Professional Practice is a core service that sees ONA specialists work collaboratively with Bargaining Unit leaders and members to achieve significant wins that positively impact their work environments and ability to provide quality care.
Professional practice is one of ONA’s core services. Recent cases in Kingston once again prove just how effective the service is for members.
Our Professional Practice Specialists work in an advisory capacity for our front-line leaders in dealing with practice matters in their workplaces. They might also meet with employers directly to discuss best practices and ensure employers know when they are falling short. The experts in this equation are the nurses on the front lines who know when things are not working well.
Through our professional responsibility process, members get the support needed to file grievances. They can report instances where they have cause to believe they are being asked to perform more work than is consistent with effective, quality care, and where patients, residents and clients are or may be at risk.
The tool used to capture these instances is the professional responsibility workload form. This mechanism helps to identify and address quality patient care issues and improve unsatisfactory working environments/conditions, such as staffing issues, skill-mix issues or lack of equipment or supplies. The forms serve as documentation and protection for the nurse or nurses advocating on behalf of safe patient care and as a mechanism for improving communication and collaboration with the employer.
ONA was the first union to have the professional responsibility process included in our collective agreement as a result of thorough documentation of workload by nurses at Mount Sinai Hospital in Toronto in 1977.
ONA’s Professional Practice Team supports our leaders in this work, with the specialists providing the services. Together, they have had some impressive successes.
One such file was Kingston Health Science Centre’s (KHSC) Connell 10 medicine unit. Within two separate time periods, members documented sufficient evidence to advance this file to an Independent Assessment Committee (IAC), a panel of three nursing experts that investigates practice and workload concerns. Following a three-day hearing, during which ONA and the employer presented evidence, the panel developed recommendations to support resolution of the workload issues.
The committee hearing for Kingston took place in November 2023. A total of 99 recommendations were made by the panel. The recommendations, which were released on January 17, 2024, included increasing personal care assistants overnight by one and working towards resuming the previous baseline of 11 registered nurses (RNs) prior to the model of care change. The current baseline is nine RNs, plus two registered practical nurses, for 11 nursing staff.
Additional recommendations were made regarding leadership and communication practices, charge nurse supports, professional development, and recruitment and retention. A meeting with the employer was set to work through the recommendations. Note, this is the second unit in less than a year at this organization that was advanced to an IAC.
Another KHSC unit that has experienced many professional workload issues and two IAC investigations is Burr 4 – an inpatient mental health unit. The last investigation was held in October 2022. The employer met regularly with ONA but refused to sign minutes of settlement or items in agreement.
Issues taken to the IAC included:
Ultimately, after regular meetings among members, ONA and the employer, all recommendations were implemented. The employer signed the minutes of settlement. The number of professional responsibility complaints have decreased markedly, from 132 in 2022 down to 17 in 2024. To date this year, there have been no forms submitted.
There are similar stories at this employer with other units, Children’s Outpatient Clinic, cardiovascular lab and renal unit. They have now implemented the recommendations.
With regard to current “hot” areas, Bargaining Unit President Annette Saccon and the employer are holding town halls with members to discuss issues and determine resolution. This is a hugely positive step from when they wouldn’t speak to the members at all, and is largely due to the hard-nosed dedication of Saccon.
“It can be challenging to deal with the employer on such critical issues, but the process is good and it works,” she says.
The professional responsibility process does work, but it takes patience, diligence and a lot of coffee.
Tanya Beattie, a seven-year Professional Practice Specialist with ONA, says the process can also be occasionally frustrating.
“It can take time to see resolution to professional practice issues identified by our members in their workplaces. The first step in the process is to try to solve or mitigate the situation with the resources available at the time of the occurrence. If there is no resolution at the unit level, the issues then advance to labour management; and if there is still no resolution, meetings are scheduled with ONA’s Professional Practice Specialists and the highest level of nursing authority at the organization.”
If there is a lack of collaboration or no resolution, they will ultimately take the issue to an IAC, where they will investigate the complaints and bring back recommendations.
Adds Jackie Kehoe-Donaldson, Senior Manager, Professional Practice/Health and Safety, “On occasion, an employer will accept the recommendations and agree to implement them by a certain date. In other cases, the employer won’t agree and it becomes a difficult negotiation process to get them to acknowledge that there needs to be profound changes.”
In all cases, it’s up to the members, Bargaining Unit leaders and Professor Practice Specialists to work collaboratively with the employer to implement the recommendations or consider taking further action.
Says Beattie, “The professional responsibility process does work, but it takes patience, diligence and a lot of coffee.”
“We have to thank all the members, ONA leaders and staff who assist with workload issues and help with ONA achievements in this area,” notes Saccon.
Adds Kehoe-Donaldson, “it’s admirable the way our specialists and members stick with it.”
The achievements in Kingston have allowed for a collaborative approach between the deputy chief nursing executive and Bargaining Unit President at the unit level, along with labour management and the IAC process. There were improvements to orientation, education, charge nurse supports, policies and procedures. In addition, improvements to equipment and supply issues occurred, such as additional communication devices and arrest carts.
The Professional Practice Specialists continue to meet with Bargaining Unit leaders every six to eight weeks for file reviews to ensure communication and collaboration of priorities of files.
For more information on our professional responsibility process, see Reporting Workload Concerns.
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