Nursing on the front lines of opioid crisis
Oct 30, 2018
Above: Tracy Hobson
You read about it in the news almost every week: thousands of people are dying of opioid overdoses in Canada and each year the number goes up. For most, the news is troubling but it doesn’t touch us personally.
For RN Tracy Hobson, though, it’s a part of her daily work life. Last week, five clients overdosed at the downtown Guelph Overdose Prevention Site where Hobson works, and were brought back from the brink of death.
Hobson is one of the nurses serving on the front lines of the opioid crisis. In addition to working at the Guelph Overdose Prevention Centre, this McMaster graduate (BScN 1997) is employed as a harm reduction, outreach and Hepatitis C treatment nurse at the Sanguen Health Centre. Both positions are located at the downtown Guelph Community Health Centre and Hobson says that she sees many of the same people in both positions. One night a week, Tracy also goes out with the Guelph community health van to reach those who will not come to the clinic. The van service offers everything from condoms and pregnancy testing to vein, wound care, naloxone kits, and overdose prevention training.
“I have been working with people who use substances for the last 11 years,” says Hobson. “In 2007 while working as a public health nurse, I began offering screening for blood borne infection and sexually transmitted infection at an addiction treatment center. I became very dedicated to working with a population that is often stigmatized by the general population and the health care system itself.”
The clients Hobson sees face very complex social and health issues: homelessness, addiction and mental health issues, in addition to the whole gamut of other chronic and acute illnesses faced by the local population. Hobson draws on all her critical thinking, nursing skills, and creativity in her work, which is wide-ranging in nature.
When asked to describe a typical day, at first Hobson is at a bit of a loss to answer. “You never know quite what your day is going to be like. I may have booked appointments but none of those patients may show up. But five replacement patients may have walked in to see me. Many outreach workers will bring clients to me. With those clients, I’m sometimes doing crisis intervention. Maybe they’re using substances and they’d like to stop. Or they are concerned that they have an infection, and I’ll need to do testing and treatment. There is a lot of abscess assessment, wound care, and vaccinations. Sometimes it’s a referral to other agencies who can assist those clients, for example, finding primary health care providers or psychiatric assessments.”
Deadly opioids are a problem even for clients who aren’t intentionally using them, says Hobson, because “unfortunately fentanyl is found in pretty much all substances currently.” Training clients on how to administer naloxone and getting it into the right hands is another major life-saving role. “Lots of people are saving each other. So as nurses we do follow-up about how they are handling the overdoses. Are they having any trauma? Did they call 911 and replace their naloxone kit? At the overdose prevention site, there’s usually just one nurse and a peer. But it can be very stressful for the nurse in that space as well.”
What does an overdose prevention site look like? “In our case it consists of two rooms. As you come in the door of the Community Health Centre, there’s a needle exchange program where people can get clean supplies. Across the hall is a chill-out space, where clients will wait before they go into the consumption room, or will wait after they have consumed so they can be monitored for any signs of overdose. Past that is the consumption room with two cubicles and that’s monitored by the nurse. Generally we see about 15 clients a day but busy days can be upwards of 30 clients. While the site has guidelines for time spent, many visitors are homeless and spend a longer time in the chill space to stay warm or to engage with staff/community. They don’t have food. So we have snacks and drinks. Sometimes they don’t have family physicians so we can help with accessing physicians to get an abscess looked after or a chest infection. We really try to do wrap-around care.”
Although the work is chaotic and demanding, Hobson remains hopeful and enthusiastic about her role. As she says, “Every human being deserves to receive equitable health care and to be treated with compassion and without judgment, no matter their sexual orientation, substance use history, or mental health disorder. I love meeting people where they are at and working from a harm reduction philosophy with creative and passionate people.”
Tracy Hobson, Alumni Profile