After a testy discussion, the board of the Jackson Health System approved by a vote of 4-2 a global agreement intended to resolve several major tensions between management and SEIU Local 1991.

The deal now goes to the Miami-Dade Board of County of Commissioners for final approval.

The agreement, reached earlier this month, means management will stop exploring outsourcing physician and some other services in the Jackson Memorial adult ER., but might still explore getting outsiders to provide pediatric services at Jackson Memorial as well as all ER services at Jackson North and South.

Other parts of the agreement involved Jackson nurses’ shift schedules and leave time. Some nurses who had been reduced to part-time will get their full-time status back.

At its Monday board meeting, Chair Marcos Lapciuc called the deal “fair and balanced” that resolved many problems, including formal union grievances and a federal lawsuit filed by SEIU.

“I’m really troubled,” said board member Michael Bileca, a healthcare executive and a Republican legislator. He said he wished that concessions to the union were based on Jackson’s performance. He’s troubled that the system still has only 12 days of cash on hand and “pent-up capital demands.”

Bileca feared that a feeling is “starting to creep in ... [that] we have arrived, we can revisit things, we can take our foot off the gas.”

Stephen Nuell, a board member and attorney, said he was concerned about some legal aspects of the settlement. He and Bileca voted no.

Lapciuc, Joaquin del Cueto, Darryl Sharpton and Mojdeh L. Khaghan voted yes.