Members respond to help identify what makes RNs unique and valuable to healthcare in Alberta.

CARNA - Uniquely RN Members respond to help identify what makes RNs unique and valuable to healthcare in Alberta. RNs have expressed that their role is not always understood by colleagues, employers and in some cases, by RNs themselves! RNs are often not used to their full potential in many practice settings. Clear understanding of the RN role supports the best possible patient outcomes and most effective use of RN knowledge and skills. In the fall of 2014, Alberta RNs were invited to work together to describe the RN practice. Twelve face-to-face meetings were held around the province, where members could participate in the Uniquely RN discussions. All members were invited to share their thoughts and perspectives online through Thoughtexchange.

Introduction CARNA wants to know how our members feel about important issues that affect our profession. We began Uniquely RN as our first step to work with members to identify what makes RNs unique among the broadening range of health-care professionals. In November & December of 2014, we asked members to share their thoughts about the things that make the role of registered nurses uniquely valuable among the increasing array of health-care professions. Thank you to the many members who responded with thoughts, comments and questions. Your comments were knowledgeable and perceptive; you gave everyone so much to think about. We believe this discussion has provided a broad perspective from the profession. This helps to raise overall awareness of the value of our profession, and further inform how we communicate that value to others. 02

What is Thoughtexchange? CARNA, wanting a way to reach as many members as possible and engage them in more meaningful dialogue than traditional surveys allow, had been seeking a better solution. We found Thoughtexchange a Canadian software and service partner who s successfully been changing the face of organizational collaboration across North America. Thoughtexchange helps organizations tap into the voice of their members to identify key things that will help shape their communications and directions for the future. Unlike traditional listening tools, Thoughtexchange s large-scale, online, email-based process leverages the power of group intelligence and the principles of collaborative negotiation, by providing all CARNA members with a convenient and meaningful way to share their thoughts and learn from the perspectives of others. This allows CARNA to be more responsive and accountable to a wide range of member opinions, thereby building mutual understanding and confidence in how we represent and promote our profession to others, at both an organizational and individual level. How the Thoughtexchange Process Works Thoughtexchange is a simple multi-step process that provides three different opportunities for CARNA members to engage with each other. In the first step, participants were asked five open-ended questions about the value and uniqueness of the role of registered nurses. In the second step, participants were able to review the responses of others, and assign stars to the ideas they thought were most important. Now, in the third step, we are sharing the results so that all CARNA members can see what is most important to the group as a whole. The diagram below shows the three steps of the Thoughtexchange process. On the following pages, you can find the details of the questions asked and a summary of the findings. SHARE Submit Thoughts Consider Thoughts Understand What Matters Participants provide feedback on issues that matter to them. STAR Participants consider thoughts of other participants and add stars to the ideas that are most important to them. DISCOVER Everyone learns while they explore which thoughts are most important to the most people. 03

What We Asked CARNA Members We heard from members that they wanted to be able to easily speak to many audiences about the unique role of the registered nurse. We also heard that they felt they needed help to best describe that role and the value-added that registered nurses bring to patient care in Alberta. We wanted to gather nurses thoughts in an open, wide-ranging fashion. To do that, we asked five open questions on Thoughtexchange: 1. What are your concerns about how RNs are being utilized in the broadening range of health care professionals? 2. What aspects of the RN s role and practice are unique? 3. What value-added contributions does the RN s knowledge and expertise bring to patient care where there are overlaps in the scopes-of-practice? 4. What actions would you suggest need to be taken to ensure RN knowledge and expertise are being used fully for the best patient care and safety? 5. Is there anything else you d like to say about RNs role and practice? 04

Participation 2,440 members participated 6,898 thoughts were shared 216,279 stars were assigned to prioritize the most important ideas If each member who participated was given 2 minutes to voice his or her opinions on this issue in a round-the-clock live meeting, it would take more than 3 days to hear everyone s perspective. Additionally, participants considered the value of other members responses over 200,000 times! 05

Results We ve summarized the results for the complete process by showing 5 key things we heard across all the questions. Then, on the pages following, we ve looked more deeply into the thoughts you submitted. Each page s question includes emergent themes drawn from thoughts you assigned Stars to, and some key ideas expressed in those themes. This report draws on Thoughtexchange s Interactive Web Report http://thotex.com/sites/gilgl3rr2d0 to identify all these results from thoughts you provided and then assigned Stars to. We encourage you to look at the interactive report for details of those thoughts that resonated most strongly with your colleagues. 5 Key Things We Heard 1. Proving the best care to patients and families, no matter where they are, is a core value. RNs want to use their skills to the fullest, making sure that patients and families are central to a safe health system. 2. RNs want to provide comprehensive patient care supporting both health and wellness; that includes family, environment, social and economic support for each individual. 3. RNs want to be able to practice to their full scope throughout the system; this would improve both effectiveness and efficiency. 4. RNs are passionately proud of their training, skills and profession. They advocate for nursing care and are willing to continue to do so; they would like CARNA to help them to do that. 5. Tasks are only one part of the high quality patient care puzzle, not the whole picture. RNs place those tasks in a holistic, individual context, considering needs and acuity as well as anticipating possible outcomes and responses. As you review the results, use the following questions to help interpret the data What is affirming about the thoughts that had the most stars assigned? What was surprising to you about the thoughts that had the most stars assigned? Is there anything missing from the results that you expected to be there? 06 4

QUESTION 1: What are your concerns about how RNs are being utilized in the broadening range of health care professionals? RN REPLACEMENT Task focus means RNs replaced by others without complex care management skills When you lose RNs you lose big picture view of patient Budgets, not best patient care, are driving RN replacements Patient safety best served with RNs: know both how and when to do or not do a task and understand impacts Research shows reducing RNs at the bedside reduces optimal patient outcomes; ends up costing more PATIENT CARE Concerned that money, not best patient care, dictates staff mix Case management means time to care for and evaluate patients, not just read other s notes Direct contact with patients essential to patient safety, preventative care Every task RN performs includes assessment, but that is not recognized Comprehensive skills needed to build meaningful individualized care plan RN TO PATIENT RATIO Underappreciated value in less acute, more complex patients Ratios are becoming unsafe can t properly do full assessments Working with sicker patients and less staff No time to critically assess care reduces safety MULTIDISCIPLINARY ENVIRONMENT RNs are the ones who consistently look at patient as a whole, even in care teams Embrace perspectives in and beyond health system RNs problem solve with patients according to patient priorities KNOWLEDGE & SKILLS Decision makers don t understand knowledge and ability Abilities are underutilized in health care Scope of practice not understood by non-rns Need to promote ourselves and our skills LEADERSHIP Should be leaders in holistic primary care Should be supporting people in community not just medical Should be first choice to lead comprehensive care management SCOPE OF PRACTICE Focus should be on scope of knowledge, not scope of tasks Fewer staff means roles are being shifted away from RN skills and knowledge Feels like our scope of practice is narrowing Have less time available to spend on in depth patient care and assessment Clinical scope seems to get smaller as administrative duties increase When RNs aren t used to full scope, lose that identity and role CRITICAL THINKING & PROBLEM SOLVING Trained to think critically and make decisions based on acuity not always allowed When tasks are all that people see, critical thinking skills are discounted Time pressure means we can t focus on assessments and interventions 05 07

QUESTION 2: What aspects of the RN s role and practice are unique? CRITICAL THINKING & PROBLEM SOLVING Anticipate possible needs and events Prevention: constantly assess to keep issues from arising or worsening Comprehensive understanding of patient and their care Analyze possible treatment effects and anticipate possible responses Nursing is dynamic, RNs plan for how/why/what-if Understand complexity of patient and of system/care team HOLISTIC APPROACH TO PATIENT CARE Comprehensive approach to assessment and care of whole patient Integrate patient, family and care providers Manage each case while aware of complexities Care planning is realistic, appropriate and long term Assess immediate needs and future options with patient and family MULTIDISCIPLINARY ENVIRONMENT Evaluate patient responses to treatment Communicate with patients and families so they understand all care Interact with many health care providers RELATIONSHIP WITH PATIENT Patient advocacy with a holistic wellness lens Coordinate between patient and providers See the person not just the medical issue EDUCATION & KNOWLEDGE Depth and breadth of knowledge provides for more comprehensive care Apply determinants of health to provide full range of care and support Teach and share with patients and families Evaluate actions, anticipate and plan for possible outcomes Coordinate, integrate and adapt care for the patient LEADERSHIP Prioritize patient needs as part of case management Assess and manage across all aspects of patient s environment Strong advocates for best care for patient Knows dynamics of patient/family and health care system 08 4

QUESTION 3: What value-added contributions does the RN s knowledge and expertise bring to patient care where there are overlapping scopes of practice? CRITICAL THINKING & PROBLEM SOLVING Evaluate outcomes of care to make sure it s best for patients Think through full problem, envision options and outcomes RN s clinical judgement and critical thinking supports leading care management Makes connections between overall patient care and tasks KNOWLEDGE & SKILLS Assess, question and challenge practice to ensure it s best for patient Use knowledge to anticipate outcomes and prevent issues Patient advocacy a key and important part of role Putting the puzzle together; critical assessment of both tasks and outcomes Understand intricacies of individual care and the system MULTIDISCIPLINARY ENVIRONMENT Choreographers of multiple roles and providers for best patient care RNs are the bridge between patient and care team Lead patient management using broad collaborative approach LEADERSHIP Broad understanding and leadership in coordinating and planning care across disciplines BIG PICTURE THINKING See big social determinants of health picture; solve the puzzles Do task but also understand why and what might happen Provide consistency and coordination of patient care Looking at outcomes beyond immediate care PATIENT CARE RNs working to full scope are shown to improve patient outcomes Focus care on the whole patient (and family), not just one issue Comprehensive knowledge and care optimizes patient outcomes Assessment skills improve patient safety: recognize early changes 05 09

QUESTION 4: What actions would you suggest need to be taken to ensure RN knowledge and expertise are being used for the best patient care & safety? STAFFING LEVEL Essential to have enough RN staff to assess patients and assimilate care information Best patient care needs enough RNs to provide care, not just manage other providers Need enough time to use knowledge for patient care and safety Comprehensive care needs time to gather, process and implement patient information SUPPORT FROM ORGANIZATION Organizations need to support full scope of RN practice Support to refresh or update skills and knowledge benefits patients and the system PATIENT CARE Vital that RNs keep their role in direct patient/client care High acuity/complex patients need RNs at the bedside; best use of comprehensive assessment skills Health promotion and prevention are important aspects of RN training and care RN REPLACEMENT RNs in an appropriate staff mix are essential to good patient care Some tasks may be interchangeable; breadth of clinical knowledge and judgement isn t Feels like RNs are being replaced by other staff based on budgets, not best patient care Our ability to assess and anticipate patient outcomes isn t shared by all others in care teams Not real savings when reducing RN staff leads to increases in length of stay and readmissions KNOWLEDGE & SKILLS Always emphasize best knowledge and skill mix for patient care, not just budget Nurses need to know and educate others about different skills in the wider profession Time is so important to good care; time to evaluate care as well as to learn and improve INVOLVEMENT IN DECISION-MAKING Best patient decisions are made from the bedside up, not top down Policy and practice changes that affect front line care need strong feedback Advocate at every table for the positive difference RNs make ROLES & RESPONSIBILITY Real need for a better understanding of different roles in nursing When care only looks at tasks, we lose prevention, health promotion, comprehensive care management Work to educate public and others that RNs don t just do tasks Refocus our value to assessment, care planning, evaluating outcomes 10

QUESTION 5: Is there anything else you would like to say about RNs role & practice? PATIENT CARE RN reasoning and critical thinking makes a difference for patients Essential to best patient outcomes Knowledge and clinical judgement saves money by averting or minimizing problems Need autonomy to practice full clinical scope for their patients Put all information into seeing the whole client and their needs EDUCATION & SKILLS We need to educate public and providers on how RN skills make a difference Comprehensive case management skills should be core skills We don t just care; we care, reason, assess and act Our complex knowledge and skills combined with patient centred values apply across all contexts Knowledge and values can be taken for granted compared to skills GROWTH & DEVELOPMENT Roles and practices should proactively progress, not react to changes elsewhere We are capable of expanding and embracing new roles Don t worry about where others are, focus on where we want to go as RNs Communicate the exciting diversity of nursing practice to everyone we touch LEADERSHIP Essential to have a voice and advocate as individuals and for the profession See ourselves as leaders, step up and take the lead Leading care team is the best, most effective service to Albertans and health system DEDICATION & PRIDE We are passionately proud of what we do, even when the environment is challenging Practice with integrity and pride and never lower your standards We can t earn or keep respect and support of other professions on the backs of others. We can decide what we do best as a profession, where the most value is, and focus on making that what we are about. ROLE DEFINITION & PUBLIC AWARENESS CARNA needs to help to define, grow and develop the RN role We as RNs must take pride and promote the profession to public and employers Respect ourselves and value what we do so others can see that RNs are misunderstood by media, public and employers; we can do better Should always be able to work at full scope and increase scope Communicate not only our skills but our diverse knowledge and practice Articulate all of what we do, and why it s important to Albertans 11

Looking to the Future Thank you to all the participants of Uniquely RN, whether you participated in a meeting or joined in the Thoughexchange consultation. We learned a great deal about how you see the scope of the profession and all the roles registered nurses fill in this province. CARNA will be developing a strategy to act based on what you told us. In doing so we will call upon you again (RNs and NPs) to help shape the profession s future as we move forward together. In addition to Uniquely RN plans, information will also contribute to Exploring a Future for Expert Care forums in the near future. This will be a critical conversation about vision and the future role of RNs. Your report and guidance is shaping the next round of discussions with stakeholders. To inform the broader debate, we are also making this report available to other organizations such as governing bodies, health care employers and other health care professionals. This report is one of several that provide an overview of this first stage of Uniquely RN. It was wonderful to hear so many different thoughts from our members and we appreciate the opportunity to share the results back with you. Once again, we encourage everyone to read and form their own opinions of information presented here and in the Interactive Web Report http://thotex.com/sites/gilgl3rr2d0. Strong participation in this process continues to demonstrate your interest in the future of registered nurses and nurse practitioners in Alberta, and your commitment to the health and well-being of Albertans. Thank you! What CARNA Members Said 1. We are passionately proud of what we do, even when the environment is challenging. 2. We can decide what we do best as a profession, where the most value is, and focus on making that what we are about. 3. Communicate the exciting diversity of nursing practice to everyone we touch. Report prepared by