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More than 4,000 nurses went on strike at five Twin Cities Allina hospitals Sunday — some in tears as they left their shifts early in the morning and their patients in the hands of replacements recruited from across the country to cover the seven-day walkout.

Nurse Leah Otterness said goodbye to an orthopedic patient who was crying at Unity Hospital in Fridley.

"They will do their best to take care of you," said Otterness, who like most striking nurses was shuffled out of her hospital before the replacements arrived.

Whether the transition to 1,400 replacement nurses was smooth depends on who you ask. The Minnesota Nurses Association (MNA) reported problems at Allina's flagship, Abbott Northwestern in Minneapolis, such as replacements showing up for duty in intensive care with their licenses to practice in the state still pending.

Allina officials said doctors, nursing supervisors, respiratory therapists and nursing assistants pitched in to help the new nurses acclimate. Abbott had overstaffed for the day and compensated for the nurses whose licenses weren't finalized or whose skills were mismatched to their initial assignments.

"I don't know how you could make a complete changeover of all your nurses without having some challenges," said Dr. Ben Bache-Wiig, Abbott's president. He commended nurses and staff for their handling of critical cases Sunday morning, including a cardiac arrest that occurred an hour before the 7 a.m. shift change.

Leaders of the union-represented nurses and Allina expressed eagerness to renew negotiations, but no movement on the key issue: health insurance.

Allina wants its metro hospital nurses to surrender their union-protected health benefits and transition to company plans that provide more financial incentives for using lower-cost care. Affected nurses are at Abbott in Minneapolis and Unity Hospital in Fridley, and also at United Hospital in St. Paul, Mercy Hospital in Coon Rapids and Phillips Eye Institute in Minneapolis.

MNA nurses said they are determined to protect their plans — either because they need the high-premium, low-deductible plans or because they refuse to surrender them unless Allina gives them something else.

Abbott nurse Judy Pontius, who participated in strikes in 1984 and 2010, is undergoing radiation for breast cancer and opposed the switch to the company plans, two of which come with low premiums but sharply higher deductibles.

United nurse Jo Copas said she was making the financial sacrifice of striking for a week to protect other benefits.

"It's really not about just the insurance," she said. "It's about Allina trying to chip away at our benefits. If they can get this done, then they'll go toward other things."

The mood was festive around the hospitals as the strikes started; Aretha Franklin's "Respect" blared outside United while a nurse at Abbott played bagpipes to start pickets walking the .6-mile trek around the hospital campus.

The union estimated that 600 nurses surrounded Abbott and 1,500 total were on the picket lines before 11 a.m.

Picketing nurses expressed conflicting views of the replacements — brought in by such agencies as HealthSource Global with up to $400 signing bonuses and travel and lodging benefits — knowing that they simultaneously enabled their patients to receive care but allowed Allina to resist their demands.

"It's hard," said Paul Honmyhr, who worked the overnight shift at Abbott's cardiac recovery unit. "I don't work in a job where, if I'm not at work, the work doesn't get done. People still need care. People are still sick. I can't keep that from happening, and I want those people to be cared for."

Replacement nurses began leaving Abbott at 7 p.m. Sunday, boarding waiting buses to take them to their hotels. Approached by a reporter, one said "we had a good day," but declined to be interviewed, saying "we were told not to."

In preparation for the strike, Allina condensed units at Unity so the hospital could function with fewer nurses but planned for full operations elsewhere. Between the start of the strike at 7 a.m. and noon, the hospitals had 1,109 patients on their inpatient floors, 67 new ER patients and 12 newly delivered babies.

Dr. Penny Wheeler, Allina's chief executive, called the numbers "pretty typical of a Sunday in June."

United's obstetrics unit was so full for a brief period Sunday morning that it couldn't take any more patients. While unrelated to the strike, the surge came during an unusual handoff of patients from union nurses to nonunion managers.

Nurse Patience Mbonif said it was difficult to be escorted away from her job and to leave behind patients, including mothers in labor, without seeing the replacements who were coming in to take over.

"My patients were so upset. … They're like: 'We don't even know who's coming,' " she said.

Cancer patient Joe Skubic, 27, of Maple Grove walked outside Abbott, where he received care from the replacement nurses Sunday morning. Tethered to an infusion pump, Skubic said he sympathized with the challenges they had and felt safe in their care. However, he wanted to show his support and walked over to the nurses picketing around the hospital who have been treating his non-Hodgkin's lymphoma.

"They know you by name," he said. "They know little things about you."

Outside United, patient Gina Rozumny sat on a bench to watch the picket line and said she misses nurses she's forged a relationship with over the last several weeks.

"They were all getting familiar with me," said the 42-year-old from Eagan. "Now, it's like being on a new floor."

Wheeler said 144 union nurses so far decided to continue to work during the strike.

The number of nurses who cross the picket lines will influence the financial cost of the strike, which Wheeler declined to estimate. Allina financial statements from 2010 suggest the health system spent more than $14 million preparing for a one-day strike that year.

Wheeler said Allina is determined to move nurses to the company health plans, in part because Allina will have to pay a new federal tax, starting in 2020, if it maintains the union's current "Cadillac" plans.

Aside from the tax, Allina estimates it will save $10 million per year by switching nurses to its plans. Allina leaders previously reported that the union nurses use expensive ER care 28 percent more than other Allina employees — which they attribute to the lack of financial incentives in the union plans to use cheaper urgent care.

Nurses balked at that claim, noting that the high use of ER care might be because they are injured on the job so often. Federal data shows hospital nursing to be a particularly hazardous job, and Allina nurses said they have wanted to address workplace safety in the current negotiations as well.

"I have been sent to the emergency room once," said Jean Riedy, a nurse in Abbott's neuro-intensive care unit, "when I was kicked in the back of the head by a patient."

Jeremy Olson • 612-673-7744

Christopher Snowbeck • 612-673-4744