Implementing and sustaining evidence-based practices in long-term care.

Intra-Professional Collaborative Practice among Nurses

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    This guideline, is focused on collaborative practice amongst three types of nursing professionals – registered nurse (RN), registered practical nurse (RPN) and nurse practitioner (NP) – and explores what fosters healthy work environments for them, aware that collaboration must align with the needs of the patient or client.

    This best practice guideline was developed to assist nurses, nursing leaders, other health professionals and senior managers to enhance positive outcomes for patients/clients (individual/family/group/community), nurses, and the organization through intra-professional collaborative practice. 

    The guideline identifies- best practices for intra-professional practice; and the organizational culture, values and relationships, and the structures and processes required, for developing and sustaining effective intra-professional nursing practice among nurses.

    Reference: Registered Nurses’ Association of Ontario (2016). Intra-professional Collaborative Practice among Nurses. Toronto, ON, Canada: http://rnao.ca/bpg/guidelines/intra-professional-collaborative-practice-among-nurses

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    A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

    Registered Nurses Association of Ontario (2016) Gap Analysis-Intra-professional Collaborative Practice Among Nurses. Toronto. ON

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    The website gives an overview on the four values and set of standards for accreditation for long-term care services.

    Reference: Accreditation Canada (n.d.). Accreditation standards for long term care services. Retrieved from https://accreditation.ca/solutions/senior-residential-care/

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    The website of the College of Nurses of Ontario provides Information about the requirements and process of becoming a Registered Nurse, Registered Practical Nurse and Nurse Practitioner practising within Ontario for Ontario applicants, Canadian Applicants, International applicants and for nurses to enter CNO's Extended Class.

    Reference: College of Nurses of Ontario (nd). Become a Nurse. Retrieved from http://cno.org/en/become-a-nurse/

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    This article describes the results of a consultation facilitated during the June 2017 CNA annual meeting of members. It outlines some of the opportunities nurses have to provide input into future CNA initiatives on strengthening intra-professional collaboration.

     

    Reference: Lankshear, S., & Limoges, J. (2018). Better together: A fresh look at collaboration within nursing. The Canadian Nurse, (Jan/Feb). Retrieved from Better together: A fresh look at collaboration within nursing (canadian-nurse.com)

    Source: Copyright ©, Canadian Nurses Association, 50 Driveway, Ottawa, Ontario, K2P 1E2 CANADA, 2010-2011 all rights reserved

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    CNA is the national professional voice of registered nurses in Canada. Representing nearly 139,000 registered nurses, CNA’s members include:

    • Provincial and territorial nursing associations and colleges
    • Independent RNs from Ontario and Quebec
    • Retired nurses
    • Canadian Nursing Students’ Association
    • Canadian Network of Nursing Specialties

    See more at: https://www.cna-aiic.ca/en/about-cna#sthash.H3OkfPpZ.dpuf  

    Reference: Canadian Nurses Association Website: https://www.cna-aiic.ca/en/about-cna

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    This RNAO website offers career strategies for new nurses, job seekers, mid and late career nurses.

    Reference: Careers in Nursing website http://careersinnursing.ca/

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    There are nurse mentors throughout Canada who support and assist aspiring nurses through the Canadian Nurses Association (CNA) Certification Mentorship Program. Nurse mentors have current CNA certification and at least three years of experience in a nursing specialty. The toolkit offers guidance for the process.

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    This is a short and breezy introduction to coaching and the GROW model

    Reference: Heath, M. (2015) Retrieved from https://youtu.be/xNLRo3jWPcg

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    This document is a statement of the ethical values of registered nurses and nurse practitioners. The new edition contains new and updated content that reflects the contemporary practice needs of nurses such as MAID, advanced care planning and primary care to mention a few. It is designed to inform everyone about the ethical values, subsequent responsibilities and endeavours of nurses. Included is updated nursing models and advocating healthy work environments. It is also a regulatory tool.

    Canadian Nurses Association. (2017). Code of ethics for registered nurses. Retrieved from https://cna-aiic.ca/-/media/cna/page-content/pdf-en/code-of-ethics-2017-edition-secure-interactive.pdf?la=en&hash=09C348308C44912AF216656BFA31E33519756387

    Copyright ©, Canadian Nurses Association, 50 Driveway, Ottawa, Ontario, K2P 1E2 CANADA, 2018 all rights reserved - See more at: https://cna-aiic.ca/en/terms-and-conditions-of-use#sthash.fcbIaPZC.dpuf

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    This document on a collaborative practice was created by three nursing regulatory bodies in Alberta.  The paper incorporates five principles that are believed to maximize client health-care outcomes and effective teamwork. The content is transferrable and relevant to nurses practicing in Ontario. 

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    This paper is designed to serve as a best practices resource to healthcare leaders who are considering integration of conflict engagement training and professional development in their organizations. The focus is on common language training, cognitive maps for making sense of conflict, skill building, and follow up coaching.

    Reference: Emerging Health Care Communities (EHCCO). (2010). Conflict Engagement Training for Health Professionals: Recommendations for Creating Conflict Competent Organizations. A White Paper for Healthcare and Dispute Resolution Professionals. http://www.ihi.org/resources/Pages/Tools/ConflictEngagementTrainingforHealthProfessionals.aspx

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    This guideline outlines the key factors associated with conflict with clients, colleagues and in the workplace, and offers strategies for preventing and managing conflict that has escalated. It also highlights the role of nurses in formal leadership positions, as well as the importance of the debriefing process in the prevention and management of conflict. 

    College of Nurses of Ontario.  (2018). Conflict Prevention and Management. Toronto, ON: Author. Retrieved from https://www.cno.org/globalassets/docs/prac/47004_conflict_prev.pdf

    © 2019 College of Nurses of Ontario

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    Using a poster presentation the author outlines the development of a successful mentorship program. A detailed description of the implementation processes is provided, as are the results and lessons learned during this process.

    Source: Madison Roth, BSN, RN, CCRN Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD

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    The article emphasises the importance of ensuring student nurses are provided with optimum learning environments. Strategies such as having prepared mentors to assist with the learning journey are identified as being a key strategy to overcome negative barriers.

    Reference: Emanuel V, Pryce-Miller M (2013) Creating supportive environments for students. Nursing Times; 109: 37, 18-20. Retrieved from https://www.researchgate.net/publication/257761262_Creating_supportive_environments_for_students

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    Les présentes lignes directrices sur les pratiques exemplaires, Développement et maintien des soins de santé interprofessionnels : optimisation des résultats pour le patient/client, l’organisme et le système sont conçues pour favoriser des milieux de travail sains. Les présentes lignes directrices déterminent les pratiques exemplaires pour faciliter, améliorer et maintenir le travail d’équipe ainsi que la collaboration interprofessionnelle, et pour accroître les résultats positifs pour les patients/clients, les systèmes et les organisations.

    Association des infirmières et infirmiers autorisés de l’Ontario. (2013). Développement et maintien des soins de santé interprofessionnels : optimisation des résultats pour le patient/client, l’organisme et le système. Toronto, Canada: Autheur. Récupéré: http://rnao.ca/bpg/language/d%C3%A9veloppement-et-maintien-des-soins-de-sant%C3%A9-interprofessionnels-optimisation-des-r%C3%A9sul

    Ce travail est financé par le Ministère de la Santé et des Soins de longue durée d'Ontario.

     

     

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    The resource covers being a good listener, nonverbal signal, keep stress in check and assert yourself

    Reference: Retrieved from HelpGuide.org http://www.helpguide.org/articles/relationships/effective-communication.htm

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    The article provides scripts healthcare leaders can use when addressing unprofessional behaviours. Eight common disruptive situations are provided followed with scripts on how to handle them.

    Healthy Workforce Institute (2020). Eight ways to stop unprofessional conduct: Powerful scripts for healthcare leaders. Retrieved from https://healthyworkforceinstitute.com/8-scripts/

     

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    This e-learning supports nurses in being better equipped to identify the ethical values that are important in providing and supporting nursing care. It describes the commitments nurses are obliged to maintain and the learning of the nursing decision-making process, which provides a framework for understanding and working through ethical situations.

    Reference: College of Nurses of Ontario Practice Standard (2012) Ethics E-Learning. Retrieved from http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/learning-modules/ethics/

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    This table provides sample structure, process and outcome indicators which may be useful for organizations to measure their quality progress and change.

    Reference: Registered Nurses’ Association of Ontario (RNAO) (2016). Intra-professional Collaborative Practice among Nurses, Second Edition, pages 50 - 53. Toronto, Ontario: Registered Nurses’ Association of Ontario. http://rnao.ca/bpg/guidelines/intra-professional-collaborative-practice-among-nurses

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    This framework seeks to promote a common understanding of RN practice among nurses, students and stakeholders in Canada (including other health professionals, employers, educators, policy-makers and the public).

    Reference: Canadian Nurses Association. (2015). Framework for the Practice of Registered Nurses in Canada. Retrieved August 4,2016, from http://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/framework-for-the-pracice-of-registered-nurses-in-canada

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    Health Force Ontario is the province’s strategy to ensure that Ontarians have access to the right number and mix of qualified health care providers, now and in the future. Included on the site is information about the Nursing Graduate Guarantee Initiative.

    Reference: Health Force Ontario Website: http://www.healthforceontario.ca/en/Home

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    Each of RNAO’s interest groups represents a unique specialty or population within the nursing spectrum. Together they illustrate the remarkable diversity of the profession. They offer a range of professional resources and support, both personal and sometimes financial, through bursaries and awards.The Registered Nurses' Association of Ontario (RNAO) offers many money-saving benefits that can more than offset your membership fees. RNAO members benefit from membership in a variety of ways.Through conferences, institutes, interest groups, online communities and chapter activities, RNAO provides knowledge-rich, exclusive networking opportunities for members to cultivate rewarding personal and professional relationships.

    Reference: Registered Nurses Association of Ontario. Special Interest Group. Toronto, ON, Canada. http://rnao.ca/connect/interest-groups  

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    The brief and general introduction examines what communities of practice are and identifies 3 crucial characteristics. Many other examples of CoPs are also available

    Reference: Wenger-Trayner, E., & Wenger-Trayner B.(2015). Introduction to communities of practice. A brief overview of the concept and its uses. Retrieved from http://wenger-trayner.com/introduction-to-communities-of-practice/

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    A series of 2-minute videos promoting kindness in the workplace by Renee Thompson. The focus is on helping people to cope with what is happening in today's workplace. 

    https://www.youtube.com/watch?v=ZTH__8E6tFs&list=PLuKRMTFug55Hq1vym6T25ocnobKlKKZQl

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    The Nursing Act establishes the mandate of the College of Nurses of Ontario and defines a scope of practice for the nursing profession

    Reference: (Use Referencing Guide available at http://ltcprojects.rnao.ca/ltcbpi_general/node/633) College of Nurses of Ontario. (2014). Retrieved from http://www.cno.org/globalassets/docs/prac/41064_fsnursingact.pdf

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    This document defines scope of practice for regulated health professional, outlines controlled acts and identifies who is appropriate to perform controlled acts.

    Reference: College of Nurses of Ontario Practice Reference document. (2014). Legislation and Regulation RHPA: Scope of Practice, Controlled Acts Model Retrieved from: https://www.cno.org/globalassets/docs/policy/41052_rhpascope.pdf

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    Cette ligne directrice sur les pratiques exemplaires en soins infirmières et infirmiers est un document détaillé comportant les ressources nécessaires au soutien de la pratique basée sur des données probantes. Un milieu de travail sain, c’est un milieu de pratique qui maximise la santé et le bien-être des infirmières, des résultats de qualité chez le patient ou client, le rendement de l’organisation et du système, et les retombées sociales, y compris des collectivités en meilleure santé.

    Association des infirmières et infirmiers autorisés de l’Ontario (2013). Lignes directrices sur le développement et le maintien du leadership infirmier, (2em Ed.). Toronto, ON, Canada: Auteur. Récupérée de http://rnao.ca/bpg/language/lignes-directrices-sur-le-d%C3%A9veloppement-et-le-maintien-du-leadership-infirmier

     Ce travail est financé par le Ministère de la Santé et Ministère des Soins de longue durée d'Ontario

     

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    The National League for Nursing supports nurse faculty and leaders in nursing education in the US. It contains teaching resources and promotes the use of simulation as a teaching strategy.

    Reference: National League for Nursing Website: http://www.nln.org/home

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    This website is a National Nursing Assessment Service which coordinates a consistent national approach for internationally educated nurses (IENs). It contains information, educational materials and a video on the process to guide nursing students and nurses who are internationally educated to become and practise as a nurse in Ontario or other Canadian jurisdictions using the online service.

    Reference: National Nursing Assessment Service (NNAS). Retrieved from http://www.nnas.ca/faq/

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    This video covers nurse bullying and how to tell if you're a difficult co-worker. The facilitator suggests a reflective group exercise so, the team can be more self-aware as a strategy to strengthen the team. 

    https://www.youtube.com/watch?v=ZTH__8E6tFs&list=PLuKRMTFug55Hq1vym6T25ocnobKlKKZQl

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    This 3-minute video by Renee Thompson, discusses bullying and incivility. Emphasizes that workplace culture is everyone's responsibility. 

    https://healthyworkforceinstitute.com/coffee-and-conversation-videos/?playlist=e92c9c8&video=0214b60

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    This CNO Practice Standard outlines the nursing practice expectations for all Nurse Practitioners (NPs). The College of Nurses establishes standards of nursing practice to protect the public interest. NP practice is grounded in the values, knowledge and theories of professional nursing practice.

    Reference: College of Nurses of Ontario Practice Standard (2016) Nurse Practitioner. Retrieved from https://www.cno.org/globalassets/docs/prac/41038_strdrnec.pdf

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    Nurse Practitioners' Association of Ontario represents nurse practitioners in all levels of health care: primary, secondary and tertiary care. Reference: Nurse Practitioners' Association of Ontario Website: https://npao.org/

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    As leaders of unregulated health staff, nurses may wish to direct personal support workers to the OPSWA website. OPSWA provides access to information, resources and tools to help PSWs do their job better, with more confidence.

    Website: https://ontariopswassociation.com/

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    A position paper issued by the Canadian Nurses' Association outlines their position, values and beliefs on the obligation and concepts a regulated nurse must meet to achieve an intra-professional practice.

    Canadian Nurses' Association (2020). Position paper: Intra-professional collaboration. Retrieved from https://www.cna-aiic.ca/-/media/cna/page-content/pdf-en/cna-position-statement_intra-professional-collaboration.pdf?la=en&hash=1158AB98CC407AB4C815A79F9CC3DDEA1960B9A6

    Source: https://www.cna-aiic.ca/en

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    The Preceptor Education Program is an online interprofessional program that consists of nine interactive learning modules. The modules include downloadable resources, learning exercises, video case scenarios and references. Learning is self-directed in that modules are self-directed and do not need to be completed in any particular order. Many of the modules are designed so that preceptors and students can work through them together. After completing a reflective note, a certificate can be printed at the end of each module to record the education completed.

    Reference: Kinsella, E.A., Bossers, A., Ferguson, K., Jenkins, K., Bezzina, M.B., MacPhail, A., Moosa, T., Schurr, S., Whitehead, J. & Hobson, S. (2016). Preceptor Education Program for health professionals and students. (2nd ed.) London, ON: The University of Western Ontario. Retrieved from: www.preceptor.ca

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    Cette ligne directrice sur les pratiques exemplaires en soins infirmiers est axée sur la prévention et résolution des mauvais traitements et de la négligence envers les aînés dans divers établissements de santé et services communautaires à travers le Canada. Ces auditoires comprennent les infirmières, les gestionnaires, les éducateurs, les équipes d'amélioration de la qualité, les administrateurs, les décideurs, les organismes de réglementation des soins infirmiers et les organismes gouvernementaux. Financé par le programme Nouveaux Horizons pour les aînés du gouvernement du Canada.

    Association des infirmières et infirmiers autorisés de l’Ontario. (2014). Prévention et résolution des mauvais traitements et de la négligence envers les aînés: approches axées sur la personne, coopératives et à l'échelle du système Toronto, ON, Canada: Auteur. Récupérée de http://rnao.ca/sites/rnao-ca/files/Preventing_Abuse_and_Neglect_of_Older_Adults_Final_French_0.pdf

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    The Registered Nurses’ Association of Ontario (RNAO) is the professional association representing registered nurses, nurse practitioners and nursing students in Ontario. The site provides information about membership, best practice guidelines, policy/political action and events.

    Reference: Registered Nurses' Association of Ontario (RNAO) Website: http://rnao.ca/

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    The Registered Practical Nurses Association of Ontario (weRPN) has represented Registered Practical Nurses in Ontario for over half a century. Their vision is excellent care for all and their work is focused on optimizing the professional practice of RPNs to improve the health of the people of Ontario.

    Reference: Registered Practical Nurses Association of Ontario (weRPN) website -Retrieved August 29,2016 from https://www.werpn.com/

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    For the purpose of this document, Interprofessional is defined as: Multiple health disciplines with diverse knowledge and skills who share an integrated set of goals and who utilize interdependent collaboration that involves communication, sharing of knowledge and coordination of services to provide services to patients/clients and their care-giving systems.

    This best practice guideline, Developing and Sustaining Interprofessional Health Care: Optimizing patients/clients, organizational, and system outcomes is intended to foster healthy work environments. The focus in developing this guideline was identifying attributes of interprofessional care that will optimize quality outcomes for patients/clients, providers, teams, the organization and the system.

    This guideline identifies best practices to enable, enhance and sustain teamwork and interprofessional collaboration, and to enhance positive outcomes for patients/clients, systems and organizations. It is based on the best available evidence; where evidence was limited, the recommendations were based on the consensus of expert opinion.

    Registered Nurses’ Association of Ontario. (2013). Developing and Sustaining Interprofessional health care. Toronto, ON: http://rnao.ca/bpg/guidelines/interprofessional-team-work-healthcare

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    This Best Practice Guideline focuses on evidence-based recommendations for RNs and RPNs on best nursing practices for developing and sustaining nursing leadership. This guideline addresses: system resources that support effective leadership practices and behaviours for formal leaders and nurses at the point of care; Organizational culture, values and resources that support effective leadership practices and behaviours at all levels; and personal resources that support effective leadership practices across the continuum of care.

    Registered Nurses’ Association of Ontario. (2013). RNAO Developing and sustaining nursing leadership best practice guideline (2nd Ed.). Toronto, ON, Canada: Author.

    Retrieved from: https://rnao.ca/sites/rnao-ca/files/LeadershipBPG_Booklet_Web_1.pdf

     

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    This guideline provides evidence-based recommendations for RNs and RPNs on best nursing practices for developing and sustaining effective staffing and workload practices. When effective staffing and workload practices are not followed the risk for conflict within teams increases. Learn how the decision making process must ensure that appropriate structures and supports are in place to maximize the nursing effort resulting in the best possible care and positive outcomes for the patients/clients, nursing personnel, and the organization

    Registered Nurses’ Association of Ontario. (2017, ). Developing and Sustaining Effective Staffing and Workload Practices. Toronto, ON,  Retrieved from: http://rnao.ca/bpg/guidelines/developing-and-sustaining-effective-staffing-and-workload-practices.

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    This Best Practice Guideline focuses on nursing teams and processes that foster healthy work environments. The focus for the development of this guideline was managing conflict among nursing and healthcare teams with the view that while some conflict is preventable, healthy conflict can also be beneficial.

    For the purpose of this document, conflict is defined as: a phenomenon occurring between interdependent parties as they experience negative emotional reactions to perceived disagreements and interference with the attainment of their goals (Barki & Hartwick, 2004).

    Registered Nurses’ Association of Ontario. (2012). Managing and Mitigating Conflict in Health-care Teams. Toronto, ON: http://rnao.ca/bpg/guidelines/managing-conflict-healthcare-teams

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    The purpose of this Guideline is to provide evidence-based recommendations that promote and sustain the undergraduate nursing student’s application of knowledge to practice in a variety of clinical learning environments. The Guideline explores the relationships among and between students and nursing educators, nursing staff, preceptors, and diverse health-care team members, and it considers their influence on the quality of practice education, professional socialization, and nursing excellence.

    Reference: Registered Nurses’ Association of Ontario (2016). Practice Education in Nursing. Toronto, ON, Canada: http://rnao.ca/bpg/guidelines/practice-education-nursing

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    This quick reference guide was created to support the uptake of the RNAO Best Practice Guideline Practice Education in Nursing. The full Guideline is available for free download from the RNAO website and this toolkit. This quick reference guide is targeted for nurses who are educators, preceptors, or mentors for undergraduate nursing students as a quick and easy way to review the Guideline recommendations. It will also be useful for educational institutions and service agencies implementing the Guideline. We encourage users of this quick reference guide to refer to the full Guideline for more complete and detailed information related to providing quality practice education for nursing students.

    Reference: Registered Nurses’ Association of Ontario (RNAO). (2016). Practice Education in Nursing. Toronto, ON: Registered Nurses’ Association of Ontario. http://rnao.ca/sites/rnao-ca/files/SHWE_Quick_Reference_Guide_-_WEB_0.pdf

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    Learn to identify professional practices that enhance outcomes for nurses, the recipients of nursing services, organizations and systems.

    Through implementation of this guideline, you will learn:

    • To identify the organizational culture, values and relationships and the structures and processes required for developing and sustaining effective professional practices
    • Professional practice involves structures and processes needed to achieve outcomes.

    Ensuring professional practice standards involves being accountable to your workplace for your actions and the implementation of a high ethical standard. Through translating knowledge into action, professional practice standards are met.

    This guideline provides evidence-based recommendations for RNs and RPNs on best nursing practices for professionalism in nursing.

    Registered Nurses’ Association of Ontario. (2007). Professionalism in nursing. Toronto, ON, Canada: Author. Retrieved from: http://rnao.ca/bpg/guidelines/professionalism-nursing

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    This Web page provides a training kit to learn and teach TeamSTEPPS 2.0 for Long-Term Care. The Long-Term Care Instructor Manual is designed to
    help develop and deploy a customized plan to train staff in teamwork skills, and lead a medical teamwork improvement initiative in a nursing home from initial concept development through sustainment of positive changes. Materials include; comprehensive presentations and instructional guides, including short case studies and videos illustrating teamwork opportunities and successes.

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    Workplace Liaison Program is a volunteer program administered by RNAO for nurses to strengthen connections with nursing colleagues in your workplace and to enhance communication between RNAO and the an organization where the nurse is employed. By way of improved communications, the Workplace Liaison Program acts as a vehicle to promote the role of the Registered Nurse in the healthcare system and to raise the profile of the professional association.

    Reference: Registered Nurses Association of Ontario. Workplace Liaison Program. Toronto, ON, Canada. http://rnao.ca/connect/workplace-liaisons