VON CANADA

1. VON CANADA Healthy Workplaces for Health Workers Dr. Judith Shamian, President & CEO April 12, 2007

2. The Journey:…1999…2007….

3. 1999-We had a problem….Nurses have the highest absenteeism rate among 40+ occupations.

4. Fast Forward “The way to better healthcare is through healthier healthcare workplaces and it is unacceptable to work in, receive care in, govern, manage and fund unhealthy healthcare workplaces” QW-QHC 2006 (Quality worklife-quality healthcare collaborative)

5. QWQHC= QUALITY WORKLIFE-QUALITY HEALTH CARE COLLABORATIVE • Partnership among 11 National Organizations: CCHSA, CCHSE, CNA, CMA, CHA, CFNU, CHSRF, ACAHO,ACEN, NQI, ONP-HC and 40 health care leaders who working together to develop an integrated action strategy to transform the quality of work life for Canada’s healthcare providers

6. Current reality: data & action What is next? What are some of the “new/old ideas” Today

7. Current reality: data & action In 2004, 68% of CEOs recognized that attracting and maintaining top quality employees was a major priority, up 10% from 2003 (KPMG, 2004. Tenth Annual Survey of Canada’s Most Respected Corporations, p.17) Across all socioeconomic groups, regardless of income, family status and life cycle, work-life and well-being is becoming a social and political priority. (Branham 2005)

8. Introduction • The Canadian Council on Integrated healthcare estimates the annual burden of workplace health in Canada at $32.5 billion (Blonnett, C., and Yardley. J., 2003) • A pilot study in 2002 of 11 nursing units in 6 countries revealed an average nurse turnover rate of 9.5% in six months at an average cost to the system of $21,514 US per nurse. (Shamian, O’Brien-Pallas & Laschinger, 2003) • Every year the pressure is mounting as early retirements of the baby-boomer generation increases.

9. What does the Data Show? Work Life • 25% of all physicians without dependents worked less than 40 hours per week, a number that appears to be on the rise (Physician Resource Questionnaire Results Ottawa: CMA, 2002) • 50% of Canadian physicians considered leaving medicine (The Canadian Medical Association Centre for Physician Health and Well being) • 17% of nurses in 2001 were planning to leave their jobs in the next 6 to 12 months (Aiken et al., 2001)

10. What does the Data Show? Wellness • 46% of physicians are moderately to severely burned out (Canadian Medical Association Centre for Physician Health and Well Being) • Although 86% of physicians are satisfied with their relationships with patients – only 66% were satisfied with their professional life and only 50% satisfied with work life balance. (The National Physician Survey) • Nurses are the most overworked, stressed, work-life-unbalanced and sickest workers in the country, with absenteeism rate 80% higher than other workers (McLennan, M. 2005)

11. What does the Data Show? Work life • The proportion of the nursing workforce with multiple employers increased from 12.8% in 2004 to 14.1% in 2005 (CIHI 2006) • The majority of nurses in management positions range in age from 46-55: (Heather Laschinger et al)

12. Percentage of nurses and all employed people working unpaid and paid overtime, by sex, Canada, 2005

13. Employment characteristics • Higher proportion of nurses are unionized: 82% of nurses vs. 34% of all employed • Nurses worked more paid overtime: • Women: 30% of nurses vs. 13% of all employed • Men: 37% of nurses vs. 28% of all employed • Among nurses, unpaid overtime more common than paid overtime; 50% reported unpaid overtime, averaging 4 extra hours per week. 8

14. Role overload 13

15. Percentage distribution of nurses, by reported changes in quality of patient care at workplace in past year (2005) Data Source: 2005 National Survey of the Work and Health of Nurses

16. Nurses reporting physical assault by a patient in past year 12

17. Rate of depression in past year among nurses 17

18. Summary of multivariate modelling relating fair/poor physical or mental health to working conditions • Few associations emerged between ill health and factors such as shift work or long hours. The factors most consistently related to the variables reflecting nurses’ health were: • Low autonomy • Low control over practice • Poor nurse-physician working relations • Low respect from superiors • Role overload

19. What does the Data Show? • About 12% of nurses in BC reported that they had occasionally or frequently been injured on the job in the past year, the highest proportion in the country. The proportion nationally was 9% • Nearly one-third (32%) of BC nurses said they had been physically assaulted by a patient in the year before the survey. The national figure was 29%. • About 17% reported that their organization was not taking sufficient precautions to prevent the spread of contagion. The percentage nationally was 15%. (National Survey of the Work and Health of Nurses 2005: Provincial Profiles)

20. 35% of nurses said that quality of care deteriorated the range in the country is 15-29% • Nurses in BC had the highest job strain 34% (psychological demands of the job exceed discretion in deciding how to do the job) • BC Nurses were positive about their working relationship with MDs • 16% of BC Nurses (the highest in the country) taken time off due to mental health (the national figure is 12% • BC Nurses missed and average of 18.3 days of work vs 23.9 of national average.

21. Implications Impact on Quality of Care and Patient Safety

22. Many Initiatives have Begun… • Nursing Strategy 2000 • CNAC 2002 • The 2003 First Ministers’ Accord on Health Care Renewal underlined the importance of health human resources (HHR) within Canada’s health system • The 2004 Ten Year Plan to Strengthen Health Care reiterated a commitment to HHR • The Pan-Canadian Strategy on Health Human Resources provided the policy lever to move forward on relevant HHR issues such as recruitment and retention and the promotion of health workplaces • Physician Human Resource Strategy for Canada

23. Many Initiatives have Begun… BC is the only province with Ergonomics Requirements: • Prevention and Early Active Return-to-work Safely (PEARS) • To reduce incidence and duration of musculoskeletal injuries (MSIs) • Injury rate for healthcare workers in BC has been consistently higher than the injury rate for all industries combined, with MSI representing the predominant type of WCB claim. • MSI due to patient handling or other manual materials handling represent more than half of the overal WCB claims in healthcare. (Trends in Workplace Injuries, Illnesses, and Policies in Healthcare across Canada – funded by Health Canada, Office of Nursing Policy, March 31, 2004)

24. Many Initiatives have Begun… BC’s policy and practice changes since 1998 have seen a decline in time-loss injury rate • Occupational Health and Safety Agency • formed in 1998 • reducing the provincial injury rate by 27% for the healthcare industry between 1998 – 2002 • Annual days lost per 100 FTEs dropped 38% between 1999 – 2002 • WCB premium rates fell representing about $51 million in reduced costs to the sector in two years (Trends in Workplace Injuries, Illnesses, and Policies in Healthcare across Canada – funded by Health Canada, Office of Nursing Policy, March 31, 2004)

25. Time Series of British Columbia Injury Rate to Legislation and Intervention Changes OHSAH Formed Restructuring HAs “No Lift” MOU Bill 14 Act & Regs Ministry “No Lift” Funding MSI Reg. Implemented

26. BC AB SK MB ON QC NS NB PE NL YK NT NU Planned Activities to Address Workplace Issues X X X X X  X X X Succession Planning  X X Relocation Assistance X Bursaries and Tuition Support X X X  X X Incentive eg. Education Programs Enrollment X Full-time jobs for nurse graduates X Continuing Education X X X X Career Laddering X Mentorship X X X Professional Development and Training X X X X X Salary adjustments X Conversion of Casual Work to Permanent X Leadership Training X  X X X Occupational health and safety and programs to reduce injuries X X X Phased Retirement Programs X Employee Recognition Program X X FPT Health Human Resources (HHR)Action Plans & Targets (reported ones only) Initiatives & Targets*

27. What is next??

28. What are some of the “new/old ideas” • Succession Planning • Generation Gap • Practice Issues

29. Succession Planning • Recognize emerging leaders • Support and guide emerging leaders • Provide opportunities • Leadership Pipeline

30. Mentoring:dyad, triad, network • Mentoring is a dyadic relationship that is developed by both members and has outcomes for both parties Mentoring relationships have been found to be related to a variety of organizational, career, and development outcomes: • Develops the human assets of the organization • Helps to transfer important tacit knowledge from one set of employees to another • Aids in the retention of employees • May result in career progression and higher incomes • Protégés report more career satisfaction • Protégés report more mobility Source: Harvard Business Essentials. Coaching and Mentoring. Boston: Harvard Business School Press, 2004. and Higgings, M.C., & Kram, K.E. (2001). Reconceptualizing mentoring at work: A developmental network perspective. Academy of Management Review, 26: 264-288.

31. Understanding the Generation Gap How are values different for the next generation filling health care positions?

32. Generation Gap (Stephen Sheperd)

33. Generation Gap

34. Why make employee well-being a Priority (The Vanier Institute of the family) • Structure of the family changing • Baby boomers retiring (more competition for quality employees) • Employees less willing to sacrifice personal life for work • Cost of inaction is evident, benefits of action very apparent • No longer just work/life balance, now “employee well being” is important

35. Practice Issues • Span of Control • Workload • Autonomy (moral distress) • Violence in the Workplace • Interprofessional relationships

36. Current reality: data & action What is next? What are some of the “new/old ideas” Summary

37. The race is picking up….. Positional Bargaining von von von vs Interest-Based Bargaining

38. THANKYOU Dr. Judith Shamian Judith.shamian@von.ca

39. www.nursingleadershipstudy.ca • www.von.ca • www.vifamily.ca • http://www.longwoods.com/home.php?cat=456.