Loading...
HomeMy WebLinkAbout1990-1890.Andrews et al.91-01-14 ONTARIO EMPLOYES DE LA COURONNE CROWN EMPLOYEES DE L'ONTARIO DUNDAS STREET WEST, SUITE 2700, TORONTO, ONTARI'O. MS,G ~Z$ TELEPHONE/TEL£-PHONE: (4 16) 326- t388 RUE DUNDAS, OUEST, BUREALt 2100, TORONTO (ONTARIO..]. M5G IZ8 FACSiMILE/TELECOP/E : ~4 ~6) 326-'t$96 189~89,197/90, 202/90 IN THE MATTER OF AN ARBITRATION Under THE CROWN EMPLOYEES COLLECTIVE BARGAINING ACT Before THE GRIEVANCE SETTLEMENT BOARD BETWEEN - OPSEU (Andrews et al) Grievor - and - The Crown in Right of Ontario (Ministry of Health) Employer BEFORE: J. Samuels Vice-Chairperson S. Urbain Member D. Daugharty Member FOR THE N. Coleman GRIEVOR Counsel Gowling, Strathy & Henderson Barristers & Solicitors FOR THE A. LeGault EMPLOYER Counsel Fraser & Beatty Barristers & Solicitors HEARING: September 12, 25 1990 December 17, 1990 There are about 57 grievances before us concerning the classification of the nurses who work in the twelve out-patient clinics of the Queen Street Mental Health Centre in Metropolitan Toronto. These grievances fail into three groups. Two of the groups of grievances are filed by nurses classified as Nurse 2 General who claim that. they ought to be classified as Nurse 3 General. The other group of grievances is filed by nurses classified as Nurse 3 General who claim ~hat they ought to be classified as Public Health Nurse 2. In order to facilitate the disposition of all of these grievances, at the urging of the Board, the parties agreed to present as an example the case for the Nurse 2 Generals at the Lakeshore Outpatient and Community Services Clinic. This award deals with this example only. We. hope that this decision will assist the parties to resolve the other grievances over which we retain jurisdiction. The twelve out-patient clinics of the Queen Street Mental Health Centre help patients with mental illnesses to function outside the hospital environment. The clinics are staffed by psychiatrists, social workers, psychologists, clerical employees, occupational therapists, recreationists, vocational rehabilitation counsellors, workshop instructors, and nurses. These employees offer clinical and rehabilitation assistance. The clinical staff is concerned with the treatment of the mental illness itself. The rehabilitation staff is concerned with improving the patient's ability to cope with the activities of daily living, such as finding a job and managing one's finances. The grievors are the clinical nurses. They provide professional nursing service in the clinics and in the patients' homes. Ms. Cindy Arthurs has been employed at the Queen Street Mental Health Centre since April 1981 and went to the Lakeshore Outpatient and Community Services Clinic as a Nurse Therapist in August 1981. She is a 3 Registered Nurse, and has a Bachelor of Arts from the University of Toronto. She came to Queen Street with about six and one-half years of experience in psychiatric nursing at the Clarke Institute and York Central Hospital. She told us in some detail about her work at Lakeshore. She is classified as a Nurse 2 General, and her Position Specification is appended to this award as Appendix A. This job description was prepared in 1990, but the parties agreed ~at Ms. Arthurs' job was the same in 1990 as it was when her grievance was filed in 1989. At ~akeshore, there is a clinical unit' and a rehabilitation unit. The clinical unit consists of a head nurse, four nurse therapists, one senior social worker, two social workers, four part-time psychiatrists, two psychiatric residents, one psychologist and two clerical workers. Ms. Arthurs is;one of the four nurse therapists. These people treat patients who come to the clinic from all over Metropolitan Toronto. Ms. Arthurs has a caseload of roughly 60 adult patients, who have a broad range of major mental illnesses and/or psycho-social dysfunction. Her job is to treat these problems so that the patients are able to operate in the community at their highest level of function. She is involved with the admission of patients to the clinic. Part of one day per week is spent dealing with people who come in the door for help. Some have been referred to the clinic by community agencies, hospitals, physicians, lawyers, or police. Some have been referred to Ms. Arthurs specifically. She determines whether the person is eligible for admission and whether the person needs immediate access to a therapist. The new-comer will not be admitted if he or she is already t~eing treated by a therapist, nor if the person needs immediate hospital care (in which case, the prospective patient is sent to a hospital for in-patient care), nor if the primary problem is substance abuse (in which case, the prospective patient is sent to another agency). 3 Registered Nurse, and has a Bachelor of Arts from the University of Toronto. She came to Queen Street with about six and one-half years of experience in psychiatric nursing at the Clarke Institute and York Central Hospital. She told us in some detail about her work at Lakeshore. She is classified as a Nurse 2 General, and her Position Specification is appended to this award as Appendix A. This job description was prepared in 1990, but the parties agreed'that Ms. Arthurs' job was the same in 1990 as it was when her grievance was filed in 1989. : At Lakeshore, there is a clinical unit and a rehabilitation unit. The clinical unit consists of a head nurse, four nurse therapists, one senior social worker, two social workers, four part-time psychiatrists, two psychiatric residents, one psychologist and two clerical workers. Ms. Arthurs is-0ne of the four nurse therapists. These people treat patients who come to the .clinic from all over Metropolitan Toronto. Ms. Arthurs has a caseload of roughly 60 adult patients, who have a broad range of major mental illnesses' and/or psycho-social dysfunction. Her job is to treat these problems so that the patients are able to operate in the community at their highest level of function. She is involved with the admission of patients to the clinic. Pax of one day per week is spent dealing with people who come in the door for help. Some have been referred to the clinic by community agencies, hospitals, physicians, lawyers, or police. Some have been referred to Ms. Arthurs specifically. She determines whether the' person is eligible for admission and whether the person needs immediate access to a therapist. The new-comer will not be admitted if he or she is already being treated by a therapist, nor if the person needs immediate hospital care (in which case, the prospective patient is sent to a hospital for in-patient care), nor if the primary problem is substance abuse (in which case, the prospective patient is sent to another agency). The nurse therapist assesses the mental status of the new-comer-- why is this person here? is there a major mental illness? is this person suffering from delusions? is he or she hallucinating? organized? suicidal? how can we help? The initial interview and the nurse's assessment is recorded in writing. If the nurse thinks that the person should be admitted, she makes an appointment for the person to see one' of the clinicians, perhaps herself, if there is a major mental illness, Ms. Arthurs will enlist the help of a psychiatrist, because the psychiatrist is the only person who can prescribe medication. This initial decision is brought to the next meeting of the multidisciplinary team, which meets two times per week. The team consists of all of the clinical staff. It discusses the new cases and the preliminary admission decisions. Suggestions are made. The preliminary admission decisions made by the admiring nurses are rarely overturned. The formal admission forms will be signed by a psychiatrist. Thus, every admitted patient will have been discussed at least once with a psychiatrist. After a patient is admitted, a nurse therapist will meet with the patient and will prepare a treatment plan. If medications are required, a psychiatrist will be asked to assess the patient and to prescribe the drugs. If medications are not required, the nurse will administer psychotherapy, which involves on-going meetings and assessment. Where treatment is confined to psychotherapy, generally the psychiatrist will not be involved with the patient apart from signing the formal admission form.' The nurse therapist will arrange for vocational assessment,' psychometric or psychological tests, various forms of community support (for example, assistance of a rape crisis centre, if sexual abuse is involved; welfare; family benefits; housing; individual, family, or couple counselling). 5 Once a week, the clinical staff meets with' the rehabilitation staff to discuss the rehabilitation needs of the clinical patients (for example, how to find a job, or how to manage one's finances). The nurse's treatment plans for her patients are discussed at the meetings of the multidisciplinary team. And once a week, all the nurses get together to discuss the cases, and other matters. A psychiatrist attends these meetings, because of his or her professional interest in the psychotherapy administered by the clinicians. Ms. ~rthurs receives virtually no direction from her head nurse. There is no regular contact with the head nurse concerning the caseload or Ms. Arthurs' day-to-day work. The head nurse does an annual performance evaluation of Ms. Arthurs. ThoUgh the Position Specification found in Appendix A says that the work involved with the client case load occupies 55% of the nurse therapist's time, Ms. Arthurs testified that the figure ought to be 65-70%, and this was not challenged. The second set of duties described in the Position Specification "undertakes responsibilities consistent with professional training..."--take up about 20% of her time, says Ms. Arthurs. Is ~ls. Arthurs classified properly as a Nurse 2 General? The Class Standard for the Nurse 2 General is appended to this award as Appendix B. The opening.paragraph of this standard describes a job which involves treatment of patients in a hospital or other institution. And the next two paragraphs give more detail concerning the types of duties which will be performed in this structured environment record 'and carry out physician's instructions, administer medications and injections, watch patients' symptoms and take appropriate action, assist in feeding and ward housekeeping, perform duties in an operating room. This is the kind of job 6 which was involved in Gervais, 392/89 and Nichols et al, 778/89 to which we were referred by counsel for the Ministry. In these two cases, the grievors were ward nurses at the Penetanguishene Mental Health Centre- Regional Division. This is not the kind of job performed by. Ms. Arthurs. From the initial decision to admit the patient to the Lakeshore clinic, to the preparation of the treatment plan, to the carrying out of the required psychotherapy, Ms. Arthurs exercises a much greater degree of independe/~t judgment and responsibility than is contemplated within the structured environment of a hospital ward. A patient is in the hospital because a physician said this is where the patient ought to be treated. On the other hand, at the clinic, for all intents and 'purposes, it is the admitting nurse who/determines whether or not the patient should be admitted into the clinic. In a hospital, the physician is very much involved in the treatment administered to a patient, both in the planning of that treatment and in its giving. In an out-patient clinic like Lakeshore, the physician (psychiatrist) may have very little involvement with some patients--it is the nurse therapists who develop the entire treatment plan and administer it. At Lakeshore, for many patients, the~ psychiatrist is there in the background, but is not involved at all as is a physician with a patient in a hospital. In our view, Ms. Arthurs is not properly classified as a Nurse 2 General. Would she be classified properly as a Nurse 3 General? The Class Standard for Nurse 3 General is appended to this award as Appendix C. The first paragraph of this standard, like the Nurse 2 General standard, speaks of work in a hospital or other institution. However, the second paragraph contemplates a broader range of operating environments. The last sentence of this second paragraph says that such" employees may conduct clinics or provide outpatient, orthopaedic, or emergency care. This would fit Ms. Arthurs. The second sentence of the second paragraph speaks of overseeing treatment procedures. This is the heart of Ms. Arthurs' job. The first sentence of the second paragraph speaks of exercising "some independent judgment and initiative". One would expect that a qualified registered nurse would always be exercising a measure of "independc'nt judgment and initiative" in carrying out nursing duties. This reference in the standard must mean some higher level of judgment and initiative than would be the general rule in the performance of nursing duties. And, given the job we have described as Ms. Arthurs', we have no difficulty;in concluding that she does exercise a greater degree of independent judgment and initiative than is generally the case in the performance of nursing duties..Indeed, when Ms. Arthurs first applied for the out-patient job at the Centre, she was told by her supervisor that the job needed more experience than an in-patient job, that more skill and responsibility was involved. And Ms. Arthurs' testimony concerning the job bears this out. In our view, Ms. Arthurs would be classified appropriately as a Nurse 3 General. We did hear testimony concerning the job done by Ms. W. Beaton, a Community Nurse Clinician at the Whitby Psychiatric Hospital, who is classified as a Nurse 3 General. In our view, there is little substantial difference between the position occupied by Ms. Beaton and the one held by Ms. Arthurs. It appears to us that Ms. Beaton is properly classified, and Ms. Arthurs would be properly classified at the same level. But let us be perfectly clear. We find that Ms. Arthurs ought to be classified as a Nurse 3 General because her job fits within the Class Standard for Nurse 3 General, not merely because she is doing the same work as Ms. Beaton. Ms. Arthurs should be reclassified to Nurse 3 General as of 20 days before her grievance, and should be compensated for any monies she ought' to have been paid and was not paid because of her improper classification, with interest at '10% per annum on any sum from the date it ought to have been paid to the date it is paid. We will reserve our jurisdiction to deal with the other grievances mentioned at the outset of this award, and to deal with any matter conceming:the implementation of our order with respect to Ms. Arthurs. Done at London, Ontario, this 14th day o.f January , 199~. a.nuels, Vice-Chairperson S. Urbain, Member D. Daugh~/.~,, Mer///~er  Position SF 'lcatlon & Class Allocation-CSt 615[ ~ ~ .~: {Rsler ~ ~acX ol Iorm lot cornple~on InsVucl~ons), ~ 05 - 9771 - 75 Queen Street H~pta~ He~th CeE[~~ 313~LaXesho~e Slvd. N., TorOnto Peportfn9 to the Head Nurse and i~ collaboration ~ith the muiti~isciplinary team, the Registered Nurse reintegrates an~ maintains adultS, with a b~oad range of major mental illnesses and/or psycho-social dysfunction, in the co.unity at their highest level of fdnctfon, 3. Outlet and lelat~ ~ (what it a~eym r~v~r~ to do, how mhd why? Indic~le ~r(ent~ ol dme ~ ~ ~aCh 1. Coordinates a client case load by: - screening re{errals f~om co.unity agencies, hospitals, physicians, la.ers, ~lice a~ the public to ~et~rmine clfen%'s eligibility for a~ission as outline6 by ' a&mission criteria; - :e~irec:ing inappropriate referrals to more appropriate co.unity sgencies o; ~t~tams ; to ensure appropriate client p[acement and coo~rative comunity ~elat/ons; - - eliciting, evaluating and documenting, from ¢omunity sources, the client or the ~amily,~ all relevant inJot~ation suc~ as referral circumstances, psychiatric and me&lcal ~istory hospitalization ~equency, medication requirements, supports and employmen: to assess client fog a~ission and treatment reco~en~atfons~ ;' - formulating, in consultation wi~h the client and the multidisciplinary team, a treat~nt~ 55% plan which may include supportive counselling, medication, group therapy, v~tiopal assessment, psychometric testing, family or couple counselling, co.unity supports, rehabilitation prograg; _ - ~nitoring and assessing client's response Co treaCmen: plan through interview and counselling sessions, family and co.unity feedback and/or behavioural observe=loB; - alterin9, in consultation with the clien%,-%he mul:idisci~linary teem and/or psychiatrist, [he treatment plan as reguired by interview and ObServational ou%co~s; - idestifying,contac%ing and assis:in~ the client gain access to ~eeded medical and social sup~rt services such as medical, welfare and housing services~ - co~unicating with clieo/'s social add eo~uni~y networks such as family, friends, landlords, physicians a~d ~lice to ensure co.unity sup~r[ and =onsis:ency; - intervening in clien~ crisis either in the clini¢ or ho~ e~vironment to ensure ~%~ client receives the sup~rt and resources required to resolve ~he crisis such as counselling, medication or hospi~alizatiom; ~Cont'd 4. Skills and k~owledge tequit~ to ~dorm job ~t fuU w.orkin9 level (i.d~gttt ma.~to~y g~tla~t ~, liga~m, i~ ~egistered as a nurse iB Ontario; %brough knowledge of general and psychiatric nursin9 theory -- and prac[ice to include knowledge of psychiatric illnesses, disorders am~ bebaviours; knowledge JoAnn ~avey Jovc~ painv~llg~ Assistant A~in{~t~atn~. '~, Clisl ilio=ti~ Cliu title ICllss c~e O=u~lioal ~p numar Eltgt~ ~Urse 2, General 50052 SP-06 Ol 1 OX ~90 A. Emp[oyee~ provide nursing cate :o pa:tents assoc~a:e~ ~Lth &n On:a:~o Pe:[orm a variety o[ p:o[esS~one[ nursing ~utLes under dgrect~on o[ su~v~s~g nurse, e. adminis:er medication, watch for pa:tents symptoms or reactions~ assist patients with their ~rSonal needs; provide information and counsel to patients' relatives. c. Beporti~g to a Head Nurse, the [ncumbent~ a4mi~ister medication to clinic clients~ elicit infotmation; formulate, monitor and alter, in consults%ion with the multi-disciplinary team (lnclude~ physician), a treatment plan; i~tervene in client crisis to ensure adequate are accessed;co.uniters with clients' social and co.unity networks which includes relatives. 19 1 f I 9C John Loibvc~ '& ~ ~,~ tnstructions Ior completing form ~,.6150 'l Cia.tilled Furl and P~d.llme poaltiona: F~ to ~ ~.t~ ~ ~ .mk.~ .~ ~ ~ Fu~ C~ Uncla~llled Seasonal Posilions [Group 3): ~.L. ~z ~ ~d e IxCipt f~ ~ F~ ~ ~Z ~ A~t other positions: ~tet~, of ~t ~m in ~S ~ ~ ~*~ o~ a~ve ~ Un~ili~ ~ Po~l~ns. ~ ~. Instructions lot coding Position tdentllier instructions lot c~ing Seasonal wo~ Period Code Fu~me U~B~ ~o~ md~. Feb, M~ Grip 3 wee~ ~ ~e bu~ ~ ~n 4 m~ 3 B~lld ~e ~ Io1~: b) ~o~ w~ ~ 4 ~n~i~ · Sl~il Huon. I.t.. Spring monih~ m moll b~ ~q Ih~ 1Z mon~ 4 · MullipM leaSo~, if.. Summa. Fail. Instmcl~ons for coding' Sch. Hfs. Wo~ ~. In~le 2. tn~ c~ ~ coMec~ wN~ by R.P,T. emp1~e~ illtgfl~ lO I ~il~n j ~. / Ih~ ~[ll~ ~ C~ ~ Ihe ~ch~uled H~S 01W~ will 4.Skills and KnOwledge: (concinueO) knowledge of hospital an~ clinic poliey an~ procedure, knowledge of co.unity resources. Mental HealCh Act, ~ealth Pfsciplines Act and ~ublic Hospitals Act. "' Duties and related tasks: (continued) - counselling f~milies to improve knowledge and acceptance of client's illness or Co address family concerns; - utilizing psychotherapy techniques, under the general direction of the psychiatrist, such as clear, concise direction, advice, and support or insight counselling to assist clients deal with situational problems. 2. Undertakes responsibilities consistent with professional training by: . - administering medication to clinic clients either orally or parenterally to ensure prescribed leYels are maintained; dispensing short term emergency medication packages to clinic clients to ensure medication availability; acting as a resource to multidiscipliRary team by providing information ~0% iP discipline-specific expertise, i.e,, medication, side effects and physical assessments; maintaining accurate and timely client documentation such as psychiatric ? history, rehabilitative ~treatment, treatment interventions and response, and treatment alterations to ensure effective interdisciplinary com~unicatio: - supervising nursing students to enhance student knowledge of the Community focus; - reyiewing nursing research opportunities to contribute and ensure progress in the field of mental health nursing. 3. Participates in Clinic Administration and development by: - participating vi%h and contributing to community advisory boards and committees to liaise or to enhance community perspective; - providing educational sessions to colleagues or community groups to enhance clinical Or program knowledge and understanding; 10% - participating, planning, recommending and implementing group or program initiatives to meet client needs and tO broaden clinic services; participating in the development of clinic policy and procedure as requested. 4. Performs other related duties such as: orientating new s~aff as required 5% relieving Head Nurse as required as assigned. _/ CATEGORY: $c£en~ ¢ and G~ROU~: SP-Q6 SER~E$: Nurse, General CT. ASS CODE: 50054 Sun~aar? Specificaciom NURSE 3, OENE~L CLASS DEFiNITiON: Employees ~n posit~ons allocated to ~his class provide p~ofess~onal supervision of the nursing amd personal care of a'group of patients in an infirmary, wadi or administrative unit of an Ontario Hospital or other provincial ihstitution. Most posAt[ons ~n th£s class are found on the day shift. In such poszt~ons these employees schedule duties, arrange ~the rotation of shafts and counsel and discipline staff as required. Although employees ~n this class receive direction from supervisory nursing, medzcal or institutional staff, they are ~equxred to exercise' some ~ndependent judgment~amd Ami~iative, -~ar~icularly ~n emergencies. They oversee treatment procedures, review char~s, prepare reports, maintaim records, ehsure general maintenance and cleamliness of ward facilities, order supplies, supervise the provision of food services ~o patients and assist ~n staff training programs.. They may conduct clinics or provide outpaczent orthopaedic or emergency care. QUAL[FTCATYONS: 1. Registration as a murse zn 0n~ario; goo~ knowledge of professional ~heory amd practice' as applie~ to imstitutional murs~ng; preferably comple~iom of a pos~-graduate certific~te course [n nursing administration., 2. MinAmm'~ of ~o years of acceptable grad~te nursing e~erience, preferably related ~o ~he ~u~ies ro be perfo~ed, Ab~l~- ~ ~upe~xse wa~ or ~fi~ nursing semites; ability to mee~ the public ~d to provide co~sel to staff ~ :o patients' ~e~at~ves a~ req~Ared; znit~ative; good physical ~ mental health, ~ " .~'~ ' CATEGORY: Scientific and GROUP: SP-06 Nursing ~ ~" *~l SERIEs: Nurse, General CLASS CODE: 50052 Su~m~ary Specification NURSE 2, GENERAL Employees in positions allocated to this class perform a variety of professional nursing duties for patients in Ontario Hospitals and %n znf%rmaries of provincial schools and institutions. Their duty hours are usually rotated be~een any of three shifts. Unde~ direction of a ~upervisin~ nurse, physician or other institutional officer,' they record and carry, out physicians, instruc- tions on treatments and transfers, administer medicines and h}-podermic %n3ections as authorl:ed,.obtain patients? confidence and encourage their ~nterest in actsvkties, watch for patients? symptoms or reactions and take remedial action as required~ assist in or supervise patient feedzng and ward housekeeping, assist patients w~th their ~ersonal needs and.care, record patients' cond:tions and report unusual incidents to sup~rtor~ They may accompany patients to special treatments or on transfers as required and provide information and counsel to patlents? relatives as authorL:ed. [n ad~ition, these employee~ may also make arrangements for preparation, sterilization and issuin~ of sur{ical and operatin{ room suppiles ensure aseptic condition of operatin& rooms, assist'in surgical procedures and provide pre or post-operative nursing care of patients. rn some positions~ where these employees may be on .twenty four hour call as required, principal duties of employees in this class may be provision of f:rs: aid: clinicaL, and infirmary care under direction of a full or part-time physician. Employees u~ ~his class ma}' assist in or supervise the assigr~en: cf au~les an~ check the work of subordinate staff on the same shift.. De~en~!ng on factors such as the hours of duty, the size and the amount of active nursing requzred %n the administrative unit~ they are'responsible to a suDerv%su~g nurse for ail or par~ of the nursing and personal care in an administrative unit as assigned They may. on occasion, relieve su~er- qUALI~[C~TIO5$: Regzsrration as a nurse in Ontario; preferably completion ef graduate certificate courses from a university of recognized standing. A~.~L~ty to obtain co-operation of staff and patients; ability fellow and ~o pass on verbal and written instructions on patient care: goo~ physical and mental health.