Our view: Steer state clear of nursing mandates

Let’s call this what it seems to be, this proposal weaving its way through the Legislature in St. Paul to leave it up to state government to dictate how many nurses are on duty at any given time in Minnesota hospitals and health-care facilities.

Let’s call it a blatant, obvious power grab by a union looking to beef up its membership and its dues-filling coffers.

That’s really the only description that makes any sense. A state law mandating minimum nurse-to-patient ratios has the promise of resulting in more nurses overall — meaning more members for the nurses union. The Minnesota Nurses Association is the driving force behind the misleadingly named “Standards of Care” bill.

Right now hospitals and health-care facilities determine the staffing levels necessary to provide quality care and to meet demand, as they should. It’s something determined day by day, and even hour by hour or crisis by crisis, by the facilities working with the health professionals on their staffs, especially their chief nursing officers.

Hospitals and other facilities, particularly smaller ones with tight budgets, currently are able to shift personnel between departments to meet demands. So if there are no babies being born in the maternity ward, for instance, and a nasty three-car pileup is arriving in the emergency room, nurses and other staff can now be shifted from maternity to ER. That sort of flexibility would not be possible if

government-mandated staffing ratios were made law. As a result, some already struggling facilities, especially those in rural areas, could go out of business, unable to afford full staffs in all departments at all times. Flexibility is necessary for many facilities and doesn’t negatively affect quality care.

Staffing levels aren’t something for government — or even a government-appointed panel, as the bill calls for — to be determining. Putting the government in charge of how private health-care companies do business is inappropriate overstepping at the very least and flat-line wrong at the very worst.

“Almost nothing improves when it is under government control,” the Austin, Minn., Daily Herald opined last month while also opposing the proposed nursing ratios legislation.

The current approach to staffing is one that works. Minnesota’s patient-satisfaction scores outrank the national average, according to the Minnesota Hospital Association in St. Paul. And, “Minnesota already is ranked in the top quarter of states for cost and quality of health care,” as the association’s Wendy Burt wrote in response to a request for information from the News Tribune Opinion page. “According to the Centers for Medicare and Medicaid Services, on average, Minnesota hospitals are 9 percent less costly than their national counterparts, while maintaining high quality.”

The proposed legislation is a solution to a problem that doesn’t exist.

“We have great outcomes,” Sandra “Mac” McCarthy, the chief nurse executive for Essentia Health’s east region, based in Duluth, said in a meeting with members of the News Tribune editorial board. “We are noted across the country for our excellence in health care. So I think a lot of people are asking, ‘Why is Minnesota considering this?’ ”

It’s a good question. Here’s a logical likely answer: The Minnesota House, Minnesota Senate and governor’s office all are controlled by the labor-friendly DFL party. If the Minnesota Nurses Association can’t get this through this year it maybe never will. And the union has been trying for years, typically community by community during contract negotiations, to establish staffing ratios.

Ratios will improve patient care, the union argues. But few if any numbers exist to support the claim.

“Scheduling” ranks at the bottom of the list of things that cause preventable deaths and injuries in Minnesota hospitals and clinics, according to the Minnesota Department of Health. “Scheduling” can be blamed for “adverse events” less than 1 percent of the time, the department reported.

There’s a reason only one state, California, has adopted government-mandated ratios. There are just some places where government doesn’t belong.

“The one-size-fits-all approach … fails to recognize the complexity and diversity of all health-care environments,” the District of Columbia Hospital Association reported after considering adopting ratios itself and after studying, at length, the results in California.

“California’s experience … has resulted in many unintended and negative consequences for patients, nurses, and other employees,” the D.C. association found. “If mandated ratios were the answer, other states would have adopted them … yet not one has done so. In fact, various nationally recognized studies, including those on California’s nurse-to-patient ratios, illustrate the significant consequences for nurses, patients and hospitals.”

“We are the experts in the field,” McCarthy pointed out to editorial board members. “We have the longevity. Working with the staff we’re the ones who can make the best calls.”

That makes sense. Allowing government to get involved: There seems to be only one explanation for that.

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