March 11, 2024 • 38 mins
In this episode, we delve into the inspiring journey and insights of Dr. Leigh Chapman, Chief Nursing Officer for Canada. With a rich background, including a PhD from the University of Toronto and two decades of frontline and leadership roles, Leigh's dedication to advancing nursing in Canada is undeniable. Leigh shares her experiences working in both frontline clinical healthcare, as well as national policy development and leadership.
Through engaging with nurses from coast to coast, Leigh highlights both challenges and hopes within the profession. From the despair palpable during the COVID pandemic to the emergence of optimism and desire to transform the healthcare system, she reflects on the contributions of nurses and the criticality of hearing their voices in addressing challenges within the profession. Leigh emphasizes the importance of unity and collaboration, advocating for a shift away from divisive mentalities.
Listen as Dr. Chapman shares her vision for nursing as a united profession, driven by collective efforts towards positive changes in the workplace and enhanced patient care.
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Episode Transcript
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Music.
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Welcome to Central Line, Leadership in Healthcare, the show that shares stories,
experiences, and advice from notable and innovative leaders in healthcare.
Leading in healthcare is incredibly challenging, so if you are looking to learn
firsthand from nurses, physicians, administrators, and other healthcare professionals
in leadership and management roles, this is the podcast for you.
(00:31):
Hosted by Leah Wuchek, leadership development expert, executive coach,
healthcare professional, and president and co-founder of Tall Trees Leadership.
We talk with today's successful health care leaders on how they get to where
they are, lessons learned along the
way, and what it takes to thrive as a successful leader in health care.
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Let's get started with your host, Leah Wuchick.
Dr. Lee Chapman is committed to advancing the nursing profession in Canada to
ensure equitable access to quality care.
As Chief Nursing Officer for Canada, she provides strategic advice to Health
Canada, plays a convening role on key nursing issues, and represents the federal
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government at public forums.
Leigh is a registered nurse who received her PhD from the University of Toronto's
Lawrence S. Bloomberg Faculty of Nursing.
Over the past 20 years, she has gained a deep understanding of nursing by working
in both frontline and clinical leadership capacities.
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In addition to her role as Chief Nursing Officer for Canada,
Leigh continues to work at a community-based consumption and treatment site
in Toronto, where she provides harm reduction services and frontline care.
Music.
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Hello, Leigh. Welcome to Central Line Leadership in Healthcare.
Thank you so much for being here. I'm really excited to chat with you today.
Thanks so much for having me. I'm delighted to be here.
Wonderful. So to get us started, I would love to hear what is it like to be
Canada's Chief Nursing Officer?
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Well, that's a good question. It's pretty great, actually.
I'm very lucky that that I get to represent this wonderful profession in Canada at the federal level.
And, you know, since I was appointed into the role, the role had been vacant for over a decade.
When I came into the role, since I've been appointed into the role,
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I made a really concerted effort to visit every province and territory.
And I've just completed that cross Canada engagement as of last week,
I visited up to the Northwest Territories and even got to the Arctic Ocean.
So I can say that I've been visiting nurses really from coast to coast to coast,
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which is a great privilege.
That's amazing. And knowing how big our country is, it's quite an undertaking to visit all the areas.
And I'm curious, did you have a favorite? And that's a loaded question.
I can never, I could never pick a favorite.
I think, you know, having never been to the territories,
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it was wonderful to actually see, you know, how autonomous nursing practices
in the north and rural and remote areas and how,
you know, it's so inspiring to me to see what nurses are doing where there's
really, really finite health service resources and in rural and remote parts
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of Canada, as well as the North.
And I would say like my engagement hasn't been exhaustive. It's impossible to
visit everywhere with our massive geography in this country.
But just in terms of, you know, meeting with nurses across the country,
it's been so inspirational for me to see what nurses are doing.
Certainly, there's a lot of duress in the profession,
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but more than anything, there's a lot of hope and optimism that we can turn
things around in terms terms of how we're valuing nursing and the wonderful
things that nurses do every single day in Canada.
I think that's really well said. And I definitely hear the passion that you
have and the passion that you saw in other nurses and the hard work and the
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dedication and commitment that nurses across the country have.
I'm curious to know, how did you make your way into this role?
Oh, well, I think the role is really a culmination of a lot of experiences.
In one's career, it's funny.
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The process of career planning is really iterative, I think.
But looking back, I've been a registered nurse in Ontario for over 20 years.
Nursing was my second degree. So I was a mature student when I went into nursing
and went directly into critical care, but then also was doing a lot of policy work.
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I was working at the regulatory body as well as working clinically.
So that work at the regulatory body in Ontario gave me not only a broad provincial
perspective, but also a pan-Canadian perspective because of the close collaboration
with other regulators from across the country.
And I carried that work forward when I went to the Registered Nurses Association
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of Ontario, which is a professional association.
And that work was, you know, really cross-sectoral.
So I had these two provincial roles that gave me a real breadth of experience
very early in my career as a nurse and lots of sort of policy work.
Work so you know fast forward to
2022 when the position was
(06:04):
posted I applied I was you know
one of many applicants I think who applied for the position and
I think it was probably you know the the provincial work that I had done which
was really broadening in terms of my scope that that helped in in getting the
job I I always tell this story as well because it's it's kind of comical that
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I was teaching a health policy course at U of T at the time.
And one of the students did an analysis of the reinstatement of the role as
her, as the reinstatement of the federal chief nursing officer role as her policy brief assignment.
So that was really interesting. Of course, I couldn't divulge that I had applied
for the job as well, but I always wonder what that student Thanks for having
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a policy professor who then gets the job.
Absolutely. It sounds like it's a bit of a small world, right? In many ways.
For sure. It absolutely is.
So what I'm wondering is, did you always know you were going to be a leader?
(07:08):
Oh, I think that...
For me, I think I feel very strongly that leadership is not about title.
It really is about how you show up in the world.
And so I felt that even as a new grad in critical care, I was older than most
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new grads and went right into critical care.
And I felt that I had a bit of a different lens because of my previous degree
and life experience in terms of the relational aspects of care.
So that's such a key component in nursing practice is how we relate to others,
whether it's the patient or family, our colleagues, or even how we navigate
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the system, right? right?
How we negotiate things within an organization or beyond.
And so I felt that I had a bit of a different perspective just because I had
done different things before entering into the profession.
And I had also worked in healthcare as a unit clerk throughout my nursing education and prior.
And so that gave me a really good immersion, even though I wasn't working as a nurse.
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So I think I always aspired to be a leader and I still do in how I sort of show
up in the world and how I intend to engage with others.
And to me, that's really not about title. I mean, I'm in a formal leadership
position in terms of my role now, but leadership is more of,
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I think, you know, how you show up in my view.
I really appreciate that thought. And so on that note for you,
what is your focus around how you show up?
Well, I'm mindful that, you know, there's almost, there's over 400,000 nurses in Canada.
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So there's many nurses who don't know that I exist.
And, and that's totally fine, because they're very busy doing the everyday work of being a nurse.
And but I always try to, you know, when engaging with nurses,
I try to really focus on the fact that I am a nurse, and I understand nursing
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practice, I still work clinically,
I understand everything that they're experiencing.
And, and if I don't, if I haven't worked in a particular context or setting,
I really endeavor to understand and that I am really an ally.
So I think, although I may not have, you know, direct experience,
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I really try to better understand, you know, the breadth of nursing experiences.
And, and that That means that I have to listen more than I speak.
And that's sometimes very difficult to do when you're in a formal leadership
position, because people want to hear from you.
And so I always try to balance, you know, talking about what my role is,
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what I've been up to since I've been in the role, but also really being a recipient
of sort of nurses' angst and whatever they want to tell me, because I think
the listening part of the job is probably much more important than the speaking part.
So it's sort of what I, I guess what I bring to the role.
And I think to show up authentically, I have to ensure that,
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you know, I'm okay, that I'm, you know, not distracted by other things.
I try to be very focused on who I'm engaging with and for what purpose and,
you know, feel very fortunate ultimately to be representing nurses at this level.
What I hear in that is very much this focus on understanding and really creating
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the conditions so that you can understand.
You mentioned about listening and seeking information.
What I'm wondering is of the conversations that you've had with nurses,
what are some of the messages, the repeating messages or the themes that you're hearing from them?
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Well, I think, you know, when I was appointed into the role,
it was really kind of many overlapping crises.
The COVID, you know, several years into the COVID-19 pandemic with the health
workforce challenges that we're facing.
And I think overwhelmingly nurses felt devalued. And, you know,
while they were seeing, you know, you know, I'm thinking about the fall of 2022.
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So I was appointed into the role in August, but in that fall period,
they were seeing a lot of effort on recruitment of nurses, and the nurses who
were actually working in the system felt completely devalued.
And that no one was listening and no one really sort of had their ear and was
paying attention to the actual working conditions.
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And so that's really why I tried to focus on retention as a key initiative and
key deliverable early in my role and really tried to work with nurses from across
the country in co-developing essentially best practices around nursing retention,
Including this broad definition of retention to include the return of nurses
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who may have left the profession or left the public sector or sought early retirement
just because of what they're experiencing in the workforce.
So I would say, you know, that despair was very palpable very early on.
And I feel like it is shifting.
There is a lot of attention on the health workforce crisis at all levels of
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government. And I would say there's certainly a lot.
I mean, I get to have this bird's eye view from a pan-Canadian perspective.
And from my lens, it's very positive and optimistic.
There's a lot of work to do, but we're working very hard to make things better.
And so I'm constantly in awe and so inspired by what nurses are doing every
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single day and really try to reflect that back to nurses so that there is more
hope and optimism than despair and angst.
What do you think has been the shift or what has contributed to that shift from
the despair to hope and optimism?
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Well, I think it's been, you know, over three years of a global pandemic.
I think we're sort of shifting to a better understanding of how COVID,
how endemic COVID fits into our world.
And then there's also a real desire to transform the system.
So, you know, COVID really was a bit of an unveiling of how,
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you know, who gets health care, who doesn't have access to health care,
and those who don't have access to primary care in Canada and what impact that
has on our emergency departments and so on.
So access to care has really been something that I think has been really in
the spotlight as, you know, some jurisdictions have had to close emergency departments
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or curtail surgeries and so on.
And I think that, you know, collectively for everyone sort of working in health
care or health services, health and social services, there's a real desire to change the system.
And, you know, I would say federally, we had a record investment last year in
health care of over $200 billion.
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So there's also money on the table for that system transformation to occur,
which is, I think, also really positive and optimistic.
Mystic it sounds like this has
been really a transformational couple
of years post-covid or i should
say on the tail end of our covid pandemic and and it sounds like the solution
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or the change needs to come from a lot of different angles or lenses i would
agree with that sentiment.
So you mentioned retention, and obviously that is a hot topic,
understandably so, for all of the reasons that you've mentioned before about
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the health healthcare worker crisis.
So I'm curious, what needs to be done there? How do we start to address this?
Well, I think a really good place to start is in the nursing retention toolkit
that I mentioned mentioned that has been co-developed by nurses from across the country.
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And I think it is really a playbook. It is sort of a one-stop shop.
And, you know, many nurses, nurses are very enthusiastic about it.
So we initially held an advisory committee meeting to help inform on,
you know, how we would develop this nursing retention forum.
And that advisory group first met last February, and then we held a nursing
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retention forum in June with nurses from every province and territory,
and really sort of co-developed the toolkit focused around these eight themes
that we think collectively will help improve the working lives of nurses in
Canada and ultimately optimize the work environment.
We held a number of validation sessions in the spring and fall to make sure
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we sort of heard what nurses were saying, heard what forum participants had
said to make sure we got it right, essentially.
And then we released the executive summary of the toolkit in October,
which is on the Canada.ca website.
And we released it just in time for the Federal, Provincial,
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and Territorial Health Ministers Conference, which is annual.
And during that conference, or during that meeting, the ministers all agreed
to support the dissemination and implementation of the toolkit.
What I've been hearing from nurses around the country is that it really does
reflect what nurses have been saying in the profession for some time.
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And I think there's great value in having this all compiled in one document
with lots of references and examples of where these things are already being implemented in Canada.
And these are ideas that can be scaled and spread, you know,
promising practices that other jurisdictions or other organizations can absolutely
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sort of emulate in their respective jurisdiction or context.
So I think that there are a lot of solutions in the retention toolkit,
but it's up to us to ensure they get implemented.
I really appreciate the level of engagement that it sounds like went into the
creation and development of this toolkit,
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particularly hearing from nurses across Canada and really seeking inputs on a deep level for this.
Can you give an example of one place that has implemented one of these strategies
really successfully? fully?
I mean, I would say one example that we highlight in the toolkit under flexible
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and balanced ways of working, this is the sort of the theme of flexible and
balanced ways of working, is in Manitoba.
So through the health authority, which is shared health, they have developed
a provincial float pool.
So nurses can work at Winnipeg Health Sciences and in a high acuity tertiary care facility.
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But they can also go work two hours or so outside of Winnipeg in a smaller community hospital.
They have their travel and accommodation paid, but they're still working within the public system.
They're not part of a travel or agency nursing operation.
They're still within the public sector. And this is something that's been really
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popular and other jurisdictions are copying it.
And I would say maybe another example, if I may, is under safe staff practices.
We saw in BC, I think, an historic announcement with the introduction of nurse-patient
ratios for the first time in Canada.
And that was a negotiation really between the BC Nurses Union and the BC government.
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And so that's just being implemented now, but a similar approach has been negotiated
with the Nova Scotia Nurses Union in their recent round of bargaining.
And this is something that nurses are really jazzed about and really sort of
paying attention to across the country.
Thank you for sharing those two examples, because I think both are really cool
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and really inspiring about how we can do things differently.
The example you gave of Manitoba, that level of flexibility,
I think back to my frontline nursing days, and that was unheard of.
And how exciting to have options available for nurses to be able to work in
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different hospitals and still be within that public system,
as you said, not part of a travel nurse group or whatnot.
So it sounds like the level of
creativity required for retention is pretty high. Yeah, I think it is now.
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I think COVID really forced this reimagination of how we balance work and life.
And that's super challenging to do when we think of healthcare as 24-7.
But I think the creativity lies
in really amplifying nurses' voices and echoing what nurses have to say.
So involving nurses in decision-making at the organizational level or at the
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provincial or territorial level is essential to ensure that nurses are part
of the solutions because that's where that creativity comes from.
As the largest group of regulated health professionals in Canada,
if we get nursing right, we fix the system.
You know, your comment about elevating nurses' voices, that has come up with
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many of my guests, previous guests on the podcast.
And the question I always ask of them is, how do we do that?
So I'm curious to hear your perspective on how do we elevate nurses' voices
so that they are involved in all of those levels of decision making?
Taking? I mean, I think that is, I'm very intentional when I'm doing engagement
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visits, for example, that, you know, I don't, I go to places and want to meet
with nurses who can't jump on a Zoom.
So that means that I want to meet with frontline nurses. And often meeting with
frontline nurses means you have to go to the clinics where they're working,
you have to have the hallway conversations, you have to go to the units.
Sometimes you can get nurses to be relieved, to be able to go to a boardroom
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and have a bit of a round table discussion, but often it's really those unit-based
at the point of care discussions that are really valuable.
I can meet with those in formal leadership positions, administrators,
and so on by Teams or Zoom.
I can't often meet with frontline nurses. So that is critical when I'm out there
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engaging with with nurses. And I think.
That's perhaps a different approach than others would just want to hear from the leadership.
And I think when we developed the format for the nursing retention,
we were very intentional in how we structured that.
We had two provincial or territorial nominees from employers or health authorities,
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but then those two nominees for every province and territory had to bring two frontline nurses.
So we had this dyadic structure.
And I think, you know, being intentional about, you know, who we're representing,
who is at the most proximal to the point of care.
And those are the voices that we need to hear from and we need to amplify and
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ensure that they are reflected in decision making.
So that's why I always tell nurses that I am, I'm there for them.
And so I need to hear from them. I need to hear their perspective.
I need to hear what they think I need to know to ensure that it's reflected
in policy and decision-making.
And, you know, there's many diverse perspectives, but I think overall,
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you know, there's, there's consensus sort of in terms of what nurses want and need.
And a lot of that is, is in not just the, the toolkit itself,
but in the, in the format and how we went around setting up the forum,
the nursing retention forum. And that's really, I think, how you amplify nurses' voices.
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I'm so appreciative of that focus on frontline voices.
As you said, they can't hop on a Zoom call, as many of us can.
And so going to them and making sure that their voices are heard through that process.
So we've touched on retention a little bit.
And obviously, I know it's a pretty huge discussion, but what I'm interested
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in is what else do you see as the current challenges for the nursing profession?
I mean, I think we have a great challenge in this country in nursing,
in being united and really promoting unity.
You know, we often get mired in all of the differences in Canada as a federated nation.
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So if we think of ourselves as 10 provinces, three territories,
you know, two official languages, and then you go into nursing and there's four
different categories of nurse.
There's many different areas of specialization. There's different sectors.
And I think we can get completely, you know, sort of mired and hamstrung on all those differences.
(25:07):
But I think there's great power in seeing ourselves as one profession and working together.
We may not all agree, you know, there may be some points of difference,
but I think it's really important for us to come together as one profession.
And that's really where we find our strength.
What do you think gets in the way of that sense of unity?
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I think, I mean, I can relate to the differences.
When I worked in the hospital, I had no idea about, you know,
public health, primary care, community-based care, besides my own experience as a recipient of care.
But in terms of how healthcare looked and how it was set up,
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I really didn't have a great idea.
And, you know, I went from working in a critical care unit with all the bells
and whistles to working in a community health center where we're often working
with clients who are very reluctant to go into acute care.
So we're cobbling together services for them because of their reluctance to
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engage in sort of traditional health care in an acute care facility.
So I think having that variety in my practice has certainly improved.
Been enriching, but I think, I think we get stuck in sort of our silos.
The silos are very, very prominent in healthcare.
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They're silos between organizations, silos between jurisdictions and silos even,
you know, amongst ourselves as members of the profession.
And, and I think it is really important to sort of break down some of those
silos and see our, see our strength in considering ourselves as one profession
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in Canada with despite all these differences.
You know, I think we're much, much stronger when we when we come together collectively.
I think there's so much to be said about that strength when we come together collectively.
One of the things I hear frequently from some of the people that I'm working
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with is a bit of an us versus them mentality between frontline and management.
And I'm also hearing a lot around very poor behavior like bullying.
And how do we address some of those in the moment issues so that we can better
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move towards that unified collective perspective?
I mean, I think that we absolutely need to really practice what we preach.
We may have policies that are around zero tolerance for violence,
bullying, and racism, but often it's the enforcement of those zero tolerance policies.
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And, you know, there's always contingencies.
And I think when we're not actually, you know, practicing what we preach or
implementing some of these policies, it does create a lot of moral distress in nursing.
And that's far beyond burnout.
It's really around, you know, almost an erosion of our sense of professionalism.
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I think that we need inspired leaders.
We need very strong management.
We need that management to be able to communicate effectively.
And I think ultimately, we need to recognize that our leaders are often,
most often, members of the profession. And so they're also our allies.
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So getting away from that almost territorialism or silos to really sort of working together.
And there's ways of doing so, like through shared governance and so on.
And that's a formal structure, but even just transparent, authentic leadership
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is really important for that culture change to occur so that we get away from
the us versus them mentality.
Yeah, I think there's so much to be said on the enforcement of those policies
to create safe and healthy working environments.
And you mentioned about support, like creating support for managers and leaders within the profession.
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And that's certainly something that I hear a lot about is that those that are
in formal leadership roles often feel unsupported.
And so what do you think needs to go into supporting our nurses that are choosing
to be in formal leadership roles?
Roles? I think, you know, I think part of it starts in nursing education.
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You know, we come into nursing education programs because we want to,
we want to enter into, you know, a caring, competent profession,
ultimately, because we care about people.
And then when we enter into practice, there's all these irritants that impede
our ability to sometimes derive drive satisfaction from the client care encounter
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because there's all kinds of structural things that actually impact the way care is delivered.
So then we have to look to different ways of finding our job satisfaction,
whether it's from our colleagues, others in the unit.
And if we don't find those things that sort of give us joy in work,
it again creates this sort sort of sense of moral injury or moral distress.
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So I think, you know, we need to really, I often tell students that,
you know, the most important thing that they can do in their nursing education
is to find their voice and they have to figure out how they will use their voice
if they're advocating for themselves,
for their patient, for their colleague, or for, you know, unit level,
(31:17):
organizational level things or system level things.
And, you know, I came into this role from a background in advocacy and activism.
And I think it's through that, that I really was able to find my nursing voice. And it's essential.
Yeah, I mean, I think it's just so essential.
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It's an essential part of nursing practice, but nursing practice is often thankless.
And I think we are perhaps a bit blind to that when we enter into the profession initially.
So we have to find find other strategies to really find our joy in the profession and in our work.
What brings you joy in your work?
(32:00):
Oh, there's so much. I mean, joining the federal government,
you know, was, was really like learning a whole different language.
I'm sure all of the, everything is very different. And so that's been really great.
Like it's been a very steep, but really good learning curve.
And I think it gives me a lot of joy to,
(32:21):
to meet with nurses from across the country and to understand,
understand you know what what inspires them
what they think i need to hear and you
know what they're doing every single day i
i think that you know there's a lot of bad news in health
care if we and we can always focus on the negative but in my view there's just
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miracles happening every day in health care at the hands of nurses and that
is what we need to amplify that's
what gives me a lot of joy and hope and optimism, all those good things,
but not at all.
I'm not blind to the challenges that we face in the profession.
I just am very optimistic we can get beyond them, and we can actually be stronger
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as a profession once we do get beyond them.
Your optimism is definitely infectious, and I think there's so much to be said
for that focus on opportunity and possibilities.
And as you said, not discounting the challenges that do exist.
So I hear a lot of joy for you.
(33:31):
What I'm wondering is what's been a recent good news story that you'd want to share?
Well, I mean, I think there's one that just sort of came out today,
which is, I think, you know, probably a really good example.
But, you know, one of the things when I started in the role was that I had many
(33:57):
equity deserving groups that who I was very regularly engaging with,
you know, the Canadian Black Nurses Alliance,
the Pan Canadian Nurses of African descent,
the Canadian Indigenous Nurses Association,
the Indigenous Nursing and research chairs, you know, many groups that I was connecting with.
(34:17):
And, you know, a lot of.
A lot of attention on sort of this issue of racism in health care.
And, you know, one of the challenges, I think, is that we don't really have
a good sense of the composition of our workforce, our nursing workforce in Canada.
(34:37):
We don't collect race-based data, for example.
And this is challenging.
I mean, the data, the preoccupation and focus on data is a major focus And, you know,
part of why we announced Health Workforce Canada in December and are working
very closely between CHI-HI and Health Canada on having better data,
(35:01):
health workforce planning data in Canada.
But just today, the College of Nurses of Ontario, which is the largest regulator for nurses in Canada,
announced that it's launching its workforce census for Ontario nurses where
it's trying to get at some of that demographic data for nurses.
And so this is really great from an equity, diversity, and inclusion perspective.
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We need to absolutely know whether, you know, the composition of our nursing
workforce is reflective of the diversity in our Canadian population.
And I think this will really help, you know, we always need the data.
Nurses know this. We need the evidentiary basis for any kind of policy,
for any work that we're doing. So this is, I think, a good news story, an early win.
(35:51):
That's amazing. Yeah, absolutely. And with that good data, so much can happen
with understanding what our workforce looks like.
Thank you for sharing that.
Well, my pleasure. And I have to congratulate the College of Nurses of Ontario
for their leadership in doing this work. Absolutely.
(36:14):
So in closing, Lee, what final words of wisdom would you want to put out there?
I mean, I think that there's no question we're all working in an interprofessional team-based context.
That's the everyday reality that we all work in.
But it's really important for us to talk about the uniprofessional contribution
(36:36):
of nurses and that unique perspective that we offer as the largest group of
regulated health professionals in Canada,
but also as those who are often most proximal to the point of care.
And that's really, really important perspective that needs to be heard.
I think it's important for nurses to know that they have a voice and,
(36:58):
that they do have an ally, you know, in the federal government and certainly
across every jurisdiction in Canada, there's, you know, very strong nursing leadership.
And I think, you know, we know that it's tough and we're working very hard to make things better.
And make things better is to work together. So I think, you know,
(37:19):
promoting unity is critically important.
And I do think we can make nursing a profession of choice in Canada and supporting
our publicly funded system.
And that will only happen when we work together.
I think that's so inspiring and well said. Thank you, Leigh,
for your time today. I really appreciate it.
(37:40):
Thank you so much. It's my pleasure. Thank you for having me.
Thanks so much for joining us today at Central Line, Leadership in Healthcare.
Also, if you liked what you heard, please head on over to Apple Podcasts to
leave us a review. Be sure to subscribe so that you never miss an episode.
Also, if you'd like to learn more about our host, Leah Wuchek,
check out talltreesleadership.com.
Music.
(00:07):
Welcome to Central Line, Leadership in Healthcare, the show that shares stories,
experiences, and advice from notable and innovative leaders in healthcare.
Leading in healthcare is incredibly challenging, so if you are looking to learn
firsthand from nurses, physicians, administrators, and other healthcare professionals
in leadership and management roles, this is the podcast for you.
(00:31):
Hosted by Leah Wuchek, leadership development expert, executive coach,
healthcare professional, and president and co-founder of Tall Trees Leadership.
We talk with today's successful health care leaders on how they get to where
they are, lessons learned along the
way, and what it takes to thrive as a successful leader in health care.
(00:52):
Let's get started with your host, Leah Wuchick.
Dr. Lee Chapman is committed to advancing the nursing profession in Canada to
ensure equitable access to quality care.
As Chief Nursing Officer for Canada, she provides strategic advice to Health
Canada, plays a convening role on key nursing issues, and represents the federal
(01:15):
government at public forums.
Leigh is a registered nurse who received her PhD from the University of Toronto's
Lawrence S. Bloomberg Faculty of Nursing.
Over the past 20 years, she has gained a deep understanding of nursing by working
in both frontline and clinical leadership capacities.
(01:35):
In addition to her role as Chief Nursing Officer for Canada,
Leigh continues to work at a community-based consumption and treatment site
in Toronto, where she provides harm reduction services and frontline care.
Music.
(02:03):
Hello, Leigh. Welcome to Central Line Leadership in Healthcare.
Thank you so much for being here. I'm really excited to chat with you today.
Thanks so much for having me. I'm delighted to be here.
Wonderful. So to get us started, I would love to hear what is it like to be
Canada's Chief Nursing Officer?
(02:24):
Well, that's a good question. It's pretty great, actually.
I'm very lucky that that I get to represent this wonderful profession in Canada at the federal level.
And, you know, since I was appointed into the role, the role had been vacant for over a decade.
When I came into the role, since I've been appointed into the role,
(02:45):
I made a really concerted effort to visit every province and territory.
And I've just completed that cross Canada engagement as of last week,
I visited up to the Northwest Territories and even got to the Arctic Ocean.
So I can say that I've been visiting nurses really from coast to coast to coast,
(03:07):
which is a great privilege.
That's amazing. And knowing how big our country is, it's quite an undertaking to visit all the areas.
And I'm curious, did you have a favorite? And that's a loaded question.
I can never, I could never pick a favorite.
I think, you know, having never been to the territories,
(03:30):
it was wonderful to actually see, you know, how autonomous nursing practices
in the north and rural and remote areas and how,
you know, it's so inspiring to me to see what nurses are doing where there's
really, really finite health service resources and in rural and remote parts
(03:50):
of Canada, as well as the North.
And I would say like my engagement hasn't been exhaustive. It's impossible to
visit everywhere with our massive geography in this country.
But just in terms of, you know, meeting with nurses across the country,
it's been so inspirational for me to see what nurses are doing.
Certainly, there's a lot of duress in the profession,
(04:11):
but more than anything, there's a lot of hope and optimism that we can turn
things around in terms terms of how we're valuing nursing and the wonderful
things that nurses do every single day in Canada.
I think that's really well said. And I definitely hear the passion that you
have and the passion that you saw in other nurses and the hard work and the
(04:35):
dedication and commitment that nurses across the country have.
I'm curious to know, how did you make your way into this role?
Oh, well, I think the role is really a culmination of a lot of experiences.
In one's career, it's funny.
(04:56):
The process of career planning is really iterative, I think.
But looking back, I've been a registered nurse in Ontario for over 20 years.
Nursing was my second degree. So I was a mature student when I went into nursing
and went directly into critical care, but then also was doing a lot of policy work.
(05:18):
I was working at the regulatory body as well as working clinically.
So that work at the regulatory body in Ontario gave me not only a broad provincial
perspective, but also a pan-Canadian perspective because of the close collaboration
with other regulators from across the country.
And I carried that work forward when I went to the Registered Nurses Association
(05:41):
of Ontario, which is a professional association.
And that work was, you know, really cross-sectoral.
So I had these two provincial roles that gave me a real breadth of experience
very early in my career as a nurse and lots of sort of policy work.
Work so you know fast forward to
2022 when the position was
(06:04):
posted I applied I was you know
one of many applicants I think who applied for the position and
I think it was probably you know the the provincial work that I had done which
was really broadening in terms of my scope that that helped in in getting the
job I I always tell this story as well because it's it's kind of comical that
(06:25):
I was teaching a health policy course at U of T at the time.
And one of the students did an analysis of the reinstatement of the role as
her, as the reinstatement of the federal chief nursing officer role as her policy brief assignment.
So that was really interesting. Of course, I couldn't divulge that I had applied
for the job as well, but I always wonder what that student Thanks for having
(06:47):
a policy professor who then gets the job.
Absolutely. It sounds like it's a bit of a small world, right? In many ways.
For sure. It absolutely is.
So what I'm wondering is, did you always know you were going to be a leader?
(07:08):
Oh, I think that...
For me, I think I feel very strongly that leadership is not about title.
It really is about how you show up in the world.
And so I felt that even as a new grad in critical care, I was older than most
(07:30):
new grads and went right into critical care.
And I felt that I had a bit of a different lens because of my previous degree
and life experience in terms of the relational aspects of care.
So that's such a key component in nursing practice is how we relate to others,
whether it's the patient or family, our colleagues, or even how we navigate
(07:53):
the system, right? right?
How we negotiate things within an organization or beyond.
And so I felt that I had a bit of a different perspective just because I had
done different things before entering into the profession.
And I had also worked in healthcare as a unit clerk throughout my nursing education and prior.
And so that gave me a really good immersion, even though I wasn't working as a nurse.
(08:17):
So I think I always aspired to be a leader and I still do in how I sort of show
up in the world and how I intend to engage with others.
And to me, that's really not about title. I mean, I'm in a formal leadership
position in terms of my role now, but leadership is more of,
(08:39):
I think, you know, how you show up in my view.
I really appreciate that thought. And so on that note for you,
what is your focus around how you show up?
Well, I'm mindful that, you know, there's almost, there's over 400,000 nurses in Canada.
(09:01):
So there's many nurses who don't know that I exist.
And, and that's totally fine, because they're very busy doing the everyday work of being a nurse.
And but I always try to, you know, when engaging with nurses,
I try to really focus on the fact that I am a nurse, and I understand nursing
(09:22):
practice, I still work clinically,
I understand everything that they're experiencing.
And, and if I don't, if I haven't worked in a particular context or setting,
I really endeavor to understand and that I am really an ally.
So I think, although I may not have, you know, direct experience,
(09:43):
I really try to better understand, you know, the breadth of nursing experiences.
And, and that That means that I have to listen more than I speak.
And that's sometimes very difficult to do when you're in a formal leadership
position, because people want to hear from you.
And so I always try to balance, you know, talking about what my role is,
(10:04):
what I've been up to since I've been in the role, but also really being a recipient
of sort of nurses' angst and whatever they want to tell me, because I think
the listening part of the job is probably much more important than the speaking part.
So it's sort of what I, I guess what I bring to the role.
And I think to show up authentically, I have to ensure that,
(10:29):
you know, I'm okay, that I'm, you know, not distracted by other things.
I try to be very focused on who I'm engaging with and for what purpose and,
you know, feel very fortunate ultimately to be representing nurses at this level.
What I hear in that is very much this focus on understanding and really creating
(10:55):
the conditions so that you can understand.
You mentioned about listening and seeking information.
What I'm wondering is of the conversations that you've had with nurses,
what are some of the messages, the repeating messages or the themes that you're hearing from them?
(11:15):
Well, I think, you know, when I was appointed into the role,
it was really kind of many overlapping crises.
The COVID, you know, several years into the COVID-19 pandemic with the health
workforce challenges that we're facing.
And I think overwhelmingly nurses felt devalued. And, you know,
while they were seeing, you know, you know, I'm thinking about the fall of 2022.
(11:40):
So I was appointed into the role in August, but in that fall period,
they were seeing a lot of effort on recruitment of nurses, and the nurses who
were actually working in the system felt completely devalued.
And that no one was listening and no one really sort of had their ear and was
paying attention to the actual working conditions.
(12:03):
And so that's really why I tried to focus on retention as a key initiative and
key deliverable early in my role and really tried to work with nurses from across
the country in co-developing essentially best practices around nursing retention,
Including this broad definition of retention to include the return of nurses
(12:25):
who may have left the profession or left the public sector or sought early retirement
just because of what they're experiencing in the workforce.
So I would say, you know, that despair was very palpable very early on.
And I feel like it is shifting.
There is a lot of attention on the health workforce crisis at all levels of
(12:49):
government. And I would say there's certainly a lot.
I mean, I get to have this bird's eye view from a pan-Canadian perspective.
And from my lens, it's very positive and optimistic.
There's a lot of work to do, but we're working very hard to make things better.
And so I'm constantly in awe and so inspired by what nurses are doing every
(13:13):
single day and really try to reflect that back to nurses so that there is more
hope and optimism than despair and angst.
What do you think has been the shift or what has contributed to that shift from
the despair to hope and optimism?
(13:34):
Well, I think it's been, you know, over three years of a global pandemic.
I think we're sort of shifting to a better understanding of how COVID,
how endemic COVID fits into our world.
And then there's also a real desire to transform the system.
So, you know, COVID really was a bit of an unveiling of how,
(13:56):
you know, who gets health care, who doesn't have access to health care,
and those who don't have access to primary care in Canada and what impact that
has on our emergency departments and so on.
So access to care has really been something that I think has been really in
the spotlight as, you know, some jurisdictions have had to close emergency departments
(14:19):
or curtail surgeries and so on.
And I think that, you know, collectively for everyone sort of working in health
care or health services, health and social services, there's a real desire to change the system.
And, you know, I would say federally, we had a record investment last year in
health care of over $200 billion.
(14:41):
So there's also money on the table for that system transformation to occur,
which is, I think, also really positive and optimistic.
Mystic it sounds like this has
been really a transformational couple
of years post-covid or i should
say on the tail end of our covid pandemic and and it sounds like the solution
(15:07):
or the change needs to come from a lot of different angles or lenses i would
agree with that sentiment.
So you mentioned retention, and obviously that is a hot topic,
understandably so, for all of the reasons that you've mentioned before about
(15:28):
the health healthcare worker crisis.
So I'm curious, what needs to be done there? How do we start to address this?
Well, I think a really good place to start is in the nursing retention toolkit
that I mentioned mentioned that has been co-developed by nurses from across the country.
(15:48):
And I think it is really a playbook. It is sort of a one-stop shop.
And, you know, many nurses, nurses are very enthusiastic about it.
So we initially held an advisory committee meeting to help inform on,
you know, how we would develop this nursing retention forum.
And that advisory group first met last February, and then we held a nursing
(16:12):
retention forum in June with nurses from every province and territory,
and really sort of co-developed the toolkit focused around these eight themes
that we think collectively will help improve the working lives of nurses in
Canada and ultimately optimize the work environment.
We held a number of validation sessions in the spring and fall to make sure
(16:35):
we sort of heard what nurses were saying, heard what forum participants had
said to make sure we got it right, essentially.
And then we released the executive summary of the toolkit in October,
which is on the Canada.ca website.
And we released it just in time for the Federal, Provincial,
(16:55):
and Territorial Health Ministers Conference, which is annual.
And during that conference, or during that meeting, the ministers all agreed
to support the dissemination and implementation of the toolkit.
What I've been hearing from nurses around the country is that it really does
reflect what nurses have been saying in the profession for some time.
(17:16):
And I think there's great value in having this all compiled in one document
with lots of references and examples of where these things are already being implemented in Canada.
And these are ideas that can be scaled and spread, you know,
promising practices that other jurisdictions or other organizations can absolutely
(17:37):
sort of emulate in their respective jurisdiction or context.
So I think that there are a lot of solutions in the retention toolkit,
but it's up to us to ensure they get implemented.
I really appreciate the level of engagement that it sounds like went into the
creation and development of this toolkit,
(18:00):
particularly hearing from nurses across Canada and really seeking inputs on a deep level for this.
Can you give an example of one place that has implemented one of these strategies
really successfully? fully?
I mean, I would say one example that we highlight in the toolkit under flexible
(18:23):
and balanced ways of working, this is the sort of the theme of flexible and
balanced ways of working, is in Manitoba.
So through the health authority, which is shared health, they have developed
a provincial float pool.
So nurses can work at Winnipeg Health Sciences and in a high acuity tertiary care facility.
(18:45):
But they can also go work two hours or so outside of Winnipeg in a smaller community hospital.
They have their travel and accommodation paid, but they're still working within the public system.
They're not part of a travel or agency nursing operation.
They're still within the public sector. And this is something that's been really
(19:07):
popular and other jurisdictions are copying it.
And I would say maybe another example, if I may, is under safe staff practices.
We saw in BC, I think, an historic announcement with the introduction of nurse-patient
ratios for the first time in Canada.
And that was a negotiation really between the BC Nurses Union and the BC government.
(19:29):
And so that's just being implemented now, but a similar approach has been negotiated
with the Nova Scotia Nurses Union in their recent round of bargaining.
And this is something that nurses are really jazzed about and really sort of
paying attention to across the country.
Thank you for sharing those two examples, because I think both are really cool
(19:52):
and really inspiring about how we can do things differently.
The example you gave of Manitoba, that level of flexibility,
I think back to my frontline nursing days, and that was unheard of.
And how exciting to have options available for nurses to be able to work in
(20:15):
different hospitals and still be within that public system,
as you said, not part of a travel nurse group or whatnot.
So it sounds like the level of
creativity required for retention is pretty high. Yeah, I think it is now.
(20:35):
I think COVID really forced this reimagination of how we balance work and life.
And that's super challenging to do when we think of healthcare as 24-7.
But I think the creativity lies
in really amplifying nurses' voices and echoing what nurses have to say.
So involving nurses in decision-making at the organizational level or at the
(20:58):
provincial or territorial level is essential to ensure that nurses are part
of the solutions because that's where that creativity comes from.
As the largest group of regulated health professionals in Canada,
if we get nursing right, we fix the system.
You know, your comment about elevating nurses' voices, that has come up with
(21:20):
many of my guests, previous guests on the podcast.
And the question I always ask of them is, how do we do that?
So I'm curious to hear your perspective on how do we elevate nurses' voices
so that they are involved in all of those levels of decision making?
Taking? I mean, I think that is, I'm very intentional when I'm doing engagement
(21:44):
visits, for example, that, you know, I don't, I go to places and want to meet
with nurses who can't jump on a Zoom.
So that means that I want to meet with frontline nurses. And often meeting with
frontline nurses means you have to go to the clinics where they're working,
you have to have the hallway conversations, you have to go to the units.
Sometimes you can get nurses to be relieved, to be able to go to a boardroom
(22:08):
and have a bit of a round table discussion, but often it's really those unit-based
at the point of care discussions that are really valuable.
I can meet with those in formal leadership positions, administrators,
and so on by Teams or Zoom.
I can't often meet with frontline nurses. So that is critical when I'm out there
(22:29):
engaging with with nurses. And I think.
That's perhaps a different approach than others would just want to hear from the leadership.
And I think when we developed the format for the nursing retention,
we were very intentional in how we structured that.
We had two provincial or territorial nominees from employers or health authorities,
(22:54):
but then those two nominees for every province and territory had to bring two frontline nurses.
So we had this dyadic structure.
And I think, you know, being intentional about, you know, who we're representing,
who is at the most proximal to the point of care.
And those are the voices that we need to hear from and we need to amplify and
(23:15):
ensure that they are reflected in decision making.
So that's why I always tell nurses that I am, I'm there for them.
And so I need to hear from them. I need to hear their perspective.
I need to hear what they think I need to know to ensure that it's reflected
in policy and decision-making.
And, you know, there's many diverse perspectives, but I think overall,
(23:35):
you know, there's, there's consensus sort of in terms of what nurses want and need.
And a lot of that is, is in not just the, the toolkit itself,
but in the, in the format and how we went around setting up the forum,
the nursing retention forum. And that's really, I think, how you amplify nurses' voices.
(23:57):
I'm so appreciative of that focus on frontline voices.
As you said, they can't hop on a Zoom call, as many of us can.
And so going to them and making sure that their voices are heard through that process.
So we've touched on retention a little bit.
And obviously, I know it's a pretty huge discussion, but what I'm interested
(24:22):
in is what else do you see as the current challenges for the nursing profession?
I mean, I think we have a great challenge in this country in nursing,
in being united and really promoting unity.
You know, we often get mired in all of the differences in Canada as a federated nation.
(24:46):
So if we think of ourselves as 10 provinces, three territories,
you know, two official languages, and then you go into nursing and there's four
different categories of nurse.
There's many different areas of specialization. There's different sectors.
And I think we can get completely, you know, sort of mired and hamstrung on all those differences.
(25:07):
But I think there's great power in seeing ourselves as one profession and working together.
We may not all agree, you know, there may be some points of difference,
but I think it's really important for us to come together as one profession.
And that's really where we find our strength.
What do you think gets in the way of that sense of unity?
(25:29):
I think, I mean, I can relate to the differences.
When I worked in the hospital, I had no idea about, you know,
public health, primary care, community-based care, besides my own experience as a recipient of care.
But in terms of how healthcare looked and how it was set up,
(25:51):
I really didn't have a great idea.
And, you know, I went from working in a critical care unit with all the bells
and whistles to working in a community health center where we're often working
with clients who are very reluctant to go into acute care.
So we're cobbling together services for them because of their reluctance to
(26:13):
engage in sort of traditional health care in an acute care facility.
So I think having that variety in my practice has certainly improved.
Been enriching, but I think, I think we get stuck in sort of our silos.
The silos are very, very prominent in healthcare.
(26:35):
They're silos between organizations, silos between jurisdictions and silos even,
you know, amongst ourselves as members of the profession.
And, and I think it is really important to sort of break down some of those
silos and see our, see our strength in considering ourselves as one profession
(26:56):
in Canada with despite all these differences.
You know, I think we're much, much stronger when we when we come together collectively.
I think there's so much to be said about that strength when we come together collectively.
One of the things I hear frequently from some of the people that I'm working
(27:18):
with is a bit of an us versus them mentality between frontline and management.
And I'm also hearing a lot around very poor behavior like bullying.
And how do we address some of those in the moment issues so that we can better
(27:38):
move towards that unified collective perspective?
I mean, I think that we absolutely need to really practice what we preach.
We may have policies that are around zero tolerance for violence,
bullying, and racism, but often it's the enforcement of those zero tolerance policies.
(28:04):
And, you know, there's always contingencies.
And I think when we're not actually, you know, practicing what we preach or
implementing some of these policies, it does create a lot of moral distress in nursing.
And that's far beyond burnout.
It's really around, you know, almost an erosion of our sense of professionalism.
(28:28):
I think that we need inspired leaders.
We need very strong management.
We need that management to be able to communicate effectively.
And I think ultimately, we need to recognize that our leaders are often,
most often, members of the profession. And so they're also our allies.
(28:53):
So getting away from that almost territorialism or silos to really sort of working together.
And there's ways of doing so, like through shared governance and so on.
And that's a formal structure, but even just transparent, authentic leadership
(29:15):
is really important for that culture change to occur so that we get away from
the us versus them mentality.
Yeah, I think there's so much to be said on the enforcement of those policies
to create safe and healthy working environments.
And you mentioned about support, like creating support for managers and leaders within the profession.
(29:41):
And that's certainly something that I hear a lot about is that those that are
in formal leadership roles often feel unsupported.
And so what do you think needs to go into supporting our nurses that are choosing
to be in formal leadership roles?
Roles? I think, you know, I think part of it starts in nursing education.
(30:07):
You know, we come into nursing education programs because we want to,
we want to enter into, you know, a caring, competent profession,
ultimately, because we care about people.
And then when we enter into practice, there's all these irritants that impede
our ability to sometimes derive drive satisfaction from the client care encounter
(30:29):
because there's all kinds of structural things that actually impact the way care is delivered.
So then we have to look to different ways of finding our job satisfaction,
whether it's from our colleagues, others in the unit.
And if we don't find those things that sort of give us joy in work,
it again creates this sort sort of sense of moral injury or moral distress.
(30:55):
So I think, you know, we need to really, I often tell students that,
you know, the most important thing that they can do in their nursing education
is to find their voice and they have to figure out how they will use their voice
if they're advocating for themselves,
for their patient, for their colleague, or for, you know, unit level,
(31:17):
organizational level things or system level things.
And, you know, I came into this role from a background in advocacy and activism.
And I think it's through that, that I really was able to find my nursing voice. And it's essential.
Yeah, I mean, I think it's just so essential.
(31:37):
It's an essential part of nursing practice, but nursing practice is often thankless.
And I think we are perhaps a bit blind to that when we enter into the profession initially.
So we have to find find other strategies to really find our joy in the profession and in our work.
What brings you joy in your work?
(32:00):
Oh, there's so much. I mean, joining the federal government,
you know, was, was really like learning a whole different language.
I'm sure all of the, everything is very different. And so that's been really great.
Like it's been a very steep, but really good learning curve.
And I think it gives me a lot of joy to,
(32:21):
to meet with nurses from across the country and to understand,
understand you know what what inspires them
what they think i need to hear and you
know what they're doing every single day i
i think that you know there's a lot of bad news in health
care if we and we can always focus on the negative but in my view there's just
(32:45):
miracles happening every day in health care at the hands of nurses and that
is what we need to amplify that's
what gives me a lot of joy and hope and optimism, all those good things,
but not at all.
I'm not blind to the challenges that we face in the profession.
I just am very optimistic we can get beyond them, and we can actually be stronger
(33:09):
as a profession once we do get beyond them.
Your optimism is definitely infectious, and I think there's so much to be said
for that focus on opportunity and possibilities.
And as you said, not discounting the challenges that do exist.
So I hear a lot of joy for you.
(33:31):
What I'm wondering is what's been a recent good news story that you'd want to share?
Well, I mean, I think there's one that just sort of came out today,
which is, I think, you know, probably a really good example.
But, you know, one of the things when I started in the role was that I had many
(33:57):
equity deserving groups that who I was very regularly engaging with,
you know, the Canadian Black Nurses Alliance,
the Pan Canadian Nurses of African descent,
the Canadian Indigenous Nurses Association,
the Indigenous Nursing and research chairs, you know, many groups that I was connecting with.
(34:17):
And, you know, a lot of.
A lot of attention on sort of this issue of racism in health care.
And, you know, one of the challenges, I think, is that we don't really have
a good sense of the composition of our workforce, our nursing workforce in Canada.
(34:37):
We don't collect race-based data, for example.
And this is challenging.
I mean, the data, the preoccupation and focus on data is a major focus And, you know,
part of why we announced Health Workforce Canada in December and are working
very closely between CHI-HI and Health Canada on having better data,
(35:01):
health workforce planning data in Canada.
But just today, the College of Nurses of Ontario, which is the largest regulator for nurses in Canada,
announced that it's launching its workforce census for Ontario nurses where
it's trying to get at some of that demographic data for nurses.
And so this is really great from an equity, diversity, and inclusion perspective.
(35:24):
We need to absolutely know whether, you know, the composition of our nursing
workforce is reflective of the diversity in our Canadian population.
And I think this will really help, you know, we always need the data.
Nurses know this. We need the evidentiary basis for any kind of policy,
for any work that we're doing. So this is, I think, a good news story, an early win.
(35:51):
That's amazing. Yeah, absolutely. And with that good data, so much can happen
with understanding what our workforce looks like.
Thank you for sharing that.
Well, my pleasure. And I have to congratulate the College of Nurses of Ontario
for their leadership in doing this work. Absolutely.
(36:14):
So in closing, Lee, what final words of wisdom would you want to put out there?
I mean, I think that there's no question we're all working in an interprofessional team-based context.
That's the everyday reality that we all work in.
But it's really important for us to talk about the uniprofessional contribution
(36:36):
of nurses and that unique perspective that we offer as the largest group of
regulated health professionals in Canada,
but also as those who are often most proximal to the point of care.
And that's really, really important perspective that needs to be heard.
I think it's important for nurses to know that they have a voice and,
(36:58):
that they do have an ally, you know, in the federal government and certainly
across every jurisdiction in Canada, there's, you know, very strong nursing leadership.
And I think, you know, we know that it's tough and we're working very hard to make things better.
And make things better is to work together. So I think, you know,
(37:19):
promoting unity is critically important.
And I do think we can make nursing a profession of choice in Canada and supporting
our publicly funded system.
And that will only happen when we work together.
I think that's so inspiring and well said. Thank you, Leigh,
for your time today. I really appreciate it.
(37:40):
Thank you so much. It's my pleasure. Thank you for having me.
Thanks so much for joining us today at Central Line, Leadership in Healthcare.
Also, if you liked what you heard, please head on over to Apple Podcasts to
leave us a review. Be sure to subscribe so that you never miss an episode.
Also, if you'd like to learn more about our host, Leah Wuchek,
check out talltreesleadership.com.
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