3/30/16 CBHH/CARE Meeting Minutes

1. Present: Luke Frederick, Matt Stenger, Tim Headlee, Molly Kennedy, Amanda Castle, Johanna Marzinske, Ashley Samora, Nicole Cooper, Pat Marcus, Wade Brost, Kristine Wahlberg, Deb Burger, Melissa Grau, Hanah Marinske, Nick Rose, Tracy Johanson, Mario Marberry

 2. Management Updates o An Administrative position has been posted. The posting will be open 45-60 days to try to draw in more candidates. Wade Brost thought that it might close mid-April but was not sure. o A GMW position is open and the offer has gone out. Management is waiting to see if the bid will be accepted. The earliest available orientation is April 20th. o CARE St. Peter has LPN positions open. Both are full time overnight positions. They have been posted several times without luck. A candidate did apply but did not have a nurse’s license. There is a request in to re-post. There are 2 contract nurses covering these vacancies. Management stated that they are working with the agency to keep them on part time to help with the weekends. AFSCME stated that they do not want to have contract nurses a common practice. Management stated that overnight positions are hard to fill. AFSCME stated that they need to hear that we are fighting for retention tools. Management stated that they are looking at raising the census to maybe 12-13 depending on acuity. Management stated that they would love to have the security of a staff instead of worrying about if a contract nurse will extend. Luke Frederick asked if it is possible to offer that contract nurse a fulltime job. Management stated that they have but the benefits of being a traveling nurse are better. They do have the option of hiring from a contract. o CBHH St. Peter – There are currently 10 patients. There are 3 new HST overnight positions. There is 1 intermittent open. The GMW is open and that is fulltime. o CBHH Rochester – There are 3 positions open that they are working on filling. This consists of 2 LPN’s (one at .8 and the other .75) and a full time HST. Management is finishing reference checks on one of the positions. AFSCME asked if there is any conversation about making these positions full time. We had talked about this at the last meeting 3 months ago. AFSCME stated that the job postings for that area are all full time, many with a sign on bonus. Management stated that they did talk about this with nursing staff. The challenge is that there is Mayo Clinic to compete with where many nurses want to be. Mayo took a break from utilizing LPN’s, which helped, but now they are using them again. This is adding to the shortage. Management stated that they are trying some things for how to get people interested in applying. If there is no success management stated that they will re-evaluate. Last month 2 LPN’s started. They have hired but then had to re-post due to turn over. o AFSCME asked if exit interviews are being done. Management stated that they do not mandate an exit interview but offer one.  Their understanding is that people are leaving due to the schedule and salary. They think it has had a lot to do with vacation availability and predictability of schedule. AFSCME pointed out that predictability would be there if the position is full time. Management stated that that is something they are looking at for retention. Also, the Nursing Supervisor and Administration have talked about how to go about making a more predictable schedule. There was a proposal for a rotating schedule by a staff. There is conversation about it. Management wanted to look at the contract to see if it could be an option. AFSCME asked if union representation was present. Management stated that it was not a formal meeting. AFSCME asked to be present for these discussions in the future. Management stated that making a formal meeting of these discussions will slow down the process. AFSCME stated that scheduling issues expand to other areas that they represent. They have 2 files full of different schedule patterns put together. We might be able to get through this quicker if labor is involved. Wade Brost stated that that makes sense.

3. AFSCME o Governor’s Budget Proposal o Luke Frederick talked to Kristine Wahlberg about this to see what HR knew. Wade Brost stated that he went to different sites and is trying to make his way to all sites. Derek Jones talked to St. Peter. Wade spoke to Willmar. They have spoken to all leadership. AFSCME stated that members are worried about their jobs. We are looking to have CRP being in the CARE building, CARE would move to CBHH which would displace CBHH. Management stated that this is just a proposal. The intention is not to move Anoka, it is to create a different level of care. About 50% of people in the CRP program don’t require hospital care. There is a residential need. There are also 10-12 patients in MSH who need CRP and do not require high security. There are 20-22 in AMRTC who need residential level, not hospital. This is 30-35 people based over the data from the past year. CARE moving to CBHH would allow service inside a locked environment. There is a substantial number on the CARE wait list. Management stated that the ideal situation would be that all staff will work in the CRP program. Not sure how that will work or what it will look like. The initial intent is for CRP to be under Carol Olson’s division. Management stated that they do not believe they would need to re-classify many if any. Management stated that if the proposal passes as is we’d be hiring people in the St. Peter area. We do not want to present staff impact prematurely o This information will be presented at the DCT Labor Management meeting on Friday. Hopefully this will get senate author. A lot of this is still in the proposal stage. We can start to pin point timelines soon because this is a short session. Management is hoping before May. Wade Brost stated that they want to go about this in the most staff centric way and that they want to retain everyone they can. The current proposal is 30 million dollars. This enhances all capacity. This will utilize CARE a little differently. If nothing passes this year we would continue to have 7 locations is management’s guess.

o Will there be a requirement to have a certain amount of LPN’s or RN’s? Management stated that they cannot speak in entirety. They are licensing as residential. It would depend on how we work that with DHS licensing. There is minimal staffing requirements possibly. Not sure yet. We can put the proposal forward and see what comes out of the legislative

o ARPN o At December’s meeting there was an issue with a lack of an ARPN. Prescriptions were not getting filled and AFSCME asked if this has been solved. Management stated that they haven’t heard of any of those issues since mid-January. Also, they have a fulltime Psychiatric PA that works with all sites. Management stated that as far as they are aware patients were not going without medication. Sometimes they will reach out to Dr. Pratt, who is very helpful. This was a transition period and it took a little bit to transfer to a different style. Management stated that they are more confident about how it is going now than 6 months ago.

o Crisis Situation Training o Management stated that they had heard everything went well with the latest crisis situation. It was a lot better than in the past. AFSCME asked where they are at with training and if we moved into a different phase of EASE training. Management stated that they offer EASE 1 and 2 for residential sites, 3 for hospital sites.  Management stated that they are still evaluating this as a system and if there is more benefit than work to that training. They do not want staff to ever not use this system. There is a liability piece because they do not want anyone to lose their job because they had to use natural instinct. There are no open investigations. That is part of staff doing a tremendous job o 4th Degree Penalty Law does not cover CBHH. This law states that if a patient assaults staff they are charged with a felony.

o Full time positions o There are 2 part time LPN’s that would like to be full time. Is this an option at all? The rotating FTE’s for LPN’s are full. Management stated that they will have to look at where the LPN vacancies are. There are full time spots on overnights. If hours became available on days they could look at that. AFSCME stated that it sounds like they are already working full time hours. A lot of staff were working full time until the beginning of February then 5 new staff started. More recent schedules these staff are not scheduled 80 hours. They are working at times with just 2 staff and they are not comfortable with this. If these staff were moved to full time that would change the scheduling process. Management stated that they are trying to hire. As we onboard more staff there shouldn’t be a need. Overtime at CARE is relatively low. Management stated that they are not sure moving them to full time would decrease OT. AFSCME stated that the retaining issue is a gamble. This would be no impact to the financial budget.

o Cross Program Coverage o AFSCME asked if a cross orientation between both programs would help with the overtime. Wade stated that he doesn’t think overtime is at a crisis level. AFSCME stated that from a contract position this is not what we want. AFSCME would like to move positions to full time to entice people.

o Overtime o LPN’s had 168.5 hours for a 3 month period. They are still working with 2 staff. The model was for 3-4 on a shift. Very rarely at this time is that happening. There is an Intermittent out on leave. The biggest hit for OT is on the weekends. Management stated that they try to arrange the schedule to have the minimum on and allow every other weekend off. o Nurses Meeting o There has not been a nurses meeting for about a year. Management stated that there will be on April 19th and the 21st and will run concurrent with all staff.