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  1. Helen Noble
  1. School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
  1. Correspondence to : Dr Helen Noble,
    School of Nursing and Midwifery, Queens University Belfast, Belfast BT9 7BL, UK; helen.noble{at}

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Policy report

Registered Nurses' Association of Ontario (RNAO), Mind the Safety Gap in Health System Transformation: Reclaiming the Role of the RN.

RNAO announced to its members at the May 2015 annual general meeting last year that we would undertake a major study to analyse Ontario's nursing human resources to ensure the public has access to appropriate nursing care. It was in response to our members, who voiced their concerns over a negative trend in the health system, that was robbing Ontarians of the rich knowledge and skills of registered nurses. RNAO has diligently reviewed the health system priorities outlined by health minister Eric Hoskins and compared them with trends in population health and nursing human resources. We focus our report on two top areas of concern: nursing skill-mix utilisation and organisational models of nursing care delivery. Our analysis reveals a shocking reality: trends in nursing skill mix and organisational models of nursing care delivery run counter to the Ontario government's goals for health system transformation.

RNAO says developing a comprehensive and well-thought out interprofessional HHR plan is a must for any major health system transformation, which is why it is the report's first recommendation. The other seven key recommendations address organisational models of nursing care delivery, home healthcare, full NP scope of practice, long-term care and relocation of CCAC care coordinators to primary care.

Clinical and HWE guideline publications

RNAO, System and Healthy Work Environment Best Practice Guideline Developing and Sustaining Safe, Effective Staffing and Workload Practices, second edition.

This best practice guideline (BPG) replaces RNAO's first edition of the Healthy Work Environment guideline, ‘Developing and Sustaining Effective Staffing and Workload Practices, 2007’. The goal of this BPG is to assist nurses, nursing leaders and senior management groups, across practice domains and settings, to create healthy work environments through safe, effective …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.