2015 has been off to a great start with the RNAO and CHNIG AGMs in April and the National Community Health Nursing Conference in June.

The Community Health Nurses' Initiatives Group (CHNIG) continues to be a strong and vibrant organization - an organization celebrating 37 years of advocacy and leadership for community health nursing in Ontario. As I enter my second term as President of CHNIG, I look forward to continuing to work with the CHNIG board: a dedicated, energetic and enthusiastic group of community health nurses, to address issues affecting the community sector. It is a time of change within our sector so now more than ever CHNIG must ensure it is positioned to consult with members and be the strong VOICE for community health nursing in Ontario.

The Community Health Nurses' Initiatives Group (CHNIG) is an interest group of the Registered Nurses' Association of Ontario (RNAO), which places us in a position to advocate and communicate in partnership with the RNAO to government. The diverse membership of CHNIG and of the board makes it possible for us to gather and support RNAO in responding on a diverse number of issues. In our ever changing/evolving health care system it is important that nurses from primary care, public health, home health and education work together to mold our future roles within this complex system. The board has again been very busy in 2015; particularly in consultations related to scope of practice, palliative care, community health curriculum in schools of nursing, end of life care discussions and the role of school health nurses within Public Health.

Tell us what you think needs to happen to improve community health nursing in Ontario and we can chat about this on Facebook and post a summary of your comments in our next newsletter. Email President@CHNIG.org with questions or comments.

CHNIG's ad-hoc School Health Team has worked extremely hard this year revising the school health white paper, developing an evidence paper to show support for school health nurses and developing a resolution for the RNAO 2015 AGM to influence practice and research for school health nurses which successfully passed! Thank you team! This resolution will be discussed at the next RNAO meeting and we will keep you informed with any progress.

Community Health Nurses of Canada (CHNC) held its 10th National CHNC Conference in Winnipeg, Manitoba, June 22 - 24, 2015. The theme was Blueprint for Action - Challenge the Status Quo! The conference brought together individuals who have an interest in Community Health Nursing from practice, research, administration, policy and education. The conference, as always, provided opportunities to exchange knowledge, share evidence and ideas, and generate solutions.

OPHA

Th Ontario Public Health Association (OPHA) Board of Directors has been busy the past few months as OPHA has engaged in several activities - many in response to government policy and/or legislation including Smoke Free Ontario Tobacco legislation, nutrition legislation, Ontario's Health and Physical Education curriculum, policies on alcohol availability/sales, minimum wage, and the proposed Ontario pension plan. On top of all the advocacy work, OPHA is planning their annual Fall Forum (Oct. 29th, 2015, in Toronto) and May Tao (CHNIG's Treasurer) is the CHNIG representative on the conference planning committee. The Fall Forum is titled "A Strong Voice; Enhancing Advocacy, Shifting Policy and Impacting Society" - check out the OPHA website: www.opha.on.ca.

Last but not least, a reminder that any member of CHNIG that also wants to join OPHA receives a sizable discount. Regular OPHA membership is $155 but CHNIG members can join for $115. Make sure you mention your CHNIG membership when joining OPHA!

Release of the Public Health Leadership Competencies for Public Health Practice in Canada!

Join us in celebrating the release of the Public Health Leadership Competencies for Public Health Practice in Canada: Leadership Competency Statements Release 1.0.

Community Health Nurses of Canada, Manitoba Public Health Managers Network and the Canadian Institute of Public Health Inspectors announced the release of the new Public Health Leadership Competencies for Public Health Practice in Canada: Leadership Competency Statements Release 1.0. The Project Spring 2015 Communique highlights the scientific and rigorous development of the leadership competency statements. Hard copies of the Public Health Leadership competencies are available through CHNC and are now available on the CHNC website.. Stay tuned for further details on Knowledge Translation strategies to advance the adoption of the Public Health Leadership Competencies for practice. Spread the word to your respective networks...

Is there an article or news story you would like featured in our next newsletter? Please email Newsletter@CHNIG.org

(CHNIG is not affiliated with the above mentioned news outlets, all opinions are those of the authors and do not necessarily represent the opinions of CHNIG or its board members)

Professional Development

Become a certified Community Health Nurse!

The CNA Certification Program has an exciting year ahead as they prepare for many new initiatives in 2016.

First, they are pleased to welcome Patricia (Pat) Elliott-Miller as executive lead for the certification and professional development division. Pat, a master’s-prepared RN, is a results-oriented executive nurse leader who has delivered best-in-class innovative practices through a range of administrative, academic and clinical roles. Most recently, she was the vice-president of patient care and chief nurse executive at the Children's Hospital of Eastern Ontario. Pat has a sound understanding of our certification program and the opportunities and needs all RNs have for continued professional development.

Second, CNA is working with their testing company, Assessment Strategies Inc. (ASI), to begin delivering the 20 certification specialty examinations as computer-based tests. ASI has entered into a multi-year partnership with Pearson VUE that will give candidates access to their network of proctored test centres across Canada.

Another exciting development is that the certification application and eligibility processes will be entirely online starting in 2016.

Important timelines:

• CNA and ASI will collaborate over the next few months on making the transition from paper- to computer-based exams.
• Applications/renewals will not take place this fall. We expect the online application process to open in late winter/early spring and will provide specific dates once they are confirmed.
• The first computer-based exams will take place in fall 2016. Eligible candidates will be able to write their certification exam between September 19 and October 7, 2016.
• To ensure that all certified RNs who are due to renew by April 2016 continue in good standing, CNA has extended the renewal expiry deadline to the end of 2016. Doing so will also allow RNs to renew using the new online process.

Stayed tuned to the CNA website in the coming months for webinars with helpful information about online applications and how the 2016 computer-based exams will work.

Community and Public Health Nurses and the Law

What legal processes could involve a community/public health nurse?

The community/public health nurse may be a witness or a defendant in legal proceedings. Common legal proceedings are civil lawsuits, criminal prosecutions, professional discipline hearings, inquests, and labour arbitrations. Less common are public inquiries and human rights tribunals (1).

What are the common legal issues a community/public health nurse may face?

a) Consent
Patients in the community must provide valid informed consent to treatment in order for you to provide care (2). If a patient lacks the capacity to consent, you must be familiar with the legislation pertaining to consent and substitute decision-making in your jurisdiction, as well as your employer's policies and procedures.

Treating a patient who has not given consent is battery, for which a court can award damages even if the patient did not suffer harm. In a recent lawsuit, a community health nurse was found to have committed battery by immunizing a child without parental consent. The consent form was not completed but the nurse mistakenly thought she had obtained verbal parental consent over the telephone. The nurse relied on the verbal consent when the 11-year-old child said her parent did not want her immunized. At trial, the judge cautioned that the child's assertion should not have been disregarded because consent to treatment can be revoked. "Inconvenient though it may have been," (3) the nurse should have confirmed parental consent before giving the injection.

b) Confidentiality
All health care professionals owe their patients a duty of confidentiality but there are some legal exceptions (4). For example, legislation may require you to report suspected child abuse and some communicable diseases. You may disclose information pursuant to a court order or during a legal proceeding. Otherwise, a patient must consent to disclosure of health information to a person outside the health care team. Examples of how the exceptions may affect your practice include:

• a school nurse who has reason to believe that a child is being abused reports to the local child welfare agency;
• a public health nurse at a family planning clinic knows and follows the process for communicating reportable diseases to the public health authorities;
• a community health nurse discloses otherwise confidential patient information in sworn testimony during a criminal trial; and
• at the request of the patient, a nurse on a home visit discusses the patient's condition in the presence of the patient's friend.

c) Documentation
Community/public health nurses face particular documentation challenges. As you often work alone, your documentation is as crucial as evidence. Confidentiality and security of records must be maintained, whether on paper or on a computer. If you work with inpatients (e.g. doing a well-baby assessment of a newborn in hospital), you must ensure that your findings are communicated in writing to the other members of the health care team to facilitate continuity of care (5).

Am I legally responsible for the actions of other health care providers working with me?

When you practice in the community with other health care workers, either you or your employer may delegate work to them (6). You are responsible for knowing the work approved for delegation by your employer and the circumstances under which work may be delegated. You are also responsible for making an appropriate decision to delegate and for adequately supervising other health care workers.

In a recent lawsuit (7), a disabled patient was receiving medications from community health nurses through her G and J tubes. The patient also had a central venous line [CVL] for total parenteral nutrition. The employer changed the patient assignment from an RN, delegating the patient's care to a registered practical nurse [RPN] who had never given medications. The RPN was found negligent for administering medications into the CVL instead of into the G or J tubes. The RPN's employer was also found negligent for assigning a patient with a CVL to an RPN and for failing to ensure that the RPN knew the patient had a CVL. The RN's were not found negligent even though the two references made by RNs to the CVL in the patient's chart, "were somewhat buried and inadequate at best" (8).

N.B. In this document, the feminine pronoun includes the masculine and vice versa.

1. For information on civil liability, professional discipline, criminal prosecutions and grievances, please refer to the infoLAWs on Negligence (Vol. 3, No. 1, September 1994), Malpractice Lawsuits Vol. 7, No. 2, September 1998), and Legal Risks in Nursing (Vol. 8, No. 1, November 1999).
2. infoLAW Consent to treatment: the role of the nurse (Vol. 3, No. 2, December 1994).
3. Toews (Guardian ad litem of) v. Weisner [2001] B.C.J. No. 30 (S.C.) at paragraph 24.
4. infoLAW, Confidentiality of Health Information: your client's right Vol. 1, No. 2, September 1993) and the Canadian Nurses Association Code of Ethics (1997).
5. A Jury Recommendation from the Verdict of the Inquest into the Death of Clare Azzopardi, Feb. 10-14, 1997 (Ontario) is that public health nurses be permitted and encouraged to document on the hospital chart if doing a well-baby check-up in hospital. Please note that coroner’s jury recommendations do not have the force of law.
6. infoLAW Delegation to other Health Care Workers (Vol. 9, No. 2, December 2000).
7. Till v. Walker [2000] O.J. No. 84 (Ont. S.C.J.).
8. Ibid. at para. 21.

This information has been copied with permission from the Canadian Nurses Protective Society (CNPS®). CNPS is a not-for-profit society that offers legal advice, risk management services, legal assistance and professional liability protection related to nursing practice to over 110,000 eligible Registered Nurses and Nurse Practitioners. You are generally eligible for CNPS services if you are a member of the the Registered Nurses Association of Ontario and are duly licensed or registered to practice nursing at the time of the events giving rise to your inquiry, a claim or legal proceeding. The CNPS is knowledgeable and aware of the unique challenges that community and public health nurses face, ranging from documentation to mandatory reporting requirements. We invite you to contact the CNPS to speak with a legal advisor to address your specific questions. Please call 1-844-4MY-CNPS (1-844-469-2677), or visit www.cnps.ca for more information.

THIS PUBLICATION IS FOR INFORMATION PURPOSES ONLY AND SHOULD NOT BE CONSTRUED AS LEGAL ADVICE FROM ANY LAWYER, CONTRIBUTOR OR THE CNPS. READERS SHOULD CONSULT LEGAL COUNSEL FOR SPECIFIC ADVICE.

When you join or renew your membership in CHNIG for the 2015/2016 year, it will no longer include a membership to the Community Health Nurses of Canada (CHNC) This was not a decision made by CHNIG. CHNC has developed a new membership structure for a number of reasons which you will hear more about over the coming months. All CHNIG members will need to go to the CHNC website https://www.chnc.ca/nursing-certification.cfm at the end of December this year to join CHNC. It is important to support CHNC as our national voice for community health nursing.

TOP 5 REASONS TO INVITE A FRIEND TO JOIN CHNIG:

• Knowledge Exchange and professional development including Health Promotion Seminar Series webinars
• Network with other community health nurses
• Financial Assistance including Scholarships/Awards to recognize your contributions and to aid your education or research. Bursaries are also available to support your attendance at the National Community Health Nursing Conference and the RNAO/CHNIG AGM's.
• Advocate for issues you believe are important to community health nursing
• Influence best practice development in particular changes related to Primary Care, Public Health, Home Health and Education

Changes in RNAO membership numbers

As of October 2014, RNAO is using a new program to track and monitor membership. Consequently, all members have a new RNAO number. Please make certain you check your membership card for it. Your old number is no longer valid. You need the new number to access protected RNAO information, register for webinars and to access “members only� sections on the websites of most interest groups.

• What is your role on the CHNIG Board? My role with CHNIG board is Policy and Political Action representative
• What is your role as an RN? My role in the past year as an RN is Advance Practice Nurse in Palliative Care for Central West CCAC.  Prior to this I was a palliative care case manager for several years.I provide support for patients with palliative care needs through assessment and consultation, education and capacity building through collaboration with physicians, nurses and other health care providers.I also have my Canadian Hospice Palliative Care Nursing designation through CNA and am having opportunities to influence change in the area of palliative care locally and provincially to optimize patient care at EOL and earlier.I also have worked as a residential camp nurse for the past 15 years.
• What is one of your most memorable experiences as an RN?There are so many memorable experiences in my 30 year career as an RN, that I can't really name one.The most important experiences for me have been those that highlight that I have made a difference as nurse to the patients, families and communities that I have been involved with.
• What challenges do you face in your professional role? The challenge that I face in my professional role at this point is that to continue in my present role, I need do my Masters in Nursing even though I have always done ongoing education during my 30 year career.This decision is difficult for me at this stage in my career.There are so many diverse ways for nurses to maintain professional competency through continuing education and so many options.
• If you were to share a piece of wisdom for nursing students or new graduate RNs, what would that be?Nursing students and graduate RNs need to be involved in continuing education and need to advocate and stand up for broad perspective that nurses provide to patients, their families and their communities.They need to be involved with their professional associations and consider all the influences affecting all the domains of care.

CHNIG Scholarships, Awards and Bursaries 2015 Recipients

The Community Health Nurses' Initiatives Group (CHNIG) annually supports up to 10 RN and student nurse members to attend the national conference.

With this year's conference focus on the leadership strategies required to face the growing inequities, this is what some of our successful applicants had to say about the conference.

"I listened to stories of leadership and nurses becoming aware of their own leadership capacity. The discussions included strategies to incorporate in a leadership role such as: take risks, establish trusting relationships, be resilient, have courage, and build consensus". Ruth Schofield

"It felt fantastic to arrive in Winnipeg and step into the Community Nursing Conference.I felt surrounded by colleagues who are making a difference and truly are “Challenging the Status Quo". I went to amazing talks and workshops". Amanda Sissons

"The conference demonstrated to me numerous ways nurses are working to create meaningful change to improve the health and wellness of the communities they serve; the nurse-run clinic in Winnipeg or Toronto Street Heath nurses are two of the many examples that inspired me while attending the conference". Hilary Smith

The keynote presentation, delivered by Dawn Lavell-Harvard, was moving, emotional, and very timely on the heels of the release of the Truth and Reconciliation Report. It struck me that the time is now for CHNIG to initiate discussion with RNAO and CHNC about what actions can be taken by these nursing organizations so community health nurses can be a part of addressing the important issues brought forward through this keynote and in the Truth and Reconciliation Report. Joyce Fox

My new learnings during this session included an introduction to the new Public Health Leadership Competencies, and information about different types networking and their purposes. I valued the opportunity to learn about the amazing work of students, staff nurses, leaders, and researchers across the country. Ruth Walker

"I will continue to set professional development goals that will maximize my leadership potential, strengthen community partnerships, and gain a better understanding on how to incorporate health equity principles into program/service planning. Networking and participating in an oral presentation at a national conference with my fellowship mentor was exhilarating. It reinforced the value of influential mentorships, and having the courage to accept unique, opportunistic moments". Lisa Prowd

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