SRNA Winter NewsBulletin 2012

Volume 14, Number 1, wiNter 2012

SaSkatchewan RegiSteRed nuRSeS’ aSSociation

Competent, caring, knowledge-based registered nursing for the people of Saskatchewan

Julie Levasseur4th Year NEPS student p.20

DocumentationPart of the Role

Documentation • Francophone Special Interest Group • Cosmetic Procedures Advocacy • Health Quality Council • Annual Meeting & Conference

Interviews, Research and More!

The Saskatchewan Registered Nurses’ Association

The Saskatchewan Registered Nurses’ Association (SRNA) is a professional licensing body established in 1917 by the Registered Nurses Act of the provincial legislature. Its purpose is to set standards of education and practice for the nursing profession, and to license and support nurses as RNs to ensure the puclic receives quality nursing care.

The SRNA Newsbulletin is published four times a year by the SRNA. Its purpose is to inform RNs about the Association’s activities, provide a forum for discussion and information of topical interest. Inclusion of items in the SRNA Newsbulletin does not imply endorsement or approval by the SRNA. A subscription is $21.40 per year, outside Canada, $30.00 per year.

ISSN 1494-76668

Managing Editor: Shelley SvedahlE-mail: [email protected]

The SRNA office is located at 2066 Retallack Street, Regina, SK S4T 7X5Phone: 306-359-4200 FAX: 306-359-0257Toll Free: 1-800-667-9945E-mail: [email protected] Website: www.srna.org

SRNA COUNCILPresident: Kandice Hennenfent, RN 306-694-3949President-Elect: Signy Klebeck, RN 306-659-4289Members-at-LargeJeannie Coe, RN(NP) 306-425-2174 (Ext. 3)Sherry Culham, RN 306-766-8484Robin Evans, RN 306-337-8483Janice Giroux, RN 306-842-8652Noreen Reed, RN 306-747-2603Mark Tarry, RN(NP) 306-554-3363Sandra Weseen, RN 306-752-1781Public RepresentativesKaren Gibbons 306-729-4306James Leach 306-244-4800Heather McAvoy 306-652-5442Executive DirectorKaren Eisler, RN 306-359-4200

Copy and Ad Deadlines:November 15 for Winter; February 10 for Spring; May 15 for Summer; and August 15 for Fall. The complete rate sheet is available online at: http://www.srna.org/images/stories/srna_2012_nb_ad_rates.pdf

To place advertising in the SRNA Newsbulletin please contact the SRNA at: [email protected]

Toll Free: 1-800-667-9945

winter Vol.14 n0. 1

Executive Director’s Message 3

iNterView Inspiration, Rose-coloured Glasses and Leadership 4

SRNA Council Highlights 6

ASK A PrACtiCe ADViSor Working with Unregulated Care Providers 8

CoNNeCtioNS Workplace Representative Educators 10

Continuing Competence 11

Diversity in Advanced Practice: Boundless Horizons 12

Advocacy and Practice Update 14

SRNA Regional Workshops 17

Optimizing the Role of the Registered Nurse 18

The Forces of Leadership in Patient and Family-centred Care 20

Documentation: Guidelines for Registered Nurses 21

etHiCS CorNer Documentation: An Ethical Consideration 22

iNterView Just Do It! An interview with marlene Smadu, rN 24

HeAltH QuAlitY CouNCil Nurse Practitioner Quarterbacking Care... 28

Surgical Checklist Improves Safety 30

What is a Registered Nurse? 32

Cosmetic Procedures 36

Annual Meeting & Conference 2012 38

SRNA Directory 41

Upcoming Events 43

Contents

2 SrnA newsBulletin winter 2012

On the Cover: Julie Lavasseur, 4th year NEPS student. See full article on page 20.

mailto:[email protected]


http://www.srna.org

http://www.srna.org/


First paragraph first paragraph first paragraph first paragraph first paragraph first paragraph

first paragraph first paragraph first paragraph first paragraph.Indent paragraph indent paragraph indent paragraph indent paragraph indent paragraph indent paragraph indent paragraph

De partm e nts

Head 1

by barb Fitz-Gerald, rN Nursing Advisor, member relations

Primary Health Care is a Collective Responsibility

Primary Health Care (PHC) was defined by the World Health Organization (WHO) in

1978 as “essential health care; based on practical, scientifically sound, and socially acceptable method and technology; universally accessible to all in the community through their full participation; at an affordable cost; and geared toward self-reliance and self-determination.” This noble definition is over thirty years old and we have yet to realize this vision in Canada, let alone the world.

To achieve Primary Health Care we need to focus on individuals and communities and maximize their involvement in their health care. We must transform the health system by working through an interdisciplinary approach that involves all stakeholders; individuals, communities, health care practitioners, decision-makers and policy makers.

The document, Enhancing Interdisciplinary Collaboration in Primary Health Care in Canada (EICP), was developed by Canadian organizations and released in 2005. It describes the principles and framework involved for Interdisciplinary Collaboration in

PHC. Interdisciplinary is defined as a deep degree of collaboration among team members, where individuals share their knowledge and expertise to develop solutions to complex problems to meet client’s needs. This collaboration is based on openness, trust and flexibility to

look at solutions. The composition of the teams may vary, but they will always center on the needs of the individual or community.

The EICP document outlined the following goals for interdisciplinary collaboration in

primary health care:• A client-care focus that encourages

patients/clients and communities to assume more responsibility for health;

• A multi-faceted approach that ensures quality of care and builds on existing strengths and evidence;

• Structures which facilitate teams learning new ways of working together in a trusting environment; and

• A clear flexible structure that promotes enhancedcommunication and respect for the role of personal judgment and encourages each team member to bring his/her skills to bear. (p. 16)

exec ut ive Di r ector’s r e port

As leaders in the health care system Saskatchewan RNs and RN(NP)s can incorporate these principles into their nursing practice each day. Together we can transform the health care system.

Karen Eisler, RNExecutive Director, SRNA

We must transform the health system

by working through an interdisciplinary

approach that involves all stakeholders...

Reference:enhancing interdisciplinary Collaboration in Primary Health Care. (2005). the principles and framework for interdisciplinary collaboration in primary health care. ottawa: Author.

SrnA newsBulletin winter 2012 3

Inspiration, Rose-coloured Glasses and LeadershipAn Interview with SRNA President Kandy Hennenfent, RN.

Icaught up with Kandy after she chaired an intense day and a half of SRNA Council meetings at the

SRNA. I watched as she maneuvered the dialogue to ensure the voice of all Council members was heard. She has an easy air of confidence, a magnetic smile and takes great care in listening and connecting with her Council colleagues and invited guests. I was impressed with her enthusiasm and focus.

Kandy explains with pride that “the profession chose me.” She is currently a Nurse Educator teaching clinical at the Moose Jaw Union Hospital. She admits that her favourite part of her job is “telling my stories” and that her goal is to “instill excitement about nursing to

her students and colleagues.” Her nursing journey started as a certified nursing assistant in 1975 and there was no looking back. She received her Diploma in Nursing then worked in acute surgery, medicine, intensive care, Victoria Order of Nurses (VON), home care then management. She also continued learning and received a Certificate in Health Care Administration and a Masters of Leadership.

She is admittedly a positive person. She explains that “not a day has gone by when I do not want to go to work.” She says people have chastised her for wearing ‘rose-coloured glasses’. Her response: “I like my rose-coloured glasses. Why not? Life is hard enough already.”

1 What and who inspired you to take on this leadership role with the SRNA?

I don’t think it was any one person who inspired me. I have been fortunate to have many mentors and the strong support of my family over the years, but I truly think it is my passion for the nursing profession that led me here. I remember vividly my desire to become involved with the SRNA when I became a RN.

2 What is the difference between the role of the Executive Director and the President of the SRNA?

The role of the Executive Director is to handle the operations of the organization, basically to connect governance and management. The Executive Director is the only direct employee of Council. The role of the President is to chair Council meetings, establish ENDs with Council members and ensure the business of the SRNA is managed appropriately through policy governance.

by Susan Smith brazill Director, Communications and Corporate Services

Kandice Hennenfent, rN, SrNA President



I maintain my courage, hope and

inspiration as a result of the love and passion

for this profession.

3 What are the most important decisions you will make as President of the SRNA?

I think one of the main responsibilities, as President is to ensure the organization is future focused and moving toward the established ENDs.

4 RNs and the public they serve are facing a lot of pressures. How do you maintain and encourage hope and inspiration?

I maintain my courage, hope and inspiration as a result of the love and passion for this profession. I have a wonderful, fulfilling career as a nurse and I often feel that I did not choose this profession but that the profession chose me.

5 How do you encourage creative and strategic policy thinking within SRNA’s professional self-regulatory mandate?

We are privileged to be part of a self-regulatory body and to have the opportunity to set policy moving in the direction that we feel this organization and province needs to move in. We have the decision-making strategic planning power to manage our own profession.

6 What is one characteristic that you believe every leader should possess?

It is difficult to think of one characteristic that a leader needs to possess. I think a leader needs to be able to set a vision and to motivate. Also, valuing your colleagues in the work place goes a long way. I asked my students about this question and they added three characteristics: confidence, communicating and listening. A quote from John Maxwell “A leader is one who knows the way, goes the way, shows the way” sums it up.

7 What is the biggest challenge facing the nursing profession and regulation in Saskatchewan today?

One of the biggest challenges facing the nursing profession is the perception that RNs can be replaced by a different profession and that other professions can do the same job adequately and safely. RNs are the caregivers 24/7. It is the RN that sustains health care in the province.

8 What advice would you give

to our RNs in taking a leadership role in transforming health?

RNs are leaders in health care and need to play a pivotal role in transforming health care. RNs are at the core of care and we need to be at the table when decisions are being made about health in all areas.

9 How does the SRNA involve the public in defining its strategic direction?

There are three government-appointed public representatives on Council to ensure the public voice is heard. Council has also created a Public linkages Committee to meet with groups to get feedback on health care and nursing.

10 What three words would you choose as the guiding pillars for the nursing profession in the next year?

I think the three words I would choose as guiding pillars for the nursing profession are captured in the mission of the SRNA.

Compassionate, caring, knowledge-based.

from the SRNA Staff and Council.We wish you

all the best in 2012!During the holiday season our office will be closed at noon on

December 23, 2011 until January 3, 2012.

srna cou nc i l Hig H l ig Htsby Signy Klebeck, rN, SrNA President-elect

2011 SRNA CouncilFront (left to right): Signy Klebeck, rN; Kandice Hennenfent, rN; mark tarry, rN(NP)Back Row (left to right): Noreen reed, rN; James leach, Public representative; Karen eisler, rN; Sherry Culham, rN; robin evans, rN; Janice Giroux, rN; Karen Gibbons, Public representa-tive; Jeannie Coe, rN(NP); Heather mcAvoy, Public representativeMissing: Sandra weseen, rN

in collaboration with each other in the future.

Council engaged in a discussion regarding the SRNA project “Optimizing the role of the RN in Saskatchewan.” The RN(C) will have a collaborative role within a team of a physician and RN(NP). SRNA Bylaws Standards and Clinical Competencies along with Clinical Precision Tools will be available to direct the RN(C)’s practice to ensure that the people of Saskatchewan receive competent,


SRNA staff presented the Environmental Scan. Council reviewed, modified and monitored the SRNA’s Vision, Mission and Ends ensuring that they incorporated the results of the scan.

Representatives from the Saskatchewan College of Paramedics council and staff met with council and provided a brief overview of their regulatory association. Information was shared about each of our professions with a focus on working

The SRNA is governed by an elected Council consisting of a President, President-elect and seven Members-at-large. Three public Representatives are appointed by the provincial government. The SRNA

Executive Director serves as an Ex-Officio member of Council. The council meets five times a year to review and monitor progress on achievement of goals. In addition to the regular policy approaches, the following provides a brief synopsis of major items approved and discussed at the Council Retreat August 30th, 31st, September 1st, and the meeting November 9th and 10th, 2011.

caring, knowledge-based nursing care. Educational programs for the RN(C) will be approved by the SRNA.

Angela Weber, RN, Associate Clinical Director at the Regional Psychiatric Centre, spoke to council about Nursing with the Correctional Service of Canada. She identified that the Correctional and Forensic Nurse roles are different. Correctional nursing has a significant role within society. Correctional Services of Canada offers a variety of nursing career opportunities for the RN.

Council met with nursing students from the Regina Nursing Student Society (RNSS) and the Saskatoon Nursing Student Society (SNSS). A stimulating discussion occurred involving various topics such as: Canadian Nursing Students’ Association National Conference in Saskatoon, Overcoming Challenges, Harmonizing our Voices, January 2012; Nursing Leadership Conference in Saskatoon, Courage to Lead - Transforming Health Care, March 2012, SRNA AGM May 2012; and technology in nursing, its advantages and challenges. It is always refreshing to hear and feel the passion and enthusiasm of our future RNs.

7 6 SrnA newsBulletin winter 2012

Registered Nurses as partners in an informed healthy society

Competent, caring, knowledge-based registered nursing for the people of Saskatchewan

The Saskatchewan Registered Nurses’ Association exists so that:

There is profession-led regulation ensuring accountability and professionalism in the public interest.1.1. Competent and ethical RN and RN(NP) practice in present and future roles and practice settings.

1.2. RNs and RN(NP)s influence practice environments for improved health outcomes.1.2.1. RNs and RN(NP)s develop evidence-informed practices.1.2.2. RNs and RN(NP)s use evidence-informed practice.

1.3. All RNs and RN(NP)s provide leadership for excellence, empowerment and professionalism in nursing.1.3.1. Individual RNs and RN(NP)s consistently use their first and last name and title for

identification to the public.

1.4. There is a just, timely, transparent, effective process, of which the public is aware, to address a concern regarding the practice of a RN or RN(NP).

RNs and RN(NP)s provide individual and family-centred, ethical, compassionate care for the public. 2.1. RNs and RN(NP)s provide respectful care to culturally diverse and/or vulnerable populations.

2.2. RNs and RN(NP)s work in partnership with individuals and/or populations in helping them make informed decisions about their health and well-being.

The nursing profession contributes collaboratively to a proactive health system that meets the present and emerging health needs of the public.3.1. RNs and RN(NP)s participate in life-long learning.

3.2. Health human resource planning results in sufficient numbers and diversity of RNs and RN(NP)s to meet present and emerging health needs in Saskatchewan.3.2.1. The Baccalaureate nursing degree is the minimum education level for entry as a RN.3.2.2. The Masters nursing degree will be the minimum education level for entry as a RN(NP).

3.3. Public policy makers have compelling evidence to make them aware of the potential health impact of their decisions.

3.4. RNs and RN(NP)s have and use skills to lead change for a quality health system.

Public policy makers have compelling evidence of the value of a health system that is universal, accessible, publicly administered, comprehensive, portable and accountable and the value of primary health care.

VISION

MISSION

In the Public InterestThe SRNA is the professional self-regulatory body for the province’s RNs and RN(NP)s. The Registered Nurses Act (1988) describes the SRNA’s mandate in setting standards of education and practice for the profession and registering nurses to ensure competent, caring knowledge-based care for the people of Saskatchewan. The SRNA is responsible ensuring continuing competence, professional conduct, standards of practice, a code of ethics and the approval of education programs.

These Ends are in order of priority.(Effective January, 2012)

What is my responsibility and accountability as an RN working with Unregulated Care Providers (UCPs)?

1 UCPs can provide auxiliary nursing services or services

provided in a person’s home in accordance with The Registered Nurses Act, 1988. UCPs have a variety of job titles depending on their job description i.e., home health aides, special care aides, continuing care assistants and personal care home workers. UCPs do not have a scope of practice, are not regulated and have a variance in educational preparation. Some may have taken formal educational courses (e.g. through Saskatchewan Institute of Applied Science and Technology [SIAST] or other) and others may have received on the job training from the employer.

2 Registered Nursing is a regulated profession and RNs

have the required education and legislated scope of practice to perform and coordinate health care services including but not limited to observing and assessing the health status of clients and planning, implementing and evaluating nursing care (Government of Saskatchewan, 1988). It is within the scope of the RN to delegate ‘a task’ if appropriate and in the interest of the client, however the RN remains responsible and accountable for the nursing process.


Registered Nurses who work with UCPs must be knowledgeable of the RNs

accountability, roles and responsibilities and those of the UCP.

The following are questions you will need to consider:

1 who are uCPs and what is their role?

2 what is my responsibility and accountability as the rN?

3 what is assignment and what is delegation?

4 what needs to be assessed before delegation takes place?

5 How does delegation fit with medication assistance versus medication administration and what is the difference?

Delegation must be determined to be in the client’s best interests and must be within agency

policy and within the job description of the UCP.

by terri belcourt, rN, Nursing Advisor, Practice and Suzanne Downie, rN, Director, of Nursing Practice

ASK A PrACtiCe ADViSor

In summary, a collaborative working relationship between regulated and unregulated care providers is essential in ensuring safe client care. The RN must be knowledgeable of the level of education and competence of all members of the health care team to ensure proper assignment and delegation of care for the safety of a client. When delegating, the RN is accountable for ensuring that he/she is delegating appropriately one task, for one client, to one UCP.

For further information/documents see our website www.srna.org or contact a Practice Advisor at [email protected]

5 “Administration of” and “assisting with” medications

are two different responsibilities. RNs can only delegate the assistance part of the medication administration process. UCPs do not have the knowledge, skills or judgment to administer medications.

Administering medications is the responsibility of the RN and involves the whole nursing process. It begins with the RN assessing for the appropriateness of the medication, knowing the actions, interactions, side effects, usual dosage, route and approved use, basic pharmacokinetics of the drug and the client’s response to it. Competent medication administration also includes preparing the medication according to directions, monitoring the client while administering the medication, appropriately intervening as necessary, evaluating the outcome of the medication on the client’s health status and documenting the process (SRNA, 2007).

Assisting with medications involves the technical task only. The RN may delegate this task. With additional training the UCP can be effective in assisting the client with his/her medications; however the RN retains the accountability for all aspects of the administration of the medication. For example, the UCP may be taught tasks on how to safely assist a cognitively aware client with his/her medications. UCPs may assist with medications by reminding or supporting the client to physically take their medication (for example opening blister packs or dosettes). Only the task of assisting the client with medication can be delegated to the UCP.

3 Often used interchangeably, assignment and delegation

have different meanings:Assignment of client care is a decision regarding the most appropriate care provider for the provision of a client’s care. Each care provider is responsible for providing competent care to the client and remains accountable to the RN who assigned the care. (SRNA, 2004). One example would be the RN assigning personal care for a resident to an UCP.

Delegation is the transfer of responsibility from a RN to a UCP for completion of a task. The delegating RN is accountable for ensuring that the UCP has the knowledge and sufficient training and practice to competently complete the task. The RN is accountable for the overall assessment, care planning, intervention and care evaluation. The nursing process is an RN accountability and cannot be delegated (SRNA, 2004). When delegation occurs it is by one RN to one UCP, one task, for one client.

4 The decision about whether or not to delegate is complex and

is the responsibility of the RN working with the UCP. Delegation must be determined to be in the client’s best interests and must be within agency policy and within the job description of the UCP. The RN assessment of the acuity, stability, complexity or predictability of the client’s condition, and the environment in which the client lives is paramount in the RN’s decision to delegate. The RN may decide not to delegate based on their assessment and should be supported through employer policy.

References

government of Saskatchewan. (1988). The Registered Nurses Act. Regina, Sk: author.

Saskatchewan Registered nurses’ association (SRna). (2007). Medication Administration: Guidelines for Registered Nurses. Regina, Sk: author.

Saskatchewan Registered nurses’ association (SRna). (2004). The practice of nursing: RN assignment & delegation. Regina, Sk: author.

SrnA newsBulletin winter 2012 9 SrnA newsBulletin winter 2012 9

http://www.srna.org


E ight Workplace Representative Educators participating in the SRNA Pilot Project

taking place from September 2011 to December 2012 are successfully presenting the CNA Code of Ethics and/or SRNA Continuing Competence Program to RNs and RN(NP)s in their workplaces. Comments from the participants include: improved confidence with doing their continuing competence program, feeling secure with education in a relaxed atmosphere, and enjoying the small group learning setting. They

by barb Fitz-Gerald, rN, Nursing Advisor, Practice

con n ect ion s

have described the Educators as being knowledgeable and professional in their role.

From the Educators perspective the smaller sessions are generating much discussion among the participants regarding the Continuing Competence Program including peer feedback and the audit process. Participants are repeatedly saying that their understanding of the continuing competence program is improving. This resounding success has led to the development of new presentations on medication


Workplace Rep Educators (left to right)Frank Suchorab, rN (Prince Albert Parkland Health region); lynne Farthing, rN, (Prince Albert Parkland Health region); Jill eylofson, rN, (Heartland Health region); Janette egland, rN (Cypress Health region); barb Fitz-Gerald, rN (SrNA Project liaison); Patricia maclean, rN (Saskatoon Health region); Patti leblanc, rN (regina Qu’Appelle Health region); Jennifer Guzak, rN (Saskatoon Health region); Missing Kathleen tomporowski, rN (Prairie North Health region)

“Highly satisfied!” These words describe the preliminary feedback coming from RNs and RN(NP)s who attended one of the educational workshops provided by the SRNA Workplace Representative Educators.

administration and documentation guidelines which will be added to the list of available presentation topics in the new year.

Also in 2012 there will be a call for additional Workplace Representative Educators to fill vacancies in health regions presently without an Educator. If you are interested in becoming a Workplace Representative Educator or want a presentation in your workplace contact Barb Fitz-Gerald RN, Nursing Advisor, Practice at [email protected] or Suzanne Downie RN, Director of Nursing Practice at [email protected].



SRNA Continuing Competence Review Committee

T he SRNA has struck an Ad Hoc Committee to review the SRNA Continuing

Competence Program. The committee met in March and October 2011 and plan to meet by teleconference and in person in the future. The purpose of the committee is to:

• Evaluate the content and processes including the SRNA Bylaws of the SRNA Continuing Competency Program.

• Make recommendations to SRNA staff regarding implementation of the content and processes including the SRNA Bylaws for the future Continuing Competence Program.

• Make recommendations to SRNA staff regarding the implementation of the content and processes for the SRNA Continuous Quality Registered Nursing Practice Program.

To complete its work the committee plans to review the current continuing competence practices of other nursing jurisdictions, and selected health and other professions. Members will be consulted during the process to provide feedback on the program.

Timelines for the review will be announced at a later date. Watch for additional information on the review in the upcoming SRNA Newsbulletin. For information on the review please contact Cheryl Hamilton RN, Deputy Registrar at [email protected] or Barb Fitz-Gerald RN, Nursing Advisor at [email protected].

conti n u i ng com p e te nc e

Continuing Competence Review Committee (left to right): Janet macKasey, rN, Carole reece, rN, barb Fitz-Gerald, rN, maureen Ferguson, rN, tracy Zambory, rN, Cheryl Hamilton, rN, liz Domm, rN, mary ellen Andrews, rN(NP), leah Currie (Public representative), Shirley mcNeil, rN (Chair)

SURVEY The SRNA Continuing Competence Program (CCP) has been in existence since 2006. As part of SRNA’s commitment to quality improvement, the CCP is currently under review and as such a committee has been established to conduct this review. They will be utilizing many sources of information regarding best practices as well as external and internal stakeholder feedback. Part of the review includes a member survey. Please visit our website www.srna.org to complete the CCP survey.

The survey will be available online at http://www.surveymonkey.com/s/NXXTWDW from January 5, 2012 to February 15, 2012.

http://www.srna.org

http://www.surveymonkey.com/s/




R emember when you were a student nurse? What job did you expect to be doing

today? I was in nursing school thirty years ago. At that time, I did not imagine I would be working as a nurse practitioner today. My horizon has changed. The Canadian Association of Advanced Practice Nurses (CAAPN) biennial conference was about boundless nursing horizons.

On September 28-30, 2011, the Nurse Practitioners of Saskatchewan (NPOS) and the Saskatchewan Association of Nurse Practitioners (SANP) hosted the CAAPN conference in Saskatoon. There were 156 conference participants including: Nurse Practitioners, Nurse Practitioner Students, Clinical Nurse Specialists, Nursing Graduate Students and many individuals who support advanced practice nurses. People travelled from across Canada as well as the United States and Australia.

The heart of the conference was focused on the four realms of nursing: education, leadership, practice and research through poster presentations, lectures and panel discussions. Diversity in advanced practice nursing was apparent throughout the conference, displayed by a wide range of topics. Participants had ample time to network, share ideas and view displays.

We had a grand time in 1910 Boomtown at the Western

Development Museum. After strolling through a snapshot of a prairie town, we sat down to a fowl supper and were serenaded by the Last Resort Band. What an excellent way to display prairie hospitality. Everyone went home with warm memories of the land of the living skies.

NPOS along with SANP sponsored a successful national conference that shines a light on the wide range of advanced nursing practice. Now come with me. Walk to the horizon; see how boundless it has become.

Diversity in Advanced Practice:Boundless Horizons

prof e s s ional pr act ic e grou p

NPOS/SANP CAAPN Conference Planning Committee: Back row: mary ellen Andrews rN(NP), linda Smallwood rN(NP), Pam Komonoski rN(NP), Della magnusson rN(NP) Middle row: Jan Cochrane rN CDe, Debbie bathgate rN(NP), lynn miller rN(NP) Front Row: Kendra Power, rN, Kim lato rN(NP), bev Houk rN(NP), Joyce bruce rN(NP), barb beaurivage rN(NP) Missing: Donna Flahr, rN and lee murray, rN, CNS, & events of Distinction Conference Planner Judy bodnarchuk.

by Jone barry, rN(NP) CDe, Vice-chair, NPoS

the Nurse Practitioners of Saskatchewan (NPoS) was founded in 2001 to represent the professional interests of nurse practitioners in Saskatchewan. As a Professional Practice Group within the SrNA, we are the legislated representatives of NPs in this province. the mandate of NPoS is to provide opportunities for education and research, to exchange information and to represent NPs on local, provincial and national levels.

See our website www.NPOS.ca for more information and how to become a member.

http://www.NPOS.ca


Registered Nurse (Nurse Practitioner) Patient Referrals to Specialists

The Saskatchewan Medical Care Insurance Payment Amendment Regulations have been changed to allow specialist physicians to bill the same rates for RN(NP) patient referrals as if the patient had been referred to that specialist by another physician. The RN(NP) will include their four digit billing number on the referral to support processing of the payment.

For those RN(NP)s who do not have an assigned billing number, the generic number 3401 must be used in order to facilitate the processing of the claim. Please remember that this number is for the purpose of physician referral and must only be used for this purpose.

The Saskatchewan Registered Nurses’ Association has established standards of practice for RN(NP)s. These standards include the expectation for the RN(NP) to work collaboratively and to consult with a physician should the client require care beyond the RN(NP)’s competency and scope of practice. There are no regulatory or legislative deterrents that limit the ability of the RN(NP) to refer a patient to a specialist or to provide patient follow up post consultation.

RN(NP)s will continue to work collaboratively with a family physician(s) and the team will jointly decide how and when to refer patients. Patient follow up will be provided through these teams. In order to expedite the referral process and ease the workload of teams, RN(NP) patient referrals no longer require the co-signature or billing number of a physician in order to be accepted by a specialist and processed for payment.

In situations where RN(NP)s are not linked with a family physician, the regional health authorities will work with physicians to provide linkage for consultation and patient assessment purposes. RN(NP)s will be responsible for any patient follow up required and will have means to consult physicians for support.

I want to thank the SRNA and RN(NP)s for sharing their patient care experiences with the referral process. This evidence supported the changes made to this legislation.

Please contact me at (306) 787-7195 or by email at [email protected] should any questions arise.

Lynn Digney Davis, MN, RN(NP)Chief Nursing Officer



As representatives of the Saskatchewan HIV/HCV Nursing Education Group,

PPG, we met with the Honorable, Don McMorris, Saskatchewan Minister of Health at his legislative office on September 13, 2011. Barb Fitz-Gerald, RN Nursing Advisor, Practice joined us to inform the Minister about our PPGs support for RN practice, HIV/HCV education, networking, advocacy, and nurse mentorship.

Minister McMorris was receptive to the important role RNs play in

providing accessible, holistic, and non-judgmental care to individuals, families and communities infected with or affected by HIV and/or HCV. We informed the Minister of RN advocacy for the issue of homelessness, the harm reduction model as a patient first initiative, and maintaining client autonomy and accessibility for health care programs and services. The Minister asked for feedback on the Saskatchewan HIV Strategy which we provided through general observations from our PPG’s work. The Saskatchewan HIV Strategy is

found at www.health.gov.sk.ca/hiv-strategy-2010-2014. We also provided information on our PPGs support for not-for-profit initiatives including the “Little Travellers”; information on this initiative can be found at www.littletravellers.net/.

aDvoc acy & pr act ic e up Date

Left to Right: Susanne Nasewich rN, laurel Stang, rN

by laurel Stang, rN and Susanne Nasewich, rN, Saskatchewan HiV/HCV Nursing education Group PPG

Keeping the Minister of Health Informed through RN Advocacy

Ensuring RNs Stay Focused on Positive Patient Outcomes

by laurel Stang, rN, President HiV HCV Nursing education organization

The Saskatchewan HIV HCV Nursing Education Organization, Professional

Practice Group (PPG) hosted its annual educational day on September 9th and 10th with close to 100 RNs and health care providers attending each day. The event focused on HIV and Hepatitis care, treatment and support, provided a forum to explore issues of mutual concern, exchange knowledge, share evidence and ideas, and generate solutions for these health conditions. Knowledge exchange and peer support enhances RN practice and ensures the focus of care remains

on positive client outcomes as Saskatchewan has the highest rate of HIV infection in Canada.

Speakers included Pamela Thompson, RPN from Regina who spoke about the care, treatment and support for Hepatitis C clients; Dr. David Tu and Doreen Littlejohn, RN from Vancouver Native Health Services who spoke about HIV care in conflict affected regions and the care of urban Aboriginal People; and Leegay Jagoe, RN who spoke about the peer work and outreach for people who use street drugs and how to build capacity among people with

addictions. Clients who live with HIV and HCV provided a passionate panel discussion. We learned that they are the real experts with what they need and we need to listen carefully and empathetically to their stories.

Think about joining the Saskatchewan HIV HCV Nursing Education Organization PPG. We have no registration fees and to date have offered educational events free of charge. Learn about our Professional Practice Group by contacting [email protected]. We are also on Facebook.

http://www.health.gov.sk.ca/hiv-strategy-2010-2014



http://www.littletravellers.net/

http://www.littletravellers.net/



L ors d’une réunion entre le SRNA et le Réseau Santé en Français de la Saskatchewan (RSFS), la nécessité d’améliorer les services de santé en français, pour

mieux répondre aux besoins de la population croissante de francophones de la Saskatchewan a été reconnue.

La création d’un groupe d’intérêt spécial (GIS) est un moyen pour les membres de la SRNA de se réseauter et de travailler ensemble vers un but commun. La SRNA fournit le soutien et des ressources pour former le groupe. Tout membre de la SRNA peut participer à un GIS, y compris les étudiants dans les programmes de formation pour devenir RN.

Divers membres de la SRNA et étudiants dans le réseau RSFS sont intéressés à créer un GIS pour les infirmiers (ères) qui parlent français ou qui sont disposés à fournir des services de santé en français. Le RSFS est prêt à appuyer vos efforts et vous fournira des outils pour améliorer vos compétences en langue française pour une pratique clinique en français.

En vous regroupant vous pourrez développer des idées et certains objectifs qui peuvent mieux répondre aux besoins de santé de la population francophone.

Si vous êtes intéressés à former un GIS francophone, veuillez communiquer avec: Jean-Marie Allard, RN à [email protected] au (306) 533 6343; ou Michelle Allard-Johnson, RN à [email protected] au (306) 569-8908; ou Jacqueline Plante, RN à [email protected] ou (306) 955 1750 Hortense Nsoh Tabien (liaison du RSFS) à [email protected] ou 306-966 7877

Nous vous encourageons également à identifier votre arrière-plan francophone en allant sur le site web du RSFS au lien http://www.rsfs.ca/identifiez_vous_n936_t7123.html

sp ec ial inte r e st grou p

Call to create a Francophone Special Interest Group (SIG)

Appel pour créer un groupe d’intérêt spécial en français (GIS)

At a meeting between the SRNA and the Réseau Santé en Français de la Saskatchewan (RSFS) or the Saskatchewan Network for Health Services in

French, it was determined that there is a need to improve health services in the French language to better serve the growing French-speaking population in Saskatchewan.

One of the tools for SRNA members to network and work on common issues is to form a SIG. The SRNA provides support and resources for forming the group. Any SRNA member can participate in a SIG including students in education programs leading to a RN designation.

Various SRNA members and students in the RSFS network are interested in creating a SIG for RNs who speak French and are willing to provide health services to the public in the French language. The RSFS will also work to support RNs with tools to improve French language skills and clinical practice in French.

By coming together we can develop ideas and objectives that can better address the health needs of the francophone population. If you are interested in being part of a Francophone Nurses SIG please contact: Jean-Marie Allard RN at [email protected] or (306) 533 6343; or Michelle Allard-Johnson RN at [email protected] or (306) 569-8908; or Jacqueline Plante, RN at [email protected] or 955 1750 or Hortense Nsoh Tabien (liaison for RSFS) at [email protected] or 306-966 7877

We also encourage you to self identify that you have a French language background by going to the RSFS website at the link at http://www.rsfs.ca/identifiez_vous_n936_t7123.html.




http://www.rsfs.ca/identifiez_vous_n936_t7123



http://www.rsfs.ca/identifiez_vous_


Call for Continuing Competence Program (CCP) Auditors

The SRNA is seeking two RNs and two RN(NP)S who are interested in being auditors for the continuing competence program. Auditors will review continuing competence documents and surveys

submitted from a random sample of the SRNA membership. The documents will be reviewed to ensure:• All steps of the reflective practice have been completed.• Logical linkages between the self-assessment, peer feedback, learning

plan, and evaluation are evident.

Auditors are:

• Currently registered in good standing with the SRNA.• Have attention to detail.• Knowledgeable of the CCP.• Have some experience/skill in reviewing documents/assignments and

auditing such as quality improvement initiatives.• Interested in becoming involved with the SRNA.• Not a member of another SRNA regulatory committee.

Time Commitment:

RN(NP) auditors will be required for one full day at the SRNA office in Regina.

RN auditors will be required for two full days at the SRNA office in Regina.

How to apply:

Send a brief CV which includes an explanation of why you are interested in being a CCP auditor to [email protected]. Deadline to apply is February 15, 2012. If you have questions, please call Cheryl Hamilton at 1-800-667-9945 or 359 – 4200 in Regina.

Continuing Competence ProgramNow that members have renewed their licences for the 2012 licensure year, it is a good time to start working on your 2012 continuing competence requirements. Please refer to the CCP tutorial and the SRNA website (www.srna.org) if you need assistance. CCP workshops will be arranged by request. Contact the SRNA office 1-800-667-9945 or in Regina 359-4200 for more information.

conti n u i ng com p e te nc e

Saskatchewan nurses

Foundation

Updateby robin evans, rN

on Friday, november 4,

2011 the Saskatchewan

nurses Foundation (SnF) held

its banquet and live auction

in Regina at the delta Regina.

Proceeds of this event support

the expanded bursary program for

2012. a group of 70 participated

in the event and raised $5730

during the auction and $780

from the door prize draw. the

Foundation thanks the SRna

and the Saskatchewan union of

nurses (Sun) for their support as

major sponsors for the event.

watch for more information

about the second banquet and

live auction scheduled for Spring

2012 in Saskatoon.

Thank you for your support

of the bursary program.

Application forms for the 2012

bursaries will be available in

January on the SNF website at

saskatchewannursesfoundation.org.


http://www.srna.org


by terri belcourt, rN, Nursing Advisor, Practice

2011 SRNA Regional Workshops

SRNA Council and Staff continued with Regional Workshops in 2011. This program, which was started by Barb Fitz-Gerald RN in

2010, has increased in popularity with each passing event. In 2011 workshops were held in Swift Current in June and Prince Albert in September where over 100 participants attended. Presentations on how to get involved with the SRNA, the Code of Ethics, Continuing Competence, Competence Assurance, the SRNA Practice Advisement Service and the Scope of Practice of RNs and RN(NP)s were the focus for each day. Opportunities were also provided for SRNA members and nursing students to network and discuss issues pertaining to their practice. Thanks to all Council members, staff, RN and RN(NP) members and students who attended the workshops and made them rich through many discussions and conversations.

Plans for the 2012 Regional Workshops are underway. Based on evaluation responses the agenda will be enhanced to include popular existing presentations, new topics and interactive sessions to better engage the audience. Dates for the workshops are planned for June 20th and October 10th so mark your calendars now! Locations will be determined in early 2012. Watch your inbox for additional information in the Spring of 2012.

by tracy laschilier, Advancement officer, College of Nursing, university of Saskatchewan

Nursing Students Enjoy SRNA Regional Workshop

The fourth-year class of nursing students from the University of Saskatchewan College of Nursing Prince Albert site attended the SRNA

Regional Workshop in Prince Albert on September 21, 2011. They give it an enthusiastic thumbs-up!

The students agreed that this interactive workshop was very beneficial to their professional development as future RNs. Favourite topics included the scope of an RN, Code of Ethics, and Continuing Competencies. Learning about these and other areas of nursing helped provide students with a better understanding of what happens once they graduate and where the profession is going. The biggest hit at the workshop was the free mini Code of Ethics book, a handy reference guide for students in class and clinical.

Lois Berry, Associate Dean College of Nursing North & North Western Campus and Rural & Remote Engagement says “The College of Nursing is committed to fully preparing our graduates for the nursing profession. The SRNA Regional Workshop was an excellent opportunity for learning and making connections outside the classroom.”

reg ional Wor ks Hop s

4th-year nursing students, university of Saskatchewan.


The SRNA continues to work on the Optimizing the Role of the Registered Nurse Project.

The ultimate goal of this project is to rescind the Transfer of Medical Function document and by January 2014 to have a new Registered Nurse Scope of Practice document. There are four task teams that are proceeding with work related to the Optimizing Project.

One task team is working with the College of Physicians and Surgeons (CPSS) on the dissolution of the Transfer of Medical Function model. The Medical Profession Act, 1981 does not allow for delegation and this was part of the impetus for the Optimizing Project. This task team has noted that although many competencies can become part of the nursing scope of practice, there are a few that are physician practice.This team is working to research what these competencies are, and the process that can be used to allow physicians and registered nurses to work together.

Two task teams are working on the Rural and Remote Certified Practice project. This includes the development of new competencies and clinical

expectations for the RN(C) and the preparation of new bylaws that allow RN(C) practice.

RN Certified Practice-Rural and Remote RN(C) is a registered nurse who has successfully completed the educational requirements to attain the competencies required for certified practice in rural and remote nursing, has met the licensing requirements, and is certified by the SRNA. The

RN(C) – Rural and Remote works in a team with a physician, or physician and RN(NP), providing patient centered community focused care, in practice environments which recognize a high level of interdisciplinary collaboration, consultation and clear understanding of roles and responsibilities. This role differs from

the RN(NP) as specific limitations are placed upon the conditions that may be diagnosed and treated, and medications prescribed by the RN(C). These are confined to limited common medical disorders.

Draft RN(C) Standards, Competencies and Clinical Competence, and Bylaws are on the SRNA website for your review and feedback. A final document and

Bylaws will be approved by SRNA Council in February, 2012 and will be taken to the membership at the SRNA Annual Meeting in Regina, May 2, 2012.

One task team is working on the establishment of the education process for the RN(C). There are meetings with stakeholders, including the Deans of the nursing education programs. The Registered Nurse Standards, Competencies and Clinical Competencies for Rural and Remote Certified Practice Registered Nurse RN(C) will be used by the SRNA and the educational program(s), to determine the educational requirements.The SRNA program approval framework will be presented to SRNA Council for approval in February, 2012.

Another task team is working on two areas; special nursing procedures, and those procedures currently called transfer of medical function. As healthcare has evolved RNs in specialty practice areas such as ICU, CCU, ER, Homecare, Public Health and others have been working under transfer of medical functions in their day to day practice. During this review and redefinition of these activities, the procedures will shift the focus from conducting activities that are “task focused” to RNs requiring the knowledge, skill and judgment to

Optimizing the Role of the Registered Nurse

proj ect up Date

This team is working to research the

process that can be used to allow physicians and registered nurses to work together.

by the SrNA optimizing team


perform the activity competently. The work plan for this task team is

to continue researching what activities RNs are performing, and what policies, protocols and educational requirements are currently being used by employers to support RNs in performing the activities. SRNA members, employers, government and various health care partners will be consulted as this review occurs.

As our health care system evolves and changes in Saskatchewan, and we are challenged to find solutions to issues such as timely access to care for the citizens of Saskatchewan, RNs can provide solutions. The availability of RNs with additional education in rural and remote communities serves to address the need for timely access to health care services in these areas and contributes to a sustainable and effective health care system.

As our health care system evolves and changes in

Saskatchewan...RNs can provide

solutions.

Nurse to Know

Congratulations to Dr. Lynnette Stamler, rN, Faculty, College of Nursing, university of Saskatchewan, on her induction as a Fellow of the American Academy of Nursing (FAAN) this month. the American Academy of Nursing’s approximately 1,500 Fellows are nursing leaders in education, management, practice and research.

Congratulations to Maureen Klenk, rN(NP), on her position of President-elect of the Canadian Association of Advanced Practice Nurses (CAAPN).

Congratulations to Cindy Smith, rN, on her appointment as Associate Dean of Nursing, SiASt Nursing Division at SiASt wascana Campus in regina.

Congratulations to Cathy Jeffery, rN, on her new appointment of Director, Continuing Nursing education (CNe) College of Nursing, university of Saskatchewan.

concept, as leadership is evolving beyond the traditional definition of being one-directional and stemming from a single source of referent or authoritative power. Today, leadership is seen as a reciprocal function shared by all members of the healthcare team, including the client and family (Spears, 2004).

The SRNA’s mission is to ensure that the people of Saskatchewan have competent, caring, knowledge-based registered nursing care. As evidenced in the Ends outlined by Council, RNs and RN(NP)s are expected to, “provide

individual and family-centered, ethical, compassionate care for the public” (SRNA, 2011). As such, the SRNA is ultimately responsible for ‘pulling’ client-centered care by enacting policies and through the regulation of its members in relation to our ever-evolving healthcare system.

However, the adoption of client-centered care does not rest in the nursing organizations’ hands alone. Regardless of our domain of practice we, the members, must ‘push’ for client-centered care if we hope to impart positive change in our communities. As the largest contingency of regulated healthcare professionals in the province, RNs and RN(NP)s have the capacity to foster true client-centeredness if we engage in the words of Mary Ferguson-Paré and, “lead from where we stand.”

As leaders of our own respective practices, we can empower ourselves as well as our many partners in health, most importantly our clients and their families, to be respective agents of positive change. Together, as a collective and synergistic whole, we can then ‘pull’ and ‘push’ client-centered care into the preferred future of healthcare.


Nursing leadership comes in many forms as does the platform from which nurses

can convey their message. At the recent 2011 Innovators Conference, hosted by the Saskatchewan Union of Nurses, I had the pleasure of actively engaging in leadership discussion and dialogue as nurses and other partners in healthcare put clients and their families at the forefront of innovation in health services. As a final practicum student with the Saskatchewan Registered Nurses’ Association (SRNA) I was afforded a unique perspective on how nursing organizations strive to keep clients and the public interest at the heart of all nursing work across the province.

As described by the keynote speaker at the conference, Mary Ferguson-Paré RN, PhD, CHE, client and family-centered care will only truly come to fruition when organizations ‘pull’ and practicing nurses ‘push’ for positive change. This is a powerful and relevant

The Forces of Leadership in Patient and Family-centered Care

Regardless of our domain of practice we,

the members, must ‘push’ for client-centered care if we hope to impart positive change in our communities.

by Julie levasseur, 4th Year NePS student

ReferencesSpears, larry C. (2004). Practicing Servant-leadership. leader to leader. 34(Fall). 7-11.

retrieved from http://www.pfdf.org/knowledgecenter/journal.aspx?ArticleiD=51Saskatchewan registered Nurses’ Association. (2011). mission Statement/ends/Standards/

Code. regina, SK: Author. retrieved from http://www.srna.org/images/stories/pdfs/about_us/mission_statement_2011_ends_web.pdfgwpda.org/naval/lcastl11.htm

http://www.pfdf.org/knowledgecenter/journal.aspx?ArticleID=51

http://www.srna.org/images/stories/pdfs/


by erika t. Vogel, rN, Advisor, Competence Assurance and research and terri belcourt, rN, Nursing Advisor, Practice

Documentation: Guidelines for Registered Nurses

We are thrilled to announce that SRNA Council has recently approved

a new publication, Documentation: Guidelines for Registered Nurses. The need for a guideline that would support Saskatchewan RNs in their documentation practices was established through a review of nursing practice calls made to the Practice Advisement Team as well as trends in reports made to Competence Assurance. SRNA staff has been working on the publication for several months with feedback from SRNA members and external stakeholders. The document has been developed to promote quality documentation by all RNs in all domains of practice.

The SRNA would like to thank the Association of Registered Nurses of Newfoundland and Labrador for permitting the adoption and adaption of their documentation publication, Documentation: Standards for

Registered Nurses, 2010 as it provided a solid base for the development of the SRNA guideline. The guideline provides recommendations for quality documentation by providing answers to the questions Why, Who, How, What and When. Information on where to find online and print resources, documentation tools and formats, privacy and confidentiality related to documentation, and how to address quality professional practice environments with regards to documentation are also included.

The publication can be found on the SRNA website under Nursing Practice/Resources. Questions about the documentation guideline can be addressed by the SRNA Practice Advisement team by contacting [email protected] or calling 1-800-667-9945 or in Regina, 359-4200.

“Documentation is not separate from care and it is not optional. It is an integral part of nursing

practice.” SRNA, 2011.

New GuiDeliNeS



On December 1, 2011 the SRNA released a resource for all RNs, GNs, RN(NP)

s and RN(GNP)s in Saskatchewan (hereafter referred to as RNs) entitled, Documentation: Guidelines for Registered Nurses (2011). The guideline is intended to provide assistance to RNs on documentation and safe, effective and ethical practice.

While documentation is perceived to be ‘yet another thing to do’ in an already hectic day, documentation is vital to our practice as RNs and should never be seen as an optional ‘task’ (SRNA, 2011). Documentation is not separate from care but rather an extension of the high quality and quantity of care provided by RNs. What is not always recognized is that documentation “reflects the application of nursing knowledge, skills and judgment, the client’s perspective and interdisciplinary communications” (SRNA, 2011, p. 17). A RN is accountable to uphold the expectations set out in standards and competencies, and to fulfill ethical responsibilities in the professional code of ethics as the minimum mandatory expectation for professional practice.

The guideline states: “Accountability means being answerable for one’s own actions. The health record demonstrates RNs accountability and gives credit to RNs for the care they give or the service they provide. In Saskatchewan, all RNs are required to document evidence of safe, competent and ethical care in accordance with the current Standards and Foundation Competencies for the Practice of Registered Nurses; Registered Nurse (Nurse Practitioner)

RN(NP) Standards & Core Competencies; Code of Ethics for Registered Nurses; and applicable agency policy. Documentation must reflect the RNs professional judgment, assessment, coordination of care, decisions, actions, and evaluation” (SRNA, 2011, p. 5).

The Canadian Nurses Association (CNA) outlines that the Code of Ethics for Registered Nurses (2008) is a “statement of the ethical values of nurses and of nurses’ commitments to persons with health-care needs and persons receiving care (p. 1). All RNs regardless of employment status (employed, employer, or self-employed), practice setting, or domain have an obligation to uphold ethical responsibilities including fulfilling those relevant to documentation. Nurses, not employers, are responsible for their ethical practice and must uphold the accountabilities bestowed upon the profession (CNA, 2008).

etH ic s cor n e rby erika t. Vogel, rN Advisor, Competence Assurance and research

Documentation: An Ethical Consideration

…documentation is vital to our

practice as RNs and should never

be seen as an optional ‘task’.

De partm e nts


The CNA Code of Ethics for Registered Nurses (2008) provides evidence that documentation is critical component in ethical practice. RNs who fail to document, or sufficiently and appropriately document, can breach ethical practice and accountability to the patient and health care team when the value ‘Providing Safe, Compassionate, Competent, and Ethical Care’ is not upheld, specifically the ethical responsibility that states: “Nurses have a responsibility to conduct themselves according to the ethical responsibilities outlined in this document and in practice standards in what they do and how they interact with persons receiving care as well as with families, communities, groups, populations and other members of the health care team” (CNA, p. 8).

The ethical value ‘Promoting Health and Wellbeing’ highlights the importance of communication, and that RNs have an ethical responsibility to: “...collaborate with other health-care providers and other interested

All RNs regardless of employment status ...have

an obligation to uphold ethical responsibilities

including fulfilling those relevant to documentation.

parties to maximize health benefits to persons receiving care and those receiving care and those with health care needs, recognizing and respecting

the knowledge, skills and perspectives of all” (CNA, 2008, p. 10). By communicating through documentation RNs are collaborating with health-care providers to ensure those requiring client information for decision making is readily available and in the best interest of the client at all times.

These are only two examples of ways RNs

ensure that their nursing practice is competent, safe and ethical on a day to day basis. RNs can improve documentation by becoming familiar with the documentation guideline, and reviewing standards/competencies/code of ethics, and

agency policies. If you notice that there are opportunities for improvements consider advocating for changes by speaking with colleagues and your supervisor to advance competent, safe and ethical practice.

If you have questions or would like to speak with a Practice Advisor about ethics and documentation, contact the SRNA Practice Advisement Team at 359-4200 or 1-800-667-9945 or by email at [email protected].

ReferencesCanadian Nurses Association. (2008).

Code of ethics for registered nurses. ottawa, oN: Author.

Saskatchewan registered Nurses’ Association. (2011). Documentation: Guidelines for registered nurses. regina, SK: Author.



Just Do It!An interview with marlene Smadu, rN,

on CNA’s National expert Commission and Nursing leadership

by Susan Smith brazill Director, Communications & Corporate Services

The power nursing providers have is potentially

transformational.

One of Canada’s foremost nursing leaders, Marlene Smadu, RN has sound

advice for nurses in transforming healthcare: if we aren’t actively engaged in the solutions we are part of the problem.

I asked to interview Smadu in an effort to better understand her perspectives and wisdom on her role as co-chair of CNA’s National Expert Commission and nursing leadership. As one might suspect, the conversation with Smadu covered a vast array of topics, from the Commission’s work, to the triple AIM framework, to the obesity epidemic and to the social determinants of health.

Smadu and co-chair of the Commission Maureen McTeer, a health law expert and author, Adjunct Professor, Faculty of Common Law, University of Ottawa are leading a diverse team of Canadian experts in nursing, medicine, business, government, academia and the public in a broad consultative process and review of relevant research.

Her diverse leadership responsibilities have given her an interesting outlook on her work with

this Commission. When asked about the role RNs can play, Marlene spoke with great enthusiasm and optimism: “we have so much power.” She is adamant that nursing needs to be engaged with the transformation of health and we need to figure out what actually works, so we are using our

taxpayer’s money well.She described

the role of CNA as twofold: articulating policy at the high level and supporting and energizing nurses to lead the transformation.

Smadu defines CNA’s policy work as being consistent with the code of ethics and nursing values: CNA’s work in policy is not just about nursing, but the public.

Clients are broadly defined on a continuum, as individuals, family, group, population and society and leadership is needed at all levels. She spoke eloquently on the latter: nursing as a collective making broad policy changes through her triple P: patience, perseverance and passion.

She spoke ardently about innovation Saskatchewan nurses have led and the need to share and

to replicate the ideas as a system. She used the word innovation a lot in our interview. She spoke of simple initiatives that have had great impact on our public. An example she cited was a RN who provided patient centred care to a client who could not speak English. Her no cost innovation was to use Google translate which resulted in a better patient outcome.

The power nursing providers have is potentially transformational. She spoke of not only the numbers across Canada and the fact that RNs are present in all healthcare settings but also that they are a highly trusted profession, with a significant body of knowledge and competencies. By virtue of their academic education RNs are also strategic thinkers and problem solvers.

We need leaders who have the intention of following through. She challenged nursing leaders to think in the long term despite pressures to do otherwise. In addition

to the long view, she advocates for the wide view. A big challenge Smadu recognized is leaders’ desire to take on too much, to try to do it all in the short term.

We need leaders who have the intention of

following through.


She challenged nursing leaders to think in the

long term despite pressures to do

otherwise.

As health care is the most complex system in society, she was not at a loss to offer suggestions for change: increased and better utilization of technology, the obesity epidemic, aboriginal health, social determinants of health, primary health care and Triple Aim. Her reality check and advice to RNs was to reflect on what that feels like for the individual. Her other advice was just do it.

The Commission will address key questions around the re-alignment of health services, reducing duplication and maximizing

teamwork to make our health system more effective.

The Commission invites nurse leaders, employers, union

representatives, economists, business leaders and the public to share their thoughts, ideas and advice. There are many ways to stay up-to-date on the Commission’s work and have your voice heard Facebook, Twitter, call for submissions or just tell the Commission

about an innovative idea. She encouraged nurses to check out the CNA website www.cna-aiic.ca.

So what do future leaders need to take on this new environment? Smadu encouraged RNs to take on only a few strategic directions and work collaboratively with others, to maintain sustained energy —pick something you are passionate about—pick one thing. This is sound advice.

Marlene Smadu, RN is a well known name in nursing in Canada and internationally. After all, she has held a broad range of formal leadership positions. She is currently the Associate Dean, Southern Saskatchewan Campus and International Student Affairs, for the College of Nursing, University of Saskatchewan. After serving as President of the CNA, Smadu was elected as one of three Vice-Presidents for the International Council of Nurses. She also served as the Principal Nursing Advisor and Assistant Deputy Minister, Ministry of Health and was an Education Consultant and then the Executive Director of the SRNA.

http://www.cna-aiic.ca


When the Earth Moves: Primary Health Care in Action

A sharp jolt, breaking glass, filing cabinets upending, computer screens toppling; people’s

audible gasps of fear and clouds of dust as buildings crumbled. These are my memories of the February 22 earthquake in Christchurch New Zealand, where I was working as part of the Public Health Specialist team for Canterbury District Health Board (CDHB). This was the devastating quake which claimed 181 lives and reduced a proud and beautiful city to rubble.

Six months prior, the 1st quake shattered some buildings, but there was no serious injury or death.

Both quakes brought similar issues: infrastructure destroyed as sewer and water lines cracked; power and phones down; and people forced from their homes due to significant structural damage to their homes or liquefaction (tons of silt bubbling up through the earth) that made homes and roads unusable.

So, how did health respond? Public Health, Primary Care and Mental Health services collaborated on consistent messages to support people’s normal reactions to a disaster and how to seek help. This meant providing more mental health supports to primary care; assigning mental health professionals to support families who had suffered loss of loved ones; speaking publically about

normal reactions to an abnormal situation. CDHB also coordinated care for vulnerable populations.

I acted as liaison to the social environments/welfare emergency task group. This meant ensuring a health and social determinants perspective was considered in all issues brought

to the table, e.g., the need to keep displaced families close to their home communities and schools so that social supports were in place. We recommended putting mobile homes in local communities or in people’s own

driveways instead of creating mobile communities in central locations. It also included strongly advocating for and facilitating community engagement in the recovery process.

Public Health Nurses (PHNs) served as key links to emergency shelters and addressed health and infection control issues. As we moved from emergency response to recovery, PHNs played a critical role in working with school staff to address

children’s reactions to the quakes and linking families to services.

Public Health environmental health officers (Inspectors in Canada) tested water, assessed food handling at welfare centers and supported infection control operations. Medical Officers of Health issued boil water advisories, spoke to the media about health issues and monitored gastro intestinal disease. There was no outbreak—a testament to public health diligence in monitoring and providing extensive infection control messages!

I was proud to be part of this team effort—public health, primary care and acute care working together to meet the health needs of the people of Christchurch— proving once again that all parts of the system have a vital part to play in responding to a natural disaster.

by mary martin-Smith, rN Nursing Faculty, SiASt and university of regina

…all parts of the system have a vital

part to play in responding to a natural disaster.


CNA: Call for Scrutineers This is a call for expressions of interest to be nominated by the SRNA as a scrutineer for the CNA Annual meeting being held in conjunction with on the CNA Biennial Convention, June 18 – 20, 2012 in Vancouver, British Columbia. Information on the role of the scrutineer can be obtained by contacting Barb at [email protected]

Interested individuals can apply to Debbie at [email protected] by January 16, 2012. Please include a brief note (maximum 150 words) stating the SRNA activities you participate in and the reasons the SRNA Membership Advisory Committee should choose you to be the SRNA nominee. The nominee will be approved by SRNA Council at the February meeting and forwarded to CNA. If selected, the nominee will receive up to $1500 to cover expenses to attend the CNA Biennial Convention.

Are you interested in being a SRNA voting delegate at the CNA Biennial Convention in Vancouver?

If you are interested in representing the SRNA at the CNA Convention in June, 2012 please email Julie at [email protected] In the SUBJECT line please indicate: CNA Convention, June 18 – 20, 2012.

Criteria: Voting delegates will be members actively engaged in the work of SRNA, will commit to attending briefing sessions and participating in the business meetings at the Biennium and any necessary follow up activities. The SRNA will provide registration and up to $1500 per delegate to attend.

Please include a brief note (maximum 100 words) why you should be a SRNA voting delegate.

SRNA Council will select two members at the February 2012 Council Meeting based on the criteria above. Good luck!




De partm e nts


Nurse Practitioner Quarterbacking Care Around Needs of Patients

Since arriving at the Carlyle Primary Health Clinic in 2007, Jean Daku, RN(NP) has made

patient needs the basis for her practice, collaborating with practitioners from other disciplines and equipping herself with the training and tools to meet those needs.

“Shared care is a huge benefit,” says Daku. “I can give you medications, I can talk to you, but I’m not a counsellor, or a social worker, or a mental health worker. It’s much better if patients can deal directly with these people on those kinds of issues.”

Daku has consistently moved beyond the “solo practitioner” model of care. One of her first initiatives in Carlyle was to establish an interdisciplinary clinic for people living with diabetes. Twice each month, patients can come to the clinic and access the care and counsel of a diabetic educator, a dietitian, and Daku herself, all under the same roof.

“They can get everything at once,” Daku says. “If they need prescriptions, I can provide them, if they need to talk about their diet, they can do that.”

Wanda Miller, Sun Country Health Region’s Director of Primary Health Care, has worked with Daku since 2007 when the Carlyle Medical Clinic made its transition to a primary health care site. What sets Daku apart, says Miller, is her capacity to build relationships with patients and all team members. “She sees the value in everyone and understands the roles and responsibility that each player brings to enhance patient care.

The right person at the right time for the right situation is very well understood by Jeannie.”

The diabetic clinic was Daku’s first foray into team-based care. Yet in her 25 years as a registered nurse, she had seen countless instances of the connection between patients’ physical and emotional well-being. When she

signed on for the Health Quality Council’s most recent Chronic Disease Management Collaborative, she was drawn to its resources for identifying and helping patients dealing with depression.

“I saw it as a great learning opportunity and a chance to help people,” she says.

Newly equipped with depression assessment and support tools, Daku immediately set to work adopting and adapting them for her patients at the clinic. And once again, she took an interdisciplinary approach, arranging for weekly clinic visits by a psychiatrist and a mental health nurse.

“Our physician is also involved in all the care we do, and I meet with a social worker once a month so we can discuss how our patients are doing,” she says.

Although people living with chronic diseases often experience depression, the condition can easily go undiagnosed and untreated.

“I can touch your stomach and know if you’re experiencing pain,” Daku says. “But how do I know if

He alt H Qual it y cou nc i l

What sets Daku apart, says

Miller, is her capacity to build relationships with patients and all team members.

Jean Daku, rN(NP)


you’re depressed just by looking at you?”

To address this gap, Daku has adapted the PHQ9 health questionnaire, a standard assessment tool for patients undergoing a physical. Daku’s questionnaire now includes two questions that can point to depression in a patient.

Daku makes use of algorithms that help her determine what the next care steps should be for a depressed patient. She also has her patients’ charts colour-coded so that those dealing with depression are allotted 40 minutes, rather than the usual 20, when they call in to book an appointment.

Miller says Daku’s passion for patient-centred, team-based care has made believers of many of her colleagues.

“When we first talked about running clinic days, everybody said, ‘You can’t do that, that’s patient-slot time, we have to put these patients through,’” Miller recalls. “Today they’re right on board.”

For her part, Daku is quick to credit her colleagues for their willingness to practice care collaboratively. She also says interdisciplinary care is easily achievable for any practitioner who sees the benefits.

“All you have to do is look around and see what other health professionals are doing, and how they could help your patients, and you can really do wonders,” she says.

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Surgical Checklist Improves Safety


sas k atc H e Wan su rg ic al in it iat ive s

Patient safety is a key aspect of quality healthcare and critical to “Sooner, Safer, Smarter,” our

plan to transform the Surgical Patient Experience here in Saskatchewan.

In the Canadian Adverse Events Study, Baker and Norton showed what similar studies in the USA and UK had revealed: our safety record in healthcare hasn’t been as good as it ought to be. We should therefore look to other industries with much better safety records to see what we can learn from them. In his book The Checklist Manifesto, Atul Gawande points out that the airline industry has an exemplary safety record and one of the critical factors has been the use of checklists by airline pilots.

In the increasingly complex world of modern medicine, it’s too easy for an otherwise expert surgeon to miss a simple step. The checklist is a tool to help prevent that. Furthermore,

it’s often the little things that get overlooked. Yet, these seemingly minor missed steps can have serious consequences for our patients.

At the Institute of Healthcare Improvement (IHI) meeting in Amsterdam this year, Gawande told the story of a patient from Texas involved in an MVA who suffered multiple fractures and internal

injuries. The trauma team caring for him did a fantastic job of “putting him back together” and were very proud of their work. However, the surgery included a splenectomy. They did not do

a “checklist” and overlooked the immunization he should have received. The patient went on to lose all of his finger and toes. The omission here, though minor compared to the heroics the team had performed, had drastic consequences for the patient. His fingers and toes might have been saved by that last time out on the checklist – the one that asks, ”Have we forgotten anything?”

Maureen Bisognano, the CEO of IHI, speaking at the Quality Summit in Regina in 2011, described a horrible complication suffered by her mother during a recent hospital experience. This took place in a world-renowned institution with

In the increasingly complex world of modern medicine,it’s too easy for an

otherwise expert surgeon to miss a simple step.

De partm e nts

Head 1

by barb Fitz-Gerald, rN Nursing Advisor, member relations


world famous physicians. It wasn’t a lack of expertise or resources, but an incredibly simple oversight, the failure to discontinue a medication, which led to the problem. Standardized tools such as the Surgical Checklist save us from such simple omissions with such drastic consequences.

The second reason for embracing the checklist is a more cultural one. In his address to the Executive of the American College of Surgeons, Dr. Brent James, from Intermountain Healthcare in Utah, spoke of our continued reliance on the “craft of medicine” with clinicians as stand-alone experts, relying on subjective recall to make decisions in an increasingly complex and often stressful environment. He suggests “the complexity of modern medicine exceeds the capacity of the unaided human mind.” He advises that the future will not be physicians as stand-alone experts, but rather multidisciplinary team-based care with each member of the team a valued contributor. The checklist can

help shift the cultural dynamic of the operating room from a hierarchy to an expert multidisciplinary team working on the patient’s behalf.

In his speech to the 2011 Harvard School of Medicine graduating class, titled “Cowboys and Pit Crews,” Atul Gawande used the analogy of the skills and efficiency of a NASCAR pit crew as the best way to meet

patients’ needs in the future, with discipline and standardization, doing things the same way every time. He speaks of recognition that with teamwork, others can save you from failure, no matter where they stand in the hierarchy. The future is multidisciplinary

team-based care with standardization of practice, care pathways and yes, checklists.

The Surgical Checklist has saved lives and reduced complications. For that reason, it has been endorsed by Accreditation Canada, the Royal College of Physicians and Surgeons of Canada, the College of Physicians and Surgeons of Saskatchewan, the

Canadian Anaesthetists Society, the CMA, the SMA, the Canadian Nurses Association, the Operating Room Nurses Association of Canada, as well as Patients for Patient Safety Canada and numerous other organizations.

Saskatchewan is committed to having the checklist used for all surgeries. An audit of all regions done in May 2011 showed a wide variation in use of the checklist between regions, within a region, and even within a division in a region. If you are not familiar with the checklist used in your region, please learn about it. If you are already using it, share your knowledge and help spread the implementation. We urge you to champion its use. The Surgical Checklist saves lives!

Dr. Peter Barrett is a Saskatoon based urologist and Physician leader for the Saskatchewan Surgical initiative.

Dr. Karen Shaw is the registrar of the College of Physicians and Surgeons of Saskatchewan.

Dr. Vino Padayachee is the Chief executive officer of the Saskatchewan medical Association.

With teamwork,others can save

you from failure,no matter wherethey stand in the

hierarchy.


Registered Nurses“Registered nurses (RNs) are self-regulated health care professionals who work autonomously and in collaboration with others. RNs enable individuals, families, groups, communities and populations to achieve their optimal level of health. RNs coordinate health care, deliver direct services and support clients in their self-care decisions and actions in situations of health, illness, injury and disability in all stages of life. RNs contribute to the health care system through their work in direct practice, education, administration, and research, and policy in a wide array of settings” (CNA, 2007 p.5). “The direct care role is fundamental to registered nursing, and all other roles within the profession ultimately exist to maintain and support direct nursing care” (SRNA, 2007, p.6).

Education The baccalaureate degree in nursing is the required level of education for those entering the profession. RNs can choose to pursue additional education at the masters, doctoral and post-doctoral levels. To practice registered nursing in Saskatchewan, registration and licensure with the Saskatchewan Registered Nurses’ Association (SRNA) is required. All members must have successfully passed the Canadian Registered Nurse Exam (CRNE). The Registered Nurse (Nurse Practitioner) {RN(NP)} is an advanced practice category of RN who has further education enabling them to diagnose, treat, prescribe and dispense medications for common medical disorders. In addition to the exam requirements for a RN, the RN(NP) must also successfully pass the Canadian Nurse Practitioner Exam required for this category of licensure.

The baccalaureate program in nursing prepares students for the provision of safe, ethical and competent care. This education gives RNs the breadth and depth of knowledge and skills through courses in nursing and related disciplines, enabling RNs to take on multiple responsibilities and carry out a variety of roles to meet complex client health needs in constantly evolving practice environments. “Registered nurse education prepares registered nurses to collaborate with clients, families and other members of the health-care team. Their leadership skills allow them to take responsibility for promoting healthcare team effectiveness” (CNA, 2007, p. 19).

Scope of PracticeThe Registered Nurses’ Act, 1988 specifically outlines the scope of practice of the RN. Scope of practice refers to the range of services that RNs are educated and authorized to perform. RNs are accountable to practice registered nursing in accordance with The Registered Nurses’ Act, 1988, SRNA Bylaws, SRNA Standards and Foundation Competencies for the Practice of Registered Nurses, SRNA policy, practice standards, guidelines and other relevant legislation. RNs also have ethical commitments and are required to practice according to the ethical values outlined in the Code of Ethics for Registered Nurses.

WHAT IS A REGISTERED NURSE?Competent, caring, knowledge-based registered nursing for the people of Saskatchewan.


Registered Nurse PracticeRNs perform comprehensive assessments for all types of client needs and provide nursing care for stable to complex clients of all ages throughout the lifespan and in all settings. “The registered nurse in collaboration with the client, performs an assessment of physical, emotional, spiritual, cognitive, developmental, environmental, social and learning needs and the client’s beliefs about health and wellness” (SRNA, 2007, p.8). RNs utilize analytical and decision making skills to determine nursing diagnosis, create plans of care, implement and evaluate care outcomes.

RNs facilitate the delivery of primary health care across the continuum of care from acute care, to community, to continuing care settings by promoting health, preventing disease and injury and restoring health in all settings.

Assignment and Coordination of Client Nursing Care The key components of The Registered Nurses Act (1988), identifies that RNs are responsible for the assignment and coordination of client nursing care. Therefore, the RN is responsible for appropriate assignment of client care and works collaboratively with team members to determine appropriate assignments. This is achieved through the nursing process, a legislated responsibility of the RN. The RN at the point of care* assesses the client. Through planning, implementing and evaluating client care needs, the RN determines the most appropriate care provider who can safely and competently meet the needs of the client. RNs coordinate nursing care in all health care settings.

Knowledge Navigators RNs are “knowledge navigators” and direct clients to credible resources, teaching them to interpret and evaluate information and helping them find their way in the health care system (CNA, 2007). RNs enable clients to make decisions about their health and health care, and support and respect their decisions.

Leadership and ProfessionalismLeadership is fundamental to registered nursing and is essential in ensuring quality client outcomes. RNs use transformational leadership practices including building relationships and trust, creating an empowering work environment, creating a culture that supports knowledge development and integration, leading and sustaining change and balancing values and priorities in order to promote healthy outcomes for the RN, the patient/client, the organization and the health care system as a whole (RNAO, 2006). Leadership is integral to every practice setting and is critical to client care, health promotion, policy development and health care reform (Kilty, 2005).

Professionalism requires that RNs in all roles demonstrate the following attributes: knowledge, spirit of inquiry, accountability, autonomy, advocacy, innovation and visionary, collegiality and collaboration, and ethics and values (RNAO, 2007).

*Point of care means where the RN is knowledgeable of the individual client’s needs based on ongoing nursing assessment and is responsible for the overall care for the client.

SRNA Nominations Committee Welcomes Karen Marchuk

Karen was a teacher with the Regina Public School Board for 35 years. Although she retired in December 2011, Karen is currently working as a receptionist/media buyer

for HJ Linnen Associates. She enjoys golfing, yoga, walking, gardening, reading, and entertaining. Karen and her husband Russ have two children: Michelle (Dave) Schmalenberg , grandson Ben and Melanie Marchuk.

Thank you Bobbi Schwartzenberger, Presiding Officer for the CRNE in Saskatoon

Bobbi began invigilating in August of 1970 when Edna Dumas was the Registrar in Regina. At that time there were five individual exams written over two and a half days. In August 2012 Bobbi will have been involved for fourty years. During this period she has only missed three exam dates (once in June of 1977 and twice in 1984). She has enjoyed the people and the process and the “little experiences along the way.”

Continuing CompetenceFor each RN continuing competence is an integral component of registered nursing practice. All RNs have a professional responsibility to assess their learning needs on an ongoing basis and take action to ensure they are competent to practice efficiently, effectively and safely (SRNA, 2007). Through continuous learning and the incorporation of evidence-informed practices RNs maintain their competency to practice in an evolving health care system.

Need for Registered NursesResearch demonstrates the link between RN practice and positive client and system outcomes. Client outcomes have been consistently shown to be positively affected by RN intervention across a variety of health care settings (Doran, 2003; White, Pringle, Doran & McGillis Hall, 2005). In 2011 Needleman et al., reported that staffing of RNs below target levels was associated with increased mortality, reinforcing the need to match RN staffing with clients’ needs for nursing care.

ReferencesCanadian Nurses Association. (2007). Framework for the practice of registered nurses in Canada. ottawa: Author.Doran, D.m. (ed). (2003). Nursing-sensitive outcomes: State of the science. Sudbury, mA: Jones and bartlett.Kilty, H.l. (2005). Nursing leadership development in Canada. ottawa: Canadian Nurses Association.Needleman, J., buerhaus, P., Pankratz, V. S., leibson, C. l., Stevens, S. r. & Harris, C. (2011). Nurse staffing and inpatient hospital

mortality. N Engl J Med, 364, 1037-45.registered Nurses’ Association of ontario. (2006). Developing and sustaining nursing leadership. toronto: Author.registered Nurses’ Association of ontario. (2007). Professionalism in nursing. toronto: Author.Saskatchewan registered Nurses’ Association. (2007). Standards and foundation competencies for the practice of registered nurses.

regina: Author.white, P., Pringle, D., Doran, D. & mcGillis Hall, l. (2005). The nursing and health outcomes project. Canadian Nurse, 101(9), 15-18.

srna ne Ws


MedicationSafetyAlert!Institute for Safe Medication Practices*

Table 1. Primary suspect drugs* for reported serious events in 2010

rank Generic name Canadian Brand name Cases

1 bosentan tracleer 4665

2 fentanYl duragesic 3035

3 inFliXimab Remicade 2500

4 etanercept enbrel 2446

5 teriparatide Forteo 2375

6 varenicline champix 2028

7 QUetiapine Seroquel 1585

8 zoledronic acid Zometa 1542

9 adalimumab humira 1530

10 acetaminophen tylenol 1281

11 levofloxacin Levaquin 1123

12 baclofen Baclofen 1077

13 pregabalin Lyrica 1077

14 atorvastatin Lipitor 1075

15 oxyCoDone oxycontin 1070

For 2010 in its entirety, we identified 141,829 new cases of serious, disabling, or fatal ADes reported to the FDA, a 21% increase since 2009. the increase (24,736 cases) in 2010 was the largest absolute (raw number) increase between years since 1998.

Fatal adverse event reports increased by 42.9% in 2010 to reach a total of 28,456.this deceptively alarming increase was heavily influenced by large numbers of reports from drug manufacturers about deaths in previous years in which a drug was taken but not necessarily linked to the deaths. this trend primarily reveals regulatory and compliance issues in the FDA’s monitoring program rather than a new danger to patients.


For more information on ISMP, please refer to www.ismp.org

* iSmP - A federally certified ©2011 institute for Patient Safety organizationSafe medication Practices

Safety Alert

http://www.ismp.org

There are many examples...where

inadequately trained

physicians have provided cosmetic services that have harmed patients.


by bryan Salte, CPAA Associate registrar & legal Counsel endorsed by the SrNA

Cosmetic Procedures

One of the recent challenges for professionals and regulatory bodies is the

proliferation of cosmetic treatments which are available. Medspas are a multi-billion dollar industry in the United States, and Canada appears to be rapidly catching up. This article will address two primary issues:1) What minimum

standards should physicians meet to be qualified to provide such services? and,

2) Which services must be provided by physicians, and which can be performed by registered nurses or other professionals?

Minimum StandardsPhysicians and other professionals are providing a broad range of services that are outside the traditional practice of medicine. Some examples of the services provided are botox injections, use of laser for a number of purposes, fat and cellulite manipulation, hair transplants, etc.

There are no commonly-accepted best practices or minimum qualifications for many of these

procedures. Some physicians begin to perform procedures based upon a weekend course, often sponsored by the corporation that provides the product.

There are many examples in North America where inadequately trained physicians have provided cosmetic services that have harmed patients. That can lead to significant consequences for the physicians involved.

Two maxims are relevant “Above all, do no harm”, and paragraph 15 of the Canadian Medical Association Code of Ethics “Recognize your

limitations and, when indicated, recommend or seek additional opinions and services”.

At some future time there may be standards set for physicians to participate in the delivery of such services.

Until that happens, the College would like to remind physicians that they should carefully consider whether they:

1) Fully understand all of the risks and benefits associated with the procedures and equipment;

2) Are aware of the possible complications and what is required to deal with such complications;

3) Can provide appropriate recommendations and counseling to patients considering those procedures; and,

4) Have the technical capacity to provide the service skillfully and safely.

Involving other professionals in providing services.

Both the College of Physicians and Surgeons of Saskatchewan (CPSS) and the Saskatchewan Registered Nurses’ Association (SRNA) are concerned that in some situations there is inadequate physician involvement in providing some of these services.

Saskatchewan legislation does not authorize physicians to delegate the practice of medicine to non-physicians.

The practice of medicine is broadly defined and includes acts which either diagnose a human condition or which treat a human condition. The services described in this article are the practice of medicine.

A specific example of concern is administering botox injections.


The RN is potentially without malpractice

protection and, if a patient sues for

negligence, may be left to defend the action without malpractice

coverage.

The SRNA has expressed its opinion that:

1) Injecting botox based upon a physician’s directions is within the scope of the practice of registered nursing;

2) Assessing a patient to determine whether the patient is an appropriate candidate for botox injections is not within the scope of the practice of registered nursing;

3) Making a decision whether or not to provide botox injections to a patient is not within the scope of the practice of registered nursing;

What follows from the SRNA’s position is that a physician involved in providing botox treatments must assess the patient and provide the direction to the nurse to perform the botox injection.

The CPSS perspective is that, as a physician is not able to delegate the assessment or treatment decision to a RN, a RN who injects botox without

a physician’s assessment or direction is engaged in the illegal practice of medicine. A physician who authorizes a RN to assess or treat a patient is a participant in the illegal practice of medicine.

If that happens, there are a number of significant risks for both the physician and the RN:

1) Both are potentially subject to prosecution in the courts for the practice of medicine without a licence;

2) The RN is potentially without malpractice protection and, if a patient sues for negligence, may be left to defend the action without malpractice coverage.

Physicians involved in providing services that are performed, at least in part, by other professionals should consider whether the services provided by other professionals fall within their scope of practice. If the services do not, there are significant risks to a physician who authorizes the person to perform the procedure.


SRNA ANNUAL MEETING and CONFERENCE

esolutionsMembers of the SRNA can provide input on particular issues facing the profession or on initiatives in which you think the Associationcould be involved through submitting a Resolution.

1. A letter of resolution/motion can be submitted to SRNA Council at any time.2. Resolutions/motions can be presented to the Council, by person, group,

annual or special meeting assembly at any time. Persons who wish resolutions/ motions published in the Annual Report should have resolutions submitted to Council, for presentation at the Annual Meeting, by January 31 of each year.

Resolutions not submitted by this date can be presented at the annual meeting as a motion from the floor. Resolutions must include:

• A title: subject• A Resolution statement: an expression of intent or what action you are

proposing the Association take in relation to the subject of the resolution. This statement begins with: “Be it resolved …”, and should be written in a clear and concise manner.

• Explanatory notes: identify why you believe the issue should be addressed. If you are making a number of points, order them numerically. (Remember that resolutions must have a provincial basis and relate to the mandate of the Association.)

• Identification: names of “mover” and “seconder” of resolution (must both hold active-practising status with the Association). Either the “mover” or “seconder” should be available to speak to the resolution at the Annual Meeting.

3. Resolutions/motions that are approved by the membership at the Annual Meeting will be reviewed by Council to make reasoned decisions regarding any actions to be taken.

For more information contact the SRNA or send resolutions/motions to:Kandice Hennenfent, RN, SRNA Presidentc/o SRNA, 2066 Retallack Street, Regina, SK S4T 7X5or by email to: [email protected]

SRNA ANNUAL MEETING and CONFERENCE SPONSORSHIP OPPORTUNITIES

Gold $10,000 and over Si lver $5,000 - $9,900 Bronze $2,000 - $4,999Refreshment Breaks $500 - $1,999Contact : [email protected]

Delta Hotel - Regina - May 2 & 3, 2012R

inking with MembersMay 1, 2012

nnual Meeting DayMay 2, 2012

Join us in Regina for our Annual Meeting. SRNA members and the public are invited to attend the annual meeting in the afternoon. Join us in the morning for a series of interactive sessions, information and dialogue about where we’ve been as your professional regulatory organization and where we’re going. This is your opportunity to participate in the business of the SRNA. In the evening, our banquet and awards recognition night is a tradition not to be missed.

onference DayMay 3, 2012

The event provides an opportunity for RNs, RN(NP)s to take time to rejuvenate and have fun, network with colleagues from across the province and learn about a broad range of evidence-informed nursing practice applications. A series of concurrent sessions will round out our day.

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LECTION 2012 CALL FOR NOMINATIONS FOR SRNA COUNCIL AND NOMINATIONS COMMITTEE

The Nominations Committee is seeking RNs and RN(NP)s to stand for election in 2012 for the following positions: Member-at-large for 2012 to 2015(three-year term); Nominations Committee for 2012 to 2014 (two-year term). The 2012 election is on May 2, 2012 at the SRNA Annual Meeting in Regina.

Council Positions Council members are elected to represent registered nursing in Saskatchewan. One Member-at-large is open for election in each of the following regions:

• SRNA Region IV, Kelsey Trail and Sunrise Health Regions• SRNA Region VI, Saskatoon Health Region

Nominations Committee The role of the NominationsCommittee is to provide a slate of candidates to fill the Registered Nurse positions on Council and the Nominations Committee.

• One position is open for election to the Nominations Committee for a two-year term.

Candidate nominations must comply with the requirements stated in The Registered Nurses Act (1988), SRNA Bylaws (2009) and approved changes as per May 2011 AnnualMeeting and SRNA Policies.

EADLINE FOR NOMINATIONS IS 4:30 PMFEBRUARY 2, 2012

Submit completed nominations forms to the SRNA by email to [email protected],

ALL FOR NOMINEES FOR THE SRNA 2012 MEMBER AwARDS

Celebrate Registered Nursing Excellence in Saskatchewan

The SRNA Member Recognition Awards are an opportunity for members to formally recognize and celebrate many of the outstanding contributions of individual members and groups of RNs and RN(NP)s.

Award recipients are honoured at the SRNA Member Recognition Awards Banquet and Ceremony held inconjunction with the SRNA Annual Meeting and Conference Day in May.

• SRNA Millennium Awards are eight awards that celebrate members who are in the clinical, administration, education, research and policy areas; employers of RN and RN(NP)s; and nursing students.

• SRNA Mentorship Award celebrates the significance of mentorship and its extraordinary influence in the relationship between two RNs.

• SRNA Life Membership is granted to an individual who is retiring or is retired from the nursing profession and has rendered outstanding service to registered nursing in Saskatchewan.

• SRNA Honorary Membership is awarded to a non-nurse or a nurse registered outside of the province, in recognition of distinguished service to the registered nursing profession

or for valuable assistance to registered nursing in Saskatchewan.

• SRNA Memorial Book is a historical record established to honor deceased members who during their career have provided exemplary service to the nursing profession and health care for the people of Saskatchewan.

Award guidelines and nomination forms are available at www.srna.org under the Events tab under Membership Recognition Awards or contact the SRNA at [email protected].

EADLINE FOR NOMINATIONS IS 4:30 P.M., JANUARY 15, 2012.

Call For Nominations

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SRNA ANNUAL MEETING and CONFERENCE

Delta Hotel - Regina - May 2 & 3, 2012 E


http://www.srna.org

http://www.srna.org


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De partm e ntsby barb Fitz-Gerald, rN Nursing Advisor, member relations


Did You Know?A booklet for nursing professionals, Specialized Procedures in Personal Care Homes A Guide for Nursing Professionals and Personal Care Home Licensees located at http://www.health.gov.sk.ca/specialized-procedures explains the responsibilities of the personal care home staff as well as the nursing professionals or physicians that work with the staff to ensure safe and competent care for the residents.

The Sleep and Function Interdisciplinary Group at the University of Alberta (funded by Addiction & Mental Health: Alberta Health Services) is conducting a national survey of healthcare providers’ use of non-pharmacological sleep interventions for persons with dementia. (Students are not eligible). http://app.fluidsurveys.com/surveys/cary-R/sleep-intervention-dementia/

CPSI recommending more accountability for hospital boardsHospital boards spend at least 25% of their time on patient safety and quality care – which improves outcomes. www.patientsafetyinstitute.ca

The Ministry of Health released the 2011 Progress Report for the provincial tobacco reduction strategy: Building a Healthier Saskatchewan: A Strategy to reduce tobacco use, and the 2011 Strategy Action Plan. The document is available on the Ministry of Health website at www.health.gov.sk.ca

The Saskatchewan Transfusion Resource Manual is now available on the Ministry of Health website at http://www.health.gov.sk.ca/transfusion-medicine It is a provincial resource that health care providers will find very informative and will help them provide safer transfusion services in our province.

The Saskatchewan Association for Safe Workplaces (SASWH) is a non-profit autonomous association that was established March 12, 2010. SASWH is governed by a Board of Directors representing health services workers, unions and employers. Having a unique structure such as this is crucial to driving significant industry change and improvement. Health care employees missed 84,638 days of work due to injuries in the workplace during 2010. This translates into 423 full-time vacant positions. What kind of an impact does this have on the injured individual, their family, their community, their colleagues and patient care? SASWH believes that health and safety needs to be a priority for all to eliminate injuries and illness in the workplace. It is our mission to increase awareness and proactively support all health care industry employers and workers in their efforts to prevent workplace injuries; through education, training and services. For more information go to www.saswh.ca

re sou rc e s

The Alcohol and Drug Education and Prevention Directorate at the Saskatchewan Ministry of Health provides information on alcohol, drugs, mental health and addictions services. Available information ranges from facts on alcohol, cannabis and prescription medications, mood disorders and positive body image to suggestions on what to do if alcohol or drugs are causing a problem in one’s life. Front line staff and practitioners can access this information online at http://www.health.gov.sk.ca/alcohol-addictions-factsheets and http://www.health.gov.sk.ca/mental-health-fact-sheets. Information can be printed off to share with members of the public, colleagues or managers. There is also information for parents at http://www.health.gov.sk.ca/alcohol-addictions-resources. Any of these resources can be ordered in hard copy, free of charge from the Ministry of Health distribution centre by faxing requests to 306-787-0194.

To help direct people to Addiction Services in the province, please go online and click on their RHA at http://www.health.gov.sk.ca/connections-to-help to find locations and contact information for the services available in their RHA.

http://www

http://app.fluidsurveys.com/surveys/

http://www.patientsafetyinstitute.ca

http://www.health.gov.sk.ca

http://www.health.gov.sk.ca/

http://www.saswh.ca

http://www

http://www.health




srna up Date s

SRNA DirectoryPhone/Toll-free (306) 359-4200/ 1-800-667-9945 Fax: (306) 359-0257 E-mail/Website: [email protected]/www.srna.org Internationally Educated Nurses [email protected] Registration [email protected] RN Registration [email protected] Examinations [email protected] Assurance/ Discipline/Investigations [email protected] Links [email protected] Newsbulletin [email protected] Director [email protected] Enquiries [email protected] Practice [email protected]

Registration Renewal 2012

Registration Renewal for 2012 ended November 30, 2011 with a 91 percent on-line renewal rate. We are interested in quality improvement so we have designed an online registration renewal survey. The survey will be on our website www.srna.org from January 5 to February 15, 2012.

Effective 2013, the SRNA will be discontinuing paper licence cards. Confirmation of registration and licensure is available through the Verification Service (e-register) located on the SRNA homepage (www.srna.org). Discontinuation of the paper licence is becoming a best practice across Canada in promoting public safety. The use of the e-register provides an accurate means of confirming a member’s licensure status. The paper licence may not

accurately reflect changes that have occurred in a member’s registration status since he/she was issued the paper licence. In addition, use of the e-register will eliminate the risk of lost or stolen licences; minimize the risk of identity theft and the use of fraudulent licences.

Effective 2014, it will be mandatory for all SRNA members to complete their registration renewal online.

Holistic PPG Teleconference

A teleconference for members interested in forming a SRNA Holistic/Complementary Professional Practice Group(PPG) will occur in the near future. If you wish to participate please contact [email protected]

Online Voting For SRNA Elections 2012the SrNA will be utilizing the electronic voting system again for the annual election in may 2012. eligible voters will vote on a secure electronic ballot. this will be done by clicking on the Vote Now icon on the SrNA website. each member will be able to vote online until noon on the first day of the annual meeting. Computers will also be set up on-site at the Annual meeting in regina. more information will be posted on the SrNA website at www.srna.org when the elections begin.


http://www.srna.org

http://www.srna.org

http://www.srna.org

mailto:[email protected]/www.srna.org











http://www.srna.org

srna staf f ne Ws


We welcome Joanne, Donna and Julie and look forward to their contributions to the SRNA and to our members.

Julie Benjaminexecutive Assistant to executive Director and Council

Julie joined the SRNA September 2011. She has over 22 years of progressive senior/executive administration experience – over eight of those as an Executive Assistant to Deputy Minister in the executive office within the Government and for the ADM in the department of Finance. She was responsible for briefing notes, chairing ADM meetings and giving government-staff presentations. She has a business diploma and one year towards a bachelor of admin degree.

Donna Cooke, rNNursing Policy Advisor, Practice

Donna joined the SRNA October 2011. Her previous employment was facilitator with the Nursing Education Program of Saskatchewan (NEPS) year two and Saskatchewan Collaborative Bachelor of Science in Nursing (SCBScN). Donna taught eight years for the Nursing Division at Wascana Campus, SIAST with the Nursing Re-Entry program, Practical Nursing program and the Nursing Education Program of Saskatchewan (NEPS). Her clinical areas of medical/surgical expertise include plastics, burns, otolaryngology, orthopedics, neurosurgery, general surgery, critical care and hemodialysis nursing.

Donna is a member of the Canadian Nurses Association (CNA) Canadian Registered Nurse Examination (CRNE) Exam Development team.

Joanne HahnSenior Assistant, regulatory Services

Joanne joined the SRNA February 2011. She moved to Regina from Fort McMurray, Alberta in 2009 where she worked at Syncrude Canada Ltd. for over 20 years. Her experience includes several Senior Assistant roles, including her last position Executive Assistant to the Vice President, Technical.

JANUARY

3SiASt Advanced Pathophysiology Distance education CourseFor more information contact: [email protected]

FEBRUARY

17every Nurse engaging in tomorrow Symposium, Grant macewan university, edmonton, AbFor more information contact: [email protected]

22 – 242012 western and North-western region Canadian Association of Schools of Nursing Conference, winds of Change: Diversity and Divergence in lethbridge, Abwww.wrcasn.ca/

MARCH

7Helping rNs work Smart - Professional Development workshops8:30 am – 11:45 am behavioural Styles – why Can’t they be more like me?1:15 pm – 4:30 pm emotional SmArtS® for rNswww.srna.org

8Helping rNs work Smart - Professional Development workshops8:30 am – 11:45 am Stress management and emotional wellness for rNs1:15 pm – 4:30 pm Assertive Communication in the workplacewww.srna.org

15Saskatchewan Association for Safe workplaces in Health at tCu in Saskatoon, SKwww.saswh.ca

26 - 30Foot Care nursing certification course in edmonton, Abwww.devonfootcare.com

29(pm) – 30the Saskatchewan Provincial Nursing Council is hosting its inaugural Nursing leadership Conference at the Saskatoon inn, Saskatoon, SK www.srna.org for updates

APRIL

17 – 18inspire: Health Care Quality Summit 2012 learn. lead. transform tCu Place, Saskatoon, SKwww.qualitysummit.ca for more information

25 – 27AHiC 2012 – towArDS iNteGrAteD DiAGNoStiCS: bringing Crucial information to the Point of Carewww.ahic.nihi.ca

MAY

7 – 11Nursing Foot Care management - Deadline to register is April 6, 2012 in edmonton, Abwww.devonfootcare.com

JUNE

18 – 202012 Convention – Nurses: movers and Shapers, Vancouver, bCwww.cna-aiic.ca/CNA/news/events/convention/default_e.aspx

upcom i ng eve nts


TWO Full time positions available for an independent contractor, one based in Regina and the other based in Saskatoon, Saskatchewan. If you are interested in an entrepreneurial position with a focus on patient care, drug reimbursement, collaborating with health care professionals and advocating for patients with moderate to severe chronic illness, this unique position may be for you.We require an independent contractor, with a nursing or health care background and experience with SK Health Drug Plan & Extended Benefits. The successful candidate must possess the ability to work independently, in a fast pace environment, meet specific work deadlines, is attentive to detail and adaptable to change; be fluent in English with excellent writing and communication skills based on the principles of customer care excellence; demonstrate proficiency with Microsoft Word, Excel and Outlook; and excellent organizational skills with an emphasis on patient file management. This position requires the candidate to work from a home office and be available for occasional travel for training, meetings. Full orientation is provided. Candidates will start ASAP. If you are interested in this position please fax your resume to Marie-Claude Thiffault, BioAdvance Manager, F: 403-284-4105 or email [email protected]. Only thecandidates selected for an interview will be contacted.


http://www.wrcasn.ca/

http://www.srna.org

http://www.srna.org

http://www.saswh.ca

http://www.devonfootcare.com

http://www.srna.org

http://www.qualitysummit.ca

http://www.ahic.nihi.ca

http://www.devonfootcare.com

http://www.cna-aiic.ca/CNA/news/events/


returN uNDeliVerAble mAil to: Saskatchewan registered Nurses’ Assoc. 2066 retallack St. regina, SK S4t 7X5

Publication Agreement #40005137

The SaSkaTchewan Provincial nurSing counciliS hoSTing iTS inaugural nurSing leaderShiP conference.

Saskatoon Inn, Saskatoon, March 29 (pm) & 30

The conference theme provokes a dialogue about nursing leadership and our public, working with others to courageously influence, inspire and innovate the delivery of

quality health care.

The action-oriented program will appeal to LPNs, RPNs and RNs in all roles and at every level of experience. Nursing students are encouraged to attend. The conference will focus

on leading change and impacts on the public, practitioner and system outcomes.

The Saskatchewan Registered Nurses’ Association is providing support for this year’s event — please check the web site for updates on registration, keynote speakers and

interactive sessions.

www.srna.org

http://www.srna.org

SRNA Winter NewsBulletin 2012

Documents

Transcript of SRNA Winter NewsBulletin 2012