BCNU Update Magazine March-April 2017

MARCH 2017

NEW TOOLS FOR SAFE PATIENT CARE

FIGHTING FOR SENIORS’ CARE ON THE SUNSHINE COAST

DEFENDING MEDICARE IN BC SUPREME COURT

UPDATE BRITISH COLUMBIA NURSES’ UNION

NOT PART OF THE JOB PROVINCIAL VIOLENCE PREVENTION CAMPAIGN KICKS OFF

BCNU CONSTITUTION AND BYLAWS PULL-OUT

WWW.BCNU.ORG

SAVING

LIVES BC NURSES TACKLE THE PROVINCE’S OPIOID OVERDOSE CRISIS

THE FACE OF HARM REDUCTION Insite’s Micah Cohen and Shevon Singh

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UPDATE MAGAZINE March 2017

UPDATE

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CONTENTS vol 36 no1

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march 2017

SPREADING KINDNESS From left: BCNU Executive Councillor Deb Ducharme, Vice President Christine Sorensen, President Gayle Duteil, Executive Councillor Adriane Gear and Treasurer Sharon Sponton show their colours for Pink Shirt Day. The annual event saw BCNU members join other Canadians to raise awareness and take action to end bullying and harassment.

UPFRONT

6 8

Check In

News and events from around the province.

Safe Staffing

New NBA dispute resolution process is up and running.

10 Fighting for Seniors’ Care Sechelt residents are organizing to reject for-profit care home.

13 Defending Medicare

Charter trial is underway in BC Supreme Court.

14 NOT Part of the Job

Union kicks off provincial violence prevention campaign.

DEPARTMENTS

5 PRESIDENT’S REPORT 30 PROFESSIONAL PRACTICE 34 YOUR PENSION 36 WHO CAN HELP? 37 COUNCIL PROFILE 38 OFF DUTY BCNU Constitution and Bylaws

FEATURE

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SAVING LIVES

BC nurses tackle the province’s opioid overdose crisis.

COVER PHOTO: PETER HOLST

Special pull-out on page 20 See proposed bylaw amendments and resolutions insert on page 13

BC Nurses’ Union

STAY CONNECTED

UPDATE MAGAZINE

MISSION STATEMENT The British Columbia Nurses’ Union protects and advances the health, social and

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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 43,000 members. Signed articles do not necessarily represent official BCNU policies.

EDITOR Lew MacDonald CONTRIBUTORS MC Breadner, Juliet Chang, Laura Comuzzi, David Cubberley, Gayle Duteil, Gary Fane, Kath Kitts, Shawn Leclair, Evans Li, Courtney McGillion, Cindy Paton PHOTOS David Cubberley, Kath Kitts, Shawn Leclair, Lew MacDonald

CONTACT US BCNU Communications Department 4060 Regent Street 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 Canadian addresses to BCNU 4060 Regent Street Burnaby, BC, V5C 6P5

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

PRESIDENT’S REPORT

GAYLE DUTEIL

IT’S TIME TO TALK RATIOS

PHOTO: KURTIS STEWART

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ave you been drinking and do you have childcare issues?” This is not the kind of question a nurse wants to hear after being called at home by their director, and then being ordered to work on their day off. But that’s exactly what happened to BCNU members working at Lions Gate Hospital over the holiday season.

Management there had invoked mandatory overtime – an old tactic from the nineties – to address chronic overcapacity that was exacerbated by the seasonal surge. Christmas and New Year’s and cold and flu season are as predictable as night and day, yet somehow health authorities once again found themselves caught off guard when it came to ensuring there would be adequate nursing staff needed to handle the onslaught of patients.

This is unacceptable. Nurses in British Columbia are already coming to work early, leaving late and often missing their own rest periods in an attempt to provide care for patients in hallways, lounges and other areas not equipped for safe care. Royal Inland Hospital continues to experience record high levels of overcapacity – one day recently it reached 138 percent. Victoria General Hospital recently had the highest number of extra patients in its history and on Boxing Day Kelowna General Hospital’s ER had its busiest day ever, treating over 320 patients.

In addition to mandatory overtime, the past holiday season also saw BCNU members subjected to excessive amounts of regular overtime, including routine 16-hour shifts, with some extending to 20 or even 24 hours in order to staff worksites.

There are over 30 vacancies in the Abbotsford Regional Hospital ER, over 20 positions sit empty at Children’s and Women’s NICU and PICU units, and Dawson Creek Hospital

UPDATE MAGAZINE March 2017

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is missing half of its operating room staff.

These are just a few examples of current staffing conditions that have led to nurses being ordered to work overtime.

Meanwhile, in the lead up to a provincial election, this government has announced spending of $417-million for a new patient care tower with 11 new operating rooms in Kamloops and over $100-million on new operating room theatres at Vancouver General Hospital. At the same time, BC is experiencing the most acute shortage of operating room nurses in over 20 years.

Does this make any sense?

There’s no question that nurses working in hospitals and the community are experiencing unmanageable caseloads with inadequate staffing levels to meet the needs of the patients. The disturbing levels of staffing across this province and the continued number of unfilled vacancies mean that we can no longer ignore what needs to happen.

Nurses’ collective voice must be heard when it comes to determining safe staffing levels. There are currently no Canadian standards defining minimum staffing levels, and patient loads are determined on an ad hoc basis. They differ from unit to unit, and hospital to hospital and are often motivated by budgetary constraints rather than concern for safe patient care.

Why? Would anyone board a plane without safe, mandated staffing levels?

Nursing work is measurable and quantifiable. There are many available workload assessment tools but these remain mostly unused at the unit level. Instead, nurses are handed patient loads determined by management without a system for protecting the work of the nurse and the care of the patient.

There has never been a time when evidence-based nurse-to-patient ratios were needed more. Instead of accepting mandatory overtime, nurses at every level of our system must advocate for mandatory minimum staffing ratios in order to protect our patients and ourselves. It’s time.

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CHECK IN

NEWS FROM AROUND THE PROVINCE

HUMAN RIGHTS AND EQUITY

A NEW YEAR AND A NEW NAME

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CNU’S HUMAN RIGHTS AND EQUITY Committee heads into 2017 with union vice president Christine Sorensen as its new chairperson. Sorensen takes over from Mabel Tung who retired last September, and who for many years steered the committee with tireless conviction. Sorensen is also committed to the work of the committee and to ensuring that BCNU is a leading voice for social justice and equity.

In the year ahead, the committee will continue to promote its campaigns focused on recognizing water as a basic human right and push for the enactment of the recommendations of Canada’s Truth and Reconciliation Commission. It will also continue to support the important work of all BCNU human rights and social justice caucuses.

The New Year also brings a new name for the caucus formerly known as Lesbian Gay Bisexual (and) Transgender (LGBT) caucus. It will now be known as the LGBTQ caucus. The addition of ‘Q’ (standing for Queer and widely used among LGBT communities because of its inclusiveness) had been discussed for some time but was finally adopted at the LGBTQ caucus meeting last fall.

All six of BCNU’s human rights caucuses will continue to seek common ground with each other and the membership-at-large to discover how we might work together to strengthen our union. To that end, this year’s Human Rights and Equity Conference will focus on the role of social justice allies and how we can support each other respectfully and collectively as we strive to create more just and equitable workplaces and communities. update

PRIDE INCLUSIVITY BCNU’s Lesbian Gay Bisexual (and) Transgender (LGBT) caucus is now known as the LGBTQ caucus, the ‘Q’ standing for Queer.

COLDEST NIGHT OF THE YEAR BCNU members joined over 100 communities across Canada on February 24 to walk and raise funds for the hungry, homeless and hurting. Members gather a the Caring Place in Maple Ridge. From left: BCNU President Gayle Duteil, Simon Fraser region steward liaison Jereme Bennett, Simon Fraser Region co-chair Wendy Gibbs, Simon Fraser region mental health advocate Suellen Larsen and Simon Fraser region PRF advocate Cam Ward, with friend Maggie.

UNION WELCOMES NEW PROVINCIAL TREASURER

BCNU Council has appointed Sharon Sponton as the union’s provincial treasurer.

Sponton assumed her new role on the union’s provincial executive committee last September, when she took over from previous treasurer Mabel Tung.

Sponton previously served as chair of BCNU’s North West region and was

elected to BCNU Council in 2010. Prior to this she served two terms as North West region treasurer.

Sponton began her nursing career in 1995 and first served as a steward in 2004. She graduated from UBC in 2013 with a Master’s degree in Business Administration in Health Care and is currently completing a Certificate in Financial Management from Dalhousie University.

UPDATE MAGAZINE March 2017

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OUR CHOICE, OUR VOICE

NOTICE OF BCNU ELECTION 2017

ARBITRATION WIN

Nominations open April 10 An election for BCNU leadership positions is required in 2017. Members who wish to run for positions must submit their nomination form between April 10 and 21 – watch for information sent in eNews and on the BCNU website.

Details, including candidate responsibilities and position descriptions will be available on the website April 10.

MAKING NEWS

MEMBERS in the headlines

When Shona Lobo read about the government’s recent announcement of funding for new operating rooms at VGH, the 30-year nurse was compelled to respond. Her letter was published in The Province Feb. 14.

WE NEED NURSES

I read with interest the article Shona Lobo about the expansion of operating rooms at Vancouver General Hospital.

It’s an excellent idea for those awaiting surgery.

As a nurse, I have concerns

about how this is going to be staffed. In case the government isn’t aware, there is a current shortage of nurses in all areas of the hospital. Perhaps investing in more nursing schools would be a better start. There are people interested in becoming nurses who have to wait a year or two to get into the program.

Is this another election gimmick by the BC Liberal Party?

Shona Lobo, Surrey

RIGHT TO UNION LEAVE AFFIRMED

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embers’ ability to participate in BCNU business is fundamental to the health of their union and their obligation to provide safe patient care. However, it hasn’t always been easy for members to access the union leave they need. Employers have often refused to respond to leave requests or have denied them unreasonably. But a recent union win at the BC Labour Relations Board should change that.

A labour board arbitration decision in November related to Article 44.01 (F) of the Nurses’ Bargaining Association collective agreement now requires employers to make “all reasonable efforts” to grant a BCNU member leave for union business when it is requested.

“This arbitration decision clarifies and confirms collective agreement language relating to a member’s ability to access union leave,” says BCNU President Gayle Duteil. “Union participation requires union leave. It’s pretty simple.”

The decision means that employers must make all reasonable efforts to grant members union leave. This includes finding and paying the replacement staff – either full-time, part-time or casual – to enable the leave, or redeploying staff from other units.

BCNU members requesting union leave are required to provide managers with the collective agreement article under which they are seeking leave, but they are not required to divulge the nature of the union business they are engaged in.

Duteil says the decision will go a long way to ensuring safe patient care while protecting nurses’ contract rights. “Even when allowable leave quotas are met, the employer must still make all reasonable efforts to grant union leave.” she explains. “And union leave can only be cancelled in extraordinary circumstances.”

Members who want to learn more about union leave should talk to their steward. update

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SAFE STAFFING

NEW TOOLS FOR SAFE PATIENT CARE

process is now in place.

The new staffing grievance process provides a structure that allows for the timely assessment of grievances related to the Protocol MOUs. A grievance is first presented at a local-level meeting between nurses and managers. If unresolved, the grievance may advance to the health authority-level Nurse Relations Committee (NRC), which is made up of four BCNU and four employer representatives. The NRC – which is expected to meet bi-weekly – has a duty to review and make collaborative suggestions with the aim of resolving issues quickly at the local level.

If a grievance cannot be resolved at the worksite level, the NRC may forward it to the Nurse Staffing Secretariat (NSS) for consideration. The NSS works in tandem with the Ministry of Health, the health authorities and BCNU members. It establishes data and reporting requirements in order to monitor and report on employers’ compliance with the Protocol MOUs and provides the Nurse Staffing Secretariat Steering Committee (NSC) with recom-

Effective dispute resolution process now underway

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HE SAFE STAFFING provisions that were negotiated as part of the Nurses’ Bargaining Association collective agreement have the power to make a huge difference in nurses’ working lives and the lives of their patients.

The provisions – collectively known as the “Protocol MOUs” or memorandums of understanding – address nurses’ workload and staffing concerns such as the need to meet growing patient demand, maintain baseline staffing, and provide backfill for long- and short-term absences.

BCNU members have worked tirelessly over the past five years to make sure their employers live up to their end of the bargain. From the provincial staffing grievance settlement reached in 2015 to the arbitrated

staffing settlement won in 2016, employers have received a strong message: nurses are unwavering in our fight for compliance.

The union’s ongoing commitment to safe patient care and an effective dispute resolution process can also be seen in the new committees and secretariats that were negotiated during the most recent round of contract talks (see below). These new tools will support the implementation of a comprehensive long-term strategy designed to ensure that the terms of the protocol MOUs are followed.

BCNU members have been working with representatives of the Ministry of Health and health authorities since the 2014-19 contract was ratified in order to implement a new grievance handling process to address nurses’ staffing concerns. This

NEW STAFFING GRIEVANCE RESOLUTION PROCESS STEP 1 MEETING Nurse and manager discuss a plan to prevent incident from happening again.

NSS (Nurse Staffing Secretariat) Establishes data and reporting requirements for compliance with the Protocol MOUs; it reports to the NSC.

STEP 2 MEETING Nurse and LRO/steward meet with manager and HR representative to review grievance and find a resolution.

PROVINCIAL LEVEL LOCAL LEVEL

RESOLUTION STAGE

EFFECTIVE DISPUTE RESOLUTION The new process related to staffing grievances is now in place to help foster full compliance with the staffing language negotiated in the NBA collective agreement.

It is expected that this process will address systemic problems that have resulted in legitimate staffing crises and employers will be in full compliance of their staffing obligations by 2018-2019.

SOA

NSC

NRC (Nurse Relations Committee) Includes representatives from the union and employer; it works collaboratively to address nurse staffing issues; at a local level.

NSS NRC

STEP 2 MTG

Not Resolved

GRIEVANCE FILED

Resolved

STEP 1 MTG

R 72 Hours

7 Days to respond

E

S

Gr. Filed + Step2 mtg

14 Days

O

L

U

30 Days to respond

TIME TO RESOLVE GRIEVANCE

T NRC

I

O

N NSS

SOA

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LABOUR RELATIONS

mendations on how to resolve the grievance.

Grievances that cannot be resolved by the NSS will be referred to the NSC for review.

The NSC’s main role (with support from the NSS) is to manage the efforts health authorities are making toward complying with the protocol MOUs, and report to the health ministry on progress being made.

Issues that remain unresolved at the NSS level can be directly referred to one final body for review: the Staffing Oversight and Arbitration Panel (SOA), which is made up three individuals representing the union, the employer and a neutral chair.

The SOA has exclusive authority to oversee all staffing-related disputes and make binding decisions that direct an employer to fix any non-compliance issues within a set time period. update

NSC (Nurse Staffing Secretariat Steering Committee) Sets targets and ensures strategies are in place to help employers fully implement staffing provisions; co-chaired by senior reps from the union and Ministry of Health; oversees and directs the NSS. SOA (Staffing Oversight and Arbitration Panel) Provides formal oversight and adjudication of all disputes arising from the implementation of the protocol MOUs; determines whether the employer is compliant with the provisions, or not; includes one neutral chair, one rep from BCNU, and one from the employer.

OFFICE OF ARBITRATION UP AND RUNNING New grievance process will speed up dispute resolution

EXPECTING CHANGE BCNU Thompson North Okanagan chair Tracy Quewezance and OkanaganSimilkameen chair Rhonda Croft were on hand Feb. 8 for the first meeting of the new BC Healthcare Office of Arbitration.

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CNU PRESIDENT GAYLE Duteil says she’s proud of the groundbreaking approach the union is taking to arbitrating grievances. “We negotiated new dispute resolution language in the 2014-2019 Nurses’ Bargaining Association collective agreement in order to serve our members better – and so far, it looks like it’s working.”

Duteil is referring to the new BC Healthcare Office of Arbitration (BCHOA) that is designed to shorten the length of time required to resolve disputes while providing more consistent interpretation of the NBA contact language.

The new grievance process got a first tryout at meetings in Kamloops on Feb. 8 and 9. The twoday event was the first sitting of the BCHOA. The office will now arbitrate all unresolved grievances between the Nurses’ Bargaining Association and the Health Employers Association of BC (HEABC).

Previously, issues were resolved through the old three-step grievance process, a practice that was both lengthy and costly.

“Our members were frustrated by the amount of time it took to bring an issue to resolution,”

said BCNU Okanagan-Similkameen region chair Rhonda Croft, who was on hand for the inaugural meeting. “Before, there was no incentive for management to settle early, but I’m hopeful that’s all going to change.”

Now, a revamped two-step grievance process that reduces the time available to delay making decisions will see all unresolved disputes sent to the BCHOA for handling. Arbitration will then occur in one of three streams, but expedited arbitration is intended to be the primary vehicle for dispute resolution.

The first BCHOA meeting was co-chaired by veteran arbitrators Vince Ready and Corrin Bell, who are assisting with the ongoing work of getting the office up and running and addressing unresolved disputes that were initiated under the previous process.

Ready and Bell heard seven unresolved grievances from the Interior Health Authority. These were argued between BCNU staff and HEABC lawyers who made written and oral presentations.

The arbitrators now have up to 21 days to render their binding decisions.

The new dispute resolution process is expected to decrease the time and cost of taking an issue to arbitration. It is also designed to encourage the resolution of grievances by agreement rather than in arbitrations. Cases moving through the expedited arbitration stream are also to be presented by labour relations staff instead of lawyers.

“It’s a very promising start,” said BCNU Thompson North Okanagan region chair Tracy Quewezance. “This will change the way the whole process of grievance and arbitration operates, which on management’s part seems to be more about delaying resolution.”

“I’m already impressed with the new process,” said Croft. “In less than half the time it would typically take outside lawyers to argue their way through a single grievance, seven distinct issues were presented.”

BCNU and HEABC will share BCHOA operating and administrative costs. update

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SENIORS’ CARE

SECHELT REJECTS FOR-PROFIT CARE HOME beds in the health authority” were not publicly owned and operated.

However it later acknowledged that for-profit beds comprise only about 25 percent of the total.

After learning of the contract, community groups and unions – including BCNU – that represent care home staff held a well-attended public meeting last July and have launched a petition against privatization of residential care that now has over 10,000 signatures.

Locals are especially concerned SLATED FOR CLOSURE Sechelt residents are fighting that the current caregivers who are to save the community’s publicly-owned care homes. known and respected by residents and their families will be fired when ANCOUVER COASTAL the new facility opens in 2018. Staff have Health’s unilateral decision been told they are welcome to apply for the to replace two 30-year-old new jobs. However, if hired, they would publicly owned care homes in earn less, have fewer benefits, and lose their Sechelt with a single privatized seniority with the health authority. facility has angered residents and staff, while BCNU Coastal Mountain region chair deeply offending the local community.

Kath-Ann Terrett has been one of the sparkNow, an alliance of community members plugs behind the opposition and has helped and health care unions are opposing the drive the community-based petition calling health authority’s plan to privatize seniors’ on Vancouver Coastal to revisit its flawed care, despite its decision being presented as decision process. a “done deal.”

“People want a say in how their care is Last June Vancouver Coastal disclosed a delivered,” she says. “They’re incensed that contract it had signed with Trellis Seniors caregiver relationships are to be tossed out Services Ltd. that would see 108 existing and residents will have to acclimatize to beds at the Totem Lodge and Shorncliffe new staffing, new surroundings, and less homes replaced with a new 128-bed fordirect care.” profit facility owned and operated by Trellis.

The petition, which calls on the governThe decision was made without warning ment to revisit the health authority’s decior opportunity for public input. The health sion, cites the failure to consult, the loss of authority did not even bother to inform continuity of care to vulnerable seniors, and local MLA Nicholas Simons, or Sechelt the loss of wages and benefits to care givers.

Mayor Bruce Milne, prior to announcing the The petition also cites the fact that formove to for-profit care. profit care homes are not funded adequately When questioned, Vancouver Coastal to deliver the minimum 3.36 direct care implied that the choice was simply routine hours per day as mandated by the province. by suggesting that the “vast majority of The move to for-profit care affects about

PHOTO: HTTP://ARCHIVES.SECHELT.CA/IMAGES/STMARYS/SM.39.JPG

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150 care providers, including some 20 BCNU nurses who are standing shoulderto-shoulder with the local community in defense of public residential care.

Vancouver Coastal and Trellis both declined to attend the community’s public meeting, further inflaming passions along the Sunshine Coast. Then, feeling the heat, Vancouver Coastal held a public information meeting last September attended by some 300 people opposing the decision.

“Residents will have to acclimatize to new staffing, new surroundings, and less direct care.”

BCNU COASTAL MOUNTAIN REGION CHAIR KATH-ANN TERRETT

Last November, a group of 50 Sunshine Coast doctors wrote Health Minister Terry Lake to complain that the proposed Silverstone Centre was totally inadequate to meet residential care needs in the area. In addition to expressing concern that turning care over to a for-profit operation would hurt the quality and continuity of patient care, the doctors stated that about 40 percent of existing acute care beds are now filled by patients awaiting placement.

Some 250 residents packed another meeting at the Sechelt Band Hall on Jan. 28.

Organized by the “Protect Public Health Care” coalition, the event hosted academic researchers who described studies conducted in the US and Ontario that show that privately operated for-profit care facilities provide less patient care than public facilities.

Members of the Coalition of Citizens of Sechelt attended the BC legislature on March 1, where Simons presented the petition, and where they were joined by members of BCNU’s provincial council. update

UPDATE MAGAZINE March 2017

BC SENIORS’ ADVOCATE: 9 OUT OF 10 SENIORS’ FACILITIES DON'T MEET STAFFING GUIDELINES NEW DATA PRESENTED RECENTLY BY Seniors’ Advocate Isobel Mackenzie shows that the number of seniorcare facilities in BC that don’t meet Ministry of Health staffing guidelines has increased by 10 percent over the last year, despite a governmentordered review.

The Residential Care Facilities Quick Facts Directory compiles information for all publicly funded seniors’ facilities in BC. The newly updated 2015-16 directory reports that a shocking 91 percent of care homes — 254 out of 280 facilities — failed to meet the government-mandated staffing guideline of 3.36 hours of care per senior every day.

The data also indicates that publicly operated facilities provide 40 percent more physical therapy hours and nearly double the occupational therapy hours of privately operated homes. Privately operated facilities also have 26 percent more reportable incidents than health authority facilities.

It’s a dismal picture, but one that provides more evidence to help further British Columbian’s call for greater investment in public home and community care facilities and away from for-profit facilities. update

Read the Seniors’ Advocate report here

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FIRST CONTRACT FOR SALVATION ARMY ROTARY HOSPICE HOUSE

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TAFF WHO WORK AT THE Salvation Army Rotary Hospice House in Richmond have ratified a first collective agreement, concluding an organizing effort that began over three years ago.

The 40 unionized members at the facility were certified in February 2013, but it was not until last December that they voted on the tentative agreement reached between their bargaining committee and Salvation Army management.

Michelle Schnittker has worked at the hospice since it opened in 2005. “Happy and exhilarated,” is how she described her emotions on voting day. “It’s been a long road in the making with a lot of obstacles along the way.”

She says there were a range of issues that led to staff voting to join the BC Nurses’ Union, such as training, seniority, the use of agency nurses, and a feeling that managers were

VOTING DAY Salvation Army Rotary Hospice House nurses (from left) Diana Krajic, Joy Chua, Michelle Schnittker, Elben Palawar and Rafael Sayoto voted to accept their first contract last Dec. 20.

unwilling to listen to staff or implement their recommendations.

The new collective agreement now contains language regarding casual staff availability and compensation, including language that protects a casual when the employer cancels an accepted shift. There is also recognition of industry-based date-of-hire seniority, work scheduling that assures consecutive days off, and responsibility pay for in-charge LPNs. The contract runs from April 1, 2015 to March 31, 2018, and contains initial retroactive wage increases ranging from 2 to 20.5 percent.

The agreement also has comprehensive language to prevent harassment, ensure non-discrimination and promote a respectful workplace.

Schnittker says she’s happy with the outcome. “Contract negotiations can be quite exhausting, but in the end it should be worth it for everybody on the team.” update

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LEGAL ATTACK ON PUBLIC HEALTH CARE BEGINS Plaintiffs ignore the hard reality of BC’s nursing shortage

A

fter more than seven years of procedural delays, the longawaited trial between BC forprofit surgical clinics and the provincial government began in BC Supreme Court last Sept. 6.

The figure at the centre of the case is Vancouver physician Dr. Brian Day, one of the founders of Cambie Surgeries Corporation (CSC). Day is contesting health care laws that prevent doctors who work in the public health care system from charging patients extra fees for medically necessary services already covered by the Medical Services Plan – BC’s public health insurance.

CSC decided to take the provincial government to court in 2009 after the Medical Services Commission announced that it wanted to audit CSC. The eventual 2012 audit found that Cambie had illegally billed patients almost half a million dollars in a three-month period. Dr. Day, who used the courts to delay the audit for over five years, fully admitted to the wrongdoing. But instead of paying penance and reimbursing the patients, CSC went on the offensive, claiming that health care laws designed to ensure equitable access to care violate the Canadian Charter of Rights and Freedoms.

In the meantime, Day has added as plaintiffs a number of Cambie patients, some of whom received reductions in their bills

$

if they would testify to receiving surgeries faster than had they waited in the public system.

Day’s legal strategy has been to adopt the persona of people’s champion and patient advocate whose only desire is to rescue British Columbians suffering on surgical wait lists. It’s a noble enough motive, if not for the inconvenient fact that his proposed solution – a parallel for-profit health care system and legalized private health insurance for hospital and physician services – will do nothing to address the immediate suffering of those who cannot afford to pay extra fees.

“Dr. Day and his supporters claim to act on behalf of patients, but we believe the real motive is profit,” says BCNU President Gayle Duteil. “The evidence from Canada and other jurisdictions show overwhelmingly that universal public health care – medicare – is the safest, most equitable and most costeffective way to provide care for all.”

Several groups have joined the defendant BC Government as intervenors in this case. They include the Attorney General of Canada, a group of patients sponsored by the BCNU, the BC Health Coalition and Canadian Doctors for Medicare. Some of the BCNU-supported patient intervenors were unlawfully billed at private clinics and will present evidence attesting to the high cost and negative impacts of for-profit care.

“BCNU is playing a critical role in supporting the legal counsel for these patient intervenors to ensure that the views of the patients in the public health care system are heard,” says Duteil. “It is extremely rare for a trial court to allow intervenors to present evidence, so these patients’ evidence is essential to help demonstrate the impact on care and the conflicts that arise when

doctors who control public wait lists also provide surgeries in private clinics.”

In opening statements, the lawyer representing the BCNU-supported group warned that the case could determine the fate of Canada’s public health care system, and argued that the plaintiffs’ true goal is access to more patients who are insured under a US-style private health insurance model – allowing doctors to earn more money than those who only work in the public system.

“BC is experiencing one of the worst OR nurse shortages in its history and it cannot afford to lose even one nurse to a private surgical centre.”

BCNU PRESIDENT GAYLE DUTEIL

The trial before Justice John Steeves is now entering its sixth month, and will see the plaintiffs present some 100 witnesses, including patients, doctors, academics and others. The importance of this case to public health care is matched only by its complexity. It will likely take a year to complete, with delays due to both plaintiff and defendant objections over evidence and procedure, witness unavailability, and the judge’s direction that the court will sit for only three weeks per month.

In cross-examination, government defence lawyer Jonathan Penner has focused on the actions of doctors them-

UPDATE MAGAZINE March 2017

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IN MEMORIAM

selves, and their ability to control waitlists, in order to question the plaintiffs’ argument that wait times are primarily the fault of health care system management or financing models.

So far, the plaintiffs have relied heavily on non-medical experts such as health economists who have provided only generalized views. However those plaintiff witnesses who do have direct and current experience with BC’s health care system – such as Dr. Bassam Masri, head of orthopedics for Vancouver General and UBC hospitals – were forced to admit another inconvenient fact: BC does not have enough nurses to staff the operating rooms it has now. Dr. Masri told the court of the ongoing nurse recruitment and retention challenges at VGH, how its OR is 34 nurses short of a full cohort of 120, how it only runs 16 ORs when it could be running 20, and how 35 OR days were lost in the months of Nov. and Dec. 2015 alone.

The doctor’s testimony was an attempt by the plaintiffs to portray the public system as broken. Dr. Day says the solution to long wait lists is to allow doctors who manage public wait lists to give preferential access in private clinics to patients who can afford to pay extra to queue-jump.

But BC’s specialty-educated nurse shortage is anything but an argument in favour of for-profit health care. Duteil says it puts the lie to Dr. Day’s claim that an expanded role for private health care will take pressure off the public system. “BC is experiencing one of the worst OR nurse shortages in its history and it cannot afford to lose even one nurse to a private surgical centre,” she stresses.

The defence has argued that managing health care is complex and that it allocates resources for a publicly managed and fiscally sustainable system where access to necessary medical care is based on need – and not ability to pay – in accordance with the Canada Health Act. At its current pace, the court is not expected to hear evidence from the intervenors until the summer, and closing arguments won’t likely be heard until fall at the earliest. Meanwhile, the province has chosen to halt audits while the case is before the courts, and as the litigation drags on, it’s “business as usual” at for-profit surgical clinics in the province, as CSC and others continue to flout public health care laws and take advantage of vulnerable patients.

Regardless of the outcome of this case, it will likely be appealed at the BC Court of Appeal and may ultimately end up at the Supreme Court of Canada. update

NOREEN CAMPBELL Former BCNU leader and longtime activist Noreen Campbell passed away at her home in North Sannich on Jan. 12.

Campbell became an OH&S steward in 1985 and served as BCNU treasurer from 1990 to 1992. She later held a regional leadership role on Vancouver Island.

Campbell ran one of the union’s first workload campaigns which she called Up to Your Knees in Alligators.

She was also part of a team that spearheaded the award-winning Nursing Physical Assessment that helped open the door for nurses to pursue distant education while continuing to support their families.

In retirement, Campbell remained dedicated to the nursing profession and developed a professional wound management course for blended distant learning for the University of Victoria.

Toward the end of her life she was active in the advocacy group Dying With Dignity and fought to remove prohibitions on assisted dying.

Last year she was nominated for the Canadian Nursing Association Jeanne Mance award that recognizes nurses who have made significant and innovative contributions to the health of Canadians.

FRANK GILLESPIE Former BCNU Council and staff member Frank Gillespie passed away in Moncton on Oct. 13, 2016.

Gillespie worked at St. Paul’s Hospital and was a longtime union activist. He served as chair of the BCNU Van Metro region for many years and was a member of several provincial bargaining committees.

Gillespie served on the CRNBC Board as a regional representative, was a member of the Board of Pacific Blue Cross and was active in the BC History of Nursing Society.

A dedicated LGBTQ activist, Gillespie took a staff position in the BCNU education department and helped develop the union’s human rights and equity agenda.

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Violence NOT part job is

the

of

PROVINCE-WIDE CAMPAIGN WILL PUSH HEALTH AUTHORITIES TO DO MORE TO ENSURE NURSES’ SAFETY WHEN DELIVERING CARE

UPDATE MAGAZINE March 2017

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The individual who recently wandered into the emergency room at Boundary District Hospital in Grand Forks and pulled out a gun is a chilling reminder of just how dangerous health care workplaces can be.

“At many of these small hospitals, there isn’t a security guard or any line of defence between the front door and the triage area,” says BC Nurses’ Union President Gayle Duteil.

“Sometimes locking the doors after hours is the only option.”

Duteil is on a mission to shine a light on how poorly violence is prevented in health care today. She’s also determined to change the reality that so many BCNU members face on a daily basis. “Violence is not part of our job,” she says, “yet an attitude that violence is somehow part of nursing has crept into the system – and that just gives management an excuse for doing nothing to prevent it.”

Duteil points to the latest WorkSafeBC statistics showing that acts of workplace violence as a percentage of all time-loss claims have been steadily rising over the past decade. And the health and social services subsector, which includes nurses, now accounts for over 60 percent of all time-loss claims for violence.

The overall injury rate due to workplace violence has increased by over 50 percent in the last six years. And when comparing injury rates between subsectors, health and social services is actually three times higher than public administration, which includes law enforcement.

Nurses in BC today, whether they are working in a long-term care home or an acute care

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VIOLENCE IS NOT PART OF THE JOB

hospital, face a rising risk of violence, but to date health authorities have not done enough to ensure that nurses and their patients are kept safe while care is being delivered.

TIME FOR ACTION

The recent incident in Grand Forks illustrates the current vulnerability of many hospitals in BC that are wide open to the public yet lack any form of security.

“This incident sends a clear warning that we simply have to get more serious about securing our places of care,” said Duteil at a Jan. 13 news conference following the event.

“This person entered the hospital through the ambulance bay, which is in the back of the hospital,” explained Duteil. “Staff were caught off-guard, and there’s nothing protecting our members and other frontline staff from this sort of violence.” Duteil stressed that properly trained 24-7 security staff are needed at many hospitals, but noted that few have them. She also said that many security guards, where they do exist, are trained to be “hands off ” in the event of trouble. She says it’s up to nurses to start advocacy for change.

power to minimize the risk of violence.

This means it’s not mission impossible, but more a matter of getting managers to do the things they’re obliged to do by using every possible tool to make that happen.

And she points to the progress that’s slowly being made. For example, during last years’ Nurses’ Bargaining Association (NBA) contract talks, the Ministry of Health committed to develop a coherent “We need nurses to and focused provincial violence prevention framework that sees employers committing be our eyes and ears to build “a culture of safety” in every health in the workplace, so care workplace.

“I’m proud of that language because it we can improve the commits health authorities to replace the reporting of incidents current culture with one that prioritizes and near-misses.” safety,” says Duteil. “It signals that the ministry recognizes the need for dramatic BCNU PRESIDENT GAYLE DUTEIL improvement, but our job remains making sure words translate into actions.”

“My goal is to engage nurses fully on these Duteil says she’s also energized by the issues, so we can light a fire under the health employer’s commitment to improve the authorities and local managers – we need to way joint occupational health and safety snap them out of indifference and get them ( JOHS) committees function, and notes actively addressing the issues, site by site.” that the new NBA contract calls for the Duteil knows this is a huge undertakmandatory release of members from regular ing, but quickly reminds any doubters duties to attend JOHS committee meetings that health care employers are required and participate in incident investigations at by provincial law to do everything in their their worksites. Members will also be paid at

VOICING CONCERNS BCNU President Gayle Duteil and Adriane Gear, BCNU Executive Councillor for Health and Safety, address the media at a Jan. 13 news conference following a violent incident at Boundary District Hospital in Grand Forks.

the appropriate rate of pay if an investigation is scheduled outside their regular hours.

PUBLIC OUTREACH

Raising public awareness of the rising risk of violence in the health care sector and the need for employers to prevent it is also an effective way of making sure the ministry and health authorities keep their word.

“Right now the public hears about dramatic incidents like the one in Grand Forks, but they also need to know there are many unreported acts of violence,” says Duteil. “And we need a systemic approach to address it.”

Duteil says nurses should stay tuned for an advertising campaign to roll out before this year’s provincial election that will help put violence prevention on the political agenda.

This year will also see BCNU redouble its efforts to mobilize nurses across BC to lead the fight for safe, violence-free workplaces, not just at hospitals and clinics, but also in residential care where nurses are at a greater risk of violence than anywhere else.

Duteil will be visiting worksites and reminding members that addressing violence is a key factor in reducing workplace injuries. The solution comes down to doing

UPDATE MAGAZINE March 2017

“My goal is to engage nurses fully on these issues, so we can light a fire under the health authorities and local managers.”

BCNU PRESIDENT GAYLE DUTEIL

organizational risk assessments at every workplace and ensuring that behavioral care planning is in place for patients with known factors. The solution also requires implementing control measures such as new work processes, training, alert systems, security equipment and proper onsite security guards.

“We need nurses to be our eyes and ears in the workplace, so we can improve the reporting of incidents and near-misses. And we need to use the processes available to us to create pressure for change on the ground,” she says.

Round-the-clock security rates highly on Duteil’s list of priorities because current security arrangements are often too rudimentary to properly deal with incidents.

“Nurses are licensed caregivers who are there to supply care, not to subdue patients,” she says. “In my view, nurses should not be involved in taking down patients when a Code White is called. That approach is indifferent to nurse safety, one that puts them directly in harm’s way.”

NEW LEGISLATION NEEDED

BCNU’s push for systemic change also includes making a public call for tougher sentencing for those who attack and seriously injure nurses.

“I was appalled when a man who seriously injured one of our nurses at Abbotsford Regional Hospital last year received a conditional discharge

in court,” says Duteil. “It’s simply not acceptable that a vicious attack on a nurse has no significant consequences.”

Duteil reports that BCNU will also be pushing for amendments to the Criminal Code of Canada that will direct judges to consider assault on a nurse as an “aggravating circumstance” in the same way in now does for transit operators.

But BC also needs profound changes in the organization and delivery of health care to effectively reduce the risk of violent injury.

Today there isn’t even a provincial alerting system that would warn nurses if the same patient who attacked in Abbotsford appeared in a similar state at another hospital.

“You have no way of knowing their history upon arrival. That means nurses are just sitting ducks,” says Duteil. “And that’s utterly unacceptable”.

Safe staffing is also an issue that has to be taken far more seriously, because it affects the risk to nurses and their patients. Understaffing, working short, and inappropriate staff mixes have all been shown to increase the risk of injury to nurses from violence. For example, in residential care there simply aren’t enough nurses, meaning too often they work alone with residents whose mental health may predispose them to strike out. continued on page 19

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EMPLOYER OBLIGATIONS TO PREVENT VIOLENCE IN THE WORKPLACE THE WORKERS COMPENSATION ACT AND the OHS Regulation obligate employers in BC to provide a safe workplace, which includes protecting employees from acts of workplace violence.

If there is a risk of violence, employers must inform workers who may be exposed to it of the nature and extent of the risk. This includes providing information related to the risk of violence from persons with a history of violent behaviour and whom workers are likely to encounter in the course of their work.

Further, employers must train workers in: • recognizing the potential for violence • p olicies, procedures and work environment arrangements developed to minimize or effectively control the risk to workers from violence • a ppropriate response to incidents of violence, including how to obtain assistance • p rocedures for reporting, investigating, and documenting incidents of violence

Recognize the potential

Procedures for reporting, investigating, and documenting

Training

Procedures for policies, and work environment arrangements

Appropriate response

If a workplace assessment shows there is a risk of violence, the employer must develop and implement a workplace violence prevention program. It’s important to remember that this includes planning for domestic violence which can spill over into the workplace. For example, if a worker has a violent or abusive partner, that partner may cause disruptions in the workplace and threaten the safety of that worker and other employees. update SOURCE: WORKSAFEBC

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VIOLENCE IS NOT PART OF THE JOB

Violence in BC workplaces

HEALTH CARE WORKERS SUFFER THE HIGHEST INJURY RATES VIOLENCE IN THE WORKPLACE IS widespread, but more pervasive in some industries — notably health care and social services.

When recording claims, WorkSafeBC defines violence in the workplace as incidents where an act of violence initiated a chain of events that led to an injury or illness. This includes acts of force, incidents where a person was injured or made ill by a harmful act but there was no apparent intent to injure.

During the past decade, nurses (an occupational category that includes aides and health care assistants) had more than 40 percent of all injuries as a result of violence in the workplace; security and law enforcement workers followed (14 percent), then social and community service workers (12 percent), and school teachers (7.5 percent).

Some common examples of workplace violence include a nurse hit by a patient or resident in a health care facility, a teacher struck by a student, and a store clerk assaulted during a robbery.

WorkSafeBC statistics show that claims related to acts of violence in all BC workplaces have been steadily increasing over the last six years, despite the general downward trend of all claims in recent years. The impact of workplace violence can be far-reaching, impacting not just the worker but family, co-workers, the employer, and community.

In 2015, there were 1,954 claims from people for time lost from work related to acts of violence in the workplace.

This represents an increase of more than 17 percent over 2014.

WorkSafeBC records claims of workplace violence by industry. Four industry subsectors — health care and social services, education, other services, and retail — accounted for 81 percent of all time-loss claims from acts of workplace violence from 2006 to 2015.

One of those subsectors, health care and social services, accounted for 63 percent of claims made in 2015. update

63%

Health care and social services account for 63 percent of workplace violence claims in 2015.

SERIOUS INJURIES FROM ACTS OF WORKPLACE VIOLENCE, TOP EIGHT SUBSECTORS, 2006–2015

WORKPLACE VIOLENCE INJURY RATE FOR TOP EIGHT SUBSECTORS, 2006–2015

ACTS OF WORKPLACE VIOLENCE CLAIM CHARACTERISTICS FOR HEALTH CARE AND SOCIAL SERVICES Top five workplace violence incident types, 2006–2015 All other incident types | 12% Overexertion | 7%

Assaults, violent acts by person(s) | 32%

Squeezing, pinching, scratching, twisting | 11%

Bodily reactions and exertion | 12% Hitting, kicking, beating | 26%

The top three incident types — assaults, hitting, and bodily reactions/exertions — account for 70 percent of all acts of workplace violence within the health care and social services subsector.

The health care and social services subsector had significantly higher injury rates for acts of workplace violence from 2006 - 2014. This trend continued in 2015, when the subsector’s injury rate was 0.51 while the overall rate for all acts of workplace violence in BC was 0.09.

SOURCE: WORKSAFEBC

UPDATE MAGAZINE March 2017

NOT PART OF THE JOB continued from page 17

BUILDING ON PAST WINS

Building a health care culture of safety will have many challenges, but Duteil remains optimistic about the potential for change. “The partnership we started with the Ministry of Health to retrofit four highrisk sites in 2015 is alive and growing.”

While Duteil recognizes there have been challenges implementing safety upgrades at the four pilot sites – including pushback from employers in the psychiatric sector who seem to believe that violence just goes with the job – she’s excited about the agreement in principle reached in the last round of bargaining to make upgrades worth $4-million at another six high-risk sites.

“We’re learning as we go, overcoming obstacles, changing attitudes, and slowly making work safer for nurses,” she says. “I’m confident we’ll see the tempo of change accelerate in 2017, once the public is more aware and nurses are even more engaged.”

Duteil also assures members that BCNU will continue to improve contract language on workplace violence when nurses begin bargaining a new contract next year.

“We achieved a lot of new language to better address violence at work in the current contract,” she says. “Well, we’ll see how far the new language takes us between now and the next round, then go in looking to continue our progress towards a violence-free health care workplace.” update

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BCNU A LEADER IN VIOLENCE PREVENTION

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his year’s violence prevention campaign will be reaching nurses and members of the public across BC. It’s an important new initiative, but certainly not the first. Over the last number of years, BCNU has been a leader when it comes to addressing the issue of violence in the health care sector.

Previous BCNU campaigns have made sure that employers, government, and the general public know that the issue of workplace violence needs to be taken seriously. The union’s advocacy efforts have also resulted in an impressive number of improvements at worksites around BC, and today there are more resources available for members who’ve been affected by violence.

Prior to the last round of Nurses’ Bargaining Association (NBA) contract talks, BCNU collaborated with the Ministry of Health to develop a violence reduction plan in 2015 that targeted some of the highest risk sites in the province.

Site-specific plans based on input from nursing staff and leadership included improved security systems, more cameras and upgraded personal alarms; better training in violence de-escalation techniques; Code White safety drills, better orientation and mentoring of new nurses; and staffing increases, including more security, better baseline replacement and more consistency in nursing rotations to ensure safe patient care.

“We are still working to implement these plans and prevent violent attacks from happening to nurses working on the front lines,” says Adriane Gear, BCNU Executive Councillor for health and safety. “But I remain encouraged by the fact that the ministry agrees there is a problem and that it’s unacceptable that nurses are being injured on the job.”

BCNU’s launch of its Nurses’ Violence Support Hotline in October 2015 was also a big step forward in offering members a service they can rely on in times of need. Callers from around the province now have access to a trained trauma counsellor, 24 hours a day, 7 days a week. In its first year, the hotline has received close to 200 calls. Data collected from a member survey showed that a majority of those who used the service said it made them feel validated and listened to.

“People obviously need support after they’ve been assaulted, and nurses are no different.” says Gear.

“In addition to the physical injuries they may suffer, there can be significant long-term psychological impacts, including post-traumatic stress disorder.

We are pleased that some are making the call and encourage others to use the hotline, even if they haven’t been physically hurt.”

Callers who have been injured may also be connected to legal assistance if they have a question about filing a complaint with the police or initiating a non-contact order.

The anonymous information gathered through the violence support hotline will also be used to help BCNU advocate for additional violence prevention measures in the future.

At the bargaining table, BCNU has been successful in negotiating strong contract language that makes health care safer for nurses and their patients and which commits health authorities to create a culture of safety and violence reduction in every worksite.

Gear says the recent memorandum of understanding (MOU) on workplace violence prevention signed by the Ministry of Health is the most significant occupational health and safety achievement made in the last round of bargaining. The MOU requires the development of a provincial policy framework that will provide direction and clarify expectations placed on health employers who are now required to implement a number of fundamental violence prevention measures. These include the provision of safety equipment; the establishment of communication protocols and emergency response requirements including the use of Code White teams and safety and security officers; and the involvement of appropriate staff in physical interventions.

The health ministry and NBA have also jointly agreed to fund $4-million worth of violence prevention initiatives at additional highrisk sites that will continue to build on the progress made at some of the major high-risk sites already targeted for action in 2015. update CALLING OUT VIOLENCE BCNU’s Nurses’ Violence Support Hotline 1-844-202-2728 is now an important resource members can rely on in times of need.

FEATURE COMMUNITY RESOURCE Insite nurses Micah Cohen, Shevon Singh and Sara Gill are providing invaluable access to harm reduction services

SAVING LIVES

BC NURSES TACKLE THE PROVINCE’S OPIOID OVERDOSE CRISIS

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Len Vaness is frustrated. “It’s crazy. Why is it taking so long to deal with this?” he asks. “If five planes crashed in BC over the course of a year people would be crying bloody murder and there would be inquests.”

The BCNU steward is referring to the 922 drug users who died in the province during the single year of 2016. Despite the attention the crisis has attracted, he suggests that the public would care more if this figure reflected the passenger manifestos of five commercial jetliners. “These are deaths that don’t need to happen,” he says. “We know how to prevent them.”

The massive increase in opioid-related overdose deaths that took off last year continues to affect nearly every part of BC’s health care system. It’s a challenge not seen since the HIV/AIDS epidemic of the early 90s.

From St. Paul’s to Royal Inland Hospital and

in communities across BC, nurses and other first responders have been struggling under difficult circumstances – but they are saving lives every day.

Now, as during the HIV/AIDS crisis, health care system stakeholders and decision makers at all levels of government have been working together to address the issue. Many significant regulatory changes, such as rules allowing expanded use of the life-saving drug naloxone, have been quickly implemented (see story on page 26) and broader discussions have begun to take place regarding long-term policy solutions to opioid addiction.

PHOTO: NADEAN BLAIS

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FEATURE

BCNU is also ensuring that nurses are part of the conversation. The union has worked to inform politicians and policy makers about the importance of harm reduction strategies and the need to support nurses who are feeling the impact of daily resuscitations, compassion fatigue and threats to personal safety (see story on page 24).

Vaness works at Vancouver’s Insite supervised injection facility in the city’s Downtown Eastside. The neighborhood is at the epicentre of the crisis and until recently, Insite was one of the only places addicts could legally inject opioids and other drugs without a prescription. He says 2016 saw a huge change in working conditions.

“Around April we started to see an increased frequency of overdoses,” he recalls.

“Our worst month was November, where we saw 139 emergencies in an eight-day period, and the vast majority of those were ODs.” Vaness reports that his team was struggling to handle the workload with just two nurses and the support staff on shift at any given time.

This problem prompted nurses to use the professional responsibility process to secure additional resources (see story on page 25).

Despite the huge increase in overdose deaths across the province, Insite staff are proud of the fact that not one of those occurred at their facility, which sees over 500 visitors per day. It’s a testament to the effectiveness of the harm reduction model.

But as the year wore on, Insite staff were feeling the physical and emotional toll. By September some 80 percent of tested drugs were positive for fentanyl, the powerful synthetic opioid that has been primarily responsible for the spike in overdoses.

Shevon Singh began working at Insite in 2011 after graduating from nursing school.

“I felt definite burnout by October,” she reports “It was just before the fentanyl crisis peaked. We were seeing an incessant number of overdoses and there was a very unsettling kind of atmosphere – not how it used to feel.”

She credits her co-workers for helping her work through the crisis. “The only thing that really kept me going was having such a great team – the nurses and the program staff and the peers who all work there support each other and the participants,” she says. “If I didn’t have that I wouldn’t know how to

SOCIAL DETERMINANTS Comox Valley community nurse Shanyn Simcoe says investments in areas like affordable housing are necessary to successfully address addiction.

go back and keep doing it to be honest.”

The crisis has also led to self-imposed practice restrictions. Micah Cohen has worked at Insite since 2014. He came from the medical unit at Vernon Jubilee Hospital after being drawn to community nursing and wanting to focus on addiction and harm reduction.

“With multiple back-to-back overdoses there’s no time to follow up with people and do harm reduction teaching. I don’t have a lot of time to do overdose prevention teaching or advocate for connection to other aspects of care that they might need, or follow up on STI testing – any of those things just fall by the wayside,” he explains. “It’s hard knowing that your practice has narrowed to just that.”

Cohen reports that he’s not alone. “Anyone who works in the Downtown Eastside, whether it’s EMS or firefighters, this is what they are doing now – it’s a new reality and it’s taxing on everybody. I’ll often see the same EMS teams responding to overdoses over and over throughout the night and we’ll be sharing information back and forth – that never used to be a normal thing.”

It’s not surprising that the restraints experienced by Singh and Cohen would lead to moral distress. Both are candid about the

impacts of their chosen profession.

“It’s personal,” says Cohen. “When somebody stops breathing it’s usually someone you know really well or someone you care about.” The majority of Insite’s clients come through the facility on a daily basis and have built strong relationships with staff. “When people don’t show up we know it’s not good,” he says. “We’ve lost so many people this year and the workers are always traumatized because they are people we care about and it’s really hard.”

Singh agrees. “It’s really, really difficult – it’s emotionally and mentally fatiguing work.

What I’ve learned working at Insite is that people who are using drugs do care about their health. They want support but it’s so difficult to find. And when you see those numbers and think about even one of those 922 people, it’s crushing.”

E

xpanded access to harm reduction services are critical for population health, but the service is just one pillar in the so-called four pillars approach to drug addiction that was first implemented in Europe in the 1990s and later adopted by the City of Vancouver and other BC communities. Another pillar – the treatment pillar – includes a range of interventions and support programs that encourage people with addiction problems to make healthier decisions about their lives. But like so many community nurses in BC, Singh and Cohen are frustrated by the lack of available treatment options.

“We need more options for people who are looking for help when they want to stop using,” says Cohen. “We’ve got line ups for weeks to get into detox and recovery beds.”

Singh concurs, and says the continuum of care when it comes to addictions is lacking in BC. “Supervised injection is where the connection with people begins, but then you need to offer them support if they want to stop using, like opioid replacement therapies, more detoxes and treatment centres – when someone wants treatment and detox, you really need to jump on that moment because it can be a really short window.”

Shanyn Simcoe knows what it’s like to see clients struggle with access to treatment ser-

UPDATE MAGAZINE March 2017

vices. The Courtenay community nurse and BCNU Pacific Rim region executive member is part of an Intensive Case Management Team that works with a population not traditionally well served with conventional mental health and substance use services.

Comox Valley has not escaped the opioid crisis. The north Vancouver Island region saw 24 deaths from overdoses in 2016 and 10 of those came from the Comox Valley.

That’s more than double the figure for 2015.

Adjusting for population, the situation is no less critical than it is in Vancouver.

Simcoe says her clients who use substances are at risk. “We need to increase access to suboxone and methadone,” she says. “Our service provider wait lists are generally maxed out, so if someone were to decide they want to be treated with an alternative, they have to wait weeks or months to get on the program.”

Simcoe also notes that the Comox Valley is experiencing a housing crisis that’s no less acute than in Vancouver. “That definitely reinforces my frustration with the historical allocation of resources to primarily medical as

opposed to the social determinants of health.”

She says that a lack of affordable housing means people are left fending for themselves.

That in turn means they are more likely to put themselves in risky situations. “It’s expensive to the health care system when people don’t have a home. It’s much less expensive to house them and then treat them.”

I

f there is a silver lining to the current opioid overdose crisis, it would found in its magnitude. The sheer number of deaths and communities affected has forced governments and policy makers to consider solutions that had previously been outside the realm of practical possibility.

The province and public health experts have called on Ottawa to declare a federal health emergency. Such a move would release more funding for treatment options, including injectable opioids. The government has so far resisted these appeals, but it has announced targeted funding to address the chronic shortage of mental health services.

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And as part of its recent health funding deal with BC it has committed $10 million to address the overdose crisis.

Discussion has also turned to legalizing hard drugs, including heroin. Vancouver mayor Gregor Robertson signed a proclamation on Feb. 1 calling for legal access to heroin and the funding of programs to provide injectable opioid treatments. For nurses, it’s a call that’s evidence-based and non-controversial. “We need to start from a place of compassion and end the war on drugs,” says Singh.

For Cohen, the current crisis is an opportunity to lead. “Nurses have usually been on the front lines of social movements and social justice, and they need to take the lead in this situation.”

Whatever happens, Vaness says health advocates need to keep the public’s attention focused on the “crashing planes” the crisis represents in order to ensure the policies and resources are in place that will allow nurses to not only save, but improve lives. update

BCNU A LEADER IN HARM REDUCTION PROMOTION NURSES KNOW HARM REDUCTION IS a legitimate primary health care service that saves lives. And for the past 15 years BCNU has defended and promoted access to it.

The union provided financial support to help with the production of the 2002 documentary Fix: The Story of an Addicted City, which followed Downtown Eastside street addicts in their fight to open North America’s first supervised injection site for drug users. The film helped to raise awareness about the effectiveness of harm reduction, which led to the opening of Insite on East Hastings Street a year later.

After the federal Conservatives were elected in 2006, BCNU took on a high profile role in the courts in order to protect Insite from the government’s efforts to shut it down.

The union argued that Ottawa’s positon violated the Charter of Rights and Freedoms by seeking to stop nurses from

performing lawful work in a provinciallysanctioned health care facility and ensuring its users stay safe and don’t fall victim to injection drug overdoses that can be fatal.

BCNU’s legal support helped ensure the 2011 landmark Supreme Court decision upholding Insite’s right to continue operating. The justices’ 9-0 decision ordered the federal government to abandon its attempts to close the facility.

Later, in 2015, BCNU spoke out against the federal government’s attempt to stymie harm reduction with the passing of Bill C-2, the Respect for Communities Act that made it all but impossible for new supervised consumption sites to open in Canada. Bill C-2 was repealed by the current government last December – a move the union applauded.

BCNU continues to support harm reduction strategies as an effective nursing practice that saves lives. update

RAISING AWARENESS The 2002 documentary Fix: The Story of an Addicted City brought the issue of harm reduction to a wide audience.

The BCNU-supported production also highlighted nurses’ voices in the fight for equitable access to health care.

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FEATURE

THE VOICE OF NURSES

Public outreach is an important part of BCNU’s response to the opioid overdose crisis BCNU President Gayle Duteil attended a forum at Vancouver City Hall in December that saw a variety of participants on the front lines of the opioid crisis, including police, firefighters, paramedics and other health care professionals.

Duteil says the event was a good opportunity for her to raise the point that BC nurses are being impacted directly.

“Not only did I get the chance to speak with JOINT ANNOUNCEMENT BCNU President Gayle Duteil is joined by other first responders and Gord Ditchburn, executive director of the International Association health care professionof Professional Firefighters, during a Dec. 2016 news conference. als, but we were able to Duteil and Ditchburn told reporters that the government must do get out the message that more to support first responders. nurses in BC need to be HETHER IT’S ON supported during this very difficult time,” TV, online, in the reports Duteil. The message was picked up paper or on the radio, by media outlets and we were featured in it seems like no matter several news stories. It’s just one example of where you turn, the the ongoing effort to explain how nurses and province’s opioid crisis is on everyone’s other first responders are being impacted by minds. this crisis.

But for nurses around BC, the ongoing Media outreach has been a big part of health crisis isn’t just a conversation topic.

BCNU’s effort to improve working condiIt’s become part of their daily reality as many tions for nurses on the front lines. Every find themselves managing surges television, radio and newspaper interview is of overdose victims, all while trying to a chance to explain why it’s important that manage the emotional and physical toll that nurses have the tools they need to manage comes with saving lives. the impacts of ongoing crisis management.

Over the last few months, BCNU has On Dec. 14, BCNU joined forces with the been working tirelessly to ensure the voices International Association of Professional and stories of nurses caught in the middle Firefighters to hold a joint news conferof this health care crisis are being heard. ence. Duteil and IAPFF executive director Whether calling for adequate staffing levels Gord Ditchburn told reporters that the to manage high patient volumes, or asking government must do more to support first for additional resources, BCNU’s demand responders. for improvements has been front-and-centre “I’ve heard directly from our nurses workas the union works to raise public awareness ing in ERs, addiction centres, on the street in a variety of ways. and in other areas around the province that

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they are working 16-hour-shifts,” said Duteil. “They are resuscitating people in waiting rooms and sometimes resuscitating the same person twice in one day.”

The news conference was an opportunity for BCNU to outline the union’s endorsement of harm reduction strategies, its ongoing support of Vancouver’s Insite and the need for improved treatment options for people who want to stop using drugs. It was also a chance to highlight the importance of safe staffing and the impact of impossible workloads on nurses’ health and safety.

“During this public health crisis, we have advised nurses to consider their own safety when working closely with toxic drugs like fentanyl,” says Duteil. “We have also reminded them of the services available in case they are accidentally exposed to the drug, experience a violent episode or have workload concerns.”

“This is a crisis that is spilling over in many areas of the nursing profession. We need to make sure our voices are heard.”

BCNU PRESIDENT GAYLE DUTEIL

Duteil continues to be invited by media outlets to speak about how this crisis is impacting nurses.

“Our public awareness campaign is an important part of getting the government and health employers to pay attention to nurses’ needs and demands,” she explains.

“This is a crisis that is spilling over in many areas of the nursing profession. We need to make sure our voices are heard.” update

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UPDATE MAGAZINE March 2017

PICTURE OF A CRISIS

PROFESSIONAL RESPONSIBILITY

PUSHED TO THE LIMIT

continued on page 27

IHA 21 per 100K NHA 17.3 per 100K

VIHA 20 per 100K

FHA 17 per 100K

VCA 21.7 per 100K

CAUSES OF DEATH IN BC

SOURCE: BC CORONER’S SERVICE

Drug overdose

Motor Vehicle-related

EXTERNAL DEATHS IN BC

Accidental drownings

room. A shift team also includes five non-clinical staff that include counsellors and mental health workers, as well as one or two peers to help in a postinjection “chill-out” lounge.

Singh and Gill led the effort to gather information. Their findings showed that the significant increase in the number of daily overdoses meant nurses had less time for charting, providing primary care and harm reduction teaching, or re-stocking emergency equipment.

The PRP is an important part of the Nurses’ Bargaining Association collective agreement. The contract language is designed to help nurses meet their professional standards and deliver safe patient care. The PRP framework supports nurses in identifying and documenting concerns related to nursing practice conditions and facilitates opportunities for employers and nurses to take appropriate action to resolve the issue. Speaking with an excluded manager is the first step in the process.

Vaness and Singh met with the manager responsible for Insite on Dec. 6 to lay out their concerns. And by Dec. 19, they received a written response outlining the solutions the employer agreed to provide.

Immediate measures included the addition of a temporary 12-hour RN shift to operate seven days a week and unit clerk support to help replenish supplies. Other measures to be implemented included adding a possible permanent LPN as a third nurse for all operating hours and increasing the casual pool by 12 nurses. Vaness says the Insite team was also successful in securing an amendment to the orientation procedures for new staff nurses,

Fire-related

L

EN VANESS KNEW that something had to give. In the wake of a declared provincial public health emergency, he and his nursing colleagues at Vancouver’s Insite supervised injection facility found themselves pushed beyond their emotional, mental and physical limits – compromising their own health and safety by working overtime and working short.

Insite is ground zero in BC’s opioid overdose crisis, but despite the surging demand for harm reduction services, Vaness says that for most of 2016 the facility had the same staffing levels as it did when it opened in 2003.

“We saw ODs steadily increase until we reached epidemic levels the last two weeks of November,” he recalls.

“We were seeing 500 to 600 visits a day with up to 30 of those being ODs. My colleagues and I were working multiple 15- to 17-hour shifts.”

Desperate for help to deal with the huge spike in overdosing clients, and feeling burnt out and exhausted, Vaness says the staff nursing team knew they needed relief from the increasing demands that the crisis was putting on their practice. The group looked at their options and decided to use the professional responsibility process (PRP).

Vaness, a BCNU steward, says the work done by Insite nurses Shevon Singh and Sara Gill was instrumental in helping to secure much needed staffing changes at the facility.

Insite was operating two RN shifts between 0900 and 0300, seven days a week. The nurses support clients in a large open injection room, that has 13 stations, as well as one treatment

DEATHS PER 100,000 PEOPLE

BY HEALTH AUTHORITY

Winter Activity-related

Overdose surge prompts Insite nurses to call for additional resources

26

FEATURE

HARM REDUCTION

FENTANYL CRISIS PROMPTS EXPANSION OF LIFE SAVING DRUG

Opioid overdoses force changes to health regulations that were unthinkable a year earlier

W

HEN PRACTISING harm reduction, being able to intervene rapidly to save a life if things go sideways is one of the most powerful tools.

And when communities are facing an overdose epidemic induced by powerful synthetic opioids like fentanyl, the ability to rescue people comes down

to the ready availability of a single receptorblocking drug: naloxone.

Available either as an intramuscular injection or a nasal spray, it is remarkable for its unique ability to quickly reverse the effects of an opioid overdose, which rapidly depresses breathing to the point of brain damage and cardiac arrest.

Yet at the start of 2016, this sole life-saving antidote was anything but readily available to help tackle the fentanyl crisis. Bootleg fentanyl manufactured in China is imported

by North American drug dealers and cut into other substances to increase their profits. The potent additive is 50-100 times more powerful than morphine.

Last January, naloxone was still a federally listed drug, meaning a doctor’s prescription was required to access it.

There were exceptions that allowed some first responders to carry it, like ambulance paramedics and nurses working at

LIFE SAVER Insite steward Len Vaness says that without ready access to naloxone kits, the province’s opioid overdose crisis would have claimed far more victims.

Vancouver’s Insite supervised consumption facility. It was also available in hospital ERs. But most first responders directly dealing with overdoses in the community were not equipped or allowed to administer naloxone. They would need to seek out a doctor to access a medication that only works if delivered in the briefest of windows, or they would have had to call one of the few first responders then able to carry and administer naloxone. Either way, the situation was untenable in the midst of a crisis where seconds count.

In mid-January that changed when the province’s health minister Terry Lake announced that naloxone would be provided to other first responders, like the firefighters serving Vancouver’s Downtown Eastside (the epicenter of the emerging fentanyl crisis). This also meant that the province’s entire corps of 525 communitybased paramedics would be given access to naloxone and trained in how to use it.

Making naloxone available to all first responders was an important public health response because opioid-based overdoses were rapidly spreading across BC. Further steps in freeing up access to naloxone came last March, when Health Canada removed it from the prescription drug list. Agencies like the BC College of Physicians and Surgeons shortly followed suit. This meant naloxone could finally be dispensed through pharmacies without a prescription.

The loosening of restrictions did not have an immediate effect, and in April provincial health officer Dr. Perry Kendall formally declared a public health emergency in response to the continuing surge of overdose deaths.

UPDATE MAGAZINE March 2017

The declaration enabled the collection of real-time data on the precise cause of overdose deaths and served as a signal to the federal government regarding the severity of the situation.

As the crisis grew, the BC Centre for Disease Control (BCCDC) also began dramatically expanding distribution of free naloxone to habitual drug users and their families and friends via its Take Home Naloxone program.

By June of 2016, the BCCDC would report distributing 9,700 free naloxone kits (1,400 of which had seen use) and training some 8,900 people (including doctors) in how to use them.

A total of 16,597 kits were distributed by the end of 2016, with 3,165 being refilled after use.

In July the BCCDC would also report training over 1,000 pharmacists in how to educate individuals on the proper use of naloxone.

Despite these efforts, the opioid overdose crisis continued unabated. Fentanyl, which was found present in 31 percent of all overdose deaths in 2015, reached 56 percent by mid2016, and would rise to 60 percent by October.

Seized of the need to quickly expand its limited safe-consumption capacity, the province lobbied the federal government to legislate changes to the repressive Harper-era Respect for Communities Act that prevented rapid extension of harm reduction services. But in late August, even after visiting the Downtown Eastside to witness the crisis first-hand, federal health minister Jane Philpott declined to repeal the law.

Vancouver’s Insite and Dr. Peter Centre – the only legal supervised consumption facilities in Canada at that point – continued to face surging overdoses among their clientele. Applications for five additional supervised consumption sites in BC had2016 already been filed before the crisis began, but these remained mired in the unwieldy process put in place during the Harper era.

By September, in a further effort to boost response capacity, the province removed all restrictions on emergency-use naloxone. The drug was now “unscheduled” and could be made available anywhere for purchased by anyone.

That same month the Vancouver Police Department announced it would begin equipping its own members with naloxone to protect

them in the event of inadvertent exposure to raw fentanyl or other more powerful synthetic opioids.

Then, in October, BC amended regulations under the Health Professions Act and the Emergency Services Act to “enable all health care professionals, first responders (e.g., police, firefighters) social workers and citizens to administer naloxone outside a hospital setting” (emphasis added).

So, in just nine months, naloxone’s status moved from one where few could deploy the sole antidote – and even then only in a health care setting – to one where anyone could use it in any setting.

Despite this progress, the month of November saw the crisis cross a new threshold with a recorded 128 overdose deaths, the sharpest ever single-month rise. A total of 755 people had now died in just 11 months – an increase of over 70 percent from 2015.

But without the increased availability of naloxone, the count would certainly have been much higher.

December saw even more dramatic action from policy makers still stunned by the overdose spike and spooked by the emergence of carfentanil, a synthetic opioid up to 10,000 times more potent than morphine.

The provincial government announced on Dec. 8, that it would immediately open six “overdose prevention sites” in Victoria, Vancouver and Surrey. These would allow a trained professional equipped with naloxone to stand by while users fix.

Four days later, the federal government reversed itself and announced it would repeal the reviled Respect for Communities Act and “restore harm reduction as a key pillar of Canada’s drug strategy.” Ottawa also pledged to remove the existing roadblocks to establishing new safe consumption sites and replace them with a simpler, expedited process.

By the end of December, the number of overdose prevention sites across the province would grow to 18, opening in communities like Prince George, Kamloops and Kelowna.

Overall, 2016’s opioid crisis has prompted changes to the regulatory environment affecting harm reduction services that were unthinkable a year earlier. update

27

PUSHED TO THE LIMIT continued from page 25

which incorporates one day primarily focusing on administrative preparation and two days and two nights of floor orientation before they are working independently.

A follow-up Jan. 6 teleconference was arranged with Vancouver Coastal Health to review progress, and the nurses decided they were satisfied with the employer’s response to their concerns. The parties have now agreed to hold regular check-ins to ensure the Insite team feels well-supported to handle the volume of clients at the facility.

“We were seeing 500 to 600 visits a day with up to 30 of those being ODs.” INSITE STEWARD LEN VANESS

Vaness credits the collaboration between all staff members, including the clinical coordinator – along with the extensive media coverage of the spike in overdose deaths – as the reason for the successful PRP outcome at Insite. He acknowledges that not all PRP initiatives are resolved this quickly, but encourages other BCNU members to initiate the process whenever they feel that care standards are being compromised. “The professional responsibility process is most effective when we all work together to improve our working conditions – and the end result is patient and nurse safety.” update

28

STUDENT NURSES

HELP IN TIMES OF NEED Bursaries can make all the difference in students’ lives SHARMAINE SARMENTO is just embarking on her nursing career. The Surrey nurse passed her NCLEX exam in January and has just begun working at Langley Memorial Hospital.

She’s happy to be starting on a new chapter of her life, but says that if it wasn’t for BCNU, her nursing journey may have ended before it even began.

During her second year of nursing school, Sarmento’s life was turned upside down.

Financial hardship forced her family to move from the house she had been living in for most of her life.

“We moved to a one-bedroom apartment but there was not enough space for the five of us,” she says. The young nurse then found herself living in her car

for two weeks before making arrangements to live with extended family.

Fortunately, after this setbackSarmento was able to earn some money participating in Fraser Health’s Employed Student Nurse program. The modest earnings were her only source of income, and she says that living in poverty was a humbling experience. “There would be days at school where I didn’t have money for food. It was probably the lowest point in my life and I questioned whether I should stay in school,” she says. “I questioned whether I should be a nurse and wondered how I could provide care to people if I couldn’t care for myself.”

Sarmento says it wasn’t until her fifth semester that she knew

STUDENT NURSE EDUCATION BURSARY This fund is open to student LPNs, RNs and RPNs who are BCNU student members. Students currently working as employed student nurses are not eligible. The bursary is funded by donations and fundraising at BCNU’s annual convention from vendors, members and regions.

Eligibility Requirements:

• a BSN student nurse in 2nd or 3rd year of a direct or advanced-entry nursing program

NEEDED SUPPORT BCNU student members can benefit from the union’s education bursary.

she was not going to quit, and part of her resolve came from an encounter with a BCNU member. “A BCNU rep came to Vancouver Community College to speak to my cohort.

She gave an amazing lecture and presentation on BCNU, and told us about how the union also supported nurses’ mental well-being.”

• an LPN student nurse in 2nd year • an RPN student in 2nd or 3rd year of a degree or diploma program • a British Columbia resident • not currently employed as a student nurse • a student member of BCNU membership is free. Sign up NOW! • if you have already signed up, but do NOT have your BCNU Student ID number, email the BCNU membership department: membership@bcnu.org. Your application will not be processed without your BCNU student ID number

It was at this meeting where Sarmento found out about BCNU’s student nurse education bursary. “I approached the speaker and told her my story,” she recalls. “She encouraged me to apply for this bursary, and once I found out I was eligible, I broke down in tears.” [Ed. Sarmento was eligible because she was no longer in an Employed Student

You may only receive funds once.

If you have already received help from the bursary, please do not reapply.

Application Process

Applications are accepted from January 15, 2017 through September 15, 2017. If you meet the eligibility requirements you will be notified by email of the awarded amount. Instructions regarding how to be reimbursed for funds will be provided in the notification letter.

UPDATE MAGAZINE March 2017

Nurse program.]

BCNU Treasurer Sharon Sponton says student nurse education bursaries really symbolize what the union is all about. “It’s nurses helping nurses and looking out for one another in times of need.”

Sponton stresses that nursing school is a hard place to be poor.

“Studying is expensive, and can be a cause of great stress. For many student nurses it means having to choose between paying for tuition and books or paying for rent and food,” she explains. “Poor students can’t rely on family – in fact, they often have family members relying on them.”

Sponton says BCNU’s Adopta-Student-Nurse initiative, which began in 2015, is another example of the work the union is doing to make sure no student goes hungry. “BCNU members across the province have responded to the call and are now helping our next generation of nurses and building relationships that show we care.”

Now, as she embarks on her new career, Sarmento says she certainly plans on being involved in her union. update

Award Disbursement

Applicants meeting the eligibility requirements stated above will be entered into a random draw for the bursary.

Successful applicants will be notified with instructions and a copy of the expense form.

Proof of program enrolment (letter from school, receipt for tuition paid, or a copy of your transcript) is required to be submitted along with your expense claim form before funding is released.

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CNSA CONFERENCE

ADVANCING CANADA’S FUTURE GENERATIONS OF NURSES AND NURSE LEADERS

BC DELEGATES Jennifer Sage and Ellamie Macagba were two of 17 BCNU-sponsored student nurses at this year’s CNSA conference.

NURSES SPEAKING UP From left: BCNU Simon Fraser region co-chair Lynn Lagace, BCNU Young Nurses’ Network rep Sarra Smeaton, Canadian Federation of Nurses Unions President Linda Silas, BCNU Fraser Valley region co-chair Michelle Sordal and BCNU Young Nurses’ Network chair Catherine Clutchey.

THE CANADIAN NURSING STUDENTS’ Association Annual National Conference took place Jan. 25-28 in Winnipeg, Manitoba, and BCNU delegates were there to network with their counterparts from other provinces.

The 17 BC nursing students were joined by BCNU Fraser Valley region co-chair Michelle Sordal, BCNU Simon Fraser region co-chair Lynn Lagace and BCNU Young Nurses Network chair Catherine Clutchey.

“Nursing students are the future of our profession and BC is lucky to be home to some very bright minds and caring hearts,” says Sordal. “This conference was an opportunity

for students to connect and ignite their leadership potential, and to learn how involvement in organizations like BCNU can support them to learn, grow and become leaders and nursing advocates.”

Sordal feels the theme of this year’s conference – Celebrating Diversity by Breaking Barriers Through the Exploration of Cultural Safety – was especially relevant given the current political climate. “As carers, nurses know how important respecting diversity and practising cultural safety are in our own practice and in our values as Canadians and as human beings.”

Sordal says event organizers aimed to provide nursing students with the resources to practice in a culturally safe manner and knowledge that can be used throughout the rest of their professional careers and everyday personal lives.

Conference keynote speakers included renowned aboriginal children’s advocate Dr. Cindy Blackstock and retired nurse turned storyteller Tim Hague Sr., who shared his experience of living with Parkinson’s disease. update

30

COMMUNITY NURSING

time it takes to do an assessment is always challenging. “You’re not just assessing one client – IMPROVED HOME AND COMMUNITY you have a whole case load.”

CARE CLINICAL STANDARDS WILL BENEFIT Sorensen notes that the new CLIENTS AND ADDRESS WORKLOAD standards now require clients to be assessed within 14 days of NEW GUIDELINES SUPPORT INCREASED STAFFING referral.

The improved RAI-HC LEVELS IN THE COMMUNITY standards and guidelines is the first collaborative policy initiaessential for determining which tive undertaken by BCNU and services a client requires. A care the health ministry since the ratification of the 2014-2019 plan is created and any needed Nurses’ Bargaining Association referrals to other community collective agreement. It is an services are made based on the example of the kind of work that outcomes of the assessment. can be achieved through the The new RAI-HC guidelines were developed over five months union’s participation on the new committees, secretariats and and saw nurses meeting with health authority representatives panels that were created during contract negotiations, and which to look at ways to best utilize allow nurses to deliver their conthe tools currently available to cerns to key decision makers. health care staff while putting client care front-and-centre.

Lorraine Chitty is the home “Our members health clinical practice lead for Fraser Health, and was one of find themselves the participants in the process.

CRITICAL ASSESSMENT Too many clients in the community have not been “It was time to review them,” she spending too receiving timely assessments, and care standards are suffering as a result. said, referring to the previous much time doing standards. “It was also exciting paperwork and AN AGING POPULATION improvements. be part of a process with others means that health care planners The initiative has seen the from around the province and data entry at and policy makers increasingly introduction of revised clinical review the guidelines for British the expense of need to manage the transition standards and “best practice” Columbia.” time spent with of health human resources from guidelines for the Resident BCNU Vice President the acute care sector toward Assessment Instrument-Home Christine Sorensen helped clients.” the home and community care Care (RAI-HC) assessment oversee the review. She says the BCNU VICE PRESIDENT CHRISTINE sector where there is growing system, which is used to assess RAI-HC standards and guideSORENSEN demand for services. care needs for clients in the lines needed to be updated to Unfortunately, far too many community. address nurses’ frustration with clients in the community have The new RAI-HC best practhe often cumbersome assessnot been receiving timely assess- tices guidelines apply to home When BC introduced the ment tools they are required to ments, and care standards are RAI data collection tool to care settings and are used to use. “Our members find themsuffering as a result. But a recent determine what types of supcommunity care and long-term selves spending too much time collaborative policy initiative ports a referred client may need. doing paperwork and data entry care settings over a decade ago, between the BC Nurses’ Union, The assessment instrument at the expense of time spent with the promise was to develop the Ministry of Health and population-level data that would is a mandatory tool that aids clients.” provincial health employers community nurses with care Chitty says that because of its should result in much needed planning on a daily basis, and is continued on page 32 thoroughness, the amount of

31

THINK BEFORE YOU

POST

PROFESSIONAL PRACTICE

SOCIAL MEDIA MAKES IT EASY TO RUN AFOUL OF REGULATORS THE SOCIAL MEDIA landscape changed for nurses last October when the Saskatchewan Registered Nurses’ Association (SRNA) discipline committee charged Carolyn Strom with professional misconduct.

Strom had complained on her Facebook page about the subpar care her grandfather received while in care. But once she tweeted her private Facebook post to Dustin Duncan, the province’s health minister at the time, and to Trent Wotherspoon, the Leader of the Opposition, her Facebook post became public. She stated that she wanted them to know about her concerns and that in her view, people are often afraid to speak out about their experiences.

According to the public notice of hearing, the discipline committee of the SRNA, which regulates nurses in Saskatchewan, charged Strom with violating patient confidentiality, failing to follow proper channels, impacting on the reputation of facility and staff, failing to first obtain all the facts, and using the status of registered nurse for personal purposes.

Staff at the care facility also reported feeling demoralized about the Facebook post, and were angry about what they saw as a one-sided and unfair attack.

This case should raise many concerns for BC Nurses’ Union members.

Nurses and other health care professionals are aware of the high professional standards to which they are held. And every day, nurses exercise discretion and good judgement while attending to those in their care.

However regulatory colleges must also be sensitive to nurses’ professional autonomy and judgement, and the advocacy role that is fundamental to the profession.

“Care conditions and working conditions go hand-in hand,” says BCNU Vice President and provincial lobby coordinator Christine Sorensen. “It’s important for nurses to be able to effectively advocate for their patients, and this often involves reaching out to elected officials and members of the public about the condition of our health care system.”

Sorensen is no stranger to advocacy. She coordinates the efforts of BCNU’s 16 regional lobby coordinators who are all actively engaged in key BCNU campaigns that address issues such as workload and workplace violence. “Our members are often shining the spotlight on a specific health care facility or unit and they are very aware of patient confidentiality, and sensitive to

the feelings of others on the health care team.

“But it would be unfortunate if nurses begin worrying about running afoul of their regulatory college as a result of the SRNA’s charge of professional misconduct against Strom.”

Sorensen reminds members that BCNU’s Licensing Education Advocacy and Practice (LEAP) program is in place to support them if they face disciplinary action from regulatory colleges regarding complaints of unprofessional and unethical conduct. This would include complaints stemming from members who have posted information on social media – even under the strictest of privacy settings.

Strom’s case also illustrates the importance of bringing an issue to the attention of a union steward who is often in a safer position to make controversial allegations and pursue the appropriate channels. Individual nurses “going it alone” or “blowing the whistle” can sometimes leave them appearing, and feeling, isolated.

The SRNA discipline committee dismissed Strom’s argument that she was a whistle blower, and ruled this kind of action could only be resorted to after a person had unsuccessfully used all appropriate channels to

Facebook and other social media sites help us stay connected, but some things should never be posted online.

Provocative statements about your employer, personal information about patients or discriminatory comments against individuals or groups protected under human rights law are examples of what health professionals shouldn’t post online.

Employers or colleges may try to enforce professional standards if social media postings are inappropriate.

And comments on “closed” Facebook groups can be copied and made public.

So stay connected — appropriately

32

“It’s important for nurses to be able to effectively advocate for their patients, and this often involves reaching out to elected officials and members of the public about the condition of our health care system.”

BCNU VICE PRESIDENT CHRISTINE SORENSEN

right a perceived wrong.

The committee also rejected Strom’s claim that she didn’t know who to report to, stating that, “as a registered nurse, Strom would know better than anyone about the lines of authority in a health care facility.” Strom testified in the hearing that she never brought up her concerns to the executive director or any other staff at the facility, and acknowledged she had no particular expertise in palliative care or end-of-life care. The intervention of a steward or seasoned union activist early on could have prevented some of these charges.

Strom’s case certainly shows that the formal complaint process that health employers and other organizations have in place to deal with staff critiques and concerns can easily be forgotten while tapping on a mobile device. Critics of social media have noted that there is little time for reflection or retraction. And authorities can discover posts long after they have been deleted.

Nurses are powerful advocates who enjoy considerable professional

autonomy. Part of the job is knowing and following the professional standards for their regulatory college and the Canadian Nursing Association’s code of ethics. But the Strom case is a reminder that they should also familiarize themselves with employer social media policies that have been developed to protect the reputation of its organization, patients and employees.

The SRNA discipline committee met Feb. 17 to hear submissions regarding the penalty against Strom.

SRNA legal counsel has proposed Strom be fined $5,000 for her comments and $25,000 to cover part of the SRNA’s over $143,000 in legal costs. Strom’s lawyer has filed an appeal. In the meantime, nurses across Canada have been following Strom’s ordeal, and a petition has been created that is critical of the SRNA findings. update View the petition here: www.change.org/p/ saskatchewan-registerednurses-association-letnurses-speak

IMPROVED STANDARDS continued from page 30

help the province manage care more effectively. Areas with high acuity would receive more funding, better staffing and, ultimately, more information would be available to improve care for all British Columbians.

Nurses were excited to receive new training and participate in a process they hoped would improve the system. However, as is the case with so many initiatives, staff were not provided with the resources to effectively implement the new RAI protocols, and chronic understaffing meant nurses were unable to complete the RAI assessments within intended timelines.

Ultimately, British Columbians suffered as services were delayed in an overburdened under-resourced system.

With new guidelines in place, BCNU is optimistic that clients’ quality of care and care outcomes will improve, and that the heavy workloads nurses in home and community care settings are currently experiencing will be addressed.

The commitment to hold health authorities to a 14-day standard should certainly help ensure that clients will be seen in a timely manner. However the union is aware that no health authority is currently meeting this standard.

“We know that some clients are waiting over a month to be seen,” reports Sorensen. “Although there may be extenuating circumstances that make some delays inevitable, this new standard should help ensure these cases become the exception rather than the norm.”

Health authority staff and health authority owned-and-operated providers, as well as contracted service providers, must comply with the new requirements. BCNU anticipates that additional staffing will be required in order to meet the new standards. Implementation is ongoing, and health authorities are expected to fully comply no later than March 31, 2017.

Interior Health is currently in the best position to be able to meet the new standard, as it is estimated to be 60 percent compliant. But other health authorities will likely face challenges in meeting it without hiring and training more nurses to work in the community.

Any nurse who feels they are unable to meet this new standard due to workload is encouraged to use the professional responsibility process and file grievances.

“Let your steward know if these standards are not being met,” says Sorensen. “It will be up to our nurses to hold employers responsible for ensuring that staffing is provided to meet these new standards so that patients and clients get the care they deserve.” update

Nurses working in acute care may be unfamiliar with the uses of RAI. Curious to learn more?

• Visit the interRAI website: www.interrai.org • For more specific information, review your employer’s policies on the implementation and uses of the RAI tool View the Ministry of Health’s RAI-HC Clinical Standards and “Best Practice” Guidelines on your mobile device:

UPDATE MAGAZINE March 2017

33

PROFESSIONAL ISSUES

LEARNING OPPORTUNITY MEMBERS SELECTED TO ATTEND ROYAL COLLEGE OF NURSING CONFERENCE TWO LUCKY BC NURSES’ Union members had the opportunity to attend the Royal College of Nursing (RCN) International Centenary Conference held last November in London, England.

RCN conferences are unique international nursing events that see health care leaders from around the world deliver keynote speeches covering a broad scope of topics, from technology and innovation to society, communities and relationships.

Last year’s conference was special in that it celebrated the RCN’s centenary. Organizers billed the event as an opportunity to reflect on the past 100 years of nursing and help plan for the next 100.

Last year, Victoria’s Sarah Tobin and Vancouver’s Melissa Furst both responded to a call for expressions of interest put out

by BCNU’s professional practice and advocacy department on the occasion of Nursing Week, which is celebrated throughout the world every May to honour the nursing profession.

Tobin was reading her BCNU eNews when she saw the notice.

“I knew that this was setting the bar high as a first time professional development opportunity, but it didn’t require a lot to enter so I thought I would try,” she says. Tobin, who graduated in 2015 and now has a full-time position in palliative care at Saanich Peninsula Hospital, was

WORTHWHILE EXPERIENCE Victoria’s Sarah Tobin applied what she learned at last year’s Royal College of Nursing International Centenary Conference towards her work in palliative care.

“Appropriate staffing levels was a theme in several of the sessions, as well as the power we have as nurses to change health care.”

SARAH TOBIN

delighted to be chosen.

Furst was the second member chosen. “I was searching through BCNU’s member portal accessing information about the proposed (Nurses’ Bargaining Association) contract and upcoming vote when I saw the opportunity to submit the required 300-word expression

BC NURSES IN LONDON BCNU members Teri Forster (l) and Priscilla de Medeiros (m) joined Melissa Furst (r)

the neck down as a result of a spinal cord injury, told nurses about the life-changing impact of their compassionate care, and attributed this to his success as a husband and a lawyer. of interest,” she recalls. Furst has Furst said one of her takebeen nursing for seven years, aways from King and the and has worked in the ICU at St. conference was the important Paul’s Hospital and Mount Saint reminder of how nurses address Joseph Hospital for the last two. patients and to be a patient advoBoth Tobin and Furst were cate. She spoke about this to her impressed with the caliber educators at her workplace and of speakers at the three-day now plans to do a presentation conference, many of whom were to discuss the concept of listenrecognized nursing experts. ing to patients’ needs.

Tobin says she quickly realized The RCN conference was nursing issues in Canada are sim- timely for both nurses. Tobin ilar to those in other countries. has just completed her wound “Appropriate staffing levels was a care certificate and Furst will theme in several of the sessions, soon be studying for a master’s as well as the power we have as degree in public health. Both nurses to change health care.” had high praise for the confer“There was quite a range of ence and were extremely grateconcurrent sessions to choose ful to BCNU for the continued between,” she adds, “but I learning opportunity. update selected ones pertinent to my work in palliative care.”

TIP: Visit the BCNU Patient advocate and keynote website and look for speaker Matt King was a favoucalls for expressions rite of both Tobin and Furst. of interest in 2017 King, who is paralyzed from

34

Your Pension SECURING YOUR FUTURE

NEVER TOO SOON WORKSHOP HAS YOUNG MEMBERS THINKING ABOUT PENSIONS FOR BRIE CORMIER, BCNU’s latest pension workshop came at just the right time.

The Victoria nurse was attending the union’s South Islands regional meeting in January. Deb Ducharme, BCNU’s executive councillor for pensions, was on hand to provide information to members and Cormier decided it would be a good idea to find out more.

“I’m glad I took the workshop because at the time I was just coming up on my two years of service and I was informed that I was able to buy back my non-contributory service,” says Cormier, who works as a casual in mental health and addictions for Island Heath.

When someone works for a Municipal Pension Plan employer but does not contribute to the plan, such as during a probationary period, or casual work prior to joining the pension plan, the time they were employed, or service, is called non-contributory. Casuals working for Island Health,

PLANNING AHEAD Victoria’s Brie Cormier says she has greater appreciation of the importance of her pension after attending a recent BCNU workshop.

like Cormier, must work for two years and earn at least 35 percent of the yearly maximum pensionable earnings set by the federal government for CPP before being eligible to join the MPP. “I am currently in the process of purchasing those two years where I was unable to contribute,” says Cormier, “and may have missed this deadline had it not been for the workshop!”

Ducharme says there are many MPP members who could take advantage of the opportunity to buy non-contributory service.

“If you take any unpaid LOA’s it

will impact your pension,” she explains. “And by purchasing service you increase the number of years that count toward your pension. This could get you closer to an unreduced pension and increases the amount of your benefit at retirement.”

Ducharme is happy that Cormier is taking advantage of the opportunity to buy back non-contributory service early in her career. For many younger nurses, a pension can often feel like a distant concern, and important deadlines are easy to ignore. “For example, there’s a five-year deadline for purchase

of service, and if you leave an employer you must apply to purchase within 30 days.”

Cormier began nursing in 2012, and while she says she was aware of pensions long before nursing school, she admits not understanding exactly how pensions worked or what her responsibilities were before attending the workshop.

“It was really good to know that the pension is based on a formula, which considers both your highest income years as well as the amount of time you have paid into the plan,” she says.

“That’s important information – especially for someone who works casual and makes their own hours.”

Cormier says she also has a greater appreciation for the importance of a defined benefit pension. “It seems as though a defined benefit plan is superior to other types that are dependent on uncontrollable factors. With a defined benefit plan, it is much easier to get an idea of how much your pension will pay.”

Cormier encourages other young nurses to attend a BCNU pension workshop whenever one is offered in their region. “I was really happy I attended,” she says.

“I believe a lot of younger nurses do not know enough about pensions, and we certainly were not taught any of this in grade school – or nursing school for that matter– yet it is such an important part of our future that we should really be starting to think about it now.” update

BCNU CONVENTION

2017 PENSION REMINDER

DON’T FORGET! March 31, 2017 is a key date for Municipal Pension Plan members considering buying back pensionable service for unpaid leaves of absence.

Up until March 31, members of the MPP can buy back pensionable service for unpaid LOAs taken in 2016, and their employer will be obligated to pay their share of contributions to their pension plan for the first 20 days (150 hours) of unpaid leave. After March 31, members will be required to pay the employers’ portion of their pension contribution, as they would for unpaid leave time beyond the first 20 days (150 hours).

Details concerning purchase of service can be found on the Municipal or Public Service Pension Plan website at www.pensionsbc.ca.

DID YOU KNOW?

You can transfer money from your RRSP without penalty when using it to buy back pensionable service.

SUNDAY, MAY 14 4:00 pm – 8:00 pm

Registration – Regency Foyer

4:45 pm – 5:00 pm

Sergeant At Arms, Scrutineers and Ombudsperson meets with Parliamentarian (Balmoral Room)

5:00 pm – 6:00 pm

New Delegates Information Session (Balmoral Room)

5:30 pm – 6:00 pm

Delegate Whip Information Meeting (Windsor Room)

7:00 pm – 9:00 pm

Celebrating Us (Meet and Greet)

MONDAY, MAY 15 6:30 am – 7:30 am

Wellness Workshops

May 14 – 18 Hyatt Regency Hotel Vancouver 1:30 pm – 3:00 pm

Annual Report (Executive Director (cont’d), VP and Councillors)

3:30 pm – 5:00 pm

Open Forum

5:00 pm – 6:30 pm Resolutions Committee meeting 5:30 pm – 7:30 pm

BCNU Election Candidates Speak (tbd)

WEDNESDAY, MAY 17 6:30 am – 7:30 am

Wellness Workshops

7:00 am – 8:30 am Nominations Committee Voting 8:30 am – 8:45 am

Call to Order

8:45 am – 9:15 am

Questions on Annual Report

9:15 pm – 10:00 am

Resolutions & Bylaws

10:30 am – 12:00 pm

Resolutions & Bylaws

7:30 am – 9:00 am Registration

12:00 pm – 1:30 pm

Rally and Lunch

9:00 am – 10:15 am

Call to Order

1:30 pm – 3:00 pm

Resolutions & Bylaws

11:00 am – 12:00 pm

Breakout Sessions

3:30 pm – 4:00 pm

1:30 pm – 3:00 pm

Breakout Sessions

Recognition of Retiring Activists

3:30 pm – 5:00 pm

General Session

No-Host Bar

5:30 pm – 7:30 pm

BCNU Election Candidates Speak

7:00 pm – 9:00 pm Banquet

6:30 pm

9:00 pm – 12:00 am

Dancing with DJ

TUESDAY, MAY 16

THURSDAY, MAY 18

6:30 am – 7:30 am

Wellness Workshops

6:30 am – 7:30 am

Wellness Workshops

8:30 am – 9:00 am

Call to Order

9:00 am – 9:15 am

Call to Order

9:00 am – 9:25 am

Year in Review Video

9:15 am – 10:00 am (tbd)

9:25 am – 10:00 am

President’s Opening Remarks

10:30 am – 10:35 am

Delegate Count

10:35 am – 11:00 am

Finance Report – Provincial Treasurer

11:00 am – 12:00 pm

Annual Report (Executive Director)

10:30 am – 12:00 pm

Resolutions and Bylaws

1:30 pm – 3:00 pm

Keynote Speaker

3:30 pm – 4:15 pm

Closing remarks – President

4:15 pm Adjournment

36

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 contact your steward. REGIONAL REPS If your steward can’t help, or for all regional matters, contact your regional rep. EXECUTIVE COMMITTEE For all provincial, national or union policy issues, contact your executive committee.

EXECUTIVE COMMITTEE PRESIDENT Gayle Duteil C 604-908-2268 gayleduteil@bcnu.org

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

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

EXECUTIVE COUNCILLOR Adriane Gear C 778-679-1213 adrianegear@bcnu.org

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

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

EAST KOOTENAY Lori Pearson Chair C 250-919-4890 loripearson@bcnu.org

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

FRASER VALLEY Katherine Hamilton Chair C 604-793-6444 katherinehamilton@bcnu.org NORTH EAST Veronica (Roni) Lokken Chair C 250-960-8621 veronicalokken@bcnu.org NORTH WEST Teri Forster Chair C 250-485-7586 teriforster@bcnu.org OKANAGAN-SIMILKAMEEN Rhonda Croft Chair C 250-212-0530 rcroft@bcnu.org PACIFIC RIM Rachel Kimler Chair C 250-816-0865 rachelkimler@bcnu.org RIVA Lauren Vandergronden Chair C 604-785-8148 laurenvandergronden@bcnu.org

REGIONAL REPS CENTRAL VANCOUVER Judy McGrath Co-chair C 604-970-4339 jmcgrath@bcnu.org

COASTAL MOUNTAIN Kath-Ann Terrett Chair C 604-828-0155 kterrett@bcnu.org

Marlene Goertzen Co-chair C 778-874-9330 marlenegoertzen@bcnu.org

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

SOUTH FRASER VALLEY Jonathan Karmazinuk Co-chair C 604-312-0826 jonathankarmazinuk@bcnu.org Michelle Sordal Co-chair C 604-880-9105 michellesordal@bcnu.org SOUTH ISLANDS Margo Wilton Co-chair C 250-818-4862 mwilton@bcnu.org Lynnda Smith Co-chair C 250-360-7475 lynndasmith@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 Lorne Burkart Chair C 250-354-5311 lorneburkart@bcnu.org

UPDATE MAGAZINE March 2017

Council Profile

37

HERE’S WHO’S WORKING FOR YOU

INSPIRED TO LEAD SIMON FRASER REGION CO-CHAIR LYNN LAGACE

EMPOWERING MEMBERS

“BCNU is here to make sure we police the contract language and make improvements to nursing,” says Simon Fraser region co-chair Lynn Lagace.

QUICK FACTS NAME Lynn Lagace.

GRADUATED Bathurst School of Nursing 1985.

UNION POSITION Simon Fraser co-chair.

WHY I SUPPORT BCNU? “I believe in the power of collectivity.”

LYNN LAGACE CREDITS her mom’s best friend Rosemarie, who lived across the street from her childhood home, as the inspiration for her chosen profession. “She spoke so highly of the nursing profession, and her stories of working in the ER were so caring and compassionate,” she recalls.

Lagace graduated from Bathurst School of Nursing in 1985 and received her BSN from the Université de Moncton in 1992. She says she still truly loves being a nurse and so it wasn’t easy when she moved from the bedside to assume the role of Simon Fraser region cochair last year.

Now, instead of providing direct patient care, Lagace spends her workweek helping the caregivers. “It’s a shift in the

kind of care I had been doing for 30 years, but still very fulfilling work,” she says of her new role.

Lagace confesses that her new job keeps her challenged. “I was extremely idealistic about how much I thought I would accomplish – the learning curve has been steep, and it’s not a Monday to Friday, nine-to-five position.”

In addition to being responsible for over 50 worksites in her region, Lagace serves as council liaison to BCNU’s Internationally Educated Nurse (IEN) Committee, where she helps IENs navigate the health care system and lobby for changes to make it easier for them to work in BC. Lagace, whose first language is French, knows the challenges IENs face first hand. She is bilingual and worked for two years in

Saudi Arabia where health care is conducted in English. But she had to work hard in order to get her nursing credentials recognized in BC. Lagace cites former Burnaby Hospital full-time steward Louise Pirro as another inspiration in her nursing and union career. She recalls the day in 2002 when Pirro arrived on Lagace’s unit in what she describes as the nick of time.

“I was one of two nurses into a 12-hour shift in the ER. There was job action, an overtime ban and closed beds.” She says a manager and nurse educator were helping out, but there was no indication that there was going to be any staffing relief.

“Then Louise walked on the scene. I felt like someone cared, and that they were there to help solve our problems. I was extremely grateful.”

Lagace says it was Pirro who encouraged her to become more involved in the union, and suggested she start by taking the Building Union Strength (BUS) course. Soon after she was elected as a steward, and later elected to regional executive roles including communications secretary and PRF advocate.

Lagace says there is much more to BCNU than collective agreement negotiations. “I am proud of the depth of BCNU – we have professional resources for nurses such as the Licensing, Education, Advocacy and Practice (LEAP) program, an occupational health and safety department and solid labour relations support,” she notes.

“BCNU is also here to make sure we police the contract language and make improvements to nursing.” update

38

UPDATE MAGAZINE March 2017

Off Duty MEMBERS AFTER HOURS

SKY’S THE LIMIT RAY HAWKES USES HIS MOUNTAINEERING SKILLS TO RAISE AWARENESS ABOUT PTSD WHEN HE’S NOT WORKING in the transitional care unit at Comox’s St. Joseph’s Hospital, Ray Hawkes can often be found wearing a climbing harness while teaching kids how to scale a rock face.

Hawkes is the director of Solstice Alpine Guides, a BC business that runs climbing programs at local schools and takes people on mountaineering trips around BC. The Courtenay nurse says he has always loved working with youth, and prides himself on being able to use climbing as a way to empower young people.

He has developed indoor climbing programs at local schools that see up to 350 students climbing weekly.

“The best part is when you see a grade four belaying a preschool kid,” he says, referring to the technique climbers use to exert tension on a climbing rope so that a partner does not fall. “Those kids are helping one another now, and it’s really quite something to see.”

He explains that his program is the only kind in Canada where kids start learning to belay in grades three and four. “It’s not often that you have a four-yearold climbing 60 feet up in the air and a 10-year-old lowering them

back down. And when you have five lines of this going, and let’s say there’s 20 little kids climbing, it’s pretty special.”

“My biggest thing is working with nonprofit groups and giving youth the opportunity to learn climbing,” he says. “I’ve always found climbing to be a way to boost empowerment and it’s a great way for people to experience new adventures.”

Hawkes has a degree in rec-

reation and physical education from the University of Victoria, and caught the climbing bug while studying there in his youth. He now has over 27 years of experience in mountain and rock climbing instruction and is a member of the American Mountain Guides Association.

“I’ve worked with everybody, from military people to first nations groups, government and post-secondary institutions – and I teach on a fairly regular basis now, whether it’s rock climbing or mountaineering.”

Hawkes grew up in the Comox Valley and moved back to the Island with his young family in 2011 after working at Mills Memorial Hospital in Terrace for six years.

A recent experience climbing the massive Monarch Ice Fields on BC’s central coast last year had Hawkes thinking about how his efforts could also benefit nurses and other first responders.

“I had five seasoned Canadian Forces search and rescue technicians with me, and I was guiding them as part of their training,” he recalls. “During the ascent some of these big, tough guys began talking about post-traumatic stress and their buddies who

PTSD SURVIVORS Courtenay’s Ray Hawkes leads Canadian Forces search and rescue technicians on a 2016 winter mountaineering exercise on the Monarch Ice Fields located on BC’s central coast.

had passed away after suffering from PTSD. It was very emotional, and pretty much at that moment, we knew we needed to do something more about this.”

Hawkes, who serves as the professional responsibility advocate on the BCNU Pacific Rim regional executive, has been diagnosed with PTSD himself, stemming from his work as an ambulance paramedic in his 20s.

Soon after the climb, Hawkes contacted Wounded Warriors of Canada, a national charity that promotes PTSD awareness and funds programs for veterans and their families in need.

Now, Solstice Alpine Guides is organizing an event with the goal of raising $20,000 to support Wounded Warriors. The August 2017 Mt. Waddington Climb for PTSD Awareness aims to shed light on the signs and symptoms of PTSD and also help guide individuals who may be suffering from the disorder toward resources that can help them.

Mt. Waddington is BC’s highest peak. Hawkes says the climb will involve a number of individuals. “It’s a good opportunity for members of the medical community wanting to help the cause,” he says. Participants pay $5,000 and are flown to Mt. Waddington on a Canadian Forces Cormorant helicopter based in Comox.

“We have four seats available to take physicians or nurses who want to do this climb,” says Hawkes. “But you have to have a little experience under your belt.”

BCNU members who are interested in participating in the Mt. Waddington climb or assist with fundraising can contact: solsticealpineguides@hotmail.com or 250-218-1513 update

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ATTENTION ALL RNs and RPNs 40 UPDATE MAGAZINE March 2017

Paid your 2017 college registration fees?

You’re eligible to receive $350.

BCNU has committed to paying $350 to all of our RN and RPN members covered by the NBA Provincial Collective Agreement out of the damages won from the employer for its failure to implement safe staffing language negotiated in 2012.

To access your portion of these damages, all you need to do is: 1. Pay your CRNBC or CRPNBC registration fees 2. Retain your receipt of payment 3. Go to bcnu.org/memberportal and complete the RN/RPN Damages – Proof of Registration form Members have until June 30, 2017 to submit their receipt of payment of their college registration fees to BCNU. In 2018, BCNU will be proposing in the negotiations for the new collective agreement that the employer pay college registration fees for all members, including LPNs, RNs, and RPNs. PM 40834030