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#56 – May, 2009 Newsletter

I've been a street nurse in Toronto for 20 years. I have received the Atkinson Economic Justice Award which permits me to pursue my passions for nursing and working on homelessness and housing issues. In this newsletter I hope to report on my activities, create a link to a broader group of individuals who care about these social issues and encourage critical debate.

Nurse!pdf version of this issue

Nurses Week Edition

1. The slogan for Nurses Week

2. H1N1. How much have we learned since SARS?

3. The ‘Story behind the Shoe’ contest winner is:

1. The slogan for Nurses Week

In my Nurses Week edition of this newsletter last year I wrote the following:

“Nurses Week every year uses a different slogan and I have never really felt they captured the ‘dance’ of nursing. Consider these: ‘Promoting healthy choices for healthy living’ (surely nurses know that’s a hard thing for poor people to do), or ‘Nursing: patients first, safety always’ (did this slogan follow some horrible inquest?), or ‘Nursing: knowledge and commitment at work’ (everyone knows nurses have knowledge and commitment).”

The unimaginative 2008 slogan was ‘Think you know nursing? Take a closer look.’

Well this year’s 2009 slogan is a bit more edgy, even taunting: ‘Nursing: You Can’t Live Without It!’

I wrote to the Canadian Nurses Association (CNA), the national organization which picks the annual slogan: “I have to admit I do not understand the slogan this year. It suggests a person/community cannot live without nursing, which is a bit of a stretch. The slogan suggests we expect a permanent need, dependence.”

My response from the CNA explained that the theme was to focus on the value of nurses on the system as a whole, not just to the “individual patient,” i.e. the role nurses play influencing the “health care system such as reducing wait times, influencing policy and improving better access.” I found their answer a little clinical, hospital system and patient focused.

This year’s slogan prompted me to host a Nurses Week event in Toronto that was a bit more reality based. For years, some nurses have watched an extraordinarily obscene number of people they care for die homeless. Each month names of people who have died homeless in Toronto are added to the Homeless Memorial outside the Church of the Holy Trinity behind the Eaton Centre and they now total over 550. My Nurses Week event held at the Homeless Memorial was attended by nursing leaders, Street Nurses, homeless people and social justice advocates. Their slogan was Housing: People Die Without It!

Going back to this year’s slogan: ‘Nursing: You Can’t Live Without It!’ – surely we can do better than that to capture the vitality, passion, commitment and strength of nursing.

If you have ideas for slogans that better reflect ‘the dance of nursing’ let me know!

Here are links to past issues of this newsletter’s Nurses Week editions. They feature interviews with Florence Nightingale, my mom Jean Crowe and a commentary on celebrating the Street Nurse.

2. H1N1. How much have we learned since SARS?

During SARS (Severe Acute Respiratory Syndrome) Ontario nurses faced an uphill battle fighting for information, supplies and timely directives to protect themselves, their clients and the community. Street Nurses for example, had no useful directives for their outreach sites. Information was so muddled that I began attending the daily 3 pm government press conference, just to determine what was unfolding. When homeless health care providers learned there were no safe and adequate quarantine provisions for people that were homeless, we fought and won a guarantee in Toronto, York and Durham regions.

Dozens of nurses in Toronto contracted SARS and two nurses died. Justice Campbell’s SARS Commission Final Report ‘Spring of Fear’ provided a full airing of the problems faced during SARS and made recommendations that we all hoped would be heeded. Many of us testified at this inquiry.

Nurses applauded the report.

“During SARS, nurses experienced a steady stream of inconsistent, contradictory and incorrect information about transmission, infection controls and protective protocols,” says Haslam-Stroud (Ontario Nurses Association president). “Ontario was slow to respond to the outbreak, did not have an adequate supply of protective equipment, and employers did not provide appropriate training for equipment that did exist. This sort of situation cannot be allowed to happen again. The government now has clear recommendations on what needs to be done to prevent another similar situation.”

How much have we really learned since SARS?

With H1N1, this time around I receive daily email updates from the Ministry of Health. Thanks to blackberry technology I get them immediately.

For the most part, local and WHO media conferences provide timely and clear messaging.

Public health educational materials are translated into many languages: chinese, urdu, tamil, punjabi, russian, korean, tagalog, to name just a few.

Hand washing signs are everywhere. Antiseptic hand gel dispensers are everywhere.

A multimedia national web/phone meeting was hosted by St. Michael’s Hospital to establish the state of preparedness for homeless health care providers.

So what’s wrong with this picture?

Well, unchanged since SARS is the historical and hierarchical struggle that plays itself out in the health care system. The hierarchy is top-down for those of us in Toronto caring for impoverished populations: the Emergency Management Unit and the Ministry of Health and Long-Term Care, Toronto Public Health, hospitals, hospital satellites, community health centres, homeless health care providers providing outreach, shelters and drop-ins and ‘soup kitchens’.

Today, during H1N1:

Nurses are still fighting for information and resources.

  • Doctors in one community pronounced that nurses didn’t need N95 masks but rushed to get fit-tested themselves.
  • The solitary nurse working in the largest shelter in Canada has no masks, not N95s, not even standard surgical masks.
  • Some nurses, inadequately supplied and naturally remembering SARS, are forced to purchase their own masks rather than wait for their agency to supply them.
  • Many nurses working in outreach sites have no access to space where they can isolate a patient with suspicious symptoms away from the crowd.
  • Inconsistent screening protocols are seen in a variety of health care settings. Masked health care providers in one setting triaging clients with questions, in another a simple sign and hand gel dispenser.
  • City shelters are told they are on their own when it comes to stocking infection control supplies such as masks. There remain drop-ins without adequate hand soap, paper towel or hand gel dispensers.
  • Toronto, unlike the City of Ottawa, has NO plans for a triage centre or a designated care centre for people with suspected influenza infection, to isolate them from the thousands of other homeless people they would normally be exposed to in an average day/week.

H1N1 provides a sharp lesson for us. Homelessness, poverty and hunger have only worsened since SARS. In addition, this economic tsunami is creating more casualties – increase in food bank use and mortgage foreclosures, empty parking lots at manufacturing plants and increased calls to crisis lines.

These are unprecedented times. Struggle, strength and solidarity is the injection that we need as nurses to do our job in these difficult times. Nurses need to begin to stand up and speak out.

3. The ‘Story behind the Shoe’ contest winner is:

It was close, but the winner of last month’s picture contest ‘The Story Behind the Shoe’ was Ashley Flello, a second year nursing student from Lakehead University in Thunder Bay. Thanks to all of you who submitted answers.

Ashley wrote:

Without being able to take any history, I might say that a primary diagnosis may be venous stasis ulceration. Gravity is the enemy in venous stasis ulceration, and I would wonder if there would be adequate opportunity to rest with legs elevated. Also, access to primary health care (certainly here in Thunder Bay, but everywhere...) for people who are homeless and underhoused is pitiful, and I would be concerned that he wouldn't be able to access regular wound care. Furthermore, his leg looks very small (which does make me question whether venous stasis ulceration is actually what is happening because edema isn't present...) so I would wonder if he was receiving adequate nutrition, which is key for wound healing.


Thanks to Anthony Rapoport for design, layout and web support, Bob Crocker for editing. Photo credit: Cathy Crowe

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