Nurses at Allina Health in the Twin Cities began a second day on the picket lines Monday morning. Nearly 5,000 nurses went on strike Sunday after contract negotiations failed.

The main sticking point is the nurses' health plan. Hospital officials say a transition to replacement workers went smoothly, but union members say the changeover was anything but business as usual.

Allina management was ready with 1,400 replacement workers already hired. But for the regular staff, the transition from hospital floor to picket line was not smooth.

A nurse getting off her shift at Abbott Northwestern Hospital is greeted with hugs by striking nurses outside the hospital Sunday morning. Judy Griesedieck for MPR News

Abbott Northwestern Intensive care unit nurse Vinetta Gladney worked Saturday night right up until the strike began. Instead of handing off important patient information to a peer RN, she had to talk to a supervisor who was busy handling the transition. Gladney said it was chaotic.

"I got out as much as I could, but we had concerns leaving that we didn't know who was coming in to take over these patients and if they knew how to take care of them properly," she said. "When we left, we weren't even sure there was staff there to watch them but we walked out the door. Security was there. We did the best we could. We all just kind of walked out and prayed for the best."

At a news conference Sunday afternoon, Abbott Northwestern President Dr. Ben Bache-Wiig said the switchover to replacement nurses was not glitch-free, but he has confidence in his temporary hires.

"We found the nurses overall to be highly skilled, to have the skill sets that we need them to have. They need to be brought up to speed and our leaders have been there to support them through that. And we believe that we've been able to make that transition very smoothly," he said.

Allina President and CEO Dr. Penny Wheeler said things are operating normally across the health system. Unity Hospital in Fridley scaled back some elective surgeries, but Wheeler said patients are still being treated, doctors are delivering babies and all of the emergency rooms remain open.

"Given the rest of our care, team members are still present and active and people are actually going above and beyond to support them, we still feel very, very confident that excellent care is being received," she said.

Striking nurses and supporters march in front of Abbott Northwestern Hospital in Minneapolis Sunday morning. Judy Griesedieck for MPR News

Contract negotiations between Allina and the Minnesota Nurses Association broke down over health insurance. Wheeler said the plan nurses have now is costly and unsustainable and they need to switch to the same corporate health plan other thousands of other Allina employees have.

That would mean slightly lower monthly premiums. But MNA executive director Rose Roach said members would have to pay significantly more in out-of-pocket costs.

"This is cost shifting. None of this brings health care costs down overall. All it does is shift the costs onto the backs of the nurses," she said.

Nurses say Allina has not given them enough information to assess their proposal properly. But Wheeler said the company has given the union 30,000 documents about the health plan, detailing changes going back years.

Allina nurse Angela Becchetti, who's on the union bargaining committee, said her colleagues are also concerned about low staffing levels, and getting training to deal with violent patients or visitors.

But given that the strike is scheduled to end at a specific time, she's uncertain what will happen if there's no deal.

Hundreds of nurses for Allina Health went on strike Sunday morning after contract negotiations failed. Judy Griesedieck for MPR News

"If seven days isn't enough, I don't know what's next then," she said. "Allina should take this seriously. And that's what the nurses out here walking day in day out will show them."

University of Minnesota Labor Studies professor John Budd says fixed-duration strikes have become more common in recent years — especially in the janitorial and fast food industries. But he said it's rare for them to last a full week.

"I think that what makes this unique is that it looks like MNA is continuing to sort of experiment and trying to come up with some hybrid — it's not quite open-ended, however we think we need to put more pressure on the hospital than we would be able to get with a single day, so let's try something different, let's try seven days," he said.

Unless the two sides reach a deal sooner, union members say they'll take to the picket lines from 7 a.m. to 7 p.m. through Saturday evening. And they plan to be back on the job next Sunday morning.