Loading...
HomeMy WebLinkAbout1989-1890.Andrews et al.91-01-14~ · .:' · ONTARIO EMRt..O YES DE LA COURONNE ?.' .:-,: .-~ ~--- - CROWN EMPLOYEES DEL'ONTARIO 1 /":'~ "' GRIEVANCE C,OMMISSION DE ~ '~.~ SETFLEMENT REGLEMENT BOARD DES GRIEFS' I,~0 .0UNOAS s'rl=tE~;."1' WEST, SUITE ~00, TORONTO. ONTARIO. M$O 1Z8 TELERHONE/TEL£P~Ot4E: ~4 ~6) 325-1388 ?aO, RUE ~,.;N.,INOA$ OUESTo BUREAU ~?O0, TORONTO (ONTARIOI, M~,G r~,8 F.4C$,',~4tLE.,'TEL~COPJE [4 ~6) 326-~39,6 · . ] 97/90, 202/90 IN THE MATTER OF AN ARBITRATION Under THE CROWN EMPLOYEES COLLECTIVE BARGAINING ACT Before THE GRIEVANCE SETTLEMENT BOARD BETWEEN _ OPSEU (Andrews et al) Grievor She Crown in Right of Ontario (Ministry of Heal,h) Employer BEFORE: J. Samuels Vice-Chairperson · __ S. Urbain Member D. Daugharty Member FOR THE N. Coleman GRIEVOR Counsel .... Gowling, Strathy & Henderson Barristers & Solicitors FOR THE A. LeGault EMPLOYER Counsel Fraser & Beatty . Barristers & Solicitors ,~EARING: September 12, 25 1990 December 17, 1990 There are about 57 grievances before us conceming the classification of the nurses who work in the twelve out-patient clinics' of the Queen Street Mental Health Centre in Metropolitan Toronto. These grievances fail into three groups. Two of the groups of grievances are filed by nurses classified as Nurse 2 General who claim that they ought to be classified as Nurse 3 General. The other group of grievances is filed by nurses classified as Nurse 3 General who claim/hat they ought to be classified as Public Health Nurse 2. In order to facilitate the disposition .of .all of these grievances, at the urging of the Board, the parties agreed to present as an example the case for the Nurse 2 Generals at the Lakeshore~ Outpatient and Community Services Clinic. This award deals with this example only. We hope that this decislon will assist the parties to resolve the qther grievances over which we retain jurisdiction. ? The twelve out-patient clinics of the Queen Street Mental Health Centre help patients with mental illnesses to function outside the hospital environment. The clinics are staffed by psychiatrists, social workers, psychologists, clerical employees, occupational therapists, recreationists, .- vocational rehabilitation counsellors, workshop instructors, and nurses. These employees offer clinical and rehabilitation assistance. The clinical staff is concerned with the treatment of the mental illness itself. The rehabilitation staff is concerned with improving the patient's ability to cope with the activities of daily living, such as finding a job and managing one's finances. The grievors are the clinical nurses. They provide professional nursing service in the clinics and in the patients' homes. Ms. Cindy Arthurs has been employed at the Queen Street Mental Health Centre since April 1981 and went to the Lakeshore Outpatient and Community Services Clinic as a Nurse Therapist in August i98 i. She is a ~ : Registered Nurse, and has a Bachelor of Arts from the University of Toronto. She came to Queen Street with about six and one-half years of .. experience 'in-Psychiatric nursing at the Clarke Institute and York Central Hospital. She told us in some detail about her work at Lakeshore. She is classified' as a Nurse 2 General, and her Position Specification is appended to this award as Appendix A. This job description was pi-epa, red in I990, but the parties agreed'that Ms. Arthurs' job was the same in 1990 as it was when her grievance was filed in 1989. At Lakeshore, there is a clinical unit and a rehabilitation unit. The clinical unit consists of a head nurse, four' nurse theraplsts, one senior social worker, two social workers, four part-time psychiatrists, two psychiatric residents, one psychologist and two clerical workers. Ms. Axthurs is: one of the four nurse therapists. These people treat patients who come to the clinic from all over Metropolitan Toronto. Ms. Arthurs has a caseload of roughly 60 adult patients, who have a broad range of major, mental illnesses and/or psycho-social dysfunction. Her job is to treat 'these problems so that the patients are able to operate in the community at their highest leveI of function, She is involved with the admission of patients to the clinic. Part of · ! ~ one day per week is spent dealing with people who come in the door for help. Some have been referred to the clinic by community agencies, hospital.q, physicians, lawyers, or police.. Some have been referred to Ms. ' .... Art. hum specifically.- She determines whether the person is eligible for · . admission and whether the person needs immediate access to a therapist. The new-comer will not be admitted if he or she is already being treated by a therapist, nor if the person needs immediate hospital care (in which case, the prospective patient is sent to a hospital for in-patient care), nor if the . primary problem is substance abuse (in which case, the prospective patient is sent to another agency). 3 Registered Nurse, and has a Bachelor of Arts from the University of Toronto. She came to Queen Street with about six and one-half years of experience in psychiatric nursing at the Clarke Lastitute and York Central Hospital. She told us in some detail about her work at Lakeshore. She is classified as a Nurse 2 General, and her Position Specification is appended to this award as Appendix A.. This job description Was prepared in 1990, but the parties agreed' that Ms. Arthurs' job was the same in 1990 as it was when her grievance was fried in 1989. At L~keshore, there is a clinical unit and a rehabilitation unit. The clinical unit consists of a head nurse, four nurse therapists, one senior social worker, two social workers, four part-time psychiatrists, two psychiatric residents, one psychologist and tWo clerical workers. Ms. Arthurs is one of the four nurse therapists. These people treat patients who come to the clinic from ali over Metropolitan Toronto. Ms. Arthurs has a caseload of roughly 60 adult patients, who have a broad range of major mental illnesses- and/or Psycho-social dysfunction. Her job is to treat these problems so that the patients are able to operate in the community at their highest level of function. She is involved with the admission of patients to the clinic. Part of one day per week is spent dealing with people who come in the door for help. Some have been referred to the clinic by community agencies, hospitals, physicians, lawyers, or police. Some have been referred to Ms. Arthurs specifically. She determines whether the person is eligible for admission and whether the person needs immediate access to a therapist. The new-comer will not be admitted if he or she is already being treated by a therapist, nor if the person needs immediate hospital care (in which case, the prospective patient is sent to a hospital for.in-patient care), nor if the primary problem is substance abuse (in which case, the prospective patient is sent to another agency). The nurse therapist assesses the mental status of the new-comer-- why is this person here? is there a major mental i-llness? is .this person suffering from delusions? is he 'or she hallucinating? Organ/zed? suicidal? how can we help?' The initial interview and the nurse's assessment is recorded in writing. If the nurse thinks that the person should be admitted, she makes an appointment for the .person to see one of the clinicians, perhaps herseff, ff there is a major' mental illness, Ms. Arthurs will enlist the help of a psychiatrist; because the psYchiatrist is the only person who can prescribe medication.' This initial decision is brought to the next meeting of' the multidisciplinary team, which meets two times per week. The team consists of all of the clinical staff. It discusses the new cases and the preliminai'y admission decisions. Suggestions are made. The preliminary admission decisions made by the admkting nurses are rarely overturned. The formal admission forms w.'211 be signed by a psychiatrist. Thus, every admitted patient will have been discussed at least once with a psychiatrist. After a patient is admitted, a nurse therapist will meet with the patient and will prepare a treatment plan. if medications are required, a psychiatrist will be asked to assess the patient and to prescribe the drugs. If medications are not required,._ the nurse will administer psychotherapy, which involves 'on-going meetings and assessment. Where treatment is confined to psychotherapy, generally the psychiatrist will not be involved with the patient apart from signing the formal admission form. The nurse 'therapist will arrange for vocational assessment, psychometric or psychological tests, various forms of community support . (for example, assistance of a rape crisis centre, if sexual abuse is involved; welfare; family benefits; housing; individual,, family, or Couple counselling). 5 Once a week, the clinical staff meets with the rehabilitation staff to discuss the rehabilitation needs of the clinical patients (for example, how to fred a job, or how to manage one's finances). The nurse's treatment plans for her patients are discussed at the meetings of the multidisciplinary team. And once a week, all the nurses get together to discuss the cases, and other matters. A psychiatrist attends these meetings, because of his or her professional interest in the psychotherapy administered by the clinicians. Ms. Arthurs' receives virtually no direction from her head nurse. There is no regular contact with the head nurse concerning the caseload or Ms. Arthurs' day-to-day work. The head nurse does an annual performance evaluation of Ms. Arthurs. Though the Position Specification found in Appendix A says that the work involved with the client case load occupies 55% of the nurse therapist's time, Ms. Arthurs testified that the figure ought to be 65-70%, and this was not challenged. The second set of duties described in the Position Specification-- "undertakes responsibilities consistent with professional training..."--take up about 20% of her time, says Ms. Arthurs. ' Is Ms. Arthurs classified properly as a Nurse 2 General? The Class Standard for the Nurse 2 General is appended to this award as Appendix B. The opening paragraph of this standard describes a job which involves treatment of patients in a hospital or other institution. And the next two paragraphs give more detail concerning the types of duties which will be performed ~in this structured environment--record and carry out physician's instructions, administer medications and injections, watch patients' symptoms and take appropriate action, assist in feeding and ward housekeeping, perform duties in an operating room. This is the kind of job 6 which was involved in Gervais, 392/89 and Nichols et al, 778/89 to which 'we were referred by counsel for the Ministry. In these two cases, the grievors were ward nurses at the Penetanguishene Mental Health Centre- Regional Division. 'This is not the kind of job. performed by Ms. Arthurs. From the initial decision to admit the patient to the Lakeshore clinic, to the preparation of the .treatment plan, to the carrying out of the required psychothe, rapy, Ms. Arthurs exercises a much greater degree of indepe.ndeht judgment and responsibility than is contemplated within the structured environment of a hospital ward. A patient is in the hospital because a physician said this is where the patient ought to be treated. On the other hand, at the clinic; for all intents and purposes, it is the admitting nurse wh° determines whether or not the patient should be admitted into t_he clinic. In a hospital, the physician is very much involved in the treatment administered to a patient, both in the planning of that treatment and in its giving. In an out-patient clinic like Lakeshore, the physician (psychiatrist) may have very little involvement with some patients--it is the nui:se therapists 'who develop the entire treatment plan-and administer it. At Lakeshore,. for many patients, the. psychiatrist is there in the background, but is not involved at all as is a physician with a patient in a hospital. In our view, Ms. Arthurs is not properly classified as a Nurse 2 General. Would she be classified properly' as a Nurse 3 General? The Class Standard for Nurse 3 General is appended to this award as Appendix C. The first paragraph of this standard, like the Nurse 2 General standard, Speaks of work in a hp~pi~al qr other insti~tign. However, the second paragraph contemplates a broader range of operating environments. The last sentence of this second paragraph says that such employees may .~ conduct clinics or provide outpatient, orthopaedic, or emergency care. This would fit Ms. Arthurs. The second sentence of the second paragraph speaks of overseeing treatment procedures. This is the heart of Ms. Anhurs' job. The first sentence of the second paragraph speaks of exercising "some independent judgment and initiative". One would expect that a qualified registered nurse would always be exercising a measure of "independent judgment and initiative" in carrying out nursing duties. This reference in the standard must mean some higher level of judgment and initiative than would be the general rule in the performance of nursing duties. And, given the job we have described as Ms. Arthurs', we have no difficulty in concluding that she does exercise a greater degree of independent judgment and initiative than is generally the case in the performance of nursing duties. Indeed, when Ms. Arthurs first applied for the out-patient job at the Centre, she was told by her supervisor that the job needed more experience than an in-patient job, that more skiI1 and responsibility was involved. And Ms. Arthurs' testim, ony concerning the job bears this out. In our View, Ms. Arthurs would be classified appropriately as a Nurse 3 General. We did hear testimony concerning the job done by Ms. W. Beaton, a Community Nurse Clinician at the Whitby Psychiatric Hospital, who is classified as a Nurse 3 General. In our view, there is little substantial difference between the position occupied by Ms. Beaton and the one held by Ms. Arthurs. It appears to us ithat Ms. Beaton is properly classified, and Ms. Arthurs would be properlY classified at the same level. But let us be perfectly clear. We find that Ms. Arthurs ought to be classified as a Nurse 3 General because her job fits within the Class Standard for Nurse 3 General, not merely because she is doing the same work as Ms. Beaton. , Ms. Arthurs should be reclassified to Nurse 3 General as of 20 days before her grievance, and should be compensated for'MY monies she ought' to have been paid and was not paid because of her improper classification, with interest at 10% per annum on any sum from the date it ought to have been paid to the date it is paid. We will reserve our jurisdiction to deal with the other grievances mentioned at the outset of this award, and to deal with any matter concemin~ the implementation of our order with respect to Ms. Anhurs. Done at London, Ontario, this ~4th day o.f January ,199~. '~w~aUels, Vice-Chairperson S. urbain, Member - ~ 05., ~: ~ew New I l 4 Head Nurse 74 ~e~r~inq Co the Hen4 Nurse and in collaboration wi~h the mulc~di$cip~ina~ ~eam, ~. Coo~dinaCes a c~ien: case ~oad by: , - screening referrals ~r~m comunicy agencies, hospitals, physicians, la~ers, ~lice an~ the p~lic Lo dace=mips client's el/~lDiliCy for a~ission as ou~lime~ by a~ission criteria; - re~irectin9 inappropriate referrals tO ~ ~ppgopria:e cOm~i:y agencies o~ pr~a~ to ensure appropriate client placemen~ and c~ra:ive c~nity - el.icitinq, evaluating and d~flting, from comunity sources, =he client or the all ~ele~an~ infarction such as referral C~CUms~a~es, psychia~ric and ~dical h~s~ory hospi~aliza~ion fr~vency, ~dication requirements, sup~rts a~ employ~pt ~o assess clien~ for a~issi~ and ~rea%~n% - formulating, i~ consu~%a%ton w~th the client and ~he muZtidisclplinary team, a trea~nt~ plan which ~y include sup~rtive counselling, medics:ion, group :hera., covflselli~ sessions, family an~ cOMuOl:y feedback and/oN ~havioural - idenclfyin~,con~accin~ and assisting t~e =lien~ gain acceSS ~o needed ~dical a~ - co~n~co~ng v~ c~en~*s socLa~ and c~0~7 ne~voFks s~ch as fa~, 16~d~o~ds, phTS~c~a~s and ~ce ~o ensur~ co~un~7 svp~ a~ cons~s~en~ - ln~erveflln9 in clienL crisis eisner Ln %he c~c o~ h~ en~lronMfl~ to ensue ~'e client receives the sup~rt and ~esources required to resolve the crisis such as counselling, ~d~caC~o~ or bosp~al~zac~on~ ~eglstered as a nurse in Ontario; ~h~ouqh knowledge of general and psychi~tric nursing theory and practice Co include knowledge of psychiat~ic illnesses, disorders a~d ~haviougs; of re~evant drugs and side effects~ ~ncerviewing, co~n=eLllng, and ~ocu~nCaCion JoAnn ~avev Joyce ~ainvik~<sLsta~t ~{~r~- mO~y ~ x.~lOyees provide nursing ca~e to pa~leflts ass~iaCed rich afl Often=ia ~ospical. Perform a varieLy of professional nurs£ng duties .under direction of sur~rvising nurse, L.e., 8. administer medication, watch for patients symptoms or reactions; assist patients with their personal needs; provide information and counsel to patients' rolat£ves. information; formulate, monitor and alter, in consultation wl[h the multi-disciplinary (includes physician), a trea~raent plan~ lntezvene La client crLs[s %o "1 m i I ~'c John tnstructlons for completing ~'or, In~uctio~ 1~ c~ing Po~l~on ~enUller Insl[uct~n~ fo~ c~ing Seconal Wo~ Period ~e ~e I Z 3 4 Instmc~io~ lot ~dlng Sch. Hfs, 'Wo~ 1. ~te ~. 4.Sk~lis and Kn~le~ge: (concfnued} Mental ~eAl~h AcC, Health Disciplines Act anG Public. NosplCals Duties and relate8 ~askSt ~con~inued) iZlness or to address family concerns: utilizing psychotherapy techniques, ur~:L~r the general direction of the Dsychietrist, such aS clear, concise direction, advice, a~d support or insight counselling to assi$~ clients deal with situational problems. - administering m~dication tO clinic clients either orally or to efl~ure ~dlca~lofl avail~ility; - acting as a reso~ce ~o muftidisciplinary :eam by 9ro~idin9 information in discipline-s~cific ex~ise, i.e., ~dica~ion, side effects and physical assessments; maintaining accurate and t~ely client documenta:fon such as psychiatric history, rehabilitative treatment, treat~nt interventions and ten.nsc, su~rvising nursing Ituden:s to enhance ~tudent kn~ledge of the Co.unity focus; re;iewing nursing research op~rtunities :o contribute and ensure progress in the field of mental hea~:h nursing. · ar:icipates in Clinic Adminlsttation and ~evelopmen: - ~tti~ipating ~ith and contributing to co. unity advisory ~ards co~ittees tO liaise or to enhance c~unity ~rs~c:ive; enhan:e clinical ot ~rog~am. knowledge and understanding; - participating, p~anning, reco~ending and implementing group or program initiatives to meet client needs and to broaden clinic services; participating in :he develop~nt of clinic ~licy an~ procedure as reques%ed. orientating new s~aff as required - relieving Head Nurse as reRui:ed as assigned. GROUP: ~P-06 ~u~ SE~ES: ~u~se, ~ner~L CLASS C00£; 50052 /~ Stmtna~- $9ecifica=ion CLASS DEFEqrT[ON: E~Dloyees in positions alloca:ed ~o this class perform a variety - of professional nursing duties for patients in Ontario Hospitals and tn Lnf%rmaries of provincial schools and institutions. Their duty hours zre usually ~ora~ed betn~een a~¥ of three ThirsT. : ~nder direction of a supervising nurse, physicizn or other insTiTUtional officer, choy record and carry ouc physicians' instruc- tions on treatments znd transfers, acb~J~is:er medicines and h~poder~c injections as aurho~:e~,.obca.Ln pa~ients~ confidence and encourage their mteres~ in activities, watch for ~atien~s' symptoms or reactions ~4 ~ake remedial action as requi~ed, azsis~ in or supervise feed~n~ and war~ housekeeping, assist pat~eflts w~th their sersonai ~eeds and care. recor~ patients~ conditions and report unusual incidents'to ~uFer~or~ They may accompany patients ~o specia/ treatments or on transfers as required and provide info:~ation and counsel :o patients? relatives as authori:ed. :n ad~Lt~on, these employee~ may al~o make arrangements for preparation, sterilization and issukng of surgical and operating room supDlies ensure aseptic condition of operatin~ roomz, assist'in surgical procedures aha provide pre o~ pos:-~perasive nursin~ care of patients. :n some pos:tions, where :hese'employees may be on .c~,ency fou~ hour call as requ~re~, prLncipa.L ~ut~es of employees Ln chis class m~y be provision of f~rsc aid: clinical. ~nd :nfi~ care under direction of a full or part-rL~e physician. ~ployees ~n this class may assis: Ln or supervise the cue:es ana c~eck :he work of subor~Lna:e s:&f~ on :he sa~e Th±fo.. on factors such ~s the hours o( d~', :he sloe and the a~cun: of nurs:n~ requzred :n the ad~inis:rative unLt~ ~hey are'responsible superv~sung nurse for all or par: of the nursing a~d ~ersonal care Ln an administratzve unic as assigned They may, on occasion, relieve super- QL'AL[ F £ C~TIO.NS: Re~:ssrarion as a nurse Ln Ontario; preferably completion of (radua:e cerrif~ca:e courses from a universit? of reco~i:ed AbtL~tF ~o obtain co-opera~ion of staff ~d patients; ability foLio~ and ~o pass on verb~ ~d ~itten ~s~c:icns on care; ~ood physical and menc~ he, th. GROUP: $P-06 ~urs~ng CLASS CODE: 50054 /~ Specification NURSE CLASS DEFINIT'ION: Employees in positions allocated to ~his class provide professional supervision of 'the nursing and personal care of ~ ~roup of pa~ient~ ~ ~ ~fi~, wa~ or a~is~r~tive Most pos~t~ons ~ th~s class are fo~ on the day shift. such positions these emDloyees sehed~e duties, rotation of sh%fXs ~d co.scl ~d discipl~e staff as ~equired. AlthouEh ~plcyees m ~is class l~ceive direction ~equ~d to exercise s~e ~depen~ent jud~en: ~d ~i~iative. review cha~s, prepare repo~s~ ~int~ ree~s, ~ns~e gener~ maznten~ce ~d cte~liness of w~ facilities, c~er supplies, ~u~e~ise the provision cf fo~ se~%ce~ to patients ~d ~ ~taff tra~ p~r~s. ~ey ~y conduct civics or provide outpatient, c~t~cpaedLc or ~ergency qUAL[FICATYO~$: !. Re~;strarion as a nurse zn Ontario; ~ood knowledge of ~rofess~onal theory and practice' as applied to i~stitutional nurs nng; preferably completion of a pos~-graduaue certificate course 2. Min~m~ of ~wo years of acceptable graduate nursing exTerience~ preferably rela%ed to ~he dusies to be performed. Abzl~- ~ superv%se ward or znfir~ary nursing services; ability to meet the public and ~o provide counsel to staff and to patienss' relatives as required; ~nisza~ive; good physical and mental healsk. Dece-ber. loa2.