HF 2289

as introduced - 94th Legislature (2025 - 2026) Posted on 03/13/2025 03:02pm

A bill for an act
relating to health; requiring hospitals to provide registered nurse staffing at levels
consistent with nationally accepted standards; requiring reporting of staffing levels;
prohibiting retaliation; imposing civil penalties; appropriating money; amending
Minnesota Statutes 2024, sections 144.7055; 148.264, subdivision 1; proposing
coding for new law in Minnesota Statutes, chapter 144.

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

Section 1.

new text begin [144.592] QUALITY PATIENT CARE ACT.
new text end

new text begin Subdivision 1. new text end

new text begin Title. new text end

new text begin Sections 144.592 to 144.596 may be cited as the "Quality Patient
Care Act."
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of sections 144.592 to 144.596, the following
terms have the meanings given.
new text end

new text begin (b) "Assignment" means the provision of care to a patient for whom a direct-care
registered nurse has responsibility within the nurse's scope of practice.
new text end

new text begin (c) "Charge nurse" means a nurse who:
new text end

new text begin (1) oversees and supports a nursing staff for each shift;
new text end

new text begin (2) serves as a unit resource and carries out duties that include assigning patients to
nurses in the oncoming shift, coordinating patient flow, relieving staff for breaks, and
operating as a safety valve in addressing emergency patient care issues and fluctuations in
patient acuity and nursing intensity on the unit; and
new text end

new text begin (3) has received special orientation and training to serve as a charge nurse for a unit or
department in a hospital.
new text end

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

new text begin (e) "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 (f) "Health care emergency" means a situation that creates an actual or imminent serious
threat to the health and safety of persons and that may require hospitals and other health
care facilities to provide an exceptional level of emergency services or other health care
services. A health care emergency may include a natural or man-made disaster or an illness
or health condition caused by bioterrorism or an infectious agent that causes a high probability
of a large number of deaths, serious or long-term disabilities, or substantial future harm.
new text end

new text begin (g) "Nursing intensity" means a patient-specific, not diagnosis-specific, measurement
of nursing care resources expended during a patient's hospitalization. A measurement of
nursing intensity includes the complexity of care required for a patient and the knowledge
and skill needed by a nurse for the surveillance of patients in order to make continuous,
appropriate clinical decisions in the care of patients.
new text end

new text begin (h) "Patient acuity" means the measure of a patient's severity of illness or medical
condition, including but not limited to the stability of physiological and psychological
parameters; the dependency needs of the patient and the patient's family; and any other
factors influencing the perceived health care needs of an individual patient as determined
by a licensed provider, direct-care registered nurse, or other licensed health care professional
whose primary job duties include providing care to patients more than 60 percent of the
time. Higher patient acuity requires more intensive nursing time and advanced nursing skills
for continuous surveillance.
new text end

new text begin (i) "Skill mix" means the composition of nursing staff by licensure, experience, and
education, including but not limited to registered nurses, licensed practical nurses, and
unlicensed personnel.
new text end

new text begin (j) "Surveillance" means the continuous process of observing patients for early detection
and intervention in an effort to prevent negative patient outcomes.
new text end

new text begin (k) "Unit" means an area or location of a hospital where patients receive care based on
similar patient acuity and nursing intensity.
new text end

new text begin Subd. 3. new text end

new text begin Compliance. new text end

new text begin A hospital licensed under sections 144.50 to 144.56 must comply
with this section and sections 144.593 to 144.595 as a condition of licensure.
new text end

new text begin Subd. 4. new text end

new text begin Staffing. new text end

new text begin A hospital must, at all times, provide enough qualified registered
nursing personnel on duty to provide the standard of care that is necessary for the well-being
of the patients, consistent with nationally accepted, evidence-based standards established
by this section and professional nursing specialty organizations. A direct-care registered
nurse assigned to a patient shall directly provide the planning, supervision, implementation,
assessment and evaluation of nursing care to the patient, and is responsible for the provision
of care to a particular patient within the nurse's scope of practice.
new text end

new text begin Subd. 5. new text end

new text begin Staffing plans. new text end

new text begin A hospital must adopt and implement a staffing plan that
specifies the maximum number of patients that may be assigned to a direct-care registered
nurse for each unit of the hospital in order to ensure adequate staffing levels for patient
safety. Staffing plans adopted and implemented under this subdivision must establish staffing
levels that include the flexibility to increase the number of nurses required for a unit when
necessary for patient safety. Staffing plans must also include patient-to-staff ratios for
nursing assistants and other direct-care staff providing nursing services directly to patients.
Staffing plans must be developed in agreement with direct-care registered nurses and must
comply with the requirements in subdivision 6. The staffing plan must be made available
to all employees within the facility, officers or other representatives of labor unions with
collective bargaining agreements in place with one or more employees in the facility, and
the Department of Health. The staffing plan must be agreed upon by any existing collective
bargaining units impacted by the staffing plan before it may be approved by the
commissioner.
new text end

new text begin Subd. 6. new text end

new text begin Assignment limits for direct care registered nurses. new text end

new text begin (a) A staffing plan
developed under subdivision 5 may not permit direct-care registered nurses to be assigned
more patients than the following for any shift:
new text end

new text begin (1) one registered nurse to one patient:
new text end

new text begin (i) in operating rooms;
new text end

new text begin (ii) in trauma units;
new text end

new text begin (iii) for patients who require immediate lifesaving interventions;
new text end

new text begin (iv) for hemodynamically unstable patients whose care needs include immediate response
to life-threatening conditions;
new text end

new text begin (v) for patients demonstrating compromised or otherwise unstable vital signs creating
life-threatening conditions requiring immediate response;
new text end

new text begin (vi) for pregnant patients in active delivery;
new text end

new text begin (vii) for patients in postanesthesia;
new text end

new text begin (viii) for patients with conditions or health care needs that pose an immediate threat to
life or limb;
new text end

new text begin (ix) for trauma patients requiring lifesaving interventions or patients with other conditions
qualifying as a trauma code activation; and
new text end

new text begin (x) for unstable patients requiring transfer to another unit;
new text end

new text begin (2) one registered nurse to two patients in:
new text end

new text begin (i) postanesthesia care units;
new text end

new text begin (ii) critical care units;
new text end

new text begin (iii) intensive care units;
new text end

new text begin (iv) any units treating intensive care unit patients within the emergency room;
new text end

new text begin (v) neonatal intensive care;
new text end

new text begin (vi) labor and delivery;
new text end

new text begin (vii) coronary care;
new text end

new text begin (viii) acute respiratory care; and
new text end

new text begin (ix) burn units;
new text end

new text begin (3) one registered nurse to three patients in:
new text end

new text begin (i) intermediate care newborn nurseries;
new text end

new text begin (ii) antepartum units;
new text end

new text begin (iii) adult medical and surgical units;
new text end

new text begin (iv) units providing both labor and delivery and postpartum services;
new text end

new text begin (v) postpartum couplets units providing services for infants and mothers;
new text end

new text begin (vi) step-down units;
new text end

new text begin (vii) telemetry units;
new text end

new text begin (viii) pediatric units; and
new text end

new text begin (ix) emergency departments;
new text end

new text begin (4) one registered nurse to four patients in:
new text end

new text begin (i) acute psychiatric units;
new text end

new text begin (ii) rehabilitation care units;
new text end

new text begin (iii) chemical dependency units;
new text end

new text begin (iv) immediate care nursery or Level II nursery; and
new text end

new text begin (v) any other specialty care or patient care units organized to provide care for a specific
medical condition, disease, diagnosis, or patient population for which specific assignment
limits are not established in this paragraph; and
new text end

new text begin (5) one registered nurse to five patients for skilled nursing units.
new text end

new text begin (b) Nothing in this subdivision:
new text end

new text begin (1) requires a hospital with lower patient assignment limits than those established in
paragraph (a) to increase its assignment limits;
new text end

new text begin (2) requires a hospital to establish patient assignment limits for any units named within
this subdivision in which the hospital does not organize, operate, and maintain a unit that
provides the same services as those units listed in this subdivision; and
new text end

new text begin (3) limits the rights of organized nurses to bargain on the issue of patient assignment
limits.
new text end

new text begin (c) In determining ratios for each unit, there shall be no averaging of the number of
patients and the total number of licensed bargaining unit nurses on the unit during any one
shift nor over any period of time. Only licensed bargaining unit nurses providing direct
patient care shall be included in the ratios, and no other staffing combinations or utilization
of nonnursing staff may be deployed to reduce or otherwise alter the number of nurses
assigned to a given unit. The ratios established shall be in place for all shifts throughout the
calendar year.
new text end

new text begin Subd. 7. new text end

new text begin Schedule for compliance. new text end

new text begin Hospitals must comply with the assignment limits
in subdivision 6 no later than August 1, 2027, except that hospitals in a rural area, as defined
in United States Code, title 42, section 1395ww(d)(2)(D), must comply no later than August
1, 2029. The commissioner of health shall establish a schedule by which hospitals must
comply with assignment limits and shall establish, maintain, and enforce proper
implementation of assignment limits within licensed hospitals.
new text end

new text begin Subd. 8. new text end

new text begin Application of assignment limits to hospital nursing practice standards. new text end

new text begin A
patient assignment may be included in the calculation of direct-care registered
nurse-to-patient assignment limits established in subdivision 6 only if care is provided by
a direct-care registered nurse and the provision of care to the particular patient is within
that direct-care registered nurse's validated competence.
new text end

new text begin Subd. 9. new text end

new text begin Nursing administrators and supervisors. new text end

new text begin A hospital shall not include a nursing
administrator or supervisor in the calculation of direct-care registered nurse-to-patient
assignment limits established in subdivision 6. For purposes of this subdivision, "nursing
administrator or supervisor" includes a nurse administrator, nurse supervisor, nurse manager,
charge nurse, chief nursing officer, or any other nursing staff whose regular job duties do
not include providing direct patient care during at least 60 percent of working hours.
new text end

new text begin Subd. 10. new text end

new text begin Application of assignment limits. new text end

new text begin The assignment limits established in
subdivision 6 represent the maximum number of patients to which a direct-care registered
nurse may be assigned at all points during a shift. A hospital is prohibited from averaging
the number of patients and the total number of direct-care registered nurses assigned to
patients in a unit during any one shift or over any period of time in order to meet the
assignment limits established in subdivision 6.
new text end

new text begin Subd. 11. new text end

new text begin Assignments, assignment adjustments, and adding additional registered
nurses. new text end

new text begin (a) A hospital must assign nurses, nursing assistants, and any other nursing or
direct-care personnel to the patient population consistent with the hospital's staffing plan
and the assignment limits established in subdivision 6. For each patient population, a
direct-care registered nurse shall evaluate the following factors to assess and determine
adequacy of staffing levels to meet patient care needs:
new text end

new text begin (1) composition of skill mix and roles available;
new text end

new text begin (2) patient acuity;
new text end

new text begin (3) experience level of registered nurse staff;
new text end

new text begin (4) unit activity level, such as admissions, discharges, and transfers;
new text end

new text begin (5) variable staffing grids;
new text end

new text begin (6) availability of a registered nurse to accept an assignment; and
new text end

new text begin (7) nursing intensity.
new text end

new text begin (b) A hospital shall not:
new text end

new text begin (1) assign or otherwise direct nursing staff to provide patient care to a patient unless the
direct-care registered nurse is able to demonstrate current competence in providing care to
any relevant patient populations and has received orientation, training, and experience
sufficient to provide competent care to the patient and that patient population;
new text end

new text begin (2) assign a direct-care registered nurse to provide patient care to a patient if the nurse's
professional opinion leads the nurse to believe that accepting the additional patient assignment
would force the nurse to violate any provisions of the Minnesota Nurse Practice Act, under
sections 148.171 to 148.285;
new text end

new text begin (3) assign nursing personnel from a supplemental nursing services agency to provide
patient care to a patient population until the agency nurse is able to demonstrate validated
competence in providing care to that patient population and has received orientation sufficient
to provide competent care to the patient population; or
new text end

new text begin (4) assign unlicensed personnel to:
new text end

new text begin (i) perform direct-care registered nurse functions in lieu of care delivered by a direct-care
registered nurse;
new text end

new text begin (ii) perform tasks that require the assessment, judgment, or skill of a direct-care registered
nurse; or
new text end

new text begin (iii) perform functions of a direct-care registered nurse under the supervision of a
direct-care registered nurse.
new text end

new text begin (c) If any direct-care registered nurse determines that a unit's staffing levels are inadequate
and notifies the unit's charge nurse and a manager or administrative supervisor, the manager
or administrative supervisor shall consider the following:
new text end

new text begin (1) current patient care assignments for potential redistribution;
new text end

new text begin (2) the ability to facilitate discharges, transfers, and admissions;
new text end

new text begin (3) the availability of additional staffing resources; and
new text end

new text begin (4) the hospital-wide census and staffing.
new text end

new text begin (d) If the staffing inadequacies cannot be resolved and resources cannot be reallocated
by the manager or administrative supervisor after considering the factors in paragraph (c),
the hospital shall call in extra staff to ensure adequate staffing to meet safe patient standards.
new text end

new text begin (e) Until extra staff arrive and begin to receive patient assignments:
new text end

new text begin (1) the hospital must suspend nonemergency admissions and prescheduled elective
surgeries that are not life-threatening but routinely lead to in-patient hospitalization; and
new text end

new text begin (2) the charge nurse for the unit with inadequate staffing levels is authorized to close
the unit to new patient admissions and in-hospital transfers after all good-faith efforts to
bring in additional staffing to alleviate excessive boarding issues in the emergency department
have been explored by appropriate hospital management staff, and that any open beds and
available units within the facility are being operationalized to the fullest extent in order to
meet patient needs.
new text end

new text begin Subd. 12. new text end

new text begin Prohibited actions. new text end

new text begin A hospital must not take any of the following actions as
a means to meet staffing standards:
new text end

new text begin (1) use mandatory overtime;
new text end

new text begin (2) assign or transfer a direct-care registered nurse to a patient care unit until after the
nurse has been adequately trained and oriented to work on the unit;
new text end

new text begin (3) assign a direct-care registered nurse to a patient care unit to relieve another direct-care
registered nurse during breaks, meals, or other routine and expected absences from a unit,
until after the nurse being assigned demonstrates current competence in providing care on
a particular unit and has received orientation to that hospital's unit sufficient to provide
competent care to patients in that unit;
new text end

new text begin (4) impose layoffs of licensed practical nurses, licensed psychiatric technicians, certified
nursing assistants, or other ancillary staff to meet the assignment limits established in
subdivision 6; and
new text end

new text begin (5) assign a direct-care registered nurse any patient assignments that would, in the nurse's
professional judgment, require the nurse to violate the Minnesota Nurse Practice Act, under
sections 148.171 to 148.285, if the nurse were to accept a patient assignment as directed by
a supervisor or manager. A hospital may not discharge, discipline, penalize, interfere with,
threaten, restrain, coerce, or otherwise retaliate or discriminate against a nurse who
communicates their objection to a patient assignment based on the requirements of the Nurse
Practice Act.
new text end

new text begin Subd. 13. new text end

new text begin Exemption; emergency situations. new text end

new text begin The assignment limits established in
subdivision 6 do not apply during a health care emergency if a hospital needs to provide an
exceptional level of emergency services or other health care services. If a health care
emergency causes a change in the number of patients on a unit, a hospital must make prompt
and diligent efforts to maintain staffing levels consistent with the assignment limits in
subdivision 6. The commissioner shall provide guidance to hospitals describing situations
that constitute a health care emergency for purposes of this subdivision.
new text end

new text begin Subd. 14. new text end

new text begin Charge nurse; inclusion in staffing grid. new text end

new text begin In order to facilitate optimal patient
care, a charge nurse shall not be included in the unit's staffing grid that is regularly reviewed
and determines the unit's staffing budget. This subdivision does not limit the ability of a
charge nurse to take a patient assignment in the event of an emergency when taking a patient
assignment, in the charge nurse's professional opinion, will not jeopardize overall patient
care for all patients on the unit at that time.
new text end

Sec. 2.

new text begin [144.593] PATIENT CARE; USE OF TECHNOLOGY.
new text end

new text begin Subdivision 1. new text end

new text begin Patient-acuity adjustable units prohibited. new text end

new text begin Patients shall be cared for
only on units or patient care areas where the level of intensity, type of care, and direct-care
registered nurse-to-patient assignment limits meet the individual requirements and needs
of each patient.
new text end

new text begin Subd. 2. new text end

new text begin Use of technology. new text end

new text begin (a) A hospital shall not employ video monitors or any form
of electronic visualization of a patient as a substitute for the direct observation required for
patient assessment by a direct-care registered nurse or required for patient protection. Video
monitors or any form of electronic visualization of a patient shall not be included in the
calculation of assignment limits in section 144.592, subdivision 6.
new text end

new text begin (b) A hospital shall not employ technology that limits a direct-care registered nurse from
performing functions that are part of the nursing process, including full exercise of
independent professional judgment in assessment, planning, implementation, and evaluation
of care, including the use of artificial intelligence technology in lieu of the expertise of
licensed health care professionals.
new text end

Sec. 3.

new text begin [144.594] SAFE PATIENT ASSIGNMENT COMMITTEE.
new text end

new text begin Subdivision 1. new text end

new text begin Committee required. new text end

new text begin By October 1, 2026, a hospital must establish a
Safe Patient Assignment Committee either by creating a new committee or assigning the
functions of a staffing for patient safety committee to an existing committee.
new text end

new text begin Subd. 2. new text end

new text begin Membership; compensation. new text end

new text begin At least 60 percent of the committee's membership
must be nonsupervisory and nonmanagerial registered nurses who provide direct patient
care, as defined in section 144.592, subdivision 2, paragraph (e). The committee must include
members appointed by a collective bargaining unit, if one exists, to proportionately represent
the bargaining unit's nurses. Hospitals must compensate registered nurses who are employed
by the hospital and serve on the Safe Patient Assignment Committee for time spent on
committee business.
new text end

new text begin Subd. 3. new text end

new text begin Duties. new text end

new text begin A Safe Patient Assignment Committee shall:
new text end

new text begin (1) complete a staffing for patient safety assessment by March 31, 2026, and annually
thereafter that identifies the following:
new text end

new text begin (i) problems of insufficient staffing, including but not limited to an inappropriate number
of registered nurses scheduled in a unit, inappropriately experienced registered nurses
scheduled for a particular unit, inability for nurse supervisors to adjust for increased acuity
or activity in a unit, and chronically unfilled positions within the hospital;
new text end

new text begin (ii) units that pose the highest risk to patient safety due to inadequate staffing; and
new text end

new text begin (iii) solutions for problems identified under items (i) and (ii);
new text end

new text begin (2) implement and evaluate assignment limits in section 144.592, subdivision 6;
new text end

new text begin (3) convert assignment limits in section 144.592, subdivision 6, into registered nurse
hours of care per patient;
new text end

new text begin (4) recommend a mechanism for tracking and analyzing staffing trends within the
hospital;
new text end

new text begin (5) develop a procedure for making shift-to-shift adjustments in staffing levels consistent
with section 144.592, subdivision 11, when adjustments are required by patient acuity and
nursing intensity; and
new text end

new text begin (6) identify any incidents when the hospital has failed to meet the assignment limits in
section 144.592, subdivision 6, and recommend a remedy.
new text end

Sec. 4.

new text begin [144.595] RETALIATION PROHIBITED.
new text end

new text begin A hospital shall not retaliate against or discipline a direct-care registered nurse, either
formally or informally, for:
new text end

new text begin (1) refusing to accept an assignment if, in good faith and in the nurse's professional
judgment, the nurse determined that the assignment is unsafe for patients due to patient
acuity and nursing intensity;
new text end

new text begin (2) reporting a concern regarding safe staffing levels; or
new text end

new text begin (3) communicating an objection, based on the nurse's own professional judgment, that
accepting a specific or additional patient assignment would force the nurse to violate the
Minnesota Nurse Practice Act under sections 148.171 to 148.285.
new text end

Sec. 5.

new text begin [144.596] ENFORCEMENT.
new text end

new text begin (a) The commissioner shall impose a civil penalty of not less than $25,000 for each
incident of a hospital failing to comply with sections 144.592 to 144.595, including failure
to staff patient care units to required levels.
new text end

new text begin (b) The commissioner must publicly report on the department website all incidents of
noncompliance with sections 144.592 to 144.595 on a quarterly basis, beginning September
1, 2026.
new text end

Sec. 6.

Minnesota Statutes 2024, section 144.7055, is amended to read:

144.7055 STAFFING PLAN REPORTS.

Subdivision 1.

Definitions.

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

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

(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" means a designated inpatient area for assigning patients and
staff for which a distinct staffing plan 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

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

Subd. 2.

Hospital staffing report.

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

(b) Core staffing plans shall specify the deleted text begin full-time equivalent for each patient care unit
for each 24-hour period. deleted text end new text begin following:
new text end

new text begin (1) the definition of the patient care unit;
new text end

new text begin (2) the number of beds available in each patient care unit;
new text end

new text begin (3) the average number of patients per day in each patient care unit; and
new text end

new text begin (4) the full-time equivalent for each patient care unit broken down by:
new text end

new text begin (i) shift, based on eight-hour shifts of 7:00 a.m. to 3:00 p.m., 3:00 p.m. to 11:00 p.m.,
and 11:00 p.m. to 7:00 a.m.; and
new text end

new text begin (ii) type of staff assigned, including but not limited to registered nurses, licensed practical
nurses, certified nursing assistants, and other additional care team members.
new text end

(c) Prior to submitting the core staffing plan, as required in subdivision 3, hospitals shall
consult with new text begin and obtain consent from new text end representatives of the deleted text begin hospital medical staff, managerial
and nonmanagerial care staff, and other relevant hospital personnel about deleted text end new text begin nonmanagerial
care staff and all affected exclusive bargaining representatives of nonmanagerial care staff
regarding new text end the core staffing plan and the expected average number of patients upon which
the staffing plan is based. new text begin Direct-care registered nurses must certify the report as accurate
and clearly presented by majority vote of direct-care registered nurses on staff at the hospital
or by the exclusive bargaining representative if represented by a collective bargaining unit.
new text end

Subd. 3.

Standard electronic reporting developed.

(a) Hospitals must submit the core
staffing plans to the Minnesota Hospital Association deleted text begin by January 1, 2014 deleted text end new text begin on a quarterly
basis new text end . The Minnesota Hospital Association shall include each reporting hospital's new text begin most
recently submitted new text end core staffing plan on the Minnesota Hospital Association's Minnesota
Hospital Quality Report website deleted text begin by April 1, 2014 deleted text end new text begin within three months after submission new text end .
Any substantial changes to the core staffing plan shall be updated within 30 days.

(b) 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 new text begin , per shift, based
on eight-hour shifts of 7:00 a.m. to 3:00 p.m., 3:00 p.m. to 11:00 p.m., and 11:00 p.m. to
7:00 a.m., new text end and per unit. Hospitals must submit the direct patient care new text begin staffing new text end report to the
Minnesota Hospital Association deleted text begin by July 1, 2014, and quarterly thereafter. deleted text end new text begin each quarter, and
the Minnesota Hospital Association must post the actual direct patient care staffing report
on the hospital quality reporting website within three months of receiving the reports.
new text end

new text begin Subd. 4. new text end

new text begin Enforcement of reporting requirements. new text end

new text begin (a) The commissioner shall impose
a civil penalty of not less than $25,000 for each hospital that fails to comply with subdivisions
2 and 3, including failure to report by the deadline or failure to provide information according
to the requirements of this section. Each day of the violation shall constitute a separate
violation and the penalties prescribed shall be applicable to each separate violation unless
otherwise indicated.
new text end

new text begin (b) At a minimum, the commissioner must publicly report on the department website
all incidents of noncompliance with subdivision 2 or 3.
new text end

new text begin Subd. 5. new text end

new text begin Staffing grid; compliance; enforcement. new text end

new text begin (a) A hospital must submit its staffing
grid to the commissioner quarterly and, when scheduling staff for a patient care unit, must
schedule at least the number and skill mix of staff specified in the staffing grid for that unit.
new text end

new text begin (b) The commissioner shall accept complaints from persons employed by a hospital
regarding situations in which a hospital scheduled fewer staff for a patient care unit than
the number of staff specified in the hospital's staffing grid, or a skill mix that differed
substantially from the skill mix specified in the hospital's staffing grid. The commissioner
shall impose a civil penalty of not less than $25,000 for:
new text end

new text begin (1) a hospital that fails to submit its staffing grid according to paragraph (a); or
new text end

new text begin (2) situations in which the commissioner determines that a hospital scheduled fewer
staff for a patient care unit than the number of staff specified in the staffing grid or scheduled
a skill mix of staff that differed substantially from the skill mix specified in the hospital's
staffing grid; and
new text end

new text begin (3) situations in which the commissioner determines that persistent understaffing within
a facility has led to an increase in adverse health events or instances of workplace violence,
or continues to pose safety risks for workers or patients.
new text end

Sec. 7.

Minnesota Statutes 2024, section 148.264, subdivision 1, is amended to read:

Subdivision 1.

Reporting.

new text begin (a) new text end Any person, health care facility, business, or organization
is immune from civil liability or criminal prosecution for submitting in good faith a report
to the board under section 148.263 or for otherwise reporting in good faith to the board
violations or alleged violations of sections 148.171 to 148.285. All such reports are
investigative data as defined in chapter 13.

new text begin (b) Any registered nurse or health care worker who experiences and subsequently reports
a level of staffing that, in the registered nurse's or health care worker's professional judgment,
could reasonably be expected to result in unsafe or ineffective patient care cannot be
disciplined under section 148.261, subdivision 1, clause (8). These reports may include a
report from a registered nurse or health care worker to the registered nurse's or health care
worker's supervisor at the supervisor's place of employment, the Board of Nursing, the
commissioner of health, or a professional nursing organization. Reports must be made within
ten calendar days after the incident occurred in order to be covered under this paragraph.
new text end

Sec. 8. new text begin APPROPRIATION.
new text end

new text begin $....... in fiscal year 2026 and $....... in fiscal year 2027 are appropriated from the general
fund to the commissioner of health for enforcement activities in Minnesota Statutes, section
144.7055, subdivision 5.
new text end