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Minnesota Hospitals Reduce Charity Care, Increase Profits

30 Sep patients over profits picket

Mat Keller headshot

By Mathew Keller RN JD, Regulatory and Policy Nursing Specialist

We all knew big insurers would benefit as more individuals sign up for health insurance under the provisions of the Affordable Care Act. What is surprising to me, at least, is just how much Minnesota hospitals are profiting as well.

In the latest sign of sickness in the corporate healthcare world, the Minnesota Department of Health reports that our hospitals have reduced the amount of charity care they provide to our sickest and poorest citizens by 22.4 percent.

Much of this decrease is driven by a sharp increase in the number of patients with health insurance across the state — up to 94.1 percent, an all-time high.

Hospitals, as they reduce their charitable care, should pass those cost savings on to their patients and communities. They should allow more patients to qualify for charitable care. They should increase the quality of care they provide through appropriate nurse staffing. They should engage their communities in public health outreach.

Instead, our non-profit hospitals are pocketing the money, giving it out as bonuses, spending it on advertising and branding, building the latest and greatest waterfall in the lobby. Enough is enough.

Charitable care forms the backbone of our societal contract with our non-profit hospitals — we grant them tax exemptions, and in return, we expect that they will strive to help the sickest and poorest among us in a charitable manner. It might be time to re-examine that contract.


Minnesota hospitals’ income soars

18 Sep dollar steth

Mat Keller headshot

By Mathew Keller RN JD, Regulatory and Policy Nursing Specialist

In yet another sign that Minnesota Hospitals are using the myth of a Minnesota “nursing shortage” in order to avoid appropriate nurse staffing, the Star Tribune recently reported that our 10 largest hospital systems “saw operating income jump by 38 percent in fiscal 2014 compared with the previous year.”

These healthcare systems reported sparking income growth by “putting the brakes on hiring.”

In particular, North Memorial Medical Center saw its highest net profit margin since 2006 (and yet is currently laying off RNs); the Mayo system reported a 1 percent decline in salary and benefit costs while experiencing a 36 percent increase in revenue (complaining of a nursing shortage and cutting pensions the whole time); Sanford reported eliminating positions through attrition (while also reportedly purposefully staffing 10 percent under grid in order to cut costs); and HCMC, a 472-bed facility, added the equivalent of only 38 full-time positions.

Meanwhile, nurses continue to report unsafe nurse staffing in record numbers.

Since August of last year, MNA nurses have submitted 2,802 Concern for Safe Staffing forms, indicating situations in which staffing is so bad patient safety is at risk.

Minnesota Hospitals: bragging about enormous jumps in profit obtained through unsafe staffing all the while jeopardizing the safety of our patients.

The time for a Safe Patient Standard law is now.


Video: MNA Nurses Deliver Valentines to MN Dept of Health

25 Feb 4

100 nurses delivered more than 2,000 Concern for Safe Staffing Forms to Commissioner of Health Ed Ehlinger. They lined up to tell their stories of unsafe staffing situations and the effects it has on patients.



Video: MNA Nurses Informational Picket at Cambridge Medical Center

25 Nov cambridge picket 2

Nurses braved the cold to inform the public they are fighting for a fair contract that protects patients and nurses alike.


Sign up for the Minnesota State Fair!

5 Aug fair5

Join MNA nurses by speaking up for your profession and a minimum standard of care at the 2014 Minnesota State Fair.  Go to to sign up.  Volunteer shifts are filling up fast!


Video: Fairview Lakes Nurses Speak Out about Fairness

9 Jul FairviewLakesstill


Fairview Lakes nurses are standing up for a fair contract that ends inequities in pay between nurses in clinics and the hospital.


Video: Minnesota Nurses Hold Informational Picket at North Memorial Hospital

25 Jun DSC_4552



Minnesota Nurses fighting for safe staffing levels for patients held an informational picket on Tuesday, June 24, 2014.  Legislative leaders from the area joined them to echo their concerns that patient safety is a concern.


MNA Legislative Wrap-up May 23, 2014

23 May Minnesota State Capitol St Paul Minnesota

MNA Legislative Wrap-Up Minnesota_State_Capitol

The 2014 session of the Minnesota Legislature was a success for nurses and working families. Minnesota’s growing economy produced a $1.2 billion budget surplus in 2014, allowing Governor Dayton and the legislature to deliver middle class tax relief and new investments in our schools and our economy.

Minnesotans have seen remarkable progress over the past two years following some of the most productive, efficient legislative sessions in recent memory. Much of that progress will affect patients, working families and nurses.

Health and Human Services Policy Omnibus Bill: Signed into Law

The Governor signed the package of health policy bills (HF2402) into law. Several MNA priorities were included in the bill.


  • Health Professionals Services Program (HPSP):

o   Requires health licensing boards to temporarily suspend a health professional license for 30 days and complete a disciplinary investigation during that time, if they receive a report from HPSP that the regulated person has engaged in conduct that might cause risk to the public and the board has probable cause to believe their continued practice presents an imminent risk of harm to the public.

o   Allows the 30 day temporary suspension to be lifted if the board does not complete their investigation by then, unless the regulated person requests a delay.

o   Requires all health licensing boards to stay in HPSPS until July 1, 2015.

o   Requires employers to report any knowledge of drug diversion by a regulated health professional to that persons licensing board unless the knowledge was obtained in the course of a professional-patient relationship or because of the person’s participation in HPSP.

o   MNA supported this legislation to protect patient safety and to protect the privacy and health of nurses with substance use disorder who are working to preserve their licenses and careers.

  • E-cigarettes:

o   Bans the sale of e-cigarettes from kiosks and vending machines.

o   Requires child-resistant packaging to prevent the dangerous ingestion of nicotine by children.

o   Bans the use of e-cigarettes in publicly-owned buildings.

o   Local communities can implement more restrictive regulations on e-cigarettes if they wish.

o   MNA supports restrictions on e-cigarettes since the long term health effects are unknown.


Public Employment Relations Board: Signed into Law  

On May 9th, the Governor signed into law a bill to establish a Public Employment Relations Board (HF3014). This legislation will create a board to decide Unfair Labor Practice (ULP) claims involving public employees, which includes many MNA nurses at public municipal or county hospitals (known in statute as Charitable Hospitals). Under current law, public employers and employees must litigate ULP claims in district court-a cumbersome and expensive process. MNA supported this bill because the PERB will create a process that saves employers and employees money and would mirror the ULP process in the private sector.


APRN Bill: Signed into Law

Governor Dayton signed into law a bill to allow Advance Practice Registered Nurses to practice to the full extent of their scope (SF511). The law gives full practice authority to Certified Nurse Midwives, Certified Registered Nurse Anesthetists, Nurse Practitioners and Clinical Nurse Specialists. Beginning January 1, 2015, APRNs will be able to practice independently. The new law limits, however, CRNA’s who will continue to require a collaborative management agreement with a physician to practice pain management.


This law represents years of work by advocates for APRNs, and MNA was proud to support this effort.


Steve’s Law: Signed into Law

Governor Dayton signed into law a bill to broaden the availability of Naloxone (Narcan) for first responders to use in cases of opiate overdose (SF1900). The bill received near unanimous support along every stage of the legislative process. Members of both parties spoke eloquently about the disease of addiction and the great promise this bill has to save lives and give individuals suffering with substance use disorders a second chance. MNA proudly supports this bill, and we applaud the chief authors, Rep. Dan Schoen and MNA member Sen. Chris Eaton, for their work on this common-sense, live-saving legislation.


Medical Cannabis: Awaiting Governor’s Signature

Sen. Scott Dibble and Rep. Carly Melin, the authors of different bills to legalize medical marijuana, announced they had come to an agreement based on the House version of the bill, but with some changes that broaden access, while tightening restrictions to prevent misuse.


This bill will be the strictest and most regulated medical cannabis law in the country. Only patients with qualifying conditions such as cancer, HIV/AIDS, and seizures will be eligible. It does not allow smoking of marijuana. Instead, patients can access approved forms of medical cannabis such as liquid, pill, or vapor. The bill creates a patient registry to monitor the use of prescription cannabis as well as to evaluate the health effects. Governor Dayton has said he will sign the bill next week.


MNA supports legislation that would provide compassionate relief to seriously ill patients.


Budget Issues: Signed into Law

The Governor signed the Omnibus Supplemental Budget bill into law. There are several portions of the bill that will directly affect MNA members. Highlights of Health and Human Services portion:


  • Fully funded 5% rate increase for Home and Community Based Services Providers of which 80% is encumbered to go to employees in the form of wages and benefits.
  • Increased funding for mental health crisis intervention services.
  • Funding of State Operated Services and Minnesota Sex Offender Program salary supplement. The Governor had requested $11 million each year for 2015, 2016, and 2017 for a total of $33 million to maintain current salary agreements with employees of SOS and MSOP. The conference committee funded everything fully, except for the $1 million for MSOP in 2016 and $1 million for MSOP in 2017.  They also fully funded the Governor’s recommendation for court ordered expert reviews at MSOP of $3 million in 2015.
  • $75,000 for a health care workforce study. MNA will work to ensure that nurses are included in this study.
  • The study on chronic pain therapy treatment included in the APRN bill was funded at $75,000 for 2015.


Construction Projects: Signed into Law
The Capital Investment Bonding bill to fund construction projects included several MNA priorities. Highlights include:

  • $56.3 million for design, construction and remodeling of the Minnesota Security Hospital in St. Peter.
  • $7.4 million for design and remodeling of the Minnesota Sex Offender facility in St. Peter.
  • $2 million in asset preservation for veterans homes and memorials.
  • $18 million for a new health services intake at St. Cloud correctional facility.


Minimum Wage: Signed into Law
For the first time in a decade, Minnesota’s minimum wage is set to increase. An estimated 325,000 hard-working Minnesotans will get a raise to $9.50 by 2016 (HF2091). The minimum wage will be indexed to inflation in 2018 to keep up with the cost of living. MNA supported this effort because poverty is a public health as well as an economic issue.

Synthetic Drugs: Signed into Law

The Governor signed a bill prohibiting the sale of synthetic drugsinto law. MNA members actively advocated for tougher prohibitions on synthetic drugs and were vocal supporters of the bill. We thank Representative Eric Simonson for considering MNA’s input as he worked to protect both the public and medical personnel affected by those under the influence of synthetic drugs.

Women’s Economic Security Act: Signed into Law

The Governor signed into law the Women’s Economic Security Act(WESA) on Mother’s Day. The WESA is the most significant women’s rights legislation in years.


The Women’s Economic Security Act:

  • Allows mothers to stay in the workforce by expanding family leave and providing reasonable accommodations for pregnant and nursing employees.
  • Decreases the gender pay gap through the participation of women in high-wage, high-demand occupations in fields such as science, technology, engineering, and math (STEM).
  • Decreases the gender pay gap by reducing the “motherhood penalty” by requiring equal employment treatment regardless of “familial status.”
  • Addresses negative economic consequences of domestic violence, stalking, and sexual assault.
  • Enhances retirement security by considering a state retirement savings plan for those without an employer-provided option.


MNA supported this legislation.

NNU launches “Insist on an RN” campaign with radio ads

13 May @mx_860

Sweeping changes underway in the nation’s health care delivery system that expose hundreds of thousands of patients to severe risk of harm are the focus of a major new national campaign by the nation’s largest organization of nurses announced today.

An unchecked proliferation of unproven medical technology and sharp erosion of care standards are rapidly spreading through the health care system, far outside the media spotlight but frighteningly apparent to nurses and patients, says National Nurses United.

In response, NNU has launched a major campaign featuring radio ads from coast to coast, video, social media, legislation, rallies, and a call to the public to act, with a simple theme – “when it matters most, insist on a registered nurse.”  The ads were created by North Woods Advertising and produced by Fortaleza Films/Los Angeles.

To watch the new videos and hear the radio ads visit

Or click below:


Key features of the new threat to patient safety include:

Digitalized care – experimental, unproven medical technology put patients at risk

Hospitals and other healthcare industry giants are spending billions of dollars on medical technology sold to the public as the cure for everything from medical errors to cutting costs. But the reality is proving to be far different, warns NNU.

Bedside computers that diagnose and dictate treatment for patients, based on generic population trends not the health status or care needs of that individual patient, increasingly supplant the professional assessment and judgment of experienced nurses and doctors exposing patients to misdiagnosis, mistreatment, and life-threatening mistakes.

Computerized electronic health records systems too often fail, leaving doctors and nurses in the dark without access to medical histories or medical orders. The Office of the Inspector General for the Health and Human Services Department has reported widespread flaws in the heavily promoted systems. Telemedicine and robotics marketed as improved care deprive patients of individualized care so essential to the therapeutic process central to healing.

The face of future health care – a world without hospital care

Cutting costs is now seen as the prime directive in health care. Unwilling to reduce their profits or limit excessive pricing practices, the means to limiting expenses in the healthcare industry is by restricting or rationing care.

Insurance companies do that by denying claims or setting out-of-pocket costs so high Americans lead the developed world in skipping care when they need it because of the price. Hospitals, especially those that are also insurance companies, like Kaiser Permanente, or linking up with insurers through the new Accountable Care Organizations, restrict care by cutting patient services, limiting hospital admissions, or discharging still very ill patients to clinics, nursing facilities, or home, all settings that have fewer staff and regulations. Hospitals overall, have profit margins of 35 percent for elective outpatient services, compared to just 2 percent for inpatient care.

Nurses every day see patients denied admission who need hospital care, held on hallway gurneys in emergency departments, or parked in “observation” units. Observation is the latest fad in large part because Medicare reimbursement penalties for patients re-admitted within 30 days for the same illness do not apply if the patient was discharged from an observation unit.

The ascendance of profits while reducing access to professional nursing care

Hospital industry profits are at a record high – some $64.4 billion in 2012, according to American Hospital Association data.  Kaiser Permanente, which is the model for many of the industry trends, just reported first-quarter profits of $1.1 billion, up nearly 44 percent from a year ago.

Yet, as one of the new NNU radio ads notes, many of those hospitals are spending their profits and patients’ health care dollars “on everything but quality patient care” – on technology, Wall Street investments, buying up other hospitals, while cutting the staff of bedside registered nurses, “the health professionals most critical to your care and safety.”

Inadequate, unsafe staffing is proliferating through the nation’s hospitals, even as hospitals shift care to other settings leaving the patients able to get in, and stay in hospitals, facing often perilous care standards. Just one example of many, in a report released May 12,  Washington, DC nurses cited 215 incidents of severe understaffing, including life-threatening events, in District hospitals the past 15 months. RNs in DC and several states are pursuing safe staffing legislation.

‘Behind every statistic a patient exposed to unnecessary suffering’

“The American health care system already lags behind other industrialized nations in a wide array of essential health barometers from infant mortality to life expectancy. These changing trends in health care threaten to make it worse,” said NNU Co-President Jean Ross, RN. “Behind every statistic is a patient, and their family, who are exposed to unnecessary suffering and risk as a result of the focus on profits rather than what is best for individual patient need.”

“What we are advising every patient, every American to do is stand up and be heard,” said Ross. “When it matters most, insist on a registered nurse.”

MNA Legislative Update May 2, 2014

2 May Minnesota State Capitol St Paul Minnesota

Minnesota State Capitol St Paul Minnesota

MNA Legislative Update May 2, 2014


Public Employee Relations Board

A bill to establish a Public Employee Relations Board (HF3014) was passed by the full Senate on Monday. This legislation would create a board to decide Unfair Labor Practice (ULP) claims involving public employees, which includes many MNA nurses at public municipal or county hospitals (known in statute as Charitable Hospitals). Under current law public employees must litigate ULP claims in district court-a cumbersome and expensive process. The PERB bill would create a process that saves employers and employees money and would mirror the ULP process in the private sector.


Many nurses contacted their senators last week asking them to oppose attempts to remove Charitable Hospitals from the bill, and we are pleased to report that an amendment to exempt those facilities failed. Another amendment to delay implementation of the PERB for Charitable Hospitals for one year also failed.


The companion bill was already passed by the House, and, next week, we anticipate the House will vote to concur with the Senate version of the bill, which would then go on to the Governor for his signature.



Sen. Kathy Sheran’s bill (SF511) to allow Advance Practice Registered Nurses to practice to the full extent of their scope was heard on the Senate floor. Her bill would give full practice authority to Certified Nurse Midwives, Certified Registered Nurse Anesthetists, Nurse Practitioners and Clinical Nurse Specialists. The bill allows APRNs to practice independently, but does limit CRNA’s who will continue to require a collaborative management agreement with a physician to practice pain management.


The bill passed unanimously, and we anticipate the House will vote to concur with the Senate language, which MNA supports over the House language.


Medical Marijuana

The bill to legalize medical marijuana prescribed by a physician for certain serious medical conditions (SF1641) passed the Senate State and Local Government Committee on Tuesday then passed Judiciary without recommendation on Wednesday. The Senate Health and Human Services Finance Division amended the bill today to prohibit smoking medical marijuana, but would still allow “vaping,” the inhaling of fumes through a charged liquid vaporizer.


On Thursday, Representative Carly Melin and House leadership announced a new medical marijuana proposal (SF2470) that would pave the way for clinical trials for patients with qualifying conditions such as seizures, cancer, HIV/AIDS, and glaucoma. Because the bill prohibits smoking marijuana for medicinal purposes, law enforcement is neutral; they have opposed other bills that allow smoking as well as other methods of using medicinal marijuana.


Today the House Rules Committee is hearing the compromise bill introduced by Rep. Melin. As of this writing they have not yet concluded their hearing.


MNA supports legislation that would provide compassionate relief to seriously ill patients.


Health and Human Services Policy Omnibus Bills

The Senate and House omnibus Health and Human Services Policy bills have been taken up by a conference committee to work out differences between the two. The bills both include language that MNA supports related to the Health Professionals Services Program and health professionals with substance use disorders.

Supplemental Budget Bills

The House and Senate are also working out the differences between their supplemental budget bills in a conference committee. In his supplemental budget recommendation, Governor Dayton included $11 million this year and $22 million in the next biennium to cover the cost of negotiated salary increases for staff working in 24-hour care facilities within State Operated Services and the Minnesota Sex Offender Program, which includes many MNA members. While neither the House nor the Senate has included this funding in their respective omnibus bills, we have spoken to conference committee members and about the serious consequences of not funding the State Operated Services salary supplement. We will continue to monitor the negotiations.


Nurses Week May 6-12

MNA nurses will be going to the Capitol the morning of Tuesday, May 6 for the kickoff to Nurses’ Week. We’ll meet at the MNA office at 9:00 am to carpool over to the Capitol. We anticipate the House and Senate will go into session around 10:00 or 11:00 am. As legislators enter the chambers, we will give out stickers saying “Nurses Care” then listen to speeches honoring nurses from the Galleries. Please email if you can come on Tuesday morning.


MNA Government Affairs Commissioners and staff with State Representative

Joe Atkins at the Capitol on Wednesday.


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