Leap of Faith

HONOUR IN RECOVERY Vancouver's Kinnon Ross feels confident about what she has to offer as a nurse thanks to the support she's received from her union.

Homeless. Uneducated. Unsuccessful. These were the stereotypes about substance users and people struggling with addiction that Kinnon Ross bought into while growing up.

Now an adult, the Vancouver nurse today admits those myths helped buttress the denial of her own substance use disorder. "I had a pretty normal family. I attended private school. I travelled. I hold two degrees, including one achieved with honours. I'm happily married and own a car and home," says Ross. "'I am not an alcoholic – I go to work every day,' I told myself."

All that changed when Ross pressed send on an email to the BC Nurses' Union that read: "I want to apply for the LEAP program and self-report for addiction issues. Thank you for your time." Up until that point the St. Paul's Hospital nurse had been abusing alcohol since she was a teen, eventually adding recreational stimulants. But by early 2016, Ross had hit rock bottom.

BCNU's LEAP (Licensing, Education, Advocacy and Practice) program was established in 1988 to assist members with legal problems related to professional practice incidents. Today the program provides a range of services related to registration and licensing (see sidebar). It also provides support to members who are struggling with mental health and substance use issues.

It's a unique program tailored to the needs of a union whose members are regulated professionals. BCNU President Christine Sorensen says it's making a positive impact on the lives of members like Ross.

"BCNU recognizes that when members are most vulnerable, they're in need of immediate and comprehensive services," Sorensen says. "At some point in their lifetime, it's estimated that 10 to 17 percent of the general public experience mental health concerns. Statistically, that potential for vulnerability ranges from 4,000 to 6,500 BCNU members."

She adds that on average one percent of BCNU members will need to utilize LEAP services annually, with about 15 percent of those being substance use cases.

A JOURNEY TO WELLNESS

For years Ross had been coping with trauma from her youth, including excessive bullying, by self-regulating her anxiety and depression with alcohol.

She remembers binge drinking for the first time as a teen living at home in Edmonton. "I threw up. I had upset my friends. My parents grounded me. But my first thought was 'I can't wait to do that again!'"

Heavy alcohol use continued into university where Ross participated in a widely accepted drinking culture. Again, by all appearances, she said she didn't look like someone struggling with addiction. She made it to class, studied hard and graduated with her first degree in Women's Studies from the University of Alberta in 2004. 

Looking for a fresh start, she headed to Vancouver and by 2009 she was in nursing school at Langara College. "My mom was a nurse, and I actually obsessed about being a nurse when I was younger," she says.

Ross broke her femur when she was eight years old and was hospitalized for three months. "It was a nurse who helped me do my homework, it was a nurse who read to me and it was a nurse who bathed me," says Ross about her inspiration.

Ross felt like she was following a path to career success. In 2012, she led the cohort that hosted the first Canadian National Students' Association Western Prairie Conference in Vancouver. She was also accepted into BCNU's Employed Student Nurse Program, which allows nurses to gain clinical experience in special paid positions at health-care facilities. She also had good grades, being close to the top of her class. 

But despite her academic success, early signs of Ross's inability to cope on the job started to emerge with her first full-time position in the medicine unit at St. Paul's Hospital. "My practical skills were fine, my anxiety was not," she recalls. "I was terrified of making a mistake and overwhelmed with the expectations of a new nurse. On my first day I had five patients, two needing blood transfusions and three with mental health issues."

She made mistakes, including small but noticeable ones involving narcotics. She began worrying more and felt unsupported and belittled. "Before my 90-day probation period was up, my operations leader told me in the middle of my shift that I would be required to report to the human resources department the next day," she recalls.

A more supportive learning plan, negotiated with BCNU support, which included mentoring by the new grad educator, was soon put in place. Ross was glad to still be working, but all the while her alcohol dependency was neither disclosed nor discovered.

She says she continued to self-regulate her life the only way she knew how. "I was not eating or sleeping and used recreational stimulants and alcohol to survive when I wasn't at work."

The stress of Ross's job was compounded by two significant family deaths that occurred back-to-back in late 2014 and early 2015.

She managed to complete a critical care course in 2016 at the British Columbia Institute of Technology, finishing with distinction. However, during that time and while working as a student nurse in St. Paul's intensive care unit, she collapsed from exhaustion.  She had her blood pressure and blood glucose tested and was told to get some rest.

Ross was able to dodge a urine test following her collapse, but the experience of coming so close to being discovered, and the realization that she had jeopardized a career she respected and valued brought her to terms with her disorder. "I did not want to lose my identify as a nurse and if I hurt someone - that scared me more than anything," she says.

The catalyst for action came when a nurse colleague told Ross that she had just come out of treatment with the help of the LEAP program. 

That's when Ross decided to make her call. "Self-report to the college and don't go to work" was the first piece of advice she received after connecting with a BCNU staff member.

Deborah Charrois coordinates BCNU's professional practice and advocacy department and manages the LEAP program. "Everyone who participates in the LEAP program will have different needs", she says. "Some members using LEAP services may self-report or the college will recommend that they reach out to us after being reported by an employer, colleague or member of the public."

When Kinnon reported she was supported by the Early Intervention Health Program (EIHP), which saw BCNU working together with the college to encourage nurses to self-report. The program allowed for nurses to be responsible and accountable to their regulator. In return, limits and conditions were not reported on the register. This program has since been discontinued by the BC College of Nurse Professionals (BCCNP)*.

There is no requirement in the Health Professions Act to self-report. "In our opinion the legislation only requires another health professional to report someone if they believe there is reasonable and probable grounds that the continued practice of the nurse constitutes a danger to the public," says Charrois. "As a result, we no longer advise members to self-report but do advise them to take medical leave if they are unfit to practice."

Upon intake, a BCNU professional advocacy officer is assigned to work with an individual member. If there is a BCCNP* investigation, BCNU can assist with the process, which can include providing documentation, investigations, participating in interviews with BCCNP investigators, and providing written responses.

Charrois says the professional advocacy officer will help the member navigate the BCCNP* inquiry and discipline process, negotiate interim agreements, advise members on responses, negotiate complaint resolution agreements and discipline hearings.

"While the online intake process takes little time, getting to a resolution varies case by case," she notes.

A WIDE RANGE OF SUPPORTS

"Our team supports members like Ross who need help for substance issues," says Charrois. "But we help nurses who are dealing with other professional issues."

LEAP files typically fall into three categories. There are those that deal with so-called fitness concerns, such as Ross's, which include substance use or mental health challenges. There are those that deal with practice concerns such as documentation or medication administration errors, and there are those that deal with professional concerns, such as breaches of codes of ethics or patient confidentiality, inappropriate use of social media, or behaviour unbecoming of the profession.

Charrois reports that the LEAP program has seen an increase in the number nurses being called out for social media misuse. "We worked on behalf of a keen new nurse who took a photo of an injury and posted it on social media," she says. "He was excited about the cool things he got to see in his job." Unfortunately, after his colleague reported him to the college, the nurse was charged with conduct unbecoming of the profession and breaching patient confidentiality. The injury he photographed could have identified the patient. "While the college inquiry committee originally wanted the member to agree to a term of suspension, through our successful negotiations we were able to reduce the discipline to a reprimand and further education on ethics and patient confidentiality," she says.

"Members have to remember that the mandate of the BCCNP* is to protect the public, and that the LEAP program isn't solely a remedial process," stresses Charrois, who notes that punitive outcomes are meant as deterrents for all nurses engaging in unsafe practice and behaviour. 

"We see nurses looking up records of family and friends and with just one click they have left an electronic footprint that will have them in front of their college having to defend their actions," she explains "Employers conduct electronic audits and colleagues have also been known to report the infraction."

Nurses deliver compassionate care, Charrois notes, and she reports that some members can develop bonds with their patients and clients despite rules against engaging in relationships with those in their care. The LEAP program is also available to assist in these circumstances.  

In addition to the support provided within the above-mentioned areas, the LEAP program also assists members requiring medical assessments where the BCCNP* is involved or potentially would be involved, applications for reinstatement of registration and remedial course funding.

Needless to say, LEAP is a busy program that strives to address a range of professional issues. That's why it's all the more impressive that 86 percent of members surveyed recently reported that their first contact with the LEAP program was satisfactory or extremely satisfactory (see sidebar).

Ross counts herself as one of those satisfied members even though she waited an excruciating six weeks before being accepted into an out-of-province treatment centre. "It's been the only downside to this process – the wait for an open spot in a facility."

But the 42-day stay set her on a path to recovery. "The out-of-province facility supports health-care professionals, and knowing I was not the only person in my situation was really helpful," she says. Her stay in the treatment centre also made Ross incredibly grateful for being a nurses' union member. "When interacting with other nurses from around Canada, I found that they didn't have the same kind of supports that BCNU provided me – from the step-by-step processes to the funding."

Ross then applied to work in Providence Health Care's Urban Health Program at St. Paul's Hospital in 2016 and will complete her required three-year return-to-work monitoring period in February 2020.

The Urban Health Program provides a range of coordinated inpatient and outpatient services in addition to specialized diagnostic and treatment services to a population with complex health problems that are often compounded by homelessness and substance use. "We work to hear our patients and guide them on the best course – it's a community effort."

As a recovering nurse, Ross' first year back did not allow her to work nights or be involved in delivering any part of the alcohol-management program. But it's clear that working in the Urban Health Program has been crucial for her own recovery. "People would tell me to engage in 'self care'- and to me that was confusing – I didn't think I needed more pedicures and bubble baths to fix my substance use problem," she remarks. "I think the emphasis should be on 'community care' in that we can support each other with open ears and hearts. No amount of bubble baths was going to help me – self care meant drugs and alcohol."

It would be an understatement to say that the recovery process has changed Ross's life. "I feel calm and I feel empowered," she reports. "I have created a whole new support system and feel confident about what I have to offer as a nurse." •

UPDATE (Dec 2019 / Jan 2020)