By Josphine Marcotty and Chen May Yee
Star Tribune
June 11, 2010

Drenched by morning storms, nurses across the Twin Cities were putting down their picket signs and getting ready to head back to work -- although they didn't know whether they'd be allowed to return.

"We will go in en masse," said Glenda Cartney, who was with dozens of other nurses striking outside United Hospital in St. Paul at 6 a.m. Friday.

The overnight shift at United is from 11 p.m. to 7:30 a.m., so nurses planned to clock in at 7 a.m. to cover the last 30 minutes of the shift. But they said they weren't sure whether they would be welcomed back or not.

Ten minutes before 7 a.m., the nurses were tossing their wet picket signs into piles or into a garbage container.

In the final hours of the biggest -- and perhaps shortest -- nursing strike in American history, both sides were declaring victory.

“It’s so not about the money and I hope the message got out to the community that we care about the patients and that’s why we’re out here, “ said Linda Schaefer , an ER nurse on the picket line outside United early Friday morning.

But neither the nurses union nor the hospitals could say what, exactly, will happen next.

The Minnesota Nurses Association and 14 Twin Cities hospitals still need to negotiate a new contract, and the impact of Thursday's boisterous one-day walkout remains unclear.

Now the question is whether either side is prepared to escalate.

So far, neither has brought out the biggest sticks at its disposal. For the unions, that would be an open-ended strike. For the hospitals, it would be hiring permanent replacements, while imposing new wages and work rules.

"There will be protracted negotiations," said Hy Berman, a retired professor of labor history at the University of Minnesota.

The hospitals said Thursday turned out to be a good day to be a patient. Good planning and 2,800 replacement nurses succeeded in providing excellent care for more than 2,400 patients, officials said. "Months of planning, for something we hoped would never happen, have paid off,'' said Dr. Penny Wheeler, chief medical officer of Allina Hospitals & Clinics.

Union leaders pointed to the overwhelming number of red-shirted nurses who circled the hospitals all day and night with picket signs.

"The nurses are feeling their power!" said Rose Ann DeMoro, executive director of National Nurses United, the union with which the MNA is affiliated. "It was a show of seriousness on the part of nurses to not accept the standards the hospitals are trying to set."

What lies ahead

As night fell Thursday, dozens of nurses outside Abbott Northwestern Hospital made their rounds along the picket line. Cars honked in support; a motor coach bus pulled into the hospital's parking area to pick up replacement nurses finishing their shifts.

"I'm hoping this will bring both sides to the table to negotiate," said Ursula Tuttle, a nurse in the birth center. "We're standing up for nursing standards. I love what I do, but I'm afraid it's becoming such a big business. Corporations are running health care and setting agendas for nurses and that's scary to me."

Other nurses weren't as optimistic that Thursday's strike will change negotiations. But sooner or later, said Steve Weber, a nurse in Abbott's cardio-vascular intensive care unit, "there will be a showdown" with a vote for an open-ended strike later this summer.

Mark Mathison, an attorney at the Minneapolis law firm Gray Plant Mooty, thinks the nurses might try a series of one-day strikes. "If one is good, then three is better. It's much easier for the union to talk to the nurses about missing a day at work," said Mathison, who isn't involved in the talks. "If they do it once or twice, the burden is pretty big for the hospital from a cost perspective."

But a series of one-day strikes would raise the economic stakes on both sides. Much depends on how long the nurses could get by with smaller paychecks, and how long hospitals could continue to postpone elective procedures and pay millions of dollars for replacement nurses.

"It would become an economic battle between the two sides," said Peter Rachleff, an expert in labor history at Macalester College. "Who can hold out longer?"

Union officials say they have several options.

"They can strike again, they can strike for longer,'' said DeMoro. Or they could tell the public what the nurses know about "the financial dealings of the hospitals," she said.

"We have an arsenal in terms of tactics," she said.

But in the end, labor experts said, public opinion will likely prove a powerful influence.

"If public sentiment is on the side of hospitals, saying nurses are selfish or greedy, then the nurses will have to give in," Berman said. If the public believes the nurses' assertion that they are fighting for patients, "the hospitals should give in on the question of staffing," he said.

While the one-day strike cost each side millions of dollars -- lost pay for nurses; extra staff costs for hospitals -- the cost to the general public seemed modest. Hospital officials reported a day of relatively smooth operations. Late Thursday they said they had cared for more than 2,400 patients, conducted 181 surgeries and delivered 33 babies. That was much less than normal, however. Abbott Northwestern, for example, had 299 patients by late morning, compared with 500 on a normal day.

Union spokesman John Nemo did not dispute the hospitals' assessment, but said: "Congratulations. They proved our point by actually staffing up to the levels we have been begging for.''

Assessing the degree of disruption was difficult in a strike that sprawled across the metro area. The Minnesota Department of Health dispatched six nurses to monitor the hospitals and has not heard about any incidents that raised concerns, said Darcy Miner, director of compliance monitoring.

Hospitals had plenty of capacity for much of the day, said Mark Lappe, head of the Twin Cities hospitals' emergency response system. He tracks the number of available hospital beds from a command center in the basement of Hennepin County Medical Center in Minneapolis.

HCMC, one of the safety valve hospitals because its nurses were not on strike, reported only a modest surge of patients at its emergency room. But by early evening, both HCMC and North Memorial Medical Center emergency rooms were considerably busier, although neither one was overwhelmed, officials said.

Inconvenience

There, were however, reports of disruption and inconvenienced patients.

Kathy Washington, 57, of Plymouth said her 83-year-old father was admitted to North Memorial at 10 a.m. with congestive heart failure and an infection around his defibrillator. But he didn't get anything to eat until 5:30 p.m. because the nurses did not have a doctor's order giving them instructions. It also took nurses two hours to do a test that should have taken 30 minutes, she said.

"I am beyond frustrated," said Washington, who works as a nurse in a clinic.

Quadruplet babies born this week at Abbott Northwestern were transferred to St. John's Hospital in St. Paul for staffing reasons, hospital officials said. But, they added, the transfer also put them closer to their parents' home.

For the nurses, it was a day to show their numbers and their passion for putting patients first. Thousands braved a windy, damp day of picketing, some with dogs and children in tow.

Outside United Hospital in St. Paul, a pregnant woman wearing a patient's robe walked from the hospital to the picket line, spoke with some of the nurses, picked up a picket sign and went back inside.

Later in the morning, near North Memorial Hospital in Robbinsdale, a homeowner offered up her bathroom to striking nurses. She was a friend of Colleen Patterson, a patient at North Memorial for 25 days before she was discharged Sunday. Patterson, wearing a baseball cap to cover the surgical scar on her head, sat in the back yard of the house, hugging nurses who showed up.

"I hundred percent support the nurses," she said. "They're angels in disguise. Everything they're asking for they're absolutely entitled to."

By late afternoon, patience on the picket line seemed to fray a bit, and picketing nurses at Abbott Northwestern shouted "scab'' at a van full of replacement nurses pulling away from their building.

A new drama could unfold Friday morning, when the nurses have said they will return to work for normal shifts. Some hospitals have said that, having reduced operations, they will take back nurses only as patient volumes dictate.