Navigate Magazine Summer 2016

T h e M e d i c a l P r o f e s s i o n a l ' s G a t e w a y t o H e a l t h & We l l n e s s

MEDICAL TREATMENT WAIT TIMES GIVING THE GIFT OF LIFE BULLYING IN THE WORKPLACE

SLEEPY AND UNSAFE WORKPLACE FATIGUE IN HEALTHCARE

TIPS TO HELP YOUR CAREER HOW TO SET SMART GOALS

Graymatter EDUCATION

S P O N S O R E D E D U C AT I O N & T E A M B U I L D I N G Graymatter Education offers courses, seminars, webinars and many other programs designed to educate professionals and further their skills and knowledge to be applied in his or her line of work. These programs are intended to educate persons on new advancements or to build upon a person’s expertise in a given field. These may be optional for the nursing profession, legal profession or the insurance profession.

We have various topics and certificates of completion are awarded. Canadian Nurses receive credits for their ongoing education.

• Discharge Follow-Up

• Advocacy and Ethics

• Mock Trial

• Funding the Medical

• Brain Injury in the ER

• Pediatric Emergency

System Through the Legal

• Compassion Fatigue

• Record Keeping

System

• Consent Form Education

• Spinal Cord in the ER

• Heart Attack in the ER

• Critical Incident Debriefing

• Teamwork/Adult Bullying in

• Homecare: What Happens

• Cultural Sensitivity

When a Patient Goes Home

the Workplace

• Cancer in the ER

• Insurance Ins and Outs

• Self-Defence in the ER

• Medical Malpractices

• Street Drugs

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The Medical Professional's Gateway to Health & Wellness I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r

PUBLISHER Audra Leslie

E d i t o r i a l a n d Des i gn EDITOR-IN-CHIEF ART DIRECTOR GRAPHIC & MEDIA DESIGNER PUBLISHING COORDINATOR WRITER PHOTOGRAPHY PROOFREADERS PRINTING

Karen Sheviak Kat O’Donnell Angelika Kot Katie Carroll Stephanie Hinds Kat O’Donnell Shutterstock Rob Caldwell Heather Zigelstein North Alliance Press

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INSIDE NAVIGATE NEWS................................................3

ASPARAGUS SALAD RECIPE.............................. 12

EMBRACING CABBAGE........................................4

SHIFT TOWARD HEALTHY EATING...................... 13

SETTING SMART GOALS......................................6

WAITING FOR MEDICAL TREATMENT....................................... 14

3 PIECES OF ADVICE TO HELP YOUR CAREER.......8 HEALING FROM THE GROUND UP........................9 MORE PEOPLE ARE GIVING THE GIFT OF LIFE...............................................9

Co n t a ct

SLEEPY AND UNSAFE........................................ 10

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HIDEOUT ON HOWE......................................... 15 COMPASSION FATIGUE..................................... 16 HOSPITAL INNOVATIONS................................... 19 WORKPLACE BULLYING....................................20

Editor’s Letter

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Working in healthcare is challenging at the best of times, but when other issues compound in the workplace, it can make it nearly impossible to cope with the daily stresses.

A d v e r t i s i n g Pol i cy Breeze Publishing accepts advertising based upon space availability and consistency with its mission to promote health, wellness and lifestyle for medical professionals.

Navigate is not responsible for the content of advertisements, the products offered or the viewpoints expressed therein.

E d i t o r i a l N ote The information provided in this magazine is for educational and informational purposes only. It should not be used as a substitute for the advice of a qualified and licensed practitioner or health-care provider. The opinions expressed here are not necessarily those of Breeze Publishing, its affiliates or parent company. Different views may appear in future articles or publications. Articles in Navigate are copyrighted and must not be reprinted, duplicated or transmitted in any way without permission.

Fatigue is one of those issues, and it’s increasingly in the news and on the radar for researchers and policy makers. The effects of workplace fatigue can be debilitating for healthcare workers, and dangerous for patients. Our story on page 10 covers this and new research that will hopefully influence government policy so there are changes to our healthcare system to help prevent fatigued workers.

Workplace bullying (page 20) is an often overlooked aspect of bullying, and our story, from the Public Services Health and Safety Association, goes in depth into bullying in nursing, the possible causes and the wide-ranging effects. This story is part one in a two-part series, so be sure to pick up our next issue for more information on this timely topic.

Our fall issue will also feature a story on Dr. Homer Tien, the medical director of the trauma unit at Sunnybrook and the chief medical officer at Ornge. Tien served in Afghanistan five times as a trauma physician and is a recipient of the Order of Military Merit.

I hope you find the information in this issue helpful and informative. I’d love to hear your feedback – email me or follow Navigate Magazine on Facebook and Twitter.

Karen

Karen Sheviak editor@breezemags.com

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NEWS

By Stephanie Hinds

THE ONTARIO BUDGET:

WHAT IT MEANS FOR HEALTHCARE

The healthcare industry has long been entangled in the attempt to deal with the province’s deficit. This year, it was no different. The announcement of the Ontario budget revealed spending growth of just 1 per cent — $345 million — to be added to hospital base budgets.

While it may sound like a lot of money, there is a long list of health services that require financial attention.

DIETS:

WHICH ONE IS BEST FOR YOU?

With all the diets out there, how do we know which one really goes the furthest in keeping us at our best? While some diets are lifestyle choices, others are a necessity for those with medical conditions. Here is some insight into whether a vegan, gluten-free or paleo diet could be right for you.

VEGAN

GLUTEN-FREE

PALEO

Someone who does not eat or use animal products. Veganism is a way of life that excludes, to the highest possible degree, all forms of exploitation of, and cruelty to animals for food, clothing or any other purpose. Reports suggest that a vegan diet reduces the risk of heart disease and type-2 diabetes.

The absence of gluten — a mixture of two proteins that causes the elastic texture of dough.

If you have celiac disease, this is a necessity rather than a preference, but many people still choose a gluten-free diet due to the perceived health benefits. A gluten-free diet can improve cardiovascular health.

The paleo diet is based on foods eaten by early humans — meat, fish, vegetables and fruit.

It excludes dairy, grains and processed foods. A paleo diet, because it’s full of whole foods with plenty of vitamins and minerals, can contribute to cell and brain health and muscle development.

The budget announcement revealed several new initiatives for Ontario healthcare: $175 million: To provide patients with access to more services $160 million: To improve access and wait times for hospital services $7.5 million: For small, northern and rural hospitals $6 million: For mental health hospitals But adding and improving these services comes at a cost. The government’s plan to increase income thresholds for deductibles makes drugs cheaper for 170,000 seniors, but seniors with higher incomes will be required to co-pay a dollar more for prescription drug claims, and their deductible will increase from $100 to $170.

While the attempt to increase spending on healthcare is certainly there, critics like Progressive Conservative party leader Patrick Brown, say that the damage of four years of frozen budgets is done – and irreversible.

Brown suggests curbing costs elsewhere, like in home care and administration. These suggested savings might help the government meet its expectation of $3.6 billion in revenue from the Ontario health premium.

NEW REPORT GIVES GUIDANCE ON DOCTOR-ASSISTED DEATH A 70-page report has shifted the landscape of doctor-assisted dying — a widely debated topic among Canadians. A special committee of MPs and senators contributed to the report, entitled “Medical Assistance in Dying: A Patient-Centred Approach,” citing 21 recommendations.

The report gives recommendations on key points of the issue – age of consent, insurance, eligibility, and exempting health practitioners from key criminal

code provisions. It suggests a two-stage legislative process and says that mature minors and mentally ill patients should be included in the right to doctor-assisted death.

In the meantime, Justice Minister Jody WilsonRaybould is working with the provinces toward a “comprehensive and balanced” approach to physician-assisted death. After a series of cabinet discussions and debates in Parliament and the Senate, the assisted dying bill became law in June.

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I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r

Have you read the headlines? “Cauliflower spikes to $8 a head” – CBC; “Soaring cauliflower prices come to a head” – Toronto Star; “Restaurants grapple with cauliflower crisis as prices soar” – Global News. Fresh produce prices have hit an all time high in Canada. It’s tough enough to eat a minimum of five servings of fruit and vegetables daily, but factor in rising prices and our healthy eating intentions become even less attainable. So why is cauliflower (and other fruit and veggies) so expensive and what can we do to get those five important servings and stay on budget?

Media reports explain that rising food costs can partially be attributed to the fact that 80 per cent of our produce comes from outside the country and that the value of the Canadian dollar is at its lowest in over two decades.

The University of Guelph's Food Institute estimates the average Canadian household spent an additional $325 on food in 2015. On top of that, consumers should expect an additional annual increase of about $345 in 2016.

Embracing and other ways to eat healthy

2) Look to Lentils Lentils, kidney beans, chickpeas, split peas and black beans are a wonderful source of iron, zinc and protein (similar to meat), except they are much less expensive than meat. You can cut you grocery bill by skipping beef in favour of pulses. Go meatless or make recipes with half ground beef and half lentils.

Tips to Eat Well and Not Go Broke!

1) Embrace Cabbage Cabbage is an incredibly versatile (and inexpensive) vegetable. You can get far more mileage from a head of cabbage than cauliflower, yet it contains similar nutrients. It can be eaten raw (as in your favourite coleslaw) or cooked in cabbage rolls.

4 | www.navigatemag.com

3) Frequent the Freezer Frozen vegetables are a cost-effective and nutritious option. Most vegetables are frozen within hours of being picked. As a result, the vitamins and minerals get locked in. Sometimes frozen vegetables contain more vitamins and minerals than fresh vegetables, which are shipped and stored, allowing vitamins to degrade over time.

Improving the Life of the E

By Andrea Miller MHSC, RD

Cabbage

amid soaring produce prices!

plan what to buy. This will help ensure most of it gets eaten. Make casseroles, soups and stews, and package leftovers for lunches. Cook only what you are going to use.

6) Root Around for Roots White potatoes, sweet potatoes, carrots, parsnips, onions and turnips are wonderful vegetables, and the affordable possibilities are endless, including soups, scalloped potatoes, mashed potatoes, curries, potato salad and homemade french fries. These veggies are delicious when roasted with a little olive oil and sprinkled with dried herbs, and are great in stews and even in salads.

Try to buy your veggies whole; the pre-cut versions are generally more expensive.

4) Get Canned Canned vegetables are also a good choice, but be selective. Stick to low-sodium canned tomatoes and canned beans and lentils.

5) Waste Less By far, the biggest way to save money is to reduce your food waste. A study from the University of Guelph last year found that the average family wastes $28 a week on food that goes bad or stale. That adds up to more than $1,000 a year.

How can you reduce food waste? Do a big fridge cleanup and take note of how much food you are wasting each week. Then start meal planning. Take one hour each week to look at what you have in the cupboards, browse some recipes, and

7) Slow Down Invest in a slow-cooker. Slow cookers are economical to use and they're great for making the most of budget-friendly ingredients. They offer a healthier, low-fat method of cooking and require a minimal amount of effort. For many dishes, particularly soups and stews, you really can just throw all the ingredients in and let it simmer all day so when you come home from work, dinner is ready to eat!

Finally, to help you eat well and save money, cut down on fancy coffee, pop, candy, cookies and salty snacks and spend that money on healthy calories instead.

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The Medical Professional's Gateway to Health & Wellness | 5

setting SMART Goals I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r

By Kerri Penney BScN, BSc Kinesiology CSEP-CEP, owner of Lifecents | www.lifecents.wix.com/getfit

"If you want to live a happy life, tie it to a goal, not to people or things." ~ Albert Einstein

Whether it is losing weight, getting more sleep, eating healthier or paying off debt, we all set goals in life. Some of these goals are short term, while others are set over the course of a year or more. The pathway to reaching these goals may not always be as smooth as we want, but setting goals gives us a sense of purpose and direction.

Working in the ER is hectic, and those long shifts helping others can sometimes cause us to forget to help ourselves. To help us live a healthier lifestyle, it is important to set personal goals and make our own health a priority. One way to get started is to make sure we set SMART goals.

SMART goals is an acronym for specific, measurable, attainable, realistic and timely. SMART goals are set with specificity, concrete criteria, and a clearly outlined objective that is relevant to your everyday life with a set timeline. These goals enable us to think about and identify specific behaviours we want to adopt in order to achieve our goals.

S

The "S" stands for Specific. It is the what, where, how, when and why of goal setting. An example of specificity would be, I will improve my diet by eating 50 grams of protein and drinking two liters of water every day. Or, I will increase my exercise by walking for 20 minutes three times a week and add 30 minutes of weight training three times a week.

m

The "M" stands for Measurable. It's the concrete criteria that shape the goal and what you will see when your goal is accomplished. For example, I will lose 1/2 pound a week for the first month of my diet plan. I will remove my nightly snack and add an extra 10 minutes of cardio to my workout three times per week.

A

The "A" stands for Attainable. Is this goal within your reach? It's OK to step out of your comfort zone, but it's important to be true to yourself and identify whether the goal you are setting is achievable within your current lifestyle. For example, to reach my goal of a half a pound weight loss per week for the first month of my weight loss plan, I will need to create a 300-calorie deficit per day. I can reach my goal by waking up 30 minutes earlier so I can walk to work instead of taking transit. Also, I will reduce my calorie intake by cutting out one snack each day.

R

The "R" stands for Realistic. How does this goal fit into your current life? Does it integrate well with your other goals? What is the objective behind this particular goal? For example, my long-term goal is to lose 20 pounds by the end of the year. To ensure I am on the right track, I will start slowly and make small adjustments to my current lifestyle in order to not feel overwhelmed by change. My goal of losing a half pound a week is a reasonable starting point and can be easily accomplished in my current lifestyle.

T

The "T" stands for Timely. Make a timeline.

Establish a deadline for reaching your goal. This is where you can break down your goals into 12-month, 3-month and weekly goals.

This makes it easier to clearly outline what it is you are trying to accomplish. For examples of goal setting, visit navigatemag.com.

Remember, we want to achieve goals at least 70 percent of the time. It is best to start slow. Your goals should challenge you, not stress you out. In order to create positive worthwhile change, review your SMART goals every week and then once a month, take a look at your vision to see if you're on track to making it happen.

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Dear Tina, My brother-in-law was refused entry at the U.S. border because he forgot to mention one of his three charges. None of his charges were of Moral Turpitude and all were over 17 years ago. Is there a way to fight this Waiver stuff? – Dino Dear Dino, Even though your brother’s charges were not of Moral Turpitude, the border patrol has the right to refuse access to anyone they want for any reason. Once someone is red-flagged, it is almost never removed, and that person can only gain access into the U.S. by completing and submitting a U.S. Waiver application. Border patrol will refuse Canadian citizens who are not truthful in regards to past criminal events, or under the influence of drugs/alcohol or disrespectful in any way. It’s their country and they protect it as they see fit. You can also be refused access if you are with someone who has criminal charges or who is not behaving appropriately. You can be refused access if you are found to be in possession of unclaimed items as well. Your brotherin-law will require a U.S. Waiver every time he wants to travel into the U.S. He will not be allowed in, over or on the waterways and faces criminal charges if he is caught without a waiver. We offer this service and have been very successful in obtaining five-year Waivers for our clients. Please have your brother call our office to start the process because it could take up to eight months to receive a Waiver Acceptance letter. – Tina Dear Tina, Why does it cost $3,000 for a U.S. Waiver? – Unknown Dear Unknown, Even if you have 15 to 20 charges or convictions, your U.S. Waiver processing fee should never exceed $1,200. Most of our applications are done for under $1,200, and that includes the U.S. fee of $585. It is always smart to shop around, not just for the best price but also to find a company that offers a free appeal services. This ensures that your application is done right and you get the longest possible Waiver. Offering a free appeal means we won’t fail you the first time, and at Freedom Canada we pride ourselves on success. – Tina

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3 Pieces of Advice to Help your Career

By Karen Sheviak

The Soft Skills That Can Help Your Career By the time you are working as a healthcare professional, you have spent years in post-secondary school getting the qualifications you need to start in your profession. And there are ongoing courses that can help you update your skills.

However, paying attention to other skills, known as soft skills, can increase your success in your career.

Communication: Work on communicating clearly with everyone, from patients to coworkers to your supervisors.

Attention to Detail: This may seem obvious, but the stakes are so high in healthcare that attention to detail can be crucial at any moment during your workday, no matter how busy you are or what distractions are around you.

Multitasking: Some healthcare environments are busier than others, but in most cases there will be times when you are pulled in several different directions. The ability to stay calm, prioritize and get everything done in a timely manner is crucial.

Empathy: You need to be able to recognize how information can affect a patient and her family, and act in a way that can help them deal with it.

Professionalism: No matter what you face during your work, healthcare professionals are expected to stay composed so they can focus on their job.

An App a Day If you’re a new graduate in a healthcare, there are a variety of apps out there that can enhance your knowledge and keep you up-to-date on issues in your field.

Notetaking: The most useful apps for medical professionals help with notetaking. Evernote and Noteworthy enable users to write or dictate notes, and e-reader apps such as GoodReader and iAnnotate allow users to edit text in PDFs. 8 | www.navigatemag.com

Medical Reference: There are a variety of trustworthy apps that contain information that can help you in your career. Epocrates, which lists drugs, side effects and interactions, is one of the best.

Be sure to choose one that is reputable, so the information you’re researching is accurate.

Professional Associations: If you belong to an association, downloading their app can keep you in the know about new developments in your field. DynaMed, from the Canadian Medical Association, is an evidence-based reference tool created by physicians for physicians.

Academic Journals: Having the articles from top-notch journals at your fingertips is convenient and keeps you up to date on the most current medical news. The JAMA Network Reader gives access to 11 journals on any device.

A Résumé That Works If you’re looking to change jobs in your field, including the right things on your résumé will help grab the attention of your prospective employer. Here’s what to focus on so you can land your dream job.

• Tailor your résumé to each job you apply to so you can highlight relevant skills and experience.

• Focus on your education. Since many fields in the medical indus-

try are specialized, showing that you have exactly the right degree can be critical.

• List as many skills as possible. Since you could be making decisions that affect people’s lives, the more skills you show that demonstrate your capabilities, the better.

• Include a personal statement. This highlights your accomplishments, tells why you want this position and helps you stand out among other applicants.

Healing from the Ground Up

By Dr. Adrian Robichaud, BSc, DC

know how poor foot alignment and stability can have a dramatically negative impact on how efficiently our body moves and how quickly our bodies show signs of aging.

Poor foot alignment and insufficient support may cause plantar fasciitis, heel spurs, ankle sprains, knee pain, hip pain, poor posture, spinal dysfunction and lower back pain. Fortunately, poor foot alignment and support can be remedied for most of us by wearing foot supports (orthotics) in our shoes. For many of us, these supports will need to be custom fitted since our feet are all unique and very few people have two feet that require exactly the same support.

Custom orthotics are shoe inserts designed to provide you with the precise support your body needs to help balance your posture and optimize walking, running and sport body mechanics. The creation process includes a thorough history and examination, posture and gait analysis, bone position measurements and molds of your feet.

Taking the proper steps (no pun intended) to improve your feet now can help prevent problems in the future.

As I drove to work this morning, I couldn't help but notice the almostflat tire on the car in front of me, and I thought about how that must be causing the car's tires to wear out faster than normal and how that low tire will have adverse effects on the handling of the car. We can all relate to how important proper tire alignment and proper inflation of our tires is to our car's longevity. Sadly, many people don't

Dr. Adrian Robichaud, chiropractor, has been serving Durham Region since 1999. He welcomes your queries and is accepting new patients for chiropractic and orthotics. He practises at Robichaud Chiropractic & Orthotics, 179 King Street East in Oshawa and can be reached at 905-571-0821 or info@ docadrian.com.

More People Are Giving the Gift of Life

By Stephanie Hinds

2015 was a record year for organ donations. More than 325,000 people in Ontario registered their consent to organ and tissue donation. And according to a report by the Trillium Gift of Life Network (TGLN), Ontario’s organ and tissue donations and transplants are on the rise.

The report — released in February — says that more than 2,100 people donated eyes, bone, skin and heart valves last year.

An affirmative registry was adopted in 2008, and since then, the TGLN has reported significant increases in the registration rate — which is now at 29 per cent. This means that 3.4 million Ontarians are registered donors.

In the last six years, statistics show that people in Ontario have made it a priority to become donors. The province has seen 43 per cent more people donate tissue, and there has been a 35 per cent increase in the number of deceased organ donors. Last year, 269 deceased and 279 living donors gave the gift of life to almost 1,100 people waiting for a transplant.

With 2015 being such a successful year, there’s no reason to stop there. Two minutes is all it takes to register at www.beadonor.ca.

Registration has been reported to be a source of comfort for people grieving the loss of a loved one, and helps them determine exactly what their loved one wanted and then follow their wishes.

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sleepy and unsafe

Workplace Fatigue in Healthcare

By Karen Sheviak

For most nurses, being tired is simply a fact of life. From long busy work days to shift times that vary to understaffing and overcrowding, there are plenty of reasons why nurses are fatigued and can’t get enough rest.

10 | www.navigatemag.com

"According to Workplace B.C., 17 hours awake is equivalent to a blood alcohol level of 0.05%, 21 hours is equal to 0.08% and 24 hours, 0.10%."

However, just because something is common it doesn’t mean that it is acceptable. A joint survey of 7,000 nurses from the Registered Nurses’ Association of Ontario (RNAO) and the Canadian Nurses’ Association (CNA) looked at fatigue in healthcare and the effects it has on the quality of care. It found that:

• Nurses

working 12.5 hours or longer are 3.5 times more likely to make a mistake • 80 per cent of nurses polled feel tired after work • About two-thirds of nurses polled work 10 or more overnight shifts in 28 days.

As a result of these findings, the RNAO and CNA came up with recommendations for different sectors that would lessen nurses’ fatigue and improve patient outcomes. Here are some of those recommendations.

Government Recommendations • Ensure adequate funding at all levels, increase the number of registered nurses and enrolments at nursing schools and ensure new graduates have full-time employment • Guarantee that 70 percent of nurses in any healthcare organization are employed full time • Support new research on the relationship between workplace fatigue and nurses' working conditions Healthcare Recommendations • Establish scheduling practices and allow time and space for rest and meals • Document fatigue in the workplace • Educate nurses and management about recognizing and managing fatigue Union Recommendations • Limit hours worked by nurses • Promote allowing nurses to choose the type of shift they would like to work • Review the use of the 12-hour shift • Educate the public on nurses' working conditions Nurses' Recommendations • Be aware of the signs of fatigue • Understand and work within the policies related to safe patient care in healthcare organizations • Take responsibility for managing fatigue while at work or when asked to work extra shifts These recommendations, however, may be difficult to implement unless provincial and federal governments are willing to increase funding to cover the costs. The RNAO/

CNA report was released in 2010, and it seems that little has changed since then.

Henrietta Van hulle is the executive director of Health and Community Services at the Public Services Health and Safety Association, which is funded by the Ontario Ministry of Labour and works with Ontario’s Public and Broader Public Sector employers and workers, providing training, consulting and resources to reduce workplace risks and prevent occupational injuries and illnesses.

She believes that one of the biggest gaps is the lack of research documenting an actual link between fatigue interventions and their effects. “We need to look at any interventions that have been done to address fatigue, and if there was any impact on workplace fatigue from implementing those, but not a lot has been done,” says Van hulle.

She adds that any interventions should be geared at multiple stakeholders, as spelled out in the recommendations. “Middle and frontline managers have a huge responsibility for this. They need to look at it not just as a worker refusing work, but instead link it back to quality of care and take into account the errors and injuries that result from workers being fatigued.”

Workplace fatigue is gradually getting more attention.

There are laws governing how long truck drivers can be on the road each day, and how long pilots can fly, so the professional culture of extended shifts and overtime for healthcare workers, including physicians, is puzzling.

Recently, the World Health Organization called shiftwork a carcinogen, and Van hulle hopes that statement will instigate more research on the subject. "We are connecting with Occupational Cancer Research Centre to look at the next steps from their perspective," says Van hulle. "I think that will help to put a bigger focus on it."

But in order for true changes to come, a variety of groups would have to reach a consensus. “The physicians, medical associations and educational institutions would have to get on board,” she says. “That’s where the difficulty lies – when you’ve got multiple stakeholders.

The government has to provide backing for it and support research to make sure changes are evidence based. In a unionized environment you can’t make swift changes without showing the benefit.”

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What You Can Do While the obvious sign of fatigue is sleepiness, there are other symptoms that are less well-known but just as important to pay attention to, according to the Canadian Centre for Occupational Health and Safety (CCOH). These include irritability, loss of appetite and increased susceptibility to illness.

The effects of fatigue include reduced decision making ability, productivity, attentiveness and reaction time. Workers who are fatigued may also experience increased forgetfulness, errors in judgment, sick time and accident rates.

These effects can have serious consequences, especially in a healthcare environment. But here are some tips from the CCOH that nurses can follow to mitigate the effects of fatigue or, better yet, avoid getting fatigued in the first place

• Aim to get at least seven hours of sleep per night, and go to bed and get up at about the same time every day.

• Keep your bedroom dark and slightly cool.

• Do not work in bed, and aim to shut off your phone, television and other screens at least 30 minutes before bedtime

• Get plenty of exercise and eat a healthy diet based on fresh fruits and vegetables.

• Avoid caffeine, alcohol and tobacco before bedtime.

Studying Fatigue PSHSA has started a study on work-related fatigue.

Researcher Lora Cavuoto will be supplying subjects with Fatigue Science Readibands, which are wristworn technology that monitor sleep patterns, activity and fatigue, says Van hulle. The subjects will be asked to perform a set of tasks, and the variation in relation to fatigue will be measured.

Then Cavuoto will estimate fatigue based on work schedules, sleep and work conditions. The data will be used to measure fatigue within industries that use shifts, such as healthcare and emergency services. “We are trying get a better understanding of when people are fatigued, and perhaps why, and then evaluate the interventions that may be put in place for that individual person,” says Van hulle.

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Asparagus Salad

with Creamy Lemon and Parsley Dressing

By Ernst Bucheler, Sous Chef at the Ajax Convention Centre

This salad, featuring fresh, local ingredients, is crisp, refreshing and perfect for an al fresco lunch. Serve it with grilled salmon for a light main course.

Serves: 4 Prep. Time: 20 to 30 minutes • 500 g fresh Ontario asparagus • Mixed greens of your choice • Tomato wedges Dressing: • Zest and juice of 1 lemon • 3 tbsp mayonnaise • 2 hard-cooked eggs, chopped • 1 tbsp fresh chopped parsley • Salt and pepper to taste

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Wash asparagus well in cold water. Remove bottom quarter of stem and discard. Cut remainder into 2-inch pieces. Boil in water for 2 to 3 minutes, then chill quickly in cold water. Drain and set aside.

Dressing: In small bowl, mix together lemon zest and juice, mayonnaise, chopped egg, parsley and salt and pepper.

Arrange greens on plate and add asparagus. Drizzle dressing over top and garnish with tomato wedges.

TIP: Top with crisped prosciutto to add a salty kick.

A Shift Toward Healthier Eating

By Andrea Miller MHSc, RD

Are you one of the three in 10 Canadians who work shifts? If so, you may find that eating healthy meals and snacks while working shifts can be a challenge. Shift work can upset your body’s internal clock and, for many people, planning and accessing healthy food choices around the clock can be difficult.

Below are some strategies for meal planning, managing the munchies and curbing the caffeine when working shifts. Eating healthy, well-balanced and well-timed meals, staying hydrated and limiting caffeine can help you feel better, sleep better and maintain a healthy weight.

"Shift work can upset your body’s internal clock and, for many people, planning and accessing healthy food choices around the clock can be difficult."

Meal Planning for Night Owls Meal and snack timing is key for individuals working shifts. Long gaps between meals and snacks can increase food cravings, decrease energy and negatively impact your mood. All of this often leads to more frequent trips through the drive-through or to the vending machine or coffee maker. With a little meal planning and a consistent meal and snack schedule, you can improve your nutrition while working nontraditional shifts.

• Plan to eat every four to five hours while you are awake. Eating regular meals and snacks decreases cravings, helps you manage portions and keeps appetite and hunger cues in check.

• Eat your main meal a few hours before going to work, then have a small meal and/or snacks during your shift. This will prevent you from eating a large meal twice, first at home and then again at work, which can may lead to weight gain.

manage weight. For those with access to a refrigerator and a desk or locker, consider packing all your snacks at one time and bring them to work at the beginning of the week so you will be set for the rest of the week.

• A healthy snack includes foods from Canada’s Food Guide. Aim to include two food groups in your snack, such as fruit and a handful of nuts, whole-grain crackers and cheese, or hummus and vegetables.

Keep portions small and skip sweetened snacks.

Curbing the Caffeine Many people consume coffee and tea to stay awake during shifts, but beverages that contain caffeine can affect concentration, coordination, sleep patterns, digestion, blood pressure and behaviour.

Try not to consume more than 400 mg of caffeine a day. That is about the amount of caffeine found in four small cups of regular coffee. Caffeine can stay in your system for up to eight hours. This can affect your sleep.

Switch to decaffeinated drinks, unsweetened herbal tea or water about four hours before bedtime.

Make water your primary beverage. Infuse your water with fruit, cucumber or mint leaves to add a little flavour, and keep it nearby, on your desk or work station. Studies show that if your water bottle is within reach, you will drink more. Staying well hydrated may help you to stay alert and not feel so tired during your shift. Low-fat milk, tea, unsweetened herbal tea and lower-sodium 100% vegetable juices are other nutritious beverages that you can drink. Limit sweetened beverages and 100% fruit juice because the calories can add up quickly.

Finally, take active breaks. Do some stretches, walk up a flight of stairs or go for a brisk walk. Some light exercise will give you energy to finish your shift, improve your mood and help you sleep better.

Andrea Miller is a consulting dietitian in Whitby and an instructor at the University of Ontario Institute of Technology. For more information, visit www. amillerrd.ca or www.dietitians.ca.

For more information on healthy meal planning and snack ideas, visit www.navigatemag.ca.

Managing the Munchies Planned snacks can help improve the quality of your diet, decrease trips to the vending machine and help to

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I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r

Promoting the Responsible Disposal of Medications and Sharps Did you know that in Ontario, the public can responsibly dispose of their unused or expired medications and used sharps free of charge at over 90 per cent of community pharmacies? The Ontario Medications Return Program and the Ontario Sharps Collection Program are 100 per cent industry funded and designed to give the public an accessible means to dispose of these materials. Free sharps containers are available at pharmacy counters.

Sharps not placed into approved sharps containers are not considered safe for transport.

Bleach bottles are not approved containers. Ontarians have access to the free 4.5 L sharps containers at over 3,500 locations province wide. Encourage patients to visit www.healthsteward.ca to find their nearest participating pharmacy for free sharps containers and disposal.

And remember: medications should not be flushed or poured down the drain. Remind patients that they should bring their unused and expired medications back to the pharmacy. Pills should be placed into clear plastic bags with their outer plastic and cardboard packaging recycled.

Liquids and prescription creams should be returned in their original bottles

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By Stephanie Hinds

The debate between American and Canadian healthcare has typically been in our favour because it is easily accessible to us — and virtually free. But according to a December report, the trade-off is how long we have to wait for medical treatment and procedures.

A Fraser Institute study revealed that wait times for treatment deemed medically necessary have not improved in over a year. In 2014, there were 18.2 weeks from when a patient gets a referral from a general practitioner to when they actually receive treatment. But a year later, this number was 18.3, indicating that not only were wait times not improving — they were getting worse.

The wait times depend on the specialty and type of treatment being sought out. The longest wait times are typically encountered when patients seek out orthopaedic surgery.

Total wait time is measured in two segments. The first part begins at the time of referral from a general practitioner. The average wait time in this segment was reported to be 8.5 weeks in both 2014 and 2015. However, this number is 130 per cent longer than wait times in 1993, when it was only 3.7 weeks.

The second segment is measured beginning at the consultation with a specialist, through to the patient receiving treatment. Wait times in this part were reported to be roughly the same — 9.8 weeks — over the last two years. But again, in comparison to 1993, wait times are 76 per cent longer. In 1993, wait times were only 5.6 weeks. Physicians view the wait times we are currently experiencing as well past the state of being “clinically reasonable.”

So what does this mean for the average Canadian? It means that you can expect to wait up to four weeks for a CT scan or an ultrasound and more than 10 weeks for an MRI scan. The consequences of extended wait times, such as the ones Canadians are experiencing, can be detrimental not only to your physical conditions but also to your mental state. As your pain and suffering increases, you face the risk of having reversible conditions worsen to chronic and permanent disabilities, but you can be proactive by ensuring you get your routine checkups and seeing a doctor as soon as you have any concerns.

Hideout on Howe

By Karen Sheviak

What would you do if your mother died suddenly in a limo after an evening celebrating her 51st wedding anniversary. For Chris Monkman, those devastating circumstances prompted him to change his lifestyle so every day allows him to put his family first.

He and his wife, Courttney, moved from St. Thomas and bought a waterfront property on Howe Island, just east of Kingston. And not just any property: called Hideout on Howe Retreat, it is fully off grid, with radiant in-floor heating in the main house and solar power for the house and four surrounding cottages.

“My father lives with us and has dementia, so we can’t go on vacation unless we arrange 24-7 care for him,” says Monkman. “We bought this property so we can homeschool our two young children and enjoy that vacation-type lifestyle every day.”

Visitors will be able to rent cottages by the week this summer at this idyllic island getaway with spectacular waterfront sunset views. Just minutes from Kingston and Gananoque and an easy commute from the GTA, Ottawa and Montreal, the location is perfect for families looking for a quiet place to relax this summer.

“Our retreat is set in a very peaceful and secluded area on the Island yet easily

accessible by either boat or car to major attractions, events and urban amenities,” says Monkman. There is plenty to do nearby, from the historic sites in Kingston to the unique beauty of the Thousand Islands and the picturesque town of Gananoque.

Hideout on Howe features two 2-bedroom cottages with full bath and shower, a singlebedroom with a shower, and a five-bedroom bunkie with its own separate kitchen and two bathrooms. All of the cottages come fully equipped with linens, kitchen equipment, a barbecue and wi-fi. The property also has a full boat launch, and you’ll have the option to go on fishing excursions and boat tours around the local islands.

Another unique feature is that Hideout on Howe can accommodate families who are caregivers for an elderly parent. “For our

first year we will be providing basic daily living assistance and companionship for the time the "family" is away from the cottage,” says Monkman. “Our goal is to provide an inclusive vacation with some free time for the family, whether that's a day out shopping or golfing or a night out camping on one of the nearby provincial island camp sites.”

“It’s important to take that family vacation while you can,” says Monkman. “That’s why we wanted this property; we know how difficult it is for families who are also caregivers. We created this so everyone from seniors to young kids can enjoy a vacation.”

To make a reservation, visit www.hideoutonhowe.com.

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Improving the Life of the E

Compassion Fatigue as an Occupational Hazard

By Robert Durante, Partner at Oatley Vigmond

Many healthcare providers will suffer from some degree of compassion fatigue during their careers. What is compassion fatigue? "Compassion fatigue is a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper."1 Compassion fatigue has also been described as the “cost of caring” for others in emotional pain (Figley, 1982). The helping field has gradually begun to recognize that workers are profoundly affected by the work they do, whether it is by direct exposure to traumatic events (for example, working as a paramedic, police officer, emergency hospital worker); secondary exposure (hearing clients talk about trauma they have experienced, helping people who have just been victimized, working as child protection workers) and the full gamut in between such as working with clients who are chronically in despair, witnessing people’s inability to improve their very difficult life circumstances or feeling helpless in the face of poverty and emotional anguish.

The work of helping requires professionals to open their hearts and minds to their clients and patients – unfortunately, this very process of empathy is Compassion fatigue is considered to be a serious occupational hazard in the helping what makes helpers vulnerable to being profoundly affected and even possibly professions2. Almost everyone who cares about their patients/clients is at risk of damaged by their work. developing a certain amount of it, to varying degrees of severity. Statistics Canada published its first ever National Survey of the Work and Health of Nurses (2005) It is often said that caring too much can hurt. When helpers focus on others without which found that “close to one-fifth of nurses reported that their mental health had practising self-care, destructive behaviours can surface. Apathy, isolation, bottled up made their workload difficult to handle during the previous month.” In the year before emotions and substance abuse head a long list of symptoms associated with the the survey, over 50% of nurses had taken time off work because of a physical illness, secondary traumatic stress disorder now labeled compassion fatigue. Unfortunately, and 10% had been away for mental health reasons. Eight out of ten nurses accessed compassion fatigue has become an occupational hazard in the caring professions, their EAP (employee assistance program) which is over twice as high as EAP use by where people hold themselves to a high level of integrity and service in their work. the total employed population. In addition, nurses reported on the job violence and Compassion fatigue is also characterized by deep physical and emotional exhaustion were found “more likely to experience on the job violence than all other professions.” and a pronounced change in the helper’s ability to feel empathy for their patients, their loved ones and their co-workers. It is marked by increased cynicism at work, Each individual will have their own warning signs that indicate that they may be a loss of enjoyment of their career, and eventually can transform into depression, suffering from compassion fatigue. These will include some of the following: secondary traumatic stress and stress-related illnesses.

• Exhaustion Researchers have also found that compassion fatigue may arise as a consequence • Reduced ability to feel sympathy and empathy of working in high-stress settings with heavy workloads, including busy hospitals, • Anger and irritability where staff are exposed to a large volume of cases and have little time to debrief • Increased use of alcohol and drugs and regroup. Compassion fatigue can also result from being exposed to too • Dread of working with certain clients/patients many patients with similar problems. Eventually, healthcare workers may become • Diminished sense of enjoyment of career desensitized and numbed out, which can affect the quality of care they provide. At an • Disruption to world view, heightened anxiety or irrational fears institutional level, compassion fatigue can manifest itself in rising rates of sick leave • Intrusive imagery or dissociation days, rising rates of medical and disability leaves, and overall worker dissatisfaction. • Hypersensitivity or insensitivity to emotional material When compassion fatigue hits critical mass in the workplace, the organization itself • Difficulty separating work life from personal life suffers. Chronic absenteeism, spiraling Workers’ Compensation costs, high turnover • Absenteeism – missing work, taking many sick days rates, friction between employees, and friction between staff and management are • Impaired ability to make decisions and care for clients/patients among organizational symptoms that surface, creating additional stress on workers. • Problems with intimacy and in personal relationships 16 | www.navigatemag.com

Improving the Life of the E

Learning to recognize the signs of compassion fatigue is important in order to ward off its ill effects. Mother Teresa understood compassion fatigue well. It is said she wrote in her plan to her superiors that it was mandatory for her nuns to take an entire year off from their duties every four to five years to allow them to heal from the effects of their caregiving work. While taking a full year off may not be possible for most of us, taking regular time off work to rest and reenergize our minds and bodies is critically important in managing compassion fatigue. Other things helpers can do to manage compassion fatigue include finding someone to talk to (there are qualified compassion fatigue counselors), exercising and eating properly, developing interests or hobbies outside of work, maintaining good sleep habits and understanding that the pain they feel is normal. Things to avoid include blaming others at work, complaining about coworkers, working harder and longer, self-medicating and neglecting your own needs and interests.

"While the effects of compassion fatigue can cause pain and suffering, learning to recognize and manage its symptoms is the first step toward healing."

While the effects of compassion fatigue can cause pain and suffering, learning to recognize and manage its symptoms is the first step toward healing. There are many resources one can turn to online, and within the community for help. The Compassion Fatigue Awareness Project© is dedicated to educating caregivers about authentic, sustainable self-care

and aiding organizations in their goal of providing healthy, compassionate care to those whom they serve. More information about this organization may be found at www.compassionfatigue.org.

Drs. Figley and Stamm have developed a compassion fatigue self-test called the ProQOL, which can be taken online to assess one’s own level of compassion fatigue. It is considered to be an effective screening tool and it can be accessed at www.proqol.org.

Lastly, there are counselors and therapists who specialise in compassion fatigue and other high-stress workplace illnesses. Françoise Mathieu is one such specialist, and there are several others in Ontario. Ms. Mathieu is a Certified Mental Health Counsellor and Compassion Fatigue Specialist. She works individually with clients in private practice and offers workshops and consultation to agencies on topics related to compassion fatigue, wellness and self-care.

Dr. Charles Figley, Professor Paul Henry Kurzweg Distinguished Chair, Director, Tulane Traumatology Institute, Tulane University, New Orleans, LA 1

Entitlement to benefits for work-related stress is governed by subsection 13(4) of the Workplace Safety and Insurance Act (the “WSIA”). WSIA appeal tribunal decisions involving compassion fatigue go as far back as 2008. For example, see Decision No. 1839/07, 2008 ONWSIAT 176 (CanLII).

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The Medical Professional's Gateway to Health & Wellness | 17

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Improving the Life of the E

Hospital Innovations

By Navigate Staff

Rouge Valley Gets to the Heart of Things Heart racing. Fatigue. Dizziness. Inability to concentrate. These may sound random and different, but they are all symptoms of atrial fibrillation (AF). AF occurs when there is disorganized electrical activity in the top chambers of the heart, which causes an irregular heartbeat.

A North American Pioneer in Kidney Dialysis It’s no surprise that when it comes to innovation in healthcare for children, The Hospital for Sick Children in Toronto is one of the best.

Last year, after five years of research, Sick Kids became the first hospital in North America to introduce a new form of kidney dialysis.

Kidney dialysis is a tough procedure to undergo at any age. It involves being hooked up to a machine that filters waste and toxins from the blood when the kidneys no longer function properly; it takes hours each time and must be done regularly to prevent toxins from building up again.

So for kids and teens who require dialysis, the situation is even tougher. They miss out on school and activities because they are exhausted after treatment, and it causes side effects that can disrupt kids’ daily routines.

With the new dialysis system, called online haemodiafiltration, pure water is infused directly into the patient’s blood stream, which helps to remove more toxins from the blood. This procedure has far better outcomes, including improved blood pressure, more energy and fewer diet and fluid restrictions. And, most importantly for children and teens, patients have more potential for increased physical growth, and often have near normal development.

Researchers at the Central East Regional Cardiac Care Program in the Rouge Valley Health System have developed a new therapy that will help people with AF, so they no longer have to deal with the potentially debilitating symptoms. Called cryoballoon ablation therapy, the procedure uses freezing to treat the exact heart cells that are causing the abnormal heartbeat. Doctors insert a balloon catheter into the affected heart chamber, then inflate the balloon with liquid nitrous oxide. This freezes the balloon, which in turn freezes the heart cells it is touching.

The innovative procedure is performed at Rouge Valley Centenary by Dr. Derek Yung and Dr. Bhavanesh Makanjee, who are both among the most experienced doctors in Ontario who perform the therapy.

Makanjee says that it a “quick, safe and effective” procedure, and anyone with symptoms such as heart palpitations or fainting should talk to their doctor.

According to the Heart and Stroke Foundation, AF affects about 350,000 Canadians. The risk of developing AF increases with age and risk factors such as diabetes, high blood pressure and heart disease. People with AF have a risk of stroke that is three to five times greater than those without the condition.

For more information, visit www.rougevalley.ca.

Sick Kids has a long history of pioneering changes in kidney dialysis.

They established nocturnal home haemodialysis and were one of the first hospitals in the world to introduce peritoneal dialysis for children.

For more information, visit www.sickkids.ca.

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I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r

g n i y l l Bu WORKPLACE

IN NURSING

By Olena Chapovalov and Henrietta Van hulle Courtesy of the PSHSA and the OOHNA

PREVENTION THROUGH AWARENESS Your Human Resources and Occupational Health departments report that there has been a spike in the number of employees going on sick leave in the last two months. A recent staff survey shows that employees are reporting concerns over bullying in the workplace. As an occupational health nurse, you continue to see employees who come to you with concerns over hostile working environments, not working as a team and simply not wanting to be at work because of all the interpersonal challenges on some units.

This real-life scenario speaks to the complexity of the issue of workplace bullying. Creating and sustaining healthy, safe and positive work environments is essential when the goal is to achieve dynamic, high-functioning, cohesive teams that provide high-quality patient care. Unfortunately, something very toxic is continuing to affect our healthcare workplaces.

Most of us have heard the expression that schoolyard bullies are all grown up now and have entered the workforce. For many nurses bullying is a daily occurrence that has a tremendous negative impact that extends beyond the workplace. What is bullying? What does it look and feel like? More importantly, how do we recognize, manage, control and prevent bullying from destroying our workplaces and lives?

Bullying or aggression is also referred to as lateral violence or horizontal violence, which stems from the notion that nurses are often perceived as part of an oppressed population in healthcare. This is mainly due to the close resemblance of the bullying behaviours of oppressed groups. The power structures that continue to exist in healthcare place nurses lower down in the hierarchy of power, which can predispose to increasing aggression among themselves (Griffin, 2004). This is one theory that attempts to provide an explanation to the elevated incidence of bullying among nurses. There are other possible factors thought to be responsible for the bullying behaviours in nursing. Research has shown that the nature of the healthcare environment contributes to increased risk for bullying. Factors such as shrinking healthcare resources, restructuring, stressful work environment, faster pace of patient turnover and patient acuity levels can predispose nurses to high rates of burnout, which in turn increase the likelihood of nurses to abuse other nurses (Rowe & Sherlock, 2005).

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“We had one nurse who constantly put a few other nurses down. She had her targets. Then, as soon as she left, the team was able to work very well together, and everyone felt so relieved.”

DEFINING BULLYING Bullying has been compared to a third-degree burn because it is emotionally and physically painful and leaves scars.

Workplace bullying falls under the general category of workplace harassment that is defined in the Occupational Health and Safety Act as, “engaging in a course of vexatious comment or conduct against a worker in a workplace that is known or ought to be reasonably known to be unwelcome.” Bullying has also been defined in the literature as “repeated and persistent negative acts towards one or more individual(s), which involve a perceived power imbalance and create a hostile work environment” (Salin, 2003). The person being bullied is often known as the target. It is very important to know that bullying is a behaviour and behaviour is a choice. Every worker and employer needs to have a clear understanding of what bullying is and what it entails as workplace parties may not recognize certain acts, such as verbal abuse, as a type of harassment.

Bullying is a counterproductive behaviour point on a continuum of workplace incivility and may precede physical violence, so a clear and consistent definition may encourage reporting and encourage action to prevent harassment and violence (Bartlett, 2011).

Bullying develops from multiple causes, which may include both individualrelated and work-related characteristics (Baillien et al., 2009). Individual-related alludes to the fact that people have different personalities and coping strategies, making some more likely to become bullies. Work-related characteristics speak to the particular aspects of the job, work organization and other factors inherent in the work itself.

RECOGNIZING BULLYING Managers and supervisors need to be aware of the tremendous negative impacts of bullying on staff, patients, the organization and the profession of nursing. Recognizing it early and stopping the behaviours from penetrating deeper into the team dynamics is absolutely critical. There are three main types of bullying in the workplace: topdown, lateral, and bottom-up. All types are seen in nursing, and the most common one is top-down, followed by lateral, and finally, bottom-up (Waschgler et al., 2013).

Potential signs and symptoms that bullying is a problem at your workplace or in your unit can include grievances by employees against their manager, declining work performance of dedicated and hard-working employees, increased stress and tensions between staff in a unit, poor morale, reported fear of a co-worker by other workers, individual symptoms of depression, and increased absenteeism in a team.

The majority of emotionally intelligent managers and supervisors are able to sense when team dynamics take the wrong turn and if there is any evidence of bullying behaviour present in their unit or department, and will take steps to eliminate it.

The Conference Board of Canada, in their recently published briefing titled “Workplace Bullying Primer – What Is It and How to Manage It,” has described the five essential elements of workplace bullying. Mainly from the perspective of the target, the bullying is degrading, intentional, cumulative, associated with a power imbalance and exacerbated by slow and/or ineffective management actions.

IMPACT OF WORKPLACE BULLYING ON THE PROFESSION OF NURSING Nurses care for patients and their families during some of the most difficult times of their lives. They do this by creating caring and supportive environments so patients can feel safe to go through the recovery process. What bullying does is create hostile environments that are detrimental not only to other nurses and coworkers but also patients and their families. There is an irrefutable connection between strong work teams and positive patient outcomes (Manser, 2009).

It has also been shown through research and practice that bullying negatively affects the individual being bullied, the workplace team, the patient and even the system in general. When an individual is a victim to the bullying behaviours, many aspects of their daily work and life outside of work are affected. More specifically, this can lead to lower job satisfaction, errors, absenteeism, chronic disease, weight gain, substance abuse, mental illness and even suicide.

The employer may start to see increased absenteeism, decreased work performance, missed deadlines and/or workplace errors. Costs associated with turnover, retention and worker compensation claims may increase, and a link has been found between bullying and the current recruitment and retention crisis in nursing (Rowe & Sherlock, 2005). In fact, it has been suggested that individuals are deterred from going into nursing or nurses exit the profession to avoid experiencing workplace bullying.

This suffering in silence, searching for a “bully-free” place to work, illustrates the serious consequences of workplace bullying.

SOME COMMON EXAMPLES OF BULLYING BEHAVIOUR INCLUDE:

• verbal aggression • withholding information • withholding job responsibility • trivial fault finding • replacing proper work with demeaning job tasks • setting unrealistic goals or deadlines • rumours • social isolation • personal attack of a person’s private life and/or personal attributes • excessive or unjustified criticism • over-monitoring of work (Salin, 2003; Rowe & Sherlock, 2005)

In this article (Part 1 of 2), we built awareness by focusing on the “what” to help create the foundation for the second article. Part 2 will examine tools and interventions to successfully manage and prevent workplace bullying in nursing Public Services Health & Safety Association (PSHSA) works with Ontario's public and broader public sector workers and employers, providing occupational health and safety training, resources and consulting to reduce workplace risks and prevent workplace injuries and illnesses.

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Jim walks the walk.

Jim Vigmond’s handshake is as firm as his commitment to helping his personal injury clients receive fair verdicts. is founding partner is also committed to his philanthropic pursuits. Among his many charitable organizations, Jim raises funds and travels to Cambodia every year to assist underprivileged women house themselves while giving them the opportunity to go to law school.

Lending a hand comes naturally. With exceptional experience in spinal cord and brain injury law, Jim knows that his legal contributions will make a profound difference in the outcome of his client’s life. For Jim, their right to fair compensation isn’t just of vital importance; it’s his professional mission.

Jim doesn’t have to be in court to talk the talk. Jim would be quick to tell you that despite all his success, nothing compares to the joy of actually being able to make a difference in someone’s life.

AN

LAWYER M A

2015-16

INE AZ G

CANA D I

To learn more about Jim visit www.oatleyvigmond.com/jim

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