At the Visiting Nurse Association of Central Jersey (VNACJ), president and chief executive officer Mary Ann Christopher, MSN, RN, FAAN, maintains a $100 million annual budget, a 4,000-patient daily census, and a 1,700-person staff. Services available to residents in 10 central New Jersey counties include home care, primary care, wellness services, mental health care, rehabilitation, homeless services, and hospice and palliative care. Yet despite the size and complexity of the 98-year-old organization, Ms. Christopher’s primary objective has remained simple in her 27-year career there. “People need to know that you stand for what you say you stand for,” she said. And what the VNACJ stands for is local communities “driving” the services provided. Ms. Christopher has called it Neighborhood Nursing, a collaborative model in which nurses are assigned to specific neighborhoods so they and community members can respond to what they identify as the most pressing health issues.
As an example of the model, she cites a VNACJ nurse who noticed that many residents of a retirement community were exhibiting signs of congestive heart failure. The nurse proposed that the VNACJ set up a kiosk that would contain a telehealth monitor. The device would permit residents to check their weight, oxygen saturation, and blood pressure levels and automatically transmit the values to a cardiac nurse. If a patient’s indicators were outside the desired range, the nurse and patient would converse remotely, in real time, and patients needing a medication adjustment would be visited. The VNACJ funded the idea, and outcomes are being monitored.
Ms. Christopher said that the aims of such an initiative are both immediate and long term. In the short run, the VNACJ hopes to reduce rates of emergency room (ER) use and repeated hospitalizations— expensive and inefficient means of managing chronic illness. As for the long-term goal, the VNACJ nurses strive to give individuals as well as entire communities greater control over their health. After the telehealth kiosk was set up, for example, residents began paying attention to one another’s weight and blood pressure levels.
Ms. Christopher has secured grants to test a wide range of such ideas. For example, the Mobile Outreach Program has reduced rates of ER use among deinstitutionalized mentally ill and homeless patients; funded in the mid-1980s by The Robert Wood Johnson Foundation and the State of New Jersey, it is now supported by local governments. The Mobile Outreach Program is the VNACJ initiative Ms. Christopher is the most proud of and the one, she said, that may be the most replicable.
In 1998 the Balanced Budget Act resulted in a 15 percent reduction in revenues and left the VNACJ with only $100,000 in reserve. Now, even with $24 million in reserve, Ms. Christopher worries about declines in federal, state, and philanthropic funding, especially in light of the recent increases in un- and underinsured patients being seen as a result of the recession. Still, she said that the agency’s focus on providing services the community values, even as those values change, has kept the association fiscally sound.
Not all CEOs of visiting nurse associations are nurses (those in New York City and Boston, for example, are not). Ms. Christopher said she can see why it matters that she is a nurse. First, she knows well what nurses can do. She has cultivated an atmosphere of honoring staff ideas (such as the cardiac monitoring initiative). As a result, the VNACJ has a turnover rate of less than 5 percent for nurses. Second, Ms. Christopher is sought after to serve on governing boards and advisory groups and is the only RN on the board of trustees at the University of Medicine and Dentistry of New Jersey. She believes that her nursing expertise, keen sense of community, and fiscal responsibility give her “legitimacy at any table I’m at...being a guardian for what’s best for patients and communities.”