More than 600 registered nurses at Ascension Saint Agnes Hospital in southwest Baltimore now have their first union contract, which the union says ends the practice of assigning nurses to units outside their clinical competency and ends mandatory overtime. Nurses ratified the three-year agreement on September 19, closing a bargaining fight that began in January 2024 and included one-day strikes in July 2025 and July 2026.
For patients, the most important terms may not be the raises. They are the rules on who staffs a unit on any given shift. Nurses had argued for months that moving staff into unfamiliar specialties put patients at risk.
Ascension welcomed the vote. "We are pleased St. Agnes registered nurses have ratified their new contract," a hospital spokesperson told Becker's Hospital Review, adding that the hospital looks forward to continuing to work together.
Inside the Three-Year Agreement
According to a National Nurses United release on the ratification, the contract runs from September 2026 to September 2029 and includes a 5% to 6% pay increase over three years. The union says it also creates a Professional Practice Committee and a Staffing Issues Committee, adds workplace violence prevention language, and requires security to be available to assist nurses immediately.
Other terms include a grievance procedure with the right to arbitration, just-cause and progressive discipline standards, and succession protections that keep the contract in force if the hospital changes owners. The union also says the agreement rules out the mass layoffs of per diem nurses that Ascension had originally proposed.
These details come from the union. Ascension's public statement did not describe specific terms, and the full contract has not been posted publicly.
"The contract provides much-needed protections against unsafe floating, unfair discipline, and workplace violence," said Robin Buckner, RN, an intravenous therapy nurse at the hospital.
Floating, Overtime, and Safety on the Units
Floating is a common staffing practice in which hospitals move nurses to units that are short on staff. It can fill gaps quickly, but nurses at Saint Agnes said it often placed them where they lacked specialty training. Before the July 2026 strike, labor and delivery nurse Kathryn Blackburn said the postpartum unit had been staffed by medical-surgical nurses without the specialization needed to care for newborns, according to the union's strike announcement.
Mandatory overtime raises a separate concern. Nurses required to stay past long shifts may be working while fatigued, and ending the practice means extra hours must be voluntary.
Ascension disputed the union's picture during the dispute. In a statement on its strike contingency plan, the hospital said it would remain open and fully operational with replacement nurses, and that nurses received an average 9% raise in 2025 plus an additional average 7% increase that took effect on August 2, 2026, while talks continued.
The two accounts of pay can both be true. The union says full-time and part-time nurses have seen cumulative raises of up to 34% since unionizing in 2023, while the new contract's 5% to 6% figure covers the three years ahead.
A First Contract Years in the Making
Saint Agnes nurses unionized in 2023 with the National Nurses Organizing Committee, an affiliate of National Nurses United, and began bargaining for a first contract in January 2024. The agreement arrived about 32 months after talks began.
That timeline is long but not unheard of. A Bloomberg Law analysis of first union contracts, based on 391 first contracts signed since 2005, found it took an average of 465 days for newly unionized workers and their employers to ratify a first contract, and that 53% took a year or more.
Part of the reason is structural. A renewal amends an existing agreement, while a first contract starts from nothing, so wages, schedules, discipline, and staffing rules must all be negotiated at once.
Strikes played a role at Saint Agnes. Nurses walked out for a day in July 2025, their first strike, and again on July 6, 2026. The hospital stayed open both times using replacement nurses. Nurses at two Ascension hospitals in Wichita, Kansas, Via Christi St. Francis and St. Joseph, struck the same day in their own contract dispute, Becker's reported.
Baltimore Patients and the Road to 2029
For patients at Saint Agnes, the practical effect is stability. The contract dispute that led to two strikes is now settled, with terms in place through September 2029.
The grievance and arbitration terms matter for patients in a less obvious way. The union says the contract protects nurses from discipline for raising safety concerns, and if a dispute arises, nurses can take it to a neutral arbitrator rather than leaving the final word to hospital managers.
The new staffing committees give nurses a formal channel to raise shift-level problems. Whether that leads to better staffing will depend on how the committees operate in practice, which neither side has described in detail.
Patients who have concerns about their care can ask to speak with the charge nurse or the hospital's patient advocate. Maryland residents can also file complaints about hospital care with the Maryland Department of Health's Office of Health Care Quality.
The agreement also matters beyond one hospital. The union calls it the first union contract for private-sector nurses in Baltimore, a milestone other hospital workers in the region are likely to watch as organizing continues across health systems.
Key Questions Answered
What did Saint Agnes nurses approve? A three-year first union contract covering more than 600 registered nurses, running from September 2026 to September 2029.
What does the contract change for staffing? According to the union, it ends floating nurses to units outside their clinical competency, ends mandatory overtime, and creates staffing and practice committees.
How much of a raise do nurses get? The union says the agreement includes a 5% to 6% pay increase over three years.
What did Ascension say? A spokesperson said the hospital is pleased nurses ratified the contract and looks forward to continuing to work together.
Why did the contract take so long? First contracts must be built from scratch. A Bloomberg Law analysis found they take an average of 465 days to ratify, and Saint Agnes bargaining lasted about 32 months.
Did the hospital stay open during the strikes? Yes. Ascension said the hospital remained open and fully operational using replacement nurses.
Published by Medicaldaily.com
