Outsourcing Care: The False Promise of the Nurse Licensure Compact

THE PROBLEM: Hospital Short-Staffing

Short-staffing and cost-cutting by hospital CEOs created an unsafe and unsupportive work environment inside Minnesota hospitals, leaving nurses trying to do more with less. These unsafe and unsustainable working conditions drive nurses out of the profession, causing still higher workloads for nurses at the bedside, negatively impacting patient care, and contributing to workforce shortages.

As hospital executives look to divert responsibility for the staffing crisis they created, they claim that there are simply not enough nurses willing to work in Minnesota. But the facts state otherwise. There is no shortage of Minnesota nurses who want to provide safe, high-quality care to their patients. The number of registered nurses has increased by over 14,000 in the past three years to a total of 119,209 last year. There are more than enough nurses in Minnesota to meet the needs in our hospitals.

EXISTING SOLUTIONS: Reciprocity and Temporary Workers

Already, Minnesota offers pathways for out-of-state nurses, particularly those from neighboring states, to practice here with minimal obstacles. Minnesota allows border state reciprocity for nurses with licenses from Wisconsin, Iowa, North and South Dakota meaning that if a nurse is licensed in one of those states and meets basic criteria, they can practice in Minnesota.

During the pandemic, Minnesota has been able to swiftly recruit and deploy out-of-state nurses hired through the state’s Emergency Staffing Pool. Out-of-state healthcare professionals with an active license in good standing from any U.S. state were able to render aid in Minnesota during the pandemic.

Rather than improve hospital conditions and put patients before profits, Minnesota hospital CEOs are presenting the Nurse Licensure Compact (NLC) as a false solution to the staffing and retention crisis.

We need to recognize this bill for what it is: an Outsourcing Care Act.

The Compact would outsource care to lesser-trained nurses from other states, making a consistent level of quality patient care impossible. Minnesota produces exceptional nurses who meet a high standard of patient care, but the NLC would open the door for lower-skilled nurses from states like Mississippi. This would create chaos and confusion for hospital patients who would have no guarantees as to the quality of care they would be receiving.

The Compact would undermine the bargaining power of Minnesota nurses. The Compact would allow hospital CEOs to easily bring in lower-paid and lesser-trained nurses from out-of-state in the event of a strike, undermining the efforts of nurses to put patients before profits and to protect patient care at the bedside.

The Compact would outsource decision-making to an interstate commission, reducing transparency and oversight of healthcare. The Compact would take away the power of the Minnesota Legislature and the Minnesota Board of Nursing to set and monitor nursing standards in our state, signing them over to an interstate commission which could set rules affecting our patients and nurses behind closed doors.

 The Compact would outsource care from nurses at the bedside, hurting rural healthcare. One of the goals of the interstate commission behind the Compact is to replace individualized care by registered nurses at the bedside with computerized healthcare. This can present access challenges to rural residents and could lead to more hospital closures in Greater Minnesota as visits and revenues leave the clinic.

The Compact could take nurses out of Minnesota. While Minnesota has a surplus of registered nurses, other states already in the Compact – including Texas, Mississippi, Tennessee, and Louisiana – face a nurse shortage, and may draw nurses away from Minnesota if we joined. This risk is increased as hospital managers in Minnesota continue to deny requests for more flexible schedules and for time-off from nurses who are already exhausted from overwork and under-staffing.