Hospitals Blatantly Disregard Minnesota Law
By Mathew Keller, RN JD
Patients, nurses, healthcare workers, and Minnesota citizens won a hard-fought victory in the 2013 legislative session when Governor Dayton signed into law the Staffing Plan Disclosure Act. The purpose of the Act was to increase hospital transparency and study the effects of nurse staffing on patient outcomes.
Minnesota Department of Health Cites Lack of Hospital Cooperation
In order to study nurse staffing under the law, the Minnesota Department of Health convened a workgroup consisting of nurses, hospital administrators, and other key stakeholders. Minnesota hospitals and others in the MDH workgroup agreed to many limits in data collection and study parameters in order to minimize the reporting burden for hospitals.
Regrettably, of 40 hospitals selected for inclusion in the legally mandated Staffing Plan Disclosure Act study, only one provided the required data. This egregious disregard for Minnesota law is unacceptable.
Minnesota Department of Health Finds Strong Evidence in Favor of Increased Nurse Staffing
Despite the complete lack of cooperation from Minnesota hospitals, MDH went ahead with the study in the form of an extensive literature review. According to the Department, “[Our] review of the extensive literature found strong evidence linking lower nurse staffing levels to higher rates of patient mortality, failure to rescue and falls in the hospital. There is also strong evidence that other care process outcomes such as drug administration errors, missed nursing care and patient length of stay are linked to lower nurse staffing levels.”
Nurse Staffing in Minnesota Hospitals is Getting Worse
Despite decades of robust research associating ideal nurse staffing with optimum patient outcomes and care, nurse staffing in this state is getting worse. Minnesota Nurses Association nurses self-report unsafe nurse staffing through a Concern for Safe Staffing Form, which is shared with first line supervisors and the Association.
In 2014, Minnesota nurses documented 2,148 instances of unsafe staffing with the potential to substantively impact patient care. Even one such instance would be concerning—but even scarier is that the reported rate of unsafe staffing has doubled over the past three years. Minnesota hospitals are not getting safer, they’re getting worse. This level of unsafe staffing is simply unacceptable for a state seen as a leader in healthcare.
Minnesota Hospitals are Becoming More Unsafe
In 2013, 80% of Minnesota hospitals reported preventable adverse events, representing over 96% of all Minnesota hospital beds. These events are often referred to as “never events,” since they are so preventable that they should never occur. Unfortunately, over the past ten years, Minnesota patients experienced 2,200 preventable never events, and in 2014, Minnesota patients suffered 258 never events—99 of which resulted in death or serious disability. Proper nurse staffing is the best way to prevent such adverse events.
Other studies and government agencies have found the quality of care in Minnesota hospitals is declining. Minnesota’s overall healthcare quality score fell 11 percent, according to the Agency for Healthcare Research and Quality (AHRQ), and Minnesota now ranks 15th on watchdog group Leapfrog’s Hospital Quality Safety Score, falling from top 10 status. In fact, only 30% of Minnesota hospitals received an “A” grade—down from 43% two years ago.
Another way to measure proper nurse staffing is through the percentage of patients who are readmitted to a hospital within 30 days of their initial hospital visit. Oftentimes, these readmissions are linked to care that nurses simply were not able to provide due to the lack of a limit on the number of patients a nurse can care for at one time.
In fact, hospitals can be penalized for these readmissions, costing them more money in the long run due to unsafe staffing. In 2014, 36 Minnesota hospitals were penalized by the Center for Medicare Services for high volumes of readmissions, with an average penalty of 0.4% of all Medicare payments. Alarmingly, the average penalty has doubled in the past year, showing that hospitals are getting worse at providing safe nurse staffing. Setting a standard for the maximum number of patients a nurse must care for at one time would go a long way to reducing readmission rates and halting the slide in hospital quality of care.
The Necessary Response is Clear
Because Minnesota’s hospitals are becoming less safe, because they refuse to cooperate with the legislature, the Minnesota Department of Health and the law, because they are cutting corners with nurse staffing, and because the quality of care they provide is getting worse, we need to enact a solution to the problem: a safe staffing law. Such a law would limit the number of patients a nurse can care for at one time, ensuring that each patient receives the nursing care she needs and deserves. As the evidence indicates, and as the hospitals evidently don’t want you to know, this will result in better quality care, better patient outcomes, lowered patient mortality, and fewer never events. In the long run, a limit on the number of patients a nurse can care for at one time will even save hospitals money; there will be lower readmission penalties and less non-reimbursed care for hospital-acquired infections. A safe staffing bill isn’t just the right thing to do—it’s the smart thing to do.