Minnesota 2025-2026 Regular Session

Minnesota House Bill HF2289 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1.1 A bill for an act
2	2	1.2 relating to health; requiring hospitals to provide registered nurse staffing at levels
3	3	1.3 consistent with nationally accepted standards; requiring reporting of staffing levels;
4	4	1.4 prohibiting retaliation; imposing civil penalties; appropriating money; amending
5	5	1.5 Minnesota Statutes 2024, sections 144.7055; 148.264, subdivision 1; proposing
6	6	1.6 coding for new law in Minnesota Statutes, chapter 144.
7	7	1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
8	8	1.8 Section 1. [144.592] QUALITY PATIENT CARE ACT.
9	9	1.9 Subdivision 1.Title.Sections 144.592 to 144.596 may be cited as the "Quality Patient
10	10	1.10Care Act."
11	11	1.11 Subd. 2.Definitions.(a) For purposes of sections 144.592 to 144.596, the following
12	12	1.12terms have the meanings given.
13	13	1.13 (b) "Assignment" means the provision of care to a patient for whom a direct-care
14	14	1.14registered nurse has responsibility within the nurse's scope of practice.
15	15	1.15 (c) "Charge nurse" means a nurse who:
16	16	1.16 (1) oversees and supports a nursing staff for each shift;
17	17	1.17 (2) serves as a unit resource and carries out duties that include assigning patients to
18	18	1.18nurses in the oncoming shift, coordinating patient flow, relieving staff for breaks, and
19	19	1.19operating as a safety valve in addressing emergency patient care issues and fluctuations in
20	20	1.20patient acuity and nursing intensity on the unit; and
21	21	1.21 (3) has received special orientation and training to serve as a charge nurse for a unit or
22	22	1.22department in a hospital.
23	23	1Section 1.
24	24	REVISOR SGS/DD 25-0396403/10/25
25	25	State of Minnesota
26	26	This Document can be made available
27	27	in alternative formats upon request
28	28	HOUSE OF REPRESENTATIVES
29	29	H. F. No. 2289
30	30	NINETY-FOURTH SESSION
31	31	Authored by Johnson, P.; Berg; Stephenson; Norris; Rehrauer and others03/13/2025
32	32	The bill was read for the first time and referred to the Committee on Health Finance and Policy 2.1 (d) "Commissioner" means the commissioner of health.
33	33	2.2 (e) "Direct-care registered nurse" means a registered nurse, as defined in section 148.171,
34	34	2.3subdivision 20, who is nonsupervisory and nonmanagerial and who directly provides nursing
35	35	2.4care to patients more than 60 percent of the time.
36	36	2.5 (f) "Health care emergency" means a situation that creates an actual or imminent serious
37	37	2.6threat to the health and safety of persons and that may require hospitals and other health
38	38	2.7care facilities to provide an exceptional level of emergency services or other health care
39	39	2.8services. A health care emergency may include a natural or man-made disaster or an illness
40	40	2.9or health condition caused by bioterrorism or an infectious agent that causes a high probability
41	41	2.10of a large number of deaths, serious or long-term disabilities, or substantial future harm.
42	42	2.11 (g) "Nursing intensity" means a patient-specific, not diagnosis-specific, measurement
43	43	2.12of nursing care resources expended during a patient's hospitalization. A measurement of
44	44	2.13nursing intensity includes the complexity of care required for a patient and the knowledge
45	45	2.14and skill needed by a nurse for the surveillance of patients in order to make continuous,
46	46	2.15appropriate clinical decisions in the care of patients.
47	47	2.16 (h) "Patient acuity" means the measure of a patient's severity of illness or medical
48	48	2.17condition, including but not limited to the stability of physiological and psychological
49	49	2.18parameters; the dependency needs of the patient and the patient's family; and any other
50	50	2.19factors influencing the perceived health care needs of an individual patient as determined
51	51	2.20by a licensed provider, direct-care registered nurse, or other licensed health care professional
52	52	2.21whose primary job duties include providing care to patients more than 60 percent of the
53	53	2.22time. Higher patient acuity requires more intensive nursing time and advanced nursing skills
54	54	2.23for continuous surveillance.
55	55	2.24 (i) "Skill mix" means the composition of nursing staff by licensure, experience, and
56	56	2.25education, including but not limited to registered nurses, licensed practical nurses, and
57	57	2.26unlicensed personnel.
58	58	2.27 (j) "Surveillance" means the continuous process of observing patients for early detection
59	59	2.28and intervention in an effort to prevent negative patient outcomes.
60	60	2.29 (k) "Unit" means an area or location of a hospital where patients receive care based on
61	61	2.30similar patient acuity and nursing intensity.
62	62	2.31 Subd. 3.Compliance.A hospital licensed under sections 144.50 to 144.56 must comply
63	63	2.32with this section and sections 144.593 to 144.595 as a condition of licensure.
64	64	2Section 1.
65	65	REVISOR SGS/DD 25-0396403/10/25 3.1 Subd. 4.Staffing.A hospital must, at all times, provide enough qualified registered
66	66	3.2nursing personnel on duty to provide the standard of care that is necessary for the well-being
67	67	3.3of the patients, consistent with nationally accepted, evidence-based standards established
68	68	3.4by this section and professional nursing specialty organizations. A direct-care registered
69	69	3.5nurse assigned to a patient shall directly provide the planning, supervision, implementation,
70	70	3.6assessment and evaluation of nursing care to the patient, and is responsible for the provision
71	71	3.7of care to a particular patient within the nurse's scope of practice.
72	72	3.8 Subd. 5.Staffing plans.A hospital must adopt and implement a staffing plan that
73	73	3.9specifies the maximum number of patients that may be assigned to a direct-care registered
74	74	3.10nurse for each unit of the hospital in order to ensure adequate staffing levels for patient
75	75	3.11safety. Staffing plans adopted and implemented under this subdivision must establish staffing
76	76	3.12levels that include the flexibility to increase the number of nurses required for a unit when
77	77	3.13necessary for patient safety. Staffing plans must also include patient-to-staff ratios for
78	78	3.14nursing assistants and other direct-care staff providing nursing services directly to patients.
79	79	3.15Staffing plans must be developed in agreement with direct-care registered nurses and must
80	80	3.16comply with the requirements in subdivision 6. The staffing plan must be made available
81	81	3.17to all employees within the facility, officers or other representatives of labor unions with
82	82	3.18collective bargaining agreements in place with one or more employees in the facility, and
83	83	3.19the Department of Health. The staffing plan must be agreed upon by any existing collective
84	84	3.20bargaining units impacted by the staffing plan before it may be approved by the
85	85	3.21commissioner.
86	86	3.22 Subd. 6.Assignment limits for direct care registered nurses.(a) A staffing plan
87	87	3.23developed under subdivision 5 may not permit direct-care registered nurses to be assigned
88	88	3.24more patients than the following for any shift:
89	89	3.25 (1) one registered nurse to one patient:
90	90	3.26 (i) in operating rooms;
91	91	3.27 (ii) in trauma units;
92	92	3.28 (iii) for patients who require immediate lifesaving interventions;
93	93	3.29 (iv) for hemodynamically unstable patients whose care needs include immediate response
94	94	3.30to life-threatening conditions;
95	95	3.31 (v) for patients demonstrating compromised or otherwise unstable vital signs creating
96	96	3.32life-threatening conditions requiring immediate response;
97	97	3.33 (vi) for pregnant patients in active delivery;
98	98	3Section 1.
99	99	REVISOR SGS/DD 25-0396403/10/25 4.1 (vii) for patients in postanesthesia;
100	100	4.2 (viii) for patients with conditions or health care needs that pose an immediate threat to
101	101	4.3life or limb;
102	102	4.4 (ix) for trauma patients requiring lifesaving interventions or patients with other conditions
103	103	4.5qualifying as a trauma code activation; and
104	104	4.6 (x) for unstable patients requiring transfer to another unit;
105	105	4.7 (2) one registered nurse to two patients in:
106	106	4.8 (i) postanesthesia care units;
107	107	4.9 (ii) critical care units;
108	108	4.10 (iii) intensive care units;
109	109	4.11 (iv) any units treating intensive care unit patients within the emergency room;
110	110	4.12 (v) neonatal intensive care;
111	111	4.13 (vi) labor and delivery;
112	112	4.14 (vii) coronary care;
113	113	4.15 (viii) acute respiratory care; and
114	114	4.16 (ix) burn units;
115	115	4.17 (3) one registered nurse to three patients in:
116	116	4.18 (i) intermediate care newborn nurseries;
117	117	4.19 (ii) antepartum units;
118	118	4.20 (iii) adult medical and surgical units;
119	119	4.21 (iv) units providing both labor and delivery and postpartum services;
120	120	4.22 (v) postpartum couplets units providing services for infants and mothers;
121	121	4.23 (vi) step-down units;
122	122	4.24 (vii) telemetry units;
123	123	4.25 (viii) pediatric units; and
124	124	4.26 (ix) emergency departments;
125	125	4.27 (4) one registered nurse to four patients in:
126	126	4.28 (i) acute psychiatric units;
127	127	4Section 1.
128	128	REVISOR SGS/DD 25-0396403/10/25 5.1 (ii) rehabilitation care units;
129	129	5.2 (iii) chemical dependency units;
130	130	5.3 (iv) immediate care nursery or Level II nursery; and
131	131	5.4 (v) any other specialty care or patient care units organized to provide care for a specific
132	132	5.5medical condition, disease, diagnosis, or patient population for which specific assignment
133	133	5.6limits are not established in this paragraph; and
134	134	5.7 (5) one registered nurse to five patients for skilled nursing units.
135	135	5.8 (b) Nothing in this subdivision:
136	136	5.9 (1) requires a hospital with lower patient assignment limits than those established in
137	137	5.10paragraph (a) to increase its assignment limits;
138	138	5.11 (2) requires a hospital to establish patient assignment limits for any units named within
139	139	5.12this subdivision in which the hospital does not organize, operate, and maintain a unit that
140	140	5.13provides the same services as those units listed in this subdivision; and
141	141	5.14 (3) limits the rights of organized nurses to bargain on the issue of patient assignment
142	142	5.15limits.
143	143	5.16 (c) In determining ratios for each unit, there shall be no averaging of the number of
144	144	5.17patients and the total number of licensed bargaining unit nurses on the unit during any one
145	145	5.18shift nor over any period of time. Only licensed bargaining unit nurses providing direct
146	146	5.19patient care shall be included in the ratios, and no other staffing combinations or utilization
147	147	5.20of nonnursing staff may be deployed to reduce or otherwise alter the number of nurses
148	148	5.21assigned to a given unit. The ratios established shall be in place for all shifts throughout the
149	149	5.22calendar year.
150	150	5.23 Subd. 7.Schedule for compliance.Hospitals must comply with the assignment limits
151	151	5.24in subdivision 6 no later than August 1, 2027, except that hospitals in a rural area, as defined
152	152	5.25in United States Code, title 42, section 1395ww(d)(2)(D), must comply no later than August
153	153	5.261, 2029. The commissioner of health shall establish a schedule by which hospitals must
154	154	5.27comply with assignment limits and shall establish, maintain, and enforce proper
155	155	5.28implementation of assignment limits within licensed hospitals.
156	156	5.29 Subd. 8.Application of assignment limits to hospital nursing practice standards.A
157	157	5.30patient assignment may be included in the calculation of direct-care registered
158	158	5.31nurse-to-patient assignment limits established in subdivision 6 only if care is provided by
159	159	5Section 1.
160	160	REVISOR SGS/DD 25-0396403/10/25 6.1a direct-care registered nurse and the provision of care to the particular patient is within
161	161	6.2that direct-care registered nurse's validated competence.
162	162	6.3 Subd. 9.Nursing administrators and supervisors.A hospital shall not include a nursing
163	163	6.4administrator or supervisor in the calculation of direct-care registered nurse-to-patient
164	164	6.5assignment limits established in subdivision 6. For purposes of this subdivision, "nursing
165	165	6.6administrator or supervisor" includes a nurse administrator, nurse supervisor, nurse manager,
166	166	6.7charge nurse, chief nursing officer, or any other nursing staff whose regular job duties do
167	167	6.8not include providing direct patient care during at least 60 percent of working hours.
168	168	6.9 Subd. 10.Application of assignment limits.The assignment limits established in
169	169	6.10subdivision 6 represent the maximum number of patients to which a direct-care registered
170	170	6.11nurse may be assigned at all points during a shift. A hospital is prohibited from averaging
171	171	6.12the number of patients and the total number of direct-care registered nurses assigned to
172	172	6.13patients in a unit during any one shift or over any period of time in order to meet the
173	173	6.14assignment limits established in subdivision 6.
174	174	6.15 Subd. 11.Assignments, assignment adjustments, and adding additional registered
175	175	6.16nurses.(a) A hospital must assign nurses, nursing assistants, and any other nursing or
176	176	6.17direct-care personnel to the patient population consistent with the hospital's staffing plan
177	177	6.18and the assignment limits established in subdivision 6. For each patient population, a
178	178	6.19direct-care registered nurse shall evaluate the following factors to assess and determine
179	179	6.20adequacy of staffing levels to meet patient care needs:
180	180	6.21 (1) composition of skill mix and roles available;
181	181	6.22 (2) patient acuity;
182	182	6.23 (3) experience level of registered nurse staff;
183	183	6.24 (4) unit activity level, such as admissions, discharges, and transfers;
184	184	6.25 (5) variable staffing grids;
185	185	6.26 (6) availability of a registered nurse to accept an assignment; and
186	186	6.27 (7) nursing intensity.
187	187	6.28 (b) A hospital shall not:
188	188	6.29 (1) assign or otherwise direct nursing staff to provide patient care to a patient unless the
189	189	6.30direct-care registered nurse is able to demonstrate current competence in providing care to
190	190	6.31any relevant patient populations and has received orientation, training, and experience
191	191	6.32sufficient to provide competent care to the patient and that patient population;
192	192	6Section 1.
193	193	REVISOR SGS/DD 25-0396403/10/25 7.1 (2) assign a direct-care registered nurse to provide patient care to a patient if the nurse's
194	194	7.2professional opinion leads the nurse to believe that accepting the additional patient assignment
195	195	7.3would force the nurse to violate any provisions of the Minnesota Nurse Practice Act, under
196	196	7.4sections 148.171 to 148.285;
197	197	7.5 (3) assign nursing personnel from a supplemental nursing services agency to provide
198	198	7.6patient care to a patient population until the agency nurse is able to demonstrate validated
199	199	7.7competence in providing care to that patient population and has received orientation sufficient
200	200	7.8to provide competent care to the patient population; or
201	201	7.9 (4) assign unlicensed personnel to:
202	202	7.10 (i) perform direct-care registered nurse functions in lieu of care delivered by a direct-care
203	203	7.11registered nurse;
204	204	7.12 (ii) perform tasks that require the assessment, judgment, or skill of a direct-care registered
205	205	7.13nurse; or
206	206	7.14 (iii) perform functions of a direct-care registered nurse under the supervision of a
207	207	7.15direct-care registered nurse.
208	208	7.16 (c) If any direct-care registered nurse determines that a unit's staffing levels are inadequate
209	209	7.17and notifies the unit's charge nurse and a manager or administrative supervisor, the manager
210	210	7.18or administrative supervisor shall consider the following:
211	211	7.19 (1) current patient care assignments for potential redistribution;
212	212	7.20 (2) the ability to facilitate discharges, transfers, and admissions;
213	213	7.21 (3) the availability of additional staffing resources; and
214	214	7.22 (4) the hospital-wide census and staffing.
215	215	7.23 (d) If the staffing inadequacies cannot be resolved and resources cannot be reallocated
216	216	7.24by the manager or administrative supervisor after considering the factors in paragraph (c),
217	217	7.25the hospital shall call in extra staff to ensure adequate staffing to meet safe patient standards.
218	218	7.26 (e) Until extra staff arrive and begin to receive patient assignments:
219	219	7.27 (1) the hospital must suspend nonemergency admissions and prescheduled elective
220	220	7.28surgeries that are not life-threatening but routinely lead to in-patient hospitalization; and
221	221	7.29 (2) the charge nurse for the unit with inadequate staffing levels is authorized to close
222	222	7.30the unit to new patient admissions and in-hospital transfers after all good-faith efforts to
223	223	7.31bring in additional staffing to alleviate excessive boarding issues in the emergency department
224	224	7Section 1.
225	225	REVISOR SGS/DD 25-0396403/10/25 8.1have been explored by appropriate hospital management staff, and that any open beds and
226	226	8.2available units within the facility are being operationalized to the fullest extent in order to
227	227	8.3meet patient needs.
228	228	8.4 Subd. 12.Prohibited actions.A hospital must not take any of the following actions as
229	229	8.5a means to meet staffing standards:
230	230	8.6 (1) use mandatory overtime;
231	231	8.7 (2) assign or transfer a direct-care registered nurse to a patient care unit until after the
232	232	8.8nurse has been adequately trained and oriented to work on the unit;
233	233	8.9 (3) assign a direct-care registered nurse to a patient care unit to relieve another direct-care
234	234	8.10registered nurse during breaks, meals, or other routine and expected absences from a unit,
235	235	8.11until after the nurse being assigned demonstrates current competence in providing care on
236	236	8.12a particular unit and has received orientation to that hospital's unit sufficient to provide
237	237	8.13competent care to patients in that unit;
238	238	8.14 (4) impose layoffs of licensed practical nurses, licensed psychiatric technicians, certified
239	239	8.15nursing assistants, or other ancillary staff to meet the assignment limits established in
240	240	8.16subdivision 6; and
241	241	8.17 (5) assign a direct-care registered nurse any patient assignments that would, in the nurse's
242	242	8.18professional judgment, require the nurse to violate the Minnesota Nurse Practice Act, under
243	243	8.19sections 148.171 to 148.285, if the nurse were to accept a patient assignment as directed by
244	244	8.20a supervisor or manager. A hospital may not discharge, discipline, penalize, interfere with,
245	245	8.21threaten, restrain, coerce, or otherwise retaliate or discriminate against a nurse who
246	246	8.22communicates their objection to a patient assignment based on the requirements of the Nurse
247	247	8.23Practice Act.
248	248	8.24 Subd. 13.Exemption; emergency situations.The assignment limits established in
249	249	8.25subdivision 6 do not apply during a health care emergency if a hospital needs to provide an
250	250	8.26exceptional level of emergency services or other health care services. If a health care
251	251	8.27emergency causes a change in the number of patients on a unit, a hospital must make prompt
252	252	8.28and diligent efforts to maintain staffing levels consistent with the assignment limits in
253	253	8.29subdivision 6. The commissioner shall provide guidance to hospitals describing situations
254	254	8.30that constitute a health care emergency for purposes of this subdivision.
255	255	8.31 Subd. 14.Charge nurse; inclusion in staffing grid.In order to facilitate optimal patient
256	256	8.32care, a charge nurse shall not be included in the unit's staffing grid that is regularly reviewed
257	257	8.33and determines the unit's staffing budget. This subdivision does not limit the ability of a
258	258	8Section 1.
259	259	REVISOR SGS/DD 25-0396403/10/25 9.1charge nurse to take a patient assignment in the event of an emergency when taking a patient
260	260	9.2assignment, in the charge nurse's professional opinion, will not jeopardize overall patient
261	261	9.3care for all patients on the unit at that time.
262	262	9.4 Sec. 2. [144.593] PATIENT CARE; USE OF TECHNOLOGY .
263	263	9.5 Subdivision 1.Patient-acuity adjustable units prohibited.Patients shall be cared for
264	264	9.6only on units or patient care areas where the level of intensity, type of care, and direct-care
265	265	9.7registered nurse-to-patient assignment limits meet the individual requirements and needs
266	266	9.8of each patient.
267	267	9.9 Subd. 2.Use of technology.(a) A hospital shall not employ video monitors or any form
268	268	9.10of electronic visualization of a patient as a substitute for the direct observation required for
269	269	9.11patient assessment by a direct-care registered nurse or required for patient protection. Video
270	270	9.12monitors or any form of electronic visualization of a patient shall not be included in the
271	271	9.13calculation of assignment limits in section 144.592, subdivision 6.
272	272	9.14 (b) A hospital shall not employ technology that limits a direct-care registered nurse from
273	273	9.15performing functions that are part of the nursing process, including full exercise of
274	274	9.16independent professional judgment in assessment, planning, implementation, and evaluation
275	275	9.17of care, including the use of artificial intelligence technology in lieu of the expertise of
276	276	9.18licensed health care professionals.
277	277	9.19 Sec. 3. [144.594] SAFE PATIENT ASSIGNMENT COMMITTEE.
278	278	9.20 Subdivision 1.Committee required.By October 1, 2026, a hospital must establish a
279	279	9.21Safe Patient Assignment Committee either by creating a new committee or assigning the
280	280	9.22functions of a staffing for patient safety committee to an existing committee.
281	281	9.23 Subd. 2.Membership; compensation.At least 60 percent of the committee's membership
282	282	9.24must be nonsupervisory and nonmanagerial registered nurses who provide direct patient
283	283	9.25care, as defined in section 144.592, subdivision 2, paragraph (e). The committee must include
284	284	9.26members appointed by a collective bargaining unit, if one exists, to proportionately represent
285	285	9.27the bargaining unit's nurses. Hospitals must compensate registered nurses who are employed
286	286	9.28by the hospital and serve on the Safe Patient Assignment Committee for time spent on
287	287	9.29committee business.
288	288	9.30 Subd. 3.Duties.A Safe Patient Assignment Committee shall:
289	289	9.31 (1) complete a staffing for patient safety assessment by March 31, 2026, and annually
290	290	9.32thereafter that identifies the following:
291	291	9Sec. 3.
292	292	REVISOR SGS/DD 25-0396403/10/25 10.1 (i) problems of insufficient staffing, including but not limited to an inappropriate number
293	293	10.2of registered nurses scheduled in a unit, inappropriately experienced registered nurses
294	294	10.3scheduled for a particular unit, inability for nurse supervisors to adjust for increased acuity
295	295	10.4or activity in a unit, and chronically unfilled positions within the hospital;
296	296	10.5 (ii) units that pose the highest risk to patient safety due to inadequate staffing; and
297	297	10.6 (iii) solutions for problems identified under items (i) and (ii);
298	298	10.7 (2) implement and evaluate assignment limits in section 144.592, subdivision 6;
299	299	10.8 (3) convert assignment limits in section 144.592, subdivision 6, into registered nurse
300	300	10.9hours of care per patient;
301	301	10.10 (4) recommend a mechanism for tracking and analyzing staffing trends within the
302	302	10.11hospital;
303	303	10.12 (5) develop a procedure for making shift-to-shift adjustments in staffing levels consistent
304	304	10.13with section 144.592, subdivision 11, when adjustments are required by patient acuity and
305	305	10.14nursing intensity; and
306	306	10.15 (6) identify any incidents when the hospital has failed to meet the assignment limits in
307	307	10.16section 144.592, subdivision 6, and recommend a remedy.
308	308	10.17Sec. 4. [144.595] RETALIATION PROHIBITED.
309	309	10.18 A hospital shall not retaliate against or discipline a direct-care registered nurse, either
310	310	10.19formally or informally, for:
311	311	10.20 (1) refusing to accept an assignment if, in good faith and in the nurse's professional
312	312	10.21judgment, the nurse determined that the assignment is unsafe for patients due to patient
313	313	10.22acuity and nursing intensity;
314	314	10.23 (2) reporting a concern regarding safe staffing levels; or
315	315	10.24 (3) communicating an objection, based on the nurse's own professional judgment, that
316	316	10.25accepting a specific or additional patient assignment would force the nurse to violate the
317	317	10.26Minnesota Nurse Practice Act under sections 148.171 to 148.285.
318	318	10.27Sec. 5. [144.596] ENFORCEMENT .
319	319	10.28 (a) The commissioner shall impose a civil penalty of not less than $25,000 for each
320	320	10.29incident of a hospital failing to comply with sections 144.592 to 144.595, including failure
321	321	10.30to staff patient care units to required levels.
322	322	10Sec. 5.
323	323	REVISOR SGS/DD 25-0396403/10/25 11.1 (b) The commissioner must publicly report on the department website all incidents of
324	324	11.2noncompliance with sections 144.592 to 144.595 on a quarterly basis, beginning September
325	325	11.31, 2026.
326	326	11.4 Sec. 6. Minnesota Statutes 2024, section 144.7055, is amended to read:
327	327	11.5 144.7055 STAFFING PLAN REPORTS.
328	328	11.6 Subdivision 1.Definitions.(a) For the purposes of this section, the following terms have
329	329	11.7the meanings given.
330	330	11.8 (b) "Core staffing plan" means the projected number of full-time equivalent
331	331	11.9nonmanagerial care staff that will be assigned in a 24-hour period to an inpatient care unit.
332	332	11.10 (c) "Nonmanagerial care staff" means registered nurses, licensed practical nurses, and
333	333	11.11other health care workers, which may include but is not limited to nursing assistants, nursing
334	334	11.12aides, patient care technicians, and patient care assistants, who perform nonmanagerial
335	335	11.13direct patient care functions for more than 50 percent of their scheduled hours on a given
336	336	11.14patient care unit.
337	337	11.15 (d) "Inpatient care unit" means a designated inpatient area for assigning patients and
338	338	11.16staff for which a distinct staffing plan exists and that operates 24 hours per day, seven days
339	339	11.17per week in a hospital setting. Inpatient care unit does not include any hospital-based clinic,
340	340	11.18long-term care facility, or outpatient hospital department.
341	341	11.19 (e) "Staffing hours per patient day" means the number of full-time equivalent
342	342	11.20nonmanagerial care staff who will ordinarily be assigned to provide direct patient care
343	343	11.21divided by the expected average number of patients upon which such assignments are based.
344	344	11.22 (f) "Patient acuity tool" means a system for measuring an individual patient's need for
345	345	11.23nursing care. This includes utilizing a professional registered nursing assessment of patient
346	346	11.24condition to assess staffing need.
347	347	11.25 (f) "Direct-care registered nurse" means a registered nurse, as defined in section 148.171,
348	348	11.26subdivision 20, who is nonsupervisory and nonmanagerial and is directly providing nursing
349	349	11.27care to patients more than 60 percent of the time.
350	350	11.28 Subd. 2.Hospital staffing report.(a) The chief nursing executive or nursing designee
351	351	11.29of every reporting hospital in Minnesota under section 144.50 will shall develop a core
352	352	11.30staffing plan for each patient care unit.
353	353	11.31 (b) Core staffing plans shall specify the full-time equivalent for each patient care unit
354	354	11.32for each 24-hour period. following:
355	355	11Sec. 6.
356	356	REVISOR SGS/DD 25-0396403/10/25 12.1 (1) the definition of the patient care unit;
357	357	12.2 (2) the number of beds available in each patient care unit;
358	358	12.3 (3) the average number of patients per day in each patient care unit; and
359	359	12.4 (4) the full-time equivalent for each patient care unit broken down by:
360	360	12.5 (i) shift, based on eight-hour shifts of 7:00 a.m. to 3:00 p.m., 3:00 p.m. to 11:00 p.m.,
361	361	12.6and 11:00 p.m. to 7:00 a.m.; and
362	362	12.7 (ii) type of staff assigned, including but not limited to registered nurses, licensed practical
363	363	12.8nurses, certified nursing assistants, and other additional care team members.
364	364	12.9 (c) Prior to submitting the core staffing plan, as required in subdivision 3, hospitals shall
365	365	12.10consult with and obtain consent from representatives of the hospital medical staff, managerial
366	366	12.11and nonmanagerial care staff, and other relevant hospital personnel about nonmanagerial
367	367	12.12care staff and all affected exclusive bargaining representatives of nonmanagerial care staff
368	368	12.13regarding the core staffing plan and the expected average number of patients upon which
369	369	12.14the staffing plan is based. Direct-care registered nurses must certify the report as accurate
370	370	12.15and clearly presented by majority vote of direct-care registered nurses on staff at the hospital
371	371	12.16or by the exclusive bargaining representative if represented by a collective bargaining unit.
372	372	12.17 Subd. 3.Standard electronic reporting developed.(a) Hospitals must submit the core
373	373	12.18staffing plans to the Minnesota Hospital Association by January 1, 2014 on a quarterly
374	374	12.19basis. The Minnesota Hospital Association shall include each reporting hospital's most
375	375	12.20recently submitted core staffing plan on the Minnesota Hospital Association's Minnesota
376	376	12.21Hospital Quality Report website by April 1, 2014 within three months after submission.
377	377	12.22Any substantial changes to the core staffing plan shall be updated within 30 days.
378	378	12.23 (b) The Minnesota Hospital Association shall include on its website for each reporting
379	379	12.24hospital on a quarterly basis the actual direct patient care hours per patient, per shift, based
380	380	12.25on eight-hour shifts of 7:00 a.m. to 3:00 p.m., 3:00 p.m. to 11:00 p.m., and 11:00 p.m. to
381	381	12.267:00 a.m., and per unit. Hospitals must submit the direct patient care staffing report to the
382	382	12.27Minnesota Hospital Association by July 1, 2014, and quarterly thereafter. each quarter, and
383	383	12.28the Minnesota Hospital Association must post the actual direct patient care staffing report
384	384	12.29on the hospital quality reporting website within three months of receiving the reports.
385	385	12.30 Subd. 4.Enforcement of reporting requirements.(a) The commissioner shall impose
386	386	12.31a civil penalty of not less than $25,000 for each hospital that fails to comply with subdivisions
387	387	12.322 and 3, including failure to report by the deadline or failure to provide information according
388	388	12.33to the requirements of this section. Each day of the violation shall constitute a separate
389	389	12Sec. 6.
390	390	REVISOR SGS/DD 25-0396403/10/25 13.1violation and the penalties prescribed shall be applicable to each separate violation unless
391	391	13.2otherwise indicated.
392	392	13.3 (b) At a minimum, the commissioner must publicly report on the department website
393	393	13.4all incidents of noncompliance with subdivision 2 or 3.
394	394	13.5 Subd. 5.Staffing grid; compliance; enforcement.(a) A hospital must submit its staffing
395	395	13.6grid to the commissioner quarterly and, when scheduling staff for a patient care unit, must
396	396	13.7schedule at least the number and skill mix of staff specified in the staffing grid for that unit.
397	397	13.8 (b) The commissioner shall accept complaints from persons employed by a hospital
398	398	13.9regarding situations in which a hospital scheduled fewer staff for a patient care unit than
399	399	13.10the number of staff specified in the hospital's staffing grid, or a skill mix that differed
400	400	13.11substantially from the skill mix specified in the hospital's staffing grid. The commissioner
401	401	13.12shall impose a civil penalty of not less than $25,000 for:
402	402	13.13 (1) a hospital that fails to submit its staffing grid according to paragraph (a); or
403	403	13.14 (2) situations in which the commissioner determines that a hospital scheduled fewer
404	404	13.15staff for a patient care unit than the number of staff specified in the staffing grid or scheduled
405	405	13.16a skill mix of staff that differed substantially from the skill mix specified in the hospital's
406	406	13.17staffing grid; and
407	407	13.18 (3) situations in which the commissioner determines that persistent understaffing within
408	408	13.19a facility has led to an increase in adverse health events or instances of workplace violence,
409	409	13.20or continues to pose safety risks for workers or patients.
410	410	13.21Sec. 7. Minnesota Statutes 2024, section 148.264, subdivision 1, is amended to read:
411	411	13.22 Subdivision 1.Reporting.(a) Any person, health care facility, business, or organization
412	412	13.23is immune from civil liability or criminal prosecution for submitting in good faith a report
413	413	13.24to the board under section 148.263 or for otherwise reporting in good faith to the board
414	414	13.25violations or alleged violations of sections 148.171 to 148.285. All such reports are
415	415	13.26investigative data as defined in chapter 13.
416	416	13.27 (b) Any registered nurse or health care worker who experiences and subsequently reports
417	417	13.28a level of staffing that, in the registered nurse's or health care worker's professional judgment,
418	418	13.29could reasonably be expected to result in unsafe or ineffective patient care cannot be
419	419	13.30disciplined under section 148.261, subdivision 1, clause (8). These reports may include a
420	420	13.31report from a registered nurse or health care worker to the registered nurse's or health care
421	421	13.32worker's supervisor at the supervisor's place of employment, the Board of Nursing, the
422	422	13Sec. 7.
423	423	REVISOR SGS/DD 25-0396403/10/25 14.1commissioner of health, or a professional nursing organization. Reports must be made within
424	424	14.2ten calendar days after the incident occurred in order to be covered under this paragraph.
425	425	14.3 Sec. 8. APPROPRIATION.
426	426	14.4 $....... in fiscal year 2026 and $....... in fiscal year 2027 are appropriated from the general
427	427	14.5fund to the commissioner of health for enforcement activities in Minnesota Statutes, section
428	428	14.6144.7055, subdivision 5.
429	429	14Sec. 8.
430	430	REVISOR SGS/DD 25-0396403/10/25