RNAO and Building the Nursing Profession

In many ways the Registered Nurses Association of Ontario — RNAO — is the very model of a professional nursing association, pushing hard for good health care for Ontario, advocating for nurses, and promoting best practice and clinical excellence. It was the RNAO, which during the dire days of the Harris government in the 1990s, essentially saved the nursing profession in Ontario. In some ways I can’t speak highly enough of this organization, our organization.

I was checking out the RNAO website the other day, when I came across this:

The RNAO Centre for Professional Nursing Excellence and the International Affairs and Best Practice Guidelines team are pleased to bring you the Annual Best Practice Guidelines Summer Institute, a knowledge and energy-filled week-long educational experience. This institute offers an unsurpassed opportunity to learn from experts about clinical innovation, implementing best practice guidelines and championing clinical excellence.

Sounds exciting, I thought. Or at least relevant to my practice. Or this conference:

RECHARGE Your Workplace!

An opportunity to learn from the experts the key steps to creating healthy work places and evaluating the impact.

An exciting and dynamic education event.

A powerful forum for the exchange of knowledge and strategies about Healthy Work Environments through realistic case studies.

Now this was up my alley. A topic I feel strongly about, especially because of the relationship with patient outcomes. And it was far enough ahead I could actually get the time off without too much difficulty.

So I linked to the application form. I blinked. The conference fees for the “Healthy Work Environments Summer Institute” were:

RNAO Member: $2,270.00 + GST ($113.50) = $2,383.50 or $2270.00 + HST (13%) as of July 1, 2010 ($295.10) = $2,565.10

Non-Members: $3,180.00 + GST ($159.00) = $3,339.00 or$3,180.00 + HST (13%) as of July 1, 2010 ($413.40) = $3,593.40

The fees for the “Annual Best Practice Guidelines Summer Institute” were similar.

That’s some serious change. Even if I’m an RNAO member, nearly $2,400 for a five day conference would carry some serious thought: it’s $480 a day exclusive of incidentals. It’s three mortgage payments, two weeks at a Cuban all-inclusive (with air fare) or financing for a medical mission trip to South America. To put it in perspective, to certify in Trauma Nursing (TNCC*), which directly affects my patient care and ultimately, patient outcomes, costs around $420, including textbook. And that’s over two days. If you are a new grad, or raising a family, or even furthering your education, $2400 is a pretty significant chunk of your annual income.

I’m guessing the demographic profile of attendees would be older and not younger, academic and managerial rather than front line, and wealthy (or institutionally well-funded) instead of middle middle-class. In short, the average, bedside RN is effectively barred from attending these events, not officially or as a matter of policy, but practically as a matter of money. Who can afford it?

I can’t. I don’t have a sugar-daddy, institutional or otherwise.

A clue: in the application form, there is a space for “title”, i.e. what is your exalted place in your institution’s food chain. Implication: if you have no title but Registered Nurse, don’t bother coming.**

For an organization dedicated to “[r]especting human dignity. . . a community committed to diversity, inclusivity, democracy and voluntarism,” is this right?

Granted, there are resources available to offset this extraordinary cost. The provincially-funded Nurse Education Initiative will reimburse $1500 of eligible program costs. But the process is labyrinthine and slow, the financing isn’t guaranteed, and in any case, who can afford to carry $1500 for three months while the application is decided?

I am an RNAO member, and I am concerned. My first problem is relatively minor: for years, the RNAO fought and still fights the widespread (if mainly unfair perception) that it’s an elitist society for management and academics — the ones who can say shit, as a colleague on mine once said, but would never touch it. I’m guessing that if you ask bedside nurses who are not members of the RNAO why they are not members, a fairly large percentage of them will state it’s “not for me” or “they don’t care about front line nurses.” Hard to argue the point when in fact that appears to be the case.

More seriously, there is a problem with ethics and accountability. To put it plainly, I appear to be financing conferences, through my RNAO fees, which apart from their entirely hypothetical benefit to the profession, I am effectively barred from attending because of their high cost and the cumbersome reimbursement process. Even if these conferences are self-financing (which I would hope), RNAO resources, which I pay for, are being expended in terms of organization, advertising and so forth. Bluntly, why should RNAO members enable our nursing leadership to hang out in Hockley Valley for five days when we ourselves are for all intents and purposes excluded?

Lastly, and most aggravatingly, these conference actually seem to be hugely useful. The point is not that I am against conferences of this sort, but RNAO should make them entirely more accessible to all nurses. If RNAO is serious about empowering nurses at the bedside, and making them the strongest possible advocates for the profession and their patients, it needs to give front line nurses the serious tools to do so. Because with few exceptions, we are not going to get this sort of leadership from our managers, and academia ultimately can’t do this work for us.  We really need to know about best practice and how to build a safe workplace. We need to learn the language and gain the skills. The front line is the nexus of change in the nursing profession. The future of nursing is located here.

I don’t think, of course, any of this is deliberate on the part of RNAO. I think it rather bespeaks a sort of institutional carelessness, lack of mindfulness and isolation. But ultimately, excluding nurses from gaining these skills because of financial reasons is ultimately counter-productive and estranges the front line from the leadership. Twenty-five year-old nurses two or three years from graduation should be populating these conferences, not fifty-seven year-old managers near the end of their careers.


*TNCC = Trauma Nursing Core Course

**I spent some moments thinking up titles to grant myself. Such as “Vice President of Charge Nursey Affairs” or “Anonymous Blogger Extraordinaire.”


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  1. #1 by Jenn Jilks on Sunday 16 May 2010 - 1329

    I share your shock. You’d think best practices would be part of the employers goals of ensuring up-to-date PD.
    We fought this, as teachers. Why would we want to teach all day, leave our kids at the sitter, and go for PD after school?

    Now, as a health care volunteer (Hospice), we are supplemented, but not for the big conferences, such as the Ontario Palliative Care Assoc.
    We save the government all sorts of money.
    The same issue concerned me as a volunteer on a Board of Directors. They want us to take 2-day workshops.

  2. #2 by Luke on Sunday 16 May 2010 - 1718

    Excellent post, I hope you forward this to the RNAO CEO & Chair of their board.

  3. #3 by Laura on Monday 17 May 2010 - 0801

    A trend I’ve noticed in my field (education research) is putting talks and seminars like that online. For every session at a conference/seminar/training institute, there’s a camera in the back, a microphone for the speaker, and another mic passed around the room for questions. The videos later posted online for anyone to watch. The additional cost is pretty minimal, just a few AV people and maybe some bandwidth charges. Watching those videos isn’t the same as being there but it’s still better than nothing. Maybe you could suggest something similar to the RNAO.

  4. #4 by @rdjfraser on Thursday 20 May 2010 - 1408

    I definitely agree you that I feel this is pushed way out of my range. That said I disagree with you that you fees finance the event, the major source of revenue for the organization is membership fees, but the second largest comes from the Centre’s events.

    The RNAO does their best to give away all their resources for free online which I greatly respect, but I agree with you about the need to do better educating the front line nurses. If what they are doing is important for patients, then it is most valuable in the hands of those individuals.

    I do a lot of free work for the RNAO because I support the organization, but we do need strong voices like yours to bring fresh blood to the organization. There is a bit of a stagnation in the attendees and region chairs. We need a high turnover rate in that board, we need nurses get involved, taking their chance to learn and develop and then bringing in strong successors!

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