With their seven-day strike having ended Sunday, Allina Health hospital nurses started returning to work at 7 a.m., and many expressed relief at the thought of being back on the wards.

Nurse Jennifer Duzan said she was eager to return to the ER at Abbott Northwestern Hospital, despite a nagging hand injury she suffered in January when an unstable patient kicked her. “I’m loyal to my patients,” she said during a break from picketing last week. “So, in that sense, I’m looking forward to it.”

The strike produced plenty of accusations but little apparent progress toward a new contract, and what happens next for the five hospitals and 4,800 nurses isn’t quite clear.

Neither Allina nor the Minnesota Nurses Association proposed restarting negotiations last week amid a stalemate over health insurance, and the union hasn’t disclosed whether it will pursue a second strike if Allina continues to demand that nurses switch to its lower-cost employee health plans.

“We’re eager to get back to the bargaining table,” said Dr. Penny Wheeler, Allina’s chief executive, but “both sides need to be willing to talk about a health plan transition.”

The weeklong walkout was authorized after more than two-thirds of hospital nurses voted June 6 to reject Allina’s contract offer. A new strike would require another failed attempt at negotiations and another round of voting at each hospital, said Rose Roach, MNA’s executive director.

Roach said Allina’s insistence that the nurses surrender their preferred health plans before addressing other issues is not a promising sign. “Sorry, that’s not a true desire to go back to the table,” she said.

The nurses used the walkout to promote their own concerns over workplace safety and staffing levels, which received little attention at the bargaining table while health insurance was unresolved.

Allina turned to 1,400 replacement nurses, recruited from around the country by three staffing agencies, to stay open this week and gained confidence from the fact that patients continued to use its hospitals amid the strike. The inpatient floors remained at usual summertime levels of activity, except at Unity, where Allina canceled elective surgeries and closed some recovery floors. Emergency rooms at four of the hospitals were often near capacity, Allina officials said.

Busy hospitals in some ways will ease the transition. The nurses’ jobs are protected under federal labor law in a strike of this kind, but their return might have been delayed if patients had been scared off by the strike, because the two sides agreed that nurses wouldn’t be called back on their regular schedules just to staff empty beds.

“We’re running fairly full,” Wheeler said. “So, we would anticipate the vast majority of [nurses] would be called to work their regular shifts.”

Throughout the week, Wheeler said she worried as much about the cost of damaged relationships with the nurses as she did about the economic cost of the strike, which the union pegged at $25 million. The union accused Allina of financial waste with its strike and administrative spending, while Allina accused the union of timing its strike along with similar actions in California and Massachusetts to make a political statement.

Both sides frustrated one another with diverging accounts of conditions inside the hospitals — Allina saying patients were getting quality, professional care, while the union cited several allegations of improper care.

When talks resume, perhaps at the prompting of a federal mediator, three key issues remain:

• Health insurance remains the stumbling block, as Allina insists on switching the nurses from their costly, union-protected health plans to the coverage other Allina employees receive.

The high-premium, low-deductible union plans will likely trigger a new federal “Cadillac” tax by 2020, and Allina says the plans will be unsustainable at that point. Union officials see particular value in the plans for nurses, given their occupational hazards, and don’t believe it fair to surrender them without concessions on Allina’s side.

• Nurse staffing. Initial talks about a computer acuity system to ensure adequate staffing were set aside over the stalemate on health insurance. Allina believes the system could predict staffing needs based on the medical records of patients and nurses’ input. Nurses want staffing ratios that guarantee a safe number of nurses per patient.

• Staff and patient safety. Several nurses walking the picket lines last week bore scars from job-related injuries. The union wants an increase in annual safety training and more nurses involved in the hospitals’ workplace violence planning.

Duzan and other nurses on the picket lines see the issues as interrelated. Nurses need comprehensive health coverage given their risks of infection or assault, she said, adding, “I know nurses who have tuberculosis from the job.”

Nurse Ursula Brand spent seven months out of work after a back injury from moving a patient. “I kept working until I couldn’t walk anymore and they took me down to the emergency room,” she said.

Brand and Kelly Evans, both nurses on a cardiovascular unit at Abbott, said they hope the doctors and staff would welcome them back. “A lot of them have been out walking with us, supporting us,” Evans said.

At a rally Saturday in Minneapolis, a few dozen nurses gathered to conclude the strike, reiterating their demands and criticisms of Allina. They also denounced allegations that the state union conspired with other striking nurses in Massachusetts and California. Roach called the accusation “absurd.”

“These nurses made this choice completely independently of other nurses who had their contracts ending,” Roach said.

The nurses return to work under the terms of the prior three-year contract, which expired June 1.

Any future negotiations could also be affected by rulings from the National Labor Relations Board on the union’s claim that Allina committed unfair labor practices. One claim is that Allina hasn’t been forthcoming with financial information that union leaders could use to determine whether their health plans are costly and unsustainable. But board rulings can sometimes take months.

Negotiations can continue indefinitely as long as there are signs of progress or continued effort by both sides, said Francis Rojas, an MNA legal expert. If federal labor officials declare an “impasse,” meaning talks have reached a permanent standstill, Allina would have the ability to impose new contract terms on its own.


Star Tribune staff writers Natalie Daher and Paul Walsh contributed to this report.