Necessary Precautions

CLOUDED IN UNCERTAINTY The many unknowns surrounding the novel coronavirus have made the COVID-19 pandemic especially difficult for pregnant and immune-compromised health-care workers.

BCNU is working hard to ensure vulnerable members are accommodated during the outbreak

Little was known about COVID-19 when it first emerged late last year. New evidence and information on the disease is emerging daily, and research on the behaviour of the SARS CoV2 virus is ongoing.

Health officials' decisions on how best to respond to the disease are made under challenging conditions. BCNU has been meeting with health employers and other decision makers daily, and urging them to adhere to the precautionary principle, which calls for reasonable safeguards when a virus is clouded in scientific uncertainty.

Nurses and other health-care workers have a right to be concerned about their safety and to know about any workplace hazards they may be exposed to. They also have a right to have input into decisions affecting their health and safety, and even a right to refuse work they believe to be unsafe, free from fear of discipline or retaliation.

The precautionary principle is about nurses' professional judgment and the ability to conduct point-of-care assessments that allow them to determine their own risk and act accordingly. It also means that the highest level of personal protective equipment (PPE) should be available until there is definitive, scientific proof that such PPE is not required. BCNU continues to push for unrestricted access to an adequate supply of PPE, and recently published a position statement that clearly outlines the union's expectations of health employers and the government.

But what about those workers who are immune-compromised? Or who live with vulnerable family members? Or who are pregnant and have heightened concerns about becoming infected with COVID-19? For this group, adequate PPE alone is not enough to allay their concerns.

Throughout the pandemic BCNU has been working hard to ensure vulnerable and immune-compromised members are provided with medical accommodations during the outbreak. Union labour relations officers who specialize in assisting nurses that make duty-to-accommodate (DTA) requests and staff in the joint union-employer Enhanced Disability Management Program (EDMP) have seen a huge increase in their caseloads as they assist these members affected by the pandemic. The EDMP is a customized disability management program designed to support members suffering from an occupational or non-occupational illness or injury.

The duty to accommodate flows from human rights legislation that prevents discrimination on prohibited grounds. This includes discrimination based on a disability. If a worker cannot or can no longer perform certain duties of a job because of their accepted condition or injury, their employer must look at steps to accommodate them. Options must be explored unless they would cause the employer undue hardship.

Since the COVID-19 outbreak began BCNU has assisted over 550 members who've made duty to accommodate requests of their employers. Diana Ng is one of these members. She works at Vancouver General Hospital and is one of some 25 nurses who staff Vancouver Coastal Health's Transition Services Team, which works out of six major acute care hospitals in the region.

Transition services are vitally important. They ensure that the continuum of care is a smooth one for patients moving to and from acute and community care settings. And coordinators like Ng play a critical role in keeping patients moving and ensuring they are stabilized wherever they find themselves.

"It was quite worrisome because it's a new virus and there is a lot we don't know about it."

- Diana Ng

Now on leave and expecting her second child this August, Ng was working and 22-weeks pregnant when COVID-19 hit the province. She was immediately concerned for the health of her child.

"It was quite worrisome because it's a new virus and there is a lot we don't know about it," she says. "Especially when I'm located on a unit with a small office, and I go and see patients."

The health authority's unclear and changing directives on infection control were also disconcerting for the pregnant nurse.

"We didn't have enough personal protective equipment or, in the beginning, the proper equipment or even the infection control measures that we should have been using," she reports. "Then, as the disease progressed and more information on the virus was provided, we had to use more and more PPE throughout our day, and wear it in the office too."

Ng's worry was compounded by the employer's questionable directives on PPE use.

"They gave us a surgical mask with an eye shield and said we had to use that for four hours, and then when we were running out we would have to use the same one for the entire day, which was  not the same practice before the pandemic."

In March, BCNU told health employers that, whenever possible, pregnant nurses at risk of COVID-19 exposure should be redeployed or allowed to work from home and continue to receive full extended health benefit coverage.

Ng had by then decided her work was too risky for her baby. "I contacted workplace health about being accommodated so that I'm not on the unit and at risk of getting COVID, but they took the position that there was no additional risk for pregnant women."

According to the BC Centre for Disease Control, pregnant women are not at more risk of acquiring the coronavirus nor at more risk of getting severe disease than comparable aged adults. But the issue for pregnant workers is not simply the risk of acquisition, it is the risk to their unborn fetus if they do contract the illness. And while the risk of passing the infection in utero appears to be very low, it is nevertheless reasonable for a pregnant worker to take whatever precautions they feel are needed given the many unknowns that still surround the virus.

Ng spoke with her manager, who initially okayed a transfer to a different unit. Unfortunately, the new assignment had a COVID-19 unit on it. She then spoke with VGH full-time steward Maria Oliverio."'How is that reducing my risk?' Ng recalls asking Oliverio. "And she agreed that this was not an accommodation, it was just putting me at the same level of risk."

Ng says her employer was also not open to creative problem solving that may have allowed her to work from home. "There are a lot of work options for transition services coordinators – on the weekends we don't actually go to see the patients – we phone them. But it wasn't an option."

Ng then decided to request sick leave and submitted the required doctor's note to the VCH health adviser and her manager. "The adviser told me I would not qualify for sick time because pregnancy is not a sickness," she reports.

When Ng's manager began challenging the sick note, Oliverio referred her to BCNU EDMP representative Silvia Kuntze. "She [Ng's manager] was really wanting me to return to work, so Silvia guided me through the process of successfully seeking leave. I did the occupational health and fitness assessment with my doctor and submitted that to the health adviser," explains Ng.

Kuntze also helped ensure Ng's vacation and overtime banks were paid out before beginning her leave using sick time. "Silvia helped me through that and gave me information on disability in case I ran out of the overtime, vacation and sick time," Ng says.

"Silvia was very knowledgeable and helpful, and she was very quick at responding and helping me advocate," reports Ng. "She would be my voice for advocating for my sick time because I did have pregnancy-related symptoms. And it was useful to be contacting her and having her kind of specialized knowledge in that area because I had no idea how to work through the duty to accommodate process."

Ng believes that if it wasn't for Kuntze, she would have continued to work on a unit and run the risk of joining the more than 500 health-care workers in BC who have tested positive for COVID- 19 – a risk she is grateful to have avoided as she prepares to deliver her second child.

If you have any questions regarding EDMP, please contact your BCNU regional representative. To look up your EDMP representative, log in to the BCNU Member Portal and click on the 'Contacts' tab.  •

UPDATE (Summer 2020)