Our View: Lawmakers need to go back to the drawing board on health care proposals

"First, do no harm.”

If you recognize that quote as being part of the Hippocratic Oath, good for you – kind of. In truth, that sentence wasn't part of the original oath, which has evolved considerably in the 2,400 years since Hippocrates, the “Father of Medicine,” put pen to parchment. Still, “do no harm” is good advice – something along the lines of “Measure twice, cut once” and “Look before you leap.”

We urge DFL leaders to keep those adages in mind as they hammer out the final details in legislation that could drastically alter the operational landscape for Minnesota hospitals and the patients they serve.

This week, Mayo Clinic made headlines by announcing its full-throated opposition to the Keeping Nurses at the Bedside Act and other reforms that, according to the Minnesota Nurses Association, are intended to increase nurse staffing, rein in medical costs and improve patient outcomes.

Mayo opposes these changes on the grounds that they would increase the cost of care, eliminate local control and add new levels of bureaucracy to an already-complex system.

And Mayo voiced it concerns for the first time publicly in an alarming way, threatening to reconsider more than $4 billion in planned investments in the state. That would be an economic disaster for Minnesota, and most acutely in our part of it. A line has been drawn.

To those who say the clinic is bluffing, we'd point out that it's not a bluff when you hold good cards. Plenty of states would roll out the red carpet for one of the best health care systems in the world, and the clinic already has major footprints in Arizona and Florida. In short, we don't expect Mayo to fold.

But how did we get to this point, with Mayo Clinic in a high-stakes staredown against the DFL-led Legislature?

On June 10, 2010, the Minnesota Nurses Association staged a one-day strike for better pay and pensions – and for guaranteed nurse-to-patient staffing ratios. Nurses felt overwhelmed, underappreciated and burned out.

Nearly 13 years and one global pandemic later, things are worse. At the end of last year, there were a record 5,624 vacant nursing positions in Minnesota, and a study by the Minnesota Department of Health found that 19 percent of registered nurses were considering leaving the profession in five years.

Burnout is a significant cause of this dissatisfaction. Nursing is a tough job. Its stressful. It's emotional. And, a decades-long shortage of nurses is a self-perpetuating problem that is growing like an avalanche. Resignations leave more work and more stress for those who remain on the job, and MNA believes hospitals are deliberately understaffing to save money. Perhaps Mayo and other hospitals could have done more proactively to alleviate these concerns. Big executive bonuses given each year aren't a good look in this light, either.

But the crux of the matter is this: Will the legislation being pushed by MNA actually solve the nursing shortage and improve patient outcomes?

Mayo Clinic is far from alone in its belief that the latter outcome is more likely. On May 8, the Star Tribune published a commentary piece signed by Mayo CEO Gianrico Farrugia and 67 other hospital CEOs, administrators and leaders from across the state, representing systems that include Sanford Health, Children's Minnesota, Gillette Children's, Winona Health, Olmsted Medical Center and dozens of other facilities from Ely to Windom.

They wrote: “If these bills pass as they are written, Minnesota's nonprofit hospitals are in trouble. … These proposals would negatively impact hospital care including mandating new committees to determine the day-to-day management of our hospitals, handing decision making authority for care delivery to external lawyers, fixing prices for hospital care, and limiting flexibility for healthcare partnerships.”

That's a strong statement, especially in a state that routinely ranks in the top five nationally for quality of care and access to care. If you're thinking “If it ain't broke, don't fix it,” you're not alone.

MNA, which represents roughly one-fifth of the state's 130,000 registered nurses, argues that Minnesota actually has no shortage of qualified caregivers – but the system is still broken. The crisis, they say, is one of retention, caused by hospitals demanding too much of their nurses. MNA's data indicates that about 2,000 nurses who recently left their jobs are ready to return if staffing shortages are addresed and other working conditions improve.

That might very well be true, especially in the state's largest hospitals, but what about elsewhere? A mandate for increased staffing won't magically make additional nurses appear in Moorhead, Albert Lea, St. Cloud or Marshall, where hospitals would potentially be forced to turn patients away and/or simply stop providing specialized care that requires higher staffing.

Remember when Mayo Clinic closed its labor and delivery in Albert Lea in 2017, forcing patients to go to Austin instead? Imagine similar closures all over Minnesota, especially in rural areas.

Frankly, while we don't want to see Mayo spend $4 billion in Scottsdale, we're far more concerned about the possibility that legislation one step from the governor's desk would result in consolidation of care into a few regional health centers, leaving more Minnesotans to face long drives and even longer wait times for hospital care.

That's why any thought of appeasing Mayo through a last-minute exemption from the new rules is absolutely wrong. The clinic is one of a handful of care systems across the state that would have the flexibility and sheer numbers to cope with mandated staffing levels. It's the little guys and the patients they serve who would who suffer most.

We're not saying that Minnesota should stand pat. Our hospitals, clinics, assisted living facilities and nursing homes face a critical shortage of RNs, LPNs and certified nursing assistants. Every year our state's population is older, with more of us needing hospital care and well-staffed assisted living and nursing homes.

But as we emerge from the pandemic, Minnesota should proceed cautiously. Use the carrot, not the whip. Don't require hospitals to hire nurses that simply aren't there.

Instead, focus on recruiting and educating the next generation of nurses through loan forgiveness, affordable tuition and other incentives, including better pay for nurses – and professors of nursing.

According to the American Association of Colleges of Nursing, nursing schools turned away nearly 92,000 qualified applications in 2021, the highest such number in decades, due to lack of clinical sites, classroom space and faculty. Good nurses make a lot more in the hospital than they do at the front of a classroom.

That needs to change, and soon, because our current crisis won't be solved by enticing a few former nurses to return to their jobs for a few years before they retire again. Any smart, compassionate and enthusiastic young person who wants to become a nurse should have every opportunity to do so.

Not all of them will succeed. Some won't make it through nursing school, while others will leave the profession after just a few years. It's a tough job, and there always have been easier ways to earn a dollar.

More committees and new levels of bureaucracy won't change that.