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Stretched thin, nurses want a say when it comes to staffing

To stem burnout, the Keeping Nurses at the Bedside Act would require all Minnesota hospitals create staffing committees for each unit of a hospital. These committees would be made up of direct patient care staff, and would set upper limits on patients allowed per nurse. The decisions would be binding.

Casey Johnson, a Carlton County Health Nurse, gets a patient signed in to get a booster shot
Casey Johnson, a Carlton County Health Nurse, gets a patient signed in to get a booster shot at Fond du Lac Tribal and Community College on Tuesday, Feb. 8, 2022, in Cloquet, Minnesota.
Jed Carlson / Superior Telegram
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ROCHESTER, Minn. — The worst of the pandemic behind them, Minnesota's nurses want something more than a heartfelt thanks for their service.

It's not more money that they want, and it's not more vacation: They want a say in how their employers staff the floors where they work.

Two of the more consequential elements of the Keeping Nurses at the Bedside Act in the Minnesota House omnibus bill are meant to correct what front-line professionals say are management failures driving them from the profession.

The bill , introduced by Sen. Erin Murphy, DFL-St. Paul, and Rep. Liz Olson, DFL-Duluth, also includes provisions for violence prevention, recruitment and training of new nurses, mental health services, and greater transparency with hospital safety data.

But its requirement that all Minnesota hospitals establish a staffing committee for each unit of the facility — at least 50% of whom work in direct care and with 35% employed as registered nurses — is an attempt to offset forces they say are making hospitals unsustainable for those at the bedside.

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The staffing committees as proposed would be given a mandate to set maximum patient-to-nurse limits, cutoffs that would be locally created, posted, reviewed quarterly, but only contestable through arbitration. They would be made up of direct patient care staff, their decisions would be binding.

"They are sending patients home that used to be in the hospital," explained Becky Nelson of the Minnesota Nurses Association. "And the patients that are in the hospital now are sicker than they've ever been."

On top of this worsening of average patient health, Nelson says, where a typical staffing pattern for a medical-surgical ward would be one nurse to four patients, Metro hospitals are now assigning five or even six patients per nurse.

In the ICU, she says, where the norm once was one nurse to two ICU patients, those practices have also become negotiable.

"These are critically ill patients that could potentially arrest," said Nelson, who chairs the nursing association's Government Affairs Committee. "I've heard a lot of personal accounts where they can't get (extra nurses) to come in, and so they are taking on three ICU patients ... which is really not a safe scenario."

For Olson, the bill is an attempt to think beyond the current calls to recruit more candidates or remove obstacles for nurses from across state lines. She said it is to fundamentally fix the problems causing nurses to leave the profession in the first place.

Liz Olson.jpg
State Rep. Liz Olson, DFL-Duluth

"What the nurses are saying is, we're understaffed, and this is the solution," Olson said. "It's more expensive to recruit, educate and get new nurses in. We need to take care of the ones we have."

"We all agree we have a problem that we are having a staff shortage and need to do something," she added. "The nurses believe the best way to solve this is to keep your existing workforce working. ... This bill is rooted in what nurses are telling us is driving them out of the workforce."

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Jenna Sheldon of the Minnesota Hospital Association said that the organization "is opposed to the MNA bill which mandates that all hospitals must have a staffing committee made up of 50% union representation.

"The bill language states that the staffing committee would decide nurse staffing ratios — where a nurse would care for a set number of patients," Sheldon said in an email. "Staffing decisions would be taken away from hospitals and their nurse leaders and moved to a committee process."

The association says such a measure would restrict the ability of hospitals "to adjust staffing based on patient needs and nurse experience," and that "COVID-19 has reinforced that flexibility is needed at the bedside."

"Staffing and caring for patients are about more than the number of RNs, but rather the entire care team — each of whom brings a unique skill set in serving patients — team members like nurses’ aides, respiratory therapists, physical therapists, pharmacists, and physicians," the hospital association says.

The "bedside" bill will likely meet opposition in the GOP-led Senate, where lawmakers approved a plan to enter the state into a nursing licensure compact with dozens of other states.

Nelson is hopeful the bill is a departure from previous attempts to legislate maximum patient assignment for hospitals, because those were fixed, staff-to-patient ratios that were ultimately derided as one-size-fits-all.

"This gets to the heart of what we're looking for ... except it won't be set by the Legislature, it will be set by the individuals in a hospital," Nelson said. "This appears to be more palatable to the Legislature as a whole, and we're hoping that we can get some broader support."

"I recently had a daughter in the hospital," Olson says. "The person you see the most is not the charge nurse, and its not the administrators. It's that bedside nurse. They understand what the patient needs and they are the ones who are there, providing the most hands-on support through that entire process. So they are the ones that are asking to be a part of decision-making."

Paul John Scott is the health correspondent for NewsMD and the Forum News Service. He is a novelist and was an award winning magazine journalist for 15 years prior to joining the FNS in 2019.
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