BCNU Update Magazine December 2017 by BC Nurses' Union

UPDATE DECEMBER 2017

M A G A Z I N E

STAFFING THE OR NEW PERIOPERATIVE EDUCATION MODEL HELPS ADDRESS BC’s NURSING SHORTAGE

PLUS

PULL-OUT BCNU POSITION STATEMENT ON VIOLENCE IN THE HEALTH-CARE WORKPLACE

SENIORS’ CARE

DISTRESS

CALL

New reports underscore the challenges of caring for BC’s seniors TAKING THE PULSE AT REGIONAL BARGAINING CONFERENCES | PLEDGE FOR SAFE CARE BCNU TAKES VIOLENCE-PREVENTION MESSAGE TO VICTORIA | OPIOID CRISIS HITS KELOWNA HOSPITAL

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MAY 1 - MAY 3

Hyatt Regency Hotel Vancouver Delegates should register at the hotel on the evening of April 30, 2018. All members from our unionâ&#x20AC;&#x2122;s 16 regions are urged to attend, either as observers or as voting delegates.

CALL FOR BCNU CONVENTION 2018 Itâ&#x20AC;&#x2122;s time to submit your proposed resolutions, bylaw and constitutional amendments Proposed bylaw and constitutional amendments must be received by the Bylaws Committee at BCNU no later than January 9, 2018. Please see your steward for the necessary forms. Mail them to the BCNU office, attention: chair of the Bylaws Committee. Proposed resolutions must be received by the Resolutions Committee at BCNU no later than January 9, 2018. Please see your steward for the necessary forms. Mail them to the BCNU office, attention: chair of the Resolutions Committee.

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CONTENTS

VOL 36 NO5

• DECEMBER 2017

DEPARTMENTS

VITAL SIGNS

HUMAN RIGHTS AND EQUITY

WHO CAN HELP?

OFF DUTY

UPFRONT

5 CHECK IN News and current events from around BC.

Kelowna sees the highest opioid hospitalization rate in the country.

New perioperative education model helps address BC’s nursing shortage.

31 PERSISTING FOR THEIR PATIENTS

Members attend regional bargaining conferences around BC.

Kelowna nurses use professional responsibility process to secure educator.

FEATURE

DISTRESS CALL Two new reports are a reminder of the professional and personal hardships that come with caring for seniors in BC.

ON THE COVER: BCIT NURSING STUDENT LINDA YANG. PHOTO BY PETER HOLST

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26 STAFFING THE OPERATING ROOM

12 PLEDGE FOR SAFE 16 TAKING THE CARE PULSE BCNU takes its violenceprevention message to Victoria.

BCNU POSITION STATEMENT ON VIOLENCE IN THE HEALTH-CARE WORKPLACE PULL-OUT p. 15

14 POISONED VALLEY

UPDATE MAGAZINE • DECEMBER 2017

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MOVING? NEW EMAIL? UPDATE M A G A Z I N E

MISSION STATEMENT The British Columbia Nurses’ Union protects and advances the health, social and economic well-being of our members, our profession and our communities. BCNU UPDATE is published by the BC Nurses’ Union, an independent Canadian union governed by a council elected by our 47,000 members. Signed articles do not necessarily represent official BCNU policies. EDITOR Lew MacDonald CONTRIBUTORS Juliet Chang, Laura Comuzzi, Sharon Costello, David Cubberley, Monica Ghosh, Kath Kitts, Shawn Leclair, Courtney McGillion, Umar Sheikh, Christine Sorensen PHOTOS David Cubberley, Kath Kitts, Shawn Leclair, Lew MacDonald, Courtney McGillion CONTACT US BCNU Communications Department 4060 Regent Street

STAY CONNECTED

When you move, please let us know your new address so we can keep sending you Update Magazine, election information and other vital union material. Send us your home email address and we’ll send you BCNU’s member eNews.

Burnaby, BC, V5C 6P5 PHONE 604.433.2268 TOLL FREE 1.800.663.9991 FAX 604.433.7945 TOLL FREE FAX 1.888.284.2222 BCNU WEBSITE www.bcnu.org EMAIL EDITOR lmacdonald@bcnu.org MOVING? Please send change of address to membership@bcnu.org Publications Mail Agreement 40834030 Return undeliverable

Please contact the Membership Department by email at membership@bcnu.org or by phone at 604-433-2268 or 1-800-663-9991

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Canadian addresses to BCNU 4060 Regent Street Burnaby, BC, V5C 6P5

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CHECK IN

NEWS FROM AROUND THE PROVINCE

WALK FOR RECONCILIATION

WE ARE ALL ONE TENS OF THOUSANDS OF PEOPLE TOOK TO THE streets of Vancouver on Sept. 24 to walk for reconciliation with Canada’s Indigenous peoples. The crowd included more than a dozen BC Nurses’ Union members, who said the event was a powerful experience and a reminder that there is much that remains to be done as we strive to uphold and enact the recommendations from the Truth and Reconciliation Commission (TRC). It’s the second time the event has come to the city, with the inaugural walk held in 2013. That gathering was meant to draw attention to TRC hearings that were happening at the time. That process shone a light on the abuses of Canada’s residential school system and the stories of people who lived through it, finding that the schools amounted to a form of cultural genocide. • PROUD NURSES From left: Nursing student Anita Espirirtu, Simon Fraser region co-chair Wendy Gibbs, nursing student and BCIT Outstanding Student Leadership Award recipient Kayla di Bauda, Simon Fraser region co-chair Lynn Lagace, BCNU Acting President Christine Sorensen and nursing student Candy Tran.

SHAPING THE FUTURE

RECONCILIATION WALK BCNU South Fraser Valley region co-chair Walter Lumamba (left) joins BCNU Aboriginal Leadership Circle members Carla Winchell and Sherry Ridsdale on a Sept. 24 march through downtown Vancouver.

BCNU REGIONAL EXECUTIVES and student members were guests at this year’s BC Institute of Technology Distinguished Awards Dinner. On Oct. 17 nursing student Kayla Di Bauda received the school’s Outstanding Student Leadership Award. Every year BCIT recognizes six outstanding individuals for distinguished achievement in their careers, as well as their contributions to their communities. •

WATCH THE VIDEO Kayla Di Bauda: Outstanding Student Leadership Award

UPDATE MAGAZINE • DECEMBER 2017

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CHECK IN NEWS FROM AROUND THE PROVINCE

THREE PROVINCIAL EXECUTIVE POSITIONS CONFIRMED

PLEDGING CHANGE Hundreds of BCNU members posted their commitment to action on social media ahead of this year’s Change Day. Clockwise from left: Alieh Mohebbi-Zadek and Jeanette Aldaba, Harwinder Sandhu, Lee Frederick, Frankie Salvadore and Erin Roulette.

A BC Labour Relations Board arbitrator has ruled that new elections for the positions of BCNU president, vice president and treasurer will not be required. Candidates Will Offley, Sharon Sharp and Mary Jean Lyth applied to the BCLRB in May after BCNU’s independent provincial Nominations Committee made the decision to remove these individuals from the ballot before the voting period began. On Nov. 7 arbitrator Tom Hodges issued an interim decision that found the Nominations Committee did have authority to remove the applicants from the ballot. Reasons and a final decision on all outstanding issues have yet to be released.

CHAMPIONS OF CHANGE

ELECTIONS RESUME FOR REMAINING TWO POSITIONS

MAGINE WHERE ONE small act makes a huge difference. That was the question the BC Nurses’ Union asked members after partnering with the BC Patient Safety and Quality Council and 50 other organizations to participate in Change Day 2017. Change Day is a celebration of the power of any person – patients, caregivers, health-care providers, students, volunteers – to have a positive impact on the health system. This year’s Change Day took place on November 17. The event saw hundreds of BCNU members joining the movement to drive change

and improvement in the health system. The campaign invited individuals to make a pledge to commit an act of change, or to try something new, in order to improve care of patients in British Columbia. “We looked forward to seeing what our members would pledge to effect change,” says BCNU Acting President Christine Sorensen. “We think Change Day is a great way to acknowledge the importance of healthy work environments. BCNU has been leading the way to make health-care settings healthier for nurses and their patients,” she says, noting that advocating for change is what the

union is all about. “BCNU successfully negotiated the inclusion of the Canadian Psychological Health and Safety Standard into our provincial collective agreement – a first in Canada.” Change Day is a global movement that was started in 2013 by the National Health Service in the UK. Countries from all over the world have since launched their own change days, spreading the energy and excitement to improve care globally. The first Change Day in BC happened on October 15, 2015, and inspired over 7,800 pledges from every corner of the province and every area of care. •

Hodges also issued a decision prohibiting member Todd Decker from participating as a candidate in the next two election cycles. The arbitrator found that BCNU’s earlier disciplinary action against Decker was warranted, and that his status remains as not in good standing. The decision means that elections for the two remaining positions of executive councillor on BCNU’s Provincial Executive Committee can proceed. The term of office for these seats will commence following the close of voting and announcement of the results.

DON’T FORGET TO VOTE ONLINE! Polls open Dec. 11–18

DECEMBER 2017 • UPDATE MAGAZINE

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CREATING A TRANSFORMATIVE MENTAL HEALTH AND ADDICTIONS STRATEGY

HE CREATION of BC’s first Ministry of Mental Health and Addictions was one of the most notable acts Premier John Horgan’s new NDP government undertook upon assuming office this summer. Led by New Westminster MLA Judy Darcy, the ministry has been given a mandate to lead the transformation of BC’s mental health and addictions care system. The ministry began formal consultations with health-care system stakeholders in the fall. This included the hosting of oneday working sessions to help

identify immediate actions that need to be taken. The sessions were an opportunity to ensure the provincial government gets input from the wide range of sectors needed to address the complex issues that make up the mental health and addictions landscape in BC. BCNU members attended an Oct. 11 session in Vancouver. “Minister Darcy tasked us with providing some action items to the question ‘what can we do now to help British Columbians struggling with mental health and addictions?’,’’ reports BCNU West Kootenay region mental health rep Karen

FINDING SOLUTIONS BCNU members participate in an Oct. 11 meeting hosted by the newly created Ministry of Mental Health and Addictions. From left: Terrace nurse Michael Prevost, Minister of Mental Health and Addictions Judy Darcy, BCNU Acting Vice President Adriane Gear and BCNU West Kootenay region mental health rep Karen Wasilenkoff.

Wasilenkoff, who attended the session. Wasilenkoff says the some 80 session participants, who represented a wide range of service providers, were asked to focus their discussions on key challenges such as reducing stigma and overcoming system fragmentation. “Darcy says she envisions a system where people needing mental health supports only need to ask once, where they get help fast, and where every door is the right door,”

says Wasilenkoff, who notes that the new ministry has a budget of $322 million to spend toward this effort over the next three years. After the meeting Darcy announced the province’s approval of injectable hydromorphone as a treatment for opioid addiction. Previously this therapy was only available at the Crosstown Clinic in Vancouver’s Downtown Eastside, and provided to individuals who do not respond to existing first-line therapies. •

NURSING STUDENTS MEET IN BC THE BC NURSES’ UNION WAS a proud supporter of the recent Canadian Nursing Students’ Association’s 2017 Western-Prairie Regional Conference held in Vancouver Oct. 20-22. The conference, which focused on the topic of providing care to vulnerable populations, was attended by over 200 student nurses from around Western Canada. BCNU North West region chair Teri Forster welcomed the attendees at a social event on Oct. 20. “BCNU was proud to sponsor this event,” says Forster, who is also BCNU’s student member council liaison. “We know that student nurses are the future of health care and we support their professional development.” Forster informed those in attendance

about BCNU program opportunities for student nurses and funding that’s available for bursaries and conferences. BCNU will also be participating in the upcoming 2018 CNSA National Conference taking place in Nanaimo between January 23–27, 2018. The four-day event will give attendees the opportunity to learn about various areas of nursing and gain more insight into the roles of members of the healthcare team. They will also participate in workshops and seminars while networking with nurses and nursing students from across the country. Do you know a student nurse? Information about registering as a BCNU student member for free can be found on BCNU’s website at www.bcnu.org/memberservices

UPDATE MAGAZINE • DECEMBER 2017

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INDEPENDENT BARGAINING

WILLIAMS LAKE LEVELS UP

RATIFICATION DAY Members working at Williams Lake Seniors Village gather to vote on Nov. 16. Back row from left: Shelly Methot, Brenda Coulombe, Rosan Tabalin, Illa Setah, Beverly Johnson, Jackie Davy and Lorna Crooks. Sitting from left: Debbie Lieuwen, Colleen Clow and BCNU labour relations officer Peter Knapp.

into ours, so we did a lot of streamlining to make it easier for everybody,” says Davy of the bargaining committee’s efforts to “level up” the non-nurse classifications. Highlights of the new contract include full medical and extended health benefits for casuals filling a temporary vacancy expected to be four months or longer, improved vacation scheduling, an additional sick day with pay increased from 80 to 100 percent, and full employer coverage of MSP premiums. Members will also receive a general wage increase of 1.5, 1.5, 1.2 and 1.5 percent retroactive to Jan. 1, 2016. “Members feel pretty good overall,” reports Davy. “People were satisfied with the wage increase across the board.” Williams Lake Seniors Village is owned by Retirement Concepts. The 200-bed facility opened in 2004. •

PHOTO: APRIL ROBERTS

CNU MEMBERS WHO WORK AT WILLIAMS Lake Seniors Village ratified a new collective agreement on Nov. 16 that goes a long way to improve and harmonize contract language previously scattered over several different agreements. The new contract covers 166 members, and includes nurses, residential care and activity aides, servers, cooks, housekeepers and laundry staff. Going into negotiations, the bargaining committee aimed to even out disparities that existed between various classifications while still achieving wage improvements for the group as a whole. Jackie Davy has worked at the facility for the past 11 years, and has served on the bargaining committee through three rounds of negotiations. “We had a patchwork quilt of an agreement before this one,” says the LPN, who notes that the previous contract at one time only covered nurses before all employees became BCNU members under a so-called wall-to-wall certification. “There were a lot of contracts that were cut and pasted

SOCIAL DETERMINANTS OF HEALTH

#knititforward

GIVING WARMTH BCNU student liaison Candy Tran started #knititforward to collect scarves for homeless people in her community.

CANDY TRAN RECALLS walking to her car on a cold day in October. The third-year BCIT nursing student had just finished a clinical rotation providing education and care to homeless people in New Westminster. “It was really cold and raining and I wished I had my scarf,” she said. “But I knew that I had somewhere warm to retreat to, and as soon as I got back to my car I could

turn up the heat and be okay.” Her own sense of relief made her think of the many people in the community who struggle to find shelter during the cold winter months. Soon, an idea was born. “I like helping and connecting with people,” says the Burnaby native. A knitter, Tran decided to make scarves that would be ready to distribute ahead of this winter. And using social media and the

PHOTO: JUSTIN WONG

Student’s initiative aims to help keep homeless people warmer this winter

DECEMBER 2017 • UPDATE MAGAZINE

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WILDFIRES

AFTER EFFECTS BCNU helps interior residents rebuild their lives

ENS OF THOUSANDS OF PEOPLE IN THE interior of the province have now begun the slow process of rebuilding their lives after this summer’s wildfire crisis. Assistance during the recovery phase, as was learned from the 2016 wildfire disaster in Fort McMurray Alberta, is just as important as dealing with the disaster itself. This reality prompted the BC Nurses’ Union to donate $10,000 to the United Way’s BC Wildfire Recovery Fund, which is aimed at addressing important post-disaster needs such as housing and access to food and mental health-care services. “After traumatic experiences like we saw this summer, it’s common to see more cases of domestic abuse, alcohol and drug use and a variety of public health issues,” says BCNU Acting President Christine Sorensen. Sorensen encourages union members who were impacted this summer to access mental health services and resources if they feel they need assistance. “We have to also consider the health-care professionals who worked under extremely stressful circumstances and are feeling the lasting impacts of the crisis firsthand,” she says.

hashtag #knititforward, she’s now encouraging others to participate in her effort. “In the hospital setting warm blankets are a really nice touch, but scarves are more manageable and can provide warmth, comfort and a sense of care,” she says of her decision to focus on scarves. Tran has now collected over 200 scarves and has been in touch with local outerwear company PANTAVUS, that will be donating scarves made with fabric left over from the manufacturing process. She has also received donations of yarn

and knitting supplies. Tran plans to distribute the scarves to service agencies in New Westminster and the Lower Mainland. In the meantime, she encourages other BCNU members to support her initiative. “You don’t need to know how to knit,” says Tran, who confesses to watching some YouTube videos to refresh her knitting skills. “You can donate a brand new, gently used and laundered, or handmade scarf.” • Want to support or donate supplies? Email: ctran25@my.bcit.ca

MUCH-NEEDED FUNDING BCNU Acting President Christine Sorensen presents a cheque for $10,000 to United Way Thompson Nicola Cariboo executive director Danalee Baker on Oct. 6.

United Way Thompson Nicola Cariboo executive director Danalee Baker says the union’s donation will greatly assist those who are in the process of rebuilding their lives. “We are overwhelmed at the generosity of the BC Nurses Union and their ongoing support of the people of BC, and their gift will go towards BC Wildfire Recovery in the coming months, specifically to target a common goal – mental wellness and resilience for citizens and communities,” she says. “Returning to some semblance of normal life and restoring hope for those affected by the wildfires is key to moving on from the trauma, anxiety and fear that accompany disaster.”•

YOUNG NURSES MEET Members of BCNU’s Young Nurses’ Network met at the union’s Burnaby office this September to plan outreach activities for the year ahead. The YNN enables young nurses and nursing students (age 35 or younger) to connect, share experiences, address issues of concern and get more involved in BCNU. Back row from left: Simon Fraser region’s Natasha D’Silva, North West region’s Taryn Opel, Fraser Valley region’s Nicole Hande, OkanaganSimilkameen region’s Daniel Schaefer, YNN chair and North East region member Sarra Smeaton Fedick and Pacific Rim region’s Tanja Bergen. Front row: East Kootenay region’s Gina Neumann, Thompson North Okanagan region’s Paige Bewley and South Fraser Valley region’s Danna Cattermole.

UPDATE MAGAZINE • DECEMBER 2017

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VITAL SIGNS

END OF THE HEALTH ACCORD The federal Liberals campaigned on negotiating a new health accord with the provinces and territories that would see a longterm agreement on funding.

NUMBERS THAT MATTER

FEDERAL HEALTH TRANSFERS NEEDED Ottawa's share of health-care funding has been declining since the creation of medicare. More spending is needed to ensure Canadians are covered.

5.2 %

annual increases in federal health transfers needed to maintain existing services.

3.5–4 % annual increases in federal transfers

negotiated under recent bilateral deals with the provinces – the same rate increase imposed by the previous Conservative government.

Instead of collaborating with the provinces, the federal government forced a series of separate, bilateral deals prior to the 2017 federal budget.

$33

BILLION

$4.13 BILLION

FEDERAL HEALTH CASH TRANSFER RELATIVE TO PROVINCIAL TERRITORIAL HEALTH SPENDING

The estimated cut to federal health transfers over the next 10 years.

The cut BC took over 10 years when it signed its bilateral agreement.

Every year in the province the value of this health-care cut would pay for:

2,581

registered nurses

35 30

30,075

25 %

hip and knee replacements*

20 15

1,340,909

MRIs*

* Numbers by CIHI

0 1968-69

1974-75

1980-81

1986-87

1992-93

1998-99

2004-05 2010-11 Source: Institute of Fiscal Studies and Democracy

Source: Canadian Health Coalition

DRUG PROBLEM Canada is the only developed country in the world with a universal health care program that doesn’t include a universal prescription drug plan. Instead, our multiple-payer system has resulted in the second highest prescription drug costs in the world next to the United States.

700,000

Canadians have no drug coverage

3.6 MILLION

have inadequate coverage and can’t afford their prescription drugs

$4.2 BILLION A YEAR

Amount that could be saved with a national pharmacare program by eliminating private plans, and using centralized bulk buying and generic substitution where possible and this plan would cover everyone

$28.5 BILLION

Amount Canada spent on drugs in 2015 WHO PAYS FOR DRUGS?

17% ($4.7 billion)

37% ($10.7 billion)

46% ($13.1 billion)

out of pocket by individuals private drug plans public drug plans

Source: Office of the Parliamentary Budget Officer

DECEMBER 2017 • UPDATE MAGAZINE

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RUNNING FOR A CURE BCNU MEMBERS across the province participated in this year’s Canadian Cancer Society’s CIBC Run for the Cure. The Oct. 1 event saw BCNU members, along with their family and friends, running at eight locations and raising over $7,900 for breast cancer research and support. Therese Dykstra is a retired nurse who volunteered on behalf of BCNU at the Nanaimo run. She’s been coming to the event since 2012. “In the beginning it was to help a colleague, and then it became a mission to spread the word,” she says. “I was diagnosed with terminal ovarian cancer in June 2015. I manned the booth that year with no hair – I will be there for as long as I can.” BCNU Thompson North

Okanagan region chair Tracy Quewezance was the union’s top fundraiser, gathering over $1,600 in donations. And the BCNU Prince George team led by captain Tish Trevelyan took honours as the top corporate fundraising team in that community’s event.

The first Run for the Cure was held in 1992 when a small group of volunteers in Toronto’s High Park brought 1,500 people together to raise awareness and $85,000 for the breast cancer cause. Today, the event has nearly 100,000 participants across Canada. •

THE RUNNERS 1. South Islands region co-chairs Margo Wilton and Lynnda Smith (back, left to right) are joined by Janeth Tomines (front left), South Islands region steward liaison Jessica Celeste (front centre) and Lee Yong. 2. Fraser Valley members Susanne Banta and Rose Mahoney. 3. South Fraser Valley region co-chair Hardev Bhullar, lobby coordinator Tashnumaity Minwalla and region co-chair Walter Lumamba. 4. North East region communications secretary Sarra Smeaton (back left), region chair Danette Thomsen (back, second from left), mental health rep Laura Baker (back, second from right) and professional responsibility advocate Barb Erickson (back right) are joined by (front left to right) treasurer Hanna Embree, Sonja Wall, Tish Trevelyan, lobby coordinator Tracey Jonker, Corinne McMorrow and Sharon Bryce. 5. Retired member Therese Dyksta and Pacific Rim region lobby coordinator Christine Franic. 6. Thompson North Okanagan region steward liaison Tracey Musey, region chair Tracy Quewezance and Trish Wood.

THANK YOU BCNU TEAM CAPTAINS! ABBOTSFORD Jeremy Duenk, Tracey Greenberg Heather Wiens KAMLOOPS Tracy Quewezance KELOWNA Rhonda Croft PRINCE GEORGE Tish Trevelyan NANAIMO Christine Franic SURREY Walter Lumamba VANCOUVER Brooke Raphael VICTORIA Jessica Celeste

UPDATE MAGAZINE • DECEMBER 2017

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TAKING THE VIOLENCEPREVENTION MESSAGE TO VICTORIA It’s time to get on with the changes politicians pledged to carry out

URSES NEED TO KNOW that when they go to work they can expect to come home without being assaulted on the job. The law obliges employers to protect their employees from workplace violence, but BC’s health authorities and WorkSafeBC are still not doing enough to ensure that health-care workplaces are as safe as they should be. That’s why BCNU Acting President Christine Sorensen and Acting Vice President Adriane Gear met with Labour Minister Harry Bains in October to discuss the urgent need for further action to prevent violence in health care today. Sorensen and Gear came armed with a tally of BCNU’s violence prevention pledges signed by members of the current legislature during the last election – 61 in all, 33 by NDP MLAs and two by their Green Party partners – to remind the minister of the specific actions they pledged to take. As background, they noted that violence against nurses has been steadily rising in BC, and that in 2015, injuries to nurses from attacks accounted for 31 percent of all such claims in the health and social services sector. They also presented recent Mustel Group polling numbers showing that nine out

of ten British Columbians agree that more should be done to protect nurses at work. Minister Bains is not only one of the MLAs who signed the BCNU pledge, he is also now the minister responsible for WorkSafeBC, the agency tasked with ensuring the safety of all BC workers and handling injured workers’ claims, including those resulting from violence at work. “We wanted the minister to be aware that while WorkSafeBC is technically responsible for ensuring employers eliminate or minimize all workplace hazards, including the risks of violence, it has failed to intervene effectively in health care to ensure violence is prevented,” says Sorensen. In fact, while WorkSafeBC has identified health care as one of four sectors in BC with above-average injury rates and targeted it for a “high-risk strategy” to address problems, BCNU is unaware of any concrete actions taken to effectively reduce the risk of violence in the sector. “That’s one reason we mobilized our lobby coordinators, occupational health and safety reps, and mental health reps to go out and get politicians to sign pledges committing them to act,” says Gear. “WorkSafeBC has not been doing its job of ensuring appropriate protec-

tion for nurses, and so we want to get politicians committed to actions that are long overdue.” Sixty-one signed pledges do create an expectation that, once elected, politicians will actually take action, she notes. BCNU’s electoral pledge states that it’s essential there be enough nurses working at all times to manage care safely. Inadequate staffing is known to increase the risks of violence, because patients, residents and family members can become agitated, frustrated with delays, and anxious about their needs. The pledge also places high priority on making properly trained security available, 24-7, at high-risk sites across BC. Today there are numerous hospitals with ERs, psychiatric wards, and other high-traffic, high-risk services that do not have properly trained security on hand. Proper training includes being equipped with de-escalation techniques, ready-to-go and hands-on in the event of an emergency. “We informed the minister that few sites come anywhere near this standard today, but the rising incidence of violence means this needs to become the norm at every high-risk site,” says Sorensen. “We also told him that while our collective agreement identifies an extensive list of sites for priority upgrades, health authorities are still dragging their heels rather than providing properly trained security to protect nurses.” The 61 politicians who signed the BCNU pledge also committed to speak out in favour of tougher sentencing for those convicted of assaulting a nurse. Specifically, they agreed to publicly advocate modifying the Criminal Code of Canada to make violence against a nurse an “aggravating circumstance”

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“Health authorities are still dragging their heels rather than providing properly trained security to protect nurses.” BCNU Acting President Christine Sorensen

for sentencing purposes, as was done in 2015 for transit operators. “We also shared our intention to approach Health Minister Adrian Dix in the near future, and deliver over 14,000 postcards from supporters calling on politicians to make good on their pledges to act,” she adds. “We will also be inviting Minister Dix to lead the charge on tougher sentencing and the other improvements the pledges commit to.” The MLA pledge cards also commit signatories to support the establishment of safety, security and Code White standards that protect nurses across BC from aggression at work. “The sanctuary nature of health care in our society requires a violence-free workplace, and the pledges signed by so many sitting MLAs means there’s promise that this will happen,” says Sorensen. “Our message to the minister was that it’s time to get on with the changes politicians pledged to carry out.” •

NURSES’ DELEGATION BCNU Acting Vice President Adriane Gear and Acting President Christine Sorensen met with Labour Minister Harry Bains in Victoria this October to discuss the urgent need for action to prevent violence in health care today.

TRAUMA’S AFTERMATH Exposure to trauma at work should be deemed causal for nurses hit with PTSD THE BCNU LEADERS WHO met with Labour Minister Harry Bains in late October lobbied to have nurses covered by any new legislation conferring a post-traumatic stress disorder (PTSD) presumption on first responders. The NDP government is expected to introduce such legislation soon, having proposed it in a private member’s bill while in opposition. “PTSD presumption” means that if an individual is diagnosed with PTSD, the condition is automatically assumed to have been caused by exposure to trauma at work. Currently, nurses and other emergency care-providers have to prove their PTSD was caused by traumatic incidents at work in order to qualify for benefits. Nurses are just as exposed to trauma as paramedics, firefighters, police officers and other first responders. Indeed, the experience of trauma is ongoing in many nursing jobs, whether they are in the community, acute care settings or other areas. BCNU leaders are proposing that BC follow the Manitoba model on PTSD presumption, which extends it broadly, rather than the Alberta model, which limits it to traditional first responders (who happen to be occupations that are overwhelmingly male-dominated). In late October, Nova Scotia passed a bill amending its WCB legislation to extend PTSD presumption to all

“frontline and emergency response workers,” a definition that includes nurses. “Nurses see patients experiencing pain and suffering when they are at their most vulnerable,” says Nanaimo nurse Paul Smith. “Sometimes the horrific events we witness stay with us and affect our ability to continue providing care as usual.” Smith wrote to his MLA Leonard Krog in October asking him to support amendments to the province’s Workers' Compensation Act that would see similar changes to the ones enacted in Nova Scotia. “Because we too can be traumatized by our work, we should also qualify for PTSD presumption so we get access to benefits and services in a timely manner,” argues Smith. Currently, nurses’ claims are frequently denied on the grounds that the conditions causing them are the result of pressures and tensions that are deemed a normal part of their work. But BCNU is also calling for the entire spectrum of psychological injuries affecting nurses to be placed on the same plane as physical injuries when claims are made to WorkSafeBC. BCNU’s health and safety advocates feel that WorkSafeBC currently stigmatizes workers who suffer from mental disorders and treats psychological injuries in a discriminatory manner versus the approach it takes with physical injuries. •

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POISONED VALLEY Kelowna struggles with the highest opioid hospitalization rate in Canada

ESTLED IN BC’S verdant Okanagan Valley, the city of Kelowna takes pride in being known for its hot summers, sprawling vineyards and temperate lakes. In fact, it’s often considered one of the country’s most livable cities. But recently, however, Kelowna has been making headlines for other reasons. New figures released this September by the Canadian Institute of Health Information (CIHI) list the city as having the highest opioid poisoning hospitalization rate in Canada. According to the report, an average of 16 people a day were admitted to Canadian hospitals in 2016-17 for accidental or deliberate opioid overdoses, a figure that’s seen a 70-percent increase over the past decade.

The CIHI report also shows that, based on population, it’s smaller cities that are facing the highest rates of hospitalizations related to opioid poisoning. Kelowna’s hospitalization rate due to opioid poisoning is currently 36.3 for every 100,000 people. By comparison, Toronto, the country's largest city, ranks second-lowest on a list of 34 metropolitan areas with a rate of 7.9 hospitalizations for every 100,000 people. Vancouver ranks near the middle of the report’s list of cities, with a rate of 20.5. Officials say there are a number of factors that can be attributed to the spike in opioid poisoning in Kelowna. The city’s warm weather and lake views has made it a popular resort town, inviting thousands of visitors and a young party crowd. It’s also considered to be one of many BC cities on the drug circuit, and

there’s been a significant increase in organized crime which is behind much of the drug distribution. Susan Kirwin has worked in the emergency room at Kelowna General Hospital (KGH) since 1995. The seasoned nurse is no stranger to treating overdose victims. But when the opioid crisis started to make headlines in 2016, Kirwin says she and her team began adjusting their daily routines to manage the steadily rising numbers of patients coming through the ER doors on a daily basis. They started taking simple steps, like keeping Narcan (naloxone) at the triage desk for quicker responses – measures that have now become the norm for a nursing team that relies heavily on one other for support. But the crisis has escalated so quickly, it’s caught Kirwin and her team off guard at times.

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“We are all struggling with the numbers and the fact it’s every day and every shift.” Susan Kirwin

“We used to just keep about 0.4 milligrams [of naloxone] at the desk, with some needles, so we were ready. What we’re finding now is that it isn’t enough, and we’re having to give more and more to bring these people back up. The drugs are just that strong,” she reports. “Also, it [opioid poisoning] used to be such an emergency before since it was such a rare thing. But now, when people tell us they are bringing in someone who’s unconscious, the entire response has become quite routine and we just go get the Narcan.” Kelowna is the province’s largest city outside of Metro Vancouver, but Kirwin says that, despite its size and growing population, it lacks any 24-hour services for people who need more immediate help in the community. “There’s a real gap in services. Besides the police, we are the only 24-hour option for many people. It would be nice to refer some of these people to outreach programs that weren’t just Monday to Friday. Our marginalized population doesn’t have many places to go if they need shelter. Our emergency room is often their first stop.” Recently, Interior Health gave Kelowna City Council an overview of the current crisis, along with some startling statistics, reporting that the city is on track for 90 deaths in 2017. To try and help those people using drugs at home, the health authority began operating a mobile supervised drug-use service in April after receiving a Health Canada exemption to operate. The mobile unit travels to

neighbourhoods that are known hot spots for drug use. Kirwin also observes that the opioid poisoning crisis doesn’t discriminate – they’ve been seeing more and more people come through the ER doors whom many wouldn’t consider an average drug user. “This crisis has evolved across the board to include young people, middle-aged people, those with families, those with higher educations, middle class and upper class people - the problem has gone everywhere,” she says. “There are people who are casually using drugs on the weekend, or at a party, and they are overdosing. We had five people come in last weekend from a wedding after using cocaine. I can assure you they weren’t expecting that.” The psychological toll that comes with treating the high numbers of patients, day in and day out, is significant for the entire team at Kelowna’s ER. “Unfortunately, we had a young man come in recently who had overdosed. We brought him back by giving him Narcan and CPR and he had a strong heart and pulled through,” reports Kirwin. “However, he was severely brain dead and passed away here just the other day after a couple days in the ICU. It’s incredibly sad.” For first responders, including Kirwin, it can be hard to see a light at the end of the tunnel when it comes to finding a solution to the ongoing opioid crisis that grips the community. “It’s hard when we see it’s taking a toll on everybody on the team.

ALWAYS AT THE READY Kelowna General Hospital emergency room nurse Susan Kirwin regularly treats opioid poisoning at her facility. Mid-sized cities such as hers lack the kinds of community treatment services that help keep patients in larger urban centres out of hospitals.

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From the firefighters who are first on scene, to the paramedics, and then those of us in the emergency room, it’s defeating for all of us up the line. I know we are all struggling with the numbers and the fact it’s every day and every shift.” Kirwin hopes that public health officials will be able to facilitate discussion and education so that everyone understands the risks of opioid poisoning. “It’s tragic to lose

sitting at an unprecedented 1,103 people for the first nine months of the year – up from 982 deaths over the same period in 2016. In addition, worrying figures show that the synthetic opioid fentanyl was detected in about 83 percent of the deaths, representing a 147 per cent increase over the number of fentanyl-detected deaths recorded between January and September of 2016. •

everybody. Some people are in this life and this culture and they kind of have a bit of an expectation of it and they are taking their chances,” she reflects. “What’s sad is when we see people coming in who lose their lives after being completely caught off guard.” New numbers released in October by the BC Coroners Service show the death toll from what it terms illicit drug overdoses

OPIOID CRISIS TAXES HOSPITALS Figures released this September by the Canadian Institute for Health Information (CIHI) show how the opioid poisoning crisis is impacting the acute care sector. An average of 16 people a day were admitted to hospital in 2016–17 for accidental or deliberate opioid overdoses. Canadian hospitals logged 5,670 admissions for inpatient care related to significant opioid poisoning in 2016–17, up

METROPOLITAN AREAS ACROSS CANADA WITH THE HIGHEST RATES OF OPIOID POISONING HOSPITALIZATIONS Rate per 100,000 population, year ending March 31, 2017*

Kelowna, BC Brantford, Ont London, Ont Abbotsford-Mission, BC Peterborough, Ont Regina, Sask Thunder Bay, Ont Trois-Rivieres, Que Saskatoon, Sask Saint John, NB Moncton, NB Edmonton, Alta Barrie, Ont Sherbrooke, Que Hamilton, Ont Vancouver, BC Greater Sudbury, Ont Victoria, BC Calgary, Alta St. Catherines-Niagara, Ont

36.3 31.6 30.4 29.4 29

586 64

1,190

936

244

69 138

865

ON 140

QC 29

1,965

827

134

53 111

5 26 16 NL 62 11 Territories 37 PEI

The Globe and Mail, Source: Hospital Morbidity Database, Canadian Institute for Health Information *Figures for metropoolitan areas in Quebec are for the fiscal year ended March 31, 2016

978

20 19.9 19.2 10

Number of apparent opioid-related deaths in 2016 (calendar year) Number of significant opioid poisoning hospitalizations in 2016-17 (Quebec is 2015-16)

21.8 20.5 20.5

THE ESCALATING TOLL FROM CANADA'S OPIOID EPIDEMIC

28.3 28.2 26.9 26.7 25.9 24.7 24.5 23.9 22.8

from 3,344 in 2007–08. Those patients stayed in hospital for an average of 71/2 days. The figures do not include people treated in emergency departments and sent home. The CIHI report also shows that it’s smaller cities that are facing the highest rates of hospitalizations owing to opioid poisoning in 2016–17, based on population.

500

1000

1500

2000

The Globe and Mail, Source: PHAC, CIHI

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TAKING THE

PULSE

Province-wide strategy conferences see nurses gear up for bargaining in the year ahead

CNU REGIONAL bargaining strategy conferences were held throughout the province in October and November. The meetings are an important first step in the provincial bargaining process and allow BCNU members to shape the direction and priorities that will help determine the outcome of future negotiations between the union and health employers. BCNU Acting President Christine Sorensen and CEO/Executive Director Umar Sheikh travelled the province and listened closely to members concerns. Conference attendees were given reports on current issues of interest arising from the last round of bargaining and participated in group exercises to help determine the top priorities for the next round. Members who follow Nurses’ Bargaining Association (NBA) negotiations closely can be forgiven if they feel surprised that the process for a new provincial contract is already underway. This is in part due to the fact that the current 2014–2019 contract was not ratified until May 2016.

“Nurses will need to be vocal and active in their communities and in their worksites.” BCNU CEO/Executive Director Umar Sheikh

A significant reason for this delay was the government wage pattern locked in place by a so-called “me-too” clause accepted by other public sector bargaining associations, and which prevented the NBA from negotiating a superior wage package that would not then require employers to provide the same improvement to members of other bargaining associations. To prevent this from happening again, the NBA negotiated a clause that now sees negotiations for the next contract commence no later than April 1, 2018. The political environment in which negotiations take place can have a significant effect on bargaining. Sheikh gave conference participants an overview of

BC’s political landscape and an assessment of the New Democrat government’s mandate. The election of a new provincial government is certainly the biggest change that has occurred since the last round of NBA bargaining, and the NDP’s commitment to invest in public services such as health care is reason enough to be optimistic about negotiations the year ahead, Sheikh observed. But the precarious nature of a minority government also means there is no telling how long the current government will last. “BCNU will continue to work with all political parties to make sure nurses’ voices are most effectively heard and respected,” he said.

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Sheikh also stressed the importance of connecting with the public and ensuring nurses’ message resonates with patients and their families. “Nurses will need to be vocal and active in their communities and in their worksites in order to secure the gains they want to see in the next contract,” he said. The next round of bargaining will also be informed by BCNU’s recently approved three-year strategic plan that aims to strengthen the organization through sound governance and strong member advocacy. Reviewing the plan, Sorensen noted that BCNU aims to build relationships with nursing and labour organizations, and enhance collaboration with other health-care stakeholders such as education and research institutions. “We are well-educated and well-spoken, we are critical thinkers and we are professional in our approach,” she said, when characterizing the union’s course going forward. Conference partici-

“I was impressed by SETTING PRIORITIES attendees had the opportuthe knowledge and Conference nity to review a range of current chalenthusiasm of our lenges that need to be considered before members wherever negotiations with health employers begin, such as I went.” ongoing workload and staffing issues

from unfilled shifts to chronically understaffed nursing specialty areas – all of which contribute to members being pressured to work unpaid overtime pants were given a summary report on before and after shifts – to the probthe progress made on a number of fronts lem of rising long-term disability and over the last two rounds of bargainextended health benefit costs. ing, from making ongoing progress on Every conference concluded with workload and staffing, to protecting an exercise in “dotmocracy” that saw job security, or advancing professional participants discuss and select their top practice. two priority issues and indicate their Sheikh highlighted the success of preference with stickers. the new expedited dispute resolution BCNU Acting Vice President Adriane process that replaced the previous Gear was also present at the confertime-consuming and expensive proences. Gear is responsible for overseeing cess of resolving grievances at indithe union’s health and safety mandate, vidual arbitrations. The standing BC and she took the opportunity to proHealthcare Office of Arbitration has vide an update on BCNU’s provincial effectively shortened the time it takes to violence prevention campaign that was resolve disputes using a two-step griev- launched in March. ance procedure while also providing “In a relatively short period of time, continuity of contract interpretation. we’ve succeeded in calling attention Donna Bouzan, BCNU Executive to the steadily rising risk of violence in Director of the new Nurse Staffing health care and the need to keep nurses Secretariat attended many of the consafe,” Gear told South Fraser Valley ferences and provided members with region members on Nov. 7. She reported an overview of the progress that’s now that polling done after BCNU’s major being made on the staffing front since advertising campaign showed that 9 out the strengthening of NBA contract of 10 British Columbians agree that more language last year that saw the should be done to prevent violence in creation of a series of innovative hospitals and other health-care settings. committees to ensure employSince then, she informed members ers’ compliance with agreed that nurses have secured more than upon targets. 14,000 signatures calling on elected officials to honour the pledges they signed during the provincial election promising to advocate for violence-free workplaces LEADERS’ REPORT Conference attendees were (see story on page 14). given a comprehensive overview Gear also told members about the on the progress that’s been made union’s plans to assist with the filing under the terms of the current Nurses’ Bargaining Association contract as well of grievances at high-risk sites and its as a report on the strategic outlook ahead ongoing work to “establish a culture of of future negotiations. Clockwise from left: BCNU Acting President Christine Sorensen, safety and violence reduction at every BCNU CEO/Executive Director Umar Sheikh, worksite” under the terms of the memand BCNU Nurse Staffing Secretariat Executive Director Donna Bouzan. orandum of understanding signed by BCNU Acting President Christine Sorensen

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FIRST-TIME PARTICIPANTS

THE PARTICIPANTS 1. Coastal Mountain region members Josh Gardiner, Yolanda Hamilton, David Kang and Valerie Williams attend the Oct.31 bargaining conference in Burnaby. 2. Fraser Valley region members Remy Dhillion and Parveen Gill. 3. Shaughnessy Heights region members Fahrin Jiwani and Shalini Sudhakar at their region’s conference Oct. 30 conference in Burnaby. 4. Fraser Valley members Jeremy Duenk, Heather Wiens and Leah Izmirlija attend their region’s Nov. 2 conference.

“We are committed to developing proposals to advance our violenceprevention goals when negotiations open in 2018.” BCNU Acting Vice President Adriane Gear

health employers during the last round of bargaining. Gear stressed that health and safety will continue to be a top priority at the provincial bargaining table. “We are committed to developing proposals in consultation with nurses to advance our violence-prevention goals when negotiations open in 2018,” she said.

PROVINCIAL BARGAINING STRATEGY CONFERENCE AHEAD Regional conference participants also elected delegates to BCNU’s Provincial Bargaining Strategy Conference to be held January 15-16 in Vancouver. Provincial conference participants will be presented with the results of the union’s NBA bargaining survey that was sent in November to the more than

40,000 members covered by the NBA provincial collective agreement. The survey, conducted by leading opinion and social research firm Mustel Group Market Research, will also provide critical feedback for guiding BCNU’s discussions with health authorities and government on ways to improve nurses’ quality of work life and their nursing practice conditions. “I truly enjoyed getting to hear the concerns of members from every corner of the province,” says Sorensen when asked about her impression of the conferences. “I was impressed by the knowledge and enthusiasm of our members wherever I went, and I’m confident our bargaining process will allow members to work together to reach our goals and support our common interest.” •

For many BCNU members, attending their region’s bargaining conference this fall was their first experience at a union event. Update Magazine spoke to three of these members at the Nov. 7 South Fraser Valley region conference in Surrey. Myline Villador has worked in neurology at Surrey Memorial Hospital for the past seven years. “It’s been great,” she says when asked how it feels to have an opportunity to participate in the bargaining process. “I’m able to see how the process works, what’s going on with the collective agreement and what we have to do next.” Alison Alldritt has worked in the emergency room at Peace Arch Hospital for the past 13 years and has just become a BCNU steward. “I’m excited to be a part of it,” she says of her participation in the conference. Another new steward, Premdeep Saran, has worked in extended care at Peace Arch Hospital for over five years. “It feels really good,” he says of the event. “Before I wasn’t that involved, but now I feel so empowered.” Saran believes that all members should participate in the bargaining process. “If you don’t try to find out how we do things then you really don’t have much of a say,” he notes. “Whether you are a steward or not – attend your region’s meetings – this is the only way you can find out more about what’s going on and how you can be involved,” is Saran’s advice to co-workers. Almost 200 nurses attended the region’s event. FIRST-TIMERS Surrey nurses Alison Alldritt, Myline Villador and Premdeep Saran attended their first BCNU regional bargaining conference on Nov. 7. The three have 25 years of nursing experience between them.

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SENIORS' CARE

DISTRESS

CALL

Nurses experience professional and personal hardships that come with caring for seniors in BC

C’s nurses play a vital role in promoting the health and wellbeing of seniors. And BC Nurses’ Union members – especially those who work in the community and long-term care – are all too aware of the need for greater investment in the home and community care sector. And yet, despite the aging population, BC’s seniors and their families have witnessed an almost two-decade long erosion of health support services available to them. BCNU has been calling for improved investments in home and community care for years, and members working in long-term care facilities have also been raising the alarm about deteriorating care conditions, rising acuity and understaffing. For many nurses, the toll is compounded when they are affected professionally and personally, both as caregivers for seniors while on the job and as unpaid caregivers for aging family members at home.

Unfortunately, there is little relief in sight for these nurses and other British Columbians caring for seniors today, as any improvements to the system of care would be measured in years given the level of neglect the home and community care sector has experienced. This reality was made clear in the Canadian Centre for Policy Alternatives latest report, Privatization & Declining Access to BC Seniors’ Care, which

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shows that seniors in this province have less access to home support, home health care, assisted living and residential care now than they did in 2001. The CCPA research found a 30 percent decline in access to publicly funded home support combined with a 20 percent drop in access to residential care and assisted living spaces over the last 15 years. The lack of access to home and community care for seniors

also has the effect of increasing hospital overcrowding and surgical wait times, which affect all British Columbians. It’s a dire picture that was framed again recently with the release of two publications from BC’s Seniors Advocate Isobel Mackenzie. The office released an updated report on Aug. 30 confirming that family caregiver distress is rising in BC while supports and services are not keeping pace

TIME TO CARE The need for “more staff, more freedom and more conversation” is what BC’s Seniors Advocate heard in a landmark survey of more than 20,000 long-term care residents and their families.

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SENIORS' CARE

BY THE NUMBERS

PROVINCIAL RESIDENTIAL CARE This September BC’s Office of the Seniors Advocate released the results of its survey of residents of publicly subsidized residential care homes and their families. Survey data gathered between June 2016 and May 2017 show that more needs to be done to ensure that seniors in care have the very best experience possible.

62%

of residents say they do not get to bathe or shower as often as they want

residents say they sometimes, rarely or never get help to the toilet when needed

residents report they are not consistently getting the help they need at mealtimes

46%

of residents report there is no one living in the facility that they consider a close friend

49%

of residents only sometimes, rarely or never have the same care aide on most weekdays

OUT OF

residents living in residential

10 care do not want to be there

READ THE SURVEY ON YOUR MOBILE DEVICE Every Voice Counts surveyed publicly subsidized residential care homes and is the most extensive survey of residents’ quality of life ever conducted in Canada.

There’s no time to care – patients’ families don’t always understand the pressure we’re under.” Shaun Wyman

with growing need. The update found that significant numbers of home support clients had an unpaid caregiver – almost always a family member – experiencing symptoms of distress such as anger, depression or feelings of not being able to continue with their caregiving duties. Then, on Sept. 15, the office released, Every Voice Counts, a landmark survey of people living in BC’s publicly subsidized residential care facilities today – the most extensive survey of its kind ever conducted in Canada, targeting over 22,000 individuals in 292 residential care facilities. Residents painted a bleak picture of overall neglect – although they believe they are being cared for by qualified people. “For the first time in this province, we have heard the collective voices of some of our most frail and vulnerable seniors across all of our care homes,” said Mackenzie. “What they are telling us is that while some are satisfied in some areas, overall, we need to be doing better, and in some cases, much better in ensuring the needs of residents are met,” she added. The survey, conducted between June 2016 and May 2017, asked a range of questions on residents’ experiences of day to day activities and care from questions about food quality and staff responsiveness to observations of physician care and social connectedness. Residents’ most frequent visitors, usually a family member, were also mailed surveys.

“We are very good at using clinical measurements to gauge how we’re doing in this area such as numbers of falls etc.,” said Mackenzie. “What we haven’t been good at is actually asking the residents themselves what they think of the care they receive and this survey gave us the opportunity to hear feedback that is so critical in making care improvements. “We have heard from 20,000 British Columbians – 10,000 residents and 10,000 family members – and together their voices send three strong messages: more staff, more freedom and more conversation,” said Mackenzie, noting that residents need more help in some areas reflecting the fact there are not enough staff. She also stressed that many residents are lonely and want to be talked to and engaged and they want more freedom to control all aspects of their day to day lives from when they get up in the morning to what time of day they eat their meals. The advocate makes eight recommendations in the report for system improvements, the most important being that employers should maintain a commitment made in March 2017 by the Ministry of Health to ensure a minimum of 3.36 funded care hours per resident per day (this would result in almost three million additional care hours per year). It also recommends that staffing levels be enforced and monitored by heath authorities, increasing flexibility of how and when care is delivered,

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increasing training focused on the emotional needs of residents, expanding the role of nurse practitioners in residential care facilities and increasing the range of activities provided in residential care facilities, particularly in the evenings and weekends. “We have to remember that for people who are living in residential care, this is their home, and very likely their last home,” said Mackenzie. “We need to do all that we can to ensure those who live there, have the very best experience possible.”

he survey’s findings are no surprise for BCNU members like Shaun Wyman. “There’s no time to care,” he says. Wyman was employed for six years as a special care nurse in a long-term care facility in Prince George where he says the nurses’ workloads were often unmanageable. He describes “regular floors with one LPN and two care aides assigned to care for 20 residents,” and says that patients there only got about 2.64 care hours per day. Wyman also notes that health and safety violations are common when understaffing combines with patients entering care who have increasingly complex needs. He says the strain is having a clear effect on nurses. “You worry about residents when you go home. You feel horrible that you’re barely able to provide basic care,” he explains. “My co-workers would cry before and after their shifts. Patients’ families don’t always understand the pressure we’re under.” BCNU member Jessica Celeste has worked in the geriatric specialty unit at Victoria’s Community Health Services for the past 17 years. She can attest to the problems highlighted in Mackenzie’s survey. “What’s happening in long-term care is not working for seniors out there,” she says. “What is needed are not just more beds but improved staffing, so

patient assessments aren’t neglected.” She says that more home support in the community is also needed before clients require long-term care. “I’ve seen home support workloads so unmanageable that clients are falling through the cracks.” While Celeste can bear witness to the conditions she’s encountered in long-term care, she’s also one of the thousands of regular British Columbians feeling the stress of caring

for an aging family, which is the subject of Mackenzie’s updated report on caregiver distress. “Unpaid caregivers are a vital, often unrecognized yet critical piece in ensuring the stability of our health care system,” said Mackenzie on the report’s release, adding there are approximately one million unpaid caregivers in the province whose paid value is estimated to be $3.5 billion. “The importance of maximizing

HOW TO FIX SENIORS’ CARE? NURSES KNOW THE MORE THAN 6,000 BCNU members who provide care daily in long-term care facilities across the province are more than aware of the challenges facing seniors today. The union consulted these members ahead of the last round of Nurses’ Bargaining Association contract negotiations. Their message? The lack of accessible long-term care services is a serious issue, and it’s one that policy makers cannot afford to ignore as BC’s population ages and more people require full-time home and community health-care services. The common challenges these nurses face include: • Chronic underfunding Nurses report that government neglect and the lack of a provincial/national long-term care strategy has led to the problems they are experiencing in their workplaces. • Increasing patient acuity Nurses report facing daily challenges and obstacles as they provide care to an increasingly complex resident population. • Short-staffing and heavy workload Long-term care nurses have

heavy workloads and high nurse-topatient ratios. They often feel they are doing little more than “putting out fires” and don’t have the opportunity to build relationships with their patients and this puts health outcomes at risk. • Communication challenges Heavy workloads cause communication problems with residents, managers and families. Nurses want more education to create positive environments that combine clinical care with family engagement. Many also said that managers aren’t connected to front-line employee and don’t understand nurses’ experiences. • Unfair compensation Long-term care nurses have a wide body of knowledge and provide health services to patients with multiple issues. But they feel that their work and their unique body of nursing knowledge is neither valued nor appreciated by managers, other members of their profession or co-workers. LPNs in particular felt that they should be fairly compensated for their nursing work.

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SENIORS' CARE

BY THE NUMBERS

CAREGIVERS IN DISTRESS Seniors’ Advocate Isobel Mackenzie’s recent report confirms that unpaid caregivers’ distress is rising in BC while supports and services are not keeping pace with growing need. The updated data highlighted in the report paints a disturbing picture.

31% 29%

of seniors had a primary caregiver in distress in 2017 – a 7% increase from 2015

14% 5% 5%

of unpaid caregivers are experiencing symptoms of distress such as anger, depression or feelings of not being able to continue with their caregiving duties. increase since last year in the actual number of family members and other unpaid caregivers who identify as being in distress decrease in the number of home support clients accessing adult day programs over the last year. the number of days delivered to these clients decreased by 2% decrease since last year in the number of average hours of home support per day per client over 65, signaling less intensive service

READ THIS SENIORS’ ADVOCATE REPORT ON YOUR MOBILE DEVICE Caregivers in Distress: A Growing Problem, is an update to a 2015 report showing that BC has one of the highest rates of caregiver distress in BC.

supports can’t be underestimated when we consider costly alternatives such as residential care or hospital stays.” Mackenzie’s office looked at data two years ago showing that BC has one of the highest rates of caregiver distress in Canada. “We were hoping when we looked at the data in this area this year that we would see improvements, but unfortunately, this is not the case.” The report, Caregivers in Distress: A Growing Problem, is an update to a 2015 report that indicated 29 percent of unpaid caregivers are experiencing symptoms of distress such as anger, depression or feelings of not being able to continue with their caregiving duties. Data highlighted in the current report indicate rates of distress have increased by 7 percent to 31 percent. “This is a disturbing trend on its own when we think of the daily reality for all the sons, daughters, spouses, neighbours and friends who are dedicating hundreds of hours caring for loved ones,” said Mackenzie. “However there is even more cause for concern when we look at additional data in this report that indicate the frailty and complexity of those we are caring for at home is actually increasing, and the supports and services that can make an immense difference to the lives of caregivers are not keeping pace.” The report focuses on the caregivers of individuals receiving publicly subsidized home support in the province, as this is the only sub-set of the caregiving community where measurable data using detailed health care assessments are available. This report also relies on data that tracks key support services such as Adult Day Programs, which provide regular programming and relief to caregivers, respite in residential care

facilities, and additional home support services, that also help provide a reprieve from caregiving duties. “Having a break for even a few hours can make a huge difference in the lives of caregivers who are feeling exhausted and overwhelmed,” said Mackenzie. “For some caregivers, time alone to refocus and recharge is something very precious and we need to recognize that it can make the difference between feeling strong enough to carry on with caring commitments, or giving up entirely.”

or Celeste, Mackenzie’s report hits close to home. Both of her parents have recently moved into care facilities. First her mother needed to be settled into a long-term care facility and then her father moved into an assisted living facility. She managed it all in addition to her usual job and union workloads (Celeste served as co-chair of BCNU’s South Islands region). Celeste already went through a similar experience with both her mother-in-law and father-in-law just a few years earlier. “I fought hard to care for both my parents at home until the very last moment when we were no longer able to manage on our own,” she says. “I had to train new caregivers over and over, and even with home support, things don’t always work out.” Now that her mother is in a longterm care facility, Celeste says she knows it is a time of change for her family, and she and her siblings are working together to ease the transition. They have arranged a schedule so a family member can feed their mother at mealtimes given the lack of time that staff have to spend with her. Not long ago, Celeste’s father also began to show signs of dementia and

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eventually accepted that he was no longer able to manage living on his own. “He was struggling with everyday tasks and cognitive impairment – I think he knew he needed care.” Celeste says there is a unique burden that comes with being the nurse in the family. “I’m who they rely on in terms of knowledge. I have to take the lead, direct caregivers, remedy problems. At times you end up doing extra work because you are the only one who knows how.” For self-care Celeste makes time for yoga and gym workouts, and has been using massage to help handle the added stress. “You need to find activities that fit your schedule and you have to commit to it, that’s how I balance my life.” She also credits her spouse, children and siblings for their teamwork and support. “Work with your family’s doctors, community nursing, home care, and telehealth nursing for information and referrals to resources,” is Celeste’s advice to nurses facing similar challenges. Celeste also wrote herself a checklist and created an action plan with a timeline to organize her thoughts. “When I stay focused I can accomplish great things. Challenges come to us, it’s up to you to find out how to cope and be resilient.”

udy McGrath has also experienced the challenges of caring for a senior family member. The BCNU Central Vancouver regional co-chair has been a nurse since 1974 and has worked in neuropsychiatry at UBC Hospital since 1994. Her father was a fit and healthy 67-year old who enjoyed woodworking and social activities when he came from South Africa to live with her in 1997. But in 2011 his health began to decline and he was diagnosed with Parkinson’s Disease. Over time he

I’m who they rely on – I have to take the lead, direct caregivers, remedy problems.” Jessica Celeste

became frailer, yet still managed to cope with daily living at home. In 2016, he was hospitalized repeatedly and his Parkinson’s was getting worse. McGrath found herself “doing more and more to care for him.” When he was admitted to Burnaby Hospital in June 2017 with an infection, hospital doctors wanted to send him home once he began to improve, but McGrath says she insisted that he wait for a care assessment. “Sure enough, the doctors agreed that my father needed to be placed in a constant care environment,” she reports. In July, her father moved into longterm care. The changes mean that McGrath “is finding a new normal.” Now, when she works late, “I don’t have to worry about him. It means that I can really do my job without that extra stress.” She now dedicates every Sunday to spending time with her father, in addition to making extra visits during the week when she has the opportunity. “I took things one day at a time,” says McGrath on coping with the stress of being her father’s caregiver. Today, supportive friends and long walks with her dog help keep her fit, and she is resuming activities that she stopped enjoying because she didn’t want to leave him alone. She also finds her work more satisfying and now has time for activities that recharge her. “I have so many things I’m looking forward to doing in the future. Knowing he’s being taken care of is peace of mind I didn’t have before.”

Celeste and McGrath are all too aware of the need to ensure that the informal and formal caregivers of our senior population are receiving the care and financial, physical, emotional, and educational support they require to continue to perform this invaluable, though often invisible, work. For many years BCNU has advocated for solutions which include an end to the privatization of home and community care and more access to publicly funded care provided by health authorities and non-profit organizations. To that end, the development of a home and community care framework is necessary, with an action plan to improve access and service integration, and the inclusion of legislated staffing levels consistent with research evidence. BCNU believes that all seniors have a right to health care and diverse social supports that promote their quality of life. And nurses in BC will continue to speak up about the critical lack of safe, affordable housing, accessible public health care and community support services. The Office of the BC Seniors Advocate was created in 2014 to deal with systemic difficulties that seniors face in BC. Isobel Mackenzie was appointed by the Ministry of Health. The appointment doesn’t have a time limit and is similar in nature to the hiring of deputy ministers. Legislation mandating the job allows Mackenzie to form an advisory council to determine strategies and priorities. •

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FEATURE

andra Meeres remembers the spring of 2016 like it was yesterday. The BC Children’s Hospital nurse watched helplessly as nurse after nurse served notice and left one of the busiest operating rooms in the province. The exodus forced the closure of two of the hospital’s eight pediatric operating rooms in May of that year, and resulted in some 60 families having scheduled surgeries postponed. The crisis made headline news, with then-health minister Terry Lake informing the media that it would be nine to 10 months before the facility would be back to a full operating schedule.

STAFFING THE

New perioperative education model is helping to address BC’s nursing shortage

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READY TO SCRUB IN BC Children’s Hospital operating room nurses Nartila Romansini, Tina McVeigh, Madeline Ramos and Hannah Egan are just four of the hundreds of nurses taking advantage of the province’s new perioperative education model that’s designed to address BC’s chronic shortage of specialized OR staff.

Lake also characterized the hospital’s OR as having a “tense work environment” — with nurses vulnerable to burnout and difficult to replace. None of this came as a surprise to Meeres. The general duty nurse has worked in the surgical suite at Children’s Hospital for 17 years, and she’s served as a BCNU steward for the past five. “Before 2016 the OR was staffed,” she says. “Then management began to reduce the number of nurses to an amount they thought was adequate. We went from three to two nurses per shift – but that makes no sense because a trauma could come through the door and you would need that third nurse,” she explains. “They were trying to save money.” Meeres attributes the sudden loss of 20 percent of the staff to a 2015 staffing model that used fewer nurses and put increased pressure on those who remained. “A number of seasoned nurses were lost and they were not replaced,” she says. “The management team were saying that two nurses in a room is fine, and no nurses on nights or one nurse at night is fine,” she recalls. “I’m pretty sure that working alone in a tertiary care centre at night should not be an option.” Meeres says nurses wrote many notices of complaint over their employer’s unwillingness to comply with negotiated staffing agreements, but between nurses quitting, moving, getting sick and retiring, the effort had little effect. However, the crisis of May 2016 also became a catalyst for creative problem solving at the hospital. Within a year, the operating room that was once the epicentre of the province’s nursing shortage became the poster child for constructive collaboration and problem solving to address the crisis. With a new management team in place, the challenge lay in finding the number of nurses needed to bring the OR back up to baseline staffing levels and ensuring those staff were adequately educated. But obstacles were in the way. The perioperative program at BCIT did not have additional capacity and other health authorities were unable to assist with

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FEATURE

training because they were dealing with their own OR nurse shortages. The logical solution lay in providing in-house education. Unfortunately, this approach often does not qualify nurses to work in other facilities. If the hospital were to provide perioperative training that would attract nurses, it would need to have standardized core content that’s portable across the province. Meeres says educators at the hospital had become aware of a program developed by the Association of periOperative Registered Nurses (AORN). It had met with success in other jurisdictions and was soon chosen for Children’s Hospital. Based on AORN Periop 101TM curriculum, the program offers site-based integrated perioperative training. It is currently being used by more than 2,500 facilities across Canada and the US and combines a standardized, evidence-based online curriculum with hands-on skills labs, in-situ OR experiences and clinical practicums. “It makes sure that standards are followed and standard practices maintained – it’s a great program that’s worked well for us,” says Meeres, who credits nurse educators Vanja Ryan and Kat Lidstone as instrumental in getting the program off the ground. “Vanya and Kat did the work,” she says. “They got everyone on board with it. It’s a hands-on training program and it’s very intense.” The first group of nurses to go through the AORN program started in June 2016 and Meeres says they have been a success. “The nurses have worked really hard and we have some fabulous OR nurses as a result.”

PROVINCE-WIDE CRISIS

Despite this recent success, the Children’s Hospital OR is still deal-

“It’s a handson training program and it’s very intense.” Sandra Meeres

ing with the same challenges facing other ORs in BC. The province is experiencing the most acute shortage of specialty trained nurses in over 20 years. Any acute care nurse working in BC today knows all too well about the chronic and ongoing nurse retention and recruitment problems plaguing the operating rooms in hospitals across the province. Vacant lines are considered normal and minimum staffing levels are only being maintained through the consistent use of overtime that comes at the cost of nurses’ health. As nurses leave their units, the inadequate supply of qualified OR nursing staff only gets smaller, and employers have little success finding nurses willing to work under the current conditions.

SOLUTIONS AT THE BARGAINING TABLE

Without the education investments that are needed, the problem will remain. BCNU is committed to ensuring the province invests in the nurses required for safe patient care. In the last round of Nurses’ Bargaining Association (NBA) negotiations the union secured an agreement to increase BC’s education capacity by 850 full-time specialty-educated positions across the province, which includes operating room nurses. The last round of bargaining also saw BCNU negotiate a provincial contact that further promotes the professional practice of nursing while advancing nurses’ professional influence within the health-care system. One of these

advances was the creation of the Nursing Policy Secretariat (NPS) within the Ministry of Health which now allows unprecedented BCNU involvement in the development of nursing and health service policies. The NPS mandate allows it to deal with a variety of issues, from the expansion of nursing practice in response to population health needs, to the resolution of inconsistencies in permitted scopes of practice and enabling expanded scopes. The creation of the NPS established the groundwork for meaningful change, and it wasn’t long after the current NBA agreement was ratified in May 2016 that the Ministry of Health requested that the NPS lead work to establish a provincial model of care and education in perioperative settings in order to help address the urgent need for nurses in the OR. Representatives from each health authority and the NBA met to discuss the options. A key requirement voiced by BCNU was that the education should allow for portability throughout the province and that nurses would receive certification. Discussions with health authority Chief Nursing Officers, Chief Operating Officers, VPs of Human Resources and health ministry staff were held soon after. And based on the success at Children’s Hospital the decision was made to use the AORN framework as the provincial model for perioperative nursing education in BC. There was also a recognition that the care model must be built on strong, collaborative relationships that focus on meeting the needs of patients wherever services are provided while at the same time optimizing the practice of both RNs and LPNs in OR settings. This also meant that the education would be geared to meet the tier level of the relevant OR,

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FULLY STAFFED The new OR at Children’s Hospital was the first worksite to benefit from the new provincial model for perioperative nursing education in BC.

and if a nurse moved to a higher tiered OR, they would build on their foundational education to meet higher level requirements.

PHOTO: KENNETH CHAN – DAILY HIVE

STORIES OF SUCCESS

Update Magazine talked to four RNs in the first cohort of nurses who have completed the AORN program and who have all been on staff in the Children’s Hospital OR since June 2016. Hannah Egan started working full time at Children’s Hospital in February after completing her AORN program over a six-month period. She’s now working in general surgery. “We essentially do everything other than cardiac and spines. Anything from neuro to general surgery to urology,” she explains. Egan says she sent out many resumés after graduating from Trinity Western University in April 2016 but didn’t receive any calls. A friend then told her that PHSA was hiring. “They told me about this big OR nursing shortage,” she recalls. But Egan felt that, as a new grad with limited work experience, she might not qualify. “But I was told they were taking new grads. They were really looking for anybody. So I thought I would interview and see how it goes. I ended up getting hired and started the program.”

Nartila Romansini began working at Children’s Hospital during her preceptorship. “A year and a half ago they had an open house where they were trying to recruit people,” she recalls. But as a third-year student at the time, Romansini said she wasn’t sure if she could start working in the OR before graduating. “But they said absolutely – that is actually the best thing. They introduced the AORN program during my preceptorship, so I did three months of the program as a student and upon my graduation I received an offer and I accepted it while I continued with my course.” Romansini graduated from the AORN program in July and now works full time while she prepares for her NCLEX exam. Madeline Ramos worked as nurse in Arizona for three years before moving to Vancouver to live with her Canadian husband last year. “I was a float nurse. I worked all through pediatrics – in the PICU, NICU and med/surg – anywhere they were short.” She says she discovered the AORN program by happenstance. “I was just walking along one day around the hospital and I saw an advertisement for OR nurses, so I went to a presentation and actually met some people who worked in the OR,” she recalls. “That

intrigued me quite a bit and it felt like all the stars aligned for me to apply to this program.” Before coming to Children’s Hospital, Tina McVeigh worked on the general surgical unit at St. Paul’s Hospital since graduating in 2013. “We were taking care of patients pre- and post-op. So this is a nice circle for me – doing inter-op,” she says of her new role in the OR. McVeigh was already looking for a change before she heard about the perioperative program. “My manager at St. Paul’s moved to Children’s and she told me to let her know if I was looking for something else,” she says. “I had a daughter and the schedule and hours also worked better for me.” The group have all remarked on the supportive learning environment they encountered while working through the program. McVeigh, who has a small child, was drawn to the program because the course is taught at the hospital and worked with her busy schedule. She also appreciated the course’s multiple modalities. “You’d have days where you did your modules and another day where you did your skills and another day where you did your practice,” she explains. “I like that it was broken up and that it was self-led, because even though I did my module work on site, I could choose which chapters I wanted to do and which to set aside if I wanted to do them at home in the evenings – it was very flexible.” Egan says she really appreciates how many nurses in the OR stepped up to teach her. “A lot of people were willing to teach and help out,” she says. “After the

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FEATURE

first seven weeks we would just kind of go into a room and get paired up with whoever was there. “We got a lot of variation being paired up with different nurses, and a lot of them were willing to teach because they saw that in the future we were going to be co-workers.” Ramos concurs. “The support from senior nurses here was beyond amazing – everybody was just so happy that there were more nurses coming to help. They understood that we were going to be their colleagues, so they really invested a lot of their time and energy into helping mold us into the nurses we are.” Did any of the nurses have concerns about working in an OR that had just gone through a fairly high-profile staffing crisis? “I had some trepidation about whether I should make the decision to come over, because I just felt like it was going to be a lot of pressure,” admits McVeigh. “But I knew that I was going to make a difference. It was scary but also exciting to know that eventually I would be part of a group that would help get the OR working again.” “I know that there can be a stigma associated with the OR, as a place where there is bullying, but I’m lucky to say that Children’s is not like that in any way,” says Ramos. “Everyone is very supportive here and I have not come to work one day feeling that I wasn’t able to handle anything that came to me because I knew I would be 100 percent supported in any position I was in.” Romansini feels like the Children’s Hospital OR has already turned a corner despite the recent difficulties. “Going to an OR that’s experiencing a shortage is challenging because the senior nurses need to take their time to teach the new nurses coming in,” she

This model has given me a much broader foundation than just pediatrics.” Madeline Ramos

admits. “I’m here in training and I’m being a little bit of a weight on those people right now, but as soon as I finish I’ll be there to help them. It goes two ways – they give to me by training me and supporting me and I’ll give it back to them by helping them as well. So it’s very fulfilling to be part of a team that has been struggling but coming out of this stronger.” AORN’s standardized core content and portability was a key draw for all of the nurses. “I was thankful that the AORN framework was not just for kids. It’s for adults, for the whole spectrum,” says Egan. If the focus was just on children I think I would be less prepared to go to other places – so this model has given me a much broader foundation than just pediatrics.” “I like that too,” says McVeigh. “It’s portable across the province and North America and if I wanted to take my practice elsewhere I wasn’t limited to just Canada.” McVeigh says she now feels like she could comfortably work in another OR in the province. “And now that more hospitals are starting to adopt the AORN program that’ll make me feel more comfortable. I like that it goes with the NCLEX – it’s standardized,” she adds. Meeres agrees that nurses’ ability to work in different OR settings makes the AORN program a good opportunity. “Life changes, people move,” she

says. “We wanted our nurses to be certified [to work in multiple settings] and gain a broad knowledge base about being a good perioperative nurse, being able to identify issues and having a surgical conscience.” All of the nurses report being happy with their decision to work in the OR and feel like there is no shortage of opportunity and rewarding challenges in the years ahead. The new perioperative training program is just one more tool to encourage nurses to work in the OR, and it promises to be effective in helping address many of the staffing challenges operating rooms are experiencing across the province. “Without this program having been introduced into our OR, we would still be struggling to fill the need for trained perioperative nurses, and I do believe ORs would still be closed,” says Meeres. Utilizing the AORN curriculum, Fraser Health began offering a 10-month in-house education program this November to both RNs and LPNs working at Royal Columbian and Eagle Ridge hospitals. A second implementation is planned for Surrey Memorial Hospital in 2018. Children’s Hospital has now educated four cohorts, and the nurses working there encourage others who are curious to consider applying when the program is rolled out in other health authorities. “There’s so much nursing care that we can apply within the OR context,” says Romansini. “Nursing isn’t limited at all in the OR.” She encourages those who have any doubts to ask their employer for an orientation. “Maybe it will open a new door for you,” she says. “The OR is a great place where we can actually provide meaningful care for vulnerable patients – just be open and curious about it and go check it out.” •

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PROFESSIONAL ISSUES IN THE WORKPLACE

PERSISITING FOR THEIR PATIENTS

A determined group of Kelowna nurses persevere for four years before securing much needed staffing and the re-hiring of a nurse educator on their unit

DEDICATED TEAM Kelowna General Hospital post-anesthesia recovery unit nurses were some of the first BCNU members to use the improved professional responsibility process negotiated as part of the current Nurses’ Bargaining Association contract. From left: Kathy Porritt, Louise Bernardin, full-time steward Tim Fitzimmons, Breanna Snow and Carmen Zachary.

TALK TO ANY ACUTE care nurse working in BC today and they’ll tell you about a range of staffing challenges they face on their units daily. Inadequate staff replacement coupled with chronic overcapacity means that nurses’ practice conditions are in almost constant jeopardy. For a team of nurses working in the post anesthesia care unit (PACU) at Kelowna General Hospital (KGH), the list of practice concerns was extensive, and their efforts

to resolve many of them stretch back several years. KGH is one of the largest hospitals in Western Canada with more than 700 beds. It offers high-level, specialty medical care including 24-hour emergency and trauma services, ambulatory and outpatient clinics, and diagnostic/paramedical services. In BC, it is the only hospital outside the Lower Mainland or Vancouver Island that performs angioplasty or cardiac surgery. In 2013 some 30 nurses

worked at KGH’s post-anesthetic care unit. PACU nurses have extensive training in critical care and provide close monitoring of vital signs during surgical patients’ immediate postoperative recovery. Nurses at this tertiary facility care for a variety of critically ill, complex patients from infants to adults. They work closely with the anesthesia department to ensure that patients leaving PACU are stable and comfortable before being transferred to the medical/

surgical ward or an intensive care bed. In March of that year, managers at the busy hospital began overnighting patients in the PACU because beds were no longer available in the facility’s surgical recovery unit. It was an untenable situation that saw a group of PACU nurses turn to the Professional Responsibility Process (PRP) in an attempt to ensure their patients’ safety. The PRP is a way for nurses to safeguard their practice and protect their patients and residents. The multi-step process is part of the Nurses’ Bargaining Association collective agreement. It outlines the steps that nurses and managers must follow when nurses feel their ability to meet professional standards is being threatened. This process is a critical tool for defending professional standards. When raising concerns, nurses have the opportunity to describe the events or circumstances that contributed to the concern. This can include policies and procedures, workload and staffing issues, and workplace communication. Nurses start the process by having a conversation

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PROFESSIONAL ISSUES IN THE WORKPLACE

with their manager and if that doesn’t result in action, they move to step two and fill out a professional responsibility form (PRF). Kathy Porritt has worked on the PACU at KGH for the last 33 years. “There were many shifts that had workload issues with inadequate staff and unsafe patient scenarios,” she says of conditions that she and her colleagues endured. To make matters worse, their employer did not acknowledge emails outlining their concerns, and did not provide them with an opportunity to discuss the staffing situation. Porritt says she and her team started filing PRFs as a means to document practice conditions on the unit. The PRP is an important tool that can ensure safe patient care results in positive change for nurses, but the process is by no means a quick fix. For Porritt and team, the road to success was a long one with many obstacles along the way. Under the PRP, after a PRF is filed, the worksite Professional Responsibility Committee (PRC) must hold a meeting within 14 days The PRC is composed of standing members (one appointed by the NBA and one by the employer) along with ad hoc members, such as the nurse or nurses with the concern, a PR rep or union steward, the immediate supervisor and the excluded manager. After the meeting, the PRC has 30

“If there had been only one individual championing this file, it would have been abandoned long before three years had elapsed.” Kathy Porritt

days to submit a final written report including action items and timelines. Porritt and 16 other PACU members had filed some 40 PRFs by the time Porritt and three of her coworkers had their first meeting with the employer in November 2014, and this resulted in some important improvements. “One of our accomplishments was creating staffing guidelines for overnight patients using data from the many PRFs we filed,” says PACU nurse Louise Bernardin about the group’s efforts. Bernardin, who has been nursing for over 29

years, says the group’s PRFs also evidenced the need to secure additional staff for patients staying in the PACU as a result of the bed shortage elsewhere in the hospital. While staffing guidelines were a good start, the team continued filing PRFs to address their staffing concerns. Subsequent PRC meetings resulted in the hiring of a care aide and a unit clerk, and the expedited the filling of vacant lines.

NEED FOR EDUCATION

Despite their progress on the staffing front, the group

was nevertheless concerned about a larger patient-safety issue. The PACU lost its nurse educator in 2014 due to displacement. The growing complexity of OR procedures and the addition of new equipment, makes a nurse educator integral to any PACU team. An educator ensures that students and new staff are oriented, and that nursing competencies are met. They also act as a liaison with other departments to facilitate the continuity of patient care. But unlike their push for staffing guidelines, the group was unable to convince their employer to replace the nurse educator despite the PRFs that were filed, and were confronted with arguments about budgetary constraints. “At the beginning of 2016, we felt we had taken it as far as we could and we sat in limbo”, recalls Porritt. If a practice issue cannot be resolved by the PRC, it

A TWO-PATH PROCESS

Conversation with manager

File PRF

STAFFING ISSUES

NRC

NSS (Binding Arbitration)

OTHER ISSUES

SRC

CEO

PRC NPS

A BETTER PROFESSIONAL RESPONSIBILITY PROCESS Nurses at Kelowna General Hospital took advantage of the improved professional responsibility process negotiated as part of the Nurses’ Bargaining Association collective agreement. A two-pronged approach now allows PRFs that focus on staffing issues to be referred to a Nursing Relations Committee (NRC) and, if necessary, to the new Nurse Staffing Secretariat (NSS), and on to arbitration if still not settled.

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ration)

can be referred to step three of the PRP, and can take one of two paths: practice concerns not directly related to staffing are dealt with by the senior review committee (SRC) – a health authority-wide body with union and employer reps. The SRC has 60 days to issue its recommendations. But if the practice concern requires the hiring of additional staff to address, it is referred to the health authority’s Nurse Relations Committee (NRC). This new committee was established under the terms of the Nurses’ Bargaining Association 2014-2019 collective agreement that was ratified in May 2016. The NRC is composed of union representatives and employers who meet bi-weekly. Committee members have decision-making authority to work collaboratively but, unlike the SRC, this committee is not bound to make recommendations within a set timeframe. The PACU team’s PR issue was referred to the NRC. At the beginning of this year, PRC employer reps suggested creating a halftime temporary educator position that would be reviewed in six months. But the union’s NRC rep did not agree to the proposed terms of a part-time educator, arguing that tertiary care requires highly specialized equipment and expertise, and that it is was unreasonable for the PACU team to be simultaneously learning

“The PACU nurse team who pushed for these changes have to be commended for their incredible determination to achieve results.” BCNU Okanagan-Similkameen region chair Rhonda Croft

electronic charting while conducting orientation for student nurses. The union also noted that PACU nurses working in nearby Vernon Jubilee Hospital shared a full-time educator with their operating room staff. “It was what we had prior to losing our half-time educator in 2014,” says Porritt of the employer’s proposal, “but we also had a smaller staff complement and less acuity in the department back then.” A 2015 building renovation also underscored the need for a nurse educator. That year the OR was moved to a new and larger building that resulted in the PACU being divided by a medication room and two nursing stations. Patient acuity also increased with the additional patient numbers – but nurses saw no increase in staff following the changes. Porritt recalls feeling that managers had not heard or recognized staff efforts to champion a full-time educator, and says that she and her colleagues were deflated and emotionally drained at that point in the process.

“This team did their homework and they worked so well together. However, they encountered every imaginable circumstance that continued to defer their file,” says BCNU OkanaganSimilkameen region chair Rhonda Croft. Because the issue still remained unresolved, the group’s request for an educator could now be referred to the Nursing Staffing Secretariat (NSS), which is responsible for establishing data and reporting requirements for compliance with the protocol MOUs negotiated by BCNU and HEABC in 2014 and requires employers to provide adequate staffing levels for safe patient care. The NSS is also part of the new, two-pronged approach to resolving professional practice issues, and builds on previous ground-breaking contract language that now sees even more improvements to Article 59 (the Professional Responsibility Clause) of the NBA provincial contract. The Kelowna PACU team was one of the first groups to consider advancing their

concerns to this level, and they continued to develop a very clear case that demonstrated the PACU nurses were unable to meet their practice standards for licensing without an educator for clinical support and education. They also argued that they were continually denied access to educational resources normally available to PACU staff working in other tertiary centres. And the fact that the nurses did not have time to mentor the sheer volume of students at the hospital also formed part of their rationale for a fulltime educator. However, likely as a result of these nurses’ dogged advocacy, Interior Health chose to make a decision before an NSS meeting could take place, and instead made an announcement at an NRC meeting informing the union that it would be able to fund a full-time educator. The PACU team was more than relieved when they received a joint letter from the union and the employer this June informing them that Interior Health had finally listened to their calls. Carmen Zachary has worked on the PACU at KGH for the past eight years. “As nurses, we must be very persistent about the issue and never give up if we believe there’s need for improvement,” says the 36-year nurse. “We work at the ground level and see the needs first.” She credits Porritt for acting as

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TRAINING DAY BCNU stewards met at the union’s Burnaby office on October 31 for a PRP foundations course. To enhance common understanding of the professional responsibility process, both BCNU and health employers have agreed to deliver PRP education based on an agreed upon curriculum.

the group’s secretary. “She took very specific notes on what transpired, kept everything transparent for us and we owe her a huge amount of gratitude.” PACU nurse Breanna Snow agrees. “I thought when we first embarked on this, it would take a year. I never anticipated it being this lengthy a process. Kathy was the driving force that kept us together.” Tim Fitzimmons was working as BCNU’s fulltime steward at KGH when the PACU nurses began their efforts. He says that patients will be the primary beneficiaries. “After years of effort, patient care will benefit from safer staffing levels and adequate support for existing and new staff.” Bernardin notes that this PRP shows how improvements can be made if nurses stick together and work toward a goal. “This was successful because of our team,” she says. “We have much work to do on maintaining our com-

petencies, but at least it has been identified and work will continue,” she adds. “Morale has also improved just by having our needs identified and reaching success through this long process.” “Every professional responsibility process will have multiple varying factors that will impact the route to ensuring safe patient care,” says Croft. “The PACU nurse team who pushed for these changes has to be commended for their incredible determination to achieve results.” Porritt says she was kept on track by working with a dedicated and passionate group of individuals whose goals were to provide optimum patient care and to improve their working environment. “If there had been only one individual championing this file, it would have been abandoned long before three years had elapsed,” she says. “I think that the recurring theme for any PRP is the need for patience and persistence.” •

HOW TO CONTACT YOUR REGIONAL PROFESSIONAL RESPONSIBILITY ADVOCATES If you need help, please contact your current Professional Responsibility Advocates listed below. Central Vancouver Lesley Edora lesleyedora@bcnu.org

RIVA Romeo de Leon romeodeleon@bcnu.org

Coastal Mountain Genevieve Dallimore genevievedallimore@bcnu.org

Shaughnessy Heights Manpreet Mann manpreetmann@bcnu.org

East Kootenay vacant TBD

Simon Fraser Roy Hansen rhansen@bcnu.org

Fraser Valley Ravi Kochar ravikochar@bcnu.org

South Fraser Valley Edmundo David edmundodavid@bcnu.org

North East Barbara Erickson

South Islands Daphne Wass

barbaraerickson@bcnu.org

daphnewass@bcnu.org

North West Prisicilla de Medeiros priscillademedeiros@bcnu.org

Thompson North Okanagan Myrna Nichols myrnanichols@bcnu.org

Okanagan Similkameen Heather Picklyk heatherpicklyk@bcnu.org

Vancouver Metro Luba Veverytsa lyubovveverytsa@bcnu.org

Pacific Rim Sharon Fulton sharonfulton@bcnu.org

West Kootenay Glenna Lynch glennalynch@bcnu.org

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Q&A

HUMAN RIGHTS AND EQUITY

AN INTERVIEW WITH MEN IN NURSING GROUP CHAIR LEE FREDERICK BCNU’S MEN IN Nursing (MiN) group works to break down outdated stereotypes and encourage more men to enter the nursing profession and to become more active in the union. Men working in the nursing profession face some unique challenges. By taking on a non-traditional role, they may face gender-based bias. And while many more men are entering nursing today, the prevailing view is that nursing is still a “female occupation.” Lee Frederick was elected chair of the MiN group in October 2017. The Nanaimo LPN has worked at Arrowsmith Lodge in Parksville for nearly seven years. He earned his nursing degree from Vancouver Island University. Update Magazine recently spoke with Frederick to find out more about the ongoing work of

the MiN group. UPDATE Why did you choose nursing? FREDERICK My mother was a nurse and I have always been interested in the medical field. I also knew that nursing was a career in demand. One of the practicum placements for my nursing program was at Arrowsmith Lodge. During that time I grew to care very much about the residents there and I really liked the environment, so after I graduated I applied for a job there and they hired me. UPDATE What did you do before nursing? FREDERICK I was an educator before I became a nurse. I lived in China for 10 years as a teacher and worked my way up to school headmaster before I returned to Canada. UPDATE How did you become involved with the MiN group? FREDERICK Joanne Ord, the communications sec-

retary for BCNU’s Pacific Rim region, convinced me to take the Building Union Solidarity (BUS) course, so that was my introduction to activism in my union. I also completed my OH&S certification and became a BCNU steward so I could be the Joint Occupational Health and Safety Committee representative at my worksite. I began to attend regular BCNU meetings and I really liked my union’s message, so I thought it was a good place to be an advocate for both my patients and my co-workers.

I gradually started to look for ways to be more involved in my union and found out the Men in Nursing position for my region was vacant so I put my name forward and was happy to fill that position. That was almost a year and a half ago and now I’m honoured to chair BCNU’s MiN group. Our most recent meeting was my first serving in this new capacity, so I’m still figuring out all the duties and relationships that are involved. But anyone who knows me says that I am a vocal person. I have opin-

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HOW TO CONTACT YOUR HUMAN RIGHTS AND EQUITY REPS ions and I'm not afraid to share them, so becoming involved with BCNU was a natural fit for me. UPDATE Why is this group needed and what are some of the shared challenges you face? FREDERICK Male nurses are a recognizable minority in our profession. I think the MiN group gives focus to a group within BCNU that allows us to be strong allies to the equity-seeking caucuses. In a union that's 90 percent female, our voice might otherwise be lost if MiN didn't exist. Men usually are not belittled or discriminated against in general society, but within the nursing profession and in the workplace there are lingering role discrepancies. Men may occupy disproportionate roles of leadership at some worksites. At other facilities the Code White team is mostly male. In many instances male nurses are more likely to be called on to deal with dangerous or violent patients. However, according to the language in our contract, I’m still a “she”. My predecessors in the MiN group worked really hard to finally get paternity leave included in our contract, which took a long time.

UPDATE What has the group been working on lately? FREDERICK We're in the middle of our participation in the national Movember campaign, so many of us are growing a mustache. The annual event takes place in November and men are encouraged to grow mustaches to raise funds and awareness about men's health issues like prostate cancer, testicular cancer, and men's suicide. Mental health and suicide prevention in particular is one of my personal areas of vital concern. For males, the lack of healthy communication skills typically goes back to stereotypes that say strong men internalize negative emotions and don't talk about things. Too often that is what's expected of us. Men everywhere have to start talking about these issues more and the MiN group wants to lead the way by example. UPDATE What are some of the goals of the MiN caucus? FREDERICK A key goal is to be a strong ally for the BCNU equity-seeking groups since our circle intersects with all of BCNU’s other human rights and equity caucuses. Since roughly 50 per-

cent of the population is male but 90 percent of the people caring for them are not, we are also focused on encouraging more men to join the nursing profession. We want to do outreach such as job fairs at secondary schools so young people can see past the stereotypes. We can show them the professional male face of nursing. Young men should know that being a nurse is a good job, and an interesting job. UPDATE What message would MiN like to share with readers? FREDERICK Men in nursing matter. The way we communicate differently means that some patients may feel more comfortable and be more open when discussing their health concerns with a male nurse. As a minority we hope to have a voice that is seen as important, so our work will continue to focus on issues that need representation. •

To join the Men in Nursing group, please contact the chair via email at meninnursing@bcnu.org or Hanif Karim, BCNU human rights, equity and health policy officer: hkarim@bcnu.org

BCNU Human Rights and Equity Committee Christine Sorensen, Chair E christinesorensen@bcnu.org C 250-819-6293 Aboriginal Leadership Circle Diane Lingren, Chair E aboriginal@bcnu.org Rhonda Croft, Council Liaison C 250-212-0530 E rcroft@bcnu.org Workers with Disability Caucus Kelly Woywitka, Chair E disabilities@bcnu.org Teri Forster, Council Liaison C 250-485-7586 E teriforster@bcnu.org LGBTQ Caucus Hanna Embree, Chair E lgbtq@bcnu.org Tracy Quewezance, Council Liaison C 250-320-8064 E tquewezance@bcnu.org Men in Nursing Group Lee Frederick, Chair E m eninnursing@bcnu.org Tracey Greenberg, Council Liaison C 604-613-0381 E traceygreenberg@bcnu.org Mosaic of Colour Caucus Harwinder Sandhu, Chair E moc@bcnu.org Sara Mattu, Council Liaison C 778-989-8231 E saramattu@bcnu.org Young Nurses’ Network Sarra Smeaton Fedick, Chair E ynn@bcnu.org Hardev Bhullar, Council Liaison C 778-855-0220 E hardevbhullar@bcnu.org

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WHO CAN HELP? BCNU IS HERE TO SERVE MEMBERS

BCNU CAN. Here’s how you can get in touch with the right person to help you. CONTACT YOUR

Stewards for all workplace concerns. Regional Reps if your steward can’t help, or for all regional matters. Executive Committee for all provincial, national or union policy issues.

EXECUTIVE COMMITTEE

PRESIDENT Gayle Duteil

On leave

ACTING PRESIDENT Christine Sorensen C 250-819-6293 christinesorensen@bcnu.org

REGIONAL REPS CENTRAL VANCOUVER Marlene Goertzen Co-chair C 778-874-9330 marlenegoertzen@bcnu.org Judy McGrath Co-chair C 604-970-4339 jmcgrath@bcnu.org COASTAL MOUNTAIN Kath-Ann Terrett Chair C 604-828-0155 kterrett@bcnu.org EAST KOOTENAY Helena Barzilay Chair C 250-919-3310 hbarzilay@bcnu.org FRASER VALLEY Tracey Greenberg Chair C 604-613-0381 traceygreenberg@bcnu.org

ACTING VICE PRESIDENT Adriane Gear C 778-679-1213 adrianegear@bcnu.org

EXECUTIVE COUNCILLOR Deb Ducharme C 250-804-9964 dducharme@bcnu.org

TREASURER Sharon Sponton C 250-877-2547 sharonsponton@bcnu.org

ACTING EXECUTIVE COUNCILLOR Rhonda Croft C 250-212-0530 rcroft@bcnu.org

NORTH EAST Danette Thomsen Chair C 250-960-8621 danettethomsen @bcnu.org

SHAUGHNESSY HEIGHTS Claudette Jut Chair C 604-786-8422 claudettejut@bcnu.org

SOUTH ISLANDS Lynnda Smith Co-chair C 250-360-7475 lynndasmith@bcnu.org

NORTH WEST Teri Forster Chair C 250-485-7586 teriforster@bcnu.org

SIMON FRASER Lynn Lagace Co-chair C 604-219-4162 lynnlagace@bcnu.org

Margo Wilton Co-chair C 250-818-4862 mwilton@bcnu.org

OKANAGAN-SIMILKAMEEN Deanna Jerowsky Acting Chair C 250-499-9134 deannajerowsky@bcnu.org

Wendy Gibbs Co-Chair C 604-240-1242 wendygibbs@bcnu.org

PACIFIC RIM Rachel Kimler Chair C 250-816-0865 rachelkimler@bcnu.org RIVA Sara Mattu Chair C 778-989-8231 saramattu@bcnu.org

SOUTH FRASER VALLEY Hardev Bhullar Co-chair C 778-855-0220 hardevbhullar@bcnu.org Walter Lumamba Co-chair C 604-512-2004 walterlumamba@bcnu.org

THOMPSON NORTH OKANAGAN Tracy Quewezance Chair C 250-320-8064 tquewezance@bcnu.org VANCOUVER METRO Meghan Friesen Chair C 604-250-0751 meghanfriesen@bcnu.org WEST KOOTENAY Ron Poland Chair C 250-368-1085 ronpoland@bcnu.org

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OFF DUTY MEMBERS AFTER HOURS

NO LOOKING BACK PAULINE BARLOW STAYS HEALTHY AND WINS GOLD WHEN PAULINE BARLOW visited her doctor in 2013, she was shocked to learn that her blood pressure was “hitting the ceiling.” “My doctor told me he was either going to put me on blood pressure pills forever, or I had to lose some weight,” Barlow recalls. “So I chose the latter, and told him I'm going to try my best.” Barlow has worked in acute medicine at Lions Gate Hospital since 2008, and served as the professional responsibility advocate on BCNU’s Coastal Mountain region from 2012 until 2017. She used to run when she was a youngster in school in Kenya in the 70s and 80s, but had stopped by the time she was in nursing school. She started running again after immigrating to Canada in 2008. “But I only walked and jogged at that time,” she says. But in 2014 Barlow started running again and never looked back. “When I started jogging, I wasn’t sure if I was doing it right, it was intimidating,” she recalls. Barlow ended up talking to a fellow

nurse on her regional executive and asked her, “why is it so hard to get out and go jogging?” Her colleague offered to run with her and they started jogging together before progressing to running. They soon joined a running club. “My friend had finished 5km and 10km races

that I never thought I could run,” confesses Barlow. But in 2015 Barlow surprised herself by completing her first half-marathon in one hour and 58 minutes, which became another turning point for her. “Since that race,” she says, “I can't stop running, I'm addicted, I run rain or shine!” Best of all, Barlow’s health has improved dramatically. “In 2013 I weighed 197 pounds; I now weigh 125,” she reports. “My GP said my blood pressure is like a teenager's – it went down so quickly and he doesn't know what to say.” Barlow is also enjoying the psychological benefits of running. “When I hit the street for my run, if I had something stressing me, it just clears my brain – there’s nothing better you can invest in than getting out there and improving your health,” she says. “At first my cardiovascular condition didn’t allow me WINNER Pauline Barlow crosses the finish line at the 55+ Games in Vernon this summer. The North Vancouver nurse won gold in the women’s 10k race.

to run for long but now I can do 20k comfortably.” Barlow says her spouse and colleagues are very encouraging, and that finding the time to run is about making time for herself. “I wake up at 5:00am, run my 10k, come home, have breakfast and go to work. Running gives me a lot of energy and my attitude improves. I see myself dealing with patients better because my mind is clear.” At work, she encourages her colleagues to be active with her at break time. “Our little group now can jog for up to 10 minutes continuously, something none of them thought they could ever do,” says Barlow. Barlow is also defying the expectations of her Kenyan relatives. “Women of my age are not expected to be running on the streets wearing tights,” she explains. ”When my family first saw me, they thought I was sick because I had lost so much weight!” Barlow has now raced in the Lower Mainland, Calgary, Victoria and as far away as Atlanta, Georgia. This summer she won a gold medal at the 55+ BC Games. She says she’s won so many medals that she doesn’t know where to put them all. “Whenever I travel somewhere, the first thing I pack is my running gear,” she says. “I don't want to forget it.” Barlow is currently in training for her 13th half-marathon and hopes to continue her winning streak in 2018. •

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The right ingredients make all the difference

A RECIPE FOR SUCCESS BCNU governance renewal process

BCNU is reviewing the contents of our constitution and bylaws. We want to make sure our rules contain language that best reflects our organization and supports the work we do.

ADD YOUR VOICE TO THE MIX! Find out more at www.bcnu.org

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From Your BCNU Council (named in alphabetical order)

Helena Barzilay Hardev Bhullar Rhonda Croft Teri Forster Meghan Friesen Adriane Gear Wendy Gibbs Marlene Goertzen Tracey Greenberg Deanna Jerowsky Claudette Jut Rachel Kimler Lynn Lagace Walter Lumamba Sara Mattu Judy McGrath Ron Poland Tracy Quewezance Lynnda Smith Christine Sorensen Sharon Sponton Kath-Ann Terrett Danette Thomsen Margo Wilton Not pictured Deb Ducharme

Season's Greetings PM 40834030

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