Journal of Healthcare Management - September/October 2016 - 373

M edI cal S taff c onf I guratIonS Preferences and Perceptions: Roles, Perceived Quality of Care, Experience, Likelihood of Retention, and Personal Characteristics CEOs of CHCs that had high ratios of nurses described a different division of labor from that of CHCs with mostly MAs. The New Hampshire CEO described hiring nurses for triage, direct care, and one-to-one provider support: "One of the reasons we have the one [provider] to one nurse [ratio] is that the nurses actually [help] provide care to that panel of patients. [They handle] 90% of the calls coming in from the patient, all of the tracking, all of the follow-up, all of the referrals. So not only are they [responsible for] the clinical components of the visit, they are also [responsible for] the care management." CEOs at CHCs in New Hampshire and Virginia that had high proportions of nurses tended to have strong opinions about the quality of care they provided compared with that provided by MAs. On the basis of the CEOs' experience, they argued that hiring LPNs and RNs (as opposed to MAs) has proven to be cost-effective because it greatly reduces providers' workload. The New Hampshire CEO commented, "It's costly, but based on the evidence-based guidelines and protocols set up in our [electronic health records] . . . there is a lot of time that the RNs and LPNs actually save the providers." Many CEOs valued LPNs with experience, especially those who had worked outside the direct supervision of RNs. A Michigan CEO noted, "We treat our LPNs and RNs the same. We are looking for LPNs who In c o MMunIty H ealt H c enter S have had a high level of responsibility in a previous occupation, or who have [worked in] home health care where they [exercise] more independent judgment." The Virginia CEO suggested that RNs improved the quality of care and provided leadership in emergencies. "When there is an emergency . . . where we have to run out to the parking lot, my RNs are at the head of it. Providers just kind of stand back and let the nurses take care of [the emergency]. I [prefer] nurses; they're more helpful to providers than are MAs." The New Hampshire CEO echoed this sentiment: "If you ask providers whether they would prefer an RN, LPN, or MA, they will all say an RN because having someone with more skills and experience [makes their lives easier]." However, a CEO from Tennessee suggested that MAs could do highquality work as long as they were supervised: "Not for a minute do I feel that our quality is compromised because we have an MA in that position; the midlevels [NPs and PAs] are closely supervising [the MA]." A California CEO was more skeptical about MAs: "They're poorly trained by for-profit schools that are just [taking] their money. People are getting heavily into debt and coming out [of school] barely knowing anything." In making hiring decisions, CEOs also considered the likelihood of retention. The availability of career ladders for nurses was considered an advantage compared with the more limited career advancement opportunities for MAs. CEOs also favored nurses who remained with their organizations 373

Table of Contents for the Digital Edition of Journal of Healthcare Management - September/October 2016