The departing CIUSSS Director of Nursing reflects on her career, her profession, and the future of health care
360: How did you come to the nursing profession, and what are your qualities that carried you through your career?
I came to nursing because I wanted to help people. My whole career has been driven by wanting to make a difference in peoples’ lives.
I’ve done 12 years of nursing at the bedside, 12 years as a Head Nurse and 12 years in a more senior role.
The most rewarding is when I was intervening with patients and families directly because you get immediate feedback. Nursing is a privileged profession. It’s a mix of knowledge and competence, but it’s also how you accompany people, patients and their family, through difficult times.
I’ve done a lot in chronic care, including 12 years in dialysis accompanying people over a long period of time. It’s a sector where I developed my nursing, helping people cope with a disease that is ongoing and ongoing and ongoing.
How, in instances like that, when patients are faced with a lifelong, possibly progressive disease, how as a nurse can you help them to cope, to come to terms with their condition, to help them manage their life?
We all have strength. You help people to seek within themselves the strength that they have to move on.
I bumped into the son of a dialysis patient recently. It was such a coincidence, I left 18 years ago and yet apparently she had died just three weeks previously. He and I reminisced, he had had a brain aneurysm when he was 12 and was in a coma. I recalled discussing with our team how would we have approached the mother if he had not survived, about getting the organs of the son. He removed his baseball cap to show me the scars.
You see, it’s a privilege to follow families over time. I remember also when I was in dialysis we would go to the funerals of patients, you accompany them till the end, and then beyond, because you know there’s a family behind.
You’re helping patients and families to discover the strength that they have within, but it can’t be an easy profession if you’re attending people’s funerals, if you are confronted daily with people who are suffering long term. It’s not as though they go through an intervention and are healed and go on to live a long healthy life. What strengths have you needed, as a nurse, as a human, to withstand this relentless exposure to distress?
When we have the most difficulty it’s when we find a similarity, whether it’s because of age, or a mother with children. You need that distance, you need to empathize instead of sympathizing too much because then you wouldn’t be able to help. With a patient who is our age or young cases, it affects you more personally and profoundly, but you need to be able to keep the distance to be able to help.
As a manager, we would debrief, and arrange for professional counselling to help our teams let go all of the emotions around it.
You have a background in endurance athletics. What related traits have helped carry you through all these years?
What has helped me in the role of manager, I’ve always been competitive in life. As a kid in skiing, to be in great shape for the ski season, I started to run competitively. With me, everything is about competition, being the best, being the first. I am pushing the teams, nothing is good enough.
All of the sports training, there’s a strong parallel with my professional life. It’s all about perseverance, working hard, putting an objective and working toward it. You may fail sometimes but you pick up yourself and you go again, it’s about training harder.
I never wanted to be a manager. When I did my Masters I wanted to be in education. But I believe there’s a destiny, there is a bigger strength that guided me on this path. One door closed in my face but others opened and I was pushed through. I never wanted to be a Head Nurse or Director of Nursing, but reflecting back, it was the right path to follow.
Well there are elements of education, of teaching, of guiding, that are still very much a part of your work…
But I’m not a patient person in life. Teaching takes a lot of patience. I’m very much an achiever, a deliverer, an organizer, a systems person. I had no ambition in life other than to make a difference in people lives and enjoy doing what I do. That is what has driven my career.
When I came here in 1982, I didn’t even know there was a Director of Nursing in the organization. I knew there was a Head Nurse, but more than that I didn’t know, I didn’t aspire to anything.
When Lynne [McVey, JGH Director of Nursing, 2008-2013] left, and Dr. [Hartley] Stern [JGH Executive Director, 2008-2012] approached me, I said I didn’t want to do this job. But then you mature, you think about the alternative. Who’s coming? Do I want to have someone else’s vision imposed on me, or do I want to lead the vision? That’s when I decided to take it on. My destiny was here.
When I was skiing competitively in Mont St. Agathe at 10 years old, do you know who had a country house in Mont St. Agathe? Sir Mortimer B. Davis [visionary philanthropist to whom JGH was dedicated].
When I first started running at 12 years old, the first place I trained was l’Université de Montréal on the corner of Park and Mount Royal. What’s the name of that building? The Sir Mortimer B. Davis Young Men’s Hebrew Association.
He was following you!
I was following him, actually it’s quite spooky! And then I ended up here. Who as a manager has her whole career in one place? There were opportunities to go elsewhere, sometimes I didn’t take it, sometimes the door slammed in my face, but I think I was meant to have my career here, to be leading this organization. I started reading about Davis when preparing for my interview for Director of Nursing in 2012, and I said, Hunh? I am following him!
On those occasions when you opted not to go elsewhere, what kept you here?
There’s a sense of belonging here, really. Thirty-six years here I spent, in cycles of six years, as Director of Nursing, as Associate Director of Nursing in Critical Care, as Head Nurse in the ICU and Dialysis, and twelve years at the bedside. What’s kept me here are the people. I’ve made such great encounters with personnel, with families, my roots are very deeply here.
I would go back to my former job at any time. We’re responsible for quality but not the resources. You need to influence the change.
For young nurses entering the profession, they’re entering a network. What is within our capacity to change, how can we direct ourselves?
We should ask the staff at the bedside, what would they want? I can come with all my ideas, but I’d like to know from the base.
It’s still a beautiful profession, I would do it all over again. Nursing is really a privilege, there are so many opportunities with nursing, there have always been. There’s nursing at the beside, frontline, hospital, rehab, healthy, sick, dying people, do research, teach, in managing, you can do it all, it opens a lot of doors.
I never imagined I wouldn’t nurse at the bedside for my whole career. You don’t even know these opportunities exist when you begin.
I’ve heard from nurses at the JGH that those opportunities are offered, there is a culture to help to promote talent.
We do talent management. You identify and bring on the best talent. That’s how I became who I am. Someone identified Johanne as having great potential, they gave me opportunities to grow and develop.
I’m the sum of all the previous leaders that made me who I am. A true leader generates more true leaders and not followers.
We have a very strong Department of Nursing, with strength at all levels. We identify the strong and give them opportunities to grow. Even though there are those that are leaving, there is a wealth of talent.
In succession planning, you don’t train just one, you train a lot of people with a lot of talents.
You come and you do the job differently, with your own lens. Johanne will do it with her colour. If I can shape it differently, then I’m interested.
Emerging talents, how are they different, what are their expectations, are they more aware of options, more savvy, do they take a longer view?
The younger generation is better balanced in their personal and work life.
We have quite a lot of eager nurses on the Comité de la relève infirmière (CRI). They’re so dynamic, and engaged in so many activities. They are great advocates of nursing, of nursing in the future.
I wish that our future Health Minister would be a nurse, I think that we would have a different health system if we had a nurse at the helm of the Ministry.
I’m looking for less stress, not more!
Tell us then what you see in your future?
To spend time at our country house, doing outdoor activities. For now, I want to take the time to take the time. Give me some time, I’m not sure what I want to do, if I do contract work, I’d like to do something different, but the stress will be gone, it’s on your own terms, you deliver and step away.
It’s been quite heavy the last few years. Innovation, it’s one of the defining values of this organization, you can’t do the same as everyone else. Even in a family, you have different strengths, different ways of seeing things.
Do not follow the lead. If you believe you have the best approach, pursue it!
Who have been you mentors over the course of your career, in or out of the nursing profession? Who inspired or guided you?
Most were within nursing, there’s Mona Kravitz [JGH Nursing Director, 1996-2006], may G-d keep her soul, Marie-Hélène [Carbonneau, interim Director of Nursing] was my mentor and my boss way back when. In Dialysis, Jan Barrow and Linda Edgar, these are people who encouraged me to return to school get my Masters and look at other opportunities.
Would you urge other nurses to pursue higher education?
Our patient population is getting so much sicker, we need higher-level-educated nurses at the bedside to be able to provide the care.
During your Masters studies, you go through the process to think, to organize. I really believe education makes a difference, I’m very happy I went back.
I had said I’d never get a Masters, and I got one. Then I said I’d never do it with a thesis, and I did a thesis. I will never say never, because life has a way to make you lie so I said, most likely I don’t think I will. But you never know, life has a way of making it happen if it’s meant to be.
Tell us about the move to Pavilion K [Critical Care Facility at the JGH inaugurated in 2015]?
I toured recently with colleagues from the CISSS de la Montérégie because they’re planning a new hospital. To be able to plan, execute, move, and see the benefit, to see the whole cycle… you are privileged as a team to be able to move your patient population to a new environment. It’s so nice, though it is a challenge for the teams, the size, it’s so big, they’ve doubled their footsteps.
Remember the old ICU, it was horrible for infection prevention but for teamwork…. A private room is perfect for patients but for staff….
When they worked the transition, they worked it in, they knew it would be difficult.
On a appris de grandes leçons, it was well planned, well executed, the layout was wonderful. We’re a great team, we’re the best! I like to be the best, I like to be the first, I like to be the fastest!
Tell us about your fondest memories, your greatest achievements…
To be a nurse at the bedside is to make a difference in people’s lives.
As a leader, the greatest achievement was to protect the care model that is different from the one offered by the rest of the province.
We participated in a study comparing four different nursing care models in the province. Ours was the Innovative Professional Model. It produced 52 per cent less adverse events with consequence than the other models. There’s been a lot of pressure to change the model, attacks on the model, but we fought strong, with evidence-based data, with financial data. That is how I was able to preserve the model. That’s what I’m the proudest of, we’re here for what it best for patients, we are at the bedside, we know.
I strongly believe that in an acute-care hospital, a tertiary-quaternary institution, you need nurses. The eyes of a nurse on a patient. The nurse enters the room to take the blood pressure, but she’ll also ask questions about discharge planning, evaluate something else at the same time. They’ve identified that nurses do four or five things at once when they go in the patient room, they’re not simply carrying out tasks. The nurse will see if you’re decompensating, they will intervene.
You get the best value, that is, the ratio of outcomes over costs, with this model.
I am now able to leave with my head held high. I protected what I needed to preserve, what my predecessors valued, what they taught me to promote. I am extremely proud of that, the last six years have been all about protecting what is best for patients.