Running on Overtime

SETTING THE AGENDA BCNU members who attended this spring's provincial bargaining strategy conference reviewed results from the union's nurse bargaining survey and learned that unpaid work is a growing concern among members.

For nurses, long shifts and extended workweeks have become an almost permanent part of what it means to work within BC's health-care system. There simply are not enough nurses to go around, and there is no question that the resulting workloads are bad for patient care and harmful to caregivers.

Unfortunately, it would seem that health employers are more than happy to run the system using overtime in order to keep hospital wards staffed. It's an approach that's short-sighted and costly. BC's two largest health authorities paid out a total of $73.7-million in nurse overtime in 2014 – a massive outlay driven by a severe shortage of both regular and specialty-educated nurse positions, such as ER and OR nurses.

But the financial cost is not borne by employers alone. Many BCNU members who attended last fall's regional bargaining strategy conferences reported that one of the most common and frustrating experiences they face today is the expectation that they do unpaid work before and after their shifts. And it's an issue they'd be willing to engage in job action to fix.

BCNU is listening. "We are all striving for an efficient, cost-effective and sustainable health-care system that meets the needs of patients and their families," says union President Christine Sorensen. "One of the best ways to achieve this would be to provide safe levels of nurse staffing that would reduce the health system's reliance on both paid and unpaid overtime."

Fahrin Jiwani and Shalini Sudhakar work in the surgical unit at BC Children's Hospital. Both care for patients with complex needs.

"We need to take the [extra] time, because often the patients have a lot going on," says Jiwani. "The time we spend is never paid."

Sudhakar says it feels necessary to do unpaid work in order to feel confident in the care she provides on-shift.

"I come 10 minutes before my shift and stay usually 15 to 20 minutes to do handover – every shift. Otherwise, I don't know what's going on with my patients."

David Kang and Josh Gardiner also work in surgical settings at North Vancouver's Lions Gate Hospital – Kang in orthopedics and Gardiner in general surgery.

"You are giving up 15 to 20 minutes of your time on either end of the shift, each shift."

- Josh Gardiner

"Unfortunately, I work for free," admits Kang. "I come to work early and don't leave until my tasks are done."

Gardiner reckons that he and all of his colleagues do unpaid work.

"We don't have a critical care work environment – it's considered basic general surgery – and as a consequence of that we are expected to show up early or stay late and we don't get paid for it," he explains. "So no matter which way it's going, whether the outgoing nurse stays late or the incoming nurse comes early, you are giving up 15 to 20 minutes of your time on either end of the shift, each shift."

Nurses working at Abbotsford Regional Hospital report similar working conditions.

"I'm expected to stay 10 to 15 minutes a shift for handover which we do voluntarily. I often eat through meetings or eat at my desk and not take my actual break – that's how I work for free," says ER nurse Remy Dhillon. "This happens at least once a week, sometimes more, and many of my colleagues do the same."

Parveen Gill works with Dhillon at ARH, and she says it's very common for nurses to skip breaks when they're on shift.

"You get used to it and think as long as you get to eat and sit for a little bit, you'll be okay," she explains. "However, that takes a toll on you through the shift and through the week and, at the end of the shift, you also have to give a report and make sure the handover is done properly – it's not the kind of job where you just leave at the end of the day without following up."

Stories of unpaid work are not unique to acute care settings. Port Alberni's Marianne Pitt works in mental health and substance use.

"I worked on a case management team of four nurses and three support workers, and within a year, management got rid of one of the nurses and a care aide," she recalls. "There was no backfill, and management's attitude was, 'You guys are basically over-staffed anyway, so you don't get any more replacements.' And so for the next two years we were short-staffed."

It's not surprising to hear that working conditions suffered.

"We did so much work beyond normal working hours, hardly ever got breaks and worked above and beyond," says Pitt. "I think it [unpaid work] should definitely be part of the bargaining agenda."

Lynette Amos works in residential care in the Comox Valley. She says that clinical practice concerns also force nurses to do unpaid work.

"We sometimes have an LPN take an RN's shift, and I feel I can't just walk out and leave them with clinical issues they're not experienced with, so I stay an hour and a half doing staffing for them while they're starting their shift," she reports. "I feel strongly that I have to make sure the shift starts smoothly for them."

Nurses' experiences clearly show that unpaid work and short-staffing go hand in hand.

"It comes down to staffing and patient needs, all of the time. How do you leave the floor when we're short?"

- Lynette Amos

"Literally there's always somebody that's not taking their breaks. It comes down to staffing and patient needs, all of the time. How do you leave the floor when we're short?" asks Amos.

Unpaid work is an issue the union has flagged for some time.

"We always encourage nurses to take their breaks," says Sorensen. "If they don't get a break they should file for overtime, and if their request is rejected they should file a grievance."

BCNU estimates that an RN with nine years of service who works 30 minutes of unpaid overtime per week is giving their employer over $1,400 a year in free labour.

A report released last June by the Canadian Federation of Nurses Unions shows that nurses' unpaid overtime has continued to take a toll on the health and well-being of the country's nurses and on patient care. It found that in 2016 aggregated unpaid overtime of public sector health-care RNs and nurse supervisors totaled 4,940,000 hours – the equivalent of 2,700 full-time nursing positions.

The report, prepared by Jacobson Consulting Inc., broke down this figure by province and found that unpaid overtime in BC averaged 11,300 hours per week in 2016 at an annual value of $21.3 million.

The report is an urgent call for provinces to ensure they have effective health human resources plans that support safe nurse staffing levels.

In 2012 BCNU negotiated groundbreaking workload and staffing contract language covering staff replacement, regularization of hours, additional patient demand and vacation replacement to help address the unfair and unsafe demands on nurses' time.

Sorensen reminds members that these new tools for safe patient care are an opportunity for BC nurses to secure the working conditions they deserve – but only if nurses use them. 

"We understand that it's not always easy for nurses to hold a manager to the letter of the contract," she says. "But we cannot allow the normalization of unpaid work – it's a growing problem that threatens the health and safety of our members and the patients in their care." •

UPDATE (July - August 2018)