Minnesota nurses and hospital leaders are divided on whether giving caregivers more say in staffing levels will bring nurses back to the bedside.
Nurses unsuccessfully pushed the issue during months of contentious contract negotiations and have now turned to the Minnesota Legislature to put new staffing rules in state law. Health system leaders say the proposed changes will result in reduced hospital capacity and worse access to care.
Despite those differences, the state Senate Health and Human Services Committee advanced the “Keeping Nurses at the Bedside Act” on Wednesday. Sen. Erin Murphy, DFL-St. Paul, the chief sponsor of the bill and a nurse, said the Legislature has struggled to address the nurse staffing issue for over a decade.
She noted that too many nurses who train to work in hospitals leave because of burnout.
“That is a signal we need to do more within these facilities to hold onto our people,” Murphy said. “Pumping people through not only doesn’t solve the problem of inadequate staffing; it undermines the goal of a skilled, experienced group of nurses in the hospital prepared to take care of our patients.”
The bill is largely supported by Democrats, but it also has some Republican support. There also is general bipartisan agreement Minnesota needs to do more to attract and retain health care workers because as many as 20 percent of positions in the state are vacant.
Health system leaders point to the pandemic as the leading cause of staffing shortages. Nurses contend that years of understaffing to increase profits has led to unsafe conditions, burnout and stress.
Sen. Jim Abeler, R-Anoka, said he signed on as bill sponsor because he’s talked to nurses who don’t feel safe at work and who worry patients are at risk. He said creating committees to address workplace challenges seems like a good way to address growing concerns over hospital staffing and safety.
“Luckily for everybody, the public doesn’t know how at risk they are, ” Abeler said.
What the bill does
The latest iteration of the “Keeping Nurses at the Bedside Act” would do three main things: establish committees of nurses and managers to set agreed-upon staffing levels, enhance workplace safety protections and increase funding for student loan forgiveness.
The staffing committees are the most contentious part of the legislation. It would require committees of nurses, other caregivers and hospital leaders to monitor staffing levels nurses’ workloads.
The committees would meet monthly or quarterly to address problems and disputes over possible violations of a facility’s core staffing plans. Issues not resolved could be taken to arbitration, often a lengthy legal process.
Hospitals already must have core staffing plans, which are currently created by leadership. Under the bill, those plans would be agreed to by staffing committees and set a maximum number of patients a nurse could care for safely.
To deviate from a hospital’s staffing plan, leadership would need the agreement of at least half the nurses on the affected unit. Without the agreement of nurses on the unit, more patients could not be admitted.
Hospitals would be required to make staffing plans publicly available and also post emergency department wait times for patients who are not critical.
Hospitals also would have to report their compliance quarterly to the Minnesota Department of Health, which would publicly grade facilities. Hospitals that are out of compliance could be fined.
Some Republicans on the Senate health panel unsuccessfully tried to remove the creation of the oversight committees.
“To me, article two is a so-called solution looking for a lot of problems,” Sen. Paul Utke, R-Park Rapids, said of that section of the bill.
Why hospitals are opposed
Hospital leaders say the committee structure proposed in the bill is overly onerous and would result in as much as a 15 percent reduction in hospital capacity. They say allowing nurses to refuse to take on extra patients will force hospitals to hire high-cost temporary nurses in order to meet demand or otherwise patients will have to be turned away.
“If implemented, these harmful mandates will reduce our ability to provide care, leading to potential unit closures, increased costs, longer wait times for patients, and the loss of vital health care services that communities rely on,” said Dr. Rahul Koranne, president and CEO of the Minnesota Hospital Association, in a statement.
MariBeth Olson, vice president of acute care nursing at Allina Health, said her health care system recently settled union contracts with nurses that included generous pay increases and input on staffing. The proposed bill would make it hard to manage hospitals’ ever-changing staffing needs.
“It moves staffing to a decision by committee,” Olson said. “That does not allow for real-time decision making and flexibility, nor accountability to the cost of care or the workforce challenges.”
Olson was one of more than 60 directors of nursing and other leaders who wrote to lawmakers in opposition to the proposed legislation.
“Staffing and caring for patients is about more than just the number of registered nurses,” their letter said, noting multiple types of caregivers are key to treating patients. “Flexibility in assigning the right care team is critical to positive patient outcomes and the capacity to serve community needs at the right time.”
The changes would also hurt financially, especially at smaller and rural facilities, said Rachelle Schultz, president of Winona Health. Like many hospitals, Schultz’s facility posted an operating loss last year.
“In my 35 years in health care management I’ve never seen finances so poor,” Schultz said. “If enacted, this bill will make finances more grim.”
Why nurses say it’s needed
For more than a decade, nurses have been pushing for more than just staffing committees. What they really want is defined nurse-to-patient ratios, but that was pulled out of the current bill after opposition from hospitals.
Members of the Minnesota Nurses Association released a “Why We Left” report and held a roundtable discussion at the Capitol on March 6. It featured survey responses from close to 500 nurses who left their jobs, primarily they said because of burnout, stress, staffing and safety concerns.
Carrie Mortrud, a staffing specialist for the nurses association, said she gave up bedside nursing 18 years ago over patient safety concerns. She described how staffing cutbacks continue to hurt patient care and cause more adverse outcomes.
“The old way of doing things isn’t working,” Mortrud said. “How many nurses must leave before we are heard? How many patients must suffer substandard or unsafe staffing before we are heard?”
Mary C. Turner, union president, said health system leaders refused to give nurses any more say in staffing levels in the contracts they recently settled and “would have to be directed by the Legislature to do so.”
“We have done all we can through negotiations,” Turner said. “Today, the need continues to be dire, as nurses work on the front lines through short-staffed units, increasing violence, abuse and trauma.”
Nurses also described the growing number of their colleagues who faced post-traumatic stress from the pandemic and other problems. The proposed legislation sets aside $10 million in state funding for competitive grants to help improve the mental health of nurses and other caregivers.
“We are being used up physically and emotionally,” said Becky Nelson, a registered nurse and union leader, who noted that 2,400 nurses quit in the last year. “The conditions that they faced made it impossible to stay.”
The “Keeping Nurses at the Bedside” Act was advanced by the Senate health committee and will next be debated in the chamber’s labor committee. A companion bill in the House, which also has bipartisan support, was referred to the chamber’s health committee, but so far has not had a hearing.
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