Last week, 15,000 nurses at seven Twin Cities hospitals voted to authorize a strike. Their demand is simple: put patients before profits.

Minnesota nurses rally to demand safe staffing levels, joined by elected officials including Rep. Ilhan Omar, on August 22, 2022. (Minnesota DFL Party / Twitter)

The Minnesota Nurses Association (MNA) is prepared to launch what the union claims is one of the largest nurses’ strikes in US history. After a summer of stalled contract negotiations, 15,000 nurses in the Twin Cities area overwhelmingly authorized a strike, sending an ultimatum to the seven corporate health care systems that employ them. They echo the demands of nurses’ unions around the country: staff our hospitals, keep nurses safe, and put “patients before profits.”

Rep. Ilhan Omar weighed in on the nurses’ side this week, both on the picket line in Minneapolis and in Jacobin, writing, “We don’t have a shortage of nurses; we have a shortage of dignified workplaces in our health care system.”

Jacobin’s Tadhg Larabee recently spoke to Kelley Anaas, an intensive care nurse at Abbott Northwestern Hospital in Minneapolis, Minnesota. Since before the pandemic, she says, her hospital has deprived nurses of the resources they need to care for patients as part of its shift to a “lean production” model of work. If Anaas and her colleagues go on strike, she says, it will be on behalf of the victims of this profit-seeking model.

Tadhg Larabee

Take us through life at your hospital over the past couple of years, so that we can understand how your fight got to this point. What were conditions like before the pandemic? How did your work change during the pandemic? And why are you now considering striking?

Kelley Anaas

I’ve been an RN at my hospital for fourteen years now. I have watched patient care conditions deteriorate slowly, as the health care system I work for has become more and more corporatized and interested in a “lean” model of work. Ultimately, this model has resulted in lower-quality care inside the hospital.

I’m a steward on my unit, and shortly before COVID, I was in a meeting with my manager, my director, and the chief nursing officer. They told us they were going to cut our staffing model, which we call a “grid.” It basically establishes that, if you have this many patients on the unit, you get this many staff to care for them; they were going to cut that by 20 percent.

We were going to be doing more work, with fewer registered nurses expected to provide the same amount of care. And there wasn’t anything that we could do about it.

They basically said, “We can make this unilateral move.” And we expressed concerns about what patient outcomes would look like, on the measurable parameters that hospitals use to determine that their care is adequate, and whether the hospital would still be eligible for Medicare reimbursements.

We brought up those concerns, and they were like, “Yeah, we absolutely hear you. But hospitals around the country are doing the same work with fewer nurses at the bedside. So the expectation now is that you’re going to do that.”

That began their race to the middle, which seems to be their new goal. We don’t need to be the best; we just need to be as good as everyone else.

Then the pandemic hit. I work in the medical ICU, which became the COVID ICU. We were taking the brunt of these patients, who were some of the sickest patients I’d ever taken care of in my career.

At first we were given more staff, because so much was unknown. We were staffed according to the needs of the patients, which is what we’ve always advocated: staff us for what the patients need, not just for the number of patients that are on the unit, in the beds.

We don’t have enough time to do the things that ultimately matter to patients.

[Management] did that, and we had help. We’d leave these isolation areas, after a few hours of not being able to drink water or scratch our noses. They staffed us so that we could sometimes leave and take off our respirator masks.

But eventually, they started doing away with this help. They realized that this pandemic wasn’t going away in a matter of weeks; this is going to be with us for a while. So they went back to the old way of staffing.

As a result, we’ve seen our working conditions and the patient care conditions deteriorate again. We don’t have enough time to do the things that ultimately matter to patients.

When you have fewer resources to take care of a patient, something has to go. Corners get cut, and patients don’t get those extra touches: that extra time spent with them, which makes them feel a little less scared and a little more human, in a situation that is frankly terrifying.

The ICU can rob people of their dignity. That’s been really hard to watch, because I work harder than I’ve ever worked in my life, and I leave work thinking that my best wasn’t good enough, that it could have been better for the patients if I had more resources to care for them.

Tadhg Larabee

Is that what the lean model means? You have to work with the minimum possible resources, which comes at the expense of patient and nurse welfare?

Kelley Anaas

That’s exactly what it means. In the lean model, patient welfare gets sacrificed.

We used to be staffed so that we’d be ready to admit a patient from a smaller tertiary hospital or from our emergency department. If a patient had a cardiac arrest somewhere else in the hospital and needed an ICU bed, we used to be able to take them right away, with a nurse and a bed ready to go.

We stopped doing that. And that has resulted in delays: Patients sit in the emergency department until the next shift.

Nurses on medical units are taking care of ICU-level patients, along with full surge assignments. They might have three, four, five, or six patients, depending on the shift, while they’re also taking care of a patient who’s waiting for an ICU bed.

That patient may have needed my ICU-level care for hours. By the time they get to me, they’re often a lot worse than they would’ve been, had I been available to them earlier.

Tadhg Larabee

Hospital management has tried to excuse this understaffing by claiming that there’s a labor shortage of nurses, but your union has argued that this labor shortage is a myth: it covers up problems caused by profit-seeking and declining nurse retention.

What is management’s explanation, and what is the union’s response?

Kelley Anaas

They have said that there just aren’t enough nurses, but we know that there are something like four million registered nurses in the United States right now. They’re licensed, and they’re ready to work. But these nurses, like so many of my friends and coworkers, are just fed up with the conditions inside hospitals.

For so long, management and the hospital executives have exploited our dedication to our profession and ignored the fact that we are humans, with human needs. There’s a limit to what we can do as they continually decrease our resources.

So nurses have left. Or if they haven’t left completely, they have cut back their hours, leaving big holes in the schedule. There aren’t enough nurses willing to work because of the conditions that the hospitals have created.

Management and hospital executives have exploited our dedication to our profession and ignored the fact that we are humans, with human needs.

Tadhg Larabee

What first made you get involved in union organizing at your hospital? As the MNA prepared for this vote, how did you build solidarity with colleagues at your hospital and others in the area?

Kelley Anaas

I got increasingly involved in the organizing process, first just on my unit in the medical ICU. After they cut our staffing, we pushed back against that and signed petitions and marched on the boss.

When I talked to my coworkers, everybody knew what the problem was, but they didn’t know where to take their energy and their newfound rage. So, with the guidance of the union staff and the union chairs at the time, I was able to organize, and we were able to keep a reasonable staffing structure in place on our ICU.

When COVID hit, management wasn’t meeting our needs. The nurses again were able to band together and say, “We need housekeeping to start coming into these rooms again, and we need phlebotomists to start drawing blood again, because we can’t do everybody’s jobs and do our own.”

I knew my unit didn’t exist in a vacuum. If they had cut staffing on my unit, they would have cut it in other places. I float to the other ICUs, and I knew that their staffing had been cut too.

Through word of mouth, we heard more and more about the ways the staffing cuts were impacting care in other units. In the mental health units, where the structure of a nurse’s shift looks different from mine, the cuts hurt the care for that unique population.

We have a lot of important conversations: What did it look like to work on your unit five years ago? How has it changed? What would you want to see improve? We hear so many different ideas about how care could be better.

There’s never any question about who’s to blame: if management hadn’t done these things, we wouldn’t be in this situation.

As for the other hospitals, because there are several large corporate health care systems in the Twin Cities, we were able to connect through MNA with nurses at similar hospitals, who work in units like mine and who experienced the same or even worse conditions.

It’s been really easy for us to be together in this fight, because we’re all fighting for the same things, even though we’re pushing back against different employers.

There’s never any question about who’s to blame: management.

Tadhg Larabee

I know that at least 15,000 nurses in your union have been working without a contract all summer. What have those contract negotiations been like? And what concessions from management could potentially avert a strike?

Kelley Anaas

All the hospitals in the metro area have been working without a contract since June 1. This is my fifth round of negotiations as an Allina employee, and they’ve gotten increasingly contentious each time.

This has really felt like a moment — given the public support nurses have received throughout the pandemic, and given that it’s hard to get travel and replacement nurses right now — when we can concretely address the staffing issues and other safety concerns inside hospitals.

We want more say in what it looks like to staff a hospital. We want a day-to-day charge nurse who is the expert at what their unit needs to take care of the patients, and we want that person to be able to say, “This is what I need for the next shift so that the patients are cared for.”

And we want the ability to say, “No, I’m not going to take care of another patient assignment, because it isn’t safe.”

This isn’t because we refuse to work. Certainly, nurses are not averse to working hard, and we’re not looking for ways to get out of working. We’re looking for ways to make our work and our patients safer.

We want to be able to say, “I’m not going to take this assignment, because it wouldn’t be safe for the patient, and it wouldn’t be safe for me to put my license on the line like that.” And we want to say that without fear of retaliation or discipline from our employer.

We need this say now more than ever, given how much our jobs have changed during the pandemic. We’ve been taking care of the sickest patients we’ve ever seen.

Whether you work in the medical ICU or on an orthopedic floor, everybody’s jobs have changed for the worse. We want an acknowledgement that, as our patient populations have changed, we need more nurses to be able to do our jobs.

Tadhg Larabee

One of your main slogans is “patients before profits.” Because of this commitment, your union has been advocating for a variety of large-scale political initiatives, such as single-payer health care and the Keeping Nurses at the Bedside Act in the Minnesota state legislature.

How does your experience in the hospital connect to your fight for these political goals?

Kelley Anaas

I became a nurse right before the recession hit in 2008, and I saw firsthand what our employer-provided health insurance gets people when they don’t have an employer.

People put off necessary medical care. They put off elective surgeries that would improve their lives. I take care of diabetic patients who can’t afford their insulin, so they end up in the ICU with me in a diabetic crisis.

If people could just show up, get the care they needed, and not even have to think about the cost, what that would do for our patients, for our community, and for our country would be incredible. Single-payer health care would only lead to better health outcomes for patients.

As far as the Keeping Nurses at the Bedside Act, that has a lot of the same goals as our contract proposals. That’s by design, because whenever we pressure the legislature — around staffing or around patient care improvements — we are told these are labor issues and we should try to get them in our contract.

We’ve tried that for decades, and it isn’t working. So we’ve been able to point legislators to that fact, while continuing to push at our negotiating tables for the exact same things.

Minnesotans can only benefit from Minnesota nurses taking care of them when they’re in the hospital. That’s not to say that traveling nurses aren’t good at their job, but they don’t have the same connection to the community that they’re temporarily taking care of. They don’t have the same sense of connection as a nurse who’s worked at the same hospital for twenty years.

That connection means a lot, especially when you have a patient getting admitted from Stacy, Minnesota, whose family had to drive three hours to get to Abbott. If their nurse understands how far they’ve traveled, how stressed out they are, and has a connection to the area that they’re from, that makes a huge difference for them.

The Keeping Nurses at the Bedside Act, besides fighting off nurse licensure compacts, would bring Minnesota nurses into Minnesota hospitals and improve patient care conditions for everyone.

Tadhg Larabee

Anything else?

Kelley Anaas

If we file a ten-day notice and they live near a hospital that’s going to be striking, certainly show up, support the nurses, and grab a picket sign. We’d love to talk with you and hear about why you’re there.

There’s also a website that the awesome communications team at the MNA put together, called mnpatientsbeforeprofits.com, where you can get more information about our contract campaign.

It has an “Act Now” section, with a public petition and a place to donate to our strike fund. You can also change your social media profile pictures to a little icon that says, “I support nurses.”

That would be an incredible show of support. Those simple things show nurses around the state that you’re in our corner.

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