Dear Colleagues: Welcome to our Friday, July 31 report – now in the sixth month of COVID-19 in Ontario. Visit the COVID-19 Portal for the many resources RNAO offers on COVID-19 You can refer to earlier update reports here, including thematic pieces in my blog. RNAO media hits and releases on the pandemic can be found here. Daily Situational Reports from Ontario's MOH EOC can be found here. As always, feel free to share this report or these links with anyone interested – they are public.
Our continuing response to the crisis in long-term care
RNAO has raised the public profile of the Ontario government’s tabling of a staffing study in long-term care (LTC) due at the end of July under the recommendations of the 2019 Justice Eileen Gillese inquiry. The government tabled yesterday its report and RNAO responded with the press release below. Please add your voice by re-tweeting this tweet. Also, please continue to sign our action alert here. Nursing home residents, their families and staff can’t wait – we must now begin hiring RN, RPNs, NPs and PSWs. THANKS!
LTC staffing study highlights what RNAO has been saying for two decades: Government must immediately mandate hiring to avert second tragedy
RNAO says the long-term care (LTC) staffing study released by the government today highlights deficiencies known for decades, and underlines an LTC sector that has been neglected by government after government, resulting in severe underfunding and understaffing.
“While these are, for the most part, sound recommendations within a comprehensive report, there is nothing here that we have not discussed before. Also not new is the government statement that ‘This study will inform the development of a comprehensive staffing strategy to be released later this year.’ What we needed to hear today was that Premier Doug Ford is ready to move swiftly to hire staff. This is foundational to the care residents in nursing homes will receive,” says Dr. Doris Grinspun, RNAO’s CEO.
“We urge the minister of long-term care, Merrilee Fullerton, to immediately direct nursing homes to hire personal support workers, registered nurses, registered practical nurses and nurse practitioners ahead of the second wave of COVID-19, which will coincide with the coming Influenza season,” says Grinspun. “There is not a minute to wait if we are to prevent a second massive tragedy in Ontario’s nursing homes come the fall.”
The need for immediate action is outlined in RNAO’s submission to the government’s, which was struck by minister Fullerton in response to the public inquiry on LTC homes, which issued its recommendations on July 31, 2019. Justice Eileen Gillese led that inquiry and gave the government a deadline of July 31, 2020 to table in the legislature a staffing plan for regulated staffing in LTC.
The government’s report, released this afternoon, highlights a minimum staffing complement to provide four (4) direct hours of nursing and personal care per resident, per day. However, the report fails to specify the skill-mix composition of those four hours, leaving residents, families and staff to the will of operators.
RNAO will continue to call for the as the only way forward. It will also continue to urge that no nursing home – whether for-profit or not-for-profit – go below four hours of direct nursing and personal care per resident, per 24 hours. All homes must guarantee a proper skill mix as follows:
RNAO is also calling on government to fund each LTC home for one NP per 120 residents, in the role of attending NP or director of clinical care; as well as one additional nursing full‐time equivalent (FTE) staff (preferably an RN) to support the functions of infection prevention and control and quality improvement.
RNAO and others have repeatedly sounded the alarm about inadequate staffing levels in the sector. In June, RNAO released a list of 35 reports that have been published over the last 21 years, each with recommendations on how to address ongoing systemic failings. That list included the Gillese inquiry report. A common theme in those reports was the need for more staff in nursing homes, as well as a proper mix of regulated staff, in particular RNs, RPNs and
NPs, which are scarce in this sector and are central to improving the safety and quality of care needed to meet the complex care needs and rising acuity levels among residents. The government's own report states today that: "The Long-Term Care Staffing Study Advisory Group concludes that if barriers to optimal staffing are addressed, as recommended in this report, the sector could more consistently deliver safe, quality and resident-centred care, to better meet the needs of long-term care residents." Yet, once again, the government has failed to move into action.
Close to 2,000 nursing home residents died during the first wave of the COVID-19 pandemic in Ontario. “The government’s announcement demonstrates it is willing to learn from its past and recent mistakes, and make the necessary improvements that we desperately need to see in long-term care,” says Grinspun. That political will is extremely important, she adds: “However, to save residents’ lives and boost their well-being, we must immediately move from more reports to decisive actions.”
Important announcement regarding the VIANurse program
RNAO played a central role during the first wave of the pandemic, in many ways, including by running the VIANurse program to recruit and channel thousands of NPs, RNs, RPNs, and PSWs to health organizations in need. Until May 26 it had served 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. Many of these organizations accessed VIANurse multiple times. RNAO’s initiative and capabilities helped address many of the worst outbreaks, aggravated by staff shortages, and thus saved many lives.
RNAO has now decided it will not re-open the VIANurse program if another wave of COVID hits the province. VIANurse addressed an emergency in a province that was slow in responding to the pandemic, and thus played a vital role. The next waves of COVID should not be an emergency as we can prepare now. In the hard-hit long-term care sector, RNAO has insisted to government and to health organizations – see our press release above – the time to hire staff is NOW, in August, with immediate on-boarding and training of staff to be ready for the second wave of COVID-19 + Influenza season.
RNAO’s RNCareers program – a service open to employers and employees since 2005 – is ready to help you find the resources you need. The career site has served thousands of employers to hire NPs, RNs, RPNs, PSWs, and other health professionals. Individuals seeking work can register for free in the website.
Preparing for the second wave of COVID-19: Discussion
Last week I posted RNAO’s thoughts on preparing for upcoming waves of COVID-19. It is impossible to know for certain if and when these waves may come, or if and when an effective vaccine and access to therapeutics will be available. RNAO has argued since January that we must prepare for the worst and hope for the best. We raised 15 lines
of action, many of them interrelated, as part of that required preparation. Keep sending us your feedback, as it is very important and much appreciated! Please write to firstname.lastname@example.org and copy my executive assistant, Peta-Gay (PG) Batten
The Ontario government acted on one of RNAO’s recommendations today by requiring bars and restaurants to keep client logs for a period of 30 days so as to facilitate case and contact tracing in case of need.
The federal and provincial governments released today the new Ontario COVID Alert app that will serve as an additional tool in case and contact tracing. This app has been developed taking account of privacy concerns (it does not collect location, contact, health or other personal data) and RNAO is strongly recommending downloading and activating it. Please encourage co-workers, family and friends to do so as well. I already did + RT this tweet!
Our provincial government has not yet acted on the recommendation to implement universal masking requirements across Ontario rather than rely on a hodge-podge of different regulations across various municipalities and regions. We call, once again, on the Ontario government to act – now is the time to keep moving in the right direction.
Thoughtful feedback received from two readers:
RNAO member Erin McPherson writes:
Flu vaccine schedule:
Normally, we don't have access to the flu shot until early November, much later than the schedule in the US where the flu shot is available in September. Normally, I would say that doesn't matter as flu season doesn't really start until late November or early December, but given the real risk of competing viruses, is there any possibility of moving the distribution of flu shots earlier? I imagine that the schedule from development to distribution is already quite tight and thus, altering the timeline may not be feasible, but thought it might help with compliance.
RNAO response: We agree, Erin, that this year the timetable should be advanced as much as practically possible. I have asked the question from our medical officer of health and will get back to you.
Masks in schools:
What is RNAO's stance on masks in school? I understand that Sick Kids put out guidance in June stating the masks weren't necessary in schools but I'm concerned that their guidance is already 1 month old in a pandemic that is 6 months old.
While I appreciate that the recommendations are mixed on the use of masks in kids, there is evidence that the use of masks indoors reduces transmission of the virus without much downside, especially in older kids (references below)
I appreciate the fact that the data is mixed and can only assume that as we learn more, the guidance will continue to evolve.
RNAO response: As you may know, RNAO has advocated for the use of masks in children three years and older and we run the #Maskhaton campaign to promote their use. We are sensitive to the challenges of having younger children use masks for a full day, so the advice of Children’s Hospital of Philadelphia seems wise. Their advice is similar to a prominent Harvard study that recommends “students wear face masks as much as possible, especially when in hallways or bathrooms.” The revised Sick Kids guidelines recommend masks for high school children but the authors could not agree on recommendations for younger children. The Ontario government’s plan for reopening schools indicates that students from Grade 4-12 and school staff will be required to wear masks.
Where is Ontario on batch / pool testing? I am reading about approval and use of this technique in other areas and feel like we should be talking about it more. This could be particularly relevant in schools, long-term care, etc., where screening full floors, classrooms and so on – instead of each person separately –, might help prevent outbreaks. Thanks so much for all you are doing to keep us connected.
RNAO response: An explanation on batch/pool testing can be found here. This technique only works in scenarios where the case count is low, so you are right – it fits the current context. I am not aware of consideration and use of batch/pool testing in Canada so thanks for raising it.
RNAO member Timea Andersen writes (we shortened the long message):
I have read this week's letter and, as usual, I applaud the work that you are attempting to do. There is one part, however, that concerns me.
With regards to asking government to control the "false health information" being posted on social media, I have intense concerns. What I interpret you to be suggesting sounds like censorship, which is a slippery slope indeed, even with the best intentions.
I was born in communist Eastern Europe and my family immigrated to Canada when I was a child to escape a regime that did exactly that. All other opinions, good and bad were replaced with their own propaganda… Yes, some people do have very misinformed and possibly harmful opinions on any and all possible subjects, but it is not up to the government to decide that. It is up to the reader…
As a perfect example, it was anti-establishment and absurd to suggest at one point in healthcare history for doctors to wash their hands between patient examinations… There may be some controversial opinions now and in the future which sound incorrect or far-fetched, but at least a few of those may turn out to be cutting edge, ahead of their time, out of the box thinking… We must strive to educate people with the best current knowledge available and hope, not only that the general public chooses wisely but also that the information we now think is the best, turns out to be the best in hindsight…
RNAO response: Thanks, Timea, for raising a crucial issue and helping us clarify our ideas; you are right our writing could be misinterpreted as inviting censorship. You are referring to our item on Fighting misinformation as a public health threat where we say “One of the sad lessons from the debacle south of the border is that misinformation can cause death and suffering on an unimaginable scale. Science and evidence-based information is not a luxury but an absolute necessity if we want to minimize death and disruption to the economy… Government should engage measures to diminish these negative impacts, including demanding that social media venues remove fake and false information on health matters. Governments have sway over Facebook, Twitter, Instagram, WhatsApp, and other platforms that have an enormous influence on health outcomes, and they should use it.”
To clarify our position, we are not calling for government censorship or for government to dictate which views are acceptable or not. The suggestion is that legislators should enact laws that require social media giants to have public accountability and enforce posting standards and ethical frameworks similar to what mainstream media has. This doesn’t silence anyone, but assures there are checks and balances as well as recourse mechanisms when there is evidence of sustained harm. RNAO takes the position that health professionals hold substantive power and should inform that public accountability. That means they must speak with the best available scientific evidence, and caution about damaging health information.
We support freedom of speech, recognizing also that there are limits and constraints to that right. Everyone would agree that free speech does not convey the right to scream “fire” in a packed theatre, when there is no evidence of fire. Does it convey the right to access mass social media platforms indiscriminately to propagate information that science tells us can kill people in the thousands? That’s a thorny question. A nuanced understanding of freedom of speech that reflects our thinking can be found here.
Let’s Talk about Anti-Black Racism and Discrimination in Nursing
As updated earlier, RNAO launched a task force to tackle anti-Black racism within the nursing profession. A powerful webinar on July 20 offered an update on the work of the task force and an open consultation with participants (the presentation slides are available here). The consultations of the task force will continue in the form of a webinar series, to be held the third Monday of each month. Mark your calendar for the upcoming dates: Aug. 17, Sept. 21, Oct. 19 and Nov. 16, 2020. The plans for the webinar series are presented here.
Update on webinars
RNAO held weekly COVID-19 webinars every Monday evening between March 30 and early July, with decreased frequency after that. Attendance is always anywhere between 200 and 350! The COVID-19 Webinars: Together We Can Do It! are free and open to all.
The next webinar will be on Monday, August 10, 6:45-8:00 pm, focusing on nurses’ mental health and wellbeing. The global pandemic has exacerbated health and mental health concerns amongst nurses. Shortages of PPE, fear of infecting family members, isolation from family members, increased emotional and physical exhaustion, and inability to take time off – all exacerbated mental health concerns among nurses which predated the pandemic. Come hear about the healthy professional worker partnership that aims to identify interventions to better support nurses’ mental health and facilitate healthy return to work. Share your experiences and find out how to support this research. You can register here. An article presenting the issues is here. The guest speakers are:
If you have not had a chance to watch previous webinars, here are a couple of them:
MOH EOC Situational Report
As announced above, we will be posting each day the Daily Situational Reports from Ontario's MOH EOC at RNAO’s website. That way, you will be able access the Ministry’s guidance without having to wait for my COVID-19 report. Again, the link is here and you can check it every day.
Since this report will come out once weekly, that will provide a more timely access to Ministry guidance.
For a more detailed Ontario epidemiological summary from Public Health Ontario, you can always go here.
Here is a segment from the latest Situation Report #188 for 31 July:
Staying in touch
Please continue to keep in touch and share questions, comments and challenges. Send these to me at email@example.com and copy my executive assistant, Peta-Gay (PG) Batten <firstname.lastname@example.org>. Due to the volume of comments and questions, we are responding as fast as we can. 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. We want to send huge love and support to our colleagues and BPSOs in Latin America – they are still hit hard, striking the poorest communities. 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
PAST BLOG ITEMS:
24 July - Preparing for the second wave of COVID-19: What is the plan? – go here
17 July - RNAO launches new social media campaign #Maskathon – go here
17 July - RNAO calls on government to reunite families in LTC homes in Ontario – go here
10 July - Nurses’ mental health, leave of absence and return to work experiences – go here
10 July - RNAO continues to pursue family reunification in LTC – go here
10 July - Support Zimbabwean nurses arrested and fired for protesting deteriorating pay and working conditions during pandemic – go here
3 July - RNAO launches task force to tackle anti-Black racism within the nursing profession – go here
3 July - Rather than praise, let’s protect our nurses – go here
3 July - Nurses celebrated diversity during Pride month – go here
26 June - Nursing Home Basic Care Guarantee – go here
26 June - Masks for all – the policy imperative in Canada – go here
18 June - Annual General Meeting – an exhilarating week! – go here
12 June - Petition on masks for Canada – go here
12 June - LTC: RNAO releases list of 35 reports and recommendations dating back 20 years – go here
6 June - Statement – RNAO stands together with our Black sisters and brothers – go here
3 June - Adapting harm reduction during a pandemic – go here
29 May - Foot care nurses – go here
29 May - Update on pandemic pay; pandemic pay in consumption and treatment sites – go here
28 May - RNAO Calls for Immediate Action in Response to the Canadian Armed Forces’ LTC report – go here
26 May - Update on VIANurse – go here
26 May - Ending homelessness: Will you join us to build a COVID-19 recovery for all? – go here
24 May - Technology as a solution: Opportunities and pitfalls of COVID contact-tracing apps – go here
21 May - Debunking PPE myths with Dr. Jeff Powis: Which masks should health care workers wear during COVID-19? – go here
20 May - RNAO response to announcement of an independent commission into Ontario's long-term care system – go here
19 May - With the pandemic curve flattening, VIANurse program will focus its effort on outbreaks – go here
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.
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.
You can find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE.
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