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Competent, caring, knowledge-based registered nursing for the people of Saskatchewan

Volume 14, Number 1, winter 2012

Julie Levasseur 4th Year NEPS student p.20

Documentation Part of the Role Documentation • Francophone Special Interest Group • Cosmetic Procedures Advocacy • Health Quality Council • Annual Meeting & Conference Interviews, Research and More!

Sask atch ewan R egi ster ed N u rses’ Association


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Contents Executive Director’s Message

The Saskatchewan Registered Nurses’ Association The Saskatchewan Registered Nurses’ Association (SRNA) is a professional licensing body established in 1917 by the Registered Nurses Act of the provincial legislature. Its purpose is to set standards of education and practice for the nursing profession, and to license and support nurses as RNs to ensure the puclic receives quality nursing care. The SRNA Newsbulletin is published four times a year by the SRNA. Its purpose is to inform RNs about the Association’s activities, provide a forum for discussion and information of topical interest. Inclusion of items in the SRNA Newsbulletin does not imply endorsement or approval by the SRNA. A subscription is $21.40 per year, outside Canada, $30.00 per year. ISSN 1494-76668 Managing Editor: Shelley Svedahl E-mail: communications@srna.org

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INTERVIEW Inspiration, Rose-coloured Glasses and Leadership 4 SRNA Council Highlights

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ASK A PRACTICE ADVISOR Working with Unregulated Care Providers 8

CONNECTIONS Workplace Representative Educators 10 Continuing Competence

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Diversity in Advanced Practice: Boundless Horizons

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Advocacy and Practice Update 14 SRNA Regional Workshops 17

The SRNA office is located at 2066 Retallack Street, Regina, SK S4T 7X5 Phone: 306-359-4200 FAX: 306-359-0257 Toll Free: 1-800-667-9945 E-mail: communications@srna.org Website: www.srna.org

Optimizing the Role of the Registered Nurse

SRNA COUNCIL President: Kandice Hennenfent, RN 306-694-3949 President-Elect: Signy Klebeck, RN 306-659-4289 Members-at-Large Jeannie Coe, RN(NP) 306-425-2174 (Ext. 3) Sherry Culham, RN 306-766-8484 Robin Evans, RN 306-337-8483 Janice Giroux, RN 306-842-8652 Noreen Reed, RN 306-747-2603 Mark Tarry, RN(NP) 306-554-3363 Sandra Weseen, RN 306-752-1781 Public Representatives Karen Gibbons 306-729-4306 James Leach 306-244-4800 Heather McAvoy 306-652-5442 Executive Director Karen Eisler, RN 306-359-4200

ETHICS CORNER Documentation: An Ethical Consideration 22

Copy and Ad Deadlines: November 15 for Winter; February 10 for Spring; May 15 for Summer; and August 15 for Fall. The complete rate sheet is available online at: http://www.srna.org/ images/stories/srna_2012_nb_ad_rates.pdf

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The Forces of Leadership in Patient and Family-centred Care 20 Documentation: Guidelines for Registered Nurses 21

INTERVIEW Just Do It! An Interview with Marlene Smadu, RN 24 HEALTH QUALITY COUNCIL Nurse Practitioner Quarterbacking Care... 28 Surgical Checklist Improves Safety

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What is a Registered Nurse? 32 Cosmetic Procedures 36 Annual Meeting & Conference 2012 38 SRNA Directory 41 Upcoming Events 43

To place advertising in the SRNA Newsbulletin please contact the SRNA at: communications@srna.org Toll Free: 1-800-667-9945

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On the Cover: Julie Lavasseur, 4th year NEPS student. See full article on page 20.

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D E xeepac ur t imv e nDt si r e c to r ’ s

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by Barb Fitz-Gerald, RN Nursing Advisor, Member Relations

Primary Head 1 Health Care is a Collective Responsibility

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rimary Health Care (PHC) was PHC. Interdisciplinary is defined irst paragraph first paragraph as a deep degree of collaboration defined by the World Health first paragraph first paragraph among team members, where Organization (WHO) in first paragraph first paragraph individuals share their knowledge 1978 as “essential health care; based first paragraph first paragraph first and expertise to develop solutions to on practical, scientifically sound, paragraph first paragraph. complex problems to meet client’s and socially acceptable method and Indent paragraph indent paragraph needs. This collaboration is based technology; universally indent paragraph indentaccessible paragraphto on openness, trust and flexibility to all in the community through their indent paragraph indent paragraph look at solutions. full participation; indent paragraph at We must transform The composition of an affordable cost; the teams may vary, and geared toward the health system but they will always self-reliance and selfcenter on the needs determination.” This by working through of the individual or noble definition is an interdisciplinary community. over thirty years old The EICP and we have yet to approach that involves document outlined realize this vision in all stakeholders... the following goals Canada, let alone the for interdisciplinary world. collaboration in To achieve Primary Health Care we need to focus primary health care: • A client-care focus that encourages on individuals and communities and patients/clients and communities maximize their involvement in their to assume more responsibility for health care. We must transform the health; health system by working through • A multi-faceted approach that an interdisciplinary approach ensures quality of care and builds that involves all stakeholders; on existing strengths and evidence; individuals, communities, health care • Structures which facilitate teams practitioners, decision-makers and learning new ways of working policy makers. together in a trusting environment; The document, Enhancing and Interdisciplinary Collaboration in • A clear flexible structure that Primary Health Care in Canada promotes enhancedcommunication (EICP), was developed by Canadian and respect for the role of personal organizations and released in judgment and encourages each 2005. It describes the principles team member to bring his/her and framework involved for skills to bear. (p. 16) Interdisciplinary Collaboration in

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As leaders in the health care system Saskatchewan RNs and RN(NP)s can incorporate these principles into their nursing practice each day. Together we can transform the health care system.

Karen Eisler, RN Executive Director, SRNA

Reference: Enhancing Interdisciplinary Collaboration in Primary Health Care. (2005). The principles and framework for interdisciplinary collaboration in primary health care. Ottawa: Author.

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by Susan Smith Brazill Director, Communications and Corporate Services

Inspiration, Rose-coloured Glasses and Leadership An Interview with SRNA President Kandy Hennenfent, RN.

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What and who inspired you to take on this leadership role with the SRNA? I don’t think it was any one person who inspired me. I have been fortunate to have many mentors and the strong support of my family over the years, but I truly think it is my passion for the nursing profession that led me here. I remember vividly my desire to become involved with the SRNA when I became a RN.

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Kandice Hennenfent, RN, SRNA President

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caught up with Kandy after she chaired an intense day and a half of SRNA Council meetings at the SRNA. I watched as she maneuvered the dialogue to ensure the voice of all Council members was heard. She has an easy air of confidence, a magnetic smile and takes great care in listening and connecting with her Council colleagues and invited guests. I was impressed with her enthusiasm and focus. Kandy explains with pride that “the profession chose me.” She is currently a Nurse Educator teaching clinical at the Moose Jaw Union Hospital. She admits that her favourite part of her job is “telling my stories” and that her goal is to “instill excitement about nursing to

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her students and colleagues.” Her nursing journey started as a certified nursing assistant in 1975 and there was no looking back. She received her Diploma in Nursing then worked in acute surgery, medicine, intensive care, Victoria Order of Nurses (VON), home care then management. She also continued learning and received a Certificate in Health Care Administration and a Masters of Leadership. She is admittedly a positive person. She explains that “not a day has gone by when I do not want to go to work.” She says people have chastised her for wearing ‘rosecoloured glasses’. Her response: “I like my rose-coloured glasses. Why not? Life is hard enough already.”

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What is the difference between the role of the Executive Director and the President of the SRNA? The role of the Executive Director is to handle the operations of the organization, basically to connect governance and management. The Executive Director is the only direct employee of Council. The role of the President is to chair Council meetings, establish ENDs with Council members and ensure the business of the SRNA is managed appropriately through policy governance.


I maintain my courage, hope and inspiration as a result of the love and passion for this profession.

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What are the most important decisions you will make as President of the SRNA? I think one of the main responsibilities, as President is to ensure the organization is future focused and moving toward the established ENDs.

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RNs and the public they serve are facing a lot of pressures. How do you maintain and encourage hope and inspiration? I maintain my courage, hope and inspiration as a result of the love and passion for this profession. I have a wonderful, fulfilling career as a nurse and I often feel that I did not choose this profession but that the profession chose me.

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What is one characteristic that you believe every leader should possess?

How does the SRNA involve the public in defining its strategic direction?

It is difficult to think of one characteristic that a leader needs to possess. I think a leader needs to be able to set a vision and to motivate. Also, valuing your colleagues in the work place goes a long way. I asked my students about this question and they added three characteristics: confidence, communicating and listening. A quote from John Maxwell “A leader is one who knows the way, goes the way, shows the way” sums it up.

There are three government-appointed public representatives on Council to ensure the public voice is heard. Council has also created a Public linkages Committee to meet with groups to get feedback on health care and nursing.

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What is the biggest challenge facing the nursing profession and regulation in Saskatchewan today? One of the biggest challenges facing the nursing profession is the perception that RNs can be replaced by a different profession and that other professions can do the same job adequately and safely. RNs are the caregivers 24/7. It is the RN that sustains health care in the province.

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How do you encourage creative and strategic policy thinking within SRNA’s professional selfregulatory mandate?

What advice would you give to our RNs in taking a leadership role in transforming health?

We are privileged to be part of a self-regulatory body and to have the opportunity to set policy moving in the direction that we feel this organization and province needs to move in. We have the decision-making strategic planning power to manage our own profession.

RNs are leaders in health care and need to play a pivotal role in transforming health care. RNs are at the core of care and we need to be at the table when decisions are being made about health in all areas.

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What three words would you choose as the guiding pillars for the nursing profession in the next year? I think the three words I would choose as guiding pillars for the nursing profession are captured in the mission of the SRNA. Compassionate, caring, knowledge-based.

from the SRNA Staff and Council. We wish you all the best in 2012! During the holiday season our office will be closed at noon on December 23, 2011 until January 3, 2012.

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SRNA C o u n c i l H i g h l i g h t s by Signy Klebeck, RN, SRNA President-elect

2011 SRNA Council Front (Left to Right): Signy Klebeck, RN; Kandice Hennenfent, RN; Mark Tarry, RN(NP) Back Row (Left to Right): Noreen Reed, RN; James Leach, Public Representative; Karen Eisler, RN; Sherry Culham, RN; Robin Evans, RN; Janice Giroux, RN; Karen Gibbons, Public Representative; Jeannie Coe, RN(NP); Heather McAvoy, Public Representative Missing: Sandra Weseen, RN

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he SRNA is governed by an elected Council consisting of a President, President-elect and seven Members-at-large. Three public Representatives are appointed by the provincial government. The SRNA Executive Director serves as an Ex-Officio member of Council. The council meets five times a year to review and monitor progress on achievement of goals. In addition to the regular policy approaches, the following provides a brief synopsis of major items approved and discussed at the Council Retreat August 30th, 31st, September 1st, and the meeting November 9th and 10th, 2011. SRNA staff presented the Environmental Scan. Council reviewed, modified and monitored the SRNA’s Vision, Mission and Ends ensuring that they incorporated the results of the scan. Representatives from the Saskatchewan College of Paramedics council and staff met with council and provided a brief overview of their regulatory association. Information was shared about each of our professions with a focus on working

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in collaboration with each other in the future. Council engaged in a discussion regarding the SRNA project “Optimizing the role of the RN in Saskatchewan.” The RN(C) will have a collaborative role within a team of a physician and RN(NP). SRNA Bylaws Standards and Clinical Competencies along with Clinical Precision Tools will be available to direct the RN(C)’s practice to ensure that the people of Saskatchewan receive competent,

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caring, knowledge-based nursing care. Educational programs for the RN(C) will be approved by the SRNA. Angela Weber, RN, Associate Clinical Director at the Regional Psychiatric Centre, spoke to council about Nursing with the Correctional Service of Canada. She identified that the Correctional and Forensic Nurse roles are different. Correctional nursing has a significant role within society. Correctional Services of Canada offers a variety of nursing career opportunities for the RN. Council met with nursing students from the Regina Nursing Student Society (RNSS) and the Saskatoon Nursing Student Society (SNSS). A stimulating discussion occurred involving various topics such as: Canadian Nursing Students’ Association National Conference in Saskatoon, Overcoming Challenges, Harmonizing our Voices, January 2012; Nursing Leadership Conference in Saskatoon, Courage to Lead Transforming Health Care, March 2012, SRNA AGM May 2012; and technology in nursing, its advantages and challenges. It is always refreshing to hear and feel the passion and enthusiasm of our future RNs.


VISION Registered Nurses as partners in an informed healthy society

MISSION Competent, caring, knowledge-based registered nursing for the people of Saskatchewan

The Saskatchewan Registered Nurses’ Association exists so that: There is profession-led regulation ensuring accountability and professionalism in the public interest. 1.1. Competent and ethical RN and RN(NP) practice in present and future roles and practice settings. 1.2. RNs and RN(NP)s influence practice environments for improved health outcomes. 1.2.1. RNs and RN(NP)s develop evidence-informed practices. 1.2.2. RNs and RN(NP)s use evidence-informed practice. 1.3. All RNs and RN(NP)s provide leadership for excellence, empowerment and professionalism in nursing. 1.3.1. Individual RNs and RN(NP)s consistently use their first and last name and title for identification to the public. 1.4. There is a just, timely, transparent, effective process, of which the public is aware, to address a concern regarding the practice of a RN or RN(NP).

RNs and RN(NP)s provide individual and family-centred, ethical, compassionate care for the public. 2.1. RNs and RN(NP)s provide respectful care to culturally diverse and/or vulnerable populations. 2.2. RNs and RN(NP)s work in partnership with individuals and/or populations in helping them make informed decisions about their health and well-being.

The nursing profession contributes collaboratively to a proactive health system that meets the present and emerging health needs of the public. 3.1. RNs and RN(NP)s participate in life-long learning. 3.2. Health human resource planning results in sufficient numbers and diversity of RNs and RN(NP)s to meet present and emerging health needs in Saskatchewan. 3.2.1. The Baccalaureate nursing degree is the minimum education level for entry as a RN. 3.2.2. The Masters nursing degree will be the minimum education level for entry as a RN(NP). 3.3. Public policy makers have compelling evidence to make them aware of the potential health impact of their decisions. 3.4. RNs and RN(NP)s have and use skills to lead change for a quality health system.

Public policy makers have compelling evidence of the value of a health system that is universal, accessible, publicly administered, comprehensive, portable and accountable and the value of primary health care. These Ends are in order of priority. (Effective January, 2012)

In the Public Interest The SRNA is the professional self-regulatory body for the province’s RNs and RN(NP)s. The Registered Nurses Act (1988) describes the SRNA’s mandate in setting standards of education and practice for the profession and registering nurses to ensure competent, caring knowledge-based care for the people of Saskatchewan. The SRNA is responsible ensuring continuing competence, professional conduct, standards of practice, a code of ethics and the approval of education programs.

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by Terri Belcourt, RN, Nursing Advisor, Practice and Suzanne Downie, RN, Director, of Nursing Practice

ASK A PRACTICE ADVISOR

What is my responsibility and accountability as an RN working with Unregulated Care Providers (UCPs)?

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egistered Nurses who work with UCPs must be knowledgeable of the RNs accountability, roles and responsibilities and those of the UCP. The following are questions you will need to consider: 1

Who are UCPs and what is their role?

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What is my responsibility and accountability as the RN?

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What is assignment and what is delegation?

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What needs to be assessed before delegation takes place?

UCPs can provide auxiliary nursing services or services provided in a person’s home in accordance with The Registered Nurses Act, 1988. UCPs have a variety of job titles depending on their job description i.e., home health aides, special care aides, continuing care assistants and personal care home workers. UCPs do not have a scope of practice, are not regulated and have a variance in educational preparation. Some may have taken formal educational courses (e.g. through Saskatchewan Institute of Applied Science and Technology [SIAST] or other) and others may have received on the job training from the employer.

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How does delegation fit with medication assistance versus medication administration and what is the difference?

Delegation must be determined to be in the client’s best interests and must be within agency policy and within the job description of the UCP.

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Registered Nursing is a regulated profession and RNs have the required education and legislated scope of practice to perform and coordinate health care services including but not limited to observing and assessing the health status of clients and planning, implementing and evaluating nursing care (Government of Saskatchewan, 1988). It is within the scope of the RN to delegate ‘a task’ if appropriate and in the interest of the client, however the RN remains responsible and accountable for the nursing process.

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Often used interchangeably, assignment and delegation have different meanings: Assignment of client care is a decision regarding the most appropriate care provider for the provision of a client’s care. Each care provider is responsible for providing competent care to the client and remains accountable to the RN who assigned the care. (SRNA, 2004). One example would be the RN assigning personal care for a resident to an UCP.

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Delegation is the transfer of responsibility from a RN to a UCP for completion of a task. The delegating RN is accountable for ensuring that the UCP has the knowledge and sufficient training and practice to competently complete the task. The RN is accountable for the overall assessment, care planning, intervention and care evaluation. The nursing process is an RN accountability and cannot be delegated (SRNA, 2004). When delegation occurs it is by one RN to one UCP, one task, for one client. The decision about whether or not to delegate is complex and is the responsibility of the RN working with the UCP. Delegation must be determined to be in the client’s best interests and must be within agency policy and within the job description of the UCP. The RN assessment of the acuity, stability, complexity or predictability of the client’s condition, and the environment in which the client lives is paramount in the RN’s decision to delegate. The RN may decide not to delegate based on their assessment and should be supported through employer policy.

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“Administration of ” and “assisting with” medications are two different responsibilities. RNs can only delegate the assistance part of the medication administration process. UCPs do not have the knowledge, skills or judgment to administer medications.

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Administering medications is the responsibility of the RN and involves the whole nursing process. It begins with the RN assessing for the appropriateness of the medication, knowing the actions, interactions, side effects, usual dosage, route and approved use, basic pharmacokinetics of the drug and the client’s response to it. Competent medication administration also includes preparing the medication according to directions, monitoring the client while administering the medication, appropriately intervening as necessary, evaluating the outcome of the medication on the client’s health status and documenting the process (SRNA, 2007). Assisting with medications involves the technical task only. The RN may delegate this task. With additional training the UCP can be effective in assisting the client with his/ her medications; however the RN retains the accountability for all aspects of the administration of the medication. For example, the UCP may be taught tasks on how to safely assist a cognitively aware client with his/her medications. UCPs may assist with medications by reminding or supporting the client to physically take their medication (for example opening blister packs or dosettes). Only the task of assisting the client with medication can be delegated to the UCP.

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In summary, a collaborative working relationship between regulated and unregulated care providers is essential in ensuring safe client care. The RN must be knowledgeable of the level of education and competence of all members of the health care team to ensure proper assignment and delegation of care for the safety of a client. When delegating, the RN is accountable for ensuring that he/she is delegating appropriately one task, for one client, to one UCP. For further information/documents see our website www.srna.org or contact a Practice Advisor at practiceadvice@srna.org

References Government of Saskatchewan. (1988). The Registered Nurses Act. Regina, SK: Author. Saskatchewan Registered Nurses’ Association (SRNA). (2007). Medication Administration: Guidelines for Registered Nurses. Regina, SK: Author. Saskatchewan Registered Nurses’ Association (SRNA). (2004). The practice of nursing: RN assignment & delegation. Regina, SK: Author.

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Connections by Barb Fitz-Gerald, RN, Nursing Advisor, Practice

“Highly satisfied!” These words describe the preliminary feedback coming from RNs and RN(NP)s who attended one of the educational workshops provided by the SRNA Workplace Representative Educators.

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ight Workplace Representative Educators participating in the SRNA Pilot Project taking place from September 2011 to December 2012 are successfully presenting the CNA Code of Ethics and/or SRNA Continuing Competence Program to RNs and RN(NP)s in their workplaces. Comments from the participants include: improved confidence with doing their continuing competence program, feeling secure with education in a relaxed atmosphere, and enjoying the small group learning setting. They

have described the Educators as being knowledgeable and professional in their role. From the Educators perspective the smaller sessions are generating much discussion among the participants regarding the Continuing Competence Program including peer feedback and the audit process. Participants are repeatedly saying that their understanding of the continuing competence program is improving. This resounding success has led to the development of new presentations on medication

Workplace Rep Educators (Left to Right) Frank Suchorab, RN (Prince Albert Parkland Health Region); Lynne Farthing, RN, (Prince Albert Parkland Health Region); Jill Eylofson, RN, (Heartland Health Region); Janette Egland, RN (Cypress Health Region); Barb Fitz-Gerald, RN (SRNA Project Liaison); Patricia Maclean, RN (Saskatoon Health Region); Patti LeBlanc, RN (Regina Qu’Appelle Health Region); Jennifer Guzak, RN (Saskatoon Health Region); Missing Kathleen Tomporowski, RN (Prairie North Health Region)

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administration and documentation guidelines which will be added to the list of available presentation topics in the new year. Also in 2012 there will be a call for additional Workplace Representative Educators to fill vacancies in health regions presently without an Educator. If you are interested in becoming a Workplace Representative Educator or want a presentation in your workplace contact Barb Fitz-Gerald RN, Nursing Advisor, Practice at bfitz-gerald@srna. org or Suzanne Downie RN, Director of Nursing Practice at sdownie@srna.org.


Continuing Competence SRNA Continuing Competence Review Committee

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he SRNA has struck an Ad Hoc Committee to review the SRNA Continuing Competence Program. The committee met in March and October 2011 and plan to meet by teleconference and in person in the future. The purpose of the committee is to: • Evaluate the content and processes including the SRNA Bylaws of the SRNA Continuing Competency Program. • Make recommendations to SRNA staff regarding implementation of the content and processes including the SRNA Bylaws for the future Continuing Competence Program.

• Make recommendations to SRNA staff regarding the implementation of the content and processes for the SRNA Continuous Quality Registered Nursing Practice Program. To complete its work the committee plans to review the current continuing competence practices of other nursing jurisdictions, and selected health and other professions. Members will be consulted during the process to provide feedback on the program. Timelines for the review will be announced at a later date. Watch for additional information on the review in the upcoming SRNA Newsbulletin. For information on the review please contact Cheryl Hamilton RN, Deputy Registrar at chamilton@srna.org or Barb Fitz-Gerald RN, Nursing Advisor at bfitz-gerald@srna.org.

SURVEY The SRNA Continuing Competence Program (CCP) has been in existence since 2006.  As part of SRNA’s commitment to quality improvement, the CCP is currently under review and as such a committee has been established to conduct this review. They will be utilizing many sources of information regarding best practices as well as external and internal stakeholder feedback. Part of the review includes a member survey. Please visit our website www.srna.org to complete the CCP survey.  The survey will be available online at http://www.surveymonkey.com/s/ NXXTWDW from January 5, 2012 to February 15, 2012.

Continuing Competence Review Committee (Left to Right): Janet MacKasey, RN, Carole Reece, RN, Barb Fitz-Gerald, RN, Maureen Ferguson, RN, Tracy Zambory, RN, Cheryl Hamilton, RN, Liz Domm, RN, Mary Ellen Andrews, RN(NP), Leah Currie (Public Representative), Shirley McNeil, RN (Chair)

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Professional Pr actice Group by Jone Barry, RN(NP) CDE, Vice-chair, NPOS

Diversity in Advanced Practice: Boundless Horizons

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emember when you were a student nurse? What job did you expect to be doing today? I was in nursing school thirty years ago. At that time, I did not imagine I would be working as a nurse practitioner today. My horizon has changed. The Canadian Association of Advanced Practice Nurses (CAAPN) biennial conference was about boundless nursing horizons. On September 28-30, 2011, the Nurse Practitioners of Saskatchewan (NPOS) and the Saskatchewan Association of Nurse Practitioners (SANP) hosted the CAAPN conference in Saskatoon. There were 156 conference participants including: Nurse Practitioners, Nurse Practitioner Students, Clinical Nurse Specialists, Nursing Graduate Students and many individuals who support advanced practice nurses. People travelled from across Canada as well as the United States and Australia. The heart of the conference was focused on the four realms of nursing: education, leadership, practice and research through poster presentations, lectures and panel discussions. Diversity in advanced practice nursing was apparent throughout the conference, displayed by a wide range of topics. Participants had ample time to network, share ideas and view displays. We had a grand time in 1910 Boomtown at the Western

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NPOS/SANP CAAPN Conference Planning Committee: Back row: Mary Ellen Andrews RN(NP), Linda Smallwood RN(NP), Pam Komonoski RN(NP), Della Magnusson RN(NP) Middle row: Jan Cochrane RN CDE, Debbie Bathgate RN(NP), Lynn Miller RN(NP) Front Row: Kendra Power, RN, Kim Lato RN(NP), Bev Houk RN(NP), Joyce Bruce RN(NP), Barb Beaurivage RN(NP) Missing: Donna Flahr, RN and Lee Murray, RN, CNS, & Events of Distinction Conference Planner Judy Bodnarchuk.

Development Museum. After strolling through a snapshot of a prairie town, we sat down to a fowl supper and were serenaded by the Last Resort Band. What an excellent way to display prairie hospitality. Everyone went home with warm memories of the land of the living skies. NPOS along with SANP sponsored a successful national conference that shines a light on the wide range of advanced nursing practice. Now come with me. Walk to the horizon; see how boundless it has become.

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The Nurse Practitioners of Saskatchewan (NPOS) was founded in 2001 to represent the professional interests of nurse practitioners in Saskatchewan. As a Professional Practice Group within the SRNA, we are the legislated representatives of NPs in this province. The mandate of NPOS is to provide opportunities for education and research, to exchange information and to represent NPs on local, provincial and national levels. See our website www.NPOS.ca for more information and how to become a member.


Registered Nurse (Nurse Practitioner) Patient Referrals to Specialists The Saskatchewan Medical Care Insurance Payment Amendment Regulations have been changed to allow specialist physicians to bill the same rates for RN(NP) patient referrals as if the patient had been referred to that specialist by another physician. The RN(NP) will include their four digit billing number on the referral to support processing of the payment. For those RN(NP)s who do not have an assigned billing number, the generic number 3401 must be used in order to facilitate the processing of the claim. Please remember that this number is for the purpose of physician referral and must only be used for this purpose. The Saskatchewan Registered Nurses’ Association has established standards of practice for RN(NP)s. These standards include the expectation for the RN(NP) to work collaboratively and to consult with a physician should the client require care beyond the RN(NP)’s competency and scope of practice. There are no regulatory or legislative deterrents that limit the ability of the RN(NP) to refer a patient to a specialist or to provide patient follow up post consultation. RN(NP)s will continue to work collaboratively with a family physician(s) and the team will jointly decide how and when to refer patients. Patient follow up will be provided through these teams. In order to expedite the referral process and ease the workload of teams, RN(NP) patient referrals no longer require the co-signature or billing number of a physician in order to be accepted by a specialist and processed for payment. In situations where RN(NP)s are not linked with a family physician, the regional health authorities will work with physicians to provide linkage for consultation and patient assessment purposes. RN(NP)s will be responsible for any patient follow up required and will have means to consult physicians for support. I want to thank the SRNA and RN(NP)s for sharing their patient care experiences with the referral process. This evidence supported the changes made to this legislation. Please contact me at (306) 787-7195 or by email at ldigneydavis@health.gov.sk.ca should any questions arise.

Lynn Digney Davis, MN, RN(NP) Chief Nursing Officer

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A d v o c a c y & P r a c t i c e U p d at e by Laurel Stang, RN and Susanne Nasewich, RN, Saskatchewan HIV/HCV Nursing Education Group PPG

Keeping the Minister of Health Informed through RN Advocacy

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s representatives of the Saskatchewan HIV/HCV Nursing Education Group, PPG, we met with the Honorable, Don McMorris, Saskatchewan Minister of Health at his legislative office on September 13, 2011. Barb Fitz-Gerald, RN Nursing Advisor, Practice joined us to inform the Minister about our PPGs support for RN practice, HIV/HCV education, networking, advocacy, and nurse mentorship. Minister McMorris was receptive to the important role RNs play in

providing accessible, holistic, and non-judgmental care to individuals, families and communities infected with or affected by HIV and/or HCV. We informed the Minister of RN advocacy for the issue of homelessness, the harm reduction model as a patient first initiative, and maintaining client autonomy and accessibility for health care programs and services. The Minister asked for feedback on the Saskatchewan HIV Strategy which we provided through general observations from our PPG’s work. The Saskatchewan HIV Strategy is

Left to Right: Susanne Nasewich RN, Laurel Stang, RN

found at www.health.gov.sk.ca/hivstrategy-2010-2014. We also provided information on our PPGs support for not-for-profit initiatives including the “Little Travellers”; information on this initiative can be found at www. littletravellers.net/.

by Laurel Stang, RN, President HIV HCV Nursing Education Organization

Ensuring RNs Stay Focused on Positive Patient Outcomes

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he Saskatchewan HIV HCV Nursing Education Organization, Professional Practice Group (PPG) hosted its annual educational day on September 9th and 10th with close to 100 RNs and health care providers attending each day. The event focused on HIV and Hepatitis care, treatment and support, provided a forum to explore issues of mutual concern, exchange knowledge, share evidence and ideas, and generate solutions for these health conditions. Knowledge exchange and peer support enhances RN practice and ensures the focus of care remains

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on positive client outcomes as Saskatchewan has the highest rate of HIV infection in Canada. Speakers included Pamela Thompson, RPN from Regina who spoke about the care, treatment and support for Hepatitis C clients; Dr. David Tu and Doreen Littlejohn, RN from Vancouver Native Health Services who spoke about HIV care in conflict affected regions and the care of urban Aboriginal People; and Leegay Jagoe, RN who spoke about the peer work and outreach for people who use street drugs and how to build capacity among people with

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addictions. Clients who live with HIV and HCV provided a passionate panel discussion. We learned that they are the real experts with what they need and we need to listen carefully and empathetically to their stories.  Think about joining the Saskatchewan HIV HCV Nursing Education Organization PPG. We have no registration fees and to date have offered educational events free of charge. Learn about our Professional Practice Group by contacting skhivhcv@gmail.com. We are also on Facebook. 


Special Interest Group

Call to create a Francophone Special Interest Group (SIG)

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t a meeting between the SRNA and the Réseau Santé en Français de la Saskatchewan (RSFS) or the Saskatchewan Network for Health Services in French, it was determined that there is a need to improve health services in the French language to better serve the growing French-speaking population in Saskatchewan. One of the tools for SRNA members to network and work on common issues is to form a SIG. The SRNA provides support and resources for forming the group. Any SRNA member can participate in a SIG including students in education programs leading to a RN designation. Various SRNA members and students in the RSFS network are interested in creating a SIG for RNs who speak French and are willing to provide health services to the public in the French language. The RSFS will also work to support RNs with tools to improve French language skills and clinical practice in French. By coming together we can develop ideas and objectives that can better address the health needs of the francophone population. If you are interested in being part of a Francophone Nurses SIG please contact: JeanMarie Allard RN at 12allard12@gmail.com or (306) 533 6343; or Michelle Allard-Johnson RN at mva123@ sasktel.net or (306) 569-8908; or Jacqueline Plante, RN at jacqueline.plante@sasktel.net or 955 1750 or Hortense Nsoh Tabien (liaison for RSFS) at hortense.nsohtabien@ usask.ca or 306-966 7877 We also encourage you to self identify that you have a French language background by going to the RSFS website at the link at http://www.rsfs.ca/identifiez_vous_ n936_t7123.html.

Appel pour créer un groupe d’intérêt spécial en français (GIS)

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ors d’une réunion entre le SRNA et le Réseau Santé en Français de la Saskatchewan (RSFS), la nécessité d’améliorer les services de santé en français, pour mieux répondre aux besoins de la population croissante de francophones de la Saskatchewan a été reconnue. La création d’un groupe d’intérêt spécial (GIS) est un moyen pour les membres de la SRNA de se réseauter et de travailler ensemble vers un but commun. La SRNA fournit le soutien et des ressources pour former le groupe. Tout membre de la SRNA peut participer à un GIS, y compris les étudiants dans les programmes de formation pour devenir RN. Divers membres de la SRNA et étudiants dans le réseau RSFS sont intéressés à créer un GIS pour les infirmiers (ères) qui parlent français ou qui sont disposés à fournir des services de santé en français. Le RSFS est prêt à appuyer vos efforts et vous fournira des outils pour améliorer vos compétences en langue française pour une pratique clinique en français. En vous regroupant vous pourrez développer des idées et certains objectifs qui peuvent mieux répondre aux besoins de santé de la population francophone. Si vous êtes intéressés à former un GIS francophone, veuillez communiquer avec: Jean-Marie Allard, RN à 12allard12@gmail.com au (306) 533 6343; ou Michelle Allard-Johnson, RN à mva123@sasktel.net au (306) 569-8908; ou Jacqueline Plante, RN à jacqueline.plante@ sasktel.net ou (306) 955 1750 Hortense Nsoh Tabien (liaison du RSFS) à hortense.nsohtabien@usask.ca ou 306-966 7877 Nous vous encourageons également à identifier votre arrière-plan francophone en allant sur le site web du RSFS au lien http://www.rsfs.ca/identifiez_vous_n936_t7123. html

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Continuing Competence Call for Continuing Competence Program (CCP) Auditors

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he SRNA is seeking two RNs and two RN(NP)S who are interested in being auditors for the continuing competence program. Auditors will review continuing competence documents and surveys submitted from a random sample of the SRNA membership. The documents will be reviewed to ensure: • All steps of the reflective practice have been completed. • Logical linkages between the self-assessment, peer feedback, learning plan, and evaluation are evident.

Saskatchewan Nurses Foundation Update by Robin Evans, RN

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n Friday, November 4,

Auditors are: • • • •

Currently registered in good standing with the SRNA. Have attention to detail. Knowledgeable of the CCP. Have some experience/skill in reviewing documents/assignments and auditing such as quality improvement initiatives. • Interested in becoming involved with the SRNA. • Not a member of another SRNA regulatory committee.

2011 the Saskatchewan

Nurses Foundation (SNF) held its banquet and live auction in Regina at the Delta Regina. Proceeds of this event support the expanded bursary program for 2012. A group of 70 participated

Time Commitment:

in the event and raised $5730

RN(NP) auditors will be required for one full day at the SRNA office in Regina.

during the auction and $780

RN auditors will be required for two full days at the SRNA office in Regina.

Foundation thanks the SRNA

How to apply: Send a brief CV which includes an explanation of why you are interested in being a CCP auditor to info@srna.org. Deadline to apply is February 15, 2012. If you have questions, please call Cheryl Hamilton at 1-800-667-9945 or 359 – 4200 in Regina.

from the door prize draw. The and the Saskatchewan Union of Nurses (SUN) for their support as major sponsors for the event. Watch for more information about the second banquet and live auction scheduled for Spring

Continuing Competence Program Now that members have renewed their licences for the 2012 licensure year, it is a good time to start working on your 2012 continuing competence requirements. Please refer to the CCP tutorial and the SRNA website (www.srna.org) if you need assistance. CCP workshops will be arranged by request. Contact the SRNA office 1-800-667-9945 or in Regina 359-4200 for more information.

2012 in Saskatoon. Thank you for your support of the bursary program. Application forms for the 2012 bursaries will be available in January on the SNF website at saskatchewannursesfoundation.org.

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Regional Workshops by Terri Belcourt, RN, Nursing Advisor, Practice

by Tracy Laschilier, Advancement officer, College of Nursing, University of Saskatchewan

2011 SRNA Regional Workshops

Nursing Students Enjoy SRNA Regional Workshop

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RNA Council and Staff continued with Regional Workshops in 2011. This program, which was started by Barb Fitz-Gerald RN in 2010, has increased in popularity with each passing event. In 2011 workshops were held in Swift Current in June and Prince Albert in September where over 100 participants attended. Presentations on how to get involved with the SRNA, the Code of Ethics, Continuing Competence, Competence Assurance, the SRNA Practice Advisement Service and the Scope of Practice of RNs and RN(NP)s were the focus for each day. Opportunities were also provided for SRNA members and nursing students to network and discuss issues pertaining to their practice. Thanks to all Council members, staff, RN and RN(NP) members and students who attended the workshops and made them rich through many discussions and conversations. Plans for the 2012 Regional Workshops are underway. Based on evaluation responses the agenda will be enhanced to include popular existing presentations, new topics and interactive sessions to better engage the audience. Dates for the workshops are planned for June 20th and October 10th so mark your calendars now! Locations will be determined in early 2012. Watch your inbox for additional information in the Spring of 2012.

he fourth-year class of nursing students from the University of Saskatchewan College of Nursing Prince Albert site attended the SRNA Regional Workshop in Prince Albert on September 21, 2011. They give it an enthusiastic thumbs-up! The students agreed that this interactive workshop was very beneficial to their professional development as future RNs. Favourite topics included the scope of an RN, Code of Ethics, and Continuing Competencies. Learning about these and other areas of nursing helped provide students with a better understanding of what happens once they graduate and where the profession is going. The biggest hit at the workshop was the free mini Code of Ethics book, a handy reference guide for students in class and clinical. Lois Berry, Associate Dean College of Nursing North & North Western Campus and Rural & Remote Engagement says “The College of Nursing is committed to fully preparing our graduates for the nursing profession. The SRNA Regional Workshop was an excellent opportunity for learning and making connections outside the classroom.�

4th-year nursing students, University of Saskatchewan.

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P r o j e c t U p d at e by the SRNA Optimizing Team

Optimizing the Role of the Registered Nurse

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expectations for the RN(C) and the he SRNA continues to work on the Optimizing the Role of preparation of new bylaws that allow RN(C) practice. the Registered Nurse Project. RN Certified Practice-Rural and The ultimate goal of this project is Remote RN(C) is a registered nurse to rescind the Transfer of Medical who has successfully completed the Function document and by January educational requirements to attain the 2014 to have a new Registered Nurse Scope of Practice document. There are competencies required for certified practice in rural and remote nursing, four task teams that are proceeding has met the licensing requirements, with work related to the Optimizing and is certified by the SRNA. The Project. RN(C) – Rural and One task team is This team is Remote works in a team working with the College with a physician, or of Physicians and Surgeons working to physician and RN(NP), (CPSS) on the dissolution research the providing patient centered of the Transfer of Medical Function model. The process that can community focused care, in practice environments Medical Profession Act, be used to allow which recognize a high 1981 does not allow for of interdisciplinary delegation and this was physicians and level collaboration, part of the impetus for the Optimizing Project. registered nurses consultation and clear understanding of roles This task team has noted to work together. and responsibilities. that although many This role differs from competencies can become the RN(NP) as specific limitations part of the nursing scope of practice, are placed upon the conditions that there are a few that are physician may be diagnosed and treated, and practice.This team is working to medications prescribed by the RN(C). research what these competencies are, These are confined to limited common and the process that can be used to allow physicians and registered nurses medical disorders. Draft RN(C) Standards, to work together. Two task teams are working on the Competencies and Clinical Competence, and Bylaws are on the Rural and Remote Certified Practice project. This includes the development SRNA website for your review and feedback. A final document and of new competencies and clinical

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Bylaws will be approved by SRNA Council in February, 2012 and will be taken to the membership at the SRNA Annual Meeting in Regina, May 2, 2012. One task team is working on the establishment of the education process for the RN(C). There are meetings with stakeholders, including the Deans of the nursing education programs. The Registered Nurse Standards, Competencies and Clinical Competencies for Rural and Remote Certified Practice Registered Nurse RN(C) will be used by the SRNA and the educational program(s), to determine the educational requirements.The SRNA program approval framework will be presented to SRNA Council for approval in February, 2012. Another task team is working on two areas; special nursing procedures, and those procedures currently called transfer of medical function. As healthcare has evolved RNs in specialty practice areas such as ICU, CCU, ER, Homecare, Public Health and others have been working under transfer of medical functions in their day to day practice. During this review and redefinition of these activities, the procedures will shift the focus from conducting activities that are “task focused” to RNs requiring the knowledge, skill and judgment to


Nurse to Know

perform the activity competently. The work plan for this task team is to continue researching what activities RNs are performing, and what policies, protocols and educational requirements are currently being used by employers to support RNs in performing the activities. SRNA members, employers, government and various health care partners will be consulted as this review occurs.

As our health care system evolves and changes in Saskatchewan... RNs can provide solutions. As our health care system evolves and changes in Saskatchewan, and we are challenged to find solutions to issues such as timely access to care for the citizens of Saskatchewan, RNs can provide solutions. The availability of RNs with additional education in rural and remote communities serves to address the need for timely access to health care services in these areas and contributes to a sustainable and effective health care system.

Congratulations to Dr. Lynnette Stamler, RN, Faculty, College of Nursing, University of Saskatchewan, on her induction as a Fellow of the American Academy of Nursing (FAAN) this month. The American Academy of Nursing’s approximately 1,500 Fellows are nursing leaders in education, management, practice and research.

Congratulations to Maureen Klenk, RN(NP), on her position of President-elect of the Canadian Association of Advanced Practice Nurses (CAAPN).

Congratulations to Cindy Smith, RN, on her appointment as Associate Dean of Nursing, SIAST Nursing Division at SIAST Wascana Campus in Regina.

Congratulations to Cathy Jeffery, RN, on her new appointment of Director, Continuing Nursing Education (CNE) College of Nursing, University of Saskatchewan.

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by Julie Levasseur, 4th Year NEPS student

The Forces of Leadership in Patient and Family-centered Care

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ursing leadership comes concept, as leadership is evolving in many forms as does the beyond the traditional definition of platform from which nurses being one-directional and stemming can convey their message. At the from a single source of referent or recent 2011 Innovators Conference, authoritative power. Today, leadership However, the adoption of hosted by the Saskatchewan Union is seen as a reciprocal function shared client-centered care does not rest of Nurses, I had the pleasure of by all members of the healthcare in the nursing organizations’ hands actively engaging in leadership team, including the client and family alone. Regardless of our domain discussion and dialogue as nurses (Spears, 2004). of practice we, the members, must and other partners in The SRNA’s Regardless of our ‘push’ for client-centered care if we healthcare put clients mission is to ensure hope to impart positive change in and their families that the people of domain of practice we, our communities. As the largest at the forefront Saskatchewan have contingency of regulated healthcare of innovation in the members, must ‘push’ competent, caring, professionals in the province, RNs and health services. As knowledge-based for client-centered care RN(NP)s have the capacity to foster a final practicum registered nursing true client-centeredness if we engage student with the care. As evidenced if we hope to impart Saskatchewan in the Ends outlined in the words of Mary Ferguson-Paré positive change in and, “lead from where we stand.” Registered Nurses’ by Council, RNs As leaders of our own respective Association (SRNA) and RN(NP)s are our communities. I was afforded a expected to, “provide practices, we can empower ourselves as well as our many partners in unique perspective on how nursing individual and family-centered, health, most importantly our clients organizations strive to keep clients and ethical, compassionate care for the and their families, to be respective the public interest at the heart of all public” (SRNA, 2011). As such, agents of positive change. Together, nursing work across the province. the SRNA is ultimately responsible as a collective and synergistic whole, As described by the keynote for ‘pulling’ client-centered care by we can then ‘pull’ and ‘push’ clientspeaker at the conference, Mary enacting policies and through the centered care into the preferred future Ferguson-Paré RN, PhD, CHE, regulation of its members in relation client and family-centered care will to our ever-evolving healthcare system. of healthcare. only truly come to fruition when organizations ‘pull’ and practicing References nurses ‘push’ for positive change. Spears, Larry C. (2004). Practicing Servant-Leadership. Leader to Leader. 34(Fall). 7-11. This is a powerful and relevant Retrieved from http://www.pfdf.org/knowledgecenter/journal.aspx?ArticleID=51 Saskatchewan Registered Nurses’ Association. (2011). Mission Statement/Ends/Standards/ Code. Regina, SK: Author. Retrieved from http://www.srna.org/images/stories/pdfs/ about_us/mission_statement_2011_ends_web.pdfgwpda.org/naval/lcastl11.htm

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by Erika T. Vogel, RN, Advisor, Competence Assurance and Research and Terri Belcourt, RN, Nursing Advisor, Practice

NEW GUIDELINES

Documentation: Guidelines for Registered Nurses

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e are thrilled to announce that SRNA Council has recently approved a new publication, Documentation: Guidelines for Registered Nurses. The need for a guideline that would support Saskatchewan RNs in their documentation practices was established through a review of nursing practice calls made to the Practice Advisement Team as well as trends in reports made to Competence Assurance. SRNA staff has been working on the publication for several months with feedback from SRNA members and external stakeholders. The document has been developed to promote quality documentation by all RNs in all domains of practice. The SRNA would like to thank the Association of Registered Nurses of Newfoundland and Labrador for permitting the adoption and adaption of their documentation publication, Documentation: Standards for

Registered Nurses, 2010 as it provided a solid base for the development of the SRNA guideline. The guideline provides recommendations for quality documentation by providing answers to the questions Why, Who, How, What and When. Information on where to find online and print resources, documentation tools and formats, privacy and confidentiality related to documentation, and how to address quality professional practice environments with regards to documentation are also included. The publication can be found on the SRNA website under Nursing Practice/Resources. Questions about the documentation guideline can be addressed by the SRNA Practice Advisement team by contacting practiceadvice@srna.org or calling 1-800-667-9945 or in Regina, 359-4200.

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“Documentation is not separate from care and it is not optional. It is an integral part of nursing practice.� SRNA, 2011.

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Ethics Corner by Erika T. Vogel, RN Advisor, Competence Assurance and Research

Documentation: An Ethical Consideration

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The guideline states: “Accountability n December 1, 2011 the means being answerable for one’s SRNA released a resource own actions. The health record for all RNs, GNs, RN(NP) demonstrates RNs accountability s and RN(GNP)s in Saskatchewan and gives credit to RNs for the care (hereafter referred to as RNs) entitled, Documentation: Guidelines for Registered they give or the service they provide. In Saskatchewan, all RNs are Nurses (2011). The guideline is required to document evidence of intended to provide assistance to RNs safe, competent and ethical care in on documentation and safe, effective accordance with the current Standards and ethical practice. and Foundation Competencies for While documentation is perceived the Practice of Registered Nurses; to be ‘yet another thing to do’ in an Registered Nurse (Nurse Practitioner) already hectic day, documentation is RN(NP) Standards & Core vital to our practice as …documentation Competencies; Code of RNs and should never Ethics for Registered Nurses; be seen as an optional is vital to our and applicable agency ‘task’ (SRNA, 2011). policy. Documentation practice as RNs Documentation is not must reflect the RNs separate from care but and should never professional judgment, rather an extension assessment, coordination of of the high quality be seen as an care, decisions, actions, and and quantity of care optional ‘task’. evaluation” (SRNA, 2011, provided by RNs. p. 5). What is not always recognized is that documentation “reflects the application of nursing knowledge, skills and judgment, the client’s perspective and interdisciplinary communications” (SRNA, 2011, p. 17). A RN is accountable to uphold the expectations set out in standards and competencies, and to fulfill ethical responsibilities in the professional code of ethics as the minimum mandatory expectation for professional practice.

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The Canadian Nurses Association (CNA) outlines that the Code of Ethics for Registered Nurses (2008) is a “statement of the ethical values of nurses and of nurses’ commitments to persons with health-care needs and persons receiving care (p. 1). All RNs regardless of employment status (employed, employer, or selfemployed), practice setting, or domain have an obligation to uphold ethical responsibilities including fulfilling those relevant to documentation. Nurses, not employers, are responsible for their ethical practice and must uphold the accountabilities bestowed upon the profession (CNA, 2008).


D e pa r t m e n t s

The CNA Code of Ethics for Registered Nurses (2008) provides evidence that documentation is critical component in ethical practice. RNs who fail to document, or sufficiently and appropriately document, can breach parties to maximize health benefits ethical practice and accountability to persons receiving care and those to the patient and health care team receiving care and those with health when the value ‘Providing Safe, care needs, recognizing and respecting Compassionate, Competent, and the knowledge, skills Ethical Care’ is not upheld, specifically the All RNs regardless and perspectives of all” (CNA, 2008, p. 10). ethical responsibility that of employment By communicating states: “Nurses have a through documentation responsibility to conduct status ...have RNs are collaborating themselves according to with health-care an obligation to the ethical responsibilities providers to ensure outlined in this document uphold ethical those requiring client and in practice standards information for in what they do and responsibilities decision making is how they interact with including fulfilling readily available and in persons receiving care the best interest of the as well as with families, those relevant to client at all times. communities, groups, documentation. These are only two populations and other examples of ways RNs members of the health ensure that their nursing practice care team” (CNA, p. 8). is competent, safe and ethical on a The ethical value ‘Promoting day to day basis. RNs can improve Health and Wellbeing’ highlights the documentation by becoming importance of communication, and that RNs have an ethical responsibility familiar with the documentation guideline, and reviewing standards/ to: “...collaborate with other healthcompetencies/code of ethics, and care providers and other interested

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agency policies. If you notice that there are opportunities for improvements consider advocating for changes by speaking with colleagues and your supervisor to advance competent, safe and ethical practice. If you have questions or would like to speak with a Practice Advisor about ethics and documentation, contact the SRNA Practice Advisement Team at 359-4200 or 1-800-667-9945 or by email at practiceadvice@srna.org. References Canadian Nurses Association. (2008). Code of ethics for registered nurses. Ottawa, ON: Author. Saskatchewan Registered Nurses’ Association. (2011). Documentation: Guidelines for registered nurses. Regina, SK: Author.

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by Susan Smith Brazill Director, Communications & Corporate Services

Just Do It! An Interview with Marlene Smadu, RN, on CNA’s National Expert Commission and Nursing Leadership

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to replicate the ideas as a system. She this Commission. When asked about ne of Canada’s foremost used the word innovation a lot in the role RNs can play, Marlene spoke nursing leaders, Marlene our interview. She spoke of simple with great enthusiasm and optimism: Smadu, RN has sound initiatives that have had great impact “we have so much power.” She is advice for nurses in transforming on our public. An example she cited adamant that nursing needs to be healthcare: if we aren’t actively was a RN who provided patient engaged in the solutions we are part of engaged with the transformation of health and we need to figure out what centred care to a client who could the problem. not speak English. Her no cost actually works, so we are using our I asked to interview Smadu in innovation was to use Google translate taxpayer’s money well. an effort to better The power nursing which resulted in a better patient She described understand her outcome. the role of CNA as perspectives and wisdom providers have The power nursing providers have twofold: articulating on her role as co-chair is potentially is potentially transformational. She policy at the high level of CNA’s National spoke of not only the numbers across and supporting and Expert Commission transformational. Canada and the fact that RNs are energizing nurses to and nursing leadership. lead the transformation. present in all healthcare settings but As one might suspect, also that they are a highly trusted Smadu defines CNA’s policy work the conversation with Smadu covered profession, with a significant body as being consistent with the code of a vast array of topics, from the Commission’s work, to the triple AIM ethics and nursing values: CNA’s work of knowledge and competencies. By in policy is not just about nursing, but virtue of their academic education framework, to the obesity epidemic RNs are also strategic thinkers and the public. and to the social determinants of problem solvers. Clients are broadly defined health. We need leaders on a continuum, as Smadu and co-chair of the who have the intention individuals, family, Commission Maureen McTeer, a We need leaders of following through. health law expert and author, Adjunct group, population and who have the She challenged nursing society and leadership Professor, Faculty of Common Law, leaders to think in is needed at all levels. University of Ottawa are leading a intention of the long term despite She spoke eloquently on diverse team of Canadian experts following through. pressures to do the latter: nursing as a in nursing, medicine, business, otherwise. In addition collective making broad government, academia and the public to the long view, she advocates for policy changes through her triple P: in a broad consultative process and the wide view. A big challenge Smadu patience, perseverance and passion. review of relevant research. recognized is leaders’ desire to take She spoke ardently about Her diverse leadership on too much, to try to do it all in the innovation Saskatchewan nurses responsibilities have given her an short term. have led and the need to share and interesting outlook on her work with

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As health care is the most complex teamwork to make our health system more effective. system in society, she was not at a The Commission invites loss to offer suggestions for change: nurse leaders, employers, union increased and better utilization of representatives, technology, the obesity She challenged economists, business epidemic, aboriginal health, social determinants nursing leaders leaders and the public to share their thoughts, ideas of health, primary health to think in the and advice. There are care and Triple Aim. Her reality check and advice long term despite many ways to stay up-todate on the Commission’s to RNs was to reflect on pressures to do work and have your voice what that feels like for heard Facebook, Twitter, the individual. Her other otherwise. call for submissions or advice was just do it. just tell the Commission The Commission about an innovative idea. She will address key questions around encouraged nurses to check out the the re-alignment of health services, reducing duplication and maximizing CNA website www.cna-aiic.ca.

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So what do future leaders need to take on this new environment? Smadu encouraged RNs to take on only a few strategic directions and work collaboratively with others, to maintain sustained energy­—pick something you are passionate about— pick one thing. This is sound advice. Marlene Smadu, RN is a well known name in nursing in Canada and internationally. After all, she has held a broad range of formal leadership positions. She is currently the Associate Dean, Southern Saskatchewan Campus and International Student Affairs, for the College of Nursing, University of Saskatchewan. After serving as President of the CNA, Smadu was elected as one of three VicePresidents for the International Council of Nurses. She also served as the Principal Nursing Advisor and Assistant Deputy Minister, Ministry of Health and was an Education Consultant and then the Executive Director of the SRNA.

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by Mary Martin-Smith, RN Nursing Faculty, SIAST and University of Regina

When the Earth Moves: Primary Health Care in Action

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sharp jolt, breaking glass, filing normal reactions to an abnormal situation. CDHB also coordinated cabinets upending, computer care for vulnerable populations. screens toppling; people’s I acted as liaison to the social audible gasps of fear and clouds of environments/welfare emergency task dust as buildings crumbled. These group. This meant ensuring a health are my memories of the February and social determinants perspective 22 earthquake in Christchurch New was considered in all issues brought Zealand, where I was working as part to the table, e.g., the need of the Public Health …all parts of the to keep displaced families Specialist team for Canterbury District system have a vital close to their home communities and schools Health Board (CDHB). part to play in so that social supports were This was the devastating in place. We recommended quake which claimed responding to a putting mobile homes 181 lives and reduced a proud and beautiful city natural disaster. in local communities or in people’s own to rubble. driveways instead of creating mobile Six months prior, the 1st quake communities in central locations. It shattered some buildings, but there also included strongly advocating was no serious injury or death. Both quakes brought similar issues: for and facilitating community engagement in the recovery process. infrastructure destroyed as sewer and Public Health Nurses (PHNs) water lines cracked; power and phones served as key links to emergency down; and people forced from their shelters and addressed health homes due to significant structural damage to their homes or liquefaction and infection control issues. As we moved from emergency (tons of silt bubbling up through the response to recovery, PHNs earth) that made homes and roads played a critical role in unusable. working with school So, how did health respond? staff to address Public Health, Primary Care and Mental Health services collaborated on consistent messages to support people’s normal reactions to a disaster and how to seek help. This meant providing more mental health supports to primary care; assigning mental health professionals to support families who had suffered loss of loved ones; speaking publically about

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children’s reactions to the quakes and linking families to services. Public Health environmental health officers (Inspectors in Canada) tested water, assessed food handling at welfare centers and supported infection control operations. Medical Officers of Health issued boil water advisories, spoke to the media about health issues and monitored gastro intestinal disease. There was no outbreak—a testament to public health diligence in monitoring and providing extensive infection control messages! I was proud to be part of this team effort—public health, primary care and acute care working together to meet the health needs of the people of Christchurch—­proving once again that all parts of the system have a vital part to play in responding to a natural disaster.


CNA: Call for Scrutineers This is a call for expressions of interest to be nominated by the SRNA as a scrutineer for the CNA Annual meeting being held in conjunction with on the CNA Biennial Convention, June 18 – 20, 2012 in Vancouver, British Columbia. Information on the role of the scrutineer can be obtained by contacting Barb at bfitz-gerald@srna.org Interested individuals can apply to Debbie at dcummings@srna.org by January 16, 2012. Please include a brief note (maximum 150 words) stating the SRNA activities you participate in and the reasons the SRNA Membership Advisory Committee should choose you to be the SRNA nominee. The nominee will be approved by SRNA Council at the February meeting and forwarded to CNA. If selected, the nominee will receive up to $1500 to cover expenses to attend the CNA Biennial Convention.

Are you interested in being a SRNA voting delegate at the CNA Biennial Convention in Vancouver? If you are interested in representing the SRNA at the CNA Convention in June, 2012 please email Julie at jbenjamin@srna.org In the SUBJECT line please indicate: CNA Convention, June 18 – 20, 2012. Criteria: Voting delegates will be members actively engaged in the work of SRNA, will commit to attending briefing sessions and participating in the business meetings at the Biennium and any necessary follow up activities. The SRNA will provide registration and up to $1500 per delegate to attend. Please include a brief note (maximum 100 words) why you should be a SRNA voting delegate. SRNA Council will select two members at the February 2012 Council Meeting based on the criteria above. Good luck!

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He pa a ltr h D t mQ e nutasl i t y C o u n c i l

Nurse Practitioner Quarterbacking Care Around Needs of Patients

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ince arriving at the Carlyle Wanda Miller, Sun Country Primary Health Clinic in 2007, Health Region’s Director of Primary Jean Daku, RN(NP) has made Health Care, has worked with Daku patient needs the basis for her practice, since 2007 when the Carlyle Medical collaborating with practitioners from Clinic made its transition to a primary other disciplines and equipping herself health care site. What sets Daku with the training and tools to meet apart, says Miller, is her capacity those needs. to build relationships with patients “Shared care is a huge benefit,” says and all team members. “She sees the Daku. “I can give you medications, value in everyone and understands I can talk to you, but I’m not a the roles and responsibility that each counsellor, or a social worker, or a player brings to enhance patient care. mental health worker. It’s The right person at the much better if patients can What sets Daku right time for the right deal directly with these situation is very well apart, says people on those kinds of understood by Jeannie.” issues.” The diabetic clinic Miller, is her Daku has consistently was Daku’s first foray capacity to build into team-based care. moved beyond the “solo practitioner” model of care. relationships with Yet in her 25 years as a One of her first initiatives registered nurse, she had patients and all in Carlyle was to establish seen countless instances an interdisciplinary clinic of the connection . team members for people living with between patients’ diabetes. Twice each physical and emotional month, patients can come well-being. When she to the clinic and access the care and signed on for the Health Quality counsel of a diabetic educator, a Council’s most recent Chronic Disease dietitian, and Daku herself, all under Management Collaborative, she was the same roof. drawn to its resources for identifying “They can get everything at once,” and helping patients dealing with Daku says. “If they need prescriptions, depression. I can provide them, if they need to “I saw it as a great learning talk about their diet, they can do opportunity and a chance to help that.” people,” she says.

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Jean Daku, RN(NP) Newly equipped with depression assessment and support tools, Daku immediately set to work adopting and adapting them for her patients at the clinic. And once again, she took an interdisciplinary approach, arranging for weekly clinic visits by a psychiatrist and a mental health nurse. “Our physician is also involved in all the care we do, and I meet with a social worker once a month so we can discuss how our patients are doing,” she says. Although people living with chronic diseases often experience depression, the condition can easily go undiagnosed and untreated. “I can touch your stomach and know if you’re experiencing pain,” Daku says. “But how do I know if


you’re depressed just by looking at you?” To address this gap, Daku has adapted the PHQ9 health questionnaire, a standard assessment tool for patients undergoing a physical. Daku’s questionnaire now includes two questions that can point to depression in a patient. Daku makes use of algorithms that help her determine what the next care steps should be for a depressed patient. She also has her patients’ charts colour-coded so that those dealing with depression are allotted 40 minutes, rather than the usual 20, when they call in to book an appointment. Miller says Daku’s passion for patient-centred, team-based care has made believers of many of her colleagues. “When we first talked about running clinic days, everybody said, ‘You can’t do that, that’s patient-slot time, we have to put these patients through,’” Miller recalls. “Today they’re right on board.” For her part, Daku is quick to credit her colleagues for their willingness to practice care collaboratively. She also says interdisciplinary care is easily achievable for any practitioner who sees the benefits. “All you have to do is look around and see what other health professionals are doing, and how they could help your patients, and you can really do wonders,” she says.

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S ae spak ratc D t mhe enwa t s n S u r g i c a l I n i t i at i v e s

Surgical Checklist Improves Safety

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it’s often the little things that get atient safety is a key aspect of overlooked. Yet, these seemingly quality healthcare and critical to “Sooner, Safer, Smarter,” our minor missed steps can have serious consequences for our patients. plan to transform the Surgical Patient At the Institute of Healthcare Experience here in Saskatchewan. Improvement (IHI) meeting in In the Canadian Adverse Events Amsterdam this year, Gawande told Study, Baker and Norton showed the story of a patient from Texas what similar studies in the USA and involved in an MVA who suffered UK had revealed: our safety record multiple fractures and internal in healthcare hasn’t been as good as injuries. The trauma it ought to be. We In the increasingly team caring for him should therefore look did a fantastic job of to other industries complex world of “putting him back with much better together” and were safety records to see modern medicine, very proud of their what we can learn it’s too easy for an work. However, the from them. In his book The Checklist otherwise expert surgeon surgery included a splenectomy. Manifesto, Atul to miss a simple step. They did not do Gawande points out that the airline industry has an exemplary safety record and one of the critical factors has been the use of checklists by airline pilots. In the increasingly complex world of modern medicine, it’s too easy for an otherwise expert surgeon to miss a simple step. The checklist is a tool to help prevent that. Furthermore,

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a “checklist” and overlooked the immunization he should have received. The patient went on to lose all of his finger and toes. The omission here, though minor compared to the heroics the team had performed, had drastic consequences for the patient. His fingers and toes might have been saved by that last time out on the checklist – the one that asks, ”Have we forgotten anything?” Maureen Bisognano, the CEO of IHI, speaking at the Quality Summit in Regina in 2011, described a horrible complication suffered by her mother during a recent hospital experience. This took place in a world-renowned institution with


D e pa r t m e n t s by Barb Fitz-Gerald, RN Nursing Advisor, Member Relations

Head 1

help shift the cultural dynamic of the world famous physicians. It wasn’t a operating room from a hierarchy to an lack of expertise or resources, but an incredibly simple oversight, the failure expert multidisciplinary team working on the patient’s behalf. to discontinue a medication, which In his speech to the 2011 Harvard led to the problem. Standardized tools School of Medicine graduating class, such as the Surgical Checklist save us from such simple omissions with such titled “Cowboys and Pit Crews,” Atul Gawande used the analogy of the drastic consequences. skills and efficiency of a NASCAR The second reason for embracing pit crew as the best way to meet the checklist is a more cultural one. patients’ needs in the In his address to the future, with discipline With teamwork, Executive of the American and standardization, College of Surgeons, others can save doing things the same Dr. Brent James, from way every time. He Intermountain Healthcare you from failure, speaks of recognition in Utah, spoke of our no matter where that with teamwork, continued reliance on others can save you the “craft of medicine” they stand in the from failure, no matter with clinicians as standhierarchy. where they stand in the alone experts, relying hierarchy. The future on subjective recall is multidisciplinary to make decisions in team-based care with standardization an increasingly complex and often of practice, care pathways and yes, stressful environment. He suggests checklists. “the complexity of modern medicine The Surgical Checklist has saved exceeds the capacity of the unaided lives and reduced complications. For human mind.” He advises that that reason, it has been endorsed the future will not be physicians by Accreditation Canada, the Royal as stand-alone experts, but rather College of Physicians and Surgeons multidisciplinary team-based care of Canada, the College of Physicians with each member of the team a and Surgeons of Saskatchewan, the valued contributor. The checklist can

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Canadian Anaesthetists Society, the CMA, the SMA, the Canadian Nurses Association, the Operating Room Nurses Association of Canada, as well as Patients for Patient Safety Canada and numerous other organizations. Saskatchewan is committed to having the checklist used for all surgeries. An audit of all regions done in May 2011 showed a wide variation in use of the checklist between regions, within a region, and even within a division in a region. If you are not familiar with the checklist used in your region, please learn about it. If you are already using it, share your knowledge and help spread the implementation. We urge you to champion its use. The Surgical Checklist saves lives! Dr. Peter Barrett is a Saskatoon based urologist and Physician Leader for the Saskatchewan Surgical Initiative. Dr. Karen Shaw is the Registrar of the College of Physicians and Surgeons of Saskatchewan. Dr. Vino Padayachee is the Chief Executive Officer of the Saskatchewan Medical Association.

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What is a Registered Nurse? Competent, caring, knowledge-based registered nursing for the people of Saskatchewan.

Registered Nurses “Registered nurses (RNs) are self-regulated health care professionals who work autonomously and in collaboration with others. RNs enable individuals, families, groups, communities and populations to achieve their optimal level of health. RNs coordinate health care, deliver direct services and support clients in their self-care decisions and actions in situations of health, illness, injury and disability in all stages of life. RNs contribute to the health care system through their work in direct practice, education, administration, and research, and policy in a wide array of settings” (CNA, 2007 p.5). “The direct care role is fundamental to registered nursing, and all other roles within the profession ultimately exist to maintain and support direct nursing care” (SRNA, 2007, p.6).

Education The baccalaureate degree in nursing is the required level of education for those entering the profession. RNs can choose to pursue additional education at the masters, doctoral and post-doctoral levels. To practice registered nursing in Saskatchewan, registration and licensure with the Saskatchewan Registered Nurses’ Association (SRNA) is required. All members must have successfully passed the Canadian Registered Nurse Exam (CRNE). The Registered Nurse (Nurse Practitioner) {RN(NP)} is an advanced practice category of RN who has further education enabling them to diagnose, treat, prescribe and dispense medications for common medical disorders. In addition to the exam requirements for a RN, the RN(NP) must also successfully pass the Canadian Nurse Practitioner Exam required for this category of licensure. The baccalaureate program in nursing prepares students for the provision of safe, ethical and competent care. This education gives RNs the breadth and depth of knowledge and skills through courses in nursing and related disciplines, enabling RNs to take on multiple responsibilities and carry out a variety of roles to meet complex client health needs in constantly evolving practice environments. “Registered nurse education prepares registered nurses to collaborate with clients, families and other members of the health-care team. Their leadership skills allow them to take responsibility for promoting health- care team effectiveness” (CNA, 2007, p. 19).

Scope of Practice The Registered Nurses’ Act, 1988 specifically outlines the scope of practice of the RN. Scope of practice refers to the range of services that RNs are educated and authorized to perform. RNs are accountable to practice registered nursing in accordance with The Registered Nurses’ Act, 1988, SRNA Bylaws, SRNA Standards and Foundation Competencies for the Practice of Registered Nurses, SRNA policy, practice standards, guidelines and other relevant legislation. RNs also have ethical commitments and are required to practice according to the ethical values outlined in the Code of Ethics for Registered Nurses.

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Registered Nurse Practice RNs perform comprehensive assessments for all types of client needs and provide nursing care for stable to complex clients of all ages throughout the lifespan and in all settings. “The registered nurse in collaboration with the client, performs an assessment of physical, emotional, spiritual, cognitive, developmental, environmental, social and learning needs and the client’s beliefs about health and wellness” (SRNA, 2007, p.8). RNs utilize analytical and decision making skills to determine nursing diagnosis, create plans of care, implement and evaluate care outcomes. RNs facilitate the delivery of primary health care across the continuum of care from acute care, to community, to continuing care settings by promoting health, preventing disease and injury and restoring health in all settings.

Assignment and Coordination of Client Nursing Care The key components of The Registered Nurses Act (1988), identifies that RNs are responsible for the assignment and coordination of client nursing care. Therefore, the RN is responsible for appropriate assignment of client care and works collaboratively with team members to determine appropriate assignments. This is achieved through the nursing process, a legislated responsibility of the RN. The RN at the point of care* assesses the client. Through planning, implementing and evaluating client care needs, the RN determines the most appropriate care provider who can safely and competently meet the needs of the client. RNs coordinate nursing care in all health care settings.

Knowledge Navigators RNs are “knowledge navigators” and direct clients to credible resources, teaching them to interpret and evaluate information and helping them find their way in the health care system (CNA, 2007). RNs enable clients to make decisions about their health and health care, and support and respect their decisions.

Leadership and Professionalism Leadership is fundamental to registered nursing and is essential in ensuring quality client outcomes. RNs use transformational leadership practices including building relationships and trust, creating an empowering work environment, creating a culture that supports knowledge development and integration, leading and sustaining change and balancing values and priorities in order to promote healthy outcomes for the RN, the patient/client, the organization and the health care system as a whole (RNAO, 2006). Leadership is integral to every practice setting and is critical to client care, health promotion, policy development and health care reform (Kilty, 2005). Professionalism requires that RNs in all roles demonstrate the following attributes: knowledge, spirit of inquiry, accountability, autonomy, advocacy, innovation and visionary, collegiality and collaboration, and ethics and values (RNAO, 2007). *Point of care means where the RN is knowledgeable of the individual client’s needs based on ongoing nursing assessment and is responsible for the overall care for the client.

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Continuing Competence For each RN continuing competence is an integral component of registered nursing practice. All RNs have a professional responsibility to assess their learning needs on an ongoing basis and take action to ensure they are competent to practice efficiently, effectively and safely (SRNA, 2007). Through continuous learning and the incorporation of evidence-informed practices RNs maintain their competency to practice in an evolving health care system.

Need for Registered Nurses Research demonstrates the link between RN practice and positive client and system outcomes. Client outcomes have been consistently shown to be positively affected by RN intervention across a variety of health care settings (Doran, 2003; White, Pringle, Doran & McGillis Hall, 2005). In 2011 Needleman et al., reported that staffing of RNs below target levels was associated with increased mortality, reinforcing the need to match RN staffing with clients’ needs for nursing care. References Canadian Nurses Association. (2007). Framework for the practice of registered nurses in Canada. Ottawa: Author. Doran, D.M. (Ed). (2003). Nursing-sensitive outcomes: State of the science. Sudbury, MA: Jones and Bartlett. Kilty, H.L. (2005). Nursing leadership development in Canada. Ottawa: Canadian Nurses Association. Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S. R. & Harris, C. (2011). Nurse staffing and inpatient hospital mortality. N Engl J Med, 364, 1037-45. Registered Nurses’ Association of Ontario. (2006). Developing and sustaining nursing leadership. Toronto: Author. Registered Nurses’ Association of Ontario. (2007). Professionalism in nursing. Toronto: Author. Saskatchewan Registered Nurses’ Association. (2007). Standards and foundation competencies for the practice of registered nurses. Regina: Author. White, P., Pringle, D., Doran, D. & McGillis Hall, L. (2005). The nursing and health outcomes project. Canadian Nurse, 101(9), 15-18.

SRNA N e w s SRNA Nominations Committee Welcomes Karen Marchuk

Thank you Bobbi Schwartzenberger, Presiding Officer for the CRNE in Saskatoon

Karen was a teacher with the Regina Public School Board for 35 years. Although she retired in December 2011, Karen is currently working as a receptionist/media buyer for HJ Linnen Associates. She enjoys golfing, yoga, walking, gardening, reading, and entertaining. Karen and her husband Russ have two children: Michelle (Dave) Schmalenberg , grandson Ben and Melanie Marchuk.

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Bobbi began invigilating in August of 1970 when Edna Dumas was the Registrar in Regina. At that time there were five individual exams written over two and a half days.  In August 2012 Bobbi will have been involved for fourty years. During this period she has only missed three exam dates (once in June of 1977 and twice in 1984). She has enjoyed the people and the process and the “little experiences along the way.”


Safety Alert

MedicationSafetyAlert!

Institute for Safe Medication Practices* Table 1. Primary suspect drugs* for reported serious events in 2010 Rank

Generic Name

1 bosentan

Canadian Brand Name

Cases

Tracleer 4665

2 fentaNYL Duragesic

3035

3 inFLIXimab Remicade

2500

4 etanercept Enbrel

2446

5 teriparatide Forteo

2375

6 varenicline Champix

2028

7

QUEtiapine Seroquel

1585

8

zoledronic acid

1542

Zometa

9 adalimumab Humira

1530

10 acetaminophen Tylenol

1281

11 levofloxacin

Levaquin

1123

12 baclofen

Baclofen

1077

13 pregabalin

Lyrica

1077

14 atorvastatin

Lipitor

1075

15 oxyCODONE Oxycontin

1070

For 2010 in its entirety, we identified 141,829 new cases of serious, disabling, or fatal ADEs reported to the FDA, a 21% increase since 2009. The increase (24,736 cases) in 2010 was the largest absolute (raw number) increase between years since 1998. Fatal adverse event reports increased by 42.9% in 2010 to reach a total of 28,456.This deceptively alarming increase was heavily influenced by large numbers of reports from drug manufacturers about deaths in previous years in which a drug was taken but not necessarily linked to the deaths. This trend primarily reveals regulatory and compliance issues in the FDA’s monitoring program rather than a new danger to patients. For more information on ISMP, please refer to

www.ismp.org

* ISMP - A federally certified Š2011 Institute for Patient Safety Organization Safe Medication Practices

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by Bryan Salte, CPAA Associate Registrar & Legal Counsel Endorsed by the SRNA

Cosmetic Procedures

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procedures. Some physicians begin ne of the recent challenges to perform procedures based upon for professionals and a weekend course, often sponsored regulatory bodies is the by the corporation that provides the proliferation of cosmetic treatments product. which are available. Medspas are a There are many examples in multi-billion dollar industry in the North America where United States, and Canada There are many inadequately trained appears to be rapidly catching up. examples...where physicians have provided cosmetic services that have This article will address inadequately harmed patients. That two primary issues: can lead to significant 1) What minimum trained consequences for the standards should physicians meet to be physicians have physicians involved. Two maxims are qualified to provide provided cosmetic relevant “Above all, do no such services? and, 2) Which services services that have harm”, and paragraph 15 of the Canadian Medical must be provided by harmed patients. Association Code of physicians, and which Ethics “Recognize your can be performed limitations and, when indicated, by registered nurses or other recommend or seek additional professionals? opinions and services”. Minimum Standards At some future time there may be standards set for physicians to Physicians and other professionals are participate in the delivery of such providing a broad range of services that are outside the traditional practice services. Until that happens, the College of medicine. Some examples of the services provided are botox injections, would like to remind physicians that they should carefully consider whether use of laser for a number of purposes, they: fat and cellulite manipulation, hair transplants, etc. 1) Fully understand all of the risks There are no commonlyand benefits associated with the accepted best practices or minimum procedures and equipment; qualifications for many of these

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2) Are aware of the possible complications and what is required to deal with such complications; 3) Can provide appropriate recommendations and counseling to patients considering those procedures; and, 4) Have the technical capacity to provide the service skillfully and safely. Involving other professionals in providing services. Both the College of Physicians and Surgeons of Saskatchewan (CPSS) and the Saskatchewan Registered Nurses’ Association (SRNA) are concerned that in some situations there is inadequate physician involvement in providing some of these services. Saskatchewan legislation does not authorize physicians to delegate the practice of medicine to nonphysicians. The practice of medicine is broadly defined and includes acts which either diagnose a human condition or which treat a human condition. The services described in this article are the practice of medicine. A specific example of concern is administering botox injections.


The SRNA has expressed its opinion that: 1) Injecting botox based upon a physician’s directions is within the scope of the practice of registered nursing; 2) Assessing a patient to determine whether the patient is an appropriate candidate for botox injections is not within the scope of the practice of registered nursing; 3) Making a decision whether or not to provide botox injections to a patient is not within the scope of the practice of registered nursing; What follows from the SRNA’s position is that a physician involved in providing botox treatments must assess the patient and provide the direction to the nurse to perform the botox injection. The CPSS perspective is that, as a physician is not able to delegate the assessment or treatment decision to a RN, a RN who injects botox without

a physician’s assessment or direction is engaged in the illegal practice of medicine. A physician who authorizes a RN to assess or treat a patient is a participant in the illegal practice of medicine. If that happens, there are a number of significant risks for both the physician and the RN: 1) Both are potentially subject to prosecution in the courts for the practice of medicine without a licence; 2) The RN is potentially without malpractice protection and, if a patient sues for negligence, may be left to defend the action without malpractice coverage.

The RN is potentially without malpractice protection and, if a patient sues for negligence, may be left to defend the action without malpractice coverage.

Physicians involved in providing services that are performed, at least in part, by other professionals should consider whether the services provided by other professionals fall within their scope of practice. If the services do not, there are significant risks to a physician who authorizes the person to perform the procedure.

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SRNA ANNUAL MEETING

and CONFERENCE

Delta Hotel - Regina - May 2 &

R esolutions

3, 201 2

Members of the SRNA can provide input on particular issues facing the profession or on initiatives in which you think the Associationcould be involved through submitting a Resolution.

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1. A letter of resolution/motion can be submitted to SRNA Council at any time. 2. Resolutions/motions can be presented to the Council, by person, group, annual or special meeting assembly at any time. Persons who wish resolutions/ motions published in the Annual Report should have resolutions submitted to Council, for presentation at the Annual Meeting, by January 31 of each year.

inking with Members May 1, 2012 nnual Meeting Day May 2, 2012

Join us in Regina for our Annual Meeting. SRNA members and the public are invited to attend the annual meeting in the afternoon. Join us in the morning for a series of interactive sessions, information and dialogue about where we’ve been as your professional regulatory organization and where we’re going. This is your opportunity to participate in the business of the SRNA. In the evening, our banquet and awards recognition night is a tradition not to be missed.

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onference Day May 3, 2012

The event provides an opportunity for RNs, RN(NP)s to take time to rejuvenate and have fun, network with colleagues from across the province and learn about a broad range of evidence-informed nursing practice applications. A series of concurrent sessions will round out our day.

Resolutions not submitted by this date can be presented at the annual meeting as a motion from the floor. Resolutions must include: • A title: subject • A Resolution statement: an expression of intent or what action you are proposing the Association take in relation to the subject of the resolution. This statement begins with: “Be it resolved …”, and should be written in a clear and concise manner. • Explanatory notes: identify why you believe the issue should be addressed. If you are making a number of points, order them numerically. (Remember that resolutions must have a provincial basis and relate to the mandate of the Association.) • Identification: names of “mover” and “seconder” of resolution (must both hold active-practising status with the Association). Either the “mover” or “seconder” should be available to speak to the resolution at the Annual Meeting. 3. Resolutions/motions that are approved by the membership at the Annual Meeting will be reviewed by Council to make reasoned decisions regarding any actions to be taken. For more information contact the SRNA or send resolutions/motions to: Kandice Hennenfent, RN, SRNA President c/o SRNA, 2066 Retallack Street, Regina, SK S4T 7X5 or by email to: president@srna.org SRNA ANNUAL MEETING and CONFERENCE SPONSORSHIP OPPORTUNITIES

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Gold $10,000 and over Silver $5,000 - $9,900 Bronze $2,000 - $4,999 Refreshment Breaks $500 - $1,999 Contact: gmintram@srna.org


Call For

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Nominations

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lection 2012 Call for Nominations for SRNA Council and Nominations Committee

Celebrate Registered Nursing Excellence in Saskatchewan

The Nominations Committee is seeking RNs and RN(NP)s to stand for election in 2012 for the following positions: Memberat-large for 2012 to 2015(three-year term); Nominations Committee for 2012 to 2014 (two-year term). The 2012 election is on May 2, 2012 at the SRNA Annual Meeting in Regina. Council Positions Council members are elected to represent registered nursing in Saskatchewan. One Member-at-large is open for election in each of the following regions: • SRNA Region IV, Kelsey Trail and Sunrise Health Regions • SRNA Region VI, Saskatoon Health Region Nominations Committee The role of the Nominations Committee is to provide a slate of candidates to fill the Registered Nurse positions on Council and the Nominations Committee. • One position is open for election to the Nominations Committee for a two-year term. Candidate nominations must comply with the requirements stated in The Registered Nurses Act (1988), SRNA Bylaws (2009) and approved changes as per May 2011 Annual Meeting and SRNA Policies.

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EADLINE FOR NOMINATIONS IS 4:30 PM FEBRUARY 2, 2012 Submit completed nominations forms to the SRNA by email to communications@srna.org,

all for Nominees for the SRNA 2012 Member Awards

The SRNA Member Recognition Awards are an opportunity for members to formally recognize and celebrate many of the outstanding contributions of individual members and groups of RNs and RN(NP)s. Award recipients are honoured at the SRNA Member Recognition Awards Banquet and Ceremony held in conjunction with the SRNA Annual Meeting and Conference Day in May. • SRNA Millennium Awards are eight awards that celebrate members who are in the clinical, administration, education, research and policy areas; employers of RN and RN(NP)s; and nursing students. • SRNA Mentorship Award celebrates the significance of mentorship and its extraordinary influence in the relationship between two RNs. • SRNA Life Membership is granted to an individual who is retiring or is retired from the nursing profession and has rendered outstanding service to registered nursing in Saskatchewan. • SRNA Honorary Membership is awarded to a non-nurse or a nurse registered outside of the province, in recognition of distinguished service to the registered nursing profession or for valuable assistance to registered nursing in Saskatchewan. • SRNA Memorial Book is a historical record established to honor deceased members who during their career have provided exemplary service to the nursing profession and health care for the people of Saskatchewan. Award guidelines and nomination forms are available at www. srna.org under the Events tab under Membership Recognition Awards or contact the SRNA at info@srna.org.

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eadline for nominations is 4:30 p.m., January 15, 2012.

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R ee spaorutrmc ee ns t s D by Barb Fitz-Gerald, RN Nursing Advisor, Member Relations Did You Know? Head 1 professionals, A booklet for nursing

Specialized Procedures in Personal Care Homes A Guide for Nursing Professionals and Personal Care Home Licensees located at http://www. health.gov.sk.ca/specialized-procedures explains the responsibilities of the personal care home staff as well as the nursing professionals or physicians that work with the staff to ensure safe and competent care for the residents. The Sleep and Function Interdisciplinary Group at the University of Alberta (funded by Addiction & Mental Health: Alberta Health Services) is conducting a national survey of healthcare providers’ use of non-pharmacological sleep interventions for persons with dementia. (Students are not eligible). http://app.fluidsurveys.com/surveys/ cary-R/sleep-intervention-dementia/ CPSI recommending more accountability for hospital boards Hospital boards spend at least 25% of their time on patient safety and quality care – which improves outcomes. www.patientsafetyinstitute.ca The Ministry of Health released the 2011 Progress Report for the provincial tobacco reduction strategy: Building a Healthier Saskatchewan: A Strategy to reduce tobacco use, and the 2011 Strategy Action Plan. The document is available on the Ministry of Health website at www.health.gov.sk.ca

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The Saskatchewan Transfusion Resource Manual is now available on the Ministry of Health website at http://www.health.gov.sk.ca/ transfusion-medicine It is a provincial resource that health care providers will find very informative and will help them provide safer transfusion services in our province.

The Saskatchewan Association for Safe Workplaces (SASWH) is a non-profit autonomous association that was established March 12, 2010. SASWH is governed by a Board of Directors representing health services workers, unions and employers. Having a unique structure such as this is crucial to driving significant industry change and improvement. Health care employees missed 84,638 days of work due to injuries in the workplace during 2010. This translates into 423 full-time vacant positions. What kind of an impact does this have on the injured individual, their family, their community, their colleagues and patient care? SASWH believes that health and safety needs to be a priority for all to eliminate injuries and illness in the workplace. It is our mission to increase awareness and proactively support all health care industry employers and workers in their efforts to prevent workplace injuries; through education, training and services. For more information go to www.saswh.ca

w i n t e r 2012

The Alcohol and Drug Education and Prevention Directorate at the Saskatchewan Ministry of Health provides information on alcohol, drugs, mental health and addictions services. Available information ranges from facts on alcohol, cannabis and prescription medications, mood disorders and positive body image to suggestions on what to do if alcohol or drugs are causing a problem in one’s life. Front line staff and practitioners can access this information online at http://www. health.gov.sk.ca/alcohol-addictionsfactsheets and http://www.health. gov.sk.ca/mental-health-fact-sheets. Information can be printed off to share with members of the public, colleagues or managers. There is also information for parents at http://www.health.gov.sk.ca/ alcohol-addictions-resources. Any of these resources can be ordered in hard copy, free of charge from the Ministry of Health distribution centre by faxing requests to 306-7870194. To help direct people to Addiction Services in the province, please go online and click on their RHA at http://www.health.gov.sk.ca/ connections-to-help to find locations and contact information for the services available in their RHA.


SRNA U p d at e s Registration Renewal 2012 Registration Renewal for 2012 ended November 30, 2011 with a 91 percent on-line renewal rate. We are interested in quality improvement so we have designed an online registration renewal survey. The survey will be on our website www.srna.org from January 5 to February 15, 2012.

accurately reflect changes that have occurred in a member’s registration status since he/she was issued the paper licence. In addition, use of the e-register will eliminate the risk of lost or stolen licences; minimize the risk of identity theft and the use of fraudulent licences.

Effective 2013, the SRNA will be discontinuing paper licence cards. Confirmation of registration and licensure is available through the Verification Service (e-register) located on the SRNA homepage (www.srna. org). Discontinuation of the paper licence is becoming a best practice across Canada in promoting public safety. The use of the e-register provides an accurate means of confirming a member’s licensure status. The paper licence may not

Effective 2014, it will be mandatory for all SRNA members to complete their registration renewal online.

Holistic PPG Teleconference

Online Voting For SRNA Elections 2012 The SRNA will be utilizing the electronic voting system again for the annual election in May 2012. Eligible voters will vote on a secure electronic ballot. This will be done by clicking on the VOTE NOW icon on the SRNA website. Each member will be able to vote online until noon on the first day of the annual meeting. Computers will also be set up on-site at the Annual Meeting in Regina. More information will be posted on the SRNA website at www.srna.org when the elections begin.

A teleconference for members interested in forming a SRNA Holistic/Complementary Professional Practice Group(PPG) will occur in the near future. If you wish to participate please contact lmuzio@srna.org

SRNA Directory Phone/Toll-free (306) 359-4200/ 1-800-667-9945 Fax: (306) 359-0257 E-mail/Website: info@srna.org/www.srna.org Internationally Educated Nurses international@srna.org RN Registration register@srna.org Renew RN Registration renew@srna.org Nursing Examinations exams@srna.org Competence Assurance/ Discipline/Investigations professionalconduct@srna.org Member Links links@srna.org SRNA Newsbulletin SRNAnewsbulletin@srna.org Executive Director execdir@srna.org General Enquiries communications@srna.org Nursing Practice practiceadvice@srna.org

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SRNA S ta f f N e w s We welcome Joanne, Donna and Julie and look forward to their contributions to the SRNA and to our members.

Joanne Hahn

Donna Cooke, RN

Julie Benjamin

Senior Assistant, Regulatory Services

Nursing Policy Advisor, Practice

Joanne joined the SRNA February 2011. She moved to Regina from Fort McMurray, Alberta in 2009 where she worked at Syncrude Canada Ltd. for over 20 years. Her experience includes several Senior Assistant roles, including her last position Executive Assistant to the Vice President, Technical.

Donna joined the SRNA October 2011. Her previous employment was facilitator with the Nursing Education Program of Saskatchewan (NEPS) year two and Saskatchewan Collaborative Bachelor of Science in Nursing (SCBScN). Donna taught eight years for the Nursing Division at Wascana Campus, SIAST with the Nursing Re-Entry program, Practical Nursing program and the Nursing Education Program of Saskatchewan (NEPS).  Her clinical areas of medical/ surgical expertise include plastics, burns, otolaryngology, orthopedics, neurosurgery, general surgery, critical care and hemodialysis nursing.

Executive Assistant to Executive Director and Council

Donna is a member of the Canadian Nurses Association (CNA) Canadian Registered Nurse Examination (CRNE) Exam Development team.

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Julie joined the SRNA September 2011. She has over 22 years of progressive senior/executive administration experience – over eight of those as an Executive Assistant to Deputy Minister in the executive office within the Government and for the ADM in the department of Finance. She was responsible for briefing notes, chairing ADM meetings and giving governmentstaff presentations. She has a business diploma and one year towards a bachelor of admin degree.


U p co m i n g E v e n t s January

April

3

8

17 – 18

SIAST Advanced Pathophysiology Distance Education Course For more information contact: pcnp@siast. sk.ca

Helping RNs Work Smart - Professional Development Workshops 8:30 am – 11:45 am Stress Management and Emotional Wellness for RNs 1:15 pm – 4:30 pm Assertive Communication in the Workplace www.srna.org

Inspire: Health Care Quality Summit 2012 Learn. Lead. Transform TCU Place, Saskatoon, SK www.qualitysummit.ca for more information

February 17 Every Nurse Engaging in Tomorrow Symposium, Grant MacEwan University, Edmonton, AB For more information contact: SimpsonN9@macewan.ca

22 – 24 2012 Western and North-Western Region Canadian Association of Schools of Nursing Conference, Winds of Change: Diversity and Divergence in Lethbridge, AB www.wrcasn.ca/

15 Saskatchewan Association for Safe Workplaces in Health at TCU in Saskatoon, SK www.saswh.ca

AHIC 2012 – TOWARDS INTEGRATED DIAGNOSTICS: Bringing Crucial Information to the Point of Care www.ahic.nihi.ca

May 7 – 11 Nursing Foot Care Management - Deadline to register is April 6, 2012 in Edmonton, AB www.devonfootcare.com

26 - 30 Foot Care nursing certification course in Edmonton, AB www.devonfootcare.com

June 18 – 20

March

29(pm) – 30

7

The Saskatchewan Provincial Nursing Council is hosting its inaugural Nursing Leadership Conference at the Saskatoon Inn, Saskatoon, SK www.srna.org for updates

Helping RNs Work Smart - Professional Development Workshops 8:30 am – 11:45 am Behavioural Styles – Why Can’t They Be More Like Me? 1:15 pm – 4:30 pm Emotional SMARTS® for RNs www.srna.org

25 – 27

2012 Convention – Nurses: Movers and Shapers, Vancouver, BC www.cna-aiic.ca/CNA/news/events/ convention/default_e.aspx

TWO Full time positions available for an independent contractor, one based in Regina and the other based in Saskatoon, Saskatchewan. If you are interested in an entrepreneurial position with a focus on patient care, drug reimbursement, collaborating with health care professionals and advocating for patients with moderate to severe chronic illness, this unique position may be for you. We require an independent contractor, with a nursing or health care background and experience with SK Health Drug Plan & Extended Benefits. The successful candidate must possess the ability to work independently, in a fast pace environment, meet specific work deadlines, is attentive to detail and adaptable to change; be fluent in English with excellent writing and communication skills based on the principles of customer care excellence; demonstrate proficiency with Microsoft Word, Excel and Outlook; and excellent organizational skills with an emphasis on patient file management. This position requires the candidate to work from a home office and be available for occasional travel for training, meetings. Full orientation is provided. Candidates will start ASAP. If you are interested in this position please fax your resume to Marie-Claude Thiffault, BioAdvance Manager, F: 403-284-4105 or email mthiffau@its.jnj.com. Only the candidates selected for an interview will be contacted.

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The Saskatchewan Provincial Nursing Council is hosting its inaugural Nursing Leadership Conference.

Saskatoon Inn, Saskatoon, March 29 (pm) & 30 The conference theme provokes a dialogue about nursing leadership and our public, working with others to courageously influence, inspire and innovate the delivery of quality health care. The action-oriented program will appeal to LPNs, RPNs and RNs in all roles and at every level of experience. Nursing students are encouraged to attend. The conference will focus on leading change and impacts on the public, practitioner and system outcomes. The Saskatchewan Registered Nurses’ Association is providing support for this year’s event — please check the web site for updates on registration, keynote speakers and interactive sessions.

www.srna.org

RETURN UNDELIVERABLE MAIL TO: Saskatchewan Registered Nurses’ Assoc. 2066 Retallack St. Regina, SK S4T 7X5

Publication Agreement #40005137


SRNA Winter NewsBulletin 2012  

This is the NewsBulletin released December of 2011.

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