Minnesota Hospital Association


November 01, 2018

Hospitals and nurses share the same goal - delivering high-quality, safe patient care

Nurses, physicians, pharmacists, therapists and staff from all disciplines work together as a team to support a culture of safety.

  • Minnesota's hospitals value the important and trusted role our nurses play in providing high-quality care. Every day, nurse leaders work with bedside and charge nurses to appropriately staff units based on individual patient needs and on the training, experience and capabilities of the care team.
  • Hospitals and health systems have robust processes in place for nurses or other staff to raise and resolve patient safety concerns. Hospitals encourage all staff to report any potentially unsafe situation.

Hospitals and health systems agree that staffing is important to delivering high-quality care.

  • Safe, high-quality patient care is delivered by a care team that includes more than nurses – physicians, nursing assistants, therapists such as PT or respiratory, dietitians and more.
  • There are many variables to consider in terms of what constitutes safe, efficient staffing for a particular hospital unit. Every patient care unit is different based upon the types of patients cared for on that unit, and the way in which care is organized and delivered.
  • The condition of the patient, the experience of the care team, and the mix of the care team has as much to do with patient outcomes – if not more – as the number of nurses.

Staffing decisions are best made at your local hospital by health care professionals closest to the bedside.

  • Minnesota hospitals have processes in place to appropriately staff each unit. To ensure safe, high-quality care, hospital staffing models are developed and implemented to adjust and flex up and down on the basis of patient needs and the experienced judgment of the nurses on the unit.

Legislators, hospitals and the nurses’ union worked hard in 2013 develop a lasting compromise that would provide for greater transparency and reporting of nurse staffing levels in Minnesota hospitals.

  • Under the Nurse Staffing Plan Disclosure Act, staffing plans are shared with key hospital employees and annual nurse staffing plans are publicly posted on the Minnesota Hospital Association’s (MHA) quality website, www.mnhospitalquality.org.
  • Hospitals are required to report on a quarterly basis how their actual nurse staffing levels and patient census compared to their nurse staffing plans. This information has been posted online since July 1, 2014, and is updated quarterly.

Studies of staffing do not show a relationship between nurse staffing decisions and patient outcomes.

  • In 2015, the Minnesota Department of Health completed a report to the Legislature studying the correlation between nurse staffing levels and patient outcomes. The commissioner of health wrote, “Available studies do not prove causal relationship, or indicate that changes in patient outcomes are solely the result of nurse staffing decisions; they also do not identify points at which staffing levels become unsafe or begin to have negative effects on outcomes.”
  • Despite multiple studies by academic researchers throughout the country, no definitive staffing level number has been identified to ensure quality outcomes for patients.
  • Conducting his own analysis of hospital quality measures and staffing, a health and quality expert from the University of St. Thomas showed that there is only a weak correlation, and it is not possible to determine the ideal mix or number of care providers – including all of the other members of the care team such as physicians or nursing assistants – for a given workload of patients.

Minnesota's hospitals are places of healing – and hospitals want to ensure that they remain safe for patients, visitors, nurses and all staff.

  • In 2014, MHA and the Minnesota Nurses Association were part of a broad coalition of health care stakeholders developing prevention strategies and responses to workplace violence. The coalition’s work resulted in a road map for health care organizations to help identify risks for violence and put effective strategies in place. The road map and supplemental resources can be found on MHA’s website.
  • The 2015 Legislature passed a law requiring hospitals and health systems to have a violence prevention plan and a committee that includes front-line, direct care workers to review annual incidents of workplace violence. In addition, hospitals must provide workplace violence prevention training to new employees and annually to direct care employees.

Massachusetts voters in 2018 defeated a ballot initiative that would have put mandated ratios in all units in all hospitals at all times. 

  • Prior to the November election, the Massachusetts Health Policy Commission released an independent study on how mandated nurse-to-patient staffing ratios contained in the ballot question would affect the Massachusetts health care system. The study found that a mandate would cost the state up to $949 million annually, would most likely result in "no systematic improvement in patient outcomes" and would adversely affect community hospitals serving a high proportion of MassHealth and Medicare patients. 

Multiple independent quality organizations rank Minnesota among the top for health care quality.

  • The federal Agency for Healthcare Quality and Research (AHRQ) has ranked Minnesota among the best states overall for health care quality in the nation. This report is considered the gold standard for measuring the health care quality performance of states.
  • Minnesota is ranked third in the nation for health care access, quality and outcomes by the Commonwealth Fund, a private foundation. Minnesota was one of only two states rated in the top quartile for all five dimensions measured – access and affordability, prevention and treatment, avoidable hospital use and cost, healthy lives, and disparity.
  • A report from the Centers for Medicare and Medicaid Services (CMS) shows that Minnesota is among the lowest-cost states for hospital care. Adding these quality and cost factors together, Minnesota offers among the best health care value of any state in the nation.