WEBVTT 00:00:06.111 --> 00:00:07.398 position:50% align:middle - [Anne] Good afternoon, everyone. 00:00:07.398 --> 00:00:13.609 position:50% align:middle It is a real pleasure to have the opportunity to speak with you today about NP education and the impact 00:00:13.609 --> 00:00:16.357 position:50% align:middle of COVID-19 in the Canadian context. 00:00:16.357 --> 00:00:21.460 position:50% align:middle My name is Anne Marie Shin, and as the director of Professional Practice at the 00:00:21.460 --> 00:00:25.696 position:50% align:middle College of Nurses of Ontario, I have oversight of the registration area, 00:00:25.696 --> 00:00:29.211 position:50% align:middle quality assurance, practice quality, and education. 00:00:30.335 --> 00:00:35.513 position:50% align:middle I will be providing some context regarding nursing demographics across Canada. 00:00:35.513 --> 00:00:39.049 position:50% align:middle However, my focus will be from an Ontario perspective. 00:00:39.049 --> 00:00:44.412 position:50% align:middle Ontario is the province with the largest population in Canada accounting for 00:00:44.412 --> 00:00:47.644 position:50% align:middle 13.7 out of 38 million Canadians. 00:00:47.644 --> 00:00:54.400 position:50% align:middle This presentation will provide an overview of advanced practice nursing in Canada as well as how 00:00:54.400 --> 00:00:56.012 position:50% align:middle NPs are regulated. 00:00:56.012 --> 00:01:01.225 position:50% align:middle I will also review NP education in Ontario and how it is approved. 00:01:01.225 --> 00:01:06.662 position:50% align:middle Then we will end by discussing how COVID-19 has impacted education. 00:01:07.508 --> 00:01:12.976 position:50% align:middle I am also looking forward to the panel discussion later regarding the impact of COVID on education 00:01:12.976 --> 00:01:17.239 position:50% align:middle and if we should go back to our previous teaching methods and processes. 00:01:17.239 --> 00:01:22.366 position:50% align:middle I am hoping my session will generate some insights to carry on later this afternoon. 00:01:23.778 --> 00:01:30.441 position:50% align:middle Advanced practice nursing is an umbrella term for RNs who integrate graduate nursing educational preparation 00:01:30.441 --> 00:01:34.458 position:50% align:middle with in-depth specialized clinical nursing knowledge and expertise. 00:01:34.458 --> 00:01:39.497 position:50% align:middle There are two advanced practice nursing roles recognized in Canada. 00:01:39.497 --> 00:01:45.246 position:50% align:middle They are the Clinical Nurse Specialist or CNS, and the Nurse Practitioner. 00:01:45.246 --> 00:01:50.158 position:50% align:middle The NP role is regulated while the CNS role is not. 00:01:51.400 --> 00:01:57.805 position:50% align:middle Advanced practice nursing first emerged in the 1970s as client care grew more complex. 00:01:57.805 --> 00:02:04.048 position:50% align:middle The role was developed to provide clinical consultation, guidance, 00:02:04.048 --> 00:02:09.418 position:50% align:middle and leadership to nursing staff, manage complex and specialized client care with the 00:02:09.418 --> 00:02:14.342 position:50% align:middle goal to improve quality of care, and to promote evidence-informed practice. 00:02:14.342 --> 00:02:17.868 position:50% align:middle You can see both roles are on a continuum. 00:02:17.868 --> 00:02:25.740 position:50% align:middle CNSs are focused on complex client care and system issues that require improvements which result 00:02:25.740 --> 00:02:27.237 position:50% align:middle in measurable outcomes. 00:02:27.237 --> 00:02:32.472 position:50% align:middle The NP role, however, is regulated with a protected title and is farther 00:02:32.472 --> 00:02:35.047 position:50% align:middle along in the clinical practice continuum. 00:02:35.047 --> 00:02:40.317 position:50% align:middle The NP scope is greater with enhanced access to controlled acts. 00:02:43.978 --> 00:02:48.785 position:50% align:middle Nurse Practitioners practice in all 10 provinces and 3 territories. 00:02:48.785 --> 00:02:56.614 position:50% align:middle As a bit of a fun geography fact, Canada and the U.S. are tied as the world's second-largest country landmass 00:02:56.614 --> 00:03:00.187 position:50% align:middle after Russia with 3.8 million square miles. 00:03:00.187 --> 00:03:08.687 position:50% align:middle Based on the latest numbers from 2018, there are 5,700 NPs working in Canada. 00:03:08.687 --> 00:03:14.269 position:50% align:middle The majority are Ontario which, as stated, also has the largest population. 00:03:16.027 --> 00:03:21.498 position:50% align:middle Of the 5,700 NPs in Canada, the majority of them work in primary healthcare. 00:03:21.498 --> 00:03:26.316 position:50% align:middle The others work as adult, pediatric, and neonatal Nurse Practitioners. 00:03:26.316 --> 00:03:31.319 position:50% align:middle NP regulation has had a long run-up period to becoming formalized. 00:03:31.319 --> 00:03:36.600 position:50% align:middle As mentioned, in the '70s, there was a need identified for advanced practice 00:03:36.600 --> 00:03:39.566 position:50% align:middle nurses to support their growing system requirements. 00:03:39.566 --> 00:03:45.002 position:50% align:middle Many nurses were seeking formal and informal education to address those needs. 00:03:45.002 --> 00:03:52.065 position:50% align:middle In the mid-1990s, the Ontario government initiated changes to introduce the formal Primary Health Care 00:03:52.065 --> 00:03:57.180 position:50% align:middle Nurse Practitioner role to address physician shortages in rural Ontario. 00:03:57.180 --> 00:04:04.372 position:50% align:middle In 1998, the government introduced regulation of NPS and the RN extended class. 00:04:04.372 --> 00:04:11.365 position:50% align:middle In this new role, nurses performed activities previously considered medical scope of practice. 00:04:11.365 --> 00:04:18.102 position:50% align:middle The government introduced it with caution and the level of regulation deemed appropriate for the time. 00:04:18.102 --> 00:04:25.112 position:50% align:middle Activities of the new role were somewhat limiting and not reflective of autonomous NP practice today. 00:04:25.112 --> 00:04:30.661 position:50% align:middle For example, there were restrictive lists for medications and tests that could be ordered. 00:04:30.661 --> 00:04:36.463 position:50% align:middle There was a condition on NPs diagnosing and that there had to be a collaborating physician. 00:04:36.463 --> 00:04:42.497 position:50% align:middle And there were also requirements for when and how to consult a physician, for example, 00:04:42.497 --> 00:04:44.341 position:50% align:middle in certain health conditions. 00:04:44.341 --> 00:04:49.197 position:50% align:middle Over the following decade, the NP role in Ontario expanded and changed. 00:04:49.197 --> 00:04:55.587 position:50% align:middle There was an expansion of the scope of practice as well as practice settings where NPs could treat patients. 00:04:55.587 --> 00:05:01.576 position:50% align:middle There was elimination of the physician collaboration requirement as well as the drug list. 00:05:01.576 --> 00:05:08.077 position:50% align:middle Also, at that time, there was an introduction of the regulation of different types or specialties of NPs 00:05:08.077 --> 00:05:10.945 position:50% align:middle including adult and pediatrics. 00:05:12.685 --> 00:05:19.553 position:50% align:middle Also, at the time, we started to see NP roles regulated in other provinces and territories across Canada. 00:05:19.553 --> 00:05:23.461 position:50% align:middle Each were introduced by government to meet the local needs. 00:05:23.461 --> 00:05:26.710 position:50% align:middle What evolved over time was a patchwork. 00:05:26.710 --> 00:05:34.200 position:50% align:middle There was inconsistency in education requirements, exams, scopes, standards, consultation requirements, 00:05:34.200 --> 00:05:35.762 position:50% align:middle and protected title use. 00:05:35.762 --> 00:05:42.554 position:50% align:middle Thus, the current work by the Canadian Council of Registered Nurse Regulators are working to identify 00:05:42.554 --> 00:05:47.121 position:50% align:middle a way forward to a single model of NP regulation. 00:05:47.121 --> 00:05:53.507 position:50% align:middle In 1995, the Primary Health Care Nurse Practitioner program was established as a partnership between 00:05:53.507 --> 00:05:57.037 position:50% align:middle 10 universities and the Ministry of Health and Long-Term Care. 00:05:57.037 --> 00:06:02.071 position:50% align:middle Today, a consortium of nine Ontario universities offer the program. 00:06:02.071 --> 00:06:09.497 position:50% align:middle The model provides yearly access for approximately 200 students across the province, including urban, 00:06:09.497 --> 00:06:12.699 position:50% align:middle rural, remote, and francophone communities. 00:06:12.699 --> 00:06:19.839 position:50% align:middle The program is offered at a master's level with seven core courses taken either in conjunction with a larger 00:06:19.839 --> 00:06:23.614 position:50% align:middle master's in nursing or as a post-master's diploma. 00:06:23.614 --> 00:06:30.338 position:50% align:middle Master's in nursing courses ensure that candidates have the theoretical and research foundations 00:06:30.338 --> 00:06:31.747 position:50% align:middle for NP practice. 00:06:31.747 --> 00:06:37.040 position:50% align:middle A blended learning model is used to deliver the different elements of the curriculum, 00:06:37.040 --> 00:06:43.561 position:50% align:middle including online courses, face-to-face tutorials, and labs offered at each university site 00:06:43.561 --> 00:06:48.009 position:50% align:middle and preceptored clinical placements within the home university region. 00:06:48.009 --> 00:06:55.221 position:50% align:middle The University of Toronto is the one university that offers primary healthcare and also adult 00:06:55.221 --> 00:06:57.315 position:50% align:middle and pediatric NP programs. 00:06:57.315 --> 00:07:01.984 position:50% align:middle In Ontario, our council accepts a number of regulatory exams. 00:07:01.984 --> 00:07:06.714 position:50% align:middle We have a national exam called the Canadian Nurse Practitioner Exam. 00:07:06.714 --> 00:07:12.440 position:50% align:middle American exams are accepted for specialties, including adult and pediatrics. 00:07:12.440 --> 00:07:18.651 position:50% align:middle And in some Canadian jurisdictions like Ontario, they accept the American Family/All Ages Exam. 00:07:19.767 --> 00:07:23.426 position:50% align:middle Now, a little bit more about how the Canadian exam was developed. 00:07:23.426 --> 00:07:30.033 position:50% align:middle A practice analysis was conducted to obtain a description of entry-level NP practice in Canada 00:07:30.033 --> 00:07:35.728 position:50% align:middle and to provide evidence to help regulators harmonize approaches in NP regulation. 00:07:35.728 --> 00:07:40.743 position:50% align:middle We needed this description to write national competencies that would be the basis 00:07:40.743 --> 00:07:43.079 position:50% align:middle for the Canadian Nurse Practitioner Exam. 00:07:43.079 --> 00:07:52.678 position:50% align:middle In 2015, a practice analysis was completed that surveyed approximately 1,500 NPs from across Canada, 00:07:52.678 --> 00:07:56.883 position:50% align:middle from primary healthcare, adult, and pediatric specialties. 00:07:56.883 --> 00:08:05.094 position:50% align:middle Findings concluded that patients differ in needs, context, age development, condition, and complexity. 00:08:05.094 --> 00:08:10.573 position:50% align:middle Yet no matter the stream of NP practice, practice setting, or patient population, 00:08:10.573 --> 00:08:14.252 position:50% align:middle NPs were found to be using the same competencies. 00:08:14.252 --> 00:08:21.979 position:50% align:middle The NP practice analysis led to the development of common entry-level NP competencies across all 00:08:21.979 --> 00:08:26.269 position:50% align:middle specialties that are currently in use by regulators across Canada. 00:08:27.145 --> 00:08:33.822 position:50% align:middle These competencies are the basis of the NP exam and form the basis of the NP education programs. 00:08:35.933 --> 00:08:41.406 position:50% align:middle The purpose of the common entry-level NP competencies is to provide information 00:08:41.406 --> 00:08:45.219 position:50% align:middle about what is required practice for a new NP. 00:08:45.219 --> 00:08:54.510 position:50% align:middle At CNO, we use these competencies to approve NP education programs, assess the education of individuals 00:08:54.510 --> 00:09:01.199 position:50% align:middle applying to become registered as an NP, to approve entry-level exams for NP registration, 00:09:01.199 --> 00:09:08.286 position:50% align:middle assess the ongoing continuing competence of NPs, and to inform the development of standards 00:09:08.286 --> 00:09:10.041 position:50% align:middle of practice for NPS. 00:09:10.041 --> 00:09:16.091 position:50% align:middle One of the registration requirements is to have graduated from an approved program. 00:09:16.091 --> 00:09:19.536 position:50% align:middle Two reasons why we do program approval. 00:09:19.536 --> 00:09:26.100 position:50% align:middle The first is with regards to registration regulation that requires all applicants to have graduated from a 00:09:26.100 --> 00:09:28.257 position:50% align:middle program approved by council. 00:09:28.257 --> 00:09:34.072 position:50% align:middle Making sure this regulatory accountability is consistently and effectively applied 00:09:34.072 --> 00:09:38.380 position:50% align:middle to all nursing education programs is fundamental to protecting the public. 00:09:38.380 --> 00:09:44.723 position:50% align:middle Program approval ensures graduates are prepared to practice nursing safely, competently, 00:09:44.723 --> 00:09:49.413 position:50% align:middle and ethically for the nursing category in our class for which they want to register. 00:09:51.436 --> 00:09:53.949 position:50% align:middle A little bit more about program approval. 00:09:54.821 --> 00:10:01.599 position:50% align:middle This framework was developed to achieve standardized expectation of all entry-level nursing programs. 00:10:01.599 --> 00:10:07.459 position:50% align:middle The framework is based on three standards, program structure, program curriculum, 00:10:07.459 --> 00:10:09.009 position:50% align:middle and program outcomes. 00:10:09.009 --> 00:10:12.416 position:50% align:middle Under each standard is a number of indicators. 00:10:12.416 --> 00:10:15.765 position:50% align:middle The triangle represents the review process. 00:10:16.775 --> 00:10:22.525 position:50% align:middle The principles listed on the right-hand side have provided an important foundation in this process 00:10:22.525 --> 00:10:26.140 position:50% align:middle and continue to be key in our decision-making processes. 00:10:28.435 --> 00:10:34.417 position:50% align:middle There are two types of review processes that programs undergo, an annual monitoring review 00:10:34.417 --> 00:10:35.999 position:50% align:middle and a comprehensive review. 00:10:35.999 --> 00:10:41.735 position:50% align:middle Program approval status is determined yearly based on the results of these assessments. 00:10:41.735 --> 00:10:48.921 position:50% align:middle This scorecard is used by the assessors to evaluate and rate each program during a review process. 00:10:48.921 --> 00:10:53.274 position:50% align:middle You will note that each standard and indicator is weighted differently. 00:10:53.274 --> 00:10:57.871 position:50% align:middle This is due to the relative level of importance of each indicator. 00:10:57.871 --> 00:11:05.632 position:50% align:middle For example, the curriculum mapping indicator is weighted at 25% while the program governance indicator 00:11:05.632 --> 00:11:07.283 position:50% align:middle is weighted at 6%. 00:11:07.283 --> 00:11:12.576 position:50% align:middle You will recall that the curriculum is centered around the entry-to-practice competencies. 00:11:12.576 --> 00:11:18.818 position:50% align:middle Two mandatory indicators are client and student safety and curriculum. 00:11:18.818 --> 00:11:22.529 position:50% align:middle The school must fully meet these requirements to be approved. 00:11:22.529 --> 00:11:29.339 position:50% align:middle So, now that we have had a level set about NP education and regulation in Ontario, 00:11:29.339 --> 00:11:35.092 position:50% align:middle we will move into discussing the impact of COVID-19 on NP education. 00:11:35.092 --> 00:11:39.792 position:50% align:middle To state that it has been a difficult year would be an understatement. 00:11:39.792 --> 00:11:45.325 position:50% align:middle COVID-19 has impacted us all and in every aspect of our lives. 00:11:45.325 --> 00:11:50.316 position:50% align:middle It has stretched the healthcare system and educational system to its limits. 00:11:50.316 --> 00:11:56.092 position:50% align:middle While this adversity has been difficult, it has forced us to rethink the way we do things. 00:11:56.092 --> 00:12:01.182 position:50% align:middle This challenge has brought about change and this change has brought about innovation. 00:12:01.182 --> 00:12:12.131 position:50% align:middle To put COVID in context, as of mid-February, Canada has had 835,000 cases with 22,000 deaths. 00:12:12.131 --> 00:12:16.920 position:50% align:middle Ontario has had 300,000 cases and 7,000 deaths. 00:12:16.920 --> 00:12:26.291 position:50% align:middle As far as vaccines, 1.5 million vaccines have been administered and 520,000 in Ontario. 00:12:26.291 --> 00:12:31.544 position:50% align:middle To date, we have vaccinated 2.6% of the total population. 00:12:31.544 --> 00:12:33.512 position:50% align:middle We still have a long way to go. 00:12:33.512 --> 00:12:37.167 position:50% align:middle Let's talk about the impact on NP programs. 00:12:37.167 --> 00:12:42.252 position:50% align:middle In preparation for this talk, we have followed up with our programs to understand 00:12:42.252 --> 00:12:44.335 position:50% align:middle what some impacts have been. 00:12:44.335 --> 00:12:50.859 position:50% align:middle Firstly, I will talk about the impact on the theoretical delivery of the programs then followed 00:12:50.859 --> 00:12:53.122 position:50% align:middle by the impact on clinical placements. 00:12:53.122 --> 00:12:59.203 position:50% align:middle Since the consortium delivers the courses online previous to COVID in a modular format, 00:12:59.203 --> 00:13:04.864 position:50% align:middle the programs noted there was no significant impact on theoretical learning as they already had 00:13:04.864 --> 00:13:06.175 position:50% align:middle this virtual format. 00:13:06.175 --> 00:13:12.938 position:50% align:middle Schools reported to moving to asynchronous delivery format and they adapted well to this. 00:13:12.938 --> 00:13:19.255 position:50% align:middle The reason for this switch was due to the need to promote more face-to-face time with faculty 00:13:19.255 --> 00:13:20.839 position:50% align:middle and other students. 00:13:20.839 --> 00:13:27.019 position:50% align:middle They also stated they moved from an Adobe platform to Zoom, which streamlined and eliminated 00:13:27.019 --> 00:13:29.512 position:50% align:middle pre-existing technology issues. 00:13:29.512 --> 00:13:35.879 position:50% align:middle Schools followed up with students about satisfaction around delivery methods and most reported good 00:13:35.879 --> 00:13:38.239 position:50% align:middle satisfaction with the Zoom format. 00:13:38.239 --> 00:13:44.060 position:50% align:middle Schools had to be flexible with facilitating staggered end dates for students. 00:13:44.060 --> 00:13:49.210 position:50% align:middle This was necessary depending on where the student was at in the overall program, 00:13:49.210 --> 00:13:51.605 position:50% align:middle as well as access to placements. 00:13:51.605 --> 00:13:57.529 position:50% align:middle In the initial stages of the pandemic, particularly from April to June, 2020, 00:13:57.529 --> 00:14:03.242 position:50% align:middle there were interruptions in programs, particularly with clinical placements and lab courses. 00:14:03.242 --> 00:14:10.478 position:50% align:middle At this time, agency sites were not allowing clinical placements and labs at universities were closed. 00:14:10.478 --> 00:14:18.455 position:50% align:middle This was normalized over time with an opening of more clinical placements and onsite lab opportunities. 00:14:18.455 --> 00:14:24.538 position:50% align:middle To deal with the disruption to placements in the spring, Year 1 clinical placements 00:14:24.538 --> 00:14:28.755 position:50% align:middle were held to accommodate integrated practicum placements. 00:14:28.755 --> 00:14:32.781 position:50% align:middle Those are the placements for the final practicum of a program. 00:14:32.781 --> 00:14:37.572 position:50% align:middle To make up for the first-year students' decreased placements in the spring, 00:14:37.572 --> 00:14:41.687 position:50% align:middle extra clinical hours were offered during the summer session. 00:14:41.687 --> 00:14:47.890 position:50% align:middle Also, students were encouraged, if able, to videotape themselves doing skills, 00:14:47.890 --> 00:14:50.960 position:50% align:middle like a head-to-toe assessment on someone in their home. 00:14:50.960 --> 00:14:56.676 position:50% align:middle These sessions were viewed by an instructor and these students received real-time feedback. 00:14:56.676 --> 00:15:02.351 position:50% align:middle During the spring and fall, there were more acute care placements available. 00:15:02.351 --> 00:15:06.479 position:50% align:middle It was harder to get community placements, however. 00:15:06.479 --> 00:15:12.943 position:50% align:middle Also, with reduced placement opportunities, schools allowed a decrease in clinical placement hours 00:15:12.943 --> 00:15:18.146 position:50% align:middle and increase in simulation and tutored learning as long as they were meeting competencies. 00:15:18.146 --> 00:15:25.463 position:50% align:middle Another interesting phenomenon that our border towns encountered was for their students that were working 00:15:25.463 --> 00:15:31.270 position:50% align:middle as RNs in both U.S. and Canada, they often had to do a two-week quarantine period 00:15:31.270 --> 00:15:32.511 position:50% align:middle due to the outbreaks. 00:15:32.511 --> 00:15:36.840 position:50% align:middle Also, there were a greater number of outbreaks in the clinical areas. 00:15:36.840 --> 00:15:41.388 position:50% align:middle So clinical placements were reduced in hours or canceled. 00:15:43.170 --> 00:15:47.512 position:50% align:middle Despite the challenges I have mentioned, there were some innovations that were adopted. 00:15:47.512 --> 00:15:55.110 position:50% align:middle A few of these were virtual simulation with avatars and real-time use of tutors during simulation, 00:15:55.110 --> 00:15:58.379 position:50% align:middle either virtual or other settings like home. 00:15:58.379 --> 00:16:06.197 position:50% align:middle Students reported that they liked simulation and felt that it was as good as clinical in some instances. 00:16:06.197 --> 00:16:12.394 position:50% align:middle While there is a recognition that the skill acquisition could benefit from a simulated environment, 00:16:12.394 --> 00:16:19.240 position:50% align:middle the actual clinical placements are necessary for the experience of integrating and socializing the role 00:16:19.240 --> 00:16:24.070 position:50% align:middle and working in a complex care environment, collaborating with other students 00:16:24.070 --> 00:16:26.023 position:50% align:middle and multidisciplinary partners. 00:16:26.023 --> 00:16:34.310 position:50% align:middle At present, the NP programs are using a hybrid model with online learning, simulation, real-time tutoring, 00:16:34.310 --> 00:16:35.859 position:50% align:middle and clinical placements. 00:16:35.859 --> 00:16:41.245 position:50% align:middle In some cases, the placements continue to be decreased and are subject to cancellations 00:16:41.245 --> 00:16:43.831 position:50% align:middle depending on outbreaks in facilities. 00:16:43.831 --> 00:16:50.040 position:50% align:middle Despite these challenges and delays, the programs have been able to graduate similar number 00:16:50.040 --> 00:16:52.161 position:50% align:middle of students compared to previous years. 00:16:52.161 --> 00:16:58.924 position:50% align:middle This has been done through quick pivoting of processes and some innovative ways of creating meaningful 00:16:58.924 --> 00:17:01.334 position:50% align:middle teaching and learning experiences. 00:17:03.170 --> 00:17:04.398 position:50% align:middle Thank you for your time. 00:17:04.398 --> 00:17:06.831 position:50% align:middle And I'd be happy to take any questions. 00:17:25.469 --> 00:17:30.604 position:50% align:middle - [Michelle] Thank you, Anne Marie, for sharing this interesting information about Canadian 00:17:30.604 --> 00:17:35.724 position:50% align:middle and specifically Ontario NP education programs and regulation. 00:17:35.724 --> 00:17:42.613 position:50% align:middle I'd like to invite everyone now to enter their questions into the Q&A function if you'd like to ask 00:17:42.613 --> 00:17:44.256 position:50% align:middle Anne Marie any questions. 00:17:44.256 --> 00:17:49.764 position:50% align:middle But while we wait, I would like to kick us off with a question that I have if you don't mind, Anne Marie. 00:17:49.764 --> 00:17:55.468 position:50% align:middle In U.S. Nurse Practitioner programs, the students are required to have a minimum of 00:17:55.468 --> 00:17:58.677 position:50% align:middle 500 direct clinical hours. 00:17:58.677 --> 00:18:04.490 position:50% align:middle Is there such a requirement or standard for clinical placement hours in Canada? 00:18:04.490 --> 00:18:08.421 position:50% align:middle And if so, is it unique to the program or the province? 00:18:08.421 --> 00:18:10.823 position:50% align:middle Can you give us some more information on that? 00:18:11.848 --> 00:18:13.802 position:50% align:middle - Thanks so much, Michelle. 00:18:13.802 --> 00:18:17.673 position:50% align:middle And I'm so happy to be here this afternoon. 00:18:17.673 --> 00:18:25.422 position:50% align:middle So, as far as your question, there is no minimum standardized clinical hours 00:18:25.422 --> 00:18:28.198 position:50% align:middle that the programs have to meet. 00:18:28.198 --> 00:18:34.576 position:50% align:middle However, it really is up to each jurisdiction to set their parameters. 00:18:34.576 --> 00:18:40.485 position:50% align:middle I can tell you with Ontario, we don't have a finite number, 00:18:40.485 --> 00:18:44.623 position:50% align:middle but it is part of our program approval process. 00:18:44.623 --> 00:18:49.105 position:50% align:middle So, I showed the nine indicators. 00:18:49.105 --> 00:18:53.595 position:50% align:middle One of the indicators is specific to clinical placements. 00:18:53.595 --> 00:18:59.850 position:50% align:middle So, we look at sort of the depth and breadth of the clinical placement, the settings, the areas, 00:18:59.850 --> 00:19:05.333 position:50% align:middle as well as we look at simulation and the quality of simulation. 00:19:05.333 --> 00:19:12.052 position:50% align:middle So, yes, it's really jurisdiction-specific. 00:19:14.207 --> 00:19:15.650 position:50% align:middle - Thank you very much. 00:19:15.650 --> 00:19:18.455 position:50% align:middle We do have a question from Jennifer Whrite. 00:19:18.455 --> 00:19:24.811 position:50% align:middle She asks, "How did you determine the standards on the scorecard as well as identify 00:19:24.811 --> 00:19:27.152 position:50% align:middle the weight and percentages?" 00:19:28.218 --> 00:19:29.420 position:50% align:middle - Thank you. 00:19:29.420 --> 00:19:31.549 position:50% align:middle That's a great question. 00:19:31.549 --> 00:19:42.889 position:50% align:middle So, the indicators were developed from a collaborative effort with stakeholders across the province, 00:19:42.889 --> 00:19:49.302 position:50% align:middle as well as across Ontario, as well as it was informed by, you know, 00:19:49.302 --> 00:19:51.457 position:50% align:middle the latest research at the time. 00:19:51.457 --> 00:20:00.269 position:50% align:middle And we also piloted these, you know, indicators as well as our scoring rubrics, 00:20:00.269 --> 00:20:05.705 position:50% align:middle and through the pilot, we learned quite a bit and we actually streamlined 00:20:05.705 --> 00:20:12.719 position:50% align:middle some of these indicators because we noticed some of the indicators were not resulting in what we really had 00:20:12.719 --> 00:20:16.759 position:50% align:middle intended the indicator to tell us. 00:20:16.759 --> 00:20:23.823 position:50% align:middle As far as the weighting, the weighting was done again from representatives 00:20:23.823 --> 00:20:26.129 position:50% align:middle across Canada and Ontario. 00:20:26.129 --> 00:20:34.122 position:50% align:middle So, we had clinicians as well as academics, and we had a statistician who led us through a modified 00:20:34.122 --> 00:20:39.200 position:50% align:middle Angoff process where we determined the weighting. 00:20:39.315 --> 00:20:44.881 position:50% align:middle At that time, we also determined two of our indicators to be mandatory. 00:20:44.881 --> 00:20:53.759 position:50% align:middle So, one of those indicators speaks to client and student safety and the other is around the curriculum. 00:20:53.759 --> 00:21:01.814 position:50% align:middle So, those are two indicators that the school must meet while the other indicators, 00:21:01.814 --> 00:21:09.449 position:50% align:middle they could have a score that, you know, yields are not met. 00:21:09.449 --> 00:21:18.395 position:50% align:middle However, if they're able to still meet the 75% cutoff score, then they can still be approved. 00:21:20.618 --> 00:21:21.980 position:50% align:middle - Thank you. 00:21:21.980 --> 00:21:23.520 position:50% align:middle Oh, we've got quite a few questions. 00:21:23.520 --> 00:21:32.342 position:50% align:middle So, next question is from Rita Doused, [SP] she asks, "Did you assess clinical performance during simulation? 00:21:32.342 --> 00:21:33.917 position:50% align:middle And if so, how?" 00:21:35.108 --> 00:21:36.518 position:50% align:middle - Great question. 00:21:36.518 --> 00:21:44.641 position:50% align:middle And so, when we went out to the schools in preparation for this talk, we had asked them what sort 00:21:44.641 --> 00:21:52.453 position:50% align:middle of simulation they were using because previous to that, they were using high fidelity simulation in the labs, 00:21:52.453 --> 00:21:57.168 position:50% align:middle but they pivoted to an online simulated environment. 00:21:57.168 --> 00:22:04.854 position:50% align:middle And they said that they hadn't at the time, you know, been able to establish outcome metrics 00:22:04.854 --> 00:22:06.630 position:50% align:middle and measure them. 00:22:06.630 --> 00:22:16.549 position:50% align:middle At that time, they were doing experiential sort of surveys of faculty as well as the student participant. 00:22:19.341 --> 00:22:20.440 position:50% align:middle - Thank you. 00:22:20.440 --> 00:22:27.300 position:50% align:middle Next question is from Alison Neil, she asks, "Who provides mental health services for patients?" 00:22:29.832 --> 00:22:39.413 position:50% align:middle - Well, I think the whole healthcare team would provide mental health services. 00:22:39.413 --> 00:22:46.489 position:50% align:middle There are specialized you know, clinicians both in nursing and Nurse Practitioners 00:22:46.489 --> 00:22:55.818 position:50% align:middle that have developed specialties within their roles to help with mental health services. 00:22:55.818 --> 00:23:04.480 position:50% align:middle I'm not sure I've answered your question or whether you're referring specifically to mental 00:23:04.480 --> 00:23:06.055 position:50% align:middle health Nurse Practitioners. 00:23:08.431 --> 00:23:10.564 position:50% align:middle - I'm not certain what Alison is... 00:23:10.564 --> 00:23:15.845 position:50% align:middle Maybe, Alison, you can post some additional detail in the Q&A and we can follow up on that. 00:23:15.845 --> 00:23:21.279 position:50% align:middle Next question, and I think you may have addressed this already. 00:23:21.279 --> 00:23:27.510 position:50% align:middle It's from Molly Schleicher, "How are virtual simulations used to help supplement 00:23:27.510 --> 00:23:35.069 position:50% align:middle the clinical hours lost due to the pandemic and were they able to use simulation to replace those hours?" 00:23:36.708 --> 00:23:37.335 position:50% align:middle - Yes. 00:23:37.335 --> 00:23:47.610 position:50% align:middle So, I think the schools did a really amazing job at pivoting to different environments to ensure that the 00:23:47.610 --> 00:23:53.018 position:50% align:middle students had a broad range of teaching and learning environments. 00:23:53.018 --> 00:23:59.901 position:50% align:middle So, in the beginning of the pandemic, particularly around April to June, 00:23:59.901 --> 00:24:09.236 position:50% align:middle the placements were essentially stopped for most, you know, Ontario Nurse Practitioners. 00:24:09.236 --> 00:24:13.815 position:50% align:middle You know, there were some happening, but I would say the majority were not. 00:24:13.815 --> 00:24:23.124 position:50% align:middle At that time, there was an increase in different, you know, learning techniques and they pivoted away 00:24:23.124 --> 00:24:31.628 position:50% align:middle from sort of the module format to sort of more real-time Zoom classroom-like sort of settings. 00:24:31.628 --> 00:24:36.910 position:50% align:middle And at the same time, they adopted a virtual simulated environment. 00:24:36.910 --> 00:24:47.832 position:50% align:middle And in some cases, that was able to augment the clinical hours that were needed. 00:24:47.832 --> 00:24:53.090 position:50% align:middle However, it totally depended where the student was in their practice. 00:24:53.090 --> 00:24:59.832 position:50% align:middle So, in some cases, if they were at the end of their program in their integrated practicum, 00:24:59.832 --> 00:25:02.850 position:50% align:middle those hours were not replaced. 00:25:02.850 --> 00:25:04.722 position:50% align:middle They were just extended. 00:25:04.722 --> 00:25:09.327 position:50% align:middle So the student ended up finding the clinical placement hours in the summer, 00:25:09.327 --> 00:25:16.282 position:50% align:middle whereas at the beginning of the program, there was other opportunities to really integrate 00:25:16.282 --> 00:25:20.720 position:50% align:middle some of those competencies, like whether it be sort of that home technique 00:25:20.720 --> 00:25:27.048 position:50% align:middle and real-time tutor feedback or they were using simulated environments as well. 00:25:29.479 --> 00:25:35.043 position:50% align:middle - We're on about our last minute and a half, so I'm going to try and sneak in one more question. 00:25:35.043 --> 00:25:39.870 position:50% align:middle Valerie Dearman asks, "When initiating regulation of NPs, 00:25:39.870 --> 00:25:44.134 position:50% align:middle were there grandfather clauses for previous NPs?" 00:25:47.578 --> 00:25:50.872 position:50% align:middle - That is a great question. 00:25:50.872 --> 00:26:00.443 position:50% align:middle So, yes, I'm just trying to think how that would have applied, and I'm assuming she's speaking about 00:26:00.443 --> 00:26:03.033 position:50% align:middle Nurse Practitioners in other jurisdictions. 00:26:03.033 --> 00:26:13.206 position:50% align:middle So, yes, there was grandfathering that went in and, in particular, the biggest change was when 00:26:13.206 --> 00:26:20.793 position:50% align:middle Nurse Practitioners...to become a Nurse Practitioner, it's a graduate-level requirement. 00:26:20.793 --> 00:26:25.473 position:50% align:middle So, you need a master's in nursing with a Nurse Practitioner certificate. 00:26:25.473 --> 00:26:33.410 position:50% align:middle So, those nurse practitioners that did not receive a master's level preparation that got their Nurse 00:26:33.410 --> 00:26:39.025 position:50% align:middle Practitioner certification before that time, those Nurse Practitioners were grandfathered in. 00:26:41.705 --> 00:26:43.289 position:50% align:middle - Thank you very much. 00:26:43.289 --> 00:26:47.980 position:50% align:middle Really appreciate your presentation today, Anne Marie. 00:26:47.980 --> 00:26:54.063 position:50% align:middle And now, I'd like to welcome our next speaker, John Stanley, who will begin speaking 00:26:54.063 --> 00:26:56.788 position:50% align:middle to us very shortly. 00:26:56.788 --> 00:26:56.990 position:50% align:middle Thank you.