OCHU

BRIEFING NOTE (for information)

For: OCHU RPN Committee, OCHU and CUPE Ontario RPN’s, OCHU Executive,
Gwen Hewitt, Margaret Evans, Doug Allan

C.C Anthony Pizzino, Irene Jansen

TOPIC
College of Nurses of Ontario (CNO), RPN Research & News Stories: Spring 2007 Update
College of Nurses of Ontario (CNO)

BACKGROUND:
Through the Regulated Health Professions Act, the College of Nurses of Ontario (CNO) sets competency requirements for registration purposes. Every Ontario RPN must be registered with the CNO in order to use the title “registered practical nurse”. Competency is tested through two means: (A) self-test or self-assessment, and by
(B) the College itself.

(A) The College issues information on self-assessment, “quality assurance” or reflective practice. In summary all these terms mean:

1. Complete a self-assessment.
2. Obtain peer feedback.
3. Create a learning plan.
4. Implement the learning plan.
5. Evaluate the learning and application of knowledge in practice.

As part of the Annual Membership Renewal each year, each RPN must sign the Reflective Practice Declaration, which means that all five steps have been completed.

(B) The College reviews 400 nurses randomly each year. This is called a Practice Review and includes a written test. If the test is not passed, nurses go through an interview process and possible steps to address any issues identified in the test or interview. Employers are not able to refer nurses for this review. Practice review results are not available outside of the CNO. For more information:

Click on
http://www.cno.org/docs/qa/44026_fsPracRev.pdf.

UPDATE:

New Competency Review Tool (2007)

This new document helps RPNs do a written self-test or self-assessment. This is particularly important in case of a College audit or Practice Review. It is comprised of five areas: professional behaviour/ethics; critical thinking, research and leadership; client and nurse safety/illness and injury prevention; relationships/caring; and clinical skills. There is also an evaluation of the document that you can return to the College anonymously. The document replaces the 1996 Self-Assessment Tool.

Click on
www.cno.org/docs/qa/44028_CRT.pdf for an electronic copy.

The CNO is also developing a web-based program for assessment purposes. The College suspended the Practice Review in 2007 while their new assessment is being developed. For more information,

Click on page 22 of December 2006’s The Standard at http://www.cno.org/pubs/mag/TSMvol31no4.pdf.


“Delegation” for Ontario Nurses: CNO Proposed Regulation Revision (January 2007)

The CNO has proposed that the regulation on “delegation” be changed. It is soliciting feedback to its proposed changes until May 23, 2007. The CNO explains that the reasons for their proposed changes are due to the “rapid evolution of health care environments and the enactment of regulations allowing RPNs to initiate controlled acts”.

The proposed changes are mainly about nurses’ delegation record-keeping. They propose that nurses now place a copy of the delegation in the client record or ensure that a written copy of the delegation exists within the organization. Previously, the regulation read that the delegation could be in the client record only. The CNO proposal seems a welcome change for CUPE/OCHU RPNs.

Click on
http://www.cno.org/for/rnec/pdf/PoropDelegationRegsR1284CD.pdf for an electronic copy of the CNO proposal.


Nursing Utilization CNO Teleconference (February 14, 2007)

There may be a new trend regarding the importance of RPN work at the CNO. There was a teleconference on the utilization of RNs and RPNs earlier this year. The documents discussed were not new.

For a copy of the slides used for the teleconference:

Click on
http://www.cno.org/prac/learn/teleconferences/utilization/pdf/02_14-Slides.pdf.

Click on
http://www.cno.org/prac/learn/teleconferences/utilization/index.htm for an outline of the teleconference itself.

For more updates from the College of Nurses, click on www.cno.org.

Selected RPN Research

BACKGROUND:

The Nursing Health Services Research Unit (NHSRU) is based at both the University
of Toronto and Hamilton’s McMaster University. The unit is funded through the Ontario government. Formed in 1990, the unit conducts research about the effectiveness, quality, equity, utilization and efficiency of health care and health care services in Ontario with a focus on nursing. For more information, click on www.nhsru.com.

The Canadian Institute for Health Information (CIHI) is an “arms-length” government institute formed in 1994 by Canada’s health ministers. It reports on health care services, health spending, health human resources and population health. It has a 16-member board comprised of federal, provincial and territorial government representatives, and university and hospital administrators. It is entirely funded by government funding through the institutions and departments that are represented on the board.

For more information:
Click on www.cihi.ca.

UPDATE:

Nursing Health Services Research Unit’s (NHSRU) Rural Ontario Nursing Workforce Study (November 2006)

In November 2006, the NHSRU released a research report about nursing in rural Ontario. It focused on the Ontario rural area of Local Health Integrated Network (LHIN) 2 (South West LHIN) and was commissioned by the Ontario Ministry of Health and Long-term Care. The entire name of the study is The New Healthcare Worker: Implications of Changing Employment Patterns in Rural and Community Hospitals.

The timing of the study, the title of their fact sheet – “Rural Nursing Workforce: How sustainable is it?” and the overall tone of the report, may beg the question `why the focus on rural hospital nursing now?’ This is particularly important as it relates to our possible future and current struggles against hospital closures and downsizing especially in rural areas.

The relevant main results of the report about rural LHIN 2 are:

• there are a high number of part-time nurses;
• nurses experience stress due to fluctuation in the number of patients;
• stress is caused by an unpredictable call-in system; being sent home if there are not enough patients; working more than one part-time job; some part-time nurses working full-time hours without full-time benefits;
• some full-time nurses work overtime (since some part-time staff don’t want more hours);
• and “Among nurses who left the system 2002-2004, 70% resigned while 30% retired”.

Recommendations include:

• more nurse training (to work with different patient groups);
• hospitals using a better system to predict patient numbers;
• more full-time nurses to work in more than one site;
• co-op programs and bursaries for rural high school students to attract them into nursing;
• properly funded, standardized rural education/training;
• longer orientation and mentoring programs;
• standardized security measures;
• and, evaluation and action on nurses’ security concerns.

Click on http://www.nhsru.com/factsheets/Rural%20Nursing%20Workforce%202%20of%202.pdf for an electronic copy.


Canadian Institute for Health Information’s (CIHI) Regulated Nursing Workforce in Canada 2005 study (October 2006)

In October 2006, CIHI released its “Regulated Nursing Workforce in Canada,
2005” study. The study includes RNs, RPNs (listed as LPNs in this study) and Registered Psychiatric Nurses. A specific study on each classification was also released. The “Workforce Trends of Licensed Practical Nurses in Canada,
2005” is useful. Main points include:

• casual rates of RPNs in Ontario are the lowest in the country;
• fewer Ontario RPNs work in hospitals (45.9%) than the Canadian average
of 46.4%;
• more Ontario RPNs worked for a single employer (89.3%) compared to the Canadian average of 84.3% (10.7% of Ontario RPNs worked for multiple employers);
• part-time and casual rates in the country have increased since 2003;
• most practical nurses in Canada work in geriatrics/long-term care.

Click on
http://secure.cihi.ca/cihiweb/products/ndb_workforce_trends_licensed_practical_nurses_canada_2005_e.pdf for the full report.


Selected RPN News Stories

New relevant Ontario RPN news stories are as follows:

*”Hospital approves cutbacks” by Carol Martin, SooToday.com, February 17, 2007: This story quotes the CEO of the Sault Area Hospital (SAH) (Ron Gagnon) who argues that there is a trend in Ontario of RPNs replacing RNs in palliative care and that SAH would be vulnerable to the pending RN shortage if it didn’t follow this trend. Sharon Kirkpatrick, SAH senior vice president and chief nursing officer, agrees.

Click on
http://www.sootoday.com/content/news/full_story.asp?StoryNumber=22741
for the full story.

*”Nurse project in hospital ER”, Chatham Daily News, June 14, 2006: This story reports on the Chatham campus emergency department who has implemented a six-month pilot project with a triage-support RPN. The RPN will provide a “visual assessment, triage patients using provincial guidelines and perform reassessments for those awaiting care”. To buy the archived story:

Click on
http://www.chathamdailynews.ca, or contact hfarrow@cupe.ca.


TRANSMITTAL INFORMATION

Heather Farrow
Research Assistant
613-237-1590, ext. 320
hfarrow@cupe.ca

March 28, 2007




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April 5, 2007