SPRING 2011 | ISSUE 2
THE IMPERATIVE OF LEADERSHIP–
CENTR E FOR PROF E SSION AL N URS I N G E D U C AT I O N
AT THE BEDSIDE AND BEYOND
ANT M AC EWAN UNIVERSITY | SPRING 2011 | ISSUE 2
INNOVATION AND LEADERSHIP Photo by Bluefish Studios Inc.
LEADERSHIP IN GLOBAL EDUCATION
GRANT M ac EWAN UNIVERSITY
Accessible Flexible Relevant MacEwanâ€™s Centre for Professional Nursing Education is dedicated to serving frontline multi-disciplinary practitioners who strive to improve the health and quality of individuals, communities and industry. Programming is responsive to the needs of industry and practitioners as a whole. Many courses are offered online and through distance delivery, making professional development easily attainable. The centre also offers workshops that can be customized to suit the needs of corporations, organizations, and associations to help keep employeesâ€™ skills and knowledge sharp and current. Workshop topics include leadership, case management, clinical skills, CRNE preparation, best practices, and more.
DEANâ€™S MESSAGE It is my pleasure to bring greetings from the Faculty of Health and Community Studies at Grant MacEwan University. Nursing PRN is a means by which we are able to share with you some of the interesting activities occurring within our Centre for Professional Nursing Education. At MacEwan, we strongly value our connection with practice and strive to respond to the continuing education needs of nursing professionals. In addition to developing new courses, we are in the process of significantly upgrading the instructional technology in our Clinical Simulation Centre. Our aim is to provide an environment that is accessible, conducive to learning and fosters the integration of knowledge into practice. We sincerely appreciate your interest in MacEwan and hope you find value in Nursing PRN and in the many education opportunities available to you through the Centre for Professional Nursing Education.
Sharon Bookhalter, RN, BScN, M.Ed. Dean, Faculty of Health and Community Studies Grant MacEwan University
Spring 2011 | Issue 2 | Nursing PRN | 3
WELCOME! Since the publication of the first edition of Nursing PRN last year, the faculty and staff at the Centre for Professional Nursing Education have engaged in an ongoing dialogue with our stakeholdersâ€”clinicians, nurse educators, nurse managers, administrators and representatives from the relevant regulatory bodiesâ€”to identify the key topics of consequence for nurses and other health professionals today, so that we can focus continuing education opportunities on those areas most relevant to you. In discussions throughout the year the theme of leadership continually rose to the forefront, and a number of questions were educed. What does leadership mean? Does leadership solely rest with management? Whose responsibility is it? How do we support and encourage all nurses to take on leadership roles? With these questions in mind, it was easy to determine that the focus theme for this edition of the magazine would be leadership. Whether you are already in a leadership role or are feeling your way through the new expectations for leadership in nursing, I hope you enjoy our second edition of Nursing PRN and find the following articles interesting, informative and inspiring.
Shirley Galenza, RN, BScN, M.Ed. Director Centre for Professional Nursing Education Grant MacEwan University
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On the Cover 8 | Innovation and Leadership by Lisa Ricciotti 16 | The Imperative of Leadership –
at the bedside and beyond by Cheryl Mahaffy
24 | Leadership in Global Education by Cynthia Dusseault
6 | Research Update 7 | Nursing PRN Contributors 8 | Innovation and Leadership by Lisa Ricciotti
12 | Graduate Spotlight: Cathy Storowotksy by Cheryl Mahaffy 14 | Spotlight: Up and Coming Programs by Cynthia Dusseault 16 | The Imperative of Leadership –
at the Bedside and Beyond by Cheryl Mahaffy
22 | Scholarship of Teaching and Learning Research by Lisa Ricciotti 24 | Leadership in Global Education by Cynthia Dusseault
28 | Faculty Spotlight: Roxanne Fox by Cynthia Dusseault 30 | Every Nurse Leadership Symposium
by Lisa Ricciotti
34 | Top 10 Tips for Positive Leadership
by BJ Anderson
Spring 2011 | Issue 2 | Nursing PRN | 5
Research Update by BJ Anderson
Issue 2 | Spring 2011
Acknowledgements BJ Anderson, Marketing Consultant Charlene Barrett, Marketing Manager Sharon Bookhalter, Dean Faculty of Health and Community Studies Gail Couch, Program Chair Shirley Galenza, Director Centre for Professional Nursing Education Lindsay Kirstiuk, Graphic Designer Joan Mills, Academic Co-ordinator Nicole Simpson, Academic Co-ordinator Deb Troendle-Scott, Editor Bluefish Studios Inc. Photography McCallum Printing Group Inc.
Nursing PRN is published by MacEwan’s Centre for Professional Nursing Education. Grant MacEwan University 9-206, 10700-104 Avenue Edmonton, AB T5J 4S2 780-497-5163 Contents copyright 2011 by Grant MacEwan University. No part of this publication may be reproduced without written approval.
The first issue of Nursing PRN highlighted a research project undertaken by Gail Couch, program chair at the Centre for Professional Nursing Education at Grant MacEwan University, and Kari Krell, a faculty member at the centre. For many years, MacEwan has offered a three-day workshop to help nurses prepare for the rigorous Canadian Registered Nurse Examination (CRNE), which nurses must pass in order to practice in Canada. Couch and Krell had a unique opportunity in 2009 to examine the effectiveness of this preparatory workshop for internationally educated nurses, when the centre was contracted to provide the workshop to a cohort of nurses recruited to work in Alberta from Australia, the United Kingdom and the Philippines. Now the findings are in, and they’ve affirmed the benefits of the workshop for internationally educated nurses. The first step these nurses must take to work in Canada is to apply for licensure, which for most, means writing the Canadian licensure exam—the CRNE. This is often an overwhelming task for nurses unfamiliar with Canada’s health care system and the roles and responsibilities of Canadian nurses. Anecdotal evidence showed previous CRNE preparatory workshops had been well-received by Canadian-trained nurses; Couch and Krell designed a descriptive program evaluation study to explore the efficacy of the workshops for internationally educated nurses, hypothesizing that participation would likewise contribute to their success in passing the CRNE. Questionnaires were administered to study participants following the workshop and again after the release of examination scores. Results showed that 94 per cent of participants positively associated workshop attendance with successful test scores. Questionnaire results showed nurses perceived increased knowledge in all of the following areas: community nursing; social programs; role and responsibilities of RNs in Canada; use of technology in Canadian health care; medications in Canada; the relationship between the nurse and clients, or between nurses and doctors in Canada; health promotion; and illness and injury prevention. A commitment to diversity in nursing compels nurse educators and researchers to examine strategies that will help prepare internationally educated nurses to practice in Canada. Formal program requirements along with preparation for writing the CRNE are necessary so that these nurses may successfully complete the examination and begin their nursing practices here. While prior learning assessments, courses about Canada’s health care system, and bridging programs are available in Alberta, Couch and Krell’s work has shown that the preparatory workshops offered by the centre are an appropriate avenue for addressing the learning needs of this population. Given the previous successes of the workshops, no doubt these findings will be reflected in similar accolades from international nurses grateful for the support of the centre in preparing them for a future in nursing in Canada. For more information contact Gail Couch at couchg@MacEwan.ca
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Contributors BJ Anderson BJ is the marketing consultant with the Faculty of Health and Community Studies at Grant MacEwan University. She is a journalism grad, is currently pursuing her English degree part-time at MacEwan, and enjoys writing for both work and play.
Cynthia Dusseault Cynthia is an Edmonton-based writer with a health and education background. A former medical radiation technologist and elementary school teacher, she realized that no matter what she did, she was drawn to any task that involved writing, so she decided, over a decade ago, to write full time. Since then, she has written for a variety of magazines, including The National Review of Medicine, University Affairs, Your Health, Education Leaders Today, Today’s Parent, Children’s Playmate, Western Grocer ... and many more. She has also had a picture book for children published by Scholastic Canada, and has written copy for websites and numerous corporate clients.
Cheryl Mahaffy Cheryl Mahaffy launched the freelance business Words that Sing in 1996 with the goal of writing about things that matter. Her work has appeared in numerous magazines and several books, including the anthologies Big Enough Dreams, Edmonton on Location, and Outside of Ordinary. Co-author of Agora Borealis: Engaging in Sustainable Architecture, she also writes for a broad range of nonprofit, civic, and corporate clients.
Lisa Ricciotti Lisa Ricciotti somehow didn’t follow the path of her mother and three of her four sisters, who chose nursing as a career. Instead, she’s an award-winning freelance writer, happily working from an Edmonton home base shared with three French bulldogs, a grumpy old English bulldog, and one very patient husband. While not a nurse, Ricciotti credits her sisters’ passion for nursing as the source of her keen interest in writing about health and medical matters.
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Job Listings Practice Consultation Registration Information LPN Competency Profile
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Online Members Registry Education Grants Re-Entry Bursaries CARE Magazine
Spring 2011 | Issue 2 | Nursing PRN | 7
INNOVATION AND LEADERSHIP by Lisa Ricciotti ho’s the more patient “patient”? Stan, who willingly vomits, endures endless IV insertions and opens wide for anesthesia intubations? Or the ultra-prolific, chronically pregnant Noel, eternally prepared to give birth on demand?
Bookhalter’s well aware you don’t get to be a leader by standing still. “We have to be nimble, remaining responsive to the needs of nurses and health care agencies in our ever-changing environment.” Or as Lynn Feist, the co-ordinator of distance and distributed education, notes: “We’re not doing the same things we were three years ago. We’re always looking ahead, innovating and adapting to offer the skills students need for the future.”
On this particular day, most would pick Stan. He’s already endured several cardiac arrests, while Noel’s resting comfortably, still labour-free. (She did have a difficult delivery yesterday though—twins with complications.) It’s a hard choice, but it really doesn’t matter, since neither is human. Lifelike though they are, both are high-fidelity patient simulators, standing in for real patients in simulation labs at Grant MacEwan University’s Faculty of Health and Community Studies.
Innovative programming on the leading edge of care
Although far beyond the wildest dreams of nurses who trained in a less high-tech era, simulation is just one of many learning innovations at MacEwan. As Dean Sharon Bookhalter explains: “Nursing education at MacEwan has come a long way from its humble beginnings 40 years ago. We’ve grown in prominence regionally, nationally and even internationally, building on our strengths to create a very rich learning experience. Our goal is to be a leader in continuing education for nurses and other health care practitioners.”
“Shirley’s a visionary,” Mills states. “She looks ahead to identify gaps in training between what exists and what’s needed now, or 10 years from now. Then she figures out how to fill those niches with the right programs.”
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Shirley Galenza, director of the Centre for Professional Nursing Education, spends a lot of time thinking about the future. She isn’t one to draw attention to the importance of those forward-thinking skills, but Joan Mills, her enthusiastic academic co-ordinator, jumps in to make the point.
Of course Galenza doesn’t create new programs and courses on her own. It’s a collaborative process, a gathering of input from health care partners, agencies and regulatory bodies, as well as the first-hand experiences of working nurses and practitioners—and much discussion between colleagues and program advisory committees. Now some of the fruits of that labour are ready: new professional development modules and certificate programs in ER/ICU nursing and a new cardiac care nursing program.
The ER/ICU programs were developed to bridge the gap between the competencies of novice and expert nurses. As Galenza explains, there’s little intermediate-level training available, although beginning nurses often discover they need more skills in certain clinical settings. In the past, hospitals provided on-site training and orientation to prepare nurses for more complex procedures, but that ended after system-wide staffing cuts. “And the old mentoring system, where experienced nurses passed on knowledge, really isn’t viable anymore,” Galenza notes. “Who can take on the role of teaching new nurses when everyone’s so busy?” Enter the solution—the new courses and modules introduced in January for emergency and intensive care nursing skill development. “Nurses want to grow and expand their horizons,” explains Bookhalter. “These courses help them move from entry-level to intermediate and beyond, building a more advanced skill set.” Recognizing that every nurse has different training needs, the ER/ICU professional development modules feature an innovative “à la carte” option. Students can pick and choose from a wide menu of non-credit modules, taking only what’s relevant to their needs. Or instead, they can complete a series of credit courses to receive certificates of achievement. “We offered some of these courses previously on a contract basis,” says Galenza. “But now they’re all online, available anywhere and modularized. This is what nurses across the country have asked for.” At the other end of the training spectrum is the new Cardiac Nursing Post-basic Certificate program, designed to help intermediate nurses with a solid knowledge base progress to advanced status. “Cardiac nursing is its own subspecialty, with unique challenges,” says Mills, who admits to a personal passion for anything involving the heart. “As Edmonton’s become a centre of excellence for cardiac care, nurses need more depth and diversity to cope with the huge leaps and bounds in new techniques, pharmacology and technology. But there wasn’t anything comprehensive out there; most training focuses only on acute episodes. This new program will fill that need, encompassing the whole journey of cardiac nursing from preventative to end-of-life care.” The new Ministry of Advanced Education and Technology-approved cardiac program begins in September, and Mills can hardly wait, she’s so pumped about its possibilities.
“We have to be nimble, remaining responsive to the needs of nurses and health care agencies in our ever-changing environment.”
Whether students sign on for cardiac care or ER/ICU training, Galenza believes the strong clinical focus of these extra courses will empower nurses. “They’re designed to give working nurses the tools they need to succeed at the bedside.” Spring 2011 | Issue 2 | Nursing PRN | 9
Embracing technology for innovative delivery As MacEwan develops new programming, it’s also using technology to help nurses and practitioners respond to a rapidly changing health care landscape. By embracing the latest advances in e-learning and the virtual reality world of simulation labs, students are offered cutting-edge techniques for learning new skills. And equally important, technology lets students access the latest information in ways that match their individual learning preferences and lifestyles. “The innovative delivery of online distance education means students can access courses without being onsite,” says Bookhalter. “It also engages students in different ways than the traditional classroom. Students enjoy interacting with other participants, as well as the opportunity for independent learning.” “We’re building on the success of our online wound management courses,” Galenza adds. “Our instructors have become very creative in how they use Blackboard and Elluminate technology to bridge the distance, incorporating videos and photos for case study discussions and demonstrations. Distance education works very well for the adult learner.” So well, that sometimes students find it hard to log off, says Feist. “Often the students don’t want to leave the discussion groups when the class ends. Today’s generation expects a lot of feedback and interaction and they’re comfortable with technology. They love how distance education connects them with a wide range of professionals in many locations, expanding their contact base for future consultation. They learn so much by sharing experiences.” Recognizing the benefits that online distance learning can bring, the centre is now applying the online advantage to its Nursing Refresher program. “We’re known across Canada for our refresher program,” says Galenza. “It was print-based; now we’re moving to all online delivery. We hope to have two theory courses online with Blackboard technology by July and more by July 2012.”
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“We’re always looking for the best way to link education and practice.” “There’s a big age range in refresher participants,” adds Bookhalter. “But most people have computer skills now, and instructors help if there are any technological learning curves. The timing’s right to go online.” The timing’s also right for the centre to refresh its own refresher course materials, which will be updated based on current best practices in nursing education for online and blended learning. The centre is also using innovative technology in simulation labs to provide hands-on training that might not otherwise be possible. “The trend is toward experiential learning,” says Bookhalter. “Students don’t want to just go to class; they want to go do something in class. In sim labs, there’s a comfort zone for making mistakes in situations where learning by doing on real humans isn’t always possible, practical or safe.” MacEwan was the first teaching institute to use simulation in Western Canada, beginning in 2003. Since the opening of its state-of-the-art lab at Robbins Health Learning Centre in 2007, the simulation program has grown to a size and quality that’s hard to match anywhere in Canada. Various scenarios are created in labs, from basic patient interactions to technical procedures to critical situations, using two different methods.
The standardized patient method involves role-playing between students and actors who perform as real patients would during clinical encounters, while human patient simulators replace humans in the second approach. Patient simulators range from low-fidelity basic models (like a plastic arm or stuffed torso for practicing bandaging or IV insertion) to highly sophisticated, fullsize mannequins like Stan and Noel, which almost seem alive. These high-fidelity patient simulators respond to interventions in a very realistic manner, driven by complex computer models. “Students often forget their ‘patient’ isn’t real,” says Galenza. “They get so involved and engaged.” “We’re always looking for the best way to link education and practice,” Bookhalter summarizes. “Whether it’s a sim lab, innovative programming or online delivery, our goal is accessibility, flexibility and engagement. That’s how MacEwan will remain a leader in lifelong learning and continuing competence. And that’s how we’ll equip nurses and practitioners to be everyday leaders in the work settings of their choice.”
They breathe, they bleed, their toes turn blue. You can feel their pulse and hear their heartbeats. Their eyes open and close, their pupils dilate. The baby giggles and coos, the pregnant woman often screams for an epidural and the man might moan in pain. They’re realistic in every detail, right down to the feel of their skin. The high-fidelity human patient simulators are definitely the stars of the simulation labs at the Faculty of Health and Community Studies, thanks to computer programming that makes them respond realistically to the administration of drugs, anesthesia or defibrillator shock paddles. Yet beyond the lifelike mannequins, other technology is also working hard to maximize students’ learning experiences. Take a tour with Meagan Lehman, co-ordinator of the Clinical Simulation Centre, and she’ll point out the many other high-tech features. All scenarios with live actors or mannequins are recorded and instantly available to students at multiple computer stations. At their debriefings, students review their performance, while typing in answers to follow-up questions and reflective assignments from instructors. This step reinforces their hands-on experience and encourages critical thinking. Instructors behind two-way mirrors also monitor students in action on small video screens, and can speak directly into the room of their choice, or change how a simulator reacts to introduce a new clinical symptom.
Photos by Bluefish Studios Inc.
“Technology makes the scenarios highly interactive,” Lehman explains. “Simulation is a very rich part of learning. Students love it!”
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SPOTLIGHT by Cheryl Mahaffy
love this job.” Cathy Storowotsky has found the perfect place to use her leadership skills as an occupational health nurse with Alberta’s Effective Case Management (ECM) Group. On the phone, online and sometimes in person, she helps workers from several companies navigate disability systems, tapping into all she has learned in two decades of nursing. Storowotsky knows what her clients are going through, for in 2006 she was in those same shoes—on disability and needing support as she healed and eased back into work. Her experience with disability, in fact, is the reason she is working in this downtown Edmonton office today. After several years in the high-pressure, high-emotion world of intensive care nursing, she had been feeling the strain—and losing her drive for the work. While on disability, she was impressed by the blend of expertise and compassion shown by the occupational health nurse assigned to her case. “I saw there was another world of nursing where you could use your autonomy and connect with people without having to deal every day with death and dying,” she says. A single mother, she was attracted by the prospect of leaving shift work behind and spending more evenings with her daughters, who are entering their teens. Yet she wanted to continue working in positions that 12 | Nursing PRN | Issue 2 | Spring 2011
challenge her to think independently and take leadership roles. That same year, Storowotsky entered Grant MacEwan University’s Occupational Health Nursing post-diploma/ degree certificate program. Having never done distance learning, she wondered whether she’d have the discipline to learn online. She needn’t have worried. Taking one course at a time while continuing to work casual shifts in ICU, she finished the 10-course program in about four years. The program was essential to moving with confidence into her new career, Storowotsky says. “I think leadership is a mix of education, a solid skill foundation, experience and confidence. This gave me exactly the education I needed. Maybe I’m idealistic, but really I feel the whole program was designed for success.” And succeed she did, earning the Occupational Health Nursing Scholarship in 2009 for her top academic record. Equipped with that training, Storowotsky worked for about a year in an office doing pre-employment physicals and drug and alcohol testing before being hired by ECM Group in May 2010. “I saw the posting, walked into the interview and felt like I’d known these women forever,” she says. “It’s exactly what I wanted.” Founded in
Calgary, ECM does short-term disability management for companies that don’t have on-site health nurses. Work on a case typically begins when a human resource officer in a client firm alerts ECM Group that someone is going on disability leave. After contacting the worker to find out details, Storowotsky develops an action plan. As the plan unfolds, she plays an intermediary role between the worker, the employer and any doctors and specialists who are or should be involved. Employer communications can be especially delicate due to privacy concerns, she says. “We can’t tell employers any medical information, yet some companies want to know every detail. So you’re walking a fine line between respecting privacy and advocating for the client.” The insights and professional contacts built up over 21 years of nursing are proving invaluable, Storowotsky says. “We do a lot of adjudication here, so we’re the ones who decide whether and when someone goes back to work.” Gaining the trust of a client’s supervisor is important, she adds, especially if the work environment is at all responsible for the disability. A supervisor’s willingness to modify hours or other working conditions can allow a client to return sooner than might otherwise be the case. A self-professed “people person,” Storowotsky earns client confidence with her ability to assess what is needed and recommend next steps. “We keep in touch with people, sometimes every two weeks, so we really make a connection,” she says. Contact continues even after clients are back on the job, until it seems the disability is truly behind. Clients who need to be on disability longterm shift to the company insurance provider for support, a difficult transition for some. In addition to disability management, ECM Group conducts physicals and drug and alcohol testing, both in the office and on-site. “When I go out to worksites, I really love the hands-on work,” Storowotsky says. “Generally the people are healthy, so it’s nothing like ICU. All the body fluids I’ve dealt with over the years—I don’t miss that at all.”
“I think leadership is a mix of
education, a solid skill foundation, experience and confidence.”
Storowotsky says she is far from alone in shifting from intensive care to occupational health nursing. Both specialties attract strong personalities who thrive in leadership, she muses, and perhaps it’s no surprise. “In this office, we have to be strong and make on-the-spot decisions, because we’re dealing with people’s livelihoods. Some occupational health nurses work in the oilfield or other remote locations where you’re the only source of health care for miles around. If you come from an area where you’re dealing with incredibly intense life-or-death situations and have freedom to talk to doctors as equals and make your own decisions, you have the maturity for this job, because you have that experience under your belt.”
Studying occupational health nursing at Grant MacEwan University was a mind-expanding experience, says graduate Cathy Storowotsky. “It opens your eyes to the world of industry and the hazardous jobs out there.” The post-diploma/degree certificate program, provided through online distance delivery, provides grounding in the field’s history, current practices and trends, Storowotsky says. “Once you understand how occupational health nursing came about and why there’s a need for it, you feel more empowered.” She also learned important techniques, such as how to perform lung, vision and hearing tests. Her favourite course? “Toxicology,” she says, “which surprised me because chemistry was my worst subject.” In addition to completing assignments, field visits and papers, students must participate in online discussions. While not always a popular task, Storowotsky comments, “it gave me insight into things I might have missed.” University advisor Marilyn Romanyk proved particularly helpful, Storowotsky adds. “She is the greatest gift to that program. She made me feel like the most important person in her world, and everybody I talked to said the same.” For Storowotsky, occupational health training builds on a two-year nursing diploma and a six-week program in intensive care, both earned years ago at Keyano College in Fort McMurray. Don’t be surprised to see her back in the classroom again. “I would like to focus on safety,” she says. “I’m sure there’s more that I haven’t discovered.” Spring 2011 | Issue 2 | Nursing PRN | 13
SPOTLIGHT: & COMING
PROGRAMS by Cynthia Dusseault
ducational institutions must be innovative in order to provide education that’s current and that meets the needs of students, the working population and the workplace, regularly introducing new programs and modifying or revamping existing ones. The Centre for Professional Nursing Education at Grant MacEwan University strives to stay at the forefront of continuing education for nurses, taking a leadership role in the development of initiatives that address current and projected educational demands. The centre’s new and modified programs are testament to the fact that it is responsive to the changing needs of nurses, as well as the evolving demands of the health care system.
New Cardiac Nursing Post-basic Certificate In the fall of 2011, the centre will be launching its new Cardiac Nursing Post-Basic Certificate, a comprehensive, five-course, 17-credit program offered through online distance delivery for RNs seeking the knowledge and skills they require to meet the specialized needs of cardiac patients in acute care settings, rehabilitation settings and primary care settings. Approved by Alberta’s Ministry of Advanced Education and Technology, the program will also provide nurses with the skills to target larger groups and the population as a whole in terms of health promotion and disease prevention. “We know that people who have cardiac disease are huge users of the health care system,” says Joan Mills, the centre’s academic co-ordinator. “The whole cardiac speciality has many protocols, and if all nurses follow the same protocols, I believe this will benefit the patients and the health care system. And addressing health promotion and disease prevention, I believe, will have a positive impact on use of resources.” With the opening of the Mazankowski Alberta Heart Institute at the University of Alberta in 2008, and the 14 | Nursing PRN | Issue 2 | Spring 2011
projected opening of the C. K. Hui Heart Centre at the Royal Alexandra Hospital in April of 2011, the timing is perfect for offering nurses the opportunity to enhance their skills in this specialty area. Mills says that MacEwan expects nurses working in these two facilities or in similar facilities to constitute the target group of learners for this exciting program. “There are other cardiac programs out there, but they tend to focus more on acute care,” points out Mills. Mills adds that she believes MacEwan’s program will be the only one offering nurses an “A to Z” range of speciality training in aspects of cardiac care including rehabilitation, health promotion, disease prevention and palliative care.
Critical care programs go the “distance” For the past five years MacEwan has been providing face-to-face delivery of two critical care programs— Emergency Nursing and Critical Care Nursing—on a contract basis to nurses employed by Alberta Health Services. The Centre for Professional Nursing Education has revamped these two programs, for which students can earn certificates of achievement, and will be now be offering them through online distance delivery. The first courses in the programs opened in January, with additional courses to be launched soon. Mills explains that in the Edmonton region, it’s mandatory for ICU nurses to have taken a certificate course in critical care, and while it’s not mandatory for emergency nursing, it’s desirable. “Because of the severity of illness in these areas, there’s definitely a need for specialty education beyond what someone would get in a basic nursing program,” she says, “and rural nurses don’t always have the same educational resources or opportunities that are available to nurses within urban areas. Now nurses across the country will have access
to these programs, and this will promote best practices everywhere.” The programs have lab components which, as Mills points out, will require some creativity to set up. “If someone in Newfoundland registers, we’ll have to design the lab component with support from institutions there. It’s do-able; we do that in some of our other programs.” Another option for health care professionals who want to advance their knowledge in emergency/intensive care nursing is to enrol in one or more of the professional development modules now offered to nurses as individual, non-credit modules in a variety of areas. Nurses can take as many or as few modules as they choose. Mills explains that, for example, if a nurse wants to review how to interpret blood gases, she or he can take just that specific module, without having to enrol in a certificate or other program.
Updates to life support courses The centre currently offers three life support courses— Basic Life Support (BLS, which is often called CPR or cardiopulmonary resuscitation), Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS)—taught in accordance with the standards set out by the Heart and Stroke Foundation of Canada, which revises its standards approximately every five years. New standards came out in December 2010, which means that changes will be implemented in all three courses during 2011. These courses are all currently taught on-site in a faceto-face learning environment, but Mills says the Heart and Stroke Foundation is considering offering the theory component of the courses online in the near future. That’s a change that will make taking the courses less of a challenge for individuals with busy schedules. Mills also points out that MacEwan offers a unique programmed learning version of the ACLS course. “It’s basically an extra tutorial, and it involves individuals coming in for five evenings prior to the course. These are five evenings of theory and it helps people with their confidence level going into the weekend course. It improves their chances of success.” Fostering student success is what MacEwan is all about, and by offering new programs, revising existing ones and modifying delivery methods, the Centre for Professional Nursing Education offers students opportunities to achieve that success.
What’s new? Cardiac Nursing Post-basic Certificate This brand new program, which will be open for fall 2011 registration, consists of the following five courses: PBNS 465 PBNS 466 PBNS 467 PBNS 468 PBNS 469
Pathophysiology of Cardiac Disorders Focused Assessment of Cardiac Function Management of Cardiac Disorders Care of the Cardiac Surgical Patient Advanced Management of Cardiac Disorders
Emergency Nursing Level 1 Certificate of Achievement program This program, formerly offered in face-to-face format for Alberta Health Services employees only, is now an online distance delivery program, open to nurses across the country. It consists of the following two intensive courses: NURS 460 Essentials of ER/ICU Nursing NURS 461 Emergency Nursing Practice I
Critical Care Nursing Certificate of Achievement program This program, like the Emergency Nursing program, is now also an online distance delivery program, open to nurses anywhere in Canada. It consists of the following two intensive courses: NURS 460 Essentials of ER/ICU Nursing NURS 463 Critical Care Nursing Practice
Life support course updates and anticipated future delivery method changes Updates to the life support courses will be implemented in 2011. Distance learning options for life course theory modules are anticipated in the near future. Spring 2011 | Issue 2 | Nursing PRN | 15
Photo by Bluefish Studios Inc.
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THE at the bedside and beyond by Cheryl Mahaffy
“We employ only leaders here, no followers.” That’s what newly hired nurses at the Ottawa Hospital hear from Ginette Lemire Rodger, officer of the Order of Canada and the hospital’s chief nursing executive. or nurses trained in an era when leadership in the profession was synonymous with management or academia, it’s a shift in thinking—possibly an uncomfortable one. But it’s an essential shift, Rodger says. In Nursing Leadership and Management in Canada, a textbook for aspiring nurse leaders, she terms the need for leadership “the most pressing issue requiring concerted action by the nursing profession.” With the health care system in a constant re-engineering mode, challenged by finite resources, political choices and new ways of giving care, she writes, leadership is critical to “the ultimate goal of health for all people.” In Edmonton to present the keynote address at the Every Nurse Leadership Symposium hosted by the Centre for Professional Nursing Education at Grant MacEwan University, Rodger expanded on that perspective, making it clear that in her ideal world, every nurse would exercise leadership—at the bedside and beyond. Increasingly, nurses work in shifting and almost autonomous teams where they need to make on-the-spot decisions, she says, and being a follower rather than a leader in such circumstances could compromise patient care. “We want clinical nurses to make decisions about their clinical practice. Not managers, or educators, or researchers, but clinical nurses.”
Although leadership can be strikingly different depending on the setting, Rodger believes nursing leaders share key attributes: vision, knowledge, confidence, courage and visibility. Echoing the textbook, her keynote speech elaborated on each in frank and realistic terms. • Vision: Because the care environment is so complex, the only people who get somewhere are those with a vision of where they are going. •
Knowledge: People will see you as a leader if you know a lot about something—especially in this information age, when knowledge is a key driver. But with knowledge doubling every six months, nurses cannot hope to know everything about everything. What’s needed is just-in-time knowledge that integrates the artistic, social, scientific and intuitive aspects of nursing.
Confidence and courage: In the past, nurses could sit on the fence and say nothing. In today’s complex environment, values are key to making right decisions. Nurses need the confidence and courage to articulate what they believe and why—not just once, but every time an issue arises.
Visibility: Nurses have trouble being up front and visible. Even though nurses know a lot about a lot, many don’t want to be seen as experts. But the reality is, you can’t lead if you’re invisible.
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The Canadian Nurses Association (CNA) seconds those attributes, noting that “nursing leadership is about critical thinking, action and advocacy—and it happens in all roles and domains of nursing practice.” In its position statement on leadership, the CNA outlines that nursing leadership “is about the competent and engaged practice of nurses who provide exemplary care, delegate and take charge appropriately, think critically and independently, inform their practice with evidence, advocate for patients and communities ... and push the boundaries of practice to innovative new levels.” In environments where nurses are invited and equipped to lead, the results are fantastic, Rodger says. Care improves as a result—and the nurses involved find their work more fulfilling. “Those who know this is possible gravitate to places where it is happening.” Experiential learning is key to effective leadership, Rodger notes. When emerging leaders lay plans that threaten to go awry, managers trained in the top-down, policy-heavy industrial age may be tempted to take back the reins. “Sit on your hands and zip it,” she advises senior nurses. “The only thing you should do is ask pertinent questions.”
Supporting every-nurse leadership Alberta’s recent health care journey amply illustrates why leadership is needed in every corner of nursing, says Nicole Simpson, academic co-ordinator at the Centre for Professional Nursing Education and a key organizer behind the Every Nurse Leadership Symposium. Back in 1992, when Simpson earned a BScN from the University of Alberta, leadership was still seen as the job of middle and higher management. Then came the
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mid-’90s cutbacks, and an entire layer of positions disappeared, leaving care teams rudderless. By growing leaders at every level and in every area of nursing practice, she says, “at the end of the day we still have people who can lead that care.” Because nursing has expanded to encompass many roles and contexts, leadership in the field takes many shapes. “For some nurses, it may be providing the best patient care there is, while for others it may be taking on a mentoring and precepting role, or starting a wound care team, or ensuring really clear standards of care,” Simpson says. “The definition of leadership will vary depending on the roles we take on, but it is important that all nurses know for themselves what leadership means to them and where they want to go.” Although the Alberta health care scene is still in transition, it doesn’t mean there aren’t nursing leaders working right in our midst, Simpson adds. “There are really innovative, creative, fabulous nurses right here who are trying ideas out and analyzing the results— someone else working a 12-hour shift just like you who had a question and truly showed leadership in finding an answer.” Many nurses may not even recognize themselves as leaders, since every-nurse leadership does not depend on formal assignment of roles, Simpson adds. Perhaps they would say they are simply ensuring best practices, or advocating for their patients. Yet this approach to nursing demands skills and attributes distinctly different from those taught in the past. “Nurses need to be supported in this, because it isn’t the ‘toolkit’ we all necessarily graduated with,” she says. “Given that MacEwan is in the business of education, we need to support nurses, so they can develop the skills to lead.”
Training for leadership MacEwan’s undergraduate nursing program is supporting the call for every-nurse leadership with a course specifically focused on leadership. Nursing education shifted from a diploma to a degree program at MacEwan in 2007, and the first BScN students are now taking the course as part of their final year of study. After a semester in the classroom, students shadow nurse preceptors in various Alberta Health Services settings, says Sharon Bookhalter, dean of the Faculty of Health and Community Studies. Feedback from both students and their mentors is overwhelmingly positive. “Probably all of them down the road will assume what people commonly refer to as leadership positions, but we’re trying to instill skills and knowledge they can implement in everyday practice,” Bookhalter says. “Hopefully that improves their ability to create positive change within whatever practice setting they’re in—and through that enhance our community and our lives.” Quoting Grant MacEwan, after whom the university is named, she added, “We want to leave the vineyard better than we found it.”
Opening the leadership door Donna Hogg can pinpoint the day she began thinking of herself as a nursing leader. About a decade into her career as a registered nurse, she was working in emergency at the Izaak Walton Killam Hospital for Children in Halifax when the director of nursing invited her to step into the role of discharge planner for patients with complex needs.
Hogg and her colleagues frequently field questions from nurses who want to know whether certain interventions fit within the boundaries of their work. “Nurses are already demonstrating leadership when they choose to question whether an intervention is within their scope of practice before doing it,” she notes. “Our role is not to go in and fix an issue, but to give registered nurses the tools to work through the issue themselves.” This may include individual coaching, workshops, conference calls or facilitated discussions in workplace settings, Hogg adds. “Mentoring is one of strongest components that will help registered nurses grow and evolve.” While mentoring, Hogg continues to learn every day. “Our members teach us many things. They also ask questions that prompt us to seek out evidencebased information, or review relevant legislation, or connect with experts related to their inquiry,” she says. “Leadership is also learning—we need to remember that.” Registered nurses also need to become more adept at talking about the expertise they bring to patient surveillance and care, Hogg adds. “That’s the invisible work RNs do that the public is totally unaware of. Part of the leadership challenge as we go forward is being able to talk about the value we add in a way that is not selfserving, but patient centered. Some of the resolve I see in terms of registered nurses having the answers, as well as identifying issues, tells me we’re moving more towards that. I think registered nurses are finding their voice.” Looking back, Hogg still says her experience as the
“My first response was ‘I don’t think I can do it,’ but as we sat and talked, her confidence in my ability convinced me to try,” recalls Hogg. “She saw potential in me that perhaps I didn’t recognize myself. And she promised support would be there for me; they wouldn’t just leave me hanging.” Since then, Hogg’s varied career has taken her many places—most recently to the College & Association of Registered Nurses of Alberta (CARNA). As a policy and practice consultant, she helps to unravel the standards and scope of practice that define the practices and skills registered nurses are educated, authorized and competent to perform.
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discharge planner in Halifax was pivotal to understanding how and why registered nurses exercise leadership. Only by working closely with unit clinical nurses, patients, families, insurers, equipment suppliers and many other health professionals and community agencies could she ensure the best possible transition home for young patients, she says. “Yet at the end of it, I was responsible to put all that together, make sure patient and family needs were met and then evaluate the outcomes. That role, and the support from the entire team, really opened my eyes to the fact that leadership is essential—and it isn’t something you do on your own.” Hogg is not alone in tracing her affinity for leadership to a particular circumstance in her career. Rodger recalls asking a room of 60 respected nurses what told them they had the ability to lead. “All but one identified a trigger event,” she says. “Typically, somebody they respected asked them to represent them, do something on their behalf or be in charge.” It’s a memory worth heeding for any nurse in a position to influence a colleague’s career.
Leading from the first Like many newly graduated nurses, Kate Young found her first year of professional practice a shock. “I just didn’t know what to expect,” she recalls. “I didn’t know there would be distinct stages a graduate goes through— and I didn’t know anything was available to help.”
Then she discovered Nursing the Future. Begun in 2004, the national not-for-profit organization equips young nurses to support those coming behind while preparing everyone involved to address critical health care issues. Besides reassuring Young that most first-year nurses go through periods of stress, distress, discouragement and disillusionment, Nursing the Future offered the tools and mentors she needed to not only cope, but flourish. Determined to support others as she had been supported, Young became a graduate liaison for Nursing the Future. Now she’s mentoring Sophia Lepore, who will graduate from the University of Alberta in 2011 and move into the liaison role. Together, the duo presented one of several posters at the leadership symposium—another step in the mentoring relationship, but also an opportunity to invite other nurses to equip themselves as leaders. Their poster compared the transfer of leadership to planting and nurturing seeds through the cycle of life. The cycle does not end at harvest, but rather begins anew, Young notes. “Even without knowing that model, looking back, I was definitely supported, mentored and very slowly released out into my fully functioning role—and now the process is happening again with Sophia.” Newly graduated nurses face challenges unlike any the profession has known and many are leaving the profession, Simpson observes. By equipping young nurses for effective leadership and advocacy, Nursing the Future
Every Nurse Leadership Symposium – Quotes from Delegates When you think of a nurse who is a leader in your work setting, what is it that makes them a leader? “A leader is one who unintentionally inspires, respectfully challenges, beams with enthusiasm and isn’t afraid to do the right thing despite the circumstances.” Misty Zisin, RN, NP
What do you believe is needed for nurses to develop their leadership skills? “Empower nurses and they will become good leaders.” Arlene Roasa-Antonio, RN
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“For nurses to develop their leadership skills, they must look within themselves and appreciate and acknowledge their talents and skills so they can influence their colleagues and the community. More so, the support of the management is essential, for quality is everyone’s responsibility in rendering evidence-based patient outcomes.” Melissa Villagomez, LPN “We need to believe in ourselves and to believe in our profession.” Elizabeth Jones, RN
is offering another path. “This group really means to support new graduates and keep nurses in nursing. They are looking to lead from the day they graduate.”
Mentoring others to lead Decades into her career, Berni Baer co-ordinates a study group that serves as a lifeline for nurses who are preparing to write the CNA’s national certification exam in gerontology nursing. The volunteer post consumes countless hours, not to mention “think time.” Besides liaising with the CNA for the latest registration information, Baer scours textbooks and the Internet for case studies and practice exams, finds guest speakers and leads weekly sessions in the months leading up to the examination. Some nurses preparing for certification haven’t written an exam in 20 years or more, Baer notes. Perhaps it’s no surprise that her collection of practice exams (with answers researched by another volunteer from a past study group) has proven particularly popular with the nurses seeking certification. Every bit of practice helps. Baer is no stranger to mentorship. As Education Coordinator at St. Joseph’s Auxiliary Hospital in Edmonton, her work is all about being a coach and role model to fellow nurses. She co-ordinates education within the hospital, conducts workshops and in-service training and often does informal coaching and consulting.
“In order for nurses to develop leadership skills they need to realize what they can do individually to bring a difference generally. Take criticism positively to improve.” Ahmed Kermalli, LPN-RN student
How do you define or identify leadership? “[Leaders] listen without judgement, see the big picture and allow learning to take place in the face of error.” Karla Beam, RN “A leader is an individual who has a vision to achieve a goal which will benefit the group, without interfering with individuals’ values and beliefs.” Ahmed Kermalli, LPN-RN student
Like so many nursing leaders, Baer is passing on to others the skills and information that have benefited her. When preparing to write her own gerontology nursing certification exam in 2006, she joined a study group offered through the Alberta Gerontological Nurses Association (AGNA). She credits the group with ensuring her success. “I found it really, really, really helpful,” she says. Two years later, the study group facilitators stepped aside, leaving big shoes to fill. Knowing Baer’s passion for gerontology, the director of care at the hospital invited her to take on the challenge. With that vote of confidence, she agreed. “Part of our role as leaders is to share our experience with others and lead by example, to ensure our clients are getting the best possible care,” she says. Since becoming study group co-ordinator, Baer has begun inviting all AGNA members to attend sessions involving guest speakers, whether they are studying for the certification exam or not. It’s a win-win, she notes. Besides contributing to the wisdom in the room, nurses can count those sessions toward maintaining or enhancing their professional competence. She also fields calls from other communities wanting to start study groups and is happy to do so. “People look up to RNs; we’re still one of the most respected professions out there,” Baer says. “We are leaders no matter what role we’re in, and the sooner we all figure that out, the better.”
“Leaders to me are those who never set out to be leaders but create it with their own behaviour.” Kym Boyko, RN “Inspiring people.”
Stacey Middleton, RN
“She is knowledgeable in an assuming manner and actively demonstrates and interest in you and your perspective. She does not impose her perspectives on you but through her ability to demonstrate application and value of the information leads you to explore alternative ideas.” Liz White MacDonald, RN
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by Lisa Ricciotti
Pop quiz time—who coined this quote and when? “Nursing
is, above all, a progressive calling. Year by year nurses have to learn new and improved methods, as medicine and surgery and hygiene improve. Year by year nurses are called upon to do more and better than they have done.” Stumped? No, it wasn’t your instructor from a recent continuing education course. Fresh as it sounds, the quote dates back to 1882, and the author is none other than that famous pioneer of nursing—Florence Nightingale. ifelong learning and progressive improvement have always been part of nursing, and perhaps never more so than today. A 2004 study in the Journal of the Medical Library Association estimated that 7,287 articles were published monthly in relevant primary care journals; these would take a physician a staggering 627.5 hours per month to evaluate. So how does the Centre for Professional Nursing Education at Grant MacEwan University sift through mounds of research to keep its course materials accurate, timely and relevant?
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Peter Ryan, an instructional designer at MacEwan, tackles this task daily and passionately. With a PhD in communications and culture soon to be completed, backed by a focus on digital humanities and English, Ryan is well equipped to put the power of the Internet to work finding best practices in nursing education. He recently participated in new developments for the centre’s Nurse Credentialling: Nursing Refresher and Nursing Specialty programs and explains how it’s done. “First, we have many levels of quality assurance. All material is reviewed annually for accuracy, and to ensure it meets the standards of provincial professional regulatory bodies such as CARNA [the College & Association of Registered Nurses of Alberta]. A team of faculty and practicing experts in appropriate fields also add their contributions, along with feedback from the Program Advisory Committees and our outside teaching partners. All new courses must also be approved by the centre’s director, the dean and so on.”
That process covers any necessary updates. Just as important, however, is the process used to ensure course materials really accomplish their objective, i.e., do students fully understand the information? For that, Ryan creates a comprehensive literature review of research articles, books and other nursing education and online resources. Then he reconnects with staff, committees and experts to ensure his findings are valid. “We use all resources available. It’s a very democratic process, building consensus and continually checking with others, while working within established design principles for courses.” Ryan notes that for the recent Nursing Refresher and Nursing Specialty developments, “we started with student feedback from past courses to lay bare the process. Their comments revealed what’s working, where the problems lie and how to improve.” Because Ryan’s deeply involved in educational theory, his speech is peppered with catchphrases and concepts well understood in his field, but not so familiar to outsiders. He can quote expert after expert, outlining the pros and cons of their research on how students learn. It’s fascinating stuff, but when asked for the “Coles Notes version,” Ryan condenses his observations to facts that resonate with students. “The days of a teacher lecturing at the front of a class while students passively listen are over. Today the student is at the centre of learning, and education must emphasize interaction between students as well as with instructors. The three big trends currently in nursing education are problem-based learning, an emphasis on critical thinking, and leveraging online tools. As well, we need to consider cultural context when teaching students from other countries or ethnic backgrounds.” Putting it all together, Ryan outlines how his analysis of best practices in nursing education and feedback was applied to improve the Nursing Refresher and Nursing Specialty courses. “We’ve added more case studies, which research shows are a key component in moving from theory to practice. We also added a feature that lets students log-in to see each other’s solutions. That connects students and builds community. They can evaluate their peers’ responses and think about ideas they might have missed.”
“The days of a teacher lecturing at the front of the class while students passively listen are over. Today the student is at the centre of learning ... ”
To increase student-teacher interaction, all assignments are now completed online and reviewed by instructors before the student moves on to another section. Previously students self-checked their responses, which meant instructors couldn’t monitor a student’s progress effectively or quickly identify problem areas. And for greater student engagement, content is becoming more visual. Feedback revealed students found materials too text-heavy, so additional graphics, photos and videos are being incorporated. Courses will also emphasize exercises where students practice applying critical thinking skills. “It’s not just multiple choice and ‘yes’ or ‘no’ answers,” says Ryan. “Instead of describing a task, like how to put in an IV, students will be challenged to consider ethical situations they might encounter in clinical situations and the choices they’d make.” Specialty nursing courses will include cultural considerations to support out-of-country nurses before they enter the classroom, Ryan adds, since these programs are designed with internationally educated nurses in mind. “That includes an orientation program to help them get comfortable in their new location. We’re also providing more training to instructors so they’ll better understand different cultural perspectives. For example, some students are reluctant to speak up in the classroom since that’s not encouraged in their culture.” Who knew so much was involved behind the scenes in developing courses? When it comes to continuous improvement, it’s good to see the concept applies not just to nurses and health professionals, but to their education as well. Spring 2011 | Issue 2 | Nursing PRN | 23
n i p i h s r Leade n o i t a c u d lG obal E
s e v o M n io t a c u d ing E s r u N l a n io s s e f hip s r e n t r Centre for Pro a P e iv t a v Inno ia Dusseault h it w a n e r A l a th by Cyn into Glob
n December 2010, 28 nurses made the journey from the heat of India to the snowy cold of Alberta to study at Grant MacEwan University. Informally dubbed “The India Project,” this represents a novel undertaking for MacEwan—one that takes the university’s role in global education to a new level. The nurses, all trained in India, are enrolled in the Post-basic Nursing Practice: Hospice Palliative Care and Gerontology certificate program, offered by MacEwan’s Centre for Professional Nursing Education. To make this opportunity possible for this cohort of international students, the centre partnered with INSCOL Academy, an Indian company that provides international learning opportunities to Indian nurses with the aim of transforming them into global nurses.
Photos by Bluefish Studios Inc.
The path to a unique partnership Global education and cross-cultural learning are vital components at MacEwan, which welcomes approximately 750 international students every year. MacEwan International (formerly the Global College Council) is the university arm dedicated to recruiting international students and also to providing student exchange opportunities for its own students. A student recruitment effort in India planted the seed for the partnership between INSCOL and the Centre for Professional Nursing Education, and as a result, for the very first time MacEwan has brought an entire cohort of students from another country to study in one specific program. 24 | Nursing PRN | Issue 2 | Spring 2011
Bridging the cultural gap Shirley Galenza, the centre’s director, points out that not only have the course materials been adapted for face-toface teaching and learning, but the faculty has also been challenged to ensure that the students can relate to the material. This requires instructors to be aware of cultural differences and to understand that nursing practices differ according to the context of health care. Nicole Simpson, academic co-ordinator of the centre, explains that INSCOL was seeking an accredited program that would educate Indian-trained nurses in standards of practice and care both locally and globally. Her initial role with the project involved researching INSCOL and determining whether the company’s goals for its nurses aligned with MacEwan’s goals for nursing education. She found once that determination was made the rest of the pieces almost fell into place. The centre reviewed its programs and decided that its well-established Hospice Palliative Care and Gerontology certificate program would be a good fit. Then it moved on to finding instructors and developing the program of study for the cohort of students. “I don’t want to jinx it, because it’s not usually easy, but it was easy to find instructors for this project,” Simpson says. “There was a lot of excitement about doing this. The nurses who are instructing are all practicing nurses, and their employers have really supported them to teach these students, to learn from them and to promote to them what we consider to be pretty amazing standards of practice. The timing seemed to be just right.” The instructors are teaching the students face-to-face at the Robbins Health Learning Centre, the home of MacEwan’s Centre for Professional Nursing Education. This is a departure for the centre, which typically offers its post-basic nursing programs through online distance delivery to nurses, many of whom take the courses part-time while working. For this cohort from India, the situation is of course different, so they are full-time students in an intense, eight-month program designed specifically for them. The centre has essentially shifted gears for this project, and has modified its distance learning modules for use in on-site classroom settings.
“We know there’s a difference between Canadian and Indian health care,” says Galenza, who travelled to India in November 2010 to meet with the students and also to visit several hospitals. “I wanted to see where these students were coming from in terms of health care context, and to gain an understanding of what knowledge base they were coming with.” The program is therefore geared toward providing the students not only with the nursing knowledge that forms the basis of the program of study, but also with an understanding of how nurses apply that knowledge within the context of the Canadian health care system. This will help them understand how to adapt to other health care systems and apply their knowledge within those contexts, the true mark of a “global nurse.” Simpson agrees that context is the key. “These students will struggle to understand the independence of the nurse in Canada, the self-regulation, the professionalism, the patient advocacy role and the critical thinking that is expected of nurses here. The core piece we have to teach these nurses is how to understand their roles as RNs within the contexts of whatever countries they will work in.” “We’re not doing this to recruit nurses to work in Canada; the goal is to provide global education that opens doors for them,” Galenza points out, adding that these nurses may go back to India to work, they may seek work in other countries or they may indeed seek work in Canada. And while the program opens doors for the nurses, it will also equip them with skills that will benefit the patients they care for and the health care systems they choose to work in.
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A mandate to engage in global education The INSCOL partnership was preceded by MacEwan’s involvement in three major international health projects, one in Ukraine and two in Russia. Working in various ways with nursing institutions, ministries of education and universities, MacEwan assisted in improving nursing education and standards and competencies in these two countries through these projects, with the ultimate goal of benefiting health care delivery. Project Ukraine, for example, involved the translation of 28 of MacEwan’s nursing modules into Ukrainian, and the distribution of these to nursing schools throughout Ukraine. The modules provided the framework for the development of the country’s baccalaureate program in nursing. The goal of the Health Education Link Project (HELP) was health care reform in the Tyumen region of Russia, through the translation and sharing of the learning materials in MacEwan’s Nurse Credentialling and Human Services Administration programs. The Russian Ministry of Health, recognizing the benefits of this initiative, subsequently distributed the materials to institutions across Russia. This highly successful project won the Canadian Bureau of International Education’s 2002 award for Outstanding International Education Program. Building on HELP, the Canada-Russia Initiative in
Nursing project focused on improving nursing care, enhancing the role of nurses and making the nursing profession in Russia more self-regulated. The program introduced nursing standards and organizational models, and assisted nursing associations in embracing quality assurance and accreditation testing procedures. Dr. Roman Petryshyn, director of the Ukrainian Resource and Development Centre (URDC) at MacEwan, explains that these three major international health projects resulted largely from the passion of Geraldine Nakonechny, the former dean of the Faculty of Health and Community Studies, which is the faculty in which the Centre for Professional Nursing Education operates. Both Nakonechny and Petryshyn sit on the newly established Chair of International Health committee, created to bring the URDC and the Faculty of Health and Community Studies together to continue to work on health projects that benefit nurses, the nursing profession and health care systems in Ukraine as well as other countries. Petryshyn explains the impetus behind the Chair of International Health, which has an endowment fund that will provide the budget for international projects. “We have a policy of internationalizing the teaching we do at MacEwan, and as an institution, we are committed to engaging in work abroad,” he says. “Now, we’ve had over 10 years of involvement in international health projects, and the people involved in these projects have accumulated valuable experience. We have enough experienced people that we can move towards systematizing international learning experiences, and that will be the focus of the Chair of International Health.”
Advisory Committee Inaugurated The inaugural meeting of the Advisory Committee on the Chair of International Health was held at Grant MacEwan University in September 2010. The committee, established after more than a decade of faculty experience with international projects in various countries such as Australia, India, Ukraine and Russia, means that MacEwan now has an ongoing leadership group to advise the Faculty of Health and Community Studies on its next steps in this field.
The Advisory Committee’s role is to co-ordinate information internally and externally and recommend plans that will create applied research and project opportunities for faculty and students to engage with international health issues. The committee will promote an international learning culture at MacEwan that facilitates faculty and student participation and informs the public. The Advisory Committee will also work in relation to the Chair of International Health endowment fund created at the university in December 2008. This fund will yield seed money to sponsor small international projects by faculty and students.
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A global future The India Project has propelled the Centre for Nursing Education into the global arena, and there is great potential for future international projects in nursing education. After all, global nursing is a phenomenon that appears to be here to stay. “We’ve had many requests to do international work,” says Sharon Bookhalter, the dean of the Faculty of Health and Community Studies. “We really have to be certain that the fit is right. This project was a good opportunity for both of our institutions. It’s allowing us to teach to a different audience, and it’s offering us the opportunity to demonstrate that the programs we’re delivering here will prove useful to nurses from other countries in their contexts.” Simpson says there’s a good reason why MacEwan is often approached by other countries to engage in educational partnership. “We’ve always been a leader in offering flexible education through different methods.” The India Project will be a learning experience for the Centre for Professional Nursing Education, as well as for the 28 nurses in the program. As Bookhalter says, “It’s kind of a test for us, because we’re doing something we haven’t done before.” This is a test that the centre will surely pass, and the experience will enhance cultural understanding and provide insights that can only serve to benefit future initiatives in global nursing education.
Attendees at the inaugural meeting of the Advisory Committee were (left to right): Sharon Bookhalter, dean, Faculty of Health and Community Studies Gerri Nakonechny, former dean, Faculty of Health and Community Studies Danin Bodnar, former faculty member, Nursing program at MacEwan Roman Petryshyn, director, Ukrainian Resource and Development Centre Shirley Galenza, director, Centre for Professional Nursing Education Donna Kowalishin, past president, Pharmacist Association of Canada Irene Coulson, faculty member, Bachelor of Science in Nursing program at MacEwan
Not pictured: Wayne Tymchak, professor, Division of Cardiology, University of Alberta Hospital Richard Cook, dean, Community Relations and Fund Development at MacEwan
Sandy Kostashuk, faculty member, Bachelor of Science in Nursing program at MacEwan Lesia Boychuk, associate clinical professor, Division of Infectious Diseases, University of Alberta and Misericordia Hospital
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Roxanne Fox, Perioperative Nursing Program Instructor by Cynthia Dusseault oxanne Fox doesn’t deal with a daily commute. She spends most of her days working from home, engaged in online communication. A part-time instructor in Grant MacEwan University’s Perioperative Nursing program—a program she was instrumental in developing—Fox utilizes her strong communication skills to share her nursing expertise with others through online distance delivery. For this dedicated nursing professional, this is a perfect fit. An interesting career path led Fox to her current position at MacEwan. She graduated as an LPN in 1982, became an RN in 1987 and obtained her BScN from the University of Alberta in 2001. She gained approximately half of her clinical experience while engaged in general duty hospital nursing and also spent a short period in neonatal intensive care. But it was when Fox moved into the OR that she found the specialty that would become her passion and ultimately lead to her involvement with the Perioperative Nursing program at MacEwan. The intensity of perioperative nursing appealed to Fox. “The OR is an area that’s just so different from other nursing specialties,” she says. “You have a different relationship with the patient—a very short relationship— and you have to go through your entire nursing process 28 | Nursing PRN | Issue 2 | Spring 2011
with a patient in the first five minutes after you meet them. That’s a very short window of time to connect with a conscious patient.” “You need good communication skills to gather information from patients at this critical time in their lives, as they’re going in for surgery,” she continues. “You must adapt to the needs of each patient at that particular point in time. And then you go from this emotionally based relationship with the patient to a technically based relationship, focusing on the machines and equipment in the OR. In the OR itself, you need the ability to work in a confined space for a very long period of time with a multidisciplinary group.” Fox gained her profound understanding of perioperative nursing during eight years working in OR settings, first at the Edmonton General Hospital and then at the Grey Nuns Community Hospital. In 2002, while at the Grey Nuns, she decided to share her knowledge and experience with the next generation of nurses and began teaching in MacEwan’s undergraduate nursing program. In 2005, when the university received the go-ahead to develop online distance delivery programs in perioperative nursing, the name “Roxanne Fox” reached the ears of the administrative folks charged with developing the program.
“The Perioperative Nursing program gives nurses the opportunity to have options in their careers and the opportunity to try something different. ” “Roxanne’s name was mentioned to us because she has extensive experience in perioperative nursing,” says Shirley Galenza, the director of MacEwan’s Centre for Professional Nursing Education. “She has been sort of the pillar—the centre—of the development of both the RN and LPN programs in perioperative nursing. She has a strong clinical background and she’s well respected in the OR community. Most importantly, she’s committed to making sure that individuals in the OR area have the fundamental and foundational skills for working in that area.” Fox worked full-time for approximately a year developing the courses for the RN program, which was implemented in 2007. She also revised the courses in the pre-existing LPN program and for the new LPN program that was implemented in 2008. Now, she’s a part-time instructor, teaching three courses per term. Just as Fox became adept at assessing the needs of patients in perioperative settings, she has become adept at assessing the needs of her students. “I have to determine on a weekly basis, depending on the cohort of students, how much additional assistance they need,” she explains, adding that some cohorts require more technical assistance, while others require more support with course content. She goes online at scheduled times to answer questions and engage in group discussions or live chat. She responds to student emails and monitors the progress of students as they complete online learning activities. Fox also attends regular meetings with the nurse preceptors who work with students who are in the clinical phase of the program.
Fox epitomizes the axiom of lifelong learning. When she’s not engaged in her work with MacEwan, she’s furthering her own education. For the past three years, she has been a distance learner herself at the University of Phoenix. In June, she’ll graduate from a blended degree program: Master of Science in Nursing/Master of Business Administration/Health Care Management. What comes next? “That’s the big question,” says Fox. “I’m not sure. I’d like to continue my involvement in the Perioperative Nursing program and continue improving it and keeping it current. I actually started taking courses for my master’s degree on the basis of general interest, but the business courses were just so different from the nursing courses that I found them so interesting. Maybe that’s something I’ll explore further.” “The Perioperative Nursing program gives nurses the opportunity to have options in their careers and the opportunity to try something different,” adds Fox, and we can undoubtedly expect to see her own career path continue to evolve as she herself tries different things.
Perioperative Nursing Program at-a-glance The RN Post-diploma/degree Certificate program: PBNS 401 Foundations of Perioperative Nursing Practice PBNS 402 Concepts of Anesthesia Within Perioperative Nursing PBNS 403 Perioperative Nursing in the Preoperative, Intraoperative and Postoperative Environment PBNS 404 Fundamentals of Perioperative Techniques PBNS 405 Perioperative Clinical Preceptorship
The LPN Certificate of Achievement program: LPNR 300 LPNR 301 LPNR 302 LPNR 303
Introduction to LPN Perioperative Nursing LPN Perioperative Nursing Theory LPN Perioperative Techniques LPN Perioperative Clinical Preceptorship
In addition to teaching, she devotes time to updating the online learning modules when required. The course content for both the RN and LPN programs is based on the standards of the Operating Room Nurses Association of Canada (ORNAC), so when ORNAC revises its perioperative nursing criteria—which Fox jokingly says “seems to be monthly”—she updates the course material accordingly. Spring 2011 | Issue 2 | Nursing PRN | 29
Photos by Bluefish Studios Inc.
Every Nurse Leadership Symposium by Lisa Ricciotti
Caring. Compassionate. Competent. hose are all adjectives typically used to describe the ideal nurse. Now try adding another word to the usual list of attributes: leader. Every nurse is a leader? Less than 20 years ago, putting the words “nurse” and “leader” together might have sounded ironic. But a whirlwind of change has transformed our lives over the past two decades—and transformed the nursing profession as well. Today, nurses are responding to new realities by adding leadership to their repertoire of essential skills. Judging by the sold out crowd of 150 nursing and health professionals at Alberta’s first Every Nurse Leadership Symposium, interest in everyday leadership for nurses is keen. The symposium, hosted by Grant MacEwan University’s Centre for Professional Nursing Education in January, grew from conversations between the university, Alberta Heath Services and the College & Association of Registered Nurses of Alberta (CARNA) about the skills often-beleaguered nurses need in order to thrive in clinical settings. The centre���s Academic Co-ordinator Nicole Simpson helped organize the event and explains how the answer kept coming back to understanding and embracing a new kind of leadership.
“The traditional model of nurses as followers in a hierarchy of leadership was devastated during the 1990s,” Simpson explains. “Now that assigned leadership is gone, nurses need to take responsibility for their careers and patient care. But it’s such a new approach that many nurses feel lost about how to accomplish that.” To provide answers, Simpson expanded the usual selection of speakers and presenters to include experts from the front lines of nursing, as well as regulatory professionals and higher authorities. The symposium launched strongly with an inspiring keynote address from Ginette Lemire Rodger, chief nursing executive at the Ottawa Hospital and senior vice president, professional practice. Rodger has a PhD in nursing—along with seven honorary PhDs and a shelf of awards—but she’s never lost her connection to hands-on nursing. Drawing on years of theoretical study as well as practical experience, Rodger shared her insights on leadership, a topic she’s passionate about. “It’s important to understand that leadership is not the same as management,” Rodger says, explaining that while theorists have devoted decades trying to define what makes a good leader, “they still don’t know.” Instead, Rodger proposed a very simple definition—leadership is the ability to influence others toward a goal. “That’s what nurses do every day in patient care, so even if you don’t think you’re a leader, you are!” Heads nodded in agreement as Rodger declared that the old system of wisdom passed from above no longer works. “A military, top-down approach where roles were clearly defined, with lots of policies and procedures,
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“It’s important to understand that leadership is not the same as management.” was a by-product of the industrial age. Today it’s the information age; knowledge flows freely and often chaotically. And who’s in charge of helping us transition to a new era? Usually management who grew up in the industrial age, ill-prepared to lead change. So nurses need to challenge ‘my-way-or-the-highway’ assumptions. And stop relying on staff above to fix things.” Rodger walks the talk, so her words hit home. After 10 Ottawa hospitals were forced to amalgamate in 1998, she helped develop a fresh, functioning nursing system. “Leadership was key to that journey, on an individual level,” says Rodger. “Initially the common reaction from nurses was, ‘Whoever said we want to be autonomous?’ Now nurses are the second most powerful force in the hospital.” Being a leader takes courage and commitment, Rodger concluded. “The era of blaming others is over. If you want to keep your right to complain, lead by getting involved with making things better. That’s not always easy and it takes lots of time. But every nurse can learn new ways to move things ahead, using influence instead of delegated authority.” One attendee described Rodger’s talk as “an awakening.” Although Rodger set the bar high, presenters at the following break-out sessions also succeeded in wowing participants with pragmatic advice, including takehome materials for further learning. Between sessions, symposium-goers browsed posters that spotlighted how practicing nurses are acting as leaders in their work settings—from creating programs on how nurses can deal
with physical and verbal abuse (at Misericordia Hospital in Edmonton), to a national online support network for new grads (Nursing The Future), to creating a CD and book on birthing meditation techniques for expectant parents (The Energy of Birthing by RN Ava Curtola). “The most frequent ‘complaint’ we heard is that people wanted longer sessions—a good problem to have,” notes Simpson. “We left them wanting more and received many suggestions for future topics. There’s definitely demand for another symposium and we’ll have details as plans develop.” Expect some lively sessions, especially from return participants who’ve learned how to release their inner leaders and follow Rodger’s challenge: “Give yourself the power; don’t expect an organization to do it for you, or the union. Stand out, speak up—and take on.”
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Learning Leadership Scientists might not be able to deconstruct leadership, but agree leadership can be learned—it’s not just in the genes. THESE are some OF THE tips that presenters shared. •
Leaders take charge of their careers. Don’t wait for promotions; plan your path by knowing where you want to go and how to get there. Donna Hogg, CARNA policy and practice consultant, showed how to use the latest NIC research results (the Nursing Interventions Classification system), now available on CARNA’s website, to determine the competencies required to perform specific interventions.
• Leaders live ethics daily. Wendy Austin, Canada research chair in relational ethics at the University of Alberta, explained how ethical decisions are built into the life of every nurse and warned of the dangers in the trend toward considering patients as “clients” rather than persons. •
Leaders are always looking for a better way—and use research as a resource. Shannon Scott, a University of Alberta assistant nursing professor, explained how to take research off the shelf and put it into practice. Her research into reasons why nurses don’t always do what they know they should provoked spirited debate and proved research is far from dull.
Leaders look at the big picture—including finances. David Dyer, director of nursing at Glenrose Rehabilitation Hospital in Edmonton, demystified health care finances and showed how nurses can play a key role in lowering costs through patient care, especially by reducing infections and falls and through wound management. (Jane Ratay, a faculty member at the Centre for Professional Nursing Education, also had a wealth of information on this topic.)
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Leaders go beyond problem-solving to become critical thinkers. Focusing on problems is just one part of a larger process called critical thinking. Through discussion sparked by real-life scenarios, Clinical Nurse Educator Liz Swajkowski from the Royal Alexandra Hospital in Edmonton showed the power of adding questions like “What else?” “What if?” and “Why?” to the usual “What’s wrong?”. She encouraged nurses to “develop good habits of inquiry” through reflection and creative thinking. “Replace the phrases ‘I don’t know’ and ‘I’m not sure why’ with ‘I need to find out’.’”
• Leaders listen. MacEwan nursing faculty member Christy Raymond led a panel of senior nurses and nurses of the future, revealing the view from both sides and how communication can make or break good working relationships. • Leaders laugh. Cloaked in her signature sparkly cape and sporting a tiara, Debbie Elliott, director of surgical services at Edmonton’s Misericordia Community Hospital, stepped out of her usual RN role to become a stand-up comic. Elliott closed the symposium with an entertaining reminder of the power of humour in the workplace, the benefits of laughter and the hazards of “global whining.”
From hospital to clinic, community to home EXPERT CARING MAKES A DIFFERENCE
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Every Nurse SYMPOSIUM SAVE THE DATE! Attend the next Every Nurse Symposium
February 24, 2012 FOR MORE INFORMATION Contact: Nicole Simpson, RN, BScN Academic Co-ordinator Centre for Professional Nursing Education Grant MacEwan University
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Top 10 Tips for Positive Leadership by BJ Anderson Debbie Elliot, director of surgical services at Misericordia Community Hospital in Edmonton, has been a nurse for 36 years, and in various leadership roles for 20 of them. Elliot recently spoke at the Every Nurse Leadership Symposium, hosted in January 2011 by the Centre for Professional Nursing Education at Grant MacEwan University. To complement Elliot’s closing keynote session “Humour: The Power of Fun,” here are her top tips on how to keep your sense of humour within a leadership role:
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Humour is about positive attitude, perspective, flexibility and optimism, which are all invaluable to leadership. It’s about a joy in being alive, an ability to take yourself lightly and the ability to see the absurdity in difficult situations.
Remember that fun forges co-operation faster than any human dynamic other than catastrophe. As a leader you must have co-operation, and the ability to keep things light and sometimes humorous is an asset in getting teams to work well together.
Hire people who are fun and positive. Develop relationships with the people you deal with every day.
The most powerful leadership tool is to radiate hope in tough times.
Infuse fun into your work environment. Organize celebrations at work, potlucks, dinners or pink days (when everyone wears pink). Wear funny socks with your business attire.
Humour is a safety valve for stress, so use it to keep yourself flexible and to relieve tension. Remember that humour is not for everyone—it is only for people who want to enjoy life and feel fully active.
Recognize and reward your staff. Catch people doing things right, practice random acts of kindness and focus on making others happy—it rubs off on you.
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Resist the urge to criticize—look for the best in the people you work with. But do deal with employees with performance issues—it is good for the rest of the team to know that someone is dealing with the issues.
Focus on what you can control. Decide you will love what you do even if you aren’t doing exactly what you love.
Remember that you become what you practice most.
Grant MacEwan University offers print-based self-study registered courses to health care professionals wishing to renew/advance their nursing practice knowledge. Course offerings: • Nursing Orientation, Resources, Review and Update (up to 24 different courses) • Level II Nursery Orientation: These modules contain the keys to accurate assessment and interventions for Special Care Nursery, Level II Nursery, and Neonatal Intensive Care Unit nursing staff who care for the newborn. • • • • • • • • • • • • • • •
ER / ICU Advanced Nursing Skills Initiation of Intravenous Therapy Theory IV Therapy Lab Medication Administration by IV Push Newborn Health Assessment Support of the Breastfeeding Dyad Interpretation of Laboratory Tests & Diagnostic Procedures Mental Health Disorders Obstetrics Oncology Pediatric Nursing Gerontological Nursing Trauma Nursing Cardiac Nursing
For more information call 780-497-4511 or visit www.MacEwan.ca/RN