Nursing Advisory Council Report 2018-19

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Nursing Advisory Council Report UNITY UNITYHEALTH HEALTH TORONTO TORONTO

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

OUR MISSION Unity Health Toronto is a Catholic health care organization providing compassionate physical, emotional and spiritual care to all in need. We advance excellence in health care through world-class education, research and innovation.

OUR VISION The best care experiences.

Created together

OUR VALUES Human Dignity: We affirm that every person has sacred value and is worthy of respect.

Compassion: We enable health and healing by understanding each person's needs and by providing care with kindness and sensitivity.

Excellence: We strive to achieve the best care and quality through innovation and continuous improvement.

Community: Together we embrace diversity, trust and teamwork to fulfill human potential.

Inclusivity: We foster an inclusive, welcoming environment where everyone is treated equitably and without judgement.

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Message from Sonya Canzian Vice President Clinical Programs, Chief Nursing and Health Disciplines Officer Welcome to the St. Michael’s Hospital Nursing Advisory Council Report 2018-19!

It is my pleasure to share with you the many accomplishments of this past year.

In this report, you will see how nursing at St. Michael’s Hospital is committed to exceptional care, quality, evidenced based practice, and a healthy work environment. In the pages that follow, you will learn more about the work of the Nursing Advisory Council and how through it’s seven subcommittees, we ensure that nursing practice, policy, education, research, patient safety and quality are at the forefront of our work.

Our commitment to continuing our work as a Best Practice Spotlight Organization (BPSO) remains unwavering. This year we supported 42 best practice guideline champions who implemented 32 best practice guidelines across 24 different clinical areas. Congratulations to each of our champions and their mentors!

Our BPSO work is highly recognized and we were proud to host visitors from Spain and China this year who came to St. Michael’s to learn about how we implemented best practice guidelines in our organization. This year, we were also pleased to host several international visitors through the Global Nursing Scholars Program at the Lawrence S. Bloomberg’s Faculty of Nursing, University of Toronto. In that visit, two of our programs hosted four international visitors. It is an honour to meet with our international colleagues and aid in the advancement of nursing practice, scholarship and leadership around the world!

The nursing culture at St. Michael’s has been built on a tradition and long history of nursing quality and excellence. This year, one of our generous donors stepped forward with a wish to celebrate and preserve this culture of excellence. Working closely with Bernie and Mildred Syron, we celebrated this excellence in care through the launch of the Bernie and Mildred Syron Nursing Excellence Program. This program has reinforced our demonstrated commitment to ongoing professional development and lifelong learning.

The active involvement and collaboration of all nursing staff is an important investment in the advancement of nursing care at St. Michael’s. To that end, the Nursing Advisory Council ensures that our nurses’ voices continue to be heard at the unit level through the various subcommittees and forums. The Council is also instrumental in ensuring that nurses’ feedback is utilized in the development and implementation of corporate initiatives in the advancement of healthy and safe work environments, workflows and the provision of excellent and quality patient care at St. Michael’s Hospital.

I am truly impressed by the hard work, academic productivity, and enthusiasm as evidenced by the many accomplishments this year. I would like to thank all the nurses and our interprofessional colleagues across the hospital and recognize our collective dedication to our professions, and the excellent care, education and research we deliver at St. Michael’s Hospital.

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

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Message from the Nursing Advisory Council Co-Chairs We have the privilege of co-chairing NAC that purposefully supports a shared a shared governance approach to professional nursing practice. This means engaging with our nursing colleagues to promote interactive dialogue about opportunities and best practices that impact nursing.

The mandate of NAC at St. Michael’s is to support the advancement of professional nursing practice that promotes excellence in safe quality patient care. Through our co-leadership model, membership, subcommittees and communication strategies, NAC continues to reach out to the larger St. Michael’s nursing community. As a profession and Council, all nurses have the privilege of enhancing professional nursing practice and quality improvement initiatives through evidence based practice supported by systems and operations.

This has been a busy year for St. Michael’s NAC as reflected in the 2018/19 report. NAC is embracing Unity Health Toronto’s newly launched mission, values and vision and corporate strategic plan while setting direction for professional nursing practice that is consistent with the Interprofessional Strategic Plan: Advancing Interprofessional Excellence through Collaboration, education and professional development and quality.

We would like to thank current and past members of NAC, subcommittees and co-chairs and Nursing Professional Practice for their commitment and participation in making meetings interactive and meaningful. We also want to recognize and acknowledge all our nursing colleagues and interprofessional teams for their commitment to evidence based, quality care that demonstrates excellence in clinical practice.

The Nursing Advisory Council (NAC) is pleased to present the 2018-2019 NAC Report – our 4th annual report. We encourage everyone to review and share the report. We also trust that it gives you a sense of pride in what nurses at St. Michael’s Hospital, Unity Health Toronto continue to achieve.

Your Nursing Advisory Council Co-Chairs,

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

Vivian Iwenofu RN, BScN General Internal Medicine

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Table of Contents The Nursing Advisory Council Co-Leadership Model......................................................7 Nursing Advisory Council Membership .................................................................................8 Nursing Advisory Council Subcommittees......................................................................... 14 Nursing Rounds Subcommittee Update............................................................................. 15 Transfer of Accountability Subcommittee Update.......................................................... 17 Policies, Procedures and Standards Subcommittee Update...................................... 21 Self-Regulation Subcommittee Update................................................................................ 23 Nursing Orientation Subcommittee Update..................................................................... 24 Healthy Work Environment Subcommittee Update...................................................... 27 Nursing Week Subcommittee Update.................................................................................. 28 2019 Nursing Excellence Awards, Scholarship and Fellowship recipients.......... 36 Global Nursing Scholars Program........................................................................................... 41 Nursing Advisory Council Program Presentations.......................................................... 43

Nursing Practice and Education Corporate Initiatives and Collaborations Professional Development Support....................................................................................... 45 Quality Improvement Initiatives............................................................................................. 48 Collaborations.................................................................................................................................. 54 Education........................................................................................................................................... 59

Canadian Nurses’ Association (CNA) Certification Canadian Nurses’ Association (CNA) Certification..................................................... 62

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 (staff nurse) who: • Facilitate Nursing Advisory Council meetings • Collaborate with chairs of subcommittees and others stakeholders to set agendas • Ensure timely, efficient communication of Nursing Advisory Council’s business Vice President, Clinical Programs, Chief Nursing and Health Disciplines Officer Sonya Canzian, RN, MHSc, CNN(C)

Nursing Advisory Council co-leadership model

Director, Nursing Practice & Education Murray Krock, RN, MN co-chair 2014-19

Staff Nurse, General Internal Medicine Vivian Iwenofu RN, MSN General Internal Medicine co-chair 2018-19

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Nursing Advisory Council Membership Nursing Advisory Council membership consists of nursing leaders and staff nurse representatives from clinical programs. Introducing the 2018/19 nursing leadership members:

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

Vanessa Chavez Prieto Corporate Nursing Education, Manager, Professional Practice

Cecilia Santiago Nursing Practice Manager, Professional Practice

Ashley Skiffington Evidence Based Practice Nursing Manager, Professional Practice

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

Kaleil Mitchell Project Coordinator, Nursing Practice and Education, Professional Practice

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Nursing Advisory Council Membership (cont’d.)

Susan Camm Co-Clinical Leader Manager, General Internal Medicine

Virginia Wojcik After Hours Clinical Manager

Jenny Pak Nurse Practitioner-Adult, Trauma & NeuroSurgery

Denise Ouellette Clinical Nurse Specialist, Trauma Neurosurgery

Shirley Bell Clinical Nurse Educator, General Internal Medicine

Janice Glen Staff Nurse, CVICU Ontario Nurses’ Association

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Nursing Advisory Council Membership Clinical Program Representation Nursing Advisory Council membership consists of nursing leaders and staff 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 staff nurse members and areas they represent:

Clinical Program Women’s Health

Clinical Program Family Health Team

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

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

Clinical Program Trauma Neurosurgery

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

Clinical Program Perioperative Services

Meghan Goudie Staff Nurse, Operating Room Additional Communication areas: Cystoscopy

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Lisa Manswell Staff Nurse, Surgical Day Care Additional Communication areas: Post Anaesthetic care Unit, Pre Admission Facility

Clinical Program Representation (cont’d.)

Clinical Program Heart and Vascular

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

Ashnit Chhina Staff Nurse, Cardiac Catherterization Lab Additional Communication areas: Cardiology

Lucksshika Thivakaran Staff Nurse, Cardiac and Vascular Surgery Additional communication areas: Coronary Intensive Care Unit, Heart Health Unit & Cardiac Rehab, Electrophysiology Service

Marie Prystay Staff Nurse, Cardiology Additional communication areas: Cardiac Catherterization Lab

Clinical Program Mobility

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

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Clinical Program Representation (cont’d.)

Clinical Program: Inner City Health

Vivian Iwenofu (NAC co-chair) Staff Nurse, General Internal Medicine Additional Communication areas: Regional Geriatric Program, Acute Care of the Elderly Unit

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

Michelle Dumdum Staff Nurse, Inpatient Mental Unit Additional Communication areas: Psychiatric Emergency

Clinical Program: Specialized Complex Care

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

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

Clinical Program: Diabetes Comprehensive Care

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

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

Past Clinical Program Representation

A special thanks to these members who served on the Nursing Advisory Council.

Jennifer Rogers Staff Nurse, Mental Health Emergency Services Inner City Health

Karen D’Souza Staff Nurse, Ambulatory Care, Post Anaesthetic Care

Nesa Vijayaratnam Staff Nurse, Cardiology Heart and Vascular Program

Kira Bahinski Staff Nurse, Emergency Department Inner City Health

Karen Wannamaker Clinical Leader Manager, Medical Surgical Intensive Care Unit Specialized Complex Care

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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 specific policy, procedure and medical directives review

Nursing Rounds

Vanessa Chavez Prieto, 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 

Ashley Skiffington, Evidence Based Practice Nursing Manager/ 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

Vanessa Chavez Prieto, Corporate Nursing Education Manager

Corporate Nursing Orientation

Healthy Work Environment

Murray Krock, Director, Nursing Practice & Education/Ashley Skiffington, Evidence Based Practice Nursing Manager

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 reflective practice and professional development.

MEMBERSHIP • • • • • • •

Vanessa Chavez Prieto, 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, Staff Nurse, Inpatient Mental Health (past) Jenny Pak, Nurse Practitioner, Trauma/Neurosurgery Murray Krock, Director Nursing Practice and Education Ryan Hoekstra, Staff Nurse, Community Mental Health

Nursing Rounds are monthly presentations that provide an opportunity for sharing knowledge and program/unit accomplishments led by Registered Nurses in collaboration with other members of the team to enhance care provision.

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.

Using the Case Reviews Utilizing Evidence (CRUE) format, each presentation depicts a patient’s/patients’ journey or episode of care that “tells a story” to demonstrate one of the following: • • • • •

Utilization of evidence that was applied and/or could have been applied Highlights of transfer of accountability (ToA) processes and opportunities where applicable Links to local implementation and sustainability initiatives Reflection on care processes, interventions and evaluations Identification of any relevant or related data and literature references

2018 to 2019 Nursing R o u n d s E v a l u a t i o n 246 Data*: 20 Total number of different types of attendees

16

Total number of individuals who attended nursing rounds

8

94.5%

of attendees indicated Nursing Rounds presentations stimulated their thinking/ held their interest

*Data from June 2018April 2019 N u r s i n g R o u n d s Resource Guide Total number of nursing rounds presenters

Total number of nursing rounds

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Nursing Rounds Nursing Rounds Presentations June 2018-April 2019 Presentations

The Nursing Rounds subcommittee partners with the Health Sciences Library to create an online Resource Guide on every topic presented at the monthly Nursing Rounds.

The aim of this partnership is to: 1.

P romote the scholarly n a t u r e o f N u r s i n g Rounds 2.

Provide an avenue for nurses to access lpresented i t e r a t u r e at oeach n topics Nursing Round The online Resource Guide can be accessed on the intranet under “my Nursing” by clicking the following links, in order: Nursing Education June 2018

Heart and Vascular Program

Nurse Practitioner Led Models of Care: lnnovative Care Delivery Solutions for Acute Care.

Presenter(s): Esmeralda Carson, NP-Adult Ashley Dobbin, NP-Adult

October 2018

Inner City Health Program

Substance Use Disorders And Harm Reduction

Presenter(s): Samantha Szilagyi RN, BA, BScN Keith Hansen RN (EC), Ed.D, DNP, Ph.D (c) Jean-Paul Michael, Peer Support Worker

January 2019

Women’s Health Program

Supporting Oral Feeding Skill Development In Preterm Infants: An Evidence-based Approach

Presenter(s): Natalie Puccio, Nurse Practitioner Jeanne Zielonka, Nurse Practitioner Alyson Martinez, Registered Dietitian

March 2019

Women’s Health Program

My Patient Is For P.L.E.X. What Does That Mean Anyway?

Presenter(s): Megan Buchholz, RN

September 2018

Specialized Complex Care

Collaborative Efforts In Socking It To Sepsis

Presenter(s): Brigitte Delaurier RN, BScN, MN, CCNC(C) Katherine Mansfield RN, BScN, MN,CGN

November 2018 Professional Practice

Supporting The Journey Of A Patient On Constant Care: A Collaborative Approach

Presenter(s): Shirley Bell, RN Cecilia Santiago, RN, MN, CNCC(C)

February 2019

Trauma Neurosurgery Program

Inspiring Hope: The Impact Of Organ And Tissue Donation Presenter(s): Christine Wong, BScN, RN Diana Lee, BScN, RN

April 2019

Family Health Team Program

Supporting Seniors In Advance Care Planning: Nursing Leading The Way Presenter(s): Cathy Wilson RN CCHN(C)

Nursing Rounds Resource Guide

Nursing Led Presentations That The Nursing Rounds subcommittee partners with the Health Sciences Library to create an online Resource Guide on each topic at monthly Nursing Rounds. Journey The goals of this partnership are to: Tellpresented A Story Through A Patient’s 1. Promote the scholarly nature of Nursing Rounds

Utilizing Evidence To Help Improve Care

2. Provide an avenue for nurses to access literature on topics presented that are interesting and/or relevant to their Provision And Patient Experience 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

•

Cecilia Santiago, Nursing Practice Manager (Chair)

•

Zeineb Abdulkader, Staff Nurse, Urology/Nephrology

•

Shirley Bell, Clinical Nurse Educator, General Internal Medicine

•

Ashnit Chhina, Staff RN, Cardiac Investigation Unit

•

Michelle Dumdum, Staff RN, Inpatient Mental Health

•

Kyrene Fabroa, Staff RN, General Surgery

•

Monica Gordon, Clinical Nurse Educator, Perioperative Services

•

Katelynn Greenough, Psychiatric Emergency Services

•

Melissa Guiyab, Clinical Nurse Specialist, Medical Surgical ICU

•

Katey Knott (ad hoc), Director, Health Discipline Collaborative Practice and Education

•

Murray Krock, Director, Nursing Practice and Education

•

Wendy Legacy, Clinical Nurse Educator, Perioperative Services

•

Shawna McIntyre, Clinical Nurse Educator, Inpatient Mobility

•

Victoria McLean, Staff RN, Palliative Care Unit

•

Ekaterina Mikhelson, Clinical Nurse Educator, Specialty Clinics and Palliative Care Unit

•

Judy Pararajasingham, Clinical Nurse Educator, Trauma and Neurosurgery

•

Marie Prystay, Staff RN, Cardiology

•

Andrea Richards, Staff RN/BPG Champion, Post Anesthetic Care Unit

•

Sarah Sweetnam, Resource Nurse, Respirology/CF Program

•

Lucksshika Thivakaran, Staff RN, Cardiovascular Surgery

•

Sandee Westell, Staff RN, Respirology Clinics

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Achievements of Transfer of Accountability Subcommittee Intershift (shift to shift and break coverage) Transfer of Accountability (ToA) The Intershift Nursing Transfer of Accountability Policy specifies the four expectations that at shift change both incoming and outgoing nurses: 1.

Conduct ToA at patient’s bedside

2.

Engage patient (and family when patient consents to family presence)

3.

Perform safety checks

4.

Use ToA worksheet/checklist to structure information exchange

RNs Gloria Cardinal and Vivian Iwenofu performing safety checks and engaging the patient during bedside ToA at shift change (Photo by Yuri Markarov, Medical Media Centre)

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 offered to new and returning RNs.

•

Patient Education: The updated version of Nursing report at the patient’s bedside is now active on the Online Health Library. Permalink: https://smh.andornot.com/en/permalink/stm464

•

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 each BPG cycle.

This cycle, October 2018 - March 2019, there were three BPG champions working on ToA.

•

Audit and Feedback: Monthly ToA audits of compliance to the four elements of intershift ToA are conducted by unit leadership. 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 audits show that we continue to surpass our corporate target of 75% for each of the ToA elements overtime (May 2013 - May 2019) with the most marked increase in the use of a structured ToA checklist.

100% 90% 80% 70%

Target ≥ 75%

60% 50% 40% 30% 20% 10% 0%

2013 (n=1551) 2014 (n=2164) 2015 (n=2142) 2016(n=1978) 2017(n=1907) 2018 (n=1886) Jan-Mar 2019 (n=420) % RNs going to bedside

% RNs engaging patient and/or family

% RNs using checklist/worksheet

% RNs conducting safety checks

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Intra-hospital Transfer of Accountability Intrahospital includes ToA processes between patient care areas and between patient care areas and procedure/ diagnostic areas. The Guideline for Intrahospital ToA 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).

RN Gloria Cardinal and CA Beverly Turner double check the name on a patient’s wristband before she goes to Medical Imaging.

(Photo by Yuri Markarov, Medical Media Centre)

Education The intrahospital ToA education program is comprised of an eLearning module which is offered to new and returning staff to promote an understanding of: •

Intrahospital ToA tool: eTicket, an electronic ToA form

•

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

•

Different roles of clinicians and intermediary personnel in intrahospital ToA.

The REB-approved study titled Staff 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.

Ongoing intrahospital ToA and Care Transition initiatives 1. Intensive Care Unit ToA Processes with: •

Perioperative Services

•

Emergency Department

•

Cardiac Investigation Unit

•

Inpatient Units

2. Post Anesthetic Care Unit (PACU) and Non Critical Care Inpatient Unit ToA 3. Ambulatory Care Areas to Inpatient Units ToA 4. Care Transition Initiative - Improving GIM Heart Failure Patient Care Transition Using Teach-Back

To learn more about Transfer of Accountability initiatives, please check the St. Michael’s Intranet: SMH A-Z → T → Transfer of Accountability

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Transfer of Accountability (cont'd.)

Presentations and Publications 1. Santiago, C., Krock, M. & Canzian, S. (2019). A collaborative initiative to address potential safety risks in intrahospital patient transitions. Oral presentation at the Nursing Leadership Network Conference, Toronto, ON. 2. McNamee, C., Santiago, C., Mitchell, K., Krock, M. (2018). The impact of simulation in sustaining shift-to shift transfer of accountability. Poster presentation at the Nursing Leadership Network Conference, Toronto, ON. 3. Kidani, A., McGrady, M., Kacikanis, A., Santiago, C. (2018). Transfer of accountability for breast cancer patients. Poster presentation at the Canadian Association of Nurses in Oncology Conference, Charlottetown, PEI. 4. Jeffs, L., Saragosa, M., Hindle, A., Santiago, C., Krock, M., Stergiopoulos, V., Bulmer, B., Mitchell, K. Ramji N. (2017). Collaborative care transitions symposiums: Insights from participants. Nursing Leadership, 30, 39-56. Accessed through https://www.longwoods.com/content/25256 5. Aquino, M., D’Cambre, M., Buczek, V., Meleca, C., Santiago, C. (2017). The development and implementation of a transfer of accountability tool between the cardiac catheterization laboratory and the cardiac intensive care unit [Abstract]. Canadian Journal of Critical Care Nursing, 28, 61.

Accessed through https://www.caccn.ca/files/CJCCN/28-2-2017%20CJCCN.pdf 6. Santiago, C., & Krock, M. (2017). Enhancing the patient experience through standardized nurse-tonurse intershift bedside transfer of accountability. Poster presentation at the International Council of Nursing, Barcelona, Spain.

7. Guiyab, M., Rudyk, N., Mustard, M., Grandy, J., Snatenchuk, D., McLachlan, P. (2016). Transfer of accountability among the operating room, post anesthesia care unit, and intensive care units [Abstract]. Canadian Journal of Critical Care Nursing, 27, 39 Accessed through https://www.caccn. ca/files/CACCN-R27-2-2016%20(revised).pdf 8. Guiyab, M., Paramalingam, V., Swift, S., Savedra, P., Barratt, L., Den Bok, J. (2016). Transfer of accountability between the emergency department and the intensive care units [Abstract].

Canadian Journal of Critical Care Nursing, 27, 39 Accessed through https://www.caccn.ca/files/ CACCN-R27-2-2016%20(revised).pdf 9. Wannamaker, K., Michelsen, K., Santiago, C. (2015) Ticket to ward: Transitioning patients from MSICU to inpatient areas [Abstract]. Canadian Journal of Critical Care Nursing, 26, 33. Accessed through https://www.caccn.ca/files/CACCN-26-2-2015.pdf

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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 findings and best practices and reflect interdisciplinary collaboration as appropriate.

MEMBERSHIP • • • • • • • • • •

Gail Wilson, Director, Clinical Systems Adoptions (Chair) Cecilia Santiago, Nursing Practice Manager Vanessa Chavez Prieto, Corporate Nursing Education Manager Denise Ouelette, Clinical Nurse Specialist, Trauma Neurosurgery 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 Mansfield, Clinical Nurse Educator, GI/General Surgery/Plastics Kimberly Tan, Clinical Nurse Educator, Heart and Vascular Program Wendy Legacy, Clinical Nurse Educator, Perioperative Services

Picture: St Michael's HospItal Corporate Policies and Procedures System

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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 health-care system, and influenced decisions that affect 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) Shirley Bell, Clinical Nurse Educator, General Internal Medicine Melissa Guiyab, Clinical Nurse Specialist, Medical Surgical Intensive Care Unit Katey Knott, Director, Discipline Collaborative Practice and Education Murray Krock, Director, Nursing Practice and Education Wendy Legacy, Clinical Nurse Educator, Perioperative Services Art Jerome Lopez, Clinical Leader Manager, Nursing Resource Team and Nephrology/Urology Antoinette Meinders, Clinical Nurse Educator, Clinical Informatics Shannon Swift, Clinical Nurse Educator, Medical Surgical Intensive Care Unit Michelle Williams, Clinical Nurse Educator, Cardiovascular ICU & Cardiac Intensive Care ICU 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 staff with reminders to complete their annual renewal by December 31st each year.

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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 find the repository of the presentations, go to the SMH Intranet: SMH A - Z > N > Nursing Advisory >Self regulation subcommittee Month

2018 Topics

2019 Topics

January

Documentation Series Part 1.

Contemporaneous charting: Mind the time

Horizontal violence: Does it still exist?

February

Documentation Series Part 2.

Refraining from subjectivity

Horizontal Violence: What It Looks Like and How To Respond

March

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

College of Nurses' of Ontario Code of Ethics

April

Optimizing team and family communication in the practice setting

Engaging In Therapeutic Nurse-Patient Relationship While Keeping In The Zone

May

Documentation Series Part 3.

Documentation accountability of nursing preceptors and learners

Access to Medical Records

June

Changes to Protecting Patients Act, 2017: What these mean to nursing

September

Ensuring client safety: Assessment and care transitions

October

Ensuring patient safety: Knowing your professional accountability and scope of practice

November

Annual Quality Assurance: A Regulatory Requirement

December

‘Tis the Season – Accepting Gifts from Patients

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 directly coordinates the development, delivery, and evaluation of the Corporate Nursing Orientation Program and supports the development of cross-program mandatory and required orientation and key topics.

PURPOSE • Ensuring the Corporate Nursing Orientation Program is evidence based, efficient and effective • Identifying and embedding into orientation the foundational nursing information needed to support competencies and skills that newly hired nurses need to integrate into their practice to deliver safe, effective, patient care.

MEMBERSHIP • • • • • •

Vanessa Chavez Prieto, Corporate Nursing Education Manager (Chair) Shirley Bell, Clinical Nurse Educator, General Internal Medicine Meriam Jayoma-Austria, Staff Nurse, Transplant Clinic Elizabeth Butorac, Program Director (Interim), Trauma Neurosurgery and Mobility Murray Krock, Director, Nursing Practice and Education Mary Murphy, Program Director, Obstetrics & Gynaecology, Women’s Health Centre, Neonatal ICU, Paediatrics Clinic • Katherine Mansfield, Clinical Nurse Educator, GI/General Surgery/Plastics • Kaleil Mitchell, Project Coordinator, Nursing Practice and Education

Corporate Nursing Orientation Program The Corporate Nursing Orientation Program primary’s goals are to introduce newly hired nurses to the nursing practice at St. Michael’s Hospital and to prepare nurses to embark on their program or unitspecific orientation.

Overall the feedback received about the various offering of the Corporate Nursing Orientation Program has been positive. Participants have highlighted the following themes:

Nursing Advisory Council Report 2018-2019 | 25

Corporate Nursing Orientation Program Corporate Nursing Orientation Goal: Purpose of nursing orientation is to introduce all new hired RNs to the organization, the various programs and services available. In addition, The intent of the day is to familiarize new hires with nursing professional practice, clinical resources, and essential information regarding mandatory and required training and safety at St. Michael's Hospital.

Session Components: • Introduction to professional practice • Patient care essentials and services • Nursing Online resources and tools • Ontario Nurses Association (ONA) • Safety and body mechanics

Length: Full day Number of sessions held: 11 Number of attendees: 151

Preventing Falls Is SIMPLE Goal: To educate frontline health care staff on the risk factors, prevention and management of falls. To review the Components of the Preventing Falls is SIMPLE program.

Session Components: • Fall risk screening: fall risk assessment tool • Fall risk care plan: SIMPLE interventions tool • Patient and family education • Communication of fall risk within the team • Post-fall DEBRIEF expectations

Length: one hour Number of sessions held: 10 Number of attendees: 103

Prevention, Early Recognition, And Management Of Delirium Goal: To educate the health care team on the prevention, recognition and management of elderly patients who are either at risk of or have delirium.

Session Components: • Define delirium, dementia and depression • Prevention strategies using HANDOVER tool • Recognition strategies using the CAM tool • Management strategies using the order set • Discuss patient and family involvement • Review SMH Delirium Policy

Length: one hour Number of sessions held: 10 Number of attendees : 97

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Centralized Inpatient Nursing Orientation Goal: Introduce newly hired Nurses to a number of key practices, processes and equipment that are common across St Michael’s inpatient medical/surgical units. A variety of teaching methods including interactive didactic, case scenarios, demonstrations and hands on skill stations are used.

Session topics: • Sepsis recognition, management and nursing considerations • Direct IV administration, glucometers, IV pumps, & restraints • ECG recording • CIWA protocol and Seizure precautions • TGLN and End of Life Care • Mental Health Care in medical/surgical settings • Hazardous Medications handling • Introduction to code blue and crash cart

Length: Full day Number of sessions held: 9 Number of attendees: 113

RN to RN Bedside Transfer of Accountability (ToA)

Hands Simulation & eLearning module

Goal: To educate nurses in St. Michael’s Hospital inpatient units about the processes and tools for performing nurse-to-nurse bedside transfer of accountability.

Session Components: • Define and State the significance of ToA • Describe the background of ToA at St. Michael’s • Identify and apply the four elements of ToA • Explore barriers to beside reporting • Identify strategies to support effective ToA

Elearning Modules:

Length: two hours Number of sessions held: 13 Number of attendees: 87

Best Practice Guidelines (BPG) Booster: The module provides an overview of St. Michael's journey to becoming an Registered Nurses’ Association of Ontario (RNAO) designated Best Practice Spotlight Organization (BPSO). It educates nursing staff on the development of BPGs and how they are used to improve patient care. The booster also highlights the nurses’ role in supporting St. Michael's ongoing BPG implementation, evaluation and sustainability activities.

Alternatives to the Use of Physical Restraints: The module reviews the legal implication and professional accountabilities related to the use of restraints. It identifies the decision making process for emergency and non emergency use of restraints. Describes the methods of monitoring, assessing, and caring for patients in restraints. It also lists the documentation and reporting requirements and identifies the patient and family resources

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 staff. 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).

MEMBERSHIP • Ashley Skiffington, Evidence Based Practice Nursing Manager (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 • Vanessa Chavez Prieto, Corporate Nursing Education Manager • Dominic Gascon, Operational Readiness Specialist, • Vivian Iwenofu, Staff Nurse, General Internal Medicine • Luisa Muffo, Human Resources Consultant • Orla Smith, Clinical Leader Manager, Cardiovascular Intensive Care Unit • Anna Nassis, Staff Nurse, Labs Blood Management, Laboratory Medicine The Nursing HWE subcommittee work continues to evolve from the Nursing Health and Wellness study (2015) which informed the design of the Achieving Resilience in Acute Care Nurses (ARISE) study (2017). Based on the findings from the ARISE study a corporate Resiliency Workshop was offered to nurses and allied health in 2018. The findings from the ARISE study were presented by Orla Smith (PI) at the Society of Critical Care Medicine’s (SCCM) 48th Critical Care Congress held in San Diego, California, USA in February 2019.

March 2019 marked the second Resiliency Workshop that was offered. Refer to the diagram to your right to view the workshop objectives. The results of the workshop evaluations were highly favorable with participants indicating that they would recommend the workshop to their colleagues and the content of the workshop contribute to a healthy work environment. See woordle depiction above summarizing participant’s reflections about the workshop.

Other subcommittee achievements include providing on unit resiliency sessions, mentorship to 8 BPG Nurse Champions who implemented Healthy Work Environment Best Practice Guidelines (BPGs) in their respective clinical areas and supporting the integration of a health and wellness theme into the 2019 Nursing Week events.

Photo: Resiliency Workshop Flyer

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

MEMBERSHIP: • Ashley Skiffington, Evidence Based Practice Nursing Manager (co-chair) • Marta Sliz, Administrative Coordinator, Nursing Practice and Education (co-chair) • Murray Krock, Director, Nursing Practice and Education • Cecilia Santiago, Nursing Practice Manager • Vanessa Chavez Prieto, Corporate Nursing Education Manager • Debbie Ashikawa, Ontario Nurses Association • Shirley Bell, Clinical Nurse Educator, General Internal Medicine • Lorraine Ciccarelli, RN, Pain Services • Elizabeth Datars-Shkolnik, RN, Perioperative Services • Michelle Williams, Clinical Nurse Educator, Cardiac and Vascular Intensive Care Unit • Stephanie Munger-Ferrara, RN, Outpatient Mobility

Nursing Week 2019 Highlights National Nursing Week was celebrated at St. Michael’s Hospital from May 6th to May 10th, in alignment with Florence Nightingale’s birthday. This year the International Council of Nurses (ICN) selected the theme: “Nurses: A Voice to Lead – Health for All’ which reflects the fact “every nurse has a story and every story has the potential to improve the health system and enable individuals and communities to achieve their highest attainable standard of health. From these insights comes the power for change”. “Health for All” means “not just the availability of health services, but a complete state of physical and mental health that enables a person to lead a socially and economically productive life.” (CNA, 2019).

Based on the feedback from past post Nursing Week evaluations, St. Michael’s events also focused on health and wellness.

The Nursing Week Planning subcommittee of the Nursing Advisory Council organized and hosted a number of popular events and activities, including the Nursing Week Night Shift Breakfast and Musical Entertainment, Kickoff Celebration, Visit to night staff with Chief Nursing & Health Disciplines Officer, Nursing Excellence Awards and Scholarship Ceremony, Best Practice Guideline (BPG) Sustainability Poster Gallery Walk and Nursing Talent Showcase.

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St. Michael's Nursing Week Schedule 2019 Unity Health Toronto May 6 -10 "Nurses: A Voice to Lead - Health for All" MONDAY, MAY 06

Schedule of Events

TUESDAY, MAY 07

WEDNESDAY, MAY 08

THURSDAY, MAY 9

UNITY HEALTH TORONTO

2019 St Michaels' Hospital Nursing Week Schedule of Events

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’.

Opening remarks from Don Naduriak, Musician, SMH volunteer and former patient Don Naduriak joined the Nursing Week breakfast for his fifth consecutive year sharing his musical talent and saying “thank you” to nurses for the care that he received over five years ago when he was treated for a GI bleed at St. Michael’s. Don acknowledged all the nurses who were part of his care team at different stages of his hospital stay. Don recalled the nurse in the Emergency Department who “warmly, cheerfully and compassionately” assisted him before going on to surgery and then to recovery and intensive care. “I can’t really express how much the compassionate care and kindness I was shown meant to me, especially at a time when I was so vulnerable and needy. There were various events that impressed me,” said Don. Don Naduriak, St Michael’s Hospital There were various people who impressed Don. He Volunteer recalled two young nurses who walked with him from intensive care to his first room on a medical/surgical floor.

When he thanked the nurse’s one responded by stating, “Well, it’s our job.” Don responded, “Well, yes it is your job, but it’s the attitude with which you do your job that is so important, perhaps the most important aspect of it.” Don recounted that during his hospital stay that he gained strength through compassionate nursing care. He believes the “helping, healing attitude to be wide spread” amongst all St. Michael’s nurses who meant so much to him.

Don stated, that among the day-to-day jobs, “You fill an important gap, an emotional gap in the process of healing that patient, in this case, me. The gap that can only be filled, over time, with care and compassion, and that’s what I found here.” Don is grateful and he wanted to give thanks for the nursing care he received. “What can I give to say thanks? Well, I’m a musician, and I spend most of my time with a piano. I love to play. As you may know most musicians don’t make a lot of money, so I couldn’t really dedicate a wing to you, but perhaps I can give what I have, some time and some music. I just hope to inject a little peace and relaxation into a very stressful atmosphere” said Don.

Ashley Skiffington, Evidence Practice Nursing Manager with staff nurse at the Nursing Week Night Shift Breakfast

Sonya Canzian, EVP, Clinical Programs, Chief Nursing and Health Discipline Officer and nurses at the Nursing Week Night Shift Breakfast

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Nursing Week Kickoff Event Keynote Address How Nurses Can Maintain Resiliency While going Through Times of Change and Uncertainty

Photo:Dr. Mike Condra, Ph.D., C.Psych, Compassion Fatigue Specialist, Adjunct Assistant Professor in the Department of Psychology at Queen’s University

This year’s Nursing Week Kickoff celebration keynote speaker was Dr. Mike Condra. Dr. Condra is a Psychologist, Compassion Fatigue Specialist and Adjunct Assistant Professor in the Department of Psychology at Queen’s University. The title of his keynote was, “How Nurses Can Maintain Resiliency While going Through Times of Change and Uncertainty”.

His address was well received by a full audience. One attendee described him as “down-to-earth, someone who had lived change, and someone who understood individuals going through great change and all the stress associated with that”. Dr. Condra spoke to a number of strategies for bedside nurses, managers and executives to consider in helping to strengthen individuals’, teams’ and the organization’s resiliency while going through change. One powerful strategy he spoke of was to remind yourself why you became a nurse. The keynote address was videotaped and available for viewing following the kickoff celebration.

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Nursing Week Best Practice Guideline Sustainability Poster Gallery Walk This annual Nursing Week event recognizes and celebrates all the nurses and teams who have led and mentored Registered Nurses’ Association of Ontario (RNAO) Best Practice Guideline (BPG) initiatives in the past year. This year we celebrated St. Michael’s seventh year as a designated RNAO Best Practice Spotlight Organization (BPSO) and the implementation of 39 BPGs since 2009. We also celebrated and recognized the many nurses and teams who were instrumental in implementing 32 BPG quality improvement initiatives across 24 different clinical areas from October 2018 to March 2019. These initiatives were led by 42 BPG Nurse Champions and supported by BPG Unit mentors and Professional Practice mentors. Champions and mentors were also recognized during a pinning ceremony at the event.

The 2019 Piera Cardella Scholarship recipient was the Inpatient Mobility Unit for their BPG initiative entitled, ‘Managing Responsive Behaviours on the Inpatient Unit’. The BPG Nurse Champion from Inpatient Mobility Olga Krasik presented an overview of her initiative. Jennifer Cardella, daughter of the late Piera Cardella was presented with flowers and thanked for her family’s generous gift.

Mentorship for this BPG initiative was provided by Shawna McIntyre, Clinical Nurse Educator (Unit Mentor), Ashley Skiffington, Evidence Based Practice Manager (Professional Practice Mentor) and Ines DeCampos, Clinical Leader Manager, Inpatient and Outpatient Mobility.

Joining in the celebration was Heather McConnell, RN, BScN, MA(Ed), Associate Director of Guideline Implementation and Knowledge Transfer at the RNAO. Heather provided inspiring opening remarks and spoke to the importance of BPG Nurse Champions and the leadership role they have in making meaningful improvements to the quality of patient care and work environment. International RNAO BPSOs visitors from Peking University First Hospital in Beijing, China and Lanzouh University Second Hospital in Lanzouh, China also attended the event with the RNAO to learn about SMH BPSO achievements. A virtual poster gallery was created and is accessible on the Nursing Week intranet page.

BPG Mentor Pin

Cardella Scholarship Award Recipient 2019 from Inpatient Mobility Unit: Olga Krasik, RN with Jennifer Cardella (right) Heather McConnell, Associate Director Guideline Implementation and Knowledge Transfer, Registered Nurses’ Association of Ontario (RNAO) (left) with Ashley Skiffington, Evidence Based Practice Nursing Manager; Mallory Harris, RN Emergency Department and Murray Krock, Director, Nursing Practice and Education at St. Michael’s Hospital Nursing Week BPG Sustainability Poster Gallery Walk 2019

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Nursing Week Best Practice Guidelines Sustainability Poster Gallery Walk Nursing Week Greetings from Heather McConnell 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 Board President, Dr. Angela Cooper-Braithwaite, and our Chef Executive Officer, Dr. Doris Grinspun. I'd like to thank Ashley for the invitation to join you today - this event is one of the highlights of my Nursing Week. I am proud to be part of St. Michael's Nursing Week celebrations, as we acknowledge your commitment as a Best Practice Spotlight Organization designate, your dedication to evidencebased practice, and to enhanced outcomes for your patients, health care providers, your organization and the health system.

When the idea of creating a program of nursing best practices first emerged 20 years ago, no one at the Registered Nurses’ Association of Ontario imagined that the program would be where it is today. From the first four guidelines published in 2002, the program has developed 54 Heather McConnell, best practice guidelines on clinical and work environment topics. As we Associate Director, all know, through the leadership and commitment of your BPSO team Guideline Implementation and and Best Practice Champions, St. Mike’s has implemented and sustained Knowledge Transfer Registered numerous clinical and healthy work environment best practices guidelines Nurses' Association of Ontario since you started your BPSO work ten years ago in 2009 - in fact, more than any other acute care BPSO, if my count is correct! This work has had a positive impact on the practice of all staff, and the outcomes for your patients and their families. We’ve long known that members of the public consider nurses as the most trusted of health-care professionals, regarded for the compassionate care that we provide. However, you’re evidence-based BPSO work and this Nursing Week celebration 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.

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 Ontario, across Canada and internationally. The program was established as an organizational level implementation strategy to support the uptake of the clinical guidelines the Registered Nurses’ Association of Ontario had just started to publish. The BPSOs were initially conceptualized as “living labs”, where we could collectively learn from, and with, each other how to effectively implement and sustain practice change in complex health care organizations across the continuum of care. As of this month, the Registered Nurses’ Association of Ontario is proud to state that the Best Practice Spotlight Organization Program has engaged over 800 health care and academic organizations. There are BPSOs in almost 20 countries, and many more are on the way. St Michael's Hospital is leading the way as part of this international group of health organizations and academic centres. The common thread you share is the desire to prepare nurses and other health care providers 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 collectively you are helping to make our health-care systems more effective, efficient and responsive.

I would like to express our appreciation to St. Michael’s BPSO team for your generous support of so many of our international BPSOs as they visit Toronto. In particular, I'd like to thank you for your gracious hosting today of BPSO leads from two of our BPSOs in China who have accompanied me here today - Peking University First Hospital (Beijing), and Lanzhou University Second Hospital (Lanzhou). These nursing leaders are here for study visits with the RNAO and various BPSOs to learn more about evidence-based practice, guideline implementation, evaluation and sustainability, and I know that their time with you here today will enhance their learning experience and provide new ideas on introducing and supporting practice change. A sincere thank you for welcoming them here today.

We are so proud that nurses and other health professionals working in a variety of roles at St. Mike's have been so actively engaged as Champions in planning, implementing, evaluating and sustaining practice changes. The critical structures you have put in place to support capacity building and professional development through your Champions, the projects they have undertake with the support of local teams and the guidance of Unit Mentors has provided a foundation for the knowledge and skills necessary to integrate evidence-based practices into everyday work, and ultimately sustain those changes for the long-term.

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Nursing Week Greetings from Heather McConnell (cont'd.)

Today's BPG Sustainability Gallery Walk is a unique expression and celebration of your commitment to evidencebased practice. The importance of having clinical nurses in the role of Champions in leading practice change cannot be underestimated - it is clear from all here today, and the work you are highlighting through your posters, that you have, indeed, made a difference in practice for the teams you work with and the patients you care for. The support of your mentors in guiding your exploration of new knowledge and skill is fundamental to a knowledge profession, and I look forward to meeting the many mentors who are here with the Champions today. In addition to improving patient outcomes as I mentioned previously, your work also empowers and energizes nurses, transforms nursing practice, raises the profile of nurses as knowledge professionals and has contributed to addressing St. Michael’s strategic directions and priorities.

I’d like to congratulation all those gathered here today that have contributed to the planning and preparation for your Nursing Week celebrations and today's Gallery Walk. Our colleagues from China, RNAO team members in attendance and I are truly looking forward to reviewing your posters and discussing your work, learning from you and with you about the unique opportunities that your work as Champions has opened for you, and the goals you have achieved. We are excited to be able to join you at this point in your professional journey, and I look forward to continue to follow St. Mike's evolution as a Best Practice Spotlight Organization. By applying the best knowledge and evidence, nurses and other health-care professionals are ensuring the care they provide for patients and families at St. Michael's Hospital is the very best. And for that, our sincere thanks.

In closing, I would like to take this opportunity to wish you all the very best for a happy, memorable Nursing Week! Thank you again for the opportunity to join you today for this very special event.

Recently, to celebrate 20 years of the BPG Program, RNAO published a book entitled Transforming Nursing Through Knowledge. Best Practices Picture: Heather McConnell, Associate Director - Guideline Implementation and Knowledge for Guideline Development, Transfer, Registered Nurses’ Association of Ontario (RNAO) ; Ashley Skiffington, Evidence Implementation Science, and Based Practice Nursing Manager with Chinese delegates at St. Michael’s Hospital Nursing Evaluation. This publication Week BPG Sustainability Poster Gallery Walk 2019 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 profiled, 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 reflections on the strategies St. Michael’s has utilized to imbed evidencebased 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 influence 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 effective, efficient 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.

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Nursing Week Talent Showcase The Nursing Talent Showcase profiled St. Michael’s nurses’ artistic talents and promoted health and wellbeing through creative arts. This was the fifth annual showcase featuring paintings, drawings, window boxes, poetry, knitting, crocheting, indoor plants and floral arrangements. There was also a creativity station set up for attendees to take time to be creative through colouring, drawing and/or creating cards.

Aestus Rogers, RN , Perioperative Services Knitting

Gyan Sandhu, RN , MSICU Painting

Chris Carless, RN, Cardiology Painting

Kryene Fabroa, RN, General Surgery/ Gastroneterology/Plastics Paper Floral Design

Maureen Leslie, RN, TNICU Poetry

Cecilia Santiago, Nursing Practice Manager Creative Gardening

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Nursing Week Talent Showcase (cont’d.)

Vanessa Chavez Prieto, Corporate Nursing Education Manager Floral Arrangement

Shannon Steele, RN (left) Pauline Bowers,RN (right) General Surgery/Gastroneterology/Plastics Knitting

Alyssa Alanguilan, RN, Trauma Neurosurgery Calligraphy and Drawings

Sophie Garmulewicz, RN, Inpatient Mobility Acrylic Painting

Lynn Hilton-Nat, RN, Inpatient Mental Health Crochet Animals

Nurses engaged in freestyle sketching at the Nursing Talent Showcase Creative Corner

University of Toronto Bloomberg Faculty of Nursing provided treats for nurses who attended the Nursing Talent Showcase Nursing Advisory Council Report 2018-2019 | 35

2019 Nursing Excellence Awards, Scholarship and Fellowship Recipients St. Michael’s twelfth annual nursing recognition ceremony celebrated nurses for their contribution to excellence in patient care, quality, education and research. The Nursing Week Planning subcommittee received forty five (45) Nursing Excellence Award nominations from nurses, physicians, managers, health discipline colleagues, students and support staff, representing diverse nursing roles at St. Michael’s, including frontline nurses, clinical leader/managers, program directors, nurse practitioners, clinical nurse educators and clinical nurse specialists. Recipients of the Syron Graduate Nursing Fellowship, Chuckie Shevlen Scholarship, Theresa Ann Ford awards, Parthenia Maria Wilson Nursing Education Grant and the Mehramat and Satwant Gill Nursing Scholarship were also recognized during the ceremony.

Nursing Excellence Award Recipients

Parthenia Maria Wilson Culture of Caring Recipient Maria Rodrigues-Fernandez, Registered Nurse General Internal Medicine

Culture of Discovery Award Recipient Samantha Scime, Registered Nurse Medical Day Care Unit

Healthy Work Environment Award Recipient Registered Nurses on the Mental Health FOCUS Team: Ryan Hoekstra, Susan Brittany, Llijah Pearce, Hart, Katherine Edmond and Jessica Ferrara (not photographed)

C. William and Ruth Daniel Innovation in Nursing Award Recipient Samantha Boumeester, Registered Nurse Withdrawal Management Services

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2019 Nursing Excellence Awards, Scholarship and Fellowship Recipients

Elizabeth Crawford Clinical Scholarship Award Recipient Eliane Stockler-Leite, RN Medical Surgical Intensive Care Unit

Chuckie Shevlen Scholarship Recipient Virginia Wojcik , RN After Hours Clinical Manager Diabetes Comprehensive Care Program

Parthenia Maria Wilson Nursing Education Grant Recipient Newton Leong, Registered Nurse Family Health Team

The Mehramat and Satwant Gill Nursing Scholarship Recipients Esmee Carson, Nurse Practitioner, Heart and Vascular Program and Alicia Polato, Nurse Practitioner, Heart and Vascular Program

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2019 Nursing Excellence Awards, Scholarship and Fellowship Recipients -Theresa Ann Ford Awards

Theresa Ann Ford Annual Clinical Nurse Educator Award Recipient Michelle Williams, Clinical Nurse Educator Heart and Vascular Program

Theresa Ann Ford Preceptorship Award (Newly Hired Nurse) Recipient: Mercedes Valera, Registered Nurse Inpatient Trauma and Neurosurgery

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Theresa Ann Ford Preceptorship Award (Undergraduate Student) Recipient Chrissy Wong, Registered Nurse General Internal Medicine

Theresa Ann Ford Preceptorship award (Graduate Nurse) recipient: Joyce Fenuta, Program Director Specialized Complex Care

2019 Syron Graduate Education Fellowship Recipients

2019 Syron Graduate Education Fellowship recipients photographed with donors, Bernie and Mildred Syron and Sonya Canzian, VP Clinical Programs, Chief Nursing & Health Disciplines Officer (far right) and Dr Tim Rutledge, President and CEO, Unity Health Toronto (far left)

List of 2019 Syron Graduate Eduaction Fellowship Recipients (in alphabetical order) 1.

Gabriela Escobar, RN, Multiple Sclerosis Clinic

2.

Anne Kha, RN, Medical Surgical Intensive Care Unit

3.

Samantha Scime, RN, Oncology/Hematology/HIV

4.

McKenzie Querillon, RN, Endoscopy

5.

Newton Leong, RN, Family Health Team

6.

Chantel Barry, RN, Trauma Neurosurgery Intensive Care Unit

7.

Yuriy Ilyin, RN, Mental Health Emergency Services

8.

Lhamo Dolkar, RN, Cardiovascular Surgery

9.

Vanessa Rozario Roy, RN, Trauma Neurosurgery Intensive Care Unit

10. Katrina Flores, RN, Inpatient Trauma and Neurosurgery 11. Julie Arsenault, RN, Trauma Neurosurgery Intensive Care Unit 12. Olga Levi, RN, Medical Surgical Intensive Care Unit 13. Samantha White, RN, Inpatient Trauma and Neurosurgery 14. Miranda Priestman, RN, Inpatient Trauma and Neurosurgery 15. Shannon Swift, Clinical Nurse Educator, Medical Surgical Intensive Care Unit 16. Tatyana Nichkasova, RN, Medical Surgical Intensive Care Unit 17. Arjay Ordona, RN, Emergency 18. Elyse Ancrum, RN, Inpatient Trauma and Neurosurgery 19. Kristen McMillan, RN, Trauma Neurosurgery Intensive Care Unit Nursing Advisory Council Report 2018-2019 | 39

Remembering Piera Cardella, Donor The Piera Cardella Nursing Scholarship was established in 2013, by the family of the late Piera Cardella, in memory of her nursing career and focus on quality improvement. The scholarship was established to fund nursing quality improvement projects in alignment with St. Michael Hospital's strategic commitment “to build quality improvement across all aspects of our work.�

Professional Practice, Nursing Practice and Education engages local nursing leadership to identify and support quality improvement ideas. Once the topic focus and clinical area have been determined and agreed to, clinical areas will solicit interest from RNs by an application process. Funds will be utilized to backfill or provide salary support for RN(s) engaged in the initiative. The chosen scholarship project begins during the fall and completed by the end of the fiscal year (March 31st). Nursing Professional Practice provides ongoing support to ensure identified initiatives are well defined, utilize quality improvement approaches and are linked to best practices (including Best Practice Guidelines where applicable). The recipients of the Piera Cardella Scholarship are recognized during Nursing Week at the Best Practice Guideline (BPG) Sustainability Poster Gallery Walk event.

Piera Cardella Scholarship Recipients 2013-14

Project: Reducing Foot Complications for People with Diabetes and Assessment and Management of Foot Ulcers for People with Diabetes Nurses from Family and Community Health Team: Jane Parry, Health Centre; Jennifer Bugera; Allison Curry; Patricia Griffith; Karin Bogad Pictured with the Cardella Family and Bob Howard, previous CEO, SMH at the 2014 Nursing Week BPG Sustainability Poster Gallery Walk

2014-15

Project: Improving Metabolic Monitoring in the Community Mental Health Service Nurse from Mental Health and Addiction Services: Vi Linlet Ensoy, STEPS for Youth Program, Community Mental Health Pictured with the Cardella Family and Ella Ferris, previous Chief Nursing Executive SMH at the 2015 Nursing Week BPG Sustainability Poster Gallery Walk

2016-17

Project: Intrahospital Transfer of Accountability: 2 Donnelly to Medical Imaging Nurse from Haematology/Oncology/HIV, Specialized Complex Care: Suzanne Scotland; Carl Leushuis Pictured with the Jennifer Cardella at the 2017 Nursing Week BPG Sustainability Poster Gallery Walk

2017-18

Project: Standardizing Advance Care Planning Assessment with Cystic Fibrosis Patients Nurse from Respirology Department, Specialized Complex Care: Jessie Kar Yan Chiu; Erin Cuaresma; Grace Appiah- Kubi Pictured with the members of Professional Prcatice and Heather McConnell from the RNAO at the 2018 Nursing Week BPG Sustainability Poster Gallery Walk

2018-19

Project: Managing Responsive Behaviours on the Inpatient Mobility Unit Nurse from Mobility Program: Olga Krasik, Inpatient Mobility Pictured with the Jennifer Cardella at the 2019 Nursing Week BPG Sustainability Poster Gallery Walk event

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Global Nursing Scholars Program St. Michael’s Hospital was pleased to host international visitors through the Global Nursing Scholars Program at the Lawrence S. Bloomberg’s Faculty of Nursing. The program focuses on international initiatives to create dynamic partnerships and collaborations with global organizations. It provides learners with opportunities to advance their nursing practice, scholarship and leadership capacity. The Global Nursing Scholars Program also provides exposure to the broader academic health network including affiliate hospitals like St. Michael’s.

Photo Credit: Google Images

Heart and Vascular Program hosted registered Nurse Yip Fung Kiu Shirley in the following clinical areas: • Cath Lab • Cardiac Intensive Care Unit • Cardiovascular Unit Specialized Complex Care Program hosted 3 Registered Nurses Leung Shan, Lin bik Shan Josephine, and Wong Chung Wa in the following clinical areas: • Oncology unit • Medical Day Care unit • Palliative care unit • Breast Centre (CIBC) This year St. Michael’s hosted 5 visitors from Hong Kong Sanatorium & Hospital located in Hong Kong, China who were undertaking an international clinical observership in the following clinical units and programs, special thanks to the following staff who made this possible: • • • • • • • • • • •

Vanessa Chavez Prieto, Corporate Nursing Education Manager, Professional Practice Murray Krock, Director Nursing Practice Education, Professional Practice Orla Smith, Clinical Leader Manager, Heart and Vascular Program Victoria Buczek, Clinical Leader Manager, Heart and Vascular Program Michelle Williams, Clinical Nurse Educator, Heart and Vascular Program Emily Kennedy, Clinical Nurse Educator, Heart and Vascular Program Kimberly Tan, Clinical Nurse Educator, Heart and Vascular Program Charmaine Mothersill, Clinical Leader Manager, Specialized Complex Care Program Anna Kacikanis, Clinical Leader Manager, Specialized Complex Care Program Ekaterina Mikhelson, Clinical Nurse Educator, Specialized Complex Care Program Rosemarie Rivera, Clinical Nurse Educator, Specialized Complex Care Program

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My Nursing Intranet Page: A Nursing Advisory Council Accomplishment The 2013 St. Michael’s Hospital Staff Engagement Survey results indicated that nursing staff 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 staff nurse colleagues. A Nursing intranet working group was established in 2014 with representation from Nursing Advisory Council, Communications, Professional Practice and clerical staff. 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.

Picture: Icons on the My Nursing Intranet Page, June 19, 2019

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Nursing Advisory Council 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.

Date

2018 Presenters

2019 Presenters

January

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

Mobility Program Stephanie Munger Ferrara, Staff Nurse, Outpatient Mobility

February

I am Wellness Certificate Shivalee Paliwal, Performance and Wellness Consultant

Perioperative Services Karen D’Souza, Staff Nurse, Ambulatory Care, Surgical Day Care

March

Inner City Health Vivian Iwenofu, Staff Nurse, 14CC

Diabetes Comprehensive Care Program Meriam Jayoma-Austria, RN, BScN, CNeph(C) Renal Transplant Nurse Coordinator – Pre Transplant Assessment

April

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

Heart and Vascular Program Lucksshika (Lucky) Thivakaran, Staff Nurse Cardiac and Vascular Surgery

May

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

Family Health Team Laura Drygas, Staff Nurse Health Centre at 410 Sherbourne

June

Specialized Complex Care Kyrene Fabroa, RN, 16CCN: General Surgery, Gastroenterology, Plastics

September

Community Mental Health and Addiction Services Ryan Hoekstra, RN, Community Mental Health

October

Specialized Complex Care Program - 4CC Marotta & Squires Medical/Surgical Clinics for the Adult Population Irene Pryshlak, Staff Nurse, Specialty Clinics

November

Labour & Delivery, NICU, Obstetrics & Gynaecology Galina Davydova, Staff Nurse, Labour and Delivery

December

Inpatient Mental Health Unit Jennifer Rogers, Staff Nurse, Mental Health and Addictions Service

Nursing Advisory Council Report 2018-2019 | 43

St Michael's Hospital Shool of Nursing Pin, 1942

St Michael's Hospital Nursing Cape, 1942

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

44 | Nursing Advisory Council Report 2018-2019

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

Nursing Excellence Grant Recipients 2018/19 Recipient

1

Anna De Marchi

Title

Clinical Leader Manager

Unit/ Area

Conference Name

Location

Presentation title

Women's Health

43rd Annual AAACN Conference

Florida

Two Ambulatory Clinic Models Compared: Can the Efficiency of an Ambulatory Clinic Be Improved by Implementing Operating Standards?

Charlottetown, PEI, Canada

Nurse Led Initiative and Implementation of Transfer of Accountability Tool in the Breast Center

2

Aryam Kidane

Staff Nurse

Breast Center

30TH CANO/ ACIO Annual Conference

3

Bertha Hughes

Nurse Practictioner

Heart and Vascular

Canadian Society of Vascular Nursing

Montreal, Quebec

The Root of All Evil

Staff Nuse

HIV/ Haematology/ Oncology

CANO/ACIO

Charlottetown, PEI

An Interdisciplinary Approach to Addressing Malnutrition Among Oncology Patients

Staff Nurse

HIV/ Haematology/ Oncology

Canadian Association of Nurses in Oncology (CANO)

Charlottetown, Prince Edward Island

Integrating Smoking Cessation Practices Among Cancer Patients in an Ambulatory Cancer Setting

Staff Nurse

Renal Transplant Clinic

European Transplant Nursing Symposium

Berlin, Germany

ABO-incompatible kidney transplantation using ABO Immunadsorption Columns: The North American Experience

4

5

6

Carl Leushius

Criselda Gonzales

Galo Meliton

Nursing Advisory Council Report 2018-2019 | 45

Nursing Excellence Grant 2018/19 Recipients (cont’d.)

Recipient

7

8

9

10

Jeanne Zielonka

Unit/ Area

Conference Name

Nurse Practitioner

18th National Neonatal Nurses Conference

18th National Neonatal Nurses Conference

Women's Health

Spring National Advanced Practice Neonatal Nurses Conference

Karen Carlyle

Nurse Practitioner

Karen Wannamaker

Past Clinical Leader Manager

Lee Barratt

11

Maria Laylo

12

Michaela McCrady

13

Title

Rachel Tong

Nurse Practitioner

Staff Nurse

Staff Nurse

Staff Nurse

MSICU

AACN NTI

Emergency Department

3rd Global Conference on Emergency Nursing & Trauma Care

Location

Presentation title

New Orleans, Louisiana

The Effect of Eyemasks on Reducing Distress Associated with the Retinopathy of Prematurity

Portland, Oregon

Infant Cuddler Study: Neonatal Abstinence Syndrome and Impact of the Family Support Program

Boston, USA

Keeping our Patients Safer with Enhanced CPE Screening in a Medical Surgical Intensive Care Unit

The Netherlands

Turn up the Heat!

It’s Not Cool to be Cool: Understanding Hypothermia in Trauma Patients

2 Donnelly

CANO conference

Prince Edward Island

Integrating Smoking Cessation Practices Among Cancer Patients in an Ambulatory Cancer Setting

2 Donnelly

30TH CANO/ ACIO Annual Conference

Charlottetown, PEI

Nurse Led Initiative and Implementation of Transfer of Accountability Tool in the Breast Center

Home Dialysis

Canadian Association of Nephrology Nurses and Technologists

Quebec City, Quebec

Home Dialysis Training Videos

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Nursing Excellence Grant 2018/19 Recipients (cont’d.)

Recipient

14

15

16

Samantha Scime

Title

Staff Nurse

Samra Sukhjeet

Staff Nurse

Shannon Swift

Clinical Nurse Educator

Unit/ Area

Conference Name

Location

Presentation title

Medical Day Care

30TH CANO/ ACIO Annual Conference

PEI, Canada

Optimizing Sexual Health and Emotional Well-Being for Breast Cancer Patients and Survivors through Nurse-Led Interventions’

Home Dialysis

Canadian Association of Nephrology Nurses and Technologists

Quebec City, Quebec

‘Home Dialysis Training Videos’

Boston, USA

‘Keeping our Patients Safer with Enhanced CPE Screening in a Medical Surgical Intensive Care Unit’

MSICU

AACN NTI

Nursing Advisory Council Report 2018-2019 | 47

Nursing Practice and Education Corporate Initiatives and Collaboration Quality Improvement Initiatives Best Practice Spotlight Organization Sustainability 2019 marks St. Michael’s eighth year designated as a Registered Nurses’ Association of Ontario (RNAO) Best Practice Spotlight Organization (BPSO). In 2018/2019 Nursing Practice and Education supported BPG implementation, evaluation and sustainability activities across the organization by: • Offering 4-hour monthly BPG Communities of Practice (CoPs) from October 2018 to March 2019 • Supporting 42 BPG Nurse Champions implementing 32 BPG initiatives across 24 clinical 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

2018/19 BPG CoP Kickoff

2018/19 BPG Nurse Champions and Mentors

A focus of this year’s BPG initiatives was on introducing debriefing processes and other wellness offerings to support nurses health and wellbeing, based on recommendations from the RNAO BPG ‘Workplace Health, Safety and Well-Being of the Nurse’. The standardization of transfer of accountability (TOA) at different patient transfer points across clinical areas continue to be a focus for units this year, based on recommendations from the RNAO BPG entitled ‘Care Transitions’. Also, managing responsive behaviours was a large focus of many initiatives which were informed by the RNAO BPG entitled ‘Caregiving Strategies for Older Adults with Delirium, Dementia and Depression’. To learn more about the initiatives that were underway, look for the third edition of our annual BPSO Newsletter entitled ‘Shining a the Light on St. Michael’s Best Practice Spotlight Organization Achievements’ which will be released Fall 2019. The 2018 edition and other information including this year’s BPG Nurse Champion posters and tools can be found on SMH BPSO intranet page.

The BPG CoP is evaluated every year. Results from past BPG CoP Evaluations were presented by Ashley Skiffington at the Nursing Leadership Network of Ontario Conference in March 2019 and the Annual RNAO BPSO Symposium in April 2019. In 2018/19 SMH was proud to host visitors from international RNAO BPSOs. The BPSOs came to SMH to learn about how we have implemented BPGs in our clinical areas and the impact BPGs have within our organization. Visitors came all the way from Spain in February and China in April 2019.

Nursing Professional Practice team members with the international BPSO site visitors from Spain (left) and China (right).

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Preventing Falls is SIMPLE Program Falls Prevention has been a corporate quality priority at St. Michael’s (SMH) since 2013. The ‘Preventing Falls is SIMPLE’ program was implemented across all medical/surgical inpatient care units in 2012. Following an extensive evaluation of the program led by Professional Practice in 2014, the SMH Falls Steering Committee was established in 2015. It is co-chaired by the Directors of Nursing Practice and Education and Health Disciplines Practice and Education. Membership includes: Nursing, Health Disciplines, Pharmacy, and Clinical Leaders/Managers with consultation from Clinical Informatics, Decisions Support and Quality.

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 SMH. Responsibilities include: • Monitoring the implementation, ongoing evaluation and sustainability of the Preventing Falls is SIMPLE Program • Identifying and making recommendations for ongoing improvements (e.g., Soarian enhancements) • Providing support and direction to units on work streams and targeted quality improvements • Reviewing falls with harm according to unit completion of the Falls with Harm: Standard Review Template and make recommendations for corporate improvements based on identified findings Components of the ‘Preventing Falls is SIMPLE program are: • Screening for falls risk: Fall Risk Assessment tool • Implementing falls risk care plan: SIMPLE Interventions tool • Patient and family education • Communication of fall risk within the health care team The major undertaking of the Falls Steering Committee in 2017-18 was the development of guidelines, documentation and education for using falls risk mitigation tools (bed-exit alarms and low beds).

In 2018-19 the group spear headed the development of corporate guidelines to support intentional rounding across all inpatient medical/surgical units. An interporfessional working group was established and undertook an in-depth literature search, consultation through the Professional Practice Network of Ontario and focus groups with front line clinical staff who previously implemented intentional rounding with the support of Nursing Professional Practice and Education and best practice guideline implementation. The corporate guidelines and the experience and sustainability of intentional rounding by clinical teams will support the implementation on three remaining SMH clinical units.

The Falls Steering Committee acknowledges and thanks Colleen McNamee, former Corporate Nursing Education Manager and Colleen Dunphy, former interim Manager, Collaborative Practice and Education for their leadership on this work.

With the launch of the new Compass CUE Dashboard, Nursing Professional Practice reviewed data collection methodology with Decision Support for the completion of the SIMPLE Interventions tool when a patient is assessed at risk for falls. We identified that the methodology did not identify if a patient was reassessed after their initial admission Falls Risk assessment and subsequently reassessed as not a falls risk. The corrected collection of this data in the electronic documentation system has demonstrated a significant increase in unit SIMPLE compliance rates.

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Preventing Falls is SIMPLE Program (cont'd.)

There was no necessary change to Falls Risk assessment methodology. Congratulations to all inpatient medical/surgical nurses and clinical teams who consistently work to prevent falls and keeping patients safe.

The Unity Health Toronto Falls Network has been established in the last year. All three hospital sites have implemented falls prevention programs with the goal of identifying risk factors and reducing falls through interventions.

For this reason, the Falls Network has three overarching goals: • Reducing the number of patient falls cross Unity Health Toronto • Reducing the severity of falls if they occur • Facilitating a coordinated approach to falls prevention and injury reduction with the in the Network, while recognizing the unique needs across the sites, programs and services.

Accordingly, falls prevention and injury reduction is included in the 2019-20 Unity Health Toronto’s Quality Improvement (QIP) Work Plan. Each site will be working to reduce the number of falls with serious injury (moderate harm, sever harm, death) that occur. Two Network change ideas that may assist in reducing all falls including serious injury are: • partnering with patients/residents and their caregivers around safety and falls prevention • standardizing post-fall debrief and huddle process at all sites • as noted above, SMH has also committed to implementing intentional rounding on three remaining inpatient units.

Care Utilizing Evidence (CUE) Dashboard The CUE Dashboard is an interactive electronic dashboard displaying: • process and outcome measures linked to nursing Best Practice Guidelines (BPGs) • shares narrative accounts from patient and family satisfaction and staff satisfaction datasets This audit and feedback mechanism provides clinicians a vehicle for conversation around the impact of BPGs on patient care and experience. It also supports BPG uptake and sustainability for unit specific initiatives and corporate initiatives including falls, delirium and TOA. The CUE Dashboard was originally designed and implemented across multiple clinical departments by the Picture: CUE Dashboard Interface Nursing Research Team in 2011.

Twelve clinical areas have a CUE Dashboard that is updated by Nursing Professional Practice on a quarterly schedule. The updated CUE Dashboard is sent to unit Clinical Leader/Managers and members of the leadership team who then share the data with clinicians. Based on unit preference, the dashboard is available on smart boards, continuous loop monitors, shared drives, email, unit computers, and/or bulletin boards.

The Evidence Based Practice Nursing Manager and Nursing Practice Manager meet with the unit Clinical Leader/Manager and unit leadership team on a quarterly schedule to review the data and discuss challenges and successes in relation to meeting targets.

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Compass CUE Dashboard Nursing Professional Practice in collaboration with Decision Support Services (DSS) developed a care utilizing evidence (CUE) Dashboard on the Compass Portal entitled Compass CUE Dashboard.

As of November 2017, metrics that were collected from nursing documentation on Soarian Clinicals and displayed on the unit CUE Dashboard are now accessible on the Compass CUE Dashboard.

The Compass Portal has streamlined the data collection process for Soarian indicators resulting in improved access and decreased data lag time from 2-3 months to 1 month.

The roll-out of the Compass CUE Dashboard involved drop-in learning sessions for users and the development of a user resource guide.

The screenshot below is of the Compass CUE Dashboard and reveals the indicators that are collected and displayed for the following clinical areas: • Oncology/hematology • Respirology • Cardiac and Vascular Surgery • Cardiology • Obstetrics/Gynecology/Labour and Delivery • General Surgery • Palliative Care • Trauma/Neurosurgery • General Internal Medicine • Inpatient Mobility Unit • Inpatient Mental Health • Nephrology Clinical Leader/Managers and unit leadership teams can access the Compass CUE Dashboard through a button located on their existing CUE Dashboard, desktop icon or website link.

Picture: Compass CUE Dashboard Interface

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Late Career Nurse Initiative Late Career Nurse Initiative (LCNI): Expert Nurses Creating a Healthier Work Environment

2018/19 LCNI Participants

Thirteen nurses from different departments at SMH participated in the 2018/19 Ontario Ministry of Health and Long Term Care (MOHLTC) Late Career Nurse Initiative (LCNI). SMH LCNI is facilitated by Ashley Skiffington, Evidence Based Practice Nursing Manager in Professional Practice.

This year’s LCNI program was funded by Nursing Practice and Education.

The LCNI was designed by the MOHLTC 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 fifty-five 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 goal of St. Michael’s LCNI program is to enhance the work environment, quality patient care and staff satisfaction while supporting corporate objectives and priorities including the Corporate Strategic Plan and Our People Strategy.

In September 2013, St. Michael’s Nursing Practice & Education launched the LCNI program entitled, “Expert Nurses Creating a Healthier Work Environment.” This year marks the program’s sixth year providing 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 influence the quality of the work environment. LCNs are ideally positioned for this program as they are well respected by peers, viewed as role models, excellent resources and clinical experts SMH’s LCNI program involves a series of bi-weekly targeted professional development workshops and communities of practice from November to March. Refer to the diagram to the right to view the list of workshop topics.

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, understanding different generations in the workplace, preceptorship and DiSC.

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Late Career Nurse Initiative (cont'd.)

The program evaluations were overwhelmingly positive. One of this year’s LCNI participants created a poem to articulate her experience in the program (see below).

Late Career Nursing Initiative 2018-2019 Maureen Leslie, RN TNICU, 2018/19 LCNI Participant

The program confirmed; Never too late to learn.

The knowled ge, I’ve earn ed; I’ve used in return.

LCNI; I gave it a try.

Encouraged by others; So I did apply.

A move from daily, routin It expanded e and focus. my minds, th inking and locus.

We engaged with peers, a cross the org This boost th anization. e experience and improve d relations.

Through com munity of pr actice and a ction plannin g; I’ve noticed.

We can all b e leaders, an d mentors; T hat’s a bonu s.

Thanks to Pro fessional Pra ctice and Ed I would also ucation. h a ve to mention: Information specialist on Health inform ation.

Corporate H ealth and sa fety; Commu All answered nity Health Programs. my queries a nd conundru ms.

I learned m ore about Bes t Practice ev Guided by L& idence.

O developmen Learning styl t. es, mindfuln ess training ; I’ve grown in my element.

(Great to do , before retire The tools I’ve ment.) gained, I wil l definitely im I wrote this to plement. motivate oth ers, hope this it is evident.

Nursing Advisory Council Report 2018-2019 | 53

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 reflects 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 efficiently, effectively and collaboratively with all staff, 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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Managing Responsive Behaviours The Managing Responsive Behaviours/Constant Care Working Groupis an interprofessional group tasked to plan, implement, evaluate, sustain and spread initiatives that improve the capacity of interprofessional teams to prevent and manage responsive behaviours in patients, including those requiring constant care.

Responsive Behaviour / Constant Care Working Group- Front row left to right: Heather McDonald (co-chair), Cecilia Santiago (co-chair), Vanessa Chavez Prieto. Second row left to right: Oscar Cahyono, Mary Copeland, Judy Pararajasingham, Shirley Bell, Stephanie Lucchese, Lauren Massey.

Missing from the photo: Murray Krock, Lisa Buenaventura, Hazel Sebastian, Orla Smith, Connie Camilleri, Shawna McIntyre, Linda Stoyanoff, Vasuki Paramalingam, Kimberly Tan, Marnee Wilson, Melissa Guiyab, Allison Rinne (ML) / Alison Baker, Danielle Zvezdonkin (Picture by Katherine Cooper).

Managing Responsive Behaviours Program Elements of the Program 1. Four-hour workshop “Caring for Persons with Responsive Behaviours� designed to increase the knowledge, self-efficacy, and interprofessional collaboration of point of care staff 2. Best practice tools: collaborative care plans, My Story, and decision making algorithm 3. Person centred language guidelines

Managing Responsive Behaviours Education The four-hour workshop took place on General Internal Medicine (14CC), Trauma/Neurosurgery (9CC) and Cardiovascular Surgery (7CCN) where 479 point of care staff attended one of the 36 workshops in 2015-16. Moving forward to 2017-18, the components of the Managing Responsive Behaviours (MRB) education program were integrated into the Constant Care education curriculum, inclusive of the person centered language in documentation processes and emphasis on non-pharmacological interventions to prevent and minimize responsive behaviors.

Managing Responsive Behaviours Program Evaluation The MRB Research Group is one of the recipients of the inaugural Interprofessional Practice Based Research grant. The mixed method study is evaluating the impact of managing responsive behaviours education workshop on staff knowledge, confidence, interprofessional collaboration and the use of patient care plans. The manuscript has been submitted for publication and is currently under review.

Nursing Advisory Council Report 2018-2019 | 55

Constant Care Program Elements of the Program 1. Decision-making algorithm to guide teams on risk assessment, initiating, weaning, discontinuing and documentation of Constant Care 2. Documentation tools: Behaviour Tracking Log and electronic clinical documentation form

Constant Care Education Corporate Constant Care Education The education program used a blended learning approach comprised of eLearning module and faceto-face learning session for team members to apply the material from the eLearning module to a case scenario that was specific to the patient population and clinical area. Using a Train the Trainer model, nurse champions and clinical nurse educators provided the constant care curriculum to approximately 800 point of care staff in 2017-18.

Next step: incorporate the Constant Care education in the orientation program for new and returning point of care staff.

Constant Care Program Review Day On March 22, 2019, the first annual Constant Care Program Review Day was attended by participants from inpatient units including constant care champions and clinical nurse educators who joined last year’s 8-hour Constant Care Train the Trainer session. The purpose of the annual review was to: • Reinforce the elements of the Constant Care Program • Identify the Constant Care Program strengths, weaknesses, opportunities and threats • Update on sustainability strategies and future priorities • Overall, the review session was well attended with positive feedback!

28 participants from 11 different units accross the hospital 100% of participants indicated strongly agree/agree to the following statements: • The education is likely to alter my practice in the workplace • I experienced a substantial increase in knowledge by attending “Great opportunity to discuss strategies and share knowledge that will be transferrable to my unit.”

“Great case studies, it was interesting to hear how other units adopted the Managing Responsive Behaviours and Constant Care initiatives!”

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Constant Care Program (cont’d.)

Corporate Constant Care Program Evaluation Nursing Professional Practice, Clinical Informatics and Decision Support are working on data analysis of constant care metrics that are abstracted from the Responsive Behaviours Constant Care Restraints Record.

2018-19 Managing Responsive Behaviours and Constant Care Initiatives After determining that the deliverables of the MRB Working Group and the Constant Care Working Group have been achieved, the two groups have merged in September 2018 with the purpose of continuing to identify, develop and evaluate evidence-based approaches and tools for preventing and managing responsive behaviours that can be shared in the emergency department, medical surgical inpatient and critical care areas.

Practice Based Rounds It is a supportive team forum to highlight the corporate and unit/program-based initiatives in care planning of patients with complex and challenging behaviours using a case based learning approach that integrates the use of best practice MRB tools and processes held every two months.

Intranet Website It is a repository of best practice MRB and constant care tools and guidelines, education resources, publications, and internal and external behaviour support that can be leveraged by clinical teams.

Check the page!

SMH A-Z → C → Constant Care / SMH A-Z → M → Managing Responsive Behaviours

Best Practice Guideline Work on MRB and Constant Care Building on existing tools and processes, Best Practice Guideline (BPG) champions from Orthopedic, MSICU and TNICU have developed/tailored and implemented tools to support patients and staff in the care of patients with responsive behaviours. Although constant care is not initiated in critical care, decisions to put patients on constant care are sometimes made in ICUs prior to patient’s transfer to inpatient units. The BPG champions’ initiatives support clinical decisions on the appropriateness of initiating constant care for patients being transitioned out of the ICUs.

Patient and Family Advisors In alignment with the 2018-19 Quality Improvement Plan, the MRB Constant Care Committee will invite two patient advisors to the group to ensure we are incorporating what’s important to patients as we advance out initiatives.

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Constant Care Program (cont’d.)

Presentations and Publications 1.

Santiago, C., Krock, M., Canzian, S. (March 2019). Supporting the journey of a patient on constant care: A collaborative approach. Poster presentation at the Nursing Leadership Network Conference, Toronto, ON.

2.

Cahyono, C., Paramalingam, V., Santiago, C. (2019). Responsive behaviour in Trauma and Neurosurgery Intensive Care Unit. Poster presentation at the St. Michael’s Hospital Nursing Week Poster Gallery, Toronto, ON.

3.

Keating, A. (2019). Using responsive behaviour language and de-escalation strategies in the ICU to improve staff and patient safety. Poster presentation at the St. Michael’s Hospital Nursing Week Poster Gallery, Toronto, ON.

4.

McDonald, H. (February 2019). Responsive behaviours: Care planning for hospital transitions. Oral presentation at the Psychogeriatric Services of Ottawa, Ottawa, ON.

5.

Dawson, E. (March 2019). Getting to the root of why. Shared Purpose Newsletter, feature story on Managing Responsive Behaviours, accessed through http://unityhealth.to/getting-to-the-root-of-why/

6.

Santiago, C., & Bell, S. (November 2018). Supporting the journey of a patient on constant care. Oral presentation at the Nursing Rounds, St. Michael’s Hospital, Toronto, ON.

7.

SMH Newsroom. (May 2018). #yesthisisnursing. Shared Purpose Newsletter, feature story on Constant Care, accessed through http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2018/0508

8.

Santiago, C., & TAHSN Constant Care Working Group. (March 2018). Developing the constant care guidelines for an academic health science network. Poster presentation at the Nursing Leadership Network Conference, Toronto.

9.

Santiago, C., Whelan, L., McDonald, H., Ringer, L., Fearon, E., Ellis, M., Bolt, L., Egan, J., Bell, S., McNamee, C., Krock, M., Smith, O. (May 2017). Evaluating the impact of managing responsive behaviours education workshop. Poster presentation at the International Council of Nursing, Barcelona, Spain.

10. Flores, K., & Rinne, A. (November 2017). Development and implementation of “High Observation Rounds” to promote interdisciplinary collaboration in responsive behaviour management on the Trauma and Neurosurgery Inpatient Unit. Poster presentation at the Health Achieve Conference, Toronto, ON. 11. Flores, K. (November 2017). Managing Responsive Behaviour: Maintaining and sustaining collaborative practice. Poster presentation at the Health Achieve Conference, Toronto, ON. 12. Santiago, C., & TAHSN Constant Care Working Group. (May 2017). Developing the constant care guidelines for an academic health science network. Oral presentation at the International Council of Nursing Conference, Barcelona, Spain.

13. Cosi, A., Bell, S., McNamee, C., Santiago, C. (May 2017). Sustaining the managing responsive behaviour initiative on General Internal Medicine. Poster presentation at the Best Practice Guideline Gallery Walk, St. Michael’s Hospital.

14. Smith, O., Santiago, C., Whelan, L., Wilson, G., Wilson, M., Ringer, L., McDonald, H. (March 2017).

Prospective, observational study of constant monitoring practices in an acute care setting: The Pro Con Study.

Poster presentation at the Nursing Leadership Network, Toronto, ON. 15. McDonald, H., Ringer, L., Santiago, C., Whelan. (March 2017). St. Michael’s Hospital: A collaborative approach to managing responsive behaviours. Poster presentation at the Senior Friendly Hospital ACTION Showcase, Toronto.

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

2.

3.

4.

5.

6.

7.

8.

9.

Corporate Nursing Orientation (monthly) Centralized Inpatient Nursing Orientation (monthly) Centralized Preventing Falls is SIMPLE education (monthly) Prevention,Early Recognition and Management of Delirium education (monthly) RN to RN, Shift to Shift Bedside Transfer of Accountability Simulation Workshop (monthly) Nursing Rounds (monthly) Nursing Advisory Council Professional Practice Scenario of the Month (monthly) Nursing Preceptorship Workshop (quarterly) New Graduates Thriving in the Workplace (semiannual)

Nursing Preceptorship Workshop The Nursing Preceptorship workshop is designed to help prepare our nursing preceptors in supporting the transition and integration of new nurses and nursing students into the organization and nursing practice setting. It is intended for experienced preceptors, new preceptors, or those nurses who are considering becoming preceptors.

This interactive 4-hour workshop covers key topics to prepare nurses with the knowledge and skills necessary for them to function effectively in a preceptor role including: • Benefits of preceptorship programs • Qualities of an ideal preceptor • Promoting critical thinking • Factors that affect preceptorship • Providing effective feedback • Conflict resolution strategies • Evaluating the preceptorship

45

Nurses participated in the Nursing Preceptorship Workshop between June 2018 and March 2019

• Roles & responsibilities Evaluation continues to be overall very positive*: • 100% Stated the tools and activates met their needs • 100 % indicated that the workshop overall met their expectations • 100% will alter their teaching practice related to how their precept

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New Graduates Thriving in the Workplace Workshop The New Graduates Thriving in the Workplace Workshop is designed to prepare and support our new graduate nurses with interpersonal management skills. The overarching goal for this one-day interactive workshop is to provide them the opportunity to reflect on their experience as new nurses and help them: • Enhance their time management and organization skills to include proactive measures • Examine their current situation and develop a personal plan to boost their resilience • Learn strategies to effectively discuss their current needs with team members to legitimize feelings • Learn practical ways to address possible early-stage conflict and having courageous conversations Feedback on this workshop continues to be overall very positive*:

100% of participants indicated they learned valuable tips and tactics that will help them develop their resilience at work

*Data from June 2018 to January 2019

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88% This workshop was relevant to me as a new graduate RN The case studies were valuable in generating valuable ideas

Nurse Educator Network The Nurse Educator Network (NEN) was established to optimize the role of Clinical Nurse Educators and other nurses who have educational leadership roles, and to advise other stakeholders on matters related to best practices in nursing education and practice within St Michael’s Hospital. Members of the NEN collaborates with Professional Practice, Nursing Practice and Education to co-facilitate centralized nursing education sessions such as : Centralized Inpatient Nursing Orientation; RN to RN Bedside Transfer of Accountability (ToA) Simulation; Prevention, Early Recognition & Management of Delirium; Centralized Preventing Falls is SIMPLE and the Nursing Preceptorship workshop.

Membership: • • • • • • • • • • • • • • • • • • • • • • •

Allison Rankine, Clinical Coordinator, Wound Care Catherine Bishop, Clinical Nurse Educator, Labour and Delivery Postpartum/Gynaecology/Level 2 Nursery Cecilia Santiago, Nursing Practice Manager Christine Morton, Clinical Nurse Educator, Haemodialysis Danielle Bender, Clinical Nurse Educator, Emergency Department Ekaterina Mikhelson, Clinical Nurse Educator, Palliative Care and Specialty Clinics Emily Sestito, Clinical Nurse Educator, Nephrology/ Urology, Nursing Resource Team and Home Dialysis Judy Pararajasingham, Clinical Nurse Educator, Trauma/Neurosurgery Inpatient Katherine Mansfield, Clinical Nurse Educator, General Surgery/GI/Plastics Kimberly Tan, Clinical Nurse Educator, Cardiology and CV Surgery Lorraine Ciccarelli, RN, Acute Pain Service Michelle Williams, Clinical Nurse Educator, CVICU and CICU Monica Gordon, Clinical Nurse Educator, OR-Perioperative Services Murray Krock, Director, Nursing Practice and Education Nida Irshad, Clinical Nurse Educator, Respirology /IV Team Rosemarie Rivera, Clinical Nurse Educator, Haematology/Oncology/MDCU Shannon Swift, Clinical Nurse Educator, MSICU Shawna MacIntyre, Clinical Nurse Educator, Inpatient Mobility Shirley Bell, Clinical Nurse Educator, General Internal Medicine Tasha Penney, Clinical Nurse Educator, Mental Health Acute Care Vanessa Chavez-Prieto, Corporate Nursing Education Manager, Professional Practice (chair) Vasuki Paramalingam, Clinical Nurse Educator, TNICU Wendy Legacy, Clinical Nurse Educator, PACU/Pre Admission Facility/Surgical Day Care Unit

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Canadian Nurses’ Association (CNA) Certification Professional Practice, Nursing Practice and Education supports nurses who have successfully passed the CNA certification exam by providing reimbursement for exam application fees. Throughout the years, St Michael's Hospital has established processes that pays tribute to the value and achievement of CNA-certification . In 2005, SMH received the CNA Employer Recognition Award and Honourable Mention in 2013.

In addition to encouraging CNA certification, Nursing Practice and Education undertakes additional efforts to develop and sustain support for certification, we acknowledge CNA-certified nurses by name during Nursing Week events and in our Nursing Advisory Council Annual Report. This year we surveyed nurses about their CNA certification, here is what they shared.

138 nurses shared their interest about CNA certification

Nurses had the following level of agreement with the statements below:

97%

85%

81%

The certification process promotes growth and development of nurses

85%

CNA-certified nurses are recognized nationally for practice excellence and commitment to lifelong learning

79%

As a CNA-certified nurse, I am viewed as having enhanced professional credibility

The hospital’s support of the nursing specialty certification program clearly demonstrates our commitment to nursing excellence

CNA-certified nurses are valued by employers, because their certification demonstrates specialized knowledge and brings many benefits to organizations

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Canadian Nurses’ Association (CNA) Certification CNA CERTIFICATION – COMMIT TO EXCELLENCE ORGANIZATIONAL IMPACTS

CNA CERTIFICATION IS THE ONLY BILINGUAL, NATIONALLY RECOGNIZED NURSING SPECIALTY CREDENTIAL. CERTIFIED NURSES ARE COMMITTED TO AN ADVANCED STANDARD OF PROFESSIONAL COMPETENCE DIRECTLY CORRELATED WITH IMPROVED PATIENT OUTCOMES.

16.7% TO 8.1%: THE REDUCTION

2.5% INCREASE

21

SPECIALTIES

17,500

IN PATIENT SATISFACTION WHEN CERTIFIED NURSES

OVER CERTIFIED RNs AND NPs ACROSS CANADA

INCREASED BY 60% IN ACUTE CARE UNIT1

CERTIFICATION CONFIRMS

IN HOSPITAL NURSE TURNOVER AFTER 60% INCREASE IN CERTIFIED NURSES 2

THAT A NURSE’S PRACTICE IS CONSISTENT WITH NATIONAL BEST PRACTICE STANDARDS 3

IMPROVED PATIENT SAFETY AND OUTCOMES

2% DECREASE IN THE ODDS OF MORTALITY AND FAILURE TO RESCUE FOR EVERY 10% INCREASE IN CERTIFIED NURSES 4

SIGNIFICANTLY LOWER RATES OF FALLS IN UNITS

LOWER RATES OF CENTRAL-LINERELATED INFECTIONS

AVERAGE LENGTH OF HOSPITAL STAY REDUCED BY ONE DAY

WITH TWO OR MORE GERIATRICCERTIFIED NURSES 5

IN SURGICAL ICUs ARE CORRELATED TO HIGHER RATES OF CERTIFIED NURSES 6

AFTER A 6% INCREASE IN CERTIFIED NURSES 7

AWARD THE RECOGNIZED NATIONAL CREDENTIAL

THE RIGOROUS EXAM DEVELOPMENT PROCESS

CERTIFIED NURSES RENEW THEIR CREDENTIAL EVERY FIVE YEARS.

ESTABLISH NATIONAL STANDARDS

BY NURSE EXPERTS IN THE SPECIALTY FROM ACROSS THE COUNTR Y

1

DEVELOP RELATED TEST QUESTIONS WITH PSYCHOMETRICIANS AND NURSE EXPERTS

2

CREATE EXAM PREP RESOURCES

BY THE SPECIALTY ASSOCIATION

3

Photo Credit: Canadian Nurses' Association

getcertified.cna-aiic.ca

ADMINISTER THE FIRST EXAM, EVALUATE AND ADJUST AS REQUIRED

4

REVISE REGULARLY TO ADHERE TO CURRENT NATIONAL STANDARDS

5

Care tothe BeBest 1 Craven, H. (2007). Recognizing excellence: Unit-based activities to support specialty nursing certification. MedSurg Nursing, 16, 367-371.

2 Craven (2007). 3 Straka, K. L., Ambrose, H. L., Burkett, M., Capan, M., Flook, D., Evangelista, T., . . . Thornton, M. (2014). The impact and perception of nursing certification in pediatric nursing. Journal of Pediatric Nursing, 29, 205-211. doi:10.1016/j.pedn.2013.10.010 4 Kendall-Gallagher, D., Aiken, L. H., Sloane, D. M., & Cimotti, J. P. (2011). Nurse specialty certification, inpatient mortality, and failure to rescue. Journal of Nursing Scholarship, 43, 188-194. doi:10.1111/j.1547-5069.2011.01391.x 5 Lange, J., Wallace, M., Gerard, S., Lovanio, K., Fausty, N., & Rychlewicz, S. (2009). Effect of an acute care geriatric educational program on fall rates and nurse work satisfaction. Journal of Continuing Education in Nursing, 40, 371-379. doi:10.3928/00220124-20090723-03 6 Boyle, D. K., Cramer, E., Potter, C., Gatua, M. W., & Stobinski, J. X. (2014). The relationship between direct-care RN specialty certification and surgical patient outcomes.

AORN Journal, 100, 511-528. doi:10.1016/j.aorn.2014.04.018 7 Nelson, A., Powell-Cope, G., Palacios, P., Luther, S. L., Black, T., Hillman, T., . . . Gross, J. C. (2007). Nurse staffing and patient outcomes in inpatient rehabilitation settings.

Rehabilitation Nursing, 32, 179-202.

® CANADIAN NURSES ASSOCIATION, the CNA flame design, the CNA CERTIFICATION AIIC design and CARE TO BE THE BEST are registered trademarks of the Canadian Nurses Association. CNA is a trademark of the Canadian Nurses Association. © Copyright 2017 Canadian Nurses Association.

Nursing Advisory Council Report 2018-2019 | 63

Canadian Nurses’ Association (CNA) Certified Nurses There over 21 CNA certification specialities andt St Michael's Hospital has representation in almost all of them. This list includes 284 nurses who have declared their CNA certfiication to Professional Practice, Nursing Practice and Education.

Canadian Nurses Association Certification: Cardiovascular Surgery

Canadian Nurses Association Certification: Emergency

Anne Kha Denise Galszechy Dong Wei Xu Jennifer Cruz Jennifer Martin Jennifer Predhomme Leora Wanounou Maria Aquino Marian Adeboboye Mary Mustard

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 Esther Cho Gisela Colucci Jannet Hudson Jeannelle Pereira Jennifer Daviau Jennifer Jolley Jonathan Tel Karen Olivero Kirsty Nixon

Canadian Nurses Association Certification: Community Health Cathy Wilson

Canadian Nurses Association Certification: Critical Care Angel Cubing Brigitte Delaurier Cecilia Santiago Christine Chu Corinne Risling Danielle Makuch Debbie Snatenchuk Demetre Photopoulos Diana Lee Denise Elliott Dong Wei Xu Elaine Selby Eliane Stockler-Leite Eva Klein Gabriella Tataru Hyojung Kim Jenna Moulder Jessica Nanni Josephine Ly Karen Michelsen Karen Wannamaker Katherine Mansfield Kathy Mills Kelly Metcalfe Kimberly Tan Leigh Ngo Haitsma Maija Shannon

Maria Teresa Diston Marinka Kocjan Mary Mustard Masako Katsuki Megan Rhoden Melissa Wang Melissa Devera Michelle Narine Michelle Williams 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

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Kylie Kaitlynn Krystal Fox Lee Barratt Leighanne Mackenzie Luke Costello Maggy Parsons Mary Dimeo Megan Cairns Melissa Reynen Melissa Guiyab Michael Postic Nancy Linklater Natalia Liakicheva Ray Howald Rob Ford Ryan Henderson Sharon Mills Sherry Armstrong Stacy Lew Tina Sperling

Canadian Nurses Association Certification: Gastroenterology Allison Rankine Aster Yemane Charline Ductan Joanne Bennett Katherine Mansfield Petula Wilmot-Chambers Stephanie MacDonald

Canadian Nurses Association Certification: Gerontology Avinash Solomon Charlene Chu Frances Carbonel Junyan Shi Kathryn Sametz Marjorie Hammond

Canadian Nurses Association Certification: Hospice Palliative Care Kathryn Vogel Penny McCrimmon Rebecca Clarke Slawomir Zulawnik Victoria McLean

CNA Certified Nurses (cont'd.)

Canadian Nurses Association Certification: Medical Surgical

Canadian Nurses Association Certification: Neuroscience

Halley Velasco Avinash Solomon Karen Michelsen

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

Canadian Nurses Association Certification: Mental Health Brenda Bergamin Caitlin Keeble Daniel Bois Danijela Ninkovic Dominic Gascon Donna Romano Ellen Marchildon Glen D'Souza Heather Dunlop Heather Rawnsley Heather Sinclair-McDonald Janet Hill Joan Wight Junyan Shi Keith Hansen Keschey Marcelle Lynn Hilton Nat

Marcia Hale Mary Rhodes Monique Harding Nicole Kirwan Olive Laranang Parul Giare Parya Nazari Ryan Hoekstra Sara Lamoureux Susan Hart Stephanie Lucchese Tamy Jung Tessa Birtch Vi Linlet Ensoy-Landicho Virginia Romero Wendy Keller Winnie Leung

Canadian Nurses Association Certification: Neonatal Nursing Catherine Bishop Daniel Bois

Canadian Nurses Association Certification: Nephrology Alison Thomas Ann Jones Calen Blackwell Candice Cousins Claudia Garzon Connie Ignacio Eleonora Goman 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 Certification: Oncology Althea Stewart Anna Solala Donna Monis Gemlina Balagasay

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CNA Certified Nurses (cont'd.)

Canadian Nurses Association Certification: Orthopaedic Shea MacKenzie Kathryn Hanson

Canadian Nurses Association Certification: Perianesthesia Nursing Kirsty MacQueen Maria Susana Carrusca Andrea Richards Deborah Moore Lisa Manswell-Charles Marian Adeboboye

Canadian Nurses Association Certification: Perinatal Anna De Marchi Beretta Ferron Debbie Dawe-Mattausch Elaine Lau Sharon Adams Zhanna Von Kaiser

Canadian Nurses Association Certification: Perioperative Anna Czemiel Becky Lei Camille Ma Diane Eley Esther Lee Eugenie Fernandez Francis Bobis Jane Hume

Canadian Nurses Association Certification: Wound, Ostomy and Continence Juliann Vander Meer

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Nursing Advisory Council Membership 2018/19

Photo: Nursing Advisory Council Members Front row (L to R): Marie Prystay, Lidia Yamane, Vivian Iwenofu (NAC co-chair), Cecilia Santiago, Meriam Jayoma-Austria, Kyrene Fabroa,Meghan Goudie, Ashnit Chhina, Jane Topolovec-Vranic Second Row (L to R): Janice Glen, Murray Krock, Galina Davydova, Lisa Manswell, Shirley Bell, Stephanie Munger-Ferrara,Virginia Wojcik, Zeineb Abdulkader, Michelle Dumdum, Kaleil Mitchell See page 8 of this report for the Nursing Advisory Council membership details

Historical photos courtesy of St. Michael’s Hospital Archives

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