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1199 SEIU Professional & Technical Newsletter October 2011
1199 Social Workers Win Recognition for Their Clinical Work IN THIS ISSUE:
· Dietitians Expand their Clinical Role and Support Licensure Bill · 1199 Social Workers Win Recognition for Their Clinical Work · Hospital Ambulance Services Saved from Attack! · Challenges for Professional Staff in Changing World of Long-Term Care · Hospital Pharmacists Expand Scope of Practice in New York State · Legislative Update · Academic Calendar The Monitor is available online. Go to www.1199seiu.org and click on “professional workers.”
Mental Health 1199 meeting Left to Right:Practitioners MaimonidesatRegistered Dietitians Inessa Falina, Anna Nabutovskaya, and Lori Levine
Dietitians Expand their Clinical Role and Support Licensure Bill
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ietitians and Nutritionists are an integral part of the multidisciplinary healthcare team. However, for too many years they were erroneously seen as dietary workers whose main responsibilities were to modify menus and count calories. Today their critical role is finally starting to be recognized. In order to become a Registered Dietitian (RD) one must obtain a Bachelor’s degree plus a one-year internship in a clinical setting consisting of inpatient, outpatient, community and food service rotations prior to taking the certification exam. While a Bachelor’s is the minimum degree requirement for this profession, many RDs also complete their Master’s degree. The American Dietetic Association (ADA) is now asking that RDs create professional portfolios, citing specific goals. The ADA monitors these portfolios and requires that the RDs submit 75 CEUs (continuing
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educational credits) every 5 years. These credits must be pre-approved and target one or more areas of expertise. Examples include Diabetic Educator, Neonatal Nutritionist or Weight Loss Specialist. In a clinical setting dietitians often treat people who are very ill or have multiple conditions. There are certain diseases and criteria that indicate high risk factors for malnutrition. Dietitians assess a patient’s nutritional status and make recommendations on the most effective dietary treatment. This can include nutrition therapy, counseling, and the use of specialized nutrition supplements for long term management to promote optimal nutritional health. Several recently published studies have found that people seen by dietitians tend to have better outcomes, particularly those with diabetes or kidney disease. “We are profes-
“We have to protect our profession for future generations.” Inessa Falina, Maimonides Registered Dietitian
sional food educators. We provide medical nutritional therapy.” states Anna Nabutovskaya, RD and CDE (certified diabetes educator) of Maimonides Medical Center in Brooklyn. Her colleagues, all Registered Dietitians, share that sentiment. “Many people call themselves ‘nutritionist,’ but they don’t have the education or skill levels that we have. We are the experts,” states Lori Levine RD, CDN, Adult/Childhood Weight Specialist. Over the past 20 years, Maimonides Medical Center has undergone a tremendous expansion to include multiple specialty areas and sub-units that require the expertise of clinical dietitians. These include the ICU, the Cancer Center, the Vent Unit, the Stroke Unit, and the Mental Health Unit. Servicing a patient population that is multicultural and multilingual requires additional knowledge about different dietary needs and food preferences. The Dietitians must be able to create, translate and update their educational materials to fit this diverse population. The Dietitians also provide comprehensive education to nutrition interns as well as training to new residents and medical staff. In addition, they participate in interdisciplinary rounds as part of the Nutrition Committee, the Wound Care Committee, and the Diabetic Task Force. “The last few years have shown good positive changes here at MMC for our profession. We are no longer viewed as members of the food service department, but as respected, essential experts in our field,” says Rivka Langer RD, CDN. Today there is much conversation and renewed excitement surrounding a proposed bill that would offer licensure to Registered Dietitians. “We are very excited about supporting this bill,” states Inessa Falina RD. “We have to protect our profession for future generations. We are one of the lowest paid professions in the healthcare industry and licensure is one way we can unite industry-wide to fight for better wages to insure that people will want to pursue this field of work in the future. It is also a way to stand with other licensed professionals and get long overdue recognition as valued members of the healthcare team.” There is an abundance of pride and passion amongst the MMC dietitians. They are passionate about their profession, and embrace the daily challenges. The passage of the proposed licensure bill would give them the respect and recognition they deserve.
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1199 Social Workers Win Recognition for Their Clinical Work
Pictured here: Esther Mendoza, formerly oncology social worker, presently working in the psychiatric E.R. Cover Photo from Left to Right: Montefiore Social Workers Bruni Matos, Erin Lauinger, Emily Dorfman, and Esther Mendoza. 4
“The family is important because that’s the patient’s support.” Bruni Matos, Homecare Social Worker at Montefiore Medical Center (above)
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ver the last few years, 1199 social workers and their allies in the broader social work community have worked successfully to expand the social work experience defined as clinical that allows one to sit for the Licensed Clinical Social Work (LCSW) exam in New York. When New York implemented social work licensing nine years ago, it established two levels of credentials, the Licensed Master Social Worker (LMSW) and the Licensed Clinical Social Worker (LCSW), the highest credential in the state, which can only be achieved with a certain amount of clinical experience. Since that time, amendments had passed that greatly restricted this clinical experience to mental health therapy within an institution or private practice. 1199 social workers and their allies argued that there are many other social work settings in which they use clinical skills, often extensively. The State Board of Social Work has heard them, and is now expanding its definition of clinical social work to settings outside of mental health. In particular, 1199 social workers from Montefiore and from St. Luke’s submitted scenarios to the State Board of Social Work detailing the incredibly varied and complex world of medical social work. These descriptions played a major role in changing how the State defined clinical experience. Thus, 1199 social workers can be proud that their efforts contributed to making the LCSW more broadly available to qualified social workers in all settings.
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“Without 1199 we would not have had that voice.” Lorelei Fields, Medical Social Worker at St. Luke’s/Roosevelt Hospital (left)
“Good mental health affects good physical health.” Zoraida Torres, OB/GYN and Pediatric Outpatient Social Worker at Montefiore (right)
1199 Social Workers Win More Flexibility in NY Licensing Law (continued)
When speaking with the social workers, it quickly became clear that medical social work is a rich and complex profession. At Montefiore Erin Lauinger is a pediatric transplant social worker and Emily Dorfman is a liver transplant social worker. “When you have a chronic illness, you need the patient to be motivated to deal with and handle the illness,” said Lauinger. “Their mental health is important in dealing with their physical health.” Dorfman added that many of her patients have a “tremendous amount of post-traumatic stress” from learning about their illness and going through the transplant procedure. Both of them stressed the importance of working with the families. “It’s all about engaging,” Lauinger added. “Once you can engage, then you open the door to a clinical relationship with the patient and the family.” Until recently, Esther Mendoza was an oncology social worker at Montefiore. While she is now working in the psychiatric ER, she will reference her oncology experience when applying for the LCSW because this experience “was as clinical as my work now.” Mendoza worked with both newly diagnosed patients, those who were undergoing treatment, and those in hospice or palliative care. “I had longterm relationships with many of my patients,” she said. Like her colleagues, Mendoza worked not only with the cancer patients but with their families, including their 6
children. “Children are the unheard voice in the cancer world,” she said. In one case, she worked with a mother suffering through a particularly difficult case of cancer whose 14-year-old boy was acting out at home and at school. By working with the family, Mendoza said she was able to help them speak openly about the illness. As a result, the son improved markedly in school. At St. Luke’s Hospital, the two social workers who submitted scenarios were Union delegate Elise Rackmill, now a school social worker who previously ran a sickle cell program, and Lorelei Fields, a medical social worker. Perhaps no one has worked as long and hard on this issue as Lorelei (see the Feb. 2009 issue of The Monitor). She went to countless meetings, including meetings of the State Social Work Board. “It’s important for the profession not to disregard different types of clinical work. It’s important to acknowledge clinical work done in a variety of settings,” Fields said, adding that hospital social workers need “excellent interviewing skills, skills of engagement, and great skills for assessment.” “I’m extremely happy to hear that our write-ups made such a difference,” she added. “Without 1199 we would not have had that voice.”
Hospital Ambulance Services Saved from Attack! For 100 years, New York City’s voluntary hospitals have been providing us with ambulance services at no cost to the city. This saves our government millions of dollars a year that would otherwise come out of taxpayers’ pockets. But earlier this year, Mayor Bloomberg included in the 2012 budget a fee to voluntary hospitals for continuing to provide ambulance services. If approved, this fee would have resulted in staff shortages, higher taxes for hardworking New Yorkers and, scariest of all, fewer ambulances, meaning longer response times during emergencies.
The Real Facts Mayor Bloomberg had claimed that charging voluntary hospitals these fees would have helped close the city’s budget gap. But in truth it could have ended up costing taxpayers millions of dollars and worsened our financial crisis. If struggling hospitals would cease providing ambulance services, the associated costs would have been transferred to the city’s already strained budget at a greater expense. The Fire Department, which dispatches all Emergency Medical Services (EMS) workers in the 911 system, including those employed by the non-profit hospitals, would have been forced to pick up the slack by hiring hundreds of new EMS professionals and buying new ambulances.
Hospitals Rejected Proposed Dispatch Fee Under the new budget, starting in 2012 some hospitals would have had to pay the city over $1 million to remain in this system. Many hospitals
1199 Paramedics and EMT’s meeting to discuss strategy in opposing proposal to impose fees on hospitals
say that in order to pay these fees, they would have had to reduce services elsewhere, in some instances discontinuing ambulance services altogether. Hospitals and 1199SEIU EMS members asked City Hall to reconsider this ill-conceived attempt to generate money that could devastate our vulnerable health system. “The city is saving millions of dollars with the help of the hospitals’ ambulance services—says retired paramedic Marvin Bethea. “It will cost them a lot more money to provide adequate staffing, purchase equipment and pay EMS worker salaries.”
Saved! Because of the hard work, lobbying and cooperative efforts of the 1199 SEIU Hospital Based EMS member Committee, the 1199 SEIU Professional Technical Department, the 1199 SEIU Political Action Department, The Greater New York Hospital Association (GNYHA), the New York City Council, and Mayor Bloomberg’s office, a compromise was reached regarding the fees. GNYHA has agreed to work with the City to develop cost saving and revenue generation through efficiencies that will benefit both the FDNY and hospitals. The cost saving initiatives are expected to save NYC over 9 million dollars a year. When the expected level of revenue generation is achieved, we are confident that the fees will be eliminated from the Fiscal Year 2013 budget, and will not be implemented in the Fiscal Year 2012 budget.
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Delmaliz Rodriguez, Cert. Occuptional Therapy Assistant, Daughters of Jacob Nursing Home, working with a patient
Challenges for Professional Staff in Changing World of Long-Term Care
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rofessional staff in nursing homes provides a range of important functions and services. Dietitians, LPNs, Physical, Occupational and Speech Therapists, Social Workers, Activities Leaders, and others are critical members of the interdisciplinary care teams that design and deliver individualized care and treatments to elderly and physically disabled residents. Recent national and state reforms and regulations are creating unprecedented challenges for these dedicated staff. As the health care system is pressured to establish and expand community and home-based care programs, the number of hospital and nursing home beds is expected to decrease in the coming 5 years. It is anticipated that nursing homes will admit increasing numbers of patients who either require short-term rehabilitation or long-term care for late-state dementia, palliative care, chronic mental health and behavioral health issues, developmental disabilities and complex medical conditions. Incentives to reduce re-hospitalizations, demonstrate financial competitiveness and improve performance on quality measures will require professional and technical staff to add new skills to their already bulging tool kits.
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“There is an increased danger that many person-centered care initiatives may fall by the wayside” Janice Dabney, Labor Management Project, 1199SEIU Training & Employment Funds (above left)
Janice Dabney, (lead consultant with the Labor Management Project, a department within the 1199SEIU Training & Employment Funds) predicts that “we will see fewer and smaller nursing homes. Staff will need to communicate more effectively and efficiently both within their individual facility and across health care settings. Professional and technical staff will need to enhance their critical thinking, problem-solving skills in helping to create new systems and approaches to care. Documentation of evidence-based, data-supported interventions will help ensure the success and continued viability of their facilities.” The stresses that come with having to treat more patients along with additional documentation requirements affect all staff titles. Delmaliz Rodriguez, Occupational Therapy Assistant at Daughters of Jacob Nursing Home, candidly shares her views: “The role of OTs (Occupational Therapists) has changed from providing quality therapy with minimal documentation, to spending less time with each patient due to increased caseloads and documentation requirements. Therapists need to be more creative with treatment sessions in addressing residents’ functional and adaptive needs.” There is a perceived conflict between providing quality vs. quantity care. Ms. Dabney observes that “There is an increased danger that many person-centered care initia-
tives may fall by the wayside; however there is also the belief that facilities will only survive if they enhance their commitment to individualized care expressed through culture change values.” 1199SEIU, the Training & Employment Funds and Institute for Continuing Education all strive to support professional and technical workers to succeed in their changing roles. Creating Professional Practice Committees (PPCs) in each facility could be one approach. Ms. Rodriguez agrees: “The PPC can be useful for the professional and technical staff to have a say in what happens in the institution.” Do you want to influence your institution’s leadership with your ideas of how to improve patient care? 1199SEIU’s Professional and Technical Department invites you to join with colleagues in forming a PCC in your facility. With support from 1199SEIU’s Professional & Technical Department staff, your Committee will be equipped with the resources and skills to work collaboratively with other union members and management in resolving practice issues, improving care, and increasing staff satisfaction. To learn more about establishing a PPC within your institution, please contact Joseph Chinea, Professional/Technical Specialist, at 212-8574302, or joseph.chinea@1199.org.
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From Left, NYU Pharmacists Alicia Sammarco, Chetak Jain, Esther Adebayo-Olojo, Wulin Yu, and Manuel Horvitz
Hospital Pharmacists Expand Scope of Practice in New York State
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his May 17, Governor Cuomo signed into law the Collaborative Drug Therapy Management (CDTM) bill, which allows pharmacists who have a written protocol with a physician “to modify and manage drug regimens, order and evaluate clinical laboratory tests related to the management of drug therapy, and order or perform other routine patient monitoring functions.” 1199 pharmacists, who played a significant role in getting this bill passed, applaud the increasingly active role it allows hospital pharmacists to play with patients. The current law restricts the responsibilities outlined by the bill to teaching hospitals and their outpatient clinics and diagnostic centers. The law is written as a demonstration project that will sunset in three years, at which time it will be evaluated. 1199 pharmacists are confident that the program will be a success that will eventually expand to other settings. According to NYU clinical pharmacist Manny Horvitz, the CDTM law validates the direction the hospital’s pharmacy has been moving in over the last several years. “When I first started working at NYU over 25 years ago, the main job for the pharmacist was dispensing medications,” he said. While he emphasized that this role and its 10
many responsibilities remain important to the profession, pharmacists are increasingly “directly involved with patient care.” He explained that clinical pharmacists design and provide disease management programs based on epidemiological data and risk reduction strategies, and that the new legislation will allow this clinical role to expand. According to Horvitz, 12 out of 70 pharmacists at NYU currently work as part of medical teams on the floors, and he expects this number to grow with the passage of CDTM. These medical teams include the attending MD, a resident, an NP, the clinical pharmacist, and occasionally others. These pharmacists “are involved with patient counseling, discharge counseling, drug reconciliation, and preventing duplication of medicines.” With the new legislation, they will also be responsible for medication assessments on patients, ordering tests, and adjusting drug regimens. His colleague, Esther Adebayo-Olojo, a pharmacist at NYU since 1985 and also on the faculty at LIU, expects that the law “will give us a more active role with patients,” as well as “a more solid ground for teaching the pharmacist to play a more clinical role.”
LEGISLATIVE UPDATE Pharmacists: CDTM legislation for hospital pharmacists (see article in this issue).
“It’s impossible for the doctors to master all of these medications. The pharmacist is crucial.” Suhail Khan, Pharmacist at Northshore at Forest Hills
“Before the pharmacist played a reactive role; now they can play an active role.” George DiBenedetto, Pharmacist retired from Montifiore
Two of the earliest advocates of this legislation were 1199 pharmacists George DiBenedetto, who recently retired from Montefiore, and Suhail Khan, a pharmacist since 1971 presently working at Northshore at Forest Hills. Khan agrees with Horvitz that the hospital pharmacy has evolved “from a purely dispensing profession to an active patient care profession.” He added that when he started there were 600 drugs on the market; now there are over 18,000, a difficult amount for doctors to manage on their own. “It’s impossible for the doctors to master all of these medications. The pharmacist is crucial.” DiBenedetto added: “The pharmacist is the drug expert. The number of drugs out there is increasing all the time. This legislation will allow the pharmacist to be an active part of the health care team. Before the pharmacist played a reactive role; now they can play an active role.” Khan stressed that most doctors support this clinical role for pharmacists. He said that 121 attending MDs at his hospital sent individualized letters supporting the passage of the CDTM legislation. All of these pharmacists made the point that with those in their field increasingly playing a bigger role on the floors, the pharmacy technicians who work in the pharmacies will be left with more work and responsibility, leading to a greater demand for certification. The bottom line is that this is both good for the profession of pharmacy and for patient care. It will save costs, reduce adverse drug reactions, and improve patient outcomes.
Surgical Technicians: This bill passed both houses of the Legislature, but was vetoed by the Governor on September 23, 2011. This bill would have required that, going forward, hospitals could only employ nationally certified surgical techs. All those individuals who were employed as surgical technicians either on the effective date of the bill, or within two years prior to the effective date of the bill, would have been exempted from this requirement. Additionally, those surgical techs who received their training in the military would have been exempted from the certification requirement. However, this bill did not become law due to the Governor’s veto. 1199 will be consulting with the sponsors and the Governor’s office in order to work out the changes needed to allow this bill to become law at a future date. We will be keeping you informed. For further information on this issue contact Debora Hunte, Professional & Technical Specialist, at Debora.hunte@1199. org., or at 212-857-4398. Sleep Technicians: (also known as polysomnographic technicians) Legislation has passed and been signed into law that will require those technicians who work in sleep labs assisting in performing sleep studies to receive authorization from the New York State Education Department (SED). This authorization will serve as the equivalent of a license. Licensed respiratory therapists who work in sleep labs will not be required to attain such authorization (their respiratory license will suffice.) While the legislation is written very generally as to the requirements, 1199 had been involved in (continues, next page) 11
LEGISLATIVE UPDATE (continued)
talks with SED to negotiate prior legislation on this issue which spelled out specifically both the requirements, and the grandfathering provisions for existing sleep techs. We have been assured by SED that they will follow these provisions in their regulation of this profession. The requirements to receive the authorization will be to complete an associate level program either in polysomnography, or an equivalent acceptable to the
department, and to pass an exam. Those techs who are presently nationally certified in polysomnography and have practiced at least 18 months in the last 3 years as of the effective date of this act will be able to receive the authorization without taking the exam. Additionally, any sleep tech who has worked under a licensed physician for at least 3 years in the last 5 will be able to receive authorization without taking the exam. The continuing education requirement for all sleep techs will be 24 continuing education credits every three years. For further information on this issue contact Dolores Chase, Professional & Technical Specialist at doloresc@1199.org, or call her at 212-261-2385.
1199 SEIU League Training & Upgrading Fund Institute For Continuing Education
2011 CONTINUING EDUCATION CALENDAR SATURDAY, OCTOBER 15, 9:00am – 5:00pm Neurological Disorders: Degenerative Diseases
FRIDAY, DECEMBER 9, 7:45am – 3:30pm Palliative Care
6 hrs, Interdisciplinary** Location: The Times Center ONSITE, LIVE VIDEOCAST, AND LIVE WEBCAST
6 hrs, Interdisciplinary** Location: The Times Center ONSITE, LIVE VIDEOCAST, AND LIVE WEBCAST
THURSDAY, OCTOBER 27, 5:30pm – 9:00pm Medications of Respiratory Therapy
SATURDAY, JANUARY 28, 8:45am – 4:30pm AIDS at “30”: Evolution of an Epidemic
3 hrs, Respiratory Therapists Location: Cherkasky/Davis Conference Center ONSITE ONLY
6 hrs, Interdisciplinary** Location: The Times Center ONSITE, LIVE VIDEOCAST, AND LIVE WEBCAST
WEDNESDAY, NOVEMBER 9, 5:30pm – 9:00pm Over Radiation Liabilities: Institutions and Practitioners
SATURDAY, MARCH 3, 7:45am – 3:30pm Cystic Fibrosis, Pulmonary Disease
3 hrs, Imaging Technologists Location: Cherkasky/Davis Conference Center ONSITE ONLY
6 hrs, Interdisciplinary** Location: The Times Center ONSITE, LIVE VIDEOCAST, AND LIVE WEBCAST
THURSDAY, DECEMBER 1, 5:30pm – 9:00pm Medication Errors
WEDNESDAY, APRIL 4, 8:45am – 4:30pm Geriatrics
3 hrs, Interdisciplinary: Pharmacists and Pharmacy Technicians, Nurses, Physicians and Physician Assistants Location: Cherkasky/Davis Conference Center ONSITE, LIVE VIDEOCAST, AND LIVE WEBCAST
6 hrs, Interdisciplinary** Location: The Times Center ONSITE, LIVE VIDEOCAST, AND LIVE WEBCAST
Register today. Call: 212-894-4390 Please call for specific location on each seminar. Email: Institute @1199Funds.org www.1199Funds.org - click “Training & Employment,” and then on “Continuing Education.”
** Interdisciplinary seminars are usually accredited for Physicians, Pharmacists and Pharmacy Techs, Physician Assistants, Nurse Practitioners, Respiratory Therapists, Radiologic Techs, Dieticians, RNs and LPNs, Social Workers, Clinical Laboratory Practitioners, Rehab Therapists (OTs and PTs), CASACs. Please call for specific professions.
1199SEIU Professional & Technical Department Staff Listing and Areas of Responsibility: Dolores Chase - Imaging, Respiratory, EMS Workers, Medical Records Coders -- 212-261-2385, DoloresC@1199.org Joseph Chinea - Social Work, Substance Abuse Counselors, OT/PT/Speech -- 212-857-4302, , joseph.chinea@1199.org Farah Hargett - LPN’s, Physician Assistants, Dietitians -- 212-261-2246 - FarahH@1199.org Debora Hunte - Laboratory, Pharmacy, Surgical Technicians, Central Sterile Technicians -- 212-857-4398, debora.hunte@1199.org David Kranz, Director - All other professions not mentioned above -- 212-261-2494, davidk@1199.org