Alberta health centre decided to put two areas under one nurse in charge
Alberta Health Services (AHS) violated its collective agreement requiring a designated “in-charge” nurse for every unit when it decided to designate one nurse in charge of two areas of a small-town medical health centre, an arbitrator has ruled.
The collective agreement between AHS and its nurses’ union, the United Nurses of Alberta (UNA), required AHS to “designate a person to be in charge of a ward or unit.”
Each nurse who was designed to be “in charge” was paid a premium.
The Sacred Heart Community Health Centre in McLennan, Alta., is a primary care facility that sent patients requiring specialized services to other facilities — it had a limited operating room and no long-term care beds.
The emergency department was open 24 hours a day and was staffed with one registered nurse for two eight-hour shifts, plus a unit clerk during the day from Monday to Friday.
There was no nurse on duty from midnight to 8 a.m., when one of the in-patient unit nurses was assigned to emergency.
The in-patient unit had two registered nurses and two licensed practical nurses on 12-hour shifts, so it was staffed for 24 hours a day.
The in-patient unit and the emergency department each posted separately when recruiting new nurses, had separate budgets and contact numbers.
There was only one staff schedule for the centre but emergency nurses were grouped together.
It was common policy for the centre to designate a nurse to be in charge of the emergency department and another nurse to be in charge of the in-patient unit, with both nurses receiving the in-charge premium.
Between midnight and 8 a.m., the in-charge nurse for the in-patient unit would assume responsibility for the emergency department, since it was staffed by an in-patient unit nurse — though it could not be seen from the in-patient unit nursing station.
If the emergency department nurse wasn’t busy at the Sacred Heart Community Health Centres, they were to help with the in-patient department. In-patient nurses would cover emergency nurses’ breaks.
Change announced in 2009
On May 1, 2009, the Sacred Heart site administrator issued a memo to all staff announcing that, going forward, the centre would only have one nurse designated to be in charge on each shift, instead of one for the in-patient unit and one for the emergency department.
The UNA grieved the new policy, arguing that the emergency department was a “ward or unit” under the collective agreement and required a nurse to be designated “in charge” separate from the in-patient unit.
Arbitrator Lyle Kanee noted that the collective agreement “covers hundreds of facilities of various sizes serving a range of populations offering many different services.”
The difference in various facilities meant that an emergency department in one could be considered a stand-alone unit, while in another it would be integrated with another unit.
In Sacred Heart’s case, Kanee found that the in-patient unit and emergency department were close by but were physically separate and had been historically treated as separate units.
The decision to treat Sacred Heart as one unit was motivated by streamlining the teamwork between the areas as opposed to a change in the physical layout of the hospital or the organization.
However, staff at any hospital are expected to operate as a team to some extent and to help each other, regardless of how many separate units there are, Kanee said.
Different shifts
Kanee pointed out that in addition to physical separation, nurses at in the two areas at the Sacred Heart Community Health Centre worked different shifts — eight hours in emergency, 12 hours in the in-patient unit — had different budgets, contact numbers and staff assigned specifically to them.
In addition, other than during the graveyard shift when an inpatient unit nurse covered emergency, the emergency department operated separately from the inpatient unit, with little interaction between them, other than covering for breaks.
And other than the graveyard shift, the in-charge nurse for the emergency department was in control of and responsible for the operation of the department during the busy times.
“The emergency department, during the days and evenings, largely operates independently of the in-patient unit,” said Kanee.
“Most of the patients in the emergency department will have no contact whatsoever with inpatient unit staff. When in-patient unit staff help out in the emergency department, the emergency nurse directs their care. The emergency department is primarily a self-contained operation.”
Kanee concluded that the emergency department at the Sacred Heart Community Health Centre constituted a “unit” and therefore required a nurse to be designated in charge while staffed, under the collective agreement.
For more information see:
• Alberta Health Services and UNA (Charge Pay), Re, 2016 CarswellAlta 2186 (Alta. Arb.).
