A red flag from Rochester on nurse staffing rules

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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Minnesota lawmakers ought to take heed when Mayo Clinic, the state's largest employer, is warning that it may direct billion-dollar investments elsewhere if controversial health reforms clear the Legislature this year.

The Rochester-based medical center recently flexed its political might as bills that would regulate nurse staffing levels and set spending growth targets for hospitals rapidly advanced at the Capitol. In an email to Gov. Tim Walz earlier this month, a Mayo lobbyist cited "harms" that would result if the legislation passes. If necessary, the note warned, Mayo could direct future construction dollars to locations outside Minnesota's borders.

While there are fair questions about the blunt force with which Mayo wielded its clout, its hard-line stance should nevertheless serve as a serious red flag to lawmakers in the session's waning days.

If such a large, deep-pocketed institution as Mayo sees the proposed reforms as a threat, the measures will almost certainly be even more challenging to the state's other hospital systems. Specifically, they are likely to be less able to absorb the potential costs of additional staffing and administrative requirements expected to result from the nursing legislation.

For these reasons, the Star Tribune Editorial Board continues to oppose the bill. If it goes forward, compromises hammered out in the days ahead — such as alternatives that would deploy sophisticated technology to boost staffing more rapidly than a committee — should be open to all of the state's medical centers, not just one.

"We absolutely love our nurses. ... I get the privilege of watching every day how committed they are to their patients and community," Allina Health President and CEO Lisa Shannon said. In an interview with an editorial writer on Tuesday, she aimed her criticism at the staffing legislation.

"The way this has been constructed, there hasn't been sufficient analysis and it would make Minnesota an outlier. There is time needed to study and understand what this model would mean for all hospitals. We have a health care ecosystem that is already strained beyond anything I've seen."

The Editorial Board argued against the nurse staffing bill in mid-March. Its objections included many Minnesota hospitals' current grim financials, along with the grave labor shortage afflicting the state and nation.

Hospitals are already scrambling to hire more nurses. Passing legislation that would likely create additional demand was called "unachievable" and "doomed to failure" at that time by a health care expert. "It's a supply issue. We don't have enough people," said Robert Hackey, a Providence College professor of health care policy and management.

The Minnesota Nurses Association union has long sought to legislate staffing but has been unsuccessful even with DFL state government control in past years. The latest effort calls for nurses and hospital administrators to set a "core staffing plan" for inpatient units. Arbitration would ensue if there's no agreement, a process that seems unwieldy at best given the fast-paced needs of providing patient care.

And again, how would hospitals hire additional nurses in this labor market? It will take time to boost the ranks of these vital caregivers.

In an interview Tuesday, Minnesota House Speaker Melissa Hortman underscored the importance of ensuring that Mayo continues to invest in Minnesota. That's understandable. The famed Rochester medical center is indeed a critical cog in the state's economic engine. Hortman also noted that the House bill's lead author has worked diligently with the state's health care community to accommodate concerns and improve the legislation.

But so far, that work has fallen well short of allaying the concerns of the Minnesota Hospital Association and many individual medical centers. All of Minnesota's health care systems contribute to the state's health and prosperity. Lawmakers should recognize this and work carefully to ensure that any health reforms help, not hinder, this mission.