MAY 15, 2023 – Debate is heating up as Minnesota legislators consider passing a bill that would limit Minnesotans’ access to hospital care.
The “Keeping Nurses at the Bedside Act” would establish staffing committees that set nurse staffing ratios. Rigid ratios would make it impossible for hospitals to adapt to the day-to-day needs of the patients who come to them for care: Hospitals would not be allowed to adjust staffing as the number and acuity of patients fluctuates.
This would limit the number of patients a hospital can treat. If passed, the bill could reduce current hospital capacity by 15% . . . leaving 70,000 patients a year without access to care.
Yesterday, House Speaker Melissa Hortman (DFL, Brooklyn Park) said on 4 News Sunday Morning that the House DFL caucus likely will agree to a deal on the nurse staffing bill that would exempt Mayo Clinic, after Mayo warned legislative leaders that more than $4 billion in investments planned in Minnesota could be jeopardized if the proposed law is approved in its current form. Hortman said, in part: “Mayo is an asset that is known all over the world. There are not other hospitals in the state that have kings and princes flying in to stay to get treatment.”
Hortman adds that Mayo Clinic “has a very good acuity tool that they use” to determine nursing staffing needs.
It is common practice for hospitals to use an acuity tool to adjust staffing based on the number and acuity (severity of illness) of patients.
“Many health systems across Minnesota have acuity tools like those at the Mayo Clinic, and to leave behind the Minnesotans they serve is unacceptable,” says Dr. Rahul Koranne, CEO of the Minnesota Hospital Association (MHA).
“Any alternative that works for any hospital and health system in Minnesota must work for every hospital and health system in Minnesota,” Koranne continues. “An alternative that benefits only one health system is not a solution at all.”
MHA asserts that the bill “requires significant changes. The current language introduces an alarming shift from patient-focused decision making within hospitals to litigation-driven decisions in courtrooms. It grants nurses the power to refuse patient assignments, a precedent that could jeopardize the timely provision of care.” The bill must be revised to ensure “it truly supports our shared goal of delivering exceptional patient care across Minnesota to all patients,” MHA states.
Northfield Hospital uses acuity tools that evaluate staffing in real time, adjusting nurse-to-patient ratios to accommodate higher- or lower-acuity patients. Acuity tools help nursing leaders set assignments to ensure nurses have equitable workloads. If there is a patient (or more) with unusually high acuity, the nursing staff, charge nurse, house supervisor and chief nursing executive huddle in real time to adjust staffing ratios.
Routine staffing is based on a ratio using the hospital’s history of total treated, taking into account the average number of discharges and admissions the unit has hour by hour during each day of the week.
If the hospital’s census is high and new patients need to be admitted, the charge nurse can call in more staff to ensure all patients get the care they need.