- and the yet-to-be-quantified financial implications of federal health care reform -- Moody's Investors Service said in a report this week that the four rated hospital systems involved in the dispute could ill afford a strike. More significantly, their long-term financial health would have been seriously threatened by the higher costs that would have come from the MNA's original contract demands on unproven nurse-to-patient staffing ratios, wages and benefits.

Caving into the union's demands would have been financially irresponsible for the hospitals. "Over the long term, Twin Cities providers will find it difficult to maintain current levels of financial performance, as inflexible labor costs and the effects of health care reform put pressure on operating margins,'' Moody's sobering analysis concluded.

Staffing ratios were the key sticking point in the negotiations. The MNA maintained that patient safety was its primary concern, and the union wanted fixed limits on how many patients could be assigned per nurse. The hospitals convincingly argued that such ratios were too expensive and that changes in health care delivery forced by needed reforms and cost-cutting will demand more workplace flexibility in the future -- not less.

The American Nurses Association, the longer-established labor organization from which the Minnesota union broke, advocates not for fixed ratios but for flexible staffing that reflects the changing demands of hospital units.

The overarching issue in this dispute was that administrators, not union nurses, are ultimately held accountable for the performance of their hospitals -- both financially and in terms of patient outcomes. Allowing the union to set fixed staffing levels would have been tantamount to handing over the keys and abdicating that responsibility.

That does not mean the thousands of dedicated nurses in Twin Cities hospitals who come to work every day wanting to provide the best possible care for their patients should not be heard. Quite the contrary: The tentative contract is just a starting point for what we hope will be a serious effort by hospital administrators and their employees to collaborate on legitimate questions about how to continue to provide efficient, high-quality care as financial pressures mount.

Minnesota became a national leader in health care quality -- and its hospitals consistently rank highly in patient outcomes -- in part because of innovative teamwork between physicians, nurses and other critical staff. That kind of innovation is needed now more than ever.