HF 1700

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/16/2023 04:17pm

A bill for an act
relating to health; establishing requirements for hospital nurse staffing committees
and hospital nurse workload committees; modifying requirements of hospital core
staffing plans; requiring the commissioner of health to grade and publicly disclose
hospital compliance with core staffing plans; modifying requirements related to
hospital preparedness and incident response action plans to acts of violence;
modifying eligibility for nursing facility employee scholarships; establishing a
hospital nursing education loan forgiveness program; modifying eligibility for the
health professional education loan forgiveness program; requiring the commissioner
of health to study hospital staffing; establishing a grant program to improve the
mental health of health care workers; requiring a report; appropriating money;
amending Minnesota Statutes 2022, sections 144.1501, subdivisions 1, 2, 3, 4, 5;
144.566; 144.608, subdivision 1; 144.653, subdivision 5; 144.7055; 144.7067,
subdivision 1; 147A.08; proposing coding for new law in Minnesota Statutes,
chapter 144.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

ARTICLE 1

KEEPING NURSES AT THE BEDSIDE ACT

Section 1. new text begin TITLE.
new text end

new text begin This act shall be known as "The Keeping Nurses at the Bedside Act of 2023."
new text end

ARTICLE 2

HOSPITAL STAFFING

Section 1.

Minnesota Statutes 2022, section 144.653, subdivision 5, is amended to read:

Subd. 5.

Correction orders.

Whenever a duly authorized representative of the state
commissioner of health finds upon inspection of a facility required to be licensed under the
provisions of sections 144.50 to 144.58 that the licensee of such facility is not in compliance
with sections 144.411 to 144.417, 144.50 to 144.58, 144.651, new text begin 144.7051 to 144.7058, new text end or
626.557, or the applicable rules promulgated under those sections, a correction order shall
be issued to the licensee. The correction order shall state the deficiency, cite the specific
rule violated, and specify the time allowed for correction.

Sec. 2.

new text begin [144.7051] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin For the purposes of sections 144.7051 to 144.7058, the
terms defined in this section have the meanings given.
new text end

new text begin Subd. 2. new text end

new text begin Concern for safe staffing form. new text end

new text begin "Concern for safe staffing form" means a
standard uniform form developed by the commissioner that may be used by any individual
to report unsafe staffing situations while maintaining the privacy of patients.
new text end

new text begin Subd. 3. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of health.
new text end

new text begin Subd. 4. new text end

new text begin Daily staffing schedule. new text end

new text begin "Daily staffing schedule" means the actual number
of full-time equivalent nonmanagerial care staff assigned to an inpatient care unit and
providing care in that unit during a 24-hour period and the actual number of patients assigned
to each direct care registered nurse present and providing care in the unit.
new text end

new text begin Subd. 5. new text end

new text begin Direct-care registered nurse. new text end

new text begin "Direct-care registered nurse" means a registered
nurse, as defined in section 148.171, subdivision 20, who is nonsupervisory and
nonmanagerial and who directly provides nursing care to patients more than 60 percent of
the time.
new text end

new text begin Subd. 6. new text end

new text begin Hospital. new text end

new text begin "Hospital" means any setting that is licensed under this chapter as a
hospital.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2025.
new text end

Sec. 3.

new text begin [144.7053] HOSPITAL NURSE STAFFING COMMITTEE.
new text end

new text begin Subdivision 1. new text end

new text begin Hospital nurse staffing committee required. new text end

new text begin (a) Each hospital must
establish and maintain a functioning hospital nurse staffing committee. A hospital may
assign the functions and duties of a hospital nurse staffing committee to an existing committee
provided the existing committee meets the membership requirements applicable to a hospital
nurse staffing committee.
new text end

new text begin (b) The commissioner is not required to verify compliance with this section by an on-site
visit.
new text end

new text begin Subd. 2. new text end

new text begin Staffing committee membership. new text end

new text begin (a) At least 35 percent of the hospital nurse
staffing committee's membership must be direct care registered nurses typically assigned
to a specific unit for an entire shift and at least 15 percent of the committee's membership
must be other direct care workers typically assigned to a specific unit for an entire shift.
Direct care registered nurses and other direct care workers who are members of a collective
bargaining unit shall be appointed or elected to the committee according to the guidelines
of the applicable collective bargaining agreement. If there is no collective bargaining
agreement, direct care registered nurses shall be elected to the committee by direct care
registered nurses employed by the hospital and other direct care workers shall be elected
to the committee by other direct care workers employed by the hospital.
new text end

new text begin (b) The hospital shall appoint 50 percent of the hospital nurse staffing committee's
membership.
new text end

new text begin Subd. 3. new text end

new text begin Staffing committee compensation. new text end

new text begin A hospital must treat participation in the
hospital nurse staffing committee meetings by any hospital employee as scheduled work
time and compensate each committee member at the employee's existing rate of pay. A
hospital must relieve all direct care registered nurse members of the hospital nurse staffing
committee of other work duties during the times when the committee meets.
new text end

new text begin Subd. 4. new text end

new text begin Staffing committee meeting frequency. new text end

new text begin Each hospital nurse staffing committee
must meet at least quarterly.
new text end

new text begin Subd. 5. new text end

new text begin Staffing committee duties. new text end

new text begin (a) Each hospital nurse staffing committee shall
create, implement, continuously evaluate, and update as needed evidence-based written
core staffing plans to guide the creation of daily staffing schedules for each inpatient care
unit of the hospital.
new text end

new text begin (b) Each hospital nurse staffing committee must:
new text end

new text begin (1) establish a secure, uniform, and easily accessible method for any hospital employee,
patient, or patient family member to submit directly to the committee a concern for safe
staffing form;
new text end

new text begin (2) review each concern for safe staffing form;
new text end

new text begin (3) forward a copy of all concern for safe staffing forms to the relevant hospital nurse
workload committee;
new text end

new text begin (4) review the documentation of compliance maintained by the hospital under section
144.7056, subdivision 10;
new text end

new text begin (5) conduct a trend analysis of the data related to all reported concerns regarding safe
staffing;
new text end

new text begin (6) develop a mechanism for tracking and analyzing staffing trends within the hospital;
new text end

new text begin (7) submit a nurse staffing report to the commissioner;
new text end

new text begin (8) assist the commissioner in compiling data for the Nursing Workforce Report by
encouraging participation in the commissioner's independent study on reasons licensed
registered nurses are leaving the profession; and
new text end

new text begin (9) record in the committee minutes for each meeting a summary of the discussions and
recommendations of the committee. Each committee must maintain the minutes, records,
and distributed materials for five years.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2025.
new text end

Sec. 4.

new text begin [144.7054] HOSPITAL NURSE WORKLOAD COMMITTEE.
new text end

new text begin Subdivision 1. new text end

new text begin Hospital nurse workload committee required. new text end

new text begin (a) Each hospital must
establish and maintain functioning hospital nurse workload committees for each unit.
new text end

new text begin (b) The commissioner is not required to verify compliance with this section by an on-site
visit.
new text end

new text begin Subd. 2. new text end

new text begin Workload committee membership. new text end

new text begin (a) At least 35 percent of each workload
committee's membership must be direct care registered nurses typically assigned to the unit
for an entire shift and at least 15 percent of the committee's membership must be other direct
care workers typically assigned to the unit for an entire shift. Direct care registered nurses
and other direct care workers who are members of a collective bargaining unit shall be
appointed or elected to the committee according to the guidelines of the applicable collective
bargaining agreement. If there is no collective bargaining agreement, direct care registered
nurses shall be elected to the committee by direct care registered nurses typically assigned
to the unit for an entire shift and other direct care workers shall be elected to the committee
by other direct care workers typically assigned to the unit for an entire shift.
new text end

new text begin (b) The hospital shall appoint 50 percent of each unit's nurse workload committee's
membership.
new text end

new text begin (c) Notwithstanding paragraphs (a) and (b), if a hospital has established a staffing
committee through collective bargaining, then the composition of that committee prevails.
new text end

new text begin Subd. 3. new text end

new text begin Workload committee compensation. new text end

new text begin A hospital must treat participation in a
hospital nurse workload committee meeting by any hospital employee as scheduled work
time and compensate each committee member at the employee's existing rate of pay. A
hospital must relieve all direct care registered nurse members of a hospital nurse workload
committee of other work duties during the times when the committee meets.
new text end

new text begin Subd. 4. new text end

new text begin Workload committee meeting frequency. new text end

new text begin Each hospital nurse workload
committee must meet at least monthly whenever the committee is in receipt of an unresolved
concern for safe staffing form.
new text end

new text begin Subd. 5. new text end

new text begin Workload committee duties. new text end

new text begin (a) Each hospital nurse workload committee
must create, implement, and maintain dispute resolution procedures to guide the committee's
development and implementation of solutions to the staffing concerns raised in concern for
safe staffing forms that have been forwarded to the committee. The dispute resolution
procedures must include an expedited arbitration process with an arbitrator who has expertise
in patient care. The committee must use the expedited arbitration process for any complaint
that remains unresolved 30 days after the submission of the concern for safe staffing form
that gave rise to the complaint.
new text end

new text begin (b) Each hospital nurse workload committee must attempt to expeditiously resolve
staffing issues the committee determines arise from a violation of the hospital's core staffing
plan.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2025.
new text end

Sec. 5.

Minnesota Statutes 2022, section 144.7055, is amended to read:

144.7055 new text begin HOSPITAL CORE new text end STAFFING PLAN deleted text begin REPORTS deleted text end .

Subdivision 1.

Definitions.

(a) For the purposes of deleted text begin this section deleted text end new text begin sections 144.7051 to
144.7058 new text end , the following terms have the meanings given.

(b) "Core staffing plan" means deleted text begin the projected number of full-time equivalent
nonmanagerial care staff that will be assigned in a 24-hour period to an inpatient care unit deleted text end new text begin
a plan described in subdivision 2 new text end .

(c) "Nonmanagerial care staff" means registered nurses, licensed practical nurses, and
other health care workers, which may include but is not limited to nursing assistants, nursing
aides, patient care technicians, and patient care assistants, who perform nonmanagerial
direct patient care functions for more than 50 percent of their scheduled hours on a given
patient care unit.

(d) "Inpatient care unit" new text begin or "unit" new text end means a designated inpatient area for assigning patients
and staff for which a deleted text begin distinct staffing plan deleted text end new text begin daily staffing schedule new text end exists and that operates
24 hours per day, seven days per week in a hospital setting. Inpatient care unit does not
include any hospital-based clinic, long-term care facility, or outpatient hospital department.

(e) "Staffing hours per patient day" means the number of full-time equivalent
nonmanagerial care staff who will ordinarily be assigned to provide direct patient care
divided by the expected average number of patients upon which such assignments are based.

deleted text begin (f) "Patient acuity tool" means a system for measuring an individual patient's need for
nursing care. This includes utilizing a professional registered nursing assessment of patient
condition to assess staffing need.
deleted text end

Subd. 2.

Hospital new text begin core new text end staffing deleted text begin report deleted text end new text begin plans new text end .

(a) The deleted text begin chief nursing executive or nursing
designee deleted text end new text begin hospital nurse staffing committee new text end of every deleted text begin reporting deleted text end hospital deleted text begin in Minnesota under
section 144.50 will deleted text end new text begin must new text end develop a core staffing plan for each deleted text begin patient deleted text end new text begin inpatient new text end care unit.

new text begin (b) The commissioner is not required to verify compliance with this section by an on-site
visit.
new text end

deleted text begin (b) deleted text end new text begin (c) new text end Core staffing plans deleted text begin shall deleted text end new text begin must new text end specify new text begin all of the following:
new text end

new text begin (1) new text end the new text begin projected number of new text end full-time equivalent deleted text begin for deleted text end new text begin nonmanagerial care staff that will
be assigned in a 24-hour period to new text end each deleted text begin patient deleted text end new text begin inpatient new text end care unit deleted text begin for each 24-hour period. deleted text end new text begin ;
new text end

new text begin (2) the maximum number of patients on each inpatient care unit for whom a direct care
nurse can typically safely care;
new text end

new text begin (3) criteria for determining when circumstances exist on each inpatient care unit such
that a direct care nurse cannot safely care for the typical number of patients and when
assigning a lower number of patients to each nurse on the inpatient unit would be appropriate;
new text end

new text begin (4) a procedure for each inpatient care unit to make shift-to-shift adjustments in staffing
levels when such adjustments are required by patient acuity and nursing intensity in the
unit;
new text end

new text begin (5) a contingency plan for each inpatient unit to safely address circumstances in which
patient care needs unexpectedly exceed the staffing resources provided for in a daily staffing
schedule. A contingency plan must include a method to quickly identify, for each daily
staffing schedule, additional direct care registered nurses who are available to provide direct
care on the inpatient care unit;
new text end

new text begin (6) strategies to enable direct care registered nurses to take breaks they are entitled to
under law or under an applicable collective bargaining agreement; and
new text end

new text begin (7) strategies to eliminate patient boarding in emergency departments that do not rely
on requiring direct care registered nurses to work additional hours to provide care.
new text end

deleted text begin (c) deleted text end new text begin (d) Core staffing plans must ensure that:
new text end

new text begin (1) the person creating a daily staffing schedule has sufficiently detailed information to
create a daily staffing schedule that meets the requirements of the plan;
new text end

new text begin (2) daily staffing schedules do not rely on assigning individual nonmanagerial care staff
to work overtime hours in excess of 16 hours in a 24-hour period or to work consecutive
24-hour periods requiring 16 or more hours;
new text end

new text begin (3) a direct care registered nurse is not required or expected to perform functions outside
the nurse's professional license;
new text end

new text begin (4) a light duty direct care registered nurse is given appropriate assignments;
new text end

new text begin (5) a charge nurse does not have patient assignments; and
new text end

new text begin (6) daily staffing schedules do not interfere with applicable collective bargaining
agreements.
new text end

new text begin Subd. 2a. new text end

new text begin Development of hospital core staffing plans. new text end

new text begin (a) new text end Prior to deleted text begin submitting deleted text end new text begin
completing or updating new text end the core staffing plan, deleted text begin as required in subdivision 3, hospitals shall deleted text end new text begin
a hospital nurse staffing committee must new text end consult with representatives of the hospital medical
staff, managerial and nonmanagerial care staff, and other relevant hospital personnel about
the core staffing plan and the expected average number of patients upon which the new text begin core new text end
staffing plan is based.

new text begin (b) When developing a core staffing plan, a hospital nurse staffing committee must
consider all of the following:
new text end

new text begin (1) the individual needs and expected census of each inpatient care unit;
new text end

new text begin (2) unit-specific patient acuity, including fall risk and behaviors requiring intervention,
such as physical aggression toward self or others or destruction of property;
new text end

new text begin (3) unit-specific demands on direct care registered nurses' time, including: frequency of
admissions, discharges, and transfers; frequency and complexity of patient evaluations and
assessments; frequency and complexity of nursing care planning; planning for patient
discharge; assessing for patient referral; patient education; and implementing infectious
disease protocols;
new text end

new text begin (4) the architecture and geography of the inpatient care unit, including the placement of
patient rooms, treatment areas, nursing stations, medication preparation areas, and equipment;
new text end

new text begin (5) mechanisms and procedures to provide for one-to-one patient observation for patients
on psychiatric or other units;
new text end

new text begin (6) the stress that direct-care nurses experience when required to work extreme amounts
of overtime, such as shifts in excess of 12 hours or multiple consecutive double shifts;
new text end

new text begin (7) the need for specialized equipment and technology on the unit;
new text end

new text begin (8) other special characteristics of the unit or community patient population, including
age, cultural and linguistic diversity and needs, functional ability, communication skills,
and other relevant social and socioeconomic factors;
new text end

new text begin (9) the skill mix of personnel other than direct care registered nurses providing or
supporting direct patient care on the unit;
new text end

new text begin (10) mechanisms and procedures for identifying additional registered nurses who are
available for direct patient care when patients' unexpected needs exceed the planned workload
for direct care staff; and
new text end

new text begin (11) demands on direct care registered nurses' time not directly related to providing
direct care on a unit, such as involvement in quality improvement activities, professional
development, service to the hospital, including serving on the hospital nurse staffing
committee or the hospital nurse workload committee, and service to the profession.
new text end

new text begin Subd. 2b. new text end

new text begin Failure to develop hospital core staffing plans. new text end

new text begin If a hospital nurse staffing
committee cannot approve a hospital core staffing plan by a majority vote, the members of
the nurse staffing committee must enter an expedited arbitration process with an arbitrator
who understands patient care needs.
new text end

new text begin Subd. 2c. new text end

new text begin Objections to hospital core staffing plans. new text end

new text begin (a) If hospital management objects
to a core staffing plan approved by a majority vote of the hospital nurse staffing committee,
the hospital may elect to attempt to amend the core staffing plan through arbitration.
new text end

new text begin (b) During an ongoing dispute resolution process, a hospital must continue to implement
the core staffing plan as written and approved by the hospital nurse staffing committee.
new text end

new text begin (c) If the dispute resolution process results in an amendment to the core staffing plan,
the hospital must implement the amended core staffing plan.
new text end

new text begin Subd. 2d. new text end

new text begin Mandatory submission of core staffing plan to commissioner. new text end

new text begin Each hospital
must submit to the commissioner the core staffing plans approved by the hospital's nurse
staffing committee. A hospital must submit any substantial updates to any previously
approved plan, including any amendments to the plan resulting from arbitration, within 30
calendar days of approval of the update by the committee or the conclusion of arbitration.
new text end

Subd. 3.

Standard electronic reporting developed.

deleted text begin (a) Hospitals must submit the core
staffing plans to the Minnesota Hospital Association by January 1, 2014. The Minnesota
Hospital Association shall include each reporting hospital's core staffing plan on the
Minnesota Hospital Association's Minnesota Hospital Quality Report website by April 1,
2014. any substantial changes to the core staffing plan shall be updated within 30 days.
deleted text end

deleted text begin (b) deleted text end The Minnesota Hospital Association shall include on its website for each reporting
hospital on a quarterly basis the actual direct patient care hours per patient and per unit.
Hospitals must submit the direct patient care report to the Minnesota Hospital Association
by July 1, 2014, and quarterly thereafter.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2025.
new text end

Sec. 6.

new text begin [144.7056] IMPLEMENTATION OF HOSPITAL CORE STAFFING PLANS.
new text end

new text begin Subdivision 1. new text end

new text begin Plan implementation required. new text end

new text begin (a) A hospital must implement the core
staffing plans approved by a majority vote of its hospital nurse staffing committee.
new text end

new text begin (b) The commissioner is not required to verify compliance with this section by on-site
visits during routine hospital surveys.
new text end

new text begin Subd. 2. new text end

new text begin Public posting of core staffing plans. new text end

new text begin A hospital must post its core staffing
plan for each inpatient care unit in a public area on the relevant unit.
new text end

new text begin Subd. 3. new text end

new text begin Public posting of compliance with plan. new text end

new text begin For each publicly posted core staffing
plan, a hospital must post a notice stating whether the current staffing on the unit complies
with the hospital's core staffing plan for that unit. The public notice of compliance must
include a list of the number of nonmanagerial care staff working on the unit during the
current shift and the number of patients assigned to each direct care registered nurse working
on the unit during the current shift. The list must enumerate the nonmanagerial care staff
by health care worker type. The public notice of compliance must be posted immediately
adjacent to the publicly posted core staffing plan.
new text end

new text begin Subd. 4. new text end

new text begin Posting of compliance in patient rooms. new text end

new text begin A hospital must post on a whiteboard
in a patient's room or make available through a television in a patient's room both the number
of patients a nurse on the patient's unit should be assigned under the relevant core staffing
plan and the number of patients actually assigned to a nurse during the current shift.
new text end

new text begin Subd. 5. new text end

new text begin Deviations from core staffing plans. new text end

new text begin (a) Before hospital management lowers
the staffing level of any unit, management must consult with and receive agreement from
at least 50 percent of the direct care registered nurses staffing the unit.
new text end

new text begin (b) Deviation from a core staffing plan with the agreement of at least 50 percent of the
direct care registered nurses staffing the unit does not constitute compliance with the core
staffing plan.
new text end

new text begin Subd. 6. new text end

new text begin Public posting of emergency department wait times. new text end

new text begin A hospital must maintain
on its website and publicly display in its emergency department the approximate wait time
for patients who are not in critical need of emergency care. The approximate wait time must
be updated at least hourly.
new text end

new text begin Subd. 7. new text end

new text begin Disclosure of staffing plan upon admission. new text end

new text begin A hospital must provide an
explanation of its core staffing plan to each patient upon admission.
new text end

new text begin Subd. 8. new text end

new text begin Public distribution of core staffing plan and notice of compliance. new text end

new text begin (a) A
hospital must include with the posted materials described in subdivisions 2 and 3 a statement
that individual copies of the posted materials are available upon request to any patient on
the unit or to any visitor of a patient on the unit. The statement must include specific
instructions for obtaining copies of the posted materials.
new text end

new text begin (b) A hospital must, within four hours after the request, provide individual copies of all
the posted materials described in subdivisions 2 and 3 to any patient on the unit or to any
visitor of a patient on the unit who requests the materials.
new text end

new text begin Subd. 9. new text end

new text begin Reporting noncompliance. new text end

new text begin (a) Any hospital employee, patient, or patient
family member may submit a concern for safe staffing form to report an instance of
noncompliance with a hospital's core staffing plan, to object to the contents of a core staffing
plan, or to challenge the process of the hospital nurse staffing committee.
new text end

new text begin (b) A hospital must not interfere with or retaliate against a hospital employee for
submitting a concern for safe staffing form.
new text end

new text begin (c) The commissioner of labor and industry must investigate any report of retaliation
against a hospital employee for submitting a concern for safe staffing form. The commissioner
of labor and industry must fine a hospital $250,000 for each instance of substantiated
retaliation against a hospital employee for submitting a concern for safe staffing form.
new text end

new text begin Subd. 10. new text end

new text begin Documentation of compliance. new text end

new text begin Each hospital must document compliance
with its core nursing plans and maintain records demonstrating compliance for each inpatient
care unit for five years. Each hospital must provide to its nurse staffing committee access
to all documentation required under this subdivision.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2025.
new text end

Sec. 7.

new text begin [144.7057] HOSPITAL NURSE STAFFING REPORTS.
new text end

new text begin Subdivision 1. new text end

new text begin Nurse staffing report required. new text end

new text begin Each hospital nurse staffing committee
must submit quarterly nurse staffing reports to the commissioner. Reports must be submitted
within 60 days of the end of the quarter.
new text end

new text begin Subd. 2. new text end

new text begin Nurse staffing report. new text end

new text begin Nurse staffing reports submitted to the commissioner
by a hospital nurse staffing committee must:
new text end

new text begin (1) identify any suspected incidents of the hospital failing during the reporting quarter
to meet the standards of one of its core staffing plans;
new text end

new text begin (2) identify each occurrence of the hospital accepting an elective surgery at a time when
the unit performing the surgery is out of compliance with its core staffing plan;
new text end

new text begin (3) identify problems of insufficient staffing, including but not limited to:
new text end

new text begin (i) inappropriate number of direct care registered nurses scheduled in a unit;
new text end

new text begin (ii) inappropriate number of direct care registered nurses present and delivering care in
a unit;
new text end

new text begin (iii) inappropriately experienced direct care registered nurses scheduled for a particular
unit;
new text end

new text begin (iv) inappropriately experienced direct care registered nurses present and delivering care
in a unit;
new text end

new text begin (v) inability for nurse supervisors to adjust daily nursing schedules for increased patient
acuity or nursing intensity in a unit; and
new text end

new text begin (vi) chronically unfilled direct care positions within the hospital;
new text end

new text begin (4) identify any units that pose a risk to patient safety due to inadequate staffing;
new text end

new text begin (5) propose solutions to solve insufficient staffing;
new text end

new text begin (6) propose solutions to reduce risks to patient safety in inadequately staffed units; and
new text end

new text begin (7) describe staffing trends within the hospital.
new text end

new text begin Subd. 3. new text end

new text begin Public posting of nurse staffing reports. new text end

new text begin The commissioner must include on
its website each quarterly nurse staffing report submitted to the office under subdivision 1.
new text end

new text begin Subd. 4. new text end

new text begin Standardized reporting. new text end

new text begin The commissioner shall develop and provide to each
hospital nurse staffing committee a uniform format or standard form the committee must
use to comply with the nurse staffing reporting requirements under this section. The format
or form developed by the commissioner must present the reported information in a manner
allowing patients and the public to clearly understand and compare staffing patterns and
actual levels of staffing across reporting hospitals. The commissioner must include, in the
uniform format or on the standardized form, space to allow the reporting hospital to include
a description of additional resources available to support unit-level patient care and a
description of the hospital.
new text end

new text begin Subd. 5. new text end

new text begin Penalties. new text end

new text begin Notwithstanding section 144.653, subdivisions 5 and 6, the
commissioner may impose an immediate fine of up to $5,000 for each instance of a failure
to report an elective surgery requiring reporting under subdivision 2, clause (2). The facility
may request a hearing on the immediate fine under section 144.653, subdivision 8.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2025.
new text end

Sec. 8.

new text begin [144.7058] GRADING OF COMPLIANCE WITH CORE STAFFING PLANS.
new text end

new text begin Subdivision 1. new text end

new text begin Grading compliance with core staffing plans. new text end

new text begin By January 1, 2026, the
commissioner must develop a uniform annual grading system that evaluates each hospital's
compliance with its own core staffing plan. The commissioner must assign each hospital a
compliance grade based on a review of the hospital's nurse staffing report submitted under
section 144.7057. The commissioner must assign a failing compliance grade to any hospital
that has not been in compliance with its staffing plan for six or more months during the
reporting year.
new text end

new text begin Subd. 2. new text end

new text begin Grading factors. new text end

new text begin When grading a hospital's compliance with its core staffing
plan, the commissioner must consider at least the following factors:
new text end

new text begin (1) the number of assaults and injuries occurring in the hospital involving patients;
new text end

new text begin (2) the prevalence of infections, pressure ulcers, and falls among patients;
new text end

new text begin (3) emergency department wait times;
new text end

new text begin (4) readmissions;
new text end

new text begin (5) use of restraints and other behavior interventions;
new text end

new text begin (6) employment turnover rates among direct care registered nurses and other direct care
health care workers;
new text end

new text begin (7) prevalence of overtime among direct care registered nurses and other direct care
health care workers;
new text end

new text begin (8) prevalence of missed shift breaks among direct care registered nurses and other direct
care health care workers;
new text end

new text begin (9) frequency of incidents of being out of compliance with a core staffing plan; and
new text end

new text begin (10) the extent of noncompliance with a core staffing plan.
new text end

new text begin Subd. 3. new text end

new text begin Public disclosure of compliance grades. new text end

new text begin Beginning January 1, 2027, the
commissioner must publish a compliance grade for each hospital on the department website
with a link to the hospital's core staffing plan, the hospital's nurse staffing reports, and an
accessible and easily understandable explanation of what the compliance grade means.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026.
new text end

Sec. 9.

new text begin [144.7059] RETALIATION AGAINST NURSES PROHIBITED.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given.
new text end

new text begin (b) "Emergency" means a period when replacement staff are not able to report for duty
for the next shift, or a period of increased patient need, because of unusual, unpredictable,
or unforeseen circumstances, including but not limited to an act of terrorism, a disease
outbreak, adverse weather conditions, or a natural disaster, that impacts continuity of patient
care.
new text end

new text begin (c) "Nurse" has the meaning given in section 148.171, subdivision 9, and includes nurses
employed by the state.
new text end

new text begin (d) "Taking action against" means discharging, disciplining, threatening, reporting to
the Board of Nursing, discriminating against, or penalizing regarding compensation, terms,
conditions, location, or privileges of employment.
new text end

new text begin Subd. 2. new text end

new text begin Prohibited actions. new text end

new text begin Except as provided in subdivision 5, a hospital or other
entity licensed under sections 144.50 to 144.58, and its agent, or other health care facility
licensed by the commissioner of health, and the facility's agent, is prohibited from taking
action against a nurse solely on the ground that the nurse fails to accept an assignment of
one or more additional patients because the nurse determines that accepting an additional
patient assignment, in the nurse's judgment, may create an unnecessary danger to a patient's
life, health, or safety or may otherwise constitute a ground for disciplinary action under
section 148.261. This subdivision does not apply to a nursing facility, an intermediate care
facility for persons with developmental disabilities, or a licensed boarding care home.
new text end

new text begin Subd. 3. new text end

new text begin State nurses. new text end

new text begin Subdivision 2 applies to nurses employed by the state regardless
of the type of facility where the nurse is employed and regardless of the facility's license,
if the nurse is involved in resident or patient care.
new text end

new text begin Subd. 4. new text end

new text begin Collective bargaining rights. new text end

new text begin This section does not diminish or impair the
rights of a person under any collective bargaining agreement.
new text end

new text begin Subd. 5. new text end

new text begin Emergency. new text end

new text begin A nurse may be required to accept an additional patient assignment
in an emergency.
new text end

new text begin Subd. 6. new text end

new text begin Enforcement. new text end

new text begin The commissioner of labor and industry shall enforce this section.
The commissioner of labor and industry may assess a fine of up to $5,000 for each violation
of this section.
new text end

Sec. 10. new text begin INITIAL IMPLEMENTATION OF THE KEEPING NURSES AT THE
BEDSIDE ACT.
new text end

new text begin (a) By October 1, 2024, each hospital must establish and convene a hospital nurse staffing
committee as described under Minnesota Statutes, section 144.7053, and a hospital nurse
workload committee as described under Minnesota Statutes, section 144.7054.
new text end

new text begin (b) By October 1, 2025, each hospital must implement core staffing plans developed by
its hospital nurse staffing committee and satisfy the plan posting requirements under
Minnesota Statutes, section 144.7056.
new text end

new text begin (c) By October 1, 2025, each hospital must submit to the commissioner of health core
staffing plans meeting the requirements of Minnesota Statutes, section 144.7055.
new text end

new text begin (d) By October 1, 2025, the commissioner of health must develop a standard concern
for safe staffing form and provide an electronic means of submitting the form to the relevant
hospital nurse staffing committee. The commissioner must base the form on the existing
concern for safe staffing form maintained by the Minnesota Nurses' Association.
new text end

new text begin (e) By January 1, 2026, the commissioner of health must provide electronic access to
the uniform format or standard form for nurse staffing reporting described under Minnesota
Statutes, section 144.7057, subdivision 4.
new text end

Sec. 11. new text begin APPROPRIATION; HOSPITAL STAFFING.
new text end

new text begin (a) $....... in fiscal year 2024 and $....... in fiscal year 2025 are appropriated from the
general fund to the commissioner of health for the administration of Minnesota Statutes,
section 144.7057.
new text end

new text begin (b) $....... in fiscal year 2024 and $....... in fiscal year 2025 are appropriated from the
general fund to the commissioner of health for the grading duties described in Minnesota
Statutes, section 144.7058.
new text end

Sec. 12. new text begin REVISOR INSTRUCTION.
new text end

new text begin In Minnesota Statutes, section 144.7055, the revisor shall renumber paragraphs (b) to
(e) alphabetically as individual subdivisions under Minnesota Statutes, section 144.7051.
The revisor shall make any necessary changes to sentence structure for this renumbering
while preserving the meaning of the text. The revisor shall also make necessary
cross-reference changes in Minnesota Statutes and Minnesota Rules consistent with the
renumbering.
new text end

ARTICLE 3

WORKPLACE VIOLENCE PREVENTION

Section 1.

Minnesota Statutes 2022, section 144.566, is amended to read:

144.566 VIOLENCE AGAINST HEALTH CARE WORKERS.

Subdivision 1.

Definitions.

(a) The following definitions apply to this section and have
the meanings given.

(b) "Act of violence" means an act by a patient or visitor against a health care worker
that includes kicking, scratching, urinating, sexually harassing, or any act defined in sections
609.221 to 609.2241.

(c) "Commissioner" means the commissioner of health.

(d) "Health care worker" means any person, whether licensed or unlicensed, employed
by, volunteering in, or under contract with a hospital, who has direct contact with a patient
of the hospital for purposes of either medical care or emergency response to situations
potentially involving violence.

(e) "Hospital" means any facility licensed as a hospital under section 144.55.

(f) "Incident response" means the actions taken by hospital administration and health
care workers during and following an act of violence.

(g) "Interfere" means to prevent, impede, discourage, or delay a health care worker's
ability to report acts of violence, including by retaliating or threatening to retaliate against
a health care worker.

(h) "Preparedness" means the actions taken by hospital administration and health care
workers to prevent a single act of violence or acts of violence generally.

(i) "Retaliate" means to discharge, discipline, threaten, otherwise discriminate against,
or penalize a health care worker regarding the health care worker's compensation, terms,
conditions, location, or privileges of employment.

new text begin (j) "Workplace violence hazards" means locations and situations where violent incidents
are more likely to occur, including, as applicable, but not limited to locations isolated from
other health care workers; health care workers working alone; health care workers working
in remote locations; health care workers working late night or early morning hours; locations
where an assailant could prevent entry of responders or other health care workers into a
work area; locations with poor illumination; locations with poor visibility; lack of physical
barriers between health care workers and persons at risk of committing workplace violence;
lack of effective escape routes; obstacles and impediments to accessing alarm systems;
locations within the facility where alarm systems are not operational; entryways where
unauthorized entrance may occur, such as doors designated for staff entrance or emergency
exits; presence, in the areas where patient contact activities are performed, of furnishings
or objects that could be used as weapons; and locations where high-value items, currency,
or pharmaceuticals are stored.
new text end

Subd. 2.

deleted text begin Hospital duties deleted text end new text begin Action plans and action plan reviews required new text end .

deleted text begin (a) deleted text end All
hospitals must design and implement preparedness and incident response action plans to
acts of violence by January 15, 2016, and review new text begin and update new text end the plan at least annually
thereafter. new text begin The plan must be in writing; specific to the workplace violence hazards and
corrective measures for the units, services, or operations of the hospital; and available to
health care workers at all times.
new text end

new text begin Subd. 3. new text end

new text begin Action plan committees. new text end

deleted text begin (b) deleted text end A hospital shall designate a committee of
representatives of health care workers employed by the hospital, including nonmanagerial
health care workers, nonclinical staff, administrators, patient safety experts, and other
appropriate personnel to develop preparedness and incident response action plans to acts
of violence. The hospital shall, in consultation with the designated committee, implement
the plans under deleted text begin paragraph (a) deleted text end new text begin subdivision 2 new text end . Nothing in this deleted text begin paragraph deleted text end new text begin subdivision new text end shall
require the establishment of a separate committee solely for the purpose required by this
subdivision.

new text begin Subd. 4. new text end

new text begin Required elements of action plans; generally. new text end

new text begin The preparedness and incident
response action plans to acts of violence must include:
new text end

new text begin (1) effective procedures to obtain the active involvement of health care workers and
their representatives in developing, implementing, and reviewing the plan, including their
participation in identifying, evaluating, and correcting workplace violence hazards, designing
and implementing training, and reporting and investigating incidents of workplace violence;
new text end

new text begin (2) names or job titles of the persons responsible for implementing the plan; and
new text end

new text begin (3) effective procedures to ensure that supervisory and nonsupervisory health care
workers comply with the plan.
new text end

new text begin Subd. 5. new text end

new text begin Required elements of action plans; evaluation of risk factors. new text end

new text begin (a) The
preparedness and incident response action plans to acts of violence must include assessment
procedures to identify and evaluate workplace violence hazards for each facility, unit,
service, or operation, including community-based risk factors and areas surrounding the
facility, such as employee parking areas and other outdoor areas. Procedures shall specify
the frequency with which such environmental assessments will take place.
new text end

new text begin (b) The preparedness and incident response action plans to acts of violence must include
assessment tools, environmental checklists, or other effective means to identify workplace
violence hazards.
new text end

new text begin Subd. 6. new text end

new text begin Required elements of action plans; review of workplace violence
incidents. new text end

new text begin The preparedness and incident response action plans to acts of violence must
include procedures for reviewing all workplace violence incidents that occurred in the
facility, unit, service, or operation within the previous year, whether or not an injury occurred.
new text end

new text begin Subd. 7. new text end

new text begin Required elements of action plans; reporting workplace violence. new text end

new text begin The
preparedness and incident response action plans to acts of violence must include:
new text end

new text begin (1) effective procedures for health care workers to document information regarding
conditions that may increase the potential for workplace violence incidents and communicate
that information without fear of reprisal to other health care workers, shifts, or units;
new text end

new text begin (2) effective procedures for health care workers to report a violent incident, threat, or
other workplace violence concern without fear of reprisal;
new text end

new text begin (3) effective procedures for the hospital to accept and respond to reports of workplace
violence and to prohibit retaliation against a health care worker who makes such a report;
new text end

new text begin (4) a policy statement stating the hospital will not prevent a health care worker from
reporting workplace violence or take punitive or retaliatory action against a health care
worker for doing so;
new text end

new text begin (5) effective procedures for investigating health care worker concerns regarding workplace
violence or workplace violence hazards;
new text end

new text begin (6) procedures for informing health care workers of the results of the investigation arising
from a report of workplace violence or from a concern about a workplace violence hazard
and of any corrective actions taken;
new text end

new text begin (7) effective procedures for obtaining assistance from the appropriate law enforcement
agency or social service agency during all work shifts. The procedure may establish a central
coordination procedure; and
new text end

new text begin (8) a policy statement stating the hospital will not prevent a health care worker from
seeking assistance and intervention from local emergency services or law enforcement when
a violent incident occurs or take punitive or retaliatory action against a health care worker
for doing so.
new text end

new text begin Subd. 8. new text end

new text begin Required elements of action plans; coordination with other employers. new text end

new text begin The
preparedness and incident response action plans to acts of violence must include methods
the hospital will use to coordinate implementation of the plan with other employers whose
employees work in the same health care facility, unit, service, or operation and to ensure
that those employers and their employees understand their respective roles as provided in
the plan. These methods must ensure that all employees working in the facility, unit, service,
or operation are provided the training required by subdivision 11 and that workplace violence
incidents involving any employee are reported, investigated, and recorded.
new text end

new text begin Subd. 9. new text end

new text begin Required elements of action plans; white supremacist affiliation and support
prohibited. new text end

new text begin (a) The preparedness and incident response action plans to acts of violence
must include a policy statement stating that security personnel employed by the hospital or
assigned to the hospital by a contractor are prohibited from affiliating with, supporting, or
advocating for white supremacist groups, causes, or ideologies or participating in, or actively
promoting, an international or domestic extremist group that the Federal Bureau of
Investigation has determined supports or encourages illegal, violent conduct.
new text end

new text begin (b) For purposes of this subdivision, white supremacist groups, causes, or ideologies
include organizations and associations and ideologies that promote white supremacy and
the idea that white people are superior to Black, Indigenous, and people of color (BIPOC);
promote religious and racial bigotry; seek to exacerbate racial and ethnic tensions between
BIPOC and non-BIPOC; or engage in patently hateful and inflammatory speech, intimidation,
and violence against BIPOC as means of promoting white supremacy.
new text end

new text begin Subd. 10. new text end

new text begin Required elements of action plans; training. new text end

new text begin (a) The preparedness and
incident response action plans to acts of violence must include:
new text end

new text begin (1) procedures for developing and providing the training required in subdivision 11 that
permits health care workers and their representatives to participate in developing the training;
and
new text end

new text begin (2) a requirement for cultural competency training and equity, diversity, and inclusion
training.
new text end

new text begin (b) The preparedness and incident response action plans to acts of violence must include
procedures to communicate with health care workers regarding workplace violence matters,
including:
new text end

new text begin (1) how health care workers will document and communicate to other health care workers
and between shifts and units information regarding conditions that may increase the potential
for workplace violence incidents;
new text end

new text begin (2) how health care workers can report a violent incident, threat, or other workplace
violence concern;
new text end

new text begin (3) how health care workers can communicate workplace violence concerns without
fear of reprisal; and
new text end

new text begin (4) how health care worker concerns will be investigated, and how health care workers
will be informed of the results of the investigation and any corrective actions to be taken.
new text end

new text begin Subd. 11. new text end

new text begin Training required. new text end

deleted text begin (c) deleted text end A hospital deleted text begin shall deleted text end new text begin must new text end provide training to all health
care workers employed or contracted with the hospital on safety during acts of violence.
Each health care worker must receive safety training deleted text begin annually and upon hire deleted text end new text begin during the
health care worker's orientation and before the health care worker completes a shift
independently, and annually thereafter new text end . Training must, at a minimum, include:

(1) safety guidelines for response to and de-escalation of an act of violence;

(2) ways to identify potentially violent or abusive situations new text begin , including aggression and
violence predicting factors new text end ; deleted text begin and
deleted text end

(3) the hospital's deleted text begin incident response reaction plan and violence prevention plan deleted text end new text begin
preparedness and incident response action plans for acts of violence, including how the
health care worker may report concerns about workplace violence within each hospital's
reporting structure without fear of reprisal, how the hospital will address workplace violence
incidents, and how the health care worker can participate in reviewing and revising the plan;
and
new text end

new text begin (4) any resources available to health care workers for coping with incidents of violence,
including but not limited to critical incident stress debriefing or employee assistance
programs new text end .

new text begin Subd. 12. new text end

new text begin Annual review and update of action plans. new text end

deleted text begin (d) deleted text end new text begin (a) new text end As part of its annual
review new text begin of preparedness and incident response action plans new text end required under deleted text begin paragraph (a) deleted text end new text begin
subdivision 2 new text end , the hospital must review with the designated committee:

(1) the effectiveness of its preparedness and incident response action plans new text begin , including
the sufficiency of security systems, alarms, emergency responses, and security personnel
availability new text end ;

(2) new text begin security risks associated with specific units, areas of the facility with uncontrolled
access, late night shifts, early morning shifts, and areas surrounding the facility such as
employee parking areas and other outdoor areas;
new text end

new text begin (3) new text end the most recent gap analysis as provided by the commissioner; deleted text begin and
deleted text end

deleted text begin (3) deleted text end new text begin (4) new text end the number of acts of violence that occurred in the hospital during the previous
year, including injuries sustained, if any, and the unit in which the incident occurred deleted text begin . deleted text end new text begin ;
new text end

new text begin (5) evaluations of staffing, including staffing patterns and patient classification systems
that contribute to, or are insufficient to address, the risk of violence; and
new text end

new text begin (6) any reports of discrimination or abuse that arise from security resources, including
from the behavior of security personnel.
new text end

new text begin (b) As part of the annual update of preparedness and incident response action plans
required under subdivision 2, the hospital must incorporate corrective actions into the action
plan to address workplace violence hazards identified during the annual action plan review,
reports of workplace violence, reports of workplace violence hazards, and reports of
discrimination or abuse that arise from the security resources.
new text end

new text begin Subd. 13. new text end

new text begin Action plan updates. new text end

new text begin Following the annual review of the action plan, a hospital
must update the action plans to reflect the corrective actions the hospital will implement to
mitigate the hazards and vulnerabilities identified during the annual review.
new text end

new text begin Subd. 14. new text end

new text begin Requests for additional staffing. new text end

new text begin A hospital shall create and implement a
procedure for a health care worker to officially request of hospital supervisors or
administration that additional staffing be provided. The hospital must document all requests
for additional staffing made because of a health care worker's concern over a risk of an act
of violence. If the request for additional staffing to reduce the risk of violence is denied,
the hospital must provide the health care worker who made the request a written reason for
the denial and must maintain documentation of that communication with the documentation
of requests for additional staffing. A hospital must make documentation regarding staffing
requests available to the commissioner for inspection at the commissioner's request. The
commissioner may use documentation regarding staffing requests to inform the
commissioner's determination on whether the hospital is providing adequate staffing and
security to address acts of violence, and may use documentation regarding staffing requests
if the commissioner imposes a penalty under subdivision 18.
new text end

new text begin Subd. 15. new text end

new text begin Disclosure of action plans. new text end

deleted text begin (e) deleted text end new text begin (a) new text end A hospital deleted text begin shall deleted text end new text begin must new text end make its new text begin most recent new text end
action plans and deleted text begin the information listed in paragraph (d) deleted text end new text begin most recent action plan reviews new text end
available to deleted text begin local law enforcement deleted text end new text begin all direct care staff new text end and, if any of its workers are
represented by a collective bargaining unit, to the exclusive bargaining representatives of
those collective bargaining units.

new text begin (b) A hospital must also annually submit to the commissioner its most recent action plan
and the results of the most recent annual review conducted under subdivision 12.
new text end

new text begin Subd. 16. new text end

new text begin Legislative report required. new text end

new text begin (a) The commissioner must compile the
information into a single annual report and submit the report to the chairs and ranking
minority members of the legislative committees with jurisdiction over health care by January
15 of each year.
new text end

new text begin (b) This subdivision does not expire.
new text end

new text begin Subd. 17. new text end

new text begin Interference prohibited. new text end

deleted text begin (f) deleted text end A hospital, including any individual, partner,
association, or any person or group of persons acting directly or indirectly in the interest of
the hospital, deleted text begin shall deleted text end new text begin must new text end not interfere with or discourage a health care worker if the health
care worker wishes to contact law enforcement or the commissioner regarding an act of
violence.

new text begin Subd. 18. new text end

new text begin Penalties. new text end

deleted text begin (g) deleted text end new text begin Notwithstanding section 144.653, subdivision 6, new text end the
commissioner may impose deleted text begin an administrative deleted text end new text begin a new text end fine of up to deleted text begin $250 deleted text end new text begin $10,000 new text end for failure to
comply with the requirements of this deleted text begin subdivision deleted text end new text begin section new text end . new text begin The commissioner must allow
the hospital at least 30 calendar days to correct a violation of this section before assessing
a fine.
new text end

Sec. 2. new text begin APPROPRIATION; PREVENTION OF VIOLENCE IN HEALTH CARE.
new text end

new text begin $50,000 in fiscal year 2024 and $50,000 in fiscal year 2025 are appropriated to the
commissioner of health to continue the prevention of violence in health care programs and
to create violence prevention resources for hospitals and other health care providers to use
to train their staff on violence prevention.
new text end

ARTICLE 4

PIPELINE TO REGISTERED NURSE DEGREES

Section 1. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES.
new text end

new text begin The commissioner of human services must define as a direct educational expense the
reasonable child care costs incurred by a nursing facility employee scholarship recipient
while the recipient is receiving a wage from the scholarship sponsoring facility, provided
the scholarship recipient is making reasonable progress, as defined by the commissioner,
toward the educational goal for which the scholarship was granted.
new text end

ARTICLE 5

NURSE LOAN FORGIVENESS

Section 1.

Minnesota Statutes 2022, section 144.1501, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) For purposes of this section, the following definitions
apply.

(b) "Advanced dental therapist" means an individual who is licensed as a dental therapist
under section 150A.06, and who is certified as an advanced dental therapist under section
150A.106.

(c) "Alcohol and drug counselor" means an individual who is licensed as an alcohol and
drug counselor under chapter 148F.

(d) "Dental therapist" means an individual who is licensed as a dental therapist under
section 150A.06.

(e) "Dentist" means an individual who is licensed to practice dentistry.

(f) "Designated rural area" means a statutory and home rule charter city or township that
is outside the seven-county metropolitan area as defined in section 473.121, subdivision 2,
excluding the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud.

(g) "Emergency circumstances" means those conditions that make it impossible for the
participant to fulfill the service commitment, including death, total and permanent disability,
or temporary disability lasting more than two years.

(h) new text begin "Hospital nurse" means an individual who is licensed as a registered nurse and who
is providing direct patient care in a nonprofit hospital setting.
new text end

new text begin (i) new text end "Mental health professional" means an individual providing clinical services in the
treatment of mental illness who is qualified in at least one of the ways specified in section
245.462, subdivision 18.

deleted text begin (i) deleted text end new text begin (j) new text end "Medical resident" means an individual participating in a medical residency in
family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.

deleted text begin (j) deleted text end new text begin (k) new text end "Midlevel practitioner" means a nurse practitioner, nurse-midwife, nurse
anesthetist, advanced clinical nurse specialist, or physician assistant.

deleted text begin (k) deleted text end new text begin (l) new text end "Nurse" means an individual who has completed training and received all licensing
or certification necessary to perform duties as a licensed practical nurse or registered nurse.

deleted text begin (l) deleted text end new text begin (m) new text end "Nurse-midwife" means a registered nurse who has graduated from a program
of study designed to prepare registered nurses for advanced practice as nurse-midwives.

deleted text begin (m) deleted text end new text begin (n) new text end "Nurse practitioner" means a registered nurse who has graduated from a program
of study designed to prepare registered nurses for advanced practice as nurse practitioners.

deleted text begin (n) deleted text end new text begin (o) new text end "Pharmacist" means an individual with a valid license issued under chapter 151.

deleted text begin (o) deleted text end new text begin (p) new text end "Physician" means an individual who is licensed to practice medicine in the areas
of family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.

deleted text begin (p) deleted text end new text begin (q) new text end "Physician assistant" means a person licensed under chapter 147A.

new text begin (r) "PSLF program" means the federal Public Service Loan Forgiveness program
established under Code of Federal Regulations, title 34, section 685.219.
new text end

deleted text begin (q) deleted text end new text begin (s) new text end "Public health nurse" means a registered nurse licensed in Minnesota who has
obtained a registration certificate as a public health nurse from the Board of Nursing in
accordance with Minnesota Rules, chapter 6316.

deleted text begin (r) deleted text end new text begin (t) new text end "Qualified educational loan" means a government, commercial, or foundation loan
for actual costs paid for tuition, reasonable education expenses, and reasonable living
expenses related to the graduate or undergraduate education of a health care professional.

deleted text begin (s) deleted text end new text begin (u) new text end "Underserved urban community" means a Minnesota urban area or population
included in the list of designated primary medical care health professional shortage areas
(HPSAs), medically underserved areas (MUAs), or medically underserved populations
(MUPs) maintained and updated by the United States Department of Health and Human
Services.

Sec. 2.

Minnesota Statutes 2022, section 144.1501, subdivision 2, is amended to read:

Subd. 2.

Creation of account.

(a) A health professional education loan forgiveness
program account is established. The commissioner of health shall use money from the
account to establish a loan forgiveness program:

(1) for medical residents, mental health professionals, and alcohol and drug counselors
agreeing to practice in designated rural areas or underserved urban communities or
specializing in the area of pediatric psychiatry;

(2) for midlevel practitioners agreeing to practice in designated rural areas or to teach
at least 12 credit hours, or 720 hours per year in the nursing field in a postsecondary program
at the undergraduate level or the equivalent at the graduate level;

(3) for nurses who agree to practice in a Minnesota nursing home; an intermediate care
facility for persons with developmental disability; a hospital if the hospital owns and operates
a Minnesota nursing home and a minimum of 50 percent of the hours worked by the nurse
is in the nursing home; a housing with services establishment as defined in section 144D.01,
subdivision 4; or for a home care provider as defined in section 144A.43, subdivision 4; or
agree to teach at least 12 credit hours, or 720 hours per year in the nursing field in a
postsecondary program at the undergraduate level or the equivalent at the graduate level;

(4) for other health care technicians agreeing to teach at least 12 credit hours, or 720
hours per year in their designated field in a postsecondary program at the undergraduate
level or the equivalent at the graduate level. The commissioner, in consultation with the
Healthcare Education-Industry Partnership, shall determine the health care fields where the
need is the greatest, including, but not limited to, respiratory therapy, clinical laboratory
technology, radiologic technology, and surgical technology;

(5) for pharmacists, advanced dental therapists, dental therapists, and public health nurses
who agree to practice in designated rural areas; deleted text begin and
deleted text end

(6) for dentists agreeing to deliver at least 25 percent of the dentist's yearly patient
encounters to state public program enrollees or patients receiving sliding fee schedule
discounts through a formal sliding fee schedule meeting the standards established by the
United States Department of Health and Human Services under Code of Federal Regulations,
title 42, section 51, chapter 303 deleted text begin . deleted text end new text begin ; and
new text end

new text begin (7) for nurses who are enrolled in the PSLF program, employed as a hospital nurse by
a nonprofit hospital that is an eligible employer under the PSLF program, and providing
direct care to patients at the nonprofit hospital.
new text end

(b) Appropriations made to the account do not cancel and are available until expended,
except that at the end of each biennium, any remaining balance in the account that is not
committed by contract and not needed to fulfill existing commitments shall cancel to the
fund.

Sec. 3.

Minnesota Statutes 2022, section 144.1501, subdivision 3, is amended to read:

Subd. 3.

Eligibility.

(a) To be eligible to participate in the loan forgiveness program, an
individual must:

(1) be a medical or dental resident; a licensed pharmacist; or be enrolled in a training or
education program to become a dentist, dental therapist, advanced dental therapist, mental
health professional, alcohol and drug counselor, pharmacist, public health nurse, midlevel
practitioner, registered nurse, or a licensed practical nurse. The commissioner may also
consider applications submitted by graduates in eligible professions who are licensed and
in practice; and

(2) submit an application to the commissioner of health. new text begin Nurses applying under
subdivision 2, paragraph (a), clause (7), must also include proof that the applicant is enrolled
in the PSLF program and confirmation that the applicant is employed as a hospital nurse.
new text end

(b) An applicant selected to participate must sign a contract to agree to serve a minimum
three-year full-time service obligation according to subdivision 2, which shall begin no later
than March 31 following completion of required training, with the exception of new text begin :
new text end

new text begin (1) new text end a nurse, who must agree to serve a minimum two-year full-time service obligation
according to subdivision 2, which shall begin no later than March 31 following completion
of required training deleted text begin . deleted text end new text begin ;
new text end

new text begin (2) a nurse selected under subdivision 2, paragraph (a), clause (7), who must agree to
continue as a hospital nurse for the repayment period of the participant's eligible loan under
the PSLF program; and
new text end

new text begin (3) a nurse who agrees to teach according to subdivision 2, paragraph (a), clause (3),
who must sign a contract to agree to teach for a minimum of two years.
new text end

Sec. 4.

Minnesota Statutes 2022, section 144.1501, subdivision 4, is amended to read:

Subd. 4.

Loan forgiveness.

new text begin (a) new text end The commissioner of health may select applicants each
year for participation in the loan forgiveness program, within the limits of available funding.
In considering applications, the commissioner shall give preference to applicants who
document diverse cultural competencies. The commissioner shall distribute available funds
for loan forgiveness proportionally among the eligible professions according to the vacancy
rate for each profession in the required geographic area, facility type, teaching area, patient
group, or specialty type specified in subdivision 2 new text begin , except for hospital nurses new text end . The
commissioner shall allocate funds for physician loan forgiveness so that 75 percent of the
funds available are used for rural physician loan forgiveness and 25 percent of the funds
available are used for underserved urban communities and pediatric psychiatry loan
forgiveness. If the commissioner does not receive enough qualified applicants each year to
use the entire allocation of funds for any eligible profession, the remaining funds may be
allocated proportionally among the other eligible professions according to the vacancy rate
for each profession in the required geographic area, patient group, or facility type specified
in subdivision 2. Applicants are responsible for securing their own qualified educational
loans. The commissioner shall select participants based on their suitability for practice
serving the required geographic area or facility type specified in subdivision 2, as indicated
by experience or training. The commissioner shall give preference to applicants closest to
completing their training. new text begin Except as specified in paragraphs (b) and (c), new text end for each year that
a participant meets the service obligation required under subdivision 3, up to a maximum
of four years, the commissioner shall make annual disbursements directly to the participant
equivalent to 15 percent of the average educational debt for indebted graduates in their
profession in the year closest to the applicant's selection for which information is available,
not to exceed the balance of the participant's qualifying educational loans. Before receiving
loan repayment disbursements and as requested, the participant must complete and return
to the commissioner a confirmation of practice form provided by the commissioner verifying
that the participant is practicing as required under subdivisions 2 and 3. The participant
must provide the commissioner with verification that the full amount of loan repayment
disbursement received by the participant has been applied toward the designated loans.
After each disbursement, verification must be received by the commissioner and approved
before the next loan repayment disbursement is made. Participants who move their practice
remain eligible for loan repayment as long as they practice as required under subdivision
2.

new text begin (b) For hospital nurses, the commissioner of health shall select applicants each year for
participation in the hospital nursing education loan forgiveness program, within limits of
available funding for hospital nurses. Applicants are responsible for applying for and
maintaining eligibility for the PSLF program. For each year that a participant meets the
eligibility requirements described in subdivision 3, the commissioner shall make an annual
disbursement directly to the participant in an amount equal to the minimum loan payments
required to be paid by the participant under the participant's repayment plan established for
the participant under the PSLF program for the previous loan year. Before receiving the
annual loan repayment disbursement, the participant must complete and return to the
commissioner a confirmation of practice form provided by the commissioner, verifying that
the participant continues to meet the eligibility requirements under subdivision 3. The
participant must provide the commissioner with verification that the full amount of loan
repayment disbursement received by the participant has been applied toward the loan for
which forgiveness is sought under the PSLF program.
new text end

new text begin (c) For each year that a participant who is a nurse and who has agreed to teach according
to subdivision 2 meets the teaching obligation required in subdivision 3, the commissioner
shall make annual disbursements directly to the participant equivalent to 15 percent of the
average annual educational debt for indebted graduates in the nursing profession in the year
closest to the participant's selection for which information is available, not to exceed the
balance of the participant's qualifying educational loans.
new text end

Sec. 5.

Minnesota Statutes 2022, section 144.1501, subdivision 5, is amended to read:

Subd. 5.

Penalty for nonfulfillment.

If a participant does not fulfill the required
minimum commitment of service according to subdivision 3, new text begin or for hospital nurses, if the
secretary of education determines that the participant does not meet eligibility requirements
for the PSLF, new text end the commissioner of health shall collect from the participant the total amount
paid to the participant under the loan forgiveness program plus interest at a rate established
according to section 270C.40. The commissioner shall deposit the money collected in the
health care access fund to be credited to the health professional education loan forgiveness
program account established in subdivision 2. The commissioner shall allow waivers of all
or part of the money owed the commissioner as a result of a nonfulfillment penalty if
emergency circumstances prevented fulfillment of the minimum service commitment new text begin , or
for hospital nurses, if the PSLF program is discontinued before the participant's service
commitment is fulfilled new text end .

Sec. 6.

Minnesota Statutes 2022, section 144.608, subdivision 1, is amended to read:

Subdivision 1.

Trauma Advisory Council established.

(a) A Trauma Advisory Council
is established to advise, consult with, and make recommendations to the commissioner on
the development, maintenance, and improvement of a statewide trauma system.

(b) The council shall consist of the following members:

(1) a trauma surgeon certified by the American Board of Surgery or the American
Osteopathic Board of Surgery who practices in a level I or II trauma hospital;

(2) a general surgeon certified by the American Board of Surgery or the American
Osteopathic Board of Surgery whose practice includes trauma and who practices in a
designated rural area as defined under section 144.1501, subdivision 1 deleted text begin , paragraph (e) deleted text end ;

(3) a neurosurgeon certified by the American Board of Neurological Surgery who
practices in a level I or II trauma hospital;

(4) a trauma program nurse manager or coordinator practicing in a level I or II trauma
hospital;

(5) an emergency physician certified by the American Board of Emergency Medicine
or the American Osteopathic Board of Emergency Medicine whose practice includes
emergency room care in a level I, II, III, or IV trauma hospital;

(6) a trauma program manager or coordinator who practices in a level III or IV trauma
hospital;

(7) a physician certified by the American Board of Family Medicine or the American
Osteopathic Board of Family Practice whose practice includes emergency department care
in a level III or IV trauma hospital located in a designated rural area as defined under section
144.1501, subdivision 1 deleted text begin , paragraph (e) deleted text end ;

(8) a nurse practitioner, as defined under section 144.1501, subdivision 1 deleted text begin , paragraph (l) deleted text end ,
or a physician assistant, as defined under section 144.1501, subdivision 1 deleted text begin , paragraph (o) deleted text end ,
whose practice includes emergency room care in a level IV trauma hospital located in a
designated rural area as defined under section 144.1501, subdivision 1 deleted text begin , paragraph (e) deleted text end ;

(9) a physician certified in pediatric emergency medicine by the American Board of
Pediatrics or certified in pediatric emergency medicine by the American Board of Emergency
Medicine or certified by the American Osteopathic Board of Pediatrics whose practice
primarily includes emergency department medical care in a level I, II, III, or IV trauma
hospital, or a surgeon certified in pediatric surgery by the American Board of Surgery whose
practice involves the care of pediatric trauma patients in a trauma hospital;

(10) an orthopedic surgeon certified by the American Board of Orthopaedic Surgery or
the American Osteopathic Board of Orthopedic Surgery whose practice includes trauma
and who practices in a level I, II, or III trauma hospital;

(11) the state emergency medical services medical director appointed by the Emergency
Medical Services Regulatory Board;

(12) a hospital administrator of a level III or IV trauma hospital located in a designated
rural area as defined under section 144.1501, subdivision 1 deleted text begin , paragraph (e) deleted text end ;

(13) a rehabilitation specialist whose practice includes rehabilitation of patients with
major trauma injuries or traumatic brain injuries and spinal cord injuries as defined under
section 144.661;

(14) an attendant or ambulance director who is an EMT, EMT-I, or EMT-P within the
meaning of section 144E.001 and who actively practices with a licensed ambulance service
in a primary service area located in a designated rural area as defined under section 144.1501,
subdivision 1 deleted text begin , paragraph (e) deleted text end ; and

(15) the commissioner of public safety or the commissioner's designee.

Sec. 7.

Minnesota Statutes 2022, section 147A.08, is amended to read:

147A.08 EXEMPTIONS.

(a) This chapter does not apply to, control, prevent, or restrict the practice, service, or
activities of persons listed in section 147.09, clauses (1) to (6) and (8) to (13) deleted text begin , deleted text end new text begin ; new text end persons
regulated under section 214.01, subdivision 2 deleted text begin , deleted text end new text begin ; new text end or deleted text begin persons deleted text end new text begin midlevel practitioners, nurses,
or nurse-midwives as new text end defined in section 144.1501, subdivision 1 deleted text begin , paragraphs (i), (k), and
(l) deleted text end .

(b) Nothing in this chapter shall be construed to require licensure of:

(1) a physician assistant student enrolled in a physician assistant educational program
accredited by the Accreditation Review Commission on Education for the Physician Assistant
or by its successor agency approved by the board;

(2) a physician assistant employed in the service of the federal government while
performing duties incident to that employment; or

(3) technicians, other assistants, or employees of physicians who perform delegated
tasks in the office of a physician but who do not identify themselves as a physician assistant.

Sec. 8. new text begin APPROPRIATION; HOSPITAL NURSING LOAN FORGIVENESS.
new text end

new text begin Notwithstanding the priorities and distribution requirements under Minnesota Statutes,
section 144.1501, $5,000,000 in fiscal year 2024 and $5,000,000 in fiscal year 2025 are
appropriated from the general fund to the commissioner of health for the health professional
education loan forgiveness program under Minnesota Statutes, section 144.1501, to be
distributed to eligible nurses who have agreed to be hospital nurses in accordance with
Minnesota Statutes, section 144.1501, subdivision 2, clause (7).
new text end

Sec. 9. new text begin APPROPRIATION; LOAN FORGIVENESS FOR NURSING
INSTRUCTORS.
new text end

new text begin Notwithstanding the priorities and distribution requirements under Minnesota Statutes,
section 144.1501, $....... in fiscal year 2024 and $....... in fiscal year 2025 are appropriated
from the general fund to the commissioner of health for the health professional education
loan forgiveness program under Minnesota Statutes, section 144.1501, to be distributed in
accordance with the program to eligible nurses who have agreed to teach in accordance
with Minnesota Statutes, section 144.1501, subdivision 2, clause (3).
new text end

ARTICLE 6

REPORT ON HOSPITAL STAFFING

Section 1.

Minnesota Statutes 2022, section 144.7067, subdivision 1, is amended to read:

Subdivision 1.

Establishment of reporting system.

(a) The commissioner shall establish
an adverse health event reporting system designed to facilitate quality improvement in the
health care system. The reporting system shall not be designed to punish errors by health
care practitioners or health care facility employees.

(b) The reporting system shall consist of:

(1) mandatory reporting by facilities of 27 adverse health care events;

(2) new text begin mandatory reporting by facilities of whether the unit where an adverse event occurred
was in compliance with the core staffing plan for the unit at the time of the adverse event;
new text end

new text begin (3) new text end mandatory completion of a root cause analysis and a corrective action plan by the
facility and reporting of the findings of the analysis and the plan to the commissioner or
reporting of reasons for not taking corrective action;

deleted text begin (3) deleted text end new text begin (4) new text end analysis of reported information by the commissioner to determine patterns of
systemic failure in the health care system and successful methods to correct these failures;

deleted text begin (4) deleted text end new text begin (5) new text end sanctions against facilities for failure to comply with reporting system
requirements; and

deleted text begin (5) deleted text end new text begin (6) new text end communication from the commissioner to facilities, health care purchasers, and
the public to maximize the use of the reporting system to improve health care quality.

(c) The commissioner is not authorized to select from or between competing alternate
acceptable medical practices.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2025.
new text end

Sec. 2. new text begin DIRECTION TO COMMISSIONER OF HEALTH; DEVELOPMENT OF
ANALYTICAL TOOLS.
new text end

new text begin (a) The commissioner of health, in consultation with the Minnesota Nurses Association
and other professional nursing organizations, must develop a means of analyzing available
adverse event data, available staffing data, and available data from concern for safe staffing
forms to examine potential causal links between adverse events and understaffing.
new text end

new text begin (b) The commissioner must develop an initial means of conducting the analysis described
in paragraph (a) by January 1, 2025, and publish a public report on the commissioner's
initial findings by January 1, 2026.
new text end

new text begin (c) By January 1, 2024, the commissioner must submit to the chairs and ranking minority
members of the house and senate committees with jurisdiction over the regulation of hospitals
a report on the available data, potential sources of additional useful data, and any additional
statutory authority the commissioner requires to collect additional useful information from
hospitals.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2023.
new text end

Sec. 3. new text begin DIRECTION TO COMMISSIONER OF HEALTH; NURSING
WORKFORCE REPORT.
new text end

new text begin (a) The commissioner of health must publish a public report on the current status of the
state's nursing workforce employed by hospitals. In preparing the report, the commissioner
shall utilize information collected in collaboration with the Board of Nursing as directed
under Minnesota Statutes, sections 144.051 and 144.052, on Minnesota's supply of active
licensed nurses and reasons licensed nurses are leaving direct care positions at hospitals;
information collected and shared by the Minnesota Hospital Association on retention by
hospitals of licensed nurses; information collected through an independent study on reasons
licensed nurses are choosing not to renew their licenses and leaving the profession; and
other publicly available data the commissioner deems useful.
new text end

new text begin (b) The commissioner must publish the report by January 1, 2026.
new text end

Sec. 4. new text begin APPROPRIATION; DEVELOPMENT OF ANALYTICAL TOOLS.
new text end

new text begin $....... in fiscal year 2024 and $....... in fiscal year 2025 are appropriated from the general
fund to the commissioner of health for an examination of adverse event data, available
staffing data, and available data from concern for safe staffing forms to identify potential
links between adverse events and understaffing.
new text end

Sec. 5. new text begin APPROPRIATION; NURSING WORKFORCE REPORT.
new text end

new text begin $....... in fiscal year 2024 and $....... in fiscal year 2025 are appropriated from the general
fund to the commissioner of health for a report on the current status of the state's nursing
workforce employed by hospitals.
new text end

ARTICLE 7

MENTAL HEALTH SERVICES FOR NURSES

Section 1. new text begin APPROPRIATION; IMPROVING MENTAL HEALTH OF HEALTH
CARE WORKERS.
new text end

new text begin $10,000,000 in fiscal year 2024 and $10,000,000 in fiscal year 2025 are appropriated
from the general fund to the commissioner of health for competitive grants to hospitals,
community health centers, rural health clinics, and medical professional associations to
establish or enhance evidence-based or evidence-informed programs dedicated to improving
the mental health of health care professionals.
new text end