In This Issue

VOL XXXII NO 3 SEPTEMBER 2011 ACCESS

in THIS ISSUE: • AWARDS FOR EXCELLENCE IN NURSING RECIPIENTS • • provincial election: make your vote count for health • • education and research trust celebrates 25 years • • welcome, nursing graduates! . . . & more! • ARNNL STAFF

Executive Director Pegi Earle 753-6173 [email protected]

Director of Regulatory Michelle Osmond 753-6181 Services [email protected]

Director of Policy Lynn Power 753-6193 & Practice [email protected]

Communications Officer Jennifer O’Neill 753-6198 [email protected]

ARNNL COUNCIL Director of Corporate Services Elizabeth Dewling 753-6197 Beverly White, President (2010-2012) [email protected] Cathy Stratton, President-Elect (2010-2012) Nursing Consultant – Siobhainn Lewis 753-0124 Colleen Kieley, Eastern Region (2011-2014) Policy & Practice [email protected] Sandra Evans, Central Region (2009-2012) Jennifer Ballett, Western Region (2011-2014) Nursing Consultant – Beverley McIsaac 753-6174 Regulatory Services & [email protected] Beverly Pittman, Labrador/Grenfell Region (2009-2012) Advanced Practice Cathy Alyward, Advanced Practice (2009-2013) Evelyn Peyton Murphy, Practice (2009-2013) Regulatory Officer Bradley Walsh 757-3233 Madonna Manuel, Education/Research (2009-2012) [email protected] Cathy Burke, Administration (2009-2012) Project Consultant JoAnna Bennett (part-time) 753-6019 Dr. Carmel Doyle, Public Representative (2011-2014) QPPE [email protected] Ray Frew, Public Representative (2011-2014) Irene Baird, Public Representative (2011-2014) Research Analyst & Julie Wells 753-6182 ARNNL Trust [email protected] Walter Arnold, Public Representative (2011-2014) Pegi Earle, Executive Director Administrative Assistant to Christine Fitzgerald 753-6183 Representatives from nursing student societies (observers) Executive Director & Council [email protected]

Administrative Assistant to Jeanette Gosse 753-6060 Consultants & Workplace [email protected] Representative Program

Administrative Assistant to Jennifer Rideout 753-6075 Consultants, ACCESS & QPPE [email protected]

contents Administrative Assistant to Colleen Jones 753-6041 Consultants & Professional [email protected] 1 | Message from the President Conduct Review Administrative Assistant to Renee Reardon 753-6040 2 | From the Executive Director’s Desk Consultants, Data Processor [email protected] &Registration 3 | May 2011 Graduates

4 | Excessive Hours of Work: Professional and Union Considerations ACCESS is the official publication of the Association of Registered Nurses of 5 | Ask a Practice Consultant Newfoundland and Labrador.

6 | Home Visits: Optimizing Medical Care for the Elderly ACCESS is published three times a year in January, May and September. Subscriptions are available for $25.00 per year.

7 | Nurses of Note ON THE COVER: ARNNL’s Awards for Excellence in Nursing were presented during ARNNL’s 57th Annual General Meeting in June. L to R: Ellen Peddle, RN – Practice; Sharon Smith, BN, MN 8 | Students Dressed in Red – Administration; Beverly White, ARNNL President; Denise English, RN, BN, MN – Education; Paula Didham, RN, BN – Research (missing from photo: Ashley Preston, RN, BN – Elizabeth 9 | Dominos, Public Policy, and the Provincial Election Summers Novice Nurse Award)

10 | Goings On Editor | Jennifer O’Neill, Communications Officer

12 | ARNNL Council Matters Creative Design | Vanessa Stockley, GraniteStudios.ca

13 | Clinical Corner Contributing Editor | Danielle Devereaux

14 | ARNNL Trust: Reaching a Milestone Administration | Jennifer Rideout, ARNNL

16 | Regulatory Notes: Substance Abuse in the Workplace Advertise in the next issue of ACCESS 18 | Improving Member Services: A Review of Online Registration Contact Jennifer O’Neill, Communications Officer, ARNNL [email protected] 753-6198 19 | Workplace Reps 55 Military Road St. John’s, NL A1C 2C5 Ph: (709) 753-6040 Fax: (709) 753-4940 Toll Free: 1-800-563-3200 email: [email protected] www.arnnl.ca

©Association of Registered Nurses of Newfoundland and Labrador (ARNNL). All rights reserved. For editorial matters, please contact the editor. The views and opinions expressed in the articles and advertisements are those of the authors or advertisers and do not necessarily represent the policies of ARNNL.

Access VOL xxXII NO 3 SEPTEMBER 2011 Messagefrom the President

As I write this article for the September issue of ACCESS, summer is just beginning. I hope everyone enjoyed the bit of good weather that we did get, and that you had some time to take care of yourself and relax with family and loved ones.

The Council meeting on June 8 marked a milestone for ARNNL – for the first time we had students sitting at the Council table as observers! This is an initiative to increase nursing students’ awareness of ARNNL, and to spark their interest in becoming active ARNNL members once they graduate and become registered nurses, thus supporting the valuable profession they have chosen as their life’s work. From now on, one of the three schools of nursing will be represented Aat each Council meeting, with the exception of the meeting immediately preceding the biannual conference and annual general meeting (AGM), where all three sites will be represented and will then take in the conference as well. Students who attended this year’s meeting, AGM, and conference certainly appreciated the opportunity and enjoyed the experience. We look forward to a continued partnership with the schools of nursing to sustain this initiative in the future.

June 9 and 10 marked ARNNL’s 57th AGM and certainly highlighted the busy year Council has had, and the many successes at ARNNL as a result of the hard work, commitment and dedication of our staff and volunteers. The two-day meeting was action-packed with the business of the Association, as well as numerous presentations related to evidence-based practice. There was also opportunity to honour some of our colleagues with Awards for Excellence in Nursing and Honorary Membership. Congratulations to all and thank you for your valuable contribution to the nursing profession and for the profound difference you make to individuals, families, and communities in Newfoundland and Labrador.

One of the AGM events that Council is particularly proud of was the launch of the new ENDS. These ENDS were developed at an October 2010 strategic planning session and were presented during a member linkage session at the AGM. Council will now be working with these new ENDS to guide and monitor activity to move nursing practice and the Association into the future. These ENDS are fewer in number than previously, thereby making them more focused. They are also more geared toward areas that ARNNL has the ability to influence and therefore have an effect on. As we go forward, Council will be working with these ENDS to monitor successes and identify areas that need attention. The new mission of ARNNL is “Nursing Excellence for the Health of the Population” and the ENDS are in the areas of:

• Accountability for Self-Regulation; • Professionalism; • Quality Professional Practice Environments; and • Healthy Public Policy.

As we monitor progress on these ENDS, I look forward to reporting many successes moving the nursing profession into the future. I also look forward to continued linkage with ARNNL members (you) and owners (the public) to inform our work, which confirms our current ENDS and/or indicates a need for revision. Thank you for any input that you have given to date and I look forward to other opportunities to engage in linkage activity with you.

Beverly White, RN, MScN, CCHN(C) [email protected]

FMargareromt (P egit)h Eearle , RN, MScN Exe cutive Director’s Desk Recruitment and Retention: The important role you play in keeping our nursing graduates home

n this issue of ACCESS we welcome the province’s There is no doubt that the availability of full-time employment newest graduates to our profession. In May, 190 with good benefits is very important for retention, however, nursing students graduated with a Bachelor of Nursing the significance of the quality of a new graduate’s work life on (Collaborative) degree from our province’s three schools of his/her decision to stay in the province cannot be understated. nursing. At least 82 per cent (n=155) of these new graduates Research has validated the obvious: the transition from graduate accepted employment in the province and along with a small nurse to registered nurse is stressful. While new graduates are numberI of graduates from other provinces and countries, have anxious to achieve, they often feel a lack of confidence in their helped to reduce the provincial external vacancy rate to one clinical decisions and organizational skills. This phenomenon per cent (n=81), the best it has been in years. Recruitment has been referred to as ‘reality shock.’ This is where you, initiatives are working. Government’s ARNNL members – as experienced RNs contract with the Newfoundland and Studies and experience – have a part to play in the provincial Labrador Nurses’ Union (NLNU), along recruitment and retention strategy. Studies with financial incentives such as education alike demonstrate that and experience alike demonstrate that when bursaries and signing bonuses, play an when new graduates are new graduates are mentored by supportive important role in this positive trend. These colleagues, they adjust positively to recruitment initiatives must continue as mentored by supportive their new professional role, they stay in there are still areas of chronic understaffing, colleagues, they adjust supportive practice environments, and most difficulties with meeting demands for relief, importantly, they will become great RNs – and increasing numbers of retiring “baby positively to their new just like their mentors! boomer” registered nurses (RNs) who will professional role, They Many stakeholders have a role to play in need to be replaced (e.g., 2010-11, n=243). stay in supportive practice the recruitment and retention of RNs – Of course recruitment is only ‘one side of the government, ARNNL, NLNU, employers, RN supply coin’ – the other side is retention. environments, and most and RNs. ARNNL has established Best The province is also doing well with importantly, they will Practice Guidelines for RN Orientation retention, as the majority of our province’s Programs (2003); all Regional Health become great RNs – just BN graduates are staying in the province Authorities are working to achieve these to practice. For three years in a row there like their mentors! guidelines. Coupled with ARNNL’s has been a positive trend in the two-year Quality Professional Practice Environment retention rate of new graduates, culminating with 78 per cent Standards (2006), these resources can assist members who are of the class of 2009 still working in the province in 2011. This working to ease the transition for new graduates. We can already is very good news. For some time now, employers have been see that the efforts are working, as this year there was a 2.7 per targeting activities to retain new graduates, including increasing cent increase in practicing members and the total number of the availability of full-time positions. In 2010-11, 73 per cent of members has reached an all-time high at 6,731! new graduates reported working in full-time positions, which Welcome, new graduates. And thank you to our members exceeds the national target of 70 per cent and is the best it has who support your growth and development as professionals. been in years. Furthermore, we expect to see this employment Everyone benefits from an increasing number of nurses in trend continue for the 2011 graduates (an expectation which our province, especially the people of Newfoundland and we will be able to confirm at licensure year-end, 2012). Labrador. Pegi can be reached at [email protected].

Access VOL xxXII NO 3 SEPTEMBER 2011 BN (Collaborative) Program

From the MAY 2011 Graduates Exec utive Director’s Desk Welcome to the Nursing Profession! Antle, Jennifer Burin Hayden, Melissa Grand Falls-Windsor Pike, Katelyn Pasadena Ashe, Katherine Fredericton, NB Hayter, Shalane norris Arm Pippy, Michelle St. John’s Baker, Caitlyn Lower Sackville, NS Hayward, Vanessa St. Mary’s Pittman, Carla Mobile Baker, Sheree newman’s Cove Head, Rebecca Comfort Cove Poole, Lacey Ramea Bath, Samantha twillingate Hearn, Renée Grand Falls-Windsor Porter, Christina Conception Bay South Bennett, Ashley Corner Brook Hedderson, Dinah Straitsview Powell, Marie St. John’s Bennett, Victoria Rushoon Hillier, Natalie Grand Falls-Windsor Power, Alison tors Cove Bent, Mariel Kingsport, NS Hillier, Nicole Grand Falls-Windsor Power, Robyn Mount Pearl Billard, Gina Burgeo Hillier, Samantha Griquet Reid, Crystal Gander Bay Blake, Lesley hant’s Harbour Hiscock, Victoria Maddox Cove Roberts, Robin triton Bolt, Travis terrenceville Hodder, Chantal Fredericton Roberts, Samantha Shoal Harbour Bond, Ashley Garnish Hoddinott, Jennifer Corner Brook Robinson, Laura Middle Arm Boyd, Jessica Summerford Howell, Courtney victoria Roil, Nancy Conception Bay South Bradbury, Megan upper Island Cove Howell, Krista St. Anthony Rowsell, Laura St. John’s Brake, Meghan Meadows Hudson, Megan Black Tickle Shelswell, Lisa London, ON Brown, Kristel hawkes Bay Humber, Christopher Rocky Harbour Short, Jessica Pouch Cove Browne, Deanne Mount Pearl Hunt, Jessica Centreville Singleton, Laura old Perlican Bruce, Lauren Long Harbour Hynes, Boyd St. Philip’s Skeffington, Matt Irishtown Budden, Kendra Sop’s Arm Hynes, Cassandra Benoit’s Cove Skiffington, Joanne Bunyan’s Cove Bungay, Christina Burgeo Kavanagh, Diane St. John’s Skinner, Dinah Isle Aux Morts Burt, Robin Grand Falls-Windsor Kearley, Danielle Milltown Slade, Jennifer Carbonear Burton, Natasha Grand Falls-Windsor Kearley, Melissa head Bay d’Espoir Slade, Nicole Salmon Cove Caines, Danielle Pasadena Kennedy, Michele Mobile Smart, Lisa Mount Pearl Carew, Vanessa Port Kirwan Kippenhuck, Angela happy Valley-Goose Bay Snook, Gerri harbour Breton Carey, Amanda Cape Broyle Lambert, Angela Lewisporte Snow, Angela norris Arm Carey, Melissa Fortune Harbour Langdon, Courtney Botwood So, Matthew St. John’s Casey, Nicole Mount Pearl Lannon, Traci Placentia Spurrell, Alicia Portugal Cove-St. Philip’s Chan, Krista Buchans Lee-Hunt, Nicolle Milltown St. Croix, Melissa St. Georges Clarke, Mallory St. Lawrence Legge, Erin Clarenville Stamp, Karalyn Mount Pearl Collins, Ashley hare Bay Leonard, Ashlee Colliers Story, Lachlan St. John’s Collins, Kelly Lewisporte Lindner, Hans-Steffen happy Valley-Goose Bay Sutton, Chantel English Harbour West Connors, Ashley Goulds (Waygaard, Germany) Symes, Zuleika Fortune Conway, Cherise Cupids Linehan, Amanda Colinet Taylor, Crystal victoria Coombes, Vanessa St. Lawrence Lynch, Adam upper Island Cove Taylor, Holly Bay Roberts Crawford, Ashley victoria Lynch, Sarah St. John’s Taylor, Terri Forrester’s Point Curran, Michael Conception Harbour MacDonald, Rebecca Corner Brook Testu, Sarah Labrador City Dalley, Denene Botwood MacIssac, Robin Clarenville Thompson, Jessica Point Leamington Dalton, Erica harbour Main Maher, Tiffany Ferryland Tobin, Leighanne St. John’s Dalton, Kendra Bishop’s Falls Maloney, Tina Goulds Tobin, Natasha St. John’s Derraugh, Lynsey St. John’s McDonald, Daniel Conne River Tracey, Melissa St. John’s Drodge, Melissa Clarenville Mercer, Lana St. John’s Tremblett, Rhonda Bell Island Drover, Amanda hodge’s Cove Milley, Jillian St. John’s Tulk, Char-lee Aspen Cove Drover, Jennifer upper Island Cove Mitchell, Courtney Marystown Tuttle, Kayla Bay Roberts Dunphy, Joy Monkstown Moores, Adelle Portugal Cove-St. Philip’s Twyne, Megan Lewisporte Durnford, Brandon Burgeo Moores, Donna St. John’s Ward, Kerri-Lyn Goulds Eddison, Nikita noddy Bay Morgan, Andrea Conception Bay South Warren, Jacquelyn Bell Island Elford, Shauna Corner Brook Neil, Ashley Conception Bay South Watkins, Danielle Lewisporte English, Sherri Lynn Appleton Northcott, Kristina St. John’s Welsh, Courtney Whiteway Enserink, Elizabeth Cambridge, NS O’Keefe, Alison St. John’s Wheaton, Sarah Corner Brook Flynn, Ashley Labrador City O’Reilly, Michael St. John’s White, Erin Catalina Flynn, Rebekah Pasadena Obeid, Menal Richardson, Texas White, Jessica Labrador City Follett, Karla Lawn Ouellette, Stephanie new Denmark, NB White, Kathleen St. John’s Fowler, Amy St. John’s Parsons, Angela St. John’s Whitten, Simone St. John’s Gambin, Laura Dunville Parsons, Krista torbay Williams, Dana Gaskiers Gear, Tina Goose Bay Paul, Stephanie Ferryland Windsor, Nicole Aquaforte Gordon, Rebecca Glovertown Peddle, Mallory upper Island Cove Winsor, Catrina harbour Grace Grandy, Alicia Chamberlains Peddle-Barrow, Joanne Conception Bay South Winsor, Janine Glovertown Greeley, Mitchell Corner Brook Peddle-Drover, Jessica hodge’s Cove Winsor, Sarah Labrador City Greene, Jonathan Corner Brook Penney, Megan Glovertown Wolfrey, Shelley Rigolet Hagos, Mulue Deroq, ER Penny, Nicole Grand Falls-Windsor Woodman, Amanda Corner Book Hann, Crystal Mount Pearl Philpott, Amanda Gander Young, Mir-Randa Stephenville Crossing Hann, Wayne Summerside Philpott, Mallory Bridgeport Hawe, Michael Bay Roberts Pierce, Miranda harbour Breton Hawkins, Glenn Marystown Piercey, Susannah Corner Brook

3 Excessive Hours of Work: Professional and Union Considerations Joint document outlines safe practices to manage excessive hours of work

By: Siobhainn Lewis, RN, MN, Nursing Consultant– Policy and Practice - ARNNL & Maureen Harris, RN, MN, Research and Education Specialist - NLNU

t can be difficult for registered nurses (RNs) when they are determine his/her fitness to work overtime, including assessing asked to work overtime, and when asking others to work his/her level of fatigue and how such fatigue could compromise Iovertime. Feelings of frustration, fear, and concern for clients care or safety for clients, coworkers, or themselves. and your own well-being often surface. RNs owe a duty of care to Along with organizational strategies to help reduce the impact clients and are responsible to provide safe, competent, ethical care of having to work excessive hours, there are individual level under all circumstances. Yet at the same time, RNs have the right, strategies that RNs can employ. RNs have the responsibility and the responsibility, to take care of themselves. ARNNL and to come to work rested and prepared for work. This poses the the Newfoundland and Labrador Nurses’ Union (NLNU) recently greatest challenge for RNs who work shifts. “What Day is it? released a document to address professional and employment Strategies for Shift Workers,” is a booklet by Jon Shearer. It is concerns when working excessive hours. circulated to all new NLNU members and posted on myNLNU, While efforts to reduce the need for excessive hours of work NLNU’s members-only website. Shearer outlines key strategies continue, this document addresses questions around liability for reducing fatigue due to shift work. While you can’t always protection, workers compensation coverage, abandonment, control what happens at work, you can help stabilize your sleep and occupational health and safety issues. Excessive Hours of cycle by getting into a pre-sleep ritual (e.g., taking a warm bath, Work: Professional and Union Considerations (ARNNL and reading), sleeping on a quality mattress, selecting a room with a NLNU, 2011) provides long and short-term strategies at both the cooler temperature, going to sleep in the dark, and waking up in organizational and individual level for the RN working excessive the light. Diet also plays an important role in managing fatigue. hours, and the manager requesting that overtime be worked. It For example, it helps to divide your waking hours into thirds to also provides a guide for directing concerns to ARNNL, NLNU, establish meal times, follow good nutrition habits, and be mindful or both. Additionally, RNs are expected to use a professional of caffeine consumption. approach when addressing concerns related to excessive hours of Reducing and managing fatigue when working or when asking work, and this document outlines such approaches. others to work excessive hours is in the best interest of the Staffing and workload issues, along with working excessive hours, client and the nurse. The ARNNL-NLNU joint document is a can result in fatigue and impact judgment, decision-making, useful guide, and utilized with some “at home” strategies, can attendance, and quality of interaction with colleagues and clients be effective in addressing the fatigue that results from excessive (CNA, 2010). There is no professional or legal definition of hours of work. “excessive hours” in nursing. Nor are there limits on the number Excessive Hours of Work: Union and Professional Considerations of hours a RN can work in Newfoundland and Labrador, as there is available at www.arnnl.ca and www.nlnu.ca. are, for example, for pilots in the airline industry. The RN must

Access VOL xxXII NO 3 SEPTEMBER 2011 Ask a Practice Consultant Q&A By: Siobhainn Lewis, RN, MN, Nursing Consultant – Policy and Practice

Q: I am a RN working needs. As LPNs work to their full scope Statement and Guidelines, The Role of of practice, the RN role in long-term care the Registered Nurse in Long Term Care in long-term care. may move from direct care provider to (ARNNL, 2004). I’ve been hearing leader in establishing and maintaining It might be necessary to rethink the plans of care; coordinating the delivery question being asked. Perhaps the question lately that other of the plan; acting as an expert clinical should be twofold: “Am I prepared for the resource to other members of the care challenging role I face as a RN working in care providers are team; evaluating client outcomes; and the specialty area of Gerontology? What “taking over” my role. intervening when care needs are best met skills do I need to provide direction to the by a RN. The RN must, through coaching various levels of care providers involved Will the role of the and education, assist other members of in the plan of care?” the team to maintain standards of care. RN in long-term care The Role of the Registered Nurse in While the RN scope of practice includes Long Term Care document is being disappear? all LPN and PCA scopes of practice, revised to articulate the varied and it includes much more. RN education complex roles that RNs in long-term provides a depth and breadth of nursing care undertake in today’s environment, A: It must not! The list of “tasks” that knowledge, making the RN the most RNs once performed may be shifting, but and the role that RNs must assume to comprehensive, versatile and flexible meet future needs. Additionally, the the roles of advocate, leader, practitioner, of these providers (CNA, 2002). While program planner, educator and researcher ARNNL document Guidelines Regarding some nursing competencies are shared Shared Scope of Practice with Licensed (ARNNL, 2004) have never been more with LPNs or PCAs, it is the RN that important. Acuity and complexity of Practical Nurses (2000) is being revised brings an expanded knowledge base and to reflect changing scopes of practice. needs in long-term care are increasing and independence in all nursing competencies. evidence shows that higher professional Work will begin in fall 2011 and continue When the RN is coordinating care he/she over the coming year. If you would like staffing is linked with better patient must be aware of the scope of practice of outcomes (Kane, Shamliyan, Mueller, to participate in these revisions, please the other care providers (LPN and PCA), email [email protected]. Duval, 2007). their competencies and proficiency level. Providing quality resident-centered care A new LPN competency profile has just References available upon request. in this complex environment requires been released by the College a team of regulated (RN, NP & LPN) of Licensed Practical Nurses and unregulated (PCA) care providers. of Newfoundland and MANAGEMENT OF INCONTINENCE Collaborative work environments based Labrador. RNs should be Two self-managed study units: on mutual respect are critical for the familiar with the educational Ɣ Nursing the Patient with Urinary Incontinence: An benefit of all. However, this does not programs and scope of Introduction (4 hrs). Learn conservative management of stress & urge incontinence using case studies. $50+GST. mean that we all do the same thing. It both PCAs and LPNs. It Ɣ Urinary Incontinence and the Geriatric Patient: means we each bring differing levels of is also important that RNs A Nursing Resource (6 hrs). Gives RNs specialty knowledge and skill, and work within our help other members of the knowledge of assessment skills & conservative scopes of practice (what we are educated care team understand the management in the elderly. $125+GST. and authorized to do). Scopes of practice RN role. Become familiar For information, phone/fax 780-438-2341 evolve in response to client and system with ARNNL’s Position email: [email protected]

Ask a Practice Consultant reflects questions frequently asked about general topics. Members can access confidential practice consultation with ARNNL Nursing Consultants. See www.arnnl.ca under “Contact Us” for consultant contact information.

5 HomeOPTIMIZING Visits: MEDICAL CARE FOR THE ELDERLY By: Denise Cahill, RN, BN, PHC-NP, MNS

In Newfoundland and Labrador people over the age of 65 make up 13.9 per cent of the population; this number is expected to increase by 20 per cent within the next 10 years (Government of Newfoundland and Labrador, 2008). Elderly patients typically require a disproportionate amount of health care related to an increased number of chronic conditions. A study by the Canadian Institute for Health Information (CIHI) noted that 24 per cent of seniors reported living with three or more chronic conditions and were responsible for 40 per cent of health care use – making three times as many visits to emergency departments as seniors with no chronic conditions (CIHI 2011). Despite an appropriate focus on healthy aging, early intervention, prevention, and management of chronic conditions, a literature to maintain patients at home – avoiding emergency room visits, review revealed that little research was available that clearly hospital admissions, and premature admissions to long-term care related the benefits of preventative home-based community care facilities. programs to elderly patients. In 2009, a poster presentation profiling a patient (X.Y.) with six Gaps in medication management and patient safety were identified chronic conditions, compared hospital admissions and emergency by the CIHI as an area of concern in this population: seniors who room visits in a 44-month period before and after the introduction took more than five prescription medications were 13 per cent of our program. This comparison revealed a significant reduction more likely to suffer adverse effects than seniors taking one to two in emergency room visits/ hospital admissions. Based on this prescription medications (CIHI, 2011). Despite this knowledge, 48 profile, in 2010 a pilot study was initiated to evaluate the effect of per cent of seniors reported not having medications reviewed by our program, which provides comprehensive inter-professional a physician, and 47 per cent had no side effects or adverse effects primary care to homebound frail elderly patients in the St. John’s explained (CIHI, 2011). An increase in chronic disease equates metropolitan area. The study includes all homebound seniors to more medications, which increases the risk of side effects and in our clinic over the age of 80 with three or more co-morbid utilization of hospital resources. Comprehensive geriatric care and conditions. The purpose of this study is to evaluate the effect of medication assessments provided by an interdisciplinary team led our primary care program for frail elderly patients by measuring by a nurse practitioner can potentially reduce complications and their rate of emergency room visits and hospital admissions before co-morbidities and provide more effective, cost-efficient health and after the program, and compare these to a similar population care to seniors. with multiple chronic conditions receiving usual care. The Ross Medicine Centre, a satellite clinic of the Memorial An aging population coupled with rising health care costs and University Discipline of Family Medicine, began operating shortage of health care professionals provides challenges in in 2007 and is a community-based family practice clinic with delivering cost-effective care to our older population. Health a high population of geriatric patients, including those that care authorities and government agencies need to know where require access to physicians providing house calls. In 2007, in to direct financial resources to ensure cost-effective, high-quality collaboration with Dr. Roger Butler, I started a nurse practitioner- management to this population. Innovative, comprehensive led home-based program to frail elderly clients. In 2008, a clinical solutions are required, and interdisciplinary teams are one such pharmacist was added to our interdisciplinary team. Our structure solution. This pilot study will evaluate the effects of our program provides an interdisciplinary teaching model to nurse practitioner and the results of this study will be used to develop a larger and pharmacy students, along with family practice residents. All prospective study using a similar intervention. Together we can members of the team liaise on plan of care, as well as student skill make a difference and provide high-quality, holistic care to the progression, incorporate aid from community health nurses, and seniors of Newfoundland and Labrador. utilize community resources to provide holistic comprehensive Denise presented at ARNNL’s 57th Annual General Meeting and care. This model provides comprehensive geriatric care that aims Conference in June.

References available upon request. 6

Access VOL xxXii NO 3 SEPTEMBER 2011 N u r s e s of Note By: Jennifer O’Neill, BA, COMMUNICATIONS OFFICER

ARNNL’s Awards for Excellence in Nursing were presented on June 9, 2011. Since the provincial awards program was established in 1992, 44 RNs have been honoured with this prestigious recognition. Four RNs have received the Elizabeth Summers Novice Nurse Award since that category was created in 2007. ARNNL congratulates this year’s recipients, and is inspired by their dedication and commitment. For more information about the Awards for Excellence in Nursing program, visit www.arnnl.ca.

Ellen Peddle Community Health Nurse, Victorian Order of Nurses, Award for Excellence in Nursing – Practice Ellen’s compassion and unconditional respect for her clients is evident through her understanding of their holistic needs. Through her innovative approach, she has proven that limited resources need not be a barrier to quality care. Practicing in the community, often with clients with challenging needs and social constraints, Ellen takes pride in developing individualized care plans. Whether this means unorthodox time or meeting places, her targeted one-on-one approach has helped many families receive exemplary care. Ellen volunteers within her organization, shares her free time with local charities, and participated in a missionary trip to Zimbabwe with a suitcase full of health care supplies and items for local children in tow. A well-respected preceptor and mentor, all who work alongside Ellen say she is a true leader.

Denise English Nurse Educator, Centre for Nursing Studies, Award for Excellence in Nursing – Education A committed and passionate educator, Denise strives to create learning environments that foster open discussion, stimulate reflection, and impact practice. She has been praised for innovative student placements (particularly within theEating Disorders Interprofessional Team), introducing ‘tough’ topics in the classroom (such as global health, and equity and violence in the workplace), and implementing self-reflection exercises that challenge students to articulate their own vision for nursing practice. She is a member of several committees that foster and recognize scholarship, develop and apply standards, and advance evidence-based and collaborative practice at Memorial University and within Eastern Health, and was among the first educators at the Centre to use Desire to Learn (D2L) technology, an improved method of delivering course content and maintaining contact with students online.

Sharon Smith Program Director (Cancer Care), Eastern Health, Award for Excellence in Nursing – Administration Sharon sees the big picture, designs the path to achievement, and inspires change. Her work has supported improvements in client flow through the introduction of protocols, care maps and structured discharge planning. Her influence can be seen in the standards used to guide the administration of chemotherapy. Sharon was integral to the development of Eastern Health’s professional practice model, and she motivates others to support evidence-based practice and pursue professional development. Sharon was ARNNL’s President for the Association’s 50th Anniversary Celebrations, and during her tenure from 2001 to 2004, the profession made significant advances in the nurse practitioner and advanced practice nursing roles. She also presented ARNNL’s positions at national consultation events, including the Romanow Commission and the Senate Standing Committee on the Health of Canadians.

Paula Didham Nurse Educator, Western Regional School of Nursing, Award for Excellence in Nursing – Research Paula’s contributions as a researcher help to advance nursing knowledge and support the development of the nursing profession. Her research has been utilized to support a wide range of initiatives, including the Western Newfoundland Women’s Wellness Program and the Student Wellness Program at Grenfell Campus, Memorial University. She has been instrumental in getting dedicated research time for nursing faculty at Western Regional School of Nursing and worked with a team to secure a Grenfell Campus research grant - the first time this grant was awarded to a nursing faculty member. In 2008, Paula received an International Nurse Research Internship and participated in two international research projects under the direction of Dr. Nancy Edwards, Scientific Director with the Canadian Institute for Health Research.

Ashley Preston Staff Nurse, Acute Surgical Unit, Western Regional Hospital, Elizabeth Summers Novice Nurse Award Although a novice, the enthusiasm and professionalism Ashley demonstrates on a very busy surgical unit, as well as excellent assessment skills and belief in client advocacy, sets her apart. Described by her peers as “a breath of fresh air with a cheerful disposition and an infectious positive attitude,” Ashley has been commended for a great work ethic, an ability to work collaboratively, and a willingness to take on challenges and accept feedback. Staff and families alike have taken note of her leadership skills and resourcefulness, and she is already a sought-after mentor and preceptor to new nurses.

If you would like to nominate a RN you know for Nurses of Note, please email [email protected] 7 Students Dressed in Red: The Heart Truth Red Dress Fashion Show 2011 By: Catherine Barnes and Gina Colbourne

Traditionally believed to be a men’s health issue, heart disease and stroke has become an increasing concern for women. Although statistics report that heart disease is on the decline, “heart disease and stroke kills seven times as many women as breast cancer” (The Heart and Stroke Foundation, 2011).

n light of this information, it is important for women to be aware I of the risks and take early action to decrease their chances of developing these diseases. This paper highlights the experiences of nursing students who partnered with the Heart and Stroke Foundation (HSF) to raise awareness about heart disease and stroke in women. The HSF is a volunteer-based charity dedicated to eliminating and reducing the impact of heart disease and stroke. One of the organization’s major events is the Heart Truth Fashion Show, a national fundraiser and awareness invaluable not only to the students, but also to the population event that features local women modelling designer red dresses. involved. As students, we learned the importance of organization On Feb. 4, 2011, the show was held in St. John’s for the first time. and teamwork, and how to capitalize on our individual strengths Women from academia, entertainment, business, and heart disease to ensure overall success. We also increased our knowledge and stroke survivors took to the runway to raise awareness and of cardiovascular health and the various ways to reach out to funds. Guests were treated to a fashion show, local entertainment, a community to promote healthy lifestyles. In addition, we heart-healthy snacks, and a health promotion booth, organized by experienced the vital role a nurse can play in the community, Memorial University nursing students. while contributing to a meaningful cause. Nursing students from across the curriculum participated in this Our experience with the Heart Truth Fashion Show was educational event. The students took knowledge and skills learned in courses and enjoyable. The event provided an opportunity for nursing such as “Complex Care” and “Nursing Leadership,” and put them students to come together to raise awareness about cardiovascular into practice. Under the direction of Professor April Manuel, a disease in women. This experience allowed us to develop our select group of students interested in cardiovascular health leadership skills, provided insights into the role of the nurse as an worked with the HSF to make the evening inspiring, informative, advocate for populations at risk, and enabled students to translate and fun. The students’ primary responsibility was to develop a theoretical concepts into practice. Experiences such as the Heart health promotion resource booth to raise awareness and provide Truth event are imperative to the facilitation of student learning information about cardiovascular health. Activities included in a fun and positive manner. And we looked good, too! a blood pressure clinic, free heart-healthy recipes, information Catherine Barnes is in her last year of the fast-track BN on food labelling, and an interactive fitness station utilizing the Program at Memorial University. Nintendo Wii Fit. Gina Colbourne is in her 4th year of the BN (Collaborative) While this was an evening of fashion and fun, the learning Program at Memorial University and will graduate in 2012. experience cannot be overstated. Opportunities that allow students to voluntarily participate in community initiatives are References available upon request.

Access VOL xxXII NO 3 SEPTEMBER 2011 Dominos, Public Policy, and the Provincial Election By: Lynn Power, RN, MN, Director of Policy and Practice

Have you ever played dominos? This game in public policy requires government to create supportive involves the strategic balancing and aligning environments that enable people to live healthy lives, and makes healthy choices possible (WHO, 1998). of a series of small blocks – if one gives away, So how has public policy played out in our province? How many they all collapse. blocks are in our game of dominos? Are they all interconnected and leaning upright? To help our political candidates think about all his simple game highlights the concept of interconnectedness, the dominos, RNs need to reflect on their own nursing experience an idea that sometimes gets lost in the health care debate. and local issues. Questions to consider might include: T The domino blocks representing acute care get played most • What is the value of mandatory legislation? Think about the often and the health promotion and illness prevention blocks are effect of seatbelt and smoking legislation. Are there more moved into a separate game; bigger determinants of health, such areas that could benefit from legislative direction? as income, housing, and education, which have been shown to • The recent bus strike in St. John’s highlighted how a lack have a greater impact on health than any other variable, may be of access to transportation can negatively affect health left out altogether. care clients and providers. What is the state of our public But to be successful in the game, one needs to align all the blocks. transportation system? What impact does this have on As RNs we need to help policy makers understand the importance seniors? What options exist in rural areas? of the domino effect, and of the linkages between all the blocks, if • Is fitness a basic need? Given the reduction in the amount of we want to advance the health of the people of our province. You physical education provided in schools in the 90s, could the couldn’t ask for a better time to step up to this task as we head to current increase in childhood obesity have been foreseen and the polls in a provincial election next month. more importantly, forestalled? RNs need to help candidates learn what is important in health • What is needed to age gracefully at home? Is there adequate policy. This may sound daunting, or even boring, but it is a far cry snow clearing, access to healthy foods, and age-specific from either. Like the game of dominos, this task requires conscious recreational opportunities in your community? attention, patience and knowledge. Knowledge attainment must Yes, we will always need new diagnostic equipment, upgrades to include gaining a better understanding of the significance of hospitals and enough qualified staff, but don’t let the game end public policy. Day-to-day clinical care is crucial to the quality of there. There are more domino blocks to be played. RNs need to client service nurses provide, but to make a long-term impact we make sure that the candidates running in next month’s election need strong policies. Why? Because public policy is the broad are aware of all the determinants of health. Nurses must advocate framework of ideas and values within which decisions are taken for comprehensive, interconnected healthy public policies. Make and action or inaction is pursued by governments in relation to your voice and your vote count for health on Oct. 11. issues or problems – it is the game plan that guides government Visit www.arnnl.ca for election resources and information to action. Making sure that health in its broadest sense is included assist you in raising health matters with your candidates.

9 Goings on...G oings on...

LOCAL RNs RECEIVE NATIONAL ACCOLADES HEALTH AUTHORITY RECOGNIZES RNs DURING Goldie White, RN, in Makkovik, EMPLOYEE RECOGNITION WEEK Labrador, has been recognized for her Four RNs received Eastern Health’s CEO Awards in June. contribution to nursing in Canadian First The CEO Award expresses appreciation for the contributions Nation and Inuit communities. Goldie, that employees make in supporting the health authority’s past president of ARNNL, was one of vision of Healthy People, Healthy Communities. Individual three registered nurses honoured with Goldie White, R N awards were presented to Karen Donovan, Occupational Health Canada’s 2011 First Nations and Health Nurse Coordinator, Health Sciences Centre, and Inuit Health Branch National Award of Charmaine Lane, Division Manager, Medicine, St. Clare’s Excellence in Nursing during National Mercy Hospital. An award was also presented to the Nursing Week in May. In June, Bertha Adult Orthopedic Surgery Team for demonstrating team Schofield, RN, MN, received the 2011 excellence. RNs April Muggeridge, Division Manager, Canadian Lung Association Founders Orthopedics, St. Clare’s Mercy Hospital and Manager of Bertha Schofield, R N ,M Award, which honours individuals the Total Joint Assessment Clinic (TJAC), and Marilyn who have devoted themselves to the affairs of the Lung Tessier, Division Manager, Orthopedics, Health Sciences Association and to the cause of respiratory health. Centre, were recognized for their contributions to the Congratulations, Goldie and Bertha! team’s efforts.

EASTERN HEALTH PRESENTS The 2011 Eastern Health Nursing Gala Awards, which recognize ANNUAL NURSING GALA AWARDS outstanding nurses in areas of practice, education, leadership, management, and preceptorship, were presented on May 9. ARNNL congratulates this year’s RN recipients! Beginning Practitioner of the Year – Melissa Lambert Nurse Educator of the Year – Gloria Earle Nursing Leadership of the Year – Jackie Brockerville Nurse Manager of the Year – Beth Snow Nursing Director of the Year – Elaine Warren Nurse Preceptor of the Year – Shirley Coombs Advanced Nursing Practice of the Year – Barbara Earles Nursing Practice of the Year – Christine Broders Susan Morgan Anita Forward Alana Langdon Barbara Albrechtsons

Conferences and Workshops

Canadian Hospice Palliative Care Showcasing Nursing Scholarship – Newfoundland & Labrador Nurse Conference Nursing Research Conference 2011 Practitioner Association Navigating Safe Pathways to Quality (affiliated with the 40th Anniversary Conference & Annual General Meeting Hospice Palliative Care, Sept. 8-11, 2011 celebrations of the Western Regional Sept. 22 and 23, 2011 Delta St. John’s Hotel and Convention School of Nursing), Sept. 17, 2011 Mount Peyton Hotel, Grand Falls-Windsor Centre, St. John’s, NL The Pepsi Centre, Corner Brook, NL www.nlnpa.ca www.conference.chpca.net Email [email protected] for details Go oings on... 10 ings on...G Access VOL xxXII NO 3 SEPTEMBER 2011 g ACADEMIC AWARD HONOURS LONG-TIME Goin s on. RNs WITH EASTERN HEALTH PARTICIPATE IN ..Go HAITIAN RELIEF EFFORT NURSING EDUCATOR in ... From July 15-24, 13 RNs visited Haiti to assist medical staff The Ruby Dewling Memorial gs on at Bernard Mev Hospital in Port-au-Prince, the country’s Award in Nursing has been created earthquake-ravaged capital. The RNs were part of a team at Memorial University in memory of health care professionals from Eastern Health who of Ruby Dewling, a respected voluntarily took part in the relief effort through Team Broken MUNSON faculty member. Upon Earth 2011 and the University of Miami Global Institute. graduation from the General “We had a dynamic team from all areas of nursing,” said Hospital School of Nursing, Ruby Lynn Anderson, an Operating Room nurse at the Health attended the University of Toronto Sciences Centre. “I think everyone felt it was a worthwhile where she received a post-graduate investment of our time, energy, and resources. It certainly diploma in clinical supervision was the highlight of my career!” Team members used and teaching; in 1967, she joined annual leave for the journey, and raised funds to cover the the founding staff and faculty of costs of airfare, accommodations, and other expenses. MUNSON. A lifelong learner, Ruby went on to earn a BScN from Mount St. Vincent and a M.Sc. (Medicine) from Memorial. Throughout her career and retirement, Ruby was active in ARNNL’s activities as well as the work of the Atlantic Region – Canadian Association of Schools of Nursing (ARCASN). She also volunteered on committees for organizations related to her field (e.g., honorary life member of the Canadian Public Health Association, and Past Provincial President of the Cancer Society). To honour the pride she had for her profession, and her enduring belief in continuing education, the Ruby Dewling Memorial Award will be presented annually to a graduate student at MUNSON who is completing research in or has a demonstrated passion for community health, and meets the academic requirements for an award. To contribute to this fund, please contact Darcy McMeekin, Development Officer, MUNSON at (709) 777-8977 or email [email protected].

NURSING DIRECTOR RETIRES On July 29, 2011, Joan Rowsell, Director of the Centre of Nursing Studies (CNS), retired. Joan’s distinguished nursing career spans almost 40 years, beginning with her graduation from Memorial University of Newfoundland’s School of Nursing (MUNSON) in 1973. Since that time, Joan has worked in a number of roles including: Nursing Consultant, Department of Health; Director of Nursing (and later Director of Planning & Development) at the Waterford Hospital; Clinical Nurse Specialist at Lakeside Psychiatric Hospital in Toronto; ARNNL Practice Consultant; Associate Director and Assistant Professor at MUNSON; and since 1996, as the Director of the CNS. In more recent years, along with the directors of the Western Regional School of Nursing and MUNSON, Joan has provided leadership in establishing the process for the consolidation of nursing education within Memorial University. Joan’s contribution to the CNS has helped the Centre grow to become the great educational institution it is today. Her commitment and dedication to nursing and nursing education has been enormous and will continue to impact faculty, students and graduates for many years to come.

Go oings on... ings on...G 11 PAST PRESIDENT RECEIVES PRESTIGIOUS HONORARY MEMBERSHIP During ARNNL’s 57th Annual General Meeting (AGM) in June, Honorary Membership was conferred to Jeanette Walsh, RN, BN, MScN (retired). Recipients of this distinction are voted upon by ARNNL Council; the honour is bestowed upon individuals who have helped advance the nursing profession and/or the Association. Honorary Membership has been conferred to 48 nurses since 1954. Throughout her career, Jeanette has had a meaningful impact on the nursing profession and the quality of nursing education in Newfoundland and Labrador. She has been instrumental

r s tte in nursing education development at both the General Hospital and Memorial University schools of nursing. From 1972 to 1996, she was a formative educator at the General Hospital School of Nursing, and served as director from 1986 to 1996. Her visionary leadership facilitated many innovative changes to program content and delivery. A Past President of ARNNL, Jeanette served on Council for 11 years, and worked with ARNNL, the five directors of the schools of nursing, and many others to

m a consolidate the Diploma Schools of Nursing and to develop support for changing nursing education from Diploma to the Bachelor of Nursing (Collaborative) program. A passionate historian, Jeanette was the Coordinator of ARNNL’s 50th Anniversary Celebrations in 2004, and has co-written three books: From the Voices of Nurses: An Oral History of Newfoundland Nurses Who Graduated Prior to 1950 (2004); A Life of Caring: 16 Newfoundland Nurses Tell Their L L Stories (2008); and Overseas Recruitment: Experiences of Nurses Immigrating to Newfoundland and Labrador (to be published in fall 2011). Jeanette is an exemplary nurse leader whose distinguished service has contributed immensely to ARNNL and the nursing profession.

OUTGOING COUNCIL NATIONAL NURSING WEEK MEMBERS RECOGNIZED FOR During National Nursing Week, May 9-15, 2011, ARNNL EXEMPLARY SERVICE representatives visited several sites around St. John’s.

Bea Courtney Anne Doyle Patricia Rodgers COUNCI ARNNL wishes to thank Bea Courtney (Public Representative from 2008-11), Anne Doyle (Western Region councillor from 2010-11), and Bradley Walsh, Regulatory Officer (standing – left), and Pegi Earle, Patricia Rodgers (Eastern Region councillor from Executive Director (standing – middle), met with RNs at the Hoyles- 2009-11), for their dedication and commitment Escasoni Complex. to the work of Council. Anne and Patricia were recognized at their last Council meeting on June Attend an ARNNL Council meeting! The next 8. Bea received special recognition at ARNNL’s in-house Council meeting takes place on Oct. 27 and 28 th banquet, held in conjunction with the 57 AGM, at ARNNL House in St. John’s. Contact Christine on June 9. Fitzgerald, Executive Assistant, at (709) 753-6183 or [email protected] for details.

*More details about the business of ARNNL’s Council are available in UPDATE, ARNNL’s e-newsletter. Email [email protected] to subscribe today! L NN AR

Access VOL xxXII NO 3 SEPTEMBER 2011 Documentation “#20 gauge angiocath inserted in (Rt) hand.” Have Clinical you ever written this? The ARNNL Documentation Standards for Registered Nurses identifies the expectations for clinical documentation. Standard 4.1 states that precision in documentation is imperative. Corner So, did you put the IV in the right hand? You most likely inserted the angiocath in the vein in the dorsal aspect of right hand. Documentation is strengthened by the inclusion of details and accurate descriptions. The lawyer will certainly ask! For more information about accurate, clear and concise documentation, see ARNNL’s Documentation Standards for Registered Nurses in “Position Statements” under the “Publications” tab at www.arnnl.ca.

The price of gas Radon is a radioactive, colourless, odourless, tasteless gas that occurs naturally and is all around us. Radon can accumulate in buildings, especially in confined areas Linking to the work of others such as attics and basements. The question is not “if” A free online tool is making it easier for RNs to find but “how much” radon is in your home. Studies show provincial/territorial and federal policies addressing a clear link between breathing high concentrations of cancer and chronic disease risk factors such as radon and incidence of lung cancer. Smokers are at nutrition, physical activity, alcohol consumption, an even higher risk. Commercial radon test kits are tobacco control, infectious agents, environmental and available at most large department stores and home occupational exposures, and UV/Ionizing radiation. building supply stores. Place the test kit in the lowest The Prevention Policies Directory (www.cancerview. part of your home during months when the windows ca/preventionpolicies) is updated regularly, searchable are closed and leave it there for three to four months, and is a one-of-a-kind database of Canadian policies. then send for analysis as per kit instructions. If your Have a look! home test shows higher than 200 Bq/m3, you should Provincial Wellness Advisory Council make repairs to reduce the amount of radon entering your home.

Greg Noel, Executive Director (Acting) Newfoundland & Labrador Lung Association To reuse or not to reuse Have you ever been tempted to reuse a medical device that is intended for single-use only? Think again! There is insufficient scientific evidence to support Keeping the beat! the reprocessing and reuse of most, if not all, critical There are two types of heart failure – right and left, which and semi-critical single-use devices in clinical can be further subdivided into systolic and diastolic practice. In fact, as of 2010 all provincial Regional dysfunction. Systolic dysfunction is when the ventricle Health Authorities have issued policies that essentially has decreased ability to pump, and therefore decreased prohibit the reprocessing and reuse of medical ability to empty. Diastolic dysfunction is when the devices labelled as single-use. Read the full report at ventricle has decreased ability to relax, and therefore www.nlcahr.mun.ca/research/chrsp/suds.php. decreased ability to fill. Both types lead to decreased cardiac output, resulting in venous and pulmonary Janice Butler, BN, MN, MSc, Senior Research Officer / Program Coordinator congestion. Your patient assessment may reveal fatigue, Contextualized Health Research Synthesis Program (CHRSP) chest congestion, edema and shortness of breath. Newfoundland and Labrador Centre for Applied Health Research, Memorial University Paula Perham, RN, Heart Failure Clinic, Western Health

Editor’s Note: Clinical Corner is designed for nurses to share information that they have found in their experience to be practical, safe, and effective. ARNNL requires that the information provided reflect good nursing judgment. We do not confirm the validity of the submitter’s tip in the literature. ARNNL does not endorse any products identified in the submissions to this column. 13 Reaching a Milestone: THE Trust Celebrates 25 Years By: Violet Squires Ruelokke, RN (retired)

During this, the 25th anniversary of the formation of ARNNL’s Education and Research Trust, I am excited to reflect briefly on the history of educational support for registered nurses (RNs), and how the Trust began.

Despite the many obstacles they may have the goal. This was an exciting adventure. encountered, RNs in our province have Advice was sought from national sources always taken advantage of opportunities and legal experts, as a little band of to increase their nursing knowledge. nurses ventured into rules and regulations Awards Ceremony (Eastern Region), 1999 Even before the Trust was established, of the unknown world of charitable employing agencies were encouraged organizations. Their hard work resulted in to arrange courses that met ARNNL the federal government’s approval of the criteria; ARNNL provided educational formation of the Trust. Its creation was conferences to which limited numbers formally announced in ARNN News in of RNs were given time off from work 1986. Since then, ARNNL members have to attend; nurses left home to go to worked hard and inventively to develop other provinces and countries where and expand the Trust’s funds. Today, many educational institutions offered post- ARNNL members successfully receive graduate programs that met their needs; funding from their own Trust to advance and ARNNL had a small scholarship their nursing knowledge. At the ARNNL Awards Ceremony (Western Region), 2001 fund that awarded several scholarships AGM in 2010, members voted that each to successful applicants annually. Also, member would donate $10 each year, as as a member of the Canadian Nurses part of their licensure renewal fee, “to Association (CNA), ARNNL supported be used toward activities of the ARNNL the CNA Foundation through an annual Education and Research Trust” – a move contribution of 50 cents per ARNNL which confirms the high value ARNNL member, which meant ARNNL members members place upon nursing education could apply to the CNA Foundation and the work of the Trust. for its grants and scholarships. In time, The formation and growth of ARNNL’s Awards Ceremony (Eastern Region), 2006 Memorial University’s School of Nursing Education and Research Trust is a offered opportunities for advanced monumental achievement, of which RNs nursing education. in Newfoundland and Labrador can be As has been the case historically for the justifiably proud! province’s RNs, in the early 1980s ARNNL Violet is past Secretary-Treasurer members took a bold step: they decided the of the Trust and past President and time had come to form their own Education former Executive Director of ARNNL. and Research Trust. The Trust would add She is also an Honorary Member of to the education and research funding the Association, and a recipient of the already available to the province’s RNs. A Canadian Nurses Association (CNA) small group met to draft a plan to achieve Centennial Award (2008). Awards Ceremony (Western Region), 2007

Access VOL xxXII NO 3 SEPTEMBER 2011 Since its establishment in 1986, ARNNL’s Education Fall Application Deadline and Research Trust has been supporting the goals and aspirations of registered nurses in Newfoundland The Deadline is Oct. 15 – apply today! and Labrador, and today, proudly distributes a wide- range of scholarships, bursaries, and awards. Here’s Criteria and application forms are available what some recipients had to say about what the Trust online at www.arnnl.ca/trust. means to them:

The financial support I received from Continuing Education Awards ARNNL’s Education and Research Trust is Bursaries for Conferences and Post-Basic Specialty Courses immeasurable and indescribable. Doing a (up to $1,000) graduate degree at a distance is difficult Florrie Penney Continuing Education Bursary ($500) enough, but when you have financial support, Violet Ruelokke Primary Health Care Award (up to $1,000) that eases the journey significantly.I sincerely Nancy Llewellyn Pediatric Nursing Bursary ($500) thank ARNNL, for without your resources, my NL Gerontological Association Bursary ($500) PhD journey may not have been so fruitful or Peter & Elizabeth Yetman Oncology Nursing Scholarship – NEW financially achievable. (up to $1,000) Kay Daley Scholarship for Nursing Leadership – NEW - Lisa Adams, recipient of the Nursing Research (up to $1,000) Award (2010) for Doctoral Thesis: The Utilization of Acute Hospital Services by Seniors with a Mental BN (Post RN) Scholarships ($750-$1,500) Illness; ARNNL 50th Anniversary Nursing Scholar- ship (2009); The Marcella Linehan Scholarship BN Post RN Scholarship (2008); and Graduate Nursing Scholarship (2006) St. Clare’s Alumni Association Scholarship Bay St. George Chapter Scholarship

I was grateful to receive ARNNL’s Education Graduate Scholarships ($1,000-$2,000) and Research Trust Fund award of $1,000 Graduate Nursing Scholarship (MN & PhD) to Graduate student, Non-Nursing Masters. Marcella Linehan Scholarship This fund enabled me to offset the cost ARNNL 50th Anniversary Scholarship (PhD) of finishing my Masters in Education, Graduate Non-Nursing Scholarship Counselling Psychology internship. With this degree, I have added to my competencies as Bachelor of Nursing Scholarship ($1,000) a Community Mental Health Nurse, in the role Bachelor of Nursing – Year 2, 3, 4 of Mental Health and Addictions Counsellor. Bachelor of Nursing (Fast Track) – Year 2 Flo Hillyard Memorial Scholarship - Anna-Marie Kean, recipient of the Graduate Non-Nursing Scholarship (2010) General Hospital School of Nursing Alumni Association Scholarship

Nursing Research Award (up to $2,500) Receiving funding from the Trust opened up possibilities for me to finish my master’s RN Re-Entry Scholarship ($500) degree, avail of opportunities to complete research for my thesis, and travel to Toronto to do a poster presentation about my research findings at a national nursing conference. The process of completing the MN degree has been long and drawn out because of family illness, and the funds helped to take some of the financial pressure away. Thanks!

- Karen Whitehorne, recipient of the Nursing Research Award (2009) and Graduate Nursing Scholarship (2005)

15 Regulatory Notes Substance Abuse in the Workplace Recognizing the signs and symptoms in your RN colleague By: Michelle Osmond, RN, MS(N), DIRECTOR of regulatory services

A recent issue of Canadian Nurse featured an article on substance use and addictions among nurses (March 2011, “I think my colleague has a problem …”). This article hit home with one reader who responded with a letter that was published in the May issue of the journal. The reader wrote of a personal experience with narcotic addiction and highlighted the need for nurse colleagues to be aware of the signs of substance abuse and to “raise the red flag when necessary.” While statistics on the prevalence of substance use in the nursing profession vary, estimates in the literature report that between 10 to 20 per cent of nurses will have a substance abuse problem at some point during their lives. In the past five years, 14.7 per cent of allegations filed against ARNNL members have been related to substance use or addictions issues. Given these statistics, and the fact that registered nurses (RNs) have a direct role in the delivery of client care and health services, all RNs need to be aware of the signs and symptoms of problematic substance use among their peers.

What are the signs and symptoms that a nurse colleague may have a substance abuse problem? Signs and symptoms are potential behaviours associated with problematic substance use or addictions. Caution should be applied if only one sign is observed, as this may not necessarily indicate a problem with alcohol or drugs. While these signs are not exclusive to substance use, observing multiple signs with a colleague, over an extended period of time, may be indicative of a problem.

Physical: • Requests for shifts with less supervision and more access • Deterioration in appearance and/or personal hygiene to drugs • Slurred speech, hand tremors • Drowsiness or sleeping at work • Excessive sweating, flushed face, runny nose • Not complying with policies • Marked nervousness, increased anxiety • Complaints from clients/families regarding poor care • Pinpoint or dilated pupils • Unsteady gait Social: • Odour of alcohol • Withdrawal and increasing isolation from peers at work • Frequent hangovers • Family problems • Frequent trips to the washroom • Inappropriate responses or behaviours • Diarrhea and vomiting • Irritability with others, defensive • Blood spots on clothing (may indicate self-injecting) • Mood swings

Performance: Medication/controlled substance-related: • Gradual decline in work performance • Insists on giving medication via IM or injection when other • Excessive involvement in incidents or mistakes nurses give the same medication orally • Errors in judgment, particularly with medication • Signs out more controlled substances than other colleagues • Poor recall • Frequent wastage or breakage • Sloppy, illogical charting • Fails to follow policy regarding observation or co-signing for • Attendance issues, repeated absences with a pattern narcotic wastage • Unexplained absences from work, tardiness, leaving work • Discrepancies between patient charts and narcotic records early • Tampers with drug vials or containers • Prolonged/frequent breaks, absences from work areas during • Patient complaints of pain out of proportion to medication shifts charted • Preference for overtime/extra shifts • Frequent medication errors • Preference to take assignments for medication administration • Frequently disappearing after signing out narcotics

Access VOL xxXII NO 3 SEPTEMBER 2011 What should I do if I see these signs in a colleague? Refund Policy – Practicing/ Colleagues are most likely to identify changes or problems Interim Licenses and Non- in a co-worker’s practice given the close daily interaction Practicing Memberships they have in the work setting. Recognizing that a colleague To ensure effective budget planning and is demonstrating signs suggestive of problematic substance that the licensure statistics submitted use or an addiction may be the first step in the process to provincial and federal agencies are necessary to help him/her get the assistance they need. accurate, ARNNL has reviewed its refunds You may consider talking privately and honestly with your process. As of April 1, 2011, once the colleague and encouraging them to seek help. However, effective date for a practicing/interim when a nurse’s work performance and practice is impacted, license or non-practicing membership has regardless of the cause, your primary responsibility is to passed, a refund will not be issued. ensure client safety. The Standards for Practice (2007) and Code of Ethics for Registered Nurses (2008) set out the expectation for nurses to intervene in situations where client safety may be at risk. Furthermore, the Registered Nurses Act (2008) requires RNs who have knowledge, from direct observation or objective evidence, of another RN’s conduct Have You Moved? deserving of sanction to report the facts to ARNNL. This Having your current home mailing address is referred to as “duty to report;” it is a responsibility of on file ensures ARNNL can continue to all RNs and is critical to ensuring client safety and public send you news and information (including protection. The Act includes “incapacity and unfitness the annual membership/licensure renewal to engage in the practice of nursing” in the definition form) that matters to you. So, stay in the of conduct deserving of sanction (Section 18 (c) (iv)). A loop! If your home address has changed, nurse who has a substance abuse problem or an addiction let us know by simply filling out our online illness that is impacting his/her ability to practice must be Change of Address Form at www.arnnl.ca removed from the work setting until he/she is well enough (view the “Registration” tab). Also, be sure to practice safely. to notify the Canadian Nurses Association If you observe a colleague with overt signs that he/she may (CNA) at 1-800-361-8404 to ensure you be under the influence of a substance, reassign client care continue to receive Canadian Nurse to another staff person and notify your manager. The RN magazine. Act (2008) requires that the details of these situations be reported to ARNNL. Similarly, if you see a pattern of signs and behaviour in a colleague that may be indicative of a problem, raise that “red flag” and bring these concerns to your manager. Don’t forget to document the facts using organizational reporting protocols (e.g., occurrence What’s in a Name? reporting forms). If you change your name, it is important to RNs with problematic substance use or addictions can notify ARNNL. The name on your license place clients, colleagues and themselves at risk. Early card and ARNNL’s website matches the identification is critical in intervening to ensure client safety name on your ARNNL file. Employers and that the nurse is supported to get help and recover. and others use this information to verify To assist in early identification, all RNs need to be aware the licensure status of members. To of the relevant warning signs. RNs must intervene when avoid potential confusion, please forward a colleague’s ability to practice is impacted, regardless documentation of a name change (e.g., of the cause. The duty to report impaired practice is a copy of marriage certificate) to ARNNL. professional, ethical, and legal responsibility. For more information, contact Registration at (709) 753-6040 or 1-800-563-3200 (toll- For more information, please email [email protected]. free), or email [email protected]. References available upon request.

17 Improving Member Services: A Review of Online Registration Renewal

By: Bradley Walsh, RN, BN, MN, CPON, regulatory officer

On Jan. 17, 2011, ARNNL launched within seconds,” says Renee Reardon, its online registration renewal service. Member feedback: Administrative Assistant - Registration. Approximately 26 per cent of members Once a member’s license/membership renewed their practicing license or non- “Its structure promoted ease of has been processed, the information is practicing membership online. ARNNL completion and I found it to be automatically updated on the ARNNL has moved to online registration to very clear in comparison to other website, where a member or employer improve member services and become online systems I have used.” can verify that a license has been issued more environmentally conscious. The by using the RN and NP member search online system uses industry-standard “Thanks for finally making this feature. encryption technology to ensure all process available online and ARNNL is now in the process of information provided, including credit more environmentally friendly.” completing a full evaluation of the card numbers, are safe. Initial feedback online registration renewal system. New from members and key stakeholders has “Very user-friendly, even for not- features will be added to the system to been extremely positive. so-savvy computer users.” improve member services. Launching in Members are required to have a valid email early fall 2011, ARNNL members will address on file with ARNNL to access the “… easier than finding parking be able to update and edit their profile online renewal system. Approximately 70 on Military Road!” information 24 hours a day; members per cent of members already have an email will be notified when this service address on file; members may submit their becomes available. email address at any point during the registration year. In the spirit of environmental consciousness, ARNNL is moving In this first year of online renewal, there was some confusion toward a paperless licensure/registration application process. among members as to whether they could renew using the online For the 2012-13 registration renewal period, ARNNL has set a system and still pay fees via payroll deduction. Members enrolled goal of 50 per cent online renewal. Please note: paper renewal in payroll deduction are permitted and encouraged to renew online. notices and application forms will not be mailed to members Once the online renewal process is completed, a confirmation who renewed online in 2011-12; notification will be provided email is sent to the member’s email account. Members then print via email. Beginning fall 2011, ARNNL plans to host a number and submit the email confirmation to their employer, who then of educational teleconferences about the online registration forwards the required fees to ARNNL. Members are reminded renewal process. Visit www.arnnl.ca for important information to ensure confirmation emails are submitted by the cut-off dates and updates. established by their employer. ARNNL incorporated a number of support features to assist members in the transition to online registration renewal. Live online support was available on the ARNNL website during ARNNL business hours, a feature that is now available year-round by clicking on the live support button on the ARNNL homepage. Question mark icons have been placed next to key questions throughout the online system. When a member clicks on a specific icon, additional information related to the question becomes available. ARNNL also developed a Frequently Asked Questions document, which will continue to be updated on a yearly basis. According to ARNNL’s registration staff, the online system has significantly decreased the amount of time required to process and issue a license. “The online registration system allows me to process and issue a practicing license

Access VOL xxXII NO 3 SEPTEMBER 2011 Workplace Reps

Workplace Representatives (WPRs) volunteer to represent ARNNL by supporting professional nursing practice and communicating information in their workplaces. Reps complete an orientation and a workshop on Leadership in Professional Practice to prepare for the role. Ongoing support and development is provided through regular meetings and education sessions. Our Reps are introduced in Access so you will get to know these important volunteers!

Natalie Morgan, BN, MN, Mabel Chaytor, RN, CGN(C) CCHN(C) Mabel Chaytor has been a Workplace Natalie Morgan completed her BN in 1994 Representative since January 2004. She and MN in 2002, both from Memorial University. has enjoyed a 34-year nursing career, and In 2008 she achieved CNA certification in currently works as Patient Care Coordinator Community Health Nursing. Natalie became in the Endoscopy unit at St. Clare’s Hospital an ARNNL Workplace Representative in June in St. John’s, a position she has held for 2010. She currently works as Clinical Nurse two years. Mabel holds CNA certification Coordinator within Community Health at Eastern Health in Gastroenterology Nursing and is the Canadian Society of in Bay Roberts, where she provides clinical leadership within Gastroenterology Nurses and Associates (CSGNA) President- the Rural Avalon areas. Natalie is an active committee member Elect for 2010-12. She is a member of the Newfoundland and and is involved with advancing issues in relation to breastfeeding Labrador chapter of the Canadian Society of Gastroenterology and child health. Natalie says that she enjoys working through Nurses and Associates (NL-CSGNA), as well as the Canadian professional practice issues. “I enjoy supporting nurses in Association of Nurses in Oncology, and Canadian Association their daily practice with the goal of providing quality care,” of Hepatology Nurses. “I find nursing to be a very meaningful she says. career,” she says. “Providing support to patients undergoing stressful procedures is very rewarding.”

Colleen Kieley, RN, BN Diane Foss, RN Colleen Kieley became an ARNNL Workplace Diane Foss is a staff nurse at the North Haven Representative in November 2008. A graduate Manor in Lewisporte. She has spent 26 of her 29 of St. Clare’s School of Nursing (1994) and years in nursing working in this long-term care Memorial University (2007), Colleen works environment and became an ARNNL Workplace for Service Canada in St. John’s as a Medical Representative in 2010. “We have two inpatient Adjudicator. “There are 30 RNs working as wings, a palliative care room, and for the past 11 medical adjudicators with the Canada Pension years have had an after-hours clinic to serve the Plan Disability Unit in St. John’s, completing work for regions urgent needs of community members,” she says. Diane receives across Canada,” she says. “We assess medical information a sense of satisfaction from helping people who are unable, for regarding client’s medical conditions in determining eligibility whatever reason, to be independent. She eloquently describes for Canada Pension Plan Disability benefits.” Colleen is an her experience working with palliative patients: “There is a deep active volunteer in her community, within her children’s school satisfaction in serving the needs of someone during their last council and with her professional association. In addition to days or hours of life and ensuring that they have everything they her role as Workplace Representative, Colleen is a member need, including physical, mental and spiritual care. I consider it a of the working group to develop the Requisite Skills and privilege to be with our residents when they pass.” Abilities position paper, and is the newly-elected eastern region representative on ARNNL Council.

Registered Nurses Required Are you looking to expand your nursing scope of practice while earning up to $160,000 a year? If so, join our team of Registered Nurses in Nunavut, in providing primary care and emergency services.

Indigenous Health Group Inc. (IHG) is a well-established nursing services leader with an excellent track record as an employer and a provider of nursing services. We need nurses who can meet the challenge and responsibility in providing the best care possible.

We Offer: • Competitive pay rates, northern allowance, education incentives, bonuses and employee benefits • Scheduling flexibility to enhance your ability to manage both your professional and personal life • 24/7 access to travel specialists and professional nursing support Qualifications: • Current registration with RNANT/NU • Previous experience in northern nursing, maternal/child, chronic and emergency care is considered an asset Contact Human Resources Director, Poornima Saraswati, at 1-204-284-2189 or forward your resume to [email protected]. Visit us at www.indigenoushealth.ca

Alternative Dispute Resolution Workshop negotiation and mediation skills a learn how to deal with emotional and difﬁcult people St. John’s a learn how to resolve disputes October 18-21 a learn how to deal with tough negotiators a receive individual coaching in mediation a earn a certiﬁcate from the University of Windsor Law School

“The hands-on approach to the “Very educational. It is very learning was very effective.” applicable and hands on - Lisa Sullivan, Eastern Health, St. John’s without being intimidating.” - Jolene A. Roberts, Nurse, A.E. GROUP Roberts Medicine Professional Corp., Tecumseh 1.800.318.9741 | www.adr.ca | [email protected]

Access VOL xxXII NO 3 SEPTEMBER 2011 “My group rates saved me a lot of money.” – Kitty Huang Satisﬁed client since 2009

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The TD Insurance Meloche Monnex program is underwritten by SECURITY NATIONAL INSURANCE COMPANY. The program is distributed by Meloche Monnex Insurance and Financial Services Inc., Financial Services Firm in Quebec and by Meloche Monnex Financial Services Inc. in the rest of Canada. Due to provincial legislation, our auto insurance program is not offered in British Columbia, Manitoba or Saskatchewan. *No purchase required. Contest ends on January 13, 2012. Each winner may choose the prize, a 2011 MINI Cooper Classic (including applicable taxes, preparation and transportation fees) for a total value of $28,500, or a cash amount of $30,000 Canadian. Odds of winning depend on the number of eligible entries received. Skill-testing question required. Contest organized jointly with Primmum Insurance Company and open to members, employees and other eligible persons belonging to all employer and professional and alumni groups who have an agreement with and are entitled to group rates from the organizers. Complete contest rules and eligibility criteria available at www.melochemonnex.com. Actual prize may differ from picture shown. MINI Cooper is a trade-mark, used under license, of BMW AG, which is not a participant in or a sponsor of this promotion. ®/ The TD logo and other trade-marks are the property of The Toronto-Dominion Bank or a wholly-owned subsidiary, in Canada and/or other countries.

OO-MM8437-10 MMI.EN•arnnl (7.5x10).indd 1 11-02-03 9:10 AM 21

Projet : Annonce MMI 2011 Province : Newfoundland & Labrador Épreuve # : 3 Client : Meloche Monnex Publication : Access Date de tombée : 17/01/2011 No de dossier : Format : 7.5x10 OO-MM8437-10 MMI.EN•arnnl (7.5x10) Couleur : N&B Graphiste : Yannick Decosse

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WORKSHOP FEES

KŶĞͲĚĂǇtŽƌŬƐŚŽƉƐ͗ dǁŽͲĚĂǇtŽƌŬƐŚŽƉƐ͗ ǁǁǁ͘ĐƚƌŝŶƐƟƚƵƚĞ͘ĐŽŵ Ψϭϳϱ;ĞĂƌůǇͿΎΨϮϬϱ;ƌĞŐƵůĂƌͿн'^d ΨϯϮϬ;ĞĂƌůǇͿΎΨϯϴϬ;ƌĞŐƵůĂƌͿн'^d ΎϯǁĞĞŬƐƉƌŝŽƌƚŽǁŽƌŬƐŚŽƉ &ĞĞƐůŝƐƚĞĚĂƌĞƉĞƌǁŽƌŬƐŚŽƉ

PROVIDING WORKSHOPS FOR PERSONAL GROWTH THAT EMPOWER AND MOTIVATE

emotional intelligence mediation - Increasing Harmony and Productivity - An Informal Process for Conflict Intervention St. John’s: October 26, 2011 St. John’s: October 27-28, 2011

ŵŽƟŽŶĂůŝŶƚĞůůŝŐĞŶĐĞ;/ͿƌĞĨĞƌƐƚŽƚŚĞĂďŝůŝƚǇƚŽŝĚĞŶƟĨǇĂŶĚĂƐƐĞƐƐ dŚŝƐƐŬŝůůƐďĂƐĞĚǁŽƌŬƐŚŽƉŝƐĚĞƐŝŐŶĞĚƚŽŐŝǀĞƉĂƌƟĐŝƉĂŶƚƐƚŚĞ ƚŚĞĞŵŽƟŽŶƐŽĨŽŶĞƐĞůĨĂŶĚŽƚŚĞƌƐĂŶĚƚŚĞŶƚŽƵƐĞƚŚĂƚŝŶĨŽƌŵĂƟŽŶ ƵŶĚĞƌƐƚĂŶĚŝŶŐƚŽǁŽƌŬǁŝƚŚĚŝƐƉƵƟŶŐƉĂƌƟĞƐƚŽŝĚĞŶƟĨǇŝŶƚĞƌĞƐƚƐ͕ ƚŽŐƵŝĚĞŽŶĞƐ͛ĂĐƟŽŶƐ͘WĂƌƟĐŝƉĂŶƚƐŽĨƚŚŝƐǁŽƌŬƐŚŽƉǁŝůůůĞĂƌŶƚŽ ĐůĂƌŝĨǇŝƐƐƵĞƐĂŶĚǁŽƌŬƚŽǁĂƌĚƐŽƉƟŽŶƐĨŽƌƌĞƐŽůǀŝŶŐƚŚĞĐŽŶŇŝĐƚ͘ ƵƟůŝǌĞĞŵŽƟŽŶĂůŝŶƚĞůůŝŐĞŶĐĞŵŽƌĞĞīĞĐƟǀĞůǇƚŚƌŽƵŐŚďŽƚŚƐĞůĨͲ WĂƌƟĐŝƉĂŶƚƐǁŝůůŚĂǀĞƚŚĞŽƉƉŽƌƚƵŶŝƚǇƚŽĞǆƉĞƌŝĞŶĐĞƐĐĞŶĂƌŝŽƐƚŚĂƚ ĂƐƐĞƐƐŵĞŶƚĂŶĚƐŬŝůůĚĞǀĞůŽƉŵĞŶƚĞǆĞƌĐŝƐĞƐ͕ƌĞƐƵůƟŶŐŝŶĂŶŝŶĐƌĞĂƐĞĚ ǁŝůůŚĞůƉƉƌĞƉĂƌĞƚŚĞŵĨŽƌŝŶƚĞƌǀĞŶŝŶŐŝŶǀĂƌŝŽƵƐĐŽŶŇŝĐƚƐŝƚƵĂƟŽŶƐ͘ ƐĞŶƐĞŽĨŚŽǁƚŽĞŶŐĂŐĞŵŽƌĞĞīĞĐƟǀĞůǇǁŝƚŚŽƚŚĞƌƐ͘

working through assertive communication personality differences St. John’s: November 22, 2011 St. John’s: November 21, 2011 ĞŝŶŐĂƐƐĞƌƟǀĞŝŶĐŽŵŵƵŶŝĐĂƟŽŶŝƐƚŚĞĂďŝůŝƚǇƚŽĞǆƉƌĞƐƐƉŽƐŝƟǀĞ ĂŶĚŶĞŐĂƟǀĞŝĚĞĂƐĂŶĚĨĞĞůŝŶŐƐŝŶĂƚƌĂŶƐƉĂƌĞŶƚ͕ǁĞůĐŽŵŝŶŐĂŶĚ hƟůŝǌŝŶŐƚŚĞDǇĞƌƐͲƌŝŐŐƐdǇƉĞ/ŶĚŝĐĂƚŽƌ;Dd/Ϳ͕ƚŚŝƐǁŽƌŬƐŚŽƉǁŝůů ĚŝƌĞĐƚǁĂǇͲƚŽƐƚĂƚĞĐůĞĂƌůǇĂŶĚǁŝƚŚŽƵƚĚĞĨĞŶƐŝǀĞŶĞƐƐǁŚĂƚŽŶĞ ƉƌŽǀŝĚĞƉĂƌƟĐŝƉĂŶƚƐǁŝƚŚĂƉĞƌƐŽŶĂůĂƐƐĞƐƐŵĞŶƚ͕ĞƋƵŝƉƚŚĞŵƚŽ ŶĞĞĚƐ͘WĂƌƟĐŝƉĂŶƚƐŽĨƚŚŝƐǁŽƌŬƐŚŽƉǁŝůůďƵŝůĚĂŶĂǁĂƌĞŶĞƐƐŽĨƚŚĞŝƌ ƵŶĚĞƌƐƚĂŶĚƉĞƌƐŽŶĂůŝƚǇƐƚǇůĞƐǁŚŝĐŚĂƌĞĚŝīĞƌĞŶƚƚŚĂŶƚŚĞŝƌŽǁŶĂŶĚ ĐŽŵŵƵŶŝĐĂƟŽŶƉĂƩĞƌŶƐĂŶĚůĞĂƌŶƚŽĚĞĂůĐŽŶĮĚĞŶƚůǇǁŝƚŚƉĞŽƉůĞ ƉƌŽǀŝĚĞƐƚƌĂƚĞŐŝĞƐƚŽĞīĞĐƟǀĞůǇŝŶƚĞƌĂĐƚǁŝƚŚ͘ ĂƌŽƵŶĚƚŚĞŵ͘

WORKSHOP FEES dŽƌĞŐŝƐƚĞƌŽƌĨŽƌĨƵƌƚŚĞƌŝŶĨŽƌŵĂƟŽŶ͗ ǁǁǁ͘ĂĐŚŝĞǀĞĐĞŶƚƌĞ͘ĐŽŵ KŶĞͲĚĂǇtŽƌŬƐŚŽƉƐ͗ dǁŽͲĚĂǇtŽƌŬƐŚŽƉƐ͗ Ψϭϲϱ;ĞĂƌůǇͿΎΨϭϵϱ;ƌĞŐƵůĂƌͿн'^d Ψϯϴϱ;ĞĂƌůǇͿΎΨϰϲϬ;ƌĞŐƵůĂƌͿн'^d ŝŶĨŽΛĂĐŚŝĞǀĞĐĞŶƚƌĞ͘ĐŽŵ ϭ͘ϮϬϰ͘ϰϱϮ͘ϬϭϴϬ ΎĞĂƌůǇƌĞŐŝƐƚƌĂƟŽŶϯǁĞĞŬƐƉƌŝŽƌƚŽǁŽƌŬƐŚŽƉ͘ZĂƚĞƐĂƌĞƉĞƌǁŽƌŬƐŚŽƉ͘