registered nurses’ union newfoundland &...

In TouchREGISTERED NURSES’ UNION NEWFOUNDLAND & LABRADOR

The Duty to Accommodate RNs with a Disability9

Violence in Health Care

Page 14

PRESIDENT’SMESSAGE

Update tomembers on

CollectiveBargaining

Page 2

PRESIDENT’SMESSAGE

Update tomembers on

CollectiveBargaining

Page 2

FALL 2017

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Message from the PresidentDEBBIE FORWARD, RN

“Increased complexity and acuity, high workloads, working short-staffed – you feel the effects of this every day. It wears on you. It brings you down. It can put your nursing practice in jeopardy.”

The summer we long awaited for

is nearly over and fall is upon us.

I hope you were able to get some

time off to take that special trip,

tackle a home project or sit on

your deck and enjoy the moment.

As I write this article, I am looking

forward to some R & R with family

and friends to recharge my battery.

The fall is shaping up to be a critical and busy time for RNU. Collective bargaining is at the top of RNU’s agenda.

While it’s been looming on the horizon for a year, we started bargaining in June. The priorities set in RNU’s opening package are progressive. They focus on moving forward—on making improvements to registered nursing and health care.

Improvements that will positively impact you, as well as the patients, clients, and residents in your care. I’d like to spend some time reviewing our four priority areas. These priorities were set by your Board of Directors, and the proposals in our opening package were developed by your Negotiating Team after careful review of member proposals, the results of our member bargaining survey, as well as input from RNU staff and trends across the country.

Workload/StaffingIn our bargaining research, we asked members to think about things that affect their work-life and workplace. The single most important issue identified by you was workload and staffing. Here are some of the comments you made:

“Adequate staffing and ability to grant leave.”

“Increase in RN to patient ratio for safety of patients and RNs. Decrease nursing workload.”

“For me it’s staffing levels. If we cut back on staffing then it has a domino effect, sick leave goes up, call-backs increase and stress goes up.”

When appropriate staffing is not in place, changes in patient conditions are missed, pain medications and treatments are delayed, basic care suffers and the risk of patients dying increases. It’s as simple as that.

RNs are concerned for their patients. They’re concerned for themselves.

Increased patient acuity and complexity, high workloads, working short-staffed – you feel the effects of this every day. It wears on you. It brings you down. It can put your nursing practice in jeopardy.

We know inadequate staffing is the norm. Over $48 million was spent on RN overtime and sick leave in 2015-16. Yet, new grads cannot get full-time employment.

84% of Newfoundlanders and Labradorians feel we don’t have enough RNs to provide quality care.

We need to address RN staffing and workload.

More RNs would mean shorter hospital stays, less complications, less preventable deaths, and increased patient outcomes and satisfaction.

More RNs would save our province money. Research studies repeatedly demonstrate that proper RN staffing creates a more efficient and effective system. You avoid soaring overtime cost. You prevent complications and readmissions. You even lower mortality rates.

Our package includes a number of measures to address workload and advocate for more RNs. Here are just two examples:

Core Staffing Review: To help establish safe RN staffing, RNU is calling on the provincial government to complete a core staffing review. A staffing review will examine the

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IN TOUCH | FALL 2017

number and types of nursing providers currently working in the system.

The last review was done over 16 years ago. It’s time to re-evaluate staffing levels. Since the last review, our population has continued to age and health care needs have become more complex. We need to ensure staffing meets patient demand.

Replacing “Like with Like”: Registered nurses should be replaced with registered nurses. It doesn’t take a rocket scientist to understand why that makes sense. RNs practice to a higher scope of practice. We are the only nursing provider to care for the most stable or chronic to the most critical and complex conditions. If it was determined an RN was needed for a particular unit or area of care in the first place, then guess what – when that RN is absent, she/he should only be replaced by another RN.

Quality Work EnvironmentsAnother area that members highlighted in proposals and research was work environment.

Here are some of the comments you made:

“Resources to safely do my job”

“We need time off. To know we can get holidays and not just on short notice”

“Working conditions – staffing levels, compensated time off, rest time following on call”

The challenges and obstacles you face at work can sound outrageous to those outside our profession.

Challenges like safety. Just by doing your job, you’re at a higher risk of violence than a police officer. Imagine that.

The requirement to work a 24-hour shift. How is this ever safe for patients or for you the RN?

Short-term leave is another one. In what other profession do you ask for a day off six months in advance only to be told that it cannot be approved until the day of the leave? If that day off is for an important family commitment that response is just not acceptable. It is no wonder sick leave is high. Does it have to be like this? Wouldn’t it be better for everyone if you didn’t have to face this kind of environment at work? We think so.

Again, we have put forward measures that are progressive – measures that will help create quality work environments.

I’d like to highlight two proposals in this area.

Position Protection: There has been growing concern regarding position protection among our members. In this round, we plan to address the employer’s recent practice of denying position protection for permanent employees who are the successful applicants for temporary positions. We want language to provide position protection for our members.

Strengthening Professional Practice Process: Increasingly, RNs feel their ability to provide the highest level of care is being compromised. You are doing the best you can, but at the end of the day you are being asked to do more with less. These concerns are more than just RNs being unhappy at

work – this is about your Professional Practice being compromised. This translates into patients being unintentionally put at risk and a decline in patient safety and quality of care.

The current process to address Professional Practice concerns outlined in the RNU Provincial Collective Agreement requires stronger language that ensures both the employer and the union are more accountable. This round, we are proposing language to develop a standard, provincial reporting form; clearly stated timelines to resolve PPC issues; and the creation of an Independent Assessment Committee, which can step in when issues are not resolved at the committee level.

Maintaining Current BenefitsWe recognize the economic outlook of the province. We aren’t being unrealistic in our proposals. We do, however, want to reach a deal that will ensure the recruitment and retention of RNs in our province. We will not to return to the days of 1,000+ vacancies.

Our goal is to reach a deal at the table that is fair and respectful and that means maintaining our wages and benefits. We know you agree.

In our bargaining research, we asked members to identify the number one priority in bargaining. You clearly identified that maintaining wages and benefits was a top goal.

Here is some of the feedback we heard:

“Contract to remain the same, nothing taken.”

Continued on next page.

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Message from the President (continued)

DEBBIE FORWARD, RN

Through our Clarity Project, we have been showcasing the RN value. We are demonstrating to the public and leaders within government and employers that RNs nurse to a higher level.

“No concessions. We have worked hard in the last two contracts to bring the benefits and salaries of RNs on part to nurses in Atlantic Canada. We need a competitive salary and benefits package to retain our nurses and recruit new nurses to our province.”

“To not lose any of our benefits and to at least keep pay the same.”

Language Clarifications When things are written clearly and openly stated, it makes life easier. There are number of areas in our contract where we would like clarity on language.

For instance, since we signed the last collective agreement the new Job Evaluation System has been implemented. We want to ensure our new collective agreement is reflective of the new system. We believe clarifying contract language in a number of areas will be beneficial to RNs, the union and employers.

It’s still very early in the process. At the time of writing this message, we have only met once with the employer team. While I’m not able to share the entire package at this stage, I hope this provides a good sense of RNUs priorities for this round.

Public Awareness Campaign Coming Soon Through our Clarity Project, we have been showcasing the RN value. We are demonstrating to the public and leaders within government and employers that RNsnurse to a higher level.

In-depth knowledge and higher education. Advanced judgment and critical thinking. Comprehensive assessment and analysis. Registered nurses are a good investment. An investment this province needs.

Demands on the health care system are increasing, not decreasing.

We have an aging population. A population with a lot of sick people. Our province has some of the highest rates of cardiovascular disease, obesity, and diabetes. Over half of Newfoundland and Labrador residents aged 12 years and older have at least one chronic disease; many people live with more than one.

How much will the province pay for RN overtime and sick leave this year? 50 million? 55 million? What about next year? Without proper RN staffing, we’ll continue to throw money in the wrong direction.

This fall, as part of our bargaining work, we will unveil a campaign to show that smarter spending through proper RN resourcing will create a more efficient system and build safer, healthier communities across Newfoundland and Labrador.

And we’ll be calling on you, RNU members, to help spread our message. You know what safe RN staffing would mean to the health care system and the patients, residents and clients in your care.

Let’s tell our stories. Let’s make our voices heard.

In solidarity,

Debbie Forward, RNpresident

CAMPAIGN

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Elections are now underway for the 2018-2020 RNU Board of Directors.Visit myRNU for election information, including candidate bios and pictures.

A voting package will be mailed to members in regions where more than one candidate is running. All ballots must be returned by September 30.

The results of the election will be posted on myRNU.

RNU Board of Directors Election

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Message from the Executive DirectorJOHN VIVIAN, QC

Update on Collective Bargaining The RNU negotiating team met with the four employers covered by the Provincial Collective Agreement to exchange proposals on June 29, formally beginning the process of bargaining our contract. As your chief negotiator, I can say the employer’s opening package was among the most unreasonable we have seen in provincial bargaining. I know you have heard the rumors and news reports about government’s plan to freeze wages for public sector workers and look for concessions in sick leave, severance, group insurance and premiums. While government takes this regressive approach, RNU is committed to do the opposite. Our package is progressive. Our proposals will take health care and registered nursing in the right direction. I refer you to the President’s Message on page 2 to learn more. We will keep you updated as the bargaining process unfolds. The next meeting dates set with the Employer Team are October 11-13. After every round of meetings with the employer team, we’ll email and post an update to members on myRNU.

Early Intervention Grievance Process to begin in Central The Early Intervention and Grievance Process will begin this fall in Central Health. The goal of this new grievance process, which is now in place in Eastern Health and Western Health, is to provide members with an opportunity to

resolve workplace issues at the lowest level through a new early intervention component. This means that before a grievance is even filed, RNU members and managers are encouraged to resolve issues through collaborative discussions. In Eastern and Western, the addition of the early intervention component has decreased the number of overall grievances filed. It is also helping to foster more open and positive union-management relations by creating an environment that enables more communication. Education sessions on the new process were held with RNU volunteers and Central Health managers in May. Resources and tools for RNU volunteers and members will be posted in the “Resources” section of myRNU.

Improving Grievance Resolution We continue to use several strategies to improve the timeliness of grievance resolution. One recent approach is the increased use of the mediation/arbitration process. This approach allows a less costly and more expeditious method to resolve grievances using a third-party alternative to arbitration. RNU has been using this format for some time to resolve denied position files. We expanded the process to other files within Eastern Health, concluding 17 files over a seven-day period in May. Seventy per cent of those files were more than five years old. Our members were well served by this process. For example, one member

was awarded a $4,000 payment for several files regarding bumping. Another member received a reduction in a suspension from four weeks to one week, and reimbursement for three weeks salary. Several members were awarded cash payments ranging from $1,000 to $6,000 to settle denied accommodations and/or position files. As well, other members received up to 300 hours in payments to their benefits banks. Our goal is to establish monthly schedules with each employer to hold mediation/arbitration hearings. We’re hopeful we’ll continue to see high success using this approach.

BN Arbitration – Patient Care Facilitator Positions A few years back, RNU challenged the employer’s requirement of a bachelor of nursing degree for all positions above the level of Nurse 1. In September 2014 an arbitrator ruled in our favour and stated the employer could not arbitrarily require a BN for all positions above the level of Nurse I. Despite this ruling, Eastern Health has continued to require a BN for some Patient Care Facilitator (PCF) positions. RNU believes RNs with an equivalent combination of experience and training should be considered for PCF positions. As such, we recently arbitrated the issue of whether the employer can require a BN for PCF positions. Alternatively, we argued that even if a BN can be required for PCF positions, the employer also has to consider

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any “equivalent combination of experience and training.” We expect an arbitration award this fall and will provide an update once we receive it. We are aware of and understand the frustration that our members are experiencing with respect to this issue. It is our hope that this decision will finally decide the issue for positions above the level of Nurse I.

Staff lawyer / LRO Service Areas I would like to wish our staff lawyer of 15 years a fond farewell. David Conway has been an integral and invaluable part of our organization. I will certainly miss his insight, wit and commitment. While we say goodbye to David, who begins a new job as Chair of the Labour Relations Board, I’m thrilled to see our own Tracey Trahey take the torch. Tracey has been an LRO with RNU since 2006 and has worked with various service areas. She is a practicing lawyer and we look forward to seeing Tracey bring her experience and education to the staff lawyer role. Congrats, Tracey. Another change to our labour relations team, is the addition of LRO David Hammond. David began working with RNU in June. He’s already found his place on our team and is having a positive impact on the organization. These changes will mean some shifting of service areas represented by LROs. We are still working through these changes and will notify RNU volunteers when it is finalized.

It is hard to picture a more perfect fit for the role of Labour Relations Officer than David Hammond. David is the newest member of RNU’s Labour Relations team, and brings with him a wealth of enthusiasm and experience.

David has a Master’s Degree in Employment Relations and is a Charted Professional in Human Resources. On top of this, he has nearly 10 years of human and labour relations experience working for Eastern Health.

David’s life is deeply intertwined with registered nursing. Not only is he married to a RN, many of his close friends are also RNs, giving him a deep appreciation for the work environment and challenges faced by RNU members.

During his time working at Eastern Health, David was heavily involved in recruiting, employee relations, as well as disability management. His expertise in these areas has led to a smooth transition into his position at RNU.

“I was ready for a change in my career. When the opportunity arose to work at RNU I couldn’t wait to get involved,” said David. “I believe registered nurses play an invaluable role in the well-being of our society, and I am committed to providing the best support to our members to ensure their rights are protected.”

We are very excited to have David join our team. Welcome, David!

RNU Welcomes David Hammond to our Labour Relations Team

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You can now access all the great features of the myRNU website on your phone. • Ask questions in the forum • View your Collective Agreement • Breaking news updates • Use the planner to stay organized• Access valuable Resources

If you already have a myRNU account, simply go to the App Store or Google Play and download the myRNU app. To sign up for a myRNU account, visit rnunl.ca. The member verification process may take a day or two.

There’s an App for That!Stay Connected. Download the myRNU App.

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RNU Bids Farewell to Staff Lawyer David Conway

It’s been a highly successful and memorable ride for Staff Lawyer David Conway, but the time has come to say good-bye.

David recently accepted a new position as the Chairperson of the Labour Relations Board. He will begin his new job in August.

David began working for RNU almost 15 years ago on November 18, 2002. Since that time he has been an enthusiastic and invaluable component of the RNU team. He began working for the union as a temporary LRO, but seized the opportunity to become the staff lawyer when the position became available.

“I have thoroughly enjoyed my time working for RNU,” said Conway. “It has been a privilege to work directly with RNU members to resolve labour relations issues.”

As the staff lawyer at RNU, David was primarily responsible for legal guidance with regard to significant labour relations issues, as well as providing overall strategic legal direction to the organization and its membership.

David has accomplished a lot in his time at RNU, a highlight of which was arguing a case on behalf of RNU in the Supreme Court of Canada, a very prestigious and rare opportunity.

“Working closely with Debbie (RNU President) and John (RNU Executive Director) as well as the rest of the RNU staff has made my time working for RNU an incredible experience.

I will look back fondly at my time at RNU,” reflects Conway.

It is bittersweet for all of us at RNU who must bid adieu to David. He will be greatly missed, but we are very proud of his success and wish him all the best! Congratulations, David.

SIGN UP ON myRNU myRNU is a website & app just for registered nurses. By signing up for an account, you can access education information and keep up-to-date on nursing & union issues. You can also connect with fellow registered nurses in the discussion forum – to share ideas, ask questions, and learn about things happening across the province. rnunl.ca

SEE YOUTHERE!

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Spreadsheet Helps Branch 13 Track and Streamline Professional Practice ProcessTo say that RNs at Branch 13

(St. Anthony) have struggled with

high workload and staffing would

be an understatement. The lack of

a casual float pool, combined with

short staffing of full-time RNs, means

there is often no RNs available to

cover shifts when someone is sick or

patient demand is high. As a result,

sometimes an RN finishing a 12-hour

shift can be mandated to work for a

full 24 hours.

“The majority of our issues revolve around the short staffing of full-time RNs,” said Branch 13 President Marina Davidson. “Although, like many worksites, we have a variety of issues that extend beyond staffing alone such as lack of security.”

Workload and patient safety is a top concern for RNs at Branch 13, ensuring that patients receive the highest quality of care is paramount. The occurrence of 24-hour shifts and other professional practice concerns has fueled RNs and the Professional Practice Committee (PPC) in St. Anthony to look at new and innovative approaches to help resolve practice and patient care issues.

Beverly Simms is the Region 2 Representative on the RNU Board of Directors and works in St. Anthony. Throughout her career, she has taken an active role in the professional practice process at her branch.

Simms knows how important it is to track professional practice issues and ensure issues stay on the PPC agenda as they move through the resolution process. She credits the HR team at Labrador Grenfell Health for making this task easier by creating a new spreadsheet to track and organize professional practice forms. This spreadsheet has been instrumental in driving the work of the PPC.

“It has greatly improved the committee’s ability to document, organize and resolve professional practice issues in the workplace,” said Simms.

When a professional practice form is submitted, it is registered in the spreadsheet. The date and the name of the RN who submitted the form, as well as their workplace location, is recorded.

The professional practice issue is then coded based on a number of categories such as workload and skill mix. Once the issue is categorized, a colour code is used to identify whether the issue is waiting to be reviewed, under review, or resolved.

The use of categories and colours allows for all forms to be easily organized and tracked. It’s significantly helped the committee keep sight of all professional practice issues and has improved the resolution rate.

In addition to the spreadsheet, a few other techniques have been adopted to keep the committee’s work moving along. Branches often report to RNU that PPC meetings are cancelled because the required representation is unable to attend from either the union or management side. To ensure meetings always go ahead, the PPC has begun the process of assigning a substitute. If a committee member

Professional Practice Success Story

Some members of the Professional Practice Committee (left to right): Rita Reardon, RN; Bev Simms, RN; Rhonda Green, RN; Jennifer McGrath, RN; and HR Manager Angela Hedderson

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Professional Practice Success Story

cannot attend a meeting, an alternate is assigned. This means meetings go ahead as scheduled and the committee maintains its momentum.

Due to the small size of the branch, the PPC has also begun the practice of inviting the RN who submitted a professional practice form to attend the PPC meeting when possible. This allows the RN, or a designate from the unit, to explain the issue in person, often providing further context and clarity than what was given on a form. Simms and Davidson feel this has been an effective and valuable technique for the committee.

Together the PPC members are working to make a difference for RNs in St. Anthony. One of the big successes that’s come out of the PPC’s work is the creation of guidelines for 24-hour shifts. The guidelines set out steps to alleviate the stress of having one staff member cover the whole shift. The guidelines include measures such as:• Split the shift between two staff, i.e. one staff member stay on until midnight allowing the other to go home to rest and come back at midnight. • Staff member coming on next shift to come in early to start shift at 6am instead of 8am, thereby allowing the RN working an extended shift to go home at 6am.

Having the day RN come in at 6am means the RN who is working an extended shift is not required to dispense morning medications to patients. This measure helps ensure medications will be administered

correctly and reduces the chance of error due to exhaustion.

Simms and Davidson agree that employer support has been vital to the success of the PPC in St. Anthony. While employer buy-in to the professional practice process can sometimes be challenging, Branch 13 is fortunate to have employer representatives, such as HR Manager Angela Hedderson, who are fully committed to the process of issue resolution.

The PPC is doing great work and moving in the right direction. Branch 13 continues to face its fair share of issues. Like many rural sites, the challenge of staffing is constant. Due to a lack of dedicated staff, RNs also have concerns for security.

As RNs know all too well, the majority of professional practice issues take time to resolve. Filing a professional practice form is a key step because it puts an RN’s concerns on paper and serves as documentation that an issue exists. A submission of a form may be used in defense of a RN if they are forced to care for patients in what they deem is an unsafe environment. Furthermore, it puts pressure on the employer to act.

“The issues we are faced with are so complex that they cannot be resolved overnight,” said Simms. “Filling out a form and submitting it initiates a conversation between the union and management. The conversation is the beginning of issue resolution.”

Professional practice issues will always come up. That is certain. It’s also certain that the PPC in St. Anthony is well poised to take on these issues, and to bring about positive change for RNs and patients alike.

Branch 13’s Recipe for Success• Developed a spreadsheet to organize & track professional practice forms and progress • Began assigning substitutes to attend meetings when regular PPC members cannot attend so meetings aren’t cancelled• When possible, RNs who submit professional practice forms attend PPC meetings to speak about an issue in person • RNs use the RNU Professional Practice Toolkit as a point of reference • Employer and Union actively participates in the PPC• HR attends meetings and mediates the process to ensure consistency and fair representation

What Was Achieved• An active and effective PPC with a formalized process that is resolving issues in the workplace • Spreadsheet tracking system ensures issues are not overlooked• Guidelines developed for 24hr shifts• RNs have bought into the professional practice process and regularly complete forms when issues arise

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The Ontario Nurses Association, and the Canadian Federation of Nurses Unions, and its member organizations, including RNU, are very pleased to support the work of the Stephen Lewis Foundation (SLF) with a commitment of $135,000 per year for the next three years. This initiative is part of CFNU’s commitment to international solidarity efforts.

“We’ve never received such a large contribution from any individual trade union before, it’s extraordinary,” said Stephen Lewis. “The contribution you make will alter the lives of tremendous numbers of people.”

The SLF works with community-based organizations to fight the pandemic of HIV and AIDS in Africa. The foundation was founded in 2003 and has funded over 1,400 initiatives, partnering with over 300 community-based organizations in 15 countries.

Since the very beginning, SLF has relied on the support of Canada’s labour movement. From funding special initiatives to general unrestricted funds, the support, solidarity and commitment of

our movement has had, and continues to have a profound impact on communities across sub-Saharan Africa.

The commitment from Canada’s Nurses will support two projects with a particular focus on health care and health human resources: The Panzi Hospital Mobile Outreach Clinic and Blood Bank in the Democratic Republic of Congo and the Swaziland Nurses Association’s mobile clinic.

The role of nurses in supporting health care in developing countries is crucial. In a thank you message, Stephen Lewis reflected on the commitment of nurses which he witnessed timeand again during his work as the Special Envoy for HIV/AIDS. He said, “The one group, the one profession that was holding together the clinics, the hospitals and the communities were the nurses.”

Stephen Lewis thanks Canada’s Nurses: http://bit.ly/SLFNurses

Canada’s Nurses Team Up to Support the Stephen Lewis Foundation

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Violence in the Health Care Sector - It’s Not Part of the Job!Violent incidents in health care

settings are occurring more

frequently. Registered nurses are

not immune, and in fact, they are

just as much at risk for violence in

the workplace as those who work

in corrections and law enforcement.

In Newfoundland & Labrador,

assaults and violent acts have

increased 96.9% since 2012 in

the health care & social services

industry (hospitals, nursing homes,

social services, day care services,

physicians’ offices, and health and

community services).

Exposure to violent incidents in the workplace can negatively impact someone’s personal and professional life. Over time, cumulative experiences can lead to post-traumatic stress disorder (PTSD), depression, anxiety, burnout, and absenteeism.

What do we know about violence in health care? Several nursing unions have assessed violence in the workplace, but at different times, using different methods, and across different sectors. Therefore, it’s difficult to assess trends and establish worthwhile comparators.

Recently, the Canadian Federation of Nurses Unions (CFNU) and Vector Polling surveyed unionized Canadian nurses about violence in

the workplace. The survey findings give us a snapshot into what our RNs are experiencing. This data combined with other statistics and research help paint a more updated picture of violence in health care.

Compared to other Canadian nurses, RNU members underreport violent incidents. Just over half of RNU members have reported the most recent violent incident to their managers/supervisors (53%), followed by union reps (16%), security staff, (15%) or police (3%). This means a significant number of incidents are unreported, and leaves us with a vague picture of the reality of RNs’ experiences with violent incidents. The CFNU/Vector Polling revealed that in the past 12 months RNU members reported serious problems at work, including bullying (32%), verbal threats or abuse (32%), harmful or malicious gossip

or ridicule (23%), or hitting/physical assault (22%). Overall, these rates are on par with the rest of Canada.

It is important to consider where the abuse is coming from in order to recognize where resources need to be developed for prevention. Patients are most often cited as sources of abuse (60%), followed by coworkers/employees (53%), or a patients’ spouse, partner, family member, or someone in their household or in relationship with the patient (36%).

There are many factors that contribute to violent incidents in the workplace. This includes the type of care setting where you work. For example, RNs who work in emergency, psychiatry, or long-term care are often most vulnerable to incidents of violence. Other factors that contribute to violence in the workplace include: • Inadequate staffing, increased

Education Corner

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Education Corner

workload, poor quality work environments• Poor security or physical environment, poorly-placed patients• Accepted as part of the job, incidents and near misses have become normalized• Lack of clear policies & enforcement• Working in isolation• Domestic violence flowing over into in the workplace

Violent incidents in the workplace can have a domino effect on the individual RN, the nursing profession, and patient care. Across Canada, even when compared to police and correctional officers combined, health care workers experience more than double the number of incidents that result in time lost at work related to violence.

Overall, those working in the health care and social services industry lose more time at work than the average worker in NL. In fact, registered nurses (13%), LPNs (18%), and PCAs (20%) make up 51% of all lost-time claims in this industry (Workplace NL, Health Care & Social Services Industry Facts, 2016).

Violence (or threat of violence) plays the largest role in the development of PTSD in nurses. PTSD is twice as common in women as men and the nursing profession is predominantly female. It would stand to reason that we should expect PTSD to be higher in nursing than other male-dominated professions. Despite the evidence, nurses have been excluded from new presumptive PTSD legislation in many provinces. We do know, however, that approved

claims for mental health injuries are increasing for frontline workers (including RNs) and police, firefighters, and corrections. But we cannot become complacent, and must continue to advocatefor inclusion.

What can be done to put a stop to violence in health care?At the individual level, RNs can: • Join in efforts to increase awareness about violence against nurses• Adopt zero tolerance• Be aware of risk factors for violence and how to mitigate them • Report all acts of violence, including verbal abuse and near misses• Ensure violent incidents are reported to proper people, including managers/supervisors, union reps, security, and police • Use the Professional Practice process to document issues regarding patient and/or RN safety

CFNU and provincial nurses’ unions commit to: • Advocate to

strengthen

and improve OH&S legislations to create safe workplace standards for health care workplaces• Advocate for consistent enforcement of OH&S legislation and consistent

reporting, as well as strong language around the prevention of violence & bullying in health care workplaces• Lobby for changes to provincial and federal legislation regarding criminal charges for patients who assault nurses • Advocate to streamline provincial services around the development and implementation of risk assessments, education, training, and emergency preparedness• Lobby to include health care workers and physicians in the PTSD presumptive legislation framework federally

CFNU released a discussion paper, Enough is Enough – Putting a Stop to Violence in the Health Care Sector, at its biennial convention in June. The paper calls on governments, employers, unions, and frontline nurses to take a more comprehensive approach to end the violence in health care. Check out the full report on CFNU’s website: www.nursesunions.ca.

Enough is Enough: Putting A Stop toViolence in the Health Care Sector

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Serving up Information at MHA Breakfast:Political leaders learn about safe RN staffing

On May 16, RNU hosted provincial MHAs for an early-morning information session on safe RN staffing.

Eighteen MHAs and various other stakeholders started their day with this important breakfast event and heard from Mike Villeneuve, a nursing leader well known across Canada for his work in health system policy and the future of nursing.

The goal of this breakfast was to provide MHAs with real evidence on the importance of safe staffing and present nursing research that clarifies just how valuable RNs are to the health care system.

“We were able to demonstrate the need for safer staffing practices in order to ensure positive health outcomes and a more fiscally responsible health care system,” said RNU President Debbie Forward. “Through the vast compilation of nursing evidence it was made very clear that there is a direct correlation between RN staffing and a healthy health care system.”

MHAs were encouraged to consider the communities they represent in the House of Assembly and how safer RN staffing levels can help improve health care for these residents and the system as a whole.

Armed with this new information, MHAs are better prepared to hear concerns from their constituents and work with the Regional Health Authorities and government members to effect change.

In addition to presenting at the breakfast, nursing and health policy expert Mike Villeneuve also met privately with former Finance Minister Cathy Bennett and Health and Community Services Minister Dr. John Haggie. Events like the MHA Breakfast help RNU ensure our message is heard and clearly understood; it allows us to give the information directly to those who make the decisions and influence change.

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The MHAs were receptive to the information and showed a genuine interest. The event garnered significant media attention. Having a third-party expert like Mr. Villeneuve on board was and is extremely helpful.

THE RESEARCH AT A GLANCEThe research presented by Villeneuve, which includes a review of over 50 national and international studies, reiterates that RNs have the in-depth knowledge, skills, and judgement that make them a vital profession in our health care system.

The presentation highlighted that when there are safe RN staffing levels and healthy work environments, patient outcomes improve and the cost to deliver health care decreases.

Highlights:• When RN staffing is low, length of stay and adverse events are higher than they need to be• Every year Canadian patients spend more than 1 million extra days in hospital being treated for injuries or complications from their hospital care, which can be prevented with better RN staffing levels• Registered nurses are highly educated, self-regulated, and highly trusted by the public• When staffing is low, registered nurses may not have the time, training, or experience to carry out their work in a manner that allows for efficient and effective delivery of care• For every surgical patient added to the average RN workload, the risk of patient complications and death increases by 7% • One person dies in Canada every 17 minutes as a result of adverse events suffered during acute hospital care • The way registered nurses are educated, regulated, deployed,

employed, and rewarded has significant effects on individual safety, organizational effectiveness, and system costs

The information that came from this presentation is valuable and can help RNU as we work hard to fight for better work environments for RNs and safer health outcomes for the people of Newfoundland and Labrador.

THE CALL FOR ACTIONAs a first step in establishing safe RN staffing, RNU has called on the provincial government to complete a core staffing review. This staffing review will examine the number and types of health care providers currently working in the system.

The last review was done over 16 years ago. It’s time to revisit this and evaluate staffing levels. Since the last review, our population has continued to age and health care needs have become more complex. There has been an outcry from the public to see improvements in health care and this review would be a step toward positive change.

“Cutting the number of RNs is not the way to save money; quite the opposite,” said Forward. “The research shows that. Now that we have given our government this information, a review will further reflect that we are not staffing our facilities adequately. We believe a review is the next step to a better health care system for the people of NL and a better work environment for RNs.”

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Understanding Your Contract

Step Progression (Schedule A) & Experience Credits (Schedule B) BY DAVE CONWAY, STAFF LAW YER

This article explains how and when experience is used to place a registered nurse on the appropriate step scale of the Provincial Collective Agreement.

Step Progression & Experience Credits are the elements of your contract that are used in determining the step scales. This article provides an interpretation of this contract language.

Step Progression is contained within Schedule A (page 95) of the Collective Agreement and Experience Credits are outlined in Schedule B (page 105).

You can also read the contract language by looking up “Step Progression” or “Experience Credits” in the Agreement section on the myRNU App or website.

COLLECTIVE AGREEMENT INTERPRETATION

Experience Credits now work on a “one for one” premise. That means that, upon hiring, a registered nurse is asked to provide proof of his/her experience and is then placed on the salary scale in accordance with her/his full-time equivalent years of registered nursing experience.

Registered nurses with less than two (2) years’ experience are placed on step one; registered nurses with two (2) years but less than three (3) years of experience are placed on step 2 of the salary scale, and so on. The maximum credit is afforded to registered nurses with six (6) years or more of full-time equivalent registered nursing experience who are placed on step 6 of the salary scale.

Experience Credits are initially applied when a registered nurse is hired with an employer covered by the Collective Agreement. It is possible, however, to

move up another step on the salary scale soon after hiring. For example, a registered nurse who is hired full-time on step 2 of the salary scale with two years and 11 months of experience, can advance to step 3 on the salary scale one month later because s/he qualifies for the Experience Credits

equated with step 3. At this point, the registered nurse qualifies for step 3 because s/he has three years of experience. After that, this registered nurse will advance on the salary scale one year later for step progression purposes, until the maximum of step 6 is reached.

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Experience is defined in Article 2.01 (h) as: Time worked as a registered or graduate nurse where such work is acceptable for the purposes of obtaining and maintaining an active license to practice nursing.

In order for an employee to receive credit for any past experience, s/he must make every reasonable effort to provide written documentation from her/his previous employer(s) to her/his employer outlining the length and type of experience worked.

Service Credits work on a “one for one” premise as well. That is, for each full-time year of service (1950 hours or 1820 hours for Public Health registered nurses), a registered nurse shall advance one step on the salary scale until s/he reaches step 6. Registered nurses working part-time will take longer to advance on the scale. Once a part-time registered

nurse accumulates the qualifying 1950 hours (or 1820 for PHN’s), s/he will advance to the higher step.

Registered nurses transferring or resigning to take a position with another employer in the province can avail of the Transfer and Portability clause contained in Article 38.01 (page 79) of the Collective Agreement which states: “An employee transferring in good standing between hospitals covered in Schedule “C” or an employee who accepts employment in a hospital within one hundred and twenty (120) days of the resignation date from another hospital, shall retain the following benefits … service for step progression …” (Registered nurses hired on a casual basis are exempt).

Also, if re-employed after termination, Article 38.02 allows a registered nurse to be placed on her/his respective

salary scale on a step not lower than the step s/he was on at the date of termination provided that s/he has not been out of the employment of the employer covered by the Public Service (Collective Bargaining) Act for a period of more than two (2) years (casual registered nurses are exempt from this article).

If employees have any questions about the step that they are presently on, they should approach a shop steward and set up an appointment to review their payroll records. If not satisfied with the response, they should contact their Labour Relations Officer at their union office for assistance. This information is provided for internal RNU education purposes only. It does not represent the official position of RNU and is strictly “without prejudice” to any formal position whatsoever that RNU may choose to take in proceedings, legal matters, negotiations, or otherwise.

When a registered nurse becomes ill or is injured at work, we usually think about how the illness or injury will impact the RN.

In many cases, a disability will affect their overall quality of life, which can cause a strain on family, friends, and co-workers. It’s also possible the injured RN may incur

financial hardship due to lost wages and benefits.

One in seven Canadians aged 15 years and older reported a disability in the Canadian Survey on Disability in 2012. That’s 3.8 million Canadians who were sometimes or often limited in their daily activity due to a disability. There are many forms of disability – acute or

chronic, physical, mental or cognitive. Disability can impact anyone, at any point in their lives.

Everyone has the right to equal opportunity and full participation in the workplace. RNU is firmly committed to doing its part in working with employees and employers to support

Continued on next page.

The Duty to Accommodate RNs with a Disability

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members who are impacted by an injury or illness.

The Duty to Accommodate provides a means by which disabled RNU members can return to work and/or have a disability accommodated within their workplace.

Duty to Accommodate stems from human rights legislation stipulating that employers may not discriminate against a worker based on a disability.

Human Rights Commissions and court decisions make it clear that both the employer and RNU have an obligation to accommodate disabled RNU members in the workplace. To refuse to do so could be deemed a violation of the Human Rights Act, as discrimination in employment based upon a disability. Employers, as well as RNU, can be held accountable for failing to accommodate union members with a disability.

Generally, Duty to Accommodate situations arise when an RNU member is unable to perform certain duties associated with his/her position because of a disability. The Human Rights Act defines, in general terms, what may constitute a “disability.”

Once notified of the need for an accommodation due to a disability, the primary onus is on the employer to accommodate RNU members up to the “point of undue hardship.” The employer should assess that person’s current position in order to determine if modifications and/or adaptations can be made that will accommodate his/her

disability. That person’s own position must be examined first before the employer considers alternate options.

Initial discussions regarding accommodations should involve the employer, a local RNU branch member, and the disabled employee. The employer is responsible for communicating to co-workers the implementation of an agreed-upon accommodation. The failure to inform and educate other staff members about accommodations can result in unwarranted negative responses in the workplace.

The disabled RNU member is responsible for providing objective medical evidence that establishes the need for an accommodation based upon a disability. The medical evidence must identify specific work restrictions (i.e. what exactly the disabled member can and cannot do).

The employer must undertake accommodation of the disabled RNU member up to the “point of undue hardship.” The employer and co-workers should understand that the Duty to Accommodate: • Requires changes to the previous work routines of disabled RNU members;• Requires exceptions, where appropriate, to the otherwise clear wording of the RNU Collective

Agreement with the consent of the RNU Provincial Office;• Requires the cooperation and input of the disabled RNU employee;• Requires that accommodations be made even if there are consequences that lead to some degree of hardship or inconvenience to the employer, the RNU, or co-workers.

In most cases, the Duty to Accommodate a disabled RNU member does not result in undue hardships on co-workers. That said, RNU members affected by accommodations should address their concerns with the RNU branch president or shop steward. As mentioned above, the employer is responsible for advising staff that an accommodation will be implemented, as well as for explaining and educating staff about the Duty to Accommodate.

If an employer is not meeting its obligations to a disabled RNU member under the Human Rights Code, the RNU will assist that member in assessing and/or challenging the employer’s decision, as needed.

The Duty to Accommodate RNs with a Disability (continued)

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A Look Back at Nursing Week 2017

RNs from Canadian Blood Services in St. John’s (Branch 49) celebrate Nursing Week in style.

What a fine looking bunch - love the old-school touch! Happy Nursing week from Labrador Health Centre and Long Term Care Home, Happy Valley-Goose Bay!

Happy Nursing Week from Medicine at Dr. GB Cross!

Members of Branch 38, along with some retired RN colleagues, enjoy a night out.

Branch 20 (St. Lawrence) celebrates Nursing Week.

RNs across the province took time to celebrate & recharge.

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Emily Briand, RNEmily Briand is a young and energetic registered nurse, who has a passion for helping others and a desire to improve the health care system for Newfoundland and Labrador. She has been an RN for two years and worked in Long Term Care (LTC) for the past year. Emily currently works at Pleasant View Towers in St. John’s.

As an active and passionate RN, Emily is certainly a valued member of RNU and the health care community. She has a keen interest in ensuring patient comfort and well-being, and was recently awarded two Comfort in Care Awards by Eastern Health.

Originally from Mainland, Newfoundland, which is located on the western shore of the Port au Port Peninsula, Emily’s first language is French. She completed her nursing studies in Moncton before returning to NL. What do you like most about working in LTC? What do you like least?I like the expanded leadership position; giving direction to a team. I enjoy ensuring the residents are well-cared for. As well, in LTC I appreciate that I can walk into work knowing what I will be doing each day – there is a routine. While at the same time there is variety. It’s a unique environment that way. Can you give an idea of what a “typical” shift looks like for you?Sure. I receive a report from the outgoing RN, and then ensure safety checks were completed. After that I give my report to the incoming staff and determine the resident assignment. However, what I do next differs depending on whether it’s a day or night shift.

If it’s a day shift, I’ll collect samples for blood work or urines for analysis. Then I’ll make sure all necessary preparations are completed for appointments such as escort, paperwork, and medication responsibilities. After, I’ll prepare for doctor or nurse practitioner rounds. For example, if a resident’s insulin needs to be reassessed, I print out their glucometer

readings. I also put in requisitions when things aren’t working or residents need something installed. I attend to concerns of families and do ongoing assessments. I handle catheter, peg tube, and suprapubic catheter changes, take orders as they come in, update care plans, organize mid-shift huddles, and check trach cuff pressures. As one of the vent-trained RNs on-site, I respond when assessment is required to ventilator alarms; adjusting cuff pressure, usually.

If it’s a night shift, I do vent checks and vitals, then jump into the HS care. Then it’s checking the crash cart and oxygen tanks, entering blood work, preparing paperwork for appointments, writing out the shift report, preparing for doctor rounds, updating and printing the kardexes, doing cycle refill of medications, reordering stock medications, stocking up ventilator supplies, doing MDS assessments, completing unit stats, and checking MARs around the end of the month. Then there’s of course whatever other assessment come up. What makes LTC a unique work environment for an RN?There are other RNs in the building, but you’re the decision-maker on the floor. People suggested I could lose my skills if I went to LTC. However it’s quite the opposite. I’m now

Registered Nurse Spotlight

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ventilator proficient and I can do cough assist. I feel I have grown as an RN and really enjoy the LTC environment.

Can you tell me what you believe makes RNs so valuable to the LTC sector?Assessment is such an important function in LTC, which requires the knowledge and skills of an RN. In LTC, RNs are constantly updating the plans of care and making key decisions. Also, RNs are in a position to step back and do a thorough assessment when necessary. We’re always watching for risks that could result in negative outcomes.

Do you wear the white and black RN uniform?I do. I feel it’s important to be a part of the movement. Why is involvement in the RNU important to you?I find union involvement to be empowering. It’s so encouraging to hear that other RNs face similar issues and struggles that I may be dealing with in the workplace. It means a lot to know that others react the same way to the challenges of today’s workload. Furthermore, I love having the tools to try and improve the workplace.

I’m a much better patient/resident advocate since getting involved with the union and I feel better about myself as a person. Congratulations on your recent Comfort in Care awards!The Health Care Foundation gives out grants for items that can bring comfort to our patients/residents every year. When I learned of the grants program I felt I had to apply. The residents on my floor are cognitively well. Leisure activities are important for many reasons, including promoting mental health and even pain management. Thankfully, my application was chosen and we received two grants, to be used to purchase board and video games. With these comfort supplies, I hope to further improve quality of life for our residents.

To nominate someone for our next RN Spotlight, please email Communications Specialist Karyn Whelan at [email protected].

Moving? New Email Address?

Please contact RNU if you move or change your email address. We’d like to keep you informed on issues that matter to you. Email [email protected] call 753-9961 to update your information.

Registered Nurses’ Union Newfoundland & LabradorBoard of Directors

Debbie Forward, RNPresident

Yvette Coffey, RN Vice President

Wendy Dale Woodford, RNSecretary-Treasurer

Ashley Jones, RNRegion 1 (Branch 14, 15)

Beverly Simms, RNRegion 2 (Branch 13, 18, 26)

Mike FaganRegion 3 (Branch 11, 40, 41)

Jean Aucoin, RNRegion 4 (Branch 12, 23, 24, 46)

Quinton Hewlett, RNRegion 5 (Branch 9, 32, 33, 38, 43, 45)

Nancy Healey-Dove, RN, NPRegion 6 (Branch 8, 17, 25, 42)

Mark Aylward, RN, NPRegion 7 (Branch 10, 20, 21, 30, 36)

Niki Parsons, RNRegion 8 (Branch 16, 28, 29)

Rosalie Gillis, RNRegion 9 (Branch 5, 34, 35, 37, 47)

Miranda O’Driscoll, RNRegion 9 (Branch 7, 31, 44, 48, 49)

Tony Moores, RNRegion 9 (Branch 2, 3, 4)

John Vivian, QCExecutive Director (non-voting member)

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