Author Archives: ARNBC

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 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.


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 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.


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.


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.”


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 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:

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.



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.




Nurses and Shiftwork: Sleep Well to Be Well, by Dr. Carolyn Gotay

It’s estimated that most people spend one-third of their lives sleeping, but until recently, the links between sleep and health were not well understood. Recent research has identified relationships between disrupted sleep and increased risk of obesity, diabetes, cardiovascular disease, and some cancers, suggesting that sleep has significant effects on health and well-being.

There are an estimated 4.1 million shift-workers in Canada, and approximately 1.9 million regularly work shifts between midnight and 5AM; these workers are the largest group at risk of disrupted sleep. According to a Statistics Canada Survey of nurses from 2005, six percent of B.C. nurses work permanent night shifts, and an additional 45 percent work mixed shifts, including nights. This suggests that slightly more than half of all 38,000 registered nurses in B.C. suffer from regular circadian disruption due to shiftwork. In fact, in 2010, IARC classified shiftwork with circadian disruption as Group 2A, “probably carcinogenic to humans.” In particular, IARC identified increased breast cancer risk in night shift-workers.

The ICOS study (Improving Cancer-related Outcomes in Shiftworkers) is funded by the Canadian Cancer Society and led by Dr. Carolyn Gotay, Canadian Cancer Society Chair in Cancer Primary Prevention at the University of British Columbia. The study tested whether a sleep hygiene intervention for women who work shifts could reduce their risk of breast cancer.

Study participants were 47 women (including 23 nurses) from the Vancouver region. On average, these women had worked seven night shifts per month for more than 16 years. At baseline, about four in five (79 percent) reported poor sleep. Since obesity is an additional risk factor for breast cancer that is linked to poor sleep, participants also self-reported their BMI and were categorized as normal weight, overweight, or obese.

The sleep intervention consisted of 10, telephone-delivered cognitive behavior therapy (CBT) sessions. CBT is a psychotherapeutic method that focuses on changing unhealthy patterns of behaviour and thinking, and it has been endorsed as a first-line treatment for insomnia by a National Institutes of Health Consensus Conference and the British Medical Association. The intervention was delivered by an experienced sleep counselor.

Six months after the intervention, the proportion of participants reporting poor sleep had decreased by more than one-third, from 79 percent to 49 percent. This positive impact was maintained when we went back to the women six months later, a year after they began the study. The effect was stronger in women with BMIs less than 25, but it was also statistically and clinically significant in women who were overweight and obese. This promising finding suggests that a sleep hygiene program like the one used in the ICOS study can result in significant and lasting improvements in sleep quality in night shift-workers.

We are still analyzing other data collected in the study, including information about health behaviours, objective measures of physical activity, and biological indicators in blood and saliva. We are very grateful to the nurses who took part in this research – we couldn’t have done it without them! We’ve already learned a lot from this study, and we plan to build on our findings in future research. In particular, we are thinking about providing sleep hygiene sessions for nurses who are just beginning their careers as night shift-workers.

If you have comments about this idea, suggestions for other sleep research that would be helpful to you, or if you’d like more information about the ICOS study, please contact Jennifer Parisi, Communications Director at the Centre of Excellence in Cancer Prevention (


Gotay, Carolyn_high-resCarolyn Gotay, PhD, FCAHS is Professor and Canadian Cancer Society (CCS) Chair in Cancer Primary Prevention at the University of British Columbia (UBC). She also holds an appointment at the BC Cancer Agency. Dr. Gotay received her PhD in psychology from the University of Maryland, and she came to UBC in 2008 after positions at Gettysburg College, the University of Calgary, the (US) National Cancer Institute, and the University of Hawaii.

President’s Message: Looking Forward, by Zak Matieschyn, BSN, MN, RN, NP(Family)

I am honoured to write my first President’s Message to the registered nurses and nurse practitioners of British Columbia who have entrusted me to lead the Association over the next two years. I look forward to the challenge ahead with excitement at the potential that exists for the Association and nursing to make transformative changes in the healthcare system, the nursing profession and the lives of individual RNs and NPs. The nurses of British Columbia have elected a diverse and strong group of directors who will lead our board and I am thrilled to work with them as we serve the nursing profession over the coming months.

I grew up in British Columbia and have been an RN in this province since 2000, working in a variety of settings including med/surg, ICU and emergency nursing in Victoria, Vancouver, and the Kootenays. For the past six years I have worked as an NP at a primary healthcare practice in Castlegar and I thoroughly enjoy the opportunity to work directly with patients at every stage of their lives and provide for their primary healthcare needs.

Although my interests are diverse, a particular passion of mine is around the social determinants of health (e.g. housing, income, education, etc). This is an area that nursing has been aware of for decades, because we know that health is so much more than the absence of disease or making good lifestyle choices. Nursing needs to be at the forefront in offering an evidence-informed opinion when it comes to developing the health and social policy that will address the social determinants. And while governmental policy that seeks to improve these health determinants should be applauded, policy that worsens the health of British Columbians by negatively affecting these factors must be constructively critiqued. I look forward to applying my passion in this area to help strengthen the nursing response in addressing social determinants that impact our families and communities.

This is an important time for nursing, and for healthcare in British Columbia. Through the policy papers issued in March of this year, the provincial government and the Ministry of Health have signaled that the next few years will bring transformative change to our healthcare system – with a focus on patient-centred, team-based care and a move to revitalize primary and community care. These are areas in which nursing and nurses have extensive knowledge and expertise. The success of this transformative policy change is greatly dependent on the involvement of nursing throughout the process. I am pleased to say that the ARNBC is specifically named in these policy papers as a consultant and contributor to this process. I encourage any RN/NP interested in being involved in this exciting work to share your thoughts with us so we can bring your voice forward to government.

Join me in strengthening the nursing profession and nursing community. There are a multitude of opportunities to be engaged with your Association, your College and your Union. Let’s demonstrate the incredible knowledge and strength that this amazing profession brings to healthcare transformation. Together we can build positive, lasting change.


ZakZak’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.