ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, November 17, 1996 TAG: 9611180074
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
Faced with two unions saying they would return to Roanoke this week to woo its employees and embarrassed by recently having to defer patients to a competitor because it didn't have staffed beds at its largest hospital, Carilion Health System has backed off some of its re-engineering schedule.
Hospital system officials told employees Friday that Carilion will delay "until further notice" the second phase of a new nursing staff plan that depends on noncertified assistants to do some of what are now duties of licensed staff.
The company also pledged to hire a temporary nursing service to help it meet the acute need for staff and said it will add positions so that management personnel will always be on site at its two Roanoke hospitals.
Carilion said that 72 inpatient nursing employees who have been in orientation will move to patient units between now and February and that 101 nursing employees who for several months have spent part of their work time training for the new patient care system will return to their units this week.
Also, the equivalent of 10 additional full-time nursing positions have been posted, the company said.
However, Carilion plans to go ahead with implementation of the new inpatient care plan in four units at Carilion Roanoke Memorial and Carilion Roanoke Community hospitals during December and January.
The plan, designated the Carilion Care Model, establishes a patient team led by a registered nurse but assigns new duties to unlicensed personnel, such as inserting needles to start intravenous liquids or medications and inserting catheters to capture urine.
The Carilion Care Model has been in place at Carilion Bedford County Memorial Hospital for several months and had been scheduled for the Roanoke units in mid-October, about the time the employees' collective bargaining discussions intensified.
Originally, 18 of the system's 45 nursing units were scheduled to change over to the new plan next year.
Saturday, nurses attending a collective bargaining information meeting at the Roanoke City Library hailed Carilion's decision to hire additional staff and delay the changes, but said they feared it was only holding off the inevitable.
"Things are kind of hot now, and they want to calm us down," said one nurse, who asked to remain anonymous.
She said she would be happier if Carilion had said it would rethink the new patient care plan.
The plan is based on one used by some Pennsylvania hospitals. Criticism of it from nurses and patients has prompted Pennsylvania legislators to consider setting overall staffing standards for hospitals and creating new certification rules for nursing assistants.
The Roanoke-area nurses said they have similar concerns about the plan and turned to unions for help when they couldn't get management's attention.
Friday's missive from management included a note from Carilion President Tom Robertson saying that, in addition to delaying full rollout of the new plan, some of the company's "other long-term initiatives" are being postponed to give managers more time to work with the nursing staff on maintaining quality patient care.
Late last month, organizers from the Kentucky Nurses Association and from the Service Employees International Union spent several days in the area meeting with hospital employees. The Kentucky group represents only registered nurses and is not a member of the AFL-CIO. The SEIU represents all levels of health care employees and has the most health care members of any union.
Saturday's gathering at the library was sponsored by Virginia Nurses for Change, a local group operating from a post office box in Hardy. The group also held a session last week at a local church and expects to be back at the library Monday.
In recent weeks, nurses interviewed expressed fear that they are being asked to work under conditions that jeopardize patients and their professional licenses.
Carilion employs about 7,800 workers throughout a 14-hospital chain that stretches from Farmville to far Southwest Virginia and includes facilities owned or managed by the not-for-profit company. Union activities are focused in the Roanoke Valley facilities.
Information released Friday was in the form of a special edition of the company's regular newsletter, System Update, and was presented as a "plan for peak census."
Hospital officials said it had more patients than usual and that forced it to divert some patients on several occasions recently from Roanoke Memorial to Columbia Lewis-Gale Medical Center in Salem. However, the number of available beds at Roanoke Memorial is 23 fewer than a year ago, down to 356 from 379. Officials would not say how many of those beds are staffed, except that the number varies.
Roanoke Memorial is licensed as a Level One trauma center, which means it is equipped to handle the most serious accident victims.
Employees said the hospital is so thinly staffed, though, that on one recent evening a unit with 26 patients had only one nurse on duty. More than three sources confirm that some nights no technician is assigned to watch the bed monitors at the nursing stations in the "step-down" units. These units are for patients who need special attention, but who do not need to be in intensive care.
At least two physicians have told Carilion administration that they did not want their patients in the units unless staffing was kept at a specified level.
In the past two years, Carilion consolidated labs and hospitals, and reorganized according to services instead of by facility. At each phase, staff have had to reapply for jobs and some positions were lost. From June 1995 to June 1996, the system cut the equivalent of 350 workers and eight corporate positions.
The company also standardized its compensation across the system, causing some employees to lose hundreds of dollars in income per bi-weekly paycheck. It also announced that in December it would close the child care centers that operate in three of its hospitals and employed 47 people. It said the child care service only benefitted 4.5 percent of its employees and would require a capital investment to remain open.
Even though the company helped the staff with placement of their children, some nurses said they found that most centers open so late in the morning that they have less than a half hour between dropping off a child and getting to work on time. Also, some nurses who work 12-hour shifts said they were unable to find centers to take their children and have had to find in-home care.
Carilion also put the nursing staff on mandatory overtime, meaning they had to work a certain number of extra hours per week, if asked, or jeopardize their jobs.
Carilion, which estimates its 1995 operating expenses will be $457.4 million, has about 70 percent of the health care business in the Roanoke Valley. But it is battling increasing competition as insurance companies direct employee groups to the lowest-cost facilities. Carilion said last year that its goal is to cut the company's operating costs by $75 million by 2000.
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