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Publications & Resources > The Standard > September 2004   

  Last modified September 1, 2004  

Letters to the Editor

The Standard, June 2004

I read The Standard from cover to cover the day it arrived. The layout flows logically. The Test Your Knowledge section allows nurses to apply principles learned into current practice situations.

It seems particularly appropriate that the “praises” follow the “disciplines.” I am left feeling proud to be a nurse rather than horrified by some of the scenarios for which nurses are disciplined.

Well done!

– Ruth McAughey, RN Stoney Creek

 

Scope of Practice

I have been employed at Grey Bruce Regional Health Centre, Owen Sound site for the past 16 years working on long-term care, medicine, pediatrics, obstetrics and currently on the 6th floor – surgery.

In May, I received a phone call stating RPNs were being deleted and I wouldn’t be called anymore. The facility received extra funding to enable them to staff the floor with all RNs as patient acuity is higher.

I have received several calls asking me to come in for shifts since that disappointing phone call. It appears we are needed until this fall when they complete the bumping and lay-off process.

Meanwhile, we have the next five months to work there while the patient acuity is said to be too high to receive our care. The majority of patients on the surgical floor are stable, so there are many patients we can care for, and I have always handled the heavy workload.

The scope of practice for RPNs has widely increased in the past years as we have taken added skills courses. The current college course is two years in length. We are being utilized to our fullest potential, and the hourly cost is much less than an RN with experience.

The hospital has received extra funds for their budget, but with the rising cost of health care, how long will the money last and what other areas will be cut to accommodate this decision? If it was my budget, I would make more use of RPNs and help keep health costs down.

As a competent, capable and caring nurse for 25 years, I feel very disheartened.
What a waste of a group of caring professionals.

– L. Harris, RPN Sauble Beach

 

Infection Control

I read with interest and concern your Infection Prevention and Control practice standards that came with The Standard (June 2004). I assume these were developed in response to last year’s SARS disaster, the increase in nosocomial infections, especially in hospitals, and also in anticipation of new infection sources, which we will almost certainly be required to address in the near future.

As a nurse with 49 years in active practice, I’m glad you have developed and published these policies; however, I am very disappointed that there was a need for CNO to do this. What is the state of our undergraduate nursing education that these procedures are not well known? Why are we having to remind practising nurses to wash their hands? What is the state of refresher and in-service education in hospitals and community agencies that requires you to restate these safety procedures? Are we beginning at the beginning?

I have direct knowledge of the situation in one of the Toronto hospitals most affected by SARS last spring. The section on maintaining a quality practice setting in your standards is very good. The problem at this particular hospital was that although the front line nurses recognized what was happening and, especially when the second wave of SARS occurred, requested personal protective equipment, their administrators, some of whom were not nurses, declined to provide it (at first). Who will regulate those administrators who are not nurses?

Patients and visitors from affected institutions were sent home to self-isolation, presumably by nurses or administrators. Yet little information was given to them about how they would manage at home. Because it is very likely last year’s situation will recur, if not with SARS then with another virulent virus or antibiotic-resistant bacteria, who will take responsibility for providing practical information to those affected?

Why is CNO not addressing these issues also?

There will be a next time, and isn’t it up to we who have specific, practical knowledge about the transmission of disease to act now?

– Barbara Organ, RN Via E-mail

 

Dear Reader

CNO considers a number of factors when revising practice standards, such as the age of the current standard and whether a standard continues to reflect current evidence-based practice and the needs of the practice setting.

The new Infection Prevention and Control practice standard, a revision of the 1999 Infection Control guideline, establishes the expectations of all practising nurses in non-outbreak situations and should be utilized with government directives in outbreak situations. To ensure the new standard reflects current infection prevention and control guidelines and is applicable to nurses in all practice settings, it is based on a review of current literature and feedback from nurse focus groups.

Translation of knowledge into changes in practice requires multiple approaches. As you identified, hand washing is basic nursing practice. The appearance of new terms such as “hand hygiene” requires us to restate the basis of this concept.

Adult education principles suggest that adults often require a message to be repeated several times and in different forums. According to the literature, hand hygiene encompasses more than just hand washing alone. Hand hygiene was stressed in the new standard because research clearly indicates it is still the single most important activity in the prevention of disease transmission among health care workers.

Because CNO standards apply to both the novice nurse and the experienced practitioner, it is important to stress basic principles of infection prevention along with any updated information. This reinforces learning and provides an opportunity for nurses to update their knowledge and share information with the health care team. CNO encourages all employers and agencies to offer learning opportunities associated with the particular needs of their staff.

Nurses are seen to be excellent health teachers by the public. As with all aspects of nursing practice, the accountability of health teaching lies with each individual nurse.

Nurses are accountable for what they know and what they do. The teaching role extends to educating administrators who are not nurses about the standards of practice expected of nurses. For example, the new Infection Prevention and Control standard includes a section on quality practice settings that can be shared with other health care providers and non-nurse administrators.

The College expects nurses to be aware of all practice standards, to consider government guidelines for outbreak and non-outbreak situations and to apply evidence-based practice to ensure safe, ethical nursing care.

Corrections

In the Working with Unregulated Care Providers practice guideline (document # 41014), the chart titled: When is delegation required? on page 11 is incorrect. The corrected chart can be obtained by visiting CNO’s website at www.cno.org and going to the What’s New/Corrections link. The chart can also by obtained by contacting the College.

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