Minnesota 2025-2026 Regular Session

Minnesota Senate Bill SF2775 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	25-03964 as introduced03/10/25 REVISOR SGS/DD
25	25	SENATE
26	26	STATE OF MINNESOTA
27	27	S.F. No. 2775NINETY-FOURTH SESSION
28	28	(SENATE AUTHORS: PORT, Abeler, McEwen, Kupec and Hoffman)
29	29	OFFICIAL STATUSD-PGDATE
30	30	Introduction and first reading03/20/2025
31	31	Referred to Labor 2.1 (d) "Commissioner" means the commissioner of health.
32	32	2.2 (e) "Direct-care registered nurse" means a registered nurse, as defined in section 148.171,
33	33	2.3subdivision 20, who is nonsupervisory and nonmanagerial and who directly provides nursing
34	34	2.4care to patients more than 60 percent of the time.
35	35	2.5 (f) "Health care emergency" means a situation that creates an actual or imminent serious
36	36	2.6threat to the health and safety of persons and that may require hospitals and other health
37	37	2.7care facilities to provide an exceptional level of emergency services or other health care
38	38	2.8services. A health care emergency may include a natural or man-made disaster or an illness
39	39	2.9or health condition caused by bioterrorism or an infectious agent that causes a high probability
40	40	2.10of a large number of deaths, serious or long-term disabilities, or substantial future harm.
41	41	2.11 (g) "Nursing intensity" means a patient-specific, not diagnosis-specific, measurement
42	42	2.12of nursing care resources expended during a patient's hospitalization. A measurement of
43	43	2.13nursing intensity includes the complexity of care required for a patient and the knowledge
44	44	2.14and skill needed by a nurse for the surveillance of patients in order to make continuous,
45	45	2.15appropriate clinical decisions in the care of patients.
46	46	2.16 (h) "Patient acuity" means the measure of a patient's severity of illness or medical
47	47	2.17condition, including but not limited to the stability of physiological and psychological
48	48	2.18parameters; the dependency needs of the patient and the patient's family; and any other
49	49	2.19factors influencing the perceived health care needs of an individual patient as determined
50	50	2.20by a licensed provider, direct-care registered nurse, or other licensed health care professional
51	51	2.21whose primary job duties include providing care to patients more than 60 percent of the
52	52	2.22time. Higher patient acuity requires more intensive nursing time and advanced nursing skills
53	53	2.23for continuous surveillance.
54	54	2.24 (i) "Skill mix" means the composition of nursing staff by licensure, experience, and
55	55	2.25education, including but not limited to registered nurses, licensed practical nurses, and
56	56	2.26unlicensed personnel.
57	57	2.27 (j) "Surveillance" means the continuous process of observing patients for early detection
58	58	2.28and intervention in an effort to prevent negative patient outcomes.
59	59	2.29 (k) "Unit" means an area or location of a hospital where patients receive care based on
60	60	2.30similar patient acuity and nursing intensity.
61	61	2.31 Subd. 3.Compliance.A hospital licensed under sections 144.50 to 144.56 must comply
62	62	2.32with this section and sections 144.593 to 144.595 as a condition of licensure.
63	63	2Section 1.
64	64	25-03964 as introduced03/10/25 REVISOR SGS/DD 3.1 Subd. 4.Staffing.A hospital must, at all times, provide enough qualified registered
65	65	3.2nursing personnel on duty to provide the standard of care that is necessary for the well-being
66	66	3.3of the patients, consistent with nationally accepted, evidence-based standards established
67	67	3.4by this section and professional nursing specialty organizations. A direct-care registered
68	68	3.5nurse assigned to a patient shall directly provide the planning, supervision, implementation,
69	69	3.6assessment and evaluation of nursing care to the patient, and is responsible for the provision
70	70	3.7of care to a particular patient within the nurse's scope of practice.
71	71	3.8 Subd. 5.Staffing plans.A hospital must adopt and implement a staffing plan that
72	72	3.9specifies the maximum number of patients that may be assigned to a direct-care registered
73	73	3.10nurse for each unit of the hospital in order to ensure adequate staffing levels for patient
74	74	3.11safety. Staffing plans adopted and implemented under this subdivision must establish staffing
75	75	3.12levels that include the flexibility to increase the number of nurses required for a unit when
76	76	3.13necessary for patient safety. Staffing plans must also include patient-to-staff ratios for
77	77	3.14nursing assistants and other direct-care staff providing nursing services directly to patients.
78	78	3.15Staffing plans must be developed in agreement with direct-care registered nurses and must
79	79	3.16comply with the requirements in subdivision 6. The staffing plan must be made available
80	80	3.17to all employees within the facility, officers or other representatives of labor unions with
81	81	3.18collective bargaining agreements in place with one or more employees in the facility, and
82	82	3.19the Department of Health. The staffing plan must be agreed upon by any existing collective
83	83	3.20bargaining units impacted by the staffing plan before it may be approved by the
84	84	3.21commissioner.
85	85	3.22 Subd. 6.Assignment limits for direct care registered nurses.(a) A staffing plan
86	86	3.23developed under subdivision 5 may not permit direct-care registered nurses to be assigned
87	87	3.24more patients than the following for any shift:
88	88	3.25 (1) one registered nurse to one patient:
89	89	3.26 (i) in operating rooms;
90	90	3.27 (ii) in trauma units;
91	91	3.28 (iii) for patients who require immediate lifesaving interventions;
92	92	3.29 (iv) for hemodynamically unstable patients whose care needs include immediate response
93	93	3.30to life-threatening conditions;
94	94	3.31 (v) for patients demonstrating compromised or otherwise unstable vital signs creating
95	95	3.32life-threatening conditions requiring immediate response;
96	96	3.33 (vi) for pregnant patients in active delivery;
97	97	3Section 1.
98	98	25-03964 as introduced03/10/25 REVISOR SGS/DD 4.1 (vii) for patients in postanesthesia;
99	99	4.2 (viii) for patients with conditions or health care needs that pose an immediate threat to
100	100	4.3life or limb;
101	101	4.4 (ix) for trauma patients requiring lifesaving interventions or patients with other conditions
102	102	4.5qualifying as a trauma code activation; and
103	103	4.6 (x) for unstable patients requiring transfer to another unit;
104	104	4.7 (2) one registered nurse to two patients in:
105	105	4.8 (i) postanesthesia care units;
106	106	4.9 (ii) critical care units;
107	107	4.10 (iii) intensive care units;
108	108	4.11 (iv) any units treating intensive care unit patients within the emergency room;
109	109	4.12 (v) neonatal intensive care;
110	110	4.13 (vi) labor and delivery;
111	111	4.14 (vii) coronary care;
112	112	4.15 (viii) acute respiratory care; and
113	113	4.16 (ix) burn units;
114	114	4.17 (3) one registered nurse to three patients in:
115	115	4.18 (i) intermediate care newborn nurseries;
116	116	4.19 (ii) antepartum units;
117	117	4.20 (iii) adult medical and surgical units;
118	118	4.21 (iv) units providing both labor and delivery and postpartum services;
119	119	4.22 (v) postpartum couplets units providing services for infants and mothers;
120	120	4.23 (vi) step-down units;
121	121	4.24 (vii) telemetry units;
122	122	4.25 (viii) pediatric units; and
123	123	4.26 (ix) emergency departments;
124	124	4.27 (4) one registered nurse to four patients in:
125	125	4.28 (i) acute psychiatric units;
126	126	4Section 1.
127	127	25-03964 as introduced03/10/25 REVISOR SGS/DD 5.1 (ii) rehabilitation care units;
128	128	5.2 (iii) chemical dependency units;
129	129	5.3 (iv) immediate care nursery or Level II nursery; and
130	130	5.4 (v) any other specialty care or patient care units organized to provide care for a specific
131	131	5.5medical condition, disease, diagnosis, or patient population for which specific assignment
132	132	5.6limits are not established in this paragraph; and
133	133	5.7 (5) one registered nurse to five patients for skilled nursing units.
134	134	5.8 (b) Nothing in this subdivision:
135	135	5.9 (1) requires a hospital with lower patient assignment limits than those established in
136	136	5.10paragraph (a) to increase its assignment limits;
137	137	5.11 (2) requires a hospital to establish patient assignment limits for any units named within
138	138	5.12this subdivision in which the hospital does not organize, operate, and maintain a unit that
139	139	5.13provides the same services as those units listed in this subdivision; and
140	140	5.14 (3) limits the rights of organized nurses to bargain on the issue of patient assignment
141	141	5.15limits.
142	142	5.16 (c) In determining ratios for each unit, there shall be no averaging of the number of
143	143	5.17patients and the total number of licensed bargaining unit nurses on the unit during any one
144	144	5.18shift nor over any period of time. Only licensed bargaining unit nurses providing direct
145	145	5.19patient care shall be included in the ratios, and no other staffing combinations or utilization
146	146	5.20of nonnursing staff may be deployed to reduce or otherwise alter the number of nurses
147	147	5.21assigned to a given unit. The ratios established shall be in place for all shifts throughout the
148	148	5.22calendar year.
149	149	5.23 Subd. 7.Schedule for compliance.Hospitals must comply with the assignment limits
150	150	5.24in subdivision 6 no later than August 1, 2027, except that hospitals in a rural area, as defined
151	151	5.25in United States Code, title 42, section 1395ww(d)(2)(D), must comply no later than August
152	152	5.261, 2029. The commissioner of health shall establish a schedule by which hospitals must
153	153	5.27comply with assignment limits and shall establish, maintain, and enforce proper
154	154	5.28implementation of assignment limits within licensed hospitals.
155	155	5.29 Subd. 8.Application of assignment limits to hospital nursing practice standards.A
156	156	5.30patient assignment may be included in the calculation of direct-care registered
157	157	5.31nurse-to-patient assignment limits established in subdivision 6 only if care is provided by
158	158	5Section 1.
159	159	25-03964 as introduced03/10/25 REVISOR SGS/DD 6.1a direct-care registered nurse and the provision of care to the particular patient is within
160	160	6.2that direct-care registered nurse's validated competence.
161	161	6.3 Subd. 9.Nursing administrators and supervisors.A hospital shall not include a nursing
162	162	6.4administrator or supervisor in the calculation of direct-care registered nurse-to-patient
163	163	6.5assignment limits established in subdivision 6. For purposes of this subdivision, "nursing
164	164	6.6administrator or supervisor" includes a nurse administrator, nurse supervisor, nurse manager,
165	165	6.7charge nurse, chief nursing officer, or any other nursing staff whose regular job duties do
166	166	6.8not include providing direct patient care during at least 60 percent of working hours.
167	167	6.9 Subd. 10.Application of assignment limits.The assignment limits established in
168	168	6.10subdivision 6 represent the maximum number of patients to which a direct-care registered
169	169	6.11nurse may be assigned at all points during a shift. A hospital is prohibited from averaging
170	170	6.12the number of patients and the total number of direct-care registered nurses assigned to
171	171	6.13patients in a unit during any one shift or over any period of time in order to meet the
172	172	6.14assignment limits established in subdivision 6.
173	173	6.15 Subd. 11.Assignments, assignment adjustments, and adding additional registered
174	174	6.16nurses.(a) A hospital must assign nurses, nursing assistants, and any other nursing or
175	175	6.17direct-care personnel to the patient population consistent with the hospital's staffing plan
176	176	6.18and the assignment limits established in subdivision 6. For each patient population, a
177	177	6.19direct-care registered nurse shall evaluate the following factors to assess and determine
178	178	6.20adequacy of staffing levels to meet patient care needs:
179	179	6.21 (1) composition of skill mix and roles available;
180	180	6.22 (2) patient acuity;
181	181	6.23 (3) experience level of registered nurse staff;
182	182	6.24 (4) unit activity level, such as admissions, discharges, and transfers;
183	183	6.25 (5) variable staffing grids;
184	184	6.26 (6) availability of a registered nurse to accept an assignment; and
185	185	6.27 (7) nursing intensity.
186	186	6.28 (b) A hospital shall not:
187	187	6.29 (1) assign or otherwise direct nursing staff to provide patient care to a patient unless the
188	188	6.30direct-care registered nurse is able to demonstrate current competence in providing care to
189	189	6.31any relevant patient populations and has received orientation, training, and experience
190	190	6.32sufficient to provide competent care to the patient and that patient population;
191	191	6Section 1.
192	192	25-03964 as introduced03/10/25 REVISOR SGS/DD 7.1 (2) assign a direct-care registered nurse to provide patient care to a patient if the nurse's
193	193	7.2professional opinion leads the nurse to believe that accepting the additional patient assignment
194	194	7.3would force the nurse to violate any provisions of the Minnesota Nurse Practice Act, under
195	195	7.4sections 148.171 to 148.285;
196	196	7.5 (3) assign nursing personnel from a supplemental nursing services agency to provide
197	197	7.6patient care to a patient population until the agency nurse is able to demonstrate validated
198	198	7.7competence in providing care to that patient population and has received orientation sufficient
199	199	7.8to provide competent care to the patient population; or
200	200	7.9 (4) assign unlicensed personnel to:
201	201	7.10 (i) perform direct-care registered nurse functions in lieu of care delivered by a direct-care
202	202	7.11registered nurse;
203	203	7.12 (ii) perform tasks that require the assessment, judgment, or skill of a direct-care registered
204	204	7.13nurse; or
205	205	7.14 (iii) perform functions of a direct-care registered nurse under the supervision of a
206	206	7.15direct-care registered nurse.
207	207	7.16 (c) If any direct-care registered nurse determines that a unit's staffing levels are inadequate
208	208	7.17and notifies the unit's charge nurse and a manager or administrative supervisor, the manager
209	209	7.18or administrative supervisor shall consider the following:
210	210	7.19 (1) current patient care assignments for potential redistribution;
211	211	7.20 (2) the ability to facilitate discharges, transfers, and admissions;
212	212	7.21 (3) the availability of additional staffing resources; and
213	213	7.22 (4) the hospital-wide census and staffing.
214	214	7.23 (d) If the staffing inadequacies cannot be resolved and resources cannot be reallocated
215	215	7.24by the manager or administrative supervisor after considering the factors in paragraph (c),
216	216	7.25the hospital shall call in extra staff to ensure adequate staffing to meet safe patient standards.
217	217	7.26 (e) Until extra staff arrive and begin to receive patient assignments:
218	218	7.27 (1) the hospital must suspend nonemergency admissions and prescheduled elective
219	219	7.28surgeries that are not life-threatening but routinely lead to in-patient hospitalization; and
220	220	7.29 (2) the charge nurse for the unit with inadequate staffing levels is authorized to close
221	221	7.30the unit to new patient admissions and in-hospital transfers after all good-faith efforts to
222	222	7.31bring in additional staffing to alleviate excessive boarding issues in the emergency department
223	223	7Section 1.
224	224	25-03964 as introduced03/10/25 REVISOR SGS/DD 8.1have been explored by appropriate hospital management staff, and that any open beds and
225	225	8.2available units within the facility are being operationalized to the fullest extent in order to
226	226	8.3meet patient needs.
227	227	8.4 Subd. 12.Prohibited actions.A hospital must not take any of the following actions as
228	228	8.5a means to meet staffing standards:
229	229	8.6 (1) use mandatory overtime;
230	230	8.7 (2) assign or transfer a direct-care registered nurse to a patient care unit until after the
231	231	8.8nurse has been adequately trained and oriented to work on the unit;
232	232	8.9 (3) assign a direct-care registered nurse to a patient care unit to relieve another direct-care
233	233	8.10registered nurse during breaks, meals, or other routine and expected absences from a unit,
234	234	8.11until after the nurse being assigned demonstrates current competence in providing care on
235	235	8.12a particular unit and has received orientation to that hospital's unit sufficient to provide
236	236	8.13competent care to patients in that unit;
237	237	8.14 (4) impose layoffs of licensed practical nurses, licensed psychiatric technicians, certified
238	238	8.15nursing assistants, or other ancillary staff to meet the assignment limits established in
239	239	8.16subdivision 6; and
240	240	8.17 (5) assign a direct-care registered nurse any patient assignments that would, in the nurse's
241	241	8.18professional judgment, require the nurse to violate the Minnesota Nurse Practice Act, under
242	242	8.19sections 148.171 to 148.285, if the nurse were to accept a patient assignment as directed by
243	243	8.20a supervisor or manager. A hospital may not discharge, discipline, penalize, interfere with,
244	244	8.21threaten, restrain, coerce, or otherwise retaliate or discriminate against a nurse who
245	245	8.22communicates their objection to a patient assignment based on the requirements of the Nurse
246	246	8.23Practice Act.
247	247	8.24 Subd. 13.Exemption; emergency situations.The assignment limits established in
248	248	8.25subdivision 6 do not apply during a health care emergency if a hospital needs to provide an
249	249	8.26exceptional level of emergency services or other health care services. If a health care
250	250	8.27emergency causes a change in the number of patients on a unit, a hospital must make prompt
251	251	8.28and diligent efforts to maintain staffing levels consistent with the assignment limits in
252	252	8.29subdivision 6. The commissioner shall provide guidance to hospitals describing situations
253	253	8.30that constitute a health care emergency for purposes of this subdivision.
254	254	8.31 Subd. 14.Charge nurse; inclusion in staffing grid.In order to facilitate optimal patient
255	255	8.32care, a charge nurse shall not be included in the unit's staffing grid that is regularly reviewed
256	256	8.33and determines the unit's staffing budget. This subdivision does not limit the ability of a
257	257	8Section 1.
258	258	25-03964 as introduced03/10/25 REVISOR SGS/DD 9.1charge nurse to take a patient assignment in the event of an emergency when taking a patient
259	259	9.2assignment, in the charge nurse's professional opinion, will not jeopardize overall patient
260	260	9.3care for all patients on the unit at that time.
261	261	9.4 Sec. 2. [144.593] PATIENT CARE; USE OF TECHNOLOGY .
262	262	9.5 Subdivision 1.Patient-acuity adjustable units prohibited.Patients shall be cared for
263	263	9.6only on units or patient care areas where the level of intensity, type of care, and direct-care
264	264	9.7registered nurse-to-patient assignment limits meet the individual requirements and needs
265	265	9.8of each patient.
266	266	9.9 Subd. 2.Use of technology.(a) A hospital shall not employ video monitors or any form
267	267	9.10of electronic visualization of a patient as a substitute for the direct observation required for
268	268	9.11patient assessment by a direct-care registered nurse or required for patient protection. Video
269	269	9.12monitors or any form of electronic visualization of a patient shall not be included in the
270	270	9.13calculation of assignment limits in section 144.592, subdivision 6.
271	271	9.14 (b) A hospital shall not employ technology that limits a direct-care registered nurse from
272	272	9.15performing functions that are part of the nursing process, including full exercise of
273	273	9.16independent professional judgment in assessment, planning, implementation, and evaluation
274	274	9.17of care, including the use of artificial intelligence technology in lieu of the expertise of
275	275	9.18licensed health care professionals.
276	276	9.19 Sec. 3. [144.594] SAFE PATIENT ASSIGNMENT COMMITTEE.
277	277	9.20 Subdivision 1.Committee required.By October 1, 2026, a hospital must establish a
278	278	9.21Safe Patient Assignment Committee either by creating a new committee or assigning the
279	279	9.22functions of a staffing for patient safety committee to an existing committee.
280	280	9.23 Subd. 2.Membership; compensation.At least 60 percent of the committee's membership
281	281	9.24must be nonsupervisory and nonmanagerial registered nurses who provide direct patient
282	282	9.25care, as defined in section 144.592, subdivision 2, paragraph (e). The committee must include
283	283	9.26members appointed by a collective bargaining unit, if one exists, to proportionately represent
284	284	9.27the bargaining unit's nurses. Hospitals must compensate registered nurses who are employed
285	285	9.28by the hospital and serve on the Safe Patient Assignment Committee for time spent on
286	286	9.29committee business.
287	287	9.30 Subd. 3.Duties.A Safe Patient Assignment Committee shall:
288	288	9.31 (1) complete a staffing for patient safety assessment by March 31, 2026, and annually
289	289	9.32thereafter that identifies the following:
290	290	9Sec. 3.
291	291	25-03964 as introduced03/10/25 REVISOR SGS/DD 10.1 (i) problems of insufficient staffing, including but not limited to an inappropriate number
292	292	10.2of registered nurses scheduled in a unit, inappropriately experienced registered nurses
293	293	10.3scheduled for a particular unit, inability for nurse supervisors to adjust for increased acuity
294	294	10.4or activity in a unit, and chronically unfilled positions within the hospital;
295	295	10.5 (ii) units that pose the highest risk to patient safety due to inadequate staffing; and
296	296	10.6 (iii) solutions for problems identified under items (i) and (ii);
297	297	10.7 (2) implement and evaluate assignment limits in section 144.592, subdivision 6;
298	298	10.8 (3) convert assignment limits in section 144.592, subdivision 6, into registered nurse
299	299	10.9hours of care per patient;
300	300	10.10 (4) recommend a mechanism for tracking and analyzing staffing trends within the
301	301	10.11hospital;
302	302	10.12 (5) develop a procedure for making shift-to-shift adjustments in staffing levels consistent
303	303	10.13with section 144.592, subdivision 11, when adjustments are required by patient acuity and
304	304	10.14nursing intensity; and
305	305	10.15 (6) identify any incidents when the hospital has failed to meet the assignment limits in
306	306	10.16section 144.592, subdivision 6, and recommend a remedy.
307	307	10.17Sec. 4. [144.595] RETALIATION PROHIBITED.
308	308	10.18 A hospital shall not retaliate against or discipline a direct-care registered nurse, either
309	309	10.19formally or informally, for:
310	310	10.20 (1) refusing to accept an assignment if, in good faith and in the nurse's professional
311	311	10.21judgment, the nurse determined that the assignment is unsafe for patients due to patient
312	312	10.22acuity and nursing intensity;
313	313	10.23 (2) reporting a concern regarding safe staffing levels; or
314	314	10.24 (3) communicating an objection, based on the nurse's own professional judgment, that
315	315	10.25accepting a specific or additional patient assignment would force the nurse to violate the
316	316	10.26Minnesota Nurse Practice Act under sections 148.171 to 148.285.
317	317	10.27Sec. 5. [144.596] ENFORCEMENT .
318	318	10.28 (a) The commissioner shall impose a civil penalty of not less than $25,000 for each
319	319	10.29incident of a hospital failing to comply with sections 144.592 to 144.595, including failure
320	320	10.30to staff patient care units to required levels.
321	321	10Sec. 5.
322	322	25-03964 as introduced03/10/25 REVISOR SGS/DD 11.1 (b) The commissioner must publicly report on the department website all incidents of
323	323	11.2noncompliance with sections 144.592 to 144.595 on a quarterly basis, beginning September
324	324	11.31, 2026.
325	325	11.4 Sec. 6. Minnesota Statutes 2024, section 144.7055, is amended to read:
326	326	11.5 144.7055 STAFFING PLAN REPORTS.
327	327	11.6 Subdivision 1.Definitions.(a) For the purposes of this section, the following terms have
328	328	11.7the meanings given.
329	329	11.8 (b) "Core staffing plan" means the projected number of full-time equivalent
330	330	11.9nonmanagerial care staff that will be assigned in a 24-hour period to an inpatient care unit.
331	331	11.10 (c) "Nonmanagerial care staff" means registered nurses, licensed practical nurses, and
332	332	11.11other health care workers, which may include but is not limited to nursing assistants, nursing
333	333	11.12aides, patient care technicians, and patient care assistants, who perform nonmanagerial
334	334	11.13direct patient care functions for more than 50 percent of their scheduled hours on a given
335	335	11.14patient care unit.
336	336	11.15 (d) "Inpatient care unit" means a designated inpatient area for assigning patients and
337	337	11.16staff for which a distinct staffing plan exists and that operates 24 hours per day, seven days
338	338	11.17per week in a hospital setting. Inpatient care unit does not include any hospital-based clinic,
339	339	11.18long-term care facility, or outpatient hospital department.
340	340	11.19 (e) "Staffing hours per patient day" means the number of full-time equivalent
341	341	11.20nonmanagerial care staff who will ordinarily be assigned to provide direct patient care
342	342	11.21divided by the expected average number of patients upon which such assignments are based.
343	343	11.22 (f) "Patient acuity tool" means a system for measuring an individual patient's need for
344	344	11.23nursing care. This includes utilizing a professional registered nursing assessment of patient
345	345	11.24condition to assess staffing need.
346	346	11.25 (f) "Direct-care registered nurse" means a registered nurse, as defined in section 148.171,
347	347	11.26subdivision 20, who is nonsupervisory and nonmanagerial and is directly providing nursing
348	348	11.27care to patients more than 60 percent of the time.
349	349	11.28 Subd. 2.Hospital staffing report.(a) The chief nursing executive or nursing designee
350	350	11.29of every reporting hospital in Minnesota under section 144.50 will shall develop a core
351	351	11.30staffing plan for each patient care unit.
352	352	11.31 (b) Core staffing plans shall specify the full-time equivalent for each patient care unit
353	353	11.32for each 24-hour period. following:
354	354	11Sec. 6.
355	355	25-03964 as introduced03/10/25 REVISOR SGS/DD 12.1 (1) the definition of the patient care unit;
356	356	12.2 (2) the number of beds available in each patient care unit;
357	357	12.3 (3) the average number of patients per day in each patient care unit; and
358	358	12.4 (4) the full-time equivalent for each patient care unit broken down by:
359	359	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.,
360	360	12.6and 11:00 p.m. to 7:00 a.m.; and
361	361	12.7 (ii) type of staff assigned, including but not limited to registered nurses, licensed practical
362	362	12.8nurses, certified nursing assistants, and other additional care team members.
363	363	12.9 (c) Prior to submitting the core staffing plan, as required in subdivision 3, hospitals shall
364	364	12.10consult with and obtain consent from representatives of the hospital medical staff, managerial
365	365	12.11and nonmanagerial care staff, and other relevant hospital personnel about nonmanagerial
366	366	12.12care staff and all affected exclusive bargaining representatives of nonmanagerial care staff
367	367	12.13regarding the core staffing plan and the expected average number of patients upon which
368	368	12.14the staffing plan is based. Direct-care registered nurses must certify the report as accurate
369	369	12.15and clearly presented by majority vote of direct-care registered nurses on staff at the hospital
370	370	12.16or by the exclusive bargaining representative if represented by a collective bargaining unit.
371	371	12.17 Subd. 3.Standard electronic reporting developed.(a) Hospitals must submit the core
372	372	12.18staffing plans to the Minnesota Hospital Association by January 1, 2014 on a quarterly
373	373	12.19basis. The Minnesota Hospital Association shall include each reporting hospital's most
374	374	12.20recently submitted core staffing plan on the Minnesota Hospital Association's Minnesota
375	375	12.21Hospital Quality Report website by April 1, 2014 within three months after submission.
376	376	12.22Any substantial changes to the core staffing plan shall be updated within 30 days.
377	377	12.23 (b) The Minnesota Hospital Association shall include on its website for each reporting
378	378	12.24hospital on a quarterly basis the actual direct patient care hours per patient, per shift, based
379	379	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
380	380	12.267:00 a.m., and per unit. Hospitals must submit the direct patient care staffing report to the
381	381	12.27Minnesota Hospital Association by July 1, 2014, and quarterly thereafter. each quarter, and
382	382	12.28the Minnesota Hospital Association must post the actual direct patient care staffing report
383	383	12.29on the hospital quality reporting website within three months of receiving the reports.
384	384	12.30 Subd. 4.Enforcement of reporting requirements.(a) The commissioner shall impose
385	385	12.31a civil penalty of not less than $25,000 for each hospital that fails to comply with subdivisions
386	386	12.322 and 3, including failure to report by the deadline or failure to provide information according
387	387	12.33to the requirements of this section. Each day of the violation shall constitute a separate
388	388	12Sec. 6.
389	389	25-03964 as introduced03/10/25 REVISOR SGS/DD 13.1violation and the penalties prescribed shall be applicable to each separate violation unless
390	390	13.2otherwise indicated.
391	391	13.3 (b) At a minimum, the commissioner must publicly report on the department website
392	392	13.4all incidents of noncompliance with subdivision 2 or 3.
393	393	13.5 Subd. 5.Staffing grid; compliance; enforcement.(a) A hospital must submit its staffing
394	394	13.6grid to the commissioner quarterly and, when scheduling staff for a patient care unit, must
395	395	13.7schedule at least the number and skill mix of staff specified in the staffing grid for that unit.
396	396	13.8 (b) The commissioner shall accept complaints from persons employed by a hospital
397	397	13.9regarding situations in which a hospital scheduled fewer staff for a patient care unit than
398	398	13.10the number of staff specified in the hospital's staffing grid, or a skill mix that differed
399	399	13.11substantially from the skill mix specified in the hospital's staffing grid. The commissioner
400	400	13.12shall impose a civil penalty of not less than $25,000 for:
401	401	13.13 (1) a hospital that fails to submit its staffing grid according to paragraph (a); or
402	402	13.14 (2) situations in which the commissioner determines that a hospital scheduled fewer
403	403	13.15staff for a patient care unit than the number of staff specified in the staffing grid or scheduled
404	404	13.16a skill mix of staff that differed substantially from the skill mix specified in the hospital's
405	405	13.17staffing grid; and
406	406	13.18 (3) situations in which the commissioner determines that persistent understaffing within
407	407	13.19a facility has led to an increase in adverse health events or instances of workplace violence,
408	408	13.20or continues to pose safety risks for workers or patients.
409	409	13.21Sec. 7. Minnesota Statutes 2024, section 148.264, subdivision 1, is amended to read:
410	410	13.22 Subdivision 1.Reporting.(a) Any person, health care facility, business, or organization
411	411	13.23is immune from civil liability or criminal prosecution for submitting in good faith a report
412	412	13.24to the board under section 148.263 or for otherwise reporting in good faith to the board
413	413	13.25violations or alleged violations of sections 148.171 to 148.285. All such reports are
414	414	13.26investigative data as defined in chapter 13.
415	415	13.27 (b) Any registered nurse or health care worker who experiences and subsequently reports
416	416	13.28a level of staffing that, in the registered nurse's or health care worker's professional judgment,
417	417	13.29could reasonably be expected to result in unsafe or ineffective patient care cannot be
418	418	13.30disciplined under section 148.261, subdivision 1, clause (8). These reports may include a
419	419	13.31report from a registered nurse or health care worker to the registered nurse's or health care
420	420	13.32worker's supervisor at the supervisor's place of employment, the Board of Nursing, the
421	421	13Sec. 7.
422	422	25-03964 as introduced03/10/25 REVISOR SGS/DD 14.1commissioner of health, or a professional nursing organization. Reports must be made within
423	423	14.2ten calendar days after the incident occurred in order to be covered under this paragraph.
424	424	14.3 Sec. 8. APPROPRIATION.
425	425	14.4 $....... in fiscal year 2026 and $....... in fiscal year 2027 are appropriated from the general
426	426	14.5fund to the commissioner of health for enforcement activities in Minnesota Statutes, section
427	427	14.6144.7055, subdivision 5.
428	428	14Sec. 8.
429	429	25-03964 as introduced03/10/25 REVISOR SGS/DD