Transcript: Nursing | Jun 03, 2003

(music plays)

A title appears inside the shape of a house: More to Life. Words spin against a red and orange background: Health, Family, Home, Money, Fitness, Life. Fast clips show images related to the previous concepts, such as a dollar bill, a wheat field, and strands of DNA.

In animation, the title appears inside the shape of a house: "More to life."

Then, Mary Ito sits in a studio with textured yellow walls and plants in the background.

Mary is in her late thirties, with short black hair and bangs. She's wearing a bright pink sweater and a golden pendant necklace.

Mary says HELLO. I AM MARY ITO. ON TODAY'S MORE TO LIFE, A LOOK AT THE INDIVIDUALS ON THE FRONT LINES OF HEALTH CARE. NURSS TAKE CARE OF US, BUT WHO IS TAKING CARE OF THEM? WITH THE OUTBREAK OF SARS, MANY HAVE BECOME ILL OR ARE IN QUARANTINE AND MANY OTHERS ARE TAKING ON LONG HOURS AND ADDITIONAL RESPONSIBILITIES IN PATIENT CARE. AND THIS IS AT A TIME WHEN THE PROFESSION WAS ALREADY IN CRISIS OVER UNSTABLE WORKING CONDITIONS. AND HERE TO DISCUSS THE STATE OF NURSING, ARE DORID, EXECUTIVE DIRECTOR OF THE REGISTERED NURSES ASSOCIATION OF ONTARIO AND DIANE MCCLOUD. VICE PRESIDENT OF THE CENTRAL REGION OF THE VICTORIA ORDER OF NURSES. IT'S A NONPROFIT AGENCY DEVOTED TO COMMUNITY CARE...

Dorid is in her sixties, with long wavy brown hair and bangs. She's wearing glasses, a black blazer over a red sweater, and a pearl necklace.
Diane is also in her sixties, with short straight blond hair. She's wearing glasses and a black blazer over a red blouse.

Mary continues ARE YOU A NURSE WHO IS STRESSED TO THE LIMIT? WHAT HAVE BEEN YOUR EXPERIENCES AS A NURSE? AND WHAT WOULD YOU LIKE TO SEE CHANGE IN THE PROFESSION? GIVE US A CALL. TELL US YOUR THOUGHTS AND CONCERNS. IN TO AREN'T OWE, THE NUMBER TO DIAL IS...

A caption reads "416-484-2727. 1-888-411-1234."
Then, it changes to "moretolife@tvo.org"

Mary continues I WOULD LIKE TO KNOW, HOW DO YOU FEEL THAT THE SARS OUTBREAK, OUTBREAK HIGHLIGHTED PROBLEMS THAT HAVE ALREADY EXISTED IN THE NURSING PROFESSION?

The caption changes to "Doris Grinspun. Registered Nurses Association of Ontario."

Doris says AND THAT'S A VERY GOOD WAY TO PUT IT BECAUSE IT IS NOT ABOUT FINGER POINTING TO ONE HEALTH CARE ORGANIZATION OR EVEN ONLY TO ONTARIO TO TELL YOU THE TRUTH. THE FIRST THING THAT HAS HIGHLIGHTED IN THE SECOND ROUND IS THIS THE SYSTEMIC PROBLEM OF NURSES BEING HURT, OF THEIR KNOWLEDGE AND EXPERTISE BEING TAKEN AS SERIOUSLY AS IT SHOULD BE. AS YOU KNOW, NURSES NOT ONLY HAVE THE KNOWLEDGE THAT COMES FROM EXTENSIVE EDUCATION, BUT THEY ALSO HAVE AN ADDITIONAL ADVANTAGE THAT I DON'T THINK THE SYSTEM UNDERSTANDS WELL. AND IT IS THE FACT THERE ARE 12 HOURS THERE WITH THE PATIENTS AND IN THE SAME UNIT. THEREFORE, THEY PUT THE CLINICAL KNOWLEDGE ALONG SIDE THE PATTERNS THEY SAID AND THAT'S WHAT HAPPENED IN THIS SITUATION. THEY PUT THE PATTERNS BEFORE ANYBODY COULD SEE IT AND THEY WERE RINGING THE ALARM BELL AND THEY WERE TOLD OVER AND OVER, NO, IT'S NOT SARS BECAUSE THE REST WERE NOT PUTTING THE PATTERN AS FAST AS THEM. NOW, THIS IS A SYSTEMIC PROBLEM, WE HAD THIS IN MANITOBA WHERE 12 BABIES DIED AND NURSES WERE RAISING THE CONCERNS, THEY WERE TREATED AS NO, THIS IS NOT, THERE ARE NO ERRORS HERE. NO, YOU ARE EMOINGAL, ETC., ETC. IT SAID MIXTURE OF GENDER MAYBE, K PAINGAL BEAR YERS?

Mary says GENDER BECAUSE PRENOM NANTLY WOMEN ARE STILL NURSES.

Doris says AND BECAUSE, YOU KNOW, THEY ARE NOT TAKEN FOR WHAT THEY ARE, EXPERTS, EXPERTS IN THEIR OWN RIGHT. SO THAT'S THE FIRST THING THAT THAT'S, ONCE AGAIN BEEN HIGHLIGHTED, WHICH HAS HAPPENED IN MANY PROVINCES, IN MANY COUNTRIES, BEFORE INCLUDING IN OURS.

Mary says BEFORE YOU GO TO THE NEXT POINT... BECAUSE IT IS RELATED TO THIS... I FIND IT INTERESTING BECAUSE AT THIS POINT, THEY ARE SEEN AS WHISTLE BLOWERS, RIGHT? IT'S INTERESTED WHEN YOU LOOK AT THE PER SESSION OF NURSES THROUGH THE SARS OUTBREAK. THERE WERE PERIODS WHEN NURSES WERE SEEN AS POSSIBLY BEING THE CAUSE OF SPREADING THE DISEASE. SO GOING FROM, YOU KNOW, SCAPEGOATS TO WHISTLE BLOWERS, HOW DO NURSES THEMSELVES SEE THEIR ROLE AS PORTRAYED.

Doris says THAT'S FASCINATING. IT IS A GOOD THING FOR A STUDY, IT'S FASCINATING. I HAD NOT MAKE THOSE TWO EXTREMES. IN BETWEEN THAT, HEROES, THE HEROES, RIGHT.

Mary says YES.

Doris says SO TODAY, JUST BEFORE I CAME, YOU KNOW, AGAIN LOOKED AT MY AND I GOT SO MANY E-MAILS AND PHONE CALLS IN THE LAST FEW DAYS AND SO DID, BUT THE LAST ONE OF A LETTER OF AN EDITOR, A NURSE SKPRX IT IS ALET TORE EDITOR SO IT IS PUBLIC, THAT'S WHY I AM GIVING HER NAME. SHE SENT THAT TO THE LETTER TO THE EDITOR SAYS, I DON'T KNOW WHERE THE NURSES THAT BLOW THE WHISTLE BUT THOSE ARE HEROES, SHE SAID. THOSE NURSES HAVE EXTREME ELINGT KAL DILEMMAS TO STRUGGLE WITH AND THEY DID THE RIGHT THING. AND WE NEED TO KEEP BEING THERE FOR THE BENEFIT OF THE PARTY. AND IT IS A LONG E-MAIL, I DON'T WANT TO TAKE ALL OF THE TIME BUT I THINK IT SUM ARIZES HOW NURSES ARE FEELING. NURSES ARE SKPRX NOT ONLY INCLUDES STAFF NURSES, THIS INCLUDES ADMINISTRATORS, SENIOR ADMINISTRATORS AND NURSES THAT MANY TIMES IN DIFFERENT SITUATIONS, NOT NECESSARILY JUST ON THIS ONE, HAVE RAISED CONCERNS. AND THEY ARE NOT LISTENED, I KNOW MY COLLEAGUES DURING THE RESTRUCTURING AND DOWN SIZESING, CONCERNS, NOT LISTENED. NOT UNDERSTANDING THE IMPACT THAT SOME OF THOSE POSITIONS HAVE ON PATIENT CARE. I THINK, I THINK THAT'S WHY THE PUBLIC ASK WHEN THE PUBLIC KAULS, THAT'S WHY YOU SEE THE HIGHEST TRUST THAT THE PUBLIC HAS IS ON NURSES, BECAUSE NURSES WILL GO OUT, IF THEY CAN... IF THEY'RE NOT HURT INSIDE, THEY WILL GO OUT TO PUT THE ALRM BELL BECAUSE OF THEIR ETHICAL DILEMMAS.

Mary says I WOULD LIKE YOUR OPINION ON THIS. YOU COME FROM A COMMUNITY CARE STANDPOINT, WHAT DO YOU THINK OF WHAT DIRS HAS BEEN SAYING ABOUT CONCERNS NOT BEING TAKEN SERIOUSLY FROM NURSES?

The caption changes to "Diane McLeod. Victorian Order of Nurses."

Diane says I THINK IT'S OFTEN THE CASE. I DON'T KNOW WHY IT IS BUT IT CERTAINLY IS A CONCERN THAT WE FACE WITHIN THE PROFESSION. I WOULD HAVE TO SAY IN TERMS OF THE SARS OUTBREAK IN THE COMMUNITY SECTOR, IT HAS HAD CERTAINLY A LESSER IMPACT THAN IT HAS HAD ON OUR COLLEAGUES IN THE HOSPITAL BUT IT CERTAINLY IS A CONCERN. IT HAS HAD A LESSER IMPACT BECAUSE WE HAVE NOT BEEN DEALING DIRECTLY WITH CLIENTS THAT HAVE BEEN AFFECT WIDE SARS BUT CERTAINLY IT HAS US ON THE ALERT AS WE SCREEN OVER CLIENT BEFORE WE ENTER THE HOME AS NURSES DO A SELF-SCREENING OF THEMSELVES, LOOKING WHAT THEY HAVE BEEN DOING IN PERSONAL LIFE FIST THEY ENTERED INTO THE HOSPITALS, AND THE VOICES OF THESE NURSES NEED TO BE HEARD. AND WE CERTAINLY DO SUPPORT OUR COLLEAGUES IN THE HOSPITAL SECTOR.

Doris says THE SECOND ISSUE THAT HAS BEEN RAISED WHICH WILL RING WITH MY COLLEAGUE AGAIN, THE SITUATION IN THE COMMUNITY, IS THE FACT OF THE INCREDIBLE NUMBER OF NURSES THAT WORK FOR MULTIPLE EMPLOYERS, NOT BY CHOICE MOST OF THEM BUT BECAUSE THEY CANNOT HAVE A FULL-TIME JOB. LET ME GIVE SMU FIGURES THAT THEY'RE STARTING. WE HAVE 15 PERCENT, ACTUALLY 15.6 PERCENT, ALMOST 16 PERCENT OF THE NURSES IN THIS PROVINCE WHICH EQUATES TO ABOUT 30,000 NURSES. THAT WORK IN WHAT IS CALLED MULTIPLE EMPLOYER AND THAT MEANS BETWEEN 2 MINIMUM TO 3 AND SOMETIMES FOUR. NOW, WHAT HAPPENED DURING THE SARS? DURING THE SARS NURSES WERE TOLD YOU CAN ONLY WORK IN ONE PLACE. NOW, LET ME LINK THAT TO COMMUNITY. THAT I AM GLAD THAT THE COMMUNITY HAS NOT BEEN AFFECTED BECAUSE IF EVER WE ARE, WE WILL NOT BE ABLE TO DEAL WITH THAT. IN THE COMMUNITY, WE HAVE 70 PERCENT, 70 PERCENT OF NURSES WHO WORKING PART TIME CASUAL, ONLY 30 PERCENT THAT HAVE STABLE EMPLOY., I AM NOT SPEAKING ABOUT VOA IN MY COLLEAGUE REPRESENTS BUT COMMUNITY, ALL OF THE HOME CARE SECTORS.

Mary says RIGHT, RIGHT.

Doris says MOST PRIVATE OR NOT FOR PROFIT, AS A WHOLE, 70 PERCENT, WE'LL POLLED THE FOLLOWING FROM THE COLLEGE OF NURSES, 70 PERCENT PART TIME CASUAL. NOW, AFTER THE SARS OUTBREAK, EVEN AT THE FIRST, THESE NURSES RIGHTFULY SO BY THE SYSTEM WERE TOLD, YOU ARE TO WORK ONLY IN ONE PLACE.

Diane says THAT'S RIGHT.

Doris says RIGHT?

Mary says YES.

Doris says AND YOU ARE NOT TO CROSS SECTORS, MANY OF THE 70 PERCENT, PART-TIME CASUAL, THEY CAN'T LEAVE ON PART TIME CASUAL, SO THEY WORK PART TIME CASUAL FOR HOME CARE AND THEN A COUPLE OF SHIFTS FOR A HOSPITAL. DURING THE SARS, THEY COULDN'T. THEY NEEDED TO CHOOSE BETWEEN THIS AND THIS. SO, NOT ONLY YOU PUT THAT NURSE IN JEOPARDY FOR LIVELIHOOD FROM A POINT OF FINANCIAL POINT OF VIEW, WHICH IS CRITICAL, BUT YOU ALSO PULL FROM HUMAN RESOURCES CAN ONLY WORK NOW IN ONE, REGARDLESS OF ISSUE. THE ONLY TWO, THREE OR FOUR PLACES DON'T HAVE THAT NURSING CARE. SO, AGAIN, THIS SOMETHING WE HAVE BEEN RAISING FOR FOUR YEARSS, AS YOU KNOW.

Mary says REGARDLESS OF SARS, IF SARS WASN'T HERE, AND CONTINUE CONSCIENCE WERE NORMAL, SO TO SPEAK, THERE STILL IS A SHORTAGE OF NURSES.

Doris says WELL, I SPOKE WITH YOU LAST YEAR, LAST YEAR, WE WERE SITTING DIFFERENT SETTING, CONGRATULATIONS ON YOUR NEW SETTING, BUT LAST YEAR WE WERE SPEAKING ABOUT THE WORK FORCE. AT THAT POINT, I FTS SPEAKING WITH YOU ABOUT A REPORT THAT WE RELEASED IN 2-01 OF WHY REGISTER NURSES WERE LEAVING THIS PROVE SKPINS THIS COUNTRY, MANY TO THE US, AS WE KNOW. 68 PERCENT SAID BECAUSE WE CANNOT FIND FULL TIME WORK. WHAT WILL WRING YOU BACK? FULL TIME WORK. YET, WHAT IS SO DEVASTATING IS THAT WE HAVE NEW GRADUATES THAT AS I SPEAK WITH YOU, THAT WAS ONE OF THE FOCALS I HAD BEFORE WE WERE SPEAKING. WAS TELLING ME, SORRY, NO, I AM LEAVING. SHE HAS THE TICKET. SHE'S LEAVING BECAUSE SHE CANNOT FIND FULL TIME WORK. SO, THIS IS A SYSTEMIC PROBLEM. THIS IS, A PROBLEM OF CONTINUOUS AND INADEQUATE FUNDING BUT ALSO A PROBLEM OF HOPEFULLY WHEN IT CONTINUES AND PERMANENT FUNDING WILL BE THERE, THAT THE EMPLOYERS WILL OPEN THE DOORS TO FULL-TIME EMPLOY. IF NOT, YOU JUST HAVE A VERY UNSTABLE WORK FORCE.

Mary says RIGHT. THE FIGURE OF THAT DOR IS GAVE, ABOUT 70 PERCENT OF COMMUNITY NURSES ARE WORKING ON A CASUAL BASIS, WHAT DOES THAT DO...

Doris says CASUAL PART-TIME.

Mary says SO WHAT DOES THAT DO TO COMMUNITY CARE?

Diane says WELL, I THINK IT CERTAINLY PUTS THE CHALLENGE FORWARD BECAUSE CERTAINLY, I CAN ONLY SPEAK FOR VON BUT WE ALSO TRY TO HAVE THE PRINARY NURSE FOR OUR CLIENT AS A FULL-TIME NURSE SO IT CAN INCREASE THAT NURSE'S CASE LOAD. BUT, IT ALSO IS AN UNFORTUNATE A NECESSITY BECAUSE OF, AGAIN, THE WAY WE'RE FUNDED IN THE COMMUNITY, THROUGH COMMUNITY CARE ACCESS CENTRES, FUNDING ON A VISIT BASIS. SO WE DON'T HAVE GLOBALIZED FUNDING TO BE ABLE TO MOVE STAFFING AROUND OR, MAKE CHANGES AS, AS THE REQUIRE. MAY COME FORWARD. SO, IF OUR VOLUME DROPS, SO FOR EXAMPLE IN THE SARS OUTBREAK, OF COURSE, IT WAS CANCELED SURGELYS, WE WERE NOT HAVING CLIENTS DISCHARGED FROM HOSPITAL, OUR VOLUME DECREASES SIGNIFICANTLY, WHICH MEANS THE REVENUE DECLINES, THAT'S THE FUNDING OF THAT PARTICULAR SYSTEM. SO, IF YOU HAVE FULL TIME STAFF ON BOARD OR TOO MANY, WHATEVER TOO MANY MEANS, THEN, YOU ARE IN A POSITION OF HAVING TO LAY OFF. WE TEND IN THE COMMUNITY TO MANAGE THE BUSINESS SIDE OF IT TO HAVE MORE CASUAL STAFF TO ALLOW US THE FLEXABILITY TO DEAL WITH THE CASE LOAD THAT'S UP TO TODAY AND DOWN TOMORROW. AND I AM NOT SAY TING IS RIGHT BUT THAT'S THE REALITY OF WHAT WE DEAL WITH. IT DOES CREATE A VERY UNSTABLE ENVIRONMENT FOR OUR STAFF. IT ISN'T OUR PREF ENS.

Mary says LET ME JUSTY REMIND OUR VIEWERS THAT THE TOPIC IS NURSING TODAY. IF I WOULD LIKE TO CALL IN WITH YOUR COMMUNITY OR YOUR DURING THE RECENT STARS OUTBREAK OR A PATIENT STORIES OR QUESTIONS TO ASK. WE HAVE TWO NURSES RIGHT HERE. TWO REPRESENTATIVES. GIVE US A CALL TODAY. WE'LL ALSO TAKE YOUR E-MAIL COMMENTS AND QUESTIONS AT MORE TO LIFE AT TVO.ORG.

The phone numbers and email reappear briefly.

Mary says WE HAVE JANICE ON THE LINE FROM SCARBOROUGH. HELLO, JANICE. Sorry WE HAVE AN E-MAIL.

Text pops up on screen. It reads "My daughter is a nurse. Other children don't want to play with my two grandchildren and my friends are even avoiding me, since I babysit the kids. Please let people know we need support from our friends right now. Janice, Scarborough."

Doris says WE HEAR ABOUT THAT, JANICE. WE HEAR FROM OUR NURSES THAT, LET ME GIVE YOU SEVERAL EXAMPLES. I MEAN AN EXAMPLE WHY THE NURSE, I WAS SAYING TO THE LADY, THE ONE THAT WAS PUTTING THE MAKE UP, THAT THIS IS HER DRESSER HAIR DRESSER, STAY AT HOME UNTIL THINGS ARE OVER BECAUSE THE DAUGHTER IS A NURSE, OF COURSE. ED AND ANOTHER ONE THAT THE HUSBAND, WOULD SAY, STAY AT WORK. AND MANY, NOT ONE, THAT, THE KIDS HAVE NOT BEEN ACCEPTED TO DAY CARE BECAUSE THE MOTHER IS WORK. AND THE LIST GOES ON AND ON AND ON. AND IT IS UNFORTUNATE BECAUSE, NUMBER ONE, IT'S UNNECESSARY AND THAT'S WHAT IS CRITICAL TO UNDERSTAND, WE HAVE SARS CENTRALIZED IN CERTAIN HOSPITALS. WE DON'T HAVE SARS UP AND OPEN IN THE COMMUNITY. AS I SAID, IT WOULD BE A DISASTER IF WE WANT FROM A VARIETY POINT OF VIEWS. SO, IF IS, IT IS UNNECESSARY FOR PEOPLE TO BEHAVE THAT WAY AND IT IS ALSO UNFAIR.

Mary says LET'S LOOK AT SOME STATS HERE. HOW MANY NURSES ACTUALLY FELL ILL WITH SARS?

Doris says WELL, IN MY COUNTS, UP TO A COUPLE OF DAYS AGO, SO THIS MAY NOT BE CORRECT, IS THAT WE HAVE EITHER CLOSE TO OR SOMETHING LIKE 60 NURSES THAT EITHER...

Mary says 16?

Doris says 60. EITHER PROBABLY, SUSPECTED OR UNDER INVESTIGATION. THAT IS A LARGE, LARGE NUMBER. AND SOME THAT ARE VERY ILL.

Mary says AND SOME VERY ILL. HAVE ANY NURSES DIED FROM SARS?

Doris says NO, NO. I WAS PROMISED I WOULD BE THE FIRST TO KNOW. AND I HOPE I NEVER RECEIVE A CALL LIKE THAT.

Mary says WHAT ABOUT AS FAR AS QUARANTINE?

Doris says HUNDREDS, THOUSANDS. IN BETWEEN THE FIRST OUTBREAK AND THE SECOND, THOUSANDS. I KNOW IN THE COMMUNITY THERE ARE THOUSANDS. SO IN THE HOSPITALS, EVEN MORE.

Mary says COMMUNITY NURSES?

Diane says YES, BECAUSE, CLIENTS WERE DISCHARGED INTO THE COMMUNITY FROM THE FACILITIES, ST. JOHN CONVALESCENT HOME INTO THE COMMUNITY BAFER WE KNEW THERE WAS ANY RISK. SO THAT ANY NURSE THAT HAD BEEN IN CONTACT WITH THOSE CLIENTS WAS IMMEDIATELY QUARANTINED TO KEEP IT CONTAINED AND WE HAVE BEEN SUCCESSFUL IN DOING THAT. BUT IT IS ABSOLUTELY. AND IN CASES WE MAY HAVE HAD STAFF, AS DOR IS WAS SPEAKING ABOUT EARLIER, THAT WORKED IN ONE OF THESE OTHER FACILITIES, EITHER ACCUSE CARE HOSPITAL OR ST. JOHN'S AND THEY WOULD BE UNDER QUARANTINE AND UNABLE TO WORK FOR US DURING THAT PERIOD OF TIME SIMPLY BECAUSE THEY WERE STAFF MEMBER OF THOSE FACILITIES.

Mary says YEAH.

Doris says JUST TO ADD, BECAUSE WE RIGHTFULY SO FOCUS ON THE HOSPITAL BECAUSE THAT'S WHERE MOST OF THIS THE STARS TAKE PLACE. BUT, LET ME TAKE THE OPPORTUNITY TO PUBLICLY ACKNOWLEDGE MY COLLEAGUES IN HOME CARE. MY COLLEAGUES IN PUBLIC HEALTH AND ALTHOUGH THE NURSES THAT WORK, NOT JUST IN THE SARS UNIT, NOT ONLY IN THE SARS UNITS BUT IN ICU'S, IN MANY OF THE GENERAL FLOORS IN VARIOUS HOSPITALS TO WHERE, WHERE MANY PATIENTS HAVE BEEN ILL AND NURSES HAVE BECOME SICK THEY ARE COURAGEOUS LEADERS DAY IN AND DAY OUT. IT'S IMPORTANT THAT WE ALSO ACKNOWLEDGE THAT THE NURSES IN HOME CARES AND THE NURSES IN PUBLIC HEALTH HAVE BEEN TREMENDOUS.

Mary says YEAH.

Doris says THE NURSES IN LONG-TERM CARE AND ANOTHER EXAMPLE. IN LONG-TERM CARE, THE NURSES IN ORDER TO HELP PEOPLE WITH COGNITIVE AGING PROBLEMS, RIGHT. RIGHT, OF COGNITIVE PROBLEMS LIKE dementia.

Mary says ALZHEIMER'S.

Doris says THAT THOSE INDIVIDUALS NEED VERY MUCH DETACH AND FACE EXPRESSION BECAUSE, THEIR MEMORIES ARE NOT AS SHARP, RIGHT. THOSE NURSES HAVE MADE ALL KINDS OF STRAJ GEES TO PLAY WITH THE PATIENTS WITH THE MASKS SO THEY WILL NOT BE FEARFUL, SO, I MEAN, I AM JUST... I AM JUST SO HONORED TO BE IN THIS PR THIS PROFESSION AND SEE WHAT MY COLLEAGUES ARE DOING. IT'S JUST AMAZING.

Mary says THAT'S TRUE, THE WORKING CONDITIONS THEM ARE SO ARD YOUS. YOU ARE ABSOLUTELY RIGHT ABOUT THE MASK. THAT'S SOMETHING I NEVER THOUGHT OF, WHEN IT IS SO IMPORTANT THEY SEE YOUR FACE.

Diane says I THINK THAT IN THE COMMUNITY SECTOR, I MEAN, PEOPLE ARE NOT ACCUSTOMED TO SEEING THEIR NURSE COME TO THEIR DOOR WITH A MAFERK AND A GOWN AND GLOVES ON. AND SO, THE EDUCATION THAT HAS TO OCCUR AND THAT CAN BE VERY STRAIGHTFORWARD FOR PEOPLE WHO ARE ABLE TO, ABLE TO COMMUNICATE IN ENGLISH AND UNDERSTAND THE COMMUNICATIONS WE HEAR ON THE TELEVISION AND READ IN THE NEWSPAPERS, BUT IN MANY CASES, THERE ARE LANGUAGE BARRIERS THAT WE WORK THROUGH, OUR STAFF ARE VERY ACCUSTOMED TO DOING THAT ON ORINGT ON, KAINGZS BUT THESE ARE NOT NORMAL CIRCUMSTANCES AND COGNITIVELY IMPAIRED.

Mary says WHEN THE NURSE COMES WITH A MASK AND GOWN, AND, THE PERSON AT THE DOOR, PERHAPS, DOESN'T SPEAK ENGLISH, MAYBE IS A RECENT IMMIGRANT, WHAT DO THEY MAKE OF THIS? YOU KNOW, I MEAN THEY MIGHT SEE IT AS A THREAT, SOME KIND OF A...

Diane says WE ARE VERY CREATIVE, OUR STAFF ARE AMAZING AND THEY WOULD EITHER, IF THEY ARRIVED AT THE DOOR WITH A MAFK, EITHER BE BECAUSE THE PERSON HAD BEEN QUARANTINED OR WE HAD ASSESSED OVER OUR PHONE CALL WE NEEDED TO EXERCISE PRECAUTIONS BECAUSE THEY ARE EXHIBITING SOME OF THE SYMPTOMS THAT ARE ON THE LIST. SO WE WOULD COMMUNICATE WITH THEM, AS AUFERN OUR NURSES SPEAK THE LANGUAGE. WE HAVE MANY NURSES THAT ARE FROM DIF RINT CULTURES. THEY MAY CALL A COMMUNITY CENTRE WHERE SOMEONE COULD TRANSLATE, A FAMILY MEMBER WHERE SOMEONE CAN TRANSLATE, THEY ARE VERY RESOURCEFUL PEOPLE. THEY WILL REACH OUT, THEY DON'T HAVE THE FOUR WALLS OF A FACILITY TO WORK WITHIN. BUT THEY WILL REACH OUT TO OTHER COMMUNITY PARTNERS.

Mary says THE EXPERIENCE OF THE COMMUNITY NURSE IS QUITE DIFFERENT BECAUSE THEY'RE ON THEIR OWN. AS YOU SAY TLRX'S NOBODY THEY CAN REFER TO, NOBODY OTHER DOCTOR OR NURSE. I AM CURIOUS TO KNOW, WHAT, WHAT WOULD A TYPICAL EXPERIENCE OR A DAY BE LIKE FOR A COMMUNITY NURSE?

Diane says WELL, IT WILL VARY DAY-TO-DAY.

Mary says LIKE EVEN PATIENT LOAD.

Diane says OUR NURSES SEE ON AVERAGE, WITHIN OUR ORGANIZATION, ABOUT 9 CLIENTS A DAY, ON AVERAGE.

Mary says THAT'S FULL TIME?

Diane says ACTUALLY IT IS ANY NURSE BECAUSE IF SHE'S WORKING A DAY, WE TRY TO GIVE HER A FULL'S DAY WORK SO A CASUAL NURSE ONE DAY A WEEK OR TWO DAYS A WEEK WOULD SEE THAT MANY CLIENTS IN A DAY. SHE WOULD START WITH HER EARLY MORNING DIABETIC CLINTS WITH INSULIN REQUIRE.S OR DRESSINGS THAT NEED TO BE DONE TWO OR THREE TIMES A DAY BECAUSE THE TIMING HAS TO BE SPLIT. SHE WILL WORK THROUGH HER DAY TO THE CLIENTS THAT DON'T HAVE ANY TIME REQUIRE.S AROUND THEIR DRESSING OR THEIR TREATMENT AND IT MIGHT BE AN IV THERAPY. IT MIGHT BE DIALYSIS TREATMENT. ANY NUMBER OF THING.

Mary says AT HOME?

Diane says ABSOLUTELY.

Mary says HAS CHA THAFERJED. THE SCOPE OF PRACTICE OF THE COMMUNITY CARE NURSE, THAT'S DRAFT KAET CHANGED, HASN'T IT?

Diane says YES, IT HAS.

Mary says IT ENCOMPASSES A WIDER, I GUESS, RANGE OF PROCEDURES THAT THEY'RE DOING.

Diane says OH, ABSOLUTELY. SINCE THE HOSPITAL RESTRUCTURING THAT OKURD, I MEAN, YOU HAVE HEARD THE EXPRESSION. GETTING HOME QUICKER AND SICKER, WE ARE VERY PLEASED TO HAVE THESE PEOPLE BE ABLE TO CARE FOR IN THEIR HOME. WE THINK THEY RECUPERATE MUCH FASTER BUT THERE IS NO QUESTION THEY'RE BEING DISCHARGED EARLIER, A LOT MORE DAY SURGERIES THAT WE'RE SIGHING, CLIENTS, OUR NURSES ARE OUT IN THE EVENING VISITING CLIENTS TO ADMINISTER PAIN MED KAING.

Mary says DOES THAT MEAN MORE TRAINING THEN FOR COMMUNITY CARE NURSES?

Diane says OUR NURSES ARE TRAINED THE SAME AS OTHER NURSES ARE. IT'S A FOUR YEAR PROGRAM NOW. BUT WE DO HAVE SPECIALTY REQUIRE.S, WE DON'T HAVE AN IV TEAM TO CALL ON START THE IV. MANY, SOMETIMES IN A PARTICULAR LOCATION, ALL OF OUR NURSES IN A MORE RURAL LOCATION, ALL OF OUR NURSES WOULD BE CERTIFYED IN IV STARTS AND THEY WOULD BE DOING THAT ON A VERY REGULAR BASIS. SO. THEY'LL HAVE SPECIALTY TRAINING IN PARTICULAR AREAS, CARE WHERE COMMUNITY NURSES ARE VERY INVOLVED. DIE IN THE COMFORT OF THEIR OWN HOME WITH THE FAMILY AROUND THEM. IF THE FAMILY CAN MANAGE THAT AND DEAL WITH THAT, OR WITH THE SUPPORT THAT THE COMMUNITY CAN OFFER, WE CERTAINLY ENCOURAGE IT AND WE'RE SEEING MORE OF THAT ALL OF THE TIME.

Mary says BUT THERE MUST ALSO BE A DILEMMA AS WELL IN THE FACT THAT WE NEED MORE NURSES, RIGHT. WE NEED MORE COMMUNITY.

Diane says ABSOLUTELY.

Doris says MAY EXPLAIN ALSO WHY IT IS SO CRUCIAL THAT WE HAVE A MORE SOLID WORK FORCE AND MORE STABLE WORK FORCE IN HOME CARE. IT IS TIS BETTER FOR PEOPLE, RIGHT. IT IS BETTER FOR THE SYSTEM, AND IT NEEDS TO BE BETTER FOR PATIENTS AND IN ORDER TO BE BETTER FOR PATIENTS, MY COLLEAGUES NEED TO HAVE, NOT 30 PERCENT FULL TIME, BUT MANY MORE. THEREFORE, THEY NEED THE MODEL THAT WILL ALLOW THEM NOT ONLY THIS UPS AND DOWNS BECAUSE IF NOT TO ERAISE DIFFERENT PEOPLE SEEING THE PATIENT EVERY DAY.

Mary says RIGHT. BUT AND I AM ALSO THINKING ABOUT THE REALITY OF THE SITUATION. I MEAN IDEALLY, YOU WANT NURSES WHO ARE EXPERIENCED AND WELL TRAINED IN DIFFERENT SPECIALTY. IF YOU DON'T HAVE ENOUGH OF THEM, IN ONE POINT, WEREN'T VON, I THINK THEY NEEDED SO MUCH EXPERIENCE BEFORE THEY ACTUALLY CAME OUT TO THE COMMUNITY, RIGHT? THEY NEEDED SOME HOSPITAL EXPERIENCE. BUT TODAY, IF YOU DENT HAVE ENOUGH OF THOSE BODIES, WHAT HAPPENS?

Diane says WELL, WE HAVE ADJUSTED OUROR YEN TAING PROGRAM AND OUR PRECEPTORSHIP MODEL AND ALTHOUGH WE STILL PREFER TO HAVE NURSES WITH EXPERIENCE, BECAUSE, NOT BECAUSE THEY OUR NEW GRADUATES ARE NOT WELL QUALIFIED. THEY ARE. THE DIN DEPENDENCE IN THE COMMUNITY, THEY DON'T HAVE SOMEONE AT THE NURSING STATION OR SOMEONE TO CALL ON. WE HAVE ADJUSTED OUR ORIENTATION AND OUR PRECEPTORSHIP MEANING WE BUDDY THEM UP WITH AN EXPERIENCED NURSE AND THAT LASTS LONGER FOR A NEW GRADUATE.

Mary says SO MEANING YOU ARE TAKING NEW GRADUATES IN NOW.

Diane says WE ARE. WE ALSO WORK VERY CLOSELY WITH THE COLLEGES AND THE UNIVERSITIES TO ENSURE THAT WE HAVE STUDENTS THAT HAVE A FIELD EXPERIENCE IN THE COMMUNITY SECTOR AND WE HAVE MANY STUDENTS THAT COME AND WORK IN VIEW WHEN TO DO THAT PART OF THE TRAINING.

MARY says JUST GOING TO TAKE THIS CALL.

Doris says AND ANOTHER EXAMPLE IS, THE HEALTH CARE, AGAIN, NOT FOR PROFIT ORGANIZATION, WHERE YOU MAY HAVE HEARD OF HER, THE PRESIDENT AND CEO. SHE'S A NURSE AND ONE OF OUR COLLEAGUES, THEY ALSO TAKE NEW GRADUATES, THANK GOODNESS. BECAUSE IF NOT, WE WOULD HAVE NEW GRADUATES LEAVING AGAIN BECAUSE THEY CANNOT FIND WORK. IT'S GOOD TO SEE THAT, MANY OF OUR COLLEAGUES ARE NOW STARTING TO TAKE NEW GRADUATES AND DO THIS MENTORSHIP PROGRAM. IT'S VERY GOOD.

Mary says LET'S TAKE A CALL. MARCIA IS ON THE LINE. GO AHEAD.

The caller says HI. I AM NOT VERYEN THUSED ABOUT THE TALK OF RECRUITMENT OF NURSE BUT I AM MORE CONCERNED WITH THE RETAIN. OF THE NURSES THAT ARE ALREADY IN EXISTENCE. I HAVE BEEN WORKING IN THE HOSPITAL SYSTEM FOR ALMOST 15 YEARS NOW AND I SEE VERY LITTLE EFFORT TO RETAIN THE NURSES WHO ARE ALREADY TRAINED, VERY EXPERIENCED, VERY LITTLE EFFORT, YOU KNOW, IF YOU WANT TO GET FULL TIME EMPLOY., YOU HAVE TO WORK NIGHTS, YOU DON'T GET ANY INCENTIVE OR ANY REWARD FOR STAYING IN THE PROFESSION, YOU KNOW, YOU SORT OF GET TREATED LIKE YOU DO AT THE VERY GET-GO. I AM WONDERING, WHAT DO YOU ANSWER TO THIS?

Doris says YEAH, THAT IS A VERY GOOD QUESTION. BECAUSE ACTUALLY, IT IS ALSO SOMETHING WE IDENTIFY THAT WE HAVE PUT A VERY STRONG FOCUS RECRUITMENT BECAUSE WE ARE SO FEARFUL WE DON'T HAVE ENOUGH NURSES BUT NEED TO STEP UP OUR ROLE IN RETENING. LET FIRST OF ALL. LET ME ACKNOWLEDGE YOU HAVE A GR VERY GOOD POINT. LET ME TELL YOU SOME OF THE THINGS WE HAVE DONE AND INITIATIVES AND HOPEFULLY YOU WILL BE AWARE BECAUSE WE HAVE SENT INFORMATION TO EVERY SINGLE NURSE IN THE PROVE PROVINCE AND SOME OF THIS NIRKTIVES ARE ACTUALLY SUPPORTED WITH FUNDING FROM THE MINISTER OF HEALTH THAT WE HAVE WORK ON A PARTNERSHIP WITH THIS. MANY ARE RELATED TO TRYING TO GIVE YOU A BREATHER. SO LET ME START WITH THAT. WHAT DO I MEAN BY THAT?? THE ABILITY TO GO TO CONFERENCE AND BE REIMBURSED. NOT FOR THE DAY OF THE CONFERENCE BUT OTHER FEEL OF THE CONFERENCE. THE ABILITY TO GO BACK TO SCHOOL, IF YOU WANT TO GO BACK TO SCHOOL FOR A DEGREE OR IF YOU WANT TO GO BACK TO SCHOOL FOR A RN OR FOR A MASTER OR WHATEVER. THAT THE NURSE CAN RECEIVE UP TO 1500 A YEAR, AGAIN, IN FUNDING.

Mary says THIS IS REGARDLESS OF WHERE THEY WORK?

Doris says YES. SECTORS AND WE IS SENT LETTERS TO EVERY SINGLE NURSE. SO AT LEAST THOSE ARE SOME OF THE THINGS WE ARE DOING. THE ISSUE OF FLEXABILITY. I KNOW THAT MY COLLEAGUES ONTARIO NURSES ASSOCIATION DID WORK IN THEIR CONTRACT 1 ASPECT AT LEAST WHICH THE ABILITY FOR NURSES TO WORK ONLY WEEKENDS. AND THEY CAN HAVE THE WEEK IF THEY WISH TO GO TO SCHOOL. AND I WOULD URGE YOU, I WOULD URGE YOU, AND I AM HOPEFULLY, YOU KNOW HOW TO CONTACT ME, BUT IF NOT, I WILL TELL YOU IMMEDIATELY. IF YOU HAVE ANY IDEAS OF STRATEGIES THAT WE CAN UNDERTAKE TO HELP RETAIN NURSES, NUMBER 1, BECAUSE WE NEED EACH ONE OF YOU GUYS AS IT IS AND LET ME CLEAR ABOUT THAT. YOU HAVE EXPERTISE. NUMBER 2, BECAUSE WE NEED YOU TO STAY EVEN IF IT IS TWO MORE YEARS THAN WHAT YOU ORIGINALLY THOUGHT, AND NUMBER 3, AN EQUALLY IMPORTANT, IS THAT WE NEED YOU TO MENTOR ALL OF THESE NEW GENERATION AND THAT'S VERY, VERY SERIOUS. SO, PLEASE, IF YOU HAVE GREAT IDEAS OR EVEN THOUGHTS, YOU KNOW, THAT YOU CAN SHARE WITH US OF THINGS THAT WE CAN DO, PLEASE SEND THEM, BECAUSE NOW IS THE TIME, WE ARE DEVELOPING THE PLANS FOR THE NEXT YEAR. AND WE DO WANT TO FOCUS MORE ON RETENTION. SO PLEASE SHARE WITH US.

Mary says I AM CURIOUS TO KNOW, DO WE KNOW WHAT THE AVERAGE AGE OR, YOU KNOW, ALSO AVERAGE LENGTH OF EXPERIENCE IS FOR NURSES WHO ARE WORKING OUT THERE.

Doris says WE KNOW THAT NURSES WORK UP TO MORE OR LESS, 54, 55 YEARS OLD. SO IT IS A LOT LESS THAN WHAT WE COULD. WE KNOW KNOW THAT THE REASON FOR THAT IS BECAUSE THEY ARE SIMPLY EXHAUSTED. PHYSICALLY, THEY CANNOT KEEP UP WITH A WORKING NIGHTS, EVENINGS, WEEKENDS, CONNECT. WE, BUT WE'RE NOT, WE ARE THE PROFESSIONAL ASSOCIATION, HAVING VARIOUS OCCASIONS, RECOMMENDED, SUGGESTED, EVEN IN WRITING INCLUDING IN A REPORT, CALLED ENSURING THAT CARE WILL BE THERE, WHICH WAS RELEASED TO THE MINISTER IN 2002, THAT SHIFT DIFFERENT IALS, MEANING FOR EVENING SHIFT AND FOR NIGHT SHIFT, AND FOR WEEKEND, SHOULD BE HIGHER THAN WHAT IT IS. AND I LIVED IN THE US FOR SIX YEARS BEFORE I CAME TO CANADA AND IT WAS A LOT HIGHER AND WHAT THEN HAPPENS, YOU HAVE SOME NURSES THAT PREFER EVENINGS, NIGHTS OR WEEKENDS BECAUSE OF FAMILY REASONS. OR BECAUSE THEY GO TO SCHOOL. AND THEN OTHERS CAN HAVE MORE FLEXABILITY OF ONLY THIS. I DON'T SEE ANYTHING WRONG WITH THAT. I DO THINK THAT WE NEED TO MOVE IN A MORE LIBERAL, IN A MORE, I GUESS THAT'S WORD, LIBERAL WAY THAT WE ARE NOT...

Mary says FLEXIBLE.

Doris says NOT SO RESTRICTED.

Mary says LET'S TAKE ANOTHER CALL HERE. WE HAVE LUCILLE ON THE LINE FROM KINGSTON.

The caller says HIGHWAY, HOW ARE YOU?

Mary says FINE, THANK YOU.

The caller says I HAVE TO GIVE THE LADIES ON YOUR PANEL TODAY, A VERY, PREERK, BECAUSE I AM A CANCER PATIENT, MYSELF. COMPREHEND AND I REALLY THINK THAT THE NURSES AND THE VON REALLY DO NEED TO BE PRAISED FOR THE WORK THEY DO ON A DAILY BASIS. MY FATHER IS 86 YEARS OLD. HE HAS A VON THAT COMES IN AND ATTENDS TO HIM, I KNOW HE APPRECIATES IT VERY MUCH. I KNOW THE NURSES ARE OVER WORKED IN THE HOSPITALS BECAUSE I SEE IT EVERY TIME I TAKE MY TREATMENTS. I SEE THE SAME ONES ON THE DAILY BASIS THAT I AM THERE AND I KNOW IT IS HARD, HARD WORK FOR THEM. I REALLY WANT YOU TO UNDERSTAND THAT WE DO APPRECIATE YOU HERE IN CANADA.

Mary says THANK YOU VERY MUCH, LUCILLE.

Diane says THANK YOU VERY MUCH FOR THAT CALL. WE, YOU KNOW, COMPLIMENTS LIKE THAT JUST GO SUCH A LONG WAY AND I'LL MAKE SURE THAT MY BRANCH IN KINGSTON HEARS THAT COMMENT WHEN I GET BACK TO THE OFFICE. THANKS FOR YOUR CALL.

Doris says IF I CAN ADD, LUCILLE, FIRST OF ALL, GOOD LUCK. GOOD LUCK. WE NEED TO KEEP YOU HEALTHY AND YOUR FAMILY HEALTHY. AND SECOND, COMMENTS LIKE YOURS IS WHAT KEEPS US GOING. THAT'S THE TRUTH. THAT'S WHAT KEEPS US GOING. THAT'S WHAT KEEPS NURSES ON DAY-TO-DAY BASIS IN THE TRENCHES GOING.

Mary says YEAH.

Doris says SO THANK YOU.

Mary says WE TALKED EARLIER ABOUT, YOU KNOW, WHAT'S INVOLVED WITH BEING A COMMUNITY CARE NURSE, WHEN YOU TALK TO COMMUNITY CARE NURSES, WHY WOULD THEY MAKE THAT CHOICE OF GOING INTO COMMUNITY CARE AS OPPOSED TO LET'S SAY A HOSPITAL? I THINK FROM JUST A FINANCIAL POINT OF VIEW, THE PAY IS BETTER IN HOSPITALS, RIGHT?

Diane says IT IS INDEED.

Mary says IT IS.

Diane says I WISH I COULDN'T TELL YOU IT IS TRUE.

Mary says WHAT IS IT ABOUT COMMUNITY CARE WORK?

Diane says I AM SURE THERE ARE MANY THINGS. BUT I GUESS, WHAT I HAVE OBSERVED AND EVEN EXPERIENCED MYSELF IS THAT FIRST OF ALL, INDEPENDENT IN YOUR PRACTICE, YOU WILL EXPERIENCE THAT IN THE COMMUNITY. I MENINGED BEFORE BEING ALONE AND MAKING DEZUINGS. AND YOU CERTAINLY ARE ALLOWED TO DO THAT AND I THINK THAT YOU ARE VERY RESPECTED AS A PART OF THE HEALTH CARE TEAM WHEN YOU ARE A COMMUNITY NURSE. I THINK SECONDLY, THE NURSES WHO WORK IN THE COMMUNITY HAVE QUITE A VARIETY IN THEIR CASE LOAD I WAS EXPLAINING EARLIER. EVERY DAY IS DIFFERENT. AND EVERY DAY BRINGS WONDERFUL THINGS AND IT BRINGS ITS CHALLENGES AND IF YOU INTI THAT VARIETY, YOU WON'T JUST SEE THE CLIENTS, YOU WON'T JUST SEE CLIENTS AFFECTED BY CANCER, YOU WILL SEE A VARIETY IN YOUR CASE LOAD, A VARIETY OF AGES. A VARIETY OF HEALTH PROBLEMS, AND I THINK THAT THE THIRD THING WHICH IS VERY SATISFYING TO COMMUNITY NURSES IS THAT YOU CAN SEE THE CLIENT IN THE CONTEXT OF THEIR OWN ENVIRONMENT WHICH UNFORTUNATELY YOU DON'T SEE, YOU CAN'T SEE IN THE HOSPITAL OR IN LONG-TERM CARE FACILITIES, SO WHEN YOU GO INTO THE HOME, YOU SEE THE PERSON IN THEIR OWN ENVIRONMENT. YOU MEET THEIR FAMILY, YOU MEET THEIR FRIENDS, YOU MEET THE PEOPLE THAT ARE IMPORTANT TO THEM AND THE PEOPLE THAT HAVE AN IMPACT ON THEIR HEALTH, BECAUSE, THE HEALTH, YOU KNOW, DETERMINES OF HEALTH CARE, A LONG LIST OF THOSE SKPRX IT REALLY IMPORTANT AND THE NURSE HAS AN OPPORTUNITY TO INTER ACT ON A DIFFERENT LEVEL, YOU KNOW, CERTAINLY THE HOSPITAL, NURSES WHO WORK IN HOSPITAL SEE THE FAMILY AS THEY ENTER TO VISIT, BUT, REALLY, TO BE RESPECTFUL AND TO ALLOW PRIVATE TIME FOR VISITING, THEY USUALLY REMOVE THEMSELVES FROM THE ROOM AT THAT TIME UNLESS SOMETHING IMPORTANT TO COMMUNICATE. WHERE AS IN THE HOME, YOU CAN INVOLVE THEM IN THE CARE PLANING AND INVOLVE THE CLIENT IN THAT, IT IS JUST A BROADER SCOPE, SO I WOULD SAY IF I HAD TO SAY THREE THINGS, THAT'S WHAT ATTRACTS NURSES TO THE KMUNLT.

Mary says LET'S TAKE ANOTHER CALL. NORTH BAY, SANDRA IS ON THE LINE. HI. GO AHEAD.

The caller says I AM NOT AN RN, I AM AN RPN BUT SPEAK FOR ALL OF US, I HAVE WORKED IN THE COMMUNITY AND AT A HOSPITAL, THE HOSPITALS ARE NO BETTER AT GETTING FULL-TIME WORK. I WORKED FOR 10 YEARS ON THREE MONTHS ROTATING CONTRACT. I WAS PRETTY MUCH FORCED IF YOU DIDN'T DO IT, YOU WOULD BE LET GO WORKING SOMETIMES THREE DIFFERENT SHIFTS ICHANGING THREE TIMES IN TWO WEEKS. AND AFTER 10 YEARS OF DOING THAT WITHOUT A FULL-TIME JOB, I ENDED UP WITH BURN OUT. I HAD EXTREME HIGH BLOOD PRESSURE. IT WENT UP TO 220 OVER 120 AND NOW I AM OFF WORK AND I HAVE NO BENEFITS BECAUSE I DON'T HAVE... I DIDN'T HAVE ANY BENEFITS BECAUSE I HAD NO FULL TIME CONTRACT.

Mary says SANDRA, WELL LET ME ASK YOU. WHAT DO YOU THINK ARE THE MOST IMPORTANT THINGS THAT NEED TO CHANGE?

The caller says WELL, I THINK THAT THERE IS ENOUGH WORK TO GIVE PEOPLE FULL-TIME JOBS.

Doris says ABSOLUTELY.

The caller says THAT'S THE PROBLEM. THERE ISN'T A LACK OF NURSES, THERE SAY LACK OF FULL-TIME JOBS.

Doris says ABSOLUTELY.

The caller says THAT'S THE PROBLEM.

Doris says YOU JUST HIT THE NAIL. WE HAVE BEEN SAYING THIS EVERY TIME SOMEONE SPEAKS TO ME ABOUT NURSING SHORTAGE. I SAY WHAT SANDRA SAYS, WE DON'T HAVE A SHORTAGE OF NURSES, WE HAVE A SHORTAGE OF POSITIONS. AND THEY, THAT ALL OF THE POSITIONS, BE FILL WIDE MORE FULL TIME PEOPLE, BY CHOICE. I AM NOT SAYING MANDATING FULL TIME. BUT THERE IS ENOUGH PEOPLE LIKE MY COLLEAGUE LEER AND I KNOW MANY IN THE NURSING FACTORS HAVE BEEN WAITING, 10 OR 15 YEARS FOR FULL TIME. AND THEY GET A CALL THE DAY THAT I GET A CALL. I CAN'T FIND CASUAL PART TIME WORK, THEN I WILL STOP SAYING THIS. MEANWHILE, ON THE PHONE CALLS I GET ARE LIKE HER, RIGHT. EXACTLY LIKE THAT. WE CANNOT FULL TIME WORK. SO, THAT'S WHY I ALSO, ECHO THE SAME, WHAT WE HAVE IS A SHORTAGE OF POSITIONS.

Mary says WHAT IS STOPPING MORE POSITIONS?

Doris says ADEQUATE FUNDING. PERMANENT FUNDING. LONG-TERM FUNDING. NOT STOP AND GO. AND YOU GT TO GIVE THE FAMILY, WE HAVE SAID THIS TO THE PREMIER AND THE MINISTER INCLUDING IN THE LAST FEW DAYS, STRINGS ATTACHED TO THE FUNDING, SO THAT EMPLOYERS THEN, NOT BECAUSE THEY BECAUSE THEY HAVE PRIORITIES, THAT THEY OPEN FULL TIME PO ZUINGS. WHEN THEY WILL GIVE PEOPLE SAYING THAT'S IT. WE DON'T NEED SATURATION OF FULL TIME, WE CAN MOVE TO MORE. MANY EMPLOYERS ARE MOVE NOTHING THAT DIRECTION AM I KNOW FOR A FACT, SHELLY SPOKE WITH ME. SHE IS GOING TO HIRE MANY FULL TIME PEOPLE. SHE SAID, I DON'T CARE ANY MORE. MORE FULL TIME PEOPLE. END OF STORY. I KNOW THAT UNIVERSITY HEALTH NETWORK, ALSO HAVE HIRED MORE FULL TIME. I KNOW SEVERAL OF THE FACILITIES, IN FACT, THAT THEY'RE JUST, EXHAUSTED BY THIS INSTABILITY AND ARE MOVING THERE. BUT, IF WE ALL MOVE AS A SYSTEM THERE, THAT YOU WOULDN'T HAVE PEOPLE MAKING THIS TYPE OF CALLS.

Mary says I WANT TO ASK YOU WHAT YOU THINK. THE GOVERNMENT RECENTLY ANNOUNCED IT IS GOING TO GIVE FREE TUITION TO NURSES IF THEY WILL PRACTICE, I GUESS, IN REMOTE AREAS, WHAT DO YOU THINK OF THAT?

Doris says YES THAT CAME OUT OF THE REJ STERED NURSES PREELECTION CALL. WE THOUGHT, WITH THE ELECTION AND ALWAYS, WE ARE TWO STEPS AHEAD. SO, IN JANUARY, 2 AT QUEEN'S PARK. WE HAD THIS BIG PRESS CONFERENCE SKPRX NATIONAL LEVEL, WE RELEASED A PREELECTION PLATFORM. TYPE OF CALL AND WE THEN SHARE THAD WITH EACH ONE OF THE PARTIES AS WE ALWAYS DO. AND EACH ONE PICKED AND CHOOSED WHAT THEY WERE GOING TO DO. SO, OUR GOVERNMENT CHOSE FREE TUITION WHICH WE WELCOME VERY MUCH. IT IS A FANTASTIC INITIATIVE. IT IS SOMETHING THAT WE HAVE REQUESTED AND THAT THEY HAVE COME FORWARD. SO IT IS FANTASTIC. NOW, WE ALSO HAVE SAID TO THE MINISTER, THAT ALONG SIDE WITH THAT INITIATIVE, TWO OTHERS NEED TO BE PICKED UP FROM THE PLATFORM AND THEY STAY SOMEWHERE, THEY ARE LOST. ONE IS THAT WE NEED MORE FACULTY. SO WE NEED UNIVERSITIES OUR GOVERNMENT TO PROVIDE MORE SUPPORT FOR CURRENT FACULTY THAT DON'T HAVE A PHD TO OBTAIN A PHD. IF NOT, WHO IS GOING TO TEACH THEM AND DO THE RESEARCH. WE HAVE A 90 PERCENT, ACTUALLY 90.2 PERCENT OF OUR CURRENT FACULTY BEING 45 YEARS OLD OR OLDER.

Mary says WOW.

Doris says IT CH MEANS FIVE OR 10'S FROM NOW, THEY'LL BE GONE. NOW, YOU KNOW THAT IT TAKES, YOU NL, A GOOD FEW YEARS TO GET A PHD. SO HENCE THE NEED FOR THAT. SECOND, THOSE NEW GRADUATES THAT WILL COME THROUGH THE FREE TUITION REIMBURSE. NEED TO KNOW THEY WILL HAVE FULL TIME POSITIONS. YOU HEARD WHAT HAPPENS IN THE NORTH. WE HAD THE SAME INITIATIVE OF FREE TUITION IN THE BEGINNING 80'S. IT FAILED. YES. BECAUSE WE DIDN'T HAVE FULL-TIME JOBS.

Mary says YOU ARE SAYING PEOPLE... STUDENTS WERE NOT GOING IN BECAUSE THEY WANT THAD GUARANTEE.

Doris says THEY LEFT THE COUNTRY BECAUSE THERE...

Mary says THEY WENT IN AND THEN THEY LEFT.

Doris says WE ENDED UP SUBSIDIZING FREE ED KAING FOR THE US. SO, IT IS A... LET ME, IT'S A FABULOUS INITIATIVE. BUT...

Mary says BUT SU HAVE TO HAVE...

Doris says THERE IS AN URGENCY TO MOVE TO FULL-TIME EMPLOY. BECAUSE IF NOT, ALL WE ARE DOING IS SUBSIDIZING THEIR TICKET TO THE US.

Mary says LET'S TAKE ONE MORE CALL. WE HAVE ESTESIA ON THE LINE. HELLO.

The caller says YES, HELLO. I HOPE YOU CAN HEAR ME.

Mary says YES, WE CAN HEAR YOU.

The caller says OKAY. I WAS FORCED TO RETIRE LAST YEAR. I AM A NURSE OVER 35 YEARS OF EXPERIENCE. AND I WANTED TO CONTINUE WORKING BUT THEY HAD THIS GROUP SKPRX NOW EVEN WITH THE LATEST ROUND OF LEGISLATION, APPARENTLY BECAUSE OF CONTRACTS, THEY STILL CAN'T DO IT SKPRX YOU WERE JUST MENTIONED HOW YOU WANTED TO HAVE, YOU WANTED TO KEEP PEOPLE WITH EXPERIENCE IN THE HOSPITALS, AND NOW OBVIOUSLY, I DON'T WANT TO WORK FULL TIME, I JUST WANTED TO WORK CASUAL. I DON'T WANT TO TAKE ANY YOUNG NURSE'S JOB. AND THERE IS A NEED FOR CASUAL BECAUSE PEOPLE DO GO OFF SICK, THEY HAVE SPECIAL EVENTS COME UP. AND I KNOW THAT THE MANAGER ON MY FLOOR WOULD HAVE BEEN MORE THAN HAPPY TO KEEP ME AND ALSO ANOTHER NURSE THAT RETIRED LAST YEAR. SO, I MEAN, THIS IS A... I ENT DO KNOW HOW THIS PROBLEM WITH BE OVERCOME, BUT IT IS REALLY, LIKE, THERE ARE AND THERE ARE GOING TO BE MORE OF US IN THE YEARS TO COME BECAUSE A LOT OF US ARE HITTING 65.

Doris says LET ME SKR TWO VERY IMPORTANT POINTS YOU MAKE. THE FIRST ONE SKPRX NOT KNOWING THE PARTICULARS OF YOUR SITUATION, AND I CAN'T FULLY COMMENT, BUT THE PROPOSED IDEA OF DOING AWAY WITH MANDATORY RETIREMENT HAS NOT COME TO FRUITION. THAT IS AN ELECTION PLATFORM. IT IS NOT SOMETHING THAT THERE, THAT YOU ARE MANAGER, AND SO THAT'S THE FIRST THING AM THE SECOND THING, WE HEAR FROM MANY, MANY SENIOR NURSES. THEY WANT MORE FLEXABILITY, EVEN THOSE THAT ARE STILL AT WORK. SOME OF THEM ARE KEEPING THEIR FULL TIME EMPLOY. WITH PREFERRED PART TIME BECAUSE THEY NEED THE FULL TIME BENEFITS. SO, THIS IS THE STORY. WE NEED FLEXABILITY IN BOTH ENDS, WE NEED FLEXABILITY FOR THE MORE SENIOR NURSES SO THEY CAN WORK LESS HOURS WITHOUT LOSING THEIR BENEFITS IF THEY SO CHEESE. AND WE NEED FLEKTSABILITY IN TERMS EVER NEW COMERS THAT DON'T HAVE SENIORITY FOR EXAMPLE. TO BE ABLE FULL TIME IF THAT'S WHAT THEY WANT AND MOST OF THEM DO. SO, IT IS KIND OF A MISMACHL, RIGHT.

Mary says YEAH. LET'S TRY TO SQUEEZE OUT ONE MORE CALL AM WE ARE ALMOST OUT OF TIME. HI, RICK.

The caller says HELLO.

Mary says GO AHEAD.

The caller says YES, I AM IN MY 40 AECHLT I HAVE MULTIPLE SCLEROSIS. MY FATHER IS A DOCTOR. I HAVE BEEN IN THE HEALTH CARE SYSTEM ALL MY LIFE AND I KNOW THE CUT BACKS AND WHAT'S GONE ON. BUT WOFERN THING I WOULD LIKE TO SAY, IS THAT SARS HAS BASICALLY IN THE GOVERNMENT'S EYES BLOWN THEIR BUDGET ALL TO HELL. AND WE REALLY NEED TO HAVE THE MONEY IN HEALTH CARE FOR THESE TYPES OF EMERGENCIES. ALSO, THE OTHER POINT I WOULD LIKE TO SAY, IS HOW COME TEACHERS GET PAID MORE THAN NURSES? THAT'S ALL I REALLY WANTED TO SAY.

Mary says WELL, THAT... THAT IS LIKE A NEVER-ENDING ARGUMENT.

Doris says BECAUSE I AM NOT SURE. I MEAN I SHOULD BE SAYING YOU ARE RIGHT BUT I'M NOT SURE TEACHERS GET PAID MORE THAN NURSES. NOW TEACHERS, I DON'T WANT. BUT NURSES NEED TO BE WELL REMUNERATED. BUT I WOULD AGREE WITH YOU ABOUT THE ISSUE OF THEIR NEEDS TO BE ALWAYS FUNDING IN HEALTH CARE FOR CRISIS SITUATIONS. BUT ALSO, IN IN ADDITION TO THAT, IF I MAY ADD, THERE ALWAYS NEEDS TO BE ENOUGH EVER A STABLE SYSTEM WITH STRONG HOSPITALS, STRONG COMMUNITIES SECTORS, STRONG LONG-TERM CARE. STRONG PRIMARY HEALTH. SO THAT WE CAN RESPOND IN CRISIS SITUATIONS, THAT'S WHAT WE'RE ATTEMPTING TO DO AND HOPE WILLY WE WILL GET THERE SOONER THAN LATER.

Mary says LET ME ASK YOU FOR A FINAL COMMENT.

Diane says SURE. I ABSOLUTELY AGREE WITH THE CALLER THAT TALKING ABOUT THE FUNDING. I MEAN, WE, WE SHOULD ANTICIPATE THIS KIND EVER THING HAPPENING. AND SO IT SHOULDN'T BE SOMETHING THAT THEN PUTS A DRAIN ON OUR ALREADY EXISTING RESOURCES WHICH ARE TOO FEW, IN MY OPINION. SO, I CERTAINLY WOULD HOPE THAT WE LOOK TO A SYSTEM WHERE WE CAN RESPOND TO THIS TYPE OF SITUATION BECAUSE, THIS IS ONE BUT THERE WILL BE OTHERS. THERE ARE BOUND TO BE.

Doris says ABSOLUTELY.

Mary says LET ME SKU QUICKLY. THERE MAY BE MANY ASPIRING NURSES OUT THERE. YOU KNOW, WHO ARE LISTENING, PERHAPS, FUTURE NURSES. THEY HEAR A LOT OF NEGATIVE, RIGHT. I MEAN, IN GENERAL, WE WERE TALKING ABOUT THE UNSTABLE CONSCIENCE, SARS, HAS HIGHLIGHTED THAT. WHAT, DO YOU GET ANY SENSE FROM YOUNG PEOPLE OUT THERE, I MEAN, IS THERE A GREAT INTEREST IN ENTERING...

Doris says GREAT.

Mary says IT IS THERE? THEY'RE NOT DISSUADED.

Doris says NURSES HAVE BECOME IN THE HIGH EYES OF THE PUBLIC AND IT IS REAL, BECAUSE IT IS TRUE, AND IN THE EYES OF THE YOUNG GENERATION THE FIRE FIGHTERS OF THE 9-11. THAT'S HOW I HAVE EQUATED IT. AND IT IS TRUE. NOT TO SAY THAT PARAMEDICS, THEY HAVE BEEN INCREDIBLE AND DOCTORS AND PEOPLE THAT ARE IN HOUSEKEEPING, EVERYBODY. BUT NURSES ARE IN THE FRONT LINE ALL OF THE TIME, RIGHT. THEY ARE OUR HEROES OF THIS BATTLE ON SARS.

Mary says I HAVE TO STOP YOU THERE. WE ARE ALL OUT OF TIME. ENDING ON A HIGH NOTE. THANKS FOR COMING IN. THE EXECUTIVE DIRECTOR OF THE REGISTERED NURSES ASSOCIATION OF ONTARIO. DIANE IS WITH THE VICTORIA ORDER OF NURSES. FOR MORE INFORMATION, YOU CAN VISIT OUR WEB SITE...

A slate reads "For more information on nursing, www.tvo.org."

Mary says Often IN MEDICINE, SCIENTISTS STUMBLE UPON ONE DISCOVERY WHILE LOOKING FOR ANOTHER. IT HAPPENED WITH RESEARCHERS LOOKING AT A SUSPECTED LINK BETWEEN TYPE 1 DIABETES AND MULTIPLE SCLEROSIS. WHAT THEY FOUND MAY HELP PEOPLE WITH A HIGHLY IRRITATING CONDITION KNOWN AS SYNDROME. TVO TOOK A CLOSER LOOK.

A clip plays on screen.

As a montage shows a reddened teary human eye blinking, a female voice says I DON'T KNOW IF YOU EVER GOT SOMETHING IN YOUR EYE AND YOU CAN'T GET IT OUT. JUST THINK IF YOU ALWAYS HAD THIS FEELING OF SAND ALL OF THE TIME AND OF COURSE, YOUR SKIN IS VERY DRY AM THE REALITY IS YOU CAN'T GO ANYWHERE AND UNLESS YOU ALWAYS HAVE WATER. I SORT OF DESCRIBE IT AS BEING LIKE A DRIED UP raisin.

The woman speaking appears on screen and sips form a mug. She's in her sixties, with curly blond hair.

She continues BECAUSE SOMETIMES THAT'S KIND OF THE FEELING THAT YOU HAVE.

As a clip shows the woman swimming in a pool, a female announcer says FOR PAULA, WATER IS HER SALVATION. IT SOOTHES HER EYES, RELIEVES HER PARCHED MOUTH, EASES ACHING MUSCLES AND STRENGTHENS WEAKENED LUNGS.

A caption appears on screen. It reads "Paula Abraham. Sjogrens sufferer."

Paula says ONE NIGHT, WE WENT TO BED AND I DEVELOPED SEVERE INFECTION, I HAVE NO WAY TO KNOW HOW IT HAPPENED. BUT THESE TWO GLANDS, MY SALIVARY GLANDS I LOOKED LIKE I HAD MUCHLS ACTUALLY. AND I HAD A TEMPERATURE OF 106 FOR 18 HOURS.

As a physician approaches Paula, he says HOW ARE YOU DOING??

The announcer says PAULA WAS 42 YEARS OLD WHEN SHE BEGAN TO DEVELOP MYSTERIOUS SYMPTOMS. NONE OF THEM SEEMED CONNECTED AT THE TIME. BUT SHE WOULD SOON LEARN OTHERWISE.

Paula says THE VERY FIRST CLUE HAD NOTHING TO DO WITH THE GLANDS. IT HAD TO DO WITH, PAINS IN MY KNEES. AND I THOUGHT, I WAS GETTING ARTHRITIS SKPPLT THAT'S REALLY WHAT LEAD ME TO THE DOCTOR.

The caption changes to "Doctor Arthur Bookman. Rheumatologist."

Arthur, in his fifties, clean-shaven, says OUR PATIENTS TELL US, WE HAVE SURVEYED THEM. THAT IT TAKES THEM AN AVERAGE OF THREE YEARS TO COME TO A DIAGNOSIS AND USUALLY HAVE TO SEE MORE THAN THREE PHYSICIANS.

The announcer says DOCTOR BOOKMAN RUNS A CLINIC AT TORONTO WESTERN HOSPITAL. HIS PATIENTS TELL HIM THAT GETTING AN ACCURATE DIAGNOSIS IS AUFERN THE HARDEST PART.

Arthur says THERE ARE SO MANY SPIFTS TRYING TO TREAT THE SAME PATIENT FROM THEIR OWN PERSPECTIVE THAT NOBODY PULLS IT ALL TOGETHER.

Paula says I RECOGNIZED THAT I WAS ALWAYS GETTING DRY. BUT I ACTUALLY DIDN'T REALLY THINK ANYTHING OF THAT. BECAUSE I ALWAYS ASSUMED THAT EVERYBODY FROM TIME TO TIME, YOU GET OLDER, WOULD HAVE TIMES WHEN YOU WOULD WAKE UP IN THE MORNING AND, YOU KNOW, YOUR EYES DIDN'T HAVE A LOT OF LIQUID AND YOU RUN YOUR EYES AND I HAD THAT A LOT. BUT I DIDN'T ACTUALLY ASSOCIATE MY MOUTH WITH MY EYES AT ALL.

Arthur says THE SYNDROME IS A DISEASE WHERE YOUR IMMUNE SYSTEM GOES HAY WIRE AND THE CAUSES AN INFLAMMATION OF THE GLANDS THAT MAKE TEARS AND SALIVA. THOSE GLANDS CAN SWELL AND THEY DRY UP, THEY STOP FUNCTIONING. AND THAT RESULTS IN CONSIDERABLE DAMAGE TO THE SURFACE OF YOUR EYES AND MOUTH. IT ALSO SPILLS OVER FROM THE GLANDS INTO YOUR BLOODSTREAM WHERE YOU, YOUR IMMUNE SYSTEM STARTS TO ATTACK OTHER PARTS OF YOUR BODY AND SOME OF THESE PATIENTS. FOR EXAMPLE, YOUR BLOOD VELSS, YOUR LUNGS AND YOUR KIDNEYS AND SOMETIMES YOUR BRAIN.

The announcer says DR. MICHAEL IS AN IMMON OL GIST AND THE SENIOR INVESTIGATOR ON A SCIENTIFIC TEAM THAT RECENTLY DISCOVERED A PROTEIN THAT IS CRITICAL IN THE DEVELOPMENT OF THE SYNDROME.

The caption changes to "Michael Dosch, M.D. Professor of Immunology."

Michael, in his late fifties, clean-shaven, with short gray hair, says OUR IMMUNE SYSTEM IS A FAIRLY COMPLEX APPARATUS. AND IT IS BASICALLY OUR ARMED FORCES. THE CELLS OF THE IMMUNE SYSTEM CAN GO TO ANY PLACE IN THE BODY, AND THEY ARE ABLE TO DEAL WITH INFECTION AM AND NOW FOR REASONS THAT WE STILL DO NOT FULLY UNDERSTAND IF YOU HAVE THE RIGHT SET OF GENES, THEN YOUR IMMUNE SYSTEM CAN, ONCE IN AWHILE TURN ON ITSELF. COMPREHENDED IT THEN CAN DEVELOP INTO AUTO IMMUNE DECEASE AND THEN YOU GET VERY SLOWLY PROGRESSIVE PROCESS AT THA EVENTUALLY DOES TISSUE DAMAGE, AND DIABETES THAT ELIMINATES THE INSULIN PRODUCING CELLS AND MS THAT DESTROYS CELLS IN THE BRAIN.

The announcer says FOR PAUL ATHE PRO GREG OF HER DISEASE WAS BEGINNING TO HAVE A PROFOUND EFFECT ON HER DAY-TO-DAY LIFE.

Paula says I HAD TO READ, I HAD TO WRITE AND IT WOULD GET SO BAD AND THE ITCHING MD BE SO WHO REND US, JUST A MINUTE AND I WOULD STOP AND PUT THE THINGS IN MY EYES.

Arthur says TEARS HAVE A BACTERIA KILLING QUALITY TO THEM. IF YOU DON'T MAINTAIN TEAR FLOW IN YOUR EYES, YOU DEVELOP INFECTIONS MORE FREQUENTLY AND ALSO, DAMAGE TO THE CORNEA THAT YOU SEE OUT OF.

Paula says I EVENTUALLY DEVELOPED AN INFECTION ON THE CORNEA OF MY EYE WHICH I DIDN'T KNOW UNTIL I KNEW I HAD A LOT OF PAIN.

Arthur says AND THE MOUTH, THE SAME THING APPLIES.

Paula says I GUESS, IT WAS A GRAD WAL DEVELOPMENT WHERE I WAS UNAWARE FOR AWHILE THAT THERE WAS ANYTHING NOT NORMAL ABOUT THAT UNTIL I REALIZED THAT I HAD TROUBLE TALKING AND I HAD TROUBLE SWALLOWING.

Arthur says AND HOW'S YOUR TONGUE? HAS IT BEEN SORE AT ALL?

Paula says NO, BUT I ALWAYS HAVE A FUNING US. SO I HAVE TO WATCH THAT.

Arthur says PEOPLE GET OVER GROWTH OF FUNING US IN THEIR MOUTH WHEN THE BACTERIA KILLING QUALITY OF THE SALIV A IS TAKEN AWAY.

Paula says I MEAN, I HAD FUNING US LIKE YOU WOULDN'T BELIEVE. IT WAS TERRIBLE.

Arthur says AND THEY GET INCREASED DECAY OF THEIR TEETH USUALLY WHERE THEIR TEETH MEET THE GUM LINE. I HAVE HAD SO MUCH WORK ON MY TEETH.

Paula says I HAVE HAD 11 ROOT CANALS AND I HAVE HAD ALL OF MY TEETH CAPPED AND THEN EVENTUALLY I HAD TO HAVE THEM ALL OUT.

A dentist speaking to Paula says SO I UNDERSTAND YOU ARE HAVING (S WITH THE DENTURES AND THE REASON FOR THAT IS THAT YOUR CONDITION HAS CAUSED A DECREASE IN THE SALIVA AND THE SALIVA FORMS THE SEAL FOR YOU TO HOLD THE DENTURES IN PLACE.

Arthur says AND THAT MEANS THAT YOU DON'T HAVE THE STABILITY THAT MANY PEOPLE WOULD HAVE THAT WOULD FORM THAT SALIVA SEAL AND HOLD THE DENTURES BY SUCTION. SO, AND THEY GET THE PROBLEMS WITH SORENESS OF THEIR TONGUE SDP AS I MECHKZED, SWELLING BECAUSE OF THE INFLAMED GLANDS.

Paula says YOU SEE, I COULD NEVER REALLY EAT UNLESS HI WATER. BECAUSE I CAN'T GET THE FOOD TO GO DOWN.

Arthur says IN PAULA, THE DISEASE HIS ALWAYS AFFECTED HER LUNGS WHERE SHE'S HAD INFLAMMATION AND SCARRING OF HER LUNGS AND SOMETIMES THAT'S BEEN ASSOCIATED WITH SO, PAIN WHEN SHE BREATHES. SHE'S ALSO HAD ARTHRITIS WITH THIS AND AT TIMES, THE ARTHRITIS HAS BEEN VERY ACTIVE, ALMOST LIKE RHEUMATOID ARTHRITIS AND AT TIME IT IS JUST MELTS AWAY AND DISAPPEARS. SO PAULA HAS HAD THE FULL GAMMET OF THE DISEASE. THE OTHER ISSUE WITH THE SYNDROME IN TERMS OF THEIR LONG-TERM OUTLOOK IS THAT, ABOUT 6 PERCENT OF THE THEM CAN DEVELOP A TYPE OF MALIGNANCY CALLED LYMPHOMA.

At home, Paula says WHAT TIME IS OUR APPOINTMENT?

An elderly man says I THINK AROUND O'CLOCK.

Arthur says OKAY. WE HAVE THE NUMBER OF TREATMENT OPTIONS, WE CAN TREAT OUR PATIENTS, WHAT WE CALL TOPICALLY. THAT MEANS YOU DEAL WITH THE PROBLEM RIGHT WHERE IT IS. SO IF THE EYES ARE DRY, WE CAN GIVE THEM ARTIFICIAL TEARS. IF THE EYES ARE REALLY SO SEVERE THAT THOSE DROPS AND OINTMENTS DON'T HELP ACCIDENT WE CAN MAKE CHANGES IN THE EYE GLASSES THAT STOP THE TEARS FROM EVAPORATING OR WE CAN ACTUALLY PLUG THE DUCTS AT THE LOWER EYELID OR EVEN THE UPPER EYELIDS THAT CAUSE DRAINAGE OF THE TEARS SO THE TEARS CAN'T DRAIN AWAY.

Addressing Paula, Arthur says THE EYES, ARE YOU HAVING SAND FEELING IN THEM?

Paula says ACTUALLY, THEY HAVE BEEN VERY GOOD EVER SINCE TEAR DUCTS WERE CAUTERIZED.

Arthur says SIDE SO JUST A COUPLE OF PIECES OF FILTER PAPER, JUST HANG DOWN FROM YOUR EYES TO SEE HOW WET THEY GET.

Paula says OKAY.

Arthur says JUST LOOK UP AND IN THE SKY THERE.

Paula says WHAT HAS HAPPENED AS A RESULT OF THAT, IS THAT, THE LITTLE BIT OF ELECTRICITY LIQUID THAT IS IN MY EYE SYSTEM SUFFICIENT DURING THE DAY. I HAVE TO SAY WHEN I GET UP IN THE MORNING, I CAN'T SEE. I MEAN, I HAVE TO GO PUT HOT WATER AND GET THE MOVEMENT GOING BECAUSE THEY ARE DRY AT NIGHT. THEY DRY TOTALLY.

Arthur says IN THE MOUTH, WE CAN, WE CAN USE VARIOUS COMPOUNDS TO KEEP THE MOUTH MOIST, AND SOMETIMES WE JUST STIMULATE SALIVA BY HAVING PEOPLE CHEW ON SOMETHING ALL DAY LIKE SUGAR FREE GUM. FINALLY, WE HAVE MEDICATION.

Michael says AND NOW THE DISEASE, BY ITSELF DOESN'T REALLY HAVE A THERAPY AT THIS POINT. THE THERAPY THAT IS USED IS SYMPTOM ATTIC. AND TO MAYBE HAVE A VAC EEN ABOUT THE PROGRESSION EAR THE SEVERITY IS REALLY AN EXCITING THING.

Paula says WHAT I WANT TO DO IS TO KNOW AND UNDERSTAND THE DISEASE, I AM NOT AFRAID OF ANYTHING THAT DOWN THE ROAD, BUT I LIKE TO BE PREPARED AND KNOW HOW TO DEAL WITH IT BECAUSE I'M A SURVIVOR.

Arthur says OUR PATIENTS WITH THE SYNDROME AND EVEN WITH DRY EYES AND DRY MOUTH WITHOUT THE AUTO IMMUNE DISEASE RATED THE SEVERITY OF THEIR DISEASE TO THE SAME DEGREE AS PATIENTS ON DIALYSIS, AND THE PATIENTS WITH MULTIPLE SCHRER OS IS. SO THEY CONSIDER THE IMPACT OF THERE DISEASE TO BE HUGE.

The Announcer says HELP FOR PEOPLE LIVING WITH THIS SYNDROME MAY NOT BE TOO FAR OFF. DR. DOSCH KP HIS TEAM ARE HOPING TO FIND A WAY TO TURN OFF THE PROCESS THAT TRIGGERS IT. THEIR AIM IS STOP OR EVEN REVERSE THE DAMAGE BY VACCINTING PEOPLE WHO SUFFER FROM IT.

Michael says IN MOST OF THESE ORGAN SELECTIVE AUTO IMMUNE DECEASES SUCH AS, THE DIABETES, MS AND OTHERS, THE DISEASE PROCESS SLOWLY SPREADS AND EVENTUALLY TARGETS MANY, MANY PROTEINS IN THE TARGET ORGAN. IT SEEMS THAT THIS IS MUCH LESS THE CASE. WHERE BY REMOVING ONE TARGET THE WHOLE DISEASE PROCESS COMES TO A HALT. THAT'S UNUSUAL. AND THAT GIVES US HOPE THAT WE MAY BE SUCCESSFUL WITH THE VACCINE BECAUSE WE CAN TARGET THAT SPECIFIC AUTO IMMUNITY AND SORT OF, SORT OF SURGICALLY MODIFY IT.

Paula says I HAVE ALWAYS HAD A POSITIVE ATTITUDE THAT I WOULD NOT LET THIS GET TO ME BECAUSE I HAD too much in life to do.

The clip ends.

Back in the studio, Mary says And that wraps up our show for today. Thank you for watching. And please join us each weekday, Monday to Friday, for More to Life at 1 o'clock.

Watch: Nursing