ST. PAUL, Minn. - The long battle over nurse staffing levels in hospitals has switched from the picket lines to the halls of the Minnesota State Capitol.
Democratic lawmakers have introduced measures that would set minimum levels of registered nurses in the state's 148 hospitals. The standards, similar to those used in California, would vary by department and unit based on how critical the level of care is.
"Nurses working at the bedside tell me that they are at risk and I believe them," Sen. Jeff Hayden, the chief author in the Senate, told reporters at the Capitol Wednesday.
"We don't want to demonize or vilify our hospitals but what we really want to do is have conversation at the Capitol that really talks about these issues."
It's an issue that has become the main point of contention in recent contract talks between the state's largest nurses union, the Minnesota Nurses Association, and the 64 hospitals where its members work.
"One-two-three-four, more nurses on the floor!" was the rallying cry from MNA members in 2010 during their tense labor dispute with unionized hospitals.
The MNA contends shortages of registered nurses can lead to medical mistakes and injuries that stem from patient neglect.
"Too often, I and my colleagues are faced with the circumstances of ignoring someone in order to take care for someone else," Sandy Anderson, an RN and active MNA member, said during a Capitol press conference.
"That someone is perhaps a grandparent in a confused state who tries to get out of bed and falls."
Hospitals have long contended that hiring more nurses to meet a mandated nurse/patient ratio would be costly and drive up costs for institutions that are already being hit by low reimbursements from insurers and government health plans.
But Rep. Joe Atkins, the lead author of the bill in the House, contends that health care costs at those hospitals will drop in the long run if staffing levels are boosted.
"Study after study has shown this actually leads to a decrease in health care costs," Rep. Atkins, the South St. Paul Democrat who heads the House Commerce Committee, said.
"In states that have instituted this change, we've actually seen double digit decreases in the probability of death."
Atkins and Hayden tipped off the Minnesota Hospital Association about the legislation ahead of Wednesday's announcement. That organization maintains the idea will interfere with patient care.
"We believe that staffing decisions should be made locally with healthcare professionals in our hospitals," Mary Krinkie, Vice President of Government Affairs with the hospital association told KARE.
"We believe that physicians and nurses at the bedside should be making those decisions and not government."
Krinkie said the if hospitals are required by law to place more RN's on the schedule, the cost of those highly skilled employees will leave less room in the budget for other types of providers such as licensed practical nurses.
"If hospitals had to meet a government quota, we'd probably have to lay off other employees within the hospitals," Krinkie said.
"We involve physicians, RN's, nursing aids, LPNs, respiratory therapists, and others. It's about the care team approach."
Some rural hospitals in Minnesota rely more heavily on LPN's and nurses aids.
But MNA leaders said they've seen no hard evidence of the professional mix in hospital units being altered in states that required hospitals to have minimum number of RN's on duty.
One of the Democratic gubernatorial candidates who joined MNA nurses on the picket lines at the time was Mark Dayton, even those the MNA had formally endorsed one of his rivals, Rep. Margaret Anderson Kelliher.
Now that Dayton is governor, and both chambers of the legislature are controlled by his fellow Democrats, the minimum staffing standards legislation has better odds of passing than in the past.
But even the authors of the bills acknowledge that the proposal is controversial and is far from a slam dunk.
"We have professionals on both sides of the table. We've got folks that really care about their patients on both sides of this issue," Rep. Atkins remarked.
"We look forward to having that dialogue and coming up with a good solution, not just for nurses and not just for hospitals but for the patients they serve."
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