News Column

Nurse Staffing Standards Pass Partisan Test in Minnesota House

Feb 22, 2013

Christopher Snowbeck

The push to mandate nurse staffing levels in Minnesota hospitals appears to be developing into a partisan battle at the Capitol.

DFLers and Republicans lined up on opposite sides of a bill to enforce staffing standards as the legislation cleared its first committee hurdle by a 9-6 vote Thursday, Feb. 21.

The bill does not specify particular nurse-to-patient ratios. It instead would direct medical centers to implement staffing standards set by professional societies or a group appointed by the state health commissioner.

Democratic-Farmer-Labor Party legislators on the House labor committee voted unanimously to support of the measure, which is backed by the state's largest nurses union.

All Republicans on the panel voted against the bill, which is opposed by hospitals.

Both chambers of the Legislature are controlled by DFL majorities. DFL Gov. Mark Dayton has not taken a position on the bill.

Hospitals contend the legislation would impose quotas that would drive up the cost of care and eliminate flexibility to make staffing decisions. Nurses, however, say hospital managers too often create dangerous situations for patients by failing to adequately staff units.

"My one motive here is patient safety," said Rep. Joe Atkins, DFL-Inver Grove Heights, who is chief author of the bill.

Referring to testimony from nurses Thursday that described patient safety risks stemming from low staffing levels, Atkins said: "Clearly, there is a demand for something

that sets the bar."

Rep. Mark Uglem, R-Champlin, countered that the bill "intrudes on the management-labor relationship a great deal. ... You need that flexibility."

Hospitals argue that medical centers in Minnesota are among the safest and highest quality in the country. They say the standards set forth in the bill wouldn't improve care but ultimately would give power to "a politically appointed work group," testified Lawrence Massa, president of the Minnesota Hospital Association.

Under the bill, a committee of nine nurses, a hospital representative and two members of the public would be created to set staffing standards.

"The only outcome from (a union) work group is quotas," Massa said.

A companion bill was introduced this month in the Senate; it has not had a hearing.

The House bill would have at least three more committee stops if it continues to move forward, said Rep. Sheldon Johnson, DFL-St. Paul, who chairs the labor committee.

In arguing against the bill, hospitals say staffing standards for registered nurses would force them to cut jobs for other workers. On Thursday, the bill was amended to stipulate that no hospital registered nurses, licensed practical nurses or nurse assistants would be laid off as a result of the legislation.

The change doesn't help, hospitals said.

"It would make it impossible to implement this," said Wendy Burt, spokeswoman for the Minnesota Hospital Association.

"Minnesota has done a good job in controlling the rising cost of health care. This would eliminate all the work that's been done without any improvement in outcomes or patient safety."

Naomi Freyholtz, a nurse at Sleepy Eye Medical Center in the south-central town of Sleepy Eye, testified that nurses at her hospital recently organized a bargaining unit under the Minnesota Nurses Association because of concerns about patient safety.

She said 31 nurses have quit over unsafe staffing concerns in the past three years.

"Understaffing occurs on all shifts," Freyholtz said. "We have to live with the moral distress that we may have overextended ourselves past the point where we can safely care for our patients."

Nurse understaffing can lead to long waits before emergency room patients can be admitted to beds, testified Joe Howard, a nurse in the burn unit at Miller Dwan Medical Center in Duluth.

"We continue to have situations where two nurses are taking care of 18 patients," Howard testified. "We continue to ask for more help, but we're told there are no nurses available to come in."

Linda Hamilton, president of the Minnesota Nurses Association union, testified that nurses' patient safety concerns are backed up by the state Department of Health's annual report on hospital problems, including medication errors, patient falls and bed sores.

But hospitals say those same health department reports show that staffing is seldom the root cause of such problems. They point to a report from the federal Agency for Healthcare Research and Quality to support assertions that Minnesota hospitals provide high-quality care.

To attract the best nurses, Minnesota hospitals pay wages that are higher than the national average, testified Mary Pynn, chief nursing quality officer at the St. Paul-based HealthEast care system.

The average hourly rate for a union nurse in the Twin Cities is $44 per hour, she said, while the national average is about $29 per hour.

Hospitals have argued that one result of a 1999 law in California to mandate staffing ratios was an increase in nurse salaries.

Medical centers rely on registered nurses to work with managers to adjust staffing levels as needed, testified Sandra McCarthy, chief nursing officer at Essentia Health, a hospital and clinic system based in Duluth.

That flexibility works, she said, and would be threatened by the bill.

"We depend on nurses to make good judgments about the care of patients but also about the flow of work and being able to move staff as needed," McCarthy said.

"I have heard very few instances when nurses need additional staff to a unit based on acuity or numbers that has not been met. We have been able to move staff."

But DFLers on the committee were not convinced.

"We are not mandating quotas," said Rep. Erik Simonson, DFL-Duluth. "We are mandating a referral to national standards."

Rep. Peter Fischer, DFL-Maplewood added: "We've done staffing ratios in many other industries."

The House bill now moves on to the Government Operations Committee.

Christopher Snowbeck can be reached at 651-228-5479. Follow him at Twitter.com/chrissnowbeck.

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Distributed by MCT Information Services



Source: (c) 2013 the Pioneer Press (St. Paul, Minn.)


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