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Nursing Practice and Education

At Unity Health Toronto, Nursing Practice and Education promotes a quality, patient-centered, evidence-based practice environment that supports nurses to practice to their full potential in alignment with patient care needs, legislative scopes of practice and institutional polices. Nursing Practice and Education is committed to a practice environment where care is delivered efficiently and effectively in collaboration with our community partners and members of the interprofessional health care team to achieve the best outcomes. We are dedicated to treating all with respect, compassion and dignity and are guided by a commitment to excellence, continuous improvement and leadership. 

The Nursing Practice and Education team supports clinical and collaborative practice by engaging in work focused in the following four domains:

Best Practice and Trends
  • Consulting on day-to-day practices including regulatory implications and scope of practice
  • Identifying and supporting the embedding of evidence-based practices including providing strategic and instrumental leadership
  • Developing strong stakeholder relations with partners (internal and external) to continue to implement, improve and evaluate the impact of evidence integrated at point of care
  • Supporting and role modeling effective professional relationships (professional specific and interprofessional)
Education
  • Promoting a culture of continuous learning in collaboration with key internal and external stakeholders through targeted activities
  • Providing oversight and leadership to the Clinical Educator Nursing Network
  • Overseeing the development, coordination and management of all affiliation agreements with Unity Health Toronto’s academic partners
  • Developing quality improvement strategies and initiatives to improve the delivery of educational programming across the health disciplines and nursing
Performance
  • Conducting Competency assessment and development
  • Supporting Conflict Resolution through coaching and mentorship
  • Conducting practice reviews and making discipline-specific recommendations
  • Contributing to the development of tools and processes that guide specific competencies and skills that link day-to-day practice and performance reviews
Nursing Professional Standards
  • Conducting regulatory and practice inquiries and maintaining an ongoing awareness of regulatory changes that impact the profession and practice
  • Leading practice councils and relevant committees/work groups
  • Developing strong stakeholder relations with partners (internal and external) to continue to support the implementation and evaluation of practice changes in relation to positive patient outcomes

Unity Health Toronto has a strong commitment to fostering professional growth for nurses as evidenced by:

  • Hospital and unit specific orientation programs
  • Participation in the Ministry of Health initiatives such as New Graduate Guarantee Initiative
  • The number of scholarships and other financial assistance programs available to nurses pursuing further studies
  • The number of dedicated clinical education roles
  • Numerous educational initiatives and courses offered on-site

Orientation to Unity Health Toronto

In addition to the Unity Health Toronto’s general orientation, Corporate Nursing Orientation is provided to all nurses who are new to the organization or who are returning after extended absence. The purpose of Corporate Nursing Orientation is to introduce newly hired nurses to professional practice and clinical resources that complement further orientation within clinical programs and patient care units. Examples include respiratory therapy, pain management, pharmacy, IV therapy, infection prevention and control, wound care and others.

More in-depth orientation within clinical programs and patient care units is provided to:

  • Familiarize new staff with program/unit goals and routines, interdisciplinary team members, best practices, policies, protocols, directives, procedures and equipment within a specialty
  • Continually develop expert knowledge and skill in providing patient care
  • Authorize nurses to carry out specialized nursing skills specific to a patient care unit such as specialized clinical nursing assessment, monitoring and clinical skills.

Unit orientation may vary from two to three weeks. In Critical Care, Perioperative Services and Specialty Areas (such as Obstetrics, Hemodialysis, Medical Surgical Intensive Care, Emergency, Trauma/Neurosurgery) orientation varies from four to eight weeks. Orientation may be extended for new graduates.

Nursing Graduate Guarantee Initiative

The Nursing Graduate Guarantee Initiative at St. Michael’s Hospital, St Joseph’s Health Centre and Providence Healthcare provides new graduates and internationally educated nurses upon hire with:

  • Extensive orientation
  • Preceptorship by an experienced nurse with clinical expertise in the chosen area
  • Acquiring new clinical knowledge and skills
  • Learning how to prioritize patient care needs and manage a workload

The goal is to promote the transfer of knowledge to new graduates and internationally educated nurses within an accountability framework focusing on the new graduate and internationally educated nurse’s professional growth and autonomy, which will lead to active participation as a member of the clinical team.

RN performance appraisal process

Developing and enhancing employee skills are vital to making Unity Health Toronto a great place to work. Having a standardized performance appraisal system for all nurses is one important step in this process. The hospital’s performance review tool for nurses is competency-based and has been designed to support the College of Nurses annual quality assurance requirements and is based on a model of self-reflective practice. Along with maintaining the requirements for nursing registration, the performance review process promotes learning and continuous professional development by helping nurses to:

  • Analyze their nursing practice
  • Reflect on where they are in terms of their own professional development
  • Receive meaningful feedback from their manager and peers about their performance
  • Create a learning plan to identify areas for growth not only to meet their professional standards but to achieve an expert level of practice

The Unity Health Toronto delivery of nursing care is guided by the following four principles of nursing professionalism.

Autonomous Practice

Autonomous practice involves self-directed nursing care with an emphasis on professional functions, increased leadership responsibilities, professional development and advanced technical skills.

Professional Accountability

Professional accountability involves self-directed nursing practice, participation in inter-professional education and practice and requires nurses to be systems thinkers who support quality improvement initiatives and safer systems in health-care delivery.

Scope of Practice

Functioning within full scope of practice requires nurses to be aware of evidence and best practices within their scope, promote critical thinking in the evaluation and use of evidence at the point of care as defined by the College of Nurses of Ontario.

Direct Nursing Care

The principle of promoting direct nursing care requires enhancement of direct nursing care time spent with patients that result in better patient outcomes.

Unity Health Toronto believes that:

  • Nursing makes a valuable, unique contribution to patient care and plays an integral role in maintaining and sustaining our culture of caring and discovery.
  • Essential to the provision of quality care is the design and delivery of professional, scholarly nursing services that are integrated and aligned with inter-professional practice structures.
  • Decision making is enhanced by the collective wisdom acquired through dialogue and discourse of diverse representation (representing all domains of nursing practice, education, research, informatics, administrative/management) of council members.

Guided by these values, we adopt a shared governance approach to nursing professional practice implemented through the establishment of the nursing advisory councils.

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education.  Unity Health offers exciting career development and learning and growth opportunities for nurses across our three sites and in a variety specialty areas.

St. Joseph’s Health Centre:

  • Cardiology
  • Community and family practice
  • Critical care
  • Diagnostic imaging
  • Emergency
  • Gerontology
  • Gynecology
  • Gynecology
  • Infection control
  • IV service
  • Mental health
  • Nephrology/urology
  • Nursing informatics
  • Occupational health
  • Oncology
  • Orthopedics
  • Palliative care
  • Pediatrics
  • Perinatal
  • Perioperative

St. Michael’s Hospital:

  • Cardiology
  • Cardiovascular
  • Community and family practice
  • Critical care
    • Cardiovascular intensive care
    • Cardiac intensive care unit
    • Medical surgical intensive care
    • Neonatal intensive care
    • Trauma and neurosurgical intensive care
  • Diagnostic imaging
  • Emergency
  • Gastroenterology
  • Gerontology
  • Gynecology
  • Infection control
  • IV service
  • Laboratory services
  • Mental health
  • Nephrology/urology
  • Neurology
  • Neurosurgery
  • Nursing informatics
  • Occupational health
  • Oncology
  • Orthopedics
  • Palliative care
  • Perinatal
  • Perioperative
  • Respirology
  • Trauma

Providence Healthcare

  • Adult day program
  • Ambulatory care
  • Bariatric centre of excellence
  • Long term care
  • Palliative care
  • Rehabilitation:
    • Stroke and neuro rehab
    • Geriatric and medical rehab
    • Orthopedic and amputee rehab

Staff Registered Nurses and Registered Practical Nurses

Staff Registered Nurses (RNs) and Registered Practical Nurses (RPNs) work within a changing environment and in inter-professional teams to advocate for and promote wellness while ensuring the delivery of safe, effective and ethical nursing care.  They share their knowledge and expertise with others and contribute to the advancement of nursing practice excellence. RNs and RPNs continually share enhance their practice and competencies through ongoing learning, education, experience and reflective practice.

A staff RN and RPN is responsible for delivering patient-centred care through the following eight domains of nursing practice:

  • Assessment and patient monitoring
  • Administering and monitoring therapeutic regimens
  • Managing increasing complex and rapidly changing situations
  • Creating a climate for and establishing a commitment to healing
  • Teaching and coaching
  • Leadership and professional practice
  • Building and maintaining a therapeutic team and managing in a changing environment
  • Using evidence based practice and clinical judgment

Nurse Practitioner

Nurse Practitioners (NPs), registered in either the Primary Health Care, Adult or Pediatric specialties, work within collaborative teams in many programs within St. Michael’s Hospital and St Joseph’s Healthcare to provide advanced care to patients and families that optimizes patient outcomes and enhances safety, efficiency, effectiveness and accessibility to care within defined populations. NPs work within a scope of practice that allows them to autonomously diagnose, order and interpret diagnostic tests, prescribe pharmaceuticals and perform procedures and demonstrate the following competencies:

  • Professional role, responsibility and accountability (including Knowledge Translation, Scholarship, and Leadership).
  • Advanced Health Assessment and Diagnosis
  • Therapeutic Management
  • Health Promotion and Prevention of Illness and Injury

Clinical Leader/Manager and Patient Care Manager

The  Clinical Leader Manager (CLM) or Patient Care Manager (PCM) provide leadership and direction at the unit level to interdisciplinary teams to ensure the effective and efficient delivery of high quality patient care. The CLM and PCM using their teambuilding and change management skills, are primarily accountable for the quality of patient care, utilization of resources, professional practice and staff development, customer and staff satisfaction, and developing innovative, team-based approaches to the day-to-day management of the unit and to the delivery of service.

Clinical Nurse Specialist

Clinical Nurse Specialists (CNSs) are registered with the College of Nurses of Ontario in the general class.  They hold either a master’s or doctoral degree in nursing and have expertise in a clinical nursing specialty.  The CNSs demonstrate advanced knowledge, skill and judgment in providing care to patients that is consistent with the College of Nurses of Ontario.  At Unity Health Toronto, CNSs:

  • Support the delivery of quality care to diverse patient population, and facilitate the development of comprehensive care plans in conjunction with the interprofessional team to enhance patient safety, outcomes, access to care, and experience
  • Blend clinical expertise with education, knowledge translation, leadership and research skills to serve as consultants and resources to nurses, nursing leadership, interprofessional teams and external partners in the process of decision-making, developing clinical guidelines and protocols, promoting the use of evidence, and facilitating system change

Clinical Educator-Nursing

The primary role of the Clinical Educator-Nursing is to facilitate a learning environment where evidence-based knowledge is translated via education to optimize the patient’s outcomes and experiences. The Clinical Educator – Nursing teaches, guides, supports and evaluates staff learning to maximize their potential as learners and to enhance their care capabilities. At Unity Health Toronto, Clinical Educator – Nursing:

  • Are change agents that advocate for and create learning environments that enhance clinical and professional practice
  • Work with other nurse leaders to support the development of nursing staff including participation in nursing and corporate initiatives
  • Collaborate with the interprofessional team and external partners to influence and advance evidence based nursing practice

BPSO stands for Best Practice Spotlight Organization, the designation awarded by the Registered Nurses’ Association of Ontario (RNAO) upon successful implementation, evaluation and knowledge translation of established nursing best practice guidelines (BPGs). The association created its BPG program to provide nurses and health care teams with the most up-to-date, comprehensive, best evidence-based patient-care and healthy work environment recommendations. RNAO BPGs are recognized provincially, nationally and internationally.

St. Michael’s Hospital site, Unity Health Toronto launched its three-year BPSO candidacy journey during Nursing Week 2009 and achieved its designation in spring 2012. St. Michael’s joins hundreds of national and international health care organizations and academic settings who have achieved BPSO designation.

St. Michael’s is committed to renewing its annual BPSO designation through actively engaging nurses to take the lead in contributing to St. Michael’s evidence-based nursing culture and care. In implementing, evaluating and sustaining BPGs, our nurses are proactively improving patient outcomes and raising the profile of nurses as knowledge professionals and change leaders

Last updated May 25, 2021