I am excited to announce that CACCN is launching a new visual identity this week!

After almost three decades of the old logo serving the organization well, it was decided by the Board of Directors (BOD) in the spring of 2011 that it was time for a new, fresh and updated appearance.  

We asked members to send us your ideas and we were pleased that some people took the opportunity to share with us some very innovative, thoughtful and meaningful designs.  These designs were displayed at the fall Dynamics conference in London, ON for members to ponder.  There was no one design that was selected as submitted, but I am pleased to say that many of the elements that were in those submissions helped to shape the final version that we asked our graphic designer at Pappin Communications to create. 

The new logo maintains a link to our proud past and the founding organizations by incorporating the circle, maple leaf and red and black colour design.  Inside the circle there are now five figures holding hands signifying the interdependence and unity we have as critical care nurses around Canada, while also numerically corresponding to the five pillars of the CACCN Strategic Plan.

We also felt it was important that CACCN be “spelled” out so that it was clear who we are to anyone who may come across our logo, thus our full name is part of the new look, in addition to highlighting the first letter of each word in red, to make the acronym “CACCN“  stand out.

Over the coming weeks, you will see the new logo start to appear on  our visual materials.  We hope you like the fresh new look!

Thank you to the following individuals who sent in design ideas:

• Lissa Currie and Sarah Unrau
• Teresa Coughlan
• Josefa Inot
• Céline Pelletier
• Ariel Rogozinski
• Michael Wheatley

As always….take care of yourself and each other!

Kate Mahon
CACCN President

Recent Decision by Canadian Regulators to Use U.S. NCLEX-RN® Exam ~  Time to “Find Your Voice”

The CACCN National Board of Directors learned at the same time as other RN’s across Canada on December 2 that ten (10) of the nursing regulators in Canada have supported the bid of the U.S. company, the National Council of State Boards of Nursing (NCSBN) to develop a computerized nursing examination that new nurses will write for entry to practice. The nursing regulators rejected the submission by the Canadian Nurses Association (CNA) who have administered Canada’s Registered Nurse Entry (CRNE) exam for 40 years to update and computerize the current CRNE exam making it more accessible and flexible to write for new nurses. Despite assurances from the regulators that the exam will not be the U.S. NCLEX-RN® exam the NCSBN has announced on their website that this will mark the first time the US NCLEX-RN exam will be used internationally as an entry to practice requirement.

The CACCN BOD has been joining with other speciality associations and the CNA by teleconference to become informed and to understand how this decision has been able to be announced with no consultation by regulators with either the public or practicing RN’s across the country. The impact of this decision should be very concerning for the public and for nurses across the country for many reasons. Recent communication from the regulators in the form of near identical announcements in support of the decision and Q & A documents have done little to allay or address the concerns of the BOD and most nurses across the country who are aware of what is happening.

Although the regulators have reminded us that they are within their full power and rights to make this decision, the lack of consultation done with nurses and the general public across the country prior to the issuing of the Request for Proposal (RFP), is not the kind of accountability we would expect from regulating bodies for professional nurses or in the best interest of protection of the public and Canadian public health care dollars. The United States is predicting a greater shortage of nurses than in Canada in the near future. The NCLEX-RN exam would enable access to Canadian nurses to be aggressively recruited to relocate to the United States by privately owned hospitals and employers with strategies that Canadian employers with public health care dollars would simply be unable to compete with (ie large sign- on bonuses, relocation assistance, housing, debt payments and other financial incentives etc).

It is the position of the CACCN Board of Directors that this decision by the Regulators needs to be revisited within the 120 day window of opportunity that exists to ensure that proper consultation is completed with the public and registered nurses across the country prior to any of the regulators signing a contract with NCSBN. There are far too many unanswered questions at this time. A full and transparent disclosure of the rationale leading to their decision would be an expectation along with a complete impact analysis of the full implications of choosing a U.S. based company to develop and administer Canadian content exams. CACCN further believes and supports that Canadian health care dollars should be used to engage Canadian nursing leaders, educators and theorists to create a state-of-the art, flexible and more accessible computerized exam, rather than contracting this out to an American company.

Therefore the CACCN Board of Directors is urging our members to become well informed on this recent announcement within your province and territory and to consider your personal position on this. We have issued a special Critical Connections Bulletin with all the information to date we have been able to gather from the regulators and the Canadian Nurses Association. As we learn more we are committed to keeping you updated, so please regularly check the CACCN web site to keep yourself informed. We have developed a letter template for you to write to your regional regulating body to let them know if you are not pleased with their decision. We ask that you also complete the poll on the website on this issue so that the BOD can get a sense of how our members feel on this issue in a timely manner.

I would welcome any dialogue on this by your response either to this blog or in the RN Examination forum we have set up in the Members Only section of the CACCN web site.

I am sorry that such an important issue needs discussion over the holiday season but the timing was not ours on this and the 120 day clock is ticking before the final decision is not able to be influenced by us finding our voice now.

Thank you in advance for your attention to this important issue for nursing in Canada and as always…take care of yourself and each other,

Kate Mahon
CACCN President

The perfect one!

I was out on a family woodlot in Nova Scotia with my family and friends this past weekend for our annual “chop the Christmas tree” party.

As usual the day was one of joy being together and sharing in the hunt for the perfect tree for each family’s home, followed by hot apple cider, warm chilli, freshly made bread and lots of homemade goodies. Traditions seem to abound this time of year but I am reminded that for many people the holiday season can be one of the most difficult and stressful times of the year.

Working in critical care we recognize what the loss of a family member means to traditions at such a festive time for so many of the families who have been in our care over the past year.  In the PICU in the hospital where I worked, there has a been a tradition for many years where the nurses on the bereavement follow-up  committee make sure a special card and message of “thinking of you at this time” is sent to every family who has lost a child in the past year.  For the nurses it is their way of saying “we still care”.  The feedback from the families has been “we so appreciated your kind words and are grateful that you remembered us”.  These are small gestures with big impact for families.  This group of committed ICU nurses do not see their job as “finished” with bereaved families until they make connections like this at significant milestones in the first year after a death of a child in the PICU. This is excellence in the “art” of critical care nursing and I applaud the nurses who take on this emotional task every year.

Fond memories of Christmas 2010

This year I too know what it is like to lose someone special as it will be the first Christmas without my father who passed away in June.  His presence at Christmas dinner will be missed as we begin to adjust to life without him when we congregate at these special family times. 

To all who have lost someone dear to you over the past year, I hope that in the busy times of the holiday season and in your intense work in the ICU, you are able to find time for yourself.  Time to do something that you enjoy and that brings you joy. 

Making memories...

As critical care nurses we are used to giving so much to others in caring for them.  Now at this time of the year it is a time to give to you ~~ find some “alone” moments away from the bustle of the celebrations, and use the time to pause and recall those that are gone from your life.  Instead of remembering it as a loss, rather remember with fondness the lasting wonderful memories they left with you ~ a most precious and enduring gift “under” your tree this year.

As always…take care of yourself and each other,

Kate Mahon, President

** Please feel free to share your special Christmas memories

The Globe and Mail had a lengthy article on the topic of end-of-life issues in the ICU that patients, families and health care providers struggle with, in this weekend’s Saturday edition (Globe and Mail, Saturday November 26, 2011 Section F) called “Mortal Choices“. 

The article was  well written by health reporter, Lisa Priest who spent two and a half months in the Intensive Care Unit at Sunnybrook Hospital in Toronto.  Lisa followed the stories of several patients and the team in the ICU who cared for them with compassion and courage to “do the right thing” honouring the patient’s wishes and direction.

As critical care nurses we know very well the incredible guts that it takes to be able to care for patients at the end of life, while simultaneously supporting a grieving family in the midst of all the technology in the ICU. As the constant bedside care provider, the critical care nurse is present in the minute-to-minute care for patients and so we see the pain and the anguish of both the patient and the family in the many “stories” that play out daily in every ICU across the country.

In my career I know there have been many times when I or my nursing colleagues asked the question “Why are we doing this?” Sometimes the question was never expressed aloud, only thought, and at other times the physician was directly confronted, often in our frustration, with this query. What I came to learn and appreciate over my nursing career is that as the nurse I was experiencing moral distress at these times, often as a result of my intimate relationship with the dying patient and their family. I was getting worn out mentally and physically as I provided constant care that seemed futile and caused me at times to feel like I was torturing my patient. It was tough on those shifts.  But I also came to understand that as tough as it was for me as the nurse, the physician bears a totally different burden,  one that I will never thankfully have to do and that is the act of making the final decision to stop treatment and allow a patient to die.

Each of us in the ICU has a role to play in supporting patients at the end of life and for the physicians, they need to be able to maintain some emotional distance from the patient’s suffering in order to preserve the objectivity they need to ensure that when they do make the decision to allow the patient to die, that they have done this for the right reasons and not because they are worn out as well. What is essential is that both the physician and nurse support each other in the unique roles we play at the end of life in the ICU. For the physician it is to continue to diagnose and treat the patient until the decision is made to discontinue treatment and for the nurse it is to assist the patient and family in the human response to illness at the end of life. Regular explanation by the physician greatly assists the bedside nurse in understanding “why we are still doing this.”  As nurses, a kind word to the physician expressing the difficulty of the decision they are responsible for acknowledges the burden he/she carries, albeit different than the one we do.

Together we share the goal of “a good death” for the patient. By supporting one another in the roles we play at the end of life for the patients and their families in the ICU, we can still come out “whole,” growing as an individual and strengthening as a team from the experience that we share in a job and profession that we have chosen as our life’s work. We need to do this well to remain resilient to carry out this important job for many years.

The Globe and Mail article portrays why this work requires an incredibly expert and compassionate team of care providers to share the burden of end of life care in the ICU, partnering with patients and families at their most vulnerable moments of living…and dying. 

As aways…take care of yourself and each other,

Kate Mahon, President

Note:  Don’t miss the Special End of Life Issue of Dynamics:  Journal of the Canadian Association of Critical Care Nurses.  This issue will be released in the coming weeks.

There is some controversy brewing in Nova Scotia about a clause that was successfully negotiated by the Nova Scotia Nurses Union (NSNU) in their recent contract settlement with 10 employers. The Union made the case that the attire currently worn by nurses was creating confusion with the public as to who was caring for them because everyone from cleaners to nurses wear similar scrubs. 

Janet Hazelton, President of NSNU contends that the nurse and patient would be better served by nurses wearing a common standardized colour uniform.  She made the analogy that one knows who is pulling them over when you see the uniform of an R.C.M.P. officer. Several options were considered and voted on by members of NSNU and the outcome is the selection of a white top and black pants (or skirt) for almost 6,000 nurses working in Nova Scotia. The annual cost to the province to purchase this new visual identity is approximately $500,000. The uniform is to be mandatory attire for nurses with some exceptions (e.g. nurses working within Mental Health).  The memorandum of agreement in the contract states (NSNU, 2011):

The Nurse Uniform Policy will include the following:

• Expectations for mandatory use
• Consequences for non-compliance
• Rules surrounding care, use, and responsibilities of Nurses
• Distinction between RN and LPN
• Rules surrounding number of uniforms available to individual Nurses
• Exclusive use of black pants and white tops worn by Nurses

In a recent Critical Thinking column in the Dynamics Fall 2011 journal, I spoke about the impressions we leave, commenting on the fact that being dressed casually may not be serving us well as professional nurses. But is going back to the days of mandatory standardized dress codes really the answer? I remember only too well when I was required to wear a nursing cap and an impractical wrap-around dress uniform in only pink, green or blue pastel colours chosen by the employer in the PICU where I worked.  When I became Head Nurse a few years later, I was a “rebel” and called to the Director of Nursing’s office because I had ordered pant suits with stripes for my staff in a variety of colours which was contrary to the dress code policy of the hospital at the time.

Over the years we drifted away from these kinds of prescriptive and often strict dress codes, but did we go too far the other way? Are nurses too casual and less than professional in some of the clothing they wear to work when caring for the public?  Is the NSNU bargaining team correct in wanting their members to stand out visually as “the nurse” amongst all the health care team? Once again our opinions seem divided on this issue with those in support of the change citing anecdotal stories including one where a cleaner in scrubs, mistaken for a nurse, has been given report on a patient being admitted from the operating room to a patient care unit.  Those opposed to the new standardized apparel, equally cite stories from their experience of the impact on the paediatric population that nurses in white uniforms have on young patients and the ability to gain their trust. 

Both sides are correct ~ that presenting the right professional image of nursing and being easily identifiable as the nurse is important. It is unfortunate that what we agree on we seem to be disagreeing on publicly with less-than-professional web links popping up with cartoons of nurses in white uniforms making “fun” of the issue and Facebook comments that do nothing to enhance the professional image we want to portray.  

So what do you think about this “black and white” issue?

As always…take care of yourself and each other,

Kate Mahon

President, CACCN

Knowledge Translation in Action

Four members of the National Board of Directors (BOD) of CACCN are in attendance at the Critical Care Canada Forum (CCCF) annual conference in Toronto this week.

CCCF is about bringing together an international community of critical care practitioners, particularly intensivists, nurses and respiratory therapists to focus on and share leading science and practice across the spectrum of subspecialty critical care.

As I am sitting in on the sessions, it is obvious that everyone has a common purpose…to push their own practice by ensuring that they are up to date in the latest science, clinical trials and best care practices with the goal to improve patient outcomes. It amazes me how in such brief periods of time “things” change in accepted practice…yesterday what we once believed was best practice for the care of our patients has today been either disproven by research or been advanced through incremental improvements in our knowledge. The sacred cows of yesterday we once held on to as “best” practices in the absence of available research are now being measured and quantified and qualified. The status quo for critical care seems to be a brief period of time in the life of any critical care unit. The best units keep abreast of new knowledge in medicine, nursing and respiratory care and other disciplines like nutrition, physiotherapy etc and then implement needed changes to practice quickly at the bedside.

CACCN and CCCF share common goals in providing an annual conference as a platform to showcase what is happening internationally. As well, the connections we make at such forums link us face to face in a way that social media and electronic means cannot.

It is important that CACCN have a strong voice with our critical care medicine colleagues. I was delighted and proud to hear a physician at a session today talking about critical care nurses probably being one of the most important “variables” in the quality of care and outcomes in an ICU, even more so than the presence of a board certified intensivist! The measure of “nurse sensitive” interventions on outcomes of care is a relatively recent body of nursing knowledge emerging in the literature and one that we need to pay attention to in the ICU where expert critical care nurses often make the observations and assessments that can rescue a patient before he/she deteriorates. It is not intuition when this happens, rather the expert critical care nurse recognizes a sometimes subtle pattern of signs and symptoms and anticipates what that is going to lead to (as she/he has seen it before) and intervenes early to prevent further complications from occurring. This is why it is so important that in the interest of saving money by reducing RN salaries, that new models of care are being suggested in some organizations by having multiple levels of care providers, LPN’s and Support Workers, does not inadvertently fragment the view the RN has of the patient by dividing the patient into “tasks.” The pattern will not be visible to the RN if she/he does not have the role of holistically caring for the patient. Truly this is one where “the whole is greater than the sum of its parts” if we want the best outcomes for critically ill patients. Providing more support to the RN to allow her/him to focus on caring for the patient is the right thing to do, but should not be a substitute for the RN.

There is science that already identifies the benefits of RN care on patient outcomes. The ICU is a place where we need to apply this knowledge.

In the meantime CACCN and CCCF will continue to partner to share our knowledge.

As always…take care of yourself and each other.

Kate Mahon, President

Note:  CACCN Board members attending CCCF this week include, myself and Teddie Tanguay (as speakers) and Ruth Trinier and Karen Dryden-Palmer.