May/June 2016 May/June JOURNAL
Better health behind bars RNs advocate for a forgotten population.
AGM 2016 • Nurses and PTSD • Nursing Week 2016 BILINGUAL ONLINE ONTARIO BREASTFEEDING SERVICES
Breastfeeding mothers benefit from peer support. Sometimes they need help and support from professionals and experts as well. This directory has it all. You can now give your patients this link: Bilingual Online Ontario Breastfeeding Services directory www.ontariobreastfeeds.ca
To order postcards for your office, call 1 (800) 397-9567 or go to www.beststart.org/resources/ breastfeeding
RÉPERTOIRE EN LIGNE BILINGUE DES SERVICES D’ALLAITEMENT DE L’ONTARIO
Les mères allaitantes bénéficient du soutien mutuel d’allaitement. Parfois, elles ont aussi besoin d’aide et de soutien de professionnels et d’experts. Ce répertoire vous donne accès à une mine d’information. Vous pouvez maintenant partager ce lien avec vos patients : Répertoire en ligne bilingue des services d’allaitement de l’Ontario à: www.AllaiterEnOntario.ca
Pour commander des cartes postales pour votre bureau, composez le : 1 800 397-9567 ou visitez le www.meilleurdepart.org/ resources/allaitement
RNAO and JOGNN – full page bilingual ad – Trim Size 8 1/8 x 10 7/8 o. 3, May/June 2016 Vol. 28, N o. 3, May/June contents
Features 14 10 COVER STORY Better health behind bars Corrections nurses understand the complicated determinants that affect the health of Canada’s inmate population, and are advocating for changes that address their unique needs. By Daniel Punch
14 AGM 2016 Taking nursing and the health system to new heights. By Kimberley Kearsey and Daniel Punch
21 Nursing Week 2016 Members host events to mark this week-long celebration of the profession, and share their images with the Journal. Compiled By Kimberley Kearsey
24 A path to healing Job-related PTSD is a reality for RNs, yet new legislation does not offer support for those diagnosed with the illness. By Kimberley Kearsey
the lineup 30 24
4 editor’s Note 5 President’s View 6 CEO Dispatch 7 nursing Notes 8 nursing in the News 20 rn profile 27 Policy at work 30 in the End
Cover photography: Jeff kirk Registered nurse journal 3 The journal of the REGISTERED NURSES’ Editor’s Note Kimberley Kearsey 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: rnao.ca Email: [email protected] Letters to the editor: [email protected] EDITORIAL STAFF Marion Zych, Publisher Kimberley Kearsey, Managing Editor Finding strength in struggle Daniel Punch, Writer Victoria Alarcon, Editorial Assistant EDITORIAL ADVISORY COMMITTEE Steve Buist, Una Ferguson, Rebecca Harbridge, Paula Manuel Art DIRECTION & Design howing vulnerability is difficult Fresh Art & Design Inc. S are revealing the needs of this for anyone. That’s because people subculture within our health ADVERTISING Registered Nurses’ Association of Ontario often believe there’s a correlation system, and are advocating for Phone: 416-599-1925 Fax: 416-599-1926 between being vulnerable and changes and improvements being weak. We are all vulnerable that inmates are not in a SUBSCRIPTIONS Registered Nurse Journal, ISSN 1484-0863, is a at various times in our lives, and position to ask for themselves. benefit to members of the RNAO. Paid subscriptions It will not come as a surprise are welcome. Full subscription prices for one year there should be no shame in that. (six issues), including taxes: Canada $38 (HST); In this issue of the Journal, to anyone that nurses are Outside Canada: $45. Printed with vegetable-based inks on recycled paper (50 per cent recycled and you will meet two nurses who speaking out for marginalized 20 per cent post-consumer fibre) on acid-free paper. open up about their post populations. But we need to Registered Nurse Journal is published six times a traumatic stress disorder acknowledge that RNs can find year by RNAO. The views or opinions expressed in the editorials, articles or advertisements are those (PTSD) (page 24). Julie Prince themselves marginalized as of the authors/advertisers and do not necessarily and Brenda Leonard have well. Dianne Roedding (page represent the policies of RNAO or the Editorial Advisory Committee. RNAO assumes no responsibility struggled with the condition, 20) can identify with the need or liability for damages arising from any error or and agree that sharing their to ask for help, and the value in omission or from the use of any information or advice contained in the Registered Nurse Journal experiences publicly isn’t easy, offering it. A self-identified including editorials, studies, reports, letters and but it’s important for their own lesbian, Roedding avoided advertisements. All articles and photos accepted for publication become the property of RNAO. healing. They also believe that discussing her personal life Indexed in Cumulative Index to Nursing and Allied others who may be suffering with peers early in her career, Health Literature. will take comfort in knowing for fear of persecution. She has CANADIAN POSTMASTER Undeliverable copies and change of address to: they are not alone. Their since become a vocal advocate RNAO, 158 Pearl Street, Toronto ON, M5H 1L3. stories will inspire you, and for LGBTQ issues as a founder Publications Mail Agreement No. 40006768. will no doubt lead to more of RNAO’s Rainbow Nursing RNAO OFFICERS AND SENIOR MANAGEMENT Carol Timmings, RN, BScN, MEd (Admin) voices joining the chorus of Interest Group (RNIG). She is a President RNs calling for legislation that great example of someone who Vanessa Burkoski, RN, BScN, MScN, DHA includes nurses among those turned vulnerability into Immediate Past-President Doris Grinspun, RN, MSN, PhD, LLD(hon), O.ONT to receive better supports strength, and is a role model we Chief Executive Officer, ext. 206 following a PTSD diagnosis. can all learn from. Irmajean Bajnok, RN, MScN, PhD In the world of corrections, This June marks Pride Director, International Affairs and Best Practice Guidelines Centre, ext. 234 showing vulnerability is Month. It’s a time to celebrate nneth R. W nneth R. W nneth R. W nneth R. W nneth R. W nneth R. W Ke ilso Ke ilso Nancy Campbell, Ke MBilso A Ke ilso Ke ilso Ke ilso the differences between us. rix n rix n rix n rix n rix n uncommon.rix Andn weakness of P 20 P 20 P 20 P 20 P 20 P 20 s 1 s 1 s 1 s 1 s 1 s 1 e 5 e 5 Director,e Finance and Administration,5 ext.e 229 5 e 5 e 5 L L Médaille L Médaille L Magazine L Magazine any kindL Site can Web be dangerous, That’s something the nurses in Finaliste Daniel Lau, MBA de l’année
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4 may/june 2016 president’s view with carol timmings
Leadership: a shared responsibility
This column marks my first chief nursing officer and community care will be practice guidelines (BPG) into message to you as your new director of child health and delivered. The seeds of those our practice and have been president. As I assume my role, development at Toronto Public changes were planted by RNAO motivated by the improved health I feel a deep sense of honour Health. An underlying principle in 2012 with our report, outcomes they have generated in and privilege. RNAO is a top of our work in and with Enhancing Community Care for the clients and communities we organization, and I promise to communities is “engagement.” Ontarians (ECCO). Another serve. We have RNAO’s body of bring my leadership experience, By being engaged in building an recent example is the release of evidence-based practice recom- energy and commitment to understanding of the needs of the Mind the Safety Gap in Health mendations and BPG champions advance the work of our clients/patients, each of us can System Transformation: to thank for our success. vibrant association. contribute this knowledge into Reclaiming the role of the RN. As I assume my role as The leadership my prede- RNAO to further strengthen the This report lays out clearly why RNAO president, I want to cessor, Vanessa Burkoski, credible voice we are in practice RN replacement must stop, and remind you of a message I provided for all of us, and the and policy. Your engagement and why organizational models of shared at last year’s AGM about mentoring and friendship she extended to me personally “whichever setting you work in, and wherever you during my time as president- elect, are invaluable. I admire practise, rnao needs your perspective and your and respect RNAO as a source of unique insight into what enhances health promotion, inspiration. We have a rich legacy to build upon, and endless health equity, health care, and our profession.” opportunity to use our wisdom and influence to improve health your voice are vital sources of nursing care delivery that my philosophy of leadership. I and to advance our nursing RNAO’s influence. fragment patient care compro- view it as a process of working profession even more. In this time of unprecedented mise patient safety (read more together to achieve great things. Fulfilling RNAO’s mission is change and opportunity, I will on pages 6 and 27). RNAO’s Leadership is not something not something that is limited to count heavily on the active influence and impact was also that is invested in a few people the office of the president, the engagement of each of you. I palpable in Minister Hoskins’ or positions. As members of board of directors, or the CEO. plan to visit a number of regions announcement at the associa- RNAO, you are all leaders. You It’s a collective responsibility and chapters throughout my tion’s annual general meeting also give life to the issues we that we all share as RNAO term as president to meet you (AGM) that he is moving ahead must address, because you see members. Our powerful and hear your perspectives on with independent RN pre- day-in and day-out, what network of chapters and regions nursing and health, and how, scribing; and that he is looking influences health and what has without chapters, and the together, we can continue to into enabling NPs to prescribe an impact on our profession. diverse collection of interest improve the health outcomes of controlled substances. The theme of this year’s AGM groups, provide the structure Ontarians. Whichever setting While it’s true that so much of was Taking nursing and the within which to do this work. you work in, and wherever you RNAO’s excellent work is in health system to new heights. But this also happens daily practise, RNAO needs your policy, I would be remiss if I did Our annual celebration may be through the passion and work of perspective and your unique not talk about the association’s behind us, but our work does individual members. And with insight into what enhances expertise with regard to clinical not end. On behalf of RNAO’s 41,000 members to draw from, health promotion, health equity, practice. In my role at Toronto board of directors, I hope you we have wisdom, insight and health care, and our profession. Public Health, I have had the accept my invitation to engage experience on a grand scale. RNAO has been tremen- privilege of working with nurses and lead nursing to new heights Many of you know that I have dously visionary; most recently and other professionals as part of with me. RN spent the majority of my evident by Health Minister Eric our Best Practice Spotlight nursing career in the public Hoskins’ announcement to Organization (BPSO) initiative. carol timmings, rn, bscn, med health sector. I am presently the revamp the way home and We have integrated several best (admin), is president of rnao.
Registered nurse journal 5 CEO Dispatch with Doris Grinspun
Reclaiming the role of the RN will save lives and money
At its core, RNAO’s ground- longer anecdotes or statistics. lengths of stay in hospital and in especially those of hospital breaking report, Mind the Safety These were realities that required home care. Do decision-makers patients deemed the sickest Gap in Health System Transfor- RNAO to step up its action. understand how they are of the sick. mation: Reclaiming the role of the At that AGM in 2015, I compromising nursing care and This is why one of the eight RN, is about putting patients committed to work with our patient outcomes, and in the recommendations in Mind the first – a vision we share with policy and communications staff process, creating havoc? Safety Gap is for the ministry of Minister of Health Eric Hoskins. to immediately launch a strong RNAO does. health to legislate an all-RN But, putting patients first campaign titled #StopRNre- Mind the Safety Gap presents nursing workforce in acute care demands we tackle fundamental placement, as well as to bring the research on the negative within two years for tertiary, flaws in health human resources back to the 2016 AGM a impact of RN replacement on quaternary and cancer centres; (HHR), because health profes- and within five years for large sionals are the fuel that will the dangers of rn replacement community hospitals. We are move this concept to reality. “ also urging that all initial home This is where the rubber bubbled to the surface at last year’s health care visits be completed meets the road. by an RN. It strikes me to my core every annual general meeting (agm), when Mind the Safety Gap is very time I hear colleagues talk about member after member after member similar in many ways to RNAO’s RN replacement. The issue has groundbreaking ECCO been percolating for several years, approached the microphone to ring (Enhancing Community Care for and RNAO has raised concerns alarm bells and share what was Ontarians) report, issued first in with former Health Minister Deb 2012 and re-issued in 2014. Matthews and with our current happening at their organizations.” Minister Hoskins has publicly minister. We have also made it a acknowledged he looked to top priority at our annual Queen’s comprehensive report about patient outcomes, alongside the ECCO as he created his strategy Park Day, where 130 RNAO nursing HHR in Ontario. shocking statistical HHR reality. to put patients first. We urge the leaders bring their views about Mind the Safety Gap in Health It shows that between 2005 and minister to now look to our latest health, health care and nursing to System Transformation: Reclaiming 2010, the ratio of RNs to diploma- recommendations as he develops MPPs. This year, we shared the role of the RN is the result of prepared RPNs was 3:1. Last year, an HHR strategy in Ontario that trends that show clearly that RNs active listening, research, and that ratio had dropped to 2.28:1. is in the best interests of patients are being replaced with other in-depth analysis. It’s a compel- Indeed, when we released our and their families. health professionals, and the ling report that reveals the report in May, Ontario had the We call on every nurse, in all impact this is having on patients province’s dangerous HHR second-worst RN-to-population roles and sectors; every nursing and the system. Our efforts have reality. It shows that trends in ratio in the country. It saddens student, in all colleges and been direct and powerful, and yet nursing skill mix and organiza- me to tell you that – based on the universities; and members of the these efforts have not fully tional models of nursing care latest Canadian Institute for general public to stand up and stopped RN replacement. delivery run counter to the Health Information statistics – speak out about RNAO’s The dangers of RN replace- Ontario government’s goals for Ontario is now the worst. This is recommendations. They affect all ment bubbled to the surface at health system transformation. simply unacceptable. sectors, all nurses, and most last year’s annual general We must wonder if decision- These statistics should trigger importantly, the future of meeting (AGM), when member makers, who are so focused on alarm bells, because if the Ontarians’ health and health care. after member after member the bottom line, do not under- government’s goal is to shorten Together, let’s put patients approached the microphone to stand the economics of RN lengths of stay in hospital and first. RN ring alarm bells and share what replacement. Simply put, RN re-orient the system towards was happening at their organiza- care is not more expensive. It greater community care, a large doris grinspun, rn, msn, phd, lld tions. These were no longer results in less complications, influx of RNs is needed to (hon), o.ont, is chief executive isolated cases. These were no lower mortality rates, and shorter respond to rising acuity levels, officer of rnao.
6 May/june 2016 nurcontinued sing notes
In memoriam Doris Gibney 1922-2016
An assistant executive director for RNAO from 1961 to 1981, Doris Gib- ney touched many lives in the nursing community before passing away in April, at the age of 94. During her 20 years at RNAO, she worked closely with former Executive Director Maureen Powers, assisting with the imple- mentation of board policy. She was also a strong presence at chapter meetings. Gibney marked her retirement from the association at its 56th annual general meeting (Spring 1981), calling her time at RNAO a “tre- mendously rewarding experience” with “many fond memories of people and events.” She was recognized at that time with a lifetime achievement membership (now award). Born in Bradford, Gibney was an honour stu- dent, graduating from nursing at Orillia Soldiers’ Memorial Hospital, then the University of Toronto. Before joining the RNAO team, she worked at Soldiers’ Memorial, then Toronto Psychiatric Hospital as a head nurse, instructor and assistant director of nursing. With a passion for life and an eagerness to learn, Gibney will be remembered for her caring ways, her generosity, and her warm, gentle smile. RNAO extends its deepest condo- lences to Doris Gibney’s family and friends. Condolences and memories Doris Gibney may be shared at www.humphreymilesnewbigging.com
Two newest BPGs guideline assists teams working to decision-maker, and the level of them will be diagnosed with a dia- released assess and manage existing pres- treatment patients wish to receive betic foot ulcer in 2016. Two This spring, RNAO released two sure injuries in people 18 and at the end of their lives. Janet thousand Ontarians annually are new best practice guidelines (BPG) older. This new BPG replaces the Riehl, the unit’s clinical manager, forced to endure a diabetes-related about nursing education and pres- Assessment and Management of says the pilot is formalizing infor- amputation, with an overall annual sure injuries. Published in May, the Stage I to IV Pressure Ulcers, and mal discussions hospital staff have cost to the health system of $140 Practice Education in Nursing BPG shifts the focus from pressure been having – and in some cases million dollars. The RNAO/CAWC rec- provides recommendations to nurs- “ulcers” to “injuries” as per the not having – with patients for years. ommendations will save millions of ing educators and other health-care new terminology defined by the With the project underway, HSN is health-care dollars, if implemented. professionals on how to support National Pressure Ulcer Advisory hoping to standardize the protocol Among the recommendations: uni- effective teaching and learning Panel (NPUAP). To access these around advance care planning so it versal access and free, preventive strategies for undergraduate nurs- BPGs, visit RNAO.ca/BPG can be used in other units and foot-care services, including offload- ing students in a variety of practice other areas of health care. ing devices to relieve pressure on settings. The guideline explores the Advance care planning the feet; at least one annual foot relationships among and between in the spotlight Better diabetes wound assessment by a qualified health students and nursing educators, A pilot project, launched in January care to improve lives professional who can refer to a spe- nursing staff, preceptors and other by Health Sciences North (HSN) in At Queen’s Park on April 12, RNAO cialist as needed; and an health-care team members. Also in Sudbury, is bringing advance care and the Canadian Association of Ontario-wide interprofessional May, the association released the planning to the forefront. Patients Wound Care (CAWC) brought forward approach to diabetic foot care third edition of its newly named (85+) and their families at the recommendations to improve quality through the establishment of at least Assessment and Management of Ramsey Lake Health Centre’s of life for people suffering from dia- one multidisciplinary diabetes foot- Pressure Injuries for the Interprofes- inpatient cardiology unit are being betes complications, particularly foot care team for each Local Health sional Team BPG. Geared towards encouraged to think about how they ulcers. According to the Canadian Integration Network (LHIN). For interprofessional teams that can be want to spend their last days. The Diabetes Association and Ontario RNAO’s research-based guidelines made up of nurses, physical thera- project helps families and patients Health Technology Adivsory Commit- and teaching tools related to diabetic pists, occupational therapists, settle issues such as power of tee, 1.53 million people in Ontario foot ulcers, visit RNAO.ca/search/ physicians and dieticians, the attorney, appointing a substitute have diabetes. Up to 25,000 of content/diabetes RN
Registered nurse journal 7 RNAO & RNs weigh in on… nursing in the news by victoria Alarcon
RNAO weighs in on Nursing Week 2016 assisted dying Nursing Week activities across Ontario generated quite a lot of media coverage. For more on events hosted by The inability of the federal RNAO and its chapters/regions, see page 21. government to pass its assisted- dying legislation, Bill C-14, before the June 6 deadline is leaving many nurses in limbo, says RNAO CEO Doris Grinspun. Senators have sent the bill back to the House of Commons with proposed changes. Until a final vote happens, the Supreme Court of Canada’s decision in the Carter v. Canada case is now the law of the land. That decision, which allows physicians to provide assisted-dying services for people who are experiencing “grievous and irremediable” medical conditions, protects physicians from liability, but is silent on the role of other health-care providers. “Often, nurses participate with physicians in the care that patients need,” says Grinspun. “Given that the Carter decision does not protect nurses, we are extremely concerned.” RNAO is RNAO releases HHR report calling for the federal govern- RNAO Immediate Past-President Vanessa Burkoski and CEO Doris Grinspun marked the start of Nursing Week ment to move fast in passing (May 9) with a media conference at Queen’s Park to release a groundbreaking report Mind the Safety Gap in Bill C-14. (CTV News, June 6) Health System Transformation: Reclaiming the Role of the RN (for more details, see pages 6 and 27). The report calls for a provincial interprofessional health human resource (HHR) plan. In the meantime, RNAO is calling for a NOTE: The federal moratorium on RN replacement along with several other recommendations that focus on putting patients first. government’s assisted- “The changes we are proposing reclaim the role of the RN as the care provider needed for those with a high dying legislation became law after receiving royal degree of complexity, instability and a lack of predictability. Our focus is on putting patients first, and our posi- assent on June 17. tion is grounded in evidence,” says Burkoski.
Sudbury proclaims Nursing Week, celebrates RNs Big step forward RNAO’s Sudbury chapter invited the city’s Mayor Brian Bigger to mark the start of Nursing Week by proclaiming in system the event in the city, and with the distribution of nursing awards for the hard work and dedication nurses bring to transformation their practice on a daily basis. Local RNAO members Gloria Richer and Shelley Westhaver were among those to Changes introduced by Health receive awards for their contributions to the profession and the community. “Without nurses, our clinics, hospi- Minister Eric Hoskins are being tals and other centres would not be able to run as smoothly and provide the quality care we need,” says Bigger, hailed by RNAO as the biggest adding nurses are the backbone of the health-care system. (The Sudbury Star, May 9) changes to the system in 20
8 May/june 2016 nursing in the news by victoria Alarcon
years. On June 2, Hoskins Health Unit. Carol Munro, the introduced the Patients First Act, unit’s clinical manager, says the 2016, which will expand the equipment purchased as a result mandate of Local Health of the fundraising “…greatly Integration Networks (LHIN) to benefits the children who are include home care planning and patients…” at their hospital. A funding, and eliminate vascular imaging system was Community Care Access purchased thanks to funds Centres (CCAC). RNAO raised as part of the challenge, President Carol Timmings says and is already helping staff more patients are falling through the easily find the veins of young cracks with CCACs, and often patients requiring an IV or blood struggle to find care in a work. “Babies and children can complex system. “We don’t have have small and intricate veins, so room in Ontario’s health system committed to working for three but not for kids in the Niagara starting IVs on them can be very for duplication. We have to close weeks at outreach clinics in region. On June 5, more than difficult,” explains Munro. the gaps,” says Timmings. The Tanzania to learn about public 900 participants between the Since the first Kids Ultimate legislation would also give health initiatives for women. As ages of four and 13 participated Challenge three years ago, LHINs the authority to plan and part of the experience, the in the 2016 Kids Ultimate more than $76,000 has been implement better integration group was involved in activities Challenge, an obstacle course to raised. This year’s event raised across sectors. RNAO welcomes such as providing health raise funds for the Niagara $55,000. (St. Catharines the plan to eliminate CCACs, education and worksite Health System’s Children’s Standard, May 4) RN but is wary of LHINs playing any hypertension screenings with role in service delivery. The local health-care providers at the association wants to ensure the Pamoja Tunaweza Women’s Letter to the editor 3,500 care co-ordinators (mostly Centre. Clarke-McMullen, who RNAO’s Region 10 President Jill Courtemanche shares her RNs) who will now be employed has gone with students to thoughts in a letter to the Ottawa Citizen in response to the by the LHINs are located in Tanzania in the past, says the government’s decision to leave nurses out of the province’s Bill primary care so they can work experience not only helps those 163: Supporting Ontario First Responders Act (see page 24 for within interprofessional teams in Africa, but also the local more on this) (April 27) and co-ordinate care for patients community in Kingston. It with complex needs. RNAO helps students ask the right Recognizing nurses as first responders would also like to see the questions and provide culturally No one fits the description of first responder more than province’s 36 public health units sensitive care to the increasing nurses working in an emergency department. Many included within the mandate of number of refugees and other patients arrive on their own, or are dropped off, and the the LHINs. (CBC Radio One immigrants coming to Canada, triage nurse is the first professional with hands on. Ottawa, June 2) she adds. To read about the It has been decades now, but I still have flashbacks to a students’ experiences, visit young girl. I don’t remember much about her, just what she Nursing students Facebook.com/helpfulhandsto calmly said as she handed me her baby: “He’s gone to a expand their horizons tanzania (Kingston Whig-Stan- better place.” I looked down at the baby I was holding, To gain a new perspective on dard, May 8) dressed in a white sleeper with cartoon characters, sleeping health care, nursing students peacefully with a piece of plastic wrap across his face. That from Kingston’s St. Lawrence Kids raise funds for was just the first of many such incidents I experienced over College joined their nursing children’s health unit the next years, and since. As for the costs of treating PTSD, professor Donna Clarke- Running through mud puddles, the costs of not treating it ultimately are far greater. McMullen for a trip to Africa on hurdles and mountains of hay
Photo: I sto c k p hoto. o m /Jann H ui z enga May 8. The 12 students may seem like a daunting task,
Registered nurse journal 9 Correctional nurses want to improve the poor health of incarcerated people in Canada. by Daniel Punch Better health velyn Wilson still remembers the sinking Ontario correctional system, Wilson got to know this feeling in the pit of her stomach the first time population and became an advocate for them. The E the jail doors closed behind her. nearly 500 nurses – most of whom are RNs – The century-old Brantford Jail smelled of sweat and working in Ontario’s provincial jails represent the cigarettes. Intimidated, she was led past onlooking largest group of health-care professionals in the inmates to the small nursing station, where a barred correctional system, and are an integral part of this window looked out onto the razor wire that lined the unique community. jail’s perimeter. “For the most part, inmates would agree (correctional “I wondered what I was getting myself into,” she recalls. nurses) are an asset. We’re on their side,” Wilson says. It was the late 1980s, and Wilson was a young nurse “Most of them are glad to see us.” attracted to the stable hours and autonomy of correc- But recent research has brought to light the tional nursing. But she admits she wasn’t sure what to realities Wilson and other correctional nurses have expect from a population most people tend to forget. observed for years. Despite their best efforts, Behind those locked doors, she found a surprising Canada’s incarcerated population is unhealthy. In subculture caught up in the cycle of incarceration. fact, inmates are often dramatically sicker than the This was not a random sampling of the population. general population, with mental health issues, This was a group whose members often experienced addiction, and communicable illness prevalent at poverty, childhood trauma and significant challenges alarming levels. to their health. This has led many nurses to advocate for a major shift “I just didn’t know these people existed, and that so in a correctional system where health care is too often much of their lives were spent dealing with the law,” overshadowed by security. They say more resources, and Wilson explains. “And almost all of them were marginal- more direct links to the broader health system, would ized in some aspect within their communities.” help nurses bring correctional health more in line with
During nearly three decades as an RN in the care provided on the other side of those locked doors. Photo: I sto c k p hoto. o m / oweroffore v er
10 May/june 2016 caption (L to R) Evelyn Wilson, Ian Clarke and Shirley Kennedy discuss issues of inmate health in front of Hamilton Wentworth Detention Centre, a facility at which all three RNs worked at various points in their careers.
iona Kouyoumdjian doesn’t recall learning about the health of The United Nations’ Basic Principles for the Treatment of Prisoners incarcerated people while studying to become a physician. asserts that incarcerated people should have “access to the health F Doctors and nurses are educated about marginalized popula- services available in the country without discrimination.” Kouyoum- tions, but she says inmates are mostly absent from the agenda, despite djian’s research suggests this is not always the case in Canada. 60,000 Ontarians spending time behind bars every year. Although essential services are provided, there are many “It’s a very large proportion of our population and I think it “missed opportunities” to help this unique and disproportionately deserves more attention,” says the postdoctoral fellow for the Centre ill population, she says. Addictions programs, needle exchanges, for Research on Inner City Health at Toronto’s St. Michael’s diabetes education, and other supportive services – which are Hospital, and physician in the Ontario correctional system. available in the community – are few and far between in jails, and Kouyoumdjian’s research is helping to bring attention to inmate much of that is the result of inadequate staffing levels. JHS health, but many of her findings are troubling. Her recent clinical Ontario reports 8.5 per cent of health-care positions in Ontario review revealed the majority of incarcerated people in Canada show jails are vacant, and research from the University of Toronto signs of mental illness, and about one in five people in custody found correctional nurses consistently face heavy workloads and have attempted suicide at some point in their lives. Research has limited resources. also found mental illness is two to three times more common “It’s a very sick population, so it takes a lot of time and nursing among inmates. Communicable disease is a major concern as well, energy to care for them, and that might come at the expense of with tuberculosis rates up to five times higher among incarcerated doing some of the important initiatives all of us would like to see,” people, and rates of hepatitis C at nearly 30 per cent – compared to Kouyoumdjian says. less than one per cent in the general population. A report from the John Howard Society of Ontario (JHS Ontario), ou don’t go to jail prepared. Health is usually the last thing a non-profit organization that advocates for humane reforms to the on a new inmate’s mind when they land in a correctional criminal justice system, says HIV rates are seven- to 10-times Y facility. “It’s a pretty chaotic time,” says retired correctional higher in correctional facilities than in the rest of Canada. It also nurse Ian Clarke. found 80 per cent of the incarcerated population deals with severe Chronic conditions are often at their worst during this chaos. If drug or alcohol addiction. an inmate has diabetes, what are the odds they’ve taken their The social determinants of health seem to be a major factor. insulin that day? Do they know the names of their medications? Kouyoumdjian’s research has found incarcerated Canadians tend to Do they even have a primary care provider in the community? have lower employment and income status, and less education than These questions present a unique set of challenges for correc- the general population. The majority of inmates in Canada also tional RNs. experienced some kind of adverse event as children, including physical Within hours of landing in jail, each inmate will be examined by
and sexual abuse, or being forced to attend residential schools. an RN as part of their admission process. The Maplehurst Photos: j eff kirk
12 May/june 2016 Correctional Complex in Milton, where Clarke spent 13 years as continuity of care and greater oversight. Adopting this model would nursing administrator, receives about 12,000 admissions every year, also follow in the footsteps of France, Norway and England, as well meaning nurses assess as many as 30 new inmates a night. as Alberta and Nova Scotia, where the local health authorities The interview questions are similar to triage in an emergency deliver care in jails. JHS Ontario has also been a strong advocate for department. Nurses take vital signs, ask about health history and this shift. In a March 2015 meeting with Yasir Naqvi, Minister of medications, and determine what needs immediate attention, and Community Safety and Correctional Services, and a February 2016 what may require follow-up down the road. But this is not a hospital. submission to MCSCS, RNAO called for health services in jails to At least one correctional officer is always by the inmate’s side during be transferred to MOHLTC. the assessment, making confidentiality virtually impossible. “Reporting to a health body rather than correctional services has These also are not your average patients. Clarke says drugs and the potential to positively impact the screening, detection, treatment alcohol are a factor in the vast majority of these screenings, whether and care of inmates,” the submission reads. new inmates are addicts, were intoxicated at the time of their Continues on page 26 assessment, or their arrest was drug-related. There is also a serious risk of suicide, so he says nurses must get a quick read on their patient’s emotional state. “You really have to...do your detective work, and make sure they’ll be safe,” Clarke says. Limiting segregation for Once admitted, inmates have regular access to nurses during their rounds, and can approach them in common areas to discuss their Better inmate health health. Physicians visit jails regularly to provide primary care, but security is always a looming consideration. Enhancing health-care services in jails is one step toward improving “Health care is definitely secondary. If a security concern inmate health. But it’s also crucial to reduce practices that can be det- happens, (correctional officers) may not bring all the inmates to see rimental to health. For many correctional nurses, that means limiting the doctor,” Clarke says. “The ones who don’t (get to see the the use of segregation. physician) can be ticking time bombs, medically speaking.” Often referred to as ‘solitary confinement,’ segregation is the physi- If an injury or health concern is beyond the correctional nurse’s cal isolation of inmates by confining them to a cell for 22- to scope, the inmate is taken to a local health-care facility. But that 24-hours-a-day. Used for disciplinary or administrative purposes, segre- presents another challenge, since two security officers are needed to gation often deprives inmates of human contact and other privileges take an inmate into the community, which is not always possible within the jail. Evidence shows segregation can have a significant due to staffing limitations. impact on health, especially for people with pre-existing mental health Throughout her 27 years in correctional nursing, Wilson saw the challenges, or when used over long periods. It can lead to depression, push and pull between health and security every day. “Sometimes it impaired memory, and increased risk of suicide. seems unfair to expect the correctional (officers) to appreciate the “It is not appropriate for people with mental illness, or anyone over a level of illness,” she says. “They’re not health-care people.” long term,” veteran correctional RN Shirley Kennedy says. “It causes health problems.” hirley Kennedy doesn’t think most people realize health care An April 2016 Globe and Mail investigation found at least 360 is provided in jails. inmates in the Ontario correctional system were put in prolonged seg- S Nurses began working in federal and provincial correctional regation – defined by the United Nations as more than 15 consecutive facilities around the early 1970s and steadily became more common. days. Of inmates housed in segregation 30 or more consecutive days, Though jail services were cut in the early 1990s when law-and-order staff cited mental health challenges or other special needs as part of politics prevailed – “forget drug and alcohol counselling, you couldn’t the justification for extended segregation in 40 per cent of cases, the even get a library book,” Clarke recalls – services have since improved. Globe and Mail reported. But Kennedy thinks a more foundational change is needed. RNAO has consistently urged the provincial government to abol- “The system developed over a period of time in a reactionary way,” ish the use of segregation for people with serious or acute mental says Kennedy, president of RNAO’s Ontario Correctional Nurses’ illness, and limit all segregation to no more Interest Group (OCNIG), and a 27-year veteran of correctional than 15 days at a time. A May 2016 report Limit all nursing, including stints in the provincial and youth systems. “But from the provincial ombudsman called for a segregation now we’re at a place where we need to...tear (the system) down to the similar 15-day limit. to no more bare bones and rebuild based on what’s the best model for health.” “Without substantive transformation of the than 15 days As employees of the jail, correctional nurses in Ontario work for correctional system, including segregation prac- at a time. the Ministry of Community Safety and Correctional Services tices, more marginalized...people will die (MCSCS), rather than the Ministry of Health and Long-Term Care prematurely or experience negative health out- (MOHLTC). This leaves correctional health care in a silo, discon- comes,” RNAO wrote in a submission to the nected from the broader health system, Kennedy says. It also means Ministry of Community Safety and Correctional administrative decisions about health are usually made by people Services (MCSCS) in February 2016. without a health-care background. Read more about RNAO’s stance, and its Kennedy and OCNIG – backed by RNAO – would like Ontario to submission to MCSCS earlier this year, at explore shifting responsibility for health care in correctional RNAO.ca/segregationsubmission facilities to the MOHLTC. She says this would lead to better
Registered nurse journal 13 2016 AGM annual general meEting Reaching new heights at AGM
By Kimberley Kearsey AND Daniel Punch
NAO’s 2016 annual general meeting (AGM) was a chance for the association to show off its breadth and R diversity. The three-day event opened with a talented group of samba dancers, closed with a keynote panel about First Nations health issues, and was filled with the strong evidence and expert advocacy RNAO has made its trademarks. The association’s signature event drew more than 700 RNs, NPs, Health Minister Eric Hoskins nursing students, politicians, and other guests to downtown Toronto (centre), NDP Leader Andrea Horwath (second from right), from May 5-7. The board of directors thanked outgoing President and PC Leader Patrick Vanessa Burkoski on behalf of members, and Carol Timmings is Brown (far right) join RNAO now the association’s new president. Four new board members CEO Doris Grinspun (left) at the AGM opening ceremo- were also elected. This year’s theme: Taking nursing and the health nies on May 5. The MPPs system to new heights. were among several special As Health Minister Eric Hoskins addressed the energetic crowd, guests at the event, invited to talk to members about he noted issue after issue upon which RNAO has made its mark in the influence they have at relation to healthy public policy. From providing the “blueprint” for Queen’s Park. the government’s Patients First strategy (he referenced RNAO’s Enhancing Community Care for Ontarians report), to drawing attention to the need for better wound care for people with diabetes and foot complications, Hoskins said the government depends on RNAO to highlight where it can do better. “Your organization is so vital and so strong,” Hoskins said. “I and celebrated outstanding reporting with the presentation of its never cease to be impressed by your outstanding advocacy.” annual Media Awards. PC Leader Patrick Brown and NDP Leader Andrea Horwath also Some of the most poignant moments came during the event’s commended the association for helping to build a healthier Ontario, closing presentation. After viewing In this Heaven/Ring of Fire – a and vowed to lobby the government on other RNAO priorities, documentary about suicide and opiate addiction in Ontario’s including stopping RN replacement and addressing the social northern First Nations communities – an expert panel discussed the determinants of health. health issues raised in the film. The event ended with RNAO and During the business session of the meeting on May 6, RNAO Ontario Regional Chief Isadore Day signing a letter of intent to work CEO Doris Grinspun recapped the association’s accomplishments together to improve health in the province’s First Nations communi- in her annual report (see more at RNAO.ca/AnnualReport). During ties. Find out more about this at RNAO.ca/FirstNationsHealth the consultation session later in the day, members set key objectives for next year’s agenda by passing 10 resolutions. The event also For video highlights from the event, visit RNAO.ca/AGM2016highlights honoured some of RNAO’s brightest stars with Recognition Awards,
14 May/june 2016 annual general meEting
Kaiyan Fu, Ontario’s Provincial Chief Nursing Officer (left), Members of RNAO’s board of directors, including Angela Cooper Brathwaite, Member-at-Large, Nursing socializes with members during a wine and cheese Research, and Region 8 Board Representative Beatriz (Betsy) Jackson (second and third from left, reception on May 5. respectively), network with colleagues (L to R) Rona Khudayer, Sarah Pelletier and Kamala Persad-Ford.
This year’s AGM closing keynote presentation on May 7 focused on the challenges and opportunities linked to health and well-being of Ontario’s First Nations Peoples. Panelists included (R to L): Ontario’s Regional Chief Isadore Day; Neskantaga First Nation Chief Wayne Moonias; Bearskin Lake resident Marty Beardy; primary care NP Mae Katt; RNAO CEO Doris Grinspun; and moderator and CBC News personality, Duncan McCue, a member of the Chippewas of Georgina Island First Nation in southern Ontario. The keynote presentation started with a viewing of a documentary about Katt’s work with Aboriginal youth in northern Ontario, and ended with the formal signing of a letter of intent between RNAO and Chief Day to work together to address the physical, mental and spiritual health needs of Ontario’s First Nations.
Registered nurse journal 15 And the recognition award goes to...
Ryerson University RNAO Promotion in a Nursing Program Award Philosophy: Educate students to be leaders and change makers to generate real social impact.
Mental Health Region 7 Nursing Interest Chapter of the Year Group (MHNIG) Philosophy: If you want to boost membership numbers, embrace Interest Group of the Year different ways of communicating Philosophy: The success of any with members through social interest group comes from media, teleconferences, emails actively engaging members. and regular meetings.
16 May/june 2016 2016AGM And the recognition award goes to...
Una Ferguson Staff nurse, Royal Ottawa Health Care Group Maria De Leon Recipient of the Leadership Award in Political Action Patient care manager, Mississauga Halton CCAC Philosophy: Always make sure colleagues and students who are Recipient of the Leadership Award in new to political events feel included and feel that their voices Nursing Administration have been heard. Philosophy: Good leaders start from the bottom and work their way to the top.
Jennifer Stinson Nurse clinician scientist and advanced practice nurse, Hospital for Sick Children Recipient of the Leadership Award in Nursing Research Philosophy: Research has great potential if it is translated back appropriately to change practice.
Kimberly LeBlanc Adjunct professor, Western University Recipient of the Leadership Award in Nursing Education (Academic) Philosophy: If I can get one student to become passionate about what they do, I can improve the lives of many patients.
Melanie Cates Professional practice leader, Thunder Bay Regional Health Sciences Centre Recipient of the Leadership Award in Nursing Education (Staff Development) Philosophy: Go the extra mile to find opportunities and funding to provide ongoing education for nurses.
Amanda Sissons Researcher, St. Michael’s Hospital Recipient of the Student of Distinction Award Philosophy: Seek out opportunities at RNAO and network with peers from your chapter or region.
Shannon Carney Health promotion specialist, Toronto Public Health Recipient of the Leadership Award in Student Mentorship Philosophy: Follow your passion. Nurses are powerful leaders who can transform the health-care system.
To read the full biographies of all of this year’s Recognition Award winners, visit RNAO.ca/2016recognitionawards
Registered nurse journal 17 Jacqueline Smith Diabetes nurse educator, Two Rivers Family Health Team Recipient of the President’s Award for Leadership in Clinical Practice Philosophy: Nursing is not just a job. It’s a passion.
Several winners of RNAO’s annual Recognition Awards were honoured during the President’s Banquet on May 6. (L to R) Kathy Moreland received a Lifetime Achievement Award for her resilience over 34 years of nursing, and her Tanis Brown philosophy to always believe in yourself. Ioana Gheorghiu received an Award of Merit for launching a number of ini- Public health nurse, Leeds, Grenville tiatives to help new grads as they start their careers. Sandra Donnelly, a physician and associate professor at and Lanark District Health Unit University of Toronto, won the Honoured Friend of Nursing award for always providing opportunities for her nursing Recipient of the President’s colleagues to grow through professional development or research. Arlene Burla de la Rocha was recognized with a Award for Leadership in HUB Fellowship for her commitment to best practice guidelines, and will participate in a week-long, one-on-one Clinical Practice placement with RNAO CEO Doris Grinspun. And Julie Kwan, clinical practice manager for Ontario Telemedicine Net- Philosophy: Leadership means leading work (OTN), accepted the organization’s RNAO in the Workplace Award in honour of OTN’s work to cultivate by example, and encouraging others. leadership and engage frontline staff in RNAO activities.
Members approve 10 resolutions and set the course for action over the coming year
RESOLUTION 1 On behalf of: RNAO Kirkland- that RNAO explore and develop assistance programs before the Temiskaming Chapter a strategy for nurses and nurs- year 2020. Ontario Assistive Devices ing students in all domains of Program THEREFORE BE IT RESOLVED CARRIED that RNAO: endorse and engage nursing practice to increase their Submitted by: Cheryl Forchuk in opportunities for advocacy competence in using a health On behalf of: RNAO Brant- RESOLUTION 5 of the Basic Income Guarantee equity lens to fully participate in Haldimand-Norfolk Chapter (BIG) as a means to alleviate addressing and mitigating the Reduction of violence and and Mental Health Nurses poverty, and; support advocacy factors affecting the social deter- harassment in the nursing Interest Group minants of health. efforts made by health profes- workplace sionals and community allies THEREFORE, be it resolved CARRIED Submitted by: Randie Gregoire, to advocate for and participate that the Registered Nurses’ RN, BScN, in consultation with in the development of a BIG as Association of Ontario (RNAO) RESOLUTION 4 RNAO Algoma Chapter executive lobby the provincial government a viable means of alleviating to change the Ontario Assis- poverty. Oral health program for THEREFORE IT BE RESOLVED that RNAO continue to advocate tive Devices Program to include CARRIED low-income adults mental as well as physical Submitted by: Poonam K. Sharma for specific legislation in Ontario disabilities. On behalf of: RNAO Peel Chapter that addresses violence towards RESOLUTION 3 nurses and other health-care CARRIED Imbedding a health equity THEREFORE BE IT RESOLVED that workers, including public educa- RNAO advocate to extend public tion, and advocating for cultural lens in nursing practice dental programs that include change in the nursing commu- RESOLUTION 2 Submitted by: Erin Cowan, Erika prevention and treatment ser- nity that violence is not “part of Basic Income Guarantee Haney, Judy Stanley, and Danika vices to low-income adults and Wentzel the job.” Submitted by: Erin Cowan and those who have limited dental Erika Haney THEREFORE BE IT RESOLVED coverage through existing social CARRIED
18 May/june 2016 2016AGM
From the Samba performers (left) and lively networking throughout this year’s AGM, members were – as always – engaged and enthusiastic.
Members approve 10 resolutions and set the course for action over the coming year
RESOLUTION 6 Therefore be it resolved discharged from psychiatric units. Submitted by: Lead person, Dorothy that the Registered Nurses’ Asso- C. Klein, RN, BScN Nursing students and CARRIED ciation of Ontario (RNAO) support THEREFORE BE IT RESOLVED that the Mandatory Blood the Council of Ontario University RNAO advocate for an education Testing Act Programs in Nursing (COUPN) to RESOLUTION 9 strategy in Ontario for registered Submitted by: Sarah Loseth, RN lobby the regulator, the College of Mental health nursing on nurses, nurse practitioners, and On behalf of: RNAO Peel Chapter Nurses of Ontario (CNO), to have nursing students that includes the an entry-to-practice exam that truly Ontario post-secondary THEREFORE BE IT RESOLVED that UN Declaration on the Rights of reflects Canadian content and campuses RNAO advocate that nursing stu- Indigenous Peoples, treaties and competencies. Submitted by: Ontario Campus dents specifically be added as a aboriginal rights, Indigenous law, Health Nurses Association prescribed class who can make CARRIED Crown-aboriginal relations, and the application under Section 2 of the THEREFORE BE IT RESOLVED that history of residential schools. RNAO lobby the provincial govern- Mandatory Blood Testing Act when THEREFORE BE IT FURTHER Resolution 8 ment to provide dedicated funding exposed to bodily substances RESOLVED that RNAO advocate Transitional discharge for a full-time equivalent mental while engaged in training. for the development of evidence- health nurse on each of Ontario’s model and peer support informed practices for engaging CARRIED post-secondary campuses. Submitted by: Cheryl Forchuk Indigenous peoples, families and from Brant-Haldimand-Norfolk CARRIED communities with appropriate RESOLUTION 7 Chapter support services, and explore the NCLEX-RN exam and THEREFORE BE IT RESOLVED that RESOLUTION 10 possibility of revising the BPG for culture and diversity to include the Canadian values RNAO lobby the provincial govern- Truth and Reconciliation Submitted by: Oona St-Amant ment for stable funding for mental Truth and Reconciliation Commis- On behalf of: RNAO Brant- health consumer survivor initiatives Commission of Canada sion of Canada report. Haldimand-Norfolk Chapter for peer support for people being report recommendations CARRIED
Registered nurse journal 19 RN Profile By Daniel Punch
Taking PRIDE in her work As a long-time public health nurse working in HIV-AIDS, and a strong advocate for LGBTQ issues, Dianne Roedding has spent much of her career empowering marginalized people.
Dianne roedding learned the self-identified lesbian. She Clients and Colleagues webinar the parent-infant program for power of a handshake, or spent her early career avoiding series, and initiating work on an Halton Region Department of friendly touch on the arm, discussing her personal life upcoming best practice Health. At first, she had trouble while telling people they were with colleagues for fear of guideline on LGBTQ health. identifying as a teacher. “I’m HIV-positive. persecution, but has since She says she’s very proud of the not a teacher, I’m a nurse,” she As the only nurse in the become an advocate for group’s work, and hopes it will thought to herself. “Then I Region of Waterloo Public LGBTQ issues. Together with prevent others in the commu- realized…teaching is an Health’s HIV-AIDS program in public health colleagues, she nity from feeling as alone and important part of nursing.” the late 1980s, Roedding had the created the Public Health powerless as she once did. Roedding loved working with “devastating” job of informing children, and even spent two people they tested positive for years running a daycare. But the virus that causes AIDs. Back Three things you she knew her niche was in the then, the life expectancy for didn’t know about community, helping people someone who developed the Dianne Roedding: make healthy lifestyle choices, disease was about 10 years. And so she returned to public health 1. She was manager of her she had to reassure newly faculty of nursing varsity in Waterloo in 1988, where she diagnosed patients they would hockey team in university. spent the next two decades in not become pariahs. the HIV-AIDS program. 2. She sponsored a family “That touch came to mean so Over the years, she has seen from Uganda, who spent much,” Roedding recalls. “The attitudes slowly change about their first year in Canada most important thing was living in a granny flat in HIV-AIDS, and about homo- letting them know they weren’t Roedding’s back yard. sexuality. She was able to come (outcasts).” out to her supervisor in 3. She recently started But that wasn’t necessarily Waterloo, marry her partner of playing the ukulele. the attitude in the community. 25 years, and share her story When Waterloo launched its about coming to terms with HIV-AIDS program in 1988, her sexual orientation in most local funeral homes would Alliance for Lesbian, Gay, Roedding graduated from RNIG’s webinar series. not even accept people who died Bisexual, Transsexual, University of Toronto (U of T) Pride events are taking place from the disease. Roedding was Transgender, Two-Spirit, with her nursing degree in 1974, across Ontario throughout the one of just a few applicants to Queer and Questioning Equity and got her start that same year summer, including Toronto’s the new program, and she (PHA) in 1997, a working at a 21-bed hospital in rural Nova first-ever Pride Month in June, believes the lack of interest was group of Public Health Scotia. The following year, she and Roedding says she’ll never thanks to misinformation and Ontario. The alliance later moved to Victoria General forget the feeling she got during fear about the emerging virus. realized the potential for a Hospital in Halifax, before RNIG’s first march in the It also had roots in underlying similar interest group within heading back to Ontario in 1978 Toronto Pride Parade. It was a homophobia, since HIV-AIDS RNAO, and in 2007, Roedding to become a public health nurse hot day in June 2008, and was most often associated with became a founding member of for the Simcoe County District nearly one million people came gay men, she says. the Rainbow Nursing Interest Health Unit. out to see the parade. “You “At the time...youth coming Group (RNIG). In 1981, her career took an could see people read our to terms with their sexual RNIG has accomplished a lot unexpected turn. She became banner and cheer,” she recalls. orientation were feeling lost and over the last nine years, interested in infant develop- “It was a phenomenal experi- alone and had nowhere to go,” including advocating for ment and decided to return to ence (and) so empowering.” RN she recalls. legislation promoting LGBTQ U of T to get a diploma in child Roedding is no stranger to rights, creating the Respectful studies. She graduated in 1983, daniel punch is staff writer these feelings as a Care and Support for LGBTQ and spent two years teaching in for rnao.
20 May/june 2016 Nursing week
2016May 12 not only marks Florence Nightingale’s birthday, it also marks that time each spring when nurses gather for a week-long celebration of the profession. We hope you had a wonderful Nursing Week, and enjoy this collection of images from across the province.
RNAO BPSOs raise awareness RNAO best practice guideline (BPG) Program Manager Grace Suva (far right) joined staff at Renfrew Victoria Hospital on May 12 to celebrate the facility’s implementation of the association’s guidelines. The hospital was one of seven Best Practice Spotlight Organizations (BPSO) to host Nursing Week media conferences to highlight the impact evidence-based practices are having at their organizations. Other sites host- ing events: Leeds, Grenville and Lanark District Health Unit; North Bay Nurse Practitioner-Led Clinic; Thunder Bay Regional Health Sciences Centre; Thunder Bay District Health Unit; St. Joseph’s Care Group; and Pioneer Ridge Long-Term Care.
Registered nurse journal 21 Nursing week2016
Fifty-six Ontario MPPs participated this year in RNAO’s annual Take Your MPP To Work visits. The initiative gives politicians a chance to see health care up close and better understand the challenges and joys of the work nurses do on a daily basis. For a glimpse of what the experience is like, read a first-hand account online (RNAO.ca/TYMTW2016) from the organizers of the Kitchener visit with NDP MPP Catherine Fife (below).
Nurses talk to MPP about TEAMWORK NP Jacqueline Kirkland (left) and RN Brenda Arbery (right) were among those to sit down with PC MPP John Yakabuski during his visit to Beachburg’s Whitewater Bromley Community Health Centre on May 13. By intro- ducing Yakabuski to an imaginary client, the group was able to show how its team approach to care means less duplication and fewer emergency department visits.
MPP learns more about long-term care Shaila Aranha, RNAO’s long-term care (LTC) best practice coordinator for the Waterloo Wellington LHIN (left) was one of many coordinators to arrange for MPP visits to LTC homes during Nursing Week. NDP MPP Catherine Fife (second from left) visited Pinehaven Nursing Home on May 13, meeting with Aranha and the facility’s administrator and director of care, Cindy Chamber- lain and Kami Johnson (second-from-right and right, respectively).
NDP leader at Hamilton roundtable NDP Leader Andrea Horwath (centre) participated in a roundtable discussion with nurses in Hamilton during Nursing Week. Larissa Gadsby, a nurse at McMaster Children’s Hospital (left) and Sriti Mizan, RNAO’s policy and political action executive network officer for the Hamilton chapter (right), Caring for children focus of visit to sickkids talked to Horwath about health On May 13, Liberal MPP Han Dong (right) toured The Hospital for Sick Chil- human resource planning and dren’s (SickKids) dialysis unit and learned the facility is the first paediatric a, S i c k K ids evidence of the link between RN hospital in North America to use hemodiafiltration, a new type of dialysis care and patient outcomes, associated with better outcomes. He also visited the in-patient cardiology among other issues. unit to participate in a daily continuous improvement huddle with (L to R) Mary McAllister, Associate Chief, Nursing Practice; Jennifer Kilburn, Quality
Team Leader; and RN Courtney Lindsay. v P HOTO : N elson Pai
Breastfeeding clinic welcomes Peel MPP Liberal MPP Harinder Malhi (centre, in white) visited with nurses at the Brampton Healthy Sexuality and Breastfeeding Clinics, part of Peel Public Health, on May 24. (From left) Brampton Councillor Gael Miles, clinic supervisor Damian Power, Chief Nursing Officer Isabelle Mogck, Malhi, clinic supervisor Linda De Vouge, RNAO Peel chapter President Anita Tsang- Sit, and Peel’s Medical Officer of Health Eileen de Villa.
22 May/june 2016 Golfers come together for Nursing Week Fifty-six golfers hit the links at Peterborough’s Heron’s Landing Golf Club on May 9 to celebrate Nursing Week. The event was organized by RNAO’s Kawartha-Victoria chapter.
CEO visits with public health nurses in Kingston RNAO CEO Doris Grinspun (second from right) visited Kingston, Frontenac, Lennox & Addington Public Health on May 12. (From left) Nursing Practice Leader and Kingston chapter President Allison Kern, Chief Nursing OfficerS usan Potvin, Medical Officer ofH ealth Ian Gemmill, dental hygienist Jamie Young, and public health nurse and Kingston chapter communications officer Dawn Cole.
An appreciation for evidence-based care in LTC PC MPP Laurie Scott (centre), who practised as an RN before getting into politics, was at Hyland Crest Long- Term Care Home in Minden during Nursing Week, learning about point-of-care leadership from the centre’s Director of Care April DeCarlo (left) and RNAO long-term care best practice coordinator Connie Wood (right).
Award winner, runners up recognized at RNAO Expo Each year, the Toronto Star honours its Nightingale Award winner at RNAO’s annual career fair. The 2016 winner was Jennifer Keeler (third from right), who, along with three runners up, received congratulations from Provincial Chief Nursing Officer Kaiyan Fu and RNAO IABPG Program Director Irmajean Bajnok (second-from-right and right, respectively). The Star’s Cath- erine King (left) presented the award to Keeler and runners up (second-from-left to R) Birgit Belter King, Namarig Ahmed and Michelle O’Rourke. RN
Registered nurse journal 23 Prior to her struggles with PTSD, Julie Prince travelled with World Partners Canada to Tanzania, where she provided general health care in the Mwanza District, alongside local health professionals. These twins at the Urafiki Medical Centre were born on the first day she arrived in Tanzania.
A path to healing
As the government passes legislation that makes life a little easier for first responders struggling with PTSD, nurses are left wondering why the day-to-day trauma in nursing is not being acknowledged as a trigger for mental illness. By Kimberley Kearsey
hen I first started nursing in 2002, I never imagined for at least a year before she decided to leave bedside nursing in the that 12 years later, I would be crippled by nightmares, fall of 2014. She says she felt as though she “just didn’t want to take anxiety and depression as a result of my job,” says care of anyone anymore.” Two months after her departure, her ‘‘ Julie Prince. “Yet that’s exactly where I ended up.” symptoms of PTSD began to peak, and she couldn’t even drive past WA full-time labour and delivery (L&D) RN for three years, who the hospital without experiencing anxiety. During those initial also worked occasionally in the neonatal intensive care unit (NICU), months away from work, she says “the grief and depression was Prince describes feeling immense anxiety at the start of each shift unbearable at times.” Many evenings, she would just sit on her
24 May/june 2016 couch crying. “While I sobbed, all I could see were the images of formally diagnosed with PTSD and approached the Workplace dead babies and feel haunted by the multitude of tragic stories Safety and Insurance Board (WSIB) for help, she received nothing. where I had played a role as a nurse.” ““This is part of your everyday job.” That’s what I was told over and Prince was formally diagnosed with depression and post traumatic over again,” Leonard said in an emotional television interview stress disorder (PTSD) in December 2014. “I thought I was burned out following the passing of Bill 163 in April. Going public with her story and….I was,” she explains. “I just didn’t realize the complexities of all was not easy, but Leonard says she did it because people – particu- that was happening within my psyche.” larly nurses – don’t talk about this, and they need to. “I felt so much Prince kept silent about her diagnosis until she heard about the shame and I held that shame for years,” she says. “Nobody would provincial government’s Supporting Ontario’s First Responders Act (Bill recognize nurses get post traumatic stress, and I had nowhere to go.” 163), which received royal assent on April 6 this year. When she The one place Leonard knew she would not go was back to the learned the new legislation does not recognize nurses as first bedside, but she didn’t want to let that stop her from moving on with responders – which means nurses are not afforded the same accom- her career in nursing. She headed back to school, and 10 years later, modation as other first responders seeking support for job-related she has master’s degrees in both counseling psychology and PTSD – Prince took to Facebook to open up about her own mental education. Leonard now runs her own business and provides health challenges directly related to her day-to-day work as an RN. counseling to individuals with anxiety, depression and PTSD. “My story is just one of many,” she says. “While I have held this part of my life very private for more than a year now, I do believe that good I’m very proud of can come out of my decision to share…and I am seeing that already.” In fact, her Facebook post on April 5 has been viewed by more where I am today. It than 21,000 people. It has been shared more than 3,100 times. “I have had responses from many, many nurses, and also families made me who I am that have been on the other side,” Prince says. “It has been very today. But I wish it moving and also a step of healing on my own journey. I am remarkably encouraged because it is getting nurses talking about didn’t have to be the day-to-day traumas and cumulative sorrow that we face.” this way, because Bill 163 recognizes that first responders develop PTSD during their employment, and entitles them to improved access to benefits for 10 years, it was under the Workplace Safety and Insurance Act. The legislation covers firefighters, fire investigators, police officers, paramedics, emer- really hard. And I gency medical attendants, and workers in correctional institutions think it could have been a lot better or secure custody. Appalled by the omission of nurses, RNAO issued an action if there were people to support me. alert on April 8, and sent an open letter to Premier Kathleen – Brenda Leonard Wynne and Minister of Labour Kevin Flynn, urging an immediate fix to this mistake. “It is both offensive and ludicrous to exclude nurses as first “I’m very proud of where I am today. It made me who I am today. responders when they are regularly among the first to assist during But I wish it didn’t have to be this way, because for 10 years, it was emergency situations,” RNAO wrote in its letter to the premier. really hard,” she says. “And I think it could have been a lot better if “How fast is our government forgetting the SARS crisis, or the there were people to support me.” Ebola scare? And, how little do political leaders know about what In his remarks during the opening ceremonies of RNAO’s nursing work entails?” annual general meeting in May, Ontario’s Health Minister Eric Nurses experience physical violence, oftentimes from patients who Hoskins told nurses he knows about the realities of PTSD. “I am are cognitively or mentally impaired, the letter notes, suggesting very understanding of your disappointment,” he acknowledged of triggers that lead to PTSD can also be associated with work-related the government’s oversight and the overwhelming response from violence. And it is not just limited to in-patient settings either. “In the nurses following the passing of Bill 163 (the action alert got more community, nurses work in neighbourhoods with high crime rates, than 2,300 responses in the first 24 hours following its release, and and in home care, nurses enter patients’ private residences to provide now sits at 5,359). care. Nurses also have roles during events that require immediate The minister also said he wants to “…keep this conversation going.” action at their organizations…that could trigger the onset of PTSD: His acknowledgement is welcome by nurses, but not without cautious cardio-respiratory arrests, violent persons, missing patients, infant optimism given the legislation falls under the ministry of labour, not abductions, hostage situations, bomb threats, pandemics, and the ministry of health. patients with life-threatening blood loss.” Whether Hoskins’ admission leads to legislative change, and an In 2006, Brenda Leonard was working in the ICU. The RN with acknowledgement of nurses as first responders under Bill 163, remains 30 years of nursing experience was caring for a patient who began to be seen. Meanwhile, the realities of everyday practice – and the risk losing blood so rapidly that it went from the bed to the floor and of PTSD in the nursing workforce – continue to weigh heavy on the onto Leonard’s hands. “I literally had blood on my hands,” she minds of RNs. RN recalls of the incident that triggered her PTSD. She had to leave the job she loved to go on disability for two years, and when she was kimberley kearsey is managing editor for rnao.
Registered nurse journal 25 Better health behind bars standards. It also recommends reducing improvements to inmate health would save (Continued from page 13) overcrowding, building stronger mental Ontarians significant tax dollars by avoiding Transforming Ontario’s Correctional Services: health and addiction programs, and expensive incarceration. It would also Starting, But Not Stopping, With Segregation addressing recruitment and retention issues contribute to a healthier society at large, with recommends various other improvements to among correctional nurses by bringing their former inmates better positioned as parents, health care in correctional facilities, particu- compensation in line with that of RNs in employees, partners, and community larly in terms of solitary confinement (see other sectors (they make nearly $5 per hour members, she says. sidebar on page 13 for more on this). The less than colleagues in the community). In April, Naqvi said the idea of shifting to a association insists segregation be used only Kouyoumdjian believes inmates who leave new governance model “has merit” and as a last resort, and abolished for prisoners jails healthier than they came in – especially vowed to improve care in Ontario jails by with serious or acute mental illness, to bring in terms of addiction and mental health – working with Health Minister Eric Hoskins. the system in line with United Nations may be less likely to reoffend. This means Other positive steps have been taken, particularly around mental health. There are now more mental health nurses in jails. Their presence has allowed new mental Happy Nursing Week health screening processes during admis- sions to identify symptoms and provide opportunities for treatment. And many On behalf of your professional association and the people of Ontario, nurses point to the St. Lawrence Valley we would like to extend a heartfelt thanks to the province’s RNs, NPs, Correctional and Treatment Centre in and nursing students. Brockville – where the Royal Ottawa Health Care Group operates a secure mental health treatment unit in partnership with MCSCS – You have each chosen to pursue a career of knowledge and as a possible springboard for corrections and compassion that has a profound impact on countless lives. Day in and health organizations to work more closely day out, you use your expertise to nurse people from all walks of life together in Ontario. But as long as health care and security during their time of need. Your talents shine in clinical settings, the funding come from the same envelope, they community, the classroom, and the boardroom, and your powerful will have competing interests, says Kouy- oumdjian. “There is a finite number of voice is helping shape policy in the halls of Queen’s Park and beyond. dollars. If you’re asking for money for health care, in some ways you’re asking for that to As we celebrate National Nursing Week, we congratulate you on come out of security.” another year of outstanding contributions. Take pride and reflect on Clarke adds it’s difficult to build the political will to make significant changes. your positive impact on patients, clients, their loved ones, and on the “It’s not politically popular to spend money health of Ontario as a whole. on inmates,” he says. “People are going to ask who deserves (funding) most. And Thank you for becoming a nurse, and for your continued excellence. guess who doesn’t make the top of the list?” Yet people who find themselves in We salute you! custody are often in desperate need of supports, particularly due to their economic and social marginalization, and high rates of childhood trauma. “Everyone feels empathy for a victim, Carol Timmings, Doris Grinspun but (that) only lasts until that victim RN, BScN, MEd RN, MSN, PhD, becomes a perpetrator, and the empathy (Admin) LLD (hon), O.ONT. President, RNAO Chief Executive disappears,” Clarke says. “The trick is to Officer, RNAO hold the adult accountable for what they have done, but recognize the eight-year-old victim that’s inside.” RN
daniel punch is staff writer for rnao.
For more information on Canada’s inmate population, and the difference between provincial jails and federal prisons, visit RNAO.ca/InmateHealth
26 May/june 2016 policy at work
Mind the Safety Gap RNAO kicked off Nursing Week with a warning that there is a glaring safety gap in Ontario’s health system. The warning was expressed in a report released at Queen’s Park by Immediate Past-President Vanessa Burkoski and CEO Doris Grinspun on May 9. Data analyzed by the association reveals that since 2010, the number of RNs working in hospitals has decreased. Many have been replaced by less qualified health-care workers, such as registered practical nurses and Dementia care personal support workers. RNAO board member Veronique Boscart (centre) appeared before the Senate Committee on Social Affairs, Science and Technology on April 13 to talk about dementia care. In addition to being an expert on seniors care at Conestoga College, RNAO says this trend is Boscart is also president of the Canadian Gerontological Nursing Association. The Senate committee is writing a report alarming given patient acuity and wanted advice on how many nurses and other professionals are needed to care for people with dementia, and what levels are increasing, both in additional educational requirements are needed to help care for the estimated 1.4 million Canadians who will be diagnosed with the disease by 2031. hospitals and in the community. It wants Health Minister Eric more and more hospitals plan to align population health practise to full scope, Hoskins and Local Health resorting to functional or needs and the full and including: prescribing Integration Networks (LHIN) to team-based organizational expanded scopes of practice of controlled substances; acting issue a moratorium on the models of nursing care delivery, all regulated health profes- as most responsible provider replacement of RNs, citing RNAO warns of increasingly sions with system priorities. (MPP) in all sectors; evidence that shows lower fragmented care. These models, 2. MO HLTC and LHINs issue a implementing their proportions of RNs are associ- in which patient care is broken moratorium on nursing skill legislated authority to admit, ated with higher complication down into a series of tasks mix changes until a compre- treat, transfer and discharge rates, increased re-admissions, delegated to various members of hensive interprofessional hospital in-patients; and and higher mortality rates. the nursing team, affect quality HHR plan is completed. utilizing fully the NP-anaes- In addition to the moratorium, of care and safety because no 3. Mandate LHINs to use thesia role inclusive of RNAO’s report, Mind the Safety one is actually in charge of the organizational models of intra-operative care. Gap in Health System Transfor- overall care needs of patients. nursing care delivery that 7. MOHLTC legislate mation: Reclaiming the role of the RNAO’s report recommends advance care continuity and minimum staffing stan- RN, outlines the need for a that hospitals organize nursing avoid fragmented care. dards in long-term care comprehensive interprofessional care using primary nursing as a 4. MO HLTC legislate an all-RN homes: one attending NP health human resources (HHR) more effective model. Under nursing workforce in acute per 120 residents, 20 per plan. This is an essential step this model, one nurse is in care within two years for cent RNs, 25 per cent RPNs before the ministry proceeds charge, and takes full account- tertiary, quaternary and and 55 per cent personal with full-scale reforms that will ability for planning all of the care cancer centres (Group A and support workers. change how care is delivered needs of a patient throughout D hospitals) and within five 8. L HINs locate the 3,500 across the province. their stay, and, when at work, years for large community community care access Changes in nursing skill mix also delivers that care. hospitals (Group B). centre care co-ordinators and the lack of an HHR plan are The report contains eight 5. L HINs should require that all within primary care to not the only concerns high- recommendations: first home health-care visits provide health system care lighted in RNAO’s report. The 1. T he Ministry of Health and be completed by an RN. co-ordination and naviga- way nurses are increasingly Long-Term Care (MOHLTC) 6. MO HLTC, LHINs and tion, which are core being forced to deliver care is develop a provincial evidence- employers eliminate all functions of interprofes- another troubling trend. With based interprofessional HHR barriers, and enable NPs to sional primary care. RN
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HMS_RNAO_Print_Ad-Apr_2016-FINAL.indd 1 2016-05-12 4:14 PM in the end By deborah kane
What nursing means to me…
Though i started my career in critical care, my goal was always to minded about their community clinical placements. work in public health, where I would have more opportunity to influ- I also warn them: “You may come to love community nursing; ence the health of individuals, families and communities from a health and, you may begin to define nursing from a health promotion promotion perspective. It always seemed odd to me that our health- perspective.” care resources focused on treating illness, rather than promoting Such was the case early in my teaching career, when a student asked wellness and preventing illness. When I became a public health nurse why her community placement required her to attend a city council in 1983, my colleagues and friends asked if I would miss ‘real nursing.’ meeting. I explained that “advocating for funding to support a city-wide “I am a real nurse,” I would reply as I shared examples of how bike path addresses many principles of health promotion,” and that’s health promotion, advocacy and political action help keep our why it is an appropriate activity for a nursing student. Six weeks into clients, families and communities healthy. This is what nursing the term, and immediately after attending the city council meeting, the means to me. student called me at home to declare: “I get it…physical activity, safe After working as a public health nurse for 10 years, I accepted a neighbourhoods, less traffic….it all promotes the health of our faculty position at the University of Windsor. I welcomed the opportu- community. I really get it!” Her realization – and my role in helping nity to encourage nursing students to expand their definition of what her reach it – exemplifies what nursing means to me. nursing means to them by exploring the impact health promotion can The most exciting shift that I have seen, as a nursing professor, have in their community placements. It is no secret that most students is that I no longer have to convince students to request commu- line up to secure clinical placements in fast-paced units such as nity clinical placements with a health promotion focus. Watching emergency departments and intensive care units. When they complete my students develop and implement wellness initiatives rein- that 12-week acute care clinical rotation, they have the opportunity to forces what nursing is all about for me: promoting the health of provide care, for example, to a surgical patient from admission to our communities. RN discharge. Thus, they see the patient’s immediate health crisis resolved. Rarely does a student see the positive health benefits that deborah kane is a professor in the faculty of nursing at the result from health promotion and disease prevention strategies in a university of windsor. she is also region ¡ representative on rnao’s
illustration: j a c kie b este m an illustration: 12-week community placement. But, I encourage them to be open- board of directors.
30 May/june 2016