Dear Colleagues: Welcome to our Saturday, July 17 report during this seventeenth 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. 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. Scroll down for policy updates for all to act on & must join events.
UPDATE: We are delighted that the Ontario Medical Association has joined the #MandatoryVaccination movement. RNAO invites other organizations and individuals to do so urgently. You do not need any approvals to join, and you are welcome to benefit from all our materials and promotions here.
Mandatory vaccination for healthcare workers – Exploring issues, challenges and supports
RNAO has lead the advocacy for mandatory COVID-19 vaccination for healthcare workers in Ontario. Drawing on experts, in this article we explore the issues and challenges involved and the way forward.
Provincial and territorial governments in Canada should institute mandatory COVID-19 vaccination for health care workers that cut across all public and private settings, argues an article in the Canadian Medical Association Journal. As frontline workers, those in healthcare are both at increased risk of contracting the virus and of transmitting it. The authors argue that an effective vaccine provided to all healthcare workers in Canada would protect both the health workforce and patients, reducing the overall burden of COVID-19 on services and ensuring adequate qualified personnel to ensure people’s health needs are met through the pandemic. They also point to other advantages of mandatory vaccinations: the expense and difficulty of procuring PPE [editor: as well as that of ongoing COVID-19 testing] and, pragmatically, whether PPE is used appropriately to effectively reduce the risk of acquiring SARS-CoV-2 infection for both healthcare workers and their patients.
The authors call on provincial and territorial governments to set clear rules for vaccination of health care workers across public and private settings and not to leave this task to individual employers. They also address the legality of these mandates. Legality would likely be determined via labour law that considers the “reasonableness” of the employer’s directive, such as what happened with case law related to mandatory influenza vaccination. In 2019, nurses in B.C. won a case against mandatory vaccination policies at their workplaces, making vaccination a matter of individual choice. However, COVID-19 is not influenza. Given the severity of the global pandemic, the authors suggest it is unlikely that challenges to a government mandate would be successful. The authors believe that a challenge under the Canadian Charter of Rights and Freedoms would likely not succeed if provisions were made for those who could not receive the vaccination due to underlying health issues or for those who object to vaccination on religious or conscientious objection grounds.
This article was published in February 2021. Since it was published, I will argue that five developments strengthen the conclusions of the study. One is the growing evidence about the outstanding effectiveness of the COVID-19 vaccines rolled out in Canada in preventing serious illness and hospitalization (much higher than the effectiveness of the typical influenza vaccine). Second, there is mounting evidence that vaccines reduce transmission of the virus (although they do not eliminate it). Third, the deployment of the vaccines and the minuscule rate of serious side effects across millions of individuals has reinforced their safety profile. Fourth is the arrival of new variants, such as delta, that are more transmissible and dangerous and that target those who are unvaccinated. And fifth, we are experiencing a major health human resources crisis – especially in nursing – that makes COVID-19-related absences from work more challenging to replace. Thus, from a legal perspective, the health reward from mandating the vaccine and the risk from remaining unvaccinated have both increased. In short, the “reasonableness” test for mandating vaccines has strengthened.
Many jurisdictions, organizations and coalitions are raising the question of mandatory vaccination for healthcare workers. Hospitals and other healthcare facilities should require employees to be vaccinated against COVID-19, argues a consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and six other leading U.S. organizations representing medical professionals working in infectious diseases, infection prevention, pharmacy, pediatrics, and long-term care. The paper specifies exemption for those with medical contraindications and some other circumstances in compliance with federal and state laws. The guidelines issued by the coalition — which include recommendations for engaging wary employees, navigating regulations and how to enforce a mandatory coronavirus vaccination policy — were crafted by a team of nearly 30 experts during the past two months. This is a move supported by infectious-disease expert Anthony S. Fauci, who suggested that “there should be more mandates” at the local level to curb virus spread.
Enacting a mandatory vaccination policy encourages the vast majority of the workers to take the vaccine, but it also raises resistance from a small number of opposers. That has been the experience of Houston Methodist, a large U.S. hospital system that announced April 1 to staffers they would need to be vaccinated to keep their jobs. While 24,974 workers are now vaccinated, about 150 workers resigned or were fired for refusing to do so. Last month, a federal district court judge dismissed a lawsuit brought by one of those employees, Jennifer Bridges, a former nurse who alleged the policy was unlawful and forced staffers to be “guinea pigs” for vaccines that had not gone through the full Food and Drug Administration approval process.
A paper in the BMJ journal assesses the British and international experience implementing mandatory vaccination for healthcare workers. Here is a summary:
In recent days, France and Greece have announced that vaccinations will be mandatory for healthcare workers. On July 12 French president Emmanuel Macron announced that mandatory vaccination would apply to anyone who comes into contact with vulnerable people, including doctors, nurses, office staff, and volunteers. They must be fully vaccinated against the coronavirus by 15 September or will risk not being paid. He added that from 21 July anyone wanting to visit a theatre, cinema, sports venue, or festival involving an audience of more than 50 people would need to show a pass proving that they were either fully vaccinated or had tested negative. From August 1st this requirement will extend to cafes, bars, restaurants, shopping malls, and long distance trains. After his announcement almost a million people, most of them under 35, booked their vaccination. In Greece the prime minister, Kyriakos Mitsotakis, announced that nursing home staff needed to get vaccinated immediately, while healthcare workers would have to be vaccinated from September 1st.
Experts agree that simply imposing a mandate to vaccinate is not enough. There must be accompanying policies to promote, facilitate and encourage vaccination. An article focuses on the Australian mandate for COVID-19 vaccination for residential aged-care workers, with the aim to ensure all aged-care staff have received their first dose by mid-September. The author identifies several actions and policies to support implementation:
The author identifies leave time (paid time off) to take the vaccine as an important factor. It is essential to ensure aged-care workers can take time off if needed to access off-site vaccination appointments, and to recover if they experience any adverse reactions.
POLICY UPDATES FOR ALL TO ACT ON & MUST JOIN EVENTS – OPEN TO ALL
NP LTC Council Webinar
Jul 22, 2021, 12:00pm - 4:00pm
Please join us for our upcoming NP LTC Council webinar to be held on July 22, 2021. This is our regular monthly NP LTC Council that has been an important forum for NPs working in LTC to discuss clinical, operational, and policy-related issues in LTC, build networks, exchange knowledge, and inform RNAO’s advocacy work related to NPs and the LTC sector.
By popular request, we are focusing our July webinar on the Serious Illness Conversation Program, which NPs will find very helpful in working with residents, and their families. The Serious Illness Conversation Program helps those with identified palliative care needs or their substitute decision-makers have structured discussions with their inter professional health care team about their goals of care. These values-based discussions focus on ensuring an accurate understanding of both the illness and treatment options so the person or their substitute decision-maker has the information they need to make decisions about their treatment.
Jean Benton, NP-PHC, Attending NP, Marianhill Long-Term Care and Community Services, Pembroke
Continuing the Conversation: An Open Forum for Nurses
Aug 18, 2021, 2:30pm - 4:00pm
Topic: Nursing student transitions into the workplace: Experiences and supports
COVID-19 has disrupted nursing education. Hands-on clinical placements have been replaced by simulation, in-class learning has gone virtual and students are completing their education at a time when all energy is focused on the global pandemic. Thousands of Ontario nursing students will be entering the nursing workforce at a critical time in history for health care: one where structural inequities and system failures have been brought to the spotlight, and where nurses, exhausted from relentless waves of the pandemic, are facing burnout and considering leaving the profession in larger numbers than usual. However, the pandemic has also raised the centrality of our profession and reinforced that without nurses the health-care system will collapse. RNAO is issuing a call to ensure the next generation of nurses thrive in the profession.
During this heart-to-heart nursing forum, you will hear from nursing students, new grads and educators who will discuss the following questions:
Visit our COVID-19 Portal for additional resources and information on psychosocial support.
Information about prior webinars can be found here.
Webinar: COVID-19 Webinar Series
, 2:00pm - 4:00pm
When: Every second Monday of the month (except for August)
RNAO's CEO Doris Grinspun will be hosting COVID-19 webinars for health providers.
Health providers from Ontario, Canada, and anywhere in the world are welcome to join at no cost.
We are here with you in solidarity. Together, we will continue to tackle COVID-19 with the best tools at hand, including accurate information, calmness, determination and swift actions!
September 13, 2021, 2 - 4 p.m. ET
Details and registration link coming soon.
Watch and read about earlier webinars 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 last Situation Report #472 for July 15:
Staying in touch
Keeping in touch remains important as we face the pandemic and other challenges in Ontario, in Canada and elsewhere – in particular, in Africa and Latin America – two of the continents most affected by COVID-19 and its variants – delta and lambda. Feeling that we are part of a community and that we have each other’s backs helps us get through these challenges, becoming better people in the process. We are eager to hear how we, at RNAO, can best support you. Send us your questions, comments, and challenges. Recommend ideas for articles and webinars. Write to me at firstname.lastname@example.org and copy my executive assistant, Peta-Gay (PG) Batten at email@example.com. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!
Thank you for being there for your community – everywhere and in all roles! Together, in solidarity, we are strong and resilient. In Canada we see hope at the end of this long pandemic tunnel. Please keep encouraging your colleagues, their loved ones and your communities to be fully vaccinated. We must not forget, however, about our privilege. Canada has purchased more vaccines than what it needs, while 9 out 10 countries have almost nothing. Like in other challenges we face, such as racism, Islamophobia, and other forms of discrimination, we are not safe until everyone is safe. Vaccines for all – literally for all, across the world – must guide policy in the upcoming 12 months. Let’s learn from the 17-month pandemic and take real action to build a better world.
To everyone – THANK YOU! Please take care of yourself and know that RNAO always stands by you!
Here’s one constant throughout the pandemic. The silver lining of COVID-19 has been to come together and work as one people for the good of all. Let’s join efforts to demand political leaders bring about #Vaccines4All!
Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, FCAN, O.ONT
RECENT BLOG ITEMS:
10 July - A Detailed Study of Patients with Long-Haul COVID – go here
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3 July - RNAO’s continuing media profile: The June report – go here
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26 June - Global herd immunity out of reach because of inequitable vaccine distribution – go here
26 June - Canada is virtue signalling while waffling on global access to COVID-19 vaccines – go here
20 June - Building your Twitter presence: Here are tips from RNAO – go here
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12 June - RNAO statement on the terrorist attack in London, Ontario – go here
12 June - Reducing the time interval for second dose after first AstraZeneca dose – go here
12 June - AstraZeneca second dose: Should I get the same vaccine or Mrna? – go here
5 June - RNAO’s continuing media profile: The May report – go here
5 June - RNAO supports Premier Ford's announcement on schools as risk is too high – go here
29 May - Vaccination passport apps could help society reopen – go here
29 May - Email updates highlight best new evidence about COVID-19 – go here
23 May – NPs speak about LTC during the COVID-19 Pandemic – go here
23 May – Three surveys on the impact of COVID-19 on Canadian nurses – go here
23 May – Exemption of nurses and other health-care workers from Bill 124 – go here
23 May – RNAO’s statement on the government’s phased-in re-opening plan – go here
23 May – Remembering Charlotte Noesgaard (1948-2021) – go here
15 May - Nursing Now Ontario Awards Ceremony – go here
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8 May - Nurses must be fully vaccinated immediately, RNAO demands – go here
8 May - A bill to support individuals with assistive devices for mental health – go here
8 May - Action alert: Ensure global vaccine access, prime minister! – go here
1 May - RNAO statement on the passing of RN Lorraine Gouveia – go here
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We have posted earlier ones in my blog here. I invite you to look.
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