INTRODUCING. Renewal just got easier. Renew early. Hope and Humanity Jasper RN recounts her experiences in Haiti. TOP 5 Continuing

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1 JULY/AUGUST 2010 VOLUME 66 NO 4 Renew early forachancetowin an Apple ipad with WiFi + 3G! PAGE 8 TOP 5 Continuing Competence Myths PAGE 11 Hope and Humanity Jasper RN recounts her experiences in Haiti PAGE 24 Renewal just got easier INTRODUCING PAGE 8

2 CARNA Provincial Council PRESIDENT Joan Petruk, RN, MHS Camrose PRESIDENT-ELECT Dianne Dyer, RN, BN, MN Calgary NORTHWEST REGION Ellen Jones, RN Grimshaw NORTHEAST REGION Carol Ulliac, RN, BScN, MN, GNC(c) Atmore EDMONTON/WEST REGION Joann Nolte, RN, BScN Edmonton Scott Fielding, RN, BsN, MBA Edmonton Lloyd Tapper, RN, BScN, MN, NP Edmonton CARNA Staff Directory ALL STAFF CAN BE REACHED BY CALLING: or toll free CENTRAL REGION Andrea Miller, RN, BN Camrose Tammy Syrnyk, RN Camrose CALGARY/WEST REGION Sandra Cook Wright, RN, BN Calgary Kerry Hubbauer, RN, BN Calgary Kevin Huntley, NP, MN Calgary SOUTH REGION Leslie McCoy, RN, BN, MN Lethbridge Chief Executive Officer: Mary-Anne Robinson Complaints Director/Director, Conduct: Sue Chandler Director of Communications and Government Affairs: Margaret Ward-Jack Director of Corporate Services: Jeanette Machtemes Director of Policy and Practice: Lynn Redfern Registrar/Director, Registration Services: Cathy Giblin Deputy Registrars: Jean Farrar, Terry Gushuliak, Rosie Thornton, Barbara Waters Competence Consultants: Michelle Morrison, Barb Perry Conduct Counsel: Gwendolyn Parsons Conduct Counsel/Senior Investigator: Vacant Policy and Practice Consultants: Debra Allen, Marie-Andrée Chassé, Donna Hogg, Debbie Phillipchuk Librarian and Archivist: Lorraine Mychajlunow NEPAB Consultants: Lori Kashuba, Margareth Mauro Alberta Registered Nurses Educational Trust: Margaret Nolan Regional Coordinators: Northwest: Kathleen Waterhouse Northeast: Barb Diepold Edmonton/West: Penny Davis Alison Adams Central: Heather Wasylenki Calgary/West: Christine Davies Beverlie Johnson South: Pat Shackleford Valerie Mutschler PUBLIC REPRESENTATIVES Murray Donaghy Airdrie Margaret Hunziker, BA, MA Cochrane Mark Tims, QC Westlock Rene Weber, DVM Red Deer Mark L. Zivot, DPM, FACFAS, FACFAOM Calgary CONTENTS 5 Provincial Council Highlights 12 Volunteer Opportunities 16 CARNA Awards Gala Wrap-up ARNET Scholarship Recipients 20 Mental health services within a comprehensive community care program help the frail elderly 28 Accolades 29 Demonstrate your expertise through CNA certification 30 Publications ordered by Hearing Tribunals 32 ISMP Nurse Advise: Don t Be A Borrower Nor A Lender 36 NoticeBoard/Reunions 46 CEO s Message: It s Time to Have Your Say Alberta RN is published six times a year by: College and Association of Registered Nurses of Alberta Street Edmonton, AB T5M 4A6 Phone: Toll free in Canada: Fax: Managing Editor: Margaret Ward-Jack Editor: Rachel Champagne Assistant Editor: Rose Mary Phillip Designer: Julie Wons Advertising Representative: Jan Henry, McCrone Publications Phone: Fax: mccrone@interbaun.com Please note CARNA does not endorse advertised services, products or opinions. US Postmaster: Alberta RN (USPS # ) is published six times per year in February, April, May, July, October and December by the College and Association of Registered Nurses of Alberta. c/o U.S. Agent: Transborder Mail, 4708 Caldwell Rd E, Edgewood, WA Alberta RN is published at a rate of $42 per year. Periodicals postage paid at Puyallup, WA and at additional mailing offices. US Postmaster: Send address changes (covers only) to Alberta RN, c/o Transborder Mail, PO Box 6016, Federal Way, WA ISSN Canadian Publications Mail Agreement No Return Undeliverable Canadian Addresses to: Circulation Dept., Street, Edmonton, AB T5M 4A6. albertarn@nurses.ab.ca 2 Alberta RN July/August 2010 Volume 66 No 4 XXX-XXX-000

3 update President s Update AGM Address The following is an excerpt from the president s address delivered at the CARNA Annual General Meeting on April 29, 2010 in Edmonton. To read the full text, visit and click on Provincial Council under the About Us tab. is the international year 2010 of the nurse a global initiative honouring nurses voices, values and wisdom. One of the great privileges of presidency is that I get to meet with RNs from around the province and hear about the great work being done. RNs continue to provide the best possible care, continue to advance skills and knowledge and continue to mentor the next generation of nurses to hone their abilities and foster the profession s values. The stand out success in 2009 was the RN role in the H1N1 immunization program. I want to thank registered nurses for their hard work and dedication during the pandemic. Albertans benefited from the expert care you provided at all levels of the system from administration to the front line. For many Albertans, the immunization program was one of only a handful of times they have had to access health care. Previous to that experience, many were unaware of the issues challenging the system. There is no one-size-fits-all solution to these issues. Working toward multi-faceted solutions, CARNA met with, and will continue to meet with, government officials, employers and educators. We met with former health minister Ron Liepert several times during his tenure. We met with the new health minister, Gene Zwozdesky, this past February. CARNA staff, provincial councillors and I will continue to build these relationships. There has been a definite shift in the approach to health care in our province in the last few months. The doors of communication are beginning to open. Drastic cuts to services have been halted for re-examination and the RN voice is being heard once more by government. However, there is still some reluctance to acknowledge the impact of the very real nursing shortage. Often, when we speak of the nursing shortage, we speak in numbers. Numbers like 6,000 the number of RNs the province will be short by Or 1,400 the number of vacant RN positions last year. Or zero the number of external job vacancies left during the hiring freeze. But these numbers do not tell the full story. They do not speak about the patients with complex, acute and unpredictable conditions who got to go home to their loved ones and to their communities because the clinical judgement and critical thinking of RNs saved their lives although that number is in the thousands each year. Numbers don t speak to the shorter wait times for mothers, fathers and children because RNs provide more entry points into the health system and promote better health. Numbers don t speak about the reduced infection rates on surgical units because RN expert care reduces hospital infections. Research proves the value and unduplicated contribution of RN care, but it is still not widely understood. That is why provincial council made the difficult decision to redirect resources from our annual educational conference for members to a public awareness and advocacy campaign. Restrictions on travel, difficulty getting time off and lack of funding support for professional development were creating barriers for the majority of members to attend. Instead, we used these resources to educate the public [through our Expert Caring Makes a Difference campaign]. Our commitment to Albertans does not end with patient safety. It includes all areas of health and wellness. That is why, last year, we spoke out on legislation and policy issues that could negatively impact the health, privacy and well-being of patients and their families. We will continue to speak out at every opportunity. One such opportunity this past year was our presentation to the Minister s Advisory Committee on Health. In the presentation and CARNA s subsequent submission to the committee, I promoted the implementation of evidence-based changes in our health system and raised CARNA s objections to sustainability strategies that included providing care by using less expensive providers. Many members provided positive feedback and their support of the presentation. No doubt, the year ahead will be an interesting one. So far, it has been marked with milestones. In 2010, the CARNA Regional Coordinator Program and the Nursing Education Program Approval Board celebrate their 10-year anniversaries. Congratulations to both on a decade of much success also marks a milestone year for nursing as a whole in Alberta. As of January 1, a baccalaureate degree was the minimum educational requirement for initial entry to practice as a registered nurse the culmination of 30 years of effort. Nursing excellence is all around us. It is in our RN administrators who support and develop their staff. Nursing excellence is in our front-line workers who provide expert care with compassion and a heart-to-heart connection with patients. Nursing excellence is in our educators who prepare the next generation of nurses to take the reins of our great profession. Nursing excellence is in our researchers who arm us with evidence to practise in the very best interests of Albertans. To all of them and to you, thank you. RN Joan Petruk, RN, MHS president@nurses.ab.ca Phone: July/August 2010 Volume 66 No 4 Alberta RN 3

4 Letters to the Editor Cultivating a positive image for RNs I find the substance of the Legal Issues in Nursing conference advertisement in the April issue of Alberta RN appealing and timely. However, the photo of what I assume is a professional nurse is neither unless it s supposed to constitute a case of a disheveled, angry-looking, unapproachable, poorly-postured professional nurse. If the intent is to present positive nurse images in promotional materials, I d recommend that they choose those wisely. Shirley Stinson, OC, AOE, RN, EdD Edmonton Long-Service Award triggers RN pride Recently, I received a certificate acknowledging 30 years of nursing service in Alberta. Since the deep cuts to health care in the early 90s, I have had to reach deeper and look further for the satisfaction in my nursing work. Receiving this certificate was a lovely surprise and it really put a smile on my face. The pride that I feel to be a registered nurse rose to the surface. I discovered it wasn t buried so deeply after all!! Thanks for rekindling the flame in me that I thought was almost extinguished. Jennifer Spring, RN, BN Edmonton EDITOR S NOTE: Long-Service Awards are mailed to members on the 30th anniversary of the year they graduated from a nursing program. The award acknowledges and thanks members for their dedication and commitment to the profession and for their work through the years. Tell us what you think Do you have an opinion about an article in Alberta RN magazine or a general comment on nursing or health-care? Send it to AlbertaRN@nurses.ab.ca. Letters should be a maximum of 300 words and may be edited for length and clarity. Please include your name and city. CORRECTION The May/June issue of Alberta RN inadvertently omitted Rockyview General Hospital as the workplace of Lida Yedynak, recipient of the 2009 ANEA Leadership in Education Preceptor Award. Yedynak helps nursing students in the emergency room develop their expert caring skills as they grow into their new role. Alberta RN apologizes for the omission. Have your say in the development of the Alberta Health Act Albertans are being asked for their ideas and recommendations for the forthcoming Alberta Health Act. CARNA encourages RNs to participate to ensure the RN perspective is heard as this new legislation is created. Your insight and knowledge about the strengths and gaps in the health system will be invaluable during the consultation process. How you can be heard Participate in community workshops. Twelve health advisory councils began hosting workshops across the province in June and will continue through mid-july. Complete the online survey. Go to for a complete listing of workshop locations and dates or to the complete survey. Consultations and written comments from health-care provider groups, advocacy groups and other key stakeholders will also be included in the consultation phase for the new act. The act is in response to a report released last January by the Minister s Advisory Committee on Health, of which CARNA CEO Mary-Anne Robinson was a member. Robinson is also a member of the eight-person advisory committee leading the consultation phase. This September, a report with a detailed plan to move forward that reflects the feedback from Albertans will be presented to Health Minister Gene Zwozdesky by MLA Fred Horne. CARNA CEO Mary-Anne Robinson discusses the new act and why RN participation is important in her Closing Perspectives column on page 46. At the time of publication, CARNA was preparing its written submission to the committee. CARNA is also participating in a stakeholder consultation with physicians and pharmacists. 4 Alberta RN July/August 2010 Volume 66 No 4

5 Provincial Council Highlights Meeting of May 19, 2010 RN Workforce Capacity Remains Priority Issue Members presented and carried two resolutions at the 2010 AGM held April 29, 2010 in Edmonton. The first resolution asked CARNA to advocate to government and employers for sufficient numbers of registered nurses and for a vibrant, supported and engaged registered nurse workforce Council supported this resolution by passing a motion to maintain existing advocacy efforts. Council Affirms Support for CNA A second resolution passed asking council to suspend further participation of CARNA in the National Council of State Boards of Nursing (NCSBN) or the Canadian Council of Registered Nurse Regulators (CCRNR) pending further discussion of the need for participation in other international or national nursing organizations separate from CNA, the benefits of such participation, the financial implications of such participation and the impact of these two new organizational memberships on the united voice of Canadian nurses nationally and internationally and for council to undertake those discussions in a way that general membership of CARNA who wish to participate in such discussions would be able and encouraged to do so. CARNA members had the opportunity to speak to this issue during the council meeting s open forum and council also discussed it during the meeting. Key points raised during the discussion include: CARNA supports CNA, is committed to being a member and has never contemplated leaving. Registered nursing is the only major health profession that does not have a national body representing regulation at the national level. CNA s membership does not include the two largest nurse regulators in Canada. Its expertise and credibility are in advocacy, not regulation. CCRNR membership will allow CARNA to coordinate regulator activities to meet labour mobility requirements, participate directly in regulatory discussions at a national and international level and network with Canadian nurse regulators, including Ontario and Québec. As an NCSBN associate member, CARNA gains access to a forum for discussion of regulatory issues and access to a comprehensive Members Only website with information and resources relevant to excellence in self-regulation for a modest annual fee. Several other Canadian nursing jurisdictions are also associate members. In response to this resolution, council passed a motion which emphasizes its continued commitment to CNA: That Provincial Council does support CARNA s participation in the National Council of State Boards of Nursing (NCSBN) and the Canadian Council of Registered Nurse Regulators (CCRNR) and the Canadian Nurses Association (CNA). Council Sets New Strategic Priorities Council passed a motion identifying four strategic priorities to govern CARNA s work for the next three years. Regulatory Demonstrate leadership in self-regulation strength in enforcement leading in collaboration with other regulators regulatory excellence patient safety/moral space Improve continuing competence program program rigour (structure, process and outcomes) Association Support registered nurses and nurse practitioners in current, expanded and new roles in current and new settings support nurses in existing and evolving practice settings provide framework to support nurses accepting new responsibilities identify, promote and support new roles for RNs in the system Engagement, dialogue and partnership (members and stakeholders) grassroots membership involvement stakeholder coalitions and partnerships CARNA staff will develop an operational plan for based on the new strategic priorities. Dialogue with Parliamentary Assistant Dr. Raj Sherman Dr. Raj Sherman, parliamentary assistant to the Minister of Health and Wellness, shared his perspective on the role and contribution of registered nurses in the health system. He wanted RNs to know that government realizes that patients are satisfied with the care they receive in the health system due to the efforts of front-line staff. He encouraged RNs to provide input into the Alberta Health Act. Other Council Decisions Council made an exception to a December 2008 motion that NPs are not required to take an Observed Structured Clinical Exam (OSCE) for registration such that Alberta NP graduates applying for NP Child- Neonatal registration will be required to take the Québec Neonatal Nurse Practitioner exam (inclusive of OSCE) as a requirement for registration. Council approved the following revised documents: Ethical Decision-Making for Registered Nurses in Alberta: Guidelines and Recommendations. Problematic Substance Use: Are You Affected? Self-Employment for Nurses: Position Statement and Guidelines Decision-Making Standards for Nurses in the Supervision of Health Care Aides July/August 2010 Volume 66 No 4 Alberta RN 5

6 Let s face it, RNs are busy. You ve got expert care to give, clients to educate and so much else to do that contributes to the health and well-being of Albertans. You need the freedom to update your address, change the focus of your continuing competence activities and access helpful resources anytime, anywhere. INTRODUCING your 24/7 one-stop destination for renewal and so much more! 6 Alberta RN July/August 2010 Volume 66 No 4

7 WIN an Apple ipad* with WiFi + 3G! Renew your practice permit online via MyCARNA by August 1 and you could be entered to win one of two Apple ipads. * To be eligible, members must renew online, submit fees in full and, if selected for the continuing competence audit, submit the requested materials by August 1. Complete contest rules are posted at. Access MyCARNA at /MyCARNA at renewal and all year round. It s simple: just log in with your user ID (registration number) and password. In a few clicks, you can update your personal information, renew your practice permit, access your continuing competence information and more! Manage your personal information Recently moved? Transferred positions? Changed addresses? Update your personal information when and where it s most convenient for you. Renew your practice permit Summer has arrived and it s time to renew your practice permit. With MyCARNA you can complete your application and submit your payment online with just a few clicks. Last year, more than 70 per cent of members renewed their practice permit online. CARNA is expecting more than 90 per cent to do the same when they apply for the 2011 practice year. It s simple, fast and always secure. Manage your continuing competence information So, you ve decided to change the focus of your professional development mid-way through the practice year. Why wait for the next renewal period to report the change when you can update your focus indicators online, anytime. With MyCARNA, you also confirm if you have been selected to participate in the continuing competence audit and check the status of your audit. Access tools and resources MyCARNA gives you access to member-only tools and resources, a comprehensive database for nursing literature, and resources on legal topics affecting nursing practice. The Nursing Interventions Classifications (NIC), a key element of the RN competency profile, is also available online on MyCARNA. See page 11 for details. Courtesy of Apple July/August 2010 Volume 66 No 4 Alberta RN 7

8 Online renewal is officially open. This year, we re expecting 90% of members to renew online. Beat the rush and renew your practice permit online before August 1 and we ll enter you to win one of two Apple ipads! Complete contest rules are posted at ready,set... RENEW BY SEPT. 1, 2010 Applications received after the September 1 deadline will be charged a $50 late fee. NEW payment options You can now pay your renewal fees using your current internet banking account the same way many of us now pay our household bills. Most major financial institutions will allow you to add CARNA as a payee under your bill payments. Check with your bank to confirm availability. Other payment options include: Interac online money transfer Visa, MasterCard or American Express cheque money order cash (in person at the CARNA office) Were you selected for audit? Twelve per cent of members (about 3,000) have been randomly selected to participate in this year s continuing competence audit. Selected members were notified in their renewal and will also receive notification on the renewal welcome screen at the start of the online renewal process. If you were selected, you must submit the requested materials complete with your renewal application and full renewal fee to CARNA by September 1. Submit the requested materials and renew online via MyCARNA before August 1 to be entered to win one of two Apple ipads with WiFi+3G. Complete contest details are available online at. NEW NEW How to renew your practice permit We continue to make online renewal easier to access and more user-friendly, including more on-screen assistance to help you through the process. 1. Go to /MyCARNA 2. Login using your user ID (registration number) and password. 3. Click on Renew Your Practice Permit Now 4. Follow the step-by-step instructions We re here to help If you have any questions about your current registration or about renewal, go to /renewal or contact CARNA s registration department at or toll free at Practice permit renewal has gone green! This year, CARNA significantly reduced paper consumption by sending renewal notices by rather than by sending paper applications. If you did not receive your notification, you can still renew online by logging in at /MyCARNA. All you need is your user name (registration number) and password. If you forgot or don t have a password, just click Forgot My Password and one will be ed to you. 8 Alberta RN July/August 2010 Volume 66 No 4

9 Committed to Competence: Completing your 2010 Learning Plan and Planning your 2011 Learning Plan Now that practice permit renewal is underway, it s a good time to review your 2010 learning plan to make sure you re on track. The review will also help prepare you to report on your professional development activities on your renewal application. You do not necessarily have to meet your learning goal before renewing your practice permit, but you do need to be working on it. If you don t feel you have completed, or fully completed, your current learning plan, you may choose to work on the same indicator(s) in the upcoming practice year. As long as this focus remains a priority for you and fits your practice, all you need to do is develop a new learning plan and complete new learning activities in the upcoming year. After reviewing your 2010 learning plan you can turn your attention to developing your 2011 plan. This requires some careful thought and attention before you submit your practice permit renewal application. Reporting your indicator(s) for the 2011 practice year requires that you have completed the first three steps in the reflective practice process. 1. Assess your practice against the nursing practice standards. Remember, each indicator is a statement of expectation for all nurses in all practice settings. To assess your practice, you need to determine how you meet that expectation in your own setting. Ask yourself as you read each indicator Is there anything I need to learn in order to be able to demonstrate, or better demonstrate, this indicator in my practice? You may need to review the responsibilities of your role, the policies of your workplace or the goals of your organization. You may find it helpful to review the Core Interventions for Nursing Specialty Areas section of the Nursing Intervention Classification (NIC). For more information on NIC or how to access it online, see page Collect feedback. Collecting feedback is a good way to get objective input from a respected colleague about your practice. Compliments are nice, but the most useful feedback is honest and constructive with the goal of nurses helping nurses to further professional development. The feedback you receive can help to support or refute your self-assessment and help guide you toward identifying your strengths and areas for improvement. 3. Select your learning focus for the coming year. Once you have identified your priority indicator(s) you should create your specific learning objective(s). Keep in mind that indicators themselves are not learning objectives; you must develop your own learning objective that clearly outlines your own learning needs. A strong and specific learning objective is the backbone of a good learning plan. It will help you decide what learning activities will help you meet your learning needs. It will also help you evaluate the effectiveness of your learning activities. This initial effort in developing your learning plan will help keep your learning needs in your mind and prevent leaving it to the last minute or feeling rushed to complete it. Questions about completing your 2010 learning plan or developing your 2011 plan? Contact us at: / ext. 411 continuingcompetence@nurses.ab.ca The Continuing Competence Program Audit is being conducted concurrently with practice permit renewal. Information about what is required if you were randomly selected for audit was included in the May/June issue of Alberta RN and can also be viewed on the CARNA website at. Remember, if you were selected for audit, the requested materials and your 2011 application must be received before Sept. 1, For more information on practice permit renewal, see page 8. July/August 2010 Volume 66 No 4 Alberta RN 9

10 TOP 5 Continuing Competence Myths MYTH 1 MYTH 2 MYTH 3 MYTH 4 MYTH 5 There is no way of finding out which indicator(s) I selected for this year or which one(s) I focused on in previous years. Your continuing competence reporting history, including this year s selection, is easily accessible at /MyCARNA. All you need is your registration number and password. I cannot change my priority indicator during the practice year. You may change your indicator(s) during the practice year as often as you like. This may be very appropriate, especially if your practice setting changes. You can make this change yourself using MyCARNA or you indicate the change on your renewal application form at the end of the year. It is this final indicator(s) that you will report on and that you are accountable for in the event of audit. The workshops, in-services, on-the-job learning, CNA certification learning activities and informal learning that I complete don t qualify for the continuing competence program. These activities are the way in which we maintain our competence to practice in our designated role and practice setting and are exactly what is required for the program. Any learning activity that contributes to your professional development and is relevant to your practice setting meets the requirements of the program. Only formal education (university or college courses) are considered acceptable education. Learning can encompass many different methods. The Continuing Competence Program does not dictate what is or isn t acceptable education. The requirement that continuing education be formal education is only for calculating annual practice hours and is not related to the Continuing Competence Program. You can include any type of learning activity on your learning plan that you felt was relevant. There are no resources available to help me meet or understand the program or audit requirements. We re here to help. Call the help line at / ext. 411 or reach us by at continuingcompetence@nurses.ab.ca. The following website resources may also be helpful and are available at : the continuing competence reference manual, including sample worksheets ( Member Info > Continuing Competence > Worksheets and Forms > Links and Resources ) blank, downloadable worksheets and forms (under Member Info > Continuing Competence > Worksheets and Forms ) the continuing competence tutorial or video presentation (click on the computer icon at the bottom of the homepage) a continuing competence education session (dates, time, and locations throughout the province can be found under Events ) details about audit requirements and evaluation criteria ( Member Info > Continuing Competence > Program Monitoring ) 10 Alberta RN July/August 2010 Volume 66 No 4

11 Are you 1of 10,000? The Nursing Interventions Classification (NIC) has been accessed online almost 10,000 times since becoming available to CARNA members in October RNs are utilizing NIC to help communicate the visible and invisible aspects of RN expert care, like critical thinking and clinical judgement. The use of NIC also helps to plan and document care and enhances communication between nurses, other care providers and the public. Do you work in clinical practice? Medical-surgical nursing? Perioperative nursing? Gerontological nursing? NIC readily identifies a comprehensive list of RN competencies at the level of specific nursing interventions for these speciality areas of practice and many more. Together with the entry-to-practice competencies and the International Classification of Nursing Practice, NIC describes the competency profile for RNs in Alberta. NIC is available online 24 hours-a-day, seven days-a-week at no charge to CARNA members. How to access NIC online 1. Go to /MyCARNA 2. Enter your user ID (your registration number) and password. 3. Click on the Nursing Interventions Classification icon in the bottom right. 4. Click on the Contents tab. 5. In the contents section, click on Part Three: Classification to view nursing interventions listed in alphabetical order. 6. Click on the intervention you wish to view to see a definition and associated activities. Job Seekers Search for jobs. Post your résume. Register today. RN specific job board allows you to connect with Alberta employers Control the confidentiality of your information Set up automatic searches that will be ed to your inbox FREE to job seekers Visit us today at: /careers July/August 2010 Volume 66 No 4 Alberta RN 11

12 VOLUNTEER OPPORTUNITIES Advance the RN profession by sharing your knowledge and experience. A number of CARNA committees are seeking members. Choose an opportunity that appeals to your interests, experience and availability. CARNA reimburses committee members for travel expenses related to committee meetings and offers a salary replacement/ per diem to compensate members for time away from work. Orientation and relevant reference materials are provided. Download application forms at. Click on Volunteer Opportunities under the Member Info tab. Recognize RN excellence Awards Selection Committee Three members needed Term beginning Oct. 1, 2010 The CARNA Awards Selection Committee is an operational committee composed of five volunteer RN members and the chief executive officer. The committee reviews criteria, reviews nominations and selects recipients for the CARNA annual awards program. Qualifications member in good standing Expectation of Members serve a two-year term prepare for meetings and teleconferences review nomination submissions and objectively apply award criteria participate in two-to-four meetings per year Questions? If you have questions about the work of the committee or expectations of members, please contact: Rachel Champagne Manager, Communications / , ext. 516 rchampagne@nurses.ab.ca Work with Provincial Council Elections and Resolutions Committee Five members needed Term beginning Oct. 1, 2010 The Elections and Resolutions Committee (ERC) consists of CARNA s past president, two provincial councillors and up to six RN members from diverse nursing practice areas and different CARNA regions. The committee recommends a slate of qualified candidates for provincial council and president-elect, whenever an election for that office is required; develops the rules governing the CARNA election process for approval by council; provides support for members submitting resolutions for CARNA s annual general meeting; and supports the development of resolutions for the 2012 CNA Biennium for council s consideration. Qualifications member in good standing Expectations of Members serve a two-year term prepare for meetings and teleconferences participate in four-to-six teleconferences and possibly one or two face-to-face meetings in Edmonton generate nominations of qualified members to run for positions on CARNA Provincial Council Questions If you have questions about the work of the committee or expectations of members, please contact: Leslie McCoy Chair, Elections and Resolutions Committee lrmccoy@shaw.ca APPLY BY: AUG. 31, 2010 APPLY BY: AUG. 31, Alberta RN July/August 2010 Volume 66 No 4

13 Learn more about RN regulation Registration Committee Two members needed Term beginning Oct. 1, 2010 The Registration Committee works with CARNA staff to develop registration policy, reviews applications for registration and practice permits and considers requests for exemption to standard policy due to extraordinary circumstances. As a committee member, you will be responsible for determining if an applicant/member has met legislated requirements and whether a danger to the public would result from the applicant/ member engaging in or continuing to engage in nursing as a graduate nurse, registered nurse, graduate nurse practitioner or nurse practitioner. The committee may approve, defer or refuse eligibility for registration and/or practice permits and identify needed conditions or restrictions on the practice permit. Qualifications a minimum of three years nursing experience not serving as a member of another CARNA regulatory committee provide direct care as a staff nurse, community health nurse or nurse practitioner Expectations of Members serve a three-year term with an option to renew for a fourth year attend two-day meetings every five-to-seven weeks participate in urgent teleconferences as required be willing to serve as chair or vice-chair after sufficient exposure to the role and responsibilities Questions? If you have questions about the work of the committee or expectations of members, please contact: Cathy Giblin Registrar/Director, Registration Services / , ext. 508 cgiblin@nurses.ab.ca Registration Review Committee Two members needed Term beginning Oct. 1, 2010 The Registration Review Committee is delegated by CARNA Provincial Council to hear reviews of decisions made by the registrar, Registration Committee or Competence Committee. In a formal hearing, the committee hears and reviews the reason for requesting a review, sworn testimony and submitted documents. After hearing submissions from both parties and considering the applicable legislation, regulation, bylaws and policies, the committee may: confirm, reverse or vary the original decision refer the matter back to the registrar, Registration Committee or Competence Committee for further assessment and decision make any further order necessary for the purpose of carrying out the committee s decision Qualifications a minimum of 10 years nursing experience not currently serving as a member of another CARNA regulatory committee have previously served on the Registration Committee or Competence Committee (preferred) Expectations of Members serve a three-year term with an option to renew for a fourth year attend meetings on as-needed basis review documents in advance of a meeting attend an orientation session prior to hearings volunteer on a rotating basis to draft and finalize decisions of the committee Questions? If you have questions about the work of the committee or expectations of members, please contact: Cathy Giblin Registrar/Director, Registration Services / , ext. 508 cgiblin@nurses.ab.ca CARNA Volunteering 101 Self-regulation means that registered nurses, not the government or any other outside group, determine our standards of practice and our professional ethics. Through this privilege, we demonstrate accountability to the public, to ourselves and to this incredible profession. For self-regulation to remain effective, it requires registered nurses to take an active role. How much time is involved? Time commitments can vary for each committee. Each volunteer opportunity lists the expectations of committee members, including the number of meetings each year and other time commitments. Which committees are seeking volunteers? For an up-to-date list of opportunities visit and click on Member Info. Volunteer opportunities are also listed in Alberta RN magazine and the AB RN Online electronic newsletter. Can I volunteer on more than one committee? CARNA bylaws state members can serve on only one regulatory committee at a time. However, there is no limit to the number of committees you can serve on throughout the duration of your nursing career. When your term ends on one committee, you can apply for a position on another. How do I apply? Download an application form at by clicking Volunteer Opportunities under the Member Info section. Fill it out and send it to the contact listed on the form. To request a form by mail, call or the CARNA contact listed on the opportunity. APPLY BY: JULY 23, 2010 APPLY BY: JULY 23, 2010 July/August 2010 Volume 66 No 4 Alberta RN 13

14 VOLUNTEER OPPORTUNITIES Learn more about the conduct process Work with the competence program Hearing Tribunal Five members needed Terms beginning Oct. 1, 2010 Members of a Hearing Tribunal adjudicate hearings into allegations of unprofessional conduct. Hearing Tribunal members have to be objective in their consideration of evidence presented to them in determining whether the behaviours constitute unprofessional conduct. If a member is found to be unskilled or has engaged in other unprofessional conduct, the tribunal decides what measures are necessary to protect the public, how to remediate and rehabilitate the nurse and determines compliance with the discipline order. Qualifications: a minimum of 10 years current active registered nurse practice in education, professional practice and/or as an acute-care staff nurse not a serving member of another CARNA regulatory committee CARNA strives to achieve broad representation of membership by appointing members from a variety of practice settings and geographic regions. To complement the current composition, three members from the CARNA Edmonton/West, Calgary/West and/or Northeast regions and two members from any other CARNA region are needed. Expectations of Members serve a four-year term attend an average of 20 hearing days or compliance meetings per year in Edmonton attend a one-day orientation session attend an annual meeting accept responsibility of the chair of the Hearing Tribunal after approximately one year Questions? If you have questions about the work of the committee or expectations of members, please contact: Sue Chandler Complaints Director/Director, Conduct / , ext. 519 schandler@nurses.ab.ca Conduct Decision Review Committee Two members needed Term beginning Oct. 1, 2010 The Conduct Decision Review Committee reviews Hearing Tribunal decisions to identify significant trends and issues that affect the ability of Alberta s RNs to provide safe, competent and ethical nursing care. It provides an excellent opportunity for RNs who want to make a difference by examining what resources are needed to support nurses in their practice. Qualifications a minimum three years experience as a direct-care provider in active medical or emergency/critical care setting or long-term care setting not a serving member of another CARNA regulatory committee Expectations of Members attend three-to-four full day meetings per year at the CARNA provincial office in Edmonton commit to preparatory time for meetings CARNA reimburses committee members for travel expenses related to committee meetings and offers a salary replacement/ per diem to compensate members for time away from work. Orientation and relevant reference materials are provided to all committee members. Questions? If you have questions about the work of the committee, or expectations of members, please contact: Marie-Andrée Chassé Policy and Practice Consultant / , ext. 526 mchasse@nurses.ab.ca Competence Committee One member needed Term beginning Oct. 1, 2010 The Competence Committee is responsible for continued development, implementation and evaluation of the CARNA Continuing Competence Program and committee policies and processes, including requests from members seeking an exception to policy. As a committee member, you will help determine: if an applicant/member has met program requirements for a practice permit if members have complied with conditions assigned to meet requirements Qualifications a nurse practitioner member of CARNA a minimum of five years nursing experience a resident of a CARNA region not a serving member of another CARNA regulatory committee Expectations of Members serve a four-year term attend nine-to-10 one-to-two day meetings per year as required at the CARNA office in Edmonton attend a half-day orientation session commit to preparatory time for meetings Questions? If you have questions about the work of the committee or expectations of members, please contact: Terry Gushuliak Deputy Registrar, Continuing Competence / , ext. 507 tgushuliak@nurses.ab.ca APPLY BY: JULY 30, 2010 APPLY BY: SEPT. 3, 2010 APPLY BY: JULY 23, Alberta RN July/August 2010 Volume 66 No 4

15 How you can help improve care for dementia and delirium patients This August, the Provincial Cognitive Impairment Strategy will launch a delirium prevention program designed to provide materials (posters, order sets, patient/family teaching materials) to help staff better manage this acute confusion. The department of Specialized Geriatric Services Seniors Health, Alberta Health Services is leading the project as older adults are at greater risk of developing delirium. Those who are especially at risk have multiple medical problems, increased need for help with their personal care and deficits in vision and hearing and may have some underlying dementia as well. Fortunately, there is evidence that with simple measures some of the delirium can be avoided and early recognition and treatment may be able to reduce the severity of this condition that leads to longer hospital stays and poorer outcomes. The delirium prevention program is the first step in a provincial strategy that will look at enhancing the knowledge about dementia care among health-care professionals and family caregivers. It s estimated that there will be almost 100,000 seniors in Alberta living with dementia this year. By 2031, the number of dementia patients is expected to more than triple from the previous 40 years. As the prevalence of cognitive impairment increases, all people involved in the provision of health, social and housing services for older adults will need to know more about it. Insufficient knowledge can lead to inappropriate medication, crisis hospitalizations, early placement in long-term care and poor quality of life for patients and their caregivers. As part of the strategy, interventions that have proven successful in improving quality of care, reducing health-care costs and reducing caregiver burden will be disseminated, as will standardized clinical pathways, dementia and delirium protocols, assessment tools and best practice guidelines for all older adults in the health system, even those without cognitive impairment. In addition to having RNs and other care providers review the materials, those with cognitive impairment and their caregivers are being asked to discuss their experiences to help improve the quality of life and care. RN If you are interested in reviewing the delirium prevention program materials, please contact Colleen Zimmel at colleen.zimmel@albertahealthservices.ca In 2009, CARNA proudly sponsored the Finding Balance seniors fall prevention awareness campaign. This campaign, spearheaded by the Alberta Centre for Injury Control & Research and the Alberta Medical Association, educates seniors about the best ways to prevent falls with an overall aim of helping seniors stay active and independent. Finding Balance saw impressive growth in many areas this year. Over 255,000 posters and flyers were distributed by pharmacists, health professionals, seniors associations and other groups. A 30-second television advertisement played on Global stations throughout the province in November and the campaign received $3.23 in advertising for every dollar spent. More than 50 stories about seniors falls prevention appeared in media. A post-campaign survey of older Albertans showed that over half (59% up from 43%) know the primary cause of incidents that lead to hospitalization among Alberta seniors is slips and falls. And 72% of survey respondents say they are currently taking measures to prevent falls, an increase from 54% in January We are very proud to have participated in this important initiative. For more information about Finding Balance, visit July/August 2010 Volume 66 No 4 Alberta RN 15

16 Dr. Marion Allen watches a video tribute to her career before accepting the Lifetime Achievement Award and receiving a standing ovation. Watch the video at Tracy Parnell is honoured for her work with the RN profession with the Partner in Health Award. Linda Youell is escorted to the stage by Const. Neal York to accept the Nursing Excellence in Education Award in front of an audience of friends, family and University of Alberta colleagues. CARNA President Joan Petruk (left) and CEO Mary-Anne Robinson (right) present Phyllis Castelein with the Nursing Excellence in Education Award. Two hundred and thirty five guests attended the 2010 CARNA Awards of Nursing Excellence Gala on April 29, 2010 at the Shaw Conference Centre in Edmonton. ARNET s top scholarship recipients were also recognized at the event. THE 11 TH CAR AWA GA recognizing nursing L to r: Const. Neal York, Joan Petruk, Phyllis Castel Jennifer Penner, Linda Youell, Tracey Parnell, Nancy G 16 Alberta RN July/August 2010 Volume 66 No 4

17 Jennifer Penner accepts the Nursing Excellence in Clinical Practice Award. ANNUAL NA RDS LA Petra Hortopanu received the Rising Star Award for her work with Calgary s marginalized youth. SUPPORTED BY Nancy Guebert, a.k.a. The Singing Nurse, accepts the award for Nursing Excellence in Administration before singing Imprints, a song she wrote to honour her patients, colleagues and the registered nursing profession. Watch the video at Dr. Karen Benzies stands as her achievements in nursing research are recognized. Visit to watch the acceptance speeches and other highlights of the gala. EXCELLENCE ein, Marion Allen, Karen Benzies, Petra Hortopanu, uebert, Mary-Anne Robinson, Const. Drew Burchett. July/August 2010 Volume 66 No 4 Alberta RN 17

18 L to r: Dr. Shannon Spenceley, Sarah Wall, Flo Myrick, Sheila McKay, Gudrun Reay, Lindsay Thomas, Sheila Elliott, Katherine Janzen at the CARNA Awards Gala on April 29, ARNET scholarship recipients Sarah Wall, Gudrun Reay, Lindsey Thomas and Katherine Janzen attended the gala to accept a combined total of almost $10,000 in educational funding ARNET Scholarship Recipients ARNET is pleased to announce the recipients of the 2010 ARNET Annual Scholarships. Scholarships are awarded to RNs who exemplify ARNET s commitment to promoting nursing excellence and are based on academic achievement, professional contributions and strengths in nursing leadership, research, administration, education and/or nursing practice. Scholarships are awarded at post-basic baccalaureate, masters and doctoral levels of study. Please join us in congratulating the 2010 ARNET Annual Scholarship recipients and expressing our sincere thanks to our donors who made this funding support possible! CARNA Presidents Scholarship Angela Russell Sarah Wall ARNET Board of Directors Scholarship Richelle Kanngiesser Wendi Lokanc-Diluzio CARNA/TD Meloche Monnex Scholarship Katherine Janzen Gudrun Reay Bernadine Wojtowicz 2010 ARNET Scholarships Kyla Craig Gwen Erdmann Lori Finley Natalie Ford Leana Forsyth Teresa Kerridge Janis Radtke Dalyce Sather-McNabb Davidson Memorial Scholarship Nicola Skelly Karen Polowick Scholarship for Nursing Leadership Jessica Deckert-Sookram Mac Smith Memorial Scholarship Ada Chan Patricia Walker Scholarship for Studies of Childbirth Education and Maternal and Child Health Nursing Katherine Bright Liz Lemire Memorial Scholarship Nicole Crisp ARNET 25 th Anniversary Scholarships Tracy Miller Inspiration Scholarship Lindsay Thomas St. Francis Xavier University Scholarship (sponsored by Sylvia Barron) Karla Wyld 18 Alberta RN July/August 2010 Volume 66 No 4

19 Attitude of Gratitude! Appreciation is a wonderful thing. It makes what is excellent in others belong to us as well. ~VOLTAIRE ARNET would like to express sincere appreciation to donors, volunteers and community partners who helped make our efforts during Nursing Week and at the CARNA Awards Gala so successful. Through your support, ARNET is able to continue the 25-year tradition of investing in nursing education and assisting Alberta s RNs. A very special thank you to the following ARNET sponsors: West Edmonton Mall Uniglobe Travel Gravity Pope Arbonne (G. Magyar) Calgary Stampede IT Works (C. Langridge) Chinook Centre Southgate Centre Silver & Stone Designs Blackstone Resort Emergia Hair Group Purdy s Chocolate Pink Book Photography Fifth Avenue Collection (G. Regnier) Have you read CARNA s AB RN Online electronic newsletter? If not, you can read it online at. Just click on the link under the What s New section of the homepage. The AB RN Online e-newsletter notifies members about information that impacts practice and other important updates. Didn t get your copy? AB RN Online is distributed monthly to CARNA members with a valid address listed in their member profile. Add your address anytime by logging into the member s section at /MyCARNA. We encourage RNs to support businesses that so generously support nursing. July/August 2010 Volume 66 No 4 Alberta RN 19

20 Mental health services within a comprehensive BY TERRY ROBERTSON, RN, BGS, CPMHN ; JENNIE HOLLINGS, RN, BN, GNC, IIWCC In 2001, the Comprehensive Community Care Program, also called the C3 Program, opened its doors at the Carewest Sarcee Long-Term Care Centre in Calgary. The former Calgary Health Region partnered with Carewest to start the program that would assist the growing aging population, help alleviate acutecare pressures, avoid unnecessary care centre placement and to provide another choice for seniors who want to live at home. The program provides coordinated case management and primary care for up to 90 frail elderly people aged 65 C3 is the only program of its type in Calgary. and older. Clients come to the program by referral through transition services. All live in their own home or a seniors apartment or lodge. The program has an integrated team made up of nursing both in an on-site medical clinic and on call rehabilitation, recreation therapy, social work, dietary services, physician and community care aide staff. In addition to the medical centre, there is a day centre, six respite/ short-term treatment beds, pharmacy services and transportation on-site. Home care aides work in the day centre assisting the clients as well as providing home support. RN Terry Robertson sees clients requiring more complex mental health services. Since 2007, Robertson has worked at C3 once a week providing staff consultation, education sessions with staff and clients, client assessment Statistics compiled in 2009 show that the C3 program has decreased acute-care hospitalization, reduced emergency room visits and delayed long-term care placement. In the year prior to participating in the program, clients had a total of 2,541 in-patient acute-care days. After one year in the program, in-patient days were reduced to 259. After three years in the program, the days in acute care were reduced to 71. In the year prior to the program, clients had 48 ER visits. One year later, they had a total of 20 visits. Three years later, the total was reduced to 11 ER visits. The first thing I tell them is that I am not the expert on who they are. They are. My goal is to work with them to fine tune their expertise so that they can help themselves. RN TERRY ROBERTSON and client follow-up. Depression and anxiety are the most common issues C3 clients present with. Often, these can be caused by stressors such as financial problems, social isolation, abuse, grief, cultural issues and medication. Deteriorating physical health can also have a dramatic effect on mental health. They begin to worry about their future, may not be able to speak or walk the way they used to and often the dynamics of their relationships change. says Robertson. The symptoms of mental health issues are often not readily recognized. Many older adults will not seek help for how they are feeling because of fear of what is wrong with them and the stigma associated with mental health issues. Lack of timely diagnosis and treatment can lead to increased risk of suicide, decreased quality of life, emergency room visits, admission to acute care facilities and premature death. The comprehensive nature of the C3 program allows staff to notice subtle changes in behaviour and mood early so that assessment, support and treatment can happen quickly. 20 Alberta RN July/August 2010 Volume 66 No 4

21 community care program help the frail elderly Once the symptoms are recognized, staff will bring their concerns to the team. When a consultation with Robertson is required, she will discuss their findings; review the client s health history, laboratory/diagnostic imaging results and team notes. After that, she will meet with the client. The first thing I tell them is that I am not the expert on who they are. They are. My goal is to work with them to fine tune their expertise so that they can help themselves, says Robertson. During the initial meeting, she will strive to develop a trusting relationship where the client s symptoms, coping mechanisms and suicide risk can be explored. Robertson will explain her role in their care, the purpose for the meeting and develop a plan with them to move forward. Nursing interventions such as cognitive behavioural therapy, sleep hygiene, medication teaching and ways to help increase socialization, activity level and relaxation techniques are provided by Robertson. Following the initial evaluations and meeting, Robertson will discuss the client with the program s psychiatrist, who is also a consultant with the program. He may begin to treat the client as well, such as in situations when medications need to be prescribed or modified. Any treatment recommendations/plan are discussed with the clinic RN and physician for their agreement. Approximately half of C3 clients are prescribed antidepressants. Dosages are kept as low as therapeutically possible, keeping with the adage start low and go slow. Clients new to the medication may be admitted to one of the six treatment beds. Admission to a community medical/ psychiatric unit may also be facilitated for those requiring closer monitoring and more intensive treatment than can be offered at C3. Although older adults are sometimes reluctant to talk about how they are feeling, they often quickly embrace mental health involvement and appreciate the support. Robertson values the time she spends with the clients at the C3 program. I am very respectful of the history and lessons they teach me about life. I m privileged to have access to their wealth of information. RN Terry Robertson (left) provides consulting mental health services at Calgary s C3 program. She feels privileged to have the opportunity to learn life lessons from program participants like Dorothy Dickinson (right). July/August 2010 Volume 66 No 4 Alberta RN 21

22 Expert caring makes a difference. Meet the RNs of the C3 program Registered nurses are an integral part of the C3 program, providing mental health services, supervising community care aides, and even leading the program! Cindy Boyle, RN Cindy has been a registered nurse since She has worked abroad and in Canada in various areas of nursing. She is currently the only RN in the medical clinic with the C3 program. Cindy strives to make a difference in the quality of life of the seniors in the program. Jennie Hollings, RN, BN, GNC, IIWCC Jennie has been a registered nurse for 37 years. She has specialized in Gerontological nursing and has completed the CNA Certification in Gerontology. She is also a member of the Alberta Gerontological Nurses Association. She has an interest in integrative medicine and encourages the integration of body, mind and spirit in the philosophy of the program. She has worked at Carewest for 28 years in a number of different roles. In 2001, she became the Client Services Manager responsible for planning and opening the C3 program in partnership with the former Calgary Health Region and Carewest. Terry Robertson, RN, BGS, CPMHN Terry has been a registered nurse for 32 years. She has specialized in psychiatric/mental health nursing for the last 25 years. Prior to that, Terry worked in the area of critical care and emergency medicine. Terry completed a general studies (arts and science) degree at Athabasca University in 1995 and has certification with the Canadian Nurses Association in psychiatric/mental health nursing. She is also certified in critical incident debriefing and has certification as an L to r: Sandra Stone, Terry Robertson, Cindy Boyle and Jennie Hollings are four of six RNs who work at the C3 program, providing comprehensive health services to Calgary s frail elderly. adult educator from Mount Royal College. Terry is based out of the Rockyview Hospital and works as a community mental health nurse consultant with the seniors health clinics at the Rockyview Hospital, Bridgeland site, Falls prevention clinic and C3 program. She views herself as a life long learner and passionate advocate for patient/client rights. Beverly Sinfield, RN Bev graduated from the Foothills Hospital school of nursing in She has worked in acute care renal medicine, medical/icu neurosciences, an Alzheimer s and dementia unit and long-term care centres. Bev has been with the C3 program for two years as one of the evening/weekend on call nurses. Sandra Stone, RN, BScN, GNC Sandra has been a registered nurse for over 20 years. She is currently the home support coordinator for the C3 program, supervising community care assistants and is also a case manager for some clients with the C3 program. Sharon Wildwind, RN, GNC Sharon is part of the evening and weekend registered nurse on-call group. She is interested in how nursing and art come together to enhance life for older people. In addition to being an registered nurse, Wildwind also writes mysteries. RN 22 Alberta RN July/August 2010 Volume 66 No 4

23 hope 1 n. belief in a positive outcome related to events and circumstances in one s life. 2 v. feeling that what is wanted can be had or that events will turn out for the best. How studying hope can positively influence quality of life, health outcomes and job satisfaction. In 2007, at age 60, Lise Boucher retired after serving more than 35 years as a registered nurse. Six months into retirement, she began to grow bored. One day, while cleaning out her briefcase, she came across a brochure she was given a few months earlier on the Hope Studies Certificate Program at NorQuest College. Intrigued, she decided to end her retirement by facilitating the program workshops. There was a title in the brochure, about using hope to increase job satisfaction that caught my eye, says Boucher. In the beginning, my goal was just to learn more about hope, but it transformed into a life mission. Boucher headed to NorQuest College to apply for a position that didn t yet exsist. She was told that before she could facilitate the program courses, she would first have to complete the three-course series. Hope Studies is an interactive program based on the philosophy that a greater understanding of hope s influence is beneficial to the healing process. The program does not have pre-requisites and integrates personal reflection, group experiential learning, the study of documented research, and the practical application of hope-focused strategies to inspire and energize caregivers and others wanting to learn how to use and nurture hope. The first of the three courses taught Boucher methods for using hope in her personal life and how to identify hope and hopelessness in others. She was so excited by what she was learning that she wanted to share it. Using construction paper, tied together with wool, she made booklets for her immediate family filled with photographs and questions designed to help them explore their own hope. It was the beginning of her growing passion to educate others about hope. In the second course, Boucher learned more about what had intrigued her initially, using hope to increase job satisfaction. Through the teachings, she explored the nature and impact of hope for professional caregivers, the value of hope in protecting workers from a vicarious trauma and the role of hope in enhancing overall job satisfaction. I used to get caught up in the grind of work and forgot my passion, says Boucher. Through the course, I learned how to reconnect with myself and my spiritual growth to achieve balance. Hope is not blind optimism. It s not ignoring the enormity of the task ahead, or the roadblocks that stand in our path. It s not sitting on the sidelines or shirking from a fight. Hope is that thing inside us that insists, despite all the evidence to the contrary, that something better awaits us if we have the courage to reach for it, work for it and fight for it. ~ BARACK OBAMA To complete the program, Boucher next participated in discussions comparing hope models and different theoretical applications. She analyzed how different hope strategies fit into particular working situations, including interacting with clients and other staff members. Boucher actively decided to apply her learning professionally. Research supports Boucher s realization that a hopeful perspective and use of hope-focused strategies can improve quality of life, health outcomes and job satisfaction. The study of hope allows caregivers to maintain a sense of hope during what often can feel like hopeless situations such as illness and death or social, economic, and spiritual challenges. Three years later, Boucher remains passionate about learning hope and teaching it to others. I have to learn more about hope so I can share it with other nurses. RN For more information on the Hope Studies Certificate Program: Visit or contact the Program Team Leader NorQuest College at or at hope.studies@norquest.ca. July/August 2010 Volume 66 No 4 Alberta RN 23

24 Hope and humanity among AT 4:53 P.M. ON JAN. 12, 2010, A MAGNITUDE 7.0 EARTHQUAKE STRUCK HAITI, NEAR THE CAPITAL CITY OF PORT-AU-PRINCE THE MOST POPULATED AREA OF THE COUNTRY. THE INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT SOCIETIES ESTIMATES THAT AS MANY AS THREE MILLION PEOPLE WERE AFFECTED BY THE QUAKE. IN THE FOLLOWING DAYS, MANY WERE FORCED TO SLEEP IN CARS, SHANTY TOWNS AND STREETS LINED WITH THOUSANDS OF CORPSES; FOOD AND WATER WAS SCARCE; AND FAMILIES WERE UNSURE IF THEIR LOVED ONES HAD SURVIVED OR WOULD SURVIVE THEIR SUBSEQUENT INJURIES. MANY HEALTH-CARE PROFESSIONALS PUT THEIR PERSONAL AND PROFESSIONAL LIVES ON HOLD TO HELP RESTORE THE COLLAPSED HEALTH SYSTEM. ALBERTA RN SANDRA HODGE WAS AMONG THE FIRST TO ARRIVE IN THE COUNTRY. EDMONTON-BASED FREELANCE WRITER LISA RICCOTTI SAT DOWN WITH HODGE TO DISCUSS HER EXPERIENCES. Scuba Shark 24 Alberta RN July/August 2010 Volume 66 No 4

25 st Jasper RN recounts her experiences in Haiti during the days following the devastating earthquake. BY LISA RICCIOTTI Scuba Shark My stomach flips as I look at the photo, but the story behind it touches my heart. Sandra Hodge, a registered nurse from Jasper, is showing me slides taken during her recent work with the Canadian Medical Assistance Teams (CMAT) following the Haiti earthquake. Hodge was part of the CMAT s initial assessment team, arriving in Haiti just days after the devastating quake. By early May, CMAT had deployed a total of eight teams, including seven Albertans. All are volunteers who travelled on their own time and expense to help with relief efforts. I found this lady under a tarp at the end of the day, says Hodge, pointing to her laptop s screen. She was injured and in pain, but insisted we look after her granddaughter first. After treating the young girl, Hodge turned her attention to the older woman. She lifted a rag from the woman s wound and discovered her ear was half gone and what was left was filled with maggots. But all she cared about was her granddaughter, Hodge marvels. July/August 2010 Volume 66 No 4 Alberta RN 25

26 The next slide shows a smiling Haitian woman holding an X-ray. This lady sums up everything for me about Haiti s people, Hodge notes. The woman waited patiently for five hours in a long line outside the CMAT field hospital, set up between two collapsed buildings in Léogâne the epicentre of the quake, 60 kilometres southwest of Port-au-Prince. Hodge noticed her several times while determining who to treat next, but didn t think she was badly hurt. When it was finally the woman s turn, she handed Hodge an X-ray showing a femur fracture. I told her that couldn t be her X-ray, Hodge says. How could she even stand, let alone smile, with such an injury? The woman insisted she d been X-rayed at a nearby Japanese medical camp, then sent to the Canadians for treatment. Not wanting to argue, Hodge ordered a new X-ray it showed a femur fracture. The CMAT team promptly performed surgery to correct the break. I had no idea humans could live so long with such severe injuries before Haiti, says Hodge. And no idea individuals could remain so cheerful and stoic, always caring about others through their pain. The Haitians really are amazing people. Equally amazing is what CMAT accomplished under such difficult conditions and how quickly its volunteers responded. Within 72 hours of hearing news of the catastrophic earthquake, Hodge and five other volunteers hastily summoned from across Canada arrived in Port-au-Prince. As the initial assessment team, they prepared the way for CMAT Deployment Team No. 1, which arrived three days later. Its nine medical members included Olivia June Soukup, a registered nurse from Camrose. You can t always rely on media reports after a disaster, but this time the news wasn t exaggerated, Hodge notes. It was total devastation and chaos. The airport was closed, but we were able to land because we had Dave Johnson, an air traffic controller, on our team and he got us in. There were no lights or water. People were drinking from street gutters; rescue teams from all over the world were searching for survivors in the rubble using dogs. CMAT s assessment team tried to join the United Nations relief efforts but found they could be more effective providing immediate support at the Port-au-Prince hospital. It was hit hard, but some sections were still standing, Hodge remembers. Bodies were everywhere and had to be cleared away before the injured could be treated. At first, staff tried to work in what remained of the hospital but the aftershocks made it too dangerous to stay indoors. I spent my first days working in the parking lot. The goal, however, was to find a safe site where CMAT could set up the large mod tent that had travelled with them to Haiti as a temporary field hospital. The assessment team decided to locate in Léogâne, rather than Port-au-Prince, because no medical staff were stationed there yet. As well, Canadian Forces were stationed near Léogâne and would provide protection from growing street violence and looters. We hired interpreters, hitched a ride in a military truck with all our supplies, then starting setting up in Léogâne, Hodge explains. Within hours, the team had delivered their first baby, a boy. We expected a stillborn after all the mother had been through, but the baby was healthy. It was a hopeful start to a task that often seemed impossible treating an overwhelming number of injuries with limited staff and supplies. We d start every day at 8 a.m. and there d already be a huge line waiting, says Hodge. From that crowd, we d manage to treat 200 to 300 patients daily. It was Hodge s responsibility to decide who those patients should be, picking out the most desperate cases from the long Scuba Shark lines. Her triage system was simple but effective. She spoke with patients through an interpreter to determine their injuries and illnesses, taped notes onto each, with a red, yellow or green code indicating urgency, then sent them on to the appropriate treatment area. Hodge went down the line in order as much as possible, bumping up the most needy to the front. It s amazing what we did with so little, Hodge says. The surgery unit was stretchers set up on cinder blocks, kept as sterile as possible. You have to be adaptable and improvise, she explains. Ropes were used for traction, tape worked miracles and the legs of a staff member s pants were used as sieves, pelvic 26 Alberta RN July/August 2010 Volume 66 No 4

27 binders and eventually as dust rags. We functioned on a lot of optimism, doing as well as we could with whatever we had. With the arrival of the first team, CMAT gained the services of an anaesthesiologist and orthopaedic surgeon. The first phase of their medical efforts included many amputations. Sadly, prospects are grim for amputees in a poverty-stricken country like Haiti. Some families chose to refuse an operation that would save their child s life, but leave them missing an arm or leg. It s tragic, says Hodge while staring at a slide of an 11-year-old girl who shyly smiles up at the camera in spite ALBERTA RNS HAVE PARTICIPATED IN RELIEF EFFORTS ALL OVER THE WORLD FROM THE EARTHQUAKES IN HAITI AND CHILE TO THE HUMANITARIAN CRISES IN AFRICA AND INDIA. RNS GENEROUSLY DONATE THEIR TIME, SKILLS AND FINANCES TO HELP THOSE IN NEED. CARNA COMMENDS AND THANKS RNS FOR THEIR COMPASSION AND ALTRUISTIC WORK AROUND THE WORLD AND RIGHT HERE IN ALBERTA. Above, l to r: Deanna Sykes and her daughters Angela Sykes and Kim Sykes are among many Alberta RNs who have used their expert care to help those affected by natural and other disasters. Left: RN Sandra Hodge of a horribly necrotic leg. Haitians are very practical. In their environment, you need all limbs to survive. Amputation could condemn their daughter to a future as a beggar or prostitute since no one would marry her and she wouldn t be able to work and her parents couldn t care for her. Still, Hodge emphasizes it wasn t her place to judge such decisions. You can t impose Western values on the reality of their lives. For them, refusing treatment was the more loving option. After-care was also challenging. We d clean up head wounds oozing with green goo and treat burns, but then we d have to send them back onto the streets. They had no water and no way to keep clean. Within days they d be back, all infected. Despite the conditions, they were able to provide effective follow-up care. The team would even go out and find people in the tent cities if they could not make it to see them. Hodge shows another slide with five young Haitians piled onto one motor scooter. We d fix a fractured leg or skull wound, then off they d go with no helmets. All we could do was cross our fingers that they wouldn t crash. Hodge remained in Haiti until the first team s stint ended and Team 2 arrived. For three gruelling weeks, home was a tent. Inevitably, every member of the team suffered bouts of dysentery. We dug a well, sterilized our water, burnt all our waste and kept digging new holes to move the latrine over, but we all got a touch of bad belly. We tried hard to take care of ourselves so we could keep helping others, but that was just the reality. A highlight for Hodge was caring for the first group of orphans flown to Canada. We went to the Canadian embassy to help. There were 55 orphans, most under two-years-old, and only one caregiver with them. They all had diarrhea and many were vomiting, with high fevers. The CMAT team cleaned them up, provided nursing care and took them to the airport. The second bus of orphans crashed into the back of the first on the way. And I got bitten three times! Hodge recalls. Now, back in Canada, Hodge has returned to her work as a casual nurse at hospitals in Hinton and Jasper and a rural clinic in Valemont, working in emergency and maternity. She admits that sometimes she feels frustration when she compares the resources that many patients take for granted in Canada to the resources available to CMAT nurses. But I can t think about that. There is there; here is here. I focus on thinking that the patient in front of me right now is the most important person in the world. Looking back, Hodge says she s very proud of what CMAT team members accomplished, although she wishes they could have done more. At times it felt hopeless. In the grand scheme of things, we may not have made that much of a difference; but in the lives of the people we treated, we definitely did. The smiles are what kept me going and what makes it all worthwhile. RN What is CMAT? The Canadian Medical Assistance Teams (CMAT) is a Canadian-based grassroots disaster relief organization of medical professionals and non-medical volunteers who donate their time and resources to provide relief aid to victims of natural and man-made disasters around the world. Teams have responded to many crises, including the 2007 Southeast Asian tsunami and earthquakes in Pakistan and China. The non-profit organization maintains a database of several hundred skilled health-care professionals from across Canada who are willing to travel at a moment s notice at their own expense when disasters strike. For more information or to volunteer or donate, go to July/August 2010 Volume 66 No 4 Alberta RN 27

28 ACCOLADES Courtesy Canadian Nurses Association Alberta RNs receive prestigious CNA Awards The Canadian Nurses Association awarded the much coveted Order of Merit to six RNs across Canada who have made an outstanding contribution to nursing. Three Alberta RNs were among this year s recipients. L to r: RNs Betty Gourlay, Greta Cummings and Alice Reid accepted their Order of Merit Awards from the Canadian Nurses Association at a gala event on June 8, 2010 in Halifax. Order of Merit for Nursing Research Dr. Greta Cummings, RN, PhD Associate Professor, University of Alberta Dr. Greta Cummings research focuses on leadership in health care. She has identified gaps in knowledge relating to factors that contribute to absenteeism, improved quality of nursing work life and cultures of patient safety. She works to examine how these factors contribute to the health system to achieve better outcomes for providers and patients. Her work as the principal investigator of the Connecting Leadership Education and Research Outcomes program has strengthened development of RN leadership. A well-funded researcher, Cummings completed 11 research studies that were supported by local, provincial and national agencies and organizations. Her work is well recognized as essential to supporting the evolution of nursing practice. She has an exceptional record, including publishing more than 50 peerreviewed papers and published chapters in refereed books. Order of Merit for Nursing Policy Betty Gourlay, RN, BScN, MHSc Principal Consultant, Care Partners Betty Gourlay s demonstrated commitment to nursing through participation on local, provincial and national committees and boards has strengthened independent RN practice and orthopaedic nursing for over 30 years. During a time of anxiety and transition for RNs in the 1990s when government cutbacks resulted in significant layoffs, Gourlay launched one of the inaugural independent nursing practices in Canada and forged the way for others looking at alternate employment options. As the first president of the Canadian Association of Nurses in Independent Practice, Gourlay was instrumental in the development of standards and criteria for the assessment and licensure of independent practice RNs. As a board member of the Alberta Registered Nurses Educational Trust (ARNET), Gourlay mobilized RNs from across the province to raise funds to support continuing nursing education. In 1988, she was instrumental in the charity securing a $10 million endowment from the provincial government. Gourlay continues her fundraising activities and is currently active with the Canadian Nurses Foundation s 4.0 campaign to raise funds to support nursing education and research in Canada. Order of Merit for Administration Alice Reid, RN Bigstone Cree National Health Center Alice Reid s 30-year career has covered almost every aspect of nursing practice. She recently acted as chief executive officer at Bigstone Health Centre in Desmarais, Alberta, where she led the transition from primary health care to home and community care. Combining community-based research methodologies and traditional healing, Reid brought together northern Cree communities and the University of Alberta to integrate traditional and western medicine to better understand determinants of health. Reid is founding director of the Pee-kis-kwe-tan or Let s Talk Society, the first Aboriginal mental health service in Canada and sits on the advisory board of the University of Alberta s Indigenous Nursing Initiative. 28 Alberta RN July/August 2010 Volume 66 No 4

29 Demonstrate your expertise through CNA certification Courtesy Covenant Health RN recognized with respect award Bonnie Mende was awarded the Covenant Health Mission Award for Respect. The award is one of six that reflects the organization s values: compassion, respect, collaboration, social justice, integrity and stewardship. Mende was nominated for exemplifying respect in her interactions with clients, their families and the over 160 volunteers she works with. Mende says she is proud to practise with the values instilled in her during her nursing education almost 50-years-ago. She is a shining example of the art and science of the nursing profession. Mende accepted her Respect Award at a gala event on April 15, Mende is the coordinator of programs and staff development at the Banff Mineral Springs Hospital. RN A certification credential from the Canadian Nurses Association (CNA) is an important indicator to patients, employers, the public and professional licensing bodies that you are qualified, competent and current in a nursing specialty/area of practice. The exam-based, voluntary credential is reserved for registered nurses who meet specific nursing practice, continuous learning and testing requirements. Certification is available in the following 19 specialties and areas of nursing practice: medical-surgical nursing cardiovascular community health critical care critical care paediatrics emergency enterostomal therapy gastroenterology gerontology hospice palliative care nephrology neuroscience occupational health oncology orthopaedics perinatal perioperative psychiatric mental health rehabilitation For complete details on certification in your speciality/area of practice, go to Maintain your credential: Renew your certification CNA certification is valid for five years. Candidates eligible for certification renewal will be sent information from CNA if they have provided their current address. To renew, you must meet the required hours of nursing experience in your specialty/area of practice and either rewrite the certification exam or complete a minimum of 100 hours of continuous learning activities in your specialty/area of practice during the five years of your certification. Benefits of certification confirms your knowledge of your specialty/ area of nursing practice is current demonstrates your commitment to registered nursing, to your area of practice and to your career shows your desire to challenge your skills and knowledge at a national level prepares you for positions of greater responsibility increases your credibility, marketability and recognition with your RN peers, other care professionals and the public IMPORTANT DATES Sept. 1, 2010 Online application process opens for initial certification Oct. 15, 2010 Application deadline for initial certification Nov. 26, 2010 Application deadline for certification renewal April 9, 2011 Initial and recertification exam writing July/August 2010 Volume 66 No 4 Alberta RN 29

30 P ublications ordered by Hearing Tribunals Publications are submitted to Alberta RN by the Hearing Tribunal as a brief description to members and the public of members unprofessional behaviour and the sanctions ordered by the Hearing Tribunal. Publication is not intended to provide comprehensive information of the complaint, findings of an investigation or information presented at the hearing. CARNA Member Registration number: 66,492 A hearing tribunal made a finding of unprofessional conduct against member #66,492 who communicated a dismissive, impatient, uncaring attitude toward a patient and the family of the patient through her words and lack of action when they requested her assistance for the patient; failed to do or document an appropriate assessment of that patient; and failed to provide complete information to the EMS team when the patient was transferred to hospital. The member was given a reprimand and required to complete courses on assessment and charting by a deadline, and be restricted to working for her current employer, pending provision of a satisfactory comprehensive performance evaluation to a hearing tribunal, unless she obtains prior permission to work elsewhere from a tribunal. The member was ordered to pay $500 in costs of the hearing. Conditions shall appear on the member s practice permit. Failure to comply with the order may result in suspension of CARNA practice permit. CARNA Member Registration number: 73,027 A hearing tribunal made a finding of unprofessional conduct against member #73,027 who failed to program an analgesic pump correctly and failed to have his calculations checked by another RN; and on one shift failed to provide adequate care to a palliative patient in that he breached his employer s expectations by not checking on his palliative patient every hour. The tribunal issued a reprimand and restricted the member to working for his new current employer, pending the completion of a satisfactory comprehensive performance evaluation from that employer covering the next several months of the member s practice. Conditions shall appear on the member s practice permit. Failure to comply with the order may result in suspension of CARNA practice permit. CARNA Member Registration number: 79,966 A hearing tribunal made a finding of unprofessional conduct against member #79,966 who for several months stole narcotics, Morphine, Demerol, Tylenol 3, Percocet and fentanyl from her employer; to cover the theft of the narcotics, falsely documented on the narcotic administration record when there was no physician s order, creating a false medication administration record for the patients; fraudulently used physicians names on the narcotic administration record; failed to obtain co-signs for wastages to be able to steal the wastages; and stole a prescription sheet from the hospital, forged a prescription, forged a physician s signature and tried to have the forged prescription filled by a pharmacy. The tribunal gave the member a reprimand and suspended her as a registered nurse pending proof from a physician and counsellor that she is safe to return to practice, at which time the member has a choice to return to either a practice setting where there is no access to narcotics or controlled substances, or do a supervised practice in a setting where the member is expected to administer medications, including narcotics and controlled substances. In either setting, the member s employer will report back to a hearing tribunal. The member is required to continue drug screening and provide further medical reports to a hearing tribunal. The member was ordered to pay a contribution towards costs of the hearing. Conditions shall appear on the member s practice permit. Failure to comply with the order may result in suspension of CARNA practice permit. RN Want to learn more about the conduct process? Learn how you can get involved on page Alberta RN July/August 2010 Volume 66 No 4

31 CARNA Requests Partial Costs at Contested Hearings and Appeals Last year, for the first time since 2002, CARNA Conduct Counsel requested a Hearing Tribunal assign costs to a member, a practice regularly applied by many regulatory colleges. However, unlike many other regulators, CARNA Conduct Counsel has thus far only requested that Hearing Tribunals assign costs to members in contested hearings. More contested hearings are a new trend observed by CARNA s professional conduct department and are contributing to the area s rising costs to perform its regulatory function of dealing with complaints. Last year, CARNA reported five contested hearings totaling 19 separate hearing days. In contrast, all complaints in previous years were resolved in a consent hearing which can typically be completed in less than one day. In a consent hearing, both parties reach a negotiated agreement on the facts to be brought before the Hearing Tribunal and usually an agreement on proposed sanctions. Witnesses are not required to appear before the tribunal, legal challenges to the hearing processes are usually not brought forward. Matters may be resolved more quickly and at a lower cost in a consent hearing than if a contested hearing was conducted because time for deliberations and delays are minimized as well as not having to have witnesses testify. During a contested hearing however, the facts or points of law are disputed by both parties and argued before the tribunal. When the facts are disputed, witnesses have to testify and it may take a number of days to have the witnesses testify. Increases in travel expenses and per diems for Hearing Tribunal members, the complainant and witnesses, fees paid for additional legal experts, court reporter fees can add up to a significant amount. CARNA must pay these costs using an operating budget funded primarily by member fees. Hearing costs to CARNA are estimated to run between $3500 per day to over $7000 per day. In all cases, CARNA Conduct Counsel has only requested partial costs be assigned to members and the costs of CARNA s in house legal counsel, staff and facilities are not requested as part of the costs. CARNA s recent decision to request costs in contested hearings is supported by the Health Professions Act which authorizes that a Hearing Tribunal may assess costs including all or part of the costs or fees related to the investigation and hearing. Hearing Tribunals have imposed full costs to members when they have refused to participate in their hearings. This includes the costs of investigations and the hearings. In Alberta, 15 of the 19 colleges represented in the Complaint Process Working Group of the Alberta Federation of Regulated Health Professions routinely ask for partial or full costs from members who find themselves the subject of any conduct hearing. Although CARNA recognizes that a member can choose to resolve a complaint brought against them through either consent or contested hearing, CARNA believes that contested or prolonged hearings also place an unreasonable burden on CARNA resources and redirect resources from other regulatory or association activities which are also primarily funded by membership fees. RN July/August 2010 Volume 66 No 4 Alberta RN 31

32 ISMP MEDICATION SAFETY ALERT! Shakespeare was on target don t be a borrower or lender The phrase, Neither a borrower nor a lender be, originated from Shakespeare s famous play, Hamlet (1603), during which Lord Polonius gives this advice to his son who is heading back to school. Because our world is different today, you may believe this advice is outdated and irrelevant. But when it comes to medication safety, Shakespeare s advice is timeless; medications should never be borrowed from or lent to others. His advice is simple enough to follow, but practitioners can be tempted to borrow a missing medication (a dose that potentially should have been available) or the first dose of a new medication from another patient s cassette, a discharged patient s unused medications, or another patient care unit. Borrowing medications is a workaround used to speed the process of administering medications due to inherent or excessive wait times associated with pharmacy dispensing; this workaround increases the risk of an error. Lest you believe that profiled automated dispensing cabinets (ADCs) and unit dose dispensing alone have sufficiently curtailed the practice of borrowing medications, a survey originally conducted in 2002 and repeated in 2008 (see Table 1) found that almost half of the 1,296 nurses who participated in the most recent survey still borrowed medications when doses for their patients appeared to be missing on the unit. 1 Table 2 describes just a few of the many errors that have been reported to ISMP as a result of borrowing medications (which are similar to errors associated with removing medications from floor stock or ADCs via an override function before pharmacy review of the orders). Because there are many opportunities for error, the ideal medication administration system is one in which there is more than one practitioner between the drug and the patient. For example, while screening orders, a pharmacist may detect a prescribing error such as an inappropriate dose, a drug allergy, or a drug-drug interaction. While checking medications before administration, a nurse may detect a pharmacy dispensing error. While reviewing the patient s medication administration record (MAR), a physician may detect the inadvertent discontinuation of a drug. Pharmacies have a system of checks before medications are dispensed. Computer software can help screen the order for appropriateness and safety, and other staff typically prepare the Table 1. Percent of nurses who borrow missing medications 1 EXTENT OF BORROWING SURVEY SURVEY Always borrow 5% 10% Sometimes borrow 43% 61% Never borrow 52% 29% medications and check them against the order before they are dispensed. However, this safety system is bypassed when doses are borrowed from other patients or obtained from an ADC before a pharmacist has screened the order. Thus, with borrowed medications, the system will not provide adequate safety checks to capture errors before they reach the patient. Borrowing medications is not just a nursing problem; it s a complex, interdisciplinary clinical issue that requires ongoing team-work and excellent communication among nurses, pharmacists, and other health-care practitioners. Assume that borrowing of medications does occur in your hospital and consider the following four-pronged approach to address this issue. REFERENCE: 1) Cohen H, Shastay AD. Nursing2008 survey report: getting to the root of medication errors. Nursing2008 December 2008;38(12): Alberta RN July/August 2010 Volume 66 No 4

33 Table 2. Examples of errors associated with borrowing medications A patient received two doses of SEROQUEL (QUEtiapine) 100 mg instead of the prescribed 200 mg dose of SERZONE (nefazodone). When the nurse could not find the patient s dose of Serzone, she thought pharmacy had forgotten to dispense it. Instead of calling the pharmacy, she asked another nurse to borrow the medication from a unit close-by. This nurse misheard the request for Serzone as SEROquel and gave the nurse two 100 mg doses of the wrong medication. The patient experienced significant somnolence and sedation after receiving 200 mg of SEROquel. A physician prescribed IV ZOSYN (piperacillin and tazobactam) for a patient with pneumonia. The nurse wanted to start the antibiotic right away, so instead of waiting for pharmacy to dispense the drug, she borrowed an unused dose from a patient who recently expired. The patient who received Zosyn (a drug in the penicillin drug class with potential for cross-sensitivity allergic reaction) had a known penicillin allergy and developed an anaphylactic reaction to the drug. Fortunately, the patient survived. The pharmacy had not dispensed the medication because staff were waiting for the prescriber to call back to change the order. When a nurse found that she could not obtain a dose of TORADOL (ketorolac) from the unit s ADC via the override feature, she borrowed a dose from another patient and administered it to an aspirin-allergic patient. Fortunately, the patient did not experience a life-threatening reaction. The pharmacy had not released the medication in the profiled ADC because they were awaiting clarification of the order because Toradol is contraindicated in patients with an allergy to aspirin. In a labour and delivery unit, a healthy young woman became hypotensive after starting epidural anesthesia. A nurse called an obstetrics resident known to be difficult at times, who snapped at the nurse and gave an order for ephedrine 10 mg slow IV push. The nurse, who was anxious because of the physician s behaviour, made a mental slip and thought of EPINEPHrine. With only a few ampuls of EPINEPHrine 1 mg on the unit, she decided to borrow more from the nursery. She found a 30 ml vial of EPINEPHrine 1:1,000 (1 mg per ml), withdrew 10 ml, and administered that amount to the patient. The patient immediately developed tachycardia, severe hypertension and pulmonary edema. Fortunately, anesthesia staff responded and recognized the problem immediately. The patient was treated successfully and the baby was delivered safely. A woman with atrial fibrillation, hypertension, lethargy, and constipation died while receiving enoxaparin and heparin concurrently. A cardiologist initially prescribed enoxaparin and warfarin. When a gastroenterologist recommended a colonoscopy, warfarin was discontinued and a heparin infusion was ordered. Enoxaparin administration continued every 12 hours. The heparin order was never faxed to the pharmacy. In order to administer the heparin bolus and begin the infusion, the nurse borrowed a vial of heparin and a premixed solution that the pharmacy had dispensed for another patient. Several hours later, the patient s aptt was greater than 90 seconds. The heparin infusion was decreased, but by morning, the patient exhibited signs of internal bleeding and her aptt was still elevated. Heparin and enoxaparin were discontinued, but the patient died despite aggressive treatment. July/August 2010 Volume 66 No 4 Alberta RN 33

34 ISMP MEDICATION SAFETY ALERT! Shakespeare was on target don t be a borrower or lender (cont d) 1) Remedy the reasons for borrowing Prohibition against borrowing medications via policy is not enough to ensure patient safety, as the reasons for this behaviour are often rooted in system deficiencies. Talk with colleagues and learn why nurses and other practitioners may borrow medications from unauthorized sources, and address these issues in a collaborative manner. If turnaround time for dispensing medications (or review of orders to allow access to medications in ADCs) is perceived to be an issue, set up measures to identify the scope of the problem, address vulnerabilities, and gain consensus among nurses, pharmacists, physicians, and hospital leadership regarding acceptable timeframes for drug delivery or order review. Uncover and address common misconceptions about the need and clinical significance of starting new drug therapies immediately. If waiting for order clarification, pharmacists should contact the nurse to communicate the reason for a delay in dispensing the drug, especially if the prescribed drug or dose might be unsafe for the patient. 2) Decrease staff tolerance Ensure nurses and other practitioners understand the risks and consequences of borrowing medications, and ensure pharmacists understand the risks and consequences of delayed order review and dispensing of medications. Promote reporting of conditions that contribute to delayed order review and dispensing, which may encourage and reward the practice of borrowing medications. Use this information to improve the medication-use system. 3) Identify reason(s) for missing medications Missing doses are an inconvenience and could be related to problems with restocking ADCs or delivering medications to patient care units. However, a medication can be missing or not available for other reasons: The medication was already given but not documented on the MAR. The dose was given on another unit. The medication time or frequency was scheduled incorrectly and is being reviewed. The order was incorrectly interpreted or mistranscribed onto the MAR or onto another patient s MAR. The medication was not dispensed by pharmacy because of a safety problem. The dose was used to replace a previously dropped dose or a dose that had been vomited. The drug was misplaced (e.g., removed from the pneumatic tube and left there or sent to the wrong nursing unit). Pharmacy never received the order. A discontinued drug is still listed on the MAR. The drug was in the refrigerator where it should be, but the nurse didn t know it was there. The drug was borrowed for another patient. 4) Eliminate unauthorized access to drugs Discourage the accumulation of discontinued or unused medications in patient care units. Provide a secure container or ADC compartment for staff to place medications from discharged or expired patients as well as other discontinued or unused medications. Conduct frequent pharmacy rounds to collect these medications (including refrigerated items). Use profiled ADCs and establish stringent criteria for removal of medications. Monitor override reports for appropriateness. RN Reprinted with permission from ISMP Medication Safety Alert! Nurse Advise-ERR (ISSN ) May 2010 Volume 8 Issue Institute for Safe Medication Practices (ISMP). Visit ismp-canada.org or ismp.org. 34 Alberta RN July/August 2010 Volume 66 No 4

35 RNLibrary The latest books, documents and audio-visual titles acquired by the CARNA Library. To reserve these and other titles, CARNA members can contact the library Monday through Friday, 9a.m. to 4p.m. at , ext. 533, or visit any time to access the library catalogue and CINAHL (Cumulative Index to Nursing and Allied Health Literature database). Byers, E. K. (2009). Guardians of the lamp: The Calgary General Hospital and its nursing school remembered. Calgary, AB: McAra Printing. [WY 11.1 B ] Corty, E. W. (2007). Using and interpreting statistics. St. Louis, MO: Elsevier Mosby. [WY 29 C ] Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (Eds.). (2008). Nursing diagnosis manual: Planning, individualizing, and documenting client care (2nd ed.). Philadelphia, PA: F. A. Davis. [WY N ] Duchscherer, G. & Guo, B. (2007). Safety and efficacy of inhaled nitric oxide in the management of hypoxemic respiratory failure in adults with acute respiratory distress syndrome. Edmonton, AB: Institute of Health Economics. [WS 410 D ] Gray s anatomy: The anatomical basis of clinical practice (39th ed.). (2005). Edinburgh: Elsevier Churchill Livingstone. [QS 4 G ] Langhorne, M. E., Fulton, J. S., & Otto, S. E. (Eds.). (2007). Oncology nursing (5th ed.). St. Louis, MO: Mosby Elsevier. [WY 156 O ] Lynn, P. B. (2008). Lippincott s photo atlas of medication administration. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. [QV 748 L ] Nursing drug handbook. (2009). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. [QV 4 N ] Porrett, T. & McGrath, A. (2005). Stoma care. Oxford: Blackwell. [WY 161 P ] Sanders, J. & Cook, G. (Eds.). (2007). ABC of patient safety. Malden, MA: Blackwell. [WA 250 A ] Silvestri, L. A. (Ed.). (2010). Saunders comprehensive review for the NCLEX-PN examination. Philadelphia, PA: Elsevier Saunders. [WY 18.2 S ] Smith, M. J. & Liehr, P. R. (Eds.). (2008). Middle range theory for nursing (2nd ed.). New York: Springer. [WY 86 M ] Tabloski, P. A. (Ed.). (2010). Gerontological nursing. Upper Saddle River, NJ: Pearson. [WY 152 G ] Thibodeau, G. A. & Patton, K. T. (2007). Anatomy & physiology (5th ed.). St. Louis, MO: Mosby. [QS 4 T ] Varcarolis, E. M. & Halter, M. J. (Eds.). (2009). Essentials of psychiatric mental health nursing: A communication approach to evidencebased care. St. Louis, MO: Saunders Elsevier. [WY 160 E ] Online Help for RNs Access the CARNA Library on Your Time Browse through the catalogue and borrow from CARNA s extensive collection of books, videos, journals, government documents, newsletters and more. Access the CINAHL database, an index of more than 1,200 nursing and allied health journals and publications from 1982 to the present for articles on various topics. Get the professional resources you need. Go to * Cumulative Index to Nursing and Allied Health Literature Database July/August 2010 Volume 66 No 4 Alberta RN 35

36 NOTICEBoard E D M O N T O N / W E S T CONTINUING COMPETENCE EDUCATION SESSION Aug. 11, Edmonton CONTACT: Alison Adams, , aadams@nurses.ab.ca CANADIAN ASSOCIATION OF NURSES IN ONCOLOGY ANNUAL CONFERENCE The Power of One The Potential of Together Sept , Edmonton. CONTACT: APPLYING A POPULATION HEALTH PERSPECTIVE TO HEALTH PLANNING AND DECISION MAKING Canadian Institute for Health Information Core Workshop Sept. 21, Edmonton. CONTACT: education@cihi.ca, CANADIAN SOCIETY FOR GASTROENTEROLOGY NURSES AND ASSOCIATES ANNUAL CONFERENCE GI Pathways for Nurses Sept. 30 Oct. 2, Edmonton. CONTACT: BEST PRACTICE RESOURCES FOR REGISTERED NURSES Oct. 13, Edmonton. CONTACT: Alison Adams, , aadams@nurses.ab.ca PAPER WORK OR PATIENT CARE WHAT MATTERS? Nov. 17, Edmonton. CONTACT: Alison Adams, , aadams@nurses.ab.ca N A T I O N A L THE CANADIAN HEALTHCARE SAFETY SYMPOSIUM Oct , Halifax. CONTACT: RECENT ADVANCES IN THE PREVENTION AND TREATMENT OF CHILD AND ADOLESCENT OBESITY CONFERENCE Oct , Hamilton. CONTACT: I N T E R N A T I O N A L INTERNATIONAL PERSPECTIVES IN THE HISTORY OF NURSING Sept , London. CONTACT: MIDWIFERY TODAY INTERNATIONAL CONFERENCE Birth is a Human Rights Issue Sept. 29 Oct. 2, Strasbourg, France. CONTACT: conferences/strasbourg2010 N E T W O R K I N G O P P O R T U N I T I E S CARNA SPECIALTY PRACTICE GROUPS Contact your CARNA regional coordinator or go to and click on Member Info. THE CANADIAN FAMILY PRACTICE NURSES ASSOCIATION This association was established for family practice/primary health-care nurses who would like to network and exchange information with their nursing colleagues across Canada. Visit or contact Marilyn Howlett at or howlett@cfpcn.ca for more information. Submission deadline for events listed in Alberta RN September/October 2010 is August 15. Go to for an up-to-date listing of events or to submit an event for publication in Alberta RN. Reunion Royal Alexandra Hospital School of Nursing Class of Year Reunion. Sept , Pigeon Lake. CONTACT: Karen Ens, , lkens@telusplanet.net IN MEMORIAM calendar Our deepest sympathy is extended to the family and friends of: Bracko, Mary, a 1944 graduate of the Saskatoon City Hospital school of nursing, who passed away on Feb. 26, Campbell, Tamara, a 1989 graduate of the University of Alberta Hospital school of nursing, who passed away on May 17, Chwyl, Mary, a 1952 graduate of the St. Joseph s Hospital school of nursing, who passed away on Feb. 28, Hasdell, Jill, a 1971 graduate of the Northampton Hospital school of nursing, who passed away on Dec. 31, Hislop, Margaret, a 1935 graduate of the Regina General Hospital school of nursing, who passed away on May 27, Howse, Catherine, a 1978 graduate of the Royal Alexandra Hospital school of nursing, who passed away on Dec. 6, Longson, Gladys, a 1944 graduate of the Medicine Hat College, who passed away on April 28, McCaffrey, Irene (née Farynowski), a 1962 graduate of the Edmonton General Hospital school of nursing, who passed away on April 14, Panych, Rozalie, a 1951 graduate of the Edmonton General Hospital school of nursing, who passed away on March 30, Sikora, Frances, a graduate of the University of Alberta Hospital school of nursing, who passed away on April 13, Spink, Doris, a 1944 graduate of the Holy Cross Hospital school of nursing, who passed away on Feb. 10, Toohey, Irene, a 1947 graduate of the Edmonton General Hospital school of nursing, who passed away on March 11, Alberta RN July/August 2010 Volume 66 No 4

37 opportunities ready, set...

38 opportunities

39 Closing Perspectives It s Time to Have Your Say This summer, you have an unprecedented opportunity to influence health-care delivery by contributing your holistic approach to how we implement the recommendations of the Minister s Advisory Committee on Health (MACH). The recommendations included a new law, the Alberta Health Act, be built around core principles, and the development of a patient charter. As one of the nine members on the advisory committee formed to assist MLA Fred Horne identify policy issues that government needs to address and provide advice on the new legislation and I m hoping RNs will actively participate in the province-wide consultation process currently underway. As a member of the largest group of front-line health-care professionals, you have a uniquely informed point of view and can contribute to a balanced and honest discussion of both the strengths and weaknesses in our health-care system. This collaborative discussion will help define the model for a patient charter that consolidates a list of patient rights and responsibilities in one document that applies to all applicable health legislation. Most charters share the same goal: increase confidence in the provision of health care by creating a shared understanding of expectations between those responsible for providing health-care service inclusive of professionals and government, and those receiving healthcare services. The choices we make now will influence the direction of legislation which in turn will influence the performance measures implemented to evaluate against expectations. Ultimately, RNs will end up playing a significant role in realizing the principles enshrined in the patient charter so it s essential to involve yourself early in the process. The community workshops currently underway and the online survey explore two broad categories of patient rights: rights in health care and rights to health care. Rights in health care generally relate to encounters between health-care providers and patients and include rights to privacy, respect, dignity, informed consent etc. For regulated health professionals, these rights are often reflected in our code of ethics. Rights to health care relate to access to services/treatment, to timely treatment, wait times guarantees and a fair process to address complaints when expectations are perceived to be unmet. Whichever rights are enshrined in a patient charter, the key to their effectiveness lies in a shared commitment to achieve success and in their enforceability. What do you want to see included in a patient charter? What do you believe a patient charter can accomplish? What do you believe about health care? RNs are well-suited to this discussion thanks to a holistic perspective which fosters a broader understanding of health and of the interdependence of factors which contribute to a healthy individual, family and community what we usually refer to as the determinants of health. This consultation on a patient charter needs the input of registered nurses who value preventative health care, evidence-based decision-making, patient safety and quality of care. For those of you interested in learning more, I particularly like an article called Waiting for Health Care: What role for a Patient Bill of Rights? written by Colleen M. Flood and Tracey Epps and published in 2004 by the McGill Law Journal (McGill Law Review, Vol. 49, Nov. 3, 2004). The authors explore the merits of a patient bill of rights and provide a detailed survey of the experiences of seven jurisdictions which implemented a bill of rights. Although Alberta is developing a patient charter rather than a bill of rights, the broad principles potentially enshrined in these documents are similar. Four years ago, the Canadian Nurses Association published the report, Toward 2020: Vision for Nursing and the authors reminded us that no one will appoint nurses to effect change we have to take up the challenge of promoting and implementing primary health care. In Alberta, we have a unique opportunity to influence the direction of future legislation on health care. Let s not pass it up. RN Mary-Anne Robinson, RN, BN, MSA Chief Executive Officer Phone: or , ext mrobinson@nurses.ab.ca At the time of publication, CARNA was preparing its written submission to the committee. CARNA is also participating in a stakeholder consultation with physicians and pharmacists. 46 Alberta RN July/August 2010 Volume 66 No 4

40 an Apple ipad * with WiFi+3G! Courtesy of Apple Renew your practice permit online via MyCARNA and meet all requirements by August 1 and you ll be entered to win one of two Apple ipads. It s simple, just log in at /MyCARNA with your user ID (registration number) and password, to complete your renewal application. Renewing online is simple, fast and always secure. MyCARNA also allows you to change your personal information, update your continuing competence activities, and gives you access to helpful memberonly tools and resources, a comprehensive database for nursing literature, and resources on legal topics affecting nursing practice. Complete contest rules are posted at * To be eligible, members must renew online, submit fees in full and, if selected for the continuing competence audit, submit the requested materials by August 1.

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