No other state has passed rigid nurse-to-patient staffing ratios since California became the first to do so 14 years ago. But when the Minnesota Legislature convened this year, it appeared poised to dictate to hospitals costly, controversial and unproven limits on how many patients a bedside nurse can care for.
The same unusual political constellation that favored California's staffing legislation had come together over Minnesota. Like California in 1999, Minnesota has a Democratic governor, Democratic majorities in both legislative chambers and a politically active nurses union intensely pushing staffing mandates, which would boost nurse hiring, as a panacea for patient-safety concerns.
Sure enough, nurse staffing legislation was introduced early in the session by some DFL lawmakers. While not specifically calling for California-style ratios, the plan as introduced would have mandated that hospitals meet staffing quotas developed by outside professional groups rather than allow health care facilities to more efficiently set their own nursing staff levels according to patient needs and on-duty nurses' experience and skills.
But Minnesota is not California. Our lawmakers' sensible handling of the "Standards of Care Act" is yet another reason to celebrate the difference.
Over the course of the session, the nurse staffing legislation has morphed into something far more cautious and pragmatic that strikes a calm balance between nurses' concerns about understaffing and state hospitals' objections to a mandate's cost and inflexibility.
The legislation is still a work in progress, but it now calls for compiling hospital staffing information on a public website, and having the respected Minnesota Department of Health (MDH) study staffing levels and patient outcomes.
These two steps, if executed with care, could yield Minnesota-specific information to help move the long-simmering debate beyond the talking points of both the nurses union and the hospitals.
The Minnesota Nurses Association, which made nursing ratios a signature issue during its tense 2010 contract negotiations with Twin Cities hospitals, has contended since that nurse understaffing puts patient safety at risk. It conceded on this issue in the settlement but has continued to publicize unverifiable anecdotal incidents reported to it by union members about situations in which patients may have been put at risk.
