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Rural hospital CEOs warn of consequences of nursing bill

If the Keeping Nurses at the Bedside Act becomes law as-written, the Minnesota Hospital Association and its members fear it could drastically hurt patient care.

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As the Minnesota legislative session winds down, the Minnesota Hospital Association is pleading with legislators to reconsider the Keeping Nurses at the Bedside Act before it becomes law.

Hospital leaders told state media in a call Tuesday they fear the bill would only cause further harm to the already struggling health care systems across the state.

Patti Banks, CEO of Ely-Bloomenson Community Hospital, said after a high volume of patients this past weekend, it's more clear than ever that the staffing requirements that would be enforced by the Keeping Nurses at the Bedside Act would hurt the rural, critical access center.

“I can assure you that if we had to adhere to the mandates in this proposed legislation, we would have had to turn patients away," Banks said. "This would have been detrimental to our communities as well as the reputation of our organization. Care delivery in Greater Minnesota looks different, but our expectation to save lives is the same.”

The bill would require every hospital in Minnesota to form staffing and nurse workload committees, as well as develop and implement core staffing plans. The Minnesota Nurses Association has been vocal about its support for the act, saying the bill was designed to address the nursing shortage and retention crisis. MNA leaders have asked Gov. Tim Walz to sign the bill into law as written.


Minnesota nurses are advocating in favor of the Keeping Nurses at the Bedside Act, which has drawn criticism from Minnesota hospital leaders.

However, Minnesota hospitals strongly oppose this outcome. A letter signed by leaders at every nonprofit hospital in the state, including Essentia Health and St. Luke's in Duluth, was sent to legislators last week, warning them of the consequences this law could have on health care.

Carrie Michalski, president and CEO of RiverView Health in Crookston, said hospitals, especially rural hospitals like hers, are already under financial and workforce strain to the point where RiverView had to close its skilled nursing facility earlier this spring. The Keeping Nurses at the Bedside Act would only add more administrative burden onto teams that have no margin to take on more work.

“This session, as someone that’s geographically far from the Capitol, it’s been feeling like the real world realities of rural health care are just not being understood and heard in St. Paul,” Michalski said. "To mandate a one-size-fits-all across a variety of hospitals and sizes and resources and geography just does not make sense.”

Rahul Koranne, president and CEO of the Minnesota Hospital Association, said there are two aspects of the bill the MHA sees as most harmful. The first is the proposal to take patient care and staffing decision-making outside the hospital system. Koranne said the decisions need to be made by professionals on care teams in hospitals, not in a legal system with arbitration and courts.

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Koranne also worries about the aspect of the bill that would allow nurses to refuse an assignment they deem unsafe, such as working on an understaffed floor that could put their license in jeopardy. He said the Keeping Nurses at the Bedside Act was designed with nurses in mind, but not patients.

“The union wants to put into state law the ability for a nurse to refuse to take care of a patient for any reason whatsoever," Koranne said. "That is going to be so disruptive. How do we know which patient a nurse is going to refuse? That’s not what we do. We take care of all patients that come through.”

The Minnesota Nurses Association says the bill will not restrict patient admissions, but will instead allow nurses to have a say in staffing levels and protections to their job and license if they raise concerns about assignments they deem unsafe according to their professional judgment. The bill is not creating staffing mandates, MNA said, but the committees would be composed of local hospital management and bedside workers to make decisions together at their hospitals.

“This bill is about taking care of Minnesota patients,” said MNA President Mary C. Turner. “Someday, all of us and our loved ones will need care in a hospital. When that day comes, people need to know there are enough skilled nurses at the bedside to provide the safe, high-quality care all patients deserve. Giving nurses a seat at the table and a voice in the process will help improve staffing levels, bring nurses back to the bedside, and protect patient care throughout the state.” 


Rachelle Schultz, president and CEO of Winona Health, said all hospitals have shortages, but there aren't enough nurses out there to fill all the open positions. Nursing programs are not filling up, so there aren't enough resources in the labor pool. Therefore, Koranne said, the MHA supports aspects of the nursing bill, including using state surplus funding to forgive nurses' student loans and working to reduce and prevent workplace violence. But the hospital leaders say the bill won't help them fill open nursing jobs because the workers aren't out there.

“Passing a law that allows nurses to pick and choose who they will care for is not just bad policy — it’s not a minor inconvenience — it’s a matter of life and death when you’re the patient in need of emergency and critical care," Michalski said. "Minutes matter and we need to be able to make quick decisions on the front line. You can’t be threatened with litigation and processes that draw out that timeline.”

Michalski, Schultz, and Rick Ash, CEO of United Hospital District in Blue Earth, said the idea that the Mayo Clinic may get an exception to the law is troubling to them and the rest of Minnesota's hospital leaders. Mayo Clinic, which said it would withdraw billions of dollars worth of state investments if the bill passed, could possibly be exempt from its requirements, DFL House Speaker Melissa Hortmann told WCCO-TV on Sunday.

“If that goes through, and there’s consideration for an alternative path, then that should be made available to every hospital,” Schultz said.

Ash also worries about transfers between hospitals, which already sometimes require patients to wait days or even weeks in rural inpatient or emergency departments for an open bed at larger hospitals. The legislative act could further limit the number of beds available if staffing ratios are reduced further.

“This is crazy," Ash said of the act. "It’s dangerous and reckless, in my opinion."

Minnesota Nurses Association members have been participating in a sit-in at the state Capitol, and plan to continue to do so until Gov. Walz signs the bill into law as written.

“Gov. Walz and legislators must stand strong against corporate bullies, and defend democracy to protect patients and retain nurses in Minnesota," Turner said in a news release from MNA last week. "All patients, at every hospital in the state, deserve safe and high-quality care from enough trained professionals. No exceptions, and no exemptions.”


Koranne, on the other hand, said legislators need to act now and listen to the state's health care leaders, before the voting is done, to prevent a harmful law from taking effect.

"The only supporter of this bill is the union, which represents less than 20% of nurses in the state. The fact that the bill authors are working to find exceptions to their own bill shows that even they know that this bill is not good for health care in Minnesota,” Koranne said. “... We’ve been saying for weeks, if not months, now: If these stacks of bills pass as written, Minnesotans, our patients, are going to suffer."

This story was updated at 9 a.m. May 17 to include a statement from the Minnesota Nurses Association. It was originally posted at 7:01 p.m. May 16.

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Laura Butterbrodt covers health for the Duluth News Tribune. She has a bachelor of arts in journalism from South Dakota State University and has been working as a reporter in Minnesota and South Dakota since 2014.
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