Nobody’s Handmaiden

Published in The Vancouver Courier, April 2001

Nurses taking a strike vote today are demanding a 60 per cent wage increase and something Aretha Franklin always wanted: A little RESPECT.

The intersection of Denman and Comox is jammed with more than 200 nurses, some in picturesque black capes lined in red. They are brandishing placards, talking to journalists and handing out lime green leaflets to curious onlookers and motorists. Every now and then they break into song. The mood is upbeat, and the song proclaims that Nurses are Powerful. A lone motorcycle cop is doing his best to keep order. The nurses have come from all over BC to support their leader, Debra McPherson, president of the BC Nurses Union, in her quest to get nurses the respect, recognition and salary increases they believe they deserve. The union’s position is that respect in our society comes down to two things: how much one gets paid and how much control one has over working conditions. And right now, nurses in BC have little of either.

Even in this swirling crowd, McPherson stands out. If Xena the mighty warrior princess had a real life counterpart, McPherson would qualify, if only for her idealism and presence. Almost 6feet tall, she exudes strength and conviction. A self-described feminist, she’s a person who believes passionately in fighting for the rights of oppressed women everywhere. Her dedication to the cause has made demonstrating nurses and McPherson herself an almost nightly sight on the news.

Nurses are taking a strike vote today and McPherson says they are doing it only to provoke the employer into putting a proposal on the table. She says the lack of respect for nurses is clearly evident from the absence of senior decision makers at the bargaining table. “Where is Phil Haasen (head of the Vancouver/Richmond Health Board), where is the deputy minister of health? In Alberta they managed to be at the bargaining table. Why are we dealing with mostly junior people?” she asks, adding, “We hope that by calling a strike vote, we will provoke the employer to come to the table with a reasonable offer. So far, they have refused to offer us anything unless we reduce our demands. I don’t see how they can get away with this; it’s a ridiculous situation.”

It’s not a new situation, though. Lack of respect and lack of understanding for the profession has dogged nursing for a long time, and have historical roots. With over 200,000 practicing members, Nurses are one of the largest female dominated professional groups in Canada, but until now they have not had the clout their numbers warrant. Their long history pre-dates that of nurses in Great Britain, where they had to wait for Florence Nightingale to do something about the deplorable conditions under which nurses practiced. Nursing in Canada used to be exclusively under the aegis of nuns. McPherson herself was trained by the Grey Nuns at St. Boniface in Winnipeg and says her class was the last one of its kind. With the advent of feminism, nursing started a 40 yearlong period of re-examination and periodic outbreaks of discontent. The traditional image of nurses as ‘handmaidens’ to doctors no longer fits the modern age. And ‘caring’ in and of itself isn’t much valued in our society, says nurse and author Sarah Jane Growe, in her book, Who Cares, the Crisis in Canadian Nursing. McPherson says the public doesn’t appreciate the advanced education and skill level of the modern nurse, and doctors themselves, while valuing the nurse, may not know exactly what the nurse does, says Marshal Dhal, the president of the BC Medical Association. Lisa Hegler, an acute care nurse with more than 20 years experience at Vancouver Hospital says it’s only because of increasing work-loads and shortages among doctors, that doctors are more willing to acknowledge nurses as equals on the medical team. Young doctors especially are more likely to do so, but she says even today, nurses tend to play a ‘mothering’ role to the residents, reminding them of tests that need to be done, etc. The issue of ‘respect’ for nurses’ professional knowledge came up with a vengeance at Winnipeg General Hospital last year.

Nurses in the Pediatric OR repeatedly tried to get the attention of hospital administrators when they noticed that babies operated on by a certain doctor were dying. Nobody paid any attention to them until other members of the medical team like the anesthetists began to boycott the doctor as well.

Nurses in BC have been front and centre with their concerns for months. With a $400,000 dollar TV ad campaign and demonstrations in the streets, they are saying this is their time to finally get the recognition they deserve. At the national level there is action as well. At the annual nurse leadership conference hosted by the Canadian Nurses Association in Ottawa this year, the mood was very upbeat, reports Marcy Saxe-Braithwaite, Vice-President, Professional Affairs and Chief Nursing Officer Vancouver Hospital & Health Sciences Centre. She said nurses see the current crisis as an opportunity to make progress within the profession. They want to be seen as partners and colleagues instead of helpers to doctors and be recognised for their unique contribution by doctors and the public. In addition, they want long-standing problems dealt with. One of the more urgent ones is getting back senior nurses to act as mentors and leaders on the wards. Young nurses are without support and leadership, and it is one of the factors behind the high numbers leaving the profession. Morale on the wards is low, says Saxe-Braitwaite. She has started to collect ‘nursing stories’ from her staff to keep up morale under trying circumstances.

In spite of all the problems, there are still many idealistic young people planning to go into what has become a stressful and underpaid profession. There are waiting lists for all nursing schools in BC. However, increasing the number of graduates is hampered by a shortage of experienced instructors. Sitting in her small, cluttered office at Langara, Chris Wasylishyn, the coordinator of student and faculty affairs in the department of nursing, is clearly frustrated. She says that even though there is now money available from provincial coffers, everyone in North America is scrambling for senior instructors. She points at some papers on her desk, “Here, look at this, during the last week alone, 4 new positions were advertised for senior positions across Canada. Where are all these people going to come from?” Another concern is that most instructors getting close to retirement age. McPherson says that it’s going to take several years before the shortsighted cutbacks in nursing education can be undone. Currently, Langara takes in 120 student nurses every year, and Wasylishyn says faculty is working on a proposal to increase the intake.

It’s cold in room 134B, and the 18 2nd year nursing students are huddled in their jackets, listening to a lecture on providing health care in Haiti. The class demographics are typical of today’s nursing students, and quite different from the all female, very young student nurses of 20 years ago. There are 4 men in the class, and while some students are in their early ‘twenties, many are older, and entering the profession after trying other careers. Their reasons for going into nursing sound remarkably similar. They like working with people and making a real contribution to society. And no, nurses are not handmaidens to doctors. As for salaries, Christine Vuono, 29, says that neither she nor anyone else in her class is going into the profession for the money. “I’m quite idealistic, and I like caring for people. My mom says I got all the caring genes in my family, and maybe it has something to do with being the oldest,” she says. For Vuono, this is her second profession; she was a youth worker in a halfway house for 2 years. She has a Bachelor of Science from the University of Toronto. The oldest of 3 siblings, she’s bright, pretty and self possessed. As to why she didn’t go into social work; she considers it too hard and the case loads just terrible. And why not medicine?  After all, 68percent of the first year medical students at UBC are women.  For Christine, the choice was clear. “It’s a different focus, the emphasis is more on the scientific aspects and the purely medical issues. I’m just more interested in working with the whole person. I think the essence of being a doctor is to cure, whereas the essence of being a nurse is to care.  Of course this is not to say that doctors don’t care, or that nursing doesn’t lead to curing patients, it’s the essence, the core of what philosophy each discipline has that is different.  And I believe my place in this world is in a caring capacity,” she says.

Vuono is planning to work abroad for a few years, and other students in the class are planning to go south, not because they want to, but to pay off their student loans. All say they will eventually return home. One of the men in the class, 34year old Don Hard, is perhaps the most unusual nurse anyone could hope for. He used to be a musician, plays guitar and piano, sings well and supported himself with jingles. He’s also good-looking and well spoken. He says that even he had a somewhat stereotypical ideal about what nurses do. His most rewarding moment came when he was able to use his musical talents in a medical setting, playing guitar and singing for a little boy with Leukemia at Children’s hospital. “It was a very different experience from performing for an audience, where, as a performer you’re worrying about the kind of impact you have, and how you’re coming across. This was really different. It was a wonderful experience,” he said.  The other young men in the class are in their early twenties, and they don’t think it’s unusual for men to want to be nurses. “If women can be truck drivers, why can’t men be nurses?”  They ask. Hard says that they all would like to see the image of the nursing profession change, so that people don’t constantly ask why they have chosen nursing. Says Hard,” Nursing isn’t fully understood by the public, and I have to admit that even I kind of bought into the stereotype of what a nurse is before I came here.” He thinks it’s to some extent the fault of programs like ER, where the focus is on doctors, and nurses play a secondary role.  He hopes that the fundamental importance of nursing as a separate profession will eventually be recognized.  He’s certainly planning to stay in the profession and keep advancing his education. Both Hard and Vuono say that one of the things that attracted them to nursing were the many different career paths within the profession. Vuono thinks that having a choice between working in a hospital setting, the community, and working abroad is one of the other reasons she decided on nursing. “Nurses are needed in so many different settings, and even in out of the way places, everyone appreciates what nurses do,” she said. Hard is planning to go into emergency nursing, a choice for many male nurses.

Meanwhile, efforts to alleviate what has become an ongoing shortage are continuing. One of the avowed goals of the government during the ‘nineties reorganization of the Health Care system, was to relieve the pressure on hospitals by moving patients out into the community as soon as humanly possible.  A good idea, stakeholders agreed, except that there was no follow through—–the resources needed at the community level have never been put in place.  What these resources might look like is currently under discussion in Victoria. The Nurse Practitioner has been dragged out of oblivion once again, and is being dusted off and re-examined. The Provincial Government is currently working on a plan to get Nurse Practitioner education and legislation in place by 2002.  Marshall Dhal thinks that his organization will support this move provided it is done “properly”, that is the scope and legality of Nurse Practitioners are defined.

One might wonder why the government didn’t think of this before. Nurse Practitioners have been around since the ‘sixties, when the NP was heralded as the solution to many of the problems in nursing, especially the issues surrounding how much supervision from doctors nurses need and how much nurses can ‘infringe’ on the doctors’ territory—diagnosing and prescribing. It is this type of ‘gate keeping’ issue that is causing some dissension within the medical profession, says McPherson, although overall, doctors respect nurses as part of the medical team and welcome the highly trained Nurse Practitioner as a valued colleague. The nurse practitioner is a Registered nurse who has extended training as well as a scope of practice that is more like a doctor. The idea was that instead of being a ‘helpmate’ to the doctor, the NP would become a recognized primary care professional, who could, within well-defined limits, diagnose and prescribe.  The idea has taken root in the United States, where NP’s act as a point of entry into the system, run clinics and take care of patients.  But even in the US, they are still regarded as on the forefront of nursing, and the American Medical Association does not unilaterally support them, says the president of the BC Nursing Association, Lorraine Gillespie.

We already have successful models in place, such as the Reach Clinic on Commercial Drive.  It has survived as a successful community clinic from the expansive and well funded late ‘sixties and has something rare: two Nurse Practitioners, who have been there for almost 30 years. Bev McMaster and Joanne Thiel are registered nurses who, because of the special nature of the Reach Clinic funding and their long history, act like Nurse Practitioners even though they didn’t attend a recognised program for NP’s. Nurse Practitioners are a rarity in Vancouver, but this type of nursing is practised widely in remote rural areas where any kind of medical care is hard to come by. Thiel, an energetic looking woman with a salt and pepper pony tail, smiles broadly, and says, “We are simply smarter North of sixty.” According to the BC Nurses Association, the NP’s in the north do the work of doctors, but are paid on the usual scale of $26.50 an hour. They were originally licensed and paid for by the federal government, but were then ‘devolved’ to the local communities and took a 30percent pay cut. “They want the highly skilled NP’s, but they don’t want to pay for them,” commented McPherson.

Support for the N.P. also comes from the Health Care Council of British Columbia, consisting of Arminee Kajanzian, Ph.D. at the Centre for Health Services and Policy Research at UBC and two colleagues. They have just delivered a hefty 1400 page report, Safe Choices, a new model for regulating health professions in B.C to the provincial health ministry. According to Dr. Kajanzian, the report re-defines the scope of practice for nurses as well as all other health care professions including doctors in such a way that long-standing turf issues can now be resolved. ” What we have done is to define the exclusive domain of each profession and also lay out where they overlap. Our recommendations are aimed at allowing all health care providers to work in a collaborative manner, and to put delegation of tasks into the hands of the professional, as opposed to the employer,” she said. Under the new regulations, nurses can delegate certain tasks to practical nurses and aides, just as doctors can delegate to nurses. The report took 6 years to prepare, and Dr. Kajanzian and her colleagues worked on it pro bono. She does not think it will solve all problems, and says that implementing the recommendations will take at least 2 years. As for the ongoing crisis in health care, she says that all stakeholders need to get away from ‘crisis mode’ thinking and start collaborating on a pro-active process aimed at solving both long and short term health care issues.

The report will be posted on a government website: http://www.health.gov.bc.ca/cpa/newsrel/2001/185.html

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