SUNstoppable Spotlight

Registered Nurses Achieve Success through Independent Assessment Committee

The RN staff from Local106 Regina General Hospital – Emergency Department and SUN Provincial have successfully escalated 54 Work Situation Reports (WSRs), and 32 subsequent WSRs.   

Since 2021, a pattern of workload and professional practice concerns have been documented on WSRs without collaborative problem-solving or resolution by the Joint Nursing Advisory Committee, Unit Leadership, or through escalation to the SHA Board of Directors. 

An Independent Assessment Committee (IAC) is the last resort within the collective agreement to address workload concerns specific to registered nurses and to resolve WSRs.

The IAC Panel of three RN experts unanimously confirmed the concerns brought forward by SUN members stating:     

…RGH ED has been unable to maintain an adequate supply of senior and experienced registered nursing staff; often functioning with a less than optimal registered nursing staffing complement, particularly on the night shift.  In turn, the deficit of senior registered nursing staff resulting in less support for junior staff continues to impact the retention of registered nurses within the department.  The ability to care for patients’ safely, corresponding with current nursing care standards is chronically jeopardized.  This has led to nursing burnout, fear, and frustration, with registered nurses unable to meet professional and ethical care requirements (2024, p. 8).

One must safeguard the emergency nursing environment to support and protect nurses and healthcare providers so registered nurses are able to deliver care to patients according to their professional standards (2024, p. 9).

The IAC Panel identified 5 primary themes in their written decision:

  1. Acuity and complexity of patients affecting workload;

  2. RN/RPN insufficiencies in staffing;

  3. Need for RN retention and mentorship;

  4. Ancillary support deficits; and

  5. Constraints of physical space and workflow. 

Binding recommendations have been confirmed between SHA Leadership, SUN Provincial, and Local 106 and are inclusive of:

  • Permanent Full-time RN staffing additions:

    • 1 RN 1930 –0747 hrs, 7 days/week

    • 1 RN 24/7for Triage

    • 1 RN 24/7for Trauma/Codes

    • Emergency Psychiatric Nurse (EPN) increased coverage to 24/7.

  • Temporary Full-time Transport RN 24/7 x 1 year (March 2025 – March 2026).  Re-evaluation is to occur at the end of the 1-year position.

  • Mentorship for Newly Hired RNs:

    • CRN/CNE engagement for enhanced mentorship program regardless of the level of RN experience.

    • Implement a formal program of mentoring/buddying for all newly hired RNs, with new RNs having a minimum of 24-12-hour shifts partnered with a consistent maximum of 2– Senior RN mentors.

    • Mentorship experience should be inclusive of adequate time and exposure to a variety of ED nursing practice situations and patient types.

  • Development of excellence in emergency nursing practice with support from the CRN/CNE by encouraging CNA certification in Emergency Nursing, journal clubs, discussion boards/groups etc.

The IAC Panel binding recommendations are in addition to the increase in Clinical Resource Nurse coverage to 24/7 from 10 hours/day received from the SHA Leadership on October 17, 2024, before the IAC Hearing on October 22, 2024. These additions were part of an Employer offer that was insufficient to address critical workload, professional practice, and patient safety concerns identified in member WSRs and the work environment. The increase in CRN coverage was successfully implemented when the IAC decision was received.

Further support for the RGH ED was received in the written decision when it was stated:

The long-used metaphor “the canary in the coal mine” as an indicator of the overall functioning of emergency care and as a predictor of impending danger, is now thought to be silent from exhaustion [CAEP, 2024] (2024, p. 8).

To learn more about WSRs, the Nursing Advisory Process, and the Joint Nursing Advisory Committee, you can review the SUN website's WSR/NAC Learning Modules & Resources and NAC Leadership.