An RN of more than 20 years, Dr. Leigh Chapman knows how powerful nurses’ work and leadership truly are. Now Canada’s Chief Nursing Officer, Dr. Chapman has long been a strong advocate for harm reduction and social justice. During the early years of COVID-19, she headed a new nursing program to support people experiencing homelessness with Inner City Health Associates in Toronto. In her role as CNO, Dr. Chapman hasn’t shied away from tackling pressing issues for nurses – integrating internationally educated nurses and nursing retention have topped that list.
In less than two years since her position was announced, Dr. Chapman led the release of the Nursing Retention Toolkit: Improving the Working Lives of Nurses in Canada. A practical resource created by and for nurses, the initiatives in the toolkit aim to tangibly improve the working lives of nurses in Canada. Dr. Chapman engaged deeply with nurses during the co-development process, from hosting discussions with nurses in community forums to traveling the country for direct insight into retention initiatives that could be spread and scaled.
The collaborative approach to the toolkit’s creation started with striking an advisory committee of key nursing leaders, including CFNU President Linda Silas, RNUNL President Yvette Coffey, SUN President Tracy Zambory, BCNU President Aman Grewal and CNSA President Eyasu Yakob. Several sessions were held with members during the CFNU Biennial Convention in PEI ahead of the June 2023 Nursing Retention Forum.
The CFNU caught up with Dr. Chapman to discuss this groundbreaking toolkit and what it means for nurses.
The following interview has been edited and condensed for length and clarity.
How did your work with Inner City Health Associates inform your approach to the Nursing Retention Toolkit?
Dr. Chapman: My biggest takeaway from that work with Inner City Health Associates comes from when we needed to engage nurses in developing a model of care and setting up a program under the duress of the first wave of the pandemic. And the success of that I attribute to a collaborative co-development process.
If the patient populations changed, or if the staff needs changed, we pivoted. It was a very low-barrier model. Certainly, low barrier for clients, but also low barrier for staff. We had regular town halls, open forums, and I was very closely connected to those working at the point of care.
That experience helped in the development of the nursing retention toolkit. I knew this couldn’t be a Government of Canada initiative that we sent out across the country. That wouldn’t work, it would just land flat. The toolkit needed to reflect what I was hearing from nurses and have nurses directly involved in the development. I’m really proud that we were able to engage nurses in co-developing it.
One of the guiding principles of the toolkit is being “organization-focused”. Why is this an important approach?
This is about structural change that’s needed in terms of how we are valuing the work of nurses. It’s not about nurses as individuals being more engaged in their own self care. That’s part and parcel of being a self-regulated professional; you have to look after yourself, put your oxygen mask on first.
The toolkit is about system-level change. It is aimed at changes needed at the organizational and structural level, not at the level of the individual nurse. We need these robust and rigorous, durable changes in how we are thinking about nursing work and how we are valuing nurses as professionals.
How do you expect to see the initiatives in the toolkit impact the lives of nurses working at 2 a.m.?
Know that I have been there, and I empathize. I have worked nights as well and have a very fond and fraught recollection of those nights at 2 a.m. where there’s great solidarity with everyone working over the midnight hour. I hope nurses who are seeing the toolkit feel validated, that they think the toolkit reflects what they’re seeing and experiencing every day. I hope they feel that this is a positive step that we as the Government of Canada in collaboration with nurses from across the country have created a resource that is really aimed at improving things.
Even though it may feel very bleak and desperate at 2 a.m. on a night shift, we are moving towards positive and lasting change in the profession and how we’re valuing nursing work. I hope the themes resonate. I hope that they know they have an ally in government. They have many allies in terms of all the nurses who are involved in this process, but they certainly have an ally in my role.
Thinking about your time as a community care nurse, what initiatives would you be the most excited to see implemented?
For me, it would be the initiative around administrative burden. There are a lot of things that nurses do in all settings that are administrative. System navigation, faxing forms, helping with medical case management for clients, and coordinating care… things that are more administrative, more navigational than clinical.
Shared governance is another one, in terms of having nurses involved in decision-making. That’s really key. Some organizations have it on lock and others have a lot of work to do in terms of how they’re involving nurses, engaging nurses in decision-making in a way that is meaningful and not tokenistic. The toolkit is a good impetus for that.
But I’m also thinking about models of care. There’s a lot we can learn from the rural and remote parts of Canada and in the north in terms of how we could expand the roles of nurses working in community settings to decrease the burden on acute care. The notion of model of care also goes with this idea of system redesign. We always have this strong acute care bias in health care, a lot of our funding goes to acute care. But people also don’t have access to primary care, which does create great strain on the acute care system. So really thinking about how we can upend the system. And nurses know this really well and need to be involved in the change that’s needed to better serve people in Canada.
How does inspired leadership translate into better working lives for nurses?
Nurses need to feel that their leaders have their backs. We heard this loud and clear at the forum. Ensuring we have people who are caring for us as workers, who are very attuned to our needs and attuned to how we can balance work and life – that builds a lot of confidence.
And ensuring we’re also fostering new leadership. Some folks want to remain at the bedside for their entire career, and that’s wonderful. We need that. But there’s all kinds of routes you can take in nursing. It’s such a broad and holistic profession. We need to ensure we’re really empowering nurses. Nurses often feel undervalued and devalued. So this is really about empowering nurses at all levels. All nurses are leaders. Leadership is not necessarily a role or title; it’s also how you show up every day.
Why is it important to have nurses involved in decision-making?
Nurses are the ones who are making these life and death decisions. If we divorce the point of care from management decision-making, we may be making decisions that are unsafe for the provider or for the patient.
It also creates a sense of pride and ownership. It’s part of building an organizational culture. Everybody needs to be engaged and have pride, not only in their profession but in their place of employment. But the only way to do that is by involving staff in decision-making.
How can safe staffing initiatives support nurses on the front lines?
It’s not possible for nurses to provide good, quality care when they’re caring for 10, 20, 30 people, residents or clients at a time.
We need to protect the therapeutic nurse-client relationship. That’s really what safe staffing frameworks are about. There’s sometimes a bit of an allergic reaction from organizational executives, when they say, “how on earth would we ever implement safe staffing ratios given the shortages, given that we’re filling vacancies, given how desperate the staffing situation is?”
But when ratios were introduced in California, it was in the context of a nursing shortage. And ultimately, if patients don’t get appropriate care, they boomerang back into the system at great cost in terms of morbidity and mortality, but also pressure on the system and on providers. So safe staffing initiatives really are a way of valuing and protecting that therapeutic nurse-client relationship, which has huge symbolic value for nurses who feel so devalued.
The initiatives in the toolkit provide approaches for nurses and employers to work together to implement strategies. What role can nurses play in bringing initiatives into their workplaces?
I would love nurses to really dig into the toolkit and use it for benchmarking. Use it as a scorecard to see how well their organization is faring. What are we doing well in this organization? What do we need to improve on? This can even be done at the unit level. This is where nurses can be involved and bring these initiatives forward. I would hope that also those in formal leadership positions are engaging their nursing staff in the toolkit implementation. But it’s not a static document. It really needs to come alive in the workplace. Nurses have a key role to play in ensuring it is taken up because that is really where we’ll derive meaning from it as it gets implemented to support nursing retention across Canada.
What is your vision of the future of nursing in Canada?
Despite the challenging times we’re currently facing in terms of the health workforce crisis, my vision is very optimistic and bright. I’m in a very privileged position given my pan-Canadian perspective. From my view, the future is actually quite promising and optimistic.
I know it’s very bleak and very difficult for nurses in some settings and contexts.
But every single day nurses are doing miraculous things. You know, we take some of these things for granted when people get appropriate wound care and don’t need to go on IV antibiotics, when people have access to primary care and things are caught early, when people deliver babies safely, or when they have a very peaceful death. All of these things happen every day, and they’re quite miraculous, and nurses are there, involved in their care.
In terms of my vision, I do hope nursing does become a profession of choice in Canada. We pride ourselves on our universal health care system. And nursing, as the largest group of regulated health professionals, has a key role to play in that. Health care is something we take for granted in Canada, almost like maple syrup. I hope nurses see themselves in the very fabric of what makes Canada such a great country. I’m not arrogant about the current challenges. I absolutely see them. But the future is definitely optimistic. It’s more positive than dire. And that gives me a lot of hope and confidence.
