The stated purpose of Maryland's "healthy start" program is to help mostly low-income pregnant women and new mothers give their children a good start. But in Anne Arundel County, there also seems to be an unstated purpose--to make money for the county health department, says Carolyn Cornett, president of the Maryland FNHP.

The federal government provides reimbursement for each completed visit, so Anne Arundel managers decreed that each Healthy Start nurse must complete 100 visits per month. Cornett says the quota was impossible to meet. Nurses spend much of their time on the phone arranging for visits and following up. And clients are often not home when the nurse arrives, even though an appointment was made. Management said missed visits would not count.

So the union filed a grievance and took its case to the public. In a guest column in the The Capital (an Annapolis newspaper), Cornett wrote, "If Healthy Start nurses can't keep up with an unreasonable home visit quota, it's a matter of life and death--literally--for their often very fragile, at-risk clients.... Rushed health care is bad health care."

Finally, management settled. The quota is now 80, missed visits receive half credit, and perhaps most important, nurses get credit for the vital telephone work that determines whether a client actually gets needed services.

Sue Rath, a union executive board member who was one of those who filed the grievance, says management "wasn't used to having a real union stand up for the employees." Maryland FNHP was organized just two years ago.

Rath says the new system is "manageable" and will allow nurses to take care of their clients. The quota system proposed by management, she said, was "defeating the purpose of the whole program."

FNHP locals have found that going public with a conflict often moves recalcitrant managers.  The public cares about quality health care, and managers care about their image.  For help in presenting your case to the public, call Janet Bass at 202/879-4400, ext. 4554.