Susie Smerz, a hospice nurse and case manager who has worked at Allina Health in Minnesota for more than 11 years, joined the America's Work Force Union Podcast to discuss her union's first contract with the health system.
Smerz helped form the union with SEIU Healthcare Minnesota and Iowa in 2025 and served on the bargaining team that won the agreement. Smerz also discussed why hospice nurses organized, what the contract covers and how the pending Sutter Health acquisition fits in.
Susie Smerz, a hospice nurse and case manager at Allina Health in Minnesota, once planned to become a doctor but admitted she lacked the stomach for it. She left healthcare for a while after a nursing home job left her depressed watching people decline. She returned and earned an entry-level master's degree in nursing. Smerz said she volunteered in hospice care first to test herself, fell in love with sitting at the bedside with people, and decided to become a hospice nurse. She said she loves walking in sacred space with people who sometimes just need to be heard, seen and supported.
Smerz said healthcare is a tough space that keeps getting tougher. Allina's hospice nurses were challenged for about eight years. She said leadership changes can make things better or worse, and that without a union contract nurses have no control over which way it goes. After COVID, she said nurses were told people were leaving due to the “Great Resignation,” but in her area, many were just leaving Allina Hospice. Since many hospice nurses go into people’s homes alone, experience matters, Smerz said, and Allina was losing its experienced nurses.
Most hospice nurses are salaried, which Smerz said is rare in healthcare, but it can also be a way nurses are exploited. While she is paid to work from 8 to 5, she sometimes works 12 hours. Other nurses are required to pick up evening and overnight shifts, so some days they work 16 straight hours for hourly pay.
Smerz said she contacted the Service Employees International Union (SEIU) a little over two years ago because the Minnesota Nurses Association primarily works in hospitals and was not interested in community-based nurses. She said the time from the first conversation with nurses to an official vote took less than three months. It was a challenge, Smerz said, because hospice nurses are siloed, working autonomously across a Twin Cities area that spans about two hours, so many did not know each other.
At first, the nurses kept the effort quiet. Smerz said she does not think management really knew conversations had started until the nurses handed in their cards. She said managers did little to dissuade them, mostly trying to make the union seem separate from the nurses.
The ratification vote was unanimous among the nurses who voted, Smerz said, and many drove quite a distance to get to the union hall. A couple of nurses who were opposed to forming a union and had crossed the picket line during the group’s two strikes came, voted yes and thanked the group. In the end, many people saw the power of the nurses’ effort and how they stood up for every type of hospice nurse, she said.
Smerz said the effort was never about wages. Nurses wanted a voice in their working conditions, work-life balance, staffing and respect for their time, she said, including limits on weekends and on-call shifts and pay for extra time. The contract has protections around weekend work and pays nurses for time over their FTE, which she called huge, because case managers often work 12-hour days.
Smerz admitted she wished Allina would have agreed to offer holiday pay. Currently, the nurses only get time-and-a-half for working on Christmas and New Year's. The nurses negotiated for a new mileage reimbursement rate. Previously, some nurses drove 120 miles to see a patient and receive nothing in return.
Sutter Health, a large California agency, is trying to acquire Allina. Smerz described it as an acquisition rather than a merger. The union has worked closely with the state Attorney General's office and is now working toward a community benefits agreement to protect community members and unions. The goal is to ensure that hospitals, clinics and programs are not closed after the merger. She credited the AG’s office for being instrumental in getting the nurses across the finish line to sign their first contract, even acting as an intermediary in the last few days of bargaining.
Smerz encouraged other workers trying to form a union to keep fighting and come together. The hospice nurses focused on what they had in common rather than their differences, she said. They all wanted to do great work and know their time is valued, so they can care for their families. She said company leaders often try to divide workers, but as long as workers remember what they are fighting for and stand with one voice, there is power in numbers.
More information on SEIU Healthcare Minnesota and Iowa is available at seiuhealthcaremn.org.
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