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Centre for Continuing Education | McMaster University | 1 James Street North, Hamilton, Ontario, L8S 4L8 | 1-800-463-6223 Vol. 30, No. 2, march/april 2018 contents

Features 24 12 COVER STORY 20 years later Ontario NPs celebrate the milestones that mark a two decade journey since groundbreaking legislation officially acknowledged the role. By Daniel Punch

16 A struggle for care Nurses at a unique walk-in clinic try to meet the needs of Ontario’s uninsured population, but they can’t do it alone. By Daniel Punch

19 Talking politics With a provincial election on the horizon, RNAO visits Queen’s Park with recom- mendations on improving health for all. Story by Daniel Punch Photography by Victoria Alarcon and Alicia Saunders Photos and captions compiled by Kimberley Kearsey 26

24 Meet your incoming president In this intimate Q&A, RNAO’s 55th president Angela Cooper Brathwaite talks about her goals for the next two years. the lineup By Daniel Punch 30 5 president’s View 6 ceo Dispatch 26 The look of change 7 mailbag We reflect back on the late 1980s in this 8 Nursi ng in the News/ installment of our six-part series about the out and about evolution of RNJ. 11 Nursing Notes 27 bpg corner By Kimberley Kearsey 30 in the end

28 The call of the north Kenora RN Brandi Milko comes full circle, London advanced landing a job at the same FHT where she practice RN Amy Van Berkum writes about was first inspired to become a nurse. health equity in this By Victoria Alarcon issue (page 30).

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

EDITORIAL STAFF Marion Zych, Publisher Kimberley Kearsey, Managing Editor Change is in the air Daniel Punch, Writer Victoria Alarcon, Editorial Assistant Alicia Saunders, Communications Assistant

EDITORIAL ADVISORY COMMITTEE Laryssa Vares, Desmond Devoy, Una Ferguson, Larissa Gadsby, Chad Johnson, Elizabeth Kerr, Joanne Laucius, Maria Rugg Each spring, winter-weary they want to see positive results Art DIRECTION & Design Ontarians watch in anticipation at the ballot box. Fresh Art & Design Inc. as lawns and parks slowly Health care is a huge issue for ADVERTISING Registered Nurses’ Association of Ontario change from an unappealing voters in Ontario, but it’s Phone: 416-599-1925 brown to a promising green. something not every Ontarian Fax: 416-599-1926 The birds start to chirp a little can access as easily as you might SUBSCRIPTIONS Registered Nurse Journal, ISSN 1484-0863, is a louder, and we begin to see think. There are thousands of benefit to members of the RNAO. Paid subscriptions buds on trees as they come back people in this province who are are welcome. Full subscription prices for one year (six issues), including taxes: Canada $38 (HST); to life. It’s a time of new not covered by OHIP for a Outside Canada: $45. Printed with vegetable-based beginnings that also marks one variety of reasons, and in this inks on recycled paper (50 per cent recycled and 20 per cent post-consumer fibre) on acid-free paper. of the busiest seasons at RNAO issue (page 16) we tell the story Registered Nurse Journal is published six times a as we ramp up preparations for of a handful of RNs and NPs year by RNAO. The views or opinions expressed in the annual general meeting who are trying to help this the editorials, articles or advertisements are those of the authors/advertisers and do not necessarily (AGM) in April, and Nursing vulnerable population. They’re represent the policies of RNAO or the Editorial Week in May. This year, we doing what they can, but they Advisory Committee. RNAO assumes no responsibility or liability for damages arising from any error or welcome Angela Cooper can’t do it alone. They need omission or from the use of any information or Brathwaite, RNAO’s 55th all-hands-on-deck to raise advice contained in the Registered Nurse Journal including editorials, studies, reports, letters and president. As she prepares to awareness of this troubling gap advertisements. All articles and photos accepted take the helm, she shares with in health services, and their for publication become the property of RNAO. Indexed in Cumulative Index to Nursing and Allied us (page 24) her path to the OHIP for All campaign is one Health Literature. presidency, and her goals for the way to enlist more supporters CANADIAN POSTMASTER next two years. Angela is for the cause. Undeliverable copies and change of address to: RNAO, 158 Pearl Street, Toronto ON, M5H 1L3. assuming this important role as Mobilizing nurses (and Publications Mail Agreement No. 40006768. Queen’s Park prepares for a others) to push for change is RNAO OFFICERS AND SENIOR MANAGEMENT provincial election. something RNAO understands Carol Timmings, RN, BScN, MEd (Admin) President Anticipation about heading to well. In fact, it’s at the heart of Angela Cooper Brathwaite, RN, MN, PhD the polls in June, and advocacy everything we do as a profes- President-Elect to advance RNAO’s platform, sional association. Our cover Doris Grinspun, RN, MSN, PhD, LLD(hon), Dr(hc), O.ONT, Chief Executive Officer, ext. 206 comes into this issue in several feature (page 12) reveals how 20 Nancy Campbell, MBA ways. Our coverage of the years of advocacy on behalf of Director, Finance and Administration, ext. 229 association’s signature political Ontario NPs has led to well- Valerie Grdisa, RN, MS, PhD Director, International Affairs and Best Practice event, Queen’s Park Day (page deserved advancement and Guidelines (iaBPG) Centre, ext. 246 19), for example, delves into the recognition. As this feature Daniel Lau, MBA interactions and discussions shows, the front-line expertise Director, Membership and Services, ext. 218 between nurses and politicians of members, plus the political Louis-Charles Lavallée, CMC, MBA Director, Information Management who attended the event, and influence of RNAO, often and Technology, ext. 264 who realize a firm under- equals change that not only Marion Zych, BA, Journalism, BA, Political Science Director, Communications, ext. 209 standing of health and nursing benefits the profession, but the issues will serve them well if public as well. RN

Registered Nurse Journal is proud to exclusively feature members of RNAO on the pages of this magazine.

4 march/april 2018 president’s view with carol timmings

Celebrating two years at the helm

It’s hard to believe this is my final influence on health system To keep up the pressure, every interaction left me column as your president. When transformation. Originally RNAO hosted a media confer- enlightened, inspired and with I reflect back on the past two detailed in our Enhancing ence last May to release the a deep appreciation for this years, that old adage “...time flies Community Care for Ontarians largest ever, publically available amazing profession we share when you’re having fun…” rings (ECCO) report (2012), we database of 70 years of research and the difference we make in so true. It has been an exhila- remain focused and firm in our into RN effectiveness. Unequivo- the lives we touch. I wish rating experience representing evidenced-informed position that cally, the results show that Angela Cooper Brathwaite the association on your behalf. optimal care co-ordination must using RNs results in improved tremendous success as she It has also been an immense be rooted in primary care clinical, organizational and takes the lead as RNAO’s 55th privilege, personally and settings. Not only is it an financial outcomes. I am president this spring. professionally. When I assumed this responsibility two years ago, I was “as i bid farewell, i know i leave a vibrant and engaged asked what excited me most organization of committed members, with the momentum about taking on the role. I talked about the endless possibilities for to continue advancing the issues that matter.” RNAO to continue shaping the health system with its strong, important way to ensure patients’ confident we will continue to I want to offer a heartfelt thank collective voice. Our reputation care needs are met, it is also the make our voices heard on this you to my board colleagues and for developing sound health only way we will ease some of the issue and reclaim the role of our CEO for their passion, policy recommendations to pressures many hospital the RN. expertise and dedicated work. improve nursing, health and emergency departments face. I am pleased that RNAO’s They consistently demonstrate health care is widely known, and Many of you have shared your tireless advocacy has resulted in courage, values-driven and I looked forward to being an experiences of hallway nursing changes to the Nursing Act and evidence-based leadership, important part of that. with us. That’s why primary care RN prescribing will become a qualities that successful I was inspired by our advocacy must be the anchor for an reality. This will improve patient professional associations on social and environmental integrated health system. access to care and optimize the require if they want to make determinants of health, and I I am proud of the thousands of role of the RN in our system. meaningful change. wanted to be part of that ongoing you who have harnessed the However, we must ensure RNs As I bid farewell, I know I leave work. The health disparities we power of the recommendations can order lab tests so they can a vibrant and engaged organiza- see in communities across this set out in our Mind the Safety initiate the necessary diagnostics tion of committed members, province are unjust. The daily Gap report. Released in May to prescribe medications. with the momentum to continue interactions many of you have 2016, just as my presidency was We have made tremendous advancing the issues that matter. with your patients provide a beginning, it highlighted the progress in shaping provincial Thank you for being an window of awareness on the toll dangerous trend of RN replace- health policy on many fronts. As integral part of my personal and poverty has on people’s health ment and offered eight the provincial election draws professional growth over the past and well-being. Increasing the recommendations to ensure safer near, Ontarians will see two years. This experience will minimum wage and ensuring patient care and a more effective additional recommendations forever be a highlight of my adequate social assistance rates, health system. You, in turn, outlined in our election nursing career and one of as well as concrete measures to provided support and platform, Improving health for all cherished memories. RN address homelessness and the momentum for these recom- (see page 19). lack of affordable housing, are mendations by signing action The role of president has carol timmings, rn, bscn, med solutions we know will affect alerts and helping to inform allowed me to meet members, in (admin), is president of rnao. poverty rates and ill-health. politicians on how RN academic settings, in urban I am also proud of our replacement affects patients in centres, rural areas, and remote Follow me on Twitter @ctimmings continued advocacy and your practice. parts of this province. Each and

Registered nurse journal 5 CEO Dispatch with Doris Grinspun

The vital pairing of evidence and politics to promote healthy public policy

If you are not an rnao member, engagement (PPE) council Timmings eloquently com- representing RNAO, but rather you may not realize the differ- members to the mix, inviting mented on how inspiring it is to leaning on our policy platform ence between policy and politics. council co-chair Sholom see Shane powerfully express only for information. In fact, you may get them Glouberman and others to hope in the midst of the If you don’t want to get involved confused. If you are a member, provide a public voice and challenges he faces. with a particular party or you are no doubt a savvy expert perspective to our conversations Now, let me get back to this politician, we urge you to consider on differentiating between the with MPPs. Also this year, we topic of evidence and politics. contacting the policy department two. And you are also very aware were privileged to have the After all, there’s an election at RNAO home office to help that advancing healthy public participation of a person with coming. Indeed, June 7 will be a organize or join an all-candidate policy – ranging from social and lived experience on the streets of big day for Ontario, with big session in your community. environmental determinants of Promote your event to nurses, the health all the way to nursing public and the media in your local human resources and scope of “the more rns, nps and nursing newspaper. Create flyers and talk practice – is RNAO’s end goal. to people about attending for a So, how does RNAO, on the students we have involved in formal chance to ask politicians the eve of a provincial election (June or informal politics, the more we tough questions. 7), use politics to advance policy? Another way to get involved is Moreover, how do we do it in an will be recognized as an influential by writing letters to the editor and environment of ongoing political body politic.” opinion pieces for publication. Is turmoil? For RNAO, political there a hot issue in your turmoil is not a barrier, but rather community that you want all an opportunity to leverage our Toronto. You may remember I decisions to make. Each and candidates and the public to expertise to influence healthy spoke with you in my last every member will have their notice? Or is dialogue about public policy. dispatch about two amazing personal choice to make. And as that particular issue absent Here is how it works. people I met on the street – Joe a non-partisan association, we from discussions in your At Queen’s Park Day 2018 (see King and Shane Choinard. We respect all choices. Regardless of community? Think about page 19), we released a robust were honoured that Shane your political leanings, we urge initiating the conversation and well-researched policy attended, was recognized by the you to get involved in this yourself through the media. platform (RNAO.ca/improving- health minister – as many of our election to help advance By getting involved, you will healthforall) that included a members were – during question RNAO’s platform. Each see this kind of respectful and beautifully designed brochure period in the legislature, and political party has work to do to well-informed politics is an and 10 evidence-based policy shared his experiences in a improve health for all. essential part of driving healthy backgrounders for issues powerful afternoon panel The more RNs, NPs and public policy. And healthy public important to members, the discussion focused on nursing students we have policy is essential for good health. nursing profession, and the homelessness. involved in formal or informal Thank you for being health of Ontarians. During our For Shane, this was a first. He politics, the more we will be engaged. RNAO is here to breakfast with MPPs, we marveled at the proceedings and recognized as an influential support you all the way. And discussed RNAO’s top priorities even more so at the beauty of the body politic. on June 7, please remember to and handed them the full set of Queen’s Park building, which, For example, think about going exercise your right to vote. RN backgrounders. This is a perfect until that day, he had only seen with a candidate to knock on example of how we use from the outside. For RNAO, it doors. If you decide to get doris grinspun, rn, msn, phd, lld evidence in our respectful was also a first to bring a person involved with a specific party or (hon), dr(hc), o.ont, is chief “politicking” with politicians to who is still living on the streets to candidate, we will celebrate that executive officer of rnao. inform and influence. share his experiences. It was a you are embracing the opportu- This year, we added the voices very moving experience for so nity, but we must remind you Follow me on Twitter @DorisGrinspun of our patient and public many of us. Our president, Carol that in such a case, you are not

6 march/april 2018 mailbag Irreplaceable As the number of RNs in the workforce decreases, so too does

ane Rajah could see her sister Anne slipping away. confidence that patients will get the A long and complex history of health problems care they need, when they need it. had already robbed the 52-year-old of a successful career in the financial industry. Diabetes, weight by daniel punch RNAO wants your comments problems, and struggles with mental health and addiction took their toll, and things only got worse after Jgastric bypass surgery in 2006 caused a number of small intestine to deliver food and medicine), recommended complications. By the time Anne was admitted to a Toronto a transfer to critical care days earlier, or alerted physicians hospital in August 2016 – following several admissions about the signs of sepsis she was demonstrating. “I think it’s dating back to December 2015 – her diabetes was out of about scope (of practice),” she says. “As an RN, I can make on what you’ve read in RNJ. control, she had a blockages in her heart, and multiple (those) judgment call(s).” bleeding ulcers in her stomach. Despite Jane’s efforts to advocate on behalf of her sister, As a long-time RN with decades of experience in various Anne continued to decline. She developed multiple health sectors, Jane could recognize the signs of Anne’s infections and eventually went into septic shock. On Dec. 9, decline. She saw her sister getting weaker every day, 2016, just a few weeks after her 52nd birthday, Anne passed watched her albumin (a protein produced in the liver) levels away surrounded by her loved ones. decline severely, and saw her struggle to keep food down. Through it all, Jane remembers how Anne kept a write to [email protected] Eventually, Jane’s dynamic older sister, who used to positive attitude and made friends with her roommates protect her from the racism they faced as immigrants at the hospital. “Her smile would light up the whole from Sri Lanka in the 1970s, weighed just 34 kilograms room,” the grieving sister recalls. “She was a very (or 74 pounds). generous and loving spirit.” To make matters worse, Jane says the overburdened Jane can’t help but wonder if things could have been health professionals who cared for Anne didn’t always see different for her sister had the staffing situation at the what she was seeing in her sister. This was especially true in hospital been better. She says Anne’s story reflects the the rehabilitation unit where Anne spent most of her time unfortunate reality that Ontario’s health system lacks RNs. after being admitted in August 2016, and where she lost “Most of Anne’s journey…I watched as nurses were most of the weight. “(Staff members) were run off their feet. overwhelmed.” she says. It was a really difficult situation,” she recalls. The numbers support Jane’s observations. Based on Not only was the rehab unit short-staffed, it also didn’t statistics from the Canadian Institute for Health Informa- have a single RN on the floor, instead relying on a mix of tion (CIHI), RNAO calculates Ontario has the lowest RPNs and PSWs. This was “extremely surprising” to Jane, RN-to-population ratio of any jurisdiction in Canada. In fact, especially given the complexity of patients like her sister. Ontario needs about 19,000 more RNs just to catch up with Jane believes Anne’s care suffered because the unit lacked the rest of the country. There have also been fundamental the expertise and decision-making skills of RNs. She thinks changes to the makeup of the province’s nursing workforce. Anne’s health might have improved if staff on the unit had Between 2007 and 2017, the RN share of the nursing recognized the need for a jejunostomy tube (j-tube, placed workforce dropped from 77.7 per cent to 69.5 per cent,

through the skin of the abdomen into the midsection of the while the RPN share increased from 22.3 to 30.5 per cent. photo: stef + ethan RN Jane Rajah says overburdened health professionals who cared for her older sister didn’t always see

photo: fred cattroll what she was seeing.

12 january/february 2018

All nurses must help to I urge RNs, NPs and RPNs, and moved to Brampton with to think about re-opening my stop RN replacement as well as nursing students, to my husband and young foot care business so I would Re: Irreplaceable, January/ continue to fight for the right daughter. For almost five have something I could do on February 2018 nurse, for the right patient, at decades, I have been blessed to my own time when I retired. I the right time. That fight experience different types of offered foot care each Saturday I was pleased to read the article requires all of us to rally nursing, and I can say with while still employed full-time, about RN replacement in the against RN replacement as the total honesty that I have and quickly rebuilt a small most recent issue. It was a safety and care of complex enjoyed all of them. clientele. After 14 years with balanced and accurate portrayal patients is at risk. We must I started out on a medical/ the Alzheimer Society, I retired of the current situation in most continue to advocate for all surgical floor. I came home in 2014, but continued with my acute care centres. I also new hires to be RNs, particu- crying silently many nights as I business on Saturdays. With commend RNAO for re-articu- larly in tertiary, quaternary and adjusted to a new job in a new extra time on my hands, I also lating that this is not a contest cancer care centres. We cannot language. Over time, I gained a pursued another dream: music. between RNs and RPNs. allow replacement of RNs to great deal of nursing knowl- I began an entertaining In hospitals, many decision- continue. All nurses and their edge and my English business to perform at local makers will say they are keeping patients will suffer. improved. In the mid-1980s, I fundraising events, luncheons, nurses who are self-regulated and Rhonda Seidman-Carlson, became a visiting nurse and long-term care and accountable to their college. They Durham-Northumberland part-time, and also secured an retirement homes. I even say their staffing decisions are chapter occupational health nurse learned to play guitar. safe. In reality, most have not position two days a week. Music is a morale booster reviewed, or do not consider, the The joys of retirement These were rewarding times. that helps with mental health, 70 years of evidence that Re: When nurses retire, By the early 1990s, I found my cognitive function and overall demonstrates the greater November/December 2017 true niche in foot care. I began health, and is great for keeping effectiveness of RNs on patients, working independently as the relationships alive. At nearly health organizations and I read with great interest your owner of a foot care business. 69, I have no plans to slow financial outcomes. Instead, they article, and would like to share After almost four years, I down. Retirement is doing are guided by difficult financial my experience on the subject needed to slow down, and what gives you pleasure, so realities. Most do not really of retirement. I am from a decided to take some time off. keep dreaming big and make understand or appreciate the large French family, raised in a In 2003, while working as a magic happen. RN difference between RN and small Quebec town. In 1970, I client support co-ordinator for Sylvianne Young, RPN practice. graduated from nursing school the Alzheimer Society, I started Kawartha-Victoria chapter

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Registered nurse journal 7 RNs, NPs, AND NURSING STUDENTS weigh in on… nursing in the news by victoria Alarcon

Indigenous nurse calls for change

Danielle Bourque, an Indigenous nursing student originally from Beaver Lake Cree Nation, Alta., is speaking out about her experiences with subtle and institutionalized racism. During her first year as an undergraduate nursing student, Bourque recalls a class assignment that required students to pick a topic at random out of a hat. One of the topics was Indigenous health. When it came time to present, a group of students presented in headdresses made out of pipe cleaners and feathers, which Bourque found offensive. In response, she voiced her criticisms to the class, noting the headdresses were culturally inappropriate and did not represent Indigenous health. The instructor rebuked her. “The instructor had stepped in and said that I was actually being inappropriate and asked me to leave – and actually commended the students for their creativity,” said Bourque, who felt discouraged for speaking up. It is important for academic institutions to have elders or an Indigenous student centre, she adds, suggesting these will provide support to Indigenous students. (CBC Radio, Feb. 25)

Nursing student Danielle Bourque says her Indigenous heritage should not be an issue in the classroom.

New hospital system Elmore, nurse manager of takes per minute, their stats on NP clinics stay open improves care emergency and inpatient the oxygen level in the blood, in Midland and A new cardiac monitoring system services at NSHN, the new blood pressure, and much Peterborough is improving patient care at the technology allows health-care more. “It’s really changed the NPs at Georgian Bay General North Shore Health Network staff to have a better look at care that we are actually giving Hospital’s nurse practitioner-led (NSHN) in Algoma District’s what a person’s heart is doing, to the patients,” says Elmore. clinic (NPLC) will continue to Blind River. According to Jaimee how many breaths that person The system can measure the care for patients after discussions length of time a patient’s heart with the North Simcoe Muskoka North Shore Health Network stopped, even if it’s for a brief Local Health Integration Network nurse manager Jaimee Elmore period, she adds. With the older (LHIN). “The clinic provides demonstrates how to use new cardiac monitoring technology. system, if a nurse or doctor was several benefits to both patients not constantly watching the and the hospital,” says NP Lisa monitor and an event happened Ladouceur. “It reduces emer- to the patient, even for an gency department visits because instant, the nurse or doctor patients have consistent would not know it had even monitoring of their health, occurred, notes Elmore. enabling more serious issues to Although the new system costs be caught before an emergency approximately $100,000, more visit is needed.” Providers at the than half ($53,000) was funded clinic will also continue to work by donations in 2017. with patients and the community (Elliot Lake Standard, Feb. 21) to transition clients to family

8 march/april 2018 nursing in the news by victoria Alarcon

Baby cuddlers provide essential Letter to the editor service RNAO CEO Doris Grinspun writes to the Ottawa Citizen Individuals with a love (March 5) about the need for a national pharmacare plan in for cuddling babies response to news that former health minister Eric Hoskins will have to look no further lead an advisory panel tasked with examining access to pharma- than the Family and care for Canadians. Children’s Services (FACS) Niagara baby National pharmacare for all cuddling program. How great is it to see Ontario’s former health minister Launched a few years leading the charge toward national pharmacare. Canadians ago, the program has a take great pride in our universal medicare system, but roster of 14 on-call there remains a huge gap in health care after we are given cuddlers who are a prescription by our nurse practitioner or doctor. No one dedicated to caring for should have to choose between buying necessary medica- and holding babies in tion and buying their next meal. Unfortunately, that is a the special care reality for too many of our friends and neighbours. During Simcoe NP Lisa Ladouceur says her in-hospital nursery. These babies his time as health minister, Eric Hoskins brought Ontario NP-led clinic helps to reduce patient visits to the need extra time in the one step closer to universal pharmacare in Ontario by emergency department. hospital, more care, introducing OHIP+, which provides medication free for physicians, freeing up space for and more frequent monitoring. those under 25. Now, he can be an integral part of giving new patients in the clinic. More Amanda Symington, a nurse all Canadians access to the medications they need. than 100 kilometres away, at the practitioner at FACS, says there Peterborough 360 Degree NPLC, are many benefits to cuddling, health professionals will also including reducing the length of symptoms due to maternal better than babies in incubators, continue to provide care despite a baby’s time in the hospital. It medications. “It’s a basic human she adds. Previously, FACS staff talks to close. That NPLC will can also shorten the time needed need,” says Symington. “We all offered their time to cuddle with become an independent for treatment for babies who are need to be comforted.” Cuddled the babies, but the need became organization with staff and board suffering from withdrawal babies settle faster and sleep so great and they could no longer members promising to continue do it. Find out more about the high-quality care. “We are program at facsniagara.on.ca/ excited to have transitioned to become-a-volunteer. (St. an autonomous governance Catharines Standard, Feb. 2) model with a diverse commu- nity-based board of directors Flu outbreaks in representing the community long-term care we work in,” says Beth Day, Outbreaks of Influenza A and B, chair of the clinic, which is and gastrointestinal bugs have dedicated to helping individu- been declared over at three of als who experience poverty, Grey County’s long-term care atcamera homelessness, chronic food homes – Lee Manor, Grey Gables insecurity, violence and and Rockwood Terrace. Denna trauma, serious mental health Leach, public health manager for issues, and social isolation. the infectious disease program at (Midland Mirror and Peterbor- the Grey Bruce Health Unit, says

photo: istoc k photo.com: f ough This Week, Feb. 8 and outbreaks were declared in Feb. 7, respectively) January to ensure a quick

Registered nurse journal 9 nursing in the news

response. “We’re definitely Sciences Centre and the Ontario out and about calling an outbreak with two or Renal Network, says the new more (cases) so those mitigation chairs will ensure patients are and containment strategies can receiving this critical treatment happen more quickly,” she says. closer to home. “We are pleased When an outbreak occurs, public to support the expansion of health works with each facility to hemodialysis services at CKHA identify the cause of the outbreak. so that more patients can It supports the homes as they continue accessing this impor- implement control measures for tant resource within their staff and residents, as well as community,” she says. (Chatham surveillance protocols. In the Daily News, Feb. 15) meantime, extra hand-washing stations are brought into the Hospital introduces homes and masks are available. breast screening In addition, cleaning protocols program become enhanced. According to As part of its efforts to increase Workshop raises awareness of tobacco intervention the Public Health Agency of regular screenings and provide initiative, BPG Canada, between 4,000 and earlier diagnoses, Headwaters RNAO tobacco intervention specialist Jennifer Callaghan (in red) 8,000 Canadians die each year Health Care Centre in Oran- was at Canadore College and Nipissing University main campus from complications of flu and geville has launched the Ontario on March 13 to speak to nursing and mental health and addic- about 20,000 people with the flu Breast Screening Program tion students about best practices for supporting clients to quit are hospitalized. (Owen Sound (OBSP). Operated by Cancer or reduce their tobacco use, and to manage withdrawal symp- Sun Times, Jan. 24) Care Ontario, and funded by the toms. The students signed up for the workshop to learn about ministry of health, the OBSP is RNAO’s Tobacco Intervention Initiative, and the recommenda- Dialysis services designed to ensure Ontario tions in its best practice guideline, Integrating Tobacco expand in Ontario women receive the benefits of Interventions into Daily Practice (2017). To address the need for dialysis regular screening. “We see our services in Southwestern Ontario, affiliation with OBSP as another the Chatham-Kent Health endorsement of the quality care Alliance (CKHA) has added three we are proud to deliver at chairs to its satellite dialysis unit. Headwaters every day, as well as “We’re actually going to be the an incredible opportunity to largest satellite in southwestern further support the health and Ontario for dialysis, so it’s very wellness of our community,” says exciting,” says Shane Helgerman, Peter Varga, vice president of program director at CKHA. The patient care and chief nursing satellite location currently executive at Headwaters. supports 54 patients with a wait According to Varga, the program list of 11 active patients who have will allow patients to self-refer. It to travel for treatment in London is expected to be particularly and Windsor up to five times a beneficial to those without a RNAO CHAPTER SUPPORTS AFTER-SCHOOL WRESTLING CLUB week. The expansion will initially nurse practitioner or family To support kids in becoming physically active, RNAO’s Sioux Lookout support six of these patients, and physician. All Ontario women chapter and Hub International, RNAO’s home and auto insurance is expected to support more wait between the ages of 50 and 74 are provider, worked together to provide $500 worth of wrestling equip- list patients within the year. eligible for the program, provided ment to elementary school students in the free after-school wrestling Pending minor renovations, the they have no acute breast club at Queen Elizabeth District High School (QEDHS). From left to additional chairs are expected to symptoms, no personal history of right: QEDHS wrestling coach Rob Sakamoto, Sakamoto’s son Sam- be in use by late spring. Janice breast cancer, and no breast urai, Sioux Lookout chapter co-president Carol Maxwell, and NP McCallum, regional renal implants. (Caledon Enterprise, Bobbie Roberts with her son Jack. director at London Health Jan. 30) RN

10 march/april 2018 nurcontinued sing notes

New health minister knows RNAO

Ontario’s new health minister is no stranger to RNAO’s initiatives and advocacy work. Helena Jaczek replaced Eric Hoskins as minister of health in February, after Hoskins resigned to lead a national pharmacare project in Ottawa. As MPP for Oak Ridges-Markham for more than a decade, Jaczek has been invited to many RNAO political events. In fact, she met with Angela Cooper Brathwaite (now president-elect) (right) and Philicia Joseph, finance chair for RNAO’s International Nursing Interest Group (INIG) (left), at her Markham office during last fall’s Queen’s Park on the Road (QPOR) event. As the minister of community and social services from 2014 to 2018, Jaczek, a physician, has provided key leadership on initiatives to improve income security, such as the basic income pilot and improvements to the social assis- tance system. She has worked (2007-2014) in various roles as the parliamentary assistant to the health min- ister, the environment minister, and the minister of health promotion. She also previously served as York Region’s medical officer of health.

Opportunity for to RNAO’s January action alert, once-in-a-generation legislation are designed to help deal with a once-in-a-generation the association was pleased before the June 7 election. growing need for harm transformation with the introduction on Feb. reduction services. Sites can of Ontario’s 20 of Bill 195, the Correctional Ontario accepting also provide additional services correctional system Services Transformation Act, applications for over- based on the local need and RNAO has been raising 2018. Although the legislature dose prevention sites capacity. This can include awareness for some time that was prorogued on March 15, Early in 2018, the Ontario supervised oral and intranasal systemic challenges within the RNAO was happy to see that government announced it drug consumption, peer-to-peer provincial correctional system Marie-France Lalonde, would begin accepting assisted injection, and fentanyl are causing premature death, minister of community safety applications for overdose test strips. Overdose prevention eroding health, and contra- and correctional services, prevention sites from health- sites that meet the criteria will vening human rights re-introduced Bill 6, Correc- care or community-based be approved to operate for three obligations. One of the tional Services Transformation organizations. The overdose to six months, with the recommendations of Howard Act, 2018 on March 20. RNAO prevention sites (OPS) are possibility of extension. Sapers, the independent continues to work closely with designed to be an extension of Approved sites will receive advisor on correctional its interest group, the Ontario an organization’s existing funding from the government reforms, is that modernized Correctional Nurses’ Interest harm reduction program. based on their days/hours of correctional legislation be Group (OCNIG), and other The sites provide supervised operation. The province had not introduced and passed. With community allies, to join Sapers injection, harm reduction set a deadline for applications thanks to those who responded in urging for the passage of this supplies, and naloxone. OPS when contacted in April. RN

Registered nurse journal 11 1998

After decades of hard work and advocacy, Feb. formally recognized, and the last remaining 18, 1998 was a day to celebrate. NP education program in Ontario shut down Bill 127 was proclaimed during an event at in 1983, NPs were consistently cited in reports RNAO home office, making Ontario the first and task forces for their ability to provide high Canadian jurisdiction to legally recognize the quality care. role of nurse practitioner. Delegates from A big break came in 1993, when then various nursing and health organizations provincial health minister Ruth Grier (NDP) came out to witness long-overdue acknowl- launched a research and consultation RNAO past president Charlotte Noesgaard (left) edgement for hundreds of NPs who had been initiative to explore expanding the NP role. offers former health minister Elizabeth Witmer a token of thanks from all nurses on the day providing enhanced care to Ontarians since This led to the introduction of the Primary legislation was proclaimed at RNAO home office. the 1960s. Health Care Nurse Practitioner (PHCNP) “For many individuals in this room education program in 1995. Today, Grier is CEO Doris Grinspun and then health today, this has been a long journey,” said proud of the immense contribution of NPs to minister Jim Wilson (PC) – paid off when in Charlotte Noesgaard, who was RNAO Ontario’s health-care system. “Having had a 1997, the government introduced Bill 127. president at the time. nurse practitioner as my own primary The legislation passed with support from all That journey began in 1965, when the first health-care provider for several years, it was three parties, enabling NPs (officially called NP program was introduced at the University exciting to become minister of health and be RNs in the extended class) to communicate of Colorado. In Ontario, the first university able to confirm their important role.” diagnoses and prescribe certain medications. program for an expanded RN role opened at All the while, RNAO, in partnership with its “(Bill 127) was an important piece of the University of Toronto in 1971. then interest group, the Nurse Practitioners’ legislation because it recognized NPs’ Over the next two decades, as many as 250 Association of Ontario (NPAO), was contribution to health care in Ontario and NPs practised in Ontario, working largely in conducting research of its own, and advo- enabled the profession to increase access to

northern outposts and community health cating on behalf of NPs. That work – and the primary care services across the province,” photo: R N AO archi v es centres. Though the role had not been strong working relationship between RNAO Wilson says.

The Ontario Primary Health Care Nurse Practitioner (PHCNP) education program is launched by the Council of The first NP program in Ontario University Programs in the U.S. is developed at Nursing (COUPN) and offered the University of Colorado. 1971 at nine Ontario universities. NPs over the years

A number of the milestones NPs have Ontario’s first education 1965 program for an expanded 1995 seen over the last two decades are a RN role is launched at the direct result of RNAO’s advocacy for University of Toronto. the NP role in Ontario.

12 march/april 2018 photo: RNAO archives and their skills...and be able to practise to that and theirskills...andbeabletopractisethat nurse shouldbevaluedfortheirknowledge across theprovince.“It(showed)thatevery day 20yearsagoasalandmarkfornurses Ontario (RPNAO). Registered PracticalNursesAssociationof Ontario NursesAssociation(ONA),and of UniversityProgramsinNursing(COUPN), of NursesOntario(CNO),ouncil celebration: representativesfromtheCollege RNAO homeoffice.Alsoonhandforthe a framedcopyofthelegislationtohangin minister ElizabethWitmer,andtheybrought attended alongsidethePC’snewhealth met in the two decadesmet two the in since. NPs across province, the and milestones the thathave been groundbreaking legislation landscape the thatchanged for health care wasn’t until official 1998. take a We look back at since 1970s, the acknowledgement of contribution their to NPs Ontario Although have care been providing expert NPs inOntario. legally recognizing Bill 127isproclaimed, University, CNO,BarbWahl, ONA,andDorisGrinspun,ED,RNAO. PetraCooke,president, president, Polytechnic oftheschoolnursingatRyerson director Risk,ED,CNO,SueWilliams, Margaret of healthontheNPinitiative,BarbaraThornber, RNAOpresident, ED,RPNAO,CharlotteNoesgaard, NPAO, pastpresident, Sargo, (L toR):Carol nursingconsultanttheministry JoanneMousseau,former row, (front Celebrating NPlegislationwiththenhealthministerElizabethWitmer right)are from third Looking back, Noesgaard remembers that Looking back,Noesgaardremembersthat At the1998proclamationevent,Wilson 1998 (report released in 2007). in2007). released (report NP integrationinOntario onbetter advise government Integration Task Team to the NursePractitioner commissions Smitherman Then healthministerGeorge 2 0 05 the 20 years since, the association has the 20yearssince,associationhas impact possibleonthehealthofOntarians.In to workensureNPscouldhavethebiggest serving trayswerecleared,RNAOwentback about improvingcareandaccessforpatients.” had theword‘patient’init,becauseitwasall ries. “Ithinkitwasimportant(thelegislation) for Patients Act –reflectsthetruebeneficia- full name–theExpandedNursing Services beyond nursing,Noesgaardsays.Thebill’s goal,” sheadds. the nursingcommunitytoreachatargeted also “…showedRNAO’spowerinorganizing level ofknowledge,skillandexperience.”It by daniel punch Not long after the celebratory glasses and Not longafterthecelebratoryglassesand And NPlegislationhadimplicationsfar

june the NProle. tointegrate efforts Canada-wide support to (CNPI) iscreated Practitioner Initiative The CanadianNurse 2 0 06

november alongside RNAO. clinic afteradvocating build Canada’sfirstNP-led $1millionto Heale secure Butcher andRoberta NPsMarilyn Sudbury RNAO – which connected them with key whichconnectedthemwithkey – RNAO was notdiscouraged.Withsupportfrom wasn’t technicallyanFHT,butthegroup proposal wasrejectedatfirstbecauseit 2006 foranNP-ledclinicinthecity.T Heale submittedaproposalinthespringof opportunity forNPstohelphercommunity. health teams(FHT),sherecognizedan issued arequestforproposalsfamily advocate fortherole,andwhenprovince the roleinOntario.Shebecameavocal fellow graduatesweredeterminedtoadvance Sudbury’s LaurentianUniversity.heandher graduating fromthefirstPHCNPclassat had thesolution. local NPsMarilynButcherandRobertaHeale primary care.Itwasasignificantproblem,but per centofresidentswithoutaccessto was facingaphysicianshortagethatleft30 came outofaprimarycarecrisisinSudbury. One ofthebiggestmilestonesinNPhistory NP-led 2006 – clinics communities everywhere. the province–benefitingpatientsand practice andincreasedtheirutilizationacross stones thathaveexpandedNPs’scopeof trail-blazed novelrolesandreachedmile- udbury-area NPs, she and Backed by15Sudbury-areaNPs,sheand Butcher becameanNP10yearsearlierafter It was2006,andthenorthernOntariocity Here arejustafewexamples… Registered nursejour nal 13 across Ontario. Ontario. across NP-ledclinics 25 more is committedtoopening office thathisgovernment announces atRNAOhome McGuinty (Liberal) Dalton Then premier 2 0 08 heir heir On Aug. 30, 2007, Ontario’s first NP-led clinic opened in Sudbury. Then On Feb. 20, 2008, then premier Dalton McGuinty hosted a media conference at RNAO health minister George Smitherman (second from right) headed north for home office to announce the creation of three new NP-led clinics in Belle River, Sault the opening, celebrating the milestone with (L-R) Pamela Pogue, Doris Ste. Marie, and Thunder Bay. Grinspun, Jennifer Fournier, Marilyn Butcher, and Roberta Heale. political leaders – they met with politicians community, Sudbury, is home to Ontario’s working with 57 pages of medical directives and spoke to the media. In November 2006, first NP-led clinic,” local NDP MPP France before finally seeing the expansion to NP then health minister George Smitherman Gélinas, who still holds the riding today, as scope that was so desperately needed in the (Liberal) stood side-by-side with Grinspun, well as the role of health critic, said about the acute-care sector. Butcher and Heale to announce his initiative. “(It) has given thousands of people Working in a hospital in-patient unit, she government had approved the proposal. access to inter-disciplinary primary health care and her colleagues did not have the ability to Sudbury was getting $1 million to open that wasn’t there before.” admit, treat, transfer or discharge patients Canada’s first NP-led clinic. Then premier Dalton McGuinty also took without orders from a physician. These were “Making more use of nurse practitioners notice, and visited the clinic in 2008. Spurred frustrating barriers, she says, that did not will increase access to health care for people by RNAO’s vision to replicate the NP-led acknowledge NPs’ advanced knowledge and across the province,” Smitherman said in a model across the province, McGuinty skills, and hindered their ability to deliver press release about the funding. “The addition introduced a plan to open 25 similar timely care. of this clinic will have a positive impact on the clinics, with the first three to open Thanks to advocacy by RNAO and front-line health of thousands of residents in north- immediately in Thunder Bay, Belle River NPs like Acorn – who was president of NPAO eastern Ontario.” and Sault Ste. Marie. (then an interest group of RNAO) – these Any doubts about the need for the clinic Sudbury’s model “…showed the (govern- barriers began to lift in the summer of 2011. were dashed on the day it opened in August ment) that NPs were capable of leading Amendments to the Public Hospitals Act 2007. Patients were lined up for two hours organizations and providing all the care a enabled NPs to discharge hospital in-patients before the doors even opened. From the patient needed,” Butcher says. “I think that and order diagnostic treatments. By the beginning, the clinic accepted only “orphan put extra pressure on the ministry during summer of 2012, further amendments were patients,” many of whom hadn’t seen a health those years to expand our scope of practice.” passed, and NPs were authorized to admit provider in a long time. The need was patients to in-patient hospital units. significant, and within a few years, NPs at the 2011 – expanded scope Acorn worked at Lakeridge Health at the clinic were providing primary care to more time, which was one of the first hospitals in than 5,000 people. Michelle Acorn, Ontario’s newest provincial Ontario to implement the changes and allow The clinic’s success attracted a lot of chief nursing officer, who is an NP, remem- NPs to practise to their full scope. She says the

attention and praise. “I’m so proud that my bers practising in Whitby prior to 2011, and shift gave her and her NP colleagues photos: R N AO archi v es

NPs in Ontario are the Ontario NPs are first in Canada to be authorized to granted the authority prescribe most to transfer, treat and medications, discharge hospital without being

2009 july 2012 in-patients. october restricted to a list.

The NP Anaesthesia RNAO launches the Care program opens at 2011 Nurse Practitioner NPs are the University of Utilization Toolkit authorized to Toronto, the first of its (updated in 2015) to admit patients kind in Canada. help hospitals integrate to in-patient july february NPs’ new authorities. hospital units.

14 march/april 2018 “...a different level of credibility,” and changed Lois Barlow has helped realize that vision as proclaimed. And with every new expansion to the language and culture of hospital care away part of the first group of 30 attending NPs NP scope, more than 3,100 Ontario NPs get from its focus on physicians. hired in 2016. Another 30 attending NP closer to realizing the full promise of that day NPs had greater accountability for their positions were funded in 2017, with 15 more back in 1998. patients, Acorn says, allowing them to expected to come in the 2018 fiscal year. Since These expansions continued in February co-ordinate patient care from start to finish, starting in the new role at a Niagara area of this year, when RNAO was integral in advocate on their behalf, and serve as their nursing home two years ago, she has convincing the province to give some NPs main point of contact. At Lakeridge, that authority to independently prescribe translated to better continuity of care, Attending NP high-dose painkillers to palliative care increased patient satisfaction, and decreased Lois Barlow patients. Under an agreement between rates of falls and wounds. was one of the RNAO and the ministry, NPs who meet first 30 in the To help NPs use their new authorities in role in 2016. the requirements and who wish to register, other hospitals with similar success, RNAO can do so through RNAO, as part of the convened an expert panel in the spring of ministry’s Palliative Care Facilitated 2011. Chaired by NP experts Acorn and Access (PCFA) program (see below). Until Vanessa Burkoski, a long-time NP, nurse this year, only physicians could authorize executive, former provincial chief nursing these medications, meaning pain relief officer, as well as RNAO president from could be delayed if a physician wasn’t 2014-2016. The panel created the Nurse immediately available. Practitioner Utilization Toolkit in 2012 “When you’ve got somebody with (updated in 2015). symptoms at the end of life, there is “These major scope of practice expansions significantly reduced the number of hospital absolutely no reason for them to suffer,” acknowledged NPs’ critical role in the system transfers from the home. She says her Barlow told CBC News. and enabled NPs to do what they’ve always presence full-time has also increased the Grinspun says the association is done – take the lead in advocating for what autonomy of the residents and given them tremendously proud of the progress NPs patients need,” Burkoski says. a voice. “I’m here every day. I know the have made, adding there is still work to be residents and they know me, so I can pick done. She says NPs must be enabled to 2014 – attending NPs in LTC up changes (in their health).” perform point-of-care testing, order bone In a related milestone moment for NPs, mineral density tests, order all diagnostic As the role of NPs continued to expand, their and after years of research and advocacy by imaging (including all x-rays, CT scans impact grew across all health sectors. And in RNAO, April 2017 marked a further and MRIs), complete applications for 2014, NPs in long-term care took centre stage. expansion in scope that would see NPs psychiatric assessment, and order At RNAO’s Queen’s Park Day in authorized to prescribe controlled electrocardiograms (ECG) in all situations. February of that year, then health minister substances, giving Barlow even more “Together with RNAO, NPs have Deb Matthews (Liberal) announced her options to treat her residents. overcome countless barriers to transform government would commit to hiring “Now, I can manage the complete health-care in Ontario and across the attending NPs in 75 Ontario long-term picture (of care) for those at the end of country,” Grinspun says. “We will care homes. The role of attending NP was life,” she says. “(I can provide) total, continue our evidence-based advocacy an important policy priority advanced by holistic, comprehensive care.” work until NPs reach their full potential, RNAO. The association knew that NPs because it’s the right thing to do for NPs, working full-time at nursing homes would 2018 for all nurses, and for the people of this be able to address health issues on-site, province.” RN cutting down on traumatic and costly Holistic care has been a trademark of NPs transfers to the emergency department. throughout the 20 years since Bill 127 was daniel punch is staff writer for rnao.

At RNAO’s Annual Queen’s Park Day, then health minister Deb Matthews announces RNAO hosts its the province will hire first-annual NP NPs are authorized to 75 attending NPs in Knowledge 2016 prescribe controlled 2018 february long-term care homes. october Exchange Forum. substances.

The Liberal government NPs are authorized to independently 2014 announces additional 2017 prescribe high-dose painkillers to funding to retain and palliative care patients by registering with recruit primary care NPs. the Palliative Care Facilitated Access (PCFA) program. Any Ontario NP can visit myRNAO.ca/PCFA to sign in and register.

Registered nurse journal 15 A struggle for care Ontarians without access to health insurance rely on a unique clinic when they need it most, but nurses are advocating for a broader solution. by daniel punch

Community health RN Melanie Spence (at the mic) is one of the founding members of OHIP for All.

16 march/April 2017 n a gloomy February evening, the pink, yellow and blue walls of Toronto’s AccessPoint on Jane are lined with occupied chairs. Children of various ethnic backgrounds explore the small community health centre (CHC) Owaiting room and meet new friends. Three young men with Caribbean accents discuss the latest basketball news. And a diverse group of patients – one of whom is wearing a Canada- branded toque – mull around the front desk. Mondays and Thursdays draw big crowds to this west-Toronto location of Access Alliance Multicultural Health and Community Services, tucked inside the second floor of an otherwise quiet plaza on RN Sideeka Narayan expects the Jane Street. RN Sideeka Narayan is behind the desk helping the patient roster at NIWIC to continue to grow with uncertainty secretary check patients in during the 4 p.m. rush. At the front of the surrounding immigration and line is a middle-aged Afghan couple, whose young son is rifling refugee policy south of the border. through public health pamphlets in every language from French to Nepali. The couple arrived in Canada two days earlier with their four workers and are in the children, hoping to make a refugee claim. In the meantime, three-month waiting their kids need to see a health-care provider. Though they Health care is a period before OHIP speak limited English, Narayan is able to ask them a few key “ human right. kicks in. And many questions. Do they have a permanent address? Do they have a asylum seekers fall phone number where the clinic can reach them? Do they have So what are we going to through the cracks of health insurance? The answer to all three questions is no. “Okay, the refugee system, we’re still going to go ahead and see them,” Narayan tells the do as a system to make and thus don’t qualify secretary, before asking her to ring up a Farsi interpreter. sure everyone has a for the Interim Federal That’s pretty much the ethos on Monday and Thursday evenings similar level of access?” Health Program at AccessPoint on Jane, when Access Alliance runs the Non-Insured (IFHP). Walk-in Clinic (NIWIC). Since 2012, the clinic has been offering NIWIC’s patients – sideeka narayan primary health care to Ontario residents who are not covered by the come from all corners Ontario Health Insurance Plan (OHIP). Though Access Alliance of the world. Portugal, operates the clinic, it was created in collaboration with six other Brazil, Mexico, Nigeria and Jamaica (in that order) are their most Toronto CHCs as a way of combining the limited resources each common countries of origin. They’re a diverse group, and for the most receives to treat non-insured patients, and of streamlining access to part, Narayan says they came to Canada seeking a better life. “These care. With an NP and RN on site, NIWIC works with more than 500 are people who are escaping poverty, abuse, violence, and may not have patients a year, providing episodic care, treating chronic illnesses, access to the most basic necessities of life, “ she explains. doing health promotion, and connecting people with other resources But without insurance in Ontario, their options for health care are in the community. limited and costly. If they’re forced to go to hospital to treat an acute But Narayan says CHCs alone cannot meet the needs of Ontario’s illness or to deliver a baby, they will likely leave with a hefty invoice for uninsured population, especially in smaller communities across the the health services they received, plus administration fees. In Naray- province. NIWIC saw a 30 per cent increase in patients in 2016-17, and an’s experience, health-care bills can be as high as $10,000 – a huge with uncertainty surrounding immigration and refugee policy in the barrier for NIWIC patients, 35 per cent of whom report having an U.S., Narayan expects the patient roster to continue to grow. To find a annual household income under $20,000. more sustainable solution for uninsured Ontarians, she is part of a Potentially exorbitant charges for health care force many uninsured large network of nurses and other health professionals advocating to Ontarians to avoid health professionals. Even where options like give everyone residing in Ontario access to health insurance. NIWIC exist, many people are not aware of them, or they fear being “This is a huge equity issue,” says Narayan, who manages the clinic deported if they do not have immigration status. By the time some as part of her portfolio in Access Alliance’s Health with Dignity uninsured people seek health care, what could have been a small, program. “Health care is a human right. So what are we going to do as preventable issue might be a lot more complicated, says NIWIC RN a system to make sure everyone has a similar level of access?” Monika Dalmacio. Though Canadians pride themselves on having a universal health To keep people healthy, Dalmacio and her colleagues promote system, it is estimated as many as 500,000 Ontario residents live preventive care and make sure they inform uninsured clients without health insurance. There are various reasons people are not about their rights. When they have to refer a client elsewhere, they covered by OHIP. Many are newcomers to the country who don’t have try and send them to providers who will not charge a fee. Dalmacio immigration status because they overstayed their visa or had it taken takes pride in advocating on behalf of her clients, and part of that away. Others have come to Ontario as immigrants or temporary advocacy is raising awareness about the challenges of living without

Registered nurse journal 17 RNAO has been a strong supporter of OHIP for All since the Community health RN Melanie Spence (left) attends the June 2016 OHIP for All launch event with fellow founding members (all physicians) (from campaign’s inception two years ago. In December 2016, the associa- left) Ritika Goel, Ashley Raeside and Justin Lam. tion sent a letter to then health minister Eric Hoskins asking for a comprehensive plan to give OHIP coverage to all Ontario residents. It was followed up with an action alert in 2017 urging Hoskins and Premier Kathleen Wynne to eliminate the three-month waiting period for OHIP as a first step toward that goal. RN Lynn Anne Mulrooney, RNAO’s senior policy analyst, led much of the association’s work on this issue. Having spent two decades nursing and studying abroad in Africa and the U.S., where she saw people struggle to access health care, Mulrooney is disheartened to see the same struggles among newly landed immigrants in Canada. “Access to health care is...a duty we have to each other as human beings,” she says. “I feel ashamed that we know this and still are willing to gamble with people’s lives.” As nurses and other advocates continue to fight for expanded OHIP coverage, people like Alice* are left with few places to turn. A young On one level, (the OHIP for All woman in her 20s, she came to Canada from the Caribbean with her partner, who promised to sponsor her for a visa. The relationship campaign) is about human dignity “ turned abusive, and Alice’s partner took away her visa papers. She and deservedness. On another ended up living in a shelter without immigration status. level, it’s about recognizing the varied and valuable contributions that everyone makes when they make a home here.”

– melanie spence

insurance. She says many people aren’t even aware this population exists. “When I share information about the work that I do, the first question is often: ‘doesn’t everyone have health insurance?’” If RN Melanie Spence gets her wish, everyone will. Spence is a community health nurse in Toronto, where she regularly encounters people without OHIP. She moved back to Ontario from B.C. in 2012, the same year Stephen Harper’s Conservative government made cuts to IFHP that would leave Monika Dalmacio is an RN at many refugee claimants without access to health care. In Access Alliance’s Non-Insured Walk-in Clinic (NIWIC). response, she became active in the grassroots organization, Health for All, which advocated reversing the cuts. RNAO was vocal on this issue as well, securing standing in court to fight When she came to NIWIC in 2014, Alice was pregnant in her third against the cuts. When IFHP coverage was restored by the Liberal trimester. Soon afterward, she disclosed she was HIV-positive. “She government in 2016, Health for All turned its sights on getting had been off her cocktail of medications for quite some time since she health insurance for the half-a-million Ontario residents without had been living here,” Narayan recalls. it. The resulting OHIP for All campaign is calling on government The clinic was able to connect Alice with a program for pregnant, to eliminate the three-month OHIP waiting period, and to provide HIV-positive women at another health-care organization. She was seen coverage to Ontarians who lack it due to their immigration status. by a midwife and an obstetrician, and the OHIP costs were covered “On one level, (the OHIP for All campaign) is about human through NIWIC. Though Alice had complications with her pregnancy dignity and deservedness,” Spence explains. “On another level, it’s and during delivery, she was discharged with a healthy baby boy. about recognizing the varied and valuable contributions that “Had (NIWIC) not existed...she might have shown up in the everyone makes when they make a home here. These are people emergency department and not disclosed her HIV status...and there who are building our buildings, who are looking after our would have been a high risk of transmission to that child,” Narayan children, and who are our coworkers, neighbours and friends.” says. “If we didn’t have the clinic, (people without insurance) wouldn’t Advocacy has become a major part of Spence’s nursing practice, have access to much else.” RN and she believes all nurses can be integral in making OHIP for All’s vision a reality. “As nurses...I think we have an obligation to daniel punch is staff writer for rnao. be part of the broader conversation around making changes to the system when health is at risk.” *A pseudonym has been used to protect privacy.

18 march/april 2018 Queen’s Park Day 2018 talking politics With a provincial election on the horizon, nurses visit Queen’s Park with pressing questions about improving health for all. by kimberley kearsey, daniel punch, Victoria Alarcon, Alicia Saunders

Then health minister Eric Hoskins (centre) shares a laugh with RNAO President Carol Timmings (left) and CEO Doris Grinspun before his keynote address during the afternoon portion of Queen’s Park Day. 1 2

here is nothing like an upcoming election to raise the stakes at RNAO’s annual “We have progressed so much with (pharmacare) for Queen’s Park Day. children and seniors, but it has to be for everyone.” With Ontario set to elect a new government on June 7, – Region 8 board member Beatriz Jackson moreT than 130 RNAO leaders – RNs, NPs and nursing students – descended on the provincial legislature on Feb. 22 with one with (pharmacare) for children and for clinicians to attend RNAO’s Wound purpose in mind: to urge all political seniors, but it has to be for everyone,” Care Institute. He also reaffirmed his parties vying to get elected to adopt the Jackson said, and Anderson agreed. party’s commitment to enabling indepen- evidence-based recommendations laid out Across the Queen’s Park dining room, dent RN prescribing, expanding NPs’ in RNAO’s 2018 election platform, Region 11 board member Jennifer Flood scope of practice, and ensuring RNs can Improving health for all. The comprehensive met with Algoma-Manitoulin MPP continue to initiate the controlled act of platform includes policy recommendations Michael Mantha, a member of the NDP psychotherapy. in five key areas: access to nursing care, party, and discussed the need for more During Yurek’s turn at the microphone, health system restructuring, social and RNs in long-term care (LTC). “Staffing in he talked about the recently released PC environmental determinants of health, and LTC...is a huge issue,” Flood said, platform*, which was developed by a our government’s fiscal capacity. explaining that LTC homes rely heavily on committee that included nurses. If elected, “The recommendations we propose are unregulated care providers. “We’re on the he said his party would be sure to locate key to building a more inclusive society– same page,” Mantha told her. “The staffing RN care co-ordinators in primary care, one that leaves no one behind, and one level is too low.” create an oral health program for 100,000 that will make our province a better place After attending question period, where low-income seniors, and improve funding for all,” RNAO President Carol Timmings PC Health Critic Jeff Yurek pressed the models in LTC. He also spoke about the said at the Feb. 22 press conference in government about overcrowding in importance of RN prescribing, adding that the Queen’s Park media studio. Represen- Ontario hospitals, RNAO members moved RNs must also be allowed to order lab tatives from each Ontario political to Hart House on the University of tests. “We’re going to need RNAO...to party were in attendance for the official Toronto campus to hear speeches from make this happen,” Yurek said of his platform release. then health minister Eric Hoskins, Yurek, party’s various policy priorities. All three parties were also well-repre- and NDP Health Critic France Gélinas. Gélinas was next, and touted the NDP sented during breakfast meetings that Hoskins, who resigned from his post as party’s plan for a pharmacare program to same morning, when RNAO members sat health minister later in the month, led off cover 90 per cent of medications on the down with 44 MPPs to advocate for the afternoon session by expressing his provincial formulary for Ontarians of all important nursing and health policies. admiration for the work of nurses and ages – though RNAO insists universal Region 8 board member Beatriz Jackson RNAO. “In the eight years I’ve been a pharmacare must cover 100 per cent of took the opportunity to tell Granville cabinet minister, I can’t think of an medications. Bringing more RNs and NPs Anderson, Liberal MPP from Durham, association or advocacy group that is into LTC is another important item on the about the importance of a universal stronger...than RNAO,” he said. NDP’s agenda, Gélinas said, as is pharmacare plan – a pillar of RNAO’s Hoskins then announced the Liberal platform. “We have progressed so much government would be providing funding *This is the platform that was developed when Patrick Brown was PC leader. 20 march/april 2018 Queen’s Park Day 2018

1 Marie-France Lalonde and Abby Deshman, minister of community safety and correctional services and her assistant (centre and left, respectively), meet with Region 10 (Ottawa) member Amber-Lynn Ward-Mahoney (right), communications representative for RNAO’s Ontario Correctional Nurses’ Interest Group (OCNIG).

2 Laurie Scott, PC MPP for Haliburton-Kawartha Lakes-Brock, and critic, community safety and women’s issues (right), meets with (from left) Harshdeep Hehar, social media representative for the Community Health Nurses’ Initiatives Group (CHNIG), Paula Manuel, assembly representative for the Staff Nurse Interest Group (SNIG), and Saima Shaikh, long-term care co-ordinator for RNAO.

3 Wayne Gates, NDP MPP for Niagara Falls, and critic, infrastructure and transportation, sits down for breakfast with Mahoganie Hines, policy and political action representative for the Niagara chapter and RNAO’s Palliative Care Nurses 3 Interest Group (PCNIG).

addressing mental health and addictions issues in a more co-ordinated way. 4 PC Health Critic Jeff Yurek touches on a number of issues during his keynote As always, after each MPP spoke, RNAO address, including the need to bring RN care co-ordinators into primary care, as well as the importance of RN prescribing. members had plenty of questions seeking to understand where each party stood on key issues from Improving health for all. Aaron Clark, president of the Mental Health Nurses Interest Group, stepped to the microphone to ask Gélinas about her party’s stance on supportive housing for people with mental health and addictions challenges – one of RNAO’s platform recommendations. “Social housing has to be looked at,” she replied. Like RNAO, Gélinas said she wants to build a future “...that leaves no one behind.’ Read RNAO’s full policy platform at RNAO.ca/improvinghealthforall RN daniel punch is staff writer for rnao.

4

5 NDP Health Critic France Gélinas shares her party’s plan to increase supports for mental health and addictions, and to provide funding for all Ontarians to get the medications they need.

5

Registered nurse journal 21 7

6 6 Aaron Clark, president of RNAO’s Mental Health Nurses Interest Group (MHNIG), steps to the mic to ask NDP Health Critic France Gélinas about her party’s stance on supportive housing.

8

7 During a Q&A following the health minister’s address, Veronique Boscart, former RNAO board member, asks the minister if the Liberal government will look into new funding models for long-term care.

8 Shirley Kennedy, president of RNAO’s Ontario Correctional Nurses’ Interest Group (OCNIG), works with youth, and thanks the health minister for launching OHIP+, which funds medications for Ontarians under the age of 25.

9 9 Each year, a select group of nursing students participate in a placement that allows them exclusive access to the activities of Queen’s Park Day. A few of this year’s participants stop for a photo with RNAO CEO Doris Grinspun (centre), including (from left): Sasha Allen (University of Ontario Institute of Technology “The (UOIT)), Rosemary Leone (Ryerson University), Tasha Hill Clarke (UOIT), and Caroline Frankfurter (Queen’s University). A total of eight students participated in recommendations the placement this year, which also included an RNAO orientation, and opportunities to attend the assembly and board meetings. we propose are key to building a more inclusive society – one that leaves no one behind, and one that will make our province a better place for all.”

– RNAO President Carol Timmings

For more photos from Queen’s Park Day, visit RNAO on Facebook.

22 march/april 2018 Queen’s Park Day 2018

Panel highlights challenges of homelessness in Ontario

CORRECTION: Shane (second from left) was incorrectly identified as Sean in the Jan/Feb 2018 issue of RNJ. We apologize for the error.

RNAO President Carol Timmings (left) and CEO Doris Grinspun (third from left) pose with participants in the powerful afternoon panel discussion about homelessness. They are (from left) Torontonian Shane Choinard, who shared details of his lived experiences on the streets, Toronto City Councillor for Trinity-Spadina Joe Cressy, and street nurse Cathy Crowe.

n a day when some of one-size-fits-all approach. “To me, creating 3,000 new units – which echoed Ontario’s most powerful (shelters) represent a canned solution that policies in RNAO’s Improving health for all politicians took the stage, doesn’t work. Homeless people don’t come platform. She encouraged nurses to be a soft-spoken man who from a can. They are all unique active in the upcoming election, vote and lives on Toronto’s streets individuals.” volunteer for candidates who will address made the biggest impact. He was joined on the panel by street the social determinants of health. OShane Choinard was the special guest nurse and activist Cathy Crowe and Cressy said that while Toronto is for a panel discussion on homelessness Toronto city counsellor Joe Cressy. consistently named among the world’s during the afternoon session of Queen’s Crowe also painted a bleak picture of best cities, it is also marred by inequality Park Day. RNAO members listened conditions in Toronto shelters, saying they and has the highest child poverty rates in attentively as he shared the details of his are “...horrendous and overcrowded.” She Canada. Twenty-nine per cent of young days sleeping on a grate near the Eaton then highlighted how factors like Indige- Torontonians live in poverty, he noted, and Centre and panhandling at Union Station. nous housing, climate change, and 181,000 people in the city are waiting for He also explained why the overcrowded gentrification were contributing to the affordable housing. “In a city like ours, shelter system does not meet his needs. problem. As part of the solution, she why isn’t it better? Why are we letting “I cannot stand to be in (shelters). It’s a advocated for increasing social assistance down the most vulnerable?” he asked. RN nightmare,” Choinard said, citing rates and investing in affordable housing, dangerous and unclean conditions, and a including repairing current units, and daniel punch is staff writer for rnao.

Registered nurse journal 23 Meet your incoming president

As she prepares to take the reins as RNAO’s 55th president at the annual general meeting (AGM) in April 2018, Angela Cooper Brathwaite sits down with RNJ to discuss her long, diverse nursing career, and her goals for the next two years.

by daniel punch RNs, NPs and nursing students. I also want I’m also looking at homelessness. to support and expand RNAO’s influence We need more shelters…and we need and impact provincially, nationally and affordable housing for low-income earners. internationally. I look at the news and I see people living in terrible conditions. Canada is supposed You were born in Trinidad and to be a wealthy country, and yet there are became a nurse there before people living like this. They need appro- moving to Canada in 1975. You also priate shelter and affordable homes so they Meet your incoming president provided nursing care in three can help their families. Fortunately, the provinces. How will your diverse minimum wage went up and will continue background influence your work? to go up, but at the same time, the cost of living has gone up significantly. I would love to continue advocating RNs, NPs and nursing students to become When you’re not nursing, culturally competent. In addition to my what other passions do you have? international experience, my PhD thesis was on cultural competence, so I have Sometimes I do volunteer humanitarian done a lot of research into (this topic). I see work in Peru. I work as a primary care Why did you become a nurse? people from diverse backgrounds (and) nurse when I go there. I also taught on a understand their issues. I want to try to volunteer basis in Ethiopia, where I did I became a nurse because I wanted to help represent them, and facilitate the develop- research methodology seminars for people and make a difference in their lives. ment and implementation of policies and master of nursing students at Addis My mom was a community health nurse, educational programs to meet their needs. Ababa University. My hobbies are and she would tell us all these stories Culture influences behaviour and deter- travelling to different countries, reading, about taking care of patients. She was a mines decision-making. And sometimes listening to classical and gospel music, good storyteller. we misunderstand people when we don’t attending live plays and engaging in understand their culture. physical activity. You have worked in nursing leader- ship roles for the past 26 years. What are some of the biggest Do you have any advice for those What have you learned during that challenges you see facing considering taking on a leadership time that you will bring to your nursing today? role in nursing? presidency? One of the biggest challenges is health system Be a “servant leader.” That means a leader I will use the leadership skills I’ve transformation. The system needs to be who wants to serve the people around developed…in acute care, public health, transformed. Right now, we know the ratio of them, and who engages in practices that primary care and mental health to inspire RNs and NPs to the population is much lower enrich the lives of individuals, build better and challenge members to become more in Ontario than any other province. That organizations, and ultimately create a involved in RNAO at the chapter, region means people have less access to RNs, and more just and caring world. (A servant and interest group level, as well as we know from research that RNs make a leader) leads by role modeling and motivate and support members through difference in producing positive outcomes mentoring, and treats their employees and role modeling and mentorship. for patients. We’re simply not hiring subordinates well. I have always treated I (also) hope to apply my knowledge, enough RNs. people with respect and dignity, and I skills and experience in advocacy to The other problem is that our population is expect the same from them. implement RNAO policy initiatives during aging. In 2017, according to Statistics Canada, I would also advise them to engage in Queen’s Park on the Road, Queen’s Park 13 per cent of the population in Canada was leadership roles on executive committees Day, Nursing Week, and throughout the 65 or older. Seniors are expected to comprise at the interest group, chapter and region year as I represent RNAO...to influence 23 to 25 per cent of the population by 2030. If levels (of RNAO). Maybe serve on the positive health outcomes for all Ontarians. we don’t transform the health-care system to board of directors, (as well as) other meet the needs of the aging population...we committees and other boards. I see Why did you want to become will not be able to adequately meet the needs leadership as a service to people. When RNAO president? of the whole population. they know that you care, you will be able to We also need to transform long-term care influence them to do better things and Being president provides an opportunity to (LTC) to keep residents healthy and safe. We make this world a better place. If I can make a difference for nursing, the health have all these unregulated staff members in make this world a better place in whatever system, and society as a whole. I have spoken LTC who do not have the knowledge, training position I hold, then I will have met my out for nurses and for patients throughout and ability to deal with residents who have God-given goal for my life. RN my career, and I want my voice to be heard at complex problems. We need to increase the all levels of government...as well as among ratio of RNs and include more NPs. daniel punch is staff writer for rnao.

Registered nurse journal 25 The look of In this second part of our six-part series celebrating RNAO’s flagship publication, we look back at the first change few years of a re-envisioned RNJ. by kimberley kearsey

hen The Registered Nurse published Volume 1, In 1992 (Volume 4), RNAO enlisted the services of a new publishing No. 1 in 1989, its cover feature was a Q&A with company to produce The Registered Nurse. Not only would the look then health minister Elinor Caplan about the change once again, but so would the frequency. These and other nursing shortage. When asked specifically about decisions about communicating with members were not made enhancing the role of nurses in health-care lightly. With the shift from a quarterly to a bi-monthly publica- Wdecision making, Caplan responded that she wants to “…make sure tion, then executive director Lynda Parks wrote a full-page article nurses have a stronger voice, that they are seen, and in fact mandated, about the process of envisioning a new look and feel, and new as an important and respected voice within the hospital system.” The expectations of an advisory board and members who would be health-care landscape – and nursing – has changed considerably since called upon to submit more stories. You can read this article and 1989, but that vision for nurses – not only in hospitals but across all more online at RNAO.ca/RNJhistory sectors of the health system – has remained constant. Watch our May/June issue for part three in this series, and our look What else was RNAO talking about in the late 1980s? at The Registered Nurse of the early 1990s. Technological change – and the onset of the computer age – made And don’t forget to contact us at [email protected] if you have a the cover in the spring of 1989, with a very clear call on nurses to story to share about the association’s flagship publication.RN embrace the benefits of technology to nursing practice rather than fear the change. Who could have guessed that, 30 years later, technology kimberley kearsey is managing editor for rnao. would be so vital to our lives in so many ways? Rounding out the cover features in 1989 were stories about the appeal of bedside nursing as a life-long career, and a series of profiles on a new breed of nurses did you know? conducting scientific research. To mark the start of Nursing Week each spring, RNAO members The mix of stories that made the covers of this first incarnation of a used to head out by the thousands to see the Toronto Blue Jays. revitalized and updated Journal was diverse and varied. From focusing As we see from these images published in The Registered Nurse, on greening hospitals and the movement to save the environment RNAO past presidents were invited to throw the first pitch during in small ways, to Ontario’s new nursing co-ordinator at Queen’s their respective years at the helm. Park, health system transformation, self employment in nursing, (1. Elsabeth Jensen, 1989, 2. Shauna Fenwick, 1990, and 3. racism and discrimination in health care, community supports for Sheila David, 1991) mental health patients, nursing education, and a series of profiles on controversial and sometimes misunderstood RN trailblazers who were referred to as “renegades.”

1

2

In this image from the May 1989 issue of The Registered Nurse, a consultant specializing in computer technology leads a series of RNAO workshops about implementing technology into practice. 3

26 march/april 2018 bpg corner

Harm reduction services enhanced thanks to SIS BPG As more and more communities open supervised injection services (SIS) to tackle the opioid crisis, RNAO’s latest BPG will help ensure these life-saving interventions are delivered effectively, providing equitable access to people who inject drugs. Implementing supervised injection services is a BPG that features 11 recommendations covering a range of topics, including integrating peer workers and On hand for the release of the SIS BPG were (L to R, back row): Lucia Costantini, IABPG associate director, guideline health and social services into SIS development and evaluation, Laura Ferreira-Legere, IABPG senior nursing research associate, Leigh Chapman, RN and harm reduction advocate, Tasha Penney, former IABPG manager and lead for the SIS BPG, Valerie Grdisa, IABPG director, programming, and aligning David McKeown, former Toronto medical officer of health, Nafsin Nizum, IABPG research associate, Glynis Gittens, IABPG future SIS locations and project co-ordinator, Jason Altenberg, South Riverdale Community Health Centre (SRCHC) director of programs and operations to the needs of the services, Shaun Hopkins, SIS BPG panel member, Lynne Raskin, SRCHC CEO, Carol Timmings, RNAO president, Angela Cooper Brathwaite, RNAO president-elect; and (kneeling, L to R) Rachel Hayden, harm reduction advocate, Amy Wright, local population. It was released Toronto Public Health harm reduction worker with lived experience, and RNAO CEO Doris Grinspun. at a media conference on Feb. 28 at South Riverdale Community Health Centre, home to one of RNAO in the Middle East organizations) who were bedside nurses who are using Ontario’s first three SIS In a first for RNAO, IABPG interested in learning more BPGs to enhance their practice programs in the city of Toronto. Director Valerie Grdisa visited about the BPSO program. and improve patient care. “Lives have been cut short and Qatar in February to lead an Readers will learn about families have been torn apart by orientation program for the New book about the developing, using, and overdose,” RNAO President newly launched Best Practice history behind the evaluating the impact of Carol Timmings said in a Spotlight Organization (BPSO) in BPG program knowledge tools in health care. statement. “Despite these that country. Co-facilitating the At the annual general meeting They will also get a behind-the- tremendous losses, we are workshop was JoAnne Mac- (AGM) in April, RNAO will scenes look at how nurse encouraged that SIS are now Donald, associate dean at the release a book that tracks the executives, health-care saving lives in our communities. University of Calgary in Qatar growth of its best practice organizations and profes- And we know this robust (UCQ), and associate professor guidelines (BPG) program sionals create evidence-based guideline will help ensure (on leave) at St. Francis Xavier from its beginnings in the late cultures. Visit RNAO.ca in late services are implemented University in Nova Scotia, where 1990s to the powerhouse it is April to get your copy. RN in a comprehensive and she was the lead in establishing today. Written by RNAO CEO inclusive way.” the school as the first BPSO in and program founder Doris “Many people who inject drugs that province. The visit provided Grinspun, and former IABPG face social and health inequities,” foundational knowledge about director Irmajean Bajnok, with said David McKeown, BPG panel evidence-based practice, RNAO’s contributors from around the co-chair and a major catalyst in guideline development process, globe, Transforming Nursing bringing SIS to Toronto during systematic implementation Through Knowledge: Best his time as the city’s medical methodology, implementation Practices for Guideline Develop- officer of health. “To be effective science, and implementation ment, Implementation Science, and accessible, SIS must offer supports. University faculty and Evaluation delves into the diverse programming responsive attended the presentations, as creation of the BPG program, to their needs.” did some of their community its theoretical foundations, and Download the guideline free partners (i.e. decision-makers the lived experiences of faculty, from RNAO.ca/BPG/SIS from local health-care students, nurse executives and

Registered nurse journal 27 RN Profile by victoria alarcon

The call of the north Primary care RN Brandi Milko always knew she would return to the north one day.

At 21, brandi milko was prepared at McMaster University and, as a community health nurse. Deciding to stay home, she to become a doctor. She had after being accepted in 2012, She applied at the Waasegiizhig began working in the emer- finished her bachelor’s degree in she withdrew her name from Nanaandawe’iyewigamig Health gency department at Kenora’s health sciences, was on the NOSM’s waiting list. Access Centre in Kenora in 2015, Lake of the Woods District waiting list for the Northern From her first class to her last, and was overjoyed to be offered Hospital. Emergency nursing Ontario School of Medicine Milko felt inspired and the position. in the north requires resource- (NOSM), and was working on impressed. “I just felt like every Community nursing was fulness, she says. “You have to her master’s degree in biology at value that nursing had seemed to different from anything she had be a generalist,” which is very Carleton University. But she says resonate for me,” she says, done before, Milko recalls. She similar to nursing in the she felt like her life wasn’t headed admitting she fell in love with was in charge of everything community. in the direction she wanted. “I When an opportunity arose kind of had a moment where I to go back to community thought to myself: what am I Three things you nursing in 2016, Milko was doing with my life right now?” didn’t know about excited, particularly because it Following her intuition, Milko Brandi Milko: was at the same FHT she had withdrew from the master’s visited and met the NP who 1. E ach spring, Milko takes program and moved back home inspired her to go into nursing. an icy plunge into Lake to Kenora, where she went Huron. Milko has come full circle, and through a time of reflection. “I has been a primary care RN at 2. She is an aunt to felt lost…things weren’t going three boys. (aged 8, 6 and the Sunset Country FHT for two well for me,” she recalls, adding 18 months) years now. She provides her uncertainty took its toll on 3. She considers herself the comprehensive health assess- her health. world’s best perogy maker. ments, screening, lifestyle Milko visited a nurse practi- support, chronic disease tioner (NP) at the Sunset Country management, and education to Family Health Team (FHT), how patient-centred and holistic from baby checks, to immuni- her patients while also running a confessing she was stressed the profession is. zations, infectious disease hypertension clinic. because she didn’t know what She graduated in 2014, and screenings, sprains, sore She is a passionate advocate for she wanted to do with her life. quickly found a job as an RN throats and much more. “What nursing in the north, and hopes She had always imagined it on the clinical resource team at stood out to me was the to recruit more nurses to work in would involve helping people by Joseph Brant Hospital in strength and resilience of the her community. She wants to seeing them as a whole person, Burlington. She cared for people I met,” she says. ensure there are enough supports not just their symptoms. After surgical and medical patients, There were individuals who so nurses can continue to provide sharing this with the NP, she was collaborated with other nurses, struggled to get clean water for essential care to some of surprised at the suggestion she and provided nursing assess- their families, access healthy Ontario’s smallest and most consider nursing. ments and care. fruits and vegetables, and remote communities. Milko was hesitant because she Milko wanted to develop her suffered with chronic condi- Milko also hopes to pilot had never seen a nurse in action, nursing skills and gain more tions. However, they continued programs to offer preventive and didn’t know what nursing experience before returning to try to be active participants health services to hard-to-reach was about. A few weeks later, she home to work in northern in their health, Milko says. populations and teens. And made arrangements to shadow Ontario. She always knew she The more she learned about maybe one day she too can inspire

the NP, and left the experience would settle back in the north. her patients, the more she an unsuspecting teen who is photo: ihor k or amazed and drawn in by the But it wasn’t long after her liked community health unsure what their future holds. RN profession. Taking a leap of graduation when her father called nursing. But when her faith, she applied to the to tell her about an opportunity to one-year contract ended, Milko victoria alarcon is editorial Accelerated Nursing Program cover a one-year maternity leave had no choice but to move on. assistant for rnao.

28 march/april 2018 join our team

RNAO represents RNs, NPs and nursing students across Ontario. Since 1925, the association has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the health system, and influenced decisions that affect nurses and the public they serve. To contribute to this important work, why not consider joining our policy team?

Director of Nursing and Health Policy Nursing Policy Analyst

Reporting to RNAO’s CEO, you will proactively identify critical issues in As a nursing policy analyst, you will be an integral contributor to the nursing, social policy and health care that impact the role of nurses and development of policy by identifying and analyzing critical nursing the health of the public. You and your team will develop policy, write practice issues. You will develop and formulate policy within the position papers, develop advocacy plans, and present findings and institutional sector, including hospitals and long-term care homes, recommendations to the CEO, board of directors, and other stakeholders. with participation in other sectors as needed. The role also includes Your ability to identify emerging issues, clearly articulate ideas, and responding to external consultations on emerging nursing and health- present evidence-based arguments will contribute to the formulation of care system issues and representing RNAO in external settings. association strategies that are congruent with our mission. You are a member in good standing with RNAO and are registered You understand the political landscape and process as it relates to policy with the College of Nurses of Ontario (CNO) as an RN or RN(EC). development and realization. You are experienced working with a range of stakeholders in the health and health-care sectors, including nurses, You possess a master’s degree or you are working towards a other health providers, governments and the public. You have superior master’s degree in nursing, political science, or a related field. writing and communication skills that will enable you to persuasively You will bring at least five years of progressive experience to the role, communicate and advance RNAO’s strategic objectives. and strong knowledge of health and social policy issues as well as superior writing and verbal communication skills. The successful candidate will be an RN or NP, and will hold a master’s degree in a relevant field with five years progressive experience in nursing and health policy at a senior level. A PhD is an asset.

These are full-time positions. Salary commensurate with experience. RNAO provides a comprehensive employee benefits program and is a member of HOOPP. Please submit your cover letter and resume by May 14, 2018 to [email protected]

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RNAO_Halfpage_MagAd_23Jan2018_PRINT.indd 1 2018-01-23 10:20 AM in the end By amy van berkum

What nursing means to me…

The sun is setting as i circle a house looking for a back entrance to wonder if we can come together and challenge each other to be where I’m told a young man lives. Knocking and calling out loudly, hopeful, and to consider the possibility that we can eradicate these I enter a crawl space that doesn’t allow me to stand up straight. “I’m inequities that contribute to poor health. down here,” echoes the tired voice of a 19-year-old Indigenous male This past fall, I attended the 2017 Canadian Alliance to End lying on the floor. I explain that I am an RN for one of London’s Homelessness conference in Winnipeg. A courageous woman, community health-care agencies, and that I’ve come by to set up his Jolene Wilson, shared a visionary exercise. She challenged us to intravenous antibiotics. He was discharged from hospital less than 24 imagine a time when we or a loved one was very sick. Imagine hours after surgery for a septic knee. I will never forget the look of pain having no one there for you, she said. Now imagine living in on his face. Without any identification or a status card, he was unable poverty, or being homeless. to pay for his prescription. I reached out to several community services, The audience sat still. People were deeply moved. Moments and found support to get him the pain relief he needed. later, an Indigenous woman encouraged us to drum against the On my way out, I left two quarters beside his blanket, asking him to table. She explained that the drum helps us to find balance, and call me if he had issues through the night with his intravenous. At 3 bring laugher and energy back into our being. We drummed, and a.m., during my on-call shift, the phone rang. He had walked two before long, some of the weight of despair in the room had lifted. kilometres in immeasurable pain to the nearest payphone. I wondered…could this experience mimic our practice? This moment in the fall of 2016 was one of many in my career In nursing, I believe we must be open to learning, empathetically when I felt overcome with fury, hopelessness, and despair. In engaged, and reflective. We must critically and courageously challenge other such moments, I listened to a homeless woman fearful that the status quo. We need to lean on the meaningful moments in our her unborn baby was cold as she wandered the streets at night; I careers to feel energized and hopeful to pursue change. felt challenged to complete diabetic health teaching for a patient Nurses have strong hands, stronger voices, and even stronger with food insecurity; I listened helplessly to stories of nursing hearts. Whether we stand for one person or one hundred, we can students burning out in hospital placements even before their become part of a catalytic shift toward emphasizing common graduation; and I watched academics working tirelessly to secure humanity and protecting and caring for all people. RN grants in pursuit of systemic change. Despite the variability in nursing roles, we all find ourselves with our amy van berkum is an advanced practice nurse at london’s st. joseph’s backs against the wall when life’s injustices are unmasked. As nurses, health care, with work experience in research, academia, professional

n : age t illustrateur illustratio we have come to expect hardship every day. But I can’t help but practice, and acute and community care.

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