Mayo Clinic wins full exemption from nurse staffing bill in agreement with state leaders

State lawmakers say they will exempt Mayo Clinic from a bill aimed at increasing nurse staffing levels, ending a two-week standoff that began when the hospital sent an email to the governor’s office threatening to move billions of dollars in future investments out of state if the bill was not gutted.

All of Mayo Clinic’s facilities in Minnesota will be fully exempt from the union-backed bill (SF1384), which will require all other hospitals to form staffing committees made up equally of direct care workers and hospital leaders.

The Democrats’ retreat in the face of Mayo’s threat is a reminder of the influence of the state’s largest private sector employer, whose influence spans the globe. As House Speaker Melissa Hortman recently said on WCCO TV, “There are not other hospitals in the state that have kings and princes flying in to stay to get treatment.”

The authors of the nurse staffing bill — called Keeping Nurses at the Bedside — previously said they were committed to moving forward with the legislation without an exception for Mayo. Similar versions of the bill had already passed both the House and Senate, but lawmakers say Gov. Tim Walz insisted.

“The governor has said that  … from his perspective … it’s better for Mayo to be carved out,” said Sen. Erin Murphy, DFL-St. Paul, the lead author of the bill. “I don’t agree, but I want, for the 90% of hospitals that are going to benefit from this legislation, I want for us to proceed.”

Mary Turner, president of the nurses’ union, called the carve out a “betrayal” by Walz, who has often touted his support for the union and joined nurses on the picket line during a strike last fall.

A separate bill aimed at reining in rising health care costs has also been watered down at the behest of Mayo, according to the bill’s author, Rep. Liz Reyer, DFL-Eagan.

Reyer proposed creating a health care affordability board that would have had the power to fine hospitals for exceeding spending growth targets. Mayo Clinic said the bill was a non-starter.

Under Reyer’s new plan, which she said she drafted without input from hospital leaders, the state will create a health affordability program that will study the drivers of rising health care costs more broadly but not publicly evaluate individual health systems.

“I’m disappointed in the heavy-handed approach that Mayo used. I’m not happy about that. At all,” said Reyer, DFL-Eagan. But she said she’d take half a loaf: “I am really, really excited about the potential for some really good work … And that’s where I’m focusing now.”

Mayo Clinic’s ultimatum over the nursing bill was not the first time it strong-armed lawmakers over its legislative agenda. In 2013, the Mayo Clinic also made a last-minute threat that it would bring billions in investments for Rochester’s Destination Medical Center to another state if lawmakers didn’t contribute $500 million toward the project.

This time around, the hospital never offered details about what future investments they would pull out of the state — only that it would be four times the size of the $1.1 billion U.S. Bank Stadium. Lawmakers said they, too, were in the dark about what they were being asked to gut legislation for. Walz’s office did not respond to questions about the project or whether he knows what specifically was at stake.

Asked if lawmakers received assurances from Mayo Clinic that the investments would proceed because of the exemption, Hortman said only they have had numerous conversations with the hospital.

After appealing to the governor’s office, the Mayo Clinic also lobbied trade unions — whose workers would ostensibly build a multi-billion dollar development — to turn against the nurses’ union and support an exemption for the hospital. No union took a public position on the bill, however.

The prospect that the state’s richest health system would get special treatment has outraged other hospital leaders, who have been lobbying to kill the nurse staffing bill since the beginning of session.

“If there is an exemption for one hospital or health system in Minnesota, it must be available to all,” Minnesota Hospital Association President and CEO Rahul Koranne said during a news conference on Thursday.

The Minnesota Hospital Association, which represents over a hundred hospitals across the state, has tried to win last-minute concessions in the scrum over the nurse staffing bill.

But other hospitals in the state don’t have the same leverage as Mayo Clinic. And Walz has said he believes Mayo Clinic is special enough to warrant special treatment.

“We’ve always supported making sure that our nurses are supported, have what they need. We also understand that Mayo Clinic’s a unique entity where it’s focusing globally on it,” Walz said.

The nurse staffing bill was tucked into a sprawling health and human services bill, which lawmakers are still debating with just a few days left in the legislative session. Worried that their bill could be watered down as the governor and lawmakers search the bill for bargaining chips, Murphy and Rep. Sandra Feist, DFL-New Brighton, decided to try to pass the nurse staffing bill on its own.

On Thursday, Murphy and Feist formed a conference committee made up of members of the House and Senate, including two Republicans, to hammer out the final details of the bill and pass it on its own.

The nurse staffing bill will require hospitals to form committees with 35% of the members direct care nurses and 15% other direct care staff. The committees will create “core staffing plans” that include the minimum number of full-time care staff that will be assigned to each inpatient unit, and the maximum number of patients each nurse can typically safely care for.

If signed into law, Minnesota would join eight other states with similar requirements for staffing committees, according to the American Nurses Association. California and Massachusetts have more stringent government-mandated nurse-to-patient ratios, which the Minnesota Nurses Association has sought in previous years but couldn’t rally enough political support for.

Under the bill, the health commissioner must develop a grading system to judge how well each hospital complies with its staffing plans and post the grades on the agency’s website beginning in 2027. That will require the Minnesota Department of Health to analyze and evaluate at least 136 separate hospital staffing plans. The bill also requires hospitals to publicly post emergency department wait times along with core staffing plans.

In addition to staffing committees, the bill includes incentives to recruit more nurses, including a student loan forgiveness program for hospital nurses and funding for mental health support.

The Mayo Clinic has touted the advanced software it uses to make staffing decisions based on patient acuity. Other hospital leaders say they use similar software that is more effective than staffing ratios, because they can adapt when there are patients who require intensive care.

Union nurses say hospital managers routinely schedule too few nurses to save money, which forces nurses to take on more patients than they can safely handle. Nurses at two of Mayo Clinic’s rural satellite facilities said they are no exception.

“Mayo relies on last-minute, Jerry-rigging, duct-taping tactics that are not acceptable for nurses and patients,” said Kari Wilkemeyer, a nurse at Mayo Clinic’s facility in Austin, Minn., during a news conference. “There are many times when we’ve taken more than we should.”

The nurses’ union say the bill is critical to shoring up staffing levels amid a dire shortage of nurses that leads to worse patient outcomes and makes workers more vulnerable to violence.

The union points to data from the Minnesota Department of Health, which show a 33% increase in adverse health events in hospitals, such as falls, bed sores and deaths. And they point to surveys that show unsafe staffing levels are a main reason nurses cite for leaving the bedside and argue minimum staffing levels will reduce burn-out and draw more nurses back to hospitals.

Hospital leaders say there simply aren’t enough nurses to hire, and that mandatory staffing minimums will prove disastrous to their precarious finances. The Minnesota Hospital Association has warned lawmakers that the bill will result in a 15% reduction in hospital capacity, affecting 70,000 people in Minnesota.

“My question for the Legislature and the governor is where will our patients receive care if our doors closed because of the staffing mandates in this bill?” said Tori Wagner, the director of nursing at Mahnomen Health in northern Minnesota, during a Thursday news conference.

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