Five Long Years (that have flown by)

(sorry about the formatting, this is like my third time posting!)

And it's been five long years
Since I've seen your loving eyes
The girl has grown
She sees right through my thin disguise
You know I still love you
You knew I'd never change
And it's been five long years and I love you
Just the same
-Colin James, "Five Long Years"

That's the song that's been running through my head this past week as we reached our five-year anniversary living in Yellowknife. It's hard to believe we arrived here exactly five years ago today. We moved into a company apartment for a week, then a hotel/apartment for another week. Our house closed on April 7, and I think our moving truck arrived from Toronto on April 9.

I have had a bit of a break between semesters. My experience at the Department of Health and Social Services was amazing. It was difficult in the sense that neither my preceptor nor I were really sure what I would be doing there, but I was able to develop a leadership initiative that has turned out to be a valid issue in the NWT, and may be recognized nationally as well. I created a position statement on the importance of quality relationships between nurses and nursing students, which lead to healthier workplace environments and improved client health outcomes. Although my course ended several weeks ago, I have continued to present my position statement to "stakeholders" and I am currently looking at turning it into a resolution that can be adopted by the nursing association of the NWT/Nunavut when they have their AGM in May. So I am still quite busy with it. I've included the draft copy below for your reading entertainment.

I think the reason it is so successful is that I have had a huge amount of support from my preceptor, who is the Chief Nursing Officer of the NWT. If I was indimidated by his title when I first started working with him, I am certainly over that, but still have a lot of awe for him and his leadership and passion to promote the nurses' voice. He has definitely taken me under his wing, and I have met a lot of really important people in nursing through him.

I have been home with Rachel for her March break the last two weeks, which has been nice although it's a challenge to keep her busy. My hours with the Dept were Mon-Fri, but I was still quite exhausted by the end of the semester, so some time off has been perfect. I completed over 380 hours there (and still counting...) and I am preparing for my next and last placement on Obstetrics. I have to complete at least 190 hours to make my grand total of 600, and even though I am looking forward to this placement, I am very much going to be counting down the shifts. So 16 12-hour shifts to go.

The snow here is finally, finally, starting to melt. The temp hovers around zero, so we might get some meltage one day, then it all freezes the next. The 'warm' weather means that we are in a constant battle with Rachel to wear her coat and boots. She seems to think that a sweater, skirt and knee high socks (with the concession of a rabbit-fur hat) are just fine, and more often than not she wins the argument and wears just that. So if you see a four-year-old playing in the snow with bare legs and a fur hat, that's our girl.

We've done our usual winter activities: visited the SnowKing Castle (not even one photo this year, partly because our photos are the same every year, but also because our camera seems to have finally died...in cold weather, the new batteries are just sucked dry in about 2 minutes). We had a winter campfire on the first warm day in March, which was quite fun, roasting hot dogs and marshmallows. The Caribou Carnival was cancelled this year due to lack of participation (no volunteers). I have been pretty happy with my non-volunteer status this year...I'm so busy and I have experienced a lot less stress than when I am juggling home, school and extra-curricular stuff. Unfortunately, the Moms, Boobs and Babies group is struggling with a lack of volunteers too, as well as a lack of good leadership, it sounds like. It's hard not to agree to helping out, but I do believe that new moms will take up the slack as needed. I feel so removed from breastfeeding that I don't know how much support I could still offer anyway. Here is the position statement (still a draft, but getting closer to completion):


Northern Nursing Leadership Forum (NLF)
and

Nursing Students of the NWT

Joint Position Statement on Quality Relationships
between Nursing Professionals and Nursing Students

We strongly believe in the importance of quality relationships between nursing professionals and nursing students. We commit to ensuring these partnerships are positive, collaborative, reciprocal and sincere. Promoting a culture of respect in healthcare practice leads to healthy workplace environments and improved client outcomes.

As nursing professionals, we commit to:

• recognizing the important role of nurse professionals in the facilitation and support of nursing education
• engaging as mentors, guides, and positive role models as part of everyday nursing practice
• valuing students for the enthusiasm, knowledge and motivation they bring to the workplace
• providing timely and constructive feedback to nursing students and novice nurses

As nursing students, we commit to:

• valuing nursing professionals for their knowledge and expertise
• identifying and communicating our learning needs and level of competency, with the understanding that quality patient care is a priority
• engaging in practice with a positive attitude towards learning
• requesting constructive feedback from nursing professionals, to enhance our Nursing Practice and work towards goal attainment


Together, we commit to:

• promoting environments that contribute to optimal health and healing outcomes for clients
• promoting environments that exemplify knowledge expansion and professional growth
• collaborating and developing solutions to resolve differences that occur within the team environment
• providing culturally competent care to clients and families and creating greater cultural awareness when knowledge deficits present


Quality relationships
• encourage intra-professional collaboration of knowledge and ideas
• strengthen a team approach to healthcare
• result in healthy workplace environments in healthcare
• lead to increased quality of care for clients
• promote a supportive culture of learning in the nursing practice environment
• enhance the transition from student, to graduate nurse, to experienced nurse
• increase clinical skill development for both nursing professionals and nursing students
• contribute positively to sharing of information and enhanced awareness and utilization of best nursing practices


Background & Significance


Promoting ethical relationships in the workplace is the responsibility of all members of the nursing profession (Canadian Nurses’ Association (CNA), 2008). While nursing professionals provide mentoring and guidance, nursing students are responsible for communicating clearly their learning goals in order to meet the standards of care that match their level of experience. Developing these relationships between nursing professionals and nursing students lead to improved collaboration and trust, and ultimately result in safe, competent, compassionate and ethical care for clients (CNA, 2008). Promoting a “climate of learning” (Baumann, 2007, p. 22) encourages organizations, nurse leaders, and individuals to support educational development and mutual knowledge sharing. Students benefit from a positive practice environment with increased confidence and enthusiasm, while nurses benefit through ongoing development of leadership competencies and professional growth.


Support in the Workplace

As with most new environments, effectively socializing into the organizational culture of a workplace can strengthen an employee’s commitment to that organization (Pangman & Pangman, 2010). Developing quality relationships is crucial at this time, because the process relies on mentoring and guidance from experienced nurses (Casey, Fink, Krugman, & Probst, 2004). It is widely recognized that the transition from nursing student to professional nurse can be challenging, with a major stressor being a perceived lack of support in the workplace (Boychuk Duchscher & Cowin, 2006; Laschinger, Finegan, & Wilk, 2009; Thomas & Burk, 2009). The reality is that if new nurses feel unsupported at this critical learning stage, they often leave their place of employment, or may leave the profession entirely (Advisory Committee on Health Human Resources (ACHHR), 2002). Becoming both a resource and a role model for nursing students is a way for nursing professionals to ease the transition for nursing students and demonstrate both responsibility and accountability in their practice (RNANT/NU, 2006).


Quality Care

No less important are the implications for clients on collaborative relationships between health professionals. The International Council of Nurses (2010) states that “patients and the public have the right to the highest performance from health care professionals and this can only be achieved in a workplace that enables and sustains a motivated well-prepared workforce” (para. 3). Research indicates that there is a direct correlation to the quality of nursing practice environments and positive health outcomes for clients (Armstrong, Laschinger, & Wong, 2009; Laschinger & Leiter, 2006). The code of ethics guides both nurses and nursing students to ensure that the health and well-being of their clients are considered as the first priority in their practice (CNA, 2008). Collaborative relationships and increased autonomy for nurses in practice result in direct positive effects on patient safety outcomes (Laschinger & Leiter, 2006). The basic principles of quality client care are achieved when healthcare professionals advocate for positive nursing practice environments.

Nurse Leadership

Nursing leadership is about advocacy and action and nursing professionals and nursing students are in an ideal position to promote leadership initiatives (CNA, 2009). One way to do this is to support positive practice environments (Ferguson & Day, 2007). Nurses who are included in decision-making are able to contribute innovative ideas and build upon the existing strengths of their work environment (Richer, Ritchie, & Marchionni, 2009). This results in feelings of empowerment for nurses, which is a sense of control over one’s environment, both personally and professionally (Pangman & Pangman, 2010). Empowered nurses recognize the value of their expertise, which enhances relationships with other healthcare colleagues (Canadian Health Services Research Foundation (CHSRF), 2006; Pangman & Pangman, 2010).

Support from Canadian Organizations

Many organizations have addressed the importance of healthy workplace environments. Organizational leaders across Canada are beginning to understand the implications of a healthy workplace and in recent years have developed strategies to address these issues.

International Council of Nurses (2010) created a Positive Practice Environments Campaign in 2009 to address the importance of quality workplaces for nurses. By raising awareness and identifying best practices they encourage strategies to enhance nursing practice environments.

Accreditation Canada (2010) recently developed a Required Organizational Practice (ROP) component to address workplace violence prevention and ensure healthier workplace environments.

Health Canada (2007) identified core values that a workplace community should possess, including honest and effective communication, resulting in an environment of learning and innovation.

Registered Nurses’ Association of Ontario (2006) believes that a healthy workplace is the responsibility of the both the nursing profession collectively as well as individually. To support this, RNAO developed guidelines for healthy work environments for nursing teams. The document provides evidence-informed best practices to ensure healthy workplaces for nurses and other health professionals.

Department of Health and Social Services (DHSS) in the Northwest Territories aims to achieve optimal work environments in healthcare workplaces for all health professionals. The DHSS made a commitment to develop initiatives for healthier healthcare work environments as outlined by the Quality Worklife Quality Healthcare Collaborative (Canadian Council on Health Services Accreditation (CCHSA), 2007).

Moving Forward

Several strategies are recommended:

Individual

• Be responsible and accountable for nursing practice, fostering a culture of respect for team members
• Develop personal empowerment strategies to support quality relationships. Possess a positive attitude; be flexible and willing to negotiate (Pangman & Pangman, 2010).

Organizational

• Ensure funding for professional development programs for nursing professionals, novice nurses, and nursing students to enhance learning and develop competencies in practice. Programs may include continuing education and mentoring.

Societal

• Support nursing leadership by giving voice to the value of nurses’ work in practice, in politics, and in public.


Acknowledgements
The position statement was developed under the leadership of NLF with the support of nursing professionals and nursing students across the NWT.





References

Accreditation Canada (2011). Workplace Violence Prevention Guidelines. Required Organizational Practices. Ottawa, Canada: Author.

Advisory Committee on Health Human Resources (ACHHR). (2002). Our health, our future: Creating quality workplaces for Canadian nurses. Ottawa, Canada: Health Canada.

Armstrong, K., Laschinger, H., & Wong, C. (2009). Workplace empowerment and magnet hospital characteristics as predictors of patient safety climate. Journal of Nursing Care Quality, 24(1), 55-62. Retrieved from http://journals.lww.com/jncqjournal/pages/default.aspx

Baumann, A. (2007). Positive practice environments: quality workplaces = quality patient care. Information and Action Tool Kit. Geneva, Switzerland: International Council of Nurses (ICN).

Boychuk Duchscher, J.E., & Cowin, L. S. (2006). The new graduates’ professional inheritance. Nursing Outlook, 54, 152-158. doi: 10.1016/j.outlook.2005.04.004

Canadian Council on Health Services Accreditation (CCHSA). (2007). Within our grasp: A healthy workplace action strategy for success and sustainability in Canada’s healthcare system. Ottawa, Canada: Author.

Canadian Health Services Research Foundation (CHSRF). (2006). What’s ailing our nurses? A discussion of the major issues affecting nursing human resources in Canada. Ottawa, Canada: Author.

Canadian Nurses’ Association (CNA). (2009). Position statement: Nursing leadership. Ottawa, Canada: Author.

Canadian Nurses’ Association. (2008). Code of ethics for registered nurses. Ottawa, Canada: Author.

Casey, K., Fink, R., Krugman, M, & Probst, J. (2004). The graduate nurse experience. Journal of Nursing Administration, 34(6), 303-311. Retrieved from http://journals.lww.com/jonajournal/pages/default.aspx

College of Registered Nurses of British Columbia (CRNBC). (2005). Guidelines for a quality practice environment for nurses in British Columbia. Vancouver, Canada: Author.

Ferguson, L.M, & Day, R.A. (2007). Challenges for new nurses in evidence-based practice. Journal of Nursing Management, 15(1), 107-113. Retrieved from http://www.blackwellpublishing.com/journal.asp?ref=0966-0429

Health Canada (2007). Building a workplace community. Retrieved from http://www.hc-sc.gc.ca/ahc-asc/activit/about-apropos/index-eng.php

International Council of Nurses (ICN). (2010). Positive practice environments for healthcare professionals. Retrieved from http://www.ppecampaign.org/

Laschinger, H. K., Finegan, J., & Wilk, P. (2009). New graduate burnout: The impact of professional practice environment, workplace civility, and empowerment. Nursing Economic$, 27(6), 377-383. Retrieved from http://www.nursingeconomics.net/cgi-bin/WebObjects/NECJournal.woa

Laschinger, H. K., & Leiter, M. P. (2006). The impact of nursing work environments on patient safety outcomes: The mediating role of burnout/engagement. Journal of Nursing Administration, 36(5), 259-267. Retrieved from http://journals.lww.com/jonajournal/pages/default.aspx

Lowe, G.S. (2007). Making a measurable difference: Evaluating the quality of work life interventions. Ottawa, Canada: Canadian Nurses Association.

Pangman, V. C., & Pangman, C. (2010). Nursing leadership from a Canadian perspective. Philadelphia, PA: Kluwer, Lippincott, Williams & Wilkins.

Registered Nurses’ Association of the Northwest Territories and Nunavut (RNANT/NU). (2006). Standards of Nursing Practice for Registered Nurses. Yellowknife, Canada. Author.

Registered Nurses’ Association of Ontario (RNAO). (2006). Healthy work environments best practice guidelines: Collaborative practice among nursing teams. In RNAO Nursing Best Practice Guidelines Program. Ontario, Canada: Author.

Richer M.C., Ritchie, J. & Marchionni, C. (2009). ‘If we can’t do more, let’s do it differently!’: Using appreciative inquiry to promote innovative ideas for better health care work environments. Journal of Nursing Management, 17, 947-955. doi: 10.1111/j.1365-2834.2009.01022.x

Thomas, S. P., & Burk, R. (2009). Junior nursing students’ experiences of vertical violence during clinical rotations. Nursing Outlook, 57, 226-231. doi:10.1016/j.outlook.2008.08.004



Also See:

Canadian Association of Schools of Nursing (CASN). (2005). Position statement: Clinical/practice nursing education. Ottawa, Canada: Author.

Canadian Nurses’ Association (CNA). (2009). Position statement: Nursing leadership. Ottawa, Canada: Author.

Canadian Nurses’ Association (CNA) and Canadian Federation of Nurses’ Unions (CFNU). (2006). Joint position statement: Practice environments: Maximizing client, nurse and system outcomes. Ottawa, Canada: Authors.

Canadian Nurses’ Association (CNA) and Canadian Federation of Nurses’ Unions (CFNU). (2006). Joint position statement: Workplace violence. Ottawa, Canada: Authors.

Registered Nurses’ Association of Ontario (RNAO). (2008). Position statement: Violence against nurses: “Zero” tolerance for violence against nurses and nursing students. Ontario, Canada: Author.