ARNBC has been working hard to raise the voice of nursing with government and partners in B.C. and across Canada.  We have met with the Minister of Health and other key government leaders to share our ideas about how to strengthen primary care services in B.C., increase collaboration between health professions and reform some of the tools we need and use on a regular basis such as best practice guidelines.  We look forward to continuing to bring the voice of B.C. nurses forward at policy tables and with stakeholders in the months and years to come.

To assist nurses in speaking up for health and health care during the provincial election campaign, ARNBC has compiled resources for nurses to use during the campaign. As part of this innovative Online Toolkit, we have added new Issues Notes on Rural Health and Mental Health with background information and sample questions to pose to candidates during All Candidates’ Meetings in your communities.

As your professional association, ARNBC has been engaged in exciting initiatives during the past few months. We were pleased to collaborate with the BC Nurse Practitioner Association and the Licensed Practical Nurses Association of B.C. to propose significant changes to primary care through the development of an interprofessional council of health professions to oversee these needed changes.  Recently ARNBC, BCNU and CRNBC developed a joint statement on the need for a Provincial Nursing Plan. We are revitalizing a network of professional practice groups in the province and providing opportunities for local groups of nurses and others to link and network together through our new Network Leads Project.  We continue to work with the Canadian Nurses Association to strengthen the voice of nursing in Canada, and were proud to co-lead their Nurse Practitioner campaign in B.C. in 2012 and to bring a B.C. nursing perspective to the CNA Board of Directors.

On June 26, 2013, we will be holding our second Annual General Meeting at the Paetzold Auditorium at Vancouver General Hospital.  All B.C. registered nurses, as well as students and retired RNs, are welcome to attend.  And if you can’t be in Vancouver on June 26, rest assured that we will make sure you can participate via webcast.  We look forward to seeing many of you there.  To register for the AGM, and to sign up to vote in the Board election, please visit our AGM Page where you will find registration forms and a call for nominations for four Board positions.

Our social media platforms continue to thrive.  We are always interested in hearing from nurses who have a passion and want to share their opinion on a current public policy or advocacy issue by writing a post for our blog.  Feel free to comment here to tell us what you and your colleagues are doing for Nursing Week and how you’ve been involved in raising health issues during the provincial election campaign.

It is a busy time for the nursing profession in British Columbia, and we are proud to be raising our collective voice in support of important changes to our healthcare system.  We are continuously reminded of how insightful, knowledgeable and passionate nurses are about providing quality, patient-centred health care.  You do an amazing job, each and every day, and we are so proud to support you in all of your efforts as a leading force for change.

Happy Nursing Week 2013!

ABOUT ARNBC

The Association of Registered Nurses of British Columbia (ARNBC) is a professional organization that provides a unified voice for registered nurses and nurse practitioners in the development of health, nursing and public policy that advances the health of British Columbians.

We welcome comments on this or any other blogpost!

April 2^nd was proclaimed by the B.C. Government as Oncology Nurses Day. That evening, the Honourable Margaret McDiarmid, B.C. Minister of Health, made a surprise visit to an oncology nurses event that was held at the Vancouver Cancer Centre and joined via teleconference by nurses from 12 sites around the province.  The Minister spoke from her heart – as Minister of Health and a former BCCA cancer patient – about the irreplaceable role that nurses play every day in providing patient-centred care. McDiarmid recalled how nurses brought an intelligent practicality to the daunting prospects of chemotherapy while supporting her with compassion and individualized guidance.  She recalled watching how nurses interacted with all of the patients in the chemo unit – careful and thoughtful, inspiring patients with a sense of competence that shone through all they did.

“I don’t think you ever get thanked enough for what you do,” McDiarmid said.  “Never forget what a profound difference you make for people at the most vulnerable times they will ever face in their lives – and not just the patients but also their families.”

And after making brief remarks, McDiarmid stayed to hear nurses talk about their practice and about their passion for oncology care. One nurse from the interior spoke about her study of the grief of family caregivers who had found themselves unable to manage the home care for their dying loved one at home until the very end.  A student nurse on the brink of graduation shared her excitement about beginning her career in cancer nursing and the many mentors who had inspired her along the way. And another nurse from the north spoke of the massive challenges her team faced in establishing the first BC cancer centre in Northern B.C. Each of these nurses spoke with commitment and passion, reminding their colleagues in the B.C. Oncology Nurses Group (the B.C. branch of the Canadian Association of Nurses in Oncology) why they came to work each day and the difference they knew they could make for patients with, through and beyond cancer.  The Minister remained throughout the entire evening, taking extensive notes and remaining after the program to speak with individual nurses and share her gratitude for the nursing care she herself received.

Minister McDiarmid acknowledged that her Ministry is well aware of the challenges B.C. nurses have faced in recent years in bringing the distinctive professional nursing perspective to matters of health and healthcare policy. However, she also assured the nurses present that she has been inspired by nurses across the province throughout her term as Health Minister. In every sector of the health care system, she sees nurses stepping up to the plate with the same kind of inspired intelligence she herself witnessed as a patient.  Clearly she understands – as BC Cancer Agency President & CEO Max Coppes said, “Nurses Rock!”

For further information about the BC Oncology Nurses Group, please contact Johanna den Duyf, President, at jdenduyf@bccancer.bc.ca

ABOUT DR. SALLY THORNE

Dr. Sally Thorne, RN is a Professor at the UBC School of Nursing, where she has been a faculty member for over 25 years. A nurse researcher and educator, she draws attention to the contribution of professional nursing to the lives of persons with cancer and chronic disease. She represents nursing as a board member in the non-profit and health sectors both in British Columbia as well as nationally.

On December 5th, 2012, student’s and nurses from the Comox Valley gathered together to discuss re-establishing a local ARNBC chapter. The meeting was full of enthusiasm and energy as members shared a sense of excitement to be reconnecting with each other and strengthening the professional presence of nursing in the region.

The group was comprised of students, retired, and practicing nurses from a variety of agencies in the community. Many of the attendees were previous chapter members with RNABC and shared what they most valued previously, the feelings of loss and disconnect since its dissolution, and their visions for moving forward as a group. Themes that emerged from the meeting included: providing an outlet for professional advocacy, seeking a connection with professionalism, mentorship amongst nurses outside of the workplace, educational opportunities, having a connection with larger nursing associations, and the opportunity to have fun and socialize with other nurses.

Communities across B.C. have experienced numerous challenges when trying to connect with nurses due to a lack of accessibility regarding contact information. Our group was faced with a similar challenge and we took a grassroots approach to connecting with nurses, beginning with personal contacts and previous Registered Nurses Association of BC chapter members. We found that there was a large knowledge gap about the past history and different roles of the nursing organizations. With this in mind we recognized the need for a professional and political voice and we believe ARNBC will fill the current void. We were able to devote time and resources through our undergraduate leadership course in the efforts of promoting the association, hosting scholarly events, and exploring the initiation of a local ARNBC chapter.

Suggestions for connecting with nurses in your area:

• Social media challenge. We found this to be an effective way of having people engage with ARNBC. Within three weeks, ¾ of the nursing student body at the local college had “liked” the ARNBC page on Facebook, and the prize was only a baked good delivery to the winning class.
• Sharing information packages through hardcopy and an email chain letter. We included the ARNBC documents: FAQ, timeline, and changing regulatory framework.
• Brief presentations at community nursing agencies.
• Media releases through local newspaper, radio, and hospital newsletter.
• The local college hosted a scholarly night where ARNBC president-elect Julie Fraser and projects-manager Nora Whyte were the guest speakers.
• Poster advertisements around hospital and community agencies.
• Local MLAs visited our classroom and we promoted the local ARNBC group to these political leaders.

Although our academic semester is over, our role in connecting nurses with ARNBC will be ongoing. Our challenge for nurses across the province is to rebuild and strengthen networks in their own communities and then join with ARNBC to project our professional voice at a provincial and national level.

Comox Valley student nurses meet with ARNBC President Elect Julie Fraser. From left, Callan Lansdowne, Trish Sanvido, Julie Fraser, Leah Peters-Michaud.

ABOUT CALLAN LANSDOWNE, LEAH PETERS-MICHAUD and TRISH SANVIDO

Callan Lansdowne is currently completing her baccaleureate degree of nursing at North Island College. She resides in the Alberni Valley but continues to stay involved in the Comox Valley ARNBC chapter as it offers an outlet to stay connected with other nurses and the opportunity to create lively discussion about issues affecting nursing. Callan has enjoyed the variety and opportunities that nursing offers and is excited about her upcoming career where she intends to pursue critical care nursing.

Leah Peters-Michaud is currently completing her final year in the registered nursing baccalaureate program at North Island College. Strengthening and being a part of the collective nursing voice is what inspired and motivated Leah and her colleagues to form a local chapter in the Comox Valley. Her passion for nursing leadership, advocacy and social justice will help guide her practice as she begins a promising career in public health and aboriginal health nursing.

Trish Sanvido is a fourth year North Island College nursing student . She has enjoyed her practice experiences in acute and home and community care and looks forward to furthering her nursing career in acute care settings. She is dedicated to advocating for excellence in stroke care and looks forward to furthering her education in critical care nursing.

It was a normal Friday morning and having not yet weaned myself from “Good Morning America” after six months in B.C., I was checking in on the news.  I was shocked to hear of a shooting at Sandy Hook Elementary School in Newtown Connecticut, my home for the past twelve years until I moved to Vancouver last summer. Shock and disbelief followed, but the early reports did not sound too bad – one or two victims. By noon, my 18-year-old son, who is in university in Philadelphia, skyped me with more details – 28 were dead by the hand of a student who was a year ahead of him in high school.  And the shooter’s older brother, an early suspect who was not involved and has been cooperating in the investigation, graduated with my daughter. Another classmate, who is now a writer, eloquently described the loss of privacy, innocence, and anonymity and how the memories we shared have been destroyed.

http://www.theatlantic.com/health/archive/2012/12/did-this-really-happen-in-my-elementary-school/266317/

As a parent and a nurse, envisioning the impact on this small community has been unbearable. In an interfaith service in Newtown Sunday night, President Obama spoke of this tragedy having an effect nationally and internationally.

From a healthcare perspective, Suzanne Gordon’s recent blog discusses the moral distress of healthcare practitioners when public policy fails to create reasonable laws and the public lack the capacity to take sensible action.

http://suzannecgordon.com/health-care-professionals-should-stand-up-en-masse-for-gun-control/

Proof of the lack of sensible action and American’s “love affair” with guns (I might call it an obsession) are the 400 gun stores within a four county radius and 36 gun stores within 10 miles of the shooting. Statistics demonstrate that in the U.S., there are more gun retailers nationally than supermarkets or McDonalds. Some believe it is beyond the point of no return with over 200 million guns in circulation in the U.S., and the purchase of firearms increasing whenever there is a “threat” of changing policies. On “Black Friday” this year, the FBI processed 154,000 background checks for firearm purchases.  In November, with the anticipation of President Obama’s re-election, two million guns were purchased. Similarly, this weekend, after the tragedy in Connecticut, sales of automatic weapons, especially rifles, increased with the fear that they would soon be “off the shelves”.

Another issue is the ineffectiveness of background checks – because of the civil liberties act and privacy laws in the U.S., single men with psychiatric backgrounds may not be identified in the system.  In the Newtown attack the guns were not his but his mother’s and easily accessible in the house.  Shooters such as this are referred to as determined, psychotic, and suicidal.  And the way the media idolizes them and creates immediate celebrity status only encourages others, who might otherwise quietly commit suicide, to be attracted to this horrific method of killing so they too can go down in history. I think the Canadian approach of not naming the shooter and minimizing media exposure decreases the risk of the “copycat” scenarios that seem all too common in the U.S.

What about the effect of violent movies and video games?  Does the enhanced social interaction and realism make it difficult for young men who have mental health problems to differentiate between fantasy and reality? Most shooters are described as “angry, alienated, and disconnected” and yet an act like this tragedy involved pre-meditation and the use of assault weapons – automatic rifles which shoot the equivalent of 30 guns almost instantaneously and ammunition which causes utmost damage. These weapons should only be accessible to the military and law enforcement – why are they in the hands of civilians? Because as Donna Brazile, the ABC News Consultant said in an interview with George Stephanopoulos Sunday evening, “U.S. gun safety laws are broken.” It remains to be seen whether there will be any changes to the U.S. gun control laws, but in Canada, gun policy must be seen as a public safety issue.

Finally – the biggest elephant in the room – access to mental health care. In the U.S., access to mental health services is limited. The cost of care runs $13,000-$17,000/year with few beds and facilities open. In this case, the mother had expressed frustration with lack of support for managing her son’s mental health issues. In the Canadian system, we must maintain strong advocacy for an effective and publicly funded mental health system. Mental health services should never be considered a luxury for those who can afford it.

So as a nurse educator, practitioner, and grief counselor, how does this experience affect my view? My heart is with all involved, including the first responders (many of whom are volunteers who live in the community), the medical examiners, spiritual and grief counselors, doctors, nurses, teachers and parents.  This has touched everyone in one way or another and nothing can ever prepare one for this. Nurses can play a strong role working with politicians and policymakers to develop policies for better gun control and sufficient mental health care services, and we can support society to manage conflict in non-violent ways. We can monitor the media, including news reporters, movie-makers, and video-game creators, and hold them accountable. We can educate the public about mental health signs and symptoms and provide the support necessary in our schools, clinics, and medical offices, working closely with parents, teachers, counselors and the justice system to manage situations before they escalate to the extent of this tragedy. Finally, we can continue to educate staff and students on quick action in case of emergency, which certainly saved many lives in Newtown. Finally, we need to help all nurses be prepared to work with people who have been traumatized by their own tragedies. Teaching self-care and mutual support has never been so important.

I know the strength of this small town community. It was a major attraction when we moved there, and I know they will overcome this tragedy in time and be stronger for it. But it will be a long and painful process. Although I will be visiting Newtown for the holidays and will participate in the vigils and grieving, my new home is here in Vancouver, and some of the aspects of Canadian life that have drawn me here have been reinforced the past few days. There is much that B.C. nurses can do to speak out for sensible public policies, strong mental health services to all in need, and for creating a more caring and compassionate society.

ABOUT SUZANNE CAMPBELL

Dr. Campbell is the Director of the University of British Columbia School of Nursing. She graduated with her BS and MS in Nursing from the University of Connecticut and her PhD in Nursing from the University of Rhode Island. She obtained her post-master’s certificate as a Women’s Health Nurse Practitioner from Boston College. Her clinical background of maternal-child health and lactation for the past 30 years has led to the support of families and the education of health care professionals in a variety of settings. She served as Director of Research and Special Projects to the Board of the International Lactation Consultant Association (ILCA) (Term 2006-2009) and presently sits on the Lactation Education Accreditation and Approval Review Committee (LEAARC) as the Higher Education Administration representative. Dr.  Campbell has consulted with the Connecticut State Women, Infants, and Children (WIC) Supplemental Nutrition Program. She was IT and curriculum expert for a grant which updated the Peer Counseling Program/Curriculum for WIC nationally. Dr. Campbell has published articles on lactation, nursing education, and is co-editor of a simulation book Simulation Scenarios for Nurse Educators: Making it Real. She was elected into the Nursing Academy of the National Academies of Practice and received the International Nurses Association of Clinical Simulation Learning (INACSL) Excellence in Academic Setting – Mentor Award. Dr. Campbell is committed to the education of all health care professionals, recognizing nursing’s role in an interprofessional setting and the continued need to develop knowledge, partnerships, and collaboration for the provision of excellent health care.

In the recently released report of the National Expert Commission (NEC), nurses were challenged to use their collective knowledge to be a mighty force in ensuring better health, better care and better value in healthcare delivery for all Canadians. The Commission noted that new models of care delivery “should be centred on what individuals and families need, should treat the individual as a whole person…, and should ensure that all professionals, including nurses, work to their full scope of practice.”¹ But to what extent is the Registered Nurse community prepared to respond to that challenge?

There is no question that Registered Nurses (RNs) should be an entry point to health promotion and disease prevention as well as to illness care, and that nursing education currently equips RNs to address the shift from an illness model to keeping people well. But to what extent do RNs in practice actually champion excellent care, caring, and preventative care? ²

Research on nursing scope of practice ^{3 4 5} has revealed that we lack a compelling vision for nursing that differentiates the distinct roles of Nurse Practitioners (NPs), RNs, and Licensed Practical Nurses (LPNs) in care delivery.  There is little evidence that differences in education (i.e., in nursing knowledge) account for how nursing providers are utilized, which contributes to significant role overlap and duplication, as well as to tension and mistrust between RNs and LPNs in the workplace. This role ambiguity is sometimes also reflected in staffing decisions made by nurse managers, who may fail to consider the potential impact on patient outcomes of replacing one type of provider with another when dealing with staffing shortages.  RN practice in acute as well as in primary care has been demonstrated to over-emphasize the management of disease and illness, with insufficient time spent on assessment of population risk factors and individual health needs. The practice of many RNs has been narrowed to a heavy focus on the performance of tasks and activities related to the bio-medical management of patients, although many of those also fall within the scope of practice of other providers.

Developing a meaningful approach to achieving the vision for nursing and healthcare that is reflected in the NEC report will be impossible in the absence of a long-term, shared vision among decision-makers (i.e., employers),  educators, regulators, policy-makers and RNs themselves. RNs recognize they are currently not working to the full extent of their knowledge and skill and are unduly absorbed by the bio-medical needs of patients, at a time when all levels of government are calling for a renewed focus on promoting health and wellness. Shifting our system away from its almost singular focus on illness toward an equal preoccupation with health and wellness will simply not happen if nurses don’t lead the way. The sustainability of our health system depends on the willingness and ability of RNs to refocus their practice toward interprofessional models of service delivery that will allow them to more effectively engage in the promotion of health and well being with individuals sick or well, which is the very essence of professional nursing practice. This will require individual commitment and collaborative effort to move beyond talking to actually making change happen.

Is anyone ready to lead the way?

1.  Could the Association work with government to develop some sort of bibliography that has all the most recent evidence and articles about this important topic?

Yes we can and will.  As we work to pull together a more comprehensive list, the Ministry has pointed out that there are some resources currently posted on the Immunize BC website (see http://immunizebc.ca/node/551).  ARNBC and the Ministry will continue to work together to develop a list of additional information that supports the discussion.  Watch this space for more information.

2.    Why did nurses learn about this change in policy through the media?  Why wasn’t there a dedicated campaign to inform those who are impacted first?

The Ministry feels it’s unfortunate that some employees learned of this decision through the media, as that was certainly not their intention. Health authorities did communicate to their staff in advance of the public announcement, and health industry unions were sent the policy for review a couple of weeks prior; however, it is likely that some staff were not able to access their employer communication before the media picked up the announcement.

Each health authority is delivering their own comprehensive communications to employees, through things like staff intranets and newsletters, QA sessions with managers or staff, work station screen savers, and the QA documents posted. Every effort is being made to ensure employees have access to the information they need, in a timely way.

 3.   Does a nurse have to put a mask on when entering the hospital and not take it off until they leave?  Are there exceptions? Can a nurse remove their mask in the cafeteria for instance, even though there are patients around? Can a nurse take it off if they are trying to talk to a patient about something personal or emotional? Do nurses have to wear masks if they’re giving a presentation or meeting with their manager?”

Immunize BC has posted information on wearing masks (Influenza Control Policy – wearing masks). The policy speaks to type of mask, where masks are required and when they should be changed. The policy states that: Unvaccinated health care workers are required to wear a mask when in patient care locations. Only areas such as cafeterias and lunch rooms reserved for the consumption of food are exempt. Unvaccinated workers would also not be required to wear a mask in administration-only areas, including a private office, where patients are not present.

 4.   Was due diligence done to determine why some individuals choose to not have flu shots?  Has government exhausted ways to get people to do it voluntarily?  Wasn’t a stepped missed – the one where people actually make the effort to not just stick up signs in bathrooms, but to educate, to inform and to provide evidence and education to change that thinking?

Each year, comprehensive education and vaccine encouragement efforts have been made across health authorities, through things like peer immunization champions, contests for staff giveaways (even for things like a vacation getaway and an iPad!) and articles on intranets and in newsletters. Despite every effort having been made to increase voluntary rates, we were still not getting the kind of uptake needed to ensure patients are safe.

 5.   Does the mask work both ways (i.e., will it prevent an individual from getting sick at the same time it keeps patients from getting sick, or does it just help the patients?)

Yes the masks work both ways. Masks can serve as a method of source control of infected health care workers who may have no or minimal influenza-like illness symptoms. Masks may protect unvaccinated health care workers from as yet unrecognized infected patients, visitors or other health professionals with influenza. However, while mask wearing does likely confer some benefit on the wearer, the primary goal in this policy is to protect patients.

6.   How or will this be applied to the dental profession?  What about community health nurses or people doing home visits?

The policy applies to all Health Authority employees (unionized and excluded), other credentialed professionals, residents, volunteers, students, contractors, and vendors (collectively, these individuals are referred to as “Covered Individuals”) who attend a patient care area.  Any dental professionals covered in the aforementioned group will be expected to adhere to the policy.

A Patient Care Location includes: any building, property, or site owned, leased, rented or operated by a Health Authority where there are patients, residents or clients who are receiving care; and any patient/client/resident home or other location where Covered Individuals interact with the patient/client/resident in the course of his/her work for the Health Authority.

 7.   If it’s just a hospital policy, isn’t that kind of like brushing only one tooth?

The policy applies to any building, property, or site owned, leased, rented or operated by a Health Authority where there are patients, residents or clients who are receiving care; and any patient/client/resident home or other location where Covered Individuals interact with the patient/client/resident in the course of his/her work for the Health Authority.

8.   As a culture we’re too heavily focused on immunizations. Normal, healthy adults should be able to either fight the flu off and if unable to do so will not suffer long term serious consequences as a result of having the flu. Is it really necessary to suggest we’re being remiss if we don’t get a flu shot? Is this really a matter of public health? What about our personal choices, not only nurses but as individuals?

Nearly every professional code of ethics in the health care field – from medicine, to nursing, to pharmacists – outlines that the interests of the patient must come first, and that healthcare workers have a duty to act in the best interests of their patients, and not put them at undue risk of harm. The flu can cause serious illness in those most at risk – including seniors, people with compromised immune systems, respiratory illnesses or a variety of other underlying causes. In other words: many of our patients and long-term care residents.

According to the Public Health Agency of Canada, nationally there are between 2,000 and 8,000 deaths per year from influenza and its complications. Hospitalized patients are frequently more vulnerable to influenza than members of the general population and healthcare workers have been implicated as the source of influenza in healthcare settings (infected individuals are highly contagious and can transmit influenza for 24 hours before they are symptomatic). Vaccination of healthcare workers will reduce their risk of getting influenza and spreading it to patients. The flu vaccine is safe and effective and, when used in conjunction with other infection control practices such as hand washing and remaining home when sick, it is extremely effective at preventing illness.

The policy allows for personal choice – workers have the option to wear a mask if they are unable to be vaccinated, or choose not to.

Government also reminds us that while normal, healthy adults are likely able to fight off infection far better, the point of this policy is to protect patients – people who by definition are NOT healthy. These are the very people who are at risk of serious complications.  By protecting yourself from getting sick with as many tools at your disposal as possible – including flu shots – you are protecting your patients who do not have those options available to them.

The provincial news release and backgrounder can be found on the Ministry of Health website (Click to View)

ARNBC’s news release on the flu shot issue can be found on our site under News (Click to View)

In November 2002, Roy Romanow issued his report Building on Values: The Future of Health Care in Canada which strongly supported Canada’s publicly administered and financed universal healthcare system, with its cornerstone being Medicare. The Commission came squarely against privatization of healthcare, stating that there was no evidence in support of such a move, and it was not congruent with the values of Canadians as expressed throughout the robust consultative process that informed the report.

Doris Grinspun, CEO of RNAO consulting with ARNBC President Susan Duncan and President-Elect Julie Fraser on strategies to ensure the future of core nursing values in Canadian health care.

The Commission supported the current inter-governmental approach to health policy and funding, and did not recommend designating health care as either a strictly federal or provincial/territorial responsibility.

The Commission did recommend significant and comprehensive reforms including improving public administration of the system; making health care policy and delivery more responsive and accountable to Canadians; improving health care access and quality; and, ensuring the system’s financial stability. It also recommended targeted funding to five priority areas: Rural and remote fund to improve access, diagnostic services fund to improve wait times, primary health care transfer to accelerate interprofessional care and move from pilot projects to whole system change, home care transfer to serve as the foundation for a national home care program, and catastrophic drug transfer to expand coverage and diminish financial burden.

Much has improved since the Romanow Report:

• Prime Minister Jean Chrétien and the Provincial Premiers and Territorial Leaders signed the 2003 Health Accord, an historic agreement with an action plan for change to renew and sustain public health care for Canadians.
• Federal funding was substantively increased.
• The Health Council of Canada was created to report regularly to Canadians on the quality of their health-care system.
• Primary Care has advanced greatly in most Canadian jurisdictions with many focusing on interprofessional teams. Yet, in comparison to other OECD countries we lag behind.
• Wait times for diagnostic tests and various clinical procedures such as cataracts, hip and knee replacements were targeted and improved.
• Universal programs for palliative care were introduced at the community level, and catastrophic drug coverage was launched in selected jurisdictions.

Looking back and looking forward gives me reasons for optimism and reasons for being worried – as much has changed since 2002 and today we have a federal government that has a different view of Federalism and interprets healthcare as a jurisdictional responsibility. Nurses should, and most are, alarmed with the Federal Government attack on Social and Environmental Programs, which is often accompanied with a hands-off approach to national programs and standards, such as the Prime Minister’s refusal to participate in negotiations around renewal of the Health Accord that is due to expire in 2014. By decreasing funding after 2017, the government’s hands-off approach threatens to undermine the publicly-funded, not-for-profit healthcare system that Canadians treasure, and foster the growth of for-profit health care that will cost taxpayers more and deliver less.

Recognizing this, the community of practice for health services and policy research in Canada, CAHSPR and the Health Council of Canada, organized an invitational Forum on November 9th entitled Ten Years Since the Romanow Report: Retrospect … and Prospect.  The forum brought health policy experts from across Canada together to look back on the issues that gave rise to the report and look forward to the challenges that remain.  I was among those at the forum raising probing questions about current federal threats to the core Canadian values associated with a publicly funded and not-for profit health care system and the silencing of civil society.

On November 15 and 16, 2012, I had the great pleasure of two days of lively dialogue with the Board of Directors of the ARNBC. Clearly, for ARNBC, this forum represents one of the most important conversations Canadians have had on the future of our publicly funded health care system. I am committed to ongoing close collaboration with BC’s professional association and others, to ensure that the expertise and knowledge that nurses bring to the table is recognized and integrated into health system planning and delivery across our country.

To view the proceedings and participate in the ongoing discussion, visit http://www.youtube.com/cahspr

ABOUT DORIS GRINSPUN, RN, MSN, PhD, LLD(hon), O.ONT

Doris Grinspun is the Chief Executive Officer of the Registered Nurses’ Association of Ontario (RNAO), the professional association representing registered nurses in the province of Ontario. RNAO’s mandate is to advocate for healthy public policy and for the role of registered nurses. Grinspun assumed this position in April 1996.  From 1990 to 1996, Grinspun served as Director of Nursing at Mount Sinai Hospital in Toronto. She has also worked in practice and administrative capacities in Israel and the United States.

Grinspun is an Adjunct Professor in the Faculty of Nursing at the University of Toronto; an adjunct professor at the School of Nursing, York University; an associate member of the Centre for Health Promotion at the University of Toronto; an affiliate member of the Centre for Health Studies at York University; and an Associate Fellow of the Centre for Latin American and Caribbean Studies (CERLAC) at York University.  In 2003, Grinspun was invested with the Order of Ontario. The award was created in 1986 by the Government of Ontario to recognize the highest level of individual excellence and achievement in any field.

Between February and May of this year, the ARNBC travelled around British Columbia and met with registered nurses in small towns, community health centres, urban areas and hospitals.  The resulting focus groups and conversations provided the Association with a wealth of information about the challenges nurses face, the pride they have in their profession and the belief we all share in the need for a strong policy voice for nursing in British Columbia.

The consultations revealed how B.C. nurses are feeling about their practice, their profession and the health care system.  In all sessions, nurses shared insights in honest and respectful conversations that point to concerns about directions in the profession and the health system along with hope that the voice of the profession can make a difference to their experience of nursing and the health and safety of the public they serve.

ARNBC is proud to share the outcomes of these consultations in the report now posted on our website ARNBC 2012 Consultations Report(http://www.arnbc.ca/images/pdfs/publications/arnbc-2012-consultations-report.pdf).  The consultations showed us what matters to nurses and gave us clear understanding of how to move forward.  As a result, the elected Board of the ARNBC has defined the following three strategic directions as our focus for this year:

1. Build an effective and affordable professional nursing association;
2. Develop strong influential  partnerships with government, nursing and professional organizations – provincially, nationally and internationally; and,
3. Continue to engage nurses’ active participation in professional issues.

The formal consultations may be over for now, but we know that the best conversation and the best sharing happens when nurses sit down and talk face-to-face.  Our newly formed engagement committee will soon be launching a plan for connecting nurses and facilitating local and regional networks. We encourage RNs to continue to share their thoughts on the future of BC nursing by posting comments on this blog, joining our Facebook or Twitter conversations, emailing us at admin@arnbc.ca or coming to one of our events.

Many thanks to all nurses who have contributed to the ongoing dialogue about the future of the Association.  Your voice really is our strength.

ABOUT DR. SUSAN DUNCAN

Dr. Susan Duncan is a faculty member at Thompson Rivers University in Kamloops. She has over 30 years of experience in nursing practice, education and leadership roles. Susan has represented nursing on regional health and hospital boards and completed a term on the Board of Directors of the Canadian Association of Schools of Nursing in 2011.

When I started nursing over thirty years ago, I never would have thought I would be nursing online, but here I am – a palliative care clinical nurse specialist with Canadian Virtual Hospice. Every day I help people across the country. In one morning I may consult with a nurse in Penticton seeking a second opinion about a complex pain issue, locate support services for a patient in Peterborough or help a family in Truro negotiate the challenges of deciding to care for a dying loved one at home.

Actually, I have my fingers and feet planted firmly in two realms of caring – virtually as a member of Canadian Virtual Hospice’s interdisciplinary clinical team and in-person with the Winnipeg Regional Health Authority Palliative Care Program’s consultation team. Whether virtually across the nation or face-to-face locally, I provide information and support about end-of-life care, loss and grief to individuals, families, and health care colleagues. I find each setting enriches the other.

At Virtual Hospice, I work with an extraordinary team of palliative care specialists, including physicians, a psychosocial consultant, spiritual care advisor and ethicists who together have more than 120 years of palliative care expertise. Collaborating in the virtual world was an adjustment at first, but we have developed a system of interdisciplinary teamwork that, well … works. Together we answer Ask a Professional questions, vet resources for Tools for Practice, write articles for the website, and provide strategic guidance on the direction and evolution of the website.

I’m particularly proud of our signature tool Ask a Professional where the public and health care professionals can ask questions about life-limiting illness, end-of-life care, loss and bereavement. As the clinical nurse specialist, I triage the questions and coordinate which team members will be involved in responding, contributing to and reviewing the answer. The answers are personal, evidence-informed and confidential and provided within 3 business days or less. While we receive some common questions, the range of questions overall is astounding. We may get a question from a wife struggling to live with the death of her husband 6 years ago or a physician in rural BC wondering about neuropathic pain that is difficult to control or someone living with a terminal illness overwhelmed by death anxiety or a pharmacist working in the North wondering about a particular medication delivery route. Interesting enough nurses submit the largest number of health care provider questions to Ask a Professional. Given the complexity of care at the end-of-life, it is understandable that many questions arise in clinical practice. For that reason, one of our goals is to support and build capacity in local teams.

It is very gratifying to help connect professionals and the public to quality information, care and resources and to support the provision of quality care whether on Vancouver’s north shore or in One Hundred Mile House. Nursing online is a great opportunity to provide information and support in an accessible, cost-efficient manner. For visitors to the Virtual Hospice it is a safe, anonymous place to browse for trustworthy, up-to-date information and ask questions 24/7 at no cost. A win-win.

Have you ever visited Canadian Virtual Hospice?

In order to effectively advocate for health issues and the nursing profession, the public needs to understand what nurses do. However many people still do not know the vast range of activities nurses perform.

This summer, many of us will gather with friends and family for BBQs. We will eat, talk, laugh and share. Inevitably, at some point the conversation will turn to work.  Many of you will make a comment about something you have done at work as a nurse and the inevitable response will be “nurses do that???”

Despite campaigns to raise the profile of nurses, I find many people still do not know what we do. Considering the wide scope of our practice, and the diversity of roles, this is understandable. Add on to that TV shows like Grey’s Anatomy and it’s no wonder people are confused about what we do.

Here are a few things that have surprised my family and friends about RNs:

• we can pronounce death (in certain circumstances)
• we get to choose which medication to give (the concept of PRNs was quite fascinating) For the non-nurses: PRNs are a list of medications that have been ordered for the patient and are to be given “as needed”. These medications range from pain relief to medications to slow a patient’s racing heart.
• not only that we can, but that we should question a physicians order if we are unclear or unsure if it is appropriate
• that if I give an unsafe medication, I am liable for that, even if the physician ordered it

What are some things that have surprised your family and friends about your role as an RN?

ABOUT NICKIE SNYDER

Nickie Snyder is an ICU RN for Fraser Health and also helps with their new graduate nurse workshops. A dual Canadian/US citizen, Nickie lives in the US, works in Canada, completed her undergraduate degree in nursing in Canada and is currently enrolled in a combined Masters and Doctorate of Nursing Practice program at the University of Washington.  Nickie plans on becoming a Nurse Practitioner, and hopes to teach nursing as well. Dynamic, energetic, and passionate about nursing, Nickie loves to share about her experiences and advocate for the nursing profession. She is also a social media addict and can be found at www.twitter.com/missnickie