Discussing Employment with First Nation Health Employers: A Guide for Nurses

Introduction

Many nurses who are planning to work for First Nations are used to working for hospitals or other organizations that have developed comprehensive employment policies. These policies stipulate the terms and conditions of your employment. Specifically, they indicate your obligations as an employee, and the organization's obligations as an employer. For example, typical employment policies clearly outline hours of work, the salary structure -- including allowances for specialties -- and the organization's employee benefits such as vacations and educational leave, liability and long-term disability protection and so on. However, not all First Nations have developed formal employment policies that cover these and other important areas. A potential First Nation employer could have employment policies that vary somewhat from those to which you may have become accustomed in the past. So it is your responsibility to ask about these policies as part of deciding whether or not to accept any position that a First Nation employer might offer.

This Guide should help you to ask the right questions on policies relating to terms and conditions of employment. Knowing in advance what these policies are and what a potential employer would expect from you and what you might expect in return will benefit you both. It will avoid surprises and promote a smoother, more productive employer-employee working relationship. In turn, a better working relationship should promote better health care in the community.

Basic Questions to Ask Before you Accept Employment

In the next few pages, we suggest a number of questions that you should explore if you are considering going to work for a First Nation health employer.

Included are some general questions about the community and working conditions. More specific questions follow, which relate directly to certain items associated with pay and benefits. Note that we don't try to discuss these items in detail. Instead, our goal is to remind you of certain matters that you may not have thought about, but which are important to consider when discussing an employment opportunity with a potential First Nation employer.

What is the Community Where I Will Be Living and Working Like?

Here are some areas to think about that will give you a sense of the extent to which a "match" exists between you and the community.

Accessibility

Consider the community's distance (in time as well as kilometres) from the nearest large town or city.

• How accessible or remote is it?
• Is it accessible by road?
• Is there scheduled air or other transportation service?

Services

The services available in the community (or its distance from those services) may be important to you.

What stores are available?
How accessible are banks, churches, synagogues and recreational services?

Accommodation

Adequate housing may not always be available or conveniently located. Therefore, think about the following items relating to housing accommodation:

• Who arranges for housing? the employer or the employee?
• Where is it? inside or outside the community?
• Is the house or apartment separate? attached to the health facility?
• Is it private or shared? furnished or unfurnished?
• How much will it cost? Who pays for items such as utilities, parking, insurance and telephone? How much do they cost?
• If you have a family, will the accommodations meet your needs?
• Who is responsible for maintenance -- including snow removal, repairs, painting, etc.?

What Are the General Working Conditions?

You should consider the conditions under which you would be working, including the scope of duties and the supervision and other support or back-up available to you when you need it.

Scope of Practice

Be sure to ask about the scope of practice and the nursing role you would be expected to perform in the community. These can vary according to the community's size and location and the nature of its health programs (see "Supervision", below). In isolated areas, the scope of practice may be expanded.

Supervision

Every nurse who works for a First Nation must have access to supervision by a nursing professional who is registered with the appropriate provincial nursing association. This supervision is in addition to the usual day-to-day administrative supervision. Adequate supervision is particularly critical if you are expected to function in an expanded role. Whether or not the scope of your practice would involve working in an expanded role, be sure to consider these questions:

• Would I receive appropriate supervision when I need it, commensurate with the nursing functions I would be expected to perform?
• Do I as a nurse supervise other health or non-health staff?
• Would I receive financial compensation for a supervisory position?

Support in the Community

Particularly in isolated or semi-isolated communities, having access to the right advice and other support in a difficult situation can be very useful. Accordingly, these questions would be appropriate:

• Where is the nearest physician located, and how often does he or she visit the community?
• Would I have the medical and other supplies I need when I need them?
• What other support such as social service agencies and alcohol and child-care workers exists in the community.
• Would someone (i.e., relief staff) be able to cover for me if I am on leave?
• Would I be expected to cover for others?

Opportunities for Training and Professional Development (TPD)

TPD is an essential part of remaining current, and an employer should provide TPD opportunities for all nursing staff. Consider these questions about the employer's TPD policies:

• What opportunities would be available to attend upgrading courses, professional workshops, etc.?
• Would I receive financial support while on educational leave?
• What expenses would the employer cover?

What Does the Salary and Benefit Package Contain?

The Canada Labour Code (Parts I, II and III) includes provisions relating to many of the items discussed below, which are usually found in a salary and benefit package. At the very least, employers are expected to meet the minimum labour standards set by the Code. If you are unsure about elements of the employment contract offered by the potential employer, check them against the Code's provisions. Information about the Canada Labour Code is available by contacting your local Labour Canada District Office.

The following elements of a typical salary and benefit package are listed below, along with certain questions for your consideration.

NOTE: Find out what benefits you have as an First Nations and Inuit Health Branch employee. Compare your existing benefit package with what the First Nation has and, if significant gaps exist, be prepared to discuss them with the potential employer.

Salary Range

Salaries change over time. So you may want to use provincial collective agreements for nurses and the Master Agreement between the Treasury Board of Canada and the Professional Institute of the Public Service of Canada as a reference point for current salary ranges.

• What increase for inflation, seniority and experience and training are built into the salary structure?

Hours of Work

Check the number of hours you would be expected to work per week.
How flexible are the hours?

Overtime Rate

• How will I be compensated for overtime? in money, or time off?

Transportation while on duty

• Does the employer provide a vehicle for travel at the work site?
• If the employer does not provide transportation, do they provide mileage rates to cover costs of operating personal vehicles while on the employer's business?

Travel Time

• Would I be compensated for work-related travel?
• Does the employer offer a holiday travel-time allowance if the community is isolated or semi-isolated?

Stand-by and Call-back

• How would I be paid for stand-by and call-back?

Shift Schedule

• What shifts would I be required to work? How would they be scheduled?

Isolated Post Allowance (IPA)

Is IPA provided for nurses working in isolated or semi-isolated areas? Check what IPA the potential employer offers, such as extra pay or an extra travel-time allowance for holidays.

Relocation Expenses

• What relocation costs would be covered?

Registration Fees

• Would the employer reimburse me for fees paid to professional nursing associations?

Clothing Allowance

This allowance varies according to the location of the First Nation and the duties associated with the position. Find out if you are eligible for an allowance for arctic and sub-arctic clothing such as parkas.

Leave

• What provisions or restrictions apply to vacation and sick leave?
• What other leave is provided for in the salary and benefits package? For example, does it provide for maternity, bereavement and educational leave and "other" leave for jury duty, family responsibilities, etc.?

The Pension Plan

The employer should be able to provide details of the pension plan. Basic questions include:

• Does the employer have an employer-sponsored pension plan?
• If so, is the plan registered with the federal government?
• Can you transfer all contributions (employer and employee) from your present pension to the employer-sponsored plan? Note: Before employer and employee contributions from the federal government's Public Service Superannuation Fund can be transferred to another registered pension plan, the administrator of that plan and the Treasury Board of Canada must have signed a "Reciprocal Transfer Agreement". Check to see whether this agreement is in place.
• Does the employer participate in the Canada Pension Plan for their status Indian employees?

Note: If not, and you are a status Indian, you can contribute to the Canada Pension Plan as a self-employed person (you contribute your share, plus the share that the employer would normally contribute).

Remember: Pensions can be complicated. Get as much literature as you can about any employer-sponsored plan, as applicable.

Insurance

Employers may offer a variety of insurance plans. Typically these include health, dental and life insurance. As well, they may offer income protection plans such as short- and long-term disability insurance. Workers' Compensation, unemployment insurance and provincial health insurance premiums must also be paid. Check on the availability of these plans, and determine who pays the premiums -- you or the employer, or both.

Find out whether the employer carries liability and malpractice insurance that covers professional staff. This important insurance should be available to supplement the general liability and malpractice insurance available to nurses either through provincial nursing associations, or through the Canadian Nurses' Protective Fund.

Conclusion

We hope that the questions and points raised in this booklet will help you to clarify the working conditions, job expectations and benefits associated with any new job you may be offered. Taken together, the items discussed here should make you a more knowledgeable candidate for any given position with a potential employer.