Community Care Nurses Unity Letter
We, the Nurses of the Atlanta VAHS Community Care Program, care deeply about taking care of our Nations' Veterans and want to ensure we retain and recruit Nurses and AWS is an important VAHS tool to do so. A National Research Study by National VAHS, “FY 2022-2026 – VHA Nursing Occupations, Workforce Resources Blueprint”, explains that VA exit surveys in FY 2020 and 2021 showed that nearly 1 out of 3 Nurses said more flexible work schedules might have convinced them to stay and calls for VAMCs to expand the use of Alternative Work Schedules (AWS) to meet the needs of nursing staff.
We respectfully submit the points below and ask you to keep the 10-hour tours intact:
· Management claims that the reason for rescinding the 10-hour tour is based on staffing shortages, an increase in workload and backlog in medical records needing RN review.
· We were given the option to work the 10-hour tour about a year ago. This was started in response to a better work-life balance. Allowing nurses to work the alternate tour was also part of Nurse retention and boosting morale. The 10-hour tour allowed some of us to utilize our day off to schedule appointments for our health, psychological and physical wellbeing as this job is very demanding and at times can also be quite tedious. Please note, not ALL the Nurses in Community Care work an alternate work schedule (AWS). 54% of the Community Care Nurses work an 8-hour tour.
1. Management stated that “This change will ensure better coverage for patient care and coordination needs and ensure more adequate coverage for clinical chart review for patient care results”.
a. We do not see any compelling practice-based evidence that there are any quantitative and/or qualitative improvements that will be made.
b. This is especially true since the hiring of the 8 Nurse positions has decreased the vacancy rate to 20% from 37%. The orientation and training of those new Nurses will take 4-6 months. The variety of the 40-hours during the work week does not constitute additional time for the Nurses asked to return to a 5-day work week.
2. The 10-hour tour was piloted and found not to impede processing of consults. As a matter of fact, there were no reports that the consult work was not done, in addition, the ED Team was recognized multiple times by national for keeping the numbers of notifications low and a best practice for Team structure.
a. It also found that Nurses had more time in their day to complete their increasing workload. The Alphabet Nurse Teams can not only review medical records but process the request for additional services.
b. In addition, the ED Team has more time to review medical records and coordinate care for patients ready for discharge, which is impossible to do with the other administrative duties during an 8-hour tour.
c. Extended support hours through an alternate work schedule can also benefit veterans and vendors who want to contact Community Care after 4:00 p.m.
3. Staffing issues and shortages are not problems generated by nursing staff. The Nurse Teams have been restructured several times within this department and some of the structure has resulted in inefficiency issues within the Team regarding time off. This was at no time a Nurses’ issue, but a planning issue. In some cases, more Nurses than should have been approved off for leave was noted.
a. Training on approving leave in an outpatient setting is needed.
b. Also, creating safe spaces for Nurses to collaborate with each other about our own staffing coverage is needed.
4. The backlog of medical records is a mixture of failures including system and managerial failures and now placed on the Nurses. This backlog has been here for more than two years and has been a consistent concern of the Nurses. We thought we had support when the Executive Leadership approved overtime for the Nurses to complete the backlog, but that did not come to fruition.
a. Community Care Nurses never started the OT for the backlog of medical records. Now that OT is exhausted, the backlog has increased even larger.
b. System and Management failures should not be the impetus for fixing something that is not broken, and the 10-hour shifts are not the problem.
c. All Community Care Nurses perceive this move as punishing and uncaring at a time when we need to keep Nurse morale high.
5. Removal of medical records from streemfax folders. We understand this was a directive from Ms. Brown. However, this was a real disservice to the Nurses because as a result records are distributed to the Nurses in no format. We can’t find the records we have requested. We are still asked to locate records by Management when they know we no longer have access to our streemfax folders.
a. We understand there were too many hands in the streemfax folders, but the Nurses knew how to work their folders. Now we are expected to Care Coordinate, but it is retrospectively.
b. This is also an issue which does prevent the efficient review of records in the backlog.
6. Nurses need time to complete the medical record review. There has been a debate about how many records the Nurses should be able to review in one hour. Nurses state six/hour and Management states 8/hour. First, the administrative tasks the Nurses are completing will need to be off-loaded. The Close Out Team suggestion for the Nurses is endearing, but it’s like “robbing Peter to pay Paul.”
a. We are playing a numbers game instead of thinking of quality strategies to control all aspects of the Nurse’s responsibilities.
b. We have strategic and tactical ideas but are not being engaged by management in an effective and collaborative fashion.
c. The ED team was given opportunities for input, but management unfortunately did not engage with the Nurses on their input nor tell them why it was not taken into consideration. Medical record review is such a huge part of Care Coordination. If Care Coordination is the true goal, to be effective and engaging, more time and collaborative discussion with the Nurses is needed.
7. The request to suspend AWS is arbitrary as nurses have voiced their displeasure of the changes and restructuring of the New Team Assignments. The backlog of medical records (in excess of 20K records) as discussed by Community Care Leadership cannot be cleared up without working overtime.
8. Patient care is every Nurse’s concern. The AWS was a strategy to combat Nurse burnout and poor nurse morale. We ask you to not lose sight of that.
"The way a team plays as a whole determines its success." — Babe Ruth