Health Nurse (IEN) Second (ESL) Nurse Project 2015fhs.mcmaster.ca/nhsru/documents/Series-37-HHS_IEN_ESL_UpdatedM… · Jane Hastie, Specialist, Human Rights ... HHS Career Progression

Hamilton Health Sciences, Internationally

Educated Nurse (IEN) and English as a

Second Language (ESL) Nurse Integration

Project 2012‐2015

INTERIM REPORT

Andrea Baumann, RN, PhD Jennifer Blythe, PhD

Series Report 37 • May 2013

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Hamilton Health Sciences, Internationally Educated Nurse (IEN) and English as a Second

Language (ESL) Nurse Integration Project 2012‐2015

Series # 37

Andrea Baumann, RN, PhD, Associate Vice President, Global Health, Faculty of Health Sciences &Scientific Director, Nursing Health Services Research Unit (McMaster University site)

Jennifer Blythe, PhD, Senior Scientist, Nursing Health Services Research Unit (McMaster University Site)

Contact Andrea Baumann Phone (905) 525‐9140, ext. 22581 E‐mail [email protected] Website www.nhsru.com

This research has been generously funded by a grant from the Ontario Ministry of Citizenship and Immigration and Citizenship and Immigration Canada. The views expressed in this report do not necessarily reflect those of the Government of Ontario or the Government of Canada.

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PROJECT TEAM

Principal Investigators

Dr Ruth Lee (Project Lead), Chief of Nursing Practice, Hamilton Health Sciences (HHS)

Dr Andrea Baumann, Associate Vice‐President, International Health, Faculty of Health Sciences and Co‐Director, Nursing Health Services Research Unit (NHSRU), McMaster University, Hamilton, Ontario

Co‐investigators

Anthea Banks, Director of Clinical Practice & Education, HHS

Kirsten Krull, Vice‐President, Inter‐Professional Practice and Chief Nursing Executive, HHS Nancy Brown‐Fellows, Program Manager, Mohawk College Institute for Applied Health Sciences: Bridging for Internationally Educated Nurses (BIEN), Hamilton, Ontario Dr. Jennifer Blythe, Senior Scientist, NHSRU Zubeida Ramji, Executive Director, Centre for Internationally Educated Nurses (CARE)

Project Manager

Daniela Dijmarescu, HHS

HHS IEN/ESL ADVISORY COMMITTEE MEMBERS

Anthea Banks, Director of Clinical Practice and Education (CP&E), Hamilton Health Sciences

(HHS)

Dr. Andrea Baumann, Associate Vice‐President, International Health, Faculty of Health Sciences and Co‐Director, Nursing Health Services Research Unit (NHSRU), McMaster University Dr. Jennifer Blythe, Senior Scientist, NHSRU

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Nancy Brown‐Fellows, Program Manager, Program Manager, Part Time and Graduate Studies Institute for Applied Health and Science (IAHS), Mohawk College Daniela Dijmarescu, Project Manager, HHS Maureen Williamson, President of Ontario Nurses Association (ONA)& Local Coordinator Abdullah Hassan, Project Participant, HHS Jane Hastie, Specialist, Human Rights and Diversity, HHS Kirsten Krull, Vice‐President Inter‐Professional Practice and Chief Nursing Executive, HHS Elisabeth Leduc, Registered Nurse, Vascular Access, HHS Dr. Ruth Lee, Chief of Nursing Practice, HHS Evelyn Myrie, Executive Director, Hamilton Centre for Civic Inclusion (HCCI) Rosalie Prokopetz, Manager, Talent Solutions: Human Resources & Development, HHS Zubeida Ramji, Executive Director, Centre for Internationally Educated Nurses (CARE) Joanne Roth, Regional Manager West, CARE Romaine Sheriff, Manager, Office of Student Education, CP&E, HHS Louise Taylor‐Green, Executive Vice‐President, Corporate Affairs & Strategy, HHS Cherilyn Van Berkel, Discharge Specialist, Quality, Patient Safety & Risk Program, Transitional care Clinical Resource Management Team, HHS Pat Wright, Manager of Training and Community Engagement, HCCI

PARTNERS

Mohawk College Institute for Applied Health Sciences, Bridging for Internationally Educated Nurses (BIEN) Centre for Internationally Educated Nurses (CARE) Hamilton Centre for Civic Inclusion (HCCI) McMaster University, Nursing Health Services Research Unit (NHSRU)

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SPONSOR/FUNDING AGENCIES

Government of Ontario, Ministry of Citizenship and Immigration

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Table of Contents FIGURES AND TABLES ........................................................................................................................... 7

EXECUTIVE SUMMARY ......................................................................................................................... 9

1. INTRODUCTION .............................................................................................................................. 15

2. DESIGN AND METHODS .................................................................................................................. 17

PURPOSE AND OBJECTIVES ............................................................................................................... 17

Purpose .................................................................................................................................... 17

Objectives ................................................................................................................................ 17

Numeric Targets ....................................................................................................................... 18

DESIGN .............................................................................................................................................. 18

Community Collaboration Employment Model ....................................................................... 18

Study Site ................................................................................................................................. 19

Project Partners ....................................................................................................................... 21

External stakeholders .............................................................................................................. 22

Project Team ............................................................................................................................ 22

METHODS .......................................................................................................................................... 23

IEN and ESL Participants: Study Sample .................................................................................. 23

Clinical Integrators: Study Sample ........................................................................................... 24

Participant and Clinical Integrators: Description and Tracking ............................................... 24

Baseline Testing: Institutional CELBAN (I‐CELBAN) .................................................................. 25

Interventions, Programs and Resources .................................................................................. 25

Publicity and Dissemination ..................................................................................................... 31

Success Stories ......................................................................................................................... 31

Evaluation ................................................................................................................................ 31

3. SAMPLE DESCRIPTION .................................................................................................................... 33

Participant Sample ............................................................................................................................ 33

Clinical Integrator Sample ................................................................................................................. 40

4. BASELINE MEASURES ..................................................................................................................... 43

5. RESULTS ......................................................................................................................................... 45

CARE Cntre for Internationally Educated Nurse's: Language Communication for IENs – Advanced

Course ................................................................................................................................................... 45

Participant Self‐Assessment of Nursing Communication Skills: Pre and Post Course ............. 45

Instructors Assessment ............................................................................................................ 46

Participant Feedback ............................................................................................................... 48

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The Mohawk Learning Resource Centre Simulation Laboratory ...................................................... 50

HCCI Cultural Training Module.......................................................................................................... 51

HHS Job Coaching/Mock Interview preparation ............................................................................... 52

Pre job‐coaching confidence questionnaire ............................................................................ 52

Post Job‐coaching interview assessment ................................................................................. 53

HHS/CNO Learning Plan/HHS Policies and Procedures on the Intranet ........................................... 54

The HHS Intranet: SharePoint Website ............................................................................................. 54

Nurses Nurturing Nurses (N3) ........................................................................................................... 56

HHS Professional Workplace Experience/Integration ...................................................................... 57

HHS Job Shadowing .................................................................................................................. 57

HHS Second Day of General Nursing Orientation .................................................................... 58

HHS Career Progression Opportunities .................................................................................... 59

6. PROJECT EVALUATION: OVERALL RESULTS AND CONCLUSIONS ...................................................... 63

Numeric Targets and Achievements ................................................................................................. 63

Participant evaluation of the project: Exit Interviews ...................................................................... 64

Assessment of Interventions ................................................................................................... 64

Evaluation of Project Manager ................................................................................................ 65

Use of SharePoint Website ...................................................................................................... 65

Recommending the program to other IEN/ESL nurses ............................................................ 65

Getting a job ............................................................................................................................ 65

Participant Recommendations ................................................................................................ 66

Evaluation of Interventions ............................................................................................................... 66

Lessons Learned ................................................................................................................................ 67

Next Steps: Program Development .................................................................................................. 67

Sustainability Planning: The Community Collaboration EmploymentModel ................................... 68

APPENDICES ....................................................................................................................................... 70

Appendix A: Evaluation Tools Index .................................................................................................. 70

Appendix B. Consent form ................................................................................................................ 72

Appendix C: Dissemination .............................................................................................................. 77

Appendix D: Participant Evaluation of the Job Shadowing Experience ............................................ 80

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FIGURES AND TABLES

Figure 1. Project Model .................................................................................................

Figure 2. Community Collaboration Employment Model ..............................................

Figure 3. Organizational Structure .................................................................................

Table 1. Participant Sample Composition .....................................................................

Table 2. Entry in Project Year ........................................................................................

Table 3. Project Referrals ..............................................................................................

Table 4. Age of Participants ..........................................................................................

Table 5. Gender of Participants ....................................................................................

Table 6. Highest Level of Nursing Education .................................................................

Table 7. Country of Nursing Education .........................................................................

Table 8. Country of Highest Level of Non‐Nursing Education .......................................

Table 9. Level of Non‐Nursing Education in Country of Origin .....................................

Table 10. Immigration Class ..........................................................................................

Table 11. Current Immigration Status ...........................................................................

Table 12. Year of Migration ...........................................................................................

Table 13. Years of Experience Prior to Migration .........................................................

Table 14. Years in Canada Not Practicing Nursing ........................................................

Table 15. Practice in Canada .........................................................................................

Table 16. Examination Status ........................................................................................

Table 17. Registration Status ........................................................................................

Table 18. Number Completing Clinical Placements in HHS ..........................................

Table 19. Location of Clinical Placements .....................................................................

Table 20. Age of CIs .......................................................................................................

Table 21. Country of Nursing Education .......................................................................

Table 22. Country of Highest Education: Non‐Nursing .................................................

Table 23. Migration Status ............................................................................................

Table 24. Year of Migration to Canada .........................................................................

Table 25. CELBAN Testing and Results ………………………………………………………………………

Table 26. Course Attendance ........................................................................................

Table 27. Summary of Completed Assessments ...........................................................

Table 28. Instructor's assessment of Participant's Progress Course 2(N=22) ...............

Table 29. Evaluation for Courses 2 and 3 ......................................................................

Table 30. Course Components Participants Reported as Valuable ..............................

Table 31. Attendance ....................................................................................................

Table 32. LRC/Simulation Lab Sessions: Physical Assessment ......................................

Table 33. Post Course Evaluation ..................................................................................

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Table 34. Pre‐Intervention Confidence .........................................................................

Table 35. Evaluation for Courses 2 and 3 ......................................................................

Table 36. HHS/CNO Learning Plan/HHS Policies and Procedures on the Intranet .......

Table 37. HHS Intranet: Share Point Website ...............................................................

Table 38. Visits per Month ............................................................................................

Table 39. Sources of Information About Website .........................................................

Table 40. Persons Accessing Web Site ..........................................................................

Table 41. NRU Participant/Clinical Integrator Partnerships .........................................

Table 42. Job Shadowing Numbers and Locations ........................................................

Table 43. Lunch and Learn Sessions ..............................................................................

Table 44. Projected and Actual Project Sample ............................................................

Table 45. Exit Interviews (N=12)* .................................................................................

Table 46. Summary Evaluation of Interventions ...........................................................

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EXECUTIVE SUMMARY

The Internationally Educated Nurse (IEN) and English as a Second Language (ESL) Nurse

Integration Project aims to ensure Registered Nurses (RNs) and Registered Practical Nurses

(RPNs) educated abroad or in Canada are fully integrated into the nursing workforce. Its

purpose is to create, implement and evaluate integration strategies. The project provides

IEN/ESL nurses with various clinical and communication skills supports from pre hire

through orientation and clinical integration, including clinical assessment and development,

problem solving, team relationships, professionalism and managing conflict in a hospital

setting.

The project was funded between April 1, 2012 and March 31, 2015. It is based on a

Community Collaboration Employment Model (CCEM) that engages stakeholders who

contribute their time and expertise. Hamilton Health Sciences (HHS), a family of six

hospitals and a cancer centre, carried out the project with the support of the following key

partners:

1. Centre for Internationally Educated Nurses (CARE): This non‐profit agency provides

services educational and advisory services to IENs in Ontario.

2. Mohawk College Institute for Applied Health Sciences: Offers a Bridging for

Internationally Educated Nurses (BIEN) program to help IENs meet the College of Nurses of

Ontario (CNO)’s criteria for registration as an RN or RPN.

3. Hamilton Centre for Civic Inclusion (HCCI): A community‐based organization committed to

creating a community that respects diversity, practices equity and speaks out against

discrimination.

4. McMaster University NHSRU: Conducts research on nursing human resources.

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OBJECTIVES

Project objectives in the Ministry of Citizenship and Immigration (MCI) contract with HHS

include:

Between April 1, 2012 and March 31, 2015, develop, adapt, deliver and evaluate

a project to support the successful workplace integration and retention of

IEN/ESL nurses into HHS and other Ontario health care facilities.

Develop a suite of tools and processes for IEN/ESL nurses, particularly new hires,

practicing in a hospital environment.

Meet the numeric targets established by the Ministry of Citizenship and

Immigration.

Build the mentorship and coaching capacity of up to 60 frontline RNs, clinical

educators and clinical managers with at least one year’s nursing experience as

clinical integrators (CIs) to facilitate the integration of IEN/ESL nurses.

Develop and implement a strategy to ensure that the program delivery will

continue beyond the end of the funding (Sustainability Plan).

Evaluate program components including interventions and stakeholder

satisfaction

Numeric Targets

The following numeric targets for IEN/ESL nurses participating in the 2012‐15 project were

set by MCI:

Nurses assessed for eligibility: 180

Participants accessing the program (i.e., participate in a minimum of two

interventions): 145

Participants completing a significant component of the program (four interventions):

120

Participants who become/remain employed as nurses: 120

CIs completing training 60

PROGRAM PARTICIPATION

Participants were encouraged to complete Institutional Canadian English Language

Benchmark Assessment for Nurses ( I‐CELBAN) testing during the project if they had not

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done so upon enrolment. Most Participants met the levels of proficiency demanded by the

CNO.

INTERVENTIONS

The following interventions were implemented:

CARE Centre for Internationally Educated Nurses Workplace Communication Course

The CARE Language Communication for Nurses Course (advanced) was offered: October,

2011, ‐February, 2012, June ‐ October, 2012 and October 2012‐ February 2013. The course

lasted 96 hours. Orientations for the second and third courses were held in May, 2012 and

October 2012 respectively. Skills taught included: the Nurse‐Client Interview, documenting

progress notes, giving verbal reports, receiving verbal reports, making and receiving

telephone calls, receiving doctors’ orders, health teaching, therapeutic listening, and

responding, and communicating assertively with colleagues and clients. Self‐evaluation by

participants and the instructor suggested a significant increase in confidence and skill levels

among participants.

BIEN Mohawk College Learning Resource Centre Simulation Laboratory

Group sessions for practical review and hands on clinical skills practice were held using the

Learning Resource Centre/Simulation Laboratory. Eight group sessions lasting 2 hours, were

led by BIEN, Mohawk College faculty and staff in October and November 2012. Twenty four

Participants attended in October and 21 in November. Eleven Participants attended in

January, 2013 and 8 in February, 2013. A pre and post survey indicated that the

participants were relatively confident before their laboratory experience and only

somewhat more confident after their experience. Nevertheless, their comments suggest

that they found their practice in the lab extremely worthwhile.

HCCI Cultural Competency Awareness Workshop

This three‐hour training workshop, held on December 19, 2012, was intended to help

IEN/ESL nurse participants, Clinical Integrators (CIs) and Clinical Managers/Manager

delegates increase their cultural awareness. Based on the participants' evaluations, the

workshop was well received and its objectives were met.

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HHS Job Coaching/Mock Interviews

This intervention prepares participants for real job interviews. Both the presentation and

the individual sessions were rated highly. Individual mock interviews were held throughout

the year.

HHS/CNO Learning Plan/HHS Policies and Procedures on the Intranet

Participants review materials relevant to their learning plan within a year of project

enrolment. Pre‐intervention questionnaires suggest that participants are relatively

confident in their ability to access and use the material. The post‐questionnaire has been

administered only to the 35 Carryover Participants from 2011‐2012.

HHS SharePoint Website

The site posts relevant forms and provides updates on the project, including interventions,

evaluation and activities (e.g., the N3 program) and resources available for IEN/ESL nurses.

The post‐intervention questionnaire was administered only to the 35 Carryover Participants

from 2011‐2012.

HHS N3 Networking Program

The Nurses Nurturing Nurses (N3) program is a loosely structured supportive arrangement

for sharing between two nurse colleagues, an experienced nurse clinician (CI) and an

IEN/ESL nurse. There are currently 17 Nurse‐clinical integrator dyads,

HHS Professional Workplace Experience/Integration

Participants took part in a number of new activities. Evaluation of some of these activities is

limited for this year as they were under development. Most participants rated the

interventions highly.

HHS Job Shadowing

Eight participants completed assignments

HHS Second Day of General Nursing Orientation

During May, September and October 2012, fifteen Participants attended. In

November and December, 8 Participants attended.

Career Progression Opportunities

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These included:

1. Academic Writing and Documentation Workshops: Workshops were held

December 20, 2012 attended by 20 participants and Feb. 15, 2013 by 12

Participants. The sessions were positively evaluated by the Participants.

2. E‐Learning lab: Participants can access online courses via e‐learning at HHS

and other resources.

3. Certification courses: Participants were able to attend the following

certification courses. Certification is a requirement of the jobs for which they

wish to apply.

Basic Cardiac Life Support (Cardio Pulmonary Resuscitation) Course.

Seven Participants attended the course. Subsequently 3 attendees

obtained nursing employment outside of HHS, 2 obtained non‐

nursing (Health Care Aide) positions outside of HHS.

HHS Advanced Cardiac Life Support Course. Six Participants attended

this course. All were subsequently hired, 4 within HHS and 2 outside

HHS.

4. Nursing Rounds (Lunch and Learns) were provided to Participants by

Clinical Integrators to review and enhance nursing skills and knowledge.

OVERALL RESULTS AND CONCLUSIONS

All numeric targets were exceeded in 2012‐13. There were 206 participants in the program

at the beginning of the Project in April 2012. However, this number included participants

who had almost completed their program and were about to exit. Thirty five participants

carried over from years 1‐3 and remained in the program until February 2012. A total of 166

new participants entered the program in the first year of the new program, more than

double the numeric target. One hundred and sixty six participants accessed a significant

component of the program by taking part in at least two interventions and 109participants

accessed four or more interventions. Seventy three nurses became/remained employed in

their profession at the end of 2012‐13.Twenty six frontline nurses completed training as CIs

in 2012‐13.

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Exit Surveys indicated that participants leaving the program had increased their nursing

skills and familiarity with the Canadian workforce,

NEXT STEPS: PROGRAM DEVELOPMENT

During 2012‐13, work was undertaken on the development of new project components,

including on‐line modules which will be implemented in 2013‐2014.

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1. INTRODUCTION

Canadians, and the healthcare professionals responsible for their care, are aging. It is vital

to tap into such sources of workforce renewal as internationally educated nurses (IENs).

During the past decade, the federal and provincial governments, nursing organizations and

educators have collaborated to make it easier for IENs resident in Canada to re‐enter their

profession. Efforts include bridging and adaptation programs intended to help IENs become

examination ready. However, there are still challenges to integration. IENs can be

disadvantaged by lack of information about licensing and registration. Once registered, IENs

are handicapped in their job search by unfamiliarity with local job markets and lack of

Canadian contacts and Canadian work experience. Some clinical managers (CMs) hesitate to

hire IENs because they are unfamiliar with their credentials and have concerns about their

communication skills. These managers also require support to hire IENs and ESL nurses if

employment barriers are to be removed. Once hired, IENs need assistance to integrate into

the Canadian workplace. Recognizing the importance of removing barriers to workplace

integration for IEN and ESL nurses to facilitate workforce renewal, Citizenship and

Immigration Canada (CIC) and the Government of Ontario, Ministry of Citizenship and

Immigration (MCI) provided funds for a targeted three‐year project (2009‐2012) entitled the

Internationally Educated Nurse (IEN) and English as a Second Language (ESL) Nurse

Integration Project.

Based on the success of this project, funding from MCI was renewed for the period of April

2012 – March 2015. The current project builds on the initial project to address the needs of

IEN/ESL nurses, such as language and clinical skills, and provides cultural competency

training for nurses, Clinical Managers and Clinical Integrators (CIs). The project helps IEN and

ESL nurses to perform competently within their scope of practice, communicate effectively

and function as part of the inter‐disciplinary health care team. IENs and ESL nurses are

supported from pre‐hire, through orientation, and during integration with a continuum of

clinical and communication supports.

An innovative aspect of this project has been the recognition of the needs of nurses who

speak English as a Second Language. Some ESL nurses educated in Canada face similar

workforce integration challenges to those educated abroad and require similar assistance.

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As new graduates, they may require support in obtaining the linguistic and cultural

competence needed in the workplace.

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2. DESIGN AND METHODS

PURPOSE AND OBJECTIVES

Purpose

The purpose of The Internationally Educated Nurse (IEN) and English as a Second Language

(ESL) Nurse Integration Project is to ensure Registered Nurses (RNs) and Registered Practical

Nurses (RPNs) educated abroad or in Canada, are fully integrated into the workforces of

Hamilton Health Sciences (HHS)and other Ontario health care facilities. The project targets

three groups: IENs with English as a Second Language, IENs with English as a First Language

and ESL nurses who have graduated from Canadian universities and colleges. It is designed

to remove workplace barriers to entry and create greater employment equity for these

nurses by enabling them to gain clinical experience in a major, Canadian teaching hospital.

The project provides IEN/ESL nurses with various clinical and communication skills including

clinical assessment skills, problem solving, team relationships, professionalism, workplace

experience, and managing conflict in a hospital setting.

Objectives

The project objectives described in the Ministry of Citizenship and Immigration (MCI)

contract with HHS include the following:

Between April 1, 2012 and March 31, 2015, develop, adapt, deliver and evaluate a

project to support the successful workplace integration and retention of IEN/ESL

nurses into HHS and other Ontario health care facilities.

Develop a suite of tools and processes for IEN/ESL nurses, particularly new hires,

practicing in a hospital environment.

Meet the numeric target established by the Ministry of Citizenship and Immigration.

Build the mentorship and coaching capacity of up to 60 frontline RNs, clinical

educators and clinical managers with at least one year’s nursing experience as

clinical integrators (CIs) to facilitate the integration of IEN/ESL nurses.

Develop and implement a strategy to ensure that the program delivery will continue

beyond the end of the funding (Sustainability Plan).

Evaluate program components including interventions and stakeholder satisfaction.

A pre‐ and post‐ evaluation of program interventions will measure participant

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Figure 1. Project Model

confidence, communication and preparation for integration into the healthcare

workforce.

Numeric Targets


set by MCI:



interventions): 145


120


CIs completing training 60

DESIGN

Community Collaboration Employment Model

Recognizing that the integration of IEN/ESL nurses into the workplace depends on various

stakeholders, the research team developed a

Community Collaboration Employment model.

The model continues to guide the current

project. Its function is to engage all

stakeholders (i.e. employers, educational

institutions and community organizations) in

helping IEN/ESL nurses integrate into the

workforce (see Figure 1). A Project Charter was

developed, approved by the IEN/ESL Advisory

Committee and submitted to the MCI.

Implementation of the model was based on an Eight Step Process:

1. Project Initiation: HHS defined the project goal, scope, parameters and

infrastructure needed for appropriate funding.

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2. Identification of Educational Institution: HHS invited the Mohawk College BIEN

program to be a project partner.

3. Identification of Community Organizations: HHS invited CARE and HCCI to be

community partners. CARE has expertise in preparing IENs for registration and entry

to the Canadian workplace, while HCCI has expertise in the areas of cultural

competence and equity.

4. Identification of Evaluator: HHS invited the NHSRU to be an evaluator and assess the

effectiveness of each intervention and the overall project.

5. Formation of an Interagency Advisory Committee: An interagency Advisory

Committee was created to advise and provide feedback.

6. Refinement of the Project Interventions: The team confirmed intake criteria and

each partner’s role in the project.

7. Development of an Evaluation Plan: Employer and project partners identified the

evaluation tools to be used and an independent evaluator led the development of

the research plan.

8. Implementation of the Project: To meet the participants' needs, the team

collaborated with partners and HHS stakeholders (e.g., CMs) to make course

corrections and modify the interventions.

Study Site

The project is being implemented at HHS, a family of six hospitals and a cancer centre that

serves more than 2.2 million residents of Hamilton and central south and central west

Ontario. HHS offers a range of acute and specialized services, catering to health care needs

from preconception through to aging adults. Each hospital has specific areas of expertise.

Hamilton General Hospital is a regional centre of excellence in cardiovascular care,

neurosciences, trauma and burn treatment. It has one of the Province's few Burn

Units and an Integrated Stroke Unit. The General is also home to leading edge

research. A 100,000‐square‐foot Regional Rehabilitation Centre, opened in

September 2009, provides care to stroke, spinal cord injury, amputee, trauma,

neuro‐behavioural and acquired brain injury patients.

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Chedoke Hospital is a major support site for non‐acute care programs and hospital

administration

Juravinski Hospital provides acute inpatient and palliative care, diagnostic services

and supports the needs of cancer patients and the Juravinski Cancer Centre. The

Juravinski Hospital's Orthopaedic program combines health care and research to

offer patients a range of services dedicated to helping them prepare for and recover

from joint replacement surgery.

Juravinski Cancer Centre provides genetic and psychosocial counselling and is the

region’s most comprehensive centre for cancer care and research.

McMaster University Medical Centre (MUMC) plays a major role in the provision of

healthcare services for Hamilton and the surrounding region of central‐west Ontario.

MUMC includes Adult Day Clinics (Medical and Surgical), McMaster Children's

Hospital and the Women's Reproductive Health and New‐born Care program.

McMaster Children's Hospital is one of the top paediatric academic health science

centres in Canada. MCH serves the special and unique healthcare needs of children

using a family‐centred model of care

Regional Rehabilitation Centre accommodates all ambulatory and outreach services

and has 91 inpatient beds. There are a number of indoor and outdoor exercise and

practice facilities, a therapeutic pool and a full range of specialized consultative

resources

St. Peter's Hospital is a complex continuing care hospital that provides inpatient,

outpatient, and community‐based programs and services that focus on Dementia,

Aging, Palliative Care and Rehabilitation.

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Project Partners

For this project, HHS has

collaborated with four partners (see

Figure 2):

1. CARE Centre for

Internationally Educated

Nurses: This non‐profit

agency provides services to

IENs in Ontario.

Responsibility: Sector Specific

Nurse Training in Workplace

Communication for IENs.

2. Mohawk College Institute for Applied Health Sciences: Offers the BIEN program to

help IENs meet the criteria of the College of Nurses of Ontario (CNO) for registration

as an RN or RPN. HHS provides 1000 clinical placements per year to nursing students

from McMaster University and Mohawk College including approximately 40 IENs

enrolled in Mohawk College Bridging for Internationally Educated Nurses (BIEN)

program.

Responsibility: Assessment and preparation of IENs for employment through CELBAN

nursing language assessment tool, skills labs and development of clinical assessment

tools with HHS.

3. Hamilton Centre for Civic Inclusion (HCCI): A community‐based organization

committed to creating a united community that respects diversity, practices equity

and speaks out against discrimination.

Responsibility: Cultural Inclusion and Diversity Training for Participants and HHS

staff.

4. McMaster University Nursing Health Services Research Unit (NHSRU):Conducts

research on nursing human resources.

Figure 2. Community Collaboration Employment Model

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Responsibility: Project Evaluation, Co‐Chair of Project Research Committee.

External Stakeholders

External stakeholders include:

1. The Canadian Nurses Association:

Responsibility: Dissemination of project model and project results.

2. York University:

Responsibility: Collaborate on respective projects and project results.

Project Team

The principal

Investigators are the

Chief of Nursing

Practice, McMaster

University Medical

Centre (MUMC) and

McMaster Children’s

Hospital, and the Co‐

Director, Nursing

Health Services

Research Unit (NHSRU),

McMaster University.

Co‐investigators

include the Director of Clinical Practice & Education who acts as project lead, HHS, and the

Vice‐President, Professional Affairs and Chief Nursing Executive, HHS (See Figure 3). Other

co‐investigators represent two project partners, the Institute for Applied Health and

Science, (IAHS) Mohawk College, CARE: Centre for Internationally Educated Nurses and

NHSRU.

Figure 3. Organizational Structure

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METHODS

IEN and ESL Participants: Study Sample

Eligibility

Eligibility criteria for participants include:

IENs with English as a Second Language

IENs with English as a First Language

ESL nurses graduating from Canadian nursing programs

Sample Size


set by MCI:



interventions): 145


120


Recruitment Strategy

Marketing, and promotion, of the IEN/ESL Nurse Integration Project is carried out externally

and internally at HHS. On the second day of the HHS Nursing Orientation, the Project

Manager provides an outline of the Project, as well as hard copies describing the Project and

contact information. IENs and ESL nurses are encouraged to enrol in the project to receive

increased support through the employment integration process within their specific area at

HHS. If necessary, the Project Manager (PM) will contact the hiring Clinical Manager. In the

past, several Clinical Managers at HHS have contacted the PM for support for their IEN/ESL

employees. The PM in collaboration with Human Resources work together to recruit IEN

and ESL nurses who are not employed at HHS. Human Resources identify current and

anticipated vacancies. The PM monitors the HHS Careers website for new job postings,

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advises on their suitability and helps participants create a profile so they can apply for

future positions.

To date, the PM has invited each BIEN student assigned to a clinical placement at HHS to

participate in the project. She has also provided an overview of the project to BIEN/CARE

students and graduates. The PM has contacted CMs and education clinicians at HHS, BIEN

and CARE and asked for their support with the recruitment of participants.

Clinical Integrators: Study Sample

Eligibility

Clinical Integrators should be HHS RN/RPNs with at least 1 year nursing experience and an

interest in supporting IEN/ESL. The role of the CI includes support and giving informal

advice to a paired participant.

Sample Size

The numeric target for CIs completing training is set at 60.

Recruitment Strategy

The Project Manager contacts potential CIs and provides them with an overview of the

project. A Project Charter and booklet have been developed and are available, together

with other information, in the documents section of the SharePoint Website. The Project

Manager gives a presentation about the Project on the second day of the HHS General

Nursing Orientation. The Project Lead and Project Manager also promote the Project at

committees of which they are members (e.g. the McMaster University/Mohawk

College/HHS/Long Term Care Joint Executive Committee, Hamilton Wentworth region).

Participant and Clinical Integrators: Description and Tacking

Participants and CIs work with the PM to complete personal profiles that include

demographic information and professional experience. Participants are tracked on a

number of variables, in including those collected for the Ministry of Citizenship and

Immigration’s Monthly Numeric Performance Indicator Reports. A detailed description of

the Participants and CIs is provided in Chapter 3.

25

Baseline Testing: Institutional CELBAN (I‐CELBAN)

I‐CELBAN is designed to assess the English language proficiency of IENs applying for

registration. The assessment is recognized and accepted by nurse licensing bodies

nationwide. The score is based on the components of "Listening‐Reading‐Writing and

Speaking" (http://www.celban.org/celban/display_page.asp?page_id=1).

It is recommended that each participant have an Institutional CELBAN score in order to

provide baseline language information. Participants are encouraged to complete I‐CELBAN

testing during the project if they had not done so upon enrolment.

Interventions, Programs and Resources

All interventions initiated in the Pilot Project, 2009‐12 have been retained as has access to

various opportunities and resources. In addition, new interventions and resources are being

developed.

CARE Centre for Internationally Educated Nurses: Language Communication for IENs –

Advanced course for Internationally Educated Nurses

This course provides advanced communication strategies for working/workplace‐ready

IEN/ESL nurses. Topics include introducing, managing and ending a nurse‐client interview;

intercultural communication skills; documentation and reporting; communicating assertively

with clients and colleagues; lay vs. technical vocabulary; telephone communication skills,

therapeutic communication skills; and health teaching.

BIEN Mohawk College Learning Resource Centre (LRC) Simulation Laboratory

The LRC houses a high‐fidelity simulation laboratory, clinical practice laboratory, “activities

of daily living apartment” and a nursing station. It also offers a wide selection of models,

audiovisual resources and clinical skills equipment for use by nursing students and faculty.

Project participants were supported in various ways, including 1:1 student‐faculty

relationships and peer tutoring. In addition, RN technologists helped participants develop

their clinical skills.

All participants self‐evaluate their level of confidence for medical/surgical and physical

assessment nursing skills. They are also required to complete a pre‐intervention self‐

26

assessment checklist for both medical/surgical and physical assessment skills at the time of

enrolment in the project.

Through the BIEN LRC simulation lab, participants have the opportunity to practice two

selected nursing skills identified during their self‐assessment learning plan. A pamphlet

provides information for orientation and use of the LRC simulation lab. The expectation is

that within one year of participating in the project, the IEN/ESL nurses will have had the

opportunity to improve their confidence and ability in clinical skills such as vital signs,

medication administration, measurement and recording of client intake and output. In

2012, the pre‐and post‐Physical Assessment Checklist was revised to better capture the

participants’ experiences at the LRC. The gastrointestinal and gyne‐urinary assessment skills

check points were removed and a “comment” section was added to the pre‐ and post‐

evaluation form. All data was collected by the Project Team and forwarded to the NHSRU.


This three‐hour training workshop for IEN/ESL nurse participants, CIs and CMs/manager

delegates was developed by HCCI with input from HHS. The session explored different

methods of communication, including verbal and non‐verbal, and examined how

understanding culture can help avoid misunderstandings and improve intercultural

communication.

The purpose of the workshop was to enable attendees to:

deepen understanding of diversity and inclusion

review personal frames of reference, biases and ladders of inference

reflect on style of communication and the effect their use of language might have on

communication

understand culture and strategies for cross‐cultural communication and conflict

resolution

develop a framework for an inclusive approach to nursing, patient care and

counselling

It included case scenarios based on cultural diversity awareness, which were drawn from

the participants' experiences. The workshop is evaluated through a post‐workshop

evaluation questionnaire. A workshop was held on Dec 19, 2012.

27


Sessions conducted by the PM are intended to prepare Participants for real job interviews.

The IEN/ESL nurses' resumes, cover letters and 3 references are reviewed before the

interview. The Participants receive a pre‐interview preparation kit, which include a

description of the interview structure. A pre‐intervention survey assesses the participants'

level of confidence and their interview skills. Job Coaching sessions take one to two hours.

The interviewee practises establishing rapport with the interviewer and responds to general

and specific nursing‐related questions based on the RPN and RN medical/surgical job

description provided by HHS.


Each participant followed a learning plan, customized to include both clinical and

communication skills development. These plans were developed in collaboration with the

Mohawk College BIEN program. After recruitment, participants met with the PM and

discussed the learning plan they would follow for the duration of the course. The plan is

intended to help participants understand and become familiar with the CNO Quality

Assurance (QA) program and includes the CNO Learning Plan.

The QA program is based on the principle that lifelong learning is essential to continuing

competence. It is mandatory for every nurse registered in the General, Transitional and

Extended Classes in Ontario to participate in the QA program, which includes self‐

assessment practice reflection, developing and maintaining a learning plan, practice

assessment and peer assessment.

The customized learning plan used in the project includes a review of the following:

Entry to practice competencies for RNs and RPNs in Ontario from CNO website

CNO Professional Nursing Standards and Guidelines and the learning modules

from CNO website

Project interventions (participants are encouraged to participate in all seven

interventions)

HHS policies and procedures

MAC ‐ Consent, Withdrawal or Refusal of Consent for Treatment Policy

28

Documentation ‐ Transcription Process for Kardex

ENG ‐ Lockout/Tagout Procedure

Infection Control ‐ Clostridium Difficile Protocol

NUR ‐ RPN Scope of Practice F5 Medicine Policy

5 South Nursing Standards for Patient Safety During Transfer of Accountability

HR ‐ Confidentiality

PRI ‐ Disclosure of Personal Health Information of Current In‐Patients to Friends

and Family Guideline

ED ‐ Emergency Department Patient Safety and Restraints Policy

HSW ‐ Guidelines for Pregnant HHS Employees Working Directly or Indirectly

with Inpatients with Communicable Diseases

Infection Control ‐ Management of Proven or Suspected Diseases ‐ Guidelines

Transcription Process for Orders

Participants were asked to review all materials incorporated in the learning plan within a

year. There are spaces in the document to record the participant’s scores for the CNO

Learning Modules quizzes. They were allowed a year to complete the quizzes.

HHS SharePoint

This website was adapted from a site that targeted only CMs. It has been modified to serve

as a resource hub for IEN/ESL nurses, CIs and HHS CMs and external partners. The site posts

relevant forms and provides updates on the project, including interventions, evaluation and

activities (e.g., the N3 program) as well as available resources for IEN/ESL nurses. The PM

informs participants about the site and the information available on it. Participants are then

sent passwords and instructions on how to access the site. In 2012, The SharePoint Website

was updated with a general user name and password. A short survey was made available to

users. A blog and a discussion board for the IEN/ESL network has been created. It is

anticipated that the site will evolve during the project to make it more interactive.

HHS N3 (Nurses Nurturing Nurse) Networking Program

The N3 program, initially written by the Academy of Medical‐Surgical Nurses in the US, is a

loosely structured supportive arrangement for sharing between two nurse colleagues: an

experienced CI and an IEN or ESL nurse. It is based on the principles of adult learning and

29

focuses on the needs of the individual being nurtured. To prepare for their role, CIs are

invited to attend a Career Development Day offered by the Oncology Program Oncology

Nursing e‐Mentorship Program at the Juravinski Cancer Centre. This program is now offered

online.

CIs received information pertinent to helping IEN/ESL nurses develop their careers. The

program provided participants with an opportunity to review their careers to date and learn

strategies to facilitate future career decisions. The participants' career plan might include

finding a mentor or a mentee to help them achieve their goals.

CIs and participants completed an N3 Networking Program form to identify their areas of

interest. Based on four to five topics of discussion, the PM matched the participant with a

CI to form a dyad. CIs were invited to attend a Lunch and Learn session with participants to

review the project goals, the N3 program and the participants' learning plans. If a CI and a

matched participant were unable to attend the Lunch and Learn session, a separate meeting

was arranged with the PM. The PM acted as coordinator of the N3 program and oversaw

the completion of the evaluation forms.

The HHS/CNO learning plan was used as a basis for the discussions. The CI and the

participant determined the objectives for each meeting. The objectives reflected the needs,

concerns and/or issues identified by the participant. CIs and participants arranged to meet

on a regular basis (preferably every two weeks). It was envisaged that meetings might

become less frequent after three months, provided both parties agreed, but monthly

meetings were the requirement.


There are three components in this group of interventions 1) Job Shadowing, 2) Nursing

Orientation, 3) Career Progression opportunities. Evaluation tools were prepared to

measure usefulness of these interventions.

HHS Job Shadowing

Ten Participants have been involved in the Job Shadowing process at HHS since April

2012, in their areas of interest including Medical/Surgical/ICU and Rehabilitation list

to participate. The Project Manager met with the Manager of Clinical Practice and

30

Education to organize this process. It was decided to streamline Participants waiting

for placements into specific areas (Medical/Surgical, Rehab, Child and Youth and

Mental Health) where Project Clinical Integrators (CI) were working at HHS and

involve the CIs in this process. Currently, participants summarize their job shadowing

experience in a one page narrative.


The participants were invited to attend the second day of nursing orientation.

HHS Career Progression Opportunities

Components include the following:

1. Use of e‐learning lab. Two computers were available at the E‐learning lab. They

provide participants with access to:

o Computer keyboarding practice

o E‐documentation (Meditech Clinical Documentation) A hard copy of the

Status Board User Guide to e‐learning at HHS is also provided to Participants

o 50 on‐line learning courses which range from reviews for Fire, WHMIS and

Emergency Codes to courses about Infection Control

o Job applications

o CNO learning modules

o DVDs on clinical skills

2. Academic skills workshops

o Nursing documentation and academic writing skills

o Examination Preparation course

3. Certification courses

o HHS Advanced Cardiac Life Support course

o Basic Cardiac Life Support (Cardio Pulmonary Resuscitation) course

4. Nursing Rounds (Lunch and Learns)

5. HHS career development e‐mentorship program

o All CIs are encouraged to complete workshops offered either in‐person or

on‐line workshops on mentorship by the Oncology Nursing e‐Mentorship

Program, McMaster University, Juravinski Cancer Centre. They were intended

31

to prepare clinical integrators to provide assistance to participants in the N3

(Nurses Nurturing Nurses) Networking program. Topics included:

The five phase mentoring relationship

Opportunity to network with nurses across the country in different

specialties

Electronic resources supporting the mentorship relationship

6. Charge Nurse Role Education Program at HHS:

o HHS Charge Nurse Orientation program

7. Volunteering opportunities ‐ i.e. HELP, e‐learning

Publicity and Dissemination

A marketing strategy was developed in 2009‐2012 to raise awareness of the project and to

facilitate recruitment remains in place (see Appendix C). Results of the project are

disseminated using various means, including posters and presentations (See Appendix C).

Success Stories

Participants and CIs complete templates, provided by the Ministry of Citizenship and

Immigration, which detail their experiences and personal stories. These are kept in their

files. With their permission, these stories are made available (see Appendix D).

Evaluation

Individual Interventions

The partners evaluate the individual interventions for which they are responsible.

Numeric Targets

A tracking mechanism has been developed and implemented to track the participants

engaged in interventions and their employment status 3, 6 and 12 months after completing

the interventions.

Measurable Success Indicators:

Project Work plan (yearly) ‐ all targeted activities achieved on time

Project Milestones (yearly) ‐ achieved on time

MCI/HHS Schedule B/Project deliverables (yearly) ‐ achieved/ funding released

32

MCI Numeric targets (yearly) ‐ achieved

Project success stories (format provided to project by MCI) ‐ released to MCI yearly

CCEM dissemination (yearly) ‐ at least one conference presentation

Overall Project Evaluation

Project evaluation, approved by the Ministry of Citizenship and Immigration, is delivered by

the Nursing Health Services Research Unit, McMaster University. The role of the NHSRU is

to integrate and discuss the implications of all evaluative data collected by the partners and

the research team and to collect and analyse additional data to assess the satisfaction of the

project partners with the project.

The project design was experiential rather than experimental. As limited research had been

carried out on the workplace integration of IEN/ESL nurses, the intention was to allow for

modification based on experience. On‐going evaluation of the program will lead to changes

resulting in increased efficacy. Interventions introduced in the early stages of the program

were refined and strengthened over time and new activities introduced to enhance

workplace exposure for participants. Some evaluation tools used in the pilot study were

modified and new tools created. A complete list of evaluation tools for all interventions is

presented in Appendix A.

33

3. SAMPLE DESCRIPTION

Participant Sample

During the first year of the renewed project 166nurses enrolled, surpassing the targeted

sample of 60 for that year. An additional 35 nurses remained in the project from the pilot

program, totalling 201.

Two nurses from year 4 exited the program before completion. Thirty four nurses from the

pilot project left, on February 6 2013 after completing the project (see Table 1).

In year 4, of the 166nurses entering the project, 23 were male, 143 were female.

Table 1. Participant Sample Composition Time IEN/ESL IEN/EFL ESL Total Exits Before Project

Completion

Year 1‐ 3 32 0 3 35 N/A

Year 4 147 15 2 166 2

Participants entered the project throughout the year (see Table 2).

Table 2. Entry in Project Year 4 Time Participants entered

April 2012 18

May 2012 19

June 2012 16

July 2012 10

August 2012 12

September 2012 17

October 2012 14

November 2012 5

December 2012 17

January 2013 18

February 2013 6

March 2013 14

Total 166

As shown in Table 3, most participants were referred to the project by HHS staff, a member

of the community or an academic advisor.

Table 3. Project Referrals Reference Year 1‐3 Year 4

Academic 2 6

Community 6 38

HHS staff 13 23

Self‐referral 2 21

Other 12 Other=8

34

Other: Colleague=3Other: DOC, LTC=1Other: Friend=23Other: Mother=1

Other: Participant=28Other: St. Elizabeth Healthcare=11

Other HHS website=3Total other =78

Total 35 166

Most of the participants were women between 25 and 44 years of age (see Table 4 and

Table 5).

Table 4. Age of Participants Age Range Year 1‐3 Year 4

18‐24 3 11

25‐29 5 40

30‐34 5 29

35‐39 11 33

40‐44 7 37

45‐49 4 11

50‐54 0 6

Total 35 166

Table 5. Gender of Participants Gender Year1‐ 3 Year 4

Male 5 23

Female 30 143

Total 35 166

The participants' level and country of nursing and non‐nursing education varied widely (see

Tables 6, 7, 8).

Table 6. Highest Level of Nursing Education Education Year1‐ 3 Year 4

BScN 5 years 0 2

BScN 4 years 0 85

BScN 3 years 16 5

BScN 2 years 2 6

BScN‐ not specified 0 1

RN diploma 3 years 1 5

RN diploma ‐ not specified

9 41

Post graduate 2 6

RPN diploma 5 15

Total 35 166

Table 7. Country of Nursing Education Country Year 1‐ 3 Year 4

Cameroons 0 1

35

Columbia 0 1

Canada 6 14

China 2 7

Singapore 0 1

Croatia 1 0

Ethiopia 1 0

Haiti 0 2

Iran 0 7

India I7 42

Ireland 0 1

Israel 0 2

Jamaica 0 1

Japan 0 1

Jordan 2 3

Kenya 0 1

Lebanon 0 1

Lithuania 1 0

Nepal 0 1

Nigeria 0 2

Pakistan 1 1

Philippines 6 63

Poland 1 0

Portugal 0 1

Romania 4 4

Serbia 0 1

Taiwan 1 0

S. Korea 1 3

USA 0 2

Zimbabwe 0 2

Total 35 166

Table 8. Country of Highest Level of Non‐Nursing Education Country Year1‐ 3 Year 4

N/A 20 0

Argentina 1 0

Cameroon 0 1

Canada 0 2

China 2 10

Columbia 0 1

Croatia 1 0

Ethiopia 1 0

Haiti 0 2

India 2 42

Iran 0 6

Israel 0 2

Jamaica 0 1

Japan 0 1

Jordan 0 3

Kenya 0 2

Lebanon 0 1

Mexico 0 1

Nepal 0 1

Nigeria 0 3

Pakistan 0 1

36

Philippines 3 63

Portugal 0 1

Qatar 0 1

Romania 3 5

Russia 1 0

Serbia 0 1

South Korea 1 3

Sri Lanka 0 1

Zimbabwe 0 3

Total 35 166

The majority of participants reported high school as their highest level of non‐nursing

education although some had degrees or diplomas. Two had been medical doctors (see

Table 9).

Table 9. Level of Non‐Nursing Education in Country of Origin Level of Education Year 1‐ 3 Year 4

High School 0 120

College/Diploma 2 6

University ‐ Bachelors 11 22

University – MA/ MBA 1 4

Medical doctor 0 2

Doctor of dental medicine

0 1

Pre‐degree 0 8

Other‐ certificate 0 2

Not Clearly Specified 0 1

N/A 21 0

Total 35 166

The majority of participants reported their immigration class as Independent Professional or

family sponsored (see Table 10). In terms of their current immigration status, the majority

were permanent residents or Canadian citizens (see Table 11). Most participants had

migrated after 2000, the majority between 2006 and 2010 (see Table 12). One nurse

migrated twice.

Table 10. Immigration Class Immigration Class Year 1‐ 3 Year 4

Independent ‐ Professions/Skilled Trades

16 96

Family Sponsored 15 34

Convention Refugee 1 7

*Work Permit 1 9

Live‐in Caregiver 1 19

Born in Canada 1 1

37

Total 35 166

*In process of obtaining PR status

Table 11. Current Immigration Status Status Year1‐ 3 Year 4

Canadian Citizen 10 29

Permanent Resident 24 108

*Work Permit 1 25

Convention Refugee 0 4

Total 35 166

*In process of obtaining PR status

Table 12. Year of Migration Year Year 1‐ 3 Year 4

1990–1995 2 2

1996–2000 3 1

2001–2005 6 16

2006–2010 18 84

2011 6 40

2012 0 22

In process 0 1

Total 35 166

The majority of participants who had practiced prior to migration had between 1 and 5

years of experience (see Table 13). However, since coming to Canada, most had not

practiced for 1 to 5 years (see Table 14).

Table 13. Years of Experience Prior to Migration Years Year1‐ 3 Year4

> 1 year 4 13

1–5 years 6 47

6–10 years 10 41

11–15 years 7 24

16–20 years 2 16

20+ years 0 7

N/A 7 18

Total 35 166

Table 14. Years in Canada Not Practicing Nursing Years Not Practicing Year 1‐3 Year 4

>1 5 21

1–5 6 108

6–10 2 7

10+ 1 1

N/A 21 29

Total 35 166

Three Year 1‐3 nurses had worked in a third country (Libya, Saudi Arabia and Singapore).

38

Forty seven Year 4 nurses had worked in a third country. Twenty three nurses had worked

in Saudi Arabia, 3 in Kuwait, 2 in the USA and the UAE and one each in Bahrain, Bermuda,

Ireland, Hungary Republic of Maldives, Singapore, Qatar, Oman and Swaziland. Five nurses

had worked in more than one country (Yemen and Saudi Arabia; Saudi Arabia and the UAE;

Viet Nam, Sri Lanka, South Africa, Ethiopia and Sudan; Qatar, USA and England; and China

and Singapore).

Only one nurse had worked in a province other than Ontario (Nova Scotia). As shown in

Table 15, almost all nurses currently practicing in Canada had been doing so for less than 5

years.

Table 15. Practice in Canada Length of Practice in Canada

Year1‐ 3 Year 4

> 1 year 5 21

1–5 years 6 15

5+ years 3 0

N/A or 0 years 21 130

Total 35 166

All the Carry‐over Participantsand102 of the year 4 participants had passed their registration examinations (see Table 16) and the majority had completed registration (See Table 17).

Table 16. Examination Status Year 1‐3 Year 4

Passed CRNE 11 39

Passed CRPNE 16 59

Both passed 0 4

Failed one or more times 0 19

N/A 3 9

Eligible to write 0 25

Pending CNRE 0 1

Pending CRPNE 0 8

Not registered 0 2

Total 35 166

Table 17. Registration Status Year 1‐3 Year 4

Registered as RN 9 38

Registered as RPN 12 53

Registered as RN and RPN 0 3

Eligible to Register 6(RN) 5(RPN)3 (RN and RPN) 13(RN) 43(RPN)14(RN/RPN)

Not yet eligible 0 2

Not registered 14 166

39

Of the 35 Year 1‐3 Carry‐overs, 21 had permanent registration with the CNO. Of the 166

Year 4 Participants, 84 have permanent registration status and two have temporary

registration. All year 1‐3 and 160/166participants in year 4 had satisfied safe practice

requirements. Three year 1‐3 participants were in the BIEN bridging program. Twenty of

year 4 had CARE/BIEN membership 58 year 4 participants (BIEN & CARE=10; CARE=11;

Yes=39) were members of BIEN and/or CARE upon entry. Four participants from Year 1‐3

and 10 from year 4 had completed clinical placements lasting between one and six weeks in

various locations at HHS. One further placement had been scheduled (see Table 18 and

Table 19).

Table 18. Number Completing Clinical Placements in HHS Clinical Placement in HHS Year 1‐3 Year 4

No 31 155

Yes 4 11

Total 35 166

Table 19. Location of Clinical Placements Five participants from Years 1‐3 had placements as follows:

• Hamilton General, 6S.Aug‐Sept.2011• HGH, Stroke Unit 7S,Aug‐Oct.2011 • McMaster Children's Hospital 3D Jan‐Apr2011 • McMaster University Medical Centre, Diabetes Program Sept.2011‐Nov. 2011 • Scheduled for May 2012

Eleven participants from Year 4 had placements as follows:

HGH & St. Peters, Apr‐May 2012

McMaster, Juravinski

St. Peters, HGH, 3 West Palliative, Trauma, Med‐Surg., April‐May 2012

St.Peters3E (palliative),HGH(8W&6SMedSurg), Juravinski,F3 (Med/Surg.),Apr‐Aug,2012

ST. Peters(3W),HGH (6S&8W), Juravinsk I (E2 ) Preceptorship

St. Peters & HGH, Complex Care, 2011

HGH & St. Peters Hospital, Apr‐May 2012

St. Peter's, Palliative Care, HGH, 6S & 8S, July‐Aug.2012

St. Peters & HGH, 3E,8S,5S, July‐Aug. 2012

HGH, St. Peters and community, July to Nov. 2012

St. Peters and JHCC, Med/Surg, July‐Nov. 2013 (scheduled)

40

Clinical Integrator Sample

Of the 42 CIs recruited during the pilot project, 38 remain. Fourteen were recruited in 2009,

2 were recruited in 2011 and the remainder were recruited in 2010. They were joined by a

further 26 CIs in 2012. In 2010, 4 participants (1 male and 3 female) exited the project after

2, 8, 9 and 11 months respectively. In 2012 there were 64 CIs participating in the project.

Seven of the current CIs are men. The CIs range in age from less than 24 to over 65 (see

Table 20).

Table 20. Age of CIs Age Range Year 3

18‐24 2

25‐29 8

30‐34 6

35‐39 9

40‐44 14

45‐49 8

50‐54 9

55‐59 6

60‐65 1

65+ 1

Total 64

There are 33 nurses in group 1 (IEN&ESL), 2 in Group 2(IEN&EFL), 17 in Group (EFL, Educated

in Canada) 3(ESL, Educated in Canada) and 11 in Group 4.

Fifty three CIs had been referred to the project by hospital staff, 3 by an academic advisor, 2

the community, 3 from other sources and 3 were self‐referred. They had received their

nursing education in a variety of countries (see Table 21).

Table 21. Country of Nursing Education

Country Number Country Number

Canada 29 Ireland 1

Canada/Poland 1 Philippines 6

Australia 1 Poland 4

Bosnia‐Herzegovina 1 Rep. Moldova 1

China 2 Romania 2

Croatia 2 Serbia 1

El Salvador 1 Yugoslavia 2

India 6 England 1

Iran 2 Total 64

41

Almost all had completed their non‐nursing education in their countries of origin (See Table

22).

Table 22. Country of Highest Education: Non‐nursing

Eight CIs reported tertiary education other than nursing. Their qualifications included: MA in

leadership, a medical degree, B. Economics, BA in commerce, an unspecified university

degree, two years of teachers college, BSc in chemistry and physics and a degree in English

and French.

Most CIs had entered Canada either family sponsored or as independent professionals (See

Table 23).

Table 23. Migration Status Category NumberConvention Refugee 4

Family Sponsored 30

Independent. Professional 16

Other: Landed Immigrant 1

Other: Student 1

Other: Work Permit 1

N/A=11 12

Total 64

Two thirds of the CIs had entered Canada before 2006 (see Table 24). Currently 51 CIs are

Canadian citizens and 14 are permanent residents. One replied N/A

Table 24. Year of migration to Canada Year Number Before 1991 12

1991‐ 95 5

Country Number Country Number

Canada 2 Poland 3

China 3 Rep. Moldova 1

England 1 Romania 2

Ethiopia 1 Serbia 1

Ghana 1 South Korea 1

India 5 Togo 1

Kenya 1 Zimbabwe 1

Netherlands 1 N/A 33

Philippines 4 Total 64

42

1996‐2000 9

2001‐2005 16

2006‐2010 10

NA 12

Total 64

Additional information describing the CIs participating in the project included:

Thirty two CIs had no nursing experience prior to arriving in Canada, 18 had five

years of experience or less, 8 had 6‐10 years of experience and 8 had more than 10

years.

Two had worked in a country other than their own or Canada; 1 had worked in the

United Arab Emirates, and one did not specify.

Thirty oneCIs found the question about how long they had not worked as a nurse in

Canada after migration to be not applicable; of the remainder, 2 reported one year

or less, 18 less than six years, 10 reported 6‐10 years and 3 reported more than 10

years.

12 CIs found the question about how long they had worked in Canada since

migration to be not applicable; Of the remainder, 26 had worked five years or less,

14 had worked 6–10 years, 3 had worked 11–15 years, 2 had worked 16–20 years

and 7 had worked more than 20 years.

Twenty five were employed at Hamilton General Hospital, 4 at the Juravinski

Hospital and Cancer Centre, 6 at McMaster Hospital, 2 at Chedoke, 3 at St. Peter’s

and 1 covered all sites. They worked in various departments. The remainder were

employed outside HHS

Forty were permanent full‐time, 5 was temporary full‐time, 13 were permanent

part‐time 2 was occasional part‐time and 1 casual part time

1 left employment at HHS during the project

43

4. BASELINE MEASURES

The intention was to test ESL participants who had not previously taken CELBAN and to

retest those who had not taken it recently. Eight IEN/ESL (year 1‐3) participants and 14

IEN/ESL (year 4) participants had a CELBAN score before they entered the project. The

remainder were either English speakers or had not taken the test before entry.

BIEN, Mohawk College held voluntary I‐CELBAN testing sessions in:

June 2012, (4 Participants)

November 2012 (5 Participants)

December 2012 (5 Participants)

One other participant was also tested in 2012.

Sixteen year 1‐3 participants and 108 year 4 participants had taken tests other than CELBAN,

and some participants took multiple tests (see Table 25). The results showed that most of

the nurses in each of the groups met the levels of proficiency demanded by the CNO.

However, a few nurses had relatively low scores. Nurses with EFL were not required to take

CELBAN and were not tested in conjunction with the project.

Table 25. CELBAN Testing and Results Years 1‐3 Year 4

CELBAN at entry to the project 8/35 14/168

Dates of pre‐project CELBAN test

2008=12009=22010=12011=4

Total tests=8

2009=22010=4

2011=4 (1 was tested twice i.e.5 tests)2012=32013=1

Total tests =15

Baseline pre‐project scores 666689877988476788778877781?

7‐7‐8‐89‐9‐8‐87‐9‐8‐77‐6‐6‐7

6‐7‐7‐6 and 9‐7‐789‐8‐7‐88‐7‐7‐87‐7‐7‐77‐6‐7‐69‐7‐7‐66‐7‐6‐810‐8‐8‐89‐5‐6‐69‐7‐6‐8

44

CELBAN test since project entry 7 nurses took CELBAN tests 2011= 4 2012 =1

One participants took tests in both 2011 and 2012

16 nurses took CELBAN tests in2012 and 7 in 2013

Scores for I‐CELBAN during the project

7464109698877

8568/887787676768

6‐8‐6‐78‐8‐7‐77‐5‐6‐79‐8‐7‐77‐6‐6‐710‐8‐8‐86‐4‐7‐88‐6‐6‐89‐9‐7‐89‐5‐6‐88‐8‐7‐79‐7‐6‐88‐7‐5‐89‐9‐7‐99‐8‐8‐95‐5‐6‐65‐6‐6‐79‐7‐6‐89‐7‐6‐98‐7‐6‐79‐7‐6‐79‐7‐6‐77‐7‐5‐6

Other language tests taken by participants

16 had taken additional language tests

MELAB=9IELTS =4TOEFL=1

MELAB and IELTS =1IELTS and TOEIC =1

139 had taken additional language tests

COPE, U. of T=1 CLB=20

CLBA=3ESL=8IELTS=38

MELAB=33TOEIC=6

Combinations of 2 tests=29Combinations of 3 tests =4

Due to the changes in the CNO English Proficiency requirements, as of January 2013, only

IELTS, CELBAN or a Bridging program will be accepted as proof of language proficiency. The

project also accepts these tests. The Canadian Language Benchmark Assessment (CLBA) test,

level 7 or higher is desirable for this program.

45

5. RESULTS

CARE Centre for Internationally Educated Nurse's: Language Communication for

IENs – Advanced course

The CARE Language Communication for Nurses Course (advanced) was offered: October,

2011, ‐February, 2012, June ‐ October, 2012 and October 2012‐ February 2013. The course

lasted 96 hours. Orientation for the second and third courses was held in May, 2012 and

October 2012 respectively. Attendance at the courses is shown in Table 26.

Table 26. Course Attendance

The reasons cited most frequently for poor attendance and/or withdrawal from the session

(when provided) included, conflicting work or educational schedules, commuting distance,

commitment to job search activities and family obligations. The percentage of participants

receiving certificates of attendance or completion was higher in the second and third course

but still represented only a third of those that attended the course.

Participant Self‐Assessment of Nursing Communication Skills: Pre and Post Course

Participants are required to complete a Self‐Assessment survey in class at the beginning of

the course, and submit it to the instructor. At the end of the course, they are given a new

copy of the same Self‐Assessment survey to complete. Each participant is required to rate

themselves from 1 to 5 based on the rating scheme outlined below in each of the 9 tasks

listed. The results of each of these assessments is tabulated, averaged and summarized in

the form. Individual forms for each participant are maintained on file.

Attendance October 2011 ‐February2012

June ‐ October, 2012 October 2012‐ February 2013

Number of registrants 26 30 34

No shows 5 (19%) 2 (7%)

11 (32%)

withdrew 9 (35%) 6 (21%)

8 (35%)

>50% attendance 1 (4%)

6 % 8 (35%)

50‐69% attendance 1(4%) 3 (11%) 2(9%)

Certificate of attendance70‐84% attendance

4 (15% )

10 (36%) 5 (21%)

Certificate of completion85%+ attendance

7 (27%) 9 (32%) 8(35%)

Total attending 22 28 23

46

The skills included: the Nurse‐Client Interview, documenting progress notes giving verbal

reports, receiving verbal reports making and receiving telephone calls, receiving doctors’

orders, health teaching, therapeutic listening, and responding, Communicating assertively

with colleagues and clients (see Table 27).

Table 27. Summary of Completed Assessments

Communication Tasks Course 1

PreAvg.

Course 1 PostAvg.

Course 2 PreAvg.

Course 2 postAvg.

Course 3 pre Avg.

Course 3 postAvg.

Nurse‐Client Interview 3 4 3.2 4.2 3.3 4.5

Document Progress Notes 2.7 4 3.2 4.2 3.1 4.4

Give Verbal Reports 2.7 4 3.0 4.0 3.4 4.4

Receive Verbal Reports 2.7 4 3.2 4.3 3.3 4.4

Make and Receive Telephone Calls

2.7 4.4 3.0 3.9 2.8 4.0

Receive Doctors’ Orders 2 4 2.9 4.2 2.8 4.3

Health Teaching 3 4 2.8 4.2 3.4 4.6

Therapeutic Listening and Responding

3 4 3.2 4.2 3.3 4.5

Communicate Assertively with Colleagues and Clients

2.7 4.4 3.3 4.2 3.0 4.3

AVERAGE 2.7 4.0

3.1 4.2 3.1 4.4

RATING SCHEME: 1 ‐ Not Confident, 2 ‐ Slightly Confident, 3 ‐ Somewhat Confident, 4 ‐ Fairly Confident, 5 ‐ Very Confident

Course 1: Oct 2011‐March, 2012. Only three nurses completed both questionnaires. The 3

respondents claimed considerable improvement overall with averages of 2.7 pre course and

4.0 post‐course.

Course 2: June ‐ October, 2012. Twelve nurses completed both questionnaires. The overall

pre‐course score was 3.1 and the average post score was 4.2, indicating significant

improvement

Course 3: October 2012‐Feb 2013.10 of 23 nurses completed both questionnaires. The

overall pre‐course score was 3.1 and the average post score was 4.2, indicating significant

improvement

Instructors Assessment

The instructor reported on the participants’ progress as a result of the course. For courses 2

and 3, a detailed table was made available (see Table 28).

47

Table 28. Instructor’s Assessment of Participant’s Progress Course 2 (N=22)

RATING SCHEME: 1 – Not Consistent, 2 – Fairly Consistent, 3 – Somewhat Consistent 4 –Consistent, 5 – Very Consistent

The instructor also provided a general assessment of the Participants’ progress in all 3 courses.

Course 1: The instructor felt that the motivation of the students that finished the course

was very high. She observed some to significant change in performance and ability of the

class overall in accuracy in spoken English, accuracy in written English and pronunciation.

Areas in which she observed significant change in performance and ability included: fluency

in spoken and written English, listening ability, ability to use nursing terminology correctly

when speaking and writing, ability to use English phraseology correctly when speaking,

Nurse‐client interview skills, colleague communication skills and client and family member

communication skills. The instructor reported that communication skills or situations the

class found most challenging included; Saying no and being assertive while advocating for

self and providing advice and empathy. The latter was challenging due to problems with

English phraseology. The Instructor’s opinion of overall communication ability of the

participants, on average, related to communication in a nursing context was Highly Skilled

Communicators.

Skill Area in Nursing Level

Course 2 3 4 5

Speaking Accuracy: Ability to use correct grammar and word choice

23

1(4%)0

12(55%)4 (31%)

9(41% 9 (69%))

0

Speaking Fluency Ability to get your meaning across while maintaining a fluid and coherent flow of conversation

23

0 7(32%)0

11(50%) 13 (100%)

4(18%)

Pronunciation Ability to speak clearly and comprehensibly to others

23

00

8(36%)1(8%)

9(41%) 12(92%)

5(23%)0

Listening ComprehensionAbility to understand main ideas and relevant details in conversation

23

00

8(36%)1(8%)

9(41%) 10(77%)

5(23%)2(15%)

Writing Proficiency Ability to write logical, coherent and grammatically accurate text when documenting

23

00

11(50%)0

9(41%) 13(100%)

2(9%)0

Socio‐Cultural ProficiencyAbility to interact according to commonly accepted cultural norms and expectations

23

00

5(23%)0

10(45%) 5 (38%)

7(32%)8(62%)

48

Course 2: The instructor noted substantial improvement was observed in the students’ self‐

confidence, especially when performing verbal reports, such as end‐of‐shift and handover

reports. Improvement was also observed in written communication skills. Anecdotally

students noted their listening skills also improved. As the course focuses on listening, taking

notes, processing information and acting on it in a timely and efficient manner, with practice

the students were able to discern the key points of the messages they listened to and not

waste time on insignificant details. In conclusion, there was significant improvement in

verbal interactive skills with colleagues, clients and family members, documentation skills,

self‐confidence and assertiveness was noted with this cohort. To a lesser degree, passive

language skills such as listening improved as well. The instructor rated the motivation of

two participants as high and two as very high.

Course 3: Based on course assessments and one–on‐one student feedback, substantial

improvement was noted in the students’ self‐confidence in telephone skills, verbal

reporting, and written reports. At the beginning of the course they admitted that verbal

interaction, especially professional telephone skills and verbal reporting, was their biggest

fear. The telephone role‐plays and situational class activities helped students learn to

process the information they listened to over the phone, and take action. By the end of the

course, students were able to create end‐of‐shift reports and reports and deliver them with

accuracy. The e‐learning lounge facilitated pronunciation, fluency, rhythm and intonation

the students needed to deliver the report. The role‐plays and activities used in the class

enabled the participants to express their professional opinions and they became very

assertive in stating their needs and negotiating their goals. Significant improvement

occurred in students’ self‐confidence using verbal communication skills with colleagues,

clients and family members, as well as using the telephone in the workplace. Substantial

progress was observed in written skills, especially summarizing, and using clipped structures

and abbreviations in documentation.

Participant Feedback

In Course 1 Participants completed a survey on perceived changes in their personal

communication ability. Five Participants completed the survey. At the end of the course

49

four participants considered themselves competent communicators and one a highly skilled

Communicator. Participants in courses 2 and 3 completed a course evaluation

questionnaire (see Table 29).

Table 29. Evaluation for Courses 2 and 3

RATING SCHEME: 5 – Excellent 4 – Great 3 – Good 2 – Fair 1 – Poor

All participants provided qualitative feedback about what they found most valuable about

the course (see Table 30).

Table 30. Course Components participants reported as valuable Course 1 Course 2 Course 3 End‐of‐shift report. Non‐therapeutic interviews. Giving advice. Communication with clients and family members. Video with different scenarios. Gambits – as these are used

The technicality and therapeutic style in the whole course Communicating well with confidence Audio and video materials New methods of communication, which will help improve job

Therapeutic communication skills Interactive portion of the class along with the chance to interact, communicate, network and make friends Documentation/progress note,

Course Element

Course number

Number of Participants Who Responded

1 2 3 4 5

Course content 23

10

00

11

4 3

1310

Audio and video materials 23

00

10

35

10 6

53

e‐Learning Lounge materials 23

00

10

71

9 7

16

Your learning experience in this class

23

10

00

21

3 4

139

Opportunity for participation and discussion

23

10

00

19

6 4

1110

Class schedule 23

10

00

40

8 4

610

Length of breaks (30 minutes) 23

10

00

10

7 2

1012

Fairness of evaluation methods 23

10

00

10

5 1

1213

Instructor’s knowledge of communication skills

23

10

00

00

5 1

1313

Instructor’s presentation of the material

23

10

00

00

5 2

1312

Helpfulness of instructor 23

10

00

00

4 2

1412

50

commonly. Writing progress notes. Assertive communication – helps in dealing with delicate situations. Mock interviews; questioning techniques – improves self‐confidence. Dialogues for comforting and supporting family members of patients.

performanceTherapeutic communication, documentation, telephone conversation, job interview Confidence to do their career in Canada e‐Learning Lounge Confidence in English communication Relevance of course content for better communication Everything is valuable; participant was happy taking the course End‐of‐shift reporting Student networking and great learning experience

assessment skills Able to communicate better in Canadian systems Language Communication techniques Learning to communicate in an effective manner

The Mohawk Learning Resource Centre Simulation Laboratory

Group sessions for practical review and hands on clinical skills practice were held using the

Learning Resource Centre/Simulation Laboratory. Group sessions for this Project year

began in October, 2012. Eight sessions lasting 2 hours were held in October and November.

These sessions were led by BIEN, Mohawk College, faculty and staff. In October these

sessions were delivered to 24 Participants, 21 in November and 11 in January and 8 in

February (weather was a factor influencing attendance on this day) (see Table 31). Pre and

post instruments were used to evaluate confidence (See Table 32). Participants needing

further practice are eligible to access the LRC/Simulation lab more than once. Further

monthly sessions are planned.

Table 31. Attendance Date Attended CommentsOctober 24

November 21

January 30 11 (Gp1=8; Gp2=2; Gp 3=1)

February 27 8 (Gp1=8) Weather problems

Total 64

Table 32. LRC/Simulation lab Sessions: physical assessment: Pre and post confidence scores A =Cardiovascular

C2 (7 Subcategories)B = Respiratory

C1 (8 Subcategories)C = Central Nervous System (i) Glasgow

Coma Scale Pre Post Pre Post Pre Post

Year 1‐3 Carryovers N=6

4.25

4.14

3.7

3.9

3.3

3.8

51

Year 4 (2012‐13) N=53

4.41 4.58 4.31 4.45 3.69 4.27

RATING SCHEME: 1=not confident, 2= Not very confident 3.Somewhat confident 4.Confident 5.Very

confident

The survey indicated that the participants were relatively confident before their laboratory

experience and were only somewhat more confident after their experience. Nevertheless,

their comments suggest that they found their practice in the lab extremely worthwhile.

They were uniformly positive. They agreed that it was an excellent workshop and that they

had both refreshed their knowledge though the review process and had learned a lot about

physical assessment skills and about the nurse client relationship in Canada. They

appreciated the hands on opportunities afforded by using mannequins and recordings of

lung/heart sounds. One noted that the she had discovered differences between procedures

learned here and her previous practice. They found the instructor knowledgeable and

helpful. Many said that the experience had increased their confidence. Several said that

they would like more or longer sessions. They suggested that all IENs would benefit by the

experience.

HCCI Cultural Training Module

Seven participants attended a 3‐hour workshop on Dec 19 2012 from 10am ‐1 pm at the

Chedoke Site. The attendees included 4 IENs, 1 CI, 1 clinical manager or their delegates and

one manager. All 7 participants completed a post course evaluation (see Table 33).

Table 33. Post course evaluation Did the course: Not at all Somewhat Mostly Completely Deepen your understanding of diversity and inclusion

1 0 4 1

Cause you to review your personal frames of reference, biases and ladders of inference

1 0 3 2

Cause you to reflect upon your communication style

1 0 2 3

Provide strategies for cross cultural communication and conflict resolution

1 0 3 2

Offer a framework for an inclusive approach to nursing, patient care and counselling.

1 0 3 2

Do you agree 1 Not at all

2 Somewhat 3 Mostly 4 Completely

The material presented was relevant to your needs

0 0 0 6

52

You will be able to apply the strategies recommended to your practice

0 0 2 2 (1 did not answer this question

How do you rate: 1 Poor

2 Adequate 3 Good

4 Excellent

The course overall? 0 0 0 6

The presenter? 0 0 0 6

The group exercises? 0 0 3 3

The usefulness of the case study? 0 0 1 5

The hand‐outs? 0 0 1 5

Based on the participants' evaluations, the workshop was well received and its objectives

were met.2 participants noted that it was excellent.

HHS Job Coaching/Mock Interview Preparation

Sixty participants have been involved in this intervention since April, 2012, some on more

than one occasion. Twenty eight of the 60 nurses who undertook the mock interviews in

2012‐13 had experienced an interview in Canada. The remaining 32 had not.

Pre job‐coaching confidence questionnaire

The majority of the participants were either not very confident or somewhat confident in

performing well in a job interview before their job‐coaching session (see Table 34).

Table 34. Pre‐intervention Confidence Level of Confidence Number of responses

Not confident 3

Not very confident 19

Somewhat confident 23

Confident 11

Very confident 4

Total 60

When asked what they would like to gain from the interview process they said:

Confidence

Assessment their interviewee skills

Constructive criticism

Learn how to prepare for an interview.

Resume preparation communication skills,

Learn expectations in nursing interviews.

Learn how Canadian employers carry out job interviews

•Learn interview skills techniques, strategies. •Improve performance at an interview •Learn how to present themselves •Learn about interview introductions, endings • Become familiar with types of questions asked •Learn how to respond to questions •Learn how to dress appropriately

53

Post Job‐coaching interview assessment

All 52 participants who answered the post‐ intervention questions replied “Yes” to the

question Has the mock interview process increased your level of confidence in your interview

skills?

Responses to the question, What did you like about the mock interview process? were very positive. The participants mentioned that they had: •Gained confidence •Learnt details of the interviewing process •Experienced a realistic interview •Benefited from one on one interview with instant feedback and suggestions. •Had practice at answering questions •Prepared for typical and unanticipated questions •Received a good presentation •Learned about resources (websites, educational opportunities etc.) •Benefited from examples and scenarios

•Learned how to emphasize strengths • Became aware of the need to know the scope of nursing practice and nursing ethics in Canada •Received clear explanations and information •Had useful discussions •Received information about nursing practice in Canada •Had the opportunity to identify their strengths and weaknesses •Received useful hand‐outs

Responses to the question What did you gain from the mock interview process? elicited similar responses •Confidence • How to succeed at interviews •What to expect in an interview • The Canadian interview process • How to prepare for an interview • How to answer different types of questions

•Information about what employers want • Knowledge of the stages of the interview, •Information about critical thinking •Improved communication skills • How to emphasise strengths •Refreshment of things already known

There were very few critical responses to the question, What did you not like about the mock interview process? One participant felt it was too long but more participants would have liked longer or multiple sessions and more practice. One participant would have liked visual aids and more questions Several recommendations were made in response to the question: How can the mock interview process be improved? The participants suggested:

There should be more than one session, more time or a whole course on the job interview

The session could include: More discussion, topics, questions, examples, visual aids, preparatory material, online support, group practice, entry to the interview room and multiple interviewers

54

The participants rated the job coaching presentation very highly. The presentation, the

topics selected and the overall quality of the presentation were given the highest rating (5)

by almost all the participants. All participants agreed that the presentation should continue

to be included in the training modules (See Table 35). The participants commented that the

presentation was excellent overall. The presentation was easy to understand and the

presenter was willing to clarify as required. The topics and examples selected were relevant

and informative. The scenarios helped with critical thinking.

Table 35. Evaluation of the Mock Interview Presentation N=52

How do you rate the instructor’s presentation? 12345 (Difficult > Easy to Understand)

How do you rate the topics of presentation? 12345 (Not Informative >Very Informative)

Overall how would you rate the presentation? 12345 (Poor >Excellent)

Should this presentation remain in the training modules? yes/no

Year 4 48=5 2=4 1=3

49=53=4

51=51=4

51=yes Missing=1


All participants took part in this intervention. The leaning plan included the CNO

(College of Nurses of Ontario) Entry to Practice National Competencies for RNs and

RPNs, professional nursing standards, Quality Assurance and use of updated learning

modules as outlined on CNO website, HHS policies and procedures are integrated into

the Learning Plan. After the intervention, most of the Carry‐over group were either very

confident or confident in their use of the policies and Procedures. The post‐intervention

questionnaire has not yet been administered to Year 4 participants (see Table 36).

Table 36. HHS/CNO Learning Plan/HHS Policies and Procedures on the Intranet Year Not

Confident Not Very Confident

Somewhat Confident

Confident Very Confident

Carryovers‐ pre 5 19 5 5 1

Carryovers‐ post

0 0 3 12 20

Year 4‐ pre 15 15 24 56 44

Year 4‐ post * * * * *1

*Not yet administered

HHS Intranet: SharePoint Website

This website is used by Participants, Clinical Integrators, Clinical Managers and the

general public. A blog for the IEN/ESL network has been created. The SharePoint

55

Website has been updated with a general user name and password. Almost all the

Carry‐over group were very confident or confident in their use of the Share Point site.

The post intervention questionnaire has not yet been administered to the Year 4

participants (see Table 37).

Table 37. HHS Intranet: Share Point Website Year Not

confident Not very confident

Somewhat confident

Confident Very confident

1‐3 carry overs ‐pre

6 18 7 4 0

1‐3 carry overs ‐pre

0 0 1 17 17

Year 4 ‐pre 21 15 29 50 39

Year 4 post * * * * *1

*Not yet administered

The SharePoint site was regularly accessed during the first year of the project. A survey

carried out on the users of the SharePoint Website provided data on 253 visits between 27

June 2012 and 25 March 2013 (see Table 38).

Table 38. Visits per month Month Number of visits June, 2012 4

July 27

August 42

September 41

October 49

November 12

December 15

January, 2013 25

February 28

March 19

Total 253

The survey revealed that while the majority of users learned about the website from the

HHS web site. The remainder learned about it from a variety of academic, community and

personal contacts (see Table 39).

Table 39. Sources of information about website Source Number using

source HHS Website 143

HHS Staff 28

Friend/relative 28

56

Community 14

CARE 11

Academic 7

St Elizabeth’s 7

Participant 3

Co‐worker 2

Google/Internet 5

Other 2

Did not answer 2

Total visits 253

The majority of individuals accessing the website were IEN/ESL nurses, including project

participants. HHS staff and managers had also accessed the site as had a number of

healthcare educators (see Table 40).

Table 40. Persons Accessing Web Site Visitor Number of

Visits Visitor Number of

Visits IEN/ESL nurse 170 Clinical integrator 1 IEN/ESL Project Participant

35 Employment advisor

1

HHS Staff 19 Director of education 1 Other Health Care Organization

6 Writer

1

HHS Clinical Manager 3 Project applicant 1 ESL educator 3 Nurse outside Canada 2 Student 3 Other 3 Nursing faculty 2 Did not answer question 2

Total 253

Nurses Nurturing Nurses (N3)

The Project continues to build on the existing networking program (Nurses Nurturing

Nurses (N3) to create an HHS network for IEN/ESL nurses. The HHS IEN/ESL network

continues to be an avenue for IEN/ESL nurses to communicate with their peers about

professional practice issues, integration, inclusion and cultural diversity as well as to

provide support to one another. One session was held in August. Four Participants

discussed differences between nursing in India and Canada. Another session was held

upon completion of the LCN3 course in which Participants were encouraged to maintain

the relationships they developed during the course.

Currently, there are 17 dyads in place (Participant/Clinical Integrator). Two CIs worked

with one of the participants. The partnerships were set up throughout the year.

57

Table 41. NRU Participant/Clinical Integrator Partnerships Month Partnerships

established

April 2012 4

May 2012 1

June 2012 1

July 2012 4

September 2012 1

October 2012 2

November 2012 3

January 2013 1


Participants took part in a number of activities. Evaluation of some of these activities is

limited for this year as they were under development. General comments made by

participants who did not rate the experiences separately reiterated comments made in the

individual evaluations. They rated the interventions highly. Suggestions for improvement

included more participation and hands –on practice. They would like to learn more from

colleagues and internet sources.

HHS Job Shadowing

Ten participants were selected to complete job‐shadowing in their areas of interest over

two or three days during 2012. Eight were scheduled to attend sessions and all did so.

Three attended in February, one in August and two each in November and December.

Sessions were held in the following locations (see Table 42).

Table 42. Job shadowing: Numbers and locations Location Attendance Comments

Juravinski, Medical Surgical

2

C4, Oncology, Juravinski

1

Medicine, HGH 0 Scheduled‐ did not attend

Mental Health 0 Scheduled‐ did not attend

HGH, 6S, Trauma Surgery

1 the last of 3 days job shadowing was cancelled due to sickness on the ward)

E3, Medical Surgical Juravinski

1

HGH, Rehabilitation, B2 North

2

Juravinski, ICU & CICU 1

Total 8

58

Four participants wrote a one page summary of their experiences (See appendix D). All

participants were positive about their experiences, there were no negative comments. All

would like to do more job‐shadowing in the future. Specific comments related to:

Friendly reception

Helpful and knowledgeable preceptors

Good unit orientation

Variety of learning materials available

Cleanliness and organization of the unit

Opportunity to become familiar with Canadian medical terminology

Introduction to modern technology (e.g. catheters, PCA, bladder catheters, TPN

solutions, vital signs machine and devices for patient’s transfer)

Introduction to workplace practices and team relations

Introduction to procedures

Introduction to documentation (forms, e‐doc)

Procedures related to medication

Four Year 4 participants completed a brief questionnaire. All said that the activity had met

their learning needs completely (1on a Likert scale of 1‐4 where 1=completely) and that they

were very confident (scoring 1on a Likert scale of 1‐4 where 1=very confident) they could

apply what they had learned to their practice. All agreed that the session had identified

gaps in their knowledge or understanding of the RN/RPN role in the Canadian Healthcare

setting. Suggestions for improvement included participation as well as observe and they

would have preferred their experience to have been in their specialist areas.


The second day of the HHS General Nursing Orientation is held on the third week of each

month and is available to 5 Participants. During the months of May, September and October

2012, 15 Participants attended, November and December, 8 Participants attended. This

intervention was not available during the summer months (June‐August) due to the high

volume of New Grad Guarantee hires at HHS. Topics covered during these sessions include:

59

Vascular Access Therapy, care and management, Senior Friendly Care, Alaris Pumps, Glucose

Meter, and Chest Drainage.

The activity was evaluated by 4 year 4 Participants who completed a brief questionnaire.

They varied in the extent to which they considered the Orientation met their needs. Using a

4 point Likert scale where 1= Completely and 4= Not at all, one participant scored the

session as 1, two as 2 and one as 3. Three felt that they could apply what they learned to

their practice completely and one to a considerable extend. All agreed that the session had

identified gaps in their knowledge or understanding of the RN/RPN role in the Canadian

Healthcare setting. They commented that they found the session overwhelming. They

needed more time to review and practice and would have appreciated more examples from

work experience.

HHS Career Progression Opportunities

Academic Writing and Documentation Workshop

Workshops were held at HHS, Chedoke Site on December 20, 2012 and Feb. 15, 2013 The

first session was attended by 20 Participants (Group 1:16, Group 2:0, G3‐ 4 and) the second

by 12 Participants (Group 1: 11, Group 2‐0, Group 3‐1).

Twelve participants evaluated the first session. Using a Likert Scale where 1 = Completely

and 4= Not at all, 3 participants rated the extent to which the presentation met their

learning needs as 1, 8 as 2 and one as 3. Five Participants reported that they were very

confident that they could apply what they had learned to their practice, 3 that they were

confident and 2 that they were somewhat confident. One did not answer that question.

Eleven agreed that the session had identified gaps in their knowledge and understanding of

the RN/RPN role in a Canadian health care setting. One disagreed.

Only two participants completed evaluation questionnaires. One Participant was very

confident and one fairly confident that he or she could apply what had been learned to their

practice. Both agreed that the session had identified gaps in their knowledge and

understanding of the RN/RPN role in a Canadian health care setting.

Suggestions for improvement included: More workshops; more cases/scenarios; more

practice questions; more information from colleagues and Internet

60

E‐Learning lab

All Participants have access to the E‐learning lab which contains 2 computers. These are

used by Participants to provide computerized resources to prepare for interventions and

employment. Resources include e‐documentation (e.g. Meditech Clinical Documentation).

A hard copy of the Status Board User Guide is provided to Participants), The Participants

have access to 50 online courses via e‐learning at HHS. The course range from reviews of

Fire, WHMIS and Emergency Codes to courses about Infection Control practices, information

about job applications, CNO learning modules. DVDs are available to review nursing skills.

There is no specific evaluation component for use of the e‐learning lab.

Certification courses

The project arranged for participants to attend the following certificate courses.

Certification was a requirement of the jobs for which they wished to apply

i.Basic Cardiac Life Support (Cardio Pulmonary Resuscitation) course. Seven

Participants attended the course. Subsequently 3 attendees obtained nursing

employment outside of HHS, 2 obtained non‐ nursing (Health Care Aide) positions

outside of HHS.

ii. HHS Advanced Cardiac Life Support Course Six Participants attended this course

All were subsequently hired, 4 within HHS and 2 outside of HHS.

Nursing Rounds (Lunch and Learns)

Lunch and Learn sessions were provided to Participants by Clinical Integrators to review and

enhance nursing skills (see Table 43).

Table 43 Lunch and Learn Sessions Title Date and Location Attendance

1.RN/RPN Exam Preparation Presentation by Sudha Sharma (HHS Participant)

Date: April 4, 2012HHS, Chedoke Site, Wilcox Building, Room 119A

Participants:9 (Group 1:7, Group 3:2) Total=9

2.RN/RPN Exam Preparation Presentation by Sudha Sharma (Participant)

Date: April 19, 2012HHS, Chedoke Site, Wilcox Building, Room 119A

Clinical Integrators:1 Participants: 9(Group 1:8, Group 3:1) Total=10

3.Wound Care‐ Presentation by EwaSawicki (Clinical Integrator, HHS RPN) & Sarah Suresh (Clinical Integrator, HHS RN)

Date: (1)May 10, 2012 (2)September 24, 2012 (3) March 28,, 2013

1.Participants:20 Total=20 2.Participants:19 (Group 1: 16, Group 2: 1, Group 3:1 CI=1)

61

HHS, Chedoke Site, Wilcox Building, Room 119A

Participants: 17 (Group 1: 15 , Group 2: 0 , Group 3: 1 CI=1 )

3, Nursing rounds‐ professional practice issues, Intravenous (IV) Therapy: Infusion Pump Use and Maintenance – Alaris Pump. Presentation by Elisabeth Leduc (Clinical Integrator, HHS, RN, Vascular Access),

Dates: (1)July 31, 2012; (2)September 24,2012 Chedoke Site, Wilcox Building, Room 119A

1,Participants: 19 (Group 1: 14), (Group 3: 5) Total=19 2.Participants:18(Group 1: 16, Group 2: 1, Group 3:1)

6.Lunch& Learn India Network This is part of the IEN/ESL Network bringing together Participants and Integrators informally, to remind them about Project Interventions, particularly, the networking program (N3 Nurses Nurturing Nurses). No presenter.

Date: August 24, 2012HHS, Chedoke Site, Wilcox Building, Room 119A

Participants:4 Total=4

Wound Care‐ Presentation Sarah Suresh (Clinical Integrator, HHS RN) and Alaris Pumps – Presentation by Elisabeth Leduc (Clinical Integrator, HHS, RN, (Clinical Integrator, HHS, RN, Vascular Access)

Date: September 24, 2012HHS, Chedoke Site, Wilcox Building, Room 119A

Participants: 18 ( Group 1=16, Group 2=1, Group 3=1) Clinical Integrators: 1 Total=18

IEN/ESL Holiday Network

Date: Thursday, December 20, 2012 Location: Chedoke Site, Wilcox Building, Room 119A

Participants: Group 1=12, Group 3=4 Total =16

Lunch & Learn, RPN Success Story, Presentor: Clinical Integrator, Lidia Dolibog

Location: Hamilton Health Sciences, Chedoke Site, Wilcox Building, Room 119A Date: February 13, 2013

Number of Participants: 14 (Group 1: 14, Group 2: 0, Group 3: 0)

Lunch & Learn Academic Writing and Documentation

(1) December 20, 2012 PresenterDaniela Dijmarescu: Project Manager (2) February 15, 2013‐ Presenter: Clinical Integrator Yayra Amenudzie

(1) 20 Participants (Group 1:16 , Group 2:0 , G3‐ 4 ) (2) 12 Participants (Group 1: 11, Group 2‐0, Group 3‐1)

* In addition to the Lunch and Learn sessions described in Table 42 above, CARE offered a one week Preparation for CRNE and CPNRE Examination course, August 23‐September 4, 2012. This short course was a pilot for CARE. These sessions were offered for the IEN/ESL nurses who had been unsuccessful in previous attempts. Five participants attended.

HHS career development/ e‐mentorship program

o E‐mentorship program.

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The CIs were informed about on‐line sessions held in May, June,

September, October, November and December, 2012. CIs have

continuing access to these sessions.

o Charge Nurse Role Education Program at HHS:

Information was sent to all Clinical Integrators working at HHS. Two 3‐

day sessions were held at HHS in May, 2012 (2 registrants) and

September, 2012 (5 registrants).

Volunteering opportunities

Participants were invited to assist others in the e‐learning lab.

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6. PROJECT EVALUATION: OVERALL RESULTS AND CONCLUSIONS

This section focuses on the extent to which this project met its numeric targets and

describes its overall evaluation by the participants. The project is also evaluated in terms of

the experiences of the participants in relation to each intervention. Recommendations for

the future are made and next steps are considered.

Numeric Targets and Achievements The following numeric targets for IEN/ESL nurses participating in the project 2012‐15 were

set by MCI: The plan was to integrate 145 IEN/ESL nurses into HHS during the three years of

the project. The research team set the following numeric targets for nurses and CIs:



interventions): 145


120


CIs completing training: 60

All numeric targets were exceeded in 2012‐13. There were 201 participants in the program

at the beginning of the Project in April 2012. However, this number included participants

who had almost completed their program and were about to exit. Thirty five participants

from years 1‐3 remained in the program until February 2012. A total of 166 new

participants entered the program in the first year of the new program, more than double

the numeric target. One hundred and sixty six participants accessed a significant

component of the program by taking part in at least two interventions and 109 participants

accessed four or more interventions. Seventy three nurses became/remained employed in

their profession at the end of 2012‐13. Twenty four frontline nurses completed training as

CIs in 2012‐13 (see Table 44).

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Table 44. Projected and actual project sample 2012‐13 Criterion Target Actual

Number of participants who applied to the program and/or services offered

60 228

(ii)Number of participants who accessed the significant component of the program/services (2 Interventions out of 8 offered by project) for which they applied

49 166

Number of participants who completed the significant component of the program/services (4 Interventions out of 8 offered by project) for which they applied:

40 109

(Number of participants who obtained employment in their profession, trade, occupation after completing the bridge training program:

40 73 24 hired at HSS into 24 jobs

49hired in nursing outside HHS into 67 jobs

Total: 91 Jobs

(v)Number of front‐line nurse mentors (Clinical Integrators) who complete the Mentorship training

20 26

Participant evaluation of the project: Exit Interviews

Thirty four nurses exited the program on February 6, 2013.They included 28 IEN/ESL and 6

ESL participants. Two Nurses had exited earlier in the year. At the time of writing, Exit

Interview Questionnaires had been completed by only 12 participants. All of these

participants had been in the Project for over a year.

Assessment of Interventions

Their answers to question about the interventions are summarized in Table45.

Table 45. Exit Interviews (N=12)* Did the Program meet your needs (Yes/No,/Somewhat)

Yes=12

Were the following interventions 1Very relevant 2. Relevant 3.

Somewhat relevant 4. Not relevant

Should the following interventions be 1 Retained 2 Minor changes 3 Major changes

4 Removed

CELBAN 1=8;2=1;3=1 1=8;2=1 Missing =1

CARE 1=10;2=1 1=10;2=1

Simlab 1=9;2=1;3=1 1=9;2=2

Job Coaching 1=10 1=9 Missing=1

Cultural Awareness module 1=7;2=1;3=1 1=8;2=1

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HHS Policies and procedures 1=9;2=1; 3=2 1=11Missing=1

HHS SharePoint site N=11 1=8; 2=2 3=1 1=10;2=1

N3 Networking program N=9 1=8;2=1 missing=1 1=10

Workplace Experience N=10 1=10 N=10;1=9;2=1

*Numbers do not add up to 12 because participants did not do all interventions

Ten of the 12 respondents had finished the project, and one left for another reason. One

response was missing. Although they had completed the program some had completed

more project activities that others. One had done no activities; 2 did 3; 1 did 4; 4 did 5; one

did 6 and one 7. Nine said they would be interested in taking part in other activities.

Evaluation of Project Manager

The project manager received very positive evaluations. Eleven respondents said that she

had provided guidance and assigned them to a Clinical Integrator. The other participant said

that the question was not relevant to her. All 12 respondents agreed that she had explained

project activities clearly, facilitated their participation in the activities and answered their

questions. Comments also indicated that the PM had performed her duties well and that the

team had been supportive.

Use of SharePoint Website

Nine of the respondents had used the SharePoint and three had not. Of those that had not

used it one had cited” no time” and one “no need for information” as the reason. One cited

both “no time” and” no need for information”. Of the 9 participants that had used the site,

1 had accessed it once, 6 had accessed it 2‐5 time, one had used it 6‐20 times and one over

10 times. The 8 participants that responded to a question about whether SharePoint was

easy to use agreed that it was.

Recommending the program to other IEN/ESL nurses

All 12 respondents said that they would recommend the program to ESL IENS and to EFL

language nurses from abroad. Eleven said that they would recommend it to ESL nurses

educated in Canada.

Getting a job

Eleven of the 12 respondents had applied for a job at HHS and 10 had subsequently

attended an interview. Six of the twelve applicants got a job at HHS as a result of their

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interview. One respondent did not accept her job offer because it was not in her specialty

area. Nine respondents had jobs outside HHS. These included 4 respondents who had jobs

both at HHS and elsewhere.

Ten of the 12 respondents said that the project had helped them get a job. Two said that it

had not. However, one of these participants had not taken part in any activity.

Participant Recommendations

Participants suggested the following enhancements would be helpful to IENs attempting to

integrate into the Canadian workforce.

1. Re‐certification of BCLS, mask fittings, and other basic requirements needed in the work

place

2. Further language and job interview support

3. Development and expansion of job shadowing

4. A website for IENS or ESL nurses

5. Courses for skill enhancement e.g. wound care

6. Work with their CI in the workplace

Evaluation of Interventions

Table 46. Summary Evaluation of Interventions Intervention Comments

1. CARE Centre for Internationally Educated Nurses: Workplace Communication Course

These courses have been rated highly but there has consistently been a problem with attendance due to time conflicts for participants. Recommendation It is recommended that the provision of pre‐course orientation/information sessions should continue so that participants were aware of the time commitment required. An overall increase in the number of participants completing 50% or more of the course after introducing the information session indicated that this initiative had achieved its purpose

2. LRC Simulation Laboratory The LRC program has been very successful and evaluation of the course suggests that it is extremely beneficial to the participants

3 HCCI Cultural competency awareness Workshop

Seven participants attended a 3‐hour workshop on Dec 19 2012. The Participants’ evaluations were extremely positive. Recognition that more participants should benefit from this course has led to recommendations and plans for the development of an on‐line version of the intervention.

4. HHS Job Coaching/Mock Interview Sessions

The participants rated this intervention very highly. Several recommended that the scope and content of the intervention be increased. Recommendation Consideration should be given to the further development of the intervention

5. HHS Intranet: Share Point Website The site continues to be used effectively by Participants, Clinical

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Integrators, Clinical Managers and the general public. A pre‐intervention summary revealed that more than one third of the 4th year participants were less than confident about accessing these documents. The post‐intervention questionnaire has not yet been administered. Post‐intervention assessment in previous years indicates that participants are either confident or very confident in accessing and using the documents. The intervention has been enhanced through the creation of a blog. It is expected that the site will continue to evolve during the project.

6. HHS/CNO Learning Plan/HHS Policies and Procedures on the Intranet

A pre‐intervention summary revealed that approximately one third of the 4th year participants were less than confident about accessing these documents. The post‐intervention questionnaire has not yet been administered. Post‐intervention assessment in previous years indicates that participants are either confident or very confident in accessing and using the documents.

HHS N3 Networking Program. Seventeen dyads of Participants and clinical integrators are currently in place Recommendation: Further efforts to encourage pairing for the N3 program may be required.

Workplace experience Most of these interventions are in the pilot stage. Evaluations have not been completed and analysed. Job shadowing – The intervention was positively evaluated by participants. Changes were made during the year to improve the process of assigning participants to clinical areas.

Lessons Learned

A recognition that it is sometimes difficult for Participants to take part in interventions due

to time conflicts and transportation problems has led to a recognition of the importance

creating a variety of communication tools and using a variety of media. The creation of a

Share point blog and planning the development of on‐line tools has been a response to this

issue. Further developments are likely during the project.

Next Steps: Program Development

During 2012‐13, work was undertaken on the development of new project components

which will be implemented in the next year

1. CARE Centre for Internationally Educated Nurses: is working with HHS to develop a

videoconference delivery format to increase access to the occupation‐specific language and

communication training workshop series offered by CARE

2. An Advanced Standing Clinical Competency Assessment Tool is being developed and

evaluated by the HHS project team and BIEN, Mohawk College for use by employers, both at

HHS and outside, to test clinical and communication competencies for Internationally

Educated Nurses with previous critical care experience.

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The purpose of the exercise is to provide an intervention that includes high fidelity

simulation exposure for Project Participants in a Critical Care situation (focus on Intensive

Care Unit (ICU)/Cardiac Care Unit (CCU)/Emergency/Operating Room (OR). The outcome is

to assist participants in building a professional portfolio and learning plan to reflect Ontario

Critical Care Standard of practice. A course will be offered to IEN RNs who are employment

ready, have completed all relevant project interventions and language specifications and

have 3 to 5 years of practice within last 10 years in ICU/CCU/Emergency/OR

BIEN Mohawk College/HHS have set up a project team and a sub‐committee for the

creation of tools and framework for the Advanced Standing Clinical Competency Assessment

Tool and a development team has been identified. An advisory/review team will also be

established with representatives from HHS, Participants, Clinical Integrators and Clinical

Managers/Delegates/Education Clinicians, and surveys have been administered. A focus

group will be held on March 21, 2013. It is anticipated that the development phase will be

complete by March 31, 2013.

3. HCCI‐ Diversity and Inclusion Training. The project Team met with a HCCI representative

in July‐2012 about the development of an on‐line tool for HHS orientation. The tool will

also be available for access on the Project Share Point website. Registration for cultural

awareness training workshop at HHS will be included in the tool. To enhance the

training provided to IEN/ESL nurses, HCCI has developed an on‐line component so that

course materials will be available to more participants.

Sustainability Planning: The Community Collaboration Employment Model

The Project has enjoyed a very successful first year. Based on the Community collaboration

Employment model (CCEM) collaboration among HHS and its community partners has

continued through the year through formal meetings and informal communication. The

partners have continued to provide interventions to assist IENs and ESL nurses throughout

the year. A strategy to ensure that the program delivery will continue beyond the end of

this funding includes the development of an array of clinical and communications

integration tools available for HHS and the community partners. The on‐line component of

current interventions to be implemented next year will contribute to the sustainability of

the project.

69

The project team has created community links beyond the immediate partnership. For

example, collaboration between the Project team with HHS Discharge Planning resulted in

an invitation to the Project team to join the Long Term Care (LTC) Joint Executive

Committee, Hamilton/Wentworth region. The Project Manager attended a meeting at St.

Peters Long Term Care facility in November and December, 2012 where other LTC facilities

participated via OTN. The Project Manager met with Human Resource (HR) and senior

leadership at St. Elizabeth’s Healthcare Agency, Halton and Hamilton, as well, with HR

representatives and clinical managers/delegates at Credit Valley/Trillium Hospital. These

networking opportunities as well as presentations at conferences and workshops has made

the project visible in the healthcare community resulted in increased awareness about the

project and the potential for hiring IEN/ESL nurses. Several Participants are employees at

these facilities and the Director of Care from St. Joseph’s Villa recognized the importance of

the Project support that their IEN nurses received. Finally, the program has helped a

considerable number of IENs to enter the work force as professional nurses. Their

appreciation of the program has led previous participants recommend the program to

colleagues and to offer their services as CIs. This has created a pool of facilitators in the

regional nursing community willing to assist incoming IENs to enrol in the program.

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APPENDICES

Appendix A: Evaluation Tools Index

CARE Centre for Internationally Educated Nurses Workplace Communication Course

Participant Self‐Assessment of Nursing Communication Skills ‐ Pre and Post Course

Instructor’s Progress Report on the Participants’ Overall Level of Proficiency in their

Communication

Participant Final Course Evaluation

BIEN Mohawk College Learning Resource Centre Simulation Laboratory

Nursing skills assessment ‐ pre

Physical skills assessment ‐ pre

Nursing skills ‐ post

Physical assessment ‐ post


Pre‐interview prep kit

Pre‐confidence survey

Post‐confidence survey

Effectiveness survey

Presentation evaluation sheet

APS Procedure for the assessment of pain in adult, paediatric and neonatal patients

as per HHS policy

Critical care nursing: Hints and kinks for nurses PQRST method of pain assessment

Post‐interview questionnaire

Interview questions based on real patient case scenarios


NHSRU Cultural Competency for IENI‐ESL Nurses Course Assessment Post Session


MAC ‐ Consent, Withdrawal or Refusal of Consent for Treatment Policy

Documentation ‐ Transcription Process for Kardex

ENG‐ Lockout/Tagout ‐ Procedure

Infection Control ‐ Clostridium Difficile Protocol

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NUR ‐ RPN Scope of Practice F5 Medicine Policy

5 South Nursing Standards for Patient Safety During Transfer of Accountability

HR ‐ Confidentiality

PRI ‐ Disclosure of Personal Health Information of Current In‐Patients to Friends and

Family Guideline

ED ‐ Emergency Department Patient Safety and Restraints Policy

HSW‐Guidelines for Pregnant HHS Employees Working Directly or Indirectly with

Inpatients with Communicable Diseases

Infection Control ‐ Management of Proven or Suspected Diseases ‐ Guidelines

Transcription Process for Orders

HHS SharePoint

SharePoint website pre‐competence survey

SharePoint website post‐competence survey

HHS N3 Networking Program

Networking program: Discussion topics questionnaire – dyads: Participant

Networking program: Discussion topics questionnaire –dyads: clinical integrator

Participants N3 program satisfaction survey

HHS Professional workplace experience/integration

HHS Professional workplace experience/integration‐post survey

Program Exit

Exit survey

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Appendix B: Consent Form

Internationally Educated Nurse (IEN) and English as a Second Language (ESL)

Nurse Integration Project

2012‐2015

Information & Consent Form

________________________________________________________________

Co‐Principal Investigators:

(1) Dr Ruth Lee, Chief of Nursing Practice, Hamilton Health Sciences, McMaster Site, 1200

Main Street West, Hamilton, ON L8N 3Z5

(905) 521‐2100 x 73828

(2) Dr. Andrea Baumann, Associate Vice President, Faculty of Health Sciences International

and the Co‐Director of the Nursing Health Services Research

Unit, Michael G. DeGroote Centre for Learning and Discovery, MDCL 3500,

1200 Main St. West, Hamilton, Ontario L8N 3Z5

(905) 525‐9140 x 22581

Community Partners:

Centre for Internationally Educated Nurses (CARE)

Hamilton’s Centre for Civic Inclusion (HCCI)

McMaster University, Nursing Health Services Research Unit (NHSRU)

Mohawk College, Bridging for Internationally Educated Nurses (BIEN)

Sponsor/Funding Agency:

73

Government of Ontario, Ministry of Citizenship and Immigration

The Project

You are being invited to take part in a project to improve the integration of Internationally

Educated Nurses and English as a Second language nurses into the workforce at Hamilton

Health Sciences and community. The project will provide you with assistance in improving

your clinical, cultural, communication skills and competencies. Recruitment, hiring and

retention of internationally educated nurses will be improved as a result of this project.

Clinical managers/educators and clinical integrators will also be involved.

What will be expected of you as a participant? You will meet with the clinical

managers/educators/clinical integrators to assess your needs and to incorporate these into

an individualized learning plan based on the National Entry to Practice Competences for

nurses. You will participate in communication and cultural workshops, School to Career

transition curriculum, a language screening tool assessment and focus groups.

How will you benefit from participating in the project? Taking part in the study is by choice.

You are free to decide whether you will participate. There are no known risks to

participation. An individualized learning plan is developed with you. You will have free

access to communication, clinical and cultural competency resources and tools to help you

to better integrate into your clinical unit. Your involvement will assist in the further

development of tools and resources to improve and support the integration of

internationally educated nurses into the workforce.

Who can participate? Participants will be recruited from Mohawk College’s Bridging for

Internationally Educated Nurses program, as well as English as a Second Language nurses

who have graduated from Canadian nursing institutions. Another recruitment source is the

community.

Confidentiality Any personal information collected during this project will be kept

confidential. It may appear in reports or publications with your permission. Your name will

74

not be identified in transcripts of interviews or focus groups. Only members of the research

team will have access to the information you provide us. Audiotapes and digital audio files

will be stored in locked filing cabinets until the end of the project, at which time they will be

destroyed. Transcripts from the focus group sessions and face‐to‐face interviews will be

entered into the INVIVO software package for analysis. All electronic files will be password

protected and will not be transmitted over the internet. Only members of the investigation

team will have access to this stored information. You have the right to listen to any tapes

made during interviews. When the project is completed, study database files, including

INVIVO files, will be burned to CD/memory disc and removed from all study computers.

These files will be retained on CD/memory disc only, for 10 years in secure storage as per

Research Ethics Board policy.

Initials

Person obtaining consent ______

Participant ______

75

Internationally Educated Nurse (IEN) and English as a Second Language (ESL)

Nurse Integration Project

2012‐2015

Consent Form

________________________________________________________________

Consent to participate

I understand the information given to me about this study. My questions about the study

have been answered clearly. I am willing to participate in the project using an individualized

learning plan developed for me, in addition to Culture and Communication Workshops,

School to Career transition curriculum, Language screening tool and Focus groups. I

understand that all information collected for this study will be confidential and that I will not

be identified in reports or publications without my permission. I know that I can leave the

study at any time and that this will not affect my job as a nurse. I understand that I will

receive a signed copy of this form.

I agree to participate in this study explained to me by

________________________________________________________________

Person obtaining consent Signature Date

________________________________________________________________

Participant Signature Date

For questions about this project, please contact:

Dr. Ruth Lee, Co‐Principal Investigator, HHS, IEN/ESL Nurse Integration Project

[email protected]

(905) 521‐2100 x 73828

76

Daniela Dijmarescu, Project Manager, HHS IEN/ESL Nurse Integration Project

[email protected]

(905) 521‐2100 x 77511

If you have any questions regarding your rights as a research participant, you may contact

the Office of the Chair of Hamilton Health Sciences/Faculty of Health Sciences Research

Ethics Board as (905) 521‐2100 x 42013

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Appendix C: Dissemination

Project Charter

A Project Charter has been developed

Project Promotion

Display of Project Panels to promote the Project to employees and visitors at

Hamilton Health Sciences’ (HHS) six hospital sites, September, 2012.

The Clinical Manager booklet is complete and the Project pens and pin are being

used for marketing and promotion. The booklet, pen and the Project Manager’s

business card will be distributed to provide Project information to Clinical

Managers/Delegates and other stakeholders. The pins will be distributed to each

Clinical Integrator, recognizing their continuous, voluntary support of our Project

Participants.

The continuous collaboration of the Project team with HHS Discharge Planning

resulted in the Project team being invited to join the Long Term Care (LTC) Joint

Executive Committee, Hamilton/Wentworth region. The Project Manager attended a

meeting at St. Peters Long Term Care facility in November and December, 2012

where other LTC facilities participated via OTN. Several of our Participants are highly

regarded employees at these facilities and the Director of Care from St. Joseph’s Villa

recognized the importance of the Project support that their IEN nurses received. The

Project Manager also met with Human Resource (HR) and senior leadership at St.

Elizabeth’s Healthcare Agency, Halton and Hamilton, as well, with HR representatives

and clinical managers/delegates at Credit Valley/Trillium Hospital. These networking

opportunities resulted in increased awareness about our Project and the potential

hiring our IEN/ESL nurses. Project information was provided to St. Joseph’s Hospital

in Hamilton and several hospitals in the Niagara Healthcare System in December,

2012.

Presentations

Dijmarescu, D.Internationally Educated Nurse (IEN) and English as a Second

Language (ESL) Nurse Integration Project – Transition and Integration into

78

Employment. The Partners in Education & Integration of Internationally Educated

Nurses: 6th National Conference, April 25–27, 2012. Winnipeg, MB.

Lee, R and Dijmarescu, D. (2012). Nursing: Caring to Know, Knowing to Care Learning

from the Past, Acting in the Present, Shaping the Future” RNAO International Nursing

Conference “Nursing: Caring to Know, Knowing to Care”,June 4‐7. Jerusalem, Israel,

Iqbal Hotel Liberty Bell Park.

Lee, R and Dijmarescu, D. (2012). The Path to Integration: A Workshop for Employers

of Internationally Educated Nurses Ontario Hospital Association, October 25.

Toronto, ON, Radisson Hotel Admiral Toronto – Harbourfront,


of Internationally Educated Nurses Ontario Hospital Association, October 26. .

Niagara‐on‐the‐Lake, ON, Hilton Garden Inn


of Internationally Educated Nurses Ontario Hospital Association, November 26.

Ottawa, ON, Hilton Garden Inn Ottawa Airport.


of Internationally Educated Nurses Ontario Hospital Association, November 30.

Windsor, ON, Holiday Inn & Suites

Dijmarescu, D. (2012). It takes a village: Harnessing the power of community

collaboration and in‐house volunteers to bolster immigrant nurse recruitment and

retention. 10th Annual International Bilingual Nurse Alliance Conference, October

25‐26, Chicago, Illinois. Mercy hospital and Medical Center

Lee, R., Baumann, A, Blythe, J & Dijmarescu, D. (2013). Internationally Educated

Nurses(IEN) and English as a Second Language (ESL) nurse integration Project. Power

Point presentation for the LHIN 4 Strategic HR Officers Group , St. Joseph’s

Healthcare Hamilton February 25, 2013

Other activities

A site visit to Bridging for Internationally Educated Nurses (BIEN), Mohawk College

included a demonstration of the simulation technology at the Learning Resource

Centre (LRC), Simulation Laboratory. (September 24, 2012A Nursing Week Dinner

was held on May 10, 2012at Carmen’s Banqueting Centre, Hamilton, Ontario. Nine

79

participants attended (Group 1: 7, Group 3: 2) , 18 CIs and one Clinical

Manager/Delegate

80

Appendix D: Participant Evaluation of the Job Shadowing Experience

1. Job shadowing at JHCC( C‐4)

First of all I would like to thank all members of the IEN project including Ms. Romaine Sheriff

&Irena. Through this shadowing I got an excellent opportunity to meet with patients,

equipment and designated staff members. Ms. Irena was my preceptor. She provided a

good unit orientation although she was very busy with her assignments. I referred to the

policy and protocols of HHS. A wide variety of learning materials opens a window towards

the future career for all aspirants. They are motivation so that this is not just a shadowing. It

is a clear reflection of job opportunity the attitude of every staff was really admirable.

Moreover the cleanliness and organization was wonderful, I think it is one of the most

remarkable hours of my life in Canada. I would like to keep in touch with all and the IEN

project.

2. IEN Project gives me a chance of job shadowing in this February 15 and 16.

The place of my job shadowing is Ward E4 in Juravinski Hospital. As an international

educated nurse, this is the first time that I was really in a Canadian hospital. I was very

excited but a little nervous. Do they welcome me? However, when I walked into Ward E4,

after the Head Nurse of this ward introduced me to everyone, everyone in this ward

welcomes me and was very kind to me. Then I felt relaxed. To me surprised, at the second

day Daniela came to E4 to see me and introduced me to the head nurse and my preceptor. I

am very appreciative.

My preceptor shows me:

All the room in E4 and their function

How is nurse working in this ward

How to work with other health team members.

How to use and fill forms

How to administer medications

How to use E‐Doc

I like and cherish this chance of Job Shadowing and I hope I can have more chances to be a

shadow

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3. My name is ‐‐‐. I am an IEN from Romania. Coming to Canada was for me a great

opportunity. Returning in to Nursing in Canada is my goal even if it is challenging in some

aspects. The IEN and ESL Integration Project help me and other IEN towards our goal.

One of the great opportunities I had was attending three sessions of job shadowing at

Juravinski Hospital‐ surgical oncology. That experience gave me the insight of hospital

health care in Canada. My clinical integrator is a great person and she showed me many

things. I saw how an IV pump works (I have not worked with one before in my country)

and how a bladder scanner works. I saw different types of iv catheters, PCA, bladder

catheters, TPN solutions, vital signs machineand devices for patient’s transfer. I was

impressed of how helpful the modern technology is in providing patient quality care. The

job shadowing gave me also the opportunity to familiarize with English medical

terminology from which I will benefit in my nursing career. I learned what you have to

do for a patient before and after the surgery and how you have to document the events.

I learned also the types of medication that are used in a particular setting and the usual

schedule for them. As a conclusion, I am glad that I had this experience, which will help

me practice successfully nursing in Canada. Considering that for IEN there are

differences between the way nursing is practiced in everybody’s home country and in

Canada, more nurses would greatly benefit from the experience of job shadowing.

4. Thank you for this opportunity which was great experience for me to see how is the

Canadian workplace going on. Actually, I saw the e‐documentation which is new to me

because my previous workplace in Qatar uses paper documentation. Also, l had a chance

to review some policies there which is good to have an idea about it. In my opinion

more time for job shadowing will be more effective , 2 days is not enough

5. A Summary of One Day’s shadowing in ICU. Participant (1‐0181)

On Dec 14th, 2012, at 8:00, I started my one day’s shadowing in Juravinski Hospital, ICU.

This was my first time accessed ICU in Canada. I was exciting but also stressful when I

entered into the unit. My preceptor is an experience‐rich nurse. She taught me her

patient’s status and her plan of that day. She introduced me about the environment as

82

well. On that day, her patient was a cardiac patient with multiple organ failure, who was

supported by ventilator and CRRT. My preceptor was very busy to deal with a new set‐

up CRRT machine and recorded every parameter in per hour. I was not familiar with this

machine, but I liked to learn it, so my preceptor explained it when she was available. I

also observed another nurse moving the artery line and followed her to transfer her

patient to a medical floor. I learned a lot and I realized that it is not easy to be a ICU

nurse, but when I saw them helped each other and tried their best to take care patients,

I made my decision to be an ICU nurse.

The day was not long enough to let me know ICU, but it is a good way to let me know if I

fit this job and what I need to fix before I can work independently in ICU, so these are

what I like. As to what I dislike, I think it was that I did not permit to do anything for

patients even help my preceptor reposition her patient. I felt weakness when I just stood

there watch them hurried. This shadowing gave me more concepts about real situation

in ICU. I agree this is a wise method to provide an international educated nurse with a

chance to be in touch a real workplace to let them reflect “Do I really prepare for this

job?”, “Being a nurse is really fit me?”… My recommend is more shadowing chances

should be provided to any international educated nurses who eager to be nurse in

Canada. This was an unforgettable experience. I feel very thankful for the two ICU

managers who provided this chance to me and also Daniela and Janice who helped me

prepare for this shadowing.

Documents

Health Nurse (IEN) Second (ESL) Nurse Project 2015fhs.mcmaster.ca/nhsru/documents/Series-37-HHS_IEN_ESL_UpdatedM… · Jane Hastie, Specialist, Human Rights ... HHS Career Progression