BISMARCK, N.D. — Registered nurses at a medical center in Bismarck have voted not to unionize.

CHI St. Alexius Health nurses voted this week against being represented by the Minnesota Nurses Association, The Bismarck Tribune reported.

Registered nurse Angela Grosz said more than 300 nurses voted and that the results were very close. The association didn’t release numbers.

“We believe that having the flexibility to work directly with each other, free of a third party, allows the staff at CHI St. Alexius Health to best serve our community and deliver the best possible care to our patients,” said Kurt Schley, president of CHI St. Alexius Health. “We appreciate the opportunity to continue our direct working relationship with our registered nurses, and we look forward to working together as an organization to continue our faith-based mission as a quality health care provider for Bismarck.”

Nurses have maintained that operational changes and declining care standards are harming patient care and the hospital’s reputation.

“Nurses initiated the process because we wanted a seat at the table where decisions about patient care are made,” Grosz said. “Nurses believe coming together and speaking with one voice is the best way to advocate for our patients. Nurses are stronger than ever after this campaign and will continue the fight to make sure our patients receive the best care possible.”

Grosz called the vote outcome a setback. She also said the process has united the nurses at the hospital.

“This isn’t the end of the road,” Grosz said.

The hospital has laid off about 120 employees over the last year and a half but officials maintain that its quality of care hasn’t suffered.

The Minnesota Nurses Association represents nearly 22,000 nurses in Minnesota, Wisconsin and Iowa.

Information from: Bismarck Tribune,