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San Francisco Department of Public Health registered nurses voted last week to authorize their contract negotiations team to call a strike, passing the measure with 99.5% approval. Votes were counted on Friday after nurses voted at SF General Hospital, Laguna Honda Hospital and various clinics throughout the week.

The bargaining team is still negotiating with the city to address staffing shortages and working conditions, but the authorization will allow them to call a stroke after their contract expires on June 30 if they feel the city has continued “refusing to engage seriously and in good faith on the nurses’ priorities to protect and improve patient care,” according to the press release from the union.

The union claims that the San Francisco Department of Public Health used per-diem temporary part-time nurses to do the equivalent number of hours of 291 full-time RNs. The union says it presented evidence of 16,000 missed breaks and over 1,400 “assignment despite objection” forms outlining unsafe conditions.

“Since negotiations began in February, the City has ignored its employees working on the frontlines of the City’s toughest public health problems as we’ve spent countless hours crafting solutions to make a serious dent in our staffing crisis,” said SEIU 1021 Community Clinic RN Chapter President Jennifer Esteen. “They called us ‘health care heroes,’ yet refuse to listen to our advocacy. This overwhelming vote to authorize a strike shows that we won’t back down when it comes to ensuring patient care in San Francisco’s public hospitals and clinics. A strike is always a last resort, but if that’s what it takes to make SFDPH management listen to us when we advocate for our patients, we will do it.”

Representatives from the San Francisco Department of Public Health were unavailable for comment on the vote or the union’s claims.