For 35 minutes, backers of a bill to make Minnesota part of a 39-state nursing licensure compact talked around the reasons why it hasn’t passed — and why it likely won’t pass this year either.
Republican lawmakers, nursing officials from the Mayo Clinic and the dean of the University of Minnesota presented the bill as an obvious step to addressing a nursing shortage. It would allow state-licensed nurses to practice in all of the other member states of the Nurse Licensure Compact. Conversely, nurses licensed from other states in the compact can work in Minnesota.
Currently, Minnesota’s 120,000 nurses must go through licensing procedures in other states even to work with patients via telemedicine. And nurses arriving in Minnesota, even on a temporary basis, must get state licensing.
Sen. Carla Nelson, the Rochester Republican who is the bill’s prime sponsor, alluded to its history of stalling in the DFL-controlled House, but said “I cannot speak to why.”
But that doesn’t mean she didn’t know why. The issue behind Senate File 2302 might relate to health care, but it is also a labor-management conflict. The handful of states that have not joined the compact are blue or purple states with strong labor constituencies in their Democratic parties.
[image_caption]State Sen. Carla Nelson[/image_caption]
Sen. Chris Eaton, DFL-Brooklyn Center, noted that the opposition comes from nurses, while the supporters are from administrators and management, adding that she stands with “the one’s saving lives, not those pushing paper.”
“This is a slap in the face to nurses in this state,” Eaton said. “This is just another way to break up the unions.”
[image_credit]National Council of State Boards of Nursing[/image_credit][image_caption]39 Nurse Licensure Compact Jurisdictions and Status[/image_caption]
[image_caption]State Sen. Chris Eaton[/image_caption]
The compact requires nurses in each state to be trained to a common standard. All nurses in the U.S. take the same licensing exams and must be graduates of accredited schools of nursing, said Connie White Delaney, the U of M nursing school dean.
The compact, operated by the national association of state nursing licensing boards, also requires criminal background checks and has a database for state’s to check records of licensed nurses.
Telemedicine also at issue
Dominick Pahl, a nursing lead at the Mayo Clinic in Rochester, said the issue goes beyond responding to temporary nursing shortages. Pahl said he must apply for separate licensing in Iowa and other states where Mayo has a presence.
“Today, a patient can travel to the state of Minnesota and without any additional nursing licensure, I can provide that patient with exceptional care,” Pahl said. “However, if that patient returns to their home state, I can’t physically travel to that state or virtually interact with that patient without first getting a license in that state.”
Pahl took issue with Eaton’s suggestion that only managers and administrators support joining the compact. He worked directly with COVID patients during the pandemic.
Delany, of the U of M, said potential students and faculty are aware of Minnesota’s absence from the compact. “This compact will empower our nursing programs in this state to attract, admit and serve a wide range of students that we currently can’t,” she said.
The national nursing shortage also includes a national nursing faculty shortage, she said. And when the school works with clinics in other states that provide training for U of M students, the faculty who supervise them must be separately licensed in those states.
“Our ability to attract faculty is hampered by not having this compact in place,” Delaney said.
Supporting the bill Monday was the U.S. Department of Defense, which said compacts help military spouses who are nurses and move around their country.
“The Department of Defense believes compacts are the future,” said Martin Dempsey, Midwest region liaison for the Defense-State Liaison Office.
While remote care was also described as the future of health care, the potential for remote care is also part of MNA’s opposition. “One of the goals of the interstate commission behind the compact is to replace individualized care by registered nurses at the bedside with computerized healthcare,” the MNA said in a statement Monday.
“This bill is a thinly-veiled attack on the bargaining power of Minnesota nurses, who have worked so hard and sacrificed so much through the pandemic, aiming to replace full-time nurse positions with temporary staff so hospital CEOs can increase their bottom lines at the expense of workers and patients at the bedside.”
Mary Turner, the president of the MNA, told the Senate Health and Human Services committee Monday that there is no shortage of nurses in Minnesota, only a shortage that want to keep working in stressful and unsafe hospital settings. “It will distract from the roots of our current workforce issues,” she said of the bill.
Turner also warned that nursing standards would be set by a D.C.-based association of nursing boards, instead of with the state’s own board. The nurses association has its own bill on nurse staffing with DFL sponsorship. Called the Keeping Nurses at the Bedside Act, the proposal would require committees of nurses and administrators to set nurse staffing rules and would also limit the number of patients per nurse in hospital settings. It would also add measures to recruit and retain nurses.
[image_credit]MinnPost photo by Peter Callaghan[/image_credit][image_caption]Mary Turner, the president of the MNA, told the Senate Health and Human Services committee Monday that there is no shortage of nurses in Minnesota, only a shortage that want to keep working in stressful and unsafe hospital settings.[/image_caption]Walz not on board
Nearly two years ago, over the objections of the MNA, Walz signed an executive order that lifted the requirement that nurses be separately licensed by the state.
“I have determined that it is necessary to support the efforts of Minnesota’s healthcare professionals by allowing certain out-of-state healthcare professionals to provide staffing support and render aid in Minnesota during the pendency of the peacetime emergency,” said Walz of the order.
Reporting required by that order showed that some 4,500 registered nurses and 300 licensed practical nurses worked in the state under the executive order. While initially intended to run through the end of Walz’s peacetime state of emergency, which ended in August of 2021, the governor rescinded the previous order that May.
Earlier this year, Walz spent $40 million in American Rescue Plan money to bring in traveling nurses to fill staffing shortages. The administration says that 200 nurses were licensed using current state law without delays.
A Walz spokesperson said the governor does not believe a permanent change in licensing rules is a solution to underlying staffing issues.
“This bill is a thinly-veiled attack on the bargaining power of Minnesota nurses, who have worked so hard and sacrificed so much through the pandemic, aiming to replace full-time nurse positions with temporary staff so hospital CEOs can increase their bottom lines at the expense of workers and patients at the bedside.”
I agree 100%.
Whenever I hear employers telling me there is a labor shortage, I check my bs meter. This article doesn’t have any data demonstrating that there is a nursing shortage in MN.
When an employer tells Neil Kashkari they “can’t find any help”, his response is always the same, “Have you raised wages?” The universal response is, “Well, no, we can’t do that!” With that in mind, have employers been bidding up the cost of nursing labor in MN?
The question I have after reading this is how do Minnesota’s licensing standards compare to the common standards under this licensing compact? What are the differences between the two?
This is the part I wonder about. What are the standards of training for licensure? Based on my experience with my family in other states that have needed medical care, there’s a VERY different standard of competence on a state-by-state basis. I’m not sure if that’s a selection bias (if you live in certain states, it might be that individuals with lack of talent/ambition are more likely to settle or, at least not leave, some areas), but I don’t like the idea of potentially downgrading our health care for convenience of licensing.
If there is a shortage of nurses it is a nationwide shortage. Joining the Compact would do nothing to increase the number of nurses, but would only increase their mobility.
It’s hard to see this law as an answer to much of anything.
If I am a nurse in MN, I would want the option to work in other states without going thru all the BS to get another license. A system that prevents a Mayo Clinic Nurse from consult with a patient in Iowa is idiotic. Nursing licensure, like any other professional license, should be focused on ensuring that people are competent and properly trained and should have nothing to do with labor / management relations or be used to artificially limit the supply of nurses working in the state.
Senator Nelson ““I cannot speak to why.” – simple answer is the 78% of state nurses supporting the compact do not have an organization giving money to DFL politicians.
Hmmm…and I wonder why a Republican that represents the Rochester area, home to Mayo Operations, is the main driver behind the bill? Have their deep pockets been explored by Republicans or the nurses who support this attack on our state’s rights? Shall we check Carla Nelson’s campaign coffers and see whose been filling them?
Very good work, MinnPost! and thanks for all the nurses’ comments. Follow the money here.
This past summer Allina front line health care workers represented by SEIU (nurses aides, housekeeping, nutrition workers, etc.) were threatening to strike. Management hired out-of-state traveling healthcare agencies to provide staff during the strike. A friend of mine from South Dakota who works for one of these agencies said her agency had been hired to replace striking workers. Allina had contracted with hotels to house all these out-of-state workers, paid for their transportation and other expenses on top of their wages.
Allina could not engage in this sort of strike-breaking activity if the strikers had been nurses. I understand why the Nurses’ Association is opposed to joining the compact. Despite denials, it is a strike breaking tool and that’s why management and the Republicans are pushing it. Perhaps the answer is to carve out some exceptions that excludes bringing in Nurses to replace striking workers.
The middle class has been so beat down and hollowed out that we need every tool we have to keep and expand decent wages, good benefits, and retirement income security.
This is absolutely a backdoor management assault on MNA (the nursing union). For decades hospital administrations have been cutting direct care staff despite some of highest profits and revenue in the economy, and NOW they want to complain about staff shortages? Bushwa!
Hospital haven’t had a problem bringing in RN’s from other States whenever nurses have gone on strike in the past, so I seriously doubt THIS is the cause of any current shortage. The nursing shortage is nationwide so obviously MN doesn’t have a unique problem.
If you’re going to write an article about this you need to make some effort to establish the actual nature of the shortage, the nature of the licensure requirement, and the nature of the compact license. It’s really hard to take this seriously without those elements.
What kind of shortage are we actually talking about and what caused it? The shortage I’m familiar with has been caused by illness and burn out associated with the pandemic. THAT pandemic is worldwide and the staff shortages are worldwide so the idea that there are RN’s sitting around doing nothing and waiting for a phone call is obviously daft.
When you say a nurse had to get credentialed in order to practice in MN, what exactly is the process you’re referring to? How onerous is the current process? Out of State RN are NOT required to take and pass the MN Nursing Boards in order to practice in MN. All they have to do is provide documentation of their current licensure and work history. Temp agencies that provide RN’s to replace striking nurses file this paperwork as a matter of course so obviously it’s not a barrier to staffing. Claims of RN’s being kept out of the State or not being able to work in other States are quite exaggerated, we’re talking about some routine paperwork here.
Listen: if your going to have some kind of multi-state universal license… who administers that and enforces professional compliance? One of the reasons for licensure is to establish professional standards of best practice, if you take THAT process away from the State Board, who takes over?
We have several nursing programs here in MN and if someone want’s to claim that our licensure process is keeping students away we need to see some data on that.
Actually this entire conversation reveals the fact hospital administrators aren’t really serious about addressing staffing shortages. This is clearly an issue emerging from temporary or short term shortages, not systemic shortages. After all, permanent staffing problems are solved with permanent staff right? So whatever the process of obtaining MN credential may be, any nurse who moves to MN to work here will obtain those credentials as a matter of course right? The only nurses who would benefit from multi-state licensure are those that float around. Clearly if THIS is the kind of staffing model administrators are pursuing this isn’t about solving systemic staffing shortages, this is about cutting staffing levels and then filling the gaps.
Finally, although we don’t have the time and space here it should be mentioned that this model of relying on staffing at the lowest possible levels and relying on temps from out of state to fill gaps or respond to high census is actually a bad model of medical practice. We know that permanent staff who regularly work in a hospital provide better health care for a variety of reasons. We know that medical teams who routinely work together and are familiar with a particular institutions layouts, processes, and procedures provide the best quality health care. So why are hospital administrators so determined to replace permanent staff with out of state temps in the first place? If you’re really serious about creating a best practice health care model, you create a best practice permanent staffing model, you don’t build a model that relies on out of state temps.
And finally finally when these administrators complain about their financial pressures and all the money they’re not making (Trust me, this is WILL be their response) don’t buy it. These guys are rolling in dough and every administrator from Mayo to the U. is raking the biggest paycheck in the building, and many of them get bonuses for figuring how to deliver cheaper health care for more money. No matter how cheap nurses are, no one here is ever going to see their hospital bill get any cheaper.
Fine reporting, Mr. Callaghan! I was in the room…