A revised proposal to manage hospital nurse staffing levels was presented Thursday to a legislative conference committee that would opt all Mayo Clinic hospitals out of its requirements.

Lawmakers behind the bill said Gov. Tim Walz and others appear to be in favor of the exclusion for Mayo, which had threatened to switch a multi-billion expansion project in Rochester to another state if its hospitals were required to meet the staffing requirements.

The bill requires all hospitals to create committees of administrators, nurses and other caregivers to set nurse staffing levels that will prevent worker burnout and preserve patient care and safety.

“We believe that registered nurses along with direct care workers need to have a powerful voice in caring for patients,” said Sen. Erin Murphy, DFL-St. Paul, a registered nurse and lead author of the bill. “Their judgment matters. Too often they have been overlooked.”

Committee approval would send the amended bill to the full House and Senate for approval. The bill was pulled out of a larger health budget bill so its controversial proposals could be considered on their own.

Leaders of every nonprofit hospital in Minnesota signed an editorial earlier this month opposing the legislation, arguing that rigid staffing levels set by committees could force hospitals to close units or deny patients on days when they lacked nurses.

“If we are legally bound to staffing levels and have the extra pressure of nurses being able to refuse care, we will have to immediately decrease beds in these units or close them entirely,” said Andrew Berndt, vice president of critical care and neonatal services at Children’s Minnesota.

Berndt and other rural and metro hospital leaders argued Thursday that they should also be exempted from the staffing committee requirements if they, like Mayo, already use an electronic acuity system to adjust staffing based on patient needs.

Murphy said she opposed exemptions for any hospital, but that she agreed to the compromise. The bill not only exempts Mayo’s Rochester hospital, which draws patients from around the world, but its community hospitals in Austin, Fairmont, Mankato and other cities.

Mayo lobbyist Kate Johansen said the health system’s electronic staffing system is “far more advanced” than the proposed committee process.

Hospital leaders also strongly opposed allowing arbitrators to set binding staffing levels if committees couldn’t reach agreement. As a compromise, lawmakers added the option of mediation to help opposing sides on the committees come to agreement on their own.

“It’s another one of those ‘getting to yes’ things,” said Rep. Sandra Feist, DFL-New Brighton, an author of the House version of the bill.

Nurses and leaders of the Minnesota Nurses Association (MNA) testified at Thursday’s committee meeting that many of their coworkers are burning out and leaving the profession, increasing the pressure on those left at the bedsides.

More than 5,600 Minnesota nursing positions were vacant in the second quarter of 2022, or about 8.2% of all positions, according to state workforce data.

Union surveys suggest thousands of nurses would return to hospital care under more favorable working conditions, said Becky Nelson, an MNA leader and nurse at Abbott Northwestern Hospital in Minneapolis. She was disappointed that Mayo nurses were exempted.

“This is a crisis of retention and crisis of patient care,” she said.

The staffing legislation appeared a lock last month when it was approved by both the House and Senate — a first for the nursing union, which has advocated for such legislation since 2008. Then Mayo’s threat upset its prospects.

Tori Wagner, nursing director for Mahnomen Health in northwestern Minnesota, predicted that the impact of the bill would be felt more in small hospitals than large regional medical centers.

Her hospital typically rotates two nurses each shift between emergency and inpatient care, but she said in one recent 24-hour period the hospital was flooded with patients with drug overdoses, infections, mental health crises and traumatic injuries. Wagner said there’s no way the hospital under that kind of unpredicted pressure could meet rigid staffing requirements.

“Who’s going to serve our patients when we need to close units — or worse, close our hospital doors?” she asked.

Whether staffing requirements would push hospitals to close units or shut down is unclear, but Minnesota’s hospitals are struggling financially. The Allina and Fairview hospital systems reported multimillion dollar losses so far this year, and the most recent Minnesota Department of Health analysis showed 29 of the state’s 128 hospitals were in financial distress in 2019. One of those distressed hospitals, Mayo Springfield, has since closed.