Sonya Hoeverman, RN, 39, New Westminster, B.C.
As an intensive care nurse, Sonya Hoeverman’s shift is full-on. ‘I love my work,’ says the petite brunette, who has been nursing for 14 years. ‘I became a nurse because I love working with people.’ Hoeverman is one ‘of many experienced registered nurses who lovingly devote their time in the trenches of gritty hospital work. While many of us groan over our eight-hour days, Hoeverman’s shifts last a gruelling 12 hours. With two boys ages eight and five, that’s a long time to be ‘at work. Her day shift at Royal Columbian Hospital’s 18-bed intensive care unit in New Westminster, B.C., begins early. She is up before 6 a.m.; gets the children awake, dressed and fed; and is in her car on her way to work before 7 a.m. when her husband, a location expert in the film industry, takes over.
‘After I get to work and change into my scrubs, the night nurse and I will sit down together and she’ll give me the history of what’s happening with our patient.’ Hoeverman then works out her daily plan and writes down her goals. ‘There is one-to-one nursing, so I’m responsible for that one patient for 12 hours. Of course we have our team that we work with really closely’physicians, residents, respiratory care, physiotherapists, dietitians, pharmacists, social workers, nurse aides, unit clerks and volunteers’and they are incredible. I’m just one part of the team taking care of that patient.’
How much has technology taken over patient care? Perhaps not as much as you might assume: Hoeverman logs her patient care hourly’using pen and paper. ‘We have talked about bringing in computers to record patient notes and charting, but right now we still do everything by hand.’
Hoeverman’s decision-making responsibilities in the ICU are crucial. ‘We have always had some autonomy in making decisions when it comes to patient care, but I think that has increased over the years.’ She has seen some changes in other aspects of her job. ‘Managers have a lot more responsibility and you don’t see as much of them as you used to.’
Her role also involves supporting patients’ families. And as an ICU nurse, Hoeverman frequently has to deal with the death of her patients. ‘When patients die, I try to make it as easy as I can for the families,’ she says. Does that affect her on a personal basis? Hoeverman hesitates before answering and her eyes carry traces of tears. ‘There are patients who sit on my shoulder, that I carry with me and I remember, absolutely,’ she says softly.
Janice Westgate, RN, 48, Toronto
In some remote rural settings where physician care is limited, nurses need lots of clinical experience. During her time in the Arctic in the mid-’90s, Janice Westgate routinely read X-rays, set pacemakers, prescribed medications, performed minor surgical procedures and made diagnostic decisions. ‘That would not have happened in the ’80s,’ says Westgate, a 27-year nursing veteran who has also worked in emergency medicine, pediatrics and poison control.
Clinical decision-making has always been a part of the work, but years ago many nurses with Westgate’s experience were taught to ‘frame’ those decisions so they appeared to come through a physician. Now they are comfortable about taking ownership. Westgate, who was a pediatric intensive care nurse for 20 years, says, ‘When we work as emergency triage nurses within a hospital setting, we regularly prioritize patients and we often make decisions to implement treatment before the patient is seen by a doctor.’
After many years in B.C., Westgate moved back home to Ontario to be closer to her parents. Now this single mother of two school-age children works an eight-hour day in education and administration in the Greater Toronto Area. Her time is divided between ‘suit’ and ‘uniform’ days. ‘I get more satisfaction from uniform days,’ she admits.
Westgate has noticed that nurses entering specialty work can lack hands-on experience. ‘Nurses in training are not getting a real picture of what it’s like on the front lines,’ she says. A former instructor of advanced practice nursing herself, she says it’s not unusual for student nurses to enter their second year of school before seeing any hospital time. ‘Back when I was a student, I began classes in September and was ‘in the hospital by October.’
In the course of researching this article, sources I contacted told me that actual hands-on hospital clinical hours for students have decreased substantially compared to original nurse training programs that were situated in hospitals. They say that, these days, there is an increased focus on cultivating critical-thinking abilities and using simulated patients.
‘Nursing is a calling, a commitment to humanity,’ says Westgate, who has travelled the world as a nurse, volunteering in places such as Cambodia, India, Lebanon and Mexico through Operation Rainbow Canada. ‘My growth as a person has been greatly influenced by my work. It has been a wonderful life-building experience.’
David Stair, LPN, 36, Vancouver
David Stair is a licensed practical nurse who works in a hospital and an extended care facility in the Greater Vancouver area. ‘He says in the past several years LPN duties have expanded to include dressing wounds, inserting IVs and changing catheters, in addition to regular personal patient care duties such as bathing, feeding and dressing patients, and changing linens and bedpans.
Stair sees this as a future trend, since RNs are now taking on more of a leadership role. LPNs in British Columbia, currently part of the Hospital Employees’ Union, are attempting to become part of the British Columbia Nurses’ Union. Recognizing the need for LPNs who are more highly skilled, some schools will likely expand the length of their programs.
An increasing number of new Canadians see the LPN programs as an ideal way to enter the workforce at a competitive wage. Stair says his class had a high percentage of new Canadians, many of whom had nursing experience in their country of origin (though some found the language barrier too difficult to overcome, and some encountered cultural conflicts such as touching body parts of the opposite sex). Stair, who is invaluable at work because of his physical strength’he’s sometimes called upon to help move patients’loves his job and says, ‘I’m good at taking care of people.’
Today you are more likely to find an RN teaching at a university, conducting research or occupying hospital administrative positions than you were a decade ago. Both Hoeverman and Westgate agree that the increased presence of nurses in the higher echelons of health administration and research is a good thing.
‘It is a much broader career now and plays a key role at all levels of health care,’ says Westgate, who notes that in one hospital where she worked, the CEO was a nurse and both directors were nurses. ‘That would not have been the case when I graduated. Administrative positions were not that available to nurses. People came to those positions from a business background,’ she says. Now this group is helping to formulate knowledge-based strategies to improve our health care.
The downside? The fact that experienced nurses often have to assist with hands-on training for newly employed nurses when they are already having to deal with broadened levels of stress because of staff shortages and increased workloads. Westgate says that she notices there is a higher number of her peers who are exhausted and calling in sick, citing a report from the Canadian Nurses Association that predicts a national shortage of 20,000 nurses in Canada over the next two years (yes, just two years). ‘Alberta already has a shortage of 2,000.’ Many nurses don’t answer their phones for fear of being asked to do overtime or added shifts, she says.
More and more, minor surgical problems are being treated on an outpatient or day-surgery basis, freeing up hospital rooms for the more seriously ill. That’s a good thing. What does that mean for nurses? They’re expected to work harder than ever.
**Help recognize our country’s greatest nurses. Nominate a nurse you know today at besthealthnursingexcellence.ca.