Author Archives: ARNBC

Nursing at the Policy Table: Are we at the Table or on the Menu? by Patrick Chiu MPH, BScN, RN

Nursing has a long and proud history of promoting health, preventing disease and injury, and addressing the social determinants of health that are so influential to the health and well-being of individuals and communities. However, as we reflect on the past and present, and recognize the tremendous history and contributions that nursing has and will continue to have on health outcomes, patient satisfaction and cost-effectiveness within the healthcare system, why is it that in 2017, nursing across the world continues to struggle with the same issue of ‘being on the menu, and not at the table’?

Last month, I had the absolute honor and privilege of being selected to attend the International Council of Nurses’ Global Nursing Policy Leadership Institute (GNPLI), alongside 26 global nurse leaders, in Geneva, Switzerland. A rare opportunity, I found myself learning and building relationships with some of the most inspiring, determined, articulate and passionate nurse leaders from 19 countries that represented all of the World Health Organization’s regions.

The theme of the residential workshop was to ‘empower, educate, mentor, and develop.’ This intensive week was filled with learning, discussions, and networking with global nurse leaders. The goal of the program was to help enhance our effectiveness in bringing about policy changes that lead to health improvement, by increasing our political and policy competence, specifically within the context of the United Nations Sustainable Development Goals. Speaking with global nurse leaders, it was clear that the inextricable linkages that we have with our communities positions nurses to be clear leaders in influencing healthy public policy. In fact, we could successfully argue that there is no other health profession that aligns more strongly with the principles and values of patient-centred care.

As 27 nurses coming from differing political, social and economic contexts, there was no doubt that we were all different. However, our collective vision, determination, and passion in improving the health and well-being of our communities and strengthening health systems was a true testament to the philosophy of the nursing profession. The belief that nursing should be at the policy table, could not be disputed. However, it was somewhat ironic that while we all held such a strong belief, the top area for improvement among global nurse leaders was, in fact, policy and political skill.

While nurses hold significant expertise in nursing, health and healthcare, our challenges with successfully influencing policy can often be attributed to a lack of understanding of the political context, process, and actors in order to advance a policy agenda. It’s not enough to assume that because of the nature of our practice and the expertise gained from our work that we’ll be invited to the table. In order to be involved in agenda setting, policy formulation, policy implementation and policy review, we need to understand power, politics and policy. Specifically, some of the take home messages that resonated with me include:

  1. Look outward, and set agendas for a broad range of health and social policy issues. It is critical that we frame issues in the interest of individuals, communities and the healthcare system, with nursing as a solution. If nursing positions itself as the solution rather than the issue, we will quickly move from being on the menu to being at the table. For example, a report developed in 2016 by the All- Party Parliamentary Group on Global health (APPG) calls for raising the profile of nursing globally and to enable nurses to work to full scope in order to achieve universal health coverage. It does so by eloquently framing how supporting and developing nursing has a broader triple impact of better health, greater gender equality and stronger economies.
  2. Learn and be familiar with political language. Yes, we’re great at using our own healthcare and nursing jargon, and often times, we quite like it. However, if we aren’t able to craft clear concise messages, and communicate effectively with our target audience (many of which are politicians and policy makers), we only end up speaking to ourselves. Achieving political sophistication involves learning and utilizing language and rhetoric commonly used in policy debates.
  3. Build Coalitions within and outside of nursing. In order for nursing to successfully influence policy, we need to collaborate and bring forward one strong unified message in everything that we do. Once this is achieved, we need to build coalitions with stakeholders outside of nursing by understanding their influence/power, interest, expectations, values, and position. If as nurses, we understand that health is impacted by a range of structural and social determinants, we should also come to the realization that collaboration beyond nursing is absolutely vital. Nurses should absolutely be taking the lead in addressing health and social policy issues, but this cannot be done without the support of politicians, policy-makers and health leaders outside of nursing.
  4. Build nursing policy leadership at all levels. Nursing is so much more than providing care at the bedside. It’s a political act. The only way to continue to engage nurses in policy is for nursing education and professional associations to be champions in supporting nurses in policy, and to develop the next generation of nursing policy leaders. We need to continue to prove that nursing’s contributions go far beyond the walls of healthcare facilities or individuals’ homes, and that the profession does in fact, have a major role to play in achieving the sustainable development goals.

We see examples of nurses being “edge-runners” on a daily basis, seeking innovative ways to bring new thinking and methods to a wide range of health challenges that confront us every day. Recently, WHO Director General, Dr.Tedros Adhanom tweeted “It’s a must to hear the voice of nurses. A force to reckon with…”, and I couldn’t agree more. Today, more than ever, we have a real opportunity to ensure that nursing is at the policy table locally, nationally and globally. But expertise in nursing is not enough. We need to think broadly, be experts in the political process and context, learn the language, and build coalitions. Only until then, will we find ourselves consistently sitting at the table, and not waiting to be selected from the menu.

ABOUT PATRICK CHIU, RN

Patrick holds a BScN from McMaster University and Master of Public Health (MPH), with a focus in population health from Simon Fraser University. He has experience working in several acute care areas including emergency, critical care, and medical/surgical nursing. Patrick is committed to working collaboratively with ARNBC’s membership and stakeholders to advance the nursing profession, and to influence health and nursing policy. Patrick is ARNBC’s Policy Initiatives Lead.

My Experiences and Recommendations for supporting IENs, by Laxmi Regmi Kaphle, RN

Canada has been welcoming immigrants for centuries, and as a result, millions of people from around the globe get to live, work, and play in a diverse, inclusive and vibrant multicultural society, where the whole world can be experienced in one place. Canada also has a long history of attracting and recruiting internationally educated nurses (IENs).

During the early 1990s-2000s when we began to see the nursing shortage in Canada, the numbers of IENs started to increase drastically. At that time, many provincial health systems and independent organizations advertised for nursing positions abroad and recruited IENs through international conferences and career fairs. To address the shortage of skilled workers, including nurses, the federal government of Canada also introduced a federal skilled worker programme (FSW), which has been attracting more IENs to Canada. While the exact number of IENs that have attempted to achieve registration in Canada is unknown, according to a study done in 2007, “IENs represent 7-8% of the nursing workforce, ranging from 1.9% in Newfoundland to 15% in British Columbia”, with numbers to be expected to increase each year. [1]

I was born, raised and educated to be a registered nurse in Nepal. I moved to Canada almost a decade ago with the hopes of investing my skills and abilities in exchange for a better and more successful life. From an immigrant’s perspective, moving to another country for a secure career and a better life is both a blessing and a challenge at the same time. For the majority of immigrants, the first few years of life after immigration are extremely challenging and require a tremendous amount of support and direction, especially in the areas of socialization, financial stability and being able to enter the profession they were trained in from their country.

For myself, this experience was no different. The process to achieve registration as a registered nurse in Canada was a long and challenging three and a half years, adding to the stress of my family’s transition to Canada. Despite feeling alone I quickly learned that I was not the only IEN facing these challenges. In fact, the majority of IENs spend, on average, three years acquiring the necessary requirements to obtain their registration in Canada. This lengthy process continues to be a major concern for IENs, and this, along with other challenges that my colleagues and I experienced suggests that greater supports are needed by all stakeholders involved in IEN integration, especially in the areas of communication, financial support, workplace integration and mental health supports.

During my integration into Canada and its health care system, communication was my biggest challenge. I suffered psychological and emotional breakdowns that not only degraded my confidence, but also my self-esteem and self-image. The emotional and psychological impact of stress, fear of the unknown and being judged by colleagues and patients was particularly difficult during this transition.  It was not that English was a difficult language to learn, but rather learning the language within the context of Canadian culture, and being able to communicate just like any other Canadian was very difficult. While I have come a long way, at times I continue to face discrimination because of my accent.

The financial burden was also particularly stressful. The inability to obtain entry level work to earn any kind of income, despite rigorous efforts (due to not having any other work experience other than nursing), while paying for private English lessons, and various expenses for registration was daunting. Even after entering into the Canadian nursing workforce, IENs still lack the support they need for a smooth transition. The unfamiliar workplace settings, culture, different roles, responsibilities and scope of practice compared to the IEN’s country of origin are some of the areas where IENs require greater support.

While the Canadian Nurses Association (CNA) predicts a shortage of almost 60,000 nurses by 2022, we also see many IENs with rich and extensive nursing experience giving up their hopes of becoming nurses in Canada due to the hardship of the lengthy registration process, as well as the lack of support and resources once in practice. Why is this happening? What can we do to prevent this? How can I make a difference and advocate for change? If I have taken anything away from my ARNBC internship, it’s to “be brave enough to start a conversation that matters.” With this in mind, I would encourage nursing organizations to take further measures in supporting and retaining the valuable IENs that have so much to contribute to nursing, the healthcare system, and patients.

Re-evaluate the current registration process and requirements, provide resource and supports to those who are in process of registering and integrating into the workplace, and support our networking, communication skills, and mental health and well-being. As IENs, we bring our unique perspectives, knowledge and experiences to nursing and healthcare, but we can’t do it alone.  To this day, I continue to appreciate the quality of life that Canada has offered me throughout the years, and I will never take this opportunity for granted. Being a registered nurse in this country is a blessing, and I know that nursing organizations and nurse leaders have the ability to continue working towards improving the quality of life of IENs. So let’s come together and continue to support each other, because when we thrive, our communities, colleagues and patients thrive.

All references:

Tregunno, D., Campbell, H., Allen, D., de Sousa, D., (2007). Internationally Educated Nurses (IEN) knowledge translation Project report. College of Nurses of Ontario. Retrieved from https://www.cno.org/globalassets/docs/policy/ienexternalsummaryjan2308.pdf

ABOUT LAXMI REGMI KAPHLE (Rosha), RN

Roshna is a proud Internationally Educated Nurse from Nepal and current Post-RN student at the University of Victoria completing her community practicum placement at ARNBC. Roshna graduated from her nursing program in 2006 where she worked for a year in a labour and gynecology unit in Nepal. After arriving in Canada in 2007, Roshna began the process of registration and completed the Graduate Nurse Internationally educated re- entry (GNIE) program from Kwantlen in 2011. Since 2012 she has worked as an RN at Langley Memorial Hospital in Acute Medicine and currently works on a Medical/Oncology Unit at Surrey Memorial Hospital. Roshna is particularly passionate about nursing in the field of global health and aspires to continue her education to work and advocate for health care internationally. Roshna will carry on her advocacy efforts for IENs in order to further the resources and supports available as they make their transition in Canada.

 

Standing Together in a Time of Uncertainty, by Tania Dick, RN, MN

My first President’s update comes at a time when our province is in a great deal of turmoil, which makes sitting down to gather my thoughts, emotions, and reflections a struggle – my nursing self wants to constantly be doing something to help. As nurses we need to almost be a CTAS 1 before we’re still, which is why we’re constantly voted the most trusted profession; because we will not stop until the work is done – and for the most part at all costs. Yet taking a moment to reflect on some of my thoughts and emotions from the last few weeks, and consider my hopes for days to come, is important as I start my Presidency of the ARNBC.

First and foremost, let me share a bit about myself. I am a proud First Nations woman from the Musgamagw Dzawada’enuxw people of Kingcome Inlet and I have been nursing for 14 years, I acquired my MN degree at UBC in the Nurse Practitioner program in 2010, and this will be my fifth year on the ARNBC Board of Directors. I am humbled, honoured, and privileged to assume the role of President for the Association of Registered Nurses of BC (2017-2019). As my Grandma would always say “Ola’kalan mu’la”. This in my language translates as ‘I am really grateful’.

As I move into my presidency, there are two significant issues that are weighing heavily on my mind, and I know on the minds of most British Columbians. We have two ongoing crises occurring in the province, each heartbreaking in its own way – the ongoing wildfires and the opioid crisis.

I know the hearts and prayers of all nurses are with those that have been displaced or otherwise effected by the wildfires and evacuations in our province, and I find myself remembering being in a similar situation in 2010 when my parents, family and loved ones experienced flooding that forced an evacuation of our entire village and displaced everyone for months. I remember the fear, uncertainty, and complete bewilderment of landing by helicopter in another community with only the clothes on our back. Although we were surrounded by safety, and were well cared for with open homes, open arms, and open hearts by another community, I will never forget the look in the eyes of my loved ones, and the energy in the air and in our hearts knowing we had lost everything – it was catastrophic and the memory of that is something I carry with me to this day.

Those memories are fresh on my mind today and make me wish I could be in seven different places at once, volunteering to help ease the unknown, the uncertainty, and fears for those communities being evacuated. It also reminds me of the nurses who work and live in those areas and what they are going through as they work to evacuate the acute care, MLC residents, and assisted living clients from Williams Lake and other communities. Nurses across B.C. have been working hard to ensure evacuated British Columbians are safe, comfortable and have their daily medications and equipment. I am bursting with pride knowing B.C. nurses have gone above and beyond for those in need, even though many also have the same uncertainty, and may also be an evacuee. I hold my hands up to the nurses and other health professionals in impacted areas during this difficult time.

At the same time, we continue to face a devastating public health crisis as more and more British Columbians suffer from overdose or death due to the opioid crisis, something which has impacted ARNBC and myself quite deeply. In December 2016, ARNBC, along with our colleagues in the BC Coalition of Nursing Associations, hosted an opioid crisis forum to bring to light some of the challenges our nursing colleagues are facing. Some of our provincial leaders and nursing leaders spent time in Vancouver’s Downtown East Side (DTES), meeting locals and some of the nurses who work with them.

I had the absolute privilege of shadowing an amazing nurse, and we stopped in and had lunch at the Vancouver Area of Drug Users (VANDU). Here I met Tracey Morrison who was president of the Western Aboriginal Harm Reduction Society (WAHRS). I was inspired by the work she had done, was doing, and wanted to do. After hearing about her day to day tasks, her hopes and dreams, I felt like I needed to triple the work I was doing as an advocate. In the very short time I spent with her, she made me want to be better, to think bigger, to do more. My world changed over a floppy piece of pizza and a Diet Coke with this incredible woman.

Like so many within this community, we were devastated to learn last week that Tracey had passed away. In an email earlier this week, the nurse who introduced me to Tracey shared her thoughts, which reflect what so many of us have been thinking – “I’m having a rough week. so many losses of people I know lately but Tracey definitely the closest one. I feel like you rarely get to meet someone with that kind of spark. I’m glad you got to meet each other. I feel like I am learning what it really means to live through a crisis; it’s not like anything I’ve ever done before, even after 20 years working in the DTES”.

The opioid crisis continues to take lives in our province, and each loss of life takes its toll on the hearts and minds of everyone who works within and around this community. ARNBC will continue to be inspired by the work of Tracey, and so many like her, and will work even harder to influence change that will save the lives of those we have come to care deeply for, while helping to protect and resource all of the healthcare professionals working on the front lines of this crisis in communities across B.C.

These two significant health emergencies are now in the hands of our freshly minted Premier, John Horgan, and the team he has put together. ARNBC was proud to see long-time friend Judy Darcy, appointed to the new position of Minister of Mental Health and Addictions. We look forward to working closely with her on numerous issues, but most urgently on the opioid crisis. With Judy and our new Minister of Health, Adrian Dix at the helm, I have great hopes that our provincial nursing organizations and our new government can work together for a safe and healthy British Columbia.

Lastly, I am excited to welcome Valerie St. John as the new Executive Director of ARNBC. Her expertise, experience, and passion for our profession will help us strengthen the voice of nursing through policy and action. Many thanks to our Interim ED, Andrea Burton, and our incredible ARNBC Staff and Board who have been instrumental in seeing us through the past six months. I am extremely proud of the work we are doing as an Association, and look forward to meeting many of you over the next two years, hearing your stories and learning from you. Working together, we can make the profession, and British Columbians, healthier than ever.

ABOUT TANIA DICK

Tania Dick hails from the Dzawada’enuxw First Nations of Kingcome Inlet and has been a Registered Nurse in British Columbia for 12 years. Her entire career has been spent in rural and remote nursing, specializing in Emergency and Aboriginal health. She attained her Master of Nursing degree in the Nurse Practitioner program at UBC in 2010. She currently works full time as a general duty nurse in her Father’s rural village of Alert Bay, BC.  Tania became president of ARNBC in June 2017 and has been on the ARNBC Board since 2012.

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

vs

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.