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Nurses reached tentative contracts with 15 Twin Cities and Duluth area hospitals, avoiding strikes amid an increase in respiratory diseases and patients.

Negotiators in marathon sessions Monday and early Tuesday closed a gap in wage demands, agreeing to 18% raises over three years for nurses in the Twin Cities at Allina Health, Children's Minnesota, M Health Fairview, North Memorial Health and HealthPartners' Methodist Hospital. Tentative contracts for Essentia Health and St. Luke's nurses in Duluth offer 17% raises and other bonuses.

"For years, hospital executives have been pushing nurses out of the profession by understaffing our units and under-valuing our nurses," said Mary Turner, president of the Minnesota Nurses Association (MNA) and an intensive care nurse at North Memorial Health. "This tentative agreement will help to keep nurses at the bedside."

The deals came five days after the union notified 16 hospitals of strikes that would start Dec. 11 and last at most locations until Dec. 31. Months of previous negotiations had failed to produce compromises on raises and solutions to workplace violence and understaffing. The breakdown already prompted some 15,000 nurses to strike for three days in September.

Allina Health alone spent $23 million extra to keep hospitals open during the September strike. A 20-day strike in December would have cost hundreds of millions of dollars collectively for the health systems, and intensified pressure on hospitals that already are full with patients battling RSV, influenza and COVID-19.

"We are thankful to be able to return our full attention to caring for the community at this time of increased illness and demand," said a statement from Allina, which reached tentative contracts for nurses at Abbott Northwestern, Mercy and United hospitals.

While nurses negotiate individually with their health systems every three years, the concurrent talks often produce multiple agreements at once. A deal with St. Luke's nurses was announced late Monday night and others followed.

The last agreement came Tuesday with nurses at M Health Fairview's St. John's Hospital in Maplewood, which has encountered extreme overcrowding in its emergency department this fall. The deal offered a unique approach to addressing a statewide rise in hospital violence: a pilot study of panic buttons for nurses in the ER and another unit.

M Health Fairview's Southdale Hospital and University of Minnesota Medical Center also reached tentative contracts. Talks are ongoing between St. Luke's and nurses at Lake View Hospital in Two Harbors, Minn.

Twin Cities nurses' contracts expired June 1, making their agreements six months overdue. Raises will be retroactive and paid for the entire first year. Nurses at one point wanted more than 30% raises over three years while the hospitals offered around 10%.

Both sides agreed from the outset on the need to boost retention and halt an exodus of nurses from hospital care that has worsened during the pandemic. Hospitals hedged on raises, though, arguing that the average full-time nurse in Minnesota receives more than $80,000 — which ranks seventh highest among states when adjusted for differences in cost of living.

Understaffing was a top concern for nurses, who argued that they were being given excessive caseloads and forced to cover back-to-back shifts when nobody else was available to care for their patients.

Solutions varied among the contracts, but all nurses gained a voice in addressing staffing, Turner said: "Nurses have more of an open door now to management when things need to change, when things are a mess."

Children's offered block scheduling for full-time nurses who requested it, preventing night shifts followed by day shifts that lead to fatigue and burnout. The agreement also spelled out nurses' rights to question assignments with excessive patient loads.

Nurses also will be part of an evaluation team that reviews staffing at least annually, and more frequently if problems such as nurse injuries or patient falls increase by 50%. Turner said that demand is reflected in all the hospital contracts, because such preventable problems are indicative of understaffing.

Last week's strike notice intensified negotiations, which took place throughout the weekend before hospitals committed millions of dollars to hire replacements. Hospital leaders said they already made some irreversible payments for strike planning but were waiting on hiring contracts as long as possible. Replacement nurses often cost two to three times more than regular nurses and incur travel, training and lodging expenses.

Children's had closed its inpatient psychiatric unit in St. Paul to admissions on Saturday and was planning to cut its intensive care capacity in half during the strike and possibly transfer critically ill patients out of state.

Allina doctors wrote Monday to Gov. Tim Walz and other state health leaders and warned that a nursing strike would result in reduced surgeries, longer ER waits and a clogged statewide hospital system.

"The downstream effects will impact access to beds at non-striking hospitals and will further delay patient care in clinics too. This risks a public health crisis for our community," the 25 doctors wrote.

The union has called off strikes even though nurses must vote to ratify the agreements. A note from Children's nurse negotiators said that "we will be sleeping all day Tuesday" after 20 hours of almost nonstop negotiating.

Meetings were scheduled Wednesday for nurses to ask questions in advance of votes by their individual hospital groups in the coming days. Votes need to happen by Dec. 15 for Children's nurses and Dec. 20 for Methodist nurses, according to their agreements, to have their raises retroactive to the start of the year.