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Publications & Resources > Here for You
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Nursing and You
Volume 2, No. 3, Aug. 2000 - Welcome to a Career in Nursing
This issue of Nursing and You is jointly sponsored by the College of Nurses of Ontario, the Registered Nurses Association of Ontario and the Registered Practical Nurses Association of Ontario.
Welcome To Nursing: A Career of Challenge and Opportunity
What comes to your mind’s eye when you hear the word ‘nurse’? Chances are, the image you’ve conjured up has more to do with old stereotypes than it does with modern realities.
Do you know that nursing today is a dynamic, exciting career that offers near unlimited opportunities? Nurses can choose to work in fast-paced hospital emergency departments or busy community health centres, with children, seniors or whole communities. They can become university professors, senior executives or world-renowned researchers. And nurses themselves are working hard in partnership with employers and government to enrich their working environment.
Do you know that nurses are among the most in-demand professionals, and enjoy the highest respect and trust among the public? Nurses have almost always been in demand — but never more than now. It’s estimated that Canada will be facing a shortage of as many as 113,000 nurses by 2011.
Do you know that nursing is a profession for everyone? Statistics show that more and more men are choosing and enjoying nursing careers, as well as students from Ontario’s rich diversity of ethnic and cultural backgrounds.
Do you know that nurses are highly valued and respected members of society? Nurses are central to health care. Nurses make a difference in the lives of individuals through one-on-one care, in communities through health promotion or even more broadly through research and leadership. Nurses positively affect the health of all Canadians.
In the following pages, you’ll learn what nursing is, and about some of its amazing career opportunities. You’ll meet nurses working in a wide variety of roles, and teens who’ve already decided that nursing is for them. You’ll learn how to prepare for a nursing education, and gain a glimpse into the daily life of a nursing student.
Through these pages, you can take a look at nursing as it really is. Perhaps you’ll see yourself in the picture.
An Urgent Need for Nurses!
In many fields, it can be difficult to predict the market for jobs. But the need for good health care will never go away, and if you choose nursing, the likelihood of employment soon after graduation is very strong, no matter what kind of practice you pursue. Here’s why.
A recent report to the Ontario Ministry of Health and Long-Term Care, entitled Ensuring the Care Will Be There, underlined a number of trends that point to a severe shortage of nurses by the end of this decade.
- Population Growth — In Canada, almost 17% growth is projected between 1998 and 2011. Fueled by immigration, Ontario’s population growth is higher than the average for Canada.
- Aging Population — The proportion of Canadians over 74 is projected
to grow from 5.32% in 1998 to 6.48% in 2011. This age group requires
a major portion of health care resources, including nursing care.
- Rising Severity Of Health Problems — Hospitals are discharging
patients earlier, resulting in sicker patients in every sector of health
care. This means more intensive patient care needs, and so, a demand
for more nurses.
These factors mean that employment opportunities for nurses will be strong for the foreseeable future. Last year, the Ontario government committed to funding 12,000 new nursing positions by the end of 2001. Now we need to fill them, and in the long run, that means you!
A Few Things You Always Wanted to Know About Nursing
The Choice is up to You!
Nursing opens the door to a wide range of career options. The skills and knowledge you’ll acquire as you prepare to become a nurse are highly marketable and portable. You can choose one area of interest when you begin to study nursing, and then explore new educational and career opportunities as you gain experience in the workforce. It’s a profession to grow in. Here are just a few of the possibilities:
Home Health Care
As the name suggests, home health care involves providing care in a home setting. Although some nurses provide care to a single individual, most home care nurses work for agencies and provide care to a number of clients. In either case, home care nurses need to be good communicators in order to teach individuals how to care for themselves as much as possible. They also need to be able to work independently – and to be part of a larger health care team.
Primary Health Care
Primary health care nurses have front-line responsibilities in the treatment of patients, and may pursue a wide variety of career tracks. Some work for one physician, others become part of a large, multi-disciplinary team of health care providers (that is one that includes doctors, social workers or dieticians) in a neighbourhood health centre. Still others become nurse practitioners, who are RNs with additional education and broader scope to work independently in their own practice or a variety of other settings, including community health centres, nursing homes or isolated rural outposts. Regardless of the environment in which they practise, primary care nurses can expect to work with diverse populations and have many opportunities to promote wellness within the community.
Public Health
For the most part, public health nurses focus on health promotion, health education and illness prevention at the community level. You’ll find public health nurses developing a wellness program with seniors at a local mall, staffing a sexual health centre where they provide education and treatment for birth control and sexually transmitted diseases, organizing a regional ‘Healthy Pregnancy’ campaign, or using straight talk and a sense of humour to motivate a group of high school students to avoid or quit smoking. Operating in a diverse and highly visible environment, public health nurses draw on their nursing education as well as their skills as negotiators, team builders and leaders.
Hospital Care
Hospital nurses attend to patients young and old and around the clock. In the charged atmosphere of emergency rooms, nurses respond quickly to life and death situations. In intensive care units, nurses utilize the latest technology to care for people who are critically ill. In neonatal units, nurses help tiny babies survive their first days of life. Nurses working in a hospital setting require the knowledge, skills and expertise needed to deal with increasingly complex illnesses and medical equipment. They are an integral part of a health care team that includes physicians, pharmacists and other health care providers.
Long-Term Care
The goal of long-term care is to assist individuals, usually the frail elderly, to achieve the highest level of physical and emotional well being possible. In the community, long-term care nurses can help an individual with disabilities to live independently. In a rehabilitation centre, nurses help people with physical injury, as well as emotional trauma, on the journey back to health. In a nursing home, nurses help to provide the highest possible quality of life for residents. Long-term care can involve complex treatments as well as a comforting word. As with most areas of nursing practice, it’s a field where the ‘science’ of nursing — the application of knowledge — and the ‘art’ of nursing — the nurturing of a caring relationship — come together.
Teaching
Although all nurses are teachers, there are growing opportunities for nurses to pursue careers as educators in a more formal sense. Nurses with post-graduate preparation can choose to become nursing teachers. For instance, clinical nurse educators, who have expertise in a specific area of health care, serve as consultants to employers such as hospitals and home care agencies, or offer continuing specialized education to other nurses. Nurses with post-graduate degrees can also opt to become teachers or professors of nursing at community colleges or universities.
Research
Individuals who choose a career in nursing tend to be especially curious about the world around them. It’s a character trait that makes nurses ideal researchers. Today, nurses are involved in essentially two fields of research: clinical research and nursing science. In clinical research, nurses, most of whom will have a post-graduate education, work as part of a research team to test new drug therapies or investigate current issues in health care. Nurses are also involved in research that contributes to the vast body of scientific knowledge that supports and improves nursing care.
Administration
Nurses are leaders in health care. Experienced nurses can become program or department directors in hospitals, where they co-ordinate the activities of nurses and other care providers. Directors of nursing establish standards of patient care and advise other hospital employees on nursing issues.
Nurses with advanced education in either nursing, health care or business administration can become senior executives in organizations such as hospitals, long-term care facilities, community health centres, home care agencies, nursing colleges and professional associations. In these positions, they are often responsible for large staffs, multi-million dollar budgets, establishing standards for care, or advocating for healthy public policy and the role of nursing.
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"So much of taking charge of your diabetes is being confident, trusting yourself and those who are helping you. Nurses have done a lot to build that trust as I was growing up; now I know I’ll never lose it." 19-year-old living with diabetes |
Public Policy Development
Working at the heart of health care, nurses have a unique perspective and a broad understanding of the concepts of good health. As front-line health care practitioners educated in a holistic approach to well-being, nurses understand the role that factors such as income, lifestyle and education play in fostering good health. Given their expertise, it’s not surprising that the ideas and opinions of nurses are increasingly being sought by the media, national and international health organizations, and governments at all levels. Certainly the government of Ontario recognizes that nurses have a valuable leadership role to play. Recently, the province appointed the first provincial Chief Nursing Officer to be a member of the senior management team at the Ministry of Health and Long-Term Care.
What is Nursing?
The goal of nursing is to restore, maintain and advance the health of the patient. It is both a "science" and an "art". The science is the application of nursing knowledge and the technical aspects of the practice. The art is the establishment of a caring relationship through which the nurse applies nursing knowledge and uses judgement in a compassionate manner. Both focus on the whole person, not just the particular health problem.
Nurses can play many different roles — direct care provider, administrator, teacher, researcher, policy maker — in many different settings — hospitals, long-term care facilities, patients’ homes, community health centres, street clinics, industry, government or classrooms, to name just a few. They care for patients at all stages of the life cycle and in all states of health, from normal functioning to crisis.
In Ontario, the nursing profession is comprised of two groups: Registered Nurses (RNs) and Registered Practical Nurses (RPNs). The two categories are subject to the same regulatory requirements. The two principal areas of difference are educational requirements and scope of practice. Although all nursing students learn from the same body of nursing knowledge, RNs study it in greater depth and breadth over a longer period of time, and accordingly provide care in more complex situations where the outcome for the patient is less predictable.
Also, there are RNs who have received additional education, and are able to perform some of the diagnostic and treatment functions which were previously the exclusive domain of doctors. These RNs, known as primary care nurse practitioners, have recently been recognized in provincial legislation, and are now registered in the Extended Class by the College of Nurses.
RNs and RPNs are the only categories of nurse regulated in Ontario; indeed, they are the only categories of health care provider entitled to call themselves "nurses".
How Nurses Regulate Their Profession: The College Of Nurses Of Ontario
For the protection of the public, health care professions in Ontario, including nurses, doctors and dentists, are regulated. The College of Nurses of Ontario (CNO) is the regulatory body for nursing (contrary to what you might think from its name, it is not an educational institution). No one can practise as a nurse in Ontario or use the titles "nurse", "registered nurse", or "registered practical nurse" without a valid certificate of registration from the College.
CNO has about 140,000 members across Ontario. We have almost 107,00 registered nurses (RNs) and over 33,000 registered practical nurses (RPNs).
All of Ontario’s health regulatory colleges have similar responsibilities, as set out in the provincial Regulated Health Professions Act (1993). They:
- decide what education and other qualifications are necessary to become a member of the profession;
- establish the standards of practice with which their members must
comply;
- administer quality assurance programs in which members are required
to participate to help maintain their competence; and
- provide a complaint and investigative process for people who feel
the standards have not been met in particular cases.
CNO is governed by a 39-member Council, 21 of whom are nurses elected by their peers from across Ontario (14 RNs and 7 RPNs). The other 18 members are appointed by the provincial government, and represent the general public.
The College of Nurses’ mission is to protect the public’s right to quality nursing services by providing leadership to the nursing profession in self-regulation. What does this really mean?
It means nurses governing themselves to ensure high standards of nursing practice. Almost all of our budget comes from annual registration fees, paid by practising nurses. Our governing Council has a majority of nurses. Most of our professional staff are also nurses.
But the term "self-regulation" also means that nurses themselves are responsible for practising in accordance with the standards of the profession, and for keeping current and competent throughout their nursing careers.
From the Minister of Education
As young people reach high school, they begin making important decisions about the kinds of careers they want to pursue. Nursing is one of a number of valuable career options from which students can choose.
Nurses provide vitally important service to our families, friends and communities, and the profession offers many rewards to the men and women who choose this career.
The Ministry of Education is providing more support than ever before to help students make career choices and select courses that support their future plans.
As part of our new high-school program all students have teacher-advisers who help them develop annual education plans setting out their course and career decisions. Teacher-advisers and guidance counsellors will help students who want to pursue nursing careers to choose the courses and programs they need to get into post-secondary nursing programs.
Ontario’s new rigorous curriculum gives students the solid preparation they need for future studies in nursing. New courses in science, and math as well as courses in medical technologies and nutrition provide the background for students pursuing such careers.
It is important to ensure that when young people step out and face the world, they are well prepared for the careers they have chosen. Many students find that the nursing profession offers a range of challenging and rewarding opportunities.
Hon. Janet Ecker
Minister of Education
From the Minister of Training, Colleges and Universities
Students who choose nursing as a career can work in a wide range of interesting and challenging areas. Some will choose public health nursing, for example, while others may prefer research or hospital nursing.
The Ministry of Training, Colleges and Universities has been working with colleges and universities on exciting changes in nursing education so students who choose nursing as a career are well prepared for their new profession.
Starting January 1, 2005, all new Ontario registered nurses will be required to have a new four-year baccalaureate degree in Nursing (BScN), as recommended by the College of Nurses of Ontario and the Nursing Task Force.
The government is improving nursing education by assisting colleges and universities in developing new, collaborative nursing programs leading to the baccalaureate degree. These programs will ensure that students learn about complex new therapies and treatments as well as new technology. The new programs will also prepare nurses to work in more independent, community-based practices.
We are confident that students taking these new programs will be well prepared to pursue exciting and challenging careers in the nursing profession.
Hon. Dianne Cunningham
Minister of Training, Colleges and Universities
From the Minister of Health and Long-term Care
Achieving consensus is rare. But when it comes to the nursing profession and the quality of care that distinguishes nurses in this province, any Ontarian who has ever had contact with our health system will agree that nurses are truly at the "heart" of health care.
As the largest single professional group within the health-care workforce, nurses are fundamental to efficient, effective health care. We know that strengthening nursing services leads directly to better care for patients.
Did You Know?That 83.3% of Ontario nurses received their basic nursing education in this province? Another 7.2% were educated elsewhere in Canada, less than 1% in the United States. England, Hong Kong, the Phillipines, and the Caribbean have also provided many Ontario nurses. |
The fact is, however, that as our population grows and ages, Ontario will need more nurses in the future. The number of students entering the profession is simply not keeping up with the number of nurses retiring or leaving the profession.
That’s why, to meet the needs of our growing and aging population, our government is taking steps now to ensure that we have a full complement of nurses to meet the current and future challenges of our health system.
As this publication shows, the nursing profession offers a diversity of career paths. Whatever you are looking for from your working life, a rewarding future with a comfortable income, respect from your community, intellectual challenge, the personal satisfaction derived from having a positive impact on the lives of others — nursing can provide it.
If you want an exciting career, if you want to make a difference, I urge you to take a serious look at being a nurse. Ontarians need you.
Elizabeth Witmer
Minister of Health and Long-Term Care
Portraits in Nursing
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Barb Bowman, RPN, Paediatrics, Bloorview McMillan Centre, Toronto. Barb has worked at Bloorview for more than 21 years, and is very involved in the life of the hospital. She has participated in everything from nursing research to budgets. |
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"Sometimes, despite all the odds, children do better than we expect. That’s what you hope for, that’s what you work for." |
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Abdiqani Qasim, RN, Coronary Intensive Care, Toronto General Hospital.
Abdiqani received his basic nursing education in Somalia, but has
continued his education here, and has started a Somali Nurses’
Association to help others adjust to life in Canada. |
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"I love teaching, sharing my ideas and skills with patients and especially with other nurses. Nurses should share with each other, that’s how you grow." |
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Lina Le Touzel, RPN, Visiting Nurse, Eastern Counties. Lina, who finds bilingualism a must on her "route", has tried many things in her brief career, from nursing homes to the regional hospital in Hawkesbury |
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"I like the one-to-one relationship in home care. I can take
more time to truly care for the patient, and I enjoy the greater
freedom." |
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Lynda Cranston, RN, CEO, Canadian Blood Services, Ottawa. Lynda, after receiving her nursing education in Ontario, served in administrative positions in hospitals across Canada before being named to head our new national blood agency in 1998. |
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"To this job I’ve brought the attitude that all nurses have, that the need of the client, the welfare of the client, is always the paramount consideration in any decision." |
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Susan Woollard, RN, Teacher at Centennial College and Nurse for the Toronto Blue Jays. |
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"There’s no excuse to not be continually challenged in nursing. The profession has such great variety, and you have such a high impact on people’s lives." |
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Linda Cheung, RPN, |
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"Sometimes the elders feel that no one loves them or respects them any more. The nurse tries to give back what they think they’ve lost." |
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Lee McDonald, RN, President, Southmedic Inc., Barrie. In the midst of a career in critical care and clinical research, Lee invented a safety device for use in the operating room, and has built it into a thriving medical equipment business. |
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"Nursing teaches you to look after people’s needs, to listen, to read non-verbal signals, to nurture. Those are skills highly in demand everywhere." |
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Betty Gillard, RPN, Queen Street Mental Health Centre, Toronto. Betty cares for 16 difficult-to-treat schizophrenic patients living in the community, and must often act as an advocate for them in the legal system. |
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"Higher functioning clients can get more services. My clients do not present well, they do not know how to ask for services. I have become their voice." |
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Capt. Caroline Price, RN, Disaster Response Team, CFB Petawawa. |
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"Nursing has given me great opportunities to see new places, and above all the satisfaction of knowing that at the end of the day, you’ve made a difference to somebody." |
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Joanne Barber, RPN, Occupational Health, Owen Sound. Joanne’s been the occupational health nurse for 26 years for Edwards, Canada’s largest maker of fire alarms and other safety equipment. |
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"My job’s a preventative one. If I’m not very busy I’m doing well. I think people want to help themselves to be healthy. That gives me a great place to start." |
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Roger Pilon, RN(EC), Primary Care Nurse Practitioner, Espanola. One of the first RNs to achieve the Extended Class designation, Roger has dedicated most of his career to helping aboriginal communities in Ontario’s north. |
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"The opportunity to work in a cross-cultural setting teaches you so much as a nurse and as a person. I have done a lot of soul-searching in these situations." |
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Lucia Matuk, RN, Nurse educator, University of Windsor. |
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"Nursing can take you anywhere, let you work with any age or state of health. I can’t imagine anything more rewarding." |
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Sandra French, RN, Founder, Clinical Research Services, Etobicoke. Sandra went from a career in intensive care to managing a blood lab, and now coordinates clinical research for physicians, hospitals and companies all across Canada. |
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"As a nurse, you have to take the opportunity to create your own niche. I started this company not just to earn more money, but to challenge my brain." |
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Margot Fournier, RN, Public Health Nurse, Simcoe. After three years in a hospital setting, Margot realized teaching was her forte, and has now been 14 years with the Health Unit, mostly working with teens and new parents. |
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"The thing about public health is the opportunity to make a long-term positive impact on people, especially kids, helping them make good decisions early in life." |
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David Fox, RN, Founder, Emergency Air Service, Toronto Island. Originally an ER nurse and teacher in Toronto, David started flying as a hobby, and has now combined his passions into an international business employing almost 70 nurses.
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"There are tons of possibilities in nursing – travel, all kinds of different things at different times – it all depends on how much risk you want to take." |
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Gillian Seaman, RN, Diabetes Educator and Movie Set Nurse, Toronto. Gillian was in critical care when a mentor encouraged her to focus on teaching. She returned for her degree and became a diabetes educator, with the movies as an exciting sideline. |
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"I’ve never regretted choosing nursing. It develops skill sets that will work in so many careers — critical thinking, teamwork, organizing. Nurses are very strong people." |
Organizations for Nursing
The Registered Practical Nurses’ Association of Ontario (RPNAO)
RPNAO is the professional association for Ontario’s RPNs. It strives to increase public awareness of the role of the RPN, and represents the interests of RPNs in the public forum. It maintains and enhances the professional skills of RPNs by researching, developing and delivering quality educational programs, and offers many other benefits to its members. For those interested in practical nursing as a career, RPNAO has a well-staffed and well-stocked Career Development Centre. Contact the Association at 905-602-4664, or by writing to 5025 Orbitor Drive, Building 4, Suite 200, Mississauga, Ontario, L4W 4Y5.
The Registered Nurses’ Association of Ontario (RNAO)
RNAO is the professional association for RNs in the province, and represents a broad network of nurses in a wide variety of roles and health care sectors. An independent, voluntary organization, RNAO’s role is to speak out for healthy public policy and the role of RNs. It provides a voice for RNs and students in clinical practice, administration, research, policy and education. RNAO’s Centre for Professional Development offers an extensive slate of professional development workshops and conferences to nurses and health care organizations. You can contact RNAO for career information by calling 416-599-1925, or by writing to 438 University Avenue, Suite 1600, Toronto, Ont., M5G 2K8.
Unions
In addition to a regulatory body, the College of Nurses of Ontario, and professional associations for both RNs and RPNs, many Ontario nurses are also represented on the job by labour unions. The Ontario Nurses’ Association represents RNs in a variety of practice settings, while RPNs are represented by several different unions, including the Registered Practical Nurses’ Federation of Ontario and various public service unions. These unions advocate for nurses in such matters as working conditions, salaries and benefits.
Nursing in a Culturally Diverse Community
To care for someone, I must know who I am.
To care for someone, I must know who the other is.
To care for someone, I must be able to bridge the gap between myself and
the other.
Ontario has some of the most ethnically diverse communities in the world. Ontario nurses need to take the time and effort to understand their own and their patient’s culture; only then will they be able to achieve the best outcome for everybody.
To help nurses provide appropriate care for these communities, the College of Nurses of Ontario recently published A Guide to Nurses for Providing Culturally Sensitive Care. The Guide outlines basic concepts about culturally sensitive care and shows how to put them into practice. A number of dramatic scenarios are used to illustrate these principles. For example:
"The smudging ceremony, in which sweetgrass, sage, cedar and/or tobacco are burned in a small bowl to create smoke, is a ritual of spiritual purification often requested by First Nation patients. How could we avoid discomfort to other patients? How could we avoid setting off the hospital’s smoke alarms? The ultimate solution was to hold the ceremony in a well-ventilated room, and have a maintenance staff member at the ready to turn off the alarms before the ceremony, and turn them back on once the smoke dissipated.
A child comes to a walk-in clinic with an ear infection, and the nurse feels the parents speak English well enough that an interpreter is unnecessary. She recommends Tylenol drops for fever and pain, as well as an oral antibiotic. Days later, she discovers the parents, based on previous treatment, had administered the drops into the child’s ears. This demonstrates the need to make sure instructions are understood, through physical demonstration if necessary.
A Hindu man with kidney failure, has suddenly changed his diet to a vegetarian one, saying that he wants God to help him with his ordeal. His treatment requires a high protein diet. The nurse must understand the reasons for the client’s wishes, and then work with a dietician to see how they can be met within a suitable diet for his illness.
Preparing for a Career in Nursing
Nursing: The Next Generation
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Alyssa McDiarmid, OAC student, Cumberland, Ontario |
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Planning: to enter baccalaureate RN program at University of Ottawa this fall Why Nursing? |
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Ella Page, Peterborough, Ontario, just graduated with her RN diploma at the age of 44, at the same time as her daughter (left in photo) got her RN degree. |
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Why Nursing? |
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Amanda McIntosh, Grade 11, Avonmore, Ontario |
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Planning: to enter RPN program at St. Lawrence College in Cornwall Why Nursing? |
A Study in Continuing Learning
Receiving a basic nursing education is just the beginning of a life long professional journey. Nurses have the opportunity — and are actively encouraged – to obtain further education and qualifications throughout their professional careers.
All nurses have ongoing access to a wide range of continuing education programs provided by employers, colleges and universities, professional associations and private companies. Meanwhile, nurses with a baccalaureate degree have the option of pursuing post-graduate studies that can lead to careers as clinical nurse specialists, nurse practitioners, educators, researchers, senior administrators and policy developers.
Here is what lifelong learning has meant to one RPN.
Did You Know?That 3.2% of RNs are male? For RPNs, the number rises to 6.0%. |
Nursing is among the least static professions. With rapid changes in technology, with great strides in research, not to mention the radical structural changes in Ontario’s health care system, nurses have to work hard to stay current. As registered practical nurse (RPN) Christiane Fillion of North Bay says, "There is always new information, new treatments. You have to keep up on things."
Growing up in Elliot Lake, about halfway between Sault Ste. Marie and Sudbury, Christiane was certain she wanted to do something exciting with her life. But what? Maybe the law, she thought, so after high school, she enrolled in a law clerk program, and quickly discovered the excitement wasn’t there. An office job was not for her.
She decided to change direction to health care, and was soon accepted at North Bay’s Canadore College for both the dental hygienist course and the program to become what was then called a registered nursing assistant.
Did You Know?That only 59.2% of RNs work in hospitals? The number is even less (51.7%) for RPNs. An increasing number of nurses are working in long-term care, home health care, public health and a variety of other settings. |
"Not long before that," she recalls, "I spent a lot of time with my grandmother in Sudbury. She was very sick, and I watched what the nurses did for her. I decided that kind of hands-on care was what I wanted to do."
After taking a refresher course in chemistry over the summer, Christiane enrolled at Canadore, graduating in practical nursing in May of 1990. A nurse at Casselholme Home for the Aged for eight years now, Christiane hasn’t had time to get stuck in a routine. She’s been too busy experiencing new things and learning.
The list of refresher or supplementary courses Christiane’s taken over the years in practice is long: medication administration, catheterization, venipuncture, human anatomy, wound management, pain management, and many others — about a dozen since she started at Casselholme.
"Casselholme’s been very encouraging. They know that everything I learn helps them. But all these courses have been baby steps, really. I’d like to go back to school full-time, maybe to become a registered nurse, and perhaps I’ll do it someday. I know I have the capability. You have to take every chance you can to better yourself, test your abilities, stretch your limits."
Learning Nursing Among the Poor in the Dominican Republic
Although the nursing programs in Ontario’s colleges and universities have many common elements, each is also unique in some of its approaches to basic nursing education. One example of this is a credit course in community nursing at Lambton College in Sarnia, which offers some of its students an extraordinary cross-cultural nursing experience – working with an order of Canadian nursing nuns in the poverty-stricken villages of the Dominican Republic.
Did You Know?That there are currently about 107,000 RNs and 33,000 RPNs in Ontario (by far the largest group of regulated health care providers)? |
This is the third year Lambton has sent students to the Caribbean nation. Nancy McRae, now an emergency nurse in a Sarnia hospital, participated in 1999.
"We didn’t really know what to expect," she recalls, "but we all learned so much: how important the family is in nursing care, how precious supplies and technology are. The patients were so grateful, just that you were there for them."
The students are picked to participate based on an essay in which they state their reasons for wanting to go. Lambton faculty member Sue Harrison says the week-long course, organized with RAYJON, a local charity, is invaluable. "They learn a lot of lessons about nursing and life in general," she says. "It dramatically tests their assessment skills, but above all it shows them that poverty is a disease in itself. It’s a tough week, but the number wanting to go just gets bigger every year."
A Time of Change
Nurses in practice today deal with patients suffering from more complex illnesses than in the past. At the same time, they must work with technology that is revolutionizing the way health care services are delivered. They are also expected to practise more independently, whether they are working in a chronic care unit as part of a larger health team, as a visiting nurse or in occupational health.
In such a complex health care environment, nurses beginning to practise their profession need a higher level of knowledge and skill from the outset. This is why the College of Nurses of Ontario recently passed new beginning practice standards for both RNs and RPNs that are set to take effect in 2005.
RNs will need bachelor’s degrees in nursing to enter the profession by that year. The new RPN competencies expand RPNs’ practice by broadening skills, by supporting independent decision-making, and by strengthening their partnership with RNs and other health providers.
The Degree in Nursing for RNs
Currently, RNs receive their basic education at either community colleges or universities and sometimes both. Beginning in 2005, newly registered RNs will require a Bachelor of Science in Nursing, which usually takes four years and can be completed either at a university alone, or through a collaborative program delivered jointly by a college and a university.
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Some universities offer a two-year nursing program for those who already have an undergraduate degree in another field. Francophone degree programs are also available in Ontario. The entrance requirements for RN programs vary according to school. However, baccalaureate programs generally require an Ontario Secondary School Diploma (OSSD) with six OAC credits including English and one or more science courses such as chemistry, physics or biology. Most degree-granting schools also require mathematics at a Grade 11 or higher level. Students are also required to obtain a Basic Cardiac Life Support Certificate prior to registration or within the first year of their studies. Upon graduation, RNs must write a national certification exam and be registered by the College of Nurses of Ontario. Nurses must renew their membership on an annual basis. It is expected that for the class entering post-secondary education in 2001, some community colleges will still offer the three-year basic education program for RNs, which results in a diploma. However, you should remember that beginning January 1, 2005, all applicants for registration from approved Ontario RN programs must hold a baccalaureate degree in nursing or its equivalent. After the phasing out of the RN diploma in 2002, many community colleges in Ontario will collaborate with universities to offer a B.Sc.N. |
"One day a nurse was shifting me in the bed and discovered a bedsore on my heel. She said she’d take care of it right away, and the way she bandaged it, she was so careful and deft and expert at it. It’s a small thing, but I wouldn’t have expected such skill and care. It really left an impression." -- 85-year-old retirement home resident |
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"I think one nurse – I don’t even know her name – made the difference between Maria living and dying. At the hospital, the first night, she was expected to die, and she didn’t. The same the next night. Finally this nurse said, ‘Look how hard this girl is fighting… don’t you think we should be fighting a little harder, too?’ When it comes down to it, nurses have made the difference between us falling part, and the way it’s turned out. They’ve meant a lot to us." -- Father of a teen with a rare disease |
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"I think we expect nurses to care for us. Not just treat our wounds and give us pills, but really care for us. The doctors treat us, but the nurses are expected to make us whole again." -- Owen Sound resident |
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The Registered Practical Nursing Certificate
Most RPNs are educated at community colleges. They participate in a three-semester certificate program.
The entrance requirements for RPN programs vary according to school but, in general, students will need an OSSD with credits at or above the general level including Grade 12 English, two sciences, and mathematics. Preference is given to applicants with advanced-level standing.
Schools offering RPN programs also require entering students to obtain a Basic Cardiac Life Support Certificate prior to registration or within the first year of their studies. Upon graduation, RPNs must write a national registration exam and be registered by the College of Nurses of Ontario. Nurses must renew their membership on an annual basis.
Discussions are ongoing regarding future educational requirements for RPNs in Ontario. While no final decisions have yet been made, it’s likely that the programs will be extended in length, and graduates will receive a diploma rather than a certificate.
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Interested?Challenge, excitement and the opportunity to be at the leading edge of health care — that’s what a career in nursing promises. To learn more about becoming a nurse, contact your school guidance counsellor or individual academic institutions offering nursing education. The professional associations profiled above also have a great deal of career information, as well as career development counsellors, who will be pleased to discuss all the options with you. Finally, take the opportunity to visit a nursing home or community health centre or hospital emergency room. Nothing will teach you more about nursing than watching one of us at work. |
Quality Assurance In Nursing
Graduating from a nursing school is only the beginning of a lifelong learning process. The world of health care is one of rapid technological and medical advances, and all health professionals have to keep up. That’s one of the exciting challenges of being a professional, and as your regulatory body, the College of Nurses (CNO) has a legal obligation to help you do it.
The College does this first by establishing professional standards of practice that all nurses are expected to follow (nurses across the province are consulted in the drafting of these standards). Then we help nurses maintain their competence in practice from year to year through our Quality Assurance Program.
One element of quality assurance is reflective practice, whereby with the assistance of colleagues, a nurse can identify the strengths of her or his practice, and put together a learning plan to address areas that need development. Participation in reflective practice is a legal requirement for all nurses practising in Ontario.
A second element, called practice review, involves randomly selected nurses, and provides a more objective and comprehensive analysis of a nurse’s practice.
The third element is voluntary, and focuses on the places where nurses work. The Practice Setting Consultation Program involves employers and nurses in a joint effort to identify elements of the workplace which support quality nursing care and professional practice, and those elements which could use improvement.
When There Are Concerns
Nurses are educated to support the wellbeing of their patients. But on occasion, something goes wrong or is misunderstood. How do self-regulating professions, like nursing, deal with concerns about one of their members?
CNO must investigate all written or verbal complaints received about a nurse’s conduct or competence, from patients or their families, employers, fellow nurses or members of the public. After investigation, if disciplinary action is warranted, it may take the form of a written or verbal caution, a reminder about the standards involved, or in extreme cases, withdrawal of the member’s right to practise as a nurse.
What Do Nurses Need to Know?
When pollsters survey the general public as to what profession most inspires their confidence and respect, nurses invariably place at the top. The public’s admiration is something nursing can be very proud of, but it also gives the profession high expectations to live up to. Just how have nurses achieved this status in the public mind?
One of the keys, of course, is nursing education. While it is true that a "caring" person is more likely to go into nursing, one cannot assume that a student naturally possesses the gifts that translate a caring attitude into high quality nursing.
Comprehensive scientific knowledge — how the human body works, and how to treat it when it doesn’t work — comprises an important component of a nurse’s basic education. But there are other core elements as well, including: how to apply nursing knowledge in various situations and practice settings; how to deal effectively and caringly with the public; how to behave professionally and ethically; and how to assure continued competence in nursing. Learning requirements in each of these areas can be found in the new entry competencies recently adopted by the College of Nurses of Ontario, and in the College’s professional standards of practice.
Nursing educators use these tools when designing their programs. As a result, nurses actually learn in the classroom not only how to administer medication, but how to decide whether to accept a gift from a patient; not only what to do in case of a heart attack, but also what constitutes verbal abuse of a patient. Nursing education equips its graduates not just to meet a patient’s health needs, but to meet them in a caring and professional manner.
What a nurse can or cannot do depends on her or his education and experience, with each nurse being accountable for knowing her or his abilities and for maintaining competence in them. The public esteem that nursing enjoys is a reflection of both the quality of nurses’ educational preparation, and their individual accountability for every professional act they perform.
Diary: Two Days in the Life of an RPN Nursing Student
Jacqueline Jabaralli is a student in the registered practical nurse program at Centennial College in Scarborough. We contacted her in the final weeks of her clinical placement before completion of the program, and when we asked her if she could record her reflections of a typical day in her student life, she asked if she could do two!
This assignment made me think again about why I wanted to become a nurse. When I finished high school, I knew that I wanted to feel needed, purposeful, useful, that I had made a difference to another’s health or well-being. There is no better satisfaction than to know that your clients depend on, and look forward to your care every day. Many people, when they think about a career, focus on things like money. But I think nursing will see phenomenal growth in a few years, and the money is not important compared to what the job is worth to my quality of my life and those I care for. Anyway, enough philosophy and on with my day!
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"Although the physical care is important, I think that the emotional support and guidance that nurses provide is even more essential." |
Wednesday, May 31, 9:30 a.m.
A theory class on mental health, talking about confusion, schizophrenia,
suicide. In the third semester, the last semester of our program (it’s
expanding to four semesters in the fall of 2001), we have classes the
first three days of the week, and our clinical placement on Thursday and
Friday. In this class, we spend a lot of time on a case study; the teacher
is excellent at stimulating discussion.
1:30 p.m. The lab continues discussion of mental health issues. We spend a lot of time in discussion groups, talking about our own experiences with mental illness. In these three semesters, the students have become comfortable with one another. Although we all get stressed from time to time, I don’t suppose that’s any different than any other course. Sometimes the workload seems overwhelming, but we’ve stuck in there, and I think we’ve learned things that are interesting and useful to our own lives as well as when we’re nursing. People even call us to ask advice about their ill family members. It makes you feel valued.
Thursday, June 1, 7:30 a.m. This is our clinical day at Sunnybrook Hospital. We start just before the morning shift, and listen to the staff as they report on the previous shift. We’re on the mental health unit, and can apply some of what we learned in class yesterday. We help with the administration of medicines and other treatments, then spend a lot of time talking to the patients.
In the last part of the semester, we will each shadow a particular staff member at Sunnybrook and eventually, under her watchful eye, we’ll take on her entire caseload for a few days. It’s very exciting but stressful. By the end of it, I think I’ll be ready to be a real nurse.
I’ll be proud to be a nurse; it’s an important profession in this society, and I’d encourage anyone to think about it.
Reflections: The Life Of A Baccalaureate RN Student
Sarah Bunn is a member of the Wabauskang First Nation in northern Ontario. Working as a secretary at the band’s health centre inspired her to go into nursing several years after graduating high school. Last spring, Sarah graduated near the top of her class in the B.Sc.N. program at Lakehead University in Thunder Bay, and is now working as a visiting nurse for St. Elizabeth Health Care. Below, Sarah reflects on life as a nursing student.
Class starts at 0830. Yawn! I get up at 0630 to spend about 30 minutes reviewing readings for today’s classes. I find that early morning is better for me to review as it is much quieter and there are no interruptions. At 0700 I shower, eat, drink my necessary cups of coffee. I make sure that my high school son and grade school daughter are up and out of bed, and head out the door by 0810 to get to class on time.
Deciding to go back to school was difficult. One factor was that I would be leaving the financial security of a full time job; there would be many living adjustments that I and my family would have to make. The other daunting factor was that I had not been in a formal educational setting for a number of years. But my husband was very supportive. To help me prepare for the baccalaureate program, I completed the Native Nurses Entry Program (NNEP), which provided the biology, physiology and chemistry background that was necessary for the first year of the nursing program. Not only did the science background prove valuable, but the life skills and study skills offered in the NNEP helped me succeed. And the people from NNEP have been there for me throughout my studies.
Today is Friday. My first class is from 0830 till 1130, and my next from 1130 till 1430. Fridays are usually a rough day, and I tend to get ‘brain strain’ by mid-afternoon.
I began the nursing program with some anxiety. I had to learn how to study, when to study, what to study, how long to study.
For our clinical placement, we have to do 12-hour shifts in our last year. Wow, talk about a dose of reality. This particular morning it is snowing and the weather station says it is about –15 Celsius. For clinical preparation the night before, I ironed my uniform and gathered my stethoscope and blood pressure cuff, my student identification, my school of nursing badge, and my watch. I did not want to forget a thing.
My nursing education created a monster. After a few years’ experience, I think I want go on and get my master’s degree in palliative care (care of the dying).
It is lunch at the hospital and I am overwhelmed. I question how all these things can be done on time. My preceptor tells me that I am taking too long with care for one client, and it takes away from providing care for my other clients. Time management is one thing I know I have to work on.
Well, the afternoon was far better than this morning. I am making notations on my sheet that I feel are important to report at the end of shift. My client care is going more smoothly now. Supper break is coming up, and I am beginning to feel tired.
My nursing education has helped me grow as a person, and I know now there are no limits as to how much I can do for my community. If you are a "people" person, I can’t suggest anything better than to be a nurse.
Contact Us
For further information about any aspect of nursing regulation in Ontario, including how to express a concern about a nurse's conduct or practice, please contact:
College of Nurses of Ontario
101 Davenport Road
Toronto, Ontario, M5R 3P1
cno@cnomail.org
Telephone: 416-928-0900 or Toll Free 1-800-387-5526
Fax: 416-928-9841
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