Staying on Site

Reprinted from PN May 2012

Annual visits to VA SCI centers ensure the best patient care possible.

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In past years during my association with PVA, I had the honor to serve on the Field Advisory Committee (FAC) in the capacity of member and later as chairman. The time I spent on this committee was rewarding and stimulating.

One of the chief functions of the FAC is to perform annual visits to the 24 VA SCI centers with our Medical Services staff from the national office. I viewed my role as if I were looking at the SCI center from the consumer’s point of view. In other words, if I would have to actually pay for the care at a particular facility, would I be willing to take out my wallet? It is sad to comment that occasionally that wallet would not have left my back pocket!

It has been a long time since I had the chance to attend one of these site visits, but I had the opportunity in February. The first task was to visit with local chapter members to collect their impressions and experiences with the SCI center. By conducting these interviews, the Site Visit Team has an overview of the direction needed when interviewing VA staff. 

This particular SCI center is usually awarded a favorable standing. Unfortunately, this year’s visit was not so positive.  

Every SCI center is to be organized under its own service line. The Spinal Cord Injury and Disorders System of Care Procedures Handbook VHA 1176.01 specifies that “SCI Centers are approved by the Under Secretary for Health and organized as an independent service line reporting to the Chief of Staff, Chief Medical Officer, or equivalent, at the medical center.” It further states, “All key staff such as nurse manager, clinical nurse specialist, psychologist, social worker, and therapist must be assigned and dedicated to the SCI Service by their respective supervisors in consultation and with the approval of the Chief, SCI Service. All SCI staff are responsible to the Chief, SCI Service. Rotations and assignments recommended by supervisors outside of the SCI Service line must have the concurrence of the Chief, SCI Service.” 

Through our staff interviews, we learned the acting director of this hospital (she was scheduled to leave her position a month after our visit) had plans to dismantle the SCI Service Line as an independent line and have all staff report to their respective supervisors rather than the SCI chief. This is in direct conflict with the handbook. This was such a major issue that the Site Visit Team leader asked for a special meeting with this director. We informed her of our objections to this plan. Needless to say, we had a spirited exchange of thoughts and ideas. 

Under the acting director’s plan, our immediate question was to ask how the SCI chief would manage the SCI center when he would not be in control of the people who work under him. He has, literally, lost all control of his employees. More importantly, why would an individual who is in an acting director position make such drastic changes with such far-reaching consequences when she would be leaving her post shortly?

I must admit to having very strong opinions on such actions. Work on an SCI unit is difficult, and it’s extremely challenging to recruit nurses. The nurses currently working on SCI love what they do and come to personally know and care deeply for their patients. Because of this recruitment issue, most SCI centers now offer retention bonuses to this valuable nursing staff. It is my belief the primary reason for this dismantling of the SCI Service Line is that the facility will no longer have to pay this bonus. Undoubtedly, this director is looking at the cost of care rather than the quality of care.

It is hard to believe how little time it takes for an SCI center that is functioning well and providing good care to our members to change overnight. Only by conducting site visits to all 24 centers on a yearly basis can we monitor the situation and prevent such devastating actions as we found at this facility. 

As always, please make time to visit with our hospitalized veterans. 


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