Author Archives: ARNBC

My Experience with SNAP: Political Engagement and Keeping Perspective, by Cedar McMechan BSN Student

As students, we are fed many different messages about nursing. Entering the profession, we’re told it is going to be hard and push our limits. We’re told that school will overwhelm us (but don’t forget self-care!). It’ll be a catalyst for transformation and growth. We’re told to persevere and that, in the end, the reward will out-weigh the struggle.

As we learn more about the profession of nursing, our reasons for choosing this path become more diverse. Some of us seek out nursing for our sense of fitting the nursing persona: the über-caring, self-sacrificing, hard-working fountain of kindness, a destination felt to be set by fate or something similar. For others, it’s a fascination with the science of it. As one of few remaining bachelor degrees with guaranteed employment prospects, many of us also choose nursing for practicality’s sake.

I was led to nursing as a result of a passion for the political and social aspects of health. I chose nursing because it seemed like a sturdy vehicle where I could navigate the complex issues of people and their wellbeing. I envisioned (and continue to) that the profession would serve as a platform to deconstruct social issues, understand people in their historical context, and change the status quo. As the meeting place of people from all walks of life, a crossroads between public and private sectors, and an institution rooted in historically paternalistic practices, surely there are few better places to be politically active than in healthcare.

Given these interests, I was thrilled when I received news that I was chosen to attend the CNA board meeting in Ottawa this past March, through ARNBC’s Student Nurses in Action Program (SNAP). I had finally (thankfully) overcome my fear of needles, blood, and vomiting, and it seemed fitting to realign myself with my original motivations of becoming a nurse. I was not let down.

My experience with the CNA proved to be inspiring on many levels. The people, for one, were extraordinary. Where I thought I might find a group of nurses tainted by years of working in an infinitely resource-challenged system, I found a group of individuals that care deeply and passionately for the future of nursing. The meeting was carried out with grace, respect, a true sense of a shared vision and allied intentions. As a student, I was welcomed wholeheartedly and felt valued as a contributor in the room.

Perhaps the most profound aspect of this experience was the reminder of the importance of political engagement as a means of keeping perspective. As students, our perspectives on nursing are often limited to our patient interactions. It’s tempting (and sometimes necessary) to ignore the other aspects of the profession, and become fixated on the clinical skills we’re taught, or the content we need to memorize for an exam that week. However, when we do this, we run the risk of reducing nursing to a set of actions and tasks, and success in the learning process becomes confined to evaluation of these tasks. It’s easy to lose sight of the context in which all of our actions as nurses are performed. I certainly had lost this perspective prior to going to Ottawa.

Witnessing leadership on this level and being reminded of the political nature of health, on the other hand, reopened my awareness to how big this job truly is. I by no means intend to undermine the extraordinary importance of bedside work, but rather mean simply to express my realization that remaining politically active as a student creates a drive greater than that of the grades you receive. In staying connected to the challenges faced by nursing and healthcare as a whole, I am able to sustain my motivation beyond what school requires of me this week or the next. The privilege of being with those who have their hands in this kind of work made me feel better equipped to take part in the process of change, both as a student now, and a nurse in the future.

It’s a funny thing – to straddle the worlds of student nurse and professional nurse. Right when I think I might appear to be fitting seamlessly into the level of competence and professionalism at the CNA, I find myself in my hotel room, eating salad from a bag, without a fork – and remember I have a very long way to go before I can truly count myself among these inspiring leaders. Alas, there is a long, but exciting road ahead of me!

CEDERABOUT CEDER MCMECHAN

Cedar is entering her third year studies of the BSN program at Camosun College in Victoria. After completing three years of a previous degree in Global Health and Health Studies at Memorial University of Newfoundland and the University of Toronto, Cedar felt inspired to seek out nursing as a practical way to put these background studies into action. With two summer practicums in Whitehorse under her belt, she hopes to gain further experience working in Canada’s North and one day pursue a future as a Nurse Practitioner.

Overdose Deaths in B.C. – Time to Scale up Supervised Consumption Services, by Dr. Bernie Pauly, RN

In the first six months of this year, 371 British Columbians died due to an overdose. This is a 74.2% increase from the previous year. Almost one quarter of these deaths are people in their 20s, 30s and 40s. Fentanyl, a powerful synthetic opiod was detected alone or in combination with other drugs in up to 60% of overdose deaths. Frequently, people consume Fentanyl unknowingly.

Overdose deaths are now the leading cause of unnatural death in B.C. For many British Columbians, the harsh reality of these numbers is hard to understand until you compare overdose deaths to motor vehicle accident deaths:

In 2015, there were 300 deaths due to motor vehicle accidents. In that same time, there were 474 drug overdose deaths.

This rising number of overdose deaths signalled a crisis so serious that it prompted Dr. Perry Kendall, the BC Provincial Health Officer, to declare a public health emergency on April 14, 2016. The province warned that without additional steps to combat overdoses, B.C. could see 600 to 800 overdose deaths in 2016.

So it seemed strangely surreal that the primary response to this public health emergency was a call for ‘real time information’ alongside the scale up of Naloxone distribution. Collecting real-time information on both the user and the circumstances of an overdose is one way to help guide a public health response. For instance, if a number of people overdose in one rooming house, officials can assign a nurse to that building to ensure everyone is trained and has access to naloxone. Nevertheless, this response to a public health emergency seemed out of sync in a province that had made history by establishing the first supervised injection site in Canada, where harm reduction is official provincial policy and there are strong voices for a public health approach to the decriminalization of illicit drugs. It seemed surreal that these overdose deaths were not seen as a clarion call to expand supervised consumption services (SCS) across the province, alongside ramping up the distribution of naloxone, increasing opiate substance therapy and detoxification services, and an increasing call for drug policy reform.

As early as 2008, the Health Officers Council of B.C. sent out an advisory urging health authorities to implement SCS where needed. Yet no new sites have been established since that time. Finally, eight years later and after the declaration of a public health emergency, there are reports from at least three heath authorities indicating that SCS are either being explored or planned.

Registered nurses have been at the forefront of the drive for SCS. In May, 2011, nursing organizations including the Association of Registered Nurses of British Columbia (ARNBC), BC Nurses Union (BCNU), Canadian Nurses Association (CNA), and the Registered Nurses’ Association of Ontario (RNAO) spoke out publically and in the Federal Supreme Court in support of Insite because of the abundant evidence as to its effectiveness and the care provided by nurses.

This action was possible because of the vision of many nursing leaders. Five years before the Federal Supreme Court hearing, the Canadian Association of Nurses in HIV/AIDS Care (CANAC) put forth a resolution at a CNA Annual Meeting requesting the development of a discussion paper on illicit drug use and harm reduction. Alongside Irene Goldstone, I had the privilege of conducting the evidence review and co-leading the development of the CNA discussion paper on harm reduction that was released the same day as nursing organizations appeared as intervenors before the Supreme Court of Canada. The decision of the Supreme Court was that closure of Insite would prevent access to essential health services and endanger the health and safety of people who use drugs. This would also undermine the intention of the Controlled Drugs and Substances Act and violate the Charter of Rights and Freedoms. Instead, Insite would remain open while having to apply annually for an ongoing exemption.

With this decision, there was hope that other supervised consumption sites would open elsewhere in Vancouver Coastal Health (VCH) and Canada. However, the Federal Government quickly moved to develop stringent guidelines in the form of Bill C-2. In early 2016, when VCH applied for an exemption for the first time since the enactment of the Respect for Communities Act (Bill C-2), VCH stated that, “In order to meet the 27 new conditions for exemption, VCH was required to submit additional volumes of information. In practical terms, these new requirements make it onerous for Insite and other supervised injection services to obtain an exemption.”

Cities like Victoria, Toronto, and Ottawa have identified a need and plans to establish SCS. However, there has been only one new site approved in Canada to date. In January 2016, the Dr. Peter Centre (DPC) in Vancouver became the second approved site in Canada. The DPC delivers an integrated model of SCS and has been operating under the auspices of professional and ethical nursing standards for nearly a decade. Current B.C. Minister of Health, Terry Lake, has identified the need for more SCS in B.C. and says he has written to the Federal Government asking them to reconsider Bill C-2, and reduce the barriers to opening more SCS. To date, there has been no response. Prime Minister Trudeau and Minister of Health Jane Philpott have spoken in support of SCS but to date there has been no shift in the requirements for establishing a site.

We need action if we are to prevent overdose deaths. At the current rate, 61 people per month are dying. There is an urgent and immediate need to establish SCS and expand opiate substitution therapy to prevent further deaths. Taking a public health approach to illicit drugs and decriminalization of drugs is equally as important as a long-term policy reform to prevent the harms of illicit drug use. Today, as nurses, we can continue to lead by calling for a scale up of harm reduction services (supervised consumption services and opiate substance therapy) and an end to drug policy that criminalizes use.

Further Reading:

Illicit Overdose Deaths in BC
Nursing Positions on Harm Reduction:  CNA, BCNU
ARNBC Blog on Insite
Research on Insite
BCCDC Naloxone Program:
Public Health Approach to Illicit Drugs

ABOUT DR. BERNIE PAULY, RN, PhD

Dr. Bernie PaulyDr. Bernie Pauly is an Associate Professor in the School of Nursing, a Scientist with the Centre for Addictions Research of BC, member of the Renewal of Public Health Services Research Team, and priority lead for the Canadian Observatory on Homelessness. The primary focus of her research is reducing health inequities associated with substance use, poverty and homelessness.

 

The role of street nurses in increasing access to health care for marginalized populations, by Meaghan Thumath, RN, BScN, MSc PH

The downtown eastside is a fascinating place to practice nursing with a rich history, diverse population and artistic flair. It is also a place where many people struggle daily without adequate housing, employment or support to manage substance use and mental health issues exacerbated by trauma and pain.

But there are numerous individuals who have made it their life’s work to support and encourage the community to thrive. Street nurses are some of the most forthright, committed and determined healthcare professionals in the country. They have made an enormous difference in the lives of those who are marginalized in places like the Downtown East Side, and they will continue, with minimal applause or accolades, to work with individuals who many others have simply written off.

While the history of street nursing in Canada has been largely undocumented, Vancouver appears to be an early pioneer of street nursing in Canada. Following the sexual revolution in 1960s-1970s, four nurses also known as “street nurses in blue jeans” began providing oral contraceptive pills and sexually transmitted infection (STI) treatment to youth. In 1988, the HIV/AIDS epidemic in Vancouver led to the creation of BC Centre for Disease Control’s (BCCDC) AIDS Prevention Street Nurse Program.

Much of the success of street nursing in Vancouver can be attributed to Liz James, the first nurse to be hired by BCCDC to provide outreach services. Sadly, Liz passed away earlier this year, but she has left a legacy of caring for those who are marginalized and struggling in Vancouver.

Liz

Liz James

Liz began working in Venereal Disease control in the 1970s and later found herself working in Vancouver city jail, where she found her passion for working with marginalized populations. Liz epitomized what it meant to build a trusting, non-judgemental therapeutic relationship with clients – many of the women she worked with saw her as a mother figure. With the rise in HIV/AIDS in the 1980s among men who have sex with men (MSM) and injection drug users in the 1990s, Liz worked with community members and purchased needles from a sympathetic pharmacist to begin a needle exchange. For every used needle she collected from clients, she would exchange one clean needle in return. Starting out as a program which targeting those that were at high risk of HIV and STIs such as injection drug users, and MSM, Liz’s needle exchange expanded to provide services to other marginalized populations such as sex workers, the broader LGBT community, and those involved with the correctional system. While the program’s primary mandate was to control and prevent the spread of HIV/AIDS and STIs, nurses like Liz also addressed the broader social determinants of health by providing resources to increase her client’s access to health and social services. Throughout the 1990s, street nurses such as Liz were determined activists, and were among the first to advocate for supervised injection services, bringing harm reduction services to correctional facilities, and education related to alcohol detoxification, to those who wouldn’t seek treatment otherwise.

According to “From the grey nuns to the streets: a critical history of outreach nursing in Canada” the grey nuns started public health visits for the sick poor in what is now known as Quebec. During the first half of the 19th century, the grey nuns spread all over the northern and western parts of Canada, where they founded many of the first hospitals within those regions. Moving into the mid-19th century, several prominent nursing leaders such as Florence Nightingale, Lillian Wald, and the Victorian Order of Nurses (VON) began to understand the relationship between the broader social determinants of health, such as housing conditions and income, and the need to reform policies that would improve the health of individuals.

The social reform movement during the turn of the 19th century led to the belief that introducing nurses into areas where people were at high risk of disease would reduce those risks, which subsequently led to the introduction of public health nurses across the country. However, with the dominance of the medical model in the early 20th century, many nurses were removed from health promotion activities. During the late 20th century, despite the presence of a universal health coverage model, the growing inequities in access to health care and determinants of health led to what we now call street nursing in large urban areas. Street nurses began working predominantly with individuals who were marginalized such as the homeless.

Street nursing today not only focuses on controlling the spread of infectious diseases such as HIV/AIDS and STIs, but also on the broader social determinants by connecting individuals to health and social services. Street nurses work in a variety of settings ranging from clinics to alleys and parks, to detox centres and correctional facilities, to name a few. The ability of nurses like Liz to build trusting, non-judgemental and non-threatening relationships with their clients is a significant contributor to the positive outcomes of these clients. She demonstrated the importance of the humanistic side of nursing, and that being empathetic and listening to the needs of patients is at the core of good nursing practice.2001 street nurse group in alley

If this history teaches us anything, it’s that nurses have the ability to improve the lives of individuals and communities, not only through knowledge, but by building trusting relationships, empowering patients to take control of their health and well-being, and speaking out for the needs of patients. Liz James’ passing serves as an opportunity to reflect back on the incredible individuals who have not only transformed the role of street nurses, but shifted the discussion around harm reduction and improved the health of marginalized populations by challenging inequities and refusing to succumb to the status quo. While our roles as nurses become increasingly complex, nurses like Liz will always serve to remind us that we should never underestimate our ability to be leaders and influence policy.

In the words of Liz’s colleague and former street nurse Janine Stevenson in the film Bevel Up “Nursing is a very political act. It is also, potentially, a revolutionary force that asks what kind of society do you really want to live in?”

The author would like to acknowledge the generous contributions of street nurses Caroline Brunt, Fiona Gold and James Tigcehlaar who provided valuable insight into the history of street nursing and their colleague Liz James.

meaghanABOUT MEAGHAN THUMATH,

Meaghan Thumath is a registered nurse and public health leader in HIV and drug policy. A former coordinator at Insite and leader of BC’s provincial HIV strategy she has over 10 years of clinical and health policy experience. Her research interests include drug addiction, health equity and gender.

Unleashing Nursing’s Potential to Improve Aboriginal Health, by Laurie Dokis, RN

With the release of the Truth and Reconciliation Commission’s report last summer, and the commitment from the Federal government to move the Aboriginal health agenda forward, there has been a renewed commitment to improve the health of Aboriginal peoples. We have also witnessed Aboriginal leaders being represented at the highest levels of decision-making, including the Honourable Jody Wilson-Raybould, Minister of Justice and Attorney General of Canada, and Melanie Mark, who recently became the first Indigenous woman elected to the B.C. Legislature.

Within our own nursing community, there has also been increased discussion and commitment among nurses in positioning themselves to lead this change – and what better way to do this by engaging in these complex, difficult, yet inspiring discussions, at the Aboriginal Nurses Association of Canada (A.N.A.C) conference, held in Montreal this past February. It was truly an honor and privilege to attend this conference in my capacity as ARNBC’s Regional Director: First Nations, alongside the ARNBC President-Elect Tania Dick, ARNBC Executive Director Joy Peacock, and France Gascoyne, the winner of ARNBC’S STAND competition.

Nursing has a long standing history of engaging in political action and advocacy, and this conference truly illustrated the need for nurses to continue to speak out and address the inequalities and injustices that exist. This year marked the 40th anniversary of A.N.A.C, and it was an absolute pleasure to listen to many founding members of A.N.A.C’s lived experiences about how Aboriginal nursing has changed throughout the years. I’ve been a member of A.N.A.C for two decades, and it’s been truly inspirational to witness and experience the on-going commitment and passion of my long-time and new colleagues in improving Aboriginal health nursing and Aboriginal health.

Several brilliant speakers were in attendance, and two presenters particularly stuck with me. One of them was Marie Wilson, the Truth and Reconciliation Commissioner, who spoke and encouraged us to familiarize ourselves with the Truth and Reconciliation recommendations related to healthcare. Cindy Blackstock, Executive Director of the First Nations Child and Family Caring Society of Canada, delivered a moving presentation that focused on the work she has done to break down the systemic and discriminatory barriers in the area of Aboriginal child welfare. Cindy’s work has directly contributed to the current push to restructure child welfare systems across Canada to ensure that Indigenous knowledge is at the centre. She encouraged each one of us at the conference to do our part by bringing concerns about substandard care forward for discussion and action. Cindy also implored that we all use the United Nations Declaration on the Rights of Indigenous Peoples as our framework to inform policy change.

My experience at this year’s A.N.A.C conference has reinforced my commitment to political action that is grounded in my indigenous nursing values and cultural beliefs. With support from our national professional associations, CNA and A.N.A.C who signed a partnership accord to commit to collaborating on Aboriginal health nursing to improve the health outcomes of Indigenous peoples, as well as ARNBC’s commitment to work with stakeholders to advance Aboriginal health nursing, I feel empowered to continue the legacy of indigenous nurse leaders before me, and those who are now beside me to ensure that the health care system in BC and in Canada recognizes that:

  1. Aboriginal people matter
  2. Healthy aboriginal people are an integral part of Canada
  3. Aboriginal people should be treated fairly and have access to quality health care services

This work cannot be done alone. We must continue to build and foster collaborative and respectful relationships, and most importantly, actively listen to the needs of Aboriginal peoples, as they see them. We must make a commitment to engage and listen to Aboriginal people to truly understand what is important to them. We have an extensive nursing family that includes LPNs, RNs, RPNs and NPs. We are joined together by our college, association and union, like the braid of sweetgrass, which strengthens our collective commitment to public safety, advancing the profession and ensuring that we have quality workplaces so that we can deliver safe, competent and ethical care. Together we can ensure that the recommendations of the TRC are implemented here in BC, and together we can ensure that Aboriginal people’s rights to quality health care are realized.

I encourage all nurses to speak up for Aboriginal health issues, and to come together as a nursing family to move towards reconciliation. With the commitment of government at all levels, we as nurses, must seize this opportunity to lead change. Collectively, we can truly improve the health of Aboriginal peoples, by challenging the systemic issues that continue to compromise this population. We can no longer accept the status quo.

Laurie DokisABOUT LAURIE DOKIS, RN

Laurie Dokis earned her MN at Athabasca University in cultural competence with an Advanced Nursing Diploma and her undergraduate BScN/BA in Psychology at UofA. She has numerous additional certifications.  She is a past president of NINA and has been a member of ANAC for 20 years.  Laurie is a proud member of Dokis First Nations and is committed to seeking ways to share and apply her passion for nursing by connecting, engaging and creating respectful relationships with nurses and others who are interested in improving access to culturally safe, competent and ethical nursing for Aboriginal peoples. Laurie is the Regional Director, First Nations for ARNBC.

The Challenges of Working in Rural Health, by Michael Sandler, RN

Approximately eighty five percent of British Columbians live and work in a city or within a short distance of a town that has a population of at least 1,000 residents. This has an important impact on healthcare as certain services can only be found in cities and towns with a large population base. If you live in a large or even moderate sized city, and you need to navigate through the healthcare system, you will enjoy relatively easy access to a long list of essential services including walk-in clinics, emergency rooms, specialist consults, physiotherapy, speciality rehabilitation services and many other healthcare essentials. Most of us never really think about the challenges faced by those who live further from the centre of a city, or in the case of B.C., the southwestern corner of the province.

Canadians are proud of our universal health coverage and the tenets that support our vision of health, including equal and equitable access to care (accessibility), portability, universality, comprehensiveness and public administration. What we don’t realise is that these pillars of the Canadian healthcare system are not equally applied. Those of us who live in rural areas often struggle with accessibility, universality and comprehensiveness, issues that are not as prevalent in larger centres.

Rural British Columbians understand why it’s more efficient to locate specialized services in Vancouver, Kelowna or Victoria, where most of the population lives. However, with centralization should come a commitment to ensure that the foundational tenets of the Canadian Health Act are adhered to for those of us who live in rural areas. Services like maternity, which used to be available in most rural and remote communities throughout B.C., are now primarily focused in the larger centres. With centralization, rural community healthcare needs have changed. The need for care has not changed, just the location it is provided in, and the need to ‘move’ patients has increased. Yet despite need, changing how rural patients access services has yet to be developed to a point where our access is equitable.

A second risk to downsizing and centralization, a risk that has so far received little attention, is the ‘reduction’ effect on rural scope of practice. What can be handled in smaller centres has started to shrink, mainly because the human health resources are no longer available. The less rural healthcare providers are exposed to a given clinical situation, the less we know about that clinical situation – and ultimately, the less we can do about it when we are presented with it. This is not a failing, it simply highlights why specialized medical services exist, and why they are concentrated in areas that will see enough clinical situations to maintain competence. There are many examples in many rural communities throughout B.C. where changing services levels have led to changing outcomes in certain clinical situations.

This dichotomy in practice leads to unique challenges for rural clinicians. On the one hand you need to know a lot while understanding that you might not have access to the resources you need. This is a challenging practice environment and not for everyone. For this reason, it can be a struggle to recruit rural focused physicians, nurses and other healthcare providers. This leads to reduced rural services and as a result, rural emergency rooms often end up being the only place to access routine healthcare. With limited access to non-urgent healthcare facilities such as walk-in clinics, NP clinics and health centres, there is downward pressure on small town hospitals and healthcare providers to handle both the urgent acute health needs of their community as well as chronic and routine needs. This leads to high rates of burnout and makes it even more challenging to attract doctors and nurses to work in rural areas.

We should be utilizing existing health human resources to their fullest potential. Nursing must be looked at closely as a solution to bridging the existing health human resource gaps. Nurse Practitioners hold promise in increasing capacity for rural centres to manage chronic conditions of patients closer to home. Rural healthcare clinicians can also look to things such as simulation and distance education to maintain skills related to high-risk low-volume medical interventions, increasing retention of rural staff. Reviving the incentives that were previously offered to individuals willing to work outside of the big centres would help to offset the costs that rural clinicians are presented with to maintain their skills and increase the possibility of recruitment. Telehealth should be looked at closely to bring specialized care to patients where they are located, instead of moving them to the coast or larger centre. Lastly, a robust, evidence-based way to move patients to centralized specialized care, when some of the previous suggestions are not practical, needs to be fostered to prevent a continued decline in rural health outcomes.

Nursing and nurses who work in rural areas would like to have a voice in how local healthcare services are developed and implemented. We know our communities, our families and our practice are affected by our location. Bringing forward solutions-based recommendations will strengthen our practice, which will benefit patients, communities and our profession.

michaelsandlerABOUT MICHAEL SANDLER, RN

Michael has been working in various capacities within healthcare for the past 15 years. He recently moved into a more rural setting away from the hustle of the city and has been working with a group of dedicated professionals at improving how and where we deliver rural care.

After 10 Years, What’s Next for Nurse Practitioners? by Mark Schultz, NP

The introduction of Nurse Practitioners in B.C has just recently passed the 10 year mark. Throughout this past decade, we have had some notable successes in NP integration – some large, some small. We’re finally starting to see general acknowledgment by the Ministry of Health, the health authorities, and even some of our medical colleagues, that nurses with advanced practice education and the appropriate resources to support them can be quite useful in keeping our population healthy.

Shortly after arriving in the rural community where I’ve been practicing the last couple of years, I remember seeing an unstable patient who needed to be evaluated at the local emergency department. Based on my training, as a provider sending someone to the emergency department, it is good practice to call and give a verbal report if the receiving provider is available. On this occasion, the receiving provider was an ER physician who, before I could explain the patient’s issues, cut me off and demanded to speak to my “attending physician.” I explained I was in solo practice, didn’t have an “attending physician,” and was the patient’s primary care provider.

This was not the answer he was looking for. Further discussion culminated in me suggesting he keep me honest by calling the CRNBC to verify nurse practitioners could practice independently. I’m happy to report that a year later, this medical colleague was sending difficult patients with multiple co-morbidities to my practice for primary care in the community. This marks a small, but for me, vital example of the daily evolution of professional recognition.

The NP4BC funding initiative is an example of a larger success. Prior to this initiative, we were losing highly (and expensively) trained B.C. nurse practitioners to other provinces and the US. I was one of those NPs who was forced to seek licensure elsewhere because prior to NP4BC, there were very few NP jobs, despite a significant healthcare provider shortage. The funding helped to get NPs into the field. This in turn allowed communities and healthcare systems to experience advanced practice nursing with good results. Some health authorities are now beginning to fund some NP positions out of their operating budget. I see this as an extremely positive development and an acknowledgment of our value across diverse practice environments.

For a number of years NPs were footballs in a game of “funding chicken.” Health authorities wouldn’t hire NPs unless funding was provided by the Ministry, and the Ministry suggested to the health authorities that if they wanted NPs they could use their multibillion-dollar (but fully utilized) budgets to hire as many NPs as they wanted. We seem to have moved past this logjam, at least for the time being, as an appreciation for the solutions that advanced practice nursing can bring to the table has become more apparent. The long-term solution to advanced practice nurse funding involves inclusion of NP funding in all current relevant streams of healthcare provider funding. I think at some point, NPs are going to have to participate in MSP.

Now I know some of my esteemed colleagues disagree, but if there’s a provider funding stream, I believe nurse practitioners should be included in it.

We’re in a time of huge change in healthcare. I’ve always enjoyed the evolutionary concept of punctuated equilibrium. Yes, evolution can take place over long periods of time, but then there are those exceptional periods in the fossil record where change comes incredibly quickly. I don’t know what the healthcare system will look like in 10 years, but I’m pretty sure it’s going to look a lot different than it does now. I’m looking forward to being part of helping nursing unlock its inherent healing powers to meet the evolving demands of our patients, our medical colleagues, and our healthcare system. I enjoy being at the ground zero of change. I have come to believe that dealing gracefully with change is now a core competency for being a nurse.

I got a call the other day from a forward thinking nurse who is working with some forward thinking medical colleagues. She was wondering if they might be able to improve outcomes by including a nurse practitioner on their team in a role not traditionally performed by nurses. In thinking about the Triple Aim- improving population health, cost sustainability, and creating patient- centered care, advanced practice nursing has a lot to offer. These are the kind of discussions I love. I look forward to being part of nursing continuing to evolve towards new healthcare solutions.

MarkprofileABOUT MARK SCHULTZ, NP

Mark has been practicing as a nurse since 2003. He received his Master of Nursing, Nurse Practitioner degree at the University of British Columbia in 2006. Since then, he has been an active member of the BC Nurse Practitioner Association, where he has developed a strong interest in health and nursing policy issues. Mark has practiced as a nurse practitioner in several areas including in-patient cardiology at Vancouver General Hospital, orthopedic reconstruction at UBC Hospital, primary care at the Comox Valley Nursing Center, and urgent/emergent care at Oceanside Health Center in Parksville and Alicia Roberts Medical Center in Klawock Alaska.

Being Poor is Expensive – Nursing Needs to Raise its Game, by Zak Matieschyn BSN, MN, RN, NP(Family)

I live in a great neighbourhood in an amazing little town in the Kootenays. I have a chubby cat. My wife and I have professional, high profile jobs that pay us well. I eat three (and ok, sometimes more) meals every single day and if I’m hungry, I jump in my car and head to the grocery store. I have decent clothes, a warm bed and good health. And I know that tomorrow and next week and next year, all or most of these things are still going to be true.

But here’s the reality of life in B.C. for one out of every five kids… they live in poverty. They don’t wonder where their next meal is coming from because a full meal is something they have rarely experienced. They don’t worry about playdates after school because they know they need to be home to look after the younger kids and make sure dinner is ready for mom before she goes to her second job. They don’t do tradsies with the other kids at lunch because they only brought one slice of bread and butter that dad made that morning.

Since my first semester of my nursing education, I’ve been interested in the social determinants of health – things like income and social status, social support networks, education, employment, working conditions, environment, gender and culture. I have a passionate drive for social justice – the fair and just relation between the individual and society. I’m sure this grew in part from being one of those kids who lived in poverty for part of my childhood.

Throughout my nursing career, I’ve struggled with the worry that I’m not doing enough. I’m not making a difference. I’m not changing lives in a big way. I’ve always worked in direct care with patients and families and I can tangibly see the impact of my work on those I care for. Some people get better, some get healthier, others don’t – but through it all, I am connected by a therapeutic relationship to every single one of them, no matter what stage of health they may find themselves in. I am grateful for every success my patients experience, but I cannot and I should not be satisfied with that.

Nursing is more than that. Health is more than the absence of disease. Good health starts with prevention. Nurses know that determinants like income, education, physical environment, housing and gender have far more impact on a person’s health than any single interaction we might have with a patient in the course of a day.

We see it. Every single day we see it. We know there are people in our communities, who come into our clinics and our hospitals, and they are struggling. They don’t have the money to buy good, nutritious food for their families. They can’t find a decent place to live because every landlord has rejected them from bias of race or sexual orientation. They are exhausted because the bedbugs in their run-down apartment make it impossible to sleep.

The single greatest determinant of health is income. We nurses totally get this – poverty is bad for your physical and mental health. With poverty comes the difficult decisions of what to prioritize first – housing, food, clothing, etc. These are difficult decisions for a relatively healthy person, but for those whose monthly income relies on disability or social assistance, these decisions are impossible because the monthly amount they receive is much too low in B.C. As a result, they often end up purchasing the cheaper, and less nutritious options, rather than items that promote good health

Nursing knows better than almost any other profession that poverty is like slow-acting poison to health. It saps health insidiously over time. In the struggle just to survive, the opportunity to thrive is lost. Nurses come into contact with those who live in poverty at every step of their involvement with the healthcare system. We are the ones who advocate for them as they negotiate this system from sickness to health. We are experts at this. And yet, all too often, once they have achieved a measure of health, we move patients out the door without giving any thought to what is waiting for them on the other side. Or rather, we do know what’s waiting, but are powerless to change it.

Am I doing enough? Probably not. Are we as a profession doing enough? I know we are not.

We already flex our minds and our hearts every day with our patients and their families. What if the entire nursing profession flexed our collective strength to address these root causes of poverty? What if we ALL became activists? What if all 40,000 RNs and NPs in the province came forward and said “ENOUGH!”? What if we tapped into our tremendous knowledge and compassion to challenge the way things are? What if we joined with those who are in poverty and together asked “how can we come together to break this cycle”? What if we pursued evidence-informed social policy for our society with the same zeal and vigor that we strive to introduce evidence-informed practice into our healthcare system?

We owe it to our patients and their families. For our communities. For the kids.

Because when you are hungry and anxious about whether mom and dad have enough money to buy bread, you just can’t make yourself care about the war of 1812, or how to carry the 4. Because one out of every five kids living in poverty is NOT acceptable – and because we should NOT be comfortable with that statistic.

Our prime minister said it well… “Because it is 2016.”

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.

Nursing Stepping up to Support New Syrian-Canadians, by Maylene Fong, RN

The last report from the United Nation Refugee Agency estimates that 4.3 million Syrians have been externally displaced as a result of civil war in their homeland. That is roughly the population of B.C. Media coverage of the refugee crisis gives us the tiniest glimpse into the desperation faced by Syrian families who have been forced to leave their homes, families and friends in search of safety.

For many Canadians, it is nearly impossible to imagine the trauma and stress of losing everything familiar to become a person without a home or country. For many nurses, it is only too clear how this type of suffering can contribute to long-term health problems. Now that the political wrangling is over and these new Canadians are beginning to arrive, nurses must consider how, when and where we can support our healthcare system, and the new arrivals, in achieving their best possible success in their new country.

B.C.’s Bridge Refugee Clinic receives government-assisted refugees (GARs) year-round – usually 900 in an average year. This year is already proving to be more challenging. The first wave of approximately 400 Syrian refugees are now being seen at the clinic and we expect our numbers to raise from the 900 per year to close to 3,500.

Refugees arrive in Canada with incredibly diverse and complex healthcare needs. At this point we are providing very basic care and assessments using primary care nurses. Public health nurses have been fantastic, supporting us with immunizations as we are managing the influx of influenza cases .Some of the refugees that we serve have spent time in refugee camps and need treatment for conditions as complex as like respiratory infections, diarrhea, malnutrition to simple skin infections. Others have suffered severe emotional trauma and require mental health and counseling services. Others come from countries where healthcare is not considered a basic human right, and are suffering from disease, complex dental problems or issues that would have been fixed had they been born in a different country.

Once they arrive, despite being in a safe place and having their healthcare costs covered by the Interim Federal Health Program, there are still significant hurdles that new refugee families need to overcome. Whether they are Government Assisted Refugees, individuals who have come to Canada independently, or arriving via private sponsorship, there is still paperwork to fill out. This includes applying for MSP and other services, which can often be a lengthy and challenging process. Imagine trying to sign a lease in a language you don’t read? Or enrolling your kids in a school where they might only understand 30% of what is being said? Riding a bus when you aren’t sure how or where to buy a ticket?

Social issues such as housing, literacy, and jobs pose significant challenges for new Canadians and caring for this population requires more than just an understanding of physical illness – it means understanding and supporting every aspect of the individual or families’ life.

Caring for refugees is far outside the standard medical model of care in Canada. As nurses we recognize the need to support our new citizens holistically because we see the long term effects of mental illness and chronic disease left unchecked. We also understand the dire need for proper care to be made available to refugees. Assisting them now will only serve them to become healthier, more productive members of our communities.

This is a moment in history where Canadians get to decide what we truly believe in. With stories of middle-eastern terrorist organizations dominating media for well over a decade, it is far too easy for some to see all Syrian refugees through the same distrusting lens. Will we fall prey to the racist rhetoric within or will we choose to see each man, women, and child as worth the human effort to care for?  As nurses, we have an opportunity to shine a light of caring and compassion into some of the hardest and darkest moments imaginable. As a human being, and as a proud RN, I know that our profession will be ready to support and uplift every person who comes through the door, listening to their stories and ensuring their good health – for this generation and the ones to come.

For more information on Nursing and Refugee Health in B.C., visit our Refugee Health Information Page and read our interview with Nurse Practitioner Ranjit Lehal who provides primary health care services for refugees at the Burnaby New Canadian Clinic

Maylene Fong-smABOUT MAYLENE FONG, RN

Maylene has worked in various roles as a front line nurse, educator, and clinical nurse specialist. She is currently a manger in community health, where she works closely with both nurses and health authority management to develop long-term, evidence based solutions to existing and emerging issues.

 

Nursing Students Raise the Alarm on the Future of the Profession, by CNSA with Micah Thompson

Financial strains on health care, the mass exodus of retiring nurses and a high attrition rates of nursing graduates will continue to have serious implications on our healthcare system. As nursing students and future registered nurses (RNs), these current healthcare facts urged the Canadian Nursing Students’ Association (CNSA) to write a letter explaining why nurses are essential to the healthcare system and some of the current challenges both nursing students and nurses are facing. Our hope is to bring these issues to the attention of candidates running for federal office in local ridings.

Nurses are the largest body of healthcare providers in Canada and are at the heart of patient care. Nurses work in all facets of the healthcare system including, but not limited to: community, clinical settings, government, rural and remote care, research and education. Nurses work intimately with patients offering highly skilled clinical expertise while fostering trusting relationships that are built on advocacy, professional responsibilities and client-centered care. Nursing leadership is integral to a strong healthcare system and must be advocated for and protected.

Between 1990 and the year 2000, 40 percent of graduate RNs left the profession due to the strain imposed on them by a lack of nursing mentorship stemming from nursing shortages. Attrition rates are associated with student debt, high stress working environments and staffing shortages. In 2010, $26,000 was the average student loan debt for Canadian students finishing a bachelors or masters program. In 2014, there was a significant reduction in RN license renewals compared to 2013. Contributing factors were retirement, changes in careers and changes in the regulatory body resulting in the first decline in decades. Public sector nurses worked 20,627,800 hours of overtime in 2010, the equivalent of 11,400 jobs costing $891 million per year.

In considering these facts, we are asking those who will be heading to Ottawa to form our new government to address student debt, provide mentorship for new graduates, and improve work environments and safe staffing levels for quality patient care. Please go to the CNSA website for more information at: http://cnsa.ca/english

If you agree with the listed recommendations please send the letter on the CNSA website to your local riding candidate to build awareness and create change! We have power in numbers and as the nurses of tomorrow we must rally together to support healthcare in Canada.

Thank you for your support and don’t forget to vote!

CNSAlogoABOUT CNSA The CNSA is the voice of nursing students and represents students in baccalaureate, practical, and psychiatric nursing entry-to-practice programs in Canada. For over forty years, CNSA has represented the interests of nursing students at local, provincial, national, and international levels, as well as within the nursing and healthcare communities. The CNSA, has nearly 30,000 members, is an affiliate member of the Canadian Nurses Association (CNA) and Practical Nurses Canada, Canadian Federation of Nurses Unions (CFNU) and Canadian Association of Schools of Nursing (CASN).

micahthompsonABOUT MICAH THOMPSON Micah Thompson is a fourth year student in the Bachelor of Science in Nursing program at North Island College in the Comox Valley.  She was lucky enough to grow up with a mother who loves being a nurse and who sparked a passion for nursing inside of Micah at a young age. As a child, Micah wanted to grow up to help people like her mother did. As she has progressed through the nursing program, Micah has come to understand the responsibility and opportunity she has to advocate for the nursing profession and health care in Canada. In recognizing that just a few voices can create change, Micah wanted to work alongside the CNSA to inform election candidates of the current situation for nurses and nursing students today in hopes of making a positive change.

Tools of the Trade, by Lori Campbell, RN

If Michelle Collins and Joy Behar of The View have learned anything in the last two days, I hope it’s that their flippant comments were misinformed and hurtful – not to mention targeted to a group of professionals who have committed their lives, passion, knowledge and skills to caring for people just like them.

If you haven’t seen it yet, these two hostesses of The View were commenting on Miss Colorado Kelley Johnson’s monologue in the talent portion of the Miss America contest. Kelley spoke from the heart and shared how the care she provided to one patient in particular stayed with her. She remarks that “Every nurse has that patient that reminds them why they became a nurse…” and she’s right. Over the last two days nurses have taken to social media to share, reminisce and reflect on our work because we have such deep understanding of the passion that Kelley speaks with. A passion she has stirred anew within each of us.

Collins and Behar have obviously never been under a nurses’ care, and they should be grateful for this. But I’m disappointed that they believe our profession is something to mock. Furthermore, Behar actually had the audacity to ask “Why does she have a Doctor’s stethoscope?”

Now, the cynical sardonic side of me would quip that Kelley’s stethoscope hasn’t yet become a doctor’s stethoscope, because a resident hasn’t yet lifted it unknowingly from the ward. But the more serious side of me fumes with the insinuation that a nurse would not need to use what we all view as a basic tool of patient care.

The first week of nursing school there are a few notable purchases in a nurses’ life. Among the giant pile of books like Anatomy & Physiology, Psychology, Pathophysiology, Biochemistry, and Pharmacology – one of the most exciting purchases is a stethoscope. This is a tool that nurses, doctors, respiratory therapists, physiotherapists, nurse practitioners, technologists and many others use every day to hear deep within our patients and perform repeated assessments of their condition. With a stethoscope a nurse listens to a fetal heartrate to hear if the rate is slowing as the mother’s uterus is contracting, to hear the progress of a resolving pneumonia, to listen for the effect of a cardiac medication that we need to assess whether to give or hold, to perform blood pressure readings that tell us if we need to administer fluids or intervene in cases of high blood pressure.

There are three basic tools in nursing practice – our brain, a caring heart and a stethoscope. It seems Behar and Collins are unfamiliar with all three.

ABOUT LORI CAMPBELL, RN

lori-campbell

Lori completed her BScN at McMaster University and started her career at VCH in 2005. She has had positions in surgical care, intensive care, harm reduction, and on Vancouver’s downtown east side. As a direct care nurse dealing with patients from every part of Vancouver’s complex social and ethnic structure, Lori has gained a passion for promoting strong, evidence-informed nursing practice.

Currently working to support direct care clinicians in the Vancouver Professional Practice department as Practice Initiatives Lead, Lori has an excellent vantage point to promote best practice, innovation and integration of technology within nursing practice. A strong team player, she is actively involved with interdisciplinary groups at VCH. In addition to working full-time Lori is also pursuing an MSN at UBC and maintains a strong presence on social media as @NurseNerdy.