Nurses picketed outside 11 Twin Cities area hospitals on Wednesday, arguing that their employers need to improve staffing and support before burned-out colleagues flee the profession.

While nurse-to-patient ratios were key concerns in prior contract negotiations, the nurses outside Abbott Northwestern Hospital in Minneapolis said staffing levels haven't improved during the past decade even as patients have become sicker and their treatment more complex.

"What used to be in the ICUs 10 years ago is now out on the med-surge floors," said Lynnetta Muehlhauser, a 26-year veteran who works in Abbott's post-op recovery unit.

Contracts for 12,500 Twin Cities area hospital nurses expired on Wednesday, but their terms will remain in effect while negotiations continue. Nurses protested during their off hours, with some still in scrubs from their night shifts when they joined the picket lines.

Leaders of the hospitals and the union, the Minnesota Nurses Association, agreed on the urgency of recruiting and retaining nurses — especially after a long COVID-19 pandemic that created additional stress and workplace safety issues. Memories of mask shortages, on-the-job exposure risks and patients and families arguing over COVID-19 treatments were fresh in the nurses' memories as they picketed.

Allina Health in a statement said that it has responded with its most generous opening wage proposal in 15 years to its nurses at Abbott Northwestern, United Hospital in St. Paul, and the combined Mercy Hospital campus in Coon Rapids and Fridley.

"We hope to be able to find common ground around contract changes that address attracting and retaining the next generation of talented nurses," the statement said.

The Fairview and Children's hospitals also are involved in contract negotiations, along with North Memorial Health in Robbinsdale and HealthPartners' Methodist Hospital in St. Louis Park. The hospitals in a joint statement said the nurses' wage demands are "not financially viable for our community members and healthcare systems recovering from a pandemic — many of which are operating with negative margins through the first quarter of 2022."

Nurse Rosalinda Strehlow said pay is only one issue. She switched from medical-surgical nursing at Abbott to labor and delivery because of the stress of treating sicker patients without more help. The number of patients who are aggressive and dangerous has increased as well, she said.

"I couldn't do it anymore. I would go home and not turn it off," said Strehlow, wearing a red MNA shirt over the blue scrubs from her night shift.

Many young nurses have left the hospital profession entirely, raising concerns about staffing and patient care in the future, she said.

Contract talks also are underway for 2,500 hospital nurses in Duluth. Separately, more than 400 psychiatric aides represented by SEIU Healthcare went on a one-day strike last week amid negotiations with Allina and Fairview.

Hospitals had hoped to focus contract negotiations on wages, but the nurses countered with proposals to increase staffing and job flexibility — a priority for many incoming younger nurses. They also sought bonuses for nurses at greatest workplace risk during the pandemic.

Twin Cities' hospital nurses went on a one-day strike in 2010, arguing for improved staffing but ultimately settling with a contract that improved pay and maintained pension benefits. Allina nurses went on two separate strikes for a collective 44 days in 2016 over health benefits.

Megan Pagel, an Abbott labor and delivery nurse, walked the picket line with her husband and two young daughters. One child was born under the old benefits and the other under the new benefits, and the cost difference was dramatic, she said.

"Being a nurse, you would think we would have great health insurance," she said, "and we don't."

Correction: Previous versions of this story misidentified the location of picketing in a photo caption.