Nurses' strike over future of hospital care impacts patients in Twin Cities, Duluth

Nursing care for Loren Avalos and her newborn changed at 7 a.m. Monday, when regular nurses at Methodist Hospital in St. Louis Park walked off their jobs in a three-day strike over pay and staffing levels.

Only two replacement nurses took over care of fragile infants in the hospital's special care nursery, where there had been four. Loren's husband, Edwin, said the nurses seemed proficient but needed prompts for things the regulars had provided intuitively — like warmed-up bottles for feedings and ibuprofen for his wife's pain.

"We had been used to having the nurses stop by and asking us pretty consistently if things were needed," said Avalos, whose son was born Saturday and admitted to the nursery because of feeding difficulties. "After the strike started, it seemed like we would have to buzz them every single time."

Striking nurses said they hoped their protest would improve the care of patients by increasing staffing levels and boosting pay to stem the rush of colleagues leaving hospital work. As the strike entered its second day, one lingering question was what, if any, patient harm occurred in the meantime.

The strike by as many as 15,000 nurses involves the Allina, Children's and Fairview systems in the Twin Cities along with Methodist and North Memorial Health in Robbinsdale. St. Luke's and Essentia hospitals in Duluth also are part of the strike.

Hospital leaders said efforts to maintain safe care were under way long before the strike started, including contracts with staffing agencies to bring in thousands of replacement nurses to take over inpatient roles. Day 1 offered optimism over the number and quality of the replacement nurses, who came from across the country to provide stopgap care at double or more the usual wages.

"We are fully staffed and extremely pleased with the quality of the replacement RNs," said a statement from St. Luke's on Monday. "We are not on divert for medical patients and have accepted every patient from the region who needs our care."

HealthPartners, the parent organization to Methodist, similarly reported a smooth transition on Monday and uninterrupted care amid the strike.

One of the few U.S. studies on patient outcomes during nursing strikes examined New York hospitals from 1984 to 2004 and found a 19% increase in patient mortality and a 6% increase in re-admissions during these actions. The results are more applicable to longer work stoppages, though, as the 2010 study was based on strikes with median lengths of 19 days.

Studies in other countries have found modest or no effects. Danish researchers in 2016 found shorter durations of breastfeeding among mothers who gave birth in hospitals under strike, possibly because of shorter lengths of stay and fewer midwife consultations.

Minnesota's experience of a 37-day nursing strike against Allina hospitals in the fall of 2016 doesn't offer much clarity. One high-profile event during that strike involved a medication error by a replacement nurse that severely injured an asthmatic patient.

State records show 144 deaths in September 2016 at the four Allina hospitals under strike that month, compared with an average of 130 in the month of September between 2012 and 2019. However, deaths in hospitals increased overall in Minnesota in September 2016, so other influences could have been at work.

Avalos' experience at Methodist was more about nuisances in patient care rather than life-or-death outcomes. After the switch to strike staffing, Avalos said he directed the new nurses where to find diapers, linens or other supplies — though that changed after they became familiar with the unit.

The OB treatment team arranged to discharge Avalos' wife on Monday after her delivery, but the couple waited for hours to receive discharge supplies and then clearance to leave. None of it was helpful at a time when the parents just wanted to see their son consume a full bottle of donor breast milk and not need a feeding tube — the key goal before he could be discharged as well.

"The strike has just added more stress," the father said. "It's already a stressful situation."

Strikes by nurses have generally been found to be ethical in free-market health care systems of competing interests. Former St. Cloud State philosophy professor Paul Neiman said his 2011 article on the morality of such actions is truer today because of the understaffing of hospitals.

"I fear we reach a point where health care enters a death spiral," said Neiman, who is now at Weber State University in Utah. "Nurses are already leaving the profession in large numbers, many of whom are burned out from two-plus years of the pandemic. The resulting short staffing increases the stress on nurses, which creates more pressure on nurses to leave the profession."

Nurses on the picket lines Tuesday said they felt for the patients they left in the hospitals this week but were resolved in their decision to strike. Children's Minnesota ER nurse Kathy Misk said the demand to take more and more patients each shift raises the risk of medication errors and other harms. Any parent with multiple kids could appreciate the pressure, she said.

"You know that feeling when the neighborhood kids come over and now you're watching six kids?" she said. "Where one is in the fridge and one is in the garage and one is in the backyard on your trampoline and you're afraid he's going to die? That's what it feels like."

The compromise solution remains unclear. The negotiating hospital systems and nurses share the goal of nurse retention and recruitment but have differing ideas on how to achieve it. The nurses have asked for pay raises of 30% over three years to incentivize colleagues to stay in the profession, but hospitals at a time of financial losses have offered just over 10% over three years.

No negotiations are scheduled during the strike, so the differences will remain when the labor action ends. The transition Thursday could involve continued use of the replacement nurses, hired under five-day contracts, while the regular nurses are phased back into their scheduled shifts.

Avalos discussed his family's experience to accentuate the needs of patients in the middle of such labor battles. Having observed both the regular and replacement nurses over the past week, he has noticed one thing in common.

"The thing that's really getting to me," he said, "is they all seem so busy, all the time."