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The gates of the Brattleboro Retreat.

Voices / Letters from readers

Retreat management: new realities in nursing require new approaches

The writer is a board-certified psychiatric registered nurse and the chief nursing officer at the Brattleboro Retreat.

RE: “Retreat nurse: staff is at the breaking point” [Letters, Jun. 27]:

In the past few decades, our society has witnessed unprecedented change in almost every area of life. This includes our professional experiences. The work we do and the ways we carry it out bear little resemblance to what most people took for granted at the start of the new millennium.

In the field of health care, sweeping change has taken place at lightning speed and continues to be the new normal.

The Brattleboro Retreat is an excellent example. Since 2008, the Retreat has launched several innovative new programs and doubled our workforce. We have added a 14-bed unit that’s part of the state hospital system, and we now care for patients whose health is far more compromised and whose needs are increasingly diverse and complex.

Ten years ago, most inpatients were admitted by appointment. Now patients arrive 24 hours a day and often come to us directly from hospital emergency rooms and the community. The need for proper staffing and adequate resources has never been more critical.

As a not-for-profit organization, we are called to stay true to our patient-centered mission, and that has required us change as both a hospital and a workplace. I’ll be the first to agree that change can be difficult. But change is also far from impossible. And when you consider that failure to adapt to new realities invites a host of risks that can quickly become untenable, it also becomes necessary.

To meet the demands of today’s health-care environment, we must first create sensible, predictable base schedules that reflect best practices for patient care and safety. Once those are in place, we accommodate worker needs wherever possible. To rely on a scheduling approach that attempts to prioritize the personal preferences and life circumstances of each employee over safe patient care and good management practices creates results that end up looking — and behaving — like a fragile game of Jenga.

The Retreat’s new approach to scheduling of inpatient direct-care nursing staff reflects industry standards and hospital best practices in Vermont and across the country. It’s what employees in 24/7 hospitals everywhere expect as normal and necessary.

While ensuring the right skill mix across every shift, it also empowers staff to arrange schedule changes and adaptations in cooperation with one another. It does not change the job or position the employee was hired into, and in no way does it impact the unit, shift, or hours worked by any employee — just potential days worked.

Our nursing leadership team has personally met with every willing employee to attempt to resolve questions and concerns about their new schedules. We have had much success.

What’s happening now is a paradigm shift. That shift is based on the universally accepted premise that as with any organization you can name, staff schedules must give first priority to those we serve (in our case, patients) and to the overall good of the organization.

When the Retreat offered to fast-track arbitration about the scheduling issue, the union unfortunately declined in favor of informational picketing. I feel confident that with face-to-face dialogue that puts patients at the center of our decision making, our shared goal of providing safe, quality care will carry the day.

Meghan Baston

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Originally published in The Commons issue #466 (Wednesday, July 4, 2018). This story appeared on page D4.

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