HLTH 8402 Week 4 Clinic Hours Leadership Case Example

Moving the Prenatal Clinic to Evening and Sunday Hours During Harvest: A Leadership Case Defended With Arrival Records by Language, National Data on Crop Work Schedules and Community Health Worker Reports, and an Answer to the Nurses Who Objected

Student Name

Walden University

HLTH 8402: Applied Leadership and Multicultural Perspectives in Public Health

Instructor Name

Month Day, Year

Moving the Prenatal Clinic to Evening and Sunday Hours During Harvest: A Leadership Case Defended With Arrival Records by Language, National Data on Crop Work Schedules and Community Health Worker Reports, and an Answer to the Nurses Who Objected

The Decision

The district health officer in the Caldera Valley, a composite figure, decided to change the district prenatal clinic's schedule for the five harvest months, June through October. The clinic, which had run from eight in the morning until half past four on weekdays, would instead open from 2:00 p.m. to 8:00 p.m. on weekdays and on Sundays from nine until three, closing on weekday mornings. Total clinic hours stayed the same. The decision drew objections from several nurses, whose schedules would change. This paper sets out the decision, the evidence for it and the answer to the objections.

Evidence 1: Who Arrived, and When

The district's clinic records for the previous harvest season, sorted by patients' preferred language, showed a pattern. English-speaking patients, mostly town residents, kept most of their morning appointments. Spanish- and Mixtec-speaking patients, most of them from farmworker households, missed morning appointments far more often during harvest months than in winter, and when they came, they more often arrived late in the day or walked in without appointments on the rare days the clinic stayed open past 4:30. First prenatal visits among farmworker patients also tended to come later in pregnancy during harvest months. Clinic data recorded Mixtec speakers only as "other language" until the district added the category midyear, so the earlier months undercount them.

Evidence 2: The Shape of Crop Work

National data on hired crop workers describe the schedules behind those records. In the most recent national survey of crop workers, workers averaged 46 hours in the week before their interview at their current farm job and were employed in farm work for an average of 39 weeks in the previous year (U.S. Department of Labor, 2022). Harvest weeks are often longer, with shifts starting before dawn to avoid afternoon heat. A pregnant worker, or a partner who drives her, cannot easily leave a field at 10:00 a.m. for a clinic forty minutes away without losing a day's pay. Holmes (2013), who worked and lived alongside Indigenous Mexican farmworkers, described how the structure of farm labor limits workers' access to health care in exactly this way.

Evidence 3: What Community Health Workers Heard

The district's community health workers, two of whom are from farmworker families themselves and one of whom speaks Mixtec, reported the same reasons in household visits: no time off without lost wages, no transportation during work hours and fear that missing work would cost a job. Several women told them they would come if the clinic were open after work or on Sunday, the one day many crews do not pick.

Why the Decision Follows

Each source alone would be weak. Clinic records show patterns but not reasons. National data describe workers in general, not this valley. Community health worker reports are firsthand but informal. Together they describe one problem: the clinic's hours fit the schedules of the population that needs it least during harvest. Shifting the same number of hours to evenings and Sundays serves farmworker families without reducing total access. Town residents lose weekday mornings but keep afternoons, and most of them are not working during the day.

The decision also follows the leadership claim of this course: a leader who cannot mirror a community earns standing by making choices families can watch play out. The federal CLAS standards call for services that respond to the needs of the populations served (U.S. Department of Health and Human Services, 2013); clinic hours are one of the most visible responses a district can make.

Alternatives Considered

The officer weighed three other options before deciding. Adding evening hours on top of the existing schedule would have avoided cutting weekday mornings, but the district had no money for added nursing hours, and a thinner staff stretched across longer days would have raised errors and burnout. A mobile prenatal van visiting labor camps in the evening would have brought care closer, but the district's one van was committed to immunizations, and prenatal visits need ultrasound and lab access the van lacks. Partnering with a federally qualified health center thirty miles away, which already offered evening hours, would have required families to travel farther. Shifting existing hours was the option that fit the district's budget and staff while reaching the families the evidence pointed to. Naming these alternatives also mattered for the nurses, since it showed the decision was not made lightly or without looking for options that would have spared their schedules.

The Nurses' Objections

Four nurses objected. Their concerns were real. Evening and Sunday shifts disrupt family life, especially for nurses with young children. Some had chosen public health nursing partly for its weekday hours. And they asked why they should bear the cost of a decision made above them.

The answer has three parts. First, the officer acknowledged the cost directly rather than describing it as a minor adjustment. Second, she made the burden shared and limited: the change runs only during harvest months; shifts rotate so no nurse works every Sunday; nurses received a shift differential for evening and Sunday hours; and the district hired a part-time nurse from the valley to reduce the load. Third, she asked the nurses to help design the schedule, including which weekday evenings to close earlier if attendance was low.

She did not reverse the decision. Reversing it would have placed staff convenience above patients' access to prenatal care, and the evidence showed that the existing hours were costing farmworker families early care.

How Results Will Be Measured

The district will compare the harvest season after the change with the season before it, by preferred language: the share of first prenatal visits in the first trimester, kept appointments and walk-in visits. Results will be reported to the community through the community health workers and to staff at the end of the season. If farmworker patients do not use the new hours, the decision will be revisited.

Limits

Because the comparison looks only at the seasons before and after, with no control group, other changes, such as a lighter or heavier harvest, could affect results. The clinic data undercounted Mixtec speakers before the new category was added. And the decision addresses hours only; transportation and language barriers remain, and a schedule change cannot by itself make a clinic welcoming to families who have had poor experiences with health services before.

References

Holmes, S. M. (2013). Fresh fruit, broken bodies: Migrant farmworkers in the United States. University of California Press.

U.S. Department of Health and Human Services. (2013). National standards for culturally and linguistically appropriate services in health and health care. https://thinkculturalhealth.hhs.gov/clas/standards

U.S. Department of Labor. (2022). Findings from the National Agricultural Workers Survey (NAWS) 2019-2020: A demographic and employment profile of United States crop workers (Research Report No. 16). https://www.dol.gov/agencies/eta/research/publications/findings-national-agricultural-workers-survey-naws-2019-2020