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MPH Placement at Registered Nurses Association of Ontario (Policy Team),…

- - - - Understood that governing bodies must make reasonable investments into the interventions that improve the health of its population, with a cost-effectiveness/willingness to pay thresholds used to outline amounts that would be sensible to spend on the outcomes provided by nurse-to-patient ratios.
      - Reviewed the financial considerations of a mandatory minimum nurse-to-patient ratio in order to ensure that is is a wise use of the scarce public funds used to sustain the Canadian Health System prior to moving forward with it as a key initiative to champion.
      - Appreciated that there would be an opportunity cost to choosing the advocate for mandatory minimum nurse-to-patient ratios over other interventions that supported the sought outcome gains.
      - Considered that healthcare funding is heavily influenced by several situational forces, including culture/values of the society, supply/demand locally, and funding models in place.
    - - Understood that sampling practices used in research may impact the inferences that can be generalized to the Ontario healthcare system. Further, considered that sample size must be appropriate for the question being investigated, as it impacts the precision of findings and statistical power. The expansiveness of the research collected on an issue was often discussed to support the readers understanding of the strength of the supporting evidence.
      - Reviewed whether the study design is able to feasibly meet the goal of the study under review, appreciating that approaches such as case-control, cohort, and randomized control trials have various strengths and weaknesses.
      - Appraised the research collected for common sources of bias and threats to internal validity, including measurement or information error
      - Understanding that correlation results do not specify a cause-and-effect relationships and interpreting statistical results with caution, when needed. Considered the Bradford Hill Criteria of Causality when pondering how research results could contribute to such conversations.
    - - Collected and distilled findings from tests of association and strength of association tests within quantitative research, including odds ratios, relative risks, pearson correlation, chi-test, linear regression, and logistic regression values. Considered the point estimate and confidence intervals as ways of viewing the research findings.
      - Understanding the need to review stratified analysis and regression modelling to understand if confounding and effect modification are present. Appreciated how confounding and effect modification obscures the relationship between variables of interest. Reviewed adjusted and unadjusted findings with a strong knowledge-base for such work.
      - When interpreting research results, it was considered that a finding may be statistical significant but not clinical significant, or vice versa. This meant that all figures were critically reviewed with this understanding.
- - - - During the nursing workforce shortage in Ontario, enhanced provider experience was a significant priority. This understanding caused a great deal of focus within this project to be placed on how mandatory minimum nurse-to-patient ratios support nurse well-being, including appreciating how heavy workload impact nurse mental health and occupational health/safety
      - Population health is supported if readmission rates decreased and 30-day mortality was reduced via receiving care from adequately staffed health services. This would indicated that health-protective interventions were provided, which was reviewed in this project.
      - Blacks living in America, Indigenous populations in Canada, individuals with cognitive impairments, and those who speak English as a second language are some groups considered to potentially be more impacted by the negative outcomes of nurse workload. Promoted system-level change to address structural inequities.
  - - - The strength of community engagement to aid political advocacy was seen when the RNAO held Queen's Park Day, where RNAO members organized at Queens park to demonstrate their support for policies that improves the nursing sector. This included meetings with politicians to discuss nursing issues and allowing party leaders answer questions, including providing their plans to address the nursing workforce shortage.
        
        In reflection, these experiences influenced my understanding of the nursing community's needs and feelings, improving my ability to champion this group's wants within my policy writing.
        
        Politicians appreciated the storytelling from RNAO members who emotionally illustrated the need for policy change. The RNAO members were authentic leaders who communicated the issues effectively. A political action bulletin was created to give RNAO members quick statistics to lean on when speaking with politicians, which we reviewed in team meetings.
        
        The RNAO reiterated the influence provided from a large community mobilization effort. The RNAO has ~56,000 members, with many efforts being pushed by petitions signed by thousands of members or rallies attended by hundreds
      - Saw various parts of the policy-development framework enacted, as the RNAO monitored and responded to the Government's proposed regulatory changes for Ontario Health Teams. This provided a practical example of MPH learnings related to how the policy advocacy can protect public health as laws drive the funding and administration of the healthcare system. The experience informed the development of my policy-related project goals.
      - Appreciated the gaps between practice and research related to nurse-to-patient ratios as nurses often cared for more patients than is found to be safe due to absent or lax staffing policies. Called for legislation to standardize the nurse-to-patient ratios in order to ensure high-quality healthcare. This work concluded around the time that the Ontario NDP proposed the Patient-to-Nurse Ratios for Hospitals Act, 2024, which can be read here: https://www.ola.org/en/legislative-business/bills/parliament-43/session-1/bill-192
        
        Over 200 citations supported the arguments to legislate nurse-to-patient ratios in my writing in order to ensure that the assumptions applied were strong. The evidence behind the bill would have been similar, stimulating my belief that this was an evidence-based action by the NDP.
        
        Understood the importance of timing and perseverance in moving policy forward as this motion received push-back from the conservatives, and eventually was rejected. Many external factors must come together to impact whether proposed legislation will pass. Read more here: https://www.ontariondp.ca/news/conservatives-say-no-reducing-nurse-burnout
        
        I appreciated the need for collaboration to change health policies when groups such as the Ontario Nurses Association, Registered Practical Nurses Association of Ontario, and OPSEU Community Health Sector Union stood together in support of the bill. This increased the bills legitimacy and demonstrated that other groups have aligning interests, who should be considered for partnerships. Read more here:https://www.ontariondp.ca/news/g-linas-act-aims-alleviate-nursing-workforce-burnout