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I am honoured to write you as the new President of the Manitoba Nurses Union. After 10 years of incredible service, Sandi Mowat officially retired from the role on July 1. On behalf of MNU’s 12,000+ members, I want to first extend my sincere gratitude and thanks for her dedication to Manitoba’s nurses and patients.
There is a long list of accomplishments that Sandi will be remembered by for many years to come. My goal is to uphold Sandi’s achievements, and follow her example by providing quality representation for MNU members in every region.
That’s why it’s my mission to visit every local and worksite in our province. I want to provide an opportunity for you to share your concerns in-person, including ideas for improving working conditions for our members and health care delivery for our patients. As part of this effort, I will continue MNU’s Wear White Wednesday campaign to raise awareness about issues impacting patient care. Wearing white on Wednesday is a simple and effective way to express solidarity with nurses across our province and use our collective position as the most trusted spokespeople in health care. I hope to see as many nurses as possible wearing white as I visit facilities across Manitoba beginning this fall.
Since I decided to run for President earlier this year, I’ve been meeting members from across the province to hear more about the issues facing each region, and how MNU can better advocate for nurses like you.
As President, I will use my decades of experience as a nursing activist to stand up for your interests every day. I have been a practicing RN for over 30 years
and have been an active MNU member since 1981. I’ve served as President of my worksite in The Pas for over two decades, and on MNU’s Provincial Collective Bargaining Committee (PCBC) in 9 rounds of bargaining, including as Vice-Chairperson. I’ve also served as a board member for the Northern Region from 2012 to 2016 and as Secretary-Treasurer from 2016 to 2018. All of these experiences have helped prepare me for this role as President, and I’m ready to get to work on your behalf.
Having spent most of my career in The Pas, I also have an intimate understanding of the difficulties facing rural facilities in our province. Although many of the major changes and cuts implemented by the provincial government have taken place in the WRHA, there are no shortage of issues facing our rural worksites that I am paying close attention to, and eager to work with members to help address.
I believe in the collective power of nurses, and that through political action we can improve working conditions for all our members and patients. I was there in the 1990s, when nurses confronted some of the most extreme health care cuts our province has ever been faced with. I’ve also been active at the local and worksite level and seen how strong involvement from our grassroots members can make meaningful changes in their facilities, which in turn help nurses provide better patient care.
Through strong teamwork and representation, I want to ensure every nurse practices in a safe and supportive environment, and that MNU will continue to advocate for safe, quality health care for all Manitobans.
I sincerely appreciate the important work all of you do and I look forward to serving you and meeting you at your workplace soon. Thank you for placing your trust in me as President.
In solidarity,
Darlene Jackson, President Manitoba Nurses Union
Manitoba’s public health-care system is at a crossroads. At a time of sweeping changes, it’s incumbent upon all of us to take notice and decide whether the course we’re on reflects our values as Manitobans.
Public opinion polls show that Canadians overwhelmingly support our single-payer public system. Nurses share these values. We believe everyone deserves the highest quality care regardless of income or social status.
It’s no secret our public health system is facing challenges associated with an aging population with increasingly complex health-care needs. Unfortunately, instead of bolstering our public system, the Pallister government has targeted health for cuts and rushed into massive changes looking for savings, which has jeopardized the quality of patient care.
The effects of Phase I of its restructuring plan have radiated across Winnipeg. St. Boniface Hospital, which saw the largest scale of change affecting almost half of the nursing workforce, has been facing outrageous mandatory overtime rates since implementation.
In mid-March, nurses had reported over 300 incidents of mandatory overtime in 2018, already more than they had for all of 2017. The Winnipeg Regional Health Authority (WRHA) and Health Minister Kelvin Goertzen said the flu was mainly to blame. As of June 25, the number has risen to 799 reported incidents.
Of course, it was never just the flu. The women and child program, cardiac sciences and surgery all experienced major increases that couldn’t possibly be flu-related. Nurses have known all along it was due to Phase I changes. Patient volumes at St. Boniface were anticipated to increase by six per cent following the changes; instead, they have increased by 30 per cent, union representatives were told by the employer during a meeting.
Excessive overtime can lead to more sick time, burnout and stress-induced leaves, which only compounds the problem and seriously jeopardizes patient care while increasing costs.
Health Sciences Centre, long faced with chronic short-staffing, also saw a significant increase in patient volume following the changes. Prior to Phase I, HSC’s emergency department (ED) averaged roughly 160 visits per day. Since the changes, it now receives more than 200 patients per day, with a recent peak of 236. As a result, the ED is seriously overcrowded, as anyone who has visited recently can attest. As services are concentrated, patient acuity is also increasing, meaning nurses are not only treating more patients, but also sicker ones
The government didn’t consult nurses; it forced the WRHA to rush implementation — and has now made existing problems significantly worse. Nurses worry that they are being stretched too thin, compromising patient care.
The Pallister government has attempted to deflect our criticisms by claiming median ED wait times declined by 15 per cent relative to last year. Even if we accept the terribly reductive logic that the success of our health system could be measured by this one small sample, it’s still misleading to suggest a decrease was due to these recent changes. In fact, wait times are up following the implementation of Phase I.
In October 2017, the median wait time in a Winnipeg ED was 1.35 hours. Last month, it was 1.67 hours. At Seven Oaks Hospital, wait times were 1.8 hours, up from 1.63 hours in April — and far above their one- hour wait time in May 2017.
Meanwhile, Goertzen and WRHA officials are patting themselves on the back for minimizing nursing layoffs through their reorganization.
Unfortunately, Manitoba’s supply of nurses is set to be reduced. Red River College recently announced its nursing program will eliminate 50 of 225 seats due to government funding cuts — a 22 per cent reduction, despite increasing student demand and hospital staffing needs.
Despite these challenges, there are signs the government might be recognizing its folly.
Though Winnipeggers have said they would prefer to see it cancelled or postponed indefinitely, Phase II is at least significantly delayed following the ongoing struggles with Phase I. We’re told ED expansions are underway at the HSC and St. Boniface. Though the “connected care” walk-in clinic replacing the Concordia ED in June 2019 is a paltry half-measure, it represents an admission that removing services entirely from that community was a bad idea.
With Phase II’s delay, there’s still time for Manitobans to make their voices heard. Our public health care system is a tremendous asset that embodies our core values of compassion, fairness and equality. We must continue to speak out and remind the government that an accessible public health care system is a service we cherish, not one to be reduced
The provincial government appears to be planning significant consolidation of health care services in rural regions. However, the details largely remain secret, as no official announcement has been made outlining which facilities may be affected.
Shared Health—a newly created provincial organization —is currently reviewing regional proposals for health care consolidation. Already, Prairie Mountain Health has overseen the closure of Emergency Medical Service (EMS) stations which has caused public backlash. However, it’s unclear what further changes will be implemented, or what impact they may have.
In June, the provincial government released its “Health Care Transformation” blueprint, which outlined in broad policy terms what goals and objectives it hopes to achieve provincewide. However, specific consolidation plans were not disclosed; the announcement appeared to serve as a stop-gap for delaying the revelation of new information to potentially impacted communities and stakeholders.
After several months of delay, the provincial government and WRHA finally released its timeline for Phase II of its health care transformation plan on May 31, 2018. Unfortunately, the plan still calls for major cuts and changes, including the closure of the Concordia and Seven Oaks Emergency Rooms. Some changes including mental health consolidation are scheduled
to go ahead in the fall of 2018 but most major changes have been pushed to spring and fall of 2019 respectively. A list of changes as provided by the WRHA is provided at the end of this article.
Two weeks after revealing its Phase II timelines, the WRHA and provincial government announced that the Concordia Emergency Department will be converted into a “connected care” walk-in clinic, which will open from 9:00 am to 9:00 pm daily. As a result, the WRHA anticipates the facility will serve “up to half” as many patients as the
facility currently does. This is by definition a half-measure that will dramatically reduce care options for the facility’s catchment area and the surrounding communities.
Changes to staffing levels at affected facilities have not yet been announced. The employer is required to provide notice of 90 days in advance of initiating an employment security process. As soon as notice is provided, MNU will communicate to affected members.
If Phase II continues as planned, it would follow the closure of the Mature Women’s Health Centre, four Quick Care Clinics, the Misericordia Urgent Care Centre, and the Corydon Primary Care Centre. In addition, Victoria Hospital has lost vital services including their Emergency Room and ICU, while HSC nursing positions including Clinical Nurse Specialists in the Trauma and Burn units, IV specialists, and lactation consultants have been cut.
MNU will continue to oppose these cuts and changes publicly by lobbying the government and the region to reconsider this initiative and will continue to ensure that nurses’ rights are protected and the provisions of the collective agreement are respected
MNU has been working closely with members to address the issue over the past several months. On March 19, 2018, MNU publicly reported that there were already 328 incidences of mandatory overtime – the equivalent of all reported incidences in 2017. At the time, former Health Minister Kelvin Goertzen and WRHA officials claimed the issue was primarily “due to the flu”, despite most of the incidences taking place in the facility’s Women & Child program (labour &
delivery). MNU disputed the explanation and pointed to a reported 30% increase in patient flows to St. Boniface following Phase I facility closures and changes, and the rushed implementation of a new scheduling system that merged high-risk and low-risk deliveries in the hospital’s Woman & Child program.
As the crisis continues, shortages have been made worse due to increased sick time and burnout, which is increasing costs for the employer and reducing the number of nurses available to work overtime.
This was one of the last issues outgoing MNU President Sandi Mowat had the opportunity to comment on before her retirement on July 1. “Nurses at St. Boniface are extremely concerned. Many have reached a point of physical and mental exhaustion,” said Mowat. “They’re doing the best they can, but many nurses are so tired they’re worried about jeopardizing patient care.”
New MNU President Darlene Jackson has pledged to do everything she can to address the issue, and hold the employer, WRHA, and provincial government accountable for the crisis of their own creation. In addition to working proactively with the employer and WRHA to find reasonable solutions within the purview of the collective agreement, MNU has written to the licensing and professional bodies representing nurses at the facility.
In August, MNU wrote letters to the College of Registered Nurses of Manitoba, College of Licensed Practical Nurses of Manitoba, College of Registered Psychiatric Nurses of Manitoba, and the Association of Registered Nurses of Manitoba. Requests were made to each to publicly express concern regarding the mandatory overtime crisis at the facility, and help ensure nurses’ rights to refuse work if they are too fatigued to provide safe, adequate and ethical patient care are protected.
“The time for excuses has run out. We repeatedly warned this government that their changes were rushed, and would put patient care at risk,” said Jackson. “MNU is pursing all available avenues with the employer to ensure they are held accountable, and that both short and long- term solutions are implemented for the benefit of nurses and patients alike.”
Members are encouraged to visit manitobanurses.ca, subscribe to The Pulse weekly e-newsletter or follow MNU’s social media feeds for the latest news and information.
"They're doing the best they can,
but many nurses are so tired they're worried
about jeopardizing patient care."
As the provincial government continues to make cuts and changes to health care servicesthroughout Manitoba, MNU is prioritizing membership engagement and political activism as a means of standing up for nurses’ interests and ensuring safe, quality patient care.
Advocacy and the nursing profession are a natural fit. Nurses can use their positive reputation and credibility to influence public policy and help determine political outcomes.
In fact, the Canadian Nurses Association Code of Ethics emphasizes that nurses have an ethical responsibility “to advocate for evidence-informed decision-making
in their practice including, for example, evidence for best practices in staffing and assignment, best care for particular health conditions and best approaches to health promotion.” This is ever more important when public services such as health care are put at risk due to government cutbacks and privatization.
There are a variety of ways to make your voice heard, and work in solidarity with nurses across the province towards achieving shared objectives.
Here is a short list of simple ways you can take action:
VISIT PUTPATIENTSFIRST.CA
This fall, MNU is relaunching its Put Patients First campaign. The updated website will include a petition, shareable social media graphics, fact sheets, and more. Visit putpatientsfirst.ca to bring your voice online and help amplify the issues and concerns of Manitoba’s nurses!
The need for membership involvement is increasingly important. The provincial government has rushed the closure of the Misericordia Urgent Care Centre,
Emergency Rooms, ICU units, QuickCare Clinics, and cancelled projects such as CancerCare Manitoba facility expansion in Winnipeg. More cuts and changes are on the way, including consolidation of rural health care facilities— it is incumbent on nurses to speak up against changes that reduce access and jeopardize the quality of patient care.
Visit manitobanurses.ca/get-involved to learn more about how you can make a difference in your local/ worksite or community. In the words of MNU President Darlene Jackson, “no matter where you work or live, there is always a way to use your passion and voice to make a difference in the lives of your fellow nurses and patients.”
As journalists and advocacy groups followed the ministers to Winnipeg, the organizers of MHC decided it was an ideal opportunity to catch the eye of media and health care organizations, and bring attention to health care issues in Manitoba.
The launch was a landmark event for the organizations – including the Manitoba Nurses Union – that worked collaboratively to form the MHC, which is a not-for-profit advocacy group governed by a board of directors. After many months of planning, MHC was finally ready to show its face and get to work on behalf of the people of Manitoba.
“I am honoured to help lead the Manitoba Health Coalition and advocate for the expansion of universal, public health care,” said Provincial Director Brianne Goertzen. “I look forward to working with our stakeholders and members of the public to raise awareness about ongoing issues and help build healthy communities.”
As Provincial Director, Goertzen brings extensive experience as a community activist, organizer, and researcher. She has worked as the Manitoba Organizer for the Canadian Federation of Students, is currently on the board of the Child Care Coalition of Manitoba, Child Care Now and serves as Vice-Chair on the Steering Committee for the CCPA-MB. She holds a Bachelor of Arts (Honours) in Sociology with a concentration in Criminology and a Master of Arts in Sociology, and currently serves as a school trustee, representing Ward 3 in the River East-Transcona School division.
The MHC shares the values and objectives of its national affiliate, the Canadian Health Coalition (CHC). Its organizational model is reflected by its core value that health care is a public good and a fundamental right for all. Ultimately, both have a vested interest in protecting and enhancing our public health care system. The MHC and CHC are both coalitions of labour unions, faith- based groups, Indigenous organizations, and various community-oriented stakeholders that share a common belief in the five principles of medicare:
Since 1979, the CHC has advocated for the preservation and improvement of universal public health care across Canada. Over time, as certain governments have attempted to erode public access to health services, the CHC has grown to include provincial affiliates to help address issues of local and regional importance.
Affiliates such as MHC work in partnership with the CHC to improve health outcomes for all Canadians through a universal, public model. This model of organization is now strengthened, as the MHC also completed the CHC’s objective of having a provincial affiliate in every province.
“We are excited to have Manitoba join as our newest provincial affiliate of the Canada Health Coalition,” said Amanda Wilson, CHC National Director of Policy and Advocacy. “Together, we will work to strengthen and expand public health care for the benefit of all Manitobans.”
The event was also timely considering Manitoba’s changing political landscape. The provincial government’s decision to make sweeping changes to health care in Winnipeg and rural regions has prompted widespread concerns about privatization and erosion
of public health care services. In many cases, changes have resulted in cuts and closures of facilities and services, which reduce public accessibility to care.
In the coming months, MHC will empower its constituent organizations and members of the public to become engaged in developing and advocating for inclusive public health care policy.
As the next federal election looms in October 2019, there is a historic opportunity to make universal pharmacare a reality in Canada. Earlier this year, Prime Minister Justin Trudeau launched the Federal Advisory Council on the Implementation of National Pharmacare, which is tasked with consulting Canadians about prescription drug coverage and developing a strategic framework for a public plan. Political analysts believe this will lead to a key campaign promise by the Trudeau Liberals heading into the 2019 election. If so, two of Canada’s three major political parties would be committed to implementing universal pharmacare if elected (the federal New Democratic Party campaigned on the promise in 2015, and is already advocating for its implementation).
The impact cannot be understated, and the stakes couldn’t be higher.
Canada is the only country with universal health care that does not include national pharmacare. Although government programs or employee plans do cover a large segment of the population, the extent of coverage varies widely. Moreover, roughly 1 in 5 Canadians have no form of coverage, and as a result cannot afford the medications they need. Canadians spend roughly $30 billion annually on prescribed medicines, yet this piecemeal approach to prescription drugs in our health care system is resulting in skyrocketing costs for employers, government and the public at large.
In July, MNU President Darlene Jackson travelled to New Brunswick for the Council of Federation summit with provincial and territorial premiers. The two day event featured a pharmacare roundtable sponsored by the Canadian Federation of Nurses Unions, which included panelists Dr. Eric Hoskins (chair of the Federal Advisory Council) and former Parliamentary Budget Officer Kevin Page. Following the event, Dr. Hoskins confirmed that a “blueprint” will be released in spring 2019, with full details on the model and costing for the federal government’s pharmacare plan.
Although momentum is on our side, there is much work left to do to make universal pharmacare a reality.
Nurses are the most trusted spokespeople in health care and understand the important role of prescriptions in preventative care. By ensuring patients – regardless of their income or where they live – have access to the medication they need to stay healthy in their communities, we’ll save our system billions of dollars each year, and improve care for all Canadians. Nurses are experts, and have an important role to play in ensuring universal pharmacare becomes a reality.
Here are a couple ways you can help today:
The next year will be pivotal for ensuring universal pharmacare becomes a reality for all Canadians. Stay tuned for updates and more information as we approach the next federal election!
Workload Staffing Reports (WSRs) are among the most powerful tools at nurses’ disposal for making real and lasting change in their workplaces. There are many examples of how WSRs have helped improve staffing levels and security at facilities throughout Manitoba, stories of which have been featured in previous issues of Frontlines (see our October 2017 feature on St. Paul’s Personal Care Home). At a time of many changes impacting the delivery of health care in Manitoba, the importance of filing WSR forms is ever growing, and it is incumbent on nurses to report staffing issues and unsafe workloads as they occur.
All parties—including MNU and employer representatives—have worked diligently to improve WSRs forms for nurses. The Acute Care and Community Care forms were redesigned to ensure questions were phrased more concisely and clearly, while providing more writing space for describing situations and proposing solutions. As well, a Long- Term Care form was created for more accurate reporting of staffing and workload issues in LTC facilities/units.
The new WSR forms were revealed to members at the MNU Annual General Meeting in May and will be distributed this September. The official changeover date is October 1, 2018. Locals and worksites should replace old forms with new forms as of that day, however, old WSR forms will still be accepted. The new forms will be accompanied by a variety of educational materials to promote their use among members, and inform all parties (i.e. nurse, manager, employer, local/worksite representatives) of their responsibilities.
Examples of the new WSR forms are available at manitobanurses.ca/workload-staffing-reports. Stay tuned for news and updated information on the webpage and in MNU’s weekly e-newsletter The Pulse.
On October 17, 2018, Canada’s Cannabis Act will officially come into effect. The legalization of cannabis will not only change how and where cannabis is regulated, retailed and consumed – it will have widespread impacts on our health care system as a whole, including nurses in all practice settings.
Nurses have already encountered professional practice questions regarding the administration of medical cannabis. The College of Registered Nurses of Manitoba (CRNM), College of Registered Psychiatric Nurses of Manitoba (CRPNM) and the College of Licensed Practical Nurses of Manitoba (CLPNM) collaborated to create guidelines for nurses such as Medical Cannabis: Guidelines for Manitoba Nurses (2018), which outlines the legal framework governing the administration of medical cannabis, as well as the extent and limitations of a nurse’s professional responsibilities in hospitals and personal care homes.
Nonetheless, once the Cannabis Act takes effect, nurses of all designations will be required to deal with cannabis beyond situations where it is medically prescribed, including treating patients who use the drug legally yet recreationally. These rules and regulations will inevitably vary for nurses across Canada, as the Cannabis Act leaves much of the enforcement in the hands of provinces, which must regulate the distribution, consumption and sale of cannabis. In Manitoba, the provincial government has passed The Safe and Responsible Retailing of Cannabis Act, which prohibits the consumption of cannabis products for persons under the age of 19, and The Cannabis Harm Prevention Act, which bans consumption of the drug in public spaces.
In turn, there are outstanding questions about the potential effects of cannabis legalization in workplaces, and the implications for professional practice. Cannabis will be readily accessible to Manitobans in the near future, and nurses are responsible for ensuring they understand the rules and guidelines for themselves, coworkers and patients. It’s important nurses refer to policies and procedures provided by their employer, and refer to their regulatory body/college for professional practice and ethical guidelines.
The Canadian Centre for Occupational Health and Safety has online resources to help public employees and employers understand how cannabis legalization may impact their workplace. An e-course entitled “Impairment and Cannabis in the Workplace” can help nurses identify impairment in the workplace (see link below).
The laws and science regarding cannabis are evolving, and its important for nurses stay up to date as new information is made available from their regulatory body, as they determine the ethical and professional guidelines nurses must follow in the workplace.
In the meantime, visit the links below to learn more about pending cannabis legislation, as well as rules and guidelines to navigate the issue.
Medical Cannabis: Guidelines for Manitoba Nurses
www.crnm.mb.ca/support/resources www.clpnm.ca/practice-guidance/medical-cannabis/
www.crpnm.mb.ca/news/medical-cannabis- guidelines-for-manitoba-nurses-2018/
Cannabis Legalization & Regulation (MB Government)
www.gov.mb.ca/cannabis/index.html
Impairment and Cannabis in the Workplace
www.ccohs.ca/products/courses/impairment/
The Safe and Responsible Retailing of Cannabis Act (Provincial Legislation)
web2.gov.mb.ca/bills/41-3/b011e.php
The Cannabis Harm Prevention Act
web2.gov.mb.ca/bills/41-2/b025e.php
