As we mark 25 years of RNAO’s Best Practice Guideline (BPG) Program, we would be remiss if we did not take a closer look at how today’s social landscape informs BPGs and the work of Best Practice Spotlight Organizations® (BPSO®). The issues of anti-Black racism, Indigenous health, 2SLGBTQI+ health equity and harm reduction are social concerns that RNAO addresses.

So, what do these social issues have to do with BPGs?

Simply put: Lots. 

RNAO’s relentless commitment to evidence-based healthy public policy and equity BPGs serves to inform nursing practice in clinical settings, academic institutions, research, policy and administration. 

Let’s take a closer look at these social issues in the context of the BPGs that inform nursing practice in these areas, and the ongoing and crucial advocacy of BPG champions, BPSO leads and RNAO to stay true to a commitment that places patients, clients and community members at the core of practice change and policy development.

Work began in October 2023 on a new RNAO BPG focused on anti-Black racism in nursing, set for release in February 2026. Leading this work are RNs and co-chairs Dr. Bukola Salami, Canada Research Chair in Black and Racialized Peoples’ Health, and Dr. LaRon Nelson, Associate Dean for Global Health & Equity and Independence Foundation Associate Professor of Nursing at Yale University.

“We know that anti-Black racism is real,” Salami explains. “Black people experience disparities, and Black nurses…have challenges in terms of access to leadership and…face micro-aggressions.” Despite this, she says the social landscape has shifted since the early days of the racial reckoning tied to the murder of George Floyd in 2020. “What we’ve seen lately is a rise against...EDI (equity, diversity and inclusion) initiatives,” Salami says. “And we have to keep asking ourselves: How can we strategize and continue to address issues related to inequities and disparity?”

“It isn’t just going to help Black nurses; it’s going to help white nurses and racialized nurses too. We’ll have a competency that’s diverse rather than a competency that looks from one lens. Even though we’re doing work that has to do with equity, sometimes we build our own enclaves and get stuck in that. Let’s open these doors so we can walk into each other’s understanding.”

Prendergast says she “gets a lot” from her work on the panel. “With change, there’s going to be pain and discomfort, and I can walk with (colleagues) through this discomfort. I can walk through my own discomfort and my own pain. But the process of walking through this pain will transform me into a better person and will transform my colleagues to be better.”

Salami says the panel is a strong group of Black nurses who are committed to social justice and equity. And there’s an acknowledgement that the work isn’t done when the BPG is published. “Even after the BPG, we must continue on the journey towards equity. It’s not about reaching a goal (the BPG) and we’re done. It’s a continuous process.”

“We lost a champion a year ago due to suicide. She was part of the team, and helped the team move forward and grow,” Meekis remembers fondly. The trauma of that loss has stirred a need in Meekis to participate in the new BPG. “For my healing journey, I feel I need to try and help others. We’ve lived it, and we as a team at Sandy Lake…recognize the gaps. There’s the before, during and after (with suicide). There’s a lot of prevention and a lot of support during, but the after…there’s a lot of gaps…there’s something lacking there. As part of the panel for the new BPG, we can be part of the change and bring more awareness to this.”

BPG implementation for Sandy Lake – which is also implementing guidelines on peri-natal depression and person- and family-centred care – is all about one-on-one communication with clients, Meekis explains. “If we can change one person’s opinion or perspective, that has a big impact for us because that one person will let others know, and that’s the start of the change.”

One of the team’s most successful awareness building campaigns came in the form of a radio show in the spring of 2023. Everyone in the community loves to tune in to the local station, and many listeners are engaged by calling in to win prizes, Meekis says. 

“For individuals who are non-binary or who identify as trans…any medical procedure is incredibly anxiety-provoking because you’re never quite sure how you’re going to be perceived,” Stranges adds. “It’s always an uphill battle around ensuring that your preferred pronouns are being used, and people understand your preferences around language, around body parts…and just respecting your dignity.”

Quest’s general client experience survey, handed out by providers after appointments or to clients in the waiting area, has also resulted in positive feedback. According to Ailish Westaway, a health promoter and the BPSO lead at Quest, 100 per cent of 2SLGBTQI+ clients who completed the survey in 2023 responded that Quest uses language that makes them feel included, and 92 per cent felt Quest welcomed them and treated them in a non-judgmental way.

“Interactions with the health-care system have been unfortunately historically quite painful for the population,” Stranges says. “Building that trust and word-of-mouth that it is a place you can come, feel safe, feel respected and have boundaries respected – it makes a big difference.”

As a BPSO, Quest is implementing a total of eight RNAO BPGs. It participates on several community committees and works with community partners such as Rainbow Health Ontario to raise awareness at events and conferences. It works with other community care partners to train-the-trainer on culturally competent care for the 2SLGBTQI+ community accessing post-operative services, which can be challenging after gender affirming surgery. Quest also works closely with Niagara Region’s Ontario Health Team to ensure the needs of the 2SLGBTQI+ population are represented in all health sectors. 

“The BPG is so important because…(2SLGBTQI+ health equity) is an ever-changing and evolving (issue). It takes work. You have to keep working at it and this is a great opportunity to keep working and evolving as an organization.”

Read more about the impetus for the BPG, and the lived experiences of some of its panel members in the Winter 2022 issue of RNJ. 

RN Giulia Daniele is its addictions medicine and mental health clinical nurse specialist and best practice champion. She assumed her role in June 2023, when TBRHSC acknowledged the need for an individual dedicated to this work. Thunder Bay has been identified as the number-one city for opioid overdose deaths per 100,000, she explains. “That was a major contributor to us doing some of this work because we recognized there was a concern.” 

In her role, Daniele supports staff who have questions and concerns in relation to mental health and substance use. She leads efforts to educate colleagues on stigma, harm reduction and trauma-informed care, and improves policies and procedures to support nurses who work with patients who use substances. The BPG “helps guide a lot of our initiatives…any time policies and procedures come about…we are looking to see what is in the BPG and how we can implement that into our practices.”

Daniele works closely with RN Kim Gross, who was also hired to raise attention to harm reduction in acute care. On a referral basis, Gross assesses patients and supports their families in collaboration with the health-care team and ensures seamless discharge to the community by connecting with external partners. This transition is critical to ensure patients and families continue to get what they need, when and where they need it. 

In fact, it became even more critical in August 2024, when Path 525 – a supervised consumption services (SCS) site operated by the NorWest Community Health Centre in Thunder Bay – received notice that it would be one of 10 Ontario sites closing in March 2025 (read more below and in RNAO’s response to the news of the closures). 

Tali Magboo Cahill is an Ottawa acute care RN and the former eastern Canada representative for the Harm Reduction Nurses Association of Canada. She helped plan and acted as a panelist in a webinar hosted by RNAO’s Mental Health and Substance Use Program. 

The webinar focused on the need for increased harm reduction efforts in hospital settings. Nurses in acute care are uniquely positioned to help people who use substances, she says. “We have the ability to make or break a patient’s day and to work with them on making them comfortable. I think that’s a power we need to recognize…when people are in a very vulnerable time.”

“Harm reduction is evidence-based practice for people who use drugs. There’s a growing gap between what’s happening in the community…and what’s happening in the hospital. The more this gap grows…the poorer we’re serving our patients,” she says.  

Acute care nurses are often unsure of their harm reduction role(s) because there are limited policies and procedures that clearly define what they should be doing, Magboo Cahill adds. But “...you don’t need a policy to give you permission to treat people with empathy and to treat them well,” she reminds nurses. “You don’t need a policy to be non-judgmental.”