Dear Colleagues:  Welcome to my Thursday, April 30, COVID-19 report – now in the fourth month of COVID-19 in Ontario. For the many resources RNAO offers on COVID-19, visit the COVID-19 Portal. In particular, VIANurse is your go-to page if you need to augment your nursing and personal support worker human resources. You can refer to earlier update reports here, including thematic pieces in my blog. Feel free to share this report or these links with anyone interested – they are public.

Nursing Now – Webinar in Spanish, Today: Thursday, April 30, 3:00 pm (Toronto time)

As I mentioned earlier, Nursing Now 2020 has recognized once again Ontario’s nursing strength -- before COVID-19, when we did webinars for Nursing Now related to RNAO’s Best Practice Guidelines Program (BPG) and Best Practice Spotlight Organizations (BPSO) – and now during COVID-19. To remind you, Nursing Now is a three-year global campaign (2018-2020) that aims to improve health by raising the profile and status of nursing worldwide. Run in collaboration with the World Health Organization and the International Council of Nurses, Nursing Now calls on governments worldwide to place nurses at the heart of tackling 21st century health challenges and maximize their contribution to achieving universal health coverage.

Today, we are delivering a collaborative webinar for Nursing Now: Thursday, April 30, at 3:00pm, Toronto time (8:00pm, London time and 9:00pm Spain time). Here is the link for any of you to register.

Please RT this Nursing Now Tweet

Vulnerable population: COVID-19 pandemic in provincial institutions and correctional centres

We continue our focus on vulnerable populations – how they are faring under the COVID-19 pandemic and what are the challenges of health providers taking care of them. The following report focuses on the pandemic in provincial institutions and correctional centres. We are hugely appreciative to Angela Di Marco, RN, BScN, MA, President of RNAO’s Ontario Correctional Nurses Interest Group (OCNIG), for her contribution.

As the pandemic progresses into months, new and emerging themes continue to arise that impact our practice setting.

The novel feature of the virus results in daily changes to screening and assessments, which are communicated and implemented within short timelines. This pandemic experience highlights the critical need for a co-ordinated strategy to address staffing in general and also staffing ratios. Flattening the curve is necessary, and how does that look in a correctional setting?

The answer: challenging, to say the least.

Admissions processes: Enhancements have been made to symptom screening prior to building entry and during the admission assessment. This includes isolation for symptomatic patients. Those who test positive do not return to the general population until further testing results in two negative swabs. Positive cases are tracked and reported to Corporate Health Care. These numbers remain low, according to media reports. Each change to the admissions process results in additional nursing duties that are added to already heavy assignments. There is an impact at all levels, including management. Nurse Managers are provided with minimal resources and limited information. The result is long work hours and overtime in an already fast-paced and quickly changing environment.

Phone access for patients in custody: The Correctional Reform Coalition sent a letter to Solicitor General Sylvia Jones and Deputy Solicitor General Deborah Richardson to acknowledge the provision of improved phone access for patients in custody. This is not only important from a health perspective, it is also critical that patients have phone access to maintain contact with supports, access to justice, and safe planning post-release. Diverting and de-carcerating are promoted as strategies to prevent the spread of COVID-19.

Staffing levels: The most critical factor in implementing safe staffing levels is to ensure the workforce has the tools and the capacity to implement policies and processes. Several correctional institutions rely on agency staffing. Nursing staff are impacted by absences, which create last-minute additions to already heavy work assignments. Short scheduling is disruptive to staff and delays care to patients. When several staff members are absent simultaneously, the work assignments become heavy and staffing ratios are also affected. For example, there could be (at times) double the number of patients for a med pass and contingency planning. Or there could be limited trained staff available to complete necessary screenings and admission assessments. This creates a stressful work environment. The strain can potentially lead to increased absenteeism and turnover. Both of these de-stabilize the workforce capacity to provide consistent care within a strict institutional daily schedule. Front-line workload issues continue to be challenging and recruitment and retention of staff is an ongoing issue. This was already a challenge prior to the pandemic.

Health and safety: The availability and use of PPE is an ongoing discussion. The media has reported that some health providers have refused to work at some institutions as the number of positive cases (both staff and patients) continues to climb. There are unconfirmed reports that suppliers allocate more PPE to hospitals and other health-care settings, and don't consider corrections a priority. Every effort is being made to source PPE.

Social distancing: For those in custody, the opportunities for social distancing are comparable to other institutional environments. There are a number of challenges. Correctional operations and processes are greatly impacted, resulting in the need to increase staff numbers as well as review assignments on a daily basis. Protecting health-care workers with PPE in the institutional setting becomes integral in order to prevent spread.

Lessons are being learned each day and with each new directive, policy and screening direction. Correctional nurses are staying connected through social media and by sharing new and emerging information. The struggle to manage day-to-day is real. Together, we must continue to work towards advocating for resources to ensure our patient population receives the high quality health care they deserve. Front-line nurses and nurse managers continue to strive for sustainable processes.

RNAO: Again, our thanks to Angela Di Marco for this important update. There have already been COVID-19 outbreaks in correctional institutes across the U.S., British Columbia and Quebec. In Ontario, the largest outbreak has centred on the Ontario Correctional Institute (OCI), where of 109 inmates, 80 have tested positive, as well as 21 correctional officers. But it’s not just inside the jails and prisons, as the government is letting many low-risk offenders out to ease the burden on the system, and many are entering a different world, with less post-release support facilities in place.

The Correctional Reform Coalition (CRC), a group of organizations dedicated to improvements in corrections in Ontario, wrote on April 24 to the Ontario Solicitor General to support the “efforts to safely reduce the number of provincial prisoners in Ontario…; diverting and decarcerating as many prisoners as is safely possible to do is critical to preventing the spread of COVID-19 behind and beyond bars at this time. When combined with appropriate community supports where they are required, these measures… are also critical to promoting family connectedness and enhancing public safety.” Among other requests, the Coalition asks to “Invest further in community re-entry supports, the most essential of which is safe, affordable, and in some cases supportive housing that is readily available to people experiencing homelessness post-release…” See here full letter.

RNAO’s ViaNurse Program               

RNAO’s VIANurse program, launched on March 13, has already registered 7,338 RNs for virtual and clinical care, 1,022 critical care RNs (who have experience and continued competency in the provision of critical care), and 285 NPs. RNAO is continuously responding to requests from health organizations. So far, we have served 271 organizations, of which 206 are nursing homes and retirement residences. RNAO has also offered the government to identify NPs and RNs who can help manage LTC organizations that are in crisis, and assist with urgent interventions where severe outbreaks are ongoing. For any nursing HHR needs go to RNAO’s VIANurse program

** Seeking RNs, NPs and nursing graduates ready to work in nursing homes in active outbreak

RNAO launched on Friday, April 24^th a fourth survey for RNs, NPs and nursing graduates urging them to register for work in nursing homes that are on an active outbreak. The availability of these colleagues is already fastening even more the matching of nursing staff to homes in dire need. For example, between April 20^th and April 29, we deployed RNs, NPs and/or PSWs to 96 organizations, including 92 nursing homes, with some of these organizations having been served multiple times. Yesterday, on a matter of hours from request we responded to the staffing needs of 8 additional organizations. Also important to know is that VIANurse has no backlog requests, and we also respond after hours and on weekends – as we understand the urgency of each request. Please retweet the following urgent tweet to have many more RN, NP and new graduates enrolled.  

For those of you ready to work in a nursing home with an outbreak – we need you –please CLICK HERE and complete our survey ASAP. We need your response as soon as possible given the rapidly evolving situation, and the urgent need in nursing homes across the province. The government has now improved the compensation, recognizing your critical role – see Ontario’s press release here.

So far we have got 290 responses: 246 RNs and 34 NPs – ready to go to nursing homes in an active outbreak - plus, 10 RNs who can do non-clinical work. These colleagues are being deployed as we speak, including over the weekend. 

Your messages: Voices and responses

Each day we welcome new readers to this daily report: thank you deeply for the work you do always and especially during this public health crisis, and also for keeping us well informed. You can see previous reports at RNAO updates and resources on COVID-19 for members and other health professionals. Feel free to share these updates with other health professionals and other organizations both at home and abroad. RNAO media hits and releases on the pandemic can be found here. Daily Situational Reports from Ontario's MOH EOC can be found here. Many of the articles you see here are posted in my blog, where you can catch up with earlier issues. The COVID-19 Portal is here.

• “A big shoutout to Diana Sebera. She says it all. Being retired, she talks with the wisdom of experience. The people of Ontario need to heed her remarks and stand up for their hard won Medicare, whose governing principles guide all front line workers in delivering equal and quality care to the infirmed. But it’s near impossible. Mr. Ford is right. The system got broken. Thank you RNAO for confronting him on that and staying the course.” Magee McGuire, another retired RN.
• One member would like to encourage nurses to change into their uniform when they arrive to their workplace, and then change out of their uniform into clean clothes at the end of their shift – to be then taken home in a plastic bag. With no visitors and decreased transfers to and from hospital, staff are likely the main vectors for the virus entering facilities such as long-term care. With PPE in place, it may be carried in and out on our shoes / uniforms / clothing. We must take every precaution and would recommend this to all staff in non-hospital locations. “Thank you for all of your hard work and initiatives during these uncertain times and always.” Karen North-Lewis, NP, proud RNAO member since 2000.

Together we can do it

MOH EOC Situational Report #95 here for Wednesday, April 29

Situation:  

• 347 new cases were reported today in Ontario, bringing the cumulative total to 15,728 (this includes 9,612 resolved cases and 996 deaths).
• In Ontario, a total of 264,594 tests have been completed, with tests performed at Public Health Ontario Laboratories and non-Public Health Laboratories. There are currently 9,530 tests under investigation.
• 977 patients are currently hospitalized with COVID-19; 235 are in ICU; and 186 are in ICU on a ventilator.

EOC report #95 for April 29 informs of the following actions taken:

• The Government of Ontario announced it is further expanding the list of essential workers eligible to receive free emergency child care during the COVID-19 outbreak. Those who will benefit include people who work in the food supply chain, retirement homes, grocery stores and pharmacies, and certain federal employees, including the military.
• A new memo was issued today regarding transfers from hospitals and the community to long-term care homes. See here.

Staying in touch          

Please continue to keep in touch and share questions and/or challenges of any kind, and especially shortages of PPE. Send these to me at dgrinspun@rnao.ca. We are responding daily and are continuously solving your challenges. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you deeply colleagues in the front lines; in administrative roles; in all labour, professionals and sector associations, and in governments in Ontario, in Canada and around the world. We are here with you in solidarity. These are stressful and exhausting times; the only silver lining is coming together and working as one people – for the good of all!

Together, we must redouble our efforts to tackle COVID-19 with the best tools at hand: full, accurate and transparent information, calmness, determination and swift actions. 

Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
Chief Executive Officer, RNAO  

RECENT RNAO POLICY CORNER ITEMS:

28 April - Supporting First Nation Communities during COVID-19 – go here.

27 April - Responses to COVID-19 for persons experiencing homelessness in Toronto: An update – go here.

25 April - Lessons learned through a COVID-19 nursing home outbreak – go here.

25 April - Letter from a retired RN to Premier Ford: The problems with LTC were evident long before COVID – go here.

23 April - Working with seniors in long-term care requires specialized knowledge – go here.

22 April - Shaking the stigma: We need a proactive COVID-19 response for mental health and addiction – go here.

21 April - We Require Expanded and Accessible COVID-19 Data in Ontario – go here.

20 April - Can Loss of Smell and Taste Help Screen for COVID-19? – go here.

18 April - COVID, Trump and the World Health Organization – go here.

16 April - A Home Based Model To Confront COVID-19 – The Case Of The Balearic Islands – go here.

15 April - COVID-19 and the Challenges in Homecare – go here.

14 April - Reprocessing Of N95 – An Update – go here.

14 April - A New COVID-19 Facility For Persons Experiencing Homelessness In Toronto – go here. 

13 April - Practical Tips for Safe Use of Masks – go here.

10 April - Ontario’s Tragedy in Long Term Care Homes and Retirement Homes – go here.

10 April - RNAO Action – Supporting Long-Term Care – go here.

10 April - Update For Nursing Students – NCLEX Exam – go here.

9 April - Celebrating Passover, Good Friday, Holy Saturday, Easter Sunday and the start of Ramadan during a pandemic – go here.

9 April - Guidance on use of N95 mask – go here.

7 April - Sentinel surveillance and on-site testing in the homeless service sector – go here.

7 April - Reprocessing of n95 – safe? – go here.

5 April - We must change the way we do testing and case definition – go here.

5 April - Ringing the alarm bells on critical care beds – go here.

4 April - COVID-19, stay at home and domestic violence – go here.

We have posted earlier ones in my blog here. Please go and take a look.

Information Resources

Public Health Ontario maintains an excellent resource site on materials on COVID-19. This is an essential resource for Ontario health providers. 

Ontario’s health provider website is updated regularly with useful resources here.

Ontario’s public website on the COVID-19 is there to inform the general public – encourage your family and friends to access this public website. The WHO has provided an excellent link for you to share with members of the public here.

Please promote the use of Ontario’s COVID-19 self-assessment tool: It also has a guide where to seek care, if necessary. Its use will provide the province with real-time data on the number and geography of users who are told to seek care, self-isolate or to monitor for symptoms. Data will inform Ontario's ongoing response to keep individuals and families safe.

Health Canada's website provides the best information capturing all of Canada. It contains an outbreak update, Canada's response to the virus, travel advice, symptoms and treatment, and resources for health professionals.

The World Health Organization plays a central role in addressing the COVID-19 pandemic. See here and here.

You can find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE.

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