Gov. Juan F. Luis Hospital on Tuesday terminated the positions of 85 employees made up of licensed practical nurses and certified nursing assistants as it reorganizes work categories and moves towards a "R.N.-dominant model" for patient care; registered nurses will take over the bulk of patient care duties.
Juan F. Luis CEO Jeff Nelson said the decision has been coming since last July, when in testimony to the V.I. Senate he said the hospital needed an infusion of capital or it would have to change the way it does business. Since then, the JFL budget has taken two cuts in revenues allocated from the territory’s general fund. In fact, the hospital board declared a financial emergency a year ago.
"We’ve been saying since last February, if the financial situation doesn’t change we’re going to have to make some changes," Nelson said Tuesday while speaking at a press conference announcing the changes.
Nelson said it was a difficult decision, but an inevitable one given the hospital’s financial condition. Instead of shutting down operations, the hospital is trying to grow itself out of its financial hole, Nelson said. Moving to a system in which R.N.s are responsible for more of the patient care is part of an attempt to become a "magnet hospital," which typically attracts and retains more patients. According to the administrator, more than $56 million goes off island each year as residents of the USVI seek medical care on the mainland. Moving to an RN-dominant model will help the hospital provide more of those services on St. Croix.
In the long run, improving the level of care provided at the hospital will create more jobs for the hospital, Nelson said. Registered nurses provide the highest level of patient care and critical thinking and perform the full range of care services, whereas LPNs and CNAs are restricted by law to provide fewer services.
Nelson also added that the hospital "respects and honors" the dismissed employees, and is creating a fund to help the dismissed LPNs and CNAs go back to school to become registered nurses. Prior to the move, the hospital employed 650 full-time-equivalent people. Of those, 90 were registered nurses and 85 were the LPNs and CNAs terminated Tuesday.
The hospital board has already approved an increase in the pay for registered nurses in the hopes of reducing the number of "traveling nurses" and drawing and retaining a staff of local nurses. Nelson said the goal is to cut the number of traveling nurses in half by the end of September and by 90 percent by the end of the year. He added he believes they will meet those goals far earlier.
"The opportunity has been placed before the RNs to do the things RNs typically do in stateside hospitals," Nelson said. "We want them to spend more time with patients and less time doing things that take them away from patients."
While the hospital staff adapts to the new work schedules and requirements, the number of patient beds will be reduced by about 9 percent, from "65 or 66" to about 59 or 60.
Nelson acknowledged that the Senate had passed over Gov. John deJongh’s veto – a measure forgiving a $50 million debt owed by the hospital to the government of the Virgin Islands – which "cleaned up the balance sheet," but did little in providing additional money: the hospital still owes vendors $28 million. Even with a recent fee increase, Nelson added, if the situation doesn’t improve the hospital could still be in the red at the end of the fiscal year.
Sen. Alicia "Chucky" Hansen attended the press conference and pressed Nelson on why other options had not been tried, stressing that many of the dismissed nurses have given their entire professional lives to the hospital. Nelson agreed that it was a sad turn of events, but also said if the financial slide were not reversed the hospital couldn’t survive. Even terminating the entire executive team would not provide the budgetary boost needed, he said. Instead, the goal is to shift the focus to the R.N. dominant model in the hope that improving the product will increase patient numbers. And without those improvements it might not be possible to continue receiving Medicaid payments, which would doom the hospital.
Nelson likened the situation to the recent problems with the hemodialysis unit, which came under fire from the Medicare/Medicaid providers. Instead of fighting the ruling, the hospital drew fire from its patients by reducing the numbers it could treat while it revamped the system. Now patients are delighted with the service provided, he said, and the unit recently received the highest quality rating available.
The terminated CNAs and LPNs will receive:
• A severance package, consistent with collective bargaining agreement, providing 10 days of severance pay for the CNAs and four weeks for the LPNs.
• Individual consultation of the team member’s personnel file, review of annual leave payout and transitional support including letters of recommendations based on performance and years of services.
• Assistance with the unemployment and job seeking/career counseling processes through the Department of Labor.
• Consultation of the Government Employee Retirement System (GERS) benefits for qualified team members.
• Support and counseling services through the Employee Health and Clinical Psychology services.
• Eligibility for scholarship grants to become an RN through UVI and/or other accredited colleges and universities. JFL will fund up to $500,000 in grants in order to assist JFL’s CNA and LPN to become future RNs. Nelson said the $500,000 fund is not a firm number and could increase depending on the demand. Applications for these grants will be available beginning March 1.
