April 24, 2020

Health Care Workers Step Up Their Fight to
Protect Themselves and the Public

A Most Pressing Concern

Nova Scotia
Immediate Action Required to Protect Seniors and Workers at Northwood Manor - Nova Scotia Government and General Employees Union
Workers Call on Public to Demand Government Provide Personal Protective Equipment

Nursing Graduates Address Letter to Premier

Long-Term Care Nurses Protest Untenable Working Conditions

Workers Report Initial Gains in Protecting Long-Term Care Residents

British Columbia
Conditions of Health Care Workers and Seniors - Interview, Rhonda Bruce, Rehabilitation Assistant and Regional Vice-President (Interior), Hospital Employees' Union

Health Care Workers Step Up Their Fight to Protect Themselves and the Public

A Most Pressing Concern

A most pressing concern during the COVID-19 pandemic is the staggering number of deaths of seniors and health care workers from the disease. There is an urgent need for seniors' homes and long-term care centres to be properly staffed and provided with adequate working conditions for all personnel, including full protective equipment. Just as urgent is the need to provide the problems in this sector with viable solutions. This issue of Workers' Forum continues to address how health care workers are playing a leading role in this work.

Health care workers are the first line of defence for the health and safety of seniors in continuing care facilities. Their demands and solutions must be taken seriously and implemented to resolve the crisis in a way that favours the people. For years, the workers and families have raised the state of affairs in senior's homes which now, with the pandemic, are causing such tragedies. By smashing the silence on the conditions there and how the demands of the workers are dismissed out of hand, one aim is to make sure governments do not get away with merely wringing their hands and crying on television but must end the privatization of seniors' care and health care as a whole and increase investment in social programs.

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Nova Scotia

Immediate Action Required to Protect Seniors and Workers at Northwood Manor

NSGEU nurses redeployed to Northwood Manor are reporting extremely serious concerns about the health and safety of vulnerable seniors due to poor infection control and limited safety protocols at the facility.

Government's Ministerial Order forced nurses and other health care workers to leave the Halifax Infirmary and report to the epicentre of the COVID outbreak at Northwood. NSGEU members are working at 11 Manor, an 11th floor unit with a capacity of 16 and an occupancy of 12 residents, and 1 Centre a first-floor unit with a capacity of 22-23 beds which is fully occupied. Both are COVID-positive units.

One staff member described the conditions at Northwood Manor as "horrible" and noted there is little wonder why the virus has run rampant through the facility, given the lack of Personal Protective Equipment (PPE) and basic infection control protocols in place.

"Our members are telling us it was like walking into a war zone," said NSGEU President Jason MacLean.

"They desperately want to help these seniors in their terrible time of need. But for the safety of those seniors and the staff, this has to be done correctly or things will continue to deteriorate."

Here is a list of a few of the concerns these frontline workers have brought to our attention:

- Lack of infection control measures to protect vulnerable seniors and front line workers;
- Lack of appropriate PPE available on both units;
- Lack of consistent, thorough cleaning of these units;
- Clustering of both negative and positive seniors together on some units, making it confusing as to who is positive or negative;
- Lack of patient armbands to identify which patients require medications;
- Lack of "clean rooms" (a space that is not accessible to patients where staff can safely don PPE without risk of contamination);
- And lack of garbage receptacles to properly dispose of contaminated PPE, so workers must carry them through the unit, potentially contaminating "clean" areas.

The NSGEU brought these concerns forward to the Premier, Minister of Health & Wellness, and Chief Medical Officer on Monday, April 20, but NSGEU members continue to report concerns that put both seniors and workers at risk.

"Our nurses and frontline healthcare workers have put their own personal safety and lives on the line by going to work at the epicentre of the COVID-19 crisis, and they feel betrayed by our government," said MacLean.

NSGEU is calling on government to take the following steps to ensure our members can continue to provide much needed care to the residents and staff at Northwood Manor:

- Allow these workers access to N95 masks, as these are COVID-positive units;
- Ensure PPE supplies are available at the entrance of each room, so staff are able to safely respond to a patient in crisis;
- An increased and sustained presence of Infection Control to educate staff and ensure protocols are being followed;
- Allow these units to develop a model of care and staff appropriately for patient ratio and acuity;
- Removal of humidifiers from all patient rooms;
- Ensure units are deep-cleaned by housekeeping and then maintained with regular cleanings per day;
- Establish clean rooms for donning PPE, charting and breaks;
- And provide yellow bags to ensure contaminated PPE is disposed of properly and ensure there are sufficient receptacles in each patient room.

NSGEU frontline healthcare workers remain committed to working with government to fight COVID-19 and protect vulnerable seniors at Northwood Manor, provided they are supported and feel safe at work.

"Premier McNeil needs to learn to work collaboratively with workers, and to hear and respect the concerns they are bringing forward. They are the trained professionals, and they know what is needed to protect both them and the clients," MacLean said.

"By forcing our members to work without the appropriate safety protocols in place, government is essentially forcing them to put their license to practice on the line, as well."

NSGEU and the other unions representing frontline healthcare workers already had the Good Neighbour Protocol in place, and had reached an additional agreement with government to call for volunteers to temporarily redeploy to Northwood Manor. The Premier's order to force workers into the Manor was unnecessary and, without the proper precautions taken, potentially put more lives at risk.

Furthermore, management did not notify health care workers of their redeployment: they learned of the move from social media posts and the news media.

We are only going public with these concerns now because we have exhausted all other avenues to deal with the safety issues and concerns for the residents and our members.

(April 22, 2020)

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Workers Call on Public to Demand Government Provide Personal Protective Equipment

In a press release dated April 16, the Canadian Union of Public Employees (CUPE) Nova Scotia is calling on the public to demand that provincial government provide frontline health care workers all the personal protective equipment they require.

The press release reads:

"Health care workers are here for all of us, doing everything possible to keep Nova Scotians safe. They're on the frontlines of the COVID-19 pandemic, working around the clock to stop its spread and to care for those who are infected. But there's still no protocol for workers to get the appropriate Personal Protective Equipment (PPE). They need your help to make this happen.

"They need you to tell the Nova Scotia government to make sure our frontline health care workers have the appropriate PPE so they can do their jobs safely."

With the press release comes an email message that people can send to the government.

The message reads:

"Our health care workers always put patients first. And during the COVID-19 pandemic, these workers are on the frontlines, working around the clock to stop its spread.

"Every hour, they are keeping people safe and saving lives. But too many frontline health care workers are working without the appropriate Personal Protective Equipment (PPE) they need to protect us all. They are being sent to the frontlines of this pandemic without the right tools to stay safe and keep all Nova Scotians safe, too.

"Protecting health care workers protects us all. And it's time for the Nova Scotia government to step up.

"Government must provide better access to PPE for all health care workers, and trust these professionals to use their judgement in assessing the level of protection required to keep themselves and their patients safe. Ontario, Alberta, British Columbia and New Brunswick have all reached agreements with their health care workers, and it's time for Nova Scotia to follow their lead.

"The government must follow the precautionary principle, established in the aftermath of the SARS epidemic. It states that where there is scientific uncertainty about the possible causes of transmission, we must err on the side of caution. That's why we must ensure health care workers are afforded fit-tested N95 respirator masks when interacting with possible or confirmed COVID-19 cases.

"Nova Scotians are all in this together, united. Each of us is doing our part to help flatten the curve. But when our health care workers get sick, they can't take care of patients, residents and clients, and that puts all of us at greater risk.

"As a member of the provincial legislature, I urge you to act immediately to protect our nurses and frontline health care workers. All health care workers must have the PPE they need to do their job safely."

To sign the message, click here

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Nursing Graduates Address Letter to Premier

Letter to Quebec Premier François Legault and his entire extraordinary team.

On behalf of the next generation of nurses.

Mr. Legault, your press briefing on April 15 at 1:00 pm made me fall off my chair, just as it did many of my colleagues. Personally, it made me lose confidence in the way you are managing this crisis in the Long-Term Care Facilities (CHSLDs) and even in the consideration you have for the nursing vocation. Are you panicking?

Because in hearing how you talk, you seem to be forgetting that Quebec has a significant quantity of competent staff actually waiting to help and who have graciously been offering to assist since the start of the pandemic.

Mr. Premier, do you know how many graduates we have in health and nursing that are qualified to provide the care you are appealing for in the CHSLDs?

Factually, Mr. Legault, there are indeed many. And they already have more training than nursing assistants and orderlies. Beginning in May, as soon as their graduation is official, they will become candidates for the nursing profession and will perform the duties of registered nurses in our communities while waiting to pass their Quebec Order of Nurses' (OIIQ) examination in the fall.

Do you know what all this beautiful, cheap and healthy workforce is doing right now and will be doing for the next four weeks?

Taking improvised online courses, too often of poor quality. Doing online internship work, which in no way compensates for the essential experience that come with a real internship. All this under appalling conditions of social inequality, without any coherence between educational establishments. To boot, they have no guarantee of graduating as planned in May, as their professional order (OIIQ) has yet to validate or plan anything official that will allow them to access the profession at the beginning of May (due to the cancellation of the final internship of their 3-year advanced education training).

In addition, you are currently urging their teachers to abandon them to join the CHSLDs, obliged under force majeure, seriously threatening their already uncertain graduation.

Mr. Premier, if the situation is so critical and now requires asking medical specialists with salaries beyond the system's means, who do not have the qualifications to practice as nurses, to go to the CHSLDs, would it not be time to do like many other countries and consider our nursing graduates?

With all due respect, Mr. Premier, you appear to have the mistaken and awkward belief that the work of a nurse is beneath, rather than parallel and complementary to that of a doctor. As if a doctor had to master training as a nurse before being able to become a doctor. As if at university, that after studying nursing one continues on with accredited courses into medical school. Unfortunately, besides being degrading for the nursing profession, your perception is completely false and out of touch with reality.

Contrary to what you said during the previous press briefing, most of our doctors are not "overqualified" for the job, but untrained for the position. Most of them do not know how to take a blood sample, insert a catheter, perform ostomy care, apply specialized dressings, etc., or almost any nursing skills acquired after at least three years of solid training, combined with internship experience to master them. Unlike our graduates in care giving and nursing, for the most part they never learned to master the methods of safely moving patients according to [the established guidelines].

With your plan, which has become the subject of a lot of talk, you are using taxpayer money, our money, to pay doctors an exorbitant stipend even though they'll be doing at most only half of the work that nurses do. You cannot expect that they will be able to do much more than that with their valuable medical skills. For the vast majority of them do not even know how to install and adjust an intravenous infusion pump.

And of course that's to be expected because it's not their job, they haven't learned how to do it. Their essential skills lie elsewhere. You would not ask nurses to do the work of doctors. Well, it's the same thing. This hierarchy of health professions is a stubborn social prejudice. Please, Mr. Premier, do not feed that prejudice which is at the base of the faulty remuneration of our health professionals and the lack of recognition of these valuable professions within the system. Do not act as the vehicle of these false beliefs of another era.

I ask of you Mr. Legault, Mr. Premier and all your team, that for the sake of the safety of all our patients and cherished elders, for the sake of efficiency and out of respect for the nursing profession, which is not the basis for the profession of physician but, indeed, a full-fledged complete profession parallel and complementary to medicine, and so as not to place our valuable doctors in the awkward position of having to admit that they do not have the skills required to effectively replace a seasoned nurse, to consider the option of requesting the assistance of our graduating nurses and in the process, credit them for the 3-4 weeks of inconsistent and disconnected lessons they are currently being required to take online instead of responding to the current vital emergency.

Mr. Premier, give the CHSLDs the competent and efficient workforce they expect while saving our money by limiting our expenses and allowing our graduates and their professors to put their nursing skills to good use -- a profession, a vocation, still too little known and recognized.

Cordially and probably very awkwardly,

Graduating nurses of Quebec.

(April 15, 2020. Translated from original French by TML.)

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Long-Term Care Nurses Protest
Untenable Working Conditions

On April 15, the Ontario Nurses' Association (ONA) issued a press release in which it denounces the working conditions for nurses and all health care workers in long-term care homes as "unfathomable." The statement points out that health care staff require immediate access to proper personal protective equipment (PPE) to stop the spread of COVID-19 to vulnerable residents.

"As the media has noted, dozens of long-term care facilities across Ontario are reporting COVID-19 outbreaks and resident deaths," writes ONA President Vicki McKenna, RN. "Our hearts go out to the residents and their families, and to the staff who provide the day-to-day care -- and who consequently become very close to their residents. Our nurses and all health-care workers in this sector are doing the very best they can, even as dozens of them have become infected themselves."

The press release stresses that long-term care homes were understaffed before the pandemic and are now in crisis. It notes that the ONA has been calling for changes and PPE for all workers since the pandemic began and that it will continue to call for action until the government acts to protect some of the most vulnerable Ontarians.

Amongst others, the changes the ONA is demanding include:

- Immediate access to appropriate personal protective equipment, including N95 masks, when caring for suspected or confirmed COVID-19 positive residents -- if staff are not safe, neither are residents.

- An immediate strategy to separate COVID-19 residents from non-COVID-19 residents -- and the separation of staff caring for each group -- to prevent the contamination of PPE and reduce the spread of the virus inside long-term care homes.

The ONA has been calling for part-time and casual staff at long-term care centres to be limited to one facility by increasing part-time workers' hours to full-time, or paying for lost wages. The statement informs that because of the pressure exerted by health care workers, the Ontario government has started to act on that demand.

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Workers Report Initial Gains in Protecting Long-Term Care Residents

On April 17, the Canadian Union of Public Employees (CUPE) Saskatchewan reported that after weeks of pressure from CUPE and other health care unions, the Government of Saskatchewan has finally announced a continuous masking policy for health care providers, and a transition to single site employment for workers in acute and long-term care. This move puts in place protections for the at most risk demographic: long-term care residents.

"Long-term care homes have been at the centre of major COVID-19 outbreaks in other provinces and account for the majority of deaths attributed to the virus," says CUPE Local 5430 President Sandra Seitz. "Halting multi-site work will help stop the spread of COVID-19 by limiting movement between seniors' care facilities."

The communiqué points out that COVID-19 has placed a spotlight on some of the most serious issues in health care: underfunding and short staffing.

"Staffing levels in long-term care have been inadequate for years. COVID-19 has exacerbated this issue, and our members are working short staffed more often than not," said Seitz. "Physical distancing protocols such as in room dining for residents and increased cleaning requirements means we need more staff, not less."

"The continuous masking policy is a start, but the government needs to take steps to ensure that it is being implemented across the health care sector, and all community-based services," said Seitz.

The press release also informs that CUPE 5430 has secured a Letter of Understanding (LOU) protecting its members during redeployment. The LOU lays out the following protections for workers and residents:

- Prevent workers from working in multiple facilities while maintaining their guaranteed hours.

- Create a labour pool for redeployment to respond to COVID-19 health care needs within clearly established parameters that protect the public and the workers.

- For the duration of the agreement, there will be no new layoffs.

- Employees who have been redeployed will be protected from incurring expenses, including accommodation where required.

- All redeployed employees will be provided with orientation and training fitting with the situation at the receiving site, which includes orientation and training to the required personal protective equipment (PPE) and provision of said PPE prior to commencing work.

"We have seen a significant rise in precarious work in our health care system. Many of our members are forced to work multiple jobs, across jurisdictions, to cobble together full-time equivalency work," said Seitz. "This LOU will offer some protections to our members who are facing changes in the work environment from COVID-19."

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British Columbia

Conditions of Health Care Workers and Seniors

As of April 22 there were 19 outbreaks in long-term care and assisted living facilities in British Columbia and workers are taking measures throughout the province to prevent further outbreaks. This is not just a matter of the vulnerability of the seniors who live in these residences. For decades, workers and families of residents have been sounding the alarm about the conditions in long-term care and assisted living homes, particularly those that operate for private profit. "Normal" conditions mean workers who are absent not being replaced, excessive overtime and thousands of hours of unpaid work being done by visitors and volunteers. The sudden loss of family members and volunteers during the pandemic has made a bad situation even worse. Workers in long-term care are speaking out about what is needed to be able to do their jobs safely, to protect their residents, their families and communities and themselves.

Workers' Forum interviewed Rhonda Bruce, a front line long-term care worker in British Columbia. She is a rehabilitation assistant and a member of the provincial executive of the Hospital Employees' Union (HEU).

Workers' Forum: What measures have been taken to prepare in your workplaces to deal with COVID-19?

Rhonda Bruce: What they have done in the hospitals is they have sent many patients home and made preparations for caring for COVID-19 patients. Many hospitals are at less than 50 per cent capacity. Some long-term care facilities have outbreaks of colds or flu. What's changed is that before when you had an outbreak they had to have three residents with symptoms for three days to declare an outbreak and now if they have one resident with a cold then they shut the facility down to visitors and introduce special infection control measures. A lot of sites in the province have been declared to be on an outbreak because it's cold and flu season. As soon as somebody gets a cold they shut everybody down, which means no recreation programs at all. Many sites have central dining rooms which are usually pretty packed. Most residents eat in dining rooms, but are separated when there is an outbreak declared. Instead of eating in a dining room residents are eating in their rooms or other areas. Even with recreation and other staff being re-deployed to help there are not enough staff for this or for the extra cleaning that is required, and so on. Recreation programs are not taking place. People are also needed to arrange video calls to family for residents so they can see their family because no visitors are coming in.

WF: So you're in preparatory mode for COVID-19. Do workers have what is needed?

RB: We have some problems in some places. The Ministry of Health said that they were going to take care of all our workers with child care but that is not always taking place. I know of a case of a young mother who has a toddler and no daycare. She tried to get special leave. We have a provision for special leave in our contract and this worker has a special leave bank. They refused to give it to her. She had four days where she didn't have a family member to support her to give her child care because her child care was cancelled. This is stressful every single day for parents of young children. Then of course there are lots of memos from the Health Authorities and managers giving different interpretations of the memos and sometimes giving wrong instructions to the workers regarding personal protective equipment (PPE). Last week a dietary worker in one of the long term care homes said they had been told they have to change their gloves after each person served. The person serving has gloves on and never touches the resident so that makes no sense and they will just burn through the PPE and not have them when they are really needed. That protocol applies for staff who are feeding residents, who of course have to change gloves and wash their hands between residents.

Many hospitals and long-term care facilities share casual employees between them and have float pools -- workers that go to different areas of the hospital or residence or even between facilities as needed. There was a case recently of a nurse who was doing front line work -- first response triage in an Emergency Department -- who the next day went to work in a long-term care facility. This is playing with fire. If that nurse is the first person dealing with a patient who is found to have COVID-19 and became infected they would be bringing it straight to the vulnerable seniors in the long-term care home. So far, although the province has restricted movement of staff between long-term care facilities, there is no restriction on staff moving between hospitals, group homes and long-term care.

WF: What was the situation prior to the COVID-19 pandemic and measures to prepare for it?

RB: Throughout BC there is overtime almost every shift because there is not enough staff. There never has been enough staff. We have lots of casual workers and most of them want full-time work. They have to work in three or four places, wherever they can get their hours, because they need to make a living.

WF: What is the reason that more full time and part time positions are not created?

RB: Because the employer saves on benefits. Casuals don't have benefits. Lots of time people take part-time positions, which do have benefits, and then they pick up more work. Not all long-term care sites are covered by the Facilities Bargaining Association (FBA) Collective Agreement where industry standard wages and benefits are in place, under a master agreement for the province. There are other long-term care homes in the region that are private and have lower wages. In the sites which are privately operated for profit, and the wages are much lower than those in the Facilities Agreement, the workers try their best to get a job at another workplace. They can even be working full-time but if they get a job in an FBA site they'll leave. There are always lots of workers stepping out of those sites when they get work in an FBA site.

WF: What kind of things is the union advocating for?

RB: There are things that can be done right now. Workers who need it should be able to use their special leave bank. Our employers could make sure we have meals, coffee from time to time, increased funding for uniforms and shoes because of the new rules, proper changing facilities. People who are not on the front lines don't understand what it is to be in the situation we're in. We been working on the brink for so long and this situation is even worse, so we need support and employers have to listen to us. We all want to stop this. We are all committed to the residents that we care for. Our collective agreement is being respected. The union is really advocating for us. As an HEU provincial executive officer on the front line, I still have a job to do. I spend most of my day doing occupational safety, instructing people on PPE, etc. and constantly answering questions. My manager is working with me. I can't imagine what it is like for workers in Ontario and Quebec where their collective agreements are not being respected. How can you walk the extra mile in those conditions?

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