HF 41/SF 331 (Rep. Frazier/Sen. Murphy): Essential Workers Emergency Leave Act
Why We Left
2022 Nursing Workforce Report
EXECUTIVE SUMMARY There is a staffing and retention crisis in Minnesota hospitals. This crisis was created by the profit-first policies of hospital CEOs, and it can be corrected if patients and nurses are put before the bottom line of corporate boardrooms. Studies conducted by the Minnesota Nurses Association of its current members, former members, and of the general public make this point clear: •
Minnesotans understand the nature of the staffing and retention crisis, as 85 percent believe it will not be solved without direct action, and two-thirds understand that hospital executives created the problem before the pandemic.
•
There is no shortage of registered nurses in Minnesota, as studies and reports by the Minnesota Hospital Association, the U.S. Department of Health and Human Services, and the Minnesota Board of Nursing clearly demonstrate.
•
In 2021, 63 percent of MNA nurses reported that they had considered leaving their job or the profession altogether, or that they knew someone who had, due to being overworked, understaffed, and demoralized about the quality of patient care they could provide.
•
In over 80 percent of cases where nurses filed a concern over the impact of short staffing on patient care, the nurses reported no response or inadequate action from hospital management.
•
In a survey of MNA nurses who left their bedside nursing positions, the top-cited reasons for their departure were hospital management and chronic short-staffing.
•
Despite the pandemic, over 75 percent of MNA members indicated their desire to stay at the bedside for the near future; of nurses who left the bedside in the last two years, 84 percent indicated that they would not return to the bedside if conditions did not improve.
These findings are supported and reinforced by independent research conducted by management consulting firm McKinsey & Company, which found: • • •
32 percent of nurses surveyed said they “may leave their current direct-patient-care-role”, an increase of 10 percentage points from February to November of 2021. Nurses reported “staffing, pay, and lack of support” as the top factors driving their decision to leave. Of those likely to leave a current nursing position, only 29 percent indicated plans to continue in a direct patient care position.
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BACKGROUND Minnesota nurses are overworked and overwhelmed, hospitals are understaffed, and patients are overcharged by hospital executives trying to boost their bottom lines. Years of short-staffing and cost-cutting by hospital CEOs leave nurses trying to do more with less. These conditions that hospital CEOs created are driving nurses away from the profession and hurting patient care. The pandemic did not create the nurse retention crisis. Rather, years of cost-cutting and short-staffing left hospital management poorly equipped to handle the pandemic, as nurses struggled to provide the care that patients expect and deserve without sufficient PPE, medical equipment and supplies, or staff to meet the need. Even as the pandemic surged, several Minnesota hospitals closed units and facilities and furloughed nurses. Meanwhile, hospitals are paying temporary, out-of-state travel nurses far more than the pay and bonuses they are willing to provide for their own Minnesota nurses. There is no shortage of nurses who want to care for patients, there is a shortage of nurses willing to work under these unsafe and unsustainable conditions. • In 2014, the Minnesota Hospital Association (MHA) issued a study which found “the state-level supply of RNs will more than meet the demand” through 2024, assuming that RN graduate numbers continue to climb; this conclusion is echoed by the U.S. Department of Health and Human Services which projects a surplus of registered nurses in Minnesota through 2030 • A 2021 report from the MN Board of Nursing shows that new RN graduates have climbed in Minnesota despite the pandemic • The number of registered nurses in Minnesota has increased by over 14,000 in the past three years to a total of nearly 120,000 last year, the highest ever recorded in the state IN THE LAST THREE YEARS
14K nearly 120,000 total RNs in MN highest-ever total nurses Now, Minnesota nurses are advocating for changes that will retain nurses and prioritize quality patient care by ensuring adequate nurse staffing levels and fair compensation and benefits, putting nurses and patients at the bedside ahead of hospital CEOs and corporate profits in the boardroom. Our healthcare workforce is in critical condition. The future of our healthcare system in Minnesota depends on the choices we make now.
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Our healthcare workforce is in critical condition. The future of our healthcare system in Minnesota depends on the choices we make now.
EXISTING SURVEYS EXISTING SURVEYS In the twothe years, the Minnesota Association conducted extensive ofits both its membership and of the In the last twolast years, Minnesota NursesNurses Association conducted extensive studiesstudies of both Minnesota public to better understand the scope and severity of the staffing and retention crisis in our hospitals. membership and of the Minnesota public to better understand the scope and severity of the staffing Beforecrisis exploring the details of the Workforce Report below, several highlights from these previous MNA surveys are and retention in our hospitals. worth revisiting. Before exploring the details of the Workforce Report below, several highlights from these previous MNA 2021 MNA Member Survey surveys In are2021, worth revisiting. MNA conducted a survey of our members, asking a variety of questions about their experiences in the nursing
future ofprofession. our healthcare system in Minnesota 2021 MNA Member Survey the highlights of thisofsurvey: In 2021,Among MNA conducted a survey our members, asking a variety of questions about their experiences • 55 percent of nurses reported that they had in the nursing profession. experienced a situation where they were not able highlights to provide the care the patient required due to Among the of this survey: on conducted extensive studies of both its short staffing • 55 percent of nurses reported that they had experienced a nderstand the• scope and severity of the staffing percent reported patient had gotten worse situation44where they were not able safety to provide the care the Considering leaving the bedside, in their hospital over the last five years, while only 6 patient required due to short staffing or know someone who has percent felt itpatient had improved • 44 percent reported safety had gotten worse in their below, several from these previous • highlights 63 percent reported that while theyMNA had hospital over the last five years, onlyconsidered 6 percent felt it had leaving their job or the profession altogether, or that improved theyreported knew someone who due to being over- • 63 percent that they hadhad, considered leaving their job or worked and understaffed the profession altogether, or that they knew someone who had, sking a variety• of questions their experiences Despite theabout pandemic, over 75 percent of nurses due to being overworked and understaffed that they wanted to stayofon the job and in that • Despite reported the pandemic, over 75 percent nurses reported the profession for at least four more years they wanted to stay on the job and in the profession for at least
four more years experienced a e the care the
n worse in their percent felt it had
Want to stay at the bedside for the near future
Considering leaving the bedside, or know someone who has
d leaving their job or someone who had,
rses reported that ofession for at least Want to stay at the bedside for the near future
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Concern for Safe Staffing Forms In Minnesota, nurses voluntarily file Concern for Safe Staffing (CFSS) Forms when they encounter situations where shortStaffing staffingForms is negatively impacting patient care. Concern for Safe Concern forvoluntarily Safe Staffing Forms for Safe Staffing (CFSS) Forms when they encounter situations where short In Minnesota, nurses file Concern No response or insufficient A survey of CFSSfor forms 2021(CFSS) reveals: In Minnesota, nursespatient voluntarily file Concern Safefrom Staffing Forms when they encounter staffing is negatively impacting care. action from hospital • Minnesota nurses filed 7,857 CFSS situations where short staffing is negatively impacting patient care. forms in 2021 management • In over 80 percent cases,from nurses reported A surveyof ofthose CFSS forms 2021 reveals:no response or inadequate action from hospital management No response or insufficient A survey of CFSS forms from 2021 reveals: • Minnesota nurses filed 7,857 CFSS forms in 2021 action from hospital when they brought up concerns for patient safety • Minnesota filedof 7,857 CFSS forms in 2021 • In overnurses 80 percent those cases, nurses reported management • Compared•to 2020, there was a 213 percent increase in In over 80 percent of those cases, nurses reported no response or inadequate action from hospitalno reported casesresponse of brand-new nurses being pulled offhospital or inadequate action from management management when they brought up concerns for orientation prior to completion toup care for patients when they brought concerns for patient safety patient safety • Compared to 2020, there was a 213 percent increase in • Compared to 2020, there was a 213 percent increase reported cases of brand-new nurses being pulled offpulled off in reported cases of brand-new nurses being orientation prior to completion to care for patients orientation prior to completion to care for patients 2022 MNA Public Polling In January 2022, MNA conducted a public poll of 1,025 registered voters in Minnesota with an independent polling firm. 2022 MNA2022 Public Polling MNA Public Polling In January 2022, MNA conducted a public pollaof 1,025poll registered in Minnesota an independent In this poll, Minnesotans the following: In January shared 2022, MNA conducted public of 1,025voters registered voters inwith Minnesota with an polling firm. • Minnesotans understand the nature of the staffing and retention crisis, as 85 percent believe it independent polling firm. In this poll, Minnesotans shared the following: will not be solved without action, and two-thirds understand • Minnesotans understand the nature of the staffing Hospital executives created the that hospital executives createdshared the problem and that it preIn this poll, Minnesotans the following: datesand crisis, as 85 percent believe it will not staffing crisis the believe it theretention pandemic • Minnesotans understand the nature of the staffing and retention crisis, asbefore 85 percent be solved without action, and two-thirds understand pandemic • Minnesotans believe CEOs can afford to make the will nothospital be solved without action, and two-thirds understand that hospital created thethey problem andproblem that and that it prechanges necessary to fix theexecutives problems created. An Hospital executives created the thatexecutives hospital created the it pre-dates the pandemic overwhelming 88 percent of Minnesotans stated that they staffing crisis before the dates the pandemic • Minnesotans believe hospital CEOs can afford to believe hospitals are run likebelieve for-profit corporations, 77 to make the pandemic • Minnesotans hospital CEOs canand afford percent make the changes necessary to problems they understand that many hospitals were profitable changes necessary tofix fixthe the problems theyover created. An the past created. overwhelming percentofofMinnesotans Minnesotansstated that they two An years despite the8888 pandemic. overwhelming percent stated that they believe hospitals are run like for-profit • Minnesotans are especially concerned with the high salaries believe hospitals are run like for-profit corporations, and 77 corporations, and 77 percent understand that many were and compensation of hospital executives in Minnesota, who profitable over percent understand that many hospitals were profitable over the past two years take hospitals home multi-million-dollar salaries while nurses are the past two years despite the pandemic. despite• the pandemic. understaffed and patients are Minnesotans areovercharged. especially concerned with the high salaries • Minnesotans are especially concerned withexecutives the high in Minnesota, who and compensation of hospital salaries and compensation of hospital executives take home multi-million-dollar salariesinwhile nurses are Minnesota,understaffed who take home andmulti-million-dollar patients are overcharged. salaries while nurses are understaffed and patients are overcharged. “’Nominally nonprofit community-spirited institutions have actually come to operate as profit-maximizing monopolies,’ with the excess going to executive compensation “’Nominally instead of dividends” nonprofit community-spirited institutions community-spirited institutions Phil“Nominally Longman, nonprofit Policy Director, OpentoMarkets have actually come operateInstitute as profit-maximizing have actually come to operate as profit-maximizing The Intercept, December 20 2020 monopolies,’ with the excess going to executive monopolies,’ with the excess going to executive compensation instead of dividends” compensation instead of dividends” Phil Longman, Policy Director, Open Markets Institute Phil Longman,The Policy Director, December Open Markets Intercept, 20Institute 2020 The Intercept, December 20, 2020
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2022 MNA WORKFORCE REPORT
If they intend to come back to bedside Why they left bedside nursing Between December 22, 2021 and January 17, 2022, MNA surveyed 748 nurses who left a 2022 MNA WORKFORCE REPORT position where they were represented by MNA within the past two years. • •
What year did you leave your bedside nursing position?
Between December 22, 2021 and January 17, 2022, MNA surveyed 748 nurses who left a position where they were The survey on determining why nurses left these bedside positions, and asked represented by MNA within the pastfocused two years. The survey focused onquestions determiningincluding: why nurses left these bedside positions, and asked questions including: • • • • •
When the nurse left the bedside • When the nurse left the bedside Whether they had another job when they left • Whether they had another job when they left If they are currently working elsewhere as an RN If they nursing are currently working elsewhere as an RN If they intend to come back• to bedside • If they intend to come back to bedside nursing Why they left bedside nursing • Why they left bedside nursing
2020
46% | 2021
54%
Did you secure new employment What year did you leave your bedside nursing position? youbefore secureleaving? new employment before leaving? What year did you leave your bedside nursingDid position?
2020202046% 54% 46%| •2021 2021 51%
Yes Did you secure new employment before leaving?
Yes
46% | No
54%
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YES 46% • NO 54%
46% | No
54%
After leaving your MNA beside nursing position, are you now working in another hospital?
After leaving your MNA beside nursing position, are you
Yes
25% | No
75%
If nothing changes, do you plan to return to a bedside nursing position in the future?
After leaving your MNA bedside If nothing changes, do you plan Yes 25% | No 75% nursing position, are you now to return to a bedside nursing working in another position? inchanges, the future? After leaving your MNA beside nursing position, are you now working another hospital? Ifposition nothing doinyou plan to return to a bedside nu
Yes
16% | No
Why We Left
84%
YES 25% • NO 75%
YES 16% • NO 84%
25%nurses | Nowere asked 75% to explain why theyYes 16% | No nursing 84% In a free-textYes response, left their bedside position. Some explained that they retired on-schedule, while others shared the unsafe and unsustainable Whynurses We Left If nothing changes, do of youbedside plan tocare. return to a bedside nursing position in the future? conditions which pushed them out
In a free-text response, nurses were asked to explain why they left their bedside nursing position. Some nurses explained Why We Left that they retired on-schedule, while others shared the unsafe and unsustainable conditions which pushed them out of Nurses’ which contributed to their bedside care. responses were analyzed and categorized for all of theInreasons a free-text response, nurses were asked to explain wh
decision to leave bedside care. Many nurses identified more than one contributing factor, and highlights
Nurses’ responses were analyzed and categorized for all of the reasons which contributed to their to leave bedside nurses explained that decision they retired on-schedule, while ot of this cross-analysis are included below. care. Many nurses identified more than one contributing factor, and highlights of this cross-analysis arethem included conditions which pushed out below. of bedside care. Setting aside those who retired, nurses’ most-cited reasons for leaving their bedside position were:
Setting aside those who retired, nurses’ most-cited reasons for leaving their bedside position were: Nurses’ responses were analyzed and categorized for all decision to leave bedside care. Many nurses identified m Reason for Leaving Count of this cross-analysis are included below. Management Issues 262 Short Staffing 120 those who retired, nurses’ most-cited reas Setting aside Yes 16% | No 84% COVID-19 Pandemic 104 Reason for Leaving Working Conditions 97 Management Issues 70 Why We Left Stress or Burnout Short Staffing Family Factors 61 In a free-text response, nurses were asked to explain why they left their bedside nursing position. Some COVID-19 Pandemic Closures or Reductions 55 nurses explained that they retired on-schedule, while others shared the unsafe and unsustainable Working Conditions Personal Safety 39 conditions which pushed them out of bedside care. Stress or Burnout 6 Highlights ofNurses’ this dataresponses show: were analyzed and categorized 7 Family Factors for all of the reasons which contributed to their • Concerns with poor hospital management and chronic under-staffing were the top drivers of Closures orand Reductions decision to leave bedside care. Many nurses identified more than one contributing factor, highlights nurseofdepartures, dwarfing this cross-analysis areconcerns includedspecific below. to the COVID-19 pandemic or so-called “burnout.”
Highlights of this data show: • Concerns with poor hospital management and chronic under-staffing were the top drivers of nurse departures, dwarfing concerns specific to the COVID-19 pandemic or so-called “burnout.” • Of those who cited the COVID-19 pandemic as a driving reason for their departure nearly 40 percent also cited management concerns as contributing to their decision to leave the bedside. • Of those who identified stress or so-called “burnout” as a driving factor in their departure, nearly 40 percent also cited management concerns and 26 percent cited short staffing. • Of the 188 nurses who retired, 13 percent cited management issues as a contributing factor, 6 percent cited hospital closures or service and position reductions, and 4 percent mentioned short staffing as a contributing factor. •
Just 20 respondents out of 748 cited COVID-19 vaccine requirements as a reason for their departure. Of these 20 respondents, 20 percent of them also cited management concerns with another 20 percent citing concerns with short staffing.
SAMPLE RESPONSES Below is a sampling of responses from the survey to the question: What were your motivating factors for leaving? These responses are being presented anonymously, and with minimal editing for content and clarity, to protect the confidentiality of survey respondents. “Bad management with COVID – told me to spend ‘least amount of time with patients as possible!’ Said we had all the PPE we needed and threatened if we got COVID, it was not from the hospital. They were threatening and patients were being very undertreated and their families were not informed. After 34 years of faithful nursing at that hospital, I left crying after every shift the last 4 months.” “Poor management and understaffing. Money-oriented administration.” “Didn’t feel supportive as a new grad nurse. I was a brand-new nurse working in the hospital during COVID and I was very overwhelmed and underappreciated.” “Ongoing short staffing issues, risk of my license, management not caring about subpar patient care or the risk of patient harm due to staffing. Lack of support and/or respect by some nursing supervisors, social work, and other charge nurses… It broke my heart to have to leave there.” “Trying to do more with less. Fatigue, exhaustion from less and less resources for bedside nurses.” “1. Inadequate staffing 2. Safety concerns (for patients and staff) 3. dearth of advancement opportunities 4. Misplaced priorities on the part of executive leadership (i.e. plenty of resources for marketing/press interactions, very limited resources for actual patient care improvement projects).” “Lack of safety, lack of staffing, overall treatment of the nursing staff.” “Lack of staffing. Lack of support from Admin.”
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SUPPORTING RESEARCH Independent research by the management consulting firm McKinsey & Company supports the findings of MNA’s study of nurse workforce departures. In November 2021, McKinsey surveyed 710 direct care nurses throughout the nation to “better understand their experiences, needs, preferences, and career intentions.” Key findings of this study show:
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32 percent of nurses surveyed said they “may leave their current direct-patient-care-role”, an increase of 10 percentage points from February to November of 2021.
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Nurses reported “staffing, pay, and lack of support” as the top factors driving their decision to leave.
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The number one reason cited by nurses in the McKinsey study was “insufficient staffing levels,” which 15 percent cited as a top concern.
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The second reason was compensation, followed closely by not feeling “listened to or supported at work,” at 11 and 10 percent respectively.
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Only 5 percent cited “fear of COVID-19” as a factor driving their decision to leave.
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A safe environment and unmanageable workload were top concerns for surveyed nurses, including both those who planned to stay and those who planned to leave.
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Of those who indicated a likeliness to leave their current bedside positions, 35 percent indicated “plans to stay in the workforce but in a non-direct patient-care role,” while 20 percent planned to retire or otherwise “exit the workforce completely.”
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Of those likely to leave a current nursing position, only 29 percent indicated plans to continue in a direct patient care position.
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CONCLUSION Minnesota nurses want to be at the bedside doing what they love, providing exceptional care to their patients. But the profit-first policies of hospital CEOs are driving nurses away from the bedside. There are more than enough nurses in Minnesota to meet the needs in our hospitals. These nurses want to stay at the bedside for the near future, despite the pandemic and the often unsafe and unsupportive work environments they have faced. However, without changes that will solve the crisis of under-staffing and retention, which hospital CEOs have created, nurses will continue to be pushed away from the bedside and from the careers and patients they love. Minnesota nurses are ready to fight and win legislation and contract language to put patients before profits, retain nurses at the bedside, and prioritize quality patient care throughout Minnesota.
APPENDIX: Methodology MNA Public Poll On behalf of the Minnesota Nurses Association, Change Research surveyed 1,025 registered voters in Minnesota between January 8-10, 2022. Respondents were recruited into an online survey instrument via Dynamic Online Sampling which continuously rebalances online advertisements to obtain a representative sample. Post-stratification was done on gender, region, age, ethnicity, education, and 2020 vote. MNA Workforce Survey Between December 22, 2021 and January 17, 2022, MNA surveyed nurses who left an MNA bargaining unit in the past two years and did not take a new job in another MNA bargaining unit. MNA received responses from 748 nurses who fit these criteria. The survey focused on determining why nurses left the bedside, and asked questions including: when the nurse left the bedside; whether they had another job lined up when they left; if they are currently working, in what capacity, and where; if they intend to come back to bedside nursing; and why they left bedside nursing at an MNA-represented facility. Based on the data collected, MNA categorized the reasons why nurses left their positions into the following key categories. If a nurse identified more than one reason that they left the bedside, multiple categories were tagged and counted. An explanation of examples for each category is included in the chart on the next page.
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categories were tagged and counted. An explanation of examples for each category is included in the chart below. Category
Key Words
Count
Closures
Facility closures, unit closures, unit downsizing, merger
55
Compensation
Pay
22
COVID
Mentions of the pandemic, pandemic specific stress, COVID, personal health risks
Discrimination
Prejudice, racism, discrimination
Education
Continuing education, graduate school
12
Family
Family health, death, family life, new child
61
Fired
Fired for cause
9
Reduced
Involuntary reduction of hours
2
Management
262
Other
Lack of response to patient safety concerns, poor management in the unit, toxic culture, not feeling valued, poor communication, unwillingness to accommodate Advancement opportunities, moved out of state
Retired
Planned retirement, early retirement
188
Safety (Nurse)
Assignments that were unsafe for nurses, neighborhood safety
Staffing Stress
Mentions of nursing shortage, inadequate staffing, disregard for patient safety, inexperienced staff, poor staffing model, short staffing Direct mentions of stress, fatigue, burnout, exhaustion
Travel
Took a job as a travel nurse
Union
Ineffective union, lack of union communication, union dues
11
Vaccine Working Conditions
Left or were fired due to vaccine mandates
20
Scheduling, working conditions, better hours, job satisfaction, employer location
97
104 3
88 39 120 70 9
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These data were also cross analyzed to display how often two factors were cited together; for example, how often a respondent indicated both staffing and management as concerns which drove their decision to leave the bedside (82 times), or how often both management and closures were mentioned together (45 times).
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