Meet RNAO’s new president • Helping international nurses register • RNAO’s Day at Queen’s Park

March/April 2004 Registered Nurse JOURNAL

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VOLUME 16, NO. 2, MARCH/APRIL 2004

FEATURES

19 NURSING’S HISTORY OF HAZARDS 12 By Kimberley Kearsey The government’s promise to fund the purchase of new, safer equipment in Ontario hospitals is good news, but is it enough to fix the age-old occupational hazards that have become “part of the job” for nurses?

Q&A WITH JOAN LESMOND 17 By Carl Mavromichalis Joan Lesmond will take the helm as RNAO president on April 23. She offers members and colleagues a glimpse of her goals over the next two years.

CULTURE SHOCK 19 By Kimberley Kearsey and Carl Mavromichalis With a little guidance and CARE, more and more internationally educated nurses are making THE LINEUP the grade in Ontario.

EDITOR’S NOTE 4 BIG DREAMS IN A BIG RIG 21 By Carl Mavromichalis PRESIDENT’S VIEW 5 A passion for nursing and a penchant for MAILBAG/CHNAC STANDARDS 6 trucking drives one nursing student to a BScN and the opportunity to fulfill her dream EXECUTIVE DIRECTOR’S DISPATCH 7 of outpost nursing. OUT & ABOUT 8 A DAY IN THE LIFE OF RNAO’S BOOK REVIEW 9 22 EXECUTIVE DIRECTOR NURSING IN THE NEWS 10 By Cheryl Yost, RN, BScN, MEd Cheryl Yost shares her experience as the first RN PROFILE 23 recipient of the Hub Fellowship, and the CALENDAR 27 necessities that go along with job shadowing executive director Doris Grinspun for one week.

POLITICIANS PROMISE RNs, 24 CHANGE IS A PRIORITY By Kimberley Kearsey For the fifth consecutive year, RNAO’s Annual Day at Queen’s Park provokes policy discussion between nurses and provincial politicians. The journal of the Editor’s Note REGISTERED NURSES ASSOCIATION OF ONTARIO 438 University Avenue, Suite 1600, Toronto ON M5G 2K8 Phone: 416-599-1925 Toll-Free: 1-800-268-7199 Fax: 416-599-1926 Web site: http://www.rnao.org E-mail: [email protected] Letters to the editor: [email protected]

EDITORIAL STAFF Lesley Frey, Acting Publisher Kimberley Kearsey, Acting Managing Editor The power of change, Jill Shaw, Editorial Assistant EDITORIAL ADVISORY COMMITTEE the importance of initiative Patricia Stiles, Chair Kathy Dawe, Joseph Gajasan, Rebecca Hagey, Ann Lukits, André Picard, Rani Srivastava, With this issue, I celebrate one year as managing editor Carol Yandreski DESIGN, ART DIRECTION, PRODUCTION of Registered Nurse Journal. It’s been a tremendous experience, Tammy Hunter/Ireland+Associates and one that has offered me invaluable insight into the sweep- ADVERTISING Registered Nurses Association of Ontario ing and often complicated policy and practice challenges nurs- Phone: 416-599-1925, ext. 211 Fax: 416-599-1926 es face across the province and the country. SUBSCRIPTIONS Our cover feature, for example, touches on two pieces of an The Registered Nurse Journal is a benefit to members of the Registered Nurses Association of Ontario. Paid sub- intricate and complicated occupational health and safety puzzle with which nurses scriptions from others are welcome. Subscription rate (six issues): Canada $36 per year. Outside Canada: $42 per contend daily.It is a telling example of just how sizable the challenges for the profes- year. Publications Mail Registration No. 10239. Agreement No. 4006768, ISSN 1484-0863. Printed with sion can be. It also serves as an example of the kind of professional hazards nurses need vegetable-based inks on recycled paper (50% recycled and 20% post-consumer fibre) on acid-free paper. to persistently bring to the attention of government and employers. The Registered Nurse Journal is published six times a year by the Registered Nurses Association of In this issue we review RNAO’s 5th Annual Day at Queen’s Park, and look at what Ontario. The views or opinions expressed in the editorials, politicians propose to address some of the other big-picture issues for the profession. articles or advertisements are those of the authors/adver- tisers and do not necessarily represent the policies of We offer you their perspectives on the need for more full-time employment, com- RNAO or the Editorial Advisory Committee. RNAO assumes no responsibility or liability for damages arising petitive bidding in the community health sector, funding and accountability, and the from any error or omission or from the use of any infor- mation or advice contained in the Registered Nurse ongoing struggles to understand how public/private partnerships impact the lives of Journal including editorials, studies, reports, letters and advertisements. All articles and photos accepted for publi- nurses and their patients. cation become the property of the Registered Nurse Journal.Indexed in Cumulative Index to Nursing and Each of the stories we bring you this month explore the power of change and the Allied Health Literature. importance of initiative. In the eyes of political leaders and decision-makers, change RNAO OFFICERS AND DIRECTORS may be complicated, expensive, fraught with red-tape, and achievable only in the long Adeline Falk-Rafael, RN, PhD term. In the eyes of nurses, change is essential. And it’s the only option if people are President ext. 202 Joan Lesmond, RN, BScN, MSN to get the care they need and deserve from nurses. President-Elect, ext. 204 Doris Grinspun, RN, MSN, PhD (Candidate) I’ve enjoyed my front-row seat this past year as political change unfolded across the Executive Director ext. 206 Irmajean Bajnok, RN, MScN, PhD entire health-care system.And I’m excited to share in the political strides of the asso- Director, Centre for Professional Nursing Excellence ext. 234 ciation in the year to come. Nancy Campbell Director, Finance and Administration ext. 229 Jacqueline Choiniere, RN, MA Director, Policy and Research ext. 215 Lesley Frey Acting Director, Communications ext. 209 Daniel Lau, MBA Director, Membership and Services ext. 218 Kimberley Kearsey Acting Managing Editor

www.rnao.org 4 March/April 2004 President’s View with Adeline Falk-Rafael

Awe, pride define two years as RNAO president

Two years ago I reason for nurses to be political and speak ment accountable to campaign promises to became your presi- truth to power than the loss of 44 deliver 8,000 more nurses, with 70 per cent dent and I challenged Ontarians to SARS, including two nursing of RNs working full-time; and to strengthen nurses to a course of colleagues who made the supreme sacrifice our beleaguered public health system to political action and in the line of duty.Registered nurses risked ensure we are prepared for future health professional citizenship their own health and safety to protect their emergencies. that would embrace patients, families and colleagues, and it is As my term draws to a close, the 30- the notion that politi- impossible to separate the personal tragedy year-old words of Hildegard Peplau that I cal advocacy is a dimension of caring that is of SARS from political decisions related to shared with you when we embarked on this a moral imperative. I challenged each of us health care. For instance, SARS shone a remarkable journey in 2001 are an equally to assume the role of citizen nurse, to put spotlight on the danger of ill-conceived fitting vision for the next leg of our mission: ‘health’ and ‘care’ back into an illness treat- “And this is the test:Whether or not the ment system while at the same time keeping will and the energy of nurses can be mobi- profit out of the equation. As I reflect lized sufficiently to meet the new [and As I reflect on my time as president, I “ not-so-new] challenges on the horizon for am proud of the perseverance and persis- on my time the profession of nursing…Silence gives tence demonstrated by members of our consent, it is said.” She continued: “This is professional association. We have built an the time for nurses to stand up and be association that is a force to be reckoned as president, I am counted as men and women who intend to with, often setting the political and policy continue the advancement of the profes- agenda rather than simply responding to it. proud of the sion of nursing in the public interest.” Our ability to lead reform and influence While it may seem like Ontario’s regis- change has increased exponentially and perseverance and tered nurses are being perpetually tested, will continue to do so as more and more we have not opted for silence. I trust that registered nurses join RNAO. persistence each of us will continue to stand up and be As I write this, my last column as your counted.We are at the forefront and on the president, I am awed by the enormity of the demonstrated front lines. We are behind the scenes, opportunities seized and the challenges con- around decision-making tables, before leg- fronted over the course of the past two years. by members of islative committees and royal commissions, To gether we have spoken truth to power. in front of the media, and across communi- Take,for example, the run up to the our professional ties and sectors. release of Commissioner Roy Romanow’s There is power in numbers, and I look final report, Building on values:The future of association.” forward to the day that every registered health care in Canada, in November 2002. nurse in Ontario chooses to be a member The common thread that nurses wove suc- of this association. cessfully into the commission’s 18-month policy decisions such as Ontario’s overre- I want to thank you all for the privilege consultation is the notion that the person- liance on casual and part-time nursing and of serving as your president. I look forward al is political. Nurses work with people at irresponsible cuts to public health services. to continuing to work with you under the the point where health-care policies meet Nurses have a legacy of advocacy and very able leadership of president-elect Joan their personal lives. It was from this privi- political action that dates back to Nightingale’s Lesmond and executive director Doris leged vantage point that we steadfastly time, and we still have much to do: to cham- Grinspun, as we continue to build a endeavoured to strengthen and preserve pion the full implementation of Romanow’s stronger profession for a healthier Ontario. Medicare all the while refuting arguments 47 recommendations and halt provincial and in favour of for-profit, two-tier health care. federal musings about two-tier health care; ADELINE FALK-RAFAEL, RN, PhD, IS And I cannot imagine a more personal to hold Premier McGuinty’s Liberal govern- PRESIDENT OF RNAO.

Registered Nurse Journal 5 Mailbag

Raising awareness for promotion staff to ensure students and staff A healthy school promotes the physical, the health of our children have access to high quality health and physi- mental, social and spiritual health of the Re: Healthy Schools--A recipe for a healthy cal education curriculum resources, health whole school community and constantly tomorrow, November/December 2003 and other relevant services,a supportive social strengthens its capacity as a healthy setting On behalf of the Ontario Healthy Schools environment, a healthy physical environ- for living, learning and working. The Coalition,I would like to thank Adeline ment, and health-supporting policies. Ontario Healthy Schools Coalition is looking Falk-Rafael for the issues she raises in her Ontario must have adequate numbers of forward to working with our new minis- (Nov/Dec) President’s View. At least 41 public health nurses and other health promo- ters of education, health, children’s services, European countries, as well as Australia, tion staff with a mandate to work in partner- and others, to make this vision a reality in the United States and many Canadian ship with school boards, principals, teachers, Ontario. provinces have prioritized the promotion of parents and students to identify each school’s Carol MacDougall, RN healthy schools. strengths and health-related needs, and to Mississauga Ontario needs to build on the excellent plan and take action to address the identified investment it has made in the early years (0- needs. Ontario requires inter-ministerial 5), and now coordinate the resources of the commitment to a vision of healthy schools, WE WANT TO HEAR FROM YOU. various ministries to support children and and sustained funding for a provincial coor- Please e-mail letters to [email protected] youth through their school years. Schools dinating centre to disseminate the model or fax 416-599-1926. need public health nurses and other health more widely throughout the province.

Community health nursing standards released Is my membership fee

ew national standards for community goal of CHNAC. The standards were built on tax deductible? Nhealth nurses, released in October 2003, work done by RNAO’s Community Health have led to the formal designation of com- Nursing Initiatives Group (CHNIG). "Their very year at this time members ask, "Is munity nursing as a specialty by the support and expertise was pivotal for the Emy RNAO membership fee tax Canadian Nurses Association (CNA). national process early on," Mildon says. deductible?" The answer is – it depends. "Based on the principles of primary Mildon hopes the new standards will If you are an employed nurse, RNAO fees health care, the standards articulate the influence nursing curricula across the coun- and interest group fees do not qualify as a unique contribution of community health try. She would also like to see the standards deduction from salary since RNAO fees are nurses, with a focus on public health and integrated into on-the-job performance not necessary for the individual to maintain home health," Barb Mildon, RNAO board appraisal tools, and used to inform service professional status recognized by law. member and president of the Community funding processes. She praises the communi- Self-employed individuals have to include Health Nurses Association of Canada ty health nursing administrators who have in their personal income tax returns a (CHNAC), says. They also "serve as quality purchased the standards for their staff mem- Statement of Business Activities or indicators, and demonstrate collective and bers, and the educators who are inserting Statement of Professional Activities. These individual practice accountability." them into their course readings. She also taxpayers are permitted to deduct expenses The standards were developed by extends thanks to the many community incurred for purposes of earning business or CHNAC, in consultation with nearly 1,000 health nurses who contributed to the devel- professional income and for them it is a mat- RNs across Canada. opment of the standards, and to the funders ter of satisfying the Canada Customs and The development of the standards and who made it possible. Revenue Agency that payment of voluntary the availability of CNA certification for com- The standards can be downloaded free of membership fees are expenses incurred to munity health nursing (scheduled for the fall charge, or purchased in booklet form from earn such income. of 2005) mark the realization of a founding www.communityhealthnursescanada.org

6 March/April 2004 Executive Director’s Dispatch with Doris Grinspun

Engage tomorrow’s leaders to secure nursing’s future

In my last column,I up with their futile search for full-time any nursing employment in Ontario. Other put forward a new def- employment responded immediately with recent graduates and nursing students – from inition of nursing lead- letters to the editor. freshmen to seniors – with similar experi- ership. I defined true The momentum continued to build.The ences made the trip to Queen’s Park to sup- leadership as a combi- Toronto Star wrote an editorial (Jan. 15, Let’s port their colleagues in a spectacular display nation of sound knowl- invest now in young nurses) pointing to the of solidarity. edge, an unwavering need for a more aggressive strategy in Their concerns did not fall on deaf ears. passion for a cause, and Ontario as students graduating this year On Feb. 24, Minister of Health George the courage to share these with others. cannot get the promise of full-time jobs in Smitherman announced $385 million in Indeed, nurses can and must be leaders in Ontario and are being actively wooed by additional funding for the provinces hospi- all aspects of health-care delivery and the U.S. and other Canadian provinces. tals, including $50 million earmarked to hire reform.To do so, we must embrace this new full-time nurses. definition to create shared leadership, recog- We have a most remarkable and convinc- nizing and rewarding leadership from the “We must foster ing ally in this new generation of nurses. bedside to the boardroom. Despite the fact that approximately 3,000 We must also cultivate and nurture the leadership in the young RN professionals are at the starting innate leadership capacity of future genera- next generation, gates of their career, full-time employment tions of nurses. We must ask ourselves: How has eluded them. Soon-to-be graduates are do we move students from silence to voice? encouraging new already accepting positions in the U.S. and How do we engage tomorrow’s nurses in other jurisdictions. Full-time employment the issues of today to continue the profes- grads to own and will not only keep them here, but it’s also the sion’s tradition of shaping health care and only way for novice nurses to integrate their nursing? How do we alleviate their con- shape the future superb education into exquisite nursing prac- cerns about reprisals from potential employ- of our profession, tice.This is a matter of urgency to attract suf- ers that may result from speaking out for ficient numbers of students to the profession, health, speaking out for nursing? and applauding them and to keep the graduates we do have here. The answer is quite simple: tap into their We must foster leadership in the next passion for nursing. Students are no different when they do so.” generation, encouraging new grads to own from the rest of us; their passion for nursing and shape the future of our profession, and knows no bounds. And once they’ve taken In response, nursing students, recent grad- applauding them when they do so. Just as those hesitant first steps into the political uates and registered nurses from across registered nurses need assurances that they side of nursing, their reservations and reluc- Ontario launched letter writing campaigns are part of a team, the next generation needs tance fade quickly away. demanding Premier McGuinty and Minister to know that new recruits are most wel- Take, for example, the recent grassroots of Health and Long-Term Care George come and needed. action taken by nursing students to add their Smitherman keep their election promise to After all, we too were once students in voice to the call for more full-time employ- hire 8,000 nurses, with 70 per cent of regis- need of guidance and support as we started ment opportunities in Ontario. It began tered nurses working full-time. our careers. We must be vigilant in our with an opinion piece RNAO submitted to This flurry of activity culminated in a efforts to bring students and novice nurses the Toronto Star (Dec. 30, Employment picture joint media conference at Queen’s Park on into the fold.Together, we can make a dif- grim for Ontario nurses) calling for govern- Jan.29,hosted by Ontario’s New Democratic ference for nurses, the profession and most ment and employers to stop the musings Party in conjunction with RNAO, where importantly, our patients and society. about a hiring freeze or slowdowns and Christine Weeden told reporters why she open the door to full-time nursing employ- accepted a job in Connecticut, and Heather DORIS GRINSPUN, RN, MSN, PhD (CAND) IS ment. Nursing students frustrated and fed Bryan recounted her failed attempts to find EXECUTIVE DIRECTOR OF RNAO.

Registered Nurse Journal 7 Out & About

Amy Bender, a full-time PhD student at the Faculty of Nursing, University of Toronto, was awarded the first Nursing Best Practice Guidelines PhD Fellowship at RNAO’s 5th Annual Day at Queen’s Park on Jan. 23. Funded by MOHLTC, the award will help Bender develop On Jan. 13, Health Minister George Smitherman attended the research capacity in the launch of RNAO’s Nursing Best Practice Guidelines (NBPG) spot- evaluation of the clinical, light organizations, three-year partnerships with health-care orga- financial and system outcomes resulting from the implementation nizations to implement and evaluate clinical guidelines. Pictured of RNAO’s best practice guidelines.With this fellowship, Bender (left to right): NBPG project director Tazim Virani, Minister will use RNAO’s Establishing Therapeutics Relationships guideline to Smitherman, and RNAO executive director Doris Grinspun. explore its impact on the health of individuals and communities.

On Jan. 22, RNAO hosted its assembly meeting at the Metropolitan Hotel in Toronto. Seated (left to right) is RNAO On Feb. 16, RNAO president-elect member Julie Page, president of Quinte On Jan. 29, nursing graduates, Christine Weeden,29 Joan Lesmond (right) visited with Chapter, and MPPs Linda Jeffrey, (middle left), and Heather Bryan, 25 (middle right), nurses in region 10 to discuss public Brampton Centre, Mario Racco, joined Nickel Belt NDP MPP Shelley Martel Thornhill, and Laurel Broten, Etobicoke (right) and RNAO president-elect Joan Lesmond health cuts in Ottawa,the implementation Lakeshore. The three politicians were at the Queen’s Park media studio to share their sto- of BPGs, and the need for nurses invited to discuss strategies to establish ries of struggle finding full-time work in Ontario. across the province to engage in more a relationship with a new MPP and Both students, who graduated from Humber political activity. Riek van den Berg Page shared success stories from College, were frustrated trying to find employment (centre), communications ENO for Quinte Chapter. in their home province, and Weeden accepted an region 10, and Una Ferguson, political offer to work in Connecticut. She left in February. action ENO, organized the event.

8 March/April 2004 by Zoë McDougall

at the end of their life. The mysteries Groopman includes in this most interesting book, his own jour- ney of pain. Disc disease severely disabled him. His rehabilitation physician told him to “ignore the pain. Just disregard its demands.As of human nature your mind reorients its beliefs, it will lessen the pain.”The author followed that advice and recovered fully. and our struggles This book teaches an important lesson that hope is comprised of two elements: belief and expectation. Groopman has successfully set out on a journey to answer questions like: Is there a biological mech- against disease anism whereby hope can contribute to clinical recovery? Is there a biology of hope? What are its limits? Is hope a feeling that occurs along with physical changes? Does it have any link to these feelings? When I began reading this book, I was unsure how Dr. n his latest book, Anatomy of Hope,Dr. Jerome Groopman uses Groopman would tackle the immense job of studying the complex story telling to teach us about human nature and the struggle and immeasurable task of pain management. Initially I was disap- I against disease. As the title implies, it is a book about instilling pointed that he could not provide a magical solution to the chal- hope in the seriously ill, and the mind’s role in healing. Early in the lenges of treating pain. The more I thought about it, however, the book, Groopman captures our interest with the personal stories of clearer it became that any hope of a magical solution is more than George, Dan and Barbara. Dr. Groopman or any caregiver can expect. The story of George, Groopman’s colleague and fellow Harvard That said, Dr. Groopman has made an excellent start and has pro- professor, is entrancing. When diagnosed with stomach cancer, vided some flavourful food for thought for all nurses who care for George undertakes a brutal treatment plan of high dose chemother- the living and the dying. RN apy with intensive radiation so overwhelming that the author labels it “iatrogenic torture.”George has “plunged himself into an abyss of ZOË MCDOUGALL, RN, IS A PAIN RESOURCE NURSE AND PALLIATIVE suffering” that nearly kills him.The reader follows George’s progress CARE NURSE SPECIALIST AT SAULT AREA HOSPITAL IN SAULT ST. and finds that rational science cannot explain George’s survival from MARIE, ONTARIO this seemingly incurable disease. What keeps George going despite overwhelming suffering? The story of Dan, also a cancer patient, shows us how he sensed his death coming and identified with a recently deceased friend who lost his battle with the disease.Dan decided he would die.Groopman, begging Dan to accept therapy, becomes convinced his friend can and will be saved.And Dan does just that. “I learned over the years to pay close attention when patients say they feel they are going to die,” Groopman writes, adding that he believes increasing pressure on the visceral organs due to a rapidly growing tumour can be interpreted in the brain as an accurate sig- nal of approaching death. The story of Barbara, and her struggle with breast cancer, teach- es us many lessons. It teaches us how to speak to people who are extremely ill, particularly after they find out “nothing else can be done.”Barbara teaches both the reader and Dr. Groopman that step- ping back and recognizing your quest for a cure is futile does not translate into giving up. She helps us to understand that there is always value in the care and comfort we provide to patients/clients “This book teaches an important lesson that hope is comprised of two elements: belief and expectation.”

Registered Nurse Journal 9 by Jill Shaw Nursing inthenews

New funding to open • RNAO member Pat Savean said funding RNAO & RNs nursing positions to incorporate the pain management BPG, weigh in on . . . The annoucement of $385 million to bail Gaining Control of Your Pain, into the cur- out Ontario’s hospitals, including $50 mil- riculum will allow Lakehead University Ontario’s shortage lion to hire full-time nurses, garnered and Confederation College to offer their of full-time employment province-wide coverage. pain management program • In a column in York University’s Critical • RNAO executive director “The home online (Kenora Daily Miner & Times, RNAO president Adeline Falk- Doris Grinspun said the services we News,Jan. 16). Rafael called on the provincial govern- funding means full-time jobs ment to keep its promise to hire 8,000 new for new graduates (Toronto provide are not Saving public health nurses, with 70 per cent of RNs working Star,Feb. 25). Grinspun’s dependent on • In a letter to the editor, full-time (January 2004). comments were also covered RNAO president Adeline • At a joint news conference held by by the Peterborough Examiner, where we house Falk-Rafael chastised Ottawa RNAO and the NDP, RNAO president- Kenora Daily Miner and News, our desks.” city council for proposing elect Joan Lesmond said more full-time Brockville Recorder and Times, cuts to local public-health nurses are needed immediately.“Ours is an CBC Radio One, CBC – RNAO member services. (Ottawa Citizen, urgent call for action.We know that insuf- television and CH News Lynn Beath, Feb. 18). ficient numbers of full-time nurses render (Hamilton) (Feb. 25). Orangeville Banner • RNAO member Lynn continuity of care, quality of care, patient • RNAO member Janis Beath reassured local resi- safety and positive nurse-patient relation- North applauded the funding announce- dents that public-health services would not ships impossible.” (Sault Star,Jan. 31) ment’s recognition of home-care and pub- suffer despite a potential office closure.“The • The Toronto Star, St. Thomas Times-Journal, lic health.“Strong community health-care home services we provide are not dependent Kenora Daily Miner & News,CP Wire,Welland services are vital to having an effective on where we house our desks.” (Orangeville Tr ibune, London Free Press, St. Catharines health-care system.” (Hamilton Spectator, Banner,Feb.17) Standard and Brantford Expositor also covered Feb. 25) • Joan Davison said Peel’s Healthy Babies the news conference (Jan. 30-31, Feb. 6). Healthy Children program is closing because • RNAO member Meghan Cholette told Improving care with best practice of budget cuts (Metroland Papers (Brampton), the To r onto Sun American recruiters have guidelines Feb. 22). been enticing her with offers of more On Jan. 13, RNAO announced new part- money and full-time work nerships with seven spotlight A career in nursing (Jan. 23). “We can’t organizations to implement In an article showcasing the challenges and • In a letter to the editor, stu- and evaluate nursing best rewards of nursing, RNAO executive direc- dent member Deborah expect people practice guidelines, as well as tor Doris Grinspun and RNAO members Dacombe expressed her to maintain funding for 11 collaborative Theresa Agnew, Rishma Bhanji and frustration at the lack of health if they nursing programs to incor- Mary Ferguson-Paré shared their passion full-time work in Ontario. porate NBPGs into their for the profession. “It’s a fast-paced, high RNAO members Debra don’t have curricula. pressure environment.You really have to be Grant, Matthew Somerset housing.” • RNAO member Kirsten up for the challenge,” Bhanji said (Toronto and Claudine Bennett also Krull-Naraj was pleased Star, Feb. 14). wrote letters supporting the – RNAO member Royal Victoria Hospital in call for more full-time Cathy Crowe, Barrie was chosen as a spot- Helping the homeless employment for new grads. The Kingston Whig- light organization. (Barrie • Upon receiving the Atkinson Charitable (Toronto Star,Jan. 8, 16, Feb. Standard Examiner & Barrie Advance, Foundation’s Economic Justice Award, 12; Mississauga News,Feb.9). Jan. 19) RNAO member Cathy Crowe told

10 March/April 2004 Toronto Star readers about the importance Easing the pain of mental illness announcement of $14 million in hospital of housing to good health. “We can’t • The Toronto Star featured RNAO member equipment, including patient lifts, RNAO expect people to maintain health if they Ellen Marchildon,who works with executive director Doris Grinspun told don’t have housing.” The Kingston Whig- police responding to calls involving dis- the Canadian Press: “Equipment is good, Standard also covered Crowe’s accomplish- tressed individuals, in an article detailing but equipment needs people.” Grinspun’s ment (Jan. 22, 23). the challenges of safely policing individuals comments were also covered by the • RNAO member Carol Lynch said she with a mental illness (Feb. 14). Brockville Recorder and Times, Sault Star and often treats the homeless for frostbite weeks • RNAO member Winnie Doyle said ren- Ottawa Sun (Feb. 10, 11). after they are initially affected because they ovations needed at the Centre for Mountain • RNAO member Diane Wilkinson said don’t seek medical care as soon as a problem Health Services are essential to equip the the equipment will improve retention in develops, and lack proper footwear (Kingston facility with technology to nursing by making work- Whig-Standard,Jan. 20). diagnose and treat mental “I felt this moral places safer (Kitchener-Waterloo illnesses. (Hamilton Spectator, Record,Feb.11). obligation to Ontario Hospital Association Feb. 11) Report Card improve things Nursing students share • RNAO member Pat Somers told the Funding for for patients. skills abroad Windsor Star lower patient satisfaction rat- hospice care • RNAO member Jackie ings for physician care are a result of a • The $63,496 raised for Their needs are Levere travelled to Honduras provincial doctor shortage, while Mary the Hospice of Providence so urgent.” in January as part of a med- Major, also an RNAO member, pointed Palliative Care Service in ical care team.“I know it will out improvements have been made since Brockville was good news – RNAO member be an eye-opening experi- the data was collected two years ago for RNAO member Cheryl Anita Stern, ence … I just want to go (Windsor Star,Jan. 27). Chapman (Brockville Recorder Hamilton Spectator down there and help out any • RNAO member Lynn Hall was pleased and Times,Feb.9). way I can.” (Peterborough over 75 per cent of respondents were satis- • RNAO member Liliane Locke said the Examiner,Jan. 19) fied with emergency room waits at new Palliative Care Demonstration Project • Sylvia van der Weg said Georgian Brockville General, Perth and Smith Falls in the Ottawa region will improve com- College nursing students travelling to the Hospitals. “The emergency department is munication between nurses, doctors and Dominican Republic this spring will learn at the heart of the service we provide our patients,particularly those who require hos- to provide care for patients without access community.” (Brockville Recorder and Times, pice care.“We’re trying to alleviate some of to health care. (Metroland Papers, (Barrie), Jan. 27) the anxiety a patient may have when they Feb. 15). • RNAO member Anne Atkinson provid- end up leaving the hospital.” (Ottawa Sun, ed reassurances that high levels of emer- Jan. 16). Sharing NP expertise gency care will continue • Susan Berry said hospice with local communities when a new urgent care “We’re trying to funding is needed to allevi- • Elizabeth Baker and Cynthia Kitson centre replaces Hotel Dieu ate pressure for acute care educated the public about the care nurse Health Sciences emergency alleviate some beds (St. Catharines Standard, practitioners can provide to patients with- department, “...so we’re still of the anxiety Jan 22). out family doctors.“As nurse practitioners, meeting patients’needs and • The Hamilton Spectator and we really promote self-care and the pre- a patient may we’re doing it in a timely Maclean’s magazine reported ventive aspects,” Baker said. (Brockville fashion.” (St. Catharines have when they on Anita Stern’s virtual Recorder and Times,Jan. 21) Standard,Jan. 27) end up leaving hospice, which provides • RNAO member Marilyn Butcher was information about death profiled in a column for children about a Better care for the hospital.” and dying for families, nurse practitioner’s roles and responsibili- infants and online networking for ties (Sudbury Star,Feb.14). RNAO member Shannon – RNAO member researchers.“I felt this moral Landry said the addition of Liliane Locke, obligation to improve things six new beds for infants in the Ottawa Sun for patients.Their needs are For complete versions special-care nursery at Royal so urgent.”(Feb. 7, 23) of any of these stories Victoria Hospital will ease stress for parents of contact Jill Shaw at new babies in intensive care (Metroland Papers, New funds for hospital equipment [email protected]. Jan. 23). • Following the Ontario government’s

Registered Nurse Journal 11 by Kimberley Kearsey

Nursing’s history of hazards

Feb. 10, the Ministry of Health and Long-Term On Care, in collaboration with the Ministry of Labour, announced $14 million in new hospital funding for the pur- chase of modern equipment. The Liberals say this equipment will protect the safety and well-being of nurses. While this announcement is a good start that instills confidence the gov- ernment recognizes a problem, nurses, health-care experts and researchers agree: it won’t stretch as far as is necessary to fix the long-standing, daily occupational hazards some nurses

Illustrations: Elesavet Triantafillou have grown to accept as “part of the job.”

12 March/April 2004

According to Ontario’s Workplace Safety but I also think there’s a need to educate may be, it is only one small part of the total and Insurance Board (WSIB), 4,332 lost nurses that they don’t have to take it.A lot of management of occupational health and envi- time injury claims were filed by nurses in nurses feel that this is…just something that ronmental safety issues,” she says. Simply put, 2002.That translates into more than 120,000 happens.Well,you know what? It happens all when it comes to musculoskeletal injuries and lost days of work at a cost of over $10 mil- the time but it doesn’t have to happen.” nurse abuse, there’s no quick fix. Addressing lion to the WSIB. Annett’s experience offers an important these challenges requires more than just one- Behind these unsettling statistics are hun- perspective on the severity of two of the most time funding. It requires education, a strong dreds of nurses who have experienced first- predominant and often overlooked hazards of financial commitment from employers, the nursing profession: musculoskeletal enforcement of legislation, policy develop- injuries and abuse/violence against nurses. ment, and unwavering demands – from nurs- Although Annett’s encounter took place es and management alike – that the culture in in a psychiatric facility, hers is a scenario that the workplace, a culture that accepts these could play out in any sector.Acts of violence hazards as “part of the job,”must change. against nurses, and the musculoskeletal Pam Mancuso, an RN at Sault Area injuries that result from personal attacks or Hospital (SAH), and Worker Co-Chair for other workplace hazards, are very real profes- the Joint Occupational Health and Safety sional risks that nurses take every day. Committee at SAH, knows first-hand the According to WSIB, an examination of the importance of policy development and top six injury categories for all of health care employer support. According to Mancuso, reveal that nursing comprises more than 60 SAH had 1,796 reported injuries from staff per cent of the claims in those categories. at the hospital between 1996 and 1999: 578 Fortunately, Ontario’s Liberal government back injuries; 338 musculoskeletal injuries; and 459 strains and sprains. As a result of those poor statistics, the hospital began “We are delighted that at least someone is assessing its options for initiating a Zero-Lift policy, which was finally incorporated starting to think about how to prevent back throughout the facility in 2000. “It’s (been) well-received,”Mancuso says. injuries and improve workplace injuries in general.” In fact, SAH has seen a downward trend in injuries since the implementation of its new policy. On average, within each nursing unit hand the hazards of the profession. One of recognizes the importance of improving the that has implemented the policy,the hospital those nurses is Lynn Annett, formerly a full- health of the nursing workforce,and February’s has seen a 50 per cent decrease in patient lift time RN at the Queen Street Mental Health funding announcement is one example of the and transfer incidents. The most dramatic Centre in Toronto. Annett’s story is signifi- commitment it promises to make to the pro- decrease has been seen in the medical and cantly different from some of her injured fession. “This one-time funding is going to nursing home units, which report a 70 per colleagues because her encounter with assist us,” RNAO member Paula Bond,VP of cent drop since the policy’s inception. workplace injury did not simply result in a acute care and chief nursing executive for But despite the hospital’s significant string of unwanted and preventable days off. Windsor Regional Hospital, said of the $1.5 financial investment into the program, and In fact, it resulted in a year of court proceed- million her facility has received. the positive results it has produced, Mancuso ings, seven in all, and in the troubling recog- “Is (the funding) going to resolve the acknowledges there will always be nurses nition that front-line nursing was no longer problems? No.We certainly could do with a who find that in the course of providing care in the cards for her professionally. lot more,”she said.“We are delighted that at they may be required to ignore these policies “I would love to go back to frontline least someone is starting to think about how to get the job done. nursing,”Annett says.“But I can’t do it.”With to prevent back injuries and improve work- Bond sees the same thing in Windsor.“As a chronic neck injury sustained during a vio- place injuries in general but certainly it is nurses, we tend to put the patient first and lent episode with a patient, Annett is physi- going to take continued funding before we our backs last,”she says. cally restricted and has moved from the see any real results from it.” “In a lot of cases, it’s more the workload frontlines to a management role with WSIB. Jill King, co-chair of RNAO’s Occupational that’s the problem, not the way that people “I knew the dangers of working in Health Nursing Interest Group (OHNIG), are doing the work,”Mickey Kerr, researcher psych,” she says. “I think (violence) is a risk agrees.“However helpful the new equipment for the Institute for Work and Health and

14 March/April 2004 assistant professor in the School of Nursing culture is different from the older culture.” to educate nurses about abuse and violence at University of Western Ontario, says.“Until According to Kerr,important strides have in the workplace.The campaign is the result that workload issue is dealt with – and it’s been taken to recognize the need for a cul- of a study conducted at the Network’s three unlikely to be dealt with through technolo- ture shift.“People are talking about it at least. sites in 2002, a study that explored incidence gy – the problems will continue.” There’s recognition now that nursing is one of abuse and the reactions of nurses on the According to a research paper that of the professions with the highest rate of receiving end.According to the study,nurses appeared in the American Journal of Nursing in disability and injury, and that something are 16 times more likely to experience abuse February 2003, the prevalence of work relat- needs to be done.That’s one of the reasons than other health-care professionals. Of the ed back injury in nursing is among the high- you have this announcement from the 515 UHN nurses who responded to the sur- est of any profession internationally, includ- Ministry,” he says. “There’s a lot of interest vey, 28 per cent experienced abuse within ing truck drivers,construction workers,min- now in ‘what can we do?’ and that’s starting the last year.This is on par with national sta- ers, agricultural workers and manufacturing to create interest in other areas too.” tistics which say 30 per cent of nurses expe- employees. Although the risk of injury is Nurse abuse is one of those “other areas” rience workplace violence every year. most prevalent when nurses are required to receiving significant attention these days. Given the prevalence of this occupational lift or move patients, back injury and muscu- To ronto’s University Health Network hazard, it’s somewhat bewildering that inci- loskeletal problems are also caused by time (UHN) will soon launch a poster campaign dence of abuse are underreported in Ontario. spent bending forward with a twisted back “Nurses don’t want to feel they are responsi- when bathing, dressing or undressing, and Study reveals nurses’ ble for being the cause of a problem,” turning patients, or when making beds. Bhandat Lurkhur, UHN clinical nurse edu- There are many instances when nurses are response to abuse cator (mental health), says of the findings of required to move, guide, steady or position a his study.“From the literature we reviewed, patient that, due to cumulative trauma, may n 2002, the University Health Network this is the kind of response investigators got lead to musculoskeletal problems over time. I(UHN) conducted a study of nurses at from nursing staff. They felt ashamed. They Some experts also believe that increased acu- its three sites to assess their response to felt that if they reported it, they would be ity of patients and the population’s increasing abusive behaviour from patients. blamed by management for being incompe- obesity rates are also adding to the strain on Following are some of its findings: tent.They probably felt they wouldn’t get the nurses’ backs. • Most respondents (289 out of 515) type of support they needed.” “I don’t know a nurse who doesn’t have a reported experiencing emotional abuse “I do believe it’s under-reported and I do bad back,”Bond says.“We have a tremendous in their last five shifts. believe it’s because a lot of nurses think ‘well, number of nurses who are off with back • Over the previous year, as many as it’s my job and I can’t change it,’” Mancuso injuries or neck strain. And what actually 3,550 threats of assault were uttered says. “I was hit by a patient eight or nine goes to WSIB I would suggest is a fraction of to nurses at UHN, only just exceeding years ago. She was an elderly lady who was what actually occur.We have a lot of nurses the year’s tally of physical violence at confused and had been restrained. I had to who continue to work…and go home each 3,507 incidents. go in and bath her. As I untied her, she hit shift in pain. I started as a staff nurse and I • Most (46 per cent) reported being me in the lip and I got a fat lip. My manag- remember those days well.” angry. Feelings of avoidance (32 per er’s comment at that time was ‘well, what did This culture of acceptance by nurses is cent), a reduction in patient contact you do to agitate her?’” one that puzzles some experts.“For whatev- (30 per cent), shock (27 per cent), and When Annett was attacked, the intensity er reason, a lot of people view themselves as a reduction in job satisfaction (26 per of the attack,the motivation behind it,and the immune to injury until it happens,”Kerr says. cent) were also predominant responses. violent history of the patient all led to her “The focus of the profession is not self • Less than half of respondents were troubling decision to press criminal charges. preservation; it’s about providing high quality aware of UHNs abuse policy or of the She received the support of her employer but care. And rightly so. But there needs to be a College of Nurses of Ontario (CNO) was surprised at the limited support of her balance. At some point it would be good to guidelines on abuse. peers. Annett found herself trying to balance see a bit of a shift…so you don’t have to • Most respondents wanted to see a her inclination as a nurse to act as patient change practice and culture.” clearer UHN policy, a more direct advocate against her rights to feel safe in the “It’s been slow,” Mancuso says about the process of actions following abuse, workplace. Despite this difficult balancing act, culture shift at SAH since the inception of and education programs for nurses Annett felt she was acting in the best interest the Zero-Lift policy.“The new nurses we’ve to become more comfortable with of her patient by moving forward with legal hired in the last year or so, they use the lifting disclosing experiences of abuse. action. By pressing charges, she says, her equipment very well. The younger nurses’ patient ultimately got the care she needed.

Registered Nurse Journal 15 “The court ordered her to take her pre- safety act; musculoskeletal injuries; best prac- With direction from a national advisory scribed meds,”Annett says.“This girl did have tices for patient handling; lift policies; proac- group comprised of experts within the field psychotic episodes at times. But when she tive, preventative steps to avoid injury; needle of nursing policy,research and healthy work- attacked me, she wasn’t psychotic. I didn’t stick instances; violence in the workplace; place environments, the survey will examine want to see it happen to anyone else. And I and even fragrance sensitivity as a hazard of the health and working conditions of nurses thought, as a nurse, that isn’t part of our job.” the profession. across Canada, and will provide information RNAO, the College of Nurses of “Probably one of the greatest benefits of that can be used to contribute to the devel- Ontario (CNO) and the Ontario Nurses the network is that we have leaders from all opment of evidence-based workplace health Association (ONA) agree.“If nurses are being across Ontario…sharing their best practices strategies aimed at improving the health and abused, they should come forward and talk and solutions,” Linda Haslam Stroud, presi- well being of nurses. The findings are also about it because it’s only by knowing what’s dent of ONA, says. expected to support the development of happening that it can be prevented and dealt That kind of support and discussion is government policies. with,” CNO practice consultant and RN essential if nurses are to change the culture of “It’s about time,” Mancuso says of the Trudy Molke says. “It isn’t acceptable and it acceptance that plagues the profession. attention nurses’ health is receiving. Many isn’t part of the job.” Stronger statistical data is also vital. RNs who secretly contend with chronic aches and pains, or who are struggling through the emotional or physical impact of “If nurses are being abused, they should come abuse, are sure to agree.“I think right now it’s more open and okay to discuss (workplace forward and talk about it because it’s only by knowing safety issues),”Annett says, adding, “When it happened to me, it wasn’t.” what’s happening that it can be prevented.” Promoting that openness and improv- ing awareness among nurses is at the heart of change. And, although the impetus for Recognizing the impact of abuse,muscu- “It’s very difficult to get information that change may be the government’s loskeletal injuries, and other occupational about the health of nurses right now.You commitment to the safety of the profes- hazards on nurses, ONA launched a pilot have to piece it together from individual sion, the passion for change must come project in northern Ontario in 2002, which (sources),” Kerr says. To address that, the from the frontlines. has since become a permanent structure Canadian Institute for Health Information We will see slight change one funding within the union and operates five separate (CIHI), in collaboration with the Office of announcement at a time but we’re sure to see networks across the province. Aptly named Nursing Policy at Health Canada and more significant strides as nurses consciously the Occupational Health and Safety Network, Statistics Canada, is developing a national and proactively step away from that culture of these groups hold quarterly meetings to dis- health of nurses study.Kerr, a member of the acceptance and insist on safer workplaces. RN cuss occupational health challenges. Most committee facilitating the study,suggests that recently, the network has addressed: rights although it will take two to three years to KIMBERLEY KEARSEY IS ACTING MANAGING and obligations under Ontario’s health and complete, it is good news for the profession. EDITOR FOR RNAO.

Workplace Health and Safety next on BPG agenda

n its efforts to advance the overall health RNAO initiative funded primarily by the ument the strongest evidence available will Iof the profession, and the quality of care Ontario Ministry of Health and Long-Term be used to develop and evaluate six healthy patients receive, RNAO’s Nursing Best Care (MOHLTC), with additional support pro- workplace guidelines that can be used in all Practice Guidelines (NBPG) project is devel- vided by Health Canada’s Office of Nursing health-care settings. The project will deliver oping guidelines that hold the promise of Policy. The HWEBPG project will deliver six six guidelines, including Workplace Health improved working conditions and healthier guidelines over a two-year period and develop and Safety of the Nurse. work lives for nurses. fourteen international, systematic literature For more information about RNAO’s The Healthy Work Environments Best reviews related to healthy work environments. HWEBPG project, visit www.rnao.org/pro- Practice Guidelines (HWEBPG) project is an A systematic process to identify and doc- jects/hwe.asp.

16 March/April 2004 by Carl Mavromichalis

Q&A with Joan Lesmond

Joan Lesmond is set to take the helm as RNAO president What attracted you to nursing and the RNAO presidency? on April 23. In an interview with Registered Nurse Journal, I was originally a teacher in my native St. Lucia, but I was drawn to nursing while my Lesmond offers a glimpse of her goals over the next two mother was dying. I watched the individuals who cared for her and the amount of care they gave her – in such a holistic way – and years, the invaluable critical thinking and issues resolutions it had a big impact on me.When I came to Canada, I found work as a health-care aide skills she brings to the position, and a few words of in a nursing home, which was when I decid- ed to pursue nursing as a career. wisdom for young people entering the profession. I was drawn to the presidency by the

Registered Nurse Journal 17 leadership role RNAO has taken in promot- My priorities are diverse. New nurses have the flexibility to ing positive public policy for health care “ work in a wide variety of environments – across the system. I strongly feel that I want from health-care facilities like hospitals to to be a part of the decision-making process. endless, but I’d community health – so expose yourself to I would like to build on the association’s as many different areas of the profession work in this area as well as the promotion of definitely like to as possible. healthy work environments for nurses. I’d also tell young nurses to get involved continue on the with RNAO now. Don’t wait until you’re What are your objectives and/or officially a nurse to help us lobby for full- goals for this term? time jobs and better working conditions.We The priorities of our association are very path set by my can use your help bettering the profession in much the priorities of the entire profession. Ontario today. A major priority for me at this time is to predecessors.” continue advocating for healthy public poli- How can nurses better influence cy, like the federal health accord and its nursing policy to improve working accountability principles. Through these experiences, I have conditions? But one of my biggest goals is to address sharpened my critical thinking and issues Get politically involved and stay involved. For the recruitment and retention of nursing stu- resolution skills by approaching decisions years, I was involved in the District Health dents, without whom there is no future for from different perspectives. Council. I called this my “power time” as it our health-care system. We need to ensure In addition to my experience as director gave me knowledge to understand the leg- the system allows new nurses educated here of clinical programs at Casey House (on the islative process. Now, I know the issues and to find full-time work in Ontario straight front lines of nursing), I am currently enre- feel comfortable bringing the issues to the out of school. Also, ensuring 70 per cent of olled in a doctoral program in health poli- forefront with my local MP or MPP.I often registered nurses are working full-time in cy and health education and I am teaching contact them to inform them of the latest healthy work environments is vital if nurses at Ryerson University.This experience has issues in nursing. are to continue delivering high quality care. helped me understand diverse elements at Another way to get involved is attending Taking care of nurses is key to the sustain- work in nursing in Ontario. functions at the local or provincial level, such ability of our health-care system. But above all else, my fundamental belief as regional or chapter meetings, RNAO Another priority for me is the Nursing in the basic value of respect for all people annual general meeting, or RNAO’s annual Best Practice Guidelines (NBPG) project. I and a willingness to learn precedes all else Day at Queen’s Park.Every year, members just attended a session with 350 NBPG and is the foundation on which I will build bring the issues facing nurses to politicians, champions, who help promote the guidelines my presidency. some of whom may not have been very aware in their facilities. Their enthusiasm was fan- These qualities, I think, will keep me of nursing issues specifically,but they are now. tastic and it tells me we are on the right track. well informed of the issues and will allow Don’t be dissuaded if you need to educate Beyond these commitments, helping the me to respond to the latest developments in your representatives on health-care or nursing homeless and other marginalized members nursing as they occur, whether I am repre- issues. Sometimes, I think we give up too eas- of society receive care, and working to have senting the membership at the policy table ily if we think others are not listening. It takes the profession reflect the diversity of our or elsewhere. a lot of energy and effort to influence public population are key issues for me. My priori- policy. Hopefully, through an improved work ties are endless, but I’d definitely like to con- What would you say to a young environment, nurses will have more time and tinue on the path set by my predecessors. person considering nursing? energy to become involved and sit on com- I would tell him or her that this is the best mittees after their shift is over. What special attributes do you profession to work in. We are a profession Imagine the benefit not only for the bring to the position and how focused on caring for people,and our knowl- individual, but also for the profession and will they help you in your role? edge and expertise are a vital component of society at large, if we get involved.Together Whether I’m at a board meeting of RNAO, the country’s health-care system. we can build healthy public policy and bet- Canadian AIDS Society, Canadian Nursing Young people should not be dissuaded by ter the lives for nurses and all people across Protective Society, or the Regent Park today’s threat of ‘not enough jobs.’We are work- the province. RN Community Health Centre, I am used to ing to turn that around because we definitely working collaboratively with a wide variety want, and need, our nurses to stay at home. CARL MAVROMICHALIS WAS FORMERLY of health-care professionals and individuals. This profession is very rewarding and STAFF WRITER FOR RNAO.

18 March/April 2004 by Kimberley Kearsey and Carl Mavromichalis

Culture shock

With a little

guidance and

CARE, more

and more

internationally

educated nurses

are making

the grade.

fter being displaced from his home by civil war, Nebojsa was unsure how to obtain an Ontario license, or even how to pre- Kovacvic left Croatia, formerly Serbia, and came to Canada pare for the exam. A as a refugee in December 1999. Even though he was an He first sent his application to CNO one year after arriving in experienced surgical RN, Kovacvic was not registered to practice in Canada. Two years later, he passed the exam on his fourth attempt, Canada and had to take whatever work he could find to get by.First, which he had decided would be his last. It was an expensive process. he worked the door at a night club in Niagara Falls.Then he drove Kovacvic says he spent over $3,000 for courses, exams, travel, supplies a taxi. All the while, he dreamt of registering here as a nurse and and textbooks, in addition to living expenses, before passing the exam. returning to his profession. According to CNO, registrants from abroad must meet all the But fulfilling his dream of practising in Ontario was difficult for requirements for registration, including completion of additional Kovacvic, and he’s not alone. study if necessary.The College says this is necessary to ensure new Thousands of internationally educated nurses (IEN) apply for reg- registrants have the basic competencies to provide safe, effective and istration in Ontario every year. Brenda Lewis, registration consultant ethical care to the public. All nurses, including Ontario educated at the College of Nurses in Ontario (CNO), says the province has applicants, must meet these requirements. seen a spike in applications during the past five years. In 1997, CNO According to Lewis, 35 to 45 per cent of IENs pass the exam. received 461.That number climbed to 2,444 in 2002. Critics say that rate is simply not good enough, and CNO agrees.

Illustration: Malcolm Jones “From the start, I had poor information,”Kovacvic contends. He Sylvia Scott, president of RNAO’s International Nursing

Registered Nurse Journal 19 Interest Group (INIG), says lack of informa- It told me everything I needed Colleges and Universities tion is the biggest barrier IENs face. “ (MTCU), George Brown and Recognizing this, INIG submitted a resolu- to know, especially around Centennial Colleges, the pro- tion to RNAO’s 2003 annual general meet- gram meets the specific needs ing to explore how the association can help the law and nurses’ limits and of IENs qualified to write the IENs register in Ontario. registration exam. It focuses “(IENs) don’t even know where to start how to answer multiple on health-care terminology, looking for information,” says Scott. “The nursing legal requirements and majority of them have significant experi- choice questions.” test writing strategies. RNAO ence in specialty areas, like obstetrics, where and CNO have been advisors we have a shortage in Ontario.Their skills CNO staff about the registration process, a on the project and RNAO president-elect remain untapped.” guide to registration, a comprehensive, inter- Joan Lesmond serves on the advisory com- Lilia Concepcion, a 30-year veteran of active guide to registration on its Web site, mittee. Ontario’s health-care system, has seen and documents such as the Welcome to Nursing “Their (CARE) exam preparation course dozens of nurses come from foreign coun- in Ontario guide that outlines what IENs was the reason I passed,” Kovacvic says. “It tries through her work as nurse educator at need to know to register in Ontario. After told me everything I needed to know, espe- Scarborough Hospital. “Many nurses have meeting the education and practice require- cially around the law and nurses’ limits and trouble accessing the system and under- ments and becoming eligible to write the how to answer multiple choice questions.” standing the registration process,” says exam, CNO provides IENs with a fact sheet So far, CARE has helped close to 400 Concepcion, who came to Canada from the entitled Preparing to write the RN and RPN nurses like Kovacvic better prepare them- Philippines in 1973. National Exam.From time to time it will also selves to work within Ontario’s nursing pro- According to Concepcion and others,there conduct information sessions with ethnic fession. And, according to Lewis, it has pro- are some troubling barriers for IENs in Ontario. nursing groups in the community. duced results. Over 70 per cent of IENs who But, fortunately, there is help available. For Kovacvic, accessing this and other complete the CARE program pass the reg- CNO, for instance, supports IENs by helpful information may have been difficult istration exam. offering one-on-one consultation with but it was not nearly as challenging as under- Concepcion says familiarity with job standing the social and cultural differences responsibilities, clinical case studies, role between the role of nurses in Croatia and the expectation and the English language are RNAO supports RNs’ role of nurses in Ontario. Understanding the vital to the well being of patients and success right to practice psychosocial questions on the registration on the job.“From my experience, IENs did exam, the answers to which cannot be found much better in the clinical area if they par- around the world in textbooks, was perhaps the most difficult ticipated in the CARE program or complet- part of the exam for Kovacvic. ed the refresher course,” she says. NAO respects the rights of nurses to According to CNO, INIG and Kovacvic But the program does have its limitations. Rwork in whatever country they the Creating Access to Regulated Employment Still in its pilot phase, CARE is only available choose. That is why the board of directors (CARE) program for nurses, which started in Toronto, and very recently in Ottawa. It passed a unanimous motion in January in 2001, is a great resource. has yet to receive long-term, stable funding 2001 in support of the International A joint initiative of Kababayan Community and is undergoing adjustments following the Council of Nurses (ICN) position statement Centre, Woodgreen Community Centre, St. requirement for RNs to possess a university on foreign recruitment, which reads: “ICN Michael’s Hospital, Yee Hong Centre for degree beginning Jan. 1, 2005. and its member associations firmly believe Geriatric Care, the Ministry of Training, As a result,“Things are really in flux until that quality health care is directly depen- we see what happens next year,” Dawn dent on an adequate supply of qualified Sheppard, CARE program manager, says.The nursing personnel. ICN recognizes the Getting registered program has received two more years of fund- right of individual nurses to migrate, ing from the MTCU, as well as financial assis- while acknowledging the possible adverse nternationally educated nurses must tance from Citizenship and Immigration effect that international migration may Ifollow specific steps to register with Canada for nursing specific language training. have on health-care quality. ICN con- the College of Nurses of Ontario (CNO). Kovacvic feels lucky to have completed demns the practice of recruiting nurses to To find out more about application the program and become an RN in Ontario. countries where authorities have failed to packages, professional requirements, He is grateful to Scarborough Hospital for address human resource planning and criteria for eligibility to write the exam, giving him a chance to prove himself on the problems that cause nurses to leave the and upgrading opportunities, visit job.“This is a great organization,” he says of profession and discourage them from www.cno.org or call 416-928-0900/ Scarborough Hospital.“They are really pro- returning to nursing.” 1-800-387-5526. fessional and can recognize that (IENs) can contribute to nursing in Ontario.” RN

20 March/April 2004 by Carl Mavromichalis

Big Dreams in a big rig

ew nursing graduates may be facing challenges of securing full-time work in Ontario, but that doesn’t seem to be N dulling their passion for the profession.In fact,the province’s new crop of nurses is more determined than ever to realize their goals. Case in point: Sarah Gray-Nicol, a Chatham resident, nurs- ing student and qualified truck driver. Gray-Nicol is so determined to become a nurse that she has been hauling auto parts from the United States to Chatham’s Ford plant, traveling upwards of 800 kilometres per week for the past six years to pay her way through nursing school. A passion for nursing and a penchant for trucking drives one nursing student “I really wanted to go to school to become a nurse, that was to a BScN and the opportunity to fulfill her dream of outpost nursing. my dream,” explains the Chatham resident, who is in her fourth year at the University of Windsor. “I started school in 1996 but tion was very important to me.” Her employer, then B.R. Smith had to drop out because I couldn’t afford it.” Trucking, helped her by offering a flexible schedule. But her boss Discouraged, Gray-Nicol decided to get her AZ truck driving wasn’t the only person who offered a guiding hand. license (which gives her the authority to operate large vehicles “My professors have been amazing, especially Anna Temple, with air brakes) as a way to buy herself some time and plan her who helped me through the accelerated program,” she says.The next move. It was also a way for her to see the U.S. and get paid program is an intensive,summer-long session that packs a full-year for doing something she loves to do – drive. of studying into four months. This move was instrumental in After two years of trucking between 60 and 80 hours per week, helping Gray-Nicol graduate with virtually no student debt, a sig- she saved up enough money to go back to nursing school and this nificant concern for her. time without taking on student loans. Gray-Nicol re-enrolled in “My classmates have also been…amazing,”she says,noting that the nursing program at the University of Windsor in 2000. they helped her cover notes she missed from lectures.“I am lucky Now in her fourth year of the program, Gray-Nicol has had to have had such a great group to study with.” to eliminate almost all of her trucking, driving only on a casual Between trucking and studying, Gray-Nicol also found time basis for a trucking agency. “With clinical placements, you just to get involved in her professional association with help from can’t work full time and go to school,” she adds. RNAO’s Essex chapter.The local executive sponsored her 2003 Just a few months shy of graduation, Gray-Nicols has made it membership when they found out how determined she was to through school with barely any debt. enter the profession. The road, she says, was long and winding – both literally and By the end of August, Gray-Nicol will complete her work figuratively.“I did both trucking and schooling full-time for the placement as an outpost nurse with hopes to move into that past three years,” driving 40-hours per week and attending a full occupation full-time. “I’ll be doing my placement in Fort slate of classes, she says.“It was very tiring.” Attawapiskat for ten weeks,” she says. When it came time to crack the books and start studying, she Why outpost nursing? “The variety of work is very appealing. had to get creative to keep on trucking. I want to be able to rely on my resourcefulness to meet the “I taped all the lectures and would listen to them when I was health-care needs of remote communities,” she says. driving,” she says.“It is actually a very effective way to study.” Having navigated her way through the trials of post-secondary In fact, Gray-Nicol was able to apply her studies on a few education, Gray-Nicol has some words of wisdom for other cur- occasions while on the road. rent or prospective nursing students, to help them manage the “On one trip, just outside Chatham, a truck had gone into the demands of work and academics in the pursuit of a dream. median,” she explains. “The driver fell asleep at the wheel and I “Talk to employers about your schooling, most are supportive had to pull over, call 911 and take his vitals.” and understanding. If possible, start taking courses ahead of enrolling “It’s nice to know that I can put my schooling into action, it (in nursing) so you can learn your own strategies for studying and helps make the hard work all worthwhile,” she says. working with students,”she says. Even though Gray-Nicol’s determination to succeed has been Most of all, Gray-Nicol says nursing students need to be per- tenacious, she still needed help from her employer, teachers and sistent and follow through with their education. classmates to realize her dream. “Keep your eyes focused on the final goal,”she says.“It’s worth

Photograhy: Diana Martin, Yvonne Bendo,The Chatham Daily News Photograhy: Diana Martin, Yvonne “My boss was great,”she says.“He understood that my educa- the heartache. Nursing is the most amazing job.” RN

Registered Nurse Journal 21 by Cheryl Yost

Health Canada, Judith Shamian, and additional leaders from academ- One year ago Cheryl Yost received news that she had been selected as the first ic, professional and union groups. recipient of the Hub Fellowship.The fellowship,created by RNAO and affil- I quickly learned that meals are not regular, cell phones are a must iate partner The Hub Group (Ontario) Ltd., gives one RNAO member the and a first aid kit with comfortable shoes,snacks and water are an asset. opportunity to job shadow executive director Doris Grinspun for one week. I observed as Doris travelled from one meeting to the next, an Yost, president of RNAO’s Perth chapter and director of training and devel- important influence in the political process, speaking out for nursing opment at the Huron Perth Healthcare Alliance, arrived at home office for her and health. I soon realized that Doris and the strong RNAO team whirlwind week on Jan. 23. kept a keen eye on how Ontario’s new government was addressing the needs of RNs and the population of Ontario. During the meet- ings and discussions, I saw the leader in Doris as she explained, moti- vated, affirmed values, envisioned goals and spoke out for nurses Running shoes, while encouraging her own team to recognize and explore the many alternatives for policy development that affects nurses.There was def- bridge mix and initely a wide array of knowledge and expertise within her team, Applying which clearly supports the RNAO bottled water... goals locally, regionally and beyond. for the HUB What I saw was a team support- Fellowship hat every RN needs to survive a week with RNAO’s ing provincial strategies to overcome executive director. obstacles and sustain an affordable he Hub Fellowship, W What nurses learn about leadership and politics in text- health-care system. Day after day the Tvalued at approxi- books pales in comparison to the real thing.As a member of RNAO association’s activities supported mately $2,000, is an and a registered nurse working in rural Ontario for the last 30 years, RNAO’s commitment to work with annual scholarship that I felt I knew what RNAO stood for, and what the executive direc- government and opposition mem- provides an RNAO mem- tor’s daily activities would entail. To my surprise that perception bers to ensure nurses’ voices continue ber with the opportuni- changed when I started my placement with the HUB Fellowship. to influence government decisions in ty to job shadow execu- This was not a textbook visit. a way that restores public trust in tive director Doris My first day started in a committee room at Queen’s Park with health and social services. Kudos to Grinspun for one week. the Minister of Health and Long-Term Care, the executive director Doris as a dynamic leader. She con- The successful candidate of RNAO and 150 registered nurses from across Ontario. I was wit- tinues to advocate for getting the must provide a brief ness to an active political process at multiple levels, a process that nursing piece right to ensure quality (250 word) profile of included Minister of Health George Smitherman, Parliamentary health care and quality of work life. professional activities Assistant Peter Fonseca, Provincial Chief Nursing Officer Sue Thank you to Doris,the Nursing (i.e. exemplars of advo- Mathews, Executive Director for the Office of Nursing Policy at Leadership Network (NLN) and cacy and leadership HUB for this valuable opportunity. potential from academ- This placement was a once-in-a- ic, administrative or clin- lifetime experience. Summarizing it ical accomplishments). with words like amazed, enjoyable, Applicants must also big picture, looking to the future, demonstrate leadership passion, strategic thinking and fun potential and a commit- do not begin to describe what I ment to the nursing gained during my visit with Doris. profession. The insight I’ve gained has rein- For more informa- forced my belief that involvement in tion, contact RNAO’s RNAO and NLN provides a front- Membership and row opportunity to see nursing Recruitment and leaders advancing the profession of Retention Committee, nursing to strengthen Medicare. RN c/o Hilda Swirsky, (416) 599-1925/1-800-268- CHERYL YOST, RN, BSCN, MEd, IS THE 7199, ext. 231 or e-mail FIRST RECIPIENT OF THE ANNUAL [email protected]. HUB FELLOWSHIP.

22 March/April 2004 by Carl Mavromichalis

was also on the RNAO panel that developed the Prevention of Falls Nurse researcher and Fall Injuries in the Older Adult Best Practice Guideline. In Sept. 2003, Edwards was appointed to the governing council of the Canadian Institutes of Health Research (CIHR).As the coun- joins CIHR cil’s sole representative of Canada’s nursing community,Edwards will spend the next three years working with fellow health-care experts governing council on the cutting edge of health research in Canada.

Challenges: Edwards admits there are not enough hours in the day to adequate- Why Nursing? ly pursue all of her interests. In addition to that challenge, she says Nancy Edwards says it was serendipity that she became a nurse. In finding money for her research is always difficult. It helps, however, her teens, she told her mother she would like to study physiothera- that she was awarded a prestigious Nursing Chair Award from CIHR py so she could help the injured Vietnamese children who were vic- and the Canadian Health Services Research Foundation in 2000, one tims of the war with the U.S. during the 1960s. But there was no of only five winners from across Canada. physiotherapy program offered at the local university. Edwards will receive $1.5 million over 10 years to build capacity “My mother suggested I think about nursing instead,” explains for research in community health nursing. Edwards, who is now a professor of nursing at the University of "It was wonderful to be in the right place at the right time and to Ottawa.“I always meant to go back to study be granted this incredible opportunity. It physiotherapy, but it never happened.” encouraged me to do more thinking about how After completing her BScN at the to provide mentorship for nurses interested in University of Windsor in 1974, Edwards doing research," she says. worked as a staff nurse on Canada’s west coast. She then headed to Queensland, Australia to Memories of a job well done: work as a nurse educator,returning to Canada Edwards takes great pride in her direct work with two years later to work as a public health traditional birth attendants in basic midwifery care nurse in Newfoundland.Through her experi- in Sierra Leone. She educated attendants on the ences, Edwards found that community health importance of using a sterilized razor blade to cut nursing was her passion. the baby's umbilical cord, rather than a bamboo Upon completion of her master’s degree sliver stored in the mudwall of the delivery hut.She in 1982, Edwards spent several years abroad, also helped attendants identify women with high travelling, researching and helping people in risk pregnancies who needed to deliver their baby developing countries. In Sierra Leone, where in hospital, and taught the importance of tetanus she lived for five years, Edwards helped local immunization for women of child-bearing age. Name: Nancy Edwards health-care workers understand, plan and "When I arrived in Sierra Leone, the country Occupation: Professor of Nursing, prioritize the health-care needs of their com- had some of the highest neonatal tetanus mortali- munities.Working in West Africa from 1978 University of Ottawa, and ty rates in the world," she explains. "Six years later, to 1984 sealed Edwards’ conviction to dedi- Member, Governing Council, through the efforts of many talented primary cate her career to research. Canadian Institutes of Health health-care colleagues in our region, neonatal In 1988, Edwards began teaching part- Research (CIHR) tetanus had been virtually eliminated in our area." time at the University of Ottawa and started Home Town: Montreal, Quebec her PhD at McGill University, which she Future plans: completed in 1995. Edwards’ immediate future will see her focusing on her work with the CIHR governing council as she believes it will challenge her Responsibilities: within the scope of her own research. "The council will be a place In addition to teaching at the university, Edwards researches com- to hear about some of the most innovative, cutting-edge research munity health nursing locally and internationally. being done across the country," she says. "We have a new initiative in China where we are developing But Edwards says she would also like to step back a bit from her major maternal and child health programs there," she explains. work to cultivate her personal life as well, a challenge that she hopes Closer to home, Edwards is studying ways to prevent falls among will offer balance between her home and professional lives. seniors through an education, awareness and action program. Her "I’d really like to get out and do some more cross-country skiing," aim is to ensure every bathroom in Canada has grab-bars. Edwards she muses. RN

Registered Nurse Journal 23 by Kimberley Kearsey

Policy at Work

POLITICIANS PROMISE RNS that change is a priority

ach January, RNAO board, assembly outside Canadian borders due to a lack of to what nurses have to say, and their respect and political action officers from local full-time employment in Ontario. for the profession showed in their support of E chapters and interest groups converge “Our very first priority is to ensure that this year’s event. “I’ve appreciated so much on the corridors of Queen’s Park armed nursing has a strong foundation for the the openness not just of this association, but with the political savvy and passion to take future,” Minister of Health George especially of the profession,” Smitherman provincial politicians to task on the issues Smitherman said in his opening address on said.“We’ve got our work cut out for us but that define nursing practice in Ontario. Jan. 23. “That’s why RNAO was my very we’re going to get on with the job at hand.” With a particularly rough year for health first stop after being appointed Minister of That job, one the Liberal government care behind us, this year’s 5th Annual Day at Health. Before I even knew my way to the contends may take some time, is to clean Queen’s Park brought out an especially pow- Minister’s boardroom, I found my way to up the health-care system’s nursing chal- erful show of enthusiasm and strength, and the offices of RNAO and I intend to be a lenges that have been snowballing since the sparked insightful debate about full-time living demonstration that it was not just a early 90s. employment for nurses, not-for-profit one-time act.” “When you see the retirement age health care, public/private partnerships (or Given the unprecedented political activ- expressed in points and dropping, it sends P3s), health human resources, and the surge ity of RNAO and its members over the past the message pretty clearly that the profession of nursing students accepting offers to work several years, politicians are paying attention you’re all proud to be part of, is expressing

1 2 3 4

PHOTOs 1 and 2: RNAO President Adeline Falk-Rafael (at podium) MPP and RN Laurie Scott attended the event with colleague John joined President-Elect Joan Lesmond (seated left) and Executive O’Toole, PC Critic, Management Board of Cabinet. Scott shared her Director Doris Grinspun in welcoming Minister of Health George personal and professional belief that Ontario’s government must Smitherman to the 5th Annual Day at Queen’s Park. She thanked him address nursing challenges, including: the safety of nurses and the for accepting RNAO’s invitation to provide the opening keynote importance of a quality work environment; quality of life and quality address, and for presenting the first Nursing Best Practice Guidelines of practice; the pace and intensity of nursing work; the PhD Fellowship to Amy Bender. PHOTOs 3 and 4: Newly elected PC lack of employment; and limited use of scope of practice.

24 March/April 2004 how well it is doing, or how poorly it is to cancel private MRI and CT scan clinics doing, by the fact that you get out while you introduced by the province’s previous PC “Our very first can,” Smitherman said of retention and government. retirement challenges.“This is a stark way of In response to a call for the government’s priority is to ensure presenting the challenge that is before us. support of practical recruitment and reten- But I want you to know that I understand it. tion strategies, such as a recommendation I want you to recognize that we’ve got a lot that newly graduated nurses be offered that nursing has a of work to do. But more than anything else, immediate, full-time employment, the min- I want you to know that this is a huge pri- ister said, “At the moment, we’ve got so ority for us.” much work to do in the current system that strong foundation A lengthy Q&A session following bringing a new crop in and placing them on Smitherman’s presentation brought on a bar- top of a system which on so many indicators for the future.” rage of questions which addressed such issues is not performing very well for nurses is a as: the need to keep graduating RN students very serious concern of mine.” – George Smitherman, Minister in the province; the important role of NPs On the issue of community health cen- and family practice nurses on interdiscipli- tres and the lack of movement on interdisci- of Health and Long-Term Care nary health-care teams; the need to cancel plinary health teams, Smitherman said, competitive bidding in the community “When I came into the ministry three health sector; support for increasing taxes to months ago, the idea I heard around nurse la over time will likely be two or three nurse pay for improved health care; operating practitioners in interdisciplinary settings was practitioners, a doc and a social worker. I increases for hospitals and accountability for you have three or four docs, a nurse practi- think we have so much more to do on this.” putting those dollars into nursing; strength- tioner, maybe a social worker or a pharma- Although Smitherman addressed the ening public health; nursing challenges in cist. Increasingly, when I look at a lot of need to see change across all sectors, he did underserviced communities; and the urgency communities in Ontario, I think the formu- not commit to looking more closely at the

5 6 7 8 9

PHOTO 5: McMaster University nursing student, Zumil Damji, spoke on PHOTOs 7 and 8: NDP Leader Howard Hampton, along with his behalf of new nursing graduates when he shared with Minister party’s health-care critic Shelley Martel, offered nurses their party’s Smitherman and the rest of the group that he too had difficulty find- view of what’s happened politically since Ontario’s October election ing full-time work in Ontario, and was contemplating accepting an and the sweeping win by the Liberals. According to the NDP, very offer for full-time work from a facility in the U.S. PHOTO 6: Laurie little has been done to address some of the most troubling health- McKellar, president of RNAO’s Middlesex Elgin Chapter, addressed care challenges in this province. PHOTO 9: Region seven representa- Shelley Martel after her presentation, asking what the NDP plans to tive Victoria Pennick shared her concerns about nursing with NDP do to increase the number of RNs working in long-term care. MPP Michael Prue, Beaches-East York.

Registered Nurse Journal 25 competitive bidding process in the commu- “I can say, as someone who is front and ers pledge that said they would not…increase nity health sector.The issue, he says, is on his centre,watching it every day,it’s very difficult taxes. I invite you to turn over the page on radar screen, but is not one that will receive to determine what the agenda of the new that taxpayers pledge because…it says what immediate attention. “If you take a look at government is,” he said. “The further gov- governments must do in lieu of increasing tax the breadth of the health-care agenda, none ernments move down the road toward pri- revenue (i.e. more private health care, more of us could ever be successful in addressing it vate, profit-driven involvement, not just in private education, more privatization of other if we chose to have 50 or 75 priorities. We hospitals but in other aspects of the health- essential public services).Your voice has to be have to be very cautious about which agen- care budget, the less money there will be for a voice to say no, these things must remain in da points we focus on first.” patient care because more and more will be public control so they are affordable, reliable When the issue of canceling private MRI siphoned off into the corporate bottom line. and available to all of us…” and CT scan clinics was broached by RNAO This is a very serious mistake.” Newly elected PC MPP, registered president Adeline Falk-Rafael, Smitherman Hampton went on to say,“Your organiza- nurse and RNAO member, Laurie Scott, offered this response: “We’re going to fulfill tion has the opportunity to play a very impor- joined at the podium by PC Critic, Manage- that commitment but I can’t give you a tant role in health care and other aspects of ment Board of Cabinet John O’Toole, also timetable because (we’re involved in) chal- public policy in this province over the next weighed in on the issues and offered her lenging negotiations. It would be easy just to three years.This government signed a taxpay- vision for the future as she addressed col- blow them out of the water, shut them down leagues and peers at this year’s event. and send everybody packing and just write a “As we move forward, we must…push cheque. The cheque would be significant. I Individual MPP meetings forward what’s best for nurses. Your issues can’t give you a number except to say that a resounding success and challenges must be addressed,” she said. with the same amount of money, we would “We all know bandaids are not enough.We be able to offer a significant number of full- his year’s 5th Annual Day at must get to the heart of these issues and time opportunities for nursing grads.” TQueen’s Park took on a whole new develop long-term solutions.” He went on to say that the private clinics spin when RNAO invited ministers, par- Scott urged RNAO and all registered are operating in communities where access is liamentary assistants and key opposi- nurses, as health-care professionals and as badly needed.“I spoke earlier about making tion MPPs to meet with groups of Ontarians, to hold the government account- sure that, as a government, we are addressing eight to12 nurses to discuss cessation able and to continue to probe politicians wait times at these access points. I’m com- of P3 hospitals, 70 per cent full-time with questions like “Where are the 8,000 mitted to Medicare and you’re committed to employment for RNs, and the promise new nurses? What percentage of nurses are Medicare but at the time that I’m in a line- of 8,000 new nursing positions. After a working full time? Where are our future up for two years to have a diagnostic test full-hour dialogue with Minister of nurses coming from? And how is the gov- done, or for two-and-a-half years to have my Health George Smitherman, RNAO ernment supporting a patient safety agen- knee replaced, I’m frankly getting a little less members assembled into their groups da?” She also urged all nurses to get more committed to Medicare and a little more to meet political members at various involved in political activity in order to give committed to my own survival. This is the Queen’s Park offices and boardrooms. more voice to the nursing profession. Ontario that I work for as well.Twelve-mil- Participating in these individual RNAO continues to push for more lion people who expect a system that isn’t meetings were: political activity at the provincial and local just value-based, but that is also outcome and •Marilyn Churley, NDP MPP levels and offers this year’s event as proof that performance based.” •Peter Fonseca, Parliamentary this call to action is being heard,and that nurs- According to NDP Leader Howard Assistant, Ministry of Health and es across the province need to build on the Hampton, who appeared at the event with Long-Term Care momentum by getting to know their local Shelley Martel, NDP Health Care Critic, and •Gerard Kennedy, Minister of Education MPPs and decision-makers. With continued Michael Prue, Critic for Municipal Affairs •Michael Prue, NDP MPP efforts, we hope to see the same success at our and Housing, those millions of people for •Lou Rinaldi, Parliamentary Assistant, 6th Annual Day at Queen’s Park,scheduled to whom Smitherman works have been waiting Ministry of Public Infrastructure Renewal take place Friday,Jan. 28, 2005. RN for three months to see the agenda of the •Laurie Scott, PC Critic, Training, new government, particularly as it relates to Colleges and Universities KIMBERLEY KEARSEY IS ACTING MANAGING privatizing hospitals across the province. EDITOR FOR RNAO.

26 March/April 2004 Calendar

Date Event Details

May 10 RNAO Recruitment & Retention Fair Toronto Board of Trade, Toronto

May 19 Ethics for Nurses Marriott Eaton Centre, Toronto Regional Workshop

May 26 Keep Your Nurses for Life 2004 – Recruitment and Crowne Plaza, Ottawa Retention in Nursing: It Takes a Team! National Workshop

May 27 Essential Strategies for Becoming the Health-Care Crowne Plaza, Ottawa Employer of Choice National Workshop

May 30-June 4 2nd Annual International Nursing Best Practice Delawana Inn, Honey Harbour Guidelines Summer Institute

June 3 - 5 12th Family Practice Nurses' Conference: London, Ontario Open the Door in 2004 Sponsored by For information, the Ontario Family Practice Nurses Interest Group http://members.rogers.com/ fpn-london or [email protected]

June 17 Computer Basics for Nurses Location TBA Regional Workshop

August 8-13 Policy Summer Institute Nottawasaga Inn Convention Centre & Golf Resort Alliston

September 20 Computer Basics for Nurses Location TBA Regional Workshop

September 22-23 3rd Annual International Elder Care Conference Westin Prince Hotel, Toronto

September 30 Postpartum Depression: Recognizing the Metro Hall, Toronto Signs, Community Support and Resolution Regional Workshop

September 30, How to Design Effective Training Programs RNAO Head Office, Toronto October 1, 4, 5 & 6 RNAO/OHA Joint Program

October 7 RNAO Recruitment and Retention Fair Ottawa Congress Centre, Ottawa

October 19 Ethics for Nurses Location TBA Regional Workshop

October 27-28 2nd International Nurse Educator Conference Hilton Toronto Suites, Markham

Unless otherwise noted, please contact Vanessa Mooney at the RNAO Centre for Professional Nursing Excellence at [email protected] or 416-599-1925/ 1-800-268-7199, ext. 227 for further information.

Registered Nurse Journal 27 CLASSIFIED

THE HOSPITAL FOR SICK CHILDREN, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada is pleased to announce the following conferences in 2004: Paediatric Update 2004, April 21 – 24; Paediatric
                  Emergency Medicine Conference, September 29 – October 2;   Child Development Conference, November 17 – 19 . For information contact: Brenda Rau, continuing medical educa-
 tion, at [email protected].

QUO VADIS FORMER GRADUATES AND INSTRUCTORS    are invited to celebrate the 40th anniversary of the Quo Vadis School of Nursing on Saturday, May 8, 2004 at the former school in !#Srp ˆv‡€r‡Sr‡r‡v‚Ahv Etobicoke. Luncheon and speaker. Telephone Marie at 905-690-9326.

NATIONAL FAMILY PRACTICE NURSES’ CONFERENCE: Hh’  !#U‚ ‚‡‚ AS@@ Hh’  !#U‚ ‚‡‚ June 3-5, 2004 in London, Ontario. Open to all health professionals UP Pp‡‚ir & !#P‡‡hh UU@I9! with an interest in family practice. For information, visit http://mem- 6 I‚‰r€ir   !#U‚ ‚‡‚ bers.rogers.com/fpn-london. Email:[email protected].

CONESTOGA COLLEGE SCHOOL OF HEALTH SCIENCES
         CELEBRATES 30 YEARS OF EXCELLENCE IN NURSING              EDUCATION, May 20, 2004. Partners in Learning: Looking Back,               Looking Forward. Conestoga College RN and RPN (RNA) alumni          and nursing faculty/staff are invited. Further information to fol- low from Alumni Services and the celebration steering commit-         !     tee. Contact: [email protected].   "   #   $ $ $

ARE YOU LOOKING FOR A SUMMER JOB that’s both fun and rewarding? Then a camp staff position might be just right for you! We are currently hiring a few registered nurses and nurse prac- titioners to work in our health centre with our camp physician. Nurses should be fun loving and enjoy working with children for this challenging and rewarding opportunity. For more information, call us at (416) 322-5888 or visit us online at www.manitoucamp.com. To apply, fax your resume,     !   " # $  cover letter and references to (416) 322-3635 or e-mail to      % &  
' [email protected] or send by mail to 2660 Yonge St., 2nd 9 :  *; floor, Toronto, Ontario, CANADA, M4P 2J5. ,-        DECISION-MAKING STUDY TO BRING CLARITY    ,- &
   .,./  TO SHARED EXPERIENCES OF RNs, RPNs   0#  0

he Ontario Ministry of This study will look at the kinds  !" 5678 -688$ T Health and Long-Term Care of decisions RNs and RPNs is funding a two year study to make, and how these decisions
# $%    & examine RN and RPN clinical are influenced by the nature of decision making. The study is the environment, nurse experi-
 '$()* #$   *( being conducted at McMaster ence and education.  +" 5678 -688$ University by the Nursing You may be asked to partici- Effectiveness, Utilization and pate in this study. Please consider    < Outcomes Research Unit (NRU). it an opportunity to share your .8. ;  RNs and RPNs are legislated voice about nursing practice.  *  *=.01 through the same regulatory For information, contact body and work in similar envi- principal investigator Dr. Sheryl         (  )    ronments. However, there are Boblin at 905-525-9140, ext. *& + + *   ,   differences in clinical decision- 22404 or research coordinator
  -./011.120 !+223    making and scope of practice. Candia Hadley, ext 22829. &  4 + + Nursing and Health Care Leadership/ Management Distance Education Program

GRANTING UNIVERSITY CREDIT AND CERTIFICATE Endorsed by the CNA. All courses individually facilitated by an Educational Consultant Courses Offered:

Leadership/Management (6 units) • 9 month home study course • both theoretical and practical content important in today’s work environment

Leading Effective Teams (3 units) • 6 month home study course • theory and methods of teams by intergrating professional and leadership disciplines

Decentralized Budgeting (1 unit credit) • 16 week home study format • concepts of financial management and budget preparation • important to nurses involved with Canadian nurses protective decentralized management society Total Quality Management/ (Jonathan to pick up from last Quality Assurance (1 unit credit) issue) • 16 week home study format • theoretical and practical aspects applicable to developing quality assurance/improvement programs

For further information please contact: Leadership/Management Distance Education Program McMaster University, School of Nursing 1200 Main Street West, 2J1A Hamilton, Ontario, L8N 3Z5 Phone (905) 525-9140, Ext 22409 Fax (905) 570-0667 Programs starting every January, April & September ediefrsbisos a 1 2004 May21, Deadline for submissions: To ➤ ➤ ➤ ➤ Board ofDirectors’committees: One vacancyexistsonthefollowing 2004-2006 of Directors’ Committees, RNAO Board CALL FORSUBMISSIONS, GET INVOLVED. and/or theirinterestintheposition. C.V. withaletter outlininganyrelevantexperience We should bedirectedtothename listedonour Services. E-mailsubmissionsare encouraged,and W ments necessarytofilleachvacancy, visitRNAO’s eb siteat

view theTerms ofReferenceandrequire- Development Committee Policy Analysisand r Education Committee Editorial AdvisoryCommittee Bylaws Committee b site.Interestedcandidatesmust submittheir epr esenting collegepr www .r nao.or g and clickonMember ograms Selection ofNew&Used Vehicles IMY 3 UDSS.E,MISSISSAUGA E., 230 DUNDAS ST. ❤ or Visit usatourWebsite: Come andSeeOurWide Located intheHeartofDowntownMississauga Honda T L FREE OLL MISSISSAUGA (905)896-3500

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Cawthra www.readyhonda.com Y ou AreInOurArea” ”Tune-in When Honda (905) 896-3500 LOOKING FOR A NEW NURSING EDUCATION CHALLENGE? TRAVEL INITIATIVE THROUGHOUT ONTARIO A new funding cycle has been approved by the MOHLTC! RNS AND RPNS For pertinent deadline information or REQUIRED to obtain a copy of the application form please SEPTEMBER TO NOVEMBER, 2004 visit the RNAO Web site

Ontario Ministry of Health at (www.rnao.org). and Long-Term Care Levels of Care Classification For the most current information Call 1-800-293-4092 about the Nursing Education Initiative For Application/Job Description/Information please contact: • Front line long-term care or chronic care facility experience • Fee-for-service at $28/hr Registered Nurses Association • Travel and expenses paid of Ontario Frequently Asked Questions • Six-day paid training in late August line 1-866-464-4405 • Application deadline: May 2, 2004 OR e-mail Meagan Wright and Iris McCormack at This is not an OPS* position *(Ontario Public Service) [email protected].

We change the way people look at barriers

West Park Healthcare Centre is dedicated to meeting the rehabilitation, NP/Manager, CAVC Ambulatory Services complex continuing and long-term care A proven leader and practitioner, you will assume responsibility for primary care and support for needs of adults in its diverse community, the long-term ventilated population. Your master’s degree in Nursing is complemented by a post- by consistently building on its expertise master’s certificate from an accredited nurse practitioner program, and current RN (EC) registration in providing the best healthcare in good standing with the College of Nurses of Ontario. You bring at least 5 years of experience possible. In line with our philosophy as a Nurse Practitioner or ACNP, including work in intensive care. Expertise with ventilation that life is in the challenge, we management in the long-term ventilated population is essential, as are demonstrated abilities in continually strive to improve on best practice and/or protocol development and implementation, and clinical development and everything we do, to better help our evaluation. You will prepare and manage an annual CAVC ambulatory services and inpatient supply patients and residents achieve the budget, and be accountable for CAVC ambulatory service planning. highest quality of life, and provide an exciting and rewarding environment for Advanced Practice Nurses our employees. Located on a 27-acre Gerontology (Full-Time) Neurology (6-Month Contract) property, in a residential neighbourhood With a minimum of 5 years of experience as a Clinical Nurse Specialist in gerontology or neurology, in Toronto’s west end, our award- you will excel in this role. Your master’s degree in Nursing, and BScN are enhanced by demonstrated winning grounds feature extra-wide experience in the provision of effective clinical consultation for the complex frail elderly, ideally walkways, gently sloping ramps allowing in a rehabilitation and complex continuing care environment. Current registration, or the ability two-way wheelchair traffic, and wheel- to obtain registration, with the College of Nurses of Ontario, is required, as is a background in the chair-height garden beds. Not to application of best practice, specifically within a clinical setting. Experience with a neurological mention tree-lined courtyards and population is an asset. patios, perfect for hosting our various outdoor events where staff, patients If you are interested in applying for, or finding out more about these opportunities, please visit our Web and residents interact in a casual, site, or contact: Human Resources, West Park Healthcare Centre, 82 Buttonwood Ave., Toronto, non-clinical atmosphere. Ontario, M6M 2J5. Fax: 416-243-3422. E-mail: [email protected]. Web site: www.westpark.org What Toronto’s Best Nurses Are Wearing

S.R.TMed-Staff is a trusted leader in the healthcare community with a reputation RANKED for excellence in quality of care. In a recent survey of Toronto’s RN’s & RPN’s, S.R.TMed-Staff ranked #1* in every category: The most variety of shifts, the * #1 highest pay rates, the best overall agency to work for and the best quality nurses. That’s why our staff are in such high demand. Hospitals know they can trust IN TORONTO S.R.TMed-Staff personnel to provide an exceptional level of care. If you want to work with the best, make S.R.TMed-Staff your first choice. For a personal interview, please call us at 416 968 0833 or 1 800 650 2297.

SRT.. e-mail: [email protected] MED-STAFF FACILITY STAFFING • VISITING NURSING • PRIVATE DUTY * Summit Strategy Group 2000