Letters

Nursing BC, Feb 2003

Nurse Shortage:

Fact or Fiction

As a future British Columbia nursing student and resident, I read with interest the article, Crisis Level Nurse Shortage Can be Resolved, in the October 2002 issue. I am confused. The final paragraph states that "more than 40,000 nurses in Canada. . . could not find full-time employment and many left nursing or left Canada." Yet, the point of the article was that the nursing shortage is "worsening," with solutions ranging from increasing the number of nursing school graduates to retaining experienced nurses.

How can there be a shortage when 40,000 nurses can't find work? To me, this indicates a glut of nurses and a shortage of nursing jobs, not nurses.

While I start at a B.C. nursing school in 2003, 1 worry that when I graduate with my BSN, nursing jobs will be scarce. Several current B.C. nursing students seem to feel the same way, joking that the only work for a BSN grad is as a crew member on the B.C. ferries.

So tell me (and others), is there a true shortage of nurses and, if so, why can't all current nurses find work? Thank you for an excellent publication.

Jennifer Blacke

Portland, OR

While there is a shortage of registered nurses in B.C. and across Canada, there are indications that some registered nurses are being laid off in B.C. However, according to the Canadian Nurses Association, the shortage will worsen over the next few years due to more nurses retiring than new nurses entering the profession. RNABC's survey of registered nurses who graduated in 2001 (reported in the December 2002 issue of Nursing BC) found that 73% had found permanent positions compared to 24% in 1998. The CNA data reported in the October Nursing BC reflects an earlier trend in which registered nurses were not able to obtain full-time permanent positions and were forced to work in casual positions or leave the country in order to find full-time employment - ed.

Asthma Article Lauded

We applaud Jo-Anna Gillespie for her article Optimal Asthma Care (Nursing BC, December 2002). It is an excellent effort to assist nurses to understand the serious health issues related to asthma. From a pediatric perspective, we would like to highlight one issue. We find the point about not labeling children under the age of seven worrisome.

The majority of asthma we see in the emergency department at British Columbia Children's Hospital is with children under the age of five. We will label a child over the age of one with two previous episodes of wheezing, that responded to salbutamol, as asthmatic on their third visit. The stigma that comes with labeling may help them to get the care and medications they need on a regular basis. Families are better able to understand the health issue and access community education and other outpatient resources.

Asthma care has improved significantly in the past few years with the introduction of clinical practice guidelines and best practices developed from quality improvement collaboratives. We welcome the opportunity to share our emergency department's pediatric asthma clinical practice guideline upon request. Contact Susan Heathcote at sheathcote@cw.bc.ca

Susan Heathcote, RN

Denise Hudson, RN

Scott MacRae, RN

Vancouver, BC

Removing Barriers Requires Cooperation

As an emergency nurse, I am truly sick and tired of being criticized for the perceived inadequate care received by some drug addicted patients. Ms. Stewart's generalizations, in the December issue of Nursing BC (Removing Barriers to Health Care Services) indicate that despite "years of experience" in critical care, she has no insight into the workings of the emergency department. To suggest that some patients are labeled "low priority" simply because of their lifestyle is narrow minded and irresponsible.

The drug addicted patients who feel they are not getting appropriate care are likely the same ones who can be violent, threatening and hostile. They are likely also the ones who refuse treatment, refuse medications, blood work, x-rays, etc., and expect they will still be able to take up a valuable bed. In an era of severe financial constraints and bed and staffing shortages, we cannot afford to indulge this behaviour from anyone, drug addicted or not.

We try to meet their demands for housing, clothing and food the best we can. We have set someone up with shelter, detox or whatever else they require, then a few days or weeks later they have not followed up and are back on the street. With some, this is repeated multiple times. Some can have more than 100 encounters in emergency. Despite that, we try to accommodate them. And, in appreciation, many swear at us, threaten us and accuse us of maltreatment because they are addicts.

We would not be expected to accept this behaviour from any other patient population. Why are we to accept it from the addicted?

The only barrier to a person requiring medical attention is their cooperation, or lack thereof. I do not expect more cooperation of the drug addicted than I do of anyone else. However, they must meet me halfway or, because of our limited resources, I have no choice but to attend to the next patient. Unlike Ms. Stewart's inference that the addicted patient cannot cope with the structure of the emergency department, I have found that most are quite capable of cooperation, and that is all I and most of my colleagues ask.