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MARCH 2007Healthy Work EnvironmentsBest Practice GuidelinesProfessionalismin Nursing

Healthy Work EnvironmentsBest Practice GuidelinesGreetings from Doris Grinspun, Executive DirectorRegistered Nurses’ Association of OntarioIt is with great pleasure that the Registered Nurses’ Association of Ontarioreleases the “Professionalism in Nursing Guideline." This is one of a series of six Best PracticeGuidelines (BPGs) on Healthy Work Environments (HWE), developed by the nursing community.The aim of these guidelines is to provide the best available evidence to support the creation ofthriving work environments.Evidence-based HWE BPGs, when applied, will serve to support the excellence in service thatnurses are committed to delivering in their day-to-day practice. RNAO is delighted to be able toprovide this key resource to you.We offer our endless gratitude to the many individuals and organizations that are making ourvision for HWE BPGs a reality. To the Government of Ontario and Health Canada for recognizingRNAO’s ability to lead this program and providing generous funding. To Donna Tucker – program director from2003 until 2005 – and Irmajean Bajnok – Director, Centre for Professional Nursing Excellence and the program’slead since 2005, for providing wisdom and working intensely to advance the production of these HWE BPGs. Toeach and all HWE BPG leaders and in particular, for this BPG, Panel Chair Andrea Baumann and PanelCoordinator Dianna Craig, for providing superb stewardship, commitment and above all exquisite expertise.Thanks also go to the amazing panel members who generously contributed their time and knowledge. Wecould not have delivered such a quality resource without you!We thank in advance the entire nursing community, committed and passionate about excellence in nursing careand healthy work environments, who will now adopt these BPGs and implement them in their worksites. We askthat you evaluate their impact and tell us what works and what doesn’t, so that we continuously learn from you,and revise these guidelines informed by evidence and practice. Partnerships such as this one are destined toproduce splendid results – learning communities – all eager to network and share expertise. The resultingsynergy will be felt within the BPG movement, in the workplaces, and by people who receive nursing care.Creating healthy work environments is both a collective and an individual responsibility. Successful uptake ofthese guidelines requires the concerted effort of nurse administrators, staff and advanced practice nurses,nurses in policy, education and research, and health care colleagues from other disciplines across theorganization. It also requires full institutional support from CEO’s and their Boards. We ask that you share thisguideline with all. There is much we can learn from each another.Together, we can ensure that health organizations including nurses and all other health care workers, buildhealthy work environments. This is central to ensuring quality patient care. Let’s make health care providers,their organizations and the people they serve the real winners of this important effort!Doris Grinspun, RN, MSN, PhD (c), OOnt.Executive DirectorRegistered Nurses’ Association of Ontario

Professionalismin NursingDisclaimer & CopyrightDisclaimerThese guidelines are not binding for nurses or the organizations that employ them. The use of theseguidelines should be flexible based on individual needs and local circumstances. They neither constitute aliability nor discharge from liability. While every effort has been made to ensure the accuracy of the contentsat the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) giveany guarantee as to the accuracy of the information contained in them nor accept any liability, with respectto loss, damage, injury or expense arising from any such errors or omissions in the contents of this work.CopyrightThis document is in the public domain and may be used and reprinted without special permission, exceptfor those copyrighted materials noted for which further reproduction is prohibited without the specificpermission of copyright holders. The Registered Nurses’ Association of Ontario (RNAO) will appreciatecitation as to source. The suggested format for citation is indicated below:Registered Nurses’ Association of Ontario (2007). Professionalism in Nursing. Toronto, Canada: RegisteredNurses’ Association of Ontario1

Healthy Work EnvironmentsBest Practice GuidelinesDevelopment Panel MembersAndrea Baumann, RN, PhDHeather Campbell, RN, BN, MSPanel ChairAssociate Vice-PresidentInternational Health, Faculty of Health SciencesDirector, McMaster University Site,Nursing Health Services Research UnitHamilton, OntarioDirector of Practice and PolicyCollege of Nurses of OntarioToronto, OntarioAnne Moorhouse, RN, PhDDeputy ChairProfessorCollaborative Seneca-York University BScN NursingProgramSeneca College of Applied Arts & TechnologyToronto, OntarioJudy Costello, RN, MScN, CCN(c)Director of Surgical ServicesToronto General HospitalToronto, OntarioAudrey Danaher, RN, MScSenior Policy AnalystRegistered Nurses’ Association of Ontario(up to June 2005) andCouncil of Ontario Universities (August 2005-)Toronto, OntarioJacqueline M. Andrew, RN, MScProfessional Practice CoordinatorHotel Dieu Grace HospitalWindsor, OntarioBeth Brunsdon-Clark, RN, BN, MNVice-President Programs and Patient ServicesChief Nursing OfficerVictoria General HospitalWinnipeg, ManitobaCathy Burke, RN, MNRegional Director of Professional Development – NursingEastern HealthSt. John’s, Newfoundland2Margaret Keatings, RN, MHScVice-President, Professional Practice andChief Nurse ExecutiveThe Hospital for Sick ChildrenToronto, OntarioMartha MacLeod, RN, PhDAssociate ProfessorNursing ProgramUniversity of Northern British ColumbiaPrince George, British Columbia

Professionalismin NursingMartine Mayrand Leclerc, RN, MGSS/MHA, PhDColleen Van Berkel, RN, BNSc, MHScProfessor and Coordinator, Nursing Graduate ProgramsNursing DepartmentUniversité du Québec en OutaouaisGatineau, QuébecManagerPublic Health and Community Services DepartmentApplied Research and Evaluation BranchProgram Policy and Planning DivisionCity of HamiltonMillgrove, OntarioMarisa Neves, RNWound/Ostomy Resource NurseHome Health CareSaint Elizabeth Health CareToronto, OntarioAnn Rhéaume, RN, PhDKristin Cleverley, RN, BScN, MScResearch CoordinatorNursing Health Services Research UnitMcMaster UniversityHamilton, OntarioAssociate ProfessorÉcole de science infirmièreUniversité de MonctonMoncton, New BrunswickMonica Seawright, RPN(Registered Practice Nurse)PresidentRegistered Practical Nurses AssociationMississauga, OntarioJo Anne Shannon, RNLabour Relations OfficerWest District Service TeamOntario Nurses AssociationSt. Catherines, Ontario3

Healthy Work EnvironmentsBest Practice GuidelinesResponsibility for DevelopmentThe Registered Nurses’ Association of Ontario (RNAO), with funding from the Ministry ofHealth and Long-Term Care and in partnership with Health Canada has embarked on a multi-year projectof healthy work environments best practice guidelines development, pilot implementation, evaluation anddissemination that will result in the development of six guidelines developed by six expert panels. Thisguideline was developed by an expert panel convened by the RNAO, conducting its work independent ofany bias or influence from funding agencies.Project TeamIrmajean Bajnok, RN, MSN, PhDDirector, RNAO Centre for Professional Nursing ExcellenceProject Director (2005-)Donna Tucker, RN, MScNProject Director (2003-2005)Dianna Craig, RN, BA, MEdPanel CoordinatorLisa Beganyi, BSc, BAProject Assistant (August 2004 – September 2005)Erica Kumar, BSc, GC, DipHlthPromProject Assistant (September 2005-)Contact InformationRegistered Nurses’ Association of OntarioHealthy Work Environments Best Practice Guidelines Project158 Pearl Street, Toronto, Ontario, M5H 1L3Website: http://www.rnao.org4

Professionalismin NursingStakeholder AcknowledgementThe Registered Nurses’ Association of Ontario wishes to acknowledge the following for their contribution inreviewing this nursing Healthy Work Environments Best Practice Guideline and providing valuable feedback:Barbara Aileen Bowles, RN, BSN, PNC(C)Mary-Agnes Beduz, RN, BScN, MNStaff NurseNiagara Health SystemsSt. Catharines, OntarioDirector Nursing Education and DevelopmentMount Sinai HospitalToronto, OntarioSylvia Alloy-Kommusaar, RNBarbara Bickle, RNSupervisorExtendicare Van DueleSault Ste. Marie, OntarioCritical Care NurseNorth York General HospitalToronto, OntarioPalese Alvisa, BN, RN, MSN, DNMichelle Bott, RN, BScN, MNProfessorUdine UniversityUdine, ItalyDirector, Professional PracticeGuelph General HospitalGuelph, OntarioTammy Armstrong, RN(EC), BS,MS, PhD(c)Gwendolyn D. Bourdon, RN, BScN, MEdProfessorLoyalist CollegeBelleville, OntarioEducation ManagerRunnymede Healthcare CentreToronto, OntarioMargaret Astill, RN, BA, BScN, MScTTabatha Bowers, RN, BScN, MN, GNC(C)Educator, Mental HealthBluewater HealthSarnia, OntarioClinical Nurse SpecialistThe Scarbourgh HospitalScarborough, OntarioJacqueline A. Barrett, RN, BScN, MHScDebbie Bruder, RN, BA, MHSDirector of Maternal Child, Emergency DepartmentJoseph Brant Memorial HospitalBurlington, OntarioEducation, Practice LeaderGrand River HospitalKitchner, OntarioNancy A. Bauer, Hon BA, Hon B.Comm, RN, ETKaren Bruton, RN, ETProfessional Practice LeaderLeamington District Memorial HospitalLeamington, OntarioClinical Resource LeaderNorthumberland Hills HospitalCobourg, OntarioLinda Bayly, RN, BScN, GNC(C)Mary Anne Carson, RN, BScNAssociate Director of Care, Nursing ConsultantAON Inc.Peterborough, OntarioHealth Protection ServicesRegional Municipality of HaltonOakville, Ontario5

Healthy Work EnvironmentsBest Practice GuidelinesBarbara G. Cassel, RN, BScN, MN,GNC(C), NCAAdvanced Practice NurseWest Park Healthcare CentreToronto, OntarioMarianne Cochrane, RN, BAS, MHSc(N)ProfessorDurham CollegeOshawa, OntarioElizabeth Cooper, RN, MNAndrea T. Chonin, RN, MSN, EdDNurse EducatorJackson Health System, Dept. of Education andDevelopment, Miami Beach, FloridaClinical Nurse SpecialistIWK Health Care CentreHalifax, Nova ScotiaBetty Cragg, RN, EdDElizabeth Chu, RN, BAS, BScN, MNDirector of CareTall Pines Long – Term Care CentreBrampton, OntarioInterm Director, ProfessorSchool of Nursing University of OttawaOttawa, OntarioMarta Crawford, RN, BN, MNAnne Clark, RNStaff NurseQueensway Carleton HospitalOttawa, OntarioConsultant, Nursing PracticeCollege of Registered Nurses of ManitobaWinnipeg, ManitobaTracey DasGupta, RN, BScN, MN(c), CON(C)Debra Clarke, RN, BScNClinical Practice CoordinatorOrillia Soldiers Memorial HospitalOrillia, OntarioAdvanced Practice Nurse, Practice LeaderToronto Sunnybrook Regional Cancer CentreToronto, OntarioJulie DeCicco, RN, BScN, MScNJulie Clarke, RN, BScNLearning ConsultantLakeridge HealthOshawa, OntarioClinical Research ConsultantSaint Elizabeth Health CareMarkham, OntarioCécile Diby, RN BScNMargarita Cleghorne,Registered Practice NurseClinical InstructorWescom SolutionsOshawa, OntarioPatrick Clifford, BA, BSW, BEd, MSW, RSWCoordinator Professional Practice, Research AdministratorSouthlake Regional Health CentreNewmarket, OntarioNursing Education SpecialistSCO Health Care ServiceOttawa, OntarioPat DiRaimo, RN, BScN, CDEManager Acute MedicineHumber River Regional HospitalDownsview, OntarioKaren Eisler, RN, BScN, MScN, PhD(c)Director of Nursing PracticeSaskatchewan Registered Nurses’ AssociationRegina, Saskatchewan6

Professionalismin NursingCheryl Evans, RN, BScN, MScNCyndi Gilmer, RN, MHSc(N)Nursing Professional Practice ConsultantSt. Joseph's Healthcare HamiltonHamilton, OntarioDirector – Ambulatory, Complex Continuing CarePeterborough Regional Health CentrePeterborough, OntarioMichelle Farah, RN, BAChris Glen, RNStaff NurseOakville Trafalgar Memorial HospitalOakville, OntarioStaff NurseSt. Joseph’s Health CareLondon, OntarioJoyce Fenuta, RN BScN MHSGillian Graham, RN(EC), PHCNP, MNClinical Leader, ManagerSt. Michael’s HospitalBrampton, OntarioPrimary Health Care Nurse PractitionerOCAD Health and Wellness CentreToronto, OntarioFrances Flint, RN, MNLinda Gould, RPN (Registered Practical Nurse)Director Nursing PracticeSunnybrook Health Science CentreToronto, OntarioStroke Data & Evaluation SpecialistHamilton Health SciencesHamilton , OntarioNancy Flynn, RN, BScN, MN(c)Susan Grant, RN, BScNNurse ManagerQueensway Carleton HospitalOttawa, OntarioProfessional Practice LeaderRoss Memorial HospitalLindsay, OntarioThomas Fulton, RN, MScJulie Gregg, RN, BScN, MAd EdLeader, Professional Practice and Chief Nursing OfficerInterior HealthKelowna, British ColumbiaCoordinator Member Relations and DevelopmentCollege of Registered Nurses of Nova SoctiaHalifax, Nova ScotiaSusan Garnett, RN, ENC(C), DOHNLucie Grenier, RN, BAA, MAPProfessional Practice CoordinatorLennox and Addington County General HospitalNapanee, OntarioDirectrice Générale Adjoinite-affaires cliniquesCentre hospitalier affilie Universitaries de QuebécQuébec City, QuébecRoss Gass, RN, BA, MHSc(c), ENC(C)Debbie Hanna-Bull, RN, BScN, MNDirector Emergency and Intensive CareNorkfolk General HospitalSimcoe, OntarioClinical Nurse Educator-MedicinePeterborough Regional Health CentrePeterborough, OntarioCheryl Harris, RNProject Manager, Policies and ProceduresThe Hospital for Sick ChildrenToronto, Ontario7

Healthy Work EnvironmentsBest Practice GuidelinesCheryl Harrison, RN, BA, MHSc, CHECatherine Kohm, RN, MEdProgram DirectorRoss Memorial HospitalLindsay, OntarioDirector of NursingBaycrestToronto, OntarioJohanne Hayes, RN, BScN, MN(c)Denise Konopaskie, RN, HBA, ACRPSNurse Educator, General Internal MedicineSt. Joseph's Healthcare HamiltonMississauga, OntarioAdvanced Certified Relapse Prevention SpecialistEQUINOX Counselling and Health ServicesKeswick, OntarioLinda Heffernan, RNIrene Koutsoukis, RN,