Damen DeLeenheer

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What is your current role, and is your work related to rural health?

I am currently working as a clinical nurse educator. I provide practice support to all mental health practice in the Northern Interior. That covers Valemont to Granisle, Quesnel to Mackenzie, and all of the community programs in Prince George itself. My work ranges from developing health authority wide mental health education initiatives and programs, individual nursing practice support, the development of hospital based programming, and the delivery of rural health education resources.

Can you speak about the populations you serve in rural and remote BC?

The population is quite diverse. I provide support to nurses and other staff working with individuals across the lifespan receiving mental health care within the Northern Interior, this includes patients living in long term care homes, those being treated in acute psychiatric units, to patients receiving cognitive behavioural therapy in community based programs. The majority of patients are adults, however, we also work with youth in areas such as out-patient substance use programs and inpatient units.

Literature consistently indicates that the health outcomes of those living in rural and remote areas are poorer compared to their urban counterparts? Based on your experience, why do you think that is?

The health outcomes of those living in rural and remote areas are poorer for multiple reasons. The lack of access to resources is a significant contributor to poor health. While there are multiple rural hospitals, patients tend to be transported to more urban centres within rural areas, such as Prince George, leading to issues in capacity and access in the regional centre. People living in rural and remote areas aren’t as close to specialists and despite advancements in technology assisting in long distance treatment, delays related to travel often affect health outcomes.

In terms of mental health services, access can be an issue as many tertiary care facilities are affected by geography as most of the provincial mental health facilities are situated in the lower mainland and interior. Patients transported to these tertiary centres frequently require significant sedation, something people traveling for other health needs aren’t required to undergo. Space is also limited in the inpatient psychiatric units and the Mental Health Act determines which hospitals are capable of providing involuntary care, as not all the hospitals in Northern Health are designated facilities.

What are some key systemic issues that currently exist in Northern BC that impact the health of British Columbians living in that area?

Several issues come to mind:

• Regionalization: Small rural hospitals understandably do not offer the same degree of specialization and expertise that can be found in larger, regional centres. This creates a steady flow of people from rural and remote locations into the regional centres for care who then 'compete' with local residents for access to care and create capacity issues and reduce access for all.
• Transportation: considering where we are situated geographically, transportation, coupled with weather conditions make it difficult for patients to make it to their appointments for tests or procedures. People often have to travel hundreds of kilometers for diagnostic tests that determine future care pathways. When that assessment is missed due to issues related to travel (dangerous weather, animals, limited daylight), subsequent treatment is delayed that can negatively affect health outcomes.
• Lack of primary health care providers: There is a lack of primary health care providers in the north. Some communities have no resident primary care providers and rely on physicians flying in and out to provide services. In other centres there are just not enough primary care providers to meet the needs of the residents.
• Difficulties in recruiting: There are many barriers to recruiting staff, such as geographical and social isolation and lack of support and education. While it’s easier to fill full-time lines, recruiting nurses to work casual shifts is difficult. This contributes to significant overtime and burnout.

What solutions are currently in place to mitigate these issues?

• Northern Health Bus. This service offers subsidized travel throughout the north and makes regular trips to the lower mainland to help reduce the risks associated with travel on northern roads.
• BC ambulance service. The BCAS is also providing limited shuttle services for patients with low health needs for routine diagnostics and assessments in regional centres.
• Telehealth resources. Prince George is the hub of an expanding rural opioid substitution program that is run through telehealth services. As staff competency with the technology grows, the program is able to increase scope and access to people requiring this service.
• Nursing programs located in northern communities. Four northern communities now have post-secondary campuses offering nursing programs. These programs rely on rural centres for practicum placements, exposing students to potential employment opportunities that they might not otherwise have experienced.

What challenges exist for nurses working in rural health?

Education, practice support, and professional development are the biggest challenges. There are limited resources to support the practice of nursing staff throughout the north. Clinical Nurse Educators are rare in rural centres and the nursing leaders are challenged to provide ongoing clinical supervision. I spend up to three days a week on the road and will drive up to 800 kilometers (through some really bad weather in the winter) to meet with staff face-to-face. Educational opportunities frequently require travel with all of the associated problems identified earlier. When opportunities are present, programs without causal to cover for staff struggle to take the time away from person care.

How can ARNBC better support nurses working within rural and remote areas?

Support the development of provincially based, online learning opportunities so that nurses in McBride can take the same courses alongside a nurse from Vancouver. This will support professional development and foster a province wide community of nursing practice.

What key policy issues in rural health would you like ARNBC to further examine and address?

The development of nursing leadership is key. As the professional association of nursing in the province, ARNBC can take the lead on building tools and resources that support nurses to understand what it takes to be a leader, and what leadership is about. The Network Leads Program has been a great way for nurses to build leadership skills and focus on issues that impact the nursing profession. I think ARNBC should continue to build and develop this program.

Developing nursing leaders in the north will create a pool of knowledge and leadership that can work together to address the issues facing nurses that are relevant to their own unique setting and take advantage of local strengths and resources. The challenges that nurses face every day in rural and remote settings should ideally be community centred. A cadre of nursing leaders, working within rural and remote northern communities will have the knowledge and competencies to identify and resolve local issues in a way that simultaneously supports the development of the nursing profession and the people to whom they provide care.