June 29, 2012 Mr. Ron Gagnon and Ms.

Johanne Messier Mann Sent via e-mail Dear Mr. Gagnon and Ms. Messier Mann: Re: Moving Forward with the IACs Recommendations re. Sault Area Hospitals ER

I am writing regarding the deep concern of the Ontario Nurses Association (ONA) about the delay of Sault Area Hospital (SAH) in moving forward with the top-three priorities of the Ontario Nurses Association (ONA) flowing from the 35 recommendations made by the Independent Assessment Committee (IAC) for improving patient care in the emergency department. As you are aware, the composition of the IAC panel of nursing experts SAH and ONA. SAH and ONA representatives met on June 20 th recommendations. ONA is committed to its role as an advocate for our them, for safe, quality and ethical patient care, and wishes to see SAH most vital of the IACs recommendations. was approved by both to review the expert members and through move forward with the

The key issue for the emergency nurses and the key recommendations by the IAC concerned increased staffing. To claim to be implementing the majority of recommendations and ignoring two of the three main recommendations for staffing demonstrates a lack of respect for the RNs working for the Sault Ste. Marie community at large and the RNs working in the ER specifically. It also demonstrates that SAH management does not value or support the IAC panel of nursing experts opinion. You are well aware of the three priority recommendations regarding the ER RNs workloads: 1. Ensure that the baseline RN staffing complement is addressed by adding one RN midshift (from 1200 to 2400 h) in the emergency department (ER) and assign this RN as a float to see and treat and/or reassignment to the triage zone; 2. Appoint the educator to the ER on a full-time basis. Should this not be possible, the educator should be assigned to the department on a full-time basis until the departments Nurse Manager has been recruited and in place for six months. Thereafter, SAH must ensure the educator is available to the department on a clearly defined basis and to focus on practice and education issues, including the implementation of medical directives, clinical practice issues and the integration of newly hired ER RNs. ONA understands that the local parties are working on implementing this initiative on a temporary basis, and congratulate SAH on moving forward.; however, we must caution that our priority remains a permanent, full-time ER educator. 3. Implement a unit aide position in the ER on a 24/7 basis.

Ron Gagnon and Joanne Messier Mann June 29, 2012

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The failure of SAH to implement these vital recommendations in a timely manner will force ONA to take further action. Safe, quality and ethical patient care and a tolerable workplace where RNs can fulfill their roles and responsibilities as front-line caregivers, as required by the College of Nurses of Ontario, is our priority and should be that of SAH management as well. Our patients deserve no less. We note that the recent issue of VITAL LINKS, SAHs staff newsletter, details the achievement of the hospitals $2.2-million operating surplus; this is extremely laudable and negates any argument SAH may make that budget concerns prevent the recommendations from being implemented and to only move forward on a temporary full-time nurse educator. While ONA does not wish to have to take this issue further and prefers to problem-solve with SAH directly, please be assured that the safe and quality care of our care of our ER patients and the health of our members is our priority. I am therefore requesting that you implement the staffing recommendations immediately. Sincerely, ONTARIO NURSES ASSOCIATION

Linda Haslam-Stroud, RN President C.: Vanda Cooper, Critical Care Program Director Marie Paluzzi, COO Derek Garniss, Chief of Staff Heather OBrien, Chief of Staff Glenda Hubley, ONA Local 46 Local Coordinator SAH Board of Directors Hon. Deb Matthews, Minister, Ministry of Health and Long-Term Care Wallace Wiwichair, Interim Chair, Northeast LHIN Jo Anne Shannon, ONA Professional Practice Officer David Cheslock, ONA Labour Relations Officer