About 15,000 nurses in Minnesota walked off the job this week to demand better pay and more robust staffing they say is desperately needed to improve patient care.

Nurses at seven hospitals in the Minneapolis and Duluth metro regions halted work Monday in what the union says is the largest strike ever by private-sector nurses. The hospitals recruited temporary nurses to maintain most services during the three-day strike.

One of Wisconsin's largest hospitals narrowly averted a strike when negotiating teams representing nurses and UW Health hospital announced Sunday a proposed settlement. More than 4,000 nurses in Michigan this month authorized a strike over what they described as unfair labor practices.

The strikes punctuate workforce shortages that worsened during the coronavirus pandemic as nurses navigated safety risks to care for Americans in crowded hospital wings. Now, nurses are fed up after years of being overworked and underpaid — conditions that they say jeopardize patient care.

The American Nurses Association, which urged the Biden administration last year to declare a national nurse staffing crisis to fix the "unsustainable nurse staffing shortage facing our country," reiterated a call for federal action.

Although the nation added 48,000 health care workers over the last year in hospitals, doctors offices and nursing homes, the number of Americans with health care jobs still lags pre-pandemic levels, Bureau of Labor Statistics show.

"The challenges that we highlighted around the fatigue and the mental well being of nurses continue to this day," said Zina Gontscharow, a senior policy adviser at the American Nurses Association. "Nurses are really feeling a lot of stress with not having adequate (staffing) on the floor, overtime and long shifts."

Kelley Anaas, an intensive care unit nurse at Abbott Northwestern Hospital in Minneapolis, said the pandemic strained working conditions. She said nurses in her wing typically must cover two patients at a time, a challenge when critically-ill patients need constant monitoring.

"We're doing twice as much work essentially for the same compensation and with fewer resources," said Anaas, who has worked at the hospital 14 years.

'Vicious cycle of low morale'

On Monday, nurses began walking the picket line at 7 a.m. outside Children’s Hospital in Minneapolis, one of 15 hospitals affected. Clad in the red T-shirts of the Minnesota Nurses Association and carrying signs with such slogans as, “Something has got to give,” several said their chief concern was patient safety.

Tracey Dittrich, 50, a registered nurse at the hospital for nearly 24 years, said nurses are tired of “hospital administrators and managers that are telling us to do more.” The hospitals need more nurses and more support staff, and higher pay will help, she said.

Union spokesman Sam Fettig said the nurses chose a three-day strike, rather than an open-ended walkout, out of concern for patients.

The hospitals have offered a 10-12% wage increase over three years, but nurses are seeking more than 30%. Hospital leaders called their wage demands unaffordable, noting that Allina and Fairview hospitals have posted operating losses and that the cost of such sharp wage increases would be passed along to patients.

“The union rejected all requests for mediation and held fast to wage demands that were unrealistic, unreasonable and unaffordable,” said several of the Twin Cities hospitals under strike in a joint statement.

The statement said people with emergency issues should continue to call 911 or go to emergency rooms. People may see some delay in being treated, it said, despite staffing hospitals with “experienced nurse managers, trained replacement nurses and some existing traveler nurses.”

The COVID-19 pandemic exacerbated longstanding nursing workforce challenges, said Patricia Pittman, a George Washington University professor and director of the Fitzhugh Mullan Institute for Health Workforce Equity.

While unions have authorized a handful of strikes, she said most of the nation's nine major nursing unions are willing to negotiate with hospital administrators rather than halt work. And nurses in large swaths of the country are not unionized, Pittman said.

But she said nurses likely sympathize with the hard-bargaining tactics employed by aggressive unions seeking better pay and staffing.

"It's is symptomatic of something that is felt among the entire nurse workforce, not just those that are unionized," Pittman said.

Hospitals used pandemic relief money from the Federal Emergency Management Agency to hire travel nurses from staffing agencies who often were paid more than nurses employed by hospitals. Some nurses quit their hospital jobs for more lucrative travel nursing positions.

Because hospitals have struggled to adequately staff facilities during the pandemic, many hospital-employed nurses have become frustrated over pay and bad morale.

"You're creating basically a vicious cycle of low morale of the people who stayed behind," Pittman said. "They're fundamentally angry about being put in a position where they could lose their license and patients could die because there are not enough nurses."

Anaas cited surveys predicting many nurses plan to leave bedside care. Elsevier Health, which provides health research and analytics, reported 47% of U.S. nurses and physicians planned to leave their current position within two to three years.

She said her fellow Minnesota nurses are striking to call attention to hospital administrators about demands for better staffing and pay, factors that will improve patient care, she said.

"What's driving this is just like fear for the future of our profession," Anaas said. "When we're out here fighting for better contract language, improved working conditions, improved compensation, it's about making nursing a desirable profession — a profession that people can stay in for an entire career. Right now, it isn't."