Sandra Bourrie-Wilson recalls the night she was working on her acute adult psychiatry unit when several unstable and unpredictable patients were admitted under the supervision of just two nurses. It was at that moment she knew something needed to be done about the insufficient staffing that was leading to serious professional practice concerns.
1,540PRFs filed province-wide
“When an incident happens where one nurse cannot go alone, the other nurse has to go too. It’s an open unit, which means the door is not locked, and unsupervised patients could just walk right out,” recalls Bourrie-Wilson. “It was very unsafe.”
Concerned for the well-being of patients and staff, Bourrie-Wilson and her co-workers at Chilliwack General Hospital talked with their manager and recommended a third nurse be added to the unit. However they were told no funding was available for such a move.
Undaunted, the team turned to the Nurses’ Bargaining Association (NBA) professional responsibility (PR) process, which helps nurses resolve professional practice concerns that may be raised in response to patient safety and care conditions. Determined to see positive change, the nurses began filling out Professional Responsibility Forms (PRFs) that formally identified several practice concerns. These included: high acuity leading to nurses unable to provide appropriate nursing care; decreased ability for appropriate observations of patients required by level of observation policy; nurses being unable to chart on time; high volumes of patients and safety concerns related to care that was needed; and nurses being unable to take breaks.
“We were getting discouraged — working on our unit felt unsafe and against our standards. But we continued filing PRFs — every single nurse in the unit, including casuals, had banded together and filled out at least one PRF.”
The team’s efforts initially resulted in some short-lived success: A third nurse was brought in, but the position only lasted for six months due to lack of funding. “We were getting discouraged — working on our unit felt unsafe and against our standards,” recalls Bourrie-Wilson. “But we continued filing PRFs — every single nurse in the unit, including casuals, had banded together and filled out at least one PRF.”
Two years passed, and the number of patients on the unit kept growing. Sometimes more than 20 patients with serious psychiatric challenges would be under the supervision of just two nurses during a 12-hour shift. Going to work became a daunting task, and many of the nurses contemplated quitting. But with BCNU support, Bourrie-Wilson and her co-workers continued to pursue the PR process and redoubled their efforts for a third nurse.
Respectful and genuine dialogue between nurses and managers is the foundation of the PR process. The goal is to foster solution-based teamwork. This approach saw the nurses collaborating with their unit manager and their regional executive’s PR advocate to help find a solution that ultimately saw them taking their concerns to the Nurse Relations Committee (NRC),which reviews unresolved staffing PRFs that impact practice. And it was at an NRC meeting in May 2017 that Bourrie-Wilson was told her unit would finally get its third nurse.
“It was so amazing,” recalls Bourrie-Wilson. “I was expecting we would have to negotiate more, and keep advocating. All of our nurses were happy, but also felt that it was about time — it shouldn’t have taken two years. We went through a lot, but the teamwork at Chilliwack General was amazing.”
Without the support of the union, Bourrie-Wilson says her team’s fight for a third nurse would have been even more difficult. She encourages anyone facing challenges in the workplace to reach out for support, even if the process seems overwhelming.
“If it seems hopeless or you get discouraged, reach out to the BCNU office to get you back on track,” she says, noting the nurses at Chilliwack General are now advocating for a fourth nurse to keep up with the constantly rising number of patients. “Just totally be honest with the support that you need, and try not to get discouraged with timelines. As a member, the union is there for you.”