july/august 2017 july/august JOURNAL Celebrating 1 years of member stories
We take a look back at the best of our summer story collection.
Notice of 2018 AGM • One-on-one care for seniors • Nursing in Ontario’s north Hilton Toronto Notice of 2018 April 19–21
Take notice that an annual general meetingA (AGM) of the RegisteredG Nurses’ Association of Ontario M(hereinafter referred to as ‘association’) will be held at the Hilton Toronto hotel commencing the evening of April 19 for the following purposes:
• To hold elections of directors as provided • To consider other business as may By order of the RNAO Board of Directors for in the bylaws of the association (for properly come before annual and general Carol Timmings process of elections, see below*) meetings, or any adjournment or RN, BNSc, MEd (Admin) • To appoint auditors adjournments thereof President
* Voting for the AGM shall be by electronic means, during April 2018. Results will be reported at the AGM.
CALL FOR NOMINATIONS
2018-2020 RNAO Board of Directors Being a member of RNAO provides you rewarding and energizing experience. Over DEADLINE: Dec. 18, 2017 at 5:00 p.m. EST with opportunities to influence provincial, the course of two years, you will contribute As your professional association, RNAO national and international nursing, health- to shaping the present and future of RNAO. is committed to speaking out for nursing, care and health policy; to discuss and You will also act as a professional resource speaking out for health. Your talent, share common challenges related to for your constituency. Please access the expertise and activism are vital to our nursing, nurses, health care, and social nomination form at RNAO.ca success. For the term 2018-2020, and environmental determinants of health; RNAO is seeking nominees for: and to network with numerous health • One representative of the interest group professionals dedicated to improving the chairs (two-year term) health and well-being of all Ontarians. If you require further information, contact • One representative of the interest group Becoming a member of RNAO’s board of Sarah Pendlebury, RNAO board affairs chairs (one-year term) directors will provide you with an extremely co-ordinator, at [email protected]
CALL FOR RESOLUTIONS
DEADLINE: Dec. 18, 2017 at 5:00 p.m. EST IMPORTANT TO NOTE: used must be no smaller than Arial 10 or RNAO encourages individual members, • Resolutions must bear the signature(s) of Times New Roman 11. Margins must also be chapters, regions without chapters, RNAO member(s) in good standing for 2018. reasonable (an absolute minimum of 0.7 all and interest groups to submit resolutions • Resolutions submitted on behalf of a chapter around). for review and discussion at the 2018 or interest group must have been provided to • All resolutions will be reviewed by the AGM. Please send enquiries or the members of that chapter or interest group provincial resolutions committee. materials to Sarah Pendlebury, for consultation and a formal vote. RNAO • For clarity of purpose and precision RNAO board affairs co-ordinator, at home office can assist with the voting process. in the wording of a resolution, we recommend [email protected] • A backgrounder (one-page maximum) must it include no more than three ‘Whereas’; and accompany each resolution. This single page preferably only one, but never more than two, must also include any references. The font ‘Therefore be it resolved that…’ . 4, july/august 2017 V o l. 29, N . 4, july/august contents
Features 12 12 COVER STORY Celebrating 10 years of member stories We mark a decade of summer stories by republishing the submissions that made us laugh, wonder and reflect on different aspects of nursing. Compiled by Kimberley Kearsey
22 Making a difference for seniors We may need system transformation targeted to our graying population, but we also need individual nurses supporting seniors every day in their practice. By Daniel Punch
the lineup 22 26 5 President’s View 6 CEO Dispatch 7 RN Profile 8 Nursing in the news/Out and about 11 Nursing Notes 21 POlicy at work 26 In the End
Sandra Trubyk is the writer of this issue’s In the End on page 26.
Registered nurse journal 3 The journal of the REGISTERED NURSES’ Editor’s Note Kimberley Kearsey ASSOCIATION OF ONTARIO (RNAO) 158 Pearl Street Toronto ON, M5H 1L3 Phone: 416-599-1925 Toll-Free: 1-800-268-7199 Fax: 416-599-1926 Website: rnao.ca Email: [email protected] Letters to the editor: [email protected]
EDITORIAL STAFF Marion Zych, Publisher Kimberley Kearsey, Managing Editor Revisiting summers past Daniel Punch, Writer Victoria Alarcon, Editorial Assistant
EDITORIAL ADVISORY COMMITTEE Laryssa Bilinsky, Desmond Devoy, Una Ferguson, Larissa Gadsby, Elizabeth Kerr, Joanne Laucius, Maria Rugg s you read this issue of the Art DIRECTION & Design A important and often stressful Fresh Art & Design Inc. Journal, the summer of 2017 is work you do every day. ADVERTISING coming to a close. Shorter, In this issue, we bring you a Registered Nurses’ Association of Ontario Phone: 416-599-1925 cooler days lie ahead as we collection of our favourite Fax: 416-599-1926 welcome a new season. It’s stories (page 12). We’ve SUBSCRIPTIONS always bittersweet to say selected one from each of the Registered Nurse Journal, ISSN 1484-0863, is a benefit to members of the RNAO. Paid subscriptions goodbye to summer, which last nine years. are welcome. Full subscription prices for one year symbolizes fun and freedom Also in this issue, you’ll meet (six issues), including taxes: Canada $38 (HST); Outside Canada: $45. Printed with vegetable-based and sunshine, and hello to fall, three members making a inks on recycled paper (50 per cent recycled and which, despite the return to difference caring for seniors 20 per cent post-consumer fibre) on acid-free paper. routine and structure, has (page 22). We talk so much at Registered Nurse Journal is published six times a year by RNAO. The views or opinions expressed in always been my favourite RNAO about broad transforma- the editorials, articles or advertisements are those season for the comfy sweaters tional change that will help us of the authors/advertisers and do not necessarily represent the policies of RNAO or the Editorial and amazing colours. to build a stronger health Advisory Committee. RNAO assumes no responsibility Saying goodbye to summer system, but these nurses or liability for damages arising from any error or omission or from the use of any information or also symbolizes the stories of remind us that the one-on-one, advice contained in the Registered Nurse Journal members that have been personalized and profound including editorials, studies, reports, letters and advertisements. All articles and photos accepted appearing on the pages of our interactions RNs and NPs have for publication become the property of RNAO. summer issue for 10 years now. with their patients are just as Indexed in Cumulative Index to Nursing and Allied Health Literature. We have been privileged to important.
CANADIAN POSTMASTER publish some amazing I hope you have enjoyed the Undeliverable copies and change of address to: anecdotes about your experi- summer of 2017, and that RNAO, 158 Pearl Street, Toronto ON, M5H 1L3. Publications Mail Agreement No. 40006768. ences on the front lines, your you’re reading this issue of the
RNAO OFFICERS AND SENIOR MANAGEMENT touching tales of patients or Journal by a lake, in your Carol Timmings, RN, BScN, MEd (Admin) mentors who have made a backyard, on a balcony, or President difference in your life, and your wherever you can relax and soak Angela Cooper Brathwaite, RN, MN, PhD President-Elect funny moments that help to in the last of the summer rays. Doris Grinspun, RN, MSN, PhD, LLD(hon), O.ONT add some levity to the RN Chief Executive Officer, ext. 206 Nancy Campbell, MBA Director, Finance and Administration, ext. 229 Valerie Grdisa, RN, MS, PhD Director, International Affairs and Best Practice Guidelines Centre, ext. 246 Daniel Lau, MBA Director, Membership and Services, ext. 218 Louis-Charles Lavallée, CMC, MBA Director, Information Management and Technology, ext. 264 Lisa Levin, B.A., M.Sc.Pl, Director, Nursing and Health Policy, ext. 237 As a member, you are eligible to receive a Marion Zych, BA, Journalism, BA, Political Science digital copy of Registered Nurse Director, Communications, ext. 209 Journal. You can choose to receive RNJ Is only an electronic version of the magazine by emailing [email protected] DIGITAL! and stating your preference for a paperless version. If you haven’t received the magazine electronically, please let us know by contacting [email protected]
4 july/august 2017 president’s view with carol timmings
Inspiration at ICN
I recently had the privilege of Sir Michael Marmot, an achieving excellence in health were three rows deep and very attending the International international leader in social outcomes for our patients. Her enthusiastic. Delegates were Council of Nurses’ (ICN) determinants of health and health research is featured prominently clamouring for information about annual congress meeting in equity, continues to inspire me in RNAO’s public database that our BPGs and to speak with Barcelona, Spain. RNAO and with his overarching message to highlights 70 years of RN RNAO staff, obtain access to other nursing colleagues from always advocate for the larger effectiveness. resources in their respective our country were proudly forces that keep people healthy in One of the other highlights of languages, and learn more about visible, with Canadian flags the first place. Income, education ICN was witnessing the interna- the program’s impact. held high. Watching the official and a healthy environment, for tional recognition of the impact of When RNAO CEO Doris opening ceremony was a example, are important areas of RNAO’s policy and best practice Grinspun gave a presentation in spectacle as nurses repre- focus. Health care can’t just be guidelines (BPG) programs. Spanish on the success of the senting their associations from around the world paraded in “one of the highlights...was witnessing the international wearing their beautiful and colourful cultural dress. recognition of the impact of rnao’s policy and best It was truly exhilarating to practice guidelines programs.” meet and learn from each other and gain insight into some of about treatment. We must place During a visit to Vall d’Hebron BPG program, and talked about the common challenges we all greater emphasis on how these University Hospital in Barcelona, how it is sweeping the world, the face in health care, including factors affect the health of I saw firsthand the positive conference room was filled with ensuring sustainable public populations everywhere. organizational and patient people spilling into the hallway. If access to care, and fully utilizing Another powerful speaker was outcomes it achieved because of you are not already aware, Doris nursing resources. Julia Duncan-Cassell, who is the BPG implementation. It was enjoys icon or rock-star status Taking part in the ICN minister in charge of gender, apparent from the hospital CEO, among nursing and other health congress felt like getting an child care and social protection for across the board to the nursing professionals in Latin American “injection” of passion and energy. the Republic of Liberia. She spoke staff, that our guidelines and and other Spanish-speaking My own sense of professional powerfully about how issues of RNAO’s policy work are making a countries. Her belief in the pride was buoyed while among a gender inequality persist in her tremendous difference in patient program she founded – and her community of nurses numbering country, and in many other parts care, in improving safety, and in ongoing commitment to in the thousands. of the developing world. She building confidence, competence ensuring evidence-based nursing The knowledge-sharing talked about how discrimination and expertise. knowledge is shared for the opportunities were incredible, and abuse against women and I also had the privilege of taking benefit of patients and families and the conference program children must stop, and how part in a panel discussion, sharing everywhere – endures. offered topics ranging from women must be empowered to my own organization’s (Toronto I have always been in awe of social determinants of health move from vulnerability to action. Public Health) experience as a RNAO’s stellar work on evidence- and health promotion to She hopes her government can Best Practice Spotlight Organiza- based practice. And yet end-of-life care. achieve this with new initiatives tion (BPSO) and the success we witnessing how our association’s There was an impressive list they have funded to help the have had implementing offerings are sought after by so of keynote speakers, three of vulnerable. evidence-based practice through many nursing and health leaders whom resonated with me Linda Aiken, a well-known RNAO’s robust BPGs. was truly remarkable to see. ICN because they touched on the nursing scholar and researcher At these kinds of events, it’s not was yet another reminder that we values of our association and from the U.S., spoke about her unusual for nursing organiza- should all be proud of the power on the critical importance and influential findings related to RN tions to have exhibits that allow of our strong association. RN impact of nursing knowledge effectiveness and the critical role visiting delegates to learn more and leadership in a global RNs play in the health system, about each other’s work. The carol timmings, rn, bscn, med health environment. particularly when it comes to crowds around RNAO’s booth (admin), is president of rnao.
Registered nurse journal 5 CEO Dispatch with Doris Grinspun
Public inquiry will lead to better care
It was a tragic day for the applauding the government for courage to disclose the truth. These homes are funded on the nursing profession when news having the courage to put this And we are urging others to basis of complexity of care. broke last October that former tragedy under the microscope. continue to share their concerns This means that when our BPG RN Elizabeth Wettlaufer would We are especially pleased that with us. We know the vast recommendations are imple- be charged with the murders of Premier Kathleen Wynne, majority of nurses – RNs, RPNs mented and patient outcomes eight elderly Ontarians using a Attorney General Yasir Naqvi and NPs – go to work wanting to improve, care becomes less lethal dose of insulin in each and Health Minister Eric do good and wanting to deliver complex and funding is case. She was also charged with Hoskins have heeded our calls safe, quality care. The staffing decreased. This too is outra- four counts of attempted murder for an inquiry with a broad circumstances, however, are geous and unacceptable. and two counts of aggravated mandate. We are now urging deficient, if not deplorable. We need to bring funding and assault. As details emerged about Justice Eileen Gillese, a sitting Older persons deserve the best staffing models into the 21st this serial killer, RNAO and its judge with the Ontario Court of evidence-based care we can century, and a public inquiry will members were outraged that a help us do that. We also need to colleague could commit such a “nurses across the province are delve more deeply into when and gross violation of the most sacred how regulatory colleges tackle principle of our profession – the applauding the government for having disciplinary issues. We now unwavering commitment to the courage to put this tragedy under know that Wettlaufer was fired in ensure the well-being of patients 2014 for making a number of and their families. the microscope.” medication errors, but was not RNAO began advocating for a investigated by CNO at that time. full public inquiry when the Appeal since 2002, to make full provide. Their vulnerability is A disciplinary hearing this July former RN pleaded guilty to the use of this broad mandate as the greater than ever as they arrive in also revealed the former nurse murders in early June. As the inquiry’s commissioner. She long-term care older and frailer, was investigated for stealing only nursing organization to must look at anything and and with more cognitive medication in 1995. How was issue this call, we spoke to the everything that might have deterioration. And yet, the she able to continue to practise media, sent letters to political contributed to this horrific funding and staffing models in despite these red flags? We need leaders, and circulated two tragedy. RNAO is also urging the sector are archaic. to muster the courage to look in action alerts urging members to Justice Gillese to look beyond By legislation, only one RN is the mirror and learn. voice their outrage. More than a this particular case and make required per nursing home in The tragic murders of eight thousand people joined us in recommendations to address the Ontario. Some nursing homes Ontario seniors will forever demanding answers to what failings of our long-term care have as many as 300 residents. remind us that health profes- happened, how it happened, system, including examining This is outrageous and sionals are in a very privileged and what can be learned from legislation and regulations, unacceptable. position. Nurses enjoy higher an organizational, regulatory funding models and staffing, and Funding models in long-term public trust than any other and system perspective to any other aspects required to care penalize nursing homes for profession (see page 11). We ensure nothing like this ever create a safer environment for improving patient outcomes. must cherish that trust by leaving happens again. seniors living in nursing homes. RNAO has been going into no stone unturned. This public On June 26, the same day RNAO has received numerous long-term care homes across this inquiry is our collective opportu- Elizabeth Wettlaufer was calls from nurses who have province for many years with nity to do just that. RN sentenced to life in prison with revealed to us that things are just best practice guidelines (BPG) no chance of parole for 25 years, not right in their nursing homes. that teach regulated and doris grinspun, rn, msn, phd, lld the government announced it They have told us patients are unregulated staff about pre- (hon), o.ont, is chief executive would launch a public inquiry. not turned as often as necessary, venting pressure injuries, officer of rnao. The details of that inquiry were and some sleep all night in the preventing falls, managing revealed on Aug. 1, and nurses same soiled diapers. We have incontinence, reducing the use Follow me on Twitter @ DorisGrinspun across the province are thanked each caller for their of restraints, and so much more.
6 july/august 2017 RN Profile by daniel punch
The road less travelled Mobile RN finds late-career niche in northern communities.
The trip from thunder bay to the working in obstetrics in acute nurse on staff and the only Upsala. In addition to her tiny northwestern Ontario care settings, until a change in health-care provider in town. It nursing duties, she helped the community of Upsala typically government policy sent her takes a special kind of nurse to underserviced and aging takes about 90 minutes on the career in a different direction. handle the professional and community by co-ordinating care Trans-Canada Highway. The It was the late 1990s, and deep personal challenges that entails, between different agencies to route passes through towns cuts to health-care funding but Nutikka says it suit her just ensure people’s needs were met. like Sunshine and Shabaqua Corners, and a vast expanse of boreal forest. Three things you didn’t But for Donna Nutikka, that journey took nearly four know about Donna decades. On the road from Nutikka: 19-year-old registered nursing 1. She owns 24 James Bond films on assistant (RNA) in Thunder Bay VHS and DVD. to veteran RN at the Upsala 2. She used to make her own goat nursing station, she stopped in cheese. three provinces, one territory, 3. While in Nicaragua, she briefly taught the U.S., and even a small English to the staff of a local hotel. fishing village in Nicaragua. It all began in Port Arthur (now called Thunder Bay) in the 1950s. Young Nutikka watched made nursing jobs scarce in fine. “You have to be confident Though she officially retired her mother, an RNA, and her Ontario. So she uprooted her in who you are, be confident in this past spring, Nutikka still friend’s mother, an RN, take life and moved to Calgary in your practice...and be okay with works part-time at the nursing great pride in caring for others. 1998, where she switched to being alone,” she says. station. Looking back, she “They were both very proud of emergency nursing. Eventually, Nutikka met cherishes the unique experi- their jobs, and good at (them),” A few years later, Nutikka the love of her life and was ences she gained nursing in she recalls. was on the move again. Her looking to settle down once remote communities. Where Inspired, she earned her RNA kids had grown up and moved again. Her partner was also from else would she have cared for certificate in 1972 and became away, and she was looking for Thunder Bay, so the couple a man who cut himself while the youngest health professional something new. Armed with a moved back to Ontario in 2010 skinning a polar bear, or on the medical floor at Thunder diverse nursing background and bought a 160-acre farm in removed so many errant fish Bay’s St. Joseph’s Hospital. Her and a thirst for knowledge, she Sunshine. Shortly after moving, hooks? early career also included stints put everything she owned in she was hired at the Upsala She says nursing was the at a local nursing home and storage and applied to travel nursing station. perfect career choice because psychiatric hospital, and in nursing agencies. After a brief Just as she did in so many it provided her the flexibility to non-nursing roles bartending, stop in San Juan del Sur, other small communities, she move around and learn new driving a gravel truck, and at a Nicaragua to learn Spanish, began to ingratiate herself to things. It also didn’t hurt to youth hostel. she began working as a travel Upsala’s 190 residents by have an adventurous spirit. Looking to do more for her nurse in Hayward, Calif. and attending local events and “Jump in first, think later,” patients, she completed Tacoma, Wash. making herself visible. “You she says, laughing. “You’ve just Confederation College’s RN She continued travel nursing show your face and show them got to do it. Tomorrow may program in 1988 while throughout the 2000s, ven- you’re a part of their commu- never come.” RN juggling two young kids and a turing into remote communities nity,” she explains. part-time job. She spent most in northern B.C. and Nunavut. In the seven years since, she daniel punch is staff writer for of the next 10 years happily There, she was often the only became an essential part of life in rnao.
Registered nurse journal 7 RNAO & RNs weigh in on… nursing in the news by victoria Alarcon
he lost all feeling in the left side of his body. He was sent to The Ottawa Hospital for treatment for three weeks before being transported to Pembroke Regional Hospital for rehabilita- tion. During his recovery, Peterson was given an exercise program tailored to his specific needs, which included receiving at least one hour of exercise at home, assisted regularly by As part of a Mobile Crisis specialists (physiotherapists, Intervention Team, RN Shelagh Scanga joins Toronto police on occupational therapists and calls involving people in crisis. PSWs). Today, Peterson uses a
p h o t : C r a i g Ch iv e s / CBC Ne w walker and has regained approximately 70 per cent of his mobility. He is one of many Nurses and police team up to save lives stroke patients admitted to the hospital’s District Stroke Centre. RN Shelagh Scanga is on a mission. It’s early May, and alongside police constable and partner Rob Koops, Scanga RN Beth Brownlee, clinical responds to a call for a person with a history of mental health issues. Frontline police officers, a sergeant, and para- director of the rehabilitation medics are already at the scene when Scanga arrives. “This person has a history of requiring many officers to program, says the department apprehend,” she says. The woman invites them into her apartment, but her thoughts are disorganized and hard to fol- has worked hard to increase the low. Scanga immediately introduces herself as a registered nurse and sits beside the woman on the couch. “When amount of time stroke patients someone hears...there’s a nurse involved, it can help with decreasing their anxiety and fears,” she says. Scanga learns are engaged in active face-to-face that the woman has schizophrenia and receives medication by injection once a month. She is almost due for her next rehabilitation therapy during shot and agrees to leave for the hospital. Since 2013, Toronto’s Mobile Crisis Intervention Teams (MCIT), a joint effort their stay. “Best practice research between the Toronto Police Service and mental health nurses from six area hospitals, have been responding to calls shows that increasing a stroke involving people who are in crisis. As a result, the police apprehension rate dropped from 66 to 25 per cent between patient’s amount of therapy time 2013 and 2016. (CBC News, July 4) per day results in better outcomes in their functional abilities,” RNAO welcomes gaps, and see what needs to be “We believe this independent Brownlee says. Since September broad-based public done to ensure the safety of inquiry is going to strengthen… 2016, the average amount of inquiry seniors in nursing homes funding in nursing homes and therapy per patient has increased Following the sentencing of across the province. “We have to ensure there is a level of staffing by 52 per cent. (Pembroke Daily former RN Elizabeth Wettlaufer look at how the ministry of and oversight to provide the best Observer, July 25) for the murders of eight elderly health…provides legislation and quality of evidence-based care to nursing home residents, RNAO regulatory oversight. What are residents.” The inquiry will be led Knitted hats offer is welcoming the broad-based the accountability measures? by Justice Eileen Gillese. Her comfort, warmth public inquiry launched by What’s the inspection process? final report is due on July 31, Babies in red and white hats Ontario’s health minister and And how does the chief 2019. (AM980, Aug. 2) celebrated Canada Day in style attorney general. Carol coroner’s office report deaths in this summer, thanks to a group Timmings, RNAO president, nursing homes?” she says. In Advances in stroke of retired teachers from the says the inquiry must look at addition, the inquiry must look treatment Stratford chapter of the Retired how the overall long-term care at the funding models and Brian Peterson knew he was Women Teachers of Ontario. The sector is operating, find the staffing levels in nursing homes. suffering a stroke last fall when group donated more than 200
8 july/august 2017 nursing in the news by victoria Alarcon
Letter to the editor In a letter to the Ottawa Citizen (July 5), RN Donna McFaul responds to the shocking elder-abuse case of Georges Karam, an immobile and non-verbal dementia patient who was punched in the face by a PSW in March.
Respect key to stopping elder abuse There is no other word but horrifying to describe what happened to Georges Karam. I have no doubt that it has happened to others and will happen again until there is a total overhaul of the long-term care “industry” throughout this country, and a wide-reaching inquiry into the education and accountability of all who care for the most frail. RN Kerri Hannon (back left) says more than 200 knitted hats donated Coming in the aftermath of the nurse (Elizabeth Wettlaufer) to the maternal and child unit at Stratford General Hospital will help convicted of killing eight of her patients, families and their loved keep newborn babies warm. ones must be terrified. However, statistics can be used to support or detract from any debate. I do not believe for one moment that 70 per cent of nurses self-identify as having abused or neglected their patients. Nor do I believe that most personal service workers would intentionally harm those they care for. The majority of nurses and support workers I’ve worked with will always have my utmost respect. Yes, the system is broken. Are we truly willing to fix it? Elder care has never been a priority for any group other than those who can profit from it. How can we teach students in nursing or support workers to respect the elderly when society…doesn’t?
animals. With a stethoscope, who have sustained injuries. MPP Jeff Leal (left), a former Trent University student, joins a tour of the bandages and medicines (St. Catharines Standard, July 9) school’s new health clinic with RN Ruth Walker (second from left). available at the nurses’ station, school nurse Christine Philbrick Newly renovated health red and white baby hats to the hats of different themes: orange taught kids how to apply clinic open to students maternal and child unit at for Halloween, and purple in bandages and give oxygen to their Peterborough’s Trent Univer- Stratford General Hospital as part November to raise awareness of beloved stuffies. “The purpose of sity is hoping to make students of a Canada 150 project. RN Kerri shaken baby syndrome. All hats the teddy bear hospital is to feel more at ease with a newly Hannon, manager of the unit, and blankets donated to the familiarize kids with health-care renovated student health clinic. says 1,100 babies are born at the hospital are made by community providers and clinics through a Two new features include: an hospital each year and the hats groups and local knitters. (London play setting,” Philbrick says, accessible, barrier-free exam are a welcome gift to parents. Free Press, July 17) adding that the activities help table that allows providers to “Babies tend to lose the majority decrease some of the fear kids better support the dignity of of their heat through the top of Teddy bear check-ups might have when visiting a students unable to access a their head,” she says, adding that July 9 marked the second-annual health-care provider. Participating standard exam table; and keeping their heads warm “...will Teddy Bear Picnic in St. in the event also gave Philbrick therapeutic artwork to help keep their body temperature Catharines, and children with an opportunity to teach kids alleviate any anxiety while regulated...whether they’re out of teddy bears in need of repair about the importance of visiting the centre. In June, the blanket or in the blanket.” lined up to learn from nurses nutrition, physical activity, safety, university staff and students,
c ey / T he Bea con H e r ald p h o t : r e n u niv s i ty a d Mega S ta The hospital also receives knitted about how to treat their stuffed vaccination, and first aid to bears along with Liberal MPP and
Registered nurse journal 9 nursing in the news
alumnus Jeff Leal, participated out and about in a tour. “We are fulfilling our goals for an inclusive space that meets students’ clinical needs, but also helps them feel Pride festivities stretch welcome,” says RN Ruth across Ontario Walker, manager of the Members of RNAO’s Kingston university’s health services. chapter were out in full force “When students arrive to Trent, on June 17, celebrating diver- many are accessing health care sity by participating in their for the first time on their own. city’s Pride Parade. (L to R) We want this to be a place Susan Potvin, RNAO board where they feel comfortable member Allison Kern, Jean asking for help.” (The Peterbor- Clipsham, and Cadence Gillis ough Examiner, June 20) carry an RNAO and Rainbow Nursing Interest Group (RNIG) Making patients banner through town with fel- feel at home low revelers. “As experts in
Patients are playing a larger role population health, nurses are p h o t : To dd Ho dgs on in who is involved in their care at among the best advocates for LGBTQ individuals,” said Johnathon Martin, co-chair of RNIG. “When Sarnia’s Bluewater Health, which nurses come together and send their support, it comes with a passion that is truly inspiring.” RNAO announced recently that it would urged nurses from across Ontario to continue its long tradition and participate in Pride events around allow patients to have greater say the province. in who they identify as ‘family.’ “Patients, their families, and other partners in care are respected as essential members of the health-care team, helping to ensure quality and safety,” says chief nursing executive Shannon Landry. “A person’s family includes all those who the patient identifies as significant in his or her life.” At the beginning of a hospital experience or emergency room visit at Bluewater Health, patients are asked to define their ‘family’ and how they will be involved in care and decision- making. Patients identify who may be present during rounds, change of shift report, exams and Leadership academy marks six years of great learning procedures. That ‘family’ is Nursing leaders from across the province attended RNAO’s 6th Annual Nurse Executive Leadership Acad- welcome 24-hours-a-day, emy (NELA) in Niagara-on-the-Lake this past June. (L to R) Peel Public Health CNO Isabelle Mogck, RNAO seven-days-a-week. In the event CEO Doris Grinspun, RNAO Policy Director Lisa Levin, Sudbury RN Aileen Restoule, and RNAO Nursing of an emergency requiring visitor Policy Analyst Cheryl LaRonde-Ogilvie, were among 60 participants who took the opportunity to engage restrictions, staff will work with with fellow health system leaders, senior government officials, and other leading edge thinkers about patients to ensure select family health system transformation, expanded scope of RNs and NPs, medical assistance in dying, mental members are still welcome to health and addiction, and much more. provide support. (Sarnia Observer, June 20) RN
10 july/august 2017 continued nursing notes
Street nurse invested into Order of Canada
Long-time RNAO member Cathy Crowe, a street nurse and social justice advocate for almost three decades, was invested as a member of the Order of Canada in June. “I think this is an honour for nursing,” she says of receiv- ing one of the country’s highest civilian honours. “It speaks to the work so many nurses do to achieve housing – one of the most important determinants of health.” Crowe has been an RN for 45 years, and began focusing her attention on the homeless in the 1980s. She co-founded the Toronto Disaster Relief Committee, a group that declared homelessness a national disaster in 1998. Crowe has also been involved in several documentary films as executive producer, giving voice to homeless families and children in Toronto and Calgary. She is now a distinguished visiting practitioner in the depart- ment of politics and public administration at Ryerson University. In 2004, Crowe received the Atkinson Charitable Foundation’s Economic Justice Award, working both locally and nationally on issues related to homeless- ness, and writing her first book, Dying for a Home: Homeless Activists Speak Out. Members of the Order “…have all enriched the lives of others and have taken to heart the motto of the Order: ‘They desire a better country,’” according to the governor general’s media release announcing the latest list of recipients. Crowe says “I believe this honour gives weight to the right to a home that all Canadians deserve.”
Nurses “most has established a panel of 30,000 together on the bill because of per- three years for the implementation respected” for second Canadians who volunteer to share sonal experiences. Oliphant spent of a provincial dementia strategy, year in a row their opinions on a variety of political, 25 years as a United Church minis- and RNAO was involved with other A Canada-wide poll has found nurses economic, social and other issues. ter, and his church raised money to stakeholders in bringing forward rec- – for the second year in a row – are help build housing for Alzheimer’s ommendations on what that the most respected professionals in National and dementia patients. Nicholson’s strategy should look like. the country. Ninety-two per cent of dementia strategy father died from Alzheimer’s dis- the 1,257 Canadian adults who com- Canadians with Alzheimer’s disease ease. According to the Alzheimer’s Third edition tobacco pleted an online survey this past and other dementias will soon have Society of Canada, there are intervention BPG spring said they have a positive opin- a standardized and strategic 564,000 Canadians currently living released ion of nurses. This is exactly the approach to their care thanks to the with dementia. That number is In June, RNAO released Integrating same proportion who felt this way passage (on June 22) of Bill C-233, expected to jump to 937,000 in 15 Tobacco Interventions into Daily when the same poll was conducted An Act respecting a national strategy years. “A comprehensive dementia Practice (Third Edition), which in 2016. Following in at a close sec- for Alzheimer’s disease and other strategy is essential to support a replaces the 2007 BPG, Integrating ond were doctors and scientists dementias. The passing of the legis- person and their family throughout Smoking Cessation into Daily Nurs- (both at 89 per cent and up slightly lation now means politicians, health the course of the disease,” says ing Practice. The updated BPG is for from 2016), and farmers and veteri- providers, researchers and patients Susan McNeill, guideline develop- nurses and other members of the narians (both at 88 per cent). will come together to address the ment lead for RNAO’s delirium, interprofessional team to enhance Rounding out the list at the bottom overwhelming scale, impact and dementia and depression best prac- the quality of their practice with were lawyers (50 per cent), building cost of dementia. Conservative MP tice guideline (BPG). “A concerted clients who use commercial contractors (54 per cent), and Rob Nicholson and Liberal MP Rob effort across sectors can help tobacco, ultimately improving clinical priests/ministers (59 per cent). The Oliphant are behind the private people with dementia to live as fully outcomes through the use of evi- research company that conducted member’s bill, originally introduced as possible.” Ontario’s 2017 dence-based care. To find out more, the poll, Insights West, in February 2016. The MPs worked budget includes $100 million over visit tobaccofreeRNAO.ca RN
Registered nurse journal 11 celebrating 1 years of member stories
As we mark a decade since the creation of our summer story collection, we look back at some of your most memorable submissions. compiled by kimberley kearsey
e hear time and time again how much you – our readers – love reading the personal stories of colleagues. Whether the stories are a reflection of what’s happened to you in your career, or they are a complete departure from what youW know and understand nursing to be, they are stories that resonate and keep you coming back for more. For 10 years, we have asked you to take a look at your work lives and to tell us about: the rewards of nursing; the special skills required to be a great nurse; the experiences that have influenced your outlook on nursing; the memorable mentors; the real-life lessons; the funniest moments; the value of collaboration; the perks of membership in RNAO; and what it is like to be on the receiving end of care as a patient. Your stories have made us laugh, ponder and pause to reflect on so many different aspects of nursing. We are grateful to all of our nurse writers who have shared a piece of themselves over the years.
12 july/august 2017 2008
Haliburton Highlands is a rugged stretch of Paralyzed and in constant pain, she glowed Nursing forest and rock. Famous for glittering lakes, with good will and kindness Although her winter sports and fall colours, it attracts home was isolated, it was the centre of her in god’s tourists year round. Some call it God’s universe and it became a school of wisdom country. I call it home. for me. She taught me that nursing is about country When I started my career here more than building relationships. I learned that, when 30 years ago, the hospital was a small Red nurses empower patients and families to be By Connie Wood Cross outpost with eight beds. Now, our partners in health care, strength of spirit and community has a new facility that has been greater independence is the result. This praised by Ontario’s Minister of Health as a woman showed tremendous courage in model for integrated health care. raising her family, and I consider it a privilege Years ago, when I drove down forgotten to be part of a profession that helps people back roads delivering nursing care, I like her live full and productive lives, despite sometimes felt as if I was travelling back in their health challenges. time. I remember pulling up to one run-down Today, I am part of a dynamic team of farmhouse with a sagging porch. I was afraid professionals in a Family Health Team. I of the dismal conditions I might see inside. know the stories behind the faces I see in Instead, I found a woman, bedridden with the waiting room. I remember their parents multiple sclerosis, who transformed and their grandparents. We care for patients punishing poverty into a loving family home as if they are friends and family. In most by the sheer strength of her cheerfulness. cases, they are.
2009
It’s 4 a.m. and the triage line has finally week. I make light-hearted small talk while HIGH STAKES dwindled to a halt. For the first time sussing out the reason for their visit. After NURSING tonight, I have a moment to wonder if I checking the girl’s vital signs and listening was too swift in rushing the pale infant to to her chest, I pull together enough the resuscitation room, or too harsh with information to come to a triage decision. By Kate Langrish the parent who interrupted me for the “You know,” her mother says as I plug third time to ask about the wait. My mind the new details into our electronic tracking wanders to a radio program I heard board, “the last time we were here I recently that called triage “high stakes watched you run around, and I thought nursing.” It’s a glamorous label for the you must be nuts to do this job.” endless stream of assessments and I don’t bother to explain the rush of interventions that make up each shift. It’s coming across a vital bit of information the subtleties that make all the difference that pulls the puzzle together, or the here. The seemingly small detail that softness of an infant wrapping her finger makes one patient stand out against the around mine. I don’t describe the great hundreds who have presented with the laughs I have with my colleagues in the same complaint. It’s the fine balance middle of the night, or the pride I take in between knowing when to react – and not achieving a difficult skill. I don’t discuss reacting every time. the time I literally watched a child come I glance up from my thoughts and back to life, or the many other moments mechanically push my password into the when I have witnessed the deepest keyboard as I see a new family approach. sorrows. There’s little time for conversa- The woman greets me like an old friend, tion. A line up is growing again. I send my and I’m too embarrassed to admit I have patient and her mother off to the crowded
no idea who she is. Finally, I vaguely recall waiting room, knowing it’s bound to be a ion s: (t op ) j o h n w e b ste r , ( bo tt om ja nic ku i llust r at starting her daughter’s IV the previous long night. “Next, please,” I call out.
Registered nurse journal 13 2010
AWAKENING
By Nicole Walton
I joined the RNAO while I was a nursing student shared their perspectives, successes and failures at Centennial College after hearing one of my with me. It opened my eyes. Here were nurses professors speak about the benefits of member- who are still fired up about their work after 25 ship. I have attended several RNAO events and years on the job, and I was losing my passion workshops over the years, but the most after just six. It was a major reality check…an memorable was the 2009 Annual General awakening. I still wanted to be a nurse! And I Meeting (AGM), in which I was privileged to be wanted to be the best nurse I could be. Being a voting delegate. The opportunity came at a responsible for making really important good time in my career. decisions about the future of nursing in Ontario After nearly six years as a visiting nurse, I was as a voting delegate was also incredibly moti- looking for something more, and even ques- vating. To top it off, I was a change agent. tioning whether I still wanted to be a nurse. I Back at work, I was determined to pursue a chose to be a visiting nurse right out of school nursing role that would build on my accumu- because I felt it would enable me to give better lated experience (I would miss visiting nursing, quality, dedicated care to patients and their which I truly enjoyed for years) and afford me families, and it had. But I wasn’t excited or new challenges. Now I’m a clinical resource motivated about my work anymore, and I think nurse, providing education and support to a it was because I wasn’t being challenged overall. great team of visiting, shift, and mental health (In hindsight, I realize I’d just had my fill of nurses. I just love being their go-to when they bedside care.) need clinical assistance, a different perspective, I went to the 2009 AGM full of curiosity, but or just a sounding board, and they in turn, without any expectations. I was immediately inspire me every day as I observe their skills, moved by the energy and passion – there was dedication and energy at work. I hate to think literally “something in the air.” I talked to so where I might be today had I not attended many other nurses in a wide variety of fields, who that AGM.
14 july/august 2017 2011
a family affair
By Kathy Holdsworth
Perhaps it seems strange, but by the time I found her niche working with outpatients, was four years old I knew I would be a nurse and became enmeshed in the community of when I grew up. My experience with nurses hearty souls who lived on that far northeast was limited. At three, I had my tonsils out and corner of ‘the rock.’ When specialist treat- remember distinctly the brusque nurse with a ments and surgeries were required, she often wart on her nose who made me roll over for accompanied patients back to Montreal, where the needle in my behind. I wasn’t going to be services were more readily available. On these a mean nurse like her. The student nurse who working visits, I’d meet her patients and see cuddled and played with me when I was sad her nursing and supporting them in often life and missing my mom; I wanted to be like her. threatening situations. I learned first-hand But more than either of these two nurses was that death cannot always be avoided even with my Aunty Pat who, in my mind, was fun and the best of care. fearless and the best nurse ever. I will always remember Aunty Pat telling My mother tells me of the day I put a bead the story of the young lad who came into the up my nose. Fortunately, Aunty Pat came to clinic one day with his one and only fish hook the rescue and held me still for the doctor in lodged in his forehead from an unlucky cast. the emergency department. She had just The doctor wanted to simply cut the barbed graduated the Christmas I was four and used end off the hook and slide the rest back out. her student uniform to cut me out a ‘uniform’ But the hook was his livelihood, and he of my own with a red cross stitched across the begged that they keep it intact. With the front of the bib. Wearing my new nursing gentlest of hands, Aunty Pat spent over an dress, and armed with an equally new hour easing the hook out. The boy was miniature nursing bag complete with plastic delighted while the doctor shook his head. stethoscope and thermometer, I dutifully This great lesson of respecting a patient’s opened my hospital filled with dolls and choice while providing compassionate care stuffed animals and went to work bandaging will ever remain with me. How fortunate I and stitching their various wounds. was to learn from such an excellent teacher. As the years went by, I heard the stories of outpost nursing in St. Anthony, Newfound- In memory of Margaret Patricia (Aunty Pat)
: kelly s c hykulsk i ion : kelly i llust r at land where Aunty Pat had relocated. She Dunk
Registered nurse journal 15 2012
textbooks and tutorials didn’t teach me...
That I have as much to learn from patients as they have to learn from me
By Bev Chambers
In 1981, with four years of nursing experience from the other side of the room. “Och aye,” Mr. under my belt, I applied to study midwifery in D’s roommate shouted. “It’s been heavy Scotland, a post-RN program that was not gunning over there, like the Battle of Waterloo!” available in Ontario. In order to practise as a Everyone doubled over with laughter, including registered nurse in the UK, I had to work two Mr. D. months as a student on the surgical floor at Each ward at Victoria Hospital had a small Victoria Hospital in Kirkcaldy. I was not dining room, and patients who were ambula- looking forward to this as I had already worked tory would walk to it, sit at its tables, eat as an RN in Canada, but I did it because I was together and have a grand chat. Often, the most determined to go to midwifery school. mobile patients would sit with bedridden Scotland’s health-care system was very patients to keep them company, and some- different from what I was used to in Canada. times help set up the tray. In particular, Victoria Hospital’s procedures After witnessing the degree to which patients were outdated; students were not allowed to were socializing, I realized the importance of read patient charts, and the head nurse (or laughter and a sense of community among Sister) would delegate tasks during the day. patients. At school, I learned about therapeutic Although the nursing practices were unusual to conversations with my patients, and how most me, I learned about the value of community of those conversations should have a serious among patients. purpose. Humour was not something I was One day, I was assigned to care for eight encouraged to use. My experience in Scotland older men in one room. They conversed with challenged that premise. We now know that each other, and were a friendly lot. I could not laughter is beneficial, releases endorphins and always understand their Fife accent, and they helps reduce stress. teased me about my Canadian twang. I had to I never learned to encourage patients to give one of the gentlemen a suppository. There mingle. Infection control was always foremost was one large bathroom on the whole unit for in my mind. But these patients demonstrated all to share. It was quite a distance away, so I the value of peer support long before it was decided to put a commode by the bed and pull popular. The people of Scotland humbled me the curtains. The appropriate interval of time with their generosity and warmth. And they
passed, and I returned. “Mr. D,” I said. “Did the made me realize patients have far more to teach ion : j o h n w e b ste r i llust r at suppository work?” Another voice called out us than we can teach them.
16 july/august 2017 2013
Human reproduction and 10-year-olds
By Jan Slywchuk
The year was 1991. I had returned to university reactions ranged from to get my BScN. I was interested in public health, beet-red faces of and jumped into my practicum with the embarrassment to enthusiasm of a 20-year-old. I was actually challenging glares. almost twice that age, but let’s not get too caught I decided to use this up in minor details. I had been a mental health as a teaching moment, nurse for more than a decade, so I was pretty even though it was a bit sure I could handle just about anything. My of a salvage operation challenge was to teach sex education to Grade 5 from my perspective. I students. My preceptor assured me that 10 was asked what they were an exciting age, and I would have a great time. looking at. “Women in I questioned her wisdom when I walked into the bikinis,” they said. classroom for the first time and the teacher “What’s that like?” promptly left the room after introducing me. I asked, with as much I was face-to-face with a group of young casual indifference as people who looked at me silently for 30 seconds, I could muster. For the first time in the 30 then engaged in rowdy conversations with their minutes I had been there, it was dead silent. friends while I tried to get my overheads out of Finally, one brave soul piped up: “I get an my bag (it was before PowerPoint and smart ejection.” I suppressed my smile and casually boards). I managed to get their attention with suggested that “an erection is a normal reaction, bad diagrams of the naked body. Much to my and happens as a result of what hormone?” surprise, they did pay attention. After a detailed, Again, the terminal silence of 10-year-olds. age appropriate description of human reproduc- Finally, a second brave soul offered reluctantly: tion, I noticed a group of boys in the back corner “Testarossa?” He was corrected by one of his of the room completely ignoring my brilliant peers. “She’s talking about hormones, not cars… presentation, and clearly involved in something it’s testosterone!” else. When I wandered over, there was a sudden I was so thrilled that a prepubescent boy had flurry of activity. But before they could cover it heard and retained something I had shared up, I managed to get my hands on the magazine during my presentation, despite the distraction
ion : g r aha m ro u mi eu i llust r at they were engrossed in: the recently released of bikini-clad women. His response left the swimsuit edition of Sports Illustrated. Their children – and me – grinning from ear-to-ear.
Registered nurse journal 17 2014
RNs tackle trauma in the north
By Jannine Bowen
In the late 60s, amount of support. There were no “games” on psychiatrist Leonard this night. Stein published his A male teenager arrived on a piece of plywood now famous essay and was taken to the only trauma room we had. about the “doctor/ As we started the primary survey and interven- nurse game.” He tions, the crowd got bigger, the room got smaller wrote: “…the nurse and the nervousness grew. Above the crying, is to be bold, have initiative, and be responsible someone was screaming as they carried in the for making significant recommendations, while second teenager. “Where do you want him?” at the same time she must appear passive. This “Right here on the floor in front of me,” I said, must be done in such a manner so as to make glancing at the distracting deformity on his left her recommendations appear to be initiated by leg. A local teenager did the primary survey: the physician.” Revisiting that theory in the 90s, unconscious and not breathing. “Do you know Stein admitted the “game” is no longer played. CPR?” I asked him. He nodded. “Then start Any nurse working in an isolated, northern compressions.” community is likely to agree with him. I do. We took the defibrillator leads from the first In the frozen, isolated tundra, above the Arctic teenager and applied them to the second. No Circle, our health centre serves about 900 Inuit shockable rhythm. Two nurses continued on people. There are three full-time nurses life-saving measures while the third connected – supported by wonderful local staff – who are with the on-call doctor by phone. After three responsible for taking initiative and making rounds of lifesaving measures, the code was recommendations for patient care, and often stopped and we had to turn our attention back to making life and death decisions on the spot. the surviving teenager on the stretcher. The One such instance was at 11 p.m. on a July crowd continued to multiply. The crying night in 2012. The call came in that two young escalated. With one boy clinging to life, the boys who had been drinking and smoking Medivac team was called, but our hearts were marijuana got on their all-terrain vehicles (ATV) sinking in our chests as a mother bent over her to race up and down a gravel hill, and crashed. lifeless son on the floor. At the health centre that night: three community This shows the “doctor/nurse game” no health nurses with combined expertise in longer applies. In the north, it is the nurse, emergency and ICU nursing. What follows is a the community, and the grace of God and his
testament to nurses’ ability to come together to spirit that guide you to do the best you can as ion : jul i a br e c ke nr d i llust r at provide the best possible care, with the least a team.
18 july/august 2017 2015
What membership means to me (90th anniversary)
By Kerrianne Thompson
I have been a nurse for 11 years. It was a long the website for anyone to access, regardless of road to my diploma as a young single mother, membership status. attending nursing school and caring for a little RNAO also proudly supports new grads with one at the same time. I began my journey to free membership; getting new nurses off on the my BScN part-time, working full-time while right track by providing access to a wealth of caring for my daughter. During my studies, resources, job postings, mentors, and showing I learned a lot about RNAO. I learned about its new nurses they are supported by their profes- interest groups, its advocacy for our profession sional association. Over the last couple of years, in the political arena, its best practice guide- I have had the opportunity to review RNAO’s lines, and its support for nursing education. resources as not only a member and workplace I utilized RNAO’s easily accessible website, liaison, but also as a patient’s daughter. My dad applying for an education grant. I could not was diagnosed with Atypical Alzheimer’s in believe the warm welcome I received from October 2013, and has been in and out of RNAO. Everyone is professional and pleasant hospital since then. I became frustrated at to interact with. points, but organizations like RNAO provide RNAO is consistently on the frontlines, encouragement and remind me that I have other speaking out on behalf of our profession and nurses on my side to speak out on issues that I supporting nurses in a variety of different see while accessing our health-care system. ways. I admire that RNAO uses different RNAO is vocal on issues like nursing shortages, forms of communication to reach out to client-centred care, nursing models, enhancing nurses and the community, including: the medicare, and more. RNAO is an organization website, automated phone messages, interest that puts nurses and patients first. It is an groups, print, webinars, emails, meetings, association that I am so proud to be a member and more. RNAO also supports nurses who of, and a workplace liaison for. are not members, which I think is just as Thank you RNAO for being an association important as supporting members. Its that I can rely on as a patient’s family member, evidence-based research and education as a nurse, and as a member of the commu- funding information is proudly displayed on nity. You are truly one-of-a-kind.
Registered nurse journal 19 2016
Mindful listening helps patients make sense of circumstances
By Alexandra Curkovic
My transformation from a nurse to a patient might follow surgery. It was such a terrifying was abrupt. I had just wrapped up a shift, experience to hear that I – a highly athletic and doing assessments for the delirium preven- independent woman – may no longer walk tion program, when I was given the results of independently, may have facial droop or, my own CT scan done earlier that same day. perhaps even worse, may not be able to The scan was ordered because, for some time, swallow. As I was getting increasingly sad and I felt pressure in my head each time I worried, a different nurse came and asked me engaged in strenuous activity. The MRI about my concerns. For each neurological showed a large mass on my brain, and I was deficit I mentioned, he had a compelling admitted for further evaluation. It was a very explanation of how I can overcome it with trying time for me, especially for the first two additional therapy. There was something days as the diagnosis was being established. special in his approach that made me feel like I experienced two very different approaches I was not alone. I think he was able to be so taken by nurses that demonstrate the power compassionate and empathetic because he paid of mindful listening. close attention to my concerns. While still unsure of my diagnosis, I was This experience taught me that mindful contemplating all kinds of rather alarming listening enables nurses to support patients scenarios when a nurse came to do an holistically. It requires self-knowledge, which is assessment. After introducing herself, she important for many reasons. It prevents us reassured me that she would monitor me very from interacting with patients based on our closely because at any time my brain could own fears, which I suspect was the case with herniate and I could die. I appreciated her the first nurse. It also allows us to listen to the critical thinking skills, and her preparedness to patient’s story with an open mind so we can deal with a potential situation. However, I felt address their needs. so much more worried and isolated in my As nurses, we need to develop a sense of concerns after she told me this. I felt as though curiosity, asking relevant personal and she viewed me as a machine that might stop open-ended questions of patients, not only to working at any time. learn what is important to them, but also for
Once my diagnosis was confirmed, I was the patient to start making sense of their ion : aa ron mcconom y i llust r at informed of possible neurological deficits that circumstances. RN
20 july/august 2017 policy at work
emergency days to seven instead of two. Such a move would support individuals dealing with personal issues, including health concerns and urgent family matters. Given the evidence that lower income levels are associated with higher rates of disease and mortality, RNAO says the government should heed the advice it is getting from health and social justice groups, and make the necessary changes to better protect vulnerable and precarious workers. Visit RNAO.ca/newsroom/ changingworkplaces to read more. At a meeting with MPP Sophie Kiwala (centre), RNAO’s director of nursing and health policy Lisa Levin (left) and Waterloo public health nurse Mary Mueller (right) discussed the best way to use new funding for people with Fetal Alcohol Spectrum Disorder. Protecting Canada’s health and environmental More support for their work to raise awareness association praises the interests FASD programs of FASD. Visit RNAO.ca/ government for boosting the In July, RNAO issued an action Ontario’s spring budget included RNJ-Nov-Dec2013 to read the minimum wage. It also says alert about the renegotiation of $26 million in funding to expand feature article. wage differentials for student the North American Free Trade support for children, youth and employees and people who Agreement (NAFTA). Negotia- families affected by Fetal Alcohol Creating better, serve alcohol should be tors for Canada, the U.S. and Spectrum Disorder (FASD). On fairer workplaces removed. RNAO argues the Mexico began talks in August. July 20, RNAO’s director of RNAO was among dozens of minimum wage should apply While trade deals set the nursing and health policy Lisa groups that offered feedback equally without creating ground rules on how countries Levin (left), RNAO members on Bill 148: Fair Workplaces, exemptions by age or sector. import and export goods and Mary Mueller (right) and Kathy Better Jobs Act, 2017. The new Ontario is the only jurisdiction services, RNAO wants to make Moreland, and RNAO CEO legislation passed first reading in Canada that allows sure any new deal does not Doris Grinspun, met with in July and is expected to go to employers to pay younger undermine existing commit- Liberal MPP Sophie Kiwala second reading in the fall. The workers a lower minimum ments to tackle climate change (centre), parliamentary assistant proposed legislative changes wage. The province, along with and to reduce harmful levels of to the minister of children and will increase the minimum British Columbia and Quebec, chemicals such as lead. There youth services, to consult on the wage from $11.40 per hour to also permits those who serve are also fears that a new best use for this money. The $14 per hour in 2018, and $15 alcohol to be paid less. agreement could lead to group discussed next steps for per hour in 2019, a move long RNAO is pleased the bill challenges to existing govern- the roll-out of the funding. urged by RNAO. It also makes includes an amendment to ment programs and policies, RNAO’s advocacy on this issue it illegal for employers to pay allow all Ontario workers including measures to protect dates back to 2013, when part-time and temporary unpaid personal emergency health and social programs. Mueller and Moreland Layte workers less for doing the same leave. Currently, this leave is The action alert demands brought forward a resolution to work as full-time employees, just available to those who nine changes to NAFTA, the annual general meeting and increases paid vacation work for companies with 50 or including enforcing the Paris (AGM) regarding improving from two weeks to three. more employees. The associa- climate agreement. To read all FASD services. The two In a written submission to tion also recommends the nine demands, and to sign the members were later featured in the standing committee province go even further by action alert, visit RNAO.ca/ Registered Nurse Journal for examining the bill, the increasing the number of paid NAFTAactionalert RN
Registered nurse journal 21 Making a [difference
“System change is obviously crucial (to helping seniors), but there’s a huge amount of good that can be done on a one-to-one basis.”
– deborah brown
NP Deborah to their full scope of practice, and to anchor the health system in Brown calls it primary care to keep people healthier for longer. a ‘trajectory of As policymakers at the highest levels grapple with major system decline.’ transformation, individual nurses are making a difference for A frail, older seniors every day in their practice. “System change is obviously person is admitted crucial (to helping seniors),” Brown says. “But there’s a huge into hospital amount of good that can be done on a one-to-one level.” dealing with an Respectful care for seniors has been a trademark of Brown’s acute illness like career from her early days in an acute care hospital in Halifax, to pneumonia, and ends up leaving worse off than they came in. her time with the Victorian Order of Nurses (VON), and now at Falls, pressure injuries, and hospital-acquired delirium are Toronto’s Sunnybrook Hospital for the last 23 years. “I just love serious concerns for a patient who is already fragile. If they don’t being around older patients because they can teach me a lot about sleep well, eat well, and stay active during their time in hospital, life,” she explains. “So if I am able to help them out, I feel like I’m their risk of cognitive or functional decline is compounded. giving back.” By the time the patient recovers from their pneumonia, Brown Brown is in a unique position to give back as part of Sunny- says these complications “can have a more devastating and lifelong brook’s Senior Friendly strategy, an initiative she helped launch in impact than the acute illness.” Sadly, she says at least one-third of 2009. Back then, she led a group of health professionals who older patients who are admitted into acute care hospitals cannot proposed a different approach to seniors care at Sunnybrook, return to their baseline functioning once they are discharged. looking to end some of the issues associated with the trajectory of “That has huge implications not just for patients, but also the decline. health-care system,” Brown says. Nine years later, Brown works full-time on a Senior Friendly These days, it is impossible to discuss the future of Canadian team that also includes project leader Beth O’Leary, physiotherapist health care without mentioning seniors. Baby boomers are turning Jocelyn Denomme, and geriatrician Barbara Liu. The team is 65, and for the first time ever, the country’s seniors outnumber its supported by more than 100 Senior Friendly champions employed children. These changing demographics are expected to push the throughout the hospital, and hundreds of volunteers. system to its limits. A Conference Board of Canada report projected As part of her role, Brown provides education to staff, patients, the number of seniors needing continuing care supports will and families to help get Senior Friendly projects off the ground. increase 71 per cent between 2011 and 2026, and spending on those One of the team’s earliest initiatives focused on keeping seniors supports will more than double over that time. mobile, which is crucial to their long-term health. Thanks to those Clearly, health care will need to adapt to accommodate for the efforts, seniors in 31 inpatient units throughout the hospital are aasse n /su nn y broo k
country’s graying population. Home care is expected to be part of now mobilized at least three times a day. a n p the solution, and the federal government promised an additional $6 Cutting down on unnecessary medications is another project billion to bolster that sector earlier this year. RNAO has also called priority. Brown leads a project which seeks to find alternatives to
on government to build a larger workforce of RNs and NPs working prescribing antipsychotic drugs to older patients – because they are p h o t : ke vin v
22 july/august 2017 difference ] for seniors by daniel punch As policy-makers grapple with major system transformation targeted to our graying population, individual nurses are supporting seniors every day in their practice.
“wrought with potential negative side effects” – and she is working to reduce prescriptions for pharmacological sleep aids. Other ongoing projects aim to prevent delirium and manage responsive behaviours among seniors with cognitive impairments. Brown says the key to providing excellent acute care to seniors is to appreciate the life they lived before they came into hospital. “(They) were a person before they were a patient. And you need to understand and respect that,” she says.
Nursing professor Ping Zou was inspired to work with elderly Chinese immigrants because she understands the challenges they face. Zou emigrated from China in 2001, and had difficulty adjusting to life in Canada at first. But she was young and well-educated “If you stayed home and did all when she arrived in Toronto, so it didn’t take long for her long to settle in. Unfortunately, she saw many Chinese seniors struggle to this work (with) no one to talk to... make that same adjustment. it’s easy to develop depression.” She says many older Chinese people come to Canada to be full-time caregivers for their grandchildren while their children – ping zou work long hours. They often can’t speak English, can’t drive, and rarely have the chance to leave their home. This isolation can have serious implications for their physical and mental health. “Think When Zou pursued her PhD in nursing at the University of about if you stayed home and did all this work (with) no one to talk Toronto, studying the health of Chinese Canadian seniors was a to,” she says. “It’s easy to develop depression.” natural fit. She focused specifically on hypertension, because more Looking to ease their burden, Zou volunteered at her local than half of Chinese Canadian seniors have high blood pressure, church, translating and teaching beginner English classes. As she and they are more likely than Canadians of other cultural back- progressed through her nursing career – starting as an RPN in grounds to suffer lethal strokes. long-term care, earning her BScN, then her master’s degree in She knew her community was passionate about healthy food. nursing – she took a keen interest in the health of the older people And since diet is the most significant modifiable risk factor for in her community. She was often asked to give seminars about diet, hypertension, she created a dietary intervention tailored specifically exercise and chronic illness prevention at a collection of Toronto to Chinese seniors. It was derived from the internationally Chinese Canadian community centres. recognized Dietary Approach to Stop Hypertension (DASH) diet
Registered nurse journal 23 plan. To make it culturally specific, she added a sodium-reduction – mostly retired health professionals – regularly visited 16 seniors component, because many Chinese Canadians eat high-sodium to chat over coffee, play games, go on outings, or whatever the foods, and added elements of traditional Chinese medicine food client wanted. Volunteers also encouraged seniors to eat healthy therapy, which carries a lot of weight among the older Chinese meals and stay active. population. By the end of the pilot, Cameletti says participants were From 2014 to 2015, she and her research assistants screened happier, more alert, and more engaged with other people. In a blood pressure for 618 Chinese seniors in the Greater Toronto questionnaire, nearly all seniors rated the program “excellent,” Area (GTA), and recruited 60 people to participate in a dietary and one of them told her it “really improved my sisu.” intervention pilot randomized controlled trial. The results were In Sept. 2016, Cameletti organized the first-annual Finlandia encouraging. After eight weeks using the dietary intervention, Village SISU Health, Wellness and Research Conference, which participants’ blood pressure went down. Perhaps most impor- brought together seniors, health professionals and reseachers to tantly, the majority of them stuck with the diet throughout the entire study, and said they found the intervention beneficial. Zou’s work to keep Chinese Canadian seniors healthy has established her as a leader in the community. Her health semi- nars became so popular she recruited a volunteer team of health professionals to deliver them across the GTA. She credits the success of the seminars and the dietary intervention to her culturally competent approach, which considers the cultural values she shares with the participants.
RN Carol Cameletti shares a proud Finnish heritage with many of the residents at Finlandia Village, a Sudbury retirement community and long-term care home where she is on the board of directors. And a major part of that shared culture is sisu. There is no English word for it, but sisu roughly translates to ‘resilience’ or ‘grit.’ It is seen as a national character in Finland, where people pride themselves in their sisu. “I want to give (seniors) But despite their deeply rooted stoicism, Cameletti says loneliness can take a toll on the mental health of the community’s a better quality of life.” Finnish residents, just as it does for too many Sudbury seniors. Cameletti has a graduate specialization in gerontology and years – Carol cameletti of experience in seniors mental health. She says many seniors spend nearly all their time alone, get minimal exercise and discuss the changing needs of Northern Ontario’s elderly popula- struggle with depression. Some even turn to substance abuse to tion. Though the pilot project ended, she hopes her friendly visiting combat their loneliness. project will one day serve as a model for similar programs in After researching loneliness, she knew that meaningful, Sudbury, and across the province. “I would really like something one-on-one contact could make a world of difference in seniors’ like this to take off,” she says. “I want to give (seniors) a better lives. She created a ‘friendly visiting program’ for residents living quality of life.”RN independently at Finlandia. As part of the pilot project which ran between July 2015 and March 2016, a group of 15 volunteers daniel punch is staff writer for rnao.
Have you done something special for seniors? Are you participating in or leading a project that is Nurses across Ontario are developing innovative ways to improve care for seniors. Visit RNAO.ca/seniorsgamingapp to read about making a difference for one unique strategy tailored to the digital age. the elderly in your community? [ Tell us about it. We would ] love to hear from you at [email protected]
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Registered nurse journal 25 in the end By Sandra Trubyk
What nursing means to me…
I’ve been nursing since 1988. for almost 30 years, i have cared for She rested well until the next morning, when we talked some more. patients in acute care and long-term care, and provided education I held her hand again, reassuring her she was in good hands. Before to colleagues and the public in health settings, universities and I finished my shift,I popped into her room one more time to wish colleges, and in the community. I have loved it all because each her the best. I told her I would not see her later that night, since I role has been important in creating the nurse I am today. would be off-duty for the weekend. One of the reasons I went into the profession was to help A few days later, my youngest daughter Brittny, who was 16 at the people and to support them while they go through a challenging time, came home after being out with friends for the afternoon. She time in their life. It is such a great feeling when you know you was smiling as she quickly came over to me and gave me a big hug. have made a difference in someone’s life. “I love you,” she said. Though we often show affection in our family One of my fondest memories dates back to when I was a staff of four, for my daughter to suddenly hug me without an apparent nurse at Seven Oaks General Hospital in Winnipeg in 2000. It reason was a bit unusual. was a Friday night, and I was on the night shift on a geriatric “Did you look after a Mrs. Smith* on Friday night?” she asked. medical unit on the third floor. I had started my rounds and “What is this all about?” I replied. walked into a semi-private room where a female patient (let’s call She went on to tell me that her friend’s grandmother was in the her Margaret*) was in bed, but was still awake. hospital on the third floor. She said she was very impressed with the I introduced myself and asked her if she needed anything. She caring nurse who looked after her, saying the nurse made her feel spoke softly, telling me she was worried about what was going to important and supported by taking the time to be with her. happen to her tomorrow, when she would have a number of “So, mom, you work on the third floor, I know it was you,” my gastrointestinal tests. daughter said to me. “Did you look after Mrs. Smith?” I told her a w I told Margaret what she could expect to happen during and I could not say for confidentiality reasons, but I knew it was me, and after the tests. I gave her all the information she needed. I held I felt so good inside. RN her hand when she shared her fears. I made sure she was comfortable, and told her I would be back after checking on some sandra trubyk is a clinical instructor in the collaborative nursing of the other patients on the unit. program at the university of windsor.
ion : suha r u o ga i llust r at I came back about an hour later, and found her sleeping soundly. *Pseudonyms have been used to protect privacy.
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