About 4,000 nurses at Brigham and Women's Hospital in Boston voted Thursday to authorize an open-ended strike, 2,986 to 215. The vote lets the Massachusetts Nurses Association's bargaining committee call a walkout with no end date. The committee hasn't set a date. It has to give the hospital 10 days' notice first, so no walkout can start before early October. These nurses already struck for one day on July 8, the largest nurses' strike in state history, and Mass General Brigham locked them out for four more days afterward. Talks started last November and stalled in August over wages and health insurance. The union also wants limits on temporary nurses. The union wants a cost-of-living raise on top of the annual step increases nurses already get. The hospital's offer keeps the step raises and adds nothing across the board.

1. The Nurses: MGB Has the Money and Walked Away From the Table

Two nurses on the union's bargaining committee, Kelly Morgan and Jim McCarthy, say a system with a $2.4 billion surplus is choosing not to pay.

The most profitable hospital system in the state can afford a raise. Mass General Brigham posted a $2.38 billion surplus last fiscal year, more than any other system in Massachusetts, according to a state report cited by GBH. Kelly Morgan, a labor and delivery nurse who chairs the union's bargaining committee, says "MGB is trying to use its immense wealth and power to force nurses to accept a contract that does not adequately protect patients or respect our work."

The executives already got a raise. The union says chief executive Anne Klibanski's pay was nearly $9.2 million last year, up about 9 percent. Morgan says the nurses are ready "to overcome the power of MGB's billionaire board members and multimillionaire executives."

The hospital is forcing a false choice. The union says MGB told it to pick one: pursue a cost-of-living increase, or discuss its other outstanding patient-care proposals, but not both. Jim McCarthy, a post-anesthesia care nurse and the committee's vice chair, said in the union's release that "MGB cannot tell nurses to choose between the care our patients deserve, affordable health insurance, or fair cost-of-living wage increase."

Management stopped meeting in August and hasn't come back. The union says the hospital told it on August 11 that it wouldn't keep bargaining. Nobody has scheduled a session since. McCarthy calls the cost argument "smoke and mirrors" and says "this is clearly just they want to break the union." Union spokesperson Joe Markman says the ask is simple: "that MGB get back to the table and actually engage in bargaining with us."

This time they'll stay out as long as it takes. In July the nurses struck for a single day, and MGB locked them out for four more. Morgan says they "are prepared to stay on strike for as long as it takes to win a contract that protects our patients and respects the nurses who care for them."

2. Mass General Brigham: These Are Already Among the Best-Paid Nurses Around

The hospital system says another $90 million a year would squeeze patient access and affordability.

These nurses are already at the top of the market. MGB says its Brigham nurses are already among the highest-paid nurses locally, statewide and nationally, with compensation in the top 10 percent of the acute care hospital market. Nurses with twenty years in earn at least $220,000, and about a third of the union is already at the top of the pay scale.

Pay has grown far faster than what the hospital gets paid. MGB says base wages rose an average of 55 percent over the past five fiscal years, while the payment rates it receives to cover care rose 14 percent. Nurses still get annual step raises under the current scale, and the hospital's offer keeps those and adds a bonus for nurses at the top step.

Another $90 million a year isn't sustainable. That's MGB's estimate of the union's wage proposal. With an $11.2 million ratification bonus on top, MGB says it would push nursing labor costs at the Brigham alone to nearly $1 billion a year. The system says that level of expense growth "is not sustainable and would put significant pressure" on its ability to preserve access, affordability and long-term investment in patient care.

The union created the impasse by refusing to move. MGB says it has held 25 negotiating sessions. Spokesperson Jessica Pastore says the system remains "committed to reaching a responsible agreement; however, given the MNA's unwillingness to adjust their proposal, the negotiations are at impasse." The hospital says it won't come back until the union changes its proposal. It also points out it "has settled two union contracts within the last month."

The hospital will keep running if the nurses walk. Ahead of the vote, an MGB spokesperson said "none of us wants another strike." After it, the hospital said that "while we continue to hope a strike can be avoided, we are fully prepared with comprehensive plans to continue providing safe, high-quality care if the union decides to call one." In July that meant replacement nurses on five-day contracts, which is why the lockout ran four days past the strike.

3. The Governor and Boston's Elected Officials: Get Back in the Room

Governor Maura Healey says it's on MGB to schedule a session. The state's senators, two House members and Mayor Wu say it's on both sides.

Patients are the ones exposed while this drags on. Governor Maura Healey said as much in a statement before Labor Day: "This has gone on too long. It's been months of negotiations and now there are no bargaining sessions scheduled."

The hospital has to make the first move. Healey is specific about what she wants: "We need MGB to schedule a new session and then stay at it until contracts are done." She told WBUR she'd said to the system directly that "they've got to get back to the table, they've got to announce a negotiation session," and that she's "doing everything I can." She declined to say whether she's talking with hospital officials by phone.

Both sides are responsible for getting a deal. Senators Ed Markey and Elizabeth Warren, Representatives Ayanna Pressley and Stephen Lynch, and Boston Mayor Michelle Wu issued a joint statement the day before nurses walked out in July, calling nurses "the backbone of our health care system." They urged "all parties to return to the bargaining table and reach a good faith agreement that provides stability for this critical workforce, Mass General Brigham, and the patients in their collective care."

Where This Lands

The nurses say the money is there and the hospital walked away. The hospital says the nurses are already among the best paid in the market and the ask would cut into patient access. The governor says the first move is MGB's, and the senators and Mayor Wu say both sides have to get back in the room. The next thing to watch is a 10-day strike notice. If the union files one, an open-ended walkout could begin in early October at the soonest. MGB hasn't scheduled a bargaining session since August, and across town nurses at Boston Medical Center have authorized a strike of their own.

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