Bridging Gaps in Healthcare: Empowering Nurses for a Safer Future (#018)
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[00:00:00] Hussam, what are your thoughts with this and what we need to do to retain nurses and also to create safe spaces? Absolutely. Yes. Uh, you know, like I'm talking earlier about the three hours that we have retained return and recruitment. I'm going to add the four hour which is respect. So when nurses feel respected, they will feel safe.
[00:00:21] They feel like they are included. Welcome to safe space made simple a practical podcast that guides clinical leaders and healthcare managers to create trust and support with their teams. I'm your host, Trace Hobson. Join me for weekly interviews, practical tools, and inspiring transformational stories of bringing people together in healthcare.
[00:00:43] Now let's dive in. Hi, everybody. Welcome to Safe Space Made Simple. In this episode today, we have two incredibly passionate individuals that work within healthcare, Natalie Steik Duchette and Hussam Adeen Ben Ahmed. Natalie is a [00:01:00] nurse activist that works here in Canada and Husam is a researcher. In this episode, we have a candid conversation about the state of nursing in Canadian healthcare and what it is that we need to do to create a safe space for nurses.
[00:01:15] I'm really excited about today's episode. So without further ado, let's get right into the show. Welcome, Natalie and Husam to the podcast, really appreciate you being here. I've been excited to talk with both of you, waiting for it to come on the calendar. Um, what would be great is if we started off with, if both of you could share a little bit about your work and what you're really passionate about right now in your work.
[00:01:38] And why don't we start with you, Natalie, and then we'll go to you, Husam. Sure. So I'm a registered nurse. I'm also an assistant professor at the University of Montreal, the Faculty of Nursing. Okay. And first and foremost, I am a nurse activist. Um, my passion is nurses. I think nursing as a profession is the [00:02:00] most incredible job there is out there.
[00:02:01] Um, but we're not allowed to do our job as we should be able to do. Uh, we are such a. an asset to, not just an asset, we are the beating heart of the healthcare system, uh, also the brains in a lot of ways. And, um, it's just, I feel a lot of the issues in healthcare are really related to not treating nurses as humans, but treating us more as, you know, furniture, basically moving us around and not understanding the humanity that we bring, the humans that we are.
[00:02:33] Um, and so that's really sort of my, my thing, I guess you could say both in terms of research, but also in terms of activism. Uh, I'm a member of the board of the Quebec Nurses Association, whose mission is to help nurses develop their own political voices and increase the space that nurses are taking up in the political arena, both on, in the media, but also, uh, in formal political assemblies as well.
[00:02:58] Amazing work, [00:03:00] Natalie. Thank you for that. Husam, what about you? Yes. So, uh, my name is Husam Ibn Ahmed. Uh, I'm a senior research associate and a part time professor at, uh, the Canadian Health Workforce Network University of Ottawa. Uh, so I've been working with Dr. Ivy Bourgeois for almost or more than two years, you know, like on nursing workforce issues.
[00:03:21] Uh, so my main, uh, You know, uh, passion is like nursing education, nursing workforce, and especially, uh, issues related to internationally educated, uh, nurses. because we have a lot here in Canada, but they are not, they don't work. Most of them, uh, and also any other issues related to work environments where nurses are working.
[00:03:45] And now we are working in one of the, I guess I make a project like, uh, uh, it's a developing a psychological and health, uh, safety toolkit with the mental health commission of Canada. So it will be like launched in March. I [00:04:00] think in just like a few weeks. About this, but how would we can create a safe work environment for health care workers?
[00:04:06] So those are my main topics. Uh, of, of interest. Yeah. We'll talk more about that toolkit when it comes out. I'm looking forward to that, the release of that as well. That's going to be great. And we'll, we'll include that in future episodes. One of the things that I thought was really interesting in hearing you talk on an interview, Natalie, is that.
[00:04:26] In your perspective, we don't have a health care crisis. We have a nursing crisis. And so I'm really curious about what both of you think about that statement. Natalie, you said it. So what do you think about it? Or what were you trying to express? And then Hussam, I'd love to hear your thoughts too. Why do we have a nursing crisis in this country today?
[00:04:45] So, for me, you know, a lot of the issues that we see in healthcare right now, from wait times to the so called shortage of nurses, um, a lot of it relates to nursing, nursing care, access to nursing care, um, and where [00:05:00] nurses actually do work. So, you know, we've, what, especially, sort of, um, How would I put this politely?
[00:05:08] What really bothers me, let's say it like that, is um, this constant complaining of a nursing shortage. Um, you know, if you look at papers, we've had a so called nursing shortage. Politicians, especially health ministers from provinces and federal governments, and not just in Canada, but around the world, have been talking about a nursing shortage, uh, since, uh, the pandemic.
[00:05:32] As the furthest I've been looking in actual government reports and organization reports is from 1948 and there never has been a year since then that has not had some sort of report talking about a nursing shortage. So, at some point, we have to stop talking about nursing shortage and start thinking about nurse retention and attracting nurses into the workforce as well.
[00:05:53] Um, part of the idea of the shortage and the way that a lot of politicians frame the problems we're seeing in healthcare right [00:06:00] now. Sort of. Um, it, I got to stop saying sort of it. The, the way politicians speak about the crisis in healthcare and the problems that we see in healthcare and social services tends to, um, shift the responsibility from the decision makers onto issues that are out of their control.
[00:06:18] They're, you know, I've heard so many politicians say, there's nothing we can do. There are no nurses. We can't have safe patient to nurse ratios because there are no nurses. But the reason we have. Unsafe nurse to patient ratios. Um, the reason we don't have enough nurses in the health care system is because we don't have safe nurse to patient ratio.
[00:06:39] So we have to start looking at in different ways and not looking as at the so called nursing shortage as the root of the problem, but everything that drives nurses out of the health care system as the root of the problem. And until we do, we're going to be, you know, trying to, um, You know, shovel water out of a sinking boat without [00:07:00] patching the hole.
[00:07:01] And so for me, it's a deeply political question that most politicians over the last, at least 30, 40 years have refused to address the root causes. They'll put bandaid solutions on that. They know won't work, but that will help them get reelected. And so nurses and the healthcare system as a whole are often at the mercy of Different politicians, different elections, we have very little long term vision for our healthcare system in this country.
[00:07:28] This is really interesting because I was just having a conversation with, uh, an executive director, uh, who's part of a healthcare system. And originally when she came to this country, she was coming from Europe and really struggled. To be able to transition her nursing credential into the country of Canada.
[00:07:47] Now we're talking about probably 30 years ago. And so I was really surprised by that because obviously I've talked with you, who Sam about this and your, your research really double clicks on this. And I [00:08:00] thought this has been going on for a very long time to your point, Natalie. So thank you for highlighting that.
[00:08:06] I wonder, you know, if you could speak to a little bit who's salmon, you know, we have a nursing crisis. And how does this relate to your work and some of the work that you've done recently with the research that you've been doing? Absolutely. Yeah, this is an excellent question. Uh, Trey, thank you. So like, you know, like We talk about nursing crisis because nurses are the backbone of health care system, and we can see, like, the largest group of health care workers are nurses.
[00:08:29] So imagine, like, if nurses are leaving the profession of the physician, who will treat patients? You know, so we have an amazing role. It's very, very important. So now when I did, like, the report with the Canadian Federation of Nurses Unions and the Canadian Health Workforce Network, I have just, I was reading the report that will, that will publish it, and Like for the case, like I can say like two decades and I'm seeing the same recommendations are just suggested like [00:09:00] several times and there is no actions.
[00:09:03] You know, like, just like, so this, I was wondering, like, why should I, like, repeat the same recommendations and that were published, like, 20 years ago, right? So this, like, led to this crisis and why, like, many nurses are feeling, are not feeling good. So I really, I really like something what, um, uh, Linda Silas, the president, the president of Canadian Federation for Nurses Union, she said, We don't need to throw money just to do service for nurses to check if they are feel good or not.
[00:09:30] We know they are not feeling good. Now we need to move to actions and to see how we can, uh, improve that. And one of the way that we found in the, in the report that internationally dedicated nurses here in Canada are unemployed. And you have just said like 30 years ago that nurse like she struggled with this line.
[00:09:51] Now it's the same thing. You know, I'm still internationally dedicated nurse. I'm doing a great job. I'm not going to talk about myself, but also if we [00:10:00] see what was published in the Canadian Journal of Nursing and Leadership by my colleague, my colleagues, uh, uh, Siobhan and Bukola Salami, that there are two big issues.
[00:10:12] A nursing special nursing with the occasional workforce. The first one that we have shortages off, uh, PhD prepared like we don't have enough students that are in PhD programs are nursing and also take a second part of the there is a lack of diversity in nursing education leadership. So this just we are wondering who will teach nurses in the future if you don't have this diversity and enough professors in in the workforce, this is like a big question that I'm asking, and that's why, like, all my works.
[00:10:43] Now I'm focusing on this area to see how we can bring it forward. International educated nurses who would like to join the nursing faculty workforce because, you know, most of works are focusing on nursing workforce, but not faculty workforce, you know, so that's what, like, [00:11:00] I think, should be more coordinated approach between universities and nursing boards to see how we can, you know, uh, Target this, a gap that we have in nursing faculty workforce.
[00:11:13] And, um, yeah, I think this is like what, uh, what, what brings me to this, to this, uh, to this, uh, topic and to see like how we can that nursing boards see not see like how, what are the innovative intervention that we can implement to bring this nurses, uh, who would like to join the nursing faculty workforce in a clinical or in, in academia is, you know, like, uh, this, this, uh, in this area to see how we can.
[00:11:39] Use or benefits from the international expertise of this nurses to teach our nursing students. So this and this, like, create a big workload for nurses who are already teaching like now. I just like today I talked with with a friend of mine. She said, like, I cannot work anymore because now I have a lot of work and I don't know what to [00:12:00] do, you know, so.
[00:12:02] Just imagine, like, bringing more intensive care to the nurses, of course, taking into consideration the safe and quality of services, you know, for patients, and see how we can release, I think, or reduce the nursing faculty workload. Hmm. Thank you for that. So I want to refer to your research because you're talking about the research that you've done.
[00:12:25] Um, and the paper is called sustaining nursing in Canada, a set of coordinated evidence based solutions targeted to support the nursing workforce now and into the future. And that was done. With the support of the Canadian Federation of Nurses Unions. And so I think about, and some of the stats in there were just staggering with 94 percent of nurses suffering from symptoms of burnout and 45 percent experiencing severe burnout according to the 2022 CFNU survey.
[00:12:53] So how can, as I look at this, I want to just talk a little bit more about the root cause because [00:13:00] it's, it's just, So confusing to me to think about this being a problem for the last 30 years with report after report after report. So as you're doing your work now for both of you, Natalie and Hussam, what are you seeing are some of the root causes of this phenomenon and you know, what do we need to do to really change it?
[00:13:24] Okay, if I go just like a jump in for sure, jump in. So I think the cause of the road causes is like we don't have enough funds on health care system. We can select fans that are for construction sectors, etc. But in the health care system, we have lack of funds. And one of the causes like the non willingness of.
[00:13:43] Political you know the leaders we need to have a political will and willingness to move forward if we don't have that i think we can not advance we can't like change things so the willingness a political willingness is the most important thing to move forward. [00:14:00] What do you think will fuel that willingness what are some of the ingredients in that recipe that will prompt a politician to become willing and inspired to do something.
[00:14:11] The coordination, there should be like a pan pan Canadian coordination, you know, efforts between jurisdictions and the different organizations. When we have like collaborative efforts, I think we can move forward. But if each jurisdictions work for its benefits, and we there is no coordination between them.
[00:14:29] This is a problem. Is a big barrier that we can, uh, see, uh, that stop, uh, like changing this, this situation. Yeah, I also liked what you were saying about the faculty members having more diversity as well, because I can't help but wonder if maybe part of the limitation in the thinking over the last 30, 40, 50 years has been because we don't have enough people at the table to provide different perspectives.
[00:14:52] So I would, I would add that as well. Absolutely. And we are serving a diverse population as well. Like now we see many people [00:15:00] coming from other countries. We have like people, we have like people, first lighted people. So I think we need to diversify the nursing faculty workforce because we have international students, so they can bring, and they can help this uh, population to fill up in the, in the academia, academia, right?
[00:15:19] Natalie, let's, what do you think about this? I want to hear what you have to say as well about this. Well, there's so many issues, uh, that were, that are sort of welded into this or, or we've woven through this, uh, this discussion. Um, for me, there are several things that pop up. Um, Usain said it beautifully, we need political willingness, which is often not present.
[00:15:45] present. Uh, there's a lot of inertia in politics. Politicians like easy cosmetic changes that will give them brownie points, as we say, rather than real, um, deep [00:16:00] transformational changes that will positively impact life of people living in this country. And so I think part of the One of the aspects is trying to separate, um, to a certain level politicians from the health care system.
[00:16:19] Um, in the sense that I think we need more watchdogs, provincial and federal watchdogs to protect the health care system and health care workers from. yet another politician who wants to just go and change everything in Quebec. We've had major devastating health care reforms, and this is not just an opinion.
[00:16:37] I'm throwing out there. We have data to demonstrate how horrendous the last health care reform impacted the health care system, how people. Especially going through the pandemic, uh, had a direct impact on the amount of people who died, who were harmed, both healthcare workers and patients by the pandemic.
[00:16:55] And so we cannot, politicians are experts in politics. [00:17:00] They're not necessarily experts in healthcare. And a lot of our politicians, I find confuse, um, confidence with competence. And so it's great to be confident, you know, and you know, I'm all for that, but for something as complex and. And in a lot of ways, fragile as the health care system, you need experts and you need a lot of those experts have to be nurses.
[00:17:23] We see so many decision tables with only physicians and physicians are great. We need them to speak on the issue as well, but it cannot be only them and it cannot be only managers. Um, and as we said, mentioned, we're the biggest chunk of health care workers. So any decision that is taken without the input of the biggest, chunk of healthcare professionals and the people who provide the most care within the healthcare system.
[00:17:50] It cannot be a good decision if you took that decision without our input. It cannot be, even if there's no malice or, or involved, if you don't have the right [00:18:00] people at the table, you will not be able to make the right decision. And so for me, that's an essential point. And there needs to be some kind of legislation or rules or something that, you know, ensures that, um, because we know you, you spoke trace at the beginning of the hierarchies in health care and health care loves the tire.
[00:18:19] The PhD, actually, I kept going into the hospital when I felt like I was time traveling back to the 1950s. We have these hierarchies in hospitals, especially, that are toxic, that serve absolutely no one, and that contribute to silence people, nurses, patients as well, LPNs, uh, personal service workers, everybody who's, the closer you are to the patient, the less you have a voice.
[00:18:41] Um, and so that, that is problematic because it takes information, knowledge, from the places where it should be, where people make decisions. So that's without a question, one of the central issues for me, we talk to experts, people, and [00:19:00] that's important, but you cannot do it without the people on the ground and that's what reform after reform, not just in Quebec, but in other provinces as well, we tend to centralize and we.
[00:19:10] We have less and less, there's less and less power and flexibility into the hands of those actually giving the care, you know, if, if, if you want a nurse to give care, you have to respect. her clinical judgment or his clinical judgment or their clinical judgment. Um, you know, these protocols, these hierarchies that force us into doing things that sometimes we don't feel is necessarily the best way.
[00:19:32] That's not just bad for patients and bad for retention, but it's also, it's, it's kind of, it's soul crushing when everything that you've worked for, you know, the, the, everything that you've put behind becoming a nurse, getting your, Your education being there to help patients. Um, and then part of that is taken out of your hands and put into these structures that have no face that are bureaucratic, [00:20:00] that don't allow you to give care of the way, you know, you should be doing it.
[00:20:05] Yeah. Well said Natalie. Thank you for that. It's just, so what is the percentage. Of nurses for the workforce in Canada. You mentioned that they're the largest group. What is the percentage compared to others? Do either of you know that number? If I'm not, if I'm sure it's like around like 30%, right? I'm not sure.
[00:20:27] I think because you have health care workers and then health care professionals. So if in the health care professional category, I think it's much higher because for example, in Quebec, there's about 85, 000 registered nurses and about I think 25, 000 physicians, something like that. So the The, the difference is huge.
[00:20:46] Um, and if you talk about physiotherapists and, and, um, um, OT, uh, occupational therapists and social workers and, and all the other healthcare professionals, uh, they're much fewer. A lot of our [00:21:00] colleagues, especially in social work, uh, physiotherapy, they need a seat at the table as well. Um, our, our healthcare system is very hospital centric and very physician centric.
[00:21:10] And so that's, that's one of the issues that hospitals are much. Better place. Hospitals really aren't a place. For, um, how would I put this? I don't want to get in trouble. Um, hospitals, the best way to navigate a hospital is if you're healthy. You speak perfect French and English. Ideally, you're white.
[00:21:35] Ideally, you're male. Ideally, you're not sick at all. Um, because when you're hurting, when you have any kind of, but I mean, so let me get this straight. So if you're, if you're a white male with nothing wrong with you, then you're probably, you're going to be okay. You can navigate a hospital system, but if you're anything else, you're in trouble.
[00:21:59] Everything else [00:22:00] makes it much more difficult. So being in pain, having, you know, lower health literacy, uh, things like that. Hospitals are so complicated, have so many layers. You know, you know, it's in Quebec, for example, when I was working as a nurse in the hospital and You know, I, I did my time. A lot of us stayed like that, as if we were in jail at some point.
[00:22:19] You know, I did my time in the hospital, and I do not want to go back, because it is very constricting. It is, in Quebec, we have forced overtime, so sometimes it literally feels like a prison, because they don't allow you to leave, um, which is outrageous in 2024 that this is still happening. Um, you know, under threats, like, if you leave, you're going to lose your license, things like that.
[00:22:39] This is a common occurrence in this province. And so, you know, when I was working as a nurse, I didn't know when the physician would come. So, you know, you do your work, and then you're hoping that they'll come before the end of your shift, if the patient had questions and things like that. And so, there's As a nurse, we're trying to [00:23:00] coordinate all these healthcare professionals, but we don't have access to the schedules, to phone numbers, to, you know, it, it, we have so much to do and we have so little authority and power and, and access to technology, to technological objects to actually do that work.
[00:23:17] So that it's smooth. So we're, we're in a state of constant constant troubleshooting nurses for me, especially like assistant head nurses. I've seen nurses do everything from, you know, talk to contractors who were looking at a room that had, you know, where pipes had burst to, you know, organizing how to get sanitation to come because the, you know, Garbages were full, like there's nothing nurses don't do, and yet when you look at hospital records and anything like that, you will not see the record of any nursing work.
[00:23:51] All of that is, it's hard to explain, it's hard to calculate, but there's nursing notes. But aside from that, [00:24:00] there's very little, there's, there's almost no paper trail of what nurses actually do. And so I think a lot of politicians and a lot of managers don't understand that. And so when you have cutbacks and things like that, people don't understand the impact that it has on nursing work because they don't know what nurses actually do, because our hospital structure is made to obscure and make invisible the work that nurses do.
[00:24:23] Everything we do is lost. This is staggering for me to hear this. I, I work in healthcare as well. I've been fortunate enough to work with many nurse leaders, clinical experts, and um, with the frontline that I've, I've worked with as well. And, and I can't help but wonder, you know, how is it that this goes on and on and on, you know, and, and the other thought that comes to me as well is that there's no wonder why nurses are leaving healthcare like never before, because as generations are coming up, they're just saying.
[00:24:54] Yeah, no, I'm not going to do this. And so I'm curious, because I'm in your research. What are you noticing about the, [00:25:00] the, the, um, exit of nurses? And what are you seeing that we need to do to turn that around? Yeah. Um, you know, like in this report that what we have suggest, uh, like two, three hours, the approach of three hours, which is like, uh, retain, uh, nurses and then return the nurse who have left the, the, the, the public health and the profession as well, and then recruit, uh, recruitment.
[00:25:23] So this is the three hours approach, uh, you know, uh, Are very important because even when we recruit nurses, we need to know how to retain them. So, you know, like this iterative process. So, um, yeah, we have such suggest, like some solutions that we found them, like impactful according to the evidence, uh, where we can return back this nurses, uh, that they have left the profession, the, the, the profession.
[00:25:48] For example, in the, the settings and one I can select, the common solution that we suggest is to, um. In USA, they called like the gold standard, like a magnet [00:26:00] hospital. And we have suggested like to have more accredited Canadian accredited magnet program that has some, some different features to improve the work conditions of nurses.
[00:26:12] So they can come back again to the work. If we, uh, uh, improve their wages, improve the salary and improve the conditions and especially the environment where they're working. So, um, and this like may. I said, like, uh, just encourage nurses to come back to the profession because we are losing a lot of nurses.
[00:26:31] Uh, either they go to the private sector. We can see like in Quebec or in other provinces. And then the nurses who are already working in the, on the public sector, they are feeling more exhausted, more of a woman because the number of nurses is like reducing, you know, uh, I can select the day after day, but.
[00:26:51] Is it's really some. Big, big problem. And I have heard also like some students, they did not choose nursing programs because they [00:27:00] don't want to feel and to live the same thing that nurses now are living. You know, so that's why focusing on retention, returning nurses and recruiting and the process is very important to leverage this and to pay attention.
[00:27:16] No, I think this is the big role of the leaders, uh, and to see, like, what are the different policies that we can, uh, is maybe and also to put into for to improve nursing, uh, well being. So one of the things that I noticed about this too, is that there's this big push for recruitment and. You know, it's, it's the metaphor that goes through my mind is the idea that we're, we're inviting people to our house and, um, the house looks nice on the front, they come through the front door and it's actually on fire.
[00:27:48] And so now they've got to find their way out of the house because the front door is locked now. And so, you know, you hand them a water gun on the way in, so that just in case they hit any flames or be able to, you know, squirt a little water. [00:28:00] And then they run to the back, they find a way and they jump out.
[00:28:04] And so one of the things that you're talking about with wellbeing and the environment is, is an area that's really important, um, for my work, which is psychological health and safety and to look at how do we practically create a safe space on the floor and really. Chaotic circumstances, oftentimes, and then what happens when we do?
[00:28:25] And so I'd love to hear your thoughts on this. Natalie, what do you, how do we create a safe space? And how, how should nurses do that in the midst of this, this thing that's called health care that is on fire right now? Um, so that's a broad question, and it's multifaceted, and there's not just the one solution, right?
[00:28:45] I think that's one thing we have to take out of our minds. Our health care system, and even nursing as a profession, is obsessed with standardization and one size fits all. That is not a good way to move forward. One size fits all usually It's a prescriptive approach, right? And we got to stop [00:29:00] with that.
[00:29:00] We have a clinical judgment. We don't need a prescriptive approach. We need guidelines. Yes, but we need to have some flexibility and some freedom to adapt things to our own reality, whether because it's not the same if you're working in a hospital in Montreal or a dispensary in Nunavut or, you know, a primary care clinic in the prairies or anywhere else.
[00:29:16] You know, there are so many different places where nurses work that nurses work pretty much everywhere. I mean, from schools, workplaces, hospitals, clinics, um, so, so we have to, that's, that's a good thing. That's not something we should try to, you know, obscure with, you know, generalize. practices or excessive standardization.
[00:29:39] So that being said, creating safe spaces, nurse retention, is not rocket science. So USEM is doing extremely important work for our politicians that really translate it. Translates what we need into, uh, language that they can understand, but at the same time. You know, politicians understand what [00:30:00] retention is.
[00:30:01] Um, we've had our premier here justify an increase in our MP salaries, for example, a huge increase, 30 percent by saying, we want to attract the best people and we want to make sure they stay because it's not an easy job. That is what retention is all about. Recruiting the right people, making sure they stay.
[00:30:20] So he understands that. But when it comes to nursing, our politicians become, all of a sudden it's like, What could we possibly do? I have no idea. We're, you know, completely helpless in front of this unexpected crisis. And that, again, it is exhausting because nurses are not, we're not an alien species from another planet.
[00:30:46] We are human beings. And so what is good for one human usually works for nurses as well. So the main thing is ask nurses what they need, um, again, in different units, it might be different things, and ask them in a way where they don't feel [00:31:00] coerced. So in certain places with really strict hierarchies in the hospitals, for example, maybe it shouldn't be the immediate supervisor, or it could be done in an anonymous way.
[00:31:10] Uh, the whole error reporting from the airline industry, for example, is a good example of that. It's anonymized. We've taken, you know, error reporting in hospitals right now in Quebec, at least I'm not, I'm Not sure it's the same in other provinces. We've taken everything from the airline industry except the anonymous, I, anonymize, anonymous, making the content anonymous.
[00:31:30] And so, if you make a mistake, I have to write what my mistake is, and then I gave it to my boss, and then she looks at it, or he looks at it, or they look at it. And so, that's, uh, That's, that's usually not a good idea, right, that does not encourage reporting. It's not because nurses or managers are bad, it's just there's a conflict of interest there and to avoid the conflict of interest, it should go to a third party that's more neutral.
[00:31:53] So it should be the same with retention measures. So in some cases, you know, the pandemic, I think we're all very much [00:32:00] damaged from the pandemic. I went back to long term care during the first wave, it was the worst professional experience of my life. I still have nightmares about it. Um, and there was no support for us during, before, after, there still is nothing and, you know, I love, I know a lot of nurses who left because of that, they were just too injured morally to, to continue.
[00:32:20] Montreal was really the epicenter and the things that we saw were stuff nobody should ever see in their lifetime. And so, one of the One of their solutions to that to improve our well being, and this is what you should not do, was to put more work onto nurse. So instead of providing, for example, a social work, come on each shift for a couple hours to chat with the staff, to, you know, exchange, create a safe space, as you mentioned, social workers are great for that.
[00:32:52] Social workers are excellent therapists, and they're our colleagues, and they know what we've been through, and so that's. One of the good ways to do that. [00:33:00] But instead of providing somebody else, they decided they were going to train nurses on the ground to detect issues with their colleagues. And so now on top of going to work, on top of being morally injured, um, on top of being burnt out, Now, you're also, you have the responsibility of the well being of all your co workers, the mental well being of your co workers.
[00:33:21] So, again, the solutions are politicians, and often that high level managers propose are putting more responsibilities on to nurses, rather than allowing them to speak to somebody else, rather than bringing in help. It's Keeping again on to the amount of responsibility. So now we're responsible for the well being of patients, for, you know, respecting hospital policies, our code of ethics, for managing families, managing our co workers, managing the healthcare team, and now we're also responsible for the well being of, the mental well being of all our co workers.
[00:33:55] That is, That is not a good solution. Uh, that's not to say [00:34:00] if people do want to get training, that's fine. Go for it. Um, but overall, it's not about putting more on to us. We're already half broken. It's not completely broken. We need help. We need support and that support should not be, Oh, here's something else you should do that will help you, you know, do more yoga.
[00:34:20] Do you go jogging, uh, do a journal? Yeah, I think if I think we talk stress ball that I'm going to give you, yeah, here's a stress ball. And, and, you know, while you're at it, build some more resilience. No, that's not gonna. In fact, I think that most nurses I talked to, and even clinical leaders that are also nurses too, are fed up with that.
[00:34:41] And, and it's really at a breaking point for them in terms of their ability to maintain their composure, you know, because the fact is that Um, what you're saying is true. We're just downloading more and more work. It's just, it's really surprising to me that this is happening, I guess, because I know that I've been cared for in, uh, our [00:35:00] healthcare system by a nurse or nurses on several different occasions throughout my life.
[00:35:04] I've had nursing experiences that have really saved me in so many different ways. I, my daughters have also had those experiences. My granddaughter has had that experience. I just, where is the humanity in this for those that are making decisions like this to know that, hey, that I could be in that situation.
[00:35:23] Is it just that they have enough money they could buy their own health care or what is going on there? But just one thing about what you said, so you've had experiences with nurses within the health care system and what I think a lot of people need to understand is that our health care system is not a humanist health care system.
[00:35:40] It's not human. What makes it human are the nurses, right? And so nurses often protect patients from the health care system from the structures. And we have to start seeing it that way because we're losing nurses. And now we're seeing the consequences of that. So it. It's, we have to look at it as a, a very [00:36:00] sort of, it's, it's a complex problem.
[00:36:02] It's a social problem. And part of the reason it has to do with, for me, part of the issues are feminists. There's jobs that are historically conceived of as women. Both of you are nurses and you're men, but society sees nursing as a woman's job and a woman's job is not often not, and it's the same with teachers and many other professions and jobs that are, uh, mostly women.
[00:36:27] People see it as something that we owe society, right? So women caring is something that we owe society. So it's ridiculous to have to pay a woman for that or pay high wages or, you know, things like that. And so there's, there's a culture shift. I think that we need to, and especially within the healthcare system, we need to lead that because the healthcare system is.
[00:36:48] Behind even society as a whole, in terms of equity, in terms of, we've spoken about, you know, diversity and, uh, that our healthcare system is very racist, very colonialist, very sexist. And we see [00:37:00] that in the hierarchies that exist in the faces that we see of their healthcare system. And so there's, there's a lot to think about, but primarily we have to think about human beings and that's, we have to stop looking at people, patients, nurses, whoever, as.
[00:37:17] Excel spreadsheets that you can just move numbers from one column to the other, that is never going to work. And when we talk about maintaining the status quo, we're not even maintaining the status quo, because the status quo is so bad that it keeps degrading. And so, by doing more of the same, we're actually making it worse.
[00:37:37] So, you know, the, the crisis that we're seeing right now is highly preventable, is entirely man made, um, and, but it's also entirely fixable. So, because it's because of humans, right, the solutions are also fairly simple. Apply the [00:38:00] vast knowledge that exists in management science, in retention studies, to nursing.
[00:38:05] And that's what nurses want. That's why there's never been so many nursing strikes in the history of the world than in 2023, for example, because we're sick and tired. We just, so either we leave or we strike we're voting with our feet because no. There's no other way to be listened to. We try, we, you know, nurses, I've been part of committees that have written white papers, recommendations, simple solutions at very low cost, uh, for years and years and years and years.
[00:38:34] And managers, politicians have always looked at me like, oh, you're such a sweet nurse, how wonderful that you're interested in these things. Then a little tap on the back, and then, you know, you never hear from them again. So we need systemic transformation that you're talking about. And, and so Natalie's suggesting that we do something very novel.
[00:38:52] We actually ask nurses and then we listen to them. This is, this is a novel concept. I love it. It's so simple [00:39:00] and management science. It would tell you the same thing. Let's talk to the pointy end of the business and listen to what they're saying and then create systems that support them to do what they need to do.
[00:39:10] Hussam, what are your thoughts with this and what we need to do to retain nurses and also to create safe spaces? Absolutely. Yes. Um, you know, like I've talked earlier about the three hours that we have retained return and recruitment. I'm going to add the four R which is respect. So when nurses feel respected, they will feel safe.
[00:39:31] They feel like they are included and well, how, how we can do a respect nurses by, uh, dedicating the mental, mental health days, if they don't feel good, they can have one or two days, you know, to take, uh, just to energize themselves, we can like also look at the workload that they have. So this, I think, very, very important nurses to feel safe in the, in the work, uh, workplace.
[00:39:56] Uh, also they have more control on [00:40:00] their, uh, um, agenda. I can say, uh, the, the schedule. So yeah, the schedule, they have more control of the schedule so they can work because like, you know, because I come from Tunisia and nurses there, they work like seven hours, like for not from like one, since 7am until 1pm.
[00:40:18] And then there is another nurse will take, you know, the shift. So when I came here to Canada, I was like, wow, nurses are working 20 to 12 hours. Like I was, I didn't understand the concept of the beginning, you know, but this, even if we are human after all, right. So we can not Work all this hours without thinking because any nurse I think she has or he has, you know, like some other problems, family or whatever with the work.
[00:40:47] It's a lot. So giving nurses the time, respecting all these things is very important. So I think the first thing, like the fourth hour is very important. The respect of nurses, respecting as well the salary that they have [00:41:00] because I have her like, I know that. For, you know, professors or even from NASA nurses, the study is so low comparing to other health care workers and comparing even to other sectors.
[00:41:11] And even though they are doing a big job, look at the COVID 19 what nurses are strapping us, you know, in the front line and trying to protect people. So all this, I think, made it nurses feel safe. And heard when there is a decision. Just recently, they have appointed the chief nurse at the federal level, Dr Lee Chapman, which is like good.
[00:41:35] But this like was there is a bigger gap before that. I think the last one was 2006 something like that, if I'm not wrong. And now in 2022 23, they have a point again. So I think that we need to, uh, this is a good, good, good initiative. Uh, I think that we need to start To let this initial sustainable, not just like for for a few few years, but I think we need this to [00:42:00] implement nurses in the decision table, you know, to feel respected and to see how we can help nurses in the in the in the front line.
[00:42:09] So I think, like, just to sum up, the fourth hour respect is very important to feel safe within the workforce. Thank you for that, Sam. So one of the things and we'll shift gears now and talk a little bit about what we might, you know, do on the floor to close the gaps between the frontline and clinical leaders and managers so that we have a a more relational system or more relationship equity to be able to do the complex work that's going on there.
[00:42:39] Because right now there is big separation between those groups. The frontline is kind of on their own and often are talking about how they need more support and they're not getting it and they feel isolated and alone. There's lots of moral distress going on there. You've got clinical leaders that are, that were nurses at one time, but now are patient care coordinators or nurse educators or specialists.
[00:42:59] [00:43:00] Specialists and they're in the middle trying to bridge between the boardroom and the front line and feeling crushed, not really feeling like a bridge. And then you've got the managers that are trying to appease the executive team and do what they need to do and all of them are in the silos. And so to your point about respect, one of the things that I've designed is this safe space process where we answer three fundamental questions together, which is what do I need to feel safe?
[00:43:25] What do I need to be open and learn and what do I need to feel respected because if we can understand that because what I've need for respect might be different than what Natalie or Sam needs. So we need to understand that and we need to be able to have that perspective clear for us, but also to listen to other people so that something new can happen.
[00:43:45] And when we do that, we start to see these pockets of. I guess they're pockets of examples of what can happen when people feel safe inside that really complex, challenging system. So I'm curious, Natalie, in your experience, and also for [00:44:00] you as well, Hussam, do you have any experience with witnessing that kind of a safe space on the floor?
[00:44:07] And what kind of things happened when that was there?
[00:44:13] So for me, I'm working for free now. I'm a volunteer at a clinic because I love it so much. And so, and because I feel so safe there. It's one of the best places I've ever been. And I, you know, I wish I could give more hours, but it's a wonderful place to be. And that being said, I think all nurses should get paid.
[00:44:28] I'm paid as a professor. So I make, you know, I make good salary and I'm not, you know, nothing to complain about. But, um, yeah. Nurses, I mean, the four R's that Youssef mentioned are so important and so simple. Retain, return, recruit, respect. And I know we're always, nurses are so proper and we're always allergic to talk about money, but money is important.
[00:44:55] Your salary is a reflection of the value that society [00:45:00] places on your work. And nurses in this country are vastly underpaid. For the work that they do, but also the amount of responsibility that is on their shoulders. And so if, if there's one thing that the pandemic has taught us, and this is a quote from my colleague at the University of Water, where she says, she told me once, one of the things that the pandemic really showed is that nurses really are worth a hundred bucks an hour, you know, and I'm not saying we're all going to get a wage increase of a hundred dollars, although I think we do deserve it.
[00:45:29] Um, but. Why are governments willing to give billions of dollars to private agencies, um, and not invest that money into nursing? And so I think we're so used to asking for little things. I've been in so many committees with nurses who have told me, Oh, no, no, no, we can't have any proposals that cost money.
[00:45:48] We shouldn't talk about money. And I think we should ask for money. We deserve it. It is essential. And there's only so far we can go without money. And that goes through salaries, [00:46:00] through, you know, professional supports, where they're having social workers on the ground and things like that. Um, our government, there is money for healthcare.
[00:46:09] And if we don't ask it, we're never going to get our share. So that's one thing we need to feel empowered. We need to feel empowered that we deserve, um, we deserve things that cost money. Um, our governments are willing to give, throw money at all kinds of things. Um, and so we have to force them to make choices that.
[00:46:30] reflect the value that we bring to the health care system as well. So I think that's something we have to sort of unbrainwash ourselves or teach ourselves to stop doing. We are so allergic to asking for money to the point where we sometimes we don't even ask for something because we're too afraid the decision maker is going to say no, um, because it costs money or whatever, you know, movie we've started making in our heads about what the response will be.
[00:46:59] [00:47:00] Um, we are worthy. We are, we bring immense value to the healthcare system. Um, so part of it is our own vision of ourselves, knowing our worth. And that's, that's a big part of what I do as activism and encouraging nurses to speak up politically, even when they don't feel they have necessarily the words or the expertise, it's something you have to practice.
[00:47:19] It doesn't come just like that. You're not just born a perfect politician. It takes practice and through experience, you gain a lot of knowledge and especially a lot of confidence. Um, so. That's one thing. For respect, again, you know, we have to stop with the standardization, um, and look at processes instead of results.
[00:47:40] So, for example, one hospital here in Quebec, um, one of the big hospitals, one of the units, the units that had the most forced overtime and with bleeding nurses because of that, through a period of 18 months with committees and consulting, real, authentic consulting of the nurses on the [00:48:00] ground, they were able to eliminate that completely.
[00:48:02] And it didn't start with recruitment. It started with retaining the nurses that were there, asking them, What do you need to stay? We don't want to lose you. What can we do? And coming from a very humble place, not from a place of authority and coercion. And that was a great success for that hospital. But instead of looking at the end product, saying, Oh, we did this, this, this.
[00:48:25] And then applying that we look we have to look at the process that led to that. So it's not just about the final recommendation. That's how they got to that place. And that's what we need to start emulating because a lot of places are going to have maybe different recommendations at the end. But what's going to be really important is the process that they went through.
[00:48:44] and the collaboration, um, and the leadership that we've nurtured of nurses on the front lines, because leadership on the front line is all often disruptive. And instead of [00:49:00] supporting it, hospitals often try to squash it most of the time. Um, so disruptive leadership is what we need for transformational change, um, or else it's going to be more of the same kind of, you know, Management jargon, lean, six sigma, whatever, um, you know, and it's not going to lead to profound change is going to be more cosmetic change is going to be stuff that looks great on paper on stats, but that's going to have a terrible impact on the ground.
[00:49:27] So disruptive leadership is a good thing. It's not a bad thing. Um, and a lot of disrupted. I was, you know, I got in trouble so many times, but I'm very stubborn. So I refuse to let that get to me. And it took me a long time to get where I am, but I think it was through every now and then there was a nurse leader, you know, a nurse manager, very few and far between, there was a few who looked at me and instead of looking at me as troublemaker, looked at me like somebody who could help bring about good changes.[00:50:00]
[00:50:00] And so that made a huge difference because. It's normal to have nurses that are angry, that are sad, that are depressed. We can't force nurses to say, well, you can talk to me, but I don't want to hear your anger. I don't want to hear your distress. Uh, and we use words like, oh, you're not professional or you're not behaving or you're not proper, whatever.
[00:50:20] But when you've seen somebody die for reasons that could have been prevented, when you, when you, when you miss out on your child's birthday or their first steps or things like that. Of course, you're going to be angry, and we have to accept that there are emotions that we go through that make us do the things that we do, and that, and we have to respect and validate those emotions, even when it's anger, even when it's hard to hear sometimes, and our health care system does not usually like to do that, but that's one thing that I find in management, we really need to understand and be much more accepting of the emotions that we're going to feel.
[00:50:59] And for [00:51:00] me, the managers that are the most successful that I know, they have an open door policy, um, and anybody on their staff can come in and cry and vent and be angry. And that is a safe space. They don't feel like they're going to get fired, or they're going to get the worst shift, or they're going to get the worst patient assignment, because they express their anger.
[00:51:18] their feelings about something important that happened that affected their work and that affected their mental well being. Thanks for that Natalie. And Hussam, what about you? Have you witnessed any safe spaces in your area of influence? And if you did, what was that like? What, what happened? Yeah, absolutely.
[00:51:39] You know, like what I can say, according to my experience and what I have, when it's like, uh, that the safe space, the opposite is of safe space is like, and civility and civility within the workplace. So I think that to implement this safe space, I need to see what are the main cause of, of, of, uh, Of [00:52:00] offensively of this, which is instability and civility.
[00:52:03] We talk about the toxicity between colleagues, the toxicity between managers and nurses, et cetera. So this is a big like thing that I have. What is the end? Really? Let had a big impact on the on nurses and the workforce. Uh, and, um, one, the other point like we need to hear the nurses. What they, what they think about the program, for example, that we implement within the hospital, for example, we, we, we have the program of, uh, um, you know, mental health support and nurses don't go to this because they are feared to be stigmatized.
[00:52:42] So we feel that we offered nurses this program, but which is wrong. I mean, you need to see how nurses would like to suggest if they need to have this program or to have more private, uh, or individual meetings because they are feeling to feel stigmatized and many, they [00:53:00] don't want to do to reach this program.
[00:53:02] So the results that nurses will stay always, I mean, that, uh, if they don't go to this program, program, you know, for, uh, to improve their mental health. They will not do it because they are fear of of that. So we need to hear the solution that comes from nurses. What they suggest to improve, uh, and to implement a safe space.
[00:53:24] Like now with the, with the Mental Health Commission of Canada and the Canadian HealthForce Network, we are, you know, like developing a toolkit and which is nice in this toolkit that we have some different teams, uh, and then try to see how, if they are ready to implement these different resources and what are the challenges and how they can imple, uh, uh, implement this, uh, this, uh, these different resources of our toolkit.
[00:53:46] So I think. In this way, we can know how we can, uh, develop a safe space for for these people. It's not like as a leader, I can understand that. No, because this is their lived [00:54:00] experience. They can come with innovative solutions and we find the solutions to improve their, uh, safe, uh, the, the, the workplace.
[00:54:10] When is the toolkit going to be available through the mental health commission of Canada? Do you know? March, March, uh, 20, something in March. Once this talk, it is ready. So yeah, that's great. Probably we'll release then anyways. So, so just wanting to, to bring things to a close, but I have a question for both of you.
[00:54:34] I'm just thinking about the, the managers and leaders and clinical nurses that are listening right now. And what would be one. Tip that you could give to those managers, those leaders that would help them to sort of keep going and navigating inside this really complex problem right now. Um, what would be one thing, word of encouragement that you could give them?
[00:54:59] [00:55:00] If I jump in quick, I need to say that leaders need to value their health care workers and love them because I know that some nurses stay resilient and don't leave the profession because they have good leaders, even though they are feeling, uh, overwhelmed by work. But when the leader are not, they are not taking care of their nurses, nurses, they will leave, you know, their work.
[00:55:27] So I'm so glad that I heard you say the word love. So what, when, when you observe a leader, loving their nurses, what are some of the things that you see and hear? I can see like nurses are feeling well. And I feel like I feel like safe in their workplace. You know, that, for example, when they need to take some days, they will take it because the leaders take care of them.
[00:55:52] And if nurses need to, for example, to continue their education, they will be sure that they will have this opportunity because leaders love [00:56:00] them. And if they need to take a vacation because they don't feel good, so they know that they will say. How the okay from the leaders because they know the leaders love them.
[00:56:09] So this is like, oh, why love is and love is a big word. And it's like something very, very important to love each other. You know, thank you. So Natalie, same question for you. The one piece of advice. I mean, my main thing would be know your worth. And don't settle. Um, I think that's important. Um, and another thing would be the hierarchies in health care, the power that is put into them is often power that we give to those hierarchies.
[00:56:42] And so it's, it's, it's often I find nurses imagine consequences to possible disruptions they can cause and those consequences are vastly over imagined. We have very fertile imaginations and. Part of the [00:57:00] reasons the hierarchies remain so fossilized within the healthcare system is that there's very few challenges to them because they are so menacing.
[00:57:09] They're so scary to question and challenge, but once you do actually start questioning and challenge the existing hierarchies in healthcare, we're quick to realize that they're like, you know, uh, castle of cards. They just, they're, they're, they're made of dust, really. They're, they're only as strong as the power we allow them to have over us.
[00:57:32] And so that's part of educating ourselves to our worth and to understanding that these hierarchies serve no one. They are not good for patients. They're not good for healthcare professionals. They are good for nobody. And Questioning them, although it is scary when we start it and you know, it's important to find allies and things like that, but it's not.
[00:57:53] It's not as bad as you think it is. Believe me, I've been through it and I've gone [00:58:00] through it with a lot of colleagues and friends, um, including Hussam actually, that the joy of working together a few times, you know, it's not as bad as you think it's going to be. So go out there and disrupt some shit.
[00:58:16] That's great. All right. So. Just in closing, how can people get in touch with each of you if they'd like to know more about your work and support you and what you're doing email? Facebook? Um, yeah, for me, it's just like I write my name with Sam and Dean Ben Ahmed. Uh, H. O. U. S. S. E. M. Space e d d i n e space b e n a h m p d.
[00:58:44] So just like I have email, I have like a link it in Facebook, whatever. So they can, if they're interested in this, they can contact me so we can offer them, you know, like, uh, some ideas, Yeah, that's great. [00:59:00] Same for me. Google me or ask Hussam about my email. All right. Well, I'll put the, I'll put your LinkedIn profiles on the bottom of the show notes for everybody as well.
[00:59:10] Yeah. So thank you so much for your time and your passion. I really appreciate your work, Natalie and, and Hussam, what you're doing. Um, and please keep doing it. Sure. And you know, like Yeah, like I'm so pleased also that we're going to work, I'm going to work with Natalie in a great project, which is our like network that I'm developing this, like to bring, you know, nurses from different countries, including Canada.
[00:59:35] So I'm so happy that say a little bit more about that project. What is the project, please? Yeah, so this is like research network, a virtual research network that brings nurses, clinician, nursing, clinicians, students, professors, managers, and leaders within the same table to select how we can coordinate our efforts to improve the healthcare workers.
[00:59:56] So this is called the Collaborative Alliance of [01:00:00] Research and Education for Nursing Empowerment. Careful Net, the AVE acronym. And this is, uh, to improve practices within MIN region, the Middle East and North Africa in collaboration with Canada. So we would like to amazing together because I believe that we can learn from each other so countries can learn from each other.
[01:00:20] So that's why it's, um, the, the project, uh, the, the network will be launched at, uh, March 2nd. So it'll be like Facebook Live, uh, at two, uh, 2:00 PM. And then I'm going to celebrate, celebrate that with Natalie and the others here in Montreal in person. That's amazing. Amazing work. Yeah. So please give me those links so I can add those to the show notes as well.
[01:00:45] And again, thank you both for being here. Sure. Thank you so much for having us work. Yeah, you're welcome. Thank you so much for listening to the show, and if you have any comments or questions, please reach out to me on LinkedIn. I look forward to seeing you next time, either [01:01:00] online or in one of our programs.
[01:01:02] And until then, remember to be a safe space. Thank you again for getting to the end of this podcast. And if you enjoyed this and you found that there was value in it for you, my invitation is for you to subscribe for future episodes that come out weekly on Tuesdays. Thank you again. And I'm looking forward to being with you next time.
[01:01:23] Now remember to be a safe space.
