2006 annual report: Nurses Association of New Brunswick.

Table of Contents
3    Vision, Mission, Role and NANB Board Ends/Strategic Objectives
5    President and Executive Director's Message
6    Board of Directors/NANB Staff
7    Highlights from 2006
       Protection of the Public                               7
       Advancement of Excellence in the Nursing Profession   12
       Influencing Healthy Public Policy                     18
19   New/Revised Publications
20   Statistical Highlights
22   Standing and Legislated Committees
       Committee Reports                                     23
       Enhancing NANB Services                               27
28   Communications
30   Financial Statement

Vision

Nurses shaping nursing for healthy New Brunswickers.

Mission

The Nurses Association of New Brunswick is a professional regulatory organization that exists to protect the public and to support nurses by promoting and maintaining standards for nursing education and practice and by advocating for healthy public policy.

NANB Role

The Nurses Association of New Brunswick under the authority of the Nurses Act 1984) is responsible for advancing and maintaining the standards of nursing in the Province, for governing and regulating those offering nursing care and for providing for the welfare of members of the public and the profession.

Utilizing a regulatory framework based on promoting good practice, preventing poor practice and intervening when practice is unacceptable, the NANB is committed to the protection of the public and the assurance of safe, competent and ethical nursing care.

NANB Board Ends/Strategic Objectives

Protection of the public.

Advancement of excellence in the nursing profession

Influencing healthy public policy.

BOARD OF DIRECTORS 2006-07

Members of the board of directors for 2006-07 are (front row, left to right) Ruth Alexander, Region 2; Monique Cormier-Daigle, president-elect; Sue Ness, president; Roxanne Tarjan, executive director; and Bonnie Matchett, Region 7.

In the back row (left to right) are Linda Leblanc, Region 4; Ruth Riordon, Region 3; Cheryl Drisdell, Region 1; Wayne Trail, public member; Margaret Corrigan, Region 5; and Rose-Marie Chiasson-Goupil, Region 6.

President and Executive Director's Message

This report provides highlights of NANB activities during 2006 to fulfill its regulatory mandate and support and advance nursing practice in New Brunswick. Association outreach to members, enhancing connectivity and visibility remain a priority. During 2006, the Association met face to face with approximately 2000 nurses through a variety of forums and provided individual support related to regulatory, practice, policy and education issues on well over 6000 occasions to nurses using telephone, electronic and/or written communication. Ensuring members/registrants across the province are kept informed about nursing issues, enhancing awareness of nursing standards and engaging nurses in professional matters are essential activities to support the NANB's regulatory mandate. This report highlights many of those initiatives.

Implementation of the recommendations from the 2004-2005 NANB Organizational Review is ongoing. In September, the new, smaller 12-member NANB board of directors was initiated. As well, chapter presidents from across the province participated in the first Chapter President's Forum in October to facilitate communication and support to chapters, their executive team and members. For the first time this April, members across the province will select a new president-elect by mail ballot allowing every registered nurse a voice in the selection of the association president for 2009--2011.

The year 2006 has seen concern intensify about the adequacy of nursing human resources to meet health system demands provincially, nationally and internationally, The NANB is an active participant in a variety of provincial and national initiatives focusing on the education of registered nurses, the utilization of nursing care providers, maximizing nurses' ability to bring the full extent of their knowledge, skill and judgment to the delivery of nursing and health services as well as enhancing the assessment of and supports for internationally educated nurses to facilitate their successful integration in the Canadian health system and society.

Operationally, the NANB is upgrading and redesigning its Web site, enhancing the NANB data base functionality, developing an online process for initial registration, and designing and developing an electronic news bulletin for members and stakeholders. The Web site and electronic bulletin will be launched this fall. Enhancing NANB services and systems positions the Association to better meet members' communications expectations and facilitates the Association's supports to professional nursing practice.

The implementation of the Continuing Competence Program for 2008 reflects the Association's and members' commitment to competent, ethical and safe nursing services for the people of New Brunswick. Public protection through responsible and proactive regulation remains the most important aspect of our mandate. Working collaboratively, both provincially and nationally, ensures the NANB will continue to evolve as required to meet the public's need.

Thank you to all NANB members and staff for your engagement and commitment to the profession and the Association.

Sue Ness President

Roxanne Tarjan Executive Director

Highlights From 2006

Protection of the Public

Mutual Recognition Agreement

The 1994 Agreement on Internal Trade (AIT), a federal, provincial and territorial agreement, was developed to reduce interprovincial barriers to the movement of workers, goods, services and capital. In response to the requirements of the AIT, provincial and territorial nursing regulatory bodies established a Mutual Recognition Agreement (MRA) to reduce barriers and facilitate the mobility of registered nurses between provinces. This initial agreement was developed and supported by most regulatory bodies in 2000. Since that date, nurse practitioner practice has been established across Canada and a MRA is required to facilitate their inter-provincial mobility. To update the current RN agreement and develop an NP agreement, a national workgroup has been established with NANB as a member. The anticipated completion of the RN agreement will be in 2007 and the NP agreement in 2008.

Canadian Nurse Practitioner Examination (CNPE)

The provincial and territorial regulatory bodies have worked collaboratively since 2000 with the Canadian Nurses Association and its testing subsidiary (Assessment Strategies Inc.) and the Canadian Nurse Practitioner Initiative (CNPI) to develop a national registration exam for primary health care nurse practitioners. The exam which is called the Canadian Nurse Practitioner Examination: Family/All Ages (CNPE F/AA) was administered for the first time in New Brunswick in May 2006. The exam will be offered twice a year and is a requirement for registration as an NP in New Brunswick.

Temporary Nurse Practitioner Registration

The NANB board of directors approved the establishment of a temporary nurse practitioner registration in June 2006. The purpose for issuing a temporary nurse practitioner registration is to enable a registered nurse who has completed an approved nurse practitioner program and who has applied to write the Canadian Nurse Practitioner Registration Examination (CNPE) or who is awaiting the results of the CNPE to practice as a graduate nurse practitioner. Since the CNPE will only be administered twice a year (May and October), this allows the graduate NP to practise thus facilitating the integration of knowledge, skill, and judgment as a beginning practitioner.

A nurse practitioner with temporary registration is able to provide nursing care in accordance with the NANB document Competencies and Standards of Practice for Nurse Practitioners in Primary Health Care with the following limitations: the graduate nurse practitioner cannot order screening and diagnostic tests, prescribe drugs or order the application of energy without a physician or registered nurse practitioner reviewing and co-signing any order or prescription as noted above.

Jurisdictional Review of Registered Nurse Exam Questions

A requirement of the ongoing development and maintenance cycle of the Canadian Registered Nurse Examination (CRNE) is a jurisdictional review of new test questions. NANB supports this process on an annual basis by recruiting a Francophone and an Anglophone review team from nurses in clinical practice and education. The Anglophone team met in June and the Francophone team met in August of 2006 to complete the review of questions. New "test questions" are integrated into the CRNE following an established validation process to facilitate the continuous renewal of the exam. The CRNE is provided under contract with the NANB and other jurisdictions by the Canadian Nurses Association and its testing subsidiary, Assessment Strategies Inc. (ASI).

Temporary Emergency Registration

In October 2006, the Board approved a rule amendment to enable temporary emergency registration. The purpose of temporary emergency registration is to expedite the registration of eligible nurses and nurse practitioners in order to respond to an emergency situation within the province such as a natural disaster or a medical emergency such as a pandemic influenza. Temporary emergency registration will be limited to 60 days and will only apply to those nurses who meet all requirements for registration as established.

Nurse Refresher Program: 2006 Statistics

The 2006 New Brunswick Nurse Refresher Program statistics continue to show a decrease in the number of enrollments as illustrated in the table below. Former registered nurses who do not currently meet the requirements for registration wishing to return to nursing practice are required to complete the above program which includes a clinical placement to meet requirements for registration. The program is provided to New Brunswick candidates through a contractual agreement with Grant MacEwan College, Alberta.

Entry-Level Competencies

Entry-level competencies describe what is expected of an entry-level nurse or new graduate in order to provide safe, competent and ethical nursing care in a variety of practice settings. Entry-level competencies also serve as a guide for curriculum development in nursing education programs and inform the public and employers of the competencies of newly registered nurses.

NANB participated in a national collaborative project, initiated by the jurisdictional executive directors, to revise entry-level competencies with a focus on consistency between jurisdictions. The document entitled Competencies in the Context of Entry-Level Registered Nurse Practice was approved by the NANB board of director in 2006 and replaces the 2000 NANB Entry-Level Competencies document.

Sustaining the Supply of Registered Nurses

In 2006, the total number of students admitted to basic nursing education programs in New Brunswick was 428 which falls short of the 465 seats allocated for funding. The University of New Brunswick admitted 274 students out of their 281 allocated seats. This demonstrates a significant increase since 2005 when 219 students were admitted. In 2006, the Universite de Moncton admitted 154 students out of their 184 allocated seats which demonstrates a significant decrease since 2005 when 172 students were admitted. Both universities have turned away qualified applicants because of capacity limitations. The NANB is continuing to work collaboratively with the universities and government through the Nursing Education Stakeholders Group to achieve full integration of all funded seats in an effort to mitigate the impact of an aging nursing workforce as well as the current and predicted future workforce shortage.

In September 2006, the Universite de Moncton reported 36 nurses in their master's program and 20 nurses in the nurse practitioner program. The University of New Brunswick reported 46 in the master's program and 13 in the nurse practitioner program.

Survey of Graduates and Their Employers

In 2005, NANB initiated a graduate nurse survey in partnership with the Universite de Moncton. In 2006, the second cohort of New Brunswick graduates was surveyed. The goal of the survey is to identify the employment profile of graduates, their perception of their preparedness to assume the role of an entry-level nurse; their perception of the usefulness of orientation and mentorship programs and their future career intentions. Employers of nurse graduates are also surveyed to identify the employers' perception of the graduates' preparedness to assume the role of the entry-level nurse. The survey of new graduate nurses and their employers will continue over the next three years in order to facilitate analysis and trending data and inform ongoing development and maintenance of entry-level competencies and curriculum development for nursing education programs.

Nursing Education Program Approvals

The NANB has the legislated authority under the Nurses Act (1984) to develop, establish, maintain and administer standards for nursing education. The purpose of the NANB nursing education approval process is to ensure that the NANB standards for nursing education are being met. Three education programs went through the approval process in 2006.

The Universite de Moncton's (UdeM) nurse practitioner program went through its first approval visit in February 2006 and received the maximum approval status of three years with the requirement that the program submit a report to the NANB board each year demonstrating that specific recommendations from the approval team report are being addressed.

The UdeM basic nursing education program received the maximum approval status of five years with the condition that two satisfactory progress reports be submitted in 2008 and 2010.

The University of New Brunswick's nurse practitioner program went through the approval process for the second time and received the maximum approval status of three years.

Continuing Competence Program (CCP)

At the annual meeting in 2005, NANB members approved the establishment of the continuing competence program as a regulatory requirement to support public protection beginning in 2008. The purpose of CCP is to provide a framework for all New Brunswick registered nurses (RN) to demonstrate on an annual basis how they have maintained their competence and enhanced their practice.

The CCP requires nurses to reflect on their nursing practice using a three-step process. Program requirements include the development of a personal learning goal based on the Standards of Practice for Registered Nurses.

All members received a copy of the CCP manual (guide and worksheets) in January 2007. Nurse practitioner (NP) manuals include the basic RN package as well as an additional section reflecting NP competencies.

To support members in the implementation of this new regulatory requirement, one-hour information sessions will be offered throughout the province beginning in March through May, and again September through November 2007. In addition, information is available and will be updated regularly on the NANB Web site. Members can also call the practice department for personal support in meeting the CCP requirements, or using the tools. Info Nursing will continue to offer information including a column entitled "Frequently Asked Questions."

CNA Code of Ethics Review

The Canadian Nurses Association has initiated a review of its Code of Ethics for Registered Nurses. The project is being directed by Dr. Jan Storch. Work commenced in 2006 and is expected to be completed in 2008.

NANB participated in the first round of jurisdictional feedback September 19 and in a second round November 24, 2006. Early in the new year, all members had an opportunity to review and provide feedback to inform the review process. Additionally, focus groups will be facilitated through local NANB chapters.

Practice Consultations

The NANB supports professional nursing practice in the public interest by promoting good practice and preventing poor practice. To achieve this objective, the nursing practice consultation service provides individual or groups of nurses with advice, guidance and support for decision-making in their practice. The service continues to be highly valued by members. In 2006, 676 queries were received, with 87% (580 queries) of these from registered nurses, two percent from student-nurses and 11% from non-nurses. Queries to the service are received by telephone, letter or E-mail.

The majority of the calls are received from nurses providing direct care (39.5%), followed by nurse administrators (33%). Nurse educators and researchers account for 10% of calls and nurse practitioners account for 2.8%. Close to 15 % of the queries come from members who are self-employed or who work in other practice settings such as industry, government, and so forth.

Practice calls are reviewed regularly to identify significant trends and issues affecting nursing practice and to identify priorities for future development. Clinical practice calls are down slightly over last year (from 18% to 12%). Professional practice (22%), scope of practice (16%), and legal/liability concerns (12%) are the other frequent topics for which the NANB is consulted. Ethical concerns (3%) and workplace issues (8%) round off the major topics. Twenty-six percent of all calls are for general information. Sixty percent of calls required follow-up, which may include a combination of call backs, research, expert consultation, mail out, referral, written opinion and/or site visits. Some topical issues include immunization, documentation, delegation of procedures, medical orders and directives, skill mix and nurse practitioner practice.

Employer Verification of Registration

Employers are required under the Nurses Act (1984) to verify at least annually that nurses in their employ are registered with NANB. In order to assist employers with this time consuming activity, NANB introduced an on-line system which enables employers to verify the status of nurses in their employ quickly and efficiently. The system was piloted in the fall of 2004 and was made available to all employers at renewal time in 2005. The system also enables individual registered nurses to verify their registration status on-line. The system continues to be used widely and is a valued resource to both employers and nurses as reflected by positive feedback received.

Emergency-Preparedness

During 2006, further development of the NANB "Business Contingency Plan" was completed. The final draft of the business plan will be completed in 2007 for presentation and consideration by the NANB board of directors.

The NANB Web site continues to maintain links to essential information sources to assist members in accessing Information related to pandemic, influenza, Avian flu and West Nile virus as appropriate.

Advancement of Excellence in the Nursing Profession

NANB Awards

Every two years at the NANB biennial meeting the NANB awards are given to worthy recipients. The awards include: life membership; honorary membership; excellence in clinical practice; and awards of merit in practice, administration, research and education. A new award, the entry-level nurse achievement award, was approved by the NANB board of directors in October 2006 and will be given for the first time at the Awards Banquet at the biennial meeting on May 30, 2007.

CNA Certification

NANB and its members continue to contribute, participate in and support the Canadian Nurses Association (CAN) certification process. A total of 100 New Brunswick nurses received specialty certification from the CNA in 2006 in the following areas: cardiovascular, community health, critical care, emergency, gerontology, hospice palliative care, nephrology, neuroscience, occupational health, oncology, orthopaedics, perinatal, perioperative, psychiatry/mental health and rehabilitation.

Canadian Nurse Practitioner Initiative

The Canadian Nurse Practitioner Initiative (CNPI), funded by Health Canada and led by the Canadian Nurses Association, was established to develop a pan-Canadian framework to promote the sustained integration of the role of the nurse practitioner in primary health care in order to improve Canadians' access to health services. The initiative was launched in June 2004 and was completed in March 2006. The final report included recommendations relating to: legislation and regulation; practice and evaluation; health human resources planning; education; and change management, social marketing and strategic communications. The NANB will now use this report to inform the further development and integration of the NP role in New Brunswick.

CNA Memorial Book

Two New Brunswick nurses, Edith Branch Pinet of the Acadian Peninsula and Lynn Margaret Childs of Saint John, were recognized in the CNA Memorial Book at the CNA Biennial Meeting in June 2006, following nomination by the NANB board of directors.

NANB NP Forum

The objective of this annual one-day event is to support the implementation of the NP role by bringing together nurse practitioners, graduate nurse practitioners and RNs enrolled in an NP program to share information on regulatory and practice issues; to provide an update on current government initiatives; and to provide an educational component/ event. The NANB NP forum was held October 27, 2006 in Moncton with 18 nurse practitioners, seven graduate nurse practitioners, 11 NP students, and four others for a total attendance of 40. As indicated by attendance, the forum is valued by participants and has facilitated the integration of NPs into the New Brunswick health care system.

NPs are currently working to establish an NANB NP Interest Group. A small working group is currently developing a constitution and bylaws for submission to the NANB board of directors meeting in 2007.

Fall Forums

In the fall of 2006, members of the NANB practice department held 10 full-day member forums across the province. Four hundred and forty-nine (449) nurses attended the sessions: one hundred and eleven (111) for the CCP presentation only, and three hundred and thirty-eight (338) for the full-day.

Members were updated on a variety of issues related to NANB's mandate and activities. Attendees also participated in an open discussion, providing an opportunity for members to query NANB staff as well as identify areas of concern related to nursing practice and health care services including providing suggestions for improvement in these areas. Information gathered from nurses will inform ongoing or future work of NANB. The CCP review/update was clearly the most enticing part of the day. Nurses also voiced interest about the NurseOne portal, which was described or demonstrated, and directions for signing on given. Feedback provided through session evaluations was overwhelmingly positive. Members continue to value and benefit from these outreach activities. Suggestions received will be used to enhance the development of future forum agendas.

Controlled Drug and Substances Act (CDSA)

The national Advisory Committee on Expanding the Authority to Prescribe Controlled Substances (of which CNA is a member) has been working over the past few years to assist the Office of Controlled Substances (OCS) in the development of a policy framework to expand the term "practitioner" to include other health professionals.

CNA and its jurisdictions support a broad prescriptive authority at the federal level with restrictions/limitations to be decided using provincial processes already in place to determine scope of NP prescriptive authority. NANB's executive director and nursing practice consultant met with Andy Scott, MP, November 15, 2006 to discuss the draft Policy Framework. Mr. Scott agreed to meet with OCS to reinforce the need for a broad prescriptive authority for nurse practitioners.

The draft framework for granting authority to other health professionals under the CDSA is now ready and it is anticipated that the new regulations will be published in the Canada Gazette, Part 1, in the spring of 2007. Extending prescriptive authority for controlled drugs to registered nurses who have been granted prescriptive authority through their regulatory body will increase access to needed services by the public.

Supporting Quality Resident Care in Long-term Care Settings

At the June 2005 annual general meeting, a resolution was submitted by members Debbie Walls and Kim Arsenault requesting NANB to lobby the New Brunswick Government "to ensure that nursing homes throughout the province are adequately and appropriately staffed to meet the increasing needs of the residents."

As part of responding to this resolution, which was approved by members, NANB met with thirty-three representative directors of nursing or client services from nursing homes at five locations in the province in March and April 2006. These sessions highlighted the challenges the long-term care sector is facing in meeting resident care requirements as well as providing input on how current nursing services could be improved to better respond to the increasingly complex and acute population health needs in nursing homes.

The NANB has utilized this information in its communications with the Department of Family and Community Services and will inform dialogue and input into the anticipated review/development of a long-term care strategy by government.

Supporting Research

NANB collaborated with the Women's Health Research Unit, Institute for Population Health, University of Ottawa, in a national survey of civilian and military nurses and physician assistants who have worked in emergency departments or critical care. Entitled, "Caring About Healthcare Workers As First Responders," the purpose of this project is to explore which organizational arrangements and supports are needed by health care workers as they balance their work roles and family responsibilities during infectious disease outbreaks. Of 15,000 nurses to be surveyed from across Canada, 500 were selected from New Brunswick. There was a two-phase mailing to New Brunswick Nurses--one in early May 2006 and the second in early June 2006.

NANB also participated in the research study, "Interdisciplinary Collaboration in Community Practice: Assessing Attitudes and Participation in Team-Based Health Care," led by Dr. Roy Dobson, College of Pharmacy and Nutrition, University of Saskatchewan. The study is funded by the Canadian Institutes of Health Research and the Saskatchewan Health Research Foundation. The research design is a three-year panel study of community-based health care practitioners, located within the Maritime Provinces, Quebec, Ontario, the Prairie Provinces, British Columbia, and the Territories. Eligible health care practitioners include: nurses licensed to practice by their respective provincial regulator and engaged, either full-time, part-time, or on a casual basis in community practice, family physicians/general practitioners, community pharmacists, and dietitians. Nurses are recognized as essential members of interdisciplinary teams, having a significant presence in the community, primarily as home care case managers, home care nurses, public health nurses, and in remote nursing stations. Those selected to participate received a baseline questionnaire in March 2006 with a follow-up questionnaire to come around the same time in 2008.

Researchers have acknowledged the participation and support of the NANB and its members when contacted, demonstrating commitment to the advancement of nursing knowledge and practice and the quality of health care services.

Defining a Framework for Registered Nurse Practice in Canada: CNA Scope of Practice Counterparts

In early 2005, CNA established an advisory committee of jurisdictional representatives to identify and address issues relating to the changing scopes of practice and potential implications for patient safety and quality care. The committee was mandated to develop a national framework for registered nurse practice in Canada to promote a common understanding about what constitutes registered nurse practice in Canada.

The committee met four times in 2006, including three teleconference meetings and one face-to-face meeting. The final draft was circulated in October 2006 for national consultation. The steering committee discussed the feedback from the national consultation at a teleconference meeting on December 14. A final version of the framework will be drafted and approved by the committee. The proposed final version was presented to the CNA board of directors at its meeting in March 2007.

Supporting Intra-Disciplinary Collaboration

In response to direct communications from members concerned about changes in the education and practice of LPNs, NANB staff met with representatives of the Association of New Brunswick Licensed Practical Nurses (ANBLPN) and New Brunswick Community College (NBCC, English branch) April 24, 2006. The ANBLPN and NBCC representatives reviewed the process for the establishment of curriculum and competencies for LPNs in the province and the respective roles and responsibilities of the ANBLPN and NBCC in this area. Additionally, the impact of a uniform national entry to practice examination and the requirement for national mobility of LPNs was highlighted. Framework and content of the adult physical assessment program and regulatory requirements were presented by the ANBLPN and NBCC representatives. Because changes to LPN practice ultimately impact RN practice, NANB will maintain dialogue with the ANBLPN, government and appropriate stakeholders as appropriate.

Inter-professional Education

In 2005, Health Canada responded to the need to change the way health professionals are educated by creating the Inter-professional Education for Collaborative Patient-Centered Practice (IECPCP) initiative, with the support of the Canadian Interprofessional Health Collaborative (CIHC), Health Canada supplied $750,000 to the University of New Brunswick, Saint John Campus (UNBSJ) and partner organizations (Atlantic Health Sciences Corporation [AHSC]; New Brunswick Community College, Saint John [NBCCSJ]; Dalhousie University faculty of medicine) to develop and implement a project. The project is expected to demonstrate the benefits of IECPCP and to increase the number of professionals trained in collaborative patient-centered practice, with the emphasis on the benefits of collaborative practice over the continuum of care and along the trajectory of chronic disease.

NANB was represented at this project launch in November 2006, as this ties in with ongoing work on intra-professional collaboration (with LPNs) as well as conforming to some extent with certain recommendations found in the Villeneuve & MacDonald (2006) CNA report, Toward 2020 -Visions for Nursing."

NurseOne/INF-fusion

NurseONE, also known as the Nursing Portal, is a national, bilingual, web-based health information service for the Canadian nursing community. The Portal serves as a gateway to resources and information for healthcare professionals in all domains of practice--direct care, education, administration, research--to support and enhance their clinical and professional careers. The Portal has been developed through a partnership between the Canadian Nurses Association (CNA) and the First Nations and Inuit Health Branch (FNIHB) of Health Canada. The secure, subscriber-only section of NurseONE provides nurses access to a wide array of tools and resources, from reference manuals and materials that support lifelong learning, to tools to build a portfolio and forums to connect with nursing peers. Nurses from across the country have been signing on at a rate of up to 500 per day. NANB has been promoting the Portal to nurses through the Fall Forums, the NANB Web site, and Info Nursing.

Promoting Nurses' Involvement in Health Informatics 

An NANB staff member attended a one-day workshop entitled Nursing Informatics: a 21st Century Perspective, as a pre-conference of the CNA biennium held in Saskatoon in June 2006.

In November, the senior nursing advisor for Canada Health Infoway met with the NANB executive director and practice consultant to discuss Infoway's end user acceptance strategy.

Practice and policy staff participated in a CNA informatics counterparts teleconference in December for an update on CNA's ongoing commitment to nursing informatics. CNA continues to 1) partner with key stakeholders, for example, CIHI, ICN and Infoway; 2) update and communicate relevant CNA documents; 3) communicate key messages and 4) retain an advisor on health informatics. These CNA activities support NANB in promoting nurses' involvement in health informatics.

First Nations N.B. Nursing Policy Project Advisory Group

During 2006, NANB participated in the development of Policies and Procedures for First Nations: Band-Employed Registered Nurses (FN:BE-RN) in New Brunswick. This was a project of FNIHB Atlantic (First Nations & Inuit Health Branch of Health Canada) and Mi'kmaq/Maliseet Atlantic Health Board (and approved by Atlantic Policy Congress of First Nation Chiefs Secretariat). Other members included representatives from the Government of New Brunswick and nurses working on reserve in New Brunswick.

Polices were developed in the main categories of professional responsibility and accountability, nursing practice, health protection, health promotion, administration, and human resources. The development of more uniform policies and procedures for all band-employed nurses will support them in meeting practice expectations, and positive client outcomes, as well as providing a communication tool between nurses and their employers.

Maximizing the Role of the Registered Nurse in Collaborative Practice

During November and December 2005, NANB staff delivered 12 workshops across the province directed at clinical nursing leaders. Entitled "Clinical Leaders: Key to Sustaining a Model of Collaborative Nursing Practice in New Brunswick," this full-day workshop focused on clinical leaders who support staff nurses working in acute care settings in order to clarify the role of the RN when working with others, particularly the licensed practical nurse.

Activities to support this project are currently focusing on direct-care providers through a series of articles in Info Nursing.

Maximizing the Role of the Registered Nurse in Collaborative Practice -Joint Educators' Forum

Planning, in partnership with the ANBLPN, began in December 2005 to host an Educators' Forum April 27, 2006. The theme for the forum was "Preparing RN and LPN Students for Their Future Roles in Collaborative, Professional Practice in the New Brunswick Workplace." The purpose of the one-day forum was to identify strategies to enhance the preparation of students for collaborative professional practice and was identified as a priority based on feedback from the Clinical Leaders Workshop series.

The one hundred and ten (110) attendees included instructors in the English and French practical nurse and baccalaureate nursing programs, as well as representatives from the various regional health authorities and the Government of New Brunswick. Participant evaluations indicated the value of the forum in enhancing ongoing communication and collaboration. Educators on the development committee produced reports on themes and strategies put forward by participants. The summative report from the forum proceedings was distributed to attendees and their organizations and continues to inform NANB activities related to collaborative practice.

Influencing Healthy Public Policy

IN THE INTEREST OF THE PUBLIC

Government of New Brunswick Working Group on Administration of Medications by LPNs in Acute Care Settings

In April 2006, NANB was invited by the Department of Health (DH), Government of New Brunswick (GNB), to have a representative on the committee to develop a guidelines document on Medication Administration by the Licensed Practical Nurse in Acute Care Settings. All-day meetings were held May 8 and 9; June 14 and 21; July 11 and November 24, 2006. The committee is providing input to the Association of New Brunswick Licensed Practical Nurses (ANBLPN) in the development of the above document. Development of the guidelines is ongoing. The final draft of the document will be circulated by the ANBLPN to selected stakeholders for review and input. It is anticipated that a final version of the document will be submitted to the ANBLPN board of directors for consideration in the fall of 2007.

Federal/Provincial Elections

During the 2006 federal and provincial election campaigns, NANB met with all political parties to outline the Association's position on sustaining and strengthening the health care system through primary health care reform and to promote the utilization of a health screen when reviewing and developing public policy. All candidates running in the provincial and federal election were sent a copy of NANB's priority document "Registered Nurses: Partners in the Delivery of Safe, Quality Health Care." Chapter presidents and members of the workplace communications network were also provided with copies of the foregoing to assist them when meeting with candidates locally.

Primary Care Collaborative Practice Project

The Primary Care Collaborative Practice Project, a joint initiative between the Department of Health and the N.B. Medical Society (NBMS), was extended to December 1, 2006. The goal of these pilot projects was to demonstrate improved access to primary health care services in physician offices through more complete utilization of the competencies of registered nurses.

The extension gave each of the four sites the opportunity to determine their intent to retain the RN and/or NP based on negotiated funding. NANB's representative on the advisory committee has not been formally notified whether the sites will retain the RN and/or NP, although it is believed that all four sites took advantage of the offer.

The advisory committee was scheduled to meet in early 2007 to wrap up the project.

Promoting Primary Health Care

The NANB is represented on the Department of Health Primary Health Care Collaborative Committee, an advisory committee to the Deputy Minister of Health. The committee's term is 2005 to 2007, with a mandate to review and make recommendations on more accessible and effective primary health care service delivery models for use around the province.

The committee has reviewed the department's primary health care framework and, through its chair, has advised on improved linkages. The committee's focus in 2006 has been on the province's proposed chronic disease management strategy. The proposed Department of Health (DH) strategy uses an integrated chronic care model, the Wagner model, that has been shown to improve patient outcomes and reduce costs for many chronic conditions.

In October 2006, committee members attended a one-day symposium on chronic disease management hosted by the DH. The committee has held three meetings in 2006. The meeting planned for late fall has been re-scheduled for February 2007.

New/Revised NANB Publications

NANB Continuing Competence Program (new)

* Breastfeeding and Artificial Breast Milk Substitutes (revised)

* NANB Entry-Level Competencies (revised)

* Nurse Practitioner Schedules for Ordering (revised)

Standing and Legislative Committees

Complaints Committee

The complaints committee screens written complaints about the conduct of members and former members of the Nurses Association in accordance with the Nurses Act. It is the first level of a formal two-step process for dealing with such complaints. The committee screens out complaints that do not relate to professional conduct or do not require further consideration. Serious matters are referred by the complaints committee to either the discipline committee or the review committee for further consideration and investigation.

Committee members are Nicole Brideau (chairperson), Patricia Roy, Monique Ouellette, Tanya Jenkins, Erin Musgrave, Nancy Sheehan, Mark Brown, Chantal Saumure, Etienne Theriault, Albert Martin, Jack MacKay and Jeannita Sonier.

Discipline and Review Committee

The NANB discipline and review committees consider complaints referred to them by the complaints committee of the Association. The discipline and review committees perform the second step of a two-step professional conduct review process. Health related problems which prevent a nurse from practising safely are considered by the review committee, while all other complaints are handled by the discipline committee.

Committee members are Roberte Vautier (chairperson), Liette Clement, Rinette Cote, Luc Drisdelle, Marise Auffrey, Angela Arsenault-Daigle, Trevor Fotheringham, Sandra Mark, Paulette Christie, Denise Tardif, Valarie Dickeson-Gallagher, Florence Thibodeau, Heather Bursey, Claire Cyr, Raelyn Lagace, Jamie Stockton, Edith Tribe, Elizabeth Owens, Reinelde Theriault, Jean LeBlanc, Denis Morisset and Charles Flewelling.

Nursing Education Committee

The purpose of the nursing education advisory committee is to assist the NANB board of directors in fulfilling its responsibilities for developing, establishing, maintaining and administering standards for university nursing education, nurse refresher programs and continuing nursing education. The committee also tracks trends in health care which impact nursing education and recommends issues and matters to the board which may require further study.

Committee members are Nancy Logue, chairperson; Patricia Cormier, Tracie Ouellette, Linda LePage-LeClair, Reida Woodside, Jeannette LeBlanc, Rosemary Boyle, and Joan Lutes.

Nurse Practitioner Therapeutics Committee

The nurse practitioner therapeutics committee is an advisory committee to the NANB board of directors. The committee develops and reviews Schedules "A," "B," "C" and "D" of the Rules Respecting Nurse Practitioners and makes recommendations with respect to:

* the screening and diagnostic tests that may be ordered and interpreted;

* the drugs that may be selected or prescribed; and

* the forms of energy that may be ordered and the circumstances under which they may be ordered by a nurse practitioner.

The recommendations for changes to the schedules must receive approval by the Minister of Health. The committee meets annually to consider changes to the schedules. At the time of writing this report, a meeting was tentatively scheduled for April 2007.

Committee members include two nurse practitioners: Jacalyn Boone (chairperson) and Martha Vickers; two pharmacists: Bill Veniot and Hugh Ellis; two physicians: Dr. Timothy Snell and Dr. Perry Spencer.

Resolutions Committee

The resolutions committee receives and screens resolutions and decides whether to refer a resolution to the board of directors, to NANB staff or to present it to the annual meeting. Committee members edit resolutions for clarity and make suggestions to the sponsors for corrections and clarification, where necessary. Committee members determine the order in which the resolutions will be presented at the annual meeting.

Resolutions may be received at any time throughout the year, but should be received not less than six weeks before presentation at NANB board, or twelve weeks for presentation at an annual meeting.

Committee members are Debbie Marks (chairperson), Ruth Alexander, and Connie Armstrong.

Committee Reports

Complaints Committee

~ By Nicole Brideau, RN, Chairperson

This report outlines the activities of the NANB complaints committee in 2006. The complaints committee screens written complaints about the conduct of members and former members of the Nurses Association in accordance with the Nurses Act. It is the first level of a formal two-step process for dealing with such complaints. The committee screens out complaints that do not relate to professional conduct or do not require further consideration. Serious matters are referred by the complaints committee to either the discipline committee or the review committee for further consideration and investigation.

It should be noted that the formal complaint process under the Nurses Act is generally a measure of last resort. The overwhelming majority of concerns and issues related to the practice of nurses are resolved at the agency or institution level. Staff of the Nurses Association provides consultative services to members, the public and employers on how best to address concerns related to a nurse's practice or conduct.

In 2006, the complaints committee received ten complaints. Four complaints were made by members of the public against nurses respecting the treatment of the same client. Five of the complaints were lodged by a supervisor or representative of the employer and one complaint was made by the NANB registrar. It should be noted that in many cases, complaints lodged by employers relate to problems originally identified by patients and/or co-workers.

I want to extend my gratitude to the nurses and members of the public who serve on this committee for their leadership and integrity. If you would like more information about the professional conduct review process, or if you are interested in serving on the complaints committee, please contact the Nurses Association and ask to speak with the regulatory consultant--professional conduct review.

Discipline and Review Committees

~ By Roberte Vautier, RN, Chairperson

Under the Nurses Act, the Nurses Association of New Brunswick is legally required to maintain a formal process for dealing with complaints against nurses which relate to professional conduct. The NANB discipline and review committees consider complaints referred to them by the complaints committee of the Association. The discipline and review committees perform the second step of a two-step professional conduct review process. Health related problems which prevent a nurse from practising safely are considered by the review committee, while all other complaints are handled by the discipline committee.

The discipline and review committees held nine hearings in 2006 related to seven cases:

CASE 1: The discipline committee met to consider a complaint concerning a nurse from the hospital sector who was reported for incompetence. The member had successfully completed the modularized refresher program as ordered by the discipline committee in 2004. The member was granted a conditional registration and ordered to pay costs of $1,200.

As a result of the member's failure to meet the conditions imposed, the member's registration was suspended. The discipline committee held a second hearing and found the member to be suffering from conditions rendering her incapable and unsafe to practise nursing in a direct patient care environment. The member is eligible to apply for a conditional registration.

CASE 2: The review committee held a reinstatement hearing at the request of a member whose registration had been revoked in September 2004 for professional misconduct and theft resulting in a criminal conviction. The member was ordered to meet specific requirements prior to applying for a conditional registration. The member was also ordered to pay costs of $1,000.

CASE 3: The review committee met to consider a complaint referred to it by the complaints committee concerning a nurse from the hospital sector who was reported for substance abuse and theft of narcotics. At the request of the member, the hearing was adjourned to a later date. The review committee held a second hearing to consider this complaint and found the member to be suffering from an ailment or condition rendering her unfit, incapable and unsafe to practise nursing. The member's registration was revoked and reinstatement will not be considered until evidence shows that the member is ready to return to the practice of nursing in a safe manner.

CASE 4: The discipline committee met to consider a complaint referred to it by the complaints committee concerning a nurse from the hospital sector who was reported for medication administration errors and who demonstrated a lack of skills and judgement. The member was granted a conditional registration.

CASE 5: The discipline committee met to consider a complaint referred to it by the complaints committee concerning a nurse from the hospital sector who was reported for incompetence. The member was found to be suffering from an illness rendering her unfit and unsafe to practise nursing. The member's registration was suspended for a period of three months and will remain suspended until specific requirements are met, at which time the member will be eligible to apply for a conditional registration. The member was ordered to pay costs of $2,500.

CASE 6: The discipline committee held a reinstatement hearing at the request of a member whose registration had been revoked in July 2004 for breach of confidentiality and unethical conduct. The member was ordered to complete a module on ethics in nursing from the NANB modularized refresher program prior to applying for a conditional registration.

CASE 7: The review committee met to consider a member's failure to meet the conditions imposed on her registration in September 2005 subsequent to a complaint related to substance abuse. The member's registration was revoked for a period of two years. The member was ordered to pay one half of all costs incurred by the Association since the September 2005 review committee decision.

Four other cases were carried over to 2007.

ACKNOWLEDGEMENTS: I would like to extend a special thank-you to vice-chairperson, Liette Clement, for sharing this responsibility with me. I would also like to acknowledge the contribution of those nurses and members of the public who have given so selflessly of their time, expertise and caring to ensure that the process of self-regulation remains a fair and just process for all. Their task is a difficult one, and no decision is ever made lightly. The integrity of the professional conduct review process is a reflection of the commitment of the people involved. I would encourage any member who is interested in becoming involved with the discipline and review committees to contact the regulatory consultant--professional conduct review at the Nurses Association. It has been a challenging and humbling experience to serve my profession in this capacity and I would not hesitate to recommend it to anyone.

Nurse Practitioner Therapeutics Committee ~ By Jacalyn Boone, NP, Chairperson

In April 2006, the NANB nurse practitioner therapeutics committee reviewed requests for additions to the Schedules of the Rules Respecting Nurse Practitioners. The committee's recommendations for amendments to the schedule were approved by the NANB board of directors and by the Minister of Health and Wellness. The amendments were effective October 2006.

Resolutions Committee ~ By Deborah Marks, RN, Chairperson

The following Sussex Chapter members volunteered to serve on the NANB resolutions committee for a two-year term (2006-2008): Debbie Marks, Ruth Alexander, Connie Armstrong. Appointments were approved at the October NANB board meeting.

No resolutions were received in 2006.

Nursing Education Advisory Committee ~ By Nancy Logue, RN, Chairperson

The nursing education advisory committee held two regular meetings and one subcommittee meeting in 2006. The Universite de Moncton's nurse practitioner program received its first approval visit in February 2006. Based on the report of the approval team, the committee recommended to the NANB board of directors a three year approval of the program as well as the submission of an annual report to address specific recommendations from the approval team report.

The committee selected members for two teams for approval visits of the University of New Brunswick's nurse practitioner program and the Universite de Moncton's basic nursing program. The approval visits took place in November 2006.

NANB participated in a jurisdictional collaborative project to revise entry-level competencies. The final document entitled Competencies in the Context of Entry-Level Registered Nurse Practice was reviewed by the committee and recommended to replace the 2000 NANB Entry-Level Competencies document.

A subcommittee of the nursing education advisory committee reviewed a submission for approval of the Atlantic Health Sciences Corporation's Perioperative Nursing Course. The subcommittee did not recommend approval of the course since it requires major revisions in order to meet the NANB Standards for Nursing Education. Approval of continuing nursing education programs is voluntary.

Enhancing NANB Services:

IMPLEMENTATION OF THE 2004 ORGANIZATIONAL REVIEW RECOMMENDATIONS

Board Size and Structure

One of the recommendations in the final report of the 2004 NANB Organizational Review was to reduce the size of the board from 21 to 12. This recommendation was implemented in September 2006. The new Board, comprised of a president, president-elect, seven region directors and three public members, met for the first time in October 2006.

Vote-by-Mail Election

The first vote-by-mail election in which seven directors were elected to the board of directors took place in April 2006. Elections were held in Region 1 and Region 2 with 27% of eligible voting members participating, a significant increase over the usual five to six percent of members previously voting in person or by proxy during the annual meeting. Directors from the other regions were elected by acclamation.

On-line Registration Renewal

2006 marks the second year that online registration renewal has been available to registered nurses. Over 500 nurses utilized this service during registration renewal this year, up slightly from 2005 when the service was first introduced. The process involves completing an online registration renewal form and payment of the registration fee using an approved credit card. Feedback from members has been very positive and the service has facilitated the renewal process.

Communications

Web Site

Preliminary work on the "look" for a new re-designed NANB Web page was completed late in 2006 with the view of continuing to build the architecture of the site for a release in the fall of 2007.

The new site will feature improved functionality and intuitive navigation. It will also enable the Association to profile, on an ongoing basis, major projects being carried out by the Association.

Sustaining and Supporting NANB Chapters

The Association hosted its first-ever "Chapter President's Forum" in conjunction with the October 2006 board meeting. The two-day forum brought together 10 of the 11 chapter presidents to discuss ways to renew and support chapters. An education session included presentations on the resolution process, the nominations process, the awards process and meeting the challenges of multi-generational communication and engagement.

Enhancements to Chapter visibility through the NANB Web site and Info Nursing journal have also been implemented. Chapters are able to post information on NANB's Web site including meeting times and dates, chapter minutes and other information of interest to local chapter members. Chapter presidents also took advantage of the Info Nursing journal to post their schedule of events under the heading "Chapter News."

Two chapter presidents were featured in Info Nursing during 2006: Bonnie Matchett, former Miramichi Chapter president and Terry-Lynne King, president, Saint John Chapter.

Workplace Communications Network

The Workplace Communications Network continues to provide an essential link to members in their workplace. Nurse volunteers are a key success component of the program. Once again, as a way of recognizing the work of workplace communication network representatives, the names of network representatives were published in the fall 2006 issue of Info Nursing.

More than two-thirds of the network volunteers receive information via E-mail which enhances the timeliness of Communication activities.

Media Relations

The Nurses Association of New Brunswick responded to over 35 media interviews during 2006 ranging in topics from health human resources, to the role of the nurse practitioner, to the expanded role of the nurse in emergency departments, to collaborative practice, among other topics.

The communications department, in concert with the executive director's office, has developed an issues-specific resource kit to help expedite the time elapsed between media calls and actual interviews to ensure opportunities for the Association to speak out on nursing or health related issues are maximized.

NANB Nursing History Resource Centre

NANB was an active participant in a research project entitled "Connecting with the History of Labour in New Brunswick: Historical Perspectives on Contemporary Issues" which was led by UNB history professor David Frank and a co-investigator from the Universite de Moncton. The research of the project focussed on five key areas, one being the role of women as caregivers, particularly nurses. NANB provided access to archival records in the Nursing History Resource Centre and provided in-kind resources to support the cataloguing of the centre's archival material which was completed in August 2005. In 2006, under the guidance of the New Brunswick Museum, NANB began the process of cataloguing the Centre's artefacts. Cataloguing of the artefacts and archival material is essential to making the collection more accessible and to facilitate research. Additionally, ongoing concern related to the preservation of this important collection has led NANB to explore options to ensure the long-term maintenance, enhancement and promotion of the collection and the history of nursing in New Brunswick.

Phone [phone] [phone]

Fax [phone]

P.O. Sox 1051 E3B 5C2

WINSTON NICHOLSON

Chartered Accountant 

328 King Street Fredericton, NB

AUDITOR'S REPORT 

To the Executive Nurses Association of New Brunswick

I have audited the statement of financial position of the Nurses Association of New Brunswick as at December 31, 2006 and the statements of changes in fund balances, operations, and cash flaws for the year then ended. These financial statements are the responsibility of the Nurses Association of New Brunswick's management. My responsibility is to express an opinion on these financial statements based on my audit.

I conducted my audit in accordance with Canadian generally accepted auditing standards. Those standards require that I plan and perform an audit to obtain reasonable assurance whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation.

In my opinion, these financial statements present fairly, in all material respects, the financial position of the Nurses Association of New Brunswick as at December 31, 2006 and the changes in fund balances, results of its operations and its cash flows for the year then ended in accordance with Canadian generally accepted accounting principles.

Fredericton, NB February 9, 2007

Chartered Accountant

New Brunswick Nurse Refresher Program

                       2001    2002    2003    2004    2005    2006

Enrollment for year      18      64      26      25      18       9
Completed                22      43      15      15       7       9
Did not complete          4       2       0       1       0       0

Membership Highlights

Number of Members               * Year 2006    Year 2005     Year 2004

Registered                         8523          8458           8312
Non-practising                      381           370           412
Life                                19            19             18
Total                              8923          8847           8742

Number of New Registrants       * Year 2006    Year 2005     Year 2004

N.B. graduates                      256           260           283
Graduates from other                82            93             82
provinces/territories
Graduates from outside Canada       10             9             10
Total                               348           362           375

Number of Employed Nurses       * Year 2006   * Year 2005   * Year 2004

Full time                       4811 (60%)    4769 (60%)     4488 (59%)
Part time                       2176 (27%)    2176 (27%)     2126 (27%)
Casual                           604 (8%)      572 (7%)       518 (7%)
Other **                         455 (6%)      443 (6%)       549 (7%)
Total                             8046          7960           7781

* Year 2006 - Preliminary data

** Includes employed nurses on temporary leave
(ex. Maternity, educational,    disability leave, etc.)

Place of Employment             * Year 2006   * Year 2005   * Year 2004

Hospital                        5248 (65%)    5163 (65%)     5131 (66%)
Community                        592 (7%)      669 (8%)       577 (7%)
Nursing Home                     822 (10%)     776 (10%)      733 (10%)
Extra Mural Program              438 (5%)      396 (5%)       411 (5%)
Other **                         946 (12%)     956 (12%)      929 (12%)
Total                             8046          7960           7781

* 2006 - Preliminary data

** Includes physician offices, industry, educational association,
government, correctional facilities (provincial/federal), addiction
centres, armed forces.

Age Distribution
(employed nurses)               * Year 2006    Year 2005     Year 2004

under 25                         187 (2%)      218 (3%)       164 (2%)
25 - 29                          647 (8%)      575 (7%)       548 (7%)
30 - 34                          739 (9%)      767 (10%)     794 (10%)
35 - 39                         1079 (13%)    1145 (14%)     1261 (16%)
40 - 44                         1383 (17%)    1398 (18%)     1379 (18%)
45 - 49                         1339 (17%)    1331 (17%)     1278 (16%)
50 -54                          1330 (17%)    1305 (16%)     1273 (16%)
55 +                            1342 (17%)    1221 (15%)     1084 (14%)

* 2006 - Preliminary data

Gender Distribution
(employed nurses)               * Year 2006    Year 2005     Year 2004

Female                          7111 (96%)    7640 (96%)   7478 (96.1%)
Male                             335 (4%)      320 (4%)      303 (3.9%)

* 2006 - Preliminary data

Professional Conduct Review Statistics

Complaints Received             * Year 2006   * Year 2005   * Year 2004

Complaints carried forward           0             2              2
  from previous year
New complaints received in          10             4             10
  current year
Referred to Review Committee         2             3              3
Referred to Discipline               4             1              5
  Committee
Dismissed                            4             2              2
Carried forward to next year         0             0              2

Discipline and Review
Committee Hearing               * Year 2006   * Year 2005   * Year 2004

Cases carried over from              2             4             4
  previous year(s)
Cases received in                   10             4             8
  current year
Discipline Hearings                  5             3             2
Review Hearings                      4             3             7 *
Dismissed                            0             0             1
Carried forward to next year         4             2             4

* One hearing was not completed to the next year

Please note: Detailed reports of both the NANB complaints and
discipline and review committees are included elsewhere in this
report.

Allegation                   Setting        Outcome

Failure to take              Nursing Home   Dismissed
appropriate action

Failure to take              Nursing Home   Dismissed
appropriate action

Failure to assess client;    Nursing Home   Dismissed
substandard documentation

Failure to assess client;    Nursing Home   Dismissed
substandard documentation

Substance abuse, theft,      Hospital       Referred to review
medication administration                   committee. Suspension
and/or documentation error                  pending outcome of
                                            hearing

Theft of narcotics           Hospital       Referred to review
                                            committee. Suspension
                                            pending outcome of
                                            hearing

Substance abuse, theft,      Hospital       Referred to review
medication administration                   committee. Suspension
and/or documentation error                  pending outcome of
                                            hearing

Fraud/deceit, working        Hospital       Referred to review
without a valid                             committee. Suspension
registration                                pending outcome of
                                            hearing

Medication administration    Hospital       Referred to review
and/or documentation                        committee. Suspension
error; poor interpersonal/                  pending outcome of
communication skills                        hearing

Medication administration    Hospital       Referred to review
error; lack of skills/                      committee. Suspension
judgement                                   pending outcome of
                                            hearing

NURSES ASSOCIATION OF NEW BRUNSWICK
STATEMENT OF FINANCIAL POSITION
DECEMBER 31, 2006

                                                 2006         2005
                                               General      General
                                                 Fund         Fund

Current assets                                $3,357,527   $3,296,273
  Cash and investments                             9,385        4,124
  Accounts receivable                             14,022        5,319
  Prepaid expenses                                 8,003        5,671
  Accrued interest receivable                          0          214
  Due from Employee Benefit Fund               3,388,937    3,311,601

                                               1,559,611    1,607,753

Capital Assets--net of amortization           $4,948,548   $4,919,354

Current liabilities
  Accounts payable                              $411,527     $453,556
  Future revenue                               2,451,089    2,372,760
  Obligation under capital lease                  15,664       14,612
  Due to NANB Nursing History Resource                 0       10,000
   Centre Fund                                     3,729            0
  Due to Employee Benefit Fund                    47,000            0
  Due to Continuing Competency Program Fund    2,929,009    2,850,928

Long-term debts
  Obligation under capital lease                  26,800       42,464
                                                  26,800       42,464

Fund Balances
  Invested in capital assets                   1,517,148    1,550,677
  Unrestricted                                   475,591      475,285
                                               1,992,739    2,025,962

                                              $4,948,548   $4,919,354

Approved by the Executive Director