Tag Archives: Multidisciplinary Teams

Why We Need ARNBC: The Comox Valley Experience, By Betty Tate, Trish Sanvido and Jessie Shannon

We are saddened by the legal action BCNU has taken against ARNBC and CRNBC and have been reading with interest the comments nurses are making. We hear some nurses asking why we need three organizations to represent nursing and in particular why we need the ARNBC. The ARNBC was the impetus for us to develop a community of dedicated and passionate practicing, retired and student nurses in the Comox Valley and continues to support us to advocate for the health care needs of members of our community. We would like to share our development and actions as an example of why we need ARNBC working in collaboration with BCNU and CRNBC in B.C.

In the fall of 2012, a group of 4th year nursing students at North Island College, as part of their leadership practice, researched the mandates of CRNBC, BCNU and ARNBC, understood the difference between their three roles and decided the Comox Valley needed a local ARNBC network to enhance the professional voice of nurses locally. The students distributed information, visited nurses in practice, talked with nurses who had been engaged in the Comox Valley RNABC Chapter and in Dec 2012 the first meeting of the Comox Valley Network of the ARNBC was held. Nurses who attended the meeting were very enthusiastic about having a forum to discuss local nursing issues and to move forward with action on some of the health issues in our community.

Since then our network has grown to over 100 retired, practicing and student nurses and we have:

  • Provided a valuable forum for nurses across multiple contexts of nursing practice to relationship build, support one another, find their professional voice and address issues
  • Engaged in the development of a new hospital being built in our community to increase the nursing and nursing education voice in the design
  • Engaged with the CEO on the plans for re-development of the existing hospital in our community and what services will be provided there
  • Connected with the Division of Family Practice on their primary heath initiatives in the community
  • Advocated for a renewed Federal-Provincial Health Accord
  • Engaged with Canadian Nurses Association to be informed about and participate in national nursing initiatives
  • Attended a Day at the Legislature organized by ARNBC where we met with the Minister of Health, Opposition Health Critics (both NDP and Green Party) and Ministry of Health staff to advocate for nurses and nurses voice at provincial policy tables.
  • Formed a Political Action Committee to address homelessness in the Comox Valley and to promote primary health care. To date we have been very successful with a campaign to vote yes on a referendum to support a tax to reduce homelessness in our community, lobbying local politicians to move forward with a housing project and begin a process to develop a regional service to address homelessness.

None of these activities would be possible without the ongoing Board, staff and financial support from the provincial ARNBC. For example, ARNBC has assisted us to be politically active by working with us in two workshops where we learned to define an issue, develop a campaign around the issue, write and present a brief to politicians and engage other members of the community in our advocacy. ARNBC has assisted us to connect with other nurses provincially and nationally. We have formed a bond between retired nurses, practicing nurses and student nurses in our community and we continue to reach out to more and more local nurses. We are respected in the community as a voice for nurses and feel empowered to continue to speak up for our rights and the rights of our community.

In our view neither BCNU nor CRNBC could or would have provided us with the support we needed to develop and grow – it simply is not within either of their mandates. We feel that ARNBC has filled the void that came about when CRNBC became a regulatory college and we lost local chapters and a professional association. As much as we respect and value the work of BCNU we know they did not fill this void in the years after local RNABC Chapters ceased nor can they speak for all nurses in B.C. as the ARNBC does.

We ask that BCNU stop the legal action with ARNBC and CRNBC and allow all three organizations to flourish and support nurses in B.C. to raise their voices in unison to positively impact nursing, health and health care across our province.

ABOUT THE COMOX VALLEY NETWORK – ARNBC

CVThe Comox Valley Network was formed in 2012 by a group of students who recognized the need to enhance the professional voice of nurses locally.  The group has continued to grow and has become a strong political and policy voice for health and nursing policy in the Comox Valley.  For more information contact comoxvalleyarnbcnetwork@gmail.com

 

 

 

Budget Lockup: Insights from ARNBC, by Zak Matieschyn, NP

Recently, I had the privilege of joining Joy Peacock, Executive Director of ARNBC, in the B.C. Budget Lockup. For those who are not aware, this is a secured room wherein around 200 stakeholders have an advanced preview of the details of the budget and service plans. This is also where the media interviews these stakeholders in order to get their stories aired in a timely manner following the budget speech.

This was the first time ARNBC was invited to participate in the Budget Lockup – an event that can only be attended by invitation of the Finance Minister. Beginning January 1 of this year, ARNBC entered a new phase, and is now a member-driven organization representing all B.C. registered nurses and nurse practitioners. Being invited to participate in Budget Lockup was a strong signal of how government views the importance of the Association and the work we’ve been mandated to do.

The budget itself was a relatively benign affair for healthcare. Increases to healthcare spending will be a very modest 2.9% per year. My review of the Ministry of Health service plan noted much of the same language as last year: commitments to primary disease prevention and health promotion, improving primary/community care through inter-professional teams, and improving rural healthcare to name a few. From a theoretical perspective – this is music to the ears of the nursing profession. As we know and have been educated, these points are among the mainstays of what are needed to reform healthcare. What is concerning is a lack of a blueprint of how we get there. We are talking about a fundamental shift in how healthcare is delivered to become more up-stream, integrated, and team-based. Uttering the correct words is a fine start, but such an objective will require dedicated monies to operationalize this plan, as well as an understanding that this will be a front heavy, longer term process. That is, the benefits will be slower to materialize than can fit in a single budget year or government election cycle. The other point lacking is collaboration with nursing. Registered nurses and nurse practitioners possess exactly the knowledge and expertise of a healthcare system described in the service plan. It is simply a waste of available talent, capacity and leadership to exclude nursing from the spheres of policy planning and implementation.

Also disappointing was the lack of mention of nurse practitioners when commenting on plans for improving access to full service primary care. Over the past 10 years, NPs have slowly been implemented to improve access for British Columbians to primary health care – both in urban and rural settings. Once again, new NPs find themselves without an existing hiring initiative, let alone a robust funding model, to permit them the opportunity to improve primary healthcare access to regions of the province in desperate need of help.

On the brighter side, I was pleased to observe the significant step of eliminating the clawback of child-support payments for single parents on income or disability assistance. This is a relatively low cost intervention (costing only $19 million annually but helping to lift nearly 6000 children out of poverty) which directly impacts the health of these individuals and the health of our society. Nursing has long known the impacts of social determinants on health and government would do very well to continue to explore these evidenced based health and social policy reforms.

The media scrum that occurred towards the end of lockup was a chaotic scene – throngs of stakeholders and reporters mobbing each other. I noticed a friend of mine in the crowd representing another group. “How does this thing work?” I asked. “You just grab the next available reporter and talk to them” she expertly answered. Seemed simple enough yet daunting to the novice that I am, but as I observed the goings on, there did seem to be an order amongst the madness. I did manage to speak with a few reporters about our associations’ reactions to the budget and with luck they may use the story.

I will sharpen my elbows for the next opportunity.

ABOUT ZAK MATIESCHYN
Zak

Zak’s interest in health and healing began at the early age of nine years-old when he would carry a small first aid kit while playing with friends. Since then, his passion for healthcare and health policy has been unwavering. He was particularly inspired by concepts of family, community, and societal health, as well as the social determinants of health during his nursing 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 Practitioners Association Executive and is the only Nurse Practitioner in B.C. who has been invited to sit on a Division of Family Practice Board (Interior). 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 six years ago, 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-elect of ARNBC.

How nurses can contribute to transforming cancer care systems, by Tracy Truant, RN and Sally Thorne, RN

Recent commentaries by oncology health professionals, patients, journalists and the Minister of Health about the state of cancer care in British Columbia (BC) have revealed significant challenges to delivering timely, high quality cancer care in that province. It is likely that these challenges are actually felt across the country, and are not unique to B.C. Oncology health professionals, including nurses are working to their maximum with the vision to deliver care that is person centred, compassionate, effective and timely, yet many would agree that the system in which they try to operationalize this care is in fact one of the barriers they must overcome.

While exceptional leadership and collaborative relationships across both the BC Cancer Agency and the Provincial Health Services Authority are essential to delivering timely high quality cancer care, other significant shifts must also occur. Much of the dialogue in the media has focused on timely access to care and containing costs, which are important, but other elements of high quality care must also be considered when looking for solutions. In fact, some have suggested this focus on timely access to cost contained care is a distraction from the real goal, that being maximizing value for patients. Instead, Porter and Lee (Leading Health Care Innovation, Harvard Business Review) suggest that organizing care around patient needs is more likely to achieve system transformation.

Nursing has long advocated for a transformed system of care that aligns resources with patient and family needs. Perhaps this time of reflection on how well the cancer care system in BC is performing is an opportunity for nurses to add their voice to solution-focused approaches to addressing the challenges.

As more cancer treatments are delivered in ambulatory settings where patients manage much of their cancer treatment effects at home, there may be opportunities to explore positioning of oncology health professionals, including specialized oncology nurses, outside of specialized cancer centres, into primary care and home care settings. Innovative models of care, such as the Infermiere Pivot enOncologie (known as “IPO” or “Pivot Nurses”) in Quebec have demonstrated improved quality of life and patient outcomes when Pivot Nurses care for patients from the point of diagnosis throughout their cancer treatment and care, and into the survivorship period. In this way, instead of tying oncology nursing resources to treatment systems, nurses are positioned where patients and families may benefit from their expertise most, as their needs change across the cancer trajectory.

In addition, nurses caring for cancer patients within the specialized treatment setting may be optimally positioned to practice to their full scope in a way that best meet patients’ needs in the context of the interprofessional team. Rather than working in silos, which further fragments care and can create workflow issues, a renewed focus on interprofessional care needs to be initiated.

As more patients survive cancer and experience long term effects as a result of cancer treatment, positioning specialized oncology nurses and/or Nurse Practitioners in primary care settings to care for the holistic needs of survivors after primary treatment ends may be beneficial to reduce the volumes of survivors still being seen in cancer treatment settings. With survivors’ renewed focus on health promotion, cancer prevention and the need for long term symptom management, oncology nurses’ skills and knowledge align well with survivors’ needs at this point in the cancer trajectory.

Sometimes missing from the design of cancer care systems is the voice of patients and families, including those who experience marginalizing conditions within society. While many organizations have begun to include patient engagement strategies, truly effective cancer care systems will not add patient/family voices in as an afterthought to an efficiency driven and access-focused system – rather, systems of care must be built around the beliefs, values, goals and needs of patients and families to achieve high quality care.

So instead of using our voice to add to the dialogue about enhancing access and infusing more resources, let’s pause and reflect on what we are championing better access to – It’s time for nurses to advocate for high quality care and to be very clear on how we may position our unique knowledge and skills to align with patient and family in a way that infuses value for them.

 

Links to Media

October 17, Gary Mason, Globe & Mail – http://www.theglobeandmail.com/news/british-columbia/sad-decline-of-bc-cancer-agency-must-be-addressed/article21154744/

October 20, Don Carlow, Vancouver Sun – http://www.vancouversun.com/health/Cancer+Agency+lost/10294565/story.html

October 21, Carl Roy, Vancouver Sun. http://www.vancouversun.com/health/Opinion+defence+Cancer+Agency/10311601/story.html

Nov 5, Gary Mason, Globe & Mail – http://www.theglobeandmail.com/life/health-and-fitness/health/leading-oncologists-take-aim-at-troubled-bc-cancer-agency/article21451692/

 

tracytruantABOUT TRACY TRUANT, RN

Tracy Truant is currently a doctoral candidate at the UBC School of Nursing and the President-Elect of the Canadian Association of Nurses in Oncology. She is a former professional practice leader at the BCCA Vancouver Centre and is currently conducting research on systems of care for cancer survivorship.

 

 

sallythorneABOUT SALLY THORNE, RN

Sally Thorne is a professor at the UBC School of Nursing with a longstanding program of research in communication in cancer care. Former Board Chair of the BC Cancer Agency and Board member of the Canadian Partnership Against Cancer, she has been actively involved in cancer policy and strategy over many years.

 

Pine for PINE!!! by Joanne Ricci, RN, MScN

The recent decision to close several of the main primary care clinics in Vancouver Coastal Health has brought to the forefront grave concerns for not only the public but those of us in higher levels of education who are teaching the principles of primary health care and population health.

The UBC School of Nursing has had a long standing partnership with Pine Clinic where our nursing students at both the undergraduate and graduate levels have had an opportunity to work with the expert nurses at the clinic. As a result, there are a few points which are of particular concern to me.

We believe that it is important to discuss the clinic as a regional service for youth – not just a Westside or Kitsilano clinic. Young people access the Pine Clinic from across the city – it serves the ‘community of Youth’ without barriers of residency, insurance, diagnoses or other barriers such a fear of judgment, lack of privacy/confidentiality – perceived or real – which youth fear at walk-in clinics or family physicians’ offices. Youth often present with a medical concern or sexual health concern but, once trust has developed with the expert professionals at Pine, they are able to disclose other concerns such as high risk behaviours, mental health or addiction concerns. Early identification of concerns during this vulnerable age is a critical part of the work that is carried out at Pine.

The benefits of a broad approach to youth care in terms of prevention and early treatment is the crux of primary prevention and can result in long term savings for the health care system. If services become targeted only to high risk youth, there is concern that other youth, vulnerable youth, may not feel comfortable accessing care. There may be a corresponding impact on STI rates, associated complications, and pregnancy rates. Opportunities to work with youth with early mental health and substance abuse issues may also be missed. It should be noted that the current professional staff at Pine have specialized training and experience in addictions, eating disorders, street involved youth, LGBT care, primary care, psychiatry, post sexual assault care, HIV care, Emergency Room care. Youth benefit from this spectrum of skills because they are able to follow through at one site and often with one clinician.

Pine is currently configured as a stand-alone clinic that the younger generation trusts – it is not affiliated with schools or other agencies. Youth appreciate the casual and very youth friendly environment and organization of the clinic.  If they require referral to other agencies they are assisted in navigating the complex systems which increases trust, compliance and better outcomes.

The Clinic provides a team approach – collaboration between nurses in an expanded role, physicians with a specialized youth focus and counselors.   Youth benefit from the urgent care model of the drop-in format and the ability to spend time with a clinician regarding several concerns in one visit.

Research clearly indicates that outcomes for healthier populations rely on accessibility, equity, creating a supportive environment, appropriate technology, attention to health promotion and protection, intersectoral cooperation, public participation and focus on the determinants of health.  Pine clinic for the past 40 years has adhered to these components of Population Health.

It is truly a travesty that the professionals who are passionate about youth health were not involved in the decision to close Pine and that the individuals who are served by this agency were not given a voice.  Short term gain does not equate with long term savings when it comes to the health of our populations!

ABOUT JOANNE RICCI

joanneJoanne Ricci is a tenured Senior Instructor at the UBC School of Nursing. She received her BScN and MSN from UBC and has been teaching at UBC for 37 years. She has taught in various areas of nursing during her time at UBC from basic skills, maternity, surgical, Post RN and for the past 20 years in population and public health. Joanne has not only demonstrated expertise in the area of public health but is also an exemplary clinical instructor and has been instrumental in supervising masters and Nurse Practitioner students.

She has developed strong relationships with her partners in the community and has contributed to countless hours on many committees and boards. Her passion for health promotion and illness prevention of infant children and youth is evident in all aspects of her work.

 

It’s Time to Talk about CDMR, by Paddy Rodney, RN and Andrea Burton

For quite some time we have been hearing about Island Health’s1 Care Delivery Model Redesign (CDMR)2, a patient care model that, according to Island Health:

… not only improves patient care, it enhances the work environment for nursing staff by supporting nurses to work in collaborative teams. The Patient Care Model is based on nurses utilizing the full scope of their high level of training, knowledge and practice, and gives them a key role in health care planning and assessment.”3

While the intent behind the CDMR model is admirable, ARNBC has become increasingly concerned by the first-hand stories we have heard from point-of-care nurses working under CDMR.  These nurses have indicated that they are struggling with several aspects of the CDMR program, and that staff and patients are suffering as a result.

Specifically, nurses have told us that under this model, their patient loads have increased to the point where they do not believe that they are able to deliver the safe, competent, compassionate and ethical care that their profession mandates. For example, nurses have told us that one RN may be responsible for managing the care of 10 or more acutely ill patients with inadequate professional nursing support because unregulated care aides have replaced so many RN and LPN positions.

Point-of-care nurses report that it is almost impossible to deliver an appropriate level of patient care when overseeing the needs of so many acutely ill patients.We have also heard that there are nurses in management positions who are navigating conflict and uncertainty as these changes unfold.

In other words, rather than helping nurses and other health providers to provide better patient care, what we are hearing is that this new CDMR model is causing nurses undue stress and may be putting patients at risk.

On February 27, 2014, ARNBC was pleased to participate on the panel of MLA Andrew Weaver’s Town Hall on CDMR along with nursing colleagues from the BCNU and the University of Victoria.  We heard more first-hand stories from nurses as well as members of the public who are concerned about the impact CDMR is having on their communities. Along with our other nursing colleagues, we believe that it is time to speak up in support of good patient care and a healthcare system that values the health and well-being of its employees.

The Need for Evidence

As time has gone on, we have become increasingly concerned about the lack of evidence and outcome data that has been released by the Health Authority that either supports or refutes CDMR.  At the Town Hall Meeting we heard that despite requests from nursing groups and at least one FOI (freedom of information) request, the nursing community in B.C. continues to have no official data to work with when analyzing the impact of CDMR on nurses and on patients.  The only information we have to assess the situation is anecdotal stories from nurses who have been directly impacted.

It’s important that provincial research on CDMR be made publicly available so that nursing organizations, nurse researchers and others can thoughtfully and carefully analyze the impact of the program on nurses and other staff, as well as patients and their families. Through better transparency about the planning and evaluation of CDMR, nurses in B.C. would be in a stronger position to collaborate and support Island Health in their goals to improve patient care and enhance the work environment for nursing staff.  The well-being of nurses is linked to the well-being of the patients and families they serve.4

There are currently warnings emerging from the United Kingdom about what can happen if we get nurse staffing and care delivery models wrong. A recent report from the United Kingdom discussed a series of public inquiries revealing serious breaches of duty on the part of the Mid Staffordshire NHS Foundation Trust.5

One nurse expert stated that problems were “fuelled by the hospital management being driven by the achievement of targets – set centrally by the Department of Health – that were paper-based indicators of ‘quality care’ and ‘success’. These were inextricably linked to financial imperatives, which created a culture where, if the numbers look right, then it was assumed that the hospital was providing quality care.”6

In addition, a recent article published in The Lancet clearly identifies the significant problems that can arise when staffing mix decisions are not carefully thought out.7

ARNBC’s Priorities for Staff Mix/Models of Care

Our main priorities as the professional association that represents B.C. Registered Nurses and Nurse Practitioners are to:

1)      Ensure that the health of British Columbians is the first and foremost priority of all decision-makers and stakeholders as we work through the complexities of staff mix and care delivery models.

2)      Ensure appropriate, evidence-informed decisions are being made about staff mix and care delivery models on the basis of planning and outcome data that are publicly accessible and peer reviewed.

3)      Compel government and health authorities to collaborate with nurses around staff mix and care delivery models, and be transparent and accountable for the decisions they make.

4)      Promote registered nurses to be supported in every aspect of their professional work and have a safe place to share their concerns.

Fortunately, there are some good national guidelines that can help. In February 2010, the CNA established the Staff Mix: Regulated Nurses and Unregulated Care Providers Working Group.  This pan-Canadian group was comprised of RNs, licensed practical nurses (LPNs), registered psychiatric nurses (RPNs), unregulated care providers (UCPs) and a research consultant. The working group defined staff mix decision-making as the act of determining the mix of the different categories of health-care personnel employed for the provision of direct client care. The work resulted in the publication of the Staff Mix Framework which provides direct care nurses and nurse managers with excellent direction and identified five guiding principles that were agreed upon by all participants:

  • Decisions concerning staff mix respond to clients’ health-care needs and enable the delivery of safe, competent, ethical, quality, evidence-informed care in the context of professional standards and staff competencies.
  • Decision-making regarding staff mix is guided by nursing-care delivery models based on the best evidence related to (a) client, staff and organizational factors influencing quality care and work environments, and (b) client, staff and organizational outcomes.
  • Staff mix decision-making is supported by the organizational structure, mission and vision and by all levels of leadership in the organization.
  • Direct care nursing staff and nursing management are engaged in decision-making about the staff mix.
  • Information and knowledge management systems support effective staff mix decision-making.

Next Steps for ARNBC and How You Can Help

While we have been monitoring the situation in Island Health and listening to the concerns of nurses, ARNBC has become increasingly aware that tensions and stress are rising.  We have written about staff mix previously in our blog and with an issue statement, but we are increasingly concerned about the lack of availability of outcome data and related information around CDMR.

In the absence of actual evidence, we can only base our analysis of CDMR on the anecdotal evidence we hear from nurses.

Some components of the CDMR program are good for the healthcare system, good for patients and good for nurses and other team members.  As a professional nursing association, ARNBC will work with Island Health and with nurses to have an honest, frank discussion about the program, the outcomes, the stories and the data – and we would hope this discussion could help Island Health to make changes and improvements to CDMR — changes that would be a win-win for everyone.

ARNBC will undertake further policy work to explore, analyse and make recommendations around Staff Mix and CDMR.  We anticipate that this work will further refine ARNBC’s position on staff mix and care delivery models, and will provide a number of recommendations for next steps that can be taken in British Columbia.

In the meanwhile, we invite nurses who have concerns about CDMR to share your stories anonymously in the comments section of this blog (you will be prompted to share your name and email address – please don’t hesitate to make up a name and email address if you are concerned about sharing your information).  Or you can email us at aburton@arnbc.ca.  Lastly, you can make an anonymous phone call to our Communications Director, Andrea Burton, by calling 604.730.7402. We believe that hearing your stories and impressions of what is happening under CDMR will contribute to ARNBC being better able to support quality health care delivery in British Columbia.

It is time to talk more openly about CDMR, and to take a balanced, thoughtful approach to finding the middle ground between the goals of health authorities and the needs of patients and healthcare providers.

ARNBCABOUT PADDY RODNEY AND ANDREA BURTON

Paddy Rodney, RN, is a nurse educator with a specialty in ethics. Paddy is currently an Associate Professor at the UBC School of Nursing and is affiliated with the UBC Centre for Applied Ethics and the Canadian Bioethics Society. Over the last 25 years, she has lectured and consulted on nursing ethics for nursing associations and unions.  Paddy is on the ARNBC Board.

Andrea Burton is ARNBC’s Communications Director.  She has a political science background and more than fifteen years of experience in strategic communications, media relations, policy development and government relations.  Andrea has worked internationally in both the private sector and government.

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  1. Formerly Vancouver Island Health Authority
  2. CDMR is the acronym for Island Health’s Patient Care Model – similar models may be employed in other health authorities under different names
  3. http://www.viha.ca/NR/rdonlyres/63276A4E-5CD2-4755-892E-0E420089B75F/0/BoardQAMay2013.pdf
  4. Rodney, P., Buckley, B., Street, A., Serrano, E., & Martin, L.A. (2013). The moral climate of nursing practice: Inquiry and action. In Storch, J., Rodney, P., & Starzomski, R. (Eds.) Toward a moral horizon: Nursing ethics for leadership and practice (2nd ed.; pp. 188-214 ). Toronto: Pearson-Prentice Hall
  5. Francis, R. (2013). Letter to the Secretary of State. In The Mid Staffordshire NHS Foundation Trust Public Inquiry, Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive summary (pp. 3-5). London: The Stationery Office
  6. Hayter, M. (2013). The UK Francis report: The key messages for nursing. Journal of Advanced Nursing, Vol. 69, No. 8, pages e1-e3, August 2013.  Article first published online: 1 Jul 2013 DOI: 10.111/jan.12206
  7. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study, February 26, 2014

Nurse Practitioners: Essential Health Care Professionals, by Carrie Murphy NP

The Royal College of Physicians and Surgeons of Canada recently released a report entitled What’s Really Behind Canada’s Unemployed Specialists.  A subsequent Vancouver Sun article noted that the report doesn’t address whether there are too many specialists for the Canadian health care system, but does identify a number of possible reasons why newly certified specialists are having trouble finding work (i.e., competition for resources such as operating rooms, hospital beds and money to pay their fees).  However, the report also references “relatively new categories of health professionals encroaching on doctors’ territory, such as advanced practice nurses, nurse practitioners and physician assistants.”

As a family nurse practitioner (NP) who has worked in B.C. for seven years, I initially chuckled at the idea that anyone could think an NP would do the work of a cardiac surgeon.  But then I began to consider whether or not this decline in specialist positions might actually be, in part, because nurse practitioners and other primary health care providers are helping more British Columbians focus on prevention and health promotion solutions rather than waiting until they have a health crisis to see a physician.

Nurse Practitioners have expert communication skills – we partner with patients and families to promote health and prevent or manage disease; spend time listening to patients, identifying their health goals and priorities; provide expert information and advice on choices they can make to achieve their health goals and improve their chances of living a healthy, vital life.  Nurse practitioners practice holistically – we understand that patients often have challenges in the socio-economic aspects of their lives that impact their ability to achieve their health goals, and we support patients to develop action plans that are practical, based on their individual situations.  For those patients who are already struggling with chronic disease, we provide advice and support to help them understand and self-manage their health challenges to stay as healthy as possible, for as long as possible.

More and more British Columbians are seeking the services of nurse practitioners – in part, because we work closely with people to help them understand how to avoid preventable diseases and live a balanced, healthy lifestyle, that will help keep them out of the specialist’s office.  We are essential health care professionals and that is at the heart of what British Columbians need to understand about NPs.

What would happen if every British Columbian was supported to avoid preventable diseases by eating right, exercising daily, and having access to timely checkups and prevention programs at all stages of life?  Government has been warning that our health care costs are outpacing our tax revenue, and one solution is for each and every citizen to make choices that will help them avoid heavy use of the health care system.  The nursing profession has advocated for greater attention to the determinants of health such as housing, food security, community support and social programs as fundamental conditions to improving people’s health.  If we invested more in prevention and health promotion, could we spend less on curing or mitigating disease?

If all British Columbians had the opportunity to work with an NP on a regular and timely basis – for  holistic primary health care that includes health promotion, and disease prevention and management – including the small things that can grow to become significant health challenges – maybe the end result would be less visits to specialists.  In fact, perhaps what we are seeing right now is that nurse practitioners and other primary health providers have begun to shift the population into taking better care of themselves, thereby reducing the need for specialists.

Shouldn’t our priority be helping every single person achieve optimal health?  Wouldn’t it be better if our B.C. population was so focused on wellness and health promotion that only a rare few ever required the services of a specialist?

Perhaps we need to worry less that new specialist graduates aren’t getting jobs, and start celebrating that the need for specialists is being reduced!

ABOUT CARRIE MURPHY

carrieCarrie Murphy is a Family Nurse Practitioner and member of an interdisciplinary team in a full service family practice in Langley, B.C.  Her clinical focus is seniors’ health including frail seniors living in residential care facilities.   She has 20 years of experience in older adult health in various clinical and management roles but finds the NP role the most rewarding.  Carrie sits on the Executive Committee of the BC Nurse Practitioners’ Association (BCNPA) as the Regional Representative for Fraser Health Region.  Visit www.bcnpa.org for more information.

After the Error: How the Nursing Profession is Saving Lives, by Robin Wyndham and Susan McIver

Three years ago I began working with Susan McIver on a book about Canadians who had endured personal tragedy as a result of medical errors. After the Error: Speaking Out About Patient Safety to Save Lives (April 2013, ECW Press, Toronto) tells the stories of these patients and their efforts to prevent similar suffering of others.

The book provides numerous examples of what has been done to promote safer health care and reminds readers that errors continue to devastate lives, despite increasing efforts to prevent them. The latter chapters offer information on how to prevent errors when making end-of-life decisions, how to work with the media and how to organize large amounts of information such as medical records to facilitate investigations. The final chapter offers insights into medical malpractice.

During my 34 years as a registered nurse, I worked in neonatal intensive care, surgery, psychiatry and residential care and had a special interest in palliative care. I studied nursing at Vancouver General Hospital and English at the University of British Columbia. The diversity of my nursing experiences and skill as an editor complemented Susan’s background as a community coroner in British Columbia and a professor and research scientist in the basic science section of the Faculty of Medicine at the University of Toronto.

In preparing After the Error, I was naturally drawn to the role of nurses associated with medical errors. I was proud of the behaviour and accomplishments of some nurses and my heart went out to others who found themselves in difficult situations.

The response of a group of British Columbia nurses to the death of an elderly woman in February 2000 was a proud moment for the nursing profession. The woman died 15 days after entering hospital for elective hip surgery and the coroner’s report released two years later revealed disturbing deficiencies in 10 areas of care. Immediately, members of the Registered Nurses Association of BC (now the College of Registered Nurses of BC), assisted by a representative of the health region, began working with the nurses at the hospital where the woman had died. In 2003, this group launched the Acute Care Geriatric Nurse Network (ACGNN) and subsequently the Geriatric Emergency Nursing Initiative (GENI). Representatives of the ACGNN tell the woman’s story at staff orientations and at regional and national conferences. The story is also used in nursing schools throughout Canada. (See http://esthersvoice.com/Pages8-10.pdf)

Nurses are one of the target markets of After the Error which also includes other health care providers and people who have been affected by medical errors. A 2009 study in Healthcare Quarterly reported that approximately one in six Canadians said they had experienced at least one medical error in the past two years. A 2012 report stated that approximately 38,000 to 43,000 deaths occur annually in Canada in connection with health-care delivery.

After the Error has received considerable media coverage. A highlight was Susan’s interview on CBC radio’s The Current. An email we received following the interview stated “I was struck by a line in the book stating a common experience following medical errors is isolation. The book has allowed me to see I am not alone and there are others out there committed to making changes that are so desperately needed.”

The book also received coverage in The National Post, Globe and Mail, Toronto Sun, Okanagan Saturday and The Georgia Straight. A nursing instructor at Red River College in Winnipeg wrote a review for the Winnipeg Free Press. Articles have also appeared in various health-related publications such as Health Action and Update.

We have been invited speakers for events from Montreal to Vancouver Island. A particular highlight was being featured speakers at the national meeting of the Canadian Gerontological Nursing Association held in Richmond. Another highlight was the opportunity to speak at the Risk+H conference in Montreal. In Winnipeg and Calgary several MLAs and prominent individuals in the respective health regions attended our presentations. Susan and I always welcome opportunities to speak about our book.

Our overall goal is to help make health care safer and facilitate discussions on how this can be achieved. Openness about errors at all levels is crucial. Health authorities, administrators, doctors, nurses and other health care staff must work together to help patients who have been harmed and to ensure that the same situation will not be repeated. Meaningful remedies should be developed and personalized to each case. At the same time, compassion and understanding are essential for both those who have made an error and those who have suffered from one.

Through working on the book and from years of experience as a registered nurse I have seen many areas where nurses can make a difference. These range from speaking up in the workplace to becoming politically active. Errors should be reported and areas of risk identified and remedied. Nurses must speak up about their concerns around patient safety at the bedside, in their practice community and in the community at large.

No discussion of patient safety is complete without addressing the question of funding. In this time of financial constraint it is imperative that patient safety not be compromised. A particularly relevant statement was made by an independent advisory group on patient safety in England: “The failures of leadership at M.S. Hospital had to do with attention. Their attention was on their finances – understandable and even appropriate these days. But attention isn’t limitless, and faced with financial and business model pressures unlike any we’ve seen, it’s easy to spend too much of it on the wrong things. All of us need to pay attention, in person, to the work at the front lines. We need to pay attention to our systems for building effective teams to execute work and to improve. And we need to pay attention to creating and maintaining reliable ways to seek, hear, and integrate the voices of our teams and the voices of our patients.”

For information about the book visit www.ecwpress.com/aftertheerror.

ABOUT ROBIN WYNDHAM AND SUSAN MCIVER

MWRobin Wyndham studied English at the University of British Columbia and nursing at the Vancouver General Hospital School of Nursing. She worked in neonatal intensive care, surgery, psychiatry, and residential care with a special interest in palliative care.

Susan McIver holds a PhD in entomology/microbiology, was a professor at the University of Toronto with appointments to the Faculty of Medicine, and a department chair at the University of Guelph. Subsequently, she served as a community coroner in British Columbia. She is also the author of Medical Nightmares: The Human Face of Errors.

Taking a Stand for Better Primary Care, by Susan Duncan RN PhD

The ARNBC has joined with the British Columbia Nurse Practitioner Association (BCNPA) and the Licensed Practical Nurses Association of B.C. (LPNABC), to convey concerns about recently announced changes to primary care in British Columbia.

Nurses have expressed their frustration that government is moving ahead with plans to ‘solve the physician shortage’ without considering the numerous ways nurses and other health professionals can, and do, improve primary care. We know that nurses are confronted on a daily basis with patients’ unmet needs and are frustrated because they know better solutions are possible. Our three Nursing Associations are committed to finding collaborative ways to bring nurses’ voices and ideas to this critical policy issue.

We have recently conveyed our concerns and our proposed solutions in an op-ed published in the Vancouver Sun, a news release and a letter to the Minister of Health.  In formulating our position and proposed solutions, ARNBC takes direction from evidence-informed policies, some of which were recognized decades ago. These include the Hastings Report on the Community Health Centre Project, the Romanow Report and the most recent Expert Commission on Nursing and Health Care. We also look to emerging models, such as the inception of family care clinics in Alberta, as a way of opening up choices in primary care providers through collaborative, interprofessional, patient-centred, community based clinics with increased hours of access. Other provinces and territories have also shown demonstrable impact on population health through implementing interdisciplinary community health centres.

ARNBC, BCNPA and LPNABC have asked government to strike an interprofessional advisory committee of nurses, physicians and other health professionals to advise the Minister on what is needed to shift the focus of care from physician office services to models of care that are in sync with real patient needs.

In late March, ARNBC will launch a dedicated Elections webpage which will share our position on primary care and other key election issues, and provide nurses with tools and ideas for communicating these issues to candidates. Our hope is that all MLAs will head to Victoria with a solid understanding of the issues facing primary health care, and a resolve to make positive, lasting health policy decisions for all British Columbians.

In the meantime, please add to this blog post with your experiences and ideas — we need to hear from you!

SusanABOUT 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.

BC Nurse Practitioners in the News

UPDATE, January 13, 2013:  The discussion around nurse practitioners in B.C. continues to evolve on the Globe and Mail Website.  On January 11, 2013, Dr. Ross submitted a Letter to the Editor [Click here to view] querying whether or not the ‘numbers add up’.  Subsequentlly, Rosemary Graham, BCNPA President, has shared the following message with ARNBC [Click here to view].  The BCNPA would like to hear the views of nurses, colleagues and the public about nurse practitioners in British Columbia.  We welcome your thoughts and views in the comment section of this blog.

On January 5, 2013, the Globe & Mail published an excellent article by Rod Mickleburgh entitled “Are Nurse Practitioners the cure for B.C.’s family doctor shortage”.  [Click here to view]

This timely and informative article included comments from Rosemary Graham, President of the BC Nurse Practitioner Association (BCNPA) as well as Shelley Ross, President of the British Columbia Medical Association (BCMA).  In great part due to Dr. Ross’ comments, the article has received more than 80 comments and sparked broad discussion in British Columbia and across Canada.  ARNBC chose to write a Letter to the Editor to highlight our concerns over the comments attributed to Shelley Ross and the BCMA.  To read ARNBC’s Letter to the Editor, click here.

To further the discussion, on January 7, 2013, Rosemary Graham and Shelley Ross were interviewed on CKNW’s Simi Sara ShowClick here to listen to the full audio of both interviews, and the comments made by callers. [Listen to mp3.]

ARNBC is proud to be a partner and friend of the BC Nurse Practitioner Association, and we encourage all nurses and all British Columbians to learn more about the important role nurse practitioners can play in improving the health of individuals and communities across the province.  Recently ARNBC partnered with the BCNPA and the Canadian Nurses Association on the www.npnow.ca campaign to raise awareness of NPs in the province.  Visit our NP Page to view materials and information from the campaign.

Visit the BCNPA website for more information on nurse practitioners, or to download their Position Statement on Nurse Practitioners in Primary Care.

ARNBC will continue to advocate in support of strong, collaborative healthcare teams that are led by the most appropriate healthcare professional  – whether that is a nurse practitioner, a physician, a registered nurse, a physiotherapist, an LPN, a midwife or another health provider.

ARNBCABOUT 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!

 

A Nursing Call to Action: Are we ready to respond?, by Jeanne Besner RN PhD

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?


JeanneBesnerABOUT JEANNE BESNER

In April 2010, Jeanne retired from full-time work with Alberta Health Services, where she had been the director of the Health Systems and Workforce Research Unit, leading the development of a research agenda focused on promoting effective and efficient utilization of all members of the health care team through redesign of care delivery models in acute and primary care settings.

She is an adjunct associate professor with the faculty of nursing at the University of Calgary, as well as Adjunct Faculty with the School of Nursing at Mount Royal University. She is a former President of CARNA (2003 to 2005) and past member of the Board of Directors of CNA (1999 to 2005), where she served as the Primary Health Care representative from 1999 to 2003. She was appointed to the Health Council of Canada in 2003. Jeanne was awarded an Alberta Centennial Medal in 2005 for her contributions to health care. In 2008 she received a CNA Centennial Award and in 2010, the Canadian College of Health Service Executives Nursing Leadership Award. She was invested to the Order of Canada in 2011and was presented with the Queen’s Diamond Jubilee Medal in May 2012.

  1. National Expert Commission. (2012). A Nursing Call to Action: The health of our nation, the future of our health system. Ottawa, Canada Nurses Association. (p. 7)
  2. National Expert Commission. (2012)
  3. Besner, J., Doran, D., et al. (2005). A Systematic Approach to Nursing Scopes of Practice. Canadian Institutes for Health Research (www.cihr.gc.ca)
  4. White, D., Jackson, K., et al. (2009). Enhancing Nursing Role Effectiveness through Job Redesign. Health Workforce Research and Evaluation Unit. Alberta Health Services
  5. Besner, J., Drummond, J., et al. (2010). Optimizing the Practice of Registered Nurses in the Context of an Interprofessional Team in Primary Care. (www.cihr.gc.ca)