Nurses at Twin Cities and Duluth-area hospitals voted Monday to authorize strikes if they don't receive contracts that boost recruitment and retention and address workload and safety concerns.

The vote doesn't mean a strike is imminent. Negotiators with the Minnesota Nurses Association must give 10-day notices before walkouts so hospitals can hire temps and maintain patient care. More talks are scheduled this month.

Union leaders said they hoped the vote would jolt stagnant negotiations and avoid what would otherwise be one of the largest nursing strikes in U.S. history with 15,000 caregivers leaving a dozen Minnesota hospitals at once. MNA President Mary Turner said any resulting strike would be time-limited as a protest, rather than open-ended, but specific dates and lengths haven't been decided.

"We will stick together like glue, because that is our power," said Turner, an intensive care nurse at North Memorial Health Hospital in Robbinsdale. "More importantly, we have to stick together. This is a crisis."

Concurrent negotiations involve registered nurses who provide inpatient care at the Allina, Children's Minnesota and Fairview hospital systems as well Methodist Hospital in St. Louis Park and North Memorial. Nurses also are negotiating with Essentia Health and St. Luke's Hospital in Duluth. Nurse negotiators now have the authority to call strikes against their individual hospitals, but Turner said the goal is to maximize leverage by doing any actions at the same time.

Twin Cities' nurses are working under the terms of a three-year contract that technically expired May 31. The two sides are far apart on a new deal, with the hospitals offering to increase wages by 11% over three years and the nurses wanting an economic package with more than a 30% increase.

Hospital leaders said the wage demands are excessive by nurses who can make more than $100,000 working full time, and that rising costs ultimately get passed on to patients through their insurance. Hospitals have been rebuffed so far in their requests to bring in federal mediators to help reach a deal, they added.

"A strike does not benefit anyone and will only further delay reaching a settlement at the bargaining table," said a statement from Minneapolis-based Allina Health, which is scheduled to resume talks with the union negotiators on Aug. 30.

Nurses argued that the increases are necessary to stem the surge of colleagues who are leaving their hospitals — sometimes to make top dollar as travel nurses or to switch to lower-stress jobs in health care. The decline in hospital nurse staffing is partly reflected in the decline in MNA membership — down from more than 22,000 in 2019 to 20,619 in 2021, according to the most recent federal filings.

Methodist charge nurse Caitlin Moran said her unit was overwhelmed during pandemic peaks with COVID-19 patients who were dying after intensive care failed. The emotional stress showed in the third of nurses who have departed, she said. Those left behind are putting in 12-hour shifts without breaks and following night shifts with day shifts — none of which lends itself to compassionate care, she said.

"We've been drowning, and patients are the ones that are suffering the consequences," she said.

Companies such as Medical Staffing Solutions Inc. closely monitored the vote and encouraged nurses with Minnesota licenses to sign up as potential replacements. A coordinated strike of all negotiating hospitals in the Twin Cities and Duluth could tax the supply among national staffing agencies, though, and be prohibitively expensive. MSSI's posted rates for replacements more than doubled the typical hourly rate for hospital nurses.

Bloomberg Law predicted an increase nationally in nursing strikes in 2022 because of the confluence of expiring contracts. Most so far have been limited to a day or two, such as the strike by 8,000 Sutter Health nurses in Northern California. A strike by 5,000 Stanford Health Care nurses ended after one week this spring with an agreement to factor severity of patient illnesses more in setting staffing levels.

The Minnesota nurses on Tuesday linked diminished staffing to the recent increase in hospitals' self-reported adverse events. Fatal or disabling patient falls and serious bed sores increased among all Minnesota hospitals in the 12-month period ending last October. Assaults have caused 31 disabling injuries to patients or workers since 2010, and 14 have been reported in the last two years.

Inadequate staffing and security have been key issues in prior negotiations, though they were often left unaddressed in the final contracts. Twin Cities' nurses went on a one-day strike in 2010, calling for better nurse-to-patient staffing ratios but ultimately agreeing on a deal that preserved pension benefits. Allina nurses went on two strikes for a collective 44 days in 2016, but primarily over health benefits.

Allina reported $149 million in costs as a result of the strikes in 2016.

This time, nurses argued that they aren't in position to bend on staffing and safety concerns, noting that some newcomers have quit before training is over or within weeks of starting their jobs because of the challenges.

"There is safety in numbers ... in the number of nurses," said Tracie Ducksworth, a behavioral health nurse at M Health Fairview's University of Minnesota Medical Center. "Increased nursing staff means better nurse-to-patient ratios, which means better patient care and better patient outcomes."