To the editor,
On Jan. 20, over 200 nurses, members of the nearly 7,000 strong Nova Scotia Nurses’ Union (NSNU), met in Truro to discuss contract language that will ensure that staffing shortages that have dogged the health care system for decades happen less often and that the gaps that exist are filled by the right workers.
With existing staff shortages, particularly in specialty areas, and the looming retirement of 800 RNs over the next five years, accommodating vacation requests, sick time and leaves of absence (like maternity and parental leaves) sometimes becomes an exercise in futility, and overtime scheduling is often the only resort .
The NSNU, in conjunction with counterpart provincial nurse unions across the country, has for many years been exploring ways to address the problem of excessive workloads that threaten the safety of patient care and the working conditions of nurses. In September 2012, the Canadian Federation of Nurses Unions safe staffing campaigns culminated in the book Nursing Workload and Patient Care, co-authored by NSNU Researcher, Educator, and Government Relations Advisor, Dr. Paul Curry, and nursing policy expert and acting Dean of Nursing at the University of Saskatchewan, Dr. Lois Berry. The book reviews decades of research that clearly demonstrates the relationship between the amount of nursing care a patient receives and her health outcomes, including mortality rates, medication errors, shock and cardiac rest and a host of other morbidities. The lessons could not be any clearer – nursing care improves and saves lives.
In October 2013, the NSNU became the first nurse union in Atlantic Canada to negotiate a workload process that includes the use of an Independent Assessment Committee (IAC). When a disagreement about the ability to provide safe patient care cannot be resolved between a nurse and the employer, the matter may be referred to an IAC that makes recommendations on improving the work situation. This process gives nurses a strong voice and input into how best to resolve staffing problems given their front line, first-hand experience and expertise.
IACs were chosen as the primary vehicle for addressing nurse workload for a number of reasons. In the first place, they are designed to deal individually with each situation and are therefore adept at addressing the various settings our nurses work in, from large tertiary hospitals to remote health clinics. Members of the Nurses Union believe it is extremely important to recognize and account for this workplace diversity. Second, and relatedly, a committee can adequately assess and respond to the nuances of a work situation – the education and experience level of staff, the other health care workers present and so on. Most importantly, IACs were chosen because they have been tremendously successful for our sister nurse unions in Ontario, Manitoba, Saskatchewan and British Columbia. A recent IAC considering a problematic emergency department in a large Ontario hospital, for example, served as a basis not only for increasing core nurse staffing, but also for improving and enhancing the education and training of staff on the unit, updating equipment, improving safety measures and protocols, increasing the use of ward clerks and other personnel to relieve non-nursing duties and much more.
Safe staffing language is not a panacea for all that ails the health care system, but it does enable nurses to identify and report problems, and it allows the union and employers to track issues and seek resolution at the appropriate level of authority. IACs do not presume that nurses work in isolation, nor that the number of nurses alone is at the root of all workplace issues. Experience has shown that this process can address problem areas in a thorough and well thought out fashion.
The NSNU, in collaboration with its nurse union counterparts across Canada, is pleased to take a leadership role in an initiative that will benefit nurses and patients alike.
Janet Hazelton, RN, BScN, MPA
President, Nova Scotia Nurses' Union