HomeMy WebLinkAboutKarpova Group 19-02-28
IN THE MATTER OF AN ARBITRATION
BETWEEN:
Seneca College
(“the College”)
and
Ontario Public Service Employees Union (Support Staff)
(“the Union”)
Karpova Group Grievance – Classification – OPSEU # 2017-0561-0009
ARBITRATOR: Mary Lou Tims
APPEARANCES:
FOR THE COLLEGE: Nadine Zacks – Counsel
Nina Koniuch – Chair, School of Nursing
Karen Mendler – Director, Compensation, Benefits and HRIS
Marie Mach – Senior Compensation Specialist
Ted Bridge – Director, Labour and Employee Relations
FOR THE UNION: Janice Hagan – Union Representative
Cindy Cyrus – Union Steward
Shauna Smith – Grievor
Iryna Karpova – Grievor
Hearing held in Markham on February 28, 2019
AWARD
INTRODUCTION
[1] Ms. Iryna Karpova, Ms. Adesola Anjola, and Ms. Shauna Smith filed a grievance
dated October 2, 2017 (“the grievance”) alleging that the position of Clinical Supervisor,
School of Nursing, at Seneca College has been improperly classified and seeking
reclassification and retroactive compensation.
[2] The parties’ representatives advised that separate grievances were filed by other
Clinical Supervisors, and the Union referred to Ms. Harjit Brar, Ms. Karen Pileggi, Ms.
Misha Jadoo and Ms. Dennise Morgan as additional grievors. While only the grievance
form completed and filed by Ms. Karpova, Ms. Anjola and Ms. Smith was available at
the hearing and entered in evidence, and while Ms. Karpova and Ms. Smith were the only
grievors to attend the hearing, the parties’ representatives agreed that all individuals who
held the position of Clinical Supervisor as of the date that the grievance was filed, or
since such time, will be bound by this Award.
[3] There were no objections regarding my jurisdiction or the arbitrability of the
grievance.
[4] Written Briefs were filed prior to the hearing, in accordance with the collective
agreement. Included in the College’s Brief is an undated Position Description Form (“the
PDF”) which both parties agreed is the relevant PDF for my reference. Also in the
College’s Brief is a completed Arbitration Data Sheet. It indicates that the College
evaluated the Clinical Supervisor position at Payband K, and that the Union is of the view
that it belongs at Payband L.
[5] The parties identified in their Briefs that the issues in dispute were the content of the
PDF, and the rating of Analysis and Problem Solving, Service Delivery, and
Audio/Visual Effort.
[6] The Union initially argued that the PDF should be amended. The Duties and
Responsibilities section of the PDF provides that the Clinical Supervisor “assesses
students’ performance in giving client care” by engaging in enumerated functions. The
Union sought the addition of the following language there:
Assessing students’ written assignments, including learn notes, learn goals, care
plans; as well as providing written feedback bi-weekly as well as at mid-term and
final evaluations.
2
[7] During the hearing, however, the parties stipulated the following agreed facts:
• The Clinical Supervisor is the only College staff member to observe and
supervise students in clinical placements.
• Clinical placement is a required course or program component. Without
completing the clinical component of a program, a student does not
complete the program.
• The Clinical Supervisor’s assessment of whether a student satisfactorily
fulfills the requirements of a clinical placement is the only assessment that
the College can rely on in determining whether that program requirement
is satisfied.
[8] The Union’s representative advised that, given such agreement, the Union no longer
sought an amendment to the PDF. The content of the PDF was not otherwise disputed.
[9] The parties addressed the disputed ratings of Analysis and Problem Solving, Service
Delivery and Audio/Visual Effort.
[10] Counsel for the College emphasized that it is the Union that bears the onus of
proving that the Clinical Supervisor position has been improperly classified. Ms. Smith
and Ms. Karpova gave evidence for the Union, and Ms. Koniuch gave evidence for the
College.
[11] Certain factual context and some of the issues surrounding the grievance are usefully
noted here. Clinical Supervisors are Registered Nurses with the College of Nurses of
Ontario, and are required to hold current Certificates of Competence. They report to the
Chair, School of Nursing. As of October 2017 when the grievance was filed, that was Mr.
Tony Malette. Ms. Koniuch has been the Chair since October 2018.
[12] Satisfactory completion of a clinical placement is a required component of the
Bachelor of Science Nursing (“BScN”), Practical Nursing Diploma (“PND”), and the
Personal Support Worker (“PSW”) programs, and for international students upgrading
skills in order to write the College of Nurses exam in Canada. The evidence established
that at least students in the BScN, PND and PSW programs attend classes and skills
development labs on campus. I heard no evidence as to whether this is so for international
students engaged in upgrading. The College noted in its Brief that students complete
clinical courses in every semester following second semester, while the Union stated in
3
its Brief that students complete required clinical placements from second semester
onward.
[13] Clinical placements are offered in various types of facilities in the GTA, including
hospitals, nursing homes and rehabilitation centres. The College noted in its Brief that the
role of the Clinical Supervisor is somewhat unique in that the incumbents do not work out
of any of the College’s campuses.
[14] Clinical Supervisors work a forty hour week year round. The parties agreed that
during forty weeks of the year, the Clinical Supervisor supervises students in clinical
placements, and that there are no clinical placements in the other twelve weeks of the
year. Clinical Supervisors may be assigned to work with any level of student in any of the
relevant programs, and in any of the types of facilities in which placements are arranged.
[15] During each of the forty weeks in which students are engaged in clinical placements,
a Clinical Supervisor supervises three groups of students. The College endeavours to
place Clinical Supervisors in no more than two different facilities during any given
semester. Each clinical placement shift ranges in length from ten to twelve hours.
[16] Typically, a Clinical Supervisor supervises a group of six to nine students on a shift.
Students work one shift per week in their clinical placements during the relevant periods
of each semester. The Union noted in its Brief that students in clinical placements are
assigned one patient each during the first half of a semester, and two patients each during
the second half of a semester.
[17] The clinical component of the relevant programs requires students to put their
theoretical learning into practice under the supervision of Clinical Supervisors, except for
students in the final year of the degree program who are supervised by Nurse Educators
employed by hospitals.
[18] The parties offered different perspectives on the history associated with the position
in question. The College stated that prior to 2014, clinical courses within the relevant
programs were taught by partial load faculty members. According to the College, in
2014, the model was changed and the Clinical Supervisor role was introduced. In the
College’s view, the duties and responsibilities of the position were then revised. The
College asserted that partial load faculty members previously did all formal assessment of
students, and that now, “the written theoretical application/analysis assignments exist in
the classroom courses, where theoretical content is taught and assessed.” The Union, on
4
the other hand, stated that many of the grievors were part-time faculty members prior to
2015, and argued that “their jobs did not change with the change of bargaining unit.”
[19] The College included in its Brief a document dated August 16, 2017 entitled
“Clinical Supervisor’s Meeting – Job routines throughout the semester” which purports
on its face to attribute certain statements to Mr. Malette. While the Union accepted that
Mr. Malette may have communicated the College’s position that “evaluation is a Faculty
role,” it disputed that Clinical Supervisors were also at that time directed not “to do
written assessments.” Mr. Malette was not in attendance at the hearing, and no College
representative present at the hearing was at the August 2017 meeting and able to
comment on what he said at that time. The August 2017 document is not of assistance in
determining the issues before me.
[20] The Union included in its Brief the College’s November 17, 2017 Step 1 grievance
response in which the College stated in part:
In the College’s opinion it is the Professor/Coordinator’s responsibility to
evaluate students’ learn notes, learn goals, and care plans. Clinical Supervisors
only assess students’ clinical performance by observation and report them to the
Clinical Professor/Coordinator.
[21] Also included in the Union’s Brief is the College’s February 1, 2018 response to the
January 15, 2018 Step 2 meeting. The College stated in part therein:
It was communicated by Tony Mallette [sic] . . . that the Clinical Supervisors will
provide weekly feedback as this is critical for student growth and success.
Further Tony Mallette [sic] specified that formal evaluations are the responsibility
of the Professors/Coordinators.
[22] The Union commented on such communications in its Brief, stating as follows:
The clinical supervisors continued to assign Sat or Unsat to these learning tools
for clinical placement students until January 15th, the date of the Step 2 meeting of
their grievance, when they were first directed by the former program Chair, Tony
Mallette, [sic] that they were no longer to give these assignments a Sat or Unsat
grade, but were just to provide verbal and written feedback. . . . (para 5)
. . . Being directed not to give a Sat or Unsat grade does not change their
responsibilities or work in any significant way. (para 6)
[23] The College stated as follows in its Brief:
The College maintains that the Clinical Supervisor’s role in assessing students is
appropriately described in the Duties and Responsibilities section of the PDF. . . .
5
Clinical Supervisors do not assess written assignments or exams. As previously
noted, this is the faculty’s role. (emphasis in original) (p. 4)
[24] The issue raised by the grievance is whether the Clinical Supervisor position was
improperly classified as of the date that the grievance was filed in October 2017. In the
event that I find that the higher rating sought by the Union was warranted on the basis of
position duties and responsibilities as of that time, however, the parties agreed that I
should then also determine whether the above referenced communications, and
particularly Mr. Malette’s January 2018 direction, meant that any such higher rating was
as of that later point in time no longer appropriate.
[25] The parties each commented as well on the patient or client care role of Clinical
Supervisors.
[26] On the one hand, the Union stated as follows in its Brief:
The clinical supervisor must take full responsibility for all of the patients assigned
to them, at all times…. The clinical supervisor is …charged with overseeing
appropriate care of up to 16 patients in various rooms at the same time. (para 16)
[27] In addressing rating of Audio/Visual Effort, however, the Union accepted that
“hospital nurses” remain “legally responsible for the patients assigned temporarily to the
students” and that the “patient’s primary nurse will interrupt with information about the
patient, to check on progress or discuss changes to care or routines.” (para 25)
[28] Ms. Koniuch described what she characterized as the “shared oversight” of patients
by Hospital staff RN’s and Clinical Supervisors.
[29] The College argued that the Clinical Supervisor is “not there as a nurse for the
patient, but rather as a support for the student.” (p. 6 Brief) It stated:
All patients have a staff nurse (i.e. a nurse employed by the hospital) assigned
who is ultimately responsible for the patient’s care, however students are involved
in aspects of the patient’s care that are in line with the student’s skillset. (pp. 2-3
Brief)
. . .
The Clinical Supervisor is not the patient’s treating nurse and is not assigned to
diagnose the patient and develop a care plan; rather, the Clinical Supervisor’s role
is to support the student in learning the role of a nurse. (pp. 5-6 Brief)
[30] The undisputed Planning/Coordinating section of the PDF also notably states as
follows:
6
Agency is ultimately responsible for quality of client care but incumbent is to
ensure students provide safe and competent care with [sic] their scope of
knowledge and ability.
[31] During the hearing, the parties stipulated their agreement to the following facts:
• The Staff Nurse at a hospital has a patient assignment comprised of
approximately five patients.
• These patients remain on the Staff RN’s assignment even if students
provide the care. Those patients do not come off the Staff RN’s
assignment.
• As a practical matter, a student may give much of the expected care for a
patient, including feeding, bathing, ambulating and administering
medications. The Staff RN would not, however ignore the patient.
• If something happened like a patient fall, the student may still be the one
to provide patient care.
• If something of significance happens in that a previously stable patient is
no longer stable, the Staff Nurse would be notified and brought into the
mix.
• Even in that scenario, the Clinical Supervisor supervises students in their
communications with the Staff RN.
THE PDF
[32] The Position Summary in the PDF describes the “overall purpose” of the Clinical
Supervisor position as follows:
The role of the Clinical Supervisor, Nursing Program is:
• To provide students with appropriate learning experiences that require the
use of critical thinking skills and accurate judgements within an
environment that is physically and intellectually demanding.
• To assist students in these programs to meet the course learning outcomes
in their clinical experiences.
[33] The “significant duties and responsibilities associated with the position” are
described as follows in the Duties and Responsibilities section of the PDF:
7
Approximate % of
Time*
1. Provides students with appropriate learning experiences in 6%
acute and long term health care settings by:
• Selecting clients for student care according to level and ability of the
student.
• Reviewing and clarifying the nursing practice course expectations.
• Maintaining an effective and harmonious relationship with members of
the health care team, the students, clients and their families, and
medical staff.
2. Supervises and monitors ongoing client care provided by 82%
students by:
• Utilizing set educational guidelines, policies and procedures of the
clinical agency and educational institution, and Guidelines for
Professional Standards.
• Being prepared to intervene when client condition suddenly changes
and student is either unprepared to handle the situation, student is not at
the required level to deal with a complex medical crisis, or when
student performs in an unsafe manner.
• Making changes to clinical assignment and organizational plan in order
to accommodate unanticipated events, e.g., client’s surgery time moved
ahead one hour with only 15 minutes notice, IV pump alarm requires
immediate “trouble shooting”, client develops severe unexpected chest
pain, unexpected admission – fractured femur.
• Working collaboratively with faculty and other clinical supervisors to
determine and implement an effective learning environment.
3. Assesses students’ performance in giving client care by: 12%
• Adhering to the learning outcome criteria and using established forms
and evaluation tools as written and prepared by the course professor.
• Making accurate assessments and judgments with regard to students’
ability to perform the steps of the nursing process as taught in nursing
theory classes.
8
• Recording observations on student clinical performance and sharing the
written notes with students. Providing verbal clarification if necessary.
• Seek input from clinical agency nursing staff especially when there is
an incident or area of concern regarding a student’s performance.
• In consultation with the clinical coordinator/professor, determining if
students’ clinical performance has met the course learning outcomes in
relevant Practical Nursing or BScN courses.
ANALYSIS AND PROBLEM SOLVING
[34] The College assigned a rating of level 3, Regular and Recurring, and level 4,
Occasional, to this factor. The Union argued that a level 4, Regular and Recurring rating
is warranted.
[35] The Support Staff Job Evaluation Manual (“the Manual”) defines levels 3 and 4
Analysis and Problem Solving as follows:
3. Situations and problems are identifiable, but may require further inquiry in
order to define them precisely. Solutions require the analysis and collection of
information, some of which may be obtained from areas or resources which are
not normally used by the position.
4. Situations and problems are not readily identifiable and often require further
investigation and research. Solutions require the interpretation and analysis of a
range of information according to established techniques and/or principles.
[36] “Established techniques and/or principles” is defined as follows in the Manual:
Established techniques and/or principles – recognized guidelines and/or
methods to accomplish a desired outcome. Can be defined as an individualized
way of using tools and following rules in doing something; in professions, the
term is used to mean a systematic procedure to accomplish a task.
[37] The Notes to Raters provide the following guidance with respect to level 3 Analysis
and Problem Solving:
At level 3, the types of problems that are encountered are readily identifiable but
the position must be able to identify when additional information is needed to
clearly understand the problem or situation. In order to develop an appropriate
solution, the position will need to gather more information. In many
circumstances, this additional information or clarification will be readily
available, but there will be times when the position will need to seek the
additional information from a source it is unfamiliar with.
9
Level 2 versus level 3 - . . . For level 3, the incumbent would be gathering
information, analyzing each new piece of information in relation to the other
pieces, and possibly exploring new or unusual directions to seek more information
based on the results of the investigation or analysis.
[38] The PDF contains three examples of Regular and Recurring Analysis and Problem
Solving. The Union’s representative acknowledged that she was “not sure” that the
second example reflected anything more than level 3 Analysis and Problem Solving, and
the Union relied during the hearing only upon the first and third examples in support of
its argument that the higher rating sought is warranted.
[39] The first example of Regular and Recurring Analysis and Problem Solving included
in the PDF reads as follows:
#1 regular & recurring
Key issue or problem encountered. Provide written feedback to each
student on their daily performance,
recognize strategies for improvement
and communicates findings to
clinical coordinator/professor.
How is it identified? Observes and records critical
incidents and comments on
performance checklists and
documents submitted by students re
care given.
Is further investigation required May seek input from agency staff re
to define the situation and/or problem? student’s performance and/or clarify
If so, describe. behavior in specific situations.
Explain the analysis used to determine Based on observations, rationale
a solution(s) for the situation and/or provided by students and input from
problem. agency staff decides whether
performance is
satisfactory/unsatisfactory using
established performance measures.
In consultation with clinical
coordinator/professor, will develop
strategies for success when student’s
performance is unsatisfactory.
10
What sources are available to assist ⸱ Establish [sic] nursing competencies
the incumbent finding solution(s)? and standards of practice
(e.g., past practices, established ⸱ Professional textbooks
standards or guidelines). ⸱ Program practice course outcomes
⸱ Course professor/clinical coordinator
⸱ Nursing professionals ⸱ Agency protocols
[40] As noted, the parties stipulated that the Clinical Supervisor is the only College staff
member to observe and supervise students in clinical placements, and that the Clinical
Supervisor’s assessment of whether a student satisfactorily fulfills the requirements of a
clinical placement is the only assessment that the College can rely on in determining
whether the clinical placement program component is satisfied.
[41] The Duties and Responsibilities section of the PDF states that the Clinical
Supervisor “assesses students’ performance in giving client care,” in part, by “adhering to
the learning outcome criteria and using established forms and evaluation tools” and by
“making accurate assessments and judgements with regard to students’ ability to perform
the steps of the nursing process….”
[42] In the Union’s submission, Clinical Supervisors provided written feedback to
students on a regular and recurring basis, and thereby engaged in level 4, Regular and
Recurring, Analysis and Problem Solving. Insofar as Clinical Supervisors were, in the
Union’s further submission, instructed in January 2018 to no longer give assignments a
“Sat or Unsat” grade, but to provide verbal and written feedback, the analytical and
problem solving responsibility did not significantly change at that time. The Union
argued that a level 4, Regular and Recurring rating was appropriate as of the date that the
grievance was filed, and that nothing in the College’s January 2018 communication
changed this.
[43] The College did not dispute that Clinical Supervisors review student documents such
as Learn Goals, Learn Notes and Care Plans and provide feedback to students. Such role
as described in the PDF is, in the College’s submission however, captured within the
level 3 factor definition.
[44] While the Union maintained that post-grievance direction by the College did not
diminish the analytical and problem solving role of Clinical Supervisors, Ms. Smith gave
detailed evidence which in part focussed on the position’s role as of October 2017. I was
11
referred as well to a Course Outline for Practical Nursing students, and to “forms and
evaluation tools” used by the Clinical Supervisor, as referenced in the Duties and
Responsibilities section of the PDF.
[45] Ms. Smith described that students completed and submitted Learn Notes to Clinical
Supervisors. She testified that Clinical Supervisors provided written feedback to students
as of October 2017, and commented on whether the notes were “reflective.” The Union
argued that Learn Notes “must . . . conform to the critical self-reflection of professional
nursing practice, and must contain components such as ‘Look Back,’ ‘Elaborate,’
‘Analysis,’ ‘Reflect,’ and ‘New Perspective.’” In the Union’s further submission, this “is
not just a matter of observing whether these subtitles exist on paper, but checking the
quality of reflection and analysis to see if the student is truly engaged in self-awareness of
their learning.” (para 7 Brief)
[46] Ms. Smith described that students also submitted to the Clinical Supervisor Learn
Goals, and that the Clinical Supervisor provided written feedback as to whether the goals
were satisfactory. The Union stated that goals were to be “SMART” – meaning specific,
measurable, attainable, relevant and timely. They were also to relate to the student’s skill
level, and to the type of hospital unit in which the student was engaged in clinical
placement. The Union stated that Clinical Supervisors “read through the students’ goals,”
and determined if they met the “requirements of standard nursing practice as taught in the
program.” (para 6 Brief)
[47] Ms. Smith testified that Practical Nursing students submitted Clinical Preparation to
Clinical Supervisors at the beginning of each semester. She described in part that students
researched and identified questions for the Clinical Supervisor, who responded to those
questions at Orientation and ensured that student research was current.
[48] The Union noted that the Practical Nursing Diploma course outline included in its
Brief states that students were to research diagnoses and medications prior to each
clinical day. The Union argued that it would not be possible for the Clinical Supervisor
“to determine whether the student’s reflection on this learning was satisfactory without
performing the same research….” (para 12 Brief)
[49] Ms. Smith gave evidence that students prepared Care Plans in which they identified
a problem experienced by a patient within their assignment and developed a nursing plan.
She testified that Clinical Supervisors assessed such Care Plans as satisfactory or
12
unsatisfactory according to a rubric included in the subject outline, and returned it to the
student.
[50] I heard evidence as well of Post-Conferences which take place for approximately
one hour at the end of each clinical day. Ms. Smith described these as a learning
opportunity for students, and testified that students discuss and reflect upon their
experiences on the shift. Clinical Supervisors facilitate such sessions.
[51] Ms. Smith testified that the Clinical Supervisor completed Clinical Performance
Tool documents mid-term and at the end of the term, indicating whether the “core
competencies” identified in the document are “met” or “unmet,” and in the case of the
BScN students, commenting on how students met the identified competencies. Suggested
areas of improvement were noted mid-term, and at the end of the term, the Clinical
Supervisor commented on whether the student made the identified improvements.
[52] Ms. Smith gave evidence as well that Clinical Supervisors provided written weekly
or bi-weekly feedback as to whether students were meeting competencies.
[53] Ms. Smith testified that the Clinical Supervisor and the Clinical Coordinator prepare
Memos of Concern as the need arises regarding any unsafe student practice, and
identifying how it is to be rectified.
[54] In the Union’s submission, Clinical Supervisors must understand the importance of
Learn Notes and Plans, and actively participate in student development of reflective
skills. They observe student performance in the clinical setting, and compare observations
with Learn Goals, Learn Notes and reflections. The Union asked me to find that
“problems” encountered are not “readily identifiable” in that students are not necessarily
aware of their “own confidence or skill level” and do not share “their concerns.” It argued
that it would not be possible for Clinical Supervisors to comment on student reflections,
learning and research without engaging in research.
[55] The Union noted as well the various sources available to assist in finding solutions,
according to the first Regular and Recurring example in the PDF. In the Union’s
submission, solutions to the problem addressed in this PDF example require the
“interpretation and analysis of a range of information according to established techniques
and/or principles.” It commented in part as follows in its Brief:
. . . [T]he clinical supervisors must interpret and analyze a range of information,
including the students learning goals, learn notes, respectful of their various
13
writing abilities in English, as well as the students’ confidence levels, ethics,
hygiene, communication style and appropriate skill levels. For example, is the
student using appropriate wording with patients (i.e. “brief” instead of “diaper”),
is the student covering the patient properly and asking verbal permission before
touching the patient? This information is observed or collected “according to
established techniques and/or principles”, namely, those established by the
professional School of Nursing. (para 13)
[56] The College argued that a level 3 rating is “best” because “the work of the position is
characterized by clear processes, predictable problems and limited decision-making.” (p.
4 Brief) The College noted that at level 3, problems are “identifiable” although additional
information may be needed to clearly understand them. At level 4, problems “are not
readily identifiable.” In the College’s submission, Clinical Supervisors address
“identifiable problems,” in determining whether the student meets goals set out in the
documents. The fact that students may not recognize or identify deficiencies in their work
does not mean that the problems addressed by the Clinical Supervisor are “not readily
identifiable.”
[57] The College argued further that the “scope of information typically required to
address the problem” differs at levels 3 and 4. The College noted that the PDF provides
that the “analysis used to determine a solution” involves use of “established performance
measures,” and not, in its submission, “interpretation and analysis of a range of
information according to established techniques and/or principles.”
[58] In the College’s further submission, the scope of required judgement or depth of
analysis also distinguishes levels 3 and 4 Analysis and Problem Solving. It argued that
level 4 Analysis is applied to “much more unbounded problems,” and that the PDF is
clear that “established forms and evaluation tools” are used in assessing student
performance in giving client care.
[59] Having considered the evidence and the submissions of the parties, I conclude that
the Union has not established that the first example of Regular and Recurring Analysis
and Problem Solving included in the PDF warrants a level 4 rating even on the basis of its
evidence of the problem solving and analytical responsibilities of the Clinical Supervisor
as of October 2017. In providing feedback to students as described by Ms. Smith,
problems encountered are appropriately characterized as “identifiable” with the
possibility of “additional information” being needed “to clearly understand the problem
14
or situation.” The evidence did not demonstrate that problems encountered by Clinical
Supervisors in providing feedback as addressed in the PDF were not “readily
identifiable” and often required “further investigation and research.”
[60] At level 4, solutions to problems “require the interpretation and analysis of a range
of information according to established techniques and/or principles,” as defined. The
Notes to Raters are clear that level 3 problem solving requires gathering more
information, and that “in many circumstances, this additional information or clarification
will be readily available.” The problem solving role addressed in the first example of the
PDF is well captured by the level 3 factor definition.
[61] I acknowledge that the College assigned an Occasional level 4 rating to this factor,
and that one of the Occasional examples included in the PDF pertains to the position’s
problem solving role when unethical behaviour of a student is encountered. The Union
stated in its Brief that it did not “see this as significantly different from observing the
ethical (or unethical) behaviour of a student, along with multiple other indicators of
student readiness and satisfactory performance….” (para 18)
[62] While I have considered the Union’s argument, the Union has nonetheless not
demonstrated that the Analysis and Problem Solving addressed in the first Regular and
Recurring example reflects level 4 Analysis and Problem Solving as defined in the
Manual.
[63] Given that conclusion, I need not determine whether the College’s January 2018
direction would have negatively impacted on the higher rating that the Union sought as of
October 2017.
[64] In considering the Union’s argument that Analysis and Problem Solving should be
rated at level 4, Regular and Recurring, I have considered as well the third example of
Regular and Recurring Analysis and Problem Solving included in the PDF. The PDF
reads as follows:
#3 regular & recurring
Key issue or problem encountered. Identifies need when student unable
to provide client care.
How is it identified? Recognizes clinical signs that
indicate pending medical crisis, e.g.,
shock, cardiac arrest.
15
Is further investigation required Notifies agency staff of findings and
to define the situation and/or problem? determines appropriate client care
If so, describe. and role of student in the situation.
Explain the analysis used to determine May reassign student to observer
a solution(s) for the situation and/or role and/or intervene directly or
problem. request agency staff to assume
client care.
What sources are available to assist ⸱ Agency staff/protocols
the incumbent finding solution(s)? ⸱ Standards of practice
(e.g., past practices, established ⸱ Program guidelines
standards or guidelines).
[65] As noted, the Duties and Responsibilities section of the PDF also states as follows:
Supervises and monitors ongoing client care provided by students by:
. . .
• Being prepared to intervene when client condition suddenly changes and
student is either unprepared to handle the situation, student is not at the
required level to deal with a complex medical crisis, or when student
performs in an unsafe manner.
[66] I note as well that the PDF states that “when to intervene in student’s care of client”
is a decision “that would be decided by the incumbent.” (Independence of Action)
[67] The Union argued as follows in its Brief:
The third regular and recurring example provided in the PDF involves when a
patient’s status changes and the student is no longer able to provide appropriate
care. This captures the need for the clinical supervisors to also be nurses on the
ward. Patients can fall or their health can take a sudden turn for the worse . . . .
(para 16)
. . . Whenever a clinical supervisor must step in to provide assistance to a patient
in her care, she is interpreting vital signs and complex equipment readings, and
analyzing that range of information using the established techniques and
principles of the nursing profession. An issue or problem with a patient is only
simple until it suddenly isn’t. The students and clinical supervisor must always
remain vigilant for signs of more serious issues, regardless of whether or not they
materialize. (para 17)
[68] The Union argued that “problems” addressed in this example are not identifiable and
require further research. Ms. Karpova described, albeit in a somewhat different context, a
patient who exhibited extreme sleepiness, and noted that sleepiness, an identifiable
16
symptom, was not the “problem” but a sign of an underlying “problem” identified only
with further investigation. The Union noted that “Standards of Practice” assist in problem
solving according to the PDF, and it argued that Clinical Supervisors solve problems
addressed in the third PDF example through “the interpretation and analysis of a range of
information according to established techniques and/or principles” as defined in the
Manual.
[69] As noted, the College assigned a level 4 Occasional rating to this factor. The Union
noted that the first of two examples of Occasional Analysis and Problem Solving
included in the PDF addresses the problem solving role played by the Clinical Supervisor
when a student is injured in providing patient care. In its Brief, the Union stated that it
“does not understand why providing critical care, documentation and follow-up with a
student who is injured is significantly different than the critical care a clinical supervisor
would provide a patient in the third regular and recurring example.” (para 18)
[70] In addressing the appropriate rating of this factor, the College again argued that all
patients have “a staff nurse (i.e. a nurse employed by the hospital) assigned who is
ultimately responsible for the patient’s care,” (p. 2 Brief) and that the Clinical Supervisor
is not an RN for the patients but a resource for students.
[71] The College suggested that the Union conflates the roles of the staff nurse employed
by a hospital and of the Clinical Supervisor. It argued as follows in its Brief:
Throughout the grievance process, the Union focussed on the fact that patients
may come into the healthcare facility with complicated symptoms and problems
that are not readily identifiable, and that this therefore justified a higher rating.
However, this confuses the role of the Clinical Supervisor and that of the assigned
nurse. . . . The Clinical Supervisor is not the patient’s treating nurse and is not
assigned to diagnose the patient and develop a care plan; rather, the Clinical
Supervisor’s role is to support the student in learning the role of a nurse. (pp. 5-6)
[72] The College commented that it is the student’s ability (or inability) to provide care
that is addressed in the PDF example in issue. It argued as follows:
Similarly, the PDF provides an example where the Clinical Supervisor identifies
that the student is unable to provide client care because the patient’s condition has
changed. The Clinical Supervisor, through their training and experience, can
readily identify when such a situation occurs. Moreover, the solution is to hand
the patient back over to the assigned nurse, with the student observing if
appropriate. The Clinical Supervisor’s role is not to research, diagnose and treat
the patient. (p. 5 Brief)
17
[73] As noted, both parties agreed that patients receiving care from students on clinical
placement remain on a Staff RN’s assignment, and that the Staff Nurse is notified and
“brought into the mix” if something of significance happens to a previously stable patient.
The Union agreed as well in its Brief, that Staff Nurses remain “legally responsible for the
patients assigned temporarily to the students.” (para 25) The Union did not take issue with
the PDF insofar as it states that the “Agency is ultimately responsible for quality of client
care but incumbent is to ensure students provide safe and competent care with [sic] their
scope of knowledge and ability.” (See Planning/Coordinating)
[74] There was also no dispute, however, that changes to a patient’s health can arise. The
Duties and Responsibilities section of the PDF includes as a “significant” duty and
responsibility the supervision and monitoring of ongoing client care provided by students
by “being prepared to intervene when client condition suddenly changes . . . .” The third
example of Regular and Recurring Analysis and Problem Solving included in the PDF
states that the Clinical Supervisor “recognizes clinical signs that indicate pending medical
crisis,” thereby identifying “when student unable to provide client care.”
[75] While the College emphasized that the example in issue addresses the role played by
the Clinical Supervisor in monitoring care given by students, the PDF describes that the
“problem” is identified by recognizing clinical signs of pending medical crisis in the
patient under student care. The PDF also describes “further investigation required to
define the situation and/or problem,” as notification of agency staff and determination of
appropriate client care and student role. The PDF is clear as well that the analysis used to
determine a solution to the “problem” may involve direct intervention with the patient,
although I recognize that the Union acknowledged that this may be so only until the Staff
Nurse is able to take over the patient’s care.
[76] Level 3 problems are “identifiable” or “readily identifiable” according to the Notes
to Raters, although “further inquiry” may be in order to “define them precisely.” I agree
with the Union, however, that the identification of the problem in issue here through
recognition of “clinical signs that indicate pending medical crisis, e.g. shock, cardiac
arrest” as addressed in the PDF is better captured in the level 4 factor definition which
contemplates problems that are “not readily identifiable” and that “often require further
investigation.”
18
[77] The College suggested that the solution to the problem is “to hand the patient back
over to the assigned nurse.” The PDF states, however, that the analysis used to
“determine a solution” may include direct intervention with the patient. Again, I note that
the Duties and Responsibilities section of the PDF states that Clinical Supervisors must
be “prepared to intervene when client condition suddenly changes.” While level 3
Analysis and Problem Solving contemplates that problems are solved through “the
analysis and collection of information, some of which may be obtained from areas or
resources which are not normally used by the position,” the level 4 definition
contemplates solutions that “require the interpretation and analysis of a range of
information according to established techniques and/or principles” as that latter term is
defined in the Manual. Sources available to assist the incumbent in finding a solution
include “Standards of practice” according to the PDF. I am convinced by the Union that
level 4 is the better fit here in that “solutions require the interpretation and analysis of a
range of information according to established techniques and/or principles.”
[78] The College argued that the scope of judgment and depth of required analysis differ
at levels 3 and 4, although even level 3 Analysis and Problem Solving is not, in its
submission, “straightforward.” I agree with the Union, however, that level 4 problem
solving, and specifically solutions requiring interpretation of “a range of information
according to established techniques and/or principles” is the best fit for the analytical and
problem solving responsibility described in the third Regular and Recurring example in
the PDF.
[79] I have considered the Union’s submissions with respect to the first example of
Occasional level 4 Analysis and Problem Solving included in the PDF. I, like the
Union’s representative, have difficulty in appreciating “why providing critical care,
documentation and follow-up with a student who is injured is significantly different than
the critical care a clinical supervisor would provide a patient in the third regular and
recurring example.”
[80] It is on the basis of the evidence regarding the Regular and Recurring analytical and
problem solving responsibilities of the Clinical Supervisor described in the third example
in the PDF that I conclude, however, that a rating of level 4, Regular and Recurring, is
warranted. I so order, and note that the evidence of the College’s post-grievance
communications does not impact on this.
19
SERVICE DELIVERY
[81] The College assigned a rating of level 3, Regular and Recurring, to this factor. The
Union argued that level 4, Regular and Recurring is the appropriate rating.
[82] The Manual defines levels 3 and 4 Service Delivery as follows:
3. Tailor service based on developing a full understanding of the customer’s needs
4. Anticipate customer requirements and pro-actively deliver service.
[83] Other definitions provided in the Manual include the following:
Tailor – to modify or adapt with special attention in order to customize it to a
specific requirement.
Anticipate - given advance thought, discussion or treatment to events, trends,
consequences or problems; to foresee and deal with in advance.
Proactive - to act before a condition or event arises.
[84] The Notes to Raters distinguish levels 3 and 4 Service Delivery as follows:
Level 3 refers to the need to “tailor service.” This means that in order for the
position to provide the right type of service, he/she must ask questions to develop
an understanding of the customer’s situation. The customer’s request must be
understood thoroughly. Based on this understanding, the position is then able to
customize the way the service is delivered or substantially modify what is
delivered so that it suits the customer’s particular circumstances.
Level 4 means that the position designs services for others by obtaining a full
understanding of their current and future needs. This information is considered in
a wider context, which is necessary in order for the position to be able to structure
service(s) that meet both the current stated needs and emerging needs. The
position may envision service(s) before the customer is aware of the need.
[85] The Notes to Raters refer to “customers” as “people or groups of people who receive
the services delivered by the position,” and state that they “can be internal, students or
external to the College.” The parties agreed that “customers” in the present context are
students in clinical placements, and at least to some extent, patients who receive care
from such students under the supervision of Clinical Supervisors.
[86] Both parties acknowledged that level 4 Service Delivery contemplates what the
Union described as an “anticipatory requirement.” In the Union’s submission, Clinical
Supervisors must anticipate customer requirements, while the College argued that the
Service Delivery required of the position is responsive in nature.
20
[87] I have considered the examples of Service Delivery included in the PDF, along with
the evidence and submissions of both parties. Daily and weekly examples of Service
Delivery described in the PDF and relied upon by the Union include the Clinical
Supervisor’s role when the Clinical Coordinator requests specific student learning
opportunities, when students request feedback, and when assisting students in
documenting and reporting client care in response to agency staff requests for
information.
[88] The Union argued that Clinical Supervisors design learning opportunities that are
broader in scope than those arising out of immediate patient care needs, addressing what
might be required in other circumstances, and preparing students for a wide variety of
clinical environments mindful of “future directions of health care in Ontario.”
[89] The PDF states that Clinical Supervisors observe and record student performance
based on established criteria where students request feedback. The Union argued that this
contemplates more than tailoring of service as contemplated at level 3, and calls upon the
Clinical Supervisor’s “wider, deeper understanding of the profession of nursing, current
trends and issues, emerging technologies and ethical concerns, and experience in a wide
range of health care settings which enable clinical supervisors to prepare students not just
for the events of the day, but for their long careers in nursing.” (para 23 Brief)
[90] Ms. Smith described as an example of Service Delivery the assistance she offered a
student who wished to do a specialized consolidation. Ms. Smith’s evidence was that she
identified that the student would require a higher grade to be able to do so.
[91] Ms. Karpova described that she encountered an atypical diagnosis in a patient
receiving care from a student during clinical placement, and that in order to provide
appropriate student feedback, did research. The Union further argued that in order to
provide feedback as to the adequacy of student research, the Clinical Supervisor must be
current in her own research.
[92] The Union addressed as well that the Clinical Supervisor engages in continuous
learning and reflective practice so as to maintain licensing with the College of Nurses. It
emphasized the changing nature of health care, and referred by way of example to
protocols and ethics related to Medically Assisted Dying.
[93] The Union argued that Clinical Supervisors “provide services to their hospital
patients, through students, and on their own when required.” (para 22 Brief) The Union’s
21
representative addressed a student nurse’s role in caring for a patient to be discharged
from hospital, and suggested that the Clinical Supervisor must be aware of trends
regarding patient compliance so that the student can appropriately advise the patient. The
Union noted the need in such circumstances to question whether a patient discharged with
wound care instructions understands what is required, and whether the home environment
is conducive to compliance with the required care regime.
[94] The Union argued as well that Clinical Supervisors supervise clinical placements in
different settings and need to be familiar with the protocols and practices in various
environments.
[95] The College emphasized that at level 4, Service Delivery is proactive, and that the
Manual defines “proactive” as “to act before a condition or event arises.” In the
College’s submission, the evidence relied upon by the Union does not reflect the
anticipation of customer requirements and the proactive delivery of service, but
responsive tailoring of service reflected in the level 3 factor definition.
[96] Ms. Koniuch stated that there can be a lag between the theory taught in the
classroom and what is transferred into the practice realm, and that Clinical Supervisors
must be “responsive to something in the moment.”
[97] She testified that Registered Nurses must maintain their professional competencies,
and the College noted that the need for Clinical Supervisors to do so is reflected in the
rating of Education.
[98] Ms. Koniuch testified that nurses follow predetermined doctor’s orders upon a
patient’s admission to hospital, and implement a plan of care within the nursing realm
responsive to patient needs. The College acknowledged the responsibilities associated
with administering of medications to patients and the need to fully understand the
patient’s circumstances and medications in issue. It suggested that this reflects the
tailoring of service based on a full understanding of customer needs. In addressing Ms.
Karpova’s evidence regarding an atypical diagnosis encountered, the College suggested
that such example again reflects the delivery of service based on a full understanding of
customer needs. The College addressed the Union’s example of the Service Delivery
associated with student care of a patient upon discharge, and suggested that it too reflects
the need to tailor service in a responsive fashion in the context of patient discharge notes
so as to determine what needs to be communicated to the patient at that time. The College
22
reiterated that the Clinical Supervisor is “not there as a nurse for the patient, but rather as
a support for the student.”
[99] Level 4 Service Delivery contemplates the anticipation of customer requirements
and the proactive delivery of service, as defined in the Manual. In contrast, level 3 refers
to the need to “tailor service” based on a full understanding of customer needs.
[100] When the Clinical Supervisor provides student learning opportunities requested by
the Clinical Coordinator or feedback to students, or assists students in documenting and
reporting client care to agency staff as detailed in the PDF, the student may well carry
such learning forward in future nursing careers. The service delivered by the Clinical
Supervisor, however, is well captured in the level 3 factor definition. It requires an
understanding of “the customer’s situation” and is “tailored” accordingly. As described in
the Notes to Raters pertaining to level 3 Service Delivery, service may be customized “so
that it suits the customer’s particular circumstances.” Ms. Smith’s evidence of the role
played in assisting a student who sought a specialized consolidation well exemplifies this.
[101] The Education section of the PDF reflects that the Clinical Supervisor is a
“Registered Nurse with College of Nurses of Ontario” and that she “holds current
Certificate of Competence.” While ongoing learning is required in the profession, the
Union did not demonstrate that this reflects level 4 Service Delivery.
[102] I have considered as well the Union’s submission that Clinical Supervisors provide
“services to their hospital patients, through students and on their own when required.”
While the College emphasized that Clinical Supervisors act as a support for the student,
the PDF states that they are to be “prepared to intervene when client condition suddenly
changes.” (See Duties and Responsibilities) What the Union nonetheless described
through its evidence and argument was service delivery based on a full understanding of
customer needs well captured within the level 3 factor definition. This is reflected in Ms.
Karpova’s evidence pertaining to a patient with an atypical diagnosis, and the Union’s
description of the Clinical Supervisor’s role when a patient for whom a student is
providing care is discharged from hospital.
[103] The Union has not demonstrated that a level 4 rating is warranted. The College’s
rating of Service Delivery at level 3, Regular and Recurring, is confirmed.
23
AUDIO/VISUAL EFFORT
[104] Both parties accepted that this factor is properly rated at level 2. They disagreed,
however, whether the Focus Maintained rating assigned by the College is appropriate, or
if the Focus Interrupted rating sought by the Union is warranted.
[105] The Manual provides the following definitions:
Focus Maintained – concentration can be maintained for most of the time.
Focus Interrupted – the task must be achieved in smaller units. There is a need
to refocus on the task at hand or switch thought processes.
[106] The Notes to Raters direct in part as follows:
Assess the number and type of disruptions or interruptions and the impact of these
activities on the focus or concentration needed to perform the task. For example,
can concentration be maintained or is there a need to refocus or change thought
processes in order to complete the task.
[107] The Notes to Raters further state:
6. Consider the impact of the disruption on the work being done. For example,
can the incumbent in the position pick up where he/she left off or has the
interruption caused a disruption in the thinking process and considerable time is
spent backtracking to determine and pick up where he/she left off.
[108] The Union argued that the Clinical Supervisor is frequently interrupted in the
performance of her duties – by students, by Primary Nurses who the Union
acknowledged remained “legally responsible” for the patients assigned to students, by
family members of patients, by other health care providers and by other hospital staff
members interacting with patients. The Union noted as well that Clinical Supervisors may
be interrupted by monitoring machines, announcements over speakers, and by patient call
bells.
[109] The College did not contest that Clinical Supervisors may be subject to
interruptions in the course of performing duties. Counsel argued that the Manual directs,
however, that such interruptions be considered contextually. She noted that “focus
maintained” means that concentration can be maintained “for most of the time,” and not
for all of the time. In the College’s submission, concentration can be broken some of the
time so long as focus can be maintained “for most of the time.” The College relied upon
the Notes to Raters and argued as follows:
24
The intensity of concentration required in completing a task, the familiarity of the
task, the type of skills required in completing a task and the nature of the
disruption are all relevant. For the Union to succeed in its claim to a focus
interrupted rating, it has the burden of demonstrating that there are disruptions
that, in light of the type of activity undertaken, cause breaks in concentration most
of the time and which required considerable time refocussing. (emphasis in
original)
The College submits that the position fits a Level 2 (focus maintained) rating best
because although the Clinical Supervisors are subject to disruptions in their work,
such disruptions won’t cause breaks in concentration and, in any event, any
breaks in concentration will not meet the threshold required for a “focus
interrupted” rating claimed by the Union. Further, the Clinical Supervisors’
training and experience as nurses ensure that they are able to maintain focus most
of the time for the tasks that are required without the need to spend “considerable”
time backtracking to where they left off when they experience minor interruptions
through questions and updates. While their environment may be interrupted
frequently, the Clinical Supervisors’ focus is not interrupted, and that is what is
key when evaluating this factor. (emphasis in original) (p. 8 Brief)
[110] In Reply, the Union commented on the Clinical Supervisor’s role in supervising
student administration of medication. Ms. Smith described the various steps involved in
that process, and gave evidence that the Clinical Supervisor is required to be present and
to supervise and check all such steps undertaken by a student. In the Union’s submission,
if such process is interrupted, it must be re-started. While Ms. Karpova described that
both the Clinical Supervisor and the student may in some instances be interrupted, the
evidence was clear that in some cases, the student is not interrupted, and is able to refocus
the process after the Clinical Supervisor addresses whatever interruption required
attention. Ms. Smith acknowledged as well that if the administration of medication is
interrupted after medication is crushed and diluted, there would not necessarily be a need
to restart the process if interrupted. She acknowledged as well that if interrupted while
supervising the suctioning of a patient, a student who interrupted for other assistance may
be referred to the Primary Nurse.
[111] The Union’s representative commented as well that the Clinical Supervisor must
develop rapport with students, and that this may be affected by interruptions.
[112] While the Union demonstrated that the Clinical Supervisor may be subject to
interruptions in the course of performing duties, it did not establish that concentration can
be maintained for something less than “most of the time,” that there is a “need to refocus
25
on the task at hand,” or that “considerable time is spent backtracking to determine and
pick up where he/she left off.”
[113] The Union has not established that a “Focus Interrupted” rating is warranted. The
Level 2, Focus Maintained rating assigned by the College is confirmed.
CONCLUSION
[114] For the reasons set out above, the grievance is allowed in part. The College’s rating
of Service Delivery and Audio/Visual Effort is confirmed. I find, however, that Analysis
and Problem Solving was not properly rated, and order that it be rated at level 4, Regular
and Recurring.
[115] This results in a change in the point rating of the Clinical Supervisor position from
745 to 768, which falls within Payband L. I order that retroactive compensation be paid
by the College in accordance with the collective agreement and the parties’ agreement in
these proceedings as noted herein.
[116] My jurisdiction is retained to assist the parties with the implementation of this
decision.
[117] I thank the parties and their representatives for their assistance in these
proceedings.
DATED at TORONTO this 19th day of March, 2019
"M. Tims"
____________________________________
Mary Lou Tims, Arbitrator
/ Arbitration Data Sheet - Support Staff Classification
College: -W-1-400, Co�� Incumbent: Supervisor
Current Payband:.— —Payband Requested by Grievor: L
1. Concerning the attached Position Description Form:
o The parties agreed on the contents The Union disagrees with the contents and the
specific details are attached.
2. The attached Written Submission is from: a The Union o The College
Factor
Management
Union
Arbitrator
Regular/ Recurring
occasional
Regular/ Recurring
Occasional
Regular/ Recurring
Occaslanat
Level
Points
Level Po!nts
Level
Points
Level Points
Level
Points
Level
Points
1A. Education
S
]
(�
Y'..i.'
/
(�
'•+yrs`
.74n`n$.
1B. Education
-Z
, 2,RMI,
M11-04-
2. Experience
6ME
M
l
-
-`
3. Solving and Problem
:3
4. Planning/Coordinating
3
S. Gulding/Advising Others
`j
S57
3
Z
6. Independence of Action0
0
7. Service Delivery
/
8. Communication
L}-
110
L{-
i p
9. Physical Effort
:3
7
3L67
14-7
10, Audio/Visual Effort
-110
11. Working Environment
3
/
b
3
OL
7;to
`i
Subtotals
(a) 13 6
(b)
(a)
(b)
(a)
(b)
Total Points (a) + (b)
�'
-7&
Resulting Payband
L
I—
Signatures:
L0'� le Z� c� �' ����� 21'v�`i
(Grievor) (Date) (College Representative) (Date)
III i t 11'�fiz "reh
(Union Representative) (Date)
(Arbitrator's Signature) (Date of Hearing) (Date of Award)
(ry n a 14a'-pJ a ") /
0 Al
t3, -ca t-
0 C)/
0C)/