The Affordable Care Act is helping to accelerate changes in the healthcare delivery system that were underway even before the passage of the legislation.

1199er Maxine Brown has witnessed those changes during her almost 27 years as an LPN at Bronx-Lebanon Hospital. Bronx Lebanon, 120 years old, is the largest voluntary, not-for-profit health care system serving the South and Central Bronx. It treats over one million patients a year. The only larger network in the borough is Montefiore.

“I’ve worked in many departments of the hospital over the years, and I’ve witnessed a variety of changes in the hospital itself and in the neighborhood it serves,” Brown says. “Today I’m one of the two senior charge nurses in Ogden Family Medicine, an ambulatory site of the Martin Luther King, Jr. Health Center. The center is a key part of the Bronx Lebanon network.

“The caseload has become a serious problem for LPNs,” Brown notes. “Management continually assigns more tasks, but they don’t provide added compensation.”

Brown and her co-workers must deal with a high concentration of patients in the region, the growing number of baby boomers, and new guidelines and approaches that pressure the institutions to treat more patients.

“We have to do this while we must also improve performance,” she adds. Under the ACA, healthcare institutions are required to reduce re-admissions and improve overall performance. “This vacillates and if our numbers are down, we are pushed to increase productivity,” Brown says.

Brown also has another major responsibility which, she says, is not separate from her responsibility to provide the best care she can. “I’ve been a Union delegate for the past 15 years,” she says proudly. “As a delegate, I feel empowered by knowledge to educate our members and defend when necessary, their rights regarding employment. I strongly encourage and educate members to be fully informed of the Union by-laws and regulations so they can make informed decisions about their employment.”

“I also make sure they know about the Union’s mission of social justice.” Brown says she does this not just for the individual members she represent as a delegate, but for the good of the entire workforce and the patients they care for.

“Members need to know that their lives and our Union as a whole are enriched by their actions,” she says. “And that means achieving the greatest unity. I tell members, ‘that means you and me.’”