Dear Colleagues: Welcome to our Friday, August 21 report – now in the seventh month of COVID-19 in Ontario. Visit the COVID-19 Portal for the many resources RNAO offers on COVID-19. Find earlier updates 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 and links with anyone interested.

Reminder to take action regarding Nursing Homes before it’s too late! Add your name to over 8,000 who have written to Premier Ford demanding the Nursing Home Basic Care Guarantee and to begin hiring staff in August! So far all we hear is about layoffs in LTC and that is shocking!

RNAO remains concerned about the reopening schools in Ontario, and calls on the Ontario government to follow the evidence and mandate the physical distance, proper ventilation, and masking for all school children that will keep them, their families and our communities safe. See our letter to Dr. David Williams, Ontario's Chief Medical Officer of Health, detailing RNAO’s concerns and recommendations. RNAO welcomes the addition of 500 school-focused public health nurses (PHN). Please add your voice urgently: retweet.

RNAO is supporting the success of Ontario Health Teams (OHT) by offering a new Best Practice Spotlight Organization (BPSO) model called BPSO OHT. We are very proud of working with several OHT and today we want to profile the outstanding work of the East Toronto Health Partners OHT (ETHP). We thank our ETHP partners for writing the submission below that updates on their excellent community work to prepare for this year’s Winter Surge, which is likely to include new waves of COVID-19. We know other organizations, including other OHTs, can benefit from their planning. When I joined their meeting earlier this week, I was tremendously impressed with their comprehensive focus on vulnerable populations and community care.   

Winter Surge Planning: How one Ontario Health Team is Preparing for the Winter Influenza Season and a Potential Second Wave of COVID-19

Each year in the winter months, hospitals and other health and social services feel the pressure of increased demand due to influenza and other seasonal ailments such as falls and seasonal affective disorder, a phenomenon called the Winter Seasonal Surge Season, fondly termed “Winter Surge”. This year, the seasonal strain on our health care system is expected to be compounded by a second wave of COVID-19 cases, so it is even more imperative to develop effective approaches to address Winter Surge.

Health and social services organizations in East Toronto have a long history of working together to address their community’s needs and improve health care for the 300,000 residents living in the community. It is no surprise, therefore, that when planning for Winter Seasonal Surge, the ETHP look towards its engaged partners to help with planning. The strong relationships built on years of collaboration primed these organizations to become one of the province’s first Ontario Health Teams (OHT) in December 2019. The East Toronto Health Partners (ETHP) draws its success from broad involvement with its community and over 50 engaged partners.

This is the third consecutive year the ETHP have collaboratively planned initiatives to address Winter Surge, and dedicated a large portion of Winter Seasonal Surge funding to community-led initiatives. This collaborative effort recognizes that influenza (and also COVID-19 this year) does not just impact hospital capacity, but impacts the capacity of all health, mental health, and social services organizations across our community. This past week, the ETHP held a Winter Surge planning workshop with over 50 engaged partners. The aim of this workshop was to determine how organizations across the East Toronto community could come together to address the pressures related to seasonal surges in volumes. The proposed community-based initiatives tackle this aim using five different strategies:

1.          Improve Wellness and Divert from Hospital

2.          Reduce Time in the Emergency Department

3.          Help Patients Transition Home More Efficiently

4.          Address Community Health Capacity

5.          Mitigate COVID-19 Impacts

Additionally, the ETHP are making sure that the proposed initiatives consider the Year 1 priority populations identified by the ETHP OHT:

1.          Seniors and Chronic Disease

2.          Substance Use and Health

3.          Youth Mental Health and Wellness

4.          Neighbourhood Improvement Areas

In total, the ETHP will be allocating $1.1M of funding towards 14 projects, and continuing on 4 projects that are now-self funded from last year. These projects will help address surge pressures in a number of different ways. For example, in one project, VHA Home Health Care and WoodGreen Community Services have banded together with Toronto Community Housing to deliver a mobile flu clinic. This clinic will proactively deliver flu shots in seniors buildings particularly for those who are homebound, have mobility issues that limit their ability to get the flu shot in the community, cognitive challenges or mental health and substance use issues. The East Toronto CHC Network also hopes to address access to the flu shot by providing outreach to shelters, retirement homes and other local community agencies. By working with the engaged partners, the ETHP are able to further identify priority target locations for these flu outreach initiatives.

Beyond flu initiatives, the ETHP are working to improve access to short-term transitional counselling for mental health patients through the SCOPE program. Enrolled family practices will have rapid access to urgent psychotherapy, counselling, and connection to longer-term supports. A final example of the ETHP surge initiatives is the work they are doing to provide enhanced psychogeriatric support to their patients to help facilitate discharges from ED or acute care and to reduce unnecessary visits to hospital or returns to hospital.

The ETHP Community Surge planning is a prime example of the importance of collaboratively designing coordinated approaches to solving an issue that affects us all. Together, rather than siloed across sectors, the ETHP will improve care efficiency, outcomes and experience for the residents of East Toronto.

Check here for a Powerpoint presentation of this plan.

RNAO launched in June its Anti-Black Nursing Task Force, currently co-chaired by Immediate Past President Dr. Angela Cooper Brathwaite and NP member Corsita Garraway. In the following article they update on the origins and plans for the Task Force.

Black lives still, and always will, matter – Black August and an update on RNAO’s Anti-Black Nursing Task Force

Many Canadians and people around the globe on an annual basis observe Black History Month in February. It’s a time to recognize and acknowledge the substantial achievements, contributions and experiences of people of African ancestry. Lesser known (yet no less important) is Black August, a month to reflect and learn about the legacies of Black revolutionaries and honour the lives of those who were killed or imprisoned for simply defending their freedoms. Originating in California’s prisons in the 1970’s after the deaths of brothers Jonathan and George Jackson, 50 years later, we still are witnessing the violent and brutal murders of innocent Black lives around the world. Eight years after the death of 17-year-old Trayvon Martin, which sparked the #BlackLivesMatter movement, we are witnessing a horrifically unjust system of racial inequity.

Early in June, RNAO released a statement in response to a wave of atrocities in the United States, Canada and around the world, unequivocally condemning racism, oppression and discrimination in all forms. RNAO stands in solidarity with the loved ones of those who have suffered at the hands of law enforcement and those who experience gross inequities because of the colour of their skin.

RNAO reinforces its position that no sector is immune to the ingrained effects of systemic racism — including health care. Nursing has a history of excluding women of colour, who could not enter nursing school in Canada until the 1940s. The struggle to achieve equal access for women of colour to professional development, training, promotions and leadership roles remains unfinished. RNAO released its Organizational Statement on Diversity and Inclusivity in the spring of 2007. It commits to “…providing an environment that is free from racism, prejudice, discrimination and harassment. We strive to reflect the diverse communities within our organizational structure (board, staff members and students) and to promote equitable access to the programs and services we offer.” However, similar to society at large, much more work has yet to be done.

RNAO launched the Black Nurses Task Force to tackle anti-Black racism within the profession — its organizations, regulatory body, associations and the broader health system — targeted towards and experienced by Black Nurses. The task force, launched in June, began with an expression of interest request extended to all members of the association. Seeking to secure broad and equitable representation of diverse nursing career stages, roles, health sectors, geographic locations, organizations/institutions, and lived experience, the co-chairs selected 15 Black-identified RNAO members – RNs, NPs and nursing students. The task force has had two meetings of energized conversations to get to know one another and develop the plan, which will culminate with a report and action plan. The group is committed to a transparent process of reporting back and consultation via monthly, open webinars. 

A webinar series “Let’s Talk about Anti-Black Racism and Discrimination in Nursing” is one of the many activities being led by the task force. It follows the significant interest and engagement generated from the first June 15th webinar, “Let’s Talk about Racism.” On July 20, it focused on Introducing RNAO’s Black Nurses Task and sharing of personal experiences. On August 17, it focused on Understanding Anti-Black Racism in the Education System: From Preschool to Graduate School. Both events were attended by hundreds of nurses and members of the public. Access to the presentation slides for all three webinars is available here. The fourth installment in the series will be on Sept. 21. More information and registration is available here.

As professionals bound by moral and ethical obligations, nurses must denounce oppression and discrimination in all its forms. Nurses can be, and are, important allies for survivors of anti-Black racism, underserviced and vulnerable populations in the fight for social justice. We implore all RNAO members and the public to join the #BlackLivesMatter movement and observe #BlackAugust as we courageously pursue the freedom, justice and equal opportunities for Black people – including nurses – at home and around the world.

RNAO update: Information about past webinars and the upcoming one on Monday, 21 September, including registration links, can be found here.

Update on Health System Transformation & COVID-19 webinars

On Monday, September 14, 6:45 - 8:00 pm, our upcoming webinar will be on: What kind of mindset and action is needed now?

Community-anchored care is one reason why some regions of the world have fared better that others in their COVID-19 response. Come hear about successes from places like Cuba and the Balearic Islands (Spain) and discuss how these lessons apply to Ontario Health System transformation.

Ontario is at a crossroads. We can slip back into a hospital dominated model of care or re-calibrate the system to focus on prevention, health promotion and surveillance in primary care, and a robust home care system that doesn't leave long-term care behind.

Come talk about the vision, mindset and action needed now for real health system transformation.

Registration and details are here.

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On Tuesday, 15 September, 7:00-8:30 pm, we present a webinar on Approaches to Mental Health and Substance use for Health-Care Providers Supporting Indigenous People and Communities During COVID-19. This webinar is in partnership with Siouz Lookout First Nations Health Authority (SLFNHA), Chiefs of Ontario (COO), Nishnawbe Aski Nation (NAN) and Indigenous Services Canada (ISC). During this presentation, participants will learn:

• an overview of mental health and substance use issues in Indigenous communities
• the impact of COVID-19 on these issues
• withdrawal management tools and resources
• prevention and management of opioid overdoses

Audience: registered nurses, nurse practitioners, registered practical nurses and nursing students across care settings, primary care providers, public health and health promotion professionals, allied health-care providers and policy-makers.

Note: Webinar will focus on nurses and health-care providers supporting First Nations communities and organizations; however, all are welcome to attend.

Presenters:

• Mae Katt, NP, Thunder Bay
• Dr. Sharon Cirone,  Sioux Lookout First Nations Health Authority
• Dr. Lindsay Hancock, Sioux Lookout First Nations Health Authority

Registration and updates are here.

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Info on recent webinars:

• On August 10 we focused 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. We heard about the Healthy Professional Worker Partnership that aims to identify interventions to better support nurses’ mental health and facilitate healthy return to work. An article presenting the issues is here. The guest speakers were Abby Ayoub (University of Ottawa), Melanie Lavoie-Tremblay (McGill University) and Ivy Bourgeault (University of Ottawa). You can watch the video and see the presentations slides here.

• On July 6 we focused on Reuniting families and residents in LTC: What will it take? We heard from a panel as they discussed this critical and timely topic and heard about related updates from RNAO, including ECCO 3.0, Bill 175 and the Nursing Home Basic Care Guarantee. You can watch the video and see the presentations slides here.
• On July 1, we hosted Dr. Jennifer Kwan, a family physician and one of the organizers of #Masks4Canada. She spoke about what we need to do to have a successful re-opening of the economy, and the role that COVID-19 surveillance, good data and masking have in achieving that. You can watch it here.
• On June 22 we discussed the Impacts of COVID-19 on Indigenous Communities with three guest speakers: Ontario Regional Chief RoseAnne Archibald; Mae Katt, Nurse Practitioner with Temagami First Nation; and Marilee A. Nowgesic, CEO of the Canadian Indigenous Nurses Association. You can watch it here.

#Togetherwecandoit

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 to 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 #209 for 21 August: 

Action taken:

• The guidance document on COVID-19 Advice for Religious Services, Rites or Ceremonies has been updated and is attached here and here.

Staying in touch          

Please continue to keep in touch and share questions, comments and challenges. Send these to me at dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten <pgbatten@rnao.ca>. 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 to each and all of you for being there for our communities – everywhere and in all roles! Together, in solidarity, we are stronger and more resilient. These continue to be tough times for many colleagues – especially those working in the front lines in India, Brazil, Peru, Chile, Colombia, Mexico, the US, Russia, South Africa, Iran, UK  and other places that are still hit hard by evil COVID-19!

Remember, during 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

PAST BLOG ITEMS:

14 August - Insights from Cuba: Primary care as the focus of COVID-19 prevention – go here.

7 August - School reopening: Ontario government can still do the right thing on class sizes – go here.

31 July - Preparing for the second wave of COVID-19: Discussion – go here.

31 July - Important announcement regarding the VIANurse program – go here.

31 July - Government must immediately mandate hiring to avert second tragedy in LTC – go here.

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.

12 May – Enhancing Community Care for Ontarians (ECCO 3.0) – 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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