#YesThisIsNursing newsletter 2017/18

#YesThisIsNursing ST. MICHAEL’S HOSPITAL - MAY 2018

CELEBRATING NURSING WEEK MAY 7 TO 11

St. Michael’s Hospital Nursing Week Stories 2017/2018 These stories highlight some of St. Michael’s nurses and their achievements

Meet Ryan Hoekstra, RN, BPHE, BScN Community Mental Health Program Ryan has been a registered nurse for almost 4 years. Initially he was hired as a new graduate at St. Michael’s Hospital and now works full time with the Flexible Outreach Community Urban Support (FOCUS) team as part of the Community Mental Health Program. Being a Best Practice Guideline (BPG) Nurse Champion has provided Ryan with the opportunity to be an orchestrator of change in the area of: ‘Standardizing Substance use Screening and Assessment in the Community Mental Health Service.’ Being involved in this BPG initiative has allowed Ryan to explore creative ways to solve and remedy the service gaps for his client population.

As Ryan describes, “prior to this initiative, there were no standardized protocols for substance use screening or assessment in community mental health services.

Screening, assessments and subsequent interventions were left primarily to the discretion of the each client’s assigned clinician, with few clinicians having any formal addictions training.” In light of this, the objective of his BPG was to utilize a standardized screening tool for all clients registered on the FOCUS team to obtain objective data on the prevalence of substance abuse disorder.

A key success factor for Ryan’s work was to engage stakeholders from start to

finish. In doing so, this goes a long way for sustainability. According to Ryan, “an invested stakeholder often has a unique capacity to facilitate and solidify change.”

His BPG sustainability plans include integrating standardized screening into routine practice and continuing to consult with local experts in harm reduction and abstinence interventions. In doing so, his efforts will provide his team members with client-centered interventions.

Ryan identifies that the mentorship he received was incredibly valuable to the success of his BPG initiative. Murray Krock, Director of Nursing Practice & Education, Continued on page 2 MAY 2018 | #YESTHISISNURSING | 1

Meet Murray Krock, Ryan’s Professional Practice Mentor

Murray Krock, Ryan’s Professional Practice mentor has been a registered nurse for over three decades and is the Director of Nursing Practice & Education. He can still recall as a young nurse when working elsewhere having ideas about improving systems and processes of care but no venue to share his ideas. As he recalls, “back then we hadn’t heard of the terms best practice, evidence based practice, champion, mentor, mentee, and community of practice.” For Murray and his team, it was a proud moment in 2012 when St. Michael’s received its Best Practice Spotlight Organization (BPSO) designation through the Registered Nurses Association of Ontario (RNAO).

First launched in 2003, the BPSO initiative is an off-shoot of the RNAO’s Nursing BPG program which began in November 1999 and has since spread across Canada and to countries around the world.

Murray describes that being a mentor

to a BPG Nurse Champion is an enjoyable experience. Developing and implementing best practice guidelines increase all nurses’ confidence, knowledge, skills, and abilities.

As he reflects, “it is an opportunity to guide and advise the Champion on a best practice guideline that is important to their team and patient care.” Furthermore, “it is a reciprocal relationship directed by what the Champion wants to achieve. I’m always fascinated by what I learn from the Champion who I am mentoring and hopefully they learn from me. As nurses we have a professional responsibility to support one another regardless of our role and through different opportunities.”

This year, Murray has had the pleasure of mentoring Ryan, RN who works in the Community Mental Health Service. His BPG initiative is ‘Standardizing Substance Use Screening and Assessment in the Community Mental Health Service’ and aligns with the BPGs ‘Client-Centered Care’ and ‘Engaging Clients Who Use Substances’. “I’ve learned so much from Ryan about his role in community mental health and this important initiative.

His motivation and creativity for this challenging initiative will contribute to quality practice at the point of care for his team” says Murray. He outlines that

mentoring a BPG Nurse Champion also contributes developing clinical leadership among nurses while spreading safe, quality care.

The learning opportunity in monthly CoPs has been two fold for Murray. First, “we come together as a community of practice to learn and apply methodologies of quality improvement which is important to the implementation and sustainability of BPGs.” Second, “we learn from one another – the understanding and application of methodologies of quality improvement and best practice initiatives, the clinical piece.” Murray describes that he is “fascinated at how Champions share their knowledge and resources with one another. Champions never hold back from assisting one another and that for me is representative of clinical leadership and a community of practice.” The collegiality coupled with energy and enthusiasm in the CoP is a testament of the clinical leadership and commitment of all the Champions.

Ryan’s story continued from page 1

consistently made himself available and shared his valuable insights.

In addition, Nicole Kirwin his Clinical Leader Manager, helped and supported him along the way. Ryan mentions that he has enjoyed his BPG experience, especially being part of the BPG Community of Practice (CoP). He described participating in the CoPs as motivating and inspiring. From the first day, the sense of enthusiasm and the learning energy in the room was almost palpable. The CoP provided a formalized, step-by-step approach towards quality improvement methodologies.

The facilitated discussions between peers and mentors were a helpful forum which offered guidance, insight and creative options to each champion. Through it all, Ryan says he felt genuinely supported in obtaining the most from his project, and believes that this support will lead to improved care and quality of life for clients.

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Meet Alyse Ediger, RN, BScN, Nursing Resource Team (NRT) Alyse has been a registered nurse since 2015. She first worked at St. Michael’s Hospital in a casual position in the Nephrology / Urology in-patient unit then transitioned to full-time with the Nursing Resource Team and “loves it.” In addition to her clinical work, Alyse is also a children’s book author. Her most recent book is entitled Finnegan Lee and the Hemodialysis Machine. In this book, a young boy named Finnegan goes with his Grandpa to his Grandpa’s hemodialysis treatment. Alongside his stuffed manatee, Finnegan learns all about hemodialysis and takes care of patients with the help of Nurse Dan. Alyse enjoys being a children’s book author because she has the opportunity to teach kids that hospitals need not be scary, rather hospitals are places of healing and care. Writing children’s books provides Alyse with the opportunity to combine her two passions: nursing and writing. Alyse feels that there is a knowledge gap regarding medical stories for children. She is excited to bring knowledge of health care and medical procedures to children so they will feel better equipped when they or their loved ones encounter illness. Looking back, Alyse has always wanted to write a book, and her writing style is concise which is well-suited to this writing medium.

Finnegan Lee and the Hemodialysis Machine is written especially for children whose loved ones are undergoing hemodialysis, however the story also appeals to children of all ages. As Alyse describes, “children especially like Francis the stuffed manatee who is Finnegan’s mischievous companion. When people see their loved ones in the hospital undergoing medical procedures, they want to help. This story is about the little boy Finnegan helping hemodialysis patients. It is relatable because it appeals to people’s desire to help and care.”

Through her creative process, Alyse reflects on the importance of nurturing our interests outside of work and encourages others to try something new that fuels their creativity. Writing this book has been a collective partnership with her illustrator, Ali Carroll. Ali brought Alyse’s vision for each page to life with good humor and undeniable talent. Alyse admits that she enjoys the writing side much more than the marketing side, but she is learning a lot and hopes to continue writing children’s books long into the future.

Alyse acknowledges that adults can underestimate a child’s ability to understand their family member’s illness experience; they minimize the healing difference children can make. This book provides hemodialysis patients with a resource and opens up discussion with those in their support system. Alyse hopes that Finnegan Lee and the Hemodialysis Machine fosters patient and family-centred care and shows patients that they can involve children in their health journeys. Alyse’s book is available in the St Michael’s gift shop, and she is excited to announce that a second book is in the works.

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Meet the RNs behind the “Transfer of Accountability for Breast Cancer Patients” it so fulfilling and really love connecting with patients and supporting them through their journey. I also feel lucky to work with such an amazing team: physicians, technologists, clericals, nurses.” For Michaela, being a BPG Nurse Champion means “being Aryam Kidane, Michaela McCrady, an advocate for patients RN, BScN RN, BScN and figuring out how we can improve the patient Aryam graduated from Ryerson University experience. It means thinking critically and started her nursing career at Humber about how you can better your unit; River Regional Hospital eight years ago. what positive changes we can make for She has worked in various areas of the both patients and staff. As nurses, we are hospital and has specialized primarily working on the frontlines and see firsthand in oncology. Aryam joined St. Michael’s what issues may be arising and we are in a Hospital in March 2017 and has recently position to make changes.” helped to build the Nurse Navigator role, Cecilia Santiago is the Professional Practice Specialized Complex Care Program. mentor for Aryam and Michaela and has Aryam describes that being BPG Nurse Champion means “being able to actively change and implement ideas into best practices that have a positive and fulfilling impact on my nursing life and clinical practice.” The BPG initiative she is working on with Michaela is entitled: ‘Transfer of Accountability for Breast Cancer Patients.’ The Best Practice Guideline (BPG) it aligns with is ‘Care Transitions.’ The focus of the initiative is the creation, implementation, and evaluation of a Transfer of Accountability (TOA) tool for breast cancer patients.

The aim is to enhance care transitions between the multidisciplinary teams and engage patients in their care. The TOA tool is a result of the ongoing research study led by Medical Oncologist Dr. Rashida Haq. Michaela graduated from Queen’s University in 2013. She started her nursing career in thoracic, general, and vascular surgery. She has worked in the Breast Centre for the past 2 years. As she describes, “I love working at SMH and in such a specialized area. I feel that oncology nursing is my true calling. I find 6 | #YESTHISISNURSING | MAY 2018

been a registered nurse for 23 years. Cecilia has worked at SMH for 18 years and in critical care before becoming the Nursing Practice Manager in 2014. As Cecilia describes, “for me personally mentorship provides an opportunity to reflect on own practice and brings me satisfaction through supporting the development of nurse colleagues. Professionally, it allows me to share my experience and make my expertise available to the champions.” As the mentor of champions working on ToA/ Care Transition initiatives, Cecilia looks forward to each BPG cycle because she is aware that units are advancing their ToA/ Care Transition initiatives.

This BPG initiative will inform clinical practice by allowing transitions between the Breast Centre and Medical Day Care.

The goal of this quality improvement initiative is to improve the patient experience during their care trajectory and decrease anxiety. An added aim is to also increase communication between the interprofessional team. As Aryam describes, “a breast cancer diagnosis can be an overwhelming, anxiety inducing journey. Patients generally are first

diagnosed in the CIBC Breast Centre. This is where planning starts and patients are transitioned to the medical and radiation oncologists for further treatment if necessary. There are many team members involved in a patient’s care which is why effective communication is so important and also why patients can feel confused or lost.” The TOA tool consists of patient demographics, medical and psychosocial components including staging, pending tests, and follow up information. As a BPG Nurse Champion, Aryam has learned how to effectively use a Plan, Do, Study, Act (PDSA) cycle to help streamline ideas into reality. She has also learned how important nurse led project initiatives are and how impactful they can be. Staff were very happy to have all pertinent patient information summarized in one place, and accessible for the patient. Patients stated that having something tangible to take home with them really made a difference in easing anxiety. Patients also liked that it is a tool they can take with them to share with other medical professionals.

As Aryam and Michaela describe “we have received really positive feedback in our surveys from both patients and staff. We plan to continue to support staff in learning how to use the system and obtain the full benefit of the TOA.” They have also been discussing with General Practitioners (GPs) in the community ways to gather information and the best way to disseminate TOA to GPs. They plan to disseminate the TOA at CIBC Breast Centre Symposium this fall and are hoping to present at a conference.

Cecilia Santiago, RN, MN, CNCC(C)

Late Career Nurse Initiative (LCNI): Expert Nurses Creating a Healthier Work Environment The Late Career Nurse Initiative (LCNI) is funded by the Ontario Ministry of Health and Long Term Care (MOHLTC) and has existed since 2004. The LCNI was designed to address nursing retention and supply in Ontario by providing healthcare organizations the opportunity to apply for funding to create opportunities for full-time and parttime 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 overall goal of the LCNI is to retain nurses in the workforce longer and recognizing how their experience enriches the quality of patient care benefiting not only patient bust also the organization, nursing profession and the healthcare system.

In September 2013 St. Michael’s Nursing Practice & Education launched a new program for Late Career Nurses (LCNs) entitled, “Expert Nurses Creating a Healthier Work Environment.” This program provides expert nurses with an opportunity to enhance personal and professional skills that can contribute to the creation of a healthy work environment. Nurses that participate are enabled to apply 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. The goal of St. Michael’s LCN 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.

To date, there have been five cohorts since 2013 with a total of 78 RNs who have participated in the annual program. Cohort 1 (2013/14) and cohort 2 (2014/15) underwent a research ethics board (REB) approved evaluation. The evaluations were overwhelmingly positive. The program involves a series of bi-weekly targeted professional development workshops and communities of practice from November to March.

Program deliverables include: a personal action plan, learning log and sharing key learning to colleagues.

As one LCNI participant described “this program offered me the most positive and invigorating challenge to continue in these last years of my career.

It has stimulated me to do so much more teaching, supporting, and uplifting of my colleagues, friends and family.”

2017-18 Late Career Nurse Initiative participants and facilitator, Donna Romano, Evidence Based Practice Nursing Manager

Please check out the St. Michael’s My Nursing intranet site for “Live with Donna Romano” video featuring LCNI participants.

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Meet Alicia Bakker, RN, BScN Trauma Neurosurgery Intensive Care Unit The Mercy Ships Alicia has been a registered nurse for ten years. She began her nursing career on the inpatient trauma-neuro (TN) unit and after three years transitioned to TNICU. She describes her work in the TNICU as offering a variety of complex clinical situations, whereby not one day is the same. As Alicia describes, “being a nurse in the TN ICU allows me to be there for patients and families at a time that is likely the worst, most tragic thing they have ever experienced.” Alicia has been involved in her volunteer work with the Mercy Ships for the first time in 2016 after having coffee with a friend who had just returned from volunteering with the organization. Alicia enjoyed the mission work on the ship so much that she returned to volunteer again for a second time. Mercy Ships is an international charity that operates the largest non-governmental hospital ship in the world. The Africa Mercy is a former rail ferry that had been converted to a hospital, with 5 state-of-the-art operating theatres and an 82bed ward. The ship is docked for over ten months at various port-cities around the coast of Africa and offers surgery freeof-charge to individuals who would have no other options for treatment. With over 75% of the world’s population living within 150 km of a port city it has the capacity to reach some of those who live with access to little or no healthcare. These individuals come to Mercy Ships seeking life-changing treatments. It is a Christian based organization run completely by volunteers. It offers surgeries in the areas of general surgery, orthopedics, plastics, maxillofacial as well as eye and dental. Alicia explains, “Mercy Ships is such a life-changing place. It is such a beautiful thing to watch lives be transformed right before your eyes. But I’ve also learned so much from the patients and families who are

Alicia having a great time and experience at the Mercy Ships.

so warm, joyful and have so much love to offer despite the health challenges and poverty they are experiencing.”

Alicia identifies the joy she has experienced by being involved in this volunteer work and acknowledges the powerful healing that occurs. This work has informed Alicia’s clinical practice when she returns to the bedside.

She is able to care for her patients more holistically underscored by a strong therapeutic relationship that she establishes. Alicia says, “The experience has been so special to me; it’s hard to put into words…it is one of the places you have to see and experience for yourself.”

For additional Nursing Week stories please see the St. Michael's Hospital “My Nursing” intranet site. #YesThisIsNursing is a feature created

by Nursing Professional Practice.

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