Association of University Registered Nurses

March 26, 2015

ONA / AURN

Harold Fleshman, RN Transplant, Urology, Plastics

ONA Labor Relations Representatives: Sam Gieryn, JD 503-293-0011 ext. 350 gieryn@oregonrn.org Gary Aguiar, Ph.D 503-293-0011 ext. 308 aguiar@oregonrn.org

Oregon Nurses Association 18765 SW Boones Ferry Road Suite 200

Tualatin, OR 97062 1-800-634-3552 within Oregon www.OregonRN.org Oregon Nurses Association Bargaining Unit Newsletter

Oregon Health Sciences University (OHSU)

Association of University Registered Nurses –

(AURN)

In this issue

Staffing Plans and Your Unit Based Nursing Practice Committee - Pages 1, 4-6

Meals and Breaks Progress - Pages 3 Pension Contributions Grievance Settled - Page 5 Meals and Rest Periods – What do they look like? - Page 4-5 New Unit Representative Training Graduates - Page 6

Why Become a Full Member

of ONA/AURN?

(continued on page 4) (continued on page 2)

According to our Oregon Nurse Staffing Law each hospital must be responsible for the implementation of a written hospital-wide staffing plan for nursing services.

Section 27.3.2 of our Contract gives unit-based nursing practice committee’s (UBNPC) authority to create, monitor and revise the nurse staffing plan (NSP) for their unit on a quarterly basis.

Many nurses at OHSU think that they are full members of Oregon Nurses Association (ONA)/AURN even though they are fair share payers. What is the difference? First of all, fair share is the default category for all new hires at OHSU. If you have not filled out an ONA membership application, you are not a full member! Second, fair share

payers are not eligible to receive all of the benefits of full membership and are also not entitled to a range of

participation and voting rights. In order to be an active and engaged member of ONA/AURN, you must be a full member. There are a number of excellent reasons to fill out your ONA membership application now!

This article describes some of the key requirements for unit staffing plans and the opportunities presented by the Oregon Nurse Staffing Law (ORS 441.162-166) and our ONA/AURN contract (Contract) for nurses who would like to improve nurse staffing on their units. Hospital administration typically attempts to maintain

substantial control over staffing decisions, but this control is limited somewhat by the Oregon Nurse Staffing Law and by the Contract. Because of its length, this article is abbreviated. The full text can be found online at onaaurn.org.

Staffing Plans and Your Unit-Based

Nursing Practice Committee —

Requirements and Opportunities

Why Become a Full Member ?

First, full membership actually SAVES

you money

The additional cost is less than $14 a month, which gives you:

 American Nurses Association (ANA)

membership and ANA programs (saving you direct membership costs of $183 annually)

 Discounted continuing education (CE) credits at ONA Convention (saving you up to $150)

 Access to ONA sponsored continuing

education unit (CEU) opportunities throughout the year including webinars and special conferences (saving you up to $500 annually)

 Discounted American Nurses Credentialing Center (ANCC) certifications (saving you as much as $150 annually)

 Free legal consulting services (saving you potentially hundreds of dollars)

 Consumer discounts (saving you potentially thousands of dollars each year), including:

 California Casualty Auto & Home Insurance

 Rip City Rewards (Portland Trail Blazers)

 Get Away Today Vacations

 MetLife Financial Planning Services

Second, full members give us power

at the bargaining table

When administration knows that all of the nurses at OHSU are speaking with one voice, through their democratically elected leadership, they listen. The higher our membership percentage, the more power we have. The more power we have, the more likely we’ll be able to make the changes that nurses at OHSU want.

Third, full members have a voice in ONA/

AURN

Only full members can assume local bargaining unit leadership positions and vote on contract ratification and other matters affecting nurses at OHSU. Fair share payers only have an advisory vote.

Fourth, full members have access to

ONA leadership opportunities

ONA provides our members with a wide range of leadership development opportunities through ONA, including serving on any of our practice, ethics and policy cabinets, the ONA Board, or professional nursing care committees (PNCCs).

Fifth, full members have access

to professional consultations

ONA’s Professional Services staff is available to all ONA members for direct, one-on-one consultation on a wide range of practice issues. These include individual consultations on questions related to scope of nursing practice, health, safety and ergonomics, workers compensation, design of the workplace environment and career counseling.

To find out more about how to become a full member, speak with one of your ONA labor relations

representatives: Sam Gieryn: gieryn@oregonrn.org;

503-293-0011 ext. 350; Gary Aguiar:

aguiar@oregonrn.org; 503-293-0011ext. 308. Click

here to download a membership application or, go to

www.OregonRN.org and select Join ONA under the Membership tab.

You can also go online to learn more about our membership benefits and the important role ONA plays in promoting and protecting your profession.

Page 2

Page 3 AURN Newsletter March 26, 2015

(continued on page 4)

Your ONA/AURN team continues to monitor the effectiveness of the Kaizen on meals and breaks with an independent survey of UBNPC chairs. As with most processes, some units are seeing success and others need further work. Our results suggest that nurses in one-half of OHSU units are still not getting their meals and breaks. We are following the Kaizen plan timeline, which called for both OHSU and ONA/AURN to collect data in February 2015. Each party has done that work and we will meet this month to compare our results. Of the 50 UBNPC chairs contacted by AURN, half said nurses are still not getting their meals regularly.

Of these 25, 13 are just getting started on the Kaizen by collecting data and another have made no effort to begin. On the other hand, one-half of the UBNPC chairs reported that nurses in their units are regularly getting meals during their shift. Of those 25, 10 indicated that using the Kaizen process lead them to employ the buddy system effectively. Another eight reported they

were getting their meals without using the Kaizen recommendations. The remaining used

a variety of methods successfully, including better scheduling of patients and combining meals and breaks.

We encourage all nurses to clock their missed meals and breaks when they occur. Clocking provides the best evidence of the magnitude of the problem on each unit. And because nurses get paid when they clock

missed rest periods, it’s hard to argue that nurses who don’t clock them actually missed a break.

We are pleased the OHSU nursing administration supports the Kaizen process to safeguard staff nurses’ breaks and meals. We understand this will be a lengthy route to develop work routines that ensures every nurse gets their proper rest periods. We look forward to working with the administration in continually improving this important facet of nurses’ work lives.

Meals and Breaks Progress

ONA/AURN recently settled a grievance with OHSU regarding missed pension contributions for 53 nurses who retired and were later rehired. The confidential settlement covers missed contributions and market earnings dating back to 2009, when the University Pension Plan (UPP) was opened up to nurses who had previously retired under the Oregon Public Employees

Retirement System (PERS).

Going forward, OHSU will take reasonable steps to assess eligibility for PERS retirees who return to active nursing and may be eligible for the UPP, to ensure such employees receive notification, and to enroll the eligible employees in a timely fashion as described in Section 17.1.1 of the Contract.

Pension Contributions Grievance Settled

Meals and Rest Periods - What do they Look Like?

You’ve probably heard an earful about the impacts of nurse fatigue on patient care and the need for nurses to take sufficient breaks and meals at work to allow our minds and bodies to rejuvenate so we can practice at the top of our skills. We’re often asked how many breaks and meals a nurse should receive and whether downtime at work is sufficient to serve as a break. The number of meals and breaks to which each nurse is entitled depends on the length of the shift. Per the

ONA/OHSU union contract (based on Oregon Bureau of Labor and Industries standards), the hospital is expected to provide and nurses are expected to take a 15 minute paid rest break for every four hours of work and a 30 minute unpaid rest period

for a shift worked six hours or more.Under Oregon

law, RNs who work a continuous 14 hours or longer shift are entitled to a second 30-minute unpaid rest period.

At OHSU, UBNPCs bring their revised plans to the hospital-based nurse staffing committee (HBNSC) for ultimate approval and incorporation into an overall facility nurse staffing plan. The Oregon Nurse Staffing Law requires that the HBNSC have safe patient care as its primary consideration.

The responsibility of UBNPCs to create and monitor NSPs is substantial, and this effort should be a

mainstay of your UBNPC agenda. It also represents an important opportunity for ONA/AURN nurses to

improve staffing and patient care at OHSU. This article is intended to get you started if you are interested in getting involved. You don’t have to actually be a

UBNPC member to have a big impact on this process.

Establish minimum numbers of nursing staff

required on specified shifts. Oregon Revised

Statutes (ORS) 441.162(3)(d)

Usually this is either a baseline staffing that has been established based on a stable historical census, or a grid that shows how many nurses will be on the floor depending on the number of patients.

Be based on an accurate description of

individual and aggregate patient needs.

ORS 441.162(3)(a)

The plan requires a thorough description of the types of patients, usual comorbidities and possible

complications, and the needs of those patients in terms of nursing staff, including any special training.

(continued on page 5)

Oregon Nurses Association | 18765 SW Boones Ferry Road Suite 200 | Tualatin OR 97062 | 1-800-634-3552 within Oregon | www.OregonRN.org

Staffing Plans

Meal and Rest Periods

If any rest periods are missed or interrupted, your unit must make arrangement to provide the rest periods at alternative times, including, at the employer’s discretion, combining rest periods with meal periods or allowing you to leave work prior to the end of the shift. When none of the options for allowing rest breaks at alternative times is feasible, the nurse must be compensated at the straight time rate of pay. This compensation is in addition to your regular hours. Again, you have to actually clock the missed break to receive the additional compensation.

Length of work

Period breaks requiredNumber of rest periods requiredNumber of meal

Less than 4 hrs 0 0 4 hrs - 5 hrs 59 min 1 0 6 hrs - 9 hrs 59 min 2 1 10 hrs - 13 hrs 59 min 3 1 14 hrs - 17 hrs 59 min 4 2 18 hrs - 19 hrs 59 min 5 2 20 hrs - 21 hrs 59 min 5 2

More than 22 hours 6 3

But what constitutes a real break

or meal period?

Both meals and breaks must be completely duty free and uninterrupted. It was not a legal break if the break or lunch was in any way interrupted by duty-related concerns. If you are required to do anything, like monitor patients, stay on the unit, read work related emails or required study materials, or do anything you would normally do on the clock, then a break did not happen.

If a meal period is missed or interrupted, Section 7.4.1 of our Contract provides that OHSU must pay you for the whole meal period. If you were already working a regular shift of eight hours or more, you will usually be paid at the overtime rate. However, you have to actually clock the missed meal period to receive the additional compensation. (Please see the table to the right.)

Nurse Staffing Plans –

Some Required Elements

Page 2

Page 5 AURN Newsletter March 26, 2015

Oregon Nurses Association | 18765 SW Boones Ferry Road Suite 200 | Tualatin OR 97062 | 1-800-634-3552 within Oregon | www.OregonRN.org

Staffing Plans

Be based on the specialized qualifications and

competencies of the nursing staff. Oregon

Administrative Rule (OAR) 333-510-0045(3)©

Your plan needs to make sure there is experienced staff on hand at all times and also nursing staff with the specialized qualifications or skills that may be needed for all parts of your patient population.

Be consistent with nationally recognized

evidence-based standards and guidelines.

ORS 441.162(3)(d)

Nursing specialty organizations, like the Association of Women’s Health, Obstetric and Neonatal Nursing (AWHONN), for example, put out nurse staffing standards for typical hospital units that you are required to meet.

Recognize differences in patient acuteness.

OAR 333-510-0045(5

)

The best practice is for the UBNPC to research ways, or develop their own way, of scoring the acuity of the patients on the floor and having numerical

benchmarks set that result in increased staff. Developing these tools can be a creative challenge, but certainly not unsolvable.

Include a formal process for evaluating and

initiating limitations on admission or diversion

of patients to another acute care facility when,

in the judgment of the direct care

registered nurse

,

there is an inability to meet

patient care needs or a risk of harm to existing

and new patients. ORS 441.162(3)(d)

The best practice is for the staffing plan to include a provision that allows the charge nurse to

independently initiate a limitation while the chain of command (COC) is being initiated and until the COC comes up with a plan that works, “in the judgment of the direct-care registered nurse”.

What About Budgetary Constraints?

Can we exceed the hours per patient day (HPPD) limitations that hospitals attempt to impose on unit budgets?

The answer is undeniably “Yes”, because when reviewing your NSP the HBNSC must, to the extent possible:

Have as its primary consideration the provision of safe patient care and an adequate nursing staff. OAR 333-510-0045(3)(c)

What that means is that when OHSU’s HBNSC is deciding whether to approve the plan your UBNPC develops to provide safe patient care, HPPD cannot be the limiting factor.

Filling Holes in the Schedule –

Assuming you have a NSP you can live with, the

problem becomes scheduling to meet the requirements of the plan.

Your NSP should describe how this is accomplished. This has two parts:

Do you have adequate staff to schedule to implement your NSP without overtime?

Do you have nursing resources available to cover holes in the schedule caused by scheduled and/ or unscheduled sick leave, vacations, required education, and so forth.

Oregon requires hospitals to be prepared for these normal contingencies.

The hospital must maintain and post a list of on-call nursing staff or staffing agencies that may be called to provide qualified replacement or additional staff in the event of emergencies, sickness, vacations, vacancies and other absences of the nursing staff and that:

 Provides a sufficient number of replacement staff for the hospital on a regular basis and,

 Is available to the individual responsible for obtaining replacement staff. Is the list posted on your unit? OAR 333-510-0045(5)

Oregon Nurses Association | 18765 SW Boones Ferry Road Suite 200 | Tualatin OR 97062 | 1-800-634-3552 within Oregon | www.OregonRN.org Judy Vickery, RN, 9N Pediatric Acute Care, Medical

The ONA/AURN has two new unit representative training graduates. Unit representatives are your resource for information about practices on your unit and your rights under the contract. If you are called to meet with management and you

have any concern that the meeting may lead to discipline, you have a right to bring along your unit representative or an ONA labor relations representative. Look at any ONA/AURN bulletin board for a complete list of unit representatives.

Amy Stone, RN, 5B Day Stay

When developing the on-call list, the hospital must explore all reasonable options for identifying local replacement staff. That means identifying which nurse staffing agencies can reliably provide staff on both a long-term (13-week contract) and a short-term (24 to 48 hour) notice basis. The research must be

documented (OAR 333-510-0045(6)).

When a hospital learns about the need for replacement staff, the hospital has to make every reasonable effort to obtain registered nurses, licensed practical nurses or certified nursing assistants for unfilled hours or shifts before requiring a registered nurse, licensed practical nurse or certified nursing assistant to work overtime. (ORS 441.166) Reasonable effort includes the hospital seeking replacement at the time the vacancy is known and contacting all available resources as described above. Such efforts also must be documented. OAR 333-510-0045(7).

Base Your Plan on Evidence -

Our experience watching the HBNSC is that when UBNPCs bring staffing increases to them as part of a staffing plan update and back up those increases with evidence, the HBNSC approves it.

So base your increased staffing on evidence, like…

1. Falls

2. Patient safety net

3. Omissions or delays in care 4. Staffing variance forms (SVF) 5. Missed meals and breaks 6. Overtime

Next Steps:

1. Get involved in development and review of your unit staffing plan.

2. Politely insist that the plan have all of the required element and benchmarks.

3. Use patient safety evidence, including missed breaks and meals, to support

increasing staff.

4. Ask to see documentation regarding

replacement staff research, replacement call list posting, and calls being made when vacancies are known.

5. Post your NSP on the unit.

6. Note violations of your NSP on SVFs.

Staffing Plans