HEALTH AUTHORITIES ACT  
S.N.S. 2014, c. 32  
MEDIATION-ARBITRATION DECISION  
CANADIAN UNION OF PUBLIC EMPLOYEES, Local Unions 835, 1933, 2431, 2525, 4150  
NOVA SCOTIA GOVERNMENT AND GENERAL EMPLOYEES UNION  
NOVA SCOTIA NURSES’ UNION  
UNIFOR, Local Unions 4600, 4603 and 4606  
UNIONS  
SOUTH SHORE DISTRICT HEALTH AUTHORITY  
SOUTH WEST NOVA DISTRICT HEALTH AUTHORITY  
ANNAPOLIS VALLEY DISTRICT HEALTH AUTHORITY  
COLCHESTER EAST HANTS HEALTH AUTHORITY  
CUMBERLAND HEALTH AUTHORITY  
PICTOU COUNTY HEALTH AUTHORITY  
GUYSBOROUGH ANTIGONISH STRAIT HEALTH AUTHORITY  
CAPE BRETON DISTRICT HEALTH AUTHORITY  
CAPITAL HEALTH AUTHORITY  
IZAAK WALTON KILLAM HEALTH CENTRE  
EMPLOYERS  
ATTORNEY GENERAL OF NOVA SCOTIA  
ATTORNEY GENERAL  
________________________________________________________________________  
Mediator-Arbitrator:  
James E. Dorsey, Q.C.  
November 6 to 17, 2014  
Dartmouth, Nova Scotia  
December 9 to 13, 2014  
Goffs, Nova Scotia  
Dates of Mediation:  
Location of Mediation:  
Dates of Arbitration Hearing:  
Location of Arbitration Hearing:  
Dates of Written Submissions:  
December 22, 2014;  
January 5 and 12, 2015  
Date of Decision:  
January 17, 2015  
JamesE. Dorsey, Q.C. • 3380 Redfern Place, North Vancouver, B. C. V7N 3W1 • Tel 604-980-7225 • Fax 604-909-2755 dorse[email protected]shaw.ca •  
www.adrweb.ca/james-dorsey  
Representation:  
CUPE  
Susan D. Coen  
Jacquie Bramwell  
Wayne Thomas  
Carole Ferguson  
NSGEU  
Legal & Legislative Representative  
Atlantic Regional Director  
Servicing Representative  
Atlantic Research Representative  
Drew S. Plaxton  
Heather M. Jensen  
Joan Jessome  
Shawn Fuller  
Robin MacLean  
George Vaughan  
NSNU  
Counsel  
Counsel  
President  
Director of Negotiations & Servicing Health Care  
Director of Negotiations & Servicing Government & Education  
Servicing Coordinator  
Elizabeth McIntyre  
Janet E. Borowy  
Janet Hazelton  
Jean Candy  
Counsel  
Counsel  
President  
Executive Director  
Chris Albecht  
Paul Curry  
Labour Relations Representative & Chief Negotiator  
Researcher / Educator  
UNIFOR  
Barry D. Wadsworth  
Lana Payne  
Counsel  
Atlantic Director  
Susan Taylor  
Linda MacNeil  
National Representative  
National Representative  
EMPLOYERS  
Patrick J. Saulnier  
Thomas W. Groves  
Dave Collins  
Counsel  
Counsel  
Manager, Labour Relations, Capital District Health Authority  
Director, People Services, South Shore District Health  
Authority & South West Nova District Health Authority  
Senior Manager, Labour Relations, Cape Breton District  
Health Authority  
Elizabeth Henheffer  
Kevin Hooper  
Ryan Embrett-Baboushkin Director, Human Resource Operations, IWK Health Centre  
Bob Dunn  
Director of Labour Relations and Compensation Analysis,  
Health Association Nova Scotia  
Mandy Proulx  
Compensation Research Analyst, Health Association Nova  
Scotia  
ATTORNEY GENERAL OF NOVA SCOTIA  
Alex M. Cameron Counsel  
CONTENTS  
1. ACUTE CARE CONSOLIDATION AND STREAMLINING PROMISED IN 2013..........1  
1.1 Consolidating Acute Care Health Program Management for April 1, 2015...........1  
1.2 Community Health Boards and Regional Management Zones .............................5  
Map: Four Regional Management Zones...............................................................6  
1.3 Health Authority Collaboration and Provincial Shared Services............................8  
2. A THIRD RESTRUCTURING – 4 REGIONS ► 9 DISTRICTS ► 1 PROVINCIAL.......9  
3. LABOUR LANDSCAPE LEGACY OF DECISIONS AND EVOLUTION...................11  
3.1 Four Standard Hospital Bargaining Units is Labour Board Policy.......................14  
3.2 Licensed Practical Nurses in both Health Care and Nurses Units ......................18  
3.3 Government Creates Public Health and Addiction Services Unit in 1997...........22  
3.4 Halifax Regional Municipality: Four Standard Units with More Employees.........23  
Capital District Health Authority.......................................................................24  
IWK Health Centre ...........................................................................................28  
3.5 Current Representation Landscape: Bargaining Units and Employees ..............28  
Table 1: DHA Units Approx. Employee Numbers November 25, 2014.........30  
3.6 Current Collective Agreements: Number, Coverage and Expiration...................31  
Table 2: Collective Agreement Distribution..........................................................31  
3.7 Arbitrated Bargaining Impasses since 2000: NSGEU and CDHA.......................33  
3.8 Rivalry and Recent Instances of Union Collaboration .........................................42  
4. UNIONS AND EMPLOYERS DISAGREE HOW TO RESTRUCTURE........................44  
4.1 Broad Union Perspective on Restructuring..........................................................47  
4.2 Health Care Unions Propose Multi-union Bargaining Association ......................56  
Table 3: DHA Units Approximate Number of LPNs November 25, 2014......61  
4.3 Employers Reject Unions’ Proposal as Fundamentally Flawed ..........................62  
5. GOVERNMENT LEGISLATES NEW LABOUR RELATIONS STRUCTURE..............65  
5.1 Seizing the Opportunity to Streamline the Labour Relations Structure...............66  
5.2 Process Choice Implications for Labour Relations Restructuring .......................70  
5.3 Mediated Negotiations: Seeking Creative Solutions............................................73  
6. NSGEU CHARTER OF RIGHTS AND FREEDOMS CHALLENGE.............................74  
7. BARGAINING UNIT BOUNDARIES AND CLASSIFICATION GROUPINGS.............75  
7.1 Nursing Unit Composition Registered and Licensed Practical Nurses ............76  
A. “Generic” Classification Positions....................................................................76  
B. Distribution of Registered Nurses in Province-wide Unit ................................82  
Table 4: RNs in Public Health and Addictions Services Units.............................82  
Table 5: RNs - District Health Authorities & IWK November 25, 2014.............84  
C. Licensed Practical Nurses...............................................................................85  
Table 6: Nurse Staffing Mix in District Health Authorities ....................................88  
Table 7: Distribution of LPNs for Inclusion in Nursing Unit..................................98  
7.2 Health Care Unit Composition..............................................................................98  
A. Twenty Unopposed PH&AS Classifications to Health Care ...........................98  
Table 8: 20 Classifications (448 employees) from PH&AS to Health Care.........99  
B. Classifications and Associated Classifications in Two Standard Units.........100  
Medical Transcriptionist C (Clerical) ............................................................101  
Porters (Support)..........................................................................................101  
Dietetic Technician (Health Care) ................................................................102  
Ward Aide and Orderly (Health Care)..........................................................102  
Patient Attendants (reserved for continuation).............................................103  
Unit Aide and Lead Hand (reserved for continuation)..................................104  
Coordinator Information (reserved for continuation) ....................................105  
Coordinator Telecommunications (reserved for continuation).....................105  
Health Care Equipment Maintenance (reserved for continuation) ..............106  
Information Technology (reserved for continuation) ....................................106  
Sterile Processing Positions (reserved for continuation) .............................107  
Miscellaneous and Overlooked Positions (reserved for continuation) ........107  
Table 9: Distribution - Information Technology Classifications and Positions...109  
Table 10: Distribution - Sterile Processing Classifications and Positions .........110  
C. Other Health Care Proposed for Clerical (reserved for continuation)...........111  
Table 11: 5 Groups; 92 Classifications; 250 Positions ......................................123  
7.3 Clerical Unit Composition ...................................................................................126  
Resource Facilitator (Clerical)......................................................................126  
Buyers, Senior Buyers & Procurement Coordinators (Clerical)...................126  
Stores (Clerical)............................................................................................127  
Table 12: Distribution of Stores Classifications and Positions...........................128  
Eight PH&AS Clerk and Secretarial Classifications (Clerical) .....................129  
Maintenance Planner (Support) ...................................................................129  
Twenty Five PH&AS Classifications (reserved for continuation).................129  
Table 13: PH&AS Classifications Reserved for Continuation............................130  
7.4 Support Unit Composition...................................................................................131  
Transportation Driver (Support)....................................................................131  
Three PH&AS Classifications (Support).......................................................131  
8. SENIORITY INTEGRATION........................................................................................132  
9. ALL COLLECTIVE AGREEMENTS REMAIN IN FORCE..........................................133  
10. BARGAINING AGENT CERTIFICATION..................................................................137  
A. Nursing Bargaining Units ...............................................................................142  
NSNU Does Not Have Required Double Majority........................................143  
Table 14: Distribution of RN and LPN Positions in Two Nursing Units .............146  
No Authority to Conduct Representation Vote.............................................147  
What eligible union is to be certified? (reserved for continuation)...............151  
B. Clerical Bargaining Units ...............................................................................156  
NSGEU Has Required Double Majority .......................................................156  
C. Health Care Bargaining Units ........................................................................157  
NSGEU Does Not Have Required Double Majority .....................................157  
Amalgamated Successor Union as Bargaining Agent.................................157  
Table 15: All Units Approx. Employee Numbers November 25, 2014 ........169  
“Nova Scotia Health Care Amalgamated Union” .........................................174  
D. Support Bargaining Units...............................................................................176  
11. CANADIAN CHARTER OF RIGHTS AND FREEDOMS...........................................179  
Schedule 1 Integration of Seniority...........................................................................185  
Schedule 2 Interim Protocol Regarding Collective Agreements ..............................188  
Schedule 3 - Order.......................................................................................................191  
1
1.  
ACUTE CARE CONSOLIDATION AND STREAMLINING PROMISED IN 2013  
[1]  
A headline promise in the 2013 election platform of the Liberal Party of Nova  
Scotia was to spend health care dollars in emergency rooms not boardrooms. The  
promise was to “do what it takes so that our health care system puts patients first.”  
Nova Scotians elected a majority of Liberal members to the 62nd General Assembly,  
which formed government October 22, 2013.  
1.1  
Consolidating Acute Care Health Program Management for April 1, 2015  
[2]  
The new government immediately said it would streamline acute care service  
delivery by replacing nine district health authority service deliverers with one provincial  
health authority.  
[3]  
The nine district authorities established by legislation in 20001 had replaced four  
regional service delivery agents established in 1994.2  
[4]  
This course of action was affirmed by the Minister of Health and Wellness in  
February 2014.  
Our ability to pay for health services is becoming even more challenging as the  
federal government changes how it funds health services across the country,  
moving to a per capita funding formula. Nova Scotia’s demographics and burden  
of illness are not considered. It means we will receive $23 million dollars less  
from the federal government next year, and about $1 billion less over the next ten  
years. Clearly, our approach must change. Duplication must be eliminated.  
Service delivery must be as efficient as it can be, resources must be used to  
promote better health, improve quality and outcomes and target top priorities.  
Fewer health authorities will allow for a streamlined, more efficient system and  
will enable a provincial planning approach. This will allow us to integrate  
services where it makes sense, providing more equitable access to specialized  
services with a focus on quality-patient-centered, culturally competent care.  
Information can be shared across the province more easily, with more consistent  
approaches to everything from data collection to service delivery. There will no  
longer be ten different interpretations of programs, policies and services. Health  
assets will be used as efficiently and effectively as possible for the benefit of the  
patient and front line care.3  
[5]  
The goal is to improve health outcomes for Nova Scotians by maximizing  
benefits from every dollar spent. “With a more coordinated approach to service  
1 Health Authorities Act, S.N.S. 2000, c. 6  
2 Regional Health Boards Act, S.N.S. 1994, c.12  
3 Health Care Conversations: What We Heard, Nova Scotia, June 2014, p. 2  
   
2
delivery, we can enhance front-line patient care and care that is delivered in  
communities.”4  
[6]  
On increased efficiency, the Minister reported there had to be more shared  
corporate services across the province, less duplication and fewer resources spent on  
negotiating multiple collective agreements.  
[7]  
Implementing and managing service change is always challenging. Making  
sweeping change without compromising ongoing service is more challenging. The  
Minister identified the challenge, the extent to which its success depends on the people  
providing the service and the need for their involvement:  
Those working within the system are compassionate, dedicated and above all,  
resourceful. The ingenuity they display is surpassed only by their passion for the  
job and their patients. These qualities were evident at discussions that were held  
in every region of the province regarding the plan to restructure Nova Scotia’s  
health care delivery system. The plan will consolidate the nine existing district  
health authorities into one provincial authority, the IWK will continue as a  
separate entity. Change of this magnitude must be done carefully, and cannot  
be done successfully unless those who work within the system are engaged and  
involved.5  
[8]  
The Department of Health and Wellness announced a team to coordinate  
planning to implement the change effective April 1, 2015. “The messages heard on tour  
and relayed in the What We Heard report, along with the themes identified by the  
Department, will help guide the work of the Transition and Design Team.”6  
[9]  
In a June 2014 report explaining the Minister’s “Listening and Learning Tour”, the  
Department underscored the importance of health care workers in the change process.  
What will [be] the most important thing to consider as you merge the health  
authorities?  
The strength of any system is the people who are part of it and their strengths,  
skills, resourcefulness and commitment. As we consolidate the health authorities  
we will want to maintain our focus on what is best for patients and how we can  
best support those who we rely on to provide and support care and focus on  
service, teaching and research.7  
[10]  
The failings of the current structure were listed June 25th as follows:  
4 Health Care Conversations 2014 What We Heard, p. 8  
5 Health Care Conversations: What We Heard, Nova Scotia, June 2014, p. 1  
6 District Health Authority Consolidation What We Heard Report - Listening & Learning Tour Frequently  
Asked Questions, June 3, 2014, Summary  
7
District Health Authority Consolidation What We Heard Report - Listening & Learning Tour Frequently  
Asked Questions, June 3, 2014.  
3
Lack of singular purpose, direction, culture and accountability leading to  
variable care and outcomes  
10 different strategic plans, vision statements and operational goals  
Technological barriers remain despite best efforts to consolidate  
SAP system was intended to standardize approaches still  
considerable variation  
Resource capacity in the smaller DHAs creates gaps and risks  
Single incumbent positions (e.g. legal counsel, internal medicine)  
Current structure leads to interdistrict competition for health professionals  
and resources  
10 structures for approximately 900,000 residents  
Limited coordination and standardization (administrative and clinical) results  
in inefficiencies8  
[11]  
The boards of the nine district health authorities were disbanded effective July  
1st. An administrator was appointed to oversee management of the districts until April 1,  
2015.  
[12]  
The Department published “Transition News” to communicate and explain the  
change process. In the first issue in July, one of the “fast facts” was: “Staff who are  
impacted by the consolidation and ongoing transition will be treated fairly with terms and  
conditions of employment and collective agreement provisions honoured.”9  
[13]  
In September, the Minister named the Chief Executive Officer for the  
consolidated provincial health authority. She joined the Transition and Design Team  
working with principles intended to reflect seven quality components safety;  
population focus; accessibility; supportive of healthy workplace culture; people  
centered; continuity of service; and effectiveness, efficiency and sustainability.10  
[14]  
In October, the legislature enacted new health authority governance and  
structural change effective April 1, 2015.11 The existing nine district health authorities  
will become one as yet unnamed provincial health authority with a mandate to “provide  
health services to the entire Province, except for those health services provided by the  
IWK Health Centre.”12 The provincial health authority will partner or align with IWK  
Health Centre, which continues as a separate corporate body with its own board of  
8 People Centered Health Care Transition Planning for DHA Consolidation, June 25, 2014  
9 Transition News, Issue #1, July 15, 2014. p. 4  
10 Info, Design Principles, September 22, 2014  
11 Health Authorities Act, S.N.S. 2014, c. 36  
12 Section 49(1)  
4
directors and a mandate to “operate a health centre and to provide health services and  
programs for children, youth, women and families.”13 The IWK Health Centre has an  
Atlantic province mandate and receives funding from other provinces. The provincial  
health authority and IWK Health Centre are each a “health authority.”14  
[15]  
While there is recurring reference to the current structure of acute health care  
service delivery as a “system”, an identified problem is that the structure does not act  
with enough integration and consistency. The consolidation of the nine district health  
authorities aligned with the IWK Health Centre is to overcome “ten different  
interpretations of programs, policies and services” and, perhaps, health outcomes.  
[16]  
Some of the goals of this restructuring and realignment are: to use limited  
resources more efficiently and effectively; to foster and support collaborative practice  
among health care professionals; to ensure they can practice to their full scope; to  
diminish competition among communities in recruiting and retaining health care  
providers; and to promote innovative service delivery.  
[17]  
The Minister recognized employee anxiety over the impact of restructuring.  
Uncertainty increases anxiety and staff need to know as soon as possible how  
they will be affected by restructuring. Concerns were shared regarding the time,  
effort and resources spent negotiating 215 separate health contracts, noting that  
perpetual negotiations for a province of this size is simply not sustainable. As  
one health professional noted, “That’s a lot of time in hotel rooms”.  
Concerns focused on how local unions will be impacted. A strong desire to avoid  
run-off votes and the resulting impact on the workplace was consistently shared.  
Anxiety around job losses or possible job relocation is surfacing. Many stressed  
the need for a robust change-management process as part of the way forward.15  
[18]  
One part of the vision is: “The labour relations environment is less complex than  
it is now.”16 The plan moving forward was to:  
Work with union leaders and their members to ensure that the transition is as  
smooth as possible. Listen to their ideas. Provide regular, factual and timely  
information to outline the progress being made and the potential impact on the  
workplace. We will look for cooperation from unions in an effort to avoid run-off  
votes. We are committed to change that is respectful, collaborative and  
transparent.17  
13 Section 43(2)  
14 Health Authorities Act, S.N.S. 2014, c. 36, s. 2(1)(o)  
15 Health Care Conversations 2014 What We Heard, p. 12  
16 Transition News, Issue #3, September 25, 2014, p. 3  
17 Health Care Conversations 2014 What We Heard, p. 12  
5
The subsequent discussion with the unions is reviewed later.  
1.2  
Community Health Boards and Regional Management Zones  
[19]  
With a history of community based hospitals having been regionalised and then  
devolved to nine districts, there was concern about centralization in the Halifax Regional  
Municipality. The longer name of the legislation is An Act to provide for Health  
Authorities and Community Health Boards.  
[20]  
The two health authorities must prepare annual business plans that include a  
public engagement plan.18 Community health boards, whose boundaries can be altered  
by the provincial health authority, continue.  
The objects of a community health board are to advise the provincial health  
authority on local perspectives, trends, issues and priorities, and to contribute to  
health-system accountability by facilitating an exchange of information and  
feedback between the community and the provincial health authority.19  
[21]  
Regulations may establish regional management zones within the provincial  
health authority.  
(1) Management zones within the Province may be established by the  
regulations for the purpose of delivering and managing health services on a  
regional level at the direction of the provincial health authority.  
(2) Subject to clause 9(a), the provincial health authority shall determine the uses  
of management zones in the delivery and management of health services by  
the provincial health authority.20  
[22]  
Regulations have not been made, but the Department has identified there will be  
four zones. The zone coverage of the nine district health authorities is:  
Zones  
District Health Authorities  
Western  
South Shore District Health Authority  
South West Nova Health Authority  
Annapolis Valley District Health Authority  
Colchester East Hants Health Authority  
Cumberland Health Authority  
Northern  
Pictou County Health Authority  
Eastern  
Central  
Guysborough Antigonish-Strait Health Authority  
Cape Breton District Health Authority  
Capital District Health Authority  
18 Health Authorities Act, S.N.S. 2014, c. 36, s. 40(6)  
19 Health Authorities Act, S.N.S. 2014, c. 36, s. 62  
20 Health Authorities Act, S.N.S. 2014, c. 36, s. 60  
 
6
Map: Four Regional Management Zones  
21  
[23]  
County-based zone boundaries were determined by service, staffing and  
program delivery considerations:  
where Nova Scotians typically access services  
traditional community affiliations and medical staff relationships (e.g. referral  
patterns)  
recent/concurrent planning processes that address/consider boundary issues  
the impact of geographic boundaries as an enabler/barrier to future clinical  
services planning, and  
the geographic boundaries used by other connected services such as  
Community Services.  
This is a logical grouping of counties and the health facilities and services within  
them. It will help optimize collaboration and integration as part of our new health  
authority structure. In its design recommendations the DHA Consolidation  
Transition & Design team will include advice on how services and staff can be  
structured by management zones that are part of the provincial health authority,  
as well as the operations offices for the zones.22  
[24]  
The Transition and Design Team has recommended leadership structure for the  
provincial health authority and its four management zones. Seven vice-presidents have  
21 Transition News, Issue #2, September 8, 2014, p. 3  
22 Info, Management Zones, September 2, 2014  
 
7
been named. Each zone will have two Executive Directors one Operations and one  
Medical. The four Medical Executive Directors will report to one V.P. Medicine and  
Integrated Health Services. The four Operations Executive Directors will each report to  
four Vice Presidents with different program responsibilities. The role of each  
management zone Operations Executive Director is:  
Creates integrated networks within the Management Zone  
Works with Management Zone leadership to identify and recommend safe  
and quality health services by location and facility  
Engages the public, patients and families and other stakeholders in the  
identification and planning of priorities for health services  
Leads a healthy, safe, diverse and respectful workplace by championing and  
practicing sound human resources management  
Supports the transition and alignment of services and programs across zones  
Cultivates relationships with CHBs, [Community Health Boards] foundations,  
auxiliaries and local leaders23  
[25]  
The locations of the corporate and zone offices have been determined:  
Corporate Office:  
Will be located in Halifax Area (specific location to be determined)  
Will be separate from Central Zone leadership office  
Zone leadership office locations:  
Western Kentville (15 Chipman Drive offices)  
Northern Truro (Colchester East Hants Health Centre)  
Eastern Sydney (Cape Breton Regional Hospital)  
Central Halifax (to be determined)  
Rationale:  
Minimal travel distance between zone office and other main facilities within  
the zone  
Proximity to major system partners  
Technology largely available to support communication across NS24  
How were the zone office locations established?  
The transition team researched and ranked zone office locations based on a  
number of factors. The selected locations include the following advantages:  
Minimum travel distance between zone office and other main facilities within  
the zone.  
23 District Health Authority Consolidation Provincial Health Authority Executive Structure, October 30,  
2014, slide 21  
24  
DHA Consolidation Transition and Design People Centred Care Provincial Health Authority  
Executive Structure and Accountabilities, October 30, 2014, slide 25  
8
Proximity to major system stakeholders reducing travel time for system  
leaders to interact with Government, IWK Health Centre, academic  
institutions and provincial bodies, such as regulatory colleges.  
Technology is largely available to support communication across the  
province.25  
[26]  
The Transition and Design Team’s planning assumptions are:  
People centred and focus on quality and patient safety  
Focus for April 1 on executive (CEOs, VPs, administrative assistants) and  
zone leadership  
Clear links between zone management and provincial leadership  
Mission encompasses service delivery, academic and research mandates  
Explore administrative alignment opportunities with IWK as Provincial Shared  
Services evolves (in addition to current shared VP Research and Academic)  
Savings in administration on April 1, and thereafter26  
1.3  
Health Authority Collaboration and Provincial Shared Services  
[27]  
Collaboration between the provincial health authority and IWK Health Centre is  
expected: “Where directed to do so by the Minister, the health authorities shall  
collaborate with each other on all or part of their health-services business plans.”27  
[28]  
The Transition and Design Team will “also identify priorities and suggest  
approaches for sharing or merging services with the IWK.”28  
[29]  
Initiatives to share corporate and targeted services that began before 2014 are to  
continue human resources, information technology, procurement, finance, laboratory  
service and diagnostic imaging. Some services will be provided outside the provincial  
health authority and IWK Health Centre.29  
[30]  
A Shared Services Act with scope beyond health care was enacted in  
November.30 The current and future approach to human resource shared services is  
summarized as follows:  
25  
District Health Authority Consolidation Executive Structure / Recruitment Process / Zone  
Offices Questions & Answers October 2014, p. 3  
26 DHA Consolidation Transition and Design People Centred Care Provincial Health Authority Executive  
Structure and Accountabilities, October 30, 2014, slide 3  
27 Health Authorities Act, S.N.S. 2014, c. 36, s. 40(3)  
28 Transition News, Issue #2, September 8, 2014. p. 2; see also Update Shared Services, October 20,  
2014  
29 Transition News, Issue #4, October 20, 2014, pp. 4-5  
30 S.N.S. 2014, c. 38  
 
9
Given that organizations such as nursing homes and home care agencies rely  
heavily on these services [labour relations, compensation analysis and group  
benefits administration] to support their operations, the proposed model will  
recommend a continued role for the association [Health Association Nova Scotia]  
in delivering labour relations and compensation analysis and group benefits  
administration services.  
A suggested model for human resources will be finalized in the coming months  
and submitted to government for their consideration. Among other things, this  
work will identify the extent to which these services will be offered by Health  
Association Nova Scotia and the degree to which human resources functions will  
be centralized or decentralized.  
The full implementation of the redesigned human resources model will occur over  
the next two years and will depend on technology to maximize the potential  
benefits.31  
[31]  
One impact of shared services will be the transfer of some employees of district  
health authorities and the work they do to the provincial government shared services  
provider. They will become employees of the provincial government covered by  
collective agreements in bargaining units represented by the Nova Scotia Government  
and General Employees Union (NSGEU). The current estimate is 150 to 200  
employees. The projected implementation of all shared services across the provincial  
public sector is five years.32  
2.  
A THIRD RESTRUCTURING 4 REGIONS 9 DISTRICTS 1 PROVINCIAL  
[32]  
This province-wide restructuring happens against a backdrop of previous  
restructurings that apparently failed to achieve their goals.  
Fears of a centralized approach are rooted in history. The past saw communities  
feeling neglected, needs overlooked and those close to the decision makers  
holding the greatest influence. Boundaries became the lines of isolation. Local  
voices were lost and urban areas were favoured over rural.33  
[33]  
Tension between rural and urban interests or local and remote control are  
evident in the debate about the current restructuring, as in previous centralizing  
restructuring.  
[34]  
In July 1999, a Ministerial Task Force made recommendations to strengthen and  
complete regionalization and to minimize “the potential chaos of further organizational  
31 Update Shared Services, October 20, 2014  
32 Department of Internal Services, Shared Services Project - Fact Sheet October 2014  
33 Health Care Conversations 2014 What We Heard, p. 8  
 
10  
change.”34 Then in October 1999, the Minister of Health of a new government with an  
election platform “to replace the existing RHBs [Regional Health Boards] with nine  
boards that are based on the catchment areas of the nine regional hospitals”35  
announced the disbandment of Regional Health Boards.  
This decision is the Government of Nova Scotia's first step towards establishing a  
more community-responsive health care system that will see District Health  
Authorities established in the province. District Health Authorities will be smaller  
than the current Regional Health Boards, and they will have formal links to  
Community Health Boards. 36  
[35]  
Service integration goals for both the 1994 and 1999 restructurings were similar  
to the goals of the current restructuring.  
There will be nine (9) DHAs that will be aligned, in general, along county lines.  
The DHAs will be based in the areas primarily served by existing regional  
hospitals, and they will enjoy the same historical relationships, catchment areas,  
and referral patterns.  
*********  
There will be nine District Health Authorities serving geographic areas smaller  
than the previous regions. These new structures will make the system more  
responsive to the needs of Nova Scotians and enhance the efforts that are  
already under way to better integrate the province's health care services.37  
[36]  
The regional boundaries that were erased were similar to the new management  
zone boundaries replacing the boundaries of the district health authorities.  
[37]  
The 1999 policy on labour relations restructuring was succinct and in keeping  
with existing labour relations legislation – “Unions will be kept informed and provincial  
succession rights legislation will guide migration to the new structure.”38  
[38]  
Since 1994, the restructuring path has been from community-based to regional  
management to smaller, more local district/county management to central provincial  
management with regional zone management.  
34 Minister’s Task Force on Regionalized Health Care in Nova Scotia, Final Report and  
Recommendations July 1999, Letter of Transmittal  
35 Nova Scotia Department of Health, Future Direction of the Health care System …establishing District  
Health Authorities, November 1, 1999, p. 19  
36 Nova Scotia Department of Health, Future Direction of the Health care System …establishing District  
Health Authorities, November 1, 1999, p. 1  
37 Nova Scotia Department of Health, Future Direction of the Health care System …establishing District  
Health Authorities, November 1, 1999, p. 2; 4  
38 Nova Scotia Department of Health, Future Direction of the Health care System …establishing District  
Health Authorities, November 1, 1999, p. 22  
11  
[39]  
In the current restructuring, smaller geographic areas of common interest are  
recognized in the continuation of 37 community health boards across the province.  
However, historic and geographic trade union representation of acute care  
[40]  
employees generally tied to regional, now zone, management is not explicitly  
recognized in acute care labour relations restructuring in the transitional sections of the  
Health Authorities Act.  
[41]  
Each restructuring required accompanying labour relations restructuring for the  
new employer structure. In this restructuring, existing collective bargaining relationships  
are not being modified. They are being swept away. As a consequence, potential  
operational and organizational chaos is a recurring forecast for this restructuring by the  
unions that lived through past restructurings.  
3.  
LABOUR LANDSCAPE LEGACY OF DECISIONS AND EVOLUTION  
[42]  
Union resistance to this centralizing labour relations restructuring is rooted in  
history and local union loyalties. To understand this resistance, it is necessary to review  
how the current landscape evolved.  
[43]  
It begins with employees of community-based hospital employers choosing  
representation by unions active in their community. The first appears to have been in  
1955 when the Canadian Hospital Employees Union, Local Union No. 324 was certified  
by the Labour Relations Board to represent groups of employees of the Aberdeen  
Hospital Commission in New Glasgow and the City of Sydney Hospital.39  
[44]  
A 1962 fact finding inquiry into labour legislation reported a tension at hospital  
collective bargaining tables between local hospital autonomy and central funding by the  
new provincial Hospital Commission. Unions wanted to negotiate with the central  
payer. The Hospital Commission advocated local bargaining.  
The Commission also contended, and in our view with justification, that every  
effort should be made to see that local hospitals retain the measure of autonomy  
which they now have. Any lessening of that autonomy might seriously impair the  
great degree of responsibility which local hospital areas now exercise towards  
these institutions.  
39 The Aberdeen Hospital Commission, October 27, 1955, LRB #377. An earlier application was  
dismissed September 13, 1955, LRB #366. See also City of Sydney Hospital, December 21, 1995, LRB  
#402.  
 
12  
Collective bargaining, as an important factor in the matter of autonomy, should  
remain at the local hospital level. It was pointed out to us that the Hospital  
Commission encourages fund-raising by means of local campaigns and the  
imposition of extra charges for semi-private and private rooms, and that some  
hospitals have realized extra revenue through this means.  
It is suggested that this complaint may be remedied by the union and hospital  
boards negotiating new agreements early in the year but not finalizing the same  
until after the Government has ruled on the hospital budgets presented to it by  
the Commission. By this method the Commission would be aware of the terms  
agreed to by the hospital boards and, presumably, would so provide accordingly  
in the budget presented to the Government for approval. When that information  
became available, the agreement could be finalized.40  
[45]  
In the 1960’s, employees in Cape Breton chose to be represented by the Eastern  
Institutional Workers Union, which later became a local union of the Canadian  
Brotherhood of Railway Employees and General Workers Union (CBRT), which merged  
with the National Automobile, Aerospace, Transportation and General Workers Union of  
Canada that became the Canadian Auto Workers (CAW), which is now Unifor after a  
2013 merger.  
[46]  
At the same time, Yarmouth employees chose the National Union of Public  
Employees, Local 835 that is now the Canadian Union of Public Employees, Local 835.  
Other CUPE local unions were selected by employees at hospitals across the province  
outside the Halifax area.  
[47]  
Through employee choice verified by the Labour Relations Board these unions  
acquired exclusive rights to represent all classifications of employees in community  
hospitals except Registered Nurses. They represented Certified Nursing Assistants, the  
predecessor classification to Licensed Practical Nurses.  
[48]  
Exclusive trade union representation is based on verified or agreed majority  
support among a group or unit of employees for whom the union negotiates a collective  
agreement and enforces employer compliance with the agreement. The Trade Union  
Act defines a “unit” as:  
“unit” means a group of two or more employees and “appropriate for collective  
bargaining” with reference to a unit, means a unit that is appropriate for such  
purposes whether it be an employer unit, craft unit, technical unit, plant unit or  
40 Judge Alexander H. MacKinnon, Report of Fact-Finding Body Re: Labour Legislation, February 1,  
1962, p.43  
13  
any other unit and whether or not the employees therein are employed by one or  
more employers41  
[49]  
A group of employees appropriate for collective bargaining does not have to be  
the most or ideal grouping of employees. As unions applied and gained certification to  
represent bargaining units of hospital employees, the Labour Relations Board, like other  
North American boards, certified various employee groupings.  
[50]  
In the early days of organization and representation in an industry or industrial  
sector, labour relations boards followed a building block approach in setting bargaining  
structures. The boards balanced short term employee access to collective bargaining  
against long term industrial stability. Various factors influenced the shaping of units.  
One of many statements of these factors is the following from a decision involving a  
hospital by the Ontario board:  
. . . [W]hat then is the purpose of the concept of the "appropriate bargaining  
unit"? Quite simply, it is an effort to inject a public policy component into the  
initial shaping of the collective bargaining structure, so as to encourage the  
practice and procedure of collective bargaining and enhance the likelihood of a  
more viable and harmonious collective bargaining relationship. . . . It is, as we  
have noted, a matter of balancing competing considerations, including such  
factors as: whether the employees have a community of interest having regard to  
the nature of the work performed, the conditions of employment, and their skills;  
the employer's administrative structures; the geographic circumstances; the  
employees' functional coherence, or interdependence or interchange with other  
employees; the centralization of management authority; the economic  
advantages to the employer of one unit versus another; the source of work; the  
right of employees to a measure of self-determination; the degree of employee  
organization and whether a proposed unit would impede such organization; any  
likely adverse effects to the parties and the public that might flow from a  
proposed unit, or from fragmentation of employees into several units, and so  
on.42  
[51]  
Labour relations boards also deferred to bargaining unit boundaries agreed  
between a union and employer.  
41 Trade Union Act, s. 2(1)(x)  
42 Hospital for Sick Children, 1985 899 (ON LRB), ¶ 17. See also Adams, Canadian Labour Law,  
loose-leaf, Chapter 7 para 7.30-7.262; University of King’s College Teachers’ Association v. University of  
King’s College, 2011 NSLB 61 (),¶ 47, 56 - 60; National Automobile Aerospace, Transportation and  
General Workers Union of Canada (CAW-Canada) v LeHave Manor Corporation, 2012 NSLB 181  
().¶ 1; Canadian Union of Public Employees Local 2330 v Highcrest Place Ltd, 2012 NSLB 109  
(), ¶ 18 - 19  
14  
3.1  
Four Standard Hospital Bargaining Units is Labour Board Policy  
[52]  
The result is it was a combination of decisions by the Nova Scotia Labour  
Relations Board and private agreements between unions, employers and governments  
that created the current landscape of hospital bargaining units and union representation  
in acute health care.  
[53]  
On October 29, 1973, the Labour Relations Board moved to standardize future  
hospital bargaining units. This was also happening in other North American  
jurisdictions.  
The Labour Relations Board (Nova Scotia) wishes to announce guidelines in the  
determination of appropriate units for applications for certification in hospitals.  
The guidelines, set out below, are for the convenience of all parties concerned in  
applications for certification. They in no way affect existing bargaining units  
except, possibly, on an application to amend a Board Certification Order.  
The Board will continue to exercise its discretion in considering appropriateness  
of the bargaining unit in every individual application by a union for certification as  
bargaining agent on behalf of hospital employees. However, if a union applies  
for a bargaining unit that departs from the guidelines, it will be called upon to  
satisfy the Board that, under the circumstances, the unit requested is  
appropriate. In a small hospital or nursing home, for instance, the Board might  
conclude that a broader unit, or even an all employee unit, is appropriate.  
Employees excluded by Section 1(2) of the Trade Union Act of Nova Scotia will  
,
of  
course, not be included in any unit.  
In the absence of grounds which lead the Board to conclude otherwise the  
following hospital bargaining units will be considered appropriate:  
1. Nurses - all registered or graduate nurses and specialized nurses, such as  
psychiatric nurses, working in their speciality.  
2. Health Care Employees - all employees directly concerned with the treatment  
of patients.  
Without limiting the generality of the foregoing, specifically included are  
certified nursing assistants, nursing assistants, nurses' aides, orderlies,  
technicians, dieticians, pharmacy clerks, medical records staff, and  
therapists.  
3. Office Employees - all employees performing duties of a primarily clerical,  
bookkeeping or secretarial nature.  
Where employees are performing clerical, bookkeeping or secretarial duties  
in particular departments of the hospital under circumstances which  
demonstrate a community of interest with other employees in those  
departments, the Board may find them to be appropriately included in a unit  
other than a unit of office employees.  
4. Residual - all other employees working in or out of the hospital.  
 
15  
Without limiting the generality of the foregoing, specifically included are the  
kitchen, housekeeping and dietary staff.43  
[54]  
Today, there are no registered psychiatric nurses in Nova Scotia. Consistent  
with the practice at the time elsewhere in Canada, the Nurses unit did not include  
certified or other nursing assistants. Nursing assistants were included in the Health  
Care unit.  
[55]  
The distinct character of the Health Care unit is that it is a grouping of employees  
“directly concerned with the treatment of patients.” This group of non-nursing clinical  
employees is not limited to the twenty self-regulating health care occupations in Nova  
Scotia.44 It is not limited to what is referred to as “allied health professionals.” It is not a  
unit of all professionals except doctors and nurses, sometimes called a paramedical  
professional unit. It includes technicians, which in some jurisdictions are in a separate  
unit of technician or paramedical technicians. The Health Care unit includes orderlies  
and medical records staff.  
[56]  
Being “directly concerned with the treatment of patients” has been broadly  
construed. It includes all health care employees with hands on patients, such as  
orderlies, and members of the team two or three steps removed from hands on patient  
care, such as pharmacy clerks and medical records staff.  
[57]  
Other provincial labour relations boards took other approaches. To varying  
degrees multiple hospital craft units were initially certified and then later not allowed in  
an effort to limit the proliferation of bargaining units and to rationalize collective  
bargaining structures. Some non-standard and anomalous units eventually  
disappeared with health care regionalization and restructuring.  
[58]  
In some jurisdictions, increased credentialization of technical occupations and  
professionalization of proliferating health occupations created occupational  
convergence and conflict over the boundaries between paramedical professionals and  
paramedical technicians and the proper grouping assignment for individual occupations.  
This was avoided in some provinces, like Nova Scotia, which had adopted four or fewer  
standard units.  
43 Hospital Bargaining Units, LRB Policy and Procedure Statement # 023-001-073, October 29, 1973  
44 See the list and statutes in Regulated Health Professions Network Act, S.N.S. 2012, c. 48  
16  
[59]  
The Nova Scotia Board’s approach made Health Care the principal unit after  
nurses and included, in some circumstances, employees performing clerical, secretarial  
and bookkeeping duties, who were regarded not as “clerical”, but as administrative  
employees or professionals.  
[60]  
The third unit of Office employees was a grouping of employees outside clinical  
departments. Over time, the parties have called this unit the Clerical unit. The NSGEU  
collective agreements referred to the unit as “Office / Administrative Professional.”  
[61]  
The fourth Residual unit was for the remaining employees. On November 17,  
1997, the Board changed the name of this bargaining unit to “Service Support.”45  
Kitchen, housekeeping and facility maintenance employees are in this unit.  
[62]  
The four hospital unit approach was fashioned within the Board’s jurisdiction  
under the Trade Union Act when the affected facilities were primarily in smaller  
communities. However, it was easily adaptable to regional hospitals.  
[63]  
When describing some of the North American experience in defining bargaining  
unit groupings of employees for restructuring in Saskatchewan in 1997, I began with  
Nova Scotia.  
The models for appropriate bargaining unit configurations in health in Canada  
and the United States are varied. In 1973 the Nova Scotia Board adopted four  
standard units for hospital - nurses, health care employees directly concerned  
with patient treatment, office, and all others. The 1974 Ontario Report of Hospital  
Inquiry Commission recommended that future certifications recognize only three  
units for employees in public hospitals - service, nursing and paramedical. It also  
recommended that the existing craft units of operating engineers be eliminated.  
In Alberta, initial organizing was on craft lines. The Board moved to broader  
units and finally in 1976 to five standard units - direct nursing care, auxiliary  
nursing care, paramedical professional, paramedical technical and general  
support services. In community health units it limited the bargaining units to  
three - nursing, professional and support.  
In Newfoundland there are four units - nurses, allied health professionals,  
laboratory and x-ray technicians and support staff. In New Brunswick the units  
were legislated and there are eight - technical/paramedical, scientific and  
professional, three groups of administrative, administrative support, patient  
services and institutional services. The British Columbia Labour Relations Board  
adopted a practice in the 1970's of three units - nurses, paramedical  
professionals and all other employees.  
In the U.S. a special rulemaking process in 1989 determined eight units for  
hospitals - registered nurses, physicians, professionals except nurses and  
45 Queen Elizabeth II Health Sciences Centre, LRB #4453 Interim II,  
17  
physicians, technical, skilled maintenance, business office clerical, guards and all  
other non-professional.  
In jurisdictions where it was adopted, a policy of standard or predictable unit  
configuration has generally facilitated organizing by enabling unions to know  
which employees to organize. It has facilitated collective bargaining because the  
uniformity fosters province-wide agreements.46  
[64]  
When the Nova Scotia Board was pioneering standardized units for hospitals,  
there continued to be union acquisition of bargaining rights by employer voluntary  
recognition. As a consequence, the scope of some voluntarily recognized hospital  
bargaining units varied from standard units. This happened across the province in  
1997. A fifth, non-standard bargaining unit was agreed without reference to the Board  
when the provincial government devolved programs to district health authorities.  
[65]  
The presumptively appropriate bargaining units did not prevent the Board from  
making variations in some situations. However, after a public meeting in January 1981  
to discuss hospital units, the Board reaffirmed the guidelines as the preferred but not  
inflexible bargaining units.  
The Labour Relations Board (Nova Scotia) wishes to announce two matters of  
general policy following its study of its guidelines for hospital bargaining units of  
October 29, 1973.  
1. The Board has considered the guidelines for dealing with Hospital Bargaining  
Units issued by it on October 29, 1973, and has decided not to alter them.  
2. The Board, in determining who are regular part-time employees to be  
included in a hospital bargaining unit, shall have regard to the special skills  
required, the shift requirements, the regularity of shifts worked and the hours  
worked during a significant test period. If the hours worked average two shifts  
or more per week during the test period, the Board will normally include such  
employees in the unit.47  
[66]  
Some Canadian legislation expressly allowed labour relations boards to  
determine whether one classification of employees would be in one of two units on the  
basis of the majority of the employees’ wishes as expressed in a vote among the  
employees in the classification.48  
[67]  
Some Nova Scotia unit boundary decisions were based on Board directed or  
agreed representation votes among employees in merged bargaining units. For  
example, in 1996 on application to the Board to declare the Western Regional Health  
46 James E. Dorsey, Health Labour Relations Reorganization Commission, Reorganization of  
Saskatchewan`s Health Labour Relations, January 15, 1997, pp. 61 - 62  
47 Hospital Bargaining Units, LRB Policy and Procedure Statement # 023-002-081, February 28, 1981  
48 E.g., Labour Relations Act,1995, S.O. 1995, c. 1, s. 9(1)  
18  
Board a successor employer to the Health Services Association of the South Shore,  
Yarmouth Regional Hospital and Valley Regional Health Board, it was agreed there  
would be four bargaining units and representation votes by employees choosing among  
unions representing employees. It was also agreed by the employer and unions that  
Licensed Practical Nurses at ten acute care facilities would have a separate vote to  
choose to be included in a bargaining unit with Nurses or in a Health Care unit.49 They  
voted to remain with the Health Care unit and be represented by a CUPE local union.  
3.2  
Licensed Practical Nurses in both Health Care and Nurses Units  
[68]  
Not all Licensed Practical Nurses made this choice before and since 1996. One  
inconsistent result is varied inclusion or exclusion of Licensed Practical Nurses,  
previously Certified Nursing Assistants, from Nurses units. Then as now, the Trade  
Union Act provided: “The Board in determining the appropriate unit shall have regard to  
the community of interest among the employees in the proposed unit in such matters as  
work location, hours of work, working conditions and methods of remuneration.”50  
[69]  
The Nova Scotia Nurses’ Union (NSNU) was founded in 1976 to represent  
Registered and Graduate Nurses. Formerly, it was a component of the Registered  
Nurses Association of Nova Scotia negotiating terms and conditions of employment. In  
June 1980, the NSNU changed its constitution to include representation of Certified  
Nursing Assistants. In 2005, the NSNU extended representation to Nurse Practitioners.  
[70]  
This was in contrast to what was happening in Ontario and other provinces.  
. . . [F]or the purposes of collective bargaining, RNA's [Registered Nursing  
Assistants] have regularly and routinely been included in the service bargaining  
unit, even though there might be a plausible claim to group them together with  
RN's or perhaps with paramedical/technical employees.  
The precise rationale for this established practice is not entirely clear, and may  
have more to do with the historical evolution of collective bargaining in the health  
care sector than any calculated assessment of what would ultimately be the most  
rational "shape" for the collective bargaining structure. Registered nurses had an  
early and active appetite for collective bargaining through an organization (the  
Ontario Nurses' Association "ONA") which catered exclusively to the interests  
and concerns of their own professional group. ONA was not interested in, or  
able under its constitution, to represent anyone other than registered nurses,  
49 News Release To The Western Region, November 26, 1996  
50 Section 25(14)  
 
19  
and, at the time, the role of the RNA may not have been as developed, defined,  
or regulated as it is today.51  
[71]  
The NSNU change to its constitution initiated Licensed Practical Nurse  
bargaining unit inconsistency. It began in April 1981 when a four member majority of a  
five member Labour Relations Board panel acceded to the wishes of a group of  
previously unrepresented Certified Nursing Assistants at the Highland View Regional  
Hospital (founded in 1903 on donated land after a typhoid outbreak in the Amherst area)  
to be added to an existing Nurses unit. The Board included the Certified Nursing  
Assistants without holding a vote among them and against the Board’s preference.  
Notice the union composition of the unit represented by CUPE, Local 920.  
The Board would have preferred that the Certified Nursing Assistants should join  
the CUPE unit, Local 920, which was a bargaining agent at the hospital for five  
full-time and four part-time nursing assistants, twelve laboratory technicians, four  
X-Ray technicians, two respiratory technicians, a health record technician,  
seventeen clerk-typists, three full-time and three part-time P.B.X. Operators,  
three cooks, twenty full-time and four part-time general workers, nine full-time  
and two part-time utility workers, five engine operators and four general  
maintenance tradesmen, in late November, 1980.  
The CNA's however, showed no preference to join the CUPE local. Their wish  
was to join the Registered Nurses' Union. The latter had altered its constitution  
to admit of such membership and by a majority vote indicated it would accept  
CNA's. There was no evidence to indicate that the CUPE local had tried to sign  
up the CNA's. …  
In considering whether there is a community of interest, the Board has examined:  
(1) the seven departments within the 113-bed hospital; (2) the participation on a  
“team unit” basis of CNA's except in one of those seven departments, that of  
intensive care; (3) the similarities in work assignments and the differences; (4)  
the lines of authority; (5) the growing assumption of responsibilities by and the  
job functions of CNA's; (6) the common factors of their working conditions  
including location and hours and benefits; (7) the professional standards for RN's  
and CNA's.  
Having weighed the pros and cons of all these factors, the majority of the Board  
finds that there is a community of interest between the RN's and the CNA's at  
this hospital, and that it is appropriate to include the CNA's in the Nurses' local.  
A caveat. This decision is not to be construed as in any sense supporting the  
breaking up of existing units in the Group 2 category.52  
[72]  
The dissenting employer member of the Board was unwilling to create a  
precedent and deviate from the hospital unit guidelines.  
It is the community of interest theme which is the chief criteria adopted by most  
Labour Relations Boards in Canada when using any guideline to determine the  
51 Hospital for Sick Children, 1985 899 (ON LRB), ¶ 36 - 37  
52 Highland View Regional Hospital, April 14, 1981, LRB #2719