Caution with personnel reforms in nursing

Editor’s note: editorial represent the opinions of the Star Tribune Editorial Board, which operates independently of the newsroom.



“Guaranteed to fail.”

Robert Hackey, a professor of health policy and management at Providence College in Rhode Island, doesn’t mince his words when asked about a high-profile nurse staffing law now gaining momentum in the Minnesota legislature.

The legislation is the Minnesota Nurses Association’s (MNA) latest effort to address its longstanding concerns about patient safety by increasing the number of bedside nurses. The MNA union has been at odds with state hospitals for years over minimum staffing requirements and has been unsuccessfully urging them to be enshrined in state law.

HF 1700/SF 1707, also known as Keeping Nurses at the Bedside Act of 2023, is the latest version of this effort. It establishes a committee-driven process whereby nurses and hospital administrators establish a “core staffing plan for each inpatient care unit,” with arbitration to resolve conflicts if management disagrees with the committee’s decision.

While this is a better option than California’s rigid nurse-patient ratio, the legislature should reject the bill’s human resources components for now, but pass other valuable pieces of legislation, such as workplace violence prevention initiatives and loan forgiveness, to to attract more people to the nursing profession.

Hackey’s assessment is harsh but reflects a grim reality. The nation is struggling with a serious labor shortage. This challenge is even more acute in the healthcare sector. How can you increase staffing, the likely impact of this legislation when it comes into effect, if hospitals are struggling to hire and retain nurses?

“It’s a supply problem. We don’t have enough people,” Hackey told an editorial writer.

He said the current focus should be on attracting healthcare professionals as post-pandemic staff retirements and burnout continue to strain the workforce and care capacity.

Even in recent years, when the DFL has controlled the state government, as it does now – a political environment seen as more amenable to this union-led initiative – lawmakers have been wary of legislation on nursing staff. In 2013, the Star Tribune editorial team commended the DFL-controlled House and Senate for their incremental response to the MNA’s push on staffing.

The bill, passed a decade ago, was reasonably short of new requirements, but called for more publicly available information about hospital staff. It also authorized the Minnesota Department of Health (MDH) to study “the correlation between nurse staff and patient outcomes” in the state’s health care system.

This information would have helped future lawmakers make an informed decision. Therefore, it was deeply frustrating to learn from a 2015 MDH report that the study could not be completed because the hospitals refused to provide the required data.

Before the end of this year, the legislature is to prescribe a restart of the study and the participation of the hospitals. The findings would take the debate beyond the talking points of hospitals and nurses. This problem is not going away, nor should it. The 2015 MDH report, which reviewed other research, concluded that there was a “positive association” between increased nurse staffing and certain patient outcomes.

But now is not the right time to implement this. In addition to the labor shortage, the poor finances of the hospitals are another reason for restraint. Earlier this month, the Star Tribune editorial board sounded the alarm, noting that more than half of state healthcare systems will report negative operating margins in 2022. These headwinds are affecting hospitals across the country and will take time to abate.

Hiring additional nurses in response to staffing reforms is expensive, especially during labor shortages. The inability to afford or find additional nurses, in turn, can lead struggling hospitals to close departments or otherwise reduce capacity. The state’s hospital association has warned that if passed, the staffing law could jeopardize access to care for 70,000 Minnesotans.

In an interview this week, MNA officials countered that the legislation would help alleviate labor shortages. They said many nurses who left the profession would return if staffing issues were addressed.

The MNA cited as part of its justification a lower nursing job vacancy rate in California, which has a strict relationship between nurses and patients. But the pay, not the staffing, might explain this. California has the highest median annual wages for registered nurses in the nation.

A recent report also showed that California nurses are leaving the workforce for the same reasons cited by Minnesota nurses who have left bedside care. That raises further doubts as to whether staffing reforms alone would bring back enough nurses.

Lawmakers should ensure the completion of the Minnesota study and use its conclusions to inform the debate. For now, however, caution is best.

Editorial Board members include David Banks, Jill Burcum, Scott Gillespie, Denise Johnson, Patricia Lopez, John Rash and DJ Tice. Star Tribune Opinion contributors Maggie Kelly and Elena Neuzil are also contributors, and Star Tribune Editor and CEO Michael J. Klingensmith serves as an advisor to the board.


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