Legislative proposal would give Minnesota nurses more power to set staff levels
The nursing crisis and nurses' frustrations nurses are fueling support for the law, advocates say; hospital association says it would negatively impact patient care
RED WING, Minn. — Courtney Seipel has been a nurse for nearly a decade. She has loved the work and regards it as a kind of calling.
But earlier this month, fed up with the current state of the profession, Seipel decided to step away from her job as a full-time nurse at Mayo Clinic Health System in Red Wing.
The reason: Her vision of nursing no longer resembled the reality she was experiencing.
“I was questioning why I went into nursing, and that scared me,” Seipel said. “And it’s because I was so overwhelmed every shift, and I felt like I couldn’t provide the care for patients that I knew that they deserved.”
Seipel’s experience is increasingly a common one, say other nurses and advocates for the Minnesota Nursing Association, a labor union representing 22,000 registered nurses in the state. Nurses, according to one report, are leaving the job in large numbers.
Some 2,400 Minnesota nurses left bedside care in 2022, according to a new “Why We Left” report released Monday by the MNA. The report cites poor hospital management and chronic short staffing as the top issues driving nurses away from bedside care.
"Executives have created unsafe and unsustainable conditions for nurses and patients in our hospitals," the newly released report stated, citing surveys that say 50% of nurses are considering leaving the profession altogether. "By focusing on the bottom line, hospital executives are driving nurses away from the bedside, putting patient care at risk."
The nursing crisis and frustrations nurses are feeling, advocates say, are fueling support for a proposed new law that would give rank-and-file nurses greater say over staff levels.
The legislation, called “Keep Nurses at the Bedside,” mandates that hospitals form staffing committees with at least half the members being nurses and other caregivers. Minimum staffing levels for each hospital would be set by the committees, and the hospitals would be graded by the health commissioner on how well those staffing plans were being met.
The bill would apply to Olmsted Medical Center and Mayo Clinic in Rochester. Neither responded to inquiries seeking comment about the proposed legislation.
The Minnesota Hospital Association, which represents the state’s hospitals, warns that the bill's mandates would lead to unit closures, rising costs, longer wait times for patients, and the loss of vital services that communities rely on.
“If enacted, this proposal would have a drastic, negative impact on patient care,” the Minnesota Hospital Association said in a statement. “Patient needs are continually evolving, and the COVID-19 pandemic has further highlighted the importance of flexibility at the bedside.
The right balance
“Quality patient care depends on more than just the number of registered nurses. Creating a customized care plan for each patient requires an entire care team that includes nurses' aides, respiratory therapists, physical therapists, pharmacists, and physicians — each possessing a unique skill set,” it added.
The nursing shortage problem is not a new one. It’s just getting worse, officials say. Carrie Mortrud, a nursing staff specialist for Minnesota Nursing Association, said she left bedside care in 2005 “because staffing was so bad.”
Currently, there is no Minnesota law that limits the amount of patients that a nurse could be assigned in any unit at any time. For years, MNA tried unsuccessfully to pass bills in St. Paul that would mandate nurse-to-patient ratios depending on the patient population and the hospital care unit.
But legislators have been hesitant to involve themselves in an issue they feel is best left to hospital managers and nurses to negotiate and resolve.
Mortrud said the arguments in support of the current “Bedside” legislation are no different than the ones educators use seeking smaller classroom sizes. Educators are more effective in their jobs when classroom sizes are modest. The same holds true for nurses.
“There’s research that’s been done by professional organizations and researchers in health care, nursing, etc., that there is an appropriate number of patients where safe care can result in safe outcomes,” Mortrud said.
Seipel said she doesn’t pretend to speak for every hospital, including Mayo Clinic in Rochester. Her experiences are centered mostly on smaller, “baby” rural-based facilities in southeastern Minnesota. But she says the problem more or less exists “everywhere,” based on conversations she’s had with other nurses and news reports she has seen.
“I feel really passionate about it, because I think the public needs to know how short-staffed we are, and how it could impact their care, with call lights going off longer than we would like,” Seipel said.
Many nurses are leaving because of burnout. Many are opting to work remotely or become traveling nurses, where the pay can be three times greater than at a hospital. Many nurses figure, “If I’m going to have a tough day at work, I’m gonna go do traveling nursing and get paid three times as much," Seipel said.
Seipel said a “massive turnover” has occurred in her inpatient department and estimates that the department employs fewer than half the nurses it once did. Most of this turnover has occurred after the pandemic.
“We didn’t have anyone leave during the pandemic,” she said. “Now, the pandemic is better, but the working conditions are worse, really. We are really short-staffed. And I think part of that is traveling nursing became a big thing during the pandemic.”
Seipel said her hospital uses an electronic staffing system that says how many nurses should be working on a given day based on the number of patients it is caring for. But even in situations where the number of nurses working falls short of recommended staffing levels, “we’re still admitting patients beyond what we can handle.”
“There’s a lot of pressure,” she said. “If there’s an open bed, even if you don’t really have the staff to support it, we’re taking that patient.”
She said many hospitals unable to take more patients are diverting patients to other hospitals in the area. And some of these patients linger in the Red Wing hospital’s emergency room waiting for hours, if not days, for a bed. Her hospital has taken patients from all over southeastern Minnesota hospitals, including Albert Lea, Mankato, Austin, and places in Wisconsin.
“Sometimes, we will say, ‘Nope, we cannot handle any more patients.’ And then other days, there’s big pressure from upper management to take these patients. Our hands are tied,” she said.
Scheduling is also putting new pressures on nurses. It’s not unusual for nurses to work 12-hour shifts, but now many Red Wing nurses find themselves in less predictable situations as they are required to work both night and day shifts. For nurses with kids or just trying to find a sensible work-life balance, it plays havoc on their lives.
More than one shortage
Seipel said the shortage of nurses is exacerbated by a shortage of nursing assistants.
Assistant nurses normally cover basic tasks such as taking blood pressure or helping a patient to the bathroom, so registered nurses can focus on higher-end duties. But with their disappearance, registered nurses are “doing everything for all of those patients, all of the call lights, all of the bathroom trips, all of the RN duties.”
Seipel said the nursing shortage and overall harried nature of the work is forcing nurses to sacrifice a key part of their job: Getting to know their patients.
“A big reason why I left is I didn’t have time to really connect with my patients anymore. I didn’t have time to listen to what life was like before they got sick or what they did before they retired,” said Seipel, who now works remotely for another health care entity and picks up “supplemental” shifts at Mayo when she desires. "I was too busy."
But how would a committee fix a nursing shortage? Wouldn’t it just mask the problem?
Mortrud said Minnesota doesn’t lack nurses. The problem is rooted in nurses no longer “willing to work in these situations and circumstances.”
With more than 122,000 licensed nurses in the state, “we have more registered licensed nurses in Minnesota than we ever have before,” she said. The problem is the work conditions, she said.
A similar bill passed in the state House last year, but was stymied in the then GOP-led Senate. The DFL has a one-vote margin in the Senate this session; the bill’s prospects have consequently brightened.
DFL Sen. Liz Boldon, a 20-year nursing veteran whose district includes Mayo Clinic, supports the legislation. Many nurses have left the profession from burnout, and the pandemic worsened the situation. The nursing shortage was long projected to happen because of changing demographics and aging baby boomers.
“It’s important to be looking toward solutions,” she said. “I appreciate that this bill has started and continued those conversations around, how can we improve this?”