Professional Accountability-Part II

"It has become increasingly evident, that we, as Nurses, are caught in a very difficult situation. On the one hand, as professionals, we have the responsibility to meet the individual needs of the patient for patient care and on the other hand, we are constrained by employment obligations which do not recognize or acknowledge a role for us in defining and identifying safe practices and quality care.

The situation has become so acute that most Nurses acknowledge that the responsibility of employment and professional standards are in conflict. The employee has the right and duty to protest, identify and document the conflict." Documentation Program Update, SUNSPOTS, December 1980, Vol 6 No 4, pp 3.

Hoping to provide nurses with a powerful tool to help resolve this conflict between professional responsibility to protect patient safety, and the requirement to comply with employer directives which may undermine patient safety, SUN members at the 1980 Annual Meeting had passed a resolution directing that " The Union develop and implement a Documentation Program incorporating the use of a "Professional Accountability Form". (SUNSPOTS, Vol. 6, #2, June 20, 1980, pp 12.

SUN recruited Nancy Davis (formerly a Nurse Manager) as an Employment Relations Officer (ERO) and assigned her to implement the Documentation Program, which began as a pilot project on November 24, 1980. Larry LeMoal, currently a SUN ERO, recalls Davis's motivation, " Nancy told me she didn't come to work for SUN because she supported union principles-she didn't. She came to work for SUN because she thought she could help nurses use the power of SUN's documentation program to make gains for patient safety and quality care that she couldn't accomplish as a nurse manager."

Nurses at SUN's 1981 annual meeting passed a resolution directing the negotiating committee to negotiate a professional accountability clause in the collective agreement. This was achieved in the 1982-83 collective agreement. Nurses with concerns about patient safety now had a formal process:

  1. "Contact your immediate supervisor.... to make her aware of the situation and give her an opportunity to assist in the resolution of the problem."
  2. "Write the reasons for the inability to provide safe patient care on the professional accountability form. ....."
  3. "The forms are distributed as per the instructions..."
  4. "The documented incidents are discussed by the documentation committee with nursing administrator at the Nursing Advisory Committee meeting."

"If nurses are to function as professionals, then we must be allowed input into the decisions and policies that affect our lives and the quality of care we deliver." Joan Fockler, Chairperson SUN Negotiations Committee, December 1987, vol. 13, No. 10.

"Some hospital managements are endeavouring to prevent nurses from filling in Work Situation Reports by issuing a policy on confidentiality."   SUN Professional Accountability documentation committee report, SUNSPOTS, April 1987, Vol 13. No. 4, pp 17. The committee noted that these policies on confidentiality violated the intent of Article 38, which recognized the right of nurses to document concerns, and bring those to the attention of nursing management.

Year Work Situation Reports filed
1985 305
1986 60
1987 201
SUNSPOTS, Vol 14. No. 7, September 1988, pp 7.

From 1980 when the program began to September 1988, nurses filed 882 work situation reports, but with mixed results. According to Cindy Irwin, then chair of the SUN documentation program, "While some committees are functioning in an atmosphere of reasonable trust and good will on the part of nursing management, there are some in which the discussion of staffing issues, workload and related nursing problems is perceived as threatening the autonomy of nursing managers..."


"...It is obvious that bedside nurses still have no real input into the conditions of work and care of the patient imposed upon them. It also brings into sharp focus the increasing gulf between the nursing administration leadership determining staffing from a distance, and the nurse at the bedside having the responsibility for coping/accountability in the actual situation."   SUNSPOTS, April 1988 Volume 14, No. 4, Pp 11

"Due to inadequacy with the form, opposition from Management, and pressure from SHA at the bargaining table (regarding Article 38 and confidentiality) Nursing Advisory Committees across the province have not become the effective avenue for change we so desperately need in order to improve working conditions and safe patient care ." Cynthia Irwin, Chairperson, Documentation Committee, SUNSPOTS, May, 1988, Vol 14, No. 5, pp 5

  In 1986 nurses filed 60 work situation reports, by 1987, that number had risen to 201.

"The Nursing Advisory Committee is a big issue with the membership of the SHA-particularly the confidentiality aspect.....the SHA wants to modify the clause to the extent that SUN could never go public on a staffing issue." SUN/SHA Hospital Sector Negotiations Committee report, SUNSPOTS, Vol 14. No. 5, May 1988, pp 2.

Larry LeMoal, then SUN Communications ERO, remembers the internal debate within SUN. "The Saskatchewan Healthcare Association (SHA) had insisted on a "news blackout" while negotiations were continuing, which SUN had accepted. Yet, the SHA was also trying to muzzle nurses by insisting that Work Situation reports remain confidential within the facility.

As communications ERO, I believed that this was a powerful issue to mobilize our members and gain public support, so I wrote a memo urging the negotiating committee to end the news blackout, and suggested that SUN put a counterproposal on the table that added an Independent Assessment Committee to issue rulings on unresolved issues so that we could not only defeat the confidentiality demand, but improve the Nursing Advisory Committee process" LeMoal says that after a heated debate, the negotiating committee adopted the communications strategy and decided to put forward a new proposal for an Independent Assessment Committee.

In May, 1988, SUN responded to the SHA's insistence that Work Situation Reports remain confidential within the facility with a "supplementary proposal" that strengthened the Nursing Advisory Committee process-A provincial independent assessment committee of three Registered Nurses who would issue recommendations concerning work situation reports that were unresolved at the facility level. SUNSPOTS, Vol 14. No. 5, May 1988, pp 2.

"In contention is the Nursing Advisory Committee and the issue of confidentiality. SHA remains adamant that SUN members will not have the capacity to publicly voice our concerns when staffing patterns, levels and situations do not allow for the provision of safe nursing care." Joan Fockler, Chairperson, SUN Negotiations Committee, SUNSPOTS, Vol 14. No. 7, September 1988.

A Victory for Safe Patient Care

90% of SUN's membership voted, and handed the negotiating committee a strong mandate-82% had voted in favour of strike action.

A six-day withdrawal of services followed, including a major rally of striking members at the Regina Exhibition Grounds on October 12.

Two days later, on October 14th the SHA finally agreed to SUN's demand for official recognition of SUN Work Situation reports, protection against harassment or discrimination for nurses who filed Work Situation Reports, and an Independent Assessment Committee of three Registered Nurses to make recommendations to employers regarding nursing practice issues which remained unresolved at the facility level. Other outstanding issues were settled, and the strike was over.

Carry a big stick

(SUNSPOTS noted that even the stars had lined up in favour of SUN that day, reprinting President Paul Kuling's horoscope for Friday October 14 th (the date of the settlement) "Be diplomatic, but be sure others know you are not without allies. Talk softly, but carry a big stick. Message will become increasingly clear. Focus on employment, depedents, basic rights."

Insert Photo from page 4 SUNSPOTS "Only pitbulls are meant to be muzzled" October 12 th rally.

"SUN members have fought a hard battle to ensure that they are not muzzled by employers who would prefer them to be seen and not heard." Chris Rawson, SUN Executive Director, SUNSPOTS, Vol 14, No. 9, November, 1988, pp 3.

Binding Independent Assessment Committee decisions

Ten years later, SUN had determined that some employers had decided they could ignore decisions of the Independent Assessment Committee. Accordingly, SUN"s bargaining conference directed the committee to negotiate a provision which would make IAC decisions, binding, similar to arbitration board decisions.

This demand was one of the issues that led the 1999 strike, and SUN's demand that Independent Assessment Committee ruling be binding on employers was the last issue to be resolved during the strike.

However, the memorandum of agreement ending the strike, while specifying that "Decisions of the Independent Assessment Committee will be binding", contained a reference that said, "The [IAC] committee will consist of a representative of the employer, a representative of the union, and a neutral chair.(3) There shall be a roster of five persons agreed upon as chairs."

SAHO was demanding that IAC representatives, including the chairperson, no longer had to be nurses.


13. Article 52 - The resolution of the matters of composition of the Independent Assessment Committee and the process of that committee shall be resolved through binding arbitration utilizing a three person board. The hearing shall be held within three months of signing the memorandum of agreement.


The arbitrator's decision resulted in SAHO's position being adopted, namely that the IAC need not consist of Registered Nurses, although decisions of the IAC would now be binding on employers.

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