The Hospital for Sick Children v. Jane Ciordas et al., 1995 CanLII 7026

PAY EQUITY HEARINGS TRIBUNAL

0184‑91 The Hospital for Sick Children, Applicant v. Jane Ciordas and Tanya Magee and a group of General Duty Registered Nurses, Respondents

0185‑91 The Hospital for Sick Children, Applicant v. Cythia Davey, Terry Tew, Angie Holzmueller, Christina Bera, and Helena Hutton, Respondents

Before: Beth Symes, Chair and Members Bruce Budd and Janet Slone Taylor

Appearances: Janice Baker for the Hospital for Sick Children; Senka Dukovich for the Group of Nurses; no one appearing for the Assistant Clinical Co‑ordinators

Cite as: Hospital for Sick Children (14 February 1995) 0184‑91; 0185‑91 (P.E.H.T.)

DECISION OF MEMBERS JANET SLONE TAYLOR AND BRUCE BUDD, FEBRUARY 9, 1995

INTRODUCTION

1In these matters, the Hospital for Sick Children (the "Hospital") has objected to two Orders by a Review Officer. The first Order, made January 4, 1991, affected the female job class of registered nurse ("RN"); the second Order, also made January 4, 1991, affected the female job class of assistant clinical co‑ordinator ("ACC").

2The Hospital asked that the Tribunal revoke both Orders, leaving the RNs and the ACCs in the grade classifications in which they were placed by the Hospital's job evaluation committee, 9 and 12 respectively, and as posted in their revised pay equity plan.

3The Orders resulted in changes to the classifications of both job classes. The RNs were moved from Grade 9 to Grade 12, while the assistant clinical co‑ordinators were moved from Grade 12 to Grade 13.

4One of the respondents, the Group of Nurses (the "Nurses"), asked the Tribunal to uphold the Review Officer's Order that applied to them. In the alternative, they asked the Tribunal to find that the job evaluation system was not gender neutral. The other respondent, the ACCs, although given notice of the proceedings, did not respond to or attend the hearings.

5The Hospital for Sick Children is in many ways a unique institution. It is a tertiary care facility, drawing patients not only from the Toronto area, but from across the province, the country and abroad. The Hospital is famous for the quality and diversity of the care it provides. It has also achieved an outstanding reputation for dealing with the most sick of new‑born infants and young children, with the most up‑to‑date equipment and medical and nursing care.

6The panel heard extensive and complex evidence during 54 days of hearings which ended on March 11, 1993. After receipt of Ms. Symes attached decision in April 1994, the majority reluctantly concluded that a unanimous decision could not be reached. The majority has found that the issues to be decided in this matter were difficult and complex. As a result, there has been an unfortunate, lengthy delay in deciding this matter. In order to prevent any further delay, we are releasing a shorter decision than anticipated which, when read with those parts of Ms. Symes' dissenting decision with which we agree, form our final conclusions.

DECISION

7Although there are 33 different RN positions with some 1,200 incumbents in the Hospital, the parties led evidence with respect to only four of those nursing positions: RN‑Neonatal Intensive Care Unit (NICU), RN‑Paediatric Intensive Care Unit (PICU), RN‑Operating Room and RN‑Burns/Plastics. The Hospital asked us to rule that the RNs formed one job class in spite of the fact that their original evaluations of the positions for which job questionnaires had been completed fell within three different grade levels. The Nurses agreed that the RNs all fell within one job classification albeit three grades higher.

8While we appreciate that there may be administrative imperatives behind the desire for a single job class, the actual "job class" must be determined by the Tribunal after consider­ation of the evidence. Due to the design of the Hospital's job evaluation (JE) system, with fixed 50 point bands, our evaluation of the four RN positions actually revealed that half of the jobs were near the top of one grade classification and the other half were at the lower end of the next grade. Rather than fixed bands, floating bands, with a set percentage (say 3%) or set number of points (say 25) above and below each female job class, are another approach which might have resulted in all the RN jobs finding the same comparators.

9The majority has determined that the duties and responsibilities for the four RN positions about which we heard evidence are significantly different enough to fall into two job classes. The first job class contains the RN‑Operating Room and RN‑Burns/Plastics fall and corresponds to a Grade 10. The second job class, into which the Paediatric and Neonatal Intensive Care Nurses fall, corresponds to a Grade 11. The majority has rated these four RN positions as follows:

Factor	Burns/Plastics Level	Burns/Plastics Pts	Operating Room Level	Operating Room Pts	NICU & PICU Level	NICU & PICU Pts
Education	5	140	5	140	5	140
Experience	4	75	5	105	4	75
Complexity	5	125	5	125	6	150
Physical Demands & Effort	6	45	6	45	6	45
Accountability	5	60	5	60	5	60
Supervisory Responsibility	3A	15	2A	5	3A	15
Impact	6	90	6	90	6	90
Contacts with Others	6	90	6	75	6	90
Environ'l Working Conditions	7	55	7	55	7	55
Work Pressure and Stress	6	45	6	45	6	45
Total Rating Points		740		745		765
Grade		10		10		11

The majority makes no determination with respect to the other nursing positions within the Hospital, but expects that the analysis in this decision will assist the parties in finalizing the pay equity plan.

10With respect to the ACCs, the majority finds that Grade 12 is the appropriate classification for this group. In this regard, we agree with the reasons as outlined in paragraphs 37 to 40 of Ms. Symes' decision.

REASONS

11We will now comment in more detail on where we differ with Ms. Symes with respect to the RNs' evaluation and then comment on the Nurses' alternative argument. Since many of the factor definitions and relevant level descriptions are provided in Ms. Symes' decision we will not repeat them here.

Education

12The Hospital's JE system equates cognitive skills with levels of formal education. Each factor in the system begins with a definition section to assist the user in analyzing the job data consistently. In the Education definition, the factor "focuses on the minimum training necessary to prepare an individual for the job". The joint committee applied this factor to formal learning only, consistently for all jobs. Since the Hospital hires the vast majority of its RNs out of a three year community college program, an initial rating of the positions would place them at a level 5.

13However, this still leaves the question of how to handle any additional on‑the‑job training that may be necessary after hiring. Ms. Symes has chosen to include this on‑the‑job training as part of the RNs' formal education which results in her finding that three of the four RN positions should be ranked as a level 6. Her evaluation of the RN‑Burns/Plastics ranks that position at a level 5 although this was not reflected in her final outcome.

14We have concluded that this type of on-the-job training is best captured under the Experience factor. This training varies with the nursing position, is not required before hire and is not accredited by an outside agency. We thus conclude that all four RN positions should be ranked at a level 5 for Education. We also note that this is the same ranking arrived at by both the Hospital and the Review Officer whose Order the Nurses were seeking to uphold.

Experience

15The definition states that "this factor measures the length of time normally required ... to acquire the experience and background to perform the job competently...". This factor has two components: prior related experience, and "the period of adjustment, orientation and adaptation on the job".

16This factor caused considerable division on the joint committee and no consensus was reached. This lack of consensus resulted in the pay equity facilitators seeking clarification from Ms. Hutchison, Vice‑President of Patient Services. She advised that a rating of level 2 be used for all RNs. While it was understandable that her advice was sought, it was inappropriate for her opinion to be communicated to the job evaluation committee as determinative of the RNs ranking. As such, we do not find the committee's approach to the Experience rating reflective of the RN jobs.

17Counsel for the Nurses proposed another approach, the Benner model, for rating this factor. This is a classic developmental model which traces an incumbent's evolution on the job from novice to expert. It is applicable to any job which requires learning and growth over time. It has no relationship to the JE system's factor definition used for all other jobs in the Hospital and was never before the joint committee. Its adoption at this late stage in the process would then require all other jobs to be similarly evaluated, potentially 400‑500 jobs, in order to maintain consistency. This approach, which was adopted by Ms. Symes, also includes the on-the-job training that she counted in the Education factor. As with the joint committee's approach, we find the Benner Model inappropriate to use here.

18The Experience factor showed the most inconsistency in ratings. The physiotherapists got credit for their internship while the RNs did not get credit for their added nursing skills, nor for the additional orientation time required to become familiar with the range of patient problems and the diversity of machinery. In addition there was no consideration of the impact of the nurse shortage that occurred in the late '80s that required the Hospital to hire nurses with no prior experience. This then lengthened the time required to achieve the ability "to perform the job competently". Lastly, the RN‑Operating Room position has an orientation that requires the RN to rotate through up to ten different rooms for three months each before she is assigned.

19For the above reasons and in consideration of the fact that the on-the-job training is more appropriately captured under the Experience factor, the majority concludes that the RN‑Burns/Plastics, RN‑NICU and RN‑PICU should be rated a level 4. In addition, the RN‑Operating Room has a longer orientation and thus should be rated a level 5.

Complexity

20In paragraph 68 of her decision Ms. Symes sets out the scale descriptions for the two levels, 5 and 7. For the RN‑Burns/Plastics and the RN-Operating Room, we find the level 5, moderately complex, the most appropriate rating. These positions have daily routines that require the preparation of nursing plans for standard care with modifications depending on the patient's situation but, nonetheless, are not at the "very complex" level.

21For the two intensive care nursing positions, the majority agrees with Ms. Symes' comments that the rating should be a level 6, higher than moderately complex, but not quite at the level 7. This higher level is accorded because of the constantly and rapidly changing conditions of patients, the sophisticated equipment used, the leading edge treatments administered, all of which require a high degree of judgment and initiative.

Supervisory Responsibility

22The job evaluation committee erred in not considering the informal supervision of student nurses and RNAs in determining this factor level. We have rated three of the RN positions at level 3A. This is the same as for physiotherapists and properly reflects this aspect of nursing work. Since the supervision of student nurses and the RNAs was not a significant element in the work of the RN‑Operating Room, that position is rated a level 2A.

Contacts with Others

23For the NICU, PICU and the Burns/Plastics RNs, we rated this factor at a level 6, one higher than the job evaluation committee. We heard strong evidence to support the notion that the nature of the contacts extend beyond the mere exchange of non-controversial information and that more than ordinary tact is required. The children in Burns/­Plastics may have been victims of abuse requiring a delicate approach with the parents. We also heard evidence that parents can be abusive and threatening. RNs in the Intensive Care units may have to discuss the withdrawal of life support with a patient's family. As all patients in these two units are in life threatening situations, the RNs must use consid­erable tact and provide more than normal support to patients and families.

24For the RN‑Operating Room it was apparent that the frequency and complexity of their contacts with patients and family is less than for the other three RN positions on which we heard evidence. Therefore, we rated them a level 5.

Physical Demands & Effort; Accountability; Impact; Environ­mental Working Conditions; Work Pressure and Stress

25For these five factors we agree with the ratings of Ms. Symes.

26We deduce from the Hospital's evidence about the Impact factor that dual tracked description levels were intended ‑ one based on impact on the organization and the other on impact on patients. It appeared, however, that level 7 inadvertently omitted a clear reference to the "patient" track. We ranked all RN positions at a level 6 and concluded from the testimony that the Hospital intended to reflect this "patient" track in level 7. Our conclusion is reinforced by the fact that it exists at all other description levels (1, 3, 5 and 9) of this factor. This oversight should be corrected when applying the Impact factor in the future (i.e. for pay equity maintenance purposes).

Gender Neutrality

27While the Nurses' main request of the Tribunal was to uphold the Review Officer's Order, they put forward an alternative argument that the Tribunal should find the JE system gender biased. In our view, a finding that the JE system is gender biased is not an alternative argument, but a primary argument which if upheld would necessarily result in their main argument not being sustainable. The Nurses led evidence on the JE system. If the JE system is found to be gender biased, it would by necessity have to be revised and all the evaluations redone. Only if the challenge to the gender neutrality of the JE system fails, could the Review Officer's Order be upheld, or modified, using the existing system.

28Ms. Symes provides an analysis of the system's gender neutrality in paragraphs 9 to 36 of her decision, much of which we agree with. Specifically, we agree that the onus was on the Nurses to establish that the system was gender biased in this work place. While Dr. Ames' report did raise concerns, some of which we share, we were not persuaded that her report alone was sufficient to prove gender bias, given that it was general in nature, and did not refer to test data specific to the Hospital. On the evidence presented the Nurses did not meet the onus and, thus, we are not prepared to find the Hospital's JE system gender biased.

29Nevertheless, the majority is of the view that the issue of the gender neutrality of a proposed JE system must be more carefully considered by employers in the selection of a consult­ing firm to assist it in implementing pay equity. During the selection of a system, employers (and unions) should be seeking solid evidentiary support for the claims of validity, reliability and objectivity made by consult­ing firms relating to the system with particular focus on the elimination of gender bias. In other words, what analytical and empirical analyses can the consulting firm provide to demonstrate that their evaluation system, in all its descriptive and measuring components, can:

• capture all aspects of work done by women and men, particularly aspects overlooked or undervalued in the past,

• measure and value, through its factors, levels and weightings, the full range of work performed in similar organizations,

• meet the goals of the employer's organization and can be amended during pilot testing to fit the actual workplace, and

• after pilot testing, be re‑analyzed to show that the system conforms with the Act. (See also Haldimand-Norfolk (No. 6)(1991), 2 P.E.R. 105 and the various publications of the Pay Equity Commission.)

30On the process of implementing pay equity, we are of the view that the Hospital's original strategy was well designed. The job evaluation committees were to be properly trained (although the training seemed short), and the questionnaire, the size of the employee sample, the follow‑up for additional information, the rating process, the sore thumbing and the appeal process were all designed adequately. When the committees started to lose members and missed deadlines, the Hospital abandoned elements in its original implementation strategy. This was apparent when the task of evaluating job questionnaires was taken over by the mini‑committee composed only of the three facilitators (two from Human Resources and one from the consulting firm).

31The detailed evidence we received on four positions lead us to conclude that they are evenly split between two job classes. The lack of job data for many of the RN positions makes it impossible for us to speculate into which job class the remaining RN positions should fall.

REMEDY

32The majority varies the Order of the Review Officer with respect to the RNs, and orders the Hospital to amend its pay equity plan to reflect the ratings for the four RN positions which fall into Grades 10 and 11 as set out above. The Hospital is to amend the level 7 description of the Impact factor in the JE system to reflect the dual "patient" track originally intended. The Hospital is then to complete the evaluation of the remaining nursing posi­tions and determine into which grade class­ifica­tion they fall. We suggest that this evalu­ation process be undertaken in consult­ation with a repre­sent­ative group of those RN positions.

33With respect to the assistant clinical co‑ordinators, the majority revokes the Order of the Review Officer. This results in the ACC position remaining in Grade 12.

DECISION OF BETH SYMES, FORMER CHAIR

Introduction

1. The Hospital For Sick Children ( the "Hospital") requested a hearing to review two orders of a review officer. The first order, dated January 4, 1991, re-evaluated the female job class of Registered Nurse and moved that position from Grade 9 to Grade 12. The second order, dated January 4, 1991, re-evaluated the female job class of Assistant Clinical Co-ordinator, a supervisory position in the Operating Room, and moved that position from Grade 12 to Grade 13. The Hospital asked the Tribunal to quash both orders and to restore the pay equity plan which was posted on June 1, 1990.

2. The Group of Nurses (the "Nurses") sought to uphold the Review Officer's order. That is, the Nurses accepted the results of the review officer's evaluation of their jobs. In the alternative, the Nurses sought a finding that the job comparison system used to evaluate jobs is not gender neutral.

3. Notice of the proceedings was given to the Assistant Clinical Co-ordinators. They chose not to attend.

4. The hearing before the Tribunal is a hearing de novo, based on the evidence called by the parties. The Tribunal heard 53 days of evidence over a period of fourteen months. The parties called evidence about the job comparison system, the evaluation process and a number of health professionals' jobs at the Hospital, including physiotherapists, occupational therapists, perfusionists, biomedical technicians, the Transport Team and registered nurses.

Background

5. The Hospital is a large tertiary care facility with particular emphasis on patient care, teaching and research. The Hospital has 525 beds and more than 4,000 employees. The majority of these employees are highly skilled and well educated. Professional growth is not a luxury, but an expectation at the Hospital. Six hundred of these employees are unionized and represented by the Canadian Union of Public Employees ("CUPE"). All the incumbents of the job classes in dispute are not unionized.

6. The Hospital was required to evaluate the work performed by male and female job classes. The criterion to be used in determining the value of work is the composite of the skill, effort and responsibility normally required in the performance of the work and the conditions under which it is normally performed. The Hospital was required to use a gender-neutral comparison system to compare the female job classes with the male job classes and to determine whether pay equity existed for each female job class.

7. The Hospital was required to complete two pay equity plans. The first plan, for the unionized staff, was negotiated with the bargaining agent, the Canadian Union of Public Employees. The second plan, which covered all non-unionized employees, was prepared by the Hospital and was first posted on December 29, 1989. The non-unionized plan was revised and reposted on June 1, 1990.

8. The task at hand was formidable. Because of the nature of the Hospital, there were over 500 job classes to be evaluated for the non-unionized plan. Many of these jobs were highly specialized, single incumbent positions. The Hospital took the task of evaluating these diverse jobs seriously and devoted considerable time and resources to it.

Job Comparison System

9. The Hospital created a Steering Committee at the senior management level to provide strategic direction for the pay equity process. Touche Ross was chosen as the consultant in September 1987.

10. The job comparison system developed by Touche Ross is a point factor system using ten factors to evaluate the statutory requirements of skill, effort, responsibility and working conditions: education, experience, complexity, physical effort, accountability, supervisory responsibility, impact, contact with others, environmental working conditions, and work pressure and stress.

11. In February 1988, the Hospital created a Technical Committee of management and non-management persons which adapted and changed the Touche Ross system to reflect the value placed by the Hospital on patient care. Definitions of factors were changed to place equal emphasis on responsibility and care for patients as for money and machines. The weighting of the factors were chosen to reflect and value the highly skilled workforce at the Hospital. The Technical Committee pilot tested the system and evaluated 30 jobs. As a result of the pilot study, the Hospital was comfortable with the system and made no further changes to the job evaluation system. The pilot project was completed by June 1988.

12. Counsel for the Nurses challenged the job comparison system as not gender neutral. Dr. Lynda Ames, an expert in job evaluation, testified that the system was not gender neutral because it did not adequately reflect and credit the work of female-dominated jobs and the factors, definitions, and weights contained in it heavily favour male-dominated administrative and managerial jobs. In addition, Dr. Ames was critical of the way the Hospital used the system to evaluate jobs.

13. The Pay Equity Act, R.S.O. 1990, c.P.7, as amended, requires the Hospital to use a gender-neutral comparison system to compare the value of the work performed by female job classes with the male job classes. In reviewing a job comparison system, the system itself must be considered as well as the Hospital's use of the system to evaluate the jobs. The standard of review for both the system and the process is not perfection, but rather whether both are reasonable in all of the circumstances.

14. The onus is on the Nurses to establish that the system is not gender-neutral. This system was used to evaluate over 500 jobs in the non-union plan as well as the jobs in the CUPE plan. The review officer also used this system to evaluate the work of nurses. In this hearing, the Nurses are seeking to uphold the review officer's order. That is, the Nurses accept the results of the officer's evaluation of their jobs using this system. The Act is clear. The Hospital must use only one job comparison system in a pay equity plan. The statutory requirement exists in order to ensure consistency in the way jobs are evaluated. That is, the Hospital could not have used one system to evaluate the clerical staff and a different system to evaluate the professional staff. As both jobs are in the same pay equity plan, they must be evaluated using the same system. If this comparison system is not gender-neutral, the only possible remedy would be to order the Hospital to re-evaluate all 500 jobs using a new system. The Nurses did not seek this remedy. Given the number of jobs involved, the time commitment to evaluate the jobs, and the passage of time such a remedy is not practical.

15. I have reviewed the factor definitions and weightings, the results of the pilot test, and am not persuaded that the system is gender biased. I share Dr. Ames' concerns about the application of the system to the evaluation of the nursing jobs.

The Job Evaluation Process

The job evaluation committees

16. To evaluate the large number of jobs, the Hospital created two Job Evaluation Committees. The Hospital sought volunteers to staff these committees. In addition, specific people were asked to serve in order to ensure representation and balance across the Hospital. Staff from the human resources department acted as facilitators for each committee.

17. Counsel for the Nurses criticized the pay equity process on the basis that there were no non-management nurses on either of the Job Evaluation Committees. This criticism is rejected. Four of the eleven members of the two Committees were nurses, employed in a variety of capacities including administration, research, education, and the clinics. Having heard the evidence of Paula Price, a nurse representative on the Committee, I am satisfied that nurses had a strong voice during this part of the evaluation process.

18. Members of the Job Evaluation Committees were trained in job evaluation. The Touche Ross consultant provided several days of training on issues of equality, historical bias in valuing women's work, and the rational for the Pay Equity Act. In addition, the Committees spent a great deal of time evaluating the first jobs. There was much discussion as the Committees acquired the knowledge and skills to evaluate the jobs. Of course, further training may have been beneficial but, the Job Evaluation Committees were reasonably trained, took their task seriously, and dealt with the issues in good faith.

19. Commencing in June 1988, the two Job Evaluation Committees each met twice a week for the entire day to evaluate jobs. On average, it took the committees 90 minutes to evaluate each position.

20. By October 1988, it was clear that the two Job Evaluation Committees would not complete the task of evaluating the jobs by year end. The Committees had managed to evaluate only 150 jobs, and still had to evaluate another 300. Most of the remaining jobs were single incumbent positions in highly specialized areas. Several members of the Committee were unable to continue and the Hospital chose to collapse the two committees into one, the Quality Control Committee. From this point, the evaluation was performed by the Mini Committee comprised of two members of the human resources department and the consultant from Touche Ross. The Mini Committee used the Quality Control Committee as a resource for problem solving and to rate difficult jobs.

21. From time to time, the Job Evaluation Committees would "sore thumb" the jobs. This involved a review of the jobs the Committee had already evaluated in order to ensure consistency in ratings. At the end of the process, all jobs were sore thumbed by the Mini Committee and ratings were changed.

Collection of job information

22. The plan was to collect job content information using a 27 page questionnaire with a combination of open ended and closed questions. The Hospital wanted to have the questionnaire completed by staff with at least 18 months experience in the job to ensure that the incumbent had a good grasp of the job and was not still learning. The Hospital wanted at least ten percent of the incumbents in each job to complete the questionnaire. Either incumbents could complete a questionnaire or groups of employees in a job class could complete a composite questionnaire. The questionnaires were to be reviewed by supervisors who would provided their own ratings for the jobs and give additional information. Initially, each questionnaire was reviewed by the facilitators who then interviewed the incumbents, either in person or by telephone to clarify and to seek additional information. The facilitators presented the jobs to the Committees for discussion. The Committees operated by consensus, but some level of dissent was registered. If the Committee was not able to agree, that job would be set aside. Further information would be sought and the Committee would reconsider that job at the next meeting.

23. The original plan to gather job information by representative questionnaires and to have the jobs evaluated by trained committees representative of the diversity of jobs in the Hospital would have been a fair and reasonable process for evaluating jobs.

24. The Hospital was persistent in trying to gather job content information. But there were a number of difficulties. First, there were jobs, such as the youth crisis worker, which were missed in the evaluation process. Second, the Hospital encountered considerable difficulty in having nurses complete the questionnaire. Nurses testified that they never received the questionnaires; others complained that there was no opportunity to complete the questionnaires. Although the Human Resources made repeated requests to supervisors, very few nurses completed the questionnaire.

25. There are over 1,200 nurses employed in a variety of nursing capacities at the Hospital. The plan was to collect at least three questionnaires from each of the 33 nursing areas. This would have represented a sample of ten per cent of the population, which the Hospital and Touche Ross thought necessary to ensure accurate collection of job information. But at the end of the process, only thirty questionnaires were received from nineteen nursing areas. Whole areas of the Hospital were missed. No job information about nurses was collected from the Ambulatory Care program or Emergency. Moreover, the number of questionnaires actually received from each nursing area is inadequate to ensure that they were representative of the entire population. Therefore, the job information on nursing jobs was neither complete nor accurate.

Problems in the System

26. The two Job Evaluation Committees had difficulties evaluating the nursing jobs. There was no consensus on the education levels and experience required to effectively perform the job functions. In addition, a dispute arose as to whether nurses diagnosed or what was the nature and extent of the nursing diagnosis process. This dispute affected the complexity and accountability subfactors.

27. Because of these disagreements, the two facilitators took an unprecedented step and went to see Peggy Hutchison, Vice President of Patient Services on September 17, 1988. Ms. Hutchison set the education and experience levels at the minimum to be hired permanently into the position and gave her opinions on the complexity and accountability subfactors. Nursing supervisory responsibilities were also discussed. The facilitators took Ms. Hutchison's directions back to the Committees. Some members of the Committees said that Ms. Hutchison was clearly wrong. The facilitators advised the two Committees that they had to go with Ms. Hutchison's information and it became the standard to finalize the evaluations for the nursing positions. Nursing positions which had already been evaluated by the Committees were revised downward in accordance with Ms. Hutchison's direction.

28. The strength of the Hospital's intended approach to pay equity was that complete information would be obtained about each job. Not only were staff to complete a detailed questionnaire, but incumbents were to be interviewed to ensure that the information was complete, accurate, and understood by those evaluating the jobs.

29. The second strength of the proposed plan was that the members of the Job Evaluation Committees were to come from a cross section of backgrounds at the Hospital and bring their collective knowledge, experience and good judgment to the task at hand. These steps were built into the job comparison process to alleviate biases in evaluating jobs.

30. Unfortunately, when the Hospital made the decision to hurry up the pay equity process in September 1988, it lost these checks and balances. The Hospital no longer required questionnaires from each nursing area. The questionnaires completed by nurses varied enormously in terms of completeness and detail, yet the facilitators chose to interview nurses from only seven nursing areas. Many of the nursing questionnaires were screened out by the consultant from Touche Ross and not evaluated by anyone. Of the nursing questionnaires which were rated, most were evaluated by the three facilitators alone, all of whom had backgrounds restricted to human resources and at least one had very limited experience in the health care sector. Therefore, there is not the same confidence in the evaluations of the nursing jobs as in the evaluations of other health professionals such as physio therapists, occupational therapists, occupational therapists, and perfusionists.

Outcome

31. The Hospital posted the pay equity plan on December 29, 1989. Employees were advised of their right to appeal the evaluation of their job. The Hospital received hundreds of enquiries about the pay equity process and the results. Formal appeals were initiated for 91 job classes. These jobs were re-evaluated by the Quality Control Committee and 45 female job classes were raised as a result of the appeal process. The changes were re-posted by the Hospital on June 1, 1990.

32. In evaluating jobs, the various committees had operated on the assumption that the information provided on the questionnaire by the incumbent was accurate. If there was any question about that information, the incumbent was to be interviewed to resolve the issue. The Hospital stated that the reason so many of the appeals were successful was because the original committee which evaluated the jobs did not have enough information to do an accurate evaluation.

33. The registered nurses were not pleased with the results of pay equity. The Job Evaluation Committees and the Mini Committee had evaluated ten nursing jobs and had rated these jobs at between 640 and 700 points. The Hospital decided to consider all the nursing jobs as one position and had slotted that position into Grade 9. The lowest male comparator in Grade 9 was the Biomedical Engineering Technician I. Using that male comparator, there was no pay equity adjustment for nurses.

34The Hospital met with the nurses individually, in groups, and with their representatives. The nurses made it clear that they were satisfied with neither the process nor the evaluation. The Hospital advised them of their right to appeal.

35The nurses in the Paediatric Intensive Care Unit (PICU) filed an appeal and prepared extensive documentation to support their appeal. The Hospital chose not to deal with this appeal and did not re-evaluate this job.

36The other nurses chose not to exercise their rights under the internal appeal process. Instead, they filed a complaint with the Pay Equity Commission on May 11, 1990. It is regrettable that the nurses did not utilize the internal appeal mechanism. The Tribunal would have benefited from a systematic collection of job information and a re-evaluation of these jobs. But the Pay Equity Act does not require employees to exhaust their internal remedies. The Nurses came to the Pay Equity Commission pursuant to section 15(7) of the Act as of right. Therefore, their complaint must be dealt with on its merits.

Assistant Clinical Co-ordinators

37In the original pay equity process, the job class of assistant clinical co-ordinator was not identified. The Hospital believed that the incumbents were assistant nursing unit administrators working in the operating room. When the pay equity plan was posted on December 29, 1989, the incumbents asked the Hospital to evaluate their jobs separately. The incumbents completed questionnaires and their job was evaluated to be in Grade 12.

38The assistant nursing unit administrators also appealed their evaluation. As a result of the appeals process, the assistant nursing unit administrators were moved from Grade 10 to Grade 12.

39The assistant clinical co-ordinators filed an notice of objection with the Pay Equity Commission. As a settlement was not possible, the review officer re-evaluated the job class of assistant clinical co-ordinator upward from Grade 12 to Grade 13.

40At the hearing, the Hospital established that the position of assistant clinical co-ordinator in the operating room, now called assistant nurse manager, is and was comparable to the assistant nursing unit administrators. Based on this uncontradicted evidence, Grade 12, the rating given the assistant nursing unit administrators, is the appropriate rating for the assistant clinical co-ordinators.

41Therefore, the order of the review officer with respect to the assistant clinical co-ordinator should be revoked. The Hospital is to adjust the compensation for all persons who were in this job class from January 1, 1990 forward.

Evaluation of Nurses

42The Nurses have filed an objection with the Pay Equity Commission about the evaluation of their jobs. The Hospital has sought a hearing with respect to the review officer's order to re-evaluate the nursing positions. The principal problem with the job comparison system used by the Hospital is that it failed to collect complete and accurate job information about the nursing positions. To settle all outstanding issues, the nursing positions must be evaluated. I have used the job comparison system which was modified and adapted by the Hospital.

43The Hospital began the pay equity process by assuming that the job content of individual nursing positions was different. Therefore, the plan was to collect job information from each nursing area and to evaluate all of that information. At the end of the process, the Hospital decided to treat the nursing jobs as one job class and to place the generic nursing job in the Grade level where most of the nursing jobs had been rated. The review officer also considered the nursing jobs to be in one job class. The Hospital and the Nurses agreed that the nursing jobs ought to be considered as one job class.

44The Tribunal heard sufficient evidence about four nursing jobs: Paediatric Intensive Care Unit ("PICU"), Neo-natal Intensive Care Unit ("NICU"), Operating Room ("OR"), and Burns & Plastics to be able to evaluate these jobs. This evaluation is based upon the completed questionnaires, the evidence of the nurses given at the hearing, the standards used in the system, and the ratings of other comparable positions. These nursing jobs were evaluated to be consistent with the ratings for other nursing positions, and the final ratings for other health professionals such as physiotherapists, occupational therapists, perfusionists, and biomedical technicians.

45The job comparison system set out the definition for each factor and the levels within each factor. These definitions are set out in the evaluation of the nursing positions.

Factor 1: Education

Measures the level of knowledge and preliminary training (including vocational training) that is typically gained through formal education, and is required to effectively perform the job functions.

This factor should not be confused with the particular incumbent's actual education. Rather, it focuses on the minimum training necessary to prepare an individual for the job.

This factor should not be interpreted narrowly, requiring absolute specificity about particular diplomas or academic disciplines. The job analyst should assess the intellectual/knowledge demands of the position and assign a degree rating that best reflects the formal preparation and training required.

46There are two educational routes to qualify for as a registered nurse in Ontario. The first is a four year university program, which results in a Bachelor of Science in Nursing, B.Sc.N. The second, is a three year community college program, which results in a college diploma. The successful completion of either route enables the candidate to sit national examinations and to receive a Certificate of Competence from the licensing body, the College of Nurses of Ontario. Most registered nurses in the province are graduates of community college programs.

47The Hospital prefers to hire university graduates into nursing positions. Each nurse who testified either had a university degree or was actively working towards one. The Hospital does require a university degree for certain nursing positions, for example clinical instructors and nursing unit managers. For other positions, the Hospital prefers that the candidate have a degree or be actively working towards a degree.

48Pursuant to the Health Disciplines Act, R.S.O. 1990, c. H.4, the College of Nurses has established Standards of Nursing Practice which each registered nurse must maintain. These Standards were first published in 1976 and have been updated annually. The Standards set out the skill level which can be expected of a registered nurse. There are three levels: Basic Nursing Skills: A-level and B-level; Added Nursing Skills, and Sanctioned Medical Acts.

49A nurse who has completed her nursing training has a theoretical understanding and practical experience in the nursing acts which are listed as B-level skills. Therefore, the Hospital may assume that a new graduate can safely and competently perform these B-levels skills upon graduation. A level skills are skills for which graduates have received specific theoretical instruction, but have not had an opportunity to practice before graduation. For example, the care of venous and central lines is an A-level skill. If the Hospital wishes a nurse to perform A-level skills, it must teach the manual or practical aspects of that skill. It is reasonable to expect that a new graduate will acquire these A-level skills during the probationary period.

50Added Nursing Skills are acts in the practice of nursing for which the basic nursing programs provide neither specific theory nor clinical practice. Examples of added nursing skills include transfusing blood under pressure, adjusting temporary pacemakers, the care of intracranial and pulmonary lines, intubation, and ventilation of patients. Nurses cannot be expected to perform these skills without additional instruction. When the Hospital requires its staff to perform one or more of the added skills, it must select the nurses who will be taught the skill and designate the areas in which they will perform it. The instruction must include appropriate theory to enable the selected nurse to understand the skill, as well as the opportunity to develop the required manual dexterity. Individual nurses are certified for each skill and are responsible for maintaining their competence in that particular skill. The Hospital must evaluate how nurses perform these added nursing skills. Nurses are accountable to the College as well as the Hospital when they are performing added nursing skills.

51Sanctioned Medical Acts or Delegated Medical Acts are acts in the practice of medicine that registered nurses may perform in some circumstances. The medical, nursing, and administrative authorities of the Hospital select the skills to be delegated and approve the special instruction required. Delegation is to specific, named individuals working in specified areas within the Hospital. Only those individuals will carry out the procedure, and then only after suitable preparation. Individual nurses are certified for each act and must be recertified annually. Examples of Sanctioned Medical Acts include performance of procedures in connection with dialysis, endotracheal intubation, administration of life-saving drugs, the inflation of anti-shock garments, and suturing by nurses in the emergency department or operating rooms of the Hospital.

52The Hospital requires different skill levels in the various nursing areas. For example, nurses performing dialysis in the unit or in a patient's home are clearly carrying out Sanctioned Medical Acts. Nurses on the Transport Team perform endotracheal intubation and administer lifesaving drugs. These are clearly Sanctioned Medical Acts. The Hospital has identified thirty-three added nursing skills which are performed at the Hospital. These skills are taught to designated nurses and may only be performed in certain nursing areas. For example, nurses in PICU and NICU receive additional instruction and are certified for most of these added nursing skills. Nurses in the operating room receive additional instruction and training in added nursing skills for technical assistance at surgical operations.

53To become an intensive care nurse or an operating room nurse, a registered nurse must complete further education and training, usually at a community college. In addition, the Hospital has developed special educational programs for both paediatric intensive care and operating room nursing.

54The Hospital offers an eight week course in the Neo-natal Intensive Care Unit to train nurses in the theoretical basis for the care of the acutely ill newborn. The theoretical course is followed by a ten week preceptorship in which the nurse is given clinical instruction by an experienced nurse. Her nursing was supervised for a further two months in a nursing buddy system. After six to twelve months, the nurses began to receive theoretical and clinical instruction to be certified for the added nursing skills required on the Unit. Some of the added nursing skills cannot be acquired until after twelve months on the Unit. Nurses were also encouraged to take an additional four month course in Perinatal Intensive Care Nursing which was offered by George Brown College.

55Nurses in the Paediatric Intensive Care Unit are also required to complete an eight week educational course in the care of critically ill infants. The theoretical course is followed by a three month preceptorship during which the nurse acquires clinical skills through instruction. Added nursing skills and delegated medical acts are performed by nurses every day in the PICU. The Hospital expects that every nurse will be certified for every added nursing skill and every delegated medical act performed in the Unit. It takes at least 18 months to become certified for the added nursing skills and the delegated medical acts.

56Nurses in the Operating Room received a six week educational course to enable them to work in the OR. The theoretical component was followed by a series of six week rotations through each of the OR areas in order to acquire clinical skills. During each of the six week rotation, the nurse would be an extra nurse in the OR. In total, it would take a nurse two years to complete the clinical rotations needed to be qualified as an operating room nurse.

57Nurses employed in the intensive care units and the operating room must complete theoretical and clinical training which is over and above the basic education received either in the university or community college course. The job evaluation system values this additional education which is required for these nurses to effectively perform their job functions. The Hospital has narrowly interpreted this factor for these nurses and has failed to assign the degree rating that best reflects the formal preparation and training required.

58In this system, these critical care nurses should be assigned degree 6, which is the equivalent of a four year Honours B.A. or B.Sc. Degree 5 is to be used for those who have completed entrance requirements to professional fields. Such a rating is inappropriate for these specialty nurses. Moreover, a rating of degree 6 is consistent with the rating given for other health professionals, including physio therapists, occupational therapists, biomedical technicians, and perfusionists.

59New graduates continue to be hired as nurses on the Burns & Plastics Unit. Therefore, degree 5, a three year diploma from a community college, is the appropriate rating for education for nurses in this nursing area.

Factor 2: Experience

Experience is considered after the required educational level has been established. This factor measures the length of time normally required for an individual with specified educational or intellectual achievement, to acquire the experience and background to perform the job competently, and deal with the range of situations encountered in the position. Experience is basically of two types:

1. Prior job experience required in lower-level or related positions (with the Hospital for Sick Children or the other organizations); and

2. The period of adjustment, orientation and adaptation on the job with the H.S.C.

Both periods must be added together to properly reflect the overall rating. In doing so, it is important to keep in mind the separation between the background of the individual(s) holding the job, and the experiential requirements of the job itself. It is the latter which are evaluated.

60The experience factor was one of the most controversial of the factors to be rated by the job evaluations committees. There was no consensus as to the length of time it took for an individual nurse to perform the job competently. Nurses and their supervisors had provided a range of times in their questionnaires, but most had specified that it took more than two years but less than four years to become fully competent. This was one of the factors which the facilitators took to Ms. Hutchison on September 17, 1988. Ms. Hutchison directed that degree 2, more than 3 months but less than 6 months experience required, was to be used for all registered nurses. Three months is the length of the probationary period at the Hospital.

61Historically, the Hospital has preferred to hire experienced paediatric nurses into the critical care areas. Less experienced nurses take longer to train and there is a high attrition rate. But in 1987 there was an acute nursing shortage in Toronto and the Hospital was forced to hire new graduates into these positions. Although the Hospital may have preferred prior job experience, at that time it was prepared to hire new graduates with no prior experience. Therefore, these nursing positions did not require prior job experience.

62But in rating these nursing jobs, the Hospital has failed to consider the length of time normally required to acquire the experience and background to perform the job competently, and to deal with the range of situations encountered in the position. It is clear that the new graduates have taken much longer to become competent in these areas than nurses with prior paediatric experience. It makes sense. Either the nurse acquires the experience and background before she begins in a critical care area, or she acquires the same experience and background after she has worked in these areas. The step of acquiring experience and background cannot be missed.

63The nurses testified that for the first two years on the unit, they are considered to be a junior nurse and are always placed in a room with a more experienced or senior nurse. A nurse becomes senior after three to five years in the unit. Ms. McGee, a nurse in the PICU, testified that it took at least two years to be competent in the critical care areas. Before then, the nurse is still learning new skills, focusing on tasks rather than the whole patient, and cannot fulfil all the duties of a critical care nurse.

64Paula Price, a nurse educator, testified that nurses are engaged in a process of synthesizing data in order to identify health problems. Ms. Price testified that nursing judgment is based upon an incumbent's experience within her nursing practice. The Hospital has used Patricia Benner's Domains of Nursing Practice to define competencies for critical care nurses. In this model, competency is defined using five levels: novice, advanced beginner, competent, proficient, and expert. In reviewing this model and the definitions, it is clear that at 6 months in the unit, the nurse should have achieved the level of novice and would be moving towards the level of advanced beginner. Paula Price agreed with Patricia Benner that a nurse would not reach the level of competent, until at least two to three years of nursing practice. Ms. Price testified that before two years, a nurse may be skilled, may be able to respond, but is not yet competent. Patricia Benner, From Novice to Expert, Excellence and Power in Clinical Nursing Practice, (Menio Park, California: Addison-Wesley Publishing Company, 1984)

65One of the functions of a staff nurse in these areas is to assume the role of charge nurse. This assignment is rotated amongst all nurses who are fully competent. Normally it takes three years in the NICU to become a charge nurse. Therefore, a nurse has not performed all of the job functions until she has assumed charge nurse responsibilities.

66Nurses at the Hospital are paid on a wage grid with ten steps. A nurse progresses through the grid, one year at a time. The job rate is defined as the highest rate of compensation for a job class. Therefore, in comparing the compensation paid to the female job class of registered nurses with the compensation paid to a male job class, the highest rate on the grid is used, which is reached after ten years of nursing experience.

67For all of these reasons, the experience rating of level 2 used by the Hospital for these nurses is inappropriate. Instead, the appropriate rating is level 5: more than two years but less than four years experience required. This rating is consistent with the experience ratings for other health professionals, including physio therapists, occupational therapists, and perfusionists.

Factor 3: Complexity

Measures the amount and difficulty of analysis and reasoning required to perform job related duties. Characteristics to be considered include:

• analysis required for problem and solution definitions;

• creativity;

• mental challenge;

• degree of job structure; and

• planning activities.

68Complexity was another factor upon which the Job Evaluation Committees could not agree. The essence of the dispute was whether nurses diagnosed, or whether diagnosis was solely the domain of physicians. Based on the information received from Ms. Hutchison, all nursing positions were rated at degree level 5:

5 moderately complex work requires a moderate degree of mental effort and planning to adapt to a variety of duties that involve unrelated processes and methods. A moderate degree of variation from daily routines is possible. Situations may be broad in scope with limited opportunity for standardized solutions, and may require the recognition and creative definition of problems and their practical solutions.

7 very complex work requires interpretive and diagnostic analysis and the use of logical, evaluative, scientific or professional thinking to define problems, collect information, establish facts and form valid solutions. With a limited degree of job structure, situations are diverse (although not unique), and offer considerable opportunity for creativity, planning and mental challenge.

69Nursing diagnosis involves the identification of potential health problems of a patient. In arriving at her diagnosis, the nurse systematically observes and problem solves based on the information she collects about the patient and his or her environment. The nursing diagnosis is different from the medical diagnosis, but each process complements the other and is necessary for optimum patient care. The medical diagnosis is one piece of information which the nurse uses to assess the patient. Paula Price gave an example. The medical diagnosis might be appendicitis. The medical intervention might be surgery. The nursing diagnosis would include pain, alteration in self concept, and self care abilities. A nurse is required to develop a plan of care to meet the needs identified in the nursing diagnosis. The plan of care usually requires the nurse to seek the intervention of other health care professionals such as respiratory technologists, physio therapists, and dieticians and to co-ordinate the services these health professionals provide to her patient. The concept of nursing diagnosis has been developing since 1980 and is supported in the research. The Hospital both expects and requires that diagnosis be part of the nursing process.

70The patients in both intensive care units are acutely ill with a wide range of medical and surgical problems. The nursing care of these patients is not routine and requires the nurse to anticipate potential problems for a variety of patient conditions, to detect very subtle changes in a patient's condition before vital sign changes. The nurse must prioritize doctors' orders and influence what should be ordered, including convincing a doctor to assess a patient. These nurses must be able to immediately grasp the patient's health problem and to determine what interventions are required, including preparing the necessary equipment to deal with the emergency and being part of the resuscitation team.

71Based on this evidence, degree level 5, which is to be used for moderately complex tasks, undervalues these nurses' work. The Hospital used level 5 to evaluate the complexity of the data manager, the internal auditor, and the biomedical technician I. The review officer re-evaluated the complexity factor for nurses to be at level 7. But level 7 is the same level of complexity given to nurses on the Transport Team. Therefore, the appropriate level of complexity for nurses is level 6. This rating is consistent with the ratings given to other health professionals, including physio therapists and occupational therapists.

Factor 4: Physical Job Demands and Effort

• exertion;

• physical concentration;

• visual concentration and strain;

• manual dexterity: - gross and fine motor skills;

• body control and reflex requirements; and

• level of fatigue.

Note: Ratings should be based on overall annual job requirements.

72The physical demands on critical care nurses often require sustained physical exertion, including visual and physical concentration. A nurse in the operating room cannot leave the theatre until the surgery is complete. In complex surgeries, such as heart and lung transplants, the nurse will be required to stand for eight or more hours and to be visually and mentally alert to changes in the patient's condition and the progress of the surgery. Much of surgery is experimental, and nursing procedures must be adapted on short notice. Nurses in the intensive care units spend most of their twelve hour shifts on their feet, at the bedside, leaning over to care for unstable patients. Nurses require a high level of gross and fine motor skills to be able to insert a variety of intravenous and other lines into these very small patients.

73The Hospital rated the physical demands for nurses at level 6. The review officer raised that level to 7. Level 6 is consistent with the ratings for other health professionals, including physio therapists, biomedical technicians, and perfusionists. The Transport team was rated at level 7. The physical demands on the Transport Team are more demanding than for critical care nurses. Therefore, level 6 is the appropriate level for these nurses.

Factor 5: Accountability

Measures the level of accountability for expected results, quality, and accuracy associated with the position. Characteristics to be considered include:

• level of work review or supervision received.

• discretion; and

• accountability.

74The Hospital rated the degree level for nurses to be level 5 for nurses. The review officer re-evaluated nurses at level 7. The system defines Level 5 when work is evaluated for compliance with technical standards, appropriateness, and conformity to organizational policy. Employees receive general directions, but must exercise discretion and judgment in interpreting and applying rules and guidelines. Level 7 is used where work is evaluated relative to overall organizational policy in terms of feasibility, compatibility and effectiveness. The employee receives nominal direction and exercises discretion and judgement in translating broad organizational goals into specific objectives.

75Nurses, as health professionals, are responsible to the Hospital and to the College of Nurses for the nursing care provided. Nurses must follow the procedures established by the particular nursing area and the Standards of Nursing Practice. Nurses receive general direction from the charge nurse assigned for the shift and the nursing unit administrator.

76Level 5 is a more appropriate measure of accountability for nurses than level 7. This rating is consistent with the ratings given to other health professionals, physio therapists, occupational therapists, biomedical technicians, and perfusionists each of whom are also accountable for their respective practices.

Factor 6: Supervisory Responsibility

Measures accountability for "personnel management". This factor assesses the character or complexity of the work that is supervised and the type of supervision, given.

It recognizes job requirements and leadership skills in relating to staff in the process of:

• employee selection,

• orientation and training,

• performance assessment,

• morale,

• personnel problems, and

• employee development,

and this factor measures the scope of general direct supervisory responsibilities in the day-to-day management of individual staff, teams and functional departments.

This factor also measures the total number of staff directly supervised. Three scales are provided which correspond to each degree definition.

(A) = 1-3 direct staff

(B) = 4-9 direct staff

(C) = 10+ direct staff

(Note: if no staff are directly supervised, yet the incumbent provides supervisory guidance and direction in a staff or advisory role, use the (A) category.)

77The Hospital rated the nurses at level 2A, the provision of occasional guidance to other staff is required. This rating is the same as the rating given to nurses on the Transport Team, the biomedical technician I, and the youth crisis worker.

78This rating failed to value the supervisory role of charge nurse, which all competent nurses in the unit must assume on a rotating basis. It also fails to value the supervision of student nurses from George Brown College and the preceptor role that senior nurses must assume for new nurses to the unit during their clinical training. Other health care professionals, such as physio therapists, occupational therapists, and perfusionists received a rating of 3A. A rating of 3A for supervisory responsibility would be more appropriate for nurses.

Factor 7: Impact

Measures the positive impact as well as potential problems the position can create or resolve for a department or the entire organization. Characteristics to consider include:

• span of effect;

• impact on patients;

• impact on the hospital;

• employee morale;

• public image; and

• financial effects.

Assessment of the impact of errors should be based on average occurrences, and not on extreme scenarios.

79The Hospital rated this factor at degree level 5, the same rating received by physio therapists, occupational therapists, biomedical technician I, and perfusionists. The review officer re‑evaluated this factor for nurses at level 7, the same level he re‑assigned for nurses on the Transport Team.

80The system measures two kinds of impact. First, errors which might result in the loss of time or damage, waste or financial loss to the Hospital. Second, errors which might affect the health and well-being of the patients. This job comparison system was described as dual track, which equally values both types of impact.

81As the primary health care provider at the Hospital, nurses can and do have a substantial impact on the health and safety of their patients. Errors in nursing judgment and the treatment given to patients can and have caused serious harm, including death. Nursing actions can and have had a significant impact on the public image of the Hospital. In the last ten years, this Hospital has been the focus of several high profile inquests and the Royal Commission into the Deaths at the Hospital for Sick Children (the "Grange Inquiry").

82The appropriate rating for the impact factor is level 6, the same level as for the nurses on the Transport Team and perfusionists. Given the nature of the health care provided by nurses, it is both appropriate and consistent that the level for nurses be one level higher than for physio therapists, occupational therapists, and biomedical technician I.

Factor 8: Contacts with Others

Measures the need for contacting, dealing with and influencing other people in performing the duties related to the position. Interaction with employees within the hospital as well as of patients, families, university students, volunteers, professionals, clients, customers, the public, government representatives and others should be considered. Other characteristics to be considered include:

• type and level of contacts;

• purpose of contact;

• confidentiality and sensitivity; and

• emotional content of the contact.

83The Hospital rated nurses at degree level 5 for this factor. The review officer re-evaluated the nurses at level 6.

84Nurses, as the primary care providers, have daily contact with every health care professional in the Hospital who provides care to their patients. Nurses must explain health care information to the parents and other family members. Nurses speak with public health nurses, teachers, and other community persons to plan the discharge of their patients. If there are allegations of child abuse, nurses work with social workers from the Children's Aid Society, the police, and the justice system. Each of these contacts requires a high degree of confidentiality. Considerable skill is needed to deal with families of dying patients, a weekly if not daily occurrence in critical care areas. Nurses act as advocates for their patients at meetings with families to discuss decisions to cease treatment.

85The nurses have a broader range of contacts than either physio therapists or occupational therapists, both of whom were rated at level 5. Because of the nature of the nursing contacts and the potentially sensitive issues involved, nurses must be able to support families through very difficult decisions. In light of the nature and the extent of the contacts, the nursing position is more appropriately placed at level 6.

Factor 9: Environmental Working Conditions

Measures the likelihood, frequency and intensity of exposure to undesirable characteristics in the work environment, or in how the work must be performed. Characteristics to be considered include:

• physical hazards and personal health and safety risks;

• work surroundings - exposure to dangerous chemicals, infectious diseases, air contamination, noise, dirt, glare, fumes, poor ventilation, improper illumination vibration, awkward or confining work spaces, temperature extremes, etc; and exposure to adverse environmental conditions.

86The Hospital evaluated the nurses' work at level 7 for environmental working conditions. This level corresponds to frequent daily exposure to physical hazards, health and safety risks. The review officer did not change this rating. This rating is confirmed.

Factor 10: Work Pressure and Stress

Measures the likelihood, frequency and intensity of work related stress on the job. This factor does not measure the incumbent's ability or inability to tolerate stress; rather it assesses the normal degree of stress that most people would experience on the job.

Characteristics to be considered in this factor include:

• inherently frustrating working conditions;

• sacrifice and inherently stressful job demands required;

• strained personal contacts and interpersonal conflict situations;

• time pressures or urgent deadlines; where little control exists over the work place.

Note: assessment of this factor should be based on average or normal occurrences on the job, and not on extreme scenarios.

87The Hospital rated the level of workplace pressure and stress for nurses at degree level 6. The review office re‑evaluated this factor to be at level 8. Level 8 is the same level at which he rated the Transport Team. The stress level assigned for nurses is higher than the stress level for physio therapists, occupational therapists, and biomedical technicians.

88The work flow of critical care nurses is frequently interrupted by sudden and rapid changes in a patient's condition. Time pressure are often urgent, and in such situations the nurse may have little control over her workplace. But the job is not characterized by a high degree of interpersonal conflict. Instead, the nurse works within a multi‑displicinary team to provide high quality health care. A rating of 6 is appropriated for the level of stress and is consistent with the stress level for perfusionists.

Conclusion

89Both parties advised the Tribunal that they considered all nurses to be in the same job class. Using the job comparison system developed by the Hospital and the job information presented in the hearing, I have concluded that the value of the work of these nurses is 835 points. In the banding scheme used by the Hospital, these nurses now fall into Grade 12. The male comparator for nurses is now the medical engineering charge technician.

90I would vary the order of the review officer dated January 4, 1991 only to the extent of changing the grade level for certain job evaluation factors. I would confirm the review order placing these nursing jobs into Grade 12.

91I would order the Hospital to amend its pay equity plan to reflect this decision. The Hospital is to adjust the compensation for all persons who were in this job class from January 1, 1990 forward.