VOLU M E 24 ISSU E 2 • FALL 2010
ISSN 1920-6348 CARE
“Win Win” Education Infused with Collaboration A Look at Addiction One LPNs Story
Safety Net Fatigue and interruption risk
Online Renewal New this Fall
! llege o equip o C uest for LPNs t grams Q r o o ith N pecificallyly, these pr w d s ea t a nt ned e ah esig s t im p o r nt s . v d o s m o am tie s can tion progr ositions. Mare for pa e s r a c p ! uc Nu of eir oday tical ntinuing edded for th r standard T c r a e r ou t e dP gist n ab opedics, e of co ation ne g a highe e o s i e R t g n a n in rth ra or m .ca duc Lice rovid e inf uest wi d e n in O ed e c a rp ffer dva n lls fo am We o ith the a h the ski rogr his p p e di c T t w s i . c s i w c tho edi p ed them e LPNs thop or or r tho id O in o r ar t m ent e s . v g n o i n i r p t ic ep iiaaliizz ation p r ac nc y d sp ec Educ e by , emerge ient care c i d t c e l nc om f pr a nd c pe o a ca st ro t skills a Adva r sco n in
u e wo r k e s sm n d yo Expa s you to vital a ss e n ar ar Ns p re p u w i l l l e s or LP c t ion f Yo . t n i n o l I nj e sis i u a t p e a m s r c lA de Edu rgic a an d I nt r a u in g of Su ula r n a i s l t e l n c p y i Co e r a p n g Pr i n c I n t r a m u s n Th i on f u s i o a re – U s t r a t i o n – n I t ion t r at i ▶ r r i g a Ad m i n i s n d C Ad m i n i s I u r o e la d d i c at i o n ▶ W ication Nursing nd Bla ed ed h na o i t nd M a ▶ M tal Healt eriz a z et i a p eu t i c s en h t M a ▶ yC her r ina r gy T ▶ U rmacolo nt e m s ha ▶ P lt h A s ses ies Tube ud ea ia St soga stric ▶ H tia n e em Na ▶ D r t i o n of r se he n s I e r ▶ Re f h t a ▶ M
care | VOLUME 24 ISSUE 2
or tio orq For m d Educa eider@n e hn nc Adva nnifer.sc e j bou t : il on a i ema t a a il : m infor tion, em e r o a For m ing Educ est.ca u u n q i r 00 Cont nEd@no 4 - 60 o 4 C 6 N LP : 780 , c a ll r e t s gi To re
a est.c u q r . no www
inside fall 2010 VOLUME 24 ISSUE 2
8 “Win – Win” Innovative collaborative practice generates positive effects in practical nurse classrooms, fostering and showcasing trust, respect, and teamwork. Cover photo: LPN Elisabeth Degen, with students by Karen Campos, NorQuest College
From the College
The Safety Net
Know Your Healthcare Team
The Operations Room
Effects of Fatigue and Interruptions
Profile: Naturopathic Practitioners
Stay Informed with Member Information
feature 16 One LPNs Story Addiction struggles can be life changing. This brave story of recovery and management gives an enlightening glimpse into one LPNs experience.
CARE is published quarterly and is the official publication of the College of Licensed Practical Nurses of Alberta. Reprint/copy of any article requires prior consent of the Editor of Care magazine. Editor - T. Bateman Signed articles represent the views of the author and not necessarily those of the CLPNA. The editor has final discretion regarding the acceptance of notices, courses or articles and the right to edit any material. Publication does not constitute CLPNA endorsement of, or assumption of liability for, any claims made in advertisements. Subscription: Complimentary for CLPNA members. $21.00 for non-members.
8 care | FALL 2010
from the college INFLUENCING THE THOUGHT OF OUR TIMES… “He who influences the thought of his times influences the times that follow. ” - Elbert Hubbard. KUDOS AND CONCERNS: ALBERTA HEALTH ACT By the time you read this, public consultation on the new Alberta Health Act will be over and we’ll all be waiting for the results. The CLPNA was pleased to provide feedback in July to the Minister’s Advisory Committee on Health (MACH) on their report, “A Foundation for Alberta’s Health System”. The stated objective of the Alberta Health Act is to consolidate the 30 pieces of legislation and 100 regulations that currently guide the health system. Amongst those pieces is the Health Professions Act (HPA), which provides for self-governance for 73% of health professionals in Alberta including LPNs. The HPA provides the authority and framework for the business of the CLPNA including governance, regulation, continuing competence, professional conduct, and the creation of Bylaws, Code of Ethics and Standards of Practice. It is understood that the HPA will eventually be consolidated into the Alberta Health Act (Appendix 4, “A Foundation for Alberta’s Health System”). CLPNA is supportive of the principles of the new Act and of the focus on full utilization of health professionals. Principles such as a commitment to quality and safety, equitable access to timely and appropriate care, decision-making through using best available evidence, a focus on wellness and public health, and fostering a culture of trust and respect are worthy and achievable expectations. We expressed to MACH our convictions regarding the importance of long-term planning and resource allocation, better definition of overlapping professional roles, supervision of unregulated workers, removal of barriers that prevent full workforce usage, policies that foster interdisciplinary collaboration, and the alignment of legislation that promotes safety.
Different levels of nursing bring different contributions, and we heard how much that matters to you…
A few big picture concerns were shared. While evidence-based practice decisions are important to ensure quality, much of nursing research focuses on the Registered Nurse in acute care settings. Since the enactment of scope of practice of Alberta’s LPNs is broader than most other jurisdictions in Canada and the US, we strongly encourage the support of research regarding Alberta LPNs. This will ensure increased evidence for decisions in important policy areas such as staff mix, safety, and utilization.
Additionally, we feel the proposed patient charter requires more explanation. Currently, the concepts discussed for a patient charter are already covered under the Code of Ethics and Standards of Practice of each health profession, and under the Canada Health Act. It is unclear how centralizing this in one document would create change. More clarification and evidence of effectiveness of this type of charter is necessary.
COLLABORATION: FOCUS OF CANADIAN NURSES ASSOCIATION An opportunity to network with other nurse regulators and leaders in Canada arose in June at the 2010 Canadian Nurses Association (CNA) Annual Meeting and Biennial Convention in Halifax, Nova Scotia. The Canadian Nurses Association is “the national professional voice of registered nurses, advancing the practice of nursing and the profession to improve health outcomes in a publicly funded, not-for-profit health system”. Over the last five years, CLPNA has seen the CNA’s stated goals increasingly include a focus on collaboration. This trend was again reinforced during the inaugural address of incoming president Dr. Judith Shamian when she stated, “… for the next two years, I see myself as being a member of every nursing group in every community, every province, and a global nurse.” Dr. Shamian spoke of the power of over 260,000 RNs, and nearly 80,000 LPNs and registered psychiatric nurses in Canada. But as she said, “The numbers are irrelevant if we don’t act.” Dr. Shamian closed the conference with this final encouraging message: “Different levels of nursing bring different contributions, and we heard how much that matters to you. We heard about clinical nurses, generalist nurses, advanced practice nurses, policy nurses, researchers, LPNs and RPNs. Everybody brings a contribution and we have to work together.” CLPNA welcomes these messages and believes we can expect positive influence nationally toward collaboration during Dr Shamian’s tenure. Hugh Pedersen, President and Linda Stanger, Executive Director
care | VOLUME 24 ISSUE 2
care | FALL 2010
CLPNA’s Alberta Health Act Submission
• removal of barriers that prevent full workforce usage, including flattening of administrative structures to ensure flexibility and responsiveness • creation of policies that foster inter disciplinary collaboration • the alignment of legislation that promotes safety, and policies and procedures that include effective feedback loops The CLPNA believes in a health care system in which each profession should do what it does best, where overlap is minimized, and where each professional is expected to work to the full extent of their skill and ability. Turf protection, job protectionism, and political posturing of the old guard threaten teams every day. Interprofessional trust must be built throughout the health care system.
his spring, CLPNA welcomed the Government of Alberta’s invitation to participate in the review of the Minister’s Advisory Committee on Health (MACH) “A Foundation for Alberta’s Health System” regarding the proposed Alberta Health Act.
This profession is committed to working within a comprehensive, universal, portable, publicly-administered, and accessible health care system. We are pleased to support the Government of Alberta’s commitment to these guiding principles, which are the core of the Canada Health Act; and its commitment to sustainable public health care.
How the Alberta Health Act affects LPNs
CLPNA is generally supportive of the principles of the new Act and the focus on full utilization of health professionals.
The stated objective of the Alberta Health Act is to consolidate the 30 pieces of legislation and 100 regulations that currently guide the health system. LPNs are regulated by one of those pieces, the Health Professions Act (HPA), which currently provides for self-governance for 73% of health professionals in Alberta.
Principles such as a commitment to quality and safety, equitable access to timely and appropriate care, decision-making through using best available evidence, a focus on wellness and public health, and fostering a culture of trust and respect are worthy and achievable expectations.
The HPA provides the authority and framework for the business of the College of Licensed Practical Nurses of Alberta (CLPNA): governance, regulation, continuing competence, professional conduct, and the creation of Bylaws, Code of Ethics and Standards of Practice. The CLPNA develops policies and procedures in order to accomplish the mandate of ensuring LPNs practice safely, competently, and ethically. Since the Health Professions Act will be consolidated within its framework, it is important to ensure the principles ex-
care | VOLUME 24 ISSUE 2
pressed in the Alberta Health Act support appropriate care to Albertans recognizing the value of the LPN.
Our Perspective CLPNA expressed to MACH convictions regarding some additional principles proposed for inclusion in the Act. These include: • the importance of “long-term planning and resource allocation to ensure consistent, high-quality care” in addition to funding • better definition of overlapping professional roles to ensure professionals can focus on what they do best • ensuring supervision of unregulated workers
Several opportunities were shared with MACH. One is that while evidencebased practice decisions are important to ensure quality, much nursing research focuses on the Registered Nurse in acute care settings. We strongly encourage the support of research regarding Alberta LPNs. This will ensure stronger evidence for decisions in important policy areas such as staff mix, safety, and utilization. Additionally, we feel the proposed patient charter requires more explanation. Currently, the concepts discussed for a patient charter are already covered under the Code of Ethics and Standards of Practice of each health profession, and within the Canada Health Act. It is unclear how centralizing this in one document would create positive change. More clarification and evidence of effectiveness of this type of charter is necessary.
Recommended Reading The CLPNA recommends that its members learn more about the Alberta Health Act and its impact on health care in Alberta and the LPN profession. Explore the Alberta Health Act website (http://www.health.alberta.ca/initiatives/your-health-act.html). The Minister’s Advisory Committee on Health (MACH) report, “A Foundation for Alberta’s Health System,” is also available on that website. n
research n spring 2009, the Health Quality Council of Alberta (HQCA) began a multi-year collaborative project - the Blueprint Project - to develop a framework for patient safety education in Alberta. The goal is to ensure all those involved in providing health care have a common understanding of key components of patient safety and quality and use this to continually invest in making patient care safer.
Blueprint Project aims to help transform patient safety education in Alberta
The project aims to identify consistent key messages related to patient safety that should be incorporated into educational programs at all levels (undergraduate, postgraduate, workplace learning) for all health care workers (support staff, front-line care providers, managers, senior executives, and board members). This will be accomplished by developing high-level learning outcomes and objectives that are relevant to different groups of health care providers for each learning topic. In spring 2010, the project team conducted an environmental scan to determine the extent to which a systems approach to patient safety is currently being addressed in undergraduate education programs for regulated health care providers in Alberta. In addition, feedback was gathered on a self-assessment tool for patient safety education that the project team is developing. The tool will help post-secondary health care provider education programs determine where they are at in the process of integrating a systems approach to patient safety into their programs. Blueprint Project partners include the HQCA, Alberta Health Services, University of Alberta, University of Calgary, University of Lethbridge, Mount Royal University, Northern Alberta Institute of Technology, Norquest College, Canadian Patient Safety Institute, British Columbia Patient Safety and Quality Council, Manitoba Institute for Patient Safety. The HQCA, through the Blueprint Project, is co-sponsoring a new certificate course on patient safety at the University of Calgary. The course runs September 2010 to March 2011. Information on the course is available at www.hqca.ca/index.php?id=215 A brochure explaining the project and a document outlining the six foundational patient safety principles that underpin all topics the Blueprint Project will address is now available from the HQCA. For more information, contact Ms. Dale Wright at 403.355.4439 or firstname.lastname@example.org.
Do you have a desire to improve the health, wellness and quality of life of older adults? Network with other Nurses interested in gerontology!
www.agna.ca care | FALL 2010
win-win Take blood out of the body, clean, refresh, and return. Thatâ€™s how the heartbeat of life in a hemodialysis unit has been described. The scope of LPN practice in renal units in
Education Infused with Collaboration
Alberta has expanded, creating arguably
the most technically challenging healthcare
skill set environment for an LPN, and placing them at the forefront of LPN practice in Canada. But life as an LPN in a hemodialysis
By Chris Fields & Sue Robins
unit is also a much deeper human experience: itâ€™s at the soul of humanity.
care | VOLUME 24 ISSUE 2
An old African proverb states, “It takes a village to raise a child.” In the nursing world, it’s clear that it takes a team to create a nurse. These teams must be committed to impart the values, beliefs, and perspectives necessary to build the theoretical/science of nursing as the base on which the practical/art side of nursing can blossom and grow. NorQuest College’s Practical Nurse Diploma program, based in Edmonton, Alberta does just that, with a team of passionate nursing educators. Jason Dunne is Dean of the faculty of Health Sciences at NorQuest College. “NorQuest’s LPN and RN staff members complement each other. They come with different perspectives and experiences,” says Jason. “Together they create the best possible learning experience for the student practical nurse.” NorQuest College actively recruits instructors who are regulated health professionals who possess relevant education and experience. NorQuest is committed to ensuring students are exposed to the best faculty and staff to facilitate optimal learning. They also offer opportunities for interested LPN instructional assistants who have begun relevant baccalaureate studies to move into development instructor roles. As a learning institution, NorQuest encourages employees to pursue professional development opportunities and provides a variety of in-house opportunities through its faculty development department. This philosophy supports staff in their own professional growth while continually striving to provide a state-of-the-art educational experience for each student; it truly is a win-win! >
care | FALL 2010
Elisabeth Degen worked as an LPN for 20 years in palliative care and surgery before becoming an instructor at NorQuest. “Because my position is fulltime casual, I teach a whole range of courses – whatever comes open each term,” Elisabeth says, “I also cover off when the other instructors are on holiday.” Elisabeth has been teaching at NorQuest for six years, first as an instructional assistant and now as an instructor. “Our department is scattered through different buildings. We have different departments, theory, and lab people. I would say as a whole, the collaboration of LPNs and RNs works really well. The number of LPNs has
increased and roles have expanded. LPNs have so much to offer as educators; after all it is our profession.” Elisabeth teaches in the classroom. “I am lucky because there are always openings. The coordinators come to me at the beginning of each term and tell me what is available. Because I have taught almost all of the theory courses, I have been able to move through them and prep each one so I have a broad knowledge of all of the different courses,” says Elisabeth.
care | VOLUME 24 ISSUE 2
Instructors do their own theory courses and then cover a distance course. If they teach health assessment, they might cover health assessment for distance. They look after all the emails and all the assignments. During the summer months, Elisabeth covers for all of the vacationing instructors. “This is another role for me,” she says, “It is interesting and I like it.” When asked if there were areas shewould like to see improved, she responded, “I would like to see people get more exposure to other people’s jobs,” says Elisabeth. “We are all nurses; we should all be able to do each of these roles. It would help everyone to better understand each other’s jobs.” Elisabeth
is only one example at NorQuest of instructors who are passionate about patient care and preparing exemplary nurse graduates. Nursing instructor Alexis Young is an RN with a diploma in nursing and three and a half years experience teaching. Always encouraged to pursue professional development opportunities, Alexis is currently working on her degree. Alexis’s boss and team leader is an LPN. “We don’t differentiate between LPNs and RNs,” says Alexis, “as long as each
team member knows his or her job.” NorQuest has developed a team approach to instruction. Working closely together, each team member brings his or her own knowledge to the experience and each learns from the other. Prior to any lab, the team members research the topic. Then they meet and discuss best practices. One of the team members demonstrates to the group. This could be an instructor or an instructional assistant. The team members discuss and analyze the demonstration. Then they present to students. Everyone, from the instructional assistant to the program coordinator, has input. Everyone’s opinion is valued. “I have found it to be the best way to approach instruction,” says Alexis.
This style of instruction is a natural evolution. Alexis was a bedside nurse for more than 20 years, and has seen health care change. “There are phenomenal opportunities for LPNs today,” says Alexis. “The scope of practice is much broader than it was ten years ago. LPNs are working in specialized areas that they never worked in before, such as cardiology and pediatric clinics. This says something about the quality of the training that colleges, like NorQuest, provide.”
Lynne Neis is passionate about teaching. She is an operator/instructor in the NorQuest Interdisciplinary Simulation Centre (NISC). “I love having the students come in,” says Lynne. “We create a friendly atmosphere for them. Positive
attitudes help students build confidence.” “NorQuest instructors are not identified as RNs or LPNs. Everyone works as a team. We have faith and trust in our staff and respect their experience and expertise.” Lynne was a bedside nurse for 15 years. She became an instructor after taking some time out for her family. She took the refresher program at MacEwan. She enrols in internal workshops at NorQuest to keep her skills current, and attends conferences, workshops and seminars. Lynne started teaching in the lab, and then moved to the NISC. She does the setup and arranges the scenarios for the
students. She sits behind one-way glass and operates the high-fidelity patient simulator creating the symptoms as the students work through the scenario. Acting out the part of the patient through the computer simulation, Lynne controls the instructional mannequin to exhibit symptoms in response to procedures that the student nurses are performing, with the technology enhancing the learning experience.
All of the scenarios are videotaped, allowing the students to receive immediate feedback. The teams also debrief for peer-to-peer input and feedback. Often they are able to make their own analysis – identifying problem areas while improving confidence. “We create a positive atmosphere, asking what they would do differently next time, not what went wrong,” says Lynne, “They are evaluated, not tested”.
The operators role-play continuing care, surgical acute care and medical acute care. The scenarios are dress rehearsals for the students as the NISC shows what they might encounter in a real environment. A major benefit is they are able to practice in a safe environment prior to clinical practice.
“We have great staff who work together very well. Everything is for the benefit of the students,” adds Lynne. “We prepare our students to give the best possible patient care, as they are front-line caregivers,” says Lynne.
Sandy Davis has been an LPN for 28 years. Her role at NorQuest has changed in the 8 years with the College. She is now Assistant Coordinator of Lab/Clinical for the Practical Nurse program, with responsibility to oversee lab and clinical instruction. Although Sandy has only been in this role a short time, she taught in the lab and as a clinical instructor for several years prior. “I have a well-rounded knowledge of what we do working in the lab to prepare the students to integrate theory and skill acquisition, so they are prepared for clinical,” Sandy shares. >
care | FALL 2010
Lab and clinical instruction draw on a process called guided practice, which provides a non-threatening environment more conducive to learning. Guided practice blends the value of coaching, mentoring, and teaching students, and the value the team of instructors plays in this flexible approach is immeasurable. â€œOur intent is to bring expertise, knowledge and experience as a team to our students, and I think we do it really well. We are preparing our students to best serve our nursing community and to work well with other disciplines.â€? Sandy also has a role in managing staff and student issues. â€œBecause they know me, they come to my office, say how their day is going and I offer encouragement. That is what we are here for â€“ the success of the student.â€? Sandy is obviously another example of a team player. â€œOur program needs both disciplines of nursing and we are
proud of how well our program works, as are NorQuest students.â€? The NorQuest PN Diploma program puts the needs of student practical nurses first. All of the NorQuest instructors interviewed agree that they love their jobs. The passion for teaching and nursing is evident in the NorQuest staff. â€œOverall I would give my job a nine out of 10,â€? says Elisabeth. â€œI love my work â€” I love teaching. I love being an LPN and I am very proud to be one, and I tell my students daily.â€? Lynne explains the unique side of collaborative nursing that exists in their team. â€œItâ€™s about who you are as a person, your personality and your years of nursing experience that shapes you as an instructor. Then we collaborate nurse to nurse. Thatâ€™s what makes each of us unique individuals who offer a variety of life experiences, knowledge, and pas-
sion to our students to give them the ultimate learning experience.â€?
There is no doubt â€“ collaborative practice and leadership are showcased at NorQuest College. Faculty teams are integrated, communicative and respectful, and the resulting model for students shines through. The respect the team has for the broad discipline of nursing is showcased every day. What a great place to start â€“ teamwork role modeled from the first day as a student nurse. n
Many thanks to NorQuest College for participating in this feature story. This story is Part 1 of a two part series on collaboration in practical nurse education. Watch for Part 2 in next issue of CARE.
Albertaâ€™s Licensed Practical Nurses, Key Health Care Professionals 7KH$OEHUWD8QLRQRI3URYLQFLDO(PSOR\HHVÂł$OEHUWDŇ‹V ODUJHVWXQLRQÂłUHSUHVHQWVPRUHWKDQ/LFHQVHG 3UDFWLFDO1XUVHVSURYLQFHZLGH 7KHVH GHGLFDWHG /31V DUH DPRQJ PRUH WKDQ IURQWOLQH QXUVLQJ FDUH HPSOR\HHV DQG PRUH WKDQ KHDOWKFDUHHPSOR\HHVUHSUHVHQWHGE\$83( $83( LV FRPPLWWHG WR HQVXULQJ WKDW $// KHDOWK FDUH HPSOR\HHV DUH UHFRJQL]HG IRU WKH LPSRUWDQW UROH WKH\ SOD\LQTXDOLW\SXEOLFKHDOWKFDUH
care | VOLUME 24 ISSUE 2
The Safety Net: A Nursing Perspective Effects of Fatigue and Interruption By Linda Nykolyn, R.N., BScN
This article is the third in a series focusing on the critical role of nursing in keeping patients safe from harm. This month’s article raises nurses’ awareness of two important factors that create error-prone situations in healthcare and of strategies to risk manage these factors in the workplace. The patient safety literature describes many factors that create the conditions in healthcare that increase the risk of human error which can result in patient harm. There are two factors in particular that are highly relevant to nursing: fatigue and interruptions.
Fatigue Nursing is hard work. It tires the mind, the body and the emotions.1 When prolonged working hours, including use of extended work shifts and overtime, are also taken into consideration, it is easy to understand how quickly nurse fatigue can occur. Fatigue is described as the disinclination to continue performing the task at hand and is caused by either mental or physical exertion.2 The effects of fatigue on human performance include: 3,4 • Inability to concentrate • Lapse of attention to detail • Short-term memory loss • Decreased speed of mental processing • Decline in problem solving and decision making • Perseveration on ineffective solutions • Reduced vigilance • Reduced reaction time and psychomotor coordination • Poor communication • Increased negativity and irritability; bad mood Evidence informs a strong relationship between fatigue and impairment and the increased potential for human error and risk to patient safety. For example, most nurses would not consider going into work after having a couple of drinks of alcohol. Yet these same nurses, would probably not think twice about working a double shift, or going without sleep for as long as 24 hours before the first night shift in their rotation.2 Rather than signs of dedication or endurance, these behaviors pose risk to patient safety. Studies reveal that when individuals have been awake for as few as 17 hours straight, their cognitive and psychomotor performance deteriorates to equal that of someone with a blood alcohol level of .05%.5 After 24 hours of sustained wakefulness, performance deteriorates to a level of 0.1%, well over the legal definition of impairment in Canada.5
A study by Rogers6 that examined prolonged working hours and error rates in nursing, revealed a significant increase in nursing errors after 12.5 hours worked, when working overtime, and when working more than 40 hours a week. Alarmingly, evidence also informs that nurses and physicians do not appear to recognize their own level of impairment or the role that fatigue can play in harmful events. In one study that compared attitudes about fatigue between medicine and aviation7, approximately 60% of intensive care and operating room nurses and physicians indicated that even when fatigued, they believed they performed effectively during critical situations. In comparison, when pilots were asked the same question, only 26% of pilots agreed. In aviation, flight crews are educated on the limitations of human performance related to fatigue and stress and on the resulting increased potential for human error. Tired pilots manage their fatigue by saying they are tired, asking other crew members to keep an eye on them, and reallocating workload as necessary during the flight.7 Nurses should feel as comfortable in telling each other that they are fatigued, recognizing their increased risk for error. They should feel safe and supported in asking colleagues to double check their medication calculations and to provide a second opinion on clinical interpretations and nursing judgments. The Institute of Medicine points out that in hazardous highrisk industries, fatigue from long working hours is recognized as a potential for error that can cost hundreds of lives.8 Most of these industries have implemented safety countermeasures. As an example, in the airline industry, there are specifications that define how many hours a pilot can fly and how many >
care | FALL 2010
hours of rest are required between flights.9,10 In the transportation industry, truckers can be behind the wheel for a maximum of 13 hours in a 24-hour period.11
PROFESSIONAL DEVELOPMENT MODULES )RU+HDOWK&DUH3URIHVVLRQDOV Grant MacEwan University offers print-based self-study registered courses to health care professionals wishing to renew/advance their nursing practice knowledge.
Course offerings: Â‡ 1XUVLQJ2ULHQWDWLRQ5HVRXUFHV5HYLHZDQG Update (up to 24 different courses) Â‡ /HYHO,,1XUVHU\2ULHQWDWLRQ7KHVHPRGXOHV FRQWDLQWKHNH\VWRDFFXUDWHDVVHVVPHQWDQG LQWHUYHQWLRQVIRU6SHFLDO&DUH1XUVHU\/HYHO ,,1XUVHU\DQG1HRQDWDO,QWHQVLYH&DUH8QLW nursing staff who care for the newborn. Â‡ $GYDQFHG1XUVLQJ6NLOOV Â‡ ,QLWLDWLRQRI,QWUDYHQRXV7KHUDS\7KHRU\ Â‡ ,97KHUDS\/DE Â‡ (PSOR\HU6XSHUYLVHG&OLQLFDO 'HPRQVWUDWLRQ/DE Â‡ 0HGLFDWLRQ$GPLQLVWUDWLRQE\,93XVK Â‡ 1HZERUQ+HDOWK$VVHVVPHQW Â‡ 6XSSRUWRIWKH%UHDVWIHHGLQJ'\DG Â‡ ,QWHUSUHWDWLRQRI/DERUDWRU\7HVWV 'LDJQRVWLF3URFHGXUHV Â‡ 6SHFLILF6WXG\Â˛2QH&UHGLW Â‡ 0HQWDO+HDOWK'LVRUGHUV Â‡ 2EVWHWULFV Â‡ 2QFRORJ\ Â‡ 3HGLDWULF1XUVLQJ Â‡ *HURQWRORJLFDO1XUVLQJ Â‡ 7UDXPD1XUVLQJ
For more information contact the Centre for Professional Nursing Education at 780-497-4511 or visit www.MacEwan.ca/RN.
care | VOLUME 24 ISSUE 2
Nursing associations have issued position statements regarding patient safety and nurse fatigue.12,13 The position statements articulate the ethical responsibility nurses have to consider their level of fatigue when deciding whether to accept any assignment extending beyond the regularly scheduled work day or week, including a mandatory or voluntary overtime assignment. The delivery of healthcare relies heavily on human cognition and executive functions such as judgment, logic, complex decision-making, detection, memory, vigilance, information management, and communication.2 Clearly, large-scale system solutions are needed for staff scheduling that takes the human factor of fatigue into account and takes a serious stand on determining which is worse for patient safety â€“ a tired nurse or no nurse at all?
Interruptions Nurses and other healthcare providers function within an interruption-driven work environment. Interruptions are defined as an uncontrollable and unpredictable stressor that results in information overload and cognitive fatigue.14 Interruptions have a marked effect on human performance causing diversion of attention, stress, fatigue, forgetfulness, and error.15,16,17 Specifically, when a nurse is interrupted while performing a care intervention or is on her way to follow up on a patientâ€™s response to treatment or to call a physician, her attention is shifted away from these activities and is focused upon the new incoming information. During this shift of attention, the nurse may forget where she left off in the procedure and miss a step or she may forget her follow up intentions or to call the physician, each of which pose risk to patient safety. Of great concern is that the nurse may not be able to formulate a complete and coherent picture or mental model of the current state of her patientsâ€™ needs.18 Without a coherent mental model, critical thinking and problem solving may get lost in an interruption-driven workplace. This in turn affects both clinical decision-making and patient safety and accuracy of the patient situation that is shared with other care providers. In a study by Potter19, nurses were interrupted an average of 30 times during their 12 hour shift. At the time of interruption, the nurses had anywhere from 11 to 19 patient care activities on their mind that they had to perform. Although patient harm did not occur, the nurses averaged four omissions during their shift. Omissions included missed assessments, incomplete patient education, missed interventions, and failure to communicate essential patient information to a healthcare colleague. Interruptions appear to be the communication norm used in healthcare. Studies indicate that interruptions make up to 30 per cent of all communications between care providers.20 Interruptions occurred on average every 12.6 minutes in an emergency room study21 and at a rate of 14 per hour in an intensive care study.22 In the latter study,
interruptions accounted for 37% of total time spent in communication and physicians were responsible for 58 per cent of interruptions; nurses accounted for 42 per cent of interruptions. Healthcare providers tend to prefer interruptive synchronous face-to-face or over the phone channels of communication over less interruptive asynchronous channels such as written notes, electronic messaging, and voice mails.23 The preference for synchronous communication appears to be that care providers are reassured with immediate acknowledgement that conveyed messages had been received and acted upon. Additionally, synchronous channels are typically the available routes of communication in the healthcare system. Just as with fatigue, nurses and other healthcare providers do not seem to be aware of the risk of human error that is introduced by interruptions.23 The aviation industry has recognized the consequences of interruption particularly when they occur when an individual is concentrating on a particular problem or complex task. Strategies recommended for reducing vulnerability to interruptions used in aviation may be applicable to healthcare, include recognizing that interruptions are a powerful distracter and by scheduling activities to minimize interruptions, especially during critical junctures.24 Clearly, some interruptions are necessary to call attention to urgent situations; however, there is greater risk for human error when they are the norm for communication. Safer work environments can be achieved through education and raising awareness of the consequences of interruptions on human performance and patient safety, and through the development of new mechanisms and technologies that minimize the need to generate interruptions in the first place.22 In summary, fatigue and interruptions are factors that create error-prone conditions in the nursing work environment. Both are workplace hazards that can affect the nurseâ€™s ability to create a coherent picture of the total patient situation. Lack of a coherent patient situation can result in inadequate patient monitoring, delays in recognizing and communicating patient status changes, errors in clinical judgment, and performing inappropriate interventions that can cause patient harm. By raising awareness, nurses can become knowledgeable about the factors that lead to errors, be willing to act to fix the problems contributing to error, call for public policies that will support safer work environments, conduct research on nursingâ€™s contribution to patient safety, and make personal commitments to modify their own behaviors that may contribute to unsafe care.25 n This article, including references, is available for download from the Resources page of www.clpna.com in the CARE magazine section.
BUILD YOUR SKILLS G8IK$K@D<:FLIJ<J=FI?<8CK?:8I<GIF=<JJ@FE8CJ E8@K:fek`el`e^<[lZXk`fef]]\ijXYifX[iXe^\f]Zflij\j]fi k_\_`^_$[\dXe[_\Xck_jZ`\eZ\jgif]\jj`fej%C\X[`e^$\[^\ kiX`e`e^b\\gjpflXkk_\kfgf]pfliĂ”\c[#n_`c\Ă•\o`Yc\[\c`m\ip fgk`fejc\kpflal^^c\k_\[\dXe[jf]XYljpc`]\n`k_pfli \[lZXk`fe%
CPR - BASIC LIFE SUPPORT FOR HEALTHCARE PROVIDERS LEVEL C RENEWAL [CPR101] J\\nnn%eX`k%ZX&Zgi]fiZflij\j[Xk\js(''
ELECTROCARDIOGRAPHY [ML602] :fek`elflj@ekXb\s).'
ITLS BASIC PROVIDER [ITLS100] J\\nnn%eX`k%ZX&`kcj]fiZflij\j[Xk\js+''
IV CERTIFICATION [MRI500] ;\Z+#)'('s=\Y(0#)'((sDXp.#)'((s),'
PHLEBOTOMY (VENIPUNCTURE) WORKSHOP FOR HEALTH CARE PROFESSIONALS [ML500] FZk)*)+#)'('sAXe(,(-#)'((s+.,
VASCULAR ASSESSMENT WITH ABIâ€™S [DMS55] J\gk((#)'('sAXe)0#)'((sDXi)-#)'((sDXp)/#)'(( *)'
;fnecfX[X:fek`el`e^<[lZXk`feZXc\e[Xi Xknnn%eX`k%ZX&:fek`el`e^<[lZXk`fe =fidfi\`e]fidXk`fefikfi\^`jk\i# ZXcc./'%+.(%-)+/ AN INSTITUTE OF TECHNOLOGY COMMITTED TO STUDENT SUCCESS ((.-)Ă†('-Jki\\ken<[dfekfe8cY\ikX:XeX[Xk,^)i( www.nait.ca
care | FALL 2010
care | VOLUME 24 ISSUE 2
here’s a quiet strength of character in Rhoda, an Edmonton-area LPN who has lived through ten years of addiction.
She’s been clean for three years, been through rehabilitation, and survived the suspension and subsequent reinstatement of her LPN licence. “I suspect there are a lot of nurses struggling with addiction,” says Rhoda. She wants to share her experience with CARE Magazine for that very reason. “I want to tell others who are living with addiction that there’s hope,” she says. Rhoda herself is proof that there is hope – she’s seen the light at the end of a dark tunnel. Rhoda’s story starts in 1990 when she became an LPN. At the time, she was a single mom of two teenage girls, and was working as a receptionist at a hair salon. Going to NorQuest College gave her a focus and career, and she continued her learning with geriatric assessment courses and orthopedic specialty certification. Over her twenty years as a nurse, she’s worked in acute inpatient, long term care, and emergency. Today she is an LPN at a walk-in clinic – a job she’s had the past two years as she finished rehab and started rebuilding her life. Her addiction was to prescription pain killers, and it is hard for her to talk about it. “I don’t know how it started,” she says quietly, “It took years to develop into an addiction.” “Somewhere along the way, I found that the pills worked to help me with other issues in my life. I used them as an escape, and over the years, the addiction became progressively worse,” she recounts. Going through the recovery process has given Rhoda great insight into herself as a person. “I was using drugs for the wrong reasons. It got to the point where the drugs were running my life. The addiction affected everything – my relationship with my family, my job, and my health.” “I don’t know how many times over the years I said, ‘I’m going to stop this’. I tried, but I never did,” she admits. Eventually, she had an incident that was reported to CLPNA, and she lost her job. She had to comply with orders
from a CLPNA Hearing Tribunal to ensure public safety, but that didn’t slow down her addiction. Then, compounded by pain brought on by a partial knee replacement, her addiction became worse. “All I could think about all the time was the drugs and how I was going to get them. It was crazy. It is hard to explain...” Rhoda trails off. There was another incident, and Rhoda lost her job again and this time had her LPN practice permit temporarily suspended by CLPNA until a Hearing Tribunal could hear the case. This was what Rhoda terms, ‘the bottom’. “It was a huge blow when I lost my job the second time. It was just enough. I was tired of the craziness and I didn’t want to lose my whole career,” she says. This stark realization made her quit taking drugs entirely. This time it stuck, and it was the beginning of a journey to recovery that’s lasted three years.
by Sue Robins
care | FALL 2010
“First, I went through physical withdrawal. I had the support from my two daughters, and one of the doctors at work referred me to an addictions doctor. I found out who my real friends were during that time,” shares Rhoda. Rhoda ended up going to an inpatient rehabilitation program for an initial six week period. At the end of the six weeks, Rhoda made the decision to stay for the long term program, which was another three months. “It wasn’t until I was in rehab that I came to terms that I was an addict. It was a real eye-opener for me. I’m a really private person, and it took me the first six weeks to even start talk about things – it was really hard,” she admits. Rhoda is thankful for many things, including her profession as a nurse. She spent a three month stint working in a deli at a grocery store after she got out of rehabilitation. “I went home in tears every night from that job because of the way some of my co-workers would treat me. It made me really appreciate the professionalism that came with my job as a nurse,” Rhoda says. With the help of an understanding friend, who is also an LPN, she eventually got a job as a medical office assistant while she was waiting for her CLPNA disciplinary hearing. Rhoda terms her support network as “blessings in disguise”. This includes the Clinic Manager and physicians at the walk-in clinic. Rhoda’s circle of support contains people who are non-judgmental and understand that life brings challenges. We’ve all been through rough
care | VOLUME 24 ISSUE 2
times, and we’ve all done things we regret. “The College (CLPNA) were good with me, too. They were helpful and they saw I was making strides to getting the help that I needed.” Rhoda shares the lessons that she’s learned in recovery. “I never stop learning – they teach you that in rehab. I’ve discovered more ways to deal with life on a daily basis.” This includes meditation, not holding emotions inside, exercise, and appreciating living life in moderation, not excess. “Now I feel much calmer, and I handle daily stress a lot better. My life isn’t a bed of roses, but I’m a lot more content than I used to be.” Rhoda knows she still has issues that she deals with on an ongoing basis – but now she doesn’t do it alone. There are many pieces required to rebuild a life. Rhoda’s pieces include weekly attendance at Narcotics Anonymous meetings, where she can share her story, and help others who are embarking on a similar path. She regularly sees her addictions doctor and her family physician, and appreciates the support of her work colleagues who know about her past, and she has conditions on her LPN practice permit. “I don’t think people realize how widespread addictions are,” she says, “there are all sorts of addictions other than just alcohol and drugs: Internet, gambling, food. I think people are having trouble handling modern day life and they turn to these addictions as a way to cope.”
Rhoda wanted to be healthy for her four grandchildren, and now she is. She spent Canada Day with them going to the fireworks, and knows that she enjoys them more now that she is addictionsfree. She’s calmer and she’s more present. “I feel like I have my head back now,” she says. In her job, she’s taken on more responsibilities in her LPN role at work. As she says, “I’m better spiritually, mentally, and physically.” Her advice for other nurses struggling with an addiction? If you even think you have a problem – ask for help before it gets out of hand. (Please see sidebar for resources). In the end, Rhoda says, “I would like to say I’m grateful for the help I’ve received from my family, friends, colleagues, and the College.”
The journey Rhoda has undertaken the past few years has allowed her to bloom: “I know I’ve been given a second chance at life,” she says. n
Living with an addiction? Here’s where to go for confidential help: 1. Contact your Employee Assistance Program that’s available through your place of work 2. Contact your union. For example, AUPE has a Member Assistance Program (MAP). Contact them by calling: 1-800-567-9953 or emailing email@example.com 3. In Alberta, contact the 24-hour Addiction Helpline (formerly AADAC): 1-866-332-2322 or www.aadac.com 4. Talk to your family doctor.
know your healthcare team
Profile: Naturopathic Medicine in Alberta The following article has been submitted by the Alberta Association of Naturopathic Practitioners
aturopathic medicine has a long history in Alberta — the Naturopathic Association of Alberta (NAA) was incorporated in 1944. The Alberta Association of Naturopathic Practitioners (AANP) is the successor to the NAA and has been maintained to the present day. The growing popularity of naturopathic medicine and an increase in the number of naturopathic doctors in the province, led to increased interest in regulating naturopathic medicine under the Health Professions Act (HPA), which resulted in the inclusion of naturopathic medicine as Schedule 14 of the HPA in May of 1999. We are currently in the final draft of our regulations and expect to see it come into law in the fall of 2010. Presently, the following provinces are regulated: British Columbia, Manitoba, Ontario, and Saskatchewan. Nova Scotia is in process. In the United States, Alaska, Arizona, California, Connecticut, Hawaii, Idaho, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington as well as the U.S. Territories of Puerto Rico and Virgin Islands have regulations. There are active regulatory efforts in nine additional provinces and states. Each of these jurisdictions requires that naturopathic doctors be trained, complete registration exams, and are regulated under a provincial or state regulatory body. Once regulated, the AANP will transition to the College of Naturopathic Doctors of Alberta. At present, there are 112 practicing naturopathic doctors in Alberta, and approximately 1600 in Canada. Naturopathic medicine is one of the fastest growing health professions in the country.
WHAT IS NATUROPATHIC MEDICINE? Naturopathic medicine is a distinct system of primary health care - an art, science, philosophy, and practice of diagnosis and assessment, treatment and prevention of illness. Naturopathic medicine is distinguished by the principles
which underlie and determine its practice. These principles are based upon the objective observation of the nature of health and disease, and are continually reexamined in the light of scientific advances. Methods used are consistent with these principles and are chosen upon the basis of patient individuality. Naturopathic physicians are primary health care practitioners, whose diverse techniques include modern and traditional, scientific and empirical methods. The Health Professions Act (2008) defines naturopathic doctors as those who: “a) promote health, prevent illness and treat disease by using natural therapies and substances that promote the body’s ability to heal, b) focus on the overall health of the individual on the basis of naturopathic assessment and common diagnostic procedures, and
c) provide restricted activities authorized by the regulations” (Schedule 14, p. 199). The following principles are the foundation for the practice of naturopathic medicine: The Healing Power of Nature (Vis Medicatrix Naturae) The healing power of nature is the inherent self-organizing and healing process of living systems which establishes, maintains, and restores health. Naturopathic medicine recognizes the healing process to be ordered and intelligent and the naturopathic doctor supports, facilitates, and augments this process by identifying and removing obstacles to health and recovery, and by supporting the creation of a healthy internal and external environment.
care | FALL 2010
know your healthcare team Identify and Treat the Causes (Tolle Causam) Illness does not occur without cause. The underlying causes of illness and disease must be identified and removed before a patient’s complete recovery can occur. Symptoms can be expressions of the body’s attempt to defend itself, to adapt and recover, or to heal itself from the cause of disease. The naturopathic doctor seeks to treat the causes of disease, rather than to eliminate or suppress symptoms. First Do No Harm (Primum Non Nocere) Naturopathic doctors follow three precepts to avoid harming the patient: • Naturopathic doctors utilize methods and medicinal substances to minimize the risk of harmful effects. • We apply the least possible force or intervention necessary to diagnose illness and restore health. • Whenever possible the suppression of symptoms is avoided as suppression generally interferes with the healing process. Naturopathic doctors respect and work with the vis medicatrix naturae in diagnosis, treatment, and counseling, for if this self-healing process is not respected the patient may be harmed. Doctor As Teacher (Docere) The original meaning of the word “doctor” is teacher. A principal objective of naturopathic medicine is to educate the patient and emphasize self-responsibility for health. Naturopathic doctors also utilize the therapeutic potential of the doctor-patient relationship. Treat the Whole Person Health and disease result from a complex of physical, mental, emotional, genetic, environmental, and social factors. Since total health also includes spiritual health, naturopathic doctors encourage individuals to pursue their personal spiritual development. Naturopathic medicine recognizes the harmonious function of all aspects of the individual as essential to health. The multi-factorial nature of health and disease requires a personalized and comprehensive approach to diagnosis and treatment. Naturopathic doctors treat the whole person by considering all the above mentioned factors of health and disease.
care | VOLUME 24 ISSUE 2
Prevention Naturopathic medical colleges emphasize the study of health as well as disease. The prevention of disease and the attainment of optimal health for our patients are the primary objectives of naturopathic doctors. In practice, these objectives are accomplished through education and the promotion of healthy ways of living. Naturopathic doctors assess risk factors, heredity and susceptibility to disease, and make appropriate interventions in partnership with their patients to prevent illness. Naturopathic medicine asserts that one cannot be healthy in an unhealthy environment and is committed to the creation of a world in which humanity may thrive.
Naturopathic colleges also participate actively in research, most with internal research centers, because of the commitment in the naturopathic community to establishing evidence based naturopathic medicine. Of those schools also offering Asian medicine, most have reciprocity agreements with medical schools teaching traditional medicine in China and other SE Asian countries. Currently,
EDUCATION AND TRAINING Accredited Naturopathic Medical Schools Naturopathic doctors are required to complete a minimum of 7 years of post secondary education. First, at least 3 years of pre-medical training is completed at an accredited university (typically a Bachelor of Science degree) including pre-requisite coursework in general biology, general chemistry, biochemistry, organic chemistry, psychology, and the humanities. Naturopathic doctors study and graduate from a four year full-time professional program at an approved naturopathic medical college or university. The Council on Naturopathic Medical Education (www.cnme.org) accredits naturopathic medical schools. The CNME is recognized by the US Department of Education and it is a member of the Association of Specialized and Professional Accreditors (ASPA). Accreditation by the CNME means that the mission and objectives of the naturopathic college are soundly conceived and clearly stated, that its educational program has been designed to meet the standards of the profession, that its mission and objectives are accomplished, and that the College is completely organized, staffed, and supported. The AANP accepts entry-level applicants from only CNME accredited schools. All colleges and universities offering professional naturopathic programs in North America maintain one or more community outpatient clinics which are an integral part of their communities.
there are six approved educational institutions in North America. Comprehensive Curriculum Naturopathic programmes include basic and clinical medical sciences as well as out-patient clinical training under the supervision of regulated naturopathic doctors. NDs study the same basic medical and clinical sciences as other health care professionals, such as MDs, DCs, DDSs, and Nurses. These sciences lay the foundation for detailed history, intake, physical, and laboratory diagnosis. This leads to proficiency in assessment, diagnosis, treatment, and follow-up evaluation.
know your healthcare team This science-based training is very comprehensive. The number of classroom hours has been estimated to surpass those of most other medical schools. Students then concentrate on the therapeutic modalities of naturopathic medicine â€“ clinical nutrition, botanical medicine, homeopathy, physical medicine, and Traditional Asian Medicine including acupuncture. One of the
strengths of naturopathic medicine is that naturopathic doctors are well educated in and aware of many different treatment modalities. This diversity benefits the patient because naturopathic doctors can provide an appropriate treatment regimen involving these therapies or refer to other therapists that provide them. A naturopathic doctorâ€™s training then continues in a practical clinical setting under the supervision of regulated naturopathic doctors. As mentioned previously, all naturopathic medical schools run at least one outpatient training clinic, where the majority of clinical training hours takes place. In addition, students are required to attend outpatient (and
sometimes inpatient) clinics in their communities with naturopathic doctors and/or medical doctors. Many naturopathic doctors also complete a residency at a naturopathic medical college or other outpatient clinic. Currently, there is a movement in the naturopathic medical school community to expand these opportunities for their graduates.
NATUROPATHIC MEDICINE IN PRACTICE Naturopathic medicine is defined primarily by its fundamental principles. Methods and modalities are selected and applied based upon these principles in relationship to the individual needs of each patient. Diagnostic and therapeutic methods are selected from various sources and systems and will continue to evolve with the progress of knowledge. In order to qualify to practice in Alberta, NDs must satisfy several requirements. The candidate must graduate from an accredited school, successfully
pass the NPLEX registration exams, obtain malpractice insurance, keep current CPR and/or AMLS certification, and maintain continuing competence. Standardized Registration Exams In this province, as in all regulated jurisdictions in Canada and the United States, naturopathic doctors must pass standardized registration exams. Called
NPLEX (Naturopathic Physicians Licensing Examinations) these exams are administered by the North American Board of Naturopathic Examiners (NABNE, www.nabne.org). They are comparable to the Canadian Council on Medical Education Qualifying Examinations used to evaluate medical doctors. Students graduating from CNME accredited schools are the only candidates qualified to sit for NPLEX examinations. Malpractice Insurance Naturopathic medicine, as a primary care health profession, is very safe, as indicated by insurance data and favorable >
care | FALL 2010
safety records in those areas regulating NDs and recording data. All practicing naturopathic doctors in Alberta are required to carry Errors & Omissions (malpractice/professional liability) insurance. Continuing Competence In February to June 2005, sixteen members of the AANP created the Competency Profile for Naturopathic Doctors under the guidance of Dr. Bill DuPerron, principle consultant to Alberta Health and Wellness. This process was rewarding, as our participating members discovered how unified naturopathic doctors in Alberta are in defining our professional philosophy and scope of practice. As a result of this successful effort, the AANP has now developed the Continuing Competence Program including a computerized tracking system available on the World Wide Web. Restricted Activities The following are the restricted activities allowed by our final draft regulations.
HOW THE PUBLIC RECEIVES SERVICE
Typically, a patient sees a naturopathic doctor for an initial visit of 60 minutes. During this visit, the naturopathic doctor takes a complete medical history, performs a physical examination, formulates a differential diagnosis and may start a treatment plan. If indicated, the ND then orders or performs laboratory diagnostics. A follow up consultation reviews progress and/or findings and further develops the treatment plan. Patients pay out-of-pocket for naturopathic services. Most third-party insurance companies reimburse registered or licensed naturopathic doctor’s office visits and laboratory evaluations. Alberta NDs look forward to expanding our relationships to the other health professions in creating optimum health for Albertans. n
Naturopathic doctors in Alberta work in private practices and multi-disciplinary practices with regulated health professionals such as chiropractors, medical doctors, nurses, physical therapists, and massage therapists.
For more info on Naturopaths, see the Alberta Association of Naturopathic Practitioners (soon to be the College of Naturopathic Doctors of Alberta) at www.cnda.net or 403-266-2446.
• ear, nose and throat exams in the assessment of upper respiratory symptoms. • vaginal, urethral and rectal exams in assessment and to procure lab specimens for examination. Laboratory specimens are accepted from naturopathic doctors by laboratories in Canada and the United States for the evaluation of specimens. • spinal manipulation as a treatment in functional musculoskeletal disorders. • administer naturopathic IV nutrition (this is an RA formulated specifically for our profession). Currently, several NDs employ nurses in their practices to assist them in providing quality care.
Are you inspired by someone in the nursing community
Call for nominations The Bow Valley College Alumni Association (BVCAA) VCAA) is recognizing the exemplary efforts of BVC Alumni lumni through Rewards of Recognition and Rejuvenation. ation. For nomination details please contact us aat: t: firstname.lastname@example.org or 403-355-4666 66
Compassionate & caring, Amanda (Practical Nurse Alumna 2003) inspired Marie (Practical Nurse Alumna 2002) to nominate her for the Award
Award A ward rrecipients ecipients must must be be graduates graduates of of Bow Bow Valley Vaalley College V College or or AVC A AV VC Calgary Calgary 22
care | VOLUME 24 ISSUE 2
Breaking the Silence Managing Mental Health in the 21st Century By Dr. Austin Mardon
FINANCES DIFFICULT FOR MENTALLY ILL - When dealing with clients who have permanent disabilities, there are certain things you can easily take for granted. They will often deal with income, housing, and employment problems more often than the general public. This is especially the case when their disability is a serious mental illness. hen it comes to employment, I have been asked to serve on the Board of Directors for organizations that would not give me an interview for a minimum wage part-time position. Many with disabilities face the same stigma and discrimination. That can often leave them on the fringes of the economy. For those of us who grew up in middle class families, it can be hard to learn how to survive on poverty level incomes. It’s as alien an existence as moving to a third world country.
I have often found it frustrating trying to explain to my health care providers the realities of living on a small fixed income. There are programs that I qualify for that can make my quality of life better, or at least financially easier, that require the assistance of a nurse or doctor to formalize the bureaucratic paperwork involved. A benefit that may provide what seems to be a paltry amount, and not worth your time to help with the paperwork, might in fact represent 10-20% of the monthly income for someone on disability (such as Disability Tax Credit Certificates, and Registered Disability Savings Plans). An even greater obstacle comes when your clients don’t know what programs they may qualify for, and the government rarely produces large media campaigns to advertise programs that cost them money. As health care workers, if you find yourself working with disabled clients, espe-
cially the recently disabled, who are still reeling from their changed reality, educate yourself about the programs they may qualify for. I have found when dealing with the mentally ill especially, if they have a secure home, a secure relationship with their medical support staff, and a secure income source, they are much more likely to stay stable. For some conditions, the stress of everyday life is almost too much. Add to that the threat of homelessness, worry about where their next meal is going to come from, and you can imagine how tempting it would be to go off their medication so as to “escape” from reality, and the stresses that live there. The economic crisis has been especially hard on those who find themselves living paycheck to paycheck. When you have a job and a home, you have resources that many disabled individuals do not have. When a crisis hits someone on a fixed income, it can be devastating. Many mentally ill individuals are additionally estranged from their family and friends. Friends move on with their lives, and families members grow old, or sometimes just get exhausted by dealing with someone with a serious illness. Security nets that we all take for granted can be non-existent. As an example, three days before we were to leave on a June vacation, our first in five years, our home flooded. Not having X-ray vision, I didn’t know that a
water pipe between my bedroom closet and our dining room had developed a small leak over the winter. When that source was used for a water supply for a wet saw necessary to repair a small concrete patch in our parking lot, water flowed into our condo for several hours before it was discovered. We are now in that eternal limbo of dealing with insurance adjusters and contractors. At least we had resources to draw upon to help us find a place to stay for the week we needed to vacate our condo while the damaged carpets and drywall were being torn out. Had we just been renters, or not had insurance, what would we have done? Those on small fixed incomes don’t have large lines of credit to fall back on. A crisis that is just a horrific inconvenience to one person, can be a first step toward homelessness for another. Sometimes the line can be so fine, that it doesn’t take a major crisis to trigger a landslide towards homelessness. n
Austin Mardon received the Order of Canada for advocacy on behalf of those with schizophrenia in 2007. He is the local chair of the Champion’s Centre a charity devoted to alleviate homelessness in Canada.
care | FALL 2010
life & death matters I came to hospice nursing as a child… By Kath Murray, RN
This is the first in a series of articles about caring for the dying. Kath Murray, RN, is a hospice palliative care nurse with a passion for developing and delivering education. Her desire is to increase the capacity of individuals to provide excellent care for the dying and bereaved. Her hope is that the material will be practical and useful, and can be integrated into your practice. You may send your comments and questions by email to email@example.com.
he first line of “Essentials in Hospice Palliative Care” reads, “I came to hospice nursing as a child.” Though intended to refer to my early experiences with death (dead leaf, dead rat and dead bird), someone pointed out the wisdom that we should all come to hospice nursing (perhaps all nursing) as children, not filled out with knowing, but ready to question, be curious, and be open to learning what is needed.
My first deaths… It was the beginning of my second year in nursing when dear family friends phoned. Our mutual friend who lived with them was dying with lung cancer. She suddenly was in need of total care, but all the nursing services were closed on this Saturday afternoon. “Can you help us?” they asked. I drove my mechanically challenged push-start car to their home. I anticipated that I would provide care with my very limited skills until Monday morning when I would pass the torch to the home care nurses. When I arrived, Jamie was lying in a big king size bed. She was alert, oriented, and grateful to see a “nurse” (how little she knew about how little I knew!). I completed a very basic assessment and phoned the doctor – he ordered medication for pain. After giving the medication and providing some skin care, I settled in to companion her. The bed was huge so as night approached it seemed like the best place for me to rest my head. I slept on and off, and watched her through the night. We spoke at 23:30, at 04:30 and again
care | VOLUME 24 ISSUE 2
at 04:45. Then she breathed a breath – what seemed like a normal breath. And she died. Just like that. I had no idea that death was coming. Would I have done anything different if I had known? I next witnessed death at my father’s bedside. I knew more about death and dying this time. He looked like a yellow, unkempt scarecrow with a large pregnant belly. Within a day of my arrival, he became restless and confused. He mixed up words and gave directions that did not make sense. “Take me to bath,” he said, and was frustrated when I walked him to the bathroom instead of to bed. “Take my milks off,” he demanded as he sat on the edge of the bed. His frustration mounted as I struggled to understand and follow his request. Finally I “took” two imaginary socks from his bare feet. “It’s about time,” he grunted and lifted his feet into his bed. His breathing became moist and congested. He struggled to breathe. He wanted to sit up, then lie down, sit up, lie down. He gasped. His eyes spoke of fear. We opened the window. I knelt on his bed and lifted him again and again and again. I coached him as I had been coached in labour: “It is not long now Dad, you’re just about there.” His childhood friend walked into the room. “Dad, Dick is here.” He looked up, took his last breath and died. A few years later, I became a hospice nurse. I learned about the normal physical changes that often occur prior to death. I learned about symptom manage-
Comfort Measures for Patient and Family ment. I wondered, “Could we have prevented the difficulty breathing that dad experienced in dying?”
Common Physical Changes with Dying Knowing what is going to happen with dying can greatly increase the comfort of the patient and family. The physical changes that many people experience in the dying process are: • increased sleeping • decreased intake • forgetting to swallow followed by an inability • • • • • • • • •
to swallow restlessness * confusion * decreased level of consciousness irregular breathing respiratory congestion* sensation of breathlessness* cooling of the feet and hands incontinence and occasional twitching
(Items marked with an asterisk (*) indicate changes that require further assessment and symptom management.)
This information is valuable information to share with family. It is important to point out that these changes may not be experienced in this order and may not be experienced by all individuals. As well, there are cases such as Jamie’s where these changes were either not present or were too subtle to be noted. Family can use this information to anticipate further changes and to help them participate in providing comfort care. Family should be instructed to connect with the nurse or the appropriate health care person if/when their loved ones experience restlessness, confusion, respiratory congestion, breathlessness, and/or discomfort. For example, it may be normal to develop respiratory congestion in the dying process, but as a health care team, we can treat this symptom and manage the sensation of dyspnea (breathlessness). The philosophy of hospice palliative care suggests that the patient and the family are the unit of care. Therefore, supporting the family through the last days and hours is part of the care we provide. Families often have questions but many wait for the health care team to raise the questions, rather than bring the questions forward themselves. It is appropriate to explore with family their concerns, questions and needs. n In the next article, we will discuss assessment tools and a tool for communicating your assessment to the health care team. All the best in caregiving!
• Discuss with family any concerns about increased sleeping, they may be concerned that this is caused by medication • Offer to help with “gate keeping” if visitors are numerous and patient is finding visiting difficult • Normalize the decrease need for intake across the life span • Explain the loved one is “not eating because they are dying, they are not dying because they are not eating” • Establish an atmosphere appropriate to this patient/family: o Music – instrumental, vocal o Reading - poetry, books, wisdom literature • Demonstrate personal care: o Mouth care – cleanse, moisten, and lip balm o Massage feet, hands, legs, scalp o Positioning with pillows and soft touch items such as teddy bears o Warmed sheets, flannels • Explore use of guided imagery for restlessness (not appropriate for a confused patient) • Offer relaxation therapies such as reiki and healing touch • Encourage use of bedding the person would normally require. Excessive blankets may cause increased sweating/diaphoresis • Model communication with the dying person. Suggest that it is possible that hearing is the “last sense to go” and that thoughts can still be communicated For further information see “Psychosocial Implications of Physical Changes in the Last Days and Hours” in “Essentials in Hospice Palliative Care, Second Edition, 2010”
Supporting the Family • Anticipate and welcome questions. If family do not ask questions, you may want to open discussion: o “Sometimes family want to know what to expect in the last days and hours. Would you like further information?” o “Sometimes families wonder when death will occur, is that something that you are wondering about?” o “Would you like to be present when death occurs? Would you like us to call you day or night if there are changes that seem to indicate that death is imminent, realizing that we may be wrong in our assessment?” • Identify what you are seeing o Connect with the list of normal changes o Discuss what changes have occurred, and what changes may still occur in the normal dying process o If/when the person appears to be taking their last breaths, observe and comment, “It appears that death could be anytime now.”
care | FALL 2010
Power of Attorney and Advance Health Care Directive: Two Documents EVERY Adult Must Have e’ve all heard the saying: We don’t plan to fail, but often we fail to plan. What follows is based on a true story of a family that did not have a plan in place before a sudden health crisis:
Delia (not her real name), a 90-year old widow, has lived alone in her home for many years. Friends and family admire her independence. A private person, Delia proudly manages her own affairs. She believes she will continue on this way until “something happens to me”. Her children have asked her to talk to her lawyer about Power of Attorney and an Advance Health Care Directive, but she dismisses their advice. Then, Delia suffers a serious stroke and is admitted to hospital. The doctors discuss her competency and decide that she lacks the capacity to make decisions regarding her health and property. The family is told that Delia needs the professional care provided in a long-term care facility. At the long-term care centre, the family is asked to make decisions regarding level of care. Do they want a “Do Not Resuscitate” order if their mother has serious complications or develops a life-threatening illness? The family is not sure: one daughter says, “Mom would want everything done because she has always faced life head on.” But another sibling argues that “Mom would never want to continue living without her independence.” Delia’s advance health care directive would have contained her wishes in writing. To pay the care centre fees and her other debts, the family realizes that their Mom’s home must be sold. Their realtor informs them that they do not have the legal right to sell the home. Delia needs
care | VOLUME 24 ISSUE 2
to sign the agreement – but cannot do so. Family members also notice that other care centre residents have additional support from private companions and personal care aides. They decide that enhanced services would be a good idea for Mom too. They go to the bank, where they are informed that without a power of attorney, they cannot have access to Delia’s accounts. They must now apply for guardianship. They are also advised to contact a lawyer specializing in Elder Law. For the reasons outlined above, all adults – but especially seniors – need to have a Power of Attorney and Advance Health Care Directive. No one wants to imagine circumstances
where they might have to give up control over financial and care decisions. But serious illness or accidents can happen to anyone at any time. Preparing these two documents can spare your loved ones anguish and ensure that your wishes are respected. For more insight and comprehensive Canadian resources on this topic, consult the ElderWise e-guide Decide For Yourself: Why You Must Write Your POA and Advance Directive. n © ElderWise, 2010. Originally published by ElderWise Publishing, a division of ElderWise Inc. We provide clear, concise and practical direction to Canadians with aging parents. Visit us at http://elderwise.ca/ and subscribe to our FREE e-newsletter.
Orthopedic Specialty LPNs Pilot New Workshop Submitted by NorQuest College
NorQuest College’s Advanced Education in Orthopedics for LPNs is a one-year, self-paced, tutorsupported, certificate program offered through distance delivery with a face-to-face workshop and clinical practice. This program offers LPNs a post-graduate specialty in orthopedics that increases career potential in emergency departments, cast clinics or orthopedic client care areas. It is imperative for health-care professionals to maintain their continuing competencies in knowledge, skills, attitudes, and judgment. However, as a consequence of their specialty or because of a busy and demanding work environment, some professionals have fewer opportunities for professional growth. That is why in May 2010, NorQuest College in Edmonton, Alberta hosted a workshop to support a group of Orthopedic Specialized Licensed Practical Nurses (LPN) to maintain their continuing competency. The College’s Special Projects and Continuing Education team partnered with Covenant Health and Glenrose Hospital to design and deliver a three-day workshop as a pilot project. NorQuest’s Laura Milligan and Lorelei Nimco collaborated with the staff educators from the Misericordia Hospital to create a refresher clinic designed to update the frontline advanced level practitioners to the level of knowledge and skills current students learn in NorQuest’s Advanced Orthopedics for LPNs. Eleven employed and orthopedic specialized LPNs participated in this pilot. Said one participant: ”There is an important need for us to learn, maintain our knowledge and to verbalize our concerns
so that we can work together as a team.” Workshop participants received a workbook to refresh their knowledge during the months preceding the face-to-face component. This custom-designed booklet is a condensed summary of the Advanced Orthopedics for LPNs curricula including anatomy and physiology, orthopedic assessments, orthopedic pathology, orthopedic nursing interventions, and radiology. The first two days of the workshop focused on instruction, hands-on sharing of casting and immobilization techniques as well as traction and interpretation of radiological investigations for common acute and chronic orthopedic injuries and complications. The third day included experiential learning with a series of orthopedic cases staged on the METI simulation mannequins in NorQuest College’s Interdisciplinary Simulation Centre. The safe culture of the Simulation Centre was the perfect controlled environment for workshop participants to integrate their experience and knowledge. They assessed their emergency room and cast clinic
clients, assessing their overall status including a focused orthopedic assessment. Various orthopedic disorders and complications were staged with actual equipment on the mannequins. Simulation is a technique identified by the Canadian Patient Safety Institute as a valuable means to “…enhance and enrich clinical skills practice in a safe environment, as well as to enable…a multi-disciplinary, problem-solving approach” to team development. (Canadian Patient Safety Institute Patient Simulation in Canada: Current State Findings, 2005) Simulation was identified by the learners as an “awesome addition to learning” and a “good area to learn skills of working together as a team.” n For more information on Advanced Orthopedics for LPNs and other Continuing Education courses offered by NorQuest College, visit www.norquest.ca or contact Laura Milligan at firstname.lastname@example.org
care | FALL 2010
Finding the right balance fo or you. for )LHOG/DZÂ¶V3URIHVVLRQDO5HJXODWRU\*URXS )LHOG/DZÂ¶ V3URIHVVLRQDO5HJXODW WRU\*URXS
We are proud to act as legal counsel for the he College of Licensed ed Practical Nurses of Alberta HGPRQWRQÂ‡FDOJDU\Â‡\HOORZNQLIH QLIH ZZZÃ€HOGODZFRP ZZZ Ã€HOGODZFRP
$FFHOHUDWHG3UDFWLFDO1XUVH3URJUDP ZLWKWKHEHQHÃ€WRIVPDOOFODVVVL]HV 2SSRUWXQLWLHV IRU LQGLYLGXDOL]HG OHDUQLQJ ([SHULHQFHGVXSSRUWLYHDQGFDULQJIDFLOLWDWRUVKDYH HQDEOHGRXUVWXGHQWVÂ·VXFFHVV 6WXGHQWV PD\ EH HOLJLEOH IRU )5(( SUHUHTXLVLWH (QJOLVK 0DWK %LRORJ\ DQG 0HGLFDO 7HUPLQRORJ\ FRXUVHV ,QIRUPDWLRQ 6HVVLRQV DUH DYDLODEOH PRVW 0RQGD\ $IWHUQRRQV DQG 7KXUVGD\ (YHQLQJV &DOO WRGD\ 3URXGVSRQVRURIWKH&/31$6SULQJ&RQIHUHQFH
0DQQLQJ5G1(&DOJDU\$% ZZZFROXPELDDEFD 28
care | VOLUME 24 ISSUE 2
the operations room Member Information - College Activity - Best Practices
SUPERVISING HEALTH CARE AIDES MUST READ! Released in June: The newly updated document DecisionMaking Standards for Nurses in the Supervision of Health Care Aides by the College of Licensed Practical Nurses of Alberta (CLPNA), College and Association of Registered Nurses of Alberta (CARNA), and College of Registered Psychiatric Nurses of Alberta (CRPNA). This document is invaluable to nurses working with Health Care Aides and should be shared widely with colleagues and staff. With the considerable feedback received from members and stakeholders, DecisionMaking Standards will provide continued support to professional nurses who supervise Health Care Aides. Decision-Making Standards can be found on www.clpna.com on the Resources page.
CONFE R E NCE APRIL 7 - 8, 2011 DEERFOOT INN & CASINO CALGARY, ALBERTA
MARK YOUR CALENDAR w w w. c l p n a c o n f e r e n c e . c o m
Council Election Results
Congratulations to Jo-Anne MacDonald-Watson, LPN, on her reelection to another two-year term as the CLPNA representative to Council for Election District 3 (Central Zone). At the May 27-28 Council Meeting, Hugh Pedersen, LPN, was appointed to a second term as President. Congratulations Hugh. Both terms begin September 1.
Jo-Anne MacDonald-Watson, LPN District 3 (Central Zone)
care | FALL 2010
2011 REGISTRATION RENEWAL GUIDE NEW! Online Login Info & Registration Packages Registration Packages and online login information should arrive in the mail before September 30 (in Alberta). Members who do not receive this information by October 1 should contact CLPNA.
NEW! Online Registration Renewal & Security Immediate assurance that the 2011 Registration Renewal form is complete when submitted is one of the major advantages with Online Registration Renewal. Members are instantly alerted to any incomplete sections. Dropdown boxes ensure the correct data is entered. Help sections clarify common questions. Fees may be paid by VISA, Mastercard or by previous enrollment in the Pre-Authorized Payment Plan (PAP).
Deadline December 1, 2010 ctober 1 to December 1 is the annual Registration Renewal season for LPNs in Alberta. This year, the CLPNA is pleased to introduce Online Registration Renewal and personal profile updating.
The advantages of Online Registration Renewal are tremendous: it’s fast, secure, and green. It ensures a complete Registration Renewal form and is available 24/7. It will allow members to update their personal profile at any time during the year, including contact information, current employer, and employment status. In the coming years as this information is populated, members may retrieve their Continuing Competency Learning Plans as needed without contacting CLPNA. The CLPNA also anticipates a reduction in the number of incomplete Renewal forms. The CLPNA hopes that soon, as in other jurisdictions such as the College of Nursing of Ontario, our members embrace Online Registration Renewal. Eventually, submission of paper forms will be the exception rather than the norm.
The security of your personal information is a top priority with the CLPNA. That’s why the member’s website uses SSL (Secure Socket Layers), a recognized industry standard and commonly used for online transactions by banks and retail stores. “Secure Sockets Layer (SSL) protocol was developed by Netscape Communications Corporation to provide a high level of security for Internet communications. SSL provides an encrypted communications session between your web browser and a web server. When sensitive information is being sent over the Internet between your browser and a web server, SSL verifies that the information has not been altered in any way on-route. All major internet browsers released in recent years support SSL.” (Moneris Solutions) Whether you’re paying for your Registration Renewal, or updating your personal information, you can be sure your valuable information is private and secure.
NEW! Change in Process for VISA/Mastercard To use VISA/Mastercard to pay registration fees, CLPNA recommends members use the secure Online Registration Renewal. For members submitting a paper Registration Renewal form and who want to use VISA or Mastercard to pay fees, there is a change in process this year. 1) Go to www.clpna.com and download the Credit Card Authorization form 2) Print the form and complete 3) Ensure the form is submitted with your renewal for processing After processing payment, the Credit Card Authorization form will be destroyed, which reduces the risk of identity theft or fraud.
Update Your Email News, updates, and receipts from the Online Registration Renewal process are sent to members by email. CLPNA recommends that members who do not receive CLPNA emails update their online profile on www.clpna.com or contact CLPNA.
REGISTRATION FEES AND DEADLINES FOR ACTIVE PRACTICE PERMIT Renewal
Fees Paid Before December 1
Fees Paid December 2 - 31
Fees Paid January 1
Please view www.clpna.com for Holiday Office Hours.
care | VOLUME 24 ISSUE 2
The Registration Renewal Deadline is December 1, 2010
Items Needed to Renew
Online Registration Renewal is the quickest and most accurate way to renew registration for 2011. Payment may be made by VISA or Mastercard. Fees for Online Registration Renewal will change at 12:00am (midnight) on the dates listed.
In preparation for Registration Renewal season, gather the following items to complete your 2011 Registration Renewal form: 1. Practice Hours for 2010 - Locate your most recent 2010 paystub(s) from all employers and determine the number of hours you have worked so far in 2010. Add the number of hours you expect to work until December 31, 2010. Exclude vacation and sick-time hours. 2. Continuing Competency Program (CCP) Learning Plan See the article in this issue of CARE titled, “CONTINUING COMPETENCY PROGRAM (CCP) Steps for 2011” and proceed with your CCP requirements. 3. Payment Information - If paying fees by VISA or Mastercard, have the card number ready for use on the Online Registration Renewal, or on the Credit Card Authorization Form.
Paper Registration Renewal forms and payment (cheque, money order, or Credit Card Authorization form) may be submitted to CLPNA by mail, courier, or in person during office hours. Late registrants are reminded that the CLPNA office is closed at 12:00pm (noon) on December 31, 2010. Registration Renewal forms received after this time will not be processed until the office opens on January 4, 2011. Please note: 2010 Practice Permits expire on midnight on December 31, 2010, which means an LPN no longer holds the right to practice. Starting January 1, 2011, those wishing to reinstate their registration must submit a Registration Notice & Declaration in addition to their Registration Renewal form and payment.
Individuals without a 2011 Active Practice Permit are not authorized to practice as a Licensed Practical Nurse in Alberta in 2011, as per Section 43 of the Health Professions Act. Practicing without a valid Practice Permit constitutes unprofessional conduct under the Health Professions Act and may be subject to sanctions.
Within two weeks of CLPNA receiving a complete Registration Renewal form and payment, members can expect to receive their new Practice Permit. (Exception: Members using the PreAuthorized Payment Plan (PAP) to pay for their 2011 Registration Renewal may submit their Registration Renewal form before November, but must wait for their Practice Permit until the final PAP payment is processed on November 1, 2010. Practice Permits should arrive mid to late November.)
Members on Maternity or Short Leave
If a Practice Permit is not received within the above timelines, members are advised to contact CLPNA.
Practicing Without an Active Practice Permit
Members going on maternity leave in 2011 or other short breaks from the profession are encouraged to renew for an Associate Practice Permit for $50. If a member decides to return to practice before the next renewal period, the Reinstatement Fee ($50) is waived and only the Active Registration Fee is required. Associate members receive CARE magazine, practice updates, and e-newsletters. Also, Associate members receive their Registration Renewal form in the mail as usual next year. This option keeps you in touch with your profession while you are on leave!
Members Not Renewing Members not returning to the profession, retiring, or on longterm disability can notify CLPNA of their status by completing the 2011 Registration Renewal form online or on paper with the appropriate information. If CLPNA does not receive a completed 2011 Registration Renewal form, CLPNA will continue to send further notifications to the member as required by the Health Professions Act.
Proof of Registration - Public Registry Members and employers requiring proof of LPN registration status for 2011 should access the CLPNA “Public Registry” at www.clpna.com.
Incomplete Forms Returned to Member Incomplete Registration Renewal forms will be returned to the member by mail for completion and resubmission. This will result in a delay in processing and may require additional fees. CLPNA does not keep copies of incomplete forms.
Questions Contact CLPNA at email@example.com, 780-484-8886, or toll-free at 1-800-661-5866 (toll free in Alberta only).
Complete your 2011 Registration Renewal form online or submit your paper form by November 11 to be automatically entered to win in the “Ready, Click, Win! Contest”. See the ad on the back cover for details! care | FALL 2010
the operations room
NEW SUBSCRIBERS Subscribing Submit a completed 2012 PAP Subscription Form and a VOID cheque with your completed 2011 Registration Renewal form. The PAP Subscription Form is available to print from www.clpna.com from the Members webpage, or can be requested from CLPNA.
PAY 2012 FEES IN ADVANCE The Pre-Authorized Payment Plan (PAP) is a CLPNA payment option that allows members to pay a future Registration fee for an Active Practice Permit using automatic withdrawal. New subscribers to PAP will pay in advance for their 2012 Registration fee in 10 monthly withdrawals of $35 starting February 1, 2011 and ending November 1, 2011. PLEASE NOTE: New subscribers to PAP cannot use PAP to pay for their 2011 Registration Renewal fee.
Registration Renewal Form Required Current subscribers are reminded, though they have paid their 2011 Registration fee through PAP, they must still submit a completed 2011 Registration Renewal form to receive a Practice Permit for 2011. Continuing Subscription Once signed up for PAP, automatic withdrawals will continue until CLPNA receives written notice to cancel the PAP subscription. Updating Banking Info Subscribers may update their banking information during the year by sending a new voided cheque or new banking information form from the bank, with your name, your CLPNA Registration Number and address by mail or fax to CLPNA, “Attention: Finance Department”, at least seven (7) business days before the 1st of the month. Payments Returned NSF If a payment is returned due to Non-Sufficient Funds (NSF) on the 1st of the month, a second automatic withdrawal will be attempted by the bank within five banking days. If the second withdrawal attempt returns NSF, a $60 payment is required ($35 PAP payment + $25 NSF fee) to remain on PAP. Please note: These are CLPNA fees; your bank will charge NSF fees as well. Non-sufficient funds, a change in bank accounts or a closed account will result in a $25 NSF charge for each occurrence. If two payments are returned by your bank within the year, you will be unsubscribed from the PAP program for the balance of that year, and your payments to date will be refunded. Cancelling Subscription To cancel your PAP Subscription, submit a written request for cancellation “Attention: Finance” to CLPNA with your full name, CLPNA Registration Number and current address, by mail or fax, or email firstname.lastname@example.org. Fees paid to date will be refunded.
care | VOLUME 24 ISSUE 2
the operations room
How do YOU get Your DUCKS in a Row? CONTINUING COMPETENCY PROGRAM (CCP) s part of annual Registration Renewal, LPNs participate in the Continuing Competency Program (CCP) by completing a Learning Plan. There are different ways to successfully complete your Learning Plan for 2011. CLPNA recommends that all members complete an annual self-assessment of their knowledge, skills, and professional practice. Complete the CCP Self-Assessment Tool available in your Competency Profile, 2005, 2nd Edition, download the Tool from www.clpna.com under “Members”, “Continuing Competency Program” or contact CLPNA for a copy at email@example.com.
STEPS FOR 2011 1.
Complete the CCP Self-Assessment Tool • Rate your professional practice relevant to all LPN roles in Step 1 • Determine other specific competencies to your area of work, LPN role, and responsibility in Step 2.
Build a learning plan in Step 3 • Choose a minimum of 2 learning objectives from Step 1, Step 2, or other areas in your nursing practice that you want to improve knowledge, enhance competence, or develop skills in 2011. • Using the Competency Profile, identify the learning objectives by competency number, for example, Initiate and discontinue IV’s: V-3. • Note resources and strategies used to meet objectives. • Set a timeline for completing your learning plan for 2011. • Evaluate your learning through your answer to “How will I think and behave differently following this education?” • Using the above information, complete all four columns of the Learning Plan on your Registration Renewal form or through the online registration program.
Track and record your learning throughout the year • Keep a copy of your 2011 Registration Renewal form with learning plan. • (Note: Online Registration Renewal will create a file for your learning plans over time.) • Document your learning: o Certificates o Attendance letters o Filling out a concise Record of Professional Activities • File documentation in a safe place – then you are ready when it’s your turn to participate in the CCP Validation.
This fall, you can complete your 2011 Registration Renewal online including your CCP Learning Plan. Here are 2011 Continuing Competency Program Reminders:
LICENSED PRACTICAL NURSES
T A L K the W A L K
OBSERVE http://blog.CLPNA.com | www.twitter.com/CLPNA www.youtube.com/CLPNA | www.facebook.com/CLPNA
care | FALL 2010
the operations room
What is a Temporary Registration Practice Permit?
The Temporary Registration Practice Permit is the practice permit issued to new graduates of an approved practical nursing program in Alberta. The Temp Permit is issued short term; not to exceed one year, and provides the ability for a new graduate LPN to start practicing as a novice, while studying to write, and await results, from the Canadian Practical Nurse Registration Examination (CPNRE). Upon completion of the CPNRE, successful candidates automatically receive an Active Practice Permit. Candidates are allowed three opportunities to successfully complete the CPNRE.
The following are frequently asked questions to CLPNA’s Practice Consultants by our members, managers, educators, or the general public that could provide valuable information for you in your practice environment.
Temporary registrants: • Are recognized as a Licensed Practical Nurse, and may legally sign LPN after their name. • Assume responsibility and accountability for their practice. • Practice within the policies of the employer and may take applicable education in the employment setting. • Must identify and seek guidance and direction when they find situations that are beyond their competence level. • Must work in an area where another regulated health professional is staffed and available for direct/indirect supervision or consultation. - May not delegate activities to, or supervise another regulated health provider or an unregulated health care aide. • May be supported by a preceptor or mentor and learn the formal leadership role or “charge” position, including mentorship in supervision of the health care aide.
What is the scope of practice for LPNs in a Dermatology clinic?
LPN roles in clinic environments include responsibility in health assessment and a variety of clinical treatments requiring critical thinking, clinic judgment, and decision making. LPNs who have completed education in injections; intramuscular, intradermal, and subcutaneous, may administer injectable dermatology treatments once they have achieved additional competence within the workplace. CLPNA would expect that LPNs are provided additional theoretical knowledge and supervised clinical practice pertaining to the treatments. LPNs are not authorized to give dermatology treatments when there is not a Dermatologist available within the setting. CLPNA is currently updating the Competency Profile, 2005, 2nd Edition and will be clearly identifying dermatology competencies. If you work in this type of setting, please contact CLPNA to provide your feedback.
Contact our Practice Consultants at firstname.lastname@example.org or 780.484.8886
care | VOLUME 24 ISSUE 2
the operations room
Volunteer for CLPNA COMMITTEES Opportunities are now available for LPNs to participate in the College’s disciplinary and continuing competence committees for the 2011-2012 term. Orientation, training, honorarium, and travel expenses are provided. This is a great chance to get involved in some of the primary professional duties of the College: protection of the public and ensuring continuing education. Closing date for resume submission is November 19. Committee members are appointed by Council at the December 2010 meeting. n Qualifications & Compensation
Qualifications: An Active Practice Permit, in good standing with CLPNA, and a minimum three years nursing experience. Must be available to attend meetings as required. Term: Committee members are appointed for a two-year term and may be re-appointed for a second term. Terms begin January 1, 2011. Attendance is required at the Annual General Meeting/Spring Conference. Compensation: CLPNA provides orientation, training, honorarium, hotel, and travel expenses related to committee meetings. n Hearing Tribunal
Critical thinkers interested in safe and ethical nursing practice should consider volunteering for the Hearing Tribunal. The purpose of the Hearing Tribunal is to ensure the public is protected from unethical or unsafe practitioners, and functions as judge and jury at the disciplinary hearing of investigated complaints. The Hearing Tribunal: • Ensures fairness by hearing the allegations of the complainant, the response from the investigated person, and evaluating the evidence from witnesses • Determines if the actions of the investigated person constitutes unprofessional conduct as described in the Health Professions Act and writes any orders necessary arising from a guilty verdict. Members of this committee meet on demand five to 15 times a year for Hearings that typically last one to two consecutive days. Hearings are typically held in Calgary and Edmonton, but may be scheduled in any major centre in Alberta. n Complaint Review Committee
The Complaint Review Committee requires critical thinkers to review written decisions to dismiss complaints of unprofessional conduct. Members of this committee typically meet on demand for several hours by teleconference one to five times per year, with the occasional in-person meeting at the College’s office. n Registration and Competence Committee
Those who believe in life-long learning may be interested in volunteering for the Registration and Competence Committee. This committee primarily reviews and assesses documentation from the Continuing Competence Program Validation. This committee meets on demand two to six times per year for meetings that may last one to two consecutive days.
Interested in participating on a Committee? For more info on Committee opportunities, see the “About CLPNA” tab at www.clpna.com or contact email@example.com, 1-800-661-5877, or 780-484-8886. To volunteer, forward your resume to CLPNA, Attention: Tamara Richter, or email firstname.lastname@example.org by Friday, November 19, 2010.
care | FALL 2010
CLPNA SPRING CONFERENCE | April 8 & 9, 2010 Energy and spirit distinguished the proceedings of the 2010 CLPNA Spring Conference on April 8-9, 2010 at the Edmonton Marriott at River Cree Resort. The two-day professional development forum brought LPNs and colleagues from across Alberta to celebrate the nursing profession and its core purpose - the patient. Over 400 attended keynote and plenary sessions, a vibrant Celebration and Awards Dinner, a day-long Silent Auction, and a healthcare Tradeshow. A change in Alberta’s financial strength was evident in the lowered attendance compared to the 2008 Edmonton conference with its record attendance of 578. The Conference was prefaced by the CLPNA’s Annual General Meeting on April 7.
Warren McDonald launched the patient focused event with a touching personal perspective explaining the power of pursuing life, as he shared his gripping story. Warren lost his legs in a tragic hiking accident and went on to climb mountains, write bestsellers, and inspire audiences worldwide with his grit and determination. The surprising best description for Brenda Robinson’s seemingly dry and corporate challenge to “embrace generational change in the workplace” was, “I laughed so hard I cried!” The Sherwood Park-based speaker and grandmother gave an insightful look at the issue with specific advice to take back to the workplace. As one attendee exclaimed, “She was worth the price of the day!” Using social media to bring prominence to the LPN profession was the focus of lawyer and blogger Ken Chapman’s sessions. LPNs were encouraged to “TALK the WALK” and share what they do and who they are with anyone who will listen. Naturist Brian Keating shared videos from around the world as he discussed how it takes all of us to provide care to patients, just as it does to care for our environment. Attendees were kept moving between eight concurrent sessions including topics on: dealing with professional errors; improving occupational health and safety; working with families of children with disabilities; understanding communication styles; overcoming the stigma of mental illness; perspectives of international nursing; leadership in remote locations; and understanding Alzheimer’s disease. Thank you to our many Silent Auction Donors: Best Foot Forward Reflexology & Massage Therapy, Care West, Citadel Theatre, Colleen’s Artistic Creations, Columbia College, Devon Foot Care, Edmonton Opera, Executive Royal Inn - Calgary, Fantasyland Hotel, Fred Katz Photography, Jubilations Dinner Theatre, Kwik Kopy Design & Print Centre, Lakeland College, Leduc Meat Packers, Liquor Stores GP INC., Marriott Edmonton River Cree, Northern Lakes College, Panda Flowers, Red Deer College, Richardson GMP, Royal Bank, The Old Spaghetti Factory, Town of Calmar, YMCA Edmonton, Lise Bussiere, Aileen Campbell, Deanna Fakeley, Eilleen Farquharson, Alice Fontaine, Pat Fredrickson, Nancy Hewitt, Jeanette Lappenbush, Robert Mitchell, Heather Nelner, Deb Thompson, and Doreen Van Eaton.
Thank you to all event Sponsors! 36
care | VOLUME 24 ISSUE 2
2010 AWARDS WINNERS
hen the lights dimmed, excitement grew as the winners of the 2010 Awards of Excellence were revealed during the 2010 Celebration and Awards Dinner on April 8, 2010. The best representatives of LPNs excelling in the areas of Leadership, Nursing Practice, Nursing Education attended with family and supporters. A new Interprofessional Development Award was presented for the first time to recognize a health care leader who has been instrumental in building a quality practice environment.
Winners are selected by the Fredrickson-McGregor Education Foundation for LPNs, a non-profit society supporting members of CLPNA through educational grants, bursaries and awards of merit. The Foundation contributes a commemorative crystal award and $1000 to each recipient.
Pat Fredrickson Excellence in Leadership Award Sharon Rinas, Edmonton
A leader is a pioneer and Sharon Rinas, LPN, has opened many doors for LPNs with the trails she has blazed in the last 30 years. Amongst those trails was providing care to medically complex children in their homes, a role previously limited from LPN practice. Her clinical skill, problem solving, and positive attitude was instrumental in the program’s success and in highlighting the role of the LPN in a community setting. In her current role, she is one of the first LPNs to be a client coordinator in the integrated supportive living program comprised of interdisciplinary professionals. Her success supports the place for the LPN professional in leadership roles into the future.
Laura Crawford Excellence in Nursing Practice Award
Rita McGregor Excellence in Nursing Education Award Laura Milligan, Fort Saskatchewan
Soon after graduation, Laura Milligan, LPN, completed the Advanced Orthopedics course for LPNs and knew this was her passion. As her knowledge and experience increased along with her strong belief in this role for LPNs, Laura soon began to question why the Advanced Orthopedic course was not being instructed by LPNs in the classroom setting. It did not take long for Laura to convince NorQuest College of this concept, and that she was the one capable of taking on the role of primary instructor. As a result, she is today responsible for the day-to-day activities of the program, student tutoring, clinical follow-up, workshops and contract issues throughout Alberta and British Columbia.
Interprofessional Development Award
Jean Collins, Calgary
Jean Collins, LPN, had a dream of working in psychiatry long before it was a role open to LPNs, and her belief in the growth of the profession and her thirst for knowledge allowed her to be ready for one of the first positions open to LPNs. She never looked back nor did the Peter Lougheed Centre in Calgary. Jean is known and respected for developing strong behavioral/care plans that demonstrate the patient is suitable for placement in a variety of settings. Because of the comprehensiveness of the plan, it is an effective way to reduce problem behaviors and remove barriers to placement. Since Jean excels in this area, she has earned the title “Queen of Care Plans” and has assumed the responsibility for teaching and sharing her skills with other nursing staff.
Betty Fradgley, RN, Sherwood Park
From early in her career, Betty Fradgley, RN, had a goal to move people, challenge them, and see them advance to another level. When she became a Manager for Integrated Supportive Living for Senior’s Health - Edmonton Zone, she realized the hiring and integration of LPNs on her team was essential and she made it happen. Since then, she’s fostered a collaborative team environment by including PT’s, OT’s, LPN’s, and RN’s on clinical and consultation services teams. She has implemented and arranged for an initiative in supportive living to deliver formalized on the job training and education for healthcare aides. She has identified the need for the implementation of in-depth training of inter-professional team members in dementia care. Descriptive words and phrases from her sponsors include “winning attitude”, “inspirational”, “resourceful”, “determined”, and “breaks down barriers for others”. As one sponsor stated, “She has my deep appreciation and respect for recognizing the professional experience, potential and possibility that LPN’s bring to the field.”
AWARDS & BURSARY NOMINEES The CLPNA and Fredrickson-McGregor Education Foundation for LPNs congratulates the Nominees for the 2010 Awards of Excellence. These exceptional LPNs were nominated by employers and colleagues across Alberta. In the Foundation’s opinion, they are all winners. Laura Crawford Excellence in Nursing Practice Award Winner: Jean Collins, Calgary Nominees: Sharon Andersen, St. Albert Sandra Andrais, Okotoks Phyllis Blackwood, Leduc Lynn Borris, Morinville Florinda Canteras, Calgary Shirley Dutour, Edmonton Jessica Gutknecht, Sherwood Park Shirley Galliford, St. Albert Teresa Hallock, Grande Cache Sherry Harsulla, Edmonton Laurie Haynes, Bow Island Bonnie Kish, Edmonton Lisa Kriewaldt, Grande Prairie Minky Leba, Calgary Susan Moore, Calgary Jolayne Onofrychuk, Lethbridge Eileen Ruzycki, Calgary Salina Staples, Mayerthorpe Stacy Vanier, Grande Prairie Norma Wakeford, Calgary Pat Fredrickson Excellence in Leadership Award Winner: Sharon Rinas, Edmonton Nominees: Christy Gayton, Grimshaw Melissa Gibert, Alcomdale Elda Glover, Edmonton Melanie Joyce, Calgary Beverley Preston, Calgary Sheila Sumaylo, Edmonton Helen Van Nistelrooy, Picture Butte Ann Walker, Calgary Rita McGregor Excellence in Nursing Education Award Winner: Laura Milligan, Fort Saskatchewan Nominees: Cathy Brackenbury, Edmonton Gwen Evans, Wembley Crystal Genoway, Calgary Steve Ward, Calgary Interprofessional Development Award Winner: Betty Fradgley, RN, Sherwood Park David King Educational Bursary Recipient: Jody Misunis, Edmonton
care | FALL 2010
the operations room CLPNA Council President Hugh Pedersen Executive Director/Registrar Linda Stanger
To lead and regulate the profession in a manner that protects and serves the public through excellence in Practical Nursing.
District 1 (RHA Regions 1, 2) Vacant District 2 (RHA Region 3) Donna Adams - Vice President
District 3 (RHA Regions 4, 5) Jo-Anne Macdonald-Watson
Licensed Practical Nurses are a nurse of choice, trusted partner and a valued professional in the healthcare system.
District 4 (RHA Region 6) Sheana Mahlitz District 5 (RHA Region 7) Vacant
The CLPNA embraces change that serves the best interests of the public, the profession and a quality healthcare system.
District 6 (RHA Region 8) Roberta Beaulieu
By 2012 the CLPNA expects:
District 7 (RHA Region 9) Alona Fortier
• To be a full partner in all decisions that affect the profession • LPNs to embrace and fully exploit their professional scope of practice and positively impact the nursing culture • LPNs actively involved in planning and decision making within the profession and the healthcare system • LPNs to assume leadership and management roles provincial, nationally and internationally within the profession and the health care system • An increase in LPN registrations to 12,000 by 2012 • LPNs to actively promote and support the profession • Employers fully utilizing LPNs in every area of practice • The scope of practice to evolve in response to the unique and changing demands of the healthcare system
Public Members Peter Bidlock / Robert Mitchell Ted Langford To contact Council members please call the CLPNA office and your message will be forwarded to them.
CLPNA Staff Tamara Richter Director of Operations
Teresa Bateman Director of Professional Practice
Sharlene Standing Director of Regulatory Services
COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA
Linda Findlay Practice Consultant/CCP
CLPNA Office Hours
Log On to clpna.com
care | VOLUME 24 ISSUE 2
Regular Office Hours • • • • •
CLPNA Publications Learning Modules Competency Profile Job Listings Annual Report 2009
Monday to Friday 8:30am to 4:30pm Closed for Statutory Holidays
care | FALL 2010
ISSN 1920-633X CARE Publications Mail Agreement Number 40050295
St. Albert Trail Place, 13163 - 146 Street Edmonton, Alberta T5L 4S8 Telephone (780) 484-8886 Toll Free 1-800-661-5877 Fax (780) 484-9069
Return Undeliverable Canadian Addresses To: St. Albert Trail Place, 13163 - 146 Street Edmonton, Alberta T5L 4S8 email: email@example.com
Complete your 2011 Registration Renewal wal form online or submit your paper form byy November 11 to be automatically entered d in the “Ready, Click, Win! Contest”!
WIN 1 OF 2 PRIZES:
Complimentary lodging at Fantasyland Hotel Edmonton (Theme Room) Room) OR OR the the Executive Executive Royal Royal Inn Inn North North Calgary Calgary for for one one night. night. Only complete plete Registration Renewal forms with payment ent will be eligible. W Winners inners will be notified by phone and acknowledged on n www www.clpna.com. .clpna.com.
Healthcare news for Alberta's Licensed Practical Nurses: nursing practice, regulation, indisciplinary teams, provincial and national nursing...