Pulse magazine - Lawrence S. Bloomberg Faculty of Nursing

LettersCanada to make our healthcare system more effective,more caring, more efficient– and ultimately sustainable.At the leadership level,Bloomberg Nursing workswith government, regulatorsand professional associationsto advance health careand support our nursing colleaguesat home and aroundthe world in meeting theneeds of their communities.For us, there is nodivide between researchand the professional world.Bloomberg Nursing lives inthe world of practice andbrings to that world the scienceand scholarship of thebest research, be it in education,research or policy. Ourstudents benefit; our facultymembers – both standingand cross-appointed – benefit;the university benefits inthe quality of the researchand our programs; andultimately, society benefits.Better nursing researchand education means betterpatient care. For BloombergNursing, that’s the truemeaning of partnership.SIOBAN NELSON, RN, PHD, FCAHS1 Clark, I.D., D. Trick, and R. VanLoon. (2011). Academic Reform:Policy Options for Improving theQuality and Cost-Effectivenessof Undergraduate Education inOntario. Montreal and Kingston:Queen’s Policy Studies Series,McGill-Queen’s University Press.MYFAVOURITETEACHERCongratulations on anothervibrant and interesting editionof Pulse magazine. In theFall/Winter 2011 issue, I waspleased to see “A Conversationwith Ellen Hodnett,” whichably profiled her renownedscientific talents. However,many in the research communitymay not know what a fantasticteacher Ellen is.I had the privilege of being herstudent in the research course of themaster’s program in 1988, and in thecore nursing theory course for Year II of the undergradprogram. She is one of the finest teachers I ever cameacross during my university years, and I had somegood ones.Ellen was innovative in teaching us fresh-facedundergrads “lessons” about life that were not in anybook, and I’m sure were not part of any approvedcurriculum! Sharp-witted and hard-edged attimes, she insisted we be fully awake andimmersed in life. I was just crazy abouther teaching style. More than 30 yearslater, I’m grateful that many of her wordsand actions are still seared in my memory.I know the science side is critical, butBloomberg is a professional faculty thatwill always have to graduate professionalswho can actually “do” nursing. I hopefuture grads will have the benefit ofbrilliant, funny, no-nonsense, groundedteachers like I had in Ellen Hodnett.Continued success with Pulse, whichis just terrific.Michael J. Villeneuve, BScN 8T3, MSc 9T3Executive Lead,National Expert Commission Secretariat,Canadian Nurses AssociationTELL US WHATYOU THINK!Do you have an opinionor question about anarticle in this issue ofPulse? Drop us a line atpulse.magazine@utoronto.ca or theBloomberg Facultyof Nursing at:155 College St.Suite 130Toronto, ONM5T 1P8Published letters maybe edited for lengthand clarity.PHOTO: REBECCA BARANN o 3

ILLUSTRATIONS: GÉRARD DUBOISt’s the same hoary old chestnut.Nursing employers blame educatorsfor not preparing nurses who are“practice ready.” They claim newgrads don’t know enough and can’t doenough. And hospitals can’t figure outwhy they have to educate the recentlyeducated.Educators reply that they preparelifelong learners. They claim theirgraduates have the theory and skillsto adapt to all manners of practiceenvironments. With some superiority,educators claim not to be simply preparingnurses for busy acute hospitalpractice. With some exasperation,hospitals wonder who is.We need to break this deadlock onceand for all. We need to come up withnew models to make practice-basedlearning positive and our programsresponsive to the needs of the system,now and in the future. This can only bedone in partnership.A PRESSING CONCERNThe top-priority issue in nursingeducation today is clinical experience.Educators and the profession at largeagree that practice-based experienceis the key issue to resolve if we are toincrease the number of nurses in thesystem and successfully resolve thenursing shortage. Clearly, we need newapproaches for developing clinicalskills and professional identity.Simply finding enough clinicalplacements to go around is a challenge.Governments across Canada, led mostadmirably by the Ontario government,have responded to this need byinvesting in simulation centres, whichnow form the foundation of nursingclinical education. However, asevery educator knows, the challenge isputting it altogether in the pressuredenvironment of practice. Studentsmust be in the system to learn how topractise in the system.THE CURRENT REALITYAs educators, our goal is to createpatient-centred professionals whoare competent and reflective; whocan function in the fast-paced and, attimes, downright chaotic health caresystem; and who understand the needfor a system that promotes health andkeeps people well. How do we expectsuch individuals to emerge from a systemthat is acute-focused, and in whichcare is provider-focused?Some of the challenges are of ourown making. For instance, how we arrangeclinical placements for nursingstudents is far from straightforward.First, we in nursing send our studentsinto a health care facility with a paidinstructor who, more often than not,is not a staff member there. Qualityclinical instructors manoeuvre aroundthe staggering disadvantage of beingin an unfamiliar facility and mobilizeresources for their students. But isn’tthis an unnecessarily difficult way tooversee practice?For preceptored (one-to-one) placements,nursing schools place studentson a unit, but the unit manager, orperhaps the educator, decides withwhom the student will be partnered.These preceptors, who are not necessarilyconnected with the university orcollege program, are arguably amongthe student’s most influential teachers.Moreover, for a great many programsthere is no mechanism forstudent feedback to the site or preceptor,so the preceptor may have no wayto gauge his or her success at mentoringyoung professionals. Nor dothe schools or employers collectivelydo much in the way of recognizingmentors who do an outstanding jobtransitioning final-placement studentsinto the profession.A LUCKY DRAWPreceptors, more often than not, areselected by the hospital or unit onthe basis that they are efficient andcompetent, and can “cope” with theadditional pressure of mentoring astudent. In the Carnegie Foundation’sreport Educating Nurses: A call forradical transformation, the authorssingle out the issue of who mentorsnursing students as a priority thatneeds to be addressed. They challengethe “untested assumption that handlinglarger patient care loads will makestudents more efficient upon graduation.Students thus focus on acuteand episodic assignments in hospitalsettings. Instead, programs shouldensure students receive small patientcareassignments at the start of eachnew clinical rotation, and studentsshould have the opportunity to workwith nurses with clinical specialtiessuch as infection control, quality andsafety improvement, and dischargeplanning.” 1Many service providers are greatteaching organizations. But not allpractice settings offer an equal calibreof student experience. Consequently,when students go into a placement,both the students and their professorsfervently hope the environmentis supportive and welcoming.Educators want their students towitness exemplary, patient-centredcare and be mentored by practitionerswho embody the desired knowledge,skill and professional values. Whenthis happens, the educators arethrilled and the students ecstatic.When it doesn’t, educators sympathizeand hope the placement isn’t doingtoo much damage. It’s the luck of thedraw – pure and simple.In this crapshoot of good, averageand horrendous placements, we areteaching the next generation of nursestwo grim lessons. Lesson number 1: Itis what is. You must take it as it comesand continually adapt to the system.Lesson number 2: Develop resilience.You must put up with colleagues whodon’t like students, don’t like newgraduates or, frankly, don’t like you.Nothing can be done about it. Shouldwe be surprised, then, to learn aboutthe prevalence of horizontal violencein the workplace? Need we wonder whymost health services struggle to bepatient- and learner-centred?EXTRACURRICULAR LEARNINGThis fatalistic good-experience/badexperiencepathway into theprofession moulds a nurse’s professionalidentity more than we mightthink and is part of what’s called “thehidden curriculum.” This term has hadincreasing currency in recent years,following Fred Hafferty’s work onmedical education. 2The hidden curriculum recognizesthat only a small part of what is learnedis in the formal, approved curriculum.The informal, and at times poor, culturalpractices learned in professional trainingyield enormous power. In healthcare, the hidden curriculum can lead toprofessional practice that lacks empathy,N o 5

and is task focused and rule bound. Itcan result in practitioners who lack theskills to overcome the pressures of theclinical environment to provide supportive,individualized care.In My Imaginary Illness: A journeyinto uncertainty and prejudice inmedical diagnosis, author Chloë Atkinschronicles her years of being told shehas a psychosomatic illness, whichwas later diagnosed as myastheniagravis. In a clinical commentary to thebook, U of T professor Brian Hodges, apsychiatrist at and the vice-presidenteducation of University Health Network,shares how clinicianslearn to manage theiremotions in challengingsituations. He expressesgratitude to the mentors whoshowed him how to handlethe anger that certainsituations or individuals cangenerate and taught himhow to prevent his attitudefrom hardening.What Hodges so ablydemonstrates is that healthcare is skilled work. It’s easyto care for people whom welike and with whom we naturallyidentify. It’s altogetherdifferent caring for patientsand families with challengingbehaviours. Someclinicians avoid interactingwith patients who challengeor overwhelm them, whileothers are downright aggressiveto them. Evidenceshows that these patients donot receive quality care and tend to bemisdiagnosed.TAKING RESPONSIBILITYAt Bloomberg Nursing, we are seriousabout the quality of our program andtake full responsibility for every aspectof student learning. Four years ago, westarted examining student placementsby developing a comprehensive studentevaluation system to better understandthe clinical experience. Throughthis system, the student undertakesa 360-degree evaluation that includesan appraisal of the site, self-assessmentand assessment by placement staff.Bloomberg Nursing, in turn, providesfeedback to the clinical instructors, preceptorsand placement agencies.Now, with three years of data underour belt, we can say with some confidencewhat everyone intuitively alreadyknew – settings with staffing difficultiesare challenging environmentsfor students. Although our studentsevaluate their clinical placements asoverwhelmingly positive – a definitegood news story for our partners – theyalso unerringly identify problems that,although unfamiliar to BloombergNursing, are very familiar to the settingleadership. Our partners are fully awareof the units that have high turnover,leadership issues or other problems,and they’re struck by the veracity of thestudents’ observations.The service providers have trulywelcomed student feedback, bothpositive and negative. The leaders haveused the feedback that raises concernsabout the practice and learningenvironment to address issues withstaff and managers, and to learn moreabout the relationship between thelearning environment and the unitclimate. And as partners, we can nowcollectively recognize outstandingteachers, and units that are studentcentredand wonderful learningenvironments.To further integrate learning andmentorship, and emphasize the collaborativenature of our academicpartnerships, Bloomberg Nursing hasbeen working to increase the numberof clinical instructors recruited fromour hospital partners. Our ABC (AgencyBased Curriculum) program allowsstudents to spend most of their placementsat one partner agency,enhancing their confidenceand allowing them to developinto competent nurses with astrong professional identity.Meanwhile, our graduatestudents increasingly work onprojects that arise as prioritiesin the practice setting,and meaningfully engage indeveloping and evaluatinginnovative practice modelsin partnership with thefield. And there’s much morecoming down the pipeline,including an expanded ABCprogram, internships in collaborationwith our master’sprogram, and joint strategicplanning with academicpartners in the hospital andcommunity.There are compelling reasonsto think collaborativelyabout these issues. Studentsneed to be placed with mentorswho function at a high level in apatient- or population-centred practicesetting. What’s more, we have to scaleup those opportunities to meet thecurrent and future needs of all of thehealth care system.Education and practice must tacklethe hidden curriculum together. AtBloomberg Nursing, we embrace theseopportunities and envision the futureof nursing education as it can andshould be.ø1 Benner, Patricia; Sutphen, Molly; Leonard, Victoria; Day, Lisa. Educating nurses: a call forradical transformation. (2009) Carnegie Foundation for the Advancement of Teaching.2 Hafferty, Frederic. Beyond curriculum reform: confronting medicine’s hidden curriculum.Acad Med 1998; 73(4): 403-7.N o 6SPRING/ SUMMER2012

BLOOMBERG NURSING IS ABLE TO PROVIDE ASTELLAR EDUCATION BY RELYING ON THE SUPPORTOF ITS MANY PARTNERS. IT’S THROUGH THESEVALUED PARTNERSHIPS THAT BLOOMBERG NURSINGWILL NOT ONLY GROW, BUT FLOURISH.ILLUSTRATION: ©LAUGHING STOCK/CORBISN o 7

Bloomberg Nursing opens the door toclinicians and closes the theory-practice gapt’s as if the walls of the Bloomberg Nursingbuilding are permeable. Our home standsadjacent to “hospital row” on University Avenue,and students and nurses move seamlessly betweenour building and health care facilitiesthroughout the Toronto area.Bloomberg Nursing grants nurses with specialskills or knowledge an adjunct lecturer appointment.It has more than 250 adjunct lecturerswho practise everywhere from Women’s CollegeHospital, to Holland Bloorview Kids RehabilitationHospital, to the Ontario Agency for HealthProtection and Promotion. These adjunct lecturerscontribute in countless ways. They engagein preceptorship and clinical teaching, providegraduate-level clinical supervision, and have theMANY OF THE CLINICIANS WHO TEACH ATBLOOMBERG NURSING PEPPER THEIR LECTURESWITH ENLIGHTENING PERSONAL ANECDOTESTHAT RANGE FROM THE COMIC TO THE TRAGICexpertise to support, maintain and enhance ourteaching.To sustain excellence and ignite innovationin nursing education, Bloomberg Nursingestablished the Hospital and University NursingEducation Committee. This advisory group– composed of faculty from Bloomberg Nursingand staff from our affiliated teaching hospitals –plans new education initiatives, including studentplacements, and ways to further engage clinicalfaculty and preceptors in our academic mission.FIRST STEPSBeginning a clinical placement can place thesteadiest of students on shaky ground. “From anursing student’s perspective, the tasks can beoverwhelming,” reports Mary Agnes Beduz, thesenior director of surgery and oncology, and nursinglead for new knowledge innovation at MountSinai Hospital. “I tell them their most-importantjob is to learn to think. The tasks will change overtime; what’s important is the critical thinkingpiece. They need to understand the why of whatthey’re doing.”Mount Sinai has several initiatives in place tohelp nursing students make the transition fromtheory to practice. To encourage staff nurses to beclinical instructors, the hospital provides releasetime. “When the clinical instructors are familiarwith the environment, the student experience isfar better,” says Beduz, BScN 8T0, MN 0T4. Morethan 250 preceptors offer one-to-one supervisionwhile fulfilling the roles of coach, role model andeducator. “We support our preceptors with trainingso they’re able to provide worthwhile feedbackand teach in the moment,” she says.This Bloomberg Nursing adjunct lectureremphasizes that staff offer students more thanclinical training. “They socialize the studentsinto the profession,” she says. “The students learnabout what it means to be a nurse in an acute caresetting.”Toronto Academic Health Science Networknurses also partner with Bloomberg Nursingto develop and teach courses. Beduz, for example,has taught two master’s courses: AdvancedNursing Practice Scholarship and Methodologyfor Qualitative Improvement. In addition, shehas given lectures on her area of expertise –knowledge translation.WALKING THE WALKMany of the clinicians who teach atBloomberg Nursing draw from the situations thatarise in their day-to-day practice. They peppertheir lectures with enlightening personal anecdotesthat range from the comic to the tragic.These stories from the frontlines of nursing arewhat keep our students on the edge of their seats.“The foundation of what I teach is from research,texts and the course curriculum, but a lotcomes from my experiences with the patients I’veserved and the health care team I work with,” saysWilli Kirenko, who teaches the online NP courseAdvanced Health Assessment and Clinical Reasoning.“There’s something new for me to learnevery day, and I save up those experiences andshare them with the students.”N o 8SPRING/SUMMER2012

ILLUSTRATION: PAUL VISMARA ©IMAGES.COM/CORBISThe nurse practitioner co-ordinator anddirector of quality and interprofessionalpractice at Chatham-Kent Health Alliance isa favourite among NP students. In both 2010and 2011, the students and Kirenko’s peersnominated her for Bloomberg Nursing’sExcellence in Online Teaching Award, whichrecognizes the ability to engage students andfoster critical thinking through virtual modalities.In both years, she won!Kirenko, MN 0T6, merely shrugs and pointsto the goldmine of learning experiences a hospitalemergency department provides. “I canshare what I’ve learned from patients with skinconditions, infectious processes, and injuries orchronic diseases. The ED is a fantastic area forNPs to work to get a really varied exposure to differentkinds of patients and health conditions.”As a practising NP, Kirenko is also able to passonto our students her strategies for providingoptimal care. “The most-important message oradvice I can share with NP students is to avoiddistractions, focus on the work at hand, and takethe time to really listen to the patients and to heartheir story, while paying attention to not only thewords they say, but how they say them.”FINDING YOUR STRIDELeslie Vincent, the executive director of ourCentre for Advanced Studies in ProfessionalPractice (CASPP), helps plan courses for graduatenurses who want to keep right on learning. She isproud of the CASPP instructors, all of whom areleaders in clinical practice, education, researchor informatics. “And we’re always increasing thenumber and diversity of our instructors,” she says.Linda Nusdorfer, a critical-care advancedpractice nurse at Sunnybrook Health SciencesCentre, has helped develop scenarios for CASPP’sAdvanced Critical Care Competencies ThroughSimulation course, and has just facilitated thecourse for the third year.Teaching for CASPP helps her advance the profession.“It’s one way to support nurses to stretchthemselves in their roles,” says Nusdorfer, aBloomberg Nursing adjunct lecturer. “The coursepushes them beyond their basic skills by challengingtheir critical thinking ability.”The two-day course draws critical-care nursesfrom across Ontario to our Simulation Laboratory.The participants soon come to realizethat no matter the setting, they share the samechallenges. From there, Nusdorfer and the otherfacilitators catapult the learning forward. Theparticipants share their knowledge on expectedpractices based on evidence, and identify the similaritiesand differences between their practicesettings. They learn what new research is drivingstandards of care at the bedside. “The courseoffers the participants the opportunity to meetothers in the field and forge support networks,”says Nusdorfer, MN 0T4. “During the simulationdebriefing session, there is an opportunity toshare experiences and reflect on how situationscan be managed differently.”For the CASPP course, the Sim Lab is arrangedto resemble an ICU, and the mannequins arehooked up to ventilators, cardiac monitors anda plethora of pumps. “The scenarios provide thestudents with the opportunity to look at howteam members interact and how quickly the teamresponds to changing situations. Everyone has anopportunity to participate and take on a role theywould have in their practice. The course providesa safe zone to practise and build some strategies.”The Advanced Critical Care course has inspiredanother CASPP course: End-of-Life Carefor Critical Care Nurses – Developing ExpertiseThrough Simulation. Nusdorfer is helping developthis course, which will address ways to support aclient’s family. “End-of-life can be a challengingtime for both family members and health care providers,”she says. “We need to be able to engage thepatient, family members as well as team membersin conversations that aren’t laden with our personalvalues or bias. The course will help nurses feelcomfortable with understanding what the patientvalues and wants. The intent is to build confidencein having dialogues that advocate for the patientposition and support the team. End-of-life is abouthonouring the patient’s wishes and working togetherto ensure the most positive outcome.”øN o 9

All nurse researchers strive forthe same goal – better patient outcomesew Bloomberg Nursing research partnershipsare percolating all the time. Somepartnerships form to harness the synergy thatcomes from joining forces. Other researchersdecide to partner with clinicians to forge betterpathways for knowledge to flow between them.Still others create partnerships for the practicalreason of leveraging their resources.Research informs decisions, and BloombergNursing research provides the hard data toinform health care decisions around the world.Our scientists are not oriented to other scientists;their eyes are fixed on the practitioners,policy-makers and leaders that can transformthe knowledge they create into better patientoutcomes. Here are four promising partnershipsthat Bloomberg Nursing researchers recentlyestablished.THE POWER OF MANYLast year, nurse researchers from BloombergNursing and U of T’s affiliated hospitals sataround a table and volleyed about ideas for constructinga stronger partnership. They soon cameto realize that through an academia-health servicesresearch partnership they could tap intoopportunities to maximize their clinical andintellectual resources. A formal partnership couldspark the development of new knowledge. Andimportantly, it could help to quickly translate newscientific evidence into innovative care practices.The new partnership between the TorontoAcademic Health Science Network (TAHSN)and Bloomberg Nursing – through the TAHSNBloomberg Nursing Research (TBNR) Committee– provides a strong foundation for exploringexciting new ideas.“TAHSN hospitals provide a rich environmentto study patient populations and measure theimpact of process and/or practice changes,”says Ella Ferris, the chief nursing executive atSt. Michael’s Hospital. “As academic organizations,we should be implementing evidencebasedpractice and measuring clinical outcomesas well as contributing to new best practices thatwill lead to quality patient outcomes.”TBNR is co-chaired. The academic arm isrepresented by Professor Linda McGillis Hall, ourassociate dean of research and external relations;and the affiliate sites are represented by LianneJeffs, BScN 9T2, MSc 9T8, the director of nursingresearch at the Li Ka Shing Knowledge Institute atSt. Michael’s. All TAHSN-affiliated health care organizations– including nursing research chairs,clinician scientists and research scientists – areinvited to engage with TBNR.“The partnership allows us to take an inventoryof resources and gain a better understandingof our practice-based expertise across the sites,”says McGillis Hall, MScN 9T3, PhD 9T9. And thegroup keeps discovering new benefits. “One waywe hope to move forward is by collaborating onresearch grant submissions across a number ofsites,” adds McGillis Hall. “The group is a catalystfor ideas.”“I think the greatest success will come froman interprofessional approach to research witha focus on patient populations, such as chronicdisease management, mental health, diabetes orcare of the elderly,” says Ferris.Emerging plans for the group include conductingnursing research grand rounds at TAHSNhospitals. The first rounds are planned for thisfall and will be led by nurse researchers andstaff nurses. The focus will be the assessment ofpain in vulnerable populations, including youngchildren, the elderly and individuals with mentalhealth issues.AM I MAKING A DIFFERENCE?Imagine having a way to measure the effect ofthe nursing care you provide. And wouldn’t it begreat to benchmark your practice unit against apeer’s or the national average?A new partnership – led by the CanadianNurses Association and Academy of CanadianExecutive Nurses – is developing a co-ordinatedsystem to collect, store and retrieve nursingdata from coast to coast to coast. The CanadianNational Nursing Quality Report (NNQR(C)) willprovide benchmarks so clinicians and managerscan evaluate the care they’re providing. It willILLUSTRATION: GEORGE SCHILL©IMAGES.COM/CORBISN o 10SPRING/SUMMER2012

attempt to delineate the relationships betweenvarious nursing-sensitive indicators to influenceoperational and policy directions.The project leads are two Bloomberg Nursingscholars: Professor Diane Doran, the scientificdirector of the Nursing Health Services ResearchUnit (Toronto site); and Assistant ProfessorKarima Velji, MSc 9T7, PhD 0T6, Baycrest’s chiefoperating officer and chief nursing executive.The partnership grew out of a Montreal invitationalthink tank in February 2011 that drew morethan 50 nurse leaders from across Canada, as wellas thought leaders from research, education andregulatory bodies. The leaders developed a singularvision for a national report card on nursing.“Each association has its own mission, but thisproject supports mutual goals,” says Doran. “Thegoals are relevant to a variety of missions.”For example, researchers will be able to accessthe NNQR databases to study relationshipsbetween nurse staffing, patient health and safetyoutcomes. Professional associations can use thereports to co-ordinate improvement efforts. Andthe new outcomes monitoring system will enablenurse leaders to identify promising practices aswell as areas of difficulty. “The system will be likea signal, helping nurse leaders identify what partsin the process of care may be breaking down,”says Doran. “It won’t offer complete solutions, butit will raise awareness.”NNQR capitalizes on the information availablein electronic health-record databases. “Nursingsensitive indicators are hidden in various databases,so we’re pulling them out,” explains Velji.The think tank participants named a varietyof markers, including structural indicators, suchas the RN-RPN ratio; process indicators, such asmedication errors and restraint use; and outcomeindicators, such as pressure ulcers and pain. Nowthe research partnership is building a nationalconsensus on the appropriateness of these andother nursing sensitive indicators. “You can’tmeasure everything,” warns Doran. “This is aminimum set.”While the NNQR team conducts pilot studiesacross Canada, plans are underway to createvirtual communities of practice that will enableorganizations to use NNQR data to advance performance,patient safety, staffing and accreditation.Ideas include email updates, newslettersand webinars.Velji looks forward to using NNQR at Baycrest,where she can use it to chart nursing improvementswithin the organization, and compare itsnursing sensitive indicators to those of her peersas well as the national average. “NNQR is aboutnurses doing right by the people they serve,” saysVelji.CARING FOR OUR ELDERSThe focus of the new TAHSN/U of T Elder CareInitiative is to determine the best evidence ingeriatric care and then to translate that knowledgeinto practice. “It’s about evaluating researchin practice, and then building further researchon the findings,” says Velji who is partnering withtwo other chief nurse executives, Ferris from St.Michael’s and Tracy Kitch from Mount Sinai Hospital.“That’s scholarship at its best.”This scholarship network for elder care is apartnership between the chief nursing executivesand geriatric advanced practice nurses at TAHSN,and Bloomberg Nursing professors and graduatestudents concentrating on gerontology. “We’recoming together to focus on a key priority we canwork on together,” says associate professorKatherine McGilton, BScN 8T7, MScN 9T3,PhD 0T1, who has assumed a leadership role inthe Initiative. “Our key priority is to prevent thephysical and cognitive decline of older adults thatcan be associated with the hospital experience.”More than 50 per cent of acute-care hospitalbeds are occupied by patients aged 65 and older.“While hospitalization offers these patients highlevelcare during a severe illness, being in thehospital puts them at risk of adverse events andfunctional decline,” says McGilton, who is alsoN o 11

a scientist with Toronto Rehab. “Without swift,well-integrated, evidence-based and interdisciplinaryinterventions, the health of older patientscan decline rapidly in hospital. Nurses have apivotal role in implementing these interventions,”she adds. The consequences of not providing thislevel of care can include the need for additionalhospital stays, premature admission to a residentialcare facility, a permanent loss of independenceand a diminished quality of life.The Initiative calls for holistic, individualizedcare of seniors and recognition of its inherentcomplexity. “Older adults typically present withmultiple, interacting medical and social problemsthat can defy straightforward interventions,” saysMcGilton. “The management of older adults requiresa specialized body of knowledge and skills,as well as support from administrators to assistwith implementing best evidence into practice.”“How you treat older people is a reflection ofsociety and its values, and as a society we need todo better in caring for older people,” says Velji. “Wehave a responsibility to change that.”OUR NEWEST PARTNERSHIPThe Victorian Order of Nurses (VON) andBloomberg Nursing are developing a partnershipagreement that cements their relationship inthe areas of research, and home and communitynursing, reports Judith Shamian, VON’s presidentand CEO, as well as the Canadian Nurses Associationpresident. “We’re working on building arobust program that will have a strong emphasison the importance of home and community carein building a healthy nation.”“This partnership will provide the basis foran innovative approach to student learning, andprovide graduate and leadership positions,” addsSioban Nelson, the dean of Bloomberg Nursing.“We are delighted that through this partnershipBloomberg students can learn at the cutting edgeof community care. The partnership will buildthe foundation for strong research initiatives inhome care.”VON is Canada’s largest, national, not-forprofit,charitable home and community careorganization, and has previously partnered withBloomberg Nursing researchers, including DianeDoran and Linda O’Brien-Pallas, BScN 7T5, MN7T9, PhD 8T7, a recently retired professor. It considersresearch as part of its leadership role.“Home care is at the forefront of health care andcommunity partnerships, and volunteerism,” saysNelson. “Sustainable community initiatives arecritical to improving the health of Canadians.”The new Bloomberg Nursing-VON initiativealigns with Ontario’s Action Plan for Health Care,which emphasizes a wider use of home care, saysSherri Huckstep, VON’s vice-president, centralregion. “Bloomberg nurses will be leaders in thetransformation of home and community nursingin Ontario and Canada.”øFaculty members across U of T enrichthe Bloomberg Nursing curriculumhe University of Toronto is leading the wayin interprofessional education (IPE). It’s one ofonly a few Canadian universities to formally supportan IPE program that focuses on learningboth in the classroom and in the practice setting.And all across North America, universities arelooking to our IPE model for guidance and inspiration.U of T’s groundbreaking initiatives gatheredspeed in 2006 when the deans and chairs ofseveral health science faculties endorsed the developmentof a requisite IPE curriculum. In 2009,they leveraged a partnership with the TorontoAcademic Health Sciences Network to create theU of T Centre for Interprofessional Education withToronto Rehab and University Health Network aslead hospitals. The Centre, now located at TorontoWestern Hospital, co-ordinates and promotes IPEprograms across the university and in clinicalplacements in Toronto and beyond.IPE prepares students with the knowledge,skills and attitudes necessary for collaborativeinterprofessional care. If you were enrolled at theFaculty in the 1980s or ’90s, you were schooled inmultidisciplinary care. Under this model, you mayhave learned with students from different healthcare professions in the same room, but there waslittle learning about how the various professionsN o 12SPRING/SUMMER2012

approach a health problem. Prior to this, yournursing education may have been uniprofessional;that is, limited to the profession of nursing.In interprofessional care, the hierarchy isflattened, and members of the health care teamcollectively problem-solve, share care and makedecisions together. “Interprofessional carerequires the courage to step back and say youdon’t know, and the humility to admit you needhelp from the team,” says Maria Tassone, thedirector of the Centre. “Since health care professionalshave traditionally been socialized to havethe answers themselves, IPE really challengespeople to their level of comfort and discomfort.”While IPE has been accused of blurring thedistinctions between the health care professions,Tassone finds the opposite to be true. “IPE actuallystrengthens the nursing student’s identityas a nurse,” she says. “A nursing student comes torecognize his or her duality: as a proud nurse andan excellent collaborator.”AT THE UNDERGRADUATE LEVELSince 2009, Bloomberg Nursing has embeddedthe IPE core learning activities in the BScNcurriculum. In addition, it requires its undergradsto participate in two elective IPE sessions coordinatedby the Centre.The first session is a grand gathering at ConvocationHall for all of U of T’s 1,200 first-year healthscience students. Faculty members demonstratedifferent ways to engage with patients and families,and deliver care. As part of the session, aformer patient steps onto the stage and recountshis or her journey through the health care system.Finally, 100 IPE facilitators help small groups ofstudents reflect on their chosen profession andtheir future role on an interprofessional team.In second year, BScN students attend aninterprofessional seminar designed to teachthat conflict is a normal part of working life, andhealth care professionals are responsible for navigatingthrough it. These sessions are relativelysmall; 600 students come together in the ChestnutResidence ballroom. In small groups, they addressconflict about a treatment plan througha simulation process.“Nursing students are enthusiastic about IPE,”says senior lecturer Zoraida Beekhoo, our facultylead for IPE. “They don’t see it as an add-on.They see interprofessionalism as the best way toprovide quality care.”AT THE GRADUATE LEVELAs part of the IPE learning activities forstudents placed at Mount Sinai Hospital, DonnaRomano, MScN 9T8, co-facilitates seminars forinterprofessional teams made up of students fromvarious faculties, including nursing, medicine,social work and pharmacy.During the seminar, a team interviews apatient and family members as part of the intakeIt takes a universityThe following U of T faculties anddepartments contribute to educatinga Bloomberg Nursing student:• Dentistry• Medical radiation sciences• Medicine• Occupational scienceand occupational therapy• Pharmacy• Physical education and health• Physical therapy• Physician assistant• Social work• Speech-language pathologyPHOTO: REBECCA BARANMaria Tassone, the directorof the U of T Centre forInterprofessional EducationN o 13

process. “This is an excellent learning opportunityfor students to assess patients on an interprofessionalteam of learners,” says Romano, thenursing unit administrator in the department ofpsychiatry and the hospital’s inaugural interprofessionaleducation co-ordinator. Followingthe interview, the students share their reflections,and the patient and family members providefeedback on the interview process.For the master’s course NUR 1072, the BloombergNursing assistant professor (status) also organizesseminars for students on the role of theadvanced practice nurse on an interprofessionalteam.“Providing IPE learning experiences in practicesettings is essential,” says Romano. “Learningabout each others’ roles on the health care teamand collaborating together enhances the abilityof our future clinicians to meet the complex careneeds of today’s patients.”øPHOTO: REBECCA BARANDonna Romano, Mount Sinai Hospital's inauguralinterprofessional education co-ordinatorWhere would BloombergNursing be without you?here is a wonderful mythical law ofnature that the three things we crave most inlife – happiness, freedom and peace of mind –are always attained by giving them to someoneelse.” This epiphany belongs to Peyton March,a 19th-century American general. But can it beapplied to the Toronto financiers, alumni andmyriad others who have given to BloombergNursing?We can’t vouch for the happiness, freedomand peace of mind of our donors. We do know,though, that their gifts bring joy to our students.Beyond a doubt, some of these students wouldnot be fulfilling their life dream of being a nursewere it not for those willing to give them ahelping hand.THE URBAN ANGELHospital volunteer associations typically usethe money they raise at the gift shop and throughother activities for new hospital equipment or,perhaps, patient education materials. But the St.Michael’s Hospital (SMH) Volunteer Associationrecently stepped out of the ordinary and committed$500,000 to a limited-term nursing researchchair.“It’s the first time the hospital’s VolunteerAssociation has raised money for a chair,” saysKristine Thompson, the Association president.“Each year we consider opportunities, and mostoften we choose projects that ease the patientjourney in the hospital.” What caught the eye ofthe Association members is the chair’s mandateN o 14SPRING/SUMMER2012

– to further patient safety, knowledge translationand quality improvement.Part of the proceeds from the hospital’s 2011Angel Ball Gala has also been applied to the newchair. “Since 2005, nursing at SMH has had a strategicfocus on cultivating a culture of discovery,”says Ella Ferris, SMH’s chief nursing executive.“Since that time, nurses have demonstrated a commitmentto implementing evidence-based practiceby translating knowledge to action and advancinginnovations in safe care to achieve quality outcomesfor patients through nursing research. TheSt. Michael’s Hospital Volunteer Association Chairin Nursing Research will align with the hospital’spriority to achieve excellence in quality patientcare.”It will also align with Bloomberg Nursing’s commitmentto international leadership in researchand education. A committee is now searchingglobally for a scholar to fulfil the chair’s mandate.The chair will be cross-appointed to BloombergNursing, so the world-renowned scholar will be ourstudents’ new prof.ENCOURAGING THE STUDYOF GERONTOLOGYThe new Baycrest Ben and Hilda Katz Chair inGerontological Nursing Research is a joint chairwith U of T. Again, the search is international, andthis chair will not only teach classes but provideleadership for the gerontological content of ourcurriculum.The search committee is looking for a renownedscientist in the care of older adults, especiallythose with age-associated brain dysfunction. Butthey’re looking for more. The candidate must alsobe a talented educator with the capacity to inspirestudents to pursue research and clinical careers ingerontological nursing.“It is fantastic to establish a nurse scholar role ingerontology nursing,” says assistant professorKarima Velji, MSc 9T7, PhD 0T6,Baycrest’s chief operating officer andchief nursing executive. “This scholarwill push the boundaries of knowledgecreation and knowledge applicationin the field of aging; and the developmentof education curricula that willprepare practitioners to work withthe aging population.”øFOREVER REMEMBEREDThe Clare Scanlan Scholarship honours a much loved motherAt Bloomberg Nursing’s annual awardsceremony, most of the front row is filledwith members of the Scanlan family.When Clare Scanlan, RN, died suddenlyin 2003, her husband, Bernard, andtheir eight children chose to honour hermemory by establishing a BloombergNursing scholarship in her name.“The Clare Scanlan Scholarship is alegacy to my mom,” says Tom Scanlan,one of Clare’s five sons. “It’s importantthat our family has an occasion to talkabout our mom. Every fall at the awardsceremony, she’s in the spotlight. It’s acelebration of her life.”In 1945, Clare graduated from thenursing program at Hotel Dieu Hospital inKingston. Eventually, Bernard, Clare andtheir ever-increasing number of childrenmoved to Scarborough where Clare workedthe evening shift at East General Hospitaland later at Providence Villa. “Before mymom left for work, she would leave us littlenotes to tell us things like, ‘Turn off thestove,’” recalls Tom. “When Mom got homefrom work at 11, she’d get out the crackersand cheese, and talk to us kids.”“In the morning, if you wanted totalk to Mom or you just needed a hug,you could crawl into bed with her,”remembers Rosemarie McClean, Clare’ssecond-youngest daughter.It was Rosemarie who came up withthe idea of honouring their mother’smemory through a scholarship. “I thoughtof the linkage to the Faculty of Nursingbecause Mom was so proud of beinga nurse. Also, she was a big believer ineducation,” says Rosemarie. The familyendowed the scholarship, which means itwill be awarded every year for all of time.“The scholarship is based as much onneed as academic prowess,” adds Tom,“but it was the need that resonated withour family. It’s something that matchedour mom’s generous spirit.”This year’s recipient is CarolineWang from the Class of 1T2. “TheScanlan Award lightened my financialburden,” says Wang. “It helped to payfor textbooks, which can be very costly,even the used ones.” Wang’s dream isto become a paediatric nurse. After twoyears of clinical experience, she hopes toreturnto Bloomberg Nursingfor her master’s and become an NP-Paediatrics.For the Scanlan family, part of the joyof the scholarship comes from meeting therecipient at the annual awards ceremony. “Iknow my mother would have been thrilledwith every single recipient,” says Rosemarie.The occasion also offers the Scanlans theopportunity to tell the student about thewoman who the scholarship honours.“Our mom embodied the spirit ofwhat a great nurse should be,” says Tom.“But when we were growing up it didn’treally matter what she worked at, we justknew she was a wonderful mother.”N o 15

Nursing graduates play a vital role in helping studentshone their clinical skills and make informed career decisionsAlumni ShawnaArdley (left) andHilary Hall hosteda Dinner with 12Strangersloomberg Nursing is proud and privilegedto have alumni committed to partnering withtheir alma mater on a variety of student events.Here are three opportunities for you to use yourprofessional experiences to make a difference inthe life of a nursing student.DINNER WITH 12 STRANGERSIn this university-wide initiative, an alumnushosts dinner for students, a faculty member andother alumni. In February, Hilary Hall andShawna Ardley, both BScN 0T9, put on a Dinnerwith 12 Strangers in Hall’s townhouse. Over twopans of lasagne, students excitedly spoke withalumni who were just as excited to share anecdotesfrom their nursing career.“We’ve always had an interest in learningfrom other people in the health care system, peersupport, mentoring and multidisciplinary learning,”says Ardley, a nurse with Toronto PublicHealth and volunteer preceptor for IMAGINE, aninterprofessional health outreach initiative formarginalized populations. “U of T Nursing is notjust a program. It’s a community.”“When I was a student I really wanted to hearfrom other nurses,” adds Hall, a diabetes nurseeducator at South Riverdale Community HealthCentre. “So now that I’ve graduated, I feel it’s importantto connect with nursing students.”Bloomberg Nursing has a long list of studentseager to meet alumni over dinner and is currentlylooking for graduates to match them with.Volunteer commitment: With the help of theAlumni Relations Office, you design the evening.Limit the number of guests to eight or ask for 12. Orderin pizza or bake your famous eggplant parmesan.Hold the dinner at home or at the corner bistro.HAST CASTING CALLEvery December, alumni volunteer to take onthe roles of patients so first-year students can betested on their assessment skills. In BloombergNursing’s Simulation Lab, a volunteer may beasked to display signs of pneumonia at a clinicvisit. Or, he or she may be asked to don a hospi-PHOTO: REBECCA BARANN o 16SPRING/SUMMER2012

PHOTOS: SUSAN KINGtal gown, crawl into bed and exhibit the myriadsymptoms of a heart attack. During this HealthAssessment Skills Test (HAST), examiners gradethe students’ assessment technique as part of theIntroduction to the Practice of Nursing course’sfinal exam.Beverly Coburn, BScN 5T4, a former U of Tnursing lecturer, helps organize this volunteerventure. “Volunteering is essential to the activitiesof the university,” says Coburn. “Alumnienjoy the students and have a lot of fun.”Emily Jenner, Certif. in Public Health Nursing6T2, BScN 6T9, volunteered as soon as she learnedBloomberg Nursing needed her help. “I find it pleasantto be exposed to the learning environment,gain some awareness of what’s happening and seethe increase in quality standards,” says Jenner.Volunteer commitment: You will be asked toportray a patient with specific symptoms. Volunteerfor a half or full day.ALUMNI MENTORSHIP LUNCHEvery spring, this event supported by TD givessecond-year students the opportunity to explorethe career paths their nursing degree will provide.Over lunch in the Bloomberg Nursing building,alumni from various nursing fields share theirexperiences and answer questions from studentscraving a glimpse of their future.Last year, students interested in practisingoutside of Ontario were eager to speak with PaulJeffrey, MN 0T8, who has worked in an emergencysetting in Sydney, Australia, and practisedpublic health in Uganda. At the luncheon, Jeffreyencouraged students to explore as many nursingopportunities as possible. “You may have an ideaof where you want to work now, but then if youwant to try something else you have the option ofmoving on,” he says.Other alumni shared their practice experiencesin a variety of settings, including an eating disordersclinic, intensive care unit and communityhealth agency.Volunteer commitment: On the day of theluncheon, you need to be available for two hours.As well, you must be open to answering studentquestions by email for two weeks following theevent.øTo volunteer with Bloomberg Nursing, contactthe Alumni Relations Office at development.nursing@utoronto.ca or 416.946.7097.Alumni (clockwisefrom top-left) JoyMarshall, JonathanFetros, LeanneVerscheure andBeatrice Odhiamboanswer questionsfrom students at theAlumni MentorshipLunchsupported bytd canada trustN o 17

p. 19 p. 20 p. 22 p. 26 p. 28p. 29Q&A Opinion News Spotlight Time Travel EventsN o 18SPRING/SUMMER2012

ILLUSTRATIONS: MEGAN HALSEYA CONVERSATIONWITH BARBARA MILDONPulse: Why form apartnership?Mildon: The purpose ofa partnership is to cometogether to solve a problemor meet a need. In the healthcare sector, partnershipsare formed to better meetthe needs of the patient andfamily, and therefore servethe interests of the public.Partnerships have the potentialto improve or enhancehealth outcomes, and tostrengthen the health caresystem. We know that withouta strong and sustainablesystem, the health needsof Canadians across thecontinuum of promotion,prevention and treatmentcan’t be met.Partnerships need to bestrategic. Just as is said ofhuman relationships, theycan be undertaken for a reason,a season or a lifetime.Partnerships can leverageresources, expand our reach,and I would suggest theygive us greater voice. CNAstrongly believes in partnerships.For example, last yearwe partnered with the CanadianMedical Association toco-author Principles to GuideHealth Care Transformationin Canada. More recently,we released a joint statementin response to the Councilof the Federation announcementabout their approachfor a pan-Canadian dialogueon the future of the healthcare system.Closer to clinical practice,I am excited about our partnershipwith representativesfrom registered nursing,practical nursing, psychiatricnursing and unregulatedcare providers who cametogether to develop a new“Staff Mix Decision-MakingFramework,” that will soonbe published. The boardof each partner approvedthe framework, providinga strong foundation for itssuccessful implementationand uptake.Pulse: What makes asuccessful partnership?Mildon: The foundationof a partnership is equality.Without equality, thepartnership can degenerateinto bullying, into fear,into coercion. Each partnerneeds to have the opportunityto say this does or doesn’twork. Each needs an equalvote, an equal opportunityto be profiled. And youneed to be transparent withyour partner. If an issue orproblem comes up in thepartnership, it needs to beresolved quickly and openly.Trust is also vital. You haveto establish trust that thepartner will not independentlygo out with a positionthat hasn’t been agreedupon or vetted.It’s important to concentrateon the areas of agreement.There will inevitablybe areas upon which partnerscan’t agree, but thatdoesn’t mean you shouldn’thave a partnership. CNA andCMA may not agree on everylevel, but those instancesare outnumbered by themany things we do agree on.Partnerships bring differentCNA’s president-electshares the elements of asuccessful partnershipperspectives and differentlived experiences; they allowus to consider a problemfrom more than our ownexperience.Another success factor istime because partnershipstake nurturing. You need tospend time with the partner,exploring views, looking forareas of synergy, findingagreements and then translatingthose agreementsinto tangible outcomes.Attending each other’s meetingsor events is very helpful.Doing so helps you understandwhat the issues are foryour partner, and they helpyou see areas of overlap, ofintersect, of opportunity.You need to go into thepartnership with the understandingthat it won’t alwaysbe easy sailing. There willbe tough times, and eachpartner has to resolve tohave courageous conversationsabout what the issuesare and how to resolve them.If we come to a partnershipwith rose-coloured glasses,then we’re going to be disappointedand disillusioned.That’s when a partnershipcan fall apart.Pulse: Do all partnershipshave positive potential?Mildon: Yes! Sometimespartnerships require compromise,and you have to becareful about compromise.One always needs to ask:To what extent can I/wecompromise? But sometimesout of a compromise comesmuch greater strength becauseyou each leave roomfor growth and for new possibilities.But I honestly can’tthink of any other drawbacksto partnerships if theyreflect the characteristics wetalked about earlier.Pulse: Are students inpartnership?Mildon: Having been astudent at U of T for almost17 years altogether, that is agreat question! Yes, I believestudents are in partnershipwith both the educationfacility and the professors.But the power imbalancewe recognize in the nursepatientrelationship is alsopresent in the professorstudentpartnership. Thenurse has knowledge andskills the patient does nothave. The professor ultimatelydecides on the gradethe student receives. Thequality of the partnershipestablished between nurseand patient or professor andstudent influences the individual’ssuccess, whetherhealth related or academic.Pulse: What promptedyou to go back to school?Mildon: I was a diplomagraduate and had beenpractising for 10 yearswhen I became a clinicalmanager. I realized therewas so much I didn’t knowabout nursing and management,so I started my BScN.Before then, I had never beenexposed to what the professionreally was, to whatnursing philosophy was,to what the theory behindnursing was. Yes, I enjoyedN o 19

nursing. Yes, I loved mypatients. Yes, I had lovelyfeedback as a nurse. But fromthe viewpoint of the largerprofession, I was a sleepingnurse. I remain profoundlygrateful to my professors forilluminating the depth andbreadth of nursing knowledgeand history, inspiringme to continue my educationand for waking me up!Pulse: What partnershipsdid you form in clinicalpractice?Mildon: Well, first of all withpatients and families. Thatis the heart of nursing. Butin health care, we work inpartnership with all membersof the interprofessionalteam. It is by keeping thosepartnerships strong andhealthy that we can promotethe best care and outcomesfor our patients.In my role as a clinicaleducator in home care inthe late ’80s, I felt I was inpartnership with the staffnurses. HIV/AIDS was makingitself known, home careservices were expanding, andthe nurses suddenly neededto learn skills that were newto them. Bringing nursesinto the lab to coach them inhow to perform these skills –including central line care,total parenteral nutrition andthe accompanying health assessments– in the home wasimmensely fulfilling. Nursesleft with a sense of relief andrenewed confidence in theirknowledge and abilities. Bestof all, those nurses enabledpatients to stay at homewith their family and theirpets and their pictures – thepeople and things that gavethem strength and hope.Pulse: You’veaccomplished a lot!Mildon: Thank you! I likeworking. When I was eightyears old, I remember havingwhat I recall – although perhapsincorrectly – as my firsttemper tantrum. I stompedup the stairs because mymother would not let me peelthe potatoes, and I wanted topeel those potatoes!When I look back onmy life, I realize I’ve alwayswanted to work. The timesI’ve been most frustratedhave been when I felt unableto contribute in some way,shape or form. I welcomework. I appreciate work. I’malways looking for opportunitiesto contribute.That’s what makes my CNAand Ontario Shores rolessuch a privilege – they enableme to work on behalfof patients as well as CNA,nurses and our profession.It’s wonderful!øBarbara Mildon, BScN9T3, MN 9T8, PhD 1T1,is the vice-president ofprofessional practice andresearch and the chiefnurse executive at OntarioShores Centre for MentalHealth Sciences in Whitby,Ontario. In June of thisyear, Mildon will be inductedas CNA president.STEP ON UPNurses are inthe perfect positionto advance this platformby LIANNE JEFFShe two precepts I remember mostclearly from my undergraduate yearsat U of T’s Faculty of Nursing are:1. The sum is greater than itsparts; and2. Wash your hands to reduce thetransmission of micro-organisms.Today, collective efforts to ensuresystem quality and safety are still keypriorities. To make the health caresystem more efficient, integrated andpatient-centred, we require partnershipsthat cross disciplines, boundariesand jurisdictions.Because nurses have significant,continuous interactions with patients,they are in a unique position to makevisible the quality and safety platform.Nurses are ideally situated to shapeand lead the quality and safety workthat’s required to transform our healthcare environments.Numerous challenges exist to ensuringconsistent, high-quality nursingcare that’s based on the best scientificknowledge available. For example, ourcurrent economic uncertainty has thepotential to unleash another round ofdownsizing of the registered nursingworkforce, despite evidence that thisstrategy is often associated with negativepatient outcomes. This threat requiresour immediate attention and action.Our action as nurses needs to be collectiveand collaborative. We know thatN o 20SPRING/SUMMER2012

effective teamwork is a prerequisitefor safe, quality health care. To informfuture directions for safer practicesand quality care, we need evidenceinformed,collaborative leadership tocreate and enhance shared accountabilitiesand value-based partnerships– within nursing, among health careprofessionals and with patients.We can achieve this aim by takingaction at every level of the health caresystem. At the clinical interface, ourdiscipline’s value of patient-centredcare and its holistic view of the individualreceiving care can lead patientengagement efforts in daily practicesettings. At the unit and organizationallevel, nurse leaders can work withnurse clinicians, quality and risk managers,and patients to engage them inrespectful dialogues to identify, manageand develop quality improvementstrategies that can prevent or reduceadverse events, critical incidents andnear-misses.At a systems level, partnershipsbetween academic institutions andpractice settings are paramount toaddressing the current praxis gaps.By developing and then sustainingstronger value-based partnerships, wecan ensure that researchers generateknowledge on important quality andsafety issues relevant to practice settings.In turn, clinicians and administrators,working in partnership withresearchers, can ensure that the mostcurrent evidence on safety and qualityis embedded in daily practice.At a professional level, associationsand organizations can leverage valuebasedpartnerships to ensure futuredecisions regarding nursing services.They need to ensure quality and safetystrategies are informed by evidenceand result in positive clinical outcomesand experiences for health care recipients,regardless of the setting.Within the burning platform ofquality and safety are care transitionsand avoidable hospitalizations. Weknow that poorly executed care transitionsresult in additional health carecosts due to adverse outcomes. Theycan lengthen hospital stays, create theneed for a readmission and result inmedication errors. We also know thatnursing plays an integral role in ensuringsafe care transitions at severalpoints; for example, from shift to shift,unit to unit, and from hospital dischargeto home or to a different healthcare organization.Nurses have the opportunity tomake value-based partnerships a prioritypolicy issue that is consistent withthe discipline’s values and role. Thinkof the power that nurses have to influencethe quality agenda if we, whereverwe work, leverage our collective knowledge,energy and talent. Think of therisks if we do not accept the challenge.It’s time for nurses to step up to thequality and safety platform.øLianne Jeffs, BScN 9T2, MSc9T8, is the director of nursingresearch and a scientist with theKeenan Research Centre, Li KaShing Knowledge Institute at St.Michael’s. Her research focus is thedesign and delivery of safer healthcare systems. The knowledge Jeffshas generated guides the designand delivery of safer health caresystems around the globe. Jeffs isalso a Bloomberg Nursing assistantprofessor and a co-leader of theToronto Academic Health ScienceNetwork Bloomberg NursingResearch Group.N o 21

At Bloomberg Nursing’sannual Spring Reunioncelebration on Saturday,June 2, all alumni areinvited to come sharetheir memories, accomplishmentsand friendship.Here, Karen Coleman,who is marking her fifthanniversary since graduation,and June Kikuchi,who is marking her 50th,confide what they’ve beenup to since graduating.5 YEARS OUT: KarenColeman, MN 0T7, is anurse practitioner in theneurosurgery unit andoutpatient neuro-oncologyclinic at the newly mergedCredit Valley Hospital andTrillium Health Centre inMississauga. For her manycontributions to patientcare, Trillium–Mississaugahonoured her with twoawards in 2009 – theNursing LeadershipAward and the Annual ApplauseAward.As a member of Trillium–Mississauga’s NursePractitioner Task Force,Coleman helped developand implement an organizationalengagement andcommunications plan tosupport the new legislativechanges affectingNP practice. Now she’sworking with the hospital’sneurosurgical teamto start a program thatprovides ongoing medicaloncology care to patientswith a primary malignantbrain tumour. Whenlaunched, this programwill allow these patientsto receive care closer tohome.As part of her ongoingcommitment to advancingnursing practice, particularlyin the neurosciences,Coleman has presentedat numerous conferencesand workshop on topicsranging from von HippelLindau disease and stroke,to best practice care ofthe surgical spine patient.Recently, Colemanbecame a BloombergNursing adjunct lecturer.She is not only a preceptorfor NP students, shetutors first-year medicalstudents enrolled in theDeterminants of CommunityHealth course atU of T Mississauga’s newAcademy of Medicine.50 YEARS OUT: As anundergraduate, JuneKikuchi, BScN 6T2, wonderedwhy non-nursingcourses were a requirement.Despite learninga great deal about thenature of space, time,causality and truth inMarcus Long’s philosophyand logic courses, Kikuchicouldn’t understand whyshe had to philosophizeto become a nurse. Onlylater, in Muriel Uprichard’sHistory of Nursing course,did a glimmer of understandingsurface.Kikuchi put thesequestions aside as sheengaged in nursing practice.She completed theNursing Care of Childrenmaster’s program at theUniversity of Pittsburgh,and in 1970 establishedthe first clinical nursespecialist position atToronto’s Hospital for SickChildren. After earninga PhD in nursing at theUniversity of Pittsburghin 1979, Kikuchi becamethe first clinical nurseresearcher at Universityof Alberta Hospitalsin Edmonton and wasappointed to U of A’sFaculty of Nursing.During a curriculumplanning meeting,Kikuchi realized how littleshe understood aboutthe nature of nursing. Shefinally grasped the relevanceof Long’s coursesand began discussing thephilosophy of nursingwith Helen Simmons, acolleague at the Faculty.Kikuchi, to further herunderstanding of philosophy,studied at thePontifical Institute forMediaeval Studies and Uof T’s St. Michael’s College.In 1989, Kikuchi andSimmons founded theInstitute for PhilosophicalNursing Research. Later,Université Laval awardedKikuchi an honorarydegree in nursing forher contributions to thephilosophy of nursing.Although retired, shecontinues to explore andwrite about the significantphilosophical questionsunderlying nursing practice.We’re on Twitter!Follow Bloomberg Nursing on Twitter.Learn about courses for practisingnurses. Discover awards you cannominate your colleagues for. Celebratethe successes of our faculty andstudents. Be the first to hear aboutnewly published materials. Follow us@UofTNursing.N o 23

Congratulationsto Order of CanadaappointeesThree members of the BloombergNursing community have beenhonoured with an Order of Canadaappointment. The Order of Canadais one of the highest civilian honoursand recognizes a lifetime of outstandingachievement and service toCanadian society.Lawrence S. Bloomberg, whomade a visionary gift to our Faculty,was recognized for his socialengagement and philanthropy,notably in the areas of health careand education.Mary Ferguson-Paré, BScN 6T7,a former chief nursing executiveat University Health Network,was honoured for contributing toimproving patient care and thenursing profession.Seymour Schulich, the benefactorof our Seymour SchulichAwards in Nursing, was promotedfrom member to officer statuswithin the Order of Canada forsupporting post-secondaryeducation nationwide.Recent master’s gradwins stellar awardRob Fraser, MN 1T1, has received anAmerican Journal of NursingBook of the Year Award for hisguidebook, The Nurse’s Social MediaAdvantage. The book explains hownurses can use Facebook, Twitter,LinkedIn and other social media toadvance their career and the nursingprofession.“There are many other big nameson the 2011 Book of the Year list, so itis an absolute honour,” says Fraser.The AJN Award is one of the mostimportant book publishing awards forauthors in the nursing community.Students who went the distanceEvery spring, U of T presents a Cressy Award to students whose extracurricular efforts improvedthe university, their faculty, the local community or the world. This year, the university honoured fiveBloomberg Nursing students at the annual ceremony.Graduate recipientsLaura Istanboulian, in the master’s program, receiveda Cressy Award for helping our NP students in BritishColumbia and Newfoundland polish their advancedhistory-taking and physical-examination skills. Themaster’s student was integral to the success of theVirtual Interactive Teaching and Learning project thatoperated out of our Simulation Lab.Sheri Price, PhD 1T1, built collaborative stakeholderrelations through her volunteer efforts onnumerous academic boards and associations, includingcurriculum committees, graduate student seminarsand the Nursing Health Services Cluster Unit (U of T).Undergraduate recipients (class of 1t2)Sarah Gardhouse founded and facilitated the NursingMentorship Program so incoming students couldhave consistent peer support. The online discussionforum she created matched second-year studentswith those just starting Bloomberg Nursing’s undergraduateprogram.Zamin Ladha, as president of the Nursing UndergraduateSociety (NUS), helped organize social andacademic events as well as professional developmentopportunities, including a resumé writing workshop.He also successfully advocated for affordable TB testingfor all U of T students whose program requires it.Lara Schiller spearheaded a provincial nursingstudent conference in her role on the NUS executive.The conference attracted 300 nursing students andraised $7,500 for Ronald MacDonald House in Toronto.N o 24SPRING/SUMMER2012

They’ve done us proudMore than a hundred students received awards andscholarships at Bloomberg Nursing’s annual awardsceremony in October. “With a history of recruiting the‘best of the best,’ competition for these awards is quitehigh,” says Martine Puts, chair of the Faculty AwardsCommittee.Held at the Bram & Bluma Appel Salon in the TorontoReference Library, the event gave students an opportunityto show their appreciation to the donors, includingLawrence S. Bloomberg, who attended the event.Three awards were presented for the first time:the Mary B. Willet Nursing Award for undergraduate students;the Staples Family Graduate Student Awardin Nursing, made possible by second-generation U of Tnursing graduate Eric Staples; and the Class of 6T1 Award,established in recognition of their 50th anniversary.PHOTOS, THIS PAGE: DIANA BALOGH TYSZKO. MEDAL: CANADIANDESIGNRESOURCE.CAThe annualawards ceremonycelebrates thepartnershipsbetween students,faculty and donors.N o 25

SpotlightonLearningA NUCLEUS FORNURSING STUDENTSIn the Agency BasedCurriculum program,students commit to onehospital for most of theirclinical placementsn an oversized whiteboardin her office, senior lecturerZoraida Beekhoo keeps track of the 70students enrolled in the Agency BasedCurriculum (ABC) program. In thisunique initiative, BScN students doalmost all of their clinical placementsin the same hospital. But no two placementsare the same. The students reapdiverse clinical experiences on variousunits within the same hospital. Astudent can be on the obstetrical floorfor one course, then in the orthopaedicsunit for another. And with each newplacement, Beekhoo charts the changeon her whiteboard.Of the five hospitals that participatein ABC, Ryan Henderson from the Classof 1T2 chose University Health Network.“UHN has an amazing cardiology serviceand a northern outreach programfor communities in the James Bayarea,” explains Henderson, who grewup in Iqaluit, the capital of Nunavut. Sofar, he has completed a mental healthplacement at Toronto General Hospital,a cardiology placement at TorontoWestern and a cardiovascular surgeryplacement back at TGH.KEEP IT SIMPLEDoing all of your placements in onehospital has logistical benefits. There isonly one confidentiality form to reviewand sign, one orientation manual tostudy, one computer system to master.“Since computer systems aren’t standardizedbetween hospitals, knowinghow to use the computer is a hugeadvantage,” says Beekhoo, who initiatedthe program in 2006 with seniorlecturer Kate Hardie.“I’ve found that by staying in onehospital I can focus on the actual nursing,and this has improved my clinicalconfidence,” says Henderson.ABC students make a commitmentto the hospital, and the hospitals makea commitment to them. Some of thehospitals provide ABC students withspecial privileges; for example, accessto the online learning modules,and invitations to staff developmentand education sessions. “I like theconsistency of getting to know yourcolleagues and of being part of a team,”adds Henderson.CAN YOU STAY?In his cardiovascular placement,Henderson’s clinical instructor wasMarina Aronov, who won a 2010Bloomberg Nursing Senior-YearExcellence in Clinical Teaching Award.Henderson learned a valuable lessonfrom Aronov: “I learned there’s alwaystime to listen to the patient’s story andexperience with illness,” he says.“We got to see a heart surgery and avascular surgery, and that was fantastic,”continues Henderson, who has anundergraduate biochemistry degree. Inthis placement, the words from his formerbiochemistry textbooks started flyingoff the pages. “For years, I had beenstudying enzyme markers like CK-MB,markers that indicate heart damage.And here I was actually using them.”Also on this unit, a patient careco-ordinator went the extra mile andhelped Henderson prepare to launchhis future career by conducting a mockinterview with the student, helpinghim identify what UHN is looking for.“ABC gives students a foot in the door,”explains Beekhoo. “It’s a recruitmentstrategy for sure because our graduatescan hit the floor running.”øClinical instructor Marina Aronov (left)with Ryan Henderson and senior lecturerZoraida BeekhooPHOTOS: STEPHEN UHRANEYN o 26SPRING/SUMMER2012

ABC student Ryan Hendersoncompleted the majority ofhis placements at UniversityHealth Network.N o 27

Time TravelPHOTO: UNIVERSITY OF TORONTO ARCHIVESIn this photograph from the 1940s, Rockefeller fellows,some in traditional dress, assemble outsideU of T’s nursing residence at 7 Queen’s Park Cres.of T’s nursing schoolU was built on partnerships.Our first partnershipwas with the Red CrossSociety which, in 1919, askedto launch a public-healthprogram for graduatenurses. In appealing toRobert Falconer, U of T’spresident, the Society wrote,“a well equipped and wellstaffed nursing service isan important factor in thehealth and happiness of theDominion.” Falconer agreed,and nurses enrolled at U of Tto learn how to promotehealth and prevent disease.In 1923, that partnershipended, and the universitywas reluctant to finance thenursing program. But ourschool’s founding director,Kathleen Russell, was determinedthat nurses wouldhave the same educationalopportunities as otherhealth care professionals. Atough, persistent negotiator,Russell won over the university.That same year, Russellformed a new partnershipwith the Rockefeller Foundationin New York City. Itwanted to send nurses fromaround the world to study atour public-health program.The Foundation’s projectswere intended to last onlyabout five years, but ourRockefeller partnershiplasted for decades.To build the nursing residence,the school added anew partner – the Ontariogovernment. When theresidence opened in 1933,Russell began creating agracious residence experienceto augment thestudents’ education.Deploring a “dull and unimaginativelife,” she wouldoccasionally turn dinnerinto a celebration of theRockefeller fellows’ cultures.For “Uniform Night,”for example, the fellowsdressed in the nursing uniformsof their homeland.At the time, hospitalnursing schools in Canadawouldn’t accept studentswho were black. In 1937, theFoundation asked Russellif she’d take a black studentfrom Panama. Russell didn’thesitate, swung open thefront door and asked thestaff to set another place atthe dinner table.øN o 28SPRING/SUMMER2012

june2Spring ReunionWhatever happened to Wanda?At Bloomberg Nursing’s annualSpring Reunion, if you don’t runinto your old friend Wanda,chances are you’ll run into another long-lostclassmate. Everyone is invited! All of theevents take place at the Bloomberg Nursingbuilding at 155 College St.9 a.m. Join us for a complimentarybuffet breakfast.10:30 Applaud our distinguished alumniduring the awards presentation.11:30 Tour the Simulation Laboratory.There’s an intensive care unit,isolation unit, operating room and12-bed ward. See how you can honeyour clinical skills on the computerizedmedical mannequins.You’ll be an honoured guest if yougraduated in a year ending in 2 or 7 (forexample, 1962 or 1987).Some classes have planned specialevents. To ensure that your classmates canget in touch with you, send your email addressto address.update@utoronto.caClass of 6T2: To kick off the 50th anniversarycelebrations, Dean Sioban Nelsoninvited you for tea on April 24th.To RSVP: Email development.nursing@utoronto.ca or phone 416.946.7097.juneCourse: Chronic PainSelf-Management5/6/ Program (CPSMP)7/ 8 Designed for both health careprofessionals and lay peoplewith chronic pain, this important courseaims to improve coping strategies andquality of life for people who have aprimary or secondary diagnosis of chronicpain. CPSMP has been rigorously evaluatedin two randomized clinical trials funded byHealth Canada and the Canadian Institutesof Health Research, as well as in 10 painclinics across Ontario. The program hasbeen delivered to more than 800 individualswith chronic pain and improved copingskills and overall quality of life.To learn more and register:bloomberg.nursing.utoronto.ca/CASPPjune6Spring ConvocationReceptionIf you are receiving your MN,NP or PhD diploma at the June6th convocation, you and twoguests are invited to the Spring ConvocationReception at Knox College, 23 King’sCollege Circle, from 7:30 to 8:30 a.m. If youwere awarded your MN, NP or PhDdiploma in November 2011, you are alsoinvited to attend with two guests.To RSVP: Email development.nursing@utoronto.ca or phone 416.946.7097.julyCourse: Teachingand Learning9 /10 Using SimulationThis innovative two-day course isfor nurse educators who use orare interested in using simulation as ateaching modality in an academic or clinicalpractice setting. It will provide a broadoverview of the use of simulation; explorethe spectrum of simulation modalities andthe creative ways they can be used toenhance nursing education; and examine thecritical components of delivering high-qualitysimulations. In our state-of-the-art simulationlaboratory, participants will have theopportunity to develop practice simulationsunder the faculty’s expert guidance.To learn more and register:bloomberg.nursing.utoronto.ca/CASPPCourse: Preparingto Write the CRNEsept This popular two-day course isopen to anyone writing theCanadian Registered NurseExam (CRNE), including new graduates,international nurses and individualsrewriting the exam. You will receiveextensive practice in exam writing anddevelop approaches to answering multiplechoicequestions in the major contentareas. A mock CRNE will help you identifyareas needing further study. Of pastparticipants, 100 per cent said they wouldrecommend this course to a colleague.To learn more and register:bloomberg.nursing.utoronto.ca/CASPPseptoctnovAlumni LifelongLearning SeriesExclusive to U of T Faculty ofNursing alumni, this lunchtimelecture series supported byManulife Financial highlights the latestresearch of our esteemed faculty members.All lectures will be held at the BloombergNursing building at 155 College St. and willbe one-hour long. A luncheon is included.Plan to attend one lecture – or all three.To learn more: Email development.nursing@utoronto.caor phone 416.946.7097. Or,visit bloomberg.nursing.utoronto.ca.Course: End-Of-LifeCare for Critical Carefall Nurses – DevelopingExpertise ThroughSimulationThis novel simulation-based course fornurses is focused on developing confidence,competency and expertise in end-of-lifecare in the critical care unit. The two-dayprogram will focus on the principles ofcommunication, shared decision-making andconflict resolution in end-of-life care, as wellas strategies for facilitating discussions withthe family.To learn more and register:bloomberg.nursing.utoronto.ca/CASPPN o 29

Bloomberg Nursing offers innovative educational opportunitiesfor nurses and other health care professionals through itsCentre for Advanced Studies in Professional Practice(CASPP). Enrolment is limited to ensure a highqualityexperience, so register early for a programto expand your knowledge in clinical practice,education, leadership, research or informatics.Upcoming CoursesChronic PainSelf-ManagementProgramJune 5 to 8Teaching and LearningUsing SimulationJuly 9 and 10Preparing to Write the CRNESeptember 2012For information on upcomingprograms, refer to Eventson page 29 or visitbloomberg.nursing.utoronto.ca/CASPPFollow us on Twitter@UofTNursingScan code formore information