April-May, 2004 ONP Newsletter

Quick Hits

• Dr. Judith Shamian appointed as new President and CEO of the VON Canada
• Nursing Week 2004
• New Grads and Full Time Work: What's Going on Across the Country this Spring?
• Healthy workplace strategies: Creating change and achieving results
• New PhD program at University of Ottawa
• Results of Health Canada-funded nursing projects
• Funding and conference announcements

A Tribute

Assistant Deputy Minister of Health, Ian Shugart, announced on April 1, 2004 that Dr. Judith Shamian has been appointed as the new President and CEO of the Victorian Order of Nurses Canada and will be leaving Health Canada 11 June 2004.

Dr. Shamian joined Health Canada as its first Executive Director of Nursing Policy in August 1999 and quickly set about establishing the ONP team. She had spent a decade as VP, Nursing, at Mount Sinai Hospital in Toronto - developing it into one of Canada's most renowned practice settings. She was ready for a change, and she was the perfect choice to take on the challenging new job of positioning nurses and nursing perspectives more strongly in Canada's federal health policy process.

The sparks of energy, love of life and determination that shine in Judith's face were lit by her parents in Hungary more than 50 years ago. After surviving the Holocaust, they were determined to instill the sort of strength in Judith that would allow her to survive anything that might come her way. By the age of 21 she had completed her initial nursing education at Shaare Zedek Hospital in Jerusalem. From there, she went on to advanced education at Concordia University in Montreal, New York University, and ultimately, a PhD from Case Western in 1988. With that pedigree - a most complex mix of "nature and nurture" - it seems her course as a leader, mover and shaker was indeed set.

Judith's career track would take her from her initial clinical work to the heights of the worlds of nursing and health care. After coordinating Special Services & Research at the Jewish General Hospital in Montreal, she moved on to become Director of Nursing Research & Development at Sunnybrook Health Science Centre in Toronto. In 1989 she was appointed Vice President at Mount Sinai Hospital in Toronto where she would lead development of the first World Health Organization Collaborating Centre in an acute care hospital setting.

In her spare time she was appointed Assistant Professor at the University of Toronto and promoted to full professor in 2001. From 1997-2000, she served as President-Elect, President, and Past President of the Registered Nurses Association of Ontario. She was awarded the Queen's Jubilee Medal in 2003 and an Honorary Life Membership in RNAO in 2004. And now after five years as Canada's Chief Nurse, leaders in all the realms of nursing know her name in every region of the country - and all over the globe. Her vision and passion are renowned. But it is her ability to wade courageously into the most complex situations, to think, analyze, synthesize and chart a course of action that keeps the phones ringing from every corner of the world of nursing. Judith is quite simply one of the great treasures and resources in health care in any nation, and we are proud that her name, and that of the ONP, falls so easily from the mouths of colleagues around the world when they are taking on complex policy projects of all sorts.

The larger-than-life personality and public image are well known to nurses and other leaders. But we would be remiss if we did not share some personal observations of Judith as boss, colleague and friend. Day to day we see the incredible generosity of spirit that fuels the desire to be around Judith. We see the pushing, pulling, positioning and mentoring by which she makes opportunities happen for her staff, and how her actions have helped us all to shine. She has been very good at assembling teams of people that respect and like each other, and by their collective actions, help the individuals to excel. To work side by side with Judith is a rocket ride and a whirlwind adventure - and all of us feel enriched by the experience.

We have loved Judith's remarkable ability to interact in such a loving and connected way with people of all types and in every role. There is no group too small to make the time to speak to, no association chapter too far away to make the effort to meet with. She is completely at ease wherever she is, whether talking with folks providing care or mingling with Kings and Presidents. But perhaps the trait we love best is Judith's giggling, unrestrained laughter, which fills the air wherever she is. She has a delicious sense of humour and complete love of the absurd that so nicely balance her strongly academic, analytical style.

Happily for Canada, all of Judith's incredible cadre of skills and her vast experience are not lost to the country just because she is moving to another position. In her role as President and CEO of the VON, Judith will bring to bear all the same excitement and intellectual ferocity that ground every project she undertakes. We know she will put her Health Canada experiences into practice as she leads the delivery of home care to so many Canadians, just as we know she will continue to provide practical, informed policy advice to governments and decision-makers across the country. We are happy to wish you every success with VON and in all your future ventures, Judith.

Next steps for ONP leadership will be announced soon. In the interim, please join us in welcoming Sandra MacDonald-Rencz, who has been appointed the Acting Executive Director for the ONP. Sandra has been with the office since 2003 and is well known to many of you from her prior roles at the CNA and as Vice President of the Canadian College of Health Service Executives. Best of luck, Sandra!

Achievements Of The Onp, 1999-2004

• Apr 2000 - After extensive regional consultation, publishes Strategic Priorities 2000-2001
• Sep 2000 - hosts National Stakeholder Consultation Meeting on nursing and workplace health
• 2000-2001 - provides key support to launch National Sector/ Occupational Study of Nursing
• 2000-2002 - plays a leadership role in the Nursing Strategy for Canada and serves as secretariat for the Canadian Nursing Advisory Committee
• 2001-2002 - Dr. Shamian assumes vice-chair of the F/P/T Advisory Committee on Health Human Resources
• 2001-2002 - brings leaders together and provides support to the Canadian Council on Health Services Accreditation, to identify quality of worklife indicators for new accreditation standards
• Oct 2001 - issues progress report on first two years in operation, and releases Strengthening the Health of Canadians: The Nursing Role - Proposed Key Policy Directions 2002-2004
• Nov 2001 - plays a leadership role in organizing and facilitating the Global Partnerships meeting
• Feb 2002- ongoing - initiates and co-leads international study of turnover in partnership with Australia, New Zealand, the United Kingdom and the United States
• Mar 2002 - arranges and hosts World Health Organization/ Health Canada Consultation on Imbalances in the Health Workforce
• Oct 2002 - hosts national Pathfinding for Nursing Science in the 21st Century think tank
• Oct 2002 - co-hosts the Nursing Education Think Tank
• 2002- 2003 - provides substantial input to the development of the health human resources components of the First Ministers' Health Accord 2003 and leads national initiatives on interdisciplinary education and healthy workplaces
• Nov 2002 - hosts a meeting of Canada's nursing leaders with federal Minister of Health Anne McLellan to discuss the Canadian Nursing Advisory Committee Final Report
• Feb 2003 - hosts a National Policy Forum to discuss First Ministers' Health Accord 2003
• Apr- Aug 2003 - contributes to Health Canada's response to the SARS crisis
• Apr- Nov 2003 - represents Health Canada at the Organization for Economic Cooperation and Development in Paris, taking a lead role in reporting the nursing human resources component of the International Health Study
• Dec 2003 - hosts a meeting of Canada's nursing leaders with federal Minister of Health Anne McLellan to discuss key nursing issues
• Dec 2003 - publishes Moving Forward: Progress Report of the Office of Nursing Policy 1999-2003

The Nurse

The world grows better, year by year,
Because some nurse in her little sphere
Puts on her apron and grins and sings,
But keeps on doing the same old things.

Taking the temperatures, giving the pills,
To remedy mankind's numberless ills;
Feeding the baby, answering the bells
Being polite with a heart that rebels.

Longing for home and all the while
Wearing the same old professional smile;
Blessing the new born babe's first breath
Closing the eyes that are still in death.

Taking the blame for the Doctor's mistakes,
Oh Dear; what a lot of patience it takes;
Going off duty at seven o'clock
Tired, discouraged, and ready to drop.

But called back on special at seven fifteen
With woe in her heart, but it must not be seen,
Morning and evening and noon and nite
Just doing it over and hoping it's right.

When we lay down our caps and cross the bar
Oh Lord, will you give us just one little star
To wear in our crowns, with our uniforms new
In that city of God
where the Head Nurse is you.

We are grateful to the Zakus family for sharing this poem, written by Jose Zakus when she was a "Probationer" (trainee) at Holy Family Hospital, Prince Albert, Saskatchewan, 1937-1938.

Mr. Zakus found this poem in a scrapbook after Mrs. Zakus passed away - one of the first of many poems she wrote, but the only one that the family believes Jose wrote about nursing.

Nursing Week 2004 At Health Canada!

You are cordially invited to join us as the ONP marks our Fifth National Nursing Week at Health Canada, on:

Monday, May 10, 2004
The Banting Building Theatre
Tunney's Pasture
Ottawa, Ontario, Canada
08:00 - 11:30

Over the past 6 months, Health Canada funded some exciting projects focused on nursing human resources (see p. 9). We hope you'll join us for a light breakfast, and then listen in to a panel presentation in which the project leaders will highlight their findings. We'll follow up with plenty of time for open discussion of the studies and talk about next steps. The full draft agenda is on the final page of this newsletter.

Invited Guests:

• The Honourable Pierre Pettigrew, Minister of Health
• Janet Davies
• Cathy Fooks
• Paula Greco
• Elma Heidemann
• Lisa Little
• Lisa Maslove
• Dr. Linda O'Brien-Pallas
• Dr. Dorothy Pringle
• Dr. Gail Tomblin Murphy
• Tazim Virani

Taking A Pulse on the Issue of New Grads and Full Time Work: What's Going On Across The Country This Spring?

Recently we asked Chief Nurses and other informed contacts in provincial and territorial governments, as well as the members of the Academy of Canadian Executive Nurses, to share perspectives on the issue of full-time (FT) employment for newly graduating nurses across Canada. The discussion was prompted by talking with the 2004 graduating class of baccalaureate nurses at the University of Ottawa - many of whom had not found a job, and even fewer of whom had secured a FT position. So we asked Canada's executive nurses to share their perspectives on this issue.

Following are some clips from the very rich online discussion that followed. Please note that we did not over-edit these comments, and they were not originally written by the authors with the intent that they would be published. They were intended for an online discussion among nursing leaders, so please forgive any small errors. We wanted to preserve the conversational tone of the responses so our readers could really hear first hand what nursing leaders are facing and thinking. We hope you will read the responses in that spirit.

Permission was granted from all authors to publish these opinions.

What the students described is "the situation." We have a vacancy rate of about 2% but we have several projects to increase our FT numbers in the next few months (as a result of the injection of money by the government of Ontario.) We definitely need to provide additional postings for new graduates, because with the HOOP bridging at the end of Dec 2005, and our expansion plan, we will need 500 RNs or more.

We are committed to increasing the FT/PT ratio. However, to create FT positions some PT's must leave. There are limited additional funds and no approvals to actually increase the number of nurses providing care. Much of our strategy relies on attrition. Also, the union contract indicates that if a FT position is available, internal PT staff has first rights to the jobs. Thus, internal PT staff takes almost all FT jobs. So new grads often need to accept PT on the premise they then have access to FT once in. Contrary to many of our peers, we have one of the lowest turnover rates, compounding the situation. We have a very active retention and recruitment committee that has led us in moving forward on other innovative strategies too.

Wendy Nicklin, VP and
Ginette Lemire Rodger, CNO
The Ottawa Hospital

Ontario has commissioned a study of the graduating class regarding their employment. It is expected to finish in the next few weeks. We also recently announced $25 Million to hospitals to increase FT opportunities. Some of these funds are being used to hire new grad into "internship" positions. These positions however, must not contravene the collective agreement. They are supernumerary positions and can be for up to a year. We do have some instances of FT jobs sitting vacant that organizations can't fill. Most appear to be in specialty areas such as critical care.

Sue Matthews, Provincial CNO, Ontario

Manitoba is attempting to address the FT/PT ratio, and like others, we are experiencing a paucity of FT positions for new graduates. One of our strategies to address both the availability of FT/high PT FTEs, as well as the reduction of overtime relief shift availability, is to create "relief teams". These are being created under the guidance of a number of principles that include a dedicated leadership structure, and all terms and conditions afforded to patient care unit staff apply to these individuals (inclusive of collective agreement clauses, orientation and continuing education opportunities.) When new grads are hired into these teams, to the degree possible, they are assigned to a particular unit/ program to support their early professional practice. The concept of relief teams requires the commitment of the programs within a site to commit to this as the first line of resources to fill both incidental and planned vacant shifts.

To date we have not been successful gaining bridge funding to create a supernumerary situation; this would be an ideal situation and very supportive to the new grads. As a province, we have also committed to amalgamating PT positions to create FT; this will be done through attrition. In addition, FTEs of <0.4 are discouraged and require senior nursing approval in the respective site/region.

At the Health Sciences Centre, students in their final practicum are given the opportunity to meet with senior nursing and HR staff to enhance their awareness of the available positions, engage in career counseling, and support through the application/interview process. Over the last year, each class has raised increasing challenges in placing them in FTEs and positions in areas in which they are interested. Our vacancies are highest in specialty areas like critical care, ER, and L&D, for which students initially require a time of med-surg. experience. The career counseling we offer is very helpful in that they recognize that nursing is a very fluid, mobile profession, and that a year in med-surgical will support their future career directions.

Winnipeg engages in quarterly vacancy reporting, which together with overtime dollars expended, provides invaluable information as we monitor the vacancy rate, the FT/PT ratio and overtime reductions.

Helga A. Bryant, VP and CNO, Health Sciences Centre Winnipeg

Some, but not the majority, of our students have FT work. I'm hearing of more graduating students now who are obtaining FT positions in Toronto. However, some are still reporting casual work with the potential for FT hours and moving quickly into more FT positions. We have had some students indicating that they are going to other countries.

Marianne Lamb, Dean of Nursing, Queens University

Our situation is quite different. Our provincial nursing advisory committee set an 80% retention goal for new graduates and we have been able to achieve this goal for the past three years. Last year, 82% stayed, and of those, 93% found FT jobs. We have had excellent cooperation from the unions and many employers have been hiring supernumerary positions and running their rotations off contingency staffing needs (vacations, stat holidays, etc.) These staff are permanent FT, assigned to a single unit; what they don't have is a master rotation that you can predict for years. Their rotation is done a month at a time for a 4 week period - not bad. Most are able to move into the master rotation within the first year.

Another approach that has been successful is to reach agreement on the LTD positions. A few districts have been successful in having these declared vacancies, with the understanding that should the employee be able to return to work, the employer would honor their commitment and overstaff. When we looked at the LTD statistics it became apparent that the likelihood of returning to work dramatically decreases as time goes by.

Our third strategy has been to promote maternity/paternity leaves. These 12-month leaves provide a wonderful opportunity for guaranteed employment, consolidation of skills and a chance to get to know the organization. Most are able to get a permanent position in the first year and our contract allows seniority to be backdated to the start of the temporary position.

Our final strategy has been to conduct job fairs at the universities. These fairs are organized so that only NS employers attend. They are well supported by faculty and students and basically we have been able to show the students that if they are willing to go to where the jobs are, they can get FT work.

We have a little more difficulty with our LPNs and most do have to go into PT or casual positions at first. This is turning around as we see more going into the acute care system and more retirements in LTC.

Barbara Oke, Nursing Policy Advisor, Nova Scotia

We have recently done an analysis in the Ontario Council of Teaching Hospitals group re capacity to create more FT positions. The challenge will of course be matching up graduates with positions they are interested in. We will keep you informed.

Leslie Vincent, Senior VP Nursing, Mount Sinai Hospital Toronto

Our numbers are small in relation to those of other provinces, but both hospital and continuing care hire new grads when positions are available that do not require specialized skills. Community nursing is unable to hire new grads because of the specialized skills and experience required. There are no guaranteed positions for new grads. A local hire policy that applies to government positions requires that positions be advertised first within the Yukon. There are presently no permanent positions open for which new graduates would be eligible, although there are a number of term positions at the Whitehorse General Hospital to cover maternity and vacation leaves. Could be a great opportunity to see the Yukon!

Jan Horton, Coordinator, Primary Health Care Transition Fund, Yukon

Capital Health has had the New Grad Initiative in place since 2000 with the objective to retain our own new graduates by offering guaranteed FT positions for up to a maximum of one year, and to offer these positions as supernumerary to ease the transition into the full RN role. We have been quite successful in allocating these positions into areas with vacancies, including educational programs for specialty areas. At the Royal Alexandra Hospital, this has been a particular success in ER and OR. We have also had a fairly high success rate in hiring new grads directly into FT positions. We have FT float positions that always have vacancies and are available to new graduates with no seniority. Our preference is not to put new grads in a float situation where they are expected to go to many different units and therefore make it more difficult to acquire competence in any one area. We have created the positions so they are limited to two nursing units at the maximum within a program such as Med. or Surg., helping these nurses get a comfort level on a specific unit. They then apply to positions on these units as they become available.

Glenda Coleman-Miller, Senior Operating Officer - Patient Care, Royal Alexandra Hospital, Edmonton

Living within our funding envelope, we have been making changes in skill mix introducing full scope LPNs to some areas that previously had close to 100% RN staff. We made a commitment that we will not lose any RNs in this process and therefore are offering opportunities to currently employed nurses to work in other areas where there are vacancies.
We will need the students this year. We are in the process of conducting an assessment of how many new grads we think we will be able to hire over the next couple of months.

Pat Semeniuk, CNO and Lead for Professional Practice Vancouver Coastal Health

Through several initiatives we have undertaken in Capital Health in Edmonton over the past three years, we have hired 65%-75% of our graduating classes year over year. This has been done through hiring directly into line positions, through a supernumerary hiring program for new graduates, and an employed nursing student program where the students are hired after their third year. We find that many of them stay on with us and come back to the areas they worked as summer students when they graduate. Over the past 3 years we have hired nearly 700 new grads and have lowered the mean age of our nursing staff by over 2 years. Our vacancy rate is now below 4% with a turnover rate of around 6%.

Notwithstanding these successes, it remains tough to get FT jobs in place.

Wendy Hill, Executive Nursing Officer, Chief Operating Officer, Community Hospitals and Regional Support Services, Capital Health, Edmonton

The Montreal region has both permanent FT and PT positions available, as well as a multitude of temporary FT replacement positions. Graduating classes from McGill are small and cannot meet demands. University of Montreal graduates larger numbers, but there are higher vacancies in the French hospitals, so we are still competing for a small RN market within Quebec. Nurses from other provinces would readily be hired here and provided French courses for free. All RNs applying for specialty certification have exam fee and 3 study days expenses covered, plus a bonus payment.

The McGill University Health Centre is still trying to hire sufficient RNs to fill vacancies this spring. Last spring, the situation was worse as we had few permanent positions available after having had imposed a lower worked hours-per-patient-day ratio. Positions exist for regular units, critical care, and O.R. as well as advanced practice roles. In particular, we are seeking more baccalaureate and MSc graduates (have approx. a 42 % BSN rate now), but all RN applicants are welcome.

We already have a high ratio of FT:PT positions. It actually becomes difficult to balance out a rotational schedule (allowing every other weekend off due to collective agreement) when over 70 % of RN positions on a unit are FT; it creates less flexibility.

Patricia O'Connor, Reporting on Montreal region and the McGill University Health Centre

In BC, we (provincial CNO, Health Match BC, and a health authority CNO) visit each of the nursing school graduating classes in the province each year to tell them that we love them and we want them to stay - and then we advise them of the free services offered by Healthmatch BC to find them a job. I always do a straw poll to see who has jobs or who has been offered a job. The response is variable. In the North of our province for example the CNO in that authority has offered jobs to a significant number of the graduating class in that region. In the interior where it is historically difficult to get a job the opportunities are fewer and many grads will likely need to leave their region.

With each class, it is pretty clear by a show of hands that the vast majority of graduates would like to find a FT job in their region. As to what we actually know, we have been fortunate to have the RNABC do a new grad survey. They usually do this every 5 years but in 2001 decided to do it annually. In 1997 about 38% of new grads were able to find permanent FT or PT work upon graduation. That had increased to over 75% by the 2001 survey. So we are heading in the right direction. Despite the progress, RNABC remains significantly concerned that we are behind other jurisdictions in terms of the number of FT positions (51% provincially). To that end we are going to have to do additional work in this area in BC.

Anne Sutherland Boal, Assistant Deputy Minister and Chief Nurse Executive, BC Health

In Manitoba, we undertook a joint union-management project, in accordance with a Memo in the Collective Agreement, to increase the number of FT positions and to maximize the FTE of PT positions. Although this project was not able to achieve the ambitious goal that had been set, the process provided some valuable opportunities.

We have been able to review all the nursing rotations in the Winnipeg Region and have discovered that many require alterations. These alterations are necessary to meet operational needs and to ensure fairness among nurses with respect to number of weekends and night/evening shifts worked. We were also able to identify opportunities to increase the number of FT positions in our rotations. This is, in most cases, being achieved through attrition.

We have also been living through a phenomenon that appears to be somewhat unique to Manitoba. During the nursing shortage, which is now temporarily lessening, nurses chose to take PT positions instead of FT. They would supplement their incomes by "picking up" shifts. The shifts they picked up were often the most desirable shifts (e.g. day shifts during the week). This often left us very short-staffed on the less desirable shifts (e.g. nights and weekends). As a result, we have been incurring very high overtime costs to cover these shifts. New graduates, who as students had told us that they desired FT employment, quickly caught on to this trend and often requested and took PT positions upon graduation. As Helga Bryant has previously described, we are now in the process of creating "relief teams" to address this issue and to create employment opportunities for new graduates as the number of vacancies continues to decline. We are aware, through work we have done on our RN Projection Model, that we will have an adequate supply of new graduates for the next 2-3 years. Following this period, the number of nurses eligible to retire increases dramatically and stays at a very high level until 2020. We know that it is essential to create positions to retain our grads, so they will be present in the workforce when these retirements take place.

The work we have done on creating FT employment has been very beneficial on a number of fronts. We will be monitoring the number of FT positions in our Region closely. Rotations are being changed to meet operational requirements and ensure fairness among nurses where these changes do not involve significant disruptions (issuing deletions notices). Further changes in rotations will be made to improve the number of FT positions as opportunities present. Additionally, we have developed strict guidelines to minimize the posting of low (<0.4) EFT positions. We are certain that the creation of relief teams will provide a more stable staffing model and, as vacant shifts become less available, nurses will be more inclined to choose FT employment again.

Jan Currie, VP & CNO, Winnipeg Regional Health Authority

At Children's and Women's we have been experiencing some of the same issues Jan has described, but we also were faced with another interesting challenge. As you know, we are a specialty hospital that provides tertiary ped's and maternity services for BC. After several years of not needing to hire new grads because of an adequate supply of experienced nurses, about 4 years ago the job market in BC opened up a bit. As a result, nurses looking for changes began to move (and for the most part this was healthy movement to communities closer to home for working mums etc.) and we started to feel the impact of the shortages. At the same time, the one-year mat leaves were beginning to really impact. (When the job market was tight, novices and other nurses who wanted to work with us were content to accept "temporary FT positions" in the hope that they would be well positioned to assume a regular position when one came open. But as the job market opened up, fewer were willing to do this.)

So, among several other strategies, we began hiring new grads even though these novices had not had an opportunity to consolidate their learning and were not prepared to work in a tertiary specialty environment. As you will imagine, we were faced with some real issues. We quickly found that these novices were unable to manage a regular workload and needed support for up to a year before they were really proficient. Our overtime shot up as we responded to the drop in productivity and our experienced nurses were not too thrilled with the additional burden of educating novices in droves either! To address this problem, we elected to "over hire" for a period of time. This allowed us to drop our nurse-to-patient ratios and to support the novices to acquire the competencies they needed to provide safe care. As the novices became competent they were absorbed into "budgeted lines". We continue to do this in selected units such as the Neonatal ICU, but the following outcomes caused us to change to another approach recently:

1. After a couple of years we had developed a nice core of proficient nurses and the market tightened up again so we did not need to hire the same numbers (indeed we were in a hiring freeze for almost a year at BC Children's)

2. All the nurses - experienced and otherwise - got used to the lowered ratios (in some cases we were staffing 1:2 on the units) and our productivity was challenged

3. Budget cutbacks in BC made this approach unsustainable

4. These novices were often hired into sub-specialty areas from the start and as a result developed good skills to care for sub-specialty populations such as kids with cardiac disease, or post-partum women, but were not actually consolidating broader pediatric or maternity skills. This meant that they could not move around in the facility without additional support, and they were sure not well prepared to leave us and go work in less specialized community facilities.

So, recently we have tried another approach at BC Children's. We have created a Nursing Resource Team (NRT). We hire almost all our new nurses (novice or experienced) into this team in FT positions and assess their learning needs. We then develop a learning plan with them. They are placed on a "home unit" for initial orientation and preceptoring, then are moved to other units to facilitate competency development over their first year in keeping with their learning needs. They are offered a lot of education and have dedicated operational leadership support so their development is tracked and they are not "lost in space"! At the end of their learning pathway, they will be "proficient" pediatric nurses and can elect to post into a vacant position on the specialty unit of their choice to continue their development - or they can stay with the NRT to become a generalist resource nurse.

The benefit to the units/programs is that they have vacant term positions filled by NRT novice nurses who need the experience offered in that area. And although this is not intended to be a "float pool" our experienced NRT staff can be booked to backfill short term and longer-term vacancies or to release regular staff to participate in non-patient related initiatives. The NRT is paid for by pooling relief budgets from the programs. To date we are finding that this is a useful and cost effective strategy for creating full time positions for novices... and helping them to develop the skills they need to care for our patient populations. However, it is early days yet, and we are closely monitoring the outcomes.

Heather Mass, Chief of Nursing, Children's & Women's Health Centre of British Columbia

Readers: The following type of comment came from several people, so I am putting in one here that seemed representative. Mike Villeneuve, editor

I know that some people don't like to hear this but the terms in collective agreements drive rotations that require staffing patterns that we do not believe are optimal. I don't believe that it is much different in other jurisdictions from discussions I have had with my colleagues. This means that there are more PT positions than any of us would like, some of which are very small FTE's. How we resolve this dilemma I am not sure, but it would seem that the FT job status issue is something that requires a collaborative discussion and problem solving approach among unions and ourselves.

A national union perspective on the FT/PT issue.

Creating more FT work is not an option - it's a necessity. A rate of 28%-52% FT jobs is just unacceptable. We have great success stories across this country.

• Commitment from all parties to retain new graduates.
• Amalgamation of PT positions
• Supernumerary positions "over-hire"
• Monitoring of vacancy and of overtime
• "Relief teams," "floats," "nursing resource teams"
• New Graduate Initiative
• Bonus
• School visit

In the 1990's we worked together through the collective bargaining process to control the casualization phenomenon. Letters of intent were negotiated to examine casual hours, analyze them, and if they were permanent hours, a process was established to grant FT or PT jobs. This process was often outside the "regular" posting articles. Where there is a will and funding, we can find a way, regardless of the different variation of collective agreement language. Both parties wrote the scheduling and postings language, so both parties should find a solution. Let's not forget that not every "stakeholder" is convinced. Some still have the ostrich syndrome and have their heads in the sand. As for the shortage, job fairs happen without any local, regional or provincial employers present and nurses are laid off to be replaced by others. Policies of R and R are written, but not funded or followed.

Creativity outside and within the collective bargaining process must be considered:

• Career counselling
• Canada's version of the "Traveling Nurse"
• Flexible rotation
• Assessment of FT/PT ratios
• Tracking of vacancies, etc.

The process of novice to expert doesn't happen overnight or in solitude. I encourage all of us to be open to new ideas and to be committed in answering the needs of seasoned nurses and our new graduates. Merci and thank you,

Linda Silas, RN BScN, President, Canadian Federation of Nurses Unions

Health Canada Provides $2.2 Million For Nursing Projects

Late in 2003, Health Canada provided $2.2 million to fund six projects focused on nursing, and particularly on nursing human resources issues.

The projects are all done, and final reports will be posted soon on the ONP web site.

The six projects all supported the Health Human Resources components of Health Accord 2003, specifically related to recruitment and retention, interdisciplinary education, and national Health Human Resources planning.

We offer our sincere thanks to all the researchers and project leaders who responded to the incredibly tight timelines - we are grateful for all your hard work and your important contributions.

A Progress Report on Implementing the Final Report of the Canadian Nursing Advisory Committee
Canadian Policy Research Networks Inc.

A Proposal to Support the Strategic Plan to Implement the Canadian Nursing Advisory Committee Recommendations
Canadian Nurses Association, Academy of Canadian Executive Nurses, Canadian Association of Schools of Nursing, Canadian Federation of Nurses Unions,
Canadian Healthcare Association, Canadian Practical Nurses Association, and Registered Psychiatric Nurses of Canada

Needs-based Health Human Resource Planning: The Relationship between Population Health and Nursing Service
Gail Tomblin Murphy (Dalhousie University) and Dr. Linda O'Brien-Pallas (University of Toronto)

Examining the Causes of Attrition From Schools of Nursing in Canada
Dr. Dorothy Pringle (University of Toronto)

Nursing Best Practice Guidelines
Registered Nurses Association of Ontario (RNAO)

Further Development of Work Life Indicators in Canada
Canadian Council on Health Services Accreditation

ONP Web Site

The ONP web site will be fully updated in time for Nursing Week 2004, and we are happy to have Michael Cleroux on board to keep it current for us from now on!

Thanks for your patience. On May 10, point your browsers to: Nursing Policy

Sector Study Report

The report, The International Nursing Labour Market can now be downloaded from the study's web site: Building the Future

Funding Announcement

Hospital For Sick Children Foundaton (HSCF)

New Investigators Research Grants Program

The Hospital for Sick Children Foundation is pleased to announce that the Canadian Institutes of Health Research (CIHR)'s Institute of Human Development, Child and Youth Health (IHDCYH) will be committing additional funding to the New Investigator Awards Program so that we may support a greater number of excellent projects. Through the New
Investigators Grants Program, new investigators (defined as being within six years of taking up their first academic appointment) may obtain up to two years' support for biomedical, psychosocial and clinical research projects. Projects must be relevant to the health of Canada's children and significant in terms of their potential impact on health outcome. More details are available at:
Sick Kids Foundation

he Hospital for Sick Children

Deadlines:
Nov 1 2004, May 2 2005,
Oct 31 2005

Social Sciences And Humanities Research Council (SSHRC)

Aboriginal Research - A Pilot Program

This program has two overall objectives. The first is to facilitate research on a range of policy-related issues that are of concern to Canada's Aboriginal peoples: urban issues, economic development, the environment, education, research ethics, intellectual and cultural property, and languages and cultures. The program's second broad objective is to build up the capacity of the humanities and social science community to operate within, and to benefit from, the approach to Aboriginal research outlined above. This program seeks to build Canada's capacity, at the postsecondary level, to engage research questions that are of concern to Aboriginal peoples in ways that capitalize on knowledge, experience and traditions developed among and in partnership with those peoples. The program supports, in particular, but not exclusively:

• international comparative studies
• new approaches and methods of inquiry that will build understanding of the dynamics and significance of Aboriginal knowledge
• effective mobilization of knowledge within Aboriginal and other communities.

The program offers two support mechanisms: Development Grants and Research Grants. Full details can be found at
Aboriginal Research.
Deadline: Jun 30, 2004

Tammy Y. Chan
Research Programs Manager
Faculty of Nursing
University of Toronto
Room 205B, 50 St. George Street
Toronto, ON M5S 3H4
Tel.: (416) 978-8533
Fax: (416) 978-8222
Email: tammy.chan@utoronto.ca
Office of Research Affairs (ORA)

A Renewed Partnership For Health Care Sustainability In Canada

Link to: A Renewed Partnership for Health Care Sustainability in Canada - Speaking Notes for The Honourable Pierre Pettigrew, Minister of Health, Minister of Intergovernmental Affairs and Minister responsible for Official Languages to the Health Policy Summit 2004 (Moving Healthcare Forward in Canada), Toronto, Ontario Apr 20, 2004: Ministers

A Nurse's Story

A Nurse's Story: Life, Death, and In-between in an Intensive Care Unit, written by Tilda Shalof, is now available in hard copy from Mclelland & Stewart (Hardcover | March 2004 | $34.99 | 0-7710-8086-7 | 352 pages.)

Shalof is a graduate of the University of Toronto Faculty of Nursing (1983). An intensive care unit nurse with twenty years of experience in Israel and Canada, she now lives in Toronto. The book is available from Chapters for $20.99.

Conference Update

2004 Canadian Nursing Research Conference
London, Ontario
May 12 - 15, 2004
Transforming Health Care Through Nursing Research: MAY 12 - 15, 2004

National Primary Health Care Conference - Moving Primary Health Care Forward: Many Successes, More to Do
Winnipeg Convention Centre
May 16-19, 2004
National Primary Health Care Conference

The 1st Conference of the Canadian Association for Health Services and Policy (formerly CHERA)
Hyatt Regency, Montreal
May 26-28
Canadian Association for Health Services and Policy Research

The 25th Anniversary Faye Fox Education Day. Expanding Nursing Roles: Implications for Practice.
Montreal QC
May 28, 2004
aredman@nurs.jgh.mcgill.ca

Academy Health Annual Research Meeting
San Diego
June 6-8, 2004
Academy Health's Annual Research Meeting (ARM)

"Back to the Future" - 33rd Annual Conference of the Ontario Occupational Health Nurses Association
Hamilton Ontario
June 9-11, 2004
Special rates for non-nursing health care and safety associations
Ontario Occupational Health Nurses Association

CNA Biennial Convention
St. John's
June 20-23, 2004
The Canadian Nurses Association

2èmes Journées Nationales d'Etudes des Directeurs des Soins
l'Association française des directeurs des soins en partenariat avec le Secrétariat international des infirmières et infirmiers de l'espace francophone
Dijon France
Septembre 14-16, 2004

Fifth National Canadian Rural Health Research Society Conference and Fourth International Rural Nursing Congress. Rural Health: Celebrating Diversity and Strength
Sudbury, ON
October 21-23, 2004
NOTE: Abstract deadline extended to April 2, 2004
Canadian Rural Health Research Society

Health, Work & Wellness Conference
8th Annual Health, Work & Wellness Conference
Transforming the Organization
Vancouver BC
October 28-30, 2004
Health Work and Wellness

The 8th Nursing Research Conference
Seville Spain
November 17-20, 2004
Unidad de coordinación y desarrollo de la Investigación en Enfermería

23rd Quadrennial Congress of the International Council of Nurses. Nursing on the Move: Knowledge, Innovation and Vitality
Taipei Taiwon
21-27 May 2005
23rd Quadrennial Congress 2005

Healthy Workplace Strategies: Creating Change and Achieving Results

Healthy workplaces benefit employees, first and foremost, contributing to their physical psychological and social well-being. But they have big pay-offs for employers as well - lower accident rates, reduced absenteeism and turnover, higher job satisfaction, higher productivity, to name a few. It's a cause almost everyone in an organization can get behind and collaborate on. In fact, efforts to build a healthier workplace are unlikely to succeed without that kind of cooperation from all levels. Traditional workplace health promotion programs are top-down and all too often focus on individual health behaviours, rather than organizational factors. As such, they rarely address root causes.

Lowe, of the Graham Lowe Group, and Research Associate with CPRN's Work Network, has prepared a paper on the subject for Health Canada. In Healthy Workplace Strategies: Creating Change and Achieving Results, Lowe answers the question, "How can we design effective strategies to change workplaces so they become healthier and more productive?" Focusing on the organizational change processes, strategies and tactics required to bring about healthier working conditions, Lowe presents what amounts to an action model to act as a tool to that end. You can access or download a copy of his paper at: The Graham Lowe Group - Healthy Workplace Strategies

For other similar literature visit the web site of the Graham Lowe Group at The Graham Lowe Group

Canada's Food Guide To Healthy Eating To Undergo Update

Health Minister Pierre Pettigrew has officially announced that Health Canada will undertake a revision to Canada's Food Guide to Healthy Eating.

"Canada's Food Guide to Healthy Eating is at the core of the dietary guidance that the federal government provides to Canadians," said Minister Pettigrew. "We know from recent research that the current Food Guide continues to promote a pattern of eating that is scientifically sound. Health Canada will ensure the Food Guide continues to promote a pattern of eating that meets nutrient needs, promotes health, and minimizes the risk of nutrition-related chronic disease. However, our research also tells us that the Food Guide can be improved and made more meaningful to Canadians in making healthy eating choices."

Since the current Food Guide and related dietary guidance was released in the early 1990's, science about the relationship between diet and health has evolved. To ensure Health Canada's guidance is consistent with the latest science, the Department reviewed the Food Guide by consulting experts across the country. The review included an assessment of diets that follow a pattern of eating recommended by the Food Guide. The review also assessed changes in the food supply and in eating patterns; an evaluation of the use and understanding of the Food Guide by teachers, dietitians, public health personnel, and consumers; and a national stakeholder consultation.

Findings from the review have confirmed that the Food Guide remains a useful and valid tool for Canadians from both a scientific and an educational perspective. The review has confirmed the many strengths of the Food Guide including its flexibility, simplicity, visual appeal, widespread awareness and, most importantly, its consistency with current science.

In spite of its many strengths, some challenges were identified when Canadians apply the guidance put forward by the Food Guide. For example, research has shown a lack of understanding of some of the terminology and messaging used, the need to modernize some elements, and a need to improve the promotion of the balanced approach to healthy eating that is the foundation of the guide.

As such, over the next year, Health Canada will conduct further research and analysis on areas of a technical and communications nature to determine the extent of the updates that need to take place. Technical matters may include issues related to serving sizes, serving ranges and the food groups. Communications matters may include issues related to terminology, target audiences, and graphics.

"It is clear that there is a great deal of support for the Food Guide and that it can continue to be used as the basis for providing and implementing healthy eating messages," said Dr. Carolyn Bennett, Minister of State (Public Health). "At the same time, however, undertaking a revision will provide an opportunity to work with stakeholders in response to the challenges that have been identified by Canadians."

The elements of the revision process are currently under development. The target for completion of the revision is in the spring of 2006. For more information on details of the review and progress of the update, visit Health Canada's Website at: Nutrition and Healthy Eating

University Of Ottawa Doctoral Program In Nursing

The Faculty of Health Sciences and the School of Nursing is delighted to announce that, subject to the approval of the Senate of the University of Ottawa, a PhD in nursing program will be offered beginning September 2004. Applications are currently being accepted for FT students.

These are exciting times for the School of Nursing. Once final Senate approval is received, relevant documents will be posted on the School website. In the meantime, we encourage potential candidates to apply. I would be pleased to have them contact me if they would like to discuss the program.

Jean Dunning, RN, PhD
Assistant Director, School of Nursing - Graduate Programs
University of Ottawa
451 Smyth Rd.
Ottawa, ON Canada
K1H 8M5
Tel: (613) 562-5800 Ext: 8422
Fax: (613) 562-5800 Ext 5443

Office of Nursing Policy - Launch of Nursing Week 2004

Monday, May 10, 2004
Banting Theatre, Tunney's Pasture
Ottawa Canada

• Lisa Maslove, Health Network, Canadian Policy Research Networks
• Lisa Little, Health Human Resources Consultant, Canadian Nurses Association - For CNA, Canadian Association of Schools of Nursing, Canadian Healthcare Association, Canadian Federation of Nurses Unions, Canadian Practical Nurses Association, Registered Psychiatric Nurses of Canada, and the Academy of Canadian Executive Nurses
• Paula Greco, Manager, Research & Development, Canadian Council on Health Services Accreditation
• Dorothy Pringle, RN PhD, Professor, Faculty of Nursing, University of Toronto
• Tazim Virani, RN MScN, Consultant, Tazim Virani & Associates, and Project Director, Advanced Clinical Fellowship Project, Nursing Best Practice Guidelines, Registered Nurses Association of Ontario
• Gail Tomblin Murphy RN PhD(c), Associate Professor, School of Nursing and Department of Community Health and Epidemiology, Dalhousie University, and Doctoral Fellow, Nursing Effectiveness, Utilization and Outcomes Research Unit, Faculty of Nursing, University of Toronto