Nursing

The greatest impact of the administrative changes that occurred at the HSC in 1994 was with respect to nurses. Up until June 1994, as noted above, there was a Nursing Portfolio with a number of divisions. Each division had its own director, each of whom reported to the Senior Vice-President Nursing.

Under the June 1994 reorganization, Nursing as a separate portfolio disappeared. In the new system the nursing divisions were renamed patient service divisions, and the directors of these divisions reported to different vice-presidents. For the purposes of this Inquest, there was one significant nursing division or, after June 1, patient service division. That was the Division of Pediatrics and Child Health Nursing, which became the Patient Service Division (Pediatrics and Child Health).

The Division of Pediatrics and Child Health Nursing - Patient Service Division (Pediatrics and Child Health)

Isobel Boyle was the Director of Pediatrics and Child Health Nursing at the Children's Centre before June 1, 1994, when her title changed to Director of Patient Services (Pediatrics and Child Health). Whereas before June 1, 1994, Boyle had reported to Senior Vice-President Nursing VanDeVelde-Coke, after the reorganization she reported to Vice-President Wright, who also had responsibility for the Medical Department of Pediatrics and Child Health.

Through 1994 Boyle was responsible for 450 nursing positions. Because part-time employees filled many of these positions, the Director was responsible for between 600 and 700 people.

Nursing assignments were organized into units, each with a unit manager (formerly called the head nurse). While unit managers continued to perform most of the roles carried out by head nurses, the job (at least as formally described) was now refocused away from nursing to patient services and management responsibilities.

The training that nurses received emphasized the importance of dealing with any concerns they might have about medical quality through the appropriate channels. This would involve raising the matter with their unit manager, who was expected to take the concern to the next level.

Nurses from the following areas were involved with the Pediatric Cardiac Surgery program in 1994:

Nurses at the Variety Children's Heart Centre

Two nurse clinicians worked at the VCHC. Lois Hawkins, the senior nurse clinician at the VCHC, reported to Isobel Boyle.

Operating room nurses

Karin Dixon was the head operating room nurse until June 1, 1994. From that date forward, she was referred to as the unit manager. She reported to Isobel Boyle.

Carol Youngson was the senior nurse in charge of cardiac surgery. Youngson was responsible for ensuring that all supplies and equipment were ordered and for co-ordinating the surgical schedules of the other cardiac nurses. She reported to Karin Dixon.

Anaesthetic nurse

The only anaesthetic nurse was Irene Hinam. She reported to Boyle before June 1, 1994. After the reorganization she reported to Dixon.

Pediatric intensive care nurses

Until July 1994, Donna Feser was the PICU acting head nurse (and after June 1, 1994, the unit manager). In July, Evelyn Link returned from leave and resumed her position as unit manager. Both Feser and Link reported to Boyle.

Neonatal intensive care nurses

Sybil Russell was the head nurse and then the unit manager in PICU during the period under discussion. She reported to Boyle.

The Nursing Council

Before the change of June 1, 1994, there had been a Nursing Advisory Committee in place at the hospital that oversaw nursing issues. The VP Nursing sat on the Committee, which had significant status and authority within the hospital over the regulation of the nursing profession. For example, the Nursing Advisory Committee had a quality assurance subcommittee, which addressed quality assurance issues from a nursing perspective. With the changes brought about on June 1, the Nursing Advisory Committee was eliminated.

As noted above, the restructuring also removed the word "nursing" from the hospital's formal organization and vocabulary. Directors of nursing became directors of patient services, while head nurses became unit managers. Under the new structure, the hospital did not have to have nurses in any position above the level of clinical resource nurse (formerly called a senior team leader), which is one level below a unit manager. The doctors continued to be recognized organizationally through the Medical Advisory Committee. In response to these concerns, a Nursing Council was established at the hospital.

The Nursing Council was charged with:

• Facilitating the growth of professional nursing at the HSC;
• Ensuring that patient care provided by nursing services was consistent with the HSC Mission Statement and Philosophy of Nursing;
• Fostering consistency in application of nursing policies and procedures;
• Setting directions for nursing education, research and clinical practice; and
• Facilitating communication between clinical programs.

The committee's membership comprised the six directors of patient services, two nurses from each of the clinical programs, and one representative each from the School of Nursing, and Nursing and Education Research, Nursing Systems. In addition, the chairs of the Educational Advisory Committee, the Nursing Practice Committee, the Nursing Policy and Procedure Committee and the Nursing Research Steering Committee were members of the council. The President of the Hospital was an ex officio member. The Nursing Council met once a month and was responsible for addressing issues of professional practice, education and research. (Exhibit 312)