Member Spotlight: Justine Reyes
By: Kevin Champagne
Local 115 President
United Nurses of Alberta
Can you provide a little background about yourself? Where are you from, what brought you into the world of nursing and what did that journey look like?
I was born and raised in Calgary. My parents immigrated here 47 years ago. As the story goes: they were on their way to Vancouver, and made a stop in Calgary, when they noticed that the hospitals here were hiring … and here we are!
I graduated from the University of Calgary in 2008, but had started working in AHS a couple years earlier as a HCA. I’ve been fortunate to have spent the entirety of my nursing career at the FMC ICU, which I love. When I applied to nursing I did not tell my mom, as she was the nurse of the family. My mom only found out I went into nursing when we went in to buy my textbooks. It was such a great surprise for her! I recently completed my Masters, am still in health care and still enjoying it!
What was your Masters focus?
In two areas: my first focus was in teaching and education and my second focus was in health informatics and innovation. I have always been interested in how nurses learn at the bedside. During my time within the ICU I have seen the implementation of three different computer charting systems. It is always so interesting to see how front line staff adapt – I wondered if (computer) systems could have been taught differently? There is an impression that we nurses don’t like or look forward to change (for example, with a new charting system), but the reality is that we haven’t been engaged or had any input into the program development, even though we are the ones that will be using it the most. I think I waited to complete my Masters because there wasn’t a clear area of study for nursing involvement in technology.
What do you do to maintain your mental health?
It is important to have people to talk to about how your day went. Also to have hobbies that are unrelated to ICU. My Masters program was a break from ICU and allowed me to disconnect from that environment. My version of decompressing is staying busy with other things.
How has the charting changed within the ICU? Do you think the (Connect Care) improvements have helped to prevent liability?
I feel that Connect Care will improve the charting in ICU. The biggest change I thought was the “charting with exception” model. We are taught to chart everything in nursing school. In Connect Care, it is charting “within defined limits”. Initially, our charting will take longer as we are learning and understanding what these “defined limits” are. It is also about learning where we find the appropriate places to chart, but as we continue to use the system, I know that this will improve.
How did you become a Connect Care Super User?
In the ICU they had asked 2-3 individuals from each team –people who they thought would enjoy or were familiar with computers. Previously, I have also taken courses on legal charting, which really supported my learning as a Connect Care Super User.
I was fortunate to have been able to work with individuals who had already gone through the Connect Care launch prior. It was nice to meet other people from different areas that we would have never gotten to speak with otherwise.
What did you take away from the implementation of Connect Care?
Nurses need the opportunity to practice in context. Providing nurses the opportunity to utilize the charting system in a practice/clinical area allows that individual to put their learning into context. I noticed that there were a lot of staff who did not get the opportunity to practice in an environment that allowed them to safely try out the system.
The fifth wave of Connect Care launch was considered a success. Do you feel this is reflective of your experience?
It was a success! There were lots of additional support staff available to help address the controlled chaos. The unit’s capacity briefly decreased to 30. The overall ICU team was open to the change in charting system and in using the “ticket system” to share noted deficiencies (and potential learnings). It was good to be part of the fifth wave, as it had already allowed many of the “behind the scene supports” to work out the kinks in the system in the previous waves.
Walk me through a typical day as an ICU nurse.
My day starts at 0715h. Once we get our patient assignment for the day, I start by getting a full patient head-to-toe assignment done, which usually takes about 15-20 minutes. Then you are out of the fire into the frying pan. By mid-morning we complete rounds, get the orders for the day, and plan for procedures and “road trips”. In between all of this, we fit in patient care needs. The thing that I like about the ICU is that you are very busy with hourly tasks.
Does the ICU utilize a LPN model?
When I first started in the ICU, LPN’s were used to support complex dressing changes. That has since shifted over the years. Currently we have three Health Care Aides as support per 12 hour shift.
During the height of the pandemic what were some of the changes in the ICU?
The ICU went from 33 funded beds with three overcapacity spaces to 70 beds at the height of COVID. The patient-to-nurse ratio increased to 2:1, with patient acuity being much higher. When COVID peaked, I was doubled with patients that were both on CRRT and on 3-4 pressors. I was thankful for the helpers that had been redeployed to ICU, as I know I would not have had the time to even prepare the required drips and still get everything else done without their help.
Can you share your thoughts on the role of the RNs that were reassigned or redeployed to the ICU?
I would say a big thank you (!) for coming and helping us out. I know a lot of you did not have a choice. Thank you for being open to completing the difficult tasks we ask of you. Also, thank you for the camaraderie, we could not have done it without you!
Now that COVID has settled slightly, I like being able to see the same redeployed individuals I worked with during the COVID peaks throughout the hospital and saying ‘hi’.
It was also amazing to see that many of the redeployed staff chose to stay and work with us here. I can’t image a scarier time to learn in the ICU.
What has been your experience with Agency nurses?
We had 6-7 agency nurses that worked with us. They get a full assignment, but they don’t take patients with advance competencies. If we didn’t know beforehand, we would have never even guessed that they were hired as agency nurses. We are so grateful for them, as they helped us not to be tripled. We actually did know that they were being paid more to do the same work, so as a result we lost a few staff to agency nursing elsewhere.
Many Nurses have become aware of much higher salaries being offered elsewhere, and leaving for these positions can be both a tempting and tough decision to face. What keeps you at the FMC ICU?
For sure the team I work with – I love my colleagues. They are super supportive, and we became very close during the pandemic. There are also so many opportunities to learn and I enjoy the challenge. I am currently looking for something that has less night shifts – I am starting to realize that the older I get, shift work becomes a just a little more harder.
What training would you recommend to help people feel prepared in the ICU?
It will depend on the background of the nurse. Many of our nurses that come from inpatient acute care units, emergency departments or PACU generally have a smoother transition into critical care, than say, those that have a community nursing background. Taking advanced certifications like ACLS and TNCC would make more sense only once you have been in the ICU for a period of time. It you have a good preceptor and have internalized your OPPACA (which is the provincial orientation program to critical care – something all new hires go through) training well, you will succeed regardless of your prior experiences.
If you had the opportunity to speak to a new hire or a nurse interested in working in the ICU, what would you say?
I would encourage them to shadow on the various teams. This allows you to meet the staff working on that team. If a team isn’t a good fit, don’t be afraid to ask for a different one. You will have to invest a lot of time to be/feel prepared in the ICU.
If you were able to go back in time and give yourself advice for your first ICU shift, what would it be?
It’s okay to cry. The ICU is an emotional place for people. As nurses we often try to emotionally separate ourselves from the patients and families that we care for – their stay in ICU is often the worst period of their lives. It is okay to be impacted by our patients, it is okay to be sad, but remember, it is important not to attach ourselves to that sadness. You can be sad about outcomes (which is natural), but in the end, if I know I did and tried my best for my patients and families, that is still considered a positive nursing outcome in my books nonetheless.
How can we address the health human resource crisis?
We have to make nursing attractive. We also need to make educating, teaching and mentoring a positive experience – this creates an environment that allows staff to stay connected to the practice areas that they love.
In the next few years there will likely be many changes to the health system. What do you feel would be a positive changes for health care?
I would like to see more frontline nurses in leadership positions. I want to see nurses and the nursing profession making a difference and influencing provincial and federal decisions that are driving health policy.
