Dear Colleagues:  Welcome to my Tuesday, May 19 report – now in the fifth month of COVID-19 in Ontario. For the many resources RNAO offers on COVID-19, visit the COVID-19 Portal. 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. For those who have not yet checked out our activities last week, please go to last Thursday’s story as well as our Nursing Week portal. You will find over 15 videos of our visits to workplaces, including with our prime minister, our premier, ministers and Lord Nigel Crisp during the Nursing Now Ontario Awards ceremony.

Today my focus is on RNAO’s VIANurse program.

With the pandemic curve flattening, VIANurse program will focus its effort on outbreaks

The pandemic caused a sudden spike in demand for nursing human resources across the healthcare system. RNAO planned and was ready for it. Indeed, we were the first out the door addressing growing shortages, as many RNs, NPs and PSWs were being quarantined and/or falling sick, and staffing needs escalated together with the acuity of many settings.

RNAO launched the COVID-19 VIANurse program on March 12, 2020. We enlisted nurses for telehealth services to reduce ER visits, and helped public health units with case / contact tracing. We supported health facilities including hospitals augment their nursing human resources during the month of March to better position themselves to tackle the pandemic. We sent, starting April, RNs, NPs and nursing students to health facilities with active outbreaks – especially nursing homes - to save lives.

VIANurse provided these services free of charge to the entire province during an unprecedented time of need. Kudos to RNAO staff led by Daniel Lau -- director of membership & services – and his team – for working literally around the clock, seven days a week, so that organizations with staffing needs will not wait.

During this period, VIANurse registered 7,414 RNs for virtual and clinical care, 1,028 critical care RNs (who have experience and continued competency in the provision of critical care), and 287 NPs. In addition, 389 colleagues responded to our call for work at nursing homes experiencing an outbreak: 285 RNs and 40 NPs and 53 nursing students – ready to go to nursing homes in an active outbreak - plus, 11 RNs who can do non-clinical work in outbreaks places.

VIANurse served the staffing needs of more than 313 organizations in different sectors, including 238 long-term care homes, 29 hospitals, 11 public health units, 7 indigenous health facilities, 3 hospices, 3 correctional centres and other sectors. And, many organizations have accessed VIANurse multiple times.

Now the efforts of Ontarians have helped stabilize the pandemic curve, at least for this first wave, and the government is implementing plans to ease restrictions. Most health organizations in need of staffing have been served, many more than once, and staffing needs have generally stabilized across the province.

As we contemplate a new normal – and we hope that continuing public discipline and wise public health guidance will help avoid a recurrence of a major second wave –, RNAO is also re-defining the COVID-19 VIANurse program with a narrower scope for this new stage. Please take note of the change:

Since 2006, RNCareers.ca has been the official career site of the RNAO, and the first online career board that was created exclusively to meet the needs of the Ontario nursing professional. RNCareers.ca specializes in all nursing roles including point of care nurses, advanced practice as well as executive, administrative, management and academic nursing positions. The site hosts nurse practitioner (NP), clinical nurse specialists (CNS), registered nurse (RN), registered practical nurse (RPN) and all other health professional positions in clinical and non-clinical roles across all health-care. It also serves nursing students who want to work as personal support workers. If you have any questions please contact Daniel Lau dlau@rnao.ca

Below we provide glimpses into letters we received thanking RNAO for the contribution at a time of urgent need:

Tracey Comeau, Villa Colombo, “Within hours of our call for assistance, we received an immediate response… the call [went] out to over 60 RNs waiting for their call to action; within 24 hours we received over 15 responses, and new hires arrived for orientation within days. The RNAO VIANurse has also been instrumental in assisting us to recruit Nursing students to fill some PSW staffing gaps.”

Lois Cormack, Sienna Senior Living, “Through the fantastic efforts of the team at RNAO, we have been able to hire 13 staff and already have 9 of those individuals deployed to COVID-19 positive residences within one week…”

Lisa Levin, AdvantAge Ontario, “As you know, within just days of launching our partnership, thousands of students were connected with hundreds of homes bringing desperately needed support and relief. We received numerous emails of thanks from member homes and it is hard to imagine how many of them would have managed in those first few weeks without your foresight to mobilize this willing and dedicated team. You then followed shortly with a second wave of support through the placement of RNs and nurse practitioners and created COVID-19 teams for hardest hit homes. It is not an overstatement to say that these efforts saved lives.”

Esther Moghadam, Ottawa Public Health, “Through the partnership of the RNAO’s VIANurse program, OPH was able to quickly enhance its capacity for triaging test results, case management and contact tracing by an additional 100 nurses, so that service could be provided 7 days a week, without delay.”

RNAO’s response to these and other letters of thanks: We are honoured and proud to serve.

Your messages: Voices and responses

Each we receive numerous emails and phone calls. Each day we also 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.

Nurses providing foot care services: Several colleagues who work in independent practice providing foot care to persons with diabetes have written with a variety of important questions. Please know that we will coordinate a webinar in the next few days to discuss your needs and provide you with the necessary support.   

Together we can do it

MOH EOC Situational Report #114 here for Monday, May 18

Situation:    

• 304 new cases were reported in Ontario today, bringing the cumulative case count to 22,957 (this includes 17,638 resolved cases and 1,904 deaths).
• In Ontario, a total of 553,981 tests have been completed, with tests performed at Public Health Ontario Laboratories and non-Public Health Laboratories. There are currently 2,189 tests under investigation.
• 972 patients are currently hospitalized with COVID-19; 174 are in ICU; and 133 are in ICU on a ventilator.

EOC report #114 for May 18 informs of the following actions taken:

• The ministry continues to work on the revision of Directive #2 and related requirements to support the gradual restoration of health services. Please note that CMOH Directive #2 is still in effect. Providers are encouraged to continue planning and further details will be provided once confirmed.

EOC report #113 for May 17 informs of the following actions taken:

• The COVID-19 Patient Screening Guidance has been updated to reflect the recent changes to both the case definition and the testing guidance. The updated version of this screening guidance is here in English and will be available shortly on the Ministry’s website.
• The Command Table met on Friday; a summary of the discussion is here.

EOC report #112 for May 16 informs of the following actions taken:

• Directive #2 continues to be in effect.  The ministry continues to work on drafting amendments to Directive #2 to support future resumption of services, pending continued improvements in key public health indicators.
• While preparing to re-open for in person services, health service providers are reminded to follow the hierarchy of controls to eliminate or reduce the risks of transmission, and to minimize their need for PPE. Health service providers and employers should be sourcing PPE through their regular supply chain and they remain responsible for sourcing and providing PPE to their frontline workers. PPE allocation from the provincial pandemic stockpile will continue, and PPE can be accessed, within available supply, on an emergency basis through the established escalation process.

EOC report #111 for May 15 informs of the following actions taken:

• The Command Table met on Wednesday; a summary of the discussion is here.
• The Ministry is working on further direction to the health sector on restarting. Please note that CMOH Directive #2 is still in effect, but the ministry is in the process of drafting amendments to this Directive. In the meantime, providers are encouraged to continue planning for the gradual resumption of services in a safe manner. Further guidance will be forthcoming.

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:

14 May - Nursing Week update – go here.

14 May - Pandemic puts health system to the test: Nurses have answers for shortfalls – go here.

14 May - Disappointment for not being included in pandemic pay – go here.

13 May - RNAO saddened by the loss RN Brian Beattie to COVID-19 – go here.

13 May - End racism and prejudice – go here.

11 May - Nurses share their successes and challenges during National Nursing Week – go here.

10 May - A story of hope, ingenuity, support and genuine care for an LTC resident – go here.

7 May    - Counting the missing deaths: Tracking the toll of the coronavirus outbreak – go here.

5 May    - Life on the front lines of the pandemic: Profile of RNAO member NP Daria Gefrerer – go here.

5 May    - Addressing differential access to virtual care due to technology inequities – go here.

3 May    - Being person-and-family-centred during COVID-19 – go here.

1 May    - Migrant agricultural workers and the COVID-19 crisis – go here.

30 April - COVID-19 pandemic in provincial institutions and correctional centres – go here.

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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