Nurses Experiences

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 For example, the pharmacy technicians now consistently check for outdated drugs on anesthetic carts, which nurses had been doing whenever we weren’t busy.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.

 

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.

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.”

Sheila Ebbett, NBNU

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Sheila Ebbett, NBNU

Sheila is a general duty nurse at Dr. Everett Chalmers Hospital, Fredericton, N.B. Currently she works in the Post Anesthetic Care Unit while in the past she has worked in the ER and the General Surgery Unit. Sheila spends her off-work time parenting/coaching, playing hockey, golf, and in Union activities.

It was amidst the backlash of the “downsizing” and “rightsizing” of the early 1990s in New Brunswick that beginning practitioners entering the profession lost a precious professional lifeline. Squeezed out of the picture were direct supervisors such as head nurses or clinical supervisors, many opting, not out of choice, to contend with mountains of paper rather than coaching and mentoring young nurses entering the profession, as part of their everyday work.

Sheila Ebbett, a general duty nurse at the Dr. Everett Chalmers Regional Hospital, Fredericton, N.B., remembers the ripple effect of that void: “Young nurses were floundering and many journeyed a long way down the tubes before their deficiencies were recognized and addressed.”

“What was happening is that many new grads were not thriving. There wasn’t anyone to assess their day-to-day performance, recognize shortcomings, and propose supportive actions such as moving them to another area or reducing their workload,” said Sheila Ebbett.

So as a result of losing new recruits because they felt unsupported, the Dr. Everett Chalmers Regional Hospital, in 2000, introduced the concept of the “resource nurse” charged with supervising nursing care and contributing to performance appraisals. Senior nurses assume the role for a six-month period on a rotating basis.

“The resource nurse concept is working,” says Ms. Ebbett. “We’re picking up more people that need to work on certain skills or develop particular competencies. As a result, fewer new recruits are falling through the cracks. It’s also had a positive impact on retention,” she said.

“It’s not a perfect system. What I’m happy about is that the importance of our senior nursing leaders and their vital role in mentoring was recognized,” said Ms. Ebbett.

“I’m hopeful that further innovative ideas can be introduced to provide new graduates with an even ‘softer place to fall,'” she concluded.

Sara Dowe, NSNU

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Sara Dowe, NSNU

Sara Dowe, a nurse at Colchester Hospital, believes that if more hospitals provided on-site childcare, some recruitment and retention issues would be resolved, particularly for younger nurses. Apart from nursing and her family, Sara enjoys cross-stitching and reading.

The bright decorations, smiling faces of toddlers and pre-schoolers, and the warm atmosphere that greet you are telltale signs that Near to Me daycare is special.

As you learn more about the early beginnings of the daycare, and how it has evolved, you begin to understand how truly special it really is.

In March of 1990, the doors to this home-like daycare opened to children of employees at the Colchester Regional Hospital in Truro, Nova Scotia. The centre has since provided ease of access to healthcare workers whose shift work requires an untraditional approach to service. By opening at 6:30 am and closing as late as at 7:15 pm, Near to Me offers just that.

Located at the base of the slow rise that leads to the hospital, the non-profit centre is the brainchild of the hospital, and the Nova Scotia Nurses’ Union and CUPE locals. In the beginning, many employees of the hospital volunteered their time to help renovate the house that would eventually become the daycare.

Near to Me now offers care for 29 children per day, 60% of whom are children of nurses and other healthcare workers. More importantly, it provides much needed peace of mind for moms and dads, and a bonus for their employer.

Sara Hazelton is the Director of the centre which employs 8 workers. She says that studies have proven on-site daycare facilities offer benefits for both the employee and the employer. “On-site child care goes a long way to reduce tardiness and absenteeism. It reduces turnover. For parents, there are the obvious attractions — they know their child is near should anything happen. They are invested in the daycare on so many levels,” says Hazelton.

“I moved here from Halifax with two small children. Without Near to Me, I probably would not have been able to work. They offer space to hospital employees first. I was able to start work right away without a break in service,” says Dowe.

Dowe says that Near to Me takes the worry out of raising a family and working as a nurse, enabling her to concentrate on her patients and her job.

“I’ve been called into work at the last minute and in a panic, you rush out the door with the kids. Knowing that I can take my kids to a daycare on hospital property, have time to undress them and get them settled and not have to throw them in the door and run, is a big deal to me. The hospital daycare allows me to get to work without that regular morning stress so I can start my day on a positive note.”

Video

Hosp Daycare

Melanie Leckovic, BCNU

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Melanie Leckovic, BCNU

An Emergency nurse for over 30 years, Melanie is a Patient Care Coordinator at Burnaby Hospital Emergency and in her first term as Vice President of BCNU. She currently oversees the Repair the Care campaign which educates members on the impact of privatization on nursing workload and the importance of maintaining a public health system. Melanie is married with 3 grown children.

“The only way to make change is to first recognize you have a problem,” says Melanie Leckovic. “This seems so obvious but in a large structure like the healthcare system this often gets lost.” Front-line workers do not always realize that what is so obvious to them is not as obvious to decision-makers who work far away from the daily realities they control.

But there is a way to get the message across, says Melanie. “Here in BC we have a formal process to advise management of unsafe situations — the filing of Professional Responsibility Forms (PRFs). Each time we are faced with unsafe staffing, we document it and send it to the Assessment Committee which is comprised of representation from the union and the employer.” It is the purpose of the committee to “assess and make recommendations for unresolved work practice issues which impact nurses’ ability to provide safe, competent and ethical care.”

Following a period of being severely short-staffed in 2006, hospital ER nurses started using the PRF process. Two significant developments came out of this. “Each time they were short staffed to the point of potential risk to patients, the employer knew about it and had to accept some responsibility for that. This process was formal rather than anecdotal.”

“But the second benefit was perhaps even more important. The nurses knew things were bad. They all experienced it and everyone heard the stories. Like the night when there were 15 admitted patients to only one critical care nurse. The filing of these forms allowed the members to gather hard statistics.” Nurses collected information including the numbers of patients visiting the ER each day, admissions, length of stays, the numbers and skill sets of staff on duty. They ended up amassing a 500-page document of their findings.

“The employer could not ignore the solid evidence that things were getting critical,” said Melanie. After the report was issued, things began to change. “The unit saw more nurses, more support, and more resources.”

“It isn’t always convenient to fill in the forms, especially when you are under such pressure in the moment, but it is important to recognize how we can all make a difference. Change can happen,” Leckovic added.