Are We Ready? the Ebola Outbreak in West Africa Raises Questions About Preparedness Here at Home

November/december 2014 JOURNAL

Are we ready? The Ebola outbreak in West Africa raises questions about preparedness here at home.

90 years of RNAO • Improving care through technology • Medical tourism update a Recognize the outstanding achievements of nurses. Nominate a colleague, yourself, or your organization for recognition at RNAO’s 2015 AGM: Leadership Award in Nursing Administration Leadership Award in Nursing Education (Academic) Leadership Award in Nursing Education (Sta Development) Leadership Award in Nursing Research Leadership Award in Political Action Leadership Award in BPG Implementation Chapter of the Year Award Interest Group of the Year Award RNAO Promotion in a Nursing Program Award Leadership Award in Student Mentorship Student of Distinction Award Lifetime Achievement Award (formerly Honorary Life Member) Honoured Friend of Nursing (formerly Honorary Member) Award of Merit RNAO in the Workplace Award HUB Fellowship

Recognition Awards Recognition President’s Award for Leadership in Clinical Nursing Practice The deadline for nominations is January 7, 2015. For nomination forms and details visit www.RNAO.ca/awards V ol. 26, No. 6, n ovember/december 2014 contents

18 Features 12 COVER STORY Preparing for Ebola Assurances that Ebola is unlikely to arrive in Canada are not good enough for nurses who worry that they are vulnerable to this deadly disease. By Daniel Punch

18 Celebrating RNAO’s 90th anniversary Test your knowledge of RNAO history with our anniversary crossword, and reflect back on nine decades of influence and impact. By Kimberley Kearsey

20 Advancing care Technology is helping nurses to improve care at home, reduce pressure ulcers and enhance communication in acute care. By Melissa Di Costanzo

12 30 the lineup 4 editor’s Note 5 President’s View 6 ceo Dispatch 7 rN Profile 8 Nursing in the News 11 Nursing Notes 17 Policy at Work 30 In the End

Cover Photo: Jeff Kirk Registered nurse journal 3 The journal of the REGISTERED NURSES’ Editor’s Note Kimberley Kearsey ASSOCIATION OF ONTARIO (RNAO) 158 Pearl Street Toronto ON, M5H 1L3 Phone: 416-599-1925 Toll-Free: 1-800-268-7199 Fax: 416-599-1926 Website: www.rnao.ca Email: [email protected] Letters to the editor: [email protected]

EDITORIAL STAFF Marion Zych, Publisher Kimberley Kearsey, Managing Editor Melissa Di Costanzo, Writer True sacrifice leads to change Daniel Punch, Editorial Assistant

EDITORIAL ADVISORY COMMITTEE Chris Aagaard, Shelly Archibald, Marianne Cochrane, Rebecca Harbridge, Paula Manuel, Melanie McEwan, Sandy Oliver s a journalist i have a collection Art DIRECTION & Design A , ability to face difficulty with Fresh Art & Design Inc. of unforgettable interviews determination. And that’s a trait ADVERTISING that I’ve stored in my memory I have seen in other nurses, Registered Nurses’ Association of Ontario Phone: 416-599-1925 because they’ve touched me in a particularly early in my career Fax: 416-599-1926 way that others have not. During at RNAO, when the SARS out- SUBSCRIPTIONS my time at RNAO, I’ve had the break happened in 2003. Registered Nurse Journal, ISSN 1484-0863, is a benefit to members of the RNAO. Paid subscriptions privilege of interviewing two In this issue, you will read are welcome. Full subscription prices for one year military nurses: Betty Brown about the Ebola outbreak in (six issues), including taxes: Canada $38 (HST); Outside Canada: $45. Printed with vegetable-based in 2005 and Eileen Butson in West Africa (page 12), and inks on recycled paper (50 per cent recycled and 2014. Both served in the Second nurses’ refusal to accept uncer- 20 per cent post-consumer fibre) on acid-free paper. World War, and both left a tainty around preparedness Registered Nurse Journal is published six times a year by RNAO. The views or opinions expressed in lasting impression on me. plans. For me, this story con- the editorials, articles or advertisements are those In this issue, you will meet jures up memories of the of the authors/advertisers and do not necessarily represent the policies of RNAO or the Editorial Butson, a retired Hamilton strength that became nurses’ Advisory Committee. RNAO assumes no responsibility RN who is celebrating her 90th trademark during SARS. Fear- or liability for damages arising from any error or omission or from the use of any information or (RNAO will do the same in lessness – along with a fit-tested advice contained in the Registered Nurse Journal 2015). She shares some mem- N95 – was an expectation including editorials, studies, reports, letters and advertisements. All articles and photos accepted ories of her growth as a nurse during the outbreaks. for publication become the property of RNAO. around the same time RNAO A decade later, nurses are still Indexed in Cumulative Index to Nursing and Allied Health Literature. was growing as an association expected to be fearless, but in

CANADIAN POSTMASTER (page 18). Her recollections other ways. For those at the fore- Undeliverable copies and change of address to: of war will leave you feeling front of innovation in health RNAO, 158 Pearl Street, Toronto ON, M5H 1L3. Publications Mail Agreement No. 40006768. grateful for all that our troops care – those who are embracing

RNAO OFFICERS AND SENIOR MANAGEMENT sacrifice on our behalf. technological advancements Vanessa Burkoski, RN, BScN, MScN, DHA Norma Nicholson (page 7) in nursing – fearlessness is as President, ext. 502 also knows a thing or two about important as the latest piece of Rhonda Seidman-Carlson, RN, MN Immediate Past-President, ext. 504 sacrifice and the impulse to pay equipment. Learn about tech- Doris Grinspun, RN, MSN, PhD, LLD(hon), O.ONT it forward. When you read about nologies that are changing care Chief Executive Officer, ext. 206 her childhood challenges, you for the better (page 20). Daniel Lau, MBA Director, Membership and Services, ext. 218 will marvel at her strength and For many of us, change – Irmajean Bajnok, RN, MScN, PhD perseverance. She has turned technological or otherwise – is Director, International Affairs and Best Practice Guidelines Centre, ext. 234 tragedy into triumph and has not easy. But, as you will read Marion Zych, BA, Journalism, BA, Political Science made a commitment to help in this issue, it’s those difficult Director, Communications, ext. 209 young people do the same. challenges that can lead to the Nancy Campbell, MBA Nicholson has an instinctive most rewarding results. RN Director, Finance and Administration, ext. 229 Louis-Charles Lavallée, CMC, MBA Director, Information Management and Technology, ext. 264 As a member, you are eligible to receive a digital copy of Registered Nurse Journal. You can choose RNJ Is now to receive only an electronic version of the magazine by emailing [email protected] and stating DIGITAL! your preference for a paperless version. If you haven’t received the magazine electronically, please let us know by contacting [email protected]

4 November/December 2014 president’s view with vanessa burkoski

Innovative councils give nurses the chance to invest in their workplaces

One of my goals as president LHSC. As a result of their work, Another idea was the adop- control over their practice envi- is to empower nurses, particu- more than 150 initiatives are at tion of whiteboards in select ronment, it also makes nurses larly those of you who work on various stages of implementa- units, resulting in a 45 per cent feel listened to and respected. the frontline, and encourage tion and evaluation. increase in accuracy. These And the hospital benefits too you to make the kind of Here are just a few examples. boards provide all members of because we can implement changes you believe our system In the hospital’s ICU, a group the team with an at-a-glance these so-called best practices needs. You are the key to of nurses decided to change the update about their patients. right across the organization, elevating the quality of care process to stock their supplies. I feel strongly about CQI fostering a culture of contin- provided to patients. You also They noticed their supply cart councils because they ensure uous improvement. have the ideas and the know- was overflowing with equip- that suggestions do not disap- Organizations that do not how to make those changes, ment. Besides the obvious safety pear into a vacuum. Every idea engage their frontline nurses both within your own practice issues, sifting through the cart put forth in my workplace is are missing out on key conver- and within your work environ- to find the right item was time considered, assessed and then sations that could help them ments. Such changes make our consuming. Their idea was to prioritized. The councils put a make their workplaces more health system more responsive, conduct an inventory and ask structure in place so good ideas functional and deliver the kind more effective, more efficient themselves “what do we really are not ignored, and units such of care they desire. and safer. Engaging and empowering One of the accomplish- RNs through this or a similar ments I take pride in as the “the councils put a structure in model also helps nurses chief nursing executive at my enhance their professional workplace is the degree of free place so good ideas are not ignored, practice. In fact, some of the initiatives nurses have spear- thinking that has led nurses to and units such as icu medicine make London Health Sciences , , headed at LHSC have become Centre (LHSC) a better hospital obstetrics, mental health, and the focus of research papers. and a better workplace. Nurses who never imagined A few years ago, I imple- countless others function for the they would be involved in mented something called these projects – and certainly Continuous Quality Improve- benefit of patients as well as nurses.” not published on them – are ment (CQI) Councils. The now seeing the results of their inspiration for this came from involvement. the RNAO best practice guide- need during a shift?” This as ICU, medicine, obstetrics, These are just some of the line on professionalism in change in process allowed them mental health, and countless ways nurses are harnessing nursing. The idea was to give to work more efficiently and others function for the benefit their wisdom and changing nurses and others a direct hand reduced their daily frustrations. of patients as well as nurses. health care for the better. in making changes they felt Another group sat around the These kinds of initiatives are If you have a success story were necessary. table and decided that verbal very important because they that you want to share with Driven by nurses, the councils bedside reporting during shift put power in the very hands of me, please send me a note at represent an interprofessional changeovers was needed to cut nurses who see patients on a [email protected] RN team approach to identifying, down on information gaps. day-to-day basis. Your ability formulating, executing and eval- When implemented, this initia- to have a say in your own work vanessa burkoski, rn, bscn, mscn, uating ideas that will help them tive resulted in an 80 per cent environment is important. dha, is president of rnao. do just that – boost the quality decrease in critical incident Who knows better than you and safety of patient care. reports across several units. what is needed to help patients To find out more about RNAO’s professionalism in Right now, there are 70 CQI This change not only benefitted feel better, to heal faster? nursing BPG, visit RNAO.ca/ councils working collaboratively nurses, it put the patient’s care But the benefits don’t stop there. bpg/professionalism in different units throughout needs front-and-centre. By giving nurses greater

Registered nurse journal 5 CEO Dispatch with Doris Grinspun

Learning from SARS to ensure Ebola preparedness

When sars arrived in ontario co-ordinated provincial strategy Calls from media across the our federal government. I can’t in March 2003, it spread to prepare for Ebola (Oct. 15), province in October were plen- understand why Canada and quickly, and nurses were the province announced guide- tiful. Reporters were following a the U.S. waited so long to take loud and clear right from the lines, a number of which breaking story about a patient in real action on Ebola – in terms get-go about their concerns reflected the recommendations Dallas who had died from Ebola of relief in Africa and planning for the safety of their patients of RNAO (read more about this (the first in North America), here at home. It seems that the and themselves. Nobody lis- in our cover feature, page 12). and two nurses who had taken death of the patient in Dallas, tened, and that’s why, when We called for specific pro- care of him who were diag- and the two infected nurses, the province was finally free of tocols around screening, nosed with the disease. Media suddenly prompted President the virus many months later, movement of patients, per- wanted to know how Ontario’s Barack Obama and Prime Min- RNAO called for a full public sonal protective equipment nurses were feeling about it. ister Stephen Harper to take inquiry. That was a tragic (PPE), education/training, With more than 20 reporters note. But, did this deadly dis- time in Ontario’s history, but and routine teleconferences and camera operators crowded ease have to arrive in North if there is a silver lining from between health-care stake- into my office on Oct. 15, we America before any real action SARS, it’s the fact that nurses would be taken? The world in Ontario are now very much is one place and it is impera- a part of the planning and con- “we need to know political decision- tive we help one another at sultation process in preparing all times. Don’t our political for Ebola, and our views and makers will listen to nurses and leaders feel the same way? Do expertise are respected. act quickly. fortunately, this is the thousands of lives lost in A reporter recently asked me West Africa not mean as much when Ontario will be “Ebola exactly what i have experienced to our national political leaders? ready.” My response was honest I have heard directly from and direct. Ebola, like other with ontario’s minister of health many RNAO members who infectious diseases will continue eric hoskins wonder the same thing. Cana- to evolve, and we may never be .” dians have been reassured time completely ready. However, an and again that the chances of important sign of “readiness” holder organizations and the shared our views. We also asked Ebola arriving in our country in these situations is knowing ministry. The government lis- the tough questions that jour- are slim. But “slim” is a far cry our government will pick up tened and delivered. We also nalists – and nurses – wanted from “nil” when it comes to this the phone when we call. We called on health-care organi- answered. What’s in place to deadly disease. If countries in need to know political decision- zations to have chief nurse ensure we don’t have system Africa can’t cope, it would be makers will listen to nurses and executives fully involved in failures as we had during incredibly naïve to think our act quickly. Fortunately, this is the planning and delivery of SARS? How are we protecting country is somehow immune to exactly what I experienced with protocol measures in their the health professionals who the suffering we see elsewhere. Ontario’s Minister of Health organizations. We called for are stepping into the line of fire We have a responsibility as Eric Hoskins. directives for primary care, by simply going to work? nurses – and as citizens of this During SARS, the govern- and these are being issued as We also provided our best world – to not only care for ment started to pay attention we speak. Minister Hoskins advice. Minister Hoskins and I (and about) our patients, neigh- to nurses only after things has been directly involved, spoke on Oct. 15, and we were bours, and families, but also became critical. That’s not consulting with RNAO, ONA both on the same page. He and those who are suffering beyond what is happening now. Min- and other health organizations his team delivered on all of the our borders. RN ister Hoskins understands on the preparedness plans items we discussed. that it is vital to listen to the for Ebola. He is on top of this RNAO is pleased with the doris grinspun, rn, msn, phd, voice of nurses. In fact, within file, and to me, that is tremen- progress we’ve seen in Ontario, lld (hon), o.ont, is chief two days of RNAO’s call for a dously valuable. but we have questions now for executive officer of rnao.

6 November/December 2014 RN Profile By Melissa Di Costanzo

RN draws on personal challenges to help youth Norma Nicholson wants to “make a difference” for youth who find themselves in trouble.

Almost 70 years ago, six-month- library, learning how to become 1971, calling it quits as a nanny and detention facility, for almost old Norma Nicholson was found a nurse. She finished high and working full-time as an five years. It was there she devel- by a police officer outside the school in 1965, and, at 18, began RNA for eight years. oped a passion for changing the gates of her father’s house in working as a cashier at a local She completed a three-year public’s perception of adoles- Kingston, Jamaica wearing department store. It was there nursing program at George cents involved with the justice only a diaper. The baby’s des- she ran into a former classmate Brown College in the early system. Too often, people over- perate and ashamed 16-year-old who had moved to Canada. 80s, and carried on for another look the fact that many young mother left her on a sidewalk “You’re a bright kid, you should eight years as an RN in endo- people have experienced past with a note nearby that said come to Canada,” he suggested. crinology and diabetes at abuses, trauma, mental illness “this is your husband’s baby.” Nicholson was flabbergasted. SickKids. While working at a or inadequate health care that Nicholson was raised by her paternal grandmother on a rural Three things you farm until the age of seven. don’t know about When her “nana” died, she was sent to live with her aunt Norma Nicholson: and three cousins. For the next 1. She traveled to Alaska in five years, Nicholson endured 2004 and climbed atop unspeakable horrors. She was the back of a bear statue, tied to a tree and whipped. She a sign of what her husband was raped several times by one calls her missed childhood. 2. She loves hosting friends of her relatives. These are just for afternoon tea. two examples. “The flashbacks 3. Visits to the park with four- are still difficult,” she says. year-old granddaughter Olivia “Many days, I wondered if I’d always include a roll down live to see the next day.” the park hill, also known as When Nicholson was 10, “rolling down the mountain she met a teacher named Irene with grandma.” Livingston. The woman encouraged Nicholson’s aunt to allow her to attend school for the first time. Although Nicholson was “You’ve got to be joking,” she number of different GTA hos- lead them down a path of delin- taunted by classmates for her replied. “How can I just come to pitals in different roles over her quency, she says. clothing, she was happy to be Canada? I don’t know anyone, four-decade career, Nicholson It was out of this – and her worlds away from the torment and I don’t have much money.” achieved her baccalaureate own – experience that she wrote at home. She credits Livingston With his help, and the help of and master’s degrees. She’s her first book. Young Lives on the for helping her to achieve her his mother, she secured a job as been involved with the Peel Line: You can make a difference goal of becoming an RN, an idea a nanny for a family in Toronto, chapter of RNAO for more than was published in the summer that began to take root when and immigrated in 1969. 25 years, sitting on a number of 2014. “Because of how I was she met the school nurse. She One year later, Nicholson of committees and working treated as a child, I wanted to was caring and compassionate, became a registered nurse assis- groups for the association, and give back to...youth,” she says. Nicholson recalls. “She always tant (RNA, or RPN today). She taking on roles with the board “(I wanted to give them) the very had encouragement to give.” decided on this path after vol- of directors and assembly. best (health care) so they can... At 14, Nicholson moved unteering on weekends at She capped off her career become their best.” RN in with her stepmother and Toronto’s Wellesley Hospital. working as health manager cleaned for a living. She spent She moved to the Hospital for for Brampton’s Roy McMurty melissa di costanzo is staff

n i / T he B ram p to G uardia nj wa Photo: R adhi k a Pa most of her evenings in the Sick Children (SickKids) in Youth Centre, a secure custody writer at rnao.

Registered nurse journal 7 RNAO & RNs weigh in on… nursing in the news by Daniel punch

Nurses gear up for Ebola

If the deadly Ebola virus ever spreads to Ontario, nurses at Collingwood General and Marine Hospital are ready. Equipped with head-to-toe protective equipment, nurses are now screening all visitors coming to the ER and through the main doors for indicators of the disease. Norah Holder, VP and chief nursing executive, says the measures are precautionary, and there is no cause for public concern. “The safety of our community and that of our staff...is our top priority, and we are going above outlined guidelines to ensure everyone feels safe,” Holder says. (Colling- wood Connection, Oct. 29) The Ministry of Health released provincial directives regarding Ebola on Oct. 17. “There was a great deal of vari- ability in the level of preparation (at health-care facilities). Some (nurses) had received absolutely no training at all,” These training participants display the personal protective equipment worn by treatment specialists intimately interacting with patients ill with Ebola. RNAO CEO Doris Grinspun told CTV News (Oct. 18). The directives outlined proper triage procedures, personal protective primary care settings. “People with symptoms...will (not nec- equipment (PPE), and designated 11 hospitals where poten- essarily) show up in an emergency room...but actually (on) the tial Ebola cases would be treated. The directives are helpful for primary care side. So those sides also need to...know what to

Photo: CDC /Nahid B hadelia hospitals, Grinspun says, but regulations must be extended to do and what not to do.”

Influencing the elections, the Haliburton access to these social supports services provided to residents,” election agenda Kawartha Pine Ridge Dis- will face barriers to health, Nairn says. (Northumberland Good health is about far more trict Health Unit created the says RN Kristina Nairn. Since Today, Sept. 25) than just traditional health #RethinkHealth campaign to these issues are influenced at care, and a Kawartha region show the value of employment, a municipal level, the health Hospital launches inter- health unit is working to education, food, housing and unit prepared a brochure and nationally recognized spread this message. Leading other factors to overall health. video for both municipal can- breastfeeding initiative up to the October municipal People without adequate didates and voters in the fall In October, Toronto East Gen- election. “We are trying to eral Hospital (TEGH) hosted engage…candidates and make the Ontario launch of the Baby- them aware of all the factors Friendly Initiative (BFI), an affecting health,” Nairn says. evidence-based standard of “We also want to have the care that promotes and sup- electorate think about this.” ports breastfeeding. BFI was #RethinkHealth materials developed by the World Health were mailed and posted online. Organization and the United “Municipal governments have Nations Children’s Fund. a significant role to play in cre- “Breastfeeding and skin-to-skin ating a healthy community practices…are shown to improve through the decisions they not only infant health and devel- make, and the products and opment, but also to protect

8 November/December 2014 nursing in the news by Daniel punch

mothers from some types of cancer and other health prob- RN Maria Casas, communications and policy executive network officer for RNAO’s Sudbury chapter, warns lems,” says Linda Young, of the dangers of medical tourism in this Nov. 6 letter to NorthernLife.ca Later in the month, Ontario TEGH’s director of maternal, Minister of Health Eric Hoskins announced the province would put the brakes on medical tourism, asking newborn and child health. Ontario hospitals to stop soliciting and treating international patients – except for activities related to Studies indicate that children existing contracts. Hoskins also asked hospitals not to enter into new international consulting contracts who are breastfed have lower that include the treatment of foreign nationals in Ontario. (For more on this, see Policy at Work, page 17) rates of obesity and diabetes, as well as higher performance on Medical tourism erodes health care intelligence tests. In 2013, the As Ontarians who value our publicly funded health Ministry of Health announced system, the Registered Nurses’ Association of funding to encourage Ontario Ontario (RNAO) is urging the government of health-care facilities to adopt Ontario to immediately ban medical tourism in BFI standards to promote hospitals across Ontario. Medical tourism refers breastfeeding. TEGH is one of to the establishment of for-profit businesses just three Ontario hospitals to where out-of-country patients can pay their way to achieve BFI designation. It has preferential treatment. Mount Sinai, Sunnybrook developed a BFI implementa- and University Health Network in Toronto have tion toolkit and a course to assist already embarked on such initiatives, and there hospitals, nurse practitioner-led are proposals to establish additional programs in clinics, and other primary care other large centres. It is unacceptable to be mar- facilities in adopting BFI prac- keting “pay-for-treatment” health services to tices. (East York Mirror, Oct. 16) patients from abroad for both ethical and public policy reasons. For-profit health care gives priority to those who can pay over those most in need, and runs counter to the spirit of the Canada Health Act. Besides eroding the quality and acces- sibility of health services for all Ontarians, this two-tiered approach will erode public support for our cherished health system. Medical tourism opens the door to lawsuits driven by for-profit interest groups. They will use wealthy and/or vul- Ontarians to speak up and tell Premier Kathleen nerable clients to argue that if out-of-country Wynne and Minister of Health Eric Hoskins to patients can pay their way to preferential treat- immediately ban medical tourism to protect and ment, so too should Ontarians. RNAO urges all strengthen our health-care system.

RN beats cancer and recently added a rehabilitation treatment, but in March are diagnosed with life-threat- vows to help others program for women coping 2013, Talosi was cancer free. ening illnesses, and another A rare form of breast cancer with chronic illness. Talosi, Since then, she’s been devel- for women with breast cancer. gave Welland RN Rita Talosi a who retired in 2007 after 31 oping a set of tools for women “I have come to understand new perspective on health and years with VON, was diagnosed undergoing cancer treatment, what individuals with chronic recovery, and she’s sharing in July 2012. Doctors found a including a “health journal,” illness go through,” she says. what she’s learned from the “shadow” during a chest exam. which mirrors the one she kept “When… you’ve experienced disease with other women “One day I was healthy, and the full of test results, prescriptions a journey like what I’ve expe- facing the same challenge. next day I couldn’t believe what and appointments. Talosi is rienced...the empathy in Talosi runs a wellness centre I was hearing,” she recalls. also writing two books; one for you really becomes strong.” called MOSA-ICs, where she It took months of radiation children whose grandparents (Pelham News, Nov. 6)

Registered nurse journal 9 nursing in the news

out and about Nurses giving new life to patients with continence issues Two unique continence clinics are breaking down the shame and embarrassment surrounding bladder and bowel conditions and empowering patients. Etobicoke Services for Seniors has been hosting a clinic in Alderwood for two years, which has been “inundated” with Give a Day calls, nurses say. About 16 per RNAO hosted a fundraiser in November cent of Canadian men and 33 to support the work of the Stephen Lewis per cent of Canadian women Foundation and Dignitas International, over 40 have urinary conti- two organizations that have been leading nence issues, but only a frac- efforts to address the AIDS pandemic in tion have discussed them with Africa. The event, now in its 10th year, Run for the cure their primary care providers. started when Jane Philpott challenged col- On Oct. 5, members of RNAO’s Brant-Haldimand “Typically, people don’t want leagues at Markham Stouffville Hospital Norfolk chapter took part in Run for the Cure in Simcoe, to discuss it with their doctor,” (in 2004) to mark World AIDS Day (Dec. Ontario. Running (and walking) to support not only says nurse continence advisor 1) by giving one day’s pay to support com- cancer patients, but also the nurses who care for Ineke Moxam. “So many munity organizations in Africa. Attending (L them, were (L to R): Kim Meier, Marisa Blahovich, Kelly people still feel so ashamed to R): RNAO CEO Doris Grinspun; Dignatas Kokus and Erin O’Connell. The group says they did it and so alone with the issue.” representatives Edson Mwinjiwa and Anne “…in the spirit of good health,” and, of course, to raise The clinic provides assessment, Connelly; Stephen Lewis Foundation repre- money for an important cause. education and recommenda- sentative Janet Solberg; and RNAO board tions for a variety of other member Claudette Holloway. To find out conditions, without requiring more about the initiative, visit giveaday.ca a referral. “It makes a tremen- dous difference,” Moxam says. “The tools are there. They just need to realize they can (manage the issue). That they have that power.” Laura Robbs runs a second clinic at The Queensway General Hospital, where she works with people of all ages. She says nurses can improve lives for the vast majority of clients. “People say they don’t

Photo: D eve n V ele z leak anymore. Or instead of Have you had your flu shot? Annual park clean-up using 10 pads a day, they’re RNAO President Vanessa Burkoski receives Members of RNAO’s Middlesex-Elgin chapter have taken down to one,” says the clin- her flu shot on Oct. 24 from London Health ownership of Campbell Memorial Park in London, volun- ical nurse specialist. “It’s Sciences Centre RN Joan Kenney. To find teering twice each year to clean it up. Lending their lawn very rewarding.” (Etobicoke out where to get a free flu shot anywhere skills this November were (L to R) Jessie Giroux, Jeff Guardian, Nov. 13) RN across the province, visit Ontario.ca/flu Reed, Pam Bushell, Stephani Lohman and Janet Hunt.

10 November/December 2014 nurcontinued sing notes

Paying it forward Saint Elizabeth Health Care is hoping a “challenge” to nurses, PSWs, rehab therapists and support staff will help spread hope and happiness to others. The home care agency, which provides 18,000 visits every day, has launched #Hopeand- Happiness, a campaign that allows health providers to share stories in which they have gone beyond the call of duty to bring a smile to a client’s face. In one story, nurses helped a child with cerebral palsy complete his physiotherapy so he could walk across the stage to receive his Grade 8 diploma. Another story tells of how nurses helped a client celebrate her 40th birthday with lawn signs and a special lunch. “We wanted to celebrate that energy and get even more of these special things happening, every day,” says Shirlee Sharkey, president and CEO. To share a story, or to feel inspired by the stories of others, visit www.saintelizabeth.com/HopeAndHappiness

Getting closer to 70 to have full-time work than their Global Health Award will go to a to uphold the ban on assisted per cent full-time colleagues in long-term care. chapter or institution of higher suicide. The group wants to strike employment In addition to revealing the learning or practice that has under- down laws prohibiting assisted A new report, based on a provin- latest stats, the report contains taken a project(s) that address dying for terminally ill Canadians. cial survey of nursing employers, recommendations for government, global health disparities. To find End-of-life care is an important reviews their challenges and employers, as well as nursing out more about the award catego- issue for nurses, and one that successes in securing more full- associations and labour organiza- ries, eligibility requirements, fees began generating more attention time employment for nurses. tions. Its release is timely in light and submission guidelines, visit after members approved a resolu- Commissioned by the Joint of a recent survey by the College of www.nursingsociety.org/awards tion at the 2014 AGM to begin a Provincial Nursing Committee, and Nurses of Ontario which revealed public discussion about the topic. led by RNAO, the recently released 72 per cent of RNs actually prefer End-of-life care gets “We had excellent dialogue, 70 per cent Full-Time Employment to have full-time employment. national, provincial with a wide range of insightful for Nurses Survey provides a For more details, visit attention questions and comments from snapshot of how much progress RNAO.ca/70FullTime In mid-October, RNAO hosted a participants,” Grinspun said has been made towards the govern- virtual dialogue about end-of-life after the fall webinar. A second ment’s commitment to achieve 70 Call for nominations for care with President Vanessa Burk- is planned for Feb. 3. It will “… per cent full time. It is a commit- international awards soski and CEO Doris Grinspun. extend the dialogue to those ment that has been on RNAO’s Each year, the Honor Society of As many as 250 RNs, NPs and who were not able to attend radar since 2000. Nursing, Sigma Theta Tau Interna- nursing students joined the online (in October)…and also provide As of November 2014, 66.9 per tional (STTI) recognizes nurses from discussion to share their insight updates on the Supreme Court cent of RNs have a full-time job. around the world for achievements on – and interest in – this issue proceedings.” To register for the NPs have already surpassed the in practice, research, leadership, that has once again made national February webinar, and to watch the 70 per cent threshold with 83 per technology, chapter excellence headlines thanks to an appeal to archived October discussion, visit cent reporting full-time employ- and media. Nominations for the the Supreme Court of Canada. RNAO.ca/EndOfLifeDialogue RN ment. The ratio of RPNs who work 2015 International Awards for The appeal, launched by the full-time is 55.9 per cent. The Nursing Excellence are now open. B.C. Civil Liberties Association, is Do you have nursing news to share? Email Survey concludes that nurses who This year, STTI has added a new the latest since a 1994 decision [email protected] work in hospitals are more likely award. The Hester C. Klopper by the country’s highest court

Registered nurse journal 11 EPreparingb for ola

12 November/December 2014 History’s deadliest outbreak of Ebola virus disease has devastated parts of West Africa, and raised questions of preparedness around the world. Ebolaby D aniel Punch

ancy Graham is heading into the heart of the largest Ebola outbreak in history. She is about to spend five weeks in Ebola-rav- N aged Sierra Leone, on potentially the most dangerous deployment of her decade-long career with Médecins Sans Frontières (MSF)/Doctors Without Borders. In just days she’ll set off, and her biggest concern is how she’ll be received when she comes home. Will people avoid her? Will she be ostracized, or forced into quarantine? As a public health nurse and veteran RN trained in outbreak management, Graham knows she’s unlikely to contract Ebola, and even less likely to pass it to anyone back in Canada. Ebola is spread through direct contact with bodily fluids only when the carrier is showing symptoms. Still, she’s seen the stigma and suspicion faced by other health professionals, and is planning accordingly. “When I return home, my plan is to work quietly. I will probably not be in crowds or with groups of people,” she says. “For the comfort level of my friends, family and colleagues – for their comfort and peace of

Photogra p hy: Jeff Kir k mind – I will keep a low profile.”

(left) Public health nurse Nancy Graham will spend five weeks in Sierra Leone to help in the fight against Ebola virus disease.

Registered nurse journal 13 Ebola has swept through West Africa and worked in the stricken regions. Both A since March 2014, infecting more than Dallas nurses recovered thanks to early B 16,000 people and killing almost 7,000 pri- diagnosis, but their stories highlight the C marily in Liberia, Sierra Leone and Guinea. need to protect health-care workers outside The outbreak has captured the world’s of the outbreak’s epicentre. attention, and has heightened anxieties More than 230 health-care workers have here in Canada. The federal government died since the beginning of the outbreak. announced in October that it will restrict Still, thousands of health professionals like travel visas to residents of Ebola-infected Graham are choosing to work at ground countries, a move criticized by the World zero.“This is what nurses do,” she says Health Organization (WHO) as a possible violation of the International Health Reg- “I’m as well-prepared as I ulations, a treaty dealing with trade and can be. I have confidence in D travel during public health emergencies. In November, the government also the policies and procedures announced mandatory quarantine mea- in place, and in the profes- sures for “high-risk” travellers returning sionalism of my colleagues from Guinea, Liberia or Sierra Leone even if they’re not experiencing symptoms. Travel- in the field” lers deemed “low-risk” will be asked to check — Nancy Graham E in with local health authorities, self-monitor for three weeks after their return, and report proudly. “Historically, nurses have been any symptoms. The directive states that on the front lines of outbreaks, natural humanitarian workers would be “high risk” disasters, famine and conflict.” if they had any personal protective equip- Graham spent six months in Sierra F ment (PPE) failures, and these distinctions Leone in 2006 managing an MSF will be made on a case-by-case basis. inpatient hospital in the wake of the North American fears intensified in late country’s civil war. She has also worked A – Surgical hood September when Thomas Eric Duncan in Sri Lanka, South Sudan and Jordan, B – Face shield C – Fit-tested N95 respirator became the continent’s first confirmed where she managed care for injured D – Double gloves case of Ebola. Duncan died a week after Syrian civil war refugees. E – Single use gown, to mid-calf his diagnosis, but not before passing the Her latest trip to Sierra Leone will take F – Single use boot covers, to mid-calf virus to two nurses at the Dallas, Texas her to MSF’s Ebola management centre According to the directives from Ontario’s chief medical officer of health (released Oct. 30), this is hospital where he was treated. Before this, in Kailahun, near the country’s southeast the required personal protective equipment (PPE) for all confirmed cases of health-care workers borders with Liberia and Guinea. health-care providers in acute-care settings at risk with Ebola were contracted in West Africa She will work on the front line of the out- of exposure to a suspect/confirmed case of Ebola and/or a potentially contaminated environment. n : j ulia mi amata illustratio and primarily among those who lived break, but says she’s confident she is protected.

March 22 Ebola Guinea health officials confirm that Ebola is responsible for the deaths Timeline of more than 50 Guineans since December 2013, when a toddler died of the hemorrhagic fever in the town of Guéckédou. Cases of the disease are reported in Liberia within a week and in Sierra Leone two months later (May 26). The three countries will be the hardest

Photo: A P- bbas D ulleh/ T he C a n adia Press hit by the outbreak.

(left) Three people suspected of having contracted the Ebola virus await treatment outside a hospital near Monrovia, Liberia. “I’m as well-prepared as I can be. I have specific PPE requirements (see graphic) confidence in the policies and procedures and proper donning and doffing are cru- A in place, and in the professionalism of my cial. “If the majority of your staff doesn’t B colleagues in the field,” she says. “We’re all know how to put this stuff on properly, it’s C looking out for each other.” not going to do anything,” Angela says, sug- Graham’s confidence is in stark contrast gesting lessons should have been learned with some of her colleagues back home. from the 2003 SARS outbreak. “We’ve In Ontario, many nurses worry they are already gone through something like this… unprepared to face the virus. why have we not learned from our history?” Angela* is a registered nurse at an urban It took a scare for Jessica* to realize community health centre (CHC) serving her workplace, like the CHC, isn’t ready a large immigrant population, including a for Ebola either. In the early days of the contingent from Sierra Leone. In October, outbreak, she hadn’t considered Ebola a E she contacted RNAO to share her unease concern at the breastfeeding clinic where that the CHC had taken little action to pre- she works as an RN. Then one day, she D pare for Ebola. was helping a client who introduced her to Staff concerns about insufficient her mother, visiting from West Africa. F screening processes and PPE were initially “My mind was racing... because I had no ignored, she laments, with management idea what I was supposed to be doing,” she saying that infection control procedures recalls. Jessica didn’t want to stigmatize the were in line with Public Health Ontario’s visitor, so she said nothing. Both mother guidelines. Ebola didn’t even become a and daughter seemed healthy, but the inci- topic of conversation until mid-October, dent raised red flags Jessica brought to her when stories about preparedness began managers. They responded that she could making headlines thanks largely to RNAO. wear gloves if she wanted, but this was a Yet today, patients are not being properly hands-off clinic, so there was no risk of screened at the CHC’s front desk, Angela infection, and no special protocols needed. says. Staff has been encouraged to ask This didn’t satisfy the worried RN. Ebola questions (about recent travel, fever, etc.) is extremely virulent, and breast milk – in A — Goggles** B — Face shield** but nothing has been uniformly enforced. which the Ebola virus has been detected – C — Fit-tested N95 respirator “I’m worried we’re not going to be able “gets everywhere” in a breastfeeding clinic, D — Double gloves to see a possible case in front of us,” she she says. So Jessica spoke up, and she E — Full body barrier protection F — Apron (optional) says. “Then, I’d be exposed along with 30 encourages other nurses to do the same. other people in the waiting room.” “Don’t feel embarrassed to say ‘this ** Workers can choose to The CHC has ordered Ebola PPE, but doesn’t feel right,’ or ‘I don’t feel safe,’” wear goggles and face staff was given no instruction on how to she says, noting she’s gloved up for shield together, but are not required to wear both use it, Angela adds. Viruses like Ebola have the most part since. “We don’t have to simultaneously

* Pseudonyms have been used to protect privacy

Aug. 12 Aug. 24 Sept. 22 Sept. 30 The death toll surpasses 1,000 as A second outbreak is declared The death toll approaches 3,000, The U.S. Centers for Disease the scope of the outbreak captures in the Democratic Republic of but WHO declares the outbreak Control and Prevention (CDC) the world’s attention. The Canadian the Congo. Genome sequencing largely contained in Nigeria (20 confirm Thomas Eric Duncan, government announces it will donate shows it is unrelated to cases, eight deaths) and Senegal a Liberian man visiting family an experimental vaccine developed the situation in West Africa. (one case, no deaths). Nigeria, in Dallas, Texas, is North by Public Health Agency of Canada At least 66 people will be Africa’s most populous country, America’s first confirmed case to the World Health Organization infected and 49 will die in will be lauded as a success story of Ebola. Duncan visited a (WHO), just four days after WHO the Congolese outbreak. in Ebola containment. In Sierra Dallas hospital on Sept. 25 declares the outbreak an Leone, a three-day lockdown in with a fever and abdominal “international public health the capital of Freetown, aimed at pain, but was sent home emergency.” By this point, Nigeria stopping the spread of the despite telling nurses he has seen its first Ebola death, and disease, ends. traveled from West Africa. Senegal will report its first confirmed He dies roughly a week after case by the end of the month. his diagnosis.

Registered nurse journal 15 be the sacrificial lambs. We should be able education has gone a long way toward denied traveling recently, was interrupted by to speak up.” making nurses more comfortable. her young daughter, who interjected, “no, In recent weeks, more nurses have come Wendy James has overseen similar mommy, we just came from the plane.” forward to say their workplaces have stepped successful measures at Guelph General Hos- “(The lying) made me very nervous,” up their Ebola preparedness, and much of pital, where she works in infection control. Caporiccio recalls. “When I asked why she this progress is due to the advocacy work of She says she understands Ebola is fright- lied, she said she thought they’d get in trouble.” RNs and RNAO. The association was con- ening, recalling her days as an ICU nurse Federally mandated quarantines may tacted by members in the fall who felt they during the SARS outbreak. “I remember only serve to perpetuate these myths. hadn’t been adequately trained to handle putting on the big suit with the fan and the Graham plans to be mindful of others’ Ebola, and took those concerns directly to hood and everything, and feeling the hair go feelings when she returns, but she believes Ontario’s Minister of Health Eric Hoskins. the misinformation surrounding Ebola RNAO demanded province-wide Ebola direc- “If they have the knowledge can be extremely harmful. She believes tives through the media on Oct. 15, and two and techniques, they there’s an “unhealthy fear” of the virus, days later, Hoskins announced enhanced can use them to protect which may lead governments to even more Ebola preparedness measures, including restrictive protective measures. Multiple guidelines on PPE, screening and directions themselves.” U.S. states have already imposed manda- on how to handle suspected Ebola cases. — Wendy James tory quarantines for all health-care workers Suspected patients are to be immediately iso- returning from West Africa. Graham fears lated, and cared for by two dedicated nurses up on my spine,” James recalls. this could dissuade prospective volunteers who are not to treat other patients. Because of this, she’s been sure to make from lending their expertise to fight an RNAO President Vanessa Burkoski is chief herself available to answer nurses’ ques- outbreak the WHO calls “a crisis for inter- nursing executive/quality and patient safety tions and quell their fears. She’s confident national peace and security.” officer at London Health Sciences Centre she’s equipped them with the tools they Health Minister Hoskins – a physician (LHSC), one of 11 Ontario hospitals desig- need to be safe. with experience treating infectious disease nated to treat Ebola patients. She says LHSC “If they have the knowledge and techniques, in Africa – dismissed the idea of manda- staff has been hard at work ensuring the hos- they can use them to protect themselves.” tory quarantines for asymptomatic health pital complies with the ministry directives, But preparation will only go so far. professionals as “bad science.” and nurses have been heavily involved in the That’s a lesson emergency room RN “I think it actually discourages health- process. “It is critical that we listen to point- Diana Caporiccio learned during her first care workers from going to West Africa,” of-care nurses,” Burkoski says. “They can Ebola screening shift. Caporiccio donned he told the media in October. “Which is identify where there are gaps and inefficien- full PPE and greeted visitors to the ER with how we’re going to solve this epidemic.’’ RN cies, and we need to pay very close attention.” five questions, starting with whether they’d A day after the ministry directives came travelled in the last 30 days. Many ER visi- daniel punch is editorial assistant at rnao. down, LHSC held the first meeting of tors thanked her for her vigilance, but its Ebola management team. By the next others weren’t as happy to see her. In fact, To find out more about Ebola virus disease, its history, and previous day, 262 nurses had already been trained she found at least two people lied to her outbreaks, visit RNAO.ca/WhatisEbola on the additional PPE. Burkoski says about their travel history. One woman, who

Ebola Timeline

Oct. 6 Oct. 12 Nov. 10 Nov. 13 Ebola arrives in Europe when Nina Pham, a Dallas nurse who Canada imposes mandatory MSF announces it will host Spanish nurses’ assistant treated Thomas Eric Duncan, is 21-day quarantines on clinical trials at three Ebola Teresa Romero becomes the the second person outside West “high-risk” travellers returning treatment centres in Guinea to first person outside of West Africa to test positive for Ebola. from Guinea, Liberia or Sierra expedite the search for Ebola Africa to contract Ebola. Three days later, Pham’s col- Leone. A day later, North treatments. Two trials will Romero had treated two league Amber Vinson becomes America is officially Ebola-free involve antiviral drugs, while Spanish missionaries who the third. Manhattan physician as Spencer is released from a the third will use blood from a contracted the disease and Craig Spencer later tests positive Manhattan hospital. recovered Ebola patient. The were flown back to Madrid. for Ebola shortly after returning next day, the Canadian govern- She was later cleared of Ebola from working in West Arica with ment announces clinical trials and released from hospital Médecins Sans Frontières/ for a Canadian-made vaccine in November. Doctors Without Borders (MSF). will be held in Halifax. All three would later recover.

16 November/December 2014 policy at work

Nurses and physicians #banmedicaltourism call for ban on toxic RNAO’s call for a ban on medical pesticides tourism has generated results. RNAO has teamed up with On Nov. 21, Health Minister Eric the Canadian Association of Hoskins released a statement Physicians for the Environ- asking all Ontario hospitals to ment (CAPE), the David Suzuki stop marketing to, soliciting, and Foundation, and Ontario treating international patients Nature to call for a ban on unless that activity is part of a neonic pesticides. The insecti- hospital’s existing consulting cide is used on corn, canola, contract, which he is in the soy beans and other crops. process of reviewing. He also Neonic pesticides are asked hospitals not to enter into absorbed into every part of new international consulting a plant, including its leaves, contracts that include the treat- stem, fruit, pollen and nectar. ment of foreign nationals in In addition to being toxic Ontario hospitals. to worms and grubs, the RNAO, which formed a coali- RNAO was one of 160 organizations to present an open letter to federal Finance pesticides are also extremely tion with Canadian Doctors Minister Joe Oliver on Nov. 18. The letter opposes new regulations that could compel provinces to insist on residency requirements before refugee claimants harmful to bees, butterflies for Medicare, the Association can apply for social assistance. and other pollinators. of Ontario Midwives, and the A campaign was launched Association of Ontario Health RNAO advocates to implement policies that (Nov. 17) to draw attention to Centres to press its demands for for refugees pose a risk to people’s lives evidence the pesticides are a ban, says it’s pleased the min- RNAO and the Canadian and contravene the founda- responsible for killing bees. ister has taken action. Association of Community tional principles of Canada’s Within days, the provincial Health Centres (CACHC) health system. government announced a plan have filed a motion for inter- RNAO is also advocating to reduce the number of acres vener status with the Federal for refugees on another issue: planted with neonicotinoid- Court of Appeal that will allow opposing changes outlined in coated corn and soybean seeds both groups to present argu- federal legislation (Bill C-43) by 80 per cent by 2017. ments in opposition to a July that would effectively deny Gideon Forman, executive 2014 ruling regarding health refugee claimants the right to director of CAPE, says almost benefits for refugee claim- claim social assistance. In a 60 per cent of Ontario’s honey ants (read more at RNAO.ca/ Nov. 18 letter to Finance Min- bee colonies have been wiped RefugeeIntervenerStatus). ister Joe Oliver, 160 concerned out largely because of neonics. More than 4,000 people In the decision under appeal, health and community groups, The figure is alarming given have already sent letters to Pre- Justice Mactavish struck down including RNAO, asked that sec- the role bees and other pollin- mier Kathleen Wynne and controversial changes the federal tions of the bill be withdrawn ators play in our food supply. Hoskins in response to the government made to the Interim because they give provinces the In October, Environmental demand for a ban. The coali- Federal Health Program (IFHP), option to impose minimum Commissioner of Ontario tion will continue to monitor describing them as “cruel and residency requirements on Gord Miller declared the pesti- the situation, and will work unusual” treatment. claimants before they can apply cides a major threat to the bee with Minister Hoskins to The June 2012 changes to for social assistance benefits. population. RNAO and CAPE ensure the health system is not IFHP effectively left refugee Claimants already have praise this stance, and say turned into a commodity. RN claimants and their families to demonstrate need before they will press for a full ban without access to primary even qualifying for assistance. during a meeting with Environ- health care, including prescrip- Denying financial help based on ment Minister Glen Murray To read the government’s Nov. 21 statement, tion drugs. immigration status leaves them in December. visit RNAO.ca/ RNAO and CACHC say no without “the crucial lifeline that MedicalTourismUpdate government should be allowed allows them to survive.”

Registered nurse journal 17 Left: Members attend a workshop at RNAO’s Price Street offices in 1967.

by kimberley kearsey RNAO celebrates Years of influence and impact

In 1925, the Graduate Nurses’ Association Look who else is 90 night,” using the same skills she’s perfected of Ontario (GNAO) officially became the Eileen Butson says she’s been a member of over her decades-long career in specialties Registered90 Nurses’ Association of Ontario RNAO “forever. I don’t ever remember not such as military nursing, obstetrics, commu- (RNAO), welcoming Miss E. MacP. Dickson being a member,” the Hamilton RN declares, nity care, teaching and just about anything as its first (unofficial) president. Over the admitting she joined almost six decades else that made her feel her contribution next nine decades, the association and ago because that was just what you did. You was “worthwhile.” its members would flourish, growing from wanted to “feel a part of…something,” she says. Reflecting back, Butson says her most regulator, union and professional body Butson celebrated the same milestone in vivid memories of nursing are in London, all-in-one, to a trusted, evidence-based June that RNAO will celebrate next year. And during the Second World War, when the organization that influences policy and at 90, she still considers herself as much an challenges were plentiful and the work was practice. RNAO, a gold standard for other RN as she’s ever been. In fact, she’s taking “interesting.” She recalls holding the legs associations within and outside of nursing, care of her now paralyzed husband “day and of soldiers in the operating room as they has become a powerful voice for RNs, were coming off. Those were trying times, NPs and nursing students. she admits, made easier with occasional Next year marks RNAO’s 90th anniver- moments of humour. She smiles when sary, and we want to invite Ontario’s nurses she thinks back to a group of injured mili- to celebrate this milestone with us. Visit our tary men who came in search of care after anniversary website (launching in January). a bomb exploded next to their position, and Browse our historical photos on Facebook. right into a chicken coup. They were all Attend our annual general meeting. Read covered in feathers, she says with a laugh. our anniversary coverage on these pages Butson was approaching her 20th throughout 2015. And send us your stories birthday when the war ended, and she of RNAO past. remembers waiting with thousands of other We look forward to honouring nurses’ Londoners for King George VI to emerge achievements over the last nine decades, from the palace to officially announce vic- In 2005, RNAO member emeritus Eileen Butson and building momentum for the next 90 marks the 60th anniversary of Victory in Europe (VE) tory against the Nazis in the spring of years…and beyond. Day with her husband, a former military doctor. 1945. “I was too excited to sleep, and went

18 November/December 2014 Anniversary Crossword Celebrating RNAO, past and present

1 2

3 4 5

9 10

11 12 Above: Soon-to-be nurses take their nursing exam in 1933. Below: RNAO’s first official president 13 (see 2D in crossword) 14 15 16

17 18 19

20 21

23 Years 24 25 of influence and impact Pu zz le desig n ed by G we Sj ogre , author of the O C ana d a rosswor s series ACROSS 5 In 1986, we launch this program to 14 Nurses can download this from the assist nurses with work-related legal Apple store to enhance their knowledge of downtown to wait for the king,” she told issues (abbr.) evidence-based care (2010) (two words) CHCH TV in 2005, the 60th anniversary of 6 R NAO reschedules its annual meeting 16 W e sign BPSO host agreements with this Victory in Europe Day (V-E Day). due to this outbreak (2003) country and with Australia (2012) After moving to Canada in 1946, Butson 7 T his Connecticut university becomes RNAO’s 17 2012 RNAO-issued report: Enhancing first international BPSO candidate (2010) Community Care for Ontarians (abbr.) found herself drawn to obstetrics. She shares 9 O ur 2014 vision document: Charting a 20 R NAO successfully lobbies for a ban on one of her clearest post-war memories: Course for the Health _____ and Nursing this in 1986: _____ billing standing alone in an Ottawa delivery room, in Ontario 23 Name of the first RNAO member stunned when the obstetrician announced 10 In 1965, RNAO members endorse publication (1945) the baby that had just been delivered was proposed legislation that would bring 24 O ur 2002 public awareness campaign: in collective _____ dead. “They all walked off and left me there,” _____ Ontario (two words) she recalls. As she cleaned up and got blan- Down kets to wrap the baby, she had to summon 1 RNAO meets with this premier to call 13 Ontario establishes this body in 1963 to the team back into the room. The infant was for a baccalaureate degree as a minimum administer nursing-related statutes (abbr.) entry-to-practice requirement (1998) alive and “turned a nice pink colour when 15 We host an open house to celebrate our 2 Our first official president, _____E mory new building on this Toronto street (2006) he was all wrapped up and warm,” she says (1926–29) 18 Mandated public health unit position: with as much astonishment today as she 3 RNAO participates in consultations _____ nursing officer (2012) felt more than six decades ago. for the Regulated _____ Professions 19 In 2007, the first nurse practitioner-led Butson reached RN emeritus status (40 Act (1991) clinic opens in this city years of consecutive membership) in 1996. 4 RNAO releases evidence-based 21 In 1971, we support federal legislation to recommendations on this seniors’ curtail advertising of this Her membership memories don’t come as issue (2014) (two words) 22 2001 RNAO report: Earning Their Return: easily as they once did, but she does have 8 RNAO members can enrol in this type of When and Why Ontario _____ Left Canada, one piece of advice for nurses considering liability insurance plan (1970) and What Will Bring Them Back involvement in their professional associa- 11 Our 2000 political awareness initiative: 23 Database of nursing-sensitive indicators, Take your _____ to Work tion. When asked “should they join?” she established in 2011 12 RNAO advocates for formation of this responds candidly: “I would think so,” with 25 Regulatory milestone that changes labour relations group in 1973 (abbr.) nursing in Ontario: Nurses’ Registration an English accent that – like her passion _____ (1951) for nursing – hasn’t waned. RN

(Solution on page 24) Registered nurse journal 19 20 November/December 2014 Technology is reshaping health-care delivery. There’s innovation everywhere, and we thought we’d bring you just a few examples of advances that are having a positive effect on nursing practice and patients. by Melissa Di Costanzo

or years, paramedics showed up at Henry’s* house at least once a month. The man would become short-of-breath without notice. Anxious, he’d pick up the phone and dial 9-1-1. Paramedics showed up so often, he was forced to rearrange his furniture so they were able to manoeuvre around his apartment. F Henry has chronic obstructive pulmonary disease (COPD). He panicked whenever he felt as though his lungs were being squeezed, like a balloon slowly and abruptly being released of air. Without a health-care professional monitoring his coughing, wheezing and fatigue, and without a clear sense of the day-to-day effects the condition was having on his health, Henry reached out to the only resource he knew: his local emergency department. Thanks to Telehomecare, Henry is now able to largely avoid the ER. Telehomecare uses a small collection of technology – a touch screen tablet connected to a weight scale, a blood pressure cuff, and an instrument that monitors the level of oxygen in blood – installed in clients’ homes (over 4,000 people across Ontario have been enrolled to date). This technology allows patients like Henry to take their vital signs, Monday through Friday, first thing in the morning.H enry answers questions like: “Is your shortness of breath worse today?” And: “Have you missed or stopped taking any of your medications during the last 24 hours?” Patients are also screened for depression. The entire process takes about five minutes, and the data is uploaded and transmitted

n : a tho y tremmaglia illustratio to computers manned by about 40 RNs who monitor the information on a daily basis.

* Pseudonyms have been used to protect privacy

Registered nurse journal 21 Technology has permeated our personal and professional lives, and it should come as no surprise that health care has found itself at the forefront of innovation. Many – if not most – of the advancements introduced over the past decade are for the benefit of patients – especially when it comes to preventive care. This includes Telehomecare, which allows nurses to keep an eye on patients’ chronic conditions, pick up on trends, and offer early interventions. Through daily monitoring and regular phone calls, the nurse may learn that Henry is not getting enough physical activity, or he’s increased the number of cigarettes he’s smoked. Knowing this allows the nurse to work with Henry to assess what is important to him (like quitting smoking or more exercise). Patients like Henry receive a call once-a-week for six months, a check-in that allows nurses to provide information about physical activity, sleep, or whatever topic they’ve decided to address as part of the care plan. Measuring success his kind of health coaching is what Laurie Poole, an RN and VP of telemedicine solutions at Ontario Telemedicine Net- Telehomecare allows patients with chronic conditions like heart T work (OTN) (an RNAO Best Practice Spotlight Organization), failure, diabetes and chronic obstructive pulmonary disease to avoid refers to as the “real gem” of Telehomecare. “Many patients have panicky trips to the ER. had a chronic disease for a long time. Fear and anxiety drive them Here are just a few statistics – collected by three of the seven to the ER because they don’t have the support in their home or Local Health Integration Networks (LHIN) using Telehomecare – that within their community,” she says, adding nurses help to empower speak to its success. patients like Henry to make better decisions by helping them learn more about their condition and set goals to improve their health. Newmarket’s Toronto Central “Merely putting technology into the patient’s home is not going to Southlake Regional Community Care change their behaviour,” says Poole. “You have to have some type of Health Sciences Centre Access Centre coaching model...(in addition to) that technology,” which, she adds cannot be intrusive, especially considering the average age of partici- 57% 48% pants is 77-years-old. “It has to be embedded in their daily lives.” reduction in hospital admissions decrease in ER visits of patients Henry is an example of Telehomecare’s success. His trips to the enrolled in the program ER ended. He was also able to return his couch and armchair back to their rightful spots. 48% To date, Telehomecare has rolled out across seven Local Health decrease in ER visits 44% Integration Networks (LHIN). “It’s like having a personal trainer,” reduction in hospital admissions says Poole. “You know someone is keeping an eye on you, and William Osler that you have to keep up (the good) behaviour until it becomes a Health Sciences daily habit.” 87% Given the promising statistics collected by several LHINs using 70% report they would Telehomecare (see sidebar), and the positive patient response, decrease in inpatient units (this “definitely recommend” health-care professionals have realized the benefits, with some is six months after patients from the program to others primary care physicians telling Poole the program is a perfect fit Telehomecare are discharged, for their patients. compared to stats collected “This is definitely a value-add to the health-care system,” she says. before the technology was used). 98% of patients say nurses t Toronto’s George Brown College, soon-to-be RNs are using understand what is important simulated labs to test technology that developers hope will 53% to them (clients) A one day improve patients’ experiences with the system. decrease in ER visits Jaslyn Chouhan is a fourth-year student at the school. She and three other nursing students studied Sensimat, a piece of technology “The numbers are very encouraging,” says Laurie Poole, VP of telemedi- that aims to reduce pressure ulcers. cine solutions at Ontario Telemedicine Network. “It makes sense to Here’s how it works: A mat, which can be discreetly placed under- deliver care closer to home and we’re demonstrating that this is viable neath (or on top of) a wheelchair cushion, contains six sensors through enabling technologies, virtual support and care co-ordination.” connected to a smart phone app. The sensors indicate the amount A more comprehensive review of the technology across all partici- of pressure placed on them. When a patient sits on the mat, the pating LHINs will be conducted next year. sensors are activated (on the app, six green circles appear). Patients and practitioners can set the timer to 15, 20 or 30 minutes, after

22 November/December 2014 which the circles change to red and an alarm sounds, indicating of two nurse educators on the medicine floor. MPV allows nurses pressure needs to be released immediately. In other words, the to pull up hospital floor plans on their computers (this is also patient needs to be moved. displayed on 52-inch screens on all units). The grid mirrors the Chouhan and her peers used mannequins to test the product. To hospital layout and is broken into rooms. Pink or blue room num- replicate the average weight of a human thigh, they placed rice bags bers indicate the sex of the patient occupying that room. on wooden boards. They used 30 minutes as a guideline to stipulate MPV uses icons, colours and clocks to let practitioners know in an the maximum amount of time a patient should be in one position. instant how many patients are on each floor, and the layout of each Over the summer, the students acted as nurses working in the unit, which is helpful when they are directing families to different community or a long-term care facility. Their objective was to ensure areas of the building. The technology also shows how long a room the mannequins were moved every 30 minutes. has been vacant, when a bed is being cleaned, and the patient’s Their findings? That Sensimat assists health-care providers in whereabouts (i.e. it shows if they’ve gone for a test or procedure). reducing pressure ulcers. “If we did lose track of time, the alarms A bell icon indicates if a patient is at risk of being aggressive or on our phones reminded us,” says Chouhan. violent as a result of their medication or illness. A purple bar means The data they collected was sent to the creators of the product, a higher risk of falls. “W” means a patient is likely to wander, while who are now promoting it at conferences with a focus on tech- “C” indicates confusion. Other symbols indicate patient location nology and innovation. (XRAY, CT or “NM” for nuclear medicine) and procedures (“AVR” Chouhan says she was thrilled to have the opportunity to see means cardiac procedure; “URO” means urology). how technology can help community nurses in their everyday prac- Before the hospital adopted MPV, when a patient left the floor tice. “(I’ve learned) the importance of...reducing the chances of for a test or procedure, nurses would scribble that information getting pressure ulcers, because...(they’re) costly and painful,” she on a piece of paper or post it on a white board to let others on the says. “It’s so much easier to prevent them than to treat them.” unit know. Now, they can refer to their monitors. Anyone in the hospital can also look at the system to determine oanna Lu is a fourth-year student in the Ryerson, Centen- the expected date of discharge for any patient. nial, and George Brown College collaborative nursing degree MPV allows hospital staff to track how many patients will be J program. She was hired as a research assistant for a study discharged on a given day, helping the team to better prepare for by George Brown College and VHA Home Healthcare to help the arrival of new patients. In the past, there were multiple calls personal support workers (PSWs) learn how to address challenging situations regarding communication, therapeutic relationships, burnout and A brief history of EHRs compassion fatigue. Her job was to help examine the effectiveness Almost 15 years ago, Canada’s federal including Canada, which ranked lowest of e-Learning modules as an educational tool for and provincial health ministers agreed when it comes to embracing electronic PSWs in the home health-care sector. to develop electronic health records patient records, at 44 per cent. Lu says she’s grateful to have grown up with tech- (EHR), defined as a “secure and private Here in Ontario, where the provincial nology because that sensibility has helped open her lifetime record of an individual’s health- government started planning for EHRs in eyes to different methods of learning. Technology care history, available electronically to the late 1990s, we’re not much better. “makes education accessible. It allows you the authorized health providers.” At that The objective was to ensure an EHR for opportunity to learn when you have time to learn,” time, it was envisioned these records every Ontarian by 2015. As of 2012, it especially for those who live in rural settings, or who would allow a provider in Toronto to was estimated two out of three Ontari- juggle work and school. “I can’t just learn from lec- access an Edmonton resident’s file (if ans had an electronic health record, still tures or books. I have to learn from different tools they were treating that patient), leading short of the vision. such as podcasts, YouTube videos, Google and to more seamless and rapid care. Why has Ontario, in particular, been research papers,” she says, adding the technology In 2001, the federal government so slow? The so-called eHealth scandal she’s grown up with (including computers and tab- launched Canada Health Infoway, an – when eHealth Ontario was caught lets) has allowed her to learn more effectively. arms-length group that would help prov- doling out millions in untendered inces and territories develop EHRs. The contracts to consultants – has been oday’s nursing students are embracing tech- goal, set more than a decade ago, was cited as one culprit. nology before they enter the workforce, but to have EHRs for 50 per cent of Canadi- The shortfall is one of the reasons T there are plenty of nurses already practising ans (approximately 16 million people) by RNAO joined a collaborative partnership who also appreciate just how important innovation 2010. It was anticipated all Canadians with OntarioMD, adding nurse peer lead- is to their ability to improve patient care. would have electronic records by 2016. ers to an existing roster of primary care Newmarket’s Southlake Regional Health Centre A year away from that goal, we’re not clinicians and their administrative staff implemented innovative new technology in 2012, quite there yet. A 2013 global study by who were acting as peer leaders in EHR and it already has the stats to prove the impact it’s technology consultants examined adop- implementation. This project, known as having on patients and nurses. tion of EHRs and other health information the OntarioMD/RNAO Collaborative Peer Known as McKesson Performance Visibility technologies. More than 3,700 physi- Leader Program, is funded by Canada (MPV), the new surveillance system has become a cians were surveyed in eight countries, Health Infoway. valuable tool for staff, says Jennifer McQuaig, one

Registered nurse journal 23 between the ER and inpatient units to find out if a bed was ready for “You have paper for this; folders for that. But in EMR, (the an incoming patient. If it wasn’t, the nurse was usually instructed to information is) at your fingertips,” she says, which leads to better call back in 30 minutes. In some cases, they may be forced to call organization and rapid access to information. Clinicians can access again and again until it’s ready. lab work, diagnostic imaging reports and other test results with the Meanwhile, time elapses, and a patient is still in the ER, waiting click of a button. Email exchanges among nurses and others can for a bed. also be saved in the EMR. Now, nurses in the ER can see that a room is being cleaned on Wood is a telemedicine clinical co-ordinator at the Haliburton an inpatient unit. They make one phone call to the appropriate unit Highlands Family Health Team. Her role as NPL is in addition to and transfer the patient. MPV “takes away that communication this, and is one that allows her to link providers to EMR supports, nightmare,” says McQuaig. such as OntarioMD (established to support physician adoption And the proof is in the numbers. of information technology). She also coaches nurses and other The technology has helped to reduce phone calls among nurses health-care staff. “Once they realize it’s going to improve patient and other staff members by 960 minutes per day, and helped to care, everybody’s on board,” she says. eliminate about 400 interruptions of the work of nurses and other Some EMRs can also generate reminders signalling it’s time for a patient to get a specific procedure based on their medical history. For instance, Anna*, at 54, was flagged as someone who should be Now, nurses in the ER can see that a room getting colorectal screening because of her age. She was tested, is being cleaned on an inpatient unit. They and providers quickly discovered cancer had developed. Without make one phone call to the appropriate unit EMRs, Wood says Anna would have been checked the next time she showed up for an appointment. If she was well, and showed no and transfer the patient. symptoms, that cancer would not have been suspected and the test may not have happened. staff members each day (equal to roughly 12.2 hours daily). MPV Wood says she was never fearful or wary of EMRs despite seeing and a handful of other strategies are also behind a reduction in some colleagues hesitant of the change. “I think there was that fear medication errors, and a decrease in patient falls by 50 per cent. of the unknown: if you’re going to press the wrong button, you’re These are numbers staff can get behind, despite the fact that going to delete everything, or if you wrote the wrong thing, how some were challenged by the icons, and their fear that they were would you fix it,” she says. working with outdated information. McQuaig is on-hand to remind The benefits far outweigh any fears or anxieties, she insists, them that the information is in real-time, and recorded as soon as a offering a couple of tips for anyone who may be reluctant to patient registers in the ER. embrace innovation and change: understand your standards of “It’s a big communication tool for us. Staff really rely on it now,” practice, and make sure your passwords are secure. she says. “I don’t think they could live without it.” Wood’s final piece of advice? “Be fearless.” RN

erhaps the biggest recent technological shift for Ontario melissa di costanzo is staff writer at rnao. health-care providers is the switch from paper charts to P electronic medical records (EMR), or electronic health rec- Anniversary Crossword SOLUTION ords (EHR) (see sidebar for a brief history of EMRs). About two years ago, RNAO joined a collaborative partnership H F with OntarioMD, adding nurse peer leaders to an existing Peer A H E L A P Leader Program consisting of physician and clinic manager peer S A R S E L O leaders. The OntarioMD/RNAO Collaborative Peer Leader Pro- R H A R T F O R D R gram, funded by Canada Health Infoway, supports primary care I L E M E clinicians and their administrative staff in the adoption and best S Y S T E M B A R G A I N I N G use of EMRs. H It’s a significant change in culture, but RN Connie Wood A L C leapt at the opportunity to mentor colleagues through the tran- M O B P E sition. She wanted to share her knowledge of EMRs and their P N C U R many possibilities, including the ease of sharing information, B P G A P P N S P A I N accessing data, and monitoring trends to help target gaps in care E C C O E C S and trigger interventions. E X T R A H T U O R I R I D N E W S B U L L E T I N C B Have you renewed your RNAO membership? Q A F S P E A K O U T It’s not too late to join or renew for the 2014/2015 membership U C C R year. Visit myRNAO.ca/join to complete your online registration I C T Y today, or to download a printable application form. R O Questions? Call 1-800-268-7199 E

24 November/December 2014 classifieds

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Honouring outstanding nursing Honouring 1-800-268-7199 ext. 250 RNAO’s 90th Nursing policy analyst – Annual General Meeting calling on nurse practitioners Thursday, April 16 to Saturday, April 18, 2015 Join the Nursing and Health Policy team at RNAO Hilton Toronto, 145 Richmond Street West, Toronto to make a difference in health and social policy.

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HUB-RNAO-Concepts-March2014v5.indd 1 2014-04-01 9:42 AM in the end By Mia Biondi

What nursing means to me…

When i was in my early 20s i went on several outreach trips stigma is found in the form of policy, whereby the federal government to sub-Saharan Africa, where HIV affects more people than it is restricting entry visas for people who are coming from countries does here in Canada. These experiences inspired me to pursue where Ebola is a concern. This move is not grounded in science or graduate studies in the field of HIV and to get involved with sound public health policy. It’s linked to fear of the unknown. organizations like the Stephen Lewis Foundation. But something It is not surprising that the growing number of individuals was still missing. I felt the need to better understand the day- infected in West Africa, as well as recent cases involving health to-day challenges of individuals affected by HIV. This inspired providers in the U.S. and Europe, is troubling to many. However, me to pursue community nursing, so I could combine my it is important to do all we can to decrease stigma among our scientific training with front-line care. colleagues and the public. In Canada, diseases like HIV and hepatitis C disproportionately As nurses, we have a responsibility to provide care, as long as it affect marginalized popula- falls within our scope of practice. And we have a duty to be aware Drop us a line or two tions, a phenomenon that of the science behind Ebola, and share accurate information. How Tell us what nursing means to you. Email [email protected] fuels stigma, even among we react to potential or confirmed cases – and our actions to speak health-care providers. This out against unjust policies – will become a part of our identity as negatively affects care, and will be one of the major challenges in Canadian health-care providers. eliminating hepatitis C in this country. There is still much we do not know about Ebola. However, it These examples are not the first time in history that fear and is imperative to act on what we do know, and arm ourselves with stigma have been linked to that which is unknown or poorly factual information grounded in science. We must work together understood. In fact, we are now on the brink of another epidemic as a health-care community without fear. Fear and stigma of fear. The Ebola outbreak that has ravaged West Africa since affected how we reacted in the early days of the HIV epidemic, March has over 10 times more confirmed cases than any other and we would do well to learn from those lessons. It is only then documented Ebola outbreak in history. And as the virus spreads, that clients will receive the compassionate and respectful care so does the stigma. they deserve. RN In August, a pub in Seoul, South Korea displayed a sign banning “Africans” from entering. More recently, a college in Texas rejected two mia biondi is a community rn in toronto and a post-doctoral international applicants from Nigeria, stating it is not currently accept- research fellow at the university of toronto’s sandra rotman

n : L i o illustratio ing students from countries with confirmed cases of Ebola. In Canada, centre for global health.

30 November/December 2014