I graduated with my BScN in 1969. I often recall the wonderful fellowship I shared with classmates and the wisdom, expertise and compassion of our educators and mentors as we rotated through two years of intense clinical experiences — yes, two years — in all the clinical nursing areas of the day. We students found role models that endure to this day.

Evolutionary change is as natural in professional associations as it is in biology or ecology. Some changes are gradual and incremental, others more rapid and pervasive, but in both cases, foresight and effective action are key to achieving positive outcomes in the face of change. The events in nursing now unfolding in British Columbia, and to some extent in other parts of the country, will play out at the CNA board table. That we face a critical transition is not in question. How we face that transition is.

Although chronic illness remains a major cause of death in Canada, many serious diseases once considered life threatening are now being treated and managed. Nonetheless, chronic disease takes its toll on individuals and their families, and the typical trajectory of decline in health is stressful for all involved. I have been studying the quality of life of people with chronic illness for many years. We know much more about treatment and management than we did when I started this work, but I believe the standards and guidelines developed through evidence-based practice often get in the way of recognizing the uniqueness of individuals and their right to make choices about their care.

“So, how old are you?” It’s the question that no professional wants to hear. Yet this is what I’m asked whenever I begin working in a new clinical area. It is a fact that I graduated at a young age and pursued graduate studies soon afterward. But despite my youth, I feel very competent in my practice.

When someone enters a long-term care home in Ontario, a “total” assessment of the person’s needs is conducted within the first 72 hours. But are we covering everything? I work in elder care in LTC settings, rehab and palliative care, and it has been my experience that health-care providers rarely consider a resident’s sexuality and need for intimacy in the assessment process. I’m sure many of them believe that elderly individuals no longer have sexual desires and would deny that there is “any of that” going on in their LTC home. Of course, LTC home residents are not necessarily elderly; many are living with a brain injury or a debilitating illness, and it’s likely that they are sexually active.