Tag Archives: Nurse Practitioners

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

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

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

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

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

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

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

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

michaelsandlerABOUT MICHAEL SANDLER, RN

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

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

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

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

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

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

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

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

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

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

MarkprofileABOUT MARK SCHULTZ, NP

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

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

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

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

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

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

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

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

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

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

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

Maylene Fong-smABOUT MAYLENE FONG, RN

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

 

Tools of the Trade, by Lori Campbell, RN

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

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

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

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

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

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

ABOUT LORI CAMPBELL, RN

lori-campbell

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

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

 

 

 

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

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

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

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

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

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

ABOUT ZAK MATIESCHYN

ZakZak’s interest in health and healing began at the early age of nine years old when he would carry a small first aid kit while playing with friends.  Since then, his passion for healthcare and health policy has been unwavering.  He was particularly inspired by concepts of family, community and societal health, as well as the social determinants of health during his undergraduate (BSN UVic, 2000), graduate work (MN UVic, 2008), and clinical experience in urban, rural and remote B.C. communities.

Zak has served on numerous boards and committees, including the BC Nurse Practitioner Association Executive and was the first Nurse Practitioner in B.C. to be invited to sit on a Division of Family Practice Board (Kootenay Boundary, 2010 – 2014).  Through this work he has gained valuable experience in member engagement, optimizing board governance, and relationship building among diverse stakeholders.  In his clinical practice, Zak has worked med/surg, emergency, intensive care, vascular access and outpost nursing.  After obtaining his NP education in 2008, he began a practice in a West Kootenay family clinic, providing primary healthcare to the general public with a focus on marginalized populations.

Nursing Day at the Legislature: Reflections from an RN and a Nursing Student, by Lisa Constable, RN and Jennifer Kanai

Reflections of an RN

As a Registered Nurse practicing for almost 30 years Nursing Day at the Legislature on May 13th 2015 was a personal and professional highlight of my career. I have always prided myself in being someone who steps beyond their own practice setting, diving into less familiar worlds. As a nurse interacting with patients/families for most of my career I have come face-to-face with issues associated with patient safety and satisfaction, access to services, clinical outcomes and health disparities. I have seen when and how the health care system is effective, or not, in meeting the needs of the public. So here I was spending a day in the legislature arena, eager to share my years of experience and motivated to find an opportunity to bring about change to the healthcare system itself by meeting with politicians in Victoria.

Legislature Day began with a discussion on nursing unity, followed by an open forum with Ministry of Health leadership. We then sat in the Legislature gallery for Question Period, which proved to be a thought provoking experience observing the democratic process and hearing member statements and greetings read by MLAs in celebration of Nursing. Afterwards, the five nursing associations hosted a well-attended open house for all MLAs and their leadership staff in the Legislature lounge. A frank discussion with the opposition’s health critic concluded the day.

The fifty nurse leaders present were articulate in their thoughts, clear in their intentions and passionate about the health of British Columbians. I walked away invigorated, empowered and energized to do more in the legislature arena. I felt we were heard by the MLAs who showed keen interest in what we had to say and the solutions we shared. I was proud to stand shoulder to shoulder with my nursing colleague leaders and even prouder to share this day with Jennifer Kanai who is the future of nursing and health care legislature advocacy.

Jennifer Kanai is an inspirational second year nursing student at Victoria’s Camosun College and my niece. I watched in pride as she confidently joined in and spoke to the different MLAs discussing issues and articulating her position. I believe by us sharing this day together Jennifer will have the potential to become a confident advocate; be comfortable with and have the capacity to politically influence health and health care throughout her career. I look forward to seeing her influence and change policy, laws and regulations that govern the larger health care system. Jennifer is my niece but even more importantly to all is Jennifer is the future of health care and in my eyes the future looks more than promising.

Reflections of a Nursing Student

When I first went to the Nursing Day at the Legislature, I didn’t really know what I was getting into. I knew that there were five associations of nursing that would be present. It was a bit overwhelming to be a second year nursing student at the age of 21 in a large room with all of these very successful and amazing nurses; all who were incredible friendly, knowledgeable, and encouraging.

The part that stuck with me the most from this experience was going to the legislature building and having the MLAs come into the room with the nurses and having a discussion about health in the areas that they represent. They asked the nurses what their concerns were and if they had solutions. This was so incredible to watch because these MLA members were asking the nurses for advice and for their opinions; they recognized that nurses have a huge role in health care and are on the front line. By the end of the night I realized how amazing it was to have all five of the nursing associations working together and giving a strong voice to nurses. I understand that this is something that has just recently started, but it was so exciting to see this nursing coalition advocate for the health of the public.

As a student I found this to be an amazing and empowering experience. It made me more proud of my decision to go into nursing, and it may have sparked an interest for further down the road. It was great to see this other side of nursing in action, and the combination of politics and nursing together. I was very surprised that there were not more students there. I think that this is an experience that other students would benefit from; these nurses at the legislature day were working for change for the future of nursing and health care, and we students are the future of nursing. It really emphasized the impact that nurses have.

I went to the Nursing Day at the Legislature with my aunt. I am so thankful that she extended the invitation to me and encouraged me to come along with her. My aunt has had such an amazing influence, and has been an incredible role model for me. It was great to see her involved in all of these discussions and to hear her thoughts on the future of nursing.

Lisa, Jennifer and ARNBC President Julie Fraser speak with an MLA

Lisa, Jennifer and ARNBC President Julie Fraser speak with an MLA

ABOUT NURSING DAY AT THE LEGISLATURE

Nursing Day at the Legislature occurs each year during nursing week, and is an opportunity for the all members of the nursing family – licensed practical nurses, nurse practitioners, registered nurses and registered psychiatric nurses – to connect and network with one another, meet with MLAs and experience the B.C. political system in action. Our thanks to Lisa and Jennifer for sharing their reflections on this day – we hope others will share their reflections in the comments section and we look forward to an even bigger and better event next year.

Back to the future – from evolution to devolution and back again, by Heather Mass, RN

As a granddaughter, daughter and mother of registered nurses (RNs) who, with me, have lived the history of nursing in B.C., and as a registered nurse who was privileged to be involved in the “Association” work of RNABC through the 1990’s and who was involved in the creation of ARNBC, it feels appropriate for me to share my thoughts on the history of nursing in this province at this time. It is my sincere hope that B.C. nurses will urge BCNU to put aside the belief that “power shared is power lost” and instead recognize wisdom of once again having three arms.

Evolution

Beginning in 1909 when a small group of registered nurses formed the Graduate Nurses Association of Vancouver (GNAV) through to today, RNs in British Columbia have worked to create organizations that would support us and our profession. As these nurses achieved their goals, or as circumstances changed, the nursing organizations evolved – the GNAV evolved into the Graduate Nurses Association of BC (GNABC) which, in turn, evolved into the Registered Nurses Association of British Columbia (RNABC), which ultimately spawned the BC Nurses Union.

While each evolution occurred in response to changing circumstances, each “new” organization also continued to carry out three key functions:

1.  Regulation of the profession to protect the public (a regulatory function): members of the GVAV/GNABC/RNABC all lobbied for legislation that would require nurses to be registered and to ensure that people who call themselves “trained” nurses had the necessary competencies to provide safe care. Although the first step – the passing of the Registered Nurses Act was achieved in 1918 (in GNABC days), regulation did not become mandatory until 1988.

2.  Advocacy on behalf of the profession for improvements to health care and nursing practice (an “Association” function): from the beginning members of the GVAV/GNABC advocated on many issues related to health care and the profession, including championing improvements in nursing education to ensure nurses providing care were competent. As a result nursing education moved out of the patch work of “apprentice” programs that were common in the early 1900’s into institutions of higher learning which are the norm today. With the passage of new legislation – the Nurses (Registered) Act – in 1935 GNABC evolved into RNABC. While continuing the work of pursuing improvements in nursing education and working conditions, the RNABC’s Objects also permitted the Association to carry out initiatives designed to “Uphold the integrity of the nursing profession and support its contributions to the health and welfare of the people of British Columbia”.

3.  Acting in the interests of registered nurses (a labour relations function): the GVAV/GNABC/RNABC also worked hard to address issues of pay and working conditions for nurses. In 1976 a labour relations arm was created at RNABC to serve as a negotiator for better wages and working conditions for RNs.

Devolution

By the late 1970’s it was becoming clear that while all three of these functions were necessary pillars of support for professional nursing, there was also a growing perception that having one organization perform them all was a conflict of interest. Once again, changing circumstances led to changes in the Organization and – over the next 30 years – resulted in the devolution of what was one all-encompassing organization into three separate ones. This devolution occurred in three steps:

1.  As efforts to address issues related to pay and working conditions of registered nurses grew, so did the recognition of a potential conflict of interest for organizations that were mandated to regulate nurses in the public interest also negotiating on their behalf for improved pay and working conditions. In keeping with similar actions in other Canadian provinces, in 1981 RNABC supported the severing of its labour relations arm. To assist with the development of a separate organization that would take up this work for nurses, RNABC provided both funding (2.7 million/year) plus staff to support the creation of the BC Nurses Union. With this devolution RNABC focused its efforts on the remaining two functions: regulating and, where it did not conflict with regulatory functions, upholding the integrity of the profession and enhancing the health and welfare of the people nurses served.

In 2005, as part of a broad restructuring of regulation for health professionals, registered nurses came under the provisions of the Health Professions Act, and nurse practitioners were introduced in B.C. The Act mandated that regulatory organizations focus exclusively on protecting the public through professional regulation. With this changing circumstance, RNABC evolved to become the College of Registered Nurses of BC (CRNBC) and once again the potential for conflict of interest arose. Although perhaps not as obvious as the conflict between regulating the profession and bargaining on its behalf, as CRNBC restructured to focus exclusively on regulation it gradually began to sever “association” functions. Among other things, it no longer launched projects and initiatives designed to demonstrate and build further awareness of the full scope of the practice of registered nurses or the importance of integrating nursing knowledge into policy decision-making at the government level. Projects that RNABC had once mounted, such as the “New Directions for Health Care” papers that made RNs among the first providers to advocate for primary health care and describe the role of nurses in it, and the Comox Valley Nursing Centre Demonstration Project or the RN First Call program that demonstrated the importance of nursing’s role in promoting health and preventing disease were now determined to be in conflict with the College’s regulatory mandate. Although BCNU made efforts to fill the resulting gap by picking up some of the “association-type” functions, concerns about a conflict of interest between negotiating on behalf of nurses on issues of salary and working conditions and “Upholding the integrity of the nursing profession and its contributions to the health and welfare of the people of British Columbia” began to arise. So even though the “association functions” were devolved – there was no organization developed to pick them up.

2.  Withdrawing from CNA: The Canadian Nurses Association (CNA) is primarily an “Association of Associations”. CRNBC – with its mandate is to regulate the profession in the interests of the public – was now a regulatory college. Since it was no longer an “association” CRNBC Board served notice that its membership in CNA was inappropriate. Again, because there was no organized developed at the time CRNBC was established to take up the “association” arm of RNABC (and no transfer of funding and resources to support its work) there was no organization that could readily assume the role of representing B.C.’s RNs and NPs at CNA.

Evolution – Round 2

At the same time as RNs began to notice the withdrawal from CNA and the loss of a professional voice for registered nurses in British Columbia, nurse practitioners, the newest addition to the nursing family under the Health Professions Act, came together to form the BC Nurse Practitioner Association (BCNPA) which has a rich 10 year history of advocating for NP professional issues in B.C. and provided an answer to the very same concerns that RNs were facing with the introduction of the Health Professions Act.

For many nurses in B.C. the notice of withdrawal of CRNBC from CNA was a “wake up call”. For others who had watched this progressive loss of an Association it was the “final straw”.

Once again a group of registered nurses came together to create a Nursing Association that could pick up the third function: to advocate for improvements in health care for those we serve, and to ensure the involvement of RNs in the forums where decisions that will effect both the health care system and nurses role within it are made.  In 2009, out of this effort, “evolution – round 2” was begun. In 2010 ARNBC was born, and, like BCNU before it, negotiated the transfer of funding and resources from CRNBC that had once supported “association-type” work at RNABC.  The association now works closely with its three counterpart professional associations (ARPNBC, BCNPA and LPNABC) to work collaboratively on health and nursing policy issues.

Today RNs are once again supported by three separate but essential organizations – college, union and association. Ideally these organizations would, while each carrying out their unique mandate, collaborate and cooperate with each other to ensure that the vision of our colleagues in 1909 lives on. Sadly, it seems that this vision is at risk because of BCNU challenging ARNBC’s right to exist and to undermine its role with registered nurses, nurse practitioners and others. It seems that the Union believes that the new Association will somehow undermine its power.

If we can work together we will all be stronger!

ABOUT HEATHER MASS, RN

heathermHeather Mass is a nurse consultant. Prior to retiring she has held a variety of senior positions in nursing and health care administration, including the Chief Nursing Officer position for the British Columbia Children’s and Women’s Health Centre, and the Provincial Health Services Authority (PHSA). In the 1990’s she worked with the Registered Nurses Association of British Columbia as a Policy Consultant. During her time there she managed several innovative projects, including the Comox Valley Nursing Centre Demonstration Project and the RN First Call Project. She was a founding member of the group of nurses who initiated the development of the Association for Registered Nurses in British Columbia and continues to take an active interest in its success.

Seniors Advocate Takes a Strong Stance on Housing for Seniors, by Kathryn Seely

Seniors Housing in B.C.: Affordable, Appropriate, Available is a new report launched May 21, 2015 by the Office of the Seniors Advocate. This document makes progressive and bold recommendations that will enable better care for seniors and should be reviewed, discussed and acted upon by all B.C. nurses.

I was pleased to join Julie Fraser, President of ARNBC, and Patrick Chiu, RN/MPH Student and ARNBC Intern, at the release of this transformative report. There was a lot of energy in the room, which was packed with engaged and active seniors, advocates and stakeholders.

The report outlines the housing issues faced by B.C’s seniors living across the continuum from independent housing, to assisted living and to residential care, and finds that seniors’ housing must be more affordable, appropriate and available.

B.C. has the fastest growing rate of seniors in Canada. Although 93% of B.C.’s seniors live independently, 50% live on an income of $24,000 per year or less. According to this report, this is not adequate to maintain independent living conditions.

Over the course of the last year, the Seniors Advocate, Isobel Mackenzie, travelled across the province and met with thousands of seniors and their families. At each consultation she attended, housing and housing expenses were listed among seniors’ top concerns.

In her report, the Seniors Advocate urges the B.C. government to implement 18 recommendations to improve the health outcomes for low income seniors. We were impressed by the boldness of some of these recommendations, and hope nurses will take this opportunity to provide comments and feedback on this important report.

Seniors Housing in B.C.: Affordable, Appropriate, Available recommends that the B.C. government help low income seniors live in their homes longer by offering a government-backed line of credit, called a Homeowner Expense Deferral Account, which would allow low-income seniors to defer paying for utilities, home insurance and repairs until after their home is sold. This would help seniors live independently, and prevent them from paying housing expenses instead of healthcare needs, such as medications, dental care, hearing aids and medical supplies. Once their home is sold, the B.C. government would recoup its money, along with a low-interest charge. There is precedent for such a program in B.C.; seniors are able to defer their property tax payments under B.C.’s Property Tax Deferment program. The Office of the Seniors Advocate crunched the numbers and a homeowner deferral program is sustainable – most seniors would still have equity in their homes after 20 years.

The Seniors Advocate also recommends that the Registered Assisted Living program be redesigned to support more flexibility in the services offered, allowing more seniors to live independently for as long as possible. Ms. Mackenzie estimates that up to 15% of seniors in residential care could still be living at home with extra assisted living.

The other recommendation that caught my attention is that the B.C government commits to ensuring that by 2025, 95% of all residential care beds in the province will be single rooms equipped with ensuite bathrooms. A private bedroom and bathroom is enormously important to seniors, who view this as preserving privacy and dignity, at a very vulnerable time in their lives.

Please feel free to access the report, read the recommendations and let us know what you think by posting your comments.

Nursing knows the impacts that the social determinants of health have on the health of seniors and is pleased to see that the Seniors Advocate puts housing at the top of the list.

At ARNBC, we look forward to working with nurses and other stakeholders to improve seniors’ health and health care for seniors. As the Director of Nursing and Health Policy, I am committed to advancing policies that will improve seniors health, and would like to hear from nurses who have interest, expertise, or innovative ideas in this area. As the Seniors Advocate stated, these recommendations can only come to life, if we all make our voices heard.

Office of the Seniors Advocate News Release

Executive Summary

ABOUT KATHRYN SEELY

kathryn2Kathryn is a former nurse and lawyer who has spent the past decade working in the area of public policy and advocacy. Kathryn believes that effecting policy change is one of the best tools we can use to improve health outcomes and looks forward to working collaboratively with stakeholders to help develop nursing and heath policy in B.C to advance the health outcomes of British Columbians.  Kathryn is ARNBC’s Director of Health and Nursing Policy.

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

 

 

 

My Journey with ARNBC, by Linda Axen, RN

Congratulations on finding your way to the ARNBC webpage! By cruising through the website and reading blogs you have already taken your curiosity from thought to action. I also took that step exploring ARNBC online a few years ago and now I find myself privileged to sit on the Board of Directors representing the diverse voices of nurses working in northern B.C. This blog is my story of taking action which I hope will inspire some of you who have been thinking about becoming more active in your profession to find ways to take the next steps.

A professional high-point for me was having the opportunity to attend and present at the Canadian Nurses Association 2012 Biennial Conference. Attending that conference, soaking in the words of Canadian nursing leaders was an awe-inspiring event. I encourage all nurses to endeavour to attend at least one CNA conference for the simple yet profound sense of professional pride you will enjoy. Of particular interest was the sharing of the report A Nursing Call to Action: The health of our nation, the future of our health system. It filled me with hope and a sense of purpose that nurses throughout the country were capable of contributing to solutions to better the health of Canadians.

In early spring of 2014 I received an email notification that nominations for the ARNBC Board were open. I wanted to have my name put forward but at the same time I was very nervous and reluctant to compete for a Regional Director position. I overcame my fears only because I knew my regrets would haunt me if I didn’t try for the position. I am so happy that I took that risk. As a Board Director, I have attended meetings which occur approximately five times a year face-to-face and a few times per year by teleconference. The time commitments for connecting with nurses in the regions vary for each Board member. At every meeting and teleconference I am continually inspired by the passion that fellow Board members exhibit in representing nurses throughout the province. I am proud to think   that time spent on Board activities Board allows me to contribute my voice to influencing positive change on social and health issues in British Columbia.

So if you are like I was a few months ago, thinking about being more active in representing the voice of nurses, take the time to familiarize yourself with the webpage, explore becoming a network lead or consider contributing your voice on the Board of Directors. Nominations for Directors are open, so visit our website for more information http://www.arnbc.ca/agm/index.php  and consider letting your name stand for nomination. It’s a decision you won’t regret.

ABOUT LINDA AXEN, RN

Linda1Linda started with Northern Health in October 2011 as the Nursing Research Facilitator and is currently the Northern Health Cardiac Triage Coordinator. Prior to the Nursing Research Facilitator role, Linda worked for many years in clinical research in Vancouver including five years in Cardiology Research at Vancouver General Hospital. In completing her Master of Nursing in 2011 from the University of Victoria, Linda gained a greater understanding of the contributions nursing makes to health policy development and the complexities of the social and environmental forces within which nursing has developed as a profession.

Concurrent to working in Northern Health as the Nursing Research Facilitator, Linda co-taught the Introduction to Nursing Research course at the University of Northern BC. Working with the students afforded Linda insight into the amazing strength, energy and professionalism that newly graduated nurses bring to our ever-evolving work environments. Linda is passionate about encouraging practicing nurses to develop expertise in research and research-related activities and evidence-informed practice. Linda has been actively involved in the BC Ethics Harmonization Initiative and is a certified member of the Society of Clinical Research Professionals. She is well aware of the powerful economic contribution the north makes to the overall fiscal strength of our province and recognizes that this economic contribution requires a healthy and robust workforce.