ONP Update - May 2008

The Office of Nursing Policy
Health Canada

Celebrate National Nursing Week! (May 12-18)

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On the Inside...

• From the Desk of the Executive Director
• From the Desk of the Assistant Executive Director
• Federal Minister's Message for Nursing Week
• Update on ONP Initiatives
• Recent Events/Initiatives of Interest
• International News
• Federal/Provincial/Territorial News
• ONP Office Staffing News

From the Desk of the Executive Director

As this newsletter goes to "press" Nursing Week is only a week away. Nursing Week is a time when I reflect upon the changing role of nursing and the many opportunities that I have had because of the career choice I made many years ago. I know I am not alone in this experience. Whenever I talk with nurses across this country about their work and their career experiences, I hear similar comments. We work in a wide variety of roles and in many different clinical settings across the health care continuum. Many nurses have had careers that span across academic and institutional settings.

The theme for Nursing Week this year, "Think you know nursing? Take a closer look", invites the public to take a closer look at who we are and what we do. But I think that we should also use this opportunity to reflect upon how diverse the roles and opportunities for nursing have become. While it is true that as a profession we have faced many challenges, there have also been great opportunities. We are a huge workforce of approximately 300,000 nurses: Licensed Practical Nurses (Registered Practical Nurses in Ontario), Registered Psychiatric Nurses and Registered Nurses. We are everywhere in the health system, integrally involved in all levels. We play a strong role in shaping and directing this health system. We see nurses who are direct-care providers, politicians, senior government officials, Chief Executive Officers, researchers, policy advisors, teachers, mentors. The list is endless and impressive.

This year is the Canadian Nurses Association's Centennial celebration- the 100^th anniversary. I can't think of a better theme to encourage not only reflection upon what these 100 years have brought, but also to look ahead at where we still want to go. There are many developments ahead globally and nationally that will change the fabric of Canadian society in ways that we can not even imagine in 2007. Demographic factors will dictate the need for different services in many sectors, including health. The health environment will demand that nurses be flexible, innovative and able to bring the latest skills and knowledge. History has shown that over the past 100 years we have been able to respond to these changing demands- the future holds continued opportunities. All the best for Nurses Week!

Sandra MacDonald-Rencz

From the Desk of the Assistant Executive Director

I am delighted to contribute to this, my 'first' ONP newsletter! I started with the Office of Nursing Policy in December 2007 after four and a half years with the Office of Nursing Services, First Nations and Inuit Health Branch in Health Canada. Each day offers new insights and experiences and I now need to readjust my lens to the big picture of nursing nationally and internationally.

National Nursing Week is always a time to reflect on the many contributions of nurses to the health care system and this year's theme of the 'diversity' of nurses' roles is very appropriate. In my own circle of friends the diversity of roles is amazing: nurse practitioners in small First Nations communities, professors in large universities, administrators in multifaceted community care, palliative-care providers in small farming communities, counsellors for inner-city street youth, and government policy advisors are but some of the examples.

In my own career I've had the opportunity to work in most areas of acute care and community health, in large urban areas and small isolated villages. I've provided primary health care on a team consisting of two and I've developed priorities and programs in a group of 100! I've worked as a nurse on boats and planes, in homes and institutions, and at community events.

The diversity of nursing roles is a key recruitment and retention factor. This 'diversity of roles' provides a ripe environment to attract a 'diversity of individuals' into the profession. We want a multiplicity of personality types, a range of backgrounds, and a range of skills and abilities to accommodate a nursing population that mirrors our Canadian population.

We all have opportunities to counsel someone on choosing nursing as a career and the diversity of nursing and the opportunities the profession can provide are important factors for many of young people today.

The evolving multifaceted nature of nursing is what keeps us strong, contributing and creative. I hope you will find time during this nursing week to search out other nurses and learn more about their work and how they are contributing to health care.

Brenda Canitz

Federal Minister's Message for Nursing Week

May 12 to 18, 2008 is National Nursing Week in Canada. This year's theme is the same as last year "Think You Know Nursing? Take Another Look" which calls on Canadians to challenge their perceptions of the various roles that nurses have in the delivery of health care in Canada.

I know firsthand that nurses are leaders, innovators and pioneers in all areas of health: primary health care, acute care, long term care and palliative care. Nurses' knowledge, skills and judgement contribute to the well-being of individuals, families, and communities in a variety of settings, including very isolated rural and remote areas such as First Nations and Inuit communities. Daily, they work in emergency rooms, they manage complex nursing care units, they visit new mothers and babies at home, they teach in community centres and schools and they provide care throughout the life cycle. They are an integral part of interprofessional teams working alongside physicians, pharmacists and other health care providers.

Within our own Government, many of my colleagues are working with nurses. These nurses contribute significantly to public health, research, policy development, program management, clinical services delivery, in various departments and settings such as Correctional Services, National Defence, Veterans Affairs, Health Canada, the Public Health Agency, and in Aboriginal communities. As consumers of health care, we are all beneficiaries of the knowledge, professionalism, compassion and competence that they bring to our health care system.

This nursing week, please join with me in recognizing and honouring the invaluable contribution that nurses make to the health and wellness of our citizens in communities all across Canada.

Tony Clement

Update on ONP Initiatives

HHR Framework: The year 2005 saw the introduction of Canada's first Framework for collaborative, pan-Canadian HHR planning. Over the next two years, federal/provincial/territorial governments discussed with stakeholder groups, such as regulatory bodies and national Aboriginal groups, to determine how these groups can support and strengthen the action plan of the Framework. Currently, this Framework is utilized by provinces and territories to address and consider their HHR needs.

Using the Framework, jurisdictions still plan their own system of health care and establish their own HHR policies, but in a way that uses collaborative practices and shares information with others. The goal of the framework is to develop and maintain a health workforce that will support health care renewal.

To view the rest of the framework and action plan, please visit Health Human Resource Strategy.

Health Human Resources Strategy Accomplishments: The following are some accomplishments on the three critical areas of the Health Human Resource strategy:

Health Human Resources Planning:

1. Creation of national, supply-based databases for pharmacists, occupational/physiotherapists, medical laboratory technologists, and medical radiation technologists by CIHI;
2. Development of a Federal/Provincial/Territorial HHR Framework and Action Plan.

Inter-professional Education for Collaborative Patient Centred Practice Initiative (IECPCP):

1. Development of an inter-professional curriculum for classroom and clinical settings and an increase in the number of educational institutions providing mandatory inter-professional education courses;
2. Established the Canadian Inter-professional Health Collaborative as the focal point for best practice identification, dissemination, and knowledge translation in the area of IECPCP.

Recruitment and Retention:

1. Increased support for family physicians in primary care and promotional strategies to enhance the image of family medicine;
2. Created the Quality Worklife - Quality Healthcare collaborative and strategy to improve health system delivery and patient outcomes.

HHR Strategy Renewal: In February 2008, Health Canada provided a submission to the Treasury Board seeking renewal of the Terms and Conditions for the Health Care Policy Contribution Program (HCPCP) and a commitment to ongoing funding for the HHR Strategy.

The submission has been approved and is effective April 1, 2008 to March 2013. The submission included a summary of achievements to date, an action plan, and key findings and recommendations from a summative evaluation of the Program. Over the next year, the Program will be working to respond to recommendations from the evaluation report and to implement new performance and risk management strategies.

Additional information on the Strategy's evolution will be provided as it becomes available.

Healthy Workplace Initiative (HWI)

On March 17^th and 18^th, leaders from the HWI projects across the country met in Ottawa to discuss their key project findings and outcomes during a knowledge exchange:

1. Piloting the implementation and evaluation of the Registered Nurses Association of Ontario's Healthy Workplace Environment Best Practice Guideline: Developing and Sustaining Nursing Leadership;
2. Reductions in sick time, time loss claims and associated costs through the integration of a quality, health and safety program;
3. Creation of a healthy workplace by implementing a patient safety program using a comprehensive unit-based safety program (CUSP) framework from John Hopkins.
4. Successful participatory ergonomics in health-care facility design process;
5. Developed customized health promotion program for shift workers;
6. Valid and reliable tool to measure employees' perception of work climate and identification workshop. This event was the third in a series of Knowledge Exchange Workshops to enhance and transfer knowledge around healthy workplace activities and facilitate opportunities for networking.

The majority of HWI projects have ended as of March 31, 2008.

One of the key change management components of the Healthy Workplace Initiative has been the Quality Worklife-Quality Healthcare Collaborative (QWQHC) themes: 1) Culture Shift and System Change; 2) Safety and Injury Prevention; 3) Workplace Assessment and Improvements; and 4) Holistic Approach to Health and Wellness.

Results from the HWI projects include QWQHC which is a national multi-disciplinary coalition of health-care leaders working together to improve the quality of worklife for Canada's health-care providers to improve client care. The QWQHC held its National Summit following the HWI Workshop on March 19^th. The summit was a very successful event which was well attended by approximately 150 participants. The QWQHC launched their 2008 progress report which demonstrated that progress had been made in terms of awareness of healthy work environments and identified areas for future activities. Several workplace champions spoke about their efforts in implementing the QWQHC Action Strategy. The Summit also provided an opportunity to celebrate the over 40 organizations which have signed the Healthy Healthcare Leadership Charter.

The QWQHC has received funding from Health Canada to continue to support activities which will strengthen the awareness and action for healthy healthcare workplaces. More information regarding the QWQHC can be found on the newly launched website: Quality Worklife - Quality Healthcare Collaborative.

Interprofessional Education Collaborative for Patient-Centred Practice (IECPCP): In 2005, a National Expert Committee (NEC) on IECPCP was formed to provide independent expert advice to Health Canada on the development and implementation of the IECPCP initiatives across Canada and assist with the process of implementation and in the promotion of the Initiative. Recently the committee has completed its mandate and a new Health Education Task Force was created to develop recommendations for the Federal/Provincial/Territorial Conference of Deputy Ministers of Health through the Advisory Committee on Health Delivery and Human Resources to address the future of health care education.

The Canadian Interprofessional Health Collaborative (CIHC) is one of several complementary projects funded under IECPCP with a mandate to function as the focal point for best practices identification, dissemination, and knowledge translation in the area of interprofessional education. There is no charge for membership and it is open to everyone with an interest in making lasting changes to Canadian health care. Key accomplishments this fiscal year include the three regional workshops in Western, Central and Atlantic Canada. The intent of these workshops was to increase opportunities for collegial sharing and exchange of promising practice amongst cycle 1 and cycle 2 projects; foster linkages across groups undertaking related initiatives within a specific geographic area; and facilitate transference of IECPCP projects into local regional and provincial programs.

CIHC was successful in receiving additional funding from Health Canada in the amount of $300,000 for fiscal year 2008-2009 to continue their core activities. For more information on CIHC activities or if you wish to become a member, please visit Canadian Interprofessional Health Collaborative (CIHC).

March 31, 2008 marked the closing date of eleven Cycle 1 learning projects under IECPCP. Results of these learning projects are focussed on the development of interprofessional curriculum for classroom and clinical settings and an increase in educational institutions providing interprofessional education courses. For additional Information on Cycle 1 project activities and key accomplishments, please visit Canadian Interprofessional Health Collaborative (CIHC).

Events/Initiatives of Interest

Given the Government of Canada has flagged an interest in the health of families, the ONP is in the process of determining opportunities and foci for policy development related to maternal/child care.

Internationally, nursing and midwifery tend to be twined in health ministries and organizations such as the World Health Organization (WHO). In May 2006, with Canada's support, the World Health Assembly endorsed resolution WHA 59:27 which calls on member states to recommit to strengthening the capacity of nursing and midwifery for the provision of primary health care.

In addition to liaising with national nursing organizations, the ONP has begun to liaise with the Canadian Association of Midwives and the Canadian Midwifery Regulators Consortium.

Midwives are specialists in normal childbirth, providing care to women and families from pre-conception, through pregnancy, labour, and birth, and into the post-partum period. They work autonomously within a defined scope of practice and collaborate with other providers as needed. Forces that are driving a demand for midwifery include: decrease in the number of family physicians providing obstetrical care; impediments to maternity care in rural/ remote areas; and promotion of models of care that offer more comprehensive support than that provided by physicians alone.

The ONP is also starting to link with colleagues in Provincial/Territorial ministries of health whose work focuses on maternal/child care. Within Health Canada, the ONP is working closely with colleagues in the First Nations and Inuit Health Branch (FNIHB), where the government of Canada has a responsibility for service delivery.

Both nurses and midwives have expertise that contributes to the health of mothers, their children, and families. The ONP will be working to strengthen this contribution.

International News

The ONP has been very busy on the international front since January.

We co-hosted (with the VON) a study visit for Margaret Phiri, WHO Africa's regional advisor for nursing and midwifery. Her objective was to explore opportunities to work with Canada to develop a leadership program for nurses and midwifes in Africa. She met with potential funders and stakeholders over a four-day period.

In March, Suzanne Michaud, Senior Nursing Consultant, participated in meetings in Geneva that focused on nursing and midwifery capacity to contribute to the achievement of the Millennium Development Goals.

Sandra MacDonald-Rencz currently sits on the WHO Nursing and Midwifery Task Force to review WHO strategic directions for nursing and midwifery 2009-2015. ONP has consulted with Canadian colleagues on these strategic directions which will be discussed in May at the Chief Nursing Officer meeting in Geneva.

Federal/Provincial/Territorial News

New Brunswick:

On April 1^st the New Brunswick Government released a new Provincial Health Plan 2008-2012:

• By September 1^st, move from eight to two Regional Health Authorities in order to reduce costly duplication; the creation of the New Brunswick Health Council; the consolidation of selected non-clinical services now carried out by the health authorities;
• New or enhanced incentives for physicians, nurses, Licensed Nurse Practitioners and other health professionals;
• Addition of 40 Nurse Practitioners over four years;
• Addition of midwives in the public health system beginning with eight midwives in 2009.

See Department of Health - New-Brunswick for more information.

"Toward 2020: Visions for Nursing in New Brunswick.'' A two-day Nursing Forum was held on March 27^th and 28^th. Eighty participants from all nursing care sectors attended.

• As part of the Nursing Resource Strategy, the Department of Health in cooperation with the Nursing Resource Advisory Committee organized a forum with the goals to identify the major issues and opportunities related to three themes: models of care, scopes and roles; nursing education; and human resources planning. The actions prioritized by the group to meet their vision for 2020 will be part of a report.

Work is progressing toward the integration of midwives as part of the health care system. A bill is being drafted and will hopefully be presented to Legislature this spring.

New Brunswick has joined the other three Atlantic Provinces to form the Internationally Educated Health Professionals (IEHP) - Atlantic Connection. The initiative began in early 2006 with seven projects, which are ongoing. The initiative expanded as of June 2007 to include New Brunswick, and Newfoundland and Labrador. See Internationally Educated Health Professional (IEHP) Initiative.

Newfoundland/Labrador:

Undergraduate nursing students participated with students from pharmacy, medicine and social work in Memorial's Collaborating for Education and Practice Project funded by Health Canada. Students learned about interprofessional collaboration through a variety of learning blocks and modules. As part of a service-learning experience students were provided the opportunity to apply learning from their academic programs to the real needs in the community.

Recruitment and retention incentives include bursaries, signing bonuses, housing/rental subsidy, and travel assistance. There is a focus on assimilation of new graduates in practice through strengthened orientation and mentoring programs.

Finally, the Nurse Practitioner Primary Health Care Program has moved from a certificate to a baccalaureate program.

Northwest Territories (NWT):

Think you know Northern nursing? Take a closer look! In keeping with this year's CNA theme of "Think you know nursing? Take a closer look." the NWT is producing its own take with "Think you know Northern Nursing?" Nurses in the NWT work in very diverse roles and in a variety of settings you don't always see in the rest of the country. A poster featuring some of our nurses will be sent out, and an on-line slide show is being developed as well. How many nurses in the rest of the country respond to emergencies via snowmobile? It's just one of the great photos received so far!

Northern Nursing Leadership Network (NNLN) Annual Meeting: The NNLN consists of all regional nursing managers from across the NWT as well as the nursing consultants who work for the Department of Health and Social Services. This group meets by teleconference each month to discuss issues that impact health care across the NWT. The annual face-to-face meeting will be held in Hay River, NT May 13-15. Agenda items include providing effective orientation for short-term relief nurses, as well as strategies for recruiting graduates from the Northern Nursing Program. The Hay River committee has also planned an outdoor adventure race to test our other skills!

Major Policy and Guideline Revisions Completed: A major accomplishment of one of the NNLN working groups is the completion of the new NWT Policies and Guidelines manual for Community Health Nurses. The update took two years to complete and is the first major revision of this manual since 1990. After receiving final approval from the Deputy Minister it should be ready for release this summer.

Defibrilators for Community Health Centres: Each community health centre in the NWT will receive a defibrilator within the next year. The model chosen is the Lifepak-20. It operates in both manual or semi-automatic mode, provides pacing capabilities, and functions as a cardiac monitor. AEDs will also be placed in a number of community locations around the NWT such as public health units and arenas.

Saskatchewan:

The Saskatchewan Party, under the leadership of Brad Wall, have formed the new Government. The NDP is now the official opposition. Saskatchewan is showing commitment and leadership through the many exciting recruitment and retention initiatives in the province, including:

• A new Legislative Secretary for Nursing Recruitment and Retention who reports directly to the Minister of Health;
• An innovative partnership agreement with the Saskatchewan Union of Nurses outlining a framework for recruitment and retention of 800 nurses (www.sun-nurses.sk.ca);
• An additional $2M for enhanced nursing professional development to complement quality-workplace and continuing-education funding already provided to the health regions;
• Support to the Saskatchewan Registered Nurses Association so they are able to offer timely licensure review and processing for internationally-trained nurses;
• Implementation of a province-wide mentorship program alongside a guaranteed supernumerary employment program for new graduate nurses;
• A provincial recruitment agency that has been to career fairs to recruit health-care professionals in Canada and overseas. The Ministry is providing support to the orientation and integration of internationally-educated nurses into Saskatchewan health workplaces. Job postings from the different health regions and the Saskatchewan Cancer Agency as well as links to incentives, licensure information, key contacts, and information about the job location are available on the agency website; www.healthcareersinsask.ca
• $31.7M for safety equipment and training to enhance the health and safety of front-line nurses and other health professionals;
• $6M Relocation and Recruitment Grants for nurses and other health providers; this initiative has been so successful that an additional $4M has been added to the program and new recruitment targets have been set;
• $6M Retention Program that funds projects addressing specific retention issues in the workplace. Projects must address retention themes of leadership, staffing and workload, provider image, team building and communication, flexible work environments, professional development, safe and supportive workplaces, and embracing technology. Successful projects to date include, for example, aboriginal peer-support networks, succession management, interprofessional mentorship, safe and healthy workplace strategies and many more. Further information may be found on Department of Health - Saskatchewan (www.health.gov.sk.ca).

Yukon:

The Government of Yukon has established several nursing initiatives aligned with our HHR strategy and supported through monies received from the Territorial Health Access Fund.

One strategy implemented to help ensure confident and competent practitioners, is the nurse mentorship program. This coordinated program offers nurses mentorship opportunities in acute care, community nursing, continuing care, and community health. Recognizing issues exist in regard to workload and capacity, the program offers backfill funds for mentors, allowing for dedicated mentoring time.

Several activities related to the program includes a three-day mentor training and skill development workshop, the development of competency and resource tools for practice, and the establishment of a "wiki" page housing mentor resources and a forum for networking. Ongoing evaluations and changes throughout the program will ensure relevance to the Yukon.

A second strategy focuses on education for the future nursing workforce. Without a formal registered-nurse training program in the Yukon, a nursing bursary was set up to provide support to Yukon residents who wished to pursue careers in nursing and encourage a return to service in the Yukon upon completion. The bursary program has thus far supported 24 student nurses in their training. A recent evaluation of the program indicates that of those who have completed training, 67% have returned to work in the Yukon. Of the graduates completing training this year, 100% are expected to return.

ONP Office Staffing News

The ONP is pleased to welcome new staff:

Maria Boadway, FSWEP Student (May-August 2008), works with a Senior Policy Analyst in a variety of research and communications activities.

Melanie Hamilton, Administrative Assistant, provides administrative advice and general office support.

Ann Seguin, Administrative Assistant, focuses on assorted administrative tasks, including travel arrangements and claims.

Don Wildfong, Masters Practicum Placement (May-June 2008), will work with a Senior Nursing Consultant in a variety of policy development activities.

The ONP also says farewell to:

Caitlin Crossley, CO-OP Student (January-April 2008), worked with a Senior Policy Consultant on this newsletter and on the issue of the need to enhance the diversity of the health care workforce.