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UPDATE DECEMBER 2019/JANUARY 2020

M A G A Z I N E

HEAR OUR VOICE

NURSES TAKE THEIR MESSAGE TO VICTORIA

PLUS

STAFFING CRISIS BY THE NUMBERS

LEAP

HONOUR IN RECOVERY Vancouver’s Kinnon Ross feels confident about what she has to offer as a nurse thanks to the support she’s received from her union

OF FAITH Innovative program supports members on their path to recovery and career success

DEFENDING MEDICARE IN BC SUPREME COURT | NANAIMO NURSES SECURE IMPROVEMENTS TO ADOLESCENT PSYCH UNIT | EXPLORING EXTENDED HEALTH COVERAGE OPTIONS | CONNECTING WITH MEMBERS AROUND BC


JUNE 16 – 18

The Westin Bayshore Vancouver Delegates should register at the hotel on the evening of June 15, 2020. All members from our union’s 16 regions are encouraged to attend, either as observers or as voting delegates.

CALL FOR BCNU CONVENTION 2020 It’s time to submit your proposed resolutions, bylaw and constitutional amendments Proposed bylaw and constitutional amendments must be received by the Bylaws Committee at BCNU no later than February 24, 2020. Please visit the BCNU member portal to submit proposed amendments. Proposed resolutions must be received by the Resolutions Committee at BCNU no later than February 24, 2020. Please visit the BCNU member portal to submit proposed resolutions.


CONTENTS

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VOL 39 NO4

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• DEC 2019/JAN 2020 15

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DEPARTMENTS

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UPFRONT

PRESIDENT’S REPORT

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MEMBER PROFILE

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YOUR BENEFITS

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COUNCIL PROFILE

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WHO CAN HELP?

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OFF DUTY

6 CHECK IN Members are making news around the province.

10 HEAR OUR VOICE Nurses take their message to the BC legislature.

13 STUDENTS CONNECT Regional conference explores health-care diversity and inclusivity.

15 ON THE ROAD BCNU leaders are meeting with members across the province.

26 VITAL SIGNS BC’s nurse staffing crisis by the numbers.

34 PROFESSIONAL RESPONSIBILTY Nanaimo nurses secure improved youth mental health services.

FEATURE

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LEAP OF FAITH

Innovative program supports members on their path to recovery and career success.

COVER PHOTO: PETER HOLST

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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MOVING? NEW EMAIL?

UPDATE M A G A Z I N E

MISSION STATEMENT The British Columbia Nurses’ Union protects and advances the health, social and economic well-being of our members, our profession and our communities. BCNU UPDATE MAGAZINE is published by the BC Nurses’ Union, an independent Canadian union governed by a council elected by our 48,000 members. Signed articles do not necessarily represent official BCNU policies. EDITOR Lew MacDonald CONTRIBUTORS Rochelle Baker, Tina Cheung, Laura Comuzzi, Sharon Costello, Caroline Flink, Kent Hurl, Kath Kitts, Shawn Leclair, Courtney McGillion, Umar Sheikh, Christine Sorensen PHOTOS Kent Hurl, Kath Kitts, Shawn Leclair, Courtney McGillion, Lew MacDonald CONTACT US BCNU Communications Department 4060 Regent Street

STAY CONNECTED

When you move, please let BCNU know your new address so we can keep sending you Update Magazine, election information and other vital union material. Send us your home email address and we’ll send you BCNU’s member eNews. Please contact the membership department by email at membership@bcnu.org or by phone at 604-433-2268 or 1-800-663-9991

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


PRESIDENT’S REPORT SOUNDING THE STAFFING ALARM

PHOTO: PETER HOLST

CHRISTINE SORENSEN

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WENTY-FIVE THOUSAND. That’s how many nurses BC health employers will need to hire before 2029, according to the provincial government’s latest labour market forecast. It’s an eyebrow-raising number. Ask any nurse currently working short-staffed and struggling with long shifts and extended workweeks and they’ll surely express skepticism about this target being met. BC already has the lowest ratio of nurses to patients in the country, and vacancies and unfilled lines exist at almost every health-care facility in the province. Last year, nurses in the NBA worked more than two million hours of overtime at a cost of over $162 million. It’s a massive outlay driven by a severe shortage of both regular and specialty-trained nurse positions. Long shifts and extended workweeks are bad for patient care and harmful to nurses. Our own research shows that one in five RNs are very likely to leave the profession altogether. Some of the most commonly cited reasons were workload, burnout, and a perceived inability to provide safe, competent care. This is a serious concern for us all. Demand for nurses will only increase as our population ages and grows, creating even more pressure on the existing nurse workforce. We need to plan better. This was the message we brought to Victoria in October when I and the rest of your BCNU council met with decision makers from all political parties. The twoday visit was an opportunity to make it clear that BCNU is committed to finding

solutions to health-system challenges affecting nurses everywhere. We told health minister Dix that dedicated funding is needed to address the critical nurse staffing shortage so that patients’ needs can be met, and we educated all MLAs about the crisis facing our health-care system. We’ll be bringing this same message to the public next year, and telling all British Columbians that nurses provide an invaluable service – and that we are worth it. I’ll be sharing more information about this important campaign in the months ahead. In the meantime, I’m optimistic that you’ll join us on this journey as we build on the successes of 2019, and make our voice heard in 2020. The winter months can certainly bring challenging times to the workplace. I want to acknowledge those members who’ll be spending time away from families and loved ones this holiday season taking care of BC patients. I wish every BCNU member a joyous holiday season and I look forward to working together in the New Year, united in our desire for safe patient care. •

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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CHECK IN

NEWS FROM AROUND THE PROVINCE

OVERWORKED FOR WHAT?

MOVEMBER 2019

MOUSTACHE WITH A MESSAGE Raising awareness and funding for men’s health

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CNU’s MEN IN NURSING (MiN) group was busy again this year manicuring their mustaches throughout November to raise money and awareness for men’s health, specifically men’s cancer and mental health issues. In what’s now become an annual initiative, the men in the group register at Movember.ca at the beginning of the month and then trade in their clean-shaven faces to proudly sport their Mo’s (slang for moustache), asking friends, family and co-workers to donate to their efforts. With their new moustaches, these "Mo Bros" act as walking and talking billboards, bringing awareness to men’s health issues and prompting conversations.

MiN group member Tristan Newby says that 10 members participated this year and raised over $5,000 for the cause, with BCNU Thompson North Okanangan region’s Philip Kootstra being the largest fundraiser. “The MiN group are proud to support the Movember campaign – thank you to all of our donors, Mo Bros and Mo Sistas, and BCNU for the organizational support.” Newby says the event underscores the importance of not taking our health for granted, and making sure men get examined. “We need to take care of ourselves, especially when we are above 40 years of age – it’s important to check everything below the belt.” •

Carmenchita “Menchie” Rosales knows what it’s like to keep busy. The long-time BCNU Coastal Mountain region member and activist emigrated from the Philippines to Canada as a young nurse. Like many internationally educated nurses, she worked hard to provide for both an extended family in her native country and her family at home. Rosales recently published Overworked for What? – her first book about her experiences. “This book is a mustread for all overseas foreign workers, their employers or anyone interested to learn more about these humble and often unrecognized martyrs,” says Rosales. The book’s many chapters

ALL EYES ON CAMERA THERE WAS NO SHORTAGE OF smiling faces and clicking shutters at BCNU’s annual member photo shoot held at Vancouver Community College on Nov. 30. All of the communication and education materials that BCNU produces in-house use photographs of actual members – no actors needed. Many shoot participants also attended the union’s Human Rights and Equity Conference held a day earlier.

CONVERSATION PIECES The “Mo Bros” of BCNU’s Men in Nursing caucus make effective use of their hairy upper lips to raise awareness of men’s health issues.

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DECEMBER 2019/JANUARY 2020 • UPDATE MAGAZINE

Email lmacdonald@bcnu.org if you would like to participate in a future shoot.


STORYTELLER Carmenchita Rosales sells copies of her book Overworked for What? at BCNU’s November Human Rights and Equity Conference.

read like a combination of cautionary tale and advice column aimed at an audience of younger nurses who might benefit from the wisdom of an experienced elder. “Each and every one of us has a story to tell,” says

Rosales. “By having the courage to expose my own vulnerabilities and share my struggles and triumphs as a single mother and a nurse uprooted from my homeland to support my poor family in the Philippines, I’m hoping that my message will resonate with readers and transform their lives for the better. “My only child, Sarah, has also been requesting me to write a book for her for the past ten years. This book is my legacy for her.” Overworked for What? can be purchased at: www.ofmenchierosales. com All proceeds will be used to purchase a children’s centre and playground in Barangay Gahonon, Daet, Camarines Norte, Philippines.

BEHIND THE SCENES BCNU members participate in the union’s annual brand photoshoot.

ON THE LINE BCNU North East region members show their solidarity with striking University of Northern British Columbia Faculty Association members at the university’s Prince George campus on Nov. 25. From left: Niamh Walsh, Natalie Livingstone, Tracey Jonker, Victoria Macdonald and Janet Sparks.

NORTHERN NURSES SUPPORT TEACHERS

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C NURSES’ UNION members in the North spent time on the picket line in November supporting University of Northern British Columbia (UNBC) Faculty Association members. The association, which includes instructors and librarians, is on strike for sector-norm salaries that it believes should be given without having to sacrifice other non-monetary work terms and conditions. BCNU student representative Maggie Biagioni says it’s important for union members to show their support for the UNBC faculty. “Unions support unions, and we’re always in support to make sure people are getting taken

care of, especially at UNBC where nursing students are graduating,” she said, speaking to the media covering the strike from the picket line at UNBC’s Terrace Campus. “Most of us are going to be union members one day. It’s so important for our future nursing students to be well taken care of and to have good educators who are being treated fairly.” Students at the university returned to class Dec. 2, though no deal has been reached between faculty and the administration. Limited job action continues pending the outcome of a bad faith bargaining complaint the association’s union filed against UNBC with the provincial Labour Relations Board.•

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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CHECK IN NEWS FROM AROUND THE PROVINCE

PROFESSIONAL ISSUES

EXERCISING PROFESSIONAL JUDGMENT Association AGM vote ensures fees will not be levied without member consent

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VER 130 nurses gathered in New Westminster on Oct. 29 to attend the Association of Registered Nurses of BC (ARNBC) annual general meeting. The majority made a point of attending to vote on a resolution to reduce the association’s annual membership fee to one dollar per year and prevent it from collecting member fees through other organizations. Prior to the near-unani-

mous vote in favour of the resolution, over 20 percent of the registration fees nurses paid to the College of Registered Nurses of BC – now the BC College of Nursing Professionals (BCCNP) – was being automatically transferred to ARNBC without their consent, even if an individual nurse had opted out of association membership. The BCCNP will no longer collect fees on behalf of the ARNBC after Dec. 31. BCNU acknowledges that nurses not represented by the

DEMOCRACY IN ACTION Nurses vote overwhelmingly in favour of a resolution to reduce the Association of Registered Nurses of BC’s annual membership fee to one dollar per year at the association’s Oct. 29 AGM in New Westminster.

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DECEMBER 2019/JANUARY 2020 • UPDATE MAGAZINE

COLLEGE REGISTRATION RENEWAL REMINDER union, for example managers and academics, need a professional voice, and the union is always prepared to enter into dialogue with all RN organizations to determine how best to achieve this. Unfortunately, this offer has never been taken up. In 2010 the college rejected a BCNU proposal to establish a Council of Nurses for BC that would have been inclusive of all nurses including LPNs, RNs, RPNs, midwives and nurse practitioners. This could have allowed all nursing organizations to be part of a body that could provide a single, powerful professional voice for BC’s nurses. The union has always proposed working collaboratively to protect the rights of nurses. However the ARNBC had never shown a willingness to include BC nurses in important decisions, and had attempted to prevent nurses from attending its AGMs or deny them voting rights. BCNU will continue to support the efforts of our members who have stood up and demanded that the college and associations hear and respect the voices of all BC nurses. •

Nurses in British Columbia are required to renew their registration annually to ensure they still meet the requirements to practice competently, ethically and safely. For LPNs the registration renewal period is now open. Your registration must be filed before Dec. 31, 2019 at 4:30 pm PST. For RNs and RPNs the renewal period is Jan. 1 to Feb. 28 (for a practice year between March 1, 2020 to Feb 29, 2021) If you have a complex application make sure to apply early to ensure the college has enough time to process your application. BCNU is aware that rising college fees are a concern for nurses. During the last round of NBA bargaining, the union was successful in negotiating a partial reimbursement of nurses’ college and licensing fees from employers. The union will be administering the reimbursement and members covered by the provincial collective agreement will be able to apply for their reimbursement online beginning February 2020. Check your BCNU eNews for more information in the New Year.


WOMEN’S HEALTH

UNEQUAL ACCESS Report highlights the stark, gender-based inequities that persist in BC’s health-care system

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HEN IT COMES to health care in British Columbia, women are experiencing serious inequities that are affecting their physical, mental and emotional well-being, just because they are women. And despite decades of progress in health research, policy, and practice, women still face many barriers accessing the high quality health care they deserve. These are just two of the key findings of  In Her Words, a recent report on women’s health co-published in October by the BC Women’s Health Foundation and not-for-profit health insurance provider Pacific Blue Cross.

“Nurses need to make it clear to policy makers that far too many women are not receiving equitable care.” BCNU President Christine Sorensen

The findings make it clear that women generally feel their health-care needs are too often minimized in comparison to men’s. And they report experiencing serious inequities that impact their confidence to seek care. For women in BC, the barriers are many. The study surveyed a total of 1,000 women aged 16 and older and

tells the stories of those discouraged with their health-care system in general and with their individual practitioner interactions. It’s a system that significantly lowers women’s chances of even seeking out, much less receiving and being satisfied with their entire healthcare experience. Over one third of survey participants reported believing their practitioners had diminished their symptoms, and one in two women described feeling overlooked and even dismissed when presenting their health concerns. For immigrant and young indigenous women, the numbers are even more startling, with a full 83 percent of indigenous women aged 16-24 stating they had trouble even accessing the medical care they were seeking. In order to access services, immigrant women must navigate a health-care system in a foreign country and attempt to communicate their concerns in a language not their own. Immigrant and indigenous women often carry experiences of past trauma or abuses that further hold them back from seeking the help they need. The women who sought out care identified communication problems, lack of understanding, not enough time to discuss their concerns, and discrimination as reasons for their dissatisfaction with the experience. One in 11 women who reported feeling overlooked believe it happened to them because they were female. BCNU President Christine Sorensen says we need to do more. “The goal of improving women’s experience with health care needs to be a priority for all,

and as health-care workers, nurses need to support the findings of the report and make it clear to policy makers that far too many women in BC are not receiving equitable health-care services.” What can we do today? Sorensen calls on all BC’s health-care workers to be aware of this bias against women and to work towards balanced support for all patients in their care. She acknowledges the small signs of change in BC, with increased government focus on equality and progress specific to women but notes that incremental change will not bring results soon enough to ensure all women, no matter their race, religion or region, receive the care they need without discrepancies. “A disproportionate number of BC’s women are facing universal barriers to accessing essential health-care services across our province,” says Sorensen. “This reality is simply unacceptable in 2019. We need to drive changes within the system that will lead to healthy women everywhere, capable of anything.” • Read the full report at www.inherwords.ca

DID YOU KNOW?

Over 1/3 of women in BC do not feel like their needs are being met or treated effectively by the health-care system. Over 1/2 of women feel that a physician had diminished or overlooked their symptoms.

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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NURSES TALKING HEALTH CARE BCNU Council’s October trip to Victoria was an excellent opportunity to engage in face-toface conversations with over 50 MLAs about the province-wide nurse shortage, staffing crisis and need for improved violenceprevention measures. BCNU President Christine Sorensen and provincial Council members pose with Health Minister Adrian Dix at an MLA meet and greet the union hosted on Oct. 21.

NURSES VOICES’ HEARD LOUD AND CLEAR BCNU leaders meet with decision makers in Victoria

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CNU ELECTED representatives were armed with an ambitious agenda when they arrived in Victoria this October for a twoday visit aimed at bringing a number of important issues to the attention of decision makers from all political parties. The trip to the provincial capital was an excellent opportunity for BCNU Council members to engage in faceto-face conversations with over 50 MLAs about the province-wide nursing shortage, staffing crisis and nurses’ call for improved violence-prevention measures. It also offered a rare chance to sit down with key ministers and opposition critics to help identify solutions to these challenges, and talk about collaborative ways to implement them. BCNU President Christine Sorensen led the lobbying effort and made sure that every government official she met left with a better understanding of what nurses from all corners of the province and in every health-care setting are experiencing. “The trip was an opportunity to make it very clear that we are unwavering in our commitment to finding solutions to

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health-system challenges like chronic short staffing and escalating violence, and educate MLAs and all decision makers about the crisis that our health-care system is in – and how this is impacting nurses everywhere,” says Sorensen. Sorensen was joined on the first day of lobbying by BCNU Vice President Aman Grewal and Executive Councillor for health and safety Adriane Gear, where they hosted a two-hour information session at the BC legislature. In that time, they met with 25 New Democrat MLAs, including education minister Rob Fleming, Minister of Mental Health and Addictions Judy Darcy, Minister of Jobs, Trade and Technology Bruce Ralston, and Minister of Transportation Claire Trevena. “We are here today to ask you if your constituents will have the nursing care they need in the future,” said Sorensen during her presentation. “While we appreciate your government’s numerous announcements for new hospitals, SAFETY FIRST BCNU President Christine Sorensen and executive councillor Adriane Gear meet with Labour Minister Harry Bains to discuss BCNU’s call for increased services for nurses dealing with physical and mental injury.

DECEMBER 2019/JANUARY 2020 • UPDATE MAGAZINE

and emergency departments, the reality is that vacancies and unfilled lines exist at almost every single health-care facility in BC. All the while, an aging population and increase in high-acuity patients continues to put pressure on BC’s health-care system.” Throughout the session, Sorensen, Grewal and Gear all explained how the staffing shortage and ongoing workplace violence is pushing nurses out of the profession, and spoke about the many new nurses who leave after short stints due to workload pressures and unmanageable expectations. MLAs were also informed about the shocking number of nurses who are suffering from mental health issues such as post-traumatic stress, and what all of this means for their constituents. “Almost 20 percent of RNs told us in a 2016 study that they were very likely to leave the profession altogether,” Sorensen reported. “The most commonly cited reasons for wanting to leave nursing were workload, physi-


cal demands of the job, burnout and a perceived inability to provide safe, competent care in their current working conditions.” The statistics painted a dismal picture of the state of BC’s health-care system, and shocked many of the MLAs in attendance. “Our province is going to need 25,000 nurses to staff the health-care system in the next decade,” Sorensen reminded the legislators. “Where are these nurses going to come from?”

“We are asking for dedicated funding to address the critical nurse staffing shortage so that patients’ needs can be met.” BCNU President Christine Sorensen

Many MLAs thanked the nurses for the eye-opening information and vowed to work harder to address the concerns raised. A large number expressed gratitude for the professionalism and dedication of nurses everywhere – and vowed to take a closer look at what’s happening in their own constituencies. They also committed to further exploring the role that they and the provincial government can play in working to find solutions to the crisis.

MEETINGS WITH MINISTERS

Later in the day, Sorensen and Gear visited the office of labour minister Harry Bains. The conversation focused on the psychological health and safety of BC’s nurses and the implementation of the Canadian Standards Association standard for psychological health and safety that is now part of the Nurses’

Bargaining Association provincial collective agreement. Gear took the opportunity to thank Bains for his work to ensure this year’s enactment of legislation that now includes nursing on the list of occupations that have the presumption of mental injury. But she also pressed the minister to act on BCNU’s request for properly trained security staff at highrisk sites around the province. “We hope we can continue to work with you on initiatives like these that are aimed at making facilities safer for nurses and their patients,” Gear told Bains. “There’s still an unacceptable level of violence in health-care facilities around the province, and we need to start working with all levels of government to keep our nurses safe so they can provide the care all patients deserve.” Sorensen and Gear were back in the legislature the following day, but this time it was in the office of health minister Adrian Dix. The hour-long meeting was a rare opportunity to speak directly about the chronic nurse shortage and ask the minister directly when he will develop a provincial health-human resource plan to address the problem. “Without a plan, very little will be done to address the need for more skilled, experienced nursing staff,” Sorensen told Dix. “Close to 40 percent of nurses in BC are over the age of 50 and quickly approaching retirement. Meanwhile, BC ranks the lowest in the country for RNs and LPNs working in direct care per capita. We are asking for dedicated funding to address the critical nurse staffing shortage so that patients’ needs can be met.” Dix said the staffing shortage is a “complex challenge” and recognized the moral distress many nurses experience when they are unable to provide safe patient care due to workload and overcapacity pressures. He defended his government’s track record on investing in health care while acknowledging the work that still needs to be done to

improve worksite safety and manage escalating workplace violence. The meeting wrapped with an openended invitation for the minister to work collaboratively with BCNU on initiatives that would drive staffing and develop concrete solutions that would bring nurses to BC. The need for collaboration was raised again at a meeting later that afternoon with opposition leader Andrew

LISTEN AND LEARN BCNU Vice President Aman Grewal and Richmond-Steveston MLA John Yap discuss the nurse shortage and staffing challenges at an Oct 22 meet and greet.

Wilkinson and health critic Norm Letnick. Both were interested to see the nurse staffing statistics and agreed there was a looming crisis that needs serious attention.

MLAs LISTEN AND LEARN

The evening of day two saw BCNU host a meet and greet at the Empress Hotel that was attended by dozens of MLAs from both sides of the house. A twohour listen and learn session allowed BCNU council members to speak directly to their MLAs about specific issues in their communities. Grewal worked in Surrey Memorial Hospital before being elected union vice president this year. “I was pleased to have had the opportunity to speak about what I

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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feel is in need of attention at Surrey Memorial, and the community at large,” she said. “The hospital sees severe cases of overcapacity and we are almost always understaffed. Surrey Memorial continues to be one of the busiest hospitals in the region and things don’t ever seem to get better.”

“Nurses work hard every day providing the best care they can. We owe it to them to make it better.” BCNU President Christine Sorensen

The Victoria visit was a busy two days, and BCNU’s continued calls for improvements for nurses – and the union’s ongoing advocacy – came across loud and clear. For Sorensen, that made it all worth it. “We came and people definitely listened. The staffing challenges that exist in this province are complex and it’s going to take a joint effort from all sides to address the problem and bring relief to our members who work hard every day providing the best care they can. We owe it to them to make it better.” •

FACE TIME BCNU President Christine Sorensen and Executive Councillor Adriane Gear discuss the province’s nurse shortage with opposition leader Andrew Wilkinson and Liberal Health Critic Norm Letnick.

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EDITORIAL

MAKING THE CASE FOR PUBLIC HEALTH CARE

For-profit health care promoters have failed to provide evidence to show that private medical clinics improve the health of Canadians OOD HEALTH-CARE policy, like health care itself, should be holistic and evidence-based. Unfortunately, the plaintiffs’ final arguments in the long-running BC Supreme Court Charter trial aimed at bringing down provincial medicare laws have failed to provide the evidence to show that for-profit health care is the panacea they claim it to be. This should give hope to nurses and the patient intervenors we are supporting who argue that universal public health care is the safest, most efficient and most cost-effective way to provide care for all. But the outcome of this trial now rests with the decision of one judge. And if the lawyers for lead plaintiff Dr. Brian Day succeed in their efforts, British Columbians and indeed all Canadians could see themselves paying for expensive private insurance for access to hospital and physician services. This trial has never been about surgical wait lists or patient suffering, but about doctors being allowed to charge patients whatever they want for necessary medical services. Throughout the trial Dr. Day has shown himself to be a shrill ideologue unwilling to take all patients’ interests into account and seemingly immune to the ample evidence from jurisdictions across the world showing that privately funded for-profit health care harms the public health-care systems the majority rely on. Nurses know that BC’s health-care

DECEMBER 2019/JANUARY 2020 • UPDATE MAGAZINE

system isn’t perfect. We also know that expanding for-profit care is not the remedy that Dr. Day would like us to believe. It’s medicine for the well-off and the able-bodied, and augurs a future where waits for care are worse for the majority. Nurses are focused on improving our health-care system for the better. We know our patients' needs and we support changes that will benefit all of them. Our legal advocacy in this case reflects the nursing profession’s commitment to social equity and BCNU’s strong support for universal health care. From the beginning this lawsuit has been part of a concerted effort to destroy medicare – a social program valued and supported by the majority of Canadians. Dr. Day and his allies want access to more patients who are insured under a US-style private health insurance model – allowing them to earn more money than doctors who only work in the public system. They know that the prohibition on extra-billing is the essential mechanism that protects medicare – our single-payer public insurance system – from the private insurance market. Most Canadians can’t afford the thousands of dollars required for a procedure in order to jump the queue. But if Dr. Day and company succeed in their attack, many of us could find ourselves forced to pay expensive private insurance premiums for hospital and physician services no longer covered by medicare. This is a reality nurses and most Canadians do not support. •


STUDENT NURSES

INVESTING IN THE FUTURE

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GROUP OF NURSING students from the University of the Fraser Valley welcomed counterparts from across the province in Abbotsford from Oct. 31 to Nov. 3. The event was the Canadian Nursing Students’ Association (CNSA) Western Prairie Regional Conference, and the theme was: “Nursing the Spectrum: Diversity and Inclusivity within the Realms of Health.” Several nursing leaders were present for the annual event, including BCNU Council student liaison and North West region chair Teri Forster and Okanagan Similkameen region chair Rhonda Croft. “BCNU is a leader when it comes to advancing the nursing profession,” said Forster, who had been invited to make a

OUTREACH BCNU Council student liaison Teri Forster connects with LPN nursing students Cheyenne Balderson and Marcella Fernandez.

THE FUTURE OF NURSING BCNU elected leaders Rhonda Croft and Teri Forster connected with more than 100 students who attended this fall’s Canadian Nursing Students’ Association Western Prairie Regional Conference in Abbotsford.

presentation on what allyship means for nurses. Forster says she was honoured to lead a breakout session and share her own experiences as a worker with a disability and talk about the importance of allies in helping maintain a nurse’s ability to be contributing member of the health-care team. “Nurses experience challenges with discrimination, bullying and systemic isolation as a result of who they are,” said Forster, “and allies can break down these challenges and support each other.” Foster also spoke with over 125 students at the BCNU exhibitor booth. “Students had great questions around the benefits of choosing work in BC, and before entering the Teri Forster nursing field they wanted to know what BCNU is doing to support its members and create lasting change,” she reported. “I’m very proud of BCNU and the efforts we make in helping students make the transition from student nurse to practising nurse,” she said. “Being at CNSA events is an incredibly important investment and a first step in ensuring that students understand unionism and their power to advocate.” Croft was invited to conduct a breakout session on civility. She told conference participants that civility is about being conscious of our behaviour and words when we interact with another person. “Nurses are constantly

in relations – with colleagues, patients, and families,” she noted. “Civility can be hard work. It requires paying attention, but we know it increases psychological health and safety in the workplace.” Croft acknowledged that nurses are exposed to people who are in pain, scared and generally at their worst. She said that being a kind person when patients and their families are

“Being at CNSA events is an incredibly important investment and a first step in ensuring that students understand unionism and their power to advocate.” frightened and unsure can significantly change a stressful situation. “Kindness is vital,” she argues. “Be kind to yourself, ensure that you are bringing your best civil self to work and then spread that kindness to others.” The CNSA is the national voice of Canadian nursing students. Its goal is to increase the legal, ethical, professional and educational aspects of the nursing profession, and to promote the profession as a whole. The CNSA 2020 National Conference takes place from Jan. 21 to 25 in Montreal. For more information visit www. cnsa.ca

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CNSA REGIONAL CONFERENCE continued from page 13

IN THEIR OWN WORDS Every year BCNU sponsors student members from each of the union’s 16 regions to attend Canadian Nursing Students’ Association (CSNA) conferences. Several BCNU student delegates told us why they applied through BCNU to attend this fall’s CNSA Western Prairie Regional Conference, and shared highlights from their conference experience.

KIMBERLY MEERSE University of the Fraser Valley BCNU student sponsorship has been a vital part of my nursing student career. It has afforded me connections with members and fellow students from across the province. I’m truly thankful to the members for allocating their time and funds to empower a new generation of nurses. The opportunity to attend the CNSA conference was invaluable as it fostered the idea that everyone can be an advocate for changing the health-care climate to encapsulate the unique and diverse needs of every individual. The conference emboldened me to be a changemaker for my fellow students, nurses and for the people we serve, by taking steps to advocate for equality and dignity.

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MELISSA WAKEMAN University of Northern BC

KATARINA LEWIS University of Northern BC

I had always been hesitant to enter into the medical profession due to a political system that’s leaving nurses and their patients feeling taken advantage of, powerless and stigmatized. These ethical and moral dilemmas directly correlate to the high burnout rate of our nursing professionals. As student nurses, we learn about competent cultural care surrounding the biopsychosocial-spiritual model but are often left short [when it comes to applying this model]. I heard from several conference speakers who highlighted the importance of healing beyond our current skin-deep standard. We listened to stories of ignorant care, traumatic historical events, and lack of consideration for the preferences of self titles. The conference left me with a new perspective, requiring me to acknowledge my use of language, how I express my thoughts, and explore where my core beliefs come from and whether they are appropriate in my role as a caregiver. I felt empowered, and learned about available resources to health-care professionals that will ultimately enable us to advocate and care for our patients, our friends, and the families within our communities.

Becoming a student member of BCNU has changed my life. I have learned to reach out for support and understand how BCNU will influence my future practice as a registered nurse. As a BCNU student member you are able to connect with many amazing individuals such as nurses, other students, and other healthcare professionals. Through my experiences with BCNU I have been able to build a network and support system with colleagues from across the province. I became a student member because I wanted to expand my knowledge of my union at an early stage in my career. BCNU has provided opportunities and learning experiences that will forever impact my practice as a future nurse. I had an amazing experience at the CNSA conference. There were many speakers who covered important topics related to nursing, such as transphobia, fatphobia and healthism, autism, street nursing, and patient experiences. My overall experience can be summarized with these two quotes: “It’s easy to teach someone to be a caregiver, it’s hard to teach someone to care.” And: “Life isn’t where you’re from, life is where you’re going.”

DECEMBER 2019/JANUARY 2020 • UPDATE MAGAZINE


REGIONAL EDUCATION ROADSHOW

KEEPING NURSES INFORMED AND ENGAGED

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CNU’s EXECUTIVE AND provincial council capped 2019 with a province-wide series of education meetings that kept members in all of BCNU regions informed about the union’s priorities and engaged with issues nurses will be facing in the year ahead. BCNU President Christine Sorensen and CEO Umar Sheikh attended most of the meetings. They provided updates on progress that’s being made to ensure full implementation of the Nurses’ Bargaining Association (NBA) provincial collective agreement come April 1, 2020 and fielded questions on a range of issues important to nurses. “These meetings gave me the opportunity to meet one-on-one with so many members and listen to their concerns,” says Sorensen. “They also allowed us to share important updates on many ongoing projects and take stock of BCNU’s organizational successes in 2019.” Sorensen noted that the successes of 2019 were many, starting with a positive Nurses’ Bargaining Association contract ratification vote in January and the passing of important

Workers Compensation Act amendments in April that now confer the presumption of mental injury on nurses’ filing for compensation. She reminded members about BCNU’s comprehensive governance renewal process that led to a revised constitution and bylaws, and updated union policies and procedures. She also spoke about BCNU’s updated strategic plan and the adoption of a new member-centric approach that will be applied to all of the union’s important work. “Heading into 2020, we’ll be focused on good governance, empowering nurses and ensuring that members benefit from the implementation and enforcement of the NBA provincial contract,” she said. Mina Banadarvish works at Delta Hospital. The OR nurse attended the Oct. 29 meeting in Surrey. “Taking time off work and coming here today was well worth it,” she says. “We learned so much about the bargaining process and the new contract, and I appreciated being able to meet with senior leaders and staff – it was a great experience.” BCNU education officers were also on hand at every session to provide information about nurses’ extended health plan ahead of the negotiated

FULL REPORT BCNU President Christine Sorensen provides Coastal Mountain region members with an overview of current issues and initiatives at an Oct. 30 education session.

benefits review that will be conducted in early 2020. Sorensen concluded the sessions by reminding members that the World Health Organization has dedicated 2020 as the year of the nurse in honor of the 200th birth anniversary of Florence Nightingale, and told them to be proud of their work and their profession.

“Nurses have shown that they care about their contract and are committed to safe patient care.” BCNU President Christine Sorensen

“I was thoroughly impressed by what I heard from members in every corner of the province,” Sorensen reports. “Nurses have shown that they care about their contract and are committed to safe patient care – and that makes me optimistic about the year ahead.” •

CONTRACT EDUCATION Members from all 16 BCNU regions participated in fullday meetings this fall to learn about Nurses’ Bargaining Association contract improvements and progress the union is making on a number of fronts, from NBA contract interpretations to pension and benefits reviews.

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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SAFE STAFFING

ASSESSING PATIENT CARE Strategic committees are working to ensure effective contract implementation THE INNOVATIVE NURSE-DRIVEN staffing and workload language negotiated during the last round of Nurses’ Bargaining Association (NBA) provincial contract talks was a major achievement that has the potential to effectively address many long-standing staffing challenges. Strategic Nurse Staffing Committees (SNSCs) in every provincial health authority have had their sleeves rolled up since June, developing strategies to examine staffing needs using the new contract language. The committees are comprised of both union and employer representatives, all of whom share a genuine commitment to work together on a range of PRODUCTIVE DIALOGUE BCNU members across the province took the opportunity to share their experiences and provide input on Nurses’ Bargaining Association contract implementation efforts at regional education sessions this fall.

staffing initiatives. These include: • the regularization of hours • recruitment and retention strategies • regular and other relief positions • nurse education and training initiatives (including specialty nursing) • seasonal strategies • annual vacations • health service delivery initiatives and other organization-wide staffing issues. In addition to working on these longer-term strategies, each health authority SNSC is also reviewing its employer’s approach to short-term staffing challenges, particularly related to Article 60 of the NBA provincial contract. This direct patient care staffing article will come into effect on April 1, 2020, following the development of a nurse-driven staffing and workload assessment tool to ensure all short-term staffing needs are met. BCNU President Christine Sorensen and CEO Umar Sheikh met with over 1,500 members during province-wide regional education meetings the union held this fall, and shared contract implementation progress updates including SNSC work to develop an effective patient care assessment tool in support of Article 60. “A patient care assessment tool is intended to be a collab-

PROGRESS REPORT BCNU president Christine Sorensen reviews Nurses’ Bargaining Association contract improvements with Richmond Vancouver members at an Oct. 29 education session in Burnaby.

orative process for front-line nurses and managers to help them to determine staffing requirements that will address short-term patient care needs,” explains Sheikh. BCNU Coastal Mountain region member Peggy Mitchell attended the Oct. 30 education meeting in Burnaby. She sees the tool as an opportunity for managers to re-frame the way they manage their budgets. “Not having enough nurses reveals many problems, and the staffing budget figures prominently,” she said. “With a patient care assessment tool in place, perhaps the budget stranglehold on whether safe care delivery is even possible can be overcome, and current patient needs will inform and consequently provide the number of professionals actually needed to support and save lives.” All health authorities are actively developing their plans to trial new patient care needs assessment processes in specific units throughout the province ahead of April 1, when a working short premium takes effect, and an additional $5.00 per hour will be paid to any nurse working short on a unit, department or program with 10 or fewer scheduled nurses. •


WORKLOAD TOOLS ARE WORKING FOR MEMBERS STRATEGIC NURSE STAFFING committees in every health authority are hard at work developing new patient care needs assessment processes ahead of the April 1 implementation date for the Nurses’ Bargaining Association contract’s Article 60 language (Direct Patient Care Staffing). This nurse-driven staffing and workload assessment process can ensure

that all short-term staffing needs are met and allow point-of-care nurses to identify when additional nursing staff is needed. Once implemented, these patient care assessment tools will make a real difference in nurses’ working lives and the lives of our patients. In the meantime, BCNU members have been taking advantage of negotiated workload tools that are already in effect,

and incentivize health employers to match staffing with patient care needs. These include additional wage premiums that address the staffing shortage. Update magazine asked members who attended this fall’s NBA contract implementation education meetings how they’ve taken advantage of the new language: Here's what some of them had to say:

PAID END-OF-SHIFT WORK (nurses paid at straight-time rate of pay for up 14min of time spent after their shift; nurses paid at overtime rate of pay for 15min or more of their time spent after their shift) ADELA RADU, Simon Fraser

“I’m totally using it. I keep telling my co-workers to use it too. Some of them say, ‘no I don’t like to sign in for extra minutes because it doesn’t look good’ or they say that it’s a lot of work. I’m just going to keep telling them, keep pushing them. At the end of the day, it’s a culture that’s going to have to change.”

SARAH WILLOUGHBY, Simon Fraser

“I'm trying to make sure that I’m signing out when I’m done and encouraging other people to sign out for shift handover.”

MITCHEL PEREPALKIN, Coastal Mountain

“The paid end-of-shift premium is amazing, I love it, but it would be better if the managers could have training on how this joint interpretation actually works. It shows me there is an area for improvement of knowledge.”

REKHA VASHISHT, South Fraser Valley

“I have encouraged a lot of nurses on my unit to take advantage of the paid end-of-shift language because I see a lot of them staying on to do their charting, or other nurses staying late because a patient is sick. I have seen push back from PCCs, sometimes (they try to send them home) but a lot of people are using the language when they work more than 14 minutes (past the end of their shift) and they are getting paid.”

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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LEARNING ABOUT HEALTH BENEFITS Education meetings give members a comprehensive overview of their health plan THE PROVINCE-WIDE SERIES OF full-day education meetings the union held this fall included a detailed presentation on the design of BCNU’s current health benefits plan. “We believe that benefits education and consultation with members is especially important because health benefits help form nurses' total compensation under the provincial collective agreement,” says BCNU President Christine Sorensen. “Just like wages and pension benefits, health benefits are a vital part of nurses’ overall compensation package. So it makes sense that nurses have a say in determining the future of their health benefits plan.” HEALTH BENEFITS 101 BCNU members learned about benefits administration and financing at province-wide education meetings held this fall.

Sorensen says it’s also important that nurses understand how health benefit costs are determined and paid. The education sessions were touted as the start of the consultation process on benefits that will help determine any recommended changes to the nurses’ health benefits package. Those who attended the education sessions also learned about the single most important benefit plan feature they enjoy – 100 percent employer-paid benefits – and how BCNU is committed to maintaining this for the health and well-being of all nurses. Members were also invited to provide input on their health benefits priorities and asked what they’d like to see improved (see sidebar).

WHAT DO WE MEAN BY BENEFIT COSTS?

The rising cost of extended health benefits has been raised as a serious issue by health employers for nearly a decade. However, many members may wonder why employers do not just buy health insurance from a benefit provider that’s less expensive than Pacific Blue Cross. This question was the subject of much discussion during the regional education sessions. When most people think of a benefits plan, they think of what is called an insured plan, where an employer purchases benefit plan insurance from an insurer, such as Pacific Blue Cross or Manulife. When purchasing insurance, an employer is charged an informed estimate of what the benefits will cost, a charge for administration, and an additional

amount (called a risk surcharge) in case of unexpected benefits costs. If health employers were purchasing insurance for a nurses’ health benefits plan, they might save money by finding another insurer that charges a lower risk surcharge. But health employers do not purchase insurance for nurses’ health benefits.

“It makes sense that nurses have a say in determining the future of their health benefits plan.” BCNU President Christine Sorensen

Instead, health employers self-insure the health benefits plan, taking on all the risk of unexpected health benefits costs. Instead of purchasing extended health benefits insurance from the benefits provider, they contract Pacific Blue Cross only to administer, or provide, the benefits to the member. This means that employers pay Pacific Blue Cross only for the cost of the benefits used by plan members, plus a small amount for administration. As a self-insured benefit plan, expenses are largely limited to the costs of those benefits claimed by members, and nothing else. This is an important distinction. It means that, with a well administered plan, the only savings that could be found by switching benefit providers would be in the small cost of administration. Conversely, if a self insured plan were administered poorly, switching


MEMBERS' VIEWS The Nurses' Bargaining Association is currently exploring benefits plan redesign options. What would you like to see in your benefits plan? plan administrators could save a lot of money.

WHO PAYS?

As a self-insured plan, nurses’ benefits are managed by a not-for-profit health benefits trust responsible for providing the benefits agreed to in the Nurses’ Bargaining Association (NBA) collective agreement. Under this contract, the employer pays the bill for the benefits plan, no matter the cost. This arrangement protects nurses against escalating costs and safeguards the benefits offered. Regardless of the cost of the benefits plan, the employer can only make changes to nurses’ benefits through collective bargaining. Maintaining a 100 percent employer-paid benefits plan is a key achievement for the BCNU. All other health union members in BC are now forced to share the responsibility for funding their benefits plan through a Joint Benefits Trust (JBT) agreement. Under a JBT, funding for the benefits plan, including extended health, dental, and long-term disability (LTD) benefits is negotiated in advance and capped. If the benefits plan costs more than the negotiated amount, plan members and the employer share responsibility for financing the extra cost. Under the 2019-2022 NBA provincial collective agreement, BCNU negotiated the opportunity for members to have a voice in the development of their future health benefits coverage while also securing 100 percent employer-paid funding. Sorensen says it’s a deal to be proud of. “BCNU remains committed to improving the value of nurses’ benefits while protecting those members who rely on them the most.” •

LEAH IZMIRLIJA, Fraser Valley

I think vision care is huge and I’d like to see laser eye surgery added. These are things that people are really asking for. I’d like our nurses to be more aware of what their benefits are. I feel like there is a big gap – where there are so many people who are unaware of what their benefits cover. I’d like to see some changes but nothing drastic. I’m concerned about the backlash to BCNU if there are drastic changes.

NICOLE SHERLOCK, Richmond Vancouver

Improved vision care would be nice. I’m considering getting new glasses and my husband needs new glasses. It would be nice if they covered the actual eye exam. I didn’t realize that although we are covered for the eyeglasses up to $350, we still have to pay out-of-pocket for the exam. My husband needs strong lenses. He has astigmatism and he’s paying $500 just for lenses.

BROOKE RAPHAEL, Simon Fraser

With kids, the cost of things like the learning assessments, therapy and all that kind of stuff is absolutely atrocious. There are kids who have a lot of needs, and I don't think our benefit package adequately supports our children.

ALEXANDRA HANSEN, Coastal Mountain

I do want to see more flexibility with the benefits package. I use chiro, massage, and acupuncture therapy for musculoskeletal pain. I have now used up all of my chiropractic coverage and for me [paramedical benefits] are all medically necessary. At this point I’m paying 100 percent outof-pocket for chiropractic benefits because I still need them over and above what’s covered under our current benefits plan. Massage is fantastic, but it doesn’t always cure everything. I think flexibility would make benefits more accessible because my care isn’t accessible to me at this point.

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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FEATURE

LEAP OF FAITH Innovative program supports members on their path to recovery and career success

OMELESS. UNEDUCATED. UNSUCCESSFUL. These were the stereotypes about substance users and people struggling with addiction that Kinnon Ross bought into while growing up. Now an adult, the Vancouver nurse today admits those myths helped buttress the denial of her own substance use disorder. “I had a pretty normal family. I attended private school. I travelled. I hold two degrees, including one achieved with honours. I’m happily married and own a car and home,” says Ross. “‘I am not an alcoholic – I go to work everyday,’ I told myself.”

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DECEMBER 2019/JANUARY 2020 • UPDATE MAGAZINE


HONOUR IN RECOVERY Vancouver’s Kinnon Ross feels confident about what she has to offer as a nurse thanks to the support she’s received from her union.

PHOTO: PETER HOLST


FEATURE

All that changed when Ross pressed send on an email to the BC Nurses’ Union that read: “I want to apply for the LEAP program and self-report for addiction issues. Thank you for your time.” Up until that point the St. Paul’s Hospital nurse had been abusing alcohol since she was a teen, eventually adding recreational stimulants. But by early 2016, Ross had hit rock bottom. BCNU’s LEAP (Licensing, Education, Advocacy and Practice) program was established in 1988 to assist members with legal problems related to professional practice incidents. Today the program provides a range of services related to registration and licensing (see sidebar). It also provides support to members who are struggling with mental health and substance use issues. It’s a unique program tailored to the needs of a union whose members are regulated professionals. BCNU President Christine Sorensen says it’s making a positive impact on the lives of members like Ross. “BCNU recognizes that when members are most vulnerable, they’re in need of immediate and comprehensive services,” Sorensen says. “At some point in their lifetime, it’s estimated that 10 to 17 percent of the general public experience mental health concerns. Statistically, that potential for vulnerability ranges from 4,000 to 6,500 BCNU members.” She adds that on average one percent of BCNU members will need to utilize LEAP services annually, with about 15 percent of those being substance use cases.

A JOURNEY TO WELLNESS

For years Ross had been coping with trauma from her youth, includ-

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When members are most vulnerable they’re in need of immediate and comprehensive services.” BCNU President Christine Sorensen

ing excessive bullying, by self-regulating her anxiety and depression with alcohol. She remembers binge drinking for the first time as a teen living at home in Edmonton. “I threw up. I had upset my friends. My parents grounded me. But my first thought was ‘I can’t wait to do that again!’” Heavy alcohol use continued into university where Ross participated in a widely accepted drinking culture. Again, by all appearances, she said she didn’t look like someone struggling with addiction. She made it to class, studied hard and graduated with her first degree in Women’s Studies from the University of Alberta in 2004. Looking for a fresh start, she headed to Vancouver and by 2009 she was in nursing school at Langara College. “My mom was a nurse, and I actually obsessed about being a nurse when I was younger,” she says. Ross broke her femur when she was eight years old and was hospitalized for three months. “It was a nurse who helped me do my homework, it was a nurse who read to me and it was a nurse who bathed me,” says Ross about her inspiration. Ross felt like she was following a path to career success. In 2012, she led the cohort that hosted the first Canadian National Students’

DECEMBER 2019/JANUARY 2020 • UPDATE MAGAZINE

Association Western Prairie Conference in Vancouver. She was also accepted into BCNU’s Employed Student Nurse Program, which allows nurses to gain clinical experience in special paid positions at health-care facilities. She also had good grades, being close to the top of her class. But despite her academic success, early signs of Ross’s inability to cope on the job started to emerge with her first full-time position in the medicine unit at St. Paul’s Hospital. “My practical skills were fine, my anxiety was not,” she recalls. “I was terrified of making a mistake and overwhelmed with the expectations of a new nurse. On my first day I had five patients, two needing blood transfusions and three with mental health issues.” She made mistakes, including small but noticeable ones involving narcotics. She began worrying more and felt unsupported and belittled. “Before my 90-day probation period was up, my operations leader told me in the middle of my shift that I would be required to report to the human resources department the next day,” she recalls. A more supportive learning plan, negotiated with BCNU support, which included mentoring by the new grad educator, was soon put in place. Ross was glad to still be working, but all the while her alcohol dependency was neither disclosed nor discovered. She says she continued to self-regulate her life the only way she knew how. “I was not eating or sleeping and used recreational stimulants and alcohol to survive when I wasn’t at work.” The stress of Ross’s job was compounded by two significant family deaths that occurred back-to-back in late 2014 and early 2015. She managed to complete a critical


care course in 2016 at the British Columbia Institute of Technology, finishing with distinction. However, during that time and while working as a student nurse in St. Paul’s intensive care unit, she collapsed from exhaustion. She had her blood pressure and blood glucose tested and was told to get some rest. Ross was able to dodge a urine test following her collapse, but the experience of coming so close to being discovered, and the realization that she had jeopardized a career she respected and valued brought her to terms with her disorder. “I did not want to lose my identify as a nurse and if I hurt someone - that scared me more than anything,” she says.

My practical skills were fine, my anxiety was not.” Kinnon Ross

The catalyst for action came when a nurse colleague told Ross that she had just come out of treatment with the help of the LEAP program. That’s when Ross decided to make her call. “Self-report to the college and don’t go to work” was the first piece of advice she received after connecting with a BCNU staff member. Deborah Charrois coordinates BCNU’s professional practice and advocacy department and manages the LEAP program. “Everyone who

participates in the LEAP program will have different needs”, she says. “Some members using LEAP services may self-report or the college will recommend that they reach out to us after being reported by an employer, colleague or member of the public.” When Kinnon reported she was supported by the Early Intervention Health Program (EIHP), which saw BCNU working together with the college to encourage nurses to self-report. The program allowed for nurses to be responsible and accountable to their regulator. In return, limits and conditions were not reported on the register. This program has since been discontinued by the BC College of Nurse Professionals (BCCNP). There is no requirement in the Health Professions Act to self-report. “In our opinion the legislation only requires another health professional to report someone if they believe there is reasonable and probable grounds that the continued practice of the nurse constitutes a danger to the public,” says Charrois. “As a result, we no longer advise members to self-report but do advise them to take medical leave if they are unfit to practice.” Upon intake, a BCNU professional advocacy officer is assigned to work with an individual member. If there is a BCCNP investigation, BCNU can assist with the process, which can include providing documentation, investigations, participating in interviews with BCCNP investigators, and providing written responses. Charrois says the professional advocacy officer will help the member navigate the BCCNP inquiry and discipline process, negotiate interim agreements, advise members on responses, negotiate complaint resolution agreements and discipline hearings.

WHEN A MEMBER IS STRUGGLING BCNU’s Licensing, Education, Advocacy and Practice (LEAP) program can offer members assistance with practice, mental health, substance use disorders and other issues. LEAP provides funding for independent medical and competency assessments and represents members throughout the regulatory college complaint resolution process. LEAP services include: • Education and support with the initial complaint response. • Representation and advocacy throughout the college investigations, review meetings and other processes. • Funding costs associated with attending required meetings and hearings. • Referrals to medical assessments, and payment of associated fees and travel costs • Covering some costs associated with follow-up monitoring. • Educational expenses for nursing skills assessments or mandated courses. • Negotiating complaint resolution agreements. • Act as a liaison with employers and other stakeholders to assist with a return to work.

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FEATURE

“While the online intake process takes little time, getting to a resolution varies case by case,” she notes.

A WIDE RANGE OF SUPPORTS

“Our team supports members like Ross who need help for substance issues,” says Charrois. “But we help nurses who are dealing with other professional issues.” LEAP files typically fall into three categories. There are those that deal with so-called fitness concerns, such as Ross’s, which include substance use or mental health challenges. There are those that deal with practice concerns such as documentation or medication administration errors, and there are those that deal with professional concerns, such as breaches of codes

SHOULD I APPLY? All LPNs, RNs and RPNs who are BCNU members are eligible to apply for LEAP advocacy and expense coverage. If you answer “yes” to any of the following statements, or if you’re unsure, please contact the LEAP program as soon as possible: • You, your colleague(s) or employer are concerned about your fitness to practise. This may include physical or mental health conditions, such as substance use or mood disorders. • Concerns have been raised about your competency to practise. • A formal complaint was made against your nursing practice. • You’re having difficulty obtaining a practising licence. • You have failed the CRNE.

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of ethics or patient confidentiality, inappropriate use of social media, or behaviour unbecoming of the profession. Charrois reports that the LEAP program has seen an increase in the number nurses being called out for social media misuse. “We worked on behalf of a keen new nurse who took a photo of an injury and posted it on social media,” she says. “He was excited about the cool things he got to see in his job.” Unfortunately, after his colleague reported him to the college, the nurse was charged with conduct unbecoming of the profession and breaching patient confidentiality. The injury he photographed could have identified the patient. “While the college inquiry committee originally wanted the member to agree to a term of suspension, through our successful negotiations we were able to reduce the discipline to a reprimand and further education on ethics and patient confidentiality,” she says. “Members have to remember that the mandate of the BCCNP is to protect the public, and that the LEAP program isn’t solely a remedial process,” stresses Charrois, who notes that punitive outcomes are meant as deterrents for all nurses engaging in unsafe practice and behaviour. “We see nurses looking up records of family and friends and with just one click they have left an electronic footprint that will have them in front of their college having to defend their actions,” she explains “Employers conduct electronic audits and colleagues have also been known to report the infraction.” Nurses deliver compassionate care, Charrois notes, and she reports that some members can develop bonds with their patients and clients despite rules against engaging in relation-

DECEMBER 2019/JANUARY 2020 • UPDATE MAGAZINE

I have created a whole new support system and feel confident about what I have to offer as a nurse.” Kinnon Ross

ships with those in their care. The LEAP program is also available to assist in these circumstances. In addition to the support provided within the above-mentioned areas, the LEAP program also assists members requiring medical assessments where the BCCNP is involved or potentially would be involved, applications for reinstatement of registration and remedial course funding. Needless to say, LEAP is a busy program that strives to address a range of professional issues. That’s why it’s all the more impressive that 86 percent of members surveyed recently reported that their first contact with the LEAP program was satisfactory or extremely satisfactory (see sidebar). Ross counts herself as one of those satisfied members even though she waited an excruciating six weeks before being accepted into an out-ofprovince treatment centre. “It’s been the only downside to this process – the wait for an open spot in a facility.” But the 42-day stay set her on a path to recovery. “The out-of-province facility supports health-care professionals, and knowing I was not


the only person in my situation was really helpful,” she says. Her stay in the treatment centre also made Ross incredibly grateful for being a nurses’ union member. “When interacting with other nurses from around Canada, I found that they didn’t have the same kind of supports that BCNU provided me – from the step-by-step processes to the funding.” Ross then applied to work in Providence Health Care’s Urban Health Program at St. Paul’s Hospital in 2016 and will complete her required three-year return-to-work monitoring period in February 2020. The Urban Health Program pro-

vides a range of coordinated inpatient and outpatient services in addition to specialized diagnostic and treatment services to a population with complex health problems that are often compounded by homelessness and substance use. “We work to hear our patients and guide them on the best course – it’s a community effort.” As a recovering nurse, Ross’ first year back did not allow her to work nights or be involved in delivering any part of the alcohol-management program. But it’s clear that working in the Urban Health Program has been crucial for her own recovery. “People would tell me to engage in ‘self care’-

MEMBER SURVEY SHOWS POSITIVE RESULTS In April 2019, BCNU members who received services through the LEAP program were contacted via email to participate in a confidential member satisfaction survey. The results were very positive overall and reflect the value of the program to members in need of support. Here are just a few of the testimonies:

and to me that was confusing – I didn’t think I needed more pedicures and bubble baths to fix my substance use problem,” she remarks. “I think the emphasis should be on ‘community care’ in that we can support each other with open ears and hearts. No amount of bubble baths was going to help me – self care meant drugs and alcohol.” It would be an understatement to say that the recovery process has changed Ross’s life. “I feel calm and I feel empowered,” she reports. “I have created a whole new support system and feel confident about what I have to offer as a nurse.” •

OVERALL SATISFACTON How would you rate your overall experience with the services you received through the LEAP program?

11% Extremely Unsatisfied

13% Unsatisfied

40% Extremely Satisfied

36% Satisfied

“All of my concerns were addressed respectfully, with appropriate referrals to highly skilled labour relations advocates, successful result on appeal.” “The staff were warm and non-judgmental. Very accommodating.” “The woman at LEAP who assisted me in my case was amazing. She educated me well on what to expect in the days and months to come, which gave me a sense of comfort knowing I was not in this alone.”

OUTCOMES Over 70 percent of respondents said their case has been resolved. And of those, 80 percent were happy with the outcome

14%

“I was at a very difficult time in my life and when I contacted LEAP they were professional, courteous and able to quickly get me the resources I needed. I am so appreciative of what they were able to do for me. Thank you.”

The LEAP program assisted me in returning to work (or staying at work).

“They have been instrumental during my LTD and now returning to practice has been much easier and they are helping me with everything!! This program is phenomenal!”

Members surveyed = 2,034 259 members responded (13% response rate)

Strongly Disagree

41% Strongly Agree

10% Disagree

35% Agree

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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VITAL SIGNS The nurse staffing crisis by the numbers

SK ANY ACUTE CARE NURSE working 16-hour days, long-term care nurse working short, or community nurse with an overwhelming caseload, and they’ll tell you that health care is a numbers game. But they’re not talking about the numbers marked on the barrel of a syringe, or the number of pills on a med tray. One of the biggest issues of concern for working nurses today involves the number of workers available to provide the care Canadians need and expect. There is a looming demographic crisis facing almost all sectors of the economy. Acute labour shortages are opening up as a generation of baby boomers retires. In BC the number of job openings is expected to exceed the supply of available workers through to at least 2028. Nursing and residential care are the fastest growing industries, meaning the health sector will be hit hardest by the crunch. For nurses, this forecast is a perfect storm of growing health-care demand coupled with a dwindling supply of health human resources. If serious action isn’t taken, nurses can expect to work longer hours in worsening practice conditions, all the while caring for an aging population with growing acuity.

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The scale of Canada’s nurse shortage is masked by employers’ chronic reliance on overtime to keep hospital wards staffed. It’s an unfortunate practice that’s not unique to BC. It’s also a costly, vicious circle driven by the acute shortage of specialtyeducated nurse positions, such as ER and OR nurses. In 2016, public sector health-care nurses in Canada worked an estimated 20.1 million hours of paid and unpaid overtime. This number is equivalent to 11,100 full-time positions, with 1,400 of those attributable to BC. In fact, unpaid nurse overtime in BC averaged 11,300 hours per week in 2016, at an annual value of $21.3 million.

NURSES ARE NEEDED NOW

Source: Canadian Institute for Health Information (CIHI) (2018). Nursing in Canada, 2018.

The correlation between excessive workload and employee burnout is well established. BCNU-sponsored research reveals that more than half our members have cited burnout as the main reason for their intent to leave their job or profession. Workload factors associated with nurses’ dissatisfaction include emotional exhaustion, short-staffing, and a lack of time to complete necessary nursing tasks. Just as important, of those BCNU members who work parttime or casual, over one-third told researchers that they chose to work fewer hours because they felt that fulltime work was too demanding. One in five nurses in Canada leaves their job each year, resulting in enormous turnover costs. This should serve as a serious wake-up call. There’s no question that nurses are committed to safe patient care, but there is clear evidence that without the necessary support, they are sacrificing their own well-being in the process. Governments and health employers have no difficulty proclaiming the importance of nurses and other health-care workers. But to date, investments made have not measured up to the sentiment. It’s time for us to put our money and our smarts where our values are. The statistics that follow provide an overview of the staffing crisis and the changing nature of the nursing workforce.

1,316

1,019

889

1,017

1,100

1,058

935

1,294

1,452

BC also ranks second lowest in per capita health-care spending in Canada, at $6,597 per person each year, slightly above Ontario at $6,584 per person.

THE HUMAN COST

Nurse workforce by province in 2017

BC ranks lowest in the country for RNs and LPNs working in direct care per capita, at 889 RNs and LPNs per 100,000 population. The next closest is Ontario at 935.

1,015

For years, BCNU has been working constructively to help address the crisis. At the bargaining table we’ve secured employer commitments to create thousands of new regular nurse positions in all health-care sectors and provide existing staff with paid education to work in specialty nursing positions. We also understand the challenges

OVERTIME IS NOT THE SOLUTION

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LISTEN TO NURSES

of rural and remote recruitment, and negotiated dedicated funding to address the staffing needs of remote communities. This has helped fund grants for such things as tuition relief, loan forgiveness and housing assistance to help make these jobs more attractive to nurses. Most recently, BCNU negotiated detailed contract language to encourage managers to staff units appropriately and avoid the use of overtime. This kind of systemic change has the potential to save hundreds of millions of dollars that could be invested in new nurse positions and help reduce the toll on nurses’ health and well-being.

1,295

It’s clear that planning and investments are needed now. The health-care sector is as vital to the economy as any other industry. And the health-care workforce is not just an expense, but an economic driver that enables productivity and prosperity in every corner of the country. Over 1.5 million people work in Canada’s health sector and 70 percent of all direct health-care costs go to labour – the majority being nurses. According to official statistics, there were 431,769 regulated nurses in 2018 – at a cost of more than $150 billion a year. And still there are not enough. It’s a global problem. The World Health Organization estimates that within a decade we will be short some 18 million health-care workers worldwide. The US will be short one million nurses and over 100,000 doctors – and luring Canadians south as a result. Canada in turn will increasingly look beyond its borders for educated healthcare workers. Today, one in four are now internationally educated.

RNs and LPNs/100K population

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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TOO MUCH WORK AND TOO FEW NURSES

SUPPLY OF REGULATED NURSES

The number of job openings in BC is expected to exceed the supply of available workers through at least 2028, according to the most recent BC Labour Market Outlook. Job growth in the province is forecast at 11 percent annually. The health-care sector tops the list of fastest growing industries, with nursing and long-term care sitting at number one, surpassing both the IT and film industries.

NUMBER OF REGULATED NURSES WITH A LICENCE TO PRACTISE IN 2018 (These figures are greater than the number of employed nurses.)

COMPOSITION OF JOB OPENINGS RNs/RPNs Replacement of retiring workers PROVINCIAL

52,475

37,774

11,982

2,719

Registered Nurses (RN)

Licensed Practical Nurses (LPN)

Registered Psychiatric Nurses (RPN)

NATIONAL

431,769

303,146 122,600 6,023

58.6% 11,470 openings

New jobs due to economic growth 41.4% 8,110 openings

Source: CIHI (2018). Nursing in Canada, 2018.

RETIRING

NEARLY

Source: CIHI (2018). Nursing in Canada, 2018.

IN DEMAND

40%

of nurses will retire in the next ten years

25,000+ nurses needed

to staff BC’s health-care system in the next decade Source: BC Labour Market Outlook: 2018 edition.

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DECEMBER 2019/JANUARY 2020 • UPDATE MAGAZINE

LPNs Replacement of retiring workers 50.4% 2,320 openings

New jobs due to economic growth 49.6% 2,280 openings


REGULATED NURSING WORKFORCE NUMBER OF NURSES EMPLOYED IN BC IN 2018 AND NUMBERS OF JOB OPENINGS NEEDED OVER THE NEXT 10 YEARS

LEGEND

Nurses employed in 2018 Expected number of nurse job openings over the next 10 years

NORTH COAST/ NECHAKO

RN/RPN

LPN

440

80

180

30

NORTHEAST

RN/RPN

LPN

530

130

180

50

CARIBOO

RN/RPN

LPN

1,450

360

390

110

VANCOUVER ISLAND/ COAST

RN/RPN

LPN

9,400

2,200

4,290

1,080

MAINLAND/ SOUTHWEST

RN/RPN

LPN

29,200

4,790

11,730

2,420

BC NURSES LABOUR MARKET OUTLOOK (2018–2028)

RN/RPN LPN 37,500 7,500

THOMPSONOKANAGAN

KOOTENAY

RN/RPN

LPN

RN/RPN

LPN

5,280

1,730

1,100

330

2,320

770

480

140

19,580 4,610 Source: BC Labour Market Outlook: 2018 Edition.

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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CURRENT TRENDS SOME GROWTH AND A CHANGING WORKFORCE The nursing workforce in Canada grew by 1.0% between 2017 and 2018, following the same trend as the Canadian population, which saw growth of 1.2%. The annual growth rate has decreased over the last 5 years, down from 2.2% in 2014

MORE MALE NURSES Over the past 5 years, the growth in supply of male nurses was

3X

that of female nurses

GROWING WORKFORCE The nursing workforce continues to grow

41 years old

In line with the Canadian population growth (1.2%)

2014

18%

1%

Male nurse increase vs

2018

growth rate

5%

Female nurse increase

LPN WORKFORCE Saw the highest annual growth rate in 2017–2018

YOUNGER NURSES Overall, the nursing supply is younger, compared with 5 years ago

MORE THAN

UNFILLED NEED Between 2008 and 2017, the number of graduates from registered nursing programs in BC grew at an average annual rate of 3.8%, reaching 1,466. But it’s still not enough. In BC the number of job openings is expected to exceed the supply of available workers through to at least 2028. Nursing and residential care are the fastest growing industries, meaning the health sector will be hit hardest by the crunch.

4X

that of the RN workforce

60%

BC 10-YEAR TREND IN CUMULATING WORKFORCE GROWTH, 2009–2018

50%

40% 30%

52% LPN

20%

RPN

10%

16%

RN/NP

0% 2009 –10% Source: Cihi/Regulated nurse: 2017: Canada and Jurisdictional Highlights.

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20.1%

Cumulative Growth (%)

DECEMBER 2019/JANUARY 2020 • UPDATE MAGAZINE

2018


WORKING CONDITIONS NURSES PAY THE PRICE

OVERTIME IN BC

Canada’s nurse staffing crisis is characterized by an acute shortage of specialty educated nurse positions. The resulting work and practice conditions

come with an enormous human cost, and without the necessary support nurses are sacrificing their own well-being.

TOTAL ANNUAL COMBINED COST AND VALUE OF OVERTIME IN 2016

20.1 MILLION

hours of overtime worked by nurses in 2016

11,100

full-time jobs equivalent

27.1% NATIONAL

PROVINCIAL

$968

$142

MILLION/YEAR

MILLION/YEAR

292,500

42,600

COST OF PAID OVERTIME

HOURS/WEEK

$788.4M

ANNUAL COST

95,000

HOURS/WEEK

$180.1M

ANNUAL VALUE

$21.3M

MILLION

MILLION HOURS

3.3

average number of extra unpaid hours worked per week Canadian Federation of Nurses Unions (CFNU) by Jacobson Consulting Inc., Quick Facts 2017.

STRESS AND BURNOUT Source: Data shared by HEABC through bargaining of the 2019-2022 NBA provincial collective agreement

1,158,521

HOURS OF RELIEF WERE NOT FOUND

the equivalent of

96,543

UNFILLED 12-HOUR SHIFTS

or

265

19%

OF NURSES SCREENED POSITIVE FOR PTSD

INADEQUATE STAFFING IN BC IN 2018:

average number of extra hours worked ked per week

VALUE OF BC NURSES' UNPAID WORK IN 2016

the equivalent of

2.2

7.1

$21.3

AMOUNT BC HEALTH AUTHORITIES SPENT ON PAID NURSE OVERTIME IN 2018

17.5%

11,300

ANNUAL VALUE

MILLION

nurses that worked unpaid OT

nurses that worked paid OT each week

HOURS/WEEK

$162.2

12.2%

$121.1M

ANNUAL COST

VALUE OF UNPAID WORK

HOURS/WEEK

percentage working overtime in 2016

Source: NSS Staffing Data shared through HEABC, annualized to 365 days.

UNFILLED NURSING SHIFTS PER DAY

2.4%

AVERAGE RATE AMONG GENERAL PUBLIC

20%

OF NURSES HAVE CONSIDERED LEAVING THE PROFESSION DUE TO WORKLOAD Source: MacPhee, M., Rodney, P., Havaei, F., Musto, L., & Caldana, G. (2016). BC nurses’ workload impact study: Final report. Vancouver: University of British Columbia & BC Nurses’ Union.

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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MEMBER PROFILE YOUR COLLEAGUE CLOSE-UP

WEATHERING THE EBB AND FLOW BRENNA YOUNG OUTLINES THE LURE OF COMMERCIAL FISHING BRENNA YOUNG WILL never forget standing on the deck of her father’s fishing boat enjoying a glorious sunset at sea when a dozen massive humpback whales began breaching nearby. “It takes your breath away,” says the 21-year-old nursing student. “It is magical.” It wasn’t the first time, or likely the last, that Young was left wowed by the beauty to be found traversing BC’s coastal waters. She’s grown up on commercial fishing vessels, accompanying her family and father for stretches on the ocean since age four. She started working with her dad as a commercial fisher during the summer seasons in her early teens. Beyond the incredible surroundings, Young finds fishing satisfying. She gets to work with her dad, sister and close friends. And although it gets claustrophobic at times, it brings them all together. “A lot of girls my age wouldn’t be able to spend that amount of time with their dad. It’s made us super

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close,” Young says. There’s also a huge rush to be had from bringing in a good haul of fish. “When you pull up a line and see the salmon jerking and you get your gaff out and pull, landing it on the boat, there’s a high.” “That’s a $200 bill that just landed on the deck,” Young notes. There’s a sense of accomplishment in feeding so many people and in helping her dad earn what it takes to put food on the table and a roof overhead at their home in Pender Harbour. The good wages are a draw as well. Young is currently in her second year of a BSN program at the University of Victoria and hopes to work in her community after a planned 2022 graduation. Her income from fishing gives her the freedom to concentrate on her studies during the school year without having to work on the weekends. But fishing is not all comfort in clover. The days are long, the work is hard and the condi-

DECEMBER 2019/JANUARY 2020 • UPDATE MAGAZINE

OCEAN BOUNTY Brenna Young hoists a freshly caught spring salmon off the coast of Langara Island in August.

tions can be gruelling. When fishing for salmon, Young often finds herself on the water for 13 days at a time, working non-stop for as many as 15 hours a day. On her father’s troller, the Shirley Evelyn, kilos and kilos of the boat’s catch must be hauled below into the onboard freezer that sits at – 25C. “Putting fish down there is pretty brutal if it’s raining and your clothes are already wet,” Young observes. Then there’s the joy of waking up with cramped hands after snapping hundreds of hooks to lines and the constant gutting of cold halibut. And not with some understatement, she observes the elements can work against you. “The weather’s not always the best. We had four-metre seas at the end of August.” Then there’s the feeling

of vulnerability experienced during a night watch off BC’s North Coast. It’s pitch black and there are other boats, rocks and huge freighters about in the same seas. “You’re always afraid of hitting something,” Young says. But the hard spells are offset by periods of extreme calm that she cherishes. When waiting for fish, she settles down in the stern’s cockpit and stares out at the ocean, listens to music and chills out. There’s no cell service, running chores, doing homework or other pressing distractions. “I love that. You’re completely disconnected,” says Young. “It gives you a lot of time to think and reflect. It’s a calmness you never get at home. “When I finally do step back on land, I’m physically exhausted but I have a fresh mindset.” •


YOUR BENEFITS COVERAGE YOUR FAMILY RELIES ON

BIOLOGICS, BIOSIMILARS AND BLUE Rx CHANGES TO COVERAGE ACHIEVE MUCHNEEDED COST SAVINGS IN MAY 2019, BC PharmaCare announced an initiative to shift coverage of three biologic drugs that treat chronic conditions including diabetes, arthritis, ulcerative colitis and Chrohn’s disease to their biosimilar versions. It’s a move that should result in significant cost savings to both the provincial heath budget and employer-paid extended health plans, leaving more money for other kinds of medications or new and improved treatments.

used to treat conditions such as rheumatoid arthritis and Chrohn’s disease have been the single biggest expense for public drugs plans in Canada, and more than onethird of public drug spending was used to cover just two percent of beneficiaries in 2017. In contrast, biosimilar versions cost anywhere from 25 to 50 percent less to produce, as manufacturers rely on the research and development of biologic drugs. Prior to being approved for use by Health Canada,

“We are encouraged by the news that this decision will significantly reduce health-care costs without compromising patient safety.” BCNU President Christine Sorensen

Biosimilars are highly similar versions of biologic drugs – or biologics – that are bioengineered using living organisms like yeast and bacteria. Biologics are very expensive to produce. Since 2013, biologic medications

biosimilars must demonstrate through comprehensive studies and human clinical trials that there are no clinically meaningful differences in safety and efficacy between them and the biologic drug.

In 2018 BC spent $125 million on just three biologics now affected by this policy change – Lantus (insulin gargine), Enbrel (entanercept) and Remicade (infliximab). The provincial PharmaCare plan’s decision to transition coverage to the biosimilar versions of these drugs should result in savings of almost $100 million over three years. BCNU President Christine Sorensen says the expected savings will ensure that many more British Columbians are able to receive the care and medication they need. “We are encouraged by the news that this decision will significantly reduce government health-care costs without compromising patient safety and treatment – the savings will also afford employer-paid extended health plans more flexibility when planning for the services they cover.” PharmaCare coverage for certain higher-cost biologics was discontinued on Nov. 26 and coverage will instead be provided for their biosimilar equivalents. Coverage for original biologics will continue to be available for exceptional cases.

HOW IS BLUE Rx CHANGING? Reimbursement for Lantus, Enbrel and Remicade will also be changing under

the Nurses’ Bargaining Association drug plan. Blue Rx and BCNU has been working closely with Pacific Blue Cross to support members through this change. Blue Rx coverage of Lantus will continue for those plan members currently prescribed this medication. Members starting new treatments will receive coverage of the biosimilar Basalgar. Plan members who are currently prescribed Remicade and Enbrel have been encouraged to consult with their physician when transitioning to the biosimilar. If your physician determines you are medically unable to transition to the biosimilar drug, exceptional requests for coverage may be sent to BC PharmaCare and will be reviewed on a case-by-case basis in consultation with physician-led advisory committees. Blue Rx will reimburse these drugs when approved by BC PharmaCare. • Questions? The BC Government is offering extensive resources including a patient support program for affected members. Information can be found at: www.gov.bc.ca/ biosimilars Members may also contact the specialized pharmacy services staff at Pacific Blue Cross at pharmacyservices@bluecross. ca or 1-877-722-2583

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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PROFESSIONAL ISSUES IN THE WORKPLACE

ADVOCATING FOR YOUTH MENTAL HEALTH SERVICES Nurses on multiple units at Nanaimo Regional General Hospital come together and use the professional responsibility process to secure much needed services for youth who have multiple vulnerabilities THE NEED FOR APPROpriate youth mental health services has been identified as a critical area of concern for BC's health-care system. Youth mental health admissions continue to rise, and today adolescents with mental health crises wait–in some cases for days–in emergency departments across the province. Add to this a growing number of youth presenting with substance use issues and it becomes clear that more action is needed. As far back as 2014 the province’s representative for children and youth called on the government to begin providing appropriate care for children and youth who have multiple vulnerabilities. The health-care system today is still short on the skilled staff and physical infrastructure need to care for young adults. Julia Sewell works on the Psychiatric Emergency Services (PES) unit at Nanaimo Regional General Hospital (NRGH). In early 2017 she identified this problem at her facility and initiated the professional responsibility process (PRP) to document a recurring

34

situation she felt was endangering the care of children and adolescent psychiatric patients. PRP language in the Nurses’ Bargaining Association contract allows nurses to engage in productive dialogue with their employers over practice conditions that may be compromising safe patient care. The process is designed to identify problems and resolve issues without involving blame. NRGH’s PES unit is an adult psychiatric unit located within the hospital’s emergency department (ER). Sewell was concerned about the fact that there was no allocated safe space on her

known as community youth mental health substance use (CYMHSU) patients – was to move them to the hospital’s pediatric unit, but this area lacked an appropriate physical environment to treat children admitted for psychiatric or non-medical reasons. In addition, the pediatric nurses working there were not required to have the psychiatric training needed to properly assess adolescent patients. It has become clear to Sewell and others at the hospital that these CYMHSU patients were falling into a gap in the continuum of care. “By nature the PES unit can be a bit volatile – we often

“We certainly needed more education and skills to care for that age group.” Jennifer Jensen

unit to assess youth presenting with mental health or substance issues, away from potentially traumatic exposure to adults with unstable or inappropriate behaviours. The only possible alternative for this population –

DECEMBER 2019/JANUARY 2020 • UPDATE MAGAZINE

deal with substance use and our sense was that the unit was not a particularly conducive place to house minors,” Sewell explains. “Oftentimes it's their (the minor) first intake into mental health and we would like it to a be posi-

tive experience, and for them to feel safe and come back at some point if they need to.” NRGH pediatric unit nurse Carly Tarr shared Sewell’s concerns, and knew that her unit was also no place for these youths. “Pediatrics is an eight-bed unit that's only covered by two full-time nurses at any given time” she explains. “We were lacking a safe space for these kids who are a bit too dysregulated to be admitted to the pediatrics unit but also too young to be admitted to the adult-centered psychiatric emergency area.” Jennifer Jensen works with Sewell on the PES unit. The nurse also voiced her concerns using the professional responsibility process. “At that time there were no age guidelines for intake; we did our best not to have minors on the unit, but there really wasn’t any other place to service them and so that became the essence of our PR concern.” “We were all very uncomfortable with the fact that we had all too often been trying to care for a minor on a very active, very acute psychiatric unit.” Nurses start the PR process by having a conversation with their manager and if that doesn't result in action, they move to step two and fill out a professional responsibility form (PRF). Sewell first brought nurses’ concerns to managers’ attention in early 2017.


PHOTO: JENNA LEFEBVRE

SAVOURING SUCCESS Nanaimo Regional General Hospital nurses Julia Sewell and Jennifer Jensen are happy with the outcome of a professional responsibility process that has seen the facility add a dedicated space for community youth mental health patients.

“I recall having a meeting with management and we discussed the problems as we saw them. But managers soon wanted to go to the next level [of the PR process] as other nurses with similar concerns became involved,” she says. “We sat down with administration and had a round-table discussion as a team.” Afterwards, Sewell, Jensen and other nurses working on the PES unit, pediatrics and in the ER documented their concerns on PRFs, which were then forwarded to the worksite Professional Responsibility Committee (PRC). This committee is comprised of two co-chairs

representing the union and the employer, the nurses with the concerns, the union steward, immediate supervisor and the excluded manager. A PRC meeting was then called and nurses in the three affected units, management and hospital leadership all displayed a unified desire to resolve the issue. Various strategies were discussed and significant recommendations were then made: designing an algorithm to use when adolescent youth presented to the ER with signs of mental health issues, creation of appropriate safe space for these children, and creating a policy that sets the minimum

age for admission to the PES unit at 16. However, several children under the age of 16 continued to be admitted to the PES unit while the group waited for an evaluation of the newly adopted algorithm simply because there was no other appropriate place to hold them. The problems persisted despite the policy and practice changes that were eventually put in place. The nurses decided that the agreed-to changes were not sufficient to resolve the issues at the worksite level and the PRC co-chairs agreed to recommend advancing the matter to the Senior Review Committee (SRC). “It truly was about the physical space,” Jensen says. “We certainly needed more education and skills to care for that age group, but our primary concern was not how we dealt with them from a nurse-to-patient point of view, but where we cared for them so that we’re not exposing them to all that acuity.” Under the PRP language that these nurses used, when a professional practice issue couldn’t be resolved or decided at the local level it was advanced to the SRC, the third step of the PRP.* The SRC meets with

frontline nurses and listens to their challenges and then meets with leadership to navigate the challenges that staff are facing. Follow-up is critical to ensure they have all the information to discover, and then recommend, appropriate solutions. Throughout the process, the NRGH nurses were assisted by Pacific Rim region PR advocate Sharon Fulton, who also helped by consulting with experts in community mental health, like Comox Valley's Deidre Knudson. “There’s been a historic lack of support for this specific [CYMHSU] population, and we wanted to look at the big picture so we could make a [recommendation] to really keep this population safe,” Knudson explains. Nurses representing the NRGH PES unit, pediatrics and the ER spoke at an SRC hearing in early 2019, imploring the committee to help the hospital implement the changes they believed were desperately needed. Their proposals included creating the physical space required to properly care for adolescent youth; providing pediatric nurses with psychiatric education, and hiring child, youth and family crisis nurses who could work

* These members’ professional responsibility initiative followed the process that existed under Article 59 of the now expired 2014-19 NBA collective agreement. A new process was negotiated and is now in effect under the terms of the 2019-22 NBA agreement. Details can be found at www.bcnu.org

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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PROFESSIONAL ISSUES IN THE WORKPLACE

on all of the affected units to effectively care for the children and youth at NRGH. But the multiple units affected made the committee's job of assessing these proposals somewhat more challeng-

ing. BCNU West Kootenay region executive member Glenna Lynch was BCNU’s representative on the SRC. “Typically we would just be addressing issues related to one unit,” she says, “and

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

Richmond Vancouver Romy de Leon romeodeleon@bcnu.org

Coastal Mountain Genevieve Dallimore genevievedallimore@bcnu.org

Shaughnessy Heights Manpreet Mann manpreetmann@bcnu.org

East Kootenay Samantha Molloy samanthamolloy@bcnu.org

Simon Fraser Vacant

Fraser Valley Heather Tillack louisatillack@bcnu.org North East Carla Weetman carlaweetman@bcnu.org North West Samantha Martin samanthamartin@bcnu.org Okanagan Similkameen Deborah Duperreault dduperreault@bcnu.org Pacific Rim Sharon Fulton sharonfulton@bcnu.org

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South Fraser Valley Carmen Mangoyob carmelitamangoyob@bcnu.org South Islands Daphne Wass daphnewass@bcnu.org Thompson North Okanagan Myrna Nichols myrnanichols@bcnu.org Vancouver Metro Luba Veverytsa lyubovveverytsa@bcnu.org West Kootenay Nicole Cameron nicolecameron@bcnu.org

DECEMBER 2019/JANUARY 2020 • UPDATE MAGAZINE

although this PR process originated in the hospital’s PES unit, the SRC decision would also impact the ER and pediatric unit – and we would also need to take community mental health services into consideration.” She explained that her SRC co-chair Dawn Nedzelski, who was the employer representative and Island Health chief nursing officer, needed to hear from nurses in all of the units involved to understand how the continuum of care for CYMHSU patients – and the staff caring for them – would be affected. “When you look at a health authority and what it takes to create new policy and procedure - the levels of regulation can be extensive and time-consuming,” explains Lynch. Despite this challenge, she firmly believes the SRC’s collaborative approach to problem-solving helped it arrive at a solution. “There was no ‘us and them,’” she states. “We had a communications process where the front-line staff actually got to convey what happened with their patients directly to the CNO, who has the ability to make change.” Success came when the SRC issued its report stating that its recommendations were made with a view to shifting care from simply providing a safe environment during crises

to providing accessible, specialized multidisciplinary care. SRC recommendations are unanimous and binding. In this case they required Island Health to provide accessible, physical space for CYMHSU patients, design focused psychiatric education for pediatric and ER nurses required to care for this patient population and establish crisis nurse positions in the ER equivalent to 3.3 new full-time positions. Following the SRC report, Island Health began converting one of the existing quiet rooms in the ER into the dedicated safe space for youth. Fulton reports that the child, youth and family crisis nurses began their new positions on November 25, 2019. “Three of the four positions have been filled, with one more position to be hired in the near future.” She confirmed that the new positions will be staffed from 8:00am to 4:00pm and from 3:30pm to 11:30pm seven days a week to coordinate and oversee the care for youth in need. “This was such an amazing file to be a part of,” remarks Lynch. “I was so impressed and proud to see all these health-care workers come together to advocate for better care and appropriate space – it will have a positive impact on the continuum of care for these kids.” •


COUNCIL PROFILE HERE’S WHO’S WORKING FOR YOU

“I got involved with the union because it is a strong advocate for nurses and for safe patient care,” says Richmond Vancouver region chair Sara Mattu.

FOLLOWING HER HEART RICHMOND VANCOUVER CHAIR SARA MATTU

QUICK FACTS NAME Sara Mattu GRADUATED Kwantlen Polytechnic University (RN) University of BC (BSN) UNION POSITION Richmond Vancouver chair WHY I SUPPORT BCNU? “BCNU is the one organization that looks out for nurses – everything we do is about helping nurses and providing them with the support and guidance to do their job better.”

BCNU RICHMOND Vancouver region chair Sara Mattu knew from a young age that she wanted to be a nurse. On her first day of high school, Mattu’s Grade 8 teacher asked students to write down what they wanted to be when they grow up. Mattu vividly remembers writing, “I want to be a nurse,” on her piece of paper. But after Mattu graduated from high school five years later, she enrolled at Kwantlen Polytechnic University (KPU) to pursue a career in accounting. “My father was an accountant,” she explains, “and it was his desire for me to follow in his footsteps.” To her father’s dismay, Mattu only made it through the first year of the accounting program. She decided to follow her heart after learning that the nursing program was accepting applications. “I knew that I wanted to work in a field where I could care for people in their most vulnerable moments, especially seniors,” she says. “Ever since I can remember, I have enjoyed spending time with my elders. I would spend countless hours

talking to them and listening to their stories.” After working for several years at Richmond Hospital, Mattu’s passion for advocacy led her to become involved with BCNU in 2004 as a regional communications secretary. “I got involved with the union because it is a strong advocate for nurses and for safe patient care,” she explains. “I wanted to use my voice in a positive way to advocate for all nurses and contribute to change – I’ve never looked back since!” Over the years, Mattu has represented her region as a lobby coordinator, steward liaison and professional responsibility advocate. In 2017, Mattu was elected as Richmond Vancouver region chair. She now makes it her personal goal to engage with as many nurses in her region as she can through worksite visits and at regional events including lunch and dinner meetings. “Nurses work very hard and they are extremely busy. To make it easier for them, I visit worksites regularly to meet with members before or after their shifts,”

she reports. “I want them to know that I’m here to support them, I’m willing to listen, to try to address their concerns, to educate them about the collective agreement, and to empower them to utilize the many tools and resources that BCNU offers.” On top of her duties as regional chair, Mattu acts as a clinical instructor at KPU and serves on BCNU’s Bursary Committee, Mosaic of Colour caucus, Internationally Educated Nurses’ working group and the joint Nurses’ Bargaining Association-Vancouver Coastal Health Strategic Nurse Staffing Committee. Outside of her many BCNU responsibilities, Mattu can be found enjoying long walks with her beloved Havanese poodle, Coco. She also enjoys gardening and sewing traditional garments for her teenage daughters. “As they become more and more independent, I’m finding time to rediscover my own passions and hobbies. But working with BCNU and using my voice to advocate for better working conditions for nurses continues to be a top priority.” •

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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WHO CAN HELP? BCNU IS HERE TO SERVE MEMBERS

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

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

EXECUTIVE COMMITTEE

REGIONAL REPS CENTRAL VANCOUVER Marlene Goertzen Co-chair C 778-874-9330 marlenegoertzen@bcnu.org Judy McGrath Co-chair C 604-970-4339 jmcgrath@bcnu.org COASTAL MOUNTAIN Kath-Ann Terrett Chair C 604-828-0155 kterrett@bcnu.org EAST KOOTENAY Helena Barzilay Chair C 250-919-3310 hbarzilay@bcnu.org FRASER VALLEY Tracey Greenberg Chair C 604-785-8147 traceygreenberg@bcnu.org

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

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

VICE PRESIDENT Aman Grewal C 778-879-5485 amangrewal@bcnu.org

EXECUTIVE COUNCILLOR Chris Armeanu C 604-209-4260 chrisarmeanu@bcnu.org

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

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

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

SOUTH ISLANDS Lynnda Smith Co-chair C 778-977-6315 lynndasmith@bcnu.org

NORTH WEST Teri Forster Chair C 250-615-8077 teriforster@bcnu.org

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

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

OKANAGAN SIMILKAMEEN Rhonda Croft Chair C 250-212-0530 rcroft@bcnu.org

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

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

DECEMBER 2019/JANUARY 2020 • UPDATE MAGAZINE

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

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


OFF DUTY MEMBERS AFTER HOURS

BARRELLING THROUGH LIFE VANESSA LEGGETT EMPLOYS GUTS AND TRUST TO KICK UP DUST ON THE RODEO CIRCUIT VANESSA LEGGETT GREW up on the back of a horse. Many of the 24-yearold nurse’s first memories involve her careening around the “cans” in a riding ring on the back of Sage, her little white Shetland pony. “I’ve been barrel racing since I was four. I was born into it,” says Leggett. She and her horses were trained by her mother Julie, who was a professional jockey before breaking her arms and transitioning to barrel racing and ultimately the pro rodeo circuit. “I just picked it up right away, loved it, and so followed in her footsteps.” Soon enough, Leggett graduated from the pony to her mom’s old rodeo horse, appropriately named Burnit. The big black mare’s approach to barrel racing was: go fast and hang on or don’t even try,” recalls Leggett with a laugh. “I remember people would always get scared because I would go so fast when I was so little.” Barrel racing is a timed event in which a rider and horse run a cloverleaf pattern around three barrels as quickly as possible without knocking them over. Leggett credits Burnit with cementing her love

for a sport that combines adrenaline with accuracy, athleticism and balance and, of course, superior horsehandling skills. Barrel racing also requires no small amount of courage given the speed and momentum with which rider and horse navigate the course and round the large metal cans. “It’s a bit dangerous because horses really lean in during the tight turns. I’ve had a few wipe outs and it’s a little scary,” she says. “You have to be a good pilot.” But a horse that loves its job is as important as a good rider. And, so is the connection between the two, she adds. “You can’t get anywhere without a good horse. You have to have a bond with your horse,” she says. “When they do trust you, they kinda give you everything.” Leggett figures she fosters that connection through her riding style. “I have really quiet hands and don’t like to pull on them…I just work with them

and try and find their footing and encourage them.” Her riding skills have proven results in various rodeo circuits. In 2012, at age 17, Leggett won the BC High School Rodeo Association barrel racing championship in her rookie year. She followed that up by heading down to Wyoming and placing first at the National High School Finals, which includes competitors from Canada, the US and Australia. That led to a one-year scholarship at Texas Tech University and competing in the college rodeo circuit where Leggett and her horse, Shiver, regularly placed in the top 10 at events. But she decided to return home to Kamloops to study nursing. “I’ve always liked doctoring and taking care of horses, so that was a big indicator for choosing nursing,” she says. After graduating from Thompson Rivers University this June, Leggett began working on a medical and palliative unit at

Royal Inland Hospital. She juggled barrel racing during her studies, and more recently, while working a full-time job. She admits fitting it all in was hectic. But despite the costs, travel and all the hours of training and work involved, Leggett plans to continue competing and hopefully qualify for the finals in the professional circuits like her mom. But the main motivator for the self-professed adrenaline junkie is her love of barrel racing. “It’s my passion. It’s fun, exciting and very fast. Performing for large crowds is exhilarating,” she says. “You need to find something that makes you happy and keeps your mental game strong.” •

TOP RIDER Vanessa Leggett’s passion for rodeo barrel racing knows no bounds. She’s seen here riding at the British Columbia Rodeo Association year-end finals this fall.

UPDATE MAGAZINE • DECEMBER 2019/JANUARY 2020

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Season’s Greetings From Your BCNU Council

(named in alphabetical order) Chris Armeanu Helena Barzilay Hardev Bhullar Rhonda Croft Teri Forster Meghan Friesen Adriane Gear Wendy Gibbs Marlene Goertzen Tracey Greenberg Aman Grewal Claudette Jut Rachel Kimler Lynn Lagace Walter Lumamba Sara Mattu Judy McGrath Ron Poland Tracy Quewezance Lynnda Smith Christine Sorensen Sharon Sponton Kath-Ann Terrett Danette Thomsen Margo Wilton

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Profile for BC Nurses' Union

BCNU Update Magazine December 2019/January 2020  

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BCNU Update Magazine December 2019/January 2020  

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