Please note, this post originally appeared on the ARNBC Blog in December 2016. It is shared with permission.
The Opioid Crisis Can't Be Just a Headline for the Nursing Profession
by Zak Matieschyn, BSN, MN, RN, NP(Family)
I've had some great experiences during my year and a half as ARNBC president, but one will stand out for me long after my presidency ends. This week, I and a group of nurse leaders and students, had an opportunity to spend the afternoon on Vancouver’s Downtown East Side (DTES) learning, listening and supporting our frontline nurses (and let there be no mistake, with the current opioid crisis, this is truly the frontlines). No matter what we have read in the newspaper, or seen on TV, the reality of what is happening all over British Columbia is overwhelming and heartbreaking when you see it firsthand.
Our experiences were life-changing as we broke into small groups with an RN or peer leader and visited different sites throughout the DTES. The experiences were as different as they were impactful. Some visited the Crosstown Clinic, which is the only harm-reduction treatment centre in North America where addicts get actual heroin. Some walked with a street nurse as she went about her regular daily routine, checking on people in their SROs or on the street. Some visited the Downtown Eastside Community Centre to gain a better understanding of how primary care and social services are delivered to those who are struggling with healthcare issues. Still others visited the pop-up clinics and alleys where the unofficial safe sites are functioning.
I personally had the opportunity to spend time at St. Paul's Hospital, which, although it is not in the DTES, until the recent opening of the Mobile Hospital, received the majority of overdose victims in the ER. I was able to witness some of the innovative work being done to streamline access to possible treatment options for people with addictions – these are exemplary programs that would be great to see scaled out to other parts of B.C. I also had the privilege of spending a couple of hours alongside the nurses at Insite, North America’s first safe injection site, handing out Naloxone kits and training individuals on how to use them. Sitting on the floor with a heroin user who wants to know how to use a Naloxone kit ‘just in case’ makes you see this whole situation from a different point of view. People are dying, and what a privilege and a responsibility we have as nurses to do everything in our power to prevent that.
Spend a day really listening to the individuals who claim the Downtown East Side as their community and you begin to understand that there are miracles taking place here every single day. This crisis has hit hard. As a nurse, I recognize that our frontline nurses working here are exhausted, overworked, sometimes overwhelmed. They lose friends every day – people who use drugs that they have come to know and love. They sit with individuals who are scared, worried, sad. And no matter how much they do, how hard they work, how many lives they impact, how many wounds they heal – there is always more they wish they could do. Nurses here are exceptional – because by choice they are agreeing to work with a population that is often ignored, stigmatized or dismissed. And the population on the DTES is a miracle unto itself. Largely stigmatized by most of Vancouver, the reality is that many of these individuals are the kindest, most compassionate, most generous humans you will ever meet, and their sense of community and helping one another is beyond compare. I must say that I felt completely safe during my time spent there.
ARNBC has taken a strong and proactive approach to working with our nurses and colleagues to determine how we can best support all frontline healthcare workers who are dealing with this crisis. For starters, we hosted a forum on Wednesday, bringing together as many frontline workers as we could, to give them an opportunity to debrief, to share their stories, to suggestion ways we can move forward together and to show that we are serious about supporting their work.
A sampling of some of the ideas include:
- Develop a community of practice for those on the frontlines, giving them a place to talk online and share ideas (working on it)
- Advocate for increased staff for key locations (working on it)
- Develop a ‘free coffee’ program and consider expanding it to include snacks, treats, meals etc., for those working in various locations on the DTES (underway)
- Engage rural and remote workers in programs and services that help them manage in this crisis (to do)
- Advocate for safe injection sites, for safe drug supply and decriminalization (to do)
- Help set up some volunteer scheduling, including training and criminal record checks (underway)
- Advocate for better nursing curriculum to teach harm reduction/drug addiction and ensure students are exposed from the start of their nursing education (to do)
Other ideas that were brought forward will be included in the summary report, due out next week. Keep an eye on www.bccna.com if you want to learn more about what was discussed, or share what you think would make a difference.
Spending time on the downtown east side reminded me of something important – every single person who uses drugs has a powerful story to tell about how and why they started. They have family and friends (some may be other drug users, many are not). They have real fears and joys and sorrows. They are as real and alive and vital and important as any one of us. One of our speakers on Wednesday reminded us that we don’t really look at people who use drugs until after they're gone when we put them on the front page of our newspapers. We need to remind ourselves as nurses that we look after all people – and we’re at our best when they’re alive and can be helped.
When ARNBC was ‘called out’ for not doing enough by Marilou Gagnon, it made us stop and think. She was right and we knew immediately that we needed to step up. We have done that this week, and we are committed to doing it on an ongoing basis. We know we can make a difference. We welcome your ideas and thoughts on small things or big things you think ARNBC should be doing to help during this crisis. We will not be silent in our support of those things that our frontline workers need in order to manage a difficult and overwhelming situation.
Our nurses on the frontlines are calling out for help. It is time for every single nurse in the province to step up and answer that call. They would do the same for any one of us.
About Zak Matieschyn
Zak's interest in health and healing began at the early age of nine years old when he would carry a small first aid kit while playing with friends. Since then, his passion for healthcare and health policy has been unwavering. He was particularly inspired by concepts of family, community and societal health, as well as the social determinants of health during his undergraduate (BSN UVic, 2000), graduate work (MN UVic, 2008), and clinical experience in urban, rural and remote B.C. communities.
Zak has served on numerous boards and committees, including the BC Nurse Practitioner Association Executive and was the first Nurse Practitioner in B.C. to be invited to sit on a Division of Family Practice Board (Kootenay Boundary, 2010 – 2014). Through this work he has gained valuable experience in member engagement, optimizing board governance, and relationship building among diverse stakeholders. In his clinical practice, Zak has worked med/surg, emergency, intensive care, vascular access and outpost nursing. After obtaining his NP education in 2008, he began a practice in a West Kootenay family clinic, providing primary healthcare to the general public with a focus on marginalized populations. Zak is President of the Association of Registered Nurses of BC.
Thank you for making the effort to meet all frontline workers, staff, nurses and to listen to their concerns. As nurses, we need to be able to push for the changes that are very much needed to assist this crisis. We have a powerful voice and the public have confidence in us so we must move to action!
I wish you and your family and friends a very merry Christmas!
Nurse x 35 years and served my country for 21
I am glad to hear that an Emergency Opioid Forum was held. Thank you!
What saddens me though, is the statement that ARNBC was "thrilled" to participate in this. Perhaps an inappropriate use of words for such a horrific health tragedy and for those of us that see the death toll of Fentanyl and other opioids on a daily basis.
Secondly, I am somewhat shocked to read Mr. Matieschyn's observations that it is the "addictive" population that is suffering great loss from this opioid crisis. While this is true to some extent, in my observation as a 30+ year Emergency RN, it is in fact the opioid-naive that are suffering the most quickly and easily from these deadly drugs. It is those that are naively experimenting, and unknowingly with opioid-laced drugs.
Let us remember all those affected.
An RN suffering loss
I apologize for the use of the word 'thrilled' which appeared in an email (not in this blog, just to be clear in case anyone reading is looking for it in the text above). I take full responsibility for the use of the word. There is certainly no lack of caring or concern from anyone at ARNBC about this crisis and I am sorry that my inappropriate choice of words has tarnished Zak's blog or cast a negative light on what was an insightful and proactive day. -- Andrea (Communications)
Thanks Zak for sharing your thoughts. My comments are directed to Nancy. Nancy, I think Zak is focusing on what he saw on the day that he is writing about. Of course others are impacted, but this is an experiential blog, based on his observations that day.
As well, are we really devolving as a profession to the point that it's necessary to shame based on one word? Perhaps it was not the best choice of word to use, but at the end of the day why not ask a question, or point something out in a constructive way? I too am a 30 plus year RN and I see that our profession is becoming an angry, bitter and aggressive group. We see the example our union sets and we in turn have started to run on the path of anger. As nurses we are taught to question and inquire, not blame and shame. How unfortunate for us that this new way of being ushered in by BCNU is how we choose to speak to each other.
Thanks ARNBC for taking the step forward to help address this crisis. There is more work to be done, but I'm confident that if we remain calm, balanced and seek answers to questions and not lay blame, we can help.
I'm sorry to be off topic here and of course if this isn't an appropriate comment please delete it but Joyce I want to highlight something you said about a mad BCN U. I'm an RN for 12 years and I have had my patients tell me that nurses seem so mean. They reference the 'angry lady' they see on television often. I support BCNU and I support the work they do, when they do it for the good of nurses and when it's done keeping the integrity of our profession in mind. I am tired of being afraid to speak up against BCNU who are clearly working in the interest of their own bottom line. So thanks for highlighting that. To Zak thanks for sharing your thoughts.
Personally, with all the sadness and tragedy going on right now, it was refreshing to see a more positive word to remind us that there is a silver lining. We have lots of health care professionals and allies who are doing great work on the frontline, and advocating for changes to be made (and changes have been made!). Indeed, it was energizing to walk out of that forum knowing actions will be made to ensure we have support for the families, as well as nurses, who are most affected and at risk of building up traumatic stress, which will inevitability lead to burn out in the future.
From a 3rd year nursing student