Five months after negotiating a truce that prevented a massive nursing strike, nurses and hospitals in the Twin Cities are rekindling their high-stakes public argument over staffing ratios.

The Minnesota Nurses Association on Monday blasted the Minnesota Hospital Association for hiring a public relations firm to tell state legislators and the public that hospitals are safe without staffing ratios.

The hospital association fired back saying the communication activities — which include hiring a PR agency— are needed because union groups have made it clear they plan to keep pushing for staffing ratios that hospitals think are wasteful.

"They are likely going to spend hundreds of thousands — if not millions — of dollars, countless hours of staff time and other resources to fight against the very nurses they're supposed to be working with," Linda Hamilton, president of the Minnesota Nurses Association, said in a news release Monday.

Lawrence Massa, the president of the Minnesota Hospital Association, responded in a prepared statement saying that nurses "have made it clear that they plan to pursue mandated staffing ratios as their top policy priority ... regardless of the fact that ratios are unproven in advancing better patient outcomes."

The skirmish continues a debate that was tabled this summer when the nurses union and several Twin Cities hospitals agreed to contract terms that did not address the issue of staffing ratios — the stated priority of nursing groups. During the negotiations, hospitals spent nearly $24 million to deal with a one-day strike by nurses and plan for a subsequent walkout that didn't happen.

The nurses union released a November memo Monday in which Massa said the hospital association was hiring Himle Horner Inc. to develop "a coordinated, long-term, sustained media and public relations campaign focused on what hospitals are doing to ensure quality, safe patient care." The firm represented hospitals during the labor dispute leading up to this summer's contract settlement.

Massa's letter suggested that the ascendance of Republicans in both chambers of the Minnesota Legislature could be helpful to medical centers.

"The new political reality may mean less pressure on this issue at the Capitol during the 2011 session," Massa wrote. But he added "our expectation is that (the nurses) will simply pursue other opportunities to call attention to this issue through regulatory agencies, internal hospital reporting and the media."

Jan Hennings, a spokeswoman for the Minnesota Hospital Association, said her group would not say how much money it is spending to hire Himle Horner. Union leaders suggested the hospital's PR campaign is scheduled to run for three years, but Hennings would not comment on the claim.