[00:00:00]
Gail Donner: We’ll be speaking with two nurses who work in mental health. One at community nurse who works in the downtown east side of Vancouver and the other one’s psychiatric nurse who works in the emergency department in Winnipeg.
[00:00:14]
Announcer: This is Nurses’ Voices. Nurses’ voices is supported by the Canadian Nurses Foundation and by the Canadian Nurses Association.
[00:00:24]
Gail Donner: Welcome to Nurses’ Voices. I’m Gail Donner and Mary Wheeler’s with me this evening. And we have two terrific guests. Many of our episodes have focused on the COVID pandemic, but there’s another pandemic that has received much less attention. And that’s the opioid and mental and health and addictions crisis.
Today we’re talking with two nurses who work primarily with vulnerable and marginalized clients in the core of two major Canadian cities, Vancouver, and Winnipeg. They work with populations that are arguably the most stigmatized in healthcare.
Katherine Flynn is a registered nurse with 13 years of experience. She currently supports two clinics in the downtown east side of Vancouver as the primary care RN and case manager with the Vancouver HIV STOP Team.
And Bonita Fanzega, our second guest is a registered psychiatric nurse, who’s worked in a variety of mental health settings over the past 13 years. And during the last five years, Bonita has been working in the emergency department at the health science center in Winnipeg as a psychiatric emergency nurse.
So welcome to both of you and I’m gonna to get right into it. Since I know both of you have a lot of important things to say, so maybe Catherine, maybe I’ll start with you. You know, the downtown east side of Vancouver has quite a reputation across Canada. And, uh, it has a reputation as being a difficult place with many disadvantaged, marginalized, and stigmatized folks living there, uh, living on the street or living in shelters, uh, et cetera.
Can you tell the, our listeners, our watchers what you do, what your role is in that community?
[00:02:23]
Catherine Flynn: My role is a case manager primarily with the Vancouver STOP team. So that’s an initiative to help connect hard, to reach demographic people living with HIV who are not adhering to their HIV medications and just disconnected from, from care and helping them reengage to, to a provider, to a healthcare team.
So that is part of my work. Um, and then the rest of my work involves providing primary care within the clinics. Um, Kilala Lelum in the downtown east side. Kilala Lelum is a very special clinic that opened its stores. About two years ago, a small group of people who were working actually at Vancouver Aboriginal health.
Who’ve thought to provide a space culturally safe space that could connect the members to elders and help connect people to cultural services. A big focus on healing and wellbeing is a spiritual focus, for people, and a cultural focus for people and really helping to restore healthy cultural identity and as well as helping people to tap into their spiritual side.
Which can often be neglected in the Western medicine models. We are staffed with, uh, nurses, physicians, counselors, social workers, and very importantly elders and knowledge keepers, which are an integral part of helping the Western medicine trained staff to understand, a more indigenous ways of health and healing.
Every day, I’m humbled. And I feel really privileged to be able to have these opportunities, to look at health and healing in different ways and in deeper spiritual ways, rather than just our current system that supports healing, physical healing, or mental healing, just through pharmacotherapy, mostly.
This clinic understands the importance of the medicine wheel, the elements of physical, mental, spiritual, and emotional well-being; understands the importance of community and connection. There’s a real understanding here that that’s where the healing and the repair to wholeness is done. Yeah.
[00:04:57]
Gail Donner: Now Bonita you’re in also a very urban setting in downtown Winnipeg, at the Health Sciences Centre, you, a psych nurse in Emerg. Well talk a little bit about what is a psych nurse do in an Emerg department.
[00:05:10]
Bonita Fanzega: Often when people come in, if they’re presenting with any kind of mental health crisis or mental health emergency, whether they come in on their own seeking help, or whether they’re brought in under the mental health act, with police or with family members. One of my roles is to collaborate with the emergency room physician and, um, I’ll do an assessment. And then based on my assessment and based on, on what the client needs are, sometimes we are able to link people up with resources, but hopefully point them in the right direction.
If my assessment determines that the patient might need an admission, then we’ll, I’ll talk to the emergency room physician. Give them my viewpoints, and then they’ll take it and consult psychiatry. And often people are admitted. It’s kind of a unique job because you have so much intense interaction with people in a very short amount of time that a lot of our people that come in, come in more than one time.
I don’t know if you feel like this, Catherine, but very often somebody is ready, but there’s not the resources available and there’s wait lists. And then that window where people are ready. It’s gone, you know, and it’s hard because you don’t have any of that follow through. I don’t know what happens to the people that I’ve been working with.
Sometimes we see people for months on end and then we don’t see them again. And, and sometimes we’re the, we’re the most support that they have. Somebody will come in in the middle of the night because they’re, they’re hungry, they’re tired. They haven’t had a safe place to be. And they’ll find that safety in the emergency department.
[00:06:48]
Gail Donner: You were shaking your head Catherine…
[00:06:50]
Catherine Flynn: I think Bonita’s role is so important. It’s a demographic that has a hard time reaching out for help. And I feel like Bonita must have a lot of experience with seeing people in, in, in really intense states of crises, be able to connect with somebody. In that state of crisis and desperation, um, it’s a big thing for them.
The importance of providing presence and acceptance in those opportunities is, is so huge. I could see that there would be a level of, kind of, I guess, frustration and just hope that, you know, I’ve given all the resources that I have. And I know the system is so broken and there’s so much room for improvement.
I’ve laid it up the best I can. And here you go. But you know, you may ever know what has become of that interaction.
[00:07:45]
Bonita Fanzega: It’s that it’s definitely a challenging and draining job, but I love it. And I, I can’t imagine doing something else. It’s very rewarding, even though sometimes those are few and far between, or it feels that way, it can be very rewarding.
[00:08:02]
Mary Wheeler: I have a question on what took you both down these really non-traditional paths in nursing. Bonita, I think it would be helpful because a lot of people don’t know what a registered psychiatric nurse is in the, in the east. It isn’t common and it is more in the west. So Bonita, could you just talk about what is a registered psychiatric nurse?
[00:08:25]
Bonita Fanzega: We spend our entire four year degree, uh, studying mental health. So it’s a it’s through Grant MacEwan university is, uh, is where I went. Right from the get-go you start learning about mental health, mental illnesses. We do also learn, you know, some medical things, but not this, not, not the same as the RN for one of the things that they really highlighted in school is that we treat the whole person.
And right, we’re not just treating a physical ailment, we’re treating the entire person and it’s holistic care. So, um, what, what’s their whole life like? What’s what are some of the challenges, challenges that people are dealing with? What are some of the reactions to medication? Um, you know, because everybody, well, we sometimes think that the, you know, the magic cure is, is medicine, but it’s not always, it comes with all sorts of complications and, you know, some medications may fix a mental health issue or a mental illness.
But then it comes with side effects like lethargy and weight gain and all of these things that. It’s significant! Those are things that impact people daily. What psychiatric nurses do is that we look at the whole person and not just, you know, the illness that they have, but how their reaction is to medication, to therapy, um, to resources that we can make available.
And sometimes it’s, it’s something as simple as, as getting someone, um, into a walking group or into, well, that has shared similar experiences.
[00:09:53]
Gail Donner: Why did you pick it? You were probably pretty young…
[00:09:55]
Bonita Fanzega: I was not young. I went to school when I was 29, so I don’t know. I graduated when I was 35. Um, so I had. I’d always had an interest in mental health.
And I actually had a friend that went through the program. We talked so much about it. I’m so interested in her learning that she’s doing in university that ups like, you know what I think I’m, I think I’m ready. And so I, and it was, and there’s so many times that I wish that I would’ve gone earlier, but I think that I wasn’t ready at that point.
And I feel like I’m just on the right path rate. So yeah, it’s just, it’s pretty simple.
[00:10:33]
Mary Wheeler: And Catherine?…
[00:10:34]
Catherine Flynn: I knew that I would be a nurse from a very young age. All my aunties were nurses, but I thought I would be artists, but it wasn’t until I was in the hospital. And I met nurses. I said, I have to be a nurse.
This is what I have to do. And I was actually also commuting through the downtown east side. Which isn’t far from where I was growing up. And I remember looking up at the buildings and I said, I will work down here in some capacity one day.
I started my nursing career working in the HIV acute medicine ward.
And that , at St Paul’s hospital in downtown Vancouver, and that ward no longer exists as the HIV ward. It exists now the urban health ward. So that goes to show you how far we’ve come in HIV medicine. I did some time in acute medicine, palliative care, emergency overflow, and then I ended up in primary care and then came down to, to the downtown east side.
And I really feel like… this is the place. Yeah, I am of most help in the world. I think. Um, I think my passion is to support adults struggling with mental health and addictions issues. I remember I thought I would be in pediatric a pediatric nurse when I was younger, but I, I saw, wow. They get there’s so much comfort for the children, but there’s no comfort for the adults.
And. So much pain that adults and older adults have to endure. And why is this area so neglected? I want it to be, become a part of, to change that.
[00:12:14]
Gail Donner: We know across Canada, mental health is a huge issue. There’s lots of discussion about it being underfunded, undervalued, under appreciated, whatever, all of those words.
I mean, you’re right there, in the, in the thick of it with the clients who need the services. Uh, most of all, I guess the question would be, what would your dream be, what would it look like?
[00:12:40]
Bonita Fanzega: It would be nice to have easy access to the things that people need in short time. And I don’t know how, I don’t know how we can do that.
You know, and then there’s also the different, the different community resources that we have available. It would be great if we could actually network a little bit better.
We’re very involved. The police are very involved in bringing people in to see us often. Most of the time, like I consider them part of my team. Um, we’ve had good communication myself and, and the officers that, that will come in with the client. But it’s marginalizing having somebody sitting in the waiting room with police. It’s not attractive for people. It doesn’t make people feel welcomed or heard.
Um, our space is definitely not big enough. I know that we definitely need some more space. Um, It would be nice. Nice. If actually, if we had a mental health team within the police department, I think in Toronto, they have actually mental health clinicians that go out with the police. I had contacted, I had contacted them a while ago, but then the pandemic started, everthing went kinda sideways, so…
[00:13:49]
Gail Donner: Given how difficult it is, what keeps you going?
[00:13:53]
Bonita Fanzega: I know that I have enough energy and enough to give to people that in a 12 hour shift, I can give that to somebody. Hopefully help them out of a terrible situation, help them feel heard and understood.
And, and then I have enough time to go home and re-energize, you know, I don’t think that I would have that same energy if I worked on a ward where I came back day after, day after day to the same thing, but every single day, my job is very different.
And I like that. I can think outside of the box and I can talk real with somebody. And know that they feel heard. And I know that I connect quickly with people. So I feel like I’m just in the right place for what I’m doing. And that’s what keeps me coming back. Cause there’s still joy there
[00:14:36]
Catherine Flynn: Well said Bonita.
Um, yeah, I, I feel like it can be a frustrating environmental work in, in the, in the mental health field here. There are a lot of gaps in the system. There’s a lot of people. I see, just losing hope. Why, why bother doing the work? Why bother? Because there’s so many barriers and that, that is a problem. There is just when people are struggling mentally and they have to, to overcome these barriers.
It’s, it’s too much to ask and we have so much to do from streamlining detox to recovery, to. Um, having like safe and supportive housing for people, once they go through the stages of recovery, also having, having people connected to the sense of, and having a clinic. Um, having a sense of community, a sense of belonging and a sense of purpose.
So there’s, there’s so many factors that are involved. We’re always working on different approaches to addictions. Like opiate agonist therapy is one that has helped bridge people. When we have those opportunities to bridge people, then we can build relationship or we can build connection. And then we get to know the person as an individual, and then we can kind of advocate for them on their specific personhood and their needs.
I feel so lucky to come to work every day with the most amazing team. And I feel we all get to debrief with one another on a very constant basis. Although we do work in isolation a lot within our clinic rooms here. We’re always able to come together and kind of help help each other.
You know, I think I’ve learned that boundaries change kind of all the time. Like some days we can come to work and we’re really resourced and we have a lot to give and some days we’re not, we don’t have as much to get. And we’re human too. And continue on in our work without feeling that burnout is, is, is huge. Cause still work in the downtown east side. There’s a lot of burnout. Um, in the mental health area.
And we don’t, we don’t want that because we know that a continuity of care is so important for people. Um, when they build relationships, they build trust with people over time, and it makes such a difference for people under wellness journey that they have that consistency with people
[00:17:18]
Mary Wheeler: I am in thrawled by your stories and what you were giving to your clients.
How do you take care of yourself? Because I think that is one of the issues in nursing right now. Nurses stretched to the limit. It’s through really intense.
[00:17:34]
Catherine Flynn: I’ve learned to what it means to the importance of self care and making time for myself. When I feel that burnout coming on and the overwhelm, um, I think we have, uh, we have a culture here at Kílala Lelum, where we’re able to say I’m feeling it.
I’m feeling that now. And that’s okay. And that’s everyone is, can speak that without any judgment. We will try to accommodate time off for people if we need to. Um, which is, which is incredible. And then when I’m not at work, I love, um, meditating, my deep breathing practices are so important to me. Um, I play music for joy in my life.
Remember the lightness of life that it’s not always so heavy and intense and crisis mode all the time that there’s also the other side of life that needs to be really remembered and, and tapped into as well. So just fun and play and sports. And. Being in nature is so huge. Um, and I am very grateful for, uh, we have elders here that will support us as well.
So we’re able to go and, and seek counsel from our elders. And that’s really important that as that we are a, we’re able to talk to somebody about what we’re carrying. I know, I, I feel lucky that I have the ability to, to let it out, um, in my. Place of work and that, you know, spiritual, emotional, um, wellness is, is, and the expression of it is very encouraged and important.
Whereas I, in some other areas of nursing, I feel like they may not have that. And nurses hold in lot and they’re supposed to be strong and solid all the time. Like robots that it’s. That’s not possible.
[00:19:39]
Mary Wheeler: And Bonita, what about you? How do you take care of yourself?
[00:19:42]
Bonita Fanzega: For me when I’m away from work, I’m away from work.
And I’ve done that since I started nursing was, um, I can give my full self at work, but when I leave, I have to get myself time to myself. So, um, I’m active with my family. I do, I walk my dog every day, um, often on like one of the trails, which is. very… Like… it’s a trail, so it’s bushy and foresty and everything else. So it’s you get away from all of that.
Um, I also have a lot of hobbies, um, a lot, and I try to challenge myself. I try and challenge myself to something new, something new quite frequently to learn because I find that, um, I’m able to put my focus into that and I can just get out of my head a little bit.
And it’s, if things are really tough because we do have, like you said, Catherine, when, when you’re starting to feel that burnout, um, I’ll definitely access, um, somebody like, whether it’s our boss, um, who’s super supportive and just say like, I’m having a hard time and, um, I don’t take every extra shift that’s available. I work my, you know, if, if I’m not ready to go back to work and they need somebody, I don’t always take it because you do need the recoup time.
[00:21:01]
Gail Donner: I wonder if there’s any last things you’d like to say, you know, there are a shortage of mental health workers. What would you tell, um, a student maybe as a parting message, what would you tell somebody who’s contemplating a career working with marginalized folk, so people with mental health and addiction issues,
[00:21:22]
Catherine Flynn: I would just say that working in the area, of mental health and addictions with marginalized populations has in the best decision of my life. I feel like it’s been, uh, like a soul journey for me, I feel like it’s made me a better person that I’ve been able to understand and be humbled by the beautiful capacity for human resilience. Mental health, this word, has such a stigma. These, all these terms have such stigmas, but the people that come through my door are some of the most beautiful, authentic people I’ve ever met in my life.
And. Once a person can put away all those labels and get to know who that person is and what they have come through there. It’s such a beautiful thing. Those people are incredibly beautiful and I’ve taught me so much and I am grateful. I’m very, very grateful to have walked beside and witnessed people on their journey.
[00:22:28]
Gail Donner: How about you, Bonita? What would your message be?
[00:22:31]
Bonita Fanzega: Very, very similar to Catherine. Like I feel I’ve always felt very fortunate to have a career that allows me to participate in. Um, and walk alongside people while they’re struggling. And while they’re going through some of the toughest things that people go through, and like you were saying, Catherine, like they’re marginalized, they’re stigmatized, you know, and often they’re not seen for who they are.
They’re just seen as this label. And we’re really, really lucky that we have the opportunity to learn. And I feel like I’ve been learning and growing throughout my entire career. I’ve been very, very lucky. I don’t know any other career that could be so challenging and so rewarding though.
I love it.
[00:23:15]
Gail Donner: And I want to thank you.
Yes. Yes. You some tough questions and some soul searching questions, but I think we really wanted the nurses of Canada to get a real picture of. What, what, what you do every day and how you feel about it.
So, so Mary
[00:23:34]
Mary Wheeler: So Gail…
[00:23:37]
Gail Donner: that was pretty amazing.
[00:23:39]
Mary Wheeler: I was trying to think how I would describe these nurses, very intentional that “this is my work”, and I’m going to do everything that I can, to both, accept this client group help others accept this client group and do the best job that I can possible all the while, acknowledging that I have so much to learn from this client population. That’s what I found. I, again, I found stunning from both of them. Is that it? Wasn’t I looking after you, it was, we are in partnership um, what can I learn from you? How can we work together to make this a better world? I mean, that sounds corny, but it, it, you know, there’s something very compelling in both their approaches. I was mesmerized by their stories. They, they both drew me in so easily
[00:24:48]
Gail Donner: They’ve got a calmness. That is reassuring, liking, taking hold. That’s the nurse, I need if I’m ever in trouble.
[00:24:57]
Mary Wheeler: Exactly
[00:24:58]
Gail Donner: Because it’s so respectful. Their respect for their clients.
[00:25:02]
Mary Wheeler: You’re right, Gail.
[00:25:03]
Gail Donner: Overwhelming
[00:25:04]
Mary Wheeler: Students need to hear these stories. I really hope as we continue in Nurses’ Voices, that this, our episodes are distributed widely because students need to hear of all. These, uh, nurses stories, but again, in particular, especially around mental health, uh, issues right now, they need to hear from people like Catherine and Bonita.
Around, there is a place, if you want this practice, we would love you to come and join us.
[00:25:41]
Gail Donner: I hope you’ve enjoyed this episode of Nurses’ Voices you can view and listen to Nurses’ Voices on a variety of platforms, including YouTube and Apple Podcasts. And remember if you want to reach us or give us some feedback, please connect with us through: nursesvoices.ca
[00:26:04]
Announcer: Nurses’ Voices is created by donnerwheeler. It is supported by the Canadian Nurses Foundation and the Canadian Nurses Association. Nurses Voices is produced by Cecktor limited.
