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Oops, sorry, wrong patient!

A patient verification process is needed everywhere, not just at the bedside PAGE 18

Work bullies: Debunking some myths about why people bully PAGE 12 www.nurses.ab.ca

CARNA Provincial Council 2011–2012 PRESIDENT Dianne Dyer, RN, BN, MN Calgary 780.909.7058 [email protected] P R E S I D E N T- E L E C T Shannon Spenceley, RN, BN, MN, PhD Lethbridge 403.320.6959 [email protected] NORTHWEST REGION Jerry Macdonald, RN, BScN Grande Prairie 780.978.1348 [email protected] NORTHEAST REGION Debra Ransom, RN, BN, CCHN(C) Lac La Biche 780.623.2473 [email protected] EDMONTON/WEST REGION Gwen Erdmann, RN, BScN Edmonton 780.224.0675 [email protected] Joann Nolte, RN, BScN Edmonton 780.439.5731 [email protected] Marg Spilchen, RN Edmonton 780.633.7591 [email protected]

CENTRAL REGION Lisa A. Barrett, RN, MN Ponoka 403.350.8218 [email protected] Andrea Miller, RN, BN Camrose 780.s781.8472 [email protected] CALGARY/WEST REGION Kevin Champagne, RN, BN Calgary 403.966.3799 [email protected] Dory Glaser, RN, BScN, PNC(C), CLNC Calgary 403.241.3865 [email protected] Kerry Hubbauer, RN, BN Calgary 1.877.859.5054 [email protected]

PUBLIC R E P R E S E N T AT I V E S Murray Donaghy Airdrie 403.912.3242 [email protected] Fred Estlin Grande Prairie 780.532.8313 [email protected] Margaret Hunziker, BA, MA Cochrane 403.932.2069 [email protected] Mark Tims, QC Westlock 780.349.5366 [email protected] Rene Weber, DVM Red Deer 403.346.5956 [email protected]

SOUTH REGION Janet Lapins, RN, BNSc Lethbridge 403.381.1397 [email protected]

C O N T E N T S

5 CARNA needs you 6 What members said: Highlights of the 2011 member survey

12 Work bullies: Debunking some myths about why people bully

14 Publications ordered by Hearing Tribunals 17 Committed to Competence: 18 23 24 25 28 42

Entering professional development activities into MyCCP ISMP Medication Safety Alert: A patient verification process is needed everywhere, not just at the bedside Library ARNET distributes over $1 million to Alberta RNs and NPs Learning reflection: A nursing student recounts her experience with a medical emergency team Notice Board/In memoriam CEOs message: Navigating the World of Social Media

Alberta RN is published six times a year by: College and Association of Registered Nurses of Alberta 11620-168 Street Edmonton, AB T5M 4A6 Phone: 780.451.0043 Toll free in Canada: 1.800.252.9392 Fax: 780.452.3276 www.nurses.ab.ca

CARNA Staff Directory ALL STAFF CAN BE REACHED BY CALLING: 780.451.0043 or toll free 1.800.252.9392 Chief Executive Officer: Mary-Anne Robinson Complaints Director/Director, Conduct: Sue Chandler

Managing Editor: Margaret Ward-Jack Editor: Rachel Champagne Assistant Editor: Rose Mary Phillip Designer: Julie Wons

Director of Communications and Government Affairs: Margaret Ward-Jack Director of Corporate Services: Jeanette Machtemes Director of Policy and Practice: Lynn Redfern Registrar/Director, Registration Services: Cathy Giblin Deputy Registrars: Jean Farrar, Terry Gushuliak, Barbara Waters

Advertising Representative:

Registration Consultants: Nan Horne, Nancy MacPherson, Loreta Suyat

Jan Henry, McCrone Publications Phone: 800.727.0782 Fax: 866.413.9328 [email protected]

Competence Consultants: Michelle Morrison, Barb Perry Conduct Counsel: Gwendolyn Parsons Conduct Counsel/Senior Investigator: Jane Corns Policy and Practice Consultants: Debra Allen, Marie-Andrée Chassé, Donna Hogg, Debbie Phillipchuk NEPAB Consultants: Lori Kashuba, Margareth Mauro Librarian and Archivist: Lorraine Mychajlunow Alberta Registered Nurses Educational Trust: Margaret Nolan Regional Coordinators:

Northwest:

Karen McKay

Northeast:

Barb Diepold

780.826.5383

Edmonton/West:

Penny Davis

780.484.7668

Central:

Heather Wasylenki

403.782.2024

Calgary/West:

Christine Davies Beverlie Johnson

403.500.9943 403.625.3260

Pat Shackleford Valerie Mutschler

403.394.0125 403.504.5603

South:

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780.830.7850

www.nurses.ab.ca

Please note CARNA does not endorse advertised services, products or opinions. US Postmaster: Alberta RN (USPS #009-624) is published quarterly in Winter, Spring, Summer and Fall by the College and Association of Registered Nurses of Alberta. c/o US Agent -Transborder Mail, 4708 Caldwell Rd E, Edgewood, WA 98372-9221. Alberta RN is published at a rate of $42 per year. Periodicals postage paid at Puyallup, WA and at additional mailing offices. US Postmaster: Send address changes (covers only) to Alberta RN, c/o Transborder Mail, PO Box 6016, Federal Way, WA 98063-6016. ISSN 1481-9988 Canadian Publications Mail Agreement No. 40062713 Return Undeliverable Canadian Addresses to: Circulation Dept., 11620-168 Street, Edmonton, AB T5M 4A6. [email protected]

PLACE FSC LOGO HERE

update

President’s Update Together As One Voice As I begin my term as president of CARNA, I am honoured and inspired by the opportunity to work with provincial council and registered nurses across the province to address the challenges facing our profession and the health system. It is my desire and commitment to be a visible and approachable leader who will “walk” with you, listen to you and bring forward your rich, powerful stories from your practice to health-care leaders, government and the public. I am a passionate and committed registered nurse. Over the past 35 years, I have worked in public health, emergency, trauma care, education and inner-city primary health care. My roles have been staff nurse, manager, surgical nursing It is my desire and instructor, course writer for commitment to be a visible and approachable distance education, a national trauma system accreditor leader who will “walk” and a published researcher. with you, listen to you My experience has convinced and bring forward me that a health system focused your rich, powerful on primary health-care principles, interprofessional collaboration stories from your and community engagement/ practice to health-care development promotes health leaders, government and safe quality health care. and the public. Registered nurses have the education, knowledge and expertise to lead this work in all settings in partnership with the population served and to identify positive effective solutions to issues. A nursing colleague once described registered nurses as the “glue” in the health-care system. She spoke about how we work in health-care teams and our role is to make sense of this complex and often overwhelming experience for patients/ clients and families, guiding the process and coordinating the care. CARNA is challenged and committed to ensuring our contributions are recognized and valued, both in practice and as a self-regulating profession, bringing the collective messages and supporting evidence forward as one voice. We are moving towards a future where the work of registered nurses will be widely interconnected through technology. CARNA is introducing new ways to use technology to streamline processes and to communicate with both members and the

public. In January 2012, CARNA will launch a president’s blog. This is only a first step to promote timely debate on relevant professional issues. Member engagement and your ideas are valued. These are times of significant challenge and change leading to uncertainty for everyone. My belief is that change is not always negative and can open doors to new opportunities. We can design our future together. Sir Winston Churchill once said “Courage is what it takes to stand up and speak; Courage is also what it takes to sit down and listen.” I intend to listen and CARNA intends to be heard and influence decision-makers in the public interest. The new Minister of Health and Wellness Fred Horne has promised to promote and maintain stability in the province’s health system. It is my hope that we have entered a period conducive to thoughtful dialogue focused on community needs. The recent invitation for Registered nurses registered nurse participation on must continue to be the Primary Health Care Reform heard and acknowledged Advisory Committee is one step forward. As Japanese poet as highly respected professionals and leaders; Ryunosuke Satoro stated, “Individually we are one drop. 33,000 strong. Sitting Together we are an ocean.” back quietly watching Registered nurses must continue from the “sidelines” to be heard and acknowledged is not an option nor as highly respected professionals do I think it is acceptable and leaders; 33,000 strong. Sitting when we have the ability back quietly watching from the “sidelines” is not an option nor to make a difference if do I think it is acceptable when we work together. we have the ability to make a difference if we work together. I look forward with anticipation to our positive future and opportunities to “walk” with you in these times of political uncertainty, innovation and endless opportunity. Florence Nightingale wisely stated “I attribute my success to this – I never gave nor took an excuse.” No excuses, we must work together to advance our profession and design a quality health system on behalf of Albertans. Please contact me and share your stories and ideas on my new blog or by email at [email protected]. RN

D i a n n e D y e r , RN, BN, MN 780.909.7058 [email protected]

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Celebrate nursing excellence at the CARNA Awards Gala Dinner. Join us as we honour the nominees and recipients of the 13th annual CARNA Awards of Nursing Excellence and celebrate the profession at this gala event. May 31, 2012. Westin Hotel. Edmonton

Call for Scrutineers for CNA Annual Meeting CARNA has an opportunity to nominate members to serve as scrutineers for the annual meeting of the Canadian Nurses Association (CNA) being held in conjunction with the CNA Biennial Convention, June 18–20, 2012 in Vancouver. Consideration will be given to:

Email [email protected] to be notified when tickets go on sale.

• RNs who are planning to attend the annual meeting/ convention (expenses are not covered for scrutineers, but the registration fee is waived) • persons who are not voting delegates

13TH ANNUAL

CARNA AWARDS of NURSING EXCELLENCE

• persons with previous experience as scrutineers • bilingual members To apply, download an application form at www.nurses.ab.ca or contact Diane Wozniak at [email protected] or 1.800.252.9392, ext. 525.

Deadline for submission is January 22, 2012.

THANK YOU to the nominators who took the time to recognize nursing excellence with a nomination to the CARNA Awards.

CARNA Holiday Office Hours

Save the date. The CARNA Annual General Meeting will be held in Edmonton at the Westin Hotel on May 31, 2012.

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The CARNA provincial office will be closed the week of December 26th and will reopen on Jan. 2, 2012.

REDUCED FREQUENCY NOTICE: As of January 2012, Alberta RN will publish four issues per year. The next issue is scheduled for April 2012.

CARNA ELECTION 2012 NOMINATION DEADLINE:

April 2, 2012

CARNA needs you Make the decisions that affect your nursing practice and profession. Broaden your horizons and seek a position on provincial council. What are the qualifications? • a willingness to embrace a leadership and decision-making role • the ability to examine, debate and decide on issues that form

• •

the basis for policy an understanding of nursing and health-related issues a resident of the region in which you run

Why should you run for office? This is your opportunity to: • make decisions that affect nursing practice • promote and support safe, competent, ethical nursing care using regulatory tools • influence health-care policies • network with leaders • expand your leadership skills

Which council positions are open?

Northeast est Edmonton/W

REGION

POSITION

TERM

Northeast

Provincial Councillor

Oct. 1, 2012–Sept. 30, 2015

Edmonton/West

Provincial Councillor

Oct. 1, 2012–Sept. 30, 2015

Central*

Provincial Councillor

Oct. 1, 2012–Sept. 30, 2014

Calgary/West

Provincial Councillor

Oct. 1, 2012–Sept. 30, 2015

Calgary/West*

Provincial Councillor

Oct. 1, 2012–Sept. 30, 2014

Central Calgary/Wes

t

For more information about the role of provincial councillor, contact Lisa Barrett, chair of the Elections and Resolutions Committee, at 403.783.2262 or via email at [email protected]. * As CARNA did not receive nominations from Central and Calgary/West in the 2011 election, a provincial council member is needed from those two regions to serve a two-year term. The term has been adjusted to maintain a one-third turnover rate.

Nomination forms available at www.nurses.ab.ca or contact Diane at 780.453.0525, toll-free 1.800.252.9392 or via email at [email protected]. www.nurses.ab.ca

Winter 2012 Volume 67 No 6 Alberta RN

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What members HIGHLIGHTS OF THE In spring 2011, CARNA conducted a member survey to assess member satisfaction, perception and knowledge of the organization. The previous comparable member survey took place in 2004 with issue-specific surveys conducted in the interim. The objectives of the 2011 member survey were to monitor progress in selected areas benchmarked in the 2004 member survey and to benchmark member attitudes in priority areas to CARNA. NRG Research Group used a mixed methodology, conducting both telephone interviews and an online survey. A total of 1,119 CARNA members were surveyed between April 21, 2011 and May 2, 2011. Based on the total population and sample size, the maximum margin of error for the total sample is ± 2.9%, 19 times out of 20; the margin of error for the telephone sample is ± 4.4% and for the online survey is ± 3.9%, both 19 times out of 20. The overall sample proportionally reflects the six CARNA regions so no weighting of the data was necessary.

The complete survey report prepared by NRG Research Group is posted at www.nurses.ab.ca. 6

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said...

2011 MEMBER SURVEY About CARNA’s role Nine-in-ten respondents find it very important (6 or 7 on a scale of 1-7) that CARNA represents their views on patient safety (92%) and shortages of nurses (86%). These are significant jumps from ratings in 2004. Significantly more respondents in 2011 than in 2004 find it very important that CARNA represents their views on nurse staffing issues (81%), educational and professional development opportunities (80%) and clarifying the roles between nursing groups (71%).

How important is it that CARNA represents the views of registered nurses on… Patient safety 92% 88%

Shortages of registered nurses 86% 81%

Nurse staffing issues (nurse/patient ratios) 81% 76%

About perceptions of CARNA Similar to 2004, 8-in-10 respondents in 2011 strongly agree (6 or 7 on a scale of 1-7) it is important to them that nursing is a self-governing profession. Three other statements had significant increases in proportion who strongly agree compared to 2004: “The CARNA Nursing Practice Standards document is an important reference source to guide my practice as a registered nurse” (56%), “CARNA is an organization I can turn to if I have a problem or concern related to the standards of nursing care” (53%) and “CARNA does a good job of representing the interests of registered nurses” (37%).

Do you agree or disagree that… It is important to me that nursing is a self-governing profession. 80% 78%

The CARNA Nursing Practice Standards document is an important reference source to guide my practice as a registered nurse. 56% 50%

Availability of educational and professional development opportunities for registered nurses 80% 71%

CARNA is an organization I can turn to if I have a problem or concern related to the standards of nursing care. 53% 47%

Availability of nursing leadership in the health system 72%

Clarifying professional relationships with other health professions 72%

Clarifying the roles between nursing groups

CARNA does a good job of representing the interests of registered nurses. 37% 32%

CARNA understands the issues and concerns I face as a registered nurse.

71%

34%

55%

30%

2011 Very important (6, 7) 2004 Very important (6, 7) 2011: n=1,119, 2004: n=750

2011 Strongly agree (6, 7) 2004 Strongly agree (6, 7) 2011: n=1,119, 2004: n=750

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About professional conduct Two-in-five (41%) say they are knowledgeable about how professional conduct complaints are received by CARNA. Eight-in-ten members aged 30 and under are not knowledgeable, while half of those aged 51+ are knowledgeable.

In considering CARNA’s complaint process, would you say that you are very or somewhat knowledgeable, or not very or not at all knowledgeable about how professional conduct complaints are received by CARNA? PERCENTAGE BY AGE

Total

41%

≥ 30

18%

31– 40

29%

41–50

43%

51+

50%

59%

About CARNA practice consulting 43% of members are aware of CARNA’s practice consulting service. This is lower than in 2004, when 48% indicated awareness. One-half (52%) of respondents aged 51+ are aware of the practice consulting service, significantly more than all other age groups. Of those who contacted a CARNA nursing practice Cconsultant, three-quarters (73%) are very likely to use the service again, while 7-in-10 (71%) are likely to encourage other nurses to use the service. One-third (32%) are very likely to ask a nursing practice consultant to conduct a group consulting session at their workplace.

81% 71% 57%

About pressing issues 50%

One-third of respondents (33%) think staff shortages are the most pressing health-care issue in Alberta.

Knowledgeable (Very, Somewhat) Not knowledgeable (Not very, Not at all)

One-quarter (26%) mention timely access and availability to health care.

2011: n=1,119

About the registration process Significantly more members (79%) are very satisfied with receiving sufficient notice and communication from CARNA prior to registration compared to 2004 (75%). The level of high satisfaction with the information about deadlines and process (71%) and the online renewal process being easy to understand and complete (68%) is about the same as 2004. Significantly fewer members in 2011 (41%) are very satisfied with the time it takes to get a response on a question about registration. Just over half (56%) are very satisfied with the ease of adding information to their member profile.

Low nurse-to-patient ratio/poor patient care/safety and lack of beds/care facilities are mentioned by 13% each. Poor management by higher-ups/government is mentioned by 12%.

About limited prescribing for RNs One-half of total respondents (52%) strongly support CARNA’s proposal to government to change the Registered Nursing Regulations to authorize limited prescribing for registered nurses. Most members aged 30 and under (57%) strongly support this proposal, though not significantly more than the other age groups.

MEMBERS AGED 31 AND OVER ARE SIGNIFICANTLY MORE SATISFIED WITH OPPORTUNITIES TO BECOME MORE INVOLVED WITH CARNA THAN THOSE AGED 30 AND UNDER.

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About primary care Two-in-five members (41%) are very interested in working in primary care, notably 51% of those are aged 31– 40. 15% of respondents are already working in a primary care setting. Of those who answered they are interested or already work in a primary care setting, one-third (34%) say they are attracted to direct patient contact/being proactive/educating public. Smaller proportions feel it’s a good work environment (16%), it’s a challenging/diverse/effective system in helping people and get good/flexible/ part-time working hours (12% each). Of respondents who answered they are not interested in working in a primary care setting, two-in-five (41%) state they like what they currently do and are not interested. One-in-five (21%) say they are close to retirement while 16% perceive it’s a poor work environment.

About member involvement with CARNA Nearly two-thirds of respondents (63%) prefer to have CARNA address issues on their behalf. Members who work full-time (29%) significantly want to be more involved than members employed part-time (20%). Of those who want to become more involved with CARNA (n=257), just over one-quarter (27%) are very satisfied with opportunities to become involved with CARNA and one-in-five (22%) are not satisfied. Members aged 31 and over are significantly more satisfied with opportunities to become involved than those aged 30 and under.

When issues arise that are important to the registered nursing profession, do you want to become more involved with CARNA to address them or would you prefer to have CARNA appropriately address them on your behalf? Yes, I want to become more involved with CARNA to address them 24%

What would attract you to working in a primary care setting?

No, I prefer to have CARNA address them on my behalf

Direct patient contact/proactive/educating public

Don’t know

34%

Good work environment

63%

13%

2011: n=1,119

16%

Challenging/diversity/effective system in helping people 12%

Good hours/flexible hours/part-time offered

How satisfied are you with your opportunities to become involved with CARNA? PERCENTAGE BY AGE

12%

Total

27%

Can utilize all my skills/academic challenge

≥ 30

10%

31– 40

29%

10%

41–50

35%

Wages/pensions/benefits/jobs available/union positions

51+

25%

48%

22%

43%

43%

11%

More autonomy/more control

29%

17% 39%

54%

39% 18%

8%

Already work in primary care setting/enjoy it 6%

Acceptance/respect from doctors/wanted and needed

Not satisfied (1, 2, 3) Neutral (4, 5) Very satisfied (6, 7) 2011: n=267

3%

Happy working where I am/nothing would attract me 3%

Location 1%

Other/Don’t know/Refused 13%

2011: n=774

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About Alberta RN

About member online activities

Around two-thirds of total respondents (63%) have read or glanced at the last seven-to-nine issues of the Alberta RN newsletter.

Top five online activities CARNA members engage in are: personal email (67% check daily), Google and other search engines (54% use daily), work email (48% daily), text messaging (36% daily) and Facebook (26% daily).

Members aged 51 and over (72%) are significantly more likely to have read or glanced at the last seven-to-nine issues of the newsletter than the younger age groups.

All other online activities are much less frequently used. Online newsletters, web-based learning programs and online interactive learning programs are used once a month or more by at least 6-in-10 members. The CARNA website is checked once a month or less by over three-quarters of the respondents (76%). Nine-in-ten members never use/ don’t access chat rooms or Twitter.

Thinking about the Alberta RN newsletter, of the last nine issues published, how many have you read or glanced at? PERCENTAGE BY AGE

Total

63%

≥ 30

40%

31– 40

53%

41–50

63%

51+

72%

16% 27%

14%

5%

25% 19%

7%

16% 14%

Please indicate how frequently you engage in the following online activities:

8% 17%

6%

Personal email 67%

13%

10%

15%

6%

4% 7%

4%

Google or similar search engines 7 4 1 0

to 9 issues to 6 issues to 3 issues issues

54%

24%

8%

6%

7%

Work email 48%

2011: n=1,119

20%

12%

9%

11%

Text messaging 36%

About the preferred way of receiving information

13%

7%

8%

36%

Facebook

1%

26%

9%

It’s a virtual dead heat between members who prefer receiving information from CARNA via a printed newsletter (41%) and electronically (38%).

Online newsletters

As age increases in respondents, so does their preference to receive CARNA information via a printed newsletter, those aged 51+ significantly more so than other age groups.

3%5% 7%

3%8%

17%

7%

9%

48%

1%

41%

29%

Web-based learning programs

2%

51%

32%

Read or contribute to blogs

2%

3%5% 13%

2%

75%

Online interactive learning programs

If you had the option, would you prefer to receive information about CARNA via an electronic newsletter sent to your email address, a printed newsletter or would you want to receive both?

2%

4% 7%

48%

2%

36%

Podcasts

12 2

16%

73%

5%

Chat rooms

PERCENTAGE BY AGE

11

2%

4% 92%

Total

38%

≥ 30

48%

31– 40

44%

41–50

41%

51+

31%

41%

18%

4%

RSS

112

29% 31%

18% 22%

4% 3%

3%52%

Twitter

1112

2%

94% 37%

19%

3%

CARNA website

49%

17%

3%

2%

4% 76%

Electronic newsletter Printed newsletter Both Neither/Don’t know/No opinion

Daily Two or three times a week Once a week Once a month or less Never use/Don’t access Don’t know/Refused

2011: n=1,119

2011: n=1,119

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1%

17%

KEY TAKE-AWAYS

About CARNA’s website Two-in-five (41%) of total respondents are very satisfied with CARNA’s website, less than in 2004 (45%), though not statistically significant. Satisfaction with the website is similar by age, though members aged 31–40 (48%) are more satisfied than those aged 51+ (37%).

How would you rate your satisfaction with the CARNA website?

41%

48%

43%

31– 40

48%

41–50

42%

51+

37%

6%

47%

45%

≥ 30

6%

51%

6% 46%

4%

47%

6%

49%

2011 Very Satisfied (6, 7) 2011 Neutral (4, 5) 2011 Not satisfied (1, 2, 3)

8%

2004 Very Satisfied (6, 7) 2004 Neutral (4, 5) 2004 Not satisfied (1, 2, 3)

2011: n=1,119, 2004: n=493

About the advertising campaign Almost three-quarters of all respondents (72%) remember seeing or hearing CARNA-sponsored TV and newspaper ads, significantly more than in 2004 (59%). Members aged 51+ were more likely to see the ads (79%) than those in all other age groups. One-third (36%) feel the amount of CARNA ads was just right, while 44% respondents feel there was not enough. Members in the Northeast Region were more likely to feel the amount of ads was not enough.

Which of the following statements would best describe how you feel about the amount of CARNA advertising on TV and in newspapers? PERCENTAGE BY AGE 2%

Total

36%

≥ 30

32%

31– 40 41–50 51+

44%

16% 2%

51%

15% 2%

41%

43%

15% 4%

36%

42%

18% 4%

37%

Member priorities and CARNA priorities are closely aligned with patient safety being the single most important issue for both CARNA and members.

Areas for improvement

PERCENTAGE BY AGE

Total

Positives

44%

improve timeliness for responses to members increase engagement with younger members increase awareness of the CARNA complaint process and of the nursing practice consulting service improve the CARNA website and increase online communication channels increase member awareness on how to contact key CARNA representatives and how they can raise concerns increase satisfaction with opportunities to become more involved

More on member engagement Further research is underway to understand what members mean by wanting to become “more involved” with CARNA and member preferences regarding how to engage with the organization. This summer, NRG Research Group conducted focus groups in five cities: Edmonton, Grande Prairie, Lethbridge, Calgary and Red Deer. As well, NRG moderated two online focus groups, one with members from the Northeast Region and one with members from all of Alberta. Results from the focus groups were used in November to develop an online member survey on preferences for engagement with CARNA. Results of the survey are expected to be reported to Provincial Council at their January meeting. RN

15%

Just right Not enough Too much Don’t know 2011: n=1,119

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Work bullies: Debunking some myths about why people bully

BY VALERIE CADE, FOUNDER BULLY FREE AT WORK

While most of us don’t spend much time thinking about how to make another person’s life miserable, work bullies do. If you’re being bullied in the workplace, or know someone who is, you may have tried to comprehend “What makes a person a bully?” Knowing why work bullies act as they do can be helpful in understanding that the problem is truly them, not you. However, don’t let yourself get too caught up in sympathy. You need to focus your attention on coping with the bully, not in figuring them out. With that word of caution, let’s explore some myths about why people bully.

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MYTH: Work bullies feel superior to their targets. They believe they are better, smarter or more attractive than their target and want others to see that too. REALITY: Bullies feel inferior to their targets and often to others in the workplace. They may lack an appreciation of their skills and the positive aspects of their own personality. Often, the people who bully have been bullied themselves. As a result, their feelings of low self-worth were so strong that they in fact shut down their feelings in order to survive. They may not know how to have a caring relationship with anyone, including themselves. Surprisingly, work bullies often see their target as having strengths they want. Quiet self-confidence, an ability to get along with others, kindness and generosity – all of these qualities may be prized by a bully. While it’s hard for the target to believe, the bully is often trying to gain the target’s positive attributes for him or herself.

www.nurses.ab.ca

MYTH: Bullies work on the fringe of the workplace culture, because their bullying behaviour is unacceptable. REALITY: Many places of work consciously or unconsciously endorse, perhaps even encourage, bullying behaviour. Think of the workplace that places a high premium on “getting the job done, no matter how long we have to stay here,” or encourages workers to continually subordinate family to work. What about the workplace that says it “values cooperation,” but actually rewards competition? These are all examples of work situations in which bullies thrive. In these environments, work bullies can indulge their worst behaviour – finding fault, setting unrealistic goals and even aggression – and get away with it. Management may be wary of standing up to the bully for fear of losing the bully’s performance not knowing that it’s not an either/or situation. Companies can have bully-free workplaces and have high performance.

MYTH: “If I try harder or be nicer, I can get the bully to change.” REALITY: A target’s first duty is to realize the bullying behaviour for what it is. The bully has a low self-image and this has nothing to do with the target. Understanding this fact and refusing to take the behaviour personally can be difficult, but once targets accept this, they can move to bully proofing themselves so that the effects of the bullying are not so devastating.

BOTTOM LINE: Work bullies need to control others. Where the average person finds satisfaction in getting a job done, bullies try to seek power for their own sake. In the eBook Bully Free at Work, we often talk about the importance of recognizing that you are being bullied for this reason. Nothing you can do will please the bully. Start bully-proofing yourself. Bullying says more about bullies and their shortcomings than about you and your inadequacies. RN Valerie Cade, CSP is a workplace bullying expert, speaker and author of Bully Free at Work: What You Can Do To Stop Workplace Bullying Now which has been distributed in over 100 countries worldwide. Feel free to contact Valerie to speak for your organization: [email protected].

Bullying and the nursing profession

Author and founder of Bully Free at Work Valerie Cade will be the keynote speaker at the luncheon preceding the CARNA Annual General Meeting presenting “Stopping Workplace Bullying: Respect Works.” There is no fee to attend. May 31, 2012 Westin Hotel. Edmonton Registration opens in January 2012.

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P ublications ordered by Hearing Tribunals Publications are submitted to Alberta RN by the Hearing Tribunal as a brief description to members and the public of members’ unprofessional behaviour and the sanctions ordered by the Hearing Tribunal. Publication is not intended to provide comprehensive information of the complaint, findings of an investigation or information presented at the hearing. At each hearing, the Hearing Tribunal considers a number of factors mentioned in case law to arrive at the appropriate sanction and publication, including whether or not to publish the member’s name.

To find out more about sanctions and publication, go to www.nurses.ab.ca/sanctions. CARNA Member A Hearing Tribunal made a finding of unprofessional conduct against a member who, while off on medical leave, visited a home-care client and provided foot care services; provided the client and his wife her personal cell phone number, and made negative comments about her manager with the client and his wife; and further breached the employer’s confidentiality policy when she failed to ensure the security of files when they were visible in her vehicle and not secure in the trunk of her vehicle, and failed to know who her clients were; and further failed to document essential information on the clients’ records and failed to meet expected minimum standards of care with several clients. The Tribunal issued a reprimand. As the member is planning to retire from nursing, the Tribunal accepted her undertaking not to practise as a registered nurse. If the member decides to come out of retirement, she must first pass courses in documentation, responsible nursing and home-care nursing. Thereafter, she must provide a letter from her next employer confirming they will provide two performance evaluations to the Tribunal, and the member is restricted to working with that employer/site pending satisfactory provision of those two performance evaluations, unless she obtains permission to work elsewhere, in which case performance evaluations will be required from that new employer also. Conditions shall appear on the member’s practice permit. Failure to comply with the order may result in suspension of CARNA practice permit.

CARNA Member Registration number:

48,899

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53,453

A Hearing Tribunal made a finding of unprofessional conduct against member #53,453 who purposely used a large bore needle (14 gauge) for an IV on a patient with the intent to discourage the patient from returning and who had ordered an X-ray on her daughter without a physician’s order at that time. The Tribunal issued a reprimand and ordered the member to pass a course in professional ethics and pay a fine of $1,000 by a deadline. Conditions shall appear on the member’s practice permit. Failure to comply with the order may result in suspension of CARNA practice permit.

CARNA Member: Registration number:

Janet Hogenson 54,267

A Hearing Tribunal made a finding of unprofessional conduct against Janet Hogenson, member #54,267, who committed a boundary violation with an underage girl and who continued to commit a boundary violation when she continued to communicate with the girl even after the girl’s parents tried to intervene to limit her communication with their daughter. This was the second hearing and finding against this member for boundary violations. The Tribunal issued a reprimand and accepted the member’s irrevocable and permanent undertaking to never practise as a registered nurse again, effective immediately. A condition shall appear on the member’s practice permit.

CARNA Member Registration number:

A Hearing Tribunal made a finding of unprofessional conduct against member #48,899 who did the narcotic count alone, contrary to policy; on a couple of occasions charted that she gave a resident Hydrodiuril and Lotensin when his systolic blood pressure was less than 80; failed to document a physician’s verbal order in the physician’s orders for the resident which stated that medication was to be held if the BP was low; and instead documented it in the progress notes; and altered her documentation in the MAR of the resident incorrectly. The Tribunal issued a reprimand and ordered the member to take a course in documentation. A condition shall appear on the member’s practice permit. Failure to comply with the order may result in suspension of CARNA practice permit. 14

CARNA Member Registration number:

61,376

A Hearing Tribunal made a finding of unprofessional conduct against member #61,376 who wrote an order for insulin for a patient as a verbal order from a physician, when in fact the physician had not given the order and administered the insulin to the patient without a physician’s order. The Tribunal issued a reprimand and ordered the member to write a paper about the scope of RN practice. The member presented the paper at the hearing and the paper was approved.

CARNA Member Registration number:

62,758

A Hearing Tribunal made a finding of unprofessional conduct against NP member #62,758 who provided blank prescription forms signed by herself to an RN co-worker with the intention that the RN co-worker would determine what medication to order, when the NP member knew or ought to have known that was outside her RN co-worker’s scope of practice and allowed her signature to be used on prescriptions when she had not assessed the patient to make the determination as what medications to order. The Tribunal issued a reprimand and ordered the member to write a paper on safe prescribing practices of the nurse practitioner by a deadline. The member provided the paper at the hearing and it was found to be satisfactory.

CARNA Member Registration number:

74,739

A Hearing Tribunal made a finding of unprofessional conduct against member #74,739 with respect to breaching patient confidentiality. The member submitted an email to a nationally broadcast radio show and described patient situations. Although she did not disclose specifics, the information might have led to identification of patients by those already familiar with the situation including the patients’ families. The Tribunal issued a reprimand and directed the member to revise a PowerPoint presentation to deal with confidentiality by a deadline. A condition shall appear on the member’s practice permit. Failure to comply with the order may result in suspension of CARNA practice permit.

CARNA Member Registration number:

74,975

A Hearing Tribunal made a finding of unprofessional conduct against member #74,975 with respect to slapping and yelling at a patient and giving the wrong medication to a patient. The Tribunal issued a reprimand and directed the member to provide medical evidence she is fit to practise; successfully complete a course; undergo counselling; obtain performance evaluations; submit self-evaluations and restrict her work setting. Conditions shall appear on the member’s practice permit. Failure to comply with the order may result in suspension of CARNA practice permit.

CARNA Member Registration number:

76,189

A Hearing Tribunal made a finding of unprofessional conduct against member #76,189 who erroneously poured medications for an individual who was not his assigned patient and pre-signed that he had administered them when he had not; left medications unattended at his patient’s bedside; and on another patient failed to administer

Normal Saline by clysis as ordered, do glucose monitoring as ordered, measure input or output as ordered, and chart adequately. The Tribunal issued a reprimand and directed the member to pass courses in medication administration and charting; and to provide satisfactory performance evaluations from all his employers for the next year following the hearing. Conditions shall appear on the member’s practice permit. Failure to comply with the order may result in suspension of CARNA practice permit.

CARNA Member Registration number:

78,799

A Hearing Tribunal made a finding of unprofessional conduct against member #78,799 who wrongfully took Toradol, Maxeran, Morphine, Valium, Benadryl and Gravol from her employer and wrongfully charted wastages on the narcotic administration sheets when she had not wasted the drugs. The Tribunal gave the member a reprimand and accepted an undertaking to not practise as a registered nurse pending proof from a physician and counsellor that she is safe to return to practice. At which time, the member has a choice to return to either a practice setting where there is no access to narcotics or controlled substances or do a supervised practice in a setting where the member is expected to administer medications, including narcotics and controlled substances. In either setting, the member’s employer will report back to a Hearing Tribunal. The member is required to continue drug screening and provide further medical reports to a Hearing Tribunal. Conditions shall appear on the member’s practice permit. Failure to comply with the order may result in suspension of CARNA practice permit.

CARNA Member Registration number:

80,327

A Hearing Tribunal made a finding of unprofessional conduct against member #80,327 who failed to document a verbal order for Entonox or check to be sure the physician had written the order on an infant patient and failed to document a verbal order for Ketamine. The Tribunal ordered a reprimand and ordered the member to provide a performance evaluation to CARNA from his current employer. The Tribunal also restricted his employment to that employer/sites pending the satisfactory performance evaluation, unless he obtains prior permission and required him to pass courses in documentation and write a paper on documentation in medication administration. The member was ordered to pay a contribution to the costs of the hearing in the amount of $200. Conditions shall appear on the member’s practice permit. Failure to comply with the order may result in suspension of CARNA practice permit.

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P ublications ordered by Hearing Tribunals (cont’d) CARNA Member Registration number:

83,883

A Hearing Tribunal made a finding of unprofessional conduct against member #83,883 who failed to chart or ensure an adequate assessment was charted on a patient who had fallen twice the previous evening and who had a blood pressure at one point on day shift of 91/47, and who administered medication to a patient when he was struggling. The Tribunal took into account the previous discipline of the member and her failure to comply with the previous decision, in determining the appropriate sanction. The Tribunal issued a reprimand and directed the member to pass courses as follows: assessment, medication administration, pharmacology, documentation, responsible nursing and clinical skills refresher. The member shall remain suspended until she finds a supervised practice setting and shall work under supervision pending two comprehensive performance evaluations which must show that she is practising at a satisfactory standard. Conditions shall appear on the member’s practice permit. Failure to comply with the order may result in suspension of CARNA practice permit.

CARNA Member Registration number:

85,430

A Hearing Tribunal made a finding of unprofessional conduct against member #85,430 who misrepresented the facts to her manager or employer both when she called in sick and again when confronted during an investigation; when she advised them that she was not able to work her scheduled 12-hour night shift Oct. 31, 2009 due to illness when in fact she attended a Halloween party that night.

The Tribunal issued a reprimand and directed the member to prove she has passed a course in ethics by a deadline and ordered the member to pay a fine of $1,000. Conditions shall appear on the member’s practice permit. Failure to comply with the order may result in suspension of CARNA practice permit.

CARNA Member Registration number:

85,794

A Hearing Tribunal accepted an admission from member #85,794 of unprofessional conduct under section 70 of the Health Professions Act. The admission was of pilfering oxycodone and injectable morphine from two employment settings on numerous occasions, using the narcotics while on active duty and falsification of records to cover the pilfering. The Tribunal gave the member a reprimand and accepted an undertaking to not practise as a registered nurse pending proof from a physician and counsellor that she is safe to return to practice at which time, the member has a choice to return to either a practice setting where there is no access to narcotics or controlled substances, or do a supervised practice in a setting where the member is expected to administer medications, including narcotics and controlled substances. In either setting, the member’s employer will report back to a Hearing Tribunal. The member is required to continue drug screening and provide further medical reports to a Hearing Tribunal. Conditions shall appear on the member’s practice permit. Failure to comply with the order may result in suspension of CARNA practice permit. RN

Tell us what YOU think Do you have an opinion about an article in Alberta RN magazine or a general comment on nursing or health-care? Send it to [email protected]. Letters should be a maximum of 300 words and may be edited for length and clarity. Please include your name and city.

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Committed to Competence: Did I do it right? With the 2012 planning steps complete, many members have asked for feedback on the quality of the information in their MyCCP record. The information entered in MyCCP is not accessed or reviewed unless the member has requested assistance or in the case of random or directed audits. The following questions may help you test the strength of your own learning objective:

Does my learning objective clearly outline my own learning needs? Your learning objective should clearly outline what you will learn, rather than what you will do, try to do, or make sure others do.

When the practice year ends, will I be able to measure if I met this objective? Would someone else be able to measure if I met this objective?

Does my learning objective identify improvements in my practice that are logical, reasonable and achievable? Be sure to focus on what is most relevant to you in your role and practice setting, and give yourself something manageable to achieve. You may find it helpful to refer back to the May 2011 issue of Alberta RN to review the sample of member learning objectives that were highlighted from the 2010 audit. These objectives do not follow a formula. Some are long and quite detailed; some very short and direct. The common feature of these objectives was that they were clearly related to the member’s role and practice setting, and they clearly explained what the member wanted to learn. For help with developing a strong learning objective, go to www.nurses.ab.ca/competence and click on Practice Reflection, then Developing a Learning Plan.

Can I change the information I entered in MyCCP ? You can edit any of the information you have entered into MyCCP at any time. To make changes: • Click the green back arrow to undo only the last entry in that section or click on the recycle bin to delete everything in that section. • If only a green arrow is present in a section, but you want to delete everything entered in that section, click the green arrow to undo the last entry and a garbage/recycle bin icon will appear and allow you to delete the whole entry.

UPDATE : Entering professional development activities into MyCCP Following the implementation of the MyCCP online documentation program for the 2012 renewal, CARNA staff and the program developers have been addressing issues related to the functionality of the program. Solutions have involved re-configuring some of the features, removing others, and re-visiting how the next phase should work. The ability to enter learning activities in learning plans has been delayed to allow time to implement and test these changes, with the goal of improving the user experience. A message will be posted on the website when these features are available. MyCCP will continue to require access from a computer with specific minimum browser requirements (Internet Explorer 7.0, Firefox 3.6, Chrome 10, or Safari 5.x). Browser updates are available from their respective websites. CARNA cannot resolve browser issues on specific computers and users should access the help function on their computer for assistance in identifying and updating their internet browser.

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ISMP MEDICATION SAFETY ALERT! ® NURSE ADVISE-ERR

Oops, sorry, wrong patient! A patient verification process is needed everywh When you think of “wrong patient” medication errors in inpatient settings, the most common scenario that comes to mind is a nurse walking into a patient’s room and administering medications intended for one patient to another patient – often a roommate. Perhaps the patient had switched hospital beds with his roommate to be closer to the window, or he was sitting on the edge of his roommate’s empty bed. Maybe the nurse had verified the patient’s identity during initial drug administration but failed to check it again during subsequent administrations that day.1 Or the process of verifying the patient’s identity was interrupted by a visitor asking a question and the nurse simply forgot to complete the verification process. In any case, one fundamental cause of these errors is a flawed or absent patient identification process. However, a variety of reasons can lead to “wrong patient” medication errors at any point in the patient encounter or during any phase of the medication use process, not just during the administration phase at the bedside. Examples of hazards, near misses and actual “wrong patient” errors follow. Fictitious names are provided when necessary to convey the basis of the error.

Patient Registration Omitting junior/senior designation A patient’s son, John Jones Jr., was registering to donate stem cells for his father, John Jones Sr.1 After confirming the son had previously been a patient in the hospital, the registration clerk located “John Jones” in the master patient list, printed an armband and placed the armband on his wrist. The clerk was focused on the technical aspects of entering data and little attention was given to verifying the patient’s identity before applying the armband. A clerk later realized that both father and son were wearing identical armbands. Thus, any medications prescribed for the father could have been administered to the son, or vice versa, even if the nurse had properly identified the patients using name and medical record number.

A physician prescribed medications for a new patient that were based on a medication list found in the history and physical of the patient’s sister. A pharmacist discovered the error during medication reconciliation.

Mistranscribed telephone order

Order entry error A dehydrated lung cancer patient was admitted to the emergency department (ED) for intravenous (IV) hydration. Another ED patient from a motor vehicle

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Reliance on wrong patient data

Transcription

Prescribing

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crash (MVC) was awaiting intubation and transfer to a local trauma centre. The same physician was caring for both patients. The physician gave verbal orders for vecuronium, a neuromuscular blocking agent, and midazolam, a sedative, for the MVC patient, but he inadvertently entered the medication orders electronically into the cancer patient’s record. The nurse caring for the cancer patient went on break, and a covering nurse administered the paralytic and sedative to the cancer patient even though he was not intubated. The patient experienced a respiratory arrest and died.

A nurse accepted a telephone order for morphine 2 mg IV but transcribed the order onto the wrong patient’s record. The order was faxed to the pharmacy and entered onto the wrong patient’s

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electronic medication administration record (eMAR). The wrong patient, who was already receiving fentaNYL, was given the morphine which caused significant respiratory depression. A rapid response team was called, and naloxone was administered.

Intermingled patient labels When a consulting physician arrived on a unit to follow up with a known patient, he learned the patient and chart were both in radiology. The physician wrote several orders on a blank order form and asked the unit secretary to add a patient label. The labels for all active patients were kept together in a single file folder. The unit secretary located labels for the correct patient but accidentally removed a label from another patient’s supplies that were right behind the correct labels. The incorrect label was affixed to the order form. The error was captured before reaching the wrong patient.

Dispensing Data entry errors To enter an order for a patient named Franklin Hope, a pharmacist tried to access the profile using the patient’s identification number. However, the

ere, not just at the bedside A variety of reasons can lead to “wrong patient” medication errors at any point in the patient encounter or during any phase of the medication process, not just during the administration phase at the bedside.

number was poorly visible on the order form imprint, so he entered the patient’s name, Franklin Hope, and a profile appeared on the screen. While entering the order, the pharmacist happened to notice that the patient was female, not male. He soon realized that he had been entering the order into Hope Franklin’s profile, not Franklin Hope’s profile!

Coupled drug delivery An oncology patient received another patient’s IV chemotherapy despite patient verification by two nurses before administration. Typically, the pharmacy dispensed each patient’s chemotherapy inside a labeled, sealed plastic bag. In this case, the pharmacy sent chemotherapy for two patients inside the same sealed plastic bag. When the contents of the bag were removed, the nurses discovered there were IV chemotherapy solutions for two different patients. They verified the first patient and the IV chemotherapy solution for that patient, but the nurse administering the chemotherapy accidentally picked up the other patient’s IV chemotherapy solution and administered it to the first patient.

Administration Reliance on verbal affirmation of name A nurse entered the waiting area of an oncologist’s office and called for “Mrs. Jackson” to come back to the treatment room for her chemotherapy.1 The nurse carefully checked the chemo-

therapy orders against the medical record the receptionist had handed her. Verifying only that the patient was Mrs. Jackson, the nurse prepared and administered the chemotherapy. Several hours later, another patient named “Mrs. Jackson” arrived for chemotherapy, and the nurse realized she had administered this patient’s chemotherapy to the prior patient named “Mrs. Jackson.”

ADC overrides entered into eMARs In two instances, the wrong patient was selected from a patient list on the screen of an automated dispensing cabinet (ADC) in a cardiac catheterization (cath) lab. The ADC allowed access to all patients in the hospital. When withdrawing medications from the ADC in the cath lab, the search for the correct patient was typically narrowed by entering the first part of the patient’s account number or last name, and then picking the correct name among the list that appeared on the screen. In the two events, nurses incorrectly picked the names of infants in the neonatal intensive care unit (NICU) instead of similarly named adult patients who were scheduled for cardiac catheterizations. When the medications were removed from the ADC under the infants’ names, it created an override that populated the drugs on the infants’ eMARs. Fortunately, the erroneous entries in the eMARs were noticed before the infants received the drugs prescribed for the adult cardiac cath patients.

Mixing up MARs The medication administration records (MARs) for two infants were mixed up, resulting in the administration of SYNAGIS (palivizumab), used to protect infants/ young children from respiratory syncytial virus, to the wrong child. The infants were side-by-side in isolettes, and both MARs were on the counter between the two isolettes. Coincidentally, both infants had the same first name along with very similar hospital identification numbers. The nurse failed to notice that she was referring to the wrong MAR and administered a dose of Synagis to the wrong infant.

Monitoring Mixing up monitoring results A physician prescribed CARDIZEM (diltiazem) 20 mg IV followed by 30 mg orally for a patient in bed “A” after a telemetry unit nurse called to report that his cardiac monitor showed atrial fibrillation and flutter with a heart rate of 140. When the patient exhibited no improvement after receiving the drugs, the nurse called the physician again and received an order to administer 150 mg of amiodarone IV push followed by a 60 mg/hour infusion. A short time later, the nurse realized that the rhythm on the monitor at the nurse’s station was for the patient in bed “B.” The patient’s names had been mixed up and posted on the wrong channel of the central monitoring unit.

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ISMP MEDICATION SAFETY ALERT! ® NURSE ADVISE-ERR (CONT’D)

Patient verification using two identifiers should be accomplished with ALL patient-associated tasks in the medication use process.

Safe Practice Recommendations First introduced in 2003, The Joint Commission National Patient Safety Goal (NPSG) #1 aims to improve the accuracy of patient identification. Today, the goal requires health-care practitioners to use at least two patient identifiers such as the patient’s date of birth and medical record number (not the patient’s room number or location) when providing care, treatment, and services. The intent is two-fold: 1) to reliably identify the individual as the person for whom the service or treatment is intended, and 2) to match the service or treatment to that individual. The 2011 Elements of Performance for this goal require health-care workers to verify patient identity using at least two unique identifiers when administering medications, blood, and blood components; when collecting blood samples and other specimens for clinical testing; and when providing treatments or procedures. Lest you believe that only tasks associated with drug administration are included, The Joint Commission has noted in questions and answers on this goal that it applies to “other treatments and procedures,” including, for example, prescriber’s orders and reporting of test results. Thus, patient verification using two identifiers should be accomplished with ALL patient-associated tasks in the medication use process when: physicians prescribe medications pharmacists and technicians enter/ verify orders and dispense medications

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unit secretaries, nurses and other authorized staff transcribe medication orders nurses and other qualified health-care providers administer medications health-care workers set up, obtain, receive, give and/or document/file diagnostic test results (which are often used for medication prescribing) health-care practitioners participate in other critical processes Nurses should have the patient’s MAR, eMAR or order copy at the bedside for direct comparison to information found on the patient’s identification (ID) band. Pharmacists and pharmacy technicians who enter orders into the pharmacy computer should select the patient profile using the patient’s medical record number (never the room number) or by scanning the barcode on the patient’s label on an order set, and then confirming the patient’s name and number on the screen by comparing them to the patient’s name and number on the orders. Unit secretaries and nurses should compare patient information on the order form and MAR when transcribing orders. Prescribers should also use two unique patient identifiers to verify that they are entering or writing prescriptions in the intended patient’s medical record. However, ensuring that this information is available to physicians in a way that allows comparison of the identifiers for verification presents a challenge unless computerized prescriber order entry (CPOE) systems are in use. CPOE systems can be designed so that, once logged on, the physician can select the name from a list of patients assigned

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to him/her instead of a much larger list of all patients. In the ambulatory setting, a comparable list would be the schedule of patients who are to be seen that day. Enhancing the font used for the patient’s name on the screen also can improve accurate order entry (for pharmacists, too). Some systems can also alert staff to similar names in the registry and require a second form of identity (e.g., birthdate, identification number) before proceeding. Additional strategies to prevent “wrong patient” medication errors can be found in Table 1. REFERENCE 1) Schulmeister L. Patient misidentification in oncology care. Clinical J Oncol Nurs. 2008;12(3):495-98.

Table 1. Strategies to Prevent “Wrong Patient” Medication Errors PATIENT REGISTRATION > Obtain the patient’s full legal name (including junior/senior designations, initials, middle names), birthdate, address and telephone number. > Verify registration entries by asking the patient to repeat his/her name (checking the spelling) and at least one other identifier, or by cross-checking a photo identification, for comparison. > Have the patient/caregiver verify the information on his/her armband (or registration card) before applying it.

PRESCRIBING MEDICATIONS > Require prescribers to verify the patient’s identity using two identifiers when prescribing drug therapy. > Employ computerized prescriber order entry (CPOE) systems that provide safeguards to assure correct patient identification before accepting orders. > Enhance the font size of patient names on order entry screens, the electronic medication administration record (eMAR), and automated dispensing cabinet (ADC) screens; read the full name and an additional identifier (i.e., birthdate) from the screen. > Limit the selection of patients from electronic records to only patients being treated by the prescriber.

TRANSCRIBING MEDICATION ORDERS (PHARMACY AND NURSING) > Eliminate transcription of orders by employing CPOE. > For paper orders, replace addressograph imprints with laser printed identification labels to improve clarity. > When printing or imprinting orders, labels or requisition slips, verify that the correct patient information appears on the items by comparing two unique patient identifiers in the medical record with the printed or imprinted items. > Keep patient identification labels in separate files or in each patient’s medical record. > Transcribe one patient’s orders at a time; fill out, print or imprint request forms for one patient at a time. > Fax or scan orders to the pharmacy for one patient at a time and one page at a time. After verifying two unique identifiers, replace the orders in the medical record before faxing or scanning the next patient’s orders. > Verify patient identity by comparing two unique identifiers on the order and pharmacy profile when entering orders into the computer. Initially select the patient by entering the medical record number or scanning a barcode on the patient’s order set, and then verify the patient information on the screen using two unique identifiers. > Document verbal/telephone orders directly onto the patient’s medical record or use a preprinted pad of paper with a template that prompts for all necessary information (e.g., patient’s full name, medical record number, birthdate). Confirm the patient’s identity by reading back to the prescriber the patient’s name and a second unique identifier. > Verify patient identity by comparing two unique identifiers on the order form and medication administration record (MAR) when transcribing orders.

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ISMP MEDICATION SAFETY ALERT! ® NURSE ADVISE-ERR (CONT’D)

DISPENSING MEDICATIONS > Label patient-specific medications dispensed by pharmacy with at least two unique patient identifiers. > Dispense only one patient’s medications in each sealed plastic bag (or envelope, etc.). > Ensure the medication prescribed for the patient makes sense for the patient given his or her clinical condition. > Require an independent double-check that includes patient verification before dispensing selected high-alert drugs.

ADMINISTERING MEDICATIONS > When possible, limit the selection of patients in ADCs to only those being treated in that clinical location. > Explain to patients why an identification process must be carried out by staff with each drug administration. > Tell patients the names of the drugs being administered and their purpose, and show them the package, so they can question any unexpected medications. > When possible, ask the patient/caregiver to state his or her name and at least one additional unique identifier for comparison with the MAR. Avoid verifying patient identity by passive agreement (e.g., “Your birthdate is October 28, 1981, right?” or “Your name is John E. Smith, correct?”). > Ensure the MAR is available at the point of medication preparation (including at ADCs) and administration (in separate work areas for patients in ward-type settings [e.g., neonatal units, post anesthesia care units] to prevent mix-ups with MARs). > Consistently employ barcode verification of patients at the point-of-care prior to drug administration. > Require an independent double-check that includes patient verification before administering selected high-alert drugs. > Ensure the medication being administered makes sense for the patient given his or her clinical condition.

MONITORING THE EFFECTS OF MEDICATIONS > Label all monitors that display diagnostic information using a standard patient verification process. > Verify at least two unique identifiers before posting/entering monitoring and test results on the patient’s record. For verbal communication of test results, always confirm the patient identity by reading back the patient’s full name and another unique identifier (e.g., date of birth).

STRATEGIES FOR PATIENTS WITH KNOWN LOOK-ALIKE/SAME NAMES > Verify patients using a medical record number rather than a birthdate or address since patients with the same last name may live at the same address and multiple birth neonates have the same last name and birthdate. > Employ computer system/screen alerts and/or addressograph plate/patient labels with a prominent notation to warn staff about possible name confusion and remind them to identify the patient by medical record number and name. Reprinted with permission from ISMP Medication Sa fety Alert! Nurse Advise-ERR (ISSN 1550-6304) August 2011 Volume 9 Issue 8 ©2011 Institute for Safe Medication Practices (ISMP). Visit ismp-canada.org or ismp.org.

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RNLibrary

The latest books, documents and audio-visual titles acquired by the CARNA Library. To reserve these and other titles, CARNA members can contact the library Monday through Friday, 9 a.m. to 4 p.m. at 1.800.252.9392, ext. 533, or visit www.nurses.ab.ca any time to access the library catalogue and CINAHL (Cumulative Index to Nursing and Allied Health Literature database). Adelman, D. S., & Legg, T. L. (Eds.). (2009). Disaster nursing: A handbook for practice. Boston, MA: Jones and Bartlett. [WX 21.5 D60983 2009] Andreasen, N. C., & Black, D. W. (2011). Introductory textbook of psychiatry (5th ed.). Washington, D.C.: American Psychiatric Publishing. [WM 18.2 A5525 2011] Arnold, E. C., & Boogs, K. U. (2011). Interpersonal relationships: Professional communication skills for nurses (6 th ed.). St. Louis, MO: Elsevier Saunders. [WY 87 A753 2011] Callaghan, P., Playle, J., & Cooper, L. (Eds.). (2009). Mental health nursing skills. Oxford: Oxford University Press. [WY 160 M54932 2009] Chapleau, W. (2010). Rapid first responder. St. Louis, MO: Mosby Elsevier. [WX 215 C46 2010] Diepenbrock, N. H. (2012). Quick reference to critical care (4 th ed.). Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams & Wilkins. [WY 154 D5619 2012] Downie, J., Caulfield, T., & Flood, C. M. (Eds.). (2007). Canadian health law and policy (3rd ed.). Markham, ON: LexisNexis. [W 33.1 C21805 2007] Edelman, C. L., Mandle, C. L. (Eds.). (2010). Health promotion throughout the lifespan (7th ed.). St. Louis, MO: Mosby. [WY 108 H43467 2010] Hinshaw, A. S., & Grady, P. A. (Eds.). (2011). Shaping health policy through nursing research. New York: Springer. [WY 20.5 S529 2011] Robinson Vollman, A., Anderson, E. T., & McFarlane, J. (Eds.). (2011). Canadian community as partner: Theory & multidisciplinary practice (3rd ed.). Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams & Wilkins. [WY 106 C21279 2011] Ross-Kerr, J., Wood, M. J. (2011). Canadian nursing: Issues & perspectives (5 th ed.). Toronto, ON: Elsevier Mosby. [WY 16 C2207 2011] Shives, L. R. (2012). Basic concepts of psychiatric-mental health nursing (8 th ed.). Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams & Wilkins. [WY 160 S558 2012] Stanhope, M., & Lancaster, J. (Eds.). (2011). Community health nursing in Canada (2nd Canadian ed.). Toronto, ON: Elsevier Mosby. [WY 106 C73446 2011] Wiegand, D. J. L-M., & Carlson, K. K. (Eds.). (2011). AACN procedure manual for critical care (6 th ed.). Philadelphia, PA: Elsevier Saunders. [WY 154 A13 2011]

www.nurses.ab.ca

Online Help for RNs Access the CARNA Library on Your Time • Browse through the catalogue and borrow from CARNA’s extensive collection of books, videos, journals, government documents, newsletters and more. • Access the CINAHL database, an index of more than 1,200 nursing and allied health journals and publications from 1982 to the present for articles on various topics.

Get the professional resources you need. Go to www.nurses.ab.ca * Cumulative Index to Nursing and Allied Health Literature Database

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ARNET distributes over $1 MILLION to Alberta RNs and NPs. The Alberta Registered Nurses Educational Trust (ARNET) is the only registered charity with the sole purpose of providing educational funding for Alberta’s registered nurses and nurse practitioners. This year was busier than ever for us as we reviewed and processed hundreds of requests for educational funding. We are excited to report that ARNET was able to support 1,344 requests for funding support for a total distribution of $1 million in the 2011 fiscal year. ARNET is hopeful that, with careful fund management and your support as a donor or an attendee at one of our fundraising events, we will be in a position to provide similar opportunities in 2012.

two distinct educational funding support options for CARNA registered nurse and

ARNET provides

nurse practitioner members: The ARNET Annual Scholarships recognize professional excellence and academic achievement in degree level studies through a traditional scholarship review competition. ARNET Annual Scholarship applications are available for download at www.nurses.ab.ca/ARNET. The application deadline is March 15, 2012. The Educational Reimbursement Awards provide funding assistance to offset the costs of self-paid educational programs including: • registration fees for conferences and/or workshops (applications are now reviewed four times per year) • tuition and exam costs of educational programs leading to specialty nursing certification (applications are now reviewed four times per year) • tuition fees for post-RN baccalaureate, master’s and doctoral level studies

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Who is eligible for ARNET funding? All current registered nurse and nurse practitioner members of CARNA are eligible to apply for charitable support of their educational programs from ARNET. Focus of studies must be relevant to nursing practice and the profession of nursing.

Where does ARNET funding come from? ARNET is able to distribute funding support through the generosity of our donors, fundraising participants and partnerships with the province of Alberta, nursing groups and the CARNA. ARNET thanks each of our supporters for their continued commitment to Alberta’s RNs and NPs.

Where do I get more information and how do I apply for funding? All ARNET application forms and full funding details are available at www.nurses.ab.ca/arnet or by contacting our office at [email protected] or 1.800.252.9392, ext. 427

Changes to Educational Reimbursement Awards Effective Jan. 1, 2012, ARNET is making changes to our Educational Reimbursement Awards, as a result of feedback we received from Alberta registered nurses and nurse practitioners. Changes will be a direct benefit to applicants by making the ARNET educational funding process faster, easier and more efficient. Here’s what’s changing:

An increased number of funding reviews ARNET has increased the number of reviews for conference and workshop funding and specialty certification funding from twice a year to four times each year. Our new funding application dates are identified on the 2012 applications available at www.nurses.ab.ca/ARNET. Funding applications for degree level funding (studies at post-RN baccalaureate, master’s and doctoral levels) will continue to be reviewed at the August 30 application deadline.

Faster payments/less paperwork

Proof of payment by the applicant is required ARNET will only accept applications for educational funding when proof payment was made by the registered nurse or nurse practitioner is included. The program does not need to be completed at time of application but applicants must show proof of program payment.

Receipts are now required Copies of your receipts showing that you paid for the educational program must be submitted with your ARNET application. This is a significant change from prior funding years. Photocopied or faxed receipts are acceptable. Receipts should clearly show the applicant’s name, the name of the education program, dates of study and the total amount paid. You should keep your original receipt for income tax purposes. This change will significantly decrease the amount of time applicants will be out-of-pocket for a portion of their self-paid educational programs and will ensure that ARNET is able to maximize the amount of funding support we are able to distribute.

ARNET will issue T4As

Our revised application format means that you will receive your funding from ARNET sooner. In most cases, all eligible applicants will receive their educational awards within four weeks of the application deadline. No more waiting for a response or submitting additional paperwork. Your educational award will be mailed directly to you.

Based on recent changes to the ARNET funding model and to ensure applicants are in full compliance with Canada Revenue Agency standards, registered nurses and nurse practitioners receiving funding support of $500 or more within the calendar year will be issued a T4A at the end of each tax year. ARNET will request

Please note that due to the high volume of requests, submission of an application for funding does not guarantee full or partial reimbursement.

number as part of the application process. All information collected by ARNET is kept private and confidential, is stored in a secure location and is accessible only by authorized individuals. RN

that applicants submit their social insurance

Give the gift of honour This holiday season, honour a Nurse with ARNET’s Notes for Nursing. Notes for Nursing is a way for you to honour and acknowledge the efforts of an RN or NP who has been an inspiration to you and goes above and beyond the expectations of patients and coworkers. With a donation to ARNET, we will send a Notes for Nursing to your honoured nurse advising them of your appreciation for the valuable role they have played in your life and career. You will receive a charitable tax receipt for your donation and each of you will share in the knowledge you are supporting continuing nursing education in Alberta. To recognize someone this holiday season, please visit www.nurses.ab.ca/ARNET and click on Honour a Nurse or call 780.451.0043 or 1.800.252.9292, ext. 523.

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Learning reflection A nursing student recounts her experience with a medical emergency team BY CARLA ALBRIGHT, GN, BS C N PATRICIA WHELAN, RN, BS C N, MHS

In Alberta, a medical emergency team system has been initiated to decrease the occurrence of cardiac arrests. Recently, as a student in a clinical placement, I had the opportunity to observe and participate in the assessment, care and transfer of a critically ill patient cared for by a medical emergency team.

Medical emergency team call criteria Medical emergency teams are interdisciplinary teams with a critical care background. The staff respond to calls within the hospital (The Learning Centre, 2010). When a patient shows signs of becoming critically ill, the medical emergency team is consulted when a nurse calls. Criteria for a medical emergency team call include: • an acute rise or fall in respiratory or heart rate • acute drop in oxygen saturation or systolic blood pressure • threat to the airway • acute change in level of consciousness • when staff are very concerned about the patient (The Learning Centre, 2010). In a case I observed, the medical emergency team was called because of an acute change in the level of consciousness.

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You never get a second chance to make a good first impression Before the medical emergency team arrived, I assumed that as a student I would be ignored so prepared to stay out of the way. Instead, the clinical nurse educator involved in this particular call surprised me with something different than I was expecting during this crisis. The first thing she did was look me in the eye and thank me for making the call. The call had actually been made by my buddy nurse and the charge nurse. But, if I had made the call, being thanked in this way would have made me feel validated. This validation reduced the possibility of my hesitating to make an medical emergency team call in the future. Research suggests fear of criticism is one of the main obstacles to medical emergency team utilization. (Bagshaw et al., 2010). What a great start to this learning opportunity! That first exchange set the tone for the rest of the encounter. The clinical nurse educator asked me about my patient’s condition throughout the shift, helping me to communicate my knowledge and assessment findings of the patient. Seeing the team apply the information I provided gave me validation that I was a member of the interprofessional team. I learned about the process after a medical emergency team call is made and started to integrate into the care of the patient from a high-acuity nursing perspective. The other nurses on the team readily asked for my help with a number of aspects, ranging from finding supplies on the unit to assisting with procedures. In all, I was made to feel like I had a valuable part to play and was in no way “just a nursing student.”

Roles in collaboration I was able to work collaboratively with the support of my clinical instructor, staff on the unit and the medical emergency team nurse. As I left the unit with the patient, I felt privileged to have

had a chance to learn about management and care of a patient with high acuity health-care needs. The medical emergency team nurses seemed comfortable with students and didn’t ask for anything that was outside my scope of practice. My patient’s nurse in the ICU really supported my student role while still incorporating me into the experience of transition of care. Interprofessional collaboration requires clear knowledge of the role of each team member (Petri, 2010). Although I was not familiar with the ICU technologies or level of care, the medical emergency team made sure I stayed involved in all aspects of care.

Outcomes of learning The care of my patient was transferred to two RNs after the medical emergency team call: once while waiting for a CT scan and again after arriving in the ICU. Both times the transfer of care was very efficient and professional. It was clear to me that everyone involved had cared for many patients in critical condition and were experienced in what was relevant and the priority to this patient. It was a striking demonstration that in critical situations, with many people collaborating in patient care, communication between professionals must be absolutely clear, concise and complete (Miller, Riley, & Davis, 2009).

Student success The medical emergency team nurses I met at every stage were very welcoming and accommodating. They were willing to answer my questions and involve me in all critical aspects of this patient. They allowed me to learn. If this is standard practice for the medical emergency team, they are doing a tremendous service to patients by furthering the education of future health-care professionals. Thank you! RN

ABOUT THE AUTHORS

Carla Albright graduated in August 2011 from the University of Alberta after degree program and is currently employed in the emergency department at the Royal Alexandra Hospital in Edmonton.

Patricia Whelan is an assistant professor with the Mount Royal University Bridge to Canadian Nursing Program. She also works part-time with the University of Alberta faculty of nursing as a sessional instructor where she was Albright’s instructor at the time of the experience.

REFERENCES: • Bagshaw, S. M., Mondor, E. E., Scouten, C., Montgomery, C., Slater-MacLean, L., Jones, D. A., Bellomo, R., Noel Gibney, R. T., & for the Capital Health Medical Emergency Team Investigators. (2010). A Survey of Nurses’ Beliefs About the Medical Emergency Team System in a Canadian Tertiary Hospital. American Journal of Critical Care, 19(1), 74-83. doi:10.4037/ajcc2009532 • Miller, K., Riley, W., & Davis, S. (2009). Identifying key nursing and team behaviours to achieve high reliability. Journal of Nursing Management, 17(2), 247-255. Retrieved from http://login.ezproxy.library.ualberta.ca/ login?url=http://search.ebscohost.com/ login.aspx?direct=true&db=rzh&AN= 2010249557&site=ehost-live&scope=site • Petri, L. (2010). Concept analysis of interdisciplinary collaboration. Nursing Forum, 45(2), 73-82 (44 ref). doi:10.1111/j.1744-6198.2010.00167.x • The Learning Centre. (2010). UAH/ Stollery/Heart Institute Annual Update Manual: MET Module. Unpublished manuscript.

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NOTICEBoard E D M O N T O N / W E S T

EMERGENCY NURSES INTEREST GROUP OF ALBERTA A G M A N D E D U C AT I O N D AY March 2, 2012. Edmonton. CONTACT: www.nena.ca TUBERCULOSIS CONFERENCE March 22–23, 2012. Edmonton. CONTACT: www.tbconference.ca C A L G A R Y / W E S T

WESTERN AND NORTH-WESTERN REGION CANADIAN A S S O C I AT I O N O F S C H O O L O R N U R S I N G C O N F E R E N C E Feb. 22–24, 2012. Lethbridge. CONTACT: www.uleth.ca

N E T W O R K I N G

O P P O R T U N I T I E S

C A R N A S P E C I A LT Y P R A C T I C E G R O U P S Contact your CARNA regional coordinator or go to www.nurses.ab.ca and click on “Member Info.”

The submission deadline for events and reunions in the Spring 2012 issue of Alberta RN is Feb. 29, 2012. Go to www.nurses.ab.ca for a complete and up-to-date listing of events and reunions or to submit an event for publication.

SAVE DATE

THE

A L B E R T A A S S O C I AT I O N O F T R AV E L H E A L T H P R O F E S S I O N A L S A N N U A L T R AV E L H E A L T H S Y M P O S I U M June 1–2, 2012. Calgary. CONTACT: www.aathp.com

May 23-26, 2012 2012 TRI-PROFESSION CONFERENCE

IN MEMORIAM Our deepest sympathy is extended to the family and friends of: Henderson, Freda (née Hicks), a 1948 graduate of the Winnipeg General Hospital school of nursing, who passed away on Oct. 9, 2011. Jensen, Anne, a 1947 graduate of the Royal Alexandra Hospital school of nursing, who passed away on Sept. 4, 2011. Lupul, Emily, a 1950 graduate of the Vegreville General Hospital school of nursing, who passed away on Oct. 22, 2011. Mills, Winnifred, a 1952 graduate of the Holy Cross Hospital school of nursing, who passed away on Sept. 25, 2011. Mortimer, Natasha (née Moore), a 1999 graduate of Grant MacEwan/University of Alberta collaborative baccalaureate program who passed away on Aug. 23, 2011. Stewart, Margaret, a 1945 graduate of the Ontario Hospital school of nursing, who passed away on Sept. 11, 2011. 28

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JOIN CARNA NEXT YEAR AT the Rimrock Resort Hotel in Banff for the fourth joint conference of the organizations representing registered nurses, pharmacists and physicians in Alberta.

opportunities

RN Expertise for RNs

PHONE: EMAIL: FAX:

78 0.451.0043 1.8 00.252.9392 [email protected] 78 0.452.3276

Consultations available by phone, e-mail, fax or in-person CARNA policy and practice consultants provide confidential consultations to RNs who seek assistance with issues that directly or indirectly affect the delivery of safe, competent, ethical nursing care.

How policy and practice consultants can help you   assist you in understanding how legislation, regulations, standards, guidelines and position statements apply to your practice   act as an informed sounding board to help identify problems or questions related to nursing practice   propose a range of viable options that foster valid decision-making related to your nursing practice, policy or education   guide you to develop problem solving/conflict resolution strategies that you may use in your practice setting   provide constructive and supportive feedback focused on improvements related to patient safety, work environments, etc.   collaborate with stakeholders to support a professional practice environment that fosters the delivery of quality patient care   suggest accessing other relevant practice resources (e.g., CNPS, ISMP, best practice guidelines)

The advertising deadline for the Spring 2012 issue of Alberta RN is Feb. 27, 2012. Go to www.nurses.ab.ca for details.

Closing Perspectives Navigating the World of Social Media Social networking is the latest in a growing list of emerging regulatory issues for nursing professionals around the world. At a recent forum hosted by the International Council of Nurses and attended by representatives from 17 countries, it was clear to me that most organizations are wrestling with the expanding influence of this communication tool. While social media has potential to foster professional connections, share expertise and inform, any registered nurse who reads the publications ordered by CARNA Hearing Tribunals in Alberta RN has a good idea of the potential negative consequences. In the U.S., the National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA) have mutually endorsed each organization’s guidelines for upholding professional boundaries in a social networking environment. The NCSBN social media guidelines and the ANA principles of using social media emphasize the need to be mindful of employer policies, relevant legislation, and professional standards regarding patient privacy and confidentiality. In December, CARNA Provincial Council will be weighing the merits of adopting the NCSBN guidelines as an interim measure for Alberta registered nurses until similar resources reflecting Canadian and Alberta legislation are developed. NCSBN has also published A Nurse’s Guide to the Use of Social Media, an interesting read that includes seven scenarios reflecting actual cases of inappropriate use of social media by nurses. These resources *

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can be downloaded free of charge and I encourage each of you to consult them. While these resources call attention to the perils of social networking, social media also present opportunities for CARNA to address one of the challenges highlighted in the results of the recent member survey. While 80% of respondents said it was important to them that nursing is a self-governing profession, only 37% said CARNA does a good job of representing the interests of RNs and 34% said CARNA understands the issues and concerns they face as an RN. While these results indicate a four per cent increase over the results of the survey in 2004, they are far from satisfactory. The message to CARNA is loud and clear: you’re not listening to me, engage with me and respond. Social media, while not a panacea for this disconnect, is a reasonable tool to add to our communication toolbox to address it. Social media is just beginning to form part of CARNA’s communication strategies. While half of our membership is not currently using social media, the other half is regularly using social networking both personally and professionally. Research on adoption of social media indicates this contingent is likely to grow. Council has indicated it is a time for CARNA to make social media a priority with the goal of engaging members and their professional organization. As a first step, CARNA will launch a blog hosted by CARNA President Dianne Dyer and invite comments from members. According to social media experts, the most common error made by organ-

izations new to social media is failing to recognize the time commitment required to plan, update, monitor and maintain social networks. Our approach to the current availability of a multitude of social media tools will be a gradual one to build our understanding of the capacity of social media and the demands on resources. While progress is to be expected along the way, it will take time for CARNA to build a virtual community and a 12 –18 month incubation period is considered typical. Experience has taught me that some of our efforts will work and some will fail. Another significant challenge will be evaluating the relative value of existing and new communication tools and deciding how resources, both human and financial, are allotted. An American survey conducted in 2010 reported that 65 per cent of nurses surveyed indicated they are planning to use social networks for professional purposes.* Although we do not have equivalent data for Canadian nurses, a reasonable assumption is that many CARNA members and stakeholders are talking about registered nursing in social media channels and more will join in the conversation. This is an opportunity to engage we don’t want to miss. RN

M a ry- A n n e R o b i n s o n , Chief Executive Officer 780.453.0509 or 1.800.252.9392, ext. 509 [email protected]

Nicholson Kovac Inc. (2010). New media usage study: Healthcare professionals, February 2010. Retrieved from http://www.prweb.com/releases/Nicholson_Kovac/Healthcare_Study/prweb3646144.htm

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RN, BN, MSA

PM40062713