infoVOLUME 51 ISSUE 2 FALL 2020 nursing
Over 40 Years of Info Nursing Watch for a New & Improved Format in 2021!
11 Have You Completed the 13 2021 Registration 27 The Growing Mandatory Jurisprudence Renewal: Key Dates Problem of Module? & Information Drug Diversion THE NANB AWAR DS ~ 2021 ~
CALL FOR NOMINATIONS 39
The deadline for nominations is January 31, 2021.
11 Have You Completed the 13 2021 Registration Renewal: Mandatory Jurisprudence Key Dates & Information Module?
Cover For over 40 years, NANB has distributed Info Nursing, a journal highlighting trends in nursing and healthcare to RNs and NPs as well as stakeholders and Government. In 2021, Info Nursing will take on a new and improved format delivered in a user-friendly and more timely fashion. 18 Client Abuse and Health Care 27 The Growing Problem of Drug Stay tuned! Serial Killing Diversion
2 INFO NURSING FALL 2020 17 30
17 Guideline for Telenursing Practice 30 Firsthand Experience from NANB's NANB New & Revised Documents Summer Student Meredith Clark
24 Nursing Ethics Provides Guidance During the Pandemic Crises 31 Opioid Diversion in Hospitals—A Safety Concern CNA Code of Ethics
35 NANB's Virtual AGM 2020 Highlights & Feedback
the pulse
5 Message from the President 36 Professional Conduct Review Decisions 7 Message from the Executive Director 38 Calendar of Events 8 Boardroom Notes
FALL 2020 INFO NURSING 3 Info Nursing is published twice annually by the Nurses Association of New Brunswick, 165 Regent St., Fredericton, NB, E3B 7B4. Views expressed in articles are those of the authors and do not necessarily reflect policies and opinions held by the Association. Submissions Articles submitted for publication should be sent electronically to [email protected] approximately two months prior to publication (April, October) and not exceed 1,000 words. The author’s name, credentials, contact information and a photo for the contributors’ page should accompany submissions. Logos, visuals and photos of adequate resolution for print are appreciated. The Editor will review and approve articles, and is not committed to publish all submissions. Change of address Notice should be given six weeks in advance stating old and new addresses as well as registration number. DESIGNER ROYAMA DESIGN TRANSLATION JOSÉ OUIMET EDITOR JENNIFER WHITEHEAD Tel.: (506) 458-8731; Fax: (506) 459-2838; Leadership and innovation in 1 800 442-4417; Email: [email protected] Canada Post publications mail agreement number nursing regulation in 40009407. Circulation 10,000. ISSN 0846-524X. Copyright © 2020 Nurses Association of New Brunswick. New Brunswick Executive Office LAURIE JANES Executive Director Email: [email protected] SARAH O’LEARY Executive Associate 459-2858; Email: [email protected] Regulatory Services COLIN LEAHY The NANB Board of Directors Registrar 459-2856; Email: [email protected] MELISSA EVERETT WITHERS General Counsel 459-2830; Email: [email protected] NICOLE CROUSSETTE Nurse Consultant 459-2853; Email: [email protected] ANNE MARIE LAVIGNE Nurse Consultant 459-2857; Email: [email protected] MEGHAN STEVENS Registration Supervisor 459-2869; Email: [email protected] CATHERINE CLOCKEDILE Paralegal Maureen Wallace Julie Weir Julie Boudreau Rosanne Thorne 459-2878; Email: [email protected] President President-Elect Director, Region 1 Director, Region 2 MARIANNE BROWN Senior Legal Assistant 459-2866; Email: [email protected] STACEY VAIL Registration Support 459-2851; Email: [email protected] Practice and Education KATE SHEPPARD Senior Advisor Practice and Education 459-2835; Email: [email protected] SYLVETTE GUITARD Nurse Consultant 740-1734; Email: [email protected] JOANNE LEBLANC-CHIASSON Nurse Consultant Nathan Wickett Vicky Doiron Laura Gould Christian Rousselle 381-4058; Email: [email protected] Director, Region 3 Director, Region 4 Director, Region 5 Director, Region 6 ANGELA WICKETT Nurse Consultant 459-2854; Email: [email protected] KRISTA CORMIER Nurse Consultant 459-2872; Email: [email protected] JULIE MARTIN Administrative Assistant 459-2864; Email: [email protected] Corporate Services SHELLY RICKARD Finance Director, Facility Manager 459-2833; Email: [email protected] Communications and Government Relations JENNIFER WHITEHEAD Communications Officer Deborah Walls Joanne Sonier Pauline Jennifer Ingram 459-2852; Email: [email protected] Director, Region 7 Public Director Public Director Banville-Pérusse STEPHANIE TOBIAS Public Director Communications Support 459-2834; Email: [email protected]
4 INFO NURSING FALL 2020 Message from THE PRESIDENT
Election Priorities 2020: Action for Successful Change
nterorganizational collaboration among nursing organiza- that some of our issues had made it to the forefront, thanks to tions can be an effective way to share resources and pursue all of you who took the time to inform yourselves and to become I common goals. NANB and NBNU recently partnered to raise involved. healthcare priorities in the lead-up to the 2020 provincial Our lobby efforts cannot end with the election. It is critical election. that the next government transform our traditional model of Our five election priorities to address health care and nurs- care and implement a more proactive and preventative approach. ing with candidates in our constituencies were: access to The work of the Nursing Resource Strategy must be ramped up primary care services; national universal Pharmacare plan; to address the growing nursing shortage; nurse practitioners comprehensive long term care strategy; mental health and must be hired and deployed in sufficient numbers to allow all addictions issues; health human resource planning and the those waiting on the Patient Connect Registry to have access to shortage of registered nurses in New Brunswick. Details regard- a primary care provider; and registered nurses and nurse prac- ing these priorities were made available in both English and titioners must be utilized to their full scope in the areas of French at www.nbnursingmatters.ca. On this site, nurses could mental health and addictions. get information on how to become effectively involved in the There is much to be done and working in harmony with election campaign, how to meet candidates to discuss issues other nursing organizations such as NBNU, our national coun- that mattered to nurses, and sample draft letters to candidates terparts, as well as nursing organizations in other provinces were provided. Throughout the Campaign, it became evident can often result in successful change.
MAUREEN WALLACE President [email protected]
FALL 2020 INFO NURSING 5 contributors this issue
13 17
COLIN LEAHY, JOANNE LEBLANC-CHIASSON, RN Registrar, NANB Nurse Consultant, NANB
18 27
SUSANNE PRIEST, RN, MN MEREDITH CLARK Nurse Consultant, NANB Nursing Student (UNB Fredericton), NANB Summer Student
Call For Entries
Do you have a story idea or article you would like to see in Info Nursing? Do you have someone you’d like to see profiled or an aspect of nursing you’d like to read more about? Please submit your ideas and suggestions to:
Jennifer Whitehead, Communications Officer
[email protected] 165 Regent St, Fredericton, NB E3B 7B4
6 INFO NURSING FALL 2020 Message from THE EXECUTIVE DIRECTOR
The Roles of Regulator and Association
ver the past five years, staff at NANB have participated to support an association mechanism that would serve to work in many sessions/meetings/forums and reviews on the toward advancement of the nursing profession in that O topic of being a “dual mandate” organization (regulator province. and association) for nurses. Several provinces have moved to The CARNA approach echoes similar approaches in British sole mandated regulatory or association focused nursing bodies, Columbia and Manitoba, whereas the separation of mandates due to perceived conflict of interest. This conflict of interest is occurred and there was a clear commitment within those tran- not unlike the nursing union compared to that of the nursing sition plans to foster resources toward the development of a regulator; while the New Brunswick Nurses Union (NBNU) was separate association. Two to three years after separation in those originally created and housed within NANB headquarters, the provinces, nursing associations have attained a solid founda- organizations separated in the late 1970’s due to a conflict of tion and are moving forward in tandem with other nursing interest with respective mandates. organizations, viewed as important partners in continued high Following a governance review and professional conduct quality nursing services for the public. review report, NANB has refocused and strengthened the regu- Members of NANB Board and staff are preparing to explore latory position, as mandated through legislation. However, the viability of regulatory and association nursing organiza- some nurse members are concerned with losing the advocacy tions for New Brunswick. Nurse members, stakeholder groups, for professional excellence typically performed by the associa- partners and members of the public will receive communication tion. This is work that would not be conducted by a “nursing and have an opportunity to participate in various ways as the college/regulator” and does not align with the work/mandate dialogue moves forward. Registered nurses are critical in the of the NBNU. delivery and coordination of quality health care for New The largest existing dual mandate nursing organization in Brunswick. Supporting safe, competent, ethical and compas- Canada is the College and Association of Registered Nurses of sionate care is the role of the nurse regulator. Supporting the Alberta (CARNA). Members of the Council and CARNA staff optimization of nursing education and professional develop- struggled with separation of regulation and association for sev- ment is the role of the nurse association. Together, both types eral years. However, in a governance review released in July of organizations protect the public interest. 2020, recommendations supported the separation. In August, Stay tuned for further progress and participation opportuni- CARNA Council members voted to separate, with commitment ties on this issue.
LAURIE JANES Executive Director [email protected]
FALL 2020 INFO NURSING 7 BOARDROOM Notes
The Board of Directors met via videoconference using Zoom Pro on June 9, 2020.
Board of Director Election Results and liability and information security. exam. A practice analysis is required to 2020 Election results were as follows: The revision resulted in strengthening identify entry level competencies (ELC) the purpose and principles, including a for the development of the exam. The • Region 1: Julie Boudreau (elected) glossary and removal of FAQs from project is meant to standardize NP • Region 3: Nathan Wickett (acclaimed) within the document. practice across the country and will hopefully help modernize NP practice Candidates begin their three-year 2 Pilot Programs in NB. mandate June 1, 2020. NANB is engaging in two different pilot program approval processes this year. Chapters Report Standards for Documentation Each of these new approval processes Many jurisdictions have moved away Documentation by nurses is fundamen- include engagement with employers of from Chapter’s, seeing activity tal to recording and evaluating nursing new graduates. This could determine if continue to decrease over the years. In care and is only as complete as the they are seeing the same or improved 2018, a resolution was passed to remove information entered into the permanent level of performance with increased the Chapters from the by-laws but client record. Nurses are accountable for simulation hours. The feasibility study NANB continues to provide financial ensuring that their documentation proposal outlined several other tools to support. Chapters receiving funds are meets NANB’s Standards for evaluate various tangible outcomes. required to submit activity and Documentation and Standards of Practice. expense reports annually. Currently, Regulation there are only two active chapters: The Standards for Documentation explain NP Regulation Project: Phase 2 Edmundston, and Miramichi. All the regulatory and legislative require- An update on the CCRNR NP active Chapters have reported they ments for nursing documentation. Regulations project was provided. A intend to close in 2020/21 and have There are three standards of documen- working group will be struck to develop indicated where remaining funds will tation: communication, accountability a request for proposal (RFP) for the NP be allocated.
8 INFO NURSING FALL 2020 f.y.i.
NANB Annual Meeting 2021 Seasonal Influenza 2020-2021
The Office of the Chief Medical Officer of Health of New Brunswick provides guidance for the delivery of the seasonal influenza vaccine, when ongoing COVID-19 activity may continue to stress public health capacity and affect clinic operations and attendance.
Please refer to the following resources for additional information:
• Department of Health: Immunization in Orange Phase
In accordance with Article XIII of the Resolutions for Annual Meeting • Seasonal Influenza 2020–2021 bylaws, notice is given of an annual Resolutions presented by practising meeting to be held May 12, 2021. The members according to the prescribed • Guidance for Influenza Vaccine purpose of the meeting is to conduct the deadline, April 1, 2021 will be voted on by Delivery in the Presence of affairs of the Nurses Association of New the voting members. During the business COVID-19 Brunswick (NANB). session, however, members may submit resolutions pertaining only to annual • 2020–2021 Seasonal Influenza Practising and non-practising members meeting business. Vaccine Information for of NANB are eligible to attend the Immunization Providers annual meeting. Only practising Voting members may vote. Confirmation of Pursuant to Article XII, each practising • Questions and Answers for membership will be required for nurse member may vote on resolutions providers: Influenza Vaccine admission. Nursing students are and motions at the annual meeting either Delivery in the Presence of welcome as observers. in person or by proxy. COVID-19
LAURIE JANES Executive Director, NANB
CNA Accreditation Program
CNA’s Accreditation Program continues to grow with new courses, programs and examinations. This program upholds standards of quality for continuing professional development for nurses in Canada.
Visit CNA’s website for a full list of offerings as well as information for organizations interested in the application process.
FALL 2020 INFO NURSING 9 f.y.i.
Have you recently moved? If so, be sure to contact the Association and let us know. It’s easy. Call NANB Registration Services at 1-800-442-4417 CNF Scholarship Recipients ext. 851 (toll-free in NB) or 506-458-8731. Or send us an email at [email protected], Christine Martin have a lot I can bring to clients. Attn: Registration Services— I love the human interactions and all Change of Address. NANB CNA the education that we provide to clients Centennial to help them achieve a better health. I Be sure to include your name, old Scholarship love that I get to spend so much time and current address, and your with them. I really feel honored to be able registration number. Since I was a young to work by their side and that they share girl, I always liked their stories with me. What I also to help people around me and health was appreciate, is to be able to discuss and always intriguing me. That is when I establish a plan of care that will work for Trends in Nursing decided to become a nurse. I completed them and that is more realistic and easier my bachelor’s degree and went on to for them to achieve. I find it so important Regulation travel as a nurse. I worked as a registered to involve the clients in their care, it nurse in Canada, Switzerland and then in empowers them so much and they get Nurses should note: for the past the USA before coming back home to much better results that way. decade governments across Canada Canada. I now work as a nurse clinician I truly love being a nurse and I am so have encouraged or mandated doing virtual primary care. I decided to grateful I chose this career. I have dual-mandate nursing organizations become a nurse practitioner because I become such a better person because of it. (conducting both association and love doing primary care and I feel that I regulatory business) to move to a single -mandate with a focus on regulatory work in the public interest. This trend has contributed Patricia Morris times. I love working in the community to anxiety in the national nursing and in long-term care, and I recently got community, as associations which New Brunswick to share my love for geriatric nursing support professional advocacy and PhD Nursing with a group of first-year students when I excellence in nursing practice have Scholarship served as a clinical instructor at the struggled financially to maintain University of New Brunswick. I am member services. I became a nurse excited to be continuing my education in because I am nursing because I believe so strongly in passionate about social justice, and I our role as advocates and agents of wanted to combine that passion with change. My research interests include practical work with older adults. My best practices in dementia care for people grandmother, mom, and sister are all who show challenging behaviors, and I nurses and I grew up understanding the am specifically interested in understand- The Governance Review Report important role that nurses can play in ing the emotional impacts of these commissioned by the College and people’s lives during really vulnerable behaviors on clients and caregivers. Association of Registered Nurses in Alberta (CARNA) (dual-mandate), and was published publicly in August 2020. Follow and Like NANB on Facebook and Twitter! The information and NANB has joined the world of social media, as an added media presence and recommendations align with monitoring tool; as well as an opportunity to promote to members, both governance review work underway at existing and future, of the Association’s events, supports and services available NANB, and the organizational vision while increasing traffic to our existing website. for the future: a focus on nursing regulation excellence and initial Facebook Twitter support for the continuance of a single-mandate nursing association in New Brunswick.
10 INFO NURSING FALL 2020 The Jurisprudence Module Must Have You Completed the Mandatory be Completed Prior to Renewing Jurisprudence Module? Your 2021 Registration
ll RNs and NPs will be required to • If you have forgotten your password, will start where you left off. Acomplete the jurisprudence learning click “forgot your password” and module prior to renewing 2021 NANB complete the required steps. • If you move backward, the slide will registration. NANB is one of the last re-set and you will need to repeat all jurisdictions in Canada to implement • The module is not mobile friendly actions. jurisprudence as a mandatory compo- and requires a computer to complete. nent of the Continuing Competence • At the completion of the module you Program (CCP) available through ‘My • You must complete all actions (listen will come to a certificate screen Profile’ on the website. to all content and complete any (printing this is optional and not As this mandatory module is new, activities) on each slide to move required). we want to thank nurses that have forward. reported technical issues and believe • Please note that it can take up to 24 they have been corrected. For more • Use the arrow button on the bottom hours to show as “Complete” in your information, visit NANB’s website or right of the slide page to move to the ‘My Profile’. contact NANB. next slide. Tips for completing the • Technical support is available Jurisprudence module: • If the > to proceed does not “bold” during regular business hours, call (indicating that you can proceed), 1-800-442-4417 (toll free) or email • Your registration number is your double check that you have clicked [email protected]. username. If you do not know your on every item. registration number, you can find For more information on CCP or this on the NANB website by going • If you still have issues moving Jurisprudence please view our FAQs: to Registration Services and forward, try using the “menu” tab on selecting Registration Verification in the top left to move forward or try • CCP FAQs the drop-down menu. logging out and back in. The module • Jurisprudence FAQs
FALL 2020 INFO NURSING 11 f.y.i.
NANB Office Closure: For Your Safety and Ours
The NANB staff have now transitioned back to work and can be reached by CCP Winners telephone or direct email. A full staff directory can be found on our website. For your safety and ours, the NANB office building will remain closed to NANB would like to thank all visitors for the time being. Thank you for your cooperation. members who completed the The NANB office hours are Monday to Friday, from 08:30 to 16:30. Jurisprudence module prior to the 2021 registration renewal period. We NANB WILL BE CLOSED appreciate your patience during the first year of this online learning module as we address technical December 24, 2020–January 4, 2021 Holiday Closure issues and continue to improve the DATES TO REMEMBER process for our members.
November 30, 2020 Registration Renewal Deadline Congratulations to all the winners from this year’s Jurisprudence Deadline for NANB Award January 31, 2021 incentive contests: Nominations
May 1 Draw Accommodations to the Algonquin Hotel, Dinner at the Rossmount and Free Registration for 2021
Get Involved • Nathalie Doiron, Lower Newcastle Play an Active • Jordan King, Saint John August 3 Draw Role in Your Free Registration for 2021
Association • Sandra MacLeod, Riverview • Ginette Robichaud-Lagace, Laplante • Kimberly Quick-Pirie, Upper Brighton • Huguette Boudreau, Nigadoo The Nurses Association of New experience in educational programs, • Sandra Munroe, Saint John Brunswick (NANB) is presently curriculum development and/or looking for members interested in program approval/accreditation September 30 Draw becoming involved in various would be an asset.) $250 Visa Gift Card standing committees: If you are interested in volunteering • Sonya Sullivan, Moncton • Nursing Education Advisory for one of the Committees and you • Michelle Stoddard, Darlings Committee* meet some or all of the criteria, Island • Complaints Committee please submit your resume to nanb@ • Dawn Walsh, Quispamsis • Discipline / Review Committee nanb.nb.ca for consideration, stating • Theresa Williams, Miramichi • Nurse Practitioner Therapeutics your language proficiency. Only • Ryan Joy, Fredericton Committee eligible candidates will be contacted. • Angie Hunter, Oromocto • Catherine Moar, Rusagonis * NEAC has one (1) committee For additional information and a full • Eric Lesser, Quispamsis vacancy in the following area: Public list of committees and criteria's, visit • Laura Shaw, Riverview representative (individuals with NANB's website. • Liette Duguay, Tracadie-Sheila
12 INFO NURSING FALL 2020 2021 Online Registration Renewal KEY DATES & INFORMATION
November 15, 2020 Employer Payroll Deduction Deadline
November 30, 2020 Registration Renewal Deadline
December 1, 2020 Empoyers Notified of Expired Registrations 2021 ONLINE REGISTRATION RENEWAL FEATURE
Key Dates & Information
Renew online via your Pre-authorized Debit (PAD) Option December 1, 2020 “My Profile” account Members have the option to pay annual Employers Will Be Notified About Registration renewals are to be renewal fees by pre-authorized debit Expired 2020 Registrations completed online via your “My Profile” (PAD). The PAD payment option is open The renewal deadline is 4:30 pm on account. Log in to your secured “My to all active practice members who November 30. Under NANB bylaws, your Profile” account or create your profile at intend to renew their registration the registration will automatically expire if Create my profile.Reminder: your user following year. you have not completed your renewal on name is your Registration Number. or before the deadline. On December 1, November 30, 2020 2020, all members whose registration November 15, 2020 2021 Registration Year Date and has expired will receive a notice by Employer Payroll Deduction Deadline Renewal Deadline email. In addition, NANB will contact Members participating in employer Members’ registrations expire on all NB employers to provide a list of payroll deduction of registration fees November 30 every year—if you intend members whose registration has must renew online by November 15. to practise or use the RN or NP title after expired. After November 15, payroll deduction November 30, 2020 you must renew your fees must be returned by NANB to the registration prior the deadline of employer and members will have to use 4:30 pm on November 30, 2020. their debit or credit card to renew online. Avoid the Late Fee—Renew Your Payment Options Online for Those Not Registration Early on Payroll Deduction Registrations that are renewed after You have the option to pay your online November 30, 2020 will be subject to a registration renewal fee by VISA, late fee of $57.50. Any nurse, who MasterCard and debit. Debit (Interac) is practises while not being registered, is only available to clients of Scotia Bank, also in violation of the Nurses Act and TD, RBC or BMO. may be charged an additional unauthorized practice fee of $287.50.
CCP Compliance Monitoring
Completing the CCP is a requirement last year. The audit process will for any active practice nurse or nurse consider: practitioner who wishes to renew their registration with NANB. NANB’s • Did the member complete all by-laws (article 1.03G), require that the required components of the CCP CCP program must also include an (self-assessment; learning plan; audit process to ensure that members implementation and evaluation of are compliant with the requirements of last year’s learning plan; mandatory the CCP. learning module) Each year registered nurses and nurse practitioners are randomly • Do the learning plans relate to the selected for review of their CCP member’s self-assessment The renewal portal submission from the previous year. NANB staff will review the • Member’s evaluation of how the is open for 60 days. learning plan submitted by the member learning activities informed and Don’t wait until the for the upcoming year and the member’s influenced the member’s evaluation of their learning plan from professional practice. last minute.
14 INFO NURSING FALL 2020 Important Information About Late Renewal
NANB’s registration year runs from payment fee. An additional penalty fee your employer’s insurance coverage, if December 1 to November 30. Each year, is charged if the member is found to the terms of the insurance cover services members renew their registration by have been practising nursing during the provided by “registered nurses” or completing the Continuing Competence time that their registration has expired. “regulated health professionals” and you Program, submitting the annual were not registered at the time that you renewal form, and paying the annual You Have No Insurance Coverage if provided the services. fees. The online renewal portal is Your Registration Has Expired available through the NANB website for There is significant risk, to both the NANB Will Notify All Employers About 60 days, from October 1 to November 30. nurse and the public, if a former Expired Memberships member continues to practice after their Each year, NANB speaks with many Your Registration Expires on registration has expired. Your nurses who have continued to practice November 30 registration fees with NANB include the nursing even though their registration Under NANB by-laws if a member does fees for professional liability insurance has lapsed. On December 1, all not renew their registration by the through the Canadian Nurses Protective members whose registration has established deadline, their certificate of Society (CNPS). expired because they failed to renew on registration automatically expires and If a lawsuit or complaint is filed or before the deadline of November 30 they are no longer authorized to practise against you for practice that you engaged will receive a notice by email. as a nurse or nurse practitioner in the in while not registered, you will not be In addition, NANB will be province of New Brunswick. Members covered by CNPS for the costs of legal contacting all NB employers to provide are not permitted to renew their fees or any damages or fines that may be a list of members whose registration has registration until they pay a late awarded. You may also be excluded from expired.
Preauthorized Debit (PAD) Option for Paying NANB Fees
Members have the option to pay annual to read the PAD program policy, provide renewal fees by pre-authorized debit the banking information for the account (PAD). The PAD payment option is open that you wish to use for the pre- to all active practice members who authorized payments, and confirm your intend to renew their registration the authorization for NANB to deduct the following year. monthly payment from your account. Your completed registration form How does the PAD program work? must be submitted by January 15, 2021 When you sign up for the PAD program, in order to participate in the PAD NANB will collect your renewal fees in program for 2022. for the upcoming year in eight monthly payments, from January to August. The Is there a cost to participate in the fees already collected will be credited to PAD program? your account when you log in to the There is a $20 administration fee NANB website in October/November to required to participate in the PAD complete your annual renewal. program. Your monthly fee will be your annual fee plus the $20 administration How do I register for the program? fee, divided by eight. The registration form will be available under “My Profile” on the NANB website What if I decide not to renew or to starting in October. withdraw from the program? Once you have logged in with your Members who withdraw from the NANB registration number and program will receive a refund of all password, click the link to the PAD pre-authorized fees paid for that year, registration form. You will be required minus the $20 administration fee.
FALL 2020 INFO NURSING 15 2021 ONLINE REGISTRATION RENEWAL FEATURE
Is your address on file with Check the email address you Verification of NANB up to date? have on file with NANB. NANB uses multiple formats to NANB uses both mail and email to Registration Status communicate with members. General communicate confidential information for all members may be information to members about their for Employers communicated through ebulletin, Info registration. For this reason, an and Members Nursing, on the website, or through mail email address that is shared with or email. co-workers or other members of your For important communications family is not appropriate. Employers are required under the related to your registration, NANB will During annual renewal, all Nurses Act to annually verify that communicate via mail or email. Don’t members will be required to provide nurse employees are registered miss a deadline because you forgot to an e-mail address that is private and with NANB. A quick and efficient update your address. When you move or that you check personally on a way to verify the registration status change jobs, add NANB to the list of regular basis. of nurse employees is to go to the companies that you notify as soon as NANB website and access the possible. registration verification system as follows:
• go to the NANB website at www.nanb.nb.ca; Are You Really a Non-Practising Member? • select Registration from menu at the top of the screen; Tips to Avoid Engaging in Tip 3: Going on leave? Unauthorized Practice Read Tips 1 and 2! • select Registration During annual renewal, all members Not everyone who goes on leave stops Verification. must make a decision about their practising nursing. To decide whether registration status for the upcoming to take a non-practising status while on This login page will allow you to: year. For most members that means maternity leave, long-term disability, or choosing between active practice or other leave, you must ask yourself the • Access your nurse registration non-practising status. Do you question whether you will be using your list if you are currently understand the difference? nursing knowledge while on leave. registered as an employer with Teaching a first aid class? Doing a NANB. Enter your user ID and Tip 1: Are you using your nursing presentation at your child’s school? password to verify the knowledge? These would be considered active registration status of your nurse The most important question to ask practice. employees. You may verify yourself when choosing between active registration of a nurse for the practice and non-practising status is Tip 4: Practising while not registered first time by entering her name “Am I using my nursing-specific can be costly. or registration number and knowledge, skills, or judgment”? If the Only nurses and nurse practitioners adding it to your list; answer is yes, then you must register as who are registered and in good standing an active practice nurse or nurse with NANB as active practice members • Register as an employer with practitioner. are authorized to practice nursing or as NANB if you have not done so a nurse practitioner in the province of previously. Once approved, you Tip 2: Work status is different from New Brunswick. will be able to create and save a practice status Under NANB rules, if you are found list of your nurse employees Many nurses assume that if they stop to have been practising as a nurse or with their registration status; working or retire from their long-term nurse practitioner while not registered, job, they should choose non-practising you may be required to pay a penalty fee • Verify the registration status of status. This is not the case. before you can complete your renewal. an individual nurse without Just because you retire from your job The fee can vary depending on how long having to use a password. doesn’t mean that you stop practising as you were practising without a a nurse. If you are engaged in any registration and whether it is you have Individual registered nurses can activity (paid or volunteer), where you engaged in unauthorized practice use the registration verification are relying on your nursing knowledge before. system to verify their own and skills, then you are practising In extreme cases, the Nurses Act registration status one business nursing. This includes volunteer, casual, permits NANB to apply for an injunction day after completing their online contract, or consulting work. to prevent a person from continuing to renewal. engage in unauthorized practice.
16 INFO NURSING FALL 2020 NANB NEW & REVISED DOCUMENTS Guideline for Telenursing Practice By JOANNE LEBLANC-CHIASSON
s telenursing or virtual care is being adopted or required in practice Nurse Consultants regularly produce Amany New Brunswick (NB), nurses have reached out to NANB with their documents to support safe, competent and questions. As a result, NANB has developed a guideline for telenursing to ethical nursing practice or documents best answer some of your commonly asked questions and provide informa- directly related to questions that members tion on the nursing principles that are considered essential components of have asked. Recent resources that NANB telenursing. has produced include: Currently if you are physically located in NB and providing telenursing services or are located in another Canadian jurisdiction providing • Standards for Documentation telenursing services to residents of NB you are required to hold a practicing • Guideline for Telenursing Practice nurse membership with NANB. For some nurses this requires registration in • Guideline: Duty to Provide Care multiple provinces, which can be a barrier. NANB is participating in work on • COVID-19: RN and NP Information multi-jurisdictional licensing, which focuses on a common verification • Nursing Intraprofessional Collaboration database with plans for a national database for nursing in the future. Guideline: LPNs and RNs Working Together (NANB/ANBLPN) • The Role of the Nurse and Scope of Practice Toolkit • Fact Sheet: Abandonment • Fact Sheet: Handover of Care • Fact Sheet: Reassignment to an Unfamiliar Practice Setting • Fact Sheet: Responsibilities When Assignment Care Amongst Team Members • Fact Sheet: Client Abuse • Fact Sheet: Health Care Serial Killers • FAQ: Documentation • Care planning: An Essential Element of RN Practice • How NANB Nurse Consultants Support RN and NP Practice Standards for Medication Management Webinars The Practice Standard: Medication Administration has been revised and the • RNs and LPNs Working Together document is now titled Standards for Medication Management. The revision • Social Media, Mobile Devices and resulted in significant changes to the content.FAQs on medication Information Technologies’ use in the management are also available to support nurses in applying these workplace standards in practice. We encourage nurses to consult these updated • Online Continuing Competence documents to continue to provide safe, competent and ethical nursing care. Program (CCP)
All documents are available on the NANB website at www.nanb.nb.ca.
FALL 2020 INFO NURSING 17 CLIENT ABUSE& HEALTH CARE SERIAL KILLING
BY SUSANNE PRIEST ursing care is intended to be compassionate, safe, and fessed to murdering eight patients and attempting to kill four ethical; however, in some situations, nurses fail to meet others. Most of the attacks took place in long-term care facilities, N these expectations. In such circumstances, the nurse’s and they spanned from 2007 to 2016. Colleagues of Wettlaufer’s actions may be considered client abuse. Client abuse can take reported feeling uncomfortable around her due to her odd and many forms, and it ultimately results in causing harm to the unprofessional behaviour. After the final attack, Wettlaufer patient. An unfamiliar and more severe form of client abuse is resigned from her nursing position and sought mental health health care serial killing. This phenomenon occurs when the treatment, where she ultimately confessed to her crimes. same healthcare professional kills two or more clients in sepa- It is easy to disregard the concepts of client abuse and health rate events (Tilley et al., 2019). Some potential characteristics care serial killing because they can be uncommon; however, of healthcare serial killers include having a mental health dis- Wettlaufer’s case shows how important it is to be aware of these order, making colleagues feel anxious, possessing unauthorized concepts. Unfortunately, there is no simple approach to identi- medications at home, and making frequent changes in employ- fying healthcare providers who intend to harm their clients but ment (Tilley et al., 2019). A well-known case of healthcare serial being educated on the topic is a step in the right direction. In killing is that of Elizabeth Wettlaufer. considering this, NANB has developed two fact sheets to edu- In 2016, Elizabeth Wettlaufer, a former nurse in Ontario, con- cate nurses on client abuse and health care serial killing.
Tilley, E., Devion, C., Coghlan, A. & McCarthy, K. (2019). A regulatory response to healthcare serial killing. Journal of Nursing Regulation, 10(1), 4-14.
CLIENT ABUSE
Under the Nurses Act, NANB is legally responsible to protect the • behaviour or remarks of a sexual nature by the member public by regulating members of the nursing profession in New towards the client. Brunswick. Regulation makes this profession, and nurses1 as individuals, accountable to the public. Safe, competent, ethical Nurses giving special attention to a client to the point of cross- and compassionate care is the goal of the nurse-client relation- ing over the boundaries of the nurse-client relationship to a ship and nurses are responsible to be professional in all more personal one, is a common antecedent to sexual abuse. encounters with clients. Examples of special attention include: spending prolonged time A nurse-client relationship exists if the nurse has direct with the person before or after work; giving gifts; sharing per- interaction with an individual for the purpose of providing sonal information and communicating via telephone or nursing care, in any practice setting. Client abuse can be defined electronically. as the misuse of power or a betrayal of trust, respect or intimacy Social media provides a venue for boundary crossing by between the nurse and the client,2 which may cause physical or facilitating a way for a nurse and a client to exchange personal emotional harm. This includes all types of abuse, such as: information about each other. Maintaining professional bound- aries is always the nurse’s responsibility because of the power • neglect (e.g., failing to provide the necessities of life); imbalance that exists between the client and the nurse. Any sex- • physical abuse (e.g., striking a client or causing ual or romantic relationship a nurse has with a client, is abuse, discomfort); even if the client consents. In the nurse-client relationship, the • verbal/emotional abuse (e.g., shouting at or insulting nurse holds a position of power by virtue of having: a client); • financial abuse (e.g., soliciting gifts from a client); or • professional knowledge and skills clients rely on for their • sexual abuse (e.g., inappropriately touching a client). well-being; • access to a client’s body; and Abuse can be subtle or overt and it interferes with meeting the • access to a client’s personal health information. client’s therapeutic needs. It can permanently damage the nurse-client relationship and result in negative health out- Preventing Client Abuse comes. Abuse can also erode the public’s confidence in the Not all nurse-client boundary violations will lead to abuse, but nursing profession. the potential exists. Healthcare professionals who abuse clients often have a progression of unprofessional behaviours and a Sexual Abuse history of other professional misconduct matters. Many abuse Sexual abuse is defined in theNurses Act (section 28.1[2]) as: situations involve a vulnerable client such as individuals with mental health conditions, residents of long-term care facilities • sexual intercourse or other forms of physical sexual and/or clients receiving home care. relations between the member and the client; Creating a safe culture in health care settings is important • touching, of a sexual nature, of the client by the member; or for the protection of both clients and employees. Everyone has
FALL 2020 INFO NURSING 19 CLIENT ABUSE AND HEALTH CARE SERIAL KILLING FACT SHEET
a role in developing an environment where clients and employees Raising a Concern or Reporting Abuse can speak up about unsafe practice. The objective of a safe culture Any nurse who has reason to believe that another healthcare is to empower nurses to protect clients, their colleagues and professional is not practising safely to such an extent that the themselves. The following actions can decrease the risk of client welfare of clients is jeopardized, is obligated to report their con- abuse: cerns5. You are partner in ensuring public protection—if you are concerned about a situation impacting the safety of a client, • Education about client abuse, including signs of abuse it is your obligation to intervene. and how to report it. It can be hard to know what information to report and to whom. This is a good conversation to have within your team at • Know the legislation regarding sexual abuse3 and signs of work, before the need arises. Being knowledgeable of the NANB sexual abuse by healthcare providers. Standards of Practice, Code of Ethics and relevant employer policies, will increase your awareness of what is acceptable and unac- • Be fit to practise—physical and emotional fatigue can ceptable behaviour. To help you further understand when and impair judgment.4 how to report a concern, NANB has published a document titled: Duty to Report: When am I responsible to do it and how do I do it? You • Stop, pause and reflect on your practice—do not cross are expected to recognize and take actions in situations where professional boundaries. client safety is potentially or actually at risk (NANB, 2019). If you have a concern, at minimum, it needs to be reported to your • Do not communicate with clients via social media (e.g. do employer. not ‘friend’ clients on Facebook). There are certain situations legally required to be reported directly to the NANB or another regulatory body. For example, • Intervene when you suspect a relationship is going from provincial legislation imposes a legal obligation on health care professional to personal. professionals, including nurses, to report incidents of sexual abuse6. Additionally, employers who dismiss a nurse for reasons • Bring client safety concerns forward to your employer as of incompetence or incapacity are obligated by law to report soon as possible. that nurse to the NANB, and failure to report is considered to be professional misconduct. • Report sexual abuse as outlined in the Nurses Act. The complaints and discipline process for nurses is outlined on the NANB website. There are also nurse consultants available to help you understand how to apply your standards of practice in relation to your duty to report. If you have questions regard- ing client abuse or your duty to report, please contact NANB by e-mail at [email protected] or by phone at 506-458-8731 or 1-800-442-4417 (toll-free in NB).
Acknowledgement The College of Nurses of Ontario granted permission to NANB to adapt content from the Sexual Abuse Prevention section of their website www.cno.org.
References 1 Johnson, J., Hall, L. H., Berzins, K., Baker, J., Melling, K., & Thompson, C. (2018). Mental healthcare staff well-being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions. International Journal of Mental Health Nursing, 27(1), 20-32.
2 Nurses Association of New Brunswick. (2002). Nurses Act. http://www. nanb.nb.ca/media/ resource/NANB-NursesAct-2008-Bilang.pdf
3 Nurses Association of New Brunswick. (2018). Standards for the Practice of Primary Health Care Nurse Practitioners. http://www. nanb.nb.ca/media/resource/NANB-NPStandards-Dec2018-E.pdf
4 Nurses Association of New Brunswick. (2019). Standards of Practice for Registered Nurses. http://www.nanb.nb.ca/media/resource/ NANB2019-RNPracticeStandards-E-web.pdf
20 INFO NURSING FALL 2020 HEALTH CARE SERIAL KILLING
ealth care serial killing is a phenomenon that has • most of the deaths by HCSKs occur in hospitals, some occurred in many countries, including Canada. Awareness have occurred in long-term care facilities and home care H of this phenomenon is a critical step because we cannot settings; be vigilant for something, unless we are aware of what it is and what signs to look for. In this fact sheet, information on what • HCSKs commit their murders in similar patterns and in is currently known about the commonalities of Health Care similar practice settings; Serial Killers (HCSKs), including their work environments, their victims, and possible cues for detection is shared. • the deadly acts usually occur during evening and night HCSKs are trained healthcare professionals who have taken shifts or during shift changes, when fewer people are it upon themselves to kill clients in separate incidents, with the present, or staff are distracted; psychological capacity for more killing (Yardley & Wilson, 2014). There is no specific psychological profile, nor predictive traits • HCSKs usually work or are just finishing a shift when the that are guaranteed to identify would-be serial killers. Some of questionable deaths occur; the common circumstances in which health care serial killing has occurred, includes the following: • the target population includes vulnerable clients—the very young, the very old and/or the very sick; • most HCSKs are nursing professionals who work alone in their endeavours to kill clients and who display some • the method of killing is most often an injectable warning signs in behaviour; medication such as potassium or insulin (historically,
FALL 2020 INFO NURSING 21 CLIENT ABUSE AND HEALTH CARE SERIAL KILLING FACT SHEET
other injectables used were heparin, bleach, muscle • practice concerns (for example, the HCSK repeatedly not relaxants, opioids and large quantities of air); and documenting medication administrations or falsifying documents); and • some of the HCSKs were caught due to patients and family members who observed an injection right before an • suspected mental health disorders, specifically, adverse incident such cardiac arrest or seizuring (Guy, personality disorder, extreme depression, or signs of 2018; Lisa Feldstein Law Office, 2019; Tilley et al., 2019; addiction (Tilley et al., 2019; Yorker, 2020). Yardley & Wilson, 2016). Research highlights the importance in looking at the data as a Motives for purposeful killing in healthcare are not consistent. whole and not using one single trait or characteristic on its own Review of known healthcare killings have revealed character to report suspicions of healthcare killing. Review of HCSKs has traits and behaviors which may be warning signs. A potential shown that over 70% were captured because of information pro- HCSK may: vided by direct witnesses such as colleagues, victims’ family members and even surviving victims (Tilley et al., 2019). Nurses1 • harm clients as a means of punishment, expressing need to be educated about client abuse and healthcare serial feelings of the client being a burden to them or an killing as well as their duty to report. Employers need to encour- annoyance; age a safe culture in which reporting of any actual or potential risk to clients is supported. It is also recommended that health- • thrive on the thrill of saving a life (some convicted HCSKs care administrators have processes to review death and cardiac/ have reported feeling a thrill in trying to revive a patient respiratory arrest statistics on a monthly basis by unit and by near death or relish the attention associated with the shift and think more critically when they notice a spike in event); deaths in a particular workplace setting. This review should be done in consideration with other types of evidence such as • seek to work in locations or at timeframes in which less monitoring of medication systems, staff reports of unusual staff and supervisors are on duty; behaviour, review of any available video surveillance and back- ground checks of staff with their respective regulatory body • have a history of professional conduct issues, including a and previous employer (Yardley & Wilson, 2016; Yorker, 2020). history of being terminated from previous employment; If you have questions regarding healthcare serial killing, cli- ent abuse or your duty to report, please contact NANB by e-mail • frequently change employment, moving from one at [email protected] or by phone at 506-458-8731 or 1-800-442- workplace to another; 4417 (toll-free in NB). Additional resources for nursing practice, including standards of practice, practice guidelines, and informa- • have few personal relationships and/or difficulty fitting in; tive fact sheets may be found at www.nanb.nb.ca.
• have a history of mental instability and/or a diagnosed References mental health disorder; Guy, F. (2018, July 7). Addicted to killing: Serial killers and the addiction cycle. Crime Traveller. https://www.crimetraveller.org/2018/06/ • have a tendency towards addictive personality/behaviour; addicted-to-killing-serial-killers-addiction-cycle and Lisa Feldstein Law Office. (2019, August 1). Healthcare serial killers and • be in possession of medications on themselves, in their the long-term care homes public inquiry final report. https://www. workplace locker or at home (Guy, 2018; Lisa Feldstein Law familyhealthlaw.ca/blog/ Office, 2019; Tilley et al., 2019; Yardley & Wilson, 2016). healthcare-serial-killers-and-the-long-term-care-homes-public-inquiry- final-report Barriers in identifying healthcare killings may be from the misconception that such a phenomenon “could not possibly Tilley, E., Devion, C., Coghlan, A. & McCarthy, K. (2019). A regulatory happen in our workplace”; lack of knowledge regarding health- response to healthcare serial killing. Journal of Nursing Regulation, care serial killing; and the stage of life of the victims (being old 10(1), 4-14. or very sick—living in a stage of life when death is not surpris- ing). Initially, some colleagues reported feeling badly for the Yardley, E. & Wilson, D. (2016). In search of the ‘Angels of Death’: HCSK and considered the deaths as a string of bad luck. However, Conceptualising the contemporary nurse healthcare serial killer. many colleagues voiced serious concerns and harbored suspi- Journal of Investigative Psychology and Offender Profiling, 13, 39-55. cions such as: https://doi 10.1002/jip.1434
• the HCSK had an unusual need for control and authority; Yorker, B. (2020, March 3-5). What the data tell us about healthcare serial killers [Conference session]. National Council of State Boards of • overt excitement by the HCSK in saving a client from Nursing Midyear Meeting, Boston, MA, United States. imminent death (hero complex);
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4904-0818 AMG AD Nurses_Association_of_New_Brunswick_7-5x8-5_English Final.indd 1 2018-08-15 7:55 AM 24 INFO NURSING FALL 2020 FALL 2020 INFO NURSING 25 26 INFO NURSING FALL 2020 BY MEREDITH CLARK Rx THE GROWING PROBLEM OF DRUG DIVERSION THE GROWING PROBLEM OF DRUG DIVERSION FEATURE
n RN, Megan, has been working on the same medical adequate doses of medication, they may have unrelieved pain unit for the past five years. She enjoys her job, but the (Berge et al., 2012). In the first nine months of 2017, 1.8 million A shift work is beginning to affect her mental health. doses of controlled substances were reported missing to After a long nightshift, Megan takes her patient’s PRN Health Canada across the country (Carman & Adhopia, 2018). sedative to help her sleep. She documents that the patient It should be noted that New Brunswick is not immune to this took it and does not think much about it. After this patient is issue; NANB received six complaints of drug diversion from discharged, Megan begins seeking other patients that are December 1, 2018 to November 30, 2019, and these numbers prescribed the same medication so that she can take it after are increasing each year (Nurses Association of New her nightshifts. Eventually, Megan begins requesting Brunswick [NANB], n.d.). Further, it is important to consider prescriptions for her patients, explaining that they have that many cases of drug diversion are undetected, as a result, trouble sleeping while in the hospital. A few weeks later, it may be underreported (New, 2015). Because of the harm Megan begins taking the medication during the last few medication diversion can cause, it is critical for nurses to hours of her shift so she can fall asleep as soon as she is home. know the signs to watch for, to be educated on reporting Although not frequently discussed, drug diversion is a diversion, and to understand the prevention and treatment of common issue in healthcare. The Nova Scotia College of drug diversion. Nursing (NSCN, 2016) explains drug diversion as, “the unlawful misdirecting or misuse of any medication” (p. 2). Signs of Drug Diversion Diversion of medication is described as a “slippery slope”, and Initially, signs of diversion may go unnoticed. The nurse may the scenario above is an excellent example of how it can occur arrive early for their shift and stay later than scheduled; they without malicious intent (Cohen & Smetzer, 2016, p. 2). might volunteer for more shifts and put in overtime hours Consequences of diverting medications can include subopti- (New, 2015). The nurse could be well-experienced, and they mal treatment for patients, increased risk of infection from often have an advanced education (New, 2015). It is important contaminated needles, and if the patient is not receiving to keep in mind that substance use and drug diversion can happen to anyone, regardless of age, occupation, or gender (National Council of State Boards of Nursing [NCSBN], 2018). TABLE 1 Drug Diversionary Signs As the nurse continues diverting medication, they might make frequent trips to the washroom, may offer to medicate performing narcotic counts alone and failing to ensure patients assigned to other nurses, and eventually, they will observation or co-signing for narcotic wastage begin making repeated errors and their work performance will begin to deteriorate (NCSBN, 2018; New, 2015). A com- offering to hold keys for narcotics storage cabinets plete list of drug diversionary signs can be found in Table 1. Reporting Diversion tampering with vials or packages It is important to be aware of potential drug diversion activities in the workplace. Standard one of NANB’s Standards waiting until alone to access and draw up narcotics of Practice for Registered Nurses (2019) requires nurses to report any situations in which clients or health care providers may inconsistencies between narcotic records and patient’s be at harm; therefore, a nurse must report drug diversionary medication administration record behaviour as it could cause injury to the patient. If you suspect a nurse is diverting medication, certify that the nurse’s patients are safe, and then report to your supervisor frequent reports of lost or wasted medications (NSCN, 2016). It is crucial to document your observations, and to follow-up with your supervisor to verify that action is excessive administration of PRN medications and reports of taken (NSCN, 2016). Some employers have specific policies ineffective pain relief from the same patient regarding reporting of drug diversion, ensure that you are aware of your institution’s policy when reporting. In addition, reports that medications from home have gone missing early identification that a nurse may be diverting and using drugs can lead to a better chance of recovery and returning to defensiveness when questioned about medication errors work (NCSBN, 2018). The ultimate goal of reporting medica- tion diversion is to initiate assessment and treatment, if necessary. showing up when not scheduled and hanging around the drug supply Prevention and Treatment Education on drug diversion is key to prevention. All clinical requesting assignment to patients with large amounts of and non-clinical employees should be educated on the signs prescribed pain medication to look for; moreover, staff should be aware of the steps to report suspected diversion (New, 2015). Everyone has a using fictional client names on narcotic records (NSCN, 2016) responsibility in recognition and prevention of medication diversion (Berge et al., 2012). Other methods of prevention
28 INFO NURSING FALL 2020 include frequent audits of controlled substances, requiring a Consequences of diverting witness for administering and wasting controlled substances, and the use of automated dispensing cabinets (Johnson & medications can include Borsheski, 2019). Furthermore, it is valuable to consider the impact of mental health on the development of drug diver- sionary behaviour and substance use. Nursing can be suboptimal treatment for stressful, and factors such as inconsistent schedules, high expectations at work and burnout, can lead to substance patients, increased risk of misuse (Cares, Pace, Denious, & Crane, 2015). Factors external to the workplace, such as family responsibilities, or expenses infection from contaminated may also contribute to the development of substance use. It is critical to practice self-care in order to maintain proper needles, and if the patient is mental health; activities such as, eating healthy, building social support, and developing positive coping mechanisms not receiving adequate are beneficial (College of Nurses of Ontario, 2019). A list of resources for RNs and employers managing problematic substance use is available in the Nurses Association of New doses of medication, they Brunswick’s (2016) Guidelines for the Recognition and Management of Problematic Substance Use in the Nursing Profession. may have unrelieved pain.
Conclusion Drug diversion is a growing problem in healthcare, and it is important to be aware of this issue. The Standards of Practice for Registered Nurses (2019) hold nurses accountable for their actions, and as noted previously, diversion can cause serious harm to patients. Nurses play a vital role in recognizing drug diversionary behaviour in their colleagues (NCSBN, 2018); therefore, it is imperative to understand the signs of drug diversion, how to report it, and how it can be prevented. Please contact NANB if you have any questions regarding substance use and your ability to practice safely.
References Berge, K. H., Dillon, K. R., Sikkink, K. M., Taylor, T. K., & Lanier, W. L. (2012). Johnson, Q. L., & Borsheski, R. (2019). Recognizing and preventing Diversion of drugs within health care facilities, a multiple-victim crime: perioperative drug diversion. AORN Journal, 110(6), 657–662. Patterns of diversion, scope, consequences, detection, and https://doi.org/10.1002/aorn.12878 prevention. Mayo Clinic proceedings, 87(7), 674–682. https://doi. org/10.1016/j.mayocp.2012.03.013 National Council of State Boards of Nursing. (2018). What you need to know about substance use disorder in nursing [Brochure]. Cares, A., Pace, E., Denious, J., & Crane, L. A. (2015). Substance use and https://www.ncsbn. org/SUD_Brochure_2014.pdf. mental illness among nurses: Workplace warning signs and barriers to seeking assistance. Substance Abuse, 36(1), 59–66. https://doi.org/ New, K. (2015). Investigating institutional drug diversion. Journal of Legal 10.1080/08897077.2014.933725 Nurse Consulting, 26(4), 15–18.
Carman, T., & Adhopia, V. (2018, June 27). More than half a million Nova Scotia College of Nursing. (2016). Problematic Substance Use: A Guide prescription drugs are stolen each year - and most are opioids. CBC. for Nurses. Bedford: Author. https://www.cbc.ca/news/canada/missing-drugs-pharmacies- part1-1.4708041 #:~:text=The analysis found that overall,1.1 million Nurses Association of New Brunswick. (n.d.). Annual Report 2019. doses went missing. Fredericton, NB: Author.
College of Nurses of Ontario. (2019). Self-care fact sheet [Fact sheet]. Nurses Association of New Brunswick. (2016). Guidelines for the http://www.cno.org/ globalassets/ Recognition and Management of Problematic Substance Use in the 4-learnaboutstandardsandguidelines/prac/learn/sap/ Nursing Profession. Fredericton, NB: Author. sexual-abuse-self-care-en.pdf Nurses Association of New Brunswick. (2019). Standards of Practice for Cohen, M. R., & Smetzer, J. L. (2016). Partially Filled Vials and Syringes in Registered Nurses. Fredericton, NB: Author. Sharps Containers Are a Key Source of Drugs for Diversion. Hospital Pharmacy, 51(7), 514–519. https://doi.org/10.1310/hpj5107-514
FALL 2020 INFO NURSING 29 FIRSTHAND EXPERIENCE FROM NANB'S SUMMER STUDENT
Why were you interested in the What aspects of the job did there are numerous valuable resources position with the Nurses AssociationMeredith you find most rewarding or Clark created by NANB that I was unaware of, of New Brunswick (NANB)? surprising? for example, guidelines, FAQs, fact I was interested in the student position I think it was most rewarding being able sheets, webinars and more. Regulation at NANB because I wanted to to contribute to the field of nursing, is more than just disciplining nurses understand what NANB’s role was in the especially during a pandemic. I also when something goes wrong, it also nursing profession. I thought it would found it rewarding seeing projects aims to support nurses in their be a great way to learn about nursing being completed and released over the everyday practice. and to view nursing from a regulatory course of my time at NANB. Most of my perspective. Since my clinical experience thus far has been in the What advice would you give experience to this point has focused on hospital or long-term care facilities, future student nurses looking to hands on care, I thought it would be where you don’t always see the results of work with NANB? beneficial to experience a different your work. It was exciting to be able to The summer student position was a aspect of nursing. see my work put to use this summer. great way to learn about the regulatory I think I was most surprised by the aspect of nursing. The position itself Can you describe the projects scope of responsibility that belongs to involved some research, writing, or initiatives you were tasked NANB. Regulating the nursing critical thinking, and creativity, so to complete? profession is a big task, and there is a lot experience in those areas would be I was given several projects to work on of work put into it. valuable. If you’re curious about what over the summer. Initially, I was asked to its like to work at NANB and you think complete jurisdictional reviews, write an What did you learn about you may want to work in nursing article for Info Nursing, and compile regulation’s role in nursing? regulation in the future, be sure to standard replies for common practice Working at NANB has given me a better apply. I gained so much knowledge and questions. As the summer progressed, I perspective about what the regulatory experience from this position, it will was given more projects, including body does. The purpose of regulation is make a significant impact in my recording webinars, creating quiz to promote safe, competent, and ethical nursing practice in the future. Overall, questions for the Continuing nursing care; but there is a lot that goes the team at NANB is extremely Competency Program, writing on behind the scenes. I learned that the supportive and the student position is introductions for Info Nursing and regulatory body is meant to support a great learning opportunity. e-bulletin articles, and creating webinars. nurses, as well as the public. Further,
30 INFO NURSING FALL 2020
Highlights & AGM 2020 Feedback n adhering to WorkSafeNB and public significantly resulting in an extension • Melissa Whitney, UNB SJ I health guidelines, NANB hosted a of the voting period over the weekend, • Robyn Travis, UNB Fredericton virtual AGM on Friday June 26, 2020 resulting in number of votes not cast. • Sarah Arsenault, UNB Moncton highlighting the 2019 Annual Report Four (4) resolutions were presented, • Katia Emilie Lynn Vienneau, and Auditor’s Report. With approxi- with one being carried by the Assembly. UdeM Moncton mately 130 members in attendance, To improve communications with • Julie Cyr, UdeM Edmundston typical of an in-person AGM, feedback members for future AGM sessions, a • Erika Kenny, UdeM Shippagan on the technology platform—Zoom— plain language summary will was very positive. The AGM also accompany resolutions including the Congratulations! permitted the ability for members to legal ‘whereas’ and ‘Be it resolved’. carry proxies and submit resolutions Recognizing the importance of On behalf of the Board and staff, we from the floor. However, members did member contact and opportunities for thank all members who participated express disappointment with allocated dialogue, NANB will begin offering and provided feedback to continuously time for open discussion and debate of quarterly town-hall style forums in 2021. improve your overall experience. resolutions. There was also a technical Stay tuned for details. glitch with the resolution survey Joining the AGM to receive the 2020 software which delayed delivery President Award were recipients:
FALL 2020 INFO NURSING 35 PROFESSIONAL CONDUCT REVIEW DECISIONS
SUSPENSION LIFTED AND increases in patients’ narcotics doses so nursing. The Member misread an CONDITIONS IMPOSED she could steal the overage) constituted insulin order transcribed on a In a decision dated March 30, 2020, the professional misconduct, conduct Medication Administration Record, did NANB Fitness to Practice (Review) unbecoming a member and dishonesty. not check the actual order to confirm the Committee accepted the Alternate The Committee accepted evidence that dose, and administered ten times the Complaint Resolution Proposal (“ACRP”) the Member is now fit to practice, and ordered dose to a patient. The Member submitted by Angela Arsenault-Daigle, ordered that the suspension imposed on also failed to have the medication registration number 022033 (the the member’s registration by the administration co-signed by another “Member”). As a result of the admissions Complaints Committee in a decision Registered Nurse as required by policy, made in the ACRP, the Committee found dated April 24, 2018 be lifted and and failed to exercise critical thinking by that the Member’s actions (including conditions be imposed on the member’s not questioning if the mistaken dose was poor/absent documentation, unsafe registration. correct. The Member then failed to client care, failure to follow clinical document the administration of the practice guidelines, and breaching the REGISTRATION SUSPENDED insulin overdose and the resulting Code of Ethics regarding right to know, On July 8, 2020, the NANB Complaints interventions, and did not complete an professional boundaries and Committee suspended the registration of incident report. confidentiality) constituted professional Mamadou Issa Diallo, registration misconduct, incompetence and conduct number 030733, pending the outcome The Discipline Committee reprimanded unbecoming a member. The Committee of a hearing before the Discipline the Member for not adhering to the ordered that the suspension imposed on Committee. NANB Standards of Practice for the Member’s registration by the Registered Nurses, the NANB Standards Complaints Committee in a decision REGISTRATION SUSPENDED for Documentation, the NANB Standards dated April 2, 2019 be lifted and On July 14, 2020, the NANB Complaints for Medication Administration and the conditions be imposed on the Member’s Committee suspended the registration of Horizon Health Network Policy & registration. Josianne Comeau, registration Procedure on Medication number 026130, pending the outcome of Administration, Storage and Handling. REGISTRATION SUSPENDED a hearing before the Discipline The Member had previously resigned her On April 27, 2020, the NANB Complaints Committee. registration with NANB so the Committee suspended the registration of Committee was unable to suspend her Kailee Mallery, registration number SUSPENSION LIFTED, REPRIMAND registration. The Committee ordered 027923, pending the outcome of a ISSUED, CONDITIONS IMPOSED certain preconditions that the Member hearing before the Fitness to Practice In a decision dated August 21, 2020, the must satisfy before she may apply for a (Review) Committee. NANB Fitness to Practice (Review) conditional registration. Committee reprimanded Emily Jones, REGISTRATION SUSPENDED registration number 026149 (the REGISTRATION SUSPENDED On May 7, 2020, the NANB Complaints “Member”), for not adhering to the NANB On October 9, 2020, the NANB Committee suspended the registration of Standards of Practice for Registered Complaints Committee suspended the Kassandra Braun, registration Nurses, the NANB Standards for registration of Brenda Connell, number 030193, pending the outcome Documentation, and the Canadian registration number 020080, pending of a hearing before the Discipline Nurses Association Code of Ethics. The the outcome of a hearing before the Committee. Fitness to Practice (Review) Committee Fitness to Practice (Review) Committee. found that the Member is fit to practice SUSPENSION LIFTED AND nursing, and ordered that the suspension REGISTRATION SUSPENDED CONDITIONS IMPOSED imposed on her registration by the On October 13, 2020, the NANB In a decision dated June 26, 2020, the Complaints Committee on July 25, 2019 Complaints Committee suspended the NANB Fitness to Practice (Review) be lifted and conditions be imposed on registration of Shelley Dunlap, Committee accepted the Alternate the Member’s registration. registration number 022314, pending Complaint Resolution Proposal (“ACRP”) the outcome of a hearing before the submitted by Samantha Jones, REPRIMAND ISSUED AND Discipline Committee. registration number 027307 (the CONDITIONS IMPOSED “Member”). As a result of the admissions In a decision dated September 8, 2020, REGISTRATION SUSPENDED made in the ACRP, the Committee found the NANB Discipline Committee found On October 20, 2020, the NANB that the member’s actions (which that Jennifer Martin, registration Complaints Committee suspended the included stealing narcotics from her number 025239 (the “Member”), lacked registration of Jeffery Faulkner, workplace, falsifying patient charts and professional judgment, critical thinking, registration number 029181, pending narcotic waste records, and lying to decision making and documentation and the outcome of a hearing before the prescribers to obtain unnecessary communication skills to safely practice Discipline Committee.
36 INFO NURSING FALL 2020 Call for NB Representative: CNPS Board of Directors
The Canadian Nurses Protective • Be available to attend a minimum The following skills/experience Society (CNPS) provides legal advice, of three, two-day board meetings would be considered an asset: risk management services, legal per year and ad hoc assistance and professional liability teleconferences as may be • Leadership; protection related to nursing practice required from time to time to over 135,000 eligible Canadian (Please note that Directors shall • Governance; nurses across all provinces and be reimbursed for expenses territories. incurred for attendance at Board • Financial planning, financial CNPS is seeking a NANB and committee meetings, as well management and\or the ability registrant to join the CNPS Board for as any meeting(s) that may be to understand complex financial a four-year term. attended at the direction of the information. Board in accordance with CNPS Eligibility Requirements travel allowances and guidelines); Interested candidates should • Be either a registered nurse or a forward a letter and resume to nurse practitioner in good • Be available for an initial term of [email protected] on or before standing with NANB; approximately four years; November 30, 2020.
FALL 2020 INFO NURSING 37 CALENDAR of EVENTS
NOVEMBER 2020 NOV 6–DEC 11, 202O DECEMBER 3–4, 2020 CNPS Webinars ECHO Canada Adult Intellectual & ISMP Canada Virtual Workshop: Developmental Disabilities: Mental Incident analysis and proactive risk November’s Monthly Theme: Health in the Time of COVID-19 assessment COVID-19 Legal Panel • camh.echoontario.ca • ismp-canada.org • cnps.ca
JANUARY 18, 2020 JANUARY 19–24, 2021 APRIL 22–24, 2021 CASN Lunch & Learn Theme: 2021 CNSA National Conference 21st Biennial Conference of the Nursing Education during COVID-19, • cnsa.ca Canadian Gerontological Nursing Virtual simulation and clinical Association education • Niagara Falls, ON • casn.ca • cgna.net
APRIL 29–MAY 1, 2021 APRIL 30–MAY 4, 2021 AUG 29–SEP 1, 2021 2021 CSGNA National Conference ORNAC National Conference 2021: 11th International Council of Nurses • Calgary, AB Charting the Future of Perioperative NP/APN Nursing Network Practice Conference • csgna.com • Victoria, BC • Halifax, NS • ornac.ca • npapn2020.com
CNF Nightingale MaskerAide 2020 A Virtual Celebration of Nurses Canadian Nurses Foundation’s Nightingale Gala marks its 10th anniversary with an immersive virtual event—creating a national stage to celebrate nurses and provide aid during this crucial time. Playing off a traditional masquerade ball, the Nightingale MaskerAide will feature big Canadian talent, heart-warming storytelling and an online auction like no other. This year’s gala also underscores the essential role nurses play in shaping health outcomes across Canada. BUY TICKETS
Virtually Thursday, December 3, 2020 7:30 pm–9:00 pm EST
Special tickets are available including swag bags, exclusive promotions, student rate and more! Get yours now!
38 INFO NURSING FALL 2020 CALL FOR NOMINATIONS
THE NANB AWA R DS ~ 2021 ~
ANB is keenly aware of the Membership Award; Excellence in public for NANB Awards. In the N contributions made by current and Clinical Practice Award; Entry Level document you will find the criteria for former members to the health care Nurse Achievement Award; and 4 each award, the nomination form and system in New Brunswick and also by Awards of Merit (in Nursing Practice, the direction on how to nominate a public members who have performed Research, Education and person for each award. You may find meritorious services on behalf of RNs/ Administration). this document on the website at www. NPs and nursing as a profession. nanb.nb.ca under the tab About NANB. The NANB Awards Guide was Since 1955, NANB has been recognizing created by the Practice Department members and members of the public at NANB to be used as a reference on with various awards, including: Life how to successfully nominate RNs Membership Award; Honorary and NPs, as well as members of the
THE DEADLINE FOR NOMINATIONS IS JANUARY 31, 2021. Over 40 Years of Info Nursing Watch for a New & Improved Format in 2021!
a publI catI on oF the n urses a ssocI atI on oF n ew b runswI ck a publI catI on of the n urses a ssocI atI on of n ew b runswI ck a publI catI on of the n urses a ssocI atI on of n e W b runsWIck a publI catI on of the n urses a ssocI atI on of n ew b runswI ck Info nursing Info nursing Info nursing Info nursing Volume 39 • Issue 2 • Fall 2008 • www.nanb.nb.ca Volume 40 • Issue 1 • s prI ng 2009 • www.nanb.nb.ca Volume 40 • Issue 3 • WI nter 2009 • WWW.nanb.nb.ca Volume 41 • Issue 1 • s prI ng 2010 • www.nanb.nb.ca
Reflections on a NANB’s AGM 12 Agenda and Proxy Information
Nursing Education Elections 2010 22 that Lasts Meet the Nominees CCP Audit Results 25 Canada’s What’s Next? 8 19 Visionary, Pioneer Highest and Leader… Celebrating Florence Nightingale’s Honour Contribution to Nursing rns in the air 14 NB RN Receives the anb aircare presents 2008 Flight nurse team Order of Canada.
8 Election Day: 29 NNW 2009 18 AGM, Conference 24 top-honour ‘08 Fall proFessIonal regIstratIon April 30th, 2009 Competition & Awards Banquet From peers practIce Forums renewal 2009 meet the candidates. members are challenged June 3rd & 4th: see agenda new brunwick’s Judith promoting good practice. register online at to define this year’s and pre-registration oulton receives 2008 see agenda and www.nanb.nb.ca. theme. see details. information inside. Jeanne mance award. schedules inside. 12 ÉRSI of UdeM 20 Call for Nominations 34 Support Nursing 4.0 8 10 22 redesigns its bn program. the nanb elections 2010.
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16 | PROFESSIONAL 21 | NANB ELECTIONS 31 | SOCIAL MEDIA: 2011 RegIstRatIon memBeRs sPeak uP! nanB 2010 Fall | CALL FOR | NANB LAUNCHES | ARE YOU BEING | BE ON TIME! | UNDERSTANDING | INFRINGEMENTS PRESENCE: AN 2013: CALL FOR THE PROMISES, Renewal 2010 PRoVIncIal electIon PRactIce FoRums NOMINATIONS ELEARNING BULLIED AT RENEW YOUR THE COMPLAINTS OF THE INTERNAL COMPASS NOMINATIONS THE PERILS AND ELECTION MODULE WORK? REGISTRATION & DISCIPLINE NURSES ACT TO GUIDE YOU IN THE ‘PATIENT 2.0’ ONLINE PROCESS NURSING PRACTICE
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NANB SHARES Celebrate Excellence 2014 ELECTION PRIORITIES |18 NANB AWARDS The Changing Face of Professionalism | Register Now for NANB’s Invitational Forum | Join NANB in Celebrating Our Centennial ~ 27 | PROFESSIONAL PRESENCE | MEET THE | WHO IS YOUR NURSING AS LIVED AND PERCEIVED CANDIDATES: LEADER? NANB’S ONLINE NANB’S NEXT VIRTUAL MARIHUANA FOR MEDICAL BY NEW BRUNSWICK NANB’S NATIONAL NURSING REGISTRATION FORUM: BE PART OF PURPOSES : CHANGES TO A SAFER BE A NURSING NURSING PROFILES 15 DEFINING THE RN 19 REGION 3 VOTES! 25 PHYSICIAN ASSISTED NURSES ELECTION WEEK COMPETITION RENEWAL OPENS THE CHANGE...NURSING LEGISLATION & NURSING SLEEP LEADER: NANB A COLLEAGUE’S ROLE: HERE’S WHAT MEET YOUR DEATH: WHERE ARE OCTOBER , VOICES FOR CHANGE CONSIDERATIONS ELECTIONS CALL STORY: MEET RNs HAD TO SAY CANDIDATES WE NOW? FOR NOMINATIONS NANCY DUGUAY
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2019 NANB Election Meet Your Candidates ... 13
9 YOU ARE INVITED: NANB’S AGM JUNE 5, 2019 18 JOIN US FOR THE MEMBER RECOGNITION & PRESIDENT’S AWARD Public Assurance RECEPTION 2018 Registration Renewal — 27 Nursing Matters 21 NEW STANDARDS OF PRACTICE NANB’s Centennial Celebrations Continue ~ 25 FOR REGISTERED Election Priorities 2018 ... page 25 NURSES: HOW DO 14 CANADA 150 17 WHAT IS 29 ELECTIONS 2018: THEY APPLY TO MY 13 YOU ARE INVITED: 15 REGISTRATION 51 NANB LAUNCHES CELEBRATES PROFESSIONALISM? CALL FOR PRACTICE? NANB’S 100TH AGM RENEWAL OPENS STRATEGIC PLAN NURSING WHY DOES IT MATTER? NOMINATIONS 12 CANNABIS LEGALIZATION: 19 WHEN CAN RNs 40 2019 NANB OCTOBER 1ST 2017–19 WHAT NURSES NEED ADMINISTER ELECTIONS: CALL TO KNOW NALOXONE? FOR NOMINATIONS
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