Strikes by as many as 15,000 Twin Cities- and Duluth-area hospital nurses appeared imminent Sunday night, after last-ditch negotiations failed to produce contract deals.

The walkouts at 16 hospitals were scheduled to start at 7 a.m. Monday, following the end of overnight nursing shifts, and last for three days.

Nurses argued that hospital staffing levels this weekend were proof of the reasons for their contract demands for more pay and increased staffing. A page Saturday morning alerted emergency department nurses at North Memorial Health in Robbinsdale that the ER needed seven more nurses to meet staffing needs that afternoon.

"DESPERATE PAGE!!! … PLEASE HELP IF YOU CAN!! CAP CAP CAP!!" the message read, with the final words being code for double pay for any nurses who stepped up.

The Minnesota Nurses Association hopes the collective leverage of so many nurses striking at once will motivate change. Leaving fewer nurses to treat more patients, often with more complex problems, "puts us terribly at risk and puts our patients at risk," said Mary Turner, MNA president and an intensive care nurse at North. "Our profession is in crisis."

Nurses have asked for pay increases of about 30% over three years to provide incentives to stay in the high-stress profession rather than quitting and leaving hospitals short-staffed. Hospitals have countered with increases above 10%, arguing that during a time of multimillion-dollar losses for health systems they can't afford bigger raises that ultimately get passed along to patients through insurance.

First-year nurses with baccalaureate degrees are making about $36 per hour right now at Twin Cities hospitals, while those with 10 years of experience are making around $51, according to hospital contract data.

Nurses at North Memorial and other hospitals also have sought protection in their contracts from discipline if they refuse shifts that they believe are unsafe because of the excessive number and severity of patients in their care. Hospitals have been reluctant to make contractual changes that reduce their authority to set staffing levels in response to daily patient demands.

Negotiations took place Saturday even as hospitals started the training and orientation of thousands of temporary nurses who traveled from across the country to take over inpatient care this week.

Hospitals reported strong response to their calls via staffing agencies for temporary nurses, who will be making double what many staff nurses make. Most activities will go on as planned this week, hospital leaders said, but patients will be contacted directly if there is any change in their scheduled care or procedures.

The strain of the COVID-19 pandemic has taught hospitals how to maintain patient care amid changing staffing levels, said a statement from chief nursing officers with the Children's and M Health Fairview systems along with North Memorial and Methodist Hospital in St. Louis Park.

"Our hospitals learned how to effectively train new nursing staff to ensure we remain focused on care," the statement said.

Hospitals scheduled for strikes in the M Health Fairview system include Southdale in Edina, St. John's in Maplewood and the Riverside campus of the University of Minnesota Medical Center. Allina Health hospitals under strike include Abbott Northwestern in Minneapolis, Mercy campuses in Coon Rapids and Fridley and United Hospital in St. Paul. Strikes in the Duluth area include St. Luke's and Essentia Health's St. Mary's Medical Center.

North Memorial is the only of three major adult trauma centers in the Twin Cities involved in the strike. The others at HCMC in Minneapolis and Regions Hospital in St. Paul are unaffected.