What is a Vision?

A vision is a compelling image of the preferred future that sets

out a group’s or organization’s highest aspirations in clear and

powerful, language. It is what futurist Clement Bezold calls “a

future for the heart.” It is more than an idea. When people

really take a vision seriously, it becomes an inspirational force

in their lives…acting as a self-fulfilling prophecy.

ICN 1999

There are Infinite Possible Futures…

A good scenario set should

provoke the imagination,

stretch world views, and

make explicit deeply-held

values.

ICN 1999

Three Alternative Future Scenarios

1. Business as Usual

2. Crisis and Opportunity

3. Visionary Leadership

Following the ICN model, these

RNAO scenarios identify key

trends including:

Nursing

Health and Health Care

Political Economy and

Society

Sustaining Our Publicly-Funded,

Not-For-Profit Health-Care System

Determine the

strategic milestones along the path to the preferred vision in the short, medium and long-term.

Consider enablers including health human resources, ethics, and technology.

Consult with members.

Action Plan

Action Plan: Primary Care Outcomes (Short-Term, 2012-2015)

In response to the growing need to critically examine the role of Primary Care RNs and RPNs, RNAO led the ground-breaking provincial Primary Care Nurse Task Force.

Action Plan: Primary Care Outcomes (Short-Term, 2012-2015)

All Ontarians have consistent access to nursing knowledge, skills and competencies in every primary care setting.

Primary care organizations accommodate larger client volumes, while effectively leveraging scarce health-care resources and maintaining quality of care.

Care co-ordination and health system navigation led in primary care by 2015.

Approximately 3,500 Case Managers, previously working in CCACs, transition to primary care, with their salary/benefits intact.

Action Plan: Primary Care Outcomes (Short-Term, 2012-2015)

Supporting Activities:

- Phase 1: Organizations, planners and decision-makers create environment to embrace full scope of practice and utilization.

- Phase 2: Legislative and regulatory changes enable RNs to provide an expanded scope of practice with added education

- A Transitional Primary Care Secretariat is established within the LHIN to organize 4000+ primary care entities into local networks.

- A robust labour management strategy is crafted for all CCAC case managers/care co-ordinators that secures salary/benefits

Action Plan: Primary Care Outcomes (Mid-Term, 2015-2020)

Fee-for-service and capitation remuneration are replaced with salary as one component of primary care global budgets

Primary care RNs are fully engaged in care co-ordination with expanded scopes of practice (e.g. diagnosing and prescribing).

By 2020, all Ontarians have same-day access to inter-professional primary care and walk-in clinics are eliminated.

Supporting Activities:

- Negotiations have occurred with government to introduce salary-based compensation from global budgets.

- Current AHACs, CHCs, NPLCs and FHTs are expanding where infrastructure capacity exists and new organizations have begun where no infrastructure capacity exists.

Action Plan: Primary Care Outcomes (Long-Term, 2020-2030)

A province-wide network of inter-professional primary health care hubs (PHC hubs) anchor the health system to ensure integrated, co-ordinated, comprehensive, continuous, client-centred health care from pre-conception to death; consistent with Declaration of Alma Ata.

Full representation of all professions occur within teams; each practicing to full scope.

Supporting Activities:

- Ongoing development, strengthening and integration of Ontario’s primary care system and implementation of RNAO’s ECCO model

Action Plan: Home Health Care Outcomes (Short-Term, 2012-2015)

The autonomy of providers has increased, providing access to care and support in the community while strengthening continuity of care and continuity of caregiver.

Supporting Activities:

- CCAC structure fully transitioned by 2015

- Contract renewal based on quality outcomes, successful accreditation and ability to offer comprehensive services

- Implementation of RNAO’s ECCO model

Action Plan: Home Health-Care Outcomes (Mid-Term, 2015-2020)

Access to home health-care and support is increased, with strong linkages to primary care.

Not-for-profit home health-care service providers deliver the majority of service.

NPs have an increasing presence in home health-care delivery, and CNOs are mandated in each organization to facilitate uptake of evidence-based nursing practice.

Supporting Activities:

- Wage parity

- Implementation of RNAO’s ECCO model; administrative savings are re-invested into direct home health-care delivery and support services.

Action Plan: Home Health Care Outcomes (Long-Term, 2020-2030)

All Ontarians are able to access a range of home health care and support services regardless of where they reside.

Evidence-based practice culture is embedded in all home health care.

Supporting Activities:

- Home health care nurses are mostly baccalaureate-prepared and practise to full scope, which includes prescribing.

- Establishment of multiple primary health-care hubs.

Action Plan: Public Health Outcomes (Short-Term, 2012-2015)

PHNs play a key role in advancing primary health care by mobilizing their communities to improve health, decrease health inequities and challenge unhealthy environmental and social policies.

Supporting Activities:

-PHNs work with communities in policy development and other community efforts.

-Public Health Units are under LHIN mandate (funding remains intact).

Action Plan: Public Health Outcomes (Short-Term, 2012-2015)

Designate one masters-prepared Chief Nursing Officer (CNO) per Public Health Unit by January, 2013.

Transition mental health and addictions nurses in district school boards from CCACs to Public Health Units.

Supporting Activities:

- CNOs partner with nurse educators to improve access to MN programs.

- Implement RNAO’s ECCO model.

Action Plan: Public Health Outcomes (Mid-Term, 2015-2020)

NQuIRE data demonstrates that PHNs play a pivotal role leading evidence-based nursing interventions that improve health outcomes.

Enhanced linkages between public health and other areas of the health system, including primary care.

Supporting Activities:

-NQuIRE is available to all public health units.

-Implement RNAO’s ECCO model

Action Plan: Public Health Outcomes (Long-Term, 2020-2030)

PHNs mobilize to further reduce social inequities, revitalize universal services, and strengthen democracy to improve population health and decrease health inequities.

Supporting Activity:

- CNOs and PHNs are making expert recommendations for the implementation of “Health in All Policies” at the system level within municipalities, LHINs, the province and the nation.

First Peoples: Self-Determination Improves Health and Democracy

Action Plan: Acute Care Outcomes (Short-Term, 2012-2015)

80 % of hospitals maximize NPs to admit, treat and discharge patients improving patient access, flow and safety.

All hospitals provide continuity of care & continuity of caregiver as each patient is assigned an RN or RPN based on patient complexity, stability and predictability.

Protected funding sustains expanded and advanced RN practise.

60 additional RN First Assistants (RNFAs) work in operating rooms, bringing the total to 140 across the province.

Supporting Activities:

- RNAO NP Expert Panel promotes activities of NP early adopters.

- CNEs promote appropriate staff mix with quality committees and hospital boards

Action Plan: Acute Care Outcomes (Mid-Term, 2015-2020)

Only the most acute and complex health care challenges are cared for in hospitals by an inter-professional team.

All hospitals use NPs to admit, treat and discharge.

Expanded RN scope of practice is common and established.

More CNEs are VPs and CEOs

Nurse anesthetists who independently administer 70 per cent of anesthesia free up anesthesiologists for complex cases.

Supporting Activities:

- CNEs support advanced and expanding roles.

- Funding models ensure ongoing training, education and protected positions for NP-Anesthesia in the province.

Action Plan: Acute Care Outcomes (Long-Term, 2020-2030)

RNs are now admitting, treating, transferring and discharging patients.

RNs routinely use BPGs and decision support tools (e.g., order sets) to develop evidence-based care plans that are integrated with primary care providers and other sectors.

Supporting Activities:

- NQuIRE indicator database is released to all hospitals.

- RN training, support and implementation of RNAO Order Sets.

Action Plan: Long-Term Care Outcomes (Short-Term, 2012-2015)

Evidence-based legislated minimum nurse staffing standards require no less than 4.0 hours per resident day (hprd), .59 RN hprd, 2 RNs 24/7 and one NP per LTC Home (prorated 1: 120 residents).

DOCs are recognized as CNOs

Supporting Activities:

- Legislation mandates CNOs and minimum nurse staffing ratios in LTCHs.

- Legislation enables NPs to write admission and discharge orders in all Ontario LTCHs.

Action Plan: Long-Term Care Outcomes (Mid-Term, 2015-2020)

LTCH placement co-ordination occurs in partnership with primary care co-ordinators and the LHINs. As a result, timely LTC is available for all who need it.

RN prescribing and diagnosing are common.

Supporting Activities:

- Implementation of RNAO’s primary care report.

- Implementation of RNAO’s ECCO model.

Action Plan: Long-Term Care Outcomes (Long-Term, 2020-2030)

Fewer LTCHs are needed as seniors have appropriate supports and high quality services to live at home

Timely access to high quality publicly-funded not-for-profit LTC continues for all in need.

Some LTCH residents have been “matched” with families to live in their home, smaller group home facilities or hospices.

Supporting Activity:

- Matched families are provided training, ongoing support and subsidized according to resident acuity / RUGs.

Key Enablers

Enabler: Nursing Workforce Short-Term (2012-2015):

70 per cent full-time employment of nurses in all sectors

9,000 more RNs needed to help Ontario catch up to the average RN: population ratio in the rest of Canada

Consistent funding is available for every eligible and qualified LCNI and NGG nurse.

Medium-Term (2015-2020):

20,315 more RNs are hired (including 360 NPs each year).

Long-Term (2020-2030):

44,440 additional RN positions have been created since 2010, keeping pace with population growth and the average RN:population ratio throughout Canada.

Enabler: Healthy Work Environments

Systemic implementation of RNAO’s Healthy Work Environment BPGs has improved health outcomes for both clients and staff, stabilized the nursing and inter-professional workforce by improving morale and decreasing attrition; saving thousands per nurse in staff turnover costs.

Enabler: Technology Implementation of a fully

functioning, integrated electronic health record provide nurses with timely, accurate, evidence-based information to optimize continuity of care, clinical decision-making, and client outcomes.

Smart technology / decision support tools, such as nursing order sets.

Enabler: Ethics In 2030, as in 2012, nurses

grapple with how to best live out their ethical responsibilities in a fluid environment with constrained resources and multiple competing demands.

An equity lens is increasingly used in all sectors.

Enabler: Education

Funding increases in short-term to increase nursing enrolment:

2500 undergrads/yr

360 NPs/yr

10 PhD and 100 masters/yr

Nursing education has been reoriented to embrace PHC principles. It stresses health promotion, disease prevention, social and environmental determinants of health, but NOT at the exclusion of illness care.

Enabler: Research

Rapid implementation of NQuIRE database by RNAO Best Practice Spotlight Organizations contributes to the evidence-base of nursing-sensitive outcomes.

NQuIRE will establish independent, evidence-based benchmarks and facilitate knowledge exchange of best practices locally, nationally, and internationally.

Consultation Process RNAO home office is coordinating membership engagement on where we are going and how to get there:

Meetings and informal discussions with BOD and home office staff

RNAO Visionary Leadership Consultation Series via webinar

Online survey

Social media and “tweet-ups”

Discussion Questions

Is this doable?

Is this speaking to your sector?

Is anything missing, or is there anything else we should be thinking about?