BCNU Update Magazine July-Aug 2013 by BC Nurses' Union

july/august 2013

nurses stand up for refugee healthcare

steward elections: members vote across the province

Vancouver Island nurses protest VIHA cuts

Update british columbia nursesâ&#x20AC;&#x2122; union

time to take

action on workload new nba contract language gives nurses the tools to ensure safe patient care

www.BCNU.ORG

medicare at the crossroads

Social determinants of health position statement pull-out

vancouver

pride parade August 4, 2013 Come join us! Walk with the BCNU bus or volunteer at the BCNU Pride booth at Sunset Beach where we will be testing blood pressure and blood sugars after the parade Contact Anna Fritch for more information: vanmetropride@gmail.com Join us on facebook: BCNU Marches with Pride 2013

update magazine July/August 2013

Update

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Contents vol 32 no 3

july/august 2013

UPFRONT

Check In

News and updates from events around the province.

12 Protesting VIHA’s Cuts

Health Authority takes nurses away from patients.

14 Provincial Election

What exactly did the BC Liberals promise?

15 Medicare at the Crossroads 2014 will be a defining year for public healthcare in Canada.

28 Attendance Management

Lions Gate nurses are speaking out.

30 Landscapes of Pain

Seventh annual nursing practice conference bring members together.

DEPARTMENTS

HERE WE GROW AGAIN BCNU Vice President Christine Sorensen, President Debra McPherson and Treasurer Mabel Tung break ground on the new BCNU Member Education Centre.

photo: Chris Cameron

feature

TAKING ACTION ON WORKLOAD

It’s time for nurses across the province to use the new Nurses’ Bargaining Association contract language to tackle understaffing and ensure safe patient care.

5 President’s Report 29 letters 32 Member profile 33 PrFs Work 34 YOUR PENSION 35 health and safety 36 council profile 37 Who Can Help? 38 off duty Social Determinants of Health

BCNU Posi tioN so ci al de te rm in

statemeNt

on an ts of he alth

Our pull-out on page 13 .

604.43

STAY CONNECTED

BC Nurses’ Union

Update MAGAZINE

our Mission Statement BCNU protects and advances the health, social and economic well-being of our members

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When you move, please let BCNU know your new address so we can keep sending you the Update, election information and other vital union material. Forward us your home email address and we’ll send you the latest BCNU bulletins and news releases.

and our communities. BCNU UPDATE is published by the BC Nurses’ Union, an independent Canadian union governed by a council elected by our 40,000 members. Signed articles do not necessarily represent official BCNU policies. EDITOR Lew MacDonald CONTRIBUTORS Juliet Chang, Sharon Costello, Gary Fane, Hanif Karim, Courtney McGillion, Debra McPherson, Art Moses PHOTOS Lew MacDonald, Doug Payette

CONTACT US BCNU Communications Department 4060 Regent Street, Burnaby, BC, V5C 6P5 PHONE 604.433.2268 TOLL FREE 1.800.663.9991 FAX 604.433.7945 TOLL FREE FAX 1.888.284.2222 BCNU website bcnu.org EMAIL EDITOR lmacdonald@bcnu.org MOVING? Please send change of address to membership@bcnu.org. Publications Mail Agreement 40834030 Return undeliverable Canadian addresses to BCNU, 4060 Regent Street,

Please contact the Membership Department by email at membership@bcnu.org or by phone at 604-433-2268 or 1-800-663-9991

Burnaby, BC, V5C 6P5

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president’s Report

Debra McPherson

NURSES MAKe AN IMPACT

photo: Chris Cameron

t was a special moment for those of us who attended the International Council of Nurses 25th Quadrennial Congress in Melbourne, Australia this May. Dr. Judith Shamian—a Canadian—had just been elected President of the Congress. An accomplished nurse, Judith was chosen by delegates to lead the ICN for the next four years. When taking office, every ICN President chooses a watchword to reflect the organization’s mission during their term. Judith chose the word “impact” to describe the ICN’s work in ensuring quality nursing care and sound health policies that affect the everyday lives of people and the health of populations. As I returned to Canada, I thought about Judith’s words and reflected on the many ways nurses are already making an impact on their profession, in their workplaces and in their communities. Right here in BC, nurses are having an impact on the quality of nursing care and patient safety. BCNU members are now beginning to work with their stewards to realize the promise of the new staffing and workload language contained in the Nurses’ Bargaining Association collective agreement. We are also holding health employers to account by ensuring they honour their commitment to minimize the impact on nurses’ shift rotations and job security with the move to the 37.5-hour workweek. We’ll be grieving any instance where they fail to create regular positions or maintain regular part-time members’ hours of work by incorporating casual and overtime hours into their rotations as required by the contract. I also thought about nurses’ impact in addressing the social determinants of health and the important advocacy we provide in working to remove barriers and increase access to quality healthcare. This was seen recently when BCNU delegates joined with some 800 nurses from across

update magazine July/August 2013

the country at the Canadian Federation of Nurses Union Biennium in Toronto. On June 5 we rallied in support of better mental health services and more education aimed at destigmatizing mental illness. And on June 19 BCNU members joined with healthcare professionals in 19 cities across the country to call on the federal government to reverse its shortsighted cuts to refugee healthcare. BC nurses have an opportunity to make an impact on public healthcare policy as we work with other progressive groups to secure a renewed 2014 health funding accord between Ottawa and the provinces. The heath accord represents the federal government’s commitment to what is arguably our greatest achievement as a nation: medicare. In July I will be travelling to Niagara-onthe-Lake, Ontario to join with progressive organizations who are gathering during the premiers’ meeting on healthcare. BCNU and many others will be calling on Ottawa to negotiate a renewed accord with the provinces to ensure that medicare is protected and expanded. Here in BC, our union will work to ensure that nurses have an impact at the provincial level. We congratulate the BC Liberals on their recent election victory and will be holding them to account to ensure that the promises they made to nurses and patients are kept. On Vancouver Island, nurses have already been rallying and fighting back against the Vancouver Island Health Authority’s plan to replace hundreds of nursing positions with care aides, which could put patients at risk. Finally, I want to acknowledge the impact that every individual BCNU member makes when working with fellow members to advance their shared interests. I especially congratulate all those who put themselves forward during our recent steward elections and thank all those members who took the time to cast a ballot. It’s shaping up to be a busy fall as we head into bargaining again next year. In the meantime I would like to encourage all of you to take advantage of the long days of summer, and I thank those members who will be working to ensure that everyone safely enjoys the warm days ahead. update

CHECK IN

News from around the province

Union breaks ground on new member education centre Fencing has gone up and hard hats have become de rigueur as the BCNU’s provincial office begins stage one of the construction process for the union’s new Education Centre. BCNU Executive Council members hosted a May 30th groundbreaking ceremony to mark the occasion. Invited guests included representatives from Burnaby City Council and the construction and architectural firms responsible for the project. BCNU President Debra McPherson led the proceedings, thanking the delegates for their contributions to the project and acknowledging the excitement

and anticipation in the air. She was joined by BCNU Executive Treasurer Mabel Tung and BCNU Education Coordinator Sheelagh Davis as she spoke of the future opportunities this expansion will bring to all members of the union. “I and all of BCNU’s elected representatives believe that BC’s nurses deserve the best. This building expansion will be a top-class site offering education facilities that create opportunities for our nurses to learn,” said McPherson. Cake and a light reception followed, allowing key stakeholders to meet one last time before construction begins. update

steward elections 2013

CASTING HER BALLOT Burnaby Hospital palliative care nurse Sue Or participates in the recent BCNU steward election.

Elections for BCNU Steward positions were held at workplaces across the province on June 11 – BCNU Day. “I would like to thank the thousands of members who participated in the democratic process and cast ballots for stewards at their worksites,” said BCNU Recruitment and Retention Committee Co-chair Debbie Picco. “Stewards are leaders at their worksites and guide co-workers on a host of work-related concerns – so it’s important that they are endorsed and supported by their colleagues.”

ATTENTION STEWARDS UPDATE YOUR CONTACT INFORMATION

It’s critical to keep your contact information up to date. All stewards – both new and returning – are reminded that they must complete a BCNU Steward Registration Form. Forms can be found at: www.bcnu.org/stewardelection

vital SIGNS

Numbers that matter

photo: Chris Cameron

Recent Canadian Institute for Health Information data on Canadian trends in regulated nursing between 2007-2011 show an increase in the number of regulated nurses eligible to practice. However, trends by employment status in BC show that casual employment figures for RNs in 2011 are much higher than those of other provinces.

49% BREAKING GROUND Representatives from the City of Burnaby, KMBR Architects and Planners, Smith Brothers & Wilson, and Andreas Aalhus, of Ritter Aalhus Construction joined BCNU’s Education Centre Groundbreaking Ceremony.

REGULAR FULL TIME Down 1% from 2010. National average: 58.6%

23.5% REGULAR PART TIME Down 0.5% from 2010. National average: 29.2%

27.5% CASUAL Up 1.25% from 2010. National average: 12.1%

update magazine July/August 2013

survey AND THE WINNERS ARE...The BCNU Steward Recruitment

and Retention Committee is happy to announce the winners of its recent activist survey contest. Hanne Gidora, a Quality Management Coordinator at HealthLink BC, is the winner of a $500 Future Shop Gift Certificate. Ethel Freeman, a steward at Pleasant Valley Health Center in Armstrong and Burnaby Hospital RN Lynn Lagace are both winners of $250 gift certificates. The Recruitment and Retention Committee wishes to thank all those members who took the time to fill out the survey.

making news

bcnu in the headlines

Defending harm reduction

When the federal government introduced legislation on June 6 placing conditions under which the health minister would allow supervised injection sites to operate, the Vancouver Sun spoke with BCNU President Debra McPherson. “How does this respect the Supreme Court of Canada decision that recognized these facilities save lives?” said McPherson, adding that the government appears determined to frustrate efforts to provide evidence-based healthcare services to people suffering from the disease of addiction. The Respect for Communities Act will require applicants of drug injection sites to consult with the community, provincial and municipal authorities and law enforcement officials, before setting up new facilities. Applicants must also document the site’s expected effect on crime rates, set up

procedures to mitigate local problems and demonstrate public-health reasons for needing such a site. McPherson said the proposed law “defies all evidence and makes it into an issue of prejudice against people with mental illness and addiction, misinformation and nimbyism - not in my back yard.” VIHA CUTS

When the Vancouver Island Health Authority announced that it would replace regulated nurses with care aides, radio station CKNW spoke with BCNU Vice President Christine Sorensen. “Patients that we’re seeing in hospital nowadays are far more complex, their acuity levels are much greater than they’ve ever been before, necessitating registered nurses and licensed practical nurses to provide good quality patient care, providing the nursing assessment that’s needed to determine their care needs.” Sorensen said the decision is based on cutting budgets, not patient care.

STANDING UP FOR REFUGEE HEALTHCARE BCNU members joined with healthcare professionals across Vancouver on June 17 to voice their opposition to cuts to the Interim Federal Health Program. Left to right: BCNU Treasurer Mabel Tung, Vancouver Coastal LPN rep Marlene Goertzen, Shaughnessy Heights Chair Claudette Jut, Gwen Nowe, Diane Hystad, Laurel Kathlow and North West Chair Sharon Sponton.

BCNU rallies against cuts to refugee healthcare

CNU members joined healthcare professionals in 19 cities from over 20 healthcare organizations across Canada in demonstrations June 17 – the National Day of Action in response to federal cuts to refugee healthcare. “Nurses cannot stand by while some of the most vulnerable in our society are denied basic healthcare services for urgent and acute medical needs such as prenatal care and childbirth, a heart attack, or if they are suicidal,” said BCNU Treasurer Mabel Tung at a rally outside the Canada Immigration Centre in Vancouver. “Cutting refugee claimants off from primary and preventative healthcare is an unacceptable way to address problems in Canada’s immigration system.” BCNU has strongly opposed changes to the Interim Federal Health Program (IFHP), which severely cut healthcare coverage for refugees in Canada. The cuts, which came into effect on July 1, 2012, now deny healthcare coverage for refugees unless their medical condition is deemed an issue of “public health and safety”. update

CHECK IN

photo: grant sorensen

BCNU DAY MARKED WITH A WINNER!

Making an impact BCNU Vice President Christine Sorensen and President Debra McPherson attended the International Council of Nurses 25th Quadrennial Congress.

Icn congress addresses equity and access

he International Council of Nurses 25th Quadrennial Congress was held May 1-23 in Melbourne, Australia. BCNU President Debra McPherson and Vice President Christine Sorensen were there. “The focus of this year’s congress was on issues of equity and access to healthcare”, says Sorensen. “It was an amazing experience to gather with more than four thousand nurses from 134 countries to share knowledge and discuss global health care priorities.” Sorensen says the ICN Congress plays a critical role in bringing together evidence, experience and innovations, and demonstrates how important nurses are to ensuring equal access and quality of healthcare for all. Elections were held during the meeting and Canadian nursing leader Judith Shamian was elected as the ICN’s 27th president. Dr. Shamian has held many leading national positions including President of the Canadian Nurses Association, Executive Director of Health Canada, President of the Registered Nurses Association of Ontario and Vice President of Nursing at Mount Sinai Hospital. Shamian’s academic work has focused on improving quality and access to health services and the social determinants of health. The International Council of Nurses (ICN) is a federation of more than 130 national nurses associations representing over 16 million nurses worldwide. Operated by nurses and leading nursing internationally, ICN works to ensure quality care for all and sound health policies globally. update

June 11th – BCNU Day – was an occasion for nurses to celebrate their profession, their solidarity, and their collective strength as members of one of the country’s strongest labour organizations. To help mark this event, BCNU Council developed the BCNU Day Quiz, an online quiz designed to test members’ knowledge of their union, and offering the prize of a brand new iPad Mini, just for participating. This year’s lucky winner was Lee Yong from the South Islands region. “This is amazing! I was having a lot of stress from work – I’m so glad! This has cheered me up,” she said. Don’t miss next year’s contest. Be sure to sign up to the Member Portal, and get access to this and other members-only communications.

BCNU President Debra McPherson addresses delegates at the recent CFNU Convention in Toronto.

CANADIAN FEDERATION OF NURSES FOCUSES ON MENTAL HEALTH BC Nurses joined with more than 850 of their sisters and brothers from across Canada during last month’s Canadian Federation of Nurses’ Biennial Convention in Toronto. The CFNU convention consisted of four days of training and business focusing on the future of nursing and other important healthcare issues. Featured speakers included Ontario Premier Kathleen Wynne and Canada’s former Governor General, the Right Honourable Michaëlle Jean. Delegates donated $33,769 to Partners for Mental Health to

assist with awareness, education and engagement campaigns to support the group’s mission to create “a social movement to transform the way Canadians think and act toward their own mental health, as well as toward people living with mental health problems or illnesses.” The CFNU represents close to 200,000 nurses and student nurses. The organization speaks to all levels of government, other healthcare stakeholders and the public about evidence-based policy options to improve patient care, working conditions and our public healthcare system.

update magazine July/August 2013

PHARMACARE TIE-IN

BCNU LAUNCHES GRIEVANCE OVER PRESCRIPTION DRUG COVERAGE

CNU has been hearing from many members who have reported difficulties obtaining coverage for needed medications that were to be covered under the so-called PharmaCare tie-in for coverage of prescription drugs under the NBA and FBA provincial contracts. The union was successful in getting the Health Employers Association of BC to agree to postpone the proposed February 1st implementation of the PharmaCare tie-in until June 1st. The delay was negotiated in response to members’ concerns and to give the union time to address our members’ issues and propose solutions to health employers. Many members’ problems resulted from poor coordination between Pacific Blue Cross and PharmaCare. In some cases, the delay of the PharmaCare tie-in implementation date to June 1 has allowed members to obtain Special Authority for medications or to transition onto generic medications. However, some members are continuing to have problems with their drug coverage. As result of the ongoing problems with the application of the PharmaCare tie-in, the BCNU has now launched a formal grievance against the HEABC. The grievance sets out numerous ways the employer has failed to apply what was bargained during negotiations last year and identifies many process issues involving lack of communication and coordination of drug coverage. If the parties can’t settle the dispute themselves, the union plans to arbitrate the issue no later than September 2013. update

WE WANT TO HEAR FROM YOU

Have you experienced any drug coverage issues that have not been resolved through the delay in implementation? If you have, please complete the BCNU PharmaCare implementation survey at the Member Portal on the BCNU website. If you do not have access to the internet, please call the BCNU PharmaCare Line at (604) 433-2268 or 1-800-663-9991 and press “2”. Please note, your information will be kept confidential and will only be used for the purposes of labour relations activities related to PharmaCare tie-in implementation issues.

Bottled water: something to think about this summer Members who are using BCNU’s 2013 Pocket Calendar will have noticed that it contains facts and discussion points about universal access to water. This year’s focus on water reflects BCNU’s commitment to ensuring that governments live up to their responsibilities to ensure fair access to safe water to all. The United Nations General Assembly declared 2013 the International Year of Water Cooperation. The assembly chose this year to highlight the importance of water to human health and address the growing crisis of access to water and the very real danger of future global water shortages for the nearly one billion people without access to safe drinking water. “BCNU recognizes that access to water is a fundamental human right and a key social determinant of health,” says BCNU Vice President Christine Sorensen. So where does bottled water come in? The market for bottled water is driven by large multinational corporations that have a stake in water privatization. As access to water becomes more restricted, its value as an economic commodity rises. In poor countries, the privatization of water

resources – promoted as a means to bring business efficiency into water service management – has instead led to reduced access as prices for essential water services have risen. In developed countries, a key marketing strategy of the bottled water industry has been to undermine consumers’ confidence in the safety of public tap water. These companies have benefited from media coverage of municipal water safety scares in rural communities that have often been the result of budget cuts. The vast majority of communities in BC provide their residents with some of the best water in the world. There are substantial health and environmental benefits from consuming municipal drinking water rather than bottled water. Municipal drinking water, unlike bottled water, is monitored and disinfected. Unlike bottled water, distribution and storage of municipal drinking water does not involve any risk of contamination. Sorensen encourages members to fill reusable bottles with tap water to keep hydrated this summer. “Bottled water has its place as an occasional convenience,” she says, “But it’s important for nurses to be aware of the larger health and environmental impacts of this product.” update

10 1

NURSING WEEK CELEBRATED

ACROSS THE PROVINCE BCNU members across the province celebrated National Nursing Week May 5-11. The union ran radio ads honouring our members starting May 6th, running right through to LPN Day on May 13th, and newspaper ads calling for BC’s nurses to be given a leading role in healthcare planning. Nursing Week’s theme this year was Nursing: A Leading Force For Change. The week coincided with the BC Provincial Election. Many members took the opportunity to call on candidates to listen to BC’s nurses and remind politicians they must fund the promise to hire over 2,000 more nurses to provide safe care in BC. 1. Nurses celebrate in Grand Forks (l-r): Interior Health LPN rep Janet Van Doorn, Jessie Renzie, Pat Zorn, Liane Burdikin and West Kootenay chair Lorne Burkart. 2. BCNU bus hits the Island (l-r): Kris Vanlambalgen, Jaycille Neville, Rachel Kimler, Linda Crocker, Brenda Hill Joanie Pinfold and Kelley Charters. 3. The BCNU bus was on hand for Cranbrook’s Sam Steele Day. East Kootenay executives and stewards (l-r): Lori Pearson, Helena Barzilay, Carlyn Cote, Patt Shuttleworth, Melissa Milhousen, Phoebe Ripley, Linda Blackmore, Joelene Mann, Barb Holm, Janice Canning and Amanda Gottinger. 4. BCNU bus stops in Abbotsford (l-r): President Debra McPherson, Kristy Mills, Denise Desorcy, Joanne Hamberg, Elvira Martens, Corinna Rachkowski, Fraser Valley chair Linda Pipe and Lobby Coordinator Helen Esau Ho. 5. Keep the Promise: Provincial election candidates including the NDP’s Jessica Vanderveen (l), the BC Liberal’s Ida Chong (centre) and Karen Bill (r) and the Green Party’s Jane Sterk (second from right) met with Victoria nurses Lindsey Sweet and Cynthia Reid. 6. The many faces of SUCCESS: Left, Sally Chiu, RN and Steward Coordinator and Judy Chen, LPN. 7. South Islands co-chairs Adriane Gear and Margo Wilton with Elaine Greer and Green Party candidates Susan Low and Branko Mustafovic. 8. BCNU bus heads north to meet up with members (l-r) Danette Thomsen, Tracey Jonker, Northern Health Rep. Louise Weightman, John McLeod (driver), Diane Wieler and Judith Dindayal. 9. Stand with Nurses: Nursing Week was celebrated by Nanaimo members Kris Vanlambalgen, Linda Crocker, VIHA LPN rep. Barry Phillips and Pat Stevenson. 10. Nurses at Royal Inland Hospital celebrated International Nurses Day with cake and coffee. Left front row sitting Chantal McFadden, Janet Ziebart, Cathy Wilcox, Tara Sowpal, Allison Dickenson, Maureen Grady, Joanne Dennstedt; Back Row Standing Carolyn Vossler, Mary Hunter, Chelsea Lee, Jenna Ziegler, Amy French, Jackie Drummond and Sandi Rogers.

the people

update magazine July/August 2013

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12 NANAIMO REGIONAL GENERAL HOSPITAL

with signs saying “Cutting nurses hurts patients”, “Nurses fear for patients’ safety” and “CDMR means ‘Care Doesn’t Matter... Really’”. Kelley Charters, a NRGH steward who helped spearhead the campaign, accused managers of introducing CDMR “in a most disrespectful and hurtful manner”, laughing at nurses and walking off the floor when nurses broke down in tears at the news. Board members said little at the meeting, deferring to VIHA’s acting CEO and president Brendan Carr. “What you’ve described is not what I understood, we’ll have to understand that better and we will.” Said Carr: “Our job is to continuously look at how we can change and do a better job for patients – we’ll listen and consider the evidence but even though we may not agree keep the promise! BCNU President Debra McPherson addresses members at a May 29th Nanaimo Regional General with you doesn’t mean we Hospital rally against VIHA nursing cuts. haven’t listened.” and knowledge of licensed and registered Carr insisted the plan is not designed to nursing professionals, not less. It’s outrageous cut costs. But when challenged why VIHA for VIHA to claim replacing nurses with care doesn’t simply add care aides and maintain aides will somehow provide ‘better care’.” nursing staff he replied: “we’d love to do that “This is all about VIHA cutting budgets, but we don’t have the resources.” not improving patient care.” In a letter sent to members of the public On May 29 nurses attending the Pacific who expressed their concerns, VIHA claims Rim regional meeting got on three buses the change is “to improve how care is deliven route to Port Alberni for the VIHA Board ered to patients”. meeting. “There are a number of Registered Nursing They crowded into the meeting room vacancies at Nanaimo Regional General

VIHA’S SCHEME TO CUT COSTS TAKES NURSES AWAY FROM PATIENTS

ancouver Island nurses have been fighting back hard against a health authority plan to replace hundreds of nursing positions with care aide positions in hospitals up and down the island. They call the scheme “Care Delivery Model Redesign”. Despite VIHA’s claims it will provide patients with better care, and that it’s not a cost-saving measure, budgetfocused health organizations have been introducing these types of changes across the country with a view to the bottom line. VIHA began rolling out the plan at Nanaimo Regional General Hospital with an announcement in late April. In June they served notice of a similar scheme at Royal Jubilee and Victoria General hospitals and intend to bring it to all other hospitals on Vancouver Island. In June, Alberta Health Services announced they would be replacing RNs and LPNs with healthcare assistants on medical and surgical units in major urban hospitals. “This scheme is bad news for patients and bad news for nurses,” says BCNU President Debra McPherson who spoke to a nurses’ rally outside NRGH. “Nurses welcome adding care aides to our teams. But they should not replace regulated professional nurses. Nanaimo nurses quickly got organized to hold unit meetings in the hospital, handed out leaflets to the public and took their message to all-candidates’ meetings during the provincial election campaign. BCNU encouraged nurses and the public to communicate with top VIHA officials. Says Jo Salken (nee Taylor) BCNU’s Pacific Rim chair: “VIHA admits hospital patients have greater needs for care these days. That means they need more of the skills

Please call or email VIHA`s top officials and tell them to halt the plan. Tell them your families and friends deserve better. Click the Campaigns tab at www.bcnu.org Email Dr. Brendan Carr, VIHA’s acting CEO and president at Brendan.Carr@viha.ca and Lynn Stevenson, executive vice president, chief nurse at Lynn.Stevenson@viha.ca Copy your emails to BCNU: jsalken@bcnu.org, mwilton@bcnu.org and adrianegear@bcnu.org Phone VIHA toll-free: 1-877-370-8699

update magazine July/August 2013

Hospital and we expect the implementation of the Patient Care Model will stabilize staffing at this hospital,” claims the letter. Salken says that in fact there are several vacancies for licensed practical nurses at NRGH as well, and that VIHA is ignoring letters sent by more than 40 nurses – both RNs and LPNs – seeking the opportunity to apply for those vacant nursing positions. Salken pointed out that VIHA originally developed the CDMR staffing model for use in long-term care facilities, not for acute care hospital units where patients are dealing with serious illnesses or recovering from serious injuries. They used time-and-motion studies to follow nurses with stopwatches and clipboards, noting and timing every task. Pacific Rim lobby coordinator Brenda Hill said she was followed with a clicker. “But when I walk a patient to the bathroom, I assess his gait, his neurological problems, his mental status, etc. So we do these tasks but they aren’t only tasks, they are done by a trained professional.” McPherson told the Board, “I don’t believe other professionals like doctors and dentists are being followed with a clicker and having their minutes and steps measured. They’re measured by outcomes and so should nurses, as professionals.” She challenged VIHA to share the results of its research. In fact, McPherson said, the evidence is overwhelming that outcomes deteriorate when hospitals reduce the number of nurses on a hospital unit, with the rates of mortality and morbidity going up including pneumonia, infections, bed sores and hospital re-admissions. update

VIHA’S “CARE DELIVERY MODEL REDESIGN”: REINVENTING THE 1990’S WHEEL It’s part of the toolbox health bosses open up when money gets tight and they think patients can do without nurses

ooking back through the years, it’s clear there’s nothing particularly ground-breaking or inventive about VIHA’s “Care Delivery Model Redesign” or other such projects being promoted by managers these days. In June 1995, BCNU published a special issue of Update magazine on hospital restructuring, describing precisely these kinds of schemes. “We’re told it’s ‘restructuring’ or ‘reengineering’ or ‘redesigning’ for the future,” the lead article in the magazine said. “... Call it ‘Patient-Focused Care’, call it ‘Program Management’ call it ‘Total Quality Management’ or just make up your own name. They’re all just plans to cut costs in ways that eventually eliminate jobs and erode the quality of patient care.” The issue included a story about St. Joseph’s Health Centre in London, Ontario, which hired as CEO the restructuring guru Philip Hassan, co-author of a book on continuous quality improvement (CQI). Hassan – who later served as CEO of Providence Health Care in Vancouver – immediately implemented CQI at the London Hospital, and in 1993 the hospital redesigned its long-term care section with a program called “Patient Care Partners”. They laid off 11 RNs and most of the registered practical nurses (the name for LPNs in Ontario). But the hospital rehired the RPNs as “patient care partners” and paid them $3.12 an hour less. They then brought the concept to acute care. In a perhaps haunting echo of what VIHA has done on Vancouver Island, the hospital sent assessors through the units to follow nurses and other workers minute by minute. Said the magazine in 1995: “Pie charts of the activity analysis were distributed, showing that RNs spent 45 percent of their shifts doing direct patient care, with 55 percent on ‘patient support work’, queuing, communication, idle time (breaks) and logistics (like speaking to family members, other staff, answering phones)”. The result was the replacement of nurses

with “patient care attendants” who were given 75 hours of general training and two weeks of unit-specific orientation delivered by the US hospitality corporation Marriot. According to Ontario Nurses’ Association local president Cate Black, many patients became uncomfortable “seeing the person who cleaned the toilets coming back a few hours later to give them a bed bath.” One patient died and one attempted suicide on the psychiatric unit where 16 RNs were cut to seven plus three attendants.” The buzzwords at the time were “multiskilling” and “cross-training” as well as “downsizing”, and the US-based company American Practice Management was one of the key players, promoting its “Patient Care Design Project”. Like most of these schemes it was all about finding ways to delegate work away from skilled professional nurses to lower-paid unlicensed workers. Combined with severe budget cuts in Ottawa and most of the provinces, the massive layoffs that resulted prompted many nurses to seek work elsewhere, discouraged young people from going into nursing, and helped cause the massive nursing shortage that became apparent by the late 1990s and into the 2000s. Strong resistance from nurses’ unions, as well as years of relatively solid economic growth and stable on-going federal healthcare funding reduced the pressure for de-skilling and restructuring schemes for a time. But with the economy now still struggling to pull itself out of the 2008 financial crisis, governments are once again targeting deficit reduction and severely tightening budgets. In BC, the provincial government wants to hold the increase in healthcare spending to three percent this year – and less for money going to the health authorities. Accordingly, health authority CEOs and their senior managers are dusting off their nostrums from the 1990s and are attempting to force them on healthcare workers and patients once again. update

14 provincial election

Re-election of bc liberals brings new challenges, opportunities

he surprise re-election of the BC Liberal government means new challenges and opportunities for nurses and for BCNU. During the recent provincial election campaign, the Liberals said addressing nurses’ workload concerns “is a priority”. While the Liberals made tight fiscal management, low taxes, balanced budgets and growing the private sector economy the cornerstones of their campaign, they also pledged continued support for nursing and for quality healthcare. And on the eve of the election campaign the government showed their support by passing Bill 18 into law, thereby uniting all nurses – RNs, RPNs and LPNs – in the Nurses’ Bargaining Association. The NDP promised to loosen the strings on social spending somewhat, though even their platform was not overly ambitious, nor, as it turned out, terribly inspiring to the average voter. The party’s outright opposition to Bill 18 and failure to send a speaker to BCNU’s convention this year gave nurses pause about a party with which some may have sympathized in the past. In the end, fear of the economic

unknowns under the NDP outweighed concerns over the Liberals’ record in government. With Premier Christy Clark back in power, it’s critical to review what the Liberals said and promised about healthcare and nursing in the election campaign. In their reply to BCNU’s questions to the political parties, the BC Liberals’ support for nurses was quite clear, especially the concerns identified during 2012 negotiations for a new provincial nurses’ contract. “Addressing the workload concerns that have been identified by nurses is a priority for the BC Liberals.” The party went on to say they “look forward to honouring” their contract commitment to hire 2,125 more nurses over the next four years. “In addition, we will work to create more full-time and part-time positions from casual pools. “Regarding funding, while we are striving for efficiencies in government operations, we are protecting spending in healthcare. Budget 2013 commits an additional $2.4 billion to health spending over the next three years.” Sidestepping a question about the creation of multidisciplinary healthcare centres, they touted their commitment to expanding the role of nursepractitioners. Their actual election platform emphasizes doctors, saying they will continue the $132.4 million GP for Me program, promising that “every British Columbian who wants a family doctor is able to access one by 2015.” As for seniors’ care, in Nanaimo nurses called on provincial election candidates to keep their answers to BCNU the promise during Nursing Week. From left: Kris Vanlambalgen, the Liberals pointed to NDP MLA Leonard Krog, Lynda Rose and Lori Yoachim.

the government’s Seniors Action Plan and the creation of the new Office of the Seniors Advocate “to make significant recommendations to government on how to improve seniors’ care and other systemic issues facing today’s seniors.” The Liberals avoided any mention of how they would implement the BC Ombudsperson’s recommendation on seniors’ care. The party platform talks about developing new options for care for people living with dementia, and working with the United Way to provide additional home support through the Better at Home program. Similarly, the platform plank on health professionals speaks only about doctors, pledging to expand the number of medical student spaces and encouraging new doctors to move to BC with loan forgiveness. Addressing the social determinants of health, the Liberals said the province could not afford universal child care but that they aim to create an additional 13,000 child care spaces over the next eight years. As for fighting for adequate federal healthcare funding, the Liberals said they “led the way by hosting a special Premiers’ meeting in Victoria last January to ensure provinces are united in pushing for a new and fair health transfer system that recognizes the uniqueness of provincial populations. The party made no mention of any commitment to medicare or national standards for care. Shortly after Clark named her new cabinet, BCNU was one of the first organizations to meet with new Health Minister Terry Lake, along with representatives of the Association of Registered Nurses of BC and the College of Registered Nurses. The three organizations published a joint statement during the election campaign that called for a provincial nursing strategy. For its part, the NDP named former HEU secretary/business agent Judy Darcy as Opposition Health critic. The composition of the provincial legislature remains largely the same as it was prior to May 14. However, there are many new faces at the cabinet table. In the months and years ahead the BCNU will continue to engage with these and other provincial politicians in order to advance our members’ interests. update

IT’S GOT US COVERED The red umbrella has become a symbol for public healthcare supporters across the country. It represents the universal coverage provided by medicare, Canada’s single-payer public health insurance.

medicare at the

crossroads This summer, premiers from across Canada will gather at Niagara-on-the-Lake in Ontario for a meeting of the “Council of the Federation”. This will be the last meeting of its kind before the 10-year federal-provincialterritorial health accord expires next year. The accord, negotiated in 2003, is part of a funding arrangement that represents the federal government’s commitment to medicare, Canada’s publicly funded single-payer health insurance program. Important healthcare policy issues, including federal funding arrangements, are on the agenda at this year’s premiers’ meeting. But instead of meeting with the provinces to

prepare the groundwork for a renewed accord, Ottawa has chosen to absent itself from the proceedings. The federal government has not hosted a First Ministers meeting on health since Prime Minister Stephen Harper was elected in 2006, and many observers have been concerned about the Conservatives’ commitment to medicare since they won a majority government in the 2011 federal election. This spring, the federal government cancelled funding for the Health Council of Canada, an organization that came out of the 2004 health accord negotiations that was created to track progress and quality in healthcare.

medicare at the crossroads

Critics say this is just the of the Canada Health Act, latest step in the withdrawal of allowing for-profit healthfederal leadership on healthcare. care to grow and doing next + Home & Community Care In December 2011, the Harper to nothing about user fees, + Pharmacare government announced plans to extra-billing and other viola+ Social Determinants cut federal health transfers to the tions of medicare rights. provinces by $36-billion after the If unchallenged, they say accord expires. the Harper Conservatives + Acute Hospital Care They say the signals are clear: will further weaken mediInvesting + the federal Conservatives have care, and pave the way for Primary Physician Care Money here done little to uphold single-tier, increased for-profit delivery Will Reduce public medicare, and the governwith higher costs and worse Costs here ment is now retreating from its quality; continued high traditional role in coordinating inflation in drug costs and social programs and services that seniors’ care; no guarantee create equity and improve social that community care will get progress. the boost it urgently needs; And yet Canadians want the cuts to medicare, resulting federal government to be at the in more two-tier care and EXPANDING THE MEDICARE UMBRELLA The solution to growing table with premiers this sumgreater financial burdens for healthcare costs involves investing in cost-effective services that mer. According to the results of a families; and further weakentarget the social determinants of health. This means funding services December 2012 Nanos Research ing of the Canada Health Act like home and community care with public health insurance. In the long run these investments will save money and save lives by taking survey conducted on behalf of and national standards. pressure off the more expensive acute hospital care sector. the Canadian Health Coalition, Meanwhile, groups that an overwhelming majority (88 profit from healthcare conpercent) of Canadians think that tinue to lay groundwork they vate sector, is a natural development of our the federal government should be taking a need by framing medicare as “unsustainhealthcare system.” Harper said provinces leadership role in securing our healthcare able” and outmoded, and presenting privawould be allowed to continue experiments system and ensuring all Canadians have tization as a “modernizing” solution.” A case “with private delivery within that model of access to it. in point is the Conference Board of Canada’s public health insurance.” “Canadians believe the federal governprogram called the Canadian Alliance for Observers are raising the alarm over the ment has a key role in making sure that all Sustainable Health Care. Launched in 2009, Canadians can get the healthcare they need,” federal government’s ignoring of violations it’s backed by insurance companies, banks, said Mike McBane, Executive Director of the Canadian Health Coalition.

Privatization on the federal government’s agenda

McBane and others point to research in Canada and around the world showing that a universal healthcare system is the fairest and most cost-effective way to provide care. And it is sustainable now and in the long run, regardless of claims that it’s not. But there are troubling signs that Ottawa is ignoring this evidence, and will allow provinces to use its health transfers for the funding of for-profit healthcare delivery. During the last federal election campaign, Prime Minister Harper stated: “We also support the exploration of alternative ways to deliver healthcare. Moving toward alternatives, including those provided by the pri-

SENIORS RALLY for expanded public healthcare in Victoria last summer. Investing in home and community care for seniors is one of the best ways to protect public healthcare and take pressure off the acute hospital care sector.

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big pharma, and medical products manufacturers—all of whom want a bigger share of the healthcare market.

Public innovation: the shift we need

Medicare advocates say that concerns over funding are distracting for both the public and policy makers, and they prevent the needed dialogue on how to improve public healthcare and envision its future. “The content, cost, and delivery of Canadian healthcare services have changed greatly over the past 50 years,” says BC-based health researcher Colleen Fuller. “One of the greatest changes in the past 15 years has been the need to shift focus onto community-based health services.” Fuller says that home and community care services such as home support, home care, rehabilitation, residential care, and end-of-life care are in many ways the future of medicare. “British Columbia already has a number of innovative local, small-scale initiatives that support people with significant health challenges who continue to live in their homes or in residential care. These innovations take pressure off in-patient hospital and emergency services.” It is now widely recognized that BC and other provinces must integrate primary care with community and home care in order to truly focus on prevention, reduce pressure on acute care, improve health status, and control costs. But these innovations are in jeopardy without an ongoing funding commitment from Ottawa. Says McBane: “We not only need a renewed accord, but one with funding conditions attached that will allow Ottawa to have a positive influence on healthcare policy and make the fundamental reforms needed to boost community care and other healthcare services beyond acute hospital and physician care.” With no restrictions on how the provinces spend the $30-billion a year they receive in federal health transfers, McBane says the federal role in healthcare is reduced to cheque-writing. Advocates say that’s not good enough. And they will be at this summer’s Council of the Federation meeting at Niagara-on-the-Lake to demand that premiers work to bring Ottawa back to the public healthcare table. update

UNIVERSAL PHARMACARE There are growing calls for improved access to prescription medicine

hen the C.D. Howe Institute published a report this June recommending that coverage for prescription drugs be included in our public medicare system, it didn’t come as a surprise to those who have been closely observing Canada’s spending on pharmaceuticals over the past 30 years. From 1980 to 2010, spending on pharmaceuticals used outside of hospitals in Canada grew more than 15-fold, from just under $2-billion to just over $30-billion. It’s now become the biggest unresolved problem in our healthcare system. It appears that everyone is paying more and getting less – and there is a growing chorus demanding action from the federal government. Employers have been saying for years that the costs of employee drug plans are becoming untenable—and they are coming to bargaining tables to demand that employees pick up and ever-greater part of the tab—or agree to limit their extended healthcare coverage. A May 2013 Ekos poll commissioned by the Canadian Health Coalition and the Canadian Federation of Nurses Unions shows that more than three-quarters (78 percent) of Canadians would support a universal drug plan to ensure that all Canadians are covered for medically necessary prescription drugs, with support for this idea being the highest in BC (83 percent). Steve Morgan is an Associate Professor at the University of British Columbia’s Centre for Health Service and Policy Research and a co-author of the C.D. Howe Institute report. Morgan notes that Canada is the only developed country with broad public healthcare system that does not provide universal coverage for prescription drugs. Instead, Canadian provinces allocate limited public subsidies for prescription drugs, leaving the majority of costs to be financed out-of-pocket and through private insurance. “All provincial systems in Canada involve considerable patient charges and multiple payers that are not responsible for financing patients’ medical and hospital care,” says Morgan. “The costs borne by patients are known to reduce the use of medicines that might otherwise improve patient health and reduce costs elsewhere in the healthcare system.” According to Morgan, by international standards, spending on pharmaceuticals in Canada is extraordinary. Our drug costs are higher and growing faster than all other countries in the OECD with the exception of the US. In contrast, spending on healthcare covered under the Canada Health Act – hospital care, including drugs used in hospitals, and medical care provided by physicians – has remained stable. Morgan says that when countries integrate pharmaceuticals into their healthcare systems they achieve better access to medicines, and greater financial protection for the ill, at significantly lower total cost than any Canadian province achieves. He recommends that provinces expand public pharmacare programs to all segments of the population with a specific focus on promoting access to medicines of proven value-for-money in our healthcare system. “Though the immediate effect [of the implementation of a universal pharmacare system] would be an increase in government spending, this would, over time, be more than offset by savings to patients, employers and individuals who purchase stand-alone private drug coverage,” he says. update

medicare at the crossroads

Advocates push for a renewed federal health accord 2014 will be a defining year in the fight for public healthcare

standing up for healthcare BCNU President Debra McPherson joins South Island Region’s Wendy Strong and Brenda Hill for a rally in support of a 2014 health accord in Victoria last July. Public healthcare advocates are gathering again this year for a shadow summit and mass rally in Niagara-on-the-Lake, Ontario. The event coincides with the planned July 25 Council of the Federation Premiers’ meeting on healthcare.

he current federalprovincial-territorial funding agreement on healthcare will end next year, but nurses have been active in their communities for well over the past two years, raising awareness about the importance of the federal government’s role in healthcare and the need for a renewed health accord. The Harper government’s lack of commitment to public healthcare was evident well in advance of the last federal election. In 2010 the Conservatives – then a minor-

ity in the House of Commons – sent a required review of the 2004 health accord to the unelected Senate, where it held a majority, rather than allowing the House of Commons Standing Committee on Health to conduct public hearings. And that year, key figures in the federal government called for a complete end to the annual $30-billion health transfer to the provinces and the removing of any federal role in the handling of healthcare. The government could not ignore healthcare during the May 2011 federal

election campaign. With healthcare polling as the number one issue for voters, Prime Minister Harper promised to continue the six percent annual increases in health transfers to the provinces. But come December, with an election win and a majority government, Ottawa announced that the annual increase in federal transfers to the provinces for healthcare will be cut by up to 50 percent beginning in 2016. Critics said the new funding formula, which ties the future federal funding directly to the rate of economic growth, will eventually return the country to where it was in 2002 — with Ottawa putting little into Medicare and the federal government losing all ability to enforce the national standards that Canadians expect. Healthcare workers and medicare advocates across the country wasted no time calling the government out on its dishonesty and questioning the austerity agenda used to justify the cuts. In January 2012 BC activists gathered in Victoria with allies from around the province and the country during a national premiers’ meeting on health sustainability, helping to lay the groundwork for a concerted national push for a renewed health accord. The federal government absented itself from the meeting. Activists called on premiers to stand together to keep Ottawa at the healthcare table and acknowledge that the provinces benefit from federal oversight and coordination in order to implement the national standards and programs Canadians need. Activists also took advantage of the meeting to promote a renewed 2014 health accord as an opportunity to strengthen the public healthcare that Canadians value so highly, while pointing to the threat of for-profit healthcare. “Our public healthcare system reflects

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core Canadian values of equality and equal access – we need a health accord that puts these values first,” BC Health Coalition co-chair Rachel Tutte told media gathered at the event. “Public healthcare is affordable and sustainable – it’s for-profit care that we can’t afford. The real driver of healthcare spending increases comes from for-profit health services not covered by medicare,” said Tutte, noting that any decrease in the transfer amount will effectively bankrupt the provinces and territories and open the

“BC nurses are concerned that Canadian healthcare will become increasingly fragmented and costly without leadership and investment from Ottawa.” BCNU President Debra McPherson

door to further private for-profit healthcare. The next opportunity to push for a 2014 health accord came during last summer’s Council of the Federation meeting in Halifax. Premiers from across the country met to discuss important healthcare policy issues, and again the federal government was conspicuous by its absence. Seven communities in BC were frontand-centre as part of the July 18 National Day of Action for a 2014 health accord. They were calling on the premiers to demand that the federal government get to the negotiating table. The BCNU Campaign bus was on-hand in Victoria as nurse-activists led a highly successful action in front of the Legislature building. “BC nurses are concerned that Canadian healthcare will become increasingly fragmented and costly without leadership and investment from Ottawa,” said BCNU President Debra McPherson.

“The current health accord must be renegotiated through transparent multilateral negotiations with all of the provinces and based on predictable, sustained funding with a commitment to a federally financed Canada Health Transfer equalization formula – this is the only way to protect the great gains in equality, access, fairness and efficiency that are the hallmark of our public healthcare system,” she said. Vancouver was also witness to a large red umbrella “flash mob” on the steps of the art gallery. “The absence of federal leadership shatters the potential of a renewed health accord to foster a sustainable and better performing public healthcare system, and puts inordinate pressure on the premiers to reform and improve public healthcare at a critical time,” said Dr. Vanessa Brcic of Canadian Doctors for Medicare, speaking at the event. She warned that the healthcare working groups struck by the provinces in January 2012 will likely be unable to effectively coordinate the information sharing required to improve access, quality and efficiency. Activists across the country are organizing again in advance of the July 24-25 Premiers’ meeting in Niagara-on-theLake Ontario. A mass rally and shadow summit has been planned. Council of Canadians Healthcare Campaigner Adrienne Silnicki is working to coordinate the events. “Time and time again Canadians have said public healthcare is their top priority,” she says. “Prime Minister Stephen Harper must be at the table and participating in the creation of the 2014 health accord to ensure that medicare is protected, strengthened and extended through a commitment to pharmacare, and national strategies on aging and mental healthcare services.” McPherson says 2014 will be a defining year for public healthcare. “We are at a crossroads,” she says. “Public healthcare is sustainable - it’s private care that we can’t afford. Now it is time to all make our voices heard loud and clear: Canadians treasure our universal, public healthcare system and want to see it expanded, not reduced.” update

Why a strong federal presence in healthcare is vital to Canada Without Ottawa’s coordination, Canadian healthcare will become increasingly fragmented and costly, and for-profit medicine will grow not because the public wants it, but because Ottawa allows and even encourages it. Leadership is about more than writing cheques to the provinces. Here are six reasons why: Successful nations are built on unifying infrastructure. Just like transportation, telecommunications, and judicial processes, healthcare is a basic precondition for full participation in society. It’s good for the economy. Businesses don’t have to design and fund complex health plans for their employees. Workers don’t have to worry that taking a job in another province will compromise their healthcare. Coordinated information sharing improves access, quality and efficiency. Leadership and investment from Ottawa is essential for creating high-quality, standardized information that improves clinical practice, policy and accountability. Provinces can’t improve their systems on their own. Vested interests are too powerful to allow large-scale change. Ottawa can play a major role in creating a more co-operative federation that overcomes obstacles to reform and bargains more effectively in the public interest. It reduces redundancy and bureaucracy in the system. Common process for reviewing the cost-effectiveness of drugs or assessing professional credentials and regulation could be greatly simplified and standardized with Ottawa’s coordination. It protects Medicare. Ottawa can stand up for single-payer, not-forprofit healthcare by requiring that its financial contributions reinforce this commitment across the country.

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time to take

action on workload NBA contract LANGUAGE gives nurses powerful new tools to tackle understaffing and ensure safe patient care

Pacific Rim nurse Laura Dickinson

Ask any nurse who has been working for more than 20 years and they’ll tell you about a time when they exercised greater professional autonomy and control over their practice. And they’ll likely recall a time when they experienced greater job satisfaction and positive patient outcomes. Clinical nurse autonomy and control over nursing practice is part and parcel of the responsibility nurses have to act according to their own judgement and provide nursing care within the full scope of practice as defined by existing professional and regulatory rules. But changes in healthcare delivery over the last two decades have eroded nursing autonomy while dramatically increasing nurses’ workloads. Since the 1990s, nurses have been dealing with a healthcare restructuring model based on such concepts as “lean” production and “total

quality management”, with nursing work perpetually measured by managers and becoming increasingly fragmented. Nursing leadership has also been attacked over this time, as program managers with large spans of control and little knowledge of nursing practice now exercise greater control and decision-making ability. Combined with budget cuts and the imperative to do “more with less”, this restructuring has resulted in heavier nurse workloads and loss of job satisfaction. It’s not surprising that nurses express greater anxiety, stress and feelings of being devalued by the system. Nor is it remarkable that BCNU members have consistently identified increas-

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READY FOR ACTION Vancouver Metro Stewards at recent training on the Nurses’ Bargaining Association contract replacement language. Stewards across the province are now ready to assist members with filing grievances to ensure that employers hold up their end of the bargain and implement the safe staffing they promised. Left to right: Ivy Velasco, Malou Cordero, Elsa Cabrera, Pam Gill, Michael Brodie and Irma Lacanilao.

The contract recognizes and respects nurses’ professional judgement to know what’s best for patients. And most of all, it respects nurses’ professional autonomy.

secondary to economic issues – especially since 2008. These included joint unionmanagement workload committees, Strategic Workload Assessment Teams and the Joint Quality Worklife Committee. Making progress using these tools has often been difficult and time consuming. Health employers in BC have been resistant to share decision-making power and involve nurses when making decisions about resource allocation and staffing, even though it affects their ability to deliver safe, effective quality care. It has become clear that the erosion of nurses’ professional autonomy and control of practice over the years has made it increasingly difficult to address workload issues. That’s why the new language in the Nurses’ Bargaining Association collective agreement is significant. ing workload and inadequate staffing as The union made a breakthrough in the the main source of their dissatisfaction. last round of NBA bargaining. The new Workload has been an abiding concern for staffing and workload language in the NBA the union (see article on page 26: Tackling collective agreement culminates years of Workload), and the BCNU has had signifiefforts by BCNU members and elected cant success in addressing the issue at the leaders to address the workload problem bargaining table. in a meaningful way. Now, for the first time But all too often, the mechanisms negoti- nurses have mandatory workload language ated to deal with workload were considered that requires employers to respect and

recognize their professional judgement in knowing what’s best for patients. BCNU President Debra McPherson is quick to stress the importance of the new contract language. “Now we have accomplished something unprecedented. Now we have the tools to truly make a difference, to improve workloads and nurses’ ability to provide quality care,” she says.

NEW LANGUAGE, NEW TOOLS

McPherson’s main message to members is straightforward: It’s time to start using the contract language that was bargained. She says the new language is a powerful new tool that can be used to ensure employers and the provincial government keep the promise they made at the bargaining table for safe patient care through safe staffing, and that it’s critical that nurses hold the employers to their commitments. In the workplace, the contract recognizes and respects nurses’ clinical decisionmaking ability to determine what’s best for the patients who are receiving care on their units and from their programs, while limiting managers’ rights to make decisions on their own.

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“

Now we have accomplished something unprecedented. Now we have the tools to truly make a difference, to improve workloads and nurses’ ability to provide quality care.

”

Debra McPherson, BCNU President

For the first time ever, employers will be required to provide backfill whenever acute and long-term care nurses are off from a scheduled shift, no matter what the reason. For short-term leaves, the employer will replace absences using casuals, regular parttime, float pools, redeployment of other nurses if circumstances permit, and regular full-time nurses. For facilities with more than 20 employees the language states “the employer will replace...” For facilities with less than 20 employees the language states “the employer will make all reasonable efforts to replace...”. For longer term leaves like vacation or maternity, nurses will be replaced and the employer will make all reasonable efforts to use regular relief/float positions or, in the case of long-term disability or maternity leave, create temporary positions. For sick calls, the contract requires nurses to be replaced, even if the employer has to pay overtime to do this. The only time more nurses won’t be called in is when the nurse in charge and the manager jointly agree that patient care needs don’t require it. The new contract also requires employers to call in more nurses when patient demand exceeds the normal capacity of an acute or long-term care facility or unit to meet patient care needs. Again, patient care needs will be determined jointly by the manager and the nurse in charge of the unit in question. The new contract language on patient care needs is notable: ‘Patient care needs’ includes, but is not limited to, an assessment of

number of patients, patient acuity, anticipated rate of patient turn-over, patient dependency and staff skill mix. Further, additional nurses will be called in using casuals, regular part-time, float pools, redeployment of other nurses if circumstances permit, or regular full-time. Translation? Employers are no longer allowed to impose such policies as “no replacement for the first sick call” or “no replacement if overtime pay is required.” For the union, the contract provides unprecedented access to information about staffing levels and nursing hours which it can use to support members in the workplace. And there are specific commitments to maintain existing nursing hours and to increase nursing hours well above that baseline. And most importantly, the new contract gives new respect and recognition to their professional judgement of nurses and their ability to know what’s best for patients. In effect, for the first time it recognizes nurses’ professional autonomy and control over their practice.

TAKING ACTION: THE TIME IS NOW

To make these contract provisions a reality it will be critical to be vigilant, be assertive, and be prepared to file grievances if the employer is not following the contract. McPherson says the time to use the new NBA contract gains is now. “Every member covered by the NBA contract has the responsibility and the ability to ensure the

new terms are enforced – they’ll be backed up by their BCNU stewards, their elected regional and provincial BCNU leadership and BCNU staff, who are all ready to take whatever steps are necessary to ensure the contract makes a positive difference for nurses and our patients,” she says. However, unlike previous workload provisions, the language is mandatory. Jessica Bowering, BCNU’s Director of Legal Services, says the new language – “Will” versus “May”– is significant. “It means there’s no escape clause about the employer’s ‘ability to pay’, or ‘budget problems’,” she says. “Employers see this as a significant interference with management rights and that’s why they want to ignore it. But their negotiators agreed to it and signed it. Now nurses are legally empowered to demand that managers follow it – no ifs, ands, or buts.” McPherson encourages nurses to be assertive when dealing with managers. “Make no mistake, your employer and many of your managers will do and are doing everything they can to ignore the contract and pretend it doesn’t exist.” “Your job as a BCNU member covered by this agreement is to remind them of the deal they signed and – together with your union representatives – make sure it’s followed,” she says. “Make them keep the promise they made for safe patient care through safe staffing.”

DON’T TAKE “NO” FOR AN ANSWER

McPherson reminds members that new staffing language is not only clear, but enforceable through the grievance procedure. To help nurses prepare for this responsibility, the union provided training to stewards this past spring. They are now ready to assist members in demanding, documenting and reporting any violation of the collective agreement. “If nurses aren’t replaced and you think they should be, demand answers from the charge nurse or from the manager,” she says. “Write it all down – document what’s continued on page 25

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EXAMPLE TO FOLLOW Fraser Valley region community nurses aren’t taking “no” for an answer and have begun a region-wide grievance initiative to ensure their employer provides them with vacation backfill. From left to right: Stephanie Streloff, Danielle Semple, Jennifer Roy, Cathy Saretske, Sandy Bourne-Wilson, Corinna Rachkowski, Jill Howarth and Helen Esau Ho.

HOLDING THE EMPLOYER TO ACCOUNT

Fraser Valley community nurses begin grievance campaign for vacation backfill Community nurses have long reported that failure to provide backfill while they are on vacation is a serious workload concern. That’s why the new Nurses’ Bargaining Association collective agreement language on backfill for community nurses is such a breakthrough. As of January 1, 2012, community health employers are required to replace community nurses for at least two weeks of vacation each year using regular relief positions. But no sooner had the collective agreement come into effect than nurses began hearing that managers were refusing to abide by the new language. Community nurses in BCNU’s Fraser Valley region were quick to respond to the news. They knew that filing grievances early was the best way to ensure their employers take the new vacation backfill requirement seriously. Danielle Semple is a public health nurse who works for Chilliwack Public Health. She has only been a steward since 2012 but she

jumped into her new role when she encouraged all of her colleagues to email their managers to request the vacation backfill. Semple says that every one of those nurses were emailed back and told that the vacation backfill language does not apply to public health nurses. “Nine out of the 14 nurses we have working here have now filed grievances,” she says. “Some of our members are on maternity leave and we will be working with them to request that they be backfilled when they do return from leave.” Semple says the backfill language is critical for public health nurses in her region. “With three people off on vacation it has been very difficult to run our programs and clinics. We don’t have time for deskwork, but if we had backfill it would be manageable. We also have to cover a lot of casual positions which are often not filled right away. It gets to be a little difficult.” Community nurses in the region are also concerned about the employer’s unclear

commitment on backfill for home health nurses. Helen Esau Ho is a Quick Response Case Manager at Abbotsford Regional Hospital. She’s also a steward and the Fraser Valley region’s Lobby Coordinator, Communications and Essential Services Rep. “Management has not made a clear commitment to provide backfill for home health nurses who are struggling to manage their caseloads as a result of program changes, system changes like the removal of intermediate care, and the introduction of the Resident Assessment Instrument—all of which have led to increased patient acuity,” says Esau Ho. Some home health nurses, such as home care nurses, are often provided with backfill, according to Esau Ho, but she says the new NBA language means that this can no longer be discretionary. “One manager in my area has said that there won’t be consistent backfill and that they will not meet the two weeks requirement.” Esau Ho says backfill is needed more than ever as health authorities keep patients in the community longer, leading to increased acuity but with no additional full-time case managers hired to deal with the additional workload. “When we go on vacation we do our best to pick out the highest risk clients a few weeks before we leave so we can stabilize them in order that the workload does not fall on our colleagues, because there is no backfill,” she says. “When we are on vacation our colleague is managing both our caseload and their own, and when we return all of this is waiting on our desks because people have only been applying band aid solutions while we were gone.” “New referrals have come in and they are all waiting for us when we return,” she continues. “Now we have to sit down and prioritize that, which can take one or two days, never mind actually digging into the work that we need to get done.” “In the meantime, perhaps one of our frail clients has landed in the hospital and we haven’t been able to prevent that admission

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action on workload

continued from page 23

BALANCING WORKLOAD WITH SAFE STAFFING Various breakthrough provisions in the Nurses’ Bargaining Association collective agreement will finally give nurses the tools they need to address workload – but only if they are used. BCNU is encouraging all members to take advantage of the new language to ensure they are replaced when needed.

because they haven’t had our support. Our colleagues are doing the best they can to cover for us, but they have their own caseloads,” she says. Esau Ho says that while language on community backfill can go a long way to addressing workload issues, it is also critical for ensuring that nurses have control over their practice. “Nurses know what their clients in their community need in order to have their chronic disease supported. I know that – that is my clinical expertise. When I am unable to meet those standards, then I know this will result in pressure on acute care services because the client deteriorates and lands in hospital, or it becomes a burden on families who then become frustrated with the system,” she says. Community nurses across the Fraser Valley region are continuing their grievance campaign and hope their effort will be an example for others to follow. Jennifer Roy is a public health nurse and steward working for Hope Public Health and Agassiz Public Health. She was motivated to act when she heard about employers denying community backfill at the Fraser Valley region’s meeting in April, and learned that other stewards had begun filing grievances. “I decided that they had paved the way and I wanted to support their grievance initiative using the single employer policy dispute process.” Roy has since been successful in getting all of her public health nurse colleagues to file

grievances. And she encourages other nurses to do the same. “I think it’s important that, provincially, nurses put forward grievances,” she says. “We have a democratic right to negotiate contract language but we also have a responsibility to uphold it in order for it to have legitimacy.” Semple agrees. “It’s definitely important to know the language and use it to file grievances because it shows the employer that we want these positions backfilled, otherwise they will think that we don’t really care,” she says. “But if a lot of our members file grievances it shows the employer and our managers that yes we do want this, and I think it’s important because if we don’t do it we might lose it in the next round of bargaining.” “We need this replacement language,” says Roy. “Burnout is real and we want to support our colleagues and ourselves. When we’re on vacation we need that support of extra staff who can backfill. There’s the need for worklife balance. You can’t do it all.” Esau Ho is reflective when discussing the significance of the new NBA language. “I think nurses in BC should be aware of the incredible achievement that BCNU has attained through this contract language, particularly regarding nurses’ clinical judgment and the ability to effectively address workload,” she says. “This is the first language of its kind in Canada, and it will be empowering when nurses use it to ensure employers implement the contract.” update

going on, including details of patient-resident acuity and how many nurses are normally on shift (baseline staffing) on your unit – then report it all to your steward and be prepared to file a grievance.” In all cases, don’t take “no” for an answer, she says. And don’t accept excuses about “tight budgets” or “not enough money”. Tell your manager the contract is clear – nurses will be replaced. The contract recognizes and respects the nurses’ professional judgement to know what’s best for patients. And most of all, it respects nurses’ professional autonomy. McPherson reflects on the importance of the new language given the broader legislative attack on workers’ rights and the austerity agenda that justifies budget cuts and the reduction in public services. She feels it’s important for nurses to leverage their position as regulated professionals and hold employers accountable to the contracts they sign. “The new language is a breakthrough,” she says. “No longer can flawed economic logic trump all other considerations when it comes to decisions about the provision of necessary services.” McPherson says that after many years of trying, it’s now up to BCNU members, with the support of the stewards, leadership and staff, to make sure the language is used to make a difference for nurses and their patients. “Nurses now have the authority to tackle understaffing and defend patient safety. It’s the best tool we’ve got to manage our workload and defend our professionalism and our practice.” update

feature

KNOW THE LANGUAGE. KNOW YOUR RIGHTS. Workload language education tools are coming to your mailbox! Nurses’ number one concern going into the last round of bargaining was clear: excessive workload and inadequate staffing. BCNU listened. And now we’ve gained powerful new rights on staffing. Under the new NBA collective agreement, the employer WILL: replace community nurses for at least two weeks of vacation a year replace Acute/LTC nurses on vacation or long-term leaves replace Acute/LTC nurses on short term absence (e.g., sick calls) call in more nurses when patient demand exceeds normal capacity (acute/LTC)

SAFE STAFFING NOW! Nurses rally outside Nanaimo Regional General Hospital to protest VIHA’s scheme to cut costs by taking nurses away from patients and replacing them with care aides. Employers are trying to hide behind the same cost cutting argument to deny them safe staffing rights that were bargained in the NBA collective agreement.

• • • •

We’ve developed quick reference cards you can use in your worksites to help remind you of what you have gained. LPN members: It’s important to support your RN colleagues and insist these NBA rights are respected. Pushing for proper implementation of this contract language is the best route to maintaining it in our next round of bargaining (2014) when LPNs will be brought under the NBA agreement alongside RNs.

KNOW THE LANGUAGE. KNOW YOUR RIGHTS. VISIT BCNU.ORG and SPEAK TO YOUR STEWARDS TO LEARN MORE.

Tackling Workload

New contract language requiring employers to replace and call in more nurses to meet patient demand follows years of effort by BCNU members and leaders The new staffing and workload language in the Nurses’ Bargaining Association collective agreement culminates years of intense and relentless efforts by BCNU members and elected leaders to address the problem in a meaningful way. One major milestone was BCNU’s first provincewide hospital nurses’ strike in 1989. Nurses emerged with the Professional Responsibility

clause as a way to document and seek redress for situations threatening patient safety and undermining nurses’ ability to meet their professional standards. PRFs became a key tool to highlight workload problems and occasionally secure solutions. But the process has always been marred by the fact it is not enforceable. All too often, employers cite budget issues as the reason they can’t improve staffing or maintain negotiated improvements for more than one or two budget cycles. In the mid-1990s BCNU’s education department helped organize a series of grassroots workload campaigns. Members in designated worksites developed new techniques for documenting excessive

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work demands, appealed for more staffing and learned effective forms of advocacy. The campaigns achieved some success, convincing management to adjust staffing here and there, and helped train up new teams of activists on the issue. During that period the union became increasingly influenced and inspired by the perspective and tactics of the California Nurses’ Association which had begun its long political campaign for nurse-patient ratios. Workload was the major issue during the 1998 round of provincial bargaining and the BCNU bargaining committee’s top priority was mandatory ratios of registered nurses to residents in long-term care. The employers were adamantly opposed, and the NDP government of the time responded by proposing a $60-million fund to create about 1,000 new nursing positions around the province. Unfortunately the Health Employers Association insisted the new positions be allocated throughout the system, rather than targeting them in high priority areas. Many BCNU members reported they hardly noticed a difference. In 2006 workload and patient safety were again top of the bargaining agenda. Polling showed members’ top priorities were both a wage increase and measures to address workload and improve practice conditions. But when they were asked to choose between the two – they overwhelmingly chose workload and practice solutions over wages. The 2006-10 contract did provide a significant wage increase; it also included an elaborate series of processes to address workload and practice conditions. Joint union-management workload committees would meet regularly at the regional and provincial level to examine problems and propose solutions, while Strategic Workload Assessment Teams (SWATs) would investigate the most immediate crises. A series of workload demonstration projects piloted a variety of solutions, with the nurse-driven Synergy Model for a workload and acuity measurement tool emerg-

ing as the union’s preferred option. The 2009 bargaining sessions that extended the contract another two years to 2012 added the Joint Quality Worklife Committee as a top level structure where the union would collaborate with senior health authority and government officials on solutions. Again, budget issues intervened to undermine progress, particularly after the 2008 global financial crisis. Employers preferred “lean” cost-cutting schemes or workplace restructuring packaged up with names like “Care Delivery Model Redesign” where regulated nurses are replaced by unlicensed workers. The independent assessment committees that were added to the PRF process in the 2006 contract produced some helpful recommendations. But in many cases budget concerns made long-term implementation problematic. That’s why BCNU put safe patient care through safe staffing at the top of the NBA bargaining agenda for 2012. Member surveys showed the highest level of discontent about workload ever recorded. And the worst problems were noted in hospital med.-surg. and emergency wards, in long-term care and among long-term care case managers in the community. The surveys also revealed that a serious contributor to the problem was employers who refused to replace nurses who were off from scheduled shifts. Often the reason was budgetary, with employers coming up with various policies against back-fill such as “never replace the first sick call”. During the last round of bargaining, the BCNU pursued a strategy of achieving many of the benefits of nurse-patient ratios by negotiating mandatory workload language that now requires employers to respect and recognize the professional judgement of nurses to know what’s best for patients. After many years of trying, it’s now up to BCNU members with the support of the stewards, leadership and staff to make sure the language is used to make a difference for nurses and their patients. update

TAKING ACTION ON WORKOAD: WHAT YOU CAN DO: In acute and long-term care Demand that nurses are replaced when they’re off on long-term leaves like vacation, maternity, LTD. The only exception is when services are reduced Remember: “The employer will make all reasonable efforts to backfill vacation using regular relief/float positions” (or temporary postings in the case of maternity or LTD) Demand that nurses are replaced when they’re off on short-term leaves, like sick leave Demand that more nurses are called in when patient load exceeds normal unit capacity Make sure your charge nurse knows about acuity and complexity and has all the details about the difficulties with your workload In the community Demand that all nurses are replaced for at least their first two weeks of vacation, not just those working in home care (the only exception is when a service is temporarily shut down)

a matter of respect Lions Gate nurses harsassed and demeaned by health authority’s attendance management program “I was mad, angry,” said Lions Gate Hospital RN Katharine Cabling, recalling how she felt after her first attendance management meeting. Cabling is one of many Vancouver Coastal Health employees who have been subjected to the health authority’s “Attendance and Wellness Program” (AWP). She has worked at Lions Gate since 2004 and received her first letter last year. “You don’t know what to expect from the meeting so it was very stressful,” she says. “I thought, ‘Why are they only looking at sick leave and not focusing on performance at work?’ I felt intimated and punished.” Since entering the program, Cabling says it has affected her ability to do her job. “Now I feel like I’m being watched and I’m watching myself. I try not to call in sick but often end up working anyway – and my colleagues can attest to this,” she says. Cabling, who has always taken fewer sick days than the provincial NBA contract allows, says the reason for her sick leave is simple. “I have kids. My youngest is 10 and a half and when he gets sick, I often catch his cold and get sick and -- I can’t prevent that.”

“I was horrified – absolutely horrified that they decided to put me into the AWP. I felt harassed.”

Since health authorities first began implementing attendance management programs, the union was quick to put them on notice. “These attendance programs are insulting to nurses, damaging to morale and creating toxic workplaces because they assume wrongdoing and threaten harsh penalties,” said BCNU President Debra McPherson. “I want to remind members that under our professional standards, we have a clear responsibility not to report to work when sick, in order to protect patients.” BCNU has since proceeded to arbitration to challenge Vancouver Coastal’s Attendance and Wellness Program, and hearings are ongoing. In the meantime, arbitrator Vince Ready ruled earlier this year that the health authority must end the practice of denying overtime, reducing hours or threatening to fire workers for illness or injury. The ruling came in response to a grievance launched last year by

Denise Dimock

EXPECTING RESPECT Lions Gate nurses Katharine Cabling and Denise Dimock are not happy with the arbitrary and demeaning treatment they have received in the Attendance Management Program at their workplace.

other health sector unions but which is separate from BCNU’s arbitration. “Ready’s decision represents a victory and we anticipate that all other health authorities will follow the ruling,” said McPherson last January. BCNU’s hearing will continue to address outstanding issues, including the conflict between AWP and the negotiated Enhanced Disability Management Program. The union has argued that the EDMP is the appropriate venue to address absences related to illness or injury. Nurses at Lions Gate report that managers continue to monitor and intimidate them despite having lost the ability to arbitrarily apply the punitive measures of their program. They say managers continue to schedule AWP meetings and persist in making sick leave an “issue” if it’s above the arbitrary threshold of “average” sick leave taken by all employees. Denise Dimock also works at Lions Gate. The palliative care

nurse says she was stunned when she was called into an AWP meeting. “There were five red marks on their sheet and I said, ‘You have got to be kidding. I’m being called in because I have taken five sick days in a year? I was horrified – absolutely horrified that they decided to put me into the AWP. I felt harassed.” BCNU stewards are reminding management and our members that the Nurses’ and Facilities Bargaining Association provincial contracts allows up to 18 days a year for legitimate illness – an entitlement fairly bargained that the union intends to see respected. However, employers maintain the right to schedule AWP meetings. Dimock says she has difficulty comprehending the effectiveness or purpose of the meetings. “Your manager, your shop stewards and an AWP person is there who asks everyone to look for patterns in your sick

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Open forum for bcnu members

leave that everyone agrees are not there” she says. “It’s very childish and patronizing.” “They handed me a brochure on eating properly and how to stay healthy and I said, ‘You can keep your brochure. I exercise three hours a day – I’m an exercise fanatic – so I don’t need you to tell me how much I need to exercise thank you very much’.” Dimock feels that AWP is insulting to her profession. “This is an issue that I have a responsibility to deal with as a health professional,” she says. “The real issue here is the stress from my job, both mental and physical, when we are short-staffed. I can deal with my manager directly about this. Some outside consultant is not going to know how to help me.”

“One day we worked without a unit clerk and it was absolutely horrendous and then we wonder why we get sick – we are exhausted,” she says. Dimock feels that AWP is a waste of nursing time and resources, and that it puts pressure on nurses’ professional standards. “We have a responsibility not to report to work when sick, in order to protect patients,” she says. “Now everyone is afraid and people are coming to work sick because they don’t want to phone in sick and get in trouble,” she says. “Managers think they are winning because the absentee rate has fallen. But really what’s happening is people are coming to work sick and making everybody else sick.” update

YOUR LICENSE YOUR PATIENT YOUR HEALTH KNOW YOUR RIGHTS 1. You do not have to have a personal discussion with your manager about your private medical information. 2. Your medical care, your diagnosis and treatments are not public information. 3. You can ask to have all questions referred to your union representative. 4. Your Provincial Collective Agreement gives you up to 18 days a year off for legitimate illness, a right negotiated fairly over a decade ago, agreed to freely by management, and ratified by our members. 5. As a licensed nurse, you have a professional responsibility to your patients and your own health not to work when legitimately ill. IF YOU ARE SUMMONED TO AN ATTENDANCE MANAGEMENT MEETING: 1. Do not attend without bringing your union representative along to protect your rights. 2. Recognize that managers may show concern for your health, but they’re there to send you a message that you’ll be disciplined if your sick time is above average. 3. If you don’t know who your BCNU Steward is, call us at 604.433.2268 or toll free 1.800.663.9991.

letters Adoption leave ought to be treated like parental leave

I am currently on leave after recently adopting a 2-year-old child. The adoption was a very long and expensive process – but our patience has paid off, as my husband and I are so grateful and happy to have our new son. While on adoption leave I am only entitled to combined 35 weeks parental leave (to share with my husband). This is the Employment Insurance (EI) benefit only with no topup from our employers. EI benefits are quite minimal, come with a two-week application period with no coverage and a cap on the maximum weekly amount payable. I currently receive $498 every week – a drop in the bucket for someone who has worked as a Registered Nurse for over 20 years. This makes it difficult to make ends meet – especially after the adoption costs we have incurred. As I shared the news of our adoption with colleagues at work, three themes became evident: 1. My colleagues were surprised adoption leave was not treated like maternity leave – many felt I was being penalized for not having my own biological child. 2. They agreed that adoption leave should allow more time off for bonding and attachment with the new child. 3. Quite a few colleagues have been adopted or have adopted children of their own. BCNU members need to address this issue with our stewards and regional chairs. We need to request that adoption leave be covered by the same language governing maternity leave in our collective agreement. Mandy Tanner, RN North Vancouver Editor’s note: Paid adoption leave language has been put on the negotiating table during numerous rounds of bargaining. This reflects members’ support for adoptive parents. However employers have continually opposed paid adoption leave. Please join our open forum and send your letters to: lmacdonald@bcnu.org.

Education practice conference

MAPPING THE LANDSCAPE OF PAIN: BCNU’S SEVENTH ANNUAL NURSING PRACTICE CONFERENCE HIGHLIGHTS EMPATHIC IMAGINATION

n the first day of BCNU’s seventh annual nursing practice conference author Richard Wagamese made his way to the stage, empty-handed. Standing at the podium, he informed the BCNU members in attendance that, although invited to read from his best-selling novel, Indian Horse, a narrative of hockey, winter, and Aboriginal identity, he intended to go off script and tell another set of stories – those from his life. Wagamese then recalled his abandonment and brokenness, and of the painful process of reconstructing the pieces of a shattered life. He also told participants of his encounters with healthcare institutions,

and how they were invariably instances of “being treated but not being cared for”. In other words, he got what he required in the moment but not what he needed to prevent the recurrence of future moments. Cycling through emergency departments with exhausting regularity – his body overwhelmed with the alcohol he had consumed – Wagamese was in need of someone to listen to and recognize the complex humanity of the person lying in pain before them. Elaine Scarry, Harvard scholar and author of the Body in Pain, writes that the pain of another – regardless of who they are, or how close one might be to them – appears to have “the remote character of some subterranean fact, belong-

Nurses and healthcare workers must resist the “stylistics of universality” that discourages them from listening and being present when they encounter pain and suffering.

ing to an invisible geography”. How do nurses and care givers, find their way into this invisible geography? This was the fundamental question posed by Mapping the Landscape of Pain, held May 14 – 15 at the Sheraton Vancouver Airport Hotel in Richmond. It was a question conference participants found many opportunities to explore over the two-day event. In her opening remarks, BCNU Executive Councillor, Deb Ducharme reminded participants of Robert Melzack and Warren Torgerson’s 1971 Mcgill Pain Index. This tool, she said, offered words such as “throbbing”, “flickering” and “lancinating” to describe the experience of pain, creating a common language that allows individuals to locate themselves and in so doing to be found by others – nurses, doctors and healthcare practitioners. Ducharme said that when encountering a patient in pain, healthcare practitioners must “discover who they are, what stories they possess, and to find a way of offering some solace”. This requires not merely a skilled repertoire of knowing – anatomy, physiology, the brain, nociceptors, pharmacology etc. – but a repertoire of “empathic imagination” – one that allows nurses to recognize the self in pain when they encounter them: on their wards, in their units, in their communities and households – and to reach out. Echoing Scarry, Ducharme encouraged members to cultivate their knowledge and empathic imagination in order to illuminate this so-called landscape of pain.

Dr. Brian Cairns, professor of neurophysiology at UBC told participants about the peripheral and central mechanisms of pain within the human brain. Cairns said the lateral thalamus processes sensory and discriminative aspects of pain and relays these to the sensory cortex for perception. He explained how the response to pain is controlled by the medial thalamus, which projects to limbic structures involved with emotion and aversion, and the amygdale which produce stress and anxiety.

Cairns said researchers have discovered that the experience of chronic pain results in the loss of grey matter in the brain – but the process can be slowed when pain is adequately addressed. Karen Garret de Luna, visual artist, dancer and mathematician offered conference participants another way of accessing the invisible geography of suffering. Her Illuminated Body – a series of embossed, monochromatic self-portraits – revealed both visible and invisible illnesses and injuries as seen on the skin, while focusing on the fragility and resilience of

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“I was lonely for the sky, for the feel of it on my face” – Indian Horse, Richard Wagamese

the human envelope. Projecting an image of her eye the screen, Garret de Luna read an incantation: “A few years after menarche, I started having migraines. This kind of headache can last anywhere from four hours to three days. Inevitably unilateral, I imagine an ice pick being driven through the base of my skull to the back of my eye socket. When the migraine breaks, it feels like an egg has been cracked on the top of my head, sending a tingling sensation over my scalp and down my spine.” Garret de Luna’s contribution

The illuminated body is a series of embossed, monochromatic self-portraits that reveal both visible and invisible illnesses and injuries as seen on the skin, while focusing on the fragility and resilience of the human envelope. Presented to nursing conference participants by Emily Carr instructor Karen Garrett de Luna (www.delunatic.net).

suggested that there are many doorways into the invisible geography of pain. Monia Mazigh told participants a harrowing story of her own pain and suffering triggered by the 2002 rendition of her husband Maher Arar to Syria. Deported by United States government while visiting the U.S., the Canadian authorities refused to assist Arar, who was tortured and held in Syria for a year before his release. Mazigh told of her struggle to bring her husband home and to keep herself and her children intact. Through it all she said that she maintained a steadfastness and dignity, attuned to her own pain and that of others in similar circumstances in North America and around the world. Susan Letvak*, University of North Carolina nursing professor, reminded conference participants that far too many nurses permanently inhabit the landscape of chronic pain. Her research showed that as many as 70 percent of nurses are working with musculoskeletal pain and that nearly one in five experience depression. She said that this has a serious impact on the delivery of care and healthcare budgets – with the impact on nurses themselves being incalculable.

Arthur Frank, professor of sociology at the University of Alberta and author of The Wounded Storyteller: Body, Illness, and Ethics and The Renewal of Generosity: Illness, Medicine, and How to Live, closed the conference by leading participants in a reflection on the two days they shared together. Interweaving narratives from the plenary presentations and the world of myth and literature with reflections on his own experiences with pain, Frank told nurses of the implicit and explicit value of listening to the stories of those individuals they encounter. He said it is important for nurses and healthcare workers to resist what he called the “stylistics of universality” that discourages nurses from listening and being present when they encounter pain and suffering. The task for healthcare workers, he said, is to ask what is truly needed when they are often encouraged by medical discourse and employers to administer what is merely required. In so doing they can engage in “subversive” acts of empathic imagination and range into the invisible geography of pain and suffering. update *Visit www.bcnu.org to view an in-depth interview with Susan Letvak, where she tells BCNU about her research.

Member Profile your colleague close-up

HEALING JOURNEY BURNABY RN DIANE MacCORMACK ORGANIZES OVARIAN CANCER WALK OF HOPE

ovarian cancer Overlooked and Under-diagnosed The Facts 2,600 women

are newly diagnosed each year in Canada. Every year 1,750 Canadian women

die from ovarian cancer. Late detection

results in five-year survival rates of less than 30%.

“I was totally unaware of the signs and symptoms,” says Diane MacCormack when talking about her diagnosis of ovarian cancer in 1999. Originally from Ontario, the mother of two and nurse of 45 years worked in Michigan and returned to Canada to work as a community health nurse in promoting awareness HealthLinkBC RN Ontario and Alberta Diane MacCormack wants women to think before coming to BC about the risks of ovarian cancer. in 1992. Despite a rich nursing career, annually. This year over 1,700 MacCormack found that Canadian women will die nothing could prepare her for from the illness. Non-specific the news that she had cancer. symptoms and the absence of a “Life is never the same after a screening test mean that there diagnosis of ovarian cancer,” she is a five-year survival rate of less says. “Despite my early diagthan 30 percent. nosis and very good chances MacCormack responded to for long-term survival, in the her illness by using the talent beginning I still found myself and skills she learned as a nurse. focusing on the negative side of “I have been doing adult health the statistics.” education since the early 1980s Ovarian cancer is one of the and felt there was a need to raise most fatal women’s cancers. In awareness.” Canada some 2,500 new cases “After I was diagnosed I of ovarian cancer are diagnosed started looking for organiza-

There is NO effective screening test

for the early detection of ovarian cancer. A Pap smear does NOT detect ovarian cancer

—it detects problems with the cervix. The HPV vaccine helps prevent cervical cancer, NOT ovarian cancer.

JOIN A BCNU OVARIAN CANCER CANADA 2013 WALK OF HOPE TEAM

You can create or join a team from your workplace and join others at locations across BC for the 12th annual Ovarian Cancer Canada Walk of Hope on September 8th. Walks are being organized in Duncan, Vancouver, Abbotsford, Kamloops and Victoria. You can also organize a virtual walk in your own community. Talk with your friends and visit: www.ovariancancerwalkofhope.ca

tions to get involved with and became a volunteer with the Ovarian Cancer Alliance – started by two women in Vancouver,” says MacCormack. “I worked on the first ovarian cancer support group in Vancouver, looking at education and coaching newly-diagnosed women.” Wanting to raise broader awareness of ovarian cancer, the group organized “Walk for Hope” with Ovarian Cancer Canada. Now in its eighth year in BC, the walk has raised just under $1 million to support research, education, awareness and support for women who are learning how to live with a chronic illness. All of the money raised stays in BC. MacCormack says Ovarian Cancer Canada is the only national organization that speaks to the issue of ovarian cancer uniquely and she encourages other nurses to participate in the walk this year. “I want nurses to have the awareness that I didn’t have,” she says. If I can save or extend one person’s life – like my life has been extended – I think it would be awesome.” update HOW CAN I PROMOTE AWARENESS? Host an information session Ovarian Cancer: Knowledge is Power at your workplace or home Provide Ovarian Cancer Canada resource information at your regional meeting or to your family and friends. Call the BC Regional Office of Ovarian Cancer Canada at 1-800-749-9310 or visit www.ovariancanada.org to book your information session or booth today.

Q&A

PRFs in the workplace

An interview with PRF steward and Simon Fraser region PRF resource representative Cam Ward Professional Responsibility Forms are the only tools that nurses have to raise issues in the workplace that affect their nursing practice. The PRF steward at your workplace plays an important role in helping members address their practice concerns. Ridge Meadows Hospital RN Cam Ward is one of the many BCNU stewards who is drawn, as an advocate and a professional, to promote and support members’ use of the PRF process provided for in their collective agreement. UPDATE When did you start serv-

ing as a steward? WARD I’ve been a steward since I began working at Ridge Meadows hospital in Maple Ridge eight years ago. My final preceptor was a steward, so as soon as I finished school she sent me to the BUS (Building Union Strength) course and basic steward course. I also come from a union family – both my parents are in a union so it’s a natural thing for me. UPDATE What do you enjoy about being a PRF steward? WARD I like working as a PRF steward because there’s more of a problem-solving process versus straight contract interpretation, where it’s often our opinion versus the employer’s. There’s a chance for nurses and managers to come to a consensus sitting around a table versus having labour relation officers and human resources negotiating things. The nurses who are having the issues are more involved in the

problem-solving process. We tell people it’s a member-owned process. They’re not handing things over to someone in the union office to sort out. They are at the table every step of the way and the member decides when a solution is appropriate. UPDATE What kinds of PRF issues are members dealing with right now? WARD Right now, our community nurses are dealing with workload: not being replaced, visits being deferred and caseloads that are too heavy. I’m also seeing inappropriate skill mix and not having the right balance of RNs and LPNs on the ward. Being short-staffed and having patients in the hallways are also common themes with PRFs, I find. Working short-staffed and hallway nursing - these are all issues we are trying to deal with using our new NBA contract language. The PRF process helps bring those issues to the union office and to the awareness of

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our executive and council. UPDATE What does being a regional resource representative involve? WARD I work a lot with staff in the provincial office. We discuss the contract changes that have been negotiated with health employers and how to get that information out to stewards. Acting as a resource person also means working with worksites throughout the region to see if they are having any issues with the PRF process. I also help in the establishment of PRF committees, ensuring members are familiar with the committee structure and roles. Having the committees ready is important, because there’s no point in a member filing a PRF if we can’t deal with it in a timely manner. UPDATE What does your region have planned for the fall? WARD Our region has quite a big education plan for the fall – educating our members and stewards and working with our steward coordinators and just getting the process up and running. We’ll be focusing on informing members about the changes to the NBA language and getting our members to sit down with their managers and raise the practice concerns they’re having at their worksite – be it with workload, or patient and nurse safety. We want to get our members to speak and up for themselves and not continue to normalize the abnormal by accepting things the way they are. I think the new language sets more timelines and there is a definite end point to the

PRF process versus the ongoing set of meetings we often seemed to be having in the past. UPDATE What do you have to say to members who are unaware of the new NBA workload and staffing language? WARD We have to use this new language. Why negotiate it if we are going to carry on the same way? We’re still not seeing the changes we need. We’re not seeing nurses being replaced. Units are still working short and working with patients in the hallway. We need to work with members who may not be actively involved with the union and encourage them to speak up and use the language. It’s a struggle but it’s worth it. update

Your Pension securing your future

RETENTION INCENTIVE PAYMENT KNOWING YOUR PENSION RIGHTS Eligible members may qualify for an annual retention incentive payment of up to $5,000 Are you working in a regular position (full-time or part-time) but have already maxed out your pensionable service (no longer able to contribute into the plan)? Or have you retired and returned to work in a regular position while drawing a pension? If you answered yes to either of those questions you may be eligible for an annual retention incentive payment from your employer. Pension rules stipulate that members with 35 years of pensionable service can no longer make pension contributions. Members who are receiving pension income from the plan are also no longer permitted to contribute to it. In 2006 the Nurses’ Bargaining Association negotiated an

incentive benefit with health employers for those members who are working in a regular position and do not qualify to contribute to the pension plan. This benefit incentive (Appendix P in the green book or online at www.bcnu.org) was designed to retain senior nurses and address nursing shortages. The contract language states: nurses eligible for the incentive payment will receive an amount equal to what the Employer would contribute to the pension plans (MPP & PSPP) based on eligible earnings over the preceding year. The amount you may be eligible to receive depends on your current salary and the amount your employer would have normally contributed into your pension plan. For example, an eligible DC1 nurse with nine years of experience and currently working at a full-time regular position may qualify for an approximate $5,000 annual payment. The incentive payment is due to be paid to eligible members after December 31st of each year. Each eligible employee can have their employer make the payment directly into their RRSP, or choose instead to be paid directly. After reviewing the collective agreement language, members who believe they are eligible for the incentive payment should contact their employer immediately. update

Have you applied for the retiree benefit program plan?

BCNU and other members of the Nurses’ Bargaining Association have developed a fund to provide for inflation protection and benefits for retirees. The current program offers a subsidy for the Medical Services Plan premium to eligible retirees in the Municipal, Public Service and Canadian Blood Service Pension Plans. Visit the BCNU website and download the application form today!

You may also request a copy of the application, including a complete set of instructions, the eligibility rules and the application form: • Call 604 433-2268, or toll free 1 800 663-9991 and ask for Local 2108 or • Send an email to retireebenefit@bcnu.org. Be sure to include your full name and mailing address.

update magazine July/August 2013

Health & Safety

in the workplace

MEMBERCENTRED AND PROACTIVE NEW ENHANCED DISABILITY MANAGEMENT PROGRAM SUPPORTS NURSES STRUGGLING WITH ILLNESS OR INJURY

EDMP is currently available for nurses under the NBA, including RNs and RPNs. EDMP has recently been negotiated for LPNs and the union is working to implement the program for LPNs at the earliest opportunity.

Langley RN Glenda King has benefited from the new Enhanced Disability Management Program.

Glenda King wasn’t sure what would happen after she went on medical leave in July 2012. “Up until that time I had almost never been sick – so it was a huge transition. Being sick and not being able to work was very foreign to me,” she says. Given the situation she found herself in, the clinical resource nurse for palliative care at Langley Memorial Hospital says she is grateful for the assistance she’s received through the new Enhanced Disability Management Program. “I was hooked up with the

union’s EDMP staff. They gave me contacts and sent me emails to ask how I was doing,” she says. “That was nice because you feel quite isolated when you’ve worked all your life and suddenly you are not at work. It’s a strange feeling and makes you realize how much your identity is attached to your work.” EDMP is a customized disability management program for union members with an occupational or non-occupational illness or injury. Jointly negotiated by the Nurses’ Bargaining Association and Health Employers in 2010, BCNU

enhanced disability management program

is now working with Health Authorities to fully implement this province-wide program. Based on best practices, EDMP enhances the support provided to nurses struggling with illness or injury by addressing barriers preventing them from returning to work. It sets out regular reviews and monitoring of individuals and is intended to provide a more seamless process for employees returning to work or requiring support from the Long-Term Disability (LTD) Plan. King admits that she was naive about the process involved in dealing with an occupational illness. “I’d never had a union rep meeting and I’d never talked about a leave – I’d never had any of those conversations,” she says. A holistic case management plan was developed for King, focused on recovery and safe return to work. Case management plans can address issues such as medical intervention, transitional work, graduated return to work, workplace modifications, vocational rehabilitation and retraining. King, who is currently awaiting hip surgery and hopes to return to work once her chronic pain issues are resolved, believes other nurses can benefit from the program. “There are a lot of unknowns, medically,” she says. “But union staff have been incredibly helpful and supportive – assisting with things like paperwork and providing words of encouragement.” For more information and to find the name of your EDMP Representative, please go to the BCNU website at www.bcnu.org/edmp update

Council Profile Here’s Who’s Working For You

RESPECTING NURSES’ VOICES shaughnessy heights chair claudette jut Empowering Members

“It’s important to support and mentor members who really want to be the next leaders and move forward in union positions,” says Shaughnessy Heights Region Chair Claudette Jut.

quick facts Name Claudette Jut. Graduated Douglas College in 2006. Union Position Shaughnessy Heights chair Why I support BCNU I really believe in advocating for nurses’ rights and standing up for what they believe to be real concerns in their workplaces.

Claudette Jut always knew she would become a nurse. The Shaughnessy Heights region chair recalls how well her father was treated on his many visits to the hospital when she was a child. “The youngest of eight kids, I was in and out of the hospital quite a bit with my dad’s chronic asthma and I remember how the nurses were so kind and caring. Nursing is something I just knew I would pursue one day.” Jut worked in different fields before completing her nursing degree in 2006, spending time as a switchboard operator at Telus and at Canadian Airlines, where she met her fiancée. “I had started the nursing program before my dad passed away, but that was a difficult time and I dropped my studies,” she says. “Finally I realized it was time to go back to school.” Jut began her nursing career in 2006 at BC Children’s Hospital in the Neuroscience and Surgery and Burns unit. Working as a

pediatric RN, she recalls the first time the union was there to assist her. “I was floated to an ICU after only being in pediatric nursing for six months. I had serious practice concerns – not being familiar with the unit and how to address my issues,” she says. “I filed a PRF and I had a positive outcome.” Jut says that strong mentorship and encouragement from other nurses was essential to her becoming involved in BCNU. “When I started nursing there was a very active steward on our unit who at the time was the treasurer of our regional executive,” she recalls. “She invited me to a union meeting and from there I was able to network and meet the executive – and the work of the union was just something that really captured me.” Jut had signed on as a steward and soon found herself immersed in the role when she covered for an executive member on maternity leave in 2008. “I just picked it

up quickly and it was something I could relate to, so the next year I ran for an elected position as steward liaison.” Jut was first elected to Provincial Council in 2011 and says she will likely run again in 2014. In the meantime, she says she finds the work rewarding while she learns about the leadership role her position requires. “Having the ability to listen to what the membership is asking for and truly making genuine efforts to build relationships is really important,” she says when asked what makes an effective council member. “I really feel that most of this job is about communicating and respecting nurses’ voices.” Jut also says it’s important to reach out to nurses and encourage their involvement in BCNU. “This is a team job and our region’s executive members are equal partners,” she says. “Our goal is to ensure successorship planning and provide adequate support and mentorship to members who really want to be the next leaders and move forward in union positions.” Jut currently serves on several provincial committees, including the Member Engagement Working Group, the Steward Recruitment and Retention Committee and the Retraining, Prevention and Assistance Fund Committee. She also serves as the NBA PRF Committee Co-chair at BC Women’s Hospital and Health Centre. Jut’s work in the community involves volunteering for the BC Epilepsy Society, where she cofacilitates an adult support group once a month. Despite the long hours, Jut says she finds her work to be gratifying. “I really believe in advocating for nurses’ rights and standing up for what they believe to be real concerns in their workplaces.” update

Who Can Help?

BCNU is here to serve members

regional reps Vancouver Metro Colette Wickstrom Chair C 604-789-9240 cwickstrom@bcnu.org

BCNU CAN. Hereâ&#x20AC;&#x2122;s how you can get in touch with the right person to help you.

Coastal Mountain Kath-Ann Terrett Chair C 604-828-0155 kterrett@bcnu.org

CONTACT YOUR STEWARDS For all workplace concerns contact your steward. regional reps If your steward canâ&#x20AC;&#x2122;t help, or for all regional matters, contact your regional rep. EXECUTIVE COMMITTEE For all provincial, national or union policy issues, contact your executive committee.

Central Vancouver Judy McGrath Co-Chair C 604-970-4339 jmcgrath@bcnu.org

executive committee

treasurer Mabel Tung C 604-328-9346 mtung@bcnu.org

PRESIDENT Debra McPherson C 604-209-4253 dmcpherson@bcnu.org

executive councillor Marg Dhillon C 604-839-9158 mdhillon@bcnu.org

VICE PRESIDENT Christine Sorensen C 250-819-6293 christinesorensen@bcnu.org

executive councillor Deb Ducharme C 250-804-9964 dducharme@bcnu.org

LPN reps

Diane LaBarre Co-Chair C 604-341-5231 dlabarre@bcnu.org Shaughnessy Heights Claudette Jut Chair C 604-786-8422 claudettejut@bcnu.org RIVA Lauren Vandergronden Chair C 604-785-8148 laurenvandergronden@bcnu.org Simon Fraser Liz Ilczaszyn Co-Chair C 604-785-8157 lilczaszyn@bcnu.org Debbie Picco Co-Chair C 604-209-4260 dpicco@bcnu.org

fraser health Jonathan Karmazinuk C 604-312-0826 jonathankarmazinuk@bcnu.org

providence Steven Roth C 778-870-7328 stevenroth@bcnu.org

interior health Janet Elizabeth Van Doorn C 778-214-4798 janetvandoorn@bcnu.org

vancouver coastal Marlene Goertzen C 778-874-9330 marlenegoertzen@bcnu.org

South Fraser Valley Cheryl Appleton Co-Chair C 604-839-8965 cappleton@bcnu.org

northern health Louise Weightman C 250-639-6436 louiseweightman@bcnu.org

vancouver island Barry Phillips C 778-679-9737 barryphillips@bcnu.org

Lisa Walker Co-Chair C 604-880-9105 lisawalker@bcnu.org

Fraser Valley Linda Pipe Chair C 604-793-6444 lpipe@bcnu.org West Kootenay Lorne Burkart Chair C 250-354-5311 lorneburkart@bcnu.org East Kootenay Patt Shuttleworth Chair C 250-919-4890 pshuttleworth@bcnu.org North West Sharon Sponton Chair C 250-877-2547 sharonsponton@bcnu.org North East Jackie Nault Chair C 250-960-8621 jacquelinenault@bcnu.org Okanagan-Similkameen Laurie Munday Chair C 250-212-0530 lmunday@bcnu.org Thompson North Okanagan Tracy Quewezance Chair C 250-320-8064 tquewezance@bcnu.org South Islands Adriane Gear Co-Chair C 778-679-1213 adrianegear@bcnu.org Margo Wilton Co-Chair C 250-361-8479 mwilton@bcnu.org Pacific Rim Jo Salken Chair C 250-713-7066 jsalken@bcnu.org

update magazine July/August 2013

Off Duty members after hours

A FAMILY AFFAIR: Sharon milbradt LOVES TO MAKE NURSES’ WORK WARDROBES FASHIONABLE When Royal Inland Hospital nurse Sharon Milbradt got the idea in 2005, she just couldn’t let it go. The mother of two always had an interest in fashion, but now she wanted to take it further. “It was three in the morning,” she says. “I decided that I couldn’t wait any longer and that it was time to start my own business.” Milbradt’s motivation stemmed from her dissatisfaction with the lack of style and comfort her uniforms provided. “I would spend hours poring over catalogs looking for something fashionable and fun for my work wardrobe,” she says. “I had a hard time embracing scrubs when they came along in the mid-1990s and I felt they were not very flattering. It was difficult for my generation to find something that was practical,” she says. “There is something about looking good and feeling good – a nursing image is important as well because you are in scrubs daily.” Originally from Manitoba, Milbradt worked as an LPN in Winnipeg before moving to Kamloops with her young family. She began working at Royal

Inland Hospital in 1981 as an LPN prior to going back to school when her two girls were older. She graduated with her BSc in Nursing in 1990 and worked mainly in obstetrics at Royal Inland prior to retiring this year. The first step in Milbradt’s business plan involved a call to

her eldest daughter Brandi-Ann, who was working in Montreal as a fashion designer and buyer for a major clothing chain. “As soon as I told her I wanted to launch a scrub line she was immediately on board,” says Milbradt. Soon Scrublovers was up and running as the only brand that designs, manufactures and sells its own uniforms. Milbradt brought on her youngest daughter, Jami-Lee Prasad, to handle the marketing and day–to-day running of the online business. Prasad is now spearheading the company’s first storefront opening in Langley this year, and says the business is doing well. “It’s been a different forum for us to more easily connect

with our customers and get feedback from them,” she says. “Mom gets the day-to-day feedback on what people like and what’s trending in the scrub world,” she says. “We might have a vision of what’s fashionable but mom knows what will actually work and be functional and comfortable.” “Some of the best compliments I have gotten are from nurses who tell me that, ‘when I get up the morning I’m excited now’,” says Milbradt. Milbradt says the group’s clothing is currently manufactured in Hong Kong, but they plan to move the production to Canada in the near future. For more information visit www.scrublovers.com. update

FASHION FAMILY Mother and daughter team Sharon Milbradt and Jami-Lee Prasad are excited to open the first Scrublover store in Langley this year.

BCNU HUMAN RIGHTS & EQUITY seeking CAUCUSES Promoting equity and recognizing our collective struggle for justice – in BC and around the world Find out more at bcnu.org > Human Rights

Aboriginal Leadership Circle • Lesbian Gay Bisexual Transgendered • Men in Nursing • Workers with Disabilities • Workers of Colour

BCNU

MEN IN NURSING

workers with disabilities

FINDING A FIT

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ERS

O F CO

2014 BCNU Convention call for MARCH 4-6 Hyatt Regency Hotel Vancouver

Itâ&#x20AC;&#x2122;s time to submit your proposed resolutions, by-laws and constitutional amendments Proposed by-law and constitutional amendments must be received

Delegates should register at the hotel on the evening of

by the By-laws Committee at BCNU no later than October 1, 2013.

March 3, 2014. All members are urged to attend, either

BCNU office, attention Jo Salken, chair of the By-laws Committee.

as observers or as voting delegates from our unionâ&#x20AC;&#x2122;s

Proposed resolutions must be received by the Resolutions

16 regions.

your steward for the necessary forms. Mail them to the BCNU office,

Please see your steward for the necessary forms. Mail them to the

Committee at BCNU no later than October 1, 2013. Please see attention Liz Ilczaszyn, chair of the Resolutions Committee.

PM 40834030