Marilou Gagnon: Union merely tells nurses to "protect themselves" during fentanyl crisis

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      Nurses in British Columbia, and particularly in Vancouver, have been facing the worst overdose epidemic ever documented in Canada.

      While the nurses have been feeling the impact of this epidemic for almost a year, more so over the past few months, they have received little support from their union. Since the province declared a public-health emergency in April 2016, the British Columbia Nurses' Union (BCNU) has remained silent on this epidemic and absent from public debates, media, and even social media—quite the opposite to unions representing other frontline workers such as firefighters and paramedics.

      Last Friday, BCNU broke its silence and published a bulletin to remind its members “to protect themselves from exposure to harmful drugs and violent patients”. Notwithstanding the fact that its members have already responded to more than 6,000 overdoses this year in Vancouver alone, BCNU cautions them about “the risks in responding to overdose victims”—emphasizing the dangers of drugs (such as fentanyl and carfentanil) and the importance of “staying vigilant”.

      BCNU also warns its members about “possible violence from victims who are responding to naloxone” and states that employers should help them plan and respond to this violence.

      This bulletin misses the mark in several important ways.

      First, it fails to address the pressing needs of nurses on the ground, including working conditions, staffing, extended work hours, compassion fatigue, and health issues related to repeated trauma, stress, and difficult situations.

      Second, it places the entire responsibility onto nurses, who are being asked to: protect themselves; ensure that their employers have provided them with training, information, and protective gear; contact their supervisor if that is not the case; and report concerns around professional practice and/or workload by filing a grievance or a professional-responsibility form.

      Third, it assumes that people who receive naloxone are inherently violent, which could not be further from the reality on the ground. Frontline nurses have developed extensive expertise in managing overdoses while carefully balancing the need to intervene and the risk of precipitating their patients into withdrawal. I have witnessed firsthand the effectiveness of their interventions.

      Fourth, it contributes to the wrongful assumption that people who use drugs pose a threat to nurses by exposing them to dangerous substances or by posing a risk of violence.

      Lastly, it fails to recognize that nurses have a duty to intervene in life-or-death situations. Telling them to “consider their own health and safety while assisting patients” is like telling them to think twice about intervening when nurses clearly have a duty to act in life-or-death situations. What are nurses supposed to consider, exactly? Using universal precautions and intervening based on their clinical judgement is the best they can do. It is what they have been doing for a year now.

      With this bulletin, BCNU tells nurses to protect themselves. But it fails to say what it will do to protect nurses, which is what its mandate is all about. In light of the toll that this overdose epidemic is having on nurses, we expected more from BCNU. Needless to say, it has a lot of work to do to fulfill its mandate and address the needs of its members.

      The B.C. Coalition of Nursing Associations (BCCNA) is hosting an Emergency Forum to Respond to the B.C. opioid crisis on Wednesday (December 14) from 9 a.m. to 12 noon at the Morris J. Wosk Centre for Dialogue in Vancouver.

      Marilou Gagnon, RN, PhD is an associate professor, school of nursing, faculty of health Sciences, University of Ottawa and Founder, Coalition of Nurses and Nursing Students for Supervised Injection Services. Follow her on Twitter: @mlgagnon_XVII and Instagram ml_gagnon.