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Don't Eat Your Young episode 309

Historic MN Nurses Strike: How it Impacts Nurses and Patients with Chris Rubesch

Chris came into nursing as a second career. For seven years, he has worked with cardiac patients in a large hospital where he takes care of some of the sickest patients. In order to do his job well, Chris needs time with each patient, resources to assist him in that care, and a safe environment to do so. But as we’ve seen, staff to patient ratios are not aligned, and resources are diminishing. Violence in healthcare settings is at an all time high.

Early on in his nursing career, Chris got involved. He quickly realized the impact he could make by advocating for nurses so started working with the Minnesota Nurses Association (MNA). Through that work, he helps lead the historic strike that involves 22,000 nurses in Minnesota. Determined to fight for safe staffing levels, safer work environments, and benefits that will keep nurses at the bedside, Chris is part of a movement that will shape our profession.

Episode Transcript

Intro/Outro:
Welcome to Don’t Eat Your Young, a nursing podcast with your host Beth Quaas. Before we get started, we have a few quick notes. Don’t Eat Your Young is a listener-supported podcast. To learn more about becoming a member and the perks available to you for becoming a patron yourself, visit patreon.com/donteatyouryoung. You can learn more about the show, share your story to join Beth as a guest, or connect with our wonderful community in our Facebook group. You can find all those links and more at donteatyouryoung.com. And now, on with the show.

Beth Quaas:
Welcome to Don’t Eat Your Young. I’m your host Beth Quaas. Today I am so excited to have Chris Rubesch come on. He is the VP for the Minnesota Nurses Association. He is putting up the strong fight, advocating for nurses, the historic strike that’s going on in Minnesota right now. He’s here to tell us about it and what’s going on and what we can maybe expect here coming up in the future. So, welcome, Chris, to the show. I’m so happy to have you here today.

Chris Rubesch:
Thanks so much for having me.

Beth Quaas:
Yes. So tell us a little bit about yourself.

Chris Rubesch:
I’m a cardiac nurse at Essentia Twin Ports in Duluth, Minnesota, and I’ve been a cardiac nurse there for seven years. That’s my entire nursing career. Nursing is a second career for me. I started off in the nonprofit world, international studies and political science background, and then came to nursing as a second career.

Beth Quaas:
Well, I’m so happy that you’re here today because we have a lot going on in Minnesota. That’s where we both live right now, and we’re making historic strides in the nursing world. And I’m going to let you talk about it because you are … Tell us how you got involved and what you’re doing now.

Chris Rubesch:
I got involved with nursing advocacy and the Minnesota Nurses Association pretty much right when I started as a nurse. It was a real fit for my previous work experience doing community advocacy and community organizing, and I really felt that being involved with MNA was a way that I could continue to advocate for my patient and our community and the conditions at my workplace. So I got involved and negotiated our contract at my facility three years ago, and since then, ran to be our state first vice president, where I serve today, serve our 22,000 members across the state, and again, negotiating my bargaining unit’s contract representing my coworkers in that process.

Beth Quaas:
Well, thank you for doing that work. It is very important work. It’s not always recognized, so I’m sure that everyone that you’re fighting for is very happy that you’re in that position.

Chris Rubesch:
Well, thanks. Yeah, it can be a lot of work, but it’s really a team effort, and I would say not just myself and the rest of my team members, but also all of our members who are involved in this process. They’ve been involved in this processing since electing us as they’re representative, coming to meetings, responding to our surveys, letting us know what their priorities are so we can make sure that we’re seeing gains for our patients, for our communities, and for all of our members. So it’s really a broad-based effort involving all 15,000 nurses negotiating right now.

Beth Quaas:
Before we get into this, if someone was interested in joining, how do they get into that?

Chris Rubesch:
The Minnesota Nurses Association, as a union, represents nurses at facilities that are organized. So if you have a union at your facility, you likely are a member, and you might not even know it. I hope you know it, but you might not even know it. If you are at a facility that’s interested in organizing or you want to look at what you could do working with MNA, you can visit our website mnnurses.org. We have more information there. And then MNA also has a branch that is a professional organization. So if you’re interested in just being a nurse and taking advantage of some of the continuing education classes that we offer or our annual convention, you’re certainly welcome to join as a associate member as well.

Beth Quaas:
Thanks for letting people know that. So I’m not sure how far you want go back, but I’m sure most people have heard now about the strikes in Minnesota and how large it is and how it’s affecting our state, our communities, our patients. Tell us kind of where it started, do you think, and how it got to this point now.

Chris Rubesch:
So, I think this really started last fall when the Minnesota Nurses Association involved nurses from all of our bargaining units across the state. Representatives from all those facilities came together and helped put together a pretty unique piece of legislation called the Keeping Nurses at the Bedside Act. And that legislation would’ve been essentially Minnesota’s first step towards trying to address some of the retention, recruitment, bedside care, staffing issues that we see as nurses. So, the bill would have put incentives for attracting new nurses into the field. It would have set up committees at all acute care facilities across the state, committees of both management and bedside care staff beyond just nurses, nurses aids, behavioral health techs, respiratory therapists, et cetera, to determine what staffing levels should be at our hospitals.
And we really felt that that was a Minnesota solution to the nationwide problem of staffing shortages. So we put that bill together, we brought that to the legislature this spring, we got that bill passed in the House, first time staffing’s been addressed in two decades or more. Unfortunately we weren’t able to get traction in the Senate. Having come to the end of the legislative session, we sort of came back together and said, “What’s our next step?” This issue is obviously not going away. Legislation didn’t work. So we pivoted to our contract negotiations and took some of the provisions from that bill and decided to bring them to the negotiating table to continue to push for change.

Beth Quaas:
So fast forward to leading up to the strike. What did that look like for negotiations and how people were feeling about moving towards that strike?

Chris Rubesch:
When you’re going towards a decision like that, obviously as nurses, the place that we want to be is at the bedside. That’s why we got into nursing. We love working with our patients and our communities. And so to come to the point where 15,000 nurses were even considering that was a very monumental step. And I don’t think that we can stress enough how serious the situation is, we all know, for 15,000 nurses to make that decision. It was absolutely gut-wrenching, but we came together as bargaining units across the state and said, “We don’t have another option. Our employers are not taking our staffing proposal seriously, and we need to show them how serious we are.”
So, we obviously, as negotiating teams from across the state, went to our members, extensive conversations, feedback from them, and made this decision together when we voted overwhelmingly to authorize that strike and then put in our notice that that was what we intended to do. So, it was a decision that we came to very difficult conversations with our members, but ultimately together.

Beth Quaas:
And it was a collective unit coming together to make that decision. Can you talk a little bit about, when you talk about staffing ratios, for people that don’t work in the hospital or maybe people that aren’t in healthcare that will listen to this, what do you mean when you talk about staffing ratios?

Chris Rubesch:
So, staffing ratios at their plainest sense are how many patients each nurse is caring for at a time during a shift. So you can think about that in other human service professions. This is how many children are in a classroom. This is how many babies someone at a preschool can take care of at one time. It’s the same idea for healthcare. And so as a state, we have decided to, in many cases, put limitations on the number of children per caregiver at a daycare center. We feel that we need to have the same safety precautions in place at hospitals and acute care settings to ensure that each of those patients are protected and able to be cared for safely.

Beth Quaas:
And what does a typical day look like today, when we understaffed, a full house of patients? What are some of the things that can happen when you are overloaded to yourself and for your patients?

Chris Rubesch:
At a simple level, some of the things that are “less serious,” that could mean call lights ringing off, patients waiting to go to the bathroom, patients who have soiled themselves and are waiting to be cleaned up. All the way up to very serious situations, patients whose oxygen may have become unplugged and now they aren’t getting the oxygen they need for minutes, five, 10 minutes or more; potentially patients who are having, in my unit cardiac pain. That’s something that we need to know about right away, especially if patients are waiting to have procedures or interventions.
Any time that we’re not able to respond in a timely manner to those call lights, it’s not just a matter of comfort or convenience, it could be a matter of true safety. And so we’re really looking for legislation and contract provisions that allow nurses to use their professional judgment to make that call about what is safe.

Beth Quaas:
In true nurse fashion, you talked about your patients because that’s what we do. We take care of our patients. How about you? How does it affect you when you worked so hard all day, and what does that for you when you go home?

Chris Rubesch:
Some terms are thrown around in our current work culture and staffing situations, terms like burnout, terms like moral injury, moral distress. At the end of the day, when you leave work and you’re going home and you know that maybe all your patients stayed safe, maybe all your patients got their medications on time, nobody had a fall or a sentinel event. But maybe not all my patients got a bath, maybe not all my patients got up and took the walk that they’re supposed to have. Those activities of daily living that may not have been completed that I know everyone deserves to have and that I know are going to really be crucial for getting the patient back to baseline and back home, those didn’t happen.
That’s what we walk home, leave work, and carry in our hearts and know I let my patients down. At some level, maybe they stayed safe, maybe they got their medications on time, but I didn’t do the best job that I would want to do if that was my mother in that bed. And I think that’s causing nurses to walk away.

Beth Quaas:
That doesn’t even factor in that you probably didn’t get anything to eat, you may or may not have gotten to the bathroom, you left dehydrated because you weren’t able to drink because you knew you couldn’t go to the bathroom. So beyond the patient care and safety and comfort comes what the nurse is doing to themselves, and I think that’s something that it’s hard to realize maybe, if you’re not in that and have done that job in the past.

Chris Rubesch:
And so often, again, in today’s staffing culture, many hospitals are moving towards a just-in-time staffing model. And so what that refers to is, rather than having nurses on the schedule expected to come in knowing they’re going to be working, hospitals will often try to staff as leanly as possible, as few nurses as possible, and depend upon staff picking up, staying overtime, coming in for extra shifts to fulfill that need. And ultimately that saves the hospital money by not having to have those nurses pre-scheduled, but it takes those nurses who are already feeling this moral injury, who are already not taking care of themselves, and makes them feel, “if I don’t stay for this overtime, my patients aren’t going to get cared for.” That’s a horrible, horrible mental stress to put on a nurse and to ask them to further extend themselves more. At some point you can’t ring the sponge out any more.

Beth Quaas:
Yeah, that’s a great way to look at it. So staffing problems are there across the United States. We know that, and hospitals are suffering from that. What else does this strike have to do with? What other issues are you trying to get across?

Chris Rubesch:
We’re also, in terms of our practice and professional protection, we’re trying to address the fact that the staffing crisis has existed for decades. Right? COVID, we all know, in the healthcare industry, COVID didn’t create this problem. It shone a big bright light on it, but this has been festering for quite a while, and we understand that this problem isn’t going to be fixed overnight. And so we’re really looking for workplaces and employers that are going to stand behind us when we make professional judgment. We’re looking for employers who will give us professional liability insurance.
If these are the conditions that we’re going to be expected to work in, then we should be protected when we work in these conditions. We’re looking for protection in terms of not being disciplined at work if we refuse an assignment that’s unsafe, because we want employers to recognize our highly skilled, highly educated, trained staff, make professional judgments, and our employers need to trust us in making those judgments.

Beth Quaas:
Fantastic. Kudos to you. Like you said, this is decades behind where it should be, and I applaud you for doing the work that you’re doing to move us forward. So, Chris, I know part of the issue that you’re fighting for is about money as well. And for people that don’t understand, the public or other nurses that don’t understand what it has to do with money, where we need to retain nurses, we need to bring nurses in. Speak a little bit to that.

Chris Rubesch:
Myself and a lot of other nurses and professionals like data to highlight kind of the evidence of what we’re talking about. And so I think the evidence that I would cite is the Minnesota Board of Nursing’s own statistics that show right now in the state of Minnesota, we have more Minnesotans with nursing licenses than at any point in the last five years. We also have fewer Minnesotans using their nursing licenses to provide bedside care than at any point in the last five years. So I think it’s a little disingenuine when hospital executives say, We’re have a nursing shortage.” We do, but more so I would say we have a shortage of people willing to work in these conditions.
And so, while money is certainly a factor in that, we need to look at other ways to recruit those people back. What’s going to bring them back to the bedside? Right? Is it staffing? Is it better healthcare? Is it a better work-life balance? Is it paid family leave? There’s a lot that we can do to tell those nurses, if you come back, we’ll make sure that your mental and physical health is protected.

Beth Quaas:
And part of that, we talk about that, violence is at an all-time high for nurses in every department, not just from the patients. From their families, significant others, whatever. That’s a huge deal.

Chris Rubesch:
Yeah, and that’s one of the issues that we’ve talked about at my negotiating table and I know other tables around the state, that idea of complexity compression, that more and more hospital care tasks are falling onto the nurses. Right? Now the nurses in my facility are also giving scheduled nebulizer treatments instead of respiratory therapists. We’re delivering food trays because we don’t have enough EVF. We’re often doing daily room cleaning because we don’t have enough housekeeping, environmental services staff. And in the same way, when you have patients with increasingly complex mental health issues, oftentimes we are also being expected to be security officers, deescalate those situations, protect other patients. That’s very hard to recruit nurses back to the field when they know that that’s what they’re going to face.

Beth Quaas:
They didn’t give you any more hours in the day, and they didn’t give you any more hands to do the work, but you’re expected to do more with less and smile and be happy about it. So something’s got to give.

Chris Rubesch:
Yeah, absolutely. And many of our hospital systems were founded by charitable or religious orders that have great missions and values, but we need to really ask ourselves, what are we doing to stay true to those mission and values and make sure that we are supporting the staff who give the care? And yes, that’s nurses, but also we can’t do this job alone. That’s also the respiratory therapists and certified nursing assistants and food service and housekeeping. All critical parts of that chain.

Beth Quaas:
Yes, I’m glad you mentioned that. We don’t do it alone, that’s for sure. So tell us where you are now in the whole negotiating and strike situation in Minnesota.

Chris Rubesch:
We had our three-day strike. We made some history, certainly not history that we set out to make at the beginning of this process, but what we were forced to do. We’re back at the negotiating table across the state. My own facility has been at the negotiating table twice since the strike. We’ve had some movement on an acknowledgement for shared responsibility around staffing and shared responsibility for safety of assignments. So that’s good. I think we still have a long ways to go, and as we go through the process in the coming weeks, our bargaining units across the state will be continuing to work together to plan if we need any more action, what that’s going to look like, and how we’re going to work together to do that.

Beth Quaas:
And will that decision to strike again go to the entire group for a vote? Is that how that works?

Chris Rubesch:
Yes. Yeah. So everything we do we are very proud of our history and functioning as a member-led organization. So all the decisions we make, like I mentioned at the beginning, all the proposals that we came to the table with, were directly from our members, what our members’ priorities were. In the same way, whatever action we take will come from all of our bargaining units, from our members, what they’re willing to do and want to do to continue to escalate.

Beth Quaas:
That’s incredible work. Like I said, I think you’re doing great things. I think being part of this right now, you should be proud of yourself and so should everyone else that’s working on this, because the future of nursing kind of hinges on what is happening right here in our state and the work you’re doing. So, I congratulate you for doing all that hard work.

Chris Rubesch:
Yeah, well, thank you for saying that. I agree. I think that this is obviously something we’re seeing from other states, nurses in Michigan, nurses in Wisconsin, nurses in California. So this is not a Minnesota issue, but I’m really proud that, in Minnesota, our nurses are coming together to be the tip of the spear, so to speak, to hopefully impact our patients positively.

Beth Quaas:
Do you have any sense of timeline on any of this getting resolved and contracts being signed?

Chris Rubesch:
I wish I could give a more definitive answer on that. Obviously we would hope to come to an agreement as soon as possible. I certainly hope that we can get agreements across the state before the end of the fall, but we’re willing to continue to push this issue as long as it takes to get a contract that’s fair and that keeps our patients at the center of its focus.

Beth Quaas:
Well, and I think it’s important for people to know what that puts on you when you go on strike. It’s not like you’re taking vacation. You’re not getting days off of work. Tell us what that looks like when you are on strike for those days.

Chris Rubesch:
So, as union participation and union household membership has changed, fewer people are familiar with what that means and what that looks like. So, going on strike means that the nurses who are scheduled to work those days don’t go to work. They don’t get paid for those days, so they are giving up pay. Obviously, that’s not the only reason we do our jobs, but that’s a big reason why a lot of us go to work. Right? Because we need to pay our bills.
And so, as I mentioned, it’s a very difficult decision for our nurses not only to step away from the job they enjoy, from the care that they really take pride in giving, but also to make a financial sacrifice. And I think that that is one of the things that I hope the public and our patients see most prominently out of what we did. That we had 15,000 nurses willing to make that sacrifice to show hospitals and the public that we’re serious about patient safety. Just that volume of people willing to take that stand and bear the burden financially is a monumental thing.

Beth Quaas:
Well, and I will speak from living in the same community that you work in, listening to nurses going out there. I listen to people going to city council meetings, and they’re telling the community what’s truly going on. It’s not that we want to walk away from our jobs. It’s not that we want more money, which of course you do deserve more money. But they need to hear the real issues that are happening when you’re a patient or you have a loved one in the hospital, what’s truly going on.

Chris Rubesch:
Mm-hmm.

Beth Quaas:
I don’t think people appreciate that.

Chris Rubesch:
When people ask, maybe, why is this happening now? Why are you taking this stand now? It’s the same reason we attempted a legislative fix this spring. It’s the same reason we continue to escalate this issue in our contract in Minnesota and particularly here in Northern Minnesota. Over the next 10 years, we are going to continue to see a major demographic shift. Right? We’re going to have more and more nurses and workers retiring, moving into older stages in life. They’re going to need more healthcare. And so we’re going to see a double shift of both nurses leaving the bedside as they retire and also becoming patients. And so I’m very concerned that, if we don’t address the staffing issue now, our next 10 years is going to be very bleak, and I’m very concerned about what that’s going to mean for the healthcare that I can deliver to my community.

Beth Quaas:
And at some point receive. We’re going to all be receiving that care at some point, and I want the best people there to do that job, and I want them to be healthy when they’re doing it, as well.

Chris Rubesch:
Absolutely. Absolutely. That’s what I think we all expect when we go into the hospital, and ultimately nurses just want the resources that are necessary to follow through that, to give that care.

Beth Quaas:
Well, I have the highest hopes that all of this is going to go well and that nurses are going to get what they deserve, because we’ve been asking for it for, like you said, decades. This isn’t anything new, but I’m happy that you’re finally taking a stand and hopefully getting what we need for ourselves and our patients.

Chris Rubesch:
Well, thank you. I certainly hope so, too. I know a lot of nurses who have said, if we can get some of the protections we’re talking about around staffing, that they can see themselves staying in this career far longer. And that’s exactly what I want to hear, and I think that’s what our profession needs and our patients need.

Beth Quaas:
Absolutely. What else would you like to share with nurses today?

Chris Rubesch:
I think the biggest thing that I’d like to share with nurses is just the encouragement and the reminder that, as nurses, we advocate for our patients on a daily basis. We advocate for our patients when we page the doctor about needing them to come see the patient or maybe needing another order. We work with our entire care team to do that role, and I just would encourage nurses to remember that they can do that outside of work as well, and that everything that they can do in their communities as powerful, knowledgeable, trusted voices to advocate for their communities is so important. Really, when we clock out of work, our job as nurses isn’t done. We can continue to be strong voices in our community.

Beth Quaas:
Yeah, I completely agree. Chris, if someone wants to get in touch with you, how would they do that?

Chris Rubesch:
You can certainly email me, or you can, which I believe we can post my email address along with the interview here, and then they can also follow me. I’m @Chrisformnavp on Facebook, and I am easily contacted there as well.

Beth Quaas:
Perfect. Thank you so much. Chris, again, I applaud you for what you and everyone that you’re working with is doing today for nurses, and I’m excited to see how this turns out, and I would love to have you back again when we understand the outcome of what you’re fighting for.

Chris Rubesch:
I would love that. That’d be great. Thanks so much.

Intro/Outro:
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Stories from the Incredible World of Nursing.

Welcome to Don’t Eat Your Young, the podcast that brings you stories from the trenches of the incredible, wonderful, exhausting, terrifying, joyous world of nursing with your host, Beth Quaas.