Doctors can use their platform to help nurses too, says Canada's top nurse

In August, a decade after the national role of chief nursing officer was eliminated, the federal government announced it was reinstating the post and appointing Leigh Chapman—a 20-year-nursing veteran, whose career has spanned roles in intensive, critical and home healthcare to management, academia and policy. Chapman, who has a doctorate in nursing from the University of Toronto and a master of science degree in clinical health services from the nursing graduate program at McMaster University in Hamilton, Ont., spoke with the Medical Post about her new role, the challenges ahead and what can be done to address the most pressing issues that nurses—and their physician colleagues—face today. Q: Your role as the country’s Chief Nursing Officer is a big undertaking, especially since the role stopped existing for more than a decade. Did you hesitate at all before deciding to accept this position? A: Not at all. I was really honoured to be selected for the role. I have done work that is provincial and national in scope in the past, so I very much look forward to the opportunity to work with the different provinces and territories, and with the international community. Read: Health minister appoints chief nursing officer to offer input on care concerns What have you done since you took on the role? Can you share some early steps or decisions? I started in this role on Aug. 8, two weeks before the official announcement. Since then I’ve had the opportunity to meet with a number of people within Health Canada and with other stakeholders to really understand the issues facing nurses. I’ve done a ton of reading to get briefed for the role. I’ve also been prioritizing engagement and relationship-building with existing stakeholders, including regulatory bodies —we have 22 regulatory bodies in total across the country—plus professional organizations, educational institutions, labour unions and federal employers. And of course, frontline workers. A lot of these meetings, thus far, have been virtual, but I do plan on hitting the road very soon to seek engagement with frontline workers who have been impacted by the pandemic. Read: B.C. announces new supports to attract internationally trained nurses What are your most urgent priorities, and how to you plan to address them? Without a doubt, the nursing health human resource crisis across the country is the most urgent priority for this role. Addressing this problem involves working very closely with the provinces and territories on things like advancing multi-jurisdiction registration to give nurses mobility across the country—we saw the need for this during COVID. We also need to explore options for accrediting foreign trained workers. We know there are barriers to entry, to access regulated employment. Currently many internationally trained nurses are waiting upwards of several years—the existing pathway is really not acceptable. So how do you solve this problem? A big part of the conundrum is, when nurses are immigrating to a new country, it’s hard to know where to settle and what the nuances are in each province and territory for internationally trained nurses. For example, what does the nursing practice look like? How is the education deemed equivalent for nurses trained in another country? Part of what we need to do is look at what we’re doing in each province and territory to see what’s working and not working, and then try to harmonize the pathway across the country. We need to have something that’s much more streamlined, more efficient, quicker and consistent across the country so there’s a clear picture for nursing in Canada. Read: Nursing externship program at South Bruce-Grey Health Centre a success Can you give examples of what can be done to create a more streamlined pathway into nursing in Canada if you’re trained in another country? So if the RN program in your home country is not deemed equivalent to the RN program in Canada, let’s look at other opportunities to get you into regulated employment while you’re working to bridge that gap that will get you to the RN level. It behooves us to look at these barriers and to find ways to break them down. We have so many internationally educated nurses who are already residing in Canada but can’t get regulated work. We need them, so we’ve got to find a way to bring them into the regulated workforce. Are there models in other countries that you consider exemplary and would be good for Canada to follow? It’s too early for me to say. I know anecdotally that other international jurisdictions have done things that have improved processes for nursing. But we don’t even have to look too far. Within Canada there are leading practices that are exemplary that we can look at piloting for harmonization efforts across jurisdictions. One thing that’s important to note is that we are dealing with a global health human resource crisis—other countries are facing the same nursing shortage that we are. Being a relatively rich nation that’s attractive to a lot people from other countries, we need to be very mindful about not putting lesser-privileged countries at an even greater disadvantage. Read: Nurses want national hiring and retention strategy amid staffing 'crisis' What do you foresee as the greatest barriers to your goals within this role? How do you intend to address these barriers? A key part of my role is to harmonize approaches across country, so a barrier may be the fact that healthcare in Canada is delivered at the provincial and territorial level. My goal is to play a federal role in terms of efforts to coordinate and identify solutions across Canada. With over 400,000 nurses in four different categories across the country there are also certain differences that may present a challenge. But I do think that we’re more alike with each other than we’re different and there’s a lot we can do together towards our common goals. Nurses play such a critical role in healthcare but this fact is often unrecognized or underplayed within the healthcare system, among governments and the Canadian public. Do you see a need to redefine the nursing brand, or at least create a greater awareness about what nurses do? Nursing has been one of the most trusted professions year after year, but there’s no doubt that the profession has suffered greatly from abuse and burnout especially during the pandemic. I think there is a general recognition of what nurses do, but the key role of nurses as autonomous professionals it not as widely known or celebrated. That’s why reinstating this role is so important, because it gives nurses a voice at the federal level and within the international community. In other countries, there has been better national advocacy for nurses because many of them have a chief nursing officer role. Read: Nurses across Canada are quitting their jobs and leaving because of pandemic stress The nursing profession continues to be dominated by women. Do you consider it a priority to attract more men to the profession, or is there a level of resistance among patients to the idea of male nurses? My concern is around health human resources and working with the provinces and territories on recruitment in general. When I think of expectations from the public in terms of healthcare delivery, I think they expect diversity of delivery. This means ensuring that the various groups, including LGBTQ, Indigenous and other racialized communities are not only represented but also visible and supported. What role do doctors play in resolving the challenges faced by the country’s nurses? Doctors and nurses work in lockstep, so there’s a need to harness close working relationships. Policies often have a ripple effect into other professions. Doctors are often given a platform and, in my experience, there’s often an opportunity to use the power and privilege accorded by these platforms to address particular issues outside of their own profession like, for example, the nursing shortage. Ultimately the health human resource issue affects all healthcare professionals across the country, and the key to resolving this issue is working together. What are some of the ways that different healthcare professions can work together to address today’s most urgent issues? Initiatives like the ones focused on accreditation of foreign-trained physicians could be carried out as a concerted effort to inform the efforts of other related professions. For example, I’m interested in what’s working and not working when it comes to accrediting international medical graduates and looking at what can be applied to similar challenges in nursing. What made you want to be a nurse? And given the challenges of the profession, what made you stay? I came to nursing as a second degree. I was very interested in people and wanted to make a difference. When I think of the 19 years—coming up on 20—that I’ve spent in my profession, I do still firmly believe that nurses make a difference, whether it’s at the bedside of a patient, in a classroom influencing nursing students or at the policy level. I’ve had a very eclectic journey and I can’t wait to see what the future holds. Read: Ontario gives OK for nursing college to expedite international nurse registration

Doctors can use their platform to help nurses too, says Canada's top nurse

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