SHERIDAN — Due to lack of staffing, the Sheridan Veterans Affairs Medical Center is temporarily shifting urgent care access to primary care walk-in services and limiting patient numbers in some inpatient medical units starting June 13, Sheridan VA officials announced last week. The planned change may cause additional patients for Sheridan Memorial Hospital.
For disabled Army veteran and Sheridan County resident George Kennah, the shift away from traditional urgent care services represents yet another hurdle to receiving care at the Sheridan VA.
“The [Sheridan VA’s] services are important to me and my friends that served and the other veterans, the ones I don’t know,” Kennah said. “It gets frustrating to see the services being cut [when] the sacrifice isn’t being cut for the veterans.”
The Sheridan VA is shifting current staff assignments to other patient care areas, resulting in changes to urgent care access at the VA and a decrease in patient censuses in some inpatient care units throughout the medical center, said Kristina Miller, the Sheridan VA’s public affairs and congressional liaison officer.
Rather than using the Sheridan VA’s designated urgent care entrance in Building 71 North, Miller said patients seeking quick care at the facility should call 307-672-3473 and select option 2 twice, a combination of button-pressing leading to appointments and leaving a message for the patient’s provider. They will receive care in Building 71, which is the Sheridan VA’s main entrance and the location where patients typically check in for appointments. If advance notice is not possible, patients should enter Building 71 between 7 a.m. and 4:30 p.m., where they will be seen as a walk-in appointment.
Under some clinical definitions, Miller said, this walk-in care does not qualify as urgent care.
But Miller insisted the change — which she described as an internal staff rearrangement — would not significantly affect many Sheridan VA patients. Because the facility’s urgent care did not provide around-the-clock services, Miller said it was not a highly used service.
Similarly, Miller said patients can access necessary hospital care and medical services at Sheridan Memorial Hospital and other non-VA entities under the John S. McCain III, Daniel K. Akaka and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 — or the VA MISSION Act. These benefits — which also cover VA patients receiving emergency care at SMH because the Sheridan VA does not have an emergency department — resulted in some Sheridan VA patients choosing to access urgent care at SMH instead, Miller said.
“We don’t think it’ll impact a whole ton of people,” Miller said.
In addition to the change in urgent care offerings, Miller explained the Sheridan VA will also decrease the number of patients served in some facility units, based on average daily patient census numbers for the past year.
The Sheridan VA’s Medical Unit, which serves veterans requiring acute medical care and hospitalizations for common conditions like pneumonia, heart failure and falls, will decrease its patient cap from 10 to five patients, based on an average daily census of 4.92 for the past year.
The Acute Psychiatric Unit, which offers care to veterans experiencing mental health crises, will decrease its maximum patient population from 20 to nine, based on an average daily census of 5.22 for the past year.
Finally, Miller said Sheridan VA officials will limit the population of the Mountain View Community Living Center, a nursing home facility, to 20 from 35, based on an average daily census of 21.82 patients for the past year.
These staffing changes will take effect Monday.
The cause of the staff shifts in urgent care and medical units is a lack of fully-trained nursing staff.
Like medical facilities across the U.S., Miller said the Sheridan VA is suffering from a nursing shortage. Recently, low staff levels at the Sheridan VA has required many nurses to work significant overtime hours. The shift in staff from urgent care and other medical units should help nurses at the facility maintain a healthier workload and provide safe patient care.
“What’s really important to us is maintaining the quality of care that they deserve and expect from us,” Miller said. “These shifts…are based on maintaining that level of care that they should be getting while…managing the staffing levels appropriately.”
But the problem may not go away with staffing shifts. Sheridan VA officials are currently training new nursing staff and students coming out of Sheridan College to add additional nurses to shoulder the workload, Miller said, but the facility still has a significant number of openings for nursing positions.
Some of the lack of staffing is also related to the Department of Veterans Affairs COVID-19 vaccine requirements. Anyone who did not wish to receive the vaccine had to request an exemption from the VA’s Office of General Counsel, the department’s national legal entity, which would make recommendations about whether to approve or deny the exemption request. Now, Miller said, the office’s recommendations are coming back and requiring staff members who requested exemptions to make decisions about their futures with the VA.
If the Office of General Counsel recommends denial of a COVID-19 vaccine exemption, Miller said the staff member requesting the exemption has three options: move to more administrative roles without direct patient care; receive the vaccine; or leave the Sheridan VA facility.
“We are seeing some unfortunate losses,” Miller said. “I know some people who were absolutely committed to our mission of caring for veterans…but who had to make the decision that was right for them.”
The staff shifting is temporary, Miller said, and will be lifted with sufficient nursing staff. But Sheridan VA officials are unsure when urgent care services and inpatient units will return to pre-staffing-shift levels.
Sheridan Memorial Hospital officials are unsure precisely how the changes at the Sheridan VA will impact the hospital, SMH CEO Mike McCafferty said.
SMH officially learned of the planned changes during a teleconference Thursday morning, McCafferty explained, during which Sheridan VA officials indicated the number of patients likely to be impacted by the change.
According to McCafferty, Sheridan VA officials anticipated SMH and other local urgent care facilities would have to absorb six to eight additional urgent care patients per day, a quantity the hospital will be able to incorporate in its own daily patient load.
“That is something we can readily absorb,” McCafferty said.
For SMH, McCafferty said, the real uncertainty comes with the decreases in patient censuses in the Sheridan VA’s medical unit and acute psychiatric unit. As the Sheridan VA plans to decrease medical unit capacity from 10 to five and acute psychiatric unit capacity from 20 to 9, McCafferty said the impact of these decreases on SMH remains unknown.
In particular, McCafferty said he has some concerns about SMH’s ability to absorb patients experiencing acute psychiatric crises because SMH is not designed to provide inpatient psychiatric care, and there is limited infrastructure nearby for behavioral health care. Should the decrease result in additional behavioral health care needs for SMH, McCafferty said it could further strain an already overburdened system.
To manage the possible increase in patients because of rearrangements at the Sheridan VA, McCafferty said SMH plans to be in daily communication with the hospital’s urgent care and medical departments as well as with VA officials. Hospital officials will continue to maintain staffing levels to accommodate any influx of patients and continue evaluating the impact of the shift at the Sheridan VA, McCafferty said.
For Kennah, the halt of urgent care services represents additional frustration in attempting to use Veterans Affairs medical and disability services.
The most irritating part about the change, Kennah said, was the lack of communication between the Sheridan VA and veterans in their care. Although Kennah said the facility has the ability to contact all of the veterans in their care — Sheridan VA staff did so to inform veterans of their eligibility to receive the COVID-19 vaccine — the facility did not contact him to let him know about the changes to service offerings. Kennah only found out about the impending shift in staffing by happenstance: a nurse happened to mention it while he was on the Sheridan VA campus to receive care.
Sheridan VA officials did not respond to The Sheridan Press’ requests for comment on how the medical center informed veterans about the planned rearrangement of urgent care. Miller said the Sheridan VA plans to put up signs at their facilities indicating the changes in urgent care service offerings.
The other problem with the change in staffing, Kennah said, is the Sheridan VA’s lack of accountability on the local and state level. Staffing issues exist across health care facilities, the veteran said, but Sheridan VA can change or halt services without local or state input, something community hospitals like SMH can’t do.
“They don’t have to answer to anybody for it. They can just pass it on to the local groups that don’t have that ability to…shut down their services,” Kennah said.
For Kennah, the change in urgent care services is an instance of the Sheridan VA not living up to his expectations.
“I signed a contract when I enlisted that I would have VA services when I was done…” Kennah said. “I expect as a veteran — and I expect for our other veterans that come back in a situation worse than mine — to be taken care of, no questions asked.”