Advancing RN Practice in Consumption and Treatment Services in Ontario
Supervised Consumption Services (SCS) represent a new area of health care provision in? Ontario, with the first such sanctioned service opening in 2017. Since that time, supervised? consumption and overdose prevention site services have undergone multiple waves of changes? to structure, format, and funding models. This has created challenges to dedicating the time and? resources necessary to organize nursing care with little time to devote to service program development, nursing team cohesion, or development of a coherent Nursing Philosophy of Care.
This aim of this project has been to provide the Fellow with resources and time to take on a? leadership role within the RN team to support enhanced RN practice and team cohesion at? South Riverdale Community Health Centre’s two Consumption and Treatment Services, with the? ultimate goal of being better able to meet the health care needs of CTS service users. A further? goal was to engage with other RNs working in CTS in Ontario, and to share findings and resources in the spirit of knowledge and practice sharing.
Historically, Registered Nurses at South Riverdale Community Health Centre’s (SRCHC) two CTS sites had little opportunity to define and develop the work of RNs in a way that is responsive to the wrap-around health care needs of CTS service users. This project allowed for the Fellow and the CTS nursing team to develop and define their work within the framework of Harm Reduction values, and begin the process of engaging with our management to make adjustments and improvements to the way RNs work in this setting and develop a cohesive community of practice. We have also developed a comprehensive orientation and training program for new nurses, which was approved by our management teams, to ensure that new RN hires have the resources and supports required to competently practice within a CTS setting.
Further, this Fellowship has provided the opportunity for the Fellow and CTS RN team members to disseminate and share our learnings, with an emphasis on Philosophies of Care in CTS Nursing, with other CTS in Ontario as well as adjacent service settings such as Addictions Medicine.
The goals of this Fellowship were to provide the Fellow with an opportunity to assume a more formal leadership role, within South Riverdale CHC’s CTS teams, to help promote and guide the RN team to develop a cohesive Philosophy of Care, and identify and implement changes to improve provision of nursing care in our CTS sites, as well as contribute to the larger RN community of practice in CTS in Ontario.
A primary learning goal included deepening my expertise of nursing practice in CTS settings and find ways to share and disseminate the unique and specialized aspects of nursing practice in this setting.
In terms of leadership skills, I was interested in promoting team cohesion in the RN team at South Riverdale Community Health Centres two CTS sites. Prior to this Fellowship, we largely working in isolation, with minimal training and orientation supports for new hires, and with little opportunity for the RN team to come together to discuss our work, goals for our work, and ways to facilitate and advocate organizationally for the tools and resources necessary to better meet the care needs of CTS service users. Through this fellowship, I developed new leadership skills required to facilitate open discussions with peers and management. I was able to bring together a group of people to work toward a commonly shared goal. I also acquired new skills in how to ask others for their suggestions, input, and feedback. Important to effective leadership, I gained experience and skills in developing and implementing a plan of action to achieve project goals and, as a result of COVID, I was able to adjust and map a path forward under adverse conditions.
Through this Fellowship, I have enhanced my expertise of how RNs practice in CTS settings across Ontario and the implications of various models of care, structures, and philosophies of nursing practice on health care provision and outcomes in this unique setting. I developed skills to provide leadership to the CTS RN team at SRCHC to guide the systems planning required to better meet the needs of our service users.
As a results of the Fellowship activities, I was able to provide space and time for the RN team to develop systems (such as clinical assessment support and pathways, and IT EHR integration) as well as CTS community of practice development both internally within SRCHC’s CTS nursing teams and externally through CTS site visits and presentations at national conferences (CANAC and META:PHI). I also developed a google drive resource tool that included the deliverables from this Fellowship (Literature Review and Summary, results and reflections from Community Engagement Surveys, CTS Environmental Scan Results, and notes from the 4 full-team SRCHC CTS Nursing Team Meetings that were conducted as part of this Fellowship), This resource also has a variety of tools and resources to support training and orientation of new nurses in CTS and ongoing professional development for nurses in this setting. This google drive link was sent to contacts at all CTS sites in Ontario with requests for feedback, as well as an invitation to contribute further resources to support a provincial community of practice.
The goal of these activities is to improve nursing philosophy of care and practice in CTS in Ontario, with the ultimate goal of improved care provision to CTS service users that is reflective and aligned with the ethics, values, and practice of Harm Reduction. In all activities of the Fellowship, it was highlighted that the roots of Harm Reduction rest in decades of work by people who use drugs, for people who use drugs. In order to competently meet the needs of CTS service users, the activities of the Fellowship overwhelmingly pointed to the need for nurses to challenge and resist the medicalization of PWUD, and to be creative and willing to push and advocate for changes that demand a nursing philosophy of care that is rooted in the values of Harm Reduction rather than in the values of the Western health care system, and that nurses advocate for and facilitate systems changes that create low-barrier avenues for CTS service users to access wrap-around health care services.
This fellowship provided an opportunity for SRCHC’s CTS nursing teams to come together and reflect critically on our work and discuss challenges and opportunities around which we can collectively advocate. It became clear through our discussions that the staffing models provided for CTS are not adequate to meet the needs of service users, nor the needs of staff. We discussed at length how limitations in staffing and funding models have hindered opportunities to engage in system and program planning, and have contributed to increased experiences of ‘burnout’ as the services are often short-staffed, and little room is left for opportunities to provide wrap-around nursing health care services, support case management, and engage in system and program planning. These conclusions were validated externally through the Environmental Scan of Ontario CTS nurses, as well as in conversation with CTS workers as part of site visits conducted in Ontario.
As the project progressed, I began to focus more and more on ways to include and engage other RN team members in different pieces of the fellowship work. This provided space and resources for the RN team to engage in topics of interest including clinical documentation, clinical assessments and tools, and hiring, training, and orientation practices. This not only allowed us to devote time to supporting the sustainability of our own work, but also provided opportunities for us to collaborate and communicate about our work with the larger SRCHC organization, and thus made our work more visible to the organization at large and promote our unique approach and philosophy of care for working with PWUDs.
Ultimately, this Fellowship provided a very valuable opportunity for the SRCHC CTS nurses to work together and communicate as a cohesive team, which has resulted in an increased visibility of our work and our needs and increased capacity to advocate to the larger SRCHC team.
Further, we were able to expand our reach and share our learnings with other CTS sites in Ontario as well as the larger community of health care professionals working with PWUD, ultimately contributing to a larger community of practice in CTS nursing.
It was challenging to complete a large project in the context of the pandemic. Pandemic-related restrictions on in-person meeting and travel had an impact on my originally planned Fellowship activities, but I was able to redesign those elements. The greatest impact of completing this project during the height of the pandemic was the stress and fatigue experienced by myself and my colleagues over this extremely challenging year. In addition, the COVID pandemic was accompanied by an exacerbation of the overdose epidemic. We lost many beloved friends, colleagues, and community members since the start of the pandemic, and grief has been a constant in the lived reality of our work. Despite these challenges, I was overwhelmed by the generosity of my colleagues and the communities we serve in helping me to complete this fellowship, and am so grateful for their brilliance and engagement with the various Fellowship activities.
My favourite moments of the fellowship were the Nursing Team-Building Meetings. These meetings provided the first opportunity for nurses from both SRCHC CTS sites to come together, share challenges and accomplishments, discuss our philosophy of care, and imagine the types of roles and services that we wish to provide to the communities with which we work. As a result of these meetings, we are in a position to advocate to our larger organization and move forward on important changes to the CTS RN role at SRCHC.
Another highlight was reviewing the results from the Community Consultation Surveys. Not only was it rewarding to hear positive feedback from our communities, but also reassuring to see significant accordance between the feedback of service users and the Philosophy of Care that the nursing team worked so hard to define.
Being able to define a Philosophy of Care for our nursing practice is, to me, a huge accomplishment. This Philosophy of Care will serve as a strong foundation for our work in the future, and is, I believe, an important contribution to share and disseminate to the larger Community of Practice of
people providing care to and working with communities of People who Use Drugs.