Minnesota Hospital Association

Policy & Advocacy

Past legislative efforts

The Nurse Staffing Plan Disclosure Act, passed in 2013, requires staffing plans to be shared with key hospital employees and annual nurse staffing plans to be publicly posted on MHA’s 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.

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

2013 session: HF 588/SF 471 

This legislation is the Nurse Staffing Plan Disclosure Act, a lasting compromise reached by legislators, hospitals and the nurses’ union to provide for greater transparency and reporting of nurse staffing levels in Minnesota hospitals. Requires Minnesota hospitals to submit core staffing plans to the Minnesota Hospital Association by Jan. 1, 2014, which will then post the plans on its website by April 1, 2014. “Core staffing plan” means the projected number of full-time equivalent nonmanagerial care staff that will be assigned in a 24-hour period to an inpatient care unit. Starting July 1, 2014, and every quarter thereafter, the website must be updated to include for every reporting hospital the actual direct patient care hours per patient per unit.   

Directs the commissioner of health to convene a work group to consult with the department as they study the correlation between nurse staffing levels and patient outcomes. This report shall be presented to the chairs and ranking minority members of the health and human services committees in the House of Representatives and the Senate by Jan. 15, 2015.    

Effective Aug. 1, 2013.

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.