MEDIA RELEASE: Nurses Win Personal Protective Equipment Settlement

2020-06-14 - Letter to Finance Minister

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Wednesday, June 17, 2020

Manitoba’s Nurses Support Legislation to Improve Long-Term Care

MATT AUSTMAN 32734 — Wed, 27 May 2020 23:51:04 +0000

Manitoba’s nurses are proud to support legislation introduced by the Official Opposition that will increase direct care hours and ensure safe staffing levels for long-term care residents, MNU President Darlene Jackson announced today.

“Manitoba’s nurses are proud to support this legislation which will increase direct care hours for our seniors and most vulnerable, and improve staffing levels in long-term care facilities,” said MNU President Darlene Jackson. “As our population ages, care needs are becoming increasingly complex, and therefore direct care hours must be protected by law to ensure all Manitoba seniors, regardless of income or location, receive high quality care.”

Bill 212, The Health Services Insurance Amendment Act (Personal Care Home Guidelines) would enhance care for seniors by enshrining existing guidelines into law, and require all long-term care facilities to meet or exceed the minimum standard. Moreover, the legislation would require facilities to report the number of direct care hours they provide to residents, and require the Minister of Health to be accountable for meeting the target of 4 direct care hours per resident per day.

The legislation echoes the recommendations of MNU’s 2018 report, The Future of Long-Term Care is Now, which reviewed best practices from jurisdictions across North America. The bill also establishes parameters for ensuring appropriate staff mix including nurses and other health care professionals. The bill is an updated version of legislation introduced in 2018, which dissolved on the order paper due to the early provincial election in 2019.

“The COVID-19 pandemic is a reminder of the importance of improving care standards for seniors, and requiring facilities to be accountable to the law,” said Jackson. “The tragic stories we are hearing from long-term care facilities across Canada are due in part to inadequate staffing and care standards. Ensuring safe staffing levels and direct care hours for all seniors is a critical step to prevent that from happening in Manitoba.”

MNU encourages all Manitobans to voice their support for this legislation by sending a letter to their elected representatives at www.putpatientsfirst.ca/longtermcare

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Nursing profession

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Wednesday, May 27, 2020

Nursing Week 2020: Nurses Must Advocate for Our Patients and Each Other

Michelle — Mon, 11 May 2020 17:25:33 +0000

Dear Members,

May 11 to 17 marks National Nursing Week in Canada. It’s a week to celebrate the work of nurses, and is particularly poignant this year as Manitobans continue to reel from the impacts of COVID-19.

As always, Manitoba’s nurses are committed to caring for their patients, and they demonstrate that commitment time and again when they stand in line to be screened for COVID-19, pushing their own fears and anxieties aside just to go to work. On behalf of the Manitoba Nurses Union, I want to say thank you for your courage and commitment.

As a nurse with 38 years of experience, I have been heartened by the acts of recognition and support emanating from the broader community. From postal workers driving by the Health Sciences Centre and The Grace Hospital in Winnipeg, to businesses donating goods and services to health care workers, the support from the community has been truly amazing and I also want to thank Manitobans for rallying behind nurses during these difficult times.

While the public support has been amazing, I would be remiss if I didn’t acknowledge that not all is well with the COVID-19 response to date. Many nurses don’t have the tools they need to do their jobs during this difficult time, and many more feel unsupported by the provincial government.

At times like this, nurses must advocate. And it’s important that we don’t simply rely on others to advocate on our behalf. Each nurse has their own voice, and each nurse has the ability to take a stand. One nurse speaking out can make a difference, but thousands of nurses standing together can be a powerful force to create the change we need in this province.

MNU has been advocating forcefully on your behalf, and we will continue to do so. But we need the help of individual nurses to make our collective voice louder and more powerful.

• SEND A LETTER at putpatientsfirst.ca

Thousands of nurses and supporters have already visited putpatientsfirst.ca to send a letter to government demanding action on a number of important issues. If you haven’t yet added your name to the call, please take a minute to do it today. We must not stay silent. Below are just a few of the areas where we have been speaking out recently.

Personal Protective Equipment

We remain deeply concerned about the state of Manitoba’s personal protective equipment, and the lack of transparency about PPE stocks from the Manitoba government and Shared Health. In addition to constantly changing, contradictory and often confusing guidelines on PPE use, we also know that Shared Health continues to scale back PPE requirements at a time when they ought to be enhancing them.

It’s time for the Pallister government to come clean about PPE stock levels. A reuse policy is a rationing policy, and both the WHO and the CDC note extended use should only be employed in a crisis situation. Further, nurses must be allowed to use their own clinical judgement about what PPE they need to safely treat patients. If rationing is taking place, then it’s time to bring nurses into the discussion.

Nurses must have adequate access to PPE. This issue must be resolved before we prepare for a second wave of COVID-19 cases.

Presumptive Workers’ Compensation Coverage

Last month, the province announced some limited measures for paid administrative leave for non-symptomatic health care workers forced to self-isolate due to exposure at work. However, as soon as nurses test positive for COVID-19, they face an uphill battle trying to prove that they contracted the virus at work, or WCB won’t cover them. It doesn’t make sense to penalize health care workers who develop symptoms.

Health care workers are putting themselves at risk to flatten the curve. That’s why we are demanding presumptive WCB coverage for all symptomatic health care workers. They shouldn’t have to worry about whether they will get paid if they get sick.

Personal Care Home Single Site Order

For the next six months, nurses and other health care workers who work at multiple sites are being limited to working at a single personal care home (PCH). While MNU supports limiting the risk of exposure to COVID-19 across all health care facilities, we are concerned about how this measure was put in place, the potential impact on the care of residents in those facilities, and what impact it could have on the livelihood of nurses.

This decision was made without meaningful consultation and suspends many hard-earned rights of nurses. Nurses may not be able to select their preferred facility, and they may have their schedules changed at the whim of employers. We’ve heard from nurses who are concerned that residents won’t get adequate care due to short staffing in some facilities. At a time when so much is being asked of nurses, the least the government could do is bring us to the table to work through the challenges and concerns nurses have in implementing this plan.

Pandemic Premium

Without a doubt, nurses deserve a raise. Nurses have been without a contract for over three years, while the Pallister government throws up anti-labour roadblocks like Bill 28 and Bill 29.

Prior to the COVID-19 pandemic declaration, we were hopeful that bargaining would finally start this spring. Unfortunately, we now expect the COVID-19 pandemic to further delay bargaining.

Premier Pallister has noted much he appreciates the work of nurses during this challenging time, but his actions over the last 4 years haven’t backed it up. Nurses haven’t seen a wage increase in more than 3 years, while workload has only increased.

That’s why, during the pandemic, we have called for a COVID-19 premium for all nurses to recognize the additional, varying challenges nurses are facing right now. But further, it’s time for the government to recognize the hard work nurses put in every shift, every day. They must come to the bargaining table, and bargain a fair deal that shows nurses respect.

These are just some of the many issues nurses have faced in recent months, and we know that before the pandemic hit, many nurses were struggling with dramatically increased workload, excessive overtime, short-staffing and many other issues.

This National Nursing Week, join me in celebrating nurses by demanding that the Pallister government take action to protect patients, nurses and all health care workers. By standing together, we can be an unstoppable force for positive change.

Visit putpatientsfirst.ca to show your support for increased access to PPE, paid leave and a boost to long-term care hours for our vulnerable seniors while we fight this pandemic.

Thank you for your extraordinary efforts during these unprecedented times.

In solidarity,
Darlene Jackson
President
Manitoba Nurses Union

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Monday, May 11, 2020

Emergency Order Suspends Nurses' Rights

MATT AUSTMAN 32734 — Fri, 01 May 2020 18:09:00 +0000

MNU is calling on the Pallister government to stop attacking the rights of frontline nurses and other health care workers, and instead work collaboratively to limit exposure to COVID-19 in personal care homes while ensuring safe resident care, MNU President Darlene Jackson announced today.

“Nurses understand the need for the single site order—our first concern is always the wellbeing of our patients and residents, and during this time of crisis, we understand difficult decisions need to be made” said Jackson. “Unfortunately, the Pallister government is refusing to work collaboratively with the nurses they are relying upon to provide care, and instead allowing employers to suspend nurses’ rights.”

As of today, the Pallister government has officially imposed an emergency order that allows employers to suspend Employment Standards and collective agreement provisions in place to protect nurses and other workers.

The Order regarding Personal Care Home Staffing and Work Deployment effectively allows employers to change work assignments and scheduling unilaterally. Just days earlier, MNU had been in talks with government seeking to work out an agreement that would reduce the impact on nurses, and ensure resident care standards. Instead, government decided to take a unilateral, heavy-handed approach.

Due to the widespread scheduling changes required by the public health order, nurses are deeply concerned about chronic short staffing situations in long-term care facilities, and how this order will impact the care residents receive. In 2018, MNU released a study on long-term care in Manitoba illustrating chronic short staffing in long-term care facilities, which is resulting in insufficient direct care hours per resident per day. Manitoba’s guideline is currently set at 3.6 hours, although many facilities are not able to meet that due to short staffing.

MNU has sought to ensure safe staffing levels in all facilities, and allow for disruption pay that would offset the financial impact of these changes on redeployed nurse and recognize their contributions during this difficult time, as done in other provinces such as B.C. and Quebec.

“Time and again, the Pallister government has decided to fight with nurses instead of finding reasonable compromise,” added Jackson. “During these extraordinary times, it’s all the more important to offer respect and recognition to nurses for putting patients first.”

MNU represents over 12,000 nurses of all designations from across Manitoba

2020-05-01 - LTC Emergency Order

2020-05-01 - LTC Emergency Order

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Friday, May 1, 2020

Statement on Economic Reopening

MATT AUSTMAN 32734 — Wed, 29 Apr 2020 23:55:12 +0000

On April 29, 2020, MNU President Darlene Jackson issued the following statement in response to Manitoba's economic reopening plan:

“First and foremost, the number one priority for Manitoba nurses is the health and well-being of our patients and the public. COVID-19 is a highly contagious disease that can have fatal outcomes, particularly for vulnerable populations. We are fortunate that our collective efforts to flatten the curve have resulted in relatively low confirmed case numbers compared to most other provinces. Undoubtedly, this has saved many lives and helped ensure our health care system has been able to respond to COVID-19 cases.

The decision to reopen the economy with less than a week’s notice does raise our concern about whether the curve can remain flat for the foreseeable future. By significantly loosening restrictions that contradict social distancing recommendations we risk undoing the progress we have made in limiting the spread of the virus, and put more vulnerable people at greater risk of contracting the disease and developing serious health complications.

Case numbers are likely to grow as a result of relaxed social distancing measures, and that is likely to result in more patients in our hospitals and ICUs. That means more exposure to COVID-19 for nurses and all health care workers, who continue to report inadequate access to proper PPE. For example, Shared Health is now encouraging the re-use some types of PPE, which is not recommended by the WHO and CDC except for emergency shortages. MNU continues to urge greater transparency about PPE supplies and why, if PPE are not in short supply, they are encouraging their reuse.

It is also unclear how prepared Manitoba is for a second surge of COVID-19 cases, including if the added capacity is sufficient for accommodating those patients.

MNU will continue to monitor the COVID-19 response and urge greater transparency from the Pallister government and Shared Health officials. Our number one priority must be to prevent as many fatalities and illnesses as possible, so we can ultimately plank the curve as we await a vaccine.”

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Wednesday, April 29, 2020

Day of Mourning

MATT AUSTMAN 32734 — Tue, 28 Apr 2020 13:45:40 +0000

On the National Day of Mourning, Manitoba’s nurses join workers across North America in honouring the lives lost and those forever changed due to workplace injuries or illnesses. This year, the Day of Mourning is particularly important for reflection as we collectively flatten the curve of the COVID-19 pandemic.

For decades, nurses have called on employers and government to make workplace safety and health a top priority. During the COVID-19 pandemic, our recommendations hold added significance as nurses are among the most at risk of contracting the virus. As essential workers, many nurses are required to work directly with patients, residents and clients, and require high standards of personal protective equipment (PPE) to ensure their safety on the job.

The health and safety concerns of COVID-19 are compounded by the existing issues in the system. Every year, thousands of nurses are injured on the job due to violence and inadequate workplace health & safety protections.

On this solemn day, please take a minute to honour all those who have lost their lives in service of others. Across the world, thousands of health care workers have contracted COVID-19, and hundreds have died as a result. As we continue to fight this pandemic, we mourn the dead, and fight for the safety & well-being of the living.

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Provincial PCH Bed Map list provided by Shared Health

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Tuesday, April 28, 2020

Updated May 1 MNU Responds: PCH staff to be limited to single site

MATT AUSTMAN 32734 — Wed, 29 Apr 2020 00:53:42 +0000

On April 27, the Manitoba government and Shared Health announced plans to introduce a public health order to limit nurses and other staff at personal care homes to a single site. This policy will have a significant impact on some of our 2,500+ members that work in personal care homes across Manitoba.

A list of affected sites provided by Shared Health is available here. The order is effective May 1, 2020, and is expected to last at least 6 months. Similar orders have been implemented in other provinces such as B.C., Saskatchewan and Quebec. Of particular concern, the order does allow employers to forgo certain provisions of the collective agreement, the Employment Standards Code and the Labour Relations Act.

Fundamentally, nurses agree that we must limit the risk of exposure to COVID-19 across all health care facilities. This is why we are advocating for enhanced PPE protections based on the precautionary principle, and why we’ve been in favour or visitor restrictions and other measures that reduce the chance of spread among health care workers. Limiting nurses and other staff to a single personal care home will also help slow the spread of COVID-19. However, our issue is with the approach the government has taken. Not only is this government suspending the rights of nurses, this decision was also made without meaningfully consultation with the unions involved.

In terms of how the order will be applied, for nurses who work at more than one licensed personal care home, Shared Health has said in most cases nurses will work at the PCH at which they hold the highest EFT. However, this is subject to change according to operational needs. If a nurse works in more than one facility that is NOT a PCH, they can continue working at the other site according to the current order. Shared Health has indicated they may expand the scope of the order in the future to include additional care settings (ie acute care, home care, etc).

Shared Health has emphasized internally and publicly that they are working to ensure nurses do not see a significant reduction in their hours.

The order does make clear that nurses who currently work more than a 1.0EFT between two facilities will have the opportunity to work up to 1.3 EFT at a single site, but will not be paid overtime beyond 1.0 EFT, until the 1.3EFT threshold is reached.

Employers have been given the right to override scheduling provisions where needed. Nurses that don’t currently work a particular shift might be required to do so in order to maintain their hours. How this unfolds will vary according to facilities and their operational requirements.

All affected nurses will continue to accrue seniority, but how this will affect scheduling and other matters is not yet clear.

The potential for a reduction in hours and the effects this could have on livelihood is a major concern for many nurses. Another major concern is the possible consequences of a reduction in care hours for residents. For years, MNU has advocated for increases in direct care hours per resident per day in LTC settings. In 2018, we published our recommendations in a report, The Future of Long-Term Care is Now, which recommended increasing by law the minimum required direct care hours to 4.1 per resident per day. This recommendation was drawn from extensive evidence across North America showing that care needs are becoming more complex due to an aging population, and reflects best practices from other jurisdictions. Manitoba’s current guideline requiring 3.6 care hours falls short, and many facilities are unable even to meet this benchmark due to short staffing.

Unfortunately, despite public comments, both the Pallister government and Shared Health continue to show little willingness to work with MNU and other health care unions to address these and other concerns brought forward by nurses.

Rest assured, MNU will do everything in its power to ensure this policy does not erode staffing levels or negatively impact resident care standards. We will share more information with affected members as it becomes available.

Additional Information

While we do not necessarily agree with their positions, Shared Health has produced an FAQ to address questions affected employees may have at this time.
MNU has also developed a Q and A to address additional member questions. This document will be updated as needed.
Shared Health's list of affected licensed Personal Care Homes.

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Tuesday, April 28, 2020

Join Our Call for Presumptive WCB Coverage: Send a Letter!

Michelle — Tue, 21 Apr 2020 21:33:42 +0000

Dear members,

Thousands of nurses have joined us in calling for better access to PPE for all health care workers during the COVID-19 pandemic.

Today, I’m asking for your help on another pressing matter.

SEND A LETTER calling for presumptive Workers Compensation Board (WCB) coverage for all symptomatic health care workers who are exposed to COVID-19.

The provincial government’s decision to expand 14-day paid administrative leave to all asymptomatic health care workers required to self-isolate due to COVID-19 exposure is a step in the right direction. However, by exempting symptomatic health care workers, it inexplicably penalizes those who fall ill due to the disease.

As it stands, symptomatic health care workers are still required to use sick time or vacation while they recover from illness.

At a time when we face increased risk, it’s simply not fair to further penalize health care workers who fall ill due to COVID-19.

Together our collective voices are much louder. Join us in calling for presumptive WCB coverage today.

In solidarity,

Darlene Jackson
President
Manitoba Nurses Unio

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Health and safety

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Tuesday, April 21, 2020

Protect nurses at work: Send a letter of support today

WES PAYNE 20688 — Sat, 04 Apr 2020 06:00:00 +0000

Dear members,

Yesterday, I told you about MNU’s priorities during the COVID-19 pandemic.

Today I’m asking for your help.

Please take a few moments to send a letter, calling on the Pallister government to provide better access to PPE for all health care workers, and to trust nurses to use their clinical judgement in assessing the level of protection you need to keep yourself and your patients safe.

SEND A LETTER

Safety for nurses is not negotiable. We have been clear that the government and employers must employ the precautionary principle developed following the SARS epidemic. Where there is a lack of scientific certainty around the transmission of a virus, we must take every precaution to reduce risk to frontline professionals. Enhanced safety measures need not await scientific certainty.

We want to ensure nurses have access to the health and safety controls they need. And we’re calling for Point-of-Care Risk Assessments to be completed before each interaction with suspected or confirmed COVID-19 patient. Following a PCRA, based on their own professional and clinical judgment, individual nurses should be able to determine the appropriate personal protective equipment (PPE) required to protect themselves and the patient.

Every day nurses are asked to make decisions to protect themselves and their patients based on their own clinical and professional judgement. The current situation is no different, and the model we're proposing has already been implemented in Ontario, Alberta and BC. The Manitoba government needs to follow suit.

Protecting nurses protects all Manitobans. And as nurses we must stand together. Send a letter today.

Thank you for your continued efforts during these unprecedented times.

In solidarity,

Darlene Jackson
President
Manitoba Nurses Union

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Saturday, April 4, 2020

MNU Calls on Province to Enhance PPE Access

Michelle — Wed, 01 Apr 2020 19:52:22 +0000

Following numerous reports of nurses and other health care providers being forced to self-isolate due to work-related exposure, the Manitoba Nurses Union is reiterating its call for the Pallister government to allow nurses to use their professional judgement in implementing health and safety controls to stop the spread of COVID-19 in Manitoba’s Health Care system, MNU President Darlene Jackson announced today.

“The government has failed to share adequate information or acknowledge the concerns frontline nurses have repeatedly with respect to their own health and safety, and their patients,” said Jackson. “Manitobans are counting on nurses and other health care professionals (HCPs) to respond to this pandemic. In turn, nurses and HCPs need government to protect them. We need the province to follow Alberta, BC and Ontario by allowing nurses to use their clinical judgement to determine PPE access.”

Today’s announcement regarding screening and monitoring of HCPs at hospital access points is woefully inadequate, added Jackson, pointing instead to actions being taken in other provinces.

Agreements have recently been reached in Alberta and Ontario between health care unions on provincial governments requiring point-of-care risk assessments (PCRA) to be done before each suspected, presumed or confirmed COVID-19 patient. Following the PCRA, health care workers are afforded access to appropriate health and safety control measures needed, based on their own professional and clinical judgement. A similar plan is also in place in BC.

The agreements also outline plans to jointly monitor overall PPE supply and to work together to develop plans in the event of an impending shortage.

”Nurses must be allowed to use their own professional judgement to assess the risk,” said Jackson. “Right now we have mass confusion about the current amount of supplies available, and how different guidelines and protocols on testing or PPE are to be followed. Nurses aren’t able to protect themselves, and people are falling through the cracks. If nurses start to get sick in greater numbers, the whole health system begins to fall apart.”

MNU has brought these agreements forward to the Manitoba government but to date the government has refused to respond.

Details of workplace exposures of nurses are emerging rapidly. At the time of this release, MNU is able to confirm the following:

A Winnipeg ER nurse has tested positive and is resting at home. The nurse has not travelled recently, and it’s likely that she was exposed at work.
2 staff at Grace have been confirmed positive and more than 14 ER staff are currently self-isolating following possible exposure. The total number of staff and the number of nurses affected, if any, is unknown at this time.
Following possible exposure at the Selkirk Regional Health Centre, several nurses are in isolation.
MNU has also received numerous additional reports from various parts of the province and is working to confirm details as soon as possible.

MNU represents over 12,000 nurses of all designations in Manitoba.

BACKGROUND:

Ontario PPE Agreement: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/2019_covid_joint_statement.aspx

Alberta PPE Agreement: https://www.una.ab.ca/files/uploads/2020/3/2020-03-26_AHS_Covenant_Unions_Joint_Statement_on_PPE.pdf

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Health and safety

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Wednesday, April 1, 2020

Position Statement on COVID-19: Update

Michelle — Thu, 26 Mar 2020 21:21:03 +0000

CFNU POSITION STATEMENT (This is a reproduction of the CFNU Position Statement on COVID-19, which was updated on March 23, 2020)

New evidence and information on COVID-19 is emerging daily, and CFNU’s recommendations remain based on emerging science and Occupational Health and Safety principles, including the precautionary principle; in particular, as it applies to nurses using their professional clinical judgment¹ when performing a point-of-care risk assessment². As well, the occupational health and safety principle of the hierarchy of controls applies. It starts with eliminating the hazard when possible. When that cannot be accomplished, a combination of engineering and administrative controls, combined with personal protective equipment, must be applied. The system is called a hierarchy because you must apply each level in the order that they fall in the list; a systematic comprehensive approach must be taken to reducing hazards; a hierarchy of controls cannot be applied in a piecemeal fashion.

Examples of engineering controls:

plexiglas barriers; negative pressure rooms; private rooms with private toilet and patient sink; HEPA filters; an appropriate supply of and accessibility to PPE; designated hand washing sinks for HCW use.

Examples of administrative controls:

training on the employer’s pandemic plan; active screening protocols; respiratory protection program; enhanced environmental cleaning; application of precautions (droplet, contact, airborne); safe patient transportation policies; training, testing and drilling; education, surveillance and auditing practices; visitor restriction policies; policies on PPE; policies on supply of PPE.

As promised, our Network of Occupational Health & Safety (OH&S) experts have reviewed and revised CFNU’s position on COVID-19 as of March 23, 2020, in light of the declaration of a pandemic by the World Health Organization and the spread of the virus throughout Canada.

It is the position of the Canadian Federation of Nurses Unions (CFNU) that, in the event of an outbreak of any new respiratory virus, we acknowledge that the best respiratory protection for health care workers at risk is a fit-tested N95 or greater respirator (e.g., powered air-purifying respirator (PAPR), given emerging science and the precautionary principle.

All nurses and frontline health care workers at risk in their area of work (based on an organizational infectious disease risk assessment) with the potential for exposure, and/or who are caring for a suspected or confirmed 2019 novel coronavirus patient, should be provided, fitted for and have access to a NIOSH-approved N95 or greater respirator (e.g., powered air-purifying respirator (PAPR)), and trained, tested and drilled to safely don and doff it by the employer.
The CFNU recognizes the critical importance of the point-of-care risk assessment (PCRA), an activity that is based on the individual nurses’ professional judgment (i.e., knowledge, skills, reasoning and education). All nurses and frontline health care workers at risk in their area of work are required to perform a point-of-care risk assessment. If a nurse feels the protective equipment they have been provided is inadequate, given the patient acuity, environment or other factors, they should be able to access a higher level of PPE.
At a minimum, as required of and by employers, all employees must also be equipped with personal protective equipment for contact and droplets precautions for suspected, presumed or confirmed cases of COVID-19, including gloves, eye protection (face shield and goggles), isolation gowns and surgical/procedural masks, for which they must also be trained and drilled in safe use.
Airborne precautions and the use of respirators N95 or higher must be mandated at all times in clinical areas considered aerosol-generating medical procedures ‘hot spots’ (e.g.: intensive care units (ICU), emergency rooms, operating rooms, post-anaesthetic care units and trauma centres) that are managing COVID-19 patients.

Point-Of-Care Risk Assessment (PCRA)

Given the amount of uncertainty around COVID-19 and the current threat to health care workers across Canada, the Canadian Federation of Nurses Unions (CFNU) recognizes the critical importance of the point-of-care risk assessment (PCRA), an activity that is based on the individual nurses’ professional judgment (i.e., knowledge, skills, reasoning and education). Underlying the PCRA is the principle that individual health care workers are best positioned to determine the appropriate personal protective equipment (PPE) required based on the situation and their interactions with an individual patient. They do so by evaluating the likelihood of exposure to themselves or others based on a specific task, environment, conditions, interaction or patient. Among the factors that should be considered in the PCRA are: the potential for contamination of skin or clothing; exposure to blood, body fluids or respiratory secretions; the potential for inhaling contaminated air; the patient’s ability or willingness to comply with infection control practices (e.g., wearing a mask); whether care requires very close contact; what engineering and administration controls are in place; and whether the patient could require an aerosol-generating medical procedure at any point and/or is in an aerosol-generating hot spot” (e.g.: intensive care units, emergency rooms, operating rooms, post-anesthetic care units and trauma centres) that are managing COVID-19 patients. Personal protective equipment should be selected based on the potential for exposure in order to minimize the risk of exposure to HCWs, a specific patient or other patients in the environment.

Screening and Triage

For those workers involved in triage and screening and testing for COVID-19, ideally a floor‑to‑ceiling plexiglas barrier with speaker phone would eliminate worker exposure to the hazard if there was no further direct contact with a patient required. However, if the barrier is not in place and direct contact is required, other administrative and engineering controls such as disposable equipment, signage procedures, training, separate examination rooms and waiting area should be in place before direct contact with the patient, and workers must be equipped with the PPE described above, trained and drilled in its use. Patients should be provided with surgical masks as a source control to be donned before entering the health care environment. Further, it is evident that for the direct care/treatment of presumed and confirmed cases, engineering controls are insufficient to prevent exposure.

Nasopharyngeal Swab

For those engaged in taking a nasopharyngeal swab for obtaining specimens for testing from patients with known or suspected cases of COVID-19: HCWs must perform a PCRA to determine the level of risk. Some factors to consider are the patient’s respiratory secretions, the frequency and severity of coughing, any breathing difficulties and whether there is a fever. If the PCRA indicates the need for respiratory protection, a fit-tested N95 respirator as a minimum must be worn.

Designation of aerosol-generating medical procedures hot spots

All workers in so-called ‘hot spots’ where there could be aerosol-generating medical procedures (AGMP) (e.g.: intensive care units, emergency rooms, operating rooms, post-anaesthetic care units, negative pressure rooms, single-patient rooms used to isolate patients in absence of negative pressure rooms, and trauma centres) that are managing COVID-19 patients should wear at least N95 respirators or greater (e.g., powered air-purifying respirator (PAPR)) at all times; head and foot protection; eye protection (e.g., face shield that covers the sides of the face); gloves; impermeable gowns, or at least fluid-resistance gowns, as they may suddenly be required to undertake an AGMP (e.g., intubation) and thus may risk exposure to the virus.

Having zones of the hospital dedicated to patients with presumed or confirmed cases of COVID-19, as is taking place in other jurisdictions, would also be useful; workers in these zones would be required to wear at least N95 respirator masks.

Precautionary Principle and OH&S Law

A recent legal opinion posted by a leading Canadian law firm Osler, Hoskins & Harcourt LLP recommends employers “benchmark to current best practices” and follow “appropriate precautionary measures”:

“Where there is conflicting evidence as to whether a certain precautionary measure is required or not, hospitals should adopt the elevated precautionary measure(s). Hospitals should be cognizant that it will be the hospital that will be legally liable for any failures to protect patients and staff from harm, even if hospitals have relied on federal, provincial or municipal government directives in establishing its own plans, policies and procedures.”

This legal opinion makes it clear that health care employers must respect nurses’ professional judgement as expressed through the PCRA to determine when and where to use PPEs and to determine under what circumstances the level of PPE needs to be increased. The CFNU is clear that the clinical judgement of our members – as expressed through the PCRA – should prevail.

Employers’ responsibilities are clearly laid out in provincial OH&S law: employers must work with joint OH&S committees on their pandemic plans, protocols and measures; provide training, testing and drilling for all employees on health and safety measures; establish a respiratory protection plan and provide fit-testing for N95 respirators to all employees who may need them as based on their areas of work or potential work responsibilities; and employers are also responsible for making PPE readily accessible and available to health care teams so they can do their jobs safely.

Several jurisdictions in Canada have established surgical masks as part of the precautions to be used with suspected and actual COVID-19 patients, when not involved in AGMPs. The CFNU rejects the ‘blanket’ rules currently in place which treat the safety of health care workers as an afterthought and fail to respect their professional judgement in undertaking a PCRA.

It is our position that a pan-Canadian approach to emergency preparedness must incorporate the precautionary principle so that all nurses and health care workers across Canada have the same access to health and safety in their workplaces, including the same standard for personal protective equipment (PPE) and pandemic planning. If the precautionary principle is not instituted throughout the health care system, which includes long-term care facilities, nurses and other health care workers could readily become vectors spreading the disease to each other and their patients and families. Further, it is crucial for effective infection control and health and safety strategies that a hierarchy of controls (engineering, administrative and at the worker level) be developed and implemented throughout the organization, in conjunction with joint health & safety committees that include direct care providers (including nurses) and their unions.

If AT ANY TIME you feel that your employer is not following the OH&S laws and principles as outlined above, please contact your union immediately.

The above position draws on international guidance on infection prevention and control in health care settings from the U.S. Centers for Disease Control and Prevention (CDC), the EU European Centre for Disease Prevention and Control (ECDC), and similar guidance in the UK and Australia. For more information, visit CFNU’s website for information on international infection control and prevention guidance, and the current science related to COVID-19, including how it spreads and the efficacy of personal protective equipment.

Nurses are expected to be prepared, 24 hours a day, to face any number of health emergencies. The ability to respond quickly and efficiently to emergencies is fundamental to the nursing profession. However, rapid response requires the support of many parts of the health care system. It requires emergency preparedness planning, proper administrative and engineering controls, the support of the administrators of the health system, as well as the government to ensure the necessary protocols, measures, procedures, training and protective equipment that take into consideration risk and the precautionary principle.

For workers, we recognize the critical importance of the point-of-care risk assessment and that individual health care workers, using their knowledge, skills, judgement and education, are best positioned to determine the appropriate PPE required based on their interaction with an individual patient in a particular environment.

Questions or concerns?

If you have any questions or concerns, please speak with your union or a member of your Joint Occupational Health & Safety committee.

Employer Checklist

Consult the Joint Occupational Health & Safety Committee on all measures, procedures and training with respect to COVID‑19.
Review and update existing institutional pandemic plans, developed in conjunction with the joint OH&S committees, to ensure they include staffing, communication, education and training for staff with respect to pandemic preparedness plans and the health risks of the current emergency and/or pandemic situation.
Ensure that workers have ready access to PPE, are regularly trained and fit-tested for the N95 respirator (at least biennially or in accordance with personnel changes) and regularly drilled in any potential hazards, including the reason for and use of protective equipment such as the N95 respirator and powered air-purifying respirator (PAPR), if available, how to don and doff all equipment, and all safety protocols.
It is essential to ensure that health care providers are fully trained, tested and drilled in the care provisions/protocols required during a pandemic, including conducting a point-of-care risk assessment before each interaction with a patient and/or the patient’s environment to evaluate the likelihood of exposure to contact, droplet and/or aerosols in care procedures, equipment and treatment settings to determine the appropriate safe work practices.
Conduct a comprehensive organizational risk assessment, including determining all points of potential entry (and how to restrict them using prominent signage and limiting access) and other points of potential exposure for workers (e.g., screening, triage, isolation rooms).
Implement changes in policies, procedures, equipment and the environment to eliminate or minimize identified risks in accordance with a hierarchy of controls approach to hazards.
Have in place relevant travel screening and worksite/unit exposure controls. Ensure that sufficient protective measures and equipment are in place for all screening locations at all entry points.
Have in place suitable structural barriers (e.g., ceiling-to-floor plexiglas barriers at triage and registration), disposable equipment, separate examination rooms and waiting area.
Have an adequate supply of appropriate N95 respirators, gloves, impermeable gowns or at least fluid-resistant gowns, head protection, face shield and foot protection as well as PAPR (for aerosol-generating medical procedures, e.g. intubation) and full body protection on hand.
Have airborne infection isolation rooms (negative pressure rooms) available and prepared for immediate occupancy whenever possible.
All workers operating in aerosol-generating medical procedure hot spots must wear N95 respirators, or preferably higher, at all times (e.g.: intensive care units, emergency rooms, operating rooms, post-anaesthetic care units, and trauma centres) that are managing COVID-19 patients.
When a suspected patient is identified, implement isolation measures in a negative pressure room for those with symptoms and move patient immediately to this room, separate from other patients, with access to a dedicated washroom or commode, and ensure that only trained and properly equipped personnel (with appropriate PPE) are assigned as care providers and to enter these rooms.
Create dedicated teams of clinicians who are protected with and trained, tested and drilled in the use of proper personal protective equipment for COVID-19, including teams trained in the use of N95 respirators and PAPR, if available (for aerosol-generating procedures), donning and doffing protocols, who can care for both suspected and confirmed cases of COVID-19.
Ensure sufficient staffing is available to supplement nurses and other health workers who need to care for patients in isolation, and schedule work in a manner that allows for multiple rest periods and recovery periods, as well as implement systems for monitoring fatigue.
Implement surge capacity protocols as needed.
Implement cleaning protocols requiring, at a minimum, fit-tested N95, face shield, gloves, gown, head and foot protection, and waste disposal protocols. Use disposable equipment whenever possible; non-disposable equipment should be dedicated to the patient.

Nurse’s Checklist

Comply with existing workplace infection control policies and procedures.
Stay home when you are ill.
Update your N95 respirator fit testing and wear an N95 respirator if there could be any risk of exposure to COVID-19.
Use required droplet, contact and additional airborne precautions such as (but not limited to): gloves, goggles, impermeable or at least fluid-resistant gowns, face shields, respirators, powered air‑purifying respirators (PAPR) when available (for aerosol-generating medical procedures, e.g., intubation).
Conduct a point-of-care risk assessment employing your professional judgement before each interaction with an affected patient and/or the patient’s environment to evaluate the risk of exposure to contact and/or contaminated air in care procedures, equipment and treatment settings; at any time during this risk assessment nurses may request an increase in PPE.
If you have any health conditions of concern when caring for COVID-19 presumed or confirmed cases, please consult your health care provider.
Avoid touching your eyes, nose and mouth with hands to prevent self-contamination; clean hands before contact with any part of the body.
Avoid contact between contaminated gloves/hands and equipment and the face, skin or clothing when removing PPE.
Familiarize yourself with your collective agreement and legislation with respect to pandemic preparedness, occupational health and safety (OH&S) and the right to refuse dangerous work.
STOP if you do not have the required personal protective equipment or properly fitted respiratory protection, and/or have not been trained, drilled and tested in its care, use and limitations, and speak with your manager or supervisor; document the situation and copy your union and Joint OH&S Committee representative.
REPORT any health and safety concerns, including gaps in adequate protocols and procedures and/or communications, access to PPE, fit-testing and/or training or other health and safety concerns to your manager or supervisor, copying your Joint OH&S Committee and your union.

¹ Professional judgement: knowledge, skills, reasoning and education.
² Point-of-care risk assessment: a risk assessment undertaken by the HCW prior to any interaction with the patient to determine the risk based on, for example, the client symptoms, the specific task, or the environment and the related potential for exposure, in order to determine the appropriate personal protective equipment (PPE) to protect themselves and their patients, and prevent and control the spread of infectious viruses in acute care, long-term care and the community.

"The point is not who is right and who is wrong about airborne transmission. The point is not science but safety. Scientific knowledge changes constantly. Yesterday’s scientific dogma is today’s discarded fable. When it comes to worker safety in hospitals, we should not be driven by the scientific dogma of yesterday or even the scientific dogma of today. We should be driven by the precautionary principle that reasonable steps to reduce risk should not await scientific certainty. Until this precautionary principle is fully recognized, mandated and enforced in Ontario’s hospitals, workers will continue to be at risk."

Justice Campbell, Chair of the SARS Commission

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Publish Date:

Monday, March 23, 2020

Open Letter to the Minister: International Travel Isolation Policy Not Applying to Health Care Workers

MATT AUSTMAN 32734 — Fri, 20 Mar 2020 14:29:45 +0000

March 20, 2020

Sent by email: minhsal@leg.gov.mb.ca

Hon. Cameron Friesen, MLA
Minister of Health, Seniors & Active Living
Room 302, Legislative Building
450 Broadway, Winnipeg, MB | R3C 3L6

OPEN LETTER RE: International Travel Isolation Policy Not Applying to Health Care Workers

Dear Minister Friesen,

On behalf of 12,000 nurses across the province, I am writing to express serious concerns about Shared Health’s decision to not apply the 14-day isolation policy for international travelers who are essential health care providers.

Currently your government is advising all Manitobans returning from international travel to self-isolate for 14 days immediately after returning from any international destination, including the United States. This is the right decision, and consistent with guidance from the Public Health Agency of Canada and evidence-based practices. However, the decision to forego this requirement for health care providers is causing confusion and concern among many nurses due to the serious implications for workplace health and safety and the potential spread of the virus. According to the Manager’s companion document to the Guidelines for Screening of Manitoba Health Care Workers, produced by Shared Health on March 17:

“All other health care workers [returning from international travel] who are asymptomatic are directed to contact their manager. The manager will determine if the healthcare worker’s specific position in the department is “operationally required” in the department.”

I know we agree that our collective efforts must be focused on ‘flattening the curve’ to slow the impact of COVID-19 on our health care system and Manitoba patients. But by forcing care providers to report to work following return from international travel, and leaving it to each manager’s discretion whether to apply the self-isolation policy to any given case, you are increasing the risk of transmission of COVID-19 in our health care facilities and communities.

Failure to reverse this decision could have serious implications for nurse staffing levels if transmission increases among staff due to possible undetected cases. MNU has been speaking out for many years about the nursing shortage, and we have legitimate concerns about system capacity. With an escalating number of COVID-19 cases expected in the coming weeks, the only way our health care system will be able to keep up is by ensuring the health and safety of all care providers.

The Government of Ontario has already taken action by reversing this misguided policy in their province. Here in Manitoba, we must also ensure a consistent and evidence-based approach to protect the health and safety of care providers, so they can stand ready to respond to the crisis.

For the safety of all Manitobans, we call on your government to immediately reverse this decision and respect the 14-day self-isolation period for health care providers. Further, given the hardship many will face due to the unprecedented severity of this situation, we believe the government should provide paid leave to any Manitoba worker required to self-isolate.

Thank you for your prompt attention to this matter.

Sincerely,

Darlene Jackson
President
Manitoba Nurses Union

2020-03-20 - Letter to Minister Friesen - 14 Day Isolation

2020-03-20 - Letter to Minister Friesen - 14 Day Isolation

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Publish Date:

Friday, March 20, 2020

Mandatory Overtime Legislation FAQ (Bill 205)

MATT AUSTMAN 32734 — Fri, 06 Dec 2019 22:19:22 +0000

MNU is proud to support legislation put forward by the Official Opposition that would restrict the ability of employers to mandate nurses to work overtime in Manitoba.

Bill 205, the Restricting Mandatory Overtime for Nurses Act, takes a phased-in, responsible approach to ending the use of mandatory overtime as a routine staffing tool, and requires employers and government to be more accountable for ensuring safe staffing levels.

Restricting mandatory overtime is a win-win-win for patients, nurses and government. It will improve nursing recruitment and retention efforts, patient care, and save money by reducing costly overtime.

Here are answers to frequently asked questions about this groundbreaking legislation:

Q: Why are nurses forced to work overtime? And why is legislation necessary (why not address it via collective bargaining)?

There are two primary reasons why nurses are required to work overtime, and why a legislative approach is needed to address it.

First, employers are able to routinely use mandating as a staffing tool due to gaps in the Employment Standards Code and the Regulated Health Professions Act. Under the RHPA and related legislation governing nursing colleges, employers manipulate the intent of college regulations such as the Duty to Care in order to force nurses to work overtime. If nurses want to decline for whatever reason – such as fatigue and concerns about their ability to ensure safe patient care – employers threaten to report them to their licensing body, which could be grounds for investigation and/or discipline. This is unfair because nurses should not be required to work overtime, especially due to the fact it is an employer’s responsibility to ensure safe staffing levels without relying on mandating.

The Employment Standards Code does prescribe specific situations for when an employer may be able to require an employee to work overtime. However, as it is currently written, it does not adequately take into consideration the nursing sector. The proposed amendments ban employers from using mandating to fill vacant shifts that are identified in a master rotation schedule or in response to routine events that could have been reasonably anticipated and planned for by an employer. It also clarifies that nurses may only be mandated during exceptional circumstances, and only when an employer could not have reasonably anticipated and planned for such an event.

Second, legislation is necessary for restricting mandatory overtime for all nurses, and for improving patient care and workplace health & safety standards across the province, regardless of each collective agreement. Collective agreements are limited in scope and duration, and therefore can be amended during future bargaining processes and do not cover all nurses working in the province. Moreover, because this is primarily a patient care issue, making it law will ensure nurses represented by other unions, as well as agency nurses, are protected from mandating. This will improve care outcomes for all patients, and means all nurses will have a right to decline overtime without fear of reprisal from their employer or licensing body.

In scope, the primary cause of mandatory overtime is negligent hiring and scheduling practices. Increasingly, mandating is used as a routine staffing tool to cover scheduling gaps – such as vacations and maternal/paternal leaves – that could have been avoided with appropriate planning. Due to widespread vacancies in programs and facilities across Manitoba, employers often rely on mandatory overtime to fill vacant shifts. This is creating a negative feedback loop, and needs to stop.

It’s also worth there is nothing in the current MNU collective agreement that allows employers to use mandatory overtime as a routine staffing tool. Moreover, the Pallister government has refused to come to the bargaining table for nearly three years. The current MNU collective agreement expired in March 2017, and although the terms of that agreement continue to apply until a new contract is negotiated, the Pallister government has effectively blocked the ability of MNU to negotiate related issues through the bargaining process.

Q: Mandating has existed for a long time. Why is this legislation needed now?

It’s true that mandating is not an entirely new issue. However, the scale and frequency of mandating has increased in recent years, following the Pallister government’s implementation of health care cuts and closures in the WRHA beginning in 2017. It has become an urgent workplace health and safety issue that requires amendments to the Employment Standards Code and legislation governing the nursing colleges.

Historically, mandating was primarily used as a last resort for ensuring safe staffing levels during exceptional circumstances, such as public health emergencies or surgeries. However, employers are increasingly using it as a scheduling shortcut, and by threatening to report nurses to their respective licensing college if they do not accept overtime. By citing the Duty to Care regulation, employers can force nurses to work overtime by accusing them of otherwise not meeting their professional standards, regardless of the fact employers are responsible for scheduling and ensuring safe staffing. As a result, a legislative approach is required to ensure that employers cannot manipulate college regulations or the Employment Standards Code in order to force nurses to work overtime.

Q: How common is it for nurses to work mandatory overtime?

Unfortunately, employers do not readily share data on the number of mandatory overtime incidents or hours worked in each facility and program. As a result, MNU has access to limited data obtained through Freedom of Information Requests (FIPPAs) and voluntary reporting by nurses.

Nurses have been increasingly reporting incidents of mandatory overtime to the union over the past two years. At St. Boniface Hospital, nurses voluntarily report and track incidents of mandatory overtime, thereby providing a quantitative measurement. In 2017, before most of the major health care changes in the WRHA took effect, nurses reported 328 incidents of mandatory overtime for the entire calendar year. Reported incidents increased by 475 per cent to 1886 in 2018. In 2019, nurses have reported a decline in the number of incidents, however mandating remains 200 per cent above 2017 levels. As of November 30, nurses have reported 977 incidents at the hospital in 2019.

MNU does FIPPA overtime statistics from health authorities; however, these data sets include voluntary and mandatory overtime. These statistics show a general increase in overtime in programs and facilities across Manitoba. In particular, the WRHA has seen a substantial increase in the amount of overtime since 2017.

If your workplace has an issue with mandating, we encourage you and your nursing colleagues to start reporting and tracking each incident. Contact your Labour Relations Officer for assistance in establishing a formal tracking system.

Q: Is mandating primarily a WRHA issue?

Mandating is common in programs and facilities across Manitoba. The case of St. Boniface Hospital raised public awareness about the issue, and combined with recent cuts and closures in the WRHA, media coverage has focused primarily on the impact in Winnipeg hospitals. However, nurses are reporting a rise in mandatory overtime in rural and northern regions too, as well as long-term care and public health sectors. It’s a problem affecting nurses throughout the province, and has been made worse by changes that have destabilized the system.

Q: Does this mean nurses can’t work any overtime?

No! The legislation does not ban nurses from working overtime. In fact, it will empower nurses to make that decision without fear of reprisal. It ensures that nurses have a choice whether to work overtime based on their rights as an employee and a licensed professional. Nurses should have the ability to decline overtime, especially if they are concerned about meeting their professional standards and feel they are unable to provide safe patient care. This legislation is all about empowering nurses to make the decision, and restricting employers’ ability to mandate.

Q: Some suggest they’d prefer to work mandatory overtime rather than work short. Are they right to be concerned about this legislation?

No! This legislation is not a choice between working short or banning mandatory overtime. It is a solution to the root cause of both issues. The legislation is intended and designed to ensure employers are providing for safe staffing levels, and no longer have the ability to use mandating as a shortcut for filling vacant shifts. The legislation will greatly reduce the likelihood a nurse will be forced to work short because it requires employers to employ better human resource practices that will help retain and recruit nurses. In turn, this will reduce staff turnover, burnout, sick leave and improve employee morale, all of which are critical for stabilizing and growing the nursing workforce.

It’s important to note that this legislation takes a phased-in approach. If passed, restrictions on mandating would not come into effect for up to two years. This will provide government and employers time to fill vacancies and adjust hiring and scheduling practices to ensure mandating is no logner used as a routine staffing tool.

Q: How are we going to pay for it?!

The answer is simple: it will SAVE money! Restricting mandatory overtime is a cost-saving exercise, and should not necessarily require additional investment beyond what is allotted in the current health care budget.

Nurse vacancies and short staffing levels are the underlying cause of mandating. Vacancies are positions accommodated within the existing Health budget. After all, a vacancy is an existing position already posted by an employer, who would have received approval to post that position from the health authority and the Health Minister based on the current Health budget. The choice is to fill these vacancies through mandatory overtime, or by hiring more nurses into the system. Financially, it is much more cost-efficient to hire more nurses to work straight time rather than forced ovetime, which increases costs for each shift by 50 to 100 per cent (50 per cent for regular OT, 100 per cent for double time).

Q: The Pallister government says it’s hiring 200 more nurses, and that OT and vacancies are declining from 2018 levels. Is that good enough?

It’s not good enough! Here’s why: If this is true, it should be creating conditions that should incentivize the government to pass the legislation. Why would the government want to allow mandating to be used as a routine staffing tool if it’s making significant progress in addressing nurse vacancies and overtime? As vacancies are filled and more nurses are hired into the system, the government should want to end mandatory overtime as a routine staffing tool for patient care reasons and financial savings. Mandating should only be used as a truly last resort because it puts patient and staff safety at risk and increases costs. Filling vacancies should gradually reduce the need mandating and therefore incentivize the government to pass Bill 205 to ensure employers are optimizing staff and resources.

Moreover, implementing restrictions on mandatory overtime should assist with recruitment and retention. This will help employers fill existing vacancies, and assist with additional recruitment for the creation of promised new nursing positions. It would also incentivize specialized nurses to continue working or return to working in programs that have been disrupted by the consolidation and experience(d) significant mandating. Like any other profession, mandating reduces the incentive of nurses to take jobs in facilities or programs most impacted by it. Eliminate it as a staffing tool, and more nurses will be willing to work in those facilities and programs.

Mandating is a patient care issue, a workplace health & safety issue, recruitment & retention issue, and ultimately makes baseline staffing more expensive. Banning it is a win-win-win for patients and nurses AND government!

Q: This legislation may be the first of its kind in Canada. Has it worked elsewhere?

Yes, this bill is based on best practices employed in other jurisdictions. In particular, Bill 205 is modelled after legislation passed in New York state that restricts mandatory overtime for nurses. The New York State Nurses Association (NYSNA) lobbied aggressively for the legislation because nurses knew mandating was linked to short staffing as a result of employer and government negligence. Employers were mandating nurses due to short staffing, and this created a negative feedback loop by damaging nursing recruitment and retention. The NYSNA understood that the solution was to make it illegal for employers to use it as a routine staffing tool.

The first version of the NY law was passed in 2009, and amendments have been made to ensure the law is responsive to the nursing profession and the health care sector. Including New York, 18 U.S. states have passed legislation restricting the use of mandatory overtime for nurses to great effect, citing patient and staff safety concerns and reducing the need to pay out costly overtime. Click here for a summary of U.S. laws restricting mandatory overtime for nurses.

Read MNU's announcement in support of Bill 205. Visit: manitobanurses.ca/MNU-supports-restricting-mandatory-overtime-for-nurses.

Join MNU's letter-writing campaign to support Bill 205: putpatientsfirst.ca/safestaffing.

The following is a summary of U.S. state laws and regulations that restrict mandatory overtime (source: wageadvocates.com)

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Workload staffing

Publish Date:

Friday, December 6, 2019

Union-Province showdown begins Nov 18

MATT AUSTMAN 32734 — Mon, 18 Nov 2019 17:24:14 +0000

The following editorial was published in the Winnipeg Free Press on Saturday, November 16:

Manitobans are a friendly people, and we tend to want to work together to find solutions to problems we face.

As a society, we have developed a number of rules and processes to allow us to find common ground, and to work together in fairness and mutual respect.

Collective bargaining is one of these processes. It allows workers and employers to come together to achieve goals and work toward solutions. The process has been shown to help workers and employers hammer out fair deals time and time again.

The benefits of collective bargaining are recognized in Manitoba’s Labour Relations Act, which states it is in the interest of the Province of Manitoba to encourage collective bargaining.

In fact, collective bargaining is so important that the Supreme Court of Canada has recognized it as a right protected under the Charter of Rights and Freedoms. This right doesn’t guarantee workers any particular outcome from collective bargaining, but it does guarantee the right to a free and fair process.

Collective bargaining works for several reasons.

Firstly, it requires workers to come together and prioritize things such as safer working conditions, fair wages and retirement plans and then negotiate their narrowed-down list with their employer.

Secondly, collective bargaining requires compromise. Just as employers do not want to see their operations halted, workers do not want to see the services they provide affected, or the paycheques their families rely on disappear.

Lastly, the process provides stability for workers and employers throughout the life of the contract. In other words, a deal is a deal.

Unfortunately, Premier Brian Pallister’s government does not respect the right to collective bargaining. It does not share the values of treating working people with fairness and respect.

One of the early acts of this government was to pass a heavy-handed law, called the Public Services Sustainability Act (PSSA), attacking the right to collective bargaining and which has had an overwhelmingly negative effect on public-sector bargaining in the province.

The law unilaterally imposes two years of wage freezes for more than 120,000 hard-working public-sector workers like nurses, paramedics, health-care aides, teachers, school bus drivers, custodians, group-home staff, social workers, snowplow drivers, construction workers, plumbers, electricians and many more.

These workers keep our province moving forward by providing health care to those who are sick and injured, educating our young people, taking care of the water and forests that we all enjoy, making sure our roadways are safe and doing hundreds of other vital jobs that we all rely on every day.

In the third and fourth years of a collective agreement, the law stipulates wages cannot increase by more than 0.75 per cent and one per cent, respectively, falling far below the cost of living.

As a result of these unfair constraints, public-sector bargaining has reached a standstill in this province.

Because of the Pallister government’s unwillingness to repeal the law and let public-sector workers and employers get back to the bargaining table, Manitoba’s labour movement is taking them to court to have the law struck down instead.

Our trial begins Monday, and when a decision is reached, it will be significant not only for workers in Manitoba, but across the country.

Recently, the Pallister government made a desperate attempt to stall the legal challenge to the law by introducing some proposed amendments to the law in the legislature (called Bill 2) and testing the waters on adjourning the court challenge against the law.

The bill was an attempt by the government to tinker around the edges of their bad, unconstitutional law.

We believe the PSSA fundamentally undermines workers’ right to a fair collective-bargaining process. It’s unfair and it’s unconstitutional.

Manitoba’s public-sector workers are eager to have their day in court, but it is a shame the Pallister government put us in this situation to begin with.

Kevin Rebeck is the president of the Manitoba Federation of Labour.

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Publish Date:

Monday, November 18, 2019

Pharmacare Needs Votes this Election (Op-Ed)

MATT AUSTMAN 32734 — Mon, 30 Sep 2019 21:18:37 +0000

The following op-ed by MNU President Darlene Jackson and CFNU President Linda SIlas was published in the Winnipeg Free Press on September 30, 2019:

Ask any Canadian whether they’d pay three times for something if they could pay only once, and it wouldn’t take a genius to figure out the answer.

This federal election, voters should consider this very choice. We can continue with a system that forces us to pay three times for prescription-drug coverage or we can opt to simplify it and only pay once, through a national pharmacare program.

Nurses have been at the forefront of calls for improved pharmaceutical policy for more than 20 years. Our vision: build a better system that is more efficient and ensures access for everyone.

Recent major studies by the parliamentary health committee and an expert advisory council produced a conclusive verdict: a national public pharmacare plan for everyone will save money and lives.

Despite this, some politicians continue to cling to the myth that our fragmented system can be fixed with another Band-Aid solution.

Consider the case of one Manitoban who developed a blood clot as a result of multiple invasive surgical procedures. As a single mother with a low-paying job and no drug coverage, she could not afford the low-molecular heparin to effectively treat the clot. As a result, she went without treatment, putting her life in danger.

Although the clot was eventually resolved, nurses see many patients in similar circumstances who are not so fortunate. Low-income Manitobans are most at risk of developing health complications due to the inaccessibility of life-saving drugs.

Scenarios such as these are common. Millions of Canadians do not have workplace health benefits and struggle to afford their medications. Those in part-time and precarious work often fall through the cracks of the current system.

Despite attempts by the powerful insurance and pharmaceutical industries to muddy the waters, a national public pharmacare program offers Canadians — even those with group health benefits — a better choice.

If you are like millions of Canadians who enjoy extended health benefits through your work, you may not realize that you could be paying three or more times for drug coverage.

Take, for example, a patient with diabetes who needs insulin to survive. John works full time and receives a basic extended health-benefits plan through his employer. Every two weeks, a health-insurance premium is deducted from his paycheque. To access those health-insurance benefits, John must also pay a $100 annual deductible to the insurance company.

When he goes to the pharmacy counter, the insurance covers only 70 per cent of the sticker price and he pays 30 per cent. Despite paying premiums every two weeks, John’s plan still requires that he pay a portion of the retail price of the drugs.

If John is unlucky and uses up his plan’s yearly maximum of $2,000, he has no choice but to pay 100 per cent out of pocket for his insulin for the remainder of the calendar year.

But that’s not all. John also pays income tax every paycheque and sales taxes on most of his transactions. These taxes cover the entire cost of his insulin whenever he is in hospital. As well, for a period two years ago, John had no income and was entitled to access a provincial pharmacare program for low-income residents only. Similar targeted public programs exist across Canada to cover, for example, seniors, veterans and status Indians.

Doesn’t John’s job of simply paying for the drugs he needs to live seem more complicated than it could be? That’s because it is. John is paying at least three times to access the same insulin that he could just be paying for once through his taxes.

Under a system of public pharmacare for all, John would never again have to pinch pennies to afford his life-sustaining medicine. That’s the peace of mind John’s diabetic friend Claire enjoys in Scotland. Patients in the Netherlands, Sweden and New Zealand enjoy the same.

A disciplined public pharmacare system would eliminate billions in wasted health-care dollars per year. The expert advisory council on the implementation of national pharmacare put the estimated annual savings at $5 billion.

This election, Canadians have an important choice. With drug coverage on the national agenda like never before, we shouldn’t continue with our fragmented and wasteful system.

We should choose to build a streamlined system that will save us billions every year while guaranteeing the equal access we all need. Let’s vote for pharmacare.

Linda Silas is a nurse and president of the Canadian Federation of Nurses Unions. Darlene Jackson is a nurse and president of the Manitoba Nurses Union.

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CFNU

Pharmacare

Publish Date:

Monday, September 30, 2019

2019 Provincial Election Result

MATT AUSTMAN 32734 — Thu, 12 Sep 2019 14:09:57 +0000

On behalf of Manitoba's Nurses, I offer congratulations to Brian Pallister and the PC Party of Manitoba for winning a majority government. Moving forward, we hope the government will work with nurses to address the ongoing issues in our health care system and improve the current relationship with all frontline health care professionals.

I want to thank all the candidates from every political party that put their names forward and shared their ideas for improving health care. Health care was a major issue in this election, and nurses paid close attention to the promises made by every party.

Staffing shortages, increasing workload and excessive overtime have negative consequences for patients and nurses alike. These remain key issues for nurses across the province, and we will continue to advocate at every opportunity. We hope the government will work with us to implement evidence-based measures that will help retain and recruit more nurses in Manitoba, including phasing in legislation to ban mandatory overtime which would provide accountability and incentive to fill nursing vacancies and expand baseline staffing for the betterment of patient care.

- Darlene Jackson, MNU President

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Publish Date:

Wednesday, September 11, 2019

MNU supports promise to ban mandatory overtime!

MATT AUSTMAN 32734 — Wed, 04 Sep 2019 18:08:22 +0000

Today, MNU President Darlene Jackson issued the following statement endorsing the commitment made by the Manitoba NDP to ban the use of mandatory overtime.

“On behalf of Manitoba’s Nurses we are proud to offer our full support for today’s commitment to legislate a ban on the use of mandatory overtime.

This is the strongest commitment we have seen during this election that shows a real understanding of the staffing challenges facing our health care system. Legislation like this would have a direct and positive impact for patient care, and for nurses providing that care.

The fact is forced overtime has been relied upon by employers and government to address staffing shortages that, in many instances, were created by government and employers. It’s an unsafe situation for patients and nurses alike, and nurses have been continually forced to cover for these repeated mistakes.

Certainly there are emergency situations where mandating may be required, and we recognize that such a ban would need to be phased in. Nurses will always be there for their patients. But that fact is, forcing nurses to work overtime because of health care cuts is unsafe and unfair. With a robust recruitment and retention plan, we believe a ban could be enacted within a four year timeframe. For any party serious about improving patient care and bringing more nurses into the system, banning mandatory overtime should be a top priority within a term in government.

This policy is also good for recruitment and retention, which has been hampered in recent years by cuts and excessive overtime. Nurses have repeatedly spoken out about how recent cuts and closures are chasing nurses out of a system that desperately needs more. This is a major step to correct the government’s relationship with nurses.”

- MNU President Darlene Jackson

Category:

Nursing profession

Publish Date:

Wednesday, September 4, 2019

MNU Responds to Seven Oaks ER Early Conversion to Urgent Care

MATT AUSTMAN 32734 — Tue, 09 Jul 2019 17:07:07 +0000

MNU President Darlene Jackson issued the following statement in response to the WRHA/Shared Health announcement that Seven Oaks ER will be converted to urgent care on July 22, 2019:

"Nurses are disappointed and frustrated by today's announcement that the Seven Oaks ER will be converted to urgent care on July 22, 2019.

This morning, health officials met with nurses to confirm that EMS protocols will be adjusted to divert higher acuity patients to tertiary sites, and an advertising campaign will begin to inform the public of this last minute change of plans. It should be noted this is a significant departure from the initial planned conversion date of September 10, 2019. It is important to note that no staffing changes will occur for Seven Oaks nurses until September 20, meaning it will be two months before nurses move to new positions as a result of the conversion.

We have been advised that the hospital cannot adequately staff the ER after July 22. This means that patient safety could be jeopardized due to a shortage of nurses and other front-line staff. This is a mess of the government's creation and is another indication they are having trouble recruiting and retaining nurses.

Our major concern with this decision is that it will increase patient volumes and acuity at the remaining ERs without sufficient added capacity and staffing in place to meet this demand. By rushing through these changes and ignoring the advice of nurses, they have created serious human resource challenges. This also makes it increasingly difficult to adequately recruit and retain nurses, particularly in highly specialized areas such as emergency care.

We are also concerned this decision was made without a comprehensive risk assessment as recommended by their own health care consultant, Dr. Peachey.

Added capacity depends on sufficient staffing; you cannot open beds without nurses in place to care for those patients. As reported by the Winnipeg Free Press today, there are at least 17 vacancies at St. Boniface ER alone, and the hospital cannot open the newly added beds due to staff shortages. HSC and Grace are already dealing with serious capacity and workload issues following prior cuts and closures. HSC has seen a significant uptick in patient volumes, and we know the Grace ER is relying on agency nurses to adequately staff the facility.

We believe the community deserves a fully-functioning ER as it serves a large catchment area including rural regions. For nearly two years, we have been calling on the government to rethink this plan and consult with nurses. Today, we continue to see the consequences of a plan that is focused on saving money, not improving care."

Category:

Publish Date:

Tuesday, July 9, 2019

MNU President Darlene Jackson Responds to Concordia Urgent Care Announcement

MATT AUSTMAN 32734 — Wed, 29 May 2019 19:31:26 +0000

Today, MNU President Darlene Jackson issued the following statement in response to the WRHA & Pallister government's announcement that the Concordia Emergency Department will be converted to urgent care as of June 3, 2019:

"Manitoba's nurses are extremely frustrated and disappointed by today's announcement. MNU has not received any explanation about how staffing changes at Concordia can work with such little notice. We condemn this decision to rush through this without adequate consultation with nurses.

Let us be clear: This is a rushed decision and is a reckless attempt to repair a broken plan. It's abundantly clear that the Pallister government has no idea what to do about a mess of their own creation. We are also concerned about how they plan on addressing nursing vacancies at the remaining ERs, which were depending on nurses transferring from Concordia to alleviate workload and overtime. This latest decision lacked so many details it could have been prepared on the back of a napkin.

The Pallister government has finally acknowledged it has created an unsafe situation at the facility for patients and nurses, but changing it to urgent care won't address the key issues. It will reduce the ability of nurses to treat high-acuity patients, which we expect will continue to present due to widespread confusion about where to go for emergency care, and due to capacity issues at other facilities. Even the Health Minister admits they don't know the difference yet between sub-acute and acute patients, and this raises serious questions about their entire plan to close ERs.

Last Thursday, MNU representatives met with senior WRHA and Shared Health representatives. They had no information about the details of this plan, other than to confirm it would happen by the end of June. It was apparent they were waiting for direction from the Health Minister. We presumed they would consult nurses before making any further decisions regarding the timeline; instead they have decided to rush through without more information made available to nurses and other care providers.

Most Concordia ER nurses have already selected new positions and expect to transfer to other Emergency Departments, or to a different program at Concordia. Changing the plan yet again creates massive human resources challenges, and nurses are left scrambling and guessing about the future of the facility."

Category:

Regional Health Authorities

Publish Date:

Wednesday, May 29, 2019

An Open Letter to the Health Minister Regarding Phase II Review

MATT AUSTMAN 32734 — Wed, 15 May 2019 15:35:43 +0000

The Honourable Minister Cameron Friesen
Minister of Health, Seniors and Active Living
Legislative Building
Room 302 – 450 Broadway
Winnipeg, MB | R3C 0V8

Dear Minister Friesen,

On behalf of 12,000 Manitoba nurses, I am again writing to express our deep concern over the ongoing cuts and consolidation within the WRHA. In particular, I would like to address Dr. Peachey’s return to conduct a Quality Assurance Assessment.

As you know, upon learning of this development, we immediately requested a meeting. When Dr. Peachey agreed, with just a few days’ notice we brought together nurses from five of the most affected hospitals. 17 nurses in total, from a wide range of departments—Emergency, Surgery, Labour and Delivery, Medicine, Renal, Cardiac Sciences, and Critical Care—immediately agreed to tell their story. If we had more time, I expect we could have found hundreds of nurses willing to attend.

The meeting took place last Thursday, May 9. Most nurses brought prepared remarks and walked Dr. Peachey though the challenges that they have faced in their facilities and programs since the government began implementing this plan.

Their stories clearly reflected nurses’ growing concerns. One nurse noted, “I have worked [as a nurse] for over 30 years. I have seen multiple changes and cutbacks, but I have never seen our unit experience the amount of stress and adversity that has followed the Phase 1 changes.”

Another nurse told Dr. Peachey, “I have 26 years of experience and I will honestly admit this is the worst I have ever seen.”

Another nurse told Dr. Peachey that due to increased patient volume and increased acuity, “Taking vital signs is being missed, dressing changes are not being done... Patients are not being turned, often increasing the risk of skin breakdown, bedsores, pneumonia, or blood clots developing.” Another described being stretched so thin, patients were offering to change their own bandages, acknowledging that the nurses simply don’t have time to provide basic care.

One nurse described her experience in Emergency, trying to manage roughly twice as many admitted patients as she had available beds. Consolidation has pushed patient volumes and acuity to dangerously high levels. Another nurse said, “We are here to strongly oppose the closure of Concordia Emergency and the Manitoba government’s hospital reorganization.” She went on to say that nurses “remain steadfast in our mission to provide safe patient care, but we are on a very dangerous trajectory right now. We strongly urge the government and the WRHA to stop and listen to the frontline staff, who witness the consequences of emergency department closures first hand.”

One final quote from a nurse in our meeting: “The changes that have taken place and continue to take place are not in the best interests of the nurses or the public.”

The fact is consolidation and the thousands of deletions that accompanied it have only exacerbated existing staffing shortages. The speed with which it was done created unsafe situations, and chased experienced nurses from highly specialized areas. The message nurses gave to Dr. Peachey was clear. That’s why we were completely shocked when, the very next day, Dr. Peachey emerged to report that there was “absolute consensus” among health care providers—including nurses—that the consolidation plan was right.

The stories of these 17 nurses are not unique. They are a reflection of a system increasingly in distress. We know this because MNU polls our members regularly. This year we asked them about their level of concern with respect to the changes government has made in health care. The results are overwhelmingly negative, and reflected effectively universal agreement. 97% of nurses said they were concerned about the changes, and 70% said they were extremely concerned. These results are a far cry from “absolute consensus” that consolidation is the right approach.

I have since reached out to all 17 of the nurses who attended the meeting. Not one of them supports this plan. They are extremely concerned by the effects they’ve seen to date, and they do not want to see it continue.

Dr. Peachey’s comments were so misleading that nurses can no longer trust that his findings will be a fair and accurate representation of what’s happening in health care. We are now forced to seek some reason as to why Dr. Peachey would make this claim. With the early election rumours, we fear this review is nothing more than a political exercise to attempt to delay further cuts and closures before Manitobans head to the polls.

Putting political interests ahead of the interests of Manitoba’s patients is unacceptable. It’s imperative that you take the advice of nurses and other frontline health care providers seriously, stop the consolidation plan, including the closure of the Concordia and Seven Oaks EDs, and take immediate steps to address issues such as workload, overtime and staffing shortages that these changes have made worse.

I would be more than willing to meet with you to discuss these concerns further. I await your response.

Respectfully,

Darlene Jackson
President
Manitoba Nurses Union

Cc; Wab Kinew, Leader of the Official Opposition
Dougald Lamont, Leader of the Second Opposition

2019-05-15 - Letter to Minister Friesen

2019-05-15 - Letter to Minister Friesen

Attachments:

Category:

Publish Date:

Tuesday, May 14, 2019

MNU Responds to Misleading Statements by Dr. Peachey

MATT AUSTMAN 32734 — Fri, 10 May 2019 20:52:22 +0000

Yesterday, MNU facilitated a meeting with 17 frontline nurses for Dr. Peachey. The meeting was approximately 2 hours in length. Nurses from 5 city hospitals shared what they’ve experienced on the frontlines of our health care system since this program of cuts and closures began in October 2017. Nurses took time to note the many issues consolidation has created and worsened that puts patient care at risk, including increasing overtime and workload. There was absolutely no endorsement of Phase I and Phase II.

To characterize the response from nurses as anything short of severe disappointment with the consolidation plan is completely misleading. These changes have caused massive problems in our health care system, from overcrowding in ERs, to a loss of experienced nurses in highly specialized units, and severe workload issues.

Let us be absolutely clear: Dr. Peachey does not speak for nurses and his comments are completely inappropriate. Why Dr. Peachey took it upon himself to speak on behalf of nurses is a question that must be asked of him. His statements cast severe doubt on the credibility this report, and provide all the more reason for nurses to speak out against these cuts and closures, and the Pallister government.

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Publish Date:

Friday, May 10, 2019

Nursing Week 2019: We Deserve to be Heard

MATT AUSTMAN 32734 — Mon, 06 May 2019 18:18:54 +0000

The following editorial was submitted to the Winnipeg Free Press by MNU President Darlene Jackson to commemorate National Nursing Week 2019.

As a nurse with 37 years’ experience, I can tell you that nursing is not ‘a day at the spa’.

It’s important to understand the vital roles nurses perform in our health care system. Anything can happen, any shift. Nurses have to be prepared for all scenarios, and ready to respond quickly and effectively.

We are highly-qualified professionals, requiring years of education and on-the-job training. We learn from one another, and we work together to serve others. We ensure safe, quality care on the front-lines of our health care system. We often take on the role of advocates for our patients as well.

Every year, we celebrate Nurses Week across Canada. It is a valuable reminder of the work we do in every province and territory, from the busiest city centres to the most rural and remote areas.

No matter where we are or the circumstances we face, nurses of all designations are well equipped to meet almost any challenge. Unfortunately, issues beyond our control are making the situation in health care increasingly difficult to manage.

That’s why Nurses Week is particularly important this year in Manitoba. Many nurses are working short-staffed, and increasingly mandated to work excessive overtime. Too often, we are subjected to verbal and physical violence, in care settings with inadequate or lacking security presence.

Ongoing cuts and closures to health care, including the closure of emergency departments and the Misericordia Urgent Care Centre, are creating real issues on the front-lines. Nurses are increasingly being asked to provide care to a greater number of patients, with fewer resources. This situation is unsustainable.

Nurses have real experience, and intimately understand our health care system. We know its strengths and weaknesses and have the expertise to respond to them.

We have all heard stories of a patient going without care longer than they should. It’s incredibly frustrating for patients and nurses alike. Nurses pride themselves on compassion for their patients.

A day in the life of a nurse is often an overlapping set of priorities. It’s the feeling of being pulled in a hundred different directions while still being required to provide a consistent, high-quality standard of care. It’s a conflict that requires expertise, experience and commitment to manage on a daily basis.

Often, nurses are short-staffed relative to the patient volume they were assigned, and still have to deal with emergencies at any given time. Any number of things can go wrong at any time, and without adequate staffing levels, the risk for longer wait times only increases.

Unfortunately, our concerns are all too often ignored when our experience and knowledge should be appreciated and respected.

Nursing is one the most diverse and rewarding careers in health care. There are so many different ways to help patients and their families. Nurses are increasingly confronting problems caused by cuts or restructuring that jeopardize care, and this is concerning. Nurses worry about the future of health care in our province.

All nurses deserve to be celebrated for performing such a critical role in our health care system. Licensed Practical Nurses (LPNs), Registered Nurses (RNs), Registered Psychiatric Nurses (RPNs) and Nurse Practitioners (NPs) serve Manitoba patients directly in our homes, communities, clinics, hospitals, and long-term care facilities. Without every designation, our health care system would not be complete. We are often the critical link between each member of the broader health care team, and together we ensure patients get the care they deserve.

But nursing week this year should be about more than simply celebrating the work of nurses. Now more than ever, nurses deserve to be heard; their concerns should be listened to. Nurses are there for patients at the time of greatest need. Patients put their trust in us, and we always do whatever we can to deliver the care they deserve.

Nurse advocacy is always rooted in the needs of patients, and so it’s important for our leaders and the public to take note when nurses speak out about what’s happening in our health care system.

I’d like to thank all of Manitoba’s nurses for their incredible dedication to quality patient care and advocacy. The work you do is an inspiration, and it’s an incredible honour to work on your behalf. Thank you to everyone for recognizing Nursing Week, and to all of Manitoba’s nurses for putting patients first!

Darlene Jackson is a Registered Nurse and President of the Manitoba Nurses Union, representing over 12,000 nurses of all designations.

Category:

Nursing week

Publish Date:

Monday, May 6, 2019

An Open Letter to Dr. Peachey from MNU President Darlene Jackson

MATT AUSTMAN 32734 — Fri, 03 May 2019 17:05:37 +0000

Dr. David Peachey
Health Intelligence Inc. and Associates
21 Shipping Lane
Halibut Bay, Nova Scotia B3V 1P6

Delivered by email

Dear Dr. Peachey,

On behalf of Manitoba’s 12,000 nurses and particularly the nurses in WHRA hospitals, I write to implore you to hold meaningful consultation with frontline nurses as part of your Quality Assurance Assessment of Phase II.

Since the implementation of Phase I, I’ve heard from countless nurses who are deeply concerned about the effects of the Pallister government’s consolidation plan. Patient volumes at absorbing facilities have spiked considerably without adequate staff or resources to meet the increased demand. The use of overtime and mandatory overtime has worsened since these changes were made. Staffing shortages and vacancies have become serious problems in many programs. The remaining emergency departments have become overcrowded and have seen wait times rise since October 2017.

Nurses are telling management, the health authority and government to stop the cuts, and reconsider this plan. Many nurses believe the situation has become dangerous, and fear the effects of further closures or consolidation will put safe patient care at greater risk. Overtime at Concordia Hospital has increased by 51.56% in the 2018 calendar year compared to 2017, including a staggering 82.56% in Family Medicine, 57.45% in the ER, and 35.80% increase in Critical Care, which also saw the closure of two ICU beds in recent months. This reflects a workload situation that has worsened for many nurses in the WRHA ever since Phase I was implemented.

The government has noted that you are consulting with “clinical leaders” as part of your assessment. In order to ensure you understand our concerns, I urge you to meet directly with nurses on the frontline, who know firsthand the effects these changes are having on patients, and their own ability to provide care. I believe this is necessary information for you to conduct a comprehensive assessment of the situation, and is an ethical requirement for ensuring that Manitobans can trust the conclusions of your report.

I would be more than willing to assist you in arranging meetings with nurses. I look forward to your response.

Sincerely,

Darlene Jackson
President
Manitoba Nurses Union

Cc:

Hon. Cameron Friesen, Minister of Health, Seniors and Active Living
Wab Kinew, Leader of the Official Opposition
Dougald Lamont, Leader of the Second Opposition

MNU Letter to Dr. Peachey

MNU Letter to Dr. Peachey

Attachments:

Category:

Regional Health Authorities

Publish Date:

Friday, May 3, 2019

MNU Responds to Consolidation Review

MATT AUSTMAN 32734 — Thu, 02 May 2019 20:32:16 +0000

Today, MNU President Darlene Jackson issued the following statement in response to the Pallister government announcing a review of their health care 'consolidation' plan, including the closure of the Concordia and Seven Oaks Emergency Departments.

"Today’s announcement is proof that the Pallister government knows their plan isn’t working. It also reinforces what nurses have known all along—that they never had an adequate plan, but they rushed ahead with these dangerous cuts and closures in an ill-advised attempt to save money.

It’s been clear since day one that this plan was always about balancing their books and not about improving patient care. It now appears that this government is willing to admit they have damaged our health care system, but it’s cold comfort for patients and the nurses putting in long hours trying to hold the system together. The government and Dr. Peachey must consult with frontline nurses, take their suggestions seriously, and stop this program of health care cuts and closures."

- MNU President Darlene Jackson

Category:

Publish Date:

Thursday, May 2, 2019

Legislative overview: The Regional Health Authorities Amendment Act (Bill 10)

MATT AUSTMAN 32734 — Tue, 23 Apr 2019 18:51:04 +0000

While the problems created by Phase I and Phase II of the WRHA’s cuts and closures continue to disrupt health care services in Winnipeg, the Pallister government has decided to introduce legislation that will bring about more changes to health care province-wide.

Many nurses are already aware of the newly created Shared Health Manitoba, and its growing sphere of influence. However, what is less clear is the government’s overall intent for Shared Health.

Bill 10, which was introduced on March 6th, 2019, outlines the intended role of Shared Health, its future responsibilities and sets forth a new health care governance structure for Manitoba.

In this new model, the regional health authorities will still exist, but there will be an addition of two more health authorities: the provincial health authority (Shared Health) and CancerCare. However, under Bill 10, not all health authorities are created equal – in fact, Shared Health will have greater influence and control over how clinical services are delivered by the RHAs.

Bill 10 proposes that Shared Health will assume considerable power over the RHAs. Some of the key responsibilities Shared Health would assume include:

Develop the provincial clinical and preventive services plan (PCPSP) which will direct “the delivery of healthcare services in Manitoba”
Establish clinical standards for healthcare delivery
Develop provincial health human resources plans
Prepare annual health capital plans aligned with the PCPSP
Provide administrative and support services to the other health authorities

These changes would put Shared Health in a leadership role in directing health care services and delivery. Shared Health will also have oversight functions, and will monitor the other health authorities’ implementation of the PCPSP, compliance with clinical standards and construction of capital projects (when government is funding two-thirds or more of cost).

Bill 10 also politicizes the planning & delivery of health care services by severely limiting the ability of RHAs to make decisions about services that address local needs. All the health authorities will be required to follow the PCPSP, which is developed by Shared Health and approved by the Minister of Health. The RHAs ‘participate’ in the development of the plan, but will no longer lead the process. Therefore, the bulk of the decision-making affecting the services to be available in the regions will be made in Winnipeg, with greater input and influence from politicians.

The plan is touted as a way to provide consistency of service, but a one-size-fits-all plan runs the risk of drastically diminishing the flexibility needed to address local needs. Nurses know the challenges associated with moving decision making further away from the bedside, and into the hands of politicians.

The bill also contains a number of other troubling features.

First, requirements for consultation with the public are weakened in this bill, by moving from a system that specifies who, at a minimum, should be consulted, to one wherein the Health Minister exclusively determines who would be consulted. The Bill 10 language around public consultation simply states that it must be carried out “as directed by the minister.” This is wholly inadequate as a means of ensuring proper public input into plans that will impact the healthcare services available to Manitobans.

Second, many aspects of this bill reinforce the Health Minister’s authority and centralize power in their hands. Beyond determining the extend of consultation, the minister must sign off on many of the plans, including the PCPSP, provincial capital plan and provincial health human resources plan. No health authority will be able to “purchase, lease or accept by donation” any equipment that is deemed to increase operational or capital costs without the permission of the Minister. Therefore, regional capacity for health care planning will be removed and politicized by concentrating decision-making power in the office of the Health Minister.

Other troubling aspects of the bill include the addition of “accountability agreements,” which would force RHAs to not exceed their budget. The introduction of these agreements highlights the intent of the current government to prioritize fiscal restraint in healthcare. There are no aspects to these accountability agreements that have anything to do with quality healthcare or meeting patients’ needs – they appear to be strictly intended to address financial concerns.

A final concern for nurses should be the proposed establishment of “standards committees.” Although similar language can be found in other acts, the language in Bill 10 is overly broad and encompasses all regulated health professions. Essentially, it allows for Shared Health to establish standards committees to “review the professional competence of health care providers,” and recommend additional training for individuals, or recommend “actions or systemic changes” that should be made by other providers.

When establishing the standards committees, Shared Health is required to consult with the college responsible for the type of healthcare services under review. However, consultation does not guarantee that the committee would adequately consider the nature of the profession of the provider under review. We view these committees as redundant for nurses, given that the College of Registered Nurses of Manitoba or College of Licensed Practical Nurses of Manitoba already investigates when a nurse is suspected of not meeting the profession’s standards. It is also unclear whether, or to what extent, a provider brought before a standards committee would have representation. MNU continues to investigate this section of the legislation.

Overall, Bill 10 is concerning for a variety of reasons. It appears to lay the groundwork for further cuts and closures in health care throughout the province, and gives RHAs and communities little recourse to challenge the direction provided by Shared Health and/or the Health Minister. Concentrating power into Shared Health and the minister’s office, while limiting consultation with communities being served could create serious challenges for health care delivery in Manitoba.

Bill 10 has gone through first reading, but has not passed. In April, the Official Opposition (NDP) delayed the passage of Bill 10 until at least the fall session of the legislature. MNU will continue to study the potential consequences of this bill and keep members informed. In the meantime, Shared Health is expected to release their first Provincial Clinical and Preventative Services Plan this summer.

Category:

Regional Health Authorities

Publish Date:

Tuesday, April 23, 2019

MNU Responds to Budget 2019

MATT AUSTMAN 32734 — Thu, 07 Mar 2019 22:57:53 +0000

The Pallister government’s 2019-20 budget does not address the major challenges facing our health care system. As a consequence of ongoing cuts and closures, Manitoba’s health care system is being stretched much too thin.

There is only a 0.5% increase to health care spending, which is below inflation and another de-facto cut. Moreover, the Pallister government has made a habit of underspending its budget. In 2017-18 they underspent by $200 million, and this year they are forecasting $240 million. In effect, this has wiped out any budgeted increases to health care.

Meanwhile, the federal government continues to provide Manitoba with annual 3% increases to health care, and is offering $400 million for mental health initiatives. Manitobans need to ask: what is the provincial government doing with this funding? It appears that it’s being used to balance the budget on the backs of nurses and patients.

Nurses are working flat out just to hold the system together, and this is resulting in increasing nursing vacancies, overtime, and workload. These issues undermine quality patient care, forcing patients to wait longer in emergency rooms and for important procedures like cardiac surgery.

Moreover, we have not seen a real commitment to improving care for long-term care residents. Last year, MNU released a landmark report on this issue, which recommended increasing direct care hours per resident per day from 3.6 to 4.1.

The Official Opposition has put forward legislation (Bill 201) which would legislate this target and require annual reporting by the Health Minister. However, the budget does not substantively increase funding for long-term care, and such a target is unlikely to be achieved within such austere budgetary conditions.

The fact that this government is celebrating underspending in a time of serious need shows just how out of touch they are with what’s happening on the front lines of health care.

We encourage nurses and all Manitobans to join us in speaking out, and advocate for safe patient care. Sign our petition to end health care cuts and send a letter to your elected officials in support of Bill 201 at www.putpatientsfirst.ca.

Category:

Publish Date:

Thursday, March 7, 2019

Support Long-Term Care: MNU Launches Letter Writing Campaign

MATT AUSTMAN 32734 — Tue, 19 Feb 2019 18:22:52 +0000

In order to build public support for Bill 201 that would enhance care for long-term care residents, MNU has launched a new online letter-writing campaign at putpatinetsfirst.ca/longtermcare. Supporters can enter their postal code to automatically send a template letter to their MLA expressing support for the legislation, and acknowledging the need for improved care standards for seniors and other vulnerable Manitobans. All letters are copied to the office of Health Minister Cameron Friesen and Premier Brian Pallister.

“Advocating is an essential part of nursing,” said MNU President Darlene Jackson. “We hope nurses and the public will take advantage of this template, and send a strong message to our MLA’s about the need for improved care standards for LTC residents in Manitoba.”

On November 29th, MNU announced support for Bill 201, The Health Services Insurance Amendment Act (Personal Care Homes Staffing Guidelines). Jackson and MNU Long-Term Care Board representative Karen Jantzen joined Official Opposition Leader Wab Kinew and Health Critic Andrew Swan for the announcement at the Manitoba Legislature.

The bill legislates minimum requirements for direct care hours per resident per day in personal care homes. Protecting direct care minimums in legislation will help seniors with chronic and complex needs receive the level of care they need, and support the nurses providing that care. The bill also calls on the Health Minister to make much needed enhancements to care hours going forward.

“Manitoba’s nurses see it every day: more direct hours of care are needed to maintain quality care for personal care home residents” said Jackson. “This legislation addresses the key recommendations we made earlier this year, which highlights the best available evidence from across North America.”

Last spring, MNU released a new report The Future of Long Term Care is Now, which addressed the nursing care needs in personal care homes. According to the report, the positive correlation between care quality, staffing levels and health outcomes is undeniable, and the evidence shows a need to move toward 4.1 direct care hours. In MNU focus group testing, nearly 60% of nurses state they do not have enough time to properly care for patients. Insufficient levels of care can increase the risk of care hazards for patients, such as falls, improper medication processing, bed sores or delayed monitoring of vital signs.

Visit manitobanurses.ca/long-term-care-report to read MNU’s report, and putpatientsfirst.ca/longtermcare to send a letter to your MLA today.

Category:

Workload staffing

Publish Date:

Tuesday, February 19, 2019

MNU Responds to WRHA Wait Times Increase & Workload Concerns

MATT AUSTMAN 32734 — Thu, 31 Jan 2019 22:12:01 +0000

The following statement was issued by MNU President Darlene Jackson in response to the December 2018 monthly increase to WRHA Emergency Department wait times and ongoing workload concerns:

“It’s disappointing that ED wait times are once again on the rise. Wait times have been higher ever since the WRHA implemented Phase I 15 months ago, in October 2017. If the plan was working, we should have seen wait times drop below what they were when the changes were implemented. Clearly, this ‘transformation’ is not having the intended effect.

To make matters worse, these changes are causing disruption throughout the system, including staff shortages, ICU bed closures, and concerning increases to workload and overtime. This is unsustainable and undermines quality patient care. It’s not fair to ask nurses and other front-line professionals to clean up the mess that this government has created. Instead of making excuses, the Pallister government and WRHA should acknowledge that these changes were rushed and done without adequate planning or consultation, and take nurses’ concerns seriously.”

Category: