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Registered Nurses' Association of Ontario      

Dear Colleagues: Welcome to our Saturday, January 30 report during this twelfth month 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.

It’s been one year of this COVID report…! On January 27, 2020, I sent my first report, saying “RNAO is working hard to monitor the latest on the Novel Coronavirus (2019-nCoV) and will keep you informed as new updates come in. Today, Ontario health officials confirmed its second “presumptive” case of 2019-nCoV in Toronto, Canada… RNAO is fully engaged with… developments related to 2019-nCoV and is participating in daily ministry calls to support all efforts to deal with the virus as well as ensure nurses and nursing students are kept up to date… As always, nurses are unwavering in their commitment and expertise to serve the public. We also know that we must protect health-care professionals so you can care for the public.”

 

Fast-forward a year, and…. we still have months to go, and perhaps even longer. The key factors that will greatly influence the days, weeks, months and perhaps years ahead depend mainly on two priorities. The first is how strongly the Ontario government implements policies aimed at controlling the virus. The second is how fast and effectively vaccination rollouts happen in Ontario, Canada and globally. As RNAO has repeatedly urged, we must keep our eyes on what happens beyond Canada’s borders, as it is the only way to keep down the spread and mutations from happening. The media and the public seem to be blind to what happens in countries such as Brazil, Mexico, South Africa, India and others where the virus is spreading rampant, and where mutations take foot. This affects us all, and it takes only one day for a virus to travel with an asymptomatic passenger. While most mutations may be concerning but may not stop us from progressing to a better future, it is only a question of time until mutations start to weaken the effectiveness of our vaccines. That’s why we must care about the global rollout of vaccinations, as stopping the spread of the virus everywhere will protect all anywhere. To gain deeper understanding of this challenging topic, I recommend you follow Dr. Ashish K. Jha whose tweeter thread explains the go forward simply and sharply here.

 

RNAO statement on the passing of Stefanie Van Nguyen, RN

RNAO grieves the loss of Stefanie Van Nguyen, a young RN committed to the nursing profession, her family, friends and her partner Jason Parreno. Stefanie left us way too soon. RNAO hopes that Stefanie’s kindness, selflessness and giving nature are remembered forever and serve as a lesson for others to help brighten the world. As Jason mentioned to RNAO’s CEO Doris Grinspun, “the world is a darker place without her.” Mr. Parreno has organized a fundraiser on GoFundMe to support Stephanie’s parents. We encourage our members and readers to donate.

 

CAMH has a page with links to suicide prevention help.

 

Two nursing colleagues from the Midland area struck by tragedy

RNAO also offers its deepest condolences to RNAO member NP Sarah Bremner and her son Brandon – who lost their husband and father Jereld Bremner, and their son and brother Donny Bremner – due to a tragic snowmobiling accident. CEO Doris Grinspun spoke with Sarah to express our collective sorrow on behalf of RNAO members and staff, as well as to let Sarah know that the association is there for her and the family at this most difficult time. We encourage our members to support Sarah and son Brandon through the GoFundMe page, set up by a friend of the family.

RNAO also extends heartfelt sympathies to RPN Brie Cudahy who lost her husband Bill Fournier in a tragic snowmobiling accident. In addition to his life partner, Brie, Mr. Fournier leaves behind six young children. We encourage our members to support Brie and her children through the GoFundMe page, set up by a relative of the family.

 

Join the conversation – an open virtual forum for nurses to share how they are feeling during COVID-19

Wednesday, Feb. 3, 2:30-3:30 pm ET

RNAO is aware nurses across this province – especially those working on the frontlines of COVID-19 – are experiencing tremendous levels of physical and emotional stress and burnout. We know this can affect your mental health and well-being at this challenging time and that you may have less time to devote to your own self care.

This is why RNAO is organizing an open forum on Wednesday, Feb. 3 from 2:30-3:30 p.m. ET.

All RNs, NPs, RPNs and nursing students – in all roles and sectors – are invited to take part. You may wish to share how things are going for you, if you feel comfortable doing so. Or, you can simply join and listen in. Either way, you are welcome to our open forum.

Register online.

 

Please complete this 15 minute survey from RNAO on work and wellbeing

We are nearly a year into a pandemic of historic consequence for people's health, and nurses are being deeply impacted. As always, RNAO is eager to support the nursing community individually and collectively to ensure the mental and physical well-being of our members and health providers in general.

Through this survey initiated by RNAO, we would like to learn additional ways we can support nurses and nursing students and advocate on your behalf during this trying period. We also want to hear from you about whether and how this pandemic has changed your health, your work, your attitude to your work and your future in nursing.

Your participation is important so that we can translate your experiences into learnings that will guide nursing and health policy now and for years to come. We very much appreciate you taking the time to share your experiences and thoughts.

If you feel you are in crisis, please see a list of helplines at the bottom of the survey. If you are experiencing a mental health emergency, please call 911.

RNAO urges all Ontario’s RNs, NPs and BScN students to complete the survey. Membership in RNAO is not required.

To respond to the survey, please go here.

 

POLICY UPDATES FOR ALL TO ACT ON & MUST JOIN EVENTS OPEN TO ALL

 

The PrOTCT plan for nurses: A guide to counseling vaccine hesitant patients & colleagues

As health providers, vaccine hesitancy among co-workers, clients and patients poses a significant challenge and requires informed and effective communication approaches. We are grateful to Stephanie Elliott BSc(hon), Noah Ivers MD and Cora Constantinescu MD, FRCPC for contributing the following article presenting evidence-based communication tools. We are also pleased that Dr. Constantinescu will conduct a webinar for RNAO, open to all health professionals, on vaccine hesitancy (see details below).


As healthcare systems and the heroic workers that keep them going struggle in the face of COVID-19, we look forward to the brighter future that may be achieved through vaccination programs. Unfortunately, COVID-19 vaccine hesitancy poses a significant threat to our promise of return to a ‘normal’ life.

Current levels of vaccine hesitancy pose a challenge to achieving herd immunity to COVID-19, but it is important to note that vaccine acceptance is increasing, indicating that Canadians are both open to evidence and increasingly worried about the ramifications of the ongoing pandemic. Nurses across specialties are uniquely situated to address vaccine hesitancy with their patients and colleagues. Compared to other healthcare workers, they have substantial opportunities to interact and converse with patients at the bedside, and have special skills in making scientific information digestible for a variety of audiences. Not surprisingly, nurses are consistently ranked as highly trustworthy sources of information. With the prevalence of misinformation, and the politicization of vaccines and the COVID-19 pandemic, leveraging this privileged position to speak effectively with patients about their vaccine hesitancy is critical.

Interestingly, it’s not just patients that nurses are well situated to discuss vaccine hesitancy with. Rates of vaccine hesitancy amongst healthcare workers mirror that of hesitancy in the general population. Vaccinating healthcare workers is a vital strategy to keeping our healthcare workforce strong and healthy, to protecting patients and to influencing the public through leading by example. Nurses are in the position to influence other nurses as well as the allied health professionals that support them in the workplace.

Vaccine uptake increases when trusted healthcare professionals recommend vaccines. To empower nurses to have an effective COVID-19 vaccine conversation with their patients and colleagues, we propose the PrOTCT plan, an evidence-based communication tool.

Pr: Proactively engage your patients or colleagues in Presumptive conversations. Research shows that presumptive statements that convey confidence are more persuasive. Additionally, some patients perceive more passive language around vaccines to imply that the provider is in agreement with their concerns and supports their decision to refuse vaccinations.

Example: “This vaccine will prevent you from becoming severely ill with COVID-19” or “I have taken this vaccine and I want to help you get it too: the sooner we all get this vaccine, the sooner we will be able to be with our friends and family again.”

O: Offer to share your knowledge and experiences with getting the vaccine to your patients and colleagues.

Example: “It sounds like you’re feeling really nervous about side effects. Can I share with you what I experienced when I got the vaccine?” “I’ve been doing a lot of reading about mRNA vaccines. Can I share with you what I think is so cool about them?”

T: Tailor the conversations to their specific health concerns and/or their role as a nurse. Research demonstrates that linking health behaviors to one’s identity establishes a sense of responsibility and improves adaptation of proposed behaviors.

Example for patient: “I know you’ve been working really hard on stabilizing your blood sugars, and getting your diabetes under control, but we do know that your diabetes puts you at high risk of getting really sick with COVID-19.” Or “One of the sneaky things that COVID does is that it targets blood vessels. Your high blood pressure could put you at an even higher risk of getting sick or dying from COVID, so let’s get you protected.”

Example for fellow nurses: “As nurses we’ve been putting ourselves at risk to help our patients since the beginning of this pandemic. It’s been really hard. Finally, we can protect ourselves, our families, and our patients by getting this vaccine.”

C: Address specific Concerns. Establish empathy and understanding by repeating back what the concerns are and address them to the best of your ability. Understand that concerns may be rooted in historic or personal trauma, personal experiences, or a reflection of a broader worldview that they inhabit, rather than simple misinformation. Address their concern specifically and explicitly, but do not linger on the concern, pivot towards positive and conclusive information.

Example: “It sounds like you’re really worried that this vaccine was approved too fast and feel that we don’t know that it’s safe. I can definitely see why you would be worried about that. The really interesting thing is that they’ve actually been working on this technology for a while and have used it to develop vaccines for Zika and Rabies. They didn’t cut corners with the clinical trials either. They just ran different stages of the trials at the same time. Actually, these vaccine trials have had many more participants than is typical for vaccine trials. It’s amazing what scientists can do when they all work together on a common problem!”

T: Talk about a plan for getting them the vaccine. Making plans increases self-efficacy and the likelihood that someone will enact a health behavior.

Example for patient: “It looks like you’re in group [regional grouping category] which is expected to start [date], your next appointment with us is [date] and we’ll have the vaccine clinic up and running by then. I’ll put a note in the chart to remind you to go down after you see us to get your first shot!”

Example for colleague: “How about after our shift we walk down to the vaccine clinic and get your shot and I’ll buy you a cup of coffee and a donut after!”

Research consistently shows that people respond better to personal stories and anecdotes than data and it’s better to personalize the information rather than to put too much emphasis on facts and statistics when trying to address misinformation. It’s also best to stay away from political discussions. For example, if a patient explains their hesitancy or refusal with a conspiracy theory, you can respond “I have not come across that before, but in my roles as a nurse I have seen what this illness can do to people and I don’t want that for you or for me, so I’m happy to roll up my sleeve for this vaccine.” Avoid labeling the patient as a conspiracy theorist or accuse them of being ill-informed or brainwashed, rather, try to convey your care for them and your hopes for the future. 

The Canadian Nurses Association Code of Ethics for Registered Nurses places Canadian nurses’ ethical responsibilities both within the immediate sphere of nursing practice, and also within the broader societal context in which patients live. Nurses impact their patients directly, but also the world around them and now can play a pivotal role in shifting hesitancy to vaccine acceptance. Values B (promoting health and wellbeing) and D (honoring dignity) of the code of ethics particularly exemplify the way that nurses can embody ethical practice by using the PrOTCT plan to promote COVID-19 vaccination with patients and colleagues. The emphasis on human connection and identity allow the nurse to honor the dignity of their fellow worker or patient.  Such communication empowers patients to vaccinate by not diminishing their concerns or othering them but seeking to promote health and wellbeing by calling the hesitant individual in, rather than out.

Nurses have answered the call to action throughout this pandemic. Now they directly contribute to community immunity and move towards ending the pandemic with their own vaccination and community influence by becoming vaccine communication champions for their patients and colleagues.

 

 

Webinar on vaccine hesitancy and effective vaccine communication

Monday, Feb. 8, 2021, 2:00 to 4:00 pm ET (Open to all nurses and other health professionals)

The COVID-19 vaccine will change the course of this pandemic. As millions of people are getting immunized, how can we as health-care workers become champions for this vaccine, and feel empowered to communicate about it with our patients, colleagues, family and friends?

Join Dr. Cora Constantinescu, pediatric infectious disease specialist, for a session on COVID-19 vaccine hesitancy and effective communication.

At the end of the session, the participants will be able to:

  • appreciate the extent of vaccine hesitancy around the COVID-19 vaccine and some of the reasons for this phenomenon,
  • understand how Canada measures up globally and at home; and
  • apply a communication framework to hold a vaccine hesitancy conversation around COVID-19 vaccine.

You can register here.

 

 

Past webinar on vaccines rollout

RNAO holds its Health System Transformation and COVID-19 Webinar webinar series every month to support health providers from Ontario, Canada and anywhere around the world. They are free and open to any health provider. For information on the series and on earlier webinars, go here.

The January 11 webinar was on COVID-19 vaccine distribution: Progress to date with Dr. Dirk Huyer, Chief Coroner, member, Lead Clinical Guidance and Surveillance Work-Stream, COVID-19 Vaccine Distribution Task Force. About 850 health providers participated online. You can watch the webinar here and see the slides here. Dr. Huyer’s written summary and RNAO’s perspective on vaccines can be found here.  

 

Please sign action alert urging Premier Ford to suffocate COVID-19, NOW!

Nurses call on Premier Doug Ford to act swiftly to suffocate community spread of COVID-19 – now more than ever – given the rapidly spreading new strains. While RNAO whole heartedly supports the government’s announcement to expedite vaccination of LTC residents, rampant community transmission threatens to completely overwhelm hospital intensive care units and has forced the cancellation of surgeries and procedures. As with the vaccines, delay in taking bold action to support vulnerable populations that can’t afford to self-isolate is costing lives and putting our health system and its health-care workers at undue burden – physically and emotionally.   

As we outlined in our media release, to help suffocate the virus Premier Ford must:

  • Provide working people with 10 paid days of sick leave. Workplaces have become a major source of transmission for COVID-19 yet nearly 60 per cent of Canadians aren’t entitled to a single paid sick day. When workers cannot afford to protect themselves, then they cannot protect their families, their co-workers and the rest of us. 
  • Invoke a moratorium on evictions, not only a short-term pause on eviction enforcement. As this pandemic rages on, Ontario’s Landlord Tenant Board continues to conduct eviction hearings that do not allow for adequate counsel and representation.
  • Provide accommodation for people awaiting test results and recovering from COVID-19 to self-isolate. COVID-19 has ravaged low-income communities living in overcrowded housing. Everyone needs the ability to self-isolate while awaiting testing or recovering from COVID-19.

Add your voice! Urge Premier Ford to invoke these measures to suffocate COVID-19 and save lives now!

 

Register for February 25, virtual Queen’s Park Day – open only to RNAO members

Registration is open for Queen's Park Day on Thursday, February 25, 3:30 to 7:30 pm. The virtual event will feature remarks by Premier Doug Ford, Minister of Health Christine Elliott, Minister of Long-Term Care Merrilee Fullerton, Official opposition and NDP leader Andrea Horwath, Liberal Party leader Steven Del Duca, and Green Party leader Mike Schreiner.

The agenda will also feature the release of Vision for Tomorrow: The Nurse Practitioner Task Force Report. You can register for the event 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 Situation Report #356 for January 29 (no report on January 30):

Case count as of January 29, 2021 / Nombre de cas le 29 janvier 2021

Area / Région

Case count / Nombre de cas

Change from yesterday / Changement par rapport à hier

Deaths / Décès

Change from yesterday / Changement par rapport à hier

Canada*

766 103

+ 4 877

19 664

+  131

Ontario**

264 300

+ 1 837

6 072

+  58

Update

  • Ontario Takes Immediate Action to Stop the Spread of COVID-19 Variants. The Ontario government is taking immediate and decisive action to stop the spread of new COVID-19 variants throughout the province. It is implementing a six-point plan which includes mandatory on-arrival testing of international travellers, enhanced screening and sequencing to identify the new variants, maintaining public health measures to keep people safe, strengthening case and contact management to track the spread of new cases, enhanced protections for vulnerable populations, and leveraging the latest data to inform public health decisions.

 

Staying in touch          

Keeping in touch is now more important than ever. Feeling that you are part of a community and that we have your back will help you get through this challenging time. We are also eager to hear from you how we can best support you. Send to us your questions, comments, and challenges. Feel free to also recommend ideas for future webinars. Send these to me at dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten email: 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 reach out to one another in solidarity! Our government, the public and indeed all of us as health professionals – must also keep 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 take care of yourselves and know that RNAO always 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, FCAN, O.ONT
Chief Executive Officer, RNAO

 

RECENT BLOG ITEMS:

23 Jan - Mitigating the spread in Toronto shelter settingsgo here.

23 Jan - Home care nurses are #ReadyToVaccinatego here.

23 Jan - Hurtful comments about law enforcementgo here.

15 Jan - The escalating catastrophe of the COVID-19 second wave in Ontariogo here.

15 Jan - Progress in vaccine distribution: Updates, issues and concernsgo here.

8 Jan - RNAO raises its voice in the media: Media coverage in December 2020go here.

8 Jan - A practicum experience at RNAOgo here.

8 Jan - RNCareers: Help during the holidays and help for next phases of this pandemicgo here.

29 Dec - Public health nurses in schoolsgo here.

29 Dec - Government failing Ontarians as virus runs rampant and endangers livesgo here.

29 Dec - We need your help in addressing urgent staffing needs in health facilitiesgo here.

29 Dec - Best wishes for the holidaygo here.

18 Dec - Providing compassionate nursing care in an age of artificial intelligencego here.

18 Dec - RNAO continues to express grave concern regarding the second wavego here.

18 Dec - Long-term care staffing plan lacks urgency and legislated actiongo here.

11 Dec - RNAO gravely concerned about the second pandemic wavego here.

11 Dec - Health organizations plead for Ontarians to celebrate holiday season safelygo here.

4 Dec - Continuing the conversation: Mobilizing collective action for LTC reformgo here.

4 Dec - Nurses urge dedicated funding for infection prevention and control in LTCgo here.

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

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

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

13 Nov - Mobilizing collective action for long-term care reform in Canadago 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 themselvesgo here.

6 Nov - Elections in the US: A path to healing and respect for sciencego 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 outgo here.

16 Oct - RNAO advocates for national long-term care standards in Canadago 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, actiongo here.

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

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

25 Sept - Nurses say throne speech advances A Just Recovery for Allgo 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 Scopego here.

11 Sept - International Overdose Awareness Day: Statement from RNAOgo here.

11 Sept - RNAO joins global movement: A Just Recovery for Allgo 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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