Minnesota legislators add hospital carve-out to nurse staffing bill

The Mayo Clinic's Gonda Building
Pedestrians cross the street as they leave Mayo Clinic's Gonda Building in Rochester.
Alex Kolyer for MPR News | 2016

New language being considered by a legislative conference committee working on a health budget bill would exempt some hospitals from nurse staffing rules contained in the bill. 

If approved, health care systems like Mayo Clinic could side-step some of the major provisions of the proposed Keeping Nurses at the Bedside Act, including the requirement that a committee made up of nurses, executives and others agree to staffing plans or, if they can’t, resolve their issues through arbitration. 

However, according to draft language obtained by MPR News, this provision is only available to certain eligible hospitals that are “a national referral center engaged in substantial programs of patient care, medical research, and medical education meeting state and national needs, that receives more than 40 percent of its patients from outside the state of Minnesota, and that is located outside the seven-county metropolitan area.” 

This would prevent many major hospital systems, aside from Mayo, from taking advantage of this carve-out. 

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“The issue here is not that there's an alternative provided for the Mayo Clinic, it's that the alternative is not available to other hospitals and healthcare systems,” said Dr. Rahul Koranne, president and CEO of the Minnesota Hospitals Association. "The fact that an alternative is even being considered means that the underlying bill is bad, and potentially getting worse." 

Hospitals would have to meet a number of other requirements to access this “alternative compliance pathway,” including proving that they currently seek input and feedback from direct care nurses when making staffing decisions, are using staffing software “specifically developed to provide comparative staffing and workforce management guidance for nursing staff,” and would cooperate with on-site review from the health department, among other things. 

If data shows that a hospital isn’t within 80 percent of targeted staffing projections, the health commissioner would require that they come into compliance within 90 days “and ability to continue to participate in the alternative pathway set forth in will be revoked,” per the language.

The compromise language came forward a little more than a week after a Mayo Clinic government affairs official sent a letter to lawmakers and the governor threatening to pull investments from the state unless they dropped the provisions or offered Mayo an exemption.

The Legislature is days away from its adjournment deadline, and a final version of the budget bill has not yet been made public. DFL leaders said they expected that a broader conference committee report would be made available later this week.

Red signs in the capitol-1
Union president Mary Turner said she was “totally against” any compromise that would leave nurses out of the proposed staffing committees.
Dana Ferguson | MPR News

Senate author Erin Murphy, DFL-Saint Paul, told reporters Monday that talks were ongoing. But she said that neither Mayo, nor the nurses union, would get everything they wanted.

“We are still alive and still in the work of making sure that we're able to get that done. And I do think in the end, there will be parties who care deeply about this legislation, who won't be happy,” Murphy said. 

“Our aim here is to make sure that we are putting into law an important measure that serves the safety of patients, the care in our hospitals across the state, and the means to keep nurses working at the bedside so that when someone is sick in Minnesota, they get the care that they need in the hospital,” Murphy continued.

The bill’s House author, Rep. Sandra Feist, DFL-New Brighton, said the Minnesota Hospital Association has been involved in revisions of the bill for months, but Mayo came to bill authors only recently with concerns. Feist repeated that talks were ongoing.

“Nothing is off the table. At this point, we're still trying to figure out how to balance all of the competing considerations. And obviously, all of us have at the center of it all is just making sure that we're doing the best we can to support both nurses and patients in Minnesota,” Feist said.

Minnesota nurses continued their sit-in at the Capitol for a second week, placing signs that read, “patients before profits,” and “how many nurses must leave?” The Minnesota Nurses Association – the state’s largest nurses union – organized the demonstration outside the governor’s office and said that nurses would press lawmakers and Gov. Tim Walz to pass the original bill without compromise language for Mayo.

Union president Mary Turner said she was “totally against” any compromise that would leave nurses out of the proposed staffing committees. And she said her frustration was directed at Mayo, not at officials working on the bill.

“I would fight to the bitter end to include everyone,” Turner said. “My main focus is Mayo thinking they can come in and hold our governor hostage and do these ultimatums, and this blackmail, and my question is do they do this all the time? Anytime they want something, they're going to come to the state of Minnesota, and stamp their feet and say, ‘if you don't do what we want, we'll leave’ and then everyone falls for it.”

Red signs in the capitol-2
The Legislature is days away from its adjournment deadline, and a final version of the budget bill has not yet been made public.
Dana Ferguson | MPR News