Minimum Standards for Patient Safety

MNA Nurses Call for Minimum Staffing Standards

"We need a standard to hold these hospitals accountable," said Linda Hamilton, president of the Minnesota Nurses Association, "so patients and their loves ones can count on adequate RN staffing."   Read the full media release.

View a short video of the Thief River Falls event.

Jan. 4, 2013 - Nurses from Bagley, Bemidji and Thief River Falls gathered on the ice in Thief River Falls to demonstrate that patients are falling through the cracks because of unsafe staffing. 


Report Unsafe Staffing
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Have you or a family member suffered due to unsafe staffing conditions inside the hospital? MNA wants to hear from you.

Countless case studies, surveys and statistics demonstrate that improved RN-to-patient staffing ratios save lives, improve the quality of patient care, help solve the nursing shortage and save hospitals money.

Quick Facts of Staffing for Patient Safety

MNA nurses made inadequate staffing a kitchen table discussion in 2010. It’s a fight we’ve been waging for nearly two decades – and a campaign worth our effort for as long as it takes.

Why is this necessary
Hospitals are simply not delivering on their obligation to provide the staff we need to keep patients on their path to health. They must be held accountable to their marketing claims and their ethical duty.

60+ research studies prove a correlation to adequate nurse staffing and positive patient outcomes.

Day care centers, firefighters airlines, jails and pet care facilities are required to meet basic ratios. Why wouldn’t hospitals have numbers families can count on?

Where’s the battleground?
In our workplaces, the legislature and public opinion. MNA nurses have used democratic and legal tools available to advocate for safe RN staffing standards, such as

  • MNA contracts & negotiation
  • State and national legislation
  • Social and traditional media

A Long-Term Commitment
We stand with our colleagues in many other states who have demonstrated long-term commitment to make sure hospitals are held accountable for getting staffing right.

  • The California Nurses Association spent twelve years advancing legislation before they succeeded in making it law.
  • The Massachusetts Nurses Association is now in its thirteenth year of their staffing campaign, and they are getting closer each legislative session.
  • Legislation on the federal level was introduced by California Sen. Barbara Boxer in May, 2009 and awaits committee assignment. Companion bill in House introduced by Illinois Rep. Jan Schiakowsi.

What’s Been Done So Far?
For more than two decades MNA members have dedicated organizational resources and collective action to protecting patient rights and advancing bedside initiatives. We recognize it is an ongoing battle against corporate forces, but it is the fight nurses wage as advocates for patients and families who are vulnerable and/or who can’t speak for themselves.


1985 Mandatory Overtime

  • Contract language allows registered nurses to refuse work beyond agreed shift if s/he is too tired.
  • Prevents patients from being treated by overly-fatigued professionals.
  • MNA is the first in the nation to secure this language. It would take sixteen more years before bargaining units in other states negotiate it into contracts

1990 Concern for Safe Staffing Forms

  • Forms instituted in all MNA Bargaining Units
  • RNs complete the form to systematically document unit-specific staffing concerns

1997 Staffing Grids / Staffing Plan Reviews

  • Instituted in some MNA contract facilities
  • A database for these forms is also initiated

2000 Concern For Care

  • Research study conducted and released to media.
  • The study describes trends and patterns in nurse staffing.
  • MNA continues to conduct annual compilation, trending and reporting to membership

2001 Unit Closure Language

  • Contract language that allows RNs at the point of care the authority to close nursing care units to admissions and transfers.
  • When problem-solving with management and/or administration does not result in an acceptable resolution of safe care, the charge nurses on that unit may temporarily close the unit to new patients.
  • 1, 600 Fairview nurses go on strike to win the same language other metro facilities achieved before the June 1 strike deadline.

2002 Mandatory Overtime in State Law

  • Instituted into state law. Requiring every hospital in Minnesota to abide by rules MNA contracts initiated in 1985.

Continuing Education

  • Spurred by landmark studies in staffing, conducted by researchers Peter Buerhaus and Linda Aiken, MNA develops educational sessions, including "The 3 R’s - Nurses’ Rights Responsibilities and Resources," as well as others on emerging research on nurse staffing, and evidence-based practice. Nurses learn and earn continuing education credits at sessions held in numerous bargaining units and MNA events. The education becomes the foundation for MNA’s publication Nursing Practice Handbook made available to all bargaining unit chairs.

2003 Adverse Event Reporting

  • MNA successfully champions legislation for Adverse Event Reporting.
  • Hospitals are required to document and publicly report incidents that result in death or serious injury. Adverse events are defined in Minnesota statute and bundled into six categories: Surgical; Product or Service; Patient Protection; Care Management; Environmental; Criminal.

Complexity Compression

  • Complexity Compression is identified during a meeting of the Assembly of MNA Practice and Education Leaders (AMPEL).
  • The phenomenon is what nurses experience when expected to assume additional, unplanned responsibilities while simultaneously conducting their multiple responsibilities in a condensed time frame.
  • MNA and the University of Minnesota publish nationally in nursing journals and present at several national nursing meetings. The partnership formulates a tool to use in practice settings.

2006 Think Tank on Staffing Principles

  • MNA’s convention hosts a member forum where nurses unleash pent-up frustration with existing staffing conditions.
  • The forum prompts MNA’s Board to establish a Staffing for Patient Safety Task Force and generate a Main Motion at the 2007 House of Delegates to institute an organizational priority about staffing.

2007 Acuity Measure for Nurse Staffing

  • Some MNA bargaining units negotiate contract language to form a nurse/hospital committee that would work jointly to develop an accurate acuity measure for nurse staffing. No final agreement reached.

Convention Education and Action Forum

  • MNA devotes its entire education day to creating awareness and developing action tools to pursue legislative initiatives for safe staffing.
  • 20+ legislators attend an event coordinated by MNA. Nurses gathered at tables with their representative to share insights and stories about staffing. Legislators are impressed by nurses articulating the reality inside hospitals.

RN Staffing and Patient Care in Minnesota Research

  • MNA conducts a comprehensive research project that studies the perspectives of nurses and patients in regard to patient care in the state’s acute care hospitals. Sobering results show a high level of concern about staffing by nurses and citizens. Media outlets throughout the state cover the story.

2008 Staffing for Patient Safety Legislation

  • MNA champions bills in Minnesota State House and Senate. The proposed legislation, which includes a foundation of nurse-to-patient ratios, gets hearings in committees in both chambers. MNA generates hundreds of stories from nurses and patients that illustrate the dangers of inadequate staffing.

MNA Staffing Model and Acuity & Intensity Tool Development

  • At another AMPEL meeting, MNA members and staff identify and diagram the elements of a safe staffing model, and develop an Acuity Tool with Definitions

MNA-MHA Staffing Group

  • Per legislative request, MNA and the Minnesota Hospital Association meet in an attempt to resolve staffing concerns posed by nurses. After 6 meetings, the group reaches impasse, and MNA reintroduces the 2008 legislation with no changes.

2009 Staffing Questions Added to Adverse Event Law

  • MNA successfully lobbies to enhance the existing law to include questions that address staffing levels in the root-cause analysis.
  • National Nurses United successfully secures key support from Sen. Barbara Boxer who introduces a bill in the U.S. Senate that mirrors California’s first-in-the-nation law.

2010 Nurses on the Line for Safe Patient Staffing

  • 12,000 metro nurses demand to advance metro agreements by adding maximum nurse-to-patient ratios in contract. In a very public fight, nurses shine a bright light on the risks to patients of inadequate RN staffing and expose the reality that hospitals put profits over patient care when it comes to staffing.
  • 1,350 nurses in Duluth achieve unit closure language and staffing grids in their contracts.

2013  Standards of Care Campaign Launched and Legislative Advancements

  • Legislation passed to mandate hospital reporting on staffing and conduct Research for Minnesota-specific data on the correlation between hospital staffing and patient outcomes.