March 2003 Newsletter

Health System Renewal: A National Policy Forum

Wed. February 12, 2003

Due to the overwhelming response, we had to close registration just days after announcing our February 12 Policy Forum in Ottawa! The event was a great success and was attended by over 200 delegates. The forum was hosted by the ONP, and Dr. Shamian (Executive Director) opened the day before turning over hosting duties to Susan Strelioff, who served as our facilitator. Speakers included:

• The Honourable Anne McLellan, Minister of Health
• Ian Shugart, Assistant Deputy Minister, Health Policy & Communications Branch, Health Canada
• Dr. Thomas Ward, Deputy Minister of Health, Nova Scotia
• Dr. Ginette Lemire Rodger, Chief of Nursing, the Ottawa Hospital
• Lori Stoltz, Senior Advisor to Minister McLellan.

We did not do a full transcription, but captured key messages shared by the speakers as much as we could, as follows:

Ian Shugart reviewed the Accord, which follows the culmination of pretty intense period of public dialogue. Compare to 2000, the Accord is a significant step forward, but a considerable amount of hard work still lies ahead - F/P/T collaboration, as well as government-stakeholder collaboration, will be essential. The emphasis on sustainability and concern (debate) about fiscal sustainability is not going away.

Thomas Ward positioned health care reform as social policy reform, full stop. Public policy is about morals, values, and public beliefs. Our policy is meant to speak for those who can't get to the table, can't speak, or aren't allowed to speak. Medicare is the best example in the country of serious social policy change; there was huge resistance but within a decade we had Medicare nationally. In the Charter we enshrined it as a right. As Medicare has grown, the basket expanded with it. Discussions go on about what's in or out, but the fundamentals rarely are seriously challenged. Romanow was clear - Medicare is a public good, not a market good. We are really talking about a transformational change from a view of health as accessing MD in hospital to a health-focused system with different access and caregivers. We have an important national opportunity to have the discussion. Today is an important chance to offer input to the process. This is an important chance to integrate services; to improve things where the service is delivered. Requires better concept of team care delivery.

Post FMM 2003, Post Kirby/ Romanow, discussion must be about procedural ethics. The next phase is the really hard part. Who's at the table? What are the boundaries? One of the discussions must be about educational silos - we are still confronted by the solid silos in training. They can do it in the UK - we can do it too. here are we going to deal with tradition in the face of technology? We need to get serious about care teams that wont' accept best practices. When are we going to get serious about that?

Ginette Lemire Rodger . My opinions today are personal, not representative of my former position with CNA. I think it is a very good Accord despite the negativity I'm hearing about it. What the Accord does not do or should have been, is irrelevant. We have what we have. You fight to influence; once it's done, you mobilize, minimize the negative impact, look at what you've got and go with it. The Accord is not going to meet all our expectations. The Accord is compromise - the art of the possible.

From a nursing perspective. There is a significant financial investment in health care to help move us forward. There is enhanced accountability, which nurses have wanted. The covenant that extends quality, safety, and accessibility is critical to nursing. The basket of services of HC and PHC - nurses tried during CHA to get those services expanded and included. Health Care has largely been driven by medicine . This Accord acknowledges multi-teams, prevention and so on. We have repeatedly talked about the drug coverage issue and contributed to that agenda.

CNAC . Lots of unfinished business. Just a foot-hold in the Accord. On the up side there will be more base funding - may allow us to get to workload and some of those issues. Equipment fund can help move it forward. Health Council members need to be well versed on the HHR issues and impact on overall delivery of the Accord. We have to keep on making CNAC highly visible through the discussion. But it can't be our only basket. CNAC needs to be examined at employer level with an eye to how much has been done. Use in tandem with the Accord.

We know the public was and is the greatest support and ally for the HC system. We need to stay strongly allied with them. We need to stay vigilant related to application of the Accord. Nurses must be in the tent as decisions are made around funding. We need to carry on joining forces with other stakeholders, public, etc. What we have done to date as professionals is to influence the agenda. We have been effective, we have been heard. Look at the Accord; you can see that we have had influence.

We need to stay close to the patient safety agenda.

CHA 1984 - Nurses supported the feds and were the only profession to do so. CHA and CPHA sat on the fence. Nurses had part of the agenda and pushed it (e.g., penalties for user fees). Took 3 years to settle. Politics today are the same, players are the same. But medicine more allied with nursing, timelines are shorter, civil servants are with us, money is better. We need to be vigilant.

Discussion . The morning discussion period included the following speakers from among the delegates who talked about public versus for-profit care, accountability, nursing data, the response to CNAC, workforce research, national education planning, indicators, and scope of practice.

• Kathleen Connors CFNU
• Susan Wagner U of SK Nursing
• Raquel Meyer U of T Nursing Research
• Rob Calnan CNA
• Pat Shuttleworth BCNU
• Linda O'Brien-Pallas U of T Nursing
• Wendy McBride CASN
• Lynette Best, Providence Health Care Vancouver
• Pat Fredrickson CPNA
• Roxanne NANB
• Kathy NANB
• FIIQ Rep
• Yukon Rep

Lori Stoltz . Important to speak with both formal/ organizational nursing as well as informally. Feedback and opinions of nurses are heard and are important. In developing a constructive relationship with the Minister and Health Canada, a "no surprises" trusting relationship works best. That does not mean there can be no conflicting opinions That constructive approach is best.

Judith Shamian . The experiment of this day seems to be a success. The openness of the discussion this morning from all sides is of such value. The dialogue between Health Canada and the provinces has been substantive and collegial - which you may not see in the noise of what is reported in the media. The breadth of professionals in the room is indicative of the interest. Sophisticated group. I have been very impressed with the way Health Canada takes on issues around the health of Canadians. Impressive levels of energy and effort to build evidence based decisions. An ongoing dialogue is important. Not clear how we trigger these kinds of talks at provincial and other jurisdictional levels. Accountability and participatory democracy are key concepts.

Susan Strelioff . There is a bias for action. Nursing leadership will make the Accord happen. Nursing groups must collaborate and coordinate across the country to implement change. Nursing will put evidence into change despite P/T constraints.

The Health Accord and Federal Budget 2003

Prime Minister Chrétien met with the provincial/territorial Premiers February 4-5 in Ottawa to discuss a deal for health care renewal. The result was a new Health Accord for the country, which may be accessed at: Health Canada.

The new federal budget, released on February 18, may be accessed at:

Federal budget 2003

Nursing Honours

Hearty congratulations from all of us to Dr. Judith Shamian on being honoured as one of 20 Canadian nurses who received the Queen's Golden Jubilee Medal to mark her contribution to the nation! Judith also has been named as an International Health Professional of the Year for 2003 by the Research & Advisory Board of the International Biographical Centre in Cambridge England. Congratulations Judith!

We also with to honour the contributions of the other 19 recipients of the prestigious Queen's Golden Jubilee Medal, and on behalf of the Office of Nursing Policy and Health Canada, we send them our heartfelt congratulations for their contributions to nursing and to Canada. The recipients are:

• Lucille Auffrey, CNA Executive Director, 2001-present
• Rachel Bard, CNA President, 1996-1998
• Dr. Alice Baumgart, CNA President, 1990-1992
• Lorine Besel, CNA President, 1984-1986
• Robert Calnan, CNA President, 2002-2004
• Helen Evans, CNA President, 1986 -1988
• Sister Mary Felicitas, CNA President, 1967-1970
• Dr. M. Josephine Flaherty, Principal Nursing Officer, Health Canada, 1977-1994
• Joan Gilchrist, CNA President, 1976-1978
• Fernande Harrison, CNA President, 1992-1994
• Dr. Mary Ellen Jeans, CNA Executive Director, 1996-2001
• Lynda Kushnir Pekrul, CNA President, 1998-2000
• Dr. Ginette Lemire Rodger, CNA Executive Director, 1981-1989 and
• CNA President, 2000-2002
• Patricia McLean, Executive Director, Canadian Nurses Protective Society,1987 - present
• Isobel McLeod, CNA President, 1964-1966
• Judith Oulton, CNA Executive Director, 1989-1995
• Dr. Judith Ritchie, CNA President, 1988-1990
• Eleanor Ross, CNA President, 1994-1996
• Helen Taylor, CNA President, 1978-1980

Nursing Education & Research

Career Scientist Awards

The Ontario Ministry of Health and Long-Term Care is inviting applications to the 2003 competition for Career Scientist Awards under the Health Research Personnel Development (HRDP) program. Deadline for submission of applications is Tuesday, April 22, 2003.

The award is granted for 5 years and the ministry's contribution to the Career Scientist's salary is $50,000 per annum plus benefits. The competition will be limited to researchers whose area of focus is health services research.

Candidates must have no more than 3 years (previously 2 years) of independent research experience at the time of taking up the award.

Details regarding the 2003 competition, including eligibility requirements and application form are available through the ministry's web site at http://www.gov.on.ca/health/ under Research Grants.

If you have questions please contact Ruth Suh, Research Analyst, at (416) 327-8363 or Ruth.Suh@moh.gov.on.ca

Calls for Help!

*Please note that responses to any of these studies should be sent directly to the researchers at the addresses indicated, and not to the Office of Nursing Policy. Thanks!

Canadian Nurses Foundation Nursing Care Partnership

Background

The Nursing Care Partnership (NCP) is a research initiative to increase funding for nursing care research. The Canadian Health Services Research Foundation (CHSRF) has granted CNF a five-year renewable award of $2.5 million for the administration of the partnership, to be reviewed after the first two years (Sept. 2004).

Funded by CHSRF, CNF implemented a trial program during 2000-2002. During the trial phase, NCP provided $236,465 for clinical nursing research and, through the partnerships, leveraged a further $491,459 for a total investment of nearly $730,000 over the 2 years.

The NCP defines clinical nursing research or nursing care research broadly as research that is practice-based or that will provide the groundwork for future practice-based studies. Through the NCP, CNF is committed to funding esearch that meets the needs of the public, practitioners, and health care services decision-makers.

The Partnership Structure

How the Partnerships Work

Currently, the Nursing Care Partnership works solely on a partnership structure. The purpose of forming partnerships-both large and small-is to use the NCP fund to leverage existing nursing care research funding and to encourage new supporters of nursing care research. Partners include charities, hospital foundations, nursing jurisdictions, institutes and other agencies with an interest in supporting nursing care research.

Nursing care researchers receive NCP funding by successfully competing in the partners' competitions. Partner organizations:

• Run their own competitions,
• Submit successful proposals to CNF for approval through the NCP merit review process and CNF Board, and
• Administer funds to successful candidates.

For projects that are judged meritorious by the partner organization and approved by CNF, NCP contributes a maximum of 1/3 of the total cost of the project with the partner contributing the remaining 2/3. In other words, NCP contributes $1 for every $2 contributed by the partner.

Large and Small Partnerships

In creating and retaining smaller partnerships (NCP contribution less than $20,000), NCP's goal is to fund practice-based research that addresses identified priorities - for example:

• Conducted in a clinical setting
• Multidisciplinary approach
• Novice nurse researchers as principal investigators
• Taking place in an environment with a strong commitment to establishing best practices.

With smaller jurisdictions as partners, quality practice-based thesis research-either masters or doctorate level-may be funded. However, the NCP does not contribute funds for personnel awards.

In creating and retaining partnerships for larger grants (NCP contribution over $20,000 annually), NCP is looking to establish alliances with organizations that have the capacity to conduct larger nursing research projects/programs across Canada, provinces, territories or regions.

Request for Assistance

A research team headed by Dr. Donna Wilson at the University of Alberta is conducting a large-scale study to identify best practice delivery models or approaches to providing end-of-life care. This study is funded by Health Canada.

One key aspect of this study is to obtain current Canadian perspectives on end-of-life care from individuals facing the end of life, their families, and health care providers and planners.

We invite you to share information about this study and the study's web address Health Canada Synthesis Research Study: Integrated End-of-Life Care with people in your organization and other individuals or groups - and complete a brief and anonymous questionnaire on the web site.

Thank you. Your assistance with this research is sincerely appreciated, and of much potential benefit to Canadians. If you would like additional information, notices to post, or notice cards, please contact Donna or a Research Team Member:

Dr. Donna Wilson
Faculty of Nursing
University of Alberta
Edmonton, Alberta T6G 2G3
Tele (780) 492-5574, fax 492-2551
donna.wilson@ualberta.ca

Build Your Future By Making History - Participate In One Of The Largest Surveys Of Canadian Nurses Ever

Now is a critical time in health care for nurses to be heard, and Building the Future: an integrated strategy for nursing human resources in Canada wants to hear from you.

More than 24,000 nurses from all three occupational groups (Licensed Practical Nurses/ Registered Practical Nurses, Registered Nurses, Registered Psychiatric Nurses) will be randomly selected from all parts of Canada to receive a survey later this spring. If you receive one, please complete it and return it as soon as you can.

We need to hear from you about the challenges you face every day. Your direct input is critical in helping us provide concrete options to improve the work environment of nurses.

Recent high profile studies and reports have placed emphasis on the major health human resources data dearth. Your completed survey will help fill the information/data gaps for all three nursing occupational groups. With your involvement, we can develop a long-term strategy to deal with issues, including the nursing surplus/shortage cycles that continue to plague your profession, and many other worklife issues.

While you may have answered some of these questions before, the sheer size of this sample will add strength to the findings. It is also the first survey to seek similar information from all three nursing occupational groups. Your responses will give us data that doesn't exist in any of the registrar or administrative databases.

Building the Future is a milestone project. It is the first national nursing study that is both endorsed and led by all the nursing stakeholder groups in Canada: professional nursing organizations, unions, employers, researchers, educators, physicians, provincial and territorial governments, Health Canada and Human Resources Development Canada. Together, we are committed to building a better future for nurses in Canada. Help us make history. Look for our survey this spring.

Go to Building the Future for news on when the survey will be distributed, and for more information on how to participate.

Recent Publications

Shamian J., Skelton-Green J., & Villeneuve M. (2003). Policy is the Lever for Effecting Change. In McIntyre M. & Thomlinson E. (Ed's.) pp. 83-104, Realities of Canadian Nursing: Professional, Practice, and Power Issues . Philadelphia PA: Lippincott Williams & Wilkins.

World Health Organization (2002). Ethical Choices in Long-Term Care: What Does Justice Require? Geneva: WHO. Link: World Health Organization

ONP Activities

Office News

We are happy to welcome Rosanne Jabbour, Policy Analyst, from Health Canada's Ontario Regional Office in Toronto, who joins the Office for a 6-month assignment starting in April. Welcome Rosanne!

Meanwhile, Mike Villeneuve will be away from the Office enjoying a taste of "April in Paris." Mike will be working with the Organization for Economic Cooperation and Development (OECD) on an international human resources project. He will be based in Paris for most of April and May, and then again in the Fall 2003. Congratulations Mike!

Upcoming Conferences

Diversity Canada 2003
Leveraging Your Workforce: Being Inclusive, Flexible and Competetive
April 28-29, 2003
Metro Toronto Convention Centre,
Toronto ON
International Quality and Productivity Centre

Health Policy Summit 2003: Canada's Prescription for Reform
April 28-29, 2003
The Crowne Plaza
Toronto ON
Insight Information

The 4th Offering of the Dorothy M. Wylie Leadership Institute
May 20-25, 2003
Bank of Montreal Institute for Learning,
Toronto ON
Health Human Resources

American College of Healthcare Executives
Critical Conditions: Improving the Health of Healthcare Organizations
June 2-3, 2003
Hilton New York
American College of Healthcare Executives

Canadian Association of Community Care/Canadian College of Health Service Executives/Canadian Healthcare Association
2003 National Healthcare Leadership Conference
June 9-10, 2003-03-13
Shaw Conference Centre,
Edmonton AB
2003 National Healthcare Leadership Conference