Keeping Nurses at the Bedside Act will solve retention and care crisis in Minnesota hospitals     

(St. Paul) – February 13, 2023 – Minnesota nurses today joined bipartisan state legislators to introduce the Keeping Nurses at the Bedside Act (SF1561), a bill to solve the crisis of short-staffing, retention, and patient care in Minnesota hospitals. While there are more registered nurses in Minnesota than ever before, job vacancies are increasing at Minnesota hospitals due to the unsafe and unsustainable conditions hospital CEOs have created, including chronic under-staffing which leaves nurses stretched thin trying to do more with less. Half of all nurses are now considering leaving the profession, citing short staffing as their top concern. By focusing on the bottom line, hospital executives are driving nurses away from the bedside, putting patient care at the bedside at risk.

“This legislation is coming at a critical moment for nurses, hospitals, and patients,” said Senator Erin Murphy (DFL-St. Paul), chief author of the bill in the Senate. “We have heard from nurses about staffing shortages for years, and our legislature must act with urgency. Our nurses are instrumental to providing the highest standard of care possible in our state. The Keeping Nurses at the Bedside Act will put in place conditions to ensure our nurses are supported and able to provide indispensable care across Minnesota.”

The Keeping Nurses at the Bedside Act would establish committees of direct care workers and management at Minnesota hospitals to set safe staffing levels on a hospital-by-hospital, unit-by-unit basis, including a maximum limit on the number of patients that any one nurse should safely care for. This flexible approach will allow hospitals to set and adjust staffing levels that work on a local level based on the expertise of bedside nurses at that hospital. These committees would also be charged with ensuring that patients are not being boarded in Emergency Departments, where too many patients are currently being treated in hallways due to insufficient staffing by hospital executives.

“This bill is about all of us. As a mother, I think of my daughter. As a daughter, I think of my parents. This is about our families. This is about all patients in Minnesota,” said Rep. Sandra Feist (39B, DFL), chief author of the bill in the House. “Safe staffing is the best way to retain nurses and bring nurses back, as well as decrease violence and prioritize quality patient care.”

When patients show up to a hospital, they have no way to know if they will be waiting for hours in the emergency room, if they’ll be put in a bed in a hallway, or if there are an adequate number of nurses staffed for their surgery. To hold hospitals accountable to the staffing levels set by the new committees and to provide transparency for Minnesota patients, the bill would require hospital executives to post emergency department waiting times and to inform patients of staffing levels when they arrive and throughout their stay so they know the size and scope of their care team.

“This piece of legislation merely sets up committees at every hospital, so they can talk about it in a hospital-by-hospital way how to handle these issues,” said Sen. Jim Abeler (35, R), co-author of the bill in the Senate. “There’s a hole in the bucket, and nurses are leaving. It’s time to make them feel safe at their work, to get the quality people expect.”

While the crisis of retention and care will only be solved by ensuring safe staffing levels, additional measures can help to support nurses working at the bedside and to protect Minnesota patients. The bill includes protections against workplace violence and new measures to recruit and retain workers, including mental health grants for healthcare workers, student loan forgiveness for nurses, and measures to recruit and retain more nursing school staff.

“With half of all nurses ready to leave the bedside, Minnesota nurses and patients cannot wait any longer for safe, fully staffed hospitals,” said Mary C. Turner, RN, MNA President. “Minnesota legislators must take action to hold hospital executives accountable and to solve the nurse retention and care crisis in our hospitals.”

New scholarly research confirms that staffing levels and poor hospital management are the driving factors in the nurse retention crisis: “This is at the heart of the burnout, and the job dissatisfaction and all of the turnover in hospitals.” The lead study author notes that “[t]he pandemic didn’t cause [these problems]… All this business of people throwing up their arms and saying ‘There are not nurses to hire because they’ve all left’ [is] not really true.”

“The Keeping Nurses at the Bedside Act is essential to solve the understaffing and retention crisis that hospital executives created,” said Rebekah Nelson, RN, MNA Government Affairs Commission Chair. “Now it is time for the Minnesota Legislature to act. The future of our profession and our healthcare system depends upon it.”

In addition to driving nurses away from the bedside, the crisis of retention created by hospital executives is also a crisis of care for patients. Last year, the Minnesota Department of Health reported a 33 percent increase in adverse events for patients in Minnesota hospitals – including pressure ulcers, commonly known as bedsores, and falls – and a 35 percent increase in cases of adverse events which resulted in patient harm or death. Numerous studies have shown that higher staffing levels increase the amount of care each patient receives from nurses – by as much as two to three hours per day – and drastically reduces the risk of patient harm or death while in a hospital.

“Becoming a nurse was once the single most important thing in the world to me, but the current system we have for healthcare is not one that can sustain our workforce,” said Rachel Hanneman, RN. “Unless permanent change is made for every nurse and every patient, at every hospital around the state, we will continue to see worsening conditions at the bedside and more and more nurses being pushed away.”

If the Minnesota Legislature does not act to solve the staffing and retention crisis in our hospitals, we risk losing nurses to other states who are taking action. Already, California and New York have laws in place to set safe nurse staffing levels in hospitals; and this year, at least four other states are considering similar measures. When California passed its safe staffing law, nurses not only returned to the bedside within the state, nurses moved to work there from other states. Minnesota legislators must take urgent action to hold hospital CEOs accountable, retain Minnesota nurses, and protect patient care.

About the Keeping Nurses at the Bedside Act
The Keeping Nurses at the Bedside Act (KNABA) would address the crisis of understaffing and retention in Minnesota hospitals with the following provisions.

• Establish Nurse Staffing Committees to Set Staffing Levels – Minnesota hospitals already set staffing levels on hospital units, but current levels are unsafe and unsustainable, driving nurses out of the profession and putting patient care at risk. This bill would require all hospitals in the state of Minnesota to create a staffing committee composed of direct care workers and management to produce a core staffing plan for each unit of the facility every year, including a maximum limit on the number of patients that any one nurse should safely care for. This flexible, hospital-by-hospital, unit-by-unit approach will allow hospitals to set and adjust staffing levels that work on a local level based on the expertise of bedside nurses.
• No More Patients in Emergency Department Hallways – The conditions Minnesota patients are subjected to because of understaffing by corporate healthcare executives are inhumane and unacceptable. KNABA would require the new staffing committees to create a plan to eliminate patient boarding in Emergency Departments without mandating that staff work increased hours to cover for hospital understaffing, asking nurses to do more with less.
• A Resource for Patients and Nurses – Charge nurses are meant to be a resource for patients and other nurses, to help mentor and train newer nurses, provide urgent assistance, and help to meet the needs of all patients on a unit. The role of a mentor is especially critical to retaining nurses and passing along essential knowledge. However, too often, when units are understaffed, charge nurses must take on direct patient assignments. The new staffing committees would be directed to create a plan to ensure charge nurses do not have individual patient assignments.
• Hospital Transparency for Minnesota Patients – When patients show up to a hospital, they have no way to know if they will be waiting for hours in the emergency room, if they’ll be put in a bed in a hallway, or if there are an adequate number of nurses staffed for their surgery. Patients deserve to know what is happening inside the hospitals they rely on in their most desperate moments. This bill would direct the Minnesota Department of Health to review hospital data on patient care and staffing to produce an annual report grading Minnesota hospitals on whether they follow their staffing plans. The bill would also require hospitals to post waiting times for emergency departments and to provide up-to-date unit staffing information to patients when they arrive at the hospital and throughout their stay so they know the size and scope of their care team.
• Prevent Workplace Violence – Rising rates of violence against nurses and patients are creating unsafe workplaces and unsafe care conditions in Minnesota hospitals. Nurses, like every other worker, deserve to be safe and protected on the job. Violence in our hospitals is exacerbated by understaffing when nurses do not have the support they need to safely provide patient care in difficult situations or to respond to violence or threats. The increase in unchecked and unaddressed violence in our hospitals further exacerbates the retention crisis created by hospital managers. KNABA would address these shortcomings by mandating more robust workplace violence prevention plans and training for all healthcare workers in hospitals.
• Retain and Sustain Minnesota Nurses – Last year, the Minnesota Legislature approved one-time funding for mental health grants for healthcare workers. This year, nurses request that funding becomes permanent with an annual appropriation of $10 million. To help retain nurses at the bedside, the bill would also allocate $5 million to launch a new student loan forgiveness program for nurses working at the bedside in Minnesota hospitals.
• Recruit and Train Nursing Students – This bill would dedicate resources to ensure we continue to attract and train a skilled and diverse workforce of Registered Nurses in Minnesota. This includes broadening an existing student loan forgiveness program to incentivize nurses to become nursing instructors and allowing scholarships to cover childcare costs for students pursuing a nursing degree.