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A legislatively regulated and self-regulating profession, such as nursing, holds its members (registered nurses) accountable to the public it serves for the continuous development of the competencies they profess to hold. A requirement for competency is lifelong learning and can be evidenced through certification. In this paper, the interrelationship of lifelong learning, certification, and registered nursing practice is examined. Strategies used to support certification through a lifelong learning approach are described.

In Germany and Canada, the integration of immigrants into the labour market is closely related to the various approaches towards the recognition and validation of informal learning. This paper aims to analyse the informal learning measures undertaken by immigrants as well as those offered by employers in the health and information and communication technology sectors during the labour market integration process. The study focused on nurses as well as IT project managers and programmers. The comparison focuses on the occurrence and quality of the four dimensions of the dynamic model of informal learning from an individual and an organisation perspective. The results show similarities between these two perspectives regarding the relevance of the four dimensions in the integration of immigrants into the labour market. In addition, clear differences between the two investigated sectors as well as country-specific differences appear.

This rapid systematic review examined the reported effects of large-scale online education on the behaviour and, ultimately, practice of health and social care professionals. Electronic databases of health and education literature were searched, 193 unique records were screened against inclusion and exclusion criteria, 31 papers were accessed for full text reading and six were included. Identified studies reported primarily qualitative results, which were synthesised according to outcomes. Factors that contributed to the results were also identified. All papers reported that participation in e-learning programmes resulted in changes in behaviour and practice, including: increased awareness, changes in attitudes, improved communication, increased confidence and the actual changes applied in a workplace. Observed benefits of these programmes ranged from gaining new insights into own practice, through feeling empowered to apply changes, to eventually being able to provide more person-centred services and willing to adopt and spread a more humane evidence-based practice. While the current study is an early indication of the potential of large-scale online education to effect practice change, further research is recommended as is further in-depth investigation into how these changes are achieved and what factors contribute to success.

Nurses in Canada face diverse challenges to their ongoing educational pursuits. As a result, they have been early adopters of courses and programs based on distance education principles and, in particular, online learning models. In the study described in this paper, nurses studying at two northern universities, in programs involving online learning, were interviewed about their learning experiences and the impact of these experiences on their practice. The study led to insights into the factors affecting teaching and learning in distance settings; the complex work-life-study roles experienced by some nurses; life and work realities in northern settings; and the sustained importance of access enabled by online learning approaches.

The ubiquity, flexibility, and accessibility of mobile devices can transform how registered nurses in Canada learn beyond the confines of traditional education/training boundaries in their work settings. Many Canadian registered nurses have actively embraced mobile technologies for their work-based learning to meet their competency requirements for professional nursing practice. As self-directed learners, they are using these learning tools at point-of-need to access rich online healthcare resources, collaborate, and share information within their communities of practices. Yet, paradoxically, there are Canadian healthcare organizations that have not embraced work-based mobile learning and their contextual factors constrain and/or impede registered nurses' learning. Therefore, the goal of this reflective paper is to stimulate discussion on distributive leadership strategies for embedding this pedagogical mode of learning into Canadian healthcare workplaces for registered nurses' ongoing skills and continuing professional development.

Medical Assistance in Dying (MAID) legislation has evolved rapidly in Canada with significant impacts on nursing practice. The purpose of this paper is to describe evolving complexities in legislative context and practice standards that influence the experiences nurse practitioners and registered nurses have with MAID. Qualitative interviews were conducted with 25 registered nurses and 10 nurse practitioners from diverse contexts across Canada. Participants described their practices and considerations when discussing MAID as part of advance care planning; their use of, and challenges with, waivers of consent; their practice considerations in negotiating the complexities of clients for whom death is not reasonably foreseeable; and their moral wrestling with the inclusion of MAID for persons whose sole underlying medical condition is mental illness. Findings illustrate the moral complexities inherent in the evolving legislation and the importance of robust health and social care systems to the legal and ethical implementation of MAID in Canada. [ABSTRACT FROM AUTHOR]

This paper is an examination of the methodological and theoretical perspectives of a study with an inquiry focus on the experiences and perspectives of staff who worked at an injectable opiate assisted (iOAT) clinic. Twenty-two staff members, including nurses, social workers, and peer support workers, were interviewed. The goal of the study was to uncover how the clinic staff provided care to the clients who attend the clinic, their perspectives on how the clinic program impacted both them and their clients, and their experiences with the program itself. This interpretive descriptive study was underpinned by critical social theory. Thematic analysis was undertaken to identify recurring, converging, and contradictory patterns of interaction, key concepts and emerging themes. In this paper we examine and discuss how the relationship between critical social theory and interpretive description enhanced the study. Examples from the study are presented to provide insight into the relationship. [ABSTRACT FROM AUTHOR]

As uses of plasma-derived medical products increase globally, so does the demand to collect plasma from donors. There is evidence that positive interactions with center staff motivate plasma donors to return. This paper reports on a focused ethnography investigating experiences of nurses and phlebotomists in one of Canadian Blood Services' first source plasma collection center during the COVID-19 pandemic. Participants found the transition from whole blood collection to source plasma amid a global pandemic challenging, but they adapted by coming together as a team, and then worked to put the donor experience first. Their experience resonates with scholarship on emotional labor. As blood services worldwide attempt to increase source plasma collection, there is a need to understand care work that nurses and phlebotomists perform on the front-line. This study offers insight into how blood services can support staff in plasma operations by recognizing emotional labor. [ABSTRACT FROM AUTHOR]

The labour market for care professionals has experienced significant changes, resulting in critical shortages globally. Nurses represent the largest share of health workers worldwide; nonetheless, an estimated 13 million more nurses will be needed over the next 10 years. Prior to the pandemic, the domestic supply of nurses in Canada had not kept pace with the ever-increasing demand for services. Pre-pandemic age- and needs-based forecasting models have estimated shortages in an excess of 100,000 nurses nationwide by 2030. While COVID-19 has accelerated the demand for and complexity of service requirements, it has also resulted in losses of healthcare professionals due to an increased sick leave, unprecedented burnout and retirements. This paper examines key factors that have contributed to nursing supply issues in Canada over time and provides examples of policy responses to the present shortage facing the healthcare system. To provide adequate care, the nursing workforce must be stabilized and—more importantly—recognized as critical to the health of the population. [ABSTRACT FROM AUTHOR]

This paper examines masculinity, migration and the changing occupational status of nursing through the lens of therapeutic mobilities; health related mobilities of people (nurses) and products (credentials). Indian men have become increasingly interested in nursing as a career, and this interest is strongly associated with the profession's international motility-its mobility potential. The research reported in this paper traces the migration trajectory across time (2008-2016) and over space (India to Canada) and reveals an overrepresentation of male nurses in international migration contexts (Canada), compared to the Indian context. Male nurses also disproportionally benefit from these mobilities in terms of their occupational success post-migration. Mobilities can be therapeutic for the status of nursing in India, which rises in line with the degree of international motility the profession offers, but gendered distinctions in the outcomes of the migration process illustrate the importance of highlighting uneven mobilities. International mobilities are also deeply implicated in ongoing transformations occurring in the 'moorings' of nursing educational, employment and regulatory structures in India. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Compared to the general population, people with mental illness die several years prematurely. The prevalence of chronic physical illnesses such as diabetes and cardiovascular disease is higher in people with mental health illnesses, putting them at increased risk of developing skin wounds.The majority of the studies on wound care education and management were carried out in acute care and long‐term care settings. A very few addressed the wound care needs for psychiatric patients and the educational needs of nurses in the mental health setting. What the paper adds to existing knowledge?: This study adds to the existing evidence by offering an evidence‐based solution to equip Psychiatric and Mental Health Nurses (PMHNs) with the necessary knowledge and skills to provide high‐quality wound care to patients.When a lack of wound care competency has been identified, it may be worth the effort to provide education and training to psychiatric nurses on wound care management. What are the implications for practice?: This project has the potential benefit of healthcare cost savings, which can be further investigated in a future study, for instance, a pilot randomized controlled trial to estimate the parameters for a full‐trial and cost‐effectiveness study.Future mental health nursing practice and research need to focus on finding solutions to help support PMHNs improve their competence in caring for physical illnesses. Introduction: People with mental illnesses are at increased risk of developing skin wounds. A very few studies addressed the wound care needs for psychiatric patients and the educational needs for psychiatric and mental health nurses (PMHNs). Aim: A wound care education—feasibility and quality improvement project—was implemented to improve wound care competence among nurses on the Seniors' Mental Health Units at a psychiatric hospital. Methods: A total of 36 nurses participated in wound care knowledge education and completed both the pretest and post‐test. Four nurses participated in wound care skills training. Results: The post‐intervention mean score increase for wound care knowledge was 5.14 (178%) and for skills was 7(75.7%). The results were statistically significant (p <.001). Discussion: This study adds to the existing evidence by offering an evidence‐based solution to equip PMHNs with the necessary knowledge and skills to provide high‐quality wound care to patients. Implications for Practice and Research: Future mental health nursing practice and research need to focus on finding evidence‐based practical solutions to help support PMHNs improve their ability to care for physical illnesses. A future pilot randomized controlled trial will be needed to estimate the parameters for a full‐trial and cost‐effectiveness study. [ABSTRACT FROM AUTHOR]

While it is generally recognized that nurses and nursing issues are underrepresented in the media, the contrary is also true during major public health care crises like Ebola and SARS (Severe Acute Respiratory Syndrome). We see this phenomenon unfolding in the midst of the current COVID-19 pandemic with nurses and nursing issues receiving extensive media coverage in Canada and internationally. To gain more insights into this media coverage, we analyzed the content of Canadian news stories published in both English and French during the first five months of the COVID-19 pandemic. This paper presents the findings of our analysis and identifies important lessons learned. We believe that our findings serve as an important starting point for understanding nurses' agency and the media savviness they displayed during the first months of the pandemic. [ABSTRACT FROM AUTHOR]

Background: This study reports on physicians’ experiences with chronic pain management. For over a decade prescription opioids have been a primary treatment for chronic pain in North America. However, the current opioid epidemic has complicated long-standing practices for chronic pain management which historically involved prescribing pain medication. Caring for patients with chronic pain occurs within a context in which a growing proportion of patients suffer from chronic rather than acute conditions alongside rising social inequities. Methods: Our team undertook an ethnographic approach known as institutional ethnography in the province of Ontario, Canada in order to explore the social organization of chronic pain management from the standpoint of primary care physicians. This paper reports on a subset of this study data, specifically interviews with 19 primary care clinicians and 8 nurses supplemented by 40 hours of observations. The clinicians in our sample were largely primary care physicians and nurses working in urban, rural and Northern settings. Findings: In their reflections on providing care for patients with chronic pain, many providers describe being most challenged by the work involved in helping patients who also struggled with poverty, mental health and addiction. These frustrations were often complicated by concerns that they could lose their license for inappropriate prescribing, thus shifting their work from providing treatment and care to policing their patients for malingering and opioid abuse. Interpretation: Our findings show that care providers find the treatment of patients with chronic pain–especially those patients also experiencing poverty–to be challenging at best, and at worst frustrating and overwhelming. In many instances, their narratives suggested experiences of depersonalization, loss of job satisfaction and emotional exhaustion in relation to providing care for these patients, key dimensions of burnout. In essence, the work that they performed in relation to their patients’ social rather than medical needs seems to contribute to these experiences. Their experiences were further exacerbated by the fact that restricting and reducing opioid dosing in patients with chronic pain has become a major focus of care provision. [ABSTRACT FROM AUTHOR]

Background: Global trends in migration accompanied with recent changes to the immigrant selection process may have influenced the demographic and human capital characteristics of internationally educated nurses (IENs) in Canada and in turn the assistance required to facilitate their workforce integration. This study aimed to describe the demographic and human capital profile of IENs in Canada, to explore recent changes to the profile, and to identify predictors of IENs' workforce integration.Methods: A cross-sectional, descriptive, correlational survey design was used. Eligible IENs were immigrants, registered and employed as regulated nurses in Canada. Data were collected in 2014 via online and paper questionnaires. Descriptive statistics were used to examine the data by year of immigration. Logistic regression modeling was employed to identify predictors of IENs' workforce integration measured as passing the licensure exam to acquire professional recertification and securing employment.Results: The sample consisted of 2280 IENs, representative of all Canadian provincial jurisdictions. Since changes to the immigrant selection process in 2002, the IEN population in Canada has become more racially diverse with greater numbers emigrating from developing countries. Recent arrivals (after 2002) had high levels of human capital (knowledge, professional experience, language proficiency). Some, but not all, benefited from the formal and informal assistance available to facilitate their workforce integration. Professional experience and help studying significantly predicted if IENs passed the licensure exam on their first attempt. Bridging program participation and assistance from social networks in Canada were significant predictors if IENs had difficulty securing employment.Conclusions: Nurses will continue to migrate from a wide variety of countries throughout the world that have dissimilar nursing education and health systems. Thus, IENs are not a homogenous group, and a "one size fits all" model may not be effective for facilitating their professional recertification and employment in the destination country. Canada, as well as other countries, could consider using a case management approach to develop and tailor education and forms of assistance to meet the individual needs of IENs. Using technology to reach IENs who have not yet immigrated or have settled outside of urban centers are other potential strategies that may facilitate their timely entrance into the destination countries' nursing workforce. [ABSTRACT FROM AUTHOR]

In Canada, different categories of nursing professionals, including registered nurses and practical nurses, often "collaborate" to provide care to patients. How their collaboration is currently conceptualized in the literature varies; and these conceptualizations are not always contextualized by the complex sociopolitical environment in which nursing professionals work. The purpose of this study was to explicate how different categories of nursing professionals (registered nurses and practical nurses) worked together to provide patient care after a provincial health authority implemented a new nursing care delivery model to "optimize" patient care. The authors used Smith's institutional ethnography to guide the study, and data collection methods included observing, conducting interviews, and identifying the texts activated through the nursing professionals' work. Data analysis focused on the social organization of the nursing professionals collaboration, while keeping the complex contexts within they completed their daily work in view. The article concludes with recommendations for future research. [ABSTRACT FROM AUTHOR]

Workplace violence against nurses is a significant global occupational health problem, with incidents of violence increasing in frequency since the COVID-19 pandemic began. In this article, we provide a review of recent legislative amendments meant to bolster workplace safety in health care in Canada, analyze legal cases where nurses were the victims of violence, and discuss what these legal reforms and decisions reveal about how nurses' work is treated within the Canadian legal system. Under criminal law, the limited number of cases we could find with oral or written sentencing decisions show that, historically, the fact a victim was a nurse was not always considered an aggravating factor on sentencing. Recent legislative amendments make this a specified aggravating factor and it is important to track the impact of these amendments when judges exercise their discretion in sentencing. Under employment law, it appears that, despite the government's efforts to increase the deterrence factor under legislation with significantly increased fines for employers who fail to protect their employees from injury, courts remain reluctant to impose such sanctions. In these cases, it is also important to track the impact of harsher penalties. We conclude that combating the widespread normalization of workplace violence in health care, and specifically against nurses, is acutely needed to help ensure that these ongoing legal reforms aimed at improving the safety of health workers are effective. [ABSTRACT FROM AUTHOR]

Aim This paper seeks to identify gaps within nursing collective agreements for opportunities to implement practices to sustain the nursing workforce. Background Since the majority of nurses in Canada are unionised, some of the strategies recommended in the literature to cope with nursing shortage may not apply to unionised nurses, making collective agreements a potential source for designing practices that can mitigate the impact of ageing nurses. Method Nine major collective agreements for registered nurses in each province governing the nursing employment relationship were analysed to see if different practices were already addressed in the collective agreements. Results Five such practices were identified, including: providing more mentorship opportunities; encouraging nurses who are eligible to retire to remain in the nursing workforce; attracting internationally trained nurses; implementing operational changes that include process improvements or new technologies; and empowering nurses through flexibility in work schedules. Conclusion If collective agreements are silent in any of the strategies identified in the literature, health-care organisations can adopt these practices without violating the collective agreements. Implications for nursing management Non-unionised health-care organisations can also benefit from learning about these policies and practices to assist in managing and sustaining an ageing nursing workforce. [ABSTRACT FROM AUTHOR]

Death and dying are natural phenomena embedded within complex political, cultural and social systems. Nurses often practice at the forefront of this process and have a fundamental role in caring for both patients and those close to them during the process of dying and following death. While nursing has a rich tradition in advancing the palliative and end‐of‐life care movement, new modes of care for patients with serious and irremediable medical conditions arise when assisted death is legalized in a particular jurisdiction. In early 2015, the Supreme Court of Canada released its landmark decision Carter v. Canada (Attorney General) ('Carter'), which legalized physician‐assisted suicide in particular clinical situations. The new law provided the broad national framework for Medical Assistance in Dying (MAiD) in Canada but, once the law was passed, provincial and territorial governments and health professional regulatory bodies each had to undertake a process of developing policies, procedures and processes to guide MAiD‐related practice specific to their jurisdiction. In this paper, we begin to examine the political ramifications and professional tensions arising from MAiD for nurses and nursing, focusing specifically upon the impacts for registered nurses. We identify how variations in the provincial and territorial literature and regulatory guidelines across Canada have given rise to role confusion and uncertainty among some registered nurses and how this may potentially impact patient care. We then continue to highlight the need for greater political activism among nurses to foster greater clarity in nursing roles in MAiD and to advocate for improved supports for patients and those close to them. [ABSTRACT FROM AUTHOR]

This study explores nurses' experiences of workplace conflict with patients and their family members, how it differs by ethnic/racial identity, and highlights the coping strategies engaged to lessen these conflicts. Using a qualitative research design, this study draws on phenomenology and in‐depth interviews of 66 registered nurses and registered practical nurses from multiple sites in two Canadian cities to explore the experiences of nurses with multiple marginalized identities in relation to nurse–patient and nurse–patient's family member conflicts in direct care practice. The results show that horizontal conflicts, especially, ones involving nurses, patients, and their family members are quite pervasive in the nursing profession. Direct care nurses, especially, ethnic minorities relative to majority groups experience excessive physical assaults, verbal aggressive behaviors, racial stereotyping and discrimination, and sexual harassment from patients and patients' family members. Institutional support through policies and practices designed to de‐escalate aggressive behavior from patients and their family members were identified as important support systems. We conclude that policies aimed at creating a safe and strong health‐care system call for holding patients and th'eir family members legally responsible for uncivil and aggressive behavior against caregivers. [ABSTRACT FROM AUTHOR]

Needs of parents with children with scoliosis are complex and depend on their child's treatments. The purpose of this study was to identify needs of parents with children with scoliosis. This qualitative description involved interviews with parents of children at various stages of treatment. A convenience, then purposeful sample of 16 parents (12 mothers, two fathers, and two stepfathers) was interviewed; interviews were transcribed and analyzed using thematic analysis. Parents' needs included: Needing reliable medical information; Desiring information on complementary treatments; Wanting help in supporting and advocating for their child; Needing to protect the child and family; and Seeking connection and support. Although many parents' needs are being met, this study recommends a nursing role aimed at providing parents with reliable medical information, discussing alternative treatments, assisting parents in their role of supporting their child, helping parents in their advocacy efforts, and referring parents to appropriate connections. [ABSTRACT FROM AUTHOR]

Background: Although much research has focused on nurses' retirement intentions, little is known about nurses who formally retire yet continue to practice, particularly in rural and remote settings where mobilization of all nurses is needed to assure essential health services. To optimize practice and sustain the workforce stretched thin by the COVID-19 pandemic, it is necessary to understand what it means for retired registered nurses (RNs) and licensed practical nurses (LPNs) to work after retirement. This study explored what nursing practice means for RNs and LPNs who have formally retired but continue to practice in rural and remote communities. Methods: A pan-Canadian cross-sectional survey conducted in 2014–2015 of nurses in rural and remote Canada provided data for analysis. Textual responses from 82 RNs and 19 LPNs who indicated they had retired but were occasionally employed in nursing were interpreted hermeneutically. Results: Retired nurses who continued to practice took on new challenges as well as sought opportunities to continue to learn, grow, and give back. Worklife flexibility was important, including having control over working hours. Nurses' everyday practice was inextricably tied up with their lives in rural and remote communities, with RNs emphasizing serving their communities and LPNs appreciating community recognition and the family-like character of their work settings. Conclusions: Retired nurses who continue to work in nursing see retirement as the next phase in their profession and a vital way of engaging with their rural and remote communities. This study counters the conventional view of retaining retired nurses only to combat nursing shortages and alleviate a knowledge drain from the workplace. Rural and remote nurses who retire and continue working contribute to their workplaces and communities in important and innovative ways. They can be characterized as dedicated, independent, and resilient. Transitioning to retirement in rural and remote practice can be re-imagined in ways that involve both the community and the workplace. Supporting work flexibility for retired nurses while facilitating their practice, technological acumen, and professional development, can allow retired nurses to contribute their joy of being a nurse along with their extensive knowledge and in-depth experience of nursing and the community. [ABSTRACT FROM AUTHOR]

Background: More than a dozen countries have now legalized some form of assisted dying, and additional jurisdictions are considering similar legislations or expanding eligibility criteria. Despite the persistent controversies about the relationship between medicine, palliative care, and assisted dying, many people are interested in assisted dying. Understanding how end-of-life care discussions between patients and specialist palliative care providers may be affected by such legislation can inform end-of-life care delivery in the evolving socio-cultural and legal environment. Aim: To explore how the Canadian Medical Assistance in Dying legislation affects end-of-life care discussions between patients and multidisciplinary specialist palliative care providers. Design: Qualitative thematic analysis of semi-structured interviews. Participants: Forty-eight specialist palliative care providers from Vancouver (n = 26) and Toronto (n = 22) were interviewed in person or by phone. Participants included physicians (n = 22), nurses (n = 15), social workers (n = 7), and allied health professionals (n = 4). Results: Qualitative thematic analysis identified five notable considerations associated with Medical Assistance in Dying affecting end-of-life care discussions: (1) concerns over having proactive conversations about the desire to hasten death, (2) uncertainties regarding wish-to-die statements, (3) conversation complexities around procedural matters, (4) shifting discussions about suffering and quality of life, and (5) the need and challenges of promoting open-ended discussions. Conclusion: Medical Assistance in Dying challenges end-of-life care discussions and requires education and support for all concerned to enable compassionate health professional communication. It remains essential to address psychosocial and existential suffering in medicine, but also to provide timely palliative care to ensure suffering is addressed before it is deemed irremediable. Hence, clarification is required regarding assisted dying as an intervention of last resort. Furthermore, professional and institutional guidance needs to better support palliative care providers in maintaining their holistic standard of care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describes nurses' moral experiences with Medical Assistance in Dying in the Canadian context. Background: Nurses perform important roles in Medical Assistance in Dying in Canada and do so within a unique context in which Medical Assistance in Dying is provided through healthcare services and where accessibility is an important principle. International literature indicates that participating in Medical Assistance in Dying can be deeply impactful for nurses and requires a high degree of moral sense‐making. Design: A qualitative interview study guided by Interpretive Description using the COREQ checklist. Results: Fifty‐nine nurses from across Canada participated in the study. The decision to participate in Medical Assistance in Dying was influenced by family and community, professional experience and nurses' proximity to the act of Medical Assistance in Dying. Nurses described a range of deep and sometimes conflicting emotional reactions provoked by Medical Assistance in Dying. Nurses used a number of moral waypoints to make sense of their decision including patient choice, control and certainty; an understanding that it was not about the nurse; a commitment to staying with patients through suffering; consideration of moral consistency; issues related to the afterlife; and the peace and gratitude demonstrated by patients and families. Discussion: The depth of nurses' intuitional moral responses and their need to make sense of these responses are consistent with Haidt's theory of moral experience in which individuals use reasoning primarily to explain their moral intuition and in which moral change occurs primarily through compassionate social interaction. Further, work on the moral identity of nursing provides robust explanation of how nurses' moral decisions are contextually and relationally mediated and how they seek to guard patient vulnerability, even at their own emotional cost. Conclusion: Medical Assistance in Dying is impactful for nurses, and for some, it requires intensive and ongoing moral sense‐making. Relevance to clinical practice: There is a need to provide support for nurses' moral deliberation and emotional well‐being in the context of Medical Assistance in Dying care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To (a) characterise and determine proportions of referred and enrolled children and (b) explore public health nurses' (PHNs) experiences, perspectives and recommendations regarding a new nurse‐led referral pathway for paediatric weight management. Background: Children with obesity and their families in Canada access specialised services for obesity management through physician referral. Since this requirement can prevent timely access to health services, we established and tested a referral pathway whereby PHNs directly refer children to specialised care for obesity management. Design: Nested mixed‐methods study reported using GRAMMS. Method: Our research study included children (2–17 years of age; body mass index ≥85th percentile) referred by a PHN to the Pediatric Centre for Weight and Health (PCWH; Stollery Children's Hospital, Edmonton, Alberta, Canada) from April 2017–September 2018. We summarised referral and enrolment data using descriptive statistics and conducted one‐on‐one, semi‐structured telephone interviews with PHNs; interviews were audio‐recorded, transcribed verbatim, managed using NVivo 12 and analysed by two independent reviewers using content analysis. Results: Our sample included 79 referred children (4.4 ± 1.8 years old; 3.4 ± 1.3 BMI z‐score; 52.7% male), of which 47 (59.5%) enrolled in care. PHNs' (n = 11) experiences, perspectives and recommendations regarding the new referral pathway were grouped into four categories: (a) practicality of the referral pathway (e.g., simple and straightforward), (b) utility of the referral pathway (e.g., economic and timesaving), (c) uptake of the referral pathway (e.g., physician's influence) and (d) recommendations to improve the referral pathway (e.g., having electronic access to the referral form). Conclusions: A PHN‐specific referral pathway led most children and families to enrol in paediatric weight management and overall was perceived as acceptable and appropriate among PHNs. Relevance to clinical practice: Our results highlight the valuable role that PHNs can play in directly referring children to specialised services for weight management. This pathway has the potential to reduce wait times and enhance treatment enrolment. [ABSTRACT FROM AUTHOR]

Previous studies on Canadian nurse wages were limited to individual factors and did not take into account contextual factors such as hospital market share, labour market size or unionization. Based on market share, some refer to the nursing labour market as a monopsony, which depresses wages and might explain the shortage. However, this has not yet been tested empirically in the Canadian Registered Nurse (RN) labour market. This article aims to fill this gap by using the microdata files of the Labour Force Survey for the years 2010–2012 and the multilevel analysis to shed light on this issue. The contribution of this work is that it takes into account both individual and contextual variables to try to explain nurses' hourly wage. In accordance with the monopsony model, we hypothesize a negative correlation between hourly wage and level of market share; i.e. monopsony employers would pay a lower wage rate. The results do not support the monopsony model to explain nursing labour shortage: there is no statistically significant relation between RN wages and market share; no relation was found for market size either. This suggests that an explanation for RN labour shortage must be investigated elsewhere. [ABSTRACT FROM AUTHOR]

With the advent of continuous antiretroviral therapy, HIV has become a complex chronic, rather than acute, condition. The Chronic Care Model (CCM) provides an integrated approach to the delivery of care for people with chronic conditions that could therefore be applied to the delivery of care for people living with HIV. Our objective was to assess the alignment of HIV care settings with the CCM. We conducted a mixed methods study to explore structures, organization and care processes of Canadian HIV care settings. The quantitative results of phase one are published elsewhere. For phase two, we conducted semi-structured interviews with key informants from 12 HIV care settings across Canada. Irrespective of composition of the care setting or its location, HIV care in Canada is well aligned with several components of the CCM, most prominently in the areas of linkage to community resources and delivery system design with inter-professional team-based care. We propose the need for improvements in the availability of electronic clinical information systems and self-management support services to support better care delivery and health outcomes among people living with HIV in Canada. [ABSTRACT FROM AUTHOR]

In Canada in 2015, the pass rates on the National Council Licensure Examination (NCLEX-RN) were considerably lower than pass rates on the Canadian Registered Nurse Examination (CRNE) causing nurse educators to express concern regarding the NCLEX-RN. The purpose of this study was to examine the relationship between candidate variables (e. g. academic performance, demographics) on their NCLEX-RN outcome (pass/fail). A cross-sectional data linkage design was employed using multiple sources of data on nursing graduates who wrote the NCLEX-RN in 2015, 2016 and 2017 (n = 259). Results showed that fewer questions answered on the NCLEX-RN and higher grades in various nursing courses (e. g. Introduction to Nursing, Statistics) predicted higher odds of passing the NCLEX-RN. To improve pass rates, nurse educators must integrate diverse methods of testing into existing curricula that mimic the NCLEX-RN exam, specifically computer adaptive exams. Further research is needed to determine other possible challenges for countries considering adopting the NCLEX-RN. [ABSTRACT FROM AUTHOR]

Health sociologists interested in how macro state influences affect micro health care practices have much to gain from meta-ethnography research. In this article, we bring together insights from two separate empirical studies on state health care services involving HIV/AIDS as a way to speak to larger issues about the organization and production of medical expertise and governance in health care systems. We use Noblit and Hare's meta-ethnography approach to bring these studies into conversation and identify six shared "organizers" of health care encounters. The organizers illustrate how state health interests operate across institutional contexts and impact the work of providers in seemingly unrelated health care settings. On the basis of this synthesis, we conclude that state interests both structure and create conflict in health care settings. We believe this perspective offers the potential to advance the goals of health sociology and the field of qualitative health research in general. [ABSTRACT FROM AUTHOR]

Aim: This study explored the experience of baccalaureate-prepared, internationally educated nurses who work as licensed practical nurses in Canada. Background/Introduction: Internationally educated nurses experience several barriers to workforce integration on arrival in destination countries. Given these barriers, evidence suggests that internationally educated nurses sometimes experience downward occupational mobility and deskilling in destination countries. Some baccalaureate-prepared, internationally educated nurses work as licensed practical nurses in destination countries, but there is minimal research on this population. Methods: We used an exploratory transnational feminist qualitative research design. Following ethics approval, a total of 14 baccalaureate-prepared, internationally educated nurses who currently or recently worked as practical nurses in Canada were interviewed for the study. Data were thematically analysed with the aide of NVivo 11 data software. Results: Our results revealed four key themes related to the experiences of this group of nurses: they migrate to Canada with hope for a better personal and professional life; they experience barriers to workforce integration as registered nurses and discover an easier path in the licensed practical nurse registration process; they experience deskilling and ambivalent skill recognition; and they feel dissatisfied as a licensed practical nurse in Canada. Discussion/Conclusion: There is a need for policy to support the upward mobility of baccalaureateprepared, internationally educated nurses who work as practical nurses. Implications for Nursing Policy: Implications for policymakers include the need to address the barriers to becoming registered nurses, including application processing times and lack of adequate access to educational programmes. [ABSTRACT FROM AUTHOR]

Background: In Canada, as in other parts of the world, there is geographic maldistribution of the nursing workforce, and insufficient attention is paid to the strengths and needs of those providing care in rural and remote settings. In order to inform workforce planning, a national study, Nursing Practice in Rural and Remote Canada II, was conducted with the rural and remote regulated nursing workforce (registered nurses, nurse practitioners, licensed or registered practical nurses, and registered psychiatric nurses) with the intent of informing policy and planning about improving nursing services and access to care. In this article, the study methods are described along with an examination of the characteristics of the rural and remote nursing workforce with a focus on important variations among nurse types and regions.Methods: A cross-sectional survey used a mailed questionnaire with persistent follow-up to achieve a stratified systematic sample of 3822 regulated nurses from all provinces and territories, living outside of the commuting zones of large urban centers and in the north of Canada.Results: Rural workforce characteristics reported here suggest the persistence of key characteristics noted in a previous Canada-wide survey of rural registered nurses (2001-2002), namely the aging of the rural nursing workforce, the growth in baccalaureate education for registered nurses, and increasing casualization. Two thirds of the nurses grew up in a community of under 10 000 people. While nurses' levels of satisfaction with their nursing practice and community are generally high, significant variations were noted by nurse type. Nurses reported coming to rural communities to work for reasons of location, interest in the practice setting, and income, and staying for similar reasons. Important variations were noted by nurse type and region.Conclusions: The proportion of the rural nursing workforce in Canada is continuing to decline in relation to the proportion of the Canadian population in rural and remote settings. Survey results about the characteristics and practice of the various types of nurses can support workforce planning to improve nursing services and access to care. [ABSTRACT FROM AUTHOR]

The human papillomavirus (HPV) infects approximately 550,000 Canadians annually. Cancers of the cervix, mouth, anus, throat and neck are caused by various strains of the virus. The virus also causes genital warts. The disease and economic burden of HPV is high. Primary prevention through vaccine administration prior to onset of sexual activity is evidenced as best practice. Two vaccines are available, Gardasil and Cervarix. Consistent with global practices in developed countries, these vaccines are currently publicly funded for females and provided in school-based clinics in all provinces and territories in Canada. Despite well-documented efficacy with minimal adverse effects, the uptake of these vaccines remains low in all countries, including Canada. Although HPV immunization rates have increased, they remain significantly below the rates of other vaccine-preventable diseases. This is puzzling since school-based clinics and public funding presumably increase vaccine access. Barriers explicated include family lack of knowledge about the vaccine, and attitudes that are not informed by science and epidemiology. There is evidence that a health provider's recommendation is the single biggest influence on uptake. However, not all providers are cognizant about emerging issues in this area, including controversies about universal coverage for boys as well as girls, new vaccines and more. Nurse practitioners are in a position to collaborate with public health agencies to expand knowledge and coverage across Canada. [ABSTRACT FROM AUTHOR]

The role of nurses in primary care is understudied. The purpose of this study was to describe the current registered nurse ( RN) role in three Primary Care Networks ( PCNs) in western Canada and to identify opportunities for optimal utilization of RNs in these settings. Case study methodology included interviews and document review. Although the RN role evolved during the study, most RNs focused on chronic disease management. Role ambiguity was evident between nurses and with interprofessional team members. Relationships of RNs to other providers, particularly physicians, impacted the enactment of the nursing role. Other barriers to role enactment included physician fee-for-service remuneration, management structures and processes, lack of access to electronic medical records and lack of previous opportunities to apply primary health-care education in the practice setting. Further work is needed to optimize the RN role in primary care to ensure maximum impact for patients, providers and the health system overall. [ABSTRACT FROM AUTHOR]

Background: In Canada, federal regulations allow Nurse Practitioners (NPs) to authorize medical cannabis. Nursing regulatory bodies, however, have been hesitant to include medical cannabis within NPs' scope of practice. As the interest in cannabis increases, NPs have the potential to play a pivotal role in promoting the safe and appropriate use of cannabis. This study aimed to: summarize nursing policies in Canada related to medical cannabis; explore the perspective of nursing regulatory bodies regarding practice and policy issues related to medical cannabis; and examine the inclusion of medical cannabis content within Canadian NP curricula. Methods: A descriptive study was conducted that comprised three phases. The first phase reviewed nursing regulatory bodies' existing policies related to medical cannabis. In the second phase, practice consultants from nursing regulatory bodies were interviewed regarding policies and practices issues related to medical cannabis. The interviews were analyzed using thematic analysis. The third phase was a national survey of NP program coordinators regarding inclusion of cannabis in curricula. Descriptive statistics summarized survey responses. Results: Of the 12 nursing regulatory bodies in Canada, only 7 had policies or statements related to cannabis, with only Ontario allowing NPs to authorize medical cannabis. There was confusion among practice consultants regarding the role of nurses in the administration of medical cannabis and several barriers were identified regarding nursing engagement in care related to medical cannabis, including lack of knowledge and clinical guidelines. 60% of NP programs included cannabis in their curricula, however, less than half addressed the risks and benefits of medical cannabis and dosing and administration protocols. Limited faculty expertise was a barrier to including cannabis content in NP curricula. Conclusion: Nursing regulatory bodies must be proactive in developing policies and educational resources that will support nurses in providing safe and informed care related to cannabis. To ensure patients using medical cannabis receive consistent and safe care from nurses, harmonized regulations and policies are needed across all jurisdictions. Education programs must also provide updated knowledge and training for both registered nurses and NPs that will support them in providing non-judgemental and evidence-based care to the growing number of individuals using cannabis. [ABSTRACT FROM AUTHOR]