Healthy Living in the North

Success in Smithers: How cross-training and staff education has led to a fully staffed, skilled primary health care team

Members of the Smithers primary health care team are lined up, smiling, in their office.

Members of the Smithers primary health care team. L-R: Mike Oaks, Primary Care Nurse; Heather Olsen, Primary Care Assistant; Sandra Stanley, Team Lead; Stacey Pederson, Primary Care Assistant; Sam Bosscher, Primary Care Nurse.

Over the last couple of years, the primary health care team in Smithers has been struggling to get to a point where they have a complete number of staff. Today, we’re happy to say that all primary care nurse (PCN) positions are full!

What is a primary health care team and what’s the latest on the Smithers team?

A primary health care team is composed of nurses, social workers, physiotherapists and occupational therapists, dietitians, a diabetes educator, and other professionals who work together to support patients in the community.

Out of the 11 full-time and part-time staff who make up the PCNs on the Smithers primary health care team, only three team members have worked on the team for more than 18 months. That means that 72% of the team are new staff. Right now, there are two casual employees that are in permanent positions, and only one of them has been in Smithers longer than 18 months. The team has hired nine casual PCNs over the last 18 months and nearly all of them have become permanent employees or are in temporary positions.

PCNs and primary health care are pretty new… what’s happening with training?

I spoke with Sandra Stanley, Team Lead for the Smithers primary health care team, to find out how she’s cross training the new staff.

“The ‘how we did it’ is partially the people that are here. They’re amazing people – intelligent, kind, compassionate, and motivated to give great care,” says Sandra.

When Sandra started as the Team Lead, many skilled staff had left and new staff members were struggling. They needed support to provide the full range of expected services. Smithers faced many challenges getting to this point, but they now have a stable team and good morale.

“I believe now, from talking with nurses, that the morale has improved, and they have become a tight and supportive team that work really well together, and genuinely like each other,” says Sandra. “They’ve picked up the education with enthusiasm and [they’ve] been keen learners. They’re intelligent, compassionate, and good critical thinkers. I count myself as fortunate to be leading such a team and the credit for what I see as success is due in very large part to them and their excellent qualities.”

Sandra believes that, wherever possible, a key to training is modeling the skill for others. Along with “walking the talk,” here’s how the Smithers team is tackling training for different aspects of their roles:

Palliative care
Palliative care is a “way of being” with people. It requires nurses to have the ability to assess the state people are in emotionally and spiritually, as well as physically. It can’t all be taught in a classroom. The skills are learned through experience, and being with other nurses who can mentor those skills. It was important to Sandra to pair less experienced nurses with others who have strong palliative care skills. The team was fortunate to have a primary care nurse with strong palliative care skills come back and join the team after moving away to work elsewhere. This was a game changer in many respects and helped provide that knowledgeable, consistent presence the nurses needed.

Long-term care needs assessment
Sandra’s team is focused on training related to completing the resident assessment instrument (RAI), which a requirement for a patient to go on a wait list for long-term care. With more primary care nurses using the RAI, people are assessed as needing long-term care and put on a wait list earlier. The team’s health care aides supports community members until they are ready to transition to a long-term care home. Health care aides are an essential part of a community program and are critical to supporting patients who are at home, waiting to enter a long-term care home.

Diabetes education services
After the diabetes educator in Smithers had to decrease workload, waitlists for service were longer than usual. In response, two nurses are training to help educate new diabetics to give insulin, manage blood sugars, and decide what to do when the sugars are high or low. There’s been an incredible amount of training and cross-training done in general, as well as new diabetes work taken on by the nurses due to the back log of diabetes referrals.

Mental health services
To support mental health patients in Smithers, there are cognitive behavioural therapy groups that include members of the primary health care team. These teams teach people with mental health issues how to cook, shop, bank, take care of themselves, and more. The other team lead in Smithers, Cynthia Rondeau, works very hard to ensure there is quality mental health support for clients.

Cross-community support

When the team has struggled, they’ve received help from Hazelton and Houston, and they helped those communities in return. These three communities are working well together and being generous when it comes to helping wherever they can.

“The better connected we are with the people in the community, the better we can prevent admissions to the hospital and visits to the ER that are unnecessary,” says Sandra.

Sandra’s work, helping her team learn and grow as primary care nurses, has been instrumental to providing Smithers with skilled health care professionals.

Bailee Denicola

About Bailee Denicola

Bailee is a communications advisor in the Primary Care Department and was born and raised in Prince George. She graduated from UNBC with an anthropology degree and loves exploring cultures and learning about people. When not at work, Bailee can be found hanging out with her dogs, building her house with her husband, or travelling the world.

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Advance Care Planning in Long Term Care

Patti sitting on a boulder amongst rocks.

ACP Lead Patti reminds us to have a conversation about end of life care with our loved ones.

I started working with Advance Care Planning (ACP) about a year and a half ago. While my position includes promoting ACP, I’m also a nurse consultant with the palliative care team, which means I meet with clients who reside in Long Term Care (LTC) facilities.

When I did my Registered Nurse (RN) training many years ago, I did a portion of my practicum in a LTC facility; at the time it was seen by my classmates as a position that lacked excitement and offered limited experience. Twenty-seven years later, I see this experience differently! LTC is an area where there is more of a focus on comfort and normalcy within the resident’s care, because this is likely the last home they will reside in. In these kinds of situations, we must consider the individual’s needs and wants within the care that they receive, including cultural-based values and beliefs. As such, it’s even more important that there’s a focus on the individual, and whether they have thought about what’s important to them regarding their wishes for end-of-life care.

The last year in this position has led me to further see and understand the importance of ACP in LTC facilities, including: discussions that need to happen amongst family members; awareness regarding what the future looks like for the resident; and situations and circumstances that need to be explained. Not having these conversations may lead to misunderstandings and the failure to follow the dying person’s wishes.

As health care staff, we have to ensure that there are open lines of communication with the family members and loved ones, as well as the residents. As a family member, we need to be proactive, involved, and not afraid to ask questions, in order to be informed. ACP needs to be an ongoing process to keep everyone from questioning care choices. Sometimes the residents are at a stage where they can no longer have these conversations, or they may not have loved ones who are involved, and these topics don’t always get discussed. This makes it even more important to have these conversations with our patients before it’s too late, at a time when they are still able to express their wishes.

The extended length of stay creates relationships and bonds between staff and the residents, often closer ones than exist in regular hospital wards. So, sometimes it can be difficult for the staff to experience the decline in the residents and the care involved, and even harder if there is no ACP in place.

Advance Care Planning day was April 16, but ACP should be encouraged every day whether it’s with a loved one or a patient. Find out what’s important to them and get them thinking about what their beliefs and values are, and what would matter most to them at end-of-life. Let’s all work at promoting ACP and make an effort to have those conversations. For more information on ACP visit www.speakup.ca and www.advancecareplanning.ca.

Patti Doering

About Patti Doering

Patti was raised in Prince George and graduated from the CNC Nursing Program in 1991. She has been employed with Northern Health for 26 years and has worked in many different areas such as Med/Surg, Emergency, Mental Health and the Operating Room. Patti joined the Palliative Care Consultation team in October 2017, in a one year term position which is focusing on personal support worker palliative care education, advanced care planning, and other projects which support the work of the consultation team. Patti is presently working on her BScN through the UNBC’s online program. In her spare time, she enjoys the outdoors, sports, and spending time with her daughters and her schnauzer, Dexter.

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