SF 1384A

Conference Committee Report - 93rd Legislature (2023 - 2024) Posted on 05/21/2023 01:18pm

CONFERENCE COMMITTEE REPORT ON S.F. No. 1384

A bill for an act
relating to state government; modifying labor policy provisions; modifying building
codes, occupational safety and health, and employment law; amending Minnesota
Statutes 2022, sections 13.43, subdivision 6; 120A.414, subdivision 2; 122A.181,
subdivision 5; 122A.26, subdivision 2; 122A.40, subdivision 5; 122A.41,
subdivision 2; 177.27, subdivision 4; 177.42, subdivision 2; 179A.03, subdivisions
14, 18; 179A.06, subdivision 6; 179A.07, subdivision 6, by adding subdivisions;
179A.12, subdivisions 6, 11, by adding a subdivision; 181.03, subdivision 6;
181.06, subdivision 2; 181.172; 181.275, subdivision 1; 181.932, subdivision 1;
181.939; 181.940, subdivisions 2, 3; 181.941, subdivision 3; 181.9413; 181.942;
181.9436; 181.945, subdivision 3; 181.9456, subdivision 3; 181.956, subdivision
5; 181.964; 182.659, subdivisions 1, 8; 182.66, by adding a subdivision; 182.661,
by adding a subdivision; 182.676; 326B.093, subdivision 4; 326B.106, by adding
a subdivision; 326B.163, subdivision 5, by adding a subdivision; 326B.164,
subdivision 13; 326B.31, subdivision 30; 326B.32, subdivision 1; 326B.36,
subdivision 7, by adding a subdivision; 326B.805, subdivision 6; 326B.921,
subdivision 8; 326B.925, subdivision 1; 326B.988; 572B.17; proposing coding
for new law in Minnesota Statutes, chapters 16A; 181; 327; repealing Minnesota
Statutes 2022, section 179A.12, subdivision 2.

May 21, 2023
The Honorable Bobby Joe Champion
President of the Senate

The Honorable Melissa Hortman
Speaker of the House of Representatives

We, the undersigned conferees for S.F. No. 1384 report that we have agreed upon the
items in dispute and recommend as follows:

That the House recede from its amendments and that S.F. No. 1384 be further amended
as follows:

Delete everything after the enacting clause and insert:

"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.
new text end

Sec. 2.

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.

deleted text begin (q) deleted text end new text begin (r) 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 (s) 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 (t) 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. 3.

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 new text begin ; and
new text end

new text begin (7) for nurses employed as a hospital nurse by a nonprofit hospital 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. 4.

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 A nurse applying under
subdivision 2, paragraph (a), clause (7), must also include proof 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 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 a minimum two-year service obligation; 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. 5.

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 paragraph (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. 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 designated loans.
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. 6.

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 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 that environmental assessments 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 10 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; 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 10 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. 10. 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. 11. 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. 12. 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. 13. 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 17.
new text end

new text begin Subd. 14. 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 local law enforcement 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) Beginning January 1, 2025, a hospital must annually submit to the commissioner its
most recent action plan and the results of the most recent annual review conducted under
subdivision 11.
new text end

new text begin Subd. 15. new text end

new text begin Legislative report required. new text end

new text begin (a) Beginning January 15, 2026, 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. 16. 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. 17. 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

new text begin Subd. 18. new text end

new text begin Applicability. new text end

new text begin The amendments in this act to this section do not apply to a
hospital that meets the criteria in section 144.7052.
new text end

Sec. 7.

Minnesota Statutes 2022, section 144.608, subdivision 1, as amended by Laws
2023, chapter 25, section 47, 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 (f) 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 (f) deleted text end ;

(8) a nurse practitioner, as defined under section 144.1501, subdivision 1, deleted text begin paragraph
(m), deleted text end or a physician assistant, as defined under section 144.1501, subdivision 1, deleted text begin paragraph
(p), 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 (f) 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 (f) 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, AEMT, or paramedic 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 (f) deleted text end ; and

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

Sec. 8.

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. 9.

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 hospital
employee 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 (a) "Daily staffing schedule" means:
new text end

new text begin (1) for hospitals other than critical access hospitals, the projected 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 projected number of patients assigned to each
direct care registered nurse present and providing care in the unit; and
new text end

new text begin (2) for hospitals designated as critical access hospitals under section 144.1483, clause
(9), the projected number of full-time equivalent nonmanagerial care staff, and full-time
equivalent managerial staff who provide direct patient care at least 60 percent of the time,
assigned to an inpatient care unit and providing care in that unit during a 24-hour period
and the projected number of patients assigned to each direct care registered nurse present
and providing care in the unit.
new text end

new text begin (b) A hospital may utilize a grid for daily staffing schedules.
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 Emergency. new text end

new text begin "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, a mass casualty incident, or a natural disaster
that impacts continuity of patient care.
new text end

new text begin Subd. 7. 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 Subd. 8. new text end

new text begin Patient population. new text end

new text begin "Patient population" means a group of patients with certain
diseases or disorders or certain characteristics.
new text end

Sec. 10.

new text begin [144.7052] APPLICABILITY.
new text end

new text begin Sections 144.7053; 144.7056 to 144.7059; and 144.7067, subdivision 1, paragraph (b),
clause (2), and the amendments to section 144.7055 enacted in this act do not apply to any
hospital that is part of a health care system owned, operated, or governed by a nonprofit
corporation that includes a national referral center located in Olmsted County engaged in
substantial programs of patient care, medical research, and medical education addressing
state and national needs.
new text end

Sec. 11.

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 that either: (1) the existing committee meets the membership requirements for a
hospital nurse staffing committee in subdivision 2; or (2) an existing committee agreed to
by the hospital and the exclusive representative of the hospital's registered nurses as part of
a collective bargaining agreement is modified through a memorandum of understanding to
meet the requirements of subdivision 2.
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 (c) Service on a hospital nurse staffing committee shall be considered performing duties
of the employee's position with the employer for purposes of indemnification under section
181.970, 302A.521, 317A.521, 322C.0408, or other state law.
new text end

new text begin Subd. 2. new text end

new text begin Staffing committee membership. new text end

new text begin (a) Fifty percent of the hospital nurse staffing
committee's membership must be composed of direct health care workers. Approximately
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 approximately
15 percent of the committee's membership must be other direct care workers typically
assigned to a specific unit for an entire shift. A hospital's nurse staffing committee shall
include participation from the direct care, nonmanagerial staff for each patient population
while determining or reviewing those unit staffing plans and concern for safe staffing forms.
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. Each hospital nurse staffing committee must adopt a core staffing plan
annually by a majority vote of all members.
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
to submit directly to the committee a concern for safe staffing form;
new text end

new text begin (2) establish and maintain a process to resolve disputes regarding concern for safe staffing
forms and to review unresolved concern for safe staffing forms that involves engaging with
nonmanagerial, direct care registered nurses from the unit involved;
new text end

new text begin (3) review the documentation of compliance maintained by the hospital under section
144.7056, subdivision 7;
new text end

new text begin (4) develop a mechanism for tracking and analyzing staffing trends within the hospital
and track and analyze staffing trends within the hospital, including any patterns or trends
in the submission and resolution of concern for safe staffing forms;
new text end

new text begin (5) submit a nurse staffing report to the commissioner;
new text end

new text begin (6) collect data on and review differences between projected staffing and staff available
to receive patients as it relates to the surgical schedule;
new text end

new text begin (7) 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 (8) 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, 2024.
new text end

Sec. 12.

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 estimated whole number of patients on each inpatient care unit for whom a direct
care nurse can 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 number of patients specified according to
clause (2) 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 tasks outside of
the practice of professional nursing as defined in section 148.171, subdivision 15, clause
(1), when patient care dictates;
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) except in circumstances specified by the hospital nurse staffing committee, 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 impacts on the quality of patient care and nurse retention resulting from significant
overtime, 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 appropriate additional direct care staff
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, 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 (a) 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 into a mediation process with a mutually agreed-upon
mediator. If the mediator determines that the members of the nurse staffing committee have
reached an impasse, the mediator may recommend that the members of the committee enter
an arbitration process with a mutually agreed-upon arbitrator. The members of the committee
may not enter an arbitration process without the prior recommendation of the mediator.
new text end

new text begin (b) For a three-year period beginning October 1, 2025, hospitals must annually report
to the commissioner, in a form, format, and timeline determined by the commissioner, when
a mediation process or arbitration process is used to adopt a new or updated core staffing
plan. In addition, hospitals must include the following information:
new text end

new text begin (1) the duration of each mediation process or arbitration process measured in business
days; and
new text end

new text begin (2) whether or not the mediation process or arbitration process resulted in a decision.
new text end

new text begin (c) The commissioner must analyze the data submitted under paragraph (b) and, by July
1, 2029, submit to the chairs and ranking minority members of the legislative committees
with jurisdiction over the Department of Health a report compiling the submitted information
and describing summary data and trends.
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 mediation. If the
mediator determines that hospital management and the nurse staffing committee have reached
an impasse, the mediator may recommend that hospital management and the committee
enter an arbitration process with a mutually agreed-upon arbitrator. Hospital management
and the committee may not enter an arbitration process without the prior recommendation
of the mediator.
new text end

new text begin (b) During an ongoing dispute resolution process, a hospital must continue to implement
the existing core staffing plan.
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 mediation or arbitration,
within 30 calendar days of approval of the update by the committee or the conclusion of
mediation or 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. 13.

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 annually by a majority vote of its hospital nurse staffing committee
or established through mediation or arbitration. Nothing in sections 144.7051 to 144.7058
relieves the chief nursing executive of a hospital from fulfilling the chief nursing executive's
duties under Code of Federal Regulations, title 42, section 482.23, and other standards
established by accreditation organizations approved by the Centers for Medicare and
Medicaid Services. If at any time the chief nursing executive believes the types and numbers
of nursing personnel and staff required under the hospital's core staffing plan are insufficient
to provide nursing care for a unit in the hospital, the chief nursing executive may increase
the staffing on that unit beyond the levels required by the plan.
new text end

new text begin (b) A core staffing plan does not apply during an emergency and a hospital is not out of
compliance with its core staffing plan during an emergency. A nurse may be required to
accept an additional patient assignment in an emergency.
new text end

new text begin (c) The commissioner is 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 (a) For each publicly posted core
staffing plan, a hospital must either:
new text end

new text begin (1) post a notice at each shift change stating whether the current staffing on the unit
complies with the hospital's core staffing plan for that unit; or
new text end

new text begin (2) post a notice daily stating whether the staffing on the unit complies with the hospital's
core staffing plan, provided that the notice is updated at a shift change if the unit's compliance
status changes for that shift.
new text end

new text begin (b) The hospital nurse staffing committee must determine the method of public posting
in paragraph (a) utilized by the hospital. 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 Public posting of emergency department wait times. new text end

new text begin A hospital must 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. 5. 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, visitor of a patient on the unit, or prospective patient. The statement must include
specific instructions for obtaining copies of the posted materials.
new text end

new text begin (b) A hospital must, within 12 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. 6. new text end

new text begin Reporting noncompliance. new text end

new text begin (a) Any hospital employee 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 may investigate any report of interference
with or retaliation against a hospital employee for submitting a concern for safe staffing
form. The commissioner of labor and industry may fine a hospital up to $10,000 if the
commissioner finds the hospital interfered with or retaliated against a hospital employee
for submitting a concern for safe staffing form. The commissioner of labor and industry
may issue a compliance order under section 177.27, subdivision 4, to enforce this section.
new text end

new text begin Subd. 7. new text end

new text begin Documentation of compliance. new text end

new text begin Each hospital must document compliance with
its core staffing 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 Subd. 8. new text end

new text begin Collective bargaining. new text end

new text begin Nothing in sections 144.7051 to 144.7059 shall limit
the parties to a collective bargaining agreement from bargaining and agreeing with respect
to nurse and patient protections, standards, protocols, and procedures that meet or exceed,
and do not conflict with, the minimum standards and requirements in sections 144.7051 to
144.7059.
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. 14.

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 (a) 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 performing an urgent, emergent, or elective
surgery at a time when the unit to which the patient is discharged 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) insufficient number of nursing staff with appropriate competencies and skill mix
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, including numbers of direct care registered
nurses scheduled in a unit, numbers of direct care registered nurses present and delivering
care in a unit, and differences between the numbers of direct care registered nurses scheduled
and direct care registered nurses present and delivering care in a unit, with particular attention
to these staffing trends and differences in units caring for patients for whom emergent,
urgent, and elective surgeries have been or will be performed.
new text end

new text begin (b) A hospital must submit with its nurse staffing report the turnover rate among direct
care registered nurses and other direct care health care workers at the hospital and the
frequency and extent of the hospital's noncompliance with its core staffing plan for the
purposes of reporting compliance with core staffing plans under section 144.7058.
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 commissioner 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 standard 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. The commissioner must ensure that the uniform format or standard
form complies with all applicable federal requirements, and that any information made
available to the public under this section complies with federal antitrust laws.
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. 15.

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

new text begin Subdivision 1. new text end

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

new text begin The commissioner of
health must convene a stakeholder group to recommend a system for evaluating hospital
nurse staffing. The system recommended by the stakeholder group must use data collected
from nurse staffing reports, employment turnover rates among direct care registered nurses
and other direct care health care workers within an individual hospital, the frequency of a
hospital's noncompliance with a core staffing plan, and the extent of a hospital's
noncompliance with a core staffing plan. By January 31, 2025, the commissioner must
submit to the chairs and ranking minority members of the legislative committees with
jurisdiction over the Department of Health the evaluation system recommended by the
stakeholder group and any draft legislation the commissioner recommends to ensure the
commissioner receives from hospitals data the commissioner requires to implement the
recommended evaluation system. The stakeholder group under this section is exempt from
the requirements of sections 15.014, 15.0593, and 15.0597. No member of the stakeholder
group may be a member of the legislature.
new text end

new text begin Subd. 2. new text end

new text begin Public disclosure of compliance. new text end

new text begin Beginning January 1, 2027, the commissioner
must publish on the Department of Health website a compliance report for each hospital
based on the system recommended under subdivision 1 with links to the hospital's core
staffing plan, the hospital's nurse staffing reports, and an accessible and easily understandable
explanation of what the compliance report 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. 16.

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, a mass casualty incident, 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; process. new text end

new text begin (a) 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 reasonably and in good faith determines
that in the nurse's professional judgment accepting an additional patient assignment 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. Nothing in this section modifies a
nurse's professional obligations under sections 148.171 to 148.285, which include, but are
not limited to, a nurse's obligation to not engage in unprofessional conduct and to not create
unnecessary danger to a patient's life, health, or safety. A nurse can violate a professional
obligation without a patient being actually injured.
new text end

new text begin (b) For a nurse to decline to accept an additional patient assignment, the following
process must be followed:
new text end

new text begin (1) a charge nurse must evaluate relevant factors to assess and determine the adequacy
of resources and invoke the hospital's chain of command policy to meet patient care needs;
and
new text end

new text begin (2) if the issue cannot be resolved and resources cannot be reallocated by the manager
or administrative supervisor, and the nurse reasonably and in good faith determines in their
professional judgment that accepting an additional patient assignment may create an
unnecessary danger to a patient's life, health, or safety, the nurse may decline to accept the
additional patient assignment.
new text end

new text begin A retrospective review of the incident may be initiated by the individuals involved, and
may be completed at the unit level or at the hospital nurse staffing committee level.
new text end

new text begin (c) 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 may enforce this section
by issuing a compliance order under section 177.27, subdivision 4. 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. 17.

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. 18.

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. 19. new text begin IMPLEMENTATION STAKEHOLDER GROUPS.
new text end

new text begin (a) The commissioner of health must convene a stakeholder group to advise the
Department of Health on the development of a toolkit with best practices for implementation
of hospital staffing committees. The toolkit and best practices may include a recommendation
on whether hospitals should use a federal mediator to moderate the establishment of
committees in each hospital. The commissioner must develop the toolkit with the
recommended best practices and make it available to hospitals by July 1, 2024.
new text end

new text begin (b) The commissioner of health may convene a stakeholder group to examine whether
there are objective metrics to verify that a hospital is adequately staffed or may assign this
task to the stakeholder group established under Minnesota Statutes, section 144.7058,
subdivision 1. No member of either stakeholder group may be a member of the legislature.
By February 15, 2024, the commissioner must submit to the chairs and ranking minority
members of the legislative committees with jurisdiction over the Department of Health any
recommendations on the feasibility of establishing an alternative compliance pathway to
ensure adequate hospital staffing.
new text end

new text begin (c) The stakeholder groups in paragraphs (a) and (b) are exempt from the requirements
of Minnesota Statutes, sections 15.014, 15.0593, and 15.0597. No member of any stakeholder
group under this section may be a member of the legislature.
new text end

new text begin (d) Any contracts the commissioner enters into in connection with this section are exempt
from Minnesota Statutes, sections 16C.05, subdivision 2; 16C.06, subdivisions 1, 2, and 6;
and 16C.08, subdivisions 3 and 3a.
new text end

Sec. 20. 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, the Minnesota Hospital Association, and
experts in patient safety, 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 correlations 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. 21. new text begin DIRECTION TO COMMISSIONER OF HEALTH; KEEPING NURSES
AT THE BEDSIDE ACT IMPACT EVALUATION.
new text end

new text begin By October 1, 2023, the commissioner of health must contract with the commissioner
of management and budget for the services of the Impact Evaluation Unit to design and
implement a rigorous causal impact evaluation using time-series data or other evaluation
methods as determined by the Impact Evaluation Unit to estimate the causal impact of the
implementation of Minnesota Statutes, sections 144.7051 to 144.7059, on patient care, nurse
job satisfaction, nurse retention, and other outcomes as determined by the commissioner
and the Impact Evaluation Unit. The Impact Evaluation Unit may subcontract with other
research organizations to assist with the design or implementation of the impact evaluation.
The commissioner of management and budget may obtain any relevant data from any state
agency necessary to conduct this evaluation under Minnesota Statutes, section 15.08. By
February 15, 2024, the commissioner of health must submit to the chairs and ranking minority
members of the legislative committees with jurisdiction over health finance and policy draft
legislation specifying any additional authorities the commissioner and the Impact Evaluation
Unit may require to collect the data required to conduct a successful impact evaluation of
the implementation of Minnesota Statutes, sections 144.7051 to 144.7059. By October 1,
2024, the Impact Evaluation Unit must begin collecting baseline data. By June 30, 2029,
the Impact Evaluation Unit must submit to the commissioner of health a public initial report
on the status of the evaluation project and any preliminary results.
new text end

Sec. 22. 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. 23. 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

Sec. 24. 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.
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. The
commissioner must include the following information on the form or accompanying the
form: the specific purpose of the form as compared to other forms hospitals may use for
concerns regarding personnel and other matters, and a statement that concern for safe staffing
forms do not address or replace other established hospital forms and procedures relating to
personnel issues and other hospital processes relating to matters other than staffing concerns.
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. 25. 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 "

Delete the title and insert:

"A bill for an act
relating to health; establishing requirements for hospital nurse staffing committees;
modifying requirements of hospital core staffing plans; requiring the commissioner
of health to 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; modifying eligibility for the health professional education loan
forgiveness program; requiring the commissioner of health to study hospital
staffing; requiring a report; amending Minnesota Statutes 2022, sections 144.1501,
subdivisions 1, 2, 3, 4; 144.566; 144.608, subdivision 1, as amended; 144.653,
subdivision 5; 144.7055; 144.7067, subdivision 1; 147A.08; proposing coding for
new law in Minnesota Statutes, chapter 144."

We request the adoption of this report and repassage of the bill.
Senate Conferees: .
.		.
Erin Murphy		Jim Abeler
.
Liz Boldon
House Conferees: .
.		.
Sandra Feist		Kaela Berg
.
Greg Davids