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Serving Northern St. Louis County, Minnesota

Nurses, hospitals spar over staffing bill

Measure would give nurses a say in staffing plans

David Colburn
Posted 5/17/23

REGIONAL- A nursing labor group says a bill in the Minnesota Legislature will improve hospital staffing levels and lead to better patient care, while the state’s hospital administrators are …

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Nurses, hospitals spar over staffing bill

Measure would give nurses a say in staffing plans

Posted

REGIONAL- A nursing labor group says a bill in the Minnesota Legislature will improve hospital staffing levels and lead to better patient care, while the state’s hospital administrators are sounding the alarm that the same bill could intensify budget shortfalls and lead a “grim future” of reduction of hospital capacity and tens of thousands of patients turned away.
The bill, called the “Keeping Nurses at the Bedside Act,” is so controversial that a Mayo Clinic executive has said they would move a planned $1.1 billion project out of state if it isn’t revised significantly from its current form.
The bill, authored by Rep. Sandra Feist, DFL-New Brighton, would take the scheduling of nursing care out of the hands of hospital executives and hand it over to committees comprised of 35 percent direct care registered nurses, 15 percent other direct care workers, and 50 percent appointed by the hospital. A hospital-wide staffing committee and unit-based workload committees would establish daily staffing plans and resolve staffing concerns, and the bill would require legal arbitration if a core staffing plan can’t be agreed upon. Management is prohibited from reducing unit staffing before obtaining the agreement of 50 percent of nurses assigned to a unit.
The bill imposes numerous additional reporting and notification requirements and required the Minnesota Department of Health to develop a grading system based on compliance with core staffing plans. Hospitals are also prohibited from taking any action against a nurse who declines accepting an additional assignment when he/she believes the additional workload could endanger a patient’s health.
The bill has passed both houses of the Legislature and is in conference committee to iron out differences, but both sides continue to make concerted efforts to influence the outcome.
Nurses position
The Minnesota Nurses Association is so committed to the bill that members are engaged in a sit-in at the Capitol that began May 9 and will continue, they say, until they have secured safe staffing for Minnesota patients and nurses. Association president Mary Turner has termed the Mayo Clinic and other hospital executives who oppose the legislation as “corporate bullies.”
“People need to know there are enough skilled nurses at the bedside to provide the safe, high-quality care all patients deserve,” Turner said. “Giving nurses a seat at the table and a voice in the process will help improve staffing levels, bring nurses back to the bedside, and protect patient care throughout the state.”
MNA maintains that the current nursing shortage in hospitals isn’t due to a lack of nurses, but a flight of nurses from the profession due to unsafe and unsustainable conditions. The association cites data showing there are more than 130,000 registered nurses in Minnesota, an increase of 8,000 since last year. But a survey of 2,400 nurses who left their positions last year which received responses from 500 of them cited insufficient staffing as the top factor driving them from the bedside, followed by stress and burnout, management issues, and other working conditions. Half of all nurses are said to be considering leaving the profession because of short staffing.
Including nurses in development of staffing plans, which could include establishing maximum nurse-to-patient ratios, would lead to better patient outcomes, MNA says. Better working conditions would bring up to 80 percent of departed nurses back into direct care, easing existing shortages, they claim.
CEO concerns
The Minnesota Hospital Association has been waging its battle against the bill not only at the Capitol, but in the media, trying to drum up public support. Ely-Bloomenson Community Hospital CEO Patti Banks and Cook Hospital CEO Teresa Debevec were among 68 hospital chief executives of nonprofit hospitals and health care systems who signed off on a letter published May 8 in the Minneapolis Star-Tribune voicing their concerns about the bill leading to increased costs and decreased availability of care. And Banks was among four CEOs included in a Tuesday ZOOM conference call targeting media representatives.
Banks described conditions at Ely-Bloomenson this past weekend that she said the hospital wouldn’t have been able to handle if they were forced to operate under the bill’s provisions.
She told about an elderly woman who needed hospital care but refused it because she didn’t have anyone who could care for her husband with dementia. Banks said they ended up admitting both of them to the hospital, although they won’t be reimbursed for the husband’s care.
“This was the right thing to do,” Banks said. Over the weekend we cared for 35 patients in the emergency department within about 48 hours, ending with an inpatient census of eight, including the husband and wife. I can assure you that if we had to adhere to the mandates in this proposed legislation we would have had to turn patients away. This would have been detrimental to our community as well as the reputation of our organization.”
“Care delivery in greater Minnesota looks different, but our expectation to save lives is the same,” Banks said.
The potential negative impacts on rural critical access hospitals was a recurring theme during the teleconference. Rachelle Schultz, president and CEO of Winona Health, described some of the problems she anticipates.
“That workforce shortage is really underlying many of the issues that we have,” she said. “There isn’t an organization or hospital in the state that isn’t working very hard to recruit nurses to the bedside. In this proposed legislation, there are elements of it that fundamentally change the management of healthcare in Minnesota and would remove critical decision-making from our care teams and our health care professionals and providers. They would hand it over to external parties, attorneys, potentially even judges in the court system through arbitration. This is a high risk, no reward decision that impacts people’s lives.”
CEO Richard Ash of United Hospital District in Blue Earth took issue with the fact that legislators appear to have bowed to pressure from the Mayo Clinic and have exempted them from the bill. All hospitals should be given the same consideration for exemption, he said.
“We need room to leverage our ability to innovate, to find out how our team can work differently when the environment around us changes,” he said. “We have to be ready for whoever comes through those doors. This bill is going to cause that to be much more difficult. I’ve been in health care for 30 years plus, and we’ve always had our challenges. But this is crazy. It’s dangerous and reckless, in my opinion.”
Early in the legislative debate, MHA issued a position statement on what they believe are the hazards associated with this particular bill.
“If a rigid registered nurse to patient ratio is implemented without flexibility to care for patients, MHA estimates it would reduce hospital care capacity by 15 percent and threaten care for 70,000 patients in Minnesota. The analysis also suggests that the proposed mandates would worsen the health care workforce crisis,” the statement said. “If a hospital cannot meet the mandated RN to patient ratio, it will be forced to close units, hire costly traveling nurses, limit admissions, and be unable to fulfill its mission.”
For all of the CEOs in the teleconference, the bill represents a needless restriction on the flexibility they need to adapt quickly and effectively to the staffing and patient needs of their hospitals, which differ markedly from large metro health systems. “It’s been feeling like the real world realities of rural health care are just not being understood and heard in St. Paul, said Carrie Michalski, president and CEO of RiverView Health in Crookston. “The legislation is a setback, it’s disruptive. It’s going to have terrible consequences for all of the rural communities that we serve.