De-escalation is an effective way to diffuse a potentially violent situation. In this workshop we will discuss how to recognize potentially violent situations, understanding why conflict develops, and effective management of escalating behaviours. We will explore verbal and non-verbal techniques for de-escalation including observation of our own behaviours that allow for successful diffusion. This session is interactive and includes group exercises and practicing techniques learned during the workshop. The workshop will conclude with a discussion on the strategies needed for future prevention.
Heidi Birks is a RPN with over 30 years’ experience in a variety of clinical practice roles in three provinces. Her experience also includes working for the military on two separate occasions, the first of which was in Germany. Until recently Heidi was a Professional Practice Associate for the Registered Practical Nurses Association of Ontario (RPNAO), supporting RPNs throughout Ontario. Currently, Heidi is working in a very progressive family practice office closer to her home.
People go to acute care, oncology care and emergency to be cured, fixed and sent home. They go to long term care to receive assistance, person centered and restorative care. Eventually, the statistics confirm that 100% of people die. Where do people die and who cares?
The focus of this early morning, wake up session will be to begin your day on a light and bright note, to discuss the realities of life and death, and to look at palliative care as part of the work that every nurse does. Whether in your personal or professional life, you care and touch people who are living with life-limiting illnesses, you support people who are grieving, you communicate with people who are trying to navigate the system. Attend this session and explore how integrating a palliative approach can enrich the care you provide, and perhaps even enrich your experience as a nurse.
Katherine Murray, Founder, Life and Death Matters
Kath Murray is a certified hospice palliative care nurse, educator, thanatologist, founder of Life and Death Matters and author.
Kath’s books, ‘Integrating a Palliative Approach: Essentials for Personal Support Workers”, and the new text “Essentials in Hospice and Palliative Care: A Practical Resource for Every Nurse” are designed to be delicious and digestible: engaging and practical. And… designed to help you provide excellent care for the dying and their families – in residential, acute, home and community, urgent care and in hospice and palliative care.
Kath weaves current knowledge, research and best practice with personal experience and anecdotes to bring the material to life. She is known for synthesizing material into easy-to-understand language and conveying it with warmth and humour.
In this workshop, nurses will have the opportunity to learn:
- the basics of HIV/AIDS,
- how to differentiate HIV from AIDS,
- medications used to treat HIV,
- how to care for their patient in a hospital, clinic or community setting and;
- what healthcare providers can do to reduce HIV stigma.
Also there will a discussion about Personal Protection Equipment, actions that should be taken if exposed to HIV+ blood, and post/ exposure prophylaxis medications.
Deanna Clatworthy is a registered practical nurse (RPN), public speaker and health educator. She is the HIV Clinic Coordinator and Nurse at HIV/AIDS Resources and Community Health (ARCH) in Guelph, which cares for individuals who are living with or affected by HIV. Transgender health services is a new program offered at the ARCH Clinic and was developed and led by Deanna.
In addition to her work in community- based heath care, Deanna also works part-time at two family health teams located in Guelph.
Deanna is a graduate of Conestoga College and is currently attending McMaster University and is enrolled in the Addictions Counselling program. Deanna recently completed training offered through Rainbow Health Ontario in transgender health care.
Deanna is passionate about teaching and presenting on topics regarding HIV/AIDS and is committed to reducing HIV Stigma in health care and removing barriers to enhance and better support the health of transgendered persons.
Deanna has previous experience serving as a board member with other organizations and is honoured to be a part of this esteemed panel of nurses and looks forward to representing Region 2 with RPNAO.
During this interactive workshop, nurses will learn about fundamentals of oncology and palliative care, cancer treatments, symptom assessment and management, and principles of adult learning. Also presented will be safe handling precautions when providing care for patients receiving hazardous drugs regardless of the work setting.
Komal Patel, RN, BScN (honours), MN, CON (C), CHPCN (C), CVAA (C)
Komal began her nursing career at William Osler Health System in Brampton, Ontario in 2006 on an in-patient oncology unit where she has had the opportunity to provide direct patient care, precept nursing students, mentor nurses, and educate healthcare professionals throughout the organization. Furthermore, she supported the team as the oncology unit leader. Komal values lifelong learning and has demonstrated this in many professional activities she has engaged in including the chairing of the Oncology Interprofessional Unit Base Council and the William Osler Oncology Journal Club. In 2011, Komal completed an RNAO clinical fellowship that focused on Oncology and Palliative Pain and Symptom Management. Komal holds a BScN from the University of Windsor and has completed her Masters in Nursing with a teaching focus at Athabasca University. She obtained her Oncology CNA certification in 2010, Hospice Palliative Care CNA certification in 2012 and CVAA certification in 2014. Komal is also one of the first de Souza APNs in Ontario.
Jessica Holmes, a favourite on CBC TV’s Royal Canadian Air Farce, has brought the house down opening for giants such as Ellen DeGeneres, Russell Peters, Jerry Seinfeld, and Oprah Winfrey. Her hilarious and validating take on life’s challenges have audiences in stitches, and her unique knack for skewering celebrities (including Nikki Minaj, Liza Minelli and Celine Dion) launched her to the top of Canadian comedy. Her grace, bilingualism, and ability to react on the fly make her a natural choice as an entertainer or emcee, and she has garnered rave reviews for her wellness and motivational presentations.
As a performer, Jessica’s productions have garnered her a “Platinum Award” at The Worldfest International Film Festival; nominations for Gemini Awards; and the prestigious Tim Sims Scholarship. She is also known for her work in films, including Welcome to Mooseport, Citizen Duane, and Moonpoint. She continues perform comedy across the country, with a recent appearance on CBC’s Winnipeg Comedy Festival television special.
Jessica also devotes much time to helping others live well. In her wellness keynotes, she mixes humour with her message about the importance of de-stressing and laughing at life’s shortcomings, and speaks with intelligence and insight on her own experiences of dealing with post-partum depression, finding work-life balance, and re-igniting passion. She recently received certification as a wellness coach from San Diego’s Life Purpose Institute. Her autobiographical book, I Love Your Laugh, was published in 2010, and she’s currently working on a follow-up book about mental health.
Keynote 1: Kathleen Bartholomew, Nurse Leader and Nursing Cultural Expert, Washington State, United States
Healing Nurse-to-Nurse Hostility & Creating Healthy Relationships
The expression “Nurses eat their young” is so far removed from our idea of the caring and nurturing nurse that we shudder to think it could possibly be true. But the truth is, nurses are hurting each other. Stories from the ‘front line’ cannot be ignored. These stories are the voices of nurses telling the world about their experiences. In addition, research shows that 60% of newly registered nurses leave their first position within six months because of some form of abuse from a co-worker. The first step to healing our relationships is the most difficult: to recognize and openly discuss the problem. Only by understanding the origin and reasons for our behaviors can we begin to create the healing environment that is so desperately needed in nursing, for ourselves, as well as our patients.
With a background in sociology and past positions in marketing, business, communications, and teaching, registered nurse Kathleen Bartholomew approaches nursing with a fresh perspective, allowing her to probe into the human side of the healthcare industry.
Bartholomew has been a national speaker for the nursing profession for over a decade. As the manager of a 57-bed surgical unit at the Swedish Medical Center in Seattle, she quickly recognized that creating a culture where staff felt a sense of belonging was critical to retention. During her tenure as manager, she encouraged staff to connect and value one another and implemented her down-to-earth strategies for creating community, significantly improving staff, physician, and patient satisfaction. Despite the nursing shortage, Bartholomew could always depend on a waiting list of nurses for her unit.
Bartholomew is the author of Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication—the only book to date that addresses physician-nurse issues—and Ending Nurse-to-Nurse Hostility—the first comprehensive and compassionate look at the etiology, impact, and solutions to horizontal violence. She has won the best media depiction of nursing for her Op Ed in The Seattle P.I. and was nominated by HealthLeaders Media as one of the top 20 people changing healthcare in America.
Kathleen Bartholomew’s passion for creating healthy work environments is infectious. She is an expert on hospital culture and speaks internationally to hospital boards, the military, leadership, and staff about safety, communication, cultural change, and power. With her husband, John J. Nance, she co-authored Charting the Course: Launching Patient-Centric Healthcare.
Keynote 2: Teresa Bateman, Director of Practice & Communications, College of Licensed Practical Nurses of Alberta
Leader-Ship ~ Are you on Board or Walking the Plank?
Personal leadership is a voyage, a continual learning experience of exploration and discovery. Like a ship at sea, sometimes the waters are clear with smooth sailing, and other times there are high winds with the occasional devastating storm. As Teresa Bateman shares her professional and personal journey, you will be encouraged to board your own “Ship” to examine perspectives on leadership, perseverence and resiliency, acknowledging how life’s successes and challenges help to prepare us for what’s ahead. You won’t want to miss this session, as another practical nurse shares her story and inspires you with her contagious passion and commitment.
Teresa Bateman, LPN, MA Teresa Bateman is the Director of Professional Practice and Communications at the College of Licensed Practical Nurses of Alberta and has been with the College for almost 16 years. Teresa completed her practical nurse education 26 years ago, continuing to further her studies obtaining a Certificate in Adult and Continuing Education from the University of Alberta and subsequently a Master of Arts in Professional Communication at Royal Roads University, with a focus on nursing team dynamics. Teresa is a passionate LPN, known for her strong support and representation of the LPN profession provincially and nationally, and recognized for her authentic and genuine approach to work and life.
Keynote 3: Lisa Bayliss-Pratt, Director of Nursing, Deputy Director of Education and Quality, and Board Member of Health Education England
Stronger Together: A cautionary tale of the importance of investing in a heterogeneous nursing workforce
Although government policy throughout the 1980s and 1990s had been to move the training of nurses out of hospitals and into universities, this proved not to have been the success that had been hoped for.
Now, in the wake of a series of economic and political shocks, the focus of policy- and lawmakers is once again on the merits of practical nursing. In this keynote address, Prof. Bayliss-Pratt will be sharing her experience of the loss of the State Enrolled Nurse, and speaking about the restoration of a practical nursing role in England.
Professor Lisa Bayliss-Pratt is a values-driven, transformational leader with an outstanding track-record in pre-registration nurse education, the initiation and establishment of improved nursing and caring practices, and the furtherance of the protection of patients and advancement of the reputation of the nursing profession.
As the current Director of Nursing, Deputy Director of Education and Quality, and Board Member of Health Education England, Lisa is responsible for leading national policy, workforce planning, and the commissioning of multi-professional education and training for both the medical and the non-medical healthcare workforces.
Lisa’s achievements in this role include, inter alia, the establishment of The Shape of Caring Review of the education and training of nurses and care assistants, the development of the Care Certificate, the creation of a three-tiered dementia education and training framework, and the piloting of pre-degree care experience. In addition, she is currently consulting across England on the introduction of a new nursing role, with the potential to transform the nursing and care workforce.
Lisa is currently engaged in the international agenda, exploring opportunities for international co-operation and collaboration. She is currently working with the Government of India, the British High Commission and the Government of West Bengal, focusing upon “earn-learn-return” initiatives with a view to ameliorating current shortages in nursing supply in England, whilst training Indian nurses to the UK model and standards. In July 2015 Lisa successfully completed an International Health and Social Care Leadership Programme at Yale Global Heath Leadership Institute. This included an extensive analysis and field trips to explore the differences between health and social care systems in the UK and USA.
Concurrent 1: John Remington, Professional Practice Specialist, Quinte Health Care and Terry Holland, Practice Coordinator, Quinte Health Care
Interprofessional Care; A New Leadership Opportunity for RPNs
Today’s health care environment demands an innovative approach that optimizes patient and family-centred care and all staff working to their full capacity. Quinte Health Care has chosen to implement an Interprofessional Patient Care Team (IPCT) model. This model allows Registered Practical Nurses (RPNs) in particular to optimize their leadership capabilities by not only participating in patient care but also in assisting with responsibilities traditionally assigned to the RN. John will explain the concept of interprofessional care and how the different disciplines fulfill their roles, while Terry will address the vital contribution that RPNs play in the interprofessional care team structure. An emphasis will be placed on the patient and family-centred processes, collaborative nature of interprofessional care, and how integral communication is to the success of IPCT. In the IPCT model, RPNs are able to develop their leadership abilities by functioning as a zone lead, working in collaboration with other members of the team. The zone lead position involves coordinating care, developing care plans, and meeting discharge goals. Through team collaboration, all zone members are encouraged to apply their particular clinical skills, providing patients with a more holistic approach than many other care models. The IPCT model has been rolled out across Quinte Health Care where Terry and John are members of the Professional Practice team. RPNs have been presented with an opportunity to contribute to patient health success to a greater degree than they have in previous care models. Early results indicate the RPNs are well positioned for these new challenges. The goal of our presentation is to present a model that emphasizes collaboration amongst registered and unregistered staff, with an end goal of providing more holistic, responsive care for the needs of our patients. We will also share insights into the implementation process and lessons learned.
John Remington is employed as an RN by Quinte Health Care (QHC) in the role of professional practice specialist. The first eight years of John’s nursing career were spent working as an RPN on the surgical inpatient unit at QHC’s Belleville site. John’s practice specialty areas include surgery, endoscopy, and bronchoscopy. John has collaborated with colleagues on inpatient and emergency department units to guide QHC’s transition from primary care to the interprofessional model, which has now been rolled out across all patient care areas in the organization. Always a strong advocate for the continued role expansion of the RPN scope, John has acted as a preceptor, educator, and facilitator for RPNs in acute care settings. In terms of his own professional development, John completed his bachelor of nursing from Athabasca University and is currently enrolled in the Professional Masters of Public Administration degree at Queen’s University.
Terry Holland holds dual registration at the College of Nurses as both an RPN and RN and is a member of the professional practice team at Quinte Health Care. Terry’s role as Practice Coordinator is focused on promoting best practice and nursing excellence, and leading corporate clinical initiatives at QHC, in partnership with other nursing leaders and staff. Terry has been instrumental with the development and introduction of the unregulated care provider program, as well as the Seniors Strategy and the transition to an interprofessional patient care team at Quinte Health Care. Terry is a council member with the College of Nurses of Ontario, and appreciates the benefit of having a deep understanding of nursing regulation and professional standards and accountability.
Concurrent 2: Melissa Thomson, Manager and Joanne McRobert, Manager, Grey Bruce Health Services
Let’s Be Clear: Strengthening Nursing Teams through Role Clarity
Nurses (RNs and RPNs) working in rural settings face unique challenges. They must be generalists, competent in a wide range of clinical areas. They often work in isolation without consistent access to the resources available in larger centres. As such, strong teams with clear roles are vital for the provision of high quality, safe patient care. This presentation will describe the development of a Community of Practice to support rural RPNs and RNs to advance their knowledge, their expertise and strengthen role clarity utilizing strategies including the development of rural nursing standards of care, standardized job descriptions for the Medical/Surgical and Emergency departments and identification of areas for skill development.
Melissa Thomson is a Registered Nurse with a Master’s of Nursing and has been nursing for nineteen years. She has been fortunate to obtain experience in many areas of nursing; including long term care, rural Medical/Surgical nursing, emergency, critical care as well as front line management. Melissa’s current role at Grey Bruce Health Services is the Manager of the Lion’s Head and Wiarton Hospital. She is responsible for the Combined Medical/Surgical inpatient unit at as well as the Emergency Room. She has two teenage sons, Reid and Elliot who keep her busy with extracurricular activities such as hockey and lacrosse.
Joanne McRobert has a BSCN and has been in the nursing profession for over 25 years in varying roles. She has a strong Emergency background and a keen interest in Trauma. She has held management roles both in a level one trauma centre and the rural setting. Joanne is a big supporter of nursing education and seeking out challenges
Concurrent 3: Zahra Ismail, Clinical Team Manager, North York General Hospital and Maria Monteiro, Clinical Nurse Educator, North York General Hospital
The Optimization of Nursing Staff Care Delivery through Leadership & Collaborative Nursing Practice
At North York General Hospital’s Medical Program, is 8 West Medicine and Respirology inpatient unit. The 8 West team strive to provide excellent patient and family centered care through an inter-professional care delivery model. In April 2014 the team identified the enhancement of nursing leadership and communication to optimize the delivery of care as a goal. Purpose: The purpose of the role clarity project included three major goals: First, to articulate the role of RPN and RN, and how College of Nurses of Ontario 3-Factor Framework is part of decision making process. Second, to decrease role ambiguity, confusion associated with RPN/RN role in order to optimize patient care. Lastly, to improve the care delivery through decreasing patient complaints, and increase both patient and staff satisfaction. Methods: The Role Clarity Project took on multiple activities in order to achieve project goals, this included: environmental scan, pre and post survey dissemination, nursing leadership in-services, two 6-hour workshops for nursing and allied health staff focusing on care delivery models, nursing roles, decision making, leadership accountabilities and patient assignments. Results: Interprofessional colleagues (n=41) attended workshops that increased their own and each other’s scope of practice, expectations and competencies. Learning how to utilize the 3-Factor Framework through nursing consultation and collaboration, resulted in nurse-patient assignments changes and guidelines. Staff engagement, collaboration and teamwork evolved resulting in the Unit Standard development and Unit Advisory Council inception. Leadership skills and accountabilities have developed amongst the team. Charge nurse working group was established to formalize leadership accountabilities. Lastly, consistent improvement in patient and staff satisfaction has been noted.
Zahra Ismail is a visionary leader with over 7 years of healthcare experience. She is currently the Clinical Team Manager for the Respiratory Portfolio at North York General Hospital. Previous to this, she worked as a project manager for local and international organizations. Her international work has taken her to Afghanistan, Pakistan and Tajikistan for disaster risk management initiatives (man made and natural disasters) and emergency department clinical process improvements. She has also provided emergency response in Haiti and Pakistan. Zahra has over five years of emergency nursing experience. In 2013, Zahra graduated from the MN program, Administration Stream at the Lawrence S. Bloomberg Faculty of Nursing and Collaborative Program in Resuscitation Sciences from University of Toronto. She holds a Canadian Nurses Association specialty certification in emergency nursing, and Canadian Health Executive designation from the Canadian College of Health Leaders. Zahra is intrinsically driven by advancing the nursing profession and improving care delivery for our patients and families. Zahra was recently awarded the 2016 Nursing Leadership Award at North York General Hospital.
Maria Monteiro, Clinical Nurse Educator for (8West Medicine / Resp & 5SE Medicine/Acute Care of the Elderly) at North York General Hospital. Maria graduated in 2009 from the Masters of Nursing program, Clinical Stream at the Lawrence S. Bloomberg Faculty of Nursing. She has twenty-six years of experience in cardiology, respirology and medicine in acute care settings.
Concurrent 4: Kim Jagos, MScN, RN: Professor of Nursing, Georgian College and Sandy Madorin, MScN, RN: Practical Nursing Coordinator, Georgian College
Strengthening Intraprofessional Collaboration and Role Clarity through Education of Nursing Faculty
Nursing education socializes nurses to the profession, prepares them to meet the requirements of clinical practice and is credited with shaping the various professionalizing strategies used by nurses throughout our history. Therefore, to prepare nurses to meet entry to practice requirements and to ease the transition from school to work, nursing education must adapt to meet the evolving needs of working nurses. The recent changes to PN and BScN scope of practice and resulting work have required nursing education to respond to new practice conditions and requirements. Two needs motivated this project. The first aligns with the growing evidence that collaborative care models support positive patient outcomes and the second need aligns with the recognition that the overlap in roles between RPNs and RNs is creating tension and confusion in the workplace. To ensure that nurses have the skills and attitudes to participate in collaborative care and to work collegially, nursing education must respond with appropriate education strategies. However, there is a paucity of literature and theory to guide faculty practices in these two areas. The first phase of this project involved surveying Schools of Nursing across the province of Ontario about intraprofessional activities, resources, and role clarity education for PN and BScN students. The second was an education workshop supporting PN and BScN faculty’s understanding of the similarities and differences, and social processes between nursing designations such as power relations, hierarchies, closure techniques, and gender. The influences of nursing history and industrialized healthcare was also explored. Finally, a catalogue of challenges and barriers to intraprofessional education was created. Bringing PN and BScN faculty together to learn about role clarity creates awareness of the deeply rooted discourses that are problematic to nursing and stimulates creative ideas for nurse educators around role clarity and scope of practice understanding.
Kim Jagos joined Georgian College as a part time clinical instructor in 2006 and became full time faculty in 2010. She teaches in the Practical Nursing (PN) and the Registered Practical Nurse (RPN) to Bachelor of Science in Nursing (BScN) bridging program for the University of Ontario Institute of Technology (UOIT). She has been a nursing graduate since 1981 with a clinical background in Medical / Surgical and Community nursing, and in the last two decades Intensive Care Unit nursing. She completed her Master’s Degree in Nursing from York University in 2011. Kim has an interest in research that examines the influences of nursing education on the way that nurses work and make decisions together. Her research has helped provide insight into the social construction and ruling relations embedded within the education of both PN and BScN nursing students. Kim is coauthor of a 2015 publication in Nurse Education Today entitled: “The influences of nursing education on the socialization and professional working relationships of Canadian practical and degree nursing students: A critical analysis”. She has an ongoing interest in nursing research that supports PN and BScN students to learn how to work collaboratively.
Sandy Madorin has been at Georgian College since 2001, teaching mainly in the Practical Nursing Program. She has been the coordinator of the program since 2008. Sandy received her BScN from Western University in 1991 and her MScN in 1995. Sandy’s clinical background was in a variety of medical-surgical areas and prior to coming to Georgian College, she taught in the BScN program at Western. As an educator in nursing for more than 20 years, she has worked with many student nurses on many different educational paths and the working relationships between these students is a definite interest. In 2014, she participated in a research project with researchers from Nippissing University, looking at the outcomes and intraprofessional experiences of BScN students completing a PN preceptored experience, obtaining an PN diploma and achieving and RPN designation. Working with the team at Georgian College on the RPNAO funded research has enhanced her work as a teacher in the Practical Nursing Program.
Concurrent 5: Robin Hurst, Advanced Practice Consultant, Saint Elizabeth
Geriatric RPN Knowledge to Practice Role
Frail older adults have unique physical, psychological and social needs. Standards of care suggest that frail older adults living in the community require knowledgeable staff that are trained to care for them. There is presently a gap in the health care sector in providing this type of care as most health care workers (Personal Support Worker's and nurses) do not receive this specialized training. Home care providers are challenged to maximize the capabilities of health care workers and respond to the changing acuity and complexity of older clients living in the community. Preventing falls, deconditioning of isolated frail older adults and caregiver support are critical to maintaining quality of life for this population. Innovative solutions to the changing role of the RPN, associated educational strategies, organizational commitment to capacity building and practice tools are required to meet this challenge. Method A national Home care agency has created a Knowledge to Practice (K2P) framework that allows the RPN to practice in a Geriatric K2P specialty role in home care. The agency through a collaborative model has piloted the use of RPN’s who are trained to practice in a Geriatric K2P specialty role in the community. The nurses are supported by an Advanced Practice Nurse who provides training, clinical support, and review of practice to ensure best practice compliance. The RPNs function as Frailty experts in a K2P role for their clients and provide leadership to their colleagues. This role optimizes the RPN role while meeting the needs and care of the Frail Community dwelling adults. . Conclusion This presentation will discuss key indicators of success along with the barriers and challenges to this program . It will discuss strategies to promote practical nursing, improve outcomes for this population and guide improvements in organizations practicing with older clients in the community.
Robin Hurst is an RN and received his BScN through distance education from St. Francis Xavier University, his Masters of Nursing through Athabasca University and CNA certificates in gerontological and mental health nursing. His present role is an Advanced Practice Consultant for Mental Health and Seniors Robin has worked with SEHC for the last 23 years, and has a passion for improving the quality of life for older adults, those with mental health and addictions issues and those who are marginalized. He has been an educators and a coordinator for an educational project with Corrections Canada, has helped to create the seniors based care at Saint Elizabeth. In 2005 was recognized with an Award of Merit from the Community Health Nurses Association of Canada for outstanding contribution to community health nursing.
Concurrent 6: Maija Salo, Registered Practical Nurse, Bridgepoint Hospital, Sinai Health System and Maya Nikoloski, Manager of Professional Practice Nursing, Bridgepoint Hospital, Sinai Health System
Understanding and Optimizing the RPN Role: An organizational assessment of policies, staff perceptions and understanding of scope of practice
A large urban hospital manages, delivers, researches and teaches leading healthcare practices related to complex healthcare conditions and rehabilitation. In 2008, the hospital made a strategic decision to transition to an all regulated nursing staff of Registered Practical Nurses (RPNs) and Registered Nurses (RNs). Since then, the hospital has gone through significant organizational transformations thus, a need to better understand how the RPN role has evolved since its implementation existed. The goal of this project, funded by the Registered Practical Nurses Association of Ontario (RPNAO) Role Clarity Field Study, was to understand and clarify the RPN and RN roles in the contribution to patient care, and support nurses to better understand scope of practice. The project objective was to initiate intra-professional dialogue about the distinct and overlapping nature of the roles, assess nursing staffs’ awareness and perception of roles and scope of practice and assess the current organizational policies, procedures and practices that govern practice internally. The following methods were implemented: 1. The Registered Practical Nurse Role Clarity Questionnaire© (RPN-RCQ©) 2. 23 Focus groups on 14 inpatient units (111 nursing staff participants; 69 RPN and 42 RN) 3. Creating Dialogue About the Distinct and Overlapping Nature of our Roles (RPNAO provided exercise) 4. Policy and Procedures (RPNAO provided exercise) Focus group themes (8) revealed current state and potential influences on optimal RPN utilization and role clarity. The outcome of the project provided 3 organization-specific recommendations –updated policies and standards to guide practice, staff nurses and leadership engagement in implementing a tool to determine patient care needs, and staff education of frequently misunderstood terms used to describe patient status. Themes influencing RPN utilization and role clarity can be comparatively applied to understand the RPN role at other complex continuing care and rehabilitation hospitals.
Maija Salo has been a practicing nurse for six years. She graduated from the RPN program at George Brown College in 2010 and began working at Bridgepoint Active Healthcare immediately after. Her experience in neurological rehabilitation within an accredited stroke distinction program has given her the opportunity to advance her clinical assessment skills and provide quality, patient-centered care. Her participation in the RPNAO Role Clarity Field Study has sparked a desire to continue the discussion with other nurses in Ontario to encourage intraprofessional harmony and explore opportunities to optimize scope of practice. Maija is currently enrolled in the Trent/Fleming School of Nursing post-bridge BScN program at Trent University.
Maya Nikoloski currently works as the Manager of Professional Practice Nursing at Bridgepoint Hospital, Sinai Health System. She has a Master of Nursing degree from Ryerson University, and has a certificate in gerontological nursing from the Canadian Nurses Association. She has a keen interest in patient safety is a certified Patient Safety Trainer with the Canadian Patient Safety Institute. Maya continues to be actively engaged in professional development and academia through her Adjunct Lecturer Appointment with the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto.
In September 2012, the Ministry of Health made a commitment to enhance the support for women who wish to breastfeed across the province. At that time, the Michael Garron Hospital (formerly TEGH) was asked to provide leadership for an initiative that would provide training, tools, guidance and educational resources to help Ontario healthcare organizations achieve the WHO Baby-Friendly Initiative (BFI) designation. Since that time MGH has worked in partnership with the Best Start Resource Centre at Health Nexus and the Provincial Council for Maternal Child Health to build awareness and engagement in the BFI Strategy for Ontario. The initiative has resulted in two toolkits and several workshops across the province to help hospitals and community organizations implement the BFI. A number of tools and resources have been developed to help nurses and other health professionals make practice changes that support BFI best practice implementation. This presentation will discuss the importance of BFI, the resources developed to support this initiative and how they can be accessed and the tracking processes in use to follow the implementation of BFI best practices and the impact of the BFI strategy on provincial breastfeeding rates.
Linda Young is the Director of Maternal Newborn Child, Mental Health, Interprofessional Practice and Organizational Learning at Toronto East General Hospital; and the lead for the BFI Strategy Implementation for Ontario. Linda has baccalaureate and master’s degrees in nursing and master’s and doctoral degrees in education. Linda’s work experience includes roles as a clinical nurse specialist in low risk obstetrics at Women’s College Hospital, a quality manager at Providence Healthcare, an educator for maternal newborn and pediatrics nursing at U of T and at a CEGEP in Montreal, and as a Program Director for more than 2 decades in GTA hospitals. She has worked at Michael Garron Hospital, formerly Toronto East General Hospital, for the past seven years, during which time TEGH became re-designated as a Baby Friendly Hospital.
Kristina Niedra, MA is a Project Manager at Michael Garron Hospital (formerly Toronto East General Hospital). Kristina has over five years of project management experience in healthcare coordinating organizational, city-wide and provincial change initiatives. In her current role, Kristina has coordinated the development of a number of tools to support BFI Implementation, has facilitated over 30 BFI Implementation Workshops across the province and has coached over 50 organizations in BFI implementation.
Poster 2: Registered Practical Nurses lead implementation of practice changes in intramuscular injections
Intramuscular injections are routinely used to administer long-acting antipsychotic medications in psychiatric settings. Potential complications are injury to the sciatic nerve when the dorsogluteal site is used; the presence of nodules at injection sites; and the injection of glass particles from ampoules unless filter needles are used. New nursing graduates report abandoning the preferred ventrogluteal injection site if their colleagues use the dorsogluteal site. At the Centre for Addiction and Mental Health (CAMH) in Toronto, Registered Practical Nurses updated their knowledge and skills related to intramuscular injections. A comprehensive educational program introduced several practice changes: first, the ventrogluteal site is the preferred injection site at CAMH where medication licensing allows; second, all intramuscular injection sites are identified by their bony landmarks; third, a custom designed ampoule opener minimizes the risk of nurse injury; fourth, filter needles are used when preparing medication; fifth, nurses select needles long enough to reach muscle based on clients’ weight and fat distribution; and sixth, nurses document the client’s immediate response to the procedure in the electronic medication task. Each nurse attended a four-hour simulation session and followed a competency checklist to demonstrate their skills at the end of the session, then observed two ventrogluteal injections in the clinical setting and administered two intramuscular injections coached by a nurse champion or nurse educator. Nurses reported on their confidence in their ability to administer an intramuscular injection at the ventrogluteal site before and after simulation sessions and at least three months afterward. Nurses’ mean confidence levels increased from 3.2 to 4.3 on a 5 point Likert scale after classroom sessions; findings of the confidence levels at least three months after simulation sessions are pending. Registered Practical Nurses who implement evidence based practices as shown in this initiative can influence practice change at CAMH and in other settings.
Helen McGee is an Advanced Practice Nurse at the Centre for Addiction and Mental Health. Helen's clinical experience in both inpatient and ambulatory settings is focussed on people affected by schizophrenia. She currently works as an Advanced Practice Nurse in the Professional Practice Office at the Centre for Addiction and Mental Health (CAMH). She has a longstanding interest in clinical problems related to intramuscular injections. Her current educational initiative introduces nurses to the application of evidence informed practice and is based on a guide to intramuscular injections developed in collaboration with CAMH nurses, pharmacists and physicians. She encourages nurses to lead practice changes by identifying clinical problems and collaborating with others to address them.
Lack of clarity in RPN and RN roles contributes to team conflict in the workplace, which affects overall team engagement and satisfaction. Determining appropriate patient assignments, therefore utilizing the skills of the most appropriate care giver, is an important element of providing collaborative care that leads to quality patient outcomes, job satisfaction and enhanced team functioning (CMPA, 2006). Lakeridge Health and Durham College partnered to complete research to determine what effect an educational intervention would have on front line Nurses’ role ambiguity and satisfaction with patient assignments. During the education three tools from the RPNAO report It’s All About Synergies: Understanding the Role of the RPN in Ontario’s Health care system were used to facilitate role clarity discussions. Additionally basic principles for assigning patients and a new stoplight-colour-based assignment tool were discussed and applied to a mock patient unit. The RPN-RCQ © role clarity tool and a Likert-type satisfaction survey were used to measure results pre and post intervention. Results indicated some positive trends towards establishing role clarity and increasing assignment satisfaction. The connection between effective care teams, job satisfaction and quality patient outcomes points to the value in continuing this work in support of a Quality Practice Setting. Attendees of this session will learn the details of the education provided, how the role clarity report tools were used to enhance understanding of RPN and RN roles, the positive results achieved and our next steps. We will also outline the assignment principles established and how the stoplight-colour-based assignment tool was used. The outcomes of this effort will be discussed along with planned next steps.
Colleen Wilkinson, RN, MS(N) is currently the Director, Interprofessional Practice and Informatics at Lakeridge Health. She is an experienced manager and educator who has held various positions at Lakeridge Health, the University of Ontario Institute of Technology and the Hospital for Sick Children. She holds expertise in the professional practice of health care providers; health care team and scope optimization, program planning, management and evaluation; change management; new graduate orientation; competency assessment, case based learning; curriculum development; and online learning using synchronous and asynchronous technologies.
Karen Law, RN, BscN (c) is currently a Patient Care Specialist in Interprofessional Practice at Lakeridge Health. She has over 12 years of experience as a Nurse and has practiced in various specialties, and for over 7 years in her PCS role. She has expertise in the professional practice of health care providers; health care team and scope optimization; program planning/project management; change management; new graduate orientation; evidence based practices, educational methods and design; and competency assessment.
The Montfort Hospital PICC team, is a mobile team of nurses specialized in peripheral central catheters inserted directly at the bedside. This innovative approach, which maximizes efficiency and effectiveness, helps promote patient comfort and safety. This multidisciplinary team is characterized by the key role of Registered Practical Nurses (RPN). RPNs contribute greatly to patient experience and quality of care provided through their role in the installation process, review of policies and procedures, as well as continuing education for staff, patients and families. More precisely, RPNs distinguish themselves throughout the PICC line installation process through their close collaboration with Registered Nurses for patient evaluation, prescription verification, electronic documentation, and PICC line dressing follow-ups. Moreover, working in alliance with RNs, radiology technicians and radiologists, RPNs play a key role in maintaining a sterile environment at the patient’s bedside until placement of the PICC line is confirmed. As a result of this process, risk of infection is diminished. In addition to their role at the bedside, RPNs also play an important role when elaborating and updating policies and procedures. Through their leadership skills, RPNs contribute to patient experience and quality of care by supporting continuing education to patients, families and nurses across the organization. For example, this leadership was shown through the creation of information boards and a pocket-size memory aids to help nurses follow best practice guidelines in relation to PICC lines.
Carole Bourcier has been a nurse at the Montfort Hospital since 1988, and has worked in almost every department since then. Carole has been a member of the PICC team since its creation in 2007 and member of CVAA since 2012.
Chantal Laniel is also an RPN working on the PICC Team at Ottawa’s Hôpital Montfort. She has been part of the Montfort Hospital team for the last 9 years with extensive experience in medicine units. For the last two years, she has played a key role within the hospital's PICC team and is a CVAA member.
Registered Practical Nurses (RPNs) work in acute care and care for patients with dementia. A literature review on the experiences of new graduate nurses caring for patients with dementia in acute care revealed a gap in research with RPNs. Further, no published peer reviewed literature was found on the transition from student to RPN, the experience of RPNs with dementia care in acute care, nor the contribution of RPNs to acute care. The landscape of acute care is changing. Nursing research focusing on acute care that excluded RPNs from sampling will soon become obsolete. Ontario’s Nursing Health Services Research Unit (2009) suggested that this lack of research on RPNs in acute care is a disadvantage when planning for the future, given that 57% of RPNs working in acute care hospitals in Ontario worked on medical, surgical or other acute care units, compared to 32% of Registered Nurses (RNs) (CNO, 2016). This poster presentation will include a review of the literature done within the context of a masters’ thesis, supporting the need to include RPNs in nursing research in the acute care context and discuss how the presenter is including both RNs and RPNs for his research on new graduate nurses and dementia care in acute care. References College of Nurses of Ontario. (2016). Membership Statistics Highlights 2015, College of Nurses of Ontario. Nursing Health Services Research Unit; 12 (2009). Registered practical nurses: An overview of education and practice: A report to the implementation task force. Ontario Ministry of Health and Long-Term Care.
Benjamin Hartung is a Registered Nurse and a Masters of Science in Nursing student at the University of Ottawa. He is studying new graduate nurses and dementia care in acute care. Throughout his studies, he was suspired to learn that the research available on the new gradate nurse transition and dementia care in acute care only sampled RNs. This was a surprise for him because for the last three years, Ben has worked as a RN on medical and surgical units with RPNs at two different acute hospitals in Ontario. As well, in his experience, RPNs were more frequently assigned to care for patients with dementia than RNs. This sparked Ben’s interested in the sampling of RPNs in nursing research and confirmed his decision to include both RNs and RPNs in his nursing research.
Work on role clarity began in July 2014 using the support of the RPNAO research, ‘It’s All About Synergies: Understanding the Role of the Registered Practical Nurse in Ontario’s health care system’. The Collingwood General and Marine Hospital (CGMH) identified confusion regarding scope of practice that was affecting patient care, team collegiality and nurse autonomy. A team focused on the key learning and practical strategies for enhancing RPN/RN role clarity and nursing team collaboration. Project work continued March 2015 – March 2016 with funding support from the RPNAO. A team of 3 RPNs and 1 RN along with the 2 project leads continued the work that began in 2014. The group committed to completing 4 action items to improve nursing role clarity. The action items addressed included; policy revision regarding staff mix and assignments; education of the inter and intra professional team to enable them to make assignments using evidence based literature to support decision making; use of a reporting structure to ensure appropriate assignments are within a nurse’s scope, development of an interprofessional orientation day, and opportunity at unit huddles for nurses to speak to scope of practice and their assignments. Beginning the project with the opportunity to express their fears and frustrations, the CGMH nurses worked through the discomfort that comes from role confusion. Tools and process have been developed to give Nurses language about scope of practice and the expectations around patient care within their work environment. This has allowed the nursing team at the hospital to have a better understanding of the two categories of nurses, while improving team dynamics and respect for one another.
Margaret (Peggy) Hughes MN RN is the Interprofessional Practice Coordinator at the Collingwood General and Marine Hospital. As the Interprofessional Practice Coordinator, she works with the entire team to ensure best practices are in place for our patients. Her responsibilities include overseeing policy development, project management of new initiatives and ensuring practice is evidence-based and client centered. She has over 25 years of experience in nursing. She first graduated as a diploma RN, returned to school to obtain her post grad BScN and then achieved a Master of Nursing degree (teaching focus). Much of her early career experience was in acute care in progressive leadership roles. She has worked as a contract Professor for the Georgian/York Collaborative BScN Program and for Georgian College in the Practical Nursing Diploma program. Most recently, she joined the Collingwood General and Marine Hospital as the Interprofessional Practice Coordinator where she endeavor to break down silos and improve best practice in the Interprofessional team as well as focusing on intra professional collaboration in nursing.
Kathryn Weatherall RN BScN Med is the First Year BScN Program Coordinator at Georgian College. She has been a Registered Nurse for 28 years, first graduating from a diploma program, only to return to education as a Post-RN and eventually a Masterƒrsquo;s in Education to pursue a career in educating nurses. She has experience in neuro trauma, neonatal intensive care, public health and community care. Kathryn has taught in a post RN (Laurentian University) and now in undergraduate BSCN education as faculty for 13 years as well as first year program coordinator in the past 5 years (Georgian College). In the past year she has been working in the Centre for Teaching and Learning at Georgian College to facilitate and assist faculty with curriculum design and development. She embraced the opportunity to work as a consultant alongside the intraprofessional leader at Collingwood General and Marine Hospital this past spring/summer to review, develop and implement strategies in relation to the RPN/RN scope of practice.
There is limited literature that distinguishes between Registered Practical Nurses (RPN) and Registered Nurses (RN) role and scope of practice within mental health and addiction settings. Understanding these roles would allow for maximizing the scope of practice, increased accountability, and improved inter‐ and intra‐ professional collaboration, ultimately enhancing care for the unique needs of this population. The purpose of the RPN and RN Role Clarity project was to 1) understand organizational perception of these roles, 2) define scope of practice in the context of mental health and addictions inpatient settings and 3) address role ambiguity to optimize scope of practice. This quality improvement project utilized a mixed-method approach including a review of the literature, a survey using an adapted version of the RPN Role Clarity Questionnaire (RPN-RCQ)©, in addition to focus groups and interviews.. The survey revealed meaningful differences in perspectives of the participants regarding RPN and RN roles. Results of the focus groups and interviews revealed themes including: a) challenges and opportunities to RPNs and RNs practicing to full scope, b) blurring of roles, c) patient assignment conflict and d) review of policies and unit practices. Based on these themes, recommendations were identified, implemented and evaluated. Outcomes of the activities that were implemented include the development of tools to assist in patient assignment and conflict resolution, as well as updates to policies and unit-based practices. The outcomes of this project also led to an increased understanding of the RPN and RNs role within this context, influencing scope of practice and accountability. The activities that were implemented in this project may be used to clarify or generate action in teams or organizations that wish to optimize the RPN and RN roles in mental health and addiction settings.
Gillian Strudwick is an Advanced Practice Nurse for Research & Innovation and the Centre for Addiction and Mental Health in Toronto. She is also a lecturer in the Master of Health Informatics program at the University of Toronto.