Home and Community Care Nursing Handbook
Nursing Human Resource Issues
The availability of nursing human resources is an issue across Canada and First Nations & Inuit communities are no exception. There are numerous issues associated with the recruitment and retention of nurses for First Nations & Inuit communities. Various regional strategies are currently being developed to address these issues and support communities in recruiting and hiring home care nurses.
This section provides communities with information to assist in the effective management of nursing human resources. The documents and examples referenced in this section are guidelines for communities which are designed to support and provide appropriate management direction to the nursing staff. These resources are available in the accompanying Reference Kit.
All nursing staff should have a complete orientation to their new position. It is important to have an employee orientation policy which outlines the content to be included in an orientation. A sample orientation policy is included in the Home and Community Care policies manual.
Orientation checklists are an excellent way of ensuring that nursing staff have a standardized and comprehensive orientation to the program and the community. Each Home & Community Care Program should develop a checklist specific to their community that includes all of the items comprising an orientation as identified in the policy manual. A sample of such a checklist is available in the Reference Kit, which can be utilized and adapted as appropriate.
When recruiting and hiring nursing staff, it is important for First Nations & Inuit communities to indicate in the recruitment advertisement the position title and education, skill sets and work experience requirements. In order to do this, First Nations and Inuit employers must have a clear understanding of the work to be performed and the associated competencies required.
Nurse experience, skill sets, and educational background all contribute to their individual credentials and qualifications. For example, some positions may be more applicable for a Registered Nurse (RN) while others might lend themselves better to someone with a Licensed Practical Nurse (LPN) designation. In other circumstances, nurses with a baccalaureate degree (i.e. BScN) may have the education and corresponding work experience better suited for a particular position's scope of work.
A sample job advertisement for a Home Care Case Manager is provided in the Reference Kit. It can be utilized as a guide when preparing recruiting advertisements.
It is also necessary to have a job description prepared that the nurse candidate can review prior to an interview. The job description should include the position title, the purpose of the position, who the position is accountable to and what the position is accountable for. There should be a summary of the job and a listing of the specific duties and responsibilities. The document should also include the qualifications and experience required, as well as a brief statement about the expected working conditions. Samples of job descriptions are available in the First Nation and Inuit Home and Community Care Planning Resource Kit, Booklet 4, Preparation Activities.
In order to recruit and retain nurses in today's environment, employers must be able to offer competitive remuneration packages and provide a supportive and professionally challenging work environment.
Competitive remuneration involves more than simply salary. It can also include incentives for continuing education, non-financial incentives such as additional professional development leave days, and a wide variety of other benefits. For example, communities might consider giving educational allowances for nurses in their employ who hold a Bachelor of Science in Nursing (BScN), or provide financial support to nurses who wish to further their nursing education.
The salary and benefits package must be comparable to that which a nurse can obtain from other agencies that are within close proximity. When hiring nurses it is important to compare benefits to similar employment settings. For example, home care nurses will travel extensively within a community. As such, it would be important to have a mileage reimbursement for use of personal vehicle benefit for the nurse. It is helpful when setting salary scales and benefit packages to research information from several other employers within the immediate area.
All employees of the First Nations and Inuit Home and Community Care Program (FNIHCC) must be responsible to their clients, the Program and their co-workers and must perform their duties at all times in a professional and ethical manner. In order for employees to do this, they must be sensitive to potential conflict of interest issues. The employer can facilitate this sensitivity and awareness through a comprehensive policy on Conflict of Interest. A sample is available in the Home and Community Care policy manual.
An example of a potential conflict of interest would be a Case Manager who is required to complete an assessment and determine eligibility for services on a client who is a family member. The Case Manager may feel pressure from other family members to exceed the program guidelines and provide a higher level of services.
A Conflict of Interest policy would identify a method for the Case Manager to disclose a potential conflict of interest situation, such as in the above example. In this situation, the Case Manager should identify the potential for a conflict of interest with program management as well as with the family. Once the Case Manager is placed in a conflict situation, he/she must then declare a conflict and remove him/herself from any further decision making in the case. The program supervisor and/or manager should become involved at this stage.
An employer has an obligation to provide a safe work environment for staff. The program must have standards for health and safety for both staff and clients in its care. A standard for health and safety can be found in the Home and Community Care standards manual.
There are numerous elements within a Health and Safety program. Employers must develop policies and procedures that address all of these elements. The suggested list of items to address under Health and Safety include, but are not limited to:
- the management of hazardous wastes
- emergency and/or Disaster response
- fire and evacuation plan
- an incident reporting system
- liability protection for employees
- negligence
- client abuse
- infection control
- harassment
Policies addressing all of these areas are available in the Home and Community Care policy manual.
All employees have a right to have their performance evaluated on a regular basis. Employers should have a process in place to evaluate employee performance on an annual basis as a minimum standard. Employees must be evaluated against their pre-assigned work expectations. These expectations should be provided to them upon hiring in the form of a job description. Any changes in work expectations must be communicated to the employee in writing and included in a revision to the job description.
It is also recommended that employers:
- have policies and procedures in place to standardize the performance assessment process within their organization;
- institute a minimum probationary period of six months for all new employees; and
- conduct a probationary performance appraisal at the end of that six-month period.
For informational purposes, a standard for performance measurement along with the appropriate policies can be found in the Home and Community Care standards manual.
Employers can utilize a wide variety of formats for employee performance review and/or appraisal. It is suggested that an annual written review be the bare minimum standard and this can be supplemented with additional verbal and/or written reviews either formally or informally. To assist with this process a sample of an employee appraisal form is available in the Reference Kit.
In addition to a regular performance review and/or appraisal, nursing staff may also be required to complete a self-assessment of their nursing practice according to the standards set out by their specific provincial and/or territorial nursing regulatory body. These standards must be complied with and employers should be aware of these standards in their respective jurisdiction and ensure that their nursing staff is in compliance.
One way of ensuring this compliance is through a process called "professional appraisal" whereby the practice and competence of the Home Care nursing staff is monitored and/or evaluated by a senior nurse manager/consultant. This would be considered a part of the second level services that are incorporated into the program framework. For more information on this issue, please see Section 7 on Nursing Support and Consultation in this manual.
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