IN THE MATTER OF AN ARBITRATION

BETWEEN:

The Ottawa Hospital

-and-

Canadian Union of Public Employees

Local 4000

Policy Grievance re: Dress Code Policy

Lorne Slotnick, Arbitrator

Representing the Union – Peter Engelmann, Colleen Bauman, Ben Piper

Representing the Employer – J.D. Sharp, Porter Heffernan

Hearing – Ottawa, Ont., July 25 and 27, Nov. 17 and 21 and Dec. 13, 2011,

and Jan. 9 and 10, Nov. 20 and Dec. 6, 2012

[2]

A W A R D

This grievance was prompted by a new, comprehensive dress code policy that came into effect in

March, 2011 at The Ottawa Hospital. The policy addresses a number of areas, some of which

are not contentious. The union’s challenge focussed on the requirement that employees cover up

large tattoos while at work, that employees not have visible, excessive body piercings, and that

nursing staff wear lab coats when off their units, including on breaks.

Simply put, the union’s argument is that these requirements, among other aspects of the dress

code, are an unreasonable infringement on employees’ rights to express themselves in their

appearance, unjustified by any health or sanitation concerns, or any complaints by patients. The

hospital regards the issue as a matter of professionalism, arguing that at least some patients are

put off by health care providers sporting tattoos and piercings, and that if the hospital can save

any patient some anxiety by requiring employees to cover tattoos and remove piercings, that is a

small sacrifice for the employee. With regard to the lab coats, the hospital argues that nursing

staff should be identifiable anywhere in the hospital, even when they are on breaks.

Background facts

The Ottawa Hospital is a large amalgamated hospital with three sites, known as Civic, General

and Riverside. According to its 2011-12 annual report, the hospital has more than 12,000

employees, not counting physicians, and has more than 45,000 patient admissions annually.

[3]

Local 4000 of the Canadian Union of Public Employees represents a large group of service,

trades and clerical employees at the hospital, who perform a wide range of jobs. Some of the

union’s members, including registered practical nurses, orderlies and porters, spend most of their

work time with patients. Others, including clerical workers and tradespeople, have little or no

patient contact.

The dress code policy at issue here was approved by the hospital in October, 2010, with an

implementation date in March, 2011. A separate policy on nursing lab coats, also at issue here,

was issued in February, 2011, to take effect three months later. Both policies are set out in full

as Appendices to this award.

The dress code policy consists of a main body and an appendix. It applies beyond just the

CUPE bargaining unit to all workers, physicians, volunteers, students and contractors. Many of

the rules differ between employees working in clinical settings and employees working in non-

clinical settings. It provides for accommodation pursuant to the Human Rights Code. Much of

the policy incorporates longstanding policies and practices related to infection control and

sanitation. A number of the relevant sections of the policy are set out below:

1. POLICY

1.1 In keeping with The Ottawa Hospital (TOH) vision, patient-centered model of

care, and to ensure safety, TOH staff will dress in a manner that ensures patients,

staff and the environment are safe from preventable infection.

1.2 All TOH staff will dress in a manner that portrays a professional image at all

times.

…

1.4 Staff working in non-clinical settings will wear professional attire.

…

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3. PROCEDURE

3.1 Roles and Responsibilities

Management shall:

…

Any employee not dressed in accordance with the provisions of this policy will be

sent home and directed to return in attire that complies with this policy. If sent

home for this reason, the employee will not be compensated for the time away

from work.

…

3.2 Choice of Dress

When making choices about what to wear in the workplace, the following principles

apply:

Incorporate Occupational Health, Safety and Emergency Preparedness and

Infection Control requirements for appropriate attire while in the hospital setting.

Dress to promote patient confidence.

Dress in a way that work can be completed efficiently.

Dress appropriately to the clinical/work environment while recognizing cultural

norms and religious requirements.

Dress to portray a competent, professional image.

The policy goes on to incorporate the hospital’s existing policy on personal protective garments

for staff who may frequently be exposed to blood or bodily fluids. For these employees, the

policy also addresses footwear, fingernails and jewelry, and also says that “hair that is longer

than shoulder length must be pulled back and secured away from the face.” These elements of

the policy appear not to be contentious.

The policy also states that for all staff, “clothing, including uniforms, scrubs and lab coats, worn

at work will reflect a professional image of TOH.” Employees who are not expected to be

exposed to blood or bodily fluids “must dress professionally and according to their work

environment.”

The Appendix to the policy, titled Guidelines for Proper Professional Attire, sets out some

specific requirements based on the policy, including the prohibitions related to tattoos and

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piercings. The Appendix includes some items that are not contentious (for example, being

barefoot anywhere in the hospital, wearing dirty, torn, or frayed uniforms, or revealing attire

such as tank tops or crop tops, or wearing dangling jewelry or artificial nails in a clinical setting.)

However, it also includes the following prohibitions:

Hemlines of skirts, dresses, shorts must fall around the knee

Jeans and other denim clothing

Work-out attire: Jogging, sweat suits, hoodies, t-shirts

Clothing that contains profanity, slogans, advertisements, cartoons, drawings, or any

sports-team branding (i.e. Senators.)

Jewellery, non-clinical settings – Minimal and conservative; Small unobtrusive earrings

With respect to tattoos, the Appendix says that “small discrete (sic) unobtrusive tattoos can be

exposed” but that “large tattoos, if visible, will be covered during working hours.”

The appendix also says “visible, excessive body piercings” are prohibited. In non-clinical

settings, body piercings must be “minimal and conservative. Must not pose a safety hazard and

take into consideration Infection Control and Occupational Health and Safety guidelines. If

appropriate, remove for shift.” In clinical settings, the appendix refers employees to specific

departmental policies.

The separate nursing lab coat policy says that “as per one of the priorities of the Corporate

Nursing Clinical Practice Committee, lab coats with the appropriate designation are provided to

enhance professional image.” It says all nursing staff will be given one lab coat with the hospital

logo and their nursing designation (registered practical nurses, or RPNs, are represented by

CUPE, other nursing staff are not), which should be worn “on Site when off the unit, and where

appropriate, on the unit.”

[6]

Prior to implementing the dress code policy, the hospital had in force a number of other policies

that address areas referred to in the new dress code. These policies are still in effect. They are

not at issue in the matter before me, nor, I was advised, have they been the subject of grievances

in the past. These policies include a Code of Conduct, which specifies that employees are to

conduct themselves appropriately, “which includes having a professional appearance, attire and

conduct.” The Code of Conduct also says employees are responsible for, among other items:

Adhering to all policies, procedures, rules or regulations relating to appearance

and dress designed in the interest of patient care or health and safety.

Following good personal hygiene, including hair care.

Dressing professionally and cleanly with minimal accessories.

Where uniforms are required, wearing professional and clean clothing underneath

uniforms, and keeping uniforms neat and tidy.

Other previously existing policies deal with personal protective garments and footwear. A hand

hygiene procedure policy requires health care providers to keep fingernails clean and short, have

only fresh and chip-free nail polish, and prohibits artificial nails. It also limits hand jewelry to a

watch and a smooth wedding band without projections or mounted stones. These items related to

hand hygiene are duplicated in the new dress code policy. Another pre-existing policy requires

all staff to wear a visible identification card that includes name, job title, department and photo.

In summary, nearly all the issues addressed by the new dress code policy are similarly addressed

by pre-existing policies that were not grieved. The exceptions are tattoos and piercings, which

appear not to have been mentioned in previous policies. In addition, the new dress code has

more specific rules about clothes and about jewelry in non-clinical areas. One other area that the

new dress code addresses in more detail than previous policies is hair (for example, that it must

be tied back in certain circumstances); however, the provisions about hair, beards and mustaches

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do not seem to be at issue in this case, particularly since the hospital said in its opening statement

that is willing to clarify the policy so that hair does not need to be off the shoulders in a non-

clinical area.

In its opening statement, the union advised it has no issue with any dress code provision that is

related to health and safety or sanitation, provided there is objective evidence supporting the rule.

During the hearing, the union also stated that it had no issue with the hospital requiring a cover-

up of a hateful, profane or otherwise offensive tattoo, such as a Charles Manson-style forehead

swastika tattoo. The union stated that its main objection to the dress code was the attempt by the

hospital to impose its own view of a professional image on all its employees.

For its part, the hospital acknowledged that disagreements can easily arise over whether an

employee is in compliance with the dress code, and said it was willing to implement an appeal

system with a five-member panel – two employee representatives, two management

representatives, and a member of the public – that would make a binding ruling on each

particular disputed situation and that would not be subject to the grievance procedure.

The following clauses from the local collective agreement were referred to by the parties:

ARTICLE L.2 – MANAGEMENT RIGHTS

L.2.1 Management Rights

The Union recognizes that the management of the Hospital and the direction of the

working force are fixed exclusively in the Employer and shall remain solely with the

Employer except as specifically limited by a provision of this Agreement. Without

restricting the generality of the foregoing, the Union acknowledges that it is the exclusive

function of the Employer to:

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(a) maintain order, discipline and efficiency;

(b) hire, assign, retire, discharge, direct, promote, demote, classify, transfer, layoff, recall,

and suspend or otherwise discipline employees, provided, subject to Article 7.06, that a

claim by a employee that he has been discharged or disciplined without just cause may

become the subject of a grievance.

(c) determine, in the interest of efficient operation and highest standard of service, job

rating or classification, the hours of work, work assignments, methods of doing the work

and the working establishment for any service;

(d) determine the number of personnel required, the services to be performed and the

methods, procedures and equipment to be used in connection therewith;

(e) make and enforce and alter from time to time rules and regulations to be observed by

the employees, provided that such rules and regulations shall not be inconsistent with the

provisions of this Agreement.

ARTICLE L.4 – UNION SECURITY

…

L.4.8 Hospital Policies

The Hospital shall provide the Union with an electronic copy of any policy which affects

the working conditions of bargaining unit members prior to its implementation. The

Union will be provided with an opportunity to discuss such proposed policy. Policies

affecting bargaining unit employees shall be forwarded to the Union no later than seven

(7) calendar days following the date of their approval.

Evidence

The bulk of the evidence at the hearing came through nine union witnesses, who testified about

the various ways in which the new rules affect them. The highlights of their evidence are

summarized below, but there are some common themes worth noting. First, it was clear that

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many of the witnesses regard tattoos or piercings as a significant part of their identity and mode

of self-expression. Second, all witnesses cited inconsistent application of the dress code since it

was put into effect, with some managers enforcing the policy strictly – and, on occasion, even

going beyond the policy – while others seemed not to bother with the rules at all. Third, many

witnesses said the rules combined with inconsistent enforcement created uncertainty in their

minds over what was acceptable at work and what wasn’t. Fourth, all agreed in cross-

examination that there are differing views about tattoos and piercings, and that patients would

not necessarily complain even if they were uncomfortable with how a hospital employee looked.

Fifth, the witnesses agreed that there are limits on employee behaviour and appearance that can

be enforced by the employer, so that, for example, the hospital would not be expected to tolerate

an employee who showed up for work in a bathing suit. Sixth, all agreed that the well-being of

the hospital’s patients was the top priority and that they would not want to do anything that

jeopardized that goal.

Rob Driskell, the union’s executive chief steward, testified that he has had tattoos on both his

arms since before he started working at one of The Ottawa Hospital’s predecessor hospitals

about 23 years ago. Mr. Driskell has been on full-time union leave for most of the past decade,

but before that, as a member of the housekeeping staff, he had regular contact with patients while

wearing his scrub-type uniform with short sleeves, making his tattoos visible. Most of his

tattoos, he said, are related to deaths in his family and other memorable events. He said he had

never had any negative comments, except in regard to his earring, and that was from his father.

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Kim Monette, who has worked as a clerk at the hospital for more than a decade, and currently

works in the hemodialysis unit at the Riverside site, said she spends about 5 per cent of her time

greeting and otherwise interacting with patients. She said that when she was hired she had no

visible tattoos, but had two piercings in each ear, a nose ring and a tongue piercing. Since then,

she has removed the jewelry from some of her piercings but has also added an inner ear piercing

and a upper lip piercing, known as a Marilyn or a Monroe, after Marilyn Monroe’s famous

upper-lip beauty mark. In the past three years she has also added several visible tattoos,

including about half a dozen on her arms – a star, an infinity symbol, a treble clef, and others –

and one just below the back of her neck which is sometimes partly visible, depending on what

she wears. Ms. Monette is not required to wear a uniform in her position, and described her

clothes as “business attire,” with a preference for short sleeves.

Ms. Monette said she has never received any negative reaction from patients, but has received

some positive comments. However, she said she was told by her manager to cover her tattoos,

regardless of size, and to remove all facial piercings; she said she was also told to stop wearing

what she called her “skinny pants” – tight-fitting leggings. Ms. Monette said she cannot afford

to be disciplined, but agreed to a compromise that involved her covering the tattoos and keeping

the piercings. She said removing and replacing piercings can create problems, since there can be

swelling, and there is a risk of infection; in addition, she said, some piercings must be removed

by a professional. She said the tattoos are important for her to display because they remind her

of adversity she has overcome in her personal life. Out of about 60 employees in her unit, she

said about half a dozen have visible tattoos and piercings. One has been told to make changes,

while others have not, she said.

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Mr. Monette acknowledged that there were likely differing opinions about her tattoos and

piercings. Asked whether she would be willing to cover her tattoos if that made even one

patient’s experience better, she replied, “My personality is brighter than any tattoo.” She added

that there had never been any indication that a patient had had a negative experience because of

the way she looked.

Jamie Tremblay, a porter at the General site, testified that he transports about 20 to 30 patients

daily, often having to lift them into beds or wheelchairs. He wears hospital scrubs, which he said

come only with short sleeves. This exposes the full “sleeve” of tattoos on his left arm – the

entire arm is covered with what he described as biomechanical images. He said he had never

received complaints from patients or co-workers, but called his tattoos “a conversation starter,”

saying they had prompted frequent curiosity from patients. Mr. Tremblay said he enjoyed this,

since he is a sociable person who likes to talk to patients. Asked on cross-examination about

negative impressions associated with tattoos by some people, he replied, “maybe I break some

small stereotype they have in their mind – that’s perfect for me.”

When the new dress code policy came into effect, Mr. Tremblay said he was told by his

supervisor to cover his arm, but Mr. Tremblay said he refused because he was concerned about

long sleeves catching bodily fluids and about his ability to wash his hands properly while

wearing long sleeves. After a week or two, a manager told him he must wear long sleeves, and

Mr. Tremblay said he agreed to try. He said the hospital bought him two long-sleeved

undershirts to wear under his scrubs, but he ended up rolling up the sleeves anyway to deal with

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patients and wash his hands. After a couple of weeks, he said, he found the undershirts too

uncomfortable and stopped using them. One of two warnings issued to Mr. Tremblay over

failure to comply with the policy says staff are to dress “in a manner that portrays a professional

image and promotes patient confidence. It is the hospital’s determination that visible tattoos do

not further these initiatives.” Mr. Tremblay was issued the second warning in April, 2011; when

he testified seven months later, he said he had continued to work since the warning without

covering his tattoos, and had received no further discipline. He also said he had seen other

employees with exposed tattoos.

Another union witness, Michel Guerard, testified about the difficulties he has had with

management over the wearing of shorts in the summer. Mr. Guerard works as a clerk in the

Rehabilitation Centre at the General site. He described his job as receiving outpatients and

verifying their health cards, as well as phoning patients to remind them of appointments. He said

he sits at a table with a keyboard so that patients see him only from the waist up. On hot days in

the summer, he said, he likes to wear shorts – down to the knees or below – because he sits near

the outside doors, which he said often stay open longer than normal because people in

wheelchairs are entering. He said he has been doing the same job since 2003, has never had any

negative comments, and said he did not feel he had anything to worry about when the new dress

code was announced. However, his supervisor received an e-mail message from a manager

saying that shorts were not considered professional for any employee interacting with the public,

although Capri pants, which fall just above the ankle, were acceptable. (The dress code itself

says skirts and shorts must fall around the knee.) At the hearing, Mr. Guerard displayed several

pairs of his shorts, which would generally be described as dressy Bermuda shorts. He said he

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tried wearing Capris, but said even that did not satisfy the manager. He also said he has seen

noticed many women employees wearing skirts above the knee, as well as shorts. Mr. Guerard

has filed a grievance seeking the right to wear Bermuda shorts.

Chelsea Driskell, a part-time orderly at the Civic site, said the hospital introduced short-sleeved

uniforms for orderlies in May, 2011. She has several tattoos, three of which are visible when she

wears the uniform – two on the inside of her forearms and one on the back of her neck. Ms.

Driskell said she had not been told to cover them. She also has a nose ring and plugs in her ear

lobes, and said she occasionally removes the plugs and inserts a tapered spiral ear gauge, which

increases the size of the piercing. Again, she said she has encountered no issues with

management over the piercings. However, she said she is aware of other employees who have

been told to remove jewelry and cover tattoos, citing a co-worker, Courtney Wistaff, who had

specially made wooden ear-lobe plugs with The Ottawa Hospital logo on them. Ms. Driskell

said Ms. Wistaff – who did not testify – was told to remove the plugs and also to cover her

tattoos. Ms. Driskell also said she has seen many staff wearing jeans at the hospital, and many

nurses without lab coats when they are off their units, as well as short skirts and other apparent

violations of the dress code policy.

Another union witness was Michel Mayer, who has worked in one of the hospital’s two print

shops since 1991 and is now a lead hand for both shops. Mr. Mayer said he and the other print

shop employees had always worn jeans and T-shirts, partly because they are easy to wash when

soiled with ink, toner and other materials. But when the dress code came into effect, Mr. Mayer

said, their manager told them that jeans were no longer acceptable. He said no members of the

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public enter the print shop since safety shoes are required. However, when he is on break, he

walks through the hospital to the cafeteria, for example, with his badge identifying him as a

hospital employee. Mr. Mayer said he and his co-workers had to buy new clothes, because of the

rule against jeans, and because the manager also said V-necked T-shirts or shirts with logos were

not allowed, although he said golf shirts were ruled acceptable. He also said the workers

requested uniforms and understood that the hospital would be providing them.

The union’s evidence regarding the lab coat policy was given by Neil Hillier, who has been a

registered practical nurse at the hospital since 2001. He said the lab coats that nursing staff were

given came in only one style, which he said was made for women and described as short, form-

fitting and with cuffs on the sleeves. Mr. Hillier, who is a large man, said the largest size

available does not fit him. When on duty, he said, he wears scrubs with short sleeves. The lab

coat was, according to the policy, mainly to be worn when the nurse is off unit. However, Mr.

Hillier said he finds the coat uncomfortable and inappropriate, so he stays in his unit to eat and

for coffee breaks. He also said that because only one lab coat is issued to each employee and it

is the employee’s responsibility to keep it clean, that would mean washing it very frequently

since it would pick up germs when worn in places such as the cafeteria. Mr. Hillier said he

wears a name tag that identifies him as a nurse and introduces himself to each patient. His

evidence was that few nurses are actually wearing the lab coats. Mr. Hillier also said he has a

tattoo on his upper arm that is visible when he wears scrubs, but has not been told to cover it.

Mr. Hillier was also asked about the statement in the lab coat policy that, “as per one of the

priorities of the Corporate Nursing Clinical Practice Committee, lab coats with the appropriate

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designation are provided to enhance professional image.” Mr. Hillier said he was part of this

committee, but it was not correct to say that lab coats were a priority.

Another RPN, Kylie Holliday, testified that wearing scrubs was not required in her previous job

in the dialysis unit nor her current job in the rehabilitation unit. In the dialysis unit, she said, the

supervisor told her the cotton pants she was wearing were not acceptable, apparently because

they were not similar to scrubs, and even though the pants seemed to be in compliance with the

dress code. But when she moved to the rehabilitation unit, there seemed to be no difficulty, she

said. Ms. Holliday also said she does not wear the lab coat she was issued, nor do many of the

other nurses. She has several visible tattoos, but has not been told to cover them, she said.

Robert Gauthier, another union witness, has worked since 1998 in central processing at the

General site, disinfecting and sterilizing medical instruments for reuse. He is also first vice-

president of the union. When he testified in late 2011, he said there had been a small number of

instances of discipline imposed over the dress code policy after it first went into effect –

including Mr. Tremblay and another employee with tattoos – but that he was unaware of any

discipline imposed after April, 2011. Mr. Gauthier said it appears the policy is not being

enforced: he said he sees nurses not wearing lab coats off their unit, some employees wearing

jeans and short skirts, and no change in the type of jewelry being worn, as well as logos on

workers’ shirts and hats. Mr. Gauthier also referred to written minutes of a staff meeting in his

department in which a supervisor ordered that employees were not to wear flip-flops on hospital

property, including the parking lot; he said employees felt the rule relating to the parking lot was

overkill by the employer. He also referred to a large poster produced by the hospital and on

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display, showing two smiling nurses, one of whom had three facial piercings – through her

eyebrow, her nose and below her lower lip.

The employer’s main witness was Ginette Rodger, since 2004 the hospital’s senior vice-

president of professional practice and chief nursing executive. She has nearly 50 years’

experience in nursing, nursing administration and nursing education, including a Ph.D. in

nursing. Dr. Rodger is responsible for professional practice at the hospital of all nurses and

unregulated patient care staff such as orderlies. As one of about half a dozen senior vice-

presidents, she is part of the hospital’s senior management committee, the committee that

decided to implement the dress code policy. She also was one of two senior managers who

appeared at staff forums explaining the dress code and lab coat policies.

Dr. Rodger’s 1995 Ph.D. thesis dealt with nurse-patient interaction, and in particular the theory

that certain types of nurse-patient interactions would reduce the stress level of clients. The

hospital asked that she be qualified as an expert in nurse-patient interactions, and that I admit her

thesis as evidence. The hospital sought to ask her questions as an expert about her area of

research, but not about the dress code. The union objected, mainly on the grounds that Dr.

Rodger cannot be considered an independent expert. After reviewing the relevant case law

(including R. v. Mohan [1994] 2 S.C.R. 9, Fellowes v Kansa General 1998 CanLII 14856 (ON

SC) and Re Barr et al. and Treasury Board (National Defence) 2004 PSSRB 169 (CanLII)), I

delivered the following oral ruling on January 10, 2012:

In considering whether Dr. Rodgers should be qualified as an expert to give testimony

about her Ph.D. thesis, I have noted a few important facts: 1. She clearly has expertise in

nursing management and administration. 2. Her research has not focused on the look or

attire of health care providers. 3. The research was performed before she had any

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management role at The Ottawa Hospital. 4. She has been a member of the hospital’s

senior management for several years. 5. As a senior manager, she was involved in

approval of the policies at issue here. 6. Beyond that, she had a key role in promoting

and explaining the policies at issue here.

The employer seeks to put forward Dr. Rodger to testify about her thesis on nurse-client

interaction and its effect on patient stress levels. Either that evidence is relevant in this

hearing or it is not. If it is not relevant, that ends the matter. I believe there is an

argument that it is not relevant, since the research, by Dr. Rodger’s own evidence

yesterday, did not examine the effect of the health care provider’s appearance or dress on

the patient’s stress or health outcome.

However, the employer apparently seeks to use this evidence to argue that appearance

and dress may also influence patient stress and thus health outcomes. In this sense, the

evidence may be relevant to the issues in the case.

But if Dr. Rodger’s evidence is relevant to the dress and appearance issues we are dealing

with here, we encounter another problem, and that is her very close association with the

policies being grieved. She is not an independent expert and, in my view, her research,

even though it was performed before her association with The Ottawa Hospital, cannot be

separated from why it is being offered now.

I agree with the PSSRB adjudicator [in the Barr case, cited above] that there is no

ironclad rule in administrative tribunals that expert witnesses be independent. In fact,

arbitrators often hear from witnesses testifying about specialized topics who are closely

tied to one party. However, I view Dr. Rodger’s evidence somewhat differently. She

would not be explaining a scientific or technical area for the benefit of the hearing, but

rather offering her research as a justification for a policy that she was involved in

devising, approving and promoting. That, in my view, is not the proper role for expert

evidence.

The easy way here would be to hear the evidence and give it little weight, or discount it

entirely if I felt it was not helpful, and that is what the employer has urged. However, I

see two problems with that:

First, there is an issue of principle in the conduct of a hearing regarding independence of

expert witnesses that I do not think should be dealt with simply by accepting evidence

and then dealing with weight; this would invite all sorts of semi-relevant partisan

evidence that can be dressed up as expertise.

Second, and related to this, is the cost-benefit analysis that the court talks about in R. v

Mohan. Here, the expert evidence is not about dress or appearance, so even if it is

relevant, it is marginal and takes up hearing time, inviting a battle of experts that does not

assist me and ultimately serves no one.

For these reasons I will not accept Dr. Rodger’s evidence on her Ph.D. thesis.

[18]

While Dr. Rodger was not permitted to testify about her thesis, she did give evidence regarding

the origins of the lab coat policy. She said the Corporate Nursing Clinical Practice Committee,

consisting of several dozen registered nurses and RPNs, had decided that professional image –

including identification and attire – was a priority, and formed a subgroup to examine the topic

in 2008 or 2009. The group wanted uniforms, she said, but there was not enough money for

uniforms for the 4,700 nurses, and lab coats were approved instead. Dr. Rodger said the hospital

went with men’s sizes, with knitted cuffs that could be easily rolled up for hand-washing. She

agreed that some nurses are not happy about the lab coat policy, but said many others want to

wear the lab coats.

Development of the lab coat policy sparked discussion among senior management about a

comprehensive dress code, she said.

Dr. Rodger said she supports the lab coat policy because patients need to know who is dealing

with them. Furthermore, she said, the policy is good for nurses, since they have pride in their

profession and want to be known to the public as nurses. She added her opinion that how a

health care provider dresses has an influence on how the patient perceives the competence of the

staff member. This feeling, she said, led her to support the comprehensive dress code also.

While some of the areas addressed in the dress code, such as fingernails, rings and hair, raise

sanitation and infection issues, other areas such as tattoos, piercings and bare midriffs are about

conveying to patients an atmosphere of competency.

[19]

First impressions are important, Dr. Rodger said. In dealing with a vulnerable population who

are in the hands of strangers, the hospital must put everything on the side of patients so that they

can heal better, she said.

Asked on cross-examination about her view that tattoos and piercings reflect on a health care

provider’s competency, she replied that this is a personal view that is based on evidence. She

said there was lots of research showing that when employees have tattoos “the impression they

give is lack of competence and lack of safety.” She agreed, however, that there had been few

complaints about tattoos and said that was not the reason for the policy. Records provided to the

union about concerns expressed to the hospital between 2000 and 2009 showed a total of two

unspecified complaints related to tattoos, one in 2003 and one in 2007. Forty-five of the 69

concerns reported were related to employees not identifying themselves.

Dr. Rodger did not specify the research that she said supported her views about perceptions of

competency, and the hospital produced only one study related to the issue. That study was

reported only after the dress code policy was approved at The Ottawa Hospital. I admitted it

over the objections of the union even though none of the authors was called to testify. (See Re

Ottawa Hospital and CUPE 2012 CanLII 69469 (ON LA) ).

The study is titled Patients’ Perceptions of Patient Care Providers with Tattoos and/or Body

Piercings. It is a four-page article published in 2012 in the Journal of Nursing Administration, a

U.S. publication. The four authors are identified as being affiliated with Shore Health System of

Easton, Maryland. The article is based on a study of 150 patients at a rural hospital in the U.S.

[20]

mid-Atlantic region who were shown pictures of care providers with and without tattoos and

body piercings, and who provided answers by computer as to who looked the most caring,

confident, reliable, attentive, co-operative, professional, efficient and approachable.

The article notes (in contrast to Dr. Rodger’s evidence) that “literature on the perceptions of

visible tattoos and body piercings on healthcare professionals including nurses is limited…” It

also acknowledged that patients meeting the health care providers in person may perceive them

differently from what the results show for perceptions based on photos. In any event, the study

found that the majority of patients perceived no difference in the factors listed (caring, confident,

etc.) between male patient care providers with tattoos and those without. The results were

similar for female providers, with the exception that providers without tattoos were perceived to

be more professional. Perceptions were generally less favourable regarding body piercings

(excluding ear lobes), with the majority of patients still seeing no difference in many factors, and

less favourable ratings for women with body piercings. The results, the article said, “suggest that

male and female patient care providers dressed in uniform with visible tattoos and/or nonearlobe

body piercings are not perceived by patients to be more caring, confident, reliable, attentive,

cooperative, professional, efficient, or approachable than their counterparts without visible

tattoos or piercings. Gender bias may be a factor in regard to female providers with visible

tattoos, as patients perceived them to be less professional than their male counterpart with a

similar tattoo. Also, female patient care providers with visible nonearlobe body piercings are

perceived by patients to be less confident, professional, efficient and approachable than females

with no body piercings.”

[21]

Bare Below the Elbows

There is no dispute that proper hand hygiene is critical for those working in a hospital clinical

setting. Several union witnesses stated that wearing long sleeves to cover up tattoos, as well as

the requirement to wear a long-sleeved lab coat for nursing staff, were measures that would

impede employees’ ability to wash their hands and wrists properly, and that soiled sleeves would

encourage the spread of infection. Mr. Tremblay, for example, said all scrubs are short-sleeved

to prevent cross-contamination. Mr. Hillier said nurses do not wear long sleeves when caring for

patients because of infection control; the exception is long-sleeved isolation gowns that are

removed after contact with each infected patient. Ms. Driskell, who is completing a college

nursing program, said she has been taught never to wear long sleeves when dealing with patients

because of the risk of infection.

The employer disagrees, and called as an expert witness on infection control Mary Vearncombe,

a medical microbiologist at Toronto’s Sunnybrook Health Sciences Centre, where she is the

medical director of infection prevention and control. Dr. Vearncombe was also medical co-

ordinator for five years of one of the 14 regional infection control networks set up by the Ontario

government after the SARS crisis, and has served on various committees dealing with infection

prevention and control, including chairing a provincial subcommittee that developed a 68-page

document titled Best Practices for Hand Hygiene. This document, she said, entailed a thorough

search of relevant literature.

[22]

One issue Dr. Vearncombe’s committee considered was a “bare below the elbows” policy for all

patient care workers. Such a policy was adopted in the United Kingdom several years ago.

However, she said, there was no evidence that such a policy benefits patients, or that a bare

below the elbows policy reduces the transmission of microorganisms in health care settings. The

committee concluded that hand hygiene can be performed adequately with long sleeves, since

workers can roll up sleeves or hold up their hands. Dr. Vearncombe also said long sleeves are

not a factor in cross-contamination.

On cross-examination, Dr. Vearncombe agreed that a bare below the elbows policy would not

harm efforts to prevent or control infection. Asked whether a person wearing short sleeves

would be less likely to miss cleaning their wrists, she replied that a proper education program for

health care workers was more important than a bare below the elbows policy. She acknowledged

that there are differing views among the experts about whether bare below the elbows should be

required, and that some hospitals in Ontario may recommend short sleeves for health care

providers.

While the debate over a bare below the elbows policy is interesting, I find that it has little

importance in deciding this grievance. In my view, the hospital has not acted unreasonably in

determining that wearing long sleeves will not have an adverse impact on hand hygiene. Even

though this view is not shared by all the experts, and even though the union witnesses are, I

believe, sincere in their belief that long sleeves can increase the risk that infections will spread,

there is no requirement for the hospital to implement a bare below the elbows policy. Issues

regarding the covering of arm tattoos and the wearing of lab coats will be decided in accordance

[23]

with the legal principles discussed below, rather than by whether requiring employees to cover

their arms is increasing the risk of the spread of infection.

Consultation with the union

As set out above, the collective agreement requires the hospital to provide to the union a copy of

any policy that affects working conditions prior to its implementation. The union is to be

provided with an opportunity to discuss the proposed policy. Policies are to be forwarded to the

union within a week of their approval.

Mr. Driskell’s evidence is that the union received the dress code policy on November 25, 2010,

and filed a grievance challenging it on the same day. The grievance does not specifically cite a

failure to discuss the policy or a failure to forward the policy within a week of approval. A

hospital-produced timeline put into evidence shows the policy was approved on October 13,

2010. Mr. Driskell said that on November 25 he was not aware when the policy had been

approved, although it is worth noting that the copy of the policy put into evidence states clearly

at the top that it was approved on October 13. The timeline states that there was a meeting with

CUPE regarding the policy on November 23. Mr. Driskell said he is aware of the meeting but

was not present, and understood that the actual policy was not available to the union until

November 25. As noted above, the policy was not implemented until March, 2011. Mr. Driskell

said that, aside from the November 23 meeting and the steps in the grievance procedure, there

were no other meetings between the hospital and the union to discuss the policy. There was no

evidence from the employer contradicting Mr. Driskell’s on this issue.

[24]

In its closing submissions, the union argued that the employer had not complied with its

obligations to notify and discuss the policy.

It appears that the employer was about five weeks late in providing the policy to the union after it

was approved. However, given the six-month period between approval and implementation, I

find that there has been effective compliance with the collective agreement’s intention that the

union be notified of policies prior to implementation and be given an opportunity to discuss

them. Discussions with the union took place, albeit in the context of the grievance procedure,

given that the union grieved the policy immediately upon receipt. There is no indication the

union raised the timing of the policy’s approval until the hearing of this case. For these reasons,

I do not find the timing or consultation issues to be significant in this matter. Even if there was a

technical violation of the collective agreement in the late provision of the policy to the union, it

is a violation for which no remedy is necessary.

Parties’ Arguments

The union characterizes the issue in this case as finding the correct balance between, on the one

hand, individual liberty and personal expression, and on the other, health and safety

considerations and the employer’s corporate image. The union repeats that it has no issue with

any rules based on sanitation or health and safety considerations, and points out that many

previously existing policies covered such areas as fingernails, jewelry, use of long-sleeved

isolation gowns, appropriate footwear, dressing neatly and professionally, and the requirement to

[25]

wear identification badges. These are policies that the union has accepted and continues to

accept. They are still in force. The union says it does not accept, however, any rules that are

based on the hospital’s image and that are not supported by objective evidence.

Many of the rules in the dress code, the union argues, have no connection to sanitation or health

and safety concerns, nor is there any evidence – such as complaints from patients -- that these

rules are necessary. The rules regarding tattoos and piercings are worded so broadly and vaguely

that uncertainty is created in the minds of employees, and in the minds of managers, who, the

evidence discloses, are enforcing the rules inconsistently, the union argues. In other areas, the

policy itself is inconsistent, the union says, citing as an example that the main body of the policy

does not say anything about jewelry or hair for staff who are not providing patient care but that

the appendix prescribes small unobtrusive earrings for staff in non-clinical settings. Such

vagueness and inconsistency creates the potential that some employees may be harassed or

targeted, the union argues.

Regarding the lab coat policy, the union says the employer has no right to require employees to

wear a certain garment when they are not working but are on their own time during breaks. (The

lab coat policy, as outlined above, applies in this bargaining unit only to registered practical

nurses.) The policy is unnecessary as a means of identifying employees because they are all

required to wear ID badges specifying their jobs.

While the union acknowledges management’s right to make rules, it argues those rules must be

subject to the long-accepted criteria set out in Re KVP Co. Ltd. and Lumber and Sawmill

[26]

Workers Union, Local 2537 (1965) 16 L.A.C. 73 (Robinson). Those criteria are set out in this

oft-quoted passage, at page 85:

A rule unilaterally introduced by the company, and not subsequently agreed to by the

union, must satisfy the following requisites:

1. It must not be inconsistent with the collective agreement.

2. It must not be unreasonable.

3. It must be clear and unequivocal.

4. It must be brought to the attention of the employee affected before the company can

act on it.

5. The employee concerned must have been notified that a breach of such rule could

result in his discharge if the rule is used as a foundation for discharge.

6. Such rule should have been consistently enforced by the company from the time it

was introduced.

The policies at issue here do not meet the KVP test, the union says, because they are not

consistently applied, are not clear and unequivocal, and most importantly, because they are not

reasonable in that they are not based on any evidence or any legitimate need of the employer.

The union argues that Dr. Rodger’s evidence made it clear that the most contentious rules spring

only from her personal views and perhaps the views of others in management.

The union has referred me to numerous cases involving dress codes and related policies: Re

Thrifty (Canada) Ltd. and Office and Professional Employees International Union (2001) 100

L.A.C. (4th) 162 (Larson), in which the arbitrator concluded that the employer had not

demonstrated its policy against earrings on men and facial jewelry for any employee was

necessary for any business interest; Re Borough of Scarborough and International Association

of Fire Fighters (1972) 24 L.A.C. 78 (Shime), in which the arbitrator made the statement ( at

page 84, quoted in many subsequent cases) that “there is no absolute right in an employer to

[27]

create an employee in his own image;” Re Westfair Foods Ltd. and United Food and

Commercial Workers [2005] A.G.A.A. No. 64 (Ponak) (upheld on judicial review [2006] A.J.

No. 130), in which the arbitrator used the KVP test to uphold a challenge of a facial jewelry ban;

Re West Lincoln Memorial Hospital and Christian Labour Association of Canada (2004) 126

L.A.C. (4th) 52 (Luborsky), in which the arbitrator concluded there was no connection between

facial piercings and disease transmission; Re Walfoods Ltd. and United Food and Commercial

Workers (2005) 144 L.A.C. (4th) 272 (Albertyn), in which the arbitrator upheld only those rules

that had a substantial connection to sanitation or health and safety; Re Ontario Provincial Police

and Ontario Provincial Police Association (2011, unreported, Abramsky), in which the arbitrator

struck down a rule requiring police officers to cover tattoos, saying there was no objective

evidence, such as complaints, that supported the policy; and Re Kitchener-Waterloo Record and

Communications, Energy and Paperworkers Union (2006) 147 L.A.C. (4th) 417 (Rose), in

which the arbitrator said there was no objective evidence to support a ban on editorial employees

wearing blue jeans at work.

The hospital emphasizes that its only priority is improving health care outcomes for patients. In

discharging that task, the hospital is dealing with a largely elderly demographic of patients who

are not at the hospital by choice. Rather, patients are at the mercy of the hospital and its staff,

and need all the energy they can muster to improve their health. This diverse group of patients

each has their own experience and biases, but each is owed a high quality experience, which

includes not being cared for by someone who is out to make a personal statement that

undermines the patient’s confidence in the employee’s professionalism.

[28]

Hospitals are required by the Excellent Care for All Act, 2010, to constantly seek improvement in

the quality of health care they deliver, and cannot sit back and wait for evidence of patient

complaints before making changes, the employer argues. Boosting the professional image of

employees improves patient confidence, and that improves the quality of health care, the hospital

says. In this grievance, the union seeks to have individual rights trump the collective good in a

system that must serve all patients equally, including those patients who are concerned about the

professionalism of employees with tattoos or piercings.

The hospital pointed to the agreement of all the union witnesses that there are legitimate limits

on appearance. Absent proof of physical harm to employees, the employer is entitled to set those

limits, the hospital says.

The hospital describes its dress code as minimally intrusive and says the choice is either to

enforce the rules or tell patients that hospital workers can make any statement they want with

their personal appearance. The balance must be resolved in the patients’ favour, since first

impressions are an important part of perceptions of professionalism. That, the hospital says, is a

fact of life and will not change, even though it is easy to argue that appearance should not matter.

The hospital agrees that not all elderly patients are uncomfortable with tattoos and piercings, but

says some are, even though they may make no comment or complaint. Employees with tattoos

and piercings can wait for a shift in attitude or push the issue by forcing patients to confront their

choice of appearance – but, the employer says, a hospital, with its captive audience, is not the

place to push people to accept the increasing popularity of tattoos and piercings. The hospital

[29]

need not put patients in the middle of a debate or a sociological experiment when they need all

their energy to heal, the employer argues. Freedom of expression for employees must take a

back seat in a health care setting when people are fighting for their lives. Part of the hospital’s

job is to offend as few people as possible.

While acknowledging that the union stipulated that the employer could order the cover-up of an

offensive tattoo, the hospital argued that there are differing interpretations of what is offensive.

The solution is not to turn the hospital into a debating society over what is or is not offensive, but

to simply wear long sleeves, the employer says.

The employer also argued that the KVP factors must be revisited, saying the hospital simply

cannot design a policy that complies with KVP: a policy dealing with tattoos and piercings can

be clear or it can be reasonable, but it cannot be both, since clearly defining what is acceptable

will almost automatically make the policy unreasonable by imposing arbitrary limits on the size

of tattoos, for example. In a hospital, KVP must evolve to acknowledge that patients rather than

employees must take priority. That priority given to patients is why the collective agreement (in

Article L.9.1) contains the highly intrusive requirement that employees must undergo a

vaccination, medical examination or other clinical procedure when requested by the hospital, on

pain of dismissal. Yet the union argues that the hospital cannot require an employee to wear

long sleeves.

The hospital concedes that the prohibition in the dress code appendix against “visible, excessive”

body piercings does not meet the KVP standard of clarity, since there are no specifics about

[30]

where the piercings are, how many is too many, how big is too big, and how they look. To be

clear and unequivocal means being more specific, and that creates its own difficulties with

enforcement, such as the need to measure piercings to determine whether they meet the specific

criteria. The same issue arises with tattoos – the hospital cannot be specific and start measuring

every tattoo; there is always an element of subjective judgment.

Without an evolution of the KVP principles, the hospital says, it cannot have a dress code policy,

and that does not make sense, since there is nothing in the collective agreement preventing the

employer from implementing a dress code. Therefore, the employer argues, a new test must be

developed for the hospital setting that allows the employer to set standards unless the employee

can prove that harm will result.

The hospital also does not disagree that there has been inconsistent enforcement of the new rules.

Part of the reason is the forbearance of the hospital in enforcing the rules while the grievance

hearing has been ongoing. But in another sense, the hospital says, the inconsistency issue

highlights another problem with KVP, that an institution with thousands of employees and

hundreds of supervisors cannot be expected to be entirely consistent in enforcement.

Regarding the case law, the hospital argues that any decision outside the health care field is

distinguishable, because at a hospital there is no consumer choice, no worry about competition,

and no way to survey customers when all 1.6 million people in the Ottawa area are potential

patients. The hospital says the requirement in much of the case law for objective evidence is not

an appropriate test to apply in the hospital setting, where not harming patients must be the

[31]

priority and being pro-active is an all-important element of health care. The balancing of

interests is different here than in a retail operation, the hospital says – patients must win every

time, unless the rule would physically harm the employee.

The hospital also points out that its policy does not affect employees once they leave the

hospital, when they can remove their lab coats and expose their tattoos. While in the hospital,

however, the captive audience of patients has a greater right to view an employee with a

professional image than the employee’s right to make a statement with his or her appearance.

The hospital referred me to the following cases: Re Canadian Newspaper Co. and Victoria

Newspaper Guild [1991] B.C.C.A.A.A. No 147 (Klassen), in which an arbitrator partly upheld a

ban on blue jeans, saying the employer had established that jeans in some cases detracted from

the employer’s image, and noting that a rule against jeans at work had no impact on employees

when they are away from work, unlike, for example, rules on hair length; Re Canadian Pacific

Railway Co. and Transportation Communications Union (1997) C.L.A.S. 114 (M. Picher), in

which the arbitrator said it was not necessary for the employer to amass complaints to justify a

dress rule; Re University of British Columbia Health Sciences Centre Hospital Society and

Hospital Employees’ Union (1985) 21 L.A.C. (3d) 132 (Munroe), in which a mandatory uniform

rule was upheld; and Re Aspen Regional Health Authority and Alberta Union of Provincial

Employees [2008] A.G.A.A. No 67 (Wallace), upholding a rule against artificial fingernails on

the basis of infection control.

[32]

Decision

Cases involving a challenge to employer rules have historically been decided in accordance with

the principles set out in the KVP case, cited above. Those principles include that the rules must

not be unreasonable, that they be clear and unequivocal, and that they be consistently enforced.

The union argues that the policies at issue here do not meet the KVP standards. The hospital,

rather than asserting that its policies comply with the KVP tests, argues instead that those tests

must be revisited because they are neither possible to meet in a dress code or in the context of a

large organization with thousands of employees, nor do they recognize the priority the hospital

places on patient needs over employee freedom.

I have considered the hospital’s argument that there be a new test in the hospital context in which

perceived patient interests must trump those of employees unless physical harm to the employee

can be shown. However, for reasons below, I find there is no need to revisit the KVP tests.

KVP, a 1965 case, is itself a distillation of previous arbitration decisions setting out employer

rule-making power where the particular issue is not addressed in the collective agreement. Those

principles have stood the test of time and are a bedrock of the current understanding by unions

and employers of the limits of management rights. Brown and Beatty’s Canadian Labour

Arbitration (4th

ed., Canada Law Book, at paragraph 4:1520) says that the principles summarized

in KVP “have now become universally accepted among arbitrators,” citing well over a hundred

reported decisions for that statement.

[33]

The statement by this employer that the KVP principles cannot take account of the priority it

places on patients’ needs is not correct, in my view. Certainly, a hospital is not a lumber camp

(the KVP workplace), nor is it a food plant, a grocery store or a car rental operation, to take some

examples from the cases submitted at this hearing. The nature of the workplace and the jobs

being performed will always be a major factor in assessing the reasonableness of the rule that is

in dispute. Here, however, this employer is seeking to exempt itself entirely from the

requirement of reasonableness simply because it is a hospital. It wants the power to impose any

rule that it believes will benefit patients unless that rule causes physical harm to employees,

without any requirement to provide evidence supporting the rule. I cannot accept this. There is

nothing in KVP or any other case law preventing consideration of the hospital’s primary goal of

improving patient outcomes when assessing the reasonableness of its dress code rules.

Furthermore, I disagree with the hospital’s contention that it cannot comply with the KVP

principles of clarity and consistent enforcement. The two principles are often closely related, in

that unclear rules open the door to inconsistent enforcement because so much then depends on

the subjective views and interpretations of the individual supervisor or manager. While I agree

that clarity is a challenging goal where dress codes are concerned, the requirement is still

necessary so that employees can distinguish between permissible conduct and conduct that could

subject them to discipline, and so that supervisors know what they are supposed to be enforcing.

There is also a risk that vagueness in the rules can become a tool to unreasonably target an

employee for reasons unrelated to that employee’s work performance or conduct. And while in

theory inconsistent enforcement can be dealt with at arbitration if discipline is imposed, this

[34]

seems an excessively awkward way of addressing a problem that may stem from the

inadequacies of the policy itself.

In summary, I believe this case must be decided in accordance with the KVP principles of

reasonableness, clarity and consistency, taking into account the particular nature of this

employer.

In addition to KVP, there are three other cases that deserve comment.

In the Thrifty case, the arbitrator made the following statement (at page 169-170):

I consider that the proper approach that must be taken in these kinds of cases, is to start

from the premise that employees have a personal right to groom and attire themselves as

they wish. In the ordinary course of events, they are not required to justify their manner

of dress or to prove that the way in which they choose to live has social validity.

The right to live without those kinds of constraints derives from the fundamental rights of

citizenship that individuals have in a just and democratic country, a right which is not

easily left at the factory gate, the point being that it is not the employee who must justify

his lifestyle but the employer who seeks to constrain it, even in cases of attire which is

removable…what must be constantly borne in mind is that the onus of proof resides with

the employer to convince the arbitrator that the policy is necessary, based upon good and

generally accepted business practices.

The reason why an employer carries the onus is identical to the reason employers carry

the onus in discipline cases, which is to say, that only they know why the policy was

implemented…. Certainly, the union, as the party initiating the grievance, carries the

legal or primary onus of proving its claim…by demonstrating that the policy infringes on

the personal or civil rights of certain employees. At that point, the evidentiary onus then

shifts to the employer to show, in those cases where the purpose of the policy is put into

issue, that the policy is supported by considerations of the health and safety of employees

or other generally accepted business practices, and that it was not arbitrary,

discriminatory or in bad faith.

[35]

I agree with this approach, and would add that, while the arbitrator in that case was dealing with

a private sector company and therefore point to “accepted business practices,” that concept can

be modified in the case of a hospital to require that the employer must establish that the policy is

necessary based on the employer’s role and purpose, namely delivering the best possible health

care to the public. A balancing of the hospital’s desire for the best patient experience and the

employees’ rights as individuals in a democratic society – as expressed well in the passage above

– is necessary to determine the reasonableness of the rules at issue here.

The Ontario Provincial Police case is worth comment because it is a recent case in which an

order to cover up all tattoos was ruled unreasonable and invalid. The case is also important

because one of the employer’s arguments here is that patients have no choice when dealing with

a hospital. The same, however, can be said of members of the public who come into contact

with police in areas served by the OPP. The OPP’s policy, like the case before me, was based on

the feeling that tattoos were likely to raise questions of confidence and trust among members of

the public, and did not reflect the professional appearance necessary for police officers.

However, the arbitrator concluded that the employer was relying on the personal and subjective

views of senior management rather than any objective evidence, such as complaints from the

public.

The Borough of Scarborough case is notable, partly because of its declaration that no employer

has the right to create an employee in its own image, but also because the case before me now is

in large part a replay of that decision from more than 40 years ago. While the exact issue – the

early 1970s style of long sideburns on men – seems quaint now, a look at management’s position

[36]

in that case reveals that the concerns of management there were strikingly similar to those

expressed by The Ottawa Hospital here. In a letter to the union, the Scarborough fire chief said,

The general appearance of the fire fighters to the taxpayer and general public is extremely

important as dress and personal grooming reflects well-disciplined, well-trained capable

people, employees of the Borough of Scarborough, who provide a fire protection function

equally as good as their appearance projects.

As sideburns were controversial in 1972, so tattoos and piercings are now. Anyone who has

taken a stroll on a summer day knows that tattoos are no longer confined to sailors, stevedores

and strippers. Nevertheless, I accept that there are negative connotations associated with tattoos

among a segment of the public, and I also accept that members of the hospital’s patient

demographic – skewed toward the elderly – may be more likely to share those negative

impressions. Piercings outside the earlobe have also experienced a surge in the past two or three

decades. While I have more difficulty pinpointing which negative stereotypes they may invoke –

and there was no evidence on this presented in the case -- I am confident that some hospital

patients might not be accustomed to nose rings, or jewelry in a pierced lip, eyebrow or tongue.

I accept, then, the hospital’s assertions that some patients might have a more negative first

impression of a tattooed or pierced hospital staff member than they would of a staff member who

was not tattooed or pierced. I also accept that the lack of complaints does not necessarily mean

that there is no uneasiness felt by some patients. What I cannot accept is the hospital’s argument

that there is a connection between these feelings and health care outcomes. The hospital

provided no evidence whatsoever for this assertion, which seems to be based only on the

personal opinions of Dr. Rodger and possibly other senior managers.

[37]

Dr. Rodger asserted that first impressions are important, and this statement would likely not face

much disagreement. But she went on to link that first impression with stress levels experienced

by patients and, ultimately, health care outcomes. Aside from her own assertions, there was no

evidence supporting this alleged link between patients’ health outcomes and their possibly

negative impressions about a staff member’s tattoo or piercing.

The one study produced by the employer, referred to above, made no mention of health care

outcomes, but rather dealt with patient impressions of health care providers who have tattoos and

piercings versus those who do not. Aside from the fact that none of the paper’s authors were

produced for cross-examination, there are other reasons to give the study little weight. It was

conducted in a rural hospital in the United States – a country with a different, more

commercialized, health care system – and most importantly, it was conducted using photographs

rather than real people. Even so, the results are hardly a conclusive endorsement of the

employer’s position here: on most factors, there was little or no difference in perceptions of

tattooed and pierced care providers compared with those without tattoos or piercings.

The study – and to a large extent, the employer’s argument -- also isolates tattoos and piercings

from everything else that happens to a patient in a hospital. In the course of a stay at a hospital, a

patient will interact with a wide variety of individuals who work there – from nurses and

orderlies to physicians and housekeepers, and others. Those staff members will perform many

tasks affecting the patient, some of which may be pleasant or neutral, and some of which may be

very unpleasant. They may perform those tasks with great skill or with somewhat less skill.

[38]

They will undoubtedly exhibit a range of personalities, and will likely be as diverse in their

backgrounds as the city where they work. Tattoos, piercings and other aspects of a health care

worker’s appearance are only a tiny part of the overall picture of a patient’s experience.

Therefore, I do not find it surprising that these issues appear to be virtually undetectable among

patients concerns, judging from the conspicuous lack of complaints related to the appearance of

hospital staff. As noted above, with more than 40,000 patient admissions annually, the hospital

had only a total of two unspecified concerns raised about tattoos over a 10-year period. (It is

also worth noting here that the Excellent Care for All Act, 2010, referred to by the employer,

requires (at Section 5) that every health care organization conduct an annual satisfaction survey

of people who have received its services; however, there was no evidence presented by the

hospital about the survey or whether any patients raised appearance issues.)

This is not a human rights case. But there are echoes of old human rights debates here. The

employer’s argument is explicitly based on its willingness to accept and acquiesce to patients’

perceived prejudices and stereotypes about tattoos and piercings, even as it offers no evidence

that these have any impact on health outcomes. The employer suggests in its argument that the

union wishes to “force” patients to deal with hospital workers flaunting their self-expression

through tattoos and piercings. But while tattoos and piercings are not protected under human

rights laws, the evidence in this case was clear that many of the employees regard those aspects

of their appearance as an important part of their identity. The hospital could not and would not

accede to the wishes of a patient who might be uncomfortable with a care provider based on the

employee’s race or ethnic identity, even though some patients might harbour those types of

prejudices. However, the hospital seems willing to comply with other types of prejudices and

[39]

stereotypes that have no link to the quality of the health care received by the patient. Thus, in

my view, the patient is not being “forced” to accept tattoos and piercings; the patient is merely

receiving care from workers who reflect the diversity that one would expect in a big-city

hospital. That includes employees who choose to decorate their bodies in ways that will not

appeal to everybody. It is not patients who are being “forced,” but rather employees who are

being told to suppress aspects of their identity that are important to them.

The lab coat policy raises different issues. Here, rather than attempting to cover some aspects of

employees’ identity, the hospital seeks to compel employees to proclaim their professional

identity, through the wearing of a lab coat. (As noted above, in the CUPE bargaining unit, only

registered practical nurses are affected by the lab coat policy.)

Dr. Rodger’s evidence is that patients need to know who they are dealing with. This concern is

at least partly covered by the long-standing policy that all employees wear a prescribed and

clearly visible photo identification card specifying job title while on duty. In my view, the

hospital is entitled to enhance identification and recognition of its nursing professionals by

requiring them to wear lab coats with their designation (e.g. RPN) while they are on duty. The

policy says the lab coats are to be worn in the units “where appropriate.” This determination of

when to wear the lab coat while on duty, if at all, is best left to the supervisors and managers of

the various units, although the material put into evidence indicates that the lab coats are to be

worn for “non-direct patient care activities.”

[40]

However, the lab coat policy also requires nursing staff to wear the lab coats when off the unit,

which would include the daily meal period and two rest periods given to employees under the

collective agreement. The evidence presented does not disclose any justification for imposing

dress requirements on employees when they are on their own time, albeit still on hospital

premises. While the policy, signed by Dr. Rodger, states that the policy is “as per one of the

priorities of the Corporate Nursing Clinical Practice Committee,” there is no evidence

supporting the view that nurses were pressing for mandatory wearing of lab coats, particularly

when they were not working. Minutes of a meeting of this committee from 2010 referred to

“encouraging” nurses to wear the coats when leaving the unit, and suggest that it is impractical to

make the wearing of the coat mandatory. A survey from about a decade ago, the only one

produced by the employer on this topic, recommended a colour-coded ID badge so that nurses

would not be confused with other staff such as housekeepers. Given the existing and long-

standing policy on mandatory photo identification cards – which is not in dispute – I find it is not

reasonable to impose additional dress or identification requirements on nurses when they are off

their units. It is an undue restriction on employees who are not on duty, with no evidence to

support a need. There is nothing, of course, stopping a nurse from wearing the lab coat in the

cafeteria or elsewhere in the hospital while not on duty, if desired.

In my view, the most significant fact about this case is that, before it created the dress code and

lab coat policies, the hospital had policies in place that covered all the areas that relate to

sanitation and patient and employee safety and health, including fingernails, jewelry and

footwear, as well as a code of conduct that required employees to dress professionally. These

policies were not contentious and were not grieved by the union. Employees went about their

[41]

work, and managers went about theirs, apparently unconcerned about tattoos and piercings,

Bermuda shorts and blue jeans, which, based on the evidence I heard, have been part of the scene

at The Ottawa Hospital for many years. Patients and their families, too, were apparently not

concerned enough to complain. Suddenly in March, 2011, Mr. Tremblay’s tattoos were

considered unprofessional, as were Ms. Monette’s piercings, Mr. Mayer’s blue jeans, Mr.

Guerard’s Bermuda shorts and Ms. Holliday’s cotton pants. Other employees found that their

managers had no issues with employees who, with a different and more zealous manager, might

have been considered in violation of the policy.

In argument, the union asked what prompted the move to a dress code that has led to this lengthy

hearing. The hospital’s reply is that it is mandated to make constant improvements under the

Excellent Care for All Act, 2010, and that stricter dress rules are part of that evolving

improvement. But aside from the personal opinions of its senior managers, the hospital has

provided no evidence for its rationale that there is a link between health care outcomes and the

new rules it has imposed. For this reason, it is my conclusion that the provisions of the dress

code that go beyond existing policies do not meet the test of reasonableness. The policy also

does not meet the test of clarity, and its vagueness has created uncertainty among both

employees and managers about what is considered appropriate. This has already led to

inconsistent enforcement, which would almost inevitably continue – and lead to further litigation

– if the policy remains in force.

It is hard not to conclude that the hospital has attempted to fix a problem that does not exist. The

hospital has not shown that there is any legitimate reason for the employer to control the

[42]

exposure of tattoos and piercings to the extent the dress code does. Where no harm can be

shown to either patients or employees or the hospital itself, the restrictions are an infringement of

the employees’ right to present themselves as they see fit. This does not mean there are no

restrictions as all; however, there is no indication that the previous approach had caused any

problems.

Because the code of conduct and other long-standing policies are still in effect, it is appropriate

in my view to grant the union’s request to allow the grievance by declaring the Dress Code

Policy to be void and unenforceable. As regards the policy titled Guidelines for Nursing Lab

Coats, the grievance is allowed to the extent that the employer cannot require the wearing of the

lab coat when the employee is off duty.

It is so ordered.

____________________

Lorne Slotnick, Arbitrator

January 14, 2013

[43]

CORPORATE POLICY AND PROCEDURE MANUAL MANUEL DES POLITIQUES ET PROCÉDURES DE L’HOPITAL D’OTTAWA

DRESS CODE – CODE VESTIMENTAIRE

SECTION : ADM X 310 NO. / No

: ADM X 310

ISSUED BY / PRÉPARÉE PAR : APPROVAL DATES / DATES D’APPROBATION

Date initially issued / Date de distribution initiale : 2010/10/13

APPROVED BY / APPROUVÉE PAR : Senior Management Committee / Comité de la haute direction

Date last reviewed / Date du dernier examen : yy/mm/dd

* Shaded areas to be completed by P&P coordinator only Implementation date / Date d’entrée en vigueur : 2010/10/13

1. POLICY 1. POLITIQUE 1.1 In keeping with The Ottawa Hospital (TOH) vision,

patient-centered model of care, and to ensure safety, TOH staff will dress in a manner that ensures patients, staff and the environment are safe from preventable infection.

1.2 All TOH staff will dress in a manner that portrays a

professional image at all times.

1.3 In response to a need for patients, visitors and staff to clearly identify TOH staff working in clinical settings:

(i) Registered Nurses and Registered Practical Nurses will wear lab coats, in accordance with NSG-4-B191 Guidelines for Nursing Lab Coats.

(ii) Other Health Professionals will dress in accordance with the guidelines for their professional group.

(iii) Support services staff, including transportation and housekeeping staff, will wear hospital/employer-issued uniforms at all times.

1.4 Staff working in non-clinical settings will wear

professional attire.

1.5 TOH respects cultural diversity and supports the wearing of cultural or religious attire, while maintaining compliance with employee and patient safety and quality requirements.

1.6 TOH Photo Identification Badge is considered part

of the dress code and must be worn above the waist and visible at all times, in accordance with the Photo Identification Cards policy (ADM IX 100).

1.1 En conformité avec la vision, le modèle de soins centrés sur le patient et les règles de sécurité de L’Hôpital d’Ottawa (L’HO), les employés de L’HO doivent s’habillent de façon à protéger les patients, le personnel et l’environnement contre les infections évitables.

1.2 Les employés de L’HO doivent porter des vêtements

qui projettent une image professionnelle en tout temps. 1.3 Pour permettre aux patients, aux visiteurs et aux

employés de bien identifier les employés qui travaillent en milieu clinique :

(i) Les infirmières autorisées et les infirmières auxiliaires autorisées doivent porter un sarrau conformément à la politique NSG-4-B191 (Lignes directrices sur les sarraus).

(ii) Les autres professionnels de la santé doivent s’habiller de la façon prévue aux lignes directrices propres à leur groupe professionnel.

(iii) Les employés de soutien, y compris les préposés au transport et à l’entretien ménager, doivent porter l’uniforme fourni par l’Hôpital (ou leur employeur) en tout temps.

1.4 Les employés qui travaillent en milieu non clinique doivent porter une tenue professionnelle.

1.5 L’HO respecte la diversité culturelle et accepte le port de vêtements culturels ou religieux dans la mesure où ils répondent à ses exigences en ce qui concerne la qualité des soins et la sécurité des employés et des patients.

1.6 La carte d’identité avec photo fait partie du Code vestimentaire. Elle doit être visible en tout temps au dessus de la taille, comme le précise la politique ADM IX 100.

2. DEFINITIONS

2. DÉFINITIONS This material has been prepared solely for use at The Ottawa Hospital (TOH). TOH accepts no responsibility for use of this material by any person or organization not associated with TOH. NO part of this document may be reproduced in any form for publication without permission of TOH. A printed copy of this document may not reflect the current electronic version, which is on TOH’s intranet.

Ce document a été préparé pour l’usage exclusif du L’Hôpital d’Ottawa (L’HO). L’HO n’assume aucune responsabilité concernant l’utilisation de ce document par une personne ou un organisme sans lien avec L’HO. AUCUNE partie de ce document ne peut être reproduite sous quelque forme que ce soit sans la permission de L’HO. La version imprimée de ce document ne correspond pas nécessairement à la version électronique à jour, qui figure dans l’intranet de L’HO. Page 1 / 11

DRESS CODE – CODE VESTIMENTAIRE

ADM X 310

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2.1 Staff: All workers, physicians, volunteers,

students and contractors.

2.2 Management: Persons in charge, lead hands, coordinators, supervisors, managers, directors or anyone exercising control over the work assignment and with authority over the worker.

2.3 Direct Patient Contact: Regular, hands-on

interaction with patients.

2.4 Health Care Provider (HCP): Any person delivering care to a patient where the hands of the HCP touch the patient, the patient’s body fluids or objects and surfaces located in the patient environment. HCP includes but is not limited to nurses, physicians, other health professionals and support services workers, such as transport and housekeepers.

2.5 Uniform: A distinctive outfit intended to identify

those who wear it as members of a specific group.

2.1 Employés : Tous les travailleurs, les médecins, les bénévoles, les étudiants et les entrepreneurs

2.2 Personnel de gestion : Tous les responsables, les

chefs d’équipe, les coordonnateurs, les superviseurs, les gestionnaires, les directeurs et les personnes qui exercent une forme de contrôle sur l’assignation de tâches et qui sont responsables d’un travailleur

2.3 Contact direct avec les patients : Interaction

régulière et directe avec les patients 2.4 Fournisseurs de soins : Toutes les personnes qui

doivent toucher des patients, leurs liquides corporels ou les objets et surfaces dans leur environnement pour leur prodiguer des soins (infirmières, médecins, autres professionnels de la santé, employés de soutien comme les préposés au transport ou à l’entretien ménager, etc.)

2.5 Uniforme : Tenue distinctive ayant pour but de révéler

le groupe professionnel auquel appartient la personne ainsi vêtue

3. PROCEDURE 3. PROCÉDURE

3.1 Roles and Responsibilities

Management shall:

Be familiar with all aspects of this policy; Support and enforce this policy; Discuss this policy with new employees at the time

of hire and when employees return from an extended leave of absence;

Identify all designated areas where appropriate attire is to be worn;

Ensure staff wears appropriate attire, in accordance with the provisions of this policy, and impose disciplinary actions in circumstances of non-compliance.

Any employee not dressed in accordance with the provisions of this policy will be sent home and directed to return in attire that complies with this policy. If sent home for this reason, the employee will not be compensated for the time away from work

Staff shall: Wear appropriate attire in compliance with the

provisions of this policy (see Appendix); In accordance with the Human Rights Code, any

employee who believes s/he requires an accommodation on the basis of race, religion,

3.1 Rôles et responsabilités

Le personnel de gestion doit :

Bien connaître tous les volets du Code vestimentaire. Appuyer et faire respecter le Code vestimentaire. Discuter du Code avec les nouveaux employés lors de

leur embauche et à leur retour d’un congé prolongé. Identifier tous les secteurs désignés où il faut porter

une tenue appropriée. Veiller à ce que les employés portent une tenue

appropriée conformément au Code et prendre des mesures disciplinaires en cas d’infraction.

Renvoyer à la maison l’employé qui ne respecte pas le Code et lui demander de revenir avec une tenue qui le respecte. Dans un tel cas, l’employé n’est pas payé pendant qu’il n’est pas au travail.

Les employés doivent :

Porter une tenue appropriée conformément au Code vestimentaire (voir l’annexe).

Discuter avec leur gestionnaire ou superviseur et communiquer avec les Ressources humaines si, en vertu du Code des droits de la personne, ils estiment avoir besoin d’une mesure d’accommodement en raison de leur origine ethnique, de leurs croyances religieuses, de leur incapacité ou d’autres caractéristiques citées dans le Code.

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ethnic origin, disability, etc. should discuss with their manager/supervisor and contact the Department of Human Resources;

Report to his/her manager/supervisor any contravention of this policy or existence of any related hazard of which s/he is aware.

3.2 Choice of Dress

When making choices about what to wear in the workplace, the following principles apply:

Incorporate Occupational Health, Safety and

Emergency Preparedness and Infection Control requirements for appropriate attire while in the hospital setting.

Dress to promote patient confidence.

Dress in a way that work can be completed efficiently.

Dress appropriately to the clinical/work environment while recognizing cultural norms and religious requirements.

Dress to portray a competent, professional image.

3.3 Hospital-Issued Personal Protective Garments

Authorized personnel in designated areas must wear hospital-issued garments (uniforms, scrubs, lab coats), as outlined in the Personal Protective Garment policy (ADM IV 200).

The wearing of hospital-issued uniforms, scrubs and lab coats to and from the workplace is not permitted, in accordance with the Personal Protective Garment policy (ADM IV 200). In some areas, lockers and changing facilities are available to allow staff to change into and out of their uniforms, scrubs and lab coats before and after shifts.

3.4 Attire for Staff Who May Frequently Be Exposed

to Blood or Body Fluids (Health Care Providers (HCP)/Clinical staff providing hands-on, direct patient care)

3.4.1 Clothing

Refer to Personal Protective Garment policy (ADM IV 200).

Clothing, including uniforms, scrubs and lab coats worn at work, will reflect a professional image of TOH.

Only TOH approved logos, including the University of Ottawa, may be worn.

Yellow isolation gowns are to be worn only in

Signaler à leur gestionnaire ou superviseur tout danger ou violation lié au Code vestimentaire.

3.2 Choix vestimentaires

Au moment de choisir des vêtements de travail, les principes suivants doivent servir de guide :

Respecter les exigences de la Santé et sécurité au travail et des mesures d’urgence, ainsi que celles du Contrôle des infections au moment de choisir la tenue de travail.

S’habiller de façon à inspirer confiance aux patients.

S’habiller de façon à pouvoir travailler efficacement.

Tenir compte du secteur clinique ou de travail tout en reconnaissant les normes culturelles et les exigences religieuses.

S’habiller de façon à projeter une image compétente et professionnelle.

3.3 Vêtements de protection personnelle fournis par

l’Hôpital

Les employés autorisés dans les secteurs désignés doivent porter les vêtements fournis par l’Hôpital (uniforme, tenue de chirurgie, sarrau), conformément à la politique intitulée Vêtements de protection personnelle (ADM IV 200).

Il n’est pas permis de porter d’uniforme, de tenue de chirurgie ni de sarrau pour venir au travail ou retourner à la maison, conformément à la politique intitulée Vêtements de protection personnelle (ADM IV 200). Des vestiaires sont disponibles dans certains secteurs pour permettre aux employés de se changer avant et après leur quart de travail.

3.4 Vêtements des employés fréquemment exposés au

sang ou aux liquides corporels (fournisseurs de soins et employés cliniques prodiguant des soins directs aux patients)

3.4.1 Vêtements

Consulter la politique Vêtements de protection personnelle (ADM IV 200).

Les vêtements, y compris les uniformes, les tenues de chirurgie et les sarraus portés au travail, doivent projeter une image professionnelle de L’HO.

Il est uniquement permis de porter les logos approuvés par L’HO, notamment celui de l’Université d’Ottawa.

Il faut porter une blouse de contagion seulement dans les chambres des patients ou dans celles où on réalise une intervention et l’enlever en suivant les techniques

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patient or procedure rooms and removed in accordance with established doffing techniques.

Examples of appropriate and inappropriate clothing are outlined in the attached Appendix.

3.4.2 Shoes

There are specific policies on footwear as follows:

o ADM VI 370 Footwear in Patient Care Areas and Laboratories

o ADM VI 400 Non-Clinical Personal Protective Equipment

Sensible shoes providing support, comfort and protection against workplace injury are mandatory.

Shoes must be cleaned regularly. In work environments where uniforms are

mandatory, a dedicated pair of shoes for the workplace is required.

Staff members who are providing direct patient care must wear socks and/or nylons at all times.

3.4.3 Fingernails

Nails must be kept clean and short. Nail polish, if used, must be fresh and free of

cracks or chips. Nail polish is not permitted in some designated

areas, as identified in specific departmental policies.

Artificial nails or nail enhancements are not permitted. Refer to Hand Hygiene Policy and Procedure.

3.4.4 Jewellery

Hand jewellery must be limited to a smooth wedding band, without projections or mounted stones, and/or a watch. These will be removed or pushed up above the wrist before performing hand hygiene. Refer to Hand Hygiene Policy and Procedure.

Staff must avoid wearing jewellery such as rings with large raised settings that can cause patient injury and perforate gloves.

3.4.5 Hair

Hair will be worn in such a way that it does not come into contact with the patient or obscure vision.

Hair that is longer than shoulder length must be pulled back and secured away from the face.

approuvées.

Il y a des exemples de vêtements appropriés et non appropriés dans l’annexe ci-jointe.

3.4.2 Chaussures

Il existe des politiques qui portent spécifiquement sur les chaussures :

o ADM VI 370 : Chaussures à porter dans les laboratoires et les secteurs de soins aux patients

o ADM VI 400 : Équipement de protection personnelle non clinique

Il est obligatoire de porter des chaussures pratiques, confortables et qui offrent un soutien et une protection contre les blessures au travail.

Il faut nettoyer ses chaussures régulièrement.

Dans les secteurs où il est obligatoire de porter un uniforme, il faut porter ses chaussures uniquement dans ces secteurs.

Les employés qui donnent des soins directs aux patients doivent porter des bas ou des bas de nylon en tout temps.

3.4.3 Ongles

Garder les ongles propres et courts.

Le vernis à ongle doit être propre et uniforme. Il ne peut pas être craquelé ni écaillé.

Il est interdit de mettre du vernis à ongle dans certains secteurs désignés. C’est indiqué dans les politiques relatives à ces secteurs.

Il n’est pas permis de porter des faux-ongles. Voir la Politique et procédure d’hygiène des mains.

3.4.4 Bijoux

Il est seulement permis de porter une montre et une alliance sans saillie ni pierre montée. Il faut les enlever ou remonter la montre jusqu’au poignet avant de se laver les mains. Voir la Politique et procédure d’hygiène des mains.

Il faut éviter de porter des bijoux, comme une bague avec une saillie large, qui pourraient blesser les patients ou perforer les gants.

3.4.5 Cheveux

Prendre des mesures pour veiller à ce que les cheveux n’entrent pas en contact avec les patients et n’obstruent pas la vision.

Si la longueur des cheveux dépasse les épaules, il faut

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3.5 Attire for Staff Not Expected to be Exposed to Blood or Body Fluids (Administrative and Management staff, Clinical staff who do not provide direct or hands-on patient care)

3.5.1 Clothing

Clothing, including uniforms, scrubs and lab coats, worn at work will reflect a professional image of TOH.

All non-clinical staff must dress professionally and according to their work environment.

Professional attire or a departmental uniform is required for staff members who interact with patients or the general public.

Examples of appropriate and inappropriate clothing are outlined in the attached Appendix.

3.5.2 Shoes

There are specific policies on footwear as follows:

o ADM VI 370 Footwear in Patient Care Areas and Laboratories

o ADM VI 400 Non-Clinical Personal Protective Equipment

Sensible shoes providing support, comfort and protection against workplace injury are mandatory.

Shoes must be cleaned regularly. In work environments where uniforms are

mandatory, a dedicated pair of shoes for the workplace is required.

3.6 Charitable Fundraising and Festive Holiday Dress Costume ‘dress up’ in celebration of a traditional holiday (i.e. Halloween) or ‘Friday jeans day for charity’:

Must be approved by VP; Must not inhibit the practice of hand hygiene or

the use of infection control routine practices; Must not interfere with required safe work

practices, restrict normal vision, or present an entanglement hazard;

Staff must wear an identifiable and visible lapel pin, button or sticker which clearly states the fundraising initiative (i.e. “I am wearing jeans to raise funds for charity “X”)

les attacher vers l’arrière de la tête avec un accessoire. 3.5 Vêtements des employés qui ne sont pas

normalement exposés au sang ni aux liquides corporels (employés administratifs et de gestion, employés cliniques qui ne donnent pas des soins directs aux patients)

3.5.1 Vêtements

Les vêtements, y compris les uniformes, les tenues de chirurgie et les sarraus portés au travail, doivent projeter une image professionnelle de L’HO.

Tous les employés non cliniques doivent s’habiller de façon à projeter une image professionnelle qui correspond à leur secteur de travail.

Les employés qui interagissent avec les patients ou le grand public doivent porter une tenue professionnelle ou un uniforme.

Il y a des exemples de vêtements appropriés et non appropriés dans l’annexe.

3.5.2 Chaussures

Politiques portant spécifiquement sur les chaussures :

o ADM VI 370 : Chaussures à porter dans les laboratoires et les secteurs de soins aux patients

o ADM VI 400 : Équipement de protection personnelle non clinique

Il est obligatoire de porter des chaussures pratiques, confortables et qui offrent un soutien et une protection contre les blessures au travail.

Il faut nettoyer ses chaussures régulièrement.

Dans les secteurs où il faut porter un uniforme, il faut porter ses chaussures uniquement dans ces secteurs.

3.6 Vêtements portés pendant des activités de levée de fonds ou des célébrations (p. ex. Halloween, vendredi décontracté)

Il faut au préalable obtenir l’approbation du vice-président responsable.

Les vêtements ne doivent pas empêcher l’hygiène des mains ni les pratiques courantes de prévention des infections.

Ils ne doivent pas entraver les méthodes de travail sécuritaires, restreindre la vision ni présenter un risque de chute.

Les employés doivent porter une épinglette ou un collant identifiable et visible qui indique clairement quelle est l’activité de financement (p. ex. « Je porte des jeans pour

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ADM X 310

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amasser des fonds pour la cause X »)

4. RELATED POLICIES AND LEGISLATION 4. POLITIQUES OU RÈGLEMENTS CONNEXES Photo Identification Cards, ADM IX 100 Scent-Free Workplace, ADM VI 160 Personal Protective Garments, ADM IV 200 Code of Conduct, ADM X 220 Respiratory Protection, ADM VI 340 Footwear in Patient Care Areas and Laboratories, ADM VI 370 Non-Clinical Personal Protective Equipment, ADM VI 400 Personal Protective Equipment, ADM XII 134 Hand Hygiene Policy and Procedure, IPC 2.1 Guidelines for Nursing Lab Coats, NSG-4-B191

Ontario Occupational Health and Safety Act and Regulations, R.S.O. 1990

Collective Agreements

Ontario Human Rights Code

ADM IX 100 : Carte d’identité avec photo ADM VI 160 : Milieu de travail sans produits parfumés ADM IV 200 : Vêtements de protection personnelle ADM X 220 : Code de conduite ADM VI 340 : Protection respiratoire ADM VI 370 : Chaussures à porter dans les laboratoires

et les secteurs de soins aux patients ADM VI 400 : Équipement de protection personnelle non

clinique ADM XII 134 : Équipement de protection personnelle

PCI 2.1 : Politique et procédure d’hygiène des mains

NSG-4-B191 : Lignes directrices sur les sarraus Loi sur la santé et la sécurité au travail de l’Ontario, 1990

Conventions collectives

Code des droits de la personne de l’Ontario

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APPENDIXGeneral Guidelines for Proper Professional Attire

Uniforms Clean, unwrinkled Refer to: Personal Protective Garment (ADM IV 200) Personal Protective Equipment (ADM‐XII‐134) Non‐Clinical Personal Protective Equipment (ADM VI 400) Footwear for Patient Care Areas and Laboratories (ADM VI 370) Nursing Policy, NSG‐4‐B191 (Guidelines for Nursing Lab

Coats) Code of Conduct (ADM X 220) Section 3.1

Dirty, worn, torn, frayed, has patches or holes

Non‐Uniform

Clothing

Clean, unwrinkled Professional attire

Refer to:

Code of Conduct (ADM X 220) Section 3.1

Revealing attire such as crop tops, tank tops, halter tops, midriff tops, and clothes made of transparent material or that expose areas of the body usually covered by clothing in the workplace

Hemlines of skirts, dresses, shorts must fall around the knee

Jeans and other denim clothing

Work‐out attire: jogging, sweat suits, hoodies, t‐shirts

Clothing that contains profanity, slogans, advertisements, cartoons, drawings, or any sport‐team branding (i.e. Senators).

Hospital ID

Badge

Visible, worn above waist Refer to:

Photo Identification Cards (ADM IX 100) Nursing Policy, NSG‐4‐B191 (Guidelines for Nursing Lab Coats)

Footwear Refer to:

Footwear for Patient Care Areas and Laboratories (ADM VI 370) 3.2 Fully enclosed toe and upper, has a solid covering fabric, a low or medium heel with a maximum height of 60 mm and a non‐slip sole Non‐Clinical Personal Protective Equipment (ADM VI 400) 3.11 Foot Protection ‐ Safe, clean, well maintained and appropriate to the work being done, or as identified in specific departmental policies

Barefoot anywhere in the hospital

Beach‐type sandals (flip‐ flops)

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APPENDIXGeneral Guidelines for Proper Professional Attire

Personal

Hygiene

Employees will present a clean, neat appearance and follow good grooming and personal hygiene practices

Hair/Facial Hair

Hair: Neat, tidy, off the shoulder and held back with conservative hair accessories

Facial Hair: Clean‐shaven or neat and well‐trimmed beards and moustaches

Fingernails

Nails must be kept clean and short Nail polish, if used, must be fresh and free of cracks or chips

Refer to:

Scent‐Free Workplace (ADM VI 160) Respiratory Protection (ADM VI 340) Hand Hygiene Policy and Procedure 2.1 Code of Conduct (ADM X 220) Section 3.1

Perfume

Scented deodorant, aftershave, hair and skin products

Nail polish is not permitted in some areas, as identified in specific departmental policies

Clinical Settings: Artificial nails or nail enhancements are not permitted

Jewellery Non‐Clinical Settings Minimal and conservative Small, unobtrusive earrings

Clinical Settings As identified in specific departmental policies

Refer to:

Hand Hygiene Policy and Procedure 2.1 ‐ Hand jewellery must be limited to a smooth wedding band without projections or mounted stones and/or a watch. Code of Conduct (ADM X 220) Section 3.1

Clinical Settings: Dangling and large hoop earrings, long hanging chains and bracelets pose a safety risk and are not permitted

Body Piercings Non‐Clinical Settings Minimal and conservative. Must not pose a safety hazard and take into consideration Infection Control and Occupational Health and Safety guidelines. If appropriate, remove for shift.

Clinical Settings As identified in specific departmental policies

Visible, excessive body piercings

Tattoos Small, discrete, unobtrusive tattoos can be exposed Large tattoos, if visible, will be covered during working hours

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ANNEXELignes directrices : vêtement professionnel approprié

Uniformes

Propres, non froissés Voir :

Vêtements de protection personnelle (ADM IV 200) Équipement de protection personnelle (ADM‐XII‐134) Équipement de protection personnelle non clinique (ADM VI 400) Chaussures à porter dans les laboratoires et les secteurs où l’on fournit des soins aux patients (ADM VI

370) Lignes directrices sur les sarraus (NSG‐4‐B191) Code de conduite (ADM X 220), paragraphe 3.1

Uniformes sales, usés, déchirés, effilochés, rapiécés ou troués

Vêtements

autres que les

uniformes

Propres, non froissés Projetant une image professionnelle

Voir :

Code de conduite (ADM X 220), paragraphe 3.1

Vêtements révélateurs (chemise courte exposant le ventre, camisole, vêtement transparent ou qui expose une partie du corps habituellement cachée en contexte professionnel…)

Jupes, robes et shorts trop courts (qui arrivent bien au dessus du genou)

Jeans et autres vêtements de denim

Vêtements de sport (pantalons jogging, coton ouaté à capuchon, t‐shirt sportif…)

Vêtements affichant un message inapproprié (jurons, slogans, publicités, dessins animés).

Vêtements affichant un club sportif (p. ex. Sénateurs)

Carte d’identité

Visible, portée au dessus de la taille Voir :

Carte d’identité avec photo (ADM IX 100) Lignes directrices sur les sarraus (NSG‐4‐B191)

Chaussures Voir :

Chaussures à porter dans les laboratoires et les secteurs de soins aux patients (ADM VI 370), Paragraphe 3.2 : « Les chaussures doivent couvrir les orteils et le pied, être recouvertes d’un matériel résistant, avoir un talon plat ou peu élevé (maximum 60 mm) et avoir une semelle antidérapante. »

Équipement de protection individuelle non clinique (ADM VI 400)

Se promener pieds nus dans l’Hôpital

Sandales de plage (« gougounnes »)

DRESS CODE – CODE VESTIMENTAIRE

ADM X 310

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ANNEXELignes directrices : vêtement professionnel approprié

Paragraphe 3.11 : Protection des pieds ‐ Chaussures sécuritaires, propres, bien entretenues et convenant au travail en question ou chaussures exigées dans les politiques applicables

Hygiène

personnelle

Apparence propre et soignée, bonnes pratiques pour la toilette et l’hygiène personnelle

Cheveux et poils au visage Cheveux : Propres, soignés, de longueur au‐dessus des épaules, sinon attachés vers l’arrière par un accessoire Poils au visage : Peau fraîchement rasée, ou barbe ou moustache propre et bien entretenue

Ongles Propres et courts

Vernis à ongles uniforme, non craquelé ni écaillé

Voir :

Milieu de travail sans produits parfumés (ADM VI 160) Protection respiratoire (ADM VI 340)

Politique et procédure d’hygiène des mains (PCI 2.1) Code de conduite (ADM X 220), paragraphe 3.1

Parfum et produits parfumés (déodorant, après rasage et produits pour les cheveux ou la peau parfumés)

Vernis à ongle (dans certains secteurs)

Secteurs cliniques : Faux ongles ou ongles décorés

Bijoux

Secteurs non cliniques Minimes et conservateurs Boucles d’oreilles petites et discrètes

Secteurs cliniques Voir les politiques de chaque secteur

Voir :

Politique et procédure d’hygiène des mains (PCI 2.1) Il est seulement permis de porter une montre et une alliance sans saillie ni pierre montée.

Code de conduite (ADM X 220), paragraphe 3.1

Secteurs cliniques : Boucles d'oreilles larges et pendantes, chaînes et bracelets longs (risque pour la sécurité)

Perçages

corporels

Secteurs non cliniques Minimes et conservateurs, ne doivent pas présenter de risque pour la sécurité, doivent respecter les lignes directrices du Contrôle des infections et de la Santé et sécurité au travail. Si possible, les enlever avant un quart de travail.

Secteurs cliniques Voir les politiques de chaque secteur

Perçages excessifs visibles

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ANNEXELignes directrices : vêtement professionnel approprié

Tatouages Il est permis d’exposer les tatouages petits et discrets

Gros tatouages : Couvrir pendant les heures de travail

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NURSING POLICY, PROCEDURE, PROTOCOL MANUAL NSG-4-4B191

GUIDELINES FOR NURSING LAB COATS

POLICY STATEMENT: The professional designation of all nurses working at The Ottawa Hospital (TOH) must be clearly identified by patients, visitors and other members of the staff at all times. As per one of the priorities of the Corporate Nursing Clinical Practice Committee (CNCPC), lab coats with the appropriate designation are provided to enhance professional image. PROTOCOL:

1. As part of the dress code policy all RNs, RPNs, APNs, Clinical Managers, Nurse Educators, Clinical Administrators on Site will be provided with one white lab coat with The Ottawa Hospital (TOH) logo on the upper right side and a unilingual nursing professional designation as appropriate (RN, IA, RPN, IAA) on the upper left side above a pocket. A lab coat can be obtained by contacting the Nursing Professional Practice Department.

2. Upon any new hire, new staff will be issued one lab coat from the hospital. Any new, additional, or replacement for a lost or damaged lab coat can be purchased by contacting the vendor. (Please contact NPPD for information).

3. Lab coats should be worn by RNs, RPNs, APNs, Clinical Managers, Nurse Educators, Clinical Administrators on Site when off the unit and where appropriate, on the unit. Only a TOH issued lab coat will be in compliance with the policy.

4. Lab coats are to be maintained by the nursing staff. They must be laundered regularly. 5. A hospital identification tag must be worn to conform to the dress code policy and be visible when

wearing the lab coat. RELATED POLICIES: Dress Code (ADM X 310) Personal Protective Garment (ADM IV 200)