BCNU Update Magazine October 2015 by BC Nurses' Union

OCTOBER 2015

NURSES DEMAND EVIDENCE-BASED FLU POLICIES

KELOWNA GENERAL ER NURSES PUSH FOR SAFE PATIENT CARE

UPDATE BRITISH COLUMBIA NURSES’ UNION

PRFs WORK : MEMBERS ARE SEEING SUCCESS ACROSS THE PROVINCE

WWW.BCNU.ORG

OH&S: NURSES’ VIOLENCE SUPPORT HOTLINE LAUNCHED

PULL-OUT BCNU POSITION STATEMENT ON MENTAL HEALTH SYSTEM REFORM

BARGAINING FOR SAFE PATIENT CARE

STILL WORKING

SHORT

In 2012, health employers committed to create 2,125 new registered nurse positions by March 2016

WHERE ARE THEY?

2015 FEDERAL

ELECTION

OCTOBER 19

The outcome of this federal election could be decided in BC. Take time to learn about each party’s commitments on health care and cast your ballot to improve practice conditions and patient care.

Three quick steps to voting in the 2015 Federal Election 1. Check that you’re registered to vote.

If you don’t receive a voter information card in the mail by October 1, register online or call Elections Canada.

2. Vote on October 19, or at advance polls: October 9, 10, 11, 12. 3. Bring ID that confirms your name and address.

Voter information cards are not accepted as ID. If you don’t have governmentissued photo ID with your current address, visit www.elections.ca or call 1-800-463-6868 for a list of acceptable voter ID.

IF YOU ARE ELIGIBLE TO VOTE

Employers must provide paid time off to vote on October 19 If you are an RN or RPN and covered by the Nurses’ Bargaining Association (NBA) provincial collective agreement, you are entitled to four consecutive hours free from work during the hours the polls are open to cast your vote. If you are an LPN or not covered by the NBA provincial collective

agreement you are still entitled, under the Canada Elections Act, to have three consecutive hours to cast your vote on election day. If your hours of work do not allow for three consecutive hours to vote, your employer must give you time off. However your employer has the right to decide when the time off will be given.

Employers cannot impose a penalty or deduct pay from an employee who is taking time off to vote, and an employee must be paid what he or she would have earned during the time off allowed for voting. Employers are not required to give paid time off to vote on advance polling days.

UPDATE MAGAZINE October 2015

UPDATE

•O

CONTENTS vol 34 no4

ctober 2015

BCNU PRIDE! BCNU President Gayle Duteil and Vice President Christine Sorensen march in the Vancouver Pride Parade August 2.

UPFRONT

6 8

Check In

The latest news from around the province.

Safe Patient Care

Kelowna ER nurses push for specialty-educated positions.

10 Mental Health

BCNU strategy maps the way to better care and working conditions.

15 Violence Reduction Plan Safety upgrades will make the delivery of care safer for nurses and patients.

21 Making Progress

BCNU President Gayle Duteil answers your questions ahead of bargaining.

26 PRFs Work

Nurses are seeing success across the province.

DEPARTMENTS

5 PRESIDENT’S REPORT 31 MEMBER PROFILE 32 WHO CAN HELP? 33 COUNCIL PROFILE 34 OFF DUTY

FEATURE

STILL WORKING SHORT

Health employers promised to create 2,125 new registered nursing positions by March 2016. It’s time they followed through. ON THE COVER: Burnaby Hospital acute care nurse Marta Udovicic

Read BCNU’s pull-out

Position Statement on Mental Health Reform. p. 11

BC Nurses’ Union

UPDATE MAGAZINE

December 7, 2015

HUMAN RIGHTS & EQUITY CONFERENCE

HOME

INDIGENOUS SOVEREIGNTY AND THE POLITICS OF RECONCILIATION

MISSION STATEMENT The British Columbia Nurses’ Union protects and advances the health, social and economic well-being of our members, our profession and our communities. BCNU UPDATE is published by the BC Nurses’ Union, an independent Canadian union governed by a council elected by our 43,000 members. Signed articles do not necessarily represent official BCNU policies. EDITOR Lew MacDonald CONTRIBUTORS Juliet Chang, Laura Comuzzi, Sharon Costello, David Cubberley, Monica Ghosh, Gayle Duteil, Gary Fane, Shawn Leclair, Michelle Livaja, Robert Macquarrie, Catherine Pope, Shirley Ross, Dan Tatroff, Patricia Wejr PHOTOS David Cubberley, Lew MacDonald, Robert Macquarrie, Dan Tatroff

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 www.bcnu.org EMAIL EDITOR lmacdonald@bcnu.org MOVING?

“Home: Indigenous Sovereignty, and the Politics of Reconciliation” will offer our members an opportunity to engage in dialogue about the path we might take toward genuine reconciliation, based on indigenous sovereignty, rights, and long-established treaties. Through film, music, and the words and stories of powerful indigenous presenters, we will explore the critical issues that face us. Through interactions with presenters and each other, we will discuss the meaning of “home”, and celebrate the differences and similarities that we find in our personal experiences. We invite BCNU members to join their colleagues for this historic day-long event.

Apply online at www.bcnu.org. *There is no salary reimbursement for this conference

Please send change of address to membership@bcnu.org Publications Mail Agreement 40834030 Return undeliverable Canadian addresses to BCNU 4060 Regent Street Burnaby, BC, V5C 6P5

PRESIDENT’S REPORT

GAYLE DUTEIL

SOLIDARITY WILL SECURE A STRONG CONTRACT FOR SAFE PATIENT CARE

PHOTO: ALEXIS SULLIVAN WALTERS

FEEL VERY FORTUNATE. AS I WRITE THIS COLUMN, I’M ENJOYING quality time with life-long friends, all of whom are BCNU stewards, both past and present. Stewards are the backbone of our organization. They are the reason we have been so successful in achieving our recent province-wide staffing grievance settlement in addition to many other grievance successes related to unsafe staffing conditions. BCNU stewards and members have stood together to enforce our last collective agreement and have seen monetary, educational and staffing benefits as a result. The nurses who work at Surrey Memorial Hospital’s family birthing unit are just one recent example of members who banded together to stand up for their patients. They filled in hundreds of Professional Responsibility Forms, used the new fast-track staffing dispute process, filed grievances, and now as a result will see more specialty educated nurses and share thousands of dollars. This particular success perfectly demonstrates the solidarity that will be needed as we resume bargaining this fall. We are now meeting with health employers almost daily and have identified key areas for discussion. We anticipate talks to continue until the end of October, and our provincial bargaining committee will provide members with a status report in November. We’ll also sit at the bargaining table guided by the union’s mission statement and bargaining principles: “The British Columbia Nurses’ Union protects and advances the health, social and economic well-being of our members, our profession and our communities.”

UPDATE MAGAZINE October 2015

As such, respect for the nursing profession, the health care system and the patients of British Columbia shall be a guiding force during negotiations. Bargaining will take some time, especially given the so-called “me-too” clause negotiated by the weaker health sector union HSA in an attempt to ride on BCNU’s coattails. But we will not be rushed, and we will not bargain away our benefits. Success at the bargaining table and a strong collective agreement will come when the issues and stories of frontline nurses and their patients are heard at the highest level. Last month, health employers raised concerns about the length of time required to fill a vacancy and the “internal churn” that results from the creation of subsequent vacancies. They presented detailed charts and graphs outlining the time it took – sometimes up to 28 weeks – from the initial vacancy to the end of the “churn.” However, when I asked why nurses who file applications have to wait months with no response, no one could provide an answer. I explained that I had been corresponding with a very experienced and flexible ER nurse for several weeks. He had applied to three different health authorities over the previous month and had just heard back from one recruiter, who advised him that there were no current vacancies. Two large health authorities hadn’t even responded to his application. There was no “churn” involved. There was, however, a lack of respect for this nurse’s time, credentials and professional desire to be working full time in any hospital or community, rural or urban. This nurse will be one of many I will be thinking about as we proceed through contract negotiations. I would ask you to do the same. Think of your colleagues, your friends, co-workers and stewards. Think of the patients, clients and residents you cared for today. If we harness our collective voice and stand together, united in solidarity, there is no doubt that we will secure a strong contract for safe patient care. update

CHECK IN

NEWS FROM AROUND THE PROVINCE

IN MEMORIAM MARIE ALICE MACKAY

October 22, 1938 – July 16, 2015.

NEW REGIONAL EXECUTIVE MEMBERS ELECTED BCNU MEMBERS ACROSS THE PROVINCE PARTICIPATED IN regional by-elections between September 14 and 18. The following candidates were elected to serve out terms until province-wide elections are held again in 2017: • Fraser Valley region Treasurer: Kathi Dempsey • North West region PRF Advocate: Louise Weightman • Pacific Rim region chair: Rachel Kimler • Pacific Rim region OH&S representative: Gerrie Miller (acclaimed) • South Fraser Valley region OH&S representative: Karen Evjen • South Islands region chair: Margo Wilton If you would like to vote in future elections, it is important that your personal email address (not your work email) is on file. Register or log in to the BCNU member portal to confirm we have up-to-date email information.

PENSION ALERT

RULES CHANGED FOR RETIRED MEMBERS RETURNING TO WORK Retired members choosing to return to work should note that Municipal Pension Plan rules for retirees changed this summer. If you’re retired and return to work for an MPP employer, you must now continue to receive your pension payments and will no longer have the option of suspending or re-paying your pension payments and resuming contributions to the MPP. If you are already re-employed with an MPP employer and have resumed contributing to the plan you may continue to contribute until you retire again. If you start working for an employer who is not part of the MPP, ask about their pension plan enrolment rules.

It is with great sadness that we say goodbye to an active and dedicated former BCNU activist and nurse. Among her many BCNU activities, MacKay served as BCNU provincial treasurer for three consecutive terms starting in 1992. She also sat on the original building committee and served on the RIVA regional executive.

VITAL SIGNS

Since 2000, MacKay spent six months each year volunteering in Kenya and would raise funds for needy African students at regional meetings. Her most recent work in Kenya was with the non-profit Kenya Education Endowment Fund (KEEF). MacKay’s family suggests donations to KEEF (www.kenyaeducation. org) would be greatly appreciated.

Numbers that matter

A recently released Canadian Institute for Health Information study revealed that in 2014 more nurses in Canada left their profession than entered it for the first time in 20 years. The CIHI findings are alarming, given population growth and the increasing acuity of patients.

0.3% GROWING PROBLEM The year-over-year decline in the supply of regulated nurses in Canada.

1% BIG DROP The number of registered RNs fell by this percent in Canada last year.

6 NATION-WIDE The number of jurisdictions, including BC, which experienced a decrease.

Source: Regulated nurses, 2014 Canadian Institute for Health Information

UPDATE MAGAZINE October 2015

CARE MODEL CHANGES

NANAIMO NURSE POSITIONS RESTORED

CONVENTION 2016

SAVE THE DATE! Next year’s annual convention is being held later than in previous years. Convention 2016 will take place May 16–19. Convention call will take place later this year and deadlines for proposed bylaw amendments and resolutions will be moved back accordingly.

MAKING NEWS

BCNU in the headlines

SPEAKING OUT AGAINST VIOLENCE

BCNU and the government announced a $2-million funding initiative in August aimed at reducing violence against nurses, When Victoria’s CHEK TV News covered the story, they asked South Islands OH&S rep Ken Giles and BCNU President Gayle Duteil to tell their viewers just how bad the situation has become in our province’s health care facilities. Giles, a veteran psychiatric nurse for Ken Giles Island Health, said nurses are frequently physically attacked while delivering care and are being threatened and verbally abused on a daily basis. “I’ve had to put up with death threats, name calling, people telling me they hope I burn to death,” said Giles. “It’s life-affecting. There are injuries and dangers in every job, but we have the most dangerous job in the province

– worse than tree fallers and the police.” Between 2009 and 2014, health care workers filed more injury claims with WorkSafeBC than any other occupation. “Violence against health care workers and nurses is a huge problem,” BCNU President Gayle Duteil told the reporter. “With the increasing population of dementia patients, it really is in every worksite. It’s not restricted to just the psychiatric areas. It also happens in acute care, community care and longterm care.” “You can’t provide safe care,” added Giles, “if you’re always flinching at every noise and thinking ‘am I going to be hurt?’ I have a high tolerance, but I shouldn’t have to put up with it.” For more information on the $2-million violence prevention initiative, please see page 15.

URSES ON FORMER CDMR UNITS AT NANAIMO Regional General Hospital were breathing sighs of relief when positions lost in September 2013 were finally restored after an agreement was reached with the employer last May. “The change was tangible as soon as NRGH got an increase close to pre-CDMR levels,” said former BCNU steward Kris VanLambalgen. VanLambalgen visited a friend on a recent Saturday night at NRGH shortly after the nurses were reinstated and was impressed with how happy everyone seemed. “There was a sense of calm on the entire unit. On another unit a nurse said to me ‘I’ve seen my patients’ whole body today, and reviewed all their labs and charts, and even filled out the 48-6 forms.” “It was great to feel like we had enough resiliency built into our numbers that we could respond to an emergency or to urgent demands if they arose. Thank goodness for more nurses,” said RN Sharon Fulton. Under the agreement with Island Health, a total of 10.78 RN FTEs were added back to baseline numbers. Other changes included increasing the LPN float pool by an average of 30 hours per day and regularization of two “temporary” 12-hour RN night shifts. RN Megan Johnson noted that nurses are now able to collaborate better and learn more about each other’s patients. “It makes it less frantic than it was because you’re able to anticipate more. Before it was just ‘boom, it’s happening.’” CDMR remains in force on some units at Cowichan District, Saanich Peninsula, Victoria General, and Royal Jubilee hospitals. BCNU opposes care models that replace licensed with unlicensed caregivers and is continuing to press for safe staffing at all four hospitals. update

CELEBRATING SUCCESS BCNU Pacific Rim nurses gather on August 28. From left: Megan Johnson, Rachel Kimler, Brianna Williams, BCNU President Gayle Duteil, Francine O’Donnell, Sharon Fulton and Jonathan Salken.

8 SAFE PATIENT CARE

KELOWNA ER HIGHLIGHTS NEED FOR SPECIALTY NURSE RESOURCE PLANNING Most health authorities have not developed education plans for specialty nurses, health ministry now involved

PUSHING FOR CHANGE Kelowna General Hospital ER nurse Sondra Bader says chronic short-staffing galvanized nurses at her facility to join BCNU’s provincial grievance campaign.

URSES IN THE KELOWNA General Hospital emergency room are a tenacious group. Since 2011 their unit has been chronically short staffed because the Interior Health Authority hasn’t developed comprehensive human resource plans to recruit, educate and retain specialty nurses. “The shortage of ER-trained nurses has been tough on emergency staff,” says Danika Ellis, who has worked in the KGH emergency room since 2004. “We’ve seen a huge turnover since 2011,” says Ellis. “We lost many of our senior nurses because the ER was constantly overcrowded, nurses were working a lot of overtime and management was denying time-off requests. Nurses transferred to other units where they could have reasonable practice conditions.” BCNU Okanagan-Similkameen chair Rhonda Croft concurs. “ER nurses often work short and are encouraged to work stag-

gering amounts of overtime. Added to this, they see heart-rending traumas that impact their health and personal lives.” Ellis says that since 2011 a succession of managers tried to fix these problems through external hiring, overtime and agency nurses, but it wasn’t enough to retain staff. ER nurse Sondra Bader remembers the incident that galvanized her to start pushing for change. “I clearly remember standing in Trauma Room 1 when the charge nurse told me to call home and make child care arrangements,” says Bader. “She said the agency nurses that were booked didn’t show up and because she couldn’t replace me I was legally required to stay.” For Bader it was the final straw, and at the next BCNU meeting she asked her regional executive to help the ER nurses campaign for change.

By December 2014 the ER nurses joined the provincial grievance campaign and mobilized to compile evidence that showed staffing wasn’t meeting patient care needs. The evidence they collected was added to information from other facilities and presented to Arbitrator Tom Hodges in April 2015 by BCNU President Gayle Duteil.

“We talk about improving care and they talk about budgets. So we’re not speaking the same language – even though we’re trying to solve the same problems.” DANIKA ELLIS, KGH ER NURSE

“Kelowna nurses compiled excellent evidence and it helped BCNU build its arbitration case,” says Duteil. “As evidence flowed in from across the province we learned that only Vancouver Coastal Health has long-term, comprehensive human resource plans to train specialty nurses – other health authorities don’t have adequate forecasting, and that’s not good enough for patients or nurses.”

IMPROVEMENTS FOR KELOWNA GENERAL HOSPITAL Nurses gain a new locker/shower room that’s close to the ER. For years nurses repeatedly asked for this locker room, which was used for storage. Long term temporary vacancies (LTTVs) will be filled in an expedited way. The new LTTV process will stop line-churn and gives casuals working in LTTVs full benefits. It also applies to other IHA worksites. 46 more full-time equivalents will be added to the KGH vacation relief pool. Some of those positions will be in the ER, so all vacation should be covered. BCNU is sponsoring about 20 IHA nurses in the BCIT emergency specialty training with money from the arbitration settlement. Six graduates will join the KGH ER in October 2015 and about six more will graduate in March 2016. The remaining graduates will go to other IHA facilities. See page 23 for more information on the KGH ER and EKRH arbitration.

UPDATE MAGAZINE October 2015

The Hodges-led arbitration panel issued a groundbreaking settlement that forces employers to hire enough nurses to meet patient care needs. The settlement also established new, fast-track processes to resolve nurses’ workplace issues. “I’m very proud of the work ER nurses did on the campaign,” says Croft. “We’re starting to make progress improving their workplace, like getting them an accessible change room. BCNU will keep supporting them until they have the practice conditions they deserve.” BCNU has used the new fast-track process to make some improvements for the Kelowna nurses, and the union is now working with the Ministry of Health to develop a provincial strategy to recruit, educate and retain specialty nurses. But while KGH ER nurses wait for provincewide solutions, they say improvements can be implemented at their worksite, such as using technicians for tasks like blood draws and EKGs, to free up nurses for more complex health interventions. “Someone in IHA needs to work with nurses to build a proper business case so senior management can see what ER patients need,” says Ellis. “Management hears our passion for patients, but they don’t hear that we also have solutions to run a better health care system. We talk about improving care and they talk about budgets. So we’re not speaking the same language – even though we’re trying to solve the same problems.” update

BCNU PRIDE! BC Nurses’ Union members showed their LGBT pride this summer at events across the province. BCNU President Gayle Duteil and Vice President Christine Sorensen joined the BCNU LGBT caucus in leading the union’s contingent at this year’s Vancouver Pride Parade on August 2. BCNU’s big blue bus was on hand for many of the pride events this summer, and was well-received wherever it went. 2

THE PEOPLE

1. Gagan Grewal and BCNU South Fraser Valley region co-chair Michelle Sordal march in the August 2 Vancouver Pride Parade. 2. BCNU Simon Fraser region executive members Lynn Lagace and Jereme Bennett are joined by high school students Stephanie Carter and Katie Bradshaw-White at New Westminster’s Royal City Pride Festival August 8. 3. The BCNU bus was on hand for this year’s Victoria Pride Parade and Festival July 5. Back row (from left): BCNU LGBT caucus chair Cynthia Reid, full-time steward Judith Raymer and Cassandra Zinger. Front row: Marianne Pitt, BCNU South Islands region Treasurer Leslie Zinger, Lauren Marshall, Brianna Carmichael and Nicola Bukovec. 4. BCNU South Fraser Valley region co-chair Jonathan Karmazinuk waves in the Vancouver Pride Parade August 2. 5. BCNU Vice President Christine Sorensen and President Gayle Duteil hold the union’s banner during the Vancouver Pride Parade August 2. 6. Ready to march: BCNU members gather ahead of the Vancouver Pride Parade August 2.

MENTAL HEALTH STRATEGY

SUPPORTING NURSES, CARING ABOUT PATIENTS BCNU's mental health strategy is leading the way to improved patient care and practice conditions

position statement on Mental Health System Reform. This document reflects the collective knowledge and wisdom of over 70 experienced mental health nurses (a pull-out position statement is located on page 11). Going forward, BCNU will be tapping into the enthusiasm and passion of members who participated in the creation of the statement, in partnership with other stakeholders, in order to lobby government to dramatically improve supports for patients and families struggling with mental illness. Registered psychiatric nurses participated in the workshops, and many of these members were new to BCNU, having recently joined after the merger of the Union of Psychiatric Nurses (UPN) with BCNU in October 2014. Former UPN President Dan Murphy was one of those participants. Today, Murphy is BCNU’s Executive Councillor responsible for mental health. “This initiative shows that psychiatric nursing and mental health issues are being given the priority they deserve,” he says. “BCNU is the largest and most important nursing and health care union in the province, and it’s here that all nurses who work in mental health can follow their career aspirations as leaders in mental health.” “BCNU is committed to working toward better care for patients,” adds Duteil. “And we also recognize that quality nursing workplaces are essential to quality patient care.” She says the union continues to push hard for safe staffing levels and safe

TORIES APPEAR DAILY IN “Mental health services are one of the the media highlighting the demost neglected areas of our health care plorable state of mental health system,” says BCNU President Gayle Duteil. care services in BC. Nurses “And it affects all of us – not just patients, who work on the front lines but their families and communities.” Duteil see this reality every day in communities says she’s proud to promote mental health across the province. as one of the union’s top campaign priorities The system is in crisis. Patients and their since she was elected last year. families lack support in dealing with mental BCNU members have been engaged in illness, and nurses in community, residential the strategy’s development from the beginand acute facilities work in unsafe condining. This began by capturing members’ tions under impossible workloads. The ideas for positive change through a series of police and criminal justice system have workshops held across the province in the now become the default care provider spring of 2015, which resulted in a BCNU for many seriously mentally ill people, and policy makers’ failure to address this critical issue has come at great human and financial cost. Nurses know that action is needed, and the BC Nurses’ Union has now assumed a leadership role in the push for improved patient care and practice conditions in BC’s mental health care system. In the fall of 2013, BCNU Council approved a new and exciting mental health strategy focused on improving the system of care for people with psychiatLee-Amber Gaber Jessie Renzie ric illness and creating Cowichan District Hospital Kootenay Lake Hospital healthy health care workplaces which are physically and psychologically safe for nurses.

TALKING MENTAL HEALTH BCNU’s leadership on mental health services has members thinking more about their psychological well-being.

UPDATE MAGAZINE October 2015

work environments that are essential for the well-being of health care professionals. Duteil cites the June 2015 provincial grievance settlement to secure safe staffing levels negotiated in the 2012-2014 Nurses’ Bargaining Association provincial contract, and the province’s August 2015 agreement to commit an additional $2 million towards safety improvements at four high-risk regional psychiatric facilities as two recent examples of the progress that has been made. The worksites include Coquitlam’s Forensic Psychiatric Hospital, Abbotsford Regional Hospital, Hillside Psychiatric Centre in Kamloops and Seven Oaks Tertiary Mental Health Facility in Victoria. In collaboration with the Ministry of Health, BCNU organized staff forums at all four sites, and the recommendations for action at each site came from frontline workers themselves. Eliminating workplace violence against nurses continues to be BCNU’s goal, and the union has also pledged $1 million that was bargained in the last collective agreement to support the rollout of violence prevention initiatives at these facilities. BCNU has also proposed additional sites to the minister, and the union is monitoring the project closely to ensure that nurses experience real benefits, such as the ability to go home unharmed at the end of their shifts. It’s a good first step – but much more needs to be done. Most nurses are routinely exposed to trauma, violence, and unfixable human suffering, and BCNU is continuing to work to create healthy health care workplaces that are both physically and emotionally safe. Helping members cope with the current demands of their work and providing them with the knowledge, skills, tools and supports to maintain their own emotional well-being is

a top priority in the year ahead. In the fall of 2014, the union piloted a series of personal resilience workshops that garnered rave reviews. The great response means that BCNU is now offering these free workshops to members around the province through the fall, winter and spring. Personal Resilience: Surviving and Thriving in Today’s Health Care Workplace is a psycho-educational workshop free to any BCNU member (see sidebar for dates and information about the workshops in your community) and registration details can be found on the Mental Health Strategy page of the BCNU website. Healthy workplaces are not just physically safe but also emotionally healthy, and BCNU is pressing the government and health authorities to commit to the implementation of the Canadian National Standard for Psychological Health and Safety in the Workplace (the Standard). Thirteen evidence-based elements provide a framework to support the creation of workplaces where people can work smart, give their best effort and go home at the end of the shift with energy left over. Ensuring a safe and healthy workplace is also at the top of the agenda as the union resumes bargaining with provincial employers this fall. There are many issues our negotiators will be discussing, including improved coverage for psychological services, creating best practice standards for critical incident support, making employee and family assistance program services universally available for all staff (including casuals and their immediate family members) and creating effective programs to deal with bullying and harassment in the workplace. All told, it’s a bold strategy, but one that’s critical for ensuring that adequate supports are in place for patients and health care workers alike. update

SURVIVING AND THRIVING IN TODAY'S HEALTH CARE WORKPLACE Register for one of BCNU’s personal resilience workshops today! A series of resilience workshops for members have been scheduled across the province. They began this fall and will continue into winter. Workshops are held from 9:00 a.m. to 5:00 p.m. A light breakfast commences at 8:30 a.m. and lunch will be provided. The workshop is free to selected nurses, but please note salary replacement and/ or travel expense reimbursement is not available. Maximum registration is capped at 20 people – so don’t delay! WORKSHOP DATES Lower Mainland North of the Fraser River October 15 BCNU Education Centre, FULL November 6 BCNU Education Centre December 4 BCNU Education Centre Lower Mainland South of the Fraser River November 5 Eaglequest Golf Course, Surrey November 19 Eaglequest Golf Course, Surrey December 11 Eaglequest Golf Course, Surrey The Interior October 29 October 30 December 3

Kelowna Four Point Sheraton Kamloops Coast Hotel, FULL Cranbrook Best Western

The Island December 17 December 18

Nanaimo Coast Bastion Hotel Best Western, Courtenay

The Sunshine Coast October 8 Sechelt Driftwood Inn October 16 Powell River Town Centre Hotel The North November 27

Prince George Ramada Downtown

To register please send your name and designation (LPN, RN or RPN), contact information (email address and phone number) to Beth MacPherson at bethmacpherson@bcnu.org If you have questions about this exciting initiative please contact Catherine Fast at cfast@bcnu.org

MENTAL HEALTH STRATEGY

PSYCHIATRIC NURSING

BUILDING ON STRENGTHS

BCNU members gain insights and establish new relationships at international conference

MENTAL HEALTH ADVOCATES BCNU Coastal Mountain region Mental Health Advocate Paddy Treavor and BCNU Executive Councillor Dan Murphy attended the recent World Congress for Psychiatric Nurses in Banff. Both were inspired by the event.

ADDY TREAVOR HAD NO way of knowing the soft-spoken but humorous man sharing the dinner table with him was one of the heavyweights of the psychiatric nursing world. The Powell River Hospital nurse had just arrived in Banff, Alberta as a delegate to the 2015 World Congress for Psychiatric Nurses. The May 20-22 event, organized by the Registered Psychiatric Nurses of Canada, played host to several international nursing leaders and hundreds of RPNs from around the world, including BCNU members. The conference’s aim was to share knowledge, skills and information among those dedicated to working in the mental health field. “He introduced himself as Martin and we

had a great chat,” recalls Treavor. “It wasn’t until later when I looked at the program and saw his picture that I realized who it was.” Treavor’s table mate, it turns out, was keynote speaker Martin Ward. A self-described “reformed hippie,” Ward has been associated with psychiatric nursing for over 40 years and in a variety of capacities, as a practitioner, teacher, educational manager, politician, writer, researcher and practice developer. “When you read his bio you get a real sense of his intellectual contributions to psychiatric nursing, but that was not how he came across at all,” says Treavor of Ward’s keynote presentation. “He’s very humorous, using a lot of anecdotes, not what you’d expect. His language was a little off-colour at times, but very refined in its message.”

Ward is perhaps best known for his early work in the 1980s, developing the psychiatric nursing process in the United Kingdom. After a career in nurse education he was appointed as the Director of Mental Health at the National Institute of Nursing in Oxford in 1992, and later served as Director of Mental Health Nursing UK at the Royal College of Nursing. He has written, edited or contributed to 12 books on mental health care, published in excess of 100 papers and a series of national research reports. Today, Ward heads the University of Malta’s Department of Mental Health and speaks at conferences and events around the world on topics that include leadership, practice development, care practices and nursing politics.

“It’s about creating relationships, fostering education and celebrating innovative clinical practice.” BCNU EXECUTIVE COUNCILLOR DAN MURPHY

Treavor says Ward made a strong impression on delegates. “He had people laughing and at the same time was getting across his very forward-thinking message about psychiatric nursing. He seemed to understand to its core our day-to-day experience of psychiatric nursing and what we do, which is a little bit different, and nobody understands unless they are in it.” Delegates also welcomed keynote speaker Augusten Burroughs, a bestselling author of eight books, including the groundbreaking tragicomic memoir Running with Scissors. It tells the story of Burroughs’ unconventional childhood, and deals in wildly difficult topics, including depression, alcoholism, drug abuse and the adolescent Burroughs’

UPDATE MAGAZINE October 2015

sexual relationship with a much older man. Burroughs spoke about themes from his follow-up memoir, Dry, a #1 New York Times bestseller, which chronicled his experience as an ad executive struggling to overcome alcoholism while watching his best friend and former lover succumb to AIDS. “I guarantee you that every psychiatric nurse was probably doing an assessment on him as he was speaking,” says Treavor. “The fact that he’s been able to come through his struggle and present publicly, and is so comfortable in his own skin, was very inspiring,” he adds, noting that many psychiatric nurses work in acute care or emergency care, where they see most people at their worst. “We don’t always see the recovery, so it’s good to know there are people out there who are very comfortable with themselves and who are presenting as stable and functioning in society. It is really refreshing to see somebody who is doing well and who has good insight into their condition – the triggers that may bring on acute symptoms of their illness – and how to deal with it.” Treavor was also impressed by Big Daddy Tazz. Known as the “Bipolar Buddha,” Tazz is equal parts comedian and motivational speaker. His latest routine, “Stand Up Against Stigma,” aims to empower those working to end the stigma of mental illness. “I think he was using his comedy routine as kind of a self-therapy mechanism,” says Treavor, who notes that Tazz lived with undiagnosed bipolar disorder, attention deficit disorder and mild dyslexia for 30 years. “He was open with his mental illness and diagnosis and he was very connected to his emotions related to it.” Treavor admits many nurses can get quite jaded with what they do, and it’s not often they get touched by somebody like Tazz. “I was quite moved, and actually went up and gave him a hug and thanked him.” Concurrent workshops and oral presentations from international mental health professionals made up the bulk of the conference’s program. Treavor was impressed by a presentation given by Toronto General Hospital nurses Sarah Flogen and Andrea Waddell on a humanized safety framework that has been implemented on the facility’s inpatient unit.

FINDING A HEALTHIER WORK-LIFE BALANCE Personal resilience workshops help members cope with high-pressure jobs

TALKING ABOUT TRAUMA Royal Jubilee Hospital nurses Janet McGuire and Alida Gibbs attended BCNU’s August 24 Personal Resiliency workshop in Victoria.

CNU IS HOSTING A SERIES of Personal Resilience workshops. They’re designed to equip nurses with strategies that counter the stresses and strains of delivering care to high-acuity patients in demanding circumstances. “Personal resilience” refers to the ability of nurses to recover balance and emotional well-being after experiencing difficulties or being exposed to trauma or on-the-job violence, common experiences in care settings today. The workshops will be held across BC this fall. They will offer suggestions on how to deal with incidents involving moral distress that can lead to negative outcomes like compassion fatigue and burnout. Led by trauma-specialist Dr. Jeff Morley and Registered Clinical Counsellor Carolyn Burns, the workshops provide practical advice on how best to cope with today’s high-pressure nursing and offer tools to sustain a healthier work-life balance. They also

give nurses the chance to share their personal experiences in a sympathetic setting. “As a new grad going into mental health,” said nurse Cassandria Smith, “it was good to get information on what we can do to deal with the stress and trauma of this kind of nursing. It gave me a more realistic picture of the hardships you encounter and the strategies you can use to deal with them.” Alida Gibbs, who works in psychiatric nursing at Royal Jubilee Hospital, says the workshop affirmed her personal belief that “you have to keep hope alive and stay positive in your thinking in order to do the best you can as a nurse.” Her take-away message is simple: “I have to look after me before I can truly look after others.” Janet McGuire, an LPN working in geripsychiatric care at Royal Jubilee on a unit she says is “a sad and sometimes risky environment,” agrees that the self-care message resonated with her whole group. “We all realized that you need to be looking after yourself way better.” The workshop is free to selected nurses (up to 20 per offering) and runs from 9 a.m. to 5 p.m. A light breakfast and lunch are provided; salary reimbursement and travel expenses, however, are not available. Seventeen workshops are scheduled for this fall, beginning in September in the Interior, Lower Mainland and on Vancouver Island, and continuing from October through December across BC. update Please go to BCNU > News and Events >News>Personal Resilience Workshops for more information.

MENTAL HEALTH STRATEGY

OH&S

“They’ve begun a program where they have games and activities every day on the unit,” reports Treavor. “They’re dealing with intensive care psychiatric patients, people who aren’t intentionally violent, but they’re acute, and they’re basically uncontrollable on any other unit and they’re there on high security,” he explains. “They’ve got these people doing indoor bowling and Twister and that kind of stuff. It was very interesting to hear how they’ve implemented that while still ensuring safety, and how successful it’s been and how the patients have responded.”

PHOTO: CHRISTOPHER SCHELLING

POWERFUL STORY Author Augusten Burroughs was a keynote speaker at the recent World Congress for Psychiatric Nurses in Banff.

Treavor says the workshop provided ample food for thought. “I look at that and think, ‘How can we implement this on our unit in Powell River? How can we make this work?’ We’re not a dedicated intensive care unit because we’re in a small town, but just how do you balance that recreation with the safety of other patients and staff? I found that very interesting.” “Events like this are invaluable when

it comes to helping RPNs advance their careers,” says BCNU Executive Councillor Dan Murphy, who also attended the event with Treavor and other BCNU members. “It’s about creating relationships, fostering education and celebrating innovative clinical practice.” Murphy notes that the BCNU members in attendance all serve as regional executive mental health representatives. These positions were created after members of the Union of Psychiatric Nurses voted to merge with the BCNU in October 2014. Treavor agrees the event was well worth the effort, and says he’s grateful for the opportunity to attend. “The conference was a chance for us to highlight how the BCNU is helping mental health here in BC. I know I spoke quite a bit about the mental health initiative out here, and the support I feel I’m getting that I may not have had before due to a lack of resources. “A lot of what is valuable in these events is the networking you do outside the official program – speaking with others from out of the country and province about their successes and struggles. It was interesting to hear how other people have some similar or different struggles with the employer. I think that is one solid reason why we should support members attending conferences like this.” Treavor says the event couldn’t have been more successful. “I came back feeling very inspired, and I’ve made personal connections too. In fact, one of the first people I met was a psychiatric nurse from Holland living in Manitoba. I introduced myself and told him I was from Powell River. He said, ‘Powell River. I just had a job interview there.’ We went out and had a couple of beers that night and the next and exchanged ideas.” Treavor says his new colleague emailed three months later to say he had taken the job, and asked for help finding a house. “He and his family are now here and they live two streets over, renting my friend’s house,” reports Treavor. “And we had them over for a barbecue two nights ago. There was that connection, and now we have a nurse from Holland working in my community, and working side-by-side with me. It was meant to be, I guess.” update

VIOLENCE SUPPORT HOTLINE LAUNCHED BCNU IS LAUNCHING A NEW HOTLINE for nurses who have been assaulted while on the job. Starting October 22, nurses will have immediate access to a trained trauma counsellor 24 hours a day, 365 days a year. Additionally, a BCNU staff person will follow up within one business day to offer guidance, resources and support. The service is free and confidential. “I urge all BCNU members to make use of this service if they are attacked at work while trying to provide safe patient care,” says BCNU President Gayle Duteil. “We know that emotional trauma can persist long after physical injuries have healed, so it’s very important to receive appropriate and timely support.” BCNU is the only nurses’ union in Canada to offer this type of year round, 24-7 violence support hotline. Any BCNU member can access the hotline. However, it isn’t intended for cases of bullying and harassment, which should be dealt with through employers’ workplace policies, collective agreements, and assistance from a BCNU steward. “The types of assaults and number of incidents will provide invaluable data” says Adriane Gear, BCNU Executive CouncillorHealth and Safety. “Being able to quantify the number of nurses who are victims of patient violence will help BCNU continue to pressure the health authorities and government to address this problem.” BCNU will also support members wanting to file police reports or pursue charges against employers for lack of safety and will consider these on a case-by-case basis. Under certain conditions, BCNU may also consider bridge financing for members facing financial hardship while they await processing NURSES’ of their WorkSafeBC VIOLENCE claim. update Visit the BCNU website for more information.

SUPPORT HOTLINE

1-844-202-2728

UPDATE MAGAZINE October 2015

PRIORITIZING SAFETY BCNU President Gayle Duteil joins Health Minister Terry Lake at an August 6 news conference. BCNU and the health ministry are each putting $1 million towards improving security at four facilities identified as having the highest risk for violence.

VIOLENCE REDUCTION PLAN IMPLEMENTED AT FOUR SITES Key safety upgrades to make the delivery of care safer for nurses and patients

N AUGUST 6, BCNU President Gayle Duteil and Health Minister Terry Lake announced a violence reduction plan. It initially targets some of the highest risk sites in the province: Abbotsford Regional Hospital, Coquitlam’s Forensic Psychiatric Hospital, Hillside Centre in Kamloops and Victoria’s Seven Oaks Tertiary Mental Health Facility. Each site has a plan tailored to its specific needs and challenges, based on input from nursing staff and leadership at the four facilities. “Nurses were the decision makers,” says BCNU President Gayle Duteil. “Nurses came forward and brainstormed with management about the problems and solutions. It was the nurses who decided what would make their workplace better.”

Changes at the four sites include: • improved security systems, more cameras and upgraded personal alarms. • better training in violence de-escalation techniques, Code White safety drills, better orientation and mentoring of new nurses. • staffing increases, including more security, better baseline replacement and more consistency in nursing rotations to ensure safe patient care. “In some instances, baseline staffing will be increased by adding more nurses, mental health workers or someone specially trained in hospital security,” says Duteil. “Another intervention is to improve the use of personal protective devices, ensuring that nurses have access to reliable equipment and systems to quickly signal the need for help when incidents occur.

“And at each hospital we intend to upgrade the training of our nurse workforce to prepare them to better anticipate and short-circuit violent situations. That may be done by providing training in Code White response drills, in safety mentoring of newer nurses or in violence de-escalation skills.” The Ministry of Health and BCNU each put $1 million into the plan. BCNU funds for violence prevention were negotiated in the last contract and nurses’ dues are not being used to fund the plan. Duteil says while this is a good first step, the problem is much bigger than these few sites and the threat of violence is present in virtually every care setting, including residential. “So while we’re pleased to begin reducing the risks at these four sites, we’re resolved to see the issue of violence addressed across the entire health care system.” BCNU’s leadership team is currently working on improving safety at a number of other sites and more announcements regarding safety improvements are expected soon. “Violence is not part of the job,” says Duteil. “When nurses are safe, they’re able to provide safe patient care. I’m committed to keeping the pressure on the government and health authorities until every nurse has improved safety in their worksite.” update Watch our latest video on the violence reduction plan on BCNU’s YouTube site: www.youtube.com/user/thebcnursesunion

FACT FILE BC health care workers have the highest number of WorkSafeBC injury claims for violence related injuries. They have more injuries than police officers. Between 2009 and 2014, nurses filed 1,000 injury claims with WorkSafeBC. Violence in health care has increased by 70 percent in the last decade.

ROAD TO RECOVERY

Stacie Reis endured a 14-hour nightmare trapped in her car

University Hospital of Northern BC, had been on the long drive to Smithers to say goodbye to her ailing grandfather. She stopped about one hour out of Terrace to let her mom know her arrival time and to grab a snack. The last thing she remembers before awakening at the bottom of a steep 12-metre ridge was finishing her ice cream cone. When Reis, 27, opened her eyes, all she could see was that her car was upside down with a shattered windshield. She said the nurse in her kicked in right away. “My feet were bent funny and I was sure they were broken,” she recalls. “My knees needed to be LUCKY TO BE ALIVE Prince George nurse Stacie Reis is slowly straightened as the blood recovering from the multiple injuries, including broken feet and flow was obstructed.” ankles, she suffered in a recent serious automobile accident. After several minutes of prayer, she picked them DIDN’T RE-SET MY OWN up and uncurled them, which doctors said broken bones as the media reprobably saved her legs from amputation. ported,” says Stacie Reis apologetiThough that move was agonizing, Reis said cally when asked about the 14-hour her overall pain level was surprisingly low nightmare she endured in early July, throughout the ordeal. trapped in her car down an embankment “I felt confident I would be found in the about an hour out of Terrace. But survivmorning,” says Reis, “I was not scared. I ing two broken ankles and feet, a broken knew I just had to wait and be patient.” pelvis and sternum, broken ribs, two fracThat theory – and praying – kept her tured vertebrae, a fractured shoulder and hopes up throughout the night. “I did contusions to her heart and lungs is still an sleep a bit, and then sometimes I would astonishing story. look at photos of my friends and family Reis, a nurse at Prince George’s on my cell phone to pass the time.” Even

though she was able to use her cell phone, she had no phone reception. Just as Reis hoped, her mother sprang into action when her daughter didn’t show up on time. “Almost right away my mom was worried and contacted police and friends,” says Reis. Soon, cars full of her friends, family and church members were out searching for the missing nurse. It was only after 8 a.m. the next day that Reis experienced feelings of doubt. Shortly afterwards, however, she heard the voice of her good friend Rob shouting her name.

“I felt confident I would be found in the morning. I was not scared. I knew I just had to wait and be patient.” STACIE REIS

As she was transported to hospital the shock wore off, and Reis started to feel a lot of pain. She was stabilized at the Terrace ICU and transferred to Vancouver General Hospital’s ER. That night, she underwent the first of four surgeries. Doctors told Reis she won’t be weight-bearing for another five to six months and she faces a full year of recovery. She has been cared for by nurses at Kitimat hospital, where she was happy to be surrounded by her large, close family. Despite the difficult road to recovery that lies ahead, Reis feels fortunate. “I did say good-bye to my grandpa on the phone before I left to see him. I am glad I did as he passed away that night at 1 a.m.” She also learned that a full-time permanent line she applied for will be waiting at Prince George’s University Hospital when she’s back on her feet. update

UPDATE MAGAZINE October 2015

FLU SEASON

ONTARIO RULING SUPPORTS DITCHING OF BC’s PUNITIVE “VACCINATE OR MASK” POLICY

RECENT ARBITRATION decision in Ontario has given BC nurses renewed support for their call on health employers to end punitive seasonal flu policies. Since 2012, health care workers who choose not to receive the seasonal flu vaccine have been required to wear surgical masks. Failure to do so can result disciplinary action and even termination.

“We will continue to advocate that nurses be vaccinated while respecting their professional right to decide such personal decisions.” BCNU PRESIDENT GAYLE DUTEIL

The BC Nurses’ Union has consistently argued that health care workers should have a choice whether to have the influenza vaccine or not. There simply isn’t any strong evidence to support the use of surgical masks as a tool for preventing or protecting against transmission from asymptomatic unvaccinated health care workers. The Ontario Nurses’ Association (ONA) made similar arguments before an Ontario arbitrator who last September struck down a similar, and controversial, “vaccinate or mask” policy in place at 30 hospitals in that province.

Following 17 days of hearings, arbitrator James Hayes branded the policy unreasonable and “a coercive tool” to strong-arm staff into being vaccinated. Experts, including Dr. Michael Gardam and Dr. Camille Lemieux, infection control experts from the University Health Network, Quebec epidemiologist Dr. Gaston De Serres and Dr. Lisa Brosseau, an American expert on masks, testified that forcing nurses to don masks for up to six months during the influenza season did little or nothing to prevent transmission of the virus in hospitals. They told the hearings that nurses who are asymptomatic are unlikely to be real sources of transmission and therefore it was “illogical” to force healthy nurses to wear masks. BCNU President Gayle Duteil wrote a letter to provincial health employers following the Ontario decision, calling for the withdrawal similar polices currently in place in BC. She says the mask requirement highlights the coercive and punitive dimensions of the flu control policy. Last year, members who chose not to be vaccinated reported a loss of privacy and increased scrutiny and judgment. “BCNU remains committed to supporting proven measures to reduce the spread of influenza, such as public education, hand hygiene and reducing overcrowding in hospitals,” says Duteil. “We will continue to advocate that nurses be vaccinated while respecting a nurse’s professional right to decide such personal decisions.” update

WHAT YOU NEED TO KNOW ABOUT BC’s INFLUENZA CONTROL POLICY • You must advise your employer whether or not you have been vaccinated; proof is not needed but you must provide the date and location of your flu vaccination • You are not obligated to report a colleague’s non-compliance • You are not required to wear stickers stating your vaccination status • It is a breach of confidentiality if a member’s immunization record is posted publicly • If you choose not to be vaccinated, you must follow mask requirements • If you can’t wear a mask or receive a vaccination for medical reasons, you can seek an accommodation; if you are denied an accommodation, you should file a grievance • If you experience an adverse reaction from the flu vaccine or from wearing a mask, complete an incident report and file a claim with WorkSafeBC • If wearing a mask interferes with your ability to do your job, (for example, if wearing a mask is frightening patients with psychiatric or dementia-related issues) you can ask for an exception to the policy • If you have influenza symptoms, follow policies regarding not reporting to work. BCNU will continue to push for other options, such as reassignment, vacation or leaves of absence during flu season

BARGAINING FOR SAFE PATIENT CARE

STILL WORKING Marta Udovicic Burnaby Hospital

SHORT

In 2012, health employers committed to create 2,125 new registered nurse positions by March 2016

WHERE ARE THEY?

The road to a new Nurses’ Bargaining Association provincial collective agreement has been a long one, and the unfinished business from the 2012– 2014 contract has been the focus of so much of the union’s efforts – especially in the last year.

Keith Gingerich BC Cancer Agency

The recent safe staffing grievance settlement (see report on page 22) is a testament to this work, and a major step forward as the union prepares to negotiate a new provincial contract. “I am so proud of the efforts of all of our members who have worked so hard to ensure safe patient care,” says BCNU President Gayle Duteil. The 2012 contract was negotiated to give nurses the tools to reduce heavy workloads and improve patient care by calling in nurses to replace those off sick or on vacation. It also contains clear, enforceable provisions that recognize and respect the clinical judgment of nurses on when to call in more nurses to meet the needs of patients. One of the most important agreements made during the last round of bargaining was the employer’s commitment to create 2,125 new additional nurse full-time equivalent positions by March 31, 2016. This is the equivalent of some 4,160,000 straight-time paid hours. The 2012–2014 contract also stipulates that these staffing increases should be distributed evenly over a four-year period. Unfortunately, as of June 29, 2015 – more than two-and-a half years after the contract was signed – health employers have only added 1,164,140 hours, or 596, new nurse FTE positions, into the health care system, and the Surrey Memorial Hospital expansion project alone accounted for at least 400 of these. “Employers had four years to honour this commitment, yet sadly, it would appear they are nowhere near to meeting this goal,” says Duteil, who notes that health employers have missed their obligation by 1,529 FTE positions, or 2,981,550 hours. Now, health employers are attempting to argue that the additional 1.5 hours contained in the

longer 37.5-hour workweek should be included in the calculation to determine the number of new nursing hours, and they recently claimed to have added 2,667,500 straight-time paid hours into the health care system – still well short of their contractual obligations. Duteil says that accepting the employer’s premise that the additional 1.5 hours contained in the 37.5-hour workweek should be included in the calculation is a non-starter. “Nurses agreed to work an additional 1.5 hours per week in exchange for these critically important positions that would allow them to be replaced when needed,” she argues. “That was the deal, and both parties stated publicly that the 2,125 FTE positions would represent new nurses when we were ratifying the agreement in 2012.” Duteil says that employers’ unwillingness to honour such an important contract provision calls all of the commitments they have made into question. “What is the point of negotiating replacement language if new positions aren’t created to allow nurses to be replaced when needed?” she asks. “We are all aware that our health care system depends on nurses working overtime. It’s bad for nurses and it’s bad for patients – and it has to stop.” Duteil reports that the union has placed the missing FTE positions at the top of its agenda in upcoming meetings with employers. “We have scheduled two days of arbitration per month, over the coming five months, to resolve nurses’ staffing issues,” says Duteil. “While it will not solve every staffing issue at every site immediately, it will be an opportunity to make the health authorities more accountable. It will also serve as a reminder that nurses will not allow any promises that employers make to go unfulfilled.” update

BARGAINING FOR SAFE PATIENT CARE

RUNNING ON OVERTIME Long shifts and extended workweeks are bad for patient care and harmful to nurses. Why aren’t employers doing more to address the acute care sector’s chronic overtime problem?

BY THE NUMBERS OVERTIME

268,600

number of public sector registered nurses in Canada

19,383,900

hours of overtime worked by nurses in 2014

f we had to pick only one reason to convince health employers to follow through on their 2012 commitment to create 2,125 new full-time equivalent RN and RPN positions by March 2016, it would have to be BC hospitals’ constant use of overtime to keep wards staffed. BC’s two largest health authorities paid out a total of $73.7 million in nurse overtime in 2014. This massive outlay is being driven by a severe shortage of both regular and specialty-trained nurse positions, such as ER and OR nurses. There’s no question that the health care system is running on overtime. And it’s bad for patients as well as nurses. “Health authorities have failed abysmally to plan for the supply of regulated nurse positions needed to meet current and future requirements,” says BC Nurses’ Union President Gayle Duteil. “As our population ages, the need for additional nurses also rises, and as demand for hospital services grows, so does the need for specialty-trained nurses of many kinds.” Duteil notes that while nurses don’t want to work overtime, they are also concerned for their co-workers’ wellbeing. “Our members are extremely stressed by the constant demand to work beyond the regular workweek, but they also don’t want to leave their colleagues working short.” She says the current crises caused by shortages of ER and other specialty nurses were entirely predictable and avoidable, had health authorities invested in adequate numbers of training spaces. “We simply have to do a better job of human resource planning for the nursing sector.” The failure to hire additional nurses as required by the Nurses’ Bargaining Association provincial contract, and an overdependence on casual nurses for backup, goes a long way in explaining management’s systemic failure to supply replacement nurses when faced with absences. In fact, the millions spent by Vancouver Coastal Health and Fraser Health on overtime hours in 2014 alone would have translated into an additional 737 full-time nursing positions and helped to fulfill employers’ obligation to create 2,125 of these positions by March 2016.

10,700

full-time jobs equivalent

26.3%

percentage working overtime in 2014

12.5%

nurses that worked unpaid OT

16.2%

nurses that worked paid OT each week

6.1

average number of extra hours worked per week

$679 MILLION cost of paid OT

$193 MILLION value of unpaid OT

ABSENTEEISM

21,000

public sector registered nurses were absent in 2014 due to illness or disability.

25 MILLION

work hours of absenteeism is registered annually, the workload of nearly 14,000 nurses.

rate of absenteeism for full-time nurses. All other occupations average 4.7%.

$846 MILLION the annual cost of absenteeism for 2014.

Source: Trends in Own Illness- or Disability-Related Absenteeism and Overtime among Publicly-Employed Registered Nurses: Quick Facts 2015. Prepared for the Canadian Federation of Nurses Unions by Jacobson Consulting Inc.

Q&A

UPDATE MAGAZINE October 2015

BARGAINING FOR SAFE PATIENT CARE

MEMBER ENGAGEMENT BCNU President Gayle Duteil travelled the province this summer to talk with members and listen to their concerns ahead of provincial contract talks.

MAKING PROGRESS BCNU President Gayle Duteil talks with members ahead of fall bargaining

ew Nurses’ Bargaining Association (NBA) contract talks resumed this September. It’s an exciting time, and one that the union’s leadership and bargaining committee have been preparing for since last year’s series of province-wide, full-day bargaining education meetings. In the year ahead, BCNU will be at the table across from negotiators from the provincial government, health authorities and the Health Employers Association of BC (HEABC). The union is committed to keeping all members engaged and informed throughout the process. President Gayle Duteil and Executive Director of Negotiations and Strategic Development Gary Fane will be travelling again this fall to meet with and report to union members in their communities. Duteil and Fane, along with other members of the provincial executive, BCNU staff and regional executive members, will be hearing first-hand from BC nurses about the challenges they are facing every day in hospitals and communities around the province. Duteil travelled the province this summer to talk with members and listen to their concerns. Bargaining and what’s in store for the next provincial collective agreement topped the discussions. Duteil answers some of members’ most common questions here:

Why is bargaining taking so long? The staffing provisions in the 2012–2014 NBA provincial collective agreement gave nurses a unique opportunity to make a positive difference in our working lives and for our patients. Had health employers honoured the commitments they made when they negotiated the last contract, we could all be focused on providing safe patient care with adequate resources to do our work. All parties would also have been positioned to begin bargaining in earnest as soon as the 2012–2014 contract expired. Nurses agreed to work 1.5 hours longer per week in exchange for important contract provisions designed to improve workload and promote safe patient care. Unfortunately, employers failed to acknowledge the new language that gives nurses the right to enforce staffing levels, and they failed to increase baseline staffing and replace nurses on leave. We have instead spent the last year holding the employers’ feet to the fire over their previous commitments, and have now successfully arbitrated the staffing provisions of our last NBA provincial contract. BCNU was awarded a major settlement, which resolved thousands of staffing grievances and secured $2 million for breaches of the contract, which will be distributed to individuals and groups of members who filed grievances. Another $5 million

in funding has been secured for specialty education, and we now have 60 nurses signed up for BCIT programs, with guaranteed backfilling for the positions left vacant. The recent grievance settlement contains other awards that will allow our members to work safely and efficiently. With this major hurdle cleared, we are now on a clear path to a new and better contract for BC nurses. Are our benefits at risk? I give you my commitment that BCNU will not bargain our members’ benefits. We have already suffered through the administrative difficulties that came with the switch to the provincial pharmacare drug formulary under the terms of the 2012– 2014 contract – and received an arbitration award to resolve the disruption this caused. Nurses in BC enjoy comprehensive benefits that form an important part of our total compensation. These will not be on the table in the next round of bargaining. I know nurses who are losing their jobs. What are you planning to do to protect nurses’ jobs? We will be bringing forward language that provides job security for members who may be impacted by the contracting out of services or changes related to care continued on page 24

BARGAINING FOR SAFE PATIENT CARE

STAFFING GRIEVANCE SETTLEMENT = SAFE PATIENT CARE New fast-track complaint process delivers results

CNU has made significant progress in compelling health employers to implement the safe staffing contract language contained in the current Nurses’ Bargaining Association provincial contract. And forcing employers to honour their commitments was a prerequisite to starting the current round of bargaining. The 2015 staffing grievance settlement gives BCNU members a new fasttrack process that enforces the safe staffing language that was negotiated in 2012. Now, BCNU resolves staffing complaints in a committee of senior BCNU and health authority representatives. If complaints aren’t resolved by the committee, they are sent to an arbitration panel that makes a binding decision. Here are some issues that BCNU has resolved with the fast-track process in the last three months alone:

PROVINCIAL HEALTH SERVICES AUTHORITY • 40 new FTEs were created to meet the employer’s obligations, such as the provision of vacation relief. Many of these FTEs were created through the regularization of casual positions and overtime hours. • 48 new grads were hired (18 regular and 30 casual positions). • The employer is surveying casuals about their work preferences and barriers to seeking regular positions.

PROVIDENCE HEALTH CARE • 24 casuals were hired into regular positions in medicine units. • 26 vacant positions were filled through a job fair. • Five FTE regular vacation relief positions were created. • Five more FTE vacation relief lines will be posted in the fall. Don’t have enough staff to meet patient-care needs? Fill out the new Notice of Complaint form that can be found on the BCNU website.

ISLAND HEALTH • Priority units include, Royal Jubilee Hospital ER and ICU, Victoria general Hospital ICU and West Coast General Hospital ER and ICU. • A total of 23 FTEs positions were posted to address the need for vacation relief coverage and the regularization of casual hours. Of this, 4.3 FTE (one nurse 24-7) was added to baseline in the Royal Jubilee Hospital ER. • 206 new grads were hired (six fulltime, 131 casual and 52 temporary vacancies) • BCNU and Island Health are discussing: >> specialty training programs to meet future needs. >> vacation relief that must be hired to meet the ratio of one relief for every 10 regular nurses.

NORTHERN HEALTH • 24 new vacation relief positions were created. Units or programs with more than 10 full-time equivalents (FTEs) will get one vacation relief position. • 13 people were pre-hired for difficultto-fill positions.

FRASER HEALTH • 140 new relief positions were created. • 106 new employees were hired (casual and external hires). • 247 new graduates were hired. • 30 Specialty Nurse Education (SNE) seats were funded by BCNU: 20 for ERs at Surrey Memorial (SMH) and Abbotsford Regional (ARHCC) and 10 for the family birthing unit at SMH. • 190 regular positions were posted in a job fair and 124 were filled: 65 casuals gained regular positions, 50 regular nurses moved to other positions and 66 unfilled specialty positions were posted externally. • Disputes about FHA relief guidelines were settled. FHA agreed: >> t hat regular relief nurses in float positions will not have their master rotation changed any more than other regular nurses. >> to create vacation relief positions and give those nurses a master schedule by January 31 of each calendar year.

PROVINCE-WIDE • $1 million in damages was paid to over 1600 RN/RPN members who: >> signed grievances or workload questionnaires prior to March 31, 2015. >> testified, or were on the witness list to testify, in Single Employer Policy Dispute arbitrations that were placed in abeyance during the Tom Hodges-led staffing arbitration. >> took leadership roles in the grievance/Grievalanche campaign. • Because LPNs are not yet part of the RN/RPN contract they were not paid damages. Wherever possible BCNU included LPNs in the arbitration settlement by securing $1 million in education funds and inviting them to mental health resiliency workshops.

UPDATE MAGAZINE October 2015

VANCOUVER COASTAL • 2.4 FTEs were created in Sechelt to support the ICU/ER. • Three FTEs were posted at Hilltop House to attract regular staff. • Additional staffing is still in discussion at Evergreen House, Cedarview and Kiwanis Care. • One FTE med/psychiatric float nurse was created at Powell River Hospital. NOT WORTH THE RISK Employer cost sharing proposals would expose nurses to increased drug costs.

INTERIOR HEALTH • A new process has been developed to expedite the filling of long term temporary vacancies (LTTVs). It will reduce “line churn” and provide casuals with full benefits. • 23 vacation relief FTEs were posted and 23 more will be posted on January 1, 2016. They will be spread throughout the IHA. • A new vacation bidding process will be implemented that provides vacation relief staff with schedules for a full year. • 12 positions were created that had previously been filled by casuals, overtime, etc. • 1 new 24-7 float position was created at Salmon Arm Hospital. • Going to arbitration: IHA has not posted new positions at Kelowna General Hospital ER and has only created one new position on the East Kootenay Regional Hospital medical unit. More regular positions are required to meet patient care needs and regularize the ongoing casual, overtime, and “relief-not-found” hours in these units.

A MATTER OF TRUST Cost-sharing proposal would put nurses’ benefits at risk

urses’ benefits will not be compromised in any way as bargaining for a new contract gears up – that’s the clear message from BCNU President Gayle Duteil. “Nurses in BC enjoy comprehensive benefits that form an important part of our total compensation,” says Duteil. “Those benefits still come without the co-payments other health care unions have unfortunately agreed to, and we’re committed to keeping it that way.” BCNU’s position on benefits ahead of Nurses’ Bargaining Association (NBA) provincial contract talks is a clear signal to the provincial government and the Health Employers Association of BC (HEABC) that the union will not accept the framework they imposed on other health sector bargaining associations in 2013. Of particular concern is the joint benefits

trust agreement that was ratified by the Health Science Professionals Bargaining Association (HSPBA) and HEABC that formally established the Joint Health Science Benefits Trust as part of the 20142019 HSPBA collective agreement. A joint benefits trust ( JBT) is a notfor-profit organization created to assume responsibility for all the assets, obligations and services associated with the provision of member benefits, such as extended health, dental, group insurance and long-term disability. This new entity is controlled by an equal number of trustees (representing employers and workers) and is responsible for delivering member benefits. However, in return for agreeing to joint trusteeship, workers also share the continued on page 25

BARGAINING FOR SAFE PATIENT CARE

sions with health employers and negotiating an agreement that best meets the needs of patients and nurses.

MAKING PROGRESS continued from page 21

delivery. We will also fight hard to prevent employers from implementing any care model redesign schemes, where nurses are replaced with care aides. I’m an LPN and all I hear about is how you are improving things for RNs and RPNs covered by the NBA contract. We have waited so long and fallen so far behind in wages for the skills that we use every day. What about LPNs? When negotiating our new collective agreement, we will commit to ensure that our new LPN members receive the same vacation allotment, benefits and premiums as those received by all the other members covered by the collective agreement. LPNs are an invaluable part of the health care team, and there’s no disputing that they have been undervalued by health employers. That’s one of the rea-

sons LPNs voted overwhelmingly to join BCNU in 2012. We are committed to correcting this inequity at the bargaining table using whatever tools we have. Other health sector unions have settled their contracts. Why haven’t we? While it’s true that BCNU is now the sole remaining health sector union yet to bargain a collective agreement with the province, the other unions, whose provincial contracts also expired in March 2014, were far too quick to negotiate five-year agreements, and did so within a general framework the provincial government wanted to impose on all negotiations. Nurses are unique, and it benefits the NBA to negotiate a deal that works for nurses, and not to follow the pattern the province has been all too successful in forcing onto other health and public sector workers. We have always stressed the importance of pacing discus-

Some LPNs who are still covered by the Facilities Bargaining Association contract are losing jobs and losing their seniority when they move to the Community Bargaining Association. What can you do about this? Merging the FBA and CBA contracts into the NBA contract is one of our highest priorities. Special bargaining meetings have already been scheduled to address this very issue. We are very aware that some community LPN members are not being allowed to take their FBA seniority to their CBA jobs, and others are receiving termination letters from their employer for not maintaining 225 hours-peryear in their casual position. You have my firm commitment that we are working hard to protect the job security of all our members. What kind of a raise are we going to get? Our fellow health care unions, the Health Sciences Association and Hospital Employees’ Union, hastily signed a deal that provides a 5.5 percent wage increase over five years. There’s no question that nurses can do better than this. Why don’t I hear about what’s going on with bargaining?

Is your contact information up-to-date? Make sure to sign in to the BCNU member portal that’s located on our website and provide us with your current mailing address, phone number and email. The easiest way to stay informed is to subscribe to BCNU’s weekly e-newsletter, where we’ll be providing regular updates as bargaining progresses. And of course, talk to your steward if you have any immediate concerns. They will be kept abreast of all developments during bargaining. What can I do to help with bargaining? Success at the bargaining table depends on a strong and united membership. If the employer knows that nurses are supportive of one another, they’ll be less likely to waste time and more amenable to constructively reaching a fair agreement that meets the needs of patients and care providers. Please use the contract language we already have, and the Notice of Complaint fast-track process we just achieved to file grievances. Use the PRF process, engage with new nurses, help your stewards track vacancies and do whatever else you can to safeguard patient care and your working conditions. An active membership that uses the collective agreement to its full advantage will strengthen BCNU’s position at the bargaining table. It’s also important to get the public on our side. Tell your friends and family about your

UPDATE MAGAZINE October 2015

experiences at the bedside and in the community, and about the difficulties you face every day. Remember that the provincial government is not unwilling to manipulate public opinion if it thinks this will give it an advantage at the bargaining table. Its negotiators and media relations staff are not above playing fast and loose with numbers and dollar figures taken out of context if they think they can isolate nurses and undermine our public support. Fortunately, nurses are respected and we have the authority to speak out and warn the public about care conditions in our hospitals and in our communities. British Columbians need to hear about what it’s like if it’s one of their family members who needs bedside care, but who cannot access it because of health employer policies that make it impossible to safely deliver that care. Remember: if we stay proud and united I have no doubt that we can achieve our goal of safe patient care. update

A MATTER OF TRUST continued from page 23

responsibility for financing future benefit costs. Prior to the creation of a JBT, the responsibility for providing benefits rests primarily or solely with the employer. In the case of nurses, the NBA provincial collective agreement requires employers to pay for 100 percent of premium costs. Workers whose unions are not members of the NBA are required to pay 25 percent of the annual costs of their health and welfare benefits. The other bargaining associations’ acceptance of a trust arrangement now means that their members share responsibility for funding the rising costs of benefits. It also puts union trustees in the position of choosing between trimming benefits or raising premiums. They will be forced to defend benefit cuts in the name of cost-containment or to justify premium hikes to keep benefits intact. Duteil says the deal does not

“

This is not a path nurses will accept, because it enables the employer to shed more responsibility for funding and delivering benefits. BCNU PRESIDENT GAYLE DUTEIL

”

augur well for health care workers in other bargaining associations. “As benefit costs continue to rise, their members will likely find themselves in a position to have to either cut coverage or pay more from their pockets.” This interpretation is reinforced by a recent HSPBA bulletin that states “current benefits will be maintained until at least April 1, 2016. After that, trustees may redesign the benefits plan subject to available funding.” There’s no question that the JBT agreement was a major concession, and the other bargaining associations who have signed on to this scheme have now exposed their members to significant liability and uncertainty. “This is not a path nurses will accept, because it enables the employer to shed more responsibility for funding and delivering benefits,” says Duteil. “Fully paid, high-quality benefits are important for attracting nurses into our profession, so maintaining them without any form of co-payment is a priority.” Duteil says that while health employers certainly need to do a better job of managing the

costs of delivering benefits than they have in the past, nurses will not accept changes that put existing coverages at risk or require them to make payments for benefits, and recalls the turmoil that was caused when BCNU agreed to the so-called pharmacare tie-in during the last round of negotiations. “BCNU heard in the last round of bargaining that the employer needed relief on rapidly rising drug costs in order to keep the existing benefits package intact. We were assured this could be done without pain by switching over to the provincial drug formulary. And we all know just how well that promise was kept.” BCNU received a significant arbitration award to restore most established benefits that nurses were receiving prior to the switch. Nevertheless, the trust that remains essential in reaching agreement is hard to build and easy to undermine. “Safe patient care is our top priority in this round of bargaining,” says Duteil. “That’s our focus. BCNU is not interested in bargaining away our members’ benefits.” update

PRFs

IN THE WORKPLACE: MEMBERS ARE SEEING SUCCESS AROUND THE PROVINCE

VANCOUVER COASTAL HEALTH

PRFs WORK NORTH SHORE PUBLIC HEALTH NURSES APPLAUD PRF PROCESS AND MANAGEMENT’S SUPPORT “DON’T BE AFRAID OF the PRF process and have confidence in talking to your manager when issues arise,” says North Vancouver public health nurse (PHN) Valerie Williams. “We did, and we were successful in getting a great resolution.” Williams, a nurse with 25 years of experience, has spent the past 11 years as a member of the “Early Years” program in North Vancouver. She works with the newborn to five-year-old age group, as well as occasionally helping out in schools delivering vaccinations and doing TB screening at adult vaccination clinics. In January 2015, a client visited the health unit where Williams works to pick up harm reduction supplies. After getting them, he entered a men’s washroom located on the same floor. Shortly afterwards, he was found lying face down by a janitor who called 911. The client was unconscious and unresponsive when assessed by two PHNs. They found the client making occasional gasping or snoring sounds. His hands and face were blue, and he was pale, diaphoretic with a low pulse, and respiring at only two to three breaths a minute. Williams arrived at the scene

hospital and, fortunately, survived. Afterwards, Williams spoke to her manager about the incident and suggested improvements for the emergency kit. She was concerned about the client’s safety and nurses’ ability to have appropriate emergency supplies available to practice safe patient care. “I spoke to the team leads first about the need for EFFECTIVE TOOL Public health nurse Valerie improved processes Williams says the PRF process was ideal for and a better harm helping to improve emergency protocols at her health unit. reduction emergency kit,” recalls Williams. a few minutes later. While “And then I approached my another nurse ran to the rec manager. Everyone was very center (five minutes away) to concerned, receptive and open get a defibrillator, Williams to having productive problemlooked for a stethoscope and a solving discussions. The conbag valve mask to aid with the versations that I had with them client’s breathing, whose mouth made me feel very hopeful that and teeth were clamped shut, something would happen right making it difficult to insert an away for the betterment of the oral airway. Narcan was also not health unit and the clients we available to reverse the effects of care for.” what was considered a possible After those discussions, the overdose following assessment. manager and Medical Health It was a life-threatening situOfficer took immediate action ation. The client was taken to to correct the problems.

It was agreed that it would be critically important for all staff to be given harm reduction training and commit to ensuring the proper medical equipment and supplies were readily available and accessible for any future harm reduction emergencies. Williams spoke to her manager three days later, after completing a PRF, and reviewed the incident with her again. The manager encouraged her to file a PRF as she knew that the PRF process was a useful and productive way to ensure safe patient care and make change happen collaboratively.

“The conversations that I had with them made me feel very hopeful that something would happen right away for the betterment of the health unit and the clients we care for.” VALERIE WILLIAMS

As a result of Williams’ actions, and those of her colleagues, management willingly agreed to the following course of action: • Review guidelines and protocols on how the unit was responding to emergency situations. • Develop ways to improve client service, safety and

UPDATE MAGAZINE October 2015

knowledge gaps for staff. • Review and update the emergency kit to treat all clients in any crisis situation (The kit now includes a stethoscope, ambu bag, gloves and Narcan). • Train all nurses to administer Narcan and review potential overdose management. • Develop a process for clients to take home Narcan with specific staff education (Five nurses were trained in implementing the teaching of the narcotic take-home kit to harm reduction clients and all PHNs – approximately 30 – were trained to give Narcan to ensure there is at least one PHN available each day onsite that is able to do so. • Remind nurses to renew their CPR every two years according to guidelines. • Inform clerical staff of the location of the emergency kit. • Check bathrooms regularly to ensure harm reduction clients have not experienced an emergency. Williams says that she and her colleagues realize that raising issues with management as soon as they occur, as part of the PRF process, benefits their clients and protects their ability to practice safely. “The PRF process really does work and it can be a positive experience,” she stresses. “It helped us to reflect together on what tools we need to make our work environment safe for everyone. It also made us aware of our own need as nurses to take some responsibility for our own training, skills and development. And it built our confidence when caring for harm reduction clients.” update

FRASER HEALTH

FRONTLINE NURSES’ PERSEVERANCE RESULTS IN PRF SUCCESS AT ABBOTSFORD REGIONAL HOSPITAL “WHEN I BECAME A NURSE I wanted to provide quality care, each shift,” says Natalie Maas, who graduated in 2010 and works on the single room maternity care unit at Abbotsford Regional Hospital (ARH). “I wanted to know my patients were receiving the safe, quality care they deserved. That’s why I felt it was important to raise my concerns through the PRF process.” ARH is a busy regional maternity centre in the Fraser Health Authority (FHA) with approximately 2,400 deliveries per year – many of them complex and complicated. When the new unit opened in 2008 it was staffed with 12 nurses (one patient care coordinator (PCC) and 11 RNs) 24 hours a day. In 2012, staffing practices changed, so that the first call out was not automatically replaced, meaning that the unit often functioned with only 11 nurses. In May 2013, implementation of the Maternal Infant Child and Youth Program Resource Allocation Plan came into effect, and staffing was reduced to 11 nurses on days (one PCC and 10 RNs). One RN out of the 10 was placed in-charge, usually with no patient assignment, and another RN was assigned to the triage area – leaving eight RNs to cover the rest of the unit. The unit consists of 24 beds, with another area that can

POSITIVE OUTCOME Abbotsford Regional Hospital maternity unit nurses Marnie Martin, Lynn Taylor, Jennifer Kapty and Natalie Maas successfully used the PRF process to help maintain baseline staffing levels at their facility.

accommodate an additional four off-service patients. The triage area, which is physically located outside of the maternity unit, has five stretchers and assesses up to 500 patients a month. As part of the allocation review, the PCC role was eliminated on night shift and the roles of the day shift PCC increased, further stressing the nurses’ ability to provide safe patient care. Staffing was frequently below baseline and not all nurses on the unit were labour delivery room-trained, resulting in greater workload for those who were. The length of stay for patients also was typically shorter than at other FHA facili-

ties. This meant that there were many admissions and discharges per shift with no adequate diversion policy in place. As a result of these changes, a group of approximately 10 nurses from the unit came together and decided to engage the PRF process. Seventy-seven PRFs were filed during 2013 and 2014. Nurses chose the PRF process out of concern for patient safety and their inability to meet their standards of practice based on maternity best practices, among other issues. Another complicating factor was a change to the management structure, including a continued on page 30

PRF SUCCESSES AROUND THE PROVINCE The PRF successes in Abbotsford and the North Shore (see pages 26 and 27) are just two examples of how BCNU members are using the PRF process to protect their patients and their practice standards. This map provides a summary of recent PRF successes across BC. Read on and think about how you can use PRFs to improve conditions in your own workplace.

PROVINCIAL HEALTH SERVICES AUTHORITY Surgical Day Care Unit nurses at Vancouver’s BC Women’s Hospital raised concerns about workload issues from increased volume and patient acuity. The issues were resolved at the PRF Committee. Outcomes included booking a float

PROVIDENCE HEALTH CARE PRF co-chairs delivered AC several successful info sessions this year. Co-facilitation by both employer and union reps has helped create an open and engaging atmosphere. Several acute areas of Vancouver’s St. Paul’s Hospital participated, as well as the Providence Health Care nursing practice council. Members and management were appreciative of how PRFs are both problemsolving and collaborative tools. Van Metro regional members have seen many PRFs resolved locally. “Both Van Metro and PHC are hoping to hear of more successes, with members advocating for safe and excellent patient care.” ANDREA, RN

nurse on Thursdays when there are extra patient care demands, and reviewing the caseload scheduled on those days. “If nurses are struggling, they need to file PRFs and talk to their stewards.” LAUREL, RN

VANCOUVER COASTAL Richmond Hospital 3 South nurses raised concerns around overcapacity and understaffing. The issue was resolved by the PRF Committee, which decided there would be a

2.0 FTE increase. Staff AC also achieved an extra nurse in the birthing centre, due to extremely high workload. “Fill out PRFs. They certainly had a very positive effect advocating for safe patient care.” JANET, RN

Duncan Home and Community Care nurses saw staffing reduced from five to three RNs on stats. There was also daily confusion regarding triaging and coordinating geo team workloads. Meetings between nurses and their manager led to

CC positive change. On the next two stats, there was a full complement of staff, and leadership assigned part-timers to geo teams for an even distribution of staff. “It’s best to meet with the leadership team face-to-face and try to offer solutions.” LYNDA, RN

Just two months after a PRF education session, RNs and LPNs at The Views long-term care facility in Comox completed three PRFs that will be

heard by the PRF Committee. “Nurses feel empowered and understand that PRFs make a difference.” RAY, LPN

ISLAND HEALTH

LTC

UPDATE MAGAZINE October 2015

SUCCESSES ACROSS SECTORS

ACUTE CARE

COMMUNITY CARE

LTC

LONG-TERM CARE

NORTHERN HEALTH Surgical nurses at the University Hospital of Northern BC used the PRF process to address workload and safety concerns related to unfilled lines and working below baseline. They successfully filled all

INTERIOR HEALTH At Trail’s Poplar Ridge Pavilion, the PRF process resulted in constructive collaboration between nurses and management. Monthly meetings successfully increased positive com-

AC of their empty lines and workload is always provided, including at overtime. “I talk to them about identifying problems and being part of the solution. I tell them they worked hard for their license and can’t work without it.” BARB, LPN

LTC munications and a healthier work environment. A “first draft” checklist to address workload issues has been created. “The PRF process was new to me. I see it as a very positive outcome.” KIMBERLEY, LPN

Nurses at Nelson’s Jubilee Manor were experiencing health and safety, workload, equipment and communication issues. After discussions with the PRF Committee, there were several positive outcomes: a new med

cart, team building days, LTC improved communication and workload support. “When you feel unable to meet your standards of practice or that patient safety is at risk, the sooner you contact a steward the better.” PAULA, RN

CH1 nurses at the Trail Mental Health Unit were being asked to train social workers to conduct metabolic monitoring assessments, and then sign off on their competencies annually.

Nurses and their manager CC found an acceptable alternate solution: a drop-in group setting for monitoring. “Be creative in your problemsolving suggestions.” KAREN, RPN

FRASER HEALTH ER nurses at White Rock’s Peace Arch Hospital identif ied multiple safety issues, which were resolved by the PRF Committee. Gains included ceiling lifts,

AC Plexiglas at the triage station, security doors and an extra RN 24-7 for workload in the waiting room. “It comes down to respect, which is one of the PRF Guiding Principles.” BARB, RN

FRONTLINE NURSES continued from page 27

new site director and unit manager, which impeded the nurses’ ability to consistently meet to address the on-going issues, problem-solve together and even present PRFs in a timely fashion. “We knew from hearing testimonies from other nurses across the health authority that engaging in the PRF process with their managers could result in positive improvements,” says Maas. “Knowing that kept us very motivated and committed.” Maas notes that even though management did end up resolving some of the nurses’ outstanding issues – it took a long time and implementation took even longer. “Perseverance is key throughout the PRF process,” says Maas. “Having a group to work with, and with additional support from our stewards and others, we knew that we were doing the right thing.” Vacancies were finally filled, but there still weren’t enough experienced nurses to ensure that standards were met and that workload was manageable. Of 55 FTE/PTE positions on the unit, only 33 nurses had enough experience to work in triage and only 19 nurses had enough experience to be in-charge. There was also an attempt at voluntary on-call to alleviate some of the issues, but it was infrequently utilized. A revised maternal diversion policy was released in March 2014, but due to stringent criteria and the amount of time that it actually took to find a bed, it was not an effective tool for the

nurses to use. All of the other recommendations they brought forward as part of the PRF process had not been implemented or if so, only partially. As a result of unresolved issues at the local level, the members decided to take their PRFs to the Senior Review Committee (SRC) in December 2014. The SRC released its final report in April 2015. Its major recommendations included providing an increase in the PCC coverage on the unit to 24 hours a day, seven days a week (to be evaluated in six months) and the creation of a Professional Practice Council (PPC) responsible for reviewing and monitoring skill mix, utilization of the diversion policy, mentoring of new staff and ongoing support for education and competencies. The new PCCs are to have a frontline leadership role, hands-on focus and the ability to absorb and replace the incharge role on the unit. This was a major positive outcome, and all due to the nurses’ persistence and hard work. The PCC coverage is currently in place and a decision was made to survey all staff every month to assess the impact of the additional support. The PPC held its first meeting in late September, with 23 nurses attending. “It’s great,” concludes Maas, “to be able to work in collaboration with management to make positive change on our unit. We’re hopeful that patient safety and quality care will become our mantra every day, and that we’ll all be able to provide the care we were trained to give – thanks to the PRF process.” update

HERE’S WHO CAN HELP BCNU’s PRF regional advocates offer support at the regional level. They provide education, establish committees and visit worksites to support nurses. Pictured above are the PRF advocates who attended a BCNU information meeting earlier this year. Front row, from left: Laurel Kathlow, Michelle Grant, Sara Johl, JoAnne Ratchford, Barb Erickson, Pauline Barlow. Back row, from left: Glenna Lynch, Andrea Rauh, Chauni Johnson, Kristine Congram, Cam Ward, Catherine Clutchey, Heather Picklyk, Janice Young and Ray Hawkes. If you need help, please contact your current PRF advocates listed below.

HOW TO CONTACT YOUR REGIONAL PRF ADVOCATES Pacific Rim Ray Hawkes rayhawkes@bcnu.org

South Fraser Valley Catherine Clutchey catherineclutchey@bcnu.org

South Islands Michelle Grant michellegrant@bcnu.org

Simon Fraser Cameron Ward camward@bcnu.org

Vancouver Metro Andrea Rauh andrearauh@bcnu.org

Okanagan Similkameen Kristine Congram kristinecongram@bcnu.org

Coastal Mountain Pauline Barlow paulinebarlow@bcnu.org

Thompson North Okanagan Chauni Johnson chaunijohnson@bcnu.org

RIVA Sara Johl sarajohl@bcnu.org

East Kootenay Lori Pearson loripearson@bcnu.org

Shaughnessy Heights Laurel Kathlow laurelkathlow@bcnu.org

West Kootenay Glenna Lynch glennalynch@bcnu.org

Central Vancouver Judith McGrath jmcgrath@bcnu.org

North East Barb Erickson barbaraerickson@bcnu.org

Fraser Valley Janice Young janiceyoung@bcnu.org

North West Louise Weightman louiseweightman@bcnu.org

UPDATE MAGAZINE October 2015

Member Profile

YOUR COLLEAGUE CLOSE-UP

THE FUTURE OF NURSING CNSA’s NEW PRESIDENT MAKES IMPROVING ABORIGINAL HEALTH CARE HER TOP PRIORITY

DAWN TISDALE HAS A refreshingly optimistic view of the future of nursing. The newly elected president of the Canadian Nursing Students’ Association (CNSA) believes that Canada’s nurses can transform the health care system. “I think nurses have such an amazing responsibility and the power to be able to make the changes we want to see in the health care system,” says Tisdale. “We are the biggest body within the medical system. We have the sheer numbers.” Her top priority is improving Aboriginal health care by including Aboriginal health in nursing school curriculums. “The impact that residential schools have had on the health of Aboriginals is shocking. Yet

NURSE POWER “I think nurses have such an amazing responsibility and the power to be able to make the changes we want to see in the health care system,” says Canadian Nursing Students’ Association President Dawn Tisdale.

there’s very little focus on this in education. Some schools, including North Island College and more recently UBC now offer Aboriginal health as part of their curriculum.” Tisdale believes it must be more widespread. “Including Aboriginal health in the curriculum is important because nurses are the first contact most people have with the health care system. And indigenous peoples are the fastest growing segment of the Canadian population.”

As an example of the need for better education, Tisdale points to the tragic case of an Aboriginal man who died of a bladder infection during a 34-hour emergency room wait in Winnipeg in 2008. An inquest determined his death was preventable, and the family blamed racism and a lack of cultural understanding within the health care system. Tisdale’s grandmother was aboriginal, but she grew up without receiving any substan-

tial knowledge of her cultural heritage. She says it wasn’t until she attended North Island College that she began to fully understand the history and complexities of First Nations health care. Now in her fourth year of nursing at North Island College, Tisdale is also the mother of a five-year-old boy, yet somehow finds the time to volunteer as president of CNSA. She says her instructors have been very supportive. “They let me use my role as president in my Nursing Practice courses, which focus on community health promotion and nursing leadership.” She’s always been passionate about social justice issues, and in addition to Aboriginal health, has a keen interest in mental health issues, seniors and adults with disabilities. She laughs remembering a time when she didn’t think nursing would be challenging enough. “I thought it was about taking doctor’s orders, not advocating for patients. Meanwhile, here I am now in the most rewarding and challenging degree ever.” Four other BC students were elected to the CNSA board – Courtney Hunter of Thompson Rivers University and three from Langara’s School of Nursing: VP Terrace Desnomie, Tonie Castro, and Lourdes Cua. update For more CNSA info, please visit www.cnsa.ca/english.

Who Can Help?

BCNU IS HERE TO SERVE MEMBERS

BCNU CAN. Here’s how you can get in touch with the right person to help you. CONTACT YOUR STEWARDS For all workplace concerns contact your steward. REGIONAL REPS If your steward can’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.

EXECUTIVE COMMITTEE PRESIDENT Gayle Duteil C 604-908-2268 gayleduteil@bcnu.org

EXECUTIVE COUNCILLOR Deb Ducharme C 250-804-9964 dducharme@bcnu.org

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

EXECUTIVE COUNCILLOR Dan Murphy C 604-992-7568 danmurphy@bcnu.org

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

EXECUTIVE COUNCILLOR Adriane Gear C 778-679-1213 adrianegear@bcnu.org

REGIONAL REPS CENTRAL VANCOUVER Judy McGrath Co-chair C 604-970-4339 jmcgrath@bcnu.org

Marlene Goertzen Co-chair C 778-874-9330 marlenegoertzen@bcnu.org

COASTAL MOUNTAIN Kath-Ann Terrett Chair C 604-828-0155 kterrett@bcnu.org

SIMON FRASER Lynn Lagace Co-chair C 604-219-4162 lynnlagace@bcnu.org

EAST KOOTENAY Lori Pearson Chair C 250-919-4890 loripearson@bcnu.org

Debbie Picco Co-chair C 604-209-4260 dpicco@bcnu.org

FRASER VALLEY Katherine Hamilton Chair C 604-793-6444 katherinehamilton@bcnu.org NORTH EAST Veronica (Roni) Lokken Chair C 250-960-8621 veronicalokken@bcnu.org NORTH WEST Sharon Sponton Chair C 250-877-2547 sharonsponton@bcnu.org OKANAGAN-SIMILKAMEEN Rhonda Croft Chair C 250-212-0530 rcroft@bcnu.org PACIFIC RIM Rachel Kimler Chair C 250-816-0865 rachelkimler@bcnu.org RIVA Lauren Vandergronden Chair C 604-785-8148 laurenvandergronden@bcnu.org SHAUGHNESSY HEIGHTS Claudette Jut Chair C 604-786-8422 claudettejut@bcnu.org

SOUTH FRASER VALLEY Jonathan Karmazinuk Co-chair C 604-312-0826 jonathankarmazinuk@bcnu.org Michelle Sordal Co-chair C 604-880-9105 michellesordal@bcnu.org SOUTH ISLANDS Margo Wilton Co-chair C 250-818-4862 mwilton@bcnu.org Lynnda Smith Co-chair C 250-360-7475 lynndasmith@bcnu.org THOMPSON NORTH OKANAGAN Tracy Quewezance Chair C 250-320-8064 tquewezance@bcnu.org VANCOUVER METRO Meghan Friesen Chair C 604-250-0751 meghanfriesen@bcnu.org WEST KOOTENAY Lorne Burkart Chair C 250-354-5311 lorneburkart@bcnu.org

UPDATE MAGAZINE October 2015

Council Profile HERE’S WHO’S WORKING FOR YOU

SUPPORTING MEMBERS VANCOUVER METRO CHAIR MEGHAN FRIESEN

EMPOWERING MEMBERS

“BCNU’s number one priority is our members, making sure they have a voice, and ensuring that publicly-funded health care is protected,” says Vancouver Metro chair Meghan Friesen. QUICK FACTS NAME Meghan Friesen. GRADUATED Conestoga College 1994. UNION POSITION Vancouver Metro chair. WHY I SUPPORT BCNU? It’s important to know that someone is there and has your back at work.

WHEN MEGHAN FRIESEN completed her first post-secondary degree in history and social sciences in Pennsylvania, the current chair of BCNU’s Vancouver Metro region wasn’t certain what to do next. Inspired by a close friend who was studying to be a nurse, Friesen decided to follow in her footsteps. She eventually completed her degree and training in southern Ontario’s Kitchener-Waterloo area. She graduated in 1994, when fiscally-conservative Mike Harris was Ontario’s premier. “It was a time of no nursing jobs,” remembers Friesen, “and most of my graduating class went to the US to find work.” Undeterred, she eventually launched her career at Hamilton’s Mount St. Joseph’s Hospital, working in the rheumatology, orthopedics and

plastics ward. After upgrading her nursing skills, she landed a permanent position as a cardiac care nurse. In 2000, that experience helped Friesen win a job at Vancouver’s St. Paul’s Hospital as a clinical nurse leader (DC2) in the cardiac, medicine and surgery wards. After completing BCIT’s Critical Care certificate in 2002, Friesen began delivering care at St. Paul’s cardiac ICU. In 2006, she became a clinical coordinator, the job she currently holds. A back injury resulted in what Friesen describes as “a terrible time” dealing with WorkSafeBC. “When they cut me off [my benefits], my BCNU steward helped me get a work accommodation,” she recalls. “At that point I became much more interested in my union and my contract.” Friesen became a BCNU

steward at St. Paul’s in 2009 and a full-time steward the next year. In 2012, she was elected to BCNU’s Bargaining Committee, as an acute care rep. “I believe in pushing myself to the next level and going outside my comfort zone,” she says, reflecting on her unexpected career trajectory. Last September, Van Metro members elected Friesen as their regional chair. It’s a busy job, but she found enough time to participate, along with 250 other Canadians, in the prestigious Governor General’s Leadership Conference. Its goal is to promote and develop future leaders. She was chosen as a team leader and travelled to the Northwest Territories “to study all aspects of leadership. It was an amazing experience.” Friesen currently serves on BCNU’s Member Engagement, Steward Recruitment and Retention Committee, working with steward teams to increase member involvement throughout the union. She is also a member of BCNU’s Personnel Committee. Its responsibilities include ensuring BCNU staff work in a safe, healthy environment. “I think it’s important to know that someone is there and has your back at work,” says Friesen of her role as a BCNU council member. “BCNU’s number one priority is our members, making sure they have a voice, and ensuring that publicly-funded health care is protected. I love our union’s vision, mission and values.” Friesen became a nurse because she loves working with people. She also loves her role as regional chair because “you’re nursing your members, helping to support and care for them, just like you do with your patients.” update

UPDATE MAGAZINE October 2015

Off Duty MEMBERS AFTER HOURS

him virtually while he is on course through a live on-line tracking system. “Triathlon is a solo endeavor,” says Huntley, “but there is no way you can get to the start line and undertake a sport like this without enormous support from your family, friends and colleagues.” Although Huntley hasn’t convinced any co-workers to follow in his footsteps, he believes he’s “at least inspired a few to be a bit more active.” Just five days after this summer’s surgery, he was cleared to start training again. Huntley bicycles to work year round. “It’s not much in the way of training,” he says. “But every little bit counts when you are time-crunched.” He takes his two-year-old son

with him on his three-timesa-week runs in a chariot and squeezes in swimming and bike riding sessions before and after work. Sunday is a big training RUNNING HARD DAVID day, either directly on the bike HUNTLEY COMPETES for four to five hours or as part IN GRUELING IRONMAN of a race. “I am lucky my family is so supportive,” Huntley says. COMPETITIONS WHEN HE ISN’T Despite a busy life with a CARING FOR PATIENTS toddler, and twins arriving in December, he somehow manDAVID HUNTLEY, A NURSE So imagine how he felt, just aged to complete the gruelclinical leader at Cowichan four days after finishing the ing Lake Tahoe Ironman in District Hospital, was competWhistler event, to learn that the September. “It has a reputation ing in his seventh triathlon shoulder pain he experienced for being one of the harder races this summer when he started was diagnosed as a gall bladder on the circuit,” laments Huntley. to experience shoulder pain. attack. He quickly underwent Ironman, which started in 1978 He shook it off as part of the surgery in the very operating in Hawaii, now hosts more than “normal” suffering triathletes room he works at. 50 triathlons and hundreds of often experience when particiHis co-workers have been endurance type events around pating in the infamous Ironman very supportive of his training the world. races. After all, completing a and events. Some have followed “Since its inception,” states mere 3.86 km open-water swim, organizers, “Ironman a 180.25 km bicycle ride and a has been represented by 42.2 km marathon is no small ambitious and courafeat. Despite the pain, Huntley geous individuals who finished the Whistler Ironman aren’t afraid to push race in 10:29:35, securing an their limits. It’s amazing eleventh place divisional finish. what people have overHuntley signed up for his first come to pursue their triathlon 10 years ago, while dream of becoming an attending Calgary’s Mount Ironman, and despite Royal University, following a the fact that every year dare from a friend. His first we believe that their race was a sprint triathlon, stories can’t be topped, which consisted of a 500 m season after season swim, 20 km bike ride and a we’re proven wrong.” 5 km run. Huntley said he was Huntley hopes to deliriously exhausted at the fincontinue competing in ish line, and his friend beat him. triathlons for years to His philosophy of paying come. “I plan to keep close attention to his body and doing this,” he says. “I taking preventable measures to want to be one of the keep fit and strong means he old guys in his eighties HELPING HANDS Cowichan District Hospital nurse David Huntley says “there is no has never suffered from a major way you can get to the start line and undertake a sport like this without enormous still crossing the finish injury since starting triathlons. support from your family, friends and colleagues.” line.” update

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