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Monday's session focused on the support bargaining unit. Tuesday will focus on the clerical bargaining unit. The health-care unit is scheduled for Wednesday, with nursing, the most contentious of the units, to be addressed Thursday. Joan Jessome, president of the Nova Scotia Government &General Employees Union, said it is no one's preference to take members from other unions. It is her belief that Dorsey's decision from last month "allows the unions to sit down together and put in place an amalgamated union for each of the four bargaining units."

Unions will make submissions on the appropriateness of the regulatory change Tuesday, with a representative for the attorney general in attendance. Nurses' Union president Janet Hazelton said her union would support a bargaining association, but it doesn't seem to be an option for nursing. The regulation change, which considers IWK Health Centre nurses and nurses from the other health authorities as having one employer for the purpose of bargaining, makes sense, said Hazelton.

"We've always treated them as one bargaining unit. We have one collective agreement that applies to both groups. We hold a vote (and) they're included in the vote. They sit on the bargaining committee. So we have treated the IWK and the rest of our employers as one since 1990." Unifor Atlantic regional director Lana Payne, whose union, along with the Canadian Union of Public Employees, has remained unwavering in its support for bargaining associations, said the process has been a roller-coaster ride for everyone. Payne expects a challenging week, but she remains optimistic that amalgamated units will work. "Our commitment is there, and I'm hopeful that we can pull it through." CUPE president Danny Cavanagh said the goal is to come out of the week representing as many workers as they did at the start, "if not more."

In the middle of the night, the last thing long-term care nurse Saad Akhter wants to do is send a senior to the hospital — especially someone with dementia. But there aren’t many other options available if a resident’s blood sugar is soaring, or she’s suffering from a urinary tract infection and the nurses can’t reach a physician to prescribe medication. That means the nurse must call an ambulance to take the woman to the nearest emergency department where she could wait hours for care, and potentially develop a bed sore or pick up an infection.

nursing schools.

Nurses worked more than 21 million hours of overtime in 2012 at a cost of more than $952 million to the health care system, Silas said, adding it’s no coincidence nurses’ sick time also increased.

A 2013 study for the national union reported that an average of 18,900 publicly employed nurses were absent from work each week in 2012 due to illness or injury.

Also a nursing teacher, Cleveland has brought her compassion and care to clients in hospitals, hospices and private homes. "Home is always best for palliative care, but these days, that's not always possible," said Cleveland. "The two vital pieces of this picture are accessibility and how well the care is being provided. Ontario has large areas where palliative care is not accessible." Statistics from the Canadian Hospice Palliative Care Association (CHPCA) estimate less than 30 per cent of Canadians receive any palliative or end-of-life care - and even that depends on where you live.

"There's definitely not enough money, not enough staff and there's not enough time," said Cleveland. "The staff has to fly in and fly out of homes, instead of having the time to sit and talk. "Often, the care that a person needs is just somebody listening to them." Ontario's nursing leaders know accessibility is the big tipping point for palliative care. But they also believe the Supreme Court of Canada's decision to lift the ban on physician-assisted suicide will focus more attention on all end-of-life services.

We hope the public dialogue over the Supreme Court decision will push up funding for palliative care, if we want top notch, universally accessible palliative care in every corner of this province and country. And that's not the case at present," said Dr. Doris Grinspun, executive director of the Registered Nurses' Association of Ontario. Certainly, the demand for end-of-life care in Ontario is growing fast. Within 20 years, people over 65 will double to four million, making up almost a quarter of this province's population. Many can expect to live longer, even with advanced illnesses. "There is a risk in the focus of palliative care that we will forget that the elderly, dying of natural causes, still need all of the comfort and attention of palliative care as anyone dying of life-altering illness such as cancer," cautions Dianne Martin, executive director of the Registered Practical Nurses' Association of Ontario (RPNAO).

Today, Ontario provides palliative care through a maze of sources: hospitals; 14 Local Health Integration Networks (LHINs); community care access centres; 32 hospices; and 60 other agencies providing companionship visits. Among the fortunate ones served by palliative care is 74-year-old retired firefighter Stuart Ross, who is trying to cope with the death of his wife of 46 years. Ross is a patient of the Trent Hills Family Health Team in Campbellford, southeast of Peterborough, Ont., and is able to draw on the services of Cleveland.

Cleveland provided palliative care to his wife, Barbara Ross, in the final weeks of her life at home. Now she gives followup care and support to the widower over a cup of tea at the kitchen table. "I talk to Gwen about the loneliness," says Ross. "She explains to me it can be a normal part of the recovery period. "Sometimes I just need her words of encouragement over something I'm having difficult in handling."

a place of transit for health professionals

FIQ plans to use it as a precedent in more than two dozen grievances it has filed with the board involving nurses and other employees across the province

"These private placement agencies are recruiting their personnel from the public system, and then subcontracting their services back to the same system at a higher price,"

the government pledged in its last collective agreement signed with nurses to cut by 40 per cent the use of private-agency nurses

private-agency nurses cannot provide continuity of care to patients

Combined with other savings and income, that amount might provide some retirees with all they need for decades. But everything changes when, for instance, an aging father struggling with dementia requires more help than his wife and children can manage. Plans that looked solid on paper are no match for their bills. "Within the first year most people are tapped out," said Joe Caldwell, director of long-term services at the National Council on Aging. "Middle-class families just aren't prepared for these costs." Many who can afford it buy insurance to help pay for long-term care years in advance, when insurers are less likely to reject them. But even those with insurance, like Ranzman, come up short. Forced to improvise, they sell the house and lean on family. They move in with their adult children, or arrange for their children to move in with them.

Some can save money by switching to different facilities. On average, a shared room in a nursing home runs nearly $11,000 a year less than a private room, and a room in an adult-family home runs cheaper still. Still, there's not a lot of room for creativity, said Liz Taylor, a self-employed geriatric care manager in Lopez Island, Washington. "The amount of care you need dictates the price," she said, "and there aren't that many ways around it." Hiring an aide to spend the day with an elderly parent living at home is often the cheapest option, with aides paid $20 an hour in some parts of the country. But hiring them to work around the clock is often the most expensive, Taylor said. "Needing help to get out of bed to use the bathroom in the middle of the night means you need a nursing home," she said.

EVICTED To Roslyn Duffy, it seemed that her mother, Evelyn Nappa, had everything she needed. After a stroke made it difficult to live alone, Nappa moved from Arizona to Seattle to be near her daughter and soon settled into The Stratford, an assisted-living facility, where she quickly made friends of fellow residents and the staff. "The care was great," Duffy said. "We loved that facility." With the sale of the house in Arizona, Nappa's savings appeared sufficient to cover 10 years at The Stratford, enough to last until she reached 100. Duffy said that the home's directors told her not to worry about her mother running out of money and winding up on Medicaid, even though the government program pays just a portion of what many facilities charge. After all, many of the same homes that refuse to admit seniors on Medicaid will keep those who spend all their savings and wind up on the program. "'We will keep her here' - that's what they said," Duffy recalls. "But I didn't get that in writing." A representative from the nursing home declined to comment.

As Nappa's dementia progressed, she needed more attention. That meant moving her from an independent unit that cost $3,000 a month, to a dementia unit that cost $6,000. Trips to the emergency room, hearing aids and other costs that Medicare didn't cover added up. Soon enough, the money that was supposed to last 10 years was gone in two. Duffy enrolled her mother in Medicaid, confident that The Stratford's management would keep its promises. Two months later, she received a letter saying her mother had 30 days to find a new home. Duffy protested, writing letters to the management and local newspapers, and succeeded in keeping her mother at the Stratford for two months until social workers helped line up an adult family home willing to take Medicaid payments.

But the stress and the change of surroundings strained her mother's health, Duffy said. Six weeks after moving, she was dead. "She declined so quickly," Duffy said. "Being in familiar surroundings is hugely important for dementia patients. There's no doubt in my mind that the move hastened her death. It was devastating, just devastating." NEW HOME Ranzman's story has a happier ending. Her daughter pulled her out of the Amsterdam Nursing Home and rented a house in Smithtown, Long Island, with a patio and a backyard full of azaleas and trees. It was Ranzman's own space. She had round-the-clock aides, a large window and plenty of sunlight. Her daughter, Goldblum, noticed that Ranzman's memory improved quickly. Her mother seemed happier and more alert. "It was less than half the cost of a nursing home and a million times nicer," Goldblum said. "She showed such improvement." Goldblum paid $36,000 a year for the house and her mother's long-term care insurance paid the home-health aides. The move saved around $250,000 a year in expenses. What's more important to Goldblum is that her mother seemed content when she died in April at age 86, lying in bed and surrounded by family. "It was a wonderful ending," she said.

The superhospital was built as a public-private partnership to avoid cost overruns. Under the terms of the agreement, SNC-Lavalin was bound to respect all the technical specifications during construction, including the wiring. Operating room staffrecently discovered that the heart-lung perfusion machines - which are used during coronary bypass surgery - require 20 amps of electricity, but the wiring that was installed in the ORs is not the correct gauge. During bypass surgery, a perfusionist stops the heart, pumping and oxygenating the patient's blood with a perfusion machine. "The perfusionists are running around wondering whether they can change the breaker or if the wiring will all need to be changed," the source said. "We don't know yet."

MUHC officials did not confirm or deny the wiring problem or staffing shortage, but alluded to both issues in an email statement on Thursday - two days after the Montreal Gazette requested a comment. "We are working to finalize a number of infrastructure adjustments required prior to the move of the RVH site on April 26," the statement said. "At this time we have every reason to believe that the operating rooms and clinical spaces at the Glen will be ready to accept patients on the day the hospital opens. Our team has been hard at work over the past months setting up our new facilities, identifying deficiencies and coordinating with our private partner to make the necessary modifications." Ian Popple, a spokesperson for the MUHC, said the wiring issue "is one of those things that's on the list." "There's a list of stuff, and all the changes that are going to be required to get the OR patientready by April 26 are going to get done. That's what they've assured us. Of course, patient safety is key."

The MUHC plans to hire at least 15 nurses for the Glen operating rooms, 15 nurses for its emergency room and 30 nurses for the postoperative recovery room. "One of the problems is that they did not post these positions early enough," the source said, adding it takes six weeks to train the nurses to work in the new ORs and gain familiarity with the location of instruments and equipment. "They should have foreseen this," he added. "They should have posted the positions much earlier. It's not as if they didn't know this was coming." The MUHC statement acknowledges that hiring and training should be "further advanced" at this point, but pins some of the blame on funding delays by the provincial government.

"The nursing recruitment process at the MUHC is continuous. We are always actively looking to recruit nurses and even more so at this time of transformation. ... Over 100 new positions have been posted and we have already positioned a number of experienced staffto begin training in time for the opening of the Glen site." "It should be noted that a gradual ramping-up to full capacity was always planned for the Glen," the statement adds. "We cannot predict how long it will take to reach full capacity in the operating rooms, but we are naturally focused on achieving this goal as rapidly as possible. Ideally, recruitment and training would be further advanced, but we have moved as fast as possible while remaining within our current financial parameters while we await confirmation of our Year One budget." Richard Fahey, the MUHC's director of public affairs, has suggested that the implementation of Bill 10, the government's reform of the health-care system that became law last month, might have added to the delays in approving the budget. aderfel@montrealgazette.com Twitter.com/Aaron_Derfel

In June 2011, HEU brought together 60 LPN leaders for a consultation on the evolution of LPN practice in B.C.

Coming out of that conference, the union issued a report entitled Making OUR profession stronger

During National Nursing Week in May, HEU distributed a discussion paper to LPNs entitled Taking our place in modern nursing care

And the cooking's good here," jokes Donna Fox as Rodway stops in at the well-kept bungalow she shares with Bob, her husband of 62 years. Rodway, who's worked for ParaMed Home Health Care for 17 years, manages his symptoms and keeps him comfortable during his terminal illness. "It's very important because I couldn't exist without someone looking after me," Bob, a former marathon runner, says from the raised bed where he watches sports on TV or the awakening of spring outside his window. Suzanne, a Whitby breast cancer patient, credits a home-care nurse for possibly saving her life by sending her to hospital for a swollen hand caused by a blood clot. Now she gets shots of blood thinner at home.

"You're near the end, that's awesome," Rodway tells her after administering the day's needle, the 90th in a series of 100 prescribed injections. "You've been a trooper," she adds as Suzanne says, through tears, that her last chemo treatment is just days away. "There are many times I've cried with a client," Rodway says later. "People are appreciative because you're helping them feel better." Rodway, a mother of two young children, sees five or six patients a day in Whitby and Ajax. She says working 25 or 30 hours a week gives her a good balance of career, volunteer work and home life. "I get a lot of satisfaction." For RPN Max Hamlyn, it's all about the personal touch. "You've got the ability to spend time with the person and develop a closer bond," unlike hospitals where staff are too rushed, he says. "It's more than just running in and changing a dressing. I'll ask, 'How are you doing, are you eating OK?' And I say, 'What's the most important thing I can do for you today?' "

Hamlyn, who works in Ottawa for the government branch of Bayshore Home Health, covers up to 100 kilometres a day, seeing eight to 10 patients in private homes, retirement residences, detention centres and halfway houses. After 38 years in the profession - doing community care for the last 13 - he maintains "people do much better in their home" than in hospital. "I love it. I think home care is an amazing place for RPNs to work," says Hamlyn, whose youngest client is 23 and oldest, 102. He recalls the year he spent caring for a woman with colon cancer, meeting all her children and grandchildren and always staying for coffee and cake. "You become part of the family," Hamlyn says of many of his clients. "I get along really well with my people. I have a lot of fun with them - we laugh, we joke. They're such lovely people."

Clayden said any delay in reinstating surgeries beyond the end of the year would jeopardize the facility's future. A local family physician who performed anesthesia when Clayden operated there said he would need to upgrade his training if his skills are allowed to lapse. He's not prepared to give up his thriving practice for a couple of months to do that. Paulette Goossen, an official with Southern Health, the area's regional health authority, said while the plan was to reopen the Altona OR this month, she couldn't guarantee that will happen. "We are actively recruiting nursing staff to support that service," she said.

Goossen challenged the surgeon's description of the OR as state-of-the-art, saying it is not brand-new, like other sites in the region. The hospital opened in 1994. Only about 150 surgeries a year were performed there, she said. "It is more difficult in rural Manitoba, certainly in smaller communities, to attract nursing staff," she said. Goossen dismissed the idea of hiring private nurses to fill in so surgeries could be performed, saying it would be cost-prohibitive. Such a move would also lead to problems with continuity of care, she added. "It's more difficult to just bring people in who don't know the facility."

Clayden said the Altona OR was already vastly underused. His weekly surgical trips accounted for most of the operations done there, although dental surgery was performed there occasionally. When Progressive Conservative MLA Cliff Graydon raised the matter in the legislature in May, Health Minister Sharon Blady assured him the situation would be rectified "by the fall or sooner."

On Tuesday, Blady said there were challenges in filling nursing vacancies in the community. "I know that they are working on it. I would like it to have been resolved long ago," she said. The province has found it challenging to maintain adequate staffing of doctors and nurses in many rural communities. Blady said one answer may be to build "rural health teams," rather than to focus on shortages of one type of professional or another.

"Maybe the model needs to change," she said. "Maybe we need to see what it is that needs to be done differently so there is a stronger ability to recruit and retain folks." larry.kusch@freepress.mb.ca