May 2020 CBHH/CARE Meet and Confer

CBHH/ CARE Labor/Management Meeting

May 28, 2020 130PM



Attendance: Teresa Fette, Judy Haight, Ryan Cates, Steve Wilking, Adam Castle, Alex Flores, Jim Pierce, Heather Tucky, Chen Lev, Christina Anderly, Bill Cot, Paul Mikkelson


CBHH/CARE Agenda Items

Paul-Integrated conflict system-11 trained in facilitation around conflict and team building to be more affective. Helping staff navigate conflicts. Conversations are confidential and not used for performance. Policy is 115-1080. Used all over the state of MN. Cates-Have not heard of it. Teresa-we have the core team and paperwork we can show. It started as a trial. Judy-group from different disciplines to try to work out a way to mediate for staff. Team building training. Teresa-going to move forward with this but then covid hit. Integrate at skills fair also but we have been sending updates. We also have a suggestion box. Paul-We have been in forensics too. Cates-haven’t heard about it. I get the concept. Labor and line staff haven’t heard about it in forensics. Paul-we worked with leadership there. Some of AFSCME were participating. It’s confidential so we don’t advertise. We are coming to help. Cates-Was it you guys that came in for interdisciplinary mediating? Paul-yes. Staying away from performance issues and trying to help manage the conflict outside of that. CARE-we were asked to find staff to participate. I sent the names in last week. We are looking forward to it. Paul-covid put a damper on this but we are finding ways to use video. People are more open when doing this in video which is surprise. Any way we can support staff.

  1. Unit Minimums/3 Staff to 16 Clients- Alex-What are the minimums? There isn’t black and white, it is based on acuity. Jim-census and acuity. If capacity is 6 but all 6 require 1.1. That will dictate staff on a shift. We could have 16 and low acuity and that would drive numbers also. Alex-how big is facility. Heather-can hold 16 patients. Alex-how often is that maxed out in a month. Jim-average is 12 or 13. Current is 14 due to staffing levels. If we had positions filled and present, we could run at 16 and do that as much as possible. Judy-how many open right now? Positions? We have 5 positions open, 3 close at midnight so we will have 2.

  2. Safety Meeting Items-

  3. New Covid Policies and Procedures- Alex-what new procedures? Jim-screen all staff when they come to work. Ask them to self-screen also. Call into supervisor. Universal masking. Getting ready to change to require procedure mask as well. Steve-staffing and acuity. Do you have documentation you can share with us as far as licensing status? Send that to me or Alex? Jim-yes, basic is at least 1 RN at all times. Staffing can change on the unit. Steve-any documentation for acuity parameters? 5 to 1 or a ratio formula? Jim-I’m not aware DCT or MSOCS has a specific model they are using to drive staffing. Cates-you will require procedural masks. Do you have any? Jim-yes, we have plenty and we will start swapping today. Cates-how often can they switch? Jim-once a week we trade out unless soiled we can trade out. Cates-do you have enough to do that? Jim-yes. Everyone will get mask and brown paper bag to keep on site. Also given directions. Staff coming and going will use cloth prior to and end of shift. Cates-do you provide cloth? Jim-yes.

  4. Inversing on Overnights-Alex-I was told staffing should use law enforcement for emergencies at night. What are minimum on overnight? CARE-based on acuity. I have told staff that. If we need le for a patient for staff safety. We don’t have a staff requirement for nights. Some may come in at 3 to cover also. On March 29 they had and inverse to 3am and that was enough. The staff had to leave but I came in to cover. We can’t force anyone to come in early but you can to stay. I came in to cover. We had 14 and 1 FO. Alex-opening that wasn’t filled at all and ran short. CARE-not that I am aware of. Alex-

  5. Overnight Staffing and Duties-

  6. Overtime Issues-CARE-we look at schedule and do call outs so they can pick up. Any changes, we notify them and we cover as soon as possible. They look out in advance a couple of days. Cates-last time we talked about call outs and extra shifts to part time staff and overtime call out separated? CARE-call out part time first before full timers. Cates-calling as soon as knows? Care-as soon as we know the need is there, we start looking right away. If there is a sick call in, they call out when they know. Judy-so when a schedule is posted and a shift has openings. You aren’t posting so people can pick up at straight time. CARE-not posting it, no.

  7. Medical Accommodations-Alex-how do you accommodate? Denise-same for all DCT. Every situation is different. If it’s something we can accommodate in work area. We try to work with supervisor to determine if we can accommodate based on facility and duties. Same as MSOP and forensics. Alex-an employee had restrictions that can only work during the day. What would you do in inverse situation? Denise-I don’t know specifics. I have had situations where employee can only work certain time periods. That’s an ADA route for that. Specifics are helpful. Send to me or Tracy and we can look into that. Different routes we can take based on permanent or temp. Alex-if someone can’t have contact, are they positions available? Jim-comes down to what their job and duties are. If they are an HST or LPN and spend most of day on unit with patients, we work with HR and look at each situation and look to accommodate. I would like employee being busy if we can instead of them being home. Sometimes we can and sometimes we can’t. We work with HR and workers comp to see what’s allowable.

  8. Process the Light Duty Employees-

  9. PPE Availability-Jim-if we are to get someone suspected, we have all of the required PPE that allows us to be in compliance. Face masks, shields, goggles, gowns and gloves, and booties. We have all PPE to be in contact. Cates-what kind of gloves? Judy-nitrile. Will we get n95s? Jim-we do right now but no one is fit tested. This will occur but will occur on just in time basis. We will have admin dispatched to get the folks tested who need to be. Judy-American Health Association is suggesting N95 for CPR. Jim-I can’t speak to them but if that is something out there, we need to elevate to infection prevention to make sure. Cates-chest compressions call aerosol spray and can infect other people. They should be fit tested or someone is present that does compressions. Jim-we will be getting ambu bags with the filters. We will elevate the n95s issue. I will take care of that today in my next meeting today to pose the question. Steve-Denise, chest compressions and n95 DCT driven for compressions? Denise-it may be but not HR issue, IC issue, we will go back and check with them and we will follow up. Talked about papper as well but I don’t know all of the details. Steve-thank you. Can you follow up with me or Ryan? If we have someone today that is suspected and need CPR, what is our stance? I recommend urgency to get to the bottom of this. What are we supposed to do? Thank you.

  10. Practices for Communicable Disease on Unit/Duties-Alex-if patient has covid or other disease. What procedures do you use as far as staffing and quarantine? Chen-we follow IC guidance. We isolate and assign one RN for each shift to manage the care and treatment. We have PPE cart available for those cases. Steve-PPE availability and appropriate PPE. If we have confirmed case now. How fast can you get them tested and outfitted? Jim-immediately, we have a team ready to go on 24 hours a day. They will get a call and travel. They have their own package. Trained person for testing on the road at the same time to take care of that. Alex-patient that needs to be quarantined. If patient refused to stay in their room and is out in commons. Any steps you take to protect the unit? Care-patients have access to masks also. They have them on all of the time. We had a 1.1 with patient not following and go through that and address it. Cates-patient who is presumptive positive and refuse to stay isolated or use mask, what is the plan? Care-our plan is that all patients wear masks. We don’t have locked rooms or an isolation room here in Rochester. CARE-if we have covid positive, they would be assigned county course manager out of MDH. Directions would come from the case worker. Jim-when MDH assigns a case worker to manage it, which opens up the stockpile they have as well for our use.

  11. HUC Position-Alex-staff is interested but with covid, it was sidetracked. Any updates? Jim-there is no formal position for this. It doesn’t exist on my staffing model. We talked about its months ago and had a lot staff interested. One is being done as collateral duty. We need to follow policy for how long we can do that. We took a break and we will continue to look at that and see if we can make it permanent. We have identified a need for it and want it to be permanent but it hasn’t been approved yet. Alex-duties are being assigned by someone? CARE-there are two of them. The two that were doing it before we stopped, are doing those now. Steve-That needed to discussed and extended with the union. That was slated to end in March. If there is further conversation, we are willing to talk about it through labor and HR. but over that timeframe of 6 months, we would like you to give us a plan so we aren’t extending every 6 months. Jim-no one is disagreeing with you. All CBHH runs of staffing model. Local admin has some input but ultimately what leadership wants to see is that we have consensus that most sites would want to see. I have to convince my peers it’s a good idea and then go back to execs. We can both run as collateral duty and work with you or we can just do away with collateral duty and go back the way it was. Steve-we don’t want to do that today. If you want to entertain additional conversations, we can work with you to get it at a later date. Jim-no problem.



AFSCME Agenda Items

  1. CDPAs Full Time Status-Alex-are people working full time hours but still part time? Cates-we want to meet on this and give the CDPAs full time if they want it. Christina-it is our desire for full time. Each site is allotted a certain number. Staffing has to be agreed upon and then execs. I talked to them about it and it is supported if the schedule supports it. With our full timers mostly on overnights, we can make this happen without leaving holes. We have been looking at different ways but our schedule doesn’t support it until we can get spots filled. Cates-you need spots filled before you can offer full time? Christina-we do need to do that. We have 3 open overnights positions. We can’t take them away. We have been working on it. We are having a tough time filling overnights. We would like to see it. Several are interested. We have the overnights and one RN position open.

  2. High Turn over Issues/Concerns-Christina-haven’t had any turnover since Jan/Feb. late fall, early summer we did. Brought in new nursing supervisor and haven’t had any since. Alex-what did you do to address it? Christina-The concerns were, it had to do with scheduling. It’s more consistent. Staff complained about weekends not being consistent wither. That was the first thing. We have regular communication also. I’m on the unit regularly and help out when busy as well as nursing supervisor. One is teleworking at this time and is helping with communication. We have found over the years that there has been a lot o made up rules. We are trying to get rid of those so we can know what is going on.

  3. Job Expectations for GMWs and CDPAs-Alex-They have been doing Med passing? Christina-It was never an intention to be the primary med passer. Using to cover group, CDPAs have groups scheduled 30 mins per day. I have told them if it gets busy, we can skip those. They are doing rounds and have increased cleaning with covid. Bill-With group coverage, they have been doing more in the past, its not group heavy. I have heard they want more to do. We an only offer so many non-billable groups. Breaks down to individual. Some want more, some want less. I don’t think the group time is too have and 30 mins a day. Med distribution was a concern when it was implemented but that hasn’t been a big part of their duties. It is almost a safety net if we need people to perform that duty if LPN isn’t available but that isn’t common. Alex-how may CDPAs on a shift? 1 nurse, how many LPNs? Christina-minimum requires two to be on shift. We ant 3 or 4. Difficult on weekends. If we give every other weekend off, it’s difficult. Covid has allowed us 8 more furloughed staff so there is a lot of staffing. I brought this up to execs earlier. We are working on budgets. We would like to add more CDPAs full time. They said that seeing how this has been going, they are getting closer to hiring more but won’t be till next year.

  4. Advanced OT Issues-Alex-you mentioned not being consistent? Christina-we had an interim supervisor for a couple months. Since then we have improved our process. But I think it’s gotten better.

  5. Training/New Hires-Alex-inconsistent training of new hires only spending 3 days training. Christina-I would like specifics. Our training is usually 2 to 3 weeks on the floor. One staff needed a lot of extra time to do CBTs so we did extend.

  6. 2 Staff on patient needs-Alex-older issue but seems you have improved on this.


  7. 2:1 Doctor Order Relief-Alex-The resulting in 1:1 situation by relieving 2 staff. Christina-I don’t remember that but that isn’t normal practice. Our policy doesn’t allow a 2 to 1. They would be transferred. We can’t hold more than 24 hours in that case.

  8. Supervisor Communication/Presence-Christina-we are trying to improve communication. I was sending daily emails and inviting staff to communicate with me. Nursing supervisor is very good at being on the unit as well. We have made large strides since last meeting.


Add Ons


Adjourned at 245pm