Health Department, nurses debate home-care quotas

Mandate will hurt quality, union says

June 25, 1999|By TaNoah Morgan | TaNoah Morgan,SUN STAFF

Public health nurses and the Anne Arundel County Health Department are squabbling over quotas the department wants to institute to measure the nurses' job performance.

The Health Department says the 11 nurses who administer the state's Healthy Start home-visit program in Anne Arundel should see at least 80 patients per month, a number most already meet or exceed.

But the five nurses who are state employees -- the others are contract workers -- argue that their average is not that high and that meeting quotas will force them to cut corners with patients, who are pregnant mothers and newborns.

"They want the nurses to become assembly-line workers," Carolyn Cornett, president of the nurses union, said yesterday at a news conference in the State House. "The push is no longer quality care, it's `How many patients can you see today?' "

The debate stems from a grievance the union filed last year against the Health Department after it insisted on quotas as part of state-mandated "measurable performance standards," said Douglas L. Hart, a department personnel manager.

The standards have never been enforced because of the grievance.

The Maryland Federation of Nurses and Health Professionals called the news conference in advance of a hearing before an administrative law judge July 27.

Cornett said that if Anne Arundel is successful in forcing the quota, the rest of the state would follow, affecting 40 to 60 Healthy Start nurses statewide.

The groups have met at least four times since August to settle the dispute. The only result has been a drop in the standard goal of 100 visits a month to 80, which the union deems unacceptable. The nurses' average is about 60 visits per month, Cornett said.

Visits that count toward the quota include face-to-face meetings with mother or baby in the home or at another location, or trips to physicians' offices to get referrals for the program.

Health Department officials say they came up with their number after surveying private-home health care agencies about the number of visits their nurses made. The union argues that those numbers are misleading because the private nurses are visiting homebound sick patients; pregnant and new mothers are mobile and often miss appointments so it takes more time to find and treat them.

"It's not only the visit in the home that means so much, it's coming back, digging up the service that's necessary to meet those needs," said Susan Rath, a Healthy Start nurse and executive vice president of the union. But calling, coordinating and unsuccessful attempts to meet mothers do not contribute to the quota.

Healthy Start, begun in 1989, is a statewide effort to decrease infant mortality and low birth-weight rates. In Anne Arundel last year, the nurses made 6,000 home visits to 900 pregnant women and 1,600 babies.

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