Minnesota Hospital Association


February 21, 2013

The facts about mandated staffing quotas

Legislation (SF 471/HF 588) has been introduced in the Minnesota Legislature that would transfer critical decisions on staffing from local hospitals to the government. The claims of supporters just don’t stand up to the facts:

Will the legislation improve Minnesota’s hospitals?

Claim: “The MNA contends shortages of registered nurses can lead to medical mistakes and injuries that stem from patient neglect.” (KARE-TV news report) Reality: Minnesota’s hospitals already are the national leaders in quality and safety. The most recent evaluation of the Agency for Healthcare Research and Quality ranks Minnesota’s health system as the best in the country. Hospital care is a core strength, according to the report. On 13 indicators of patient safety, the “HealthGrades Patient Safety in American Hospitals Study” ranks hospitals in Minneapolis-St. Paul as the best in the nation among metro areas of at least 1 million people.

What’s wrong with staffing standards?

Claim: “The legislation asks hospitals, when developing assignments, to abide by nationally accepted, evidence-based standards established by professional specialty organizations.” (ECM Publications news article) Reality: The legislation would lead to rigid staffing quotas, not standards. In fact, there are no national standards. Four of the organizations identified in the legislation as models of standards actually have different views on “nationally accepted standards” and on mandated staffing ratios. Mandatory staffing quotas would raise hospital labor costs an estimated 4 percent — costs that must be passed on to individuals, employers and taxpayers. 

Will this put nurses in charge of scheduling … and isn’t that a good thing?

Claim: “… we haven’t had a good conversation about patient-nurse staffing ratios in our hospitals, where life and death is at issue,” according to a legislator. (Reported by the St. Paul Pioneer Press) Reality: Nurses already drive staffing decisions; in fact, in hospitals around the state, nurse leaders work with bedside nurses and other caregivers to create schedules that reflect the needs of patients and the skill and experience of nurses and other caregivers on every shift. 

How will this affect the day-to-day scheduling decisions of local hospitals? 

Claim: “(A state legislator) says this legislation puts the decision of patient’s safety in hospitals at the bedside and not at the Capitol.” (Reported by northlandsnewscenter.com) Reality: The legislation tells a different story. The bill calls for a commission of 12 people — nine nurses, two public representatives and one hospital representative — to develop staffing regulations. In other words, the bill would have government-set staffing quotas that local hospitals must follow with no flexibility. In fact, the bill also proposes sanctions for those hospitals that don’t follow the quotas. 

 Is there evidence to support either side of the discussion?

Claim: “Study after study has shown this (legislation) actually leads to a decrease in health care costs.” (A state legislator quoted on KARE-11) Reality: Respected organizations and the facts argue against staffing quotas. To cite just a few of the many examples:
  • The American Nurses Association’s “Principles for Nurse Staffing” emphasizes the need for flexibility and to staff according to the acuity of patients as opposed to a fixed number.
  • The Center for Medicare and Medicaid Services (CMS) does not allow for standardized guidelines. They require each patient be assessed for an individualized care plan.
  • Supporters of this bill argued that additional RNs would reduce readmissions, yet Minnesota hospitals have already prevented 4,000 readmissions over the past 18 months.
  • Only California has passed legislation mandating staffing quotas. The result?
    • California’s overall system of care is on the borderline of “weak” and “average,” dragged down by “weak” hospital care measures, according to the Agency for Healthcare Research and Quality (the same nationally regarded group that ranks Minnesota as best in the country).
    • When cost is the measure, California loses to Minnesota on that count as well. According to Kaiser State Health Facts, hospital expenses per inpatient day are approaching $2,700 in California. They are $1,731 in Minnesota.