Minnesota's nursing troubles are puzzling, damaging and could get worse

Mayo Clinic has more open positions for nurses in Minnesota than it has applicants, its top executives say.

Meanwhile, there are about 122,000 Minnesotans who are licensed as registered nurses and 64,000 working as RNs, data from state agencies show.

How can this be?

The state's — if not the nation's — top hospital doesn't have enough people applying to fill nursing positions while only about half of Minnesota's RNs are doing the job they've trained to do.

At first glance, it seems nurses aren't being paid enough. You be the judge; the mean wage for Minnesota RNs last year was about $89,000.

A deeper look shows health care is being hit especially hard by Minnesota's labor force moving from an abundance to a scarcity of workers. And the problem may get even worse against the demand that's expected in a few years, when people in the huge baby boomer generation need the most care as they approach the end of their lives.

Few situations rising from demographic change will take greater creativity to solve. Changes in incentives and constraints in health care will be needed. So will the expectations you and I have about what happens when we go to a hospital or clinic.

Hospitals see technology as a solution to nurses' view of work. They think eliminating less-essential work will attract more nurses back to the job.

Unions and some politicians — like state senators Erin Murphy, a Democrat, and Jim Abeler, a Republican, along with U.S. Sen. Sherrod Brown, an Ohio Democrat — say hospitals need to hire more of them to spread workloads around. They worry technology will be used to hire fewer.

"That is my biggest fear," Mary Turner, president of the Minnesota Nurses Association (MNA), told me. "With every little technology thing that they do, they're going to use it to justify to cut the amount of staffing even further."

I recently visited Mayo Clinic in Rochester, where Ryannon Frederick, chief nursing officer for the entire system, gave a more precise critique. She said Mayo and other hospital systems need to change the target of their technology spending.

"We brought in technology to support patient care, but the technology didn't really support the nurses," she said. "The technology has to make the environment better for staff."

In 2021, post-COVID burnout led tens of thousands of health care workers to leave the field in Minnesota. The problem eased somewhat last year but not by much.

MNA earlier this year produced a survey called "Why We Left" that showed stress and staff shortages were the main causes for the exodus. The union didn't identify where nurses went.

There are other influences, and one of them is that pay and benefits provide nurses with some financial freedom. Nurses now retire as soon as they can, Turner noted, rather than working into their 60s.

Some nurses represent the second income in a household and others are in the profession as a second career. Both scenarios suggest nurses possess greater flexibility to move in and out of the profession.

And a growing number of nurses work a brief time in a hospital or clinic, then head elsewhere.

"One thing about a nursing degree is you have so much flexibility. You are wanted by everyone from consulting firms to other types of care," Turner said. "Because of the work conditions, bedside care is kind of the bottom rung. It's a crying shame that some of these young ones are putting in one or two years time so they can qualify [for other jobs] and then leave the bedside. It's totally heartbreaking."

Alissa Zimmerman, the top administrator for nurses at Mayo's Rochester sites, described the staffing trouble plainly. "It's highly unlikely that we'll be able to hire our way out of the situation that we're in today," she said.

I reached out to Mayo and the MNA because they were on opposite sides of a battle at the Legislature this spring that ended dramatically.

Majority Democrats on the session's last day retreated from an MNA-backed bill that would have required hospitals to create staffing committees that included nurses, a move that would have likely led to strict nurse-to-patient staffing ratios.

Mayo fought the measure, threatening to pull back on a planned expansion of its Rochester base. Other hospitals joined in, and they protested especially vigorously when lawmakers offered to exempt Mayo.

"The voice of the nursing staff is incredibly important. What they were proposing was actually going to be less engagement from our staff than we already have," Zimmerman said.

Both she and Frederick started as nurse interns at Mayo and were RNs in various departments. Staffing is in the hands of charge nurses at Mayo, they explained, and those nurses rely in part on software that accounts for patient conditions in real time.

"They use that system to pull forward what they're going to need for number of staff, different types of staff, for the upcoming period," Zimmerman said.

The MNA remains critical of Mayo. On Nov. 8, it posted a blistering statement on its website about the number of "adverse patient events" at Mayo, including a death, that were the most in the state in 2022. It didn't note that Mayo has the most hospital beds in the state.

The union represents some nurses at Mayo locations around the state. Nurses at Mayo's Mankato site left MNA last year. Their disagreements go beyond workplace representation and into how nursing will change in the future.

A dozen times in our conversation, Turner expressed doubt about the role technology can play. "They can try all the AI and the robots but they're only going to be able to do that so far," Turner said. "At some point, you need a human being taking care of another human being."

The Mayo execs don't see technology as the whole answer, either.

"The need for nurses is going to continue and grow," Frederick said. "What gives me hope is marrying the need for nurses with solutions that make it easier for them to use their skills."