PUBLISHED BY MOSHOLU PRESERVATION CORPORATION

Montefiore Health Center to Lose RNs

By HEATHER HADDON

Montefiore Medical Center is moving forward with a controversial plan to replace nine registered nurses at its Family Care Center with less skilled personnel. Announced last month, the change triggered protest among Montefiore physicians and nurses, but administrators remain steadfast in their decision.

The nine nurses from the Kossuth Avenue health center, a high-traffic primary care and specialties facility, will be transferred to other Montefiore sites in the coming weeks. Nine licensed practical nurses (LPNs) and patient care technicians, along with two administrative nurse managers, will replace the registered nurses (RNs).

“[The changes] will bring improvements in patient flow, customer relations and more efficient staffing,” said Steve Osborne, a Montefiore spokesperson.

The restructuring will also bring cost savings, as RNs tend to earn more than the other nursing personnel. But health care providers at the Center insist that RNs can perform additional tasks — from assessing drug interactions to diagnosing emergency situations — that lower skilled workers can’t.

“Having an RN over the past few years has actually saved patients’ lives,” said Dr. Peter Barland, director of the facility’s arthritis clinic. “We are very dependent on them.”

After they are transferred, the Center will have no RNs. Before the proposal was announced, union representatives from the New York State Nurse’s Association (NYSNA) were planning to ask administrators for additional RNs for the clinic during contract negotiations.

“The RN staff has slowly been decimated,” said Judy Sheridan-Gonzalez, a Montefiore nurse and NYSNA leader. “Because they’ve cut so many others, [these RNs] keep the ship rolling.”

The busy clinic sees thousands of patients weekly, many of whom are low-income and have a range of health issues. Services at the facility, located next to North Central Bronx Hospital, include pediatrics, primary adult care, women’s health and a variety of specialties.

RNs provide care that can’t be duplicated by LPNs or other staff, critics of the plan say. They assess patients, help speed emergencies through the Center, and can check for medication issues. LPNs can provide basic bedside care, monitor vital signs and administer injections, but cannot perform in-depth assessments. RNs typically go to school for at least three years, while training for LPNs lasts about a year.

“LPNs can only carry out orders, they can’t intervene,” said Sheridan-Gonzalez, who was formerly an LPN.

Bronia Lewin, a Montefiore RN for almost 20 years and an NYSNA leader, agreed. “We are the people who are the front line,” she said.

RNs also check that patients understand their diagnosis and treatment, which doctors often don’t have the time to do given high client loads, Barland said. “It’s difficult for physicians to take the time to show patients how to take their medication, or look for side effects,” he said. “All these things should be done with the help of an RN.”

Research has shown the advantage of an RN interacting with clients, including financial benefits for the medical facility. A 2001 study actually conducted in the Family Care Center concluded that RNs were effective in recruiting and keeping new patients. In the report, published in the American Journal of Nursing, nurses who talked to patients were able to convince them to bring in their family members for care, and 82 percent kept their appointments.

“I think [Montefiore] needs to look closer at the entire picture,” said Dolores Richards, a Center nurse. “The type of care people are accustomed to is being changed.”

Montefiore insists that the switch will not hurt service. “The majority of our ambulatory care sites are already staffed with licensed practical nurses and patient care technicians practicing under the supervision of an administrative nurse manager and/or physician,” Osborne said. “Our constant goal is to succeed in providing high quality care to all the patients we serve.”

Still, Barland, who has worked at Montefiore for 35 years, is upset. “It disturbs me a great deal,” Barland said. “I’ve never had to run a clinic without an RN.”

Roughly 30 doctors sent letters to Montefiore opposing the move. Sheridan-Gonzalez and other NYSNA members have protested the change, and Assemblyman Jeffrey Dinowitz and Community Board 7 wrote letters opposing the plan. “People should have the best possible care by highly trained people,” Dinowitz said.

Staff will continue their efforts against the policy, but Montefiore is standing firm. “I know Montefiore is trying to run with the vision and mission it has,” Richards said. “But this is a quick fix that … will affect so many people in the community.”

Ed. note: Mosholu Preservation Corporation, the organization that publishes the Norwood News, is a not-for-profit affiliate of Montefiore Medical Center.
 

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