BC's Forgotten Health-Care Heroes
PROUD HEALTH PROMOTERS Northern Health Authority public health nurses like Terrace's Lindsay Willoner and Nancy Dhaliwal have been providing important preventive care services to rural and remote communities during the COVID-19 pandemic.
Since the outbreak of this year's deadly COVID-19 pandemic, the media has often highlighted the selfless sacrifices made by BC nurses and other health-care workers – particularly those delivering care in acute and long-term care facilities. The media, however, rarely celebrates the heroic work of public health nurses – particularly those serving residents of rural and northern BC.
"We are the faceless health-care heroes trying to prevent the spread of disease," says veteran Terrace public health nurse Lindsay Willoner.
"We are the voices behind the phone, a consultation at a higher level. We are prevention and we love our jobs. This is what we train for. We're ready for a challenge when the globe is in crisis.
"We may not need PPE in our roles, but we do work very hard to ensure those at the forefront of this storm are taken care of if they come into contact with an exposure."
Willoner and Nancy Dhaliwal, both from Terrace, and their Prince George colleague Jamie Hill, recently discussed their changing public health roles with Update Magazine, and described how the pandemic has affected them, their co-workers and the public.
UPDATE Please describe your current job.
HILL I'm a registered nurse with Northern Health. I've been working alongside and within public health for the past 17 years, and as a public health resource nurse (PHRN) for the last four years.
I provide nursing clinical advice, support, mentorship and education to those responsible for delivering public health services in primary care, home and inter-professional teams.
DHALIWAL I'm the North West communicable disease coordinator for a region that stretches from Houston to Haida Gwaii and from Atlin to Kitimat. I've been in this role for five years and did CD work as a public health nurse for 16 years before that.
WILLONER I started my nursing career in BC in 2006, when I moved here from Ontario as a newer grad looking for an adventure in public health. I currently hold the portfolio of regional nursing lead for cannabis, tobacco and vapour reduction.
UPDATE How has the pandemic changed those duties?
WILLONER When redeployment hit on March 23, it was all hands on deck and a straight dive into COVID-19 work, with meetings to discuss best outcomes for the client/community and the health authority. I was redeployed by Northern Health to work on the COVID-19 urgent communicable disease response team (UCDR).
HILL I have had opportunities within public health to work in complex and changing times, with amazing and supportive peers and leadership. The pandemic has shifted my nursing duties. I now offer support for COVID-19 case and contact management as part of a responsive team. We lean on, and support, each other through a constant learning curve.
DHALIWAL It's the same work, just with a new virus and many unknowns. We are learning as we go. At first, keeping up with the pace was hard. The biggest challenge was learning about this new virus. That came first and the policies followed. But it's a smooth-running ship now.
UPDATE What does a typical day look like for you now?
WILLONER On a typical day I meet with my team (fellow UCDR RNs as well as communicable disease coordinators and medical health officers) about current cases, contacts and anything new or urgent that may have come through the communicable disease hub. From there we dispense our workload to cover the region.
HILL Days can be unpredictable. Flexibility is important during this pandemic. Responsiveness to case management, and follow-up, including contact tracing, is a key public health measure to control COVID-19. There is no typical day, but there is a need to know your supports, to communicate effectively and to lean on teammates for debriefing and navigating through emerging challenges.
UPDATE Has the return of students to school created more work for public health nurses?
WILLONER The medical health officers and the school health lead in the north have done a terrific job at supporting schools and local communities. I am very grateful for all their hard work for students and families. I think it eased tensions by making us better prepared and more aware that cases may arise, and also helping us understand what steps we should take in response.
I feel fortunate working for Northern Health, having resilient leadership and wonderful medical health officers. It is through their leadership model that we are taught how to ensure there's high quality health-care services across our vast geographical area.
UPDATE What do you think of the public's support for nurses during the pandemic?
DHALIWAL I'm so impressed with the amazing job British Columbians have done. We didn't just get lucky. People care about their communities and are willing to put themselves out for others.
HILL I feel the public's support and it fuels me to continue working passionately alongside my teammates during these challenging times. Ironically, 2020 was declared the Year of the Nurse and Midwife by the World Health Organization.
WILLONER The public has been amazing. I'm always encouraged to stay safe, and often thanked for my hard work in decreasing the spread of COVID-19. Many of my close friends and relatives have reached out to say "thank you" for all the long days and hours we put in.
UPDATE What are the conversations like when you contact people who test positive for COVID-19?
DHALIWAL I support them by offering information and advice. I contact them daily or more depending on the situation. There are people who are more difficult to work with. Stress often causes people to have trouble coping.
WILLONER My job on UCDR did involve contacting both cases and contacts. I think with any communicable disease follow-up we always prepare for uncomfortable conversations that bring about sensitivity.
The BC Centre for Disease Control has developed great resources, including for mental health and physical activity. I try to use those in my practice when talking with clients.
I found that people requested daily calls for their symptoms' check-in (the other option was a home health check-in). Connecting them with nurses built rapport and trust.
UPDATE And how do most people react when you tell them they have COVID-19?
DHALIWAL Most people are surprised and then a bit fearful when we tell them the news. But we are there to reassure them when they are nervous. We call every day to check up on them while they are in isolation.
WILLONER I found that most people were not shocked – because they had been symptomatic and gone for testing. We try to support individuals throughout their isolation period. For example, we sometimes work with BC Housing or the First Nations Health Authority to provide care.
UPDATE What is the biggest misconception about the work of public health nurses?
HILL It's not only about "just giving shots," and such. Prevention, protection and health promotion are the foundations of public health nursing.
Our roles can be broad, such as improving strategies and health outcomes for the entire population. We also provide frontline support to individuals and families for specific health needs such as communicable disease, immunizations, sexual health, harm reduction, school health, perinatal services and population health.
WILLONER The work of public health nurses is critically important in health promotion and disease prevention. These upstream approaches include Naloxone education kits, immunization clinics, communicable disease follow-up, school health, sexual health clinics and more.
DHALIWAL For me, the big lesson is that it's hard working with so many unknowns. Compassion goes a long way with clients and coworkers. Effective communication is vital. Everyone has a threshold of what it takes to feel safe.
UPDATE What are the biggest lessons you've learned about public health nursing during the pandemic?
WILLONER My biggest lesson is about self-care. As nurses we give and give and always put others first. It has taken me 14 years of public health work, and a pandemic, to learn that I am one person. I need to prioritize my mental and physical health.
UPDATE Will the experiences of the pandemic change public health nursing in the years ahead? If so, how?
WILLONER I think so. We learn from experience. Much like with SARS and H1N1, we always learn how to better protect ourselves and decrease the burden of disease. If anything, as a mother of two small kids, I can see that my children practise better hand hygiene. That in itself is a win!
DHALIWAL Hopefully the prevention, management and treatment of infectious diseases will receive more support going forward knowing this could, and probably will, happen again. I am looking forward to holding face-to-face meetings and hugging my friends again. •
UPDATE (Winter 2020)