Author Archives: ARNBC

The Gift of Nursing this Mother’s Day, by Christina Larsen, BSN Student

As Nursing Week 2017 comes to an end, and with Mother’s Day coming on the last day of Nursing Week, I find myself thinking about what to do for my Mom this Sunday. Should I pick out a bouquet of flowers? Write a thoughtful message in a card? What about taking her to the spa? What could I possibly do for my Mom to show just how much I love her? Flowers, card, and spa trips are nice gifts but they don’t come close to showing the appreciation I have for her and everything she does.

My Mom is an ICU nurse and has been for nearly thirty years. Beyond the love that she shares with me, she expresses her nurturing nature through this work. Her dedication to the profession is awe inspiring, and her expertise and attention to detail is nothing short of amazing. She is everything you would want in a nurse; a safe and compassionate practitioner who thinks critically and is a fierce patient/client advocate. As a child I did not grasp the importance of what her work entails, but now as a nursing student, I better understand both the joys and challenges in nursing. In fact, she is the reason I am pursuing a career in nursing and most importantly is my mentor.

I am so thankful for all the sacrifices my Mom made to ensure I had a happy childhood and excellent education, and I am grateful to have the opportunity to work towards a Bachelor of Science in Nursing. My Mom graduated with her diploma in 1987. A lot has changed in nursing since then. This was a time where nursing graduates spent most of their careers in hospital wards. As the profession continues to grow, students like me are exposed to the vast array of nursing positions and ways in which we can work outside of the ward setting.

My final term of nursing school involves preceptoring with the Association of Registered Nurses of BC (ARNBC). At ARNBC, I will work alongside the staff to develop health policy. As a nursing student, this empowers me to use my practicum experience as one where I can analyze health care issues using an “upstream” approach. This means I can focus on illness prevention and health promotion advocacy work as the most effective way to improve the health of British Columbians.

The nursing profession has amazing potential to build each other up. Let us stand together as a unified force and a powerful voice that speaks for those who cannot. Let us use the wealth of nursing knowledge for good and work together to address the issues nurses, nursing students, and patients/clients face. Let us also take the time to appreciate each other as nurses and as family members’ of nurses.

Ultimately, I realized that none of my prospective Mother’s Day gifts were right. I realized that the best gift I can give to my Mom is to try to live up to her by being the best nurse I can be. So on this Mother’s Day, while my Mom will be at work tending to the needs of her patients/clients and colleagues, I will be thinking of her and ways to use my preceptorship to advocate on her behalf. Thank you, Mom, and to all nurses and nursing students. I encourage everyone to take a few moments to express your appreciation, whether it’s Nursing Week or not and visit Langara College’s “Let’s Thank a Nurse” campaign where you can share your story about a nurse who has had an impact on your life.

Happy Nurses Week and Happy Mother’s Day!

ABOUT CHRISTINA LARSEN, BSN STUDENT

Christina Larsen is a Term 9 Nursing Student at Langara College.  Christina is passionate about using her nursing knowledge to address health inequity at home and abroad.

 

Use Your Voice! Use Your Vote!, by Zak Matieschyn, BSN, MN, RN, NP(Family)

I bet every nurse in the province is celebrating the return of warm weather, sunny days and the end of what was for many a frustrating and long winter. For me, one of the big changes coming in the next few months is the end of my presidency of ARNBC and all that comes with that – the election of a new Board, the end of some of my travels for association business and changing the focus of my life back to the real world. But like spring itself, it is also a time for new opportunities and new growth.

All of this got me thinking about another thing that spring brings us every four years – an election!

Nursing is a political act and we get political when we speak out about situations or practices in our work environments that do not put patients first, when we question the upstream causes of the illnesses and poor health, and when we advocate for social justice.

But an election provides opportunity for a different kind of political act.

Love it or hate it, this is a time where we as citizens have a say about the direction our province is heading. It’s a time where the average British Columbian has unprecedented access to speak with incumbent MLAs seeking re-election, as well as other potential candidates hoping to represent their areas.

As one of the nearly 40,000 RNs and NPs in B.C., you are part of a very powerful voice. You are a member of the largest single group in the healthcare workforce, and one of the largest and most respected professions in our province. You have an opportunity to ask hard questions, work to influence peers on the platforms you love or hate and consider what each party is bringing forward in terms of what will support your patients and your profession.

So let me send out a challenge to you. Every election is an important referendum of issues. These issues are defined in part by what the trending concerns of the public are. Use your power as the intelligent and thoughtful healthcare leaders you are. Take the time to get informed on the issues and to learn about each party’s platform (to that end, ARNBC has made this easier – visit our provincial election toolkit). Talk to the candidates running in your riding. Go to all-candidates forums to hear what they have to say. Ask them a healthcare question.

Together, let’s get our political candidates talking about healthcare this election. And when you’ve heard what you need to hear to make an informed choice, make sure you go and vote this May 9th.

Let’s make the voice of nursing count.

ABOUT ZAK MATIESCHYN

Zak’s interest in health and healing began at the early age of nine years old when he would carry a small first aid kit while playing with friends. Since then, his passion for healthcare and health policy has been unwavering. He was particularly inspired by concepts of family, community and societal health, as well as the social determinants of health during his undergraduate (BSN UVic, 2000), graduate work (MN UVic, 2008), and clinical experience in urban, rural and remote B.C. communities.

Zak has served on numerous boards and committees, including the BC Nurse Practitioner Association Executive and was the first Nurse Practitioner in B.C. to be invited to sit on a Division of Family Practice Board (Kootenay Boundary, 2010 – 2014). Through this work he has gained valuable experience in member engagement, optimizing board governance, and relationship building among diverse stakeholders. In his clinical practice, Zak has worked med/surg, emergency, intensive care, vascular access and outpost nursing. After obtaining his NP education in 2008, he began a practice in a West Kootenay family clinic, providing primary healthcare to the general public with a focus on marginalized populations. Zak is President of the Association of Registered Nurses of BC.

 

Healthy Baby Feeding Initiative for Vulnerable Populations, by Shauna Mc Goldrick and Viktorija Glambinskaite, BSN Students

As nursing students with a passion for public health and health promotion, we were incredibly fortunate to work with Sheway during our public health promotion clinical placement at Vancouver Community College. Sheway is a Pregnancy Outreach Program located in the Downtown Eastside of Vancouver (DTES) that provides health and social service supports to pregnant women and women with infants under eighteen months who are dealing with drug and alcohol issues. Our experience at Sheway was incredibly humbling as we gained significant insight into the deeper issues affecting the health of this community and these vulnerable families.

Our main goal while at Sheway was to explore how mothers were choosing their method of feeding their babies. To begin, we grounded our exploration around one fact and question: “Vulnerable women experience barriers to feeding their babies whether breastfeeding or formula feeding. How can we support all women to feed their babies in the way that is best for them?“

We spent nine weeks with women in the drop-in area having casual conversations and encouraging them to share as much information as they could. We offered our hearts and ears to the moms sharing their stories and our arms to the babies whom we were delighted to hold. Each week we learned something new that helped us better understand the complexity of this issue. We discovered that many families in the DTES are faced with an overwhelming lack of basic resources – things that most British Columbians take for granted. For these vulnerable families, their ability to meet basic needs largely determines their choice of how to feed their babies.

We also learned that the ‘choice’ for these moms to either breastfeed or formula feed their babies is shaped strongly by the social determinants of health:

1 — Food Security remains one of the top challenges for mothers of low socioeconomic status. Despite our first world standards in Canada, many on the DTES do not have a balanced and nutritious diet that makes it possible to produce breastmilk and some do not have any help in trying to manage the feeding schedule. Others have no reliable support and education to help troubleshoot challenges, including how to prepare a new formula when they switch brands (a common occurrence when formula is received through donations).

We were concerned by the heavily marketed perspective that ‘Breast is Best’. The current popular ideology of programs such as the Baby Friendly Hospital Initiative (BFHI) exclusively promotes breastfeeding. But there is nothing “baby friendly” about letting an infant starve. If we want to have a healthy happy baby, we need to support mothers first and recognize that anything that is dubbed “baby friendly” should take into account the needs of the baby first.

2 — Finances are another key consideration for mothers when choosing how to feed their babies. For example, we learned that formula is only covered through the Ministry if the baby has a medical condition that prevents them from receiving breast milk, or if the mother has communicable diseases that pose a health concern to the baby. Other mothers are unable to access maternity leave or struggle to afford expensive resources such as breast pumps, formula, bottles, nipples and other supplies to maintain feeding.

Many women struggle to put food on the table for their family and often end up starving themselves to pay for expensive lactose-free formula. When we asked one mother if she wanted us to get her a serving of the hot meal provided by the drop-in, she replied that she was too sick from the expired SPAM that she had eaten the night before. Families require nutritious food in order to thrive.

3 — Housing in Vancouver is a challenge, but more so for those who are living in subsidized housing. In many cases only mothers and children are allowed to reside in a unit, which excludes partners and greatly limits their ability to participate in the family. some mothers confirmed that they were choosing to formula feed over breastfeeding, as they simply did not have the luxury of partner support to look after their other children while they attended to the focused demands of breastfeeding.

4 — Past experiences of trauma and its relationship to womens’ bodies and breastfeeding also impact their decision for choice of feeding. How do they handle the disapproval and stigma that they encounter? How might issues undermine their confidence in making choices for their babies? Do they have ‘choice’ given that they don’t have all the supplies, resources, supports and education that they need to make a choice for their own autonomy?

Taking all of this into consideration, we had to ask, ‘Are we doing enough for families?’ The answer is simply no. We need to advocate for the policy changes required to enable adequate housing, better financial support, and food security. How these mothers choose to feed their babies is not simply their wish but is completely dependant on their ability to survive. And that is heavily determined by our social, political and economic systems.

The mothers that we met are some of the most resilient and dedicated parents out there, but they need our support. While our experience at Sheway is over, we know that many mothers will continue to struggle given the limitations at hand. As new nurses, we have been motivated to continue to work towards ensuring vulnerable populations have equitable access to needed resources. All British Columbians should be aware of these issues, and should demand proper funding for formula, food, and housing. If ‘children are our future’, we have a responsibility to take care of them and support the mothers who foster that future.

Thank you Sheway for sharing with us, for inspiring our nursing practice and for directing us to apply our new knowledge.

Click here to listen to an original song about Sheway, written and performed by Shauna Mc Goldrick. (Lyrics and Chords)

ABOUT SHAUNA MC GOLDRICK and VIKTORIJA GLAMBINSKAITE

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Shauna Mc Goldrick has been working in community on the DTES and in Spinal Cord Rehab while she has been completing her BScN at Vancouver Community College. She is the mother of two beautiful daughters who have kept her focused and inspired along the way. She is passionate about advocating for the health of marginalized populations; her recent nursing placement at She’way brought together two important themes: ‘motherhood’ and ‘equity’. As a future RN, she hopes to continue to assist families in achieving optimal health, by addressing the systemic problems that continue to undermine their social determinants of health.

Viktorija Glambinskaite is a first generation immigrant who came to Canada with her family 13 years ago.  She has always been passionate about caring for people and knew from an early age that she wanted to pursue a career in the health sector.  Immigrating made this dream a reality because of the many opportunities available in Canada.  She is passionate about women’s health and has worked at the BC Women’s Health Centre and in various clinics, including Oak Tree and a fertility clinic. Viktorija has worked in mental health and addictions for more than four years at the Heartwood Centre for Women.    She has been a practicing LPN for five years and is currently in the process of completing her BSN.

Innovation Series: The Nancy Chan Palliative Care Ambulatory Clinic, by Ingrid See, RN

A legacy. Something that will benefit patients and families who are living at home with a life limiting illness.” These were the thoughts of Erica Chan, daughter of Nancy Chan, and a member of a prominent Vancouver family who has made significant donations throughout the city to support arts, healthcare, and education.

When Erica approached the Vancouver Coastal Health Foundation in 2014, she and her family were thinking back to her mother’s passing 10 years ago. The family was grateful for the home care they had received and also recognized that they were fortunate to be able to hire private care for their mother. Erica realized that not many people could afford this level of care, so she began to search for ways of finding a project that could support current gaps and honor her mother.  Erica’s search ended when she met with Dr. Tim Sakaluk, Medical Director of the Vancouver Home Hospice Palliative Care Service, an advocate for services that could assist in building the capacity of primary care providers (specifically, family physicians and home care nurses), and introduce palliative care resources earlier on in a patient’s illness trajectory in order to meet the needs of those who are living with a serious illness.

The Nancy Chan Palliative Care Ambulatory Clinic was envisioned by the Vancouver Home Hospice Palliative Care Service to provide an opportunity for patients and families to be seen earlier on in their disease trajectory and assessed by an interdisciplinary team for physical, psychosocial, and spiritual support – an integral part of palliative care. The impetus behind the creation of the clinic was to better support the primary care provider, community health nurses and family physicians, who are caring for patients and families at home. These patients and families would benefit from a comprehensive assessment and care plan for concerns which are beyond the scope of practice of the primary health care providers.

This vision for the clinic was embraced by the Chan family, and in November 2014, the project charter was drawn up. In March 2015, two key project leads were identified within Vancouver Coastal Health- Mavis Friesen, Project Manager, and Ingrid See, Clinical Practice Leader. The time frame was short, with the goal of having a “soft launch” of the clinic by the end of June 2015.   Friesen developed concise timelines around leasing clinic space, furniture acquisitions, telecommunications, stakeholders and communication plans, and evaluation criteria. See focused more on the clinical side with the development of patient criteria, workflows for referral, triaging, and booking of appointments, clinical documents for clinic use, and evaluation tools.   Handouts about the clinic for home care staff, family physicians, patients and families also had to be designed and circulated to the various stakeholders.

A month prior to the “soft launch” of the clinic, See and Friesen took to the seven health units with brochures and referral processes to the clinic, patient information pamphlets in English, Chinese, and Punjabi, and answered questions on how the clinic would work with the local health units. Education also took place at the palliative care units, BC Cancer Agency, heart failure clinics, and other partners who often refer to the home hospice team and home care Launch Daynursing.   An information letter was posted on the Division of Family Practice website with the brochures and referral form for the clinic so that family physicians were aware when contacted by the community health nurses.   In October, 2015, the Minister of Health and the Chan family officially launched the opening of the Nancy Chan Palliative Care Ambulatory Clinic.

Compared to other palliative care ambulatory clinics, the Nancy Chan Clinic is quite unique.   At the beginning of each clinic visit, the client is asked to fill in the Edmonton Symptom Assessment Scale (ESAS) and the Canadian Problem Checklist which assesses for psychosocial and spiritual concerns. After the visit, each team member including the palliative care physician, clinical nurse specialist, social worker, and spiritual care consultant updates the patient care plan and medication record in the electronic chart so that the home care nurses have immediate access to the clinic visit. The physician consult note is faxed to the family physician with the recommendations within the week.

One of the key features is that the palliative care team at the clinic is already embedded within the home care system in Vancouver.   Referrals to the clinic come from the community health nurses, in consultation with the family doctor. When a patient is homebound and requires one or more of the above disciplines to support the community health nurses and/or family physician, visits by the team are done at the patient’s home, sometimes together, sometime individually. However, if the patient is still ambulatory, he/she is encouraged by the community health nurse to come to the clinic and be seen by all four disciplines. This helps the team increase their efficiency in seeing patients and allows for the patient and family to see all four disciplines at one visit.

What further makes this clinic unique is that it hopes to reach out to individuals living with non-malignant diseases that are more difficult to prognosticate such as COPD, CHF, end stage renal, and ALS. The clinic also provides specialized consult services for patients and families who are experiencing complex symptoms, pain and/or psychosocial and spiritual distress while facing a life-limiting illness.   Taking it one step further, the clinic provides grief information nights and grief counseling for the families after their loved ones have passed.

L-R - Ingrid See, Clinical Practice Leader, Dr. Tim Sakaluk, Medical Director, Sharon Salomons, Spiritual Care Practitioner, Tammy Dyson, Social Worker.

L-R – Ingrid See, Clinical Practice Leader, Dr. Tim Sakaluk, Medical Director, Sharon Salomons, Spiritual Care Practitioner, Tammy Dyson, Social Worker.

It’s hard to believe that it has already been one year since the launch. Throughout the first year, statistics were kept to evaluate the impact of the clinic. Since opening, there has been a total of 312 clinic visits by the four disciplines. This accounted for 23.56% of all visits done by the team which improved the number of visits at the clinic versus individual visits in the home setting. Further, 67 visits at the clinic were done by social work and spiritual care which primarily focused on counseling and bereavement support. In addition to clinical work, the clinic is also being used for education purposes in order to support VCH staff in improving palliative care knowledge through on site education and videoconferencing.

 

Future plans include caregiver education, support groups and holding mindfulness sessions to help families cope with stress. Ensuring high quality palliative care is one of the most important priorities within our healthcare system. As British Columbians continue to live longer with more complexities and life limiting illnesses, we need to continue to think of innovative ways to ensure patients and families are well supported holistically through collaboration, compassion and innovation.

ABOUT INGRID SEE

ingridseeIngrid has a background in home care nursing and has worked extensively as a Clinical Nurse Specialist in palliative care for many years in the community, acute, and residential care settings. Her role is to help mentor staff and improve clinical knowledge and standards of practice in palliative care, as well as providing clinical consultation while working with multi-disciplinary teams. Ingrid is also a diversity trainer and has a keen interest in developing education materials specifically focused around cultural competency and end of life care. She is the clinical lead for the Nancy Chan Palliative Care Ambulatory Clinic.

The Opioid Crisis Can’t Be Just a Headline for the Nursing Profession, by Zak Matieschyn, BSN, MN, RN, NP(Family)

I’ve had some great experiences during my year and a half as ARNBC president, but one will stand out for me long after my presidency ends. This week, I and a group of nurse leaders and students, had an opportunity to spend the afternoon on Vancouver’s Downtown East Side (DTES) learning, listening and supporting our frontline nurses (and let there be no mistake, with the current opioid crisis, this is truly the frontlines). No matter what we have read in the newspaper, or seen on TV, the reality of what is happening all over British Columbia is overwhelming and heartbreaking when you see it firsthand.

Our experiences were life-changing as we broke into small groups with an RN or peer leader and visited different sites throughout the DTES. The experiences were as different as they were impactful. Some visited the Crosstown Clinic, which is the only harm-reduction treatment centre in North America where addicts get actual heroin. Some walked with a street nurse as she went about her regular daily routine, checking on people in their SROs or on the street. Some visited the Downtown Eastside Community Centre to gain a better understanding of how primary care and social services are delivered to those who are struggling with healthcare issues. Still others visited the pop-up clinics and alleys where the unofficial safe sites are functioning.

I personally had the opportunity to spend time at St. Paul’s Hospital, which, although it is not in the DTES, until the recent opening of the Mobile Hospital, received the majority of overdose victims in the ER. I was able to witness some of the innovative work being done to streamline access to possible treatment options for people with addictions – these are exemplary programs that would be great to see scaled out to other parts of B.C. I also had the privilege of spending a couple of hours alongside the nurses at Insite, North America’s first safe injection site, handing out Naloxone kits and training individuals on how to use them. Sitting on the floor with a heroin user who wants to know how to use a Naloxone kit ‘just in case’ makes you see this whole situation from a different point of view. People are dying, and what a privilege and a responsibility we have as nurses to do everything in our power to prevent that.

Spend a day really listening to the individuals who claim the Downtown East Side as their community and you begin to understand that there are miracles taking place here every single day. This crisis has hit hard. As a nurse, I recognize that our frontline nurses working here are exhausted, overworked, sometimes overwhelmed. They lose friends every day – people who use drugs that they have come to know and love. They sit with individuals who are scared, worried, sad. And no matter how much they do, how hard they work, how many lives they impact, how many wounds they heal – there is always more they wish they could do. Nurses here are exceptional – because by choice they are agreeing to work with a population that is often ignored, stigmatized or dismissed. And the population on the DTES is a miracle unto itself. Largely stigmatized by most of Vancouver, the reality is that many of these individuals are the kindest, most compassionate, most generous humans you will ever meet, and their sense of community and helping one another is beyond compare. I must say that I felt completely safe during my time spent there.

ARNBC has taken a strong and proactive approach to working with our nurses and colleagues to determine how we can best support all frontline healthcare workers who are dealing with this crisis. For starters, we hosted a forum on Wednesday, bringing together as many frontline workers as we could, to give them an opportunity to debrief, to share their stories, to suggestion ways we can move forward together and to show that we are serious about supporting their work.

A sampling of some of the ideas include:

  • Develop a community of practice for those on the frontlines, giving them a place to talk online and share ideas (working on it)
  • Advocate for increased staff for key locations (working on it)
  • Develop a ‘free coffee’ program and consider expanding it to include snacks, treats, meals etc., for those working in various locations on the DTES (underway)
  • Engage rural and remote workers in programs and services that help them manage in this crisis (to do)
  • Advocate for safe injection sites, for safe drug supply and decriminalization (to do)
  • Help set up some volunteer scheduling, including training and criminal record checks (underway)
  • Advocate for better nursing curriculum to teach harm reduction/drug addiction and ensure students are exposed from the start of their nursing education (to do)

Other ideas that were brought forward will be included in the summary report, due out next week. Keep an eye on www.bccna.com if you want to learn more about what was discussed, or share what you think would make a difference.

Spending time on the downtown east side reminded me of something important – every single person who uses drugs has a powerful story to tell about how and why they started. They have family and friends (some may be other drug users, many are not). They have real fears and joys and sorrows. They are as real and alive and vital and important as any one of us. One of our speakers on Wednesday reminded us that we don’t really look at people who use drugs until after they’re gone when we put them on the front page of our newspapers. We need to remind ourselves as nurses that we look after all people – and we’re at our best when they’re alive and can be helped.

When ARNBC was ‘called out’ for not doing enough by Marilou Gagnon, it made us stop and think. She was right and we knew immediately that we needed to step up. We have done that this week, and we are committed to doing it on an ongoing basis. We know we can make a difference. We welcome your ideas and thoughts on small things or big things you think ARNBC should be doing to help during this crisis. We will not be silent in our support of those things that our frontline workers need in order to manage a difficult and overwhelming situation.

Our nurses on the frontlines are calling out for help. It is time for every single nurse in the province to step up and answer that call. They would do the same for any one of us.

ABOUT ZAK MATIESCHYN

Zak Matieschyn-cleanZak’s interest in health and healing began at the early age of nine years old when he would carry a small first aid kit while playing with friends. Since then, his passion for healthcare and health policy has been unwavering. He was particularly inspired by concepts of family, community and societal health, as well as the social determinants of health during his undergraduate (BSN UVic, 2000), graduate work (MN UVic, 2008), and clinical experience in urban, rural and remote B.C. communities.

Zak has served on numerous boards and committees, including the BC Nurse Practitioner Association Executive and was the first Nurse Practitioner in B.C. to be invited to sit on a Division of Family Practice Board (Kootenay Boundary, 2010 – 2014). Through this work he has gained valuable experience in member engagement, optimizing board governance, and relationship building among diverse stakeholders. In his clinical practice, Zak has worked med/surg, emergency, intensive care, vascular access and outpost nursing. After obtaining his NP education in 2008, he began a practice in a West Kootenay family clinic, providing primary healthcare to the general public with a focus on marginalized populations. Zak is President of the Association of Registered Nurses of BC.

Innovation Series: The Growing Role of Transfusion Nurses, by Clare O’Reilly, RN, RSCN

Nursing practice has become more and more complex. Some roles have been more established, and some continue to develop. If you asked a group of nurses about the type of specialties they work in, you would likely hear about the ones that nurses have traditionally practiced in –emergency care, intensive care, maternity, pediatrics, med/surg, and the list goes on. But how many would mention transfusion medicine as an area of nursing practice? Certainly for many direct care nurses, the ability to practice nursing outside of the traditional specialties may seem unfamiliar, especially when the role doesn’t require patient interaction 100% of the time. We’ve all heard it before, “nurses who don’t work with patients aren’t real nurses.” And I’m sure many would disagree with this statement. What I would argue is that as healthcare continues to advance and become more and more complex, we will see more nurses in roles that have not historically been labelled as “nursing.”

A good example of this is the emergence of the role of the Transfusion Nurse. Transfusion Nurses are a relatively new development in transfusion medicine. While there was a heavy emphasis on improving the quality and safety of blood, there has been a greater shift towards transfusion and patient safety. Similar to any medication and procedure, errors do occur, and can result in devastating consequences for our patients. Given the complex nature of transfusion processes, and that nurses are on the front line of transfusion practice, there has been a new role for nurses in transfusion safety.

Transfusion Safety Nurse, Transfusion Officer, Transfusions Leader, Clinical Resource Nurse for IV Therapy, or Clinical Coordinator are just some of the titles that are assigned to nurses working within this speciality. Internationally, titles such as Transfusion Safety Office/Nurse, Haemovigiliance Officer/Nurse and Transfusion Practitioner have been commonly used. Perhaps the many titles is in part due to the broad range of responsibilities of Transfusion Nurses.

While our work differs quite a bit from the work of direct care nurses, it is also very similar through the use of the nursing process. We assess (investigate transfusion reactions and incidents, conduct audits), diagnose (report transfusion reactions and incidents), plan (develop policies and procedures, educational resources for healthcare professionals and patients), implement (educate staff, develop and maintain transfusion medicine websites, ensure compliance with standards, liaise between lab staff and clinical staff), and evaluate (follow up with transfusion incidents and reactions, and serve on transfusion committees).

While there are no specific courses that can be taken to become a Transfusion Nurse in Canada, nurses working in this area have experience in project management, quality improvement, and health literacy, to name a few. With a new role, comes room for innovation. Most recently, in collaboration with the Provincial Health Services Authority (PHSA) Learning Hub, and Learning Development at B.C. Children’s and Women’s Hospital, Transfusion Safety Nurse Clinicians developed educational materials that would standardize critical content while also allowing for site-specific practices. This was developed because of the finding that age related practice variations among pediatric and neonatal patient populations created challenges to ensure consistency for common, critical areas of practice.

Flexibility, autonomy, the ability to utilize problem solving skills, work with interdisciplinary teams, collaborate, develop ideas to improve processes, and ensure best practice continues to be some of the many joys of the job. As nurses, our education and practice provides us with a broad skill set beyond direct care. Our sound knowledge of what constitutes as safe patient care, and the policies and processes that are needed to achieve this will continue to position us well to contribute to all aspects of healthcare. Having the opportunity to be part of a growing nursing speciality has reminded me that as nurses, we need to continue to utilize our untapped potential. As healthcare advances, nursing as a whole must continue to highlight our ability to create positive change in every aspect of healthcare. As nurses, our work goes beyond caring for patients at the bedside. We improve the quality of healthcare, we identify solutions to create change, and we bring people together to make this happen.

Let’s never forget that we are innovators, collaborators, and leaders.

ABOUT CLARE O’REILLY, RN, RSCN

clareClare is an Irish-born and UK trained RN with a Graduate Certificate in Transfusion Practice from the University of Melbourne. Clare has worked as an RN in Ireland, England and Canada in various specialties such as pediatric oncology/hematology/bone marrow transplant, adult nursing, blood donation, platelet apheresis, and haemovigilance/transfusion safety. Currently, Clare works as a Transfusion Safety Nurse Clinician at BC Children’s and Women’s Hospitals where she strives to bridge the divide between the transfusion laboratory and clinical environments. Her duties include; coordinating the follow-up of transfusion reactions and adverse events, maintaining the Transfusion Manual, creating education resources such as the Better Blood Transfusion online education modules. In her spare time, Clare enjoys reading, hiking, and knitting.

 

Breaking Down Healthcare Barriers for Transgender British Columbians, by Zak Matieschyn, BSN, MN, RN, NP(Family)

I am always amazed, and a bit shocked, when I think about how much the world has changed in the 20 years since I began my nursing career as a student at the University of Victoria. We were still in the early days of the Internet back then, and had no idea that two decades later we would all be carrying mini computers and smartphones around everywhere we went. We were plugged into our discmans in the pre-iPod era and were still recording TV shows on big black VHS tapes. Healthcare was a completely different world – HAART therapy had still not been unleashed on the AIDS epidemic, smoking was still prevalent in nearly half of the population, the Botox era hadn’t started and no one had even considered that there could be a vaccine like HPV for teens that could prevent cancer later in life.

In the midst of all of these changes, complicated social debates that had previously seemed irreconcilable were firmly decided and put to rest: gay marriage, access to abortion, medical assistance in dying and the legalization of marijuana. Much was done to reduce stigma for those living with HIV and mental health issues. Healthcare and society have undergone significant positive change.

One of the most important changes for B.C. occurred in July, when the province amended its human rights code to ban discrimination on the basis of gender identity and expression.

I can’t profess to understand the emotional, psychological or physical challenges faced by those whose gender expression varies from what they are assigned at birth. But as a health practitioner and a human being, I recognize the systemic barriers that transgendered individuals feel when seeking health services in a system that forces you to tick ‘female’ or ‘male’ on most paperwork. And while transgender health services will hopefully become an aspect of health as routine as managing a thyroid condition, it is still considered a specialized area, with many healthcare practitioners feeling inadequate and uninformed when it comes to providing transgender health services.

Earlier this year, the sole healthcare practitioner who had been offering specialized care for transgendered people in my region needed to close his doors to any new referrals. This would effectively leave people needing to travel to larger centres in our province for their appointments (at least a four hour drive). Not only do people have the right to caring, non-judgemental health services, they should also be able to access them close to home wherever possible. In light of this, I was happy to complete some further studies and step in to fill this gap. I can truly say that this is some of most fulfilling work that I do – to help support and facilitate someone’s process towards their true gender expression.

I believe that most of us have the best interest of all patients at heart, and I know I still have a lot to learn about how to support and provide care for those who identify as transgender. I also know that it is part of my responsibility to understand, to learn and to continue to grow so that the divisions and barriers that these individuals currently face when seeking health care, are permanently eradicated. The truth is that our society, and by extension, our healthcare system, is still very entrenched in two gender, what-you-were-born-with-is who-you-are understanding. Just last week Saskatchewan announced that it would cover up to 100% of gender reassignment surgery – an important and groundbreaking move that will give hope to thousands of people. And yet the public reaction to this announcement has been overwhelmingly laced with homophobia, anger, distrust and scorn. This is not the response that we, as a society, need to be giving to a group of individuals that already face significant challenges.

As a profession, nursing could be better at preparing nurses to support transgender individuals. It goes further than just helping to ensure specialized transgendered care exists regionally where people need it. We all need to work towards a healthcare system that is barrier and judgement free. Great progress has been made over the past decades towards reducing discrimination on the basis of race and sexuality (although the work is certainly not yet complete). General acceptance of a broader comprehension of gender identity and expression is really still in its first steps.

I urge all nurses to consider what actions you might need to take to change the healthcare experience of the transgender patients you meet. For individuals, Trans Care BC has some modules they offer to targeted social service and healthcare workers who specifically work with trans people. For organizations such as ARNBC, there are programs like the VPD Safeplace program, of which we are a proud member. Safeplace allows anyone from the LGBTQ community who feels unsafe to seek out our office where staff will ensure they can talk to someone, rest and call police if necessary.

By our actions, by our willingness to learn, by our assuredness that every single person has the right to express themselves in the way they see fit – we can model leadership for the healthcare community. More importantly, we can demonstrate our belief that every single Canadian deserves competent, supportive and accessible health care.

ABOUT ZAK MATIESCHYN

Zak Matieschyn-cleanZak’s interest in health and healing began at the early age of nine years old when he would carry a small first aid kit while playing with friends. Since then, his passion for healthcare and health policy has been unwavering. He was particularly inspired by concepts of family, community and societal health, as well as the social determinants of health during his undergraduate (BSN UVic, 2000), graduate work (MN UVic, 2008), and clinical experience in urban, rural and remote B.C. communities.

Zak has served on numerous boards and committees, including the BC Nurse Practitioner Association Executive and was the first Nurse Practitioner in B.C. to be invited to sit on a Division of Family Practice Board (Kootenay Boundary, 2010 – 2014). Through this work he has gained valuable experience in member engagement, optimizing board governance, and relationship building among diverse stakeholders. In his clinical practice, Zak has worked med/surg, emergency, intensive care, vascular access and outpost nursing. After obtaining his NP education in 2008, he began a practice in a West Kootenay family clinic, providing primary healthcare to the general public with a focus on marginalized populations. Zak is President of the Association of Registered Nurses of BC.

Nurses Aren’t Just Clinicians, by Katherine Villegas, RN

During my four years in the Kwantlen BSN program, I have had placements in various clinical areas which have enabled me to work with different populations in multiple specialities. While these learning opportunities have been invaluable, until my final preceptorship, it never really occurred to me how necessary it was for nursing schools to offer learning opportunities outside of the clinical setting. In my final semester, I was given an incredible opportunity to complete a practicum with the Association of Registered Nurses of British Columbia (ARNBC), where I learned that the clinical aspect of nursing is only one part that makes up the nursing profession.

If you were to ask a group of new nursing students, your friends, family or people in the public to draw a picture of what they thought nurses do, you would probably see something along the lines of a person at the bedside with his or her stethoscope tending to a patient, or an individual behind a stretcher or wheelchair transporting a patient. However, we know that this is a very narrow perception of what nurses do. As nursing has evolved, the role of nurses has expanded beyond the clinical setting into areas of health and nursing policy, research, administration and education.

Currently, students in most nursing schools are only given the option of requesting preceptorship placements within clinical areas, which has created little to no opportunities for students to learn or experience nursing in other domains outside of clinical practice. It’s also very clear that students’ exposure to organizations that support nursing in B.C. are quite limited, and usually consists of a one to two hour classroom PowerPoint presentation (but with lots of free pens, lanyards and pins of course!) This has led to a lack of knowledge regarding how the regulatory college, union, and professional association all support nurses and nursing.

Graduating nurses these days are expected to be much more than a clinician. We’re expected to be advocates and leaders for our patients and our healthcare system. But how can we do this to the best of our ability when we aren’t provided with opportunities to expose ourselves to settings that can help foster our skills in leadership, advocacy and policy? Many of these aspects can be difficult to teach in a classroom or clinical setting. While there is no doubt that providing nursing students with a range of placements within clinical settings will prepare us to become great clinicians, providing us with placement opportunities in organizations such as the ARNBC is equally important to ensure we gain the leadership, policy and administration skills needed. While dedicating a whole semester to this may be difficult, there are many options that schools could begin to explore such as expanding our community visits to nursing organization events like ARNBC’s Policy Forum or the BCCNA Day at the Legislature.

Throughout my internship at the ARNBC, I have been able to learn about the valuable work of a professional association, how health and nursing policy is developed, and ways to strengthen and advance the nursing profession as a whole. I attended multiple meetings and events such as the BCCNA’s 3rd Annual Day at the Legislature where I had the opportunity to network with nurses, educators and MLAs. I witnessed firsthand the power of nurses in using their voice to create positive changes in healthcare through a facilitated discussion with the Ministry of Health representatives. I felt empowered knowing that I was able to contribute to the discussions, and I was honoured to be a part of the nursing voice. I sat in on a BC Coalition of Nursing Associations meeting where I watched nurses from all disciplines (NPs, RNs, LPNs, RPNs and Nurse Educators) collaborate with one another. I learned the importance of all nurses coming together to form a strong united voice when positioning ourselves to tackle system wide issues. Last, I also attended the launch of the ARNBC’s Student and New Graduate Program, which really inspired me to become a leader to support other nursing students and new graduates who are experiencing hardships during their transition into the workforce.

My internship with the ARNBC opened my eyes to the many exciting options that we as nurses have in our careers. If we want nurses to excel in all nursing domains, we must all work collaboratively to ensure opportunities like the one I had, are available to all nursing students throughout their undergraduate education. These experiences build leadership, foster innovation, and teach us how to be collaborative, all of which are skills needed when working within the clinical setting as well. These aspects of nursing should be supported and cultivated throughout our education and training, and not thought of as something of less importance than our ability to insert an IV, perform an assessment or monitor changes in our patients. Our responsibilities as nurses go far beyond what we do at the bedside. We identify policy issues, we research and analyze the problem, and we collaborate to make changes at every level of the healthcare system.

Let’s try to the change that picture of what people think we do and what we think we do, because nurses aren’t just clinicians. We’re policy makers, administrators, researchers and educators. It’s time for all nurses to embrace our potential

ABOUT KATHERINE VILLEGAS, RN

katherineKatherine recently graduated from the BSN program from Kwantlen Polytechnic University in Langley BC.  Previous to nursing, she was pursuing a career in accounting. However, she knew that she wanted a career that was fulfilling, challenging and put to use her genuine care for others in a practical way. Through her clinical placement at Lionsgate Hospital in North Vancouver at the Neurosurgical unit she realized that nursing was for her. She hopes to continue to gain experience and fulfillment to one day work towards sharing her love for nursing through teaching.

Innovation Series: Advancing Foot Care Nursing in B.C. One Step at a Time, by Sandra Tetrault, RN

When Judy, a registered nurse, moved to B.C. in the late 1990’s, she arrived having taken a foot care course from a Podiatrist in Ontario. In fact, she had been practicing in Ontario as a foot care nurse for 10 years before moving to B.C. On her arrival to register with what was then the RNABC, they told her they had never heard of a foot care nurse working for herself. Judy set out to prove them wrong! She shortly met another R.N., Ruth who was a mobile foot care nurse locally, and together they started an interest group of about eight Foot Care Nurses.

Even within the nursing profession today, many nurses are unaware of what Foot Care Nurses do (although the title may sound obvious). Foot care nursing is not a new practice, and has been delivered for decades by the Victorian Order of Nurses. However, only within the last 15-20 years have nurses begun owning and operating their own foot care business.  Currently, any nurse regardless of designation (LPN, RN, RPN, and NP) who has completed a foot care course is considered a Foot Care Nurse. Most of these nurses own their own foot care business, providing clinical care, education and referrals in variety of settings including home care, senior centre clinics, assisted living and complex care facilities.

Clinical care typically involves nail care, and care for corns, calluses, dry or cracked skin, as well as short term padding for off-loading as needed until new shoes or a Pedorthist may be seen for orthotics.  We’re trained to assess diabetic patients for peripheral neuropathy using the monofilament test or tuning fork, provide education to patients, families and healthcare providers, assist in the prevention of foot issues, and make referrals to other healthcare professionals such as Wound Care Nurses, General Practitioners, Podiatrists, Pedorthists or diabetic clinics.

However, with the lack of established competencies, the quality of care being delivered has been an on-going issue within the foot care nursing community. While nursing has a long history of delivering foot care, ensuring nurses are providing the safest and highest quality of care while utilizing best practices has been difficult to do. Recognizing this issue, a group of nurses met in 2007 at a conference in Ontario and started Foot Care Canada with the goal of developing national guidelines for foot care nursing. In 2010, Foot Care Canada became the Canadian Association of Foot Care Nurses (CAFCN), with provincial and territorial advisors from each province.

Fast forward to spring 2015, CAFCN voted to hire two student nurses to gather information on the various foot care courses being taught across Canada. In the summer/fall of 2015, Dr. John Collins who had been contracted to facilitate the process of competency development asked members of CAFCN for volunteers to go through all of the competencies found in the foot care courses being taught across the country. Subsequently, the group identified a list of standard competencies for foot care nursing.

The group involved in this process consisted of nurses from all across Canada with varied nursing experience from varied foot care nurse career paths-many of us were educators in foot care programs. We met approximately weekly on “Google Hangouts” between October 2015 until April 2016 with Dr. John Collins as our facilitator. While it was a challenge for the nine of us to meet, considering our busy work schedules and time differences, we finished the competencies, and sent them out to 40 volunteers for peer review. Feedback back was subsequently reviewed, and a draft was developed.

Just a few months ago in May, the draft competencies were presented to the delegates at the CAFCN conference in Montreal, Quebec. With feedback from the conference delegates, the competency document is now currently being put together to be shared with external stakeholders before being finalized.

Some may ask: why bother with developing competencies in foot care? Well, first, they promote standardized foot care education across Canada. Currently courses range from anywhere from 8 to 180 hours, which has implications on the safety of patients. It also ensures that foot care nurses are following best practice guidelines, eliminates out-dated practices, and protects the public.  Last, it helps with looking to the future to regulation and certification of Foot Care Nurses.

Pioneers such as Judy and Ruth have truly advanced foot care nursing over the past 20 years. From owning their own foot care businesses to mentoring many new Foot Care Nurses, these retired nurses are still involved in the meetings of the Lower Mainland Foot Care Nurse Interest Group and continue to have a part in assisting new Foot Care Nurses. There have been so many positive changes within foot care nursing over the past two decades, and the nurses that have been involved in advancing this specialty have been true leaders and innovators. As we continue to see the development of foot care nursing competencies, I am sure we will enhance our ability to provide the highest quality and safest care possible.

sandraABOUT SANDRA TETRAULT, RN

Sandra has been practicing as a Foot Care Nurse for 8 years. She is a Certified Foot Care Nurse (CFCN) with the Wound, Ostomy and Continence Nursing Certification Board (WOCNCB- U.S. Certification), and currently works as Foot Care Nurse Educator. She is the B.C. Advisor to CAFCN, ARNBC Network Lead for Foot Care Nursing, Co- Instructor for Foot Care Nursing programs at Vancouver Community College and Co- writer of online foot care nursing program for Camosun College, Victoria. She is also the owner of Healthy Feet Foot Care, and Co-Owner of Pededucation: B.C. Centre for Nursing Foot Care Education and Clinical.

Innovation Series: Developing Education and Practice Support for Skin and Wound Care in Home and Community Care, by Kerstin Lewis, RN

There are around 800 clinicians in home and community care, of which approximately 550 are RNs and LPNs across the 14 health units in Island Health. Nurses practicing in home and community care are skilled professionals with a wide knowledge base. They care for some of the most complex and diverse patients such as those living with developmental disabilities, individuals with interventional type needs, and those requiring palliative care. While these clinicians see patients in every environment with every condition possible, many may not know that skin and wound care actually takes up about 52% of the work load for nursing staff.

Having worked as a home and community care nurse for nine years, and supporting clinicians in my current role for two years, it was clear to me that the clinicians needed improved access to education and educational support for skin and wound care. After identifying this issue, I began to think of ways to solve this problem. How could we provide easily accessible education and educational support to clinicians out in the community so that they aren’t wading through pages and pages of material from different sources just to find what they are looking for?

I first gathered a small working group of subject matter experts (SME’s) to complete an analysis to answer the question: “What does the interprofessional team need to know and do to perform evidence-informed skin and wound care within the scope of practice in Home and Community Care?” This group included home care nurses, enterostomal therapists, and a leader representative, where we focused on the needs of direct care nursing staff.

The group unanimously identified that what our staff really needed was a better foundation first, where etiology specific modules could be built based on a solid foundation. In fact, we determined it was about what they needed to “know” more than what they needed to “do” in wound care. This is because there are very few absolutes in skin and wound care, and what the staff needed was the knowledge to assess thoroughly, and subsequently make the most appropriate client specific treatments. The knowledge supports the professional decisions that we make, and will allow for clinical decision making to be better supported.

Once the SMEs identified the key themes and content that home and community care clinicians needed, the next step was to establish what type of education and practice supports would make the most sense. For example what needed to be face-to-face? When could we consider e-learning? Could supports built into the daily process support practice? Once the learning plan was built with these components identified, a work plan was developed.

The big question then became, where would all of the content live? After looking at several options, a website specific to Home and Community Care Skin and Wound made the most sense. We launched the website “Skin and Wound Care for Community Services” in January of 2016, and it currently houses three pages off of the landing page:

  • A product support page which contains resources for the skin and wound products on formulary. Most content on this page is external links to videos, and instructions for use from the company and Product Information Sheets from www.clwk.ca.
  • A Negative Pressure Wound Therapy Learning HUB. This page is designed to provide the staff all of resources in one location to provide NPWT, and follows a liner process for obtaining information. For example all of the resources needed for “Obtaining and order for NPWT” are located beside that task, including clinical order sets. Some resources that were developed for this learning HUB include: red flags for NPWT, process documents, and a step by step guide for clients for an alternate dressing. Also included on this page are tip sheets and therapy guidelines specific to NPWT Pump that we use in out setting.
  • A Q & A forum for Skin and Wound in HCC. This forum is a place that staff can pose general questions. However, currently it is used to post the answers for any commonly asked questions that come from staff or leaders. We also post any email/practice alerts on this site, and there are short PPT learning bursts posted. For example, there is a seven minute PPT with voice recording that outlines our procedures and guidelines for Wound Photography in HCC.

Three more Learning Hubs are currently being developed:

1. Foundational knowledge for Skin and Wound care
Including: factors impacting healing, the DIME principals, product categories for wound care, documentation standards, why wounds become chronic, etc.

2. Assessing the client and assessing the wound
Including: wound measurement and wound bed assessment, wound bed pain, medical and social history.

3. Care Planning, Treatment Planning and Providing Care
Including how to integrate the foundational knowledge to support the client to meet their goals, implementing and revision of treatment plans, and environmental considerations when providing care.

The work plan for these three HUBs includes 40+ e-learning modules (all to be 15 minutes long or less) and roughly 50 job aids, practice supports, and tip sheets. The intent is to provide the clinicians with shorter pieces of information that they can access as required. For example, one module will be on how medications effect healing-this will be a stand-alone component so that the learner does not need to wade through an hour of other content to review the information that they need. Having the material in “bite-size” pieces will also allow the material to be updated easier. With the increase use of mobile devices and access to technology, moving the majority of formal learning to a virtual platform allows easier access to ongoing knowledge development.

The last phase will then be to develop etiology specific “modules” that will support evidence informed practices and pathways. An example of a module that is being developed is for pressure injuries. This module will support best practice, and meet the required organizational practices for Accreditation Canada. We will be utilizing the Provincial Nursing Skin and Wound Committee decision support tools for prevention and treatment of pressure, friction and sheer, and will also access supports from the National Pressure Ulcer Advisory Panel.

Leading a project of this scale has not come without its challenges. One of the biggest challenges is the lack of recognition in the complexity of wound care, and the effects that it has on the client living with a wound. I continue to spend a lot of my time speaking with leadership, trying to gather support for this project, and to educate colleagues on why this is needed. Other barriers include the lack of funding and access to wound care clinicians to aid in the development of the resources. There’s also always something that is going on- a restructure, the development of the electronic health record, staff turnover- just a few of the competing priorities that have impacted the timeline of this project. Further, I am also concerned about the ability for the staff to truly utilize the material and e-learning due to the busyness of the work environment.

However, as professionals we are responsible for managing our own learning, and my role is to provide my colleagues with the opportunity to learn and develop. As nurses, we are all responsible for improving the way we deliver care, and when we identify issues, we must come up with solutions to fix them. While this can be challenging, from my experience, I believe we are all capable of leading and innovating.

Kerstin LewisABOUT KERSTIN LEWIS, RN , BScN, IIWCC

Kerstin Lewis works as a Practice Support Nurse with Home and Community Care in Island Health. Her passion and focus is to support evidence based practice for skin and wound in the community. She is Chair of the Island Health Skin and Wound Clinical Care Collaborative and a member of the Provincial Nursing Skin and Wound Committee. As well, she is a contributing member for the Canadian Association of Wound Care. Kerstin has been a strong voice and advocate for supporting clients and staff with evidence based care, taking part in initiatives at the program level, provincial level, and on a day to day basis with helping Island Health clinicians develop their skin and wound clinical skills. She has helped to create numerous practice support tools and resources and continues to help move skin and wound practice forward in Island Health. Kerstin graduated from the University of Victoria with a BScN in 2005 and will likely turn her sights towards a Masters in Nursing. She has worked in acute care and made the move to working in Home and Community and has never looked back. She lives and works in Ladysmith, BC and enjoys a very busy life with her husband, 2 young daughters, dog, cat and whatever creature her daughters sneak home in their backpacks. Other future plans include a nice long nap and enjoying a well-deserved glass of wine with her husband.