SF 471/HF 588 is one national union’s drive toward a government-mandated staffing quota in Minnesota
The MNA claims this is not a “ratio” bill but rather sets minimum standards of care.
This is false. Professional organizations such as the four
organizations cited in the MNA’s bill are not organizations that
establish “standards of care” or a “national standard.” This is
intentional. The Association of Women’s Health, Obstetric, and Neonatal
Nurses (AWHONN) and Association of Operating Room Nurses (AORN) call for
ratios. The other two, Emergency Nurses Association (ENA) and American
Association of Critical Care Nurses (AACN) call for acuity-based models
rather than ratios. The result of this is that — according to the
legislation — “in the absence of an evidence based standard” the
decision will be made by a “working group” with a super majority of RNs —
appointed by the governor — who will ultimately recommend quotas as
they said in their Feb. 13 news conference “per unit and per shift.”
- Linda Hamilton, president of MNA said on Feb. 13 there is a need
to staff to “standards of care that have been developed through
professional judgment in every hospital, on every shift, in every unit
across the state.” That is a quota.
- The union does not mention the American Nurses Association
Principles for Nurse Staffing which emphasizes the need for flexibility
and to staff according to the acuity of patients as opposed to a fixed
The MNA claims “troubling instances are not reported."
Nurses, as a matter of professional licensure, are obligated to
report incidents involving unsafe conditions to hospitals as soon as
possible. The Minnesota Department of Health can inspect a hospital for
safety at any time.
MNA’s president Linda Hamilton said: “there are not enough nurses working on duty.”
The Minnesota Department of Health reported in February 2013,
that hospital admissions declined for the third straight year yet
staffing increased. In fact, full-time equivalent positions grew by 4.2
percent. One-third of the new positions were filled by RNs.
The MNA claims that “minimum standards” would prevent hospital readmissions.
“Minimum standards” are quotas, and quotas in California have not been shown to cause an increase in quality.
Since 2011 — without this legislation — Minnesota hospitals have
prevented 4,000 avoidable hospital readmissions. Members of the care
team (which includes other health care professionals in addition to RNs)
have focused on five key areas known to be main contributors to
avoidable hospital readmissions: comprehensive discharge planning,
medication management, patient and family engagement, transition care
support, and transition communications.
At its press conference the MNA cited
the Minnesota Department of Health’s adverse health events report as a
reason for this bill. Are these events a result of inadequate nurse
- Absolutely not. Nurse staffing was identified as the root cause
in adverse events less than one percent of the time. In 2009, specific
staffing questions were added to the Adverse Health Events reporting
system to help hospitals identify whether staffing levels contributed to
a reportable event. Adverse events are much more often related to
failed communication among all team members or breakdowns in the system,
such as processes or protocols not being followed.
- For more information on staffing and adverse health events, see the Minnesota Department of Health’s information: http://www.health.state.mn.us/patientsafety/ae/staffingpatientsafety.pdf
- In recent research in California, researchers concluded that
higher registered nurse staffing per patient day had a limited impact on
adverse events in California hospitals.
The MNA’s bill authors say that “Study after study shows proper staffing lowers health care cost.”
This is false. Two studies reported the following:
- “The large wage increases for California nurses are important to
any assessment of the overall impact of California’s staffing
legislation and need to be considered by planners and policymakers in
other states who are considering the implementation of such ratios.
Furthermore, there are as yet unanswered questions about whether the
minimum-nurse staffing legislation met the policy goal of improving
quality of care.” (Health Affairs, Feb. 10, 2009)
- “Although the practice is intended to address problems in
hospital nurse staffing and quality of patient care, this commentary
argues that staffing ratios will lead to negative consequences for
nurses involving the equity, efficiency, and costs of producing nursing
care in hospitals.” (Nursing Outlook, March/April 2009)
Further, Minnesota already is ranked in the top quarter of states for
cost and quality of health care. According to the Centers for Medicare
and Medicaid, on average Minnesota hospitals are 9 percent less costly
than their national counterparts, while maintaining high quality.
The MNA claims that their bill will reduce health care costs.
- Mandatory staffing quotas would increase hospital labor costs —
TOTAL labor costs, not just nursing costs — by an average of 4 percent.
Hospital reimbursement rates already are under pressure from every
payer. This additional cost is unaffordable by hospitals and the
employers, individuals and taxpayers who pay the cost of health care. It
would have two immediate effects: health costs would increase and
hospitals would be forced to lay off caregivers and other employees to
accommodate the higher costs of registered nurses. Keep in mind, in Twin
Cities union hospitals, for example, an MNA nurse earns $44 an hour in
salary alone — not including benefits or pension costs. On a full-time
basis, that’s $91,500 per year that will have to be found for every
additional RN required by these quotas.
- In addition, a mandated staffing quota will raise costs across
the health care continuum because nurses will be drawn away from
positions in long-term care facilities, clinics or other health care
- When California passed its mandated quota bill in 1999, it also
appropriated $60 million to expand the supply of nurses at their state
institutions of higher learning.
One of the bill’s authors said at the
MNA’s press conference that this “legislation puts the decision at the
bedside and not at the Capitol.”
This does the exact opposite. It takes decisions away from nurse
leaders who work with bedside and charge nurses every day, hour by hour,
to staff according to the needs of patients and the mix and skill of
the care team and puts it in control of a politically appointed
workgroup in St. Paul.