Dear Colleagues: Welcome to our Friday, December 18 report – now in the eleventh month of COVID-19 in Ontario. Visit the COVID-19 Portal for the many resources RNAO offers on COVID-19. Find earlier update reports here, including thematic pieces in Doris’ COVID-19 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. 

RNAO continues to express grave concern regarding the worsening situation with the second wave of COVID-19 in Ontario

As discussed last week, RNAO continues to urge faster and stronger action than reflected in the current colour-coded COVID-19 Response Framework. RNAO is calling for a province-wide lockdown, or, at a minimum, following the Ontario Hospital Association recommendation to robustly enforce a four-week lockdown (grey zone) in every public health unit with an infection rate of 40/100,000 population or higher.

The expanded lockdown measures should be started immediately and not wait until December 25, which appears to be the plan of the Ontario government. Setting December 25 as the starting date is an invitation for exponential growth of community transmission until the measures come into effect.

The healthcare system is already under enormous pressure, and some sectors are collapsing, such as long-term care. Non-COVID interventions have been severely reduced or even stopped in many sectors, which will translate in increased morbidity and mortality as a result of cancer, cardiac illness, and other conditions. If the number of COVID-19 hospitalizations continues to increase, we will not be far from a situation where “ethical guidelines” will guide who receives treatment and who does not.

All this is preventable and unacceptable. We place full responsibility on the Ontario government if it does not engage immediate action to control the COVID-19 wave. 

RNAO calls again on the immediate implementation of stronger, additional restrictions over those currently established for the grey lockdown zone, as follows:

• Close all indoor malls and other non-essential indoor activities.
• Close big box stores for everything except essential products, with strict occupancy limits.
• Close religious services rites or ceremonies in indoor spaces, except for funeral services.
• There should be additional public health directives that effectively diminish non-essential movement both within and between regions, as the current grey-zone measures seem not to be working. The movement of essential workers and essential economic activity, other essential trips, and those of people who care for other people, should be allowed, but other movement should be discouraged. In particular, movement for purposes of shopping, except for basic needs, and socializing should be drastically reduced. 
• Continue to respect the current rule that "Individuals who live alone, including seniors, may consider having exclusive, close contact with another household to help reduce the negative impacts of social isolation."
• Engage measures to enforce the public health directives.

Health system leaders and government should engage in persuasive communication with the public. Rather than using the vaccine as a distraction from the current crisis, let’s use the vaccine as a tool to power aggressive action today. We should motivate all of us to join together in these last few months of battling COVID-19 – #TogetherWeCanDoIT –, to save lives and our healthcare system.

We know, from experience, that with the arrival of warmer weather in the spring, and the shift of activity to outdoor spaces, the pandemic wave will get better. We expect a massive rollout of vaccination during the spring and summer that will substantially improve our situation. Let’s keep working together and make sure that our parents, grandparents, and the many other individuals vulnerable to COVID-19 are all celebrating with us at that time.

Long-term care staffing plan welcomed, but lack of urgency and legislated action will continue to devastate residents, their loved ones, and staff for years to come

RNAO issued a media release on December 18 in response to the Ontario government’s announcement of its long-term care staffing plan, which we paste below:

RNAO welcomes the release of the government’s long-term care (LTC) staffing plan, entitled A Better Place to Live, A Better Place to Work. With COVID-19 raging through Ontario’s LTC homes, the plan could not have come soon enough. And while RNAO is pleased to see the government move on its budget commitment to ensure a daily average of four hours of direct care for each LTC resident, the minister’s staffing plan falls short on immediate action and specifics.

The government pledges to commit up to $1.9 billion to enhance staffing in the battled LTC sector, but its plan only offers an additional 15 minutes of direct care per resident on average before the next provincial election. The remaining care it promises will take an additional three years. It will come after the next election, and thus is questionable. “Without a legislated commitment to four worked hours of direct nursing and support care, delivered with the appropriate skill mix of RNs, RPNs and PSWs to enable safe and dignified care, as RNAO has repeatedly called for, the LTC staffing roadmap is nothing more than an election promise,” says RNAO CEO Dr. Doris Grinspun.

RNAO is pleased to see the plan recognizes the increasing complexity of the health-care needs of residents and calls for a larger focus on nursing within the LTC staffing skill mix. However, the association is disappointed that Minister Merrilee Fullerton shied away from committing to a clear skill mix of regulated nursing staff (RNs and RPNs) and unregulated staff (PSWs) to deliver safe care. It is exactly that increased complexity that drove RNAO to release its 2016 Mind The Safety Gap report, calling for four worked hours of care and a skill mix of 20 per cent RNs, 25 per cent RPNs and 55 per cent PSWs; as well as one (1) NP for every 120 residents.

RNAO’s call has continued and will continue. In June 2020, the association submitted to Minister Fullerton its Nursing Home Basic Care Guarantee (NHBCG), providing the government with a ready-made plan and evidence-based minimum standards for protecting Ontario’s vulnerable LTC residents. RNAO’s guarantee is for a staffing formula that provides no less than four worked hours of direct nursing and personal care per resident, per day. The formula also calls to ensure the proper skill mix by allocating a minimum of 48 minutes of RN care per resident, per day, 60 minutes of RPN care and 132 minutes of PSW care. Such an allocation would provide each resident with safe care and quality of life. RNAO estimates that the current skill mix in nursing homes averages about 18 minutes of RN care per resident, per day, 29 minutes of RPN care and 115 minutes of PSW care.

Exacerbating these already damaging staffing deficiencies is the reality that only a small number of nursing homes – about 60 out of 626 – have NPs. Most homes do without this critical advanced nursing role. RNAO will continue to call for one (1) NP for every 120 residents. The government report released yesterday makes no clear commitment – except for 15 NPs, which had been promised and committed by the previous Liberal government as part of a funded plan for 75 NP positions. Minister Fullerton’s report also leaves out action on the need for a dedicated Infection Prevention and Control (IPAC) nurse, another demand from RNAO given the devastating shortfalls of infection prevention and control experienced in recent months.    

“There has been, and remains, no excuse for delay in the implementation of a basic care guarantee for nursing home residents. The delay is causing preventable deaths of residents, anguish of loved ones, and creating post-traumatic stress disorder among administrators and health-care workers,” says Grinspun, adding that “the association will re-double its efforts to call for and to build a brighter future for those living and working in nursing homes across the province.”

RNAO is gravely concerned that the government’s staffing plan does not pursue immediate hiring of staff. And while the association fully supports the commitment to training, education and a clearer career path from PSW to RPN, and from RPN to RN, there is an urgent need to bolster staffing immediately. “Nursing homes and their staff have been battling for more than 10 months – and continue to battle – to protect and save the lives of LTC residents. To date, Ontario has lost 2,526 residents to COVID-19. Many have succumbed, in part, due to inadequate staffing. Residents, their loved ones and staff do not have the luxury of time to wait for the government’s four-year plan to unfold,” says RNAO President Morgan Hoffarth, adding that RNAO estimates a pool of more than 2,500 RNs are seeking nursing employment and ready to join the workforce.

The province has indicated that it will engage with residents and families to develop a quality framework based on what quality of life and quality of care means to them. “This is critically important in good times and over the long term. In the midst of this pandemic, however, our residents, their loved ones and front-line staff are urgently seeking to receive and provide basic care. RNAO insists that staffing increases, based on the right skill mix, must be in place immediately to protect the lives of nursing home residents. There is no time to waste. Lives depend on it,” Hoffarth urges.

Providing compassionate nursing care in an age of artificial intelligence

According to a recent Ipsos poll, more Canadians are envisioning a health-care system with health technologies powered by artificial intelligence such as predictive analytics and robotics. To shed light on virtual care delivery models in Canada, RNAO along with AMS Healthcare prepared a report and hosted a virtual pan-Canadian symposium on Oct. 21 to bring together nurses and other stakeholders to critically reflect and discuss this important topic. A digital flyer is here. The press release is next.

COVID-19 has accelerated access to virtual health care, and people from all walks of life are increasingly expecting their care to include different types of technologies powered by artificial intelligence (AI), such as predictive analytics and robotic devices. As this demand grows, a critical question emerges: How will nurses safeguard person-and family-centred compassionate care in this age of AI?

The Registered Nurses’ Association of Ontario (RNAO) and AMS Healthcare are answering that question with the release of a groundbreaking report that highlights the role of nurses in clinical environments enhanced by AI. The report, Nursing and Compassionate Care in the Age of Artificial Intelligence, is an urgent call for the nursing profession to engage in shaping this emerging future. It outlines trends in AI Health Technologies (AIHT), and how these trends can potentially transform the roles and functions of nurses in all domains of practice and all sectors. The report is being launched today, at a virtual symposium, alongside a call to action.

“Our report is a call for nurses to ensure the future brings together patients, nurses and AIHT in ethical and effective ways. Right now, some see the future of nursing and AIHT interface as threatening, while others are excited and want to play a role in shaping and preparing for it,” says RNAO CEO Dr. Doris Grinspun. “There is evidence that AIHTs can enhance care, particularly mental health care for the elderly. It has also been found to advance best practices by enhancing nurses’ ability to make informed decisions supported by high quality, real-time data and predictive analytics. And if nurses are involved, there is real potential to increase access to health services and advance health equity – rather than deepen inequities.”

There are several applications of AI predictive analytics already being used in nursing in Canada. For example, a few hospitals are using these technologies to reduce falls and fall-related injuries by alerting nurses, via mobile devices, of patients’ fall-risk scores, enabling them to intervene proactively. The implementation of relevant digital technologies can enhance the clinical and relational work of nurses, including person- and family-centred compassionate care.

“Offering compassionate, person- and family-centred nursing care while also using AIHTs requires strong, proactive nursing leaders at the ready, from the boardrooms of health care to the frontlines of clinical practice. Nurses must ensure that as new technologies expand and grow, compassionate care remains at the core of everyday nursing practice,” says AMS CEO Gail Paech.

Eight of the report’s 15 recommendations call for immediate action to:

1. Create forums for open dialogue between nurses and patients to raise awareness of the patient-nursing-AIHT interface; gain patients’ and nurses’ perspectives; and foster understanding of the roles and responsibilities of nursing in shaping effective, meaningful and ethical utilization of relevant AIHTs and timely outcome evaluation.
2. Explore the impact of AI on patients, families, caregivers and nurses and their perception of the delivery of person- and family-centred compassionate care augmented by AIHTs.
3. Identify evidence-based best practices to guide ethical implementation of appropriate AIHTs across the care continuum to enhance person-centred, compassionate nursing care.
4. Identify new care delivery models, responsibilities and competencies for nurses in all roles and sectors to support the interface between nursing science, person- and family-centred compassionate care and AI.
5. Conduct a thorough review and reform of nursing curricula to ensure congruency of the nursing role with present needs and future demands of emerging AIHTs.
6. Develop a strategic plan to build capacity for basic informatics skills and data/digital literacy in the existing and future nursing workforce.
7. Implement new and revised professional codes of ethics and standards of practice that articulate nurses’ responsibilities and accountabilities in relation to the use of AIHTs.
8. Prioritize rigorous, nurse-led interprofessional research to inform policies and procedures to support the co-design, development, implementation and evaluation of AIHTs in nursing.

Very little research has been done on how AIHTs might influence the nurse-patient relationship, specifically as it relates to compassionate nursing care. The release of this RNAO/AMS report is the first step in filling this knowledge gap. The next step is today’s virtual symposium, which brings together nurse clinicians, administrators, educators, researchers and policy makers to critically examine the report’s findings and recommendations and build an action plan.

“Nurses are encouraged to envision how technology can contribute rather than detract from humanistic caregiving by understanding AI and the possibilities that the convergence of nursing, technology and compassionate care offer,” says Tracie Risling, an associate professor at University of Saskatchewan and co-chair of the steering committee behind the report and symposium. “Nurses have always been at the leading edge of change, and with the growth of AI, it is vital that we proactively reconceptualize nursing in ways that continue to ensure compassionate care for patients.”

To read the full report, go here.

MOH EOC Situational Report

We are posting each day the Daily Situational Reports from Ontario's MOH EOC at RNAO’s website. That way, you can access the Ministry’s guidance at any time.

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 #327 for 18 December:

No updates for today.

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>. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you all 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 and we have to keep strong and focused! While the vaccine is hugely important, the immediate target is fighting the spread of the virus to preserve lives. To everyone and most especially our colleagues working in the front lines here at home and in countries around the world hit hard by evil COVID-19 – THANK YOU, and please know we stand by you!

As we have said before, the silver lining of COVID-19:  Coming together and working as one people – for the good of all!

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

RECENT BLOG ITEMS:

11 Dec - RNAO gravely concerned about the second pandemic wave – go here.

11 Dec - Health organizations plead for Ontarians to celebrate holiday season safely – go here.

4 Dec - Continuing the conversation: Mobilizing collective action for LTC reform – go here.

4 Dec - Nurses urge dedicated funding for infection prevention and control in LTC – go here.

27 Nov - RNAO, once again, plays major role in the media during November – go here.

27 Nov - COVID-19 in long-term care: A nurse’s witness statement – go here.

20 Nov - Government’s measures too late and insufficient; calling for a COVID-Zero strategy – go here.

13 Nov - Mobilizing collective action for long-term care reform in Canada – go here.

13 Nov - RNAO’s media conference to address the crisis in long-term care – go here.

6 Nov - Fall 2020 provincial budget once again leaves vulnerable populations to fend for themselves – go here.

6 Nov - Elections in the US: A path to healing and respect for science – go here.

30 Oct - 2S-LGBTQ+ Seniors: Our Existence is Our Resistance! – go here.

23 Oct - Responding to the second wave of COVID-19: RNAO continues to speak out – go here.

16 Oct - RNAO advocates for national long-term care standards in Canada – go here.

16 Oct - Reta’s Story  (a contribution of Judy Smith, Reta’s daughter-in-law) – go here.

9 Oct - RNAO relieved that Premier Ford engages late, but essential, action – go here.

9 Oct - Patient-centred-care – the dream and the reality – go here.

2 Oct - RNAO urges stricter measures to combat rapidly rising number of COVID-19 infections – go here.

25 Sept - Nurses say throne speech advances A Just Recovery for All – go here.

18 Sept - Is Your Hospital Using Blood Wisely? – go here.

18 Sept - RNAO calls to Delay Action on CNO Council Decision to Expand RPN Scope – go here.

11 Sept - International Overdose Awareness Day: Statement from RNAO – go here.

11 Sept - RNAO joins global movement: A Just Recovery for All – go here.

28 August - RNAO letter to Prime Minister Justin Trudeau regarding Speech from the Throne – go here.

21 August - Black August and an update on RNAO’s Anti-Black Nursing Task Force – go here.

21 August - Winter Surge Planning: How one Ontario Health Team is Preparing – go here.

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.

We have posted earlier ones in my blog here. I invite you to 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.

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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