Next Wednesday, October 29, is our next Vancouver All-Staff Forum and our first Wellness Fair. We’re devoting almost half the forum’s agenda to Q & A, and Mary Ackenhusen, president and CEO, will take part.

We hope you can join us next week. Registration so far is brisk, so don’t delay to reserve your spot with CCRS.

We also appreciate receiving your questions and suggestions in advance of the forum. Please email us at: onevancouver@vch.ca.

In the meantime, we’re happy to address five employee questions and cost-savings suggestions today.

Today’s answered questions

 Please note that where possible questions have been edited for brevity.

Q. With the flu season coming up, I wonder what our VCHA guidelines are in terms of colleagues coming to work obviously sick, i.e.  coughing/sneezing/headaches, and interacting closely with others all day.

A. Your question is very timely. Several VCH facilities having experienced flu outbreaks already, and we believe we’re entering what may well be a very busy flu season.

Our policy calls for ill employees to refrain from coming to work so they can focus on getting well and help us prevent transmission. For the sake of patients and staff, managers may return ill employees home. The flu, however, can leave a lingering cough for some people, but that doesn’t mean they are ill or contagious, so it’s important that we don’t jump to conclusions when observing someone at work.

Meticulous hand hygiene and practising respiratory etiquette (ie: cover your cough) will protect staff and patients, but the best protection we can recommend is to get a flu shot as soon as possible or wear a mask. Starting November 3, peer nurse immunizers will be vaccinating staff on numerous units. Special clinics for staff at some of our sites start October 27. Or you can you get a shot from a pharmacy, family doctor or Public Health clinic.

To learn more about our flu policy and immunizations, visit the VCH staff flu page.

Q. One thing that I have noticed is waiting on financial information from the family before being able to waitlist a patient for long-term care. I would think a good idea would be to have as part of the first available bed policy that everyone is immediately put on the list at the max rate, which can easily be adjusted when the family is able to bring the financial information in. Great if it happens before the patient has been transferred, we will be happy to update the info, otherwise the care facility can handle the updating. This would save a number of bed days and improve flow.

A. Thank you for the suggestion.  We recognize that there are times when a resident or family is unable to provide the paperwork needed to assess the client rate for residential care. As you note, this results in discharge delays or unnecessary extended stays in hospital.

Provincial policy as set out in the Home and Community Care Policy Manual and, specifically, chapter 6, section 6, requires a patient to agree to the assessed client rate before entering residential care. Essentially, people have the right to know the rate they’ll be charged prior to consenting and moving into residential care. And, patients are required to acknowledge their consent by signing the Financial Assessment Form (HLTH 1.6 form), all of which is outlined in chapter 7.

However, policy also allows for client rate changes due to the client’s financial circumstances or other reasons, and these changes may be made manually effective the first of the month following the date the health authority receives complete documentation from the client or client’s representative.

With that in mind, we’re exploring how we can resolve these situations. Like you, we believe there are opportunities to improve patient flow and ensure more patients access the hospital care they need, when they need it.

Q. Wonder whether we could see a more transparent budget on each facility and compare to other similar facilities. (eg. residential care compare to other similar residential care sites). We used to see our sick time percentage and budget for overtime. Could we see the actual budget in $ for the whole facility on break down? I know the majority will be salary, but what else? What if the budget in $ and actual running is less, how and where does the spending go into? VCH as a whole or does the money stay at the local site?

Are acute, residential or community able to cross-share budgets? The reason I am asking: I see lots of office chairs or computer terminals in different areas of acute, but in residential, we are like in the 3^rd world. We have office chair that is very old, but as long as still safe to sit, we still need to use. Computer monitor screen is so small that we have to stress our eyesight to work, and still sharing among the whole team in the unit.

A. Thank you for your interest in our budgets. We recognize that finances aren’t the primary interest of health care workers, but understanding our financial picture and how we can operate more efficiently helps us do what we do best — provide quality care.

We’re happy to share sick time and overtime in dollars and as percentages of the budget for all three of Vancouver’s residential care facilities: Banfield, Dogwood and Purdy. We can also supply this information in the context of each facility’s total budget, bed count and client revenues. We’ve supplied each facility this information, and we encourage you to speak with your local manager to learn more.

In Vancouver, when we review site budgets, the director works with the responsible manager to balance the local budget. As a residential care program, we also strive to work together. One site or program may find itself in a surplus situation due to changing patient demands and innovative work relating to efficiencies achieved by teams. On the other hand, another site or program may be faced with an unexpected and unavoidable surge in patient demand, which may result in a financial deficit. When this occurs, the directors work with their teams to balance these competing pressures and balance the budget overall. The same occurs across Vancouver acute and community as we strengthen integration across our operations.

Regarding furniture and computers, we do prioritize purchases to protect resident and staff safety. Recent purchases at Dogwood, for example, include new beds and dining room furniture. Computer upgrades are managed by IMITS which has a standard refresh cycle for all VCH sites; however, if you’re having trouble reading your computer screen, we encourage you and your colleagues to contact the Service Desk about your options, including the changing your screen display setting to a larger font size.

Q. I would like to bring an idea for cost savings that was triggered by the challenge that the CFO put forward in July’s forum. [M]any of us have 2 phones – work and personal. I have also talked to some others on how they use the work phone, and the answer was just email, phone and text. Even though the work BlackBerry® is capable of more, many actually don’t know much about how BlackBerry® works. I wanted to explore more about this idea as a cost-saving initiative. …

What if we have the following?

1. All personal devices are connected directly to work Email/Calendar/Task/Contacts – all information be integrated into 1 device – more efficient and staff won’t need to learn a new device.
2. No need for BB enterprise server – Cost savings
3. No buying new device – Cost savings
4. Work up an incentive program for employees with various (if not all) Mobile device Service Providers to get reduced cost if staff needs to upgrade cell phones to smart phones – volume for cell phone providers.
5. Work up a monthly discount with various (if not all) Mobile device Service Providers for unlimited data, call and text for all employees required to have work cell phone – volume for cell phone providers and possible cost savings.
6. Give a mobile device allowance to staff to monthly payment that’s half off the cost of monthly charges that VCH has to pay now for work BlackBerry® – possible cost savings.

Of course there are boundaries/parameters that have to be established because of information privacy and other contract-related issues/concerns. I just thought that if staff is expected to save $1/per day – this may be a relatively easy number to figure out and this can possibly be implemented for not just VCH but other health authorities (high impact).

A. Thank you for these suggestions! You’ll be pleased to know that the Senior Executive Team (SET) is thinking along the same lines, and work is underway to explore the costs, implications and options of implementing a “bring your own mobile device” strategy for employees.

While it’s true that there are costs to supplying smart phones to staff, we must also understand the extent of other costs — for example, the costs of connecting employees’ own Apple, Android and Windows phones to the VCH network. And, as you point out, there are security and privacy concerns as well.

Once we’ve done our homework, we’ll be in a position to share more. Please stay tuned.

Q. I would like to discuss the Palliative On Call shift that the CHNs are responsible to cover. I will be on call tonight; I have worked my 7.5 hrs today and am off at 16:30 hrs and start the on-call shift at 16:30 hrs. until 08:00 hrs tomorrow morning. I am expected to go right home after work and log onto the computer and if there is a problem with signing onto the computer then to call the help desk. The issues are as follows:

1. The computer has never worked for me at home. Nurses are requested to log on as soon as we get home and if there is a problem signing onto the computer then we contact the help desk. If the help desk cannot solve the problem, then the nurses have to answer calls without being able to look at the last case notes, review medication, unable to look at the risk screen which is a safety issue if we have to make a home visit; etc. This includes travelling to other areas of Vancouver that are unfamiliar grounds to the CHN who may not work in that area which concerns my colleagues and myself.

2. There is no back-up if a nurse becomes ill during this shift; for example, at our unit we had a POC nurse that was T-boned on her way to a visit. She called the Manager on call and they asked if she was o.k., she said she was but her car was totalled and she really was not o.k. She did the visit which was 2 hrs., drawing up medication and doing patient teaching; this is a huge risk for error! Her husband and son had to pick her up and drive her to the client’s house and wait the 2 hrs for her; post-accident outcome she ended up being off work for injury sustained by the accident and is only now returning to work.

3. If we do get a call out and we are too tired the next day we can take the next day off without pay.  This puts a burden on our colleagues as base line is then reduced.

4. I wonder why Vancouver health centres are still having their CHNs do the POC shift when Richmond and the North Shore use the PCU nurses who are already working for POC. Vancouver Coastal Health already has this program set up which Richmond and the North Shore are actively using for their palliative clients yet Vancouver is refusing to use this service.  PCU has the resources available as they have the system up and running and staff and doctors available that are already working that shift.

5. Why are these calls not screened prior to the answering service contacting the on call nurse who is sleeping as we have to work the next day.  We have received calls because cleaning staff could not get into a building, or the person wanted antibiotics. There need to be strict guidelines/dialogue set that should be provided to the palliative clients around reasons when to call.

6. Nurses receive $3.25 per hour for this shift unless called then it’s time and a half; the on-call doctors receive their full pay.  Nurses in Vancouver Community are already working more days i.e. 5 or 6 days in a row for FT staff; this shift adds stress, sleep deprived which in turn causes the nurse to be working at risk for injury or error, decreases our ability to provide holistic safe care.

7. We have lost many great nurses because of this shift. Ideally this shift should be provided by PCUs at St. Paul’s and VGH as it is in Richmond and the North Shore seeing as we are moving in the direction of being ONE.

A. First, we want to say that patient and staff safety must always come first and the situation concerning the palliative on-call (POC) nurse who was involved in a motor vehicle accident is very unfortunate. Be assured, we have processes in place in the event of unforeseen circumstances.  In this particular instance, it is our understanding that a debriefing has taken place which revealed that this situation arose from a miscommunication. As a result, standard procedures have been clarified and communicated to staff, managers and physicians. In the event that a POC nurse can’t fulfill a shift, standard procedures call for the RN to contact the palliative physician on-call who will follow up with the family. Alternatively, the coordinator (manager) on-call could contact the physician on the nurse’s behalf.

Regarding the other issues you raised, we can share the following:

• A team is working on the challenges of logging into PARIS as we write, and there is a back-up plan for you today. When PARIS is unavailable, your information/resource binder includes a paper version of the SBAR tool (assessment form) to illicit clinical information and guide decision-making. If PARIS is unavailable and the current risk screening tool is not available, then a visit can’t be made. Instead, the you can use the SBAR tool plus/minus the support of the physicians (GP and palliative care) on-call to manage the telephone call and patient needs as best as possible. POC nurses should have the information/resource binder with them at all times.

• Fortunately, we receive relatively few POC calls (fewer than 140/year) and make even fewer visits (fewer than 20/year and with more than 50% of visits occurring before 2030 hrs). Still, there are limits to the number of consecutive hours community health nurses (CHNs) may work. Limiting the number of POC shifts to 5 per year is another way of preventing fatigue and protecting our staff and clients. Of course, nurses are the best judge of how they feel and what works best for them, which is why CHNs also choose their own POC shifts within their rotations. Following a POC shift, should you feel fatigued, we encourage you to speak with your manager about your options for the day.

• When the provincial Palliative On-Call Line was first developed, Vancouver considered making the switch. After a thorough review and analysis of outcomes (e.g. Emergency Room visits), it was decided that it would be in Vancouver clients’ best interests for Vancouver CHNs to continue providing POC services, because they have the ability to offer a more comprehensive care experience, including home visits. Richmond and Coastal are both aligned with the Provincial Palliative on-call service, and their PCUs don’t provide on-call coverage.

• The number for the POC nurse is reserved for palliative clients/families only, and only when it’s felt that the client’s condition may change or support may be needed after hours. To help you with this concern, more information would be helpful. Please contact Susan Conley, manager of Hospice Palliative Care.

• Although the number of POC calls remains relatively small (fewer than 140/year), you’re correct in pointing out that the demand for POC care is rising. The complexity of cases is increasing, too. Add staff vacancies — many due to retirements — and a limited casual short-call pool to the situation, and we recognize that it can be a challenge to provide this vital service and backfill on short notice. That’s why we’re continuing to recruit for CHNs, and we’ve invested in additional palliative care clinicians to support new nurses with education and mentoring support. As a result, we’ve reduced POC training from 12 months to approximately 6 to 8 months. This will result in new nurses being able to take on this shift sooner so that the number of times a CHN is providing POC will be certainly less than 5 shifts per year. Nursing compensation for POC is determined according to the current BCNU contract. Family physicians don’t receive any compensation for being on-call for their patients unless they make a home visit. The Home Hospice physicians, who cover both Vancouver Community as well as the provincial physician palliative consult line, are compensated at an on-call rate, which is much lower than their full pay.

We recognize that many CHNs take great pride in offering POC to clients and families, and we hope this answers your questions. If you’d like more detail, we encourage you to contact Susan Conley, manager of Hospice Palliative Care.