With a carveout for Mayo Clinic, Minn. lawmakers advance standalone Keeping Nurses at the Bedside Act

ST. PAUL — Minnesota lawmakers advanced the Keeping Nurses at the Bedside Act as a standalone bill Thursday, separating it from the health omnibus legislation and exempting Mayo Clinic from the nurse staffing committee requirement.

Two weeks ago, Mayo Clinic’s opposition to KNABA turned into an ultimatum when a lobbyist for the Rochester-based health system said in a May 3 email to lawmakers that Mayo Clinic would move a multibillion dollar investment out of Minnesota if the state made Mayo Clinic subject to that staffing committee requirement and one other proposal , the Health Care Affordability Board.

A source said there are indications that another bill opposed by Mayo — a proposed Health Care Affordability Board — is dead for this session.

On Thursday, lawmakers separated KNABA from the House and Senate’s health omnibus legislation and made it a standalone bill under SF 1384 as a delete everything amendment. The committee recessed in the early evening Thursday with the intent to reconvene and potentially adopt the new language.

KNABA authors Sen. Erin Murphy, DFL-St. Paul; and Rep. Sandra Feist, DFL-New Brighton; met in the conference committee with Sens. Jim Abeler, R-Anoka; and Liz Boldon, DFL-Rochester; and Reps. Greg Davids, R-Preston; and Kaela Berg, DFL-Burnsville. Feist presented the A21 amendment of KNABA, which Murphy described as “narrowed down, streamlined” and “highly functional.”

“We have worked to create something that is the best of the compromises,” Murphy said. “We’re not going to have everybody’s support, and the hospitals will be able to speak for themselves. It is, I think, muscular, purposeful and it balances with the concerns that we’ve heard from various stakeholders along with the intention of what we want to achieve for nurses and safe staffing.”

Per the new bill language, the requirement to form a hospital nurse staffing committee does not apply to “a hospital that is a national referral center engaged in substantial programs of patient care, medical research, and medical education meeting state and national needs; that receives more than 40 percent of its patients from outside the state of Minnesota; and that is located outside the seven-county metropolitan area.”

“This is not a totally new concept,” Feist said of staffing committees, “but we would have all hospitals in Minnesota, except for Mayo, would have these important committees where nurses would have a voice.”

The exemption extends to hospitals owned by health systems in that definition — the intent is to make Mayo Clinic Health System hospitals also exempt from that portion of KNABA.

Another significant change to the KNABA is an extra mediation step before arbitration occurs in the event that a staffing committee cannot approve a hospital core staffing plan.

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“What this bill does is it has eliminated any possibility of arbitration as a mechanism for dispute resolution, anywhere at all, except for if the committee cannot agree on a core staffing plan,” Feist said.

The bill retains the establishment of a loan forgiveness program for certain health care professionals and provisions to prevent workplace violence against health care workers.

“Those who have been most concerned about this proposal, those entities who have had objection to, opposition to (the bill) have been very involved in this work product, even though they don’t necessarily support it,” Murphy said. “Much of what they’ve had to say, especially the hospital association, much of their work is reflected here.”

Mary Krinkie, vice president of government relations for the Minnesota Hospital Association, said during public testimony that MHA considers the changes made to KNABA are the “smaller changes” and shared some of the organization’s remaining concerns.

“The original language was based on a patient acuity model,” Krinkie said of the staffing committee changes. “We believe that that patient acuity model is the right approach to go rather than an exclusive carveout.”

Kate Johansen, vice chair of external engagement at Mayo Clinic, asked the committee to reconsider the amendment that Mayo Clinic previously provided to lawmakers that would let more health systems opt out of the staffing committee requirement.

Johansen also voiced a concern that the exemption for Mayo Clinic, as currently worded, would not actually apply to the health system.

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“If your intent is to exempt Mayo Clinic, the language that you currently have likely does not accomplish that objective for any of our sites,” Johansen said. “I would simply request again — I know things are very fast-moving — but time to review this language and provide thoughtful feedback so that you can achieve your stated intents, even if we do not agree with it, would be in the best interest of everyone involved.”

While Mary C. Turner, president of the Minnesota Nurses Association, was critical of Mayo Clinic and Gov. Tim Walz regarding the exemption, she said that lawmakers should advance the KNABA.

“When we fight for our career and when we fight for our profession, we are ultimately fighting for the patients of Minnesota and, ultimately, fighting for the people of Minnesota,” Turner said. “That has always been our motivation and always will.”

The Minnesota Legislature is required to adjourn its regular session on Monday, May 22.

Reporter Matt Stolle contributed to this story.