Barring a last-minute contract agreement, 4,800 registered nurses in the Twin Cities metro will go on strike at 7 a.m. Sunday, June 19.
The scheduled week-long walkout affects these facilities:
• Abbott Northwestern Hospital in Minneapolis
• Mercy Hospital in Coon Rapids
• Unity Hospital in Fridley
• United Hospital in St. Paul
• Phillips Eye Institute in Minneapolis
Allina Health says it has lined up replacement nurses for all of those facilities and intends to operate as usual.
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Why are the nurses going on strike?
The primary dispute is about health benefits, specifically the nurses union's exclusive health insurance plans.
Allina insists on shifting the nurses into the same corporate plans offered to its other employees. The company says the move would reduce its health costs $10 million a year by encouraging more frugal use of health care.
But nurses say their out-of-pocket costs would surge if they switched to Allina's insurance offerings.
What does the union's insurance look like now?
The nurses have a type of coverage that was common a few decades ago, but has since been phased out by many employers. The nurses pay higher monthly premiums than they would under the corporate plan, but have low annual deductibles and copays.
Critics of plans like the nurses' say there is little incentive to shop for less expensive care. Allina says union nurses visit the expensive emergency room for care 28 percent more often than other employees.
However, job-related factors might explain that increased ER use. Nurses say they are more likely to be exposed to dangerous infections on the job and need strong, first-dollar health coverage. And their generally non-traditional work shifts may prevent them from going to a clinic that's open only during business hours.
How does that compare to Allina's standard health plan?
Allina's so-called "core" plans have the same elements found in the union coverage, but the formula is flipped. Premiums are significantly lower. For example, the company's Allina First plan is the most comparable in popularity and provider network to the nurses' Choice plan. The Allina First premiums are from $700 to $2,000 less a year, depending on how many people are covered.
But the out of pocket maximum for the Allina plan theoretically could reach $9,000 in combined medical and pharmacy expenses, triple the max for the nurses plan. Allina says fewer than 1 percent of employees enrolled in the Allina First family coverage hit that out of pocket maximum.
On average, Allina says nurses will pay $5,620 for premiums and out-of-pocket costs this year in their current union plans. That's $600 more than employees in the corporate plan.
Plans like Allina's, that shift more financial risk to workers in the form of deductibles and other out-of-pocket expenses, dominate today's health insurance marketplace and are now viewed as the norm, rather than the exception they were just a decade ago.
Would Allina save more money than nurses by shifting them to their plans?
Because Allina pays the bulk of the total premium for its employees, Allina would save more in dollar terms than the nurses would. But on a percentage basis the savings would be equal. If an employee's premium drops 40 percent, so does Allina's.
Overall, this insurance change could save money for some nurses and add costs for others depending on their personal situations.
How dug in are both sides?
Nurses say they have given up raises in past negotiations to keep their union health coverage. They say unless Allina offers significant concessions on nurse-to-patient staffing ratios or workplace safety issues, they won't relent on their health insurance demands.
Allina Health has said that a health plan transition has to be part of the contract discussion.
How do hospitals find replacement nurses?
Allina has hired three staffing agencies to help it find nurses. The health system says it has commitments from 1450 replacement nurses. Many of those nurses are from other states. The Minnesota Board of Nursing has received almost twice as many out-of-state licensure applications in the first six months of this year than it did during the same period last year.
Unlike the 2010 nurses strike, Allina is planning to operate its facilities at mostly full capacity during this walkout. Some elective procedures may be cancelled. But the company says there will not be a significant drop in hospital services.
Is there a strike fund to compensate nurses?
Yes. Federal filings show that the union had $4.3 million in investment assets at the end of 2015. A large majority of that money is dedicated to the strike fund. So divvied up among 4,800 striking nurses, that would come out to about $900 per person. But, it's not easy to get strike benefits.
Nurses who want to tap the strike fund must prove that the seven-day walkout would result in a permanent financial burden, or that they're unable to provide necessities to themselves or dependents. They have to apply for assistance and document their household income, savings and investments.
How does this strike compare to the 2010 nurses' strike?
Six years ago, 12,000 nurses went on strike. That's more than twice the number planning to strike now. Fourteen metro area hospitals were affected, compared to five this time.
The union confined the largely symbolic 2010 walkout to just one day.
Nurses wanted hospitals to adopt specific nurse-to-patient staffing ratios. Ultimately, they did not get that into the contract.
Nurses did succeed in fending off a proposed pension cut in their 2010 contract. They also received minimal raises — far less than they were seeking.
In 2013, nurses and hospitals agreed to a wages-only contract negotiation.
If this strike goes forward, how will patients be affected?
It depends whom you ask.
Allina says it is hiring 1,450 highly qualified replacement nurses who are already trained to use its electronic medical record system. The company says it will be business as usual. Some elective procedures could be postponed, but Allina doesn't expect much of that.
If your procedure will be affected by the strike, Allina says a physician or Allina representative will contact you to reschedule.
The nurses union says 1,450 replacement nurses are not adequate to replace 4,800 striking nurses for a week.
What about wages?
Allina says a full-time nurse earns an average annual salary of $87,298, not including overtime and other wage bumps.
The Minnesota Nurses Association says that example doesn't reflect reality because most nurses are not full-time employees. The union says most are scheduled to work 24 to 32 hours a week. A spokesman said nurses earn an average of $35 to $40 an hour for scheduled work, which would translate to base incomes ranging from $43,680 to $66,560. But extra hours at enhanced wage rates are common.
Allina is offering nurses two percent wage increases in each of three years, in addition to raises based on seniority that are already in the contracts.
The union has proposed three percent raises in each of the next three years.