10/9/14 CBHH/CARE Meeting Minutes

Present: Patrick Rodning, Deb Burger, Lisa Hobday, Lynda Klersy, Pat Marcus, Tim Headlee, Molly Kennedy, Matt Stenger, Chuck Hottinger, Amanda Mathiowetz, those attending via VIDYO Kristine Wahlberg, Tonia Yates, and Stephanie Juhl

1. Introductions

2. Review previous meeting minutes – 6/26/2014

3. Management Updates (Staffing, Special Projects or other relevant items)

• CARE St. Peter – Patrick Rodning or designee - In the process of hiring 1 .8 HST, 1 part time LPN on overnights, and one rotating shift RN. - The night LPN was posted 3 times and has gotten interest this time. There have been 3 interviews. - The .8 HST just got done being posted. 18 people applied and 5 interviews are set up. - An agency LPN is starting on October 5th who prefers nights and midnights. This will help with holidays and giving more than 1 staff off. The agency nurse is for 12 weeks. AFSCME asked if there has ever been a FT nurse posted without using an agency. Management stated that it is a budget issue and that they wish they could. Upper management has not approved additional positions. Lynda stated that she has offered up an intermittent position but it was not approved by upper management.

• CBHH St. Peter – Patrick Rodning or designee - No AFSCME vacancies. - Looking at adding additional cameras to get better views in patient areas. Having the company come back to look at the angles. Management stated that cameras are used to instances with a bad outcome or to acknowledge something that worked really well / acknowledge a job well done. They are not looking for blind spots. AFSCME stated that there should be monitors for staff to view these cameras because without, it is not increasing safety. AFSCME asked if there is a proposal to put them in a uniquely staff only area? Only group led areas, not staff offices. There is one at the nursing desk facing out to the unit. The cameras are recording. - Also in the process of updating the system a little bit.

• CBHH Rochester – Tonia Yates or designee - An HST quit after working for two weeks and a .8 LPN on overnights just resigned. Will be re-posting. There are 2 LPN’s out on FMLA, both .8 and will be covered by 2 agency LPN’s. - Census is at 15. There has been a lot of positives with no major incidents recently.


• Scheduling issue - scheduling shifts understaff - If someone needs to be inversed call Lynda. If she does not answer, call Patrick. Stated that they do not want holes in the schedule.

• Update of staff training - pat search/metal detection/man-down system, personal safety technics - Man down buttons: There are 17 all operating that were just tested. Training? Discussion has started during all staff meetings. Management has been told that they are going to radios. AFSCME asked if ICS will be utilized. Patrick Rodning stated that he would be contacted Tom Christianson for ideas. - AFSCME pointed out that staff are not feeling safe. Will they be beefing up the man down system and how staff respond until radios come? Management stated that they have work to do with getting a procedure in place. This work area is different because it is hospital licensed. During a situation people on the floor respond and others report to the nurses station to backfill. - Management stated that we need to continue discussion at all staff meetings. They have adopted therapeutic intervention practice sessions where scenarios are played out. This will be starting in 6 weeks at an all staff meeting. - Per MNOSHA anything you require staff to do with patients, staff must have received training on. Management will be sharing the Ease training program with AFSCME. Gregg Ellis is the main contact for this training. At another site when two staff did not intervene, licensing saw this as an issue. Stated that even though this is Rule 31, there needs to be some way to intervene. - Wanding procedures have been requested for a long time. Management stated that this will be a bigger part of the process. Want to do this uniformly with the programs. First thing is cameras. - We need to start identifying serious assaulters and get them in a place more suitable. Management stated that it is next to impossible to demit a patient if they are determined a danger. - Can there be a barrier like half of a plexi glass wall? Management stating that there are statistics from Anoka that shows if there is a barrier, staff spend less time on the floor but Patrick said that he would ask about a buffer. There is a concern also that clients may overhear other clients private matters. Top of the hour checks were also mentioned. Staff reported that clients are reaching over the counter. In one case the client grabbed a staff radio. Per Patrick Rodning incident reports need to be done. Try to move things away from the staff desk.

• Debriefings after incident - This needs to be the whole group that was involved with the incident to figure out how we can better the situation or discuss what worked well. Per management confidence among staff is much higher compared to 6 months ago. - Patrick Rodning stated that research says debriefing creates more trauma in some cases. Not sure if it will be adopted or not. - AFSCME asked if EAP has been contacted. Management stated that they have not gotten to that point yet but it is a good suggestion. They are being transparent with any advances being made.

• Taking clients outside after dusk due to the lighting issue - Additional lighting was added to the courtyard. Staff still do not feel comfortable taking clients out after dark because that is when they run. Per management- if a client runs, the procedure is to call the police. This is an open facility. Liability will not fall on staff. Police have asked that you get a visual of what direction the client was heading. Do not chase the client. Staff have asked for a policy regarding watching clients out the window but Douglas Panser does not want to do this. - There have been transports of 5 or 6 clients with 1 staff. This is a concern. Management stated to use discretion when considering the clients going. Upping the staff will not be able to happen. Staff have been taking their personal cell phone. Lynda stated that there is a unit cell phone available. AFSCME recommended that the clients clothing description be written down before leaving on the trip.

• Equal distribution when scheduling staff up to full time - The issues with scheduling is on the weekend. Lynda stated that she wants to keep scheduling .8 every other weekend off to not mess with their lives. Do not want to go to working more weekends. Would like to consider using intermittent staff. In Anoka letters were sent to intermittents that they were expected to work 6 shifts a month, 2 on weekends. Would like to start looking into this. This is where contract nurses help because they do work every weekend. - Will be looking at an acuity tool. Management stated that it has been noticed that when recreational activities are cancelled there is more hostility. - Would like to see fulltime being offered equally, not favoritism. AFSCME stated they would like to see this done by seniority although that is not required.

5. Wrap up and miscellaneous • 2014 Next Meeting Date: December 11, 2014 • Discussion of 2015 meeting dates