For this "What Do They Do?" we profile Laura Schreiber, Nurse In Charge
How did you get into nursing?
As a young girl growing up in the Chilcotin, my experience of health care centred around the outpost nursing stations. I received my childhood immunizations on the Redstone reserve and saw how nurses were deeply valued in the community for the services that they provided.
My experience that all aspects of health care – from public health to primary care to emergency care - were provided by outpost nurses left a lasting impression, one that eventually led me to pursue a career in nursing. My first assignment out of nursing school was in Anahim Lake in 2007 - it was a homecoming to be back where I had grown up.
Reflections on what it takes to be an outpost nurse:
Working as a nurse in a remote area can be extremely challenging. Being away from family and personal support systems can be a big shock, and it is something people have to learn to cope with in positive ways.
Growing up in the Chilcotin, you spend an inordinate amount of time swatting bugs. At a young age, I kept busy with my parents learning how to smoke fish, butcher moose. I also learned to always take a book with you wherever you go, because if you get stuck somewhere because of bad weather, you will have something to do.
I credit my love of outpost nursing with growing up in a rural environment. I'm used to the quiet and to entertaining myself for long stretches of time far away from the busy city life with movie theatres and coffee shops on every corner.
Working in a city hospital can be very different from working in a remote health care facility, as a high level of independence is needed, combined with an ability to live and function often very far away from normal supports such as family and friends. Emergency care in remote areas requires nurses to be able to thoroughly assess and make recommendations to a physician who may be hundreds of kilometers away and can only be reached via phone. The physician at the receiving end may have to base his decision on the nurse's assessment of the situation, which can be terrifying to some nurses who are not used to this level of practice.
Most nurses absolutely love the job, but it is important that they develop an understanding of the scope of work and the challenges and pressures that comes along with work in remote communities. No day is like another and you never know in what kind of situation you may find yourself next. A high level of confidence around making decisions is absolutely necessary to succeed in an outpost nursing job.
Cultural Safety and building relationships:
The first time I heard the term Cultural Safety was at nursing school. Growing up next to Anahim Lake, our family was always close with the community. My grandfather, who started fishing and hunting camps in the Chilcotin back in the 1950s always maintained good working relationships with the Chilcotin. He was a very well-known and respected man. His behaviour, interactions and the way in which he conducted himself left a positive impression within the community that I would experience many years later.
My first job was at Anahim Lake and people would ask who my parents were. I found that patients' trust in me increased when they found out who my grandfather was. The respect that he showed paved the way for my relationships 50 years later.
My husband Jason is currently doing his electrical apprenticeship, but used to work at the local school as a substitute teacher. The children loved him, as he has an outgoing personality and would take the children on hikes and kayaking. In fact, the children were usually much more enthusiastic about seeing Jason than they were me (since I am generally known for immunizations).
Building relationships with the community as a nurse can sometimes be challenging. My work doesn't stop at the clinic. It is a continuing process of care. It is important to stay connected with the community members by learning and participating in their culture, attending their functions and being present at ceremonies and funerals.
With a population of 900-1500, it can be challenging to maintain professional boundaries. Confidentiality has to be kept at all times, and the perception of confidentiality is just as important. Maintaining a professional balance while being part of the community can be one of the biggest personal challenges an outpost nurse will have to navigate. Many communities have experienced a long line of transient nurses, and so relationships and trust can take a long time to build. You have to be patient with the process of relationship building.
Other experiences and adventures:
Being a remote nurse opened up many other opportunities I couldn't have imagined at the outset. During the summer months, I often work with the Canadian Coast Guard on their ice breaking ships during their arctic deployment. Each ship needs a health officer and working on the ships has allowed me to observe hydrography, archeology and ocean research.
I never thought, when I started nursing, that working as a remote outpost nurse would take me on such adventures. This year will be my fifth trip into the arctic with the Coast Guard and second time through the Bering Sea. One of the best parts of these trips is the chance to go into other remote nursing stations to meet the local staff and see what their clinics are like.
Every community – whether it is in BC or the high arctic – is so different in regards to their laws, history, languages and traditional medicines. Learning and growing with these experiences are a huge part of why I love remote nursing.