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Nursing Leaders Address the Need for Major Change in Health Policy, by Rob Calnan RN

On December 17, 2013, a small group of nurse leaders met in Vancouver to discuss the future of nursing in British Columbia, the challenges the profession is facing, and the need to have a stronger voice that represents the interests of the community of nursing.

Much of the discussion during this meeting centred on the lack of cohesiveness among nursing groups and lack of respect that many leaders within the profession have experienced.  Participants all expressed concern about the impact of the dissolution of the Nursing Directorate in the Ministry of Health and about the transition of RNABC to CRNBC. These events, among others, have led to a significant decline in nursing’s voice in public health policy and in the important area of professional advocacy. 

Nurse practitioner representatives spoke with great conviction about their significant disenfranchisement by the government and BC Medical Association primary care policy decision-making enclaves. They indicated that, without sweeping and swift reforms, the role of nurse practitioners in British Columbia is in jeopardy, a situation that would result in the loss of primary care providers to thousands of British Columbians and have consequential effects across the provincial and national health care systems.

Clearly the time to unite as one community of nurses is now. 

By the end of the day, the group had made several key decisions:

  1. The collective will continue to meet, discuss and move aggressively forward to address needed changes, (welcoming additional members and participants as required.)
  2. Strong and swift responses will be raised to key issues that impact nurses and nursing over the next weeks and months. Participants asked themselves, “Do we continue to accept the status quo, or do we act strongly and decisively when we see the need?”  The unanimous decision was to move forward with strength and determination.
  3. Initially there will be four primary areas of focus:

a)  Strengthened constructive and professional communications on issues affecting nursing, both to the nursing community and to the public. It is no longer acceptable that the only public voice for the entire profession is the perspective of the bargaining unit.

b)  An immediate communication priority will be supporting nurse practitioners, communicating the need for and strength of this vital part of our profession. This is a matter of some urgency in order to ensure that commitment to the nurse practitioner role is not lost amidst the current aggressive BCMA lobby for physician control of all primary care policy decision-making in this province.

c)  Relationship building among all the nursing groups in B.C. with the goal of moving to a strong, unified voice for the profession.  When these relationships have been forged, additional relationship building will occur outside of the profession.

d)  Establishing a visible presence on policy and advocacy issues, including active steps to shape the venues for policy influence by nursing to ensure the profession is appropriately represented.

The group agreed that it is time to act and to push forward to make significant changes in how nursing engages with health service and policy decision-making in this province.  In the short term, several members of the group have been tasked with taking on assignments – including writing short papers/briefing notes, developing campaigns, and initiating strategic conversations around the specific changes that would help us achieve our shared vision of a united nursing voice in the province.

We look forward to hearing the comments and suggestions of all nurses as we move through this process, and we are committed to sharing updates and information as it becomes available.  At the same time, we believe you will see the results of our efforts as we take a stand for nurses and nursing and collaborate together to build the collective strength that the community of nursing needs.

Nursing has been marginalized for far too long in British Columbia.  As nursing leaders, we are determined to turn this situation around, mobilizing resources as needed, to restore nursing to the proud, influential and highly respected profession it has always been.


robRob Calnan is Site Manager of Cowichan District Hospital.  He has served as President of RNABC (1997 - 1999), the Canadian Nurses Association (2002 - 2004) and the Association of Registered Nurses of British Columbia (2010 - 2012) and led two components of the Canadian Nurse Practitioner Initiative.  He is known as a passionate and articulate spokesperson for the capacity that nurses can offer in providing health care services with Canadians and as a strong proponent of a publicly funded, not for profit health care system.


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Karen R.N., BSN

Thank you for all the work of the ARNBC I am wondering, other than this blog, where exactly can comments and suggestions be put forth to the ARNBC.

Lori Campbell

Hear hear!! Well written Rob and thank you for sharing!
I'm really glad to hear these issues being discussed widely, because I think nurses have been feeling this increasingly for a few years.
The public needs to see a well-rounded and cohesive voice from BC Nurses that they can rely on to speak up for health and SDOH for the province!
Looking forward to hearing more!

Maryanne Smith

I am a RN in Sechelt who is unable to find suitable employment for over 2 years as a NP. I am hopeful that this 3rd round of NP proposals will go through so that I may practice with the adult ageing population. I feel that there is some delay to implementing the role here but I am not entirely sure why.
I would really like the opportunity to provide primary care for older adults. I have even considered opening a clinic of my own or in conjunction with another healthcare professional but I have been faced with the reality that elderly people most likely do not have the funds to pay for their care. I have tried to write to MSP to ask how I can bill as a primary care provider but have not received a response. This makes me realize that as NPs we are challenged to provide services. How can we be on the same playing field like GPs if we cannot bill as they do.
I am also concerned that if I do find employment with a health authority that I will be an out of scope employee. I would have to give up union seniority. I also have concerns about workload. I strongly feel that NPs should have the option to join the union. NPs could benefit from the power and support of a larger bargaining association for securing fare wages and working conditions
Thank you

Aharon Arnstein

Thanks for these thoughts Maryanne,

I am an RN and NP student in Victoria. A agree that If NPs are going to be salaried health authority employees vs private contractors like MDs then we should be in the union.

Sally Thorne

It has been especially frustrating that, during the period of time in which BC lost its professional association voice for nursing, the BC government dismantled its Nursing Directorate and has failed to replace it with a functional mechanism through which nursing can offer meaningful input into matters of health and health workforce policy. The BC Medical Association has been able to maintain an intimate and influential relationship with the Ministry of Health throughout, and has clearly continued to position itself as the only relevant opinion on strategic policy decisions, especially around primary care. Throughout this period, the BCMA has also maintained its firm conviction that incentivizing physicians (a euphemism for adding to their fee-for-service financial remuneration) is the only way to make the necessary changes to improve the health care delivery system. The most recent version of that attitude is their enthusiasm for “physician assistants” – a new kind of health professional for BC who would work under the direct supervision of physicians (thus expanding their billing capacity), unlike nurses and nurse practitioners, who are autonomous (and almost always salaried) professionals. A major case in point -- the global evidence is compelling for the value of nurse practitioners to a primary care system from a patient and population health perspective. However, despite their being embraced as a vital part of the interdisciplinary team package across Canada and the rest of the world, BC organized medicine continues to create serious impediments to their implementation here in BC. It is of utmost importance that the BC government starts listening to advice beyond the self-interest of one sector of the team. The primary care planning process for British Columbians deserves a much more evidence-informed, thoughtful and strategic conversation that is based on population need, not the financial priorities of some providers. Nurses and nurse practitioners are a high quality and sustainable way to keep communities healthy, reduce unnecessary burden on acute and episodic services, and support chronic illness management across the life spectrum. British Columbians deserve to have access to nurses and NPs when and where they need them, not where physicians think they ought to be. If the government won’t listen, then we know the public will!

Rebecca Anson

I LOVE that this meeting happened, and that you are taking a strong stance for nursing. This is really exciting news and I'm so glad ARNBC is participating. This is what I want my professional association to be all about. I've been watching ARNBC's development, and I haven't been excited by what I've seen so far, but this actually has caught my interest and my attention. This is what we've all been waiting for.


I do not see any action plan. Does Rob ever work a shift as a bed site nurse? Exactly what is a site manager bowing down and implementing the budget restraints going to do? His job depends upon his continued dismantling of our health care system. Easy to look in and shake your head - let's see our nurse leaders work at the bed side
I would like to see some real leadership from the ARNBC not just talk

Jan Webb

Anne, It is unfortunate you do not know Rob Calnan. I have had the privilege of knowing and working with him. Yes, he was a bedside nurse for many years at Victoria General Hospital, and he has brought a voice to nursing concerns for many years. His fairness, compassion and persevering attitude are not to be underestimated. I'm encouraged because nurses like Rob "get" both sides (nursing and management) and can move forward from there. It is the antagonistic attitudes between employers, lobby groups and nurses that have prevented solution-oriented ideas for too long. This is a process.


There is so much more to nursing than "bed side". I'm proud that we have nurses representing us and leading health care. In fact we NEED them in leadership roles. I'd much rather have a nurse at the leadership helm than a CEO who knows little to nothing about actual nursing care/health care and is most focused on the business aspects. Kudos to nurses like Stan for speaking out and leading our profession.

If a bedside nurse were to take on this role - when do you think they would actually have time to be at the bed side?

Mary Adlersberg

If I wasn’t a nurse, I might be reading some of the above comments as another group only interested in its own self-preservation. But this is not true of the people who work as nurses, nor the philosophy and the direction of the profession of nursing. Nurses and the profession’s prime focus is always in the direction of individual, group, and population health. We are the most intimate with the needs of the individual, the gaps in population health, and most aware of how to address the implications of inadequate resources for individuals and communities. So why has the government dismantled our professional capacity to have voice in health policy in this province? I don’t know the answer to this. But what I do know is that the solutions for the concerns that are being expressed by so many communities across this province come from the people who are engaged most closely with those who require continuous, available and adequate attention to their health needs. The voice of the nurse and the perspective of the profession MUST be heard by policy makers. We have so much to offer to public health policy. We are so willing to bring our distinctive knowledge and skill to the table in solving the current gaps in health systems. When will government policy makers wake up to what they are missing?

Aharon Arnstein

Mary I agree!

sorry for the rambling and disjointed post, but so many separate ideas came to mind reading all these comments.

I think we need to quickly move this conversation from the problems of how we got in this position to hammering home the reasons why nursing in it's full expression from (including NPs) is needed to improve health of british columbians. We need to think of this as a big tendering process. If nurses could spend the kind of time and money to put our agenda forth to the public that other groups do we might have a chance. Look at how much we hear from and about oil pipelines. If issues nurses know to be of crucial importance to british columbia had the same press we could get somewhere.

We need to show we are indispensible and make it clear that we will decide the future of our workforce rather than get slowly pushed aside and away from the bedside. The ARNBC likely does not have giant bank accounts to bankroll a big campaign but there are other things we can do. At this point strikes and removal of service will not help our cause. Instead I suggest we find some ways to get in front of those that need care and show them what RNs and NPs can do. Why not some free clinics in malls all across BC staffed by RNs and NPs and any other professions that want to do more to make BC healthier.

Lets get Brian Goldman from CBC radio to do an episode on the situation of NPs in BC? He has touched on it before.

I would like to say that something Rob mentioned was how we are not a united force and there is a lot of fractious relationships within nursing. Nurses are a large and varied group with many different political and social values, personal and professional goals and priorities. What can we all agree on? We need to figure that out.

I am an RN in Victoria and a NP student. I would say that a reason I went back to school to become an NP was to protect my time with patients. As an RN in VIHA I have seen the Care Delivery Model Re-design (CDMR) project moved ahead to the point where it is finally showing what the true end-point seems to be. I would say that the most basic value of nursing is how we do our work in relationship with our patients and families. This relationship is only possible when we spend time with our patients at the bedside giving direct care, doing our own physical assessments and asking our own questions. I am worried about how nurses are getting moved further away from this relationship because without it I do not see nursing having much special to offer patients.

I am heard from at least five nurses from different areas about how they feel they had their expertise and energy misappropriated by the CDMR consultations they went to. In the end, they were helping to dismantle their own jobs by creating the framework to change the staff mix and lose nurses and even worse nursing time with patients.

I could say that perhaps it was naive not to see this coming but it matters not now as the fight is upon us.

I am becoming and NP so that I can have more control over my time with my patients. I hope my concern for the direction of nursing can be proven unfounded with a renaissance for nurses in BC.

Natasha Prodan-Bhalla

As a Nurse Practitioner working in BC, I am happy to see the entire nursing community coming together with one strong voice. Regardless of the differences between groups of nursing, our core nursing values and beliefs are what unite us. This needs to remain a focus. The time is right for nursing organizations and leaders to be speaking with one united voice for the health of British Columbians across the province. Nurses are the backbone of the health care system – without us, the system would fail. So why is it that our voices and opinions are often dismissed and marginalized by both our colleagues and our government? Nurse Practitioners have increased access to both primary and specialty health care for patients across this province, and often take care of the most vulnerable populations. Now is the time to continue with successful implementation of the Nurse Practitioner role and to stand united with all of our nursing colleagues for a stronger health care system in BC.


I'd like to see a public campaign that explains the health care system to the general public. I find myself explaining it daily to clients. I explain why they feel dis-enfranchised and ignored by a walk-in clinic physician or even their own family physician...the fee-for-service system. Patients are consistently ignorant to how the system works and are amazed when I explain it to them. They are surprised that physicians would be allowed to see so many patients in a day and that they have to pay their own overhead and staff. They are amazed that most physicians do not have extended benefits or pensions. Consistently patients tell me they thought the "government" paid doctors just like they do nurses. And consistently I let them know the realities of why our primary health care system is so broken and why they aren't getting the quality care they deserve from their physicians. I think it's time that ARNBC starts pointing out the ridiculousness of our current primary care health system...and Rob seems to be starting this conversation at exactly the right time. Here here!!

Linda von Tettenborn

Thank you for your post about the December 17 meeting, Rob. Your leadership and voice are much appreciated. You have outlined the issues and concerns succinctly about a priority strongly voiced by nurses at AGM's, within ARNBC discussions, and elsewhere .

I hope-and anticipate-that this group and your post will galvanize some concrete plans, actions, and results to improve the health of BC's population, through an increased profile and access to health policy decision makers in BC for nursing. Responses so far to your post offer additional perspectives and context.

Lori Verigin

As a nurse practitioner working in a primary health care setting I am excited about the potential of a unified nursing voice. Although the role of the NP has been in existence for several years in British Columbia, many barriers impede the ability of the NP to provide comprehensive primary care. Most of these barriers have been constructed and designed to limit the practice of the NP and to control the settings in which NPs can practice. Who has been controlling this? Why has it taken so long to move forward legislation that allows the NP to do his/her work? Why can we not define a sustainable funding model?

Could it be the powerful lobby of the BC Medical Association and the collective de-valuing of nursing in general by our government?

I echo the comments posted by Natasha. Values and beliefs united nursing, no matter where we practice. Key among those values is the role we play as advocates for those we care for. As the government has removed the voice of nursing from the policy table and has failed to replace the nursing directorate, nursing voices get smaller and smaller and so do the voices of patients. We are bombarded daily by the lobby of the BCMA to further incentivize care through such programs as ‘GP for Me’, which is actually code for ‘money for me’. Such a program does little to actually improve care. Rather it is designed to sweeten the pot if a GP takes on even more patients. These fee structures create dependency and could significantly increase the cost to the taxpayer while cutting other highly educated and qualified health care providers from the work force. As the BCMA works behind the scene to silence and control scope of NP practice, patients continue to seek care that can be provided safely and efficiently by a NP. Nurse practitioners provide care to thousands of British Columbians every day in this province and many more NPs are waiting to do the same. Medicine continues to impede the full integration of NP into the health care system. It is time for government to provide a place for nursing at the policy table. Now is the time for an informed, transparent process that includes all stakeholders and gives voice to nursing and to the health care needs of the people of British Columbia. Continuing to protect the self-interests of a single interest group is hardly good for the health of our population.

Carrie Murphy NP(F)

Thank you for the thoughtful commennts everyone.

As a practicing NP I am in full agreement with the sense of urgency around the future of NPs in BC. It has become clear that impementation and integration of NPs in primary care is messy and fraught with barriers. I worry that our BC MOH is losing interest and energy in this initiative that they started with good intentions - increasing access to primary care for the people of BC. I dont think even they realized how physian centric our health care system has become.

Nursing needs to get political. We not only need nurses in health authority leadership positions, we need them in government. I wish I knew how to achieve that?

As well as being seen by the public as a strong voice for health care policy in BC, I think we need to engage the public to advocate for their own health care which is so much more than surgical waitlists and the costs of medications. I agree with Hannah's comment that the public are not well informed re the health care system. Perhaps that could be one strategy in this nursing initiative.

Lorine Scott

I have been a practicing NP in primary care for the past 7 almost 8 years and daily experience the satisfaction of providing care that meets the complex and unique needs of my families. I derive such joy personally, and feel honored to be allowed into the lives of so many folks.
As health policy has changed over the past 40 years and the voice of nurses has been relegated to the back room, I have watched many nursing leaders become corporate executives. Where is the patient in all this change. Today in BC we have doctor care for all health needs, and while many pts at times require doctor care, they also require nursing care, physio, pharmacy, psychology, alternative healing and many other options for improving and maintaining health.
I for one am tired of being nice, I want choice for myself, for my own family and my patients. BC's citizens have the right to health care and choice, and this does not just mean doctor care. We must as a nursing community work with other professional colleagues to band together to change the culture of patriarchy that exists in the MOHS, we must be loud and vocal. There are many physician colleagues who do not share the views of BCMA, so we must search for balance as we take on the giant. But as a tax payer, my taxes should be going to more that doctor care. Health care policy should set by all professions, not defined by a collective bargaining unit whose goal is to ensure the financial well being of their members I do believe MSP fees are rising again!


[…] Calnan’s more recent blogpost, Nursing Leaders Address the Need for Major Change in Health Policy, has certainly resonated with nurses, many of whom have felt that his comments echo their own […]


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