EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
Perhaps, if we’re to screen the nurses who come into the community as to what type of professional practise that they had, so that you know.
This is probably not intentional but because, maybe for the lack of experience that sometimes the nurses don’t have the know how to diagnose a patient.
Sometimes they treat the patient and send them home with Tylenol.
They didn’t diagnose the patient as to what type of illness they have and when I hear this from the community, when the nurse diagnoses a patient and says, take some Tylenol and perhaps you’ll feel better by tomorrow.
The situation deteriorates when the patient is not diagnosed.
That would create a longer illness and it creates more health problems for the patients.
This is just a suggestion that perhaps we can look at because when the nurses in all the communities, when they do their profession, they should diagnose the patient and I will be asking questions in regards to licensing the nurses or proof of certification.
This really relates to how an elder is diagnosed because we’re all getting to that age and it’s a big concern.
Perhaps in the near future, we can perhaps get an update as to where this is going.
Perhaps in the near future.
That will be my question in regards to that concern.
We’re all getting older.
Are there any other general comments?
If there are no more general comments, Ms. Williams.
While we’re talking about nursing, I have to say my piece.
The Act to Amend the Nursing Act that we’re dealing with at this time deals with the hospital; public health centre and the other nurses all have different levels of education.
I know that under the Act, the Standing Committee has scrutinized the Act.
There is also a difference between the nurses in the hospitals and nurses at public health and nurses in the communities.
It’s very hard for them to work.
We have had a nurse in Arctic Bay for 20 years and she has a relief nurse that goes there every so often.
I would like to say, during the Committee of the Whole, that communities have to look after their nurses very well and to interact with them and to realize how hard they work.
Looking at the hospital here in Iqaluit, when you go up there, you can see that they have very professional nurses up there and they’re all women.
Although, there are some doctors who are males, I would like to say that I appreciate the work that they’re doing and I would also like to say that the nurses have to be looked after properly because they’re looking after people’s health.
If they have to take more training, they should be provided with more training and for them to have a rest when they need it so that they can look after the sick.
In regards to an Act to Amend the Nursing Act that we’re dealing with at this time I feel that they have to have a license and good training and a good work experience and to be looked after by the government.
I just want to ask a question in regards to the licensing of the nurses.
As we know, the nurses come into our communities (interpretation end) just for an example, licensing nurses, how often are then renewed?
Is it for a lifetime or depending on how much training you get annually?
I’m just trying to get a picture of how often the nurses are checked to make sure that they’re properly trained to look after our patients in Nunavut.
Mr. Chairman, first of all I think we had some good comments from the Members.
I appreciate the comments from Member Williams on making sure the nurses are well respected and treated well in our communities.
Quickly on the licenser issue, Mr. Chairman, let me assure the Members of the House that no nurse can practise in Nunavut unless they’re licensed.
They have to be accredited and one of the ideas under this Act of course is that the licensing body includes designation with the Professional Nurses Association.
On the yearly basis, nurses are followed up on their license or issue and in most cases, Mr. Chairman, yes it is usually on an annual basis.
That is my understanding of that.
Mr. Havioyak (interpretation): That is very reassuring when the license of the nursing profession are reviewed, I guess, we can reassure our communities that these professionals are reviewed.
As you were saying, the licenses of the nurses are renewed every year.
(interpretation ended) Before the licenses, do you give them a test before they renew the licenses to make sure that they are still at the same level?
Mr. Chairman, I am just checking on the processes that we have in place, like, for certification and so on. I just want to go back to that quickly.
When nurses apply for a position, they have to have the certificates to prove that they are, for example, the RN, Registered Nurse, in the bachelor of nursing and so on and that has to be certified before you are given an offer of employment.
The agency nurses who come up, those are nurses that we would hire on a casual basis to fill in and so on.
The same thing, the nursing agency demonstrates and shows the qualifications of the person involved so they make sure that they are licensed when they go into a community and that they actually can make the diagnosis.
You know, we just talked about it earlier, the Member Havioyak talked about earlier.
Secondly, on the professional development side, so they can recertify and gain more skills, one of the things we think that we can bring forward here under the profession development is the usage of the telehealth that we just talked about.
In the Member’s community of Kugluktuk, we have located the special practises unit of Health and Social Services, where we do all of the licenses insured through that is where the registrar is located and so on.
So, that is some of the work that has been put into place.
Thank you, thank you, Itsivautaq Iqaqrialu.
Mr. Chairman, the Chairman of the Standing Committee’s Opening Remarks had indicated the Committee fully supports the concept of nurse practitioners bringing their extra level of expertise to Nunavut.
I am just wondering if the Minister can elaborate, a little bit, I guess, on there it say extra training and additional nurse training.
If you can elaborate on specifically what types of areas that are meant by that.
Mr. Chairman, I am going to ask the Deputy Minister to just maybe give a correlation between the designations that are earned, like, for the nurses as well as the professional development aspects and the qualifications of each as outlined in the Chairman’s Opening Comments.
Mr. Blaise.
Chairman (interpretation): Mr. Blaise.
Mr. Blaise: Thank you, Mr. Chairman.
One of the things that we are looking at right now, I think with the new telehealth technology is nurses who work in the field, medicine is a changing environment.
So, our hope in the foreseeable future is that we can, using this technology, provide ongoing education in dealing with paediatric cases, children with all kinds of challenges, mental health patients so we can educate the nurses in the field, again, on a regular basis, monthly, weekly, to provide additional training or knowledge that they require to do the work.
Additional training in obstetrics is a good example as well.
So, I think we have the opportunity to improve the level of skills and knowledge of our nurses in the field.
We have to consider, as well, that most of our nurses are coming from the south and they come to a region where there are basically, they have no physicians in most of our communities, so their knowledge base that they would be used to practicing, or where they would have been trained, would not have the same degree.
So it takes more off of them to acquire the skills to be able to function properly.
In order to provide support, each Nursing Station is assigned a physician, on call 24 hours a day.
So it the nurse requires assistance, then they can call that physician on a regular basis, and they do that, I know, consistently.
I would hope right now that we know that we have to improve the level of training and ongoing education for our nurses and other professions.
That probably is well one of the reasons why our turnover rates are so high, it is because we are not only isolating them, but we are not providing what we call professional development on a regular basis.
We have recognized that in Health and Social Services, Mr. Chairman, and we hope to be able to change that.
I think the technology and the tools that we are putting in place provide us a tremendous opportunity to achieve a very different level of training for our nurses for the foreseeable future.
Mr. Chairman, on providing professional development, and I know that this issue is pretty deep, the current Deputy Minister, and I am sure that the Minister will recall that one of the retention packages, or the things that they put out, that the Department put out there to retain nurses with a signing bonus that was paid to the Registered Nurses.
I know that there are instances, I know of here in the College for sure, and I am sure in some of the communities where you have nurses who have been there, some of them, over 20 years.
That may have been because of where they went to school, that something, a certificate that says a Registered Nurses Assistant, rather than an RN. If they had gone to another jurisdiction, it would have been an RN.
Is there anything taken into consideration?
I think the density that Mr. Blaise had indicated that the workload and the type of work that you deal with here in Nunavut, is much different than you would deal with in the South.
It is because you are alone in a lot of cases, and you have to deal with things.
You cannot just say, “Oh, go see the doctor down in the next Medical Centre, a mile or two down the road.”
You cannot do that; you have to deal with it.
It is a pretty demanding place to work.
As a result of that type of exposure, that type of work over the years, individuals learn a lot more.
Is there, in here, any looking at professional, or taking ones experience, work experience, an actual experience of working in the field here in Nunavut into consideration in looking at the designations that they have assigned to them?
Mr. Chairman, I will just ask the Deputy Minister to elaborate a little bit on this.
The issue around the Market Rate Supplement, and why we introduced and everything was based on a pandemic shortage of nurses that we see not only in Canada, but indeed North America.
The Market Rate Supplement was part of the recommendations that we brought forward and tabled in the House under the Naujaat Report, which was 23 recommendations from nurses in the field, and so on, for the recruitment and retention of nurses.
I think that we were successful on that.
We are about 80% right now with staff indeterminate and term nurses.
We have somehow to pick up the slack on the other 20%.
Part of that will be our own nurses through the Nursing Program.
The issue on the temporary Market Rate Supplement itself was based on the nursing shortage, in this case, there were some people who fell through the cracks because they were certified nursing assistants and didn’t qualify under the Market Rate Supplement as designated and defined through the collective agreement process because we had to go through our partners of the NEU.
I’ll just ask the Deputy Minister to elaborate a little bit more on that.
The issue of the supplementary has been a contentious issue for some time.
And again, I think in working with Human Resources we have decided that we should conduct a review looking at salary scales of nurses across the country.
We have agreed to a process that will hopefully start very shortly to look at all of that.
There are a number of provinces and territories that provide educational allowances and I think that’s a key issue for nurses, as it should be.
I think this process is about ready to be undertaken anyway.
The supplement, it does not seem to be something that’s working currently.
It’s not really achieved the outcomes that I think were predicted originally.
I think it’s kept us going but I don’t know whether or not it will work for the foreseeable future.
So the process that we’ve taken with Human Resources, Mr. Chairman, is to establish a review process for all of the nursing salaries both for those in health centres and hospitals and public health as well.
So, at this point I really can’t give you more information than that, other than I think that a review is necessary in order for us to ensure that we’re at least competitive with the rest of Canada.
As far as whether or not a nurse working in the north gets a higher level of salary, as you know, this is all regulated through the collective agreement.
So, we’re basically working with the unions at this point in time to work with us in trying to examine the whole issue of nursing, not only from a perspective of salary, but also looking at retention and as of next month, Mr. Chairman, we will be putting in place a Nunavut-wide retention and recruitment committee that will involve the union.
It will also involve Mr. Chairman, Human Resources and representatives from the front line staff nurses and other departments as well.
So, our hope is to begin to look at and address the issue of the turn over rates but also to examine the salary issue for nurses and other benefits that we feel would be more appropriately aligned with things that we would need in the north and that’s the purpose of this review.
Chairman (interpretation): Thank you, Mr. Blaise.
Mr. Chairman, I think it’s quite clear, as the Minister indicated that there are some people who fell through the cracks on that last, on the whole MRS process.
I would like to ask the Minister to commit, to make a commitment to those people who fell through the cracks, the things that cause those problems and for those cracks to be looked at and taken into consideration when developing and working with the union on coming up.
He had indicated that they’re re-evaluating job descriptions and you know, that whole process with, right now, with things like experience and what the actual, aside from the certificate or designation that they hold but another factor that might be considered is, what they do, that they actually do.
Because I know that in cases, as I’m sure the Minister will be more than fully aware of, these individuals often trained a lot of the nurses who came in on what to do here because they’ve been here for so long and they’ve done it, even though they don’t have the formal training to do it, they’re actually doing it.
So, I just want to get a commitment from the Minister that that will be looked at in that review process.
Mr. Chairman, we have a committee in place right now working with the Department of Health and Social Services and as well we have involvements in the Nunavut Employee's Union and Human Resources from the Government of Nunavut to review that program so, I would commit to the Member that that’s something that we will be able to review, to look at the issues in the areas around who is eligible for the Market Rate Supplement in cooperation with our partners at the Nunavut Employee's Union and Human Resources.
My question is about the nurses in the communities.
I think the Deputy Minister used the term field but they’re out in the community and they’re by themselves out there and many times, they are new and they’ve been there six weeks or something and they are also given extra duties like to do more administration for Social Services.
Why is that being done?
They are already over worked.
You already have a very high turnover and you’re giving them extra duties to do social work issues and they also do a lot of counselling, social counselling because people go to them.
Why are you giving them more duties?
The job of a nurse has changed drastically in the last 20 years.
The equipment and technology that nurses use are now complex.
We know ourselves just sitting here, about technology changing, the internet, with faxes and with other telecommunications equipment, the new telehealth equipment that we have installed, as well as some of the diagnostic tools that nurses are using.
With that type of technology change, there is a lot more administration work and so on.
We’re trying right now, Mr. Chairman, within the Human Resources and the Department of Health and Social Services to review exactly what the Member is talking about, the work load to see if there is an opportunity where we would actually have an administrative assistant for example.
One of the reasons why we moved away from the earlier First Air contract in the Baffin Region was because we had nurses filling out tickets for airline travel.
The nurses aren’t the ticket agents.
They’re not travel consultants, they’re nurses.
So, what we’re trying to do is move the administration and buracreacy away from the nurses and let them do more nursing and we’re looking at ways cooperatively in how we can accomplish that.
To sort of add to Mr. Havioyak’s concern about licensing and ability to diagnose properly, and I think that is key.
We work them so hard and they have to worry about a whole bunch of things in the community, plus we want them to do a whole bunch of paper work for the social worker or the other staff in the nursing station.
I’m more talking about the communities.
So, if we’re going to look after our professional nurses in the communities, we cannot be adding extra responsibilities and duties to those already there.
There is so much for them already to do.
It’s more of a comment than a question.
I just needed to point that out that they not be given extra responsibilities because they have enough things to do already with sick people.
If the Minister would like to make a comment to the comment that was made.
I agree with the Member.
She has made some valid points.
We have moved, I think, very quickly in the last several months now in bringing in more staffing, different specialized staffing.
At one point in the history in the last few years, you’d have just one type of standard nurse/practitioner in the community, a community health nurse.
Now we’ve brought in more expertise, for example, psychiatric nursing and so on.
We’ve put a home care program in place in every community.
That wasn’t there before.
We’ve actually taken some of the work that the nurse would have to do outside of the center, so that they can actually concentrate more on the diagnostic side.
So, all of those things are well taken and with the primary health care transition program that we’ll be bringing forward and approved just recently by Cabinets we should see another huge change in the way healthcare is being delivered in Nunavut.
It takes time; I think we have made some good steps, but there is still a long ways to go, as Members know.
Are there any further questions from the Members?
We will go on to Bill 41, An Act to Amend the Nursing Act.
Do you have the copy in front of you now?
I am sorry, Ms. Williams.
It is under 8.
Chairman (interpretation): Please specify which Clause you would like to ask question on.
Ms. Williams: On Clause 8.5, the part that says it is talking about a person may bring an option for recovery of reasonable charges for professional services, advice or visits and the cost of any materials or appliances supplied by the person during the time a person was a registered nurse, a nurse practitioner or temporary certificate holder.
Who is temporary certificate holder?
Mr. Chairman, I am just looking at the definition of temporary certificate holder in consultation with Christine Collin.
The temporary certificate, I am just going to read out the qualifications; a temporary certificate holder means a person who is registered under section 23 of the Nursing Profession Act under the Northwest Territories.
And that temporary certificate holder, for example, could be the person who has proven their registration and so on and then would be working on a temporary nature in Nunavut, like a casual agency nurse who is hired for her six week period.
So, they would have the temporary certificate because they have already proven that they have registration, they have now received their full-time certificate of approval certificate.
But just for qualification purposes, I would just ask that Mr. Alison to confirm that.
Mr. Allison.
Mr. Alison: That is correct, that is what the temporary certificate is intended to do.
Chairman (interpretation): Thank you, Mr. Alison.
We are on Clause 8. Agreed?
Mr. Chairman, I have a Motion. Mr. Chairman.
I move that the Bill be amended by the addition of the following after Clause 12.
I believe the motion now is just being passed out, so I will give the Members a chance to receive the motion.
The motion now is being passed around to the Members so I will give them an opportunity to receive the motion
Chairman (interpretation): I think it is all passed out now, so you go ahead, Mr. Picco.
Motion 019 – 1(6): Clause 12 of Bill 41 An Act to Amend the Nursing Act be Amended
Hon. Ed Picco: Do the translators have a copy in the booth to follow along?
Okay. Thank you, Mr. Chairman. Mr. Chairman, I would move that the Bill be amended by the addition of the following after Clause 12, 12.1, the following is added after Section 8, Terry.
Terry. 8.1, a Board of Inquiry will be designated under subsection 41(1) of the Nursing Act (Northwest Territories), and it shall hear complaints in accordance to Sections 41 to 43, and subsections 44(1), (2), (4) (5), and (6), of the Nursing Profession Act (Northwest Territories).
Testimony, testimony of non-residents witnesses, 8.2 for the purpose of obtaining the testimony of a witness who is outside of Nunavut, the Nunavut Court of Justice, on application by the Executive Director, the complainant, or the nurse, who is subject of the complaint, without notice to the other party, may make an order appointing the Examiner to obtain the evidence of the witness, under the rules of the Nunavut Court of Justice, with any modifications that the circumstances may require.
Civil contempt, Section 8.3 (1) an application to the Nunavut Court of Justice, in accordance with the rules of the Nunavut Court of Justices, proceedings for civil contempt of court, contempt of court may be brought against the witness (A) who fails (1) to attend before the hearing of a Board of Inquiry after receiving a notice to attend. (2) to produce documents, records, or other materials as required by a notice to produce them, or (3), in any way to comply with a notice referred to in subparagraph 1 or 2, or (B) who refuses to be sworn or affirmed, or answer any question allowed by the Board of Inquiry before whom the hearing is being conducted.
Moving on, Mr. Chairman.
Unprofessional conduct (2).
If the witness referred to in subsection (1), is the nurse who is the subject of the complaint, the failure or refusal may be held by the Board of Inquiry to be unprofessional conduct.
Compellable witness. 8.4 (1), a nurse, or any other person, who has in the opinion of the Board of Inquiry, is a compellable witness in a hearing into that complaint.
The nurse as a witness, (2) a nurse may be examined on oath, or affirmation on all matters relevant to the hearing and shall not be excused from answering a question on the grounds of professional privilege, or on the grounds that the answer might (A) tend to incriminate the nurse, (B) subject the nurse to punishment, to punishment under the disciplinary provisions of this Act, or the Nursing Profession Act (Northwest Territories), or (C) tend to establish the liability of the nurse, Section 1 in a civil proceeding at the instance of the Government of Nunavut or any person.
Or Section 2, the prosecution under an Act of Nunavut, or an Act of Canada.
Quickly winding up, Mr. Chairman, evidence not to be used (3) if the answer given by the nurse is (A) tends to incriminate the nurse (B) subjects the nurse to punishment or (C) tends to establish the liability of the nurse.
It may not be used or received against the nurse in any civil proceedings or in any proceedings under the Act of Nunavut except in a prosecution or proceedings in respect of perjury or the giving of contradictory evidence.
Here in lies the Motion.
To the Motion, questions?
Does the Committee agree that Bill 41 as amended is ready? Does the Committee agree that Bill 41 is ready for Third Reading as amended?
Thank you, for coming, Mr. Minister.