Nurses ratified three-year contracts this week that averted strikes at 15 Twin Cities area and Duluth hospitals, boosted pay and benefits, and sought to address understaffing.

Leaders of the Minnesota Nurses Association (MNA) said the 17% to 18% pay increases over three years should boost retention and prevent burned-out nurses from leaving hospitals, but they acknowledged that more work is needed to address worsening staffing shortages.

Some of the contracts improved liability protection, which will incentivize nurses to stay amid challenging conditions and higher caseloads, but that is only a stopgap, said Chris Rubesch, an Essentia Health nurse in Duluth and MNA vice president.

"We believe that is something that will help keep nurses at the bedside while we train and recruit the nurses that are needed to become the long-term fix," he said. "Ultimately, we need to stop the bleeding."

Hospitals have been under stress this winter, when a declining pool of nurses collided with an increasing volume of patients with COVID-19, influenza and other seasonal illnesses and injuries. The 8,456 patients and 87% inpatient occupancy rate in Minnesota hospitals on Dec. 7 were as high or higher than some of the worst peaks of the COVID-19 pandemic, according to federal data.

Hospital leaders had said a strike at such a vulnerable time would be dangerous and negotiated in marathon sessions last week to reach a deal. The union then called off plans to strike starting this week, but the ratification votes ensure the walkout won't happen.

"We believe the contracts are fair and address the priorities of both parties," said a written statement Wednesday from Allina Health, which reached contracts for nurses at its Abbott Northwestern, Mercy and United hospitals.

The prior contracts expired in June, but hospitals promised to make raises retroactive to the summer as long as nurses voted in favor of the new deals by mid-December.

Hospitals in the Twin Cities with new nursing contracts include Children's Minnesota, Methodist, North Memorial Health, Southdale, St. John's and the University of Minnesota Medical Center. Essentia Health and St. Luke's hospitals in Duluth also reached deals.

Some staffing solutions in the contracts only kick in if problems get worse. Contracts at most of the hospitals require consultations with nurses before any reductions in staffing. Increases of 50% or more in falls, bed sores and hospital-acquired infections also would trigger staffing reviews, because they are indications of a lack of nursing care.

Other solutions are immediate. The contract at Methodist, a HealthPartners hospital in St. Louis Park, designated six resource nurses to help on floors that are short-staffed.

Some hospitals provided block scheduling, or agreed to test it on certain units, so nurses would avoid night shifts followed by almost immediate day shifts the next day that were a source of burnout.

Today's incoming nurse won't tolerate bad schedules or wait years to get the seniority to take holidays off, said Mary Turner, MNA president and a North Memorial Health ICU nurse.

"I can't tell you how hard it is to rotate, even day-evening, and that drives people away from the bedside," she said.

Emergency department nurses in several hospitals gained $2 per hour bonuses if the majority of their patients are sick enough to be in inpatient care but can't be moved because of a lack of open beds. That has created a backlog in Twin Cities ERs, where stable patients are experiencing hourslong delays or being treated in waiting rooms.

The union conceded some priorities. Children's nurses gained two weeks of paid family leave, but others only gained assurances that the benefit would be added if the Legislature follows through on plans to create a state-managed program next year.