About 1,000 nurses at St. Boniface Hospital will be affected by a schedule overhaul that will also see the creation of 50 new positions, the Winnipeg Regional Health Authority announced Tuesday.

The schedule change is intended to balance and consolidate staffing at the hospital, which has the highest rates of overtime and sick time among hospital employees in the city, the health authority said.

"Individuals in the impacted units will receive a deletion of position letter, but will then have a number of options, which include selection of positions on their current unit or applying for vacancies on other units, or displacing other nurses at the hospital," said Karlee Blatz, WRHA senior labour relations counsel.

The Tuesday announcement came as part of a larger news release from the health authority, including the schedule changes at the Health Sciences Centre and the unveiling of new clinical criteria for outpatient physio- and occupational therapy.

The changes are part of a major overhaul of Winnipeg's health-care system, announced by the health authority and the province in April and intended to streamline and consolidate resources.

The overhaul has already seen the closure of the Misericordia Urgent Care Centre and the transformation of the Victoria Hospital emergency department into an urgent care centre.

The ER at Seven Oaks General Hospital will also be converted to an urgent care centre, and Concordia Hospital's emergency department will be closed altogether.

"The success of clinical consolidation is anchored in appropriate resourcing — both of staff and equipment — of every program and facility within the region," said Réal Cloutier, interim president of the health authority, in the Tuesday release.

Schedule changes to make care consistent

The new, standardized schedule at St. Boniface will reduce the current 80 different shift combinations to 20, Blatz said.

"There were some days where we had more nurses than we needed on unit, and some days that were chronically short-staffed, which is not good for patients and not good for units," Blatz said.

Manitoba Nurses Union president Sandi Mowat said the announcement didn't come as a surprise to the union. She said it was obvious some rotations at the hospital needed to be reviewed but she's not convinced the large-scale change is justified.

"The only thing is I would say is that no one has still proven to us that all this disruption is actually doing anything to improve patient care, so I'm still skeptical of all that piece," she said.

Sandi Mowat

Manitoba Nurses Union president Sandi Mowat said nurses are in the process of providing input on the schedule changes. (Tyson Koschik/CBC)

Consultation meetings with nurses at the hospital have already begun, Blatz said. The changes are expected to be in place by January 2018.

"I guess we'll see what happens in the end of all this, once the dust settles after we go through this whole process to see if there actually is an improvement to patient care," Mowat said.

The health authority will also introduce a new schedule for support staff at the Health Sciences Centre, eliminating "smaller, harder to staff" positions and replacing them with larger positions.

"There's many positions that have maybe one or two shifts a week, maybe three shifts in a two-week period. When those positions become vacant, they're really hard to fill, and they don't assist in continuity of care," Blatz said.

"A lot of those smaller positions are being combined together to create meaningful EFT positions that have a more regular connection to the workplace which increases continuity of care for the patients."

Schedules at the hospital haven't been reviewed in a decade, the health authority said in its release. It called the changes necessary to address services levels that currently vary throughout the day. The changes will impact roughly 250 of HSC's 2,800 support staff workers, the health authority said.

Blatz said the changes at Health Sciences Centre are set to roll out in November.

'Allied health professionals' to be hired by region

In the same news release on Tuesday, the health authority announced changes to staffing for 50 "allied health professionals," including pharmacists, occupational therapists and respiratory therapists.

Krista Williams, chief health operations officer for the WRHA, said nearly half of those workers, including staff in the echocardiography program and occupational therapists specializing in hands and upper extremities, will be regionalized — that is, hired as employees of the health authority instead of as employees of the hospitals where they work.

Karlee Blatz

Karlee Blatz, regional director of labour relations for the Winnipeg Regional Health Authority, said schedule changes will affect roughly 1,000 nurses at St. Boniface Hospital and roughly 250 support staff at Health Sciences Centre in Winnipeg. (Lyza Sale/CBC)

"They'll still have their sites that they work at, it's just that now they'll be part of a regional … expertise pool, and we'll be able to use them more efficiently and effectively," Williams said.

"We'll be able to cross-train them to both sites, so if there's issues at one site with, for example, a sudden vacancy and stuff, we'll be able to use those resources for both sites to ensure that patient care and continuity of care is continued."

The health authority is also consolidating staff with expertise in diagnostic imaging services at St. Boniface and Grace hospitals, to meet the demands of emergency departments at the sites.

"We're looking at the staff, absolutely … but we will be looking at equipment, too, to make sure that all of the sites have the appropriate diagnostic imaging equipment to manage the demand," Williams said.

Mowat said changes to health-care aide staffing could mean an increase in nurses' workloads, and she's already heard from HSC nurses concerned about the shift.

"The thing about nurses is that they go to work every day and do the best that they can and provide the best care they possibly can, and they'll continue to do that," she said.

Blatz said meetings with staff have already begun to orchestrate the changes. Timing of reassignments is tied to the closure of outpatient clinics on Nov. 24, she said.

New criteria for outpatient physio, occupational therapy

Also on Tuesday, the health authority released new, need-based criteria for outpatient physiotherapy and occupational therapy.

Earlier this month, the WRHA reversed course on a previous announcement that would have required some patients to pay out-of-pocket for the services. Under that system, patients would have been assessed for coverage based on their means to pay, instead of their clinical need.

Based on feedback from staff in the system, Williams said the authority dropped that plan and built a new, need-based assessment.

Treatments that qualify for outpatient physiotherapy service will include tendon transfers, repairs or reconstructions, periarticular fractures, hand or wrist joint arthroplasty and post-operative complications.

Treatments that qualify for outpatient occupational therapy will include wrist and elbow joint reconstructions, tendon and nerve transfers, complex upper-extremity fractures and flexor and extensor tendon injury or repair.