The Massachusetts Nurses Association said the nurses at Greenfield's Baystate Franklin Medical Center have authorized a three-day strike.
The nurses are in a two-year contract dispute with Baystate Health.
The two sides have met at the negotiating table 39 times.
Union reps say the nurses "overwhelmingly" voted to authorize the three-day strike Tuesday night.
The Massachusetts Nurses Association gave the nurses the option to authorize a strike that would last between one and three days. The nurses opted for the longest option.
How overtime pay is structured is one of the major sticking points between the two sides.
The hospital wants nurses' overtime calculated based on a 40-hour week.
The nurses want the current structure to stay the same. Currently, a nurse earns time and a half for more than eight hours of work.
Baystate Franklin Medical Center President Chuck Gijanto said Wednesday, "It's unfortunate that the union has opted to threaten the hospital with another strike. This will force us into emergency planning around a work stoppage for the second time in a little over a year. Again, we're seeing the interests of the Massachusetts Nurses Association and the National Nurses Union - of which the MNA is a part - being placed ahead of the interests of our local hospital, our patients and our community."
Gijanto also said, "Baystate Franklin Medical Center will be fully prepared to deal with any work stoppage, and we will continue caring for patients and for our community."
Last month, the nurses said they wanted to go to a third party arbitrator to find a solution. Baystate Health says it's against that and would rather have the federal mediator who's been observing their negotiations make the decision.
A date hasn't been set for a strike. The MNA said it hopes the vote will force the hospital to settle before the nurses would walk off the job.
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