Download Change - College and Association of Registered Nurses of Alberta

S P R I N G 2015
V o l u m e 71 N o 1
Leading
Change
RNs in continuing care embrace
full scope of practice
PAGE 22
Workplace absences:
Can occupational health nurses
be the leaders of change?
Page 16
The 16th annual CARNA Awards
of Nursing Excellence nominees
Page 24
Perspectives on bullying
among nursing students
Page 28
nurses.ab.ca
CARNA Provincial Council 2014–2015
President
Shannon Spenceley, PhD, RN
Lethbridge
780.909.7058
[email protected]
S P R I N G 2015
V o l u m e 71 N o 1
President-Elect
Sheila McKay, MN, RN
Red Deer
403.358.6428
[email protected]
Northwest Region
Tracy Humphrey, MCN, BA, RN
North Star
780.836.0191
[email protected]
Northe ast Region
Fiona Jakielaszek, BScN, RN
Morinville
780.405.7098
[email protected]
Edmonton / West Region
Wendy Carey, MN, RN
Edmonton
780.886.1661
[email protected]
Alison Landreville, MN, RN
Medicine Hat
403.878.4700
[email protected]
Trevor Small, MHS, BScN, RN
Edmonton
780.863.1727
[email protected]
Central Region
Elva Hammarstrand, MN, RN
Red Deer
403.357.0804
[email protected]
Amie Kerber, BScN, RN
Blackfalds
403.877.6010
[email protected]
Public
RepresentativeS
Elaine Andrews, BA, APMR
Edmonton
780.221.1650
[email protected]
George Epp
Taber
403.223.3170
[email protected]
Marlene Pedrick, BA, BSW
Sherwood Park
780.504.7889
[email protected]
Doug Romaniuk, BEd
St. Albert
780.951.3142
[email protected]
Calgary/ West Region
Christine Davies, BN, BA, RN
Cochrane
403.650.0864
[email protected]
Kevin Huntley, MN, NP
Calgary
403.875.6061
[email protected]
Andria Marin, MN, RN
Calgary
403.561.1867
[email protected]
11 Publications ordered by Hearing
Tribunals
4Nursing Week 2015
1
16 Workplace absences: Can occupational
health nurses be the leaders of change?
2
0Nursing research in Alberta
22 Leading change
24 CARNA Awards nominees
26 Prioritizing pressure ulcer prevention
2
8 Perspectives on bullying among
Alberta’s Primary Health Care Strategy
without delay
Alberta RN is published
four times a year by:
780.451.0043 or toll-free 1.800.252.9392
Chief Executive Officer: Mary-Anne Robinson
Complaints Director/Director, Conduct: Sue Chandler
Director of Communications and Government Affairs: Margaret Ward-Jack
Director of Corporate Services: Jeanette Machtemes
College and Association of
Registered Nurses of Alberta
11620-168 Street
Edmonton, AB T5M 4A6
Phone: 780.451.0043
Toll free in Canada: 1.800.252.9392
Fax: 780.452.3276
Director of Policy and Practice: Carolyn Trumper
Registrar/Director, Registration Services: Cathy Giblin
nurses.ab.ca
Deputy Registrars: Barbara Haigh, Steven Leck, Loreta Suyat
Deputy Complaints Director: Betty Anderson
Conduct Counsel: Gwendolyn Parsons
Registration Consultants: Carrie Gronau, Nan Horne, Shelley MacGregor, Nancy MacPherson, Michelle Morrison
Policy and Practice Consultants: Debra Allen, Donna Harpell Hogg, Debbie Phillipchuk, Penny Davis, Pam Mangold
Program and Evaluation Consultant: Trish Paton
NEPAB Consultants: Lori Kashuba, Margareth Mauro
Karen McKay
Robin Cooper
Barb Perry
Marilyn Walliser Betty McMorrow
Heather Wasylenki
Lisa Tran
Beverlie Johnson
Pat Shackleford
Valerie Mutschler
Alberta Registered Nurses Educational Trust: Margaret Nolan
Alberta RN Spring 2015 Volume 71 No 1
7 Practice consultations – a year in review
2 The art of healing
3
3
4NoticeBoard and In Memoriam
4
6 Closing Perspectives: Let’s implement
All staff can be re ached by calling :
2
5 Quiz: What is Jurisprudence?
30 Connecting parents and children
CARNA Staff Directory
Northwest:
Northeast:
Edmonton/West:
Central:
Calgary/West:
South:
4 Practice hours and fee increase
nursing students
South Region
Penny Kwasny, BN, RN
Lethbridge
403.894.6901
[email protected]
Regional Coordinators:
CONTENTS
780.978.7781
780.901.3293
587.523.5498
780.710.3316
780.885.5030
403.782.2024
403.919.8752
403.625.3260
403.394.0125
403.504.5603
nurses.ab.ca
Editor-in-chief: Margaret Ward-Jack
Managing Editor: Rachel Champagne
Editor: Kyla Gaelick
Designer: Julie Wons
Advertising Representative: Jan Henry, McCrone Publications
Phone: 800.727.0782 Fax: 866.413.9328
[email protected]
Please note CARNA does not endorse advertised services,
products or opinions.
ISSN 1481-9988
Canadian Publications Mail Agreement No. 40062713
Return undeliverable Canadian addresses to:
Circulation Dept., 11620-168 Street, Edmonton, AB T5M 4A6.
[email protected]
President’s Update
Make your vote count
“I am astonished at the power
you have, and at your reluctance
to use it.”
CBC correspondent Evan
Solomon said this at the 2014 CNA
Biennium. Mr. Solomon lives and
works in the corridors of political
power in Canada – a place where
people leverage their connections,
their knowledge, their relationships and their reputations
to influence others and advance their agendas. Why is he
astonished? Because he cannot understand why registered
nurses are not the most powerful political lobby in Canada.
Think about it. Connections. Knowledge. Relationships. Reputation.
Connections: we are connected, in some fashion to almost
every Canadian citizen: when is the last time you told someone
you were a registered nurse and they didn’t immediately say
“Oh, my (sister, brother, aunt, mother, father, cousin, best
friend, etc.) is a registered nurse!” Knowledge: as a profession,
we have never been more educated than we are right now – we are highly regarded as evidence-informed practitioners
of nursing science. Relationships: relationships are what we are
all about! Human interaction around topics that matter to
health is the foundation of nursing practice – again, almost
every Canadian can describe a time that registered nursing
practice made a difference. Finally, reputation: for 13 years
in a row, Gallup pollsters have ranked nursing as the most
trusted profession, by a wide margin. I’m no poker player,
but I’d say in terms of political leverage – our profession is
holding a handful of aces.
Where does the reluctance come from? Is it “unseemly”
and not “nurse-like” to advance a political agenda? Florence
Nightingale didn’t think so. She was a visible, vocal and
effective political advocate for conditions to support health.
Is it because nursing, as a profession, tends to see the world
of policy as something removed from our scope of influence:
something that happens “out there”? Is it because we are
steeped in risk aversion from our earliest socialization into
the profession? Some authors suggest that this has created
a culture of silence and conformity in the face of conflict
or confrontation (Giddings, 2005b; Myrick et al., 2006).
Here’s the thing. We cannot afford to be silent. There has
never been a more critical time for registered nurses and nurse
practitioners to bring our knowledge to the policy and political
arenas. Daily, we see the impact of health policy decisions
on client care, population health, resource allocation and the
health-care system as a whole. We (you, me, all of us) have to
challenge whatever it is that is standing in the way of exerting
influence on the decisions affecting the care we provide and
the health system we work in.
As the largest group of health-care professionals in Alberta,
we can speak up in a way that can’t be ignored. These next
few weeks are going to offer critical opportunities to use this
collective voice to advocate for patient safety and improved
health care in Alberta in the political arena. But politics is NOT
a spectator sport.
First, there’s the provincial election, and next year, a
federal election. These are opportunities to make patient care
and health-related issues a major topic for election candidates.
Challenge candidates to identify the positive changes they
would make that would support longer term solutions in
health care. Take the time to write, call, email, Facebook or
Tweet the candidates in your riding. Also let them know what
solutions RNs bring to the table – speak your knowledge in
a way that demonstrates your contribution to health care,
and to the health-care system. Give voice to the barriers
you experience, and what could put you in a better position
to improve the health of Albertans.
There is another way you can exert influence. In 2011,
I was acclaimed to the position of president-elect on CARNA
Provincial Council – it was thrilling to join a group of passionate
registered nurses dedicated to leadership that would influence
nursing in Alberta. That’s why I was dismayed when only
five per cent of CARNA members voted in the 2014 CARNA
election. When was the last time you voted in a CARNA election?
It’s you (well, about five per cent of you anyhow) that decides
who leads our profession, and makes decisions affecting your
practice. Let’s make this year’s Provincial Council election
the best one yet. Keep an eye on your email because voting
happens online in May. You can, and will, make a difference
with just the click of a button.
Bottom line: regardless of the election at hand – it is critical
to be part of a profession that is not only politically aware,
but a profession that translates that awareness into behaviour
that candidates understand: voting. I can’t stress this enough.
Voting is the number one tool at your disposal to make
a difference in the health-care system. Take the time to
understand your candidate’s positions on health care and
vote for the one that you feel will make positive change.
You can access resources to support your political knowledge
by visiting our website nurses.ab.ca.
It’s time for us to play the hand we’ve been dealt – or rather,
the hand we have earned. We can, and must, move from
reluctance to resolve. Let’s be astonishing. RN
Sh a n non Sp e nc e l e y,
780.909.7058
[email protected]
PhD , RN
Connect with Shannon: @SSpenceley expertcaringmatters.ca
nurses.ab.ca
Spring 2015 Volume 71 No 1 Alberta RN
3
Registration Update
Practice Hours:
Will you
have enough
at renewal?
What is “currency of practice”? What about hours spent
on continuing education?
Currency of practice is the minimum number
You can calculate your total hours for the past
five years by logging into your MyCARNA profile
at nurses.ab.ca. Combine the hours you have
reported for the 2011, 2012, 2013 and 2014
practice years and add/estimate the number
of hours you will work from Oct. 1, 2014 to
Sept. 30, 2015.
Every year, we contact any nurses who may
not meet the currency of practice requirement
for the upcoming renewal to give them time
to consider their options before the end of the
practice year.
of hours an RN must practise within a specified
time period to be eligible to renew their permit.
In Alberta, the minimum for RNs is 1,125 hours
in the previous five practice years. For NPs,
the minimum is 1,125 hours in the previous
five practice years plus 600 NP hours in the
previous two practice years.
What is considered
a “practice hour”?
Hours spent engaged in nursing practice
count as practice hours. Practice hours are
not the same as paid hours and do not include
vacation, sick time, or any other leave even
if these hours were paid.
For hours paid for being “on call,” only
those hours in which you were called back
(engaged in practice) count as practice hours.
Professional development activities
completed during work hours count as
practice hours.
Nurse educators may report hours spent
preparing and delivering nursing education,
marking assignments, supervising nursing
students or other related activities as
practice hours.
If you are a current CARNA member, time spent
on education can count towards your currency
of practice requirement. These education hours
may be reported for:
• university or college credit courses leading
to a baccalaureate, masters or doctorate
degree in nursing (calculated at 60 hours
per credit received)
• post-basic university level credit
nursing courses that lead to a specialty
practice certification (e.g., Occupational
Health Nursing, Gerontological Nursing
at 60 hours per credit received)
• initial certification in a CNA specialty
(count 180 hours)
Education that isn’t eligible for inclusion in
practice hours includes:
• professional development activities
completed outside of work hours
• hours spent in courses leading to
registering with CARNA for the first
time (e.g., nursing refresher program,
RN / NP clinical practicum experience)
More information about currency of practice can be found on the CARNA website and specific questions can be directed
to registration staff at [email protected] or 780.451.0043 ext. 429 (toll-free 1.800.252.9392 ext. 429)
2016 Fee Increase
The registration fee increased by
2.6 per cent to account for inflation as approved
by council in May 2012. The increase is based on
the annual Alberta Consumer Price Index (CPI)
as published by Statistics Canada.
2014 FEE* 2015 FEE* 2016 FEE*
Registered Nurse
$ 555.90 $ 566.93
$ 578.82
Nurse Practitioner
$ 603.15
$ 621.01
$ 632.89
Certified Graduate Nurse
$ 503.40
$ 514.43 $ 526.32
* Including GST.
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Alberta RN Spring 2015 Volume 71 No 1
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QUESTION:
What is
Jurisprudence?
Vascular risk reduction resources
for RNs and NPs
The Vascular Risk Reduction (VRR) project established
the long-term goal to reduce deaths from vascular disease.
RNs and NPs are key professionals in preventing
and controlling vascular disease deaths in Alberta.
“Eighty-nine per cent of deaths in Canada are caused
by non-communicable disease, particularly those that
are vascular.”* RNs and NPs have an opportunity to
take a leadership role in helping Albertans to live longer,
healthier lives.
Many resources have been developed that will not
only assist in prevention of vascular disease, but also
identification and management of those with increased
vascular risk. In the coming months we will be highlighting
these resources – watch for more information in Alberta RN,
AB RN Online enewsletter, Twitter and Facebook.
*World Health Organization
A.Understanding and applying the legal
framework within which registered nursing
practice is allowed and privileged in Alberta.
B.The expectation that registered nurses
understand and participate in self-regulation.
C.An upcoming requirement for new applicants
and current CARNA members.
D.All of the above.
Find the answer on the next page.
nurses.ab.ca
Spring 2015 Volume 71 No 1 Alberta RN
5
Call for Nominations
ANSWER:
Jurisprudence
is…
Centennial Awards
Do you know a registered nurse or nurse
practitioner who inspires others and has
made a long-lasting contribution in their
workplace, their community or the profession?
Share their story by nominating them as
a Centennial Nurse.
In 2016, we are marking the 100th anniversary
of professional nursing in Alberta with
a year-long celebration of activities
and commemoration. To recognize this
milestone, we will honour 100 outstanding
registered nurses who have inspired others
and helped shape nursing excellence.
Help us thank outstanding registered nurses
by nominating one today! Find award criteria
and start the nomination process at
carna100nurses.ca.
Nomination deadline: May 6, 2015/11 p.m. MST
6
Alberta RN Spring 2015 Volume 71 No 1
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The correct answer is:
D. All of the above.
With a lot of help from you, we have been
developing a requirement for new applicants
and current CARNA members to demonstrate
competence in jurisprudence. The module to
fulfill this requirement is now complete with
final testing scheduled for this fall.
This module integrates education about
profession-led regulation with assessment
of this knowledge. The principles of online
gaming are applied to traditional (open-book)
testing techniques to create an experience
that is both engaging and educational, while
also being a meaningful and sound assessment
of competence in jurisprudence.
Practice Consultations – A Year
2013
in Review
2014
0
c
bli
Pu ealth s
H sue
Is
600
1,000
Scope of
Practice
L
Ethegal
ic a /
l
50 0
500
400
TOTAL
NUMBER OF
ConsultationS
1,500
30 0
ing
Nurs tice
Prac ards
d
Stan
n
20 0
Edu
catio
10 0
Consultation
Categories
ns /
sitio
Tran endent
p
Inde actice
Pr
Infor
Net wmation /
orkin
g
* NOTE: 1841 requests were initially received
but for 183 of these, attempts to contact
the requestors were not successful.
The total number
Re
lat
io
of consultations
increased by 22 per cent
y
fet
Sa
ns
hip
s
from the 2013 practice year.
Health Care
Reform
CARNA policy and practice consultants provide
confidential consultations to a variety of individuals and
groups regarding issues that directly or indirectly affect
the delivery of safe, competent and ethical nursing care.
Regulated members 1 of CARNA are the primary users of
practice consultations. Other callers include employers,
administrators, other health-care professionals, government employees and members of the public.
The annual review of practice consultations helps us
identify issues that affect registered nurse and nurse
practitioner practice within a changing health-care
environment. This review also identifies trends and
issues, as well as gaps where policy development may
be needed to guide practice or to advocate for change.
Gaps that were identified this year were related to
medication management and assignment of care.
Questions about scope of practice
RN scope of practice issues change as the practice setting and
roles for nursing practice evolve. In this past year, nurses in
different settings called with a variety of scope of practice
questions. The majority of calls in this category were about
whether or not a particular intervention was within the RN
scope of practice or if the intervention could or should be
integrated into the RN scope of practice. Some examples
of these interventions were:
conscious sedation
immunizations
debridement and wound care
pap tests
administration of Botox
1 Regulated members include: registered nurses (RN),
graduate nurses (GN), certified graduate nurses (CGN),
nurse practitioners (NP) and graduate nurse practitioners (GNP).
nurses.ab.ca
Spring 2015 Volume 71 No 1 Alberta RN
7
Policy and practice consultants helped with the individual
or group to determine if this was an intervention that the
RN was authorized, competent and educated to provide.
The discussion included the context of the situation and
issues related to reducing barriers, identifying best practices
and policy supports. The CARNA document Health Professions
Act: Standards for Registered Nurses in the Performance of Restricted
Activities (2005) was used to help determine if a particular
intervention or activity should become part of an RN’s
practice.
There were several questions regarding when the regulations
that will authorize RNs to prescribe and order diagnostic
tests within a specific practice area would come into effect.
CARNA continues to work with Alberta Health in changing
the Registered Nurses Profession Regulation to authorize RN
prescribing.
There were a number of consultations related to the
development of roles and responsibilities of RNs in a Primary
Care Network (PCN). RNs employed in PCNs were supported
in exploring opportunities within the interprofessional team
and for the development of programs within the clinic where
the RN was the case manager or lead (e.g. chronic disease
management).
RNs continue to be concerned about describing their
unique contributions within their place of employment.
In response to these inquiries, the following resources were
used to explain and describe the competency profile of an RN:
Nursing Intervention Classification (2013)
Entry to Practice Competencies for the Registered Nurses
Profession (2013)
Scope of Practice for Registered Nurses (2011)
CARNA has started discussions with RNs across the province
to seek the insights, perspectives and ideas of CARNA members
on how to describe RN practice in Alberta.
Please watch your email for updates
on how this discussion is progressing.
Scope of practice questions
from nurse practitioners (NP)
Scope of practice questions from NPs were primarily
related to prescribing controlled drugs and substances
(CDS). The CARNA requirements needed prior to NPs
prescribing CDS can be found on our NP CDS webpage at
nurses.ab.ca/cdsmodule.
Other examples of interventions that were discussed
included:
performing capacity assessments
ordering radiology
completing forms such as WCB, driver’s medical and
power of attorney
CARNA continues to work with members and stakeholders to
remove barriers to the NP scope of practice.
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Questions about graduate nurses (GN)
There were a number of questions related to the role and
responsibilities of the GN. A number of consultations focused
on clarifying whether the GN needed supervision and whether
there were any restrictions to the restricted activities a GN
could perform. Supervision of the GN is not required in
legislation and the GN is authorized to perform all restricted
activities that an RN can perform if they are competent and
it is relevant to the practice setting. The CARNA interpretive
document The Graduate Nurse: Scope of Practice (2009) was
used to provide information to increase understanding
of the scope of practice of graduate nurses and provide
guidance for GNs, RNs and managers in practice settings
where GNs are employed. All employers should verify that
GNs have a practice permit and confirm if there are any
conditions on their permit.
Questions about physician assistants (PA)
There were some questions about the role and responsibilities
of the PA . PA s are unregulated workers who work under the
supervision of physicians and provide direct patient care.
Any medication order from a PA must be authorized by the
supervising physician before it is implemented by the nurse.
Legal/ethical questions
There were a large number of questions this practice year
regarding liability. RNs in volunteer positions or independent
practice (such as contract work or self-employed) asked if they
needed extra professional liability protection. The Canadian
Nurses Protective Society (CNPS) offers legal advice, risk
management services, legal assistance and professional
liability protection related to nursing practice to eligible
registered nurses and nurse practitioners. All currently
practising CARNA members have access to CNPS liability
protection and services. For further information please
visit the CNPS website at www.cnps.ca or contact them
at 1.800.267.3390.
Several members wanted clarity on their professional
responsibility or liability in a particular role or position
within their practice setting such as a supervisor, coordinator
or charge position, and many wanted to know if they were
responsible for the care provided by others. Each professional
is personally accountable and responsible for their own
decisions and care provided.
Proper documentation still a concern
Questions about documentation included concerns about:
responsibilities in reporting poor or inconsistent
documentation
responsibilities in the documentation of collaborative
team meetings
the lack of clear direction on how to correct documentation
errors
the lack of clear direction on how to cosign in the electronic
health record
lack of policy for the use of abbreviations
security and appropriateness of using email to send orders
the lack of time to document care
The CARNA document Documentation Standards for Regulated
Members (2013) outlines the professional regulatory requirements for nurses that will assist them in producing clear,
accurate and comprehensive accounts of client care within
any practice setting. Members were also encouraged to consult
other relevant resources such as those available from CNPS.
Concerns about the appropriate
use of confidential health information
RNs and NPs want to ensure that health information is
protected and disclosed in accordance with legal and ethical
requirements, while ensuring that client records are accessible
for continuity of care for clients. Questions regarding the
responsibility to protect the confidentiality of health
information in a variety of settings continued. This is
consistent with the trend identified in other annual reviews.
Some of these concerns included:
how should health information be shared with the police
access to a client’s own health information
how much information can be shared
security with texting, emailing, videotaping and use of
social media
collection, use and disclosure of health information in
non-health care environments
The CARNA document Privacy and Management of Health
Information: Standards for CARNA’s Regulated Members (2011)
identifies standards for maintaining privacy and confidentiality
as well as the management of information in records and the
management of electronic records, including the protection,
privacy and security of electronic records. Additional resources
were also referred to such as consultation with CNPS and
consultation with the Office of the Information and Privacy
Commissioner of Alberta (oipc.ab.ca).
CARNA has also developed a self-directed
learning resource called the Privacy Module
that is available at nurses.ab.ca/privacy
Questions about professional boundaries
There were several consultations related to the RN’s responsibility for maintaining therapeutic boundaries that included
issues such as:
providing nursing interventions to friends or family
members
conflicts of interest
accepting gifts from clients
having a social relationship with a client outside of
the practice setting
The CARNA document Professional Boundaries for Registered
Nurses: Guidelines for the Nurse-Client Relationship (2011) provides
information and guidance about appropriate professional
boundaries for a nurse-client relationship. The guidelines
also apply to RNs in teaching relationships with students,
working with research participants, managing staff and in
working relationships with co-workers. The potential for
harmful boundary incidents is decreased when there is good
understanding of the issues involved. The ability to establish
and maintain therapeutic boundaries with clients is an
essential component of safe, competent, ethical nursing care.
The obligation to maintain healthy professional boundaries
lies with every RN, not with the client.
When do I have to provide care?
There were several calls regarding the duty to provide care
for clients:
of all genders
to a client with disruptive or aggressive behaviours
in a pandemic or contagious disease
The values and ethical responsibilities outlined in the CNA
Code of Ethics for Registered Nurses (2008) was an important
resource used to explore concerns and provide guidance in
situations when personal values or beliefs collide with those
of others or the context of the situation where nursing care
is to be provided. The Code of Ethics outlines nurses’ ethical
responsibilities and guides them in their reflection of practice
decision-making.
Questions about
Nursing Practice Standards
The Practice Standards for Regulated Members (2013) outlines
expectations and responsibilities and is foundational in
supporting nurses in their practice, giving them a framework
to ask questions in a proactive way and identify concerns
and issues, make decisions and implement solutions in their
practice setting. The practice standards represent criteria
against which the practise of all regulated members will be
measured by CARNA , the public, clients, employers, colleagues
and themselves. The two main groups of questions in this
category were about medication management and assignment
of care.
Medication management
There were many consultations related to safe medication
practices. Issues related to medication practices included:
clarification of a complete medication order
cosigning for medications
client self-administration of medications in various
settings
transcribing a medication order
administering sample medications
addressing break-through pain and prn range dose
medication orders
phoning in prescriptions
the implementation of protocols that included either over
the counter medications and/or Schedule 1 medications
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Spring 2015 Volume 71 No 1 Alberta RN
9
The advice and guidance given about medication practices
was grounded in the CARNA document Medication Guidelines
(2014). The number of questions and concerns related to
medication practices verified that some revisions to the
CARNA Medication Guidelines (2014) document were needed
to provide further clarity. Feedback from members and
stakeholders was collected on this document between
December 2014 and February 2015.
NPs and RNs inquired if they are able to accept and
distribute medication samples. The roles and responsibilities
of the RN and NP in providing drug samples to clients, as
well as the risks associated with dispensing drug samples, are
provided in the Medication Guidelines. According to the Canada
Food and Drug Act (1985), RNs and NPs are not authorized to
accept medication samples from pharmaceutical companies.
However, they can dispense medication samples provided
they dispense in accordance with dispensing standards and
practice setting policy.
Assignment of care
Supervision and assignment of care questions included :
Who can assign care to health-care aides?
What types of interventions can be assigned?
Who needs supervision, and what type of supervision
is needed?
Do RNs need to be supervised, and when?
Due to a number of factors such as staffing shortages, changes
in acuity and an increased demand for services, assignment
of care can be challenging. Assignment of care is an important
part of the RN’s responsibilities. The documents DecisionMaking Standards for Nurses in the Supervision of Health-Care Aides
(2010) and Assignment of Client Care: Guidelines for Registered
Nurses (2014) provide information and guidance in making
decisions about assignment of care, role clarity and shared
accountability. Using these standards and guidelines can help
RNs effectively assign care within the interprofessional team
in a variety of settings.
Other frequent questions
There were questions related to a variety of topics with
the largest number of consultations being questions about
the registration process that were subsequently referred
within the CARNA office. Other consultation questions
included requirements for CPR in the workplace, hours
of work and salaries, continuing education courses and
certification requirements. Policy and practice consultants
provided specific information and recommended members
contact other suggested resources specific to the individual
request.
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Safety of the health-care system
Questions regarding the safety of the health-care system
or staffing levels related to:
a lack of sufficient orientation
outdated or a lack of employer policies
heavy or high workloads
shortages of staff
changes to staff mix
working with unsafe practitioners
Concerns were raised specifically in regards to decreasing the
overall staffing number and changing the staff mix to a greater
number of non-regulated staff. This included a perception that
the focus had become one of doing the task rather than the
knowledge and skill required to assess and make sound decisions.
The document Practice Standards for Regulated Members (2013) was
used to give guidance and direction to work towards solutions
and implement a plan of action in their practice setting.
Consultations about fitness to practise included:
poor judgment
lack of critical thinking
inability to prioritize care
problematic substance use and working with a disability
The CARNA document Working Extra Hours: Guidelines for
Registered Nurses on Fitness to Practise and the Provision of Safe,
Competent, Ethical Nursing Care (2011) was used to assist in
problem solving and the development of practical approaches
to address concerns.
Relationship issues in the workplace
There were many consultations about bullying or disruptive
behaviour either from a colleague, a physician or from their
manager. Policy and practice consultants provided specific
information and recommended members contact other
suggested resources specific to the individual request such as
the Managing Disruptive Behaviour in the Healthcare Workplace – Provincial framework and resource toolkit developed by
the Health Quality Council of Alberta (2013).
In addition to individual practice consultations, policy and
practice consultants conducted numerous group consultations
and facilitated discussions in response to complex issues that
arose within practice settings. The main topics of these group
discussions were RN scope of practice, medication best
practices and professional responsibility and accountability. RN
CARNA Policy and Practice Consultants:
Debra Allen, MN, RN
Penny Davis, MN, RN
Donna Harpell Hogg, MS, RN
Pam Mangold, MN, RN
Debbie Phillipchuk, MN, RN
EMAIL:[email protected]
PHONE:1.800.252.9392
P ublications ordered by Hearing Tribunals
Publications are submitted to Alberta RN by the Hearing Tribunal as a brief description to members and the public of members’
unprofessional behaviour and the sanctions ordered by the Hearing Tribunal. Publication is not intended to provide comprehensive
information of the complaint, findings of an investigation or information presented at the hearing.
To find out more about sanctions and publication, go to nurses.ab.ca/sanctions.
CARNA Member
A Hearing Tribunal made a finding of unprofessional conduct
against a member who documented an order for a swab on
a patient and an order for Monistat when the member had
no physician’s orders to do so. The Tribunal issued a caution.
CARNA Member
Registration number: 36,321
The Hearing Tribunal made a finding of unprofessional
conduct against member #36,321 who failed to document her
assessment of a patient and failed to adequately complete a
self-reflective assignment required by her employer. The member
volunteered to sign an undertaking to not practise or to reapply
for a practice permit, as a consequence of her own decision to
retire, which was accepted by the Hearing Tribunal.
CARNA Member
Registration number: 37,684
A Hearing Tribunal made findings of unprofessional conduct
against member #37,684 arising from two complaints. The
member made a number of errors in the dosage calculation,
administration and documentation of morphine for one
patient on one shift. The member also failed to appropriately
process physician’s orders for two patients; failed to label
narcotics which she loaned to another unit; failed to manage
in a timely way a patient’s request for cream for a rash; failed
to communicate the results of an assessment to the physician
or obtain orders; and falsely reported to a co-worker that
the member had tried to contact the physician. The Hearing
Tribunal issued a reprimand and directed the member to pass
courses in arithmetic skills in nursing, basic medication
administration, professional ethics and responsible nursing.
The member must also complete the e-modules on the Code
of Ethics and pay a fine of $100. The member is prohibited
from practising pending approval of an employment setting
and is then restricted to working at that setting pending two
satisfactory performance evaluations. Conditions shall appear
on the member’s practice permit. Failure to comply with the
Order may result in suspension of CARNA practice permit.
CARNA Member: Gloria Amendt
Registration number: 40,566
The Hearing Tribunal made a finding of unprofessional conduct
against member Gloria Amendt #40,566 who, while working
in a hospice setting and assigned the care of a patient whose
condition was deteriorating, failed to respond to staff requests
to assess the patient; failed to respond to requests from staff to
call the patient’s family; failed to assess the patient; failed to
notify the patient’s family of the patient’s change in condition,
to allow them to be present when the patient died, as they had
requested; inaccurately documented her administration of
morphine and her call to the patient’s family; failed to demonstrate leadership or support to colleagues when, as the only RN
on duty, and charge nurse, she remained at the desk reading a
book after repeated requests for assistance in providing care to
the patient; and failed to respond and participate in the CARNA
investigation into the allegations that gave rise to the above
finding of unprofessional conduct. For this finding of unprofessional conduct, the Hearing Tribunal cancelled Gloria Amendt’s
practice permit, and ordered Gloria Amendt to pay a fine in the
amount of $5,000 as well as pay costs of CARNA’s investigation
and the hearing. Conditions shall appear on Gloria Amendt’s
practice permit. Should Gloria Amendt be successful in being
reinstated with CARNA and reissued a practice permit, any
then, or thereafter, outstanding failure to comply with the
Tribunal’s Order to pay the fine and costs may result in
suspension of her practice permit.
CARNA Member
Registration number: 41,912
A Hearing Tribunal made a finding of unprofessional conduct
against member #41,912 who put medication (one pill), which
a patient had refused to take, into the patient’s mouth, pinched
or held the patient’s nose in an attempt to get the patient to
swallow the pill which the patient had refused to take. While
the patient was being held by security, the member poured
water into the patient’s mouth in an attempt to get the patient
to swallow the pill; and after the patient spit the pill out onto
the floor, the member picked the pill up from the floor and
put the pill back into the patient’s mouth. The Tribunal issued
a reprimand, and as the member is retiring from nursing, the
Tribunal accepted the member’s permanent irrevocable under­
taking to never practise as an RN again. Conditions shall appear
on the member’s practice permit. Failure to comply with the
Order may result in suspension of CARNA practice permit.
CARNA Member: Wendy McMillan
Registration number: 45,841
The Hearing Tribunal made a finding of unprofessional
conduct against Wendy McMillan, #45,841 (the “member”)
who on several occasions during the period of 2005 until 2013,
practised outside the scope of registered nurses by managing
labour and/or delivering babies; and, publicly demonstrated
ignorance and/or neglect for the nursing standards and
legislation applicable to registered nurses by running a home
birthing practice and allowing such practice to be identified
nurses.ab.ca
Spring 2015 Volume 71 No 1 Alberta RN
11
publicly (via a website). For this finding of unprofessional
conduct, the Hearing Tribunal issued a reprimand and an
Order that the member write a paper, remove the website and
pay a fine. Conditions shall appear on the member’s practice
permit. Failure to comply with the Order may result in
suspension of CARNA practice permit.
CARNA Member
Registration number: 51,224
The Hearing Tribunal made a finding of unprofessional conduct
against member #51,224, who, while under a previous Order of
a Hearing Tribunal which required her to provide a satisfactory
performance evaluation, did the following: On 11 occasions
used a 10 mg vial of Morphine to administer a 2 mg dose of
Morphine, when 2 mg vials were available on the unit, thereby
unnecessarily wasting medication; and who exercised poor
judgment when she administered 5 mg of Morphine to a
patient, not assigned to her, who had a recorded history of falls,
and who was assessed by another RN as not being in severe pain;
and who failed to document in the narrative record regarding
the administration of the Morphine until several hours after;
and who on a different day, administered 5 mg of Morphine to
this same patient twice, but failed to document regarding either
dose in the narrative record. The member also exercised poor
judgment when she administered 5 mg of Morphine to a patient
who had previously managed her pain with Tylenol #3, and
who said the member had persuaded her to take the Morphine;
and who administered the Morphine for a headache, when
the intended purpose the Morphine was prescribed was for
abdominal pain. The member exercised poor judgment when
she administered injectable Morphine to a patient who was
about to be discharged, so there was no opportunity to assess
the effectiveness of the dose or check for adverse reactions,
and who had been using oral analgesics prn and not injectable
Morphine for the previous several days. The Tribunal issued
a reprimand and required the member to pass courses in
Basic Medication Administration, Pharmacology in Nursing,
and Medication Calculations. In addition, the member must
prepare and submit a plan to reduce medication errors and be
restricted to working under supervised practice pending two
satisfactory performance evaluations. Conditions shall appear
on the member’s practice permit. Failure to comply with the
Order may result in suspension of CARNA practice permit.
CARNA Member
Registration number: 53,013
The Hearing Tribunal made a finding of unprofessional conduct
against member #53,013 who, while working in palliative home
care, on six occasions failed to document her assessment and
rationale for implementing certain resources. For this finding
of unprofessional conduct, the Hearing Tribunal issued a
reprimand, an Order requiring the member to pass courses on
gerontology, documentation, and responsible nursing; performance evaluations; and a restricted practice setting pending
the performance evaluations being satisfactory. Conditions shall
appear on the member’s practice permit. Failure to comply with
the Order may result in suspension of CARNA practice permit.
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Alberta RN Spring 2015 Volume 71 No 1
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CARNA Member
Registration number: 63,797
The Hearing Tribunal made a finding of unprofessional
conduct against member #63,797 who, while working outside
Alberta, and not registered to practise outside Alberta, administered Botox to clients without a physician’s order and after
advising clients that the member was an RN from Alberta
with the implication the member had authority to practise
outside Alberta. For this finding of unprofessional conduct,
the Hearing Tribunal delivered a reprimand and ordered that
the member complete coursework on ethics, write a reflective
paper, and pay a $12,000 fine. Conditions shall appear on the
member’s practice permit. Failure to comply with the Order
may result in suspension of CARNA practice permit.
CARNA Member
Registration number: 66,489
A Hearing Tribunal made a finding of unprofessional conduct
against member #66,489, who inadvertently left a patient on
a bedpan for over six hours; failed to properly assess the patient
throughout the shift; failed to chart accurately or adequately
regarding the patient; failed to do two patient identifiers prior
to administering Vancomycin to the patient; administered
Flagyl to the patient in error; and did not know what a toxic
megacolon is, even though there was a physician’s order to
administer Flagyl if the patient developed a toxic megacolon.
The member also failed to document adequately, accurately
or in a timely manner, regarding a patient, whose oxygen
saturation level and blood pressure dropped, and who became
unresponsive; and the next day, the member failed to document
adequately regarding the same patient, who again sustained
a drop in oxygen saturation level. The Tribunal issued a reprimand and directed the member to pass four courses: Assessment,
Clinical Skills Refresher, Documentation and Basic Medication
Administration. The member must apply for and is restricted
to working under supervised practice pending two satisfactory
performance evaluations. Conditions shall appear on the
member’s practice permit. Failure to comply with the Order
may result in suspension of CARNA practice permit.
CARNA Member
Registration number: 69,806
The Hearing Tribunal made a finding of unprofessional
conduct against member #69,806, who, while working for
the Department of National Defense, attempted to transport
a controlled substance out of the country in contravention of
the Controlled Drugs and Substances Act, and, on two occasions,
sold a controlled substance while at the workplace. For this
finding of unprofessional conduct, the Hearing Tribunal
delivered a reprimand and ordered the member to pay a fine
in the amount of $5,000 as well suspended the member’s
practice permit for a period of two months. Conditions shall
appear on the member’s practice permit. Failure to comply with
the Order may result in (further) suspension of the CARNA
practice permit.
CARNA Member
Registration number: 69,616
The Hearing Tribunal made a finding of unprofessional conduct
against member #69,616 who, while working on a unit where her
mother became a patient, accessed her mother’s health records
without authorization; failed to document her rationale for
providing care to her mother, who was not assigned to the member;
and, completed a RLS for a medication error that occurred in the
care of her mother but for which the member was not involved.
For this finding of unprofessional conduct, the Hearing Tribunal
delivered a reprimand and ordered that the member complete
course work, write a paper, and pay a fine. Conditions shall
appear on the member’s practice permit. Failure to comply with
the Order may result in suspension of CARNA practice permit.
CARNA Member
Registration number:
74,812
A Hearing Tribunal made a finding of unprofessional conduct
against member #74,812 arising from two complaints from the
same source. The member debrided a patient’s wound when not
authorized to do so, and failed to follow the employer’s policy
when the member failed to adequately consult with other staff
regarding the resident’s wound care prior to initiating changes to
that care or communicate regarding those changes that the member
had initiated. The member also failed to do or adequately
document assessments of those wounds or adequately document
the wound care the member had performed. On a different shift,
when the member was told HCA s had witnessed sexual activity
between a resident and a ‘young’ woman/girl visitor, the member
failed to make appropriate inquiries of the HCA s and other
inquiries to determine the identity of the visitor and the details
of the incident, and as a result, failed to provide adequate supervision and mentorship to HCA staff; and failed to adequately
document regarding the incident or report the incident to manage­
ment as per employer policy. The Tribunal issued a reprimand
and ordered the member to pass courses in responsible nursing
and in wound care; to write a paper on the RN’s responsibilities
in the supervision of HCA s; and be restricted to working at his
current employment sites pending a satisfactory performance
evaluation from his main employment site. Conditions shall
appear on the member’s practice permit. Failure to comply with
the Order may result in suspension of CARNA practice permit.
CARNA Member
Registration number: 90,369
A Hearing Tribunal made a finding of unprofessional conduct
against member #90,369, who violated professional boundaries by
engaging in numerous inappropriate personal communications
for about a month, by text and phone, with a patient; and who
failed to adequately inform the multi-disciplinary team about,
or document the emotional distress and social concerns of the
patient, or document the member’s advice to the patient on those
issues. On one shift, the member failed to document a phone
conversation with the patient, when the patient called from her
pass wanting to return to the hospital; the member failed to
adequately communicate the patient’s concerns about her pass
to other members of the multi-disciplinary team; and the
member inappropriately gave his personal cell phone number
to the patient when she called the unit from her pass wanting
to return to the hospital. The Tribunal issued a reprimand,
and ordered the member to pay a fine of $5,000, pass the
course in responsible nursing and complete the e-modules
on the Code of Ethics. They ordered the member to undergo
counseling to improve his communications and understanding
of professional boundary issues, and to provide a satisfactory
report from the counselor. The member was ordered to prepare
a written plan for maintaining appropriate boundaries, write a
paper on professional boundaries and be restricted to working
at his current employment site pending two satisfactory
performance evaluations focused on maintaining appropriate
boundaries. Conditions shall appear on the member’s practice
permit. Failure to comply with the Order may result in
suspension of CARNA practice permit.
CARNA Member
Registration number: 92,394
A Hearing Tribunal made a finding of unprofessional conduct
against member #92,394 who had made an admission of
unprofessional conduct under section 70 of the Health Professions
Act. The member had over two months pilfered at least fifteen
10mg/ml vials of Hydromorphone from the Pyxis machine,
had wrongfully used the names of patients and physicians
in narcotic records to cover the pilfering of Hydromorphone,
and had self-administered Hydromorphone. The Tribunal gave
the member a reprimand and accepted an undertaking to not
practise as a registered nurse pending proof from a physician
and counselor that the member is safe to return to practice
at which time, the member has a choice to return to either
a practice setting where there is no access to narcotics or
controlled substances, or do a supervised practice in a setting
where the member is expected to administer medications,
including narcotics and controlled substances. In either setting,
the member’s employer will report back to a Hearing Tribunal.
The member is required to continue drug screening and provide
further medical reports to a Hearing Tribunal. Conditions shall
appear on the member’s practice permit. Failure to comply with
the Order may result in suspension of CARNA practice permit.
CARNA Member
Registration number: 92,896
A Hearing Tribunal made a finding of unprofessional conduct
against member #92,896 who breached patient confidentiality
when she brought a friend to work and permitted the friend to
remain with the member at work for the entire shift. The friend
was present for shift report and remained at the desk which
allowed the friend access to patient monitoring screens and
electronic patient records, although there was no evidence that
the friend actually looked at the records. The member did not
disclose to colleagues that her friend was not a staff member.
The Tribunal issued a reprimand and directed the member to
complete the CARNA modules on Privacy and the e-modules on
the Code of Ethics. Failure to comply with the Order may result
in suspension of CARNA practice permit. RN
nurses.ab.ca
Spring 2015 Volume 71 No 1 Alberta RN
13
National Nursing Week
Nurses: With you every step of the way
May 11–17, 2015
National Nursing Week highlights contributions to the
health-care system, including research and innovations,
and provides nurses with an opportunity to celebrate their
profession. The awareness week is our opportunity to
remind Albertans why they trust registered nurses and
to demonstrate our credibility.
Help the profession shine
Wear your RN pin
Introduce yourself to your patients as a registered
nurse
Tell your patients about your role in their care
Sport some Alberta registered nurse gear from
expertcarewear.ca
Share a few of our Nursing Week posts on social media
Celebrate!
Send a thank-you note to your nurse mentor or a
colleague for their work
Attend an education session or Nursing Week event in
your region: nurses.ab.ca/events – or hold your own event
Celebrate professional excellence at the Awards of
Nursing Excellence Gala in Calgary on May 21
Donate to the Alberta Registered Nurses Education
Trust to support continuing education for Alberta RNs
at arnet.ca
Enter our contests – follow us on social media and keep
an eye on our enewsletter
14
Alberta RN Spring 2015 Volume 71 No 1
nurses.ab.ca
A brief history
of modern nursing
We celebrate International Nurses Day
on May 12, Florence Nightingale’s birthday.
Florence Nightingale is considered the
founder of modern nursing.
She served as a nurse during the Crimean
War at the military hospital in Scutari,
Turkey, where she became known as
“The Lady with the Lamp,” as she made
her rounds at night.
Her reforms greatly reduced the death rate.
As a result, she proved the importance
of preventative health care in sanitary
conditions, clean air, water and food.
Afterward, she established a nurse training
school and supported the reform for
management of hospitals in the United
Kingdom.
2015
Calgary/West Region
Nursing Week Dinner
Edmonton/West Region
Nursing Week Dinner
Northwest Region
Nursing Week Dinner
Thursday, May 14, 2015
Monday, May 11, 2015
Tuesday, May 12, 2015
Enjoy an evening with your nursing
colleagues and friends to celebrate:
Closing in on a Century of Nursing,
99 Years of Nursing in Alberta.
You are invited to join your nursing
friends and colleagues for an evening
of collegiality and fun. Laughter will
surely be the highlight of the evening
with Phil Callaway, award-winning author
and speaker, known worldwide for his
humorous yet perceptive look at life.
You are invited to join your nursing
friends and colleagues for an evening
of collegiality and fun.
For tickets, contact Karen McKay
780.978.7781
[email protected]
Wainwright Hotel at Heritage Park
Calgary, AB
1730 –2100
Registration closes May 5
http://carnadinnercalgarywest.eventbrite.ca
Watch out for mini celebrations
happening throughout your region
delivered by your Regional Coordinators:
Bev Johnson:
403.625.3260
[email protected]
Lisa Tran:
403.919.8752
[email protected]
Central Region
Nursing Week Dinner
Tuesday, May 12, 2015
99 Years Strong;
Alberta RNs Blazing the Prairies
You are invited to join your nursing
friends and colleagues for an evening of
collegiality and fun. All registered nurses,
retired nurses and nursing students are
invited to attend.
Heartland Room, Westerner Park
Red Deer, AB
1730 –2100
Registration closes April 30
Chateau Louis Hotel &
Conference Centre
Edmonton, AB
1730 –2100
Registration closes May 1
May 11–15, 2015
Wednesday, May 13, 2015
You are invited! Please join your nursing
friends and colleagues for an evening of
collegiality and celebration.
All CARNA members living and working in
the Northeast region are invited to attend.
We hope you can join us for an enjoyable
evening.
Madhatters Liquid Lounge
Grande Prairie, AB
1730 –2100
Registration closes May 8
South Region
Nursing Week Events
http://carnadinneredmontontwest.
eventbrite.ca
Northeast Region
Nursing Week Dinner
CARNA Tour de South – Watch for
CARNA’s South Regional Coordinators,
Pat Shackleford and Val Mutschler, as
they travel the South region throughout
Nursing Week celebrating the expert
caring of registered nurses.
Valerie Mutschler
403.528.0806
[email protected]
Pat Shackleford
403.394.0125
[email protected]
Lions Pride Room, Dow Centennial
Centre
Fort Saskatchewan, AB
1730 –2100
Registration closes Tuesday, April 28
http://carnadinnernortheast.eventbrite.ca
http://carnadinnercentral.eventbrite.ca
Do you know which region you live in? Visit nurses.ab.ca/map to find out!
nurses.ab.ca
Spring 2015 Volume 71 No 1 Alberta RN
15
Workplace absences:
Can occupational
health nurses be
the leaders of change?
By Dianne E. G. Dyck, BN, M.S c., RN, COHN(C), CRSP
Over the past 15 years, work absence rates in Canada have been high, topping out in 2007 at 8.8 per cent or 10.2 work
absence days per full-time employee. Since then, annual work absence rates have steadily decreased to 7.6 per cent or 8.8 days
per employee. The question is, “Why is this decrease happening?”
FIGURE 1: Work Absence Rates and Days (2000-2014) 1
EmployeeAbsence:Absence:
absenceLost personal family
Year
rate
workdays health
reasons
2000
6.3%
8.0
6.7
1.3
2001
7.0%
8.5
7.0
1.5
2002
7.8%
9.1
7.4
1.7
2003
7.5%
9.2
7.5
1.7
2004
7.6%
9.2
7.5
1.7
2005
8.3%
9.6
7.8
1.8
2006
8.2%
9.7
7.6
2.1
2007
8.8%
10.2
8.1
2.1
2008
8.8%
10.0
7.9
2.1
2009
8.2%
9.8
7.8
2.1
2010
8.0%
9.1
7.4
1.7
2011
8.1%
9.3
7.7
1.6
2012
8.2%
9.3
7.6
1.6
2013
8.0%
9.1
7.4
1.6
2014
7.6%
8.8
7.3
1.5
16
Alberta RN Spring 2015 Volume 71 No 1
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Current efforts to reduce absenteeism
Pre-2000, few organizations paid attention to employee
absenteeism or disability management. Organizations
began to gradually realize that employee absenteeism
and disability situations could be effectively managed and
the losses mitigated. Often this revelation was the result
of occupational health nurses (OHNs) advocating for the
development of formalized Disability Management Programs
and often the related Attendance Control Programs in the
workplace.
In addition to these efforts, organizations offered employee
support services such as Employee Assistance Programs 2 and
Workplace Wellness Programs. 3
Government agencies, Ministries of Labour and Workers’
Compensation Boards increased their focus on illness and
injury prevention. This resulted in the development of more
robust and effective Occupational Health & Safety programs.
In many provinces, financial incentives for having fewer
workplace injury claims were provided.
All these programs were implemented to prevent, as well
as mitigate, employee illness and injury. In combination, the
outcome of these workplace initiatives has been a reduction
in work absence rates and days. In an attempt to further
reduce work absences, it is important to first understand
the Canadian work absence data and what it indicates.
Who is most likely to be absent
from work, and why?
The Canadian work absence data highlights a number of key
factors that influence regular work attendance by full-time
employees.
Industry sector
For the past six years, the public sector industries work
absence days were higher than they were in the private sector
industries. In 2014, public sector employees missed 1.6 times
more work days than did employees in the private sector.
Why? Is the gap explained by differences in employee
group benefit plans, the presence of unionization, the work
culture and a belief of sick leave benefit entitlement or the
nature of the work?
Public sector industries are composed of “employees in
the public administration at the federal, provincial, territorial,
municipal, First Nations, and other Aboriginal levels as well
as in Crown corporations, liquor control boards, and other
government institutions such as schools, universities, hospitals,
and public libraries.” 4 These industries tend to be heavily
unionized and offer employees more and better employee
group benefit plans. The result is often a work culture that
embraces a belief of sick leave benefit entitlement.
Union coverage and the higher proportion of older and
female employees in the public sector industries explains
about 80 per cent of the gap in work absences between public
and private sector employees. 5 Occupational exposures also
differ between the two sectors.
Occupation
Management occupations have traditionally experienced
fewer work absence days, while health care, production,
manufacturing, utilities, trades, transportation and
equipment operator occupations experienced the highest
number of work absence days.
For example, in 2014, employees in management occupations missed less than half of the days (4.9 days) compared
to employees in the health-care occupations (13 days).
This difference is certainly understandable given the
nature of the work and the rated work hazards. Health-care
workers are exposed to many work hazards such as biological,
chemical, physical, psychological, radiation, violence and
sleep deprivation. The control of these hazards is the mandate
of an organization’s Occupational Health & Safety Management System, which helps us to understand and effectively
control these workplace risks.
Organizational size
As the number of employees increases, so do the number
of lost work days. In 2014, employees in large organizations
missed 10.6 days compared to the 7.3 days in organizations
with less than 20 employees.
Higher work absence rates and days in larger organizations
may centre on the strength of the occupational bond between
the organization (employer) and employee. In larger organi-
zations, the occupational bond may be weaker than it is
in smaller organizations. Likewise, larger organizations
may be less aware of an employee’s absence; whereas smaller
organizations certainly know when an employee is missing
and can initiate mitigation actions. Add to this, the fact
that large organizations tend to be unionized and employ
more women – both factors contributing to increases in
work absence days.
Employment status
Permanent employees miss approximately 1.3 times more
work than non-permanent employees. This is most likely
related to the employee group benefits afforded to permanent
employees, which non-permanent employees would not have.
In 2014, unionized employees missed on average 1.8 times
the number of work days than non-unionized employees.
This is not a recent phenomenon. Unionized employees have
traditionally missed more work than their non-unionized
counterparts. However, the degree of difference between
these two groups increased in 2014.
Unionized employees miss much more time (1.9 times) than
non-unionized employees, and also more time (1.5 times more)
than the general Canadian full-time employee population.
Employee educational status
Higher education is associated with fewer work absence days.
In 2014, employees with a university degree missed 4.8 fewer
days than employees with less than grade 9 education, and
4.3 fewer days than those with some secondary education.
This is understandable given that employees with higher
education tend to be employed in different types of occupations.
Although employees with university degrees demonstrate
fewer work absence days, it may be a somewhat misleading
variable in that many highly-educated employees tend to work
in less hazardous occupations. Despite that, awareness and
knowing how to control work hazards can prevent employee
injuries. Outside of the workplace, higher levels of education
are associated with healthier lifestyles and better knowledge
of, and access to, health care.
Age
As employees age, they miss more work days. This phenomenon
is not surprising and has been evident for years. In 2014,
employees 55–67 years of age averaged 12.7 lost work days as
compared to 6.5 work days lost by employees 15–24 years of age.
This finding is consistent with many research findings that
aging is accompanied by chronic illness and injury. In terms
of general disability, the prevalence of disabilities steadily
increases with age:
AGE
PER CENT REPORTED A DISABILITY
15–24
4.4%
25– 44 6.5%
45–64 16.1%
65–74 26.3%6
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Spring 2015 Volume 71 No 1 Alberta RN
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The Canadian Survey on Disability (2012) indicates that the
prevalence of mental health-related disabilities also increases
with age. Mental health-related disabilities are known to
resolve slower than do physical disabilities. The study also
notes that people with mental health-related disabilities show
a high rate of co-occurrence with other types of disabilities.
The presence of co-occurrence of disabilities is also associated
with a longer recovery period and delayed return to work.
Aging, and the onset and prevalence of disease conditions,
are directly associated. With 18.7 per cent of the Canadian
workforce being over the age of 55 years,7 the high number
of work absence days in 2014 (10.5 days) is understandable.
However, it is interesting that employees 55–64 years missed
12.7 work days (11.2 days for own disability and 1.4 days for
family responsibilities). Post-sixty-five years of age, employees
missed only 8.2 days (7.2 days for their own disability reasons
and 1.5 days for family responsibilities). The latter group
(2.7 per cent of the labour force
in 2014) tend to not receive
employee group benefits or
Age and gender
long-term disability insurance
are like gravity,
coverage – the same situation
as non-permanent employees.
“They exist,
Gender
and cannot
be eradicated;
rather they need
to be managed.”
Women missed nine work days
in 2014 and men missed 6.1 days.
This is not a new occurrence;
historically, women have missed
more time than men.
Part of this phenomenon is
due to the caregiving responsibilities that women assume.
At all ages, women experience more work absence days than
men due to personal or family responsibilities.
Age and gender are certainly challenging factors to address.
Between children, aging parents, and ailing spouses and
friends, women are sandwiched between work and home life
demands. The ensuing pressures and stress levels tend to
result in work-life interference and conflict, illness/injury
and work absence. To counter this phenomenon, society and
organizations are encouraged to develop effective support
systems and services.
Age and gender are like gravity, “They exist, and cannot be
eradicated; rather they need to be managed.” The importance of
doing so is that age and gender impact many of the other
work absence factors, such as industry sector. It is always best
to deal with the root cause of a situation instead of focusing
on the resulting symptoms.
Changes in child care and shiftwork
as an impact on work absence
Back in 1997, the presence of preschool children in the home
was a major variable impacting work absence days. At that
time, women’s work attendance was affected the most.
For the past five years, the presence of preschool children is
no longer a variable.8 Perhaps this is due to the many societal
18
Alberta RN Spring 2015 Volume 71 No 1
nurses.ab.ca
and workplace responses to the needs of the working mother
or working single parent? Daycares, preschools, kindergartens
and other child-care facilities like after-school programs exist.
As well, employers have instituted a number of family-friendly
policies enabling parents to better manage child-care needs.
As well, shiftwork was once
identified as a variable for lost
work days. Today, Statistics
Occupational
Canada no longer lists shiftwork
health nursing
as a salient variable. Perhaps
can positively
this is due to employer efforts to
effectively address the potentially
impact the organi- negative effects of shiftwork.
The number of work absence
zation,
workplace
days associated with personal and
environment,
family reasons has decreased, but
employees and
this cannot be solely attributed
the community
to the presence of Employee
Assistance Programs (EAPs) in
at large.
the workplace. Those programs
have been present for years.
However, the effectiveness of
those programs may have improved. As well, the linking
of the EAP services with absence control and disability
management efforts in the workplace may be a contributing
factor. From a societal perspective, more efforts have been
spent on addressing mental health issues and providing
resources for workplaces to use to create a psychologically
safe and healthy workplace.
What can occupational health nurses do
to promote change?
Occupational health nurses provide value to an organization
by assisting with operational efficiency, loss control, injury/
illness management and disability management. The scope
of occupational health nursing can positively impact the
organization, workplace environment, employees and the
community at large.
In terms of managing employee work attendance, OHNs
can promote change by encouraging management, unions and
employees to:
appreciate the impact that corporate culture and corporate
climate exert on employee behaviours, and to understand
how best to use these critical management tools
explore the impact of union collective agreements, employment contracts and the terms of employee group benefit
plans on employee work absence rates and days
embrace and support a robust and comprehensive
Occupational Health & Safety Management System.
OH&S can help them understand the connection between
occupational exposures and work absence days, and the
related costs – human and financial. Include in that effort
the need to address complacency in the workplace.9
understand the challenges that female employees face and
continue to support them and provide the needed services
to manage their work and home demands
appreciate that the older worker, although valuable
in today’s workplaces, experiences a number of aging
challenges; but also, that those challenges can be addressed
though a number of preventative measures. Ergonomic
modifications, health education on aging well, fitness
programs, manual handling and lifting aids, attention
to walking surfaces and enhanced area lighting are but
a few approaches that have been shown to prevent injuries
in the aging worker.
provide employee health and safety education and training
so that workplace injuries and off-the-job injuries/illness
can be avoided
track and analyze employee absence days and reasons.
Use that information to help identify effective ways to
mitigate and ultimately, prevent future similar absences
in specific organizations.
integrate employee absentee and disability data so that
not only can employee work absence days be identified, but
they can be quantified and their relationship recognized.
That approach provides the needed leverage for obtaining
adequate resources to make organizational improvements.
1 Statistics Canada, Work Absence Rates 2000-2014. Data available
online from Statistics Canada, www.statscan.gc.ca, CANSIM
tables 279-0029 to 279-0039.
2 In Canada, 75 per cent of mid-sized and large organizations
provide Employee Assistance Programs for employees and their
dependents (Dyck, D. (2013) Disability Management, Theory, Strategy
& Industry Practice, 5 th Ed. Markham, ON: LexisNexis Canada Inc.).
3 In Canada, 72 per cent of Canadian organizations have a highly
or moderately developed Workplace Wellness Program; while
only nine per cent of organizations report not having any workplace wellness initiatives in place. (Conference Board of Canada,
Healthy People, Healthy Performance, Healthy Profits: The Case for
Business Action on the Socio-Economic Determinants of Health (2008),
available online at: <http://www.conferenceboard.ca/documents.
aspx?did=2818> (date accessed: January 31, 2015)).
4 Uppal, S. & LaRochelle-Cote, S. (2013). Understanding public–
private sector differences in work absences, Statistics Canada,
Cat. No. 75-006-X, p. 5, available online at: http://www.statcan.
gc.ca/pub/75-006-x/2013001/article/11862-eng.htm
5 Uppal, S. & LaRochelle-Cote, S. (2013). Understanding public–
private sector differences in work absences, Statistics Canada,
Cat. No. 75-006-X, available online at: http://www.statcan.gc.ca/
pub/75-006-x/2013001/article/11862-eng.htm
6 Statistics Canada (2013). Disability in Canada: Initial Findings from
the Canadian Survey on Disability, Cat. #89-654 – No. 002, p. 4-5.
7 Statistics Canada (2014). Labour Force Characteristics, December
2014. Available online at http://www.statcan.gc.ca/pub/71-001-x/
2014012/t003-eng.htm
8 Statistics Canada (2015). Table 279-0033: Work Absence Statistics of
Full-time Employees by Sex and Presence of Children (2014). Available
on the Statistics Canada website.
9 Complacency in the workplace is defined as self-satisfaction
especially when accompanied by unawareness of actual dangers
Conclusion
Work absenteeism is a complex entity and its resolution,
equally complex. The best approach is to address
absenteeism through the use of “upstream” tactics 10
as opposed to dealing with individual employee absentee
situations. The OHN is in an excellent position to
assist organizations to understand the phenomenon,
its contributory factors, as well as how to overcome
the challenges of frequent work absence.
Dianne Dyck is a certified occupational health nurse and occupational
health and safety specialist who has worked for private and public-funded
agencies to develop occupational health, occupational health and safety,
disability management and workplace wellness programs. As an educator,
Dianne has developed a number of courses in the fields of disability
management, occupational health and safety, human resources
(integrated workplace health management). Her current publications
are Disability Management: Theory, Strategy and Industry Practice 5 th ed.,
Occupational Health & Safety: Theory, Strategy and Industry Practice 3 rd ed.,
and A Practical Guide to Psychological Health & Safety in the Workplace.
Dianne also teaches at the University of Fredericton and at the University
of Calgary.
or deficiencies. It is associated with workers taking shortcuts to
get things done, or practising risky behaviours.
10“Upstream”: in business, the term “upstream” refers to the product/service research, development, production and refinement
activities. In terms of attendance control and disability management, it refers to all the activities that occur to prevent employee
illness/injury, and the subsequent work absence days. The tactics
include a system and organizational approach to preventing and
mitigating workplace medical absence.
References
Conference Board of Canada, Healthy People, Healthy Performance,
Healthy Profits: The Case for Business Action on the Socio-Economic
Determinants of Health (2008), <http://www.conferenceboard.ca/
documents.aspx?did=2818> (date accessed: January 31, 2015
Dyck, D. (2013) Disability Management, Theory, Strateg y & Industry
Practice, 5 th Ed. Markham, ON: LexisNexis Canada Inc.
Statistics Canada (2015). Labour Force Survey Estimates by Sex and Age,
2014, Table 282-0002, http://www5.statcan.gc.ca
Statistics Canada (2015). Work Absences Statistics of Full Time Employees
by Sex and Age Group, 2014, Table 279-0032, http://www5.statcan.gc.ca
Statistics Canada (2015). Absences From Work of Employed Persons,
http://www.statcan.gc.ca/concepts/definitions/absences-absence-eng.
html
Statistics Canada (2014). Labour Force Characteristics, December 2014.
http://www.statcan.gc.ca/pub/71-001-x/2014012/t003-eng.htm
Statistics Canada (2013). Disability in Canada: Initial Findings from
the Canadian Survey on Disability, Cat. #89-654 – No. 002, p. 4.
Statistics Canada, Work Absence Rates 2000-2014. Statistics Canada.
Uppal, S. & LaRochelle-Cote, S. (2013). Understanding public–
private sector differences in work absences, Statistics Canada,
Cat. No. 75-006-X, http://www.statcan.gc.ca/pub/75-006-x/2013001/
article/11862-eng.htm
nurses.ab.ca
Spring 2015 Volume 71 No 1 Alberta RN
19
NURSING RESE ARCH IN ALBERTA
Current studies can help shape the future of health
Approach
Randomized controlled trials were
identified by searching the Cochrane
Dementia and Cognitive Improvement
Group’s Specialized Register of dementia
studies. All randomized controlled trials
were included in which older adults
diagnosed with dementia were allocated
to either a physical activity program or
usual care group to determine the effect
on outcomes.
In the 2008 review, four trials were
identified that included 280 participants
at baseline with 208 (74 per cent)
completing the trials.
In 2013, 13 trials were identified,
which included 1,067 participants
at baseline with 919 (86 per cent)
completing the trials. The increase in
the number of trials is encouraging.
Update on literature
review: exercise
programs for persons
with dementia
Dorothy Forbes, PhD, RN, Professor,
Faculty of Nursing, University of Alberta;
Emily Thiessen, RN, MN Student,
Graduate Nurse Practitioner, Research
Assistant, University of Alberta;
Catherine Blake, MA, Research Associate,
Western University; Scott Forbes, PhD,
CSEP-CEP, Professor, Okanagan College;
Sean Forbes, PhD, Research Assistant
Professor, Department of Physical Therapy,
University of Florida.
In the future, as the population ages,
the number of people in our commu­
nities suffering with dementia will rise
dramatically. This will not only affect the
quality of life of people with dementia,
but will also increase the burden on
family caregivers, community care and
residential care services. Exercise is one
lifestyle factor that has been identified
as a potential means of reducing, or
delaying, the progression of dementia
symptoms.
The researchers recently completed
an update of a 2008 and 2013 Cochrane
review on whether exercise programs
improve cognition, activities of daily
living (ADLs), challenging behaviour,
depression and mortality in older persons
with dementia, and whether exercise
programs have an indirect impact on
family caregivers’ burden, quality of life
and mortality.
Alberta RN Spring 2015 Volume 71 No 1
Health-care providers who work
with persons with dementia and their
caregivers should feel encouraged to
promote physical activity among this
population since improved ADLs will
have benefits for persons with dementia
and could potentially lessen the burden
experienced by family caregivers. RN
The full 2013 review can be seen at
http://online library.wiley.com/doi/
10.1002/14651858.CD006489.pub3/full.
The latest update has been submitted
to the Cochrane Dementia and Cognitive
Review Group for potential publication
in the Cochrane Library.
Highlights of the findings
EMAIL: [email protected]
20
Implications for
practice and policy
There was promising evidence that
exercise programs can improve the
ability of people with dementia to
perform daily activities, such as getting
dressed, but there was a lot of variation
among trial results. In addition, exercise
programs might have a significant impact
on improving cognitive functioning.
One study revealed that the burden
experienced by informal caregivers
providing care in the home may be
reduced when they supervise the parti­
cipation. The studies showed no clear
evidence of benefit from exercise on
challenging behaviours and depression.
In addition, there was little or no
evidence regarding mortality in older
persons with dementia, and the impact
on family caregivers’ quality of life
and mortality. Further well-designed
research is required to examine the
association between exercise programs
and these outcomes and also to determine the best type of exercise program
for people with different types and
severity of dementia.
nurses.ab.ca
Towards understanding
the experiences of
nurses and very ill
people in the home
Anna Santos Salas, PhD, RN, Assistant
Professor, Faculty of Nursing, University
of Alberta, Edmonton, Alberta, Canada.
EMAIL: [email protected]
The need to understand the experiences
of people receiving palliative care in
the home is important as it provides
information that helps clinicians to
increase the quality of palliative care
practice and end of life care.
Knowledge of people’s experiences
also assists health-care workers to
nurture ethics in practice. Bergum (1994)
identifies three kinds of knowledge that
assist clinicians to provide ethical care.
care for older adults
The first type (descriptive) has to do
with people’s own experiences such as
their personal experience of a particular
illness.
The second type (abstract) concerns
information that comes from diagnostic
and laboratory tests.
The third type of knowledge involves
placing the person’s own experiences
and the objective information from tests
into the person’s own context of life so
that an understanding of the person
as a whole is attained.
This research study sought to achieve
an understanding of people’s own
experiences in palliative home care
together with their nurses’ perspectives
and to examine how nurses engaged
with very ill people in the home.
Designs and methods
The study followed a qualitative research
methodology named hermeneutic
phenomenology (van Manen, 1997,
Bergum, 1997, and Cameron, 1998, 2004).
This methodology helps us to understand people’s experiences in life from
their own perspectives (Cameron, 2004);
in this case, the experience of people
receiving palliative care in the home.
The study took place in a palliative
home care program from a Western
Canadian province. Seven terminally ill
adults with a cancer diagnosis, one
with a non-malignant condition, and
four home care nurses with extensive
palliative care experience participated
in the study. Five patients were older
adults. Information was gathered
through observation of nurses’ practice,
conversations with patients and nurses,
and researcher’s notes. Ethics approval
was granted by the University of Alberta
Health Ethics Research Board (please
see Santos Salas & Cameron, 2010 for
a detailed description).
Study highlights
A significant finding of this study was
that the home was a very important
space that facilitated the provision of
ethical nursing practice.
The home can be understood as a
protective cloak (Santos Salas & Cameron,
2010) that surrounds the experience
of people with a terminal illness and
their loved ones. In the home, nurses
were able to develop an understanding
of patients’ situations that assisted
them to look at them as a whole and to
practise in a way that was very sensitive
of people’s own experiences.
Nurses paid attention to all kinds of
knowledge to make important clinical
decisions concerning the care of their
clients. Their careful attentiveness to
the circumstances of each person’s
particular situation was a salient feature
of their practice that made them very
responsive to patients’ own needs.
Overall, nurses practised an ethical
attentiveness to each person as a whole
that included an understanding of their
homes as a very significant space in
people’s lives. This ethical attentiveness
was central to assist patients and
families to continue to have a life
in the face of an approaching death.
Implications for practice
This study provides insight about the
need to be attentive of the various kinds
of knowledge that are present in daily
practice situations. Nurses who parti­
cipated in the study had an ability to
negotiate entry into patients’ homes
and build a relationship with their
patients and families that facilitated
the provision of care. Older adults are
a growing population in Canada and
one of the groups that requires palliative
care services (Caltagirone, Spoletini, Giani,
& Spalleta, 2009; Gardiner, Cobb, Cott, &
Ingleton, 2011; Kramer & Auer, 2005).
Attentiveness to both older adults’
own health experiences and their
relationship with their own homes
is an important component of ethics
in nursing and health-care practices
in the home.
Findings from this study show that
respectful attentiveness to what people
know, how they view their situation,
and how they live assists nurses and
health-care workers to work together
with patients and their families to ease
the pain and suffering of dying. Through
an understanding of patients’ experiences
as a whole, nurses can support them to
live life to the fullest. RN
References
Bergum, V. (1994). Knowledge for ethical
care. Nursing Ethics, 1(2), 72-79.
Cameron, B. L. (1998). Understanding
nursing and its practices. Unpublished
doctoral dissertation, University of
Alberta, Edmonton, Alberta, Canada.
Cameron, B. L. (2004). Ethical moments
in practice: the nursing ‘how are you?’
revisited. Nursing Ethics, 11(1), 53-62.
Caltagirone, C., Spoletini, I., Gianni, W.,
& Spalletta, G. (2010). Inadequate pain
relief and consequences in oncological
elderly patients. Surgical Oncology, 19(3),
178-183.
Gardiner, C., Cobb, M., Gott, M., & Ingleton,
C. (2011). Barriers to providing palliative
care for older people in acute hospitals.
Age & Ageing, 40(2), 233-238.
Kramer, B. & Casey Auer, C. (2005).
Challenges to providing end-of-life care
to low-income elders with advanced
chronic disease: lessons learned from
a model program. The Gerontologist, 45(5),
651-660.
Santos Salas, A. & Cameron, BL. (2010).
Ethical openings in palliative home care
practice. Nursing Ethics, 17(5), 655-665.
Van Manen (1997). Researching Lived
Experience: Human Science for An
Action Sensitive Pedagogy (2nd ed.).
London, ON: Althouse.
nurses.ab.ca
Spring 2015 Volume 71 No 1 Alberta RN
21
LEADING
RNs at Killam Alberta Cont
By Sheena Stewart
Whether it’s making school lunches
or driving the same route to work each
day, the things we do all the time can
become so familiar they almost become
second nature. But what if routines were
keeping you from using the skills and
experience you worked hard to acquire?
That was the situation facing RNs
at Killam Alberta Continuing Care.
After years of doing things the same
way, most of the centre’s RNs found
themselves focused on tasks rather than
on working to their full scope of practice.
It was a situation Linda Hunter, the
centre’s new continuing care manager,
set out to change.
22
Alberta RN Spring 2015 Volume 71 No 1
nurses.ab.ca
“When I arrived in Killam, it was very much a task-orientated
type of care provision,” recalls Hunter. She noted that while
RNs were administering medications and performing tasks
like assessing wounds and dressings, they weren’t fully utilizing
their skills and experience. “I realized almost immediately
that we needed to look at different ways of providing care
and connecting with residents.”
Last July, Hunter began exploring how to better apply
RN skills and expertise in the context of a continuing care
setting. “We knew we wanted the care to be more residentfocused rather than task-focused, and realized that RNs were
the ones who could lead that change.” With a new rotation
schedule planned for September, the decision was made to
start putting the RNs into new roles with different tasks.
Hunter explained that this change in roles required
the RNs to move into an area of nursing practice that was
drastically different from what they were used to doing.
“RNs have a broad scope of practice, and should be able to
apply their skills and expertise to new challenges. I liken it
to how an engineer might work. When someone hires an
engineer to build a bridge across the North Saskatchewan River,
they don’t specify how the engineer should build the bridge – they trust that they know how to get it done. It’s the same
with RNs. They have the skills and experience to figure it out.”
RNs fully using their skills and expertise has been
a long-standing priority for CARNA , which defines scope
of practice as including all the interventions that registered
nurses are authorized, educated and competent to perform.
To help them with the challenge, Hunter assigned RNs
to be case managers for groups of residents. “We asked
the RNs to choose an area of interest, and then grouped
our residents into a dementia and mental health group,
inuing Care embrace full scope of practice
a chronic lung disease and congestive heart failure group,
a wound care and ostomy management group, a pain manage-­
ment and palliative care group, and a musculoskeletal, falls
and mobility group.” With approximately 45 residents at the
centre, it meant each case manager was assigned approximately
eight to 10 residents.
Once case managers were assigned, the expectation was
that they would become experts in their chosen diagnostic
area – a challenge Hunter says the RNs quickly embraced.
They pursued online learning, and attended workshops
and conferences that would help them become better versed
in their specialized area. “I had RNs who were incredibly
motivated to learn and implement best practices… within
a couple of months they became on-site experts.”
Although RNs continued to perform all their necessary
shift assignments, the facility began to function more like a
primary-care setting where the case managers for each group
followed the care and treatment of the residents assigned
to them. “RNs began proactively focusing on residents and
their families, so that they were looking for problems before
they happened,” says Hunter. RNs connected with families
monthly to inquire about any issues or concerns. “They would
phone the family and ask ‘Is there anything you’re concerned
about and what can we do better?’”
Each RN case manager led a team that included at least
one licensed practical nurse (LPN) and any health-care aides
(HCA s) that were interested in that diagnostic area. RNs not
only led the teams, but also helped educate LPNs and HCA s
about their area of specialty and any best practices they had
learned about. Together, the teams began introducing those
best practices into the centre.
“Our dementia case manager attended a workshop that
discussed how important it was to make things less clinical
and make the facilities feel more like home. So we changed
the dining room to make it warmer and more inviting.
We worked to make everything focused on residents and
on improving their care and improving their quality of life.”
Having RNs work more fully within their scope also
changed many of the established procedures, including how
medications were administered to residents with swallowing
difficulties. “Before, it was the HCA who distributed the
medications to those patients, but it made more sense to have
the RNs take over that responsibility because RNs should be
assessing them everyday, so they can watch for changes or
issues.”
In addition to the groups, Hunter established a quality
control team that looked for ways to improve processes
and procedures throughout the facility. One of the RNs
also offered to become a senior nurse advocate, who could
intervene whenever there were issues with any of the other
teams or challenges with a resident or family member.
“The entire process empowered RNs to use their knowledgebased skills, and their critical inquiry and planning training,
to identify problems and create solutions,” notes Hunter.
Although Hunter has recently moved on from the
continuing care manager role in Killam, she remains
invested in seeing the RNs continue to expand their scope
of practice. “Killam is my home town and I know how
important continuing care is to the community. I’ve also
been actively nursing for 40 years and understand how
much RNs are capable of doing. I think initiatives like
this will help attract good RNs to the rural communities
that need them most.” RN
nurses.ab.ca
Spring 2015 Volume 71 No 1 Alberta RN
23
Education
Administration
Jacqueline Bartkiewicz
Gail Cameron
Mollie Cole
Gerald Hrychuk
Max Jajszczok
Charlene Knudsen – Recipient
Agnes Liabres
Valerie Potts
Dianne Tapp
Clinical Practice
Nominees
announced
This year, the CARNA Awards Selection
Committee was faced with the task of
selecting eight award recipients out of
64 exceptional nominees. All nominees
displayed excellence in the field of nursing
and deserve recognition.
We are pleased to announce the recipients
and nominees of the 16th annual
CARNA Awards of Nursing Excellence!
Save the date
Cathy Berry
Deb Bowers Armstrong
Brad Curtola
Colette Foisy-Doll
Janet Haworth
Wendy Motley
Nancy Moules – Recipient
Cydnee Seneviratne
Hayley Shepherd
Claudette Westerbeek
Ashley Young
Research
Theresa Green
Nicole Letourneau – Recipient
Susan Slaughter
Lani Babin
Gillian Brown
Barbara Butler
Angela Curran
Lifetime Achievement
Rita Duren
Arvelle Balon-Lyon
Charissa Elton-Lacasse – Lesley-Ann Bellefeuille
Recipient Committee’s
Libuska Cernohorsky
Choice
Caroline Garratt
Lori Fairservice
Dr. Maureen Leahey – Sheila M. Gallagher
Recipient
Michelle Gardecki
Ann Lemieux
Isabelle Giroux
Diana Mansell
Ruby Anne Gorospe
Pushpa Ramji
Stuart Grant
Partner in Health
Sherri Gussman
Peer Support Outreach
Barbara Harbers
Workers (Amy Willans;
Joan Heatherington
Jennevieve O’hare, BA,
Anita Kalia
RecT; Sheri Schmidt, BA) – Alexis Mageau – Recipient
Recipient
Alexandra Reczka
Gordon Ward
Chris Savard
Fay Schneider
Rising Star
Myra Schueler
Emilee Belyea
Linda Tee
Courtney
Campbell
Mary Toronchuk
Tyler
Hume – Recipient
Beth Woytas
Kimberly McRae
Taylor Mueller
Sharon Walia
THURSDAY, MAY 21, 2015
5 p.m. RECEPTION 6 p.m. DINNER AND AWARDS
Sheraton Suites Calgary Eau Claire
255 Barclay Parade SW, Calgary
TO BUY TICKETS, VISIT
carnaawards.ca
MARK YOUR
CALENDARS
CARNA CELEBRATES 100 YEARS!
MAR
16-18
2016
THE CARNA CENTENNIAL CONFERENCE //
REGISTERED NURSES: MAKING A
DIFFERENCE FOR ALBERTANS
DELTA EDMONTON SOUTH
EDMONTON, ALBERTA
Join us for pre-conference workshops and a 2 1/2 day conference focused
on what registered nurses and nurse practitioners are doing now to create
the health system of the future. Plenary and concurrent sessions, workshops,
posters and oral abstract presentations will highlight significant contributions
made by nurses in research, education, administration and direct care.
SHARE YOUR RESEARCH AND BE A PART OF THE PROGRAM
THE CALL FOR ABSTRACTS IS OPEN!
JUN
- 8 2015
DEADLINE //
PRECONFERENCE
WORKSHOP
SUBMISSIONS
OCT
- 5 2015
DEADLINE //
ORAL AND
POSTER
ABSTRACTS
SUBMISSIONS
For more information, please visit www.CARNA100Conference.ca
Check the website often for Conference updates
and more information!
Prioritizing
Pressure Ulcer
Prevention
By Marlene Varga, M.S c., RN
Pressure ulcers (PU) are one form of skin breakdown that
had been observed in Egyptian mummies and still exist
today. A PU is defined as “a localized injury to the skin
and/or underlying tissue usually over a bony prominence,
as a result of pressure, or pressure in combination with
shear.” The majority of PUs are preventable; however,
a small portion are unavoidable.
Pressure ulcers are costly
PUs frequently re-occur and increase the personal and financial
burden to individuals and society. The cost of PU in the
UK has been clearly documented with an estimated cost
of four per cent of the total NHS expenditure.
It has been estimated that PUs cost individual Canadian
hospitals more than one million dollars each year. PUs are
costly to individuals in terms of suffering and pain, disfigurement and loss of productive time. Caring for persons with PUs
also impacts nurses who care for them on a regular basis.
Many factors contribute to
pressure ulcer formation
There is consensus that the key factor associated with the
development of PU is unrelieved pressure. The intensity and
duration of pressure is of prime concern.
Other main factors include shear or tearing of underlying
tissue and blood vessels in the superficial and deeper layers
of the skin. The combination of shear stresses, in addition
to pressure, causes greater damage in muscle around bony
prominences than pressure alone. So if one can minimize
the shearing forces, more pressure can be tolerated.
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Alberta RN Spring 2015 Volume 71 No 1
nurses.ab.ca
We may see signs of damage as red areas, but a lot of times
the damage is occurring in the muscle which we cannot observe.
Another significant risk factor is moisture or microclimate,
which includes increased temperature and humidity and
softens the stratum corneum reducing tissue tolerance to
other risk factors. This can occur in patients with fever, sepsis,
perspiration, incontinence, warming and wound drainage.
Several intrinsic risk factors for the development of
PUs have been identified, and the time for the onset of PU
development is dependent on the patients’ own risk factors.
This time for onset is not exact, but a range of probable times
of one to six hours is supported by research.
We must be more accountable
in tracking PU incidences
There appears to be a problem of under-reporting and a lack
of evidence related to the incidence of facility-acquired PUs
in Canada and Europe.
Prevalence refers to the proportion of a defined set
of people who have a PU at a particular moment in time.
Incidence provides information on the rate of occurrence
of cases of new PU over time.
Is your organization tracking this metric? Avoidable PUs
must be documented as adverse events, something that we
should all ensure on a consistent basis.
In most cases, stage III and IV avoidable PUs should have
an investigation to determine the root cause. In the UK ,
all levels of skin damage as a result of pressure/shear must
be reported and a serious incident report and an investigation
is recommended for all stage III and IV damage.
Is there a system in place to determine if the PU was
present on admission?
Is there a system to document how well you are implementing
preventative interventions in your area?
In an era of prevention and patient safety, resources must be
put in place for PU prevention similar to resources currently
in place for infection prevention and control. Treating healthcare-associated infections in hospital is estimated at £1 billion
in the UK compared to the cost of treating ulcers at £1.4 billion.
Conclusion
In Alberta, working groups have been developing PU prevention
guidelines, policy and standardized documentation for assessments and prevention plans to meet the required organizational
practice standard for Accreditation Canada.
This top-down approach is an opportunity to meet the
standard for prevention and accountability every day in
daily practice. A bottom-up strategy begins with involving
and educating health-care aides, nurses, patients, families,
physicians and all multi-disciplinary staff who can also aid
in mobilizing these guidelines into practice and creating and
sustaining a culture of PU prevention with a collaborative
team approach.
Few conditions offer nursing a better opportunity to have
a dramatic and visible impact on quality care than does skin
care. It is imperative that we have an accurate account of
the preventative practices that are implemented for at risk
patients and systems in place to accurately monitor clinical,
financial and person-centred outcomes.
How is your environment stimulating staff engagement in
PU as part of a commitment to quality care every day? The key
is prevention and linking risk and skin assessments to timely
interventions followed by documentation, communication,
collaboration and evaluation. RN
References
Bennett, G. et al. 2004. The cost of pressure ulcers in the UK.
Age and Ageing 33, pp. 230-235.
Dealey, C. et al. 2012. The cost of pressure ulcers in the United
Kingdom. Journal of Wound Care 21 (6), pp. 261-266.
Edsberg, L. et al. 2014. Unavoidable Pressure Injury: State of the
science and consensus outcomes. JWOCN 41 (4), pp. 313-334.
European Pressure Ulcer Advisory Panel and National Pressure Ulcer
Advisory Panel (EPUAP/NPUAP) 2014. Prevention and treatment of
pressure ulcers: quick reference guide. Washington DC: National
Pressure Ulcer Advisory Panel.
NHS 2014. Pressure Ulcer Reporting and Investigation. All Wales
Guidance. {Accessed January 2015}.
Posnett, J. et al. 2009. The resource impact of wounds on health-care
providers in Europe. Journal of Wound Care 18 (4), pp. 154-161.
The Patients Association 2010. Meaningful and comparable information? Tissue Viability Nursing Services and Pressure Ulcers.
{Accessed January 2015}.
Varga, M. and Holloway, S. 2015. The lived experience of the wound
care nurse in caring for persons with pressure ulcers. International
Wound Journal (in press).
Woodbury, G. and Houghton, P. 2004. Prevalence of pressure ulcers
in Canadian healthcare settings. Ostomy/Wound Management 50
(10), pp. 22-38.
5
reasons
to start a
nursing specialty
practice group
You are in a defined area of nursing practice that
isn’t already represented by one of our current
specialty practice groups (SPGs).
You have a social concern that affects nursing
practice.
You would like to provide networking opportunities
to a group of nurses in your defined area of practice.
You would like this group to be able to provide input
into CARNA decision-making on relevant issues.
You would like to help develop knowledge and
competency throughout sharing among peers and
enhance quality of care and standards of practice.
How can CARNA support your SPG?
CARNA will provide an initial grant to help your SPG
get off the ground and will let you know of any members
who are interested in your SPG. The CARNA office may be
used for meetings during office hours. Your SPG can use
CARNA publications for promotion of your group and
use the website for dissemination of information.
In order to be recognized by CARNA as an SPG,
an application process must be completed. Please
contact Policy and Practice Consultant Penny Davis
at [email protected].
Consider joining one of the current
SPECIALTY PRACTICE GROUPs!
Visit nurses.ab.ca > Professional Resources > Practice Resources > Specialty Practice Groups
for contact information.
nurses.ab.ca
Spring 2015 Volume 71 No 1 Alberta RN
27
Perspectives on Bullying
A qualitative study into academic incivility
among nursing students
By Tatiana Penconek, MN, RN
Bullying is a troubling reality in the nursing profession. Unfortunately, as we have discovered,
this incivility between coworkers does not exclusively begin when they begin nursing practice.
In fact, academic incivility occurs between and among nursing students as well.
Academic incivility can be defined as any speech or action that disrupts the harmony
of the teaching-learning environment including, but not limited, to rude, impolite and
disrespectful oral or written words, gestures, actions or behaviours. It can occur anywhere
and include anyone in the learning environment.
I explored the experiences of academic incivility among nursing students in undergraduate nursing education from the perspectives of newly graduated registered nurses
in a qualitative descriptive study.
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Alberta RN Spring 2015 Volume 71 No 1
nurses.ab.ca
Written accounts of nursing student-to-student incivility
were gathered from six participants (newly graduated
registered nurses who graduated six to 18 months ago
from any undergraduate nursing program in Canada)
and online public domain blogs.
After analyzing the content, we discovered four main
categories that embodied the participants’ experiences.
1.Not here to make friends
Participants observed uncivil behaviours ranging from
negative comments, yelling, exclusion, to discriminatory
remarks and hostility. Participants described talking, texting,
questions at inappropriate times, and misusing technology
as uncivil behaviours in the classroom.
Social acceptance was identified as a possible factor of
incivility: “the target [of academic incivility] is not socially
accepted by some nursing students,” or they “didn’t have
a clique of friends in the program with them, were older,
or somehow seemed easy prey.”
Participants related incivility to classroom environments:
“stuffy, uncomfortable auditorium[s],” “150 of us in the class,”
and a “learning environment [that] was not stimulating
intellectually or interesting.”
2.Nobody stood up
Reactions to incivility were to “sit quiet and say nothing,”
“go along with the negative commentary,” “retaliate with
negative comments,” and “becoming anxious,” “upset,”
“guilty” or “taking offence.”
Participants described fears of speaking out about
incivility: “fear of conflict,” “fear of tarnishing rapport
with fellow classmates,” and “fear of offending someone
who has connections.”
3. Making it to the end
Participants relied on personal strengths to deal with
incivility such as “breathing exercises,” “resilience and
positive attitude,” and “connecting with positive students
and faculty who were supportive.”
Participants described the effects of incivility on their
current nursing practice: “the experience [of incivility]
has reinforced the fundamentals of being an effective
communicator… [it] has helped me become more conscientious
of what I’m going to say,” and “made me strive to be caring for
nursing students and new graduates.”
Some participants shared seemingly negative effects on
their current nursing practice: “I am unwilling to put forward
academic or best practice findings in my own practice”
and “in the long run, it has likely impacted my ability to
verbalize my opinions within the workplace. It has impacted
my confidence and sense of self; that I’m not safe to voice
my opinion or I may lose respect from my fellow colleagues
if I say the wrong thing.”
4. The role of nursing faculty
A resounding statement from participants was that nursing
students expected nursing faculty to respond to incivility:
“hoping the professor will say something” and “waiting for
the professor to address it… . We were waiting and waiting.”
Participants looked to nursing faculty to uphold civility:
“students expected the instructor to uphold academic
respect in their classrooms, and felt let-down that this
had not happened.” Participants offered suggestions for
positive learning environments: “it may be helpful to create
an atmosphere, from the beginning, that incivility is not
tolerated [and] to follow up on instances of incivility.”
Implications for nursing education
Promoting a civil learning environment through effective
classroom management, inclusion of civility content and
professional development for nursing faculty are some
practical implications for nursing education.
It is imperative that academic incivility be addressed
throughout nursing education. Nursing students need
to be given tools and guidance in developing comfort,
confidence and competence in speaking out against incivility
in both educational and practice settings with no negative
repercussions.
Educators, administrators and academic leaders need to
assess if services related to academic incivility are appropriate,
accessible and successfully shared with students. Nursing
faculty should model and exemplify civility as well as learn
strategies of fair and consistent enforcement of course
expectations when challenged by student incivility.
Conclusion
Incivility needs to be adequately addressed in nursing
education. Not only do we owe it to our nursing students
to equip them with tools needed to deal with incivility in
nursing education and practice, but we also need to equip
them with knowledge and confidence to engage in, model, and
create civil interactions throughout their nursing education
and into nursing practice. All nurses would be better for it. RN
References
1. Clark, C.M., & Springer, P.J. (2007). Thoughts on incivility: Student and faculty perceptions of uncivil behavior in nursing education.
Nursing Education Perspectives, 28(2), 93-97. Retrieved from http://www.nlnjournal.org
2. Robertson, J.E. (2012). Can’t we all just get along? A primer on student incivility in nursing education. Nursing Education Perspectives,
33(1), 21-26. Retrieved from http://www.nlnjournal.org
3. Perry, B. (2009). More moments in time: Images of exemplary nursing. Edmonton, Canada: AU Press.
4. Elo, S., & Kyngas, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107-115. doi: 10.1111/j.13652648.2007.04569.x
nurses.ab.ca
Spring 2015 Volume 71 No 1 Alberta RN
29
attachment:
ACONNECTION
FORLIFE
Child and adolescent mental health professionals
heal families through learning
By Melissa Adrian, RN
AS NURSES,
we see
the needs of our patients. These needs
can be nutrition, mobility, medication,
or something else that will contribute to
their physical health. However, in child
and adolescent mental health nursing,
a loving relationship with a parent or
caregiver may be just as vital.
I have practised as a registered nurse
in child and adolescent mental health
in Calgary for the past 24 years. Most
of my career has been immersed with
30
Alberta RN Spring 2015 Volume 71 No 1
families struggling with their relationships. Parents who express frustration
in not understanding their child, and
children distressed that they do not feel
loved and supported by their parents.
Both long for a close relationship but
feel lost in how to create one.
Many parents have said they wish
their child came with an instruction
manual. No parent wakes up in the
morning planning to have a difficult
relationship with their child; they
are just at a loss as to how to create a
healthy relationship. Sometimes they
did not grow up with parents who could
nurses.ab.ca
meet their needs and, therefore, they did
not have parenting skills modeled to
them to pass on to their children.
The foundation of a loving relationship is best described by the concept
of attachment. Attachment is the bond
or connection we make with significant
people in our lives. It is most important
at birth, but remains essential throughout
our whole lifetime. The bonds that we
make bring us security in life, especially
during difficult times when we need
extra support and guidance.
The earliest research about attachment
by John Bowlby and Mary Ainsworth
focused on babies and toddlers, but little
attention was given to the pre-adolescent
and adolescent age groups. Youth who
had not bonded with their parent(s)
as babies and grew to have delinquent
behaviours were believed to be unreachable and a lost cause. Today, we realize
that a healthy relationship can still be
nurtured, and problematic behaviours
can improve with intentional efforts by
the parent/caretaker to meet attachment
needs of the preteen and teen.
A
psychologist named Dr. Marlene
Moretti began research on
adolescent attachment about
20 years ago at Simon Fraser
University of British Columbia.
Subsequently, she and her team
developed a parenting program called
Connect. This principle-based, 11-week,
psycho-educational and experiential
group program provides parents with
an understanding of the importance
of their parent-child relationships, and
helps them develop skills to fulfill their
parenting role in more meaningful ways.
Connect has evolved over the past
10 years as parents provided feedback
about how the group could be improved.
Connect groups have been successfully
run throughout British Columbia in
schools, churches and community halls.
And now, the Connect Program has
expanded to other areas of Canada,
including Nova Scotia, Ontario and
Alberta, as well as other parts of the
world, including Sweden and Italy.
There is a growing desire to get back
to what is really important and focus
on our relationships.
IN
Calgary, the Child and
Adolescent Addictions and
Mental Health Program
(CAAMHP) adopted
the Connect program six years ago.
Psychologists Dr. Jody Carrington and
Dr. Caroline Westwood, social worker
Heather Harding and myself, a registered
nurse, were the first to be trained in the
program, implement it at the Alberta
Children’s Hospital, and become supervisors and teachers of the program.
The rollout of the Connect program
into the various CAAMHP services has
been supported and guided by a steering
committee of managers, and a coordinator
role has evolved to keep the Connect
program going.
Over the past five years, CAAMHP has
been able to provide the Connect program
to almost 200 parents, with 12 parents
per group. Twenty-one facilitators have
been trained to support this initiative.
Booster sessions have been offered to
parents who have already been a part
of a group. Education on attachment
has been provided to interested child
and adolescent mental health clinicians
in Calgary to assist in understanding
this essential underlying need that
affects all relationships and behaviours.
This fall, two more groups for parents
of both pre-adolescents and adolescents
are operating within CAAMHP.
T
he Connect program is based
on nine principles to follow in
parenting instead of providing
situation solutions to a specific
problem that may not be transferrable
to other situations. Most significantly,
it instills the belief that parents are
very important to their child or youth
(when they may have started to doubt
that they are important anymore).
It teaches skills like reflecting on the
meaning of behaviour, having empathy
for the youth’s feelings, identifying
underlying needs in the relationship,
responding in the most helpful way
to a child or youth, and repairing a
relationship when something is said
or done that was less than helpful.
And, it provides role-play examples
to illustrate the skills to parents.
The results of the Connect preand post-parental survey indicated
improvements in family functioning
in the targeted areas of the “Parents
sense of competence” and the “Conflict
response from the child to the parent.”
While the overall qualitative effect cannot
yet be determined, further research is
to be completed as we move forward
with this new program.
Families who commit to the program
and attend faithfully for the 11 weeks are
challenged and grow in their parenting
skills, and give the feedback that the
program is the best parent education
and support that they have ever received.
It is not to say that their parent-child
relationships are now without difficulties,
but as difficulties naturally arise, the
parents now have skills to respond more
effectively to the issue while preserving
their important relationship.
When a parent understands their
child or youth, and responds to their
underlying needs such as security, love,
respect, support and independence,
the relationship will not only grow, but
flourish into something very special
that brings greater joy and fulfillment.
The parents who come to the Connect
groups say that they wish for closer
relationships with their children, and
by the time they are finished the program
they have made great progress towards
this goal with hope for the future.
Nothing is more satisfying as a clinician
dedicated to assist families than to see
parents and children come together and
enjoy the relationships they desire to
share. RN
For more information about CONNECT
please contact Dr. Marlene Moretti
[email protected] or go to the website
at http://www.mcf.gov.bc.ca/maples/
index.htm
References:
Moretti, M. M. and Braber, K. (2013).
Connect Parent Program: An Attachment
Based Treatment Program. Simon Fraser
University, Burnaby, British Columbia.
Moretti, M. M., Obsuth, I., Mayseless, O.,
and Scharf, M. (2012). Shifting internal
parent-child representations among
caregivers of teens with serious behaviour problems: An attachment-based
approach. Journal of Adolescent Trauma,
5, 191-204.
Moretti, M., and Obsuth, I. (2009).
Effectiveness of an attachment-focused
manualized intervention for parents
of teens at risk for aggressive behaviour:
The Connect Program. Journal of
Adolescence, 32 (6), 1347-1357.
Hardy, T., Garrick D. and Cawthope D. (2014).
Evaluating the Connect Attachment
Based Treatment Program in a Clinical
Population. Unpublished.
nurses.ab.ca
Spring 2015 Volume 71 No 1 Alberta RN
31
By Lauren Denhartog, RN
FOR
registered nurse Holly Sykora,
printmaking is a peaceful,
reflective process. But it also serves
a very practical purpose – it inspires her
to find creative solutions to everyday
challenges during long hours in the
pediatric oncology and hematology day
unit of Edmonton’s Stollery Hospital.
“Things can get hectic on any unit
and especially when dealing with kids.
You never know if you have a kid who
won’t take meds and you have to figure
out a creative way to get them to take
their meds,” Sykora says.
Her prints feature small, white
shapes in vertical lines set against a
black background. The process involves
etching out an image onto a copper
plate, applying ink and then putting
it through a press with paper on top.
Sykora’s work was part of an
installation on display last month
at the University of Alberta Hospital
in Edmonton put on through the
Friends of University Hospitals’ Arts
in Healthcare Program. It’s part of
a unique initiative that includes
32
Alberta RN Spring 2015 Volume 71 No 1
the University of Alberta Hospital’s
McMullen Art Gallery, Artists on the
Wards and an extensive permanent art
collection encompassing over 2,000 works.
The program sees teams work yearround throughout University Hospital,
placing art in patient rooms and public
areas. Teams also deliver bedside art
programs, while offering free drop-in
art studios each week.
It’s “the most comprehensive
program of its kind in Canada,” says
Ellen Cunningham, McMullen Gallery
and collection manager.
FOR
Sykora, the benefits of making
art are profound. The simple,
repetitive process of etching out shapes
on to a copper plate has helped her cope
with panic attacks she’s experienced – often in the dead of night – for her entire
adult life.
Together with regular yoga and
meditation, making art helps her keep
her cool when facing the unexpected.
“If a kid is crashing and you have
other things going on, it really brings
the stress level down, having a meditation
practice but also the art practice. I don’t
find that I get really stressed out about it
nurses.ab.ca
anymore,” she explained.
“I can take a step back and breathe
and do what I need to do in the steps
that need to happen.”
Sykora further explained the link
between creating a piece of art and
panic attacks in a deeply personal
artist statement that accompanied
last month’s installation.
“These marks have been made by
my hand so many times that I feel
an overwhelming attachment to them.
Each mark has a certain spirit to it,
along with it being part of a larger
whole – in the same way that humans
function in this world,” Sykora wrote.
“Similarly, each panic attack
I experience has a certain spirit, or
energy, and all of them as a whole,
function to teach me something.”
She graduated from the University of
Alberta’s after degree program in 2013
and credits her nursing experience so
far with helping her speak more openly
about her mental illness.
“Part of me feels a bit of responsibility
to say ‘look I have panic attacks and
I’m okay, I’m a fully functional part
of society’,” she says.
Stephen Wreakes/Alberta Health Services
the art of HEALING
Talking openly about mental health
in the nursing world isn’t something
Sykora believes is fully accepted yet.
“I think that a lot of people are very
accepting and open to mental health
issues but there is still a lot of resistance.”
HER
path to nursing came almost
accidentally, while earning
a Bachelor of Fine Arts in printmaking
from the University of Alberta. Prior
to this, she had briefly considered a
career in medicine but decided – after a
semester studying physiology – it wasn’t
for her.
A call came out, through Home Care,
for an artist to illustrate a children’s
book that had been written by a client
who had suffered a serious brain injury
20 years earlier.
Unfortunately, the client passed away
before Sykora could start the project.
She agreed to volunteer with Home Care
anyway and ended up being matched with
three elderly women over a four-year
period.
While she had held various positions
in the arts at the time, the work was
contract-based and Sykora said she
wanted more stability. And since she
loved volunteering through Home Care,
especially working with seniors, a career
in nursing seemed a natural fit.
“I had also learned a little more about
myself, that it was caring for people and
spending time with people that I loved,”
Sykora says of her decision to go back
to school to study nursing.
Prior to her pediatric experience,
end-of-life care had always interested
her and she completed her final preceptorship at the Cross Cancer Institute in
Edmonton.
“It was a great experience. I really
liked the cancer care part of it,” she says.
After school she struggled to find
a job and, after hearing great things
about the Stollery, decided to apply
and eventually landed a position.
“It’s the opposite end of where
I thought I’d be, but it’s exactly where
I’m supposed to be, I’m totally convinced
of that.”
She hasn’t looked back.
“Kids that are sick don’t really know
that they’re sick,” she says.
“Once their symptoms are controlled
they are these funny little human beings
that you would never know are sick.”
relevant exhibitions featuring the work
of professional artists.
An annual Exhibition Jury selects
from proposals submitted by artists
from around the world and which reflect
a range of media, subject matter and
styles.
“The jury looks for quality art that is
beautiful and/or visually interesting and
compelling, art that has a story to tell or
a message to convey,” Cunningham says.
“The jury is also interested in
proposals that connect to health and
well-being, topics that are obviously
of importance of our audience.”
One recent visitor to the McMullen
had tears in her eyes as she thanked
staff for providing such a wonderful
place for contemplation and comfort.
THE
ARTS
Friends of University Hospitals,
which runs Arts in Healthcare,
originally began as a ladies auxiliary
in 1906. Back then, the group raised
$1,000 during its first year by holding
a “monster picnic,” a far cry from the
fundraising gala it now
organizes annually.
While the Friends now bring in over
$1.5 million a year, its values – extending
care and comfort to patients and their
families –haven’t changed.
In 1986, the Friends were officially
incorporated as a charitable organization,
the same year the McMullen Gallery
hosted its first show. A 1,000-squarefoot sanctuary located within the
University of Alberta Hospital, the
McMullen is a quiet and intimate space
that features engaging, inspiring and
Upcoming show at the M c Mullen
From April 11 to May 5, at the McMullen Gallery in Edmonton, artist Brad Necyk
explores the human experience and ground-breaking science of transplants.
Necyk is the 2015 Artist in Residence for Transplant Services, Alberta Health Services.
Working with tissue specialists, donors, recipients, and families at the University of
Alberta Hospitals, Necyk accessed the transplantation process in this unprecedented
artist research opportunity. This exhibition, curated by Tyler Sherard, features short
films and other works that provide a rare view into this life-saving area of health care.
To support organ and tissue donor awareness, the McMullen Gallery’s After Hours space
will feature photographs and stories related to patient and donor family experiences.
McMullen Gallery and After Hours Gallery
Main Floor, University of Alberta Hospital, 8440-112 Street, Edmonton
http://www.friendsofuah.org/mcmullen-gallery/
in Healthcare also runs
Artists on the Ward, an
initiative that brings visual arts, music
and literature to patients throughout
the hospital.
According to Cunningham, many
patients report physical, emotional,
spiritual and intellectual benefits
stemming from their engagement in
creative and artistic activities while
in hospital.
“This has just helped me release a
big ball of pain in my chest. It has just
opened me up here,” said one cardiac
patient, pointing to her chest after being
visited by an artist.
Sykora, who is also the president of
the board of Latitude 53, a contemporary
art gallery in Edmonton, says her work
explores the concept of time as she
experiences it during a panic attack.
“The idea is about anxiety and time
and how time can really warp when
you’re in the middle of a panic attack,”
she explains.
“Time can seem to stand still, or it
can race by, and I think that goes for
most people in life anyways.”
Like the yoga classes she often
squeezes in after a 12-hour shift,
printmaking is another tool in a strong
meditative practice Sykora credits with
helping her not only cope better with
her anxiety but bringing balance to
her life.
“Everything in my life has come
together and makes sense.” RN
nurses.ab.ca
Spring 2015 Volume 71 No 1 Alberta RN
33
NOTICEBoard
S OU T H
CA RN A Education Day:
“Let ’s Ta l k ” – S trategies for
Professiona l Communication
April 13, 2015. Medicine Hat.
nurses.ab.ca
CA RN A Education Day:
“Let ’s Ta l k ” – S trategies for
Professiona l Communication
April 13, 2015. Lethbridge.
nurses.ab.ca
Ed m o nt o n / W e st
the inaugural alberta nursing
informatics boot camp
May 1, 2015. Edmonton.
[email protected],
[email protected]
Operating Room Nurses
A ssociation of Cana da
conference
May 3–7, 2015. Edmonton.
ornac.ca/conference
13 th A nnua l H arm Reduction
Conference
June 2–3, 2015. Edmonton.
albertaharmreduction.com
Misericordia Nurses A l umnae
A nnua l Banquet and Meeting
April 11, 2015. Edmonton.
[email protected]
Cov enant Hea lth E thic Conference
June 11, 2015. Edmonton
covenanthealth.ca/ethics-centre
89 th A nnua l Roya l A l e x andra
A l umnae Banquet
May 1, 2015. Edmonton.
nurses.ab.ca
C a l gar y / W e st
16 th Cana dian Col l aborati v e
Menta l Hea lth Care Conference :
Jump on the Bandwagon !
June 18–20, 2015. Calgary.
shared-care.ca
R EU N I O N S
Misericordia Cl ass of 1965
50 th Reunion
April 10–11, 2015. Edmonton.
[email protected]
Our deepest sympathy is extended to the family and friends of:
Hisset, Gail, a 2002 graduate of Grant MacEwan/
University of Alberta Collaborative Baccalaureate
Program, who passed away on Feb. 3, 2015 in
Vegreville.
Mostoway, Beverly (née Kading), a 1973 graduate
of Saskatchewan Institute of Arts & Science
Technology, who passed away on Dec. 25, 2014
in Edmonton.
Paish, Hazel, a 1942 graduate of Edmonton General
Hospital School of Nursing/College St Jean, who
passed away on Jan. 4, 2015 in Grande Prairie.
Thomas, Alice Ruth (née MacKinnon), a 1946
graduate of the University of Alberta School
of Nursing, who passed away on Nov. 24, 2014
in Edmonton.
EDITOR’S NOTE: Alice was a CARNA Registrar
from June 1973 to March 1977, and a CARNA Nursing
Consultant – Education from April 1978 to December 1979.
Alberta RN Spring 2015 Volume 71 No 1
Univ ersit y of A l berta Hospita l
Cl ass of September 1975 Reunion
Sept. 11–13, 2015. Canmore.
nurses.ab.ca
Roya l A l e x andra Hospita l
Cl ass of 1980 Reunion
Sept. 18–20, 2015. Pigeon Lake.
[email protected]
The submission deadline for events and reunions in the Summer 2015 issue of Alberta RN is
May 8, 2015. Go to nurses.ab.ca for a complete and up-to-date listing of events and reunions
or to submit an event for publication.
I n M e m o ria m
34
Univ ersit y of Lethbridge
Cl ass of 1983 Reunion
July 31–Aug. 3, 2015. Lethbridge.
[email protected]
nurses.ab.ca
PROVINCIAL COUNCIL ELECTION
WHO WILL
REPRESENT YOU
ON COUNCIL THIS YEAR?
Which registered nurses will sit at the CARNA
Provincial Council table, making the decisions
that will affect you and your nursing practice?
It’s all up to you!
Check out the candidates at nurses.ab.ca and
vote starting May 1 by logging into MyCARNA.
SAVE THE DATE: MAY 1–15, 2015
Closing Perspectives
Let’s implement Alberta’s Primary Health Care Strategy without delay
In March, the Rural Health Services
Review Committee released its final
report which states, “For the most part,
residents want primary health care
services, EMS and continuing care
services available in their communities.”
The very first recommendation in the
report is “Implement Alberta’s Primary
Health Care Strategy (2014) without
delay.” I couldn’t agree more. The strategy
creates the foundation for developing and
providing access to robust health-care
services to all Albertans.
The government’s shift in attention
to primary health care and maximizing
the use of all health professionals mirrors
nursing’s holistic approach to health
care and the expressed desire to fully
apply the breadth of our expertise. In
light of the current financial challenges,
the recommendation from the rural
health services review committee to act
is extremely timely. I can’t think of any
reason not to embrace these recommendations now more than ever. We risk
losing the benefit of momentum and
falling back into the status quo.
Both reports make it clear: changing
from a disease-focussed health-care
system to a system focussed on primary
health care will be challenging. The
shift will take time, and will require
significant collaboration between
government, regulators, health-care
professionals, community organizations
and the public. A major hurdle to
overcome will be the recommended
changes to the way health-care funding
is allocated.
The challenge of funding health
care is not new or unique to Alberta.
Neither is the chronic shortage of nurses.
While new graduates keep entering the
profession, the reality is that 30 per cent
of registered nurses are over 50. We can
46
Alberta RN Spring 2015 Volume 71 No 1
put our hands up and give up, or take
this opportunity to make primary
health care a reality. My guess is that
since nurses aren’t prone to just sitting
back, we will rise to the challenge ahead.
For some it may mean new learning
or looking at ways that technology might
improve the delivery of care, or letting
go of certain roles and taking on new
ones. The experience of the staff at the
Killam Continuing Care Centre featured
in this issue is a case in point. It took
one RN to suggest they could do better,
and when they agreed together, these
RNs accomplished a great deal in a very
short time. It wasn’t magic: they engaged
in a dialogue, took on new learning,
assumed a leadership position and
focused on the needs of the patient.
A shift to primary health care is
essential. We can choose to have the
change imposed on us or take control
of our practice. RNs excel at care
coordination, case management; health
education, promotion and helping
people manage chronic diseases such as
Type 2 diabetes, cardiovascular disease,
addictions, and cancer. New doors are set
to open, such as the authority for RNs
to prescribe some medications and order
diagnostic tests. Nurse practitioners
in a primary care setting can provide
patients with greater access and support
to health services. Their advanced
education and scope of practice allows
them to carry an independent caseload,
make referrals to specialists, and most
recently, to prescribe controlled drugs
and substances.
One of the initiatives recommended
by the primary health care strategy is
to encourage and support people to be
more active participants in their care.
In 2009, 70 per cent of Canadians used
the Internet to search for medical or
nurses.ab.ca
health-related information (Statistics
Canada). That was six years ago, and
before the rapid growth of health apps!
Seeking out knowledge about health
and health care is one way patients
engage in their health. RNs need to be
prepared to engage with the “activated”
patient and discuss the learnings, ideas
and concerns that they bring to the
patient-provider conversation.
In many primary care settings, RNs
or NPs will engage with a group or panel
of patients who have a specific chronic
condition. Their responsibilities include
assessing test results, goal setting,
care planning, referral and follow-up
including ongoing problem-solving and
monitoring of the patient’s condition.
The RNs in Killam took this primary
health care approach in their practice
setting.
Evidence indicates health promotion and disease prevention programs,
screening, and identification of risk
at the primary care level can have an
impact on the health of our population
by decreasing the overall burden of
disease in society. In the long term,
we can reduce health-care costs. RNs
and NPs, as the largest group of health
professionals have a vital role to play
in achieving these goals.
“Alberta is changing and so are our
health issues,” says the Primary Health
Care Strategy. I would add that patient
needs are changing and so is the RN
profession. RN
Ma ry- A n n e Rob i n s on,
Chief Executive Officer
780.453.0509 or
1.800.252.9392, ext. 509
[email protected]
MSA, BN, RN
ILLUMINATING SPONSOR
Ready, set… run, walk, pledge!
Join ARNET in an illuminating event to celebrate nursing.
May 7, 2015 6pm Bower Ponds, Red Deer
FABULOUS PRIZES: Be the overall fundraiser and win a Luxury Weekend Under the Stars
at Fairmont Jasper Park Lodge. Be the top fundraising team and win the Ultimate Team
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CELEBRATE AT THE FINISH LINE: BBQ, wrap party and
live entertainment featuring Tera Lee, singer/songwriter/radio personality.
All funds raised support nursing education and improved health care for Albertans.
registEr NOW at
nursesontherun.ca
Alberta Registered Nurses Educational Trust
PM40062713