Real engagement for Real Action 1
This document builds on two previous reports: New Conversations: Appreciating and Considering RNs in the Future and From New Conversations to Real engagement:taking RN Practice into the Future (available at www.). February 28, 2014, College of Registered Nurses of Nova Scotia Suite 4005 7071 Bayers Road, Halifax, NS B3L 2C2 info@ www. All rights reserved. Individual copies of this document may be downloaded from the CRNNS website. Portions of this publication may be reproduced for personal use. Reproduction of this document for other purposes, by any means, requires permission of the copyright owner.
Table of Contents Message from the President and Executive Director... 1 The Real engagement Journey... 2 Charting a Course to a Positive Future... 3 The Big Shift: New Thought Patterns, at a Glance... 5 Transforming Real engagement into Real Action... 6 Continuing the Journey... 9 Appendix A: From New Conversations to Real engagement to Real Action A Timeline... 10 Appendix B: Real engagement Process...11 Appendix C: Creating Positive Change...12 Appendix D: Capturing the Essence in Metaphors...13 Appendix E: The Real engagement Team...14
A Message from the President and Executive Director It is exciting to look back and see that what began as two motions put forward by members at the CRNNS 2011 and 2012 annual general meetings has, today, evolved into an inspiring process of transformation involving more than three hundred registered nurses from all across the province. Nurses who came together in an unprecedented effort to reveal the core issues facing the nursing profession, envision the future we want to create, and identify steps that we can take to realize our individual and collective potential. We feel very positive and energized as we present this report, From Real engagement to Real Action, and are grateful to everyone who took part in the Real engagement sessions held throughout the province earlier this year. The insights and visions for action garnered through these sessions are summarized in this report, so the nursing community can appreciate what has been accomplished in the first two phases of this initiative as we move forward together in shaping the future of the nursing profession in Nova Scotia. The input gathered through the Real engagement sessions will guide us as we take steps to support RNs to re-ignite pride within the profession, lead with a solution-focused approach, and be decision-makers in health system change. In our travels as we listened to RNs share their concerns, hopes and aspirations we also realized that Real engagement was bringing frontline nurses together with nurses in policy, education, research and management, and forging new connections and a new sense of a shared vision for the nursing profession. This alignment of the positive energy of RNs across Nova Scotia represents an enormous force. Our challenge now is to foster and direct this energy as we work together to shape the future of nursing and the healthcare system. The road ahead may be challenging, however, it should also be rewarding. As we embark on the third phase of our initiative Real Action to Shape the Future of Nursing in Nova Scotia we look forward to seeing just how much RNs will accomplish with a stronger sense of community and renewed sense of pride. We are confident that our collective efforts, as RNs and CRNNS, along with our partners, will lead to important advances in nursing practice and the healthcare system, and, ultimately, be of great benefit to the people of Nova Scotia. Peter MacDougall Donna Denney President Executive Director 1
The Real engagement Journey Between March 15 and June 10, 2013, CRNNS President, Peter MacDougall, and Executive Director, Donna Denney, along with Judy Johnson, an independent facilitator, hosted 12 Real engagement sessions (see Appendix A). Approximately 350 RNs, in total, participated in these sessions. The goal of these sessions was to engage RNs in all six College districts, at all career stages and in every kind of practice setting, in open and positive discussions on strategies that nurses can apply, individually and collectively, to make a positive and tangible impact on the future of the profession. Each Real engagement session began with a discussion of the key issues facing RNs in Nova Scotia today (see Appendix B for Real engagement process). Interestingly, the following issues emerged with remarkable consistency from session to session, echoing the issues identified in New Conversations, the first phase of this project: identity crisis, role confusion, scope of practice changing demographics (aging nursing workforce, aging patient populations, retention/support of new graduates) unhealthy/unsafe work environments lack of engagement/leadership within the profession (for more information on these issues, please refer to the report entitled From New Conversations to Real engagement, p.8-10) As participants discussed these issues, many of them expressed their ongoing frustrations and deep concerns about the difficult impasse they feel they have reached as professionals and how the problems they are facing in their practice settings are affecting the quality of patient care. While some expressed despair, powerlessness and even hopelessness, others identified the opportunities emerging for RNs (if they are ready to seize them) as our healthcare system undergoes transformation. To help them approach the challenges they face from a new and more empowering perspective, participants at each Real engagement session were provided with three evidence-based practices known to effect positive change (see Appendix C). However, the majority of time in each session was spent completing three activities to further explore the following themes and sub-themes that arose out of the New Conversations initiative: Re-ignite pride in the profession»» RNs appreciate and express their value and unique contribution»» RNs value the breadth and depth of their knowledge and skill»» RNs recognize and honour the trust and respect they are given Lead with a solution-focused approach»» System requires registered nurses to lead change»» Recognize and engage the leadership potential of new RN graduates»» Embrace the opportunities created by health system change Be decision makers in health system change:»» RNs best positioned to lead client care innovation»» Use evidence to inform policy and system change»» Relationship skills to create interprofessional collaboration In these three activities, participants were asked to: imagine what the nursing profession would look like if these themes were fully realized identify metaphors that would capture the essence of each theme (see Appendix D for a list of metaphors developed by participants) identify two actions that could lead to real change in relation to each theme. 2
Charting a Course to a Positive Future In June, the Real engagement Advisory Committee, along with CRNNS Working Group, met to analyze the data collected during the 12 Real engagement sessions, and refine it within the framework of the three identified themes. The following examples are provided to give you an appreciation of the valuable data collected. RNs LEADING WITH A SOLUTION-FOCUSED APPROACH Participant quote: We are registered nurses who know who we are and what we do we empower each other in the interests of patients, families, residents, and communities. What would it look like, feel like, if this was our reality? If this was our reality, participants envisioned that they and their RN colleagues would be: embracing new ways of thinking and leading by example participating actively in organizational decision making pivotal in client care decision making optimizing their contributions in the healthcare system the go to people, playing a key role as care coordinators confidently articulating the value of their roles, and sharing ideas and opinions establishing partnerships with patients and the healthcare team to optimize health outcomes. What metaphor best illustrates this vision? RNs as lighthouses - shedding light on the issues, guiding others to solutions, providing a beacon of light that does not discriminate, and ensuring the safety of others. What steps would move RNs in this direction? To move the profession in this direction, participants said that RNs need to: return to the core of nursing and why they entered the profession have formal leadership development consistently mentor/support each other (i.e., new and experienced RNs) build a sense of community through better intraprofessional communications acknowledge the significance of and engage in continuing education/professional development acquire more knowledge about their integral role in collaborative practice and begin to consistently apply this knowledge in their practice settings. RE-IGNITING PRIDE WITHIN THE PROFESSION Participant quote: To build external respect, we must build respect amongst ourselves in every interaction. What would it look like, feel like, if this was our reality? If this was our reality, participants envisioned that they and their RN colleagues would: be enthusiastic, generous, caring and open to new ideas proudly wear RN pins (and in some settings uniforms); carrying themselves with dignity and pride exhibit confidence, with a strong professional identity and sense of self-respect and respect for others assert themselves as knowledgeable professionals with a unique perspective and pivotal role to play in providing quality, holistic, patient-centred care be fearless leaders, with a compelling voice on healthcare teams and the authority to advocate for patients and be involved in important decisions feel a sense of accomplishment, engagement and commitment to the nursing profession enjoy a balanced work/home life that enables them to perform to their full potential. 3
What metaphor best illustrates this vision? An RN looking in a mirror and seeing a lion reflected in the glass. Like the lion or lioness, the RN is ever observing, monitoring and surveying the situation, to be prepared to spring into intelligent action when necessary. I am nurse, hear me roar! What steps would move RNs in this direction? To move the profession in this direction, participants said that RNs need to: re-frame the dialogue and focus on positive conversations support each other in presenting themselves as professionals exhibit confidence in themselves and respect for others encourage each other to recognize and celebrate their strengths and achievements learn to clearly explain their roles and scope of practice work to their full scope and assume leadership roles be involved in strategic decision-making model pride in their profession, with an emphasis on building pride among nursing students remember Florence Nightingale s vision and passion for nursing and social reform. RNs AS DECISION-MAKERS IN HEALTH SYSTEM CHANGE Participant quote: Outcomes for patients would improve as a result of nurse-driven changes. What would it look like, feel like, if this was our reality? If this was our reality, participants envisioned that they and their RN colleagues would be: recognized as experts, and respected and valued for their input a strong voice and actively involved in all levels of decision-making, from patient care to institutional policy and health system change supported and expected to be leaders and decision-makers patient-focused and using their knowledge to make decisions that lead to better outcomes for patients autonomous in making decisions in the best interests of patients and families positive, proactive and empowered champions of change. What metaphor best illustrates this vision? RNs making positive changes that ripple through the system like a set of dominos. What steps would move RNs in this direction? To move the profession in this direction, participants said that RNs need to: focus on solutions and celebrate successes proactively work with colleagues and managers to identify and solve problems provide direction and support to develop as leaders and champions have protected time to take part in professional development work together to achieve a positive vision for change in their profession. 4
The Big Shift: New Thought Patterns, at a Glance Throughout the Real engagement process, RNs in all facets of practice began to recognize the urgent need for a total paradigm shift in their thinking and approach. Here are some of the key shifts that they expressed: From feeling alone in a day-to-day struggle TO feeling part of a united force with a vision and a mission for change. From thinking the system needs to be changed for us to do our jobs better TO changing ourselves to do our jobs better. From waiting for senior management to fix the problems TO implementing small changes to see if they can help. From being order takers TO being decision-makers. From sticking to this is how we do it TO taking a risk on new ideas. From keeping heads down and mouths closed TO speaking up and owning our professional knowledge and leadership capacity. From focusing on the naysayers TO supporting, recognizing and following positive people. From complaining about what we don t want TO working to create what we do want. 5
The Big Shift: New Thought Patterns, at a Glance Throughout the Real engagement process, RNs in all facets of practice began to recognize the urgent need for a total paradigm shift in their thinking and approach. Here are some of the key shifts that they expressed: Transforming Real engagement into Real Action The Advisory Committee and Working Group were struck by the consistency of the input gathered from RNs across the province and how the action steps identified by RNs to address one theme were similar to those that emerged for the others. Action Streams To provide direction for the next phase of this project, entitled Real Action to Shape the Future of Nursing in Nova Scotia, the Advisory Committee and Working Group identified five action streams to help RNs reignite pride within their profession and become solution-focused leaders and influential decision-makers in health system change: 1. Nurture and sustain positivity 2. Promote and strengthen leadership/mentorship/role modelling 6
3. Clarify the RN role 4. Articulate the RN role and communicate its importance 5. Build a strong and vibrant RN community The Advisory Committee also identified the following practical steps to establish a starting point for registered nurses and CRNNS to work together to achieve the vision reflected in the three themes. NURTURE AND SUSTAIN POSITIVITY Share positive messages share information about evidence-based practices for positive change with RNs at all levels, with a special focus on senior nurses craft and send weekly e-messages to sustain the motivation of the 300+ RNs who attended the Real Engagement sessions, and encourage them to forward the messages to others share positive messages more widely through social media, posters, fridge magnets, etc. establish a social media forum for RNs to share positive messages and success stories and create/encourage regular posts Recognize and cultivate positive attitudes and actions College profile RNs positive contributions in newsletters and social media (e.g., blogs, district internal media, Facebook, twitter) provide positivity training to new grads and registered nurses at all levels maintain connection with 300+ Real engagement participants to keep them engaged with CRNNS and the process, while providing additional input and positive energy (e.g., ask them to contribute leads for success stories) Show appreciation establish appreciation awards for nurses in frontline and other roles encourage employers to regularly show appreciation to nursing staff encourage RNs to thank their fellow nurses and other members of the team often, to help build a culture of respect, gratitude and positivity PROMOTE AND STRENGTHEN LEADERSHIP, MENTORSHIP AND ROLE MODELLING Position RNs as leaders speak of all RNs as leaders portray RNs as leaders create a reservoir of stories about RNs who demonstrate leadership qualities in a variety of settings and ways; share those stories via College newsletters, social media, community papers, bulletin boards, district internal media, etc. find ways to help RNs see themselves as leaders and encourage them to take on leadership roles in their workplaces (e.g., rounds, committees, offering day-to-day solutions) Encourage and reward mentorship partner with RN-Professional Development Centre (RN-PDC) to assess the reality of mentorship on the frontlines and to potentially expand the preceptor program partner with Nursing the Future to provide information/training on being a good mentor to new graduates produce position statements and advocate re: the connection between mentorship and quality, the 80:20 practice versus teaching ratio, mentorship as a standard of care, protected time and institutional support for RN mentoring activities promote a mentoring culture that encourages young registered nurses to seek mentors and involves RNs at all stages of their careers as mentors formally thank and recognize preceptors/mentors, through ceremonies, cards, letters, pins, and stories in various media establish an Exceptional Mentor award 7
Emphasize the importance of positive role models honour senior nurses share their insights and wisdom through various means find and share RNs stories about the impact that role models have had on their careers share information and advice about the importance of all RNs being positive role models, what qualities to model, and how to do so effectively CLARIFY THE RN ROLE Build on a strong foundation of knowledge re-visit and build on prior award-winning work in Nova Scotia to clarify the complementary roles and scopes of LPNs and RNs in a collaborative practice model research best practices in defining roles through care plans, standards of care and other successful approaches to role clarification from other jurisdictions investigate ways to establish RNs as care coordinators (e.g., institutional policy, legislation) review member survey information to see how this may help clarify the RN role investigate opportunities and means for RNs to expand their roles Create and share clear role statements develop clear statements about RN roles beyond competencies across the complete range of practice settings (e.g., community, acute care, long term care, home care) connect role clarity to patient safety and outcomes share and discuss the RN role and importance and benefits of role and scope clarity with other health professional associations, healthcare administrators, and policymakers Support RNs to maintain and expand their roles learn what skills RNs need to strengthen to best fulfill and stand firm in their roles launch training and coaching programs through CRNNS, RN-PDC and other nursing organizations, to help RNs develop these skills (e.g., care coordination and planning, managing care for fluctuating acuity, asserting role, presenting at rounds, approaching difficult conversations) partner to advocate for plans of care that are developed as a team, that establish the RN as the care coordinator, and make everyone s roles and tasks clear ARTICULATE THE RN ROLE AND COMMUNICATE ITS IMPORTANCE Develop and promote a strong and positive RN brand develop clear value statements about the RN role and RNs unique contributions, to share via social media and media campaigns, including Nursing Week supplement (could partner with NSNU or CNA on billboards, TV, radio) distribute RN pins, encourage RNs to proudly introduce themselves as RNs first profile positive, solution-focused, decision-making RNs in community and other media Encourage RNs to be more vocal and visible develop and share elevator speeches for various RN roles to help RNs learn to articulate their role and the strengths they bring to healthcare articulate the value of hidden work (valuable, higher-level RN functions that are not visible because they are not simple tasks to check off a list) involve RNs in health expos and other venues and events that provide an opportunity to articulate their role to the public encourage and support RNs to lead education sessions, take part in committees, get involved in rounds, be included as stakeholders/decision-makers in change processes investigate potential of involving key RNs in each district as public advocates for healthy living, chronic disease management, etc. encourage RNs to include patients in shift transition discussions, so patients gain firsthand insight into the RN role 8
BUILD A STRONG AND VIBRANT RN COMMUNITY Nurture a sense of belonging foster and share the sense of vision emerging through Real enagement, to build a sense of unity in pursuit of a common purpose maintain and strengthen contact between CRNNS and frontline nurses, and among nurses in all practice settings hold regular get-togethers across the province, with CRNNS and RNs from all practice settings, to touch base on Real Action progress, discuss issues of importance, and share success stories and ideas, while learning about the realities of nursing outside silos highlight unique language of different RN practices (e.g., via College newsletters), to create stronger mutual understanding among nurses in different roles and settings create an online forum for RNs to stay in touch and share their stories Build professional communities establish communities of practice within nursing sub-specialties (e.g., LTC, family practice, acute care, public health, oncology), with face-to-face and online opportunities to share best practices, new practice developments, challenges/solutions, stories check status of practice councils across province survey current status and promote more practice councils encourage RNs to hold lunchtime journal clubs to share new developments in the literature, and other kinds of learning sessions (e.g., how to develop care plans) Continuing the Journey CRNNS Council received an update on the Real engagement work in September 2013, and CRNNS staff and working group have begun to explore new ways in which to support the plan for Real Action. The Advisory Committee will meet again in December 2013 to assist CRNNS in identifying priorities and developing a strategic, workable action plan. Some of the questions that will be addressed as we go forward include: What can nurses do, on their own and with others, in their institutions, practices and communities? What can nurses within educational institutions do to guide the profession and prepare the next generation of nurses for the nursing careers of the future? What can CRNNS do to support all nurses in their efforts to forge positive change? The road ahead may be challenging, however, it should also be rewarding. As we embark on the third phase of our initiative Real Action to Shape the Future of Nursing in Nova Scotia we look forward to seeing just how much RNs will accomplish with a stronger sense of community and renewed sense of pride. 9
Appendix A: From New Conversations to Real engagement to Real Action A Timeline May 2011 December 2011 January 2012 May 2012 Motion passed at AGM to establish an ad hoc advisory committee to help shape the future of RN practice Council allocated new resources to enable College to partner with the Nova Scotia Health Research Foundation (NSHRF) on a three-year research-oriented initiative; to determine how best to shape the future of nursing in Nova Scotia First phase of project launched, entitled New Conversations, with Thought-Leaders Workshop. Senior nursing leaders from across Nova Scotia participated in a one-day workshop; to identify and discuss key issues facing the profession in a fresh new light. Report published: New Conversations: Appreciating and Considering RNs in the Future (available at www.). Motion passed at AGM to establish a geographically and professionally diverse working group, with strong (50%) frontline representation, to preserve the integrity of the nursing profession. Close to 100 RNs/NPs participated in a half-day New Conversations workshop, looking at the same questions and issues addressed at the Thought Leaders Workshop. Fall 2012 Second phase of project planned, entitled Real engagement. Objective: to engage as many RNs as possible, from across the province, in real, tangible and meaningful ways. College issued call for RN volunteers to form a 20-member Advisory Committee. Received 67 responses. February 2013 March 2013 May 2013 First Advisory Committee meeting. Analyzed the feedback from New Conversations workshops and validated themes identified by the Working Group. Advised the Working Group on the format for province-wide Real engagement sessions. Real engagement initiative launched, with the first session hosted in Halifax by the College s President and Executive Director; facilitated by Judy Johnson. 100 RNs/NPs participated in a Real engagement session held in conjunction with the College s AGM. A second report, From New Conversations to Real engagement: Taking RN Practice into the Future, published (available at www.). June 2013 Last of 11 province-wide Real engagement sessions completed, with a total of approximately 350 RNs attending (including those attending the AGM session). Real engagement Advisory Committee met in Halifax to review feedback from the Real engagement sessions and to identify practical steps to move forward with the third phase of this initiative - Real Action. Nov 2013 Working Group to develop draft strategic plan for Real Action to Shape the Future of Nursing in Nova Scotia. 10
Schedule of Real engagement Sessions March 15 Halifax April 30 New Glasgow May 1 Antigonish May 22 Amherst May 23 Truro May 30 Sydney May 31 Port Hawkesbury June 4 Yarmouth June 5 Bridgewater June 6 - Berwick June 10 Halifax Appendix B: Real engagement Process Each session unfolded according to the following process: 1. Introduction to Real engagement: goals and progress to date 2. Shifting participants mindset so they each bring their best self to the discussion (an exercise whereby participants viewed an assortment of photos and selected the image that most represents their best self, and then consciously tried to bring those qualities with them into the discussion) 3. Identification and discussion of the key issues facing RNs in Nova Scotia today (small groups) 4. Assigning the issues to each of the three themes (re-ignite pride in the profession, lead with a solution-focused approach, be decision-makers in health system change) large group 5. Evidence-based practices to create positive change (see Appendix C) 6. Positive visualization and creating metaphors: What would each of the three themes look like, feel like, if they were true? (small groups/presentation) 7. Devising practical strategies to realize the potential of each theme (small groups/presentation) 11
Appendix C: Creating Positive Change The process for the Real engagement sessions was planned to create a flow of conversation; starting with an honest recognition and discussion about the real issues being experienced by RNs and moving to an empowering experience of potential change. The process began with a presentation of the three themes that emerged from the analysis of data collected during the New Conversations phase of this project (i.e., re-igniting pride, leading with a soluction-focused approach, being decision makers in health system change). Participants were then asked to identify the top two issues currently faced by RNs in their practice settings, and write them on post-it notes. In small groups, they were asked to share their two issues and, as a group, decide which of the three main themes most closely reflected their own experiences. After displaying the groups post-it notes on a flipchart, arranged according to the themes, it was obvious to each group that there was a consistency in the issues identified. Through their conversations, the RNs in the sessions agreed that their issues were accurately reflected in the identified themes. To help the RNs approach challenges from a new and more empowering perspective, the facilitator first spoke about how complex organizational and social situations such as health care need to be managed globally. A metaphor used to demonstrate how complex predicaments cannot be solved by trying to unravel them piece by piece is to think about them as a tightly knotted ball of wool. Although it would be possible to untangle the knots by simply pulling on individual threads, this will often have the opposite affect making the knots even tighter. Participants were then presented with the following evidence-based practices known to effect positive change in complex organizational and social situations: Social transformation theory - To effect change within complex systems, it s useful to look to the work of Nobel Laureate Ilya Prirogine, a Belgian chemist who discovered that putting pressure on the nucleus of a gas molecule does not cause it to break apart. In fact, Prirogine found that the more pressure you put on the nucleus, the more it creates a protective coating to resist the pressure. In addition, he found that eventually a single proton escapes from the nucleus. An electron soon follows and a new nucleus is formed. Eventually, as more particles leave the pressurized nucleus, it implodes. This chemical model has revolutionized social transformation theory, and provides a powerful metaphor for RNs. Rather than focusing energy on changing the system, by appealing to the people most invested in maintaining the status quo, RNs participating in the Real engagement sessions were encouraged create change by becoming either positive ions or early leaders (breaking away from the nucleus to create something new) or as electrons or first followers (being confident enough to leave the nucleus to support the early leaders). To learn more about the power of first followers, check out First Follower: Leadership Lessons from Dancing Guy, at www.youtube.com/ watch?v=fw8ammcvajq Another way to think about how RNs can use social transformation theory to address the complex issues they face in today s health system is to think of the entire healthcare system as a cruise liner. Instead of trying to figure out how to change the direction of the cruise liner, RNs need to think about themselves as 9,800 nimble speedboats that can change the system by all going in the same direction. Positive psychology This study was born several decades ago, when newly invented MRI technology revealed that re-living negative experiences during psychotherapy caused these negative patterns to become more hard wired in clients brains. Ensuing research found that thinking negative, stressful thoughts also activates the fight-or-flight response and leads to a variety of stress-related health problems. 12
Conversely, positive thinking has been proven to have powerful protective effects on physical and mental health. However, it takes three times more positive thoughts to overcome the effects of the negative, and it is easier to stay stuck in negative thought patterns than to develop and maintain positive thought patterns. Both patterns can become wired into the brain and spread to other people. The lesson for RNs is that thoughts are powerful. It is important to make a daily decision to be positive at work, to think and say positive things, and to avoid getting caught up in the magnetic force field of others negativity. Sports Psychology - A sub-set of positive psychology, sports psychology gives elite athletes the mental edge they need to win at the highest level of competition - where everyone is equally fit physically. Key elements of sports psychology include managing distractions and using positive visualization. RNs can harness the power of visualization to create positive change in their practice, their workplaces and the wider healthcare system. In other words, instead of focusing on what isn t right or doesn t work which only reinforces negative patterns envision the best possible scenario and start taking small steps in that direction. Appendix D: Capturing the Essence in Metaphors RNs LEADING WITH A SOLUTION-FOCUSED APPROACH RNs as the spark that ignites the flame RNs as the rowers on a tall ship, with patients guiding the pace and direction as the ship passes through stormy seas into clearer, calmer waters RNs taking our time to lead in a ballroom dance RNs as interlocking circles that form a larger, stronger circle RE-IGNITING PRIDE WITHIN THE PROFESSION RNs as an oak tree, with deep roots and many branches (old and new) that will flourish with the proper nourishment RNs as a pizza, with nursing as the crust (unifying force) and holding the diverse toppings (individual RNs) together RNs passing the torch, going across Nova Scotia and sharing the light RNs AS DECISION-MAKERS IN HEALTH SYSTEM CHANGE RNs as a string of Christmas lights, all shining in order for the whole set to work RNs as a Nike running shoe ( Just do it! ), with a steel toe and a bolt of lightning streaking out the back RNs as gardeners/farmers who sow seeds and nurture the plants, then harvest and re-sow the seeds from the strongest plants, and so on 13
Appendix E: The Real engagement Team Real engagement is being directed by an advisory committee comprise of RNs from across Nova Scotia, and supported by a Working Group established by CRNNS. Advisory Committee Margot Corkum, Yarmouth (Western District) Braden Davie, Halifax (Atlantic District) Joanne Fairfax, Somerset (Annapolis District) Kellie Fletcher, Falmouth (Annapolis District) Donna Gamble, Halifax (Atlantic District) Maria Gillan, St. Peter s (Cape Breton District) Karen Grandy, New Germany (Western District) Barbara Holmes, Hammonds Plains (Atlantic District) Lindsay Jackson, Halifax (Atlantic District) Dawn Johnson, Glace Bay (Cape Breton District) Heather MacDonald, Halifax (Atlantic District) Patrice McDougall, North Sydney (Cape Breton District) Maureen MacEachern, Dartmouth (Atlantic District) Kate Mercer, Halifax (Atlantic District) Cara Murray, Masstown (Cobequid District) Santina Rushton, West Branch, Pictou County (Highland District) Patrick Simms, Hammonds Plains (Atlantic District) Barbara Scott, Dartmouth (Atlantic District) Kathryn Snow, Dartmouth (Atlantic District) Karen Webb-Anderson, Beaver Bank (Atlantic District) Working Group Donna Denney, Executive Director, College of Registered Nurses of Nova Scotia Peter MacDougall, President, College of Registered Nurses of Nova Scotia Teri Crawford, Director, Practice, Policy and Legislation Services, College of Registered Nurses Jennifer Best, Practice Consultant, College of Registered Nurses of Nova Scotia Marie Dauphinee-Booth, Communications Consultant, College of Registered Nurses Janis Brown, Acting Nursing Policy Advisor, Department of Health and Wellness Sheri Price, Assistant Professor, Dalhousie University School of Nursing Judy Johnson, Facilitator 14