Dear Colleagues: Welcome to our Tuesday, December 29, report – the last for this 2020 year – and one of over 150 reports I have sent out during the eleventh months of COVID-19 in Ontario. You can find earlier update reports here, including thematic pieces in Doris’ COVID-19 Blog. And, for the many resources RNAO offers on COVID-19, please visit the COVID-19 Portal where you will also find RNAO media hits and releases on the pandemic here. As always, feel free to share this report and links with anyone interested. Daily Situational Reports from Ontario's MOH EOC can be found here.

Best wishes for the holiday

The holiday season looks and feels a lot different this year than ones we have celebrated in the past. As 2020 – the Year of the Nurse – winds down, we want to thank each and every RN, NP, RPN and nursing student – for making nursing and Canadians proud!

We have all worked day and night during the COVID-19 pandemic nursing Ontarians in need, supporting nurses and nursing students, and/or engaging with government and other officials. Together we will continue to fight with every ounce of our strength and expertise this unrelenting virus – until we conquer it.

For our non-nursing colleagues, we want to thank you for working to protect the health and well-being of Ontarians. COVID-19 presented us with challenges that required all of our strength. The battle to suffocate this virus has tested us, but our resolve has strengthened to keep on fighting for a healthy society where every person, and their health and dignity, count.

For RNAO, a silver lining of 2020 has been the opportunity and the privilege to build on the relationships we had and to form new ones, working together with numerous stakeholders from all corners of society. Please know that it has been a true honour to work together!

Our tireless efforts have meant time away from family and loved ones. Many of us will be working through the holidays. Still, we ask that we all reflect on the sacrifices and the difference we have made in people’s lives, the province and the country.

I hope you have been able to take time – even if only for a few hours – to enjoy the season with those closest to you in your household.

Let’s continue to be safe and stay healthy.

#TogetherWeCanDoIt

Please listen to a holiday message from Minister of Health Christine Elliott Holiday here.

WE NEED YOUR HELP in addressing urgent staffing needs in health facilities

Several long-term care facilities and hospitals are facing urgent staffing needs due to outbreaks, staff in isolation and expanded needs through this second wave of COVID-19 in Ontario. The needs have exacerbated during the holiday season and they are not expected to diminish during the first few months of 2021.

RNAO reminds both employers and healthcare workers who have the ability to offer their availability at this urgent time of RNCareers, the largest employment website in Ontario for NPs, RNs, RPNs, PSWs and other health professionals. RNCareers is a 24x7 service.

The service is free for jobseekers and you may indicate in your posting your availability, location, full time or part time, and other details. We encourage health-care workers who are available to make yourselves available at this time of extreme need. All help is important – from those able to contribute a few hours a week during the next month to those seeking permanent full time work. If you are available, please do not delay posting your availability as many employers are in desperate need and hiring right through the holiday season.

Employers can get immediate access to postings from jobseekers, search the database according to your specific needs, and get notifications about new postings meeting your criteria. There are currently more than 11,000 open jobseekers.

It is up to jobseekers and employers to contact one the other when they have identified a potential match. All postings for both employers and jobseekers have contact information.

Jobseekers can access RNCareers here. Employers can access RNCareers here.

If you have questions, please write to Daniel Lau dlau@rnao.ca, copy to Doris Grinspun .

RNAO says Ontario government, taking belated and delayed action, is failing Ontarians as virus runs rampant and endangers lives and our health-care system

On Monday, December 21 RNAO put out the following media release responding to the Ontario government’s announcement of a provincewide shutdown starting on December 26:

The Registered Nurses’ Association of Ontario (RNAO) says the government is failing Ontarians at a crucial moment when COVID-19 runs rampant. Dramatic and immediate action is required. The government’s announcement of a province-wide lockdown comes very late and is further endangering lives and the health-care system by waiting until Dec. 26 to enact the measures.

While RNAO is pleased that the government is finally taking action, it is reckless that the measures are being delayed for several days. These measures should have been implemented weeks ago, when RNAO first called for a province-wide lockdown in November. That call was echoed by countless other organizations and independent experts. If the government had heeded the calls, the strictness of these new lockdown measures, and the length of time required, would have been substantially less.

RNAO is gravely concerned about persons sick and dying with COVID-19, and also about the countless Ontarians who are not getting appropriate access to other diagnostics, treatment and surgery. This will translate into increased morbidity and mortality across a wide spectrum of illnesses and conditions. Why has Premier Doug Ford allowed this situation to deteriorate to the extreme that Ontarians, at this time, cannot be assured the health-care system will be there for them when they need it most? The cost of inaction is also measured in the impact on health-care providers, working on the frontlines, as it places them in conditions that are unsustainable and traumatizing.

On a day when the province recorded 2,123 new cases of the virus – the seventh consecutive day of numbers above the 2,000 threshold – RNAO CEO Dr. Doris Grinspun says: “Saving people’s lives must be paramount. Saving one life is more important than shopping.” She adds: “Every day we delay action is a day too late for those who will fall ill and those who will die. And every day is one more day that health workers, desperate for action, are exhausted and hurt.”

In today’s announcement, the government contradicted itself by calling on Ontarians to stay home while allowing Christmas shopping and socializing to go on. Even after the new measures take effect on Dec. 26, they fail to restrict discount and big box retailers from selling non-essential goods. These retailers can continue to offer indoor shopping while small businesses have been shut for indoor shopping. The new measures also wrongly allow indoor religious services and indoor liquor sales to continue.

RNAO is pleased the government’s announcement includes an exception for people who live alone to visit with another household. “This is so important for people’s mental health, for companionship and well-being,” Grinspun says. 

RNAO is painfully aware of the suffering and extreme hardship the lockdown imposes on vulnerable people and small businesses, and that’s why our approach has consistently been that the virus should be controlled at very low levels to avoid extreme measures such as a lockdown. Unfortunately, that opportunity to engage measures to control exponential growth was missed earlier in the fall. We welcome the news that the government is providing $12.5 million to implement a High Priority Communities Strategy to contain the virus in high-risk communities, and urge that much more be done to address the structural inequalities these communities face. We welcome as well the support to establish isolation centres where needed, and commend the new small business support grant that will help struggling small businesses. We urge the government to also include a renewed moratorium on evictions.

Some of the discourse of the Ontario government while releasing the new measures is troublesome, as it once again politicizes the pandemic and thus undermines trust in government that is essential in this time of crisis. Sadly, Premier Ford appeared intent today on blaming the federal government for issues such as the handling of airports, when the reality is that widespread community transmission of the virus is rampant, not transmission through incoming travelers. RNAO calls on the premier – in the strongest possible terms – to stop politicizing vaccines, as every level of government is doing an outstanding job handling this issue in a collaborative manner. While RNAO is excited about the arrival of vaccines, they will not protect us from this virus until mid to late-2021. The urgent task at hand now is to get a grip on an uncontrolled virus.   

RNAO President Morgan Hoffarth says every Ontario resident also has a responsibility to help control the virus. Every one of us must be willing to make sacrifices to protect our families, friends and neighbours, especially vulnerable populations such as residents in long-term homes, those living in other congregate settings, and in racialized and marginalized communities. “It is up to all of us to do our part and obey the advice of public health officials. We can limit the spread if we heed the plea to stay home, limit our contacts with only those in our households, wash our hands, physical distance when we are outside, and wear a mask. If we do not, we will overwhelm our health system, which is already being stretched to its maximum, not to mention nurses and other health professionals who are working flat out to care for people who depend on it.”

Public Health Nurses in Schools

Schools have closed their doors for the holidays following the remarkable experience of having come back to classes in September while doing their best to protect children and staff from a pandemic. Public health nurses have played a central role and the following article provides insight into their contribution. I am grateful to Heather Lokko, RN MPH CCHN(C) (Chief Nursing Officer & Healthy Start Director, Middlesex-London Health Unit, and OPHNL Chief Nursing Officer Network Liaison), Irmajean Bajnok, RN MScN PhD FCAN (Senior Policy Analyst, RNAO), and David Groulx, RN, BScN, MPH, CCHN(C) (President OPHNL, and Manager, Professional Practice and School Health, Public Health Sudbury & Districts) who authored the article.

In the summer of 2020, as the first wave of the COVID-19 pandemic was subsiding, the government of Ontario made the decision to begin planning for children to return to school following a six-month closure, citing the advice of child care and health experts, teachers and parents. While the decision to reopen schools was widely supported, the proposed protective measures announced for teachers and students were met with concern and pleas to do more. 

One of the highly praised supports for schools – announced by the Ontario government on July 30, 2020 – was the allocation of $50 million to hire 500 school-focused nurses to join colleagues across the province to keep students and staff safe during the pandemic. This funding was subsequently increased by the federal government to facilitate the hiring of an additional 125 nurses, bringing the total to 625.

This announcement was lauded as critical and very helpful to students, school administrators and educators, and families. The government decision to look to public health and to registered nurses (RN) to provide education, support and protection in schools is based on the strong track record of successful contributions of Public Health Nurses (PHNs) in Ontario schools, and the strong advocacy of the Registered Nurses’ Association of Ontario (RNAO) and the Ontario Association of Public Health Nursing Leaders (OPHNL). Amidst the ongoing negotiations for stricter protocols, smaller class sizes, and safety precautions in schools, RNAO and OPHNL collaborated to shape the parameters of the school nurse program that would ensure success.

The two organizations met to develop a strategy for advancing this initiative as rapidly as possible. A number of critical elements were on the table, including discussions about the best approach to advocacy. Each organization prepared its own letter (OPHNL letter and RNAO letter) outlining key recommendations related to: 1) the hiring of school nurses at the public health unit (PHU) level; 2) the role of PHNs being focused on COVID-19 in addition to broader school health, as well as the expectation for nurse qualifications to align with the requirements for PHNs in Ontario (i.e. nursing baccalaureate prepared); and 3) the immediate hiring to coincide with the early days of school reopening, recognizing the time required for onboarding and orientation. Each organization also used other opportunities, such as personal contact with government decision-makers, the web and social media to continue to reinforce recommendations related to these critical elements of the initiative. 

The ministry of health established a plan for the allocation of school-focused PHNs based on the number of schools and school enrollment data provided by the ministry of education. RNAO and OPHNL recognize the benefit of funding the school-focused PHNs as an additional resource for all PHUs, and spoke about the need to ensure these positions extend at least two years, with strong consideration for these PHNs to become a permanent resource.      

Thanks to this joint effort, and the commitment of the ministries of health and education to the safe reopening of schools, the PHNs in schools initiative was formalized, and all of the issues advocated for by both groups were addressed. While RNAO was delighted with the decision to hire 625 nurses to help in schools, there was still considerable concern about safety issues regarding class size, mandatory masks and school ventilation. 

In addition to supporting PHUs by providing a role description, job posting and interview question database, the OPHNL Chief Nursing Officers Network recognized the opportunity to develop a provincial orientation program to prepare new hires for their role in the school nurse program. Such preparation had to reflect a COVID-19 context, with children and families re-experiencing school again after a six-month closure.

To ensure rapid development of an orientation that was as comprehensive as possible, OPHNL established an Orientation Curriculum Task Force, which included representation from RNAO, the Public Health Chief Nursing Officers Network, the Association of Ontario Public Health Nurse Leaders, the Public Health School Health Manager's Network, and a consultant from Public Health Ontario. This 12-member group worked tirelessly over a three-week period to establish a fully online orientation resource for school health nurses, ready when hiring began.

The orientation resource includes a Program Overview, along with five modules: Intro to Public Health; Comprehensive School Health; COVID-19 and Infection Prevention and Control;  Social Determinants of Health (SDOH) and Health Equity; and Child and Adolescent Health. Each module presents learner outcomes, reflective questions specific to the module, key online resources for learning (categorized as priority, essential and additional), and an evaluation. There is an overall program evaluation at the conclusion.    

In late August and early September 2020, PHUs began hiring RNs into the public health school nurse positions through large-scale recruitment efforts that focused on those with PHN experience. Since then, a total of 625 school-focused RNs have been hired across the province.

The orientation program was accessed online by those new to the school PHN position and those new to public health. Experienced school nurses primarily accessed the COVID-19 module. Based on evaluations to date, the orientation program has been extremely well-received, with the overwhelming majority of nurses finding its learner objectives, online content and reflective questions “very informative and useful.” Many expressed their “great appreciation” to have such a critical set of resources readily available in one place. Members of OPHNL’s Orientation Curriculum Task Force will be reviewing the feedback and revising the curriculum to reflect the views of all users. 

Following orientation and onboarding, the new hires rapidly began engaging with school communities to support the safe reopening of schools. These PHNs are currently supporting schools in the development and implementation of COVID-19 prevention, health and safety plans. They have completed tens of thousands of consultations with schools, school boards and parents. They are conducting infection prevention and control (IPAC) assessments and practices, and other assessments. They have developed many resources and decision-making tools, and are providing educational presentations that help school communities understand and apply COVID-19 guidelines. They are actively connecting school communities to health and other community partners, and are working to identify and mitigate health inequities. Within their role, PHNs are facilitating rapid response to COVID-19 cases in schools, and engaging in case, contact and outbreak management. Depending on the local context, this support to school communities is being provided by telephone, virtual platforms, email and in-person.

The COVID-19 pandemic is a new experience for everyone, and there has been much learning. PHNs are finding it very rewarding to support school communities throughout this unique time, working to prevent COVID-19 cases and outbreaks, and mitigating impacts if they occur. 

School PHNs do not focus on addressing illness in individuals. Instead, they utilize a ‘healthy schools’ approach to address health issues that are broad, impact the school population, and promote health and prevent disease and injury within the school community. School PHNs also work to address structural inequities and implement targeted programs and services that aim to mitigate the negative impacts, and leverage the positive impacts, of the social determinants of health.

In spite of the additional 625 nurses working in schools, the intensity of demands related to COVID-19 has made it nearly impossible for PHNs to engage in their usual comprehensive school health work to address critical health and wellness challenges. The inability to focus on school health more broadly has been a challenge for PHNs.

The ministry of health has surveyed all PHUs to gather some initial, early evaluation data on this initiative. Data are currently being analyzed and results will be shared when available.

From the perspective of RNAO and OPHNL, the initiative has been a successful one. From the advocacy that initiated it, through to its implementation and PHU-based delivery, it has provided invaluable support to schools across the province. The recommendations to government for this initiative were clear and consistent from the start. RNAO and OPHNL used a collective approach in terms of the specific advocacy work related to the initiative. And as the program successfully progresses, both organizations will continue their collaboration to advocate for safe schools, and to ensure new hires in the PHN role have ongoing access to a robust orientation program that provides timely, evidence-based information.

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.

The Ministry of Health has informed that there will be no Situation Report on December 25, 26, 27 & 28. Here is a segment from the Situation Report #333 for 24 December:

Update: Please see attached update and communication from General (retired) Rick Hillier on vaccines (here and here and 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>. 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:

18 Dec - Providing compassionate nursing care in an age of artificial intelligence – go here.

18 Dec - RNAO continues to express grave concern regarding the second wave – go here.

18 Dec - Long-term care staffing plan lacks urgency and legislated action – go here.

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.

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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