Minnesota lawmakers cut nurse staffing ratios from union-backed bill due to Mayo Clinic, industry pushback

Disputes between Minnesota’s hospital and nursing associations over a state bill introducing nurse-to-patient staffing ratios concluded Monday with lawmakers removing the contentious requirement but retaining other provisions around workplace violence protections and benefits assistance.

With Minnesota’s legislative session coming to a close that night, authors of the Keeping Nurses at the Bedside Act said they had lost the votes to pass the bill in its original form following opposition from Mayo Clinic and other provider organizations. The version that passed was renamed as the Nurse and Patient Safety Act.

“Today, my heart breaks for the patients in Minnesota,” Mary Turner, president of the Minnesota Nurses Association (MNA), said through tears during a Monday press conference. “We came here to pass the Keeping Nurses at the Bedside Act. Because of the power and influence of corporate healthcare executives, that bill has died. And I’m heartbroken.

“For those nurses who choose to stay at the bedside, the language in this agreement will help them to feel safe in their jobs,” Turner said. “It will help them to care for their children, to find relief from heavy student loans. It will meaningfully improve the lives and the work of those nurses who choose to stay in our profession.”

The bill, introduced in February, drew quick opposition from the Minnesota Hospital Association, which released a statement in March warning that the required staffing committees and ratios outlined in the bill would “reduce hospital care capacity by 15% and threaten care for 70,000 patients in Minnesota.”

Still, the legislation had plenty of momentum and had successfully passed through both of Minnesota’s legislative bodies and multiple hearings, said Sen. Erin Murphy, the bill’s chief author, a member of Minnesota’s Democratic party affiliate and a registered nurse.

She said the train didn’t begin to derail until Mayo sought, and received, an exemption after threatening to pull billions of dollars in future investments out of the state should the requirements become law. The $16 billion annual revenue system successfully argued that it and other systems that rely on “advanced tools” like acuity-based staffing software shouldn’t be subjected to “a government-mandated staffing model and complex regulatory structure that will limit the autonomy and flexibility needed to allow Mayo to do what it does best.”

The carve-out drew additional critiques from Minnesota hospitals that would not be exempt under the revised bill as well as other stakeholders such as the MNA, who denounced Minnesota Gov. Tim Walz “for his abdication of good government and acquiescence to anti-democratic and anti-labor corporate bullies.”

With time in the lawmaking session running short, the bill’s supporters weren’t able to rally enough support to pass the staffing ratio requirements. The rewritten Nurse and Patient Safety Act was passed in both bodies with bipartisan support before the end of the session and now awaits Walz’s signature.

“I can’t say enough how hard it is to make a compromise like this one, and it is a hard-fought compromise,” Murphy said during the press conference. “… The work that we have been doing to keep nurses [and] patients focused on this legislation really got subsumed by a fight among corporate entities—Mayo and the other corporate hospitals—and it essentially dominated and replaced the debate we’ve been having about nursing and patient safety. And that is unfortunate.”

The Nurse and Patient Safety Act includes “several nursing-related provisions previously part of the larger bill, including a study on nurse staffing and retention, new protections against workplace violence, and childcare assistance and student loan forgiveness for nurses,” according to the MNA.

In a statement, the Minnesota Hospital Association said it appreciated “the legislators' thoughtful consideration and their willingness to listen to our concerns regarding legislation impacting patient care.

“The Minnesota Hospital Association 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.”

In a statement given to reporters, Mayo Clinic President and CEO Gianrico Farrugia, M.D., thanked the governor and legislative leadership for expressing “firm support for Mayo Clinic and for our desire to grow and invest in healthcare and our communities.”

Fierce Healthcare has reached out to the system for additional comment.