Be warned right now - I did not agree with the changes that Senate Bill 1857 started (http://www.dads.state.tx.us/providers/nschanges/icf/index.html) a few years ago.
Senate Bill 1857 from 2011, pushed through by the well meaning Texas Board of Nursing, did little to help propel the ICF/IID program forward. In fact, it actually pushed the program in a backwards direction making it more akin to a nursing home than to a community based home. At a time when budgets were tight, funding was being cut, and programs were unable to pay staff decent wages, the 82nd Legislature initiated a change that turned ICF's upside down. Suddenly, ICF programs had to have Registered Nurses (R.N.) do many of the functions that the Licensed Vocational Nurses (LVN) had been doing for years including taking "on-call". Most facilities had an R.N. as a consultant to follow up on issues or provide training as needed or even do some simple reviews, but few R.N.'s had any major role in the small ICF settings (10 bed or under). With Senate Bill 1857 the state of Texas enacted stricter guidelines on the ICF programs than even the federal standards impose, and they did it without providing a single penny of extra financial support.
Regardless of what anyone says, I know for a fact that several LVN's lost their positions because of the changes. Programs either had to obtain a full-time R.N. (at R.N. pay by the way) or get an R.N. and participate in the LVN Pilot Program. The pilot program was designed into Senate Bill 1857 to study how the LVN function would do being on-call in the ICF programs, the HCS programs and others. The change required almost complete R.N. supervision for the providers that participated. Many of the providers who did not participate basically let their LVN's go and replaced them with an R.N. Without the funds needed to pay for the R.N. salary, some of them were even forced to cut the number of nursing hours provided to people living in the programs. The programs that did participate in the pilot program had to put information into the CARE system online for several years. In fact the program only recently ended and required a great deal of training and understanding to participate in the program (http://www.dads.state.tx.us/business/CBT/lvnocpp/firefox3/index.html?dhtmlActivation=fullscreen), and naturally the state had to fund all this training.
The information from the pilot program is still being studied and reviewed since it only recently ended. Without contacting many of the providers who participated in the program, I would assume they have kept their LVN's in place and continued much the way they have through the program. Ultimately, I'm looking forward to the report that DADS will review and release to providers and to the legislature. As with all statistics, it can be viewed in almost any manner.
So, in summary, an LVN On-Call Pilot Program was recently completed. It has been going on since the implementation of changes found in Senate Bill 1857 for over three years now. It consisted of the following areas where Texas tax dollars were spent:
1. Setting up an online computer reporting system
2. Training those who participated in the reporting system
3. Providers hiring R.N.'s to over see the LVN's still employed
4. Someone in Austin to compile the computer date regularly
5. Someone in Austin to analyze the data
6. Someone in Austin to prepare the reports
7. Someone to present the reports
It would be interesting to know how much money total in Texas was spent on the LVN On-Call Pilot Program that could have been poured back into services. What would be even more interesting to note is that many of the ICF programs in Texas have been in place since the late 1980's - let's just say 1988 for a starting figure. Given that the Senate Bill did not initiate the pilot program until 2011 we can know that these ICF programs have been using LVN's for on-call needs over 23 years. With over 800 (800 as an estimate) ICF programs in Texas having at least one annual survey each year, we know that the State of Texas had more around 18,400 annual surveys (and that's only annual not follow ups or investigations) to use as a review for how effective the LVN as an on-call nurse really is daily. So, was there really a need for an LVN On-Call Pilot Program? Did 18,400+ surveys and over 23 years of the program not provide enough data to avoid doing an LVN On-Call Pilot Program at the expense of the Texas Tax Payer?
Senate Bill 1857 was about more than the LVN on call pilot program. And some of the LVN duties violated the BON Nursing Practice Act - in other words, broke the law.
ReplyDeleteThank you for reading and for your feedback!
ReplyDeleteYes, I would agree that there certainly was more than just the LVN On Call Pilot Program to Senate Bill 1857; however, this article's focus was on the part dealing with the pilot program. The fact remains that for over 23 years, LVN's had served the nursing functions for ICF programs in Texas much like they do as LPN's in 48 other states (California being the 49th with LVN designations for that position). Federal guidelines for ICF programs do not specifically indicate what level of nursing education is required to perform the nursing function in an ICF program.
The state had a lot of data they could have reviewed, but instead it spent money conducting a new study with a report being completed in December 2012. LVN's were suddenly out of a job and facilities were forced to increase their consultant R.N. hours, or hire a full-time or part-time R.N. This requirement was placed on the ICF/IID programs with no increase in funding to support it.
While the LVN function certainly may have broken laws, it only broke laws submitted to the legislature by the BON at some point well after the establishment of the ICF programs in Texas. Those laws also exceed federal guidelines as indicated for the ICF programs. As one LVN stated to me, "It would have been nice for the BON to have considered the fact we've been doing this for over twenty years already and the Feds think we can do it."