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Throughout the Covid pandemic, nurses around the US have faced deteriorating working conditions and challenges, from safety concerns to increasing workloads that have stemmed from understaffing as nurses have quit their jobs or retired early.

Those nurses who are still on the job at many hospitals say they have been expected to do more with fewer resources, an issue that nurses say is causing retention crises and jeopardizing patient safety and care.

Now nurses at 15 hospitals in the Twin Cities area (Minneapolis-St Paul) and Duluth, Minnesota, that are negotiating new union contracts with their respective hospitals have overwhelmingly voted to authorize a strike. A date for the work stoppage has not been set yet by the union, the Minnesota Nurses Association, which represents about 15,000 nurses who voted on the strike authorization, but a 10-day notice must be given ahead of any strike.

If a strike is carried out, it would be one of the largest nurses’ strikes in US history.

Jayme Wicklund, a registered nurse at the Children’s hospital in St Paul, Minnesota, and member of the negotiating committee, said short-staffing issues became an issue before the pandemic when the hospital preferred relying on nurses to take overtime shifts as needed rather than bolster staff numbers. When the pandemic hit, many nurses were furloughed and Wicklund said several never returned in part because of the lack of clarity on recalling those nurses.

In the midst of short-staffing, Wicklund argued nurse-to-patient ratios, which vary by department, had increased compared with before the pandemic.

“We need more resources to take care of the patients,” said Wicklund. “The hospitals are very focused on wages. We have to be comparable to other places. But that’s all that they focus on. Once you start talking about wages, they don’t want to talk about the other important issues around patient safety or actually, other ways to save money.”

She argued that during the current negotiations the hospitals had been much less receptive to progressing on a deal than in previous years.

The Minnesota strike vote was taken as the previous contracts expired on 31 May and negotiations have been at loggerheads over compensation and staffing.

A survey conducted by the union in March 2022 of 748 nurses in Minnesota who left their jobs during the pandemic cited poor management and short-staffing as driving factors in leaving their positions. As nurses have left the bedside, adverse health events in hospitals increased by 33% from 2020 to 2021.

The union has criticized high hospital executive pay during the contract negotiations as hospital executives have deemed the wage increase requests by the union as “unrealistic”.

“Six months ago, a year ago, our management would say, this is just temporary, we can get through this, we just have to do this for now and recently, the messaging from management has become, this is the new normal, and that’s when I realized, they don’t have any intention of fixing them. They are expecting us to continue to work in these conditions forever,” said Chris Rubesch, a registered nurse at Essentia in Duluth and first vice-president of the Minnesota Nurses Association.

“Nurses want to be at the bedside, giving care to our patients and doing our jobs. So the fact that we are willing to take this extraordinary step is reflective of the severity of our staffing crisis,” added Rubesch. “We’ve tried legislatively. We tried to address this in contract language. Our employers refused to work with us on that. And so we’re left to take this extraordinary step, and we don’t take it lightly. We find it’s the only path to address the problem.”

Ali Marcanti, a nurse for seven years at Allina Health in St Paul, Minnesota, criticized hospitals’ talking points throughout the pandemic of praising nurses as healthcare heroes while refusing to address staffing issues in contract negotiations.

“Negotiations, in our eyes have been our employers’ opportunity to put their money where their mouth is, and instead of pithy statements, like ‘you’re a hero’, actually give us some substantial improvements to our work environment that make us actually want to continue working for Allina,” said Marcanti.

A spokesperson for Essentia Health said: “We are disappointed by the vote because we believe no one wins in a strike – and we have a shared responsibility to provide quality care to the patients and communities we are privileged to serve. Should it become necessary, we have contingency plans to ensure we can continue to care for our patients in the event of an MNA strike.”

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