Minnesota Nurses Association President Mary Turner speaks at a news conference on April 26, 2023, before the House debate of a bill giving nurses more power over hospital staffing levels. Photo by Max Nesterak/Minnesota Reformer.
The Minnesota House passed a sweeping health bill on Wednesday that includes a section giving hospital nurses new powers over staffing levels that their union has been seeking since 2008.
The expected passage of the new rules comes as hospitals confront crisis staffing levels, with wait times at emergency rooms stretching in some cases beyond eight hours and reports of patient injuries rising.
The Minnesota Nurses Association says the bill will protect patients by bolstering staffing levels and reducing burnout that leads nurses to leave hospitals for easier, more stable work in clinics or outside the profession entirely.
“There is no nursing shortage. What there is is a shortage of nurses willing to work in the working conditions we have in our hospitals,” said Mary Turner, president of the Minnesota Nurses Association, during a press conference ahead of the House vote.
Hospital leaders say there aren’t enough nurses and warn lawmakers the bill will backfire and lead them to raise costs, close units and even turn patients away. They say the bill will result in a 15% reduction in hospital capacity, affecting 70,000 people in Minnesota.
“There are simply not enough nurses to hire,” Rachelle Schultz, president and CEO of Winona Health, told a Senate committee in March. “It is frightening to me what will happen to those patients who will show up and can’t get care.”
The Legislature’s passage of the bill is a victory for the nurses’ union, which failed to win similar language in their contract negotiations last fall with seven of the state’s largest health systems. Some 15,000 nurses walked off the job seeking a greater say in staffing levels, as well as significant wage increases in the largest private sector nurses strike in U.S. history.
The measure moved forward along mostly party lines, but two Republicans co-authored the bill — Sen. Jim Abeler of Anoka and Rep. Greg Davids of Preston.
The Senate has already approved identical language and Gov. Tim Walz — who joined union nurses on the picket line last fall — has signaled he will sign it into law. Because it’s in a larger omnibus bill, however, it must go through a conference committee to resolve differences between the House and Senate versions on different issues before going to the governor’s desk.
The measure — dubbed Keeping Nurses at the Bedside — requires hospitals to form committees made up of nurses and other hospital staff to create “core staffing plans” that include the minimum number of full-time care staff that will be assigned to each inpatient unit, and the maximum number of patients each nurse can typically safely care for.
If signed into law, Minnesota would join eight other states with similar requirements for staffing committees, according to the American Nurses Association. California and Massachusetts have more stringent government-mandated nurse-to-patient ratios, which the Minnesota Nurses Association has sought in previous years but couldn’t rally enough political support for.
One study found that California’s minimum staffing ratios increased the number of nurse hours per patient day but there were no significant changes in nursing hours in states that created staffing committees.
Under the Minnesota bill, the staffing plans will also set criteria for determining when nurses can’t safely care for the typical number of patients, and creating a contingency plan if patient needs unexpectedly exceed the safe staffing levels.
The bill prohibits retaliation against nurses who refuse to accept more patients if they believe it would endanger a patient’s life, health or safety.
The committees must be made up equally of hospital-appointed members and rank-and-file workers, with at least 35% being direct care registered nurses and 15% other direct care workers. If the hospital is unionized, the direct care workers on the committees will be selected according to a process negotiated by the union; otherwise the members must be elected by their colleagues.
Hospitals must form the committees by October 2024 and implement the staffing plans by October 2025.
The committees will also be responsible for reviewing reports of staffing level concerns from patients and staff members; conducting trend analyses of the reports; and maintaining “dispute resolution procedures” surrounding staffing concerns.
If the committees can’t resolve concerns, the case will be forwarded to an arbitrator with expertise in patient care. Hospital leaders said that would move staffing decisions outside of a hospital.
Republicans tried to strip the rules from the larger health bill, saying they would be disastrous for hospitals.
“These mandates cost hospitals far too much money and will implement a plan that will pull nurses from patient care,” said Rep. Dave Baker, R-Willmar, during the House debate on Wednesday. “Our hospitals are barely making it the way it is.”
The bill will require hospitals to publicly post emergency department wait times along with core staffing plans.
Under the bill, the health commissioner must develop a grading system to judge how well each hospital complies with its staffing plans and post the grades on the agency’s website beginning in 2027. That will require the Minnesota Department of Health to analyze and evaluate at least 136 separate hospital staffing plans.
The bill also aims to reduce violence against hospital staff, which nurses say has surged in recent years. Nearly three-quarters of all workplace assaults happen in the health care and social service sectors.
Nurses say short staffing has exacerbated the threat of violence because there are fewer people to respond to unruly patients and hospital guests.
Hospitals will be required to form committees of nurses and hospital representatives to evaluate risk factors and create plans to mitigate and respond to workplace violence. Hospitals would also be required to provide training on responding to violence including de-escalation, “cultural competency,” and how to report and cope after violent incidents.
The bill bans hospitals from employing security guards who are affiliated with white supremacist groups. The ban doesn’t apply to nurses or other hospital staff.
Hospital leaders did support some provisions in the bill which provide incentives for nurses to work in hospitals as well as provide more mental health support.
Under the bill, nurses who are eligible for the Public Student Loan Forgiveness program and work in hospitals would be could have their student loans repaid by the state. The bill appropriates about $10 million over the next two years for the program.
