Workplace Violence Against Nurses in Canada: A Legal Analysis.

Workplace violence against nurses is a significant global occupational health problem, with incidents of violence increasing in frequency since the COVID-19 pandemic began. In this article, we provide a review of recent legislative amendments meant to bolster workplace safety in health care in Canada, analyze legal cases where nurses were the victims of violence, and discuss what these legal reforms and decisions reveal about how nurses' work is treated within the Canadian legal system. Under criminal law, the limited number of cases we could find with oral or written sentencing decisions show that, historically, the fact a victim was a nurse was not always considered an aggravating factor on sentencing. Recent legislative amendments make this a specified aggravating factor and it is important to track the impact of these amendments when judges exercise their discretion in sentencing. Under employment law, it appears that, despite the government's efforts to increase the deterrence factor under legislation with significantly increased fines for employers who fail to protect their employees from injury, courts remain reluctant to impose such sanctions. In these cases, it is also important to track the impact of harsher penalties. We conclude that combating the widespread normalization of workplace violence in health care, and specifically against nurses, is acutely needed to help ensure that these ongoing legal reforms aimed at improving the safety of health workers are effective.

Regulating in the public interest: Lessons learned during the COVID-19 pandemic.

This article has three aims. First, to reflect on how conceptualizations of the public interest may have shifted due to COVID-19. Second, to focus on the implications of regulatory responses for the health workforce and corresponding lessons as health leaders and systems transition from pandemic response to pandemic recovery. Third, to identify how these lessons lead to potential directions for future research, connecting regulation in a whole-of-systems approach to health system safety and health workforce capacity and sustainability. Pandemic regulatory responses highlighted both strengths and limitations of regulatory structures and frameworks. The COVID-19 pandemic may have introduced new considerations around regulating in the public interest, particularly as the impact of regulatory responses on the health workforce continues to be examined. Clearly articulating practitioner practice parameters, reducing barriers to practice, and working collaboratively with stakeholders were primary aspects of regulators' pandemic responses that impacted the health workforce.

Participation of women in the health workforce in the fragile and conflict-affected countries: a scoping review.

INTRODUCTION AND BACKGROUND: The full participation of women as healthcare providers is recognized globally as critical to favorable outcomes at all levels, including the healthcare system, to achieving universal health coverage and sustainable development goals (SDGs) by 2030. However, systemic challenges, gender biases, and inequities exist for women in the global healthcare workforce. Fragile and conflict-affected states/countries (FCASs) experience additional pressures that require specific attention to overcome challenges and disparities for sustainable development. FCASs account for 42% of global deaths due to communicable, maternal, perinatal, and nutritional conditions, requiring an appropriate health workforce. Consequently, there is a need to understand the impact of gender on workforce participation, particularly women in FCASs. METHODS: This scoping review examined the extent and nature of existing literature, as well as identified factors affecting women's participation in the health workforce in FCASs. Following Arksey and O'Malley's scoping review methodology framework, a systematic search was conducted of published literature in five health sciences databases and grey literature. Two reviewers independently screened the title and abstract, followed by a full-text review for shortlisted sources against set criteria. RESULTS: Of 4284, 34 sources were reviewed for full text, including 18 primary studies, five review papers, and 11 grey literature sources. In most FCASs, women predominate in the health workforce, concentrated in nursing and midwifery professions; medicine, and the decision-making and leadership positions, however, are occupied by men. The review identified several constraints for women, related to professional hierarchies, gendered socio-cultural norms, and security conditions. Several sources highlight the post-conflict period as a window of opportunity to break down gender biases and stereotypes, while others highlight drawbacks, including influences by consultants, donors, and non-governmental organizations. Consultants and donors focus narrowly on programs and interventions solely serving women's reproductive health rather than taking a comprehensive approach to gender mainstreaming in planning human resources during the healthcare system's restructuring. CONCLUSION: The review identified multiple challenges and constraints facing efforts to create gender equity in the health workforce of FCASs. However, without equal participation of women in the health workforce, it will be difficult for FCASs to make progress towards achieving the SDG on gender equality.

Nursing Experts, Hygienic Modernity, and Nation Building: The Case of Nursing in Ethiopia in the Post-Colonial Era.

This is a tale in three parts. It begins with an exploration of the story of Princess Tsahai, daughter of Haile Selassie, and the highly successful British campaign led by suffragette E. Sylvia Pankhurst to bring British-style nursing and medicine to Ethiopia in the 1940s and 1950s. Second, it examines the role of foreign women, most notably Swedish missionary nurses, in building health services and nursing capacity in the country. Finally, it examines the way in which nursing brought together gendered notions of expertise and geopolitical pressures to redefine expectations for Ethiopian women as citizens of the new nation-state.

Emigration and job security: An analysis of workforce trends for Spanish-trained nurses (2010-2015).

AIM: To analyse the relationship between Spanish nurses' intention to migrate and job security. BACKGROUND: Nursing emigration from Spain increased dramatically between 2010 and 2013. By 2015, emigration had returned to 2010 levels. METHODS: Single embedded case study. We examined publicly available statistics to test for a relationship between job security and applications by Spanish nurses to have credentials recognized for emigration purposes. RESULTS: Between 2010 and 2015, job security worsened, with poor access to the profession for new graduates, increased rate of professional dropout, increased nursing jobseekers and falling numbers of permanent contracts. CONCLUSIONS: The number of accreditation applications in Spain in 2010 and 2015 was very similar, but job security worsened on a number of fronts. The distribution of work through part-time contracts aided retention. IMPLICATIONS FOR NURSING MANAGEMENT: Policymakers and health care administrators can benefit from understanding the relationship between mobility, workforce planning and the availability of full-time, part-time and short-term contract work in order to design nursing retention programmes and ensure the sustainability of the health care system.

The Nurses No-One Remembers: Looking for Spanish Nurses in Accounts of the Spanish Civil War (1936-1939).

Accounts of Spanish nursing and nurses during the Spanish Civil War (1936-1939) that appear in the memoirs and correspondence of International Brigade volunteers, and are subsequently repeated in the secondary literature on the war, give little indication of existence of trained nurses in country. We set out to examine this apparent erasure of the long tradition of skilled nursing in Spain and the invisibility of thousands of Spanish nurses engaged in the war effort. We ask two questions: How can we understand the narrative thrust of the international volunteer accounts and subsequent historiography? And what was the state of nursing in Spain on the Republican side during the war as presented by Spanish participants and historians? We put the case that the narrative erasure of Spanish professional nursing prior to the Civil War was the result of the politicization of nursing under the Second Republic, its repression and reengineering under the Franco dictatorship, and the subsequent national policy of "oblivion" or forgetting that dominated the country during the transition to democracy. This policy silenced the stories of veteran nurses and prevented an examination of the impact of the Civil War on the Spanish nursing profession.

Factors in the drop in the migration of Spanish-trained nurses: 1999-2007.

AIM: To reveal correlates of the decrease of Spanish nurse migration (1999-2007). BACKGROUND: Nursing outmigration is a concern for countries. Nurse migration from Spain began in the 1990s. INTRODUCTION: From 1999 to 2007, the yearly number of migrations dropped significantly. We ask what social, economic and policy factors could be related to this drop. METHODS: We used publicly available statistics to confirm hypothesis (1) The drop in nursing migration coincided with a drop in nursing unemployment. Then we hypothesized that this coincided with (1a) a decrease in the number of graduates, (1b) an increase in the number of hospitals and/or beds functioning, and/or (1c) an increase in the ratio of part-time contracts. RESULTS: Our analysis confirms hypotheses (1) and (1c) and disconfirms (1a) and (1b). CONCLUSION: The greater availability of part-time contracts seems to have encouraged nurses to remain in Spain. IMPLICATIONS FOR NURSING MANAGEMENT: The strategy to reduce nursing unemployment with more part-time contracts, while temporarily successful in Spain, brings with it major challenges for patient care and the working life of nurses. We suggest that nurse leaders and health policymakers consider proactive policies to adjust the balance between supply and demand without decreasing the quality of available positions.

Workforce Integration of Philippine-Educated Nurses who Migrate to Canada through the Live-in Caregiver Program.

Nurses who migrate through the Canadian Live-in Caregiver Program face significant barriers to their subsequent workforce integration as registered nurses in Canada. This study applies the concept of global care chains and uses single case study methodology to explore the experiences of 15 Philippine-educated nurses who migrated to Ontario, Canada, through the Live-in Caregiver Program. The focus is the various challenges they encountered with nursing workforce integration and how they negotiated their contradictory class status. Due to their initial legal status in Canada and working conditions as migrant workers, they were challenged by credential assessment, the registration examination, access to bridging programs, high financial costs, and ambivalent employer support. The results of the study are pertinent for nursing policymakers and educators aiming to facilitate the integration of internationally educated nurses in Canada.

Les infirmières qui migrent par l'intermédiaire du programme canadien des aides familiaux résidants font face à des obstacles importants après leur intégration à la population active en tant qu'infirmières au Canada. Cette étude applique le concept de chaînes mondiales des soins et utilise une méthodologie fondée sur l'étude de cas unique pour explorer le vécu de 15 infirmières formées aux Philippines et qui ont migré en Ontario, au Canada, par l'intermédiaire du programme des aides familiaux résidants. L'étude se penche notamment sur les divers défis qu'elles ont dû relever dans le cadre de leur intégration en milieu de travail infirmier ainsi que sur la façon dont elles ont composé avec leur niveau de classe contradictoire. En raison de leur statut juridique au Canada et de leurs conditions de travail en tant que travailleuses migrantes, elles ont dû surmonter les obstacles que représentaient l'évaluation de leurs titres de compétences, l'examen d'accréditation, l'accès aux programmes de transition, les coûts financiers élevés et le soutien ambivalent d'employeurs. Les résultats de l'étude offrent de l'information pertinente aux décideurs et aux éducateurs qui œuvrent pour la profession infirmière et pour l'intégration des infirmières formées à l'étranger au Canada.

Acute Coronary Syndrome Pain and Anxiety in a Rural Emergency Department: Patient and Nurse Perspectives.

Rural patients can wait up to 32 hours for transfer to cardiac catheterization (CATH) for events related to acute coronary syndrome (ACS). Pain arising from myocardial ischemia can be severe and anxiety-provoking. Pain management during this time should be optimized in order to preserve vulnerable myocardial muscle. This qualitative focus group study solicited the perspectives of ACS patients and emergency staff nurses on the rural patient experience of cardiac pain and anxiety and priorities and barriers to optimal assessment and management of ACS pain. Patients described ACS pain as moderate to severe, with pain in the chest, arms, back, shoulders, and jaw. Pain was well assessed and managed upon arrival in the emergency department but anxiety was not routinely assessed or treated. Barriers identified were poor management of patients with different acuity levels, high patient volumes, and assumptions regarding patients' communication about pain. Research related to ACS pain and anxiety management in the rural context is recommended.

Les patients atteints d'un syndrome coronarien aigu (SCA) en milieu rural peuvent attendre jusqu'à 32 heures avant d'être transférés pour un cathétérisme cardiaque (CATH). La douleur associée à une ischémie myocardique peut être aiguë et provoquer de l'anxiété. La gestion de cette douleur devrait être optimisée afin de protéger le muscle myocardique, qui est en situation de vulnérabilité. Cette étude qualitative menée auprès d'un groupe cible visait à solliciter le point de vue de patients atteints d'un SCA et du personnel infirmier d'un service d'urgence en milieu rural concernant l'anxiété et la douleur cardiaque ressenties par les patients et concernant les priorités à adopter et les obstacles à surmonter pour une évaluation et une gestion optimales de la douleur liée à un SCA. Les patients ont décrit la douleur liée à un SAC comme étant légère ou aiguë et ont indiqué qu'elle se situait dans la poitrine, les bras, le dos, les épaules et les mâchoires. Selon les participants à l'étude, la douleur est évaluée et gérée adéquatement au moment de l'arrivée des patients au service d'urgence, mais l'anxiété, quant à elle, n'est pas évaluée ou traitée de façon systématique. Les obstacles mentionnés sont une mauvaise gestion des patients présentant des degrés de gravité différents, un volume important de patients et une tendance du personnel soignant à entretenir des a priori relativement à la communication par les patients de leur douleur. L'étude recommande que des recherches soient menées sur la gestion de la douleur et de l'anxiété liées au SCA en milieu rural.

The downward occupational mobility of internationally educated nurses to domestic workers.

Despite the fact that there is unmet demand for nurses in health services around the world, some nurses migrate to destination countries to work as domestic workers. According to the literature, these nurses experience contradictions in class mobility and are at increased risk of exploitation and abuse. This article presents a critical discussion of the migration of nurses as domestic workers using the concept of 'global care chain'. Although several scholars have used the concept of global care chains to illustrate south to north migration of domestic workers and nurses, there is a paucity of literature on the migration of nurses to destination countries as domestic workers. The migration of nurses to destination countries as domestic workers involves the extraction of reproductive and skilled care labor without adequate compensatory mechanisms to such skilled nurses. Using the case of the Canadian Live-in Caregiver Program, the study illustrates how the global movement of internationally educated nurses as migrant domestic workers reinforces inequities that are structured along the power gradient of gender, class, race, nationality, and ethnicity, especially within an era of global nursing shortage.

Content validity of the Toronto Pain Management Inventory-Acute Coronary Syndrome Version.

BACKGROUND: Cardiac pain and/or discomfort arising from acute coronary syndromes (ACS) can often be severe and anxiety-provoking. Cardiac pain, a symptom of impaired myocardial perfusion, if left untreated, may lead to further myocardial hypoxia, which can potentiate myocardial damage. Evidence suggests that once ACS patients are stabilized, their pain may not be adequately assessed. Lack of knowledge and problematic beliefs about pain may contribute to this problem. To date, no standardized tools are available to examine nurses' specific knowledge and beliefs about ACS pain that could inform future educational initiatives. AIM: To examine the content validity of the Toronto Pain Management Inventory-ACS Version (TPMI-ACS), a 24-item tool designed to assess nurses' knowledge and beliefs about ACS pain assessment and management. METHODS: Eight clinical and scientific experts rated the relevance of each item using a four-point scale. A content validity index was computed for each item (I-CVI), as well as the total scale, expressed as the mean item CVI (S-CVI/AVE). Items with an I-CVI > or = 0.7 were retained, items with an I-CVI ranging from 0.5-0.7 were revised and clarified, and items with an I-CVI < or = 0.5 were discarded. RESULTS: I-CVIs ranged from 0.5-1.0 and the S-CVI/AVE was 0.90, reflecting high inter-rater agreement across items. The least relevant item was eliminated. CONCLUSIONS: Preliminary content validity was established on the TPMI-ACS version. All items retained in the TPMI-ACS version met requirements for content validity. Further evaluation of the psychometric properties of the TPMI-ACS is needed to establish criterion and construct validity, as well as reliability indicators.

A gender-based review of workplace violence amongst the global health workforce-A scoping review of the literature.

Workplace violence (WPV) impacts all levels of the health workforce, including the individual provider, organization, and society. While there is a substantial body of literature on various aspects of WPV against the health workforce, gender-based WPV (GB-WPV) has received less attention. Violence in both the workplace and broader society is rooted in gendered socio-economic, cultural, and institutional factors. Developing a robust understanding of GB-WPV is crucial to explore the differing experiences, responses, and outcomes of GB-WPV with respect to gender. We conducted a scoping review and report on the prevalence and risk factors of GB-WPV in healthcare settings globally. The review followed the Preferred Reporting Items for Systematic and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We registered the scoping review protocol on the Open Science Framework on January 14, 2022, at https://osf.io/t4pfb/. A systematic search was conducted of empirical literature in five health and social science databases. Of 13667, 226 studies were included in the analysis. Across the studies, more women than men experienced non-physical violence, including verbal abuse, sexual harassment, and bullying. Men experienced more physical violence compared to women. Younger age, less experience, shifting duties, specific clinical settings, lower professional status, organizational hierarchy, and minority status were found to be sensitive to gender, reflecting women's structural disadvantages in the workplace. Given the high prevalence and impact of GB-WPV on women, we provided recommendations to address systemic issues in clinical practice, academia, policy, and research.

Professional regulation in the digital era: A qualitative case study of three professions in Ontario, Canada.

Technology is transforming service delivery and practice in many regulated professions, altering required skills, scopes of practice, and the organization of professional work. Professional regulators face considerable pressure to facilitate technology-enabled work while adapting to digital changes in their practices and procedures. However, our understanding of how regulators are responding to technology-driven risks and the impact of technology on regulatory policy is limited. To examine the impact of technology and digitalization on regulation, we conducted an exploratory case study of the regulatory bodies for nursing, law, and social work in Ontario, Canada. Data were collected over two phases. First, we collected documents from the regulators' websites and regulatory consortiums. Second, we conducted key informant interviews with two representatives from each regulator. Data were thematically analyzed to explore the impact of technological change on regulatory activities and policies and to compare how regulatory structure and field shape this impact. Five themes were identified in our analysis: balancing efficiency potential with risks of certain technological advances; the potential for improving regulation through data analytics; considering how to regulate a technologically competent workforce; recalibrating pandemic emergency measures involving technology; and contemplating the future of technology on regulatory policy and practice. Regulators face ongoing challenges with providing equity-based approaches to regulating virtual practice, ensuring practitioners are technologically competent, and leveraging regulatory data to inform decision-making. Policymakers and regulators across Canada and internationally should prioritize risk-balanced policies, guidelines, and practice standards to support professional practice in the digital era.

Protecting the public interest when regulating health professionals providing virtual care: a scoping review protocol.

BACKGROUND: Virtual care is transforming the nature of healthcare, particularly with the accelerated shift to telehealth and virtual care during the COVID-19 pandemic. Health profession regulators face intense pressures to safely facilitate this type of healthcare while upholding their legislative mandate to protect the public. Challenges for health profession regulators have included providing practice guidance for virtual care, changing entry-to-practice requirements to include digital competencies, facilitating interjurisdictional virtual care through licensure and liability insurance requirements, and adapting disciplinary procedures. This scoping review will examine the literature on how the public interest is protected when regulating health professionals providing virtual care. METHODS: This review will follow the Joanna Briggs Institute (JBI) scoping review methodology. Academic and grey literature will be retrieved from health sciences, social sciences, and legal databases using a comprehensive search strategy underpinned by Population-Concept-Context (PCC) inclusion criteria. Articles published in English since January 2015 will be considered for inclusion. Two reviewers will independently screen titles and abstracts and full-text sources against specific inclusion and exclusion criteria. Discrepancies will be resolved through discussion or by a third reviewer. One research team member will extract relevant data from the selected documents and a second will validate the extractions. DISCUSSION: Results will be presented in a descriptive synthesis that highlights implications for regulatory policy and professional practice, as well as study limitations and knowledge gaps that warrant further research. Given the rapid expansion of virtual care provision by regulated health professionals in response to the COVID-19 pandemic, mapping the literature on how the public interest is protected in this rapidly evolving digital health sector may help inform future regulatory reform and innovation. SYSTEMATIC REVIEW REGISTRATION: This protocol is registered with the Open Science Framework ( https://doi.org/10.17605/OSF.IO/BD2ZX ).

Protecting the public interest while regulating health professionals providing virtual care: A scoping review.

Technology is transforming service delivery in many health professions, particularly with the rapid shift to virtual care during the COVID-19 pandemic. Health profession regulators must navigate legal and ethical complexities to facilitate virtual care while upholding their mandate to protect the public interest. The objectives of this scoping review were to examine how the public interest is protected when regulating health professionals who provide virtual care, discuss policy and practice implications of virtual care, and make recommendations for future research. We searched six multidisciplinary databases for academic literature published in English between January 2015 and May 2021. We also searched specific databases and websites for relevant grey literature. After screening, 59 academic articles and 18 grey literature sources were included for analysis. We identified five key findings: the public interest when regulating health professionals providing virtual care was only implicitly considered in most of the literature; when the public interest was discussed, the dimension of access was emphasized; criticism in the literature focused on social ideologies driving regulation that may inhibit more widespread use of virtual care; subnational licensure was viewed as a barrier; and the demand for virtual care during COVID-19 catalyzed licensure and scope of practice changes. Overall, virtual care introduces new areas of risk, potential harm, and inequity that health profession regulators need to address as technology continues to evolve. Regulators have an essential role in providing clear standards and guidelines around virtual care, including what is required for competent practice. There are indications that the public interest concept is evolving in relation to virtual care as regulators continue to balance public safety, equitable access to services, and economic competitiveness.

Regulating During Crisis: A Qualitative Comparative Case Study of Nursing Regulatory Responses to the COVID-19 Pandemic.

Background: The COVID-19 pandemic placed intense pressure on nursing regulatory bodies to ensure an adequate healthcare workforce while maintaining public safety. Purpose: Our objectives were to analyze regulatory bodies' responses during the pandemic, examine how nursing regulators conceptualize the public interest during a public health crisis, and explore the influence of a public health crisis on the balancing of regulatory principles. We aimed to develop a clearer understanding of regulating during a crisis by identifying themes within regulatory responses. Methods: We conducted a qualitative comparative case study examining the pandemic responses of eight nursing regulators in three Canadian provinces and three U.S. states. Data were collected from semi-structured interviews with 19 representatives of nursing regulatory bodies and 206 publicly available documents and analyzed thematically. Results: Five themes were constructed from the data: (1) risk-based responses to reduce regulatory burden; (2) agility and flexibility in regulatory pandemic responses; (3) working with stakeholders for a systems-based approach; (4) valuing consistency in regulatory approaches across jurisdictions; and (5) the pandemic as a catalyst for innovation. Specifically, we identified that the meaning of "public interest" in the context of high workforce demand was a key consideration for regulators. Conclusion: Our results demonstrate the intensity of effort involved in nursing regulatory responses and the significant contribution of nursing regulation to the healthcare system's pandemic response. Our results also indicate a shift in thinking around broader public interest issues, beyond the conduct and competence of individual nurses, to include pressing societal issues. Regulators are beginning to grapple with these longer-term issues and policy tensions.

Spanish nursing under Franco: reinvention, modernization and repression (1956-1976).

This article examines Spanish nursing during a critical 20-year period (1956-76) when, under the dictatorial government of General Franco, nursing became the target of a modernization strategy. In the national standardized system of state-run schools, the previously distinct nursing and midwifery programmes were merged into a new training programme which created the single professional denomination of ATS-Ayudante Técnico Sanitario (Technical Sanitary Assistant). Under the leadership of medicine, and with the blessing of the Catholic Church and the Sección Femenina (Women's Section of the Falangist Party), nursing was positioned as feminized and subordinate to medicine, a predominantly male profession in mid-twentieth century Spain. This article discusses this crucial phase of Spanish nursing history by focusing on one influential historical document (published in 1956), Professional Moral Orientation for the Sanitary Technical Assistants, a nursing textbook on professional morals for first-year nursing students written by Rosamaria Miranda, a Catholic nun and a trained nurse. Our analysis reveals that gender-related and technical discourses concerning disciplinary and pastoral power relations presented in this textbook legitimate the core beliefs of Franquism put forward by the politically powerful women's branch of the ruling Falangist Party in mid-twentieth century Spain.

The lost path to emancipatory practice: towards a history of reflective practice in nursing.

This paper historicizes the taken-for-granted acceptance of reflection as a fundamental professional practice in nursing. It draws attention to the broad application of reflective practice, from pedagogy to practice to regulation, and explores the epistemological basis upon which the authority of reflective discourse rests. Previous work has provided a series of critiques of the logic and suitability of reflective practice across all domains of nursing. The goal of this paper is to commence a history of nursing's reflective identity. The paper begins with a discussion of Dewey and Schön then focuses on Habermas's Theory of Communicative Action as the epistemological basis of reflective practice's standing as a authoritative discourse in nursing.

Mentoring advanced practice nurses in research: recommendations from a pilot program.

Advanced Practice Nurses (APNs) need research skills to develop and advance their practice and, yet, many have limited access to research training and support following completion of their advanced degree. In this paper we report on the development, delivery, and evaluation of an innovative pilot program that combined research training and one-to-one mentorship for nine APNs in conducting research relevant to their practice. The program was organized within an academic institution and its affiliated hospitals in Toronto, Canada. Our experience with this program may assist those in other organizations to plan and deliver a similar program for APN research mentorship.