For 35 minutes, backers of a bill to make Minnesota part of a 39-state nursing licensure compact talked around the reasons why it hasn’t passed — and why it likely won’t pass this year either.
Republican lawmakers, nursing officials from the Mayo Clinic and the dean of the University of Minnesota presented the bill as an obvious step to addressing a nursing shortage. It would allow state-licensed nurses to practice in all of the other member states of the Nurse Licensure Compact. Conversely, nurses licensed from other states in the compact can work in Minnesota.
Currently, Minnesota’s 120,000 nurses must go through licensing procedures in other states even to work with patients via telemedicine. And nurses arriving in Minnesota, even on a temporary basis, must get state licensing.
Sen. Carla Nelson, the Rochester Republican who is the bill’s prime sponsor, alluded to its history of stalling in the DFL-controlled House, but said “I cannot speak to why.”
But that doesn’t mean she didn’t know why. The issue behind Senate File 2302 might relate to health care, but it is also a labor-management conflict. The handful of states that have not joined the compact are blue or purple states with strong labor constituencies in their Democratic parties.
Sen. Chris Eaton, DFL-Brooklyn Center, noted that the opposition comes from nurses, while the supporters are from administrators and management, adding that she stands with “the one’s saving lives, not those pushing paper.”
“This is a slap in the face to nurses in this state,” Eaton said. “This is just another way to break up the unions.”
The compact requires nurses in each state to be trained to a common standard. All nurses in the U.S. take the same licensing exams and must be graduates of accredited schools of nursing, said Connie White Delaney, the U of M nursing school dean.
The compact, operated by the national association of state nursing licensing boards, also requires criminal background checks and has a database for state’s to check records of licensed nurses.
Telemedicine also at issue
Dominick Pahl, a nursing lead at the Mayo Clinic in Rochester, said the issue goes beyond responding to temporary nursing shortages. Pahl said he must apply for separate licensing in Iowa and other states where Mayo has a presence.
“Today, a patient can travel to the state of Minnesota and without any additional nursing licensure, I can provide that patient with exceptional care,” Pahl said. “However, if that patient returns to their home state, I can’t physically travel to that state or virtually interact with that patient without first getting a license in that state.”
Pahl took issue with Eaton’s suggestion that only managers and administrators support joining the compact. He worked directly with COVID patients during the pandemic.
Delany, of the U of M, said potential students and faculty are aware of Minnesota’s absence from the compact. “This compact will empower our nursing programs in this state to attract, admit and serve a wide range of students that we currently can’t,” she said.
The national nursing shortage also includes a national nursing faculty shortage, she said. And when the school works with clinics in other states that provide training for U of M students, the faculty who supervise them must be separately licensed in those states.
“Our ability to attract faculty is hampered by not having this compact in place,” Delaney said.
Supporting the bill Monday was the U.S. Department of Defense, which said compacts help military spouses who are nurses and move around their country.
“The Department of Defense believes compacts are the future,” said Martin Dempsey, Midwest region liaison for the Defense-State Liaison Office.
While remote care was also described as the future of health care, the potential for remote care is also part of MNA’s opposition. “One of the goals of the interstate commission behind the compact is to replace individualized care by registered nurses at the bedside with computerized healthcare,” the MNA said in a statement Monday.
“This bill is a thinly-veiled attack on the bargaining power of Minnesota nurses, who have worked so hard and sacrificed so much through the pandemic, aiming to replace full-time nurse positions with temporary staff so hospital CEOs can increase their bottom lines at the expense of workers and patients at the bedside.”
Mary Turner, the president of the MNA, told the Senate Health and Human Services committee Monday that there is no shortage of nurses in Minnesota, only a shortage that want to keep working in stressful and unsafe hospital settings. “It will distract from the roots of our current workforce issues,” she said of the bill.
Turner also warned that nursing standards would be set by a D.C.-based association of nursing boards, instead of with the state’s own board. The nurses association has its own bill on nurse staffing with DFL sponsorship. Called the Keeping Nurses at the Bedside Act, the proposal would require committees of nurses and administrators to set nurse staffing rules and would also limit the number of patients per nurse in hospital settings. It would also add measures to recruit and retain nurses.
Walz not on board
Nearly two years ago, over the objections of the MNA, Walz signed an executive order that lifted the requirement that nurses be separately licensed by the state.
“I have determined that it is necessary to support the efforts of Minnesota’s healthcare professionals by allowing certain out-of-state healthcare professionals to provide staffing support and render aid in Minnesota during the pendency of the peacetime emergency,” said Walz of the order.
Reporting required by that order showed that some 4,500 registered nurses and 300 licensed practical nurses worked in the state under the executive order. While initially intended to run through the end of Walz’s peacetime state of emergency, which ended in August of 2021, the governor rescinded the previous order that May.
Earlier this year, Walz spent $40 million in American Rescue Plan money to bring in traveling nurses to fill staffing shortages. The administration says that 200 nurses were licensed using current state law without delays.
A Walz spokesperson said the governor does not believe a permanent change in licensing rules is a solution to underlying staffing issues.
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