The Minnesota Nurses Association orchestrated one of the largest nursing strikes in U.S. history, gained raises from 15 cash-strapped hospitals, and saw almost all of its endorsed political candidates win elections — all this fall.
But whether the labor organization is at the height of its power, or more vulnerable than ever, is debatable.
"Probably both," said Mary Turner, the union's president.
The workforce shortage that motivated a three-day nursing strike in September also meant declining union membership and dues. MNA also lost 500 Mayo Clinic hospital nurses in Mankato who voted to leave the union, but avoided a similar result at Mayo's Lake City hospital.
"Are there forces trying everything they can to get union nurses out of Minnesota? You bet there are," said Turner, an intensive care nurse at North Memorial Health in Robbinsdale.
All of which means the union's celebrations will be short-lived over contract gains for its roughly 15,000 Twin Cities and Duluth hospital nurses this year — especially with so much up for grabs at the Legislature next year.
The union will seek to steer some of Minnesota's projected $17.6 billion surplus toward solutions to the workforce shortage, which leaves hospitals shorthanded and nurses overworked — often covering extra or back-to-back shifts.
It also will stoke political opposition to the merger of Fairview Health with South Dakota-based Sanford Health, which employs union nurses at some hospitals but mostly nonunion staff. And MNA will resist legislation for Minnesota to join a multistate nurse licensing compact.
The fact that Minnesota isn't one of 37 states already in the compact is a reflection of the union's clout. Hospital leaders have argued the compact would hasten licensure — addressing the shortage — but MNA argued that it is a union-busting tactic that lets in nurses from states with lower professional standards.
MNA is the ninth largest union in the state by membership, and fifth-largest based on its $18 million in receipts last year, according to federal filings. But few labor organizations have what it has: a publicly beloved workforce.
"They're so powerful because they're so crucial to providing the high quality and compassionate care we all will need," said Tim Pawlenty, who was Minnesota's governor during a one-day Twin Cities hospital nursing strike in 2010. "That's just the way it is."
Tight labor market
MNA is like the United Auto Workers in Detroit in that it represents nurses at so many Minnesota hospitals — but unlike the auto workers it doesn't have to worry about foreign competitors, said Alan Benson, an assistant professor of work and organizations at the University of Minnesota's Carlson School of Management. The tight labor market also provides leverage for the nursing union, which can use terms it reaches at one hospital to set the negotiating floor at others.
The tight labor market presents a challenge, though. MNA membership peaked at 22,046 in 2019 but dropped to 20,629 in 2021, when the pandemic started to drive away burned-out nurses.
Understaffing has been a key concern in prior contract talks, but at times to create leverage so hospitals would give in on other demands, Turner said. That wasn't the case this year, when people could actually see the union's complaints in the form of backlogged emergency departments.
"Let's face it, you don't get out on the [picket] line and go on about wages or even benefits," she said. "You get out on the line for staffing and workplace conditions. This time, it is real. When schedules come out [for hospital floors] and there's no nurses scheduled, that is real."
Union influence doesn't always produce knockout deals for nurses. The new contracts provide 18% raises over three years for Twin Cities nurses, which Turner said was a win because the range nationally is 16% to 18%. But the union gave in more, starting with demands above 30% while the hospitals started around 10%.
Allina Health nurses went on two strikes in 2016 over health benefits, but in the end they gave up their union health plans — in exchange for guaranteed benefit levels in the corporate plans for several years.
Part of what makes MNA so strong, though, is its pragmatic and long-term view, said Larry Jacobs, director of the U's Center for the Study of Politics and Governance.
MNA didn't get paid family leave in its latest contracts for nurses, other than those at Children's Minnesota, but sensed an opportunity to get that legislatively instead. Democrats are proposing a state-managed benefit plan for all workers.
"Union organizers know that you grab the piece you can grab and you prepare for the next campaign," Jacobs said. "I think that's frankly one of the skills of the nurses."
In an era in which money equates political attention, MNA is well-stocked. The union's political action committee contributed $414,723 to campaigns and other committees through late October this year. It also made 113 endorsements, and 95 of its candidates won elections, including one Republican in Sen. Jim Abeler, who has been influential on health care matters.
Abeler said nurses could have made the difference in his re-election by 186 votes. He said he'll disagree with MNA on issues such as universal health care, but has long supported nurses in areas such as workplace safety.
"Don't make us go to work knowing we might go home injured," said Abeler of Anoka. While some incidents will happen, "you don't want to make it a custom."
Gov. Tim Walz received an endorsement and contributions, though his adherence to MNA positions has been uneven.
The governor has expressed openness to the Fairview-Sanford merger, despite strong MNA opposition and prior failed attempts. Sanford in a statement said any merger wouldn't impact existing collective bargaining agreements.
On the other hand, Turner said the governor placed a timely call just before a planned second nursing strike to the chief executive of Essentia Health, which was proposing dramatic reforms to its nurse payment schedule.
The idea was to boost retention of young nurses by getting their salaries above $100,000 in three years, but the union balked at the slower wage growth in later years. Spokespeople for Walz and Essentia declined requests to confirm the call or its contents, but the wage proposal was dropped and the hospital and nurses reached a deal that averted a wintertime strike.
The contracts included hospital commitments to review nurse staffing levels in any units where preventable problems such as patient falls and bed sores increased by 50% or more. MNA leaders said they hope legislation this year will help enforce and ensure those reviews.
"It doesn't matter what political party you are, you should be backing what the nurses are asking," Turner argued. "Because someday ... any one of you will be a patient."