Professional Responsibility Process Pays Off for Nurses and Patients
DETERMINED NURSE Richmond Hospital's Heidi O'Callaghan is happy with the outcome of a professional responsibly process that has ended her regular redeployment to other units in the hospital – a practice that she and other ICU nurses argued was undermining staff morale and compromising patient safety.
Richmond Hospital intensive care unit nurses were shocked, and thrilled, this summer to read a management memo announcing the end of a controversial redeployment policy.
"Effective immediately," stated the notice, "there is to be absolutely no redeployment of our Intensive Care Unit staff to any areas within the hospital (including ER and PACU). The only exception would be an emergency situation (i.e. plane crash)."
The unexpected announcement came shortly after three concerned ICU nurses – Fione Shing, Heidi O'Callaghan, and Brent Anstey – met with senior management and union representatives to explain why a redeployment policy implemented in 2017 was putting their patients at risk and jeopardizing their professional practice.
"The announcement was so positive that at first no one actually believed the news," says Shing, who began working at the Richmond ICU four years ago.
"It was just the most perfect scenario I could have imagined. We were able to get exactly what we pushed for, everything we wanted for our patients and for our nurses. No one will be redeployed, except in certain circumstances like a real urgent emergency."
"I'm happy about our success," adds O'Callaghan, who has worked on the busy unit since December 2015 and filed a professional responsibility form (PRF) in mid-2018 after being inappropriately redeployed.
PRFs allow nurses to outline their practice concerns in writing. They are just one part of the Nurses' Bargaining Association professional responsibility process (PRP) that allows nurses and employers at a local level to engage in meaningful conversation about common goals and to improve patient care or professional practice in a collaborative manner. The process is designed to identify problems and resolve issues without involving blame.*
"It was definitely a great feeling to finally have our PRFs recognized and our voices heard," says O'Callaghan. "A lot of nurses on the unit were involved in this, and everyone was really pleased to see the change."
"It was a real group effort from so many people," agrees Shing. "It was a long and difficult struggle, but it was worth it. I can't say enough about my co-workers for all their work on this, and for the help of our full-time steward Annelise Henderson who really helped us with her advice, coaching and knowledge. She was with us every step of the way, and I can't thank her enough."
"Nurses would worry about when it would it be their turn, and which unit they would be sent to."
The problems for nurses and their patients began shortly after the hospital implemented a new redeployment policy in September 2017.
Hospital management told nurses that "when ICU census is low and any other unit is short staffed, Vancouver Coastal Health policy indicates that ICU nurses can be redeployed from their assigned unit and placed on another unit within the same site in order to provide necessary clinical coverage for safe patient/resident care or non-clinical work as required."
Critics of the policy believed that when a unit is short, management should call in an appropriately trained and oriented nurse on overtime, rather than turning to ICU nurses. But management claimed this wasn't an option due to "fiscal responsibility," and said the redeployment policy would continue.
However, instead of quietly going along with the policy, concerned ICU nurses began using the PRP in an attempt to keep their patients safe.
Shing filed a PRF in early 2018 after being redeployed from the ICU. "It was the first time in my nursing career that I filed a PRF," she says. "I wasn't trying to create trouble. I was concerned about my patients' safety.
"I was assigned to a surgical floor. It was a very, very stressful day, ensuring I got everything right. I was really worried about my four post-op patients. I had no idea what the protocols were. I started worrying that I may make a mistake."
In addition to her four patients, Shing was also assigned to mentor a new nursing student. "I was already struggling with my own patient load and at the same time I had to coach and mentor her and show her around. It wasn't fair to anyone.
"I missed all my breaks that shift. It was such a stressful day that I had a meltdown when I got home.
"It's not that I can't tolerate a bad day," she explains. "All nurses have good days and bad days. But it shouldn't reach a point where it compromises my safety and my patients' safety."
Heidi O'Callaghan filed a PRF in July 2018, after being redeployed to a pediatric assignment. "There were a couple of separate issues for me," she explains. One centred on the lack of a proper orientation and the other on the inappropriate assignment to pediatrics.
"There was an attempt to walk me around the unit," she recalls, "but there was never a real orientation. I didn't feel I had the knowledge, skills, or ability to do my job safely.
"My PRF outlined some of the difficulties I faced trying to navigate a new environment where I didn't know any of the staff, didn't know where everything was located, didn't know all of the equipment, didn't know many of the new acronyms, and didn't know the work flow, which is quite different from the ICU.
She started to panic. "I hadn't worked with children since nursing school and caring for a child is so different than for an adult. It's just not in my wheelhouse."
Not long into her shift, a Code White was called and O'Callaghan was redeployed again, this time to emergency. "I thought I'd have the option of just being workload, an extra helping hand," she says. "But when I got there they said 'No, no, you're taking this assignment.'
She feels the redeployment put her in circumstances where she was giving patients inadequate care, putting them – and her licence – at risk.
"It's a frustrating process. It's like going to a different country and they're speaking another language that you don't understand."
After the shift ended, O'Callaghan informed a manager about her concerns. Several days later she filed a PRF.
Shing says ICU nurses filed a total of five PRFs over the redeployment issue, including ones in early 2018 from RNs Zeina Chahine, Wai Ling Winnie Lam, and Shing. O'Callaghan and Brent Anstey filed their PRFs in mid 2018.
Under the PRP that these members used, completed PRFs are forwarded to the worksite Professional Responsibility Committee (PRC) that is comprised of two co-chairs representing the union and the employer, the nurses with the concerns, the union steward, immediate supervisor and the excluded manager.
The committee had 30 days following a meeting to submit a written report that covers action items and timelines.
But despite filing those five PRFs and meeting with management to discuss the issues, the redeployments continued.
O'Callaghan says ICU nurses were being redeployed to most units at the Hospital. "It became such a habit that there were times when we weren't able to admit patients to ICU because there weren't enough nurses. It also made it really hard to cover breaks or respond to codes."
Shing says the practice adversely affected ICU morale. "There was a lot of stress – nurses would worry about when it would be their turn, and which unit they would be sent to."
But instead of giving up, the tenacious team of ICU nurses continued to file PRFs, attend meetings, and care for their patients.
"We were told that having any nurse is better than no nurse," recalls O'Callaghan. "But at the end of the day it's not about us. It's about our patients."
Under the previous PRP that these members used, when a professional practice issue couldn't be resolved or decided at the local level it was advanced to the Senior Review Committee (SRC), the third step of the PRP. The SRC was a health authority-level body with BCNU and employer representatives.
Shing, O'Callaghan and Anstey then had the opportunity to again present their arguments at an SRC meeting attended by Vivian Eliopoulos, Vancouver Coastal Health Authority vice president (Vancouver, Richmond Acute). Eliopoulos responded quickly to the nurses' concerns and issued the memo announcing an end to the policy soon after the meeting.
"We didn't expect to resolve this issue at the very first meeting," says Shing. "After all, it had already been 18 months since we filed the first PRFs. The Vancouver Coastal vice president was a very good listener and took the time to understand our situation."
"The process took a long time," adds O'Callaghan, "so we were well prepared for the meeting, which took about 90 minutes.
"We had our statistics, and we had our issues organized and lined up. I think they were surprised with all the info we brought forward, like all the times we've redeployed, the amount of time we were left short in ICU, and the impact the policy had on patients and nurses."
She reports that nurses on the unit were really happy to learn about the change in policy. "A lot of people were involved, so they felt really vindicated when their efforts led to a positive result after so much work. It was great for everyone to finally be listened to."
Shing says news of the redeployment reversal has some former Richmond Hospital ICU nurses, who left the unit while the policy was in place, now considering a return.
Both Shing and O'Callaghan are pleased with the results of the ICU team's work, and they recommend other BCNU members use the PRP to advocate for patients and nurses.
"You've got to file PRFs because that's your voice," says O'Callaghan. "And you've got to follow up and stick to the process. It may take a long time, but PRFs are sometimes the only thing nurses have."
"If you think patient safety has been compromised you should take the time to file a PRF," explains Shing. "I highly recommend it. Your issue may not be resolved right away, and you may have some bad days, but in the end your concerns will be heard and you'll have advocated for your patients' safety." •
*These members' professional responsibility initiative followed the process that existed under Article 59 of the now expired 2014-19 NBA collective agreement. A new process was negotiated and now in effect under the terms of the 2019-22 NBA agreement. Details can be found at www.bcnu.org