Nursing PRN Spring 2012 Issue 3

MacEWaN UNIVERSITY www.MacEwan.ca/RN

S P R I N G 2 0 1 2 | I S S U E 3

Globalization and Social JusticeTechnology & the Future of Nursing

Accessible.Flexible.Relevant.

MacEwan University’s Centre for Professional Nursing Education is dedicated to servicing the education of front-line health care multi-disciplinary practitioners.

Programming is responsive to the needs of industry and practitioners who strive to improve the health and quality of individuals, communities and industry. Many courses are offered online and through distance delivery, making professional development easily attainable.

The centre also offers customizable workshops to suit the needs of corporations, organizations and associations and to help keep employees’ skills and knowledge sharp and current.

www.MacEwan.ca/RN

Spring 2012 | Issue 3 | Nursing PRN | 3

It is my pleasure to bring greetings from the Faculty of Health and Community Studies at MacEwan University. Nursing PRN is a means by which we are able to share with you some of the interesting activities occurring within our Centre for Professional Nursing Education.

At MacEwan University, we strongly value our connection with practice and strive to respond to the continuing education needs of nursing professionals. In addition to developing new courses, we are in the process of significantly upgrading the instructional technology in our Clinical Simulation Centre. Our aim is to provide an environment that is accessible, conducive to learning and that fosters the integration of knowledge into practice.

We sincerely appreciate your interest in MacEwan University and hope you find value in Nursing PRN and in the many education opportunities available to you through the Centre for Professional Nursing Education.

Sharon Bookhalter, RN, BScN, MEdDean, Faculty of Health and community StudiesMacEwan University

DEAN’S MESSAGE

Accessible.Flexible.Relevant.

MacEwan University’s Centre for Professional Nursing Education is dedicated to servicing the education of front-line health care multi-disciplinary practitioners.

Programming is responsive to the needs of industry and practitioners who strive to improve the health and quality of individuals, communities and industry. Many courses are offered online and through distance delivery, making professional development easily attainable.

The centre also offers customizable workshops to suit the needs of corporations, organizations and associations and to help keep employees’ skills and knowledge sharp and current.

www.MacEwan.ca/RN

4 | Nursing PRN | Issue 3 | Spring 2012

EVERY NURSE SYMPOSIUMSAVE THE DATE! EARLY 2013For more information contact: Nicole Simpson, RN, BScN • [email protected] • Centre for Professional Nursing Education • MacEwan University

What does it take to save a life?

A cool head, steady hands, but most importantly the right training.

Life Support Training at MacEwan University provides you with up-to-date skills and training in resuscitation education.

Offerings include

• Basic Life Support (BLS), also known as Cardiopulmonary Resuscitation (CPR) • First Aid• Advanced Cardiovascular Life Support (ACLS)• Pediatric Advanced Life Support (PALS)• Custom courses available upon request

Visit www.MacEwan.ca/LST for upcoming course dates and details.

Recognized by: Heart & Stroke Foundation, Workplace Health & Safety


I am pleased to offer you our third edition of Nursing PRN. As is always the case in nursing, many changes are afoot – in the field and in practice. Evolving technology is changing the way nurses study, develop competencies and achieve certification while also managing busy lives. As much as technology plays a role in nursing, the lived experience of engaging with those in need, locally and abroad, is also at the heart of the profession, a reality that the stories of travel, volunteering and teaching found in this edition make clear. Hence the focus of this year’s edition of Nursing PRN is on how nursing practice is likely to change, how the practice environment is developing, and the impact these shifts will have on nursing education and practice. I hope you enjoy our stories of innovation and travel.

The faculty and staff look forward to welcoming you to the Robbins Health Learning Centre and assisting you with your continuing professional development.

WELCOME!

Shirley Galenza, RN, BScN, MEdDirectorcentre for Professional Nursing EducationMacEwan University


Acknowledgements

Sharon Bookhalter, Dean, Faculty of Health and community Studies

Shirley Galenza, Director, centre for Professional Nursing Education

Charlene Barrett, Marketing Manager

Tyler Butler, Marketing consultant

Lindsay Kirstiuk, Graphic Designer

Brendan Wild, Editor

Gail Couch, Program chair

Joan Mills, academic coordinator

Nicole Simpson, academic coordinator

McCallum Printing Group Inc.

TwoFiveZero Studios

S P R I N G 2 0 1 2 | I S S U E 3

Nursing PRN is published by MacEwan University's centre for Professional Nursing Education.MacEwan University9-206, 10700-104 AvenueEdmonton, AB T5J 4S2780-497-5163

Contributors

Cheryl Mahaffy

Cheryl Mahaffy launched the freelance business Words that Sing in 1996 with the goal of writing about things that matter. Her work has appeared in numerous magazines and several books, including the anthologies Big Enough Dreams, Edmonton on Location and Outside of Ordinary. Co-author of Agora

Borealis: Engaging in Sustainable Architecture, she also writes for a broad range of non-profit, civic and corporate clients.

Tyler Butler

Tyler Butler is the marketing consultant with the Faculty of Health and Community Studies at MacEwan University. He holds a Bachelor of Arts in English from the University of Alberta. He is a folk musician and blogger with a passion for writing.

Heather Andrews Miller

Heather Miller is an Edmonton writer whose work appears in several local and regional publications. She is currently writing her debut novel. A long-time resident of Edmonton, she lives with her husband in her west end condo where they enjoy visits from children and grandchildren and where she enjoys her

other passion, playing and teaching piano and classical guitar.

Lisa Ricciotti

Lisa Ricciotti somehow didn’t follow the path of her mother and three of her four sisters, who chose nursing as a career. Instead, she’s an award-winning freelance writer, happily working from an Edmonton home base shared with three French bulldogs, a grumpy old English bulldog, and one very patient husband. While

not a nurse, Ricciotti credits her sisters’ passion for nursing as the source of her keen interest in writing about health and medical matters.

Contents copyright 2012 by MacEwan University. No part of this publication may be reproduced without written approval.


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Contents

| Nursing PRN contributors

| Technology and the Future of Nursing by Lisa Ricciotti

| Women Looking Forward by Tyler Butler

| The Growing Importance of Palliative care and Education by Heather Andrews Miller

| Globalization and Social Justice by Cheryl Mahaffy

| Lifelong Learning by Tyler Butler

| Returning to active Nursing by Heather Andrews Miller

| From Radio Operator to Nurse by Lisa Ricciotti

| canadian Nursing in the 21st century by Michael J. Villeneuve, RN, MSc

| Top 10 Future Directions for Nurses and Nursing by Michael J. Villeneuve, RN, MSc

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BY LISA RICCIOTTI

Meet Sheila – a registered nurse in a large hospital. as usual, Sheila’s

had a busy day. But at shift end, she stops to think how much easier her

job has become, thanks to some recently introduced technology.

Rather than running back and forth to the nurses’ station or down hallways searching for co-workers, she’s saved herself thousands of steps by using her hospital-supplied cell phone to send off questions and updates. She consulted its “Epocrates” app several times to check for possible drug interactions and refresh her memory about an infrequently seen medical condition. When she noticed that the family of a patient was frustrated that no doctors had time to explain exactly what was wrong with their son, she showed them images, diagrams and plain-language explanations on his bedside computer. She recorded her treatments for and observations of her patients into an electronic charting system, and kept all her personal notes together on a phone app. In spite of the flurry of activity on the ward, she didn’t hear a single overhead page, announcement or critical alarm. That communication is now silently but effectively channelled to iPhones, creating a quieter, less stressful environment for both nurses and patients.

And using new technology even helped Sheila save a life today. She received electrocardiogram tracings on her iPhone from an en-route ambulance rushing in a patient with extreme chest pains. In the past, she would have tried to describe the EKG to a physician or fax it; today, though, she immediately called the cardiologist – who logged in and viewed exactly what was on Sheila’s screen – and then

BY LISA RICCIOTTI

instructed the ambulance team to intervene with medication and alerted the cath lab to prepare for the patient’s arrival. More than 15 crucial minutes were saved, which can make all the difference for a positive outcome for a heart patient.

Sheila was feeling so good about her team’s performance that she gathered all the nurses together for a celebratory photo, with everyone clutching their new iPhones. At home, she posted the happy photo to her Facebook page, with a note about how great the new technology was working out.

Unfortunately, Sheila didn’t notice that behind the nurses in the photo was a whiteboard listing names of patients scheduled for surgery. Uh oh … a serious breach of patient confidentiality. Her photo was shared by a Facebook friend, who sent it on to another friend, and eventually it landed on the nursing director’s screen. The next day Sheila was called into the hospital CEO’s office for disciplinary action. From super nurse to possibly suspended or fired nurse, all it took was one impulsive Facebook post.

Sheila’s not a real nurse, but she could be. Today, many nurses find themselves walking the double-edged blade of technology: It saves time, improves patient outcomes and creates a better healing environment, but flip it over and technology introduces new dilemmas linked to patient privacy and confidentiality.

Today, many nurses find themselves walking the double-edged blade of technology.

Seeing the big picture

Manal Kleib, RN, MSN, MBA, spends a lot of time thinking about how technology impacts our health care system. The University of Alberta faculty lecturer is currently working on her PhD dissertation, with a focus on health informatics.

“I’ve been in the informatics field for six years, but people still give me blank looks after asking what I do,” Kleib says. She could respond with the textbook definition for health informatics – the discipline in which nursing knowledge and practice intersect with technology to improve nursing – but to be more specific, she explains that her role is not teaching nurses how to use a computer but how to use technology to be better nurses. And yes, there’s a huge difference.

“We need to understand the full meaning and consequences of using technology in a larger context,” Kleib notes. “Beyond mastering a new computer program or app, nurses need to think about technology’s bigger issues: ethics, legal liabilities, how to protect electronic patient files from tampering or hacking, and how to share information to improve outcomes without compromising patient confidentiality. Nurses need education and guidance on how to safely and responsibly use technology, not just another IT course.”

Of course, most nurses are too busy nursing to do much reflecting on technology’s big picture. That’s why Kleib wants to introduce courses on health informatics into undergrad nursing programs. She’s completed two of ten planned modules that will include both online learning and hands-on training in this little-known field.

Kleib believes technological innovation shouldn’t be left in the hands of IT personnel. The nurse’s perspective needs to stay front and centre as technical advances are proposed, to ensure the essential principles and goals of nursing are preserved.

She emphasizes that nurses must continue to control technology and not let it control them. “I worry that nurses could become automatons, staring at monitors and robotically recording information. That’s dehumanizing, for both nurses and patients. Nurses need to relate to patients, not machines, and technology should enhance a nurse’s clinical judgment, never replace it. Their profession is so much more than copying down numbers. Machines introduce the possibility of technical error, and nurses must understand how to interpret results and know when the numbers don’t make sense.”


Nurses need to relate to patients, not machines, and technology should enhance a nurse's clinical judgement, never replace it.


Technology’s changed, but codes of conduct haven't

Although Tracy Shaben doesn’t work directly with Kleib, she’s a colleague in the health informatics field. Shaben, the clinical coordinator of informatics at the University of Alberta Hospitals, worked as a pediatric nurse for 20 years before shifting into health informatics a decade ago.

“I fell into it,” Shaben says. “I went to work in Grande Prairie to help nurses learn how to use new software in 1993. I didn’t know much about computers, but when they asked me if I was scared of them, I said no. I got the job and became known as The Computer Nurse.”

Shaben has seen a lot of technology come and go. “We tried things, like using hand-held instruments to input daily records, but back then the technology wasn’t powerful enough. And they were so big. We had to strap them onto a holster belt and cart them around, just to access one kilobyte of memory!”

Today Shaben is excited about mobile technology that really works, like an iPhone app with a database of heart sounds that a nurse can compare to a real patient’s heartbeat, and online photos of wounds that help guide treatment. “Telehealth technology has also introduced big changes in the last five years,” she notes. Nurses in remote settings can send tests and images electronically to larger centres for diagnosis; homecare nurses can read a patient’s oxygen saturation and glucose levels on mobile devices; patients can even electronically transmit the results of testing they perform in their homes directly to physicians.

The catch, says Shaben, is that nurses don’t have equal access to technology. “There’s so much out there, but technology is expensive to implement. We’ve talked about technology a lot for 15 years, but we’re still nowhere close to putting the latest advances in every nurse’s hands.” There’s also a generational knowledge divide. “The average age of nurses is now 45 and we don’t have large numbers in the 30- to 40-year range. Then we have brand new grads who are so tech savvy that they just blow us all away! And who’s teaching our nursing students? Most university faculty are 60-plus.”

Although Shaben is immersed in the world of technological advances, she freely admits she’s still not on Facebook. She recognizes, however, that she’s quickly becoming the exception. And as more and more nurses become active on social media sites, the need grows for awareness training.

“There’s a mistaken perception that privacy exists when nurses use social media like Facebook or blog or send emails from their homes,” says Shaben. Many employers have written policies on proper Internet and social media use, but few address what a nurse does outside the workplace. Still, court judgments are setting precedents that show venting about difficult patients to Facebook friends, even without disclosing names or medical details, can be considered a violation of patient privacy and confidentiality that comes with serious consequences.

Kleib also points out that nurses have a moral responsibility to protect and guard patient privacy. “It’s part of the professional conduct of nurses and is built into nursing’s code of practice,” says Kleib. “Unfortunately, many nurses don’t carry the idea of patient confidentiality into the virtual environment. It still applies, no matter what the medium.”


You think you’re safe. You’re on a home computer; your privacy’s set to “Friends Only” not “Public”; you never use patients’ names. So it’s OK to vent about your unfeeling boss and difficult patients, right?

anything you post on the Internet can later be passed along by whomever receives it, so what starts as a private thought could become very public. When in doubt, ask yourself: Would I want to see my words printed in the newspaper or displayed on a billboard with my name and photo beside them? If not, reword your message or don’t send it at all.

Other tips to consider:

avoid posting (or sharing) disparaging remarks about patients, co-workers and, or, management. Best not to comment on them either.

Remember that even unnamed patients can be identified by details such as age, occupation, medical condition, your care setting or occupation. Posting such information makes you vulnerable to legal action.

Read your employer’s policies about electronic technology and know the limits.

Don’t take photos or videos of patients without proper authorization, such as a signed consent form.

Offering health advice online in response to a “friend’s” question could make you professionally liable.

create strong passwords, change them often, keep them private.

Do you really know who you’re talking to online? It’s easy to assume a false identity online . . . that might not be a fellow sympathetic nurse you’re “talking” to!

always err on the side of caution. When in doubt, check professional guidelines for nurses, such as caRNa (http:// www.carnapresident.ca/index.php/social-media-guidelines), the United Nurses of alberta’s social media guide (http://www. facebook.com/UnitedNurses?sk=app_4949752878) and cNPS advice on social media (http://www.cnps.ca/index. php?page=147).

How to Keep

Facebook your “friend”

Who can help?

As electronic connectivity blurs the boundaries between professional workplace conduct and personal off-duty actions at home, how can nurses tell when they’re stepping over the ethical line? Chantal Leonard, CEO of the Canadian Nurses Protective Society (CNPS), acknowledges that even the best-written employer polices, or standards and guidelines published by nursing regulatory bodies, can’t cover every situation.

“Given the unpredictable nature of nursing practice, situations are bound to occur that aren’t expressly contemplated in these documents. In these circumstances, nurses can turn to the practice advisors within their regulatory bodies for advice. Members of the College & Association of Registered Nurses of Alberta can also contact the CNPS for confidential legal advice, a service that’s included in their CARNA membership fee.” As well, nurses can review helpful infoLAWS informational bulletins on the CNPS website (www.cnps.ca), under headings such as “Privacy and Electronic Medical Records” and “Social Media.”

“Ironically, the characteristics that represent the greatest benefits of electronic information can also be their greatest drawbacks,” says Leonard. “That said, on balance the benefits greatly outweigh the drawbacks, because once the risks have been identified, they can be managed. The key is putting the right precautions in place.”

Ultimately, the challenge for nurses, as for our fictional nurse, Sheila, is to remember that technology is just one more aid nurses must use wisely. “Computers will never become the face of nursing as long as nurses use them as a tool and don’t suspend judgement,” says Shaben.

“It’s time to acknowledge the elephant in the room,” agrees Kleib. “Technology in nursing is here to stay. The question is no longer should nurses use it; it’s how do they do so wisely, safely and professionally.”


BY TYLER BUTLER

MacEwan University’s Faculty of Health and Community Studies presented a panel on September 27, 2011, titled “Linking Education to the Future of Health Care: A View from Women in Leadership.” The goal of the panel was to explore the future of health care from the perspective of three female leaders in the field. The panelists, Sheila Weatherill, Dr. Ruth Collins-Nakai and Dr. Jane Drummond, are all health care experts who have actively engaged with MacEwan University during their careers.

Sheila Weatherill, the past president and chief executive officer of Capital Health in Edmonton, was appointed a Member of the Order of Canada in 2006. Dr. Collins-Nakai is a renowned cardiac physician and a former member of MacEwan University’s board of governors, where she was instrumental in conceptualizing and advocating for the MacEwan Student Residence. Dr. Drummond is the vice-provost (Health Sciences Council) at the University of Alberta, where her responsibilities include academic leadership and strategic direction for interdisciplinary health science learning. The vast scope of these women’s collective experience granted the panel’s attendees extensive insight into health care education in Alberta and the shape it will take in the future.

The panelists are leading voices in their field and can speak to the challenges of working in an industry where gender inequality is still very much a factor. “It is an uphill climb for women,” says Dr. Collins-Nakai. “Being a leader among male physicians is an uphill climb. At any given point, you must be better than the men to be considered equal.”

Nevertheless, Dr. Collins-Nakai notes the increase of women in leadership positions within medicine in recent years. “There are more women in medicine, so there are more women in leadership,” she explains. “My mother was a physician in the ’40s, and it was probably easier for me than it was for my mother; and if I had a daughter in medicine, I think it would be easier for her than it was for me.”

“I think it is changing, but still – if you look at the proportion of women in medicine and look at the proportion of leaders who are women – you will find an imbalance.”

Exploring the future of health care

The panel generated a candid discussion and focused mostly on audience questions. Conversation quickly gravitated toward topics that included strategies to manage the supply of and demand for health care workers; this is significant because the health care industry currently engages in cyclical hiring that tends to generate either substantial demand for workers or severe oversupply. The panelists also addressed the potential benefits of the increasing integration of technology into the health care field, both in simulation education and in the form of workplace technologies, such as tablet computers.

Dr. Collins-Nakai reflected on the technological advances she has witnessed and seen utilized over her career. “Alberta Health did a handwashing survey,” she recounts; “They went around with iPads, and the researchers kept track on a simple scoring system of who washed their hands. They tabulated it walking around from room to room.”

“When I started using computers they were very large. Now, you can walk around from room to room doing important research – a simple example of how new technology can enhance or improve care to best practice.”

The panel also discussed the rise of gerontological and palliative health care in Canada, highlighting the importance of compassion in the future of health care.

Palliative and compassionate care – especially the importance of good bedside manner – was of special interest to the audience and panelists. Dr. Collins-Nakai, in an interview after the panel, expanded on the issue: “Increasingly, we have to focus on compassionate care for patients. There is never going to be enough care for somebody who is facing death in terms of technology, because we are never going to be able to stop death. As more and more people are facing that, they grasp at more straws – but, if they have compassionate care around them, they are less likely to want the magic technology. If they are not alone in dying, they are less likely to push for the next new drug.”


Celebrating women in leadership and exploring the future of health care


Canada’s population is aging, and seniors are the fastest growing age group. Combine these facts with an increasing number of chronic diseases and it becomes clear the demand for palliative care and palliative care nurses will grow exponentially as the number of clients in hospices and acute care hospitals increases. It is now the case, though, that most symptoms can be managed well enough that clients can remain in their homes for most of their illness, unless end-of-life care becomes too difficult for the family or home care team.

“With people living longer, and dying from chronic disease more so than from acute illness, people are receiving care at older ages, often with fewer family supports.”

By Heather Andrews Miller


Trends in palliative care have shifted in recent years, affecting the practice of nursing. “The current focus is to shift dying from acute care to the community. Current trends in society, such as changes in family structure, prelude a reduction of future informal caregivers,” Tycholiz says, adding that nurses will need to assess the support system in home environments. “Studies have shown that in Canada, three-quarters of people die in long-term health care centres or acute care facilities. Of those, three-quarters could have died in hospice or at home.” Consequently, it’s necessary to invest more in home care, in training staff so that they’re comfortable managing patients with complex issues and needs, and in educating primary care personnel so they do a better job with chronic disease management. Greater awareness of the availability of these skilled nurses might encourage people to stay at home longer. As well, nurse researchers will need to understand how to support caregivers in order that they can perform their role and remain healthy. Tycholiz adds, “Nurses will face new and innovative technologies that support patients directly or indirectly, such as computer assisted assessments that are used to capture and share data, helping us to make decisions on health care resources based on current and projected needs.” The potential need for palliative care is now identified earlier in the client’s illness, replacing the decades-long emphasis on the last days or weeks of life. Ideally a crisis team can be introduced much earlier that would incorporate a variety of disciplines – nurses, physicians, respiratory and occupational therapists, and others – to manage patient care.

Tycholiz notes that nurses confront special challenges and ethical issues in the context of end-of-life care, such as the moral distress inherent in cases of dying children. Issues of autonomy, justice and futility often surface for providers in conjunction with resuscitation, palliative sedation, and artificial hydration and nutrition interventions.

“Palliative care patients will be in many settings of health care,” concludes Tycholiz, when asked about the importance of educating nurses in the speciality of palliative care. She acknowledges it’s not reasonable to educate all nurses in all sectors to manage all symptoms common in palliative care, “But at the very least, I think they should be able to recognize someone who is in need of palliative care services and know how to connect them to resources by way of a referral.” Palliative care is not just a philosophy of care combined with a field of medicine, she adds. “It also needs to be viewed as a system of care that requires research into program structure, modes of care delivery and overall integration of services that will enable us to provide the right care by the right person at the right time.”

MacEwan University’s Hospice Palliative Care and Gerontological Nursing, a component of the certificate program in Post-Basic Nursing Practice, teaches registered nurses the skills they need to work effectively in these areas. An 18-credit distance-delivery program of studies is available that graduates many skilled and satisfied nurses. While many students are nurses with 20 to 30 years’ experience, a growing number of graduates have had little previous exposure to palliative care.

Jamie Tycholiz is one graduate. She is the End-of-Life Quality Consultant in Health Policy and Service Standards Development for Alberta Health and Wellness. Tycholiz notes that during her career, including 20 years at the Cross Cancer Institute and six more as a nurse consultant in the Edmonton Zone Palliative Care Program, the need for qualified nurses has never been greater. “With people living longer, and dying from chronic disease more so than from acute illness, people are receiving care at older ages, often with fewer family supports,” she says. Even for nurses who specialize in palliative care or who work as community liaison nurses at cancer centres, hospices or home care centres, the specific knowledge and experience about palliative care gained through the program is invaluable.

Courses range from one to four credits and include topics such as Life Decisions and Moral Dilemmas, Dementia Care in the Elderly, and Co-ordinating Care Delivery Resources. “Nurses require more knowledge about symptom management of leading chronic diseases, such as dementia types, renal disease, and chronic CHF and COPD, in order to manage affected individuals effectively,” notes Tycholiz. The courses are available in online or print-based formats, and a field project is a program requirement. Increasingly, home care nurses, nurse practitioners and nurse consultants will be called upon to provide comprehensive assessments for patients in communities and facilities.

by Cheryl Mahaffy

Sent overseas to mentor the Ethiopian Nurses Association as it developed foundational documents

and policies, Debbie Phillipchuk and Debra Allen returned home with the overwhelming feeling of

having received more than they gave. Despite lengthy nursing careers capped by more than a decade as policy and practice consultants with the College & Association of Registered Nurses of Alberta (CARNA), each gained a broader understanding of what nurses can accomplish in the world – and of the inequities that demand our attention.

Sitting together at the CARNA office, the two marvel at how much Ethiopian nurses accomplish with so little. The country has just 17,000 nurses and 65 million people; in Alberta, by contrast, 33,000 registered nurses serve 3.7 million. The Ethiopian Nurses Association relies for funds on members who all too often need to choose between paying professional dues and putting food on the table. Yet the association had grown from just four members to 900 by the time CARNA became involved and was determined to lay the foundation for improved health care.

“You go over thinking maybe you’ll be able to help, but I learned a lot from them,” says Phillipchuk, who travelled to Ethiopia in 2003 and again in 2009. She recalls being humbled by the passion with which one nurse spoke about the great responsibility of


their work, as colleagues from across the country listened intently. “I really felt a rejuvenated sense of pride in my profession,” she says. “That was totally unexpected, and a gift.”

Allen, who went to Ethiopia in 2010 and 2011, saw her preconceptions “blown away” by the Ethiopian nurses’ level of education and professionalism. At the same time, seeing how they had incorporated Phillipchuk’s earlier advice into the fabric of their organization, she knew they were benefitting from the Canadians’ presence. Whether the topic was ethics or standards or building bridges with allies, she says, “They really took a lot of what we talked about to heart.”

That cross-pollination is exactly what nursing needs in a globalized world where people and diseases flow across

borders at accelerating speeds and quality of life is starkly unequal, says Dr. Irene Coulson, who teaches in MacEwan University’s Bachelor of Science in Nursing program and has extensive international experience. “The world is borderless, and we have to be cognizant of what is happening elsewhere.” Not only do circumstances around the globe affect nursing in Canada, but nurses have a responsibility to seek social justice wherever inequity compromises health.

Social Justice and Nursing Policy

Indeed, promoting justice is one of seven primary values in the 2008 Canadian Nurses Association (CNA) Code of Ethics for Registered Nurses. “Nurses uphold principles of justice by safeguarding human rights, equity

and fairness and by promoting the public good,” the code says. “Nurses should endeavour as much as possible, individually and collectively, to advocate for and work toward eliminating social inequities.” Part II of the code is entirely devoted to systemic issues nurses need to address, including environmental degradation and human rights violations. Promoting social justice, the CNA concludes, “becomes foundational to every nursing encounter.”

In 2010 the CNA took another step in defining what promoting justice means for nurses by publishing Social Justice… a Means to an End, an End in Itself. Noting that one of the key components of a just society is equitable access to and fair distribution of the conditions required for good health, the paper says this: “Recognizing that avoidable disparities

exist is not enough; it is an ethical obligation, particularly among those more advantaged, to work toward their elimination.”

A 2008 report by the World Health Organization Commission on the Social Determinants of Health sets a timeframe for that work, calling on all nations to reduce inequities in health within a generation. Its rationale: “Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death.”

Health care Education in a Globalized World

Coulson’s very first time abroad as a nurse, studying the health care system in Egypt as a master’s student, opened her eyes to inequities in health care. “It made me realize that social justice doesn’t relate only to our own country, but to people around the world,” she says. Since then, her

experience as a nurse academic in Australia, Indonesia, Nepal and Hong Kong has illuminated the chasm between rich and poor in both resources and access to health care. In Katmandu, Nepal, the entire faculty of nursing depended on two computers with sketchy Internet access, the antiquated surgical theatre at one hospital had no access to analgesics, and leprosy remained a heartbreaking fact of life despite its elimination in wealthier countries. In Jakarta, Indonesia, one of the nursing school libraries had few resources and little access to best practices. “Everyone in the world wants access to good health care, respect and dignity,” Coulson says, “but millions of people still don’t have access to clean drinking water.”

The inequity Coulson discovered between health care systems extends to education. The distribution of medical schools corresponds to neither population nor disease burden, according to an international commission charged with redesigning health care education to match global realities. The commission’s report, Health Professionals


"What we need is education that demonstrates competency-

based global awareness," Coulson says.

"Educational programs need to be internationalized, so

that at the completion of four years graduates understand

how social health determinants impact populations around

the world."

for a New Century, says disparities in total health care investment far outstrip disparities in income; the world’s richest countries generate 100 times the national income of poorer countries, but are spending 1,000 times more on health care expenditures per person. Noting that health is a human right, the commission proposes “transformative learning” that prepares students to be “change agents” who “appreciate the human rights aspect of their work.”

The commission also recommends smarter use of technology to ensure that professionals in underserved areas have access to education and training. Having carried an entire nursing course and instructions for online learning management to Russia on a memory stick while co-leading a Canadian International Development Agency–sponsored workshop, Coulson has seen how even the simplest technologies can enhance learning. E-learning can be a valuable tool for education, health promotion, research and sharing of best practices, she says, when provided with sensitivity to cultural norms and learning styles.

Even though Canada invests far more per capita in building health care expertise than most countries, our citizens are not immune to health inequity, Coulson notes. Life expectancy among First Nations people stands several years below the norm, rural communities lack doctors, poverty remains a grim predictor of disease, newcomers struggle to maintain good health.

Given that Canada is one of the most multicultural nations in the world – and that its mosaic keeps changing – we need nurses who are aware of the cultural values and expectations patients carry with them from abroad, Coulson says. While internationally involved nurses see global issues first-hand, many of those working solely

in Canada remain quite unaware, she adds. Meanwhile, internationally trained nurses who could help bridge cultural gaps have difficulty finding places in Canada to prove their skills.

“What we need is education that demonstrates competency-based global awareness,” Coulson says. “Educational programs need to be internationalized, so that at the completion of four years graduates understand how social health determinants impact populations around the world.”

MacEwan University’s International Health Advisory and Steering Committee is exploring ways to expand students’ exposure to global health issues and opportunities. Options abound, says Coulson, who sits on the committee. Global and local social justice concepts can be woven into existing curriculum, not only in nursing but in acupuncture, social work and many other programs. Students can search out courses and programs specifically about various aspects of global health, which are popping up within learning institutions around the world. Volunteering or working overseas can also provide invaluable insights while putting at least a finger in the dike of global inequity. International opportunities include capacity building through

mentorship and teaching, as Coulson, Phillipchuk and Allen have done, or working at the front lines to address health care needs.

International Nursing on the Front-line

Diana Kemp chose the front-line approach – or rather, it chose her. An offhand “Sign me up!” said half in jest after learning about a

surgical mission to Ecuador, put her on a journey that has forever changed her life – and helped give hundreds of people the gift of increased mobility. Between 2002 and 2009, Kemp played an essential role in Operation Esperanza (i.e., Hope), an orthopaedic team led by Dr. Tom Greidanus that travels to South America once a year for a week-long blitz of surgeries, mostly on hips, knees and club feet. Many of the patients are farmers in the high Andes who need to walk long distances to reach their crops. When unable to walk, they are cut off from their livelihood, she says. “They can’t work, they can’t make money, they can’t feed their families – so there’s a ripple effect. Helping one person really helps the whole community. It gives them an opportunity to actually have a life.”


Expecting to operate in something as basic as a hut, Kemp instead found herself working in a fairly modern private hospital that catered to the rich by providing procedures such as plastic surgery and breast implants. Even so, equipment was often outdated and overdue for cleaning, and safety standards left her dumbfounded. Staff would toss used needles into old bleach bottles and throw urine bags into the garbage, she recalls. “I felt like I had gone back to 1976, when I graduated from nursing school.”

In that environment Kemp faced daily judgement calls that demanded a certain blend of creativity, flexibility and backbone. “We wanted to do as many surgeries as possible, yet we had to do it in a way that was safe,” she recalls. “So I had to struggle within myself on how much to stretch the limits.” The Esperanza team was able to do some teaching while onsite, and in subsequent visits saw gratifying shifts in practice, including regular cleaning and use of biohazard containers for waste.

Even though the hard work and sketchy conditions made it anything but a holiday, to her surprise Kemp found herself wanting to return year after year. After two trips with the mission, she invited husband Bruce to come along. “I wasn’t planning to go year after year, but you kind of get the bug,” she reflects. “It’s such a rewarding experience. That’s truly what it is – an experience.” Bruce, too, caught the bug and became a key organizer for a dental team that accompanies Operation Esperanza. The couple has since travelled back to Ecuador to stay with friends met through the mission and to volunteer in Rotary service projects. And so the network of generosity grows.

Like other teams invited into the hospital for medical missions by its kind-hearted administrator, Esperanza always attracts crowds of poor patients who contrast starkly with the usual clientele. Seeing all that pent-up need, the hospital recently renovated part of its lower level to care specifically for

people who cannot pay. Thus the mission has had another positive spinoff, nudging medical professionals in Ecuador to care for the poor in their midst.

To anyone pondering international nursing, Kemp has this advice: “Just do it. Don’t put it off.” But don’t go in blind, she adds. “Talk to someone who has gone before to find out about the environment and understand the culture of the people. In markets, our group of Canadians would stick out like a sore thumb. So you want to be a good ambassador, respectful of their beliefs and values.” It’s also crucial to find out what personal gear and medical supplies to bring, especially if the place is remote, she adds. “And make sure to take care of yourself when you’re there, so you can care for others.”


Photography by Nathan Van Driel

Debbie Phillipchuk and Debra Allen each visited Ethiopia twice as

representatives of Strengthening Nurses, Nursing Networks and

Association Program (SNNNAP), a Canadian Nurses Association

initiative that is improving health outcomes by strengthening nursing

associations overseas. Funded by the Canadian International Development

Agency, the 30-year-old program matches international nursing

associations seeking mentorship with provincial nursing associations in

Canada: Ethiopia with Alberta, Vietnam with Newfoundland, Indonesia with

Saskatchewan, Nicaragua with Ontario, Burkina Faso with New Brunswick.

The Canadian Nurses Association website also contains suggestions

for other ways to become involved in international nursing. Details at

www.cna-aiic.ca (click on International Programs).

Diana Kemp made multiple trips to Ecuador with Operation Esperanza,

a medical team that spends one week a year doing orthopaedic and

dental surgery for people who could otherwise not afford it. The team

operates under the umbrella of EMAS Canada (www.emascanada.

org), an interdenominational Christian charitable agency that partners with

organizations in several countries to provide hope and healing in under-

serviced areas.

Dr. Irene Coulson encourages researchers to explore the International

Development Research Centre (IDRC), a Crown corporation that

helps developing countries use science and technology to find practical,

long-term solutions to the social, economic and environmental problems

they face. For current IDRC funding opportunities, see www.idrc.ca/EN/

Pages/default.aspx

Overseas

CONNeCTIONs

Overseas

CONNeCTIONs

The Role of Educational Institutions

Educational institutions can play an important role in supporting nurses who work internationally, says Coulson from her office at MacEwan University. “You can’t just drop them in there and expect good things to happen. There have to be all kinds of processes in place so that students and nurses are ready and then supported when they go.” She recalls becoming very ill while teaching in Indonesia, and relying heavily on both the Jakarta nursing school and her home university in Australia as she recovered.

Allen and Phillipchuk, the CARNA nurses sent to Ethiopia, soaked up all the information they could before going and agree that doing so is essential. Yet they say nothing could have fully prepared them to step off that plane into the earthy smells, the hurly-burly of people, the mishmash of vehicles and the glaring disparity of Addis Ababa, Ethiopia’s capital city.

“I was overwhelmed by the poverty; I couldn’t see anything except that,” Allen says. “And that sense of space we have as Canadians – people were in my space all the time.” The snapshots Phillipchuk carries in her memory would not look out of place in the movie Slumdog Millionaire: a smoky shantytown under her hotel window, kids knocking on car windows with misshapen limbs, a defenseless donkey trapped within a clogged-up roundabout. It takes a first trip, they both agree, to set the whole scene in context, accept it for what it is and figure out where a Canadian nurse might be able to contribute.

The second time they went, the CARNA nurses experienced a different Ethiopia. “I didn’t just see the poverty; I saw the people, and lots of happiness,” Allen says, while


" You don't realize until you go how much we have here... At the same time, you realize nursing is nursing wherever you practice, and people

are people wherever you go. The problems are similar; it's just that there, the degree can be overwhelming."

Phillipchuk nods agreement. “Struggles too, I don’t want to gloss over that, but I could see people going about their normal lives. And I wasn’t as afraid.” Through it all, the tenacity and resourcefulness of the local nurses never ceased to amaze them. “We talk about primary health care,” Allen says. “That exists there. They really do that.”

Kemp still keeps in touch with Miriam, a young woman who received care on Kemp’s first mission in 2002. Challenged by severe rheumatoid arthritis, Miriam had been unable to walk for several years before receiving hip and knee replacements – first on one side and, a year later, on the other. Jobless before, now she works as a secretary in a mayor’s office.

“It makes you feel so good that you actually changed this person’s life,” Kemp says. “And as much as we changed her life, she changed my life. We have people now in another part of the world who are our friends and always welcome us to stay in their home.”

Operation Esperanza was back in Ecuador recently. Although Kemp didn’t go with them, she checked in through cyberspace and learned that Miriam was at the hospital that day, helping out the team. “Wow,” she thought, “the care we’ve given has come full circle.” That’s the beauty of practising social justice in a global community.

Bringing the Experience Home

Not everyone can nurse internationally, yet the experience has something to teach us all. Realizing this, these nurses feel a responsibility to share the lessons they’ve learned. Doing so can be as simple as advising against sending outdated textbooks and equipment and inspiring, instead, the donation of a gift people really need. Phillipchuk recalls how a visit to a Catholic hospital and nursing school during her first trip to Ethiopia alerted her to the region’s dire need for a better water supply. Back at home, the story prompted colleagues to donate $2,236. Matched by $2,048 from the Wild Rose Foundation, this generosity built a well that drains into separate pools for drinking water, washing clothes and feeding animals. The well now attracts 8,000 people from miles around.

Their international experience has also prompted these nurses to look anew at daily work. “For us, mentoring meant going to another country, but it should be something we do even with others in practice settings every day,” Allen muses. “How can we help nurses understand the whole responsibility of mentoring?”

After being “the odd man out,” as Allen describes it, the nurses also share a new understanding of what it means to be attuned to diversity. After watching nurses struggle daily to provide health care despite glaring

inequity and injustice, they have a new appreciation for everything Canadian nurses have achieved over the years.

Kemp learned some lessons in South America as well, including how to communicate without knowing Spanish. Even the few simple phrases she tried to master caused people to look puzzled and respond, “We don’t speak English.” So she was reduced to relying on eye contact and the art and science of body language. “It helped me to really have empathy for the people I care for.”

Those lessons now inform her work as Director of Patient Safety at the Royal Alexandra Hospital, Kemp says. “Getting that different perspective really prepares you well for any future challenges. It brings you back to the basics of nursing and helps you to keep focused on the reason you went into the field in the first place.” The learning also informs her volunteer position as Chair of the Health Ministry Committee at Riverbend United Church, she adds; “I believe we are who we are as a result of all the experiences we have. It makes you a richer person.”

“You don’t realize until you go how much we have here,” Phillipchuk says, recalling the pleasure of brushing her teeth with tap water again. “At the same time, you realize nursing is nursing wherever you practise, and people are people wherever you go. The problems are similar; it’s just that there, the degree can be overwhelming.”


LIFELONG LEARNING

BY TYLER BUTLER

Claudia Seiler-Mutton has plenty of experience with international students, both as an instructor and as a student herself. Born in Switzerland, she learned English and immigrated to Canada in 1982. She trained as an RN here, supplementing her degree with a certificate in gerontological nursing obtained through distance learning with MacEwan College (now MacEwan University). Today, she has taught at MacEwan University for over 10 years, engaging with a wide range of material and diverse delivery methods. This semester she is instructing clinical nursing courses and a distance learning certificate in hospice palliative care; she is also working with a cohort of internationally educated nurses.


Claudia considers the different facets of her job exciting. “I think if I didn’t keep myself busy I would get bored . . . I like challenges. I like something different from teaching the same lab over and over again. I like the variety.”

The variety of delivery methods Claudia employs are certainly challenging, especially in the ever-advancing realm of distance education. “My biggest challenge with the distance instruction is not having the face-to-face,” she says. “The two courses I have done so far used Blackboard, the odd phone call, lots of emails. But it is hard to convey all that knowledge and all that information through emails and to trust that they are learning what they are supposed to be learning.”

The rapid changes in distance education are very noticeable, especially since Claudia was a distance education student at MacEwan College. “I did my Gerontological Nursing Certificate ten years ago,” she recalls, “and they said, ‘Here is your course package. Read the modules and do the readings and submit your assignments.’ It was all written and air mailed back and forth. So now, we are emailing and posting on Blackboard and Skyping.”

The emergence of instant communication and accessible video calling are exciting recent developments for her courses. They help bridge the distance she confronted while communicating by mail during her own education. Ongoing technology advances make the future of distance education hard to foresee, but Claudia is excited to implement it. “The possibilities are endless,” she says.

Claudia Seiler-Mutton on distance education and teaching international students

“Everytime I teach something, I learn something new.”


LIFELONG LEARNING

BY TYLER BUTLER

At MacEwan University, Claudia instructs students from around the world, through both distance education and exchange programs. Many times, her students are RNs from other countries seeking certification in Canada.

Her experience with international students presents its own challenges and rewards. Teaching international students requires Claudia to contemplate the core of her instruction and adapt it to work within different practices, cultures and, especially, languages.

“Nurses use a lot of slang,” she explains, “even, I think, in our professional language we still use a lot of slang. And for students who are not from here and did not grow up with that, I think it can be a little challenging trying to express information in a professional way that will make sense to them and still get the message across.”

Currently, Claudia is one of several instructors working with a cohort of RNs visiting from India. The cultural and practical divides have already forced her to adapt her lesson significantly. However, she views this as an opportunity to learn from her students.

“I love the information they bring with them. I ask them lots of questions about ‘What do you do in your own environments? What are your standards? How does it compare to what I know here?’ I have to adapt my teaching style to their learning style because it is quite different.”

The sophisticated technology and learning tools available at MacEwan University present a significant change for this current group of students. The Clinical Simulation Centre – a multi-floor complex that includes computerized training mannequins and replica hospital rooms – is an advanced and comprehensive learning tool unlike anything the students utilized during their training in India. However, the importance of simulating a modern clinical environment for the students cannot be underestimated.

“With the Indian students right now,” Claudia explains, “we are learning how to do pain assessment. I’m taking them to the simulation lab to do an actual pain assessment. With this group, it was very interesting to see their reaction to the simulation lab and to the technology we have in there.”

“Like all students, the Indian students are initially intimidated by the setting, especially when we tell them that we are going to be recording the simulations. With the Indian group it is a bit more than that. They are really fascinated by the mannequins themselves, the fact that they have pulses, and breathe and blink. But, even though the initial intimidation is still there, the feedback I usually get is that it is a really great learning experience.”

The benefits of Claudia’s varied portfolio as an instructor are evident. Her teaching and sense of perspective develop and improve with each new group of students she leads. Her dedication to improving the quality of education she gives her students means that each adjustment is an opportunity to grow and provide a better service.

“I like to see the changes and the growth in the students and myself. Every time I teach something, I learn something new. As they are learning, I am learning. Every time I teach a course, it is a little more advanced and I am a little more advanced. I am a bit more confident, a little more knowledgeable.”

Claudia and mannequin in the Clinical Simulation Centre

Registered nurses who have taken time away from their careers are returning to the workforce through studies in a unique program that updates all aspects of nursing knowledge. The curriculum brings nurses who have worked fewer than 1,125 hours in the preceding five practice years, and have therefore lost their registration, right back into the industry.

Bonnah Siemens is a recent graduate of the program. “I graduated from nursing in 1995 and worked for about seven years before turning my attention to raising my family,” she says, adding that her four busy youngsters absorbed most of her energy. “When the children got older and I felt I could return to my profession, I was fortunate to be able to take MacEwan’s Nursing Refresher program. It’s difficult to work and raise a family, so it’s good to know you can take a few years off and then get back into it through this program,” she says.

The self-paced delivery method of the Nursing Refresher program is flexible. Using distance delivery and with support available online, only a few days need be spent in the classroom and lab during the program’s two-year time limit. “It’s very self-driven. You can set your own schedule – so I could take a break over summer when the kids were off school, and through December and over Christmas,” Siemens explains. “But it’s demanding too, as you are writing an exam pretty well every two weeks, so you have to pace yourself.” Exams can be scheduled for weekdays, evenings and weekends. Each student is set up with a preceptor with whom she works for 160 hours in an active treatment hospital during her practicum. “It’s invaluable to observe and accompany her as she goes through a typical shift,” Siemens says. During the practicum portion of the course, Siemens put into practice skills she had not performed for many years.

“It has definitely enhanced my career, as there have been a lot of changes in health care since I first took my training many years ago. And because I’m a mature nurse and older than many of the others, I can add my life experiences to my refreshed skills and contribute a lot.” Currently Siemens is employed at the St. Marguerite Health Services building at the Grey Nuns Hospital and works with home care, although she could work in the active hospital as well if she chose.

In Alberta the Nursing Refresher program has been approved by the Nursing Education Program Approval Board, and in Canada it’s approved by the College of Registered Nurses of Nova Scotia and by the New Brunswick Nursing Association. Three theory courses are included; they address a range of subjects, including physical aspects of the human body, disease prevention, medication administration, and rehabilitation and support for clients with a variety of chronic and acute health conditions.

By Heather Andrews Miller

“It's difficult to work and raise a family, so it's good to know you can take a few years off and then get back into it through this program.”


RETURNING toACTIVE NURSING

In addition, interpersonal communications and health promotion are integrated with the theory. The program’s clinical portion may include weekend and evening work, so students have to be flexible.

Janet Schalm also recently graduated from the program. “I moved to Alberta in the mid-1990s and they weren’t hiring nurses,” she explains. “So I went on to be a teacher’s aide and then on to being a health care aide while raising my family. But then one day I asked myself why I wasn’t working as an RN.” She learned about MacEwan’s Nursing Refresher program and signed on immediately, completing the program while living in Mayerthorpe, some 120 kilometres northwest of Edmonton.

“I didn’t need to come into the city except for a few days for the lab, and I was able to stay in the student dorms at MacEwan,” Schalm says. Program materials were sent to her and she did her reading from home. “I went to Whitecourt,

"It's very self-driven. You can set your own schedule..."


RETURNING toACTIVE NURSING

which is only 40 kilometres down the road, to write my exams,” she explains. The materials were very easy to follow, which was fortunate, she adds, because there were copious amounts of reading.

Schalm feels fortunate to be more up-to-date on recent developments in the health industry and with technology that is always evolving. “I know that I encountered questions that nurses who had not taken time off in recent years, for further training, may not have been able to answer,” she says. “Fortunately there are refresher courses available that nurses who are actively working can take as well.” During the lab component, Schalm was pleased to relearn basic skills such as catheterization, applying dressings, IVs and similar procedures.

Schalm originally registered in BC and then later in the Northwest Territories. “I was anxious to return to active nursing,” she says. Now she is working in a long-term care facility in the nearby community of Barrhead and says she is using almost everything she covered in the refresher courses in her new position. “As nurses, we need to be constantly challenging ourselves. Whether we are returning to the workforce or not, we need to upgrade our skills every year. Fortunately, MacEwan University makes that possible with some great courses. I know I couldn’t have returned to my career without the program.”

BY LISA RICCIOTTI

FROM RADIO OPERATOR TO NURSEFROM RADIO OPERATOR TO NURSE

“Nurses have a huge responsibility to stay current at all stages of their careers,” says Mary-Anne Robinson, CEO of the College and Association of Registered Nurses of Alberta (CARNA). “It’s extremely challenging in our information age, when knowledge and technology advance so rapidly. But it’s part of the privilege of being a health care professional and our commitment to the best possible patient outcomes.”

Lyn Strickland has taken that attitude to heart. She’s worked in various nursing fields for 35 years – currently as a Health Canada occupational health nurse in Edmonton – and she’s just finished another course at MacEwan University.

“I needed it to keep up to date on new hearing-testing technology,” explains Strickland. “I’ve also taken courses to qualify for new positions, maintain my skills or meet work requirements. For example, refresher courses in lung-function testing that are required every five years for occupational health nurses. Or sometimes it’s a personal interest, like courses I’ve taken on trauma nursing and health promotion.” Strickland adds that as she moves toward retirement, her

goal is to volunteer or work part time in community nursing. Since she hasn’t worked in community nursing for some time, she’s taking courses in that area too.

Strickland and Smolley are two great professional development role models who’ve embraced the concepts of lifelong learning and continuous self-improvement. Like them, many nursing professionals are self-motivated to pursue additional training for personal or professional reasons. Still, nursing is classified as a profession, and that means there’s a legal responsibility too.

“Under the Health Professionals Act, registered nurses must meet minimum practice standards of continuing competency,” says Robinson. “Many don’t understand this isn’t a CARNA requirement; it’s the law under provincial legislation written for public safety.” LPNs must also meet continuing competency standards under the act, as set out by the College of Licensed Practical Nurses of Alberta.

If you’ve nursed longer than a year, you’re familiar with the mandatory renewal process that includes an annual self-assessment of your competencies. As you fill in the section that defines your learning objectives for the upcoming

When he was 44, Clarence Smolley headed back to school.


BY LISA RICCIOTTI

He kept his day job as a senior radio operator with the provincial government, but signed up for distance learning courses in the Licensed Practical Nurse (LPN) program. Medical training had always interested him, but he’d put that dream on hold while raising a young family. Now it was his time.

“It’s funny, because while I was working on my LPN courses, my older daughter was completing her nursing degree,” says Smolley. “We’d bounce homework ideas off each other.”

At 51, Smolley is now also an LPN, in the Leduc Community Hospital’s endoscopy unit. Since earning his certificate in 2007, he’s advanced his skills with additional training at MacEwan University, including an IV lab. “Direct-push IV was added as an LPN competency after I graduated,” says Smolley. “So I upgraded and I’ve taken other CPNE [Centre for Professional Nursing Education] courses as well.”

Smolley’s discovered what every good health professional knows: Learning never stops. New grad or seasoned practitioner, there’s always more that can – and often must – be learned.

BY LISA RICCIOTTI

FROM RADIO OPERATOR TO NURSEFROM RADIO OPERATOR TO NURSE

year, you may well decide that additional training is on your agenda. But don’t feel overwhelmed at having to improve yourself in competency areas and take professional development courses for your employer too. Instead, do what nurses do best – multi-task and combine the two!

Although continuing competency assessments are not the same as performance reviews done by your employer, Robinson notes that the goals of both can intersect. “One’s a professional requirement, the other’s an employee duty. But there’s no reason your performance review objectives can’t be built into your competency plan.”

You can also take this notion one step further. Why not build your personal nursing goals – moving into a new field, learning a new skill, qualifying for a more specialized position – into your professional-development cum continuing-competency plan? Create a triple-win situation that will benefit you, your employer and your patients.

As for what continuing education to pursue, the professional development modules at MacEwan University range from gerontological nursing to a six-month course on issues in breastfeeding practice. Credit and non-credit courses are offered through distance delivery in self-study courses, as well as best-practices workshops and a clinical nursing skills refresher.

“MacEwan University’s widely known throughout the nursing profession for its long history of developing quality courses for RNs and LPNs,” says CPNE Academic Coordinator Nicole Simpson. Simpson explains that MacEwan University’s distance delivery is moving increasingly to a “forest-friendly” online format, enriched by web links and videos, but because some nurses prefer the traditional hard-copy format, paper-based delivery is available too.

As a student, Smolley found MacEwan University’s distance learning was “a godsend.” On his one-hour commute in to work with his wife, he’d review course materials. “I also really like the variety of courses and the different scheduling and delivery options,” says Smolley.

Lyn Strickland agrees. “Everyone has so much on the go these days, and MacEwan’s distance learning lets you set your own timeline. You do have to be self-disciplined and keep at it, but the reward is lots of flexibility.”

With so many good reasons to pursue professional development, a savvy nurse will look for courses that fill the bill on multiple levels – to meet professional requirements, their employer’s needs and, just as importantly, personal goals. CPNE’s professional development modules are designed to focus on all three. “Our courses are written by nurses, for nurses, to fill nursing’s practical needs,” says Simpson. “We understand nurses.”


Professional Development: Nursing Review Non-credit courses

NURS-0164 arithmetic Skills in Nursing

NURS-0161 Basic Medication administration

NURS-0174 cell aberration (Digestive System)

NURS-0198 central Venous catheter Theory

NURS-0165 community Health Nursing

NURS-0185 Degenerative Process 1(of the cardiovascular System)

NURS-0186 Degenerative Process 2 (of the Respiratory & Renal System)

NURS-0187 Degenerative Process 3 (of the Nervous & Musculoskeletal Systems)

NURS-0162 Documentation in Nursing

NURS-0159 Employer Supervised clinical Demonstration Lab

NURS-0166 Health Promotion

NURS-0169 Infectious Process

NURS-0150 Initiation of Intravenous Therapy Theory

NURS-0168 Immunology in Nursing (Immune System)

NURS-0173 Interpersonal aspects of Nursing

NURS-0199 Interpretation of Laboratory Tests & Diagnostic Procedures

NURS-0163 Introduction to Health assessment

NURS-0151 IV Therapy Lab

NURS-0156 Medication administration by IV Push clinical (Demonstration required – no Lab available)

NURS-0176 Mental Health Nursing

NURS-0177 Metabolic Disorder (Endocrine System)

NURS-0160 Newborn Health assessment

NURS-0175 Nursing care of congenital Disorders

NURS-0178 Nursing care – Separation (Reproductive System)

NURS-0167 Nursing Process

NURS-0172 Perioperative Nursing

NURS-0171 Pharmacology in Nursing

NURS-0170 Responsible Nursing/Professional Responsibilities

NURS-0195 Subcutaneous Infusion and Hypodermoclysis (HDc) Theory

NURS-0179 Stages of Growth and Development

NURS-0157 Support of the Breastfeeding Dyad

NURS-0191 Issues in Breastfeeding Practice – What Health care Practitioners Need To Know

BY LISA RICCIOTTI

Seeking a new challenge and direction?

Gain both theoretical knowledge and clinical skills to work in a challenging and team-oriented environment – the operating room.

RNs can complete the post-diploma certificate and LPNs can complete the four-course certificate online and through distance delivery, providing a flexible and accessible learning opportunity.

Perioperative Nursing could be your next step.

Visit www.MacEwan.ca/RN for more information.


Across Alberta, expert registered nurses help people get well and stay healthy—at every stage in life.

Learn more at expertcaring.ca

“I help my orthopedic surgery patients recover—even when things get tough.”

DONNA PARSONS, RN

“I provide complex wound care that gives my elderly patients

a new lease on life.”

RENEE FERWEDA, RN

“I help my clients navigate the health system and get the services they need.”

JENNIFER BEAUDRY, RN

From hospital to clinic, community to homeEXPERT CARING MAKES A DIFFERENCE

in the 21st century

2011 found the Canadian Nurses Association (CNA) in the good company of most other savvy health organizations – and thinking ahead to the impending expiry of the 2004–2014 First Ministers 10-Year Plan to Strengthen Health Care – aka “the Accord.” More precisely, the CNA was concerned about “What comes next?” What fiscal and policy arrangements would be put in place to succeed the 2004–2014 Accord?

Importantly, CNA leaders were anxious to determine the strategies that would most effectively position the voices of its members in the policy discussions that were sure to emerge around the country leading up to 2014, and to the vexing problem of identifying exactly what needs to be said. What is it that nurses want the future health care system to look like? What interventions will most effectually achieve better population health? What treatments work the best to treat illnesses and injuries? Where will they be provided and by who? And at what costs?

To address these thorny questions, CNA launched its first National Expert Commission (see http://expertcommission.cna-aiic.ca) to consult nurses and other providers, students and youth, governments and the public, and to synthesize the best research in order to inform a series of recommendations to support health system transformation. The commission will table its report in June 2012 at the CNA convention in Vancouver (come and join us! http://www.cna-aiic.ca/CNA/news/events/convention/default_e.aspx).

In mid-February, the commissioners will meet for an intense deliberation of their recommendations. But even before that debate takes place, it is clear that we must transform ourselves in bold new directions if nursing is to be relevant in a transformed 21st-century health system.

By Michael J. Villeneuve, RN, MSc


Centre for Professional Nursing Educationwww.MacEwan.ca/cardiacnursing

Cardiac Nursing Post-basic CertificateDistance delivery program

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This distance program offers you the flexibility to

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Future Directions for Nurses and Nursing

01 Recruiting into nursing programs candidates

who are risk takers and who seek a collaborative,

interdependent and semi-autonomous style of career

that demands strong leadership skills and independent

decision making.

02 Educating nurses with a broad base of health, life

sciences and the humanities, with strong concentrations

in leadership, policy, politics and evidence-driven

decision making.

03 Building a seamless model of nursing education

from the level of the practical nurse to the PhD – one

that builds on demonstrated knowledge and strength,

avoids duplication and rewards expertise.

04 Strengthening the education-science-policy bridge

so that nursing research predicts, is linked with, and is

highly responsive to shifting public policy and program

needs. This bridge must underpin a system of nursing

education nimble enough to meet the changing needs

of nurse employers across the continuum of care.

05 Graduating all baccalaureate-prepared nurses to

provide a broad range of effective population wellness

education, health promotion, public health, and injury

prevention strategies.

If asked to suggest a quick top-10 list for nursing, I would say that by 2025 we must imagine a much more independent kind of nurse: one who is considerably more likely to be working outside a hospital and is much more focused on promoting health and wellness than on fighting illness and disease. Getting there will mean doing the following:

06 Abandoning “nursing diagnosis” in favour of

equipping all generalist nurses with the ability to reach

diagnoses of health/wellness needs and the pathologies of

persons typically seen by primary care teams. While the

approach to diagnoses would proceed through the lens of

nursing, the terminology and recording (charting) would

be common across the interdisciplinary team.

07 Educating all nurses to prescribe a broad range

of treatments and medications typically encountered in

primary care settings.

08 Authorizing nurse practitioners and other

designated clinical nurse leaders to admit patients to

and discharge them from all clinical settings, including

primary care clinics, virtual team contexts, acute care

hospitals, rehabilitation settings, long-term care, home-

and community-based care and palliative care.

09 Expecting all nurses employed in specialty settings

to attain an academic credential certifying specialty

knowledge in the practice area within four years of

graduation from a baccalaureate or clinical master’s

degree program (e.g., nurse practitioner).

10 Proving that every nursing student and graduate

nurse in every setting in the country is equipped with the

modern information and communication technologies

necessary to carry out their practice effectively and

efficiently.The opinions expressed here are solely those of the author and not necessarily those of the National Expert Commission or the Canadian Nurses Association.

By Michael J. Villeneuve, RN, MSc


Centre for Professional Nursing Educationwww.MacEwan.ca/cardiacnursing

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Nursing PRN Spring 2012 Issue 3

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Transcript of Nursing PRN Spring 2012 Issue 3