Blue Mountain Health System is laying off nine licensed practical nurses and seven support positions as it moves from 'team" nursing care toward a primary care nursing model.

Two other positions had their hours reduced.

The change began about six months ago, said spokeswoman Lisa Johnson. She explained that primary care nursing is a method of nursing practice which emphasizes continuity of care by having one nurse provide complete care for a small group of inpatients within a nursing unit of a hospital. It allows the nurse to give direct patient care, and communicate with other members of the health care team regarding the patient's health care.

In team nursing, each nurse focused on a task, such as dressing wounds or managing medications, but no single nurse had a glimpse of the big picture with a patient.

"Our reason for moving to primary care nursing is that the acuity of patients admitted to the hospital today is much higher, so a higher level of care is needed, and that level of care is outside the scope of an LPN's licensure," Johnson said.

LPNs are now primarily used to provide care in personal care homes, skilled nursing facilities and outpatient clinics.

BMHS LPNs were offered the opportunity to continue their educations toward a registered nursing license, with BMHS paying the bill. However, Johnson said, only one LPN took advantage of the offer.

The LPNs were also offered any open LPN jobs at The Summit At Blue Mountain Nursing and Rehabilitation Center, which is adjacent to the Gnaden Huetten campus.

another factor is the two percent reduction in Medicare reimbursement that went into effect on April 1 as a result of the federal sequestration.

The sequester, created under the Budget Control Act of 2011, is a series of automatic cuts in "discretionary" federal spending over a 10-year period. It was activated on March 1 after the 12 member Joint Select Committee on Deficit Reduction failed to come up with a plan for reducing the deficit by $1.5 trillion by 2021.

The reduction translates to an $800,000 loss for BMHS.

"This reimbursement reduction, the emphasis from inpatient to outpatient services in the health care environment, as well as the decrease in the number of days patients spend in the hospital for treatment, demands that we look our volumes and evaluate how our staffing can be reconfigured to more efficiently deliver those services," Johnson said.