MANITOBA PSYCHIATRIC NURSING PLANNING GROUP FINAL REPORT

MANITOBA PSYCHIATRIC NURSING PLANNING GROUP FINAL REPORT November 2010

TABLE OF CONTENTS Acknowledgements...2 Executive Summary...3 Introduction...4 Psychiatric Nursing: Scope Of Practice...5 Background: Psychiatric Nursing In Manitoba...5 Registered Psychiatric Nurses As A Valuable And Essential Resource...6 Integration Of And Access To Registered Psychiatric Nurses...6 Future Directions...7 Education...7 Recruitment And Retention...9 Employment And Profile...11 Summary...13 Appendix 1: Terms of Reference...14 MANITOBA PSYCHIATRIC NURSING PLANNING GROUP Final Report 1

Acknowledgements This report was made possible by the collaborative efforts of: Brandon University College of Registered Psychiatric Nurses of Manitoba Consumer and Family representatives of mental health services Council on Post-Secondary Education Health Workforce Strategies and Mental Health and Spiritual Health Care Branches of Manitoba Health Regional Health Authority representation (urban, northern and rural) Selkirk Mental Health Centre All questions regarding this report should be directed to: Terry Goertzen (Chair, Manitoba Psychiatric Nursing Planning Group) Assistant Deputy Minister of Health Manitoba Health Health Workforce 300 Carlton Street Winnipeg, Manitoba R3B 3M9 2 MANITOBA PSYCHIATRIC NURSING PLANNING GROUP Final Report

Executive Summary In response to concerns raised by the College of Registered Psychiatric Nurses of Manitoba, the RPN planning group was established in June, 2008, under the direction of the Minister of Health, the Minister of Healthy Living, and the Minister of Advanced Education and Literacy. The goal of the group was to develop strategies to address the provincial psychiatric nursing resources within the context of mental health services in Manitoba. An informed response and strategy requires holistic stakeholder consultation. As such, the working group included representatives from: Brandon University College of Registered Psychiatric Nurses of Manitoba Consumer and Family representatives of mental health services Council on Post-Secondary Education Health Workforce Strategies and Mental Health and Spiritual Health Care Branches of Manitoba Health Regional Health Authority representation (urban, northern and rural) Selkirk Mental Health Centre As a result of work undertaken during several group sessions, the three targeted areas education, recruitment and retention, and employment and profile of psychiatric nurses were identified by the working group with the intent to develop recommendations within each area. The major themes within each area are listed and summarized below: Education o Promotion of RPN education: explore and promote strategies to better recruit and retain future and existing BScPN students including a 2nd Degree Option; explore feasibility of BScPN education in the north o Graduate Level of RPN Education Recruitment and Retention o RPN Recruitment Activities: participate in national and international recruitment efforts; employ a coordinated and targeted approach in recruitment as well as in the compilation and development of materials. o Retaining and Valuing Experienced RPNs: explore options to develop province-wide supports to match new RPN with experienced RPNs, mentorship opportunities. o RPN Student Consultation o Integration of Internationally Educated RPNs: engage with relevant partners to synergize efforts and actions to achieve a clear pathway for registration of IERPNs. Employment and Profile o RPN Positions: encourage employers to explore psychiatric nurse human resource models that are based on the complexity of mental health needs of the client population; CRPNM inform and advance the unique value and role of an RPN in their organization(s). o Public Promotion of the Role of RPNs in the Delivery of Mental Health Services: develop communication tools and strategies adapted to different needs and audiences; Consideration be given to a public media campaign, sponsored by CRPNM. MANITOBA PSYCHIATRIC NURSING PLANNING GROUP Final Report 3

To achieve a consultative and constructive process, sub-working groups were established for each target area. During these sessions, two themes consistently emerged, which ultimately informed and framed the development of recommendations by the larger group. The themes were as follows: Registered psychiatric nurses are a valuable and essential resource; and Consistent and coordinated support is needed for improved utilization, integration, and recruitment and retention of registered psychiatric nurses. The final recommendations in this report reflect these themes and include suggested steps for future action to respond to current and emerging health human resource issues in the context of mental health service delivery. One effect of the planning group has been to mobilize stakeholders into further action. As a result, a number of recommendations have moved forward since the establishment of the planning group. Lastly, planning group members held information sessions and garnered feedback from the following stakeholders: Health Programs & Services Executive Network, Provincial Human Resource Council, Health Senior Executive, Provincial Mental Health Manager s Network, and the Office of the Manitoba Fairness Commissioner. Each group was provided background information on the RPN planning group and an overview of relevant recommendations. One observation by employers is the need to further integrate RPNs into the area of dementia care and in Long Term Care Facilities. It was also noted that while there may be practical challenges to dedicating psychiatric nursing positions, there is strong support for the notion of protecting and promoting the RPN profession. Other comments are incorporated in this document. Introduction The purpose of this group was to develop strategies to address the provincial psychiatric nursing resources within the context of mental health services in Manitoba. Registered Psychiatric Nurses form the largest single group of mental health professionals in Manitoba. They are the single largest group of professional human resources for all mental health programs in Manitoba. Given the development of a new mental health strategy for the Province, it is appropriate to look at the human resources that support the delivery of mental health programs. Workforce planning literature demonstrates that there are at least eight critical factors in health human resource planning. These include: 1) planning tools, 2) a service delivery model, 3) professional practice, 4) retention, 5) succession planning, 6) recruitment, 7) human resources management, and 8) labour relations and negotiation 1. Within this context, the following points should be considered in framing discussions and decisions regarding Manitoba s health human resources: The health care system constantly evolves and requires re-evaluation to achieve a fiscally responsible, patientcentred and collaborative approach to healthcare delivery; Mental health and physical health are not mutually exclusive. Placing equal importance on mental health issues with physical health issues in health planning and health care delivery is essential to address and reduce the stigma faced by mental health clients and service providers; A population health approach may be a productive perspective as part of a needs assessment for mental health professionals and to address the stigma of mental illness and corresponding health services; Achieving viable mental health human resources is one component of any mental health strategy; Registered Psychiatric Nurses have a unique contribution and set of competencies to help meet the needs of Manitoba s health care system; The concept and practice of collaborative multidisciplinary teams to better meet the needs of the population exists in the mental healthcare system in Manitoba. Supporting interprofessional collaboration provides 1. Burkoski, V. and J. Tepper. 2010. The Demonstration Projects: Creating the Capacity for Nursing Health Human Resource Planning in Ontario s Healthcare Organizations. Nursing Leadership 23: 8-17. 4 MANITOBA PSYCHIATRIC NURSING PLANNING GROUP Final Report

opportunities and enhancements in patient care, education, and research. It fosters a respectful and healthy work environment and improves opportunities in the recruitment and retention of health professionals. Labour mobility within and into Canada / Manitoba is a factor in how health care professionals are educated, recruited and retained. Healthcare delivery, in all its complexities and layers, is constantly evolving. Skills and competencies shift, technology advances, population health needs change, and adjustments within an organization and workforce occur potentially requiring different solutions across different sectors and organizations. In finding equilibrium (i.e., the right provider and right services at the right place and the right time), the workplace, professional organizations, educational institutions and government bodies all play an important role in responding to emerging realities. Psychiatric nursing: scope of practice In Manitoba, there are three regulated nursing professions: Licensed Practical Nurses, Registered Nurses and Registered Psychiatric Nurses. There are differences in the basic educational programs for each of the regulated nursing groups. All nurses are prepared to meet the entry level competencies of their respective profession. While the three nursing professions share some of the same theoretical preparation and basic competencies, there are fundamental differences in their basic education programs in terms of the focus, core content and the depth and breadth of theory 2. Psychiatric nursing is concerned with the health, especially the mental health, of individuals, families, groups and communities. As a distinct profession, registered psychiatric nurses provide services to individuals whose care needs relate to mental, physical and developmental health while recognizing the complex relationships between emotional, developmental, physical and mental health and the role of social factors, culture and spirituality in illness and recovery. Background: psychiatric nursing in Manitoba Psychiatric Nursing is recognized as a distinct health care profession throughout western Canada and in many other countries. Psychiatric nurses have had separate education programs in Canada since 1920 and the profession was first regulated in Canada in 1948 in Saskatchewan. Registered Psychiatric Nurses (RPNs) are educated with special educational focus on psychiatric and mental health issues and care delivery. Since 1995, the Bachelor of Science in Psychiatric Nursing program has been delivered in Manitoba by Brandon University with a site in each of Brandon and Winnipeg. Prior to this, diploma level psychiatric nursing education was provided at the Selkirk Mental Health Centre, the Brandon Mental Health Centre and the Manitoba Developmental Centre. Once registered by the College of Registered Psychiatric Nurses of Manitoba, and working in a practice environment, RPNs are members of an interdisciplinary team of health care professionals. RPNs work in collaboration with psychiatrists, psychologists, other nurses, occupational therapists, social workers, pharmacists, managers, community agencies, law enforcement professionals and social service providers in hospitals, facilities and communities. While there are a broad range of programs and services that benefit from the presence of RPNs, the supply of RPNs has declined over the last decade. In 1999, the CRPNM reported that there were 1,037 practicing RPNs in Manitoba. The fall to 963 by 2009 has raised the issue of how to achieve sustainability in the psychiatric nursing workforce. Although there has been progress on various levels since the planning group was first established in 2008, challenges still remain to appropriately meet mental health client needs, particularly in acute, community, and long term care. This is due to an inadequate supply and underutilization of psychiatric nurses. 2. The College of Licensed Practical Nurses of Manitoba (CLPNM), the College of Registered Psychiatric Nurses of Manitoba (CRPNM) and the College of Registered Nurses of Manitoba (CRNM) prepared a joint document on scope of practice to promote understanding of the concept of scope of practice, how scopes of practice differ among the three nursing professions and the factors to consider when making decisions about the utilization of all types of nurses. A PDF file is available on-line: http://crpnm. mb.ca/crpnm_v2/publications/understanding_scope_of_practice.pdf MANITOBA PSYCHIATRIC NURSING PLANNING GROUP Final Report 5

Shortfalls in the supply of psychiatric nurses can be partly explained by the chronic deficit in education seats from 1985 to 2004. In 2000, seat capacity increased to 60 but it has only been since 2009 that the 77 seat capacity has met the 75 seats available before 1985. The insufficient number of graduates during these years was also exacerbated by a lack of graduates from 1995-1997 due to a poor transition plan from diploma to degree program. The effects of this have been felt, and are now being addressed. Current and future efforts to address shortfalls are critical, particularly in consideration of the aging RPN workforce. While there have been some recent improvements in the admissions process, the Brandon site remains tested to fill available seats in the BScPN program. This fact combined with the lack of graduate level prepared RPNs, present challenges in achieving an optimal supply to deliver the best possible patient care. Registered psychiatric nurses as a valuable and essential resource RPNs work as staff psychiatric nurses, community mental health workers, addiction counselors, therapists, managers, faculty, researchers, case managers, and consultants in hundreds of communities in Manitoba and Canada. RPNs also work in mental illness prevention and mental health promotion programs. Given the nature and range of services provided by RPNs, a steady workforce is critical to effective mental health service delivery. There is a lack of awareness and understanding of the role and of the RPN profession which limits the exposure (and visibility) of psychiatric nursing as a viable career choice. This reality also leads to shortfalls with regard to recruitment into psychiatric nursing and retention of RPNs; it lays a difficult landscape in mental health programming and compels employers to fill a vacancy with alternative providers. There is growing evidence a link exists between appropriate staff mix and patient outcomes. While some employers are exploring different models with regard to staff mixes based on client need, there is much work to be accomplished in this regard to optimize service delivery and to maximize the use of RPNs. In fact, a population health approach in this case, a heightened awareness of the needs of persons with mental health problems accompanied by an exploration of different staff mix models, for example, could be a factor in the context of health human resource planning capacity. Integration of and access to registered psychiatric nurses Overlapping competencies and scopes of practice of health care providers along with inter-professional practice are a reality. However, it can further the misconception that health providers who may have overlapping education or experience are simply interchangeable. To ensure that client needs are paramount, an effort to determine the appropriate utilization of a particular type of health provider needs to be fostered by the employer and the larger health care system. By integrating an understanding of RPN competencies within an interdisciplinary approach, we can target an integrated network of support for mental health care services. Educating health care providers and employers who work with RPNs on the role and competencies available with this essential resource will benefit clients by providing more appropriate health care services to clients who need access to mental health services. Assuring adequate mental health service requires, among other priorities, a competent and skilled mental health workforce. There was general consensus among members of the working group that addressing the stigma of mental illness, as well as the management of registered psychiatric nurses as a support to healthcare delivery is critical to adequately respond to client needs and current and emerging health human resource needs. In summary, RPNs are a valuable and essential resource to the health care system, in which focused support is needed for improved utilization, integration, and recruitment and retention of registered psychiatric nurses. 6 MANITOBA PSYCHIATRIC NURSING PLANNING GROUP Final Report

Future Directions Guided by the Terms of Reference, the first planning group meeting was held in a mental health service client environment at the offices of the Brandon RHA Mental Health Programs. This facilitated meeting provided an opportunity to highlight the spectrum of mental health services which enhanced the day s discussions. Following meetings were held in Winnipeg to further refine the work that began in Brandon. The Manitoba Psychiatric Nursing Planning Group identified a range of critical and key issues relating to the RPN workforce in Manitoba. It became apparent that many of these issues, while overlapping, had their own unique focus and were expressed in 24 recommendations. Six of these were viewed as outcomes, while 18 were seen as recommendations key to the mandate of the Planning Group. Three sub-working groups were established to address these identified recommendations. As a result of work undertaken during several group sessions, the following three targeted areas were identified by the planning group with the intent to develop recommendations within each area: Education Recruitment and Retention Employment and Profile EDUCATION Background: A Bachelor of Science in Psychiatric Nursing (BScPN) is offered at Brandon University (BU) at both its Brandon and Winnipeg sites. BU has offered Manitoba s psychiatric nursing program since 1995. To address concerns about psychiatric nurse staffing shortages, the number of BScPN seats was expanded from 50 to 60 seats in 1999/2000. A further expansion of 20 seats implemented over three years occurred in 2005/06 at the Winnipeg site, bringing the total to the current capacity of 75 seats 3. While the Winnipeg site is fully subscribed and the number of graduates is increasing in Winnipeg, enrollment in the BScPN program at the Brandon site has been variable. According to data collected by the Council on Post-Secondary Education (COPSE), the first year seat capacity at the Brandon site in 2000/01 was 35 and there were 33 students enrolled. However, despite a significant pool of applicants, first year enrollment progressively dropped from 40 to 28 from 2005/06 to 2009/10 4. Notably, enrollment trends appear to be shifting in a new direction with the implementation of a pre-health studies year (see recommended strategies below) which is intended to expose more students to the BScPN option. As well, an enhanced process of candidate selection is expected to optimize retention rates. COPSE approved a Master of Psychiatric Nursing in March 2010 and it is targeted to commence in January or September of 2011. Until this development, there were no Master s programs in psychiatric nursing in Canada specifically designed to meet the learning needs of Registered Psychiatric Nurses holding a baccalaureate degree in psychiatric nursing. Up to this point, the absence of graduate level prepared RPNs has undermined the potential for psychiatric nursing leadership in education, mental health and health services, administration and research. Graduate prepared RPNs will not only support the recruitment into psychiatric nursing and the retention of RPNs but will enhance the capacity, skills, and knowledge of the mental health workforce as a whole. 3. The 20 seat expansion at the Winnipeg site occurred over three years: there was an increase from 20 to 27 seats in 05/06; to 34 in 07/08; and to 40 in 08/09. Seat Capacity: Brandon (35); Winnipeg (40) = Total Seat Capacity (75). 4. Brandon seat capacity = 35. MANITOBA PSYCHIATRIC NURSING PLANNING GROUP Final Report 7

A. Promotion of RPN Education Rationale: The key to a sustainable supply of registered psychiatric nurses in Manitoba is a home-grown approach through the education programs. The initial psychiatric nursing education is offered by Brandon University at sites in Brandon and Winnipeg. Two other potential sources for entry into the BScPN program are a 2nd degree option and the delivery of an education program in northern Manitoba. The 2nd degree option would appeal to students who are committed to mental health care and it would permit for some articulation of their existing academic preparation to a BScPN. Regional education opportunities to meet the mental health human resources of northern Manitoba has been an identified need by several sources and is presumed will enhance the retention of health professionals in the north. Increasing the awareness about the existence of the RPN profession and career options to high school students is another means of promoting the education program. Current initiatives like student job shadowing by students, attendance at high school career fairs and distribution of information packages to guidance counselors need to be enhanced to raise awareness and attract students to the Registered Psychiatric Nursing profession. Recommended Strategies: 1. Health Studies applicant pool for candidates interested in a BScPN BU explore more diverse marketing strategies, such as: o Promote awareness of RPN option to health studies students on a waiting list at other educational institutions; o Offer information on the BScPN program to applicants in health-related programs which are oversubscribed. BU could dialogue with student advisors to achieve this. BU implement Year 1 as pre-health studies year to expose students to either BN or BScPN option, and to improve retention rates. o Update: This strategy has been implemented and BU has received over 100 applications from students currently in the pre-health studies year. 2. 2nd Degree Option BU continue to engage with stakeholders to promote the following decisions: o Identify target population most suited to an articulated study path; o Explore existing models for best practice to establish delivery model and development of new curriculum; 3. Feasibility of BScPN education in the north through a BU/UCN partnership ACC and BU continue to work to create an articulated pathway from LPN to RPN programming. UCN approach BU to create an articulated pathway from its LPN Post-Basic Certificate in Mental Health program to the BU BScPN. Explore the option of establishing a cohort-based model of an LPN RPN education program in the north. Continue to track viability of a home-grown education opportunities approach. 4. Promoting the RPN profession to high school and university students Raise profile by Regional Health Authority recruiters who attend high school sessions. Develop a targeted strategy to determine how and why students enter the profession. Identify and promote opportunities for volunteering and job shadowing. Further develop / utilize Web- based information, video, other PR material. 8 MANITOBA PSYCHIATRIC NURSING PLANNING GROUP Final Report

B. Graduate Level RPN Education Rationale: The Registered Psychiatric Nurses of Canada asserts that there is an urgent need for Registered Psychiatric Nurses (RPN) prepared at the Master s level to provide psychiatric nursing leadership in education, mental health and health services, administration, and research. Specifically, a Master s level education for RPNs would serve to prepare holders of a BScPN credential as faculty and thus offset pending vacancies created by anticipated retirements. Graduate level RPN education will open up the doors of opportunity for growth and development of the RPN profession, including a potential route to advanced practice roles, and is a key strategy to address many of the issues identified by the planning group. Recommended Strategies: Support a graduate program to ensure an adequate supply of faculty and expertise, contributing to the success of the undergraduate program. o Update: COPSE has approved the BU Master of Psychiatric Nursing. Resourcing is required to ensure the program is sustainable. RECRUITMENT AND RETENTION Background: As noted in the introduction, the supply of registered psychiatric nurses (RPNs) has declined over the years. In 1999, the CRPNM reported that there were 1,037 practicing RPNs in Manitoba. According to the 2009 active practising register, this number has fallen to 963. The struggle to maintain an RPN supply that is steady, strong, and sustainable has been highlighted over time. The CRPNM Annual Report 2009 indicates that the demographics of the current RPN workforce, while aging, is showing evidence of renewal: 44.6% of RPN s in Manitoba are 50 years of age or older. 42% of RPN s in Manitoba are between the ages of 45 and 54. Compared to 2007, in 2008 there was a slight increase of RPN s in the 55-59 year old age group. This may suggest that RPN s are staying in the workforce longer, although this trend may also be a short term reflection of the current restrained economic climate. 35% of Manitoba RPNs are 45 or younger; and, the 25-29 year old age group is stable and increasing. Compared to 2004, there are 59% more RPNs in the 25-29 year old age group in 2008. CRPNM and Manitoba Health s workforce data indicates that immigration, whether from foreign or Canadian sources, has not had any significant impact on the RPN supply for at least 25 years. Workforce capacity and education issues articulate with challenges relating to the employment and profile of RPNs. The slower uptake of seat capacity may be partly explained by the stigma of mental illness, as well as a general lack of awareness of the role and existence of the RPN profession. Furthermore, the geographic limits to the designation also effectively limit one s portability in Canada to the four western provinces, and may be another factor in attracting individuals to consider a career as an RPN. Moreover, the recruitment of RPNs has historically not been centralized nor coordinated between all stakeholders. A. RPN Recruitment Activities Rationale: Participation in recruitment efforts locally and internationally would raise awareness of the unique role of an RPN. Interest generated from these events would confirm to employers the existence of an eligible pool of RPNs, and prompt the recognition that designated RPN positions are achievable and necessary for quality mental health care services. A centralized approach for recruitment activities and materials will minimize duplicate efforts. MANITOBA PSYCHIATRIC NURSING PLANNING GROUP Final Report 9

Recommended Strategies: Stakeholders participate in international conferences such as the Royal College of Nursing Conferences as a means to recruit RPNs. CRPNM, Employers and NRRF communicate to remain informed of opportunities for RPN recruitment. The Compilation and development of materials for recruitment activities be achieved through the following efforts: o NRRF members and CRPNM communicate to ensure appropriate information is being provided by the NRRF at recruitment events. o CRPNM develop a contact database for organizations, including international agencies, linked and dedicated to RPNs. This contact database would also be a means to send a marketing package. Continue a targeted approach to recruit RPNs, including internationally educated RPNs (IERPNs) to Manitoba, through NRRF advertisements appearing in specific nursing classification publications. B. Retaining and Valuing Experienced RPNs Rationale While some RHAs deliver mental health services within a team approach, some RPNs are working independently, particularly in rural and remote areas in Manitoba. As a consequence, RPNs, including novice psychiatric nurses, are working in a practice environment with little opportunity for mentorship or succession planning while at the same time may be faced with the reality of an expanding professional role. The enhancement of experienced RPNs in the workforce would provide succession planning to psychiatric nursing positions and minimize new graduates working in isolation. Tapping into this expertise enhances retention, increases professional and job satisfaction, and improves client care. Recommended Strategies: Generate potential options around developing province-wide professional supports: o Develop a mechanism to match new RPNs with experienced RPNs; o Create a RPN network (Bulletin Board) as a means to find a mentor. C. RPN Student Consultation Rationale: The emerging workforce is one which is more mobile, has a different expectation with regard to work/life balance in which the need for flexible hours is high, has less loyalty to one employer for the rest of their career, and has a desire to include technology in their day-to-day activities. Exploring the perceptions and expectations of current BScPN students could inform stakeholders in terms of recruitment and retention strategies, staffing models, and health human resource planning in general. Recommended Strategies: The CRPNM sponsor a focus group (one site in Brandon, one site in Winnipeg) to better understand perceptions and expectations of future RPNs. D. Internationally Educated RPNs Rationale: The Pan-Canadian Framework for the assessment and recognition of foreign qualifications articulates a vision for governments to take action to improve the integration of immigrants in the Canadian labour market. A registration process for regulated professionals such as RPNs requires the existence of a fair, transparent, timely, and consistent pathway. Beyond a qualifications assessment, this may include access to reliable information and preparation supports, self-assessment tools, a prior learning and experience assessment (PLEA), as well as opportunities to receive additional training when required to meet Canadian standards. The Foreign Qualification Recognition (FQR) framework envisions 10 MANITOBA PSYCHIATRIC NURSING PLANNING GROUP Final Report

that individuals would be provided a clear decision from the regulatory body that directs them toward their appropriate pathway within a reasonable time frame. The assessment and recognition of prior learning and experience of international nurses is essential to the successful recruitment and integration of internationally educated RPNs (IERPN). The existing Brandon University recognition of prior learning process does not have the capacity nor a suitable clinical competency component to meet this need. While there are CRPNM-approved refresher programs in Canada, access to specific gap training courses are not readily available, nor are they tailored to the needs of an IERPN. Access to existing training programs and exploring the development of other professional preparation supports that articulate enhanced training with Canadian clinical and cultural realities would better integrate IERPNs into the workplace and enhance the quality of care provided. Lastly, a formalized process would afford better opportunities for CRPNM and employers to promote to the public their ability to review and process the applications of IERPNs. Recommended Strategies: Provide support for the establishment of an integration service for Internationally Educated Health Professionals, which would include a navigational capacity. This service could facilitate dialogue between stakeholders. Stakeholders continue to engage with relevant partners to synergize efforts and actions to achieve a clear pathway for registration of IERPNs, in alignment with the FQR framework. o Examples of future initiatives could include, among others, the development of a competency based self-assessment tool, achieving access to and/ or development of gap training courses / professional preparation course. EMPLOYMENT AND PROFILE Background: Over the past few decades, there have been significant changes to the mental health system design and service delivery models. An acknowledgment that mental health is an important part of the broader concept of health and wellness, as well as an emphasis on recovery and resiliency has inspired these changes. Despite these changes, considerable stigma exists towards both mental health clients and providers. This contributes to challenges in the recruitment and retention of a mental health workforce and the shortages in psychiatric nursing. Shortages in this specific health human resource prompts employers to deliver services by filling positions with health professionals who may have overlapping competencies with an RPN, but who may not have the full scope for optimal provision of care. This practice, albeit in an attempt to provide effective care, lends a false impression that the psychiatric nurse is interchangeable with other health workers. As noted throughout this report, employers are faced with many challenges with respect to workforce capacity issues and the delivery of healthcare services. For example, employers have acknowledged that acute, community, and long term care facilities would benefit from a greater presence of RPNs than currently exists. It is encouraging to note there is a growing attention by all stakeholders on exploring research, principles, resources, tools, and models relating to client care and workforce optimization. Hence, a focus on scope of practice, staff mix, and utilization may prompt efforts to improve the integration of RPNs in the practice environment. Furthermore, while global changes in this regard need to involve employers and front line staff, such changes must also be considered strategically at a system level and be resourced appropriately. MANITOBA PSYCHIATRIC NURSING PLANNING GROUP Final Report 11

A. RPN Positions Rationale: Decisions about matching the right professional with the client are determined by various factors such as complexity of client care, predictability, and risk of negative outcomes in response to care. As such, mental health services should be delivered by trained professionals with a recognized mental health education. Employment postings anecdotally inform the public of a perceived need for the profession. A general broadening of accepted qualifications mutes the unique role and contribution of a particular qualification (e.g., RPN, RN, BA (Psych), BSW). Employers have the ability to demonstrate the unique value of a RPN to their organization and the obligation to employ them through dedicated RPN positions. While real challenges might exist to fill the proposed dedicated positions, this report presents options to work towards achieving a more appropriate utilization of RPNs in the practice setting. As noted above, employers have indicated that acute, community, and long term care (LTC) facilities require a stronger RPN presence. For example, LTC facilities are experiencing a higher number of residents with existing mental health concerns with or without the addition of dementia. As such, a targeted approach at both the educational and employment level to recruit RPNs to LTC should be considered. Recommended Strategies: Encourage employers to explore psychiatric nurse human resource models that are based on the complexity of mental health needs of the client population. o For example, employers dedicate psychiatric nursing positions, staffed by RPNs, in the community for high need, complex populations. o Change designation to Inpatient Psychiatric Nurse II rather than Staff Nurse or General Duty Nurse and Community Psychiatric Nurse rather than Community Mental Health Worker. CRPNM prepare a position statement to HPSEN, Provincial HR Council, and other employer tables to inform and advance the unique value and role of an RPN in their organization(s). B. Public Promotion of the Role of RPNs in the Delivery of Mental Health Services Rationale: There is still a lack of awareness of the role and existence of the RPN profession, particularly outside of western Canada. Public campaigns can be an effective way to promote the importance of mental health with regard to quality of life, as well as provide information around the professional profile of the RPN. They can also target service delivery issues. For example, as part of the Personal Care Home (PCH) Staffing Initiative that began in 2007, a media campaign was developed to encourage nurses, including RPNs, to work in PCHs and counter the negative image often associated with working in long term care 5. As such, while raising awareness on the role of RPNs, a public campaign could also be an effective way to address the stigma that clients encounter within the broader health care system and by society. Recommended Strategies: Develop communication tools and strategies that can be adapted to different needs and audiences. Communicate information in particular to professional associations and employer groups (HR, CEOs, etc). Give consideration to a CRPNM-sponsored public campaign, similar to the hand washing media campaign done by the College of Registered Nurses. 5. The new Personal Care Home (PCH) Staffing Guidelines for Manitoba were announced by the Minister of Health on November 29, 2007. As part of the announcement, the Province committed to several new initiatives to be implemented over the following four years including the hiring of additional staff consisting of registered nurses, registered psychiatric nurses, licensed practical nurses, health care aides, and allied health care providers. 12 MANITOBA PSYCHIATRIC NURSING PLANNING GROUP Final Report

Summary Psychiatric nursing resources are showing signs of renewal. Strengthening the capacity of the mental health service system requires a workforce strategy that builds and supports an effective and dynamic mental health workforce in Manitoba one that is consistent with the goals of the Mental Health Strategic Plan which will be released in the near future. A strong mental health workforce is one of many solutions necessary to generate appropriate mental health services, as well as to address the stigma associated with mental illness. In the goal to support the provision of high quality care within the context of changing realities, effective workforce strategies would serve to: engage appropriately trained health care workers to increase the supply of needed health professionals; revitalize the current and future health human resource planning by increasing interest in health careers in specific areas of shortage; reflect the population health needs; and optimize the appropriate utilization and distribution of health care professionals. The recommendations presented in this report are intended to address the challenges in psychiatric nursing resources and to support employers, professional organizations, educational institutions and government bodies in responding to changes in health care realities. It acknowledges that a mental health strategy is a distinct and integral part of a broader health strategy and corresponding health human resource planning. As key members of the mental health workforce, Registered Psychiatric Nurses have a unique contribution and set of competencies to help meet the needs of Manitoba s health care system and ultimately strengthening the capacity and resiliency of the mental health service system. MANITOBA PSYCHIATRIC NURSING PLANNING GROUP Final Report 13

Appendix 1: Terms of Reference Terms of Reference Manitoba Psychiatric Nursing Planning Group Purpose: To develop strategies to address the provincial psychiatric nursing resources within the context of mental health services in Manitoba. Mandate: 1. Support and participate in the development of realistic recommendations for short-term, medium-term, and longterm psychiatric nursing resource planning in Manitoba. 2. Act as a forum to provide analysis on psychiatric nursing resource matters including but not limited to supply and demand, and education in the context of mental health services in Manitoba. 3. Participate in the development of strategies to improve the supply and utilization of psychiatric nursing resources. 4. Provide recommendations to assist with the development of strategies to improve the recruitment and retention of psychiatric nurses, including educational strategies. 5. Consult with psychiatric nursing and other stakeholders as required. 6. Provide a report to the Ministers of Health and Healthy Living, and Advanced Education and Literacy, and the Board of the College of Registered Psychiatric Nurses of Manitoba upon completion of the work of the Psychiatric Nursing Planning Group. Composition: Manitoba Health (a rep to act as Chair) College of Registered Psychiatric Nurses Council on Post-Secondary Education Brandon University Selkirk Mental Health Centre RHA representation (urban, northern and rural) Consumer representation Family representation Administrative support to be provided by Manitoba Health and Healthy Living Term: June 23, 2008 to June 30, 2010 Frequency of Meetings: At the call of the Chair and as required 14 MANITOBA PSYCHIATRIC NURSING PLANNING GROUP Final Report

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