September/October 2014
PM 40006768
JOURNAL
An appetite
for advocacy
Individual members are
often behind advocacy issues
taken on by RNAO.
Perks of student membership • New BPSOs in LTC • Enhancing dementia care
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Vol. 26, No. 5, September/October 2014
contents
Features
12
12 COVER STORY
An appetite for advocacy
Whether it’s medical tourism, elder abuse,
poverty, or any other advocacy issue, there’s
usually an RN, NP or nursing student
behind the scenes who felt compelled to
speak up when others would not.
By Melissa Di Costanzo
30
18 Students say membership “opens doors”
The first step to becoming an RN is a
nursing education. For the three soon-tobe nurses featured in this story, the next
step is membership with RNAO, their
gateway to learning opportunities they
won’t find in any classroom.
By Kimberley Kearsey
22 Shifting the spotlight to LTC
Long-term care organizations face unique
challenges, and that’s precisely why a new
set of requirements for BPSO designation
has been developed for this sector.
12
By Daniel Punch
25 The right help at the right time
Nurses and other health professionals at
The Scarborough Hospital receive special
education from the Alzheimer Society on
how to care for patients with dementia.
By Melissa Di Costanzo
the lineup
4 Editor’s Note
5 President’s View
6 CEO Dispatch
7 Mailbag
8 Nursing in the News
11 Nursing Notes
17 RN Profile
21 Policy at Work
24 Legal column
30 In the End
Cover Photo: Rob Waymen
30
22
Registered nurse journal
3
The journal of the REGISTERED NURSES’
ASSOCIATION OF ONTARIO (RNAO)
158 Pearl Street
Toronto ON, M5H 1L3
Phone: 416-599-1925 Toll-Free: 1-800-268-7199
Fax: 416-599-1926
Website: www.rnao.ca E-mail: [email protected]
Letters to the editor: [email protected]
EDITORIAL STAFF
Marion Zych, Publisher
Kimberley Kearsey, Managing Editor
Melissa Di Costanzo, Writer
Daniel Punch, Editorial Assistant
Editor’s Note Kimberley Kearsey
What is an advocate?
EDITORIAL ADVISORY COMMITTEE
Chris Aagaard, Shelly Archibald, Marianne Cochrane,
Rebecca Harbridge, Sandy Oliver, Carol Timmings
Art DIRECTION & Design
Fresh Art & Design Inc.
ADVERTISING
Registered Nurses’ Association of Ontario
Phone: 416-599-1925
Fax: 416-599-1926
SUBSCRIPTIONS
Registered Nurse Journal, ISSN 1484-0863, is a
benefit to members of the RNAO. Paid subscriptions
are welcome. Full subscription prices for one year
(six issues), including taxes: Canada $38 (HST);
Outside Canada: $45. Printed with vegetable-based
inks on recycled paper (50 per cent recycled and
20 per cent post-consumer fibre) on acid-free paper.
Registered Nurse Journal is published six times a
year by RNAO. The views or opinions expressed in
the editorials, articles or advertisements are those
of the authors/advertisers and do not necessarily
represent the policies of RNAO or the Editorial
Advisory Committee. RNAO assumes no responsibility
or liability for damages arising from any error or
omission or from the use of any information or
advice contained in the Registered Nurse Journal
including editorials, studies, reports, letters and
advertisements. All articles and photos accepted
for publication become the property of RNAO.
Indexed in Cumulative Index to Nursing and Allied
Health Literature.
CANADIAN POSTMASTER
Undeliverable copies and change of address to:
RNAO, 158 Pearl Street, Toronto ON, M5H 1L3.
Publications Mail Agreement No. 40006768.
RNAO OFFICERS AND SENIOR MANAGEMENT
Vanessa Burkoski, RN, BScN, MScN, DHA
President, ext. 502
Rhonda Seidman-Carlson, RN, MN
Immediate Past-President, ext. 504
Doris Grinspun, RN, MSN, PhD, LLD(hon), O.ONT
Chief Executive Officer, ext. 206
Daniel Lau, MBA
Director, Membership and Services, ext. 218
Irmajean Bajnok, RN, MScN, PhD
Director, International Affairs and Best Practice
Guidelines Centre, ext. 234
Marion Zych, BA, Journalism, BA, Political Science
Director, Communications, ext. 209
Nancy Campbell, MBA
Director, Finance and Administration, ext. 229
An advocate is described in the
Canadian Oxford Dictionary
as someone who supports or
speaks in favour of a cause.
What’s missing from this most
basic definition of the word
is the notion that an advocate
would not be an advocate if not
for the passion and conviction
that are as instrumental to their
advocacy work as knowledge of
the cause, whatever it may be.
This issue of Registered Nurse
Journal – like RNAO – is chockfull of stories of advocates who
are making inroads on a number
of important health, health care
and nursing issues. Our cover
feature (page 12) brings you the
stories of Pierre LaPlante, Diane
Shay, Kathy Hardill and Victory Lall, four nurses who have
courageously stepped up to the
plate and become the voices
behind the push to ban medical
tourism, conquer elder abuse,
and acknowledge poverty as
more than simply a barrier to
good health, but rather a determinant of it. These nurses have
sacrificed a lot of themselves for
their respective causes, and they
possess the kind of qualities that
make a difference when raising
awareness of an issue.
Our annual membership feature (page 18) brings you more
advocates in the form of nursing
students. Peter Su, Kathleen
Kerr and Naiema Alam are some
of the newest – and youngest
– voices behind RNAO membership, and their stories and
experiences will leave you optimistic about the future of the
profession. We are all in good
hands if students like Peter,
Kathleen and Naiema remain
involved in RNAO, and remain
as passionate about patient care
as they currently are.
This issue also touches on the
advocacy role nurses play in longterm care (page 22), and even
the advocacy work of lawyers on
behalf of nurses who are facing
complaints with the College of
Nurses of Ontario (page 24).
Street health nurse Victory
Lall suggests in our cover feature (page 16) that it should not
go unnoticed just how much
advocacy work RNs do in their
day-to-day working lives and
through RNAO. This important
work is noticed, and very much
appreciated, by nurses and
patients alike. RN
Louis-Charles Lavallée, CMC, MBA
Director, Information Management
and Technology, ext. 264
RNJ Is now
DIGITAL!
4
September/october 2014
As a member, you are eligible to receive a digital
copy of Registered Nurse Journal. You can choose
to receive only an electronic version of the
magazine by emailing [email protected] and stating
your preference for a paperless version. If you
haven’t received the magazine electronically,
please let us know by contacting [email protected]
president’s view with vanessa burkoski
Membership was “one of the best career moves I ever made”
I remember the first time i
learned about RNAO. I
was 19-years-old, doing my
undergrad in nursing at the
University of Windsor. Sheila
Cameron, one of my greatest
mentors to this day, was giving
a lecture, and she kept emphasizing the need to remain
abreast of current knowledge
– calling it a condition of professional practice and College
of Nurses of Ontario (CNO)
standards. At the time, I didn’t
understand the magnitude of
what she was saying, or how I
would ever stay current, given
health care and nursing are
constantly changing. All I knew
was that I needed to make
sure I had an easy, reliable way
of satisfying this regulatory
requirement. I asked her for
advice on the best resources to
keep up-to-date.
“Join RNAO,” she replied.
Professor Cameron told me
I would gain access to new,
developing and changing information that was based on
the best-available evidence. I
would be able to ask questions
about current and anticipated
changes in nursing that would
affect my practice. I would
be able to connect with other
RNs who, like me, were new
to the profession. And I would
be able to link with seasoned
nursing experts who could
help me develop my skills
and knowledge.
When I graduated and
entered the workforce, my first
nursing position was in public
health. I did not know it at the
time, but that was where my
passion for policy advocacy
would take root. Admittedly,
I did not join RNAO early in
my practice. My membership
started when I was working
in a newly formed community health centre. My role as
health promotion co-ordinator
led me to search for innovative
policy and program initiatives
that could support the health
needs of the local population.
During that search, I kept
coming across RNAO position
opportunity to read up on our
profession. I felt like I had the
inside scoop on what was happening in practice, research,
education, administration and
policy. I knew that if I had
an idea or concern that could
make a positive difference to
patients and/or nursing colleagues, all I needed to do was
call RNAO. And, I did call with
ideas about practice issues,
regulatory changes, and more.
I was listened to, and received
practical and timely responses.
“if i have any regret, it is that i
did not join rnao while i was a
nursing student.”
papers that addressed determinants of health, such as
poverty, nutrition and housing.
I was unaware RNAO was
involved in such a broad spectrum of critical health issues,
but truly appreciated its view
that “health is a resource for
everyday living.”
Choosing to join RNAO was
one of the best career moves I
ever made. Yes, I had a young
family, and a paycheque that
I needed to stretch pretty far
back then. But RNAO membership was worth every penny
then, and still is today.
Membership kept me
informed and helped to influence my practice.
With each issue of Registered Nurse Journal, I had the
When I went back to university to become a nurse
practitioner, I relied heavily on
RNAO’s best practice guidelines. The association was a
resource to get advice on how
to raise issues with administrative leaders to improve patient
safety and enhance quality of
care. As recently as 2011, when
I began my role as chief nurse
executive at London Health
Sciences Centre, I integrated
concepts from RNAO’s healthy
work environment BPGs,
including professionalism,
staffing/workload, collaborative
practice, and inter-professionalism, to create a healthier
work environment for my staff.
For 25 years, RNAO membership has fostered my
growth and given me the
opportunity to contribute in a
meaningful way to nursing and
patient care.
If I have any regret, it is that
I did not join RNAO while I
was a nursing student. Looking
back, the knowledge and experience I gained as an RNAO
member would have been
invaluable as a novice RN.
Choosing RNAO membership
is the first step in building the
confidence to achieve a fulfilling career. I urge each and
every one of you to ensure your
association’s continued success
by renewing your membership,
and inviting others to join.
Take the time to talk to a colleague or nursing student who
isn’t yet part of what we have
built together. We are more
than 39,000-members strong
and counting. We represent
hundreds of years of nursing
experience. Let’s build on that
for the betterment of the profession and the health system
in which we work. RN
vanessa burkoski, rn, bscn, mscn,
dha, is president of rnao.
Join forces with more than
39,000 RNs, NPs and
nursing students across
Ontario. Renew your
membership
• online at myRNAO.ca
• with an application form
from RNAO.ca
• or by calling
416-599-1925 or
1-800-268-7199
Registered nurse journal
5
CEO Dispatch with Doris Grinspun
Nursing: A feast of opportunities, a passport for life
I am often asked what it is like to
work with Ontario’s new Minister of Health Eric Hoskins, and
if the priorities for nursing have
changed since June’s provincial
election. The answer: We have a
good relationship with Minister
Hoskins, but at the end of the
day, what really counts is deliverables. On this, RNAO’s vision
for RNs, NPs and nursing students has not changed.
So, what do we expect from
our new government?
To answer this, let’s first
reflect on some RNAO-led
accomplishments. We called for
70 per cent full-time employment for RNs, and are close
to achieving that target. New
graduates are now guaranteed
full-time positions, and the LateCareer Nurse Initiative allows
nurses 55 and over to spend
time mentoring and engaging
in professional development.
Ontarians are fortunate to now
have 26 NP-led clinics, and
patients in hospitals are starting
to reap the benefits of NPs’ legislated authority to admit, treat,
transfer and discharge (ATTD)
from in-patient units. Chief
nurse executives (CNE) sit as
mandatory members on hospital boards, and each public
health unit in the province must
have a chief nurse officer. For
more RNAO achievements, see
the March/April 2013 CEO Dispatch, Advancing positive change
with premiers past and present.
Let’s look now at the future,
and our focus with the new
government.
We were thrilled this spring
6
September/october 2014
when Premier Kathleen Wynne
announced at RNAO’s Nursing
Week Career Expo that, if voted
premier again, she would
ensure RNs in Ontario would
be able to prescribe medications, and NPs to order MRIs
and CT scans. These announcements were important, and
a direct result of our intense,
evidence-based advocacy. They
will allow for faster and better
access to health services.
This summer, I briefed the
premier and Minister Hoskins
on RNAO’s top priorities for
of this enhanced NP role in hospitals. On Oct. 20, RNAO will
host a think tank with Ontario
CNEs to hear their progress and
to strategize next steps to cement
the comprehensive care NPs are
educated and authorized to provide. We are thrilled to partner
with the Nurse Practitioners’
Association of Ontario (NPAO)
and the Nursing Leadership
Network (NLN) as the two most
relevant interest groups on this
important policy priority.
So, what else is in store over
the next four years?
“our relationship with minister
hoskins is a good one, but, at the
end of the day, what really counts
is deliverables.”
the next four years. In addition to holding government to
its existing promises, a critical
change is NP compensation.
NPs in primary care are not
fairly compensated compared to
NPs who work in Ontario’s hospitals and other jurisdictions,
such as Alberta. We are working
diligently to change this, both in
terms of salary and benefits, and
I am confident it will.
We will also continue our indepth work with the ATTD task
force, co-led by RNAO President Vanessa Burkoski (herself
an NP) and Lakeridge Health
NP Michelle Acorn. The task
force developed a toolkit that has
helped with the implementation
Recently we released our
bold Vision, Charting a course for
the health system and nursing in
Ontario (RNAO.ca/vision). At
its core is health system transformation that takes advantage
of the comprehensive knowledge RNs and NPs have of the
system and the patient’s journey
through it. We see a health
system anchored in primary care
where RNs play a central role
in leading care co-ordination
and health system navigation.
This role was detailed in two
RNAO reports: Primary Solutions for Primary Care (RNAO.
ca/primary_care_report) and
Enhancing Community Care for
Ontarians (RNAO.ca/ECCO).
These important documents
also highlight the critical role of
long-term care (LTC) in the years
ahead. The progress here was
palpable when then Health Minister Deb Matthews announced
at RNAO’s 2014 Queen’s Park
Day funding for 75 NP positions in nursing homes. I was
delighted to co-chair a task force
with Debra Bournes, Ontario’s
former chief nursing officer,
to develop the role description
and urge a ratio of one NP per
150 residents. RNAO will continue to work side-by-side with
relevant interest groups (NPAO,
gerontological nurses and NLN)
to support our LTC NPs.
Going forward, how do we
optimize and expand the roles
of RNs and NPs in public health
and home care? And, what’s in
store for nursing students? On
this, stay tuned.
When I envision the future of
nursing, I truly believe that, of
all health professions, nursing
students will find themselves
at graduation with a feast of
opportunities and a passport
for life. Whether they join the
ranks of RNs or advanced practice nurses, including NPs, they
will experience a career second
to none. Choosing from a variety
of sectors, specialties and roles,
they will no doubt inspire themselves and others. RN
doris grinspun, rn, msn, phd,
lld (hon), o.ont, is chief
executive officer of rnao.
Follow me on Twitter
@DorisGrinspun
mailbag
RNAO wants your comments
on what you’ve read in RNJ.
write to [email protected]
a safer
sleep
A new RNAO best practice guideline
aims to clear up confusion on
how to keep babies safe during sleep,
and reduce the risk of SIDS.
By Melissa Di Costanzo
Windsor NP Elyse
Maindonald (left)
chaired RNAO’s safe
sleep BPG panel and
says nurses must be
role models to new
parents like Hali Sitarz
and her daughter Blair.
Photo: DaviD Lewinski
10
To swaddle or
not to swaddle
Re: A safer sleep,
May/June 2014
We are concerned about the
message in the final column
of your cover story, which
essentially bans swaddling for
infant care. This message is
not consistent with national
guidelines, is not a practice
recommendation of the BPG
itself, is not supported by a
balanced review of the evidence,
and undermines many parents’
efforts to provide responsive
caregiving by swaddling
their infants while trying to
calm and later settle them to
sleep in the recommended
back-lying position.
Expert national bodies, such as
the Canadian Pediatric Society,
the College of Family Physicians
of Canada, and the American
Academy of Pediatrics, endorse
a safe approach to swaddling
as a general practice for infant
care. In addition, collaborative
resources focused on safe
sleep, led by the Public Health
Agency of Canada, though
not specifically addressing
swaddling, do allow for the
use of a lightweight blanket
“if needed.”
Studies (e.g. the systematic
review in Pediatrics 2007)
report that swaddling, an
age-old practice, is an effective response to infant crying,
promotes sleep, benefits neuro­
development, and is associated
with decreased parent anxiety
and increased satisfaction.
Caution is warranted and practice advice includes using a
light blanket and allowing
freedom for flexion of the
legs and hips.
We encourage RNAO to
clarify the message about
infant swaddling and the use
of blankets with a broader and
more balanced examination
of the evidence and guidance
from our national expert
bodies. To do otherwise results
in confusion from conflicting
advice for both health-care
providers and parents.
Nancy E. Watters, Ottawa
Leigh Baetz-Craft, Toronto
RNAO responds
Certain swaddling techniques
may be more effective than
others to comfort infants
and promote development.
However, there is currently
no evidence on safe ways to
swaddle infants in the context
of sudden unexpected death
during sleep. Our recommendations are consistent with the
Joint Statement on Safe Sleep
(developed by the Canadian
Paediatric Society, the Canadian Foundation for the Study
of Infant Deaths, the Canadian Institute of Child Health,
Health Canada, the Public
Health Agency of Canada,
and other North American
experts), which asserts that
infants are safest when dressed
in one-piece sleepwear and
placed to sleep on a firm mattress with only a fitted sheet.
RNAO’s systematic review
of research investigating the
May/June 2014
RegisteReD nuRse JouRnaL
11
RNAO’s 90th
Annual General
Meeting (AGM)
Hilton Toronto • April 16-18, 2015
Call for resolutions
DEADLINE: Dec. 8, 2014 at 1700 hours
RNAO encourages individual members, chapters, regions
without chapters and interest groups to submit a resolution
for review and decision at the 2015 AGM.
Call for nominations
2015-2017 RNAO Board of Directors
DEADLINE: Dec. 8, 2014 at 1700 hours
As your professional association, RNAO is committed
to speaking out for nursing, speaking out for health.
YOUR talent, expertise and activism are vital to our success.
For the term 2015-2017, RNAO is seeking nominees for:
• PRESIDENT-ELECT
• REGIONAL REPRESENTATIVE FOR EACH OF THE 12 REGIONS
Also:
• Member, Provincial Nominations Committee (one RN vacancy).
In accordance with RNAO policies, members of board
committees shall be appointed by the board of directors.
If you require further information about the AGM, the call for
resolutions, or the call for nominations, including possible
additional vacancies on any RNAO board committee not noted
above, contact Penny Lamanna, RNAO board affairs coordinator,
at [email protected]
association between swaddling and sudden unexpected
death found conflicting evidence. Further research is
necessary before a conclusive
recommendation on swaddling
can be made, and RNAO will
continue to seek out this evidence in future updates to
the BPG to ensure nurses
are provided with the best
available evidence.
Registered nurse journal
7
RNAO & RNs weigh in on…
nursing in th
Immigrant experience
inspires RN’s debut album
Photo: Patrick Estebar. Styling: Jodinand Villaflores Aguillon. Make-up: Charm Torres
RN Haniely Pableo explores her identity, as a
Filipina immigrant caught between two worlds,
in the songs off her brand new album. A selftaught poet and musician, Pableo moved across
the world in 2006 as a 21-year-old nursing
graduate, and says she struggled to feel
comfortable in her new home. “When you go to
another country, you think you know yourself,
but you also start to form another identity,” says When she’s not in
Pableo, who now splits her time between
the operating room,
RN Haniely Pableo is
Toronto and London, where she works part time
exploring her immigrant
as an operating room nurse. “It can get
identity through music.
confusing.” Performing under the name Han
Han, Pableo developed a musical style fusing hip hop with Philippine tribal
rhythms, and addresses themes of identity and culture in her lyrics. The
result is her eponymous new album, released in September with funding
from the Ontario Arts Council. On the album, Pableo raps in a unique
blend of English and Philippine languages Tagalog and Cebuano. The
album’s lyrics also explore the intense emotions from what Pableo calls a
“typical” Filipina immigrant experience. “These songs are physically and
mentally exhausting,” she says. (Huffington Post Canada, Sept. 3)
Diabetes sufferers
learn to harvest
healthy choices
Ten Peterborough-area diabetes
patients spent the spring and
summer cultivating the keys
to their good health. Nurses
from the Centre for Complex
Diabetes Care at Peterborough
Regional Health Centre helped
patients as they took over a community garden, planting and
harvesting organic fruits and
vegetables. Community gardening has many recognized
benefits, says nurse practitioner
Jeanne Brown. “It has a positive
impact on a person’s physical,
8
September/october 2014
mental and emotional well
being, while providing increased
access to economical, nutritious, locally grown food.” The
gardens at St. Andrews United
Church were full of beans,
tomatoes, cucumbers, peppers
and spices as part of the project.
They provided patients with
access to healthy food choices,
while giving them a sense of
accomplishment and ownership over their health. “It builds
confidence, because you feel
like you’re doing your bit,” says
Brown. (The Peterborough Examiner, Aug. 1, Peterborough This
Week, July 31)
Nursing students aim
to bring nutritious food
to soup kitchens
An “eye-opening” experience
at a London soup kitchen gave
Western University nursing student Agata Pawlowski a fresh
idea. During a placement at St.
Joseph’s Hospitality Centre,
she and fellow student Steve
Trudell saw volunteers doing
their best to create nutritious
meals with a carbohydrateheavy food supply, but the pair
was struck by the lack of fresh
produce on the menu. “Nutrition was something that quickly
became apparent to us (at the
soup kitchen),” Pawlowski
recalls. Looking for a solution, the two nursing students
visited local grocery stores and
found that produce was usually
thrown out the day before the
end of its shelf life. That’s when
they created the Feed People, Not
e news
by Daniel punch
Starting a dialogue
about suicide
Photo: (Top) Jennifer Hamilton-McCharles / North Bay Nugget
Semi-retired RN Stan French patrols Ontario’s northern lakes from the
sky, watching for boaters who are not wearing PFDs.
Dumpsters project to collect this
nutritious food before it went
to waste. “As opposed to putting it into the dumpster, bring
it to soup kitchens…and put it to
good use,” Pawlowski explains.
So far, grocery stores have been
hesitant to donate food due to
liability concerns, but Pawlowski
assures them the Donation of
Food Act protects them from litigation when food is donated in
good faith. She hopes some publicity – the project was featured
by multiple news agencies – will
help kick-start donations. “We
need that one store manager to
step up and be that leader and
hopefully others will follow.”
(CBC Ontario Morning, Aug. 11)
Flying nurse teams up
with police to promote
water safety
When emergencies happen on
the waters of Lake Nipissing,
semi-retired mental health
nurse and pilot Stan French
flies into action on search
and rescue missions. But on
the Civic Holiday weekend in
August, French teamed up
with North Bay police to prevent nautical tragedies before
they happen. The president of
BAYSAR, a North Bay search
and rescue organization, joined
local police to patrol area waters
to see how many boaters were
wearing personal flotation
devices (PFD). “We want to
promote water safety, (and) try
and get people to wear PFDs,”
French says. The 15-member
BAYSAR crew piloted float
planes and helicopters over Lake
Nipissing, Trout Lake and Lake
Nosbonsing as part of the Let’s
See You Wear Your PFD survey.
Current laws require everyone
aboard a boat to have access to
a PFD, but don’t require them
to wear it. “The more people
that recognize that they will not
have time to put on their PFD if
it’s sitting in the boat when an
unexpected emergency happens,
the better their chances will be
of surviving,” French says.
(BayToday.ca, July 31)
Suicidal thoughts can leave
people isolated and feeling “they
don’t belong (or) they don’t
have a purpose in life,” explains
Elaine Santa Mina. To show
them they’re not alone, Santa
Mina joined RNAO’s Halton
chapter for a Dialogue on Suicide
Awareness, a community event
coinciding with World Suicide Awareness Day (Sept. 10).
Santa Mina, an RN who helped
develop RNAO’s best practice
guideline on suicide prevention,
was the keynote speaker for the
event, which drew health-care
leaders, politicians and more
than 90 community members.
“We wanted…to acknowledge
that suicide is happening, it is
real, and start talking about it,”
says Karimah Alidina, president
of the Halton chapter. Nearly 30
deaths every year are attributed
to suicide in the Halton region
alone. Local police receive at
least one call per day related to
suicide, Alidina says, adding
that age, gender and medical
history can be contributing factors. With such a pervasive
issue, it’s crucial to bring awareness, she says. “A dialogue is
the only thing that’s going to
bring the awareness and change
that we require.” (Halton Insider,
Sept. 11)
Taking a gentler
approach to
dementia care
Faced with an increasing
number of dementia patients,
Norfolk General Hospital (NGH)
Halton chapter President Karimah Alidina opens up dialogue about suicide.
Registered nurse journal
9
nursing in the news
out and about
People’s Climate March
On Sept. 21, concerned citizens in 162 countries around the
world participated in rallies to demand action to end the climate crisis. The events coincided with the gathering of world
leaders at a summit on climate change in New York City. RNAO
was among those who rallied in Toronto, bringing along banners
and enthusiasm for an important movement of millions. Joining
RNAO were Lisa Kowalchuk (left) and Ritika Goel.
Students participate in unique placement
RNAO invites students to participate in board of director and
assembly meetings annually. The placement offers an up-close
look at how the board makes decisions, and how home office
makes those decisions operational. Attending in September were
(L to R): Linna Feng (Humber College), Mercy Anuruegbe (St. Clair
College), Sandrina Ntamwemezi and Tellease Williams (both from
York University).
10
September/october 2014
is taking a page out of long-term
care’s playbook to care for this
population. The Gentle Persuasive Approach – a strategy for
identifying dementia that is
typically used in nursing homes
– is being taught hospital-wide
at NGH to any staff who may
come into contact with dementia
patients. “The strategies and
techniques help de-escalate situations. It really is the right thing
to do,” says Leslie Gillies, director
of NGH’s operating room and
intensive care unit. Ontario hospitals are seeing more and more
dementia sufferers as the population ages, and are looking to
prepare their staff. The Gentle
Persuasive Approach includes
eliminating the use of words
such as “aggressive,” which can
unfairly stigmatize patients with
dementia. “You don’t want to
label them,” says clinical nurse
educator Sherry Chambers.
“You want to understand them
as a person. That helps you give
better care.” Staff is also taught to
be mindful of personal space, to
redirect a patient’s anxieties, and
to try to understand the root of
negative behaviours. “Often their
behaviour is a sign of an unmet
need” such as hunger, thirst, or
the need to go to the bathroom,
Chambers notes. (Delhi NewsRecord, Sept. 4) See page 25 for
news on a similar Alzheimer
Society educational program. RN
Letter to the editor
In this Aug. 29 letter to the Barrie Examiner, RN Marilyn Muir
discusses the need for a unified seniors care strategy.
Caring for seniors is as natural as aging
I have worked in the health-care field since 1984, and
felt I had to comment on the recent headline about baby
boomers, of which I am one, and join the call for a national
seniors care strategy. When I entered the health field, all
we really could provide was care. We now have a treatmentbased system where pharmaceuticals and technologies have
allowed us to extend life. But are we easing suffering in the
senior population? To extend life without quality is cruel. The
government over the last 30 years has dismantled the systems that provided chronic care. We have a wonderful acute
care system that we should be proud of, but getting old and
dying is not a disease to be treated.
We have privatized care for seniors and it is not cheap,
while many services in the community are waitlisted. For
me, I want someone to care for me when I get old. I want to
see more discussion around the issues facing us as we age,
like end-of-life care and dementia. The issues of an aging
population cannot be solved by one system. The community
as a whole – federal, provincial and municipal governments
– must come together to find innovative, compassionate,
humane care opinions for us as we age. This is not about
those people over there. This is about us. Unless we die early,
we shall all age and face death. It’s natural.
nursing notes
continued
Is old data better than no data?
There’s a case of ‘I told you so’ brewing with news that public health bodies across
the country are starved for the detailed census information they need to evaluate programs and plan new ones. They are unable to determine how to reach marginalized
populations, and decide who needs targeting for which services. The lack of information can be traced back to the federal government’s decision to cancel its long form
census in 2010, and replace it with a less reliable voluntary survey of Canadians. The
long form’s highly detailed, systematic information on immigration, family and household structure, racialization, demography, and other vital information about Canadians
is no longer available. Prime Minister Stephen Harper announced the cancellation
of the mandatory long form census in June 2010. RNAO opposed the decision,
noting that “…we need to be able to rely on this information so we can make sure
people don’t become invisible.” An open letter to the prime minister, action alert and
media release were issued in 2010, but did not result in a reversal of the decision.
Those words from RNAO about invisibility are now stinging four years later. Public
health bodies are trying to generate their own data, but struggle with the costs and
the validity of findings. “The scope of collecting census-like data is well beyond our
resources,” a spokesperson from Toronto Public Health said in August. In fact, many
public health units across the country are making decisions and evaluating programs
based on 2006 census data because that’s the best they’ve got.
Study finds almost all
nursing grads are
working in the field
after graduation
$69,600 compared to $76,000
themes include: Nursing; A leading
year – Sunnybrook Health Sciences
according to the study. Workopolis
force for change; You think you
Centre and North York General
VP of HR, Tara Talbot, says it’s
know nursing? Take a closer look;
Hospital are among the latest to
no wonder the jobs in highest
and Nursing: You can’t live without
announce they will make masks
An online study of seven million
demand are skilled positions in
it. A cash prize of $200 is up for
mandatory – has sparked renewed
resumes has found nursing
health care, especially given the
grabs for the winning entry, plus
discussion. RNAO encourages all
students are most likely to land
increasing needs of the baby
bragging rights. Send your sugges-
nurses to get a flu shot, and sup-
employment in their field after
boom generation. Employers
tions to [email protected] ports hospitals that give staff a
graduation. The resumes were
are looking for people who have
by the midnight deadline on
choice between wearing a mask
analyzed by Workopolis, a Cana-
“critical thinking skills” and can
Friday, Oct. 24. For additional
and being vaccinated. According to
dian website that offers online
communicate well and problem
information, visit cna-aiic.ca and
the Canadian Healthcare Influenza
career support. It found 97 per
solve. The study was conducted
follow the “events” link.
Immunization Network, vaccination
cent of those who studied nursing,
online between May 15 and June
whether it was at the bachelor,
2, 2014. More than 3,600 people
master’s or PhD level, are working
participated in the poll.
in jobs related to their education.
Second in line was pharmacy at
Nursing Week 2015
Flu shot controversy
re-emerges
rates for health-care professionals
last year hovered between 40-60
per cent. RNAO is advocating for
Flu season is just around the
85 per cent immunization. The
corner and debate has begun once
association acknowledges some
nurses may consider wearing a
94 per cent. The study also found
The Canadian Nurses Association
again about the call for health-care
more people have their master’s
(CNA) is looking for help to create
professionals to get a flu shot or
mask “stigmatization” but asks
degree and PhD than 14 years
its theme for National Nursing
wear a mask. Last year, hospitals
nurses to consider the health of
ago. Forty-three per cent more
Week 2015 (May 11–17). The
across the country stepped up
their patients, their families and
Canadians listed a master’s
winning entry, which should focus
efforts to increase immunization
themselves first. RN
degree on their resume in 2014
on something that reflects the
rates by introducing policies that
vs. 2000, and 25 per cent more
values of the profession and the
require nurses and other health
listed a PhD. Graduates in health
contributions of nurses in different
professionals to wear a mask if
care were second to engineering
areas of practice in all jurisdic-
they choose not to be vaccinated.
graduates in terms of compensa-
tions, will be used for the next
News that more organizations will
tion, earning a starting salary of
two years (2015/2016). Previous
implement similar policies this
Do you have nursing
news to share? Email
[email protected]
Registered nurse journal
11
12
September/october 2014
An appetite for
advocacy
UHN RN Pierre LaPlante first
approached RNAO with
concerns about medical
tourism in 2012.
Photo: Rob Waymen
Many of RNAO’s advocacy efforts can be traced back to frontline registered nurses, nurse practitioners and nursing
students who have stood up and spoken out on issues that are
important to them. In this issue, we bring you the stories of
four courageous members who have drawn attention to three
causes that are central to RNAO’s work: medical tourism,
elder abuse and poverty. What made them shine a light on
these contentious topics? by Melissa Di Costanzo
Room 108 on Toronto Western Hospital’s orthopedic wing
used to function as a nurses’ lounge, complete with all the usual
necessities, including a couch, fridge and microwave. In the spring of 2012, these creature comforts were moved to
another space, two patient beds were wheeled in, and the room
scrubbed clean in preparation for its new occupants. The changes
were unremarkable, save for one detail: the patients who would
now occupy room 108 were from Libya. In what is defined as
“medical tourism,” their government paid in advance for them to
receive care in Canada. Staff on the unit – including RN Pierre LaPlante – was told that
the soon-to-be new charges were casualties of that country’s civil
war: people who had lost limbs and required corrective, reconstructive surgery. Whether they were combatants or civilians was
never indicated to staff. LaPlante remembers thinking to himself: “How will this change
affect workloads and budgets? How much patient history will practitioners receive? And will Canadian patients be second-in-line – or
sometimes bumped from line – when it comes to care?”
Registered nurse journal
13
At the heart of his concerns: How are these preferential services
being offered in Canada, a country with a not-for-profit healthcare system?
LaPlante picked up the phone and dialed a number of health professionals and organizations. Only RNAO responded.
“I…knew that there was something that needed to be done about
this,” he explains, adding he also knew he was “…opening up a
significant can of worms.” LaPlante – with a master’s degree in bioethics and a second in public health, nursing experience in the U.S.
for-profit system, and a unique international nursing perspective
after spending time working in Saudi
Arabia, Somalia and Burundi – worried
that the Canadian public had not been
consulted about medical tourism. “Even
for a blood transfusion, I (have to have)
informed consent,” says the RN. “Where
is the informed consent from Ontarians, to have international patients being
treated in our facilities as a revenuegenerating venture? It’s not a hospital
decision to make. It’s Ontario’s decision.”
The practice of soliciting international
Pierre LaPlante
patients for medical treatment within
the province’s health-care system dates
back to 2011, when University Health Network (UHN) (comprised
of four Toronto hospitals, including Toronto Western) disclosed
a $75 million agreement with the Kuwait government to provide
cancer care for a small number of Kuwaiti patients at Princess
Margaret Hospital.
When LaPlante contacted RNAO in 2012, he “...wanted (to
speak with) somebody who could explore (the issue), who had
some heft,” he explains. RNAO CEO Doris Grinspun, and members of the policy team, met with him and discovered they shared
the same concerns.
A follow-up meeting with LaPlante, Grinspun and then-UHN
President and CEO Bob Bell (now the deputy health minister)
followed in September 2012. Bell defended the practice by saying
it would create revenue so the hospital could provide more
services to Ontarians.
But RNAO argues medical tourism turns health care into a commodity, and contributes to the erosion of Medicare.
Hospitals are publicly funded organizations built to care for
the people who live in Canada, Grinspun says. They are not
and should not be made available to people from outside of the
country, except for patients who are in dire need of humanitarian
care, she adds. After all: if patients from other countries can fly to
Ontario and pay for treatment, what’s stopping Ontarians from
demanding that they, too, should be allowed to pay for preferential access to medical services?
Since LaPlante approached RNAO, the association has been
raising these and other arguments with politicians, the media and
the public. In fact, RNAO’s board of directors gave Grinspun the
mandate to ramp up efforts to draw attention to the practice until
the province bans it completely.
In the spring of 2013, the association
published an opinion piece; addressed
medical tourism in a pre-budget submission to the Ontario government; issued a
resolution at the Canadian Nurses Association’s annual general meeting, which
passed by an overwhelming majority;
and joined forces with the Association of
Ontario Health Centres, Canadian Doctors
for Medicare, the Association of Ontario
Midwives and the Medical Reform Group
in an open letter to Premier Kathleen
Wynne. RNAO has also been quoted in
numerous media outlets on the topic. The province has yet to prohibit the practice, which is why
RNAO’s efforts – including a media release and action alert that
has been signed by more than 2,500 people – have spilled over
into this year.
This spring, then-Minister of Health Deb Matthews responded
to the outcry, calling for an informal review of medical tourism.
Ontario’s current Minister of Health Eric Hoskins was quoted by
the media in August saying the Ontario government is an “ardent
defender” of the province’s universal health-care system. Ministry
officials, he said, are reviewing the policy for international patients.
Since this promise to investigate, the government has been
quiet on the issue.
LaPlante, who has shared his story with RNAO’s board of directors and is thrilled to see the issue broaden past his own initiative
and courage, says he will keep the pressure on. It is his duty as a
registered nurse, he says, to act.
“We have a gem here in Canada...that needs to be cherished and
needs to be protected,” he says. “I’m taken aback that (our healthcare system has been) so violated (without due process) for such
short-term interest.” RN
Six years ago, on May 25, 2008, a client kicked over a pail of
water at Cornwall’s Glen Stor Dun Lodge, a 132-bed long-term
care home located just steps from the St. Lawrence River. An
employee responded by tying the resident’s shoelaces to a nearby
table. A nurse came into the room and untied the client. But
the employee grabbed the resident by the shoulders, pulled him
up in his chair, and began to force-feed the man. The nurse
documented the incident and the employee received additional
education and was suspended for five days.
Diane Shay, an RN of over 20 years, was the City of Cornwall’s
health and safety officer at the time. The case came to her attention
several days after the incident. Familiar with the lodge’s non-abuse policy, and aware that any
instance of resident abuse has to be reported to the police and
Ontario’s Ministry of Health, Shay brought the matter to Robert
Menagh, the city’s human resources manager at the time. According
to court documents, Menagh told Shay to “be careful” about what
she does and to “just leave it.” Stunned, Shay then approached lodge administrator, Donna
Derouchie, urging her to report the incident to the ministry.
“Where is the informed
consent from Ontarians,
to have international
patients being treated in
our facilities as a revenuegenerating venture?”
14
September/october 2014
“I didn’t know what
was going to
happen next,
or how I was going
to do my job.”
Photo: Jason McNamara
Diane Shay
Derouchie said she couldn’t establish that what had occurred was
abuse, and did not report it at that time.
After repeated pleas to Menagh and Derouchie to report the incident, Shay took matters into her own hands and called the ministry
on June 11, 2008, one day after Derouchie was also in touch with the
ministry (a fact unknown to Shay at the time).
The ordeal continued to escalate when Shay, a city employee for
18 years, was accused of being insubordinate and disloyal. Feeling
intimidated, she reminded Menagh of the city’s whistleblower
policy, which he later accused her of misunderstanding. Shay
remembers driving into work in tears, and driving home in tears.
“I didn’t know what was going to happen next, or how I was going
to…do my job.” She began to have difficulty concentrating. Muscle
spasms and numbness in her hands and face followed. “The stress
really started to get to me,” she says, adding she went on medical
leave in September 2008. Six months later, Shay was fired. As a member of RNAO, she called home office looking for support, and received it through the Legal Assistance Program. The
association “supported me and believed me from day one,” she says.
“It was the best feeling.”
Shay retained a lawyer, filed a civil lawsuit against the city, and
was eventually reinstated. Then, in a separate case that was settled
in 2011, the Ministry of Health laid charges for illegal retaliation
against the City of Cornwall and Menagh. In October 2011, the
city pleaded guilty, was fined $15,000, and was required to pay
$3,750 to the Victim/Witness Assistance Program. RNAO responded
with a media release, praising the outcome of the case, and Shay’s
courage to stand up for residents’ rights. That same year, elder abuse was on RNAO’s radar. The association
launched an initiative, in partnership with the Canadian Nurses
Association, called the Prevention of Elder Abuse Centres of Excellence
(PEACE) initiative. Ten long-term care homes across the country
signed up for the project, which helped nurses and other health-care
professionals better identify and report elder abuse. Although preventing elder abuse was already part of RNAO’s
work, Shay’s case catapulted it into the spotlight. One year after
PEACE was launched, the federal government provided RNAO with
support to create a best practice guideline (BPG) that addresses
abuse and neglect of older adults. It was released this past summer. Shay, who sits on the Canadian Standards Association’s working
group charged with developing whistleblower guidelines, is pleased
to hear about RNAO’s BPG, and calls for stronger consequences if
elder abuse occurs, and if an employee raises concern. “Canada’s
in a sad state of affairs when it comes to whistleblowing,” she says.
“The (province’s) ministry of health has to get its act together.”
Now on long-term disability, Shay isn’t sure she’ll return to work
again. She paid a heavy price for doing the right thing. In 2013, she
was diagnosed with benign multiple sclerosis, with prominent symptoms related to workplace stress. “It’s been devastating. I’ve lost
something that I love doing,” she says of a career cut short. Still, she
stands by her decision, saying “there was never a question, ever,” that
abuse had taken place. As a nurse “you always have a responsibility to
report,” she says. “(For me), there was never a choice.” Shay wasn’t the first and won’t be the last RN to blow the whistle
on abuse. RNAO plans to continue raising awareness around the
elder abuse BPG. “What scares me (is) nurses who are going to
be afraid to come forward...who’s the advocate now?” she says.
“That’s why I continue to fight.” RN
Registered nurse journal
15
“really taken ownership of…and has been involved and active on a
Kathy Hardill remembers rolling up a patient’s pants and pulling
number of different fronts,” she says. The association has advocated
off his socks, which were glued to his legs. The man’s limbs were
for a national housing strategy, supported the Raise the Rates camcovered in gaping sores. To her shock, maggots began crawling out
paign to help boost social assistance rates, demanded increases in
from underneath his skin.
minimum wage, hosted poverty panels, joined poverty rallies, and
Although early into her nursing career, Hardill was able to contain
advocated for refugee’s rights. At the
her surprise, but says she “never, in 25
beginning of September, RNAO was also
years of life on earth, had any idea that in
on hand when Deputy Premier Deb MatCanada, someone could live like that. That
thews unveiled the province’s renewed
was a profoundly eye-opening experience.” five-year anti-poverty strategy, which
Hardill was working at Toronto’s
promises to eradicate homelessness
Street Health at the time, and remem(in fact, RNAO called for an anti-povbers a colleague saying “we can clean
erty strategy long before the province
up (the patient’s) legs and dress his
implemented its poverty reduction plan,
wounds, but until he gets housing, he’s
Breaking the Cycle, in 2008).
not going to get better.” This was “an
“The RNAO we know today is not the
important lesson, and one I’ve never
same RNAO that existed in the 90s,”
forgotten,” she says. Hardill says. Now, its advocacy efforts
Working with this vulnerable populaadd a unified “nursing voice to all of
tion, Hardill says she “...became aware
these struggles around access to the
that the kinds of interventions
social and structural determinants of
I’d been prepared to provide were
health. Nursing must speak out...(and)
grossly inadequate in the absence of
RNAO has become a rich resource for
political advocacy.” The poster in her
understanding the politics of health.”
workplace that read ‘Health is politHardill is now a primary care NP
ical’ was “...not just a poster,” she adds,
in Peterborough. Since she raised
explaining it was part of nurses’ day-tothe topic of poverty with RNAO over
day work and philosophy.
two decades ago, the association has
Hardill began her career in an ICU.
focused on monitoring social assistance
She wanted to continue in acute critical
rates, and will keep insisting the provcare, but shifted her focus after listening
ince raise the minimum wage to $14 an
to Dilin Baker give a presentation on
Victory Lall (right) on seeing a
hour. It has also maintained pressure
poverty and homelessness at a Nurses for
patient using the office sink as
on the federal government to impleSocial Responsibility meeting almost 30
a makeshift shower, and combing
ment a national housing strategy and
years ago (the group of activist nurses
his hair with a fork.
to restore cuts to the Interim Federal
is now defunct). Baker founded Street
Health Program for refugees. Along the
Health in 1986, and convinced Hardill to
way, RNAO has enlisted the help of many nurses who share Harvolunteer at the organization, later offering the young RN a job.
dill’s concern for these sometimes forgotten populations.
Hardill worked at Street Health for six years, then at Toronto’s
One such nurse is Victory Lall, an RN who works for a needle
Regent Park Community Health Centre for almost a decade. She
exchange program in Toronto. This past summer, she saw a
contributed to reports on shelter conditions, advocated for improved
patient using the office sink as a makeshift shower, and combing
access to affordable housing, and threw her support behind camhis hair with a fork. “I don’t need any more than that to see that
paigns to improve social assistance rates. Advocacy, she says, is a
housing impacts health,” she says. fundamental part of any nurse’s role. “If we start to think about
Last year, she and a number of community activists met with
what’s going on in the (greater) context for patients, then it’s always
municipal staff in Toronto to talk about opening a 24-hour women’s
about politics,” she says. “It’s always about access to the (social)
drop-in shelter. The matter is now before the city’s budget comdeterminants...and if we’re speaking out for health, we must speak
mittee. If it’s viewed as a viable option, council will vote on it.
out for access to the determinants of health.”
Advocacy for poor and marginalized populations is a long-term
This is a concept at the core of much of what RNAO does today,
effort. But Lall is hopeful, because RNs are advocating in every
but that wasn’t always the case.
aspect of their jobs, whether it’s accompanying a client to the hosIn fact, Hardill remembers meeting with colleagues and RNAO
pital because they’re terrified to go alone, or getting to the bottom
representatives in the early 90s, encouraging nurses and the associaof a patient’s inability to access community services. “It should
tion to speak out on homelessness. “The blister on the foot caused
not go unnoticed: (nurses are) doing (advocacy) every day.” RN
the infection that we can treat, but what caused the blister? Homelessness,” Hardill remembers saying. Her story is one of persistence
and passion in pushing an issue that, since the late 90s, RNAO has
melissa di costanzo is staff writer at rnao.
“I don’t need any more than
that to see that housing
impacts health.”
16
September/october 2014
RN Profile
By Melissa Di Costanzo
Finding a voice
Photo: Kyle Schruder
Advocacy wasn’t on Hilda Swirsky’s radar when she passed her nursing exams in the early 70s, but it is now.
Hilda swirsky was eight years
old when a friend of the family
offered to buy her “the prettiest
dress in the world.”
“I don’t want a dress. I want a
medical kit,” she replied.
She toted the rust-coloured
box to “appointments” with
neighbourhood children,
administering toy needles, listening to heartbeats with a
plastic stethoscope, and peering
into ears. Even at this tender
age, Swirsky knew she “wanted
to make a difference...to help,”
she says, which is why “nursing
has always been a calling for
me.” But her path to the profession wasn’t as direct as
she’d hoped.
As a teenager, Swirsky left
home and worked in offices
until her early twenties, all the
while dreaming of becoming an
RN. “Stop talking about nursing
and driving me crazy,” a friend
told her. “Give it up or do something about it.”
With that, she applied to
the York Regional School of
Nursing (now, Seneca College).
When she finished the twoyear program, Swirsky began
working at Women’s College
Hospital. It was 1972, and
nurses were told to walk two
steps behind doctors. That
didn’t sit well with Swirsky
and some of her colleagues, so
they refused. Nurses are equal,
collaborative partners to physicians, they argued.
Swirsky remembers this
as her first taste of advocacy.
“I was not specifically drawn
to advocacy work,” she says,
admitting she was very shy for
a long time. However, over the
years, and “…as a champion,
fighting for social justice, fairness, equity and human rights…I
became an advocate” for patients
and nurses.
Much of Swirsky’s 40-year
career has been spent in obstetrics at Toronto’s Mount Sinai
Hospital. She helped to found
the hospital’s Violence Against
Women Awareness Committee,
and was instrumental in shaping
officer for the Diabetes Nursing
Interest Group), worked as project manager for membership
and services at home office,
and served as member-at-large
for socio-political affairs on
RNAO’s board of directors. She
also helped to found the association’s International Nursing
Interest Group.
Swirsky has attended Queen’s
Park Day, and says a 2006 political candidate training session,
hosted by RNAO, became one
was president and a founding
member of the Canadian Nurses
Association’s Canadian Nurses
for Health and the Environment,
Mount Sinai’s green committee,
and is involved with the Canadian Coalition for Green Health
Care. “Having a healthy, sustainable environment is a must for
us to continue having a world
that our children and grandchildren can grow up in,” she says.
As for the future, Swirsky is
thinking about running for a
Three things you
don’t know about
Hilda Swirsky:
1. She enjoys reading murder
mysteries.
2. She shares a special
connection with her
10-year-old granddaughter
who lives in Israel.
3. Her recently renovated patio is
her favourite spot to relax.
its staff nursing council, acting
as chair for two years.
When that role came to an
end, Swirsky began craving
another opportunity to get
involved in her profession. A colleague suggested she check out
an RNAO Region 6 meeting.
Swirsky attended and was
elected treasurer, launching the
first of more than 25 years of volunteer work with the association.
She’s participated in interest
groups (she is currently the
policy and political action
of the catalysts for her interest in
politics. After an unsuccessful
attempt to capture the Liberal
MPP nomination for Trinity-Spadina, Swirsky threw her support
behind appointed candidate Kate
Holloway. She also supports
MPP Monte Kwinter (YorkCentre), and invited him to Take
Your MPP to Work, another politically focused event that gives
MPPs a sense of what a day in
the life of an RN looks like.
Swirsky’s focus has now
shifted to the environment. She
position with RNAO’s board of
directors again, and ramping up
her work with the environment.
Either way, she wants to continue to improve the quality of
her patients’ lives.
“At one time, I thought to be
successful (meant) you have to
be CEO of some company,” she
says, noting that she’s since realized success “…is just knowing
that you make a difference.” RN
melissa di costanzo is staff
writer at rnao.
Registered nurse journal
17
Today’s students become
tomorrow’s leaders
Despite competing demands on their time, thousands of nursing students
have discovered the value of joining RNAO and the benefits of getting involved.
by kimberley kearsey
A
s Peter Su stepped up to the microphone at
RNAO’s 2014 annual general meeting (AGM),
the Queen’s University nursing student says
his heart was “throbbing.”
“As a student, it’s really intimidating,” he says.
“Everyone…is an established nurse…part of an interest group or
president of something.”
Su was participating in
the board of directors’ student placement at the AGM,
learning more about the association, and rubbing elbows
with leaders from across the
province. He approached
the microphone because he
wanted to talk about how
proud and excited he is to
Peter Su
become an RN, and to also
encourage experienced nurses to engage students, and inspire them.
And “inspired” is exactly how he felt when he left the event and
headed back to Kingston. “It’s encouraging and motivating to know
there are all these passionate nurses trying to make a difference. It
makes you want to be a part of it.”
Doing a placement helped Su recognize there was no need to
be nervous about becoming involved. “Meeting Doris and Rhonda
made me realize they’re just normal people,” he says of his preconceived notion that presidents and CEOs of large organizations are
unapproachable. “They’re nurses, and I’m going to be a nurse too.
I can do this…it’s not that far out of reach.”
Su finishes the two-year fast-track program at Queen’s this fall,
and says taking on a leadership role at school felt natural. “I’ve been
really active at school as a nursing student (on nursing council).
RNAO is definitely a way
that I can continue…on with
that leadership.”
There’s no doubt this philosophy will help Su as he
embarks on his career, but
he’s not concerned about how
his RNAO membership looks
on his resume. “It’s for my
benefit to be part of RNAO
and not for other people to
say ‘oh, it’s a credential,’” he says. “It’s for my learning and (liability)
protection…it’s for me and other nurses adding to that voice.”
Plus, he’s a firm believer that when you become involved in activities outside of work or school, you bring that experience back to
your colleagues and classmates. “I can share that…enthusiasm, and
hopefully I can encourage them to be more involved. That feeling
of security and empowerment will spread.”
“It’s difficult for students to
step out of their comfort
zone and approach these
leaders who have all
this knowledge.”
18
September/october 2014
Some of his classmates have questioned the value of joining, and
Su’s response is simple: why not?
“By joining, you’re leaving all these doors open for learning opportunities, and opportunities to grow and…meet new people,” he says.
“Why close a door when…there’s no negative to joining. It’s $20…
and it’s definitely worth the $20.”
Ryerson University graduate Kathleen Kerr, who passed her final
exam this past June, has done
plenty of her own convincing
when it comes to RNAO
membership. She was on the
executive of RNAO’s Nursing
Students of Ontario (NSO)
interest group during her third
year. As membership officer,
she spoke to classmates about
what the association offers
Kathleen Kerr
fledgling RNs.
RNAO has “…a lot of political weight…a good voice…history…
and people respect RNAO because it’s well known for putting the
facts out there and…sticking up for the public,” she would tell
others. “This is nursing in action, not in the hospital setting, but
in the grand scheme of things.”
During her first year, Kerr was heavily involved in the Canadian
Nursing Students Association (CNSA). She says the national group is a
great way to network with other students, but RNAO offers something
a little different. “When you’re a student, you’re in this encapsulated
bubble of what your faculty teaches you and where you get a placement,” she explains, adding it’s hard to meet “in-the-field nurses.”
As an RNAO member, “…you get to meet all these nurses who do
crazy-awesome things that you didn’t even realize nurses could do.”
Promoting membership, Kerr says, wasn’t always easy, especially
when the audience was firstyear students. They “…lose
their focus on anything except
‘next week I have a mid-term,
the week after that I have a
paper, then I have a wedding,
then I have to work’…they
get inundated with the necessities,” she says, comparing
first year to the process of
writing up a budget. You have
your fixed expenses and you have the things you can have fun with.
“RNAO becomes one of those flexible things in their life.”
Although there are always opportunities to engage students more
at certain times of the year – for instance, Ryerson’s professionalism
class starts in January, and Kerr says that’s a good time to connect with
students and invite them to home office – Kerr acknowledges there’s
no disputing the increasing involvement of students over the years,
“When you’re a student,
you’re in this bubble of
what your faculty teaches
you and where you get
a placement.”
Registered nurse journal
19
while at the same time developing a real affinity for BPGs,
particularly the last decade. According to statistics
and taking steps to become a BPG student champion.
compiled by RNAO’s membership department,
Trent hosted a workshop about the guidelines and
student membership is the fastest growing catRNAO’s program, and Alam signed up. The group disegory of membership at RNAO, increasing from
cussed strategies for raising awareness of BPGs. To
1,555 in 2004 to almost 4,000 today.
achieve the title of champion, she was expected to host
Having started her first degree in 2005 (she
a BPG event of her own for fellow students. Alam and
toyed with being a researcher and did human
several classmates attended a workshop in Oshawa that
biology, chemistry and math), Kerr has seen a
focused on RNAO’s smoking cessation BPG, and decided
shift in student thinking first hand. With the
to take the lessons they learned back to Trent. They
baccalaureate requirement in Ontario now,
Naiema Alam attends a BPG
Symposium group discussion
tweaked the content so it was relevant for students, and
there are more young people getting into
in 2013.
had about 50 sign up for their workshop late last year.
nursing straight out of high school and doing
Each of those students is now expected to go on and create their own
four years. “I think that changes things. They’re young. No mortevent, based on that BPG or any other of their choosing. Once they
gage. No kids,” she speculates, which means more time to get
do, they too will achieve the title of champion.
involved. In addition to that, Kerr believes the focus on professionTrent is creating “a chain of champions…and that creates a growing
alism in nursing has had a huge impact. “Nursing is a very different
interest in BPGs at the school,” Alam says, adding it’s just one of
bubble than any other undergraduate program,” she says. “You’re
several ways the school raises awareness of evidence-based pracgrooming to be a professional and I think a lot of people want to be
tice. “Every year, you have at least a couple of courses where BPGs
that professional nurse. That image comes across with RNAO very
are everywhere. They’re in your required reading; you have to write
strong…and I think a lot of students respect that.”
papers about them. The first semester of nursing school, I wrote a
Kerr also suggests another big part of the increase in student
paper about a BPG.” She had a long-term care placement coming up
membership can be linked to the best practice guidelines (BPG),
and wrote about promoting continence.
which are a big part of the curriculum. Su agrees. “So much of
Alam believes student membership is on the rise because students
our schooling surrounds the use of best practice guidelines and
have the opportunity to get involved in various ways. When she attended
evidence-based research,” he says. “Sometimes it’s hard to make
her first champions workshop last year, there were between 10 and 12
that connection between research and practice, and the school
students participating. There were 50 registrants for the event she and
makes such a big effort to help us realize that link. A lot of it
her classmates hosted. She’s not sure
revolves around the BPGs.”
she can put her finger on exactly what
Trent University student Naiema
Membership by Employer
attracted more to the event, but specuAlam has been a big part of raising
lates social media likely played a role.
awareness of that link since she
Acute Care (16,800)
“It’s easier to get a hold of students and
became one of that nursing school’s
Other* (7,350)
notify them of what’s happening.”
BPG student champions last year.
Kerr also wonders if social media
The role was a natural fit for the
Primary Care (4,200)
is the reason behind the increased
22-year-old (now in her final year of a
involvement of students, or if
compressed program), who admits to
Community & Home Health Care (3,500)
“…they’re just starting to realize how
being the type of person who finds the
Elder Care (3,150)
important it is for their career.” She
common refrain ‘because that’s the
too saw a distinct increase in student
way we do it’ falls short when it comes
*“other” includes: college/university, retired, government, self
interest when NSO had as many as 40
to caring for patients. “I’ve always
employed, mental health, agency, unemployed
new students interested in attending
valued research,” she says. “When I’m
its meeting at the 2014 AGM. When
being told as a nursing student to do
Membership by Role
she first joined the group, you could
things a certain way, I want to know
count on one hand the number of stuthe reason behind it. When I discovdents attending the AGM.
ered BPGs, it was great…it had all
Other*
Kerr also speculates that students
those answers I was looking for.”
17%
are starting to see the comfort of
Alam admits to knowing little about
being part of the RNAO “family.”
RNAO or the BPGs before starting
Educator
It’s a “good, safe place to be” she was
school. When she began reading about
9%
once told by a long-standing member
the association in first year, and undershe heard speak at a chapter event.
stood Trent’s status as a Best Practice
Staff
Admin
64%
“I agree,” she says. “When I come
Spotlight Organization (BPSO), she
10%
here, I don’t feel stressed.”
decided she wanted to get involved, spe“It’s like a hidden treasure,” Kerr adds.
cifically becoming a student liaison. In
“Students just have to tap into it.” RN
that role, she connected with the local
chapter and with RNAO about events,
and passed the information along to her
kimberley kearsey is managing editor/
*“other” includes: nurse practitioner, clinical nurse
specialist, consultant, researcher
classmates. She did that for two years,
communications project manager at rnao.
20
September/october 2014
policy at work
to achieve the original target. To
soften the negative news, Matthews made a groundbreaking
commitment to end homelessness (only two other jurisdictions
in Canada have made such a
commitment). Sadly, there were
no targets attached to this piece
of good news. Grinspun called
the event a “non-announcement.” While admitting the
federal government has a role
to play, she says the province
has a responsibility to live up
to its promise since it launched
its much-heralded strategy back
in 2008. RNAO will continue
working closely with anti-poverty organizations to hold the
government accountable.
RNAO CEO Doris Grinspun (centre) attends consultation sessions at the Peoples’
Social Forum in Ottawa.
Photo: Ben Powless/Peoples’ Social Forum
RNAO attends
national forum on
social change
RNAO was invited to the
nation’s capital in August to
speak at the Peoples’ Social
Forum, billed as a grassroots
event to promote better social
and health policies. CEO Doris
Grinspun, alongside Nursing
and Health Policy Co-ordinator Shelley Martel, delivered
a workshop on how to build
stronger alliances with those
most affected by climate
change. Grinspun also led a
session that explored strategies to protect Canada’s health
system from those seeking
to profit from the delivery of
health services. Current threats
to the system include medical tourism, for-profit plasma
collection, public-private partnerships, and entrepreneurial
models such as competitive
bidding for home health services. In addition, Grinspun
was invited to participate in a
panel discussion organized by
the Canadian Health Coalition,
Canadian Doctors for Medicare and the Ontario Health
Coalition. For more information about the event, visit
www.peoplessocialforum.org
An update on
Ontario’s poverty
reduction pledge
RNAO CEO Doris Grinspun
was among invited guests at a
September media conference
where Deputy Premier Deb
Matthews unveiled the government’s progress report on
its poverty reduction strategy.
WoodGreen Community Services, a Toronto drop-in centre,
was the site of this event that
marked Matthews’ admission
her government fell short of its
goal to reduce poverty by 25 per
cent in five years. She pledged
the Liberals would redouble their
efforts over the next five years
of attracting RNs, NPs and
RPNs across all sectors of the
health system. Its objectives
are to identify the barriers that
affect recruitment and retention, and to come up with
short-, medium- and long-term
solutions so patients, particularly those in First Nations
communities, have adequate
access to health-care services.
The group’s report is set to
be released in the spring of
2015. For more details, contact RNAO Associate Policy
Director Tim Lenartowych at
[email protected]
Mixing policy
and politics
For the second year in a row,
RNAO is calling on members to
engage with their local MPPs to
take part in Queen’s
Park on the Road, an
RNAO has taken
initiative that gives
on an issue critpoliticians a chance
ical to ensuring
to connect with RNs
the health and
about the nursing,
wellbeing of
health and health-care
rural, remote and
issues unique to their
underserviced
particular communicommunities in
ties. The association
Ontario. The assoDavid McNeil, former
has invited all of
ciation launched
RNAO President
Ontario’s 107 MPPs
a task force this
to the meetings,
spring to look into
which also provide a
strategies that will
forum for registered
help to stem a
nurses to share firstshortage of nurses
hand experiences that
working in these
can improve patient
communities. Cocare and the delivery
chaired by former
of health services. To
RNAO President
find out more, visit
David McNeil, and
Louise Paquette,
QPOR.RNAO.ca and
Louise Paquette,
CEO of the North East
follow the links to get
CEO of the North
Local Health
involved. If you have
East Local Health
Integration Network
questions, contact
Integration NetShelley Martel, RNAO’s nursing
work, the first-ever nursing
and health policy co-ordinator, at
task force includes members
[email protected] RN
familiar with the challenges
Rural and remote
nursing issues take
centre stage
Registered nurse journal
21
Turning the spotlight on
long-term
care
Four new Long-Term Care Best Practice
Spotlight Organizations foster evidencebased practice in a complex sector.
by Daniel Punch
T
cent decrease) within six months. This “small victory” inspired staff
he long-term care (LTC) residents of a historic, yellowto go further with best practices, Tibbo says. “We saw what success
brick house in the small, Bruce County farming
we could have, and we thought, ‘why don’t we do more of this?’”
community of Chesley, Ontario have seen the impact
This was Parkview’s first step toward joining 73 other RNAO Best
of evidence-based practice firsthand. They are falling
Practice Spotlight Organizations (BPSO), health-care organizations or
less in the repurposed 113-year-old mansion, known as
conglomerates that formally implement and evaluate BPGs with supParkview Manor Health Centre. That wasn’t the case in early 2013,
port from RNAO. Parkview, Hamilton’s
when Parkview’s falls rate – the perSt. Peter’s Residence at Chedoke, Sarcentage of residents who had fallen
nia’s Vision Nursing Home, and five
within the past 30 days – was more
LTC homes in the Region of Peel will
than double the benchmark set by
make up the first cohort of RNAO’s new
Health Quality Ontario. “Falls were a
LTC-BPSO program. The four organizabig issue for us,” says Teresa Tibbo, a
tions – eight homes in total – are now in
Parkview RPN and staff educator.
the early stages of a three-year designaIn fact, they’re a big issue for many
tion period. They’re laying the framework
LTC homes. The provincial falls rate
Proud members of the BPSO team at Hamilton’s St. Peter’s
for guideline implementation, and if
is just under 14 per cent, and falls are
Residence at Chedoke include (L to R): RN Janine Mills,
administrator Renee Guder, BPSO liaison Jennifer Walker,
successful in completing the program,
responsible for the vast majority of
RNAO LTC best practice co-ordinator Elaine Calvert,
they’ll gain BPSO designation in 2017.
serious injury hospitalizations among
CEO Steve Sherrer, and RN Cindy Frankum.
It’s an opportunity that was not
elderly Canadians.
possible for LTC in the past. Carol Holmes, RNAO’s LTC program
Looking to better protect Parkview residents, Tibbo turned to
manager, says that, in the past, many homes struggled to meet
RNAO’s Prevention of Falls and Fall Injuries in the Older Adult best
BPSO requirements because of the sector’s unique challenges,
practice guideline (BPG). She created a falls prevention informaincluding staff turnover rates and the high complement of unregution package and worked closely with residents and their families
lated care providers. This got RNAO thinking about how to modify
to develop holistic prevention strategies. Parkview staff reevaluated
the BPSO program to meet the needs of LTC, while keeping the
medications looking for falls risks, installed bed and chair alarms
same systematic, evidence-based, rigorous and robust approach.
to alert them if residents were in precarious positions, and thought
“We wanted to shape the program requirements in a different way
outside the box – looking at residents’ shoes, their vitamin D intake,
so that more homes could be successful and able to sustain their
and other factors to narrow down potential causes.
work,” Holmes says.
The results were striking. Parkview cut its falls in half (a 46 per
22
September/october 2014
Find out more
about the LTC BPSO program,
and the call for proposals, at
RNAO.ca/BPG/BPSO/LTC
Following consultations, a brand new BPSO request for proposal (RFP), tailored specifically to the LTC sector, was released
in late 2013. It differs from the typical BPSO RFP in a number of
key ways. Instead of five guidelines, LTC-BPSOs must implement
a minimum of three (as it was at the outset of the BPSO program
when the first hospital joined). Financial and research requirements have been loosened to account for budgetary and staffing
constraints in LTC. And RNAO is providing the services of its
LTC best practice co-ordinators, based in the province’s 14 LHINs,
to serve as BPSO coaches.
Elaine Calvert is the LTC best practice co-ordinator for the Hamilton Niagara Haldimand Brant LHIN. She’ll now be working one
day a week to support St. Peter’s Residence at Chedoke.
“My role as a BPSO coach is to support the implementation, evaluation and sustainability of the work they’re doing,” says Calvert.
“As coaches, we’re privileged to spend an increased amount of time
with the home. As a result, we have an opportunity to immerse
ourselves in their organizational culture.”
Calvert says the LTC sector has many competing demands,
including the need to meet requirements of the Long-Term Care
Homes Act. Becoming a BPSO will allow homes to satisfy these
requirements, while meeting organizational goals and fostering
an evidence-based culture for the future.
“Often, when you take care of best practice, a lot of the other
challenges you’re facing take care of themselves,” says Calvert.
St. Peter’s, a 210-bed facility, is no stranger to BPG implementation. In 2013, staff reduced its rate of wound infection by 75
per cent using a number of RNAO wound care BPGs. The home
has also implemented guidelines on falls, pain management and
incontinence, but didn’t apply for formal BPSO status until the program was adapted for LTC.
Given its best practice experience, St. Peter’s will take on an
ambitious six guidelines during its three-year BPSO candidacy
period – twice as many as is required. “Of course it’s going to be
a challenge, but it’s a challenge that we’re up for,” says Janine
Mills, RN and director of care. “We’re hoping that the guidance
of our BPG coach, and support from our colleagues in the BPSO
initiative…will help us zone in on where we can improve.”
Nurses from the four LTC BPSOs joined RNAO staff and
health-care dignitaries at the program’s official launch in
April. Deb Matthews, Ontario’s Minister of Health at the time,
congratulated them for embarking on an “extraordinary journey
of quality improvement.”
“You are pioneers,” Matthews said. “You are at the forefront of a
very important movement.”
As is the case with pioneers, others are expected to follow in
their footsteps. RNAO hopes to expand the program, enlisting
more of Ontario’s 640 LTC homes as BPSOs (the hope is to have
at least one from each of the LHINs).
“Over time, we’d like to see much more engagement,” says
Holmes. “We’d like to see this grow.”
The program has already gained plenty of ambassadors among
staff of the first four LTC-BPSOs. “Spreading the word and helping
others to realize the value of best practice is very exciting to me,”
says Tibbo, who serves as Parkview’s BPSO liaison. “Now we’re
going to put ourselves in the spotlight.” RN
daniel punch is editorial assistant at rnao.
Registered nurse journal
23
Legal Column
By Tim Hannigan
Know your rights
A practical guide to dealing with CNO complaints.
One of the most stressful situations that can arise for any nurse
is receiving notice from the College of Nurses of Ontario (CNO)
that a complaint has been
launched against you. These
complaints can take months,
and sometimes years, to reach a
final resolution, and the potential consequences may include a
suspension of your license, and
in rare cases, reversal of your
nursing certification.
I recently represented a
nurse who has been practising since 1980 without
incident. Last year, a patient’s
family member issued a complaint against all of the nurses
involved in their loved one’s
care, including my client, who
managed the nurses providing
that care. I have also represented a nurse dealing with at
least four separate complaints
over the past six years. In each
case, the nurse acted appropriately, but given she regularly
performs capacity assessments, she is at higher risk if
a family member objects to
her assessment.
As stressful and difficult as
these situations can be, there
are a number of rights that RNs
have, and should keep in mind.
You have the right to legal
assistance; the right to know the
details of the complaint and the
specific nursing issues being
investigated; the right to provide
a written response; and the right
to have adequate time to provide that response. Nurses also
have the right to an adequate
24
September/october 2014
and impartial investigation,
and a written explanation of the
final decision.
Notice of a complaint from
CNO typically arrives by mail.
The letter will include a copy of
the original criticism or grievance, and usually an invitation
to contact CNO to discuss the
matter further. Prior to initiating that contact, nurses should
first seek legal advice. For those
who have enrolled in RNAO’s
immediately to a complaint. If
CNO investigates the matter, the
investigator will gather relevant
documentation, and you will
receive disclosure of the relevant
materials. CNO will identify
specific areas that require a
response, including the practice
issues involved. You will have at
least 30 days to prepare and provide your written submissions.
It is important to note that
investigators are not decision-
“you have the right to legal assistance; the right to know the details
of the complaint and the specific
nursing issues being investigated; the
right to provide a written response;
and the right to have adequate time
to provide that response.”
Legal Assistance Program
(LAP), this starts with a phone
call to the program’s administrator. If you are represented by
a lawyer (through LAP or otherwise), CNO will not contact you
directly, but rather deal with
your lawyer. This removes some
of the stress of the situation,
particularly when it comes to
explaining your position clearly,
or worries associated with misstating something that could
prove to be an issue during
an investigation.
You do not have to respond
makers. Their job is to gather
the information, including
your response, and present
it to the Inquiries, Complaints
and Reports Committee (ICRC).
Upon review, ICRC may close
the matter without action, issue
a non-disciplinary caution or
concern, or refer the matter to
the Discipline Committee. Its
decisions are not public, and it
cannot discipline the member.
This is the responsibility of the
Discipline Committee.
Complaints may also be
resolved without a complete
investigation, through a process
called Alternative Dispute Resolution (ADR). Approximately
one-third of all complaints are
resolved this way each year. This
involves the complainant and
the nurse agreeing on a co-operative resolution. This process
is not about blame, or acknowledgement of wrong-doing, but
rather a commitment to engage
in activities that are mutually
agreed upon and approved by
ICRC. I have been involved in a
number of cases where the parties have successfully resolved
the complaint with the understanding the nurse will engage
in reviewing certain educational
information related to the
issue(s) identified.
According to CNO’s Annual
Report, there were 340 complaints resolved in 2013. Of
these, 122 were resolved
through ADR, 156 resulted in
no action, and 49 concluded
with a letter of concern or caution. Four complaints led to oral
cautions, and the same number
resulted in specific actions
agreed upon by both parties.
Only five matters were referred
to the Discipline Committee.
I always tell clients that
a complaint can happen to
anyone. Be aware of your
rights, and don’t be afraid to
ask for help. RN
tim hannigan is a lawyer at ryder
wright blair and holmes in
toronto. he has been representing members of rnao’s lap
program for more than
12 years.
A life enjoyed
with the right help
Nurses and other health professionals offer enhanced care to
dementia patients thanks to Alzheimer Society educational program.
by Melissa Di Costanzo
Photo: Carlos Osorio/Toronto Star
B
efore every shower, Jerry*
would resist, kick, hit and
yell. Staff at The Scarborough
Hospital (TSH) couldn’t understand why bathing caused him
such anxiety. A dementia patient on the hospital’s mental-health unit, his methods of
communicating discomfort were limited
to acting out due to the crippling mental
effects of the disease. Staff considered using
medication to calm him. Nurses tried
coaxing him into the stall, to no avail.
Members of the security team were
often called because providers feared
for Jerry’s safety and their own.
TSH psychogeriatric assessment
RN Sarah Aiken says heavy workloads and busy shifts often mean
nurses struggle to get to the bottom
of their patients’ anxiety. In many
instances, nurses have little time to
explain the steps leading up to – and
the pain that will accompany – an
injection, for example. Surprised
by the jab, many with dementia
will lash out if they’re not properly
warned. “We forget that patients with
dementia (lose) their verbal and reasoning insight. They know there’s
something wrong, but they can’t tell
you what’s wrong,” says Aiken.
Plus, many nurses don’t recognize
the signs and symptoms of dementia,
and may become frustrated or impatient
with patients’ loss of judgment and reasoning, and changes in mood and behaviour
that are common effects of the disease.
“If (patients) are able-bodied…you tend
to (expect) them to respond normally,”
Aiken explains.
Jerry’s team of health providers eventually learned he doesn’t like being cold.
They assured him that, before every
shower, they would run the water to
ensure it was warm. And they brought
* Pseudonyms have been used to protect privacy
extra towels to scrub him dry. “Understanding what patients are trying to
communicate is the most important
thing,” says Aiken. After this reminder,
she decided to learn more about the disease by turning to the Alzheimer Society
of Toronto (AST).
Aiken discovered the Dementia Care
Training Program, which provides practical,
theoretical and research-based education.
approaches. Participants, for example,
wear glasses that blur their vision and have
their fingers taped to mimic the effects of
arthritis. Communication is also emphasized, because dementia patients have
difficulty interpreting meaning, and words
don’t come easily to them. Relaying care
plans to providers during shift changes
also ensures everyone is aware of mood
patterns and preferences.
RNs Vivian Rabinovitch (left) and Sarah Aiken now have a framework and language to work with when
caring for patients with dementia.
She pushed for the four-class program at
TSH, and signed up 10 providers from
the psychogeriatric floor, including nurses
(Aiken was one), occupational therapists
and social workers.
“It’s about slowing down, and teaching
people to see (things) through the eyes of
the elderly,” says Aiken. Esther Atemo,
public education co-ordinator with AST,
says the focus is on non-pharmacological
For psychogeriatric RN Vivian Rabinovitch, the course helped her to put herself
in her patients’ shoes. “If you haven’t had
this kind of training, you tend to act more
from the gut,” she explains. The program
“gives you a framework and language...and it
removes some of the anxiety around caring
for (patients with dementia).” Rabinovitch has
worked with older adults for about a decade,
Continued on page 26
Registered nurse journal
25
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NPAO looks forward to welcoming you to
Three practicum starts you coaching cancer
Hamilton, Ontario this Nov. 6 - 8 for the 2014
patients in your community. Recognized
NPAO Annual Conference. This professional
Canada-wide by medical oncology
conference offers a selection of interactive
professionals. Since 2004. Classroom and
workshops, sponsored symposia dinners and
online distance program 365 days/year.
breakfasts, plenary and concurrent sessions.
Please contact us for more information.
This is the only professional conference that
www.cpccprogram.com
brings NPs together to discuss issues of
905-560-8344 • [email protected]
critical importance across specialties and
practice settings. To access further details
Too young to retire?
We are looking for retired nurses who may
consider themselves much too young to
retire and would appreciate the opportunity
to join the workforce once again. We are a
start-up, looking for the expertise of nurses
to help build our business and provide
valuable training services. Do you want to
feel more useful in your retirement? Contact
Al Kay at 416-252-2521 or by email at
[email protected]
Registered Nurses – Operating Room
Vancouver General Hospital (VGH)
Exciting • Complex • Challenging
VGH is a tertiary level organization and the
provincial trauma, neurosciences, spinal cord injury
and cancer treatment referral centre for the province
of B.C. Our perioperative services include trauma,
lung, liver and kidney transplants as well cardiac
surgery, thoracic, vascular, neurosurgery, spinal cord,
orthopedic, plastics, urology, gynecology, ENT,
ophthalmology and general surgery. Two of our
20 ORs are dedicated to robotics.
We have full time positions available for
Registered Nurses.
Apply today by visiting:
jobs.vch.ca
Phone: 604.675.2500
Toll Free: 1.800.565.1727
We are looking for RNs with two (2) years’ recent,
related experience in an acute care operating room
environment who have completed an accredited
Perioperative Nursing Specialty Certificate Program
that are ready to take the step to the ultimate level.
These positions offer you the opportunity to work
alongside experts in their fields both nationally
and internationally.
Make the move to Vancouver and be part of one
of the most innovative, fast paced and challenging
Operating Room environments in the country at
VGH, a part of Vancouver Coastal Health.
Come for the job.
Stay for the team.
and to register, please visit www.NPAO.org/
education/conferences
A life enjoyed with the right help
(continued from page 25)
and says the course was a good reminder that
“all behaviour has meaning.”
“We need to step back and remember:
whatever kind of angst we’re having, their
angst is tenfold, their suffering is tenfold,”
she says.
RNAO Immediate Past-President Rhonda
Seidman-Carlson is VP of interprofessional
practice and chief nursing executive at TSH.
In an acute-care setting – where the average
patient is over 70 – nurses make up the bulk
of the staffing pool, she says. They play a
central role when it comes to providing safe,
quality care to the elderly, which is especially
important when you consider Alzheimer
Society of Ontario statistics that suggest
181,000 seniors in the province are living
with dementia. The organization’s national
counterpart says 747,000 Canadians have
the disease, a number that is expected to
double to 1.4 million by 2031.
Nurses must understand the effects of
this disease on patients, Seidman-Carlson
says. That means using less psychotropic
medications, which can be linked to falls
and agitation, and decreasing reliance on
restraints, which can increase anxiety, skin
breakdown and incontinence. This will, in
turn, help to reduce length of stay and help
the client feel like “an individual, as someone
with remaining abilities, and not just losses.”
“For those living with dementia, we want
them to do exactly that: live with dementia,”
Seidman-Carlson says. “We do not want it
to be merely an existence, but rather a life
enjoyed in all ways possible.” RN
melissa di costanzo is staff writer at rnao.
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Lead practice change. Be an innovator.
The Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto
offers advanced educational opportunities for nurses and other health care
professionals to expand their knowledge in clinical practice, education,
leadership, research and informatics.
OCTOBER 2014
• Review of Health Assessment Across the Lifespan – October 25
DECEMBER 2014
• The Foundations and Scholarship of Clinical Teaching – December 4 & 5
• CRNE to NCLEX: A Transition Course - December 12
• NCLEX-RN Exam Prep Course – Designed for Canadian Writers – December 13 & 14
FEBRUARY 2015
• Institute on Advancing Pain Assessment and Management Across the Life Span
- 2 day course
Follow us on
Twitter
@ UofTNursing
http://bloomberg.nursing.utoronto.ca/pd
Come for the job.
Stay for the team.
Nursing Opportunities available in the Coastal Communities of
Powell River, Sechelt and Squamish:
• Acute Medicine & Surgery
• Critical Care
• Emergency
• Emergency – RN First Call /
Remote Certification
• Obstetrics/Med/Surg
• Residential / Extended Care Nurses
Nursing Opportunities available in North Vancouver, Richmond
and Vancouver:
VCH Emergency Dept. Employees – Lions Gate Hospital
4 Incredible Lifestyle
Advanced Practice Nurses:
• Clinical Nurse Educators
• Clinical Nurse Specialists
• Experienced Resource Nurse Pool
(3+ years)
4 Outstanding Career Move
Phone: 604.675.2500
Toll-Free in North America: 1.800.565.1727
VCH-JUL-041-14 RNAO
• Bone Marrow Transplant
• Community and Home Health
• Critical Care
• Emergency
• Emergency Geriatric Triage
• High Acuity Med/Surg
• Home Care Nurse (Quick
Response Team)
To find out more and to apply,
visit:
jobs.vch.ca
• Operating Room
• Palliative
• Perinatal
• Psychosis
• Cell Separator/Asphresis
• Short-stay (High acuity)
• Nurse Practitioners
• Transition Services Coordinator
in the end
By marilyn king
illustration: Dushan Milic
What nursing means to me…
Nursing to me is all about access and equity. As a nurse in the community, I see myself as an ‘accessibility agent,’ helping patients and
families to determine their needs and make the connections to get
the care they deserve. But there are a number of barriers that make
it difficult for many individuals and families to be independent
when it comes to accessing services.
As I walk up to the door of my local medical clinic, the sign
reads: Push hard to open. It bothers me every time I visit. What if
I can’t push hard? What if I
Drop us a line or two
can’t read the sign? Is this
Tell us what nursing means to
the way human services, or
you. Email [email protected]
any service, should be?
I have always known that part of a nurse’s role is to help
people to be as independent as possible. As I look at technological
and other so-called ‘advances’ in care, I am not so sure the impact
on patient accessibility is considered. The population is aging and
the number of new immigrants is increasing. I wonder if the widespread use of automated phone messaging services will meet their
needs. Can they hear or understand the phone prompts? Many
seniors I know don’t want to, and don’t leave messages. How do
they book appointments? If they do leave a message, but don’t have
an answering service at home, how do they get their appointment?
When I consider these things, I can’t help but wonder if it is the
service or the patient that is hard to reach.
30
September/october 2014
The concept of service hours stretches back before technology was even an idea, yet we struggle, as we always have, to
accommodate the person who has to work two or more jobs
to feed their family, and isn’t available for appointments during
regular working hours.
And then there’s the younger end of the age spectrum: youth
and young parents who, because of low income status, rely on text
messaging for communication. Some people call this generation
hard to reach while, in my mind, services have not changed to
accommodate their shifting needs.
As a public health nurse in rural Ontario, I see low income
families moving to the country for less expensive housing. The
housing may cost less, but accessibility problems lie in centralized services, which may appear to be fiscally responsible for the
system, but ultimately download the expense of travel to families.
There are no buses in these more affordable communities, and
cars are a considerable, ongoing expense.
I am rewarded in my work as a nurse and ‘accessibility agent’
when a family finally gets that much-needed service. And when
public health is acknowledged for helping patients rather than
simply watching them jump through hoops to find assistance. RN
marilyn king focuses on social determinants of health in her role
as a public health nurse for the huron county health unit.
PATIENT
INTERVENTIONS:
A TAILORED
APPROACH.
WHY ONE SIZE
DOESN’T FIT ALL.
DECEMBER 5 – 6, 2014
[ PRE-CONFERENCE DECEMBER 4 ]
HILTON TORONTO DOWNTOWN
2014 PROGRAM HIGHLIGHTS
• How CVD is changing, and how that affects risk factors and prevention strategies.
• Discussions on new medications: antiplatelets, DOACs, NOACs and therapies
in diabetes.
• Practical advice on applying the latest hypertension and lipids guidelines.
• How to prescribe exercise and diet for cardiac/stroke patients.
• Practical discussion on the management of cognitive impairment,
TIA, angina, palpitations, heart murmurs, and heart failure.
Call 1-866-317-8461 ext. 2 or email [email protected]
or visit heartandstroke.ca/clinicalupdate
S•R•T Med-Staff is a trusted leader in the healthcare community with
a reputation for excellence in quality of care. With the greatest variety
of shifts and top pay rates to the highest quality of nurses, it’s no wonder
Toronto RNs & RPNs continue to rank S•R•T Med-Staff number one
or that so many healthcare providers trust S•R•T Med-Staff personnel
to provide an exceptional level of care.
Contact us today for your personal interview at 416•968•0833
or [email protected]
On The Pulse
of HEALTH CARE
SRT Medstaff 4 Colour Ad – RNAO. 2011.
7.125 inches wide x 9.875 inches deep.
Contact: Eric Bell 416 961 4060 ext 224