With nurses strike reaching its final day, what comes next?

A historically large nursing strike finished with its final full day of picketing Wednesday. Whether it reshaped testy contract negotiations with Twin Cities and Duluth hospitals over pay and staffing remains to be seen.

Hospital nurses used the spotlight of the work stoppage to plead for increased staffing and solutions to a nursing shortage that jeopardizes patients. Jeff Bluem brought his squirmy 11-year-month old daughter to the picket line outside Southdale Hospital in Edina, then lamented the quality time he misses with her when he is pulled last-minute into understaffed nursing shifts.

Hospitals are taking advantage by staffing at minimum levels and trusting that nurses will feel obliged to help at a moment's notice, said Blue, who works in a neurological unit at Methodist Hospital in St. Louis Park. "We have older patients. A lot of them have dementia. A lot of them have higher falls risks because of their strokes. Leaving nurses short-staffed is going to be unsafe for these patients."

As many as 15,000 nurses went on strike for three days at 15 hospitals, including Methodist and Southdale as well as North Memorial Health in Robbinsdale and others in the Allina, Children's and Fairview health systems in the Twin Cities. Strikes by nurses with the Minnesota Nurses Association (MNA) also took place at St. Luke's and Essentia hospitals in the Duluth area.

Affected hospitals kept their public statements this week focused on their efforts to maintain safe patient care with replacement nurses during the strike, and on their regular nurses' existing pay.

"Nurses in Minnesota rank among the most highly compensated in the nation, regularly in the top ten among all the states," said a statement from several of the negotiating Twin Cities hospitals. "The average Minnesota nurse earns $80,960."

The strike followed months of failed negotiations, which left nurses asking for around 30% pay increases over three years while the hospitals offered around 10% over three years. They also sought more authority, including the ability for a majority of nurses on a joint committee to block any hospital staffing changes they deemed unsafe.

"If you can't convince 50% of your nurses to a staffing change, then maybe you shouldn't make it," said Mary Turner, MNA president and an intensive care nurse at North Memorial.

A key when negotiations resume is whether a combination of staffing and pay compromises will produce a contract or whether one issue will be sacrificed for the other. Staffing demands were sacrificed in 2010, when 12,000 Twin Cities hospital nurses went on a one-day strike and reached a contract that boosted pay and preserved pensions and benefits.

Hospital negotiators have dug in on both issues, calling the nurses' wage demands "unrealistic, unreasonable and unaffordable" at a time when their systems are losing money. They also don't want to cede majority control of staffing decisions, noting that nurses already help set staffing levels and have the contractual right to mediation over disagreements.

Bluem said something needs to change beyond pay, because nurses can make more money through extra shifts or the lure of highly paid travel nursing. The hospitals' apparent ability to weather the strike this week is proof that they can do better, he argued.

"They found a lot of nurses, they were able to pay nurses more, and they were able to control the census in order to have safe patient (levels) — three things they've been telling us .. they have no control over," he said.

Staffing shortfalls were a common lament on the picket lines, which were otherwise sunny and festive with red-clad nurses strolling to music and bringing children and dogs along with protest signs. But amid the unity, there were different opinions.

Rita Decker, an ER nurse at North Memorial, said she'd prefer to maximize pay rather than trade it for staffing plans that could have loopholes. Even if hospitals agreed to increase staffing, they'd be limited by the nationwide shortage that already has them aggressively recruiting for new nurses.

"Pay is the one thing they can guarantee," she said. "If they could guarantee staff, that would change things. The load would be lighter and we could do our jobs the way ... we want to do them. I just don't believe they can ever guarantee staff."

Nurses at the 15 hospitals opted for the three-day strike to increase financial pressure but minimize pain on patients. Nurses at Essentia's smaller hospital in Moose Lake, Minn., opted to withdraw strike plans and do informational pickets instead.

No research has evaluated whether time-limited strikes are as effective as open ones, but they are becoming more common and offer the advantage of limited financial pain for workers and less likelihood that employers will replace them, said Johnnie Kallas, director of the Labor Action Tracker at Cornell University. The doctoral student is studying strikes in the U.S. and what influences wins or losses for workers.

"The disadvantage is they require nurses to return to work unconditionally at the end of the strike and may not force a settlement, meaning that negotiations could drag on for weeks or months," he said.

The strike will be expensive, though its price tag might be lower than the $149 million Allina paid in 2016. Allina nurses went on strike over health benefits for seven days that summer, then returned to the picket lines that fall for an open-ended strike that lasted 37 days before a contract was reached.

The bill will be at least in the tens of millions for the latest strike, considering the hospitals paid $7,000 to $12,000 per replacement nurse this week, plus travel, lodging and training expenses.

"They could have put a fraction of that into the nurses behind me and our patients" to avoid the strike, said Angela Becchetti, a nurse and union negotiator at Allina's Abbott Northwestern Hospital in Minneapolis.

Some hospitals will pay double at the end of this week, because they hired the replacements on five-day contracts but will only use them for three days and put their regulars right back into patient care.

Allina announced its regular nurses would return to work starting at 7 a.m. Thursday at Abbott and its Mercy campuses in Coon Rapids and Fridley. An earlier strike notice meant that nurses at United Hospital in St. Paul were scheduled to return at 6:30 p.m. Wednesday.