OCTOBER 2014 NBA TOOLKIT NBA PRF TOOLKIT www.bcnu.org BC NURSES UNION NBA PROFESSIONAL RESPONSIBILITY PRFs
T ABLE OF CONTENTS NBA TOOLKIT 3 PRF Department Contact Information 5 Article 59 Professional Responsibility Language 9 NBA PRF 13 PRF Process Simplified Flowchart 15 Initial Conversation Email Template 17 NBA/FBA PRF Language Comparison 19 Tips for Filing a PRF 21 PRF Committee Terms of Reference 25 Guiding Principles 27 Roles and Responsibilities: Members and Stewards 29 Roles and Responsibilities: Employee and Employer Co-Chairs 31 Checklist for Advancing PRF(s) to the Union 33 PRF Committee Final Report 37 Closing Tool Page 1
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C ONTACTS Suzie Ford Professional Advocacy Officer (PRFs) 1.800.663.9991 604.433.2268 cell. 604.862.0938 email: sford@bcnu.org Suzie services the following Health Authorities: Fraser Health Authority Vancouver Island Health Authority Interior Health Authority Gina Ramsay Professional Advocacy Officer (PRFs) 1.800.663.9991 604.433.2268 local 2176 cell. 604.319.5198 email: ginaramsay@bcnu.org Gina services the following Health Authorities: Vancouver Coastal Health Authority Northern Health Authority Provincial Health Services Authority Providence PRF ASSISTANT Jennifer email: policyprf@bcnu.org www.bcnu.org Contact your PRF Regional Advocate for assistance or go to the BCNU website. Your PRF Advocate is a useful local resource for you! Page 3
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PRF PROCESS SIMPLIFIED The BCNU and CRNBC both actively encourage RNs and RPNs to report professional issues in response to workload, staff and patient safety and nursing practice conditions. 59.01 Discussion with Excluded Manager or Excluded Designate within 72 hours of issue/concern. Excluded Manager or Excluded Designate provides written response within 72 hours. Satisfied with Results? 59.02 Not Satisfied with Results? Fill out a PRF within seven calendar days of written response. cc: BCNU Steward, Excluded Manager and PRF Committee. 59.03-59.05 Not Satisfied with Results? Attend PRF Committee Meeting within 14 days. Final written report 30 days following meeting. Report provided to Nurse and Union. Satisfied with Results? Not Satisfied with Results? 59.06 Union MAY refer PRF to Senior Review Committee (SRC) within seven days of PRF committee report. SRC has 60 days to issue recommendations to Union and Health Authority. Recommendations that are unanimous are binding. Recommendations that are not unanimous detailed in report to Union and Health Authority for further consideration. Page 13
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INITIAL CONVERSATION Email Template (59.01) (Today s date) Dear (Excluded Manager), On (date) I encountered a nursing practice concern that I would like to talk to you about. (Have the nurse tell their story - what happened, what was done to remedy the situation and recommendations). As per Article 59, I would like to engage in the first step of the Professional Responsibility process which is a discussion with my excluded manager with the objective of resolving the concern within 72 hours of identifying it. I have availability to meet (dates/times). I may bring a steward to the meeting and a completed PRF to reference during our discussion; I will not submit my PRF until I have had the opportunity to review your written response. If we are unable to meet, I am willing to continue this dialogue via (phone/ email /video-conferencing) in the interest of meeting the timeline. My understanding is that within 72 hours following our meeting you will provide me with a written response including an outline of the actions to be taken to address my concerns. Thank you and I look forward to discussing this with you further. Sincerely, Nurse TIPS 1. A nurse with concerns related to nursing practice conditions, safety of patients and nurses or workload should use this email template to initiate the first step of the PRF process the conversation with the excluded manager. 2. Please put in your email subject line: Article 59.01 PRF process discussion with managers. 3. Remember a face-to-face conversation is the preferred method! 4. Dialogue involves an exchange of ideas or opinions with a view to attempt to reach an agreement. Page 15
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PROFESSIONAL RESPONSIBILITY (PRF) LANGUAGE COMPARISON FBA A Excluded supervisor (or designate) NBA Excluded manager (or excluded designate) Raise issue within 72 hours Request a written response Written Response 72 HOURS NO RESOLUTION? 14 DAYS File a PRF Meeting with Excluded Supervisor & Senior Nurse Leader 14 DAYS Written Response NO RESOLUTION? Encourage all FBA & NBA PRFs to be dealt with at the PRF Committee. (Stewards are to suggest at the Union/Management meetings). NO RESOLUTION? 7 DAYS File a PRF 14 DAYS PRF Committee Meeting 30 DAYS Written Report to member to union 7 DAYS Resubmit PRF to COO (or equivalent) Meeting with COO (or functional equivalent) or designate, Senior Nurse Leader & the Union NO RESOLUTION? Union may refer to Senior Review Committee 60 DAYS Recommendations issued to Union & Health Authority 14 DAYS Written Response Unanimous recommendations? BINDING Not unanimous? FURTHER CONSIDERATION 1. Excluded Supervisor should be an excluded manager or minimally a DC3 or DC4 with supervisory responsibilities 2. Senior Nurse Leader should be someone with a nursing background in a position of leadership 3. Steward may accompany member to meeting at all steps 4. NOTE: LPNs must use the FBA form but may also sign onto the NBA form! 1. The NBA PRF Process has been streamlined to three steps with tighter timelines 2. 72 hours for you talk to your excluded manager; 72 hours for your manager to respond in writing 3. PRF Committee to attempt to resolve issues in 30 days; written report to nurse & Union 4. Senior Review Committee final stage of process Page 17
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TIPS FOR FILING A PRF N Nursing Practice Conditions Describe patient acuity and intensity and the impact on your standards of practice and your ability to provide safe care. Are there current evidence-based policies and procedures to support your practice? Were you able to carry out your patient care plans or implement physicians orders? Describe what you were unable to complete and the implications for your patients and/or your practice. Did you receive an orientation to the unit/program? Did you have access to professional support, guidelines and education? Did you care for patients that exceeded your competencies, skills, training or education? Were you able to provide patient education? Is nurse autonomy and empowerment in the workplace supported (e.g., opportunities for meaningful input)? Did organizational or institutional systems issues impact your ability to meet your Professional Standards of Practice? Patient Safety and Nurse Safety Did you file a PSLS? Please include the number. Was there a workplace injury or near miss (e.g., injury report/ call centre data report only)? What factors contributed to the incident (e.g., inadequate or malfunctioning equipment)? Did you have adequate safety equipment (e.g., patient lift, O2, call bell etc.)? Did your assignment include confused or aggressive patients? How did the workplace culture or moral distress impact you and/or your patients? Have you experienced nurse fatigue resulting from: missed/ late breaks, OT, excessive on-call, worklife balance, etc.? Have you received safety training - general and for new equipment or procedures? Are there security issues? Page 19
TIPS FOR FILING A PRF Workload Were baseline staffing levels met? Did you request and receive replacement like-for-like (e.g., RN for RN)? If not, what replacement was provided? Accurately describe the number of sick calls, leaves etc. that contributed to the need for replacement. Was the unit over census? By how many patients? Identify the number of funded beds versus unfunded beds if over census. Was workload required to support the acuity and intensity of patients and skill mix? Was workload received for the entire shift or partial shift? Is there a sufficient casual pool? Indicate the number of admissions, discharges and transfers on your shift. Are there current vacancies? Were you assigned additional duties over and above your assignment (e.g., in-charge with patient assignment)? Were you affected by the staffing complement: lack of specialty training, novice vs. expert, orientees, students, skill mix, floating? Were you able to complete all required documentation in a timely manner? What non-nursing duties were you required to perform? What other contributing factors impacted your work (e.g., lack of physician support, lack of allied health workers)? Page 20
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ROLES - General Overview Committee Co-Chairs: PRF Author(s): Excluded Manager: Union Steward: Are neutral parties to ensure thorough exploration of the issues. Ensure an action oriented focus is used. Identify an alternate for themselves. Set meeting dates & coordinate notification of participants. Adopt Terms of Reference and PRF Guiding Principles. Develop climate goals for meeting. Ensure that the ad hoc members understand their roles and responsibilities. Presents the issues. Proposes solutions. Gives feedback on manager s suggestions. Responds to concerns and issues. Engages in dialogue and problem-solving. Provides PRF author(s) with a written response as per Article 59.01 that outlines what actions are to be taken and any unresolved concerns prior to PRF Committee meeting. Assists in representing the member s interests by offering support and guidance. Ensures that processes are fair and respectful. Follows up with PRF author(s) prior to 30 days to determine any outstanding, unresolved actions/issues. As per Article 59.05 The PRF Committee will have thirty (30) days following the meeting to attempt to resolve the identified concern(s) and to submit a final written report to the nurse(s) and the Union identifying the actions to be taken and the timeline for implementation.
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ROLES and RESPONSIBILITIES: Member and Stewards Successful use of PRFs relies on both members and stewards working together by following through on their respective roles. MEMBER STEWARD ROLES AND RESPONSIBLITIES ROLES AND RESPONSIBLITIES Talk to your steward about worksite issues or concerns. Discuss the issue with your excluded manager within 72 hours. You may bring your steward. Get written response from your manager after the conversation (72 hours to complete a PRF). Ask a steward for help if needed to complete a PRF; fill out a PRF on-line ideally point form is acceptable include your personal contact information, date and response from your conversation meeting with your manager. Keep your own copy of your PRF. Send a clear legible copy to your steward, excluded manager and chair of the PRF Committee. Attend all scheduled PRF meetings. The PRF process is designed to hear from the member. It s your responsibility to attend the meeting and your participation is crucial. If you do not attend the process grinds to a halt and the issue(s) remains unresolved. Be prepared to support your issue(s) with other data and information. Let your steward know if your PRF is resolved or not after your discussion with your excluded manager or after the PRF Committee action plan is completed. Support members in voicing concerns and raising issues. Maintain communication with members throughout the process. Encourage nurses to engage in the PRF process when issues arise. Provide education and assistance to members in filling out PRFs. Attend PRF Committee meetings to support and assist the members involved. Track PRFs as they move through the PRF process including the action plan and outcomes. Send all PRF(s) filed that are advancing to the PRF Committee to the Union office. NOTE: You may use parallel processes concurrently to address nurses concerns (e.g., PSLS, hazard reports, grievance process).
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ROLES and RESPONSIBILITIES EMPLOYEE AND EMPLOYER CO-CHAIRS Responsibilities Related to PRF MEETINGS Responsibilities Related to the PRF PROCESS Adhere to the negotiated Terms of Reference and Guiding Principles. Establish and communicate local PRF processes including: Chair the PRF Committee meetings, develop the agenda and ensure actions completed are reviewed after 30 days. Which people in the worksite need a copy of a PRF when it is submitted? How will they get it? Ensure issues and nurse recommendations are explored thoroughly and in a respectful manner: ask probing questions seek information listen and remain neutral review data and documents Keep the dialogue focused on issues, not on the people involved. Produce and distribute a document that highlights the discussion and includes an action plan with timelines and the person responsible. Who will contact the nurses and managers to book the PRF Committee meetings? Ensure all participants know they must come to the meeting prepared and be part of the action planning. How will the action plan be communicated? Shared? Monitor PRF progress/status. Attempt to resolve concern(s) within 30 days. Complete a final report indicating completion of actions or advancement to both the nurse(s) and the Union. Ensure timely final reports/responses are received by the nurse(s) submitting the PRF. Ensure excluded manager is aware of outstanding issues and is notified when PRF(s) are to be advanced to the Union. Page 29
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Checklist for Advancing PRF(s) from the PRF Committee to the Union In order for the Union to consider advancing the PRF(s) to the Senior Review Committee (SRC) as per Article 59.06, the following documents MUST be included with the summary form attached. Mandatory Documents Required Copy of the PRF(s) Written 72 hour response from the excluded manager Action plan including specific items, timeline and key person responsible for implementation (as per page 2 of the summary form attached) Meeting notes completed during the 30 day action period Data and Documents (as applicable) As the NBA PRF Steward or NBA PRF Committee Co-chair please ask the appropriate manager for any pertinent information that would be useful evidence to support the nurse(s) outstanding action items. Use your own judgment in determining what would be helpful as per the examples below. Please make this request at least twice in writing in a timely fashion. Notify the Professional Advocacy Officer (PRF) of the status of your request and contact your LRO about filing a grievance (under Article 59.04) if no information is forthcoming. Please note that Article 59.04 states: Members of the committee shall have access to documents and data as may be necessary to assist in satisfactory resolution of the nurse(s) concerns. Please tick only the applicable boxes PSLS information: required not required requested received Work Safe orders: required not required requested received Baseline staffing numbers: required not required requested received Page 31
Rotations/scheduling processes and policies: required not required requested Pertinent employer policies, e.g. OCP, diversion: required not required requested received received OT / sick time stats: required not required requested received Percentage novice versus senior staff: required not required requested received Nurses with appropriate specialty training: required not required requested received Number of casuals/relief: required not required requested received Call-in logs and final staffing complement for staff: required not required requested received Acuity and intensity measurement data: required not required requested received Admissions / discharges / transfers: required not required requested received Orientation schedules: required not required requested received ALC stats: required not required requested received Pertinent Grievances: required not required requested received Relevant research and/or program comparisons: required not required requested received Historical Information: (e.g., old PRFs, campaigns etc.) required not required requested received Other requested received Page 32
PRF Committee Final Report and Chronology of Events This must be completed and submitted to the nurse(s) and the Union (Article 59.06) if issues remain unresolved at the PRF Committee. Worksite: Unit: PRF author(s): Date of incident: Date nurse reported incident to manager: Date of conversation with manager: Date of written report received by nurse(s): Date of PRF committee meeting: Present for the NBA at PRF Committee meeting: Present for Employer at PRF Committee meeting: Page 33
List of mutually agreed upon actions to be taken within 30 days: (must include timelines and the individual responsible for each action) Page 34
Outstanding actions not completed after 30 days as identified by the PRF author(s): Page 35
Date minutes and final report summary reviewed with PRF author(s) re: actions not completed: PRFs to be advanced to the Union X NBA PRF Steward X NBA PRF Committee Co-Chair PRF Steward Contact Information PRF Committee Co-Chair Contact Information Name: Name: P. P. C. C. Email. Email. Page 36
Outcome Type 3 Page 37 Attach ments (Optio nal) NOTE: Each worksite that has PRFs will receive quarterly reports requesting your PRF status. PRF FACILITY CLOSING TOOL Worksite Name: Date: The PRF will not be advanced because... PRF was resolved at... Filing the PRF resulted in... BCNU File Number Date of PRF PRF Author(s) Unit Discussion / Actions Arising Date closed Result Closing Level Outcome Type 1 Outcome Type 2 5-666-017.160 28- Dec-11 5-666-017.165 29- Dec-11 5-666-017.170 30- Dec-11 Shawn Swenson ER Ken Ro Medical Paul Kelly OR 2-Jan-12 Resolved 1-Nov-12 Resolved Excluded Manager SRC Committee Changes to staffing levels, Allied Health Equipment provided / fixed Communication improved 5-666-017.173 31- Dec-11 5-666-017.200 25- Feb-12 5-666-017.140 8-Apr- 11 5-666-017.150 11- Nov-11 Galan Peters Kasper Steward Kasper Steward Shawn Swenson Psychiatry (Acute) Psychiatry (Acute) Psychiatry (Acute) ER 2-Jan-12 Resolved Excluded Manager Changes to staffing levels, Allied Health Communication improved Instructions : 1. Enter information under yellow highlighted areas 2. To enter information, click on the cell and a drop down box arrow will appear. Click on the arrow and make your selection. 3. For outcomes you can select one per column (up to 3 outcomes).
No longer employed at facility Excluded Manager Changes made to programs / services offered Withdrawn Changes to staffing levels, Support Services Patient Acuity tool developed / implemented Patient Assignment tool developed / implemented Policies or Procedures changed / developed Workload measurement tool developed / implemented Page 38 RESULT Abandoned CLOSING LEVEL Unknown OUTCOME TYPE Changes made to physical unit No longer working in unit/area PRF Committee Changes to staffing levels, Allied Health Resolved SRC Committee Changes to staffing levels, Nursing Communication improved Education provided Equipment provided / fixed Increased availability of Casuals Rotation change Unknown
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Professional Responsibility PRF NBA TOOLKIT