Painting a Rotten Fence - Sick Leave Among Saskatoon Nurses

At a recently purchased side-by-side duplex, an old wooden fence divides the small back yard in two. The boards in this fence are rotted, the paint is peeling, the exposed wood is soft and weak, and the fence is basically falling apart. In preparation for renting the place, do we rebuild the fence, or do we simply paint over all the soft, weak structure to make it look good for prospective tenants. Do we address the visible problems, or do we fix the underlying core?

A recent article "Sick time abuse eyed" reveals a similar dilemna in the Saskatoon Health Region. Management sees a problem with nursing staff abusing sick leave - some of the nurses seem to be treating sick leave as an entitled right rather than as a means to deal with actual illness. A previous initiative to reduce sick leave by five percent failed, and sick leave in the health region has actually increased. With renewed commitment to tackle the issue aggressively, management is telling nurses that "management will be watching the numbers closely, and looking for suggestions to help reduce the number of sick days."

Most managers experience this kind of dilemma at some point in their careers. They are under big pressure, in this case budget constraints, they have no idea how to really solve the problem, and they're feeling powerless. The only recourse is to blame the workers and plead for a solution. The desperate approach goes something like this:

"If only we had better people, we wouldn't have this problem. The workers are doing bad things, and we have to get them to stop." Management will put more metrics in place, scrutinize every sick leave, find some culprits, discipline a few workers, fight with the unions a bit, and keep the nursing staff under a microscope. The problem will continue, and will probably get worse.

Increased sick leave is not the problem here. Increased sick leave and absenteeism are symptoms of deeper systemic problems. Sick leave and absenteeism emerge from a sick system; from the workplace that legacy has created. Nurses are stressed by the workload, frustrated by the bureaucracy and beaten down by the difficulties of the day-to-day job. Trust between management and labour has been eroded to the point that they're left with airing their differences in public.

Rather than just painting the rotting fence, we need to collectively focus on rebuilding the fence, making the work itself better, making the work environment better, making the leadership better. Otherwise, we'll waste a whole lot of management effort on making the sick leave numbers look better, without addressing the core structural problems in the work itself.

Management needs to go down to the work - in the hospitals, in clinics and in home care - and help get rid of the barriers that are preventing the nurses from doing good work they can be proud of. Leaders should help make the work better, not point fingers at the workers.

Labour leaders need to encourage cross-functional cooperation and integration, encouraging people to work together to give effective care to the patients, regardless of the artificial boundaries created by what union they're in or what their job description is.

And nurses need to try to remember why they went into nursing in the first place - presumably, to care for patients, help people regain their health, and nurture them through difficult times. It's a bit of a flip in thinking, but nurses (and the public) need to start holding management and labour leaders accountable for the stressful, bureaucratic, dysfunctional systems they've created. The leaders need to pull up their socks, and help the nurses regain pride in their work.

If we work on that, I don't think sick leave will be a problem.