Delegate Report on the CNSA Western Regional Conference

Official CNSA Delegate, Aditi Lakshmanan’s Report:

Last month I had the privilege of attending the CNSA 2018 Western/Prairie Regional Conference hosted in Regina by the University of Saskatchewan College of Nursing. Students from British Columbia, Alberta, Saskatchewan and Manitoba gathered to discuss the exciting future of nursing in Canada, with a focus on rural and Indigenous communities. The conference theme this year, Breaking Barriers: Exploring the Future Through Rural and Community Nursing, brought a unique perspective on the many challenges faced by rural nurses working in these areas. By engaging in presentations, panel discussions, and workshops, I was able to enhance my understanding of rural nursing practice and gain new respect for the resiliency shown by rural nurses.

Greg Riehl, the Indigenous Nursing Student Advisor at Saskatchewan Polytechnic, and one of the keynote speakers at the conference spoke about how cultural competence and awareness can help nurses better understand the influence of colonization on the health status of Indigenous communities. Realizing that many Aboriginal peoples have deep-rooted connections to the lands they live on can better prepare the nurse to understand the impact of historical trauma and acculturation. Overall, a nonjudgmental approach is essential to building trust and developing meaningful relationships that promote community-centered care. The ability of nurses to engage in relational practice while dealing with the obvious challenges that come with working in a rural community is truly remarkable. 

One of the presentations that really drove this point home was a panel discussion with some of the responders involved in the Humboldt Broncos bus crash in Saskatchewan on April 6, 2018. Nurses working at rural hospitals in Tisdale and Nipawin related their experience of responding to a mass casualty incident with limited staff and supplies. I was amazed to hear of how quickly resources were deployed with the help of other health care centers in the province and how these small rural hospitals were able to successfully care for many of the crash victims. 

Needless to say, it was a very powerful discussion that highlighted the resiliency of rural and community nurses who continue to provide high standards of care in the face of adversity. 

            I have left this conference more inspired, with a new outlook on working in rural and remote communities, and a stronger belief in the power of rural nursing. If you would like a closer look at my conference experience, please see the attached Conference report. If you have any further questions, feel free to email me directly at aditi@uvic.ca.

Best wishes for a great semester!

Aditi Lakshmanan

CNSA 2018 WESTERN/PRAIRIE REGIONAL CONFERENCE

Location: Regina, SK

Date: October 25 – 28, 2018

Attendee: Aditi Lakshmanan, Official Delegate

 Theme: Breaking Barriers: Exploring the Future Through Rural and Community Nursing

October 25th

 1.     CNSA Western Regional Meeting

 a.   Canadian Association of Schools of Nursing (CASN) is in the process of developing a Canadian RN licensing exam. 

  1.  Since profits from the NCLEX benefit the US, Canada is losing out on revenue and funding for education. There is also a projected 1 million deficit in nurses in Canada. A new CASN exam might be the solution.

  2.  It will be similar in format to the NCLEX, and will also include a French translation, making it more accessible to Canadian students. The fees will also be lower.

  3. The NCLEX contract will be up in 2021, so the CASN is targeting to have their exam ready by then. A pilot version might be ready in January, 2019 at National Conference.

 

b.    Western Regional Budget

  1. The Western Regional budget has been split so that each Chapter school receives a $100 startup fund; and the rest is split up into awards ranging from $50-$500.

  2. The awards will be considered through a travel proposal submitted to the Western Regional Director. More information to come on the criteria for considerations. 

 

c.    National Nursing Student Week 2018

  1.  November 19th– 23rd

  2. Theme: Advocating for Safe Learning Environments

  3.  NNSW related swag has been mailed to Camosun.

 

d.    National Conference 2019

  1. January 22nd– 26th

  2. Theme: Aspire to Inspire: Students as Leaders and Advocates

  3. CNSA has some travel awards available. More information to come.

  

e.    Regional Conference 2019

  1. To be hosted by University Fraser Valleyin Abbotsford, BC. 

  2.  Proposed Venue: Quality Hotel Conference Center.

  3. Proposed Theme: Nursing the Spectrum: Diversity of Inclusivity Within the Healthcare Realms. 

  4.  Possible topics e.g. chronic pain in homeless populations, LGBTQIA+, substance use, mental health, harm reduction, poverty, immigration/refugees/migrant workers, etc.

  5.  Proposed Date: end of October, 2019. More information to come.

October 26th

1.     Keynote Address

Greg Riehl, RN, BScN, MA, Indigenous Student Advisor at Sask. Poytechnic 

  •  Discussed the “invisible backpack” carried by nurses that is filled with our experiences, beliefs, values and morals, and how it influences nursing practice.

  • Cultural competence and awareness is required to ensure Indigenous communities feel culturally safe. By reflecting on one’s practice and being accepting of differences, a trusting relationship can be built, and cultural continuity is promoted.

  • The Golden Rule of Nursing is ‘do unto others as you would have them do to you.’

  •  The Platinum Rule is more preferable. It states, ‘do unto others as they would want.’

2.     Breakout Session Presentations

a.    Nursing in Rural and Remote Practice Settings: Key Work-Life Findings from a National Survey (by Kelly Penz, RN, PhD)

  1.  Majority of rural nurses are 34 years of age or younger, 8.1% of them are male

  2. 14% of RNs claimed they work above their scope of practice, whereas 17% LPNs claimed they work below their scope of practice

  3.  Rural nurses face higher job demands, lower job resources, isolation and seclusion. However, motivators to work in rural settings include diversity in practice, a sense of community connectedness, and the advantage of working beyond one’s scope of practice.

 

b.    Exploring the Scope of Practice within City, Rural and Remote Nursing(by Karlee McKenzie, Bryce Boynton, Jake Kahler, RN)

  1. Three different perspectives on nursing in the city, rural and remote settings were discussed by a RN working in a primary care center in Manitoba, a provincial health nurse who works in a rural setting at a public health unit, and a community health nurse who works in a remote setting and is involved in primary care as well as public health promotion.

  2.  Practice in the city: Benefits…plenty of resources, on-site security, convenience, struggles…hierarchy, heavy workload

  3. Practice in the rural setting: Benefits…more autonomy than in PC, being a part of the community. Struggles…poor accessibility

  4.    Practice in the remote setting: Benefits…significantly increased scope of practice, ability to make medical diagnoses, prescribe medications and treat under clinical practice guidelines, community connected. Struggles…seclusion, very poor resources and accessibility, weather

  5. Across all three settings, some similarities include the need for culturally competent care, completing a health needs assessment, and having an understanding of the community 

  6. Major differences across all three settings include, availability of resources, the demographics, geography, accessibility and the scope of nursing practice

October 27th

1.     Keynote Address

Martha McLeod, PhD, RN – Professor at UNBC

·     Discussed the differences between rural and remote communities and the benefits and challenges in working in these areas

  •  A rural community has a population of fewer than 10,000 people and is accessible by road. A remote community is very sparsely populated, has harsh climate, challenging geography, often a “fly in” community

  • In both communities, the health status of the population is generally low in relation to low income, poor education, and high prevalence of chronic diseases

  • Although nurses working in both areas enjoy a broad scope of practice, remote nurses enjoy a higher level of autonomy and wide range of responsibilities that overlap with primary care

  • Cultural humility, flexibility, self-directed learning, open-mindedness, and curiosity are required qualities for rural and remote nurses 

  • Some challenges include lower staffing, poor availability of and access to resources, poor technology access, lack of access to continuing education, maintaining competency and confidence, lack of anonymity

  • Some benefits include broad scope of practice, diversity of cases, opportunity to learn about a new community, and connectedness

2.     Breakout Session Presentations

a.    Exploring power differentials in the context of a first-year acute rural RN (by Fred Entz, RN)

  1.  Discussed the impact of growing up in a Hutterite community, the process of breaking away from the colony, and the influence on his nursing practice today in a rural setting where many of his patients are Hutterites.

  2. Revisiting the past, processing hurt that didn’t know existed, trying to heal wounds that didn’t know he had, and dealing with the scars

  3. People who are hurt tend to hurt others so it is important to let go of hurt before it becomes bitterness. 

  4.  Having some sort of a support system is very important. 

  5. Let patients tell their story. Don’t say it to or for them.

  6.  Beliefs and values shape nurses and their practice. 

  7.  Power exists within all of us. It is important to use it justly, wisely, and with humility.

 

3.     Panel Discussion

a.     Responders to the Humboldt Broncos Bus Crash

  1. Participants: Tisdale Fire Chief, 2 RNs (from Tisdale and Nipawin Hospitals), a nurse practitioner and a family services counselor

  2.  All participants responded to the Humboldt Broncos bus crash on April 6, 2018. They discussed their roles that night and the challenges that each one of them faced dealing with a mass casualty incident.

  3.  Rural hospitals usually staffed with 2 RNs and 1 LPN on a Friday night, and only carry 2 units of blood. They had 2 hours to mobilize staff and resources for the MCI. Within 90 minutes, they had 65 staff members available and air ambulance dropped off more units of blood. 

  4.  Non-ER physicians were paired with experienced ER nurses to make care teams. Triaging was a huge challenge. Three treatment areas were set up, assuming worst acuity, so that patients could be stabilized and then sent to tertiary care centers.

  5.  RNs and NP spoke of challenges including poor staffing, limited resources, limited experience with MCIs, speed with which more patients were arriving. 

  6.  Family counselor discussed providing end of life care, family support and grief counseling. Social media was a huge challenge. False rumors and speculation about the identity of victims made family members even more anxious and frantic for information. 

  7.  Fire Chief mentioned PTSD was experienced by many of the EMS at the crash site. Most have recovered but some staff members are on extended leave and are receiving counselling.

  8. All panel members mentioned that teamwork, collaboration, open communication was the key to success. Even though they had not had a lot of experience with MCIs in the past, the staff was very experienced with traumatic injuries and MVAs.

October 28th

1.     Keynote Address

 Victoria Marchand, RN

  • Discussed the impact of colonialism on First Nations health

  •  Colonialism has led to the progression through three phases of trauma. The first phase involved trauma related to assimilation. The second phase involved the response of the population to the trauma. The third phase involves intergenerational trauma. 

  •  Residential school had impacts on the physical and social health of children who attended them, and on the generations that followed. These impacts have included: medical conditions, mental health issues, loss of languages and traditional knowledge, changes to spiritual practices, PTSD, violence and suicide

  •   Indigenous communities in northern Canada need basic infrastructure that most Canadians take for granted: things like housing and access to education, water and sanitation systems. 

  •  Federal funding for housing is less than half of what is needed. 

  •  Federal funding for many First Nations schools is less than federal contributions to provincial schools that have similar costs and needs. The gap is even wider for kids with complex needs. 

  • Thousands of people living on reserve do not have indoor plumbing. Water systems for 25 per cent of on-reserve people may be a risk to health, safety and the environment. 

  •  More nursing education and awareness is required about historical trauma and its impact on First Nations health.

 

Camosun Nursing