annual reportreport in accordance with the provisions of the registered nurses act. this report...

ANNUALREPORT2 0 0 7

April 2008

The Honourable Theresa OswaldMinister of HealthRoom 302, Legislative Building450 BroadwayWinnipeg, MB R3C 0V8

Dear Minister:

We are pleased to present our 2007 Annual Report in accordance with the provisions of the Registered Nurses Act. This report covers the period from January 1, 2007 to December 31, 2007 and includes a statement of accounts of the College, as required by the Act.

Respectfully submitted,

Sheila Dresen RN PhDPresident

2 / A N N U A L R E P O R T C O L L E G E O F R E G I S T E R E D N U R S E S O F M A N I T O B A

C O L L E G E O F R E G I S T E R E D N U R S E S O F M A N I T O B A A N N U A L R E P O R T / 3

TABLE OF CONTENTS

Letter of Transmittal 2

Vision, Mission and Strategic Priorities 4

CRNM Organizational Chart 4

College Staff 4

President and Executive Director's Message 5

Board of Directors 7

Committees Statutory Committees 8 CRNM Committees 8 National Committees 9 Other 9

Report on the Operations of the College 10 Strategic Priority 1 10 Strategic Priority 2 11 Strategic Priority 3 12 Strategic Priority 4 15 Strategic Priority 5 15 Strategic Priority 6 16

Statistics Registration Statistics 18 Complaints Statistics 20

Auditors' Report 21 Financial Statements 22 Notes to the Financial Statements 25


THE College's vision guides the work of the board of directors. It also serves as a compass for the administration as they plan the operations of the College. Together, we work toward creating an envi-

ronment where registered nurses achieve excellence in professional nursing practice and participate as full partners in shaping health services.

THE VISION OF THE COLLEGE OF REGISTERED NURSES OF MANITOBA IS:Registered nurses achieve excellence in professional nursing practice and participate as leaders and part-ners in shaping health services and influencing health outcomes.

THE MISSION OF THE COLLEGE OF REGISTERED NURSES OF MANITOBA IS:The public receives safe, competent nursing care.

STRATEGIC PRIORITIES:The board of directors sets the strategic priorities for the College. These include: ❚ Connecting with, and engaging members. ❚ Influencing outcomes by building coalitions and strengthening and expanding partnerships.❚ Exemplifying excellence and innovation in nursing regulation. ❚ Building leadership capacity.❚ Maintaining a fiscally prudent organization. ❚ Contributing as an integral, active participant in provincial and national health human resource (HHR) planning.

Vision, Mission and Strategic Priorities

BOARD OF DIRECTORS

EXECUTIVE DIRECTOR

Complaints Resolution

Nursing Practice

Registration Services

Business and Special Events

Information and Technology

Finance and Accounting

Executive Support

DIRECTOR, POLICY DEVELOPMENT

AND REGULATION

DIRECTOR, CORPORATESERVICES

DIRECTOR, COMMUNICATIONS,

MEMBER AND GOVERNMENT RELATIONS

CRNMOrganizational Structure

College of Registered Nurses of Manitoba Staff ListEXECUTIVE DIRECTORSusan D. Neilson, RN

DIRECTORSGlenn R. Hildebrand MBA, Communications, Member and Government RelationsSteven Lanktree CA, Corporate ServicesDiane Wilson Maté RN, Policy Development and Regulation

STAFFAngele Cuthbertson, Administrative Assistant, Communications, Member & Government RelationsDeb Elias RN, Manager, Complaints ResolutionLisa Fraser, Communications CoordinatorRon Halford, Administrator, Information SystemsLisa Hohm, Administrative Coordinator, Complaints ResolutionTrish Horwood, Administrative Assistant, Registration ServicesSusan Irwin, Administrative Coordinator, Corporate ServicesSheri Kressock RN, Coordinator, Complaints

Sheri Lemire, Administrative Coordinator, Policy Development & RegulationPeggy Martens RN, Consultant, Nursing PracticeDavid Mintz, Administrative Assistant, Registration ServicesMelva Nordquist, Administrative Coordinator, Nursing PracticeTammy Murdoch RN, Registration Assistant, Registration ServicesDaisy Santiaguel, Coordinator, AccountingCorey Sigurdson RN, Consultant, Registration ServicesTzena Vaughan, ReceptionistTerry Wilson, Executive AssistantJoanne Winsor RN, Consultant, Nursing PracticeSuzanne Wowchuk RN, Consultant, Nursing Practice


Sheila Dresen, RNPresident

Susan D. Neilson, RNExecutive Director

President and Executive Director’s Message

FOR many registered nurses in Manitoba, the year 2007 will be remembered as a year that foretold change for our profession. After exten-sive consultation with key stakeholder groups

across the country, a revised statement of the compe-tencies expected of graduates of basic nursing programs preparing individuals to become registered nurses has been released. The competencies were revised to reflect the anticipated changes in the health care system, changing patient demographics, increased chronic illnesses, increased concern over safety issues, the expectation of inter-disciplinary models of care, and the expected increase in autonomous registered nursing practice. The Board of the College of Registered Nurses of Manitoba approved these competencies in 2007. With the exception of the Province of Quebec, every province and territory has adopted virtually identical wording of the competencies and will be implementing them in their regulatory policies. The next revision of the Canadian Registered Nurse Examination, effective 2010, also will be based on these revised competencies.

The Board also approved changes to the Standards for Nursing Education Programs in Manitoba. Following a review of the Registered Nurses Regulation in 2006, a review of the Standards for Nursing Education was indi-cated to ensure they keep pace with the expectation of graduates of nursing education programs in our prov-ince and the requirements of the health care system. Built into the revised Standards for Nursing Education were:

❚ The expectation that graduates of a nursing educa-tion program would be prepared to meet the revised competencies❚ A specification of the minimum number of clinical practice hours throughout the program❚ An expectation that student errors and near-misses would be tracked as part of emphasis being placed on patient safety❚ The inclusion of inter-professional education oppor-tunities❚ An expectation that content regarding self-regulation and fitness to practice would be a required part of the program❚ The requirement that nursing education programs provide an annual report to the College of Registered Nurses of Manitoba


Sheila Dresen RN PhDPresident

Susan D. Neilson RN BScN MPAExecutive Director

Throughout 2007, the Executive Director and I traveled throughout the province to discuss proposed bylaw changes with our members. Following this con-sultation, and based on careful consideration of all the information available, the Board passed a motion at its December meeting to reduce the position of President to half-time, beginning in 2010. The purpose of the decision was to remove barriers to qualified members agreeing to seek the position of President. The Board also reaffirmed its position that today's communica-tion tools help ensure that the successful candidate could easily live and work in any part of the province and not just within the confines of Winnipeg.

The College's successful record of collaboration with other health care regulatory groups in Manitoba has contributed to a positive experience during the past twelve months' discussions about the provincial government's proposed Health Professions Regulation Reform Initiative. Working closely together and collab-orating with government representatives, a common understanding of the major elements of the legislation has been achieved. The College's Executive Director and I have begun traveling through the province to inform our members and other interested stakehold-ers about the proposed legislation. Members have responded with interest to this development, and have been assured that it appears not to pose a threat to the principles contained in our current Registered Nurses Act.

We are pleased to report there are 49 registered nurses on the RN(EP) register at year end. As it hap-pens, three additional registrants were added to the register within the first few weeks of 2008 bringing our total to 52 RN(EP)s in January. Thus, the target of preparing 50 RN(EP)s in the first three years of the register's existence has been met and exceeded. In the spring the Board approved a motion to give title protection to nurse practitioners. Although the formal designation of protected nurse titles is found in the

Registered Nurses Act, and provincial government had indicated it would not entertain any proposed changes in legislation while discussions of the proposed Health Professions Act were in process, the Executive Director wrote to inform the Minister of Health of the Board's decision. The Minister subsequently indicated she would entertain a change in the regulation to achieve the proposed objective of title protection. Work with the legislative drafters is underway.

The College continues to be in the public eye with our revised public education campaign on cough and sneeze etiquette, launched to correspond with the start of "flu season". A recently completed survey indi-cates that both support for the College's involvement in these public service activities and continued public appreciation for the important role of registered nurses in health care remain strong.

We are delighted with the feedback we received regarding the success of the Western Nurse Leaders Forum, co-hosted in Winnipeg in October with four other western provincial regulatory bodies for regis-tered nurses. The caliber of the conference has been described as equal to that of a national event and the participants were energized and enriched by the pre-sentations and dialogue that ensued.

Along with counterparts in western provinces and northern territories, the College will be partnering with the Manitoba government, post-secondary insti-tutions in Winnipeg, and the Health Sciences Centre, in a demonstration project to develop Internationally Educated Nurse (IEN) competence assessment services. The project, which will begin in 2008, is based on the assessment services developed at Mount Royal College in Calgary, Alberta. We believe this experience will enable us to support IEN applicants to be successful in writing the Canadian Registered Nurse Examination and in making the transition to practice as a registered nurse in Canada.


Board of Directors

2007(as at Dec. 31, 2007)

The Board of Directors is made up from two groups - members of the College of Registered Nurses of Manitoba

elected by their peers, and members of the public appointed by the board or by government. In accordance

with the Registered Nurses Act and CRNM Bylaws, the board includes the president, president-elect, ten elected

member representatives and six public representatives (three appointed by the board and three appointed by the Manitoba government). Under this structure, the board is

accountable to Manitobans and registered nurses.

Back Row: Rita Valcourt RN, Parkland District;Terrance Machalek Sr., Public Representative;Brenda Dawyduk RN(EP), Thompson District;Elsie Duff RN(EP), Interlake District

Middle Row: Darren Luellman RN, Eastman District;Val Zurba RN, Westman District;Colleen Wilson RN, Eastman District; Eileen Vodden RN, Central District;Eric Uhmann, Public Representative;Gary McPherson, Public Representative

Front row: Lorraine Avery RN, Central District;Susan D. Neilson RN, Executive Director; Sheila Dresen RN, President; Kathy Doerksen RN, President-Elect

Absent: Donna Alden-Bugden RN(EP), Interlake District;Elaine Fox, Public Representative;Judy Harapiak, Public Representative;Alice Harron-Spence RN, Norman District;Catherine Robertson, Public Representative


STATUTORY COMMITTEESAppointments Committee recruits and selects members of the College and public representatives to serve on committees of the College. Also recruits and selects public representatives to serve on the Board.

Lorraine Avery RNMarilynne Hogg RN (to August)Colleen Wilson RN (from September)Valerie Zurba RNGlenn Hildebrand, CRNM Staff Liaison

Discipline Committeea quasi-judicial body that conducts hearings and makes findings regarding the practice or conduct of registered nurses. The committee has the power to make orders and issue a range of sanctions under the Registered Nurses Act.

Mary Anne Arndt **Sheila Billinghurst *Penelope Davis RN (from June)Robert Girard *Kristine Hannah RNSandra Holben RNEthel Hook **Laura Horn *Marilyn Irving RNShirley Jones RNTracey Legary RNZenon Lisakowski RNMelany Lowen RNDouglas Mackay *Anna Maria Magnifico *Kimberley McCormick RNMaureen Morrison *Noreen Papineau **Asha Pereira RNIrwine Permut *Cynthia Petrusiak RNMarilyn Robinson **Shirley Scaletta *Corinne Shore RNChristine Simpson *Marlene Tjaden **Beverley Towler RN (to May)Carolyn Townsley RNDeb Elias RN, CRNM Staff Liaison

Investigation Committee reviews and facilitates the resolution of complaints against registered nurses in accordance with the Registered Nurses Act.

Fred Arrojado *Marla Billinghurst *Kathleen Christenson RNPamela Piche RN

Carol Poclen RNIrene Zajac-Mendela RNSheri Kressock RN, CRNM Staff Liaison

Practice Auditorsin accordance with the Registered Nurses Act, practice auditors review a member's registered nursing practice.

Deborah Drew-Taubner RNDenise Bear RNFriederike Ballantyne RNJane MacDonald RN(EP)Lalaine Bucol RNBarbara Packwood RNElizabeth Hinch RNSuzanne Wowchuk RN, CRNM Staff Liaison

CRNM COMMITTEESAd Hoc Advisory Committee on Future Educational Requirements for Initial Registration of Registered Nurses in Manitoba makes recommendations to the Executive Director regarding a plan which will outline the path to success-ful operationalization and implementation of the Board's motion regarding the future educational requirements for initial registration of RNs in Manitoba.

Noreen Wallwin RNKaren Wall RNW Dean Care RNHelga Bryant RNRobin Finney RNDiane Wilson Maté RN, CRNM Staff Liaison

Awards Committeemakes recommendations regarding professional nursing and community caring awards.

Karen Ashley *Ian Chambers RNBeverley Laurila RNMark Singh RNShelley Tallin RNSteve Lanktree CA, CRNM Staff Liaison

Canadian Nurse Practitioner Initiative Report Review Committeean Ad Hoc committee which made recommendations to the Board regarding issues related to the Canadian Nurse Practitioner Initiative Report.

Eliette Allec RNBrenda Dawyduk RN(EP)Kathleen De Leon-Demare RN(EP)Myrna Driedger *Debra Fraser RNKaren Grant *Kathleen Klaasen RNWilliam Knight RNDouglas Mackay *

Elizabeth Rock RNAndrew Swan *Noreen Wallwin RNDiane Wilson Maté RN, CRNM Staff Liaison

Continuing Competence Audit Committeeis responsible for reviewing continuing competence pro-gram materials and making recommendations as part of the annual audit.

Claire Abraham RN(EP)Olaide Adegunju RNLynne Anderson RNLaura Anning RN (from April)Angela Bachynski RNYolanda Basilan RNPatricia Benjaminson RNElaine Beyer RN (from April)Harbans Bhugtana RN (from April)Jaime Burgoyne RNMarc Carney RN (from April)Colleen Cobbe RNBrian Crawford RNShawna Cupples RNYvette Cyr RNCarolyn Demchuk RNBrenda Dow RNMary Ellis RNKimberly Fraser RN (from April)Louise Friesen RN (from April)Daniel Gagne RN (from April)Kristin Hammersley RN (from April)M Happychuk RNKelly Hinds RNMarlene Holewka RNMargaret Kvern RN (from April)Denise Levesque RNNadia Lisniak RNElaine McPherson RN (from April)Cynthia Moorby RN (from April)Lorna Moore RNCarol Mydlo RNDebra Nieuwland RNCatherine Novak RNKristi Nowicki RN (from April)Susan Permut RN (from April)Elizabeth Ptasznik RNChristopher Shay RNSara Shuster RNJudith Siemens RNLinda Smithson RNJennifer Sych RNBarbara Wheeler RNPatricia Williams RNJeanette Zahorodny RNSuzanne Wowchuk RN, CRNM Staff Liaison

Education Program Committeeidentifies alternatives and implications for the Board's consideration regarding matters related to the approval of nursing education programs in Manitoba in accor-dance with the Registered Nurses Act and Regulations.

Committees


Candie Cameron-Ciarilli * (to June)Gloria Castillo *Darlene Grantham RNKaren Schnell-Hoehn RNDavid Hultin * (from August)Helen Trudeau RNPeggy Martens RN, CRNM Staff Liaison

Extended Practice Register Advisory Committee a committee constituted under the Extended Practice Regulation to make recommendations to the Board regarding the included practices within the regulation, participate in the development and review of the stan-dards of practice for RN(EP)s and to review the results of practice audits related to included practices. The make-up of the committee is prescribed in the Regulation.

Terry Babick MDWendy Clark Brenda Dawyduk RN(EP) (to July)Debra Fraser RNRuby Grymonpre Shirley Hiebert RN(EP) (from September)Alexander Kowalski RN(EP)Wm. Pope MDRobert Sangster MDDiane Wilson Maté RN, CRNM Staff Liaison

Investment Advisory Panel assists the Executive Director in managing the invest-ments of the College.

Phil Cyrenne *Cliff Fox *Barre Hall *Steve Lanktree CA, CRNM Staff Liaison

Nominating Committeein accordance with College Bylaws, this committee assists in the nomination and election process for president-elect, registered nurse Board members and the Nominating Committee.

Karen Dunlop RNJudith Marvin RN(EP)Luella Sinha RNGlenn Hildebrand, CRNM Staff Liaison

Registration Committee makes recommendations regarding registration issues.

Patricia Benjaminson RNBrian Crawford RNGlen Gessell *M Gousseau RNPeri Venkatesh RNCorey Sigurdson RN, CRNM Staff Liaison (from June)Joanne Winsor RN, CRNM Staff Liaison (to June)

Resolutions Committee assists in receiving, considering and preparing resolu-tions for presentation at the Annual General Meeting.

Eliette Allec RNAnn Bowman RNGail Hazlitt RNCatherine Hopfner RN (from February)Linda Humphreys RNGloria King RN (to February)Glenn Hildebrand, CRNM Staff Liaisonn

NATIONAL COMMITTEESThe College participated in a number of committees with a national scope.

Canadian Registered Nurses Examination CommitteeLaurie Clark RN

Canadian Registered Nurse Examination Blueprint Committee Marie Edwards RN (from May)

Canadian Registered Nurse Examination Competency Review Committee Teresa Henderson RN (from May)

Canadian Registered Nurse Exam Item Writers and Markersseveral registered nurses were nominated as item writ-ers and/or markers for the CRNE. Item writers assisted in developing questions used in the CRNE. Markers assisted with the marking of the long answer questions used in the CRNE.

Canadian Nurse Practitioner Examination Committee Diane Labossiere RN(EP)

CNPS Adjudication CommitteeJoan Schultz RNNoreen Wallwin RN

OTHERRegistered Nurse Investigators are appointed by the Board of Directors to conduct investigations into complaints. When the Investigation Committee directs that an investigation take place, an investigator is appointed from this pool.

Jeanette Angel RNNicole Cinq-Mars RNDiane Clare RN (from February)Brenda Dawyduk RN(EP) (to July)Sue Anne Decourcey RN (from February)Donna Dixon RNJodene Dusik-Sharpe RN (from February)Carol Enns RNJanice Epp RNCarla Franklin RNMarsha Graham RN (from February)Linda Hughes RN (from February)Sylvia Jennings RN (from September)Beverley Laurila RNWendy Lynch RN (from February)Jo-Anne Mayer RNJanice Nesbitt RNBarbara Partridge RNMichelle Priestley RNJoan Schultz RNRaeAnn Thibeault RNValerie Turnbull RNNoreen Wallwin RNAndrea Zaluski RNDebra Elias RN, CRNM Staff Liaison

Association of Professional Engineers and Geoscientists of Manitoba (APEGM) Discipline CommitteeBetty Frost RN

Brandon University Nursing Advisory CommitteeCathy Hopfner RN

Health Information Privacy CommitteeMaureen Heaman RN

Manitoba Colorectal Cancer Screening Program Advisory CommitteeCindy Allan RN(EP) (from June)

Minister's Advisory Council on Workplace Safety and HealthJudith Siemens RN (from April)

Policy and Practice Task Group of the Manitoba Harm Reduction NetworkCarolyn Hill-Carroll RN

Red River College Appeal PanelBrenda Stutsky RN

Smokers' Helpline Advisory CommitteeLinda Hughes RN (from March)

Sports Medicine Council of Manitoba Nina Williams RN

UCN Nursing Advisory CommitteeLois Moberly RN

University of Manitoba Professional Unsuitability Review Committee Elizabeth Brunsdon-Clark RNCheryl Lange RN

WRHA Standards Committee Todd Torfason RNSuzanne Wowchuk RN

SCRUTINEERSassist in the conducting of voting.

Election ScrutineersHarbans Bhugtana RNJo-Anne Desjarlais RNDarcy Hutton RNKaren Murphy RN

AGM ScrutineersEric Uhmann *Terrance Machalek Sr. *Judy Harapiak *Catherine Robertson *

* Denotes a public representative** Denotes a non-practicing member

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Report on the Operations of the College

THE College's mission and vision statements guide the Board of Directors and the planning and operations of the College. As part of its planning, the Board of Directors established six strategic priority areas to help focus the College's activities

and efforts. Together, the Board and the College's staff, under the direction of the Executive Director, work toward creating an envi-ronment where registered nurses achieve excellence in professional nursing practice and participate as full partners in shaping health services and influencing health outcomes.

The mission statement of the College guides our day-to-day activities. In short, the College exists to ensure that Manitobans receive safe and competent nursing care. Within the context of our vision and mission we present a report of our operational activi-ties organized by the College's six strategic priorities. They are: Connecting with and engaging members; Influencing outcomes by building coalitions and strengthening and expanding partnerships; Exemplifying excellence and innovation in nursing regulation; Building nursing leadership capacity; Maintaining a fiscally prudent organization; and Contributing as an integral, active participant in provincial and national health human resource (HHR) planning.

STRATEGIC PRIORITY 1: CONNECTING WITH AND ENGAGING MEMBERS

FOSTER AN ORGANIZATIONAL CULTURE WHICH ENCOURAGES THE ENGAGEMENT OF MEMBERS

NURSING PRACTICE SUPPORTIn order to be engaged with the College, members must be aware

of the role, resources and priorities of the College. This information is provided to members in a number of ways including group pre-sentations as well as in interaction with members on an individual basis. In 2007, the nursing practice consultants provided 145 presen-tations and had more than 800 contacts with individual members that were specifically in relation to increased awareness of resources and role of the College. In addition, the nursing practice team pro-vided information and consultation by taking the College booth and print resources to a number of conferences throughout the province. All these contacts are well received by members and usually generate further contacts and/or presentations by the nursing practice consul-tants.

A total of 35% of contact with members by the nursing practice consultants were related to this priority.

The Professional Practice Education Series, initiated in April 2006, continues to be an extremely successful method of engaging mem-bers in discussions. Topics included professional boundaries, leader-ship responsibilities for the charge nurse, scope of RN practice, evi-dence based practice, ethical decision making, legal considerations for the nurse in charge, continuing competence, documentation and quality professional practice environments. Participants were able to join the discussion by attending in person or via telecon-ference. Teleconferencing enabled members in isolated, rural and

remote practice settings to participate. Three hundred and twenty five (325) registered nurses attended the sessions in person and 198 attended via teleconference. In addition two sessions were provided by Telehealth. Feedback continues to be overwhelmingly positive. Participants stated that they found the discussions during the pre-sentations extremely valuable and useful in their practice. An added benefit of the sessions was the opportunity for members to see the CRNM office and resources.

ENHANCED COMMUNICATION Four issues of the Manitoba RN Journal were published and dis-

tributed in 2007. The average issue was 36 pages. More than 45,000 copies were distributed. In addition to every registered nurse and non-practicing member, the Manitoba RN Journal was distributed to all Manitoba libraries, nursing education programs, Members of the Legislature, Manitoba Members of Parliament, Canadian nursing regulatory bodies, Manitoba regulated health professions, all College Board and committee public representatives, Manitoba Regional Health Authority executive management members, Manitoba Medical Officers of Health, Manitoba Health and Health Canada executive management members, major Manitoba print and broad-cast media outlets, and waiting rooms in Manitoba health centres and hospitals. In addition, seven issues of the Manitoba RN eJournal were sent to more than 8,000 members and subscribers. The elec-tronic publication is delivered by email to College members with an active email address, in addition to a growing number of subscribers throughout Canada.

The College's website continues to enjoy strong growth in usage on a year over year basis. The number of unique visitors to the web-site grew to 50,970 in 2007 — a growth of 25% over 2006. The total number of visits increased to 78,396 in 2007 — a growth of 19% over 2006. More than 11,600 visits to the College website occurred in October alone. These traffic indicators demonstrate improvements on the strong growth experienced in 2006 and 2005. The number of hits on the website grew to more than 8.3 million in 2007. On an annual basis, more than 32.9 gigabytes of data were downloaded from the website. Most traffic occurs during the week with greatest volumes during the late afternoon and evening hours (1400 - 2100 hours). Most visitors were on the site for more than 5 minutes (38.7%) with a significant number (13.7%) staying for longer than 30 minutes.

The top 5 areas visited on the site in 2007 were: Registration, Site Search Tool, Calendar of Events, Contact Information Page and the Handwashing Resource Page. The top 3 downloads from the site in 2007 were the Handwashing Posters (4,229 downloads), the Continuing Competence Forms (2,431 downloads) and the CRNE FAQ Fact Sheet (2,251 downloads).

Online renewal continues to grow with 5,427 members renewing online in 2007 representing 44% of members. This is significantly higher that last year's 26% figure. In addition, the percentage of members renewing online in the last 10 days prior to November 1 deadline continues to drop from 57% in 2005 to 50% in 2006 and 40% last year. More members are renewing online and they are choosing to do it earlier each year.

C O L L E G E O F R E G I S T E R E D N U R S E S O F M A N I T O B A A N N U A L R E P O R T / 1 1

STRENGTHEN THE RELATIONSHIP BETWEEN CRNM AND NURSING STUDENTS

Nursing practice consultants provided presentations to nursing students on such topics as rural nursing, self-regulation, the role of the College, managing practice issues and ethics. Hundreds of indi-vidual contacts were made with students in person, by telephone, and by electronic mail. The College was a sponsor of the Canadian Nursing Students' Association (CNSA) National Conference in Winnipeg in 2008.

STRENGTHEN CRNM CONNECTION/RELATIONSHIP WITH CRNM INTEREST GROUPS

Nursing practice consultants developed a group email to com-municate with and forward relevant documents, resources and best practice guidelines to interest groups. The College supports nursing interest groups by providing meeting space, coffee, and promotion of meetings via the website and magazine. In addition, nursing interest groups have been offered space in the College's discussion groups section of the members' area of the College website.

STRATEGIC PRIORITY 2: INFLUENCING OUTCOMES BY BUILDING COALITIONS AND STRENGTHENING AND EXPANDING PARTNERSHIPSNURSING PRACTICE SUPPORT

A total of 8% of documented contacts in 2007 related to this strategic priority. Of these contacts, nearly half (43%) were from outside the registered nursing community with 18% from members of the public and 25% from other professional groups. Members of the public were seeking information on what is a registered nurse, nursing education, registered nurse scope of practice, the complaints process, access to RN(EP) services, and the role of the College. Other professional groups contacted the College for information and con-sultation regarding RN(EP)s, the scope of practice of RN, GN and RN(EP), and the management of practice issues of mutual concern.

CRNM responded to several invitations from the Manitoba Pharmaceutical Association, presenting on the topic of RN(EP) to several classes with senior pharmacy students regarding RN(EP) scope of practice and the multidisciplinary Rural Hospital Review Program. The response to these presentations was very positive.

CONTRIBUTE TO AND PARTICIPATE IN NATIONAL INITIATIVES

College nursing staff participated and contributed to a variety of national initiatives including the following: ❚ Quality Practice Environments❚ Continuing Competence for the Canadian Nurses Association (CNA) Nursing Portal❚ Jurisdictional Entry Level Competency Working Group❚ Jurisdictional Review of the Canadian Registered Nurse Examination (CRNE) ❚ Code of Ethics Review❚ Registered Nursing Framework Working Group❚ CRNE Council❚ Canadian Nurse Practitioner Initiative❚ Scope of Practice for Registered Nurses in Rural and Remote Canada❚ Quality Work Life, Quality Healthcare Collaborative❚ CNA Centennial Steering Committee

The College provided feedback on provincial, national and inter-national documents, position statements and policies including the following:

CANADIAN NURSES ASSOCIATION❚ Role of Nurse in Telehealth❚ Substance Misuse and Chemical Dependency by Nurses❚ Nursing Delegation: Summary of Documents and Issues❚ Advanced Nursing Practice Framework❚ Code of Ethics❚ Workplace Violence & Incivility — Canadian Nurses Foundation Joint Position

Statement❚ Nurses Ethical Considerations in an Emergency or Pandemic

INTERNATIONAL COUNCIL OF NURSES❚ Prevention of Disability and the Care of Person's with Disabilities❚ Management of Nursing and Health Care Services❚ Protecting Patient Rights in Health Information❚ Nursing Continuum Framework and Competencies❚ Rights of the Children❚ Nurses Role in the Prevention/Early Detection of Cancer

NATIONAL GROUPS❚ Health Canada — Assisted Human Implementation Act❚ Canadian Regulatory Framework for Registered Nurses❚ Canadian Patient Safety Institute Guidelines for the Disclosure of Adverse Events❚ College of Registered Nurses of Nova Scotia (CRNNS) Profile of a Graduate Nurse❚ Saskatchewan Registered Nurses' Association (SRNA) Citizen Engagement Position Statement❚ Public Health Agency of Canada — Pan-Canadian Core Competency Initiative

PROVINCIAL GROUPS❚ Manitoba eHealth Electronic Health Record Project❚ Manitoba Institute for Patient Safety (MIPS) — Collaborative Abbreviation Project

CITATIONSDuring 2007 the College was noted as a citation in the following publications:❚ CNA — Role of the Nurse in TeleHealth Position Statement❚ Winnipeg Regional Health Authority (WRHA) Home Care Delegated Task Guideline 2007❚ Canadian Gazette — New Classes of Practitioner Regulations❚ Wowchuk, S. M., McClement, S. & Bond Jr., J. (2007). The challenge of providing palliative care in the nursing home, Part II: internal factors. International Journal of Palliative Nursing, 13(7), 345-350.❚ Continuing Competence Programs for Registered Nurses Background Paper (June 2007) — Association of Registered Nurses of Newfoundland and Labrador

CREATE A HIGHER PROFILE FOR REGISTERED NURSES AND CRNM IN THE COMMUNITY

PUBLIC AWARENESS CAMPAIGNIn 2007, building on the very successful hand washing campaign,

we produced and began to run commercials featuring a cough and sneeze etiquette message. Two clinical nurses were selected and did an excellent job with the creative material. The spots began to run in the fall and will continue throughout 2008. In addition, all of the TV commercials (5 sec., 30 sec. and 60 sec.) were closed captioned to make them more accessible and to extend the range of uses we can have for the commercials. In addition, in 2007 we ran transit adver-tising in Winnipeg and Brandon over the summer and bathroom posters in urban and rural locations through the summer and over Christmas.

This campaign continues to create a higher profile for registered nurses and the College in the community. Some radio stations continue to play the radio commercials from 2005 as public service announcements on a no charge basis.

As part of the ongoing evaluation of the initiative a recent tele-phone survey measured the effectiveness of the television and transit ads. A total of 37% of respondents recalled (without further prompt-ing) seeing or hearing the transit and/or television advertising. After being read a brief description, recall of the ads increased to 47% of respondents. A majority (64%) of those surveyed reported that they felt more positive about the College after hearing about the ads. Almost half (49%) of all respondents indicated the commercials caused them to change the way they cough or sneeze while a full 73% said they raised their awareness about the proper way to cough or sneeze. While many could recall specific details about the com-mercials including sneezing into the crook of the arm, the general hand washing message, or both, there was confusion about messages as a result of recent news coverage of nursing related issues. This additional coverage caused a clutter effect which eroded some of our results. That stated, a strong majority (94%) of respondents believe it


is important for an organization like the College to advertise about these types of issues.

The hand washing resource web page created in 2006 continued to receive strong web traffic in 2007. In addition, a cough and sneeze resource page was added in the fall of 2007 to support the new TV commercials. Traffic to this page, while not as strong as the hand washing page, continues to grow.

EXTERNAL COMMITTEE CONTRIBUTIONSThe College is represented by staff and/or registered nurse mem-

bers on a number of international, national and provincial commit-tees thus raising the profile of registered nurses and CRNM. These committees include:

❚ Association of Professional Engineers and Geoscientists of Manitoba (APEGM) Discipline Committee ❚ Brandon University Nursing Advisory Committee❚ Council on Licensure, Enforcement and Regulation (CLEAR): Professional Discipline Committee, International Relations Committee, Examination Resources and Advisory Committee❚ Canadian Nurses Association Board of Directors❚ Canadian Registered Nurse Examination Council❚ Canadian Registered Nurse Examination Committee❚ Canadian Registered Nurse Examination Blueprint Committee❚ Canadian Registered Nurse Examination Competency Review Committee❚ Canadian Registered Nurse Examination Item Writers and Markers❚ Canadian Nurse Practitioner Examination Committee❚ Canadian Nurses Protective Society Board of Directors❚ Canadian Nurses Protective Society Adjudication Committee ❚ College of Physicians and Surgeons of Manitoba Central Standards Committee❚ Health Information Privacy Committee❚ Manitoba Approaches to Primary Care Advisory Committee❚ Manitoba Colorectal Cancer Screening Program Advisory Committee❚ Manitoba Institute for Patient Safety Board of Directors❚ Manitoba Nursing Advisory Council❚ Minister of Labour's Advisory Council on Workplace Safety and Health❚ Physician Integrated Network Advisory Committee❚ Policy and Practice Task Group of the Manitoba Harm Reduction Network❚ Red River College Appeal Panel❚ Smokers' Helpline Advisory Committee❚ Sports Medicine Council of Manitoba❚ University College of the North Nursing Advisory Committee❚ University of Manitoba Professional Unsuitability Review Committee❚ Winnipeg Regional Health Authority Standards Committee❚ Winnipeg Regional Health Authority Advanced Nursing Practice Steering Committee

DEVELOP POLITICAL INFLUENCE

The political landscape in Manitoba, while dynamic in nature, has an element of predictability to it. Maintaining communication with those in a position to influence public policy at the political level is one tactic to advance the College's political agenda. College staff liaises on an ongoing basis with the staff of provincial and federal politicians to exchange information, advance positions and assist in scanning the environment we operate within.

Staff arranged and participated in a briefing session with the CRNM President and the Health Opposition Critic in 2007. One meeting between the President and Minister of Health took place in 2007. The President also attended a Standing Committee of the Legislature public hearing to present a submission on the Fair Registration Bill in 2007. As a result of our suggestions, the Bill was

amended to incorporate some of our feedback.

STRATEGIC PRIORITY 3: EXEMPLIFYING EXCELLENCE AND INNOVATION IN NURSING REGULATIONPROMOTE GOOD PRACTICE

NURSING PRACTICE SUPPORTForty-seven percent (47%) of contacts with the consultant staff

were in relation to this strategic priority.

THE COLLEGE OF REGISTERED NURSES OF MANITOBA IS A PROVINCIAL LEADER IN SUPPORTING THE APPLICATION OF BEST PRACTICES IN REGISTERED NURSING PRACTICE

Evidence based best practices are promoted and discussed with the membership through presentations and consultations and booths at conferences.

The Professional Practice Education Series has been a successful method of engaging members in discussions of best practices relat-ing to scope of practice, code of ethics and standards of practice. Participants were able to join the discussion by attending at the CRNM building or via teleconference. Teleconferencing enabled the members in isolated, rural and remote practice settings to participate in sessions.

The consultant staff traveled about 14,000 kilometers in the prov-ince meeting with members and groups to discuss, consult and pres-ent on nursing practice issues. For example, the College was present with the CRNM booth at a First Nations Inuit Health Conference providing College publications, and engaging in one on one discus-sions with members. One of the common requests is for consultants to join working groups to discuss and present on leadership, charge nurse responsibilities and working to full scope of practice. The College has completed several joint collaborative presentations with the College of Licensed Practical Nurses (CLPNM) and the College of Registered Psychiatric Nurses (CRPNM) in work sites around the province.

The College continues to participate in the Hospital Review Program, which was initiated by the College of Physicians and Surgeons in 1971. Since 2003, the College and the Manitoba Pharmaceutical Association have been formal participants of the program. Our participation has added valuable insight and recom-mendations to the provision of health care and to multidisciplinary staffing relationships. It includes a review of facility processes that enable registered nurses to practice consistently with the Standards of Practice for Registered Nurses and a review of the indicators for a qual-ity professional practice environment. The program is consultative for education and quality improvement purposes and is not part of a disciplinary process. The College participated in all 14 reviews in 2007. The Hospital Review Report is submitted directly to the facility and the CEO of the RHA. A follow up "report card" with action taken by the facility regarding the recommendations is submitted to the Hospital Review Program within 6 months of the initial report. A summative report of all the hospital reviews with recommendations from the participating regulatory bodies is submitted annually to the Minister of Health.

The Ask a Practice Consultant column has continued in the RN Journal. This column focuses on answering current questions regard-ing nursing practice with the goal to support safe, competent, ethi-cal care. The following articles were published in 2007:❚ Prescribing Standards for RN(EP)s January 2007❚ Is My Practice Nursing Practice? April 2007❚ Can a Health Care Attendant Administer Medication? July 2007❚ Professional Boundaries October 2007


The following publications were reviewed in 2007:❚ Entry Level Competencies for Registered Nurses in Manitoba❚ Professional Boundaries for Therapeutic Relationships❚ Continuing Competence Requirements for Registered Nurses❚ Immunization❚ Complaints, Investigations and Discipline Process❚ Extended Practice Registered Nurse RN(EP) FAQ❚ Self-Regulation

The following new publications were made available in 2007: ❚ Is My Practice Registered Nurse Practice?❚ PREP Practitioner Remediation Enhancement Partnership❚ Profile of the Newly Graduated/Entry-Level Registered Nurse❚ Language Testing for International Applicants

The following publication was discontinued in 2007:❚ The Roles of Midwives and Registered Nurses

CONTINUING COMPETENCE PROGRAMThe Continuing Competence Program: A Strategy for Safe,

Competent Practice and Lifelong Learning was implemented in March 2004 for all registered nurses in Manitoba. In March 2006, the Continuing Competence Program for Registered Nurses on the Extended Practice Register RN(EP) was initiated for all registered nurses on the extended practice register.

Members' compliance with the Continuing Competence Program requirements for 2004, 2005 and 2006 were audited in the spring of 2007. Five percent of members on the practicing register were ran-domly selected through a computer generated list. All electoral dis-tricts were represented. Audited members were required to submit a completed audit form and obtain verification of practice hours from their employers. Ten percent of the members selected for the audit were also required to submit copies of their completed continuing competence program documentation. The audit indicated that reg-istered nurses in Manitoba have been completing the Continuing Competence Program. The vast majority of audited registered nurses were able to provide evidence that they had successfully met the Continuing Competence Program requirements.

The findings of the audit indicated that the majority of the submissions were well documented and completed successfully. However, three areas for future education were identified: 1) the requirement to indicate at least one strength and at least one area for self-development for each Standard in the self-assessment; 2) utilizing the identified areas for self-development to develop the goal in the self-development plan; and 3) documentation of evalua-tion of the impact of learning/professional development on practice. These results are similar to the audit results in 2006. Follow-up and educational opportunities were provided to members who required assistance. In addition, the CRNM Fact Sheet entitled Continuing Competence Requirements was updated to clarify the requirements, and detailed audit findings appeared in the RN Journal.

An educational session on the Continuing Competence Program was offered during the 2007 Professional Practice Education Series, and was well attended both in person and by teleconference. In addition, practice consultants offered education on the Continuing Competence Program through individual member consultations and in worksites throughout the province. The Continuing Competence Program audit process was presented at the National Continuing Competence Conference in Toronto and was very well-received, prompting several regulated health care professional groups from across Canada to contact the College for more information about the Continuing Competence Program and auditing process.

In 2007, the timing for the 2007 Continuing Competence Program audit was changed to coincide with 2008 Registration Renewal. Members randomly selected for the 2007 Continuing Competence Program audit were notified by a letter that accom-panied their 2008 Registration Renewal Application Package. As a part of their registration renewal requirements, they were required

to submit the required audit materials. While employer verification of practice hours is part of the auditing process, College receipt of this information was not required prior to renewing an audited member's registration. However, audited members were not eligible for registration renewal unless the required audit materials (audit form and/or copy of continuing competence program documenta-tion) were received.

PREVENT POOR PRACTICE

PREPCRNM has adopted the Practitioner Remediation and

Enhancement Partnership (PREP) Program as a non-punitive early intervention strategy to remediate and improve registered nursing practice. This program makes it possible to identify those practice problems that cause concern but do not rise to the level of precipi-tating the formal complaints resolution process. PREP proposes that early intervention and remediation can forestall errors before patient harm occurs. The goal of the program is to identify and provide remediation to registered nurses who demonstrate lack of knowl-edge, skill and judgement in nursing practice. The partnership exists between the registered nurse, the employer and the College. The first intake into the PREP program was in early 2007. Education to employers and registered nurse members has been ongoing includ-ing presentations at the CRNM Education Day in May 2007 and at the Western Nurse Leaders Forum hosted in Winnipeg in October 2007.

PRACTICE AUDITSA practice audit is the examination of nursing practice of an indi-

vidual member by comparing specific components of the member's practice to established norms, standards and benchmarks, such as:❚ Standards of Practice for Registered Nurses in Manitoba❚ Standards of Practice for Registered Nurses on the Extended Practice Register❚ Entry Level Competencies for Registered Nurses in Manitoba❚ Competencies for the Registered Nurse (Extended Practice) RN(EP) Register ❚ Code of Ethics for Registered Nurses❚ Commonly accepted best practices

Practice audits include but are not limited to: ❚ Onsite review of a member's practice❚ Inspection of the practice environment in which the member works❚ Inspection of records relevant to the member's practice

The processes for conducting practice audits were developed and implemented with the first two practice audits completed in 2007.

Two issues of the employer bulletin were published in 2007, in addition to the distribution list the bulletin is emailed to, the bul-letins were downloaded a total of more than 1,500 times in 2007. Topics included information on the employer verification service, unauthorized practice, a reminder about grad nurse registration expiry, continuing competence audit details, RN(EP) update, and information about the Patient Safety Conference and the Western Nurse Leaders Forum.

The column "Raising the Bar" continued to be printed in each edi-tion of the Manitoba RN Journal. Themes arising out of situations addressed through the complaints and discipline processes are pre-sented. These themes inform and educate members, the public and other health care providers about what constitutes poor registered nursing practice and outlines strategies to address poor practice. The topics discussed in 2007 included poor medication handling practices, failure to respond to significant client health changes, professional boundary violations and the Collaborative Complaints Resolution process.

Discipline decisions and some decisions of the Investigation Committee such as notice of voluntary surrender and notice of cen-sure are published in the Manitoba RN Journal and on the CRNM website. Publication of discipline decisions has proved to be an effec-


tive strategy to inform the public and members about the orders of the discipline panel, decisions of the Investigation Committee and circumstances relevant to the findings and to educate members, student nurses and the public about professional registered nursing practice.

INTERVENE WHEN PRACTICE IS UNACCEPTABLE

A total of 71 new complaints were lodged against registered nurses in 2007; an increase of twenty-six complaints from 2006. The major-ity of complaints related to failure to intervene or take appropriate action, poor interpersonal skills and incompetence.

Nine ongoing investigations were carried over from 2006. Registered nurse investigators were appointed to conduct investiga-tions for twenty-eight new complaints that were directed for an investigation. By the end of year, fourteen investigations had been completed and twenty-three were ongoing.

The Investigation Committee took no further action on twenty-two complaints. The Committee directed that five complaints be informally resolved. Four of these were successfully resolved in 2007 with the remaining one in progress. Collaborative Complaints Resolution was utilized for four complaints and was successful for two complaints. One member was censured and two members vol-untarily surrendered their registration in 2007. Two members were suspended and four cases were referred to the Discipline Committee in 2007.

Sixty-nine members are involved in ongoing monitoring of their compliance with agreements or undertakings established by the Investigation Committee or orders determined by a panel of the Discipline Committee. Thirty-one members were reviewed by the Investigation Committee due to issues with compliance with agree-ments, undertakings or orders.

Of the four new referrals to the Discipline Committee in 2007, three discipline hearings were concluded and one hearing was adjourned. In the hearings that concluded, the panel of the Discipline Committee ordered monitoring for the three members. One discipline referral was carried over from 2005 and two from 2006. In these hearings, two referrals are still pending and one is concluded as the charges were stayed.

The Board of Directors heard one appeal in 2007 regarding deci-sions of the Investigation Committee. The Board of Directors sent the complaint back to the Investigation Committee for further con-sideration.

CONTINUE TO ENSURE A SELF-REGULATING, SELF-GOVERNING PROFESSION

At the end of 2007, the College had a total of 12,284 members. This included 11,864 registered nurses on the practicing register, 49 on the extended practice register, 116 on the graduate nurse register, and 255 on the non-practicing register.

In 2007, 590 candidates wrote the Canadian Registered Nurse Examination (CRNE). Of these, 532 were first time writers and 58 were second and third time writers. Of the 590 writers in 2007, 464 were candidates who had received their education in Manitoba and 126 were internationally educated applicants. The pass rate for Manitoba candidates is 93% and for international applicants is 62%.

In 2007, 9 candidates wrote the Canadian Nurse Practitioner Exam-Family/All Ages with all passing. Eight (8) candidates wrote the American Nurses Credentialing Centre Nurse Practitioner Exam (available in three streams: adult; pediatric; or family) and all passed.

There were 4 instances of unauthorized practice during 2007. The Board has the authority to approve entry-level nursing educa-

tion programs and nursing education programs which prepare reg-istered nurses for registration on the extended practice register. The approval status for Manitoba nursing education programs is:

❚ University of Manitoba Baccalaureate Nursing Program - to December 2010❚ Brandon University Baccalaureate Nursing Program - to June 2008❚ Red River College Diploma (Accelerated) Program - to June 2008❚ St. Boniface College Nursing Diploma Program - to June 2008❚ Red River College Nursing Refresher Program - to February 2010❚ University of Manitoba Master of Nursing, Nurse Practitioner Major - to February 2009

The College provides an online registration renewal mechanism on its website. In 2007, a total of 5,427 registration renewal applica-tions were received online (44% of the membership). This number represents an increase of 42% compared to the number of renewal applications received online in 2006.

For the fifth year, an online employer verification system was available through the College's website. During the year, 9 more employers registered for the service for a total of 97 employers par-ticipating in online verification of their RN employees' registration status. For the period January 1, 2007 to January 1, 2008 employ-ers made approximately 3,000 queries (verification requests). These ranged from queries about an individual RN to uploading data files with more than 2,300 RNs in a single query.

The College participated in reviewing and updating the Mutual Recognition Agreement on Labour Mobility for Registered Nurses in Canada. The Agreement has been translated and is being reviewed to ensure the intent and meaning is consistent between the English and French versions. The goal is for Jurisdictions to sign the Mutual Recognition Agreement by the end of March 2008.

CANADIAN NURSE PRACTITIONER INITIATIVE (CNPI) RECOMMENDATION REVIEW COMMITTEE FOLLOW-UP

In 2006, the College established the CNPI Recommendation Review Committee, which had the responsibility to review the CNPI Report and make recommendations to the CRNM Board of Directors. In 2007, the Board of Directors accepted five recommendations made by the Committee. These include (1) that the College under-take all necessary actions to protect the title "nurse practitioner"; (2) that the College review the practice hour requirement for continu-ing competence for RN(EP)s and revise the requirements based on research or well established national standards and review the com-bination of approaches used for RN(EP)s consistent with the CNPI Competence Assessment Framework and collaborate with major stakeholders to design and implement a competence assessment program for nurse practitioners; (3) that the College partner with the University of Manitoba and other stakeholders to address the short-age of clinical training sites, preceptors, qualified faculty and mon-etary resources; (4) that the College take a leadership role in develop-ing and implementing a comprehensive 3 to 5 year social marketing plan and that it continues to partner with Manitoba Health and Regional Health Authorities in the development and implementa-tion of the plan and (5) that the College, using the CNPI's evalua-tion framework, work with stakeholders to establish a process for ongoing evaluation of the nurse practitioner role in Manitoba.

RECOMMENDATION 1: This recommendation was communicated in two letters to the Minister of Health in 2007 as well as during meetings with the Minister. It is anticipated that this change will come into effect in 2008.

RECOMMENDATION 2: The CNPI Competence Assessment Framework does not suggest a minimum number of practice hours for annual registration renewal. The College established its practice hour requirement based on the belief that sufficient, appropriate and ongoing practice is fundamental to RN(EP)s keeping at the forefront of professional practice in order to provide safe, competent nursing services. The minimum requirement of 1,800 hours over three years is equivalent to working approximately a .3 EFT position annually.

The CNPI Competence Assessment Framework is based on the following principles: accountability; ongoing commitment to excel-


lence; clients' right to safe, quality care; feasible and affordable; fair, equitable and flexible; evidenced-based. In addition to the practice hour requirement, the CRNM Continuing Competence Program for RN(EP)s includes an annual self-assessment, development of a professional development plan and evaluation of the impact of the plan on practice; peer review of cases managed by the RN(EP); and, patient quality of care evaluations. The College reviewed the Program against these principles and determined that it addresses all of them. In response to feedback from RN(EP)s, the requirement for patient quality of care surveys was expanded to include reflection on practice by RN(EP)s as an alternate strategy the registrant may use to fulfill this expectation of the Program. A review of the Continuing Competence Program will be undertaken in 2009. Consistent with the College's approach to such an activity, major stakeholders will be included in the process.

RECOMMENDATION 3: The Executive Director met with the Dean of the Faculty of Nursing when the Dean assumed her new position at the University of Manitoba in July 2007. She is aware of the need to attract and retain faculty members who are nurse practitioners with advanced education and indicated she has made this one of the priorities for the faculty. The College has a productive working rela-tionship with all of the regional health authorities and takes every opportunity to educate and inform employers about RN(EP)s and the need for the health authorities to provide access to supervised clinical education in their facilities and programs.

RECOMMENDATION 4: The College developed a communication plan in 2005 to assist in educating health providers and the public about the role and value of RN(EP)s. The staged approach outlined in the plan is critical in ensuring the communication efforts do not move too far ahead of the capabilities of Manitoba RN(EP)s to meet the growing expectations that execution of the communication plan will create. In 2007 a working group was formed to guide the development of a poster to be displayed in clinics, hospitals and health and social service settings welcoming RN(EP)s as the newest member of the health care team. The poster will also form the basis for a print ad(s) delivering the same key message. These efforts were put on hold while the revisions to the regulation related to title protection were finalized and resolved. Continued communication and marketing activities will flow from the plan as RN(EP) numbers increase. The College continues to post the names of registrants on the extended practice register on the website. This is a resource for the public and other health care professionals alike.

RECOMMENDATION 5: The CNPI Report recommends adoption of the Implementation and Evaluation Toolkit for Nurse Practitioners in Canada as a national guide to support the ongoing implementa-tion of NPs in different settings. The Canadian Nurses Association is seeking the funding from Health Canada to support the integra-tion and sustainability of the nurse practitioner role in Canada. As a result, it is logical to assume that evaluation must take place on a national scale. That said, the College will undertake evaluation of the Extended Practice Regulation by June 2008.

STRATEGIC PRIORITY 4: BUILDING LEADERSHIP CAPACITYINCREASE THE POOL AND DEVELOP THE KNOWLEDGE AND SKILLS OF EMERGING NURSE LEADERS

College staff provided 27 presentations and consultations on the topic of leadership to members and employers throughout the prov-ince. The leadership presentations focus on the goal of developing and enhancing the leadership capabilities and responsibilities in all registered nurses regardless of their role. The Professional Practice

Education Series presentations: Leadership in Direct Care---Exploring the Standards of Practice and Leadership Responsibilities for the Charge Nurse were well received by attendees and triggered requests for these presentations in a number of worksites as well as at several conferences. In addition to presentations, College staff work with nursing practice councils, mentors, preceptors, and charge nurses as part of local programs to enhance leadership.

The College hosted the 4th Western Nurse Leaders Forum - "Leading the Way — the Challenge of Leadership" at the Winnipeg Convention Centre, Winnipeg, MB - Oct. 15-17, 2007. Speakers from across Canada headlined the 2 1/2 day event which included 16 concurrent sessions with a primarily Western Canadian focus. A total of 225 delegates from across Canada attended the event.

According to evaluation forms completed by participants:❚ 98% rated the overall conference as good, very good or excellent❚ 99% rated the program quality as good, very good or excellent❚ 85% rated the facility as good, very good or excellent

The speakers were all well-received. The speakers who rated the highest (in order of highest marks) are: Michael Villeneuve (Thinking Like a Chess Player: Leading Nursing Toward 2020), Dr. Marlene Smadu (Promoting High Quality Workplaces), and Dr. Jeanne Besner (From Research to Action: Leading by Optimizing Nursing Workforce Utilization). The quality of the presentations was rated very good with no lower than 65% of the respondents.

The Forum was co-sponsored by: College of Registered Nurses of Manitoba, Saskatchewan Registered Nurses' Association, College and Association of Registered Nurses of Alberta, College of Registered Nurses of British Columbia, and Yukon Registered Nurses Association.

A call for elections for president-elect, elected board members and the nominating committee was issued in 2007 and was promoted on the website and in the RN Journal. The Voice Your Interest database is being used to help identify potential candidates.

STRATEGIC PRIORITY 5: MAINTAINING A FISCALLY PRUDENT ORGANIZATIONENSURE THE BOARD'S ABILITY TO MEET ITS RESPONSIBILITIES UNDER THE REGISTERED NURSES ACT

Throughout the year the College maintains vigilance in develop-ing and executing strategies to ensure the organization remains fiscally viable. The College prepares detailed budgets which assist in determining revenue requirements. The current fee structure, approved by the membership, will ensure viability for the next two years. The College maintains a level of long-term investments, suf-ficient to cover a reasonable amount of unforeseen expenditure requirements or short term revenue interruptions. We maintain insurance to cover property loss, third party liability, employee dishonesty and business interruption. A system of internal controls designed to ensure that the College's assets are adequately protected is maintained. We monitor key liquidity measures (e.g. working capi-tal and current ratios) to ensure that the College continues to meet its financial obligations.

CONTINUE TO EXPLORE EXTERNAL REVENUE SOURCES

Wherever appropriate, the College explores opportunities to sup-plement membership and investment revenue through alternative revenue sources. Where feasible, significant events and programs are operated on a cost recovery basis. These include: Educational Events, the Western Nurse Leaders Forum, the CRNM Professional Nursing


Awards Banquet, the Pre-Authorized Chequing Program, recovery of NSF cheques and payments, the RN and RN(EP) Examinations, and Prior Learning Assessments.

Supplementary revenue sources are sought to assist in offset-ting the cost of the Annual General Meeting and the Manitoba RN Journal. The College entered into an agreement with an external firm to sell advertising in the RN Journal as a strategy to increase advertising revenue and offset the costs of producing the magazine. The relationship has resulted in significantly increased advertising sales.

CONTINUE TO CONTROL OPERATING COSTS

Given its dependency on the membership to approve fee increases and in the interest of maintaining a fiscally prudent organization, the College employs a number of management tools to ensure that operating costs are managed. We develop multi-year budgets, on a zero-based basis. This essentially means that budget expense line items are not automatically carried forward from year to year but must be re-justified each year with detailed plans, or the expense will be excluded. All planned expenditures are approved by the appropriate authority prior to its occurrence. Financial results are reviewed on a timely basis by the management team in comparison with the budget plan. Significant variances are explained, and where necessary, corrective action is taken to ensure that overall budget objectives are met. Beginning in June of each year, projected results for the coming year-end are developed by the management team. This tool helps to ensure that significant unfavorable variances from budget are prevented or controlled at an acceptable level.

Detailed budgets were developed for significant projects and events (e.g. awards banquet, Western Nurse Leaders Forum, etc.), so that component costs could be better managed. Post-event reviews were undertaken where costs varied significantly and this informa-tion was incorporated into planning for future events and projects. The College periodically tenders significant services, such as the annual audit of financial results or for the replacement registrant database now being implemented. In addition, multiple quotes are obtained for significant new suppliers and/or services. Quotes are also periodically obtained for existing services (e.g. CRNM's printing supplier), to ensure that value-for-money continues to be realized from existing suppliers.

The College provides email attachments of registration application forms whenever possible to reduce the costs of mailing application packages internationally and consistently refers members and appli-cants to the website for information and application forms. Staff reg-ularly refer members to publications on the website and contribute to the creation of Web based new member kits for RNs and RN(EP)s and continuing competence program forms. The College continues to explore ways to migrate additional documents to a primarily elec-tronic format and away from print.

STRATEGIC PRIORITY 6: THE COLLEGE IS AN INTEGRAL AND ACTIVE PARTICIPANT IN PROVINCIAL AND NATIONAL HEALTH HUMAN RESOURCES (HHR) PLANNINGMAXIMIZE THE SCOPE OF PRACTICE FOR REGISTERED NURSES

NURSING PRACTICE SUPPORTOf the contacts with the nursing practice team in 2007, 8% were

related to this strategic priority. There continues to be a great need for information about scope of practice and assistance in under-standing the scope of practice of registered nurses, graduate nurses

and registered nurses (extended practice).

THERE IS A MANITOBA HHR PLAN

There are four nursing education programs approved by the College to prepare nurses for entry to the registered nursing pro-fession and one program to prepare registered nurses to meet the educational requirements for registration on the extended practice register. In addition there is one program for nurses to re-enter the profession after a time away.

Brandon University graduated its first class of 37 in May 2007. Prior to this, graduates in Brandon were graduates of the University of Manitoba Program offered on the Brandon campus.

Collége universitaire de Saint-Boniface (CUSB) offers a 27 month (over three academic years) diploma program in French based on the program offered by the University of Ottawa. Upon completion of the program graduates may continue on to complete the fourth year from the University of Ottawa to obtain a baccalaureate degree in nursing.

Red River College offers a 25 consecutive month accelerated diplo-ma nursing program. Three rural sites (Dauphin, Gimli and Winkler) have the RRC program running with students completing year one in 2007.

The University of Manitoba offers a baccalaureate degree in nursing at the Fort Garry campus, at Red River College (Joint Baccalaureate Program) and through University College of the North. The university also offers the Master of Nursing Program, Nurse Practitioner Major.

Registered nurses who are returning to work after a period of time away or who have not accrued 1,125 practice hours in the previous 5 years can fulfill the continuing competence requirement for regis-tration on the practicing register by completing the Registered Nurse Refresher Program at Red River College or undergoing a competence assessment and successfully completing recommended courses. In 2007, a total of 16 nurses completed the refresher program and several re-entered the workforce following a competence assessment and course of instruction.

In 2007 there was one applicant for registration on the extended practice register using the Acquired Learning Assessment. To date this individual has completed phase one of the prior learning assess-ment and recognition (PLAR) process and is currently working on completion of a course of instruction.

The College was a member of the Leaders' Roundtable on Health Human Resources and the Conference Board of Canada research project on issues of legislation and regulation in the interdisciplinary health care environment.

We remain an active partner in the WRHA/RHAM RN Projection Model initiative that was developed to provide an ongoing manage-ment tool to predict nursing supply needs.

The College negotiated a new letter of agreement with the Canadian Institute for Health Information (CIHI) for the purpose of providing annual data concerning Manitoba registered nurses. This Registered Nurses Data Base (RNDB) has been in existence since 1980 and is used by all levels of government, researchers, stakeholder and advocacy groups, private and public organizations, and registered nurses as a comprehensive data source on the supply and distribu-tion of registered nurses in Canada.

The College is a partner in the Capacity Building for IEN (Internationally Educated Nurse) Assessment (CBIA) Project, which will extend from January 2008 to March 31, 2010, This project is a result of a proposal made to the Internationally Educated Health Professionals (IEHP) Initiative of the Western and Northern Health Human Resources Planning Forum. The purpose of the project is to develop IEN competence assessment services in the western provinces and northern territories based on the assessment services developed at Mount Royal College in Calgary, AB. These services were established as an outcome of the Prior Learning Assessment


and Recognition Research Project conducted from 2003 to 2006. Other Manitoba partners in the CBIA project include: Manitoba Health: Workforce Policy and Planning; Manitoba Government Labour Market Strategy for Immigrants; Council on Post Secondary Education (COPSE); Red River College School of Health Sciences and Community Services; Red River College Language Training Centre; University of Manitoba Faculty of Nursing; and Health Sciences Centre. Cathy Baxter RN has been hired as the project manager for Manitoba. CRNM will chair and provide administrative support for the steering committee in Manitoba. Although the project was established to build capacity in conducting assessments of IENs, a significant benefit of Manitoba's involvement is acquiring access to the Bridge to Canadian Nursing Program developed by Mount Royal College. This program is designed to bridge the gaps identified in the assessment in order to support IEN applicants to be successful in writing the Canadian Registered Nurse Examination and in making the transition to life and registered nursing practice in Canada.

QUALITY PRACTICE ENVIRONMENTS

In 2007, a review of Quality Practice Programs available through nursing regulatory colleges/associations in Canada was completed. A framework was adopted for use in developing a Quality Practice Program specific to Manitoba while relying on evidence-based lit-erature and the extensive work completed by the Registered Nurses' Association of Ontario. This information was presented in the November Professional Practice Education Series. Quality practice environment issues are also addressed through the Rural Hospital Reviews and through the practice calls received by the practice con-sultants on a regular basis.

The Hospital Review program provides an opportunity to discuss a variety of areas which promote best practice and safe patient care through the use of a quality practice environment framework. Areas addressed in the review which are an integral part of quality practice environments includes the resources available to individual nurses and the facility to support them in their role, the available educa-tional opportunities, level of autonomy of individual nurses, retain-ing nurses for effective staffing, factors influencing physical work demands, and policy which impacts the work of staff and safety of patients.

Many of the issues addressed in the Hospital Review program are similar to concerns addressed by registered nurses when contact-ing a practice consultant for consultation. Although nurses do not identify their concerns as a 'quality practice environment issue' their concerns are frequently a part of the components which contribute to a quality practice environment. These issues include safe work environments, concerns with physical work demands, conflicting policy at the work site, adequate staffing, and individual scope of practice. Through the practice consultation process, quality practice environment issues are addressed constantly and ultimately contrib-ute to safe patient care.


Registration Statistics

Total Registrations Type 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007Practicing 10,936 10,813 10,792 10,820 10,763 10,945 11,263 11,518 11,670 11,653 11,864Extended Practice RN(EP) - - - - - - - - 4 32 49Non-Practicing 173 166 163 186 207 396 309 257 245 282 255Graduate Nurse - - - - 64 127 90 106 130 158 116Total 11,109 10,979 10,955 11,006 11,034 11,468 11,662 11,881 12,049 12,125 12,284Total Practicing Only 10,936 10,813 10,792 10,820 10,827 11,072 11,353 11,624 11,804 11,843 12,029 Age of Members (Practicing, Extended Practice & Graduate Nurses) 2003 2004 2005 2006 2007

Age Number % of Total Number % of Total Number % of Total Number % of Total Number % of Total < = 25 138 1.2% 317 2.7% 335 2.8% 483 4.1% 506 4.2% 26 - 30 778 6.9% 894 7.7% 942 8.0% 1,005 8.5% 1,061 8.8% 31 - 35 1,124 9.9% 1,178 10.1% 1,194 10.1% 1,238 10.5% 1,232 10.2%36 - 40 1,470 12.9% 1,510 13.0% 1,493 12.6% 1,511 12.8% 1,480 12.3%41 - 45 1,862 16.4% 1,891 16.3% 1,827 15.5% 1,835 15.5% 1,786 14.8%46 - 50 1,945 17.1% 1,955 16.8% 1,890 16.0% 1,866 15.8% 1,859 15.5%51 - 55 1,941 17.1% 1,929 16.6% 2,032 17.2% 2,000 16.9% 2,041 17.0%56 - 60 1,301 11.5% 1,247 10.7% 1,343 11.4% 1,273 10.7% 1,336 11.1%61 - 65 598 5.3% 545 4.7% 584 4.9% 507 4.3% 560 4.7%66 + 189 1.7% 151 1.3% 160 1.4% 125 1.1% 168 1.4%unknown 7 0.1% 7 0.1% 4 0.0% 0 0.0% 0 0.0%Total 11,353 100.0% 11,624 100.0% 11,804 100.0% 11,843 100.0% 12,029 100.0%

55+ 18.4% 16.7% 17.7% 16.1% 17.2% <40 30.9% 33.5% 33.6% 35.8% 35.6%

Gender of Members (Practicing, Extended Practice & Graduate Nurses) 2003 2004 2005 2006 2007

Gender Number % of Total Number % of Total Number % of Total Number % of Total Number % of TotalMale 617 5.4% 661 5.7% 683 5.8% 705 6.0% 741 6.2% Female 10,736 94.6% 10,963 94.3% 11,121 94.2% 11,138 94.0% 11,288 93.8% Total 11,353 100.0% 11,624 100.0% 11,804 100.0% 11,843 100.0% 12,029 100.0%

Self Reported Working Preferences (in relation to the number of hours currently worked)

2006 2007

Full Time Part Time Casual Full Time Part Time Casual About the same 77.9% 74.9% 70.0% 77.3% 75.1% 70.4%More hours 3.8% 16.9% 18.7% 4.8% 17.0% 17.6%Less hours 16.1% 6.1% 7.8% 16.3% 6.8% 10.6% No response 2.1% 2.0% 3.5% 1.6% 1.2% 1.4%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

New Registrants by Location of Initial Nursing Education

2003 2004 2005 2006 2007

ORIGIN Number % of Total Number % of Total Number % of Total Number % of Total Number % of TotalManitoba 369 65.1% 412 68.6% 395 74.1% 347 72.6% 488 73.7% Canada 128 22.6% 84 14.0% 68 12.8% 70 14.6% 110 16.6% USA 7 1.2% 6 1.0% 4 0.8% 3 0.6% 7 1.1% Other 63 11.1% 99 16.5% 66 12.4% 58 12.1% 57 8.6% Total 567 100.0% 601 100.0% 533 100.0% 478 100.0% 662 100.0%


Educational Preparation of RN(EP) Registrants by Location of Education

ORIGIN 2005 2006 2007 Manitoba 0 19 11 Canada 0 7 5 USA 4 2 1 Other 0 0 0 Total 4 28 17

New Registrants Entry to Practice Education Level 2004 2005 2006 2007

Number % of Total Number % of Total Number % of Total Number % of Total Diploma 226 37.6% 175 32.8% 185 38.7% 236 35.6% Bachelor 375 62.4% 358 67.2% 293 61.3% 426 64.4% Total 601 100.0% 533 100.0% 478 100.0% 662 100.0%

Entry to Practice Education Level (Practicing & Extended Practice Nurses) 2003 2004 2005 2006 2007 Number % of Total Number % of Total Number % of Total Number % of Total Number % of TotalDiploma 8,909 79.1% 8,868 77.0% 8,747 74.9% 8,611 73.7% 8,532 71.6% Bachelor 2,354 20.9% 2,643 23.0% 2,927 25.1% 3,074 26.3% 3,381 28.4% Total 11,263 100.0% 11,511 100.0% 11,674 100.0% 11,685 100.0% 11,913 100.0%

Exam Pass Rates 2004 2005 2006 2007 2nd 2nd 2nd 2nd 1st Pass or 3rd Pass 1st Pass or 3rd Pass 1st Pass or 3rd Pass 1st Pass or 3rd PassCandidates writing CRNE writing rate writing rate writing rate writing rate writing rate writing rate writing rate writing rateManitoba Educated 413 98% 10 80% 425 98% 10 80% 398 93% 27 63% 441 94% 23 74%Internationally Educated 115 56% 77 60% 120 54% 30 20% 89 36% 68 37% 91 59% 35 64%

RN(EP) Exam Pass RatesCandidates Writing 2005 2006 2007 Manitoba Educated 8 11 14 Canada Educated 3 6 3 USA Educated 0 2 0 Total 11 19 17Pass Rate 91% 95% 100%


Complaints Statistics Number of Complaints Received by Year 2001 2002 2003 2004 2005 2006 2007 38 65 60 40 53 45 71

New Complaints by Source 2003 % of total 2004 % of total 2005 % of total 2006 % of total 2007 % of total Public/client/family 36 60% 8 20% 18 34% 7 16% 30 42% Employer/supervisor 18 30% 26 65% 22 42% 24 53% 30 42% Registered nurse peer 3 5% 3 8% 7 13% 8 18% 4 6% Other healthcare provider 3 5% 2 5% 4 8% 4 9% 6 8% Other agency/jurisdiction 0 0% 0 0% 0 0% 2 4% 0 0% Executive Director referral 0 0% 1 3% 2 4% 0 0% 1 1% Total 60 100% 40 100% 53 100% 45 100% 71 100%

New Complaints by Practice Setting 2003 % of total 2004 % of total 2005 % of total 2006 % of total 2007 % of totalHospital 44 73% 22 56% 23 43% 19 42% 45 63%Personal care home/long term care 7 12% 8 21% 15 28% 9 20% 8 11%Nursing station 1 2% 4 10% 3 6% 7 16% 7 10%Mental healthcare setting 0 0% 0 0% 2 4% 0 0% 1 1%Business/occupational health 0 0% 0 0% 4 8% 1 2% 0 0%Rehab/convalescent centre 0 0% 2 5% 2 4% 4 9% 1 1%Correctional facility 2 3% 2 5% 0 0% 0 0% 0 0% Home care nursing 2 3% 0 0% 2 4% 2 4% 2 3%Community health centre 4 7% 1 3% 0 0% 2 4% 2 3%Other 0 0% 1 3% 2 4% 1 2% 5 7%Total 60 100% 40 100% 53 100% 45 100% 71 100%

2003 2004 2005 2006 2007 No further action 24 6 10 25 22 Informal resolution 5 3 7 2 4Member surrendered registration 2 0 1 1 0Entered into an agreement or undertaking 6 6 5 7 10Investigation ongoing 18 24 29 7 23Carried forward 5 0 1 0 9Collaborative Complaints Resolution 0 0 0 2 2Referred to Discipline Committee 0 1 0 1 0Censure 0 0 0 0 1Total 60 40 53 45 71

Disposition of New Complaints Received as at Dec 31


Auditors’ Report

BDO Dunwoody LLP

Chartered Accountants and Advisors

To the Board of Directors of theCOLLEGE OF REGISTERED NURSES OF MANITOBA

We have audited the statement of financial position of the COLLEGE OF REGISTERED NURSES OF MANITOBA as at December 31, 2007 and the statements of operations, changes in net assets and cash flows for the year then ended. These financial statements are the responsibility of the College's management. Our responsibility is to express an opinion on these financial statements based on our audit.

Those standards require that we plan and perform an audit to obtain reasonable assurance whether the finan-cial statements are free of material misstatement. An audit includes examining, on a test basis, evidence support-ing the amounts and disclosures in the financial statements. An audit also includes assessing the accounting prin-ciples used and significant estimates made by management, as well as evaluating the overall financial statement presentation.

In our opinion, these financial statements present fairly, in all material respects, the financial position of the College as at December 31, 2007 and the results of its operations and its cash flows for the year then ended in accordance with Canadian generally accepted accounting principles.

Our examination did not include the budget figures and we do not express an opinion on them.

Chartered Accountants

Winnipeg, ManitobaJanuary 24, 2008


Financial StatementsYear Ended December 31

Statement of Operations 2007 2007 2006 Budget Actual Actual Revenue (Unaudited)

Registration $ 3,695,799 $ 3,679,012 $ 3,398,263 Examination 277,535 293,196 287,264 Investment income Realized (Note 4) 219,120 457,258 394,945 Unrealized loss on adjustment to fair value of investments - (376,148) - Miscellaneous 52,335 73,624 75,766

4,244,789 4,126,942 4,156,238

Expenditures Levies and fees 858,830 852,527 779,454 Registration 559,320 550,560 509,428 Administration 535,755 490,313 401,067 Building operations 395,290 400,665 389,123 Practice 402,084 392,705 350,596 Member relations and communications 367,173 370,167 353,563 Board of Directors 271,172 249,487 266,422 Complaints 241,364 201,770 210,924 Financial services 167,275 191,795 166,511 Office services 175,323 167,815 171,050 Information technology 200,765 154,903 106,336 Discipline 127,486 105,705 130,688

4,301,837 4,128,412 3,835,162

Excess (deficiency) of revenue over expenditures on operations before other items (57,048) (1,470) 321,076 Other items Amortization of capital assets 181,260 160,728 173,611 (Gain) loss on disposal of capital assets - (3,439) 398 181,260 157,289 174,009

Excess (deficiency) of revenue over expenditures for the year $ (238,308) $ (158,759) $ 147,067

Statement of Changes in Net Assets Invested In Capital 2007 2006 Assets Unrestricted Total Total

Balance, beginning of year $ 1,147,755 $ 2,322,550 $ 3,470,305 $ 3,323,238

Adjustment of investments to market value January 1, 2007 for changein accounting policy (Note 8) - 162,359 162,359 -Excess (deficiency) of revenue over expenditures for the year (157,289) (1,470) (158,759) 147,067Capital assests purchased during the year 116,491 (116,491) - -Proceeds on disposal of capital assets during the year (5,559) 5,559 - -

Balance, end of year $ 1,101,398 $ 2,372,507 $ 3,473,905 $ 3,470,305

The accompanying summary of significant accounting policies and notes are an integral part of these financial statements.


Statement of Financial Position December 31 2007 2006

ASSETSCurrent Assets Cash and cash equivalents $ 219,684 $ 139,430 Receivables 120,684 10,557 Prepaids 58,192 55,247 Inventory 7,926 10,862

406,486 216,096 Investments (Note 2) 6,522,301 6,226,365

Capital assets (Note 3) 1,101,398 1,147,755

$ 8,030,185 $ 7,590,216

LIABILITIES AND NET ASSETSCurrent Liabilities Payables and accruals $ 392,749 $ 239,073 Goods and services tax payable 144,854 129,930 Deferred revenue 3,762,739 3,461,220 Current portion of deferred lease inducements 33,750 33,750 4,334,092 3,863,973

Deferred lease inducements 222,188 255,938 4,556,280 4,119,911

Contingent liabilities and commitments (Notes 5 and 6)

Net Assets Invested in capital assets 1,101,398 1,147,755 Unrestricted 2,372,507 2,322,550 3,473,905 3,470,305

$ 8,030,185 $ 7,590,216

Approved on behalf of the Board

President Executive Director



Statement of Cash FlowsFor the year ended December 31 2007 2006

Cash flows from operating activities Excess (deficiency) of revenue over expenditures for the year $ (158,759) $ 147,067 Adjustments for items not affecting cash Amortization of capital assets 160,728 173,611 Amortization of deferred lease inducements (33,750) (33,750) (Gain) Loss on disposal of capital assets (3,439) 398 January 1, 2007 adjustment to market value of investment 162,359 -

127,139 287,326

Changes in non-cash operating working capital balances Receivables (110,127) 413 Prepaids (2,945) 3,106 Inventory 2,936 (1,897) Payables and accruals 153,676 (58,447) Goods and services tax payable 14,924 (45,000) Deferred revenue 301,519 221,017

487,122 406,518

Cash Flows from Financing and Investing Activities Net increase in investments (295,936) (656,390) Proceeds on disposal of capital assets 5,559 225 Purchase of capital assets (116,491) (139,915)

(406,868) (796,080)

Net increase (decrease) in cash and cash equivalents during the year 80,254 (389,562)

Cash and cash equivalents, beginning of year 139,430 528,992

Cash and cash equivalents, end of year $ 219,684 $ 139,430



Summary of Significant Accounting Policies

REVENUE RECOGNITIONThe College follows the deferral method of accounting for registration and examination revenues. Registration and examination revenues are recorded as revenue in the period to which it relates. Investment income is recognized as revenue when earned.

INVENTORYInventory is made up of promotional items held for resale and is valued at the lower of cost and net realizable value.

CAPITAL ASSETSCapital assets are stated at cost less accumulated amortization. Amortization is recorded beginning in the month of acquisition. Amortization based on the estimated useful life of the asset is calculated as follows: Equipment 20% - 33% declining balance basis Computer software 33% straight-line Leasehold improvements 15 years straight-line over the term improvements of the lease plus one renewal period

LEASE INDUCEMENTSLease inducements received are deferred and amortized over the term of the lease and reduce the rent expense otherwise incurred.

FINANCIAL INSTRUMENTSThe College utilizes various financial instruments. Unless otherwise noted, it is management's opinion that the College is not exposed to significant interest, currency or credit risks arising from these financial instruments and the carrying amounts approximate fair values. The fair values of cash and cash equivalents, accounts receivable and accounts payable approximate their carrying value because of the short-term maturity of these instru-ments. The fair value of long-term investments is estimated based on either quoted market prices for similar issues or current rates assumed for similar government guaran-teed debt of the same maturity. The College classifies its financial instruments into one of the following categories based on the purpose for which the asset was acquired. The College's accounting policy for each category is as follows:

Loans and Receivables These assets are nonderivative financial assets resulting from the delivery of cash or other assets by a lender to a borrower in return for a promise to repay on a specifieddate or dates, or on demand. They arise principally through the provision of goods and services (accounts receivable), but also incorporate other types of contractual monetary assets. They are initially recognized at fair value and subsequently carried at amortized cost, using the effective interest rate method, less any provision for impairment.

Held-for-trading This category is comprised of cash and certain investments in equity and debt instruments, standalone derivatives, other than those designated as hedging items, and embedded derivatives requiring separation. They are carried in the balance sheet at the fair value with changes in fair value recognized in the income statement. Transactions costs related to instruments classified as held-for-trading are expensed as incurred.

Other Financial Liabilities Other financial liabilities include trade accounts payable. These liabilities are initially recognized at fair value and subsequently carried at amortized cost using the effective interest rate method.

USE OF ESTIMATESIn preparing the College's financial statements, management is required to make estimates and assumptions that affect the reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities at the date of the financial statements and reported amounts of revenue and expenditures during the period. Actual results could differ from these estimates.


Notes to Financial Statements

1. NATURE OF OPERATIONS

The College of Registered Nurses of Manitoba is incorporated under the laws of the Province of Manitoba and is tax exempt as a not-for-profit organization. The College is the pro-fessional regulatory body for Registered Nurses in Manitoba. The College ensures safe nursing care for the public by establishing and monitoring standards of nursing education and nursing practice and investigating complaints concerning the conduct and practice of Registered Nurses.

2. INVESTMENTS 2007 2006

Investment portfolio, original cost $ 6,736,090 $ 6,226,365Investment portfolio, fair market value 6,522,301 6,388,724

The investment portfolio has been classified as held-for-trading financial instruments and are recorded at fair value.

3. CAPITAL ASSETS 2007 2006

Accumulated Net Net Cost Amortization Book Value Book Value

Equipment $ 1,093,987 $ 675,130 $ 418,857 $ 452,694 Computer software 53,176 40,454 12,722 18,849 Leasehold improvements 773,398 128,579 644,819 676,212Other capital assets 25,000 - 25,000 - $ 1,945,561 $ 844,163 $ 1,101,398 $ 1,147,755

4. NET REALIZED INVESTMENT INCOME

Net realized investment income for the year is comprised of the following: 2007 2006

Interest, dividends and capital gains dividends $ 192,914 $ 346,583Gain on sale of investments 264,344 48,362

$ 457,258 $ 394,945

5. CONTINGENT LIABILITIES

The College is a member of the Canadian Nurses Protective Society (CNPS), which provides liability protection to its members. If the Board of Directors of CNPS considers there is a need for additional monies to maintain the protective fund at an appropriate level, the College will be required to contribute its proportionate share of any additional assessment. No provision for an additional assessment has been included in these financial statements.

6. COMMITMENTS

The College is committed to make an annual contribution of 2.5% of active practicing member fees to the Foundation for Registered Nurses of Manitoba Inc. The College antici-pates contributions to the Foundation for Registered Nurses of Manitoba Inc. of approximately $96,500 in 2008.

The College is committed to make an annual contribution of $1 per active practicing member to the Canadian Nurses Foundation (CNF). The College anticipates contributions to CNF of approximately $12,100 in 2008.

As a member of Canadian Nurses Protective Society (CNPS), the College is required to pay annual fees to CNPS. These fees are payable January 1. The College is committed to pay fees to CNPS of approximately $139,400 in 2008.

As a member of the Canadian Nurses Association (CNA), the College is required to pay annual fees to the CNA. These fees are payable in January. The College is committed to pay fees to the CNA of approximately $630,000 in 2008.


The College has entered into agreements to lease its premises and equipment for various periods until 2015. The annual rent of premises consists of minimum rent plus realty taxes, insurance and utilities. Minimum rent payable for premises and equipment in aggregate, and for each of the next five years and thereafter is as follows:

Premises Equipment Total

2008 $ 224,250 $ 13,264 $ 237,5142009 224,250 2,726 226,9762010 230,500 - 230,5002011 239,250 - 239,2502012 239,250 - 239,250Thereafter 817,437 - 817,437

$ 1,974,937 $ 15,990 $ 1,990,927

The College has entered into agreements to develop and implement a new computer system. Progress payments are due when specific events have been satisfactorily completed. The total amount committed to the project is $230,000 with a minimum of $85,000 due in 2008.

7. PENSION PLAN

Substantially all of the employees of the College are members of the Healthcare Employees Pension Plan (a successor to the Manitoba Health Organization Inc. Plan) (the "Plan") which is a multi-employer defined benefit pension plan available to all eligible employees of the participating members of the Plan. Plan members will receive benefits based on the length of service and on the average of annualized earnings during the best five years of the last ten years prior to retirement, termination or death, that provides the highest earnings.

Pension assets consist of investment grade securities. Market and credit risk on these securities are managed by the Plan by placing plan assets in trust and through the Plan investment policy.

Pension expense is based on Plan management's best estimates, in consultation with its actuaries, of the amount, together with the contributions by employees, required to provide a high level of assurance that benefits will be fully represented by fund assets at retirement, as provided by the Plan. The funding objective is for employer contributions to the Plan to remain a constant percentage of employees' contributions.

Variances between actuarial funding estimates and actual experience may be material and any differences are generally to be funded by the participating members. The most recent actuarial valuation of the Plan as at December 31, 2006 indicates the Plan is fully funded. Contributions to the Plan made during the year by the College on behalf of its employees amounted to $103,288 ($83,180 in 2006) and are included in the statement of operations.

8. ACCOUNTING CHANGE

On January 1, 2007, the College prospectively adopted, without restatement of prior periods, CICA Handbook Section 3861, "Financial Instruments – Disclosure and Presentation" and Section 3855, "Financial Instruments – Recognition and Measurement". Under these new standards, all financial instruments are included on the statement of financial posi-tion and are initially measured at fair market value.

The impact of adoption of these new standards has been the adjustment of investments to fair value at January 1, 2007 which increased unrestricted net assets by $162,359 as at January 1, 2007. Investment income for the 2007 year includes an adjustment of $376,146 for the unrealized loss on adjustment to fair value of investments as at December 31, 2007.


890 Pembina Hwy.Winnipeg, MB R3M 2M8

Ph: (204) 774-3477Toll free in Manitoba: (800) 665-2027

Fax: (204) 775-6052

Web: www.crnm.mb.caEmail: [email protected]