Minnesota hospital and health systems, both their executives and clinicians, are rallying against nurse staffing legislation and a potential exemption for Mayo Clinic, the state’s largest provider.
In April, the state Legislature passed a bill that would require each inpatient care unit of a hospital to set up committees of nurses, other direct caregivers and executives to agree on certain staffing levels or set them via arbitration.
Rochester, Minnesota-based Mayo opposed the measure, arguing it and any provider that uses a sophisticated acuity-based staffing software should be exempted from the legislation because the software can make decisions faster than a committee that would meet “at least quarterly,” as stipulated in the bill. A Mayo spokesperson said the health system offered numerous recommendations over the past several months that would “remove or modify the harmful portions” of the bill and those recommendations were not implemented.
Mayo, which also has hospitals in Arizona and Florida, threatened to pull billions of dollars of planned construction in Minnesota if Gov. Tim Walz (D) signed the nurse staffing bill, as well as another measure that would set cost growth benchmarks. Minnesota House Speaker Melissa Hortman (D) said in a statement that “Mayo Clinic is a unique, world-class health care institution. Any final agreement will not make everyone happy—that is often the nature of a compromise.”
Minnesota Rep. Sandra Feist (D), who wrote the House version of the bill, said in a statement she would have “preferred that Mayo Clinic participate in this step forward for Minnesota healthcare,” and that the proposal would improve nurse retention and patient outcomes and reduce racial disparities.
Hospitals and health systems from across the state, including Minneapolis-based Allina Health, said the nurse staffing legislation would require them to cut services if they don’t have enough nurses to meet the staffing requirements. Hospitals continue to grapple with a shortage of workers and the law would place an unsustainable burden on their overcrowded emergency departments and ultimately reduce access, health system executives and nurses said.
If Mayo gets an exemption, every hospital operator should also be eligible, providers said.
“Healthcare is not a perfect system, but if the Minnesota Legislature moves to create exemptions for one specific healthcare system, giving them a different set of rules to operate by, for no legitimate reason—it will forever change health care in Minnesota,” Allina President and CEO Lisa Shannon said in a statement.
A Mayo spokesperson did not address the system's request for an exception but in a statement said the “bill imposes a government-mandated staffing model and complex regulatory structure that will limit the autonomy and flexibility needed to allow Mayo to do what it does best—innovate and meet the needs of our patients, our staff and the communities we serve.”
Park Nicollet Methodist Hospital in St. Louis Park, Minnesota, has been using an acuity software program since 2017 to guide staffing levels, Adam Karlen, clinical nursing director for critical care and respiratory therapy at the hospital, said during a news conference Thursday coordinated by the Minnesota Hospital Association.
“If the exemption to leverage innovative, scientifically based methods like acuity tools is good for one hospital, it must apply to all,” he said.
If the nurse staffing bill is implemented, it would likely cost Northfield Hospital and Clinics $1 million a year, Tammy Hayes, chief nurse executive and long-term care administrator at the 37-bed Northfield (Minnesota) Hospitals & Clinics, said at the news conference. “That is a big concern for us when we are already struggling,” she said.
California is the only state with mandated nurse-to-patient staffing ratios in all hospital departments, which have been in place since 2004. Massachusetts implemented a similar law in 2014 specifically for intensive-care units. Voters rejected a 2018 ballot measure to expand the law.
Critics of the mandated ratios, including the American Hospital Association and American Organization of Nursing Executives, contend that ratios would financially strain providers and hurt morale as scheduling would become more rigid. Advocates argue the hospital nurse-staffing ratios in California are associated with lower mortality rates and higher morale.