SEATTLE (AP) — Thousands of nurses and other employees at a Seattle hospital system began a three-day strike over staffing levels, wages and other issues Tuesday, forcing administrators to close two emergency departments and spend millions to bring in replacement workers from around the country.

The picketers took to the sidewalks in front of Swedish Medical Center campuses wearing clear plastic ponchos against a heavy morning rain and carrying purple signs that read “Patients Before Profits” and “United For Our Patients.”

Swedish closed two of its seven emergency departments — at its campuses in Seattle’s Ballard neighborhood and in Redmond, Washington — beginning at 7 p.m. Monday and said they would remain closed during the strike.

Swedish said it would spend millions on replacement workers. A final number wasn’t clear, but Swedish Health Services Chief Executive Guy Hudson called $11 million “a start.”

“Safe patient care is our number one priority,” Hudson said. “As it has for 110 years, Swedish will continue to provide high-quality, compassionate care to patients and their families, even during the strike.”

Susan Walker, a nurse in the day surgery department, joined dozens of others picketing outside the Ballard hospital. She said this was her first strike in 41 years as a nurse, but chronic short-staffing means she has to work on her day off every two or three weeks.

“We have to come in on our days off constantly to take care of patients,” Walker said. “It’s very disruptive to your life, but you feel sorry for your coworkers so you bite the bullet and come in.”

The labor action called by SEIU Local 1199NW, which represents 7,800 workers at Swedish, is one of the largest hospital strikes in the U.S. in recent years, and it comes amid both a national shortage of nurses and a trend of hospital consolidation.

A recent study done for the American Hospital Association found that thanks in part to efficiencies of scale, hospital mergers improve care and reduce costs for patients. Some economists have found otherwise and labor activists say it jeopardizes care.

Swedish is a nonprofit organization, meaning it doesn’t distribute profits to shareholders. But strikers said that since it was taken over by a much larger nonprofit health system — Renton, Washington-based Providence St. Joseph Health — in 2012, administrators have been cutting costs at the expense of patients.

Providence, which is also nonprofit, made $970 million in the first nine months of 2019 and has more than $11 billion on hand, according to its most recent financial statement.

Hudson said he was disappointed in the strike and that the administration had offered a strong wage and benefits package. That includes proposed raises totaling 11.25% over four years; the union has been seeking 23.25%.

Swedish has an 11% vacancy rate, a staffing shortage that the system meets by hiring temporary and traveling staff. The organization said it would like to hire more permanent staff, but hospitals around the country are struggling with nurse shortages. Health care unemployment in the Seattle area is less than 1%.

Both the Ballard and Redmond campuses have 18-bed emergency rooms, according to Swedish’s website.

The hospital is advising patients who might need emergency or urgent care services in Ballard or Redmond to go to one of its other facilities, including its emergency departments at Seattle’s First Hill and Cherry Hill campuses. The hospital network also has emergency departments at its hospitals in Issaquah, Edmonds and Mill Creek in Everett.

Labor and delivery services at the Ballard campus were also closed.

Kale Rose, a labor and delivery nurse and a member of the union’s negotiating team, said she herself had given birth there, which made her concerns about staffing all the more poignant.

In an emergency, she said, there needs to be enough “eyes and hands” present to accomplish required tasks, such as hanging IV bags, administering medication, weighing blood-soaked sponges to determine blood loss and transferring a patient if necessary.

“I know all of the scary things that can happen when you have a baby,” Rose said. “And I know what it’s like to be on staff and feel like you don’t have enough people to take care of patients.”