Chris Rubesch, the president of the Minnesota Nurses Association and cardiac nurse, stands in front of the MNA office as they gear up for the next steps in their contract fight.
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For Chris Rubesch, a cardiac nurse, the most rewarding part of the job is “to see someone come in sick, injured, in pain, and to be able to see them through the healing journey and get them back home.” However, historically low staffing levels are making that more and more difficult, he says. Rubesch is leading the charge as president of the Minnesota Nurses Association (MNA) while the labor union bargains for a fair contract for 11 Twin Cities metro hospitals and two Duluth hospitals.
MNA has repeatedly used surveys to assess the priorities of its 15,000 members in their workplaces leading up to the contract fight. Across surveys, regions, and hospitals, the top concern for nurses is safe staffing levels. Rubesch says, “From the Twin Ports to the Twin Cities, staffing is our members’ biggest focus.”
Over the past 10 years working as a nurse, Rubesch explains that he’s seen a major shift in how hospital units are staffed. “Those numbers are shrinking. So there’s a tighter and tighter margin of staff to work with. There’s less and less flux in the system,” he says.
In a press release from MNA, Megan Finnegan, a registered nurse at Aspirus St. Luke’s in Duluth, said, “Unsafe staffing levels are hurting our patients. Nurses know it. Patients know it. And hospital executives know it. But those same executives continue to prioritize profits over safe patient care.”
Rubesch says that one area where nurses are especially strained is education to patients upon discharge, which can include explaining new medications, what symptoms to watch for, and how their caretakers can support their recovery. When nurses are unable to spend this time with patients, it increases rates of patients returning to the hospital, injury, and other negative outcomes, Rubesch says.
Nurses are also being asked by hospital administration to be more flexible in working outside of their areas of expertise, the MNA president says. “We also need to recognize and understand that within nursing there’s a lot of specialization. Just like doctors, nurses will specialize in things and take years of extra training and skill-building to be competent.” However, Rubesch says, “Hospitals increasingly want to place nurses wherever they have openings, and we again see that as risky for patients.”
Isabela Escalona
Chris Rubesch, the president of the Minnesota Nurses Association and cardiac nurse, stands in front of the MNA office as they gear up for the next steps in their contract fight.Moral injury
While “burnout” is often used to describe why nurses and other caregivers are leaving the industry, some nurses have begun using the term “moral injury” instead. Nurses argue that “burnout” places the blame on the workers not being able to keep up with the demands of the job, whereas “moral injury” more accurately describes the pain and stress nurses feel when outside circumstances do not allow them to deliver the quality of care they were trained to administer to patients.
Moral injury, nurses say, occurs in the gap between the ideal scenario and the reality, a gap that exists because of lower staffing ratios of nurses to patients. “In the perfect world, in the perfect hospital, when you have everything you need, this is how you would provide care,” Rubesch underscores. “And then you get into the real world and you see that that’s not possible, that perfect hospital doesn’t exist anywhere in the country.”
Typically, the “burnout” framework places the blame for these imperfect systems on nurses’ inability to fill in gaps in the system. Nurses with MNA instead place the onus on hospital leadership prioritizing financials over patients’ care and nurses’ wellbeing.
Rachel Anderson, a registered nurse in the Twin Cities metro, said in an MNA press release, “No nurse should have to choose between their dignity and their patient’s, but we do.” She continued, “Meanwhile, hospital executives are fine letting patients lie in waste as long as the spreadsheets look clean. It’s disgusting. It’s deliberate. And it has to stop.”
Profits over patients
While Twin Cities metro hospitals’ contracts expired in May and the Duluth-area hospitals will expire on June 30, MNA’s negotiations team is not seeing a lot of progress at the bargaining table, union leadership says. On June 3, MNA filed an unfair labor practice (ULP) lawsuit against Essentia Health for what they say is refusing to bargain in good faith. “Over six months ago, Essentia’s Patient Flow nurses qualified for and won an armour-globe election, allowing them to join the existing MNA contract,” MNA said in a press release. “Despite this, Essentia is erroneously and illegally demanding that these nurses should be a part of a different bargaining unit.”
In addition to filing a ULP, the Minnesota nurses organized information pickets at various hospitals across the Twin Cities metro and Duluth. Notices were given to several hospitals that informational pickets would occur: Allina, Children’s Minnesota, HealthPartners, M Health Fairview, North Memorial, Essentia Health, and St. Luke’s.
“From my experience in the last few negotiating sessions I’ve had with my employer, they’re simply not willing to engage in any of this conversation,” says Rubesch. “They want to talk about money because they think that money is going to fix everything. What we’re telling them is there’s a lot of other substantive language that we can agree to that will make the hospitals better for patients and staff that don’t involve money.”
The Twin Cities Hospital Group, which represents Allina, Children’s Minnesota, HealthPartners, M Health Fairview, and North Memorial, responded to the MNA’s concerns, saying, “Under Minnesota law, hospitals operate as nonprofits and are required to reinvest any operational net proceeds in the community. Allegations that the hospitals put profits before patients are false.”
The Twin Cities Hospital Group cited a 2023 report by the The Minnesota Hospital Association that found that Minnesota’s hospitals contributed $6.2 billion in “community benefits as defined by IRS guidelines.” The Twin Cities Hospital Group went on to say, “These investments extend far beyond hospital walls. They address the root causes of illness, expand access to care, and ensure that every Minnesotan, regardless of their ability to pay, receives the care they need.”
However, a spokesperson for MNA told Workday Magazine over email that “while these hospitals technically hold not-for-profit status and do make some contributions to the community, they also counteract that work by making bottom line driven decisions like cutting needed services, giving executives raises and working with for-profit management consultants to make decisions that are not in the best interest of patients or workers.”
“While Minnesota’s top healthcare systems brand themselves as deeply engaged with the community, their actions prove otherwise,” MNA says. “Hospital CEOs earn millions, pushing a profit-driven model: cutting staffing levels, closing “underperforming” services, hospitals, and clinics, suing patients for medical debt, pocketing millions in tax exemptions as they spend less and less on charity care. As a result, quality care for patients suffers, and patients routinely cannot afford or find care in their local communities.”
In response to workers’ concerns, a representative from Allina Health told Workday Magazine that, “Now, more than ever, negotiations must reflect the reality of rising costs, declining reimbursements and uncertainty around programs like Medicaid. We remain focused on a responsible contract agreement with the Minnesota Nurses Association that ensures we can maintain access to care and the high-quality services people depend on.”
When asked for comment, Aspirus St. Luke, referred Workday Magazine to a statement on its website. “Aspirus has a threefold commitment: to our patients, our people and our communities,” the statement reads, adding: “We must adapt and maintain balance so we can continue to meet the needs of everyone we work with and care for.” Workday Magazine requested comment from Essentia Health but did not receive a request by the deadline.
The union is sounding the alarm that hospital executives are “in a race to the bottom.”
“Assisted by management consultants, Allina aggressively cut staffing to the 40% percentile based on national estimates, resulting in workplace violence, needlestick injuries, and patient handling concerns,” the MNA spokesperson said. “Essentia cut labor and delivery services in Fosston, depriving rural communities of services while the company recently earned $163.5 million in profits. Fairview closed two hospitals during the COVID-19 pandemic which historically served low-income communities and communities of color in the East Metro.”
MNA is currently assessing members’ needs and concerns as it moves forward in the bargaining process. Rubesch explains, “In the coming weeks, we’ll have more information from members as to what the next escalatory step they’re willing to take, and certainly strike is one of those potential tools.”