Tag Archives: Nurse Practitioners

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT TANIA DICK

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

Innovation Series: The Nancy Chan Palliative Care Ambulatory Clinic, by Ingrid See, RN

A legacy. Something that will benefit patients and families who are living at home with a life limiting illness.” These were the thoughts of Erica Chan, daughter of Nancy Chan, and a member of a prominent Vancouver family who has made significant donations throughout the city to support arts, healthcare, and education.

When Erica approached the Vancouver Coastal Health Foundation in 2014, she and her family were thinking back to her mother’s passing 10 years ago. The family was grateful for the home care they had received and also recognized that they were fortunate to be able to hire private care for their mother. Erica realized that not many people could afford this level of care, so she began to search for ways of finding a project that could support current gaps and honor her mother.  Erica’s search ended when she met with Dr. Tim Sakaluk, Medical Director of the Vancouver Home Hospice Palliative Care Service, an advocate for services that could assist in building the capacity of primary care providers (specifically, family physicians and home care nurses), and introduce palliative care resources earlier on in a patient’s illness trajectory in order to meet the needs of those who are living with a serious illness.

The Nancy Chan Palliative Care Ambulatory Clinic was envisioned by the Vancouver Home Hospice Palliative Care Service to provide an opportunity for patients and families to be seen earlier on in their disease trajectory and assessed by an interdisciplinary team for physical, psychosocial, and spiritual support – an integral part of palliative care. The impetus behind the creation of the clinic was to better support the primary care provider, community health nurses and family physicians, who are caring for patients and families at home. These patients and families would benefit from a comprehensive assessment and care plan for concerns which are beyond the scope of practice of the primary health care providers.

This vision for the clinic was embraced by the Chan family, and in November 2014, the project charter was drawn up. In March 2015, two key project leads were identified within Vancouver Coastal Health- Mavis Friesen, Project Manager, and Ingrid See, Clinical Practice Leader. The time frame was short, with the goal of having a “soft launch” of the clinic by the end of June 2015.   Friesen developed concise timelines around leasing clinic space, furniture acquisitions, telecommunications, stakeholders and communication plans, and evaluation criteria. See focused more on the clinical side with the development of patient criteria, workflows for referral, triaging, and booking of appointments, clinical documents for clinic use, and evaluation tools.   Handouts about the clinic for home care staff, family physicians, patients and families also had to be designed and circulated to the various stakeholders.

A month prior to the “soft launch” of the clinic, See and Friesen took to the seven health units with brochures and referral processes to the clinic, patient information pamphlets in English, Chinese, and Punjabi, and answered questions on how the clinic would work with the local health units. Education also took place at the palliative care units, BC Cancer Agency, heart failure clinics, and other partners who often refer to the home hospice team and home care Launch Daynursing.   An information letter was posted on the Division of Family Practice website with the brochures and referral form for the clinic so that family physicians were aware when contacted by the community health nurses.   In October, 2015, the Minister of Health and the Chan family officially launched the opening of the Nancy Chan Palliative Care Ambulatory Clinic.

Compared to other palliative care ambulatory clinics, the Nancy Chan Clinic is quite unique.   At the beginning of each clinic visit, the client is asked to fill in the Edmonton Symptom Assessment Scale (ESAS) and the Canadian Problem Checklist which assesses for psychosocial and spiritual concerns. After the visit, each team member including the palliative care physician, clinical nurse specialist, social worker, and spiritual care consultant updates the patient care plan and medication record in the electronic chart so that the home care nurses have immediate access to the clinic visit. The physician consult note is faxed to the family physician with the recommendations within the week.

One of the key features is that the palliative care team at the clinic is already embedded within the home care system in Vancouver.   Referrals to the clinic come from the community health nurses, in consultation with the family doctor. When a patient is homebound and requires one or more of the above disciplines to support the community health nurses and/or family physician, visits by the team are done at the patient’s home, sometimes together, sometime individually. However, if the patient is still ambulatory, he/she is encouraged by the community health nurse to come to the clinic and be seen by all four disciplines. This helps the team increase their efficiency in seeing patients and allows for the patient and family to see all four disciplines at one visit.

What further makes this clinic unique is that it hopes to reach out to individuals living with non-malignant diseases that are more difficult to prognosticate such as COPD, CHF, end stage renal, and ALS. The clinic also provides specialized consult services for patients and families who are experiencing complex symptoms, pain and/or psychosocial and spiritual distress while facing a life-limiting illness.   Taking it one step further, the clinic provides grief information nights and grief counseling for the families after their loved ones have passed.

L-R - Ingrid See, Clinical Practice Leader, Dr. Tim Sakaluk, Medical Director, Sharon Salomons, Spiritual Care Practitioner, Tammy Dyson, Social Worker.

L-R – Ingrid See, Clinical Practice Leader, Dr. Tim Sakaluk, Medical Director, Sharon Salomons, Spiritual Care Practitioner, Tammy Dyson, Social Worker.

It’s hard to believe that it has already been one year since the launch. Throughout the first year, statistics were kept to evaluate the impact of the clinic. Since opening, there has been a total of 312 clinic visits by the four disciplines. This accounted for 23.56% of all visits done by the team which improved the number of visits at the clinic versus individual visits in the home setting. Further, 67 visits at the clinic were done by social work and spiritual care which primarily focused on counseling and bereavement support. In addition to clinical work, the clinic is also being used for education purposes in order to support VCH staff in improving palliative care knowledge through on site education and videoconferencing.

 

Future plans include caregiver education, support groups and holding mindfulness sessions to help families cope with stress. Ensuring high quality palliative care is one of the most important priorities within our healthcare system. As British Columbians continue to live longer with more complexities and life limiting illnesses, we need to continue to think of innovative ways to ensure patients and families are well supported holistically through collaboration, compassion and innovation.

ABOUT INGRID SEE

ingridseeIngrid has a background in home care nursing and has worked extensively as a Clinical Nurse Specialist in palliative care for many years in the community, acute, and residential care settings. Her role is to help mentor staff and improve clinical knowledge and standards of practice in palliative care, as well as providing clinical consultation while working with multi-disciplinary teams. Ingrid is also a diversity trainer and has a keen interest in developing education materials specifically focused around cultural competency and end of life care. She is the clinical lead for the Nancy Chan Palliative Care Ambulatory Clinic.

The Opioid Crisis Can’t Be Just a Headline for the Nursing Profession, by Zak Matieschyn, BSN, MN, RN, NP(Family)

I’ve had some great experiences during my year and a half as ARNBC president, but one will stand out for me long after my presidency ends. This week, I and a group of nurse leaders and students, had an opportunity to spend the afternoon on Vancouver’s Downtown East Side (DTES) learning, listening and supporting our frontline nurses (and let there be no mistake, with the current opioid crisis, this is truly the frontlines). No matter what we have read in the newspaper, or seen on TV, the reality of what is happening all over British Columbia is overwhelming and heartbreaking when you see it firsthand.

Our experiences were life-changing as we broke into small groups with an RN or peer leader and visited different sites throughout the DTES. The experiences were as different as they were impactful. Some visited the Crosstown Clinic, which is the only harm-reduction treatment centre in North America where addicts get actual heroin. Some walked with a street nurse as she went about her regular daily routine, checking on people in their SROs or on the street. Some visited the Downtown Eastside Community Centre to gain a better understanding of how primary care and social services are delivered to those who are struggling with healthcare issues. Still others visited the pop-up clinics and alleys where the unofficial safe sites are functioning.

I personally had the opportunity to spend time at St. Paul’s Hospital, which, although it is not in the DTES, until the recent opening of the Mobile Hospital, received the majority of overdose victims in the ER. I was able to witness some of the innovative work being done to streamline access to possible treatment options for people with addictions – these are exemplary programs that would be great to see scaled out to other parts of B.C. I also had the privilege of spending a couple of hours alongside the nurses at Insite, North America’s first safe injection site, handing out Naloxone kits and training individuals on how to use them. Sitting on the floor with a heroin user who wants to know how to use a Naloxone kit ‘just in case’ makes you see this whole situation from a different point of view. People are dying, and what a privilege and a responsibility we have as nurses to do everything in our power to prevent that.

Spend a day really listening to the individuals who claim the Downtown East Side as their community and you begin to understand that there are miracles taking place here every single day. This crisis has hit hard. As a nurse, I recognize that our frontline nurses working here are exhausted, overworked, sometimes overwhelmed. They lose friends every day – people who use drugs that they have come to know and love. They sit with individuals who are scared, worried, sad. And no matter how much they do, how hard they work, how many lives they impact, how many wounds they heal – there is always more they wish they could do. Nurses here are exceptional – because by choice they are agreeing to work with a population that is often ignored, stigmatized or dismissed. And the population on the DTES is a miracle unto itself. Largely stigmatized by most of Vancouver, the reality is that many of these individuals are the kindest, most compassionate, most generous humans you will ever meet, and their sense of community and helping one another is beyond compare. I must say that I felt completely safe during my time spent there.

ARNBC has taken a strong and proactive approach to working with our nurses and colleagues to determine how we can best support all frontline healthcare workers who are dealing with this crisis. For starters, we hosted a forum on Wednesday, bringing together as many frontline workers as we could, to give them an opportunity to debrief, to share their stories, to suggestion ways we can move forward together and to show that we are serious about supporting their work.

A sampling of some of the ideas include:

  • Develop a community of practice for those on the frontlines, giving them a place to talk online and share ideas (working on it)
  • Advocate for increased staff for key locations (working on it)
  • Develop a ‘free coffee’ program and consider expanding it to include snacks, treats, meals etc., for those working in various locations on the DTES (underway)
  • Engage rural and remote workers in programs and services that help them manage in this crisis (to do)
  • Advocate for safe injection sites, for safe drug supply and decriminalization (to do)
  • Help set up some volunteer scheduling, including training and criminal record checks (underway)
  • Advocate for better nursing curriculum to teach harm reduction/drug addiction and ensure students are exposed from the start of their nursing education (to do)

Other ideas that were brought forward will be included in the summary report, due out next week. Keep an eye on www.bccna.com if you want to learn more about what was discussed, or share what you think would make a difference.

Spending time on the downtown east side reminded me of something important – every single person who uses drugs has a powerful story to tell about how and why they started. They have family and friends (some may be other drug users, many are not). They have real fears and joys and sorrows. They are as real and alive and vital and important as any one of us. One of our speakers on Wednesday reminded us that we don’t really look at people who use drugs until after they’re gone when we put them on the front page of our newspapers. We need to remind ourselves as nurses that we look after all people – and we’re at our best when they’re alive and can be helped.

When ARNBC was ‘called out’ for not doing enough by Marilou Gagnon, it made us stop and think. She was right and we knew immediately that we needed to step up. We have done that this week, and we are committed to doing it on an ongoing basis. We know we can make a difference. We welcome your ideas and thoughts on small things or big things you think ARNBC should be doing to help during this crisis. We will not be silent in our support of those things that our frontline workers need in order to manage a difficult and overwhelming situation.

Our nurses on the frontlines are calling out for help. It is time for every single nurse in the province to step up and answer that call. They would do the same for any one of us.

ABOUT ZAK MATIESCHYN

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

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

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.