National Nursing Week | 2019

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“To be ‘in charge’ is certainly not only to carry out the proper measures yourself but to see that every one else does so too.” Florence Nightingale “To be ‘in charge’ is certainly not only to carry out the proper measures yourself but to see that every one else does so too.” Florence Nightingale

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L’Université de Saint-Boniface is proud to announce that its School of Nursing and Health Studies was recently granted national accreditation by the Canadian Association of Schools of Nursing (CASN), becoming the first nursing school in Manitoba to receive such a recognition of excellence. bravo!

L’Université de Saint-Boniface est fière d’annoncer que son École des sciences infirmières et des études de la santé a récemment obtenu l’accréditation nationale de l’Association canadienne des écoles de sciences infirmières (ACESI), devenant la première école de sciences infirmières au Manitoba à recevoir une telle reconnaissance d’excellence.

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VOICES TO LEAD — POWER FOR CHANGE EVERY NURSE HAS A STORY AND EVERY STORY HAS THE POTENTIAL TO IMPROVE THE HEALTH SYSTEM E ach year, we pause to recognize nurses during the week of May 12 to coincide with the birthday of nursing pioneer Florence Nightingale. This year, National Nursing Week runs from Monday, May 6 to Sunday May 12, with a focus on the theme, By Jennifer McFee

Nurses: A Voice to Lead – Health for All. This theme illustrates that every nurse has a story to tell, and each of those stories has the power to improve physical and mental health outcomes for all. During National Nursing Week, we celebrate the roles nurses play in every area of health care, from cradle to grave, as researchers and administrators, educators and advocates, and as hands-on caregivers in hospitals, clinics, long-term care facilities and in the greater community.

COLLEGE OF REGISTERED NURSES OF MANITOBA

2018 was a big year for registered nurses (RNs) since they became governed under the Regulated Health Professions Act (RHPA) last May 31. “The RHPA provides a framework for how we work together as inter-professional teams in providing health care,” says Katherine Stansfield, CEO and registrar of the College of Registered Nurses of Manitoba. “We have overlapping scopes of practices. In order to provide health care in the best possible way, every profession plays a very vital role in meeting that entire need of the population.” Under the RHPA, registered nurses can pursue additional education to extend their practice to become authorized prescribers, which differs from the role of nurse practitioners. “Nurse practitioners are fully autonomous. They can order, prescribe and diagnose. They have a very broad scope of practice,” Stansfield says. “But there is a group of registered nurses that are not nurse practitioners who can prescribe certain drugs in a more limited way, and the ability to order lab tests and diagnostic tests is also available. That’s how the practice of registered nursing is evolving.” This year, another focus draws attention to the wide-ranging roles of registered nurses. “RNs have a very strong clinical role. Most people think of them in hospital settings, but we have other roles that are worth thinking about,” Stansfield says. “There are roles as communicators, collaborators and co- ordinators. RNs play a key role in ensuring that the needs of a particular individual, family or community are understood and communicated with all the other members of the team.” RNs also play vital roles as educators, scholars and leaders. “It might be a surprise for people to know that many of the leaders in the health-care system are registered nurses,” Stansfield says. “Making decisions about how the health-care system runs, where we need resources, how those resources work — all of that is influenced and led by registered nurses in an administration role.” Currently, there are 12,779 registered nurses and 227 nurse practitioners in Manitoba. For the first time, there are also four authorized prescribers. All three groups fall under the oversight of the College. “It’s a career that offers so much diversity. You can practise clinically in so many different settings with a large degree of autonomy but always within an inter-professional team,” Stansfield says. “There’s not a day that goes by that you haven’t done something that is meaningful to somebody else. As a profession, I think that’s very important and very fulfilling.”

Happy National Nursing Week

Are you worried about the state of healthcare in Manitoba thanks to Pallister’s cuts and closures to Winnipeg’s emergency rooms, cardiac surgeries and nurses? If so, tell us what you think by emailing OLO@yourmanitoba.ca Find out more at healthcare.yourmanitoba.ca

“I will rebuild our healthcare system after Premier Pallister’s cuts by listening to people on the front lines.”

Wab Kinew and the NDP Caucus are Proud to Stand with Manitoba’s Nurses.

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COLLEGE OF LICENSED PRACTICAL NURSES OF MANITOBA Manitoba’s licensed practical nurses (LPNs) have the broadest education and scope of practice in the country. “That level of education and scope of practice is not the same anywhere else in Canada, North America or the world,” says Jennifer Breton, executive director of the College of Licensed Practical Nurses. “The LPNs in Manitoba take this to heart. They are professionals and they are leaders. They keep growing with the system in order to meet the needs of our population — and we’re grateful for them.” Becoming a practical nurse in Manitoba begins with a two- year diploma program offered at three different institutions: University College of the North (which has campuses in Flin Flon and Swan River), Université de Saint-Boniface and Assiniboine Community College. “Their focus is on the nursing sciences and the humanities, and they come out ready to hit the ground running. They are leaders and they work in all practice areas, so a clinical LPN could be in the emergency department or in long-term care or dialysis,” Breton says. “We also have LPNs who work in administration as executive directors, facility managers and clinical leaders. We have LPNs in the education domain who may be educating health-care aides or other nurses, and we have LPNs who assist in research.” Today, there are approximately 3,600 LPNs in Manitoba, along with about 400 students at any given time. “The College regulates students, graduates and licensed practical nurses in the best interest of the public. Part of the regulating is to approve the practical nursing education,” Breton says. “We approve the entry-level program, but we also approve continuing education and areas such as the foot-care program. The foot-care program in Manitoba is the only one of its kind in Canada and we work with Assiniboine Community College to approve that program.” At some point, most people have had their lives touched by a nurse, Breton adds. “It is a profession where you serve others. You work with people at their most vulnerable — and that’s an honour. You walk away knowing that you helped somebody at the happiest parts of their life or maybe the worst moments of their life,” she says. “It’s a privilege to be involved and to help in some small way, so that makes it really rewarding. For someone who wants to serve society and serve humanity, nursing is a wonderful career.”

looking at people in a holistic way. Not only do we provide care to individuals and their families, we also go more broadly to provide care to groups and communities as well,” says Isabelle Jarrin, president of the board of directors of the College of Registered Psychiatric Nurses of Manitoba. “We are looking at a person in their entirety, as one of the three regulated nursing professions in Manitoba.” Currently, Manitoba is home to more than 1,000 RPNs. The education pathway in Manitoba begins with a bachelor of science in psychiatric nursing, available through Brandon University with sites in both Brandon and Winnipeg. Brandon University also offers a master of psychiatric nursing program. Traditional settings for RPNs include in-patient and out-patient mental health services. In addition, RPNs work in personal care homes and long-term care centres, as well as with clients who have developmental needs. Other RPNs can be found working in emergency departments or on geriatric teams with older adults. In Winnipeg, registered psychiatric nurses share their skills with My Health Teams, at Mount Carmel Clinic, at Klinic and with the sexual assault program. In collaboration with the Winnipeg Regional Health Authority, the College has developed a toolkit to help when considering integrating an RPN into a non-traditional mental health setting. This recently updated document looks at whether having an RPN on staff would enhance the ability to serve the population. “RPNs can have administrative roles in both mental health and non-mental health settings,” Jarrin says. “RPNs also work as part of a larger interdisciplinary health- care team that’s looking at the entire health of individuals and the surrounding community. They work in areas that have a component of mental health and well-being as well as physical health and well-being.” Each year, National Nursing Week provides a moment to pause and appreciate the work of nurses. “The College certainly appreciates all the efforts of RPNs, RNs and LPNs,” Jarrin says. “We recognize and celebrate all the work that nurses do.” ASSOCIATION OF REGISTERED NURSES OF MANITOBA Now three years strong, the Association of Registered Nurses of Manitoba (ARNM) continues to advocate for the advancement of nursing and the health of all people throughout the province. “With nurses being a majority component of the health-care workforce, we really need to be well represented at decision- making tables,” says executive director Mary Smith.

Membership is voluntary, and today more than 10,000 registered nurses are part of the ARNM. “We represent nurses across a variety of settings, so not just in clinical areas but also education, research, leadership and policy,” Smith says. “We’ve been doing a lot of great work in the areas of professional development and advocacy, recognizing that there are many changes in our health-care system. Change is certainly something that nurses are very familiar with.” When nurses become members of the ARNM, they also get membership with the Canadian Nurses Association. Any registered nurse can become an ARNM member, including nurse practitioners, graduate nurses, nursing students and former registered nurses. Membership might soon open up to include registered psychiatric nurses and licensed practical nurses. At the 2019 AGM, ARNM members unanimously passed a resolution to explore the possibility of expanding the membership structure to include the whole family of nursing. In addition, they agreed to collaborate with all designations of nurses to participate in the International Council of Nurses and World Health Organization campaign to raise the profile of nursing and to promote pride in the profession. They also aim to increase awareness about the impacts of social determinants of health as they relate to health inequities. In addition, the members approved bylaw changes so the ARNM can advance with a focus on inclusivity. The association will now offer an associate non-voting membership category for any health-care professional to access member benefits and professional development opportunities. “We’re very excited. We’re making history,” Smith says. “There are some wonderful advances happening in the nursing profession and we’re very proud of them.” The National Nursing Week theme, Nurses: A Voice to Lead – Health for All, is timely and appropriate, she adds. “We’re strength-based, positive-focused and good inter- professional team players,” Smith says. “We’re very lucky in Manitoba that we have a very broad autonomous scope of practice to provide ethical, safe care. Across the country, Manitoba nurses are very well respected for that.” ✚ The Université de Saint-Boniface’s School of Nursing and Health Sciences was recently granted a national accreditation by the Canadian Association of Schools of Nursing (CASN), becoming the first nursing school in Manitoba to reach such a recognition of excellence.

COLLEGE OF REGISTERED PSYCHIATRIC NURSES OF MANITOBA Registered psychiatric nurses (RPNs) work in a multitude of settings, yet they maintain a holistic approach to health care wherever their practice leads them. “While registered psychiatric nurses are mainly concerned with mental health, we really are

Thank You Manitoba Nurses for your compassion and care.

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Judy Klassen MLA for Kewatinook

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“I LOVETAKING CARE OF PEOPLE.THAT’S JUST PART OF WHO I AM. SO I KNEWTHAT IN TERMS OF NURSING, IWANTEDTO END UP IN GERIATRICS BECAUSE I LOVE WORKING WITH THE ELDERLY.”

Abigail Kawadza is a nurse and unit coordinator atThe Saul and Claribel Simkin Centre

PHOTO BY NATASHA WOLOSCHUK, WINNIPEG REGIONAL HEALTH AUTHORITY

AN HONOUR AND A PRIVILEGE WORKING WITH THE ELDERLY IS REWARDING FOR LONG-TERM CARE NURSES By Mike Daly

In life — much as in literature — the most insightful and inspirational parts are often found in the final chapter. That was one of the factors that drew Abigail Kawadza away from a position as an acute care nurse at Victoria General Hospital to her current position as a nurse and unit coordinator at The Saul and Claribel Simkin Centre, a 200-bed personal care home in south Winnipeg. “I believe that when you are working in long-term care facilities, you have the honour of working with residents as they live out the final chapter of their lives. You have the opportunity to be there for them, to provide care, to support them, and to advocate for them when they can no longer advocate for themselves.” A native of Zimbabwe who was raised by her grandparents, Kawadza attained her nursing degree in Manitoba after she emigrated to the province in 2004. She spent her first six years nursing at Victoria General Hospital, but knew that geriatric long-term care was where she wanted to be. “I love taking care of people. That’s just part of who I am. So I knew that in terms of nursing, I wanted to end up in geriatrics because I love working with the elderly.” It’s a love that is rooted in her upbringing, Kawadza says. “In Zimbabwe, we don’t have nursing homes. Older people are celebrated as a source of a wealth of knowledge and experience and their families take great pride in caring for them. That’s

possible because there are large extended families who stay together. Here in Canada, financial necessity often dictates that the people who might otherwise be caring for their elderly loved ones are working, and so you have no one at home during the day to provide the level of care that is required.” Those cultural differences notwithstanding, Kawadza says that Canadians take equal pride in ensuring their parents’ needs are being met. Often, that requires the kind of around-the-clock support found in nursing homes and other facilities. “Families try,” Kawadza says. “They want the best for their loved one, and will work with the supports available in the community. But there will come a point where their loved ones require 24-hour support.” This can be a very emotional and difficult time where circumstances can get complicated. “Families struggle with the decision to place a loved one into long-term care, and often feel a lot of guilt. They wonder if there is more they could have done,” Kawadza says. “But if you are working and have a family of your own, it can be very difficult, so we are there to provide the necessary support. A lot of the families are very thankful because they have the peace of mind that comes with knowing that their loved ones are being cared for. They are very appreciative of the level of care being provided.” That level of care is often extensive, Kawadza says. “Our residents can have complex health issues. They can be frail and require increased assistance as they age. Sometimes, their health issues include a diagnosis such as dementia, where

they reach a point in their life where they are no longer able to verbalize or express things like pain and they can sometimes be aggressive. So to be able to do your work effectively to assess the situation, and provide the support and care that they need can be challenging.” It can also be rewarding. “It’s a very satisfying career choice,” Kawadza says. “For residents, this is their home. Some have been here a number of years, so we have the privilege of getting to know them and develop relationships with them and their families. You spend so much time with them that they become, in a way, part of your family.” Sadly, as in all families, there inevitably comes a time when you have to say goodbye — a circumstance long-term care nurses face with professionalism and grace. “Death is just part of life,” Kawadza says. “As nurses, we find solace in knowing that we were an important part of that final chapter. We were there to provide support to help ensure the resident was comfortable, that pain and other symptoms were well managed. We grieve, of course, but we also remember their personalities, what they brought to the unit, and what we learned from them. That’s often how we cope with it. I firmly believe that our fingerprints don’t fade from the lives we touch.” ✚

Mike Daly is a communications specialist with the Winnipeg Regional Health Authority.

Thanks to the generosity of Manitobans, we are proud to support oncology nurses at CancerCare Manitoba. These health-care professionals provide outstanding care to patients all across our province experiencing one of life’s most difficult health challenges. Our heartfelt gratitude for all that you do, every day.

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“WHEN CLIENTS ARE CONNECTED WITH THE APPROPRIATE SUPPORTS,WE OFTEN SEE A SIGNIFICANT IMPROVEMENT INTHEIR OVERALL HEALTH, WHETHER IT BETHEIR MENTAL HEALTH OR THEIR PHYSICAL HEALTH,”

Hillary Mills, registered psychiatric nurse (RPN), chronic disease management clinician and certified diabetes educator for the My HealthTeam

MEETING CLIENTS WHERE THEY’RE AT

PHOTO BY NATASHA WOLOSCHUK, WINNIPEG REGIONAL HEALTH AUTHORITY

MY HEALTH TEAMS HELP CONNECT PATIENTS WITH CARE By Mike Daly

Health care is not a “one size fits all” endeavour. And so it shouldn’t be a surprise that what works well in the suburbs isn’t always suitable for those living in Winnipeg’s less affluent neighbourhoods. Hillary Mills knows that fact better than most. As a registered psychiatric nurse (RPN), she’s spent her six-year career helping people in the downtown and Point Douglas neighbourhoods better connect to care — most recently as a chronic disease management clinician and certified diabetes educator for the My Health Team working out of 425 Elgin Ave. Launched in March 2014, My Health Teams were designed to support the work of family physicians by freeing up some of the time they devoted to their patients’ follow-up care and/or social services needs. This allowed the physicians to see more patients and better meet demand for their services. “My Health Teams were created to support busy family physicians by connecting their more complex patients with appropriate resources and by helping them navigate the health-care system,“ Mills says. The work of these teams is especially important in neighbourhoods where poverty, cultural and other socio-economic factors sometimes create

anxiety, they may have trouble leaving their home and attending appointments in order to access help. Often, there can be folks who have mobility difficulties, so physically getting to an appointment might be challenging. Transportation costs may be beyond their means. So we really try to be as low-barrier as possible.” That includes “meeting clients where they’re at,” Mills says. “For our team, it’s very important to meet the individual in their environment to start building relationships and some sort of rapport that helps get them better connected to the services and supports that are out there,” she says. Mills estimates that about 40-60 per cent of her time is spent in the community — meeting patients in their homes, or in other locations where they are more comfortable. The remainder of the time is spent in the office connecting with other community programs, doing follow-up work, and documentation. Though Mills’ primary focus is on diabetes education, she frequently collaborates with partnering programs such as Community Mental Health, Employment Income Assistance, housing authorities, Public Health, Home Care, and partnering clinics to help ensure her clients

can access the supports they require. “When clients are connected with the

appropriate supports, we often see a significant improvement in their overall health, whether it be their mental health or their physical health,” Mills says. “That leads to a reduction in the use of emergency and crisis services and an overall improved quality of life. If we don’t work together and we don’t collaborate, it’s just going to make the job more challenging.” Mills adds that with the will to collaborate firmly in place, members of the My Health Team and partnering programs are making headway. “I love my job and the role that I’m in,” she says. “I believe that in my three years, we’ve made progress in eliminating barriers that existed and in helping ensure that our clients are as supported as they can be in the community. I also believe we have a lot more work to do to connect with people who perhaps have fallen under the radar and who may be slipping through the cracks in the system. Those are the folks we want to focus in on.” ✚

unintended barriers to quality care. “Many of the people we work with in

Downtown/Point Douglas are marginalized or homeless individuals,” Mills says. “We also support the new immigrant and refugee populations. Often, our clients have a number of chronic diseases and illnesses, sometimes coupled with mental health and addiction components.” These factors often require a different approach to care — one that recognizes the patients’ unique circumstances and life challenges while building trust in a system that, historically speaking, has sometimes let them down. “Sometimes there are trust issues,” Mills admits, “and sometimes other barriers come into play. There might be barriers related to mental health, for example. If they are experiencing significant

Mike Daly is a communications specialist with the Winnipeg Regional Health Authority.

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RNs ARE INVOLVED IN ALL ASPECTS OF HEALTH CARE.

PUTTING SENIORS IN PRIME POSITION By Mike Daly

For Kim Solleveld, a 32-year nursing veteran specializing in gerontology, providing care for the elderly is an endeavor that never gets old. “I find the elderly amazing,” Solleveld says. “They are the wisest people I know. Their personalities, their stories … you will learn everything from them. They’re amazing people.” Solleveld has spent her career at Deer Lodge Centre (DLC), most recently as a member of PRIME, a referral-based health centre program providing care for Winnipeg seniors whose chronic, complex health issues pose a risk of admission to a personal care home, emergency department or hospital. (PRIME is also offered out of Misericordia Health Centre.) Clients visit between one and five times per week. After hours, in- home nursing is also available. “PRIME is designed to keep the elder adult in their home setting for as long as possible,” Solleveld says. “That’s one of our biggest goals.” DLC’s PRIME team of professionals includes doctors, nurses, physiotherapists, social workers, health-care aides, occupational therapists, recreation facilitators, dieticians, pharmacists, rehabilitation assistants, receptionists and case managers. Together, they provide a holistic approach to care that’s proven popular with the program’s 180 clients — so much so that not even frigid temperatures in the depths of winter can keep clients away. “When you have clients who, when it’s -45 C outside, can’t wait to get on the bus to come here, that speaks volumes about the efficacy and popularity of the program,” Solleveld says. “In addition to meeting their health-care needs, we provide a great social environment that helps keep them active and connected to their peers. It totally improves their quality of life.” Indeed, a quick tour of the facility, located on the west side of DLC at 203 Duffield St., might have visitors thinking “clubhouse” rather than “health-care facility.” Bright-eyed, cheerful clients routinely stop to chat with staff, or to share an activity or a meal with friends in the recreation room. Examination rooms and medical facilities are found only when one ventures down a sunlit hallway, past the

closed-in patio, and a little deeper into the facility. Appearances notwithstanding, PRIME is, at its heart, a health-care centre dedicated to helping clients with complex medical, functional, cognitive and/or mental health issues. “We have some very complex cases that we need to follow up with all the time,” Solleveld says. It can be quite challenging, and the elderly are often difficult clients to assess. They often don’t present the same signs and symptoms as younger people, and you have to have the ability to read between the lines. “For example, if your elderly mother has a urinary tract infection, she might present differently than would you or I. Whereas you might have a burning sensation that would lead to a speedy diagnosis, your mother’s symptoms might include a change in behaviour, or newfound signs of aggression. These might be easily mistaken for an increase in dementia or depression. So our team has to be able to make the correct assessment.” In addition to their professional training, the PRIME team relies on strong communication for their success. “We’re a fairly small team, so we have to be well organized,” Solleveld says. “We treat clients with diabetes, cardiac issues, Parkinson’s, mobility issues, swelling issues, wounds … we care for them all. We care for the family, too, making sure that no one is left in the dark. If there is a change in condition, the family is notified.” Involving families also helps with a common problem associated with elder care — caregiver stress. “We realize, especially amongst this clientele, that there is often caregiver stress. So, if having their loved one attend PRIME allows a daughter or another caregiver time to get their groceries, run errands or enjoy some downtime, that’s a beautiful thing.” It all boils down to a simple raison d’etre. “It’s about enhancing quality of life, and knowing that we’re here for our clients and their families,” Solleveld says. “When you know you’ve contributed to that goal, you go home knowing that you’ve made a difference. It’s a great feeling.” ✚

We are proud to regulate the

profession to ensure Manitobans receive safe, competent and ethical registered nursing care.

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MAJOR MILESTONES:

MAY 31, 2018: RHPA is implemented

On May 31, 2018, we became governed under the Regulated Health Professions Act, optimizing RN scope of practice and improving access to care for Manitobans. JUNE 7, 2018: Public Benefit Policy is approved Our new strategic plan for 2019-2023 focuses on building public confidence in excellent regulation, accountable, quality professional practice and collaboration for health system impact.

AT THE END OF 2018 WE HAD:

20 Graduate Nurses

13,502 RNs

239 Nurse Practitioners

Mike Daly is a communications specialist with the Winnipeg Regional Health Authority.

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NURSES DESERVE TO BE HEARD

As a nurse with 37 years’ experience, I can tell you that nursing is not ‘a day at the spa.’ It’s important to understand the vital roles nurses perform in our health-care system. Anything can happen, any shift. Nurses have to be prepared for all scenarios, and ready to respond quickly and effectively. We are highly qualified professionals, requiring years of education and on-the-job training. We learn from one another, and we work together to serve others. We ensure safe, quality care on the front-lines of our health-care system. We often take on the role of advocates for our patients as well. Every year, we celebrate Nursing Week across Canada. It is a valuable reminder of the work we do in every province and territory, from the busiest city centres to the most rural and remote areas. No matter where we are or the circumstances we face, nurses of all designations are well equipped to meet almost any challenge. Unfortunately, issues beyond our control are making the situation in health care increasingly difficult to manage. That’s why Nursing Week is particularly important this year in Manitoba. Many nurses are working short-staffed, and increasingly mandated to work excessive overtime. Too often, we are subjected to verbal and physical violence, in care settings with inadequate or lacking security presence. Ongoing cuts and closures to health care, including the closure of emergency departments and the Misericordia Urgent Care Centre, are creating real issues on the front- lines. Nurses are increasingly being asked to provide care to a greater number of patients, with fewer resources. This situation is unsustainable.

Nurses have real experience, and intimately understand our health-care system. We know its strengths and weaknesses and have the expertise to respond to them. We have all heard stories of a patient going without care longer than they should. It’s incredibly frustrating for patients and nurses alike. Nurses pride themselves on compassion for their patients. A day in the life of a nurse is often an overlapping set of priorities. It’s the feeling of being pulled in a hundred different directions while still being required to provide a consistent, high-quality standard of care. It’s a conflict that requires expertise, experience and commitment to manage on a daily basis. Often, nurses are short-staffed relative to the patient A DAY INTHE LIFE OF A NURSE IS OFTEN AN OVERLAPPING SET OF PRIORITIES. IT’STHE FEELING OF BEING PULLED IN A HUNDRED DIFFERENT DIRECTIONS WHILE STILL BEING REQUIREDTO PROVIDE A CONSISTENT, HIGH-QUALITY STANDARD OF CARE. volume they were assigned, and still have to deal with emergencies at any given time. Any number of things can go wrong at any time, and without adequate staffing levels, the risk for longer wait times only increases. Unfortunately, our concerns are all too often ignored when our experience and knowledge should be appreciated and respected. Nursing is one the most diverse and rewarding careers in health care. There are so many different ways to help

patients and their families. Nurses are increasingly confronting problems caused by cuts or restructuring that jeopardize care, and this is concerning. Nurses worry about the future of health care in our province. All nurses deserve to be celebrated for performing such a critical role in our health-care system. Licensed Practical Nurses (LPNs), Registered Nurses (RNs), Registered Psychiatric Nurses (RPNs) and Nurse Practitioners (NPs) serve Manitoba patients directly in our homes, communities, clinics, hospitals, and long-term care facilities. Without every designation, our health-care system would not be complete. We are often the critical link between each member of the broader health-care team, and together we ensure patients get the care they deserve. But Nursing Week this year should be about more than simply celebrating the work of nurses. Now more than ever, nurses deserve to be heard; their concerns should be listened to. Nurses are there for patients at the time of greatest need. Patients put their trust in us, and we always do whatever we can to deliver the care they deserve. Nurse advocacy is always rooted in the needs of patients, and so it’s important for our leaders and the public to take note when nurses speak out about what’s happening in our health-care system. I’d like to thank all of Manitoba’s nurses for their incredible dedication to quality patient care and advocacy. The work you do is an inspiration, and it’s an incredible honour to work on your behalf. Thank you to everyone for recognizing Nursing Week, and to all of Manitoba’s nurses for putting patients first!

Darlene Jackson is a Registered Nurse and President of the Manitoba Nurses Union, representing over 12,000 nurses of all designations.

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PHOTO BY STACIE HEIDE

POLAR PRACTICE NURSING ON THE SHORES OF HUDSON BAY

By Mike Daly

All nurses working under the auspices of the Winnipeg Regional Health Authority (WRHA) are highly trained. But only a select few can boast that a course in polar bear safety was part of their orientation. That distinction belongs exclusively to nurses working at the Churchill Health Centre, which fell under the WRHA’s jurisdiction in May 2012. The centre serves the health-care needs of the approximately 900 residents of the self- proclaimed Polar Bear Capital of the World, as well as patients and clients from surrounding communities in Manitoba and the Nunavut, Kitikmeot and Baffin regions. And while many nurses might balk at the opportunity to work in a community nearly synonymous with cold weather, carnivores and isolation, the decision was an easy one for

longtime nurse Cheryl McCullough, Churchill Health Centre’s Manager of Patient Care. “I was born here,” McCullough says. “And one of the reasons I chose to work here was so that I could take care of my Churchill people. I have a lot of ties to this town. My grandfather, Dave Lundie, came here from The Pas as a trapper in 1929, and our family has been around ever since.” McCullough — who is proud of her Cree/Dene heritage and her status as Churchill’s only Indigenous and home- grown nurse currently on staff — is part of a dedicated team of 130 people at the Churchill Health Centre, which features 21 acute-care beds, a nursing unit, long-term care and an emergency department. Located 1,000 kilometres north of Winnipeg on the icy shores of Hudson Bay, the town is small, but the level of care provided at its health centre is second to none. “Quality care is important everywhere,” McCullough says, “and we have to be ready for any medical situation, from motor vehicle accidents to heart attacks to allergic reactions. Anything can come in through the door.”

While many situations can be handled in-house, more serious cases are flown via Medevac or Life Flight to Winnipeg for treatment. That’s a circumstance that can present a unique set of challenges. “Weather is often a factor,” McCullough explains. “If there’s a blizzard, you’re not going to be able to get your patient on a plane, so you’re going to have to deal with whatever it is in the emergency room. Even when the

to other communities, so we are used to being self-reliant. A few years ago, we had a blizzard that lasted for three days. Thankfully, there were no medical emergencies in town during that time. When it finally cleared, the town had to basically be dug out of the snow. My front door was snowed in to a depth of about nine feet.” For nurses — even those coming from Winnipeg and its infamously harsh

town has a surprisingly wide range of amenities. “We have a large town centre complex that features a swimming pool, an ice rink, a bowling alley, curling rink, gymnasium, library, theatre, and our school all located in one building — so there is always a lot to do,” McCullough says. ”And it’s not always cold. We have some short, but beautiful, summer months when beluga whales make their way into the Churchill River. You can even snorkel or kayak with them. Besides the polar bears, this is also a huge tourist draw to our little town.” Churchill is also far more cosmopolitan than many might suppose, with tourists arriving from countries throughout the globe, one of several factors that keeps McCullough at her post. “Working in Churchill takes an adventurous person who is looking for a challenge,” she admits, but she says the advantages outweigh any perceived drawbacks. Asked if she is ever tempted to leave for a life in the south, she doesn’t hesitate. “You can’t leave paradise,” she laughs. “Churchill is my home, and I’ve never wanted to leave home.” ✚

IF THERE’S A BLIZZARD, YOU’RE NOT GOING TO BE ABLE TO GET YOUR PATIENT ON A PLANE, SO YOU’RE GOING TO HAVE TO DEAL WITH WHATEVER IT IS INTHE EMERGENCY ROOM. EVENWHEN THE WEATHER CO-OPERATES, A MEDEVAC PLANE COULD TAKE A FEW HOURS TO ARRIVE, SO WE HAVE BE EDUCATED ENOUGHTO DEALWITHTHOSE SITUATIONS. IT PUTS SOME ADDED STRESS ON US.

Cheryl McCullough, Churchill Health Centre’s Manager of Patient Care

weather co-operates, a Medevac plane could take a few hours to arrive, so we have be educated enough to deal with those situations. It puts some added stress on us.” Dealing with bad weather and isolation is a hallmark of life in Churchill, McCullough adds. “Churchill is a very remote community, accessible only by air and train. There are no roads in or out of town leading

winters — Churchill’s frigid, sub-arctic temperatures can be daunting. “It’s a long, cold, dark winter, and it can take a lot of getting used to,” McCullough says. “We dipped down as far as -55 C this year. That was even cold for me, and I’ve lived here all my life. But the people we have here want to be here. They like being part of a resilient, tight-knit community and staff.” And, despite its reputation for cold, the

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TOURETTE’S NOT ALWAYS ‘AS SEEN ON TV,’ AND NEITHER IS NURSING By Mike Daly / Winnipeg Regional Health Authority

When some people think of Tourette’s, their minds flash back to stereotypes in movies or television programs featuring adults who involuntarily blurt out obscenities, profanities and derogatory remarks at inopportune moments. In reality, there’s a far bigger story to tell. The same holds true for how people perceive careers in nursing — while our minds often tend to think in terms of emergency rooms, hospital wards and other medicine-related settings, the fact is that there are many nurses who work outside those institutional milieus. Calvin Barbour is one of them. As a registered psychiatric nurse (RPN) at the Manitoba Adolescent Treatment Centre (MATC), Barbour works as part of a multidisciplinary team of health- care workers providing a range of mental health services to children and adolescents who experience psychiatric and/or emotional disorders. He has worked extensively in Tourette’s treatment during most of his 20 years as an RPN. “I’ve always felt that psychiatric nursing appealed to me more than the more stereotypical view of nursing as being linked exclusively to the field of medicine,” Barbour says, adding that psychiatric nursing can be just as impactful and rewarding. “I especially enjoy sitting in on assessments, knowing that we can really help families affected by Tourette’s,” he says. “Over the years, seeing our success stories, seeing individuals who may have been struggling with school and helping out with that, or seeing someone with debilitating anxiety go on to be successful in the workforce, you get to play an important part in really positive change.” Tourette’s — also called Tourette’s Syndrome or Tourette’s Disorder — is a neurological condition characterized by repetitive and involuntary movements and vocalizations called tics. According to Tourette Canada, the symptoms usually begin in early childhood around age five, but may occur as early as age one or two, or as late as the age of 17. “It’s more common than most people realize,” Barbour says. In fact, Tourette’s affects an estimated six out of 1,000 school-age children, with males being affected more than females at a ratio of roughly four-to-one. It’s often not as debilitating or noticeable as it’s portrayed in entertainment circles, Barbour adds. “For a lot of the kids we see who have Tourette’s, the vocal and movement- related tics are not their biggest issue,” Barbour says. “They are often more impacted by issues such as anxiety, and related factors such attention

deficit hyperactivity disorder (ADHD, which affects 60 per cent of children with Tourette’s), obsessive compulsive disorder (OCD, which affects up to 30 per cent of people with a tic disorder) and sleep disorders (as many as 60 per cent of children with Tourette’s have problems with sleep).” And the swearing so commonly linked to Tourette’s in movies and TV? It’s a symptom called coprolalia, and only 5-10 per cent of individuals will have that kind of a tic, Barbour says. “Tics such as sniffing, coughing, throat- clearing, and blinking are far more common, and unless they are really aware of it, people may not recognize these as symptoms of Tourette’s. Blinking, nose-scrunching, mouth- widening and facial grimacing are also common. The symptoms can be very subtle.” Many people are also unaware that Tourette’s is a condition that can improve over time. “In the past, we used to think of Tourette’s as a chronic condition,” Barbour says, “but now we know that up to a third of the individuals diagnosed with Tourette’s in childhood might completely outgrow their tics as their brains mature. Another third may experience a significant reduction in their tics, and the other third will find that the tics they experience in adolescence stay roughly the same throughout their adult lives.” As an RPN, Barbour works as a Case Coordinator and part of a multidisciplinary team working in MATC’s Tourette Syndrome Service. Services provided may include: • Assessment (psychiatric, psychological, educational and occupational therapy) • Individual therapy • Family therapy • Group therapy (tic management, positive parenting -Triple P) • Emotional regulation and organization skills • Medication management • School liaison and consultation • Public education While there is currently no one treatment that will cure Tourette’s, Barbour says there are a number of effective treatment options. These include medications, some of which can decrease the tics by as much as 50-70 per cent. A relatively new treatment called CBIT, an acronym for cognitive behavioural intervention for tics, involves learning strategies on how those affected by Tourette’s can work to block their tics. It’s not offered unless clients are over the age of 12. Barbour says that working with children and adolescents affected by Tourette’s has been a satisfying career choice. “It’s gratifying to see how well they do in our program,” he says. “We work with some students for five to eight years, so we get to see how they’ve progressed over that time. We can help them achieve greater success in school, and can often significantly decrease their symptoms.. I’ve had other jobs, but nothing has provided the sense of fulfillment I’ve had in this one.” ✚

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IN CELEBRATION OF NATIONAL NURSING WEEK, the CLPNM would like to recognize the dedication and contribution LPNs make to the health and wellness of all Manitobans. Plan a gift now, or for the future, and you can fulfill your philanthropic goals while maximizing your tax savings. Ask us how you can make a difference through scholarships, research and more, with the impact of a legacy gift. Give the gift of knowledge Bachelor of Science in Psychiatric Nursing (BScPN) (Winnipeg & Brandon) Bachelor of Nursing (BN) Master of Psychiatric Nursing (MPN) BrandonU.ca | 1.877.282.4483 Advancement@BrandonU.ca Faculty of Health Studies 270 - 18th Street Brandon, MB R7A 6A9 For information call: 204.727.7403 or 204.571.8567 IS BUILT IN Philanthropy Care to Make a Difference? Join Us in Health Studies

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CNA SUPPORTS INVESTMENTS IN CANADIANS’ HEALTH AND WELL-BEING

On March 20, Claire Betker, president of the Canadian Nurses Association (CNA), issued the following statement on the tabling of Budget 2019. “CNA supports the federal government’s commitments to lay the foundation of a national pharmacare program and improve broadband connectivity in rural and remote communities. We also support the government’s strategies to prevent and mitigate the health effects of climate change, create a national dementia strategy, and increase measures to address the persistent opioid crisis. “CNA has long advocated for a national pharmacare program, including a single, pan-Canadian list of prescription drugs that would be covered — known as a drug formulary — to eliminate inequities. We were pleased to see that this was included in the budget. We also proposed the creation of a federally led pan-Canadian drug strategy for rare diseases; the budget sets aside $1 billion over two years for such a strategy. Finally, Budget 2019 announced $35 million over four years to establish a Canadian drug agency transition office. “CNA advocated for measures that enhance access to sustainable health service innovations to better serve rural, remote, First Nations, Inuit and Métis communities across Canada. We support the proposed $1.7 billion in new targeted initiatives to establish improved high-speed internet for these communities. This will provide more opportunities for people to connect and access nursing care. We also support the government’s proposed investment of $151.23 million over

five years (and $9.28 million per year ongoing) to improve management of emergencies in these communities, including health services. This was a recommendation CNA made to the government. “CNA supports the proposed $50 million over five years for the implementation of Canada’s first national dementia strategy as well as additional funding of $30.5 million over five years, with $1 million in ongoing funding, for measures to address the gaps in harm reduction and treatment. Treatment measures include protecting people with problematic opioid use from the risks of overdose and death and supporting better access to overdose response training. “While CNA was pleased with many of the budgetary decisions, we were disappointed that there is no dedicated funding for supporting caregivers and the people in Canada who require palliative care. Here the federal government missed an opportunity to address an important federal, provincial and territorial priority. We will continue our advocacy on this issue because it matters to people and families across Canada. “Recognizing that this budget will be the last tabled prior to the next federal election, CNA looks forward to the government’s swift movement and implementation of their promises.” ✚ The Canadian Nurses Association is the national and global professional voice of Canadian nursing, representing 140,000 registered nurses and nurse practitioners in Canada. CNA advances the practice and profession of nursing to improve health outcomes and strengthen Canada’s publicly funded, not- for-profit health system.

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THE COLLEGE OF NURSING AT THE UNIVERSITY OF MANITOBA IS PROUD TO CELEBRATE NATIONAL NURSING WEEK, MAY 6-12, 2019. We congratulate all nurses in Manitoba for your leadership and commitment to the advancement of the profession of nursing and excellence in health care. Thank you for your support and mentorship of our nursing students. As education leaders, we are committed to promoting excellence and preparing our nursing students through hands-on clinical practice and state-of-the-art technology, to bring their best to their patients. It is our honour to grow the profession by educating our province’s future nurses and nurse leaders.

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