Did the Long-Term Care Physician Workforce Change During the Pandemic? Describing MRP Trends in Ontario, Canada.

OBJECTIVES: To examine the practice patterns and trends of long-term care (LTC) physicians between 2019 and 2021 in Ontario, Canada. DESIGN: Population-level descriptive time trend study. SETTING AND PARTICIPANTS: Most responsible physicians (MRPs) of LTC residents of publicly funded LTC homes in Ontario, Canada, from September 2019 to December 2021. METHODS: We examined the number of MRPs in publicly regulated Ontario LTC homes before and during the COVID-19 pandemic using population-level administrative databases. Characteristics of MRPs and practice patterns were generated at baseline and across distinct time periods of the pandemic in descriptive tables. We created a Sankey diagram to visualize MRP practice changes over time. RESULTS: More than one-quarter of pre-pandemic MRPs were no longer MRPs by the end of 2021, although most continued to practice in non-LTC settings. There was a decrease from 1444 to 1266 MRPs over time. Other characteristics of MRPs remained stable over the pandemic time periods. At baseline, LTC physicians were MRP for an average of 57.3 residents. By the end of 2021, this caseload decreased to 53.3 residents per MRP. MRPs increasingly billed monthly management compensation fees over the fee-for-service model across the pandemic time periods. The number of MRPs working in an LTC home shifted to fewer MRPs per home. CONCLUSIONS AND IMPLICATIONS: MRP demographic characteristics did not change over the course of the pandemic. The observed shifts in practice patterns showed a reduction in the overall LTC MRP workforce, who delivered care to fewer residents on average in LTC homes with fewer colleagues to rely on. Future work can study how changes to LTC MRPs' practice patterns impact physician coverage, access and continuity of care, and health services and quality outcomes among residents.

Disrupting Traditional Roles: One Nurse's Journey.

A nurse for 30 years, Rhonda Collins, DNP, RN, FAAN, has worked to disrupt the way technology is used and perceived by nurses around the globe. Intersecting clinical expertise with health care innovation, she strives to empower nurses to take a seat at the table when it comes to making technology decisions that impact their work and their lives. Nurses use technology, medical devices, and equipment every day while caring for their patients. These devices require clinical knowledge, insights, guidance, and leadership to ensure they are appropriate for the patient care environment while fitting and facilitating nurses' workflow. Nurse involvement to design and implement new technologies is critical to adoption and use of technologies. Dr Collins offers 7 guidelines for engaging with business partners and ensuring decisions will support critical nursing staffs and facilitate safe patient care. Dr Collins' passion for helping more people led her to seek opportunities beyond the hospital walls. After earning her master's degree in nursing administration while raising 2 children and working her way through the ranks at medical centers in Texas, she has been on a mission to elevate the voices of nurses and protect the profession. Dr Collins shares her personal and professional journey of leaving hospital nursing to work in nontraditional leader roles in the technology industry, detailing the challenges and opportunities for nurses now and in the future.

The Role of the Medical Director in Ontario Long-Term Care Homes: Impact of COVID-19.

OBJECTIVES: The pandemic has uncovered a broad lack of understanding of the role of the Medical Director in Canadian Long-Term Care (LTC) Homes. Our objectives were to identify the current demographics and practices of LTC Medical Directors, discover how the pandemic affected their practice habits, and inform the content of the Ontario Long-Term Care Clinicians Medical Director Course, to ensure that Medical Directors have the requisite knowledge of the responsibilities of their role. DESIGN: Email survey. SETTING AND PARTICIPANTS: Medical directors in Ontario long-term care homes. METHODS: Responses to open-ended, close-ended, multiple-choice, and free-text questions. RESULTS: A total of 156 medical directors (approximately 24%) completed the survey. Ninety-four percent were family physicians. Approximately 40% of participants had been a medical director for fewer than 5 years, whereas more than 11% have been in the role for greater than 30 years. More than 60% spend fewer than 2 hours per week in their administrative role, with fewer than 23% completing formal evaluations of the attending clinicians. Greater than 75% are either satisfied or extremely satisfied in their medical director role, citing excellent engagement and collaboration with team members. Feelings of dissatisfaction were associated with pandemic stress, increased hours and responsibility, inadequate remuneration, lack of ability to make decisions and lack of acknowledgement that physicians add value to the interdisciplinary team. CONCLUSION AND IMPLICATIONS: It is clear that medical directors are in a unique position to impact the care of residents within LTC. It is imperative to engage medical directors as integral members of the LTC health care team. This can be achieved by acknowledging their medical expertise for improving outcomes, providing them with the authority for decision making, compensating them appropriately, and clearly defining the role. By making these changes, we can ensure that there is a higher likelihood to sustain effective medical leadership in LTC.

Clinical communication.

Four tools to keep nurses safe beyond the next crisis.

CCCDTD5 recommendations on the deprescribing of cognitive enhancers in dementia.

INTRODUCTION: Cognitive enhancers (ie, cholinesterase inhibitors and memantine) can provide symptomatic benefit for some individuals with dementia; however, there are circumstances in which the risks of continuing treatment may potentially outweigh benefits. The decision to deprescribe cognitive enhancers must consider each patient's preferences, treatment indications, current clinical status and symptoms, prognosis, and dementia type. METHODS: The 5th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5) established a subcommittee of experts to review current evidence on the deprescribing of cognitive enhancers. The questions answered by this group included: When should cognitive enhancers be deprescribed in persons with dementia and mild cognitive impairment? How should cognitive enhancers be deprescribed? And, what clinical factors should be considered when deprescribing cognitive enhancers? RESULTS: Patient and care-partner preferences should be incorporated into all decisions to deprescribe cognitive enhancers. Cognitive enhancers should be discontinued in individuals without ongoing evidence of benefit or when the indication for cognitive enhancer use was inappropriate (eg, mild cognitive impairment). Deprescribing should occur gradually and cognitive enhancers should be reinitiated if patients' cognition or function deteriorates. Cognitive enhancers should be continued in individuals whose neuropsychiatric symptoms improve in response to treatment. Clinicians should not deprescribe cognitive enhancers in individuals with significant neuropsychiatric symptoms until symptoms have stabilized. CONCLUSION: CCCDTD5 deprescribing recommendations provide evidence-informed recommendations related to cognitive enhancer deprescribing that will facilitate shared decision making among patients, care partners, and clinicians.

Protect the nurse, protect the practice: Effective communication is the foundation for keeping nurses safe.

Every year around Nurses Week, Dr. Rhonda Collins, DNP, RN, FAAN, Chief Nursing Officer for Vocera Communications, publishes a report examining important issues that impact the nursing profession worldwide. Her 2021 CNO report examines how the COVID-19 pandemic put a spotlight on the realities of the nursing profession and how the lack of resources, infrastructure, and policies impact nurses' work and lives. Dr. Collins addresses the toll of mental, emotional, and physical fatigue and outlines steps to help leaders create environments that protect the well-being of nurses and their patients. Dr. Collins closes the report by asking nurses to participate in a study to measure the mental, emotional, and physical burden nurses experience during communication. The study will use the NASA Task Load Index, a tool that has been used to measure the task load of workers in high-intensity jobs, such as pilots and air traffic controllers. The objective is to gain insight and a body of knowledge toward reducing nurses' cognitive burden going forward.

COVID-19: Nurses have responded, now it is time to support them as we move forward.

The inspiration for The American Nurse Project, Dr. Rhonda Collins, DNP, RN, FAAN, is Chief Nursing Officer for Vocera Communications. Every year around Nurses Week, Dr. Collins publishes a report examining important issues that impact the nursing profession worldwide. Her 2020 CNO report looks at many of the challenges impacting nurses before, during, and after COVID-19-highlighting the mental anguish and physical burdens that COVID-19 has placed on nurses and other frontline healthcare workers as they put themselves in harm's way to protect others. Dr. Collins examines the foundation of cognitive science and outlines a three-point strategy to guide hospital and nurse leaders moving forward as they strive to support staff members: lightening clinicians' cognitive load by addressing the difference between documentation and communication, relieving the burden of adapting to multiple systems by giving clinicians control over how they communicate, and providing clinicians with clear, contextual, just-in-time information-using software to enhance workflow, not distract from it. During these unprecedented times, health leaders can honour nurses by providing them with the tools to help strengthen resiliency and healing from this crisis.