Vol. XXXVI No. 3 September 2015

The Magazine of the Association of Registered Nurses of and

IN THIS ISSUE ARNNL RECOGNIZES NURSING Council Bestows Honorary ARNNL Membership – 5 Upcoming Changes in Licensure Renewal Process – 7 EXCELLENCE ARNNL Continuing Education Teleconference Sessions – 11 PAGE 9 Technology Tips for Your Practice – 20 CONTENTS

Message from the President ...... 3 From the Executive Director’s Desk...... 4 ARNNL STAFF ARNNL Council Matters ...... 5 Lynn Power, Executive Director 753-6173 I [email protected] Q & A: You Asked...... 6 Registration Update ...... 7 Michelle Osmond, Director of Regulatory Services Canadian Nurses Protective Society ...... 8 753-6181 I [email protected] Nurses of Note ...... 9 Lana Littlejohn, Director of Corporate Services Advanced Practice View ...... 10 753-6197 I [email protected] ARNNL Continuing Education Teleconference Sessions ...... 11 Trudy L. Button, Legal Counsel Federal Election Primer: Health Is Where the Home Is ...... 12 752-1903 I [email protected]

Survey Says...... 13 Jennifer Barry, Communications Officer Goings On/Conferences and Workshops...... 14 753-6198 I [email protected] Volunteer Spotlight ...... 16 Siobhainn Lewis, Nursing Consultant, Policy & Practice Workforce of 100...... 17 753-0124 I [email protected] Regulatory Notes ...... 18 Pamela King-Jesso, Nursing Consultant, Policy & Practice Discipline Decisions ...... 19 753-6193 I [email protected] Clinical Corner ...... 20 Vacant, Nursing Consultant, Policy & Practice Trust News ...... 21 Painting a Philosophy of Nursing In Undergraduate Nursing Education ...... 22 Bradley Walsh, Regulatory Officer 757-3233 I [email protected] Congratulations, Nursing Graduates ...... 23 CNPS InfoLAW – Legal Risks of Email (Part 2) ...... 24 Rolanda Lavallee, Regulatory Officer 753-6019 I [email protected]

Julie Wells, Research & Policy Officer and ARNNL Trust Coordinator ARNNL COUNCIL 753-6182 I [email protected] Regina Coady President 2014-16 Christine Fitzgerald, Administrative Assistant, Executive Director & Council Julie Nicholas President-Elect 2014-16 753-6183 I [email protected] Patricia Rodgers Eastern Region 2014-17 Tracy MacDonald Central Region 2015-18 Jeanette Gosse (on leave), Administrative Assistant, Director of Regulatory Services 753-6060 I [email protected] Lacey Sparkes Western Region 2014-17 Beverly Pittman Labrador/Grenfell Region 2015-18 Kirsty Wiik, Administrative Assistant, Director of Regulatory Services Dena King Advanced Practice 2013-16 753-6060 I [email protected] Lisa Jesso Practice 2013-16 Jennifer Lynch, Administrative Assistant, Policy & Practice Alexia Barnable Education/Research 2015-18 753-6075 I [email protected] Elaine Warren Administration 2015-18 Carmel Doyle Public Representative 2014-17 Carolyn Rose, Administrative Assistant, Registration Ray Frew Public Representative 2014-17 753-6025 I [email protected] Irene Baird Public Representative 2014-17 Jessica Howell, Administrative Assistant, Registration Walter Arnold Public Representative 2014-17 753-6041 I [email protected] Lynn Power Executive Director Representatives from nursing student societies (observers) On the cover: ARNNL Awards for Excellence in Nursing Luncheon (June 2015). Advertise in the next issue of ACCESS Left to right: Dena King, RN, NP, BN, Award for Excellence in Nursing – Practice; Contact Jennifer Barry at [email protected] or call 709-753-6198 Cyril Daley (accepting ARNNL Honorary Membership on behalf of Kay Daley); Editor Jennifer Barry Regina Coady, RN, BN, MN, ARNNL President; Dr. Carla Wells, RN, MN, PhD, GNC(C), Award for Excellence in Nursing – Education; Lily LeDrew, RN, BN, Creative Design Brenda Andrews, Image 4 Award for Excellence in Nursing – Administration (photo credit: Don Lane) Contributing Editor Danielle Devereaux Correction: In the May 2015 issue of ACCESS, the article “Evidence in ACCESS is the official publication of the Association of Registered Nurses of Practice” was incorrectly attributed to author Sheila Tucker, Liaison Officer Newfoundland and Labrador. ACCESS is published three times a year in January, May and September. Subscriptions are available to non-members for $25 per year. (NL), Canadian Agency for Drugs and Technologies in Health (CADTH). The submission was written by Kasia Kaluzny, Knowledge Mobilization Officer, ©Association of Registered Nurses of Newfoundland and Labrador (ARNNL). All rights reserved. For editorial matters, please contact the editor. The views and opinions expressed in the articles and advertisements are those of the authors CADTH. or advertisers and do not necessarily represent the policies of ARNNL.

2 MESSAGE FROM THE PRESIDENT

It was truly a privilege to preside over our 61st Annual Business Meeting (ABM) with almost 200 participants, great participation, questions, motions and debate. The June meeting brought together registered nurses, nurse practitioners and students from all areas of the province. Canadian Nurses Association (CNA) President-elect Barb Shellian also joined us and shared details on the future directions and priorities of CNA.

Provincial Nursing Forum 2015 preceded the ABM and featured Barb Langlois, a powerful and impactful speaker who focused on better understanding our own communication patterns. She encouraged us to look inward at our own assumptions and interpersonal styles, gave us guidance for working in teams and strategies to effectively and respectfully give constructive feedback. Lifelong skills beneficial to any registered nurse!

Regina Coady, RN, BN, MN [email protected]

AS WE MOVE INTO FALL, I ENCOURAGE YOU TO BE ACTIVE AND RAISE IMPORTANT ISSUES OF HEALTH AND HEALTH CARE AS THE FEDERAL AND PROVINCIAL ELECTIONS APPROACH

The importance of advancing our leadership capability as registered As we move into fall, I encourage you to be active and raise important nurses and nurse practitioners is essential in today’s health care issues of health and health care as the federal and provincial elections system. Leadership is not a job, it’s a passion to make a difference, approach. CNA have a dedicated website focused on important issues a commitment to strong team work, advocacy for those in need and in the federal debate (http://www.election.cna-aiic.ca/en) and a unable to speak on their own behalf, ensuring a respectful workplace, federal election primer is available on p. 12. I encourage you to also “leading self” – self-awareness and self-growth – and so much more. visit ARNNL’s Document Library at https://www.arnnl.ca/document- library to review a wide range of background documents on health care In addition to the ABM and Leadership Conference, the “icing on the and healthy public policy. cake” was the Awards for Excellence in Nursing where we celebrated the contributions of three outstanding award winners – Dena King, Lily In closing I offer my congratulations to the BN Collaborative Program LeDrew and Carla Wells (see p. 9 for more details). As well, Honorary (Centre for Nursing Studies, Memorial University and Western Regional Membership was bestowed posthumously to Katherine (Kay) Daley, School of Nursing), which has achieved seven-year accreditation who dedicated most of her 34-year career to the advancement of status from the Canadian Association of Schools of Nursing. This nursing education in Newfoundland and Labrador. demonstrates excellence in academic performance and assures us that the preparation of future registered nurses is in good hands.

The Magazine of the Association of Registered Nurses of Newfoundland and Labrador 3 FROM THE EXECUTIVE DIRECTOR’S DESK

We’re all familiar with check-ups when it comes to our health. It’s also important to take time to check-up on our profession and ask: How are we doing as a self-regulated profession? A very complex question, but it’s imperative we check the vitals. The privilege of nurses regulating nurses either through an organization (e.g. ARNNL), as an employer or as individuals, demonstrates that we all have roles to play to ensure that RNs are safe, competent and ethical practitioners. This challenge is more easily accomplished when we break it down into meaningful pieces.

The results of the ARNNL Member Survey on Progress Towards Ends (2015) can give us some insight into how we’re doing in terms of a professional check-up. The survey covered topics such as quality of care, supportive work environments, continuing competence, professional development, nursing leadership and knowledge of ARNNL (see p. 13 for more information). Lynn Power, RN, MN [email protected]

A MORE IMPORTANT QUESTION IS WHAT CAN AND MUST WE ALL DO AS A SELF-REGULATING PROFESSION TO IMPROVE?

To enter into the nursing profession, a student nurse has a lot to health promotion. With health care being the number one public policy learn and even more to synthesize; thus an important component in topic, and with both provincial and federal elections around the corner, our check-up is our commitment to students and new graduates. In we need more voices. our survey, 43 per cent of respondents said that they’d volunteered And while I am pleased to report that nurses are meeting their as preceptors and 64 per cent said they were mentors. Barriers to continuing competency requirements, I’m sad to say that the number of volunteering revealed that we have work to do to increase these allegations that an RN has failed to meet the standards of practice are numbers. As I write this column, the NCLEX-RN exam is being written. rising, with most cases involving challenges in competency … why is Although at this point I do not know the full picture, I believe there this? is further need to help students master the leap from education to practice. Another mark in our checkup is professional development. The ARNNL Education and Research Trust awarded over 61 bursaries and grants, Thirty-four per cent of you had participated in an ARNNL activity in the but the Trust had a few categories where there were no applications past year and in our annual report we cite that over 2,000 members and at all. The Survey respondents gave the nursing profession a strong students participated in one of 50 activities offered by ARNNL – these grade, with 82 per cent rating the overall level of professionalism as an numbers are good, but with almost 6,500 RNs and NPs in practice, “A.” While this is encouraging, data from national sources tell a tale of they could be better. Kudos to those who participated in a workplace absenteeism, workplace bullying, psychological stress and more. improvement initiative, however, professional decisions affect everyone – is hearing from a limited sample enough? Our survey also showed How are we doing overall? We need to collectively improve our check- that 60 per cent of respondents had been involved in a proactive activity up results. Let’s talk. Over the coming year, ARNNL will be organizing a to improve quality of care – not a bad showing, but it indicates that there number of opportunities to hear solutions from you. is room for improvement. Survey results also told us that just over a third of you (37 per cent) participated in a community activity to support Stay tuned and stay in touch.

4 ARNNL COUNCIL MATTERS Council Bestows 51st Honorary ARNNL Membership Annual Report Available On June 16, Council bestowed Honorary Membership posthumously ARNNL’s 2014-15 Annual Report, Regulating Registered Nurses in to Katherine (Kay) Daley, who dedicated most of her 34-year career the Public Interest, was released in June. In addition to highlighting to the advancement of nursing education in Newfoundland and Council’s policy direction and governance accomplishments during Labrador. Established in 1954, Honorary Membership is awarded to 2014-15, the report provides details on the many important initiatives individuals who have helped advance the nursing profession and/or undertaken by staff and members to achieve ARNNL’s legislative and the Association. Kay graduated from nursing school in 1964. In 1968 policy mandate. Visit https://www.arnnl.ca/annual-report to view the she became the first director of Western Memorial Hospital School of report and financial statements. Nursing. From 1974-1995, Kay was the director of St. Clare’s School Memorial Day Parade Honours Veterans and the of Nursing. In 1995 she took the helm as the first director of the Centre Role of Registered Nurses for Nursing Studies. Her appointment was the culmination of years of ARNNL President Regina Coady laid a wreath on behalf of ARNNL at effort to establish the Bachelor of Nursing Collaborative Program and the Memorial Day parade on July 1 in downtown St. John’s. In 2004, merge the three diploma schools of nursing in St. John’s. Her vision on the occasion of the 50th Anniversary of ARNNL, the anniversary for the Centre saw the development of a centre for nursing excellence planning committee started the practice of ARNNL’s participation in the that subsequently included the Practical Nursing Program, the Nurse July 1 ceremony at the provincial war memorial, as well as the Veterans Re-entry Program, the Nurse Practitioner Program and a Research and Parade and wreath laying. Since then, both retired and practicing RNs, Development Department to facilitate nursing research and community- dressed in traditional nursing attire, take part in the annual ceremony. based service activities. Kay served as a member of ARNNL Council All are welcome next July. and was actively involved in many ARNNL committees. In 1996 she was awarded the ARNNL Award for Excellence in Nursing – Administration. ARNNL Welcomes New Council Members

Tracy MacDonald Alexia Barnable Following the first electronic-based vote for ARNNL Council Elections this past spring, two new Council members were elected and two familiar faces were re-elected by acclamation. Official election results were revealed at ARNNL’s ABM in June. Tracy MacDonald, a Risk and Cyril Daley, Kay Daley’s husband, proudly accepting the honour on her behalf Patient Safety Manager at the Central Newfoundland Regional Health Council Deliberated on Annual Meeting Motion Centre, was elected to the role of Central Region Councillor, and Alexia Barnable, a Nurse Educator with Western Regional School of Nursing st In early July, a motion brought to the floor at ARNNL’s 61 Annual will fulfill the Education/Research position. Beverly Pittman and Elaine Business Meeting (ABM) was discussed by Council. The motion was Warren were re-elected to their positions by acclamation. In addition to in regard to ARNNL’s recent career posting for a “Nursing Consultant.” welcoming new and returning members, ARNNL wishes to thank and The motion read: “Be it resolved that one of the three nursing consultant recognize outgoing Council members Madonna Manuel (Education/ positions at ARNNL, in addition to the existing job requirements, be held Research Councillor from 2009-15) and Sandra Evans (Central Region by an experienced licensed nurse practitioner. Be it resolved that this Councillor from 2008-15) for their dedication and commitment to the resolution will go to Council for further analysis.” Council met to discuss work of Council. the motion and, after a review of Council policies, determined that staffing decisions are within the authority of the Executive Director of ARNNL and Attend an ARNNL Council Meeting! proposed no restrictions or other policy recommendations. All Council The next in-house Council meeting takes place on Oct. 22-23 at policies are available for review at https://www.arnnl.ca/council-policies. A ARNNL House in St. John’s. Contact Christine Fitzgerald, Executive Assistant, at (709) 753-6183 or [email protected] for details. separate motion related to long-term care will be discussed by Council at a future meeting. *More details about the business of ARNNL’s Council are available in UPDATE, ARNNL’s e-newsletter. Email [email protected] to subscribe. Visit https://www.arnnl.ca/update-newsletter to read past issues.

The Magazine of the Association of Registered Nurses of Newfoundland and Labrador 5 Every RN is responsible for knowing their scope Q & A: YOU ASKED of practice and working By: Siobhainn Lewis, RN, BN, MN – Nursing Consultant-Policy and Practice within it.

Q: How do I know what I am allowed to do in my practice? I cannot find “the list.” There is no longer a list of activities you can reference in determining what you are “allowed” to do in your practice. Since 2006, RNs and A: NPs in Newfoundland and Labrador have used a decision-making framework to understand and identify the scope or depth and breadth of nursing practice. The framework for RN scope of practice is outlined in the ARNNL documents1 Scope of Nursing Practice: Definition, Decision-Making and Delegation (2006) and Standards of Practice for Registered Nurses (2013). NP scope of practice is articulated in the Registered Nurses Regulations (2013) and the Standards for Nurse Practitioner Practice in Newfoundland & Labrador (2013). By definition, Scope of Practice is the range of roles, functions, responsibilities and activities that RNs and NPs are educated and authorized to perform; in essence, the “circle” you work within. It is important to note that there are differences in the circle of the whole profession of nursing, and within individual circles or scopes of practice. Any one practitioner does not know how to do everything that can possibly be done within the practice of their profession.

There are factors that determine the outer limits of your circle. The boundaries for that circle are identified by what you are educated and authorized to do.

Every RN and NP accepts responsibility for knowing what they are educated to do, either as part of their basic nursing education or as continuing education. Education may be formal or informal, but always consists of both theoretical and practical components. It is important that you identify educated if additional education is needed and that you obtain the necessary education to safely and competently carry out your practice.

Each RN and NP must also be aware of what they are authorized to do. Authority comes in a variety of ways – through validation that a practice is part of nursing practice, through legislation and through employer support. Firstly, you must validate that the practice you wish to engage in is part of nursing practice in this province. Some considerations are that it must belong in the realm of authorized nursing, not belong in the exclusive legislated domain of another profession, builds on the body of nursing knowledge, is safe for an RN or NP to perform and the RN or NP must be able to manage the outcomes of care. Many practices are easily identified as nursing practice, but others may not be. Consultation with ARNNL is advised here.

As well, you must ensure there is no limitation in legislation. Some Acts list which categories of health care professionals are permitted to perform a function. For example, the Vital Statistics Act in NL is one such legislation and it authorizes RNs and NPs in certain circumstances to certify death. The Registered Nurses Regulations (2013) provide authority for NP practice to include prescription of forms of energy, lab tests and drugs.

Furthermore, employees of an organization must ensure that their employer supports them in carrying out this practice in their practice area. For example, RNs working in select long term care facilities may be authorized by their employer to certify death, but the same employer may not authorize RNs on Med/Surg to do the same. These authorizations are often articulated in a workplace policy.

So before you forge ahead or hold yourself back, think about these two key words: educated and authorized. Ask yourself: Do I have the knowledge, skill and ability to perform the task? Does my education prepare me to perform the task using evidence-informed knowledge, skill and judgment? Have I attained a level of proficiency to provide safe, competent care? Can I manage the outcomes of the care I provide? Does my employer support my carrying out this practice? Are there legislative considerations?

Seek out professional practice resources within your employer setting and/or consult with ARNNL practice consultants. After all, as an RN or NP your practice must safely, competently, ethically and compassionately meet the needs of your clients.

Q & A: YOU ASKED reflects member questions frequently asked about general topics. Members can access confidential practice consultation withARNNL Nursing Staff. Visit www.arnnl.ca/contact for ways to get in touch.

1All ARNNL documents are located in ARNNL’s Document Library at https://www.arnnl.ca/document-library.

6 REGISTRATION UPDATE Renewal 2016-17: Change in Process for Professional Liability Protection

By: Bradley Walsh, RN, MN, Regulatory Officer

The Registered Nurses Regulations (2013), made pursuant to the Will my payroll deduction be affected for the 2016- Registered Nurses Act (2008), stipulates it is a condition of a license 17 year? that all RNs and NPs must have professional liability protection in The 2016-17 licensure period will be a transition year. If you are order to practice nursing in Newfoundland and Labrador. Since 1998, enrolled in a payroll deduction program and the full amount has already the Canadian Nurses Protective Society (CNPS) has been the provider been deducted from your pay, when ARNNL receives your licensure for professional liability protection for ARNNL members who hold annual fee from the employer the professional liability protection portion of licensure. CNPS is a not-for-profit organization that has a fiduciary the fee will be forwarded directly to CNPS for this year only. Members duty to continually assess ongoing liability risks and determine relevant whose licensure fees are not submitted via an employer will see the fee fees to ensure the long-term sustainability of the liability fund available collection change this year. In the 2017-18 licensure year, all members to assist nurses when in professional legal jeopardy. Consequently, will be required to register and make payment directly to CNPS when in 2014, ARNNL changed its reporting to members such that you can they renew with ARNNL. now see the actual cost of CNPS services during your annual licensure renewal process. Will ARNNL provide additional information on this All members applying to renew a practicing RN or NP license for the change? 2016-17 licensure/membership renewal period can expect to see More information will be emailed to the entire membership this fall, and another change in the application process related to registration and an open education teleconference is scheduled for Dec. 15 (see p. payment for CNPS professional liability protection. 11 for details). CNPS offers a wide variety of services, including legal advice, legal assistance, risk management and education. It is the hope of ARNNL and CNPS that through direct engagement with CNPS, Notice beneficiaries will avail of these opportunities. Beginning in January 2016, when you complete your ARNNL practicing RN or NP licensure application online, you will be transferred to See CNPS article on p. 8 for additional information. the CNPS website to register and make direct payment for your professional liability protection. Upon completion of the CNPS Please select one of the following options: registration and payment process, you will then be automatically April 1, 2016 - March 31, 2017 Licensure or Membership Renewal Application directed back to the MyARNNL site to finalize and submit your licensure renewal application. ARNNL and CNPS anticipate that the movement You must complete the following steps, in order, to complete your application. between websites will be seamless. Step 1: Complete the ARNNL Registration Renewal Form In Progress

Why is ARNNL changing this process? Step 2: Provide Payment Direct to CNPS With CNPS fee increases in 2014 and 2015, and potential increases Step 3: Awaiting ARNNL Approval in the future, ARNNL wants to ensure that all members have current information on the actual costs of CNPS professional liability protection Screenshot of ARNNL’s online licensure application, launching in 2016. and services. Further, over 50% of our membership are enrolled in a payroll deduction program through their employer. To collect annual licensure fees, some employers require a notice of fee change six or more months in advance of payment submission to ARNNL. In the event of any future increases in fees, CNPS will now be able to notify ARNNL members directly, thus bypassing any employer limitations. Another benefit to this new process is the direct connection you can make with CNPS to learn more about its services.

The Magazine of the Association of Registered Nurses of Newfoundland and Labrador 7 www.cnps.ca

The Canadian Nurses Protective Society (CNPS) helps nurses effectively manage their professional legal risks and appropriately assists them when in professional legal jeopardy. As a benefit of membership with ARNNL, registered nurses and nurse practitioners are eligible for the professional liability protection and broad range of legal services offered by the CNPS.

What services does CNPS offer ARNNL nurses? What are the benefits of ARNNL and CNPS creating a new Legal Advice registration / renewal process? CNPS beneficiaries have access to immediate, confidential legal advice from lawyers who will explain the legal steps to take and actions to avoid when an incident occurs and More Transparency answer your questions. Separate fees for licensing and professional liability protection will be Legal Assistance clearly indicated during the registration and renewal process. CNPS provides beneficiaries with assistance in legal proceedings including civil litigation, criminal investigations and prosecutions, statutory offences and witness Quicker Service appearances. CNPS also assists with pre-contractual reviews Nurses will receive CNPS’ confidential and offers an early intervention program. services promptly without the need to send proof of licensure. Risk Management and Education CNPS delivers relevant, customized, and current education offerings including presentations, webinars, infoLAWs Improved Access and articles about new legislation, the legal implications of Nurses will have the option to receive changes in nursing practice and evolving risk management timely updates from CNPS about strategies. professional liability considerations, legal risk management, educational webinars and new publications and articles of Professional Liability Protection interest. CNPS ensures beneficiaries are adequately protected by closely monitoring court awards and adjusts the levels of professional liability protection accordingly.

Our goal is to provide you, our beneficiary, the best legal resources and risk management information and support available while you strive to provide high quality professional care to your patients.

For more information, or if you have questions or concerns pertaining to your professional nursing practice, please do not hesitate to call CNPS to speak to a Legal Advisor at 1-844-4MY-CNPS (1-844-469-2677) or visit our website at www.cnps.ca.

8 NURSES OF NOTE By: Jennifer Barry, BA, Communications Officer

ARNNL’s Awards for Excellence in Nursing were presented to three RNs at a luncheon ceremony on June 16. ARNNL congratulates this year’s recipients, and is inspired by their leadership and commitment. Nominate an outstanding RN for a 2016 Award for Excellence! Deadline for submissions is Dec. 11. For more information, visit www.arnnl.ca/about-awards.

Dena King, RN, NP, BN Nurse Practitioner, James Paton Memorial Regional Health Centre, Central Health, Gander, NL Award for Excellence in Nursing – Practice Dena King graduated from the Grace General Hospital School of Nursing in St. John’s with a diploma in nursing in 1984. She furthered her education through completion of a certificate in Home Health Nursing in 1999 and a Bachelor of Nursing degree in 2004.That same year, Dena completed the ARNNL Nurse Practitioner Competency Assessment Program under the Prior Learning Assessment Stream and was registered and licensed as a nurse practitioner (NP). Dena has practiced for 30 years in communities throughout Newfoundland and Labrador and in the Northwest Territories, and demonstrates a population health and client-centred focus. Her passion for nursing is also evident in her participation in professional activities. She has served on ARNNL Council since 2013. Dena was the first NP to practice in the emergency department at James Paton, and it seems that her love of nursing was felt by her family – Dena’s youngest daughter is also a registered nurse, working alongside her mother in the emergency department. Dena is the first NP to be awarded the ARNNL Award for Excellence in Nursing – Practice.

Lily LeDrew, RN, BN Regional Primary Health Care Consultant, Central Health, Springdale, NL Award for Excellence in Nursing – Administration In 1976, Lily LeDrew graduated from Western Memorial Hospital School of Nursing with a Diploma in Nursing. She received a Diploma in Community Health Nursing from Memorial University in 1981 and, in 1998, completed a Bachelor of Nursing degree. Although she has held numerous roles over the years, she has always practiced in Central Newfoundland. Engaging communities is Lily’s number one priority, and she has been at the forefront of the development of primary health care teams and advisory committees throughout the Central region. She has also been instrumental in heading the development, implementation and evaluation of a multidisciplinary primary health care model of service delivery. Lily views community members as partners and has a realistic, inclusive, solution-focused approach to the development of strategies to improve care and service delivery. Through her administrative roles, Lily is committed and dedicated to activities that ultimately change the way that communities identify and resolve their health care issues.

Dr. Carla Wells, RN, MN, PhD, GNC(C) Nurse Educator, Western Regional School of Nursing, , NL Award for Excellence in Nursing – Education Dr. Carla Wells graduated from Western Memorial Hospital School of Nursing with a Diploma in Nursing in 1975. She received a Bachelor of Science in Nursing from the University of Ottawa in 1984 and a Master’s degree in Nursing from Dalhousie University in 1992. In 2011, Carla was awarded a PhD through the University of Calgary. Carla has practiced as a nurse educator for the past 10 years. A former Clinical Nurse Specialist, in 2000 she received the ARNNL Award for Excellence in Nursing – Practice and is the first RN to receive ARNNL awards in both categories of Practice and Education. Carla has volunteered with ARNNL through participation in advisory and awards committees, and disciplinary panels. She has served as president of a Clinical Nurse Specialist Interest Group in Ottawa, President of the Newfoundland and Labrador Gerontological Nurses Association and President of the Canadian Gerontological Nurses Association. Carla holds memberships in several professional associations, has presented numerous times provincially and nationally, boasts several publications and is a recipient of a Queen’s Jubilee Medal for her lifelong volunteer work.

The Magazine of the Association of Registered Nurses of Newfoundland and Labrador 9 ADVANCED PRACTICE VIEW By: Melissa Manning, RN, BScN, MN, NP-Pediatrics, [email protected]

A Tuckamore in Paradise: A Treatment Centre for Youth with Complex Mental Health Needs Background: I hold a Bachelor’s of Science in Nursing from Trent capacity for up to 12 young people between the ages of 12 and 18 University in Peterborough, ON and received my Masters in Nursing years. It is divided into three living areas which each house a maximum and Pediatric Nurse Practitioner specialty from the University of Toronto. of four youth. There is also a school area with three classrooms, I started my nursing career working on the multi-organ transplant unit recreational space, an administrative/office area and an apartment for at the Hospital for Sick Children in Toronto. My career also involved visiting families. In addition to a program manager, the Centre includes working on a maternity, newborn care and pediatric unit, as well as staff from a number of specialized clinical fields, including child and teaching with Sir Sanford Fleming College and Trent University. I was youth care, nurse practitioner, psychology, psychiatry, social work and employed at the Partners in Pregnancy Clinic in Peterborough as a occupational therapy, as well as professionals in recreation, art and Nurse Practitioner (NP) and returned to Newfoundland to develop music therapy and from the public school system. the NP role at the Tuckamore Centre. I also provide instruction at the The youth at the Centre come from a wide variety of backgrounds and Centre for Nursing Studies. struggle with an array of complex mental health issues. Some may have a diagnosis such as depression, bipolar disorder, conduct disorder or attention deficit hyperactivity disorder. They may have a combination of mental health issues that cause them to have difficulty coping at home or in the community, and experience self-harming behaviour or thoughts of suicide.

Most of the young people referred have already received mental health services in the community; however, they now require a more intensive treatment environment to achieve their goals. The average length of stay at the Tuckamore Centre will be six months, though some may stay longer, depending on their individual needs.

I have had the pleasure of developing the part-time role of the NP at the Tuckamore Centre. From initial policy and program development, my NP role continually evolves to meet the needs of our clients and “The Tuckamore Tree” – an original piece by a youth residing at the Tuckamore Centre staff. I meet with each new youth shortly after they are admitted to the Tuckamore Centre and, using a client centered and harm reduction Tuckamore trees are known for surviving and thriving despite living approach, I help to identify client goals for health. I am engaged in in the harsh coastline environment of Newfoundland and Labrador. primary health promotion, such as vaccine catch-up and STI screening, Appropriately, the Tuckamore Centre name reflects the resilience of the and also see clients for acute issues, whether from self harm or illness. youth staying at the treatment centre and their potential to overcome I continually collaborate with the multi-disciplinary team, other programs and flourish despite challenges. and community partners to develop a holistic care plan for our clients.

The Tuckamore Centre was developed under the direction of the While developing a new role in a new province has been challenging, Department of Health and Community Services and is operated by it has also been very rewarding. Working within the full scope of NP the Mental Health and Addictions Program of Eastern Health. In the practice with the Tuckamore youth has inspired me professionally and past, youth who needed this level of treatment were required to travel personally, and has enabled me to further explore the complexities of outside the province for extensive periods of time. The facility has the pediatric mental health.

For additional information, please contact Program Manager Susan MacLeod at (709) 752-4950 or via email at [email protected]. For referral information, please contact one of our social workers and intake coordinators: Darlene Didham at (709) 752-4529 or via email at [email protected] or Lawrence Avery at (709) 752-8151 or via email at [email protected].

10 ARNNL CONTINUING EDUCATION TELECONFERENCE SESSIONS Fall 2015, Tuesdays 1400-1500h (Island Time)

*SEPTEMBER 15 *NOVEMBER 17 Celebrating Excellence in Nursing: The Nomination Process Evidence on the Front Line of Health Care: What Counts? Awards for Excellence Committee Members: Nicole Cheator Sheila Tucker M.L.I.S, B.Ed, B.A(Hon), CPAD., Canadian RN, Charmaine Lane RN, Lorraine Mitchell RN, Pam Ward Agency for Drugs and Technology in Health RN, Nicole Woodman RN *NOVEMBER 24 *SEPTEMBER 22 The “Self” in Self-Regulation: Being Involved in Your RNs, NPs and Provincial and Federal Elections: Influencing Professional Association Public Policy Pam King-Jesso RN, BN, MN, Nursing Consultant—Policy & Lynn Power RN, MN, Executive Director, ARNNL Practice, ARNNL Siobhainn Lewis RN, BN, MN, Nursing Consultant—Policy & *OCTOBER 6 Practice, ARNNL Community Rapid Response Team: Enhancements at Home Dawn Gallant RN, BN, CCHN(C), Primary Health Care DECEMBER 8 Manager, Eastern Health Connecting With Your President: An Annual Linkage Session Jennifer Williams RN, BN, BA, NP, Eastern Health Regina Coady RN, BN, MN, ARNNL President

*OCTOBER 27 *DECEMBER 15 Legal Issues in Nursing Practice Registration Updates: Preparing for Licensure 2016-17 Trudy Button ARNNL Legal Counsel *this session will include information on the new application process for CNPS liability protection Brad Walsh RN, MN, Regulatory Officer, ARNNL

*These sessions will be audio recorded and available online after the event. To access archived teleconference sessions, visit www.arnnl.ca.

HOW TO ATTEND A LIVE TELECONFERENCE SESSION SPECIAL EVENT: 1. Access is provided five minutes prior to start time. President’s Town Hall 2. Dial 1-888-875-1833. Wednesday, Oct. 21, 2015 3. When prompted, enter the Participant Passcode 304371659 # Lecture Theatre D, Health Sciences Centre 4. If you experience technical difficulties, press *0 (star-zero). (Main Floor, Medical School) 5. All participant lines will be muted during the presentation. To mute 7:30 p.m. – 9 p.m. your line during Q & A, press *6 to mute and *6 to turn off mute. Join ARNNL President, Regina Coady, and ARNNL REGISTRATION Council, for an in-person discussion. Members are • To register go to https://www.arnnl.ca/events-calendar. encouraged to attend and share their thoughts on • If you need assistance with registration, contact Jennifer Lynch at where the nursing profession should be directing its [email protected], 709-753-6075 or 1-800-563-3200. attention in the future.

The Magazine of the Association of Registered Nurses of Newfoundland and Labrador 11 - 2015 FEDERAL ELECTION PRIMER - HEALTH IS WHERE THE HOME IS On October 19 Canadians go to the polls for the next federal election. This primer will help you extend your influence beyond the ballot box. Join the Canadian Nurses Association: Declare that seniors home health care must be an election issue. How does CNA want federal candidates and few minutes. You won’t always get a 30-minute meeting. parties to improve seniors health? 3. Start a conversation. Get candidates talking with open-ended 1. Common standards for home health care questions. Asking if they support more assistance for caregivers 2. More support to family caregivers may only get a resounding “yes.” Instead, ask how they and their 3. Better community- and home-based health promotion party will assist caregivers. 4. Get face time. Contact your local campaign offices for an appointment with the candidate or their staff. Be persistent and Why home health care standards? follow-up if you don’t get an immediate response. ’s home health care is a patchwork of public and private 5. Work the scene. Check with your local riding association or services. That means getting health care at home has more to do campaign offices to find town halls, all-candidate meetings and with where we live than what we need. In helping establish common other public events where you can raise questions. standards across Canada by working with the provinces, territories and stakeholders — including CNA — federal parties could give Don’t forget: Use our #homeishealth hashtag on social media while Canadians equitable access to care. you’re out and about! Why more support for family caregivers? Canadians who serve as caregivers for aging family members or How to get candidates talking friends are indispensable to the well-being of our seniors and our Get your candidate talking with “how” and “what” questions on CNA’s health-care system. More support would give them a hand up as election goals. they work to balance jobs and raise families. How will you and your party help establish standards to give all Why healthy and active aging? Canadians fair and equitable access to home health care? Preventive activities and programs can help seniors maintain or • What are you going to do to fix the gaps in the home health care improve their health and reduce falls — the leading cause of seniors’ system so that a senior in B.C. has the same basic level of care as injury-related hospitalizations. Increasing balance and strength a senior in New Brunswick? are among the most effective and low-cost ways to gain stability, • How will you and your party collaborate with the provinces and manage chronic disease and get seniors more socially engaged. territories that deliver health care? How will you and your party secure more support for Extend your influence beyond the caregivers? • What are you going to do to help compensate family caregivers ballot box who pay out-of-pocket for prescriptions, groceries and Remember: Your candidates are running for office to represent you. transportation for aging relatives or lose wages for time taken off Reach out and talk to them about the issues you care about (or use work? our handy online Contact Candidates tool), whether these are in your • How will you help Canadians balance caregiving to seniors with own riding or the nation as a whole. raising families and maintaining careers?

Here’s some tips to get you started. How will you nurture and enhance community- and home-based 1. Know your stuff. Prepare 2 or 3 key issues ahead of time. healthy and active aging programs that promote and protect You never know when you’ll run into a candidate — at a good health? neighbourhood event, grocery store or on your very own doorstep • What are you going to do to bring chronic disease prevention and (during dinner, of course). management supports into seniors’ homes and communities? 2. Be concise and direct. Prepare to put your ideas across in just a • How will you support programs to keep seniors healthy and active?

cna-aiic.ca/election2015 #homeishealth /cna.aiic /canadanurses /CNAVideos

© Canadian Nurses Association. Reproduced with permission. Further reproduction prohibited.

12 SURVEY SAYS By: Julie Wells, BSc, MSc, ARNNL Research & Policy Officer

In February 2015, ARNNL conducted a telephone survey to obtain their area was added to the 2015 survey. While the results of these members’ input on issues important to the future of nursing. The questions cannot tell us how members feel about specific models of survey results also serve to measure ARNNL’s progress on Council’s care, they can provide a picture of the key points that are applicable to long term goals (ENDs) and provides data to help staff strategically all models. plan our programs and activities. Results showed that the majority of members agreed with all This year, 500 randomly selected practicing members provided statements related to the model of care in their area, although to feedback on the following areas: continuing education, leadership, varying degrees for each (Table 1). Most members agreed that the nursing management, professionalism, communications, practice model allows RNs to work to their full scope of practice (85%), enables environments, client safety and knowledge of ARNNL. RNs to develop therapeutic relationships with clients (74%) and supports continuity of care (72%). Members also agreed, but to a lesser A new series of questions in which members were asked about extent, that the model of care allows for safe and appropriate RN-Client the level of agreement with statements about the model of care in assignment (63%).

2015 Survey Highlights: • 77% agreed that the Continuing Competence Program helped them to identify areas to strengthen in their practice; • 86% agreed that RNs have autonomy to make decisions about their professional practice; • The average rating of the level of professionalism displayed by RNs was 8.54 out of 10; • The average rating of the quality of communication and collaboration among members of the interdisciplinary team was 7.64 out of 10; • 87% of members whose scope of practice changed within the last year felt they had adequate support to meet the requirements of the new role/responsibility; and • 7% of members who were not in a management role rated the likelihood they would pursue a career in management as 8 or higher on a scale of 1-10.

If you would like to know more about what ARNNL members had to say about these and other important issues, the full report of the 2015 Member Survey on Progress Towards ENDs is available online at: www. arnnl.ca/member-survey.

Table 1. Percentage of Members Who Agree or Disagree with Statements About the Model of Care Delivery Used in Their Practice Environment

Strongly Strongly Agree Disagree Don’t Know/NA Agree Disagree Allows RNs to work to their full scope of practice 18 67 9 1 6 Enables RNs to develop therapeutic relationships with clients 15 59 15 3 8 Supports continuity of client care 13 59 17 4 7 Allows for safe and appropriate RN-Client assignment 10 53 26 4 7

Thank you to the 500 members who took the time to respond to the survey!

The Magazine of the Association of Registered Nurses of Newfoundland and Labrador 13 GOINGS ON Provincial Nursing Forum Hailed a Success Over 200 registered nurses, licensed practical nurses, bachelor of nursing students and practical nursing students gathered at the Sheraton Hotel Newfoundland in St. John’s June 15-16 for Provincial Nursing Forum 2015, an education event hosted by the Department of Health and Community Services, ARNNL and the College of Licensed Practical Nurses of Newfoundland and Labrador (CLPNNL). The Forum, entitled “Enhancing Communication: RNs and LPNs, Let’s Talk,” included a communications workshop with keynote speaker, author and facilitator Barb Langlois; education sessions on leadership, scope of practice and self-regulation; as well as both ARNNL and CLPNNL annual meetings and awards recognition events. ARNNL President Regina Left to right: Paul Fisher, Executive Director/Registrar, Coady said that the expert knowledge and education offered during the Forum will enable nurses CLPNNL; Regina Coady, ARNNL President; and Steve to strengthen communication amongst the health care team and enhance positive professional Kent, Deputy Premier and Honourable Minister of the relationships in the interest of safe, competent, compassionate and ethical nursing practice. Department of Health and Community Services

Advance Breastfeeding Through “The Physician’s Breastfeeding Toolkit” Best Wishes for Outgoing The Baby-Friendly Council of Newfoundland and ARNNL Practice Consultant Labrador wishes to inform nurses about the recent In late June, ARNNL staff bid farewell launch of “The Physician’s Breastfeeding Toolkit” in an to Beverley McIsaac, ARNNL Nursing effort to validate the supportive breastfeeding care that Consultant – Regulatory Services and they practice with families. Nurses often support families Advanced Practice. Beverley had been who have had their breastfeeding goals unfulfilled or a member of the ARNNL team since mothers who have prematurely weaned their babies 2008. In her role, she managed files based on a lack of updated breastfeeding knowledge. related to nurse practitioners, clinical “The Physician’s Breastfeeding Toolkit” provides nurse specialists and nursing education. consistent, current information to physicians to guide Beverley developed standards for their breastfeeding management practices. It offers a nursing education for entry to the concise reference source for assessment, diagnosis profession and advanced nursing and treatment of common problems. Topics such as practice, and facilitated the development medication safety, diagnostic procedure considerations and implementation of approval and resources, both local and national, are addressed. processes. She was also integral to the Links to public health nurses and other community care providers are highlighted in an attempt to implementation of ARNNL’s Continuing promote comprehensive, interdisciplinary collaboration. Competence Program for RNs and NPs. ARNNL wishes Bev well in her return MUNSON Faculty Member Receives Grant Funding for to full-time nurse practitioner practice, Healthy Aging Research providing primary health care services to In April, Dr. Caroline Porr, faculty member the people of Jeffrey’s and St. Georges. with the School of Nursing at Memorial University, was awarded $9,480 for her research project “Developing and Testing a Dialect-Sensitive and Culturally Appropriate Diabetes Educational Tool for Older Adults of Rural Newfoundland and Labrador.” The project is among seven that have received a total of $108,980 through the Newfoundland and Labrador Healthy Aging Research Program. The grant supports the development of research teams in the province capable of obtaining funding from Dr. Caroline Porr national and international granting agencies in the area of applied health research. The Healthy Aging Research Program is administered by the Newfoundland and Labrador Centre for Applied Health Research at Memorial University. Since its inception in 2008, the Healthy Aging Research Program has provided close to $1.1 million in support of research into healthy aging.

14 National Nursing Week *NEW! On Oct. 21 in Lecture Theatre D, Health Sciences Centre (Main Floor, Medical May 11-17, 2015 LINKING WITH MEMBERS School), St. John’s, join Regina Coady, ARNNL President, and ARNNL Council, for PRESIDENT’S TOWN HALL an in-person member discussion about the MARK YOUR CALENDARS future of the nursing profession. This event runs from 7:30 p.m. - 9 p.m. WRSON Nurse Educator “Representing” Nursing Receives National Award Today and Tomorrow Chapel Service led by RNs at Charles S. Curtis Memorial Hospital in St. Anthony

RNs in 2 North at the Leonard A. Miller Rehabilitation Centre in St. John’s

Dr. Carla Wells Left to right: ARNNL Workplace Representative, Karen Morris, RN and her daughter, Kayla, attended Provincial In May, Western Regional School of Nursing Nursing Forum 2015 in June. Kayla, who is in her 4th educator, Dr. Carla Wells, received an year of studies at the Centre for Nursing Studies, is an ARNNL Nursing Student Representative. Honorary Lifetime Membership Award from the Canadian Gerontological Nursing Association (CGNA) at its 18th National GI Education Day Conference in Prince Edward Island. Dr. Zone 4, Community Health, St. John’s Wells, a founding member of CGNA in The Newfoundland and Labrador Chapter of the Canadian Society of 1984, has served the association in a Canadian Nurses Protective variety of executive positions (including Gastroenterology Nurses & Associates President) as well as co-chair or chair for (NL-CSGNA) held its annual GI Education Society: Upcoming Webinars three national conferences. Dr. Wells is Day on June 13. Over 50 attendees Visit www.cnps.ca to register: also President of the Newfoundland and participated in seven 45-minute education sessions at the Health Sciences Centre Legal Issues for New Grads – Sept. 15 Labrador Gerontological Nurses Association The Nurse, the Chart and the Law – Sept. 23 and welcomes new members. Members can in St. John’s. June Peckham, RN, join through www.cgna.net. If you would CGN(C), NL-CSGNA Treasurer, said that *On Dec. 15, join ARNNL for a special education like more information about the association, evaluations of the event were positive. teleconference on new CNPS enhancements to email [email protected]. Kudos to all who participated! ARNNL’s licensure/registration renewal process. See p. 11 for details. Conferences and Workshops Provincial Conference Memorial University School of Nursing (MUNSON) Classes Newfoundland and Labrador Operating Room Nurses of ‘75, ‘80, ‘90 Reunion 2015 Association (N&LORNA) Oct. 16-17, 2015 Oct. 2-4, 2015 For more information, and contact names, visit: Mount Peyton Hotel http://www.mun.ca/mundays/events/reunion_nursing.php Grand Falls-Windsor, NL Register at https://crm.stuaff.mun.ca/reunion.htm Email [email protected] for details Breastfeeding in NL – Committing to Best Practices Janeway Kids Rock Pediatric Emergency Conference & Webinar A Research and Clinical Symposium Oct. 2-4, 2015 Nov. 5-7, 2015 Email [email protected] for details Abstract submission deadline: Sept. 14, 2015 Website: www.kidsrocknl.ca www.surveymonkey.com/r/bfconference2015 or If youRegister would like to nominate by Sept. an RN or6 NP for Nurse of Note, please email [email protected]. [email protected]

The Magazine of the Association of Registered Nurses of Newfoundland and Labrador 15 VOLUNTEER SPOTLIGHT: THE ‘SELF’ IN SELF-REGULATION

Being part of a self-regulated profession means that RNs and NPs govern nursing, and are the ‘self’ in self-regulation. ARNNL engages its members, and members of the public, to contribute their knowledge and expertise to its work, and their involvement has a meaningful impact on nursing and health care in the province. These important volunteers serve ARNNL in many capacities, and we are pleased to introduce them to you in this edition of ACCESS. Continuing Competence Program (CCP) Auditors: RNs Answering the Call In the January 2015 edition of ACCESS, there was a Call for Continuing Competence Program (CCP) Auditors to participate in the 2015 CCP audit. RNs and NPs within our province answered the call! On June 4, eight volunteer RNs and five members of the Staff Advisory Committee on Continuing Competency met at ARNNL House to audit 150 CCP forms. Stay tuned for audit results and the upcoming call for CCP auditors for 2016 in the January 2016 edition of ACCESS. Left to right: Brenda Hayter, Rhonda McDonald, Krista Crane Here’s what some auditors had to say about the CCP audit process: From the Auditors: Tips for Helping You Complete Your 2015-2016 CCP “It was a great experience. Participating in this process will • Use the most current CCP forms available at https://www.arnnl.ca/ assist me in completing my own CCP forms more effectively continuing-competence. You should have your self-assessment completed and efficiently. I am quite impressed with the amount of by now and be working on activities identified in your learning plan. education RNs are currently engaged in in this province, • Ensure your learning activities fall within the correct licensure year – April as well as the diversity of educational opportunities. It is 1, 2015 - March 31, 2016. apparent that overall RNs take CCP very seriously and are • Review your target dates to ensure they include a month/year that falls committed to lifelong learning!” within the licensure year April 1, 2015 - March 31, 2016. • Review the CCP Continuous Learning Activities sheet available on “I enjoyed the process and was impressed by how well the ARNNL’s website for examples of what constitutes formal and self- CCP documents were prepared. I would encourage others directed learning activities. to participate – a great learning experience.”

“I was so delighted to be involved with the CCP audit process. It provided me the opportunity to better complete my own personal learning plan and see the great work being submitted by fellow colleagues. In a world of increasing accountability and self-directed learning, it is a pleasure to be part of the valued profession of nursing.”

“Positive experience from a personal and professional perspective. Reaffirms the importance of lifelong learning and the pursuit of excellence in caring for our clients and protecting the integrity of our profession.” Sitting (left to right): Marie Clarke, Rhonda McDonald, Krista Crane, Karen Street Standing (left to right): Anne Kearney, Cathy Burke, Glenda Roy, Tracy “Great insight into the CCP auditing process and the accountability of RNs MacDonald, Suzanne Kendall, Dorothy Bragg, Paul Alyward, Patricia Grainger, in our province.” Brenda Hayter

If you would like to volunteer with ARNNL, visit www.arnnl.ca/get-involved. 16        WORKFORCE OF 100          A Workforce of 100          By:By: Julie Julie Wells, Wells BSc, BSc., MSc, MSc. ARNNL - Research Research and Policy & Policy Officer Officer        Registered nurses are the largest group of regulated health professionals in the province. The provincial nursing workforce consists of over 6,000 registered nurses. If there were only 100* RNs it would be easier see the demographic characteristics of the workforce. If there were 100 RNs in the workforce there would be... 95 Females 5 Males RN 98 Registered NursesNP 2 Nurse Practitioners

91 educated in NL 51 with a Bachelor of Nursing degree 7 educated in another 42 with a Diploma in Nursing Canadian province 4 with a Master of Nursing degree 3 with a degree in other disciplines 1 internationally educated

6 in Labrador-Grenfell Health 65 working in a hospital

12 in Central Health 14 in 10 in community health Western Health 8 in long-term care 59 in Eastern Health 3 in an educational institution 6 employed outside the RHAs 14 in other workplaces

10 age 58+ 71 16 13 full time casual part time Average Age 6 42.9 years 24 60+ 50-59 75 staff/community health nurses 29 6 managers/administrators 24 40-49 4 instructors/educators 15 30-39 3 advanced practice nurses (NP or CNS) < 30 years old 13 employed in other positions

*statistics based on year-end 2014-15 membership data; for more nursing statistics see the ARNNL Annual Report or www.arnnl.ca/statistics. The concept for Workforce of 100 is based on the “A Village of 100” infographic in the Newfoundland and Labrador Vital Signs 2014 report.

The Magazine of the Association of Registered Nurses of Newfoundland and Labrador 17 REGULATORY NOTES By: Michelle Osmond, RN, MS(N), Director of Regulatory Services and Professional Conduct Review

Review of an Allegation by the Complaints Authorization Committee: Authority to Take Action The Registered Nurses Act (2008) (the “Act”) provides the Director of Professional Conduct Review (DPCR) with authority to resolve an allegation1 with the consent of the RN and the individual submitting the complaint (the “Complainant”) when it appears that an allegation may be satisfactorily resolved. While 67 per cent of allegations over the past five years have been resolved in this manner, allegations that the DPCR has been unable to resolve, or in the opinion of the DPCR are unsuitable for Alternative Dispute Resolution (ADR)2, are referred to the Complaints Authorization Committee (CAC) for review.

Who is the CAC? a written submission to the CAC. The CAC will meet to review The Complaints Authorization Committee (CAC) is a legislated the report. In the event that the CAC dismisses an allegation, the committee set out in the RN Act and is made up of Council members. complainant has the right to appeal A quorum of the CAC, two RNs and a public representative, is required for an allegation to be reviewed. When does the CAC order a counsel or caution? A counsel or caution may be given when the CAC is of the opinion What decisions can the CAC make when they review an that an RN has engaged in conduct deserving of sanction but, allegation? bearing in mind ARNNL’s primary mandate of public protection, The CAC has the authority to order an investigation and ADR (or both), referral to the disciplinary panel is not warranted. In deciding to issue require an RN to meet with them or dismiss the allegation. In the event a caution/counsel, the CAC considers the circumstances specifically that the CAC dismisses an allegation, the complainant has the right related to the RN’s practice/conduct, including: whether the issue is to appeal the decision. If following its review, which in most cases will isolated versus a recurring pattern of conduct/practice; whether the include a report of an investigation, the CAC is of the opinion that there RN has demonstrated insight and accountability; and whether any are reasonable grounds to believe that an RN has engaged in conduct remedial or corrective actions have been taken by the RN. Guidance, deserving of sanction, the allegation becomes a complaint. At this point, specifically referencing the standards of practice or the code of the CAC may counsel or caution the RN, or refer the complaint to a ethics, is given in writing and the CAC may also recommend the hearing by an Adjudication Tribunal. When the complaint is referred registered nurse undertake remedial courses or other measures. to a hearing, the CAC also has the authority to recommend to ARNNL Council that the nurse’s license be suspended or restricted, or an What happens when the CAC refers a complaint to a hearing? investigation of the RN’s practice be completed, pending the outcome The DPCR, as instructed by the CAC, will itemize each issue that of the hearing. the ARNNL alleges is conduct deserving of sanction with respect to the registered nurse’s practice/conduct, collectively referred to as the What is involved if an allegation is referred for an investigation? “Complaint.” The RN is provided notice of the hearing, including the The DPCR or an ARNNL Regulatory Officer will complete the date and the names of the Adjudication Tribunal members and a copy investigation. A written report containing the facts gathered during the of the Complaint. ARNNL posts notice of a hearing on the website, investigation, such as witness statements and copies of documents/ as the RN Act requires a hearing be conducted in public unless an records, is prepared by the investigator. The investigator is authorized Adjudication Tribunal orders the hearing be conducted in private. under the Act to request documents and to require persons having knowledge of the allegation to meet with him/her. A redacted3 copy of To learn more about the Professional Conduct Review Process, the report is forwarded to the registered nurse or his/her lawyer. The please see the ARNNL Annual Report at https://www.arnnl.ca/annual- RN is provided an opportunity to respond to the report and to provide report.

1An allegation is a written document alleging an RN has engaged in conduct deserving of sanction. For the definitions of conduct deserving of sanction see https://www.arnnl.ca/sites/default/files/Examples_of_Conduct_Deserving_of_Sanction_ Feb_2015.pdf 2ADR is an agreement process where an RN completes terms and conditions such as remedial courses or other measures to resolve an allegation. 3Identifying patient information is removed for privacy/confidentiality reasons.

18 DISCIPLINE DECISIONS

Pauline Hollett Newfoundland and Labrador Registration No. 14033

On May 6, 2015, the ARNNL Council suspended the license renewal of Pauline Hollett, Registrant No. 14033 pending the decision of the Adjudication Tribunal of the Disciplinary Panel.

Heidi MacNeil Newfoundland and Labrador Registration No. 18045 In the matter of a Complaint against Heidi MacNeil, Association of Registered Nurses of Newfoundland and Labrador, Registration # 18045 (the “Registrant”), an Adjudication Tribunal, in a Decision dated May 29, 2015, found the Registrant guilty of conduct deserving of sanction under the Registered Nurses Act (2008), sections 18(c)(i) professional misconduct; and 18(c) (v) acting in breach of the Code of Ethics.

At the hearing the Registrant entered a guilty plea to four issues in the Complaint, admitting that she had accidentally but carelessly discussed patient confidential health care information, unintentionally breached a patient’s confidentiality and gave inconsistent information to her Employer and ARNNL regarding matters related to the Complaint.

Pursuant to section 28(3) of the Registered Nurses Act (2008) the Adjudication Tribunal ordered:

1. The Registrant’s license to practice nursing to be suspended immediately and the license to be returned to her pending her successful completion of the following: a. Learning Modules: i. Canadian Nurses Association Code of Ethics for Registered Nurses; ii. Direct Contact with Personal Health Information: PHIA 2011; iii. Jurisprudence Module: The Legislation and Rules Governing the Practice of Nursing in Newfoundland and Labrador; b. Review of the ARNNL Interpretative Document: The Therapeutic Nurse-Client Relationship: Expectations for Registered Nurses; and c. A meeting with a Nursing Consultant – Policy and Practice, ARNNL to reflect on privacy, confidentiality and accountability.

2. The Registrant shall pay the ARNNL $1,250 towards its costs incurred.

The conduct deserving of sanction occurred on or about August 11, 2012 in , NL, and September 26, June 10, 2013 and December 3, 2013 while the Registrant practiced as a registered nurse at Health Sciences Centre, St. John’s, Newfoundland and Labrador. The Complainant was Eastern Health.

Disciplinary Update On June 8, 2015, Heidi MacNeil, Registration No. 18045, met the terms and conditions of the Order of the Adjudication Tribunal dated May 29, 2015 such that her practicing license has been returned.

The Magazine of the Association of Registered Nurses of Newfoundland and Labrador 19 CLINICAL CORNER

TECHNOLOGY TIPS FOR YOUR PRACTICE

Know and follow your Use employer-issued mobile organization’s policies on devices (where available) technology use instead of your own device

PASS

Protect your computer, Access personal health Never post work-related mobile device and social information only if it is comments on your media passwords required for client care social media pages

Keep your social Do not become a Ensure encryption when media photos, videos and client’s “electronic friend” sending external emails postings professional on social media

Reprinted with permission from the College of Registered Nurses of Manitoba.

Visit https://www.arnnl.ca/document-library for ARNNL resources, including Social Media (2013) and The Therapeutic Nurse-Client Relationship: Expectations for Registered Nurses (2014).

20 TRUST NEWS

By: Julie Wells, BSc, MSc, Trust Coordinator

Call for Applications Trust Elects New Board of Directors

Applications are now being accepted for awards in the following Members of the Trust elected a new Board of Directors at the categories: annual meeting on June 15. Congratulations to the members of Continuing Education Awards the 2015-16 Board: • Bursaries for Conferences & Post Basic Courses (up to $1,000) • Florrie Penney Continuing Education Bursary ($500) • Penny Grant, President • Kay Daley Scholarship for Nursing Leadership ($1,000) • Janet Templeton, President-Elect • NL Gerontological Nurses Association Bursary ($500) • Sara Seymore, Eastern Urban Regional Director • Nursing Leadership Awards ($500-$3,000) • Wayne Smith, Eastern Rural Regional Director • Violet Ruelokke Primary Health Care Award (up to $1,000) • Tina Drainville, Central Regional Director • Anna Marie Alteen, Western Regional Director Bachelor of Nursing Scholarships ($1,000 each) • Brenda Whyatt, Northern Regional Director • BN Years 2, 3, 4 • Paulette Roberts, Labrador Regional Director • BN Fast Track Year 2 • Joan Whelan, Director-at-Large • Flo Hillyard Memorial Scholarship • Vacant, Director-at-Large • Lynn Power, Secretary-Treasurer (non-voting) Post Basic Bachelor of Nursing Scholarships ($750 - $1,500) • Julie Wells, Coordinator (non-voting) • BN Post RN Scholarship • St. Clare’s Alumni Association Scholarship The Board extends thanks to out-going members Starlene Lundrigan (Eastern Rural Regional Director), Anita Ludlow ARNNL Bay St. George Chapter Scholarship (Director-at-Large) and Beverley Reid (Central Regional Director). • Available to RNs from the Bay St. George area It is through the willingness of members to dedicate their time and expertise that the Trust is able to achieve its goals. Graduate Scholarships ($1,000- $2,000) • ARNNL 50th Anniversary Scholarship • Masters or PhD Scholarships (Nursing & Non-Nursing) Canadian Nurses Foundation Scholarship and • Marcella Linehan Scholarship Bursary Recipients • NL Nurses Respiratory Society Legacy Scholarship The Trust extends congratulations to the following ARNNL members who received scholarships and bursaries from the RN Re-Entry Scholarship ($500) Canadian Nurses Foundation (CNF):

Nursing Research Awards (up to $2,500 each) • Kathleen Stevens ARNNL Education & Research Trust 25th Anniversary Criteria and application forms are available at: www.arnnl.ca/trust Scholarship Deadline for applications is Oct. 15. • Jill Bruneau Late or incomplete applications will not be considered. TD Meloche Monnex Doctoral Scholarship • Renee Crossman AstraZeneca Doctoral Scholarship • Holly LeDrew CNA Certification Bursary

For more information about funding from the CNF, please visit www.cnf-ficc.ca.

The Magazine of the Association of Registered Nurses of Newfoundland and Labrador 21 PAINTING A PHILOSOPHY OF NURSING IN UNDERGRADUATE NURSING EDUCATION

By: Paula Kelly, MNBNRN, Faculty MUN SON, and Dr. April Manuel, PhD RN, Faculty MUN SON

Background and Rationale Conclusion A philosophy of nursing creates a deeper Art based inquiry is an effective method to understanding of an issue (Noble & Pearce, foster the development of a personal philosophy 2014), an enhanced level of self-awareness of nursing in undergraduate education. It (Bereiter, 2002; Sawyer, 2004; Bloomqvist, encourages imagination, self-reflection, Pitkala & Routasalo, 2007; Gibson, 2007; abstract thinking, creative problem solving and Mitchell & Hall, 2007; Welsh & Welsh, 2008), knowledge of the discipline’s core values. an appreciation of how nurses influence society and a framework to provide rationale References available upon request. for approaches to care. These attributes are critical given the complexity of the existing The Art This painting compares nursing with trees; both are health care system. Art based approaches to multilayered, multifunctional and multifaceted. Trees teaching have been shown to promote critical have deep roots and strong trunks. Similarly, the nursing profession is composed of diverse areas of practice, each thinking (Oliver, 2010) and increase students’ contributing to the totality of the profession. The core of interest and motivation to learn (Chang & the tree is made up of “heartwood” which provides trees Hsu, 2010). with strength and resiliency. Likewise, the core of nursing is the heart – caring for people, helping them to find resiliency and strength. Goal The goal of this project was to help nursing students craft a personal philosophy of nursing through art based inquiry. The lighter, orb-like painting reflects idealized nursing practice. The more dynamic areas that consist of tendril-like growths and greenery represent the students’ Method current nursing practice – that is new growth, continually Second year fast track nursing students developing and growing towards idealized practice. Some (n=24) enrolled in Nursing 4103: Issues areas grow faster than others and via their own routes. Patients are like this current practice – individualized and in Nursing and Health Care were asked therefore requiring specialized care to facilitate growth to paint a representation of their personal towards optimal health. The mosaic background in this painting represents philosophy of nursing. Prior to the exercise, patients’ uniqueness and multicultural backgrounds. The students were assigned readings and given hands represent partnerships that nurses develop with patients while at the same time, empowering them to a presentation related to various ontological seek control over their own health. The hands are placed and epistemological approaches to nursing. A at the centre to signify reaching out to all aspects of question on the final exam asked students to health with the ultimate goal being holistic health. describe their personal philosophy of nursing.

Findings Students were able to articulate a deeper understanding of nursing philosophy and how their practice is informed by nursing theory. Art based inquiry is a unique and enjoyable teaching strategy that helped students problem solve in a more creative The colours in this painting are meant to reflect a sunrise/ manner. Students spoke of a greater sense sunset effect, representing continuous change throughout a patient’s lifespan. The symbols are arranged in the of awareness of oneself and others. This shape of a heart to reflect caring. The symbols within awareness was seen as a powerful tool that the heart represent health from a holistic viewpoint and they could use to guide their nursing practice. nursing as a holistic practice, as each symbol represents This image is meant to evoke a sense of mindfulness different roles RNs hold to maintain a holistic perspective. and peace, ideals that all nurses should seek to foster The black and white colours demonstrate the importance in themselves and the patients they care for. Through of upholding standards and maintaining the visibility of mindfulness and knowledge of one’s self, nurses gain nursing as a respected profession. insight into personal bias that may impact their care.

22 CONGRATULATIONS, NURSING GRADUATES of the Bachelor of Nursing (Collaborative) Program - May 2015 Jessica Danielle ABBOTT...... St. John’s Kristin Joanne FRANCIS...... Kaleigh Lauren NEWTON...... Halifax, N.S. Nicholas ANDREWS ...... England Alicia Dawn Charlene FRY...... Paradise Janine Eliza NOBLE...... Churchill Falls Tiffany Carolyn ANDREWS...... Ship Cove Brittany Patricia GALWAY...... Whitbourne Jessica Pauline NOEL...... St. John’s April Ilene ANSTEY...... Monique Ariel GAMACHE...... Lower Sackville, N.S. Jody Ann NOLAN...... Mount Pearl Megan Mary ANTLE ...... Mount Pearl Hilary GEAR...... Happy Valley-Goose Bay Elizabeth NOONAN...... Churchill Falls Samantha ARBOUR...... South Erin Marie GILLESPIE...... St. John’s Brittany NORMAN...... Breanne AYLWARD...... St. John’s Vicki Louisa GILLINGHAM...... Torbay Heather Danielle NOSEWORTHY...... St. John’s Chantal BAGGS...... Fall River, N.S. Stacie Cora-Lee GOUDIE...... Springdale Sarah Beth NURSE...... Glenda Jean BAKER...... Gambo Stephanie Nicole GREEN...... Burin Eunice ONODENALORE...... St. John’s Amanda BARRINGTON ...... Badger Tracie GREEN...... Burin Joshua James Michael O’SHEA...... St. John’s Cherilyn Marie BARRY...... Placentia Lindsay Elizabeth GRENNING...... Torbay Stephanie OUELLETTE...... Windsor, Ont. Kayla BARTER ...... Grey River Cindy Dawn GRIMES...... Mount Pearl Laura Marie Lucy PACK...... Hermitage Sara Patricia BATTEN ...... Conception Bay South Allison Elizabeth GRIST...... St. John’s Anna Victoria Naomi PADDOCK...... Robert’s Arm Heather BARTLETT...... Corner Brook Brooke Patricia HAMEL...... Happy Valley-Goose Bay Bruce PARSONS...... Amy BATTISTE...... Port aux Basques Caitlin Dorothy Mary HANLON...... North River Emily Krista PARSONS...... Grand Falls-Windsor Christopher Joseph BEER...... Mount Pearl Elizabeth Mary HANN...... St. John’s Krista Gladys PARSONS...... Grand Falls-Windsor Megan BELL...... Corner Brook Julie Catherine HARRISON...... Hubbards, N.S. Laura Marie PEACH...... Kelsey Jeanette Louise BISHOP ...... Ashley Natasha HEAD...... Wing’s Point Rebecca Dawn PEDDLE...... Paradise Libby BLAXLAND...... Bridgewater, N.S. Amanda Rose HEAL...... Dunville Melissa PENNEY...... Conception Bay South Allison Lucy BOUZANE...... Little Bay Rodolfo Guerreiro HENRIQUES...... Portugal Melissa Desirée PENNEY...... St. Lewis Tara Carlyn BOYD...... Summerford Megan HENSTRIDGE...... Grand Falls-Windsor Kelsey Marie PHILPOTT...... Plate Cove West Allison Nicole BRAGG ...... Greenspond Carmel Mary HIGDON...... Fort McMurray, Alta. Christina Maria PICKETT...... Christina Michelle BRAGG...... Grand Falls-Windsor Leslie Mary HIGDON...... Conception Bay South Katrina Pauline PICKETT...... Centreville Melissa BRAKE...... Meadows Elizabeth HILLIER...... St. Lunaire-Griquet Stephaine PICKETT...... Pasadena Robhen Julia BURRY...... Bonavista Keegan HILLIER...... Stephenvillie Jenna Christine PIERCEY...... Whitbourne Alyssa Ashley BURT...... Bonavista Victoria Lindsay HILLIER...... Conception Bay South Tiffany POIDEVIN...... Pasadena Nicole Beverley BUSSEY...... Myah April HOPKINS...... Twillingate Ashley Marie POWER...... Burin Marilyn Ruth BUTLER...... St. John’s Hedi HOTHER-YISHAY...... Kibutz Beeri, Israel Jessica Robyn POWER...... Grand Falls-Windsor Elizabeth Ann BUTTON ...... Wareham Lauren Elaine HOWELL...... Victoria Courtney Nicole POWERS...... Mount Pearl Heather CADIGAN-HAWKINS...... Paradise Jennifer Louise HOWLAND...... Berwick, N.S. Natalie Gladys QUINLAN...... Birchy Bay Sarah Marie CAHILL...... St. John’s Alicia Dawn HOWSE...... Eastport Vicki RANDELL...... Benoit’s Cove Megan Alexandra CAREY...... Grand Falls-Windsor Kristen Lee HUNT...... Conche April Jean REID...... Dildo Claire Julia CARSON ...... Saint John, N.B. Michelle Florence HUNT...... Conche Erica Megan RENDELL...... St. John’s Sara Nicole CARTER...... Conception Bay South Nicholas HURLEY...... Corner Brook Samantha Charlotte RIDEOUT...... Conception Bay South Jessica Alexandra CAVE...... Grand Falls-Windsor Natasha Melissa HYNES...... Stephenville Alana Janet ROGERS...... Catalina Emily Jean CHURCHILL...... Halifax, N.S. Amanda Shirley Violet JOY...... Mount Pearl Amanda Anne ROGERS...... Twillingate Justin George CHURCHILL ...... Spaniard’s Bay Deborah-Anne JOYCE ...... Steady Brook Leanna Michelle ROWE...... St. John’s Kristen Lee CHURCHILL...... Port Colborne, Ont. Rosemary Diane JUDD...... Fredericton, N.B. Kimberly RYAN...... Port Saunders Keisha Elizabeth CLARKE...... English Harbour East Lori Ann KALYTA-LOWE...... Suwanee, Ga. Tiffany RYDER...... Bonavista Heather COBB...... Conception Bay South Samantha Marie KELLY...... St. Lawrence Lisa SAMOTOWKA...... Nepean, Ont. Olivia Claire COBBS ...... Mount Pearl Kayla Victoria KENNEDY...... Conception Bay South Jessica SCEVIOUR...... Botwood Ashley COFFIN ...... Bishop’s Falls Helen Taylor KERR...... Halifax, N.S. Paula Katherine SEVIGNY...... Portugal Cove-St. Philip’s Chantelle Netta COFFIN...... Fogo Brittany Sue KILFOY...... Little Bay Stephanie Lynn SHARPE...... Mount Pearl Michael COLEMAN...... Corner Brook Omolade Ifedolapo KOLA-ONI...... Tede, Nigeria Chantal Cathy SHEAVES...... Lower Sackville, N.S. Krista COLLIER...... Cartwright Katelyn LAWRENCE...... Rose Blanche Jennifer Michele SHEPPARD...... St. John’s Renee COMPTON...... Deer Lake Leslie LEWIS...... Corner Brook Sarah SIMMS...... Corner Brook Jennifer CRANE...... Steady Brook Danielle Jasmine LOCKE...... Little Bay Islands Meaghan Catherine SLANEY...... St. John’s Jerica Anne CROSBY...... Wedgeport, N.S. Amanda LOVELL...... McIvers Ashley SMITH...... Dartmouth, N.S. Amy CULL...... Pasadena Nadine LOVELL...... Sops Arm Jennifer Mary SMITH...... Tilton Country CUNARD...... Brig Bay Kimberley Anne LUCAS...... St. John’s Ruth Anne SPENCER...... Torbay Jennifer Ashley DALTON...... Catalina Emily Julia LUSH...... Mount Pearl Chelsea Myra Della STAMPLECOSKI...... Paradise Tonya Dawn Judy DALTON...... Mount Pearl Jennifer Dawn MAHONEY...... Makinsons Kelsi Dawn STAPLETON...... Winterland Jessica Gertrude Mary DAWE...... Upper Island Cove Emily MAJOR...... Rocky Harbour Anna STOCKWELL...... Cambridge, Ont. Roslynn DECKER...... Rocky Harbour Cara Elizabeth MALONEY...... Southern Bay Tina Deanne SURRIDGE...... Mount Pearl Courtney Mary DOODY...... Admiral’s Beach Jennifer Donna Suzanne MARKS...... Natasha TATCHELL...... Castor River North Nancy Marie DOOLEY...... St. John’s Stephanie MARSH...... Bishop’s Falls Amanda Jane THOMAS...... Goulds Emilee Marie DOWNEY...... St. John’s Cassondra Sarah Ann MARSHALL...... Churchill Falls Rebecca May TIDSWELL...... Aberdeen, Scotland Graham DOWNEY-SUTTON...... Corner Brook Laura Jean MARSHALL...... St. John’s Caroline Sarah TOOTON...... Halifax, N.S. Melissa DWYER...... Conception Bay South Kayla Christine MAYE...... Jessica TOMS...... King’s Point Patrick Lloyd EDISON...... Springdale Ryan MCDONALD...... Deer Lake Laura Alice TRAHEY...... Goulds Ashley Mary EDMUNDS...... St. John’s Brittany MCFATRIDGE...... Cold Brook Natasha Cynthia VERGE...... Wesleyville Ifunanya EJECKAM...... Gander Andrea MCKAY...... Carter’s Cove Tyson Jeremy Dylan VERGE...... Brighton Jessica ELLSWORTH...... Conception Bay South Robyn Victoria MELINDY...... Gander Chelsea VINCENT...... Pasadena Robyn Lynn ENNIS...... St. John’s Natasha MICHELIN...... North West River Kelsey Elizabeth VIVIAN...... Mount Pearl Amie Winsor ESPERANZA...... St. John’s Leeanne MILLER...... Portugal Cove-St. Philip’s Megan Catherine WALBOURNE...... Fogo Jeffrey ESTABROOKS...... Halifax, N.S. Audrey Catherine Doris MOLLOY...... Goulds Ian Shawn WARREN...... St. Anthony Tawsha EVOY...... Benoit’s Cove Michelle Alexandra MOODY...... St. John’s Victoria WARREN...... Pike’s Arm Leah Beth FAIRN...... Lawrencetown, N.S. Sarah MOORE...... Codroy Valley Alanna WELLS...... Appleton Jasmine Mary FÉLIX...... Black Duck Brook Janessa Nicole MOORES...... Paradise Beth WILLIAMS...... Deer Lake Kayla Mary FITZPATRICK...... Victoria Samantha MORGAN...... St. John’s Peter Christian WILSON...... St. John’s Vanessa Elizabeth FOLEY...... Mount Pearl Ashley Mary MURPHY...... Dunville Mollie Anne YETMAN...... Carbonear Jason FONTAINE...... Windsor, Ont. Kelly Anne MURPHY...... Apohaqui, N.B. Elizabeth Susan Mary YOUNG...... Logy Bay Felicia FORD...... Fogo Heather Michelle NASH...... Mount Carmel

The Magazine of the Association of Registered Nurses of Newfoundland and Labrador 23 infoL AW ® Canadian Nurses Legal Risks of Email - Part 2 Protective Society Practical Considerations

Vol. 22, No. 3, Practical Considerations December 2014

Email, in some cases, may be the preferred option to communicate with patients or others effi ciently and expeditiously. Before using email, it is important for nurses to be aware of the risks and alternative ways to transmit information. In addition to the privacy and confi dentiality considerations set out in the infoLAW, Legal Risks of Email – Part I, nurses may wish to consider the following practical issues relating to email use with patients and others in their practice.

Managing ExpectaƟ ons Some nurses are using email to communicate directly with patients, both during and after Communicating hours. In addition to managing the privacy and security concerns associated with these by email: communications, nurses should consider how to best manage patient expectations about the appropriate uses of these communications, how quickly they will respond to enquiries and what Are your steps should be taken if a timely response is not forthcoming. Reasonable limits and response patients times may then be clearly communicated to patients. aware of the Further, even when a patient has consented to email communication, a nurse may insist potential risks? on an alternate mode of communication in certain circumstances. For example, if there is uncertainty as to the identity of the recipient, where the patient should be given an opportunity to ask questions, if it is necessary to ascertain whether the patient properly understood the information or if the information is simply too sensitive to be communicated by email, the nurse may consider a more traditional method of information exchange.

DocumentaƟ on Nurses are cautioned to maintain copies of all email messages to and from patients. These copies should be kept in the patient’s electronic or paper chart. This acknowledges that such communications are professional and that they have potential clinical and legal implications.

Personal Use of Email at Work Nurses using email at work for personal purposes should be aware of potential disciplinary consequences. In some cases, using an employer’s email system for personal communication or including inappropriate language and jokes has resulted in disciplinary action by employers and even termination of employment. One example involved an employee whose employment was terminated after 26 years of service for accessing inappropriate material that had been emailed to him at work by others. He forwarded such emails to some of the company’s More than employees, suppliers and contractors. The court concluded that the company’s code of conduct liability allowed employees to use its computers for “limited” personal use but expressly prohibited protection sending pornographic, obscene, inappropriate, or other objectionable communications. The employee was found to have read, understood and accepted the terms of the code of conduct.1

24 Use in Legal Proceedings Generally speaking, most documents (including electronic documents like emails) are producible in legal proceedings if their content is relevant to matters in the proceeding. As such, emails with patients or other health care practitioners that contain clinical information or other information about a patient may need to be disclosed in the event of a patient request for access to personal health information, civil action or complaint to a regulatory body or investigation by another statutory body.

It is important to recognize that email has traditionally been seen, and used, as a manner of sending informal communications and less care may be taken drafting an email than would be taken if sending a letter or writing in a patient chart. Language used in emails tends to be less factual, less precise and less professional. For these reasons, caution should be exercised when communicating via email and nurses are reminded to use a professional tone and clear content for all email communications.

Nurses should also be aware that any email communications should be considered permanent. Although email programs have a delete function, IT professionals can retrieve deleted emails with relative ease, even years later. Multiple copies may continue to reside in back-up fi les, the recipients’ email, or in the email of third parties to whom the email was forwarded.

Risk Management ConsideraƟ ons To limit the potential legal risks related to email communications, consider implementing the following risk management strategies: • Let patients and other health care providers know when the use of email is appropriate, the turnaround time for received messages and what to do in the event that symptoms worsen or there is a delay in responding; • Place emails of a clinical nature in the patient’s chart; • Be aware that when using an employer’s email system, the employer has the ability to access the email communications; • Use a professional tone, and generally take as much care as when using any other formal mode of communication or documentation; and • Follow employer guidelines and policies regarding email communications.

Please contact CNPS at 1-844-4MY-CNPS if you have any questions regarding legal risks in email and visit our website at www.cnps.ca.

1. Poliquin v Devon Canada Corporation, 2009 ABCA 216 (CanLII).

Related infoLAWs of interest: Mobile Devices in the Workplace and Legal Risks of Email – Part 1. Available at www.cnps.ca

THIS PUBLICATION IS FOR INFORMATION PURPOSES ONLY. NOTHING IN THIS PUBLICATION SHOULD BE CONSTRUED AS LEGAL ADVISE FROM ANY LAWYER, CONTRIBUTOR OR THE CNPS®. READERS SHOULD CONSULT LEGAL COUNSEL FOR SPECIFIC ADVICE.

©Canadian Nurses Protective Society www.cnps.ca 1-844-4MY-CNPS [email protected] Get more out of your ARNNL membership.

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