This document discusses challenges and opportunities in nursing in Canada. It outlines the agenda which includes an overview of Canadian nursing, challenges and opportunities, and a focus on documenting nursing in a digital age. Some key challenges discussed are chronic understaffing, political restructuring, and issues around licensure and scope of practice. Opportunities mentioned include nursing leadership, a national nursing report card, and nursing informatics. The remainder of the document focuses on documenting nursing data in electronic health records, including standards like C-HOBIC and requirements for capturing and analyzing nursing data.

1. 1
Challenges & Opportunities
in Nursing in Canada
St. Mary’s Campus
3rd Showcase of Nursing
Margaret Ann Kennedy, PhD, RN, CPHIMS-CA, PMP, PRINCE2 Practitioner
Associate Managing Partner & Clinical Subject Matter Expert
Gevity Consulting

2. 2
Agenda
• Canadian Nursing Overview
• Challenges & Opportunities
• Focus Highlight: Documenting Nursing in a
Digital Age

3. 3
Canada

4. 4
Images of Eastern Canada

5. 5
Images of Western Canada

6. 6
Canadians

7. 7
• CNA is the national professional voice of
registered nurses in Canada
• 11 provincial and territorial nursing associations
and colleges representing 151,404 registered
nurses
• Role is to advance the practice and profession
of nursing to improve health outcomes and
strengthen Canada’s publicly funded, not-for-profit
health system.
• RNs register with their provincial regulatory
college and are de facto members of CNA

8. 8
Challenges
• Chronic understaffing
– Patient safety
– Burnout
• Political restructuring
• National RN Examination
• Regionalized Licensure & Reciprocity
• Retention and Retirement
• Regulated vs unregulated resources/Scope
of practice

9. 9
Opportunities
• Nursing Leadership
– Domestic policy
– Health promotion
• National Nursing Report Card
• Nursing Informatics
– Canadian Nursing Informatics Association (CNIA)
– Nursing Reference Group
• Health Informatics
– COACH
– IMIA-NI

10. 10
DOCUMENTING NURSING
IN A DIGITAL AGE
Focus Highlight

11. How are you representing your nursing data?
11

12. 12
Nursing Data1
• Should be structured and codified to ensure the sharing
and re-use of patient information across disciplines and
care settings
• Should be directed by common centralized trusted
sources to ensure consistent understanding and
interpretation of patient information
• Should reflect practice according to clinical standards or
practice guidelines to trigger consistent application of
clinical decision support, provide real-time
recommendations, and contribute to the shared care
plan
• Should be simple and concise to facilitate timely access
to patient information
• Should be consistently understood by the data
warehouse analytics to allow meaningful analysis of
patient and service outcomes
Pan-Canadian Nursing EHR Business and Functional Elements Supporting Clinical Practice, June 2012

13. 13
NURSING DATA IN THE EHR
Clinical/Business Requirements
EHR Functional Elements
DATA SOURCES:
Nurses need to know
the source of patient
information to support
decision making
Nurses need to know who
entered the data, role, when, and
where
Displays source of data upon request
Provides data details, e.g. date time of data
entered, by whom, where, and upon request
Displays and highlights patient-entered information
Ensures the correct data for the correct patient are transmitted
to the correct destinations/recipients, which can be a provider, a
provider role, a service department, a health service delivery
program or an organization
INFORMATION FOR
PATIENT CARE &
HEALTH SYSTEM
USE:
Nurses need to
capture a core set of
discrete patient data
considered clinically
relevant for sharing
across the continuum
of care
Nurses need to compare and
analyse baseline and ongoing data
to inform patient outcomes
Nurses need to have analytic
reports for care planning and
resource management
Nurses need to ensure that the
required and mandated patient
documentation is complete
Imports and stores templates, e.g. Canadian Health Outcomes
for Better Information and Care (C-HOBIC), Canadian Triage and
Acuity Scale (CTAS) and interRAITM that can capture core sets of
discrete patient data
Presents for use the appropriate nursing core data set
templates for the right care settings (e.g. long term care, mental
health) according to pre-established criteria
Captures the core data entered in the shared health record
according to pre-established parameters
Creates and displays a report on the nursing core data
according to pre-established criteria, the nurses’ preferences and
upon request
Pan-Canadian Nursing EHR Business and Functional Elements Supporting Clinical Practice, June 2012

14. 14
C-HOBIC
• Collaboration between Canadian Nurses
Association, Canada Health Infoway and
participating provincial partners
• Standardised, nurse-sensitive outcomes data
• based on admitting and discharge assessment of
functional status, symptoms, safety, readiness for
discharge (therapeutic self care, etc)
• acute care, complex continuing care, long-term care
and home care patients
• Implemented in multiple provinces
• Phase 2 – now seeking funding to incorporate
into national Discharge Abstract Database
(DAD)

15. 15
C-HOBIC Data Set
• Standardized patient-centred clinical
outcomes reflective of nursing practice with
valid and reliable measures
Four categories:
1. Functional status & continence
2. Symptoms
• pain, nausea, fatigue, dyspnea
3. Safety outcomes
• falls, pressure ulcers
4. Therapeutic self-care (readiness for
discharge)

16. 16
C-HOBIC Measures

17. Assessment
Tools
Relationship Between
C-HOBIC and the Nursing Process
Assessment
Assessment 1
Documentation
Knowledge
Informs
Informs Planning
Plan of Care
Documentation
Produces
Evaluation Produces
Outcome
Implementation
(Act) of Care
Assessment 2
Produces Documentation
Documentation of
Interventions
Informs
17 17

18. 18
Documenting Nursing in a
Digital Age – so what??
• Person-centered
– Places service consumer at center of care
process
• Professional practice
– Visibility of practice
– Enables adaptive practice = person centered
care

19. 19
THANK YOU
mkennedy@gevityinc.com