EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
So with the international nurses, we are taking a bit of a pause in that to look at bridging our strategies a bit around the nursing program as an example here.
Mr. Curley: Mr. Chairman, I appreciate the response, but I have a further question.
I’m not at all too sure whether or not that international nurses recruiting initiative was successful or not. The reports that we have seen don’t appear to indicate that this program was successful when 50 percent or more of them initially failed their nursing certification exam.
The minister indicated to the House at one point that they have retained the services of an agency to recruit, screen, and actually recommend individuals to come to this country.
Why is it that these particular international nurses that have failed continue to enjoy their visas while at the same time enjoying payroll from this government and yet they have not met the requirements of entering into Canada?
Would the minister agree that this program is not all that successful as it was introduced and stated that this would relieve all of the shortages that we have in Nunavut?
I think it would be premature to give up our efforts in recruitment.
The international nurses have three attempts to write a Registered Nurses Association exam. Canadians write the same exam and Canadians have also failed that same exam.
We hire nurses from Canada to positions in Nunavut, they write the same exam and if they fail the exam, we give them another opportunity.
The same would apply to beneficiaries who are in nursing programs in Nunavut but fail the exam; we would still give them the same option.  The fact of the matter is: we are in a major shortage with nurses in Canada.
Last year alone, 4,000 graduated in Canada for nursing positions.
So every effort that we take to filling the positions, we have to make those efforts. We need nurses in our communities; we don’t have enough beneficiaries to fill those jobs. Until such time we have those vacancies filled will we slow down the process, but we have to continue with our efforts despite the challenges we face in the exam and so on.
So I think, in fairness to those individuals that we have recruited and that have made the commitment to work in Nunavut, we need to support the nurses in our communities and I support the hires that we have made.
They are not treated any differently than any nurse that we would have hired from outside of our communities or outside of Nunavut.
So the answer to my question is: yes, the program is successful and we will continue to recruit and hire international nurses.
We will continue to put them on salaries before they are certified. We’ll give them three chances to complete their exams and repeat their exams.
I’ve never heard that kind of benefit to fellow Inuit people in government. Normally, if we have Inuit nurses, they would only be considered nurses if they have completed their exams, otherwise, they are not paid as nurses. They would only probably be paid as one of the assistants, or whatever or what have you.
I’m asking the minister: the program, if we are to continue to finance it, does the minister not agree that we could probably look elsewhere to Europeans, and whatnot, where they may be able to have more consistent guidelines in terms of the nursing profession so that we could continue to provide vacancies in Nunavut where they are so badly needed?
Any nurse that we hire, they are offered a position, they accept it, they write the exam, and then we orient them. We don’t give applicants the exams and orientation before they are put on payroll.
We offer them a job; they accept the position.
Once they are on stream, they are on payroll; they go through the orientation and their exams, otherwise, we would be investing our resources in having people that have not accepted the positions in writing exams and so on. I think it’s a matter of process.
We need to continue with our efforts in recruitment. I mentioned earlier that we need to focus our recruitment in Canada, as well.
At the same time, I also mentioned earlier that we also need to look at building a better relationship with the students that are in the Nunavut Arctic College Nursing Program. We are investing in individuals in that program. I would like to see our department develop systems to recruit those individuals upon successful completion of the nursing program, including the exam.
The process would still apply in that we are taking a cautious approach to this.  At the same time, international nurses are international nurses; it doesn’t matter if they come from England, or Japan, or China; it doesn’t matter, they are still international.
So we are looking at those options on a regular basis on how we can address our vacancies. We’ll continue to do that until such time that we don’t need nurses in our communities, but that will be a long time coming. We are taking a cautious approach to that, but the strategy must be more than just recruitment.
It should also be in the area of training and recruiting the people that we are training within Nunavut.
Mr. Curley: Yes, I perceived that.
I fully understand and recognize that international means countries outside of the country. The reason I’m focusing on Asian nurses is because that is where the government initially targeted that region. Other countries did not have the benefit of any hiring agency; recruiting agency contracted particularly to Asian countries.
I’m asking the minister one last time. The question is: are we still continuing to have the services of the international recruiting agency to hire Asian nurses? Is that contract still in force?
The agency that we’ve contracted to do the recruitment, we’ve advised them, at this point in time, to focus on the 50 that have been hired to date. We want to evaluate those services; the initial 50 that we have recruited.
So again, I say that we are taking a cautious approach, but at the same time, we are focusing on the full completion of the 50 recruited.
After that time, we will decide what our next options will be.
I should also say in the previous government, efforts were made to recruit in Australia.
So there are other countries that we have recruited in the past, so it’s not just this one country.
At this point in time, we are focusing really just to focus on the 50 and then decide from there.
Mr. Curley: Yes, the question still is, if the 50 nurses that were recruited by the hiring agency, obviously 50 percent or more have already failed their first exam. What will happen if they fail the second time, and eventually the third time?
At the same, they are on our payroll and if they have not fully completed their certification requirements of the country to be given the status as a registered nurse within Canada, what will happen to those individuals?
I think that I have stated many, many times that individuals who fail the RN cannot work as nurses in Canada.
That applies to international nurses; that applies to Canadian nurses.
In this particular case, with this particular initiative, the arrangement we have with the firm that has assisted us in recruiting the international nurses, the obligation of that agency would be to find us the replacement of that person that failed the RN exam at their cost.
Mr. Curley: Thank you. I appreciate the minister’s response providing more information as to what’s happening with that because I have never even seen that the nurses are normally given a complete payroll package with the benefits before they have completed their certification requirements and they are still under our payroll. So that’s the reason we were asking these particular questions.
I will leave it at that and we will be asking for an update further down the road once this Assembly continues the next time.
I have a last question with respect to the government’s initiative. There’s a brief statement in the business plan with respect to the Client and Medical Escort Policy.
I indicated yesterday that there were concerns that the elders have, mainly the fact that they are unable to communicate in English.
They are unilingual and most of the time with the medical examinations that are occurring, they are normally completely not fully understanding in spite of the fact that there may be interpreters available.
The elders in our region particularly request the minister or the government to provide a relative as their medical escort when they are unilingual, and in certain conditions that require them.
So will the minister consider putting in place in the policy that the relative or for that matter, the spouses will be involved in recommending that the person does require a medical escort when they are medivaced or sent down to the hospitals down south?
At this moment, the policy says that only if the medical officer says that they require escorts, then they will do so, but our presentation to you is that the relatives are calling on the government to consider that advice be sought also from the relatives of the patients.
Would the minister confirm, yes or no, to this requirement?
And if so, please provide a copy of the change of the policy to the Assembly.
When it’s being determined that an escort is required, normally the individual patient has that flexibility to decide who within the family or individual they want to travel with to wherever the service may be.
Having said all of that, there are a number of factors that are considered in deciding whether an escort is required. One is the ability of the person to travel independently, whether they are unilingual, disabled, and so on.
So there is that flexibility in that the family has choices.
The individual has choices whether to have a family member accompany him or her to a centre, but the fact again, the decision leading to that involves a number of examinations, so I would like to keep it as open and as broad as I can in that.
Every case is different, and it’s not a yes or a no response because every case and situation is different.
At the same time, we all recognize that they are not all the same individuals and whatnot, but the level of inability to communicate is normally pretty clear-cut.
When you don’t know how to communicate, many of you have never experienced that, but when a patient is unilingual and really not able to communicate in a certain language, which is your language, which you take for granted, it’s very difficult.
You have it made. You don’t need that service.
So do I understand the minister said that you will not consider the advice of the relatives, whether in fact the patient requires a medical escort when they are medivaced to Southern hospitals?
I did not say that at all and I didn’t say that wouldn’t be considered.
I just said in deciding whether an escort is required there are a lot of other factors that are considered; not just the language, the disability or the ability to get from A and B. Those are all pieces that are considered, including minors, including children and babies.
So there are a lot of steps taken and guidelines that will be needed to ensure that there is consistency in how the policy is applied, and as much as possible, we try and apply that consistently.
In almost all cases of unilingual Inuktitut elders, escorts are provided, but I just want the member to be aware that there are other factors also. Some unilingual elders are comfortable traveling to Yellowknife, as an example, and don’t always want an escort, but in some cases, they do.
So I’d like just an open mind that there are a lot of other pieces to consider, and in most cases, unilingual elders do have escorts.
You have 45 seconds, Mr. Curley.
Mr. Curley: Mr. Chairman, I have one last point I want to make.
It has been raised with the medical people as well as the previous ministers and so on that the medevac planes, particularly in our area in the Kivalliq Region...might be evaluation with some of the requirements of the contract that there are no washrooms on these medevac planes that normally fly from Repulse Bay, Coral Harbour to Winnipeg.
You know there is maybe a milk run between. Why is it the fact that they are not compelled by the contracting agency to abide by that rule, their argument had been “Oh, we are only flying between points with an hour and a half in between.”
But the patients have said that their biology doesn’t always comply with these hourly time limits that these airlines travel from A to B to C, and then eventually to D as the final destination.
Could the minister undertake to provide a somewhat positive response to the people and the patients of the Kivalliq region that they will look at these medevacs currently normally chartered by the department when patients have to be sent down to the hospital in Churchill or Winnipeg?
I will look into that and evaluate the scheduled medical travel and contracts that we have to ensure that the service providers are meeting their contractual obligations that we have with them.
But having said that, I think it’s also important to keep medevac separate from scheduled medical travel. So I will look into that and report back to the members and at the same time I have also committed to reporting the same information to the Member for Hudson Bay.
On page H-6 of the Main Estimates, the CHR Program for $166,000, it’s a program that trains individuals from the communities to work in the health and social services field.
Can the minister expand a little bit on that statement? How many people is the department planning to train, and further to that, is there a maximum number of CHRs that are required in each Nunavut community?
The idea originally was to train at least one, well maybe more than one, but the idea was to train individuals to take on the CHR position in every community. At that time, there was a CHR in most communities, I believe in Cambridge Bay, there are two positions there, and in most other communities, there is one.
The training program rotates from community to community. I believe last year, it was offered in Pangnirtung, but I am not sure where it is this year.
I am not exactly sure if that’s the information that you are looking for, but the idea was to train individuals to work in the CHR positions in the Department of Health and the investment was made to develop the training program through Arctic College to maximize that opportunity for people in a community that want to go into that field.
Mr. Peterson: Thank you, Mr. Chairman. Thank you, Minister.
That does somewhat answers my question. A few years ago when I was with the Hamlet of Cambridge Bay, there was a CHR course in Cambridge Bay. I think there were eight or nine CHRs on the course and they appeared before the hamlet council one evening, the entire group, the entire class.
They were asking for our political support to write a letter to the Government of Nunavut to ask them to create jobs for them in the various communities.
We also took that up with the Nunavut Association of Municipalities. I think some of the CHRs did eventually receive employment; there are two ladies in Cambridge Bay doing a fine job for us.
But we were wondering if there was a mandatory requirement that is based on population that there should be one, or two, or three CHRs in every community.
And if so, do you see your department fulfilling those staffing requirements?
These are people right from your community, people that know the people, where there would be some continuity with the patients and the communities, and that they are not nurses that come from down south that don’t know anybody unless they stay around for three or four years.
So these CHRs, I think, are very valuable and important health professionals that can help improve the health delivery in their communities.
I was going to an earlier question today in regard to completing the circle and it relates to the number of training programs in the health field.
Right now, we have training programs in nurses, social workers, mental health, CHRs, and so on.
That’s one of the areas that I have directed my staff to revisit and develop ways to hire those individuals completing their training programs directly to health care professions. If we are going to invest money in the training, we also have to put in the efforts to recruit those individuals to the jobs within the Department of Health.
Having said that, one of the other areas that I have asked to look at from within the department is to examine our complements of staff such as social workers and whether we need to increase those numbers based on the growth of population of various communities.
So it’s one that has not been done, but it’s one that I think needs attention. They do provide a very critical role.
One of the other areas that I have identified as a priority in the department is to develop a Public Health Strategy on prevention and these positions play a very, very critical role in getting that information out to communities.
Having recognized that, we are examining the number of positions by community.
They are not mandatory positions, but we recognize that they have a critical role in providing services at the community level.
So we are not there yet, but it’s an area that we need to examine and examine whether we require more than one position in the communities.
I appreciate that response from the minister.
The CHRs from this graduating class are a pretty close-knit group and they have remained in close contact for several years.
I mentioned to the minister the other day or yesterday that there are three CHRs in the Kitikmeot who are looking for work.
The unemployed CHRs have told the employed CHRs that they would like to be treated like CHRs, they would like to find work with the Department of Health in their community.
I think it would be sad if they couldn’t find work in the field that they trained for.
I would urge the minister to look closely at finding work for not only those CHRs, but CHRs anywhere in Nunavut where they are available and willing to work for the Department of Health because I have stated and the minister just supported them as playing a critical role in the delivery of health in the communities.
I will leave the CHRs with the minister; I think you will understand where I’m coming from with that.
On the same page, Mr. Chairman, on page H-6 of the main estimates, there are Committees of Council and these were set up I think in the year 2000. I think they were more or less to replace health boards, so instead of having a regional health board you would have a community...well, we call them health committees, but you call them Committees of Council in the main estimates.
They were established to form a link between the community and the Department of Health.
We would have members from the community; elders, youth, and volunteers that sit on the committee, and have interaction with the Department of Health officials on issues affecting our communities.
I remember at the time, one of the former Ministers of Health that is in the House today, I asked him what the roles of the health committees are. He said that they have a very important role that they would link with the community, but if they couldn’t get things done, then they could talk with the mayor, which at the time was myself, and then I could contact the minister, which was him, and then things would start to happen. It has been very successful in Cambridge Bay over the years.
The committee would be up and down.
I’d like to get an idea from the minister of today how effective these Committees of Council, Health Committees, whatever they are known by in the communities or by the government; how effective they are in improving the health and education and the delivery of health programs in the communities.
I want to thank the member for raising that question because this is one area that I think is so important and one area that I think has been under-utilized.
Since June of last year, I had an opportunity to meet with every chair of the Committees of Council.
I met with the chairs in the Kivalliq in September, and in the Kitikmeot I met with the chairs in October, and December the fourth, I met with all the Baffin Committee of Council chairs.
The purpose of those meetings was to discuss the roles of each of the committees by community.
Some of the committees are more active than some other communities. Some of them are proactive in dealing with setting priorities as to what areas they want to address for prevention, and so on. Not every community was at that stage.
Also, I was not hearing what some of those committee members were doing. One of the things that I wanted to do, by meeting with each of those chairs, was to examine how we can strengthen their role at the community level in the delivery of some of our priorities, particularly around prevention, education, and so on.
At the same time, to utilize that group to identify what some of the community priorities are in the area of prevention, and so on. They’re all over the map in terms of where they were at. The feedback that I received from the committee members was fairly consistent across the board in that we needed to bridge closer the role of the committees with what we are doing through the health centres, through the CHRs, and so on.
Again, in some communities, the committees functioned under municipalities; in some communities they don’t. So we had to recognize that there was a bit of difference in structure. They have come forward with recommendations on ways to strengthen their roles.
That will be used to upgrade or revise the terms of reference and how they operate.
At the same time, internally, we needed to look at our operations with the three regions, how we’re structured in providing the support to each of these Committees of Council, or what relationship we’ve stayed with the Committees of Council.
That work is still progressing.
With initiatives that I’ve identified in the business plan will be projects such as the public health strategy, prevention, and so on.
We hope to engage those committees in setting not just those committees, but as many citizens as possible in coming forward with what some of those strategies or priorities may be. That work is still underway.
I would like for us to utilize that group more effectively within the organization, whether it be in the area of providing services in social services, or in healthcare, but also to come up with suggestions or recommendations where we need to focus on real grassroots community issues in the delivery of healthcare.
Mr. Peterson: Thank you, Mr. Chairman. I thank the minister, and I appreciate that answer.
I think in the Kitikmeot region, there is some concern in some corners that the regional health boards should come back. It came up at the Kitikmeot Inuit Association AGM, I think, in Kugluktuk about a year and a half ago. There was a resolution.
I think that was in response to concerns that people didn’t feel the Department of Health was listening to their issues, and they wanted more control and direction over the delivery of health programs and services in the region.
I know at the time, and I mentioned earlier, the committees of council were set up to form the transition from the health boards that the government dissolved because they were too expensive I guess at the time, and were replaced with these Committees of Council.
The people in the Kitikmeot who passed the resolution would like to be assured that the Department of Health is going to work very closely with these Committees of Council and support them and give them some real powers to effect some change, health program delivery in the Kitikmeot Region and not just pay lip service to their recommendations or ideas.
If the minister could give me some sort of indication in that regard. I’m sure it’s probably the same across Nunavut, wherever the committees of council exist.
One thing, to share my thoughts in terms of what I think we need to do in the organization to strengthen our relationship with the community in addressing healthy communities, there is no doubt when the boards were dissolved, there was some disconnection from communities.
Through the board membership, there were mechanisms in place to receive the feedback. I don’t believe going back to the board structure is the solution in getting at the grassroots issues of healthcare or social services.