Cultivating the Psychologically Healthy Workplace

PROMOTING PSYCHOLOGICAL HEALTH BCNU Acting President Christine Sorensen and Acting Vice President Adriane Gear were on hand during the BC Patient Safety and Quality Council’s annual forum on Feb. 23. The two presented the work the union has been doing to help ensure health authorities implement the National Standard for Psychological Health and Safety in the Workplace that was negotiated into the current Nurses’ Bargaining Association collective agreement. The three-day quality forum featured presentations and interactive workshops on a variety of topics related to improving care across the continuum. Over 950 attendees learned new skills and strategies, discussed opportunities and challenges, and networked with others interested in improving health care in BC.
 

Psychological health and safety is embedded in the way people interact with one another on a daily basis and is part of the way working conditions and management practices are structured and the way decisions are made and communicated. NATIONAL STANDARD OF CANADA (2013)

Last November’s Vector Group report on the workplace culture at Nanaimo Regional General Hospital (NRGH) declared the hospital on the verge of “self-destruction.” It was a damning indictment that found the facility was "failing significantly in regard to managing people" and that "the simple act of continuing with daily operations exacerbated the toxicity of the culture.”

The problems at NRGH are acute, but they are no means unique. Across the province, nurses and other health-care workers are struggling to provide safe patient care within toxic workplace cultures.

Ensuring that nurses’ working conditions are psychologically healthy and safe should be at the top of every health-care manager’s priority list, because access to a respectful, supportive work environment directly affects the quality and safety of the care that’s delivered.

Sadly, almost any nurse working in BC today will tell you that their mental health is near the bottom of their employer’s priority list. Nurses know what they need (see sidebar “What does a psychologically healthy workplace look like to you?”). The problem is determining how best to achieve the goal of a positive and supportive workplace culture that will promote psychological health.

Fortunately, nurses now have a new tool that has the potential to transform the way work is conducted in health-care facilities across the province. During the last round of Nurses’ Bargaining Association (NBA) negotiations the union was successful in having health employers and the ministry of health sign a letter of agreement that identifies psychologically healthy workplaces as “a vital requirement for a healthy, engaged and productive health care workforce.” The letter commits the ministry to ensuring that all provincial health authorities adopt the Canadian National Standard on Psychological Health and Safety in the Workplace (“the Standard”) as their own, and agreeing that a three-to-five year implementation plan is put in place by April 2017.

The Standard is the first of its kind in the world. Championed by the Mental Health Commission of Canada, and developed by the Canadian Standards Association (CSA Group), it is a voluntary set of guidelines focused on the development of a system of positive factors that support psychologically healthy and safe workplaces. Launched in 2013, the voluntary standard was developed by a panel of experts representing employers, labour unions, academic researchers and government agencies.

The push to develop the standard came from the growing recognition that mental health problems and illnesses are the leading cause of short- and long-term disability in Canada. The toll on Canadian workers and workplaces is substantial, and nurses and health-care workplaces top the list in numbers of claims. However there had been no comprehensive national standard to help guide organizations that wanted to take action. This situation prompted occupational health and safety leaders to develop the kinds of standards for psychological health that are already in place for the protection of physical health.

"We need to implement the standard or we risk seeing more situations like the one at Nanaimo Regional General Hospital."

 

- BCNU Acting Vice President Adriane Gear

BCNU is the first union in Canada to have successfully negotiated the Standard into a collective agreement, and Acting Vice President Adriane Gear says its adoption can't come soon enough.

“We need to implement the standard or we risk seeing more situations like the one at Nanaimo Regional General Hospital,” she says. “NRGH shows just how far from psychological health many of our workplaces actually are, and we need action to reverse that sort of decline now."

Gear notes that BCNU has made mental health supports for members one of its highest priorities. Dedicated mental health advocates now sit at BCNU regional executive tables. The enhanced disability management program (EDMP) first negotiated with employers in 2010 continues to support members suffering from an occupational or non-occupational illness or injury. The union’s Licensing, Education, Advocacy and Practice (LEAP) program is also an invaluable service for those needing assistance with practice, mental health, addiction and other issues. And for the past two years, BCNU has been offering personal resilience workshops designed to help nurses identify things like compassion fatigue and signs of post-traumatic stress disorder in themselves and their colleagues .

Gear says that the letter of agreement on the adoption of the Standard is a reflection of the union’s concern for members’ mental health. “It was put on the bargaining table to help further BCNU’s larger mental health strategy that was adopted in 2013,” she says. “The strategy aims to bring nurses’ knowledge, experience and unique perspectives to the issue of mental health, and is focused on improving care for patients, creating safer workplaces, and ensuring accessible mental health supports for BCNU members."

As NBA contract language, the Standard is intended to supplement the other tools that nurses have to address their working conditions, such as grievance filing and using the professional responsibility process. But what makes the Standard unique is its focus on workplace culture and the behavioral factors at play that also have a significant effect on nurses’ working conditions. Now, nurses have the ability to refer to an objective standard of psychological health when advocating for improvements to their practice environments.

Nurses across BC struggle to deliver quality patient care despite the staffing and safety limitations of the current health-care system. The Vector Group’s cultural assessment of NRGH puts a spotlight on how little nurses are supported in this struggle, and highlights the unfortunate irony that nurses, although facing trauma and other psychological stressors while delivering compassionate care, often receive little or no emotional support from their own employers.

"We need to see a concerted effort to move beyond the status quo if nurses are to be kept psychologically whole and fully engaged in care giving,” says Gear, who notes that the CSA describes the Standard as “a journey of continuous improvement” involving attitudinal change for managers and additional investments to address the many risk factors that subject nurses to low morale, disengagement, and psychological disorders.

The CSA also reports that establishing positive psychological health allows a workplace to better recruit and retain talent, achieve greater employee engagement, become more productive and operate more efficiently. Such workplaces substantially reduce the risk of conflict, grievances, turnover, disability, injury rates, absenteeism and morale problems.

The Standard identifies 13 key psychosocial factors that impact employees’ psychological responses to work and work conditions. These include excessive workload, low engagement, poor work/life balance, and lack of psychological protection against violence, bullying and harassment. Focusing on these risk factors by engaging the workforce in finding solutions is integral to the standard’s implementation process.

Surveys of nurses show that all of these factors remain as broad areas of unmanaged risk to system performance in health care today. "If employers don’t actively address these factors, retention of many older nurses and successful integration of new nurses are likely to fail," warns Gear.

"Much progress still has to be made on implementing the Standard,” she says. “But we’ve now developed an implementation plan and will be focused in our efforts to hold the government and health employers to their word."

UPDATE (March - April 2018)

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