Minnesota hospital staffing bill advances amid care delays, nurse shortages

Worsening nursing shortages and patient care delays have increased attention to hospital staffing legislation that has languished in Minnesota for 15 years.

The Senate Health and Human Services Committee on Wednesday advanced a bill that would require that nurses and administrators work together on committees in every hospital to set staffing levels. The bill also set reporting requirements and penalties if hospitals fall short of those agreed-upon levels.

"This is an act of desperation," said Sen. Jim Abeler, R-Anoka, who has talked with nurses who "don't feel safe at work and they feel overloaded and they feel incapable of providing proper care."

Abeler is co-author of a bill that is largely backed by the DFL, and contains ideas that the Minnesota Nurses Association (MNA) has brought to the Legislature every year since at least 2007. The union previously sought state-mandated minimum nurse-to-patient ratios in hospitals, but that idea has been removed from this year's bill.

What remains is still controversial.

Nurses argued that hospitals have failed to maintain adequate staffing levels on their own, driving thousands of nurses from bedside care. The MNA reached out to 2,403 nurses who left their union hospital jobs last year and received survey responses from 499. More than 70% cited burnout or understaffing, or both, as reasons for leaving. The majority had worked fewer than five years in their hospitals.

"Many of these nurses are standing on the sidelines, watching, waiting, ready to return if working conditions improve," said Wendy Wahl, adding that she is exhausted after being a nurse for 20 years. She works at the Sanford hospital in Thief River Falls.

Hospital leaders countered that inflexible staffing levels are the opposite of what is needed in today's fluid health care environment of changing patient numbers and patient sickness levels. They argued that the requirements of the bill would force financially challenged hospitals to close units that can't meet staffing levels and lengthen delays for patients.

The Minnesota Hospital Association estimated that ramifications of the bill could threaten access to care for 70,000 state residents each year.

"I've never seen finances and projections so poor," said Rachelle Schultz, chief executive of Winona Health and its 49-bed hospital. "While 2022 was a tough year, 2023 is projected to be worse. … If enacted, this bill will make our financial future even more grim."

Hospital and nurse leaders agreed on the need for solutions, including over the rising amount of workplace violence and incidents in which delirious patients or distraught visitors have assaulted nurses.

An amendment offered by Sen. Bill Lieske, R-Lonsdale, a chiropractor, that aimed to retain the workplace safety measures and other protections in the bill but do away with the required hospital staffing committees and penalties was voted down.

The amendment would have gutted the bill, said Sen. Erin Murphy, DFL-St. Paul, a nurse and lead author.

"This is a many, many years effort ... with each time more urgency, each time more concern," she said.

Steven Romenesko, 34, of South St. Paul, testified that he has been hospitalized many times because of his progressive liver disease, and that the environments were noticeably more stressful during four trips over the past year.

"At all these visits, I noticed nurses dealing with greater patient loads than I was used to," he said, "and in cases of admission, a much greater wait time to get into the hospital."