6/19/14 MSH Meeting Minutes

Carol Olsen, Tom Christensen, Scott Melby, Michelle Chalin, Rochelle Fischer, Meghan Goodrich, Jennifer Frew, Frank Schwartz, John Knobbe, Shannon Pech, Molly Kennedy, Tim Headlee, Chuck Hottinger, Scott Grefe, Amanda Mathiowetz, Mike Homer, Ryan Cates, Eric Hesse

1. Overtime / Injury Statistics
• No questions or comments on overtime
• There were 4 injuries in a row stemming from 1 client. That client has since been moved.
2. Working title of a Security Counselor
• NASHBID mentioned changing the title Security Counselor. The perception is not as engaging for patients as a term like “caregiver” would be.
• John Knobbe brought up that this has come up before with NASHBID in 2009 that generated a list of possibilities. The local has been opposed because it is a job title. Management stated that they are not suggesting changing that. At some point there will be a longer conversation about this.
3. Unit 900 relaxation trial
• Unit 900 patients are participating in relaxation exercises for approximately 10-15 minutes prior to dinner. The highest rate of assaults/incidents occurs between 5 and 6 PM so this is a trial to see if this will help calm things down.
• At some point Security Counselors and Security Counselor Leads will be leading relaxation exercise. It will later be expected that all staff participate if this is found effective through tracking.
4. Nursing schedule
• Pharmacy has expressed a need for a nursing shift to go until 5 PM. This would ensure that there is enough time to get all of the meds to the Nursing Home in time. Shifts are currently 7-3 PM and 8-4 PM. A schedule change requires a 28 day notice so once a schedule is made, the notice will be given.
• AFSCME has been hearing that nurses are transporting meds with their own vehicles and not receiving mileage. Are they able to use a state vehicle? Human Resources will look into this.
1. MSH Admissions/Crisis 800 Unit
• WBR is looking at the design/plan right now then it will need to be approved by the state and city. Management does not know the timeframe. Carol Olsen has asked for one but has not yet received a response. As soon as she gets more information it will be communicated.
2. MSH 900 short staff (Immediate risk/ 1:1’s)
• Running short has resulted in not adequately covering 1:1’s. Staff have not noticed a significant change in how 1:1’s are conducted. Is there any progress on this? Management stated that there will be a meeting June 20th.
• There is a committee that looks at how 1:1’s are implemented, initiated, and discontinued. There has been a lot of excellent discussion and staff involvement. Those on the committee are encouraged to share the information that has been discussed. AFSCME asked that those on the committee be published on the SharePoint site.
• Changing the 1:1 practice was brought up by AFSCME in February. Management stated that this is taking a while because they want to make sure that something is put in place that will stay and what best practice is.
3. Questions and concerns about Unit Mentors
• There has been a lot of confusion and clarification is needed. Unit 800 is the pilot for this program. This is meeting #7 in the Terms & Conditions by Licensing. Instead of Unit Mentor, we will be using the term “Coach.” A Coach will be present on all three shifts eventually. A Coach is not limited to SC/SCL’s. They can be part of MAAP and includes nursing. This was required within 30 days (by June 19th) per the Terms & Conditions on 2nd and 3rd Watch. A Coach will be required on 1st watch in an additional 30 days.
• Coach training consists of an initial 2 days followed up with 1 day a week for 3 consecutive weeks. Those chosen to go through this training have been based on schedule availability. This is a massive training undertaking. In order for this to work on all units a minimum of 150 staff need to complete training. 42 people are currently in training. June 18th was the 3rd day for the 1st group. The next group starts the week of June 23rd. 100% of staff has to complete the 2 day training.
• Estimate that having Coaching Circles (every 60 days minimum) will help continue practicing and talking about various things that have gone well and bad. This is about using an opportunity to practice techniques with patients and also offer ideas during the debriefing process. The only difference with a Coach is that he/she may bring a little extra when it comes to patient engagement. Coaches are there to offer support/ideas and not intended to be a, “new sheriff in town.”
• A Mental Health Practitioner requires a degree or 6000 hours working with mentally challenged patients (about 5 years). Management will be looking further into this.
• Would it be more beneficial to train Utility Pool as Coaches first? Management will look into this.
• AFSCME asked for a column to be added to the shift report that would allow staff to report on techniques used throughout the day. For example, “Tried this with patient Smith and it was successful.” It would be helpful for staff to look back on. Management had no problem with this and will be looking to the Coaches for ideas on how to make this work. There is a need for more areas to document on the shift report. Management ask that staff please keep in mind that they are working with change on a tight time frame that is not allowing them to communicate this very well. If you have any questions please ask your supervisor.
4. Licensing Terms and Conditions Update
• Term & Condition #9: Some of the practices being implemented are punitive. Management stated that since there are 14 Terms to meet, they are concentrating on those with the shortest timeframe first. Encourage staff to talk with their supervisors. Management stated that they are being as transparent as can be; have shared everything they know. Term 9 has a timeframe of 115 days while there are a lot of with 30 day timeframe.
• Management does need further clarification on Term 9 and have composed a letter asking for this clarification. Staff understood this Term to bring back Protective Isolation. This is not how management understood it. A message will be put on the SharePoint stating that clarification is needed with the letter attached that will be sent to Licensing. Carol Olsen stated that she reads Term 9 with a whole different intent than people may think. Is there a different license? When will immediate risk stop at room destruction?
• Section C: This is responding specifically towards admissions or transfers only. For example, if Unit 800 gets an admin 8 AM Monday morning within 8 hours the IPP must be created, needs to be signed within 24 hours, then everyone working will get the document and sign off on it at shift change. This is narrowly defined to admissions or transfers only. Unit staff should know all of their patients.
• Term 2: Requirement that every staff has a clinical supervision meeting every week. This is putting a very robust system into place. Was put into place on Unit 800 the week of June 2nd.
• A Mental Health Practitioner that participated in the meeting should go through the minutes from that meeting. A folder or binder with IPP’s and transfer IPP’s will have to be reviewed within 2 hours. Admissions stay in the binder for 30 days, transfers for 7 days, then they are placed into Avatar. If you are covering the unit, those are the items that should be reviewed. Looking at possibly having a checklist of 5 things on the unit that need to be done to assist coverage staff.
• There is a form that everyone signs in on. The Mental Health Practitioners name will be on the top so staff know who they are. How will a list of practitioners be maintained? Management has not gotten to that yet.
• Can staff have one spot to find all of the updated information on the terms and conditions? A table is being worked on with responses to the terms and conditions. This table will be on the SharePoint site.
• What if some terms and conditions seem deficient? Can this be used as a reprimand? Management stated that this is engaging our quality assurance people. Meeting these terms will be problem solving. We are trying to give good treatment and this is about making things better. Everyone is being looked at, not just Security Counselors.
• Management has asked for data when a patient is restrained and how soon it happens to that same patient again. Could nurses possibly put their reports on the unit instead of the nurse’s station to improve communication when responding to incidents?
5. OSI Town hall Meeting
• There are certain restrictions when it comes to pressing charges against patients and this is discouraging. MI&D is not included in 4th degree assault per legislative language. Per management this isn’t the “magic pill” people may think it is. One example: There was a serious assault in MSOP, the client was successfully charged, and pled guilty. That client was charged a fine of $500 and never left the MSOP facility. This seems to happen a lot. Nothing is charged differently from a normal citizen.
6. CRP/100 YAAP reassignments update. Overtime/scheduling/VAC
• Reassignment: 1 bid, 2 least seniors permanently reassigned, 2 temporarily reassigned. The rest of the openings have been filled with voluntary permanent reassignments. There are also 2 WOC Lead’s. The vacant LPN positions have been filled with 2 temporary reassignments, 2 night .8 and 1 FT LPN positions are posted.
• Overtime Scheduling: Need to get CRP and MSH on the same page. There has been staff doing a double in MSH then signing up for the NOCS shift in CRP being at work for a total of 24 hours. CRP has a work rule that they can do a double shift day after day while MSH follows a 3 out of 5 work rule. Management is aware of this and has been trying to figure out a time to get to this.
• If there is a mistake with assigning overtime and the SC makes the OD aware of this, it has happened where the OD tells the SC to grieve it. When this happens please let union leadership know. Scott Melby will be following up with the OD’s on this issue.
7. NOC Schedule anywhere update
• NOCS shift previously had one sheet of paper on the unit with assignments how will this look with working anywhere?
• Trying to organize a schedule that will project which unit staff will be working.
8. NOC Avatar and chart audit responsibilities
• Those who volunteered to do Avatar on the NOCS shift feel that this is a lot of work and are not supported by being left short. Encourage staff to talk to their supervisor.
9. NOC patient rounds
• Every round is now a breathing round. This involves waking patients up continuously and they are complaining about it. This was done in response to licensing so it is not a fix to take them away.
• Would like options from the night staff that will make this easier. I.e. night light in each bedroom? Flashlight with red covering? Curved plexi glass mirror? Please bring any ideas to your supervisor.
10. FNH scheduling and VAC
• AFSCME asked when the staff will be able to use the extra vacation slot with a 6-2 rotation? No answer at this time.
• Management would prefer a 6-2 for better coverage, more vacation, more consistent days off.
• Either AFSCME leadership or management (whichever is available first) will be meeting with staff soon