For two decades they've been fixtures at the bedsides of new mothers and babies at Kaweah Delta Medical Center
Licensed vocational nurses — or LVNs — staffed the hospital's second-floor post-partum unit, providing hands-on care. The employees taught new moms about nursing and other skills, including how to properly fit a diaper using the "burrito-wrap" technique.
That teaching now must come from someone else. The unit's eight LVNs have been gone since late October, when they learned in a 10-minute Friday afternoon meeting that they'd been laid off.
"At the time I thought, 'This is not happening,' " said Lisa Manley, who had worked for Kaweah Delta for 13 years.
"I was speechless," said Linda Connolly, an 11-year veteran.
"All these years of service, and this is what we mean to this department?" said Josephine Melo, who had been with the post-partum unit since its beginning in 1995. She worked at the hospital for 19 years.
Like many in the current recession, members of the group have spent the last month and a half searching for new jobs. But they're also looking for answers they said they never got from Kaweah Delta.
"We did a lot for these mommies, babies and daddies," Melo said. "Just to let that experience go ... ."
Rise in acute care
Budget cutbacks, for once, were not to blame, a Kaweah Delta nursing manager said this week. In June the hospital laid off 51 employees, including clerical, maintenance and personnel workers, as part of a bid to save more than $7 million, the expected reduction in state MediCal payments.
This time around, the layoffs were because of a recent increase in the number of post-partum patients requiring acute or advanced medical care, said Jon Knudsen, who oversees the nurses in the unit.
Those patients — mothers suffering from diabetes or heart and blood-pressure problems — require attention from registered nurses, Knudsen said. RNs have several additional years of training and can administer all medications and plan patient care from admission to discharge, duties LVNs aren't permitted to handle, he said.
"It was a very difficult decision to make," Knudsen said. "But it was the right decision for the mere fact that we've got more patients that need what RNs can do."
A statewide trend
Knudsen said he made the decision after calling five local hospitals. Among them, they employed a total of five LVNs in their post-partum units, he said.
That small number is indicative of a statewide trend. Hospitals — obstetric units in particular — are laying off, or never hiring, LVNs, said Joyce Wright, an LVN since 1968 and board member for the Licensed Vocational Nurses Association of California.
It's a problem that could exacerbate the current nursing shortage, Wright said.
"That's why LVNs came into being, to bridge that gap between nurses assistants and registered nurses," she said.
Gain vs. loss
Wright questioned Kaweah Delta's claim of a rise in acute-care patients, saying it's a common excuse given by other hospitals in staffing shake-ups.
The fired nurses said they'd noticed no such increase. They were always careful to defer to registered nurses on any high-risk cases, they said.
"We knew what we could do and what we couldn't do," said Melo, the 19-year veteran.
Wright and the nurses also questioned the financial logic behind getting rid of lower-paid nurses during hard economic times. The average total compensation among five of the post-partum Kaweah Delta LVNs in 2007 was about $47,000, hospital records show. Among five obstetric RNs it was $83,185.
But Knudsen said the hospital has actually saved money by hiring only one additional registered nurse in the aftermath of the layoffs. That wasn't a factor in the firings, he said, but it has enabled the hospital to "maximize productivity" from the six to eight RNs who now staff the unit at all times. Previously, the unit had been run by approximately six RNs and one or two LVNs.
That staffing level is unlikely to change in the near future, and neither it nor the loss of the LVNs will affect care in the post-partum unit, he said.
"We lost some friends. We lost some experience," he said. "But there wasn't a particular skill or model of care that was lost by not having the LVNs."
Meanwhile, of the eight fired nurses, four took severance pay — one has found a job — and four remain on 90-day leave, searching for open positions within the health district.
Salina Ramirez, at 30 the youngest of the group, with seven years at Kaweah Delta, said she's hesitant to return to a company that she feels pushed her out.
But the job itself, she loved.
"I'd do it again in a heartbeat," she said. source
LVN vs RN What is the difference? |
