Helping seniors age independently • Caring for kids with cancer • Bringing BPGs to bedsides Registered NurseNovember/December 2009 JOURNAL

on the front line As H1N1 spreads across Ontario, RNs are at the epicentre of plans to keep people well.

PM 40006768

Registered Nurse JOURNAL Volume 21, No. 6, November/December 2009

FEATURES

CREATING SAFER PATIENT CARE 11 By Stacey Hale Staff at Trillium Health Centre are reducing the risk of errors during shift changes.

FIGHTING THE FLU 12 By Jill-Marie Burke As the second wave of the H1N1 virus spreads around Ontario, RNs reveal the work they’re doing to protect their patients, communities, and themselves.

COPING WITH CANCER 17 By Jill-Marie Burke Pediatric oncology RN helps children and their families with everything from 20 chemotherapy treatments to home repair.

THE LINEUP DECODING A DIAGNOSIS By Stacey Hale EDITOR’S NOTE 4 18 RNs share their tricks for translating PRESIDENT’S VIEW 5 information to help non-English speaking EXECUTIVE DIRECTOR’S DISPATCH 6 people get the care they need. MAILBAG 7 CARE CLOSE TO HOME NURSING IN THE NEWS 8 20 By Jill-Marie Burke More than two years after the province OUT AND ABOUT 10 announced the Aging at Home strategy,it’s RNs POLICY AT WORK 23 who are making the program a reality for many seniors in Ontario. NEWS TO YOU/NEWS TO USE 26 CALENDAR 26 BRINGING EVIDENCE TO BEDSIDES 24 By Jill Scarrow A new project puts best practice guidelines and the latest research right into the palm of RNs’ hands.

Cover illustration: Isabelle Cardinal

Registered Nurse Journal 3 The journal of the REGISTERED NURSES' Editor’s Note ASSOCIATION OF ONTARIO (RNAO) 158 Pearl Street Toronto ON, M5H 1L3 Phone: 416-599-1925 Toll-Free: 1-800-268-7199 Fax: 416-599-1926 Website: www.rnao.org E-mail: [email protected] Letters to the editor: [email protected] Keeping pace with H1N1 EDITORIAL STAFF Marion Zych, Publisher Jill Scarrow, Acting Managing Editor Jill-Marie Burke, Acting Writer Stacey Hale, Editorial Assistant EDITORIAL ADVISORY COMMITTEE This fall, it seemed like people were talking about just one Nancy Purdy (Co-Chair) Ruth Schofield (Co-Chair), thing: the H1N1 influenza outbreak. Whether I heard friends Sheryl Bernard, Nathan Kelly, debating the pros and cons of the flu shot, or watched nightly Pauline Tam (journalist), Carol Mulligan (journalist) newscasts filled with serpentine lines of people as thousands waited to be vaccinated, the topic was nearly impossible to avoid. ART DIRECTION & DESIGN Fresh Art & Design Inc. So was the underlying message behind each news story. Every image of a terrified small child receiving a needle from a ADVERTISING Registered Nurses' Association of Ontario reassuring RN reminded us all that it’s nurses who truly are the Phone: 416-599-1925, Fax: 416-599-1926 backbone of our health-care system, especially during a pandemic.

SUBSCRIPTIONS The H1N1 discussion also spills over into this issue of Registered Nurse Journal. Our Registered Nurse Journal, ISSN 1484-0863, is a benefit to cover feature looks at the roles RNs are playing in a variety of sectors to help their members of the RNAO. Paid subscriptions are welcome. Full sub- scription prices for one year (six issues), including taxes: Canada patients, colleagues and neighbours cope with a pandemic. It wasn’t an easy story to $36 (GST); Outside Canada: $42. Printed with vegetable-based inks on recycled paper (50 per cent recycled and 20 per cent tell. As the questions around who would get a flu shot – and when and where they post-consumer fibre) on acid-free paper. would receive it – grew louder, it became harder to think of how we could keep a Registered Nurse Journal is published six times a year by bimonthly magazine on top of a story that was changing by the hour. In fact, it’s most RNAO.The views or opinions expressed in the editorials, articles or advertisements are those of the authors/advertisers and do not likely taken another turn as you read this page.That’s why we chose to focus on the necessarily represent the policies of RNAO or the Editorial one thing that’s remained constant throughout: the dedication and commitment every Advisory Committee. RNAO assumes no responsibility or liability for damages arising from any error or omission or from the use of nurse has had to keep us all as healthy as possible this fall and winter.The stories you’ll any information or advice contained in the Registered Nurse Journal including editorials, studies, reports, letters and advertise- find starting on page 12 are just a sample of the work every RN has done in the fight ments.All articles and photos accepted for publication become against H1N1, and we know each of you probably has your own story to tell of the the property of the Registered Nurse Journal. Indexed in Cumulative Index to Nursing and Allied Health Literature. way the virus has affected your own work.

CANADIAN POSTMASTER: Undeliverable copies Of course, there are still plenty of other health-care stories happening that have noth- and change of address to: RNAO, 158 Pearl Street, ing to do with the flu.That’s why,in this issue,you’ll meet RNs who are leading new pro- Toronto ON, M5H 1L3. Publications Mail Agreement No. 40006768. grams to keep older people living healthy,safe lives in their own homes for as long as pos- sible. And we look at the creativity of some RNs who work in pediatric oncology. RNAO OFFICERS AND SENIOR MANAGEMENT They’ve come up with some novel ways to communicate with patients and families who Wendy Fucile, RN, BScN, MPA, CHE President, ext. 504 may not speak English as their first language, but who still desperately need to describe David McNeil, RN, BScN, MHA the pain or symptoms their children are enduring.These RNs’ stories don’t top nightly President-Elect, ext. 502 newscasts, but they’re no less important than those of the countless nurses who have Doris Grinspun, RN, MSN, PhD (c), O.Ont. patiently doled out vaccines to try and keep everyone as H1N1-free as possible. Executive Director, ext. 206 Robert Milling, LL.M, LLB Director, Health and Nursing Policy, ext. 215 Jill Scarrow Acting Managing Editor Daniel Lau, MBA Director, Membership and Services, ext. 218 Irmajean Bajnok, RN, MScN, PhD Director, International Affairs and Best Practice Guidelines Programs and Centre for Professional Nursing Excellence, ext. 234 Marion Zych, BA, Journalism, BA, Political Science Director, Communications, ext. 209 Nancy Campbell, MBA RNAO celebrates 85 years Director, Finance and Administration, ext. 229 In 2010, RNAO celebrates its 85th anniversary. The association will be marking the Louis-Charles Lavallée, CMC, MBA occasion by showcasing the influence and success it has achieved since 1925.We Director, Information Management and Technology, ext. 264 want to get members involved and talking about their experiences with RNAO over the years. Please take some time to share your thoughts with us. What does membership mean to you? Tell us about a particular aspect of RNAO’s work that makes you proud. What’s your favourite RNAO memory? Send your thoughts or historical photos or mementoes to Jill Scarrow at [email protected] or via regular mail to 158 Pearl St., Toronto, ON M5H 1L3.

4 Nov ember/December 2009 President’s View with Wendy Fucile

Taking the long view towards meeting our goals

Over the last few for others by fear of change and loss of also seen serious challenges and made real months, several issues control. We should celebrate our successes gains on an issue in which our journey is regarding RNAO’s in reaching this point on the road and just getting started. Some health settings are advocacy have result- strengthen our conviction as we continue implementing models of care in a way that ed in success, and in to advocate and walk towards our full does not reflect what the evidence tells us is challenges yet to be vision on this issue. best for patients and best for nurses. I’m conquered. As I look We have seen the same sort of thing in referring to continuity of care and caregiv- back on our work, I the area of environmental action. er, and the need to ensure RNs deliver care am struck by how easy it is for our vision Remember the joy of celebration when for all patients who are unstable, complex and perception of things to be distorted by the first community enacted anti-pesticide and/or unpredictable and RPNs deliver the ever-growing need for immediate bylaws? What if we had stopped there? care for stable patients with predictable out- results, gratification and success. This is a Would we have the legislation today that comes, each working to their full scope of risky approach, particularly as it relates to practice. This is a contentious issue, so the the efforts of our association’s members and easy choice is to stop our journey where we staff to affect critical changes that will “As RNs and members have made early gains (see letter on page improve the health of Ontarians and the 23). Easy,but wrong.We must acknowledge quality of work-life for nurses. It is an of an influential that there will be times when the changes approach we must reject out of hand if we RNAO is pursuing won’t be popular with want to realize the long-term success we association we have everyone. In fact, that was the case when we seek. I suppose this could be seen as a ‘glass accomplished critical first began calling for 70 per cent full-time half full, half empty’ sort of thing, but that employment. Conflict is a normal part of comparison does not fully represent my things together … any change process, and avoiding it will concern. That image is too static, and I serve neither us, nor the people of this refuse to accept that we would ever be satis- we should celebrate province.We will continue to walk this long fied with a half-full option as an end point. road, with a clear vision of a goal that is As RNs and members of an influential successes, and good for Ontarians’ health, for nurses, and professional association, we have accom- for the profession. It’s never our intention plished critical things together in the last strengthen our conviction to start a fight, create enmity, or foster dis- several months. We have made gains, for cord.We will continue to walk respectfully, example, through changes that have been as we continue to but firmly. proposed in legislation to allow RNs to advocate and walk In some ways, the path RNAO is on is dispense drugs, and the introduction of similar to another long journey currently language that paves the way for open pre- towards our underway.The Olympic torch is now travel- scribing for nurse practitioners. Is this our ling across our country to Vancouver for the half-full glass? Should we accept this as full vision.” Winter Games. That too is a long journey ‘sufficient’? No way! We can still fill the that is sometimes contentious. It is also a glass. We need strong regulations that will journey that occurs in ‘legs,’ one section of allow NPs to admit, treat and discharge bans the cosmetic use of pesticides across the road at a time. It involves the efforts of patients in hospitals and other in-patient the province? Almost certainly not. By the runners who carry the flame, and the settings. And if the government wants to taking the long view, we have achieved people who support the runner. It’s also a see more collaboration among health-care one stage in our journey to improve envi- journey moving towards a clear goal. professionals, it needs to replace hospital ronmental health. Ahead on that road is So we ask you to join in taking a long medical advisory committees with inter- toxics legislation, and the critical need to view,to growing steadily over time, to contin- professional advisory committees that urge the province to enact a law that effec- uing to walk towards our goals as an associa- include nurses and other professionals.This tively removes them from our environ- tion. We know we will get there with the is a situation that requires a sustained com- ment. This issue also requires a long view commitment of members like you. RN mitment to continue to walk down a road, of the journey ahead.We are not yet at the with obstacles in the way, to reach a desti- end of this road. WENDY FUCILE, RN, BScN, MPA, CHE, IS nation we can see, but which is obscured Over the last several months, we have PRESIDENT OF RNAO.

Registered Nurse Journal 5 Executive Director’s Dispatch with Doris Grinspun

H1N1 reveals SARS’ silver lining

This fall, reaction outbreak, there was very little information whether they have a health card or not – and response to the from the government. Nurses were ring- receive antivirals if they are ill and it’s clini- H1N1 virus dominat- ing alarm bells about the disease’s resur- cally indicated. ed health-care news. gence in their workplaces, but by and Our level of readiness is also the result of Whether the stories large, they were ignored.This time around, the progress this province has made in have focused on the however, governments have a strategy, building up the nursing profession. During province’s readiness for albeit imperfect. Nurses are being listened SARS, just over half of Ontario’s RNs were a flu pandemic, the to, and our concerns are woven into the working full time, and about 18 per cent tragic deaths of children struck down by government’s influenza pandemic plan. were working for more than one employer. the illness, or winding lineups at clinics all RNAO participates in the provincial advi- When the province issued its directive that over the country, it’s a story that’s gripped sory committee for this plan, and we join nurses could only work for one employer every Canadian. in teleconferences to get the latest updates, to try and stop the spread of the illness, The story that’s less often told is that of which we disseminate to members and many hospitals were left short staffed. It was the nurses. Nearly every Ontarian who had post on RNAO’s website. a dangerous situation that exposed our a flu shot this year – including me, when I health-care system’s weaknesses. rolled up my sleeve during a visit to the Today,much has changed.We now have Sudbury District Nurse Practitioner 65 per cent of RNs, 82 per cent of NPs Clinics in October – has had contact with “Nurses are and 59 per cent of RPNs working full a nurse. The dedication of public health time. It’s welcome progress toward the goal nurses who have worked long hours to being listened to of having 70 per cent of all nurses working vaccinate thousands of people this fall has full-time, a policy advanced by RNAO, been an important part of the plan to pro- and our concerns and adopted by the Liberal government tect people from this new virus. since its first mandate in 2003. In fact, nurses in every sector of health are woven into the As well, we have at least 7,533 more care — whether they are in communities RNs, 590 NPs and 4,372 RPNs than we or caring for the ill in hospitals — are mak- government’s did during SARS. And programs like the ing sure the public gets the facts on H1N1. Nursing Graduate Guarantee, the Late When people read about deaths of other- influenza Career Strategy and NP-led clinics have wise healthy children, fear and panic can also moved from items listed in RNAO’s set in.That’s why it’s so crucial for nurses to pandemic plan.” pre-election platform to become key stay up-to-date on the latest information policy prongs of government with funded coming from reputable sources. RNs need programs that send a clear message that to have the most accurate information so Ontario’s nurses are valued. they can translate their knowledge about During a pandemic, as in any major pub- There’s still a lot of work to do.To truly the pandemic, the vaccine and related lic health challenge, there will always be be prepared for a pandemic, we must make issues into information that is easy for the questions. But this time around, our con- sure everyone has a liveable income, a roof public to understand. cerns are being heard – and acted on. Some overhead, and an adequate, healthy diet on For me, when news of this new pan- of these questions have been raised by the table. Our new health minister, Deb demic influenza strain broke earlier this RNAO members. For instance, one mem- Matthews, demonstrated her commitment year, it was hard not to think back to the ber asked us whether patients who don’t to these social determinants of health last spring of 2003. Back then, our health-care have OHIP cards can still access Tamiflu. year when she unveiled Ontario’s Poverty system was caught flat-footed by SARS. Phil Graham, Co-Director for Operations Strategy as then Minister of Children and Nurses bore the brunt of that outbreak. with the Emergency Management Branch Youth Services.As nurses, we will continue They worked long hours, risked their per- at the Ministry of Health and Long-Term to play a critical role to ensure we keep sonal safety, endured quarantines, and two Care, was quick to respond to our query, Ontarians safe; during a pandemic, and paid the ultimate sacrifice with their lives. which we passed on to the member and always. RN The only silver lining of the SARS crisis is posted online. The bottom line is that yes, how much has changed this time around. there is a clear process to deal with this situ- DORIS GRINSPUN, RN, MSN, PhD (CAND), During the first month of the SARS ation and it ensures that all Ontarians – O.ONT, IS EXECUTIVE DIRECTOR OF RNAO.

6 November/December 2009 Mailbag RNAO wants to hear your comments, opinions, suggestions

POLICY Member responds to AT WORK RNAO’S RESPONSE: Re: Ringing alarm bells on changing models Why Physician Assistants aren’t the answer

RNAO’s views on the Ministr RNAO recognizes and of care delivery,July/August 2009 y of Health and Long- ASTer m Care rolls out a pilot p deploy physician assistants roject to province (PAs) acr , RNAO is r oss the show the pub edoubling its efforts to physician assistants lic, go is well aware of the his- v We feel strongly that you have misin- ernment and media wh PAs are not in patient is no place for them ins’ our interests he and that th y ere The facts are clear alth-care system. . Nurse practitioner (NPs) already do more than ph s tory of physician assis- Re: Nursing in the News, tants cou formed readers and possibly the public by ld ever do in a clinical setting,ysician and ass inis- a way that’s safer and more cost efficient. NPs hav e better educati ence and on, more clinic greater pr al experi- Policy at Work, physician assistants. ofessional autono tants in the Canadian wrongly defining the role of the RPN. my than PAs m the direct su ust function pervision of a ph under Research already sho ysician. outcomes for patients wswho superior clinical from NPs as recei September/October, 2009 compared to P ved car Tom Bl Forces and has no criti- e Educational requirements for the RPN unt, l Of paramount c As. eft, was one of th the role wil e Regi oncern to RNAO is the l be extended stered Nurse fact that patient care and safety a after meeti First Assistan ngs b ts (RNFAs) being compromised due to P RNA etween RNAO a who le re at risk of O is also concerned t nd the Mi arned fu are unr hat since P nister of Hea nding for education and experience As’ inadequate egulated, As lth. Doris Grinspun is quot- high standards ofthe practicey are not go subjec cism of the fine and valu- and the RN have been transformed. This pr ogram at the Uni . While a ne t to the Funding ver w lated professionals. for RNFAs require students to h sity of Toronto verning regu- av does effecti PAs are also not co egister in health car e some experience ve. At an a ed Nurse First Assistants recei e, the P verage annual sala st some good news this summer McMaster Uni A program offer $92,250 to $106,641 — plus addition R ved ed at ry of the Min ed saying PAs are more Ontar versity does not. Both bonuses and stipends of $7 ister of Health and Lon .In August, able service they have pro- makes your research outdated. Updated RN io pr ograms only require applicants al announced fu g-T to hav years to the super 2,000 over tw nding for the po erm Car e two years of u vising physician o be maintained at the le e not a full degr ndergraduate study – Ontario taxpa sitions would ee – in any yers are not getti s — vel of 50 per cent. point in their past. Ontario discipline PA s at s value for their The gover ome dollar ng good nment had co PAs ar s. ting funding for this r nsidered cut- expensive than employ- spend only one year in the tudents e touted as one w vided. Our position is that and RPN competencies from the College of times, a have eliminated many ole,of thewhich po w another in general clinicalclassr education.oom and but RNAO argues thaty hiringto ease mor wait ould NPs and allowing RNs a where these RNs RNAO belie ar sitions ves this is a g e practise autonomouslye underemplo ythe Nursin education for a health-carerossly worker inadequate when tise to their f nd NPs to prac- ed. RNFAs ull scope would do much Act patient acuity is increasing and the pub more to address challenges w and provide assistance to patients and surgeons befor g the role of PAs in Ontario ing more nurses and car Nurses of Ontario no longer use old termi- deserves and demands high professional e. A position statement on iththe access r to e, during and after surg lic P procedur standards of their care As in Ontar ole of es. ical io’s health-care system is Ex providers. expected to ecutive Dir be appr Pr ector Dor board of di oved by RNAO’ esident W is Grinspun and Broader powers for NPs rectors this f s endy Fucile expressed their nurse practitioners. all. RN concerns about the fundin is not supported by their nology such as the “stable or complex October, RNAO ap meetings and letters to M g cuts in pr pear ivate INserious ed before a p and Long-T inister of Health omissions in ublic hearin erm Car Amendm Bill 179, the Re g to pursue a e, Da ent Act, 200 gulate mendm April. RNA vid Caplan, 9. Prem d Health Pro ents to address O hopes additional fundinin nurse practition ier McGu fession ers in inty promised s Statute will enable the 80 a Every day, we hear doesn’ April, but me to broa Law v g level of experience and edu- patient.”We are all nurses with different skills, t address many key concerns.mbers Most notablewer are th den th pr ailable RNFAs in the e disappointed e scope of practice of ovince to secur prescribing for NPs and not allowing them to admit, to learn the leg Cur e full-time emplo rently,only 39 ar yment. Without these changes, RNAO argues the government wille failurenot be toable mo islation e employ ve to open part-time roles. ed in full or wait times or increase timely access to care. treat, and discharg gov RNAO has also ask e hospital in-patients. ernment to tak ed the about the nursing role one step furthere itsb commitment to cation.Consequently, patient experiences and education. Client factors RN to reduce su this rgical for these positions to y100 incr 26 September/October 2009 easing funding permanent basis a per cent on a nd outside of hospital nursing budgets. shortage in Ontario, RN care and safety are at risk of should lead our decisions of what skills mix is so I wonder, where being compromised. Physician needed. To say that a mix of RN/RPNs would more nurses and NPs come from? assistants in this province are within the practice setting increases morbid- NPs are very experienced and have a signif- not subject to the high standards of practice gov- ity and infection rates is irresponsible. icant amount of education. They are at the erning other regulated health professions. In In addition, it was disturbing when you high end of the salary scale and would likely addition, nurse practitioners, RNFAs and other grouped the different RPN role together be compensated at the same level as PAs RNs are able to do far more for patients, and with unregulated health-care workers.You with similar experience and education. introducing another health-care role only adds also state that heath-care organizations As for regulation, the Canadian to public confusion. would fill vacant RN positions with RPNs Association of Physician Assistants (CAPA) or PSWs. This might be reasonable as states its goal is regulation through the RNs debate skill mix on front lines RPNs have adequate skills and experience. provincial Colleges of Physicians and Re: Executive Director’s Dispatch collects We need RNAO and RPNAO to work Surgeons. concerns and kudos, July/August 2009 together to advocate for all nurses. RNAO’s position is not necessarily the I was worried about Clarke, Trask and Pat Chornaby, position of every member. I am married to Roth’s response to Doris Grinspun’s col- Waterloo, Ontario a PA, who has been working in a demon- umn. RPNs hold a different basic educa- Helene St-Pierre, stration project in our underserviced area. tion. To provide the safest care, it would Elora, Ontario He served for more than 24 years in the make sense that RPNs work with more RNAO’S RESPONSE: Canadian Forces. Many PAs are retired stable clients with somewhat predictable The Executive Director’s Dispatch intended to draw from the military, have extensive education outcomes. Less stable clients require greater attention to the need to safeguard models of care and have passed the national PA certifica- depth in critical thinking and knowledge delivery that advance continuity of care and caregiver tion exam. application. (primary nursing and total patient care).The column I had always been a proud RNAO The focus of the letter should have been meant to stand up against versions of “team nurs- member, but I stopped wearing my RN on the health-care team being “account- ing” that fragment care by assigning RNs, RPNs pin when RNAO’s position on PAs was able for the entire care process.” No one and Patient Care Attendants to the same patient, publicized. It is neither balanced nor fully member of the team can claim independ- with each delivering aspects of his/her care. It clearly informed. ent accountability for high quality expect- states that both RNs and RPNs must deliver and I urge RNAO to fully investigate the ed client outcomes, yet one also has to be be accountable for the entire care process of their PA profession and education, and talk to accountable for one’s own role and actions. assigned patients, as continuity of care and caregiver PAs and their patients. If a PA, as a physi- I agree that “care from RPNs is no less stel- are essential to quality patient outcomes and nurse cian extender, can help to significantly lar than care from RNs.”“Stellar care” from satisfaction. RNAO’s position is that RNs be reduce ER wait times in an underserviced each member of the health-care team is assigned the entire care of patients whose condition is area, I don’t think we’ll hear much com- imperative to achieve the best expected unclear, complex and/or unstable, where outcomes plaining from the residents of this province. client outcome. are unpredictable, and RPNs be assigned the entire Marilyn Crummey Sutra Parmasad, care of patients whose condition is stable and out- Frankford, Ontario Toronto, Ontario comes predictable. RN

Registered Nurse Journal 7 by Stacey Hale Nursinginthenews RNAO & RNs weigh in on . . .

his fall, the second wave of the H1N1 virus officially hit Ontario. Thousands of Responding to H1N1 T people lined up outside clinics across the province, some waiting up to seven hours, to get a flu shot. Nurses have been at the fore- front of the largest immunization campaign in Canadian history, and a number of issues sur- faced as the program rolled out. Queue jumping by professional athletes, hospital board members, private school stu- dents and others raised questions about the ethics surrounding the vaccine distribution. In early November, controversy erupted when 3,000 doses of the shot ended up at a private clinic in Toronto to be given to its high-paying members, and to any high-risk group at no charge, so long as they came equipped with a referral from public health officials. RNAO Executive Director Doris Grinspun called the move an “abuse of public trust,” (Toronto Star,

Toronto Star

es/ Canadian Press, Hamilton Spectator, Nov. 1). “Either we ask the proof from everybody or People in Oakville, Ontario, were among the thousands

Jim Wilk Jim who lined up for flu shots across the province. we don’t ask from anybody, otherwise we Photo:

Mental health memorial quality improvement are a constant focus Port Hope Pharmacy and nursing students In October, RNAO member Marilyn St. for our hospital, and ensuring we are collected unused or expired pharmaceuti- John attended the unveiling of a memorial doing the right surgery on the right cals, including sharps and over-the-counter dedicated to people in the Niagara region patient speaks to both,”he told the medications, to raise awareness about the who have suffered from a mental illness. Sudbury Star (Oct. 12). In fact, the hospital safety hazards of unsafe disposal. St. John is the former director of the has had its own checklist system in place “People usually pour medications down Niagara community mental health since 2004. It outlines that prior to sur- the drain, flush them down the toilet, put program that organized a memorial of gery,physicians and nurses must confirm them in the trash or stockpile them,”said 10 trees and mounted a plaque in a local and document the patient’s identity,verify Prinzen. Sewage and septic systems are not nature park.“I feel a bit like a proud the surgery and surgical site, and collect designed to remove pharmaceuticals, parent watching her child grow up and pre-operative paper work.Any inconsis- which means flushing or pouring medica- move on,”St. John said of the display tencies halt the surgery until they are tion down the drain puts drugs into water (St. Catharines Standard, Oct. 8). resolved.The surgical team also does a supplies.The toxic concentration is high final check to confirm patient and sur- enough to harm small aquatic life, Prinzen Safe surgery gery-related information, including the said, adding stockpiled medications also This fall, the Ministry of Health availability of special equipment. create a risk for children and pets announced that starting next year, all (Northumberland Today.com, Nov. 6). hospitals must use a safety checklist to Medicine cabinet clean-up reduce the possibility of surgical errors. In early November, fourth-year nursing Barrie gets NP-led clinic RNAO President-Elect David McNeil, student and RNAO member Cheryl On Nov. 16, the provincial government who is also chief nursing officer at Prinzen and Trent University classmates announced its plan to fund a nurse practi- Sudbury Regional Hospital, said patient organized a Medicine Cabinet Clean-Up tioner-led clinic at Georgian College in safety is a top priority.“Patient safety and Day in Port Hope, Ont. For one day, Barrie, one of the country’s fastest growing

8 November/December 2009 For complete versions of any of these stories, contact [email protected].

create inequity,” she said. Meanwhile, several In other parts of the province, residents Ontario private schools acknowledged some were frustrated by mis-information and long On Oct. 28, RNAO member students and staff received the H1N1 vaccine lineups. In late October, seniors in Chatham Angela Connelly wrote a letter to the even though they were not among the high- hurried to get the shot, but learned they Milton Canadian Champion to risk groups. RNAO member Laura Mason weren’t eligible and would have to wait a express her concern about the dangers of works at Pickering College where the vaccine few weeks until more vaccine was available. misinforming the public about the was given to boarding students. They were RNAO member Cathy Bennett said, “The H1N1 flu vaccine. deemed to be a priority because “they were in large turnout shows people are concerned contact with a positive case,” Mason told the and are taking steps to protect their health,” Warning about flu shot Toronto Star (Nov. 11). Chatham Daily News (Oct. 27). In Ottawa, dangers off the mark Another debate also surfaced regarding the public health unit worked with RNAO In her column, Ask the Professionals, the duty of health-care professionals to be member Esther Moghadam to create a chiropractor Dr.Angela Barrow vaccinated. Lorraine Sunstrum-Mann, chief Twitter account to give real-time updates on warns people about the potential haz- nursing executive and vice-president of waits at each clinic (The Ottawa Sun, Oct 24). ards associated with vaccination professional affairs at Lakeridge Hospital in Other residents worried about the safety against influenza.Although she did Oshawa, says the provincial average for of the H1N1 vaccine. After people in not outright recommend that people staff being vaccinated is between 40 and 50 Woodstock cited allergies and long-term not get a flu shot, comments such as per cent, and Lakeridge is on par with that. effects as reasons not to get inoculated, “serious concerns over the safety of “It’s a critical discussion about whether RNAO member Mary Metcalfe, acting these flu vaccinations,”and “many or not we can mandate individuals to director of Oxford County Public Health and people who receive the flu shot receive the vaccine,” she told the Ajax News Emergency Services, reassured readers of immediately get the flu” may lead Advertiser and Pickering News Advertiser the Woodstock Sentinel-Review the vaccine people to believe that getting the flu (Oct. 21). is safe (Oct 28). RN shot causes more harm than good. This is a dangerous and misleading message. The fact is that influenza is health-care providers to provide residents a potentially lethal infection … The of the Simcoe County area with the timely vaccination has been stringently stud- and high-quality primary care services they ied and shown to be both safe and need and deserve” (Barrie Examiner, Nov. effective at reducing the spread of the 17).The clinic will be open to students, virus. Unfortunately,there is far too faculty and the general public. It will have much misinformation circulating that several NPs and collaborating physicians. leads people to believe otherwise. As It will also offer physiotherapy as well as an RN, I’ve seen the effects of dental, pharmacy and eye care services. influenza first-hand and know how devastating it can be. I’m asking peo- Climbing the ranks ple to educate themselves about this A growing number of Toronto hospitals important topic so that they can are being run by chief executive officers make a truly informed decision. (CEO) who started their careers as nurses. Angela Connelly, Nursing students joined Premier Dalton It’s a very different picture than 30 years Milton McGuinty, right, to announce the opening of an NP-led clinic in the Simcoe County area. ago.“It used to be an old boys’ club,” RNAO Executive Director Doris cities where nearly 30,000 residents don’t Grinspun told the Toronto Star (Nov. 15). RNAO member Mary Jo Haddad, have a primary care provider.“Nurse prac- Hospitals such as Women’s College, the CEO of the Hospital for Sick Children, titioners and all nurses take pride in this Hospital for Sick Children, St. Joseph’s worked her way up within a single organi- great achievement,”said Wendy Fucile, Health Centre, North York General, zation. Most of the RN-CEOs said they President of RNAO.“This clinic will allow Trillium Health Centre,York Central and wanted to see their work have a wider NPs working in collaboration with other Markham Stouffville are led by nurses. impact on the hospital.

Registered Nurse Journal 9 Nursinginthenews RNAO & RNs weigh in on . . .

Driven to succeed Healthy body, Fourth-year nursing student and RNAO mind and spirit member Daphne Belleau grabbed head- RNAO member Kim lines for the flurry of work she’s done at Watson is spearhead- Sault College and in the community. ing an initiative to Belleau is president of the Aboriginal bring complementary Student Nursing Association, carries a full therapies, such as workload at the college, and is raising her healing touch, acupres- five-year-old son as a single mom. She is sure and reflexology, also a mentor to other students.“I want to to Hôtel-Dieu Grace help those who might think, somewhere Hospital.The Windsor along the journey,that they can’t go on The Windsor Star RN is taking advantage because the program is so difficult,”Belleau of RNAO’s Advanced ason Kryk, told the Sault Star (Nov . 6). In October, J Clinical/Practice

Belleau attended the national Aboriginal Photo: Fellowship to spend Nurses Association of Canada conference in Kim Watson, right, performs healing touch therapy for a patient five months looking Edmonton with Sault College faculty receiving her flu shot at Hôtel-Dieu Grace Hospital. at ways to incorporate members Kay Vallee and Lori Matthews, complementary therapies into the hospital’s acute care setting, as well as studying their to share what the school is doing in aborig- impact and educating others. “This is another way for us to improve quality of care for inal health care. our patients,”Watson told the Windsor Star (Oct. 28). RN Out & About

On Nov. 5, members of the Nursing Students In November, RNAO, the joint RNAO/ On Nov. 11, RNAO member Mary Carley, of Ontario took part in the Drop Fees for a University of Ottawa Nursing Best pictured above in a traditional nurse’s Poverty Free Ontario Day of Action. Practice Research Unit and 21 Best Practice cape and hat, laid a wreath at the Thousands of people attended the rally in Spotlight Organizations received the cenotaph in Guelph on behalf of Toronto to draw attention to how affordable, inaugural Practice Academe Innovation Wellington Chapter. For the last five accessible education can lift more people Collaboration award at the Sigma Theta years, Carley has represented nurses’ out of poverty. The event was one of several Tau International (STTI) conference. The work during wartime in the local NSO held during November to examine award recognizes efforts between nursing Remembrance Day ceremony and parade. poverty and health. practice and academia to improve health. She began taking part after learning Pictured receiving the award (L-R): that the last living local nurse who Heather McConnell, RNAO; Barbara served during wartime could no longer Davies, co-chair of the NBPRU; Irmajean participate due to health concerns. Bajnok, RNAO; Doris Grinspun, RNAO; and Carol Huston, STTI.

10 November/December 2009 Shifting communication Bedside conversations are helping nurses get life-saving information. BY STACEY HALE

wo years ago, Barb Harvey’s shift on the orthopedic unit at Trillium THealth Centre in Mississauga began like any other. She arrived at 7:15 a.m., checked the assignment board to see which four patients she’d be responsible for that day, and headed to the nursing station to get a report from the outgoing night nurse. When her colleague went home, Harvey went to assess her first patient. The RN was startled by what she found. The 84-year-old woman was complaining of chest pain and having difficulty breath- ing. Harvey called the hospital’s medical emergency team and started her own assess- ment. The patient — who was recovering from a hip replacement — needed to be transferred to the ICU. She had suffered a pulmonary embolus, which comes on sud- Clinical educator Marcella Honour, left, and RN Barb Harvey, right, practise the safe patient hand- denly, but is a common post-operative off program at Trillium Health Centre. complication for orthopedic patients. was pioneered last December in the ortho- privacy and confidentiality. What if their Harvey was shocked.After all, the night pedic surgery unit, and has since spread patient was sharing a room with a stranger,or nurse had conducted a head-to-toe assess- across the entire hospital. if they didn’t want their family members to ment before going home and didn’t have Honour says the system mirrors high- find out about their health during the any major concerns. “I found (the situa- risk industries, such as nuclear power plants. report? Elliott and Honour helped nurses tion) totally overwhelming because the A key part of the program is a laminated through mandatory role playing so they major part of the morning was taken up template that is pinned on the bulletin board could get used to talking openly right in with this and I hadn’t seen the rest of my in every single patient’s room. It prompts front of patients, including asking their per- patients,”she explains. nurses to discuss the patient’s plan of care, mission to do the report each time. Honour In fact, Harvey wasn’t the only RN to medications, test times, and when the doctor also created a patient brochure to explain the have such a distressing experience. Others will be visiting. It also includes a safety new program, and warn them that, since had found a patient with an unexpected checklist that asks nurses to, for example, safety trumps sleep at Trillium, they’ll be symptom after shift change. Kathy Elliott, make sure the correct IV solutions are hang- woken up if they happen to be dozing dur- the unit’s manager, and Marcella Honour, ing. And since everything happens right in ing the shift change. the Clinical Educator, say that’s when the front of patients, they can ask questions, or Nearly a year later, Elliott says the pro- staff started looking for ways to do things talk about the care they’re receiving. gram has caught on, and staff are starting to differently. “Nurses now have the opportunity to say that it’s making their work easier. Most Honour says part of the problem was visualize their patients and to clarify infor- importantly,the new system is making life a how and where the nurses were exchang- mation and ask questions in the presence of lot safer for patients at Trillium. Harvey says ing information during a shift change. Both the patient,” Honour says, adding bedside that’s made all the work to get the new sys- the incoming and outgoing nurses met at reporting is even more important if someone tem up and running worthwhile, because the nursing station, but there were incon- doesn’t speak English or is cognitively after that day when her elderly patient nar- sistencies in what was talked about, and impaired because it allows nurses to look for rowly avoided tragedy two years ago, she what was being left out.To fix the problem, non-verbal cues, like grimacing when knew she never wanted to experience a rillium Health Centre

T Honour and Elliott decided the report patients are turned in bed. Honour admits shift change like that again. RN would have to happen at the bedside, in nurses were reluctant to start the new process

Courtesy front of the patient. The Transfer of at first because it was a change in their rou- STACEY HALE IS EDITORIAL ASSISTANT AT

Photo: Accountability-Safe Patient Handoff program tine.They were also concerned about patient RNAO.

Registered Nurse Journal 11 12 November/December 2009 on the front line As H1N1 spreads across Ontario, RNs are at the epicentre of plans to keep people well.

If you were a nurse during sars, the H1N1 pandemic may be giving you a dis- turbing sense of déjà vu. While SARS was a hospital-based disease and H1N1 is spreading in the community, both sparked public fear and a media frenzy. But there are some stark differences, too. RNAO Executive Director Doris Grinspun says governments and health officials learned plenty of lessons dur- ing the SARS crisis that have been applied to H1N1 planning and operations. “In Ontario, nurses’ voices are being taken extremely seriously and our advice is being acted upon,” says Grinspun, who sits on the Ministry of Health H1N1 provincial advisory committee. Since so many nurses are involved in H1N1 planning, screening for the ill- ness, immunization and the delivery of care across the province, Grinspun says they’re ideally placed to help the public sort through all the informa- tion on everything from vaccination protocols to treatments needed. “Nurses are information brokers and translators,” she says. “People have lots of questions when they are fearful. We need to be adequately informed and accurate with our facts so we can alleviate fears, rather than feeding into them.” As the second wave of H1N1 unfolds across the province, Registered Nurse Journal looks at how nurses are taking on that leadership role. Whether they’re inoculating thousands at flu-shot clinics or caring for the ill who find themselves in hospitals, RNs are coming up with creative and strategic ways to overcome the virus’ unique challenges.

BY JILL-MARIE BURKE • ILLUSTRATION BY ISABELLE CARDINAL

Registered Nurse Journal 13 BRINGING AGE-OLD TRADITIONS INTO THE H1N1 AGE

or more than a century, parishioners at organizes lunch and learn workshops after have God and each other. We try to use our F St. Louis Catholic Church in Waterloo have mass to talk about topics such as diabetes or faith to help people relax and not panic.” been dipping their fingers in holy water as hypertension. In November, the talk focused Webster doesn’t want to overwhelm her they enter the front door. But these days, on the history of pandemics, provided updates parishioners with information about H1N1, hand sanitizer can be found beside the holy on the virus and stressed the importance of but she also wants to make sure those with water fonts. Other long-standing customs that getting the vaccine. chronic conditions, the elderly, and anyone could spread nasty flu viruses have also been “Because we’re a parish, we also talked else who lives alone will have the assistance changed. Churchgoers now wave or nod about faith and hope,” she says of the session. they need if they get sick. For those who don’t instead of shaking hands, wine is no longer “We know that no matter what happens, we have anyone to call on for help, Webster and shared from a common cup, and peo- her team of volunteer visitors will make ple can’t receive the communion sure they have all the support they need. wafer on their tongue. Webster is also ensuring she can visit Parish nurse Anne Marie Webster, her parishioners if a serious outbreak who works for the church, is leading restricts hospitals’ visitor policies. St. Louis’ efforts to keep H1N1 at bay Webster says during the SARS outbreak and often explains these changes to patients were limited to one visitor a church members. day, and parish nurses couldn’t see the “I tell them that this is flu season patient if the person already had a visi- and we can spread germs if we do tor. When she recently attended a meet- these things,” she says. The parish’s ing with the city’s hospital chaplains to 1,300 families know that Webster review pandemic plans, she asked them works hard year-round to look after to urge hospital administrators to their physical and spiritual well- acknowledge that parish nurses are not being by providing health education ordinary visitors because they provide and counselling, visiting people in spiritual guidance and health coun- their homes and in hospitals, and selling in times of sickness. comforting those who’ve lost a loved Webster says it’s all part of looking at one. She also organizes blood pres- how time-honoured traditions need to sure screening and foot care clinics be revised while finding innovative ways and leads support groups for parish- to protect the physical and spiritual ioners. And a few times a year, she health of her congregation.

EASING FLU ANXIETY DURING EXAM SEASON

urse practitioner Elyse Maindonald has been opening doors Rules around sick days have been among the first to change. Nwith her elbow for years and she’s been a stickler about wash- Students, for example, who are off with the flu don’t need to worry ing her hands since her days as a surgical nurse. Now, as influenza about falling behind on their work. They can make up missed assign- coordinator at St. Clair College’s south campus in Windsor, she’s ments and tests when they return to campus. Staff are also being leading a campaign to protect students and staff from H1N1 and encouraged to stay home if they’re unwell, but the way they call in keep classes and campus activities running as usual. sick has changed. Before the pandemic, faculty simply phoned their This past spring Maindonald, who created a pandemic plan for managers if they couldn’t come to work. Now, since all possible cases the college in 2006 in case of an avian flu outbreak, was released of H1N1 need to be reported to public health, sick employees must from her teaching duties in the nursing programs so she could con- also call the college’s flu hotline and answer questions about their centrate on H1N1 planning and monitoring. In October, when staff symptoms. Since this has never been done before, Maindonald sent and students with flu-like symptoms began crowding the campus emails to staff to explain why it is necessary and to assure them that health centre where she works as an NP, the college asked her to the questions were being asked for statistical purposes only; their pri- devote all her time to managing the pandemic. Today, Maindonald is vacy is being respected. doling out H1N1 vaccines to people in high-risk groups, assessing and In spite of the fact that the health centre staff are seeing three treating students and staff who have flu symptoms, updating college times as many students and staff with flu, colds and strep throat as policies that are impacted by H1N1 and providing ongoing education this time last year, Maindonald says it’s been a challenge convincing and communication. the ill to stay home so they won’t infect others. Still, she says she’s “We’ve had the flu plan for years and you think you’re ready to starting to make headway through her constant emails, one-on-one go, but it’s a living document and we’re rewriting policies on a daily conversations and classroom presentations. “They’re beginning to basis. We’re flying by the seat of our pants,” she says. get the message,” she says.

14 November/December 2009 OUTBREAK STIRS MEMORIES STAYING HEALTHY WITHOUT A HOME at the Sherbourne Infirmary, a short term ost of the people RN Keren Elumir ebbie Tirrul remembers lining up in a health facility for the homeless, or a shelter Msees in the health clinic run by Dcrowded church basement to get the that has special rooms for people who are Sanctuary, a Christian charitable organiza- polio vaccine. She was too small to see much ill. But many of the people she meets at tion in Toronto, are so busy coping with beyond the patterns on the dresses worn by Sanctuary won’t stay inside at night, even if homelessness, mental illness and abuse that the mothers in the room, and she doesn’t they’re unwell. Some are claustrophobic H1N1 isn’t even on their radar. But she says recall the needle’s prick. But she can remem- and fear the cramped quarters at shelters. they’re at a greater risk of catching the virus ber the feeling of near-panic in the room. Others are afraid of the violence that can and passing it on because their daily strug- Today, as a nurse practitioner at Somerset break out there. A handful won’t sleep gle for survival finds them interacting with West Community Health Centre in Ottawa, inside because it brings back bad memories dozens of people at various soup kitchens Tirrul is calming the fears of a new generation of time spent in prison. The challenge is to and drop-in centres throughout the city. of parents terrified their children will be keep them warm, dry and hydrated. Add in the fact that they often sleep in caught in the clutches of the latest pandemic. Although some Toronto street nurses overcrowded shelters and lack the opportu- “Every time a young person dies it frightens began vaccinating the city’s homeless popu- nity to maintain proper hygiene, eat well people – especially moms with small children,” lation in November, Elumir says advocating and get enough rest, and you have a recipe says Tirrul, who is able to reassure most parents for services for these people must continue for spreading the virus. that their little one is going to be just fine. to be one of the most important roles she Men and women of all ages who are In the first week after Somerset West was can take on. That can mean finding housing unemployed, living on the street or coping designated a flu assessment centre in early for pregnant women or people whose with challenges like AIDS and drug addic- November, Tirrul says 200 people of all ages immune systems are compromised by ill- tion visit Sanctuary where Elumir says the streamed in to find out if their coughs and nesses like HIV. Or it can mean writing a let- staff and volunteers can help them access sneezes were anything to worry about. When welfare, housing, legal advice or patients arrive, they’re greeted by the cen- rehabilitation. They also come to tre’s social workers and triaged by RNs. eat a nutritious meal, socialize or People with coughs, muscle aches and fevers visit the health clinic, which is are sent to the flu assessment centre where staffed by nurses and a part-time they’re examined by nurses practitioners and physician. physicians wearing N95 masks, gloves, gowns Every year during cold and flu and goggles. During the first wave of season, Elumir and her colleagues patients, Tirrul says many were prescribed remind the guests to wash their Tamiflu or antibiotics, a handful needed hands and cough into their elbows. chest X-rays and two people were sent to They’ve found that signs often go hospital. Tirrul says the assessment centre is unread and formal educational ses- being staffed by nurses normally responsible sions are poorly attended, so they for seniors outreach or giving vaccinations communicate face-to-face when and blood tests, but who are now masked handing out vitamins during meals. and gloved and taking histories and doing “You see almost everybody in the assessments. room then and you mix it into the “It’s stressful because they are working in conversation at each table,” she different areas under different directives, but says. They also encourage the visi- they are very keen, have learned quickly and tors to get flu vaccines and are settled into a new role of collaborating Sanctuary provides subway tokens with nurse practitioners and physicians,” she ter to a shelter to ask them to permit a sick so they can travel to immunization clinics. says. In fact, keeping up with the latest infor- person to sleep there during the day when Elumir also tells guests that if they’re sick, mation and protocols on H1N1 has been chal- the shelter is closed for cleaning. It also she or another team member will travel to lenging for everyone, especially when they means working with groups like the them to make sure they’re okay. were changing on a regular basis this fall. Toronto Disaster Relief Committee and “Because members of the street commu- Tirrul and her nursing colleagues worked Streets to Homes to give the homeless a nity tend to know one another, we’ll often extra hours to keep up with all the reading. voice. But with flu season upon us, Elumir get a message like ‘Tony is sick, he wants to “We had tomes and tomes of things to says until that advocacy work pays off with see you; he’s in the alley.’ If they’re camped in read,” she says. “Every day there was another adequate housing for all, she’ll continue to the Don Valley, if they’re in a rooming house, 20 to 30 pages of procedures related to topics bring emergency blankets to people who we’ll go to them and make sure they have like protective gear and prescribing Tamiflu to sleep in alleys and brew endless cups of tea adequate fluids and resources,” she says. pregnant women. This is stressful for nurses to try to keep Sanctuary’s guests warm, For the sick who are willing to sleep because it’s a steep learning curve and every comfortable and healthy. inside, Elumir will try to find a bed for them day there’s more to read and a slightly differ- ent way of doing things.”

Registered Nurse Journal 15 office administering flu shots. It’s no small LEARNING FROM SARS task. Lesenke says within a three-week period, hen the World Health Organization 35 nurses administered 13,000 doses of the Wdeclared the H1N1 outbreak a pan- H1N1 vaccine and almost 3,800 doses of the demic last spring, Bonnie Alexiou, an ER seasonal flu vaccine to residents in 14 commu- nurse at Markham Stouffville Hospital, start- nities spread across 166,514 kilometres. ed to feel scared and worried. She’d worked Lesenke says transporting the vaccine during the SARS crisis and spent two months from Kenora to the various satellite offices in as an inpatient at the hospital when she con- coolers or containers that can be plugged into tracted the disease herself. a car’s lighter was not a problem. Staff mak- “H1N1 stirred up emotions I thought I’d ing the drive to far-flung communities volun- dealt with and filed away. It was weird to feel teer to take the vaccine every flu season to the fear coming back. It was almost like a post- contribute to the success of the program. But traumatic stress feeling,” says Alexiou. She administering a brand new vaccine posed says she worried about her colleagues falling other challenges. ill, wondered how the emergency department When, for example, nurses discovered would cope if large numbers of people that the needle recommended for withdraw- showed up with symptoms, and hoped that ing the adjuvant was too short to reach the lessons learned from SARS would help the hos- KEEPING COMMUNITIES WELL bottom of the vial — which had to be kept pital handle things differently this time. upright — they switched to a longer one. Julia Scott, Vice President of Clinical hether it’s measles, mumps or bed They also revised the way the vaccine was Programs and Chief Nurse Executive at Wbugs, RNs at the Victorian Order of rolled out. Once children, pregnant women, Markham Stouffville, says a lot has changed Nurses (VON) for Canada have plenty of expe- people with underlying health conditions since SARS. She says the hospital is listening rience handling community outbreaks. Their and others in priority groups received their to nurses, and has developed plans to cope infection control knowledge, the N95 masks shots, nurses offered the vaccination to with being short-staffed if employees are they always carry in their vehicles, and routine everyone who was waiting in the line. sick. There are also enough N95 masks for practices like distancing and handwashing will Because some families drove hours from every employee, and a stockpile of Tamiflu. serve them well during the H1N1 pandemic. remote communities to get inoculated, “We have appropriate infection control Irene Holubiec, the national director, clin- Lesenke says it wasn’t fair to ask those who practices, including making sure our staff ical services for VON Canada, is co-directing didn’t fall into certain categories to make have access to personal protective equip- the agency’s pandemic planning. She says one another trip to the clinic later, when they ment,” she says. of the biggest challenges of H1N1 is keeping qualified for the vaccine. Scott says counsellors are also able to up with what’s happening in different areas While the flu-shot campaign has kept support employees who lived through SARS. of the country, and passing it along to VON’s nurses very busy, Lesenke says overtime has Alexiou met with the same counsellor who front line employees. She says staff need reg- been kept to a minimum. comforted her six years ago, and she decid- ular updates so they can help their patients “We’re really trying to make sure our nurses ed that working in the hospital’s flu assess- sift through the facts and fiction that are have time to rest and take care of themselves,” ment clinic would be the best therapy of all. reported in the media. she says. “Our number one goal is to provide “It’s a good way to overcome my fears, “The clients aren’t reading the studies and safe clinics. We want to make sure our nurses strengthen my mind and set an example for the evidence, they’re only seeing the media. are well-rested and not making mistakes.” my peers,” Alexiou says, adding she feels So they’re asking: Is it safe for me to get the Lesenke says it is especially important for proud of her work. vaccine? When can I get it? Where can I get nurses to be alert because in some clinics the Many of Alexiou’s colleagues in the it?... H1N1 is different because it’s new. It will H1N1 and the seasonal flu shots are being emergency room today didn’t work during happen in waves, it will happen in our commu- administered at the same time. In smaller SARS and sometimes question why it is nec- nities, and it will impact us,” Holubiec says. offices, one nurse is working alone and pro- essary to wear protective gear such as N95 Arlene Lesenke agrees it’s important for viding both vaccines. masks, goggles, gloves, and gowns. nurses to stay on top of all the latest news Lesenke admits the mass immunization “I get on my soap box and say ‘This is about H1N1 so they can answer people’s campaign does pose some challenges for nurs- quite serious. This is is how we’re going to questions. But she admits it can be hard to es and other health-care providers, but she protect ourselves, our families and our keep up with Ministry of Health guidelines says the benefits are well worth the effort. “As patients’,” she says. that are being revised and updated regularly. Canadians we are in the enviable position of Although Alexiou and her colleagues are “Nurses want to make sure they’re giving the knowing that there’s a pandemic flu strain cir- getting scabs on their noses from the masks, absolute best information they can, but it’s culating and we have a vaccine that can pre- she vows that even when H1N1 has passed she very hard when it keeps changing,” she says. vent it. In past pandemics there was no vac- will keep wearing the protective garb. “It’s the As the Director of Health Protection at the cine,” she says. RN uncertainty of what’s out there. I don’t want Northwestern Health Unit, Lesenke is coordi- to be caught two steps behind,” she says. nating the region’s H1N1 planning and works JILL-MARIE BURKE IS ACTING STAFF WRITER side-by-side with fellow nurses in the Kenora AT RNAO.

16 November/December 2009 Coping with cancer RN helps families deal with the reality of life beyond chemotherapy. BY JILL-MARIE BURKE

it okay to hug Joshua?”“Can we arrange for a teacher to come to their house. catch cancer from him?” “Is he She also links them with child life specialists IS going to die?” These are just who can help children who’ve had an arm or some of the questions Vicky Wilton fields leg amputated learn to live and play again. from elementary school students when the Sometimes,Wilton is also a travel agent. RN visits classrooms to explain that a fel- If families need to go back to Toronto or low student has been diagnosed with can- Ottawa for appointments, she will help cer and has just started chemotherapy them access grants to offset travel costs, treatments. arrange accommodation, and link them Wilton assures the anxious children that with a support group that provides grocery it will be okay to touch their friend; cancer coupons, long distance telephone cards and isn’t contagious. She also prepares them for parking vouchers. the day Joshua will return to school. She Wilton has also been involved in proj- explains he won’t have any hair, but he’ll ects that would be more common for a still be the same boy inside.Then she tells general contractor than an RN.When one them there is always a possibility that he young boy couldn’t be exposed to dust could die, but the doctors and nurses are NAME: Vicky Wilton because he’d just had a bone marrow trans- very hopeful he won’t. OCCUPATION: Interlink Nurse plant, she called a local service club and Today, 90 per cent of children survive HOME TOWN: Sudbury, Ontario arranged to have all the carpets removed leukemia, compared to 60 per cent just 15 from the family’s home. years ago. But living with the disease is still good understanding of their child’s cancer No matter what she does for them, an emotional roller coaster for the families and the maintenance treatments he will Wilton says it’s a privilege to help families who are touched by it. As one of 10 soon begin receiving at the regional cancer get their lives back on track. “One of the Interlink nurses with the Pediatric program in Sudbury. However, they’re biggest rewards is sharing this experience Oncology Group of Ontario, it’s Wilton’s overwhelmed at the thought of coping with families,” she says. “Being able to go job to accompany them on the journey to without the team of health-care providers into their homes, being part of the school, health and help them make sense of the who were just a short walk away when being privy to their financial information – twists, turns and dips along the way. they were in Toronto or Ottawa. “They and knowing that they trust you.” Wilton’s relationship with a family begins need to be acquainted with what’s available Because Wilton knows the families she when a fellow Interlink nurse or social work- in their communities,”she says. works with so well, she says it’s hard to er at the Hospital for Sick Children in As a former home care nurse, Wilton watch them struggle financially, mentally Toronto or the Children’s Hospital of Eastern says she jumped at the chance to become and physically and to know that she can Ontario (CHEO) in Ottawa calls to say a an Interlink nurse in 2007, because it only help them so much.“Cancer is like a child from northern Ontario is receiving allowed her to combine her experience in big cloud hanging over their heads all the chemotherapy at their hospital. Wilton says the community with the 12 years she spent time. Even when the child seems better, it’s common for families to make the trip working in adult medical oncology, pallia- you never know what’s going to happen south because Sudbury doesn’t have a pedi- tive care and pediatrics at Sudbury tomorrow.So it’s always in the back of par- atric oncologist.Wilton phones the parents to Regional Hospital.Today, her role encom- ents’ minds.” introduce herself, describe the help she can passes everything from finding the nearest Still, watching families tap into courage provide, and make arrangements to meet lab where kids can go for tests, to helping and resilience that some didn’t realize they them when they return home from having families cope with the day-to-day realities had fills Wilton the memories about her job treatments in southern Ontario. of having a sick child at home. that will always stick with her.“It’s rewarding Her first face-to-face meeting with Wilton says most parents need to figure to see families overcome their struggles and families, who live anywhere between out how they can afford to stay home with their battles and be successful. A lot of fami- Thunder Bay and Parry Sound, normally their child. She helps them access compas- lies shine and really rise up to the challenge,” takes place in the family’s home. Since their sionate care benefits or arrange a short-term she says. RN child has just completed the intensive, ini- leave of absence from work. If school age tial round of chemotherapy called induc- children feel well enough to start learning JILL-MARIE BURKE IS ACTING STAFF tion, Wilton says parents usually have a again, she’ll contact the school board to WRITER AT RNAO.

Registered Nurse Journal 17 Pain, nausea, vomiting and fever are words Karen Fleming says on a daily basis. In the early hours of the morning, when dis- traught children and parents find themselves on her unit, she’ll sometimes hear these words uttered from the lips of an interpreter who is calmly explaining — in Cantonese, Mandarin or a myriad of other languages — a family’s next steps in a battle against child- hood cancer. Fleming works as a bedside and clinical support nurse in the oncology unit at the Hospital for Sick Children in Toronto. During her shifts, she often meets parents and children who are newcomers to Canada and who speak little English.These visits are often their first contact with the health-care system. In Toronto, about 50 per cent of residents are born outside of this country,according to Statistics Canada.And as immigrants come to live, work, raise families and use health servic- es, communication and health literacy can be a challenge for them.Fleming says it’s hard for parents to think straight when they’ve just TRANSLATING through trauma learned their child has cancer. But it’s espe- issue further. In October, they presented cancer patients communicate, such as pain, cially difficult for immigrant families to cope. their work at the Pediatric Nurses Interest nausea, vomiting, fever, and nothing to eat “There’s so much that comes rushing at Group’s (PedNIG) biennial conference.They or drink.They tested them on a five-year- them and we try to communicate the looked at how cultural practices and health old girl who spoke Tamil.The hope was to basics of what’s going to happen,”she says. literacy affect immigrant families, health- try to increase health literacy using pictures, Although Sick Kids has four staff inter- care providers and children with cancer. and feedback was positive; the family said preters available to translate for non- Their literature review found there are they were clear and easy to understand. English-speaking families, these linguistic serious gaps in the system that stop new Flashcards are a great clinical tool, but experts are busy and need up to 48 hours Canadians from getting the best care possi- they aren’t getting at the root of the prob- notice before they can help. In the mean- ble. They determined more needs to be lem. Kolawole says there are a number of time, nurses must find a way to communi- done to provide immigrants with access to key challenges non-English-speaking fami- cate. Some nurses try to use fewer words, or care, and to help care providers communi- lies and their care providers face. For shorter sentences, but Fleming says the cate with their patients. Fleming and starters, nurses need more time to work problem is there is no way of assessing how Kolawole want fellow nurses to understand with these families. It takes longer to edu- much a family truly understands. “Their that all families have their own cultural cate and care for these children, Kolawole care can be so fragmented because they background that imbeds itself into how argues, because someone has to translate the don’t speak the dominant language.” they perceive health. information. She says nurse managers need Fleming and colleague Bukola Kolawole, To fill some of the existing gaps, nurses to allocate more time to help these families. an RN on the same unit, work with new- and other health professionals at Sick Kids More time would also give nurses a comers during every shift and see how they are getting creative. For example, Fleming chance to monitor families more closely for struggle through the system.The pair want- and two colleagues created five flashcards signs of increased anxiety and stress. ed to help, so they decided to investigate the with pictures to convey common words Kolawole says research shows immigrant

18 November/December 2009 “A FAMILY MAY NOT KNOW WHAT’S GOING ON AND NURSES CANNOT EASILY TAKE THEM ASIDE AND SUPPORT THEM.”

Left: Angie Cabral helps a child at Sick Kids use flashcards to describe her cancer symptoms. million from the federal Ministry of families whose children have cancer suffer a their health regimes. It’s important for nurs- Citizenship and Immigration to allow the higher rate of post traumatic stress syndrome es to be open-minded and ask about com- pediatric teaching hospital to translate core than non-immigrants, because these families plementary therapies because they could patient documents, such as discharge and are already under pressure as they try to find have potentially dangerous side effects, says education papers and surgery information, work and adjust to life in Canada, and many Kolawole. She says some families use into the most commonly required languages. are also in a lower socio-economic class.And Chinese teas and herbs alongside western The funding will also provide cultural aware- communication barriers make dealing with medicine and the danger is they can interact ness education for all health-care profession- an emergency even more confusing and with cancer medications. To avoid unsafe als at the hospital. overwhelming. A family may not know situations like these, Fleming would like to Rani Srivastava has studied cultural com- what’s going on and nurses cannot easily take see eastern medicine studied in more detail petency closely. She chaired the group that them aside and support them, Kolawole says. and incorporated into treatment. developed RNAO’s healthy work environ- Nurses also need more time with inter- “We don’t explore that avenue and we are ment best practice guideline, Embracing preters, she says.The maximum amount of waiting for the research, because everything Cultural Diversity in Health Care: Developing time they can spend with each patient is has to be empirically based on western scien- Cultural Competence. She’s also written a book about two hours.That’s not enough time to tific data,”she says.“But that’s not how every- on the topic that Sick Kids educators are give a full picture of cancer and the com- body lives, it is how the western world lives.” using to develop the curriculum for some of plex science behind it. Kolawole also says End-of-life rituals also vary among dif- their cultural awareness workshops. Srivastava some nurses don’t know how to use inter- ferent cultures and religions. Fleming argues says cultural competency is a set of behav- preters to their full potential.“Nurses some- that some traditions should be incorporated iours, practices and policies in the workplace times are not using the resource effectively,” more readily for families grieving the loss of that respect all forms of culture and diversity, says the RN who has worked at Sick Kids a child. Certain practices can happen in a including skin colour, gender, age, race and for five years and is completing her PhD in safe way, she says. For example, for families ethnic identification, citizenship, sexual ori- health human resources and international who would like to light candles – which is entation, and physical and cognitive abilities. nurse migration. She says because the inter- not the most ideal in a hospital setting — Srivastava says that if nurses really want to preter is the one speaking directly to the nurses should be able to offer candles that provide top-notch care, they have to under- patient, nurses need to make sure that are battery powered. Fleming insists it’s stand where a patient is coming from, and everyone is equally engaged in the discus- about thinking in a culturally sensitive way agree that cultural awareness is a quality of sion. Kolawole says nurses should also keep instead of saying “no, we don’t do that.” care issue. Srivastava says some practitioners

RNs find new ways to communicate with families coping with a child’s illness. BY STACEY HALE in mind how fast they speak, who to face, A change in thinking would help nurses are attuned to issues of culture and diversity, and how to position their bodies. The approach patient education, too. Kolawole but on the whole the system could do better. objective is to connect with your patient, says immigrant families rely on social sup- Health providers often struggle with what Kolawole says, adding “nurses have to start port networks to make it through tough can and can’t be done for a culturally diverse looking at how they interact with people.” times, whereas Canadian-born families patient. “They wonder ‘how do I start this If how RNs communicate with patients want to read pamphlets or articles about conversation,’” Srivastava explains. makes a difference, then it makes sense that the disease. Kolawole would like to see For Fleming, Sick Kids is heading in the Fleming prefers to be face-to-face with her patient education information that is more right direction by talking about ways to patient and the interpreter. Unfortunately, accessible to all families. She says the litera- improve everyone’s cultural competency. because resources are limited, this can’t ture needs to be written in plain English or But she wants to make sure the change is always happen. So staff members at Sick Kids translated so everyone can understand. sustainable. She says health professionals rely on a service called Language Line,which She’d also like to have a parent support net- need to be in place who can continue to provides translation over the phone. The work for immigrants that is run by the hos- champion the work, even once the educa- conversation happens over a speaker phone pital so families can talk and learn from tion sessions are over.“We need to incorpo- with everyone sitting, which means it’s diffi- each other. rate cultural competency into family centred cult to read patients’ body language to see if Fleming says more resources are starting care, to the point that it becomes natural, they really understand what is being said. to become available for families, including like everything else we do in nursing.” Kolawole and Fleming also believe it’s the About Kids Health Family Resource Is your workplace looking at new ways to important to read into what cultural prac- Centre, a library where families can access improve cultural competency? Let us know by tices and values define a patient’s idea of books in different languages.They also have email to: [email protected]. RN health care. Members of some cultures access to computers and online translation incorporate unconventional treatments in tools. In April, the hospital also received $9.2 STACEY HALE IS EDITORIAL ASSISTANT AT RNAO.

Registered Nurse Journal 19 House Calls RNs play a pivotal role in helping seniors stay at home for as long as they can. by Jill-Marie Burke • Photography by Ruth Kaplan

RN JULIE CORDASCO’S THOUGHTS NEVER STRAY TOO client’s home; much of that time is spent talking – far from the seniors she regularly visits at home. It’s hard answering seniors’ questions about their disease, making not to worry that the woman with dementia who spends them aware of supportive programs and services and lis- most of her time alone will burn herself when she’s mak- tening to their concerns and stories. In many cases, ing tea. Or that the 92-year-old man with diabetes will Cordasco is the only person they confide in. eventually require dialysis and will have to leave his con- “They don’t want to worry their kids,” she says. fused 89-year-old partner at home alone when he’s “And they believe they can’t talk to their family doctor receiving treatments. For two-and-a-half days a week, because they feel the doctor is too busy. So that doesn’t Cordasco, an RN at the Prime Care Family Health Team leave them many choices.” (FHT) in Milton, just west of Toronto, becomes an aging In October, Cordasco was among the RNs who at home nurse who helps frail seniors with health con- presented their work to keep people living at home cerns stay in their own homes for as long as possible. with health and dignity at RNAO’s eighth annual elder For the 40 clients she sees on a weekly or monthly care conference in Toronto. Many RNs say their work is basis, Cordasco is much more than a visiting nurse who making Ontario’s Aging at Home strategy a reality for gives B12 shots and tests blood sugar levels. She’s an older people. Since it was launched in 2007, the pro- advocate, a link to community services, and a supportive gram has aimed to help elderly Ontarians lead inde- sounding board for spouses who have become care- pendent lives in their own homes with access to com- givers. Cordasco also reviews clients’ medications to munity-based health services and supports that can keep make sure they are taking them correctly, and it’s not people out of hospitals and long-term care homes. unusual for her to pick up a prescription for clients or Sharon Penrose, who works for Saint Elizabeth help them write a letter to an insurance company.If her Health Care in Barrie, believes spending the final years elderly patients need Cordasco when she’s working at of life at home should be an option for anyone, even the family health team, she’s always just a phone call or a for those with mild cognitive impairments and demen- short drive away. Once, when it appeared one of her tia.Too often,the clinical educator, whose own mother clients had suffered a stroke, the woman’s husband called has the illness, says caregivers assume that people living Cordasco right away and she accompanied the couple with dementia aren’t able to learn new things, and can’t to the hospital to support the husband and to ensure do routine daily tasks by themselves. She says both are that the wife, who had dementia, wouldn’t be fright- untrue. People with dementia may just need to take ened in the unfamiliar environment. new approaches to doing something as basic as getting Cordasco says the FHT created the Seniors’ Home dressed. Visiting Program in February after physicians and nurse At the conference, Penrose presented the results of practitioners realized some of their elderly patients her Advanced Clinical/Practice Fellowship — a 12- missed medical appointments because they didn’t have a week program offered by RNAO — that allowed her way to get to the clinic. Some don’t have any family to review research and RNAO’s delirium, dementia and members, and others have children who are busy with depression guidelines to give her nursing and personal their own lives or live in other cities or countries. Since support worker colleagues tools and information they many of Cordasco’s patients are over the age of 80 and need to help people with dementia live independently. have chronic illnesses, skipping injections, blood pres- Penrose says that’s important, because research shows sure checks and other necessary procedures wasn’t an the more active people with dementia are and the more option. Today, Cordasco spends about an hour in each social support they get, the longer they’re able to live at

20 November/December 2009 home. She also found that while dementia can’t be cured, getting psychiatrist at North York General Hospital in Toronto.The group people moving can slow it down. aims to ensure seniors have the supports they need to stay where Penrose says helping people stay active in their daily lives can be they want to be – at home. If family physicians in the community or as simple as teaching them to inject insulin.While a nurse who has emergency room nurses identify a patient experiencing an ongoing spent months trying to teach a woman how do it may assume she’ll problem like falls, confusion or incontinence, they can ask never master the task, Penrose says breaking it down into small steps Simmons’ team to visit the person at home in search of the cause of that are repeated consistently could be all that’s needed to help her. the problem. Simmons is the seniors’ first point of contact. She’ll And while it might be easier and less time-consuming to dress a phone them – and in some cases their primary care providers or person with Alzheimer’s instead of letting him put on the clothes by family members – to gather as much information as possible and himself, Penrose says doing so limits his abilities and independence. determine which member of the outreach team would be most RN Sheila Simmons agrees more needs to be done to keep sen- appropriate to conduct the assessment. iors in the community. For years, Simmons was a discharge planner Simmons says the majority of the seniors who come to the in an emergency room, and says she hated sending people to long- team have experienced more than two falls in the past two months. term care when they didn’t want to go.Today, she’s the telephone While the problem is obvious, getting to the root of it requires triage nurse and educator for Specialized Geriatric Outreach expertise, diplomacy and some detective work. Is improper Services to Homebound Seniors, a team including a social worker, footwear causing them to trip? Are they slipping on scatter rugs? Is occupational therapist, physiotherapist, dietitian, geriatrician and their toilet too low or too high? Do they have to walk down rick-

Julie Cordasco, centre, works closely with seniors like Ron and Doreen Wilson to help them manage their illnesses so they can live independently.

Registered Nurse Journal 21 ety basement stairs to do their laundry? Or could the falls be a side effect of one RNs take on twice the workload to of the medications they’re taking? After the visit, armed with answers and evi- care for family members at home dence, the clinician will consult with the rest of the team to decide whether the senior’s needs could be best met by a geriatrician, the Community Care Access ging at home isn’t possible for many seniors Centre, or another health-care provider. Awithout the support of a family member who Her team doesn’t provide an urgent service, but Simmons feels strongly that can help out with daily tasks or drive them to it is an important one that prevents emergency visits and, in some cases, deaths. appointments. For many RNs, that reality means “A member of our team might go out to talk to a person who is complete- their work as a health-care provider doesn’t end ly confused and discover that it’s because he hit his head and didn’t realize he when their shift does. According to Catherine Ward- had suffered a subdural hemorrhage,”she says. Griffin, an RN and researcher at the University of Many seniors know all too well that the best laid aging at home plans can be Western Ontario, about one third of nurses are not derailed by a fall. According to the Canadian Institute for Health Information only caring for patients at work, they’re also playing (CIHI),for people 65 years and older,falls were the cause of 84 per cent of all injury a major role in caring for elderly parents and admissions to hospital and 40 per cent of admissions to long-term care facilities. relatives. Ward-Griffin calls this blurring of bound- In Simcoe-Muskoka, the problem is particularly troubling. According to aries between paid nursing care and unpaid family provincial and national statistics, the region has the highest rate of hospital care ‘double-duty caregiving,’ and she says it takes a admissions for falls in Ontario (per 100,000 people) and the highest rate of hos- toll on nurses’ health. pitalization for fractured hips. While health-care experts in cottage country Ward-Griffin is currently surveying RNs in British don’t know why so many of their seniors are taking a tumble, Sandra Easson- Columbia, Ontario and Nova Scotia to better under- Bruno says they’re working on a unique program to reduce the frequency and stand the consequences double-duty caregiving has severity of falls and cut down on the number of emergency visits and hospital on nurses’ health and on the profession. stays they cause. She says the societal assumption that family Easson-Bruno is Project Director for Regional Seniors’ Health and has been members are personally responsible for caring for working with local organizations to develop an Integrated Regional Falls elderly relatives has an impact on all Canadians. But Program in the North Simcoe Muskoka Local Health Integration Network there is an even greater expectation that nurses will (LHIN).The RN, who worked as a clinical nurse specialist in geriatric care for take on the role because of their knowledge and 12 years, says the new program is bringing together professionals from all sectors skills, and many of them see it as their responsibility. of health-care, including hospitals and the community. Easson-Bruno says the She wants to understand whether it’s their occupa- project, funded by the Aging at Home Strategy, will bring together and expand tions that turn nurses into double-duty caregivers, or services including falls prevention and day hospital programs. She says RNAO’s if factors like gender come into play. best practice guide- So far, she says study results show male nurses who line on preventing care for family members have greater levels of support falls was a key part of and, therefore, better general health than female the literature used to nurses in similar situations. Ward-Griffin says some of develop the project. them have trouble sleeping, feel physically exhausted Next year, the and experience flare-ups of various illnesses. program will also get “Nurses work very hard to look after people and family health teams ensure that we’re promoting health and preventing and community illness in others,” says Ward-Griffin. “I think we do that health centres work- many times at the expense of our own health.” ing together to run Ward-Griffin says that to support double-duty community-based nurses, health-care organizations need to implement falls screening clinics. healthy work environment policies that ease some of Julie Cordasco is just a phone call away for many patients. Seniors who are at an their stress. While nurses in some workplaces can use especially high risk of ‘family days’ instead of their own sick days if they falling will be able to see a geriatrician or a nurse. And Easson-Bruno says four need to take mom or dad to an appointment, she nurses will also be hired to work with seniors who have been discharged from says what’s really required is a re-think of the emergency departments after falling to ensure that they access community sup- assumption in our society that caring for older rela- ports that will help prevent future falls. tives is a personal responsibility, and one that nurses Easson-Bruno hopes the program will reduce the lineups in the emergency in particular should be expected to take on. rooms, but for her, the real bottom line is keeping people safe and in their own “Providing care to family members shouldn’t be homes for as long as they want to live there. seen as a personal issue for individual nurses,” she “What’s important to seniors is their quality of life. It’s staying in their own explains. “We need to be proactive to prevent or home, it’s being able to get out and do their groceries,” she says.“Seniors don’t mitigate the health effects of double-duty caregiving want to go to long-term care in most cases. From my perspective, the ultimate because it will likely increase with our aging popula- goal is allowing them to age in place.That’s what seniors want.” RN tion and workforce.” RN JILL-MARIE BURKE IS ACTING STAFF WRITER AT RNAO.

22 November/December 2009 POLICY AT WORK

Social Policy. The amendments affect the Regulated Health Professionals Act, the Nursing Act and a number of other acts related to health professions. The changes mean RNs will now be allowed to dispense drugs while NPs will be able to set and cast bone fractures. RNAO is also pleased that there is an opportunity to do away with a restrictive barrier that forces nurse practi- tioners to prescribe from a limited list of RNAO member drugs, unlike their counterparts in the rest Pat Nashef, left, joined Executive of Canada and other jurisdictions around Director Doris the world where NPs can prescribe openly. Grinspun at Queen’s RNAO will continue to push for changes Park to call for improved services to the Public Hospitals Act and regulations so for people living that NPs will be allowed to admit, treat and with mental illness. discharge in in-patient settings. Another key demand would see hospital Medical RNAO wins changes nicated the value of interprofessional, collabora- Advisory Committees (MAC), comprised of tive teams (nurses, doctors, pharmacists and other physicians, transformed into Interprofessional on HAPS health disciplines) in the delivery of quality Advisory Committees (IPAC) so nurses fter intervention by RNAO, health care to Ontarians. Additionally, new and and other health professionals can play a AOntario’s Assistant Deputy Minister expanded health care provider roles have been fully collaborative role with their physician of Health undertook re-writing a section integrated in the system based on the principle of partners. RN of a document hospitals use to design and augmenting, rather than substituting or replacing deliver their services. The association one provider over another.The ministry has sup- Why mental health objected to language in the Hospital ported nursing models of care delivery that main- matters Annual Planning Submissions (HAPS) tain continuity of caregiver, including our ongo- guidebook that suggested targeted RN ing commitment and our continuous movement ental health and addictions received replacement could be undertaken under to 70 per cent full-time employment of nurses. Msome much deserved attention at certain circumstances. RNAO found this Your assistance with communicating the min- Queen’s Park in October when a special unacceptable and raised the concern with istry’s position and the change to the HAPS committee heard presentations from a num- Joshua Tepper and senior government offi- document to all hospitals within your LHIN ber of groups, including RNAO. Executive cials. The offending section was removed would be most appreciated. In your communica- Director Doris Grinspun appeared alongside and Dr. Tepper sent a letter to Tom tion we would appreciate it if you would also Pat Nashef, then chair of the Mental Health Closson, President of the Ontario Hospital direct hospitals to your website where the revised Nursing Interest Group. As a psychiatric Association, and the CEOs of the HAPS is posted.Thank you for your continued nurse with more than 30 years of experi- province’s 14 LHINs, directing them to let support and commitment to building a strong ence, Nashef talked about the need to each hospital CEO know of the changes and stable healthforce in Ontario. address the stigma in attitudes and percep- and the government’s position. Here is a Sincerely, tions that continue to exist and leave people copy of the letter to the LHINs: Dr. Joshua Tepper with mental health issues feeling isolated Assistant Deputy Minister and neglected. She also spoke about the Dear LHIN CEOs: need to create a more coordinated approach As you are aware, the Hospital Annual Practice changes for to mental health services with a single point Planning Submissions (HAPS) has been revised of access so people know where to turn. in response to concerns raised by the Registered RNs and NPs Grinspun also reinforced the need for the Nurses’ Association of Ontario (RNAO) and ong awaited changes to the scope of province to keep its promise to reduce the Ontario Nurses Association (ONA). Lpractice for RNs and NPs are on the poverty and to fast-track its plan to build This ministry remains committed to ensuring horizon. On Oct. 19, a series of amend- more affordable housing. Grinspun said patients get the best care possible in all settings ments to Bill 179 was passed by the action on these issues would go a long way including hospitals and has consistently commu- Legislature’s Standing Committee on towards alleviating human suffering. RN

Registered Nurse Journal 23 hese days, there are few places the size of a small notebook that can fit into But Bajnok acknowledges that bringing Danielle Collier doesn’t read the crook of an arm, BlackBerrys and BlackBerrys to bedsides requires more than best practice guidelines (BPGs). iPhones to access the latest knowledge, right showing RNs where the power button is. Whether she’s scrolling through the at their fingertips. Each device is equipped She believes the real challenges lie in address- documents’ recommendations at work, with software programs that allow them to ing nurses’ fear that stopping to click through or in her car while waiting to pick up instantly look up medication doses and side a guideline in front of a patient will detract her son after school, she always has effects, receive email alerts when a new from the human element of the relationship, access to RNAO’s BPGs thanks to her study is available that could affect their prac- or give patients the impression that the nurse new personal digital assistant (PDA). tice, and scroll through condensed versions doesn’t know everything she should. The tiny device is no bigger than her hand, of the clinical and healthy work environ- “Nurses have to get to a comfort level so Tand easily slides into her purse. But it gives ment best practice guidelines.Twenty-five of that when they’re working with the patient, her access to tools that would line an entire the BPGs have been condensed so far, and they can say ‘let me double check that wall of library shelves in the real world. all 42 are expected to be available next year. information for you.’ The PDA can be a Collier uses her PDA to search for the latest For the past year-and-a-half, staff from patient teaching tool that helps nurses information on drug interactions, and can beam the most recent research articles to her colleagues at Sioux Lookout Meno Ya Win Health Centre (SLMHC), where she’s the professional practice leader.Last spring, 71 of the hospital’s RNs received the devices as part of a Ministry of Health project to get PDAs into the pockets and practice settings Hands on of nurses across the province. Collier says the technology helps RNs in her workplace span the 1,700 kilometres that separate them from BPG workshops in southern Ontario. Before the hospital evidence became part of the PDA initiative last sum- NURSES ARE USING POCKET-SIZED DEVICES mer, Collier says keeping her nursing col- leagues updated on the latest evidence- TO ACCESS VOLUMES OF EVIDENCE-BASED based information meant carting paper copies of articles and BPGs around in the INFORMATION RIGHT AT THEIR FINGERTIPS. back of her car between the health centre’s eight different sites. BY JILL SCARROW • ILLUSTRATION BY JOSÉ ORTEGA “Nurses up here don’t feel connected to the outside world,” she says. “We’re so far away – it’s a 22-hour drive to Toronto.When people can access best practice guidelines, they feel more a part of it all.” Today, nurses use their PDAs to quickly RNAO’s Centre for Professional Nursing address specific concerns,”Bajnok says. look up drug interactions, and receive Excellence have led workshops to teach Diane Doran, a professor at the emails about the latest research so patients nurses how to use the devices, and provided Lawrence S. Bloomberg Faculty of Nursing instantly get the safest care.The devices are ongoing technical support to keep the proj- at the University of Toronto, says her also being used in unexpected ways. Collier ect up and running. research has also shown plenty of practical says some RNs have used the PDA’s camera Irmajean Bajnok, RNAO’s Director of reasons that can hinder getting more nurses to take pictures of patients’ wounds so they International Affairs and Best Practice to be tech-savvy. Doran is the lead investi- can track how well they’re healing. Guidelines Program and the Centre for gator on a team studying how technology SLMHC’s nurses are among the 1,300 Professional Nursing Excellence, says PDAs improves nurses’ ability to access informa- RNs taking part in the two-year project give nurses a glimpse of a future where tech- tion, and the effect it has on patient out- funded by the province. Ontario’s Chief nology will be woven into practice. comes. She says things as basic as spotty Nursing Officer, Vanessa Burkoski, says she “I think the PDA initiative is a great wireless Internet access or having to carry wanted to create the project to keep nurses example of how the information can be around devices like the larger tablet could at the forefront of the latest technology. provided right at the point of care through mean PDAs spend more time tucked in “The future is in our hands, and once again technology,” she says.“It supports nurses as their cases than at a patient’s bedside. But Ontario’s nurses are at the cutting edge of knowledge professionals and sends a mes- she says those are tiny obstacles when com- knowledge-based practice,”she says. sage that ehealth is alive and well in nurs- pared to the benefits. Doran says PDAs are Nurses are using PDAs, tablet computers ing and health care.” improving the way nurses can communi-

24 November/December 2009 cate with their colleagues on different says.“We’re able to provide better care.” pensable to practice as a stethoscope is floors or hospital sites because they can George Fieber says better care motivates today. Bauer led some of the workshops to now send a quick text message. Nurses are him to stick with the project. Fieber is the teach nurses how to use the tools, and she also reporting significant increases in their professional practice leader at Thunder Bay says if RNs start to feel frustrated with their awareness and use of research, and in the Regional Health Sciences Centre, and PDA, they should just remember one thing: quality of care they can provide. joined the PDA initiative when it began last they master more complex nursing knowl- Doran says her data is also starting to year. He says RNs are using tablets across the edge and skills during every shift. show how the technology is improving the hospital, with varying degrees of success. “Each and every day of my nursing quality of nurses’ work lives, especially in Nurse practitioners in acute care units, for career, I learned things that were far more long-term care. She believes the increased instance, can now do research on the go, and complicated than the PDAs,”she says.“This benefit may be because the PDAs are giving lower nurse-to-patient ratios in the intensive is just a tool to do the other work, which is RNs in long-term care and the community care unit meant those RNs were able to far more complicated.” access to information hospital staff has long spend time getting used to the tool. But he In Ottawa, public health nurse Nadine been able to find in the organization’s library says it was harder for nurses on the busy Hodgins says it was easy to adapt to her tablet. Hodgins is a member of Ottawa’s Live it Up team that visits high schools to promote healthy eating and exercise to stu- dents. During the school year, Hodgins is usually on the road. The tablet allows her to keep in touch with principals and teach- ers without wasting precious time travel- ling back to the office to read emails. Hodgins says she’s also glad to have the tablet on hand so she can double-check her facts, or show students the city’s web- site where they can get information on sexually transmitted infections. It’s also handy if a teacher asks Hodgins to teach students about sexual health. “We sometimes get requests from teachers about something that’s beyond physical activity and nutrition. Then we can look at the school curriculum and see how the public health resources we have match up,”she says. Back in Sioux Lookout, Collier says the PDA is more than a tool that can save time and paper – it also shows the nurses man- agement understands that they need the or by talking to another team member. medical/surgical floor to work tablets into latest knowledge. She believes the devices “In long-term care, there may only be one their shifts. Fieber says more nurses got are particularly helpful to recruit new grad- RN working, so she doesn’t have ready access excited about PDAs once they were linked uates who won’t want to work in isolated to other colleagues to consult with,”she says. to patient information on the hospital’s elec- northern communities unless they’re Jill Geiger can attest to that. She usually tronic health records, and when the hospital plugged into the latest research. Patients works the night shift at Bluewater Rest became a candidate to be an RNAO Best have also started to notice the PDAs. In Home in Zurich, 70 km northwest of Practice Spotlight Organization and set out fact, Collier says it’s funny when a patient London.That means she’s the only RN on to implement five BPGs over three years. comments on how state-of-the-art duty at 3 a.m., so if she has a question about Now, for example, RNs can use the elec- SLMHC’s nurses are, since they’re using the a new medication a resident is on or wants tronic health record to instantly see which latest technology in a building constructed to look up nutrition recommendations to patients will need information about caring long before computers became a must- prevent constipation in RNAO’s best prac- for an ostomy when they go home, and have appliance in everyone’s home. tice guidelines, she can do it quickly on her show them an electronic presentation based “We’re in a hospital that’s 70 years old. So tablet instead of relying on cumbersome on a newly released BPG on the topic. the fact that we’re pulling out PDAs is pret- books that may be outdated before the ink Nancy Bauer can understand why it ty neat,”she says. RN on their pages is dry. takes time to make PDAs an integral part of “The fact you’ve got current informa- practice, but she believes that, one day,read- JILL SCARROW IS ACTING MANAGING tion at your fingertips, that’s wonderful,”she ing a BPG on an iPhone will be as indis- EDITOR AT RNAO.

Registered Nurse Journal 25 Calendar toYou January NEWStoUse January 20 Developing and Sustaining Leadership: Working with RNAO members Sandra Kuchmak and Jeanette O’Leary were among the inaugural Interprofessional Teams recipients of the Ontario Long Term Care Association Nursing Leadership Awards this Ottawa, Ontario – available by fall. Kuchmak, Director of Care at The Wynfield in Oshawa, was honoured for her OTN across Ont. commitment to resident-centred care and mentorship. O’Leary is a Care Innovation Coach at Shalom Village in Hamilton.She ensures residents with cognitive impairments feel at home, and is committed to best practices in her daily work.The awards were January 21 presented during the OLTCA’s first-ever Long Term Care Week in October. Leadership for New Grads:

From Surviving to Thriving In September, the city of Ottawa re-named its city hall Festival Plaza after the late in the Work Environment Marion Dewar, a well-known public health nurse and human rights and peace activist. Valhalla Inn, Thunder Bay, Ont. Dewar was the mayor of Ottawa from 1978 to 1985 and later became an MP.

January 28 On Nov. 4, RNAO member Basanti Majumdar was 11th Annual Queen’s Park Day inducted into the Hamilton Gallery of Distinction, an organization Queen’s Park Legislative that publicly recognizes citizens’ efforts to improve the city. Building, Toronto,Ont. The McMaster University professor was acknowledged for her work to improve health around the world and at home. She has been a part of international partnerships in South Africa, January 29 India and Pakistan in addition to creating a course at McMaster RNAO Assembly Meeting Basanti Majumdar on international health and cultural issues. Delta Chelsea Hotel

Toronto, Ont. People without a family physician or nurse practitioner in the City of Kawartha Lakes now have another option for primary care. The Unattached Patient Health Assessment February and Referral Centre clinic opened in the fall to provide patients with a full physical exam, referrals, and follow-up care. The centre is a seven-month pilot project and is staffed February 8-12 by a team including a physician, nurse practitioner and registered nurses. Designing and Delivering Effective Education Programs This fall, Home Safe Toronto explored the effect the economic Toronto, Ont. downturn has had on people who work in the manufacturing sector.The documentary is one of three that explore the experiences of families in different Canadian cities who live February 25 with homelessness, or the threat of losing their home.The film Mid-Career Nurse Symposium: screening across Canada includes Myriam Canas-Mendes and Refresh and Refocus your Career Olga Munoz-Canas (pictured left). For more information Hyatt Regency, Toronto, Ont. visit www.skyworksfoundation.org.

February 28- March 5 In November, RNAO received the Innovations in Health Wound Care Institute: Care Award. The association was honoured for its work to Minding the Gap support long-term care staff using best practice guidelines

Sheraton Fallsview, Photo: Courtesy Skyworks Foundation in their work. The award was presented on Nov. 18. Niagara Falls, Ont. Aileen Knip has been named as the Chair of the National Diabetes Educator Section RNAO holiday office hours (DES) of the Canadian Diabetes Association.The DES is made up of RNs, dietitians and other health providers who care for people with diabetes. Knip became the chair during RNAO home office will be closed at an international diabetes conference in Montreal in October. 12:00 p.m. on Thursday, Dec. 24, 2009. We will resume normal business hours on Monday, Jan. 4, 2010. In October, RNAO member Roberta Heale received a Chair in Advanced Practice Nursing from the Canadian Health Services Research Foundation and the Have a wonderful & safe holiday Canadian Institutes of Health Research. Heale will work with Dr. Alba DiCenso, a season. prominent researcher who studies the NP role. The chair is awarded to PhD From the staff at RNAO. students to help them improve their research and advocacy skills. 26 November/December 2009 Ontario Nurses NURSING EDUCATION RENEWING INITIATIVE your MEMBERSHIP with theCollegeofNursesofOntario hasneverbeenso You may be eligible to receive up to Join the 76,000 nurses SIMPLE. $1,500 in tuition reimbursement! who renewed their College membership online last year. For pertinent deadline information or to obtain a copy of the application form, please visit the RNAO website at Visit www.cno.org starting October 20 to renew your www.rnao.org membership and pay your fee. You can also update your personal information, For the most current including your home and business address. information about the It’s fast. It’s easy. It’s secure. Nursing Education Initiative, Try it. Then tell a colleague please contact: how easy it was.

RNAO’s Frequently Asked Questions line 1-866-464-4405

To avoid the late fees, OR you must renew by December 31, 2009. [email protected] ad for RNJ quarter page colour.qxd 10/20/2009 11:48 AM Page 1

RN Journal 1/4 page ad HELP RNAO4 CELEBRATEcolour process THE BEST RNAO Recognition Awards for CollegeIN HEALTH-CARE of Nurses of Ontario REPORTING - AMR 2010 Winter Issue December 4th mailing date Do you know reporters in your community who are covering nursing and health issues effectively?

Why not encourage them to enter RNAO’s 12th annual Award for Excellence in Health-Care Reporting? The team from Sudbury District Nurse Practitioner Clinic received the RNAO in the Workplace It can be a great way to get to know Award at the April 2009 Annual General Meeting. journalists in your area. You can nominate yourself, your Submissions must have been published organization, or a colleague for or broadcast in Ontario during 2009. speaking out for health and The deadline for entries is speaking out for nursing! Feb. 12, 2010. For more details and Visit www.rnao.org/mediaaward, a nomination guide, visit e-mail [email protected], www.rnao.org/awards or call 1-800-268-7199 ext. 250 or call 1-800-268-7199. for more information. Nominations are due by January 29

Registered Nurse Journal 27 REGISTERED NURSES AND FAITH COMMUNITIES PROMOTE WHOLISTIC HEALTH Nursing – Have you thought about Parish Nursing Ministry? Is your congregation or faith based agency ready to flourish with the support of a Parish Nurse? Let us show you how! Our Parish Nursing Ministry A career to Education Program is underway at our Emmanuel College location. Here’s More Good News: An RN and members of their congregation can attend the program at Emmanuel College care for in the fall OR attend the program at our new campus located at Waterloo Lutheran Seminary in early 2010. Continuing Education at Call: 1-888-433-9422 George Brown College Visit our website at: www.ichm.ca or email: [email protected] George Brown offers professional Ask for details on our promotional offer!! development opportunities in a variety Partnership with ICHM is a necessary part of our model of “mutual ministry”. of highly specialized areas. We excel ICHM helps your team by providing a multitude of resources so that the congregation, together with in the provision of lifelong education the health committee and clergy, build a solid, enduring ministry. As a church or agency staff team by sustaining strategic partnerships member, the Parish Nurse is committed to ongoing theological reflection & education. and through our unique programs, our ICHM is in partnership with Emmanuel College, Victoria University, at the University of specialized teachers and our in-class, Toronto, Waterloo Lutheran Seminary, at Wilfrid Laurier University, online and on-site instruction options. and The International Parish Nurse Resource Center Forensic Nursing Certificate INTERCHURCH HEALTH MINISTRIES (Distance education only) Fostering healthy communities through Christ’s healing ministry This certificate offers nurses the 44 Metcalfe Street, Aurora, Ontario, L4G 1E6 opportunity to acquire knowledge Phone: 905-841-7619 Toll Free: 1-888-433-9422 and skills in the legal, scientific and psychosocial aspects of forensic Fax: 905-841-4051 nursing. (Four courses) Nurse Educator Certificate ICHM Registered Charitable No. 890261175RR0001 (Distance education only) This certificate provides baccalaureate- or master-prepared nurses with the knowledge and skills needed to function as nurse educators in didactic and clinical settings. (Four courses) Emergency Management Certificate (Distance education available) Learners from both the private and the public sectors develop knowledge and skills in emergency and disaster management with this certificate. (Six courses) Public Health Emergency Management Certificate Develop knowledge and skills in public health emergency management with this certificate emphasizing command- post operations, crisis communication, surveillance and assessment. (Five courses)

For course information or to register, visit our web site at coned.georgebrown.ca Classifieds DID YOU KNOW? DO YOU HAVE FINANCIAL PLANNING Leadership and ISSUES AS YOU NEAR RETIREMENT? You can access the ‘members only’ Management I will assist you with your questions including section of the RNAO website to update your e-mail information on: HOOP Pension Plan, Canada Program and mailing address. Never miss an issue of Pension Plan, RRSPs, RRIF, & TFSA, Taxation Registered Nurse Journal and stay connected Investment and Estate Planning. Over 20 years of consulting/planning experience. with your nursing colleagues across the province. As a certified licensed financial planner, I am Update your profile today by visiting licensed to sell products. For an appointment www.rnao.org/members. please call Gail Marriott CFP at 416 421-6867

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Now you can follow RNAO on Twitter. Leadership and Management Get the latest, instant updates on RNAO’s political advocacy, (6 units) news releases, membership opportunities and information • 9 month course completion • both theoretical and practical content important on best practice guidelines, right at your fingertips in today’s work environment www.twitter.com/rnao Leading Effective Teams (3 units) • 6 month course completion Or stay updated by becoming • study of leadership, team dynamics impacting a fan of RNAO’s Facebook page the workplace, types of and team structure in health care organizations www.rnao.org/facebook Conflict Management (3 units) • 6 month course completion • explores the types and processes of conflict in health care organizations and applies theory and 85th ANNUAL GENERAL MEETING research to conflict situations in the current APRIL 15-17, 2010 workplace RNAO’s Quality Management (3 units) • 6 month course completion CALL FOR VOTING DELEGATES • theories, concepts including safety culture Deadline: Monday Feb.15, 2010. For more information, call Penny Lamanna, leadership in creating a culture of accountability 1-800-268-7199, ext 208 or e-mail [email protected] • critically analyzes and applies paradigms to address quality and safety issues in the workplace SATURDAY KEYNOTE SESSION Advanced Leadership and Management We will be presenting a Saturday Keynote Session. (6 units) • 9 month course completion Details on the topic and speaker will follow, but please mark your calendars now, • builds on the Leadership/Management course and plan to attend on Saturday, April 17 at 11:30 am – 12:30 pm, following the • topics include transformational and quantum individual Interest Group breakfast meetings. leadership, emotional intelligence and organizational culture Integrative Leadership Project AGM REGISTRATION FORM (3 units) After Jan. 4, download your registration form at www.rnao.org or call Bertha Rodrigues • Final course integrates theories and concepts of the Program and provide opportunities to apply at 416-408-5627 or toll free at 1-800-268-7199, ext. 212. these to a real situation in the workplace Deadline for AGM pre-registration: Wednesday, April 7, 2010 • Through the use of a champion leader, the student develops and understanding of managing HOTEL RESERVATION FORM key organizational processes RNAO has reserved a block of rooms at the Hilton Toronto at $169 per night (taxes extra). PROGRAM COURSES AVAILABLE IN TUTORIAL CLASSROOM FORMAT (OVER 12 WEEKS) This rate is guaranteed until Friday, March 12, 2010. For further information please contact: The hotel reservation form will be available after Jan. 4, 2010 at www.rnao.org Leadership and Management Program or call toll free at 1-800-268-7199, for more information. McMaster University Phone: (905) 525-9140 Ext 22409 Fax: (905) 529-3673 Email [email protected] Website: www.leadershipandmanagement.ca MARK YOUR CALENDAR NOW! Programs starting every January, April & September Advance online! DFFHVVLEOH ‡ IOH[LEOH ‡ DFKLHYDEOH

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