Chapter 13: 2001-present

My early retirement move back to Sydney at my Pyrmont apartment near Darling Harbour was great - I liked the location as it was so central to everything. I hardly had to leave my neighbourhood and could access most places by walking or taking public transport. I enjoyed my year there. When I was required to pay big bills, I requested the Nursing agency provide me with work around the city. That was the only time that I used my car. I could work when and where I liked. I could dictate the number of hours I worked. The theatres were close enough for me to enjoy matinee sessions. What more could I ask for?

After a while I itched to travel again. I decided to go to Russia on a packaged holiday. I visited the travel agent and made my booking. I had to apply for a number of visas for the communist countries. In May 1997 I took my trip to Russia, starting from London. This was my third visit back to London after twenty years. The appeal was no longer there. I found the country a bit unkempt and Oxford Street did not give me the thrill that it used to. There were people lying on the streets and rubbish littered everywhere. Russsia was very interesting. I enjoyed Moscow and the Red Square. This was the place I found my man. Soon after our trip, we contacted one another. I visited Vancouver, Canada where he was from, and had a strong feeling that we were meant for one another. We got married in Australia before moving together to live in Vancouver.

After three years of enjoying my married life in Vancouver, I decided to get my nursing registration and go out a bit to make some friends and earn more pocket money. I had nursing skills which I could share. I had been registered and worked in four continents with not much of difficulty getting myself registered to their Nursing Boards, but things were different in Canada. It took me almost two years to get myself registered. The registration process in British Columbia, Canada was very rigid and slow. They required every candidate to write to all the previous Nursing Registration Boards where the nurse had been registered. You can imagine the number of nursing boards I had to write to. The documents which I had were not good enough for them. They wanted the documents to be sent direct from the respective authorities. I had graduated from a training hospital for nearly forty years and the hospital had been closed for over fifteen years during restructuring, yet I was told to get a transcript from them. I wrote a number of times to the hospital which was supposed to be amalgamated with them but they did not write back to the British Columbia Nursing Board. Despite this the British Columbia Nursing Board asked me again and again to write to them.

I wrote to England for my nursing registration verification. They replied to say that since I had left England for over five years, my nursing file was most likely to have been destroyed. I thought that it would then be a waste of my efforts and twenty-five UK pounds to pursue my nursing verification from them. I had left England over twenty years ago and informed the BC Nursing Registration Board about the matter. They still insisted that I have the verification from England. I also had to get a Californian verification, even though I did not even work with them.

I felt I treated as a criminal by the British Columbia Nursing Board. There appeared to be no trust in my word when I explained and tried to rationalise with them. They were very rigid and would not treat my case any differently from others seeking registration. The British Columbia Nursing Board also required me to undergo a TOEFL test, an English test for migrants. I wrote in for an exemption and I eventually heard from the Board that I had to organise to be assessed orally by two Canadian Educators. I rang them to say that I did not know anyone who could conduct the assessment. The officer then told me to get my General Practitioner to assess my spoken English. I wondered whether they had read my work history that I had submitted to them as requested. I had trained and worked in three English speaking countries, England, United States and Australia!

Months afterwards I heard from the British Columbia Nursing Board again that they were still waiting for my Basic Training transcript and my Australian registration verifications. I wrote again to the Australian Boards. I rang the Northern Territory Nursing Board in addition to writing to them. I even got my family in Australia to ring the New South Wales and Northern Territory Nurses' Boards. I finally received word from them and more money had to be sent before the verifications could be sent to the British Columbia Nursing Board. I did not hear from the British Columbia Nursing Board for a long while, so I decided to give them a call. I asked them what status I was in the registration process. I went through the routine of quoting my file number. I was told the person who was looking after the process of my registration had left the job. I told the officer on the phone that the application process had been going on for over a year. She said I was a special case since I was registered with so many countries. They were still waiting for my Basic Nursing Transcript, verifications from the Victorian Nursing Board, Australia, England and California. I explained again and again the reasons why I might not have verification from them as I had left England over twenty years ago, I had never worked in California even though I was registered with them and the training hospital has been closed for a number of years. It appeared that I would not be registered. I asked why I was not contacted earlier and the officer replied that there was a lack of manpower at the Board. I was so frustrated and was aware that I would not get through to the rigid officer-in-charge of registration. I had not faced such difficulties in getting registered before and if I did not act fast, I might have to go through the orientation program and sit for a British Columbia Nursing examination. The maximum period for registration should be only three months. Was that what they wanted me to do? I was not satisfied. I decided to write to the British Columbia Nursing Board Director of Nursing and informed her of my frustrations. I did not have a reply from her but instead had a phone call from her office that I was to have an interview with her at the Nursing Board office.

There was a global shortage of nurses and British Columbia was not excluded from this. Therefore, I thought that the British Columbia Nursing Board would make the process of nursing registration easier, rather than more difficult. It made me feel like a criminal that I needed to go through such a rigid long process of being investigated before being registered. I guess the British Columbia Nursing Board was very untrusting and all nurses guilty unless proven innocent. If they would make the registration process easier for nurses, they would have more foreign nurses working for them and this might also relieve their shortage of nurses. I was sure I was not the only nurse frustrated with their system.

At the interview with the Director of the Nursing' Board, I informed her of my frustrations. She examined my nursing documents and photocopied the required documents and mentioned that it looked like I was able to be registered and my qualifications appeared to meet the requirements of the British Columbia Nursing Board. She went through my papers again and got more photocopies of my documents and I was told I would be registered and would get my registration document in the mail. She also told me that I was required to work 850 hours by the end of the year. The British Columbia Nursing Board required active nurses to have 1152 clinical hours within five years for re-registration. It would be a headache to get the 850 clinical hours within six months. I had not even applied for a job yet. I could only try.

What is it like working in Canada? My first and current job is at an Intermediate Care Centre, in Coquitlam, up the road from where I live. It is convenient enough for me to even walk to work since I do not drive a car in Canada. When I rang the Director of Nursing of the Centre, she saw me the same day for an interview. I was given a nursing job straight away and was given an orientation to the centre the next day. I had a morning and an evening shift for orientation. The Centre is quite impressive. The policies of the Centre are clearly set out for nurses to follow. There is a file for general nursing duties on admitting a resident, attending to a death at the centre, transferring residents to the hospital, etc. A wound care protocol file for the different types of wound care was collated to guide nurses. There are folders for resident referrals to dentist, dietician, podiatrist etc.

I enjoy working as a casual nurse at the Centre. It is good to come away with no problems of the Centre and have a few days off without having to work again. I am often called to work, but have had to decline many offers as I put my social sporting activities before work. It was good to get my first pay cheque again, even though I was paid initially as a beginning nurse. The owner of the Centre told me that the reason for the beginning wages was that I had broken my service for three years. I think it was just a ploy to pay an experienced nurse a minimum hourly rate. I did not care enough to fight for more pay; I just wanted to be back in the workforce again after three years away. I will always be a nurse. With my nursing background, I could act as a mentor for the young nurses. This would be my final chapter in nursing. My next level of nursing would be to influence nurses in their nursing attitude. I believe nurses are required to work as a team and be nice to one another.

Working with the elderly can be quite a mental strain. The physical work is not difficult but the mental strain is quite testing. The majority of the residents are at different stages of dementia or Alzheimer's. One has to have lots of patience and tolerance caring for clients who are disoriented and dependent. One is required to repeat certain answers or explanations over and over again. Workplace violence can occur when clients did not take their medications. Nurses often face verbal and physical abuse from clients. The policy of the Centre is to allow the residents their rights and a good quality of life. However, this means that even though in many cases the residents have dementia, if they refuse care, we are to respect their wishes. So if a resident refused their medication and is a psychotic patient who needs to have their medications, the nurses are to respect their wish. During my first few years at the Centre, I often wondered whether medications or the right medications were given to the residents when their behaviour was unmanageable.

In my opinion there are issues surrounding the bubble system of dispensing medications to residents. This system is not adequate if no one checks whether medication is administered to the residents or not. The system of having all medications prescribed by the doctor packaged at the pharmacy into individual packages with the times and dosages, is far more superior to the bubble system of dispensing. The packaging system from the pharmacy makes the dispensing of medications for casual nurses easier and for the authorities to check whether the medications are administered to the residents. There is the date, time, dosage and the name and description of medications on the packages. Using the bubble system, when medications are not taken by residents, residents would often be difficult to control and manage. It is in these circumstances that I do not feel I am an effective nurse advocate. I was told the Centre is a place where when residents are admitted, they wait for their time to die. It is sad to say that often this is the case.

If I had a choice, I would have liked to have worked in a hospital more than in a nursing home. Hospital work would be more challenging and rewarding and the hourly rate of pay would be higher. Hospital clients get to go home and get well whereas clients in the nursing home stay until they die in most cases. In the nursing home one can easily be involved with the resident and their family. Pressure sores are common among the elderly in the nursing home. I have witnessed residents die with pressure sores even though they did not come into the Centre with sores. The sores get infected and residents die of septicaemia. They are many causes of pressure sores, but I have observed that generally the cause is poor nursing care rendered to the residents, for example, frequently allowing the client to be in a wet bed or brief, poor lifting technique of the client in bed, poor nutrition etc.

I consider all of these observations when I think about my highs and lows and what I have accomplished in nursing. My age, arthritis to my hand, eye-sight and speed at work made me re-examine my nursing standing. I needed to give geriatric nursing a try. Hospital nursing would be challenging and too fast for my speed of work now that I have found myself slowing down a bit.

A senior nurse who claimed to be the wound specialist did all the wound dressing; the care aides rendered the residents' care. The registered nurse gave out the medications and answered all enquires and often had no time or was too lazy to supervise or give residents care. There was a resident who had three ulcers in her leg which almost penetrated her bone for almost three years. She developed septicaemia from the infection and the dead tissue smelt like rotten meat. I almost got her ulcers healed when I relieved a nurse for three months for her sick leave. But I received resistance from the senior nurse. I was told not to touch the wounds and leave the dressing to her when she only came to work during the weekend. As an advocate for the residents I gave the care and dressed the wounds as I thought it should be done. When wounds were infected and had sloughed, they required debridements and an enzyme type of dressing to "eat" away the slough. Moreover, the wounds were healing so there must be something which I was doing right. When I did not follow the senior nurse's wishes, she left me notes reminding me not to touch the wounds. I was annoyed with her attitude. I believed as a professional registered nurse I should be given some credibility and accountability to make judgements of my patient care and moreover, the wounds were improving. I went to the Director of Care and reported the incident. She was receptive to my reasoning and spoke to the senior nurse. There was a "hoo-hah" over the incident among the other nurses. Eventually when the nurse returned from her leave, I was happy to work as a casual nurse again. I was no longer involved with the politics at the work place.

Working at a private health care residence is not without politics. The owner is the boss and one has to obey her many wishes. I believe it is not easy to make a living especially running a business with lots of overheads and salaries to pay. In any business, one has to make a profit to survive, but how much is enough and must one be ruthless in making profits? When the National Democratic Party lost in British Columbia in 2001, the then Premier of the Liberal Party changed legislation to protect businesses. Bill 29 protected the owners of private care centres from privatising and contracting out workers for the centres. The care-aides, domestic and kitchen workers' union could not stop the owners in sending out 'pink slips' to all their employees. The place where I worked as a casual nurse sacked all their care-aides and domestics and hired out contracted beginning care-aides on minimum wages. The boss believed she would get a clean slate of care-aides who would obey orders as they were dictated. I believed it was one way of saving as she would not have to pay the highest hourly rate. The sacked care-aides could apply for the positions, but would start from the salary scale the contractor saw fit. The sacking of the employees at the centre was quite traumatic for all concerned. The registered nurses were afraid that they would be the next to go. There was no counselling even though employees were grieving around the work place. Some workers had a family to raise, rental and tuition to pay, especially those who were single parents. I empathised with them and wished them luck in looking for another job. I had to hold back my opinions in the matter as I wished to continuing working at the Centre. Moreover, I believed it was not just this Centre which was taking advantage of Bill 29 but many other nursing centres too. The boss was accused of being heartless to see so many unhappy employees, especially ones who had worked in the place for over sixteen or twenty years and who saw themselves as part of the furniture.

The Centre has only 96 beds and only eight permanent registered nurses and four casual registered nurses. The permanent nurses have four days on and two days off. As all places of work, the Centre is not without bitchiness among the nursing staff. A casual nurse who had been working there for many years was forced to resign due to complaints about her work from one of the permanent nursing staff members in particular. She considered herself more superior than all the other nurses and picked on this particular casual nurse, ganging up on her with other nurses to complain about her. I felt sad for the casual nurse being victimised. After the casual nurse left, the permanent nursing staff member tried to make it miserable for another nurse who had recently joined the staff in a permanent position as a Licensed Practical Nurse (LPN). The LPN worked two days on morning shifts as a medication nurse and two days on evening shifts in charge of a team. When the LPN worked the evening shifts with her, the LPN told me that she made her working condition miserable for her. She was almost in tears when she told me that she was thinking of resigning from her position. I felt sorry for her. In my encounters with this particular registered nurse on the same shift, she often complained to me about the other nurses' performance. She believed she was the most experienced nurse at the Centre, often compared her previous work experiences to current work practices, and was critical of the performance of the Centre.

I remember once working with her on an evening shift when she reported to the Director of Care that I was not following her orders. When I confronted her about the matter, she claimed that because she was in-charge, she did not want anything to go wrong. Even though I had worked longer at the Centre than her, the permanent staff were often in-charge of the shift. From my point of view, discussing and disputing certain treatments as an accountable professional did not class as disobeying orders. The reported related to the ethics around giving a sedative to a resident who was supposed to have attacked a male nurse during their evening shift the previous day. The resident was subdued on the morning when I was on duty and his behaviour was of no threat to any personnel. The permanent registered nurse was not working the morning shift and had not seen the behaviour of the resident. I saw giving an injection to the particular resident before they come on duty for the evening shift as chemically restraining the resident. I approached the Director of Care and told her about my side of the story. I needed to cover myself, having seen what mischief she caused to the other staff members. I had to confront the problems straight away before she could cause me any mischief. I was glad I did as she was aware that I could not be bullied, kept at a distance, and left me with my work. I admit that she could be helpful if she wanted to and was quite knowledgeable, but bitchiness should not be allowed in any workplace. Nurses need to learn how to work as a team and assist and support one another. It is already stressful as a female in the workforce besides looking after the house with a family with children and husband.

Being a casual nurse has many advantages. I am not involved with the politics at work. I go home and leave the work behind me. I do not have to face the many mental strains from work day after day. The many problems and frustrations from work are left at work. When I am called for work, I go in fresh. Maybe this is why I have more patience with the residents. I find confronting the residents is not the only right way. Nurses should be more tolerant when caring for the residents. As a casual nurse I can enjoy my social life and go to work as I please, when I please. I can refuse to work when called. I can choose the shifts I want to work, and there are no night shifts. I can get away from the house and give my husband space to breathe now and then. I enjoy outside interests besides just being at home. I have my own money and thus freedom in doing what I like, without needing to ask my husband for a hand out.

The disadvantages as a causal nurse are many too. I have no sick or vacation leave. There is no health or dental insurance cover from my employer. Often when there is an educational program or conference, I have to go at my own expense whereas the permanent staff are being paid for by the employer if they are approved to attend any continuing education program. I do not feel like I belong to the group and don't socialize with the permanent nurses except when at work. I try to work to the best of my abilities and set an example to promote quality nursing care. Moreover, it is quite fun working and getting paid.

Continue to epilogue

Back to Chapter 12