Minnesota Hospital Association

Policy & Advocacy

Past legislative efforts

The Nurse and Patient Safety Act, passed in 2023 focuses on violence prevention efforts in hospitals and health systems. MHA is unwavering in its support for legislation addressing workplace violence and the workforce shortage confronting our statewide system of care. We affirm our commitment to work in collaboration with our dedicated care teams, including nurses, and welcome all assistance in addressing these challenges in service of those who matter most - our patients. 

Despite the collaborative goals of this compromise, MNA continues to put forth proposals to mandate a nurse staffing ratio. Hospitals and health systems maintain that staffing decisions are best made at your local hospital by health care professionals closest to the bedside.

Current law

Nurse and Patient Safety Act

The Nurse and Patient Safety Act has was passed in the 2023 Legislative Session and became effective on July 1, 2023. Most of the new violence prevention requirements for hospitals regarded establishing a transparent and inclusive process to incorporate input from direct care employees into the workplace violence prevention plans. Training must, at a minimum, include: 

  • Safety guidelines for response to and de-escalation of an act of violence
  • Ways to identify potentially violent or abusive situations, including aggression and violence predicting factors
  • The hospital's preparedness and incident response action plans for acts of violence, including how the health care worker may report concerns about workplace violence within each hospital's reporting structure without fear of reprisal, how the hospital will address workplace violence incidents, and how the health care worker can participate in reviewing and revising the plan
  • Any resources available to health care workers for coping with incidents of violence, including but not limited to critical incident stress debriefing or employee assistance programs

MDH report on hospital nurse staffing and patient outcomes

As part of the Nurse Staffing Plan Disclosure Act, the Minnesota Legislature directed the Minnesota Department of Health (MDH) to study the correlation between nurse staffing levels and patient outcomes. The law also required MDH to convene a work group to consult with the department in the process of conducting the study.

MDH published “Hospital Nurse Staffing and Patient Outcomes: A Report to the Minnesota Legislature” in January 2015. In his cover letter to legislators, then-Commissioner of Health Ed Ehlinger wrote, “At this point, 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.” 

Other legislative proposals

2015 session: HF 1654/no Senate companion

Sponsored by the Minnesota Nurses Association (MNA), this legislation would have given the commissioner of health responsibility for establishing the minimum number of nurses on duty and directed the commissioner to form a work group to review evidence-based literature to develop a minimum number of nurses required during all shifts and on all patient care units. The legislation would have called for creating a 12-person work group comprised of at least seven MNA members. The commissioner would have been able to impose a civil penalty of not less than $25,000 for each hospital failing to comply, including the failure to staff any patient care unit at the required levels. The commission would have been required to post on its website all incidents of noncompliance on a quarterly basis. The legislation would amend the Adverse Health Events law so that any event that caused a patient to have an extended hospital stay or readmission that was caused fully or partially by "unsafe staffing levels" as determined by the patient's direct care RN at the time of the event would be reportable under the Adverse Health Events law.

While this legislation received an informational hearing in the House, no vote was taken. No Senate companion was introduced during the 2015 legislative session.

2017 session: HF 2155/no Senate companion

This legislation sought to establish requirements for the assignment of direct-care registered nurses. Under the legislation, if any direct-care registered nurse determines that staffing levels are inadequate and notifies the unit’s charge nurse and a manager or administrative supervisor, the manager or supervisor shall review options to address the staffing level inadequacies. If the staffing inadequacies cannot be resolved and resources cannot be reallocated after considering the options and factors, the hospital shall call in extra staff to ensure adequate staffing to meet safe patient standards. Until extra staff arrive and begin to receive patient assignments the hospital must suspend nonemergency operations and elective surgeries that routinely lead to inpatient hospitalization; the charge nurse for the unit with inadequate staffing levels is authorized to close the unit to new patient admissions and in-hospital transfers; and a direct-care registered nurse is authorized to refuse an assignment that is unsafe, in the nurse’s professional opinion.   

This legislation did not receive a hearing in the House, but it was offered as an amendment to another bill on the House floor. That amendment was defeated.

2017 session: HF 2650/SF 2382

This legislation would have required hospitals to provide direct-care registered nurse staffing at levels consistent with nationally accepted standards and report shift-level nurse staffing numbers by hospitals on the MHA nurse staffing website and to the commissioner of health. It also would have required the staffing plan to have consent of union representatives, required new patient safety committees in hospitals, prohibited retaliation and imposed civil penalties.   

This legislation was introduced too late in the 2017 legislative process to be considered by a committee.