Category "BCNU"


Daphne Bramham: First Nations’ solution to a modern, medical crisis

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Ending Canada’s opioid overdose crisis will likely require much more than sophisticated drug therapies. In fact, it might mean following the lead of First Nations health-care providers and transforming how we think about and deliver medical services.

First Nations people are dying of opioid overdoses at three times the rate of the general population. Hidden in that data are Canada’s most-neglected victims — Indigenous women.

Unlike in the general population where men comprise 80 per cent of the victims, Indigenous women are as likely to overdose or die as their brothers, fathers, husbands and sons.

They are eight times more likely to overdose than other women, and five times more likely to die from an overdose.

It’s not really surprising, says Dr. Evan Adams, the First Nations Health Authority’s chief medical health officer. The terrible numbers track other devastating indicators of how their health and longevity diverge from those of other Canadians.

“A lot of First Nations women who have substance-use disorders are exploited women. They are women who are victimized by the sex trade. They’re victimized by their partners,” said Adams, who worked for five years in Vancouver’s notorious Downtown Eastside, the epicentre of Canada’s opioid crisis.

What the opioid crisis highlights for him is the endemic problem of the western medical model, where people go passively to doctors’ offices and say, “Heal me.”

Dr. Evan Adams is the Chief Medical Officer for the First Nations Health Authority.

Jason Payne /


“Our (First Nations) model is that the doctor gives you a chance to get better. But, you make yourself better,” he said. “It’s your family that does most of the work of helping you get better, not that doctor who you visit for 15 minutes every week, if you’re lucky.”

Unlike in the western model, healing and wellness in the traditional Indigenous way involve mind, body and spirit. For First Nations men and women to achieve wellness, Adams said they require much more than medicine.

“They need healers who can do ceremony. Maybe they need love. They need justice.

“How can a woman recover from opioid use disorder when you won’t let her see her children? It’s disgusting,” he said.

The day Adams and I met, the FNHA offices were being “swept” by a group of elders carrying cedar boughs and candles using traditional ceremonies to restore the spirits of the people who work there.

“Some people would say an elder is less trained in opioids than an addictions physician,” Adams said. “But wouldn’t it be nice to have both?”

It’s not that FNHA rejects modern medicine. It continues to expand access to opioid agonist treatments such as methadone and Suboxone, which quell cravings, making it available at all FNHA nursing stations and at four of the nine FNHA-funded residential treatment centres. FNHA reimburses treatment fees charged by private clinics and has spent $2.4 million in grants to 55 communities for harm-reduction programs.

Yet, for Adams and his staff, drug therapies are only a small part of what he calls harm reduction’s suite of services.

The Crosstown Clinic in downtown Vancouver.



“Harm reduction is not just, ‘Let’s make sure you don’t overdose.’ It’s the whole person that you have to treat, not just this one aspect of the person that is craving opioids.”

To incorporate First Nations wisdom into other programs, FNHA created two peer coordinator jobs at the Crosstown Clinic in the Downtown Eastside. Its compassion inclusion initiative has engaged another 144 Indigenous people with lived experience across B.C., and its Indigenous wellness team has taught indigenous harm-reduction and wellness programs in 180 communities.

“Opioid use disorder is everyone’s business. It’s yours and it’s mine and it’s everyone around us. It’s not just the domain of physicians with 24 years of training,” he said. “Why can’t Grandma help, or a family member?”

What concerns Adams about the response to the opioid crisis that is heavily grounded in the medical model is that it could widen the gap between his people and mainstream Canadians.

Indigenous people don’t necessarily trust health providers who don’t look like them or where there is no acknowledgment of the historical trauma they have suffered and their unique experiences in the world.

That’s just one more reason why the FHNA, which is unique in Canada, is so adamant that it must transform the way health care is delivered to its people so that they are empowered to help in their own healing within their own circles of trusted friends, family and elders.

This current crisis is rooted in the western medical model. The seeds were sown by an aggressive marketing campaign by Purdue Pharma, which falsely promoted its Oxycodone as being non-addictive. What followed was an epidemic of opioid over-prescription by physicians and other health-care professionals that eventually created a demand for synthetic opioids on the black market.

With so many deaths and no end in sight, this might be the time for all of us to reconsider whether the best responses to this crisis ought to be done within a much broader context of healing and an expanded understanding of what wellness really means.

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Twitter: @bramham_daphne

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B.C. nurses against tentative deal want more staff, not more money

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There are hundreds of nursing vacancies posted on the HealthMatch B.C. website, but not even the union knows how many more jobs need to be filled.

There are hundreds of nursing vacancies posted on the HealthMatch B.C. website, but not even the union knows how many more jobs need to be filled.

Christopher Furlong / Getty Images files

A vocal group of frustrated nurses is threatening to reject a three-year tentative contract with the provincial government because it doesn’t come with written guarantees that more nurses will be hired for short-staffed hospital units.

The voting deadline for the tentative deal is Jan. 21 and, as Postmedia stories have been documenting contract details this week, nurses have been voicing their concerns in emails and on social media that the deal doesn’t go far enough to hold employers to account.

This, even though the Health Employers Association of B.C., which negotiates on behalf of the government, agreed to a provision in the $3.99-billion contract in which nurses working on short-staffed units will be given an hourly bonus ranging from $3 to $5 an hour. The “working short” premiums could cost taxpayer-funded health facilities as much as $100 million a year, according to the union bargaining team which insists that it is putative and is, therefore, a huge incentive for hospitals to fill vacancies.

The cost of the premiums is considered an “unfunded liability” to health employers so amounts owing to nurses would come out of hospital and other budgets already allocated by the provincial government. It remains to be seen whether the ministry of health would hand over more money to health authorities to cover the premiums.

Naysayers are skeptical that the premiums will achieve their purpose; some say it will still be cheaper to pay the premiums than to hire new nurses. Nearly $200 million was paid in overtime to nurses last year.

Health Employers spokesman Roy Thorpe-Dorward said in an interview that the agreement “requires employers to take all reasonable efforts to fill shifts, including going to full overtime rates.

“The working short premium is intended to compensate nurses who are required to work short if a shift can’t be filled. The goal of employers is to minimize the number of times this premium would be paid.”


There are hundreds of nursing vacancies posted on the HealthMatch B.C. website but not even the union knows how many more jobs need to be filled, so the contract provides for a workload assessment process over the next year meant to show what “safe staffing” levels are for each hospital unit. The union can also press for more hirings in other ways, as it did at St. Paul’s Hospital last year.

The “working short premium” as it is called, will kick in on April 1, 2020 and B.C. Nurses Union CEO Umar Sheikh has said that many of the 6,000 casual nurses should be converted to regular, permanent positions to help plug the “four million hours” when hospitals are short staffed.

B.C. Nurses Union CEO Umar Sheikh.

B.C. Nurses Union CEO Umar Sheikh.


Sheikh acknowledged it may be difficult to find and hire enough registered nurses, registered psychiatric nurses and licensed practical nurses. Recent reports by the Canadian Nurses Association and the Canadian Institute of Health Information show that nationally, there is an alarming slowdown in the growth of employed nurses.

The annual growth rate fell to 0.7 per cent from 2016 to 2017, the slowest in a decade. In 2017 (the last year for which data is available), a total of 4,271 nurses were registered for the first time in B.C., but in the same year 3,135 retired, so there was a net gain of only 1,136 nurses. By comparison, Ontario had net gains of 1,941 nurses and Alberta had 1,183.

Nurses say they can’t speak on the record during the ratification process but they have been reaching out in droves — off the record — to articulate their worries.

B.C. Nurses Union president Christine Sorensen.

B.C. Nurses Union president Christine Sorensen.

Wayne Leidenfrost /


In a comment posted under a news story, Teresa Johnson-Fortune said:

“We have been working short staffed for years and the government has not lived up to their previous contract negotiations. The current health care system is run based on nurses doing crazy amounts of overtime. We are tired, but most of us do overtime because we feel bad for our co-workers and don’t want to leave them working short.”

Sheikh told his union members the working short premiums are high enough that hospitals will be compelled to hire extra staff rather than pay it. For example, the $5 per hour premium represents an 11.38-per-cent wage increase on top of the 7.75-per-cent increase nurses will get over three years. (Although the contract calls for a two-per-cent increase each year, an extra 1.75 is due to nurses this year as a carryover from the last contract.)

“The working short premium represents a commitment by the employers — (one) we haven’t seen before.”

Nurses union president Christine Sorensen told members in the same teleconference that the understaffing in hospitals is “simply unsustainable.” The contract addresses priorities nurses identified before bargaining, she said, including compensation for all time worked, wage increases, benefits protection, workloads and safe staffing levels, and a premium “for those times when you did not have staff (on leaves) replaced.”

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B.C. nurses negotiate pricey premium designed to force additional hiring

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A tentative contract negotiated by the B.C. Nurses’ Union for over 50,000 nurses is rich with bonuses that could far exceed the contract’s $3.99 billion in base costs paid by taxpayer-funded hospitals and other health facilities.

Details of the tentative agreement obtained by Postmedia show significant gains made by the BCNU. The deadline for ratification of the 2019–2022 contract by registered, psychiatric and licensed practical nurses is Jan. 21.

While the base wages stick to the government-framework of two per cent wage increases each year for public sector workers, the new contract compels health authorities to beef up staffing by filling hundreds of nursing positions that have been left vacant.

On average, nurses make about $45 an hour, but there are wide variations depending on experience and training.

If heath authorities do not hire more staff, nurses who are shouldering the burden of working in short-staffed units will be entitled to premiums ranging from $3 to $5 an hour. The premiums could cost taxpayers as much as $100 million a year, according to the union.

The amount is not included in the costs of the contract. It is considered an “unfunded liability” to health employers, so costs would come out of hospital and other budgets allocated by the provincial government.

The “working short premium” as it is called, will kick in on April 1, 2020 and is meant to force health authorities to get their staffing up to “safe patient care” levels and convert many of the 6,000 casual nurses into permanent positions, according to BCNU CEO Umar Sheikh.

“We think we are four million hours short of the proper level of patient care across the province. Health employers will now be the masters of their own fate,” Sheikh said.

While some nurses prefer to have casual positions for their flexibility, Sheikh said 13 per cent of the workforce are casuals, a proportion he maintains is far too high.

Nearly $200 million was paid in overtime to nurses last year and that, according to Sheikh, is a reflection of staffing shortfalls.

HealthMatch B.C., the government-funded agency that recruits health professionals from around the world, lists about 250 nursing vacancies in B.C. this week but that figure does not reflect the entire complement of vacancies since not all positions are posted. HealthMatch said it recruited 79 nurses from outside B.C. last year.

Sheikh acknowledged it may be difficult to find and hire enough nurses. But he said an assessment process will take place in the next year to help determine optimum staffing levels in various settings, based on patient needs. That means that staffing should be higher on units where patient illnesses are more severe.

Management in hospitals and other facilities should be keen to fill vacancies sooner than later if they want to avoid the “unsustainable” hit their budgets could take because of the working short premiums.

Under the tentative agreement, nurses will also be paid for every minute they work. Since nurses say they often do administrative work after their shift ends, a paid end-of-shift bonus will stop the “normalization” of unpaid work. For the first 15 minutes of such work (usually done as nurses are handing off patients to the next shift), nurses will be paid at their straight time rate of pay. When they work more than 15 minutes, they will be paid at an overtime rate.

Michael McMillan, president-CEO of the Health Employers Association of B.C., which negotiated the contract with the BCNU, could not be reached for comment. But Roy Thorpe-Dorward, a spokesman for the association, said no one there would comment until the contract is ratified.

Sheikh said there was more trust and goodwill in this round of  bargaining.

“I wouldn’t call this a scare tactic at all, I would say it’s more of a leap of faith,” he said, referring to the premiums which he said McMillan and health employers agreed to “because they are the right thing to do.”

“I applaud their courage.”

While the new contract mostly rewards those in the nursing profession, there is one nurses’ job benefit that may not be as lucrative in the future — massage therapy.

According to BCNU figures, massage therapy costs have jumped by over 900 per cent in the past 10 years. Nurses and their family members are entitled to unlimited massages and the benefit now accounts for 1.2 per cent of all payroll costs.

Sheikh said the annual cost of taxpayer-funded massages increased from $3 million to $31 million in the past decade. In the past three rounds of bargaining, the government and health employers have raised the issue of skyrocketing massage therapy costs and now the union has agreed to consider a cap or some other formula to bring such costs down.

Nurses will be consulted over the next year on possible changes to their extended health benefit plans. Under one option, they would have a flex benefit plan that would limit how much nurses and their family members spend on massage services while using cost savings there to improve vision, dental and drug benefits.

While nursing is known to be physically and emotionally draining, it is not clear why health employers and the government, many years ago, agreed to fund unlimited massages for nurses’ family members as well.

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Twitter: @MedicineMatters

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