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March 2018

Regina Young, NLNU

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Regina Young, NLNU

Regina is an operating room nurse, in charge of the orthopedic service. Married for 31 years, she has a 29-year-old daughter who lives in Qatar. Regina likes to sew, read, and do crafts. She and her husband enjoy camping and, their newest hobby, riding their motorcycle.

As an operating room nurse in central Newfoundland and Labrador, I’ve seen how non-nursing duties impact how we perform our nursing jobs, including taking us away from providing patients the nursing care they deserve. Fortunately, I’ve also seen the benefits of reducing those non-nursing duties requirements as well.

About ten years ago, the NLNU initiated a Code of Conduct that saw nurses stop performing specific non-nursing duties, such as stocking supplies and cleaning cupboards. In a busy operating room, these were very time-consuming tasks. As a result of that initiative, our employer hired additional support staff to relieve nurses of these duties and enabled us to focus on nursing care.

Over the last number of years we have seen the non-nursing duties expected of nurses increase again, particularly as staffing shortages have affected many healthcare professions. Despite the growing nursing shortage, nurses seem to be the ones expected to fill in the gaps and take on the extra duties. To alleviate this growing workload during our own nursing shortage, our union initiated a non-nursing duties campaign this past fall. This campaign has once again empowered nurses and improved our workplace.

Our manager has supported nurses throughout the campaign, which has strengthened our working relationship with her considerably. We have had some of the non-nursing duties transferred to other support staff, which has improved the overall function of the OR. For example, the pharmacy technicians now consistently check for outdated drugs on anesthetic carts, which nurses had been doing whenever we weren’t busy. The SPD department has increased its hours of operation to decrease the emergency cases we have to pick up after hours. Collectively, by working with our manager and our colleagues we have improved the efficiency of our unit. Our campaign is evidence that teamwork is a powerful advantage in any healthcare setting.

“Initiating the non-nursing duties campaign was extremely important for increasing our employer’s awareness of the amount of time nurses spend doing work that can be capably and efficiently handled by other healthcare employees. As nurses, we often take on these additional duties without realizing how much time it takes us away from our patients, and by taking that time back and engaging the healthcare team, we can all provide better patient care.”

Jill Ross, ONA

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Jill Ross, ONA

A primary nurse, Jill currently works in the ambulatory oncology unit. She also works in the “stretcher bay” where a lot of procedures are undertaken to look after patients coming from other facilities. Jill has worked in pediatrics for about 12 years, the ICU and CCU as well as in-home nursing care in the community.

After 34 years of nursing, what keeps Jill Ross motivated as an oncology nurse for southwestern Ontario’s London Health Sciences Centre?

“I love the patients. They have such hope and are very brave,” says Ross. Ross cites the opportunity to learn and ability to lead and make decisions around her patients’ care as some of the most rewarding aspects of her work.

“Currently, the position I have allows for a lot of autonomy. And oncology is such an interesting disease site. I really love palliative patients and what you can provide for their families. It gives me a lot of satisfaction,” says Ross.

Ross says the relationship between staff and management at her facility hasn’t always been positive. Several years ago, Ross’s hospital saw an increase in safety issues on inpatient mental health units, where nurses were at risk of injury from violent patients.

Although the nurses had taken their issues forward, they weren’t getting very far – until the day an orderly was nearly strangled by a violent patient. A nurse saved the orderly from death.

“We went to the media to publicize our concerns, and for months tried to get safety improvements. But we had to start really tracking incidents and getting nurses to report episodes of violence,” says Ross. “Our new Chief Operating Officer recognized the gaps and organized a Violence Prevention Committee and a Health Organization Team – HOT. He made sure ONA members were on the committees, along with other union reps. He understood we had a big problem. He began calling every employee that had been assaulted, verbally abused or whatever, and he called every nurse. He found out nurses were not only physically hurt, but were questioning their skill as nurses. That was profound for him.”

Ross says the nurses are coming forward a lot more now to report violent incidents or problems.

“We’ve done a lot of educating and more and more occurrence reports are coming in. We have about 90 to 100 incident reports a month, including injuries, and most of them involve nursing,” says Ross.

There are also trained ONA health and safety reps on site, as well as a Professional Responsibility Committee of ONA members.

“With 200 vacancies at my facility, workload is a problem. We see a lot of overtime and sickness,” said Ross. “I think our HOT Team will be very helpful in that regard.”

Sandra Brayer, UNA

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Sandra Brayer, UNA

Sandra’s been nursing for 20 years and for the last several she worked a straight night shift as a float across medical and surgical units at the University of Alberta Hospital in Edmonton.

Sandra Brayer is one of the first nurses to take advantage of the new “weekend worker” shift recently negotiated in Alberta.

“I work a 0.8 (full-time equivalent FTE) but I get paid full time. It’s been nice,” Sandra says. “I went to the weekend worker job to try out a day-evening shift schedule,” she says. I work four shifts, Friday to Monday for three weeks and on the fourth week, I just do three shifts. You get paid for an extra shift each week,” is the simple way Sandra explains it.

She says the Grey Nuns Hospital where she’s taken the new job is always short on weekends, and even with two other weekend workers, there’s always been lots of gaps to fill.

But, she says “the toughest part has been working every weekend.” Sandra has two kids, and not having time to spend with her teenage daughter on weekends has been difficult. Now with summer coming and people heading out for recreation on weekends, Sandra really wonders about working every weekend. She says it might work better for parents of young children or couples who are juggling daycare.

But this week she did have four straight days, Monday to Thursday, off. “I get all my stuff done during the week when other people are working.”

 

Cathy Kyle, SUN

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Cathy Kyle, SUN

Cathy has been a nurse for 31 years. She works at the Regina General Hospital. She has held many educator roles over the years for both patients and nurses. For the last 28 years, she has worked in Critical Care. Her focus in the last 14 years has been cardiology and patients with cardiac diseases.

The theory is a simple one: Allow nurses to spend 20 percent of their time at work in education and professional development, and 80 percent in regular nursing duties. Encourage them to focus their attention on patient care. This was the basis of the 80/20 Human Becoming study introduced to nurses on the Cardiosciences Unit in Regina’s General Hospital in March 2006.

As part of the study, participating nurses received 24 hours of education each month. Classes were initially three hours in length and repeated to accommodate nurses’ rotations. The first 12 weeks focused on learning the Human Becoming theory. In addition, some time was given to nurses to reflect on their personal practices and deal with issues happening on the unit. They could share experiences and talk about patient care.

Cathy Kyle, project leader, was very impressed with the Human Becoming theory because of its emphasis on the patient. In a very short time, she saw a change in the nurses as they adapted their learning to their work.

Kyle would like to see the 80/20 Human Becoming model integrated into more work areas. “Outcomes are very positive when you offer nurses the opportunity to learn while they’re at work,” explains Kyle.” They feel valued and encouraged to participate in things they otherwise wouldn’t have the opportunity to do.” Some nurses were inspired to start their baccalaureate prep because they had 24 hours a month as paid time for education. Others used the time to attend conferences or participate in health region education programs. The 20-percent education time also provided nurses with time in other departments. For example, if a patient was going to have a cardiac wall motion study, a nurse could spend a day in the nuclear medicine department with the patient and talk to the technicians to find out what that particular test would involve. Not only was this helpful to both patient and nurse, it helped inter-professional collaboration.

Researchers found there was a decrease in sick time, overtime and orientation costs (better staff retention). Qualitatively – the positive outcomes you can’t put numbers to – many patient stories expressed a noticeable difference, patients felt like the nurses were listening and felt safer in the care they were receiving.

“People assume all nurses do this [take time to listen to their patients’ needs],” comments Kyle. “Unfortunately, our healthcare system doesn’t always nurture or support that because of our [busyness on the job]. It’s been difficult sometimes to focus your care on the patient because you have so many interventions, so many different treatments, so many professionals involved. Focusing on the Human Becoming theory helps you to look at the patient as the reason you’re there… finding out what it is like for them and what they would believe would be helpful to them and trying to structure your care around that.”

While the actual study was completed in 2008, the Regina Qu’Appelle Health Region is continuing the 80/20 Human Becoming model on Unit 3F because it has realized the benefits to both nurses and patients.

Keeping patients at the center of care and providing nurses with the education to improve their skills is a winning combination for a healthcare system that is struggling to recruit and retain nurses.

 

Career pathways and support for education

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The availability of educational opportunities and the information and tools to seek, start and sustain a career pathway in nursing is critical. CFNU has called for the establishment of a $1-billion health education fund to support continuing education programs, nursing education programs and a bursary system for nursing students with guarantee return of service agreements. Innovative tools such as the CNA’s online portal – NurseONE – are key to helping nurses develop professionally by supporting continuing competence, education and career development. Visit www.nurseone.ca to find out how.

Health human resource strategies must include these career pathway supports as they assist nurses to access opportunities for movement into new areas of specialization, and even into management or leadership positions. CFNU’s applied research in this area (Workplace Skills Initiative – New Skills for Nurses: A Partnership Approach to Professional Development, 2005, and Research to Action: Applied Workplace Solutions for Nurses, 2008) is profiled here.

International recruitment of nurses

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CFNU has recently participated in a consultation on the World Health Organization’s development of a code of practice on the international recruitment of health personnel. This code addresses healthcare worker recruitment in countries experiencing a crisis shortage in their health workforce. CFNU also aligns itself with the principles endorsed by the International Council of Nurses’ Position Statement on Ethical Nurse Recruitment: fair labour practices, accurate disclosure, non-discrimination, objective grading criteria, access to education as well as induction and orientation programmes. Any recruitment strategy cannot be used alone as a means to rectify the nursing shortage. Recruitment can only succeed where retention efforts are even more of a priority. CFNU firmly believes that, despite the damage they cause, existing nursing shortages do not validate the recruitment of migrant health workers where a system lacks a solid foundation to support the retention of existing health workers and recruitment of domestic health workers. What do you think? Voice your opinion

Child care

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A career in nursing is 24/7 in nature, and child care is a significant challenge. Coverage of formal child care in Canada is patchy, even during more standard business week hours. We have heard from nurses across the country who cannot return to work after having children because of a lack of suitable child care options. Even for those who can find child care, if the situation is not ideal, this stress will manifest itself over the course of the workday. National leadership is needed to ensure that affordable and high quality child care and early education opportunities are available for all. Child care must be included within human resource retention and recruitment strategies. This is especially critical for already trained nurses who are needed at work, in hospitals, nursing homes, and in our communities.

CFNU proudly supports Code Blue for Child Care – a pan-Canadian campaign to build a public, non-profit child care system. Code blue means “medical emergency,” and working men and women, including many nurses, still need a national child care program to provide quality and safe child care. You can learn more about this campaign launched by the Child Care Advocacy Association of Canada (CCAAC) by logging on to www.buildchildcare.ca.

Layout of nursing units

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The layout of the unit itself has been shown to greatly impact the quality of the nurses work experience. Not only are proper ergonomics and adequate equipment critical to the maintenance of a healthy workplace, but the areas and way in which tools, meds, charts and information are placed play an important role. Research has indicated correlations between poorly organized work environments and negative patient outcomes. Research also suggests that changes in technology, unit organization and design would contribute to improvements in the use of nurses’ time and safer delivery of patient care.

Role overload and support for nurses

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A new study on role overload in Canada’s heath-care system (Duxbury & Higgins) confirms that health care workers are among the most stressed, overwhelmed and burned-out workers in the country. It showed that workers with supportive managers were the happiest and healthiest, most engaged, and have lower rates of absenteeism.

The study drove home the message that health care employers need to take care of their staff like they do their patients. (full article in Ottawa Citizen) 

What types of support could your organization provide to make you a happier, healthier nurse?

Or share an example that is already in place.

Manola Barlow, MNU

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Manola Barlow, MNU

Her role with the MNU is a great fit for Manola who, herself, loves to travel internationally and has had the opportunity to visit a number of different countries. During her spare time she also loves to play piano and make the most of our wonderful summers with camping trips and on long walks with her puppy.

The Manitoba Nurses’ Union (MNU) is reaching far beyond its provincial borders to help reduce provincial nursing shortages in hospitals and care centres. Internationally trained nurses are finding exciting new opportunities in Manitoba, and thanks to MNU-assisted programs, they are finding the cultural education, accreditation assistance and language training they need.

In her role as Diversity Coordinator with the MNU, Manola Barlow works directly with internationally educated nurses as they begin their careers in Manitoba. She meets with nurses to assist in evaluating their language and educational needs, as well as coordinating programs which offer information on Canadian culture, work place practices and more.

Barlow points out that having nurses from other countries and cultures can bring a whole new level to patient care. “To have the workplace reflect our diverse country is excellent,” explains Barlow. “If you have nurses that can talk to the patient in their first language, I think they can ultimately provide better care. As well, they know some of the cultural issues because they have experienced them first hand.”

For Barlow, it is satisfying to watch the dreams of many new nurses come to fruition after they receive the training and assistance they need. “Many nurses have expressed their thanks that we’ve been so supportive. Connecting people to the resources they need – not necessarily being all the resources – is very rewarding.”