Nursing Advisory Council Report 2017-18

Nursing Advisory Council Report 2017-18

St. Michael’s Hospital School of Nursing pin, 1942

St. Michael’s nurse’s cape, 1942

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Nursing Advisory Council Report 2017-2018

Mother De Chantal First Superior of St. Michael’s Hospital 1892

Message from Sonya Canzian Vice President Clinical Programs, Chief Nursing and Health Disciplines Executive It has been my great pleasure and honour to serve as the Chief Nurse Executive for the St. Michael’s site of our newly integrated network. In this role, I have the privilege of supporting the important work of the Nursing Advisory Council (NAC).

Through the shared governance model of the NAC, nurses at St. Michael’s have advised, participated and led many quality and safety initiatives to improve patients’ experiences and outcomes, supported education, onboarding, professional development, leadership, healthy work environments, and selfregulation. The seven subcommittees of the NAC have been busy and actively contributing to the advancement of nursing and excellence in care across the organization. Through the leadership of NAC, we have a solid foundation of shared governance that continues to expand the voice of nursing across the hospital and assist in advancing practice to improve processes and lead change across our organization.

The current healthcare environment presents special challenges to the nursing profession and the NAC has been at the forefront of advancing the art and science of nursing through its leadership and advisory role to inform excellence in nursing practice, education and research. We continue to receive excellent feedback on scholarly forums such as Nursing Rounds and Professional Practice Scenario of the month. The nursing orientation subcommittee undertook a redesign of the corporate nursing orientation program and introduced a centralized in-patient nursing orientation day that continues to evolve but has been an excellent addition to our onboarding processes. I invite you to read through this report to learn more about all the important work of the NAC and the excellence in nursing at St. Michael’s Hospital.

As I look across the organization I am continually inspired by all the important work happening across the units and departments that is driven by the passion and dedication of our nurses. Nurses at St. Michael’s are published in peer-reviewed journals, participate in and lead research studies, advance evidenced based practices, and attend and present at national and international conferences. As a result of these activities we are recognized for our ability to infuence practice changes that beneft patient care. As I refect on these activities and the numerous quality improvement initiatives, Best Practice Spotlight Organization projects, and the leadership and expertise nursing has provided to larger scale corporate work, I am reminded why I take pride in my identity as a St. Michael’s nurse.

We celebrated a wonderful and exciting Nursing Week in May at which time we announced the launch of the Bernie and Mildred Syron Nursing Excellence Program. This program will support ongoing professional development through investments in our nursing teams. In the upcoming year, we look forward to fully launching opportunities available to nurses at St. Michaels through the generous gift of Bernie and Mildred Syron.

Finally, I would like to take this opportunity to thank all of our dedicated nurses across the organization for their outstanding work demonstrated consistently each and every day. This report is a celebration of our success as a nursing organization and represents nurses in all roles and settings throughout St. Michael’s.

Sincerely, Sonya Canzian, Vice President, Clinical Programs, Chief Nursing and Health Disciplines Executive

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Message from the Nursing Advisory Council Co-Chairs On July 1, 2017 when Canada celebrated the 150th anniversary of Confederation, St. Michael’s also celebrated 125 years of values-based care and a legacy of compassionate and evidence-based nursing care that ensures safe, quality care for all.

As a profession and Council, we have the privilege of advancing professional nursing practice that promotes excellence in quality patient care by providing a forum to purposefully link the integration of evidence based nursing practices, education, research, knowledge translation and quality improvement initiatives.

Nursing plays a critical role in the achievement of the hospital’s strategic initiatives. As thought leaders on nursing, NAC members bring a wealth of knowledge and experience that contributes to making thoughtful and well informed recommendations regarding professional nursing practice and on matters pertaining to safe, quality care. The undertakings and accomplishments of NAC subcommittees contribute to NAC outcomes and in supporting nursing’s contributions to informed quality care.

The members of the Nursing Advisory Council (NAC) and its subcommittees are integral in facilitating timely, efcient two way communication among relevant stakeholders. In June 2017 NAC was evaluated by its members. Respondents strongly agreed that they are proud to be members of NAC and believe it is realistic to communicate key messages and other important information to colleagues in their units and program areas. As well, more than ninety percent of respondents indicated that NAC supports the advancement of professional nursing practice and promotes excellence in quality patient care. Several members shared their perspective on the benefts of NAC membership: •

Shared governance structure and policy discussions;

•

The opportunity to hear about things that will have an impact on nursing and the opportunity to shape and infuence the implementation of changes that will impact nursing practice;

•

RNs from diferent areas of the hospital coming together to share ideas, discussion of issues and to identify solutions;

•

An opportunity to infuence standards of practice and improve quality of care;

•

It is protected time where we can learn what is going on within the hospital without being distracted or worried about patient care and also the opportunity to share later with teams.

The NAC represents all nurses at St. Michael’s and sets strategic directions for professional nursing practice that are consistent with the mission, values, vision and strategic directions of the hospital and the Interprofessional Plan, Advancing Interprofessional Excellence through Collaboration. The NAC also acts as a formal decision-making and approval body for corporate initiatives that impact nursing services, patient care and scopes of nursing practice.

We encourage you to review the 2017/18 Nursing Advisory Council Report and refect on NAC’s contributions and accomplishments in the last year. Through this annual report, we ofer a snap shot of NAC highlights and noteworthy achievements while acknowledging that there is a multitude of exemplary accomplishments by many nurses and interprofessional collaborative teams across the organization.

We would also like to take this opportunity to thank current and past members of NAC, subcommittees, the Nursing Professional Practice team and all nurses for their ongoing commitment to evidence based, quality care that demonstrates excellence in nursing practice at St. Michael’s.

Your Nursing Advisory Council Co-Chairs,

Murray Krock, RN BScN, MN Director, Nursing Practice & Education

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Nursing Advisory Council Report 2017-2018

Stephanie Mungar-Ferrara RN, BScN Outpatient Mobility

Table of Contents The Nursing Advisory Council Co-Leadership Model......................................................6 Nursing Advisory Council Membership ................................................................................ 7 Nursing Advisory Council Subcommittees........................................................................ 13 Nursing Rounds Subcommittee Update............................................................................ 14 Transfer of Accountability Subcommittee Update......................................................... 16 Policies, Procedures and Standards Subcommittee Update...................................... 20 Self-Regulation Subcommittee Update............................................................................... 22 Nursing Orientation Subcommittee Update.................................................................... 24 Healthy Work Environment Subcommittee Update ..................................................... 26 Nursing Week Subcommittee Update................................................................................. 28 2018 Nursing Excellence Awards, Scholarship and Fellowship recipients ......... 35 My Nursing Intranet Page ......................................................................................................... 41 Program Presentations ............................................................................................................... 44

Nursing Practice and Education Corporate Initiatives and Collaborations Professional Development Support...................................................................................... 46 Quality Improvement Initiatives ............................................................................................ 49 Collaborations................................................................................................................................. 56 Education .......................................................................................................................................... 57

Canadian Nurses’ Association (CNA) Certifcation Canadian Nurses’ Association (CNA) Certifcation .................................................... 59

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The Nursing Advisory Council Co-Leadership Model The Nursing Advisory Council (NAC) demonstrates shared governance and the advancement of professional nursing practice that promotes excellence in quality patient care. The NAC is accountable to the Vice President Clinical Programs, Chief Nursing and Health Disciplines Executive through the Professional Practice Executive Committee.

Nursing Advisory Council is co-led by the Director, Nursing Practice and Education and a Registered Nurse (staf nurse) who: •

Facilitate Nursing Advisory Council meetings

•

Collaborate with chairs of subcommittees and others stakeholders to set agendas

•

Ensure timely, efcient communication of Nursing Advisory Council’s business

Vice President Clinical Programs, Chief Nursing and Health Disciplines Executive Sonya Canzian

Nursing Advisory Council co-leadership model

Director, Nursing Practice & Education Murray Krock co-chair 2014-18

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Nursing Advisory Council Report 2017-2018

Staf Nurse, Outpatient Mobility Stephanie Munger-Ferrara co-chair 2016-18

Nursing Advisory Council Membership Nursing Advisory Council membership consists of nursing leaders and staf nurse representatives from clinical programs. Here are the 2017/18 nursing leadership members:

Gail Wilson, Director, Nursing Practice, Clinical Systems Adoption, Professional Practice

Cecilia Santiago, Nursing Practice Manager, Professional Practice

Colleen McNamee, Corporate Nursing Education Manager, Professional Practice

Donna Romano, Evidence Based Practice Nursing Manager (interim), Professional Practice

Jane Topolovec-Vranic, Director, Interprofessional Practice Based Research, Professional Practice

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Nursing Advisory Council Membership (cont’d.)

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Karen Wannamaker, Clinical Leader Manager, Medical Surgical ICU

Virginia Wojcik, After Hours Clinical Manager

Jenny Pak, Nurse Practitioner-Adult Trauma & NeuroSurgery

Shirley Bell, Clinical Nurse Educator, General Internal Medicine

Jennifer Vachhrajani, Clinical Nurse Specialist, Trauma, Neurosurgery & Mobility

Denise Ouellette, Clinical Nurse Specialist, Stroke Team

Nursing Advisory Council Report 2017-2018

Nursing Advisory Council Membership Clinical Program Representation Nursing Advisory Council membership consists of nursing leaders and staf nurse representatives from the clinical programs. Each NAC member has the responsibility of communicating with their nurse colleagues in similar roles and clincial programs. Here are the NAC staf nurse members and areas they represent:

Clinical Program: Women’s Health

Galina Davydova, Staf Nurse, Labour and Delivery Additional communication areas: Obstetrics and Gynaecology

Clinical Program: Perioperative Services

Karen D’Souza, Staf Nurse, Ambulatory Care, Post Anaesthetic Care Additional communication areas: Operating Room, Pre-Admission Facility, Surgical Day Care

Clinical Program: Heart and Vascular

Darren Day, Staf Nurse, Cardiovascular ICU Additional communication areas: Coronary Intensive Care Unit, Heart Health Unit & Cardiac Rehab, Electrophysiology Service

Nesa Vijayaratnam, Staf Nurse, Cardiology Additional communication areas: Cardiac Cath Lab

Shawna McIntyre, Staf Nurse, Cardiac and Vascular Surgery Additional communication areas: Coronary Intensive Care Unit; Heart Health Unit & Cardiac Rehab, Electrophysiology Service

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Clinical Program Representation (cont’d.)

Clinical Program: Trauma Neurosurgery and Mobility

Lidia Yamane, Staf Nurse, Trauma Neuro ICU Additional Communication areas: Trauma Neuro Inpatient

Stephanie Munger, Staf Nurse, Outpatient Mobility Additional Communication areas: Inpatient Mobility

Clinical Program: Diabetes Comprehensive Care

Meriam Jayoma-Austria, Staf Nurse, Transplant Clinic Additional Communication areas: Transplant, Kidney Care Center, Diabetes Clinics, Opthalmology

Zeineb Abdulkader, Staf Nurse, Haemodialysis Additional Communication areas: Nephrology/Urology Inpatient, Home Dialysis

Clinical Program: Family Health Team

Gabriel Lee, Staf Nurse, Sumac Creek Health Center Additional Communication areas: Family Practice Units -61 Queen Street, St Lawrence Market, 80 Bond Street, 410 Sherbourne, St. James

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Nursing Advisory Council Report 2017-2018

Clinic Clinical al P Prrogram Repr Repres esent entation ation (cont’ (cont’d.) d.)

Clinical Clinical Pr Program: Inner Inner City Health Health

Vivian IIw weno enoffu, Staf N Staf Nurse, urse, General Internal Internal Medicine Additional C Communic ommunication ation areas areas:: Regional Geriatric Geriatric Program, Program, Acut Acutee Caree of Car of the Elderly Unit Unit

Kira Bahinski, Staf Nurse, Emergency Department

Ryan Hoekstra, Staf Nurse, Community Mental Health Additional Communication areas: WREP, Community Connections, CONTACT, GMHOP, Consult, Steps for Youth Program

Jennifer Rogers, Staf Nurse, Inpatient Mental Unit Additional Communication areas: Psychiatric Emergency

Repr epres esent entativ ative e fr from Ontario Ontario Nurs Nurses es’’ Association Association

Alis lison on Carre Carre, Ontario Ont ario N Nurses urses’’ Associa Association tion

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Clinical Program Representation (cont’d.)

Clinical Program: Specialized Complex Care

Kyrene Fabroa Staf Nurse, General Surgery/GI/PLastics Additional Communication areas: Respirology, IV Services, Endoscopy Unit, Medial Surgical Intensive Care Unit

Irene Pryshlak, Staf Nurse, Specialty Clinics Additional Communication Areas: Palliative Care Unit, PCC-HIV Haemophilia, Occupational and Environmental Health

Criselda Diaz Gonzales, Staf Nurse, Haematology/ Oncology/ HIV Additional Communication areas: Medical Day Care Unit

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Nursing Advisory Council Report 2017-2018

Nursing Advisory Council Subcommittees Seven subcommittees report to the Nursing Advisory Council. Each subcommittee has a unique role in ensuring that nursing practice and education is explored and fulfilled to maximum capacity. The work of the subcommittees is reported to Nursing Advisory Council and contributes largely to evidence based practice, education, research, knowledge translation, patient safety and quality improvement.

Nursing Advisory Council Subcommittees

Chair/ Co-Chairs

Subcommittee Initiatives

Nursing Policy, Procedure and Standards

Gail Wilson, Director, Clinical Systems Adoptions

Corporate and program specifc policy, procedure and medical directives review

Nursing Rounds

Colleen McNamee, Corporate Nursing Education Manager/Kaleil Mitchell, Project Coordinator, Nursing Practice and Education

Monthly Nursing Rounds Presentations

Self-Regulation

Cecilia Santiago, Nursing Practice Manager

Professional Practice Scenario of the Month

Nursing Week planning

Donna Romano, Evidence Based Practice Nursing Manager (interim)/ Marta Sliz, Administrative Coordinator, Nursing Practice and Education

National Nursing Week events

Transfer of Accountability

Cecilia Santiago, Nursing Practice Manager

Nursing Transfer of Accountability

Nursing Orientation

Colleen McNamee, Corporate Nursing Education Manager

Corporate Nursing Orientation

Healthy Work Environment

Murray Krock, Director, Nursing Practice & Education/Donna Romano, Evidence Based Practice Nursing Manager (interim)

Promoting a Healthy Work Environment for nurses at St Michael’s Hospital

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Nursing Rounds Subcommittee Update The Nursing Rounds subcommittee supports the development, delivery and evaluation of Nursing Rounds at St. Michael’s Hospital. Nursing Rounds provides a forum for sharing knowledge and program/unit successes of nurses, students and interprofessional team members as well as an opportunity for refective practice and professional development.

MEMBERSHIP •

Colleen McNamee, Corporate Nursing Education Manager (co-chair)

•

Kaleil Mitchell, Project Coordinator, Nursing Practice and Education (co-chair)

•

Jane Topolovec-Vranic, Director, Interprofessional Practice Based Research

•

Jennifer Rogers, Staf Nurse, Inpatient Mental Health

•

Jenny Pak, Nurse Practitioner, Trauma/Neurosurgery

•

Murray Krock, Director Nursing Practice and Education

•

Ryan Hoekstra, Staf Nurse, Community Mental Health

Nursing Rounds are held on the third or fourth Thursday of the month in the Upper Marketeria. Each clinical program is given an opportunity throughout the year to present at Nursing Rounds, highlighting a nurse-led quality improvement or research initiative, best practice implementation, or other project. Between June 2017 and April 2018, three hundred and forty (340) persons attended Nursing Rounds.

Overall, evaluations of Nursing Rounds in 2017/18 were highly positive, with attendees commenting on the inclusion of : •

best practices, standards and related evidence to support nurse-led projects and intiatives; and

•

the efectiveness of the presenters in facilitating learning and sharing experiences

Date

Topic

Presenter(s)

June 2017

Heart and Vascular Program

Every patient must have a destination: Transitioning care within the CVICU

Sandra Ashtarieh, RN, Cardiovascular Intensive Care Unit Darren Day, RN, Cardiovascular Intensive Care Unit Margaret Ferraro, RN, Cardiovascular Intensive Care Unit

September 2017

Specialized Complex Care Program

Should I hold my breath?: Lessons learned from TB exposures and contact investigations from 1999-2017 at St. Michael’s Hospital

Julie Seemangal, MN, NP-Adult, TB Program

The Emerging Role of the Mental Health Emergency Services Area (MHESA) and the MHESA RN at St. Michael’s Hospital

Stephanie Lucchese, RN, Psychiatric Emergency Services Dominic Gascon, RN, Operational Readiness Specialist Jennifer Holmes, RN, Interim Clinical Resource Nurse, Emergency Department

October 2017

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Program

Inner City Health Program

Nursing Advisory Council Report 2017-2018

Date

Program

Topic

Presenter(s)

November 2017

Professional Practice

Mind the Gap: A collaborative initiative to address potential safety risks in intrahospital patient transitions

Colleen McNamee, RN, MN Cecilia Santiago, RN, MN, CNCC (C)

January 2018

Women and Children’s Health Program

Implementing a Hospital/Public Health Partnership Breastfeeding Walk-in Clinic: A collaborative response to our patients’ needs

Anna DeMarchi, RN, MN, PNC(C), St. Michael’s Hospital Saro Ganeshapillai, RN, BSc, IBCLC, St. Michael’s Hospital Tracy Petrou, RN, BScN, IBCLC, Toronto Public Health Jennifer Lalich, RN, BScN, Toronto Public Health

February 2018

Trauma Neurosurgery and Mobility Program

Improving Care Transitions: Using best practices to improve patient outcomes

Tara Raine, RN, BN, CNN(C)

March 2018

Diabetes Comprehensive Care Program

St. Michael’s Hospital Nursing Resource Team: Enhancing the quality of care through RN stafng optimization.

Keriann Tingling, RN, H.BSc, BScN Kinza Malik, RN, BScN Stephanie Gramigna, RN, BScN

April 2018

Family Health Team

Community Building and Saving Lives: A collaborative approach to harm reduction

Amber Bala, RN, Hon.BScN Daniel Bois, RN, BScN, ACRN, CPMHN(C) Ann Rodrigues, RN, BScH, BScN Sandra D’Angelo, RN, BScN

Over the past year, the Nursing Rounds subcommittee continued to partner with the Health Sciences Library to produce an online Resource Guide on each topic presented at monthly Nursing Rounds. The goals of this partnership are to: 1.

Promote the scholarly nature of Nursing Rounds

2.

Provide an avenue for nurses to access literature on topics presented that are interesting and/or relevant to their work

The online Resource Guide can be accessed on the My Nursing section of the intranet by clicking the following links, in order : Nursing Education and Professional Development > Nursing Rounds > Nursing Rounds Resource Guide

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Transfer of Accountability Subcommittee Update The purpose of the Transfer of Accountability (ToA) subcommittee is to develop, monitor, evaluate and sustain a corporate, evidence based approach for nursing and interprofessional teams to engage in quality patient care transitions and transfer of accountability activities, including information exchange, at various transition points. The ToA subcommittee functions as a community of practice for point of care RNs, Health Disciplines and Professional Practice to discuss topics pertinent to ToA and care transitions.

MEMBERSHIP

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•

Cecilia Santiago, Nursing Practice Manager (Chair)

•

Sharon Adams, Clinical Nurse Educator, Obstetrics and Gynecology

•

Maria Aquino, Staf RN, Cardiac Intensive Care Unit

•

Zeineb Abdulkader, Staf Nurse, Urology/Nephrology

•

Shirley Bell, Clinical Nurse Educator, General Internal Medicine

•

Brigitte Delaurier / Melissa Guiyab (MLOA), Clinical Nurse Specialist, MSICU

•

Colleen Dunphy / Katey Knott (MLOA), Manager, Collaborative Practice and Education

•

Kyrene Fabroa, Staf RN, General Surgery

•

Criselda Diaz Gonzales, Staf RN, Oncology/Hematology

•

Stephanie Hendriks, Staf RN, Respirology Clinics

•

Murray Krock, Director, Nursing Practice and Education

•

Wen-Ya (Lory) Lee, Clinical Nurse Educator, Inpatient Mobility

•

Gabriel Lee, Staf RN, Sumac Creek Health Center

•

Victoria McLean, Staf RN, Palliative Care Unit

•

Karen Michelsen, Staf RN, MSICU

•

Judy Pararajasingham, Clinical Nurse Educator, Trauma and Neurosurgery

•

Sarah Sweetnam, Resource Nurse, Respirology/CF Program

•

Ageliki Tsakis, Resource Nurse, Cardiovascular Surgery

•

Alexis Vieira, Resource Nurse, Cardiovascular Surgery

•

Nesa Vijayaratnam, Staf RN, Cardiology

•

Sandee Westell, Staf RN, Respirology Clinics

Nursing Advisory Council Report 2017-2018

Achievements of Transfer of Accountability Subcommittee

Intershift (shift to shift and break coverage) Transfer of Accountability (ToA) The Intershift Nursing Transfer of Accountability policy specifes the following four expectations that at shift change both incoming and outgoing nurses should: • • • •

Conduct ToA at patient’s bedside Engage patient (and family when patient consents to family presence) Perform safety checks Use ToA worksheet/checklist to structure information exchange

Sustainability Strategies •

Community of Practice: Monthly ToA subcommittee meeting serves as a venue for sharing of unit champions working on ToA.

•

Centralized ToA Education: This includes a twenty minute eLearning module and one hour simulation and ofered to new and returning RNs.

•

Best Practice Guideline (BPG) Sustainability Champions: Clinical teams have been advancing ToA by having a dedicated nurse champion to lead the planning, implementation and evaluation of initiatives for fve months of each BPG cycle. Between October 26, 2017 - March 31, 2018, there were seven BPG champions working on ToA.

•

Audit and Feedback: Monthly ToA audits of compliance for the four elements of intershift ToA are conducted by units.

Compliance trends are reviewed at the monthly ToA subcommittee meetings.

Unit data are also included on unit-based CUE dashboards and reviewed quarterly

by Nursing Practice and Education with CLMs and Clinical Nurse Educators.

How are we doing?

Monthly compliance audit results show that we have surpassed our corporate target of 75% for each of the ToA elements overtime (May 2013 - March 2018) with the most marked increase in the use of a structured ToA checklist.

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Intra-hospital Transfer of Accountability Intrahospital ToA includes processes between patient care areas and procedure/diagnostic areas. The Guideline for Intrahospital Transfer of Accountability Processes for Adult Non-Critically Ill Patients provides recommendations to health care professionals (nurses, health disciplines and physicians) and intermediary personnel (clinical assistants, patient transport assistants and clerical).

Five Elements of Intrahospital ToA 1.

Assessing patient for transfer

2.

Coordinating transport (including arranging appropriate transfer personnel, required equipment and any monitoring during transport)

3.

Performing safety checks

4.

Engaging the patient/and or family (with patient’s consent)

5.

Following a standardized communication format and documentation process

Education The intrahospital ToA education program is comprised of a video and facilitated discussion to promote an understanding of the: •

Intrahospital ToA tool: eTicket, an electronic ToA form

•

Decision-making guidelines and processes of transferring patients within the hospital

•

Diferent roles of clinicians and intermediary personnel in intrahospital ToA.

The education program was piloted in two inpatient units (Hematology/Oncology and Nephrology/Urology), as well as in Medical Imaging Department and Patient Transport Department from October 2016 to March 2017.

During the pilot period, 175 staff received education. Post-education surveys showed that majority agreed that they have substantial increase in knowledge from attending the education session and that the education is likely to alter their practice in the workplace.

On August 23, 2017, Nursing Practice and Education sponsored an eight-hour Train the Trainer for Clinical Nurse Educators and nurse champions from nine inpatient units where they reviewed the intrahospital ToA program in detail and learned about best practices in education, facilitation, and being a clinical champion.

On September 2017, following their participation in the train the trainer, the Clinical Nurse Educators and nurse champions facilitated the education at the unit level and supported the roll out of the intrahospital ToA tools and processes within their teams.

Evaluation The REB-approved study titled Staf Perceptions of Intra-Hospital Patient Transitions and the Perceived Impact of an Electronic Communication Tool and Patient Transfer Guidelines is currently underway and will further inform intrahospital ToA.

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Nursing Advisory Council Report 2017-2018

RNs Carl Leushuis and Suzanne Scotland double check the name on a patient’s wristband before he goes to Medical Imaging. (Photo by Yuri Markarov, Medical Media Centre)

Intra-hospital Transfer of Accountability (cont’d.)

Other Ongoing Intrahospital ToA and Care Transition Initiatives 1.

Intensive Care Unit ToA Processes with: •

Perioperative Services

•

Emergency Department

•

Cardiac Investigation Unit

2.

Inpatient Units

3.

Post Anesthetic Care Unit (PACU) and Surgical Inpatient Unit ToA

4.

Ambulatory Care Areas to Inpatient Units ToA

5.

Care Transition Initiatives •

Family Health Team Community Care Transition

•

General Internal Medicine Congestive Heart Failure Care Transition

ToA Intranet Page The sub-committee promotes sharing of ToA tools and initiatives through the ToA repository in the SMH Intranet page. To access the page, go to SMH A-Z >T >Transfer of Accountability.

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Policies, Procedures and Standards Subcommittee Update The Policy, Procedures and Standards subcommittee reviews, evaluates, and facilitates the development and revision of clinical nursing policies and procedures related to professional nursing practice. These policies and procedures are evidence based, incorporate research fndings and best practices and refect interdisciplinary collaboration as appropriate.

MEMBERSHIP •

Gail Wilson, Director, Clinical Systems Adoptions (Chair)

•

Cecilia Santiago, Nursing Practice Manager

•

Colleen McNamee, Corporate Nursing Education Manager

•

Denise Ouelette, Clinical Nurse Specialist, General Internal Medicine

•

Lee Barratt, Clinical Nurse Educator, Emergency Department

•

Shirley Bell, Clinical Nurse Educator, General Internal Medicine

•

Melissa Guiyab, Clinical Nurse Specialist, Medical Surgical Intensive Care Unit (MLOA)

•

Katherine Mansfeld, Clinical Nurse Educator, GI/General Surgery/Plastics

•

Kimberly Tan, Clinical Nurse Educator, Heart and Vascular Program

POLICIES APPROVED AND ENDORSED

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1.

Administration of a Flourouracil Continuous Infusion via Elastomeric Balloon Device

2.

Care after death

3.

Clinical Institute Withdrawal Assessment for Alcohol Scale-Revised (CIWA-Ar) for Inpatient Units

4.

Continuous Subcutaneous Insulin Infusion Pumps (CSII or Insulin Pump) Use on Inpatient Units

5.

Critical Care Unit Flowsheet

6.

Insulin Pen Policy

7.

Ultrasound Guided Peripherally Inserted Central Catheter (PICC) Insertion by Medical Radiation Technologists & Registered Nurses In Medical Imaging

8.

Use of Nitrous Oxide in the Labouring Patient

Nursing Advisory Council Report 2017-2018

Provincial and National Nursing Organizations •

College of Nurses of Ontario CNO) was established in 1963.

•

The CNO is the governing body for Registered Nurses (RNs), Registered Practical Nurses (RPNs) and Nurse Practitioners (NPs) in Ontario, Canada.

•

Registered Nurses Association of Ontario was established in 1925.

•

The RNAO is the professional association representing registered nurses, nurse practitioners and nursing students in Ontario.

•

Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the healthcare system, and infuenced decisions that afect nurses and the public they serve.

•

Canadian Nurses’ Associtaion (CNA) was established in 1908.

•

CNA is a national professional voice of registered nurses in Canada. Representing nearly 139,000 registered nurses.

•

CNA’s members include: • • • • •

Provincial and territorial nursing associations and colleges Independent RNs from Ontario and Quebec Retired nurses Canadian Nursing Students’ Association Canadian Network of Nursing Specialties

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Self-Regulation Subcommittee Update The Self-Regulation subcommittee monitors healthcare and the regulatory environment for changes to scope of nursing practice and related competencies that may be integrated into professional nursing practice throughout the organization.

Priorities of the subcommittee include: •

Scope of Practice

•

Quality Assurance

•

Standards of Practice (College of Nurses of Ontario)

•

Professional Practice Scenario of the Month

MEMBERSHIP •

Cecilia Santiago, Nursing Practice Manager (Chair)

•

Art Jerome Lopez, Clinical Leader Manager, Nursing Resource Team

•

Antoinette Meinders, Clinical Nurse Educator, Informatics

•

Catherine Cary, Clinical Leader Manager, Cardiac and Vascular Surgery

•

Katey Knott, Manager, Collaborative Practice and Education (MLOA)

•

Shirley Bell, Clinical Nurse Educator, General Internal Medicine

•

Murray Krock, Director, Nursing Practice and Education

•

Wendy Legacy, Staf Nurse, Trauma Neuro Intensive Care Unit

•

Shannon Swift, Clinical Nurse Educator, Medical Surgical Intensive Care Unit

•

Marnee Wilson, Professional Practice Leader, Nurse Practitioners

Annual Membership Renewal Members of the College of Nurses of Ontario must renew their membership annually to continue practising as a nurse in Ontario. Renewing your membership involves answering questions about your employment status and areas of practice and education, and paying an annual fee. The Self-Regulation subcommittee and Nursing Practice and Education provides nursing staf with reminders to complete their annual renewal by December 31st each year.

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Nursing Advisory Council Report 2017-2018

Professional Practice Scenario of the Month Each month the Self-Regulation Subcommittee hosts an open forum for nurses and interprofessional colleagues to join the discussion on topics that have implications to professional practice and education. The monthly sessions are advertised through email, the Daily Dose and the SMH Intranet events page. To fnd the repository of the presentations, go to the SMH Intranet: SMH A - Z > N > Nursing Advisory >Self regulation subcommittee Month

2017 Topics

2018 Topics

January

Venting online: Is it okay?

Documentation Series Part 1 Contemporaneous charting: Mind the time

February

Abuse: One is one too many

Documentation Series Part 2 Refraining from Subjectivity

March

Family presence

Privacy in Your Hands: The powers and pitfalls of your Smartphone

April

When the patient is a friend/neighbour.

Now what?

Optimizing Team and Family Communication in the Practice Setting

May

Evolving nursing roles to enhance patient care

Documentation Series 3 Documentation Accountability of Nursing Preceptors and Learners

June

When Harm Reached The Patient: Discussion on Disclosure

September

Child welfare in a hospital setting: Everything you wanted to know but were afraid to ask

October

Quality Assurance (QA): Getting to know your professional neighbour

November

Procedural Pause

December

Putting Patient and Family First

The Self-Regulation Subcommittee plans to: • • • •

Continue with the monthly Professional Practice Scenario presentation at the Nursing Advisory Council using a case based format Continue to monitor regulatory changes through the College of Nurses of Ontario Help to spread reminders about College of Nurses of Ontario annual registration renewal Support quality assurance processes

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Nursing Orientation Subcommittee Update The Nursing Orientation subcommittee coordinates the development, delivery and evaluation of the corporate nursing orientation program and supports the development of cross-program mandatory and required orientation and topics.

PURPOSE •

To support orientation that is evidence based, efcient and efective

•

To identify foundational nursing information needed to support competencies and skills that newly hired nurses need to integrate into their practice to deliver safe, efective, patient care.

MEMBERSHIP •

Colleen McNamee, Corporate Nursing Education Manager (Chair)

•

Shirley Bell, Clinical Nurse Educator, General Internal Medicine

•

Meriam Jayoma-Austria, Staf Nurse, Transplant Clinic

•

Elizabeth Butorac, Program Director (Interim), Trauma Neurosurgery and Mobility

•

Murray Krock, Director, Nursing Practice and Education

•

Lee Barratt, Clinical Nurse Educator, Emergency Department

•

Mary Murphy, Program Director, Obstetrics & Gynaecology, Women’s Health Centre, Neonatal ICU, Paediatrics Clinic

•

Katherine Mansfeld, Clinical Nurse Educator, GI/General Surgery/Plastics

•

Kaleil Mitchell, Project Coordinator, Nursing Practice and Education

In 2017/2018- 169 newly hired nurses attended monthly Corporate NursingOrientation.

The overall goals of the corporate nursing orientation program are to introduce all newly hired nurses to professional nursing practice at St. Michael’s Hospital and to prepare nurses to begin their program or unit-specifc orientation. Specifc components of the corporate nursing orientation program organized through Professional Practice are: 1. Corporate Nursing Orientation (one day) 2. Centralized Nursing Education in class sessions: • Preventing Falls is SIMPLE • Prevention, Early Recognition and Management of Delirium 3. RN-to-RN Intershift Bedside Transfer of Accountability • eLearning module • Simulation 4. Centralized Inpatient Nursing Orientation (one day) 5. eLearning modules: • Best Practice Guidelines (BPG) Booster • Alternatives to the Use of Physical Restraints The corporate nursing orientation program also includes education on Soarian Clinical Documentation and CPOE/ MAK systems.

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Nursing Orientation Subcommittee Update (cont’d.)

Overall the feedback received about the one-day Corporate Nursing Orientation has been positive. Participants have highlighted the following themes: •

Feeling welcomed into the St. Michael’s nursing community

•

Learning about the resources available to nurses

•

The many opportunities for professional growth and development available to nurses at St. Michael’s Hospital

The major accomplishment of the Nursing Orientation subcommittee this past year has been leading the development and implementation of the Centralized Inpatient Nursing Orientation day. It was recognized that there was an opportunity to expand the corporate nursing orientation program to include a second skills-based learning day, focused on the knowledge and skills that are common across all inpatient units. Clinical Nurse Educators from inpatient units supported the development of this new orientation day to ensure that the topics included are relevant and grounded in both nursing and educational best practices. Additionally, Clinical Nurse Educators are supporting the co-facilitation on an ongoing basis.

Benefts of Centralized Inpatient Nursing Orientation day are: •

Standardizes the delivery of education for newly hired nurses

•

Supports the standardization of clinical practice across units

•

Fosters relationships across departments and teams that will further strengthen nursing at St. Michael’s Hospital

•

Enhanced collaboration among the Clinical Nurse Educator group

Centralized Inpatient Nursing Orientation has been ofered monthly since October 2017 and has received overall positive feedback from nurses who have attended. Specifcally, they appreciated the opportunity to learn and practice hands-on skills that they will use in their nursing practice on inpatient units. This day will continue to be ofered as part of corporate nursing orientation and the Nursing Orientation sub-committee will continue to monitor and review evaluation results, making adjustments to the content and structure of the day as needed.

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Healthy Work Environment Subcommittee Update The Nursing Healthy Work Environment (HWE) subcommittee guides the development, implementation and evaluation of strategies that support a healthy work environment for nurses and other staf. This subcommittee also promotes innovation and sharing of leading practices (e.g. RNAO Best Practice Guidelines) and enhances partnership building with both internal stakeholders and external organizations (e.g. RNAO).

Nursing HWE Sub-coommittee presentation at the Healthy Workplace Month Expo (2017)

MEMBERSHIP •

Donna Romano, Evidence Based Practice Nursing Manager (interim) (co-chair)

•

Murray Krock, Director, Nursing Practice and Education (co-chair)

•

Mary Copeland, Clinical Leader Manager, Trauma Neurosurgery Inpatient Unit

•

Mary Murphy, Program Director (Interim), Women and Children’s Health

•

Vasuki Papramalingam, Clinical Leader Manager, In Patient Mobility (interim)

•

Yvonne Davis-Read, Blood Transfusion Nurse, Diagnostic Lab - Blood Transfusion Services

•

Colleen McNamee, Corporate Nursing Education Manager

•

Dominic Gascon, Operational Readiness Specialist,

•

Vivian Iwenofu, Staf Nurse, General Internal Medicine

•

Luisa Mufo, Human Resources Consultant

•

Orla Smith, Clinical Leader Manager, Cardiovascular Intensive Care Unit

•

Anna Nassis, Staf Nurse, Labs Blood Management, Laboratory Medicine

The Nursing HWE subcommittee work continues to evolve from the Achieving Resilience in Acute Care Nurses (ARISE) study, 2017 a randomized controlled trial of a multi-component intervention for nurses in critical care and trauma. The ARISE study was conducted to evaluate the efect of a multicomponent health and wellness intervention for nurses on resilience, and other health and wellness related outcomes. Highlights of the Nursing HWE subcommittee initiatives included participating in St Michael’s Hospital (SMH) healthy workplace expo in Fall 2017. The HWE subcommittee interactive booth promoted the RNAO healthy work environment BPG’s with a focus on enhancing resiliency and invited staf to refect on what resiliency means to them (see wordle depiction on page 26).

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Healthy Work Environment Subcommittee Update (cont’d.)

In March 2018, a resiliency workshop day was held for nurses across SMH. The objectives of this workshop were to: understand the concepts of resiliency, compassion fatigue, vicarious trauma and burnout, acquire tools to recognize compassion fatigue and its efect on work and daily living; and begin to develop self-awareness and resiliency plans (personal and professional) to foster self-care. Results of the workshop were highly favorable with participants indicating that topics covered can contribute to a fostering a healthy work environment. See below graph for evaluation details.

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Nursing Week Subcommittee Update The Nursing Week Planning Committee is a working group responsible for the successful planning, development, implementation and evaluation of nursing week activities.

MEMBERSHIP: •

Murray Krock, Director, Nursing Practice and Education

•

Cecilia Santiago, Nursing Practice Manager

•

Colleen McNamee, Corporate Nursing Education Manager

•

Donna Romano, Evidence Based Practice Nursing Manager (interim) (co-chair)

•

Debbie Ashikawa, Ontario Nurses Association

•

Shirley Bell, Clinical Nurse Educator, General Internal Medicine

•

Lorraine Ciccarelli, RN, Pain Services

•

Elizabeth Datars-Shkolnik, RN, Perioperative Services

•

Karen Polansky, Clinical Nurse Specialist, Wound Care

•

Vasuki Paramalingam, Clinical Leader Manager, Inpatient Mobility

•

Marta Sliz, Administrative Coordinator, Nursing Practice and Education (co-chair)

Providence, St Joseph’s and St Micahel’s Hospital External Nursing Week ad featured in the Toronto Star, Hospital News and Metro News outlets.

Nursing Week 2018 Highlights Nursing Week was celebrated at St. Michael’s Hospital (SMH) from May 7th to May 11th, in alignment with National Nursing Week and Florence Nightingale’s birthday. The 2018 Canadian Nurses Association (CNA) national nursing week theme was #YESThisIsNursing. This theme speaks to expanding traditional and non-traditional roles, settings and sectors nurses work in. The theme also shows opportunities for the nursing profession presented by social media and emerging tech trends. This year included a special announcement of a 1.14 million dollar gift from the Syron family that will establish a new education program for nurses.

The Nursing Week Planning subcommittee of the Nursing Advisory Council (NAC) hosted a number of popular events and activities, including the Nursing Week Night Shift Breakfast and Kickof Celebration, Best Practice Guideline (BPG) Sustainability Poster Gallery Walk, Nursing Art Showcase. A joint nursing/speech language pathology Lunch & Learn, Oral Care Matters: Practical skills in oral care to improve patient health and safety, closed the nursing week events. Based on the feedback from past post Nursing Week evaluations, the focus of the 2018 Nursing Week events and topics were related to health and wellness.

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Nursing Week Night Shift Breakfast Nurses at the breakfast enjoyed the musical talents of pianist Don Naduriak, a St. Michael’s volunteer and a former patient.

Don provided opening remarks, thanking the nurses for the wonderful nursing care he received as a patient, which he described as ‘compassionate,’ and ‘caring’.

Don Naduriak, St Michael’s Hospital Volunteer

Nursing Week Night Shift Breakfast Attendees

Donna Romano, Evidence Based Practice Nursing Manager (interim); Sonya Canzian, VP, Clinical Programs, Chief Nursing and Health Disciplines Executive ; Murray Krock, Director, Nursing Practice and Education

Sonya Canzian, VP, Clinical Programs, Chief Nursing and Health Disciplines Executive and Nursing Week Planning subcommittee co-chairsDonna Romano, Evidence Based Practice Nursing Manager (interim) & Marta Sliz, Adminsitrative Coordinator

Nursing Week Night Shift Breakfast Attendees

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Nursing Week Kickof Event

Special Nursing Week Announcement - Syron Nursing Excellence Program This year’s Nursing Week started of with an exciting announcment. Two long-time supporters of St. Michael’s Hospital, Bernie and Mildred Syron, contributed a 1.14 million dollar gift that will establish a new education and recognition program. The Bernie and Mildred Syron Nursing Excellence Program will address key nursing priorities to support and recognize nurses: nursing recognition, professional development and education, cross-training and skill building. This will help support over 160 nurses on an annual basis to pursue graduate studies, have an opportunity to job shadow or enroll in professional development opportunities.

Bernie Syron and Mildred Syron, Donors

Bernie Syron and Mildred Syron, Donors, at the Nursing Week Kick Of -Special Announcement

Tim Rutledge, CEO, St Michael’s Hospital/St. Joseph’s Hospital/ Providence Hospital; Bernie Syron and Mildred Syron, Donors; Sonya Canzian, VP, Clinical Programs, Chief Nursing and Health Disciplines Executive

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Nursing Advisory Council Report 2017-2018

Elizabeth Butorac, Program Director, Trauma Neuro and Mobility; Mildred Syron, Donor; Gunesh Ramdehalchand, RN, Inpatient Mobility; Bernie Syron, Donor; Vasuki Paralingham, CLM, Inpatient Mobility (Interim); Wen-Ya (Lory) Lee, Clinical Nurse Educator, Inpatient Mobility

Nursing Week Kickof Event Keynote Address: Reflling the Well: What works to reducecompassion fatigue and burnout in health care environments?

Françoise Mathieu, M.Ed., RP., CCC. Compassion Fatigue Specialist, Co-Executive Director, TEND Françoise is a Registered Psychotherapist and a compassion fatigue specialist. Her experience stems from over 20+ years as a mental health professional, working as a crisis counsellor and trauma specialist in university counselling, military, law enforcement and other community mental health environments. Françoise is co-executive director of TEND, whose aim is to ofer consulting and training, helping professionals on topics related to secondary trauma, compassion fatigue, burnout, self-care, wellness and organizational health. Since 2001, Françoise has given hundreds of seminars on compassion fatigue and secondary trauma across North America to thousands helping professionals in the felds of health care, child welfare, the criminal justice system and to other similar high-stress, trauma-exposed professions.

She is one of the founding members of the Secondary Traumatic Stress Consortium. Françoise is the author of “The Compassion Fatigue Workbook” which was published by Routledge in 2012 as well as several articles and publications.

In her keynote address, Françoise highlighted the concept of compassion fatigue which refers to the profound emotional and physical exhaustion that all of us can develop over time while working in health care environments: complex cases, large volume of work, chronicity, the wear and tear of the job, challenging patients and colleagues - all of which can contribute to developing compassion fatigue. There are over two decades of research proving that working in high stress, trauma-exposed professions such as health care carries elements of risk to the care provider: compassion fatigue, secondary trauma and burnout which can take a cumulative toll on us as individuals and as teams. During her presentation, Françoise highlighted what health care professionals can do to remain efective and compassionate in today’s health care environment.

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Nursing Week Best Practice Guidelines Sustainability Poster Gallery Walk This annual Nursing Week event recognizes and celebrates all the nurses and teams who have led and mentored RNAO BestPractice Guideline (BPG) initiatives in the past year.

This year we celebrated St. Michael’s sixth year as a designated Registered Nurses’ Association of Ontario (RNAO) Best Practice Spotlight Organization (BPSO) and the implementation of 35 BPGs since 2009. We also celebrated and recognized the many nurses and teams who were instrumental in implementing 30 BPG quality improvement initiatives across 21 diferent clinical areas from October 2017 to March 2018. These initiatives were led by 45 BPG Nurse Champions and supported by 24 BPG Unit Mentors and 4 Mentors in Professional Practice. Champions and mentors were also recognized during a pinning ceremony at the event.

The 2018 Piera Cardella Scholarship nomination recipient was the Respirology team for their work entitled: Standardizing Advanced Care Planning Assessment with Cystic Fibrosis Patients. The late Piera Cardella was a nurse at St Michael’s who was dedicated to the needs of all those who were in her care. BPG Nurse Champions from Respirology Jessie Chiu, RN, and Erin Abigail Cuaresma, RN, provided unit leadership for this important quality improvement. Their mentorship was provided by Donna Romano, Evidence Base Practice Manager (interim), Sarah Sweetman, unit mentor and Wendy Cheuk, Clinical Leader Manager, Respirology.

Joining in the celebration was Heather McConnell, RN, BScN, MA(Ed) from the RNAO. Heather is the Associate Director Guideline Implementation and Knowledge Transfer at the RNAO. In this role, Heather leads a multi-faceted implementation program to support the uptake of evidence in practice. Heather is a senior member of the Nursing Best Practice Research Centre (NBPRC), and an active member of the Executive Committee.

BPG Mentor Pin

Cardella Scholarship Award Nominees 2018 from Respirology Inpatient Unit: Jessie Chiu; Erin Abigail Cuersma (2nd and 3rd from the left)

Heather McConnell, Associate Director - Guideline Implementation and Knowledge Transfer, Registered Nurses’ Association of Ontario (RNAO) (left) with nursing staf and leadership at St. Michael’s Hospital Nursing Week BPG Gallery Walk 2018 32 |

Nursing Advisory Council Report 2017-2018

Nursing Week Best Practice Guidelines Sustainability Poster Gallery Walk Nursing Week Greetings from Heather McConnell, Associate Director - Guideline Implementation and Knowledge Transfer, Registered Nurses’ Association of Ontario (RNAO) It is my great privilege and pleasure to be with you here today, bringing greetings from the Registered Nurses’ Association of Ontario, and special greetings from our new Board President, Dr. Angela Cooper-Braitwaite, and our Chef Executive Ofcer, Dr. Doris Grinspun. This event, your annual BPG Sustainability Poster Gallery Walk, is one of the highlights of Nursing Week for those of us at RNAO, and I have some colleagues with me here today who have joined me to share in the celebration of your successes.

When the idea of creating a program of nursing best practices frst came about 20 years ago, no one at the Registered Nurses’ Association of Ontario imagined that the program would be where it is today. From the frst four guidelines published in 2002, the program has grown into 54 best practice guidelines, and I do need to acknowledge that St. Mike’s has implemented 33 of them which, by the way, is the record!

We’ve long known that members of the public consider nurses as the most trusted of health-care professionals. They’re regarded for the compassionate care that they provide. However, the BPG program also provides clients and their families with the unique opportunity to learn more about the knowledge and skills that we, as nurses, bring to our work.

Heather McConnell

I have had the privilege to be involved in the Best Practice Spotlight Organization program since its inception in 2003 and have watched its evolution and spread across the province, nationally and internationally. The program was established as an organizational level implementation strategy to support the uptake of the clinical guidelines RNAO had just started to publish. We had already started to address capacity development related to evidence-based practice at the individual level with our Best Practice Champions Network, which was established in 2002, and we recognized the need to also target our eforts at the organizational level, where nurses were attempting to introduce practice changes. It was also around this time we initiated the development of healthy work environment best practice guidelines, to create work environments that would be responsive to change. The BPSOs were initially conceptualized as “living labs”, where we could collectively learn from and with each other how to efectively implement and sustain practice change in complex health care organizations across the continuum of care.

As a Best Practice Spotlight Organization since 2009, and a designated BPSO since 2012, St Michael’s has helped build and expand this program of clinical excellence. We are so proud that nurses working in a variety of roles are actively engaged in implementation and sustainability projects, and this Gallery Walk today is a unique expression and celebration of your achievements. In addition to improving patient outcomes, these nurse-led projects empower and energize nurses, transform nursing practice, raise the profle of nurses as knowledge professionals and have helped St. Mike’s to meet its strategic directions. I do want to acknowledge, that although we are celebrating Nursing Week, this work has engaged the interprofessional team across all disciplines, and we continue to look for ways to engage all health professionals in this nurse-led program through guideline development, as best practice champions, by leading or participating on BPG implementation teams and supporting evaluation and sustainability. Together, we have much to contribute.

As I have been involved in BPSO work for many years, I have had the opportunity to follow St. Michael’s evolution into a mature, well established BPSO Designate. Your willingness to share the expertise and skill you have developed in creating an evidence-based practice culture is highly valued and greatly appreciated. St. Mike’s has, over the years, participated as faculty in our annual Clinical BPG Institute, has been actively engaged in Knowledge Exchange calls and events, has documented the team’s work in progress reports and has been most willing to share successes and challenges with others, so that they can learn from your experiences. You have graciously hosted visitors from our international BPSOs, and have provided them with insights into how you have integrated best practices into the fabric of your organization.

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Recently, to celebrate 20 years of the BPG Program, RNAO published a book entitled Transforming Nursing Through Knowledge. Best Practices for Guideline Development, Implementation Science, and Evaluation. This publication has been something we have wanted to accomplish for a very long time, to document the growth and spread of the program.

We were extremely proud that St. Michael’s contributed to this publication through a case study and is profled, along with other BPSOs, in the chapter Creating Evidence-Based Cultures Across the Health Continuum. We’d like to thank Sonya Canzian for her contributions and refections on the strategies St. Michael’s has utilized to imbed evidence-based practices into your organizational culture and daily work. The case study includes discussion of aligning BPSO objectives with St. Mike’s strategic priorities, evolving governance structures, communicating updates and sharing achievements, evaluating impact, spreading and sustaining BPGs and leveraging external funding and partnership opportunities. Not surprisingly, a key strategy discussed in the case study related to communication and dissemination of BPSO work and implementation of BPGs is the role of BPG Nurse Champions, and the annual Poster Gallery Walk.

The degree of infuence and respect your BPSO work has generated is something you can certainly take great pride in and boast about during Nursing Week. St Michael’s Hospital belongs to an elite group of health and academic organizations across the province, the country and abroad. The common thread you share is the desire to prepare nurses and others with best practices, apply them to everyday practice, and have a positive impact on outcomes for clients, providers, the organization and the system. There is no doubt that you are helping to make our health-care system more efective, efcient and responsive.

I’d like to congratulation all the champions and mentors that are being recognized here today for the work you have done, and I am truly looking forward to participating in the Gallery Walk, and learning more about the outcomes you have achieved. By applying the best knowledge and evidence, nurses and other health-care professionals are ensuring the care they provide for patients at St. Michael’s is the very best.

And for that, our sincere thanks.

Donna Romano, Evidence Based Practice Nursing Manager (Interim); Heather McConnell, Associate Director - Guideline Implementation and Knowledge Transfer, Registered Nurses’ Association of Ontario (RNAO) ; Murray Krock, Director, Nursing Practice and Education

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Nursing Week Talent Showcase The Nursing Talent Showcase (formerly called Art Showcase) event profled St. Michael’s nurses’ artistic talents and promoted nurses’ health and wellbeing through creative arts. The fourth annual showcase featured a variety of artistic talents including paintings, miniature garden feature, poetry, song, children’s book author, handcrafted lotions, knits and greeting cards. Keeping with the theme of resiliency, there was also a collage feature where participants were invited to share self-care strategies.

Aestus Rogers, RN , Perioperative Services Knitting

Kathleen McGuire, RN , MSICU Painting

Chris Carless, RN, Cardiology Painting

Kathryn Hanson, RN, Inpatient Mobility Singing

Maureen Leslie, RN, TNICU Poetry

Cecilia Santiago, Nursing Practice Manager Creative Gardening

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Nursing Week Talent Showcase (cont’d.)

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Colleen McNamee, Corporate Nursing Education Manager Poetry

Tak Yin Debby Law, RN, Cardiac Cath Lab Organic beauty products

Katelyn Greenough, RN, Mental Health Services Painting

Alyse Ediger, RN, Nursing Resource Team Author

Elizabeth Datars-Sholnik, RN, Pre-Admission Knitting

Siyuan (Emmi) Wang, RN, Specialty Clinics Multimedia

Jean Bayani, RN, Pre-Admission Facility Card Art

Donna Romano, Evidenced Based Practice Nursing Practice (Interim) Resiliency Strategies

Nursing Advisory Council Report 2017-2018

2018 Nursing Excellence Awards, Scholarship and Fellowship Recipients St. Michael’s eleventh annual nursing recognition event during national Nursing Week, celebrated nurses for their contribution to excellence in patient care, quality, education and research. The Nursing Week Planning subcommittee received forty fve (45) Nursing Excellence Award nominations from nurses, physicians, managers, health discipline colleagues and support staf, representing the many diverse nursing roles at St. Michael’s Hospital, including frontline nurses, clinical leader/managers, program directors, nurse practitioners, clinical nurse educators and clinical nurse specialists. Recipients of the Syron Graduate Nursing Fellowship, the Chuckie Shevlen Scholarship, Theresa Ann Ford awards, and the Mehramat and Satwant Gill Nursing Scholarship were also recognized during the ceremony.

Nursing Excellence Award Recipients

Parthenia Maria Wilson Culture of Caring award RecipientCarolyn Hamil, Inner City Health Program

Culture of Discovery Award Recipient Karen Carlyle, Nurse Practitioner, Neonatal Intensive Care Unit

Healthy Work Environment Award Recipient Magetta Vincent, RN, General Internal Medicine

Innovation in Nursing Recipient Denis Aleynikov, RN, Inpatient Mobility

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2018 Nursing Excellence Awards, Scholarship and Fellowship Recipients

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Elizabeth Crawford Clinical Scholarship Award Recipient Daniel Bois, RN, Family Health Team

Chuckie Shevlen Scholarship Recipient Rebecca Blaguski, RN, Trauma Neuro Inpatient

Parthenia Maria Wilson Nursing Education Grant Recipient Gabriel Lee, RN, Family Health Team

The Mehramat and Satwant Gill Nursing Scholarship Recipients Julie Seemangal, Nurse Practitioner- Adult, Tuberculosis Program, Specialized Complex Care Program and Kari Fulton, Nurse Practitioner-Primary Health, Family Health Team

Nursing Advisory Council Report 2017-2018

2018 Nursing Excellence Awards, Scholarship and Fellowship Recipients -Theresa Ann Ford Awards

Theresa Ann Ford Preceptorship Award (Nurse Practitioner Student) Recipient Michael Postic, Nurse Practitioner, Emergency, Inner City Health

Theresa Ann Ford Annual Clinical Nurse Educator Award Recipient Shirley Bell, Clinical Nurse Educator, General Internal Medicine

Theresa Ann Ford Preceptorship Award (Newly Hired Nurse) Recipient: Heather Rawnsley, RN, Acute Mental Health

Theresa Ann Ford Preceptorship Award (Undergraduate Student) Recipient Reth Bun, RN, General Internal Medicine

Family and Friends of the Theresa Ann Ford Award Aldith Whorms, SMH Alumni, Class of 1955 ; Mary Jane Kachowski (cousin of Theresa Ann Ford); Ann Greenaway, SMH Alumni, Class of 1955

Theresa Ann Ford Preceptorship award (Graduate Nurse) recipient: Joanne Bennett, CLM, Gen Surg/GI/Plastics

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2018 Syron Graduate Education Fellowship Recipients

2018 Syron Graduate Education Fellowship recipients photographed with donors, Bernie and Mildred Syron and Sonya Canzian, VP Clinical Programs, Chief Nursing & Health Disciplines Executive.

List of 2018 Syron Graduate Eduaction Fellowship Recipients (in alphabetical order) 1.

Abelardino Manabat, RN,Medical Surgical Intensive Care Unit

2.

Falillat Bukky Karatu, RN, Perioperative Services

3.

Gabriel Lee, RN, Family Care Team

4.

Julie Arsenault, RN, Trauma &Neurosurgery ICU

5.

Kristen McMillan, RN, Trauma &Neurosurgery ICU

6.

Lee Barratt , RN, Emergency Department

7.

Manry Xu, RN, Cardiac and Vascular Surgery

8.

Maria Fernanda Becerra Gomez, RN, Inpatient Mobility

9.

Michelle Gabriel, RN, Renal Transplant

10. Mishka White, RN, Operating Room 11. Monica Mina, RN, Trauma Neurosurgery 12. Rebecca Blaguski, RN, Trauma Neurosurgery 13. Samantha Scime , RN, Medical Day Care Unit 14. Sarah Beneteau, RN, Mental Health Services 15. Shannon Swift , RN, Medical Surgical Intensive Care Unit 16. Tak Yin Debby Law, RN, Cardiac Cath Lab 17. Tara Raine, RN, Quality Improvement 18. Vanessa Rozario-Roy , RN, Trauma &Neurosurgery ICU 19. Yuriy Ilyin, RN, Psychiatry

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Remembering William (Bill) Daniel, Donor Bill Daniel, served as Chairman of the Board of the Wellesley Hospital and as a member of the Governors’ Council of St. Michael’s Foundation. He established the Ruth Daniel Graduate Nursing Fellowship (2013-2017) to help support St. Michael’s nurses pursuing graduate nursing education in honour of his late wife, Ruth Daniel who graduated from the Wellesley Hospital’s School of Nursing.

Bill passed peacefully on December 5, 2017 at his Toronto home. The St. Michael’s Hospital nusring community is appreciative of Bill’s friendship and generosity over the years and also for the Ruth Daniel Graduate Nursing Fellowship.

Bill Daniel being honoured at the May 2016 Nursing Awards Ceremony, for his support of nursing through the establishment of the Ruth Daniel Graduate Nursing Fellowship

Bill Daniel with the 2017 Ruth Daniel Graduate Nursing Fellowship recipients at the May 2017 Nursing Awards Ceremony.

Also present: David Daniel, Sonya Canzian, Vice President Clinical Programs, Chief Nursing and Health Disciplines Executive

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THEN

St Michael’s Hospital frst ambulance, 1892

Sister Vincenza photographed in the Obstetrics Unit, where she was a supervisor from 1928-1956

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Nursing Advisory Council Report 2017-2018

NOW

A Toronto emergency medical service ambulance at St Michael’s Hospital Emergency Department, 2012

Modern Incubation Unit in the Obstetrics and Gynaecology Unit, 2018

My Nursing Intranet Page: A Nursing Advisory Council Accomplishment The 2013 St. Michael’s Hospital Staf Engagement Survey results indicated that nursing staf felt that not enough information reaches their area of work. In 2012/13 the Nursing Advisory Council intranet page was created. The information was relevant to Nursing Advisory Council members and also resonated with their staf nurse colleagues. A Nursing intranet working group was established in 2014 with representation from Nursing Advisory Council, Communications, Professional Practice and clerical staf. A newly revised intranet section called My Nursing was launched during Nursing Week 2015 and is a one stop shop for corporate nursing related information. The page continues to be updated with valuable nursing information.

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Program Presentations Each month, Nursing Advisory Council members are invited to develop and present a brief presentation on their clinical areas. This introduces NAC members to nursing care, roles and/or activities performed in other clinical areas.

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Date

2017 Presenters

2018 Presenters

January

Nurse Practitioners Jenny Pak, Nurse Practitioner-Adult Trauma & Neuro Surgery/ Marnee Wilson, Professional Practice Leader, Nurse Practitioners

Specialized Complex Care Criselda Diaz Gonzales, Staf Nurse, 2 Donnelly Inpatient Unit

February

Leadership Needs Presentation- Achieves Results Mary Quinn, Manager Leadership & Organizational Development

I am Wellness Certifcate Shivalee Paliwal, Performance and Wellness Consultant

March

Family Health Team Gabriel Lee, Staf Nurse, Family Health Team

Inner City Health Vivian Iwenofu, Staf Nurse, 1 CC

April

Leadership Needs Presentation-Systems Tramnsformation (systems thinking) Mary Quinn, Manager Leadership & Organizational Development

Trauma Neuro and Mobility Program Lidia Yamane, Staf Nurse, TNICU

May

Diabetes Comprehensive Care Program, Nephrology/Urology Inpatient Elizangela DoRosario, Staf Nurse, Hemodialysis Unit Sandra Centeno, Staf Nurse, Haemodialysis Unit

Heart and Vascular Surgery Nesa Vijayaratnam, Staf, Cardiac and Vascular Surgery

June

Leadership Needs Presentation-Engages Others Mary Quinn, Manager Leadership & Organizational Development

September

Critical Care Response Team (CCRT) Karen Wannamaker, Clinical Leader Manager, MSICU

October

Specialized Complex Care Program Irene Pryshlak, Staf Nurse, Specialty Clinics

November

Nurses and Professional Liability Insurance Murray Krock, Director, Nursing Practice & Education Stephanie Munger-Ferrara, Staf Nurse, Outpatient Mobility, NAC Co-chairs

December

Refections on Resiliency Donna Romano, Evidence Based Practice Nursing Manager (Interim)

Nursing Advisory Council Report 2017-2018

Nurses Serving at Home and Abroad

Nurses on the ward of St Michael’s Hospital, pre 1950

First contingent of St. Michael’s nurses to serve overseas during WWI, 1915

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Nursing Practice and Education Corporate Initiatives and Collaboration Professional Development Support Nursing Excellence Grant The St. Michael’s Nursing Excellence Grant reports through the Executive Vice President, Programs, Chief Nursing Executive and Chief Health Disciplines Executive and fosters an environment of professional growth and academic achievement of nurses. The grant provides fnancial support for oral/poster presentations at national and international conferences and provides fnancial support for University visiting lectures by nurses both nationally and internationally.

Nursing Excellence Grant Recipients 2017/18 Unit/ Area

Conference Name

Location

Presentation title

Clinical Leader Manager

Women’s Health

American Association of Ambulatory Care Nurses (AAACN)

New Orleans, Louisiana

St Michael’s International Education Experience: The Qatar Journey

Bertha Hughes

Nurse Practitioner

Cardiac and Vascular Surgery

Society for Vascular Nursing Conference

Nashville, Tennesse TeTennessee Tennessee

End Stage Peripheral Artery Disease (PAD): The Challenges and the Opportunities

Cecilia Santiago

Nursing Practice Manager

Professional Practice

Nursing Leadership Network

Toronto, Ontario

Developing the Constant Care Guidelines for an Academic Health Science Network

4

Colleen McNamee

Corporate Nursing Education Manager

Professional Practice

Nursing Leadership Network

Toronto, Ontario

The Power of Simulation in Enhancing the Sustainability of RN-to-RN Intershift Bedside Transfer of Accountability

5

Danijela Ninkovic

Staf Nurse

Mental Health Services Urgent Care

6th European Conference on Mental Health

Berlin, Germany

URGENT CARE PROGRAM: Minding the gap in ambulatory care

Staf Nurse

Cardiac and Vascular

Annual CSVN Vascular Nursing Conference

Calgary, Alberta

My experience as a Research Assistant in a Vascular Research Project and the impact we made

Recipient

1

2

3

6

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Anna DeMarchi

Emily Kennedy

Title

Nursing Advisory Council Report 2017-2018

Nursing Excellence Grant 2017/18 Recipients (cont’d.)

Recipient

7

8

9

10

Galo Meliton

Jennifer Rogers

Mary Mustard

Melissa Guiyab

11

Nicole Kirwan

12

Prafulla Savedra

13

Samantha Scime

Title

Unit/ Area

Conference Name

Location

Presentation title

Staf Nurse,

Renal Transplant Program

International Transplant Society

Buena Vista, Florida

ABO-incompatible kidney transplantation using ABO Immunadsorption Column: A single center

Mental Health Services

American Psychiatric Nurses Association

Phoenix, Arizona

Promoting Safety: Using a Violence Risk Assessment Tool and Policy to Guide Care Planning to Prevent the Use of Restraints and Increase Staf Safety.

CVICU

Canadian Cardiovascular Congress Cardiovascular Congress

Vancouver, British Columbia

Every patient must have a destination: Transitioning care within the intensive care unit

MSICU

Critical Care Canada FORUM Psychiatric Nurses Association Conference

Toronto, Ontario

Implementation of an Interprofessional Early Mobility Protocol in Multiple ICUs in an Academic Health Sciences Centre.

American Psychiatric Nurses Association Conference

Phoenix, Arizona

Nurturing Compassion Energy In TraumaExposed Environments and Building Resilient Psychiatric Mental Health Nursing Teams: Creating A Culture Of Wellness In Organizations

Dynamics of Critical Care Conference

Toronto, Ontario

Transfer of Accountability between the Emergency Department (ED) and the Intensive Care Unit (ICU)

29th Annual CANO conference, “The Path to Change: Oncology Nurses Leading the Way”

Gatineau, Quebec

Patient Education in Oncology Care: A Quality Improvement Project

Team Leader

Nurse Practitioner

Clinical Nurse Specialist,

Clinical Leader Manager

Mental Health Services

Resource Nurse

MSICU

Staf Nurse,

Oncology/ Hematology/ HIV

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Nursing Excellence Grant 2017/18 Recipients (cont’d.)

Recipient

14

15

16

17

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Stephanie Voong

Sue Hranilovic

Suzanne Ezekiel

Vasuki Paramalingham

Title

Staf Nurse

Nurse Practitioner

Unit/ Area

Conference Name

Location

Presentation title

Cardiac and Vascular Surgery

Canadian Society of Vascular Nursing 17th Annual Conference

Calgary, Alberta

The Challenges of Peripheral Arterial Disease Management in Women.

Family Health Team

Canadian Professional Association of Transgender Health

Vancouver, British Columbia

Identifying Cancer Screening Rates in Trans and Gender Non-Binary Primary Care Patients

Toronto, Ontario

A Framework for reducing Alternate Level of Care (ALC) designation in elderly patients with hip fractures.

Toronto, Ontario

Improving Quality and Safety in the ICU through the Introduction of A Procedural Checklist and Pause.

Staf Nurse

Interim CLM

TNICU

GTA- Best Practice Day

Inpatient Mobility

Dynamics of Critical Care Conference 2017

Nursing Advisory Council Report 2017-2018

Nursing Practice and Education Corporate Initiatives and Collaboration Quality Improvement Initiatives Best Practice Spotlight Organization Sustainability St. Michael’s launched its three-year Best Practice Spotlight Organization (BPSO) candidacy with the Registered Nurses’ Association of Ontario (RNAO) in 2009. The BPSO designation was achieved in Spring 2012 after successfully implementing and evaluating 17 Best Practice Guidelines (BPGs). Since then, a total of 33 BPGs have been implemented. Nursing Practice and Education continues to work with local teams (e.g., CLMs, BPG Nurse Champions, Mentors) to support BPG implementation, evaluation and sustainability activities at corporate and local level.

2017/18 Best Practice Sustainability Communities of Practice In 2017/2018 Nursing Practice and Education supported BPG implementation, evaluation and sustainability activities across the organization by: •

Ofering 4-hour monthly BPG Communities of Practice (CoPs) from October 2017 to March 2018

•

Supporting 45 RN BPG Champions to implement 25 BPG initiatives across 21 clinical care areas

•

Assigning a mentor from Nursing Professional Practice to each BPG Nurse Champion in addition to their local unit Mentors to provide one on one coaching throughout the course of implementing their BPG initiatives

A focus of this year’s BPG initiatives was on the standardization of transfer of accountability (TOA) at diferent patient transfer points across clinical areas, based on recommendations from the RNAO BPG entitled ‘Care Transitions’. There were also multiple BPG initiatives that focused on the sustainability and spread of Healthy Work Environment BPGs’ that included: ‘Developing and Sustaining Interprofessional Health care: Optimizing patients/clients, organizational and system Outcomes’, ‘Preventing and Mitigating Nurse Fatigue in Health Care’, and Workplace Health, Safety and Well-Being of the Nurse.

Transforming Nursing Through Knowledge St Michael’s Hospital is delighted to be featured in a chapter of the newly released book, Transforming Nursing Through Knowledge : Best Practices for Guideline Development, Implementation Science, and Evaluation. The book coauthored by RNAO’s Chief Executive Ofcer Doris Grinspun and former Director of the International Afairs and Best Practice Guidelines Centre director, Irmajean Bajnok, tells the stpry of the assoication’s best practice guidelines (BPG) program from its inception in 1998 to the growth and reach the program enjoys today. The book shows how BPGs are developed, implemented and evaluated. It also provided readers with a behind-thescenes look at how nurses executives, health-care organizations, and professionals create evidence-based cultures. St.Michael’s is featured in a case study in the chapter, Creating Evidence Based Cultures Across the Health Continuum.

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Preventing Falls is SIMPLE Program The ‘Preventing Falls is SIMPLE’ program was implemented across all medical/surgical inpatient care units in 2012. This program is an interprofessional collaborative approach to falls prevention based on best practices.

Components of the ‘Preventing Falls is SIMPLE’ program are : •

Screening for fall risk: Fall Risk Assessment tool

•

Implementing fall risk care plan: SIMPLE Interventions tool

•

Patient and family education

•

Communication of fall risk within the health care team

•

Learning from a fall event: Post-fall DEBRIEF

Falls Prevention has been a corporate quality priority since 2013.

Following an extensive evaluation of the program in 2014, led by Professional Practice, the Falls Steering Committee was established in 2015. The Falls Steering Committee is an interprofessional collaborative committee responsible for providing ongoing monitoring and recommendations for quality improvement on the Preventing Falls is SIMPLE Program, a standardized, best practice program related to falls prevention and falls injury prevention at St. Michael’s Hospital.

It is co-chaired by the Directors of Nursing Practice and Education and Health Disciplines Practice and Education.

Membership includes: Quality, Nursing, Health Disciplines, Pharmacy with consultation from Clinical Informatics and Decision Support.

The major undertaking of the Falls Steering Committee this past year was the development of guidelines, documentation and education for using falls risk mitigation tools (bed-exit alarms and low beds). The committee undertook a literature review, external scan and focus groups with frontline staf on General Internal Medicine, General Surgery/GI/Plastics, and Inpatient Mobility. Results informed the development of decision-making tools, which were based on the following foundational principles: •

Bed-Exit Alarms and Low Beds can be useful components of a multifaceted falls prevention program

•

Bed-Exit Alarms and Low Beds should not be relied upon as sole strategies for falls prevention

•

Guidelines will help clinicians determine when Bed-Exit Alarms and/or Low Beds may be helpful, but do not replace good clinical judgment

The components that were developed to support the integration of bed-exit alarms and low beds into the Preventing Falls is SIMPLE program are: •

Decision-Making Guidelines for Use of Fall Risk Mitigation Tools

•

Updated signage to communicate use of bed-exit alarms among the collaborative care team

•

Changes to existing Soarian forms to support documentation of when bed-exit alarms and/or low beds are used as part of a patient’s fall risk care plan

All components described above were validated by frontline staf, and then further refned, before broad stakeholder engagement across the organization and fnal endorsement and approval at Falls Steering Committee in August 2017 and Quality Improvement Council in September 2017. An education session was developed and rolled out across inpatient units, using a train the trainer approach with Clinical Nurse Educators supporting the education roll out in their respective units. The decision-making guidelines, updated signage and revised documentation tools were launched live in September/October 2017.

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Preventing Falls is SIMPLE Program (cont’d.)

This past year, the Falls Steering Committee also: •

Began work to develop corporate intentional rounding guidelines, based on the successful implementation of intentional rounding on General Surgry/GI/Plastics, General Internal Medicine and Trauma/Neurosurgery Inpatient, among others

•

Improved the data collection methodology for reporting compliance rates with fall risk assessment and SIMPLE tool documentation

•

Hosted a Registered Nurses Association of Ontario (RNAO) webinar on revisions to the Preventing Falls and Reducing Injury from Falls (4th edition) Best Practice Guideline and reviewed our existing falls prevention policy in light of the revisions. The Preventing Falls is SIMPLE program remains aligned with current best practice as described in this updated BPG.

Flyer from Registered Nurses Association of Ontario (RNAO) webinar on revisions to the Preventing Falls and Reducing Injury from Falls (4th edition) Best Practice Guideline.

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Managing Responsive Behaviors Elements of the Program 1.

Four-hour workshop “Caring for Persons with Responsive Behaviours” designed to increase the knowledge, self-efcacy, and interprofessional collaboration of frontline clinicians in managing responsive behaviours.

2.

Implementation of best practice tools including: the use of collaborative care plans; “My Story” to promote collection of personhood information; use of a decision making algorithm to promote consistency in care approaches.

3.

Guidelines for person centred language to promote a common language used in documentation and face to face communication.

Education The four-hour workshop, which took place on General Internal Medicine (14CC), Trauma/Neurosurgery (9CC) and Cardiovascular Surgery (7CCN) between 2015 and 2017, was delivered to nursing, health disciplines, clinical assistants and clerical staf across the three units. Professional Practice partnered with champions (point of care and leaders) from each unit to meaningfully adapt the education and tools to meet the specifc learning needs of each team. This work also supported capacity building in facilitation among staf on the three units. Thirty six (36) workshops were conducted and four hundred and seventy nie (479) team members from the three (3) units attended.

The focus for 2017/18 has been integrating some of the components of the Managing Responsive Behaviours (MRB) education into the Constant Care education and rollout to all inpatient units. This has enabled the spread of person centred principles that were foundational to the MRB program including the integration of person centered language in documentation processes and emphasis of non-pharmacological interventions to minimize responsive behaviours.

Research The MRB Research Group was one of the fve recipients of the inaugural Interprofessional Practice Based Research grant in August 2015. The mixed method study is evaluating the impact of managing responsive behaviours education workshop on staf knowledge, confdence, and the use of patient care plans.

The group is hoping to publish the study by end of 2018 or early 2019.

Managing Responsive Behaviour (MRB) working group co- chairs Cecilia Santiago, Nursing Practice Manager and Lori Whelan, Leadership and Development Consultant showcasing the framework of the MRB program.

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Nursing Advisory Council Report 2017-2018

Constant Care Program The Toronto Academic Health Science Network (TAHSN) Senior Friendly Community of Practice (SF CoP) formed the Constant Care (CC) Working Group to develop guidelines to support decision-making processes of leaders and clinicians and to bring more consistency to the use of constant care among the TAHSN organizations. The TAHSN CC guideline was approved in June 2016, and the SF CoP developed a comprehensive knowledge to practice strategy for its dissemination.

The SMH CC Working Group, with representation from Professional Practice, Clinical Nurse Educators, Clinical Leader Managers (CLM), Clinical Informatics and point of care nursing and health disciplines staf, was formed in December 2016 with the mandate to tailor the TAHSN guidelines to local use. The Nursing Practice Manager co-chairs both the TAHSN and SMH working groups. Leveraging on the TAHSN work, the SMH CC Working Group has worked hard over the 2017/18 year to develop the CC program.

Elements of the Program 1.

Decision-making algorithm to guide teams in making point-of-care decisions re: risk assessment, initiating, weaning, discontinuing and documentation of CC

2.

Documentation tools, inclusive of the Behaviour Tracking Log and the electronic clinical documentation form, to track patient assessment, behaviours and care provided in support of clinical decision-making

Cecilia Santiago, Nursing Practice Manager and Shirley Bell, Clinical Nurse Educator on General Internal Medicine reviewing the Constant Care Decision Making Algorithm

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Constant Care Program (cont’d.)

Education

Snapshot of the Constant Care elarning module, available through the LMS

An education program to support the roll out of the Constant Care program was developed, inclusive of the following major topic areas: •

Constant Care Decision-making algorithm and documentation tools

•

Patient-centered language taxonomy, aligned with the MRB work

•

Roles and responsibilities of collaborative care team members (including CC Provider, RN, Physician, NP, Health Disciplines, and CLM)

•

Strategies for preventing and managing responsive and other behaviours, and for engaging patients on constant care

The education program used a blended learning approach comprised of an eLearning module that introduced general concepts and a face-to-face session that allowed team members to apply the material from the eLearning module to a case scenario that was specifc to their patient population and clinical area. All interprofessional staf across all inpatient units were expected to complete the CC education program. Nursing Professional Practice and Education supported a total of sixteen (16) frontline nurse champions from each inpatient unit to participate in the implementation of the program in their local clinical area.

A full-day train the trainer was held in February 2018 for Clinical Nurse Educators and nurse champions. This day reviewed the CC Education program in detail and provided them with an opportunity to learn best practices in education, facilitation, and being a clinical champion. Overall, there was very positive feedback on the train the trainer, with nearly 94% of participants indicating they strongly agree or agree that they experienced a substantial increase in their knowledge by attending the education session.

Following their participation in the train the trainer, Clinical Nurse Educators and nurse champions facilitated the education at the unit level and supported the roll out of the CC tools and processes within their teams. The documentation tools were launched live on April 2, 2018.

Evaluation The SMH CC Working Group plans to evaluate the impact of the program on CC utilization and quality measures. Currently, the group is identifying the measures that are meaningful to clinical areas. The Nursing Practice Manager also continues to colead the TAHSN SF CoP in developing the CC implementation checklist and evaluation framework for TAHSN organizations.

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Late Career Nurse Initiative Late Career Nurse Initiative (LCNI): Expert Nurses Creating a Healthier Work Environment The Late Career Nurse Initiative (LCNI) is funded by the Ontario Ministry of Health and Long Term Care (MOHLTC) and has existed since 2004. The LCNI was designed to address nursing retention and supply in Ontario by providing healthcare organizations the opportunity to apply for funding to create opportunities for full-time and part-time Late Career Nurses (LCNs), aged ffty-fve an older, to engage in activities with the potential to improve patient care and/or the quality of the work environment while utilizing their knowledge, skills and expertise. The overall goal of the LCNI is to retain nurses in the workforce longer, recognizing how their experience enriches the quality of patient care benefting not only patient but also the organization, nursing profession and the healthcare system.

In September 2013, St. Michael’s Nursing Practice & Education launched the LCNI program entitled, “Expert Nurses Creating a Healthier Work Environment.” This program is currently in its’ ffth year, provides expert nurses with an opportunity to enhance personal and professional skills that can contribute to the creation of a healthy work environment. Nurses that participate are enabled to role model and share newly learned skills in their respective areas to infuence the quality of the work environment. LCNs are ideally positioned for this 2017/18 LCNI Participants program as they are well respected by peers, viewed as role models, excellent resources and clinical experts.

The goal of St. Michael’s LCNI program is to enhance the work environment, quality patient care and staf satisfaction while supporting corporate objectives and priorities including the Corporate Strategic Plan and Our People Strategy.

Nine nurses participated in the LCNI program 2017/2018, facilitated by Donna Romano Evidence Based Practice Nursing Manager (Interim) (see above photo). The program involves a series of bi-weekly targeted professional development workshops and communities of practice from November to March. Program deliverables include: a personal action plan, learning log and sharing key learning to colleagues. Selected areas of focus for this years’ cohort were: Emotional intelligence, an environmental green initiative in the TNICU, and establishing an interprofessional unit based council on 14CC. The program evaluations were overwhelmingly positive. As one LCNI participant described “this program ofered me the most positive and invigorating challenge to continue in these last years of my career. It has stimulated me to do so much more teaching, supporting, and uplifting of my colleagues, friends and family.” As a way to further profle and promote the LCNI program a video was created. Please go the My Nursing intranet site for the ‘Live with Donna Romano” video featuring the 2017/2018 LCNI participants.

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Nursing Practice and Education Corporate Initiatives and Collaboration Collaborations Interprofessional Strategic Plan In November 2016 the second, three year Interprofessional Strategic Plan, Advancing Interprofessional Excellence Through Collaboration, was launched following extensive stakeholder consultation and a half day retreat held in April 2016. It refects the voices, expertise and aspirations of health professionals across the hospital while guiding interprofessional priority setting and decision making. The 2016-19 plan builds on the experiences and accomplishments of the previous plan and aligns with the hospital’s Corporate Strategic Plan, Education Strategic Plan, Quality Strategic Plan and People Strategy.

The Interprofessional Strategic Plan will help the interprofessional team achieve new heights in care, education and research. The plan helps us to promote an evidence-based practice environment that is patient and family centred and supports all health-care providers to practice to their full potential and to achieve best outcomes. We are committed to fostering an environment where safe, quality care is delivered efciently, efectively and collaboratively with all staf, physicians, students, patients, families and community partners.

Our Vision: We envision St. Michael’s Hospital as an exemplar of collaborative care, leadership, education and research. Within the Interprofessional Strategic Plan there are three strategic directions including: Patient Care Our Commitment: • Ensure patients are at the centre of our work • Optimize evidence-based and integrated care for patients across the care continunm Education Our commitment: • Strengthening collaborative learning as the cornerstone of education Research Our commitment: • Enhancing academic practice through practice-based research and quality improvements

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Nursing Advisory Council Report 2017-2018

Nursing Practice and Education Corporate Initiatives Education Ongoing Corporate Nursing Education Opportunites 1.

Corporate Nursing Orientation (monthly)

2.

Centralized Inpatient Nursing Orientation (monthly)

3.

Centralized Preventing Falls is SIMPLE education (monthly)

4.

Prevention,Early Recognition and Management of Delirium education (monthly)

5.

RN to RN, Shift to Shift Bedside Transfer of Accountability Simulation Workshop (monthly)

6.

Nursing Rounds (monthly)

7.

Nursing Advisory Council Professional Practice Scenario of the Month (monthly)

8.

Nursing Preceptorship Workshop

9.

New Graduates Thriving in the Workplace

Nursing Preceptorship Workshop As preceptors, nurses support the transition and integration of new nurses and nursing students into the organization and practice setting. Nursing Practice and Education continues to ofer a Nursing Preceptorship workshop about 8 times per year. This workshop is designed to prepare nurses with the knowledge and skills necessary for them to function efectively in a preceptor role. It is intended for experienced preceptors, new preceptors, or those nurses who are considering becoming preceptors.

This workshop format includes both interactive didactic and learning activities that focus on evidence based preceptorship theory, the application of adult learning styles and principles, fostering critical thinking, providing efective feedback, confict resolution strategies and evaluating the preceptorship experience. Between June 2017 and May 2018, 58 nurses participated in the Nursing Preceptorship workshop. Evaluation continues to be overall very positive: •

100% of learners indicated that they would alter their teaching practice related to how they preceptor following participation in the workshop

•

100% of learners indicated that the Nursing Preceptorship workshop overall met their expectations

The 2018 Theresa Ann Ford Preceptorship awards further highlight the dedication and commitment of many St. Michael’s nurses to the preceptorship role.

“

Being a preceptor is a responsibility that can have a big impact on students. It is helpful for preceptors to know what is expected of them and be given the tools to make the most of the experience.

”

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Nursing Education Through The Years

First graduates of the St. Michael’s Hospital School of Nursing, 1894

Last class of nurses to graduate from St Michael’s, before the program was transferred to George Brown College, 1974 58 |

Nursing Advisory Council Report 2017-2018

Canadian Nurses’ Association (CNA) Certifcation Professional Practice, Nursing Practice and Education supports nurses who have successfully passed the CNA certifcation exam by providing reimbursement for exam application fees. Required documents to process reimbursement: Original CNA receipt, copy of the CNA certifcate received from CNA post successful completion of exam, fully completed reimbursement application form. CNA certifed nurses are recognized during Nursing Week.

Canadian Nurses Association Certifcation: Cardiovascular Surgery

Canadian Nurses Association Certifcation: Critical Care

Alexis Vieira Alicia Pellini Anne Kha Benedicta Cabaluna Dong Wei Xu Haizhu Wang Jennifer Cruz Jennifer Martin Jennifer Predhomme Kamala Persad-Ford Kevin Leung Krisette Tumbagahan Lilandra O’Brien Marian Adeboboye Mary Mustard Mei Mei He Sammy Adriatico Shannon Fimio Teresa Campbell Tessy George

Angel Cubing Cecilia Santiago Christine Chu Corinne Risling Debbie Snatenchuk Demetre Photopoulos Diana Lee Denise Elliott Elaine Selby Eliane Stockler-Leite Eva Klein Gabriella Tataru Hyojung Kim Jenna Moulder Jessica Nanni Josephine Ly Karen Michelsen Karen Wannamaker Katherine Mansfeld Kathy Mills Kelly Metcalfe Leigh Ngo Haitsma Maija Shannon Maria Teresa Diston Marinka Kocjan Mary Mustard Masako Katsuki Megan Rhoden Melissa Wang Melissa Devera Michelle Narine Myra Mendoza Nina Basic Orla Smith Patrick Blute Prafulla Savedra Rosia Truan Ryan Dondiego Scott Kantymir Shannon Swift Stephen Manning Stephen Penticost Tessy George Theresa Cook Uma Bakshi Vasuki Paramalingam Yoon Lee Wong

Canadian Nurses Association Certifcation: Community Health Cathy Wilson

Canadian Nurses Association Certifcation: Gastroenterology Camille Sagun Charline Ductan Joanne Bennett Katherine Mansfeld Sheila Cannon Stephanie MacDonald Virginia Wojcik

Canadian Nurses Association Certifcation: Enterstomal & Gastroenterology Allison Rankine

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Canadian Nurses Association Certifcation: Emergency

Canadian Nurses Association Certifcation: Medical Surgical

Aimee Geiger Alida Devine Andreanne Dion Ann Marie Doherty Aster Yemane Candis Kokoski Carolyn Hamill Claire Alvarez Colleen Schmidt Chris Yu Danielle Bender Erin Newman Gisela Colucci Jannet Hudson Jeannelle Pereira Jennifer Daviau Jennifer Jolley Jonathan Tel Karen Olivero Kirsty Nixon Kylie Kaitlynn Krystal Fox Lee Barratt Luke Costello Maggy Parsons Mary Dimeo Megan Cairns Melissa Guiyab Michael Postic Nancy Linklater Natalia Liakicheva Rob Ford Ryan Henderson Sharon Mills Sherry Armstrong Stacy Lew Tina Sperling

Halley Velasco Avinash Solomon Karen Michelsen

Canadian Nurses Association Certifcation: Gerontology Charlene Chu Frances Carbonel Junyan Shi Kathryn Sametz Marjorie Hammond

Canadian Nurses Association Certifcation: Hospice Palliative Care Kathryn Vogel Penny McCrimmon Rebecca Clarke

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Nursing Advisory Council Report 2017-2018

Canadian Nurses Association Certifcation: Mental Health Brenda Bergamin Caitlin Keeble Danijela Ninkovic Dominic Gascon Donna Romano Ellen Marchildon Heather Dunlop Heather Rawnsley Heather Sinclair McDonald Joan Wight Keschey Marcelle Lynn Hilton Nat Marcia Hale Mary Rhodes Monique Harding Nicole Kirwan Olive Laranang Parya Nazari Tamy Jung Tessa Birtch Vi Linlet Ensoy Virginia Romero Wendy Keller

Canadian Nurses Association Certifcation: Nephrology Alison Thomas Ann Jones Calen Blackwell Claudia Garzon Connie Ignacio Ellie Do Rosario Fernanda Shamy Galo Meliton Gary Shkiler Helena Koltakov Hong Gao Jing Qiong Chen Joyce Hunter Juan Kilroy Julia De La Cruz Jumi Charles Kathleen McIntosh Kevin Barlow Kitty Mak Lily Zhang

Maria (Cielo) Tadeo Mary-Beth Adams Meriam Jayoma-Austria Michelle Gabriel Mina Kashani Mirella Giurgiev Ramona Cook Rhodalyn Bray Rimma Fishman Sandra Centeno Sarah Mattok Sedi Abou-Talebi Shaniel Des Vignes Tesfaldet Mengesha Tess Montada-Atin Valentina Soreanu Vicki Di Pierdomenico Vivian Ho Wen Jin Yazhi Li

Canadian Nurses Association Certifcation: Perinatal

Canadian Nurses Association Certifcation: Oncology

Anna De Marchi Beretta Ferron Debbie Dawe-Mattausch Elaine Lau Julia Lucignani Sharon Adams Zhanna Von Kaiser

Althea Stewart Anna Solala Donna Monis Gemlina Balagasay Jennifer Munroe-Antoine Johnson Dartey Joline Bell Leah Jodoin Madpuri Khushdeep Marlene McCourt Martha Abrahamse Martine Andrews Norma McVeigh Richard Leahy Suzanne Scotland Zhenxiu Cheng

Canadian Nurses Association Certifcation: Neuroscience Adriana Barbuleasa Alexandra Blight Alexandra Roll Andrea Spicer Bianca Fetros Chantel Barry Diana Lee Elyse Kalpage Elyse Ancrum Ganna Gaponenko Jacki Joy Joanne Le Jennifer Innis Jenny Espiruti Judy Pararajasingham Julie Brown Denise Ouellette Karen Brownie Katherine Hughes Lindsay Wrong Lisa Ye Lory (Wen Ya) Lee Louvain Good Martine Andrews Melissa Farne Michelle Williams Samantha White Sonya Canzian Stephanie Trombley Tara Raine Timea Urban Tom Willis Wendy Legacy

Canadian Nurses Association Certifcation: Orthopaedic Shea MacKenzie

Canadian Nurses Association Certifcation: Perioperative Anna Czemiel Becky Lei Diane Eley Esther Lee Eugenie Fernandez Francis Bobis Jane Hume Linda Whyte Lisa Horton Lori Martin Muqi Li Wuyungerile Wuyungerile

Canadian Nurses Association Certifcation: Perianesthesia Nursing Kirsty MacQueen Maria Susana Carrusca Andrea Richards Deborah Moore

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St. Michael’s Hospital Over a century of growth and development

1885

1892

1912

1895

1926-1928

1980S

Li Ka Shing Knowledge Institute 2011

Historical photos courtesy of St. Michael’s Hospital Archives

1940S

2002

Peter Gilgan Patient Care Tower 2018

30 Bond Street, Toronto, ON M5B 1W8 Canada 416.864.6060 stmichaelshospital.com