Registered nurses at Ascension Saint Agnes — who last year became the first nurses to unionize a private-sector hospital in Baltimore — are demanding better wages and more protections for their patients during contract negotiations with hospital leadership.

The workers, who are represented by the National Nurses Organizing Committee/National Nurses United, have been negotiating with hospital management since the middle of January.

Dozens of nurses rallied outside the Southwest Baltimore hospital Thursday morning in a show of support for the proposals, said Robin Buckner, a registered nurse at Saint Agnes and a member of the bargaining team.

Buckner has spent the past nine years at Saint Agnes — she’s on the vascular access team — but she’s been a nurse for 45 years. Throughout her career, she’s watched staffing shrink at hospitals, even as her patients have gotten sicker. And nurses are always the people who pick up the slack, even when they have nothing left to give, she said.

“It’s just a lot. It’s a lot. The nurses suffer because mentally, she wants to provide good care for her patients, but she’s only one person,” Buckner said. “Then, the patients are the ultimate ones that get the short end of the stick.”

Justin Blome, director of marketing at Ascension Saint Agnes, said in an email that patient and associate safety remains the hospital’s top priority. Thursday’s rally wasn’t a strike or work stoppage and did not affect patient care, he said.

During contract negotiations, Blome said, the hospital has been focused on “setting a tone and tenor of collaboration and respect” as leaders bargain in good faith with National Nurses United.

“We believe differences are best resolved at the bargaining table, rather than through public demonstrations, and look forward to continuing the work of reaching a tentative agreement on a mutually-beneficial contract that supports all,” he said.

NNOC/NNU represents more than 500 registered nurses at the hospital, the union said in a news release Wednesday. Ascension, a Catholic hospital system, is one of the country’s largest health care systems, with 140 hospitals in 19 states.

In contract negotiations, Saint Agnes nurses are asking hospital management for better compensation, higher nurse-to-patient ratios and other changes that they hope will improve staffing levels and nurse retention.

Nearly 20% of nurses currently employed at the hospital started working there less than seven months ago, according to the union’s Wednesday news release. Only about a third of the workforce has more than four years of experience at Saint Agnes — and veteran nurses are essential for delivering quality care, Buckner said in the release.

“Safe staffing puts patients and our community’s health first,” she said. “Without safe staffing protections and enforcements in our contracts, Saint Agnes nurses will be unable to provide the level of care our patients and our community deserve.”

Also at the bargaining table, nurses are asking Saint Agnes leaders to maintain all facilities and services in the community for the duration of the contract — three years, if the union gets its way. If the hospital decides to replace certain facilities or services, the nurses say, the new facilities and services should be just as accessible to community members as the old ones.

If nurses are able to win that proposal, Buckner hopes it would prevent Saint Agnes from limiting or eliminating services offered at its dialysis center or through its labor and delivery department or neonatal intensive care unit.

In the past decade, according to an analysis from National Nurses United, the health system has cut a quarter of its labor and delivery units across the country, even as pregnancy and childbirth-related mortality has increased. These closures were more common in areas with higher rates of low-income, Black and Latino patients — groups that have higher rates of pregnancy and childbirth-related deaths and complications.

Nurses at Saint Agnes also are proposing patient protections at the bargaining table that they hope would prevent the hospital from suing patients to resolve billing disputes and instituting surprise billing or excess charges against them, Buckner said.

The goal, she said, is to put “patients over profits.”

When Saint Agnes nurses unionized in November, it was the fourth time an Ascension hospital unionized in 13 months — a trend that NNOC/NNU attributed to a “stark contrast” between the health system’s practices and stated mission of providing spiritually centered holistic care and prioritizing the needs of the poor and vulnerable.

In the union’s news release Wednesday, organizers pointed to investigative reporting conducted by national news outlets, including The New York Times, that found the chain’s short staffing has led to poor patient care. They also noted the health chain has a “strikingly unusual $1 billion private equity operation,” according to the news outlet STAT, and yet is exempt from paying federal taxes because of its nonprofit status.

Tax records published by the news outlet ProPublica indicate that Ascension’s president and CEO, Joseph Impicciche, made more than $13 million in compensation in 2021.