Nursing Chat-May 27,2020

Nursing Chat-Transcript
May 27, 2020

Mary Wheeler: A month ago we started these, nursing chats. We had in the first cohort, what I would call, nurses in leadership roles. And then we had the second week students and the third week we had a nurses from a variety. So we had nurse practitioners. We had nurse educators. we had Kim English who was up in  Attawapiskat.

So we had quite an eclectic group. and we taped all these, nursing chats and posted them. It was very interesting.  what people talked about in the nursing chats when they told their amazing nursing stories of what they were  doing throughout the,  pandemic, they were feeling they were on an emotional roller coaster.

There were lots of changes going on and lots of unknown and on the opposite side, what they said is it was,  they felt there was a lot of courage. Like I was using a lot of courage to sort of leap into something. I didn't know. I was surprising myself. I was excited. lots of new learning. I had to step up to the plate because I didn't, you know, I just said, yes, I'll do it.

And, I never realized I had the capacity that I had. So that was just some nuggets  when I listened to the three conversations.

 Coming back tonight,  there were two questions and we said that. To make your experience over the pandemic, meaningful going forward. What's the one thing you'll  do, whether in your practice or in your personal life. And then the second question,  what insights do you have from this experience? That could help guide, inform or redesign the nursing profession in the future.

 So I'm wondering if both Georgina and Cathy could introduce themselves where they're working and what their role is.

Cathy Szabo:  I'm Cathy Szabo, the president and CEO of Providence care. We're a subacute hospital with 270 beds usually, but during COVID, we've gone up to  473 beds. We've doubled our capacity in the hospital, to accept COVID patients or non COVID patients as part of our regional role.

We also have a longterm care home that has 243 beds in it. And we also are in the process of redeveloping that and 22 community programs. During COVID we've had four outbreaks with no spread -- one was a nursing home resident and the rest were staff. The staff in the organization more than half of our staff had been here longer than 10 years, and they're very committed to the organization.

Mary Wheeler: Thanks Cathy.


Georgina MacDougall: Hi, I'm Georgina MacDougall. I'm the HIV clinic nurse coordinator at Sick Kids. my, leadership lies really with my relationship with my patients. And, we've continued to see our, our patients, Regularly. And, it's taken a lot of, my capacity and my trust relationship to convince families that it's safe to come to the hospital and to continue, to see us.

Mary Wheeler: Great. Thanks Georgina. So in week two, then we focused on students and, there were two, co-leads for that.

And I see Jean-Claude from that week is the only one here tonight. So, welcome back, Jean-Claude. And I'm wondering if you could just introduce yourself

Jean-Claude Fillion: Yes. my name is Jean-Claude. I am located in Toronto. now I'm actually a nursing student with Collège Boréal, just finishing up my practical nursing program.

Well, trying to, I'm in that weird, section of the program where. COVID-19 started right when we finished our class exams and we just need to do our clinical placement and then graduate and then be able to do our licensing exam. I'm actually enrolled, with George Brown for September the bridging program in order to go up to RN and hopefully, maybe a little bit higher up than I've maybe a master's or doctorate.

 I have gone through some challenges, with the coordination of transferring into the bridging program and the licensing exam dates and things like that. 

Mary Wheeler: Great. Thanks Jean-Claude. So there were two co-leads Amy and Janice, if you'd just like to introduce yourselves,

Amy Vokarek:  Hi, I'm Amy Vodereck and I am an executive coach and I teach at Mac in the school of nursing as well, leadership and management. And I'm happy to be here.

Mary Wheeler: Great.

Janice Waddell: And I'm Janice Wadell and I teach at Ryerson. I'm a associate Dean with the grad studies at Ryerson. So for the nursing students, it's, the graduate students that I work with, just in, in the chat we had that there were, there were two of them. And what was impressive to us, I think collectively was the resilience of those nurses, as they're trying to juggle not only their academics and all that stood in their way in terms of their thesis, the courses. but also their  ability to navigate that, but also to feel privileged in the role and being able to help

Mary Wheeler: Thanks Janice, so there's no one on the screen here that I see from a week three, but Michelle and Chris were the co-leads. And I'm wondering if you could just introduce yourself.

Michelle Cooper:  Michelle Cooper. . I'm a, an independent consultant  coaching, organizational development and leadership development.

I've been associate of donnerwheeler for, well, I think it's about 15 years The chat last week was nurses on the frontline. And I think that what I heard was the passion for nursing, the courage to step up and I, I know I left feeling inspired by all that people were doing.

 Chris Kebbel: I'm Chris Kebbel, I'm associate with donnerwheeler. that's sort of my part time gig my full time gig, more than full time gig as at University Health Network, my background's in critical care nursing, but now I work  in a nursing informatics role.

 At the start of this, I really thought that I would be heading back to the bedside. Given everything that was said, but, to my surprise and a little bit to my disappointment, to be honest, I didn't get called back to the bedside instead. They've got me working lots and lots and lots of overtime, helping coordinate some of the it and the electronic, assessment side of things.

Mary Wheeler: Thanks Chris. . I'm wondering Sue, if you could just introduce yourself,

Sue Bookey-Bassett: Hi everybody. So I'm Sue Bookey-Bassett. I'm currently an assistant professor at Ryerson . I didn't participate in any of the other chats, but I work with Mary and Gail and Janice on, the NIA, award committee with RNFOO.

And I've also known Michelle, Janice, Mary Gail for a long time, but I'm also working on two, studies related to COVID.  One is at UHN looking at, the impact of the PPE on nurse fatigue and nurse workload. And I'm also working on another study. That's looking at the impact of COVID on students related, particularly because of the, the cessation of in person classes and the impact that that's had  not only on their clinical experiences and potential ongoing learning, but sort of the next steps and career decisions.

So, I just wanted to chime in to see. What the conversations were given given, I'd seen a little bit on Twitter about some of the themes. So I think it's interesting to participate.

Mary Wheeler: Thanks Sue. Susan.

Susan Greenfield: . Hi. Well, nice to be on. This is lovely. I kind of fell into this accidentally. I was a classmate with Janice, many moons ago in our Halcyon days at U of A doing our BSC nursing.

I left nursing to become an actor and then sort of fell back into, connecting both worlds.

I work a lot in simulation with, the universities and colleges, standardized patients, simulation, simulated patients, and simulated persons. And I'm involved right now in creating this course up at York for clinical leadership. And I just was really interested to hear everybody's stories and what challenges people are facing these days because we're in the middle of creating scenarios that we'll do as, simulations with the people in the course. And I, I thought it would be really interesting to hear the realistic world that people are living in so that we can come up with some ideas of things that are actual challenges for people and hear, what it's like and the things that work things haven't worked.

And so, anyway, it's just been so wonderful to hear everybody's real life stories about the challenges these days. Cause they're so huge. So thank you for letting me be a part of this, it's great!

Mary Wheeler: Our pleasure, Susan. So down in the next corner, Sam, Samantha.

Samantha Salatino: My name is Samantha Salatino. I'm an a junior professional practice associate at WeRPN formerly known as the registered practical nurses association of Ontario. I am here today as an observer.

 A little bit about me. I've been an RPN for about three years now or so. Similar to Jean I, went back to school and I was trying to complete my education while this pandemic is going on. So I've recently completed a bachelor of health studies from York University. and now I'm going on to Queens University and   pursuing a  master of science in health care quality degree

Mary Wheeler:  Demi 

Demi Te: I am a registered practical nurse for six years now, up until March, I was working at Bernstein diet clinic  while I was trying to finish my OR certification, however, my placement was postponed, due to the pandemic and, just today I had an interview at a nursing home for Chartwell in Scarborough, Ontario. So hopefully I get to help out along with the community, with this fight against COVID and also develop to develop my skills  as a nurse. .

Mary Wheeler: Thanks for joining us Demi. What an amazing group of, nurses here , in this chat!  So, the first question , we posed: "To make your experience over the pandemic, meaningful going forward, what is the one thing you will do? In your practice in your personal life."

Jean-Claude Fillion: I would say that the, the thing that I would take from this pandemic and bring it into my practice, once I start my practice, would be to practice self care. Because often times I hear that some nurses they're working and working and working, and then there's burnout.

So I want to prevent that. so I, even during my practical program, I practice a lot of self care.

I listen to some soft music while studying, just to bring my mind at ease and lower anxiety and all these things and really center myself and focus on a self reflection as well. More like a weekly self-reflection to see what can I do as a person to improve.

So just being aware of what is to be worked on and, what strategies I can be doing or, Also just thinking about what I can do for the patients next time, that could be better, in planning in terms of, how I'm doing a certain care towards them. just to try to prioritize better and plan better.

Mary Wheeler: Great. Thanks Jean-Claude.

Cathy Szabo: One of the things that I've learned is not to take anything for granted or not take any time off for granted. And, the self care piece resonates because the last couple of weekends, I, when I come back to Toronto, I've actually done nothing like really nothing.

I mean, other than, you know, Make a meal or a cup of tea, or do a bit of laundry, but not have anything planned and, spent more time then just, with like, if my mother comes over just to have a conversation with her. So, I think it's, it's the doing nothing on the weekends or follows the self care piece to not over plan or be, overzealous about making sure that I'm, working flat out all the time

Chris Kebbel: I was just going to say, I think this is sort of an extension of what was said already, but it's also making sure your priorities are correct. Obviously part of that , is, self care. but also even within your workplace to, realize what your own personal professional priorities are, because very rarely are those around you's priorities the same as yours. And to always be reevaluating that, and, you could easily, you could work 70, 80 hour work weeks and still do not enough work would be done it just to take a step back and say, wait, what, what really needs to get done? Part of that may be self care.

Part of that may be what you're doing at work, but not everything needs to be done.

Mary Wheeler: Georgina then Janice.

Georgina MacDougall:  Staying connected. it's so easy when you're bombarded at work with the rapidity of change. and you get home , and you just sometimes just want to cocoon and isolate yourself and just like shut everything out. But. I think staying connected to family and friends that , you would have normally, maybe gone for coffee with, or, just, just staying connected . 

Mary Wheeler: I was speaking to someone today who lives alone.

And, she said, I miss touch and  I'm just really missing hugging someone. , Janice,

Janice Waddell:  I think probably a combination of what's been talked about, but when Jean-Claude talked to about it, you know, taking that time for self care, building your resilience, from other students' comments last week...I think as an educator remembering that, not everyone who is teaching students sees the importance of building in that kind of self care , and, highlighting resilience as a part of your practice as important. So it slips out of curriculum, quite frequently. And it's just another reminder that this is a part of what we do in education is to  reinforce the importance of building your resilience. And during this time, reaching out to students who have been research assistants with me over the years and you know how good it makes us all feel when they respond right away and we can act and connect to one another. It is so energizing. Not only I think for them, but for me.

Mary Wheeler: Thanks, Janice, Michelle.

Michelle Cooper:  This whole notion of urgency, like what is real urgency and what is false urgency and when you think about how many things no longer became urgent, when all of this struck connect both in my work, but also what I've seen happening around me and how much of that urgency do we create for ourselves, which stresses us and puts us into that stress loop and,  to step back and say, who's urgency. Is it, is it mine or somebody else's. And, and can I be more discerning , or mindful about what I really put a high self in terms of pressure and others,

Mary Wheeler: Amy.

Amy Vokarek: When I'm teaching the students in particular, just giving some space for emotions to recognize that there's a lot of emotions happening right now. Many of them are working and allow them to , have that be part of the conversation and give extra padding, like extra space into the way that I'm providing, the course material and the other piece, even from a personal perspective,  I have four kids and they're all university age now and they're back home, three of them and , the emotional roller coaster they're going through too. As all these big major life events are being missed.

Mary Wheeler: Yeah

Amy Vokarek: It was grads, all that thing. So also holding space here, which connects to me needing self care as much as providing space for them. And then looking for the silver linings. I think that's something I hear with the students and hear it at home too, is the silver is that people are finding and that sort of helps to balance out some of the more difficult emotions.

Mary Wheeler: Thanks Amy.

Michelle Cooper: I just found a personal level. We've been experiencing the isolation of the COVID as, family members. Both. I have my mother passed away and now my mother-in-law is in hospital. And  the sense of helplessness that there is, and reaching out to them to say, we need you to help us reach into our family member because  you feel very disconnected.

We were fortunate with my mother that we actually had Skype set up in the room in her longterm care and we could dial in and it would open up and see her and with my mother in law, she's confused. She can't hear, she's  doesn't know where she is and where her children are.

Why am I not here? And when you hear that and it's, it's very distressing. So we actually did manage to get somebody to break the rules and let us in and do a Skype call like a FaceTime with her. But it's, I think what my observation was is that is if I was advocating and it kind of goes into the next one, that it's, the, there needs to be more attention to helping people reach out to their families because their families are important part of the caregiving team. And when we can be there, it's very hard on the patient.  We know social isolation by itself is hard on an elderly person. And then also I was thinking now in longterm care, they've been doing a lot better job of really dedicating people to use iPads and connect and Skype and do all those things. And in the hospital, it's not sort of the orientation and , I've actually talked to the social worker to say, you know, maybe, you know, 75% of people had their own cell phones, but some of these folks need help reaching out.

Mary Wheeler: Yeah. Yeah.

Michelle Cooper: That's been my personal experience.

Sue Bookey-Bassett: So just to tag onto what Michelle was saying. So my inlaws Michelle have also had,  challenges in terms of they live in Montreal. My. Mother-in-law has dementia and is deteriorating and she's tested positive for COVID.

She's had several tests and remains positive. And my father in law, who's 92 years old lives in the same building, but he's downstairs and  they haven't been allowed to see each other, but there's also been no facilitation by the staff to allow any kind of communication. So. The communication is only because my husband who lives in Oakville, Ontario, calls the center to say, can we get an update on my mom?

And unfortunately , neither of them have any kind of  iPad or a cell phone to allow, , that communication face to face. so it's quite, quite distressing cause  no one's really seen her for,  almost two months now, I guess, in terms of her physical state. And I find it interesting because I'm almost going to say the opposite, what Michelle said, because I know in ICU, a lot of staff have made an effort to connect families using cell phones, but then I've almost heard the opposite in longterm care where that hasn't happened.

And then again, you know what came out the last two days in the reports in terms of  how do we value our elderly and the relationships with, with families? .

Cathy Szabo: I'm going to pick up on a conversation that Gail and I had, a while ago. And that's that I, I think we. We as a healthcare system made a mistake in not realizing that the family is part of the care team  and that segues into your next question, because we have to reengineer this system because even if we had all the money in the world, which we'll have to pay for all of this that we're doing now, because the purse is open and we can make some great gains right now.

We will not have the health human resources in the next 10 years to be able to care for everybody that needs care. So we need to get serious about family members being part of the care team because in longterm care had one designated family member have been by the side of the person that was in longterm care.

I don't think we would have had to have waited this long to see the carnage that was in some of those homes. one of the homes in particular, I know, had been under supervision for almost a year and they weren't changing. So it wasn't anything new, COVID amplified what was going on there. One of the ones that the military was sent to.

So we, we haven't, been serious about family as caregivers or as our partners in care. We also have been slow to jump on the virtual bandwagon. I was talking to a colleague out west, and their goal was to have a virtual hospital in three years. And what they told me was they were doing 6% of all their care and virtual visits and they run acute care, longterm care housing.

They have, they have a wide variety of care that they deliver. Within days, they were 60% virtual, within days, but it took money and the need to be able to do that. And that, that was the next best solution. And they said all of a sudden this software that the government had been,  toying around with, do we use it?  Do we not use it? Is it encrypted enough is et cetera. All of a sudden in two days it was fine and they implemented it. So I think we as care providers have to, push government a little harder and, not let perfect be the enemy of good enough and start going in the direction. Intuitively I think sometimes where we need to go.

Gail Donner: Yeah, I think that's helpful, Cathy. I wonder if that's a good segue, you're quite right into what, what can we do? What do we need to change in nursing, in the system and et cetera?

Georgina MacDougall: So just, I think the, the technology aspect is, is the, is the key change. you know, lots of people talked about moving to virtual clinics and lots of practitioners are very resistant, or had been resistant to the idea of doing that, that we can't manage patients that way. And COVID has certainly forced our hand to recognize that we can do it and what technology do we need to have.

So , it really has pushed that agenda forward , which is good. I do worry about the, two aspects of the technology and that is that, technology somehow allows families sort of this carte blanche, open access to healthcare providers.

So I've heard lots of, of my peers say that they they're getting emails and text messages from families at all hours of the night.

Oh, I've got one more question for you , where the regular office visit would be done and we'll see you next month. , and not that that's the better solution, but , this being on call 24 seven and you know, nursing in particular, having to learn how to set, the professional boundaries that,  I'm not available 24 seven.

If you have urgent issues, this is what you need to do. And I think that that's going to be a big learning for all of us.

Jean-Claude Fillion: Yes. just to add that to Georgina's, comment, the fact of the technology. Allowing us to be accessible all days, all time of the day. I see it as a potential downfall or an actual downfall of the healthcare system. If, People were to not set enough boundaries or limits. before I took the nursing program, I worked as a financial advisor and I was a consultant with, investors group, and I found that I would actually try to go through all my emails because,  I want to try to, answer everybody as quickly as possible. So I would actually wake up in the middle of the night and start emailing people and all these things, or like delay response for like 9:00 AM.

So that I'm typing the email now sending, but then it won't send until 9:00 AM and things like that. So it just ended up becoming an issue, like down the road of just trying to like set boundaries and like practice more self care. but also I really do hope that. we see technology as an option to use, but not the main option to be used.

I know that with online learning, with me doing the, the program or the class of the psychology of wellbeing with the Yale university right now, in the meantime, during the pandemic.  It's very different than face to face teaching. And I would rather have the face to face teaching. I find there's more of a connection and I know that a lot of the, school boards and government are pushing for online learning, everywhere and in the country and provincial wide as well.

Also I just wanted to continue the conversation on self care. something that . I actually just had a recent conversation with one of my  older friends.

Her husband is in a home, out in Sudbury with Alzheimer's and was, taking care of her husband for a few years at her own home. And then, ended up transferring him to, a specialized home for  that care. but I was, discussing with her how the importance of, not having that guilt of having the self care  and not time for yourself to rejuvenate your energy, because when you are caring for a loved one at home .

It is your partner, but has now become your patient. And it's 24 seven. You're not having any break from it. So I told her that , I'd rather have the mentality of knowing somebody is able to care for the loved one, at a hundred percent energy and then the tap out, basically after eight hours, 12 hours, and there's another person that's recharged at a hundred percent able to take care of that loved one compared to having to do it yourself at home and is 24 seven.

And. You might not be at a hundred percent to be able to give all the care and everything that you would love to give to the loved one,  it is also important to have at home, care as much as possible, but it comes to a limit where you want to prevent a burnout of yourself and know that there's other people as specialized people that are able to help your loved one. to give you that much needed. Space or time to collect all your energy back again.

Gail Donner: Thanks Jean-Claude. This is all part of, I guess, the compassionate piece that needs to go along with the technological piece,

Chris, I think you're next.

Chris Kebbel: I guess two things, I guess one is that with all the rush towards technology and don't get me wrong, I'm all for technology. but sometimes we forget about the simpler things. A friend of mine, works in a longterm care home and she helped facilitate a lift, like a forklift type thing so that relatives could come in and see , their loved ones from the other side of the glass, so to speak, even if it's three stories up.

Those sorts of things just cause in  an iPad doesn't necessarily mean it's the same sort of connection. And I thought that was an incredible story that she shared.

The other thing is, is that I worry that , with the zoom and all the other things is that the effect on the frontline nurse. and don't get me wrong. It's not an excuse not to have that communication, but I see that in terms of communication with family, which is obviously a key nursing role, but also with COVID.

And I see, of course I saw before COVID is that, Oh, well, a frontline nurse can , do this and collect that piece of information for my research study and do this other thing and do this other thing and do this other thing. And it all seems to trickle down and it ends up stacking up over time.


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