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Staffing to Meet Patient Care Needs

Challenges with safe staffing contract language now resolved

Safe staffing for safe patient care remains our top priority. And the BC Nurses' Union's advocacy on behalf of our patients is unwavering.

In the previous two rounds of negotiations with the Ministry of Health and provincial health employers our bargaining teams negotiated creative strategies to better align staffing levels with patient care needs. Some of those strategies were successful and some were resisted by health administrators.

The safe staffing language in our 2012 – 14 contract gave us important victories such as establishing a nurse's right to participate in staffing decisions, the regularization of hours and mandatory back-filling of leaves and vacations. These protocol memoranda of understanding were the first of their kind in Canada, and a clear reflection of our commitment to make a positive difference in our working lives and for our patients.

But ratifying a contract is just the beginning. Compelling employers to follow through with their staffing commitments is an ongoing challenge nurses face daily. The union reached an arbitrated settlement in 2016 that acknowledged health authorities' failure to adequately staff BC's hospitals and care facilities under the terms of the 2012 – 14 contract.

In the last round of talks we negotiated a joint worksite committee process to address this compliance gap, and we established a health human resources framework that committed the government and health employers to better achieve critical health delivery objectives.

DIRECT PATIENT CARE STAFFING

The latest proposed provincial collective agreement takes BCNU's push for safe staffing a step further. We learned from previous negotiations that, despite our best efforts to relieve staffing and workload pressure, the contract language lacked specific consequences for managers who fail to replace nurses when short-staffed, or compensate those nurses left bearing the cost of additional workload.

Now, we have negotiated an innovative nurse-driven staffing and workload assessment process to ensure all short-term staffing needs are met. Existing staffing language has been consolidated into a new "direct patient care staffing" article and employers must still make all reasonable efforts to replace staff or call in workload, such as calling in casuals or regular staff at straight time and overtime.

This new process will allow point-of-care nurses to identify when additional nursing staff is needed, such as when units are below baseline or have identified workload. Point-of-care nurses can provide their manager with a filled-out workload assessment tool in order to secure additional nursing staff. Significantly, the assessment tool will now be documented in order to prevent baseline manipulation. And if point-of-care nurses don't agree with managers' staffing decisions, they can grieve and may be eligible for the new working short premium.

Employers have until April 1, 2020, to hire enough nurses to meet baseline staffing before the working short premium takes effect (see sidebar: Time Equals Money).

WORKING SHORT PREMIUM WILL DRIVE APPROPRIATE STAFFING

Under the terms of the proposed agreement, health employers must pay the new working short premium when there aren't enough nurses to meet patient care needs. However, this premium is considered an unfunded liability worth approximately $100 million annually across the province. Managers will not have money in their budgets to pay nurses this premium, creating a powerful incentive to staff appropriately in order to avoid shouldering the cost.

The working short premium is an important tool that changes the nurse-management relationship and allows nurses and managers to work together to address a common challenge. Our goal is to align nurses' and managers' interests – nurses want enough staff to meet patient care needs and managers want to avoid paying an expensive, unfunded premium.

Our bargaining team carefully evaluated the existing safe staffing language, retained the best parts and added a powerful incentive for managers to staff appropriately.

Your voice was clear – you want enough staff to meet patient care needs. And when you don't have enough staff you want to be paid appropriately. The new language will help achieve those goals.

Now the onus will be on the employer to regularize positions and hire more nurses because they cannot afford this penalty if they maintain the health-care system in its current state. Arbitrations will also no longer be required because the penalty has now been written into the contact language.

UPDATE (Dec 2018)
Updated: 1/7/2019 1:11 PM

TIME EQUALS MONEY
All nurses to receive wage premiums if employers fail to meet agreed-to staffing levels

SAFE STAFFING WILL ALWAYS BE OUR NUMBER-ONE PRIORITY. Under the proposed agreement, a new direct patient care staffing assessment process will ensure that employers adequately staff units. But we’ve also negotiated a number of wage premiums that will incentivize health authorities to match staffing with patient care needs. And if they don’t, nurses will be compensated for working short.

WORKING SHORT PREMIUM

Effective April 1, 2020, an additional $5.00 an hour will be paid to any nurse working short on a unit, department or program with 10 or fewer scheduled nurses.
Nurses working short on a unit, department or program with 11 or more scheduled nurses will receive an additional $3.00 an hour.


SHORT NOTICE PREMIUM
Nurses who take a straight-time shift that begins within 24 hours will be paid a $2.00 an hour shift premium.

PAID END-OF-SHIFT WORK
Unpaid work and short-staffing go hand in hand. One of the most common and frustrating experiences nurses face today is the expectation that they do unpaid work before and after their shifts. This normalization of unpaid work is a growing problem that threatens the health and safety of our members and the patients in their care.

The practice of paying nurses for “handover” work was inconsistent throughout the system. A new article clarifies that handover time will now be paid.

<15 min
1 - 14 minutes at straight-time rate of pay.
>15 min
15 minutes and greater at overtime rate of pay

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