C. W. is the nursing manager of the chronic spinal cord specialty care department in the Boston healthcare system. I have chosen her for this interview due to the experience of collaboration from the time when I used to work in the acute medical oncology inpatient care unit, where C. W. was my manager. I find her very charismatic as a leader and extremely devoted to workers who she manages. C. W. puts a lot of effort into raising self-confidence among the staff and helps them to discover their skills and competencies and build a successful career in the future.
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In the past, C. W. used to work in the acute inpatient care department. This year, she has made the transition to the chronic spinal care unit since there was a shortage of management staff. Her other positions include being the committee member of the VA Post-Baccalaureate Nurse Residency (VAPBNR), the board member of Nurses Organization of Veterans Affairs (NOVA), and the committee member of VA staff retention.
C. W. started her career in the VA 26 years ago as a safety sitter. As the time passed, she worked as a nurse and finally a manager. She went through an intra-hospital educational program called Leadership, Effectiveness, Accountability, and Development (LEAD) to become a nursing manager. However, C. W. decided additionally to receive fundamental education and obtained a Master’s degree from the Massachusetts General Hospital Medical School. Her example encourages other nurses to receive higher education in this field.
As a manager of the chronic spinal cord injury unit., C. W. plans and coordinates processes, monitors patients’ safety, and allocates resources. The specialty of this unit is multifaceted, providing various types of care schemes. The unit may accommodate 30 patients, and currently, there are 27 of them, while most of the VA patients are aging adults. This specialty care unit is located in Brockton as a part of the VA Boston healthcare system, which is an A-1 facility containing acute and primary services. The unit has the community living center for patients with chronic spinal cord injuries, as well as provides respite care for VA community members.
One of the biggest social factors impacting the work of the unit is that the VA Boston only provides health care for veterans, and a patient must be service connected to receive treatment. Veterans may pay a small fee during the service connection, while the VA can also take into account outside health insurance held by a patient. However, most patients do not have the latter and often use the Medicare funding as a spinal cord injury is considered a disability.
The federal government provides fixed funding for the organization. However, the budget has been cut over the time and becomes smaller each year. Even though the unit’s services are free for qualified veterans, there is still a department that keeps track of costs and billing. As a manager, C. W. describes one of her responsibilities as allocating resources, especially the ones associated with the unit’s staff. She mentions that there is a hiring freeze in the VA Boston at the moment, so it is crucial to avoid staff retention. She also notes that there is a problem of receiving approval from the committee for hiring new employees, as it does not meet the funding and statistical plans.
According to C. W., one of the biggest social issues that impact her work is the amount of negativity about the VA in media. Another social factor is the increase in the use of opioids among veterans. C. W. admits that it is true according to raw statistics, yet this data does not show the reasoning behind it, like chronic pain that most combat veterans live with. Finally, C. W. mentions that one of the biggest challenges in her work is that the organization only provides care to veterans who are hundred percent service connected. She hopes that all veterans will be able to receive care in the future.
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It becomes evident that the VA currently faces many socio-economic challenges that impact its work. Budget cutting, occasional staff shortage, non-inclusive care scheme, and other issues call for changes in ways of providing services to aging veterans. For example, patients from transitional and respite care stages often receive less time contacting a nursing specialist. To answer their need for healthcare support, the organization provides an online service called the VetPro. It is created to help answering veterans’ questions, as well as to facilitate in organizing appointments receiving medicine refills. Currently, the VA Boston seeks ways to promote its Telemedicine service and to raise awareness about it. There is a positive experience of implementing the VA Optometry Telehealth service, which has received extensive positive feedback. There remains a question of how it will be best to bring Telehealth to those veterans who live in our community.
One of the biggest social policy issues that stand in the way of successfully implementing this idea is the bad coverage of the VA in media. As C. W. mentions, most of the coverage that the VA has received in the social media up to this day is negative. Inside the organization, social media usage is regarded as being a very serious matter. Patient safety and privacy are the core factors that must be minded every time an employee uses social platforms. If it is discovered that a staff member has shared a patient’s personal information, intentionally or not, his or her contract will be terminated. There was a case in the past when a picture taken on one of the facility’s floors had to be deleted since it contained patients’ personal information.
There are also other important issues that need to be addressed in the future. For example, there has been a dramatic change in the VA over the last decade as the veterans’ population has shifted regarding their places of service. Previously, veteran patients were those who used to serve in Vietnam or Korea. Nowadays, veterans from Iraq are slowly changing the statistics. This shift calls for implementing advanced technologies to fit the needs of the new incoming patients. Another change may be seen in the culture of the VA. C. W. remembers that the VA used to be an all-male health care center at the time when she began working there. Nowadays, females represent apart of the veteran patients that have served in Iraq. The VA has answered the needs of this population by building a female clinic. This is an example of flexibility shown by the VA, which can be useful in the future when adjusting to the changing external factors in the industry.
Most of my career has been associated with providing acute care. The interview with C. W. has given me an opportunity to learn about the patient needs arising in the primary and community care settings. There is a difference in objectives that present the focus of acute and community care. The former has a goal to help patients in managing acute medical issues. Primary and community care, which is designed as a service of a longer term, implements practices that are targeted at meeting patients’ needs. It is crucial to help patients stay in a community, to which they belong.
One of the most surprising facts covered in the interview was the situation of the population change mentioned by C. W. Formally, VA used to be open for all service connected veterans, independent of their gender or other social characteristics. However, until recent times, all patients were represented by male veterans. Although the situation is changing rapidly, female veteran patients are still new to the VA service sphere.
The social issues that were discussed in the interview help me in understanding what skills may be required of me as a health care professional in the future. There are still many things that must be learned and changed regarding care for veterans. Currently, most of them are those who served during the Korean and Vietnam war, although demographics slowly change. Patients who will be coming after serving in Iraq have different needs, which require the VA to change internal culture and care practices to meet them. This is also true for the future veteran generations, which concludes that the VA must be a flexible organization which constantly seeks ways of improving its services.