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HomeMy WebLinkAbout1989-1890.Andrews et al.92-02-11 · , ONTARIO EMPLOYES DE LA COURONNE · " CROWN EMPLOYEE3 DE L'ONTARIO GRIEVANCE C.OMMISSION DE SETTLEMENT REGLEMENT BOARD DES GRIEFS 1#0 DUNDAS STREET WEST, SUITE 2?00, TORONTO, ONTARIC). MSG 1Z8 TELEPHONE/T~:L~PHONE: [416) 326-1388 180, RUE OUNDAS OUEST, BUREAU 2~, TORONTO (ONTARIO). MEG 1Z8 ~ACS~MILE~T~COPIE : r416) 326-~396 1890/89, 197/90, 202/90 ~ r IN THE ~tTTER OF ~ ~It~ITI~T~ON Unde~ THE CRO~I~EMPLOYEES COLLECTZVE B~I~G~N~NG ~CT BeEore THE G~ZEV~NCE SETTLEMENT BO~.D BETWEEN OPSEU (Andrews et al) PHASE 3 Grievor The Crown in Right of Ontario (Ministry of Health) Employer BEFO~kE= J. Samuels Vice-Chairperson S. Urbain Member D. Daugharty Member FOE THE N. coleman G~IEVOR Counsel Gowling, Strathy & Henderson Barristers & Solicitors FOR TEE C. Zabek EMPLOYER Counsel Fraser & Beatty Barristers & Solicitors HE~RIN~ September 12, 25, 1990 December 17, 1990 December 3, 4, 17, 18, 1991 January 29, 1992 This is our third award dealing with some 57 grievances concerning the classification of the nurses who work in the twelve out-patient clinics of the Queen Street Mental Health Centre in Metropolitan Toronto. 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. In our first two awards, we dealt~ with the classifications of the clinical nurses who provide professional nursing service in the cYmics and in the patients' homes. These nurses were all classified as Nurse 2 General. In Phase 1, the parties agreed to present as an example 'the case for the Nurse 2 Generals at the Lakeshore Outpatient and Community Services Clinic. In late 1990, we heard evidence concerning the work of Ms. Cindy Arthurs, a Nurse 2 at Lakeshore, and we concluded, in an award released on January 14, 1991, that Ms. Arthurs was not properly classified as a Nurse 2 General, and that she ought to be classified as a Nurse 3 General. This first award enabled the parties to settle all the grievances from the Nurse 2s at the out-lying clinics. All of these nurses were reclassified as Nurse 3 General. In Phase 2, we dealt with the Nurse 2s at the three clinics located at the. Queen Street Mental Health Centre. These three clinics are Unit 1 Basement, Unit 2 Basement, and Unit 4-1 Day-care. We concluded that these nurses too were not properly classified as Nurse 2 General, but we provided a different remedy than for Ms. Arthur,. In an award released on January 29, 1992, we said: Taking all of this into consideration, it may be possible to fit the Phase 2 grievors too into the Nurse 3 General ~tandard, but we have concluded that the better remedy is to order the Ministry to develop an. appropriate class standard for them. Indeed, we will go further to suggest that 'it is necessary to develop a new class series to cover psychiatric nurses who work in clinics such as the ones we have learned about in this case. The Nurse General series is designed to cover nurses who are not the primary professional care givers it covers nurses who work in situations where a doctor orders the primary treatment. Whereas, in the clinics with which we have been concerned here, the nurses have the primary responsibility for developing the treatment plans for. the patients. A patient does not come to one of these clinics to be .the patient of a particular doctor, with the nurses performing a number of the elements of treatment, as directed by the doctor. At these ~clinics, the patients become the responsibility of a particular nurse, and the nurse is in charge of the treatment plan and its implementation. The class series and standards ought to reflect this fundamental reality. Once an appropriate class series and standards are developed, it will probably be best to reclassify all the psychiatric nurses, including those whose grievances were before us originally and who have already been reclassified to Nurse 3 General. Now we will deal with the classification of the Head Nurses at the Lakeshore Clinic and at the Queen Street Mental Health Centre in Unit 2 Basement. These nurses are classified as Nurse 3 General. They claim that 4 they are not properly classified and they ask this Board to order that the Ministry create a classification which would be appropriate for them. As in Phase 2, the parties were able to agree on the facts and this has helped us enormously to deal with these grievances in as expeditious a fashion as possible. Appended to this award you will find the Nurse 3 General Class Standard, the two Position Specifications, and the Agreed Statement of Facts. The Head Nurses carry their own clinical caseloads. This takes up about 50% of their workload. The other 50% is given to supervisory and administrative tasks. The essential argument of the Union .is that the Head Nurses cannot have the same classification as the clinical nurses over whom they exercise a measure of supervision and administration. Given that some of these clinical nurses are Nurse' 3 General, as a result of our first award, the head Nurses must be classified in some 'other classification. On the other hand, the Ministry argues that, though it may be unusual for a supervisor to have the same classification as the employee over whom the supervision is exercised, the Head Nurses' positions are embraced by the Nurse 3 General Class Standard. Our fn-st task is to determine whether the Head Nurses' positions are embraced by the Nurse 3 General Class Standard. The first paragxaph of the Standard: speaks of the "professional supervision of the nursing and personal care of a group of patients in an infirmary, ward or administrative unit of an Ontario Hospital or other provincial institution" (emphasis added). The functions contemplated include scheduling duties, arranging the rotation of shifts and counselling and disciplining staff as required. ~ 5 In the "Qualifications" required, the third paragraph speaks of the "ability to supervise ward or infirmary nursing services" (emphasis added). In our view, the Nurse 3 General Class Standard contemplates supervisory and administrative functions primarily with respect to other nurses. The Head Nurses with whom we are concerned have supervisory and administrative functions which go beyond nursing. 'In paragraph 4 of the Agreed Statement of Facts, we learn that, at the Lakeshore Clinic, the Head Nurse has administrative responsibility for the whole clinic during the absence of the Program Director (that is, when the Program Director is on vacation and while the Program Director is away two half-days every week). While this responsibility may be shared on occasion with other senior staff members, over the course of any week or any year, for about 20% of the time, the Head Nurse has the administrative responsibility for the whole clinic, replacing the Program · .. Director. And this administrative responsibility is exercised with respect to four staff nurses, one senior social worker, two social workers, four part-time psychiatrists, two psychiatric residents, one psychologist, one senior occupational therapist, two occupational therapists, one workshop supervisor, three workshop instructors, one recreationist and two clerical workers. Paragraph 6 of the Agreed Statement of Facts 'tells us that, in Unit 2 Basement, the Head Nurse at all times has administrative responsibility for the whole Clinic, coordinating the .day to day activities of all staff (including a psychometrist and an occupational therapist), excluding the part-time psychiatrist. Though the occupational therapist and psychometrist look elsewhere for their professional supervision, it is the Head Nurse who ensures that the programs scheduled for the day are running as scheduled. At both Clinics, the Head Nurses are consulted with respect to the hiring decisions of non-nursing clinical staff; and, on occasion, the Head Nurse at Lakeshore participates on the selection panel for non-nursing clinical staff (paragraph 8 of the Agreed Statement of Facts). Thus, on the one hand, -the administrative functions of the Head Nurses at the two Clinics are broader than the functions contemplated in the Nurse 3 General Class Standard. On the other hand, the degree of supervision exercised over nurses is lesser at the Clinics than is contemplated in the Nurse 3 General Class Standard or as is generally the case on a hospital ward. As we said in our first two awards, the most essential characteristic of the positions of the clinical nurses is their independence. On page 5 of the Phase i award, we said of Ms. Arthurs that she "receives virtually no direction from her head nurse. There is no regular contact with the head nurse concerning the caseload or Ms. Arthurs' day-m-day work." On page 6 of that award, we commented that "From the initial decision to admk 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 independent judgment and responsibility than is contemplated within the structured environment of a hospital ward." On page 7 of the Phase 1 award, we said "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". Having come to these conclusions concerning the clinical nurses, the corollary must be that the Head Nurses do not exercise the same degree of supervision and administration over the clinical nurses as is contemplated in the relationship generally between the Head Nurse (who is classified as Nurse 3 General) and the ward nurse (who is classified as Nurse 2 General). These two observations---concerning the scope of administrative responsibility of the Head Nurses at the Clinics, and the degree of supervision over the clinical nurses--lead us to the conclusion that Head Nurses are not appropriately classified as Nurse 3 General. The Nurse 3 General Class Standard contemplates a different working environment and a different relationship between the Head Nurse and the clinical nurses. As we said in Phase 2 (at page 8), The Nurse General series is designed to cover nurses who are not the primary professional care giversmit covers nurses who work in situations where a doctor orders the primary treatment. Whereas, in the clinics with which we have been concerned here, the nurses have the primary responsibility for developing the treatment plans for the patients. A patient does not come to one of these clinics to be the patient of a particular doctor, with the nurses performing a number of the elements of treatment, as directed by the doctor. At these clinics, the patients become the responsibility of a particular nurse, and the nurse is~ m charge of the treatment plan and its implementation. The class series and standards ought to reflect this fundamental reality. We order the Ministry to develop an appropriate class standard for the two Head Nurses. We will reserve our. jurisdiction to determine whether the grievors are properly classified in'the new classification developed by the Ministry. The grievors should be reclassified as of 20 days before each grievance, and Should be compensated for any monies which ought to have been paid and were not paid because of the improper classification, with interest at I0% per annum on any sum from the date it ought to have been paid to the date it is paid. We will also retain jurisdiction over any of the original grievances which the parties are unable to settle as a result of our three awards. Done at London,.Ontario, this ~tth dayof February ,1992 ~uels, Qice-Chairperson S. Urbain, Member D. Daugharty, Member--~/ Employees Ln positions altocate~ to this class provide profess~on~ supe~s~on of ~e n~s~g ~ i~uP of p~Ae~ts ~ ~ ~fi~. w~ or a~is~r~ive ~i~ of ~ ~io Mospit~ or o~he~ p~v~ci~ iAsti~ion. Most pos~t~ons ~ this class suc~ p~s~zons ~hese ~ployees scheme ~u~ies, ~e.the ~oca~on o~ sh~s ~ co.scl ~d ~/scipl~e s~ ~s requi~. ~hough ~p~oyees m ~hAs supe~$o~ n~s~g, ~edzc~ or insti~tion~ requt~ to exe~Ase s~e ~dependen~ j~ ~d ~i~iative. · ~[cularly ~ ~e~enc~es. rev~ chis, prepare repo~s, ~~ re~o~s, ebs~ ~ener~ ~a~nten~ce ~d cle~[iness o~ ~ ~acilities. o~er supplies, ~upe~se ~he p~vis~on of fo~ seduces' ~o pa~en~s ~d ~sis: ~ ~nff ~ra~t p~lr~s.. ~ey ~y conduc~ ¢i~ics or p~vide ou~pa~zen~ orthopa~c or ~ergen~ c~. 1. Re~L~trat£on as a nurse :n Onta.rLo; Jo~ ~l~ge :f ~rofess~o.~ ~eo~ ~d practice'~ appli~ ~o ~stituticnal nurs~; ~referably c~p2etion of ~ pos:-jrad~te certificate 2. Y~ o~ ~o years of acceptable trad~te nurs~l e~ertence, preferibly ~lated to the duties to be perform. Ab~:~ ~ super:se ~&~ or ~fi~ nur~ semites; ability to neet the publ:c ~d to provide co~el to st~ff ~ to patients' feint:yes as required; :nLczative; ~o~ physical ~d ~enc~ hez~th. Position Specification & Class AIIocaUon-CSC 61.~ .~eed ~e ~n~t 2 ~4~ent ~ 05-~77~-G~ ~ HfllCh Mental Health Facilities ~ueen S~aet Henta~ Hea~Ch Cen~el ~~''Mt~-~gSO~ L [ [ I 4.6 I Nursing C~dinator { 05-977[-04 Re.fling Co the Nursing C~rdinator, ~he Head N~se, within a mul~i-dLscipiin~y enviro~n~ pr~oCea pr~r~ planning ~d a~inis~aCLon; and ~rd&n~:es a client came lo~ to ene~e 1. ~nisCers and supervises the delive~ of N~a~n~ Se=vice~ ~: · p~Cici~:ing in the saint&on and hit~ng process ~ ensue patient c~e needs · ach~uling n~sLng staf~ to ensure ~rkload requXr~enta ~e met; ' ~nitorinq and evaluaCLnq ~ployee ~for~nce and atte~ce ~ ~th ~orma[ ~nfor~ revi~ p~oc~es Co enema p~fo~c~ ebiLit~e~ a~ ax~tat~ons ~d ~liecCive Agre~enC a~Cer consultation vi~ the ~sl~ C~rdinator end R~ion~ Personne[ Office; ' con~i~ting to ~ployee orientation a~ ~evelo~ent ~ ~acilitating and presenti~ relevant inse~ice and ~ucaCionai smaeionaa ' acting as ~ ~ofmaaionai ~d clinical race. ce t0' n~sinq ~rsonnel and och~ disciplines ~s t~uAr~ :o enhance intra ~d ~nC~ profesaioma~ ~un~cation= · p~cici~c~ng in ~i~ a~ ~ ~c hospitai/n~ing c~ittee struct~ee aa r~i~. co concri~ce ~ orqani~aCional/de~efltal goals ~d ~rsp~tivea; ' ensuing rel~C hospital a~ de~enCal ~licies a~ proc~ures ~e an& maintain~ to enhance de~r~ental goals a~ ' res~ndimg to a~ investigating client, ~ily or 4~en~ c~p/ein~s to enhance c~e dei2v~ and client Nurses and the N~aimg '4. Skills ~ imawled~ ~l~vbed tl) pi~e~m ~eb at tull w~king lcfii. {i~m ~t~ ~ehtb~ ~ i~. JI R~istered as a nurse in Ont~io; t~rough k~wi~ge of ~eneral a~ psychiatric nurmi~ th~: an~ practice to include knowi~ge o~ paychia~ic illnesses, disorders and ~haviours; o~ relevant drugs and aide e~(ects; knowk~ge of reliant m~ical conditions and ~rgency oroc~ures; AntervAewinq. Counsell:na, end documents:ion skills: de~nstra[~ [ea~rsb~ a~ ~. S}9~turl I~t~ S~ ~y M~th YW O~ O~ ~ Yer ~ree 3, ~neral S0054 SP-06 O[ ~ O1 I 90 n~ling c~e provid~ to patients/clients on a ward/progr~ o~ an ~Ca~io Hospital. a. Inc~nCs schedule and dei~aCe du[iea~ counsel or discipline stall ~ega~ding C. R~i~te=~ aa a nurse in OnC~io; ability Co su~rviae nursing services; ability Co interne with pubiic patience, =cia:ives and ~' 2. Pro~o~es Program p~an~ng and Administration ~y: PrOgram to ensure client needs are ·:~ord~nat~nq service or muLC~-d~c~p~:flar¥ meetings to evaluate and revzse outpatient program and care delivery: an~ua~i¥ and as re~red to ~nsuee ~c~q~ ~eeds ~e · monzco~ng expenditures Co en~ur~ progr~ ~dgtcs are ~especc~; .. ' ~aCZ2~CdC~ng and ~rC~c~pac~hg ~n progr~ tese~c~ 4~ zdenC~ or 3. C~dinacew 4 client casa [o4~ ~y: to decerm:ne client's eligibility for adm:sa~o~ a~ outlined by ' formuiaclag, in consultation with the client and Chi multi-disciplinary a rehab~izCaC~on tr~a~enc Plan vh~ch, may inc2ude a m~tcac~on maznCenance p=~r~, soc~a[ and rK~eat~ona2 acC~vtC~ea and vocational 35% ' monitoring and evaluating client's res~nse co trea~enC ~lan ~nce~e~s, home v~sZCs and/or f~]y end co.unity feed~ck; ' u~ating in ~onsulCa~ion ~ich the client an~ :he mult[-~sc~plinary client gain accell and co ensure e~f~:ive use of co~un:Cy resourcel; ' co~unAcac~ng w~ch clAenC'~ social and co~u~Cy net~cka such aa fr~end~, landlords, physicianJ, ~pioye~s and ~lice to ensue co~nicy sup~c and consistency; ' conductin~ patient mup~rt and life s~ill~ groups to pc~ce sec:a[ ' a~inistering m~icatio~ to clinic c~iencJ ~iChe~ orally or parenCerally 4. Sk~ll~ and know~edge required ~o perform ~o~ at ~ull ~or~ing ~evei (cont'd.) supervisory sk~ils; knovledqe of hospital and department ;~[icy an~ proc~e: knowl~ge of co.unity reso~ces; knowi~ge of relevant acta such as'~en:al Health ~t, Health Disciplines Act, Pub2ic ~wpACaAa AcC, C~oun ~pZoyees Co IJecczve Sargeining Ac~; ~cupat~ona[ Health and Safety AcC and the relevaflc Collective Agreement; knovl~ge o~ Chi Onc~o Collie of Nurses Standards. (~efet ~ blc~ of ~on~ ~cw ~tk)n ~~ NU~SE,OutpaCLent ~ Co~u~L~y Se=vtces,~keshozeI 05-~77~-74 ' HeaLth t ~ental ~ea~th Facilities I 2 J 6 I Assistant Ofrecto~ of Nu~sinq / 05-977Z-02 Re~tinq Co the Assistant Director of Nu~ing and the P~og~am D/rector, the ~ead Nurse. a multi~isc/plina~y environme~c.an~ in a co~un~t~-based outgati%nt a~inLsters and su~rvise~ nursing services; ~romote~ pr~cam planning and a~inistrac/on, coordinates a client case-load to ensure clients w~th an acute oc prolonged ~nt&L ~ll~ss are ~ehab~litaCed and ~iocal~ed within =he co. unify a~ cbe~ opCfm~ leve~ of A~inis~e~s and su~rvises the del/very OE Nursing Self,es particles=ins ~n t~e s~lection a~'d hiring process ~o ensure ~atfent care ,eeds ~e by qualified scheduling nursing s~a~f ~n~ st~n~s ~o ensure workload require~nts and educational experiences are infor~l review procedures to ensure ~rfo=mance abilities and ex~tatio.s are maximLzed~ ten.riding to employee complaints and stage one grievances, as outlined is the Col!ect/ve.Agree~C, after consultation with ~he Assistant Director of Nursing the Regional Personnel Office~ contributing co employee oriencaCfon and deveLo~flt by ~acllitat~ng and presenting relevant /~se=vLce and educa~Lonal sessLons~ acting a~ a professional and clinical'resoucce Co nursing personnel ~nd disciplines as required to enhance intra and inter professional c~unicacion~ participating tn regular and ad h~ hosp~tal/n~stng c~ftcees, as r~utr~, =o contribute =o or~anfza=~onal/depar~nCal goals and ~rs~c=ives~ and maintained ~o enhance departmental goals and ~rspeccives~ res~nding =o and Enves~i~aCin~ client, f~ily or aqency compEt~ncs ~o enhance c~e delivery ~d cLien= relacions~ pro.ting high qu~1lcy patient care by adhering ~o ~he 5~anda~ds o~ =he Co~ege of ~urses and ~he Nursing OeparCmn=, 4, Skitl~ a~d knowledge required to I~rfmm job it ~1~ ~ ~L (l~m ~ mn~e~ ~egtstege6 as a nurse En Ontario; thorough knowledge of general and psychiatric nursing tbeor and practice co include knowledge of psychiatric illnesses, disorders and ~haviours~k~iedg. of relevant drugs and side effects~ knowledge of relevant ~dfcal conditions and e~rgency p=ocedures~ interviewing, counsellln9, and docu~nC~C~on skills~ de.ns=raced leadership G, Albrecht Joyce ~ainvflle,AssLstanc A~i~istraCor, Hurse 3, General 50054 SP-06 01 I 0l j 90 A. Und~ direction of su~isory n~sing ~Cagf these /nc~ben~ su~ise and a~inister nursing c~e provid~ ~o pa~ien[s/clien[s on a w~d/proqr~ of an Ontario ~. Inc~n[s schedule and del~a=e du[Ees; c~unsel or discipline staff regarding perforate o~ co.ut c. c. R~is[er~ as a n~se in ~[ar~o; abi[i[y ~o supervise nursing services~ wi~h public pa=[en~s, relatives end ^ 3. Duties ~nd related ~asks (cont'd.) 2.- P&r~Lc£p&tes.£n Prog;&m Adm~n£~t=a~£on *. per~£c~pa~g ~n co~n£t7 committees, ~s requested, ~o enhance ¢om~un£c7 pe~spec~£ve; coordination and utilization o[ services co ~eet cl£enC needS: ~5t outpatient programs tO ensure cILent needs are met; ~ c~rd~n~t~nq nurs~n~ or mu~-d~sc~pl~na=7 meet~nqs to and revise outpatient prog~=ms and cate de~ve~y~ * s~b=~tt~ng budget ~u~p~nt and supply 'requests annually to consideTedr fac~li~inq and pa==~cipa=!ng in pr~ram/de~art=en~ research as iden=~fied o= requi~ed. * ~=sess~ng =nd screening refferr~s from ~np~c~ent units co.unity ~genc~es to dete=m~ne c~enc e~g~b~y fo= as outlined by &dm~ss~on ~ red~=ecc~nq ~nappropr~ace ~e~ecra~s to more app=op~ace co~n~cy a~enc~es oc p=og=ams to [ac~ate c~ent p~aceMnt an~ collaborative co~un~y * el~c~t~nq~ evaluac~nq and d~u~nC~ng ~nformac~on f~om the client, the family, =e~ec~&l source and ~np~t~enc cecocd a~l =e~evanc data such as psychiatric and Md~ca~ h~story, ~d~c~c~on ~eq~=emenCs, STStem sup~t~ and employment ~tent~al to assess c~e~c ~0~ admission a~d treatment ~ec~n~ac~ons~ discEpl~nary ~eam, a tehab~lE~a~ion ~=ea~n~ p~an which may ~nc~e ~dicatEon main~enance ptoqr~, socia~ and activities and v~a~ional skElls; throuq~ ~nte~v~ews, lamely and/o= cO~un~ty feedback, and co~un~y ' cO~un~ca=~nq w~h c~ent's soc~a~ end co~un~y net~rks such as ensure comuni=y super= and consEs~en~= ' adm~n~sCer~nq ~d~caC~on Co c~n~c clients e~C~er ora~2y or patentera~y, as ptesct~d. 4. Pe=~otms othet dutLe; as ass:~ned: ' as ass~9~ed. 4. $k111. and knowledge (conrad.) and sup~visoty skills; knowledge of hospital and dep&rtment policy and proceduze; knowledge o~ community resources; knowZed~e of relevant acts such as Mental He&l=h Act, Health O£~c~pl£nes Act, Public ~ospi~aL; Kcs, Cro~ ~ployees Collective Bargaining Act; Occupational Health and ~afet¥ Act and the relevant Collective Agreement~ knowledge of t~e Ontario College of Nurses Standards. G.S.B. No. 189/~9, 197/90, 202/90 IN THE MATTER OF AN ARBITRATION AND IN THE MATTER OF The Crown Employees Collective Bargaining .Act BEFORE The Grievance Settlement Board BETWEEN: ONTARIO PUBLIC SERVICE.EMPLOYEES UNION (Andrews et al.) THE CROWN IN RIGHT OF ONTARIO (Ministry of Health) AGREED STATEMENT OF FACTS 1. The representative grievors, JoAnn Leavey and Janice Wicke, are Head Nurses, respectively, at the Lakeshore and Unit 2-B Clinics providing outpatient services for the Queen Street Mental Health Centre. The Lakeshore Clinic is located at 3131 Lakeshore Boulevard West in Toronto. The Unit 2-g Clinic is located in the basement of Unit 2 at the Queen Street Mental Health Centre, I001 Queen Street West, Toronto. 2. The grievors are currently classified Nurse 3, General. They seek an order of the Board to be properly classified. 3. The staff at the Lakeshore Clinic includes a Head Nurse, four staff nurses, one senior social worker, two social workers, four part-time psychiatrists, two psychiatric residents, one psychologist (PhD), one senior occupational therapist, two occupational therapists, one workshop supervisor, three workshop instructors, one recreationist, two clerical workers and the Program Director. 4. The Head Nurse at the Lakeshore Clinic reports to the Program Director at the Lakeshor~ Clinic and the Assistant Director of Nursing at the Queen Street Mental Health Centre. The. Head Nurse and on occasion, other senior staff members have administrative responsibility for the whole clinic during any absence of the Program Director for. vacation and two half days per week which began 2 weeks prior to the filing of the grievance. The staff at the Unit 2-B Clinic includes the Head Nurse, four full-time and one part-time staff nurses, one part-time psychiatrist, one psychometrist (MA) and one occupational therapist. 6. The Head Nurse at the Unit 2-B Clinic reports to the Nursing Coordinator in Unit 2. Twice a month she attends the Unit 2 Head Nurses meeting held by the Nursing Coordinator as well as meets individually with the Nursing Coordinator. In addition, informal contact initiated by either the Coordinator or the Head Nurse occurs as required. The Head Nurse has administrative responsibility of the Unit 2-B Clinic and coordinates the day 'to day activities of all staff, excluding the part-time psychiatrist (that is, ensures that the.programs scheduled for the day are running as scheduled). The occupational therapist and psychometrist receive discipline specific professional and administrative, supervision and direction from 3 their departmental supervisors. The Head Nurse also supervises and directs volunteers and summer employment staff assigned to the program. The ultimate administrative responsibility, of the Lakeshore and Unit 2-B Clinics rests with Queen Street Mental Health Centre. 7. The Head Nurses devote approximately 50% of their time to coordinating a caseload similar to the staff nurses and carry a proportionally smaller caseload than the staff nurses. In the Lakeshore Clinic, ihe Head Nurse has a caseload of 20-25 patients whereas the nursing staff in the Lakeshore Clinic carry a caseload of 40-50 patients. In the Unit 2-B Clinic, the Head Nurse has a caseload of approximately 4-8 patients whereas the nursing staff in the Unit 2-B Clinic carry a caseload of 10-15 patients. The Head Nurses also are assigned the following additional duties and responsibilities. Staff Supervision and Administration 8. The Head Nurses of the Lakeshore and Unit 2-B Clinics participate in the selection and hiring of nursing staff at their respective clinics. The Head Nurses assist in the preparation of interview questions and the review of resumes, employment records and references of applicants for positions on the nursing staff. As members of the selection panels, the Head Nurses participate in the interview of 'nursing staff applicants and in the hiring decisions of the panels with respect to nursing staff. The Head Nurses are consulted with respect to the hiring decisions of non-nursing clinical staff. On occasion, the Head Nurse at the Lakeshore Clinic participates on the selection panel for non-nursing clinical staff. With respect to the Lakeshore Clinic, the ultimate decision rests with the Assistant Director of Nursing for ttxe hirlrtg of ~ursing staff and with the Department Head and the Program Director for the hiring of clinical staff. With respect to the Unit 2-B Clinic, the ultimate hiring decision rests with the Nursing Coordinator for the hiring of nursing staff and with the Department Head and the Chief of Service for the hiring of clinical staff. 9. Both the Head Nurses at the Lakeshore Clinic and Unit 2-B Clinic are responsible for the scheduling' and coordinating vacations of nursing staff. Most staff have regular working hours but the Head Nurses are responsible to ensure coverage when staff are absent due 'to sickness and other Unexpected absences. At the Lakeshore Clinic, other clinical staff members negotiate J~heir vacation leaves with their respective senior staff, the Program Director and their Department Head. The Head Nurse at the Unit 2-B Clinic negotiates vacation leave with the occupational therapist and psychometrist to ensure adequate coverage, but approval of vacation and time off rests with the respective Department Head. The Head Nurse at the Lakeshore Clinic is also responsible for scheduling and coordinating vacations of clerical staff. 10. The Head Nurses als0 schedule nursing students at the clinics to ensure the appropriate educational experiences. In the Unit 2-B Clinic, students of psychology and occupational therapy become a part of the multidisciplinary team and may be recommended by the Head Nurse to work with nursing staff in particular proiects or cases. However, at both Clinics, supervision of students in terms of meeting their learning objectives is a discipline specific responsibility. The Head Nurses discuss nursing student evaluations with the student coordinator/clinical supervisor of the educational institution that place the students with the clinics. The' usual number of students assigned to the clinics is 2-8 per year. 11. The Head Nurses conduct performance appraisals annually for all nursing staff. The Head Nurses may identify and discuss any problems in work performance with the nursing staff. The Head Nurses may identify and discuss any problems in work performance with other clinical staff. If such problems are not resolved, the Head Nurse would report the problem to the responsible Department Head. In addition, the Head Nurses meet with the nursing staff to discuss clinical techniques for 'treatment and care of patients at the Clinics. The Head Nurses conduct qUarterly performance reviews and evaluations of new nursing staff during the one-year probationary period to ensure compliance with performance standards. However, as the turnover of nursing staff is quite low, the hiring of new staff members occt~rs infrequently. In the Unit 2-B Clinic, the Head Nurse may participate informally in the evaluation of other staff members assigned to the Clinic. 12. The Head Nurses respond to and refer complaints from nursing staff about conditions of employment. The Head Nurses receive formal grievances and may provide the written response at stage one of the grievance procedure after consultation with the Nursing Coordinator or Assistant Director of Nursing. 13. The Head Nurses are responsible for the orientation and development of new nursing staff at the Clinics. The Head Nurses facilitate and participate in the orientation of other disciplines. The Head. Nurses explain clinic and hospital policies and procedures to new nursing staff. The Head Nurse at the Unit 2-B Clinic and the Program Director at the Lakeshore Clinic communicate new hospital and clinic policies and procedures, as revised, to all staff at the Clinics. The Head Nurses communicate revised and new nursing policies to the nursing staff. 14. TI-re Head Nurses and other nursing staff act as resources in psychiatric outpatient nursing clinical care and treatment for other staff in the Clinics. The entire clinical staff acts a resource for other units of the Queen Street Mental Health Centre and external agencies. The entire clinical staff provide information about outpatient clinical services on the basis of their experience in such treatment and care. Inquiries from other units of the Queen. Street Mental Health Centre and external agencies which are received by the Head Nurses may be responded to directly by the Head Nurses or referred by the Head Nurses to other nursing staff. 15. The Head Nurses participate in various committees at the Clinics and the Queen Street Mental Health Centre. These 'committees include Nursing Advisory Committee, Unit Head Nurse meetings, Service Advisory Committee and Facilities Management Committee. The riursing staff, on their own initiative or as requested by the Head Nurses, also participate in various service meetings and hospital committees such as Unit Education Committee, Hospital Housing Committee, and Police and Ambulance Liaison Committee. 16. The Head Nurses respond to and investigate complaints about nursing staff from clients, families or outside agencies. The Head Nurses discuss the complaints with the complainants and staff in question. The Head Nurses bring any ufiresolved complaint to the attention of the Program Director or Nursing Coordinator/Assistant Director df Nursing with any recommendations for resolving the problem or for further action. The Head Nurses may investigate and respond to complaints about other disciplines or the physical environment (such as 7 quality of air, cleanliness) and refer any such complaints to the Nursing Coordinator/Assistant Director of Nursing, Program Director, Service Chief or the appropriate Department Head. Program Administration 17. The multidisciplinary teams of the Unit 2-t5 Clinic and the Lakeshore Clinic are responsible for the development of out-patient programs at the clinics to ensure proper services to clients. The programs are reviewed and evaluated by the multidisciplinary team on a formal basis once a year and less formally throughout the year. At the Lakeshore Clinic, the senior staff, including the Head Nurse, assist tl~e' Program Director with the formal and informal processes of program review and development. At the Unit 2-B Clinic, the Head Nurse, i.n consultation with the multidisciplinary team, prepares an agenda for program review, schedules meetings of the multidisciplinary team and prepares the annual program outline. 18. The Head Nurses also prepare equipment and supply requests for use~ in budget preparations at the Queen Street Mental Health Centre. The requests . · prioritise the equipment and supplies required by the clinic in the coming fiscal year. The Head Nurses also review equipment and supply purchase orders before submitting same for approval to Nursing Administration which forwards same to the purchasing department at Queen Street Mental Health Centre. I9. The Head Nurses and other clinical staff participate in community committees .on behalf of the Clinics. The Head Nurses direct or approve the participation of other nursing staff in community c6mmittees. The purpose of committee participation is to represent the Queen Street Mental Health Centre in the community and to exchange input from other community agencies about the needs of clients of the Clinics. These committees include the Subcommittee on Health Issues in Boarding Homes (Habitat Advisory COmmittee), Workman Theatre Project, Education Program for Friends and Families of Persons with Schizophrenia, Lakeshore Area Multi-Service Project and Humber Unemployment Group. With the Head Nurses' approval, other nursing staff also liaise with community and hospital agencies to ensure effective coordination and utilization of services to meet client needs. 20. The Head Nurses, nursing staff and other clinical staff participate in research projects carried out by staff of the Clinics, Queen Street Mental Health Centre and outside agendes. The Program Director of the Lakesktore Clinic and the Head Nurse of the Unit 2-B Clinic receive the initial inquiries from such researchers and may refer the inquiries to particular nursing or other clinical staff. Date: ]anuary 29, 1992 OPSEU Ministry of Health