Every Nurse Carries Trauma w/ Jon Schmid

In this episode of The Caregivers Podcast, Dr. Mark Ropeleski sits down with John Schmid—a veteran ER nurse, former Canadian Armed Forces nursing officer, and past healthcare COO—to pull back the curtain on the "trauma-exposed" nature of healthcare. John provides an honest look at the moral injury that occurs when clinicians are unable to meet their own standards of care due to systemic constraints.

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What is The Caregivers Podcast?

The cost & courage of caring - stories that spark resilience.

Welcome to this week's episode of the Caregivers Podcast.

I'm your host, Dr.

Mark Ropeleski.

You can call me Dr.

Mark.

Today's guest is John Schmid, an ER and critical care nurse, a former nursing officer in
the Canadian Armed Forces, and a healthcare leader who's worked across domains such as

trauma care, remote northern communities, flight nursing, hospice care, and high-level
hospital operations.

What stands out about John is that he's seen caregiving from almost every angle, at the
bedside, from the air, in leadership.

and in various crises.

And he's honest about the trauma that caregivers carry, the weight leaders hold, and why
every caregiver needs an exit strategy.

John, welcome to the podcast.

I want to start with this.

Sean, welcome.

I'm so happy you're here.

When you look at caregivers today, what's the looming danger that's there blindsiding
them?

And the one thing that they don't recognize is coming until sometimes they're breaking
under it.

I think it's trauma, Mark.

Thanks for having me.

Healthcare is a trauma exposed industry.

And I think that uh the sector as an entity has done a poor job of acknowledging that uh
since time.

It's not a finger point at any particular person, government, organization, but uh we
certainly...

uh

have failed to recognize the significance of trauma in the work we do, how we metabolize
trauma and how we recover from trauma.

And I think that shows up, it's showing up right now in Canada and in most of the world
where we see lots of attrition shortages and we see the strain and the cracks in the

system at large.

And the spillover is amazing because the spillover starts affecting other members of
health care teams, uh including caregivers who are advocating for patients and becomes

this sort of big snowball.

There's always something about choosing a career where you're called to do hard things and
it's something we acknowledge.

But when trauma starts spinning out of control and we don't have the mechanisms to

contain it or to prepare people or as you said, so I've said so eloquently in a lot of
your posts on LinkedIn about the mechanisms to diffuse it and to decompress it.

That's where I think people are really running into trouble.

You've certainly acknowledged many times that, you know, every nurse carries trauma, every
healthcare provider carries trauma.

What was the moment that you sort of felt that for the first time in your mind and body
that

there's something going on here over the course of your career.

That's a great question.

I've been in healthcare now for 25 years, civilian and 30 if you combine my military
experience, which was concurrent as a reservist.

And I don't think I was honest with myself, partly because I wasn't educated and I didn't
know what I didn't know about trauma in the early phase of my career, which is from day

one when I was exposed.

My very first clinical job was an ER nurse.

was quickly indoctrinated to

to high tempo, high stress, violence, all the things that come with emergency medicine and
emergency nursing.

It accumulated slowly and consistently over time.

I did about a decade of clinical work in the ER and aircraft as a flight nurse, ICUs,
Northern primary care environments.

So with lots of autonomy responsibility where there's no positions to support your
practice outside of

you know, a telephone consult.

So there was lots of pressure and I liked it.

I thrived in it.

was, I don't have any regrets.

It's a great career and I still do it I still love it to this day, but I didn't realize
that there was lots of trauma and injury accumulating and I wasn't acknowledging it.

I didn't know about it.

I didn't have the skills to name it.

And I, that's where I think that we fail students, med students, nursing students,
physical therapy, anybody that comes into contact with healthcare.

So do they.

Yeah, we really need to do better job educating people.

And where it showed up in my career was I did just over a decade of more than full-time
clinical.

I transitioned into leadership, progressed into senior leadership positions up to the
operations director role with tertiary hospital and then a COO of a large hospice.

And I just lost the joy, like I lost the spark.

after about 12 years of senior leadership and I started to think like is healthcare still
for me?

I was frustrated for a number of reasons and I was angry um at a lot of the injustice and
inequity I saw in the system and a lot of the kind of lunacy I thought I was seeing.

um Not a lot of reasoning.

I just felt that nothing made sense and it created moral dissonance and cognitive
dissonance for me as well on a lot of topics.

And I started to really reflect on what was going on.

Of course, we all were all humans and we all have relationships outside of work and
personal circumstances for me were a challenge as well.

It's like I started to really reflect on where I was personally as well.

And I ended up taking a sabbatical.

I just kind of walked away from it.

And it wasn't like a medical leave or anything.

I just quit and ended up six months.

volunteering and just kind of re reflecting.

And I had the opportunity to do that in my life circumstances, supported that.

I had to really support a spouse and family.

And during that period where I was off, my kids started to say, dad, they just started to
interact with me a little bit differently.

And one day my oldest, who's a teenager, just said, I'm so glad you're happy again.

And that really, that really hit me.

And I started to, that's when I really started to dig into, you know, like what's going
on.

I, you after 20, that was around the 23 mark for me.

And that's the first time I ever went to counseling in my, in my entire career doing
things I've done and the trauma that I was exposed to, took me, it took me over two

decades to start looking after myself properly.

And it took me kind of like this, this walk away scenario, which

I'm very grateful for.

So when you look in the rear view mirror, I'm also a little bit, I regret it.

I regret I didn't have the knowledge and skills and I wasn't honest with myself.

And there's a whole bunch of reasons why I didn't look after myself properly.

And I really put a lot of the responsibility on me.

there's system constraints and we're all vulnerable to those.

But I wasn't honest with myself.

for number of different reasons.

know, I'm a man socialized to navigate the world a certain way.

And that involved not talking about my feelings or emotions and compartmentalizing trauma
and carrying on without complaining.

And that just didn't do me any favors.

As a clinician, it didn't do me any favors.

As a leader, uh as a spouse, as a parent, and that all accumulated with unplanned
sabbatical.

so to speak, and sabbaticals, a nice, sophisticated way of saying, you know, burned out
and threw my papers, walked away.

It all worked out really well for me.

I really found, I regained uh purpose through volunteering.

went overseas and started to do some medical work again.

And that's when I remember uh like, yeah, this is why I got into healthcare in the first
place.

This is why I got into nursing in the first place.

And I have a really...

close friend who I've known for over 30 years since high school.

And uh he's not in healthcare, not in the military.

And he said something to me one day, he was like, man, I don't know what it's like to be a
nurse or a soldier or anything.

don't know.

I can't relate to what you do in your careers, but I remember you being the happiest in
your life when you were an ER nurse, two decades prior to that.

And it really, really made me reflect.

I thought like, yeah, he's right.

I remember thinking back to the fun I had in the ER, the bonds I generated, which were
still strong to this day with lifelong friendships and the happy memories I have about it,

the learning curve that I really loved to consume, because it was a challenging specialty
to get into right out of nursing school.

And I just thought about that and I decided to get back into it.

And now being back at the bedside in a tertiary level ER,

You know, I, people asked when I first came back, people said like, how long you've been
nursing?

And I said, 25 years.

And they said, a lot of people said, cool.

I'm 25.

So we have this.

I'm working.

It's really humbling because I'm working with these highly competent 25 year olds, 24 year
olds.

really, see myself in them like I was 25 years ago and uh see their competency.

And it's really inspiring.

It's really humbling because I have to like, I have to hustle and study to keep up.

It's a demanding role.

uh We joke a lot that it's not really a, it's a young person's career right now because
the tempo and the trauma is so uh unreasonable.

And that's where I like try and grab myself right now as an informal clinical leader and
mentor to younger staff to be calm, be kind, uh be measured in how we interact with each

other.

And to kind of set an example for wellness that inspires young people to keep going and
gives them the grace to pause and to take breaks and to metabolize, like to learn how to

metabolize trauma in a healthy way so that they don't just push it down and end up walking
away from their career like I did.

Well, I think we're so guilty of it.

You just, you have your mindset and you you pointed to a really important point is that
you were most vigorous while you were still replete with energy and replete with space

that hadn't been traumatized yet.

And you were functioning at a high learning curve, high emotional learning curve, high
ability to absorb the bumps of the trade, so to speak, uh on that curve.

But then

as you well point out, suddenly you look back and it's like, what was I thinking?

Why was I so numb to all the signals?

And it takes sometimes 20 years.

you know, reinforced along the way is a way of doing things that's probably deeply rooted
in our choice to become a provider, whether it's in healthcare, whether it's in the allied

field or what have you.

But it's amazing how it just fuels forward and keeps us blindsided.

Did you recall a time, where that, now that you look back, where, like, work was really
taking a piece of you away and just hiding it out of sight that you couldn't get back at

it?

Or was it just sort of a gradual erosion?

I for me, I talk a lot about this now openly and it's amazing.

I could answer for a lot of people I've spoken to recently and they can name single
events.

They can name a time when it became, and it's often linked to critical incident.

For me, it was more of a slow erosion oh over time.

And uh it was amplified during the pandemic with moral injury uh for me.

And I was already injured at that point, but I didn't, I don't have PTSD, but I definitely
had a stress injury, but it wasn't treated, it wasn't acknowledged.

And then when the pandemic hit as a clinical operations director for you know, a 400 bed
hospital, I was just working 24 seven for two years.

So that tempo plus the, the clinical, like the dynamic challenges we were dealing with
culminated in

you know, the distance I just described.

So uh it was the two decades prior to that.

It was just slow burn.

And when I, when I sit down with my counselor and I talked to my spouse about, you know,
changes in my, personality and behavior over the years, like we all grow and evolve,

right?

Like the person I was 20 years ago, isn't the person who's sitting today talking to you.

But I definitely struggled over the years with hypervigilance.

And I think that manifest like hypervigilance and anger.

The joke in my family is I'm the fun police because, you know, have this burden of
knowledge where uh in emergency medicine and nursing, we see catastrophic things on a

regular basis.

so, you know, if I see a music festival to me is, ah you know, sexual assault because as a
nurse, I would see that.

And as a manager, would staff up all of my friends with nursing.

uh

uh resources because I knew that we were going to have a spike in sexual assault during
the local music festival, right?

Trampolines or fractures and all these things.

So when you're a parent, you just, I just saw so much risk in the world that it kind of
took the joy out of a lot of the usual things.

And that was like difficult after it.

I never talked about it with my wife and never talked about it with really with the people
around me.

I was always just right in my head.

was like, you know, no motorcycles, no.

All the things that we kind of joke about it now.

um But I was definitely um not having as much fun as I could.

And that was, course, um impacting the people around me as well.

From the places we travel for vacation to uh the activities that I would put my kids in or
not put them in because of the biases that I had formed in my mind due to the trauma that

I'd experienced at work that through bearing witness to.

to injuries and suffering.

The other thing is, to me, we don't talk about this much at all really is bereavement in
healthcare.

So we have moral injury, but the amount of bereavement that healthcare providers encounter
in their career through loss is um remarkable.

So when I stepped away to my sabbatical, I've like lost, instantly overnight I became just
John.

wasn't.

the senior leader, wasn't a chief operating officer anymore.

I wasn't a soldier.

wasn't a nurse.

Like all different hats that I worn, I was just unemployed.

And that was kind of, was good for me.

It was humbling because I realized like I'm way more, all of a sudden overnight I was a
husband and a dad as a primary person.

But I've also like, I've lost, I'm also as a friend and a colleague, I've lost over seven
people to suicide.

in the 30 years I've been in healthcare, military, civilian combined.

Two of those were nurses, some of them were paramedics and soldiers.

So when we lose people close to us, and we're more likely to lose people like to suicide
than non-healthcare providers, I think it's like, depending on the source, it's anywhere

from 1.5 to two times more likely.

We don't talk about that either.

I just finished the November campaign, had a uh ridiculous mustache and just generated a
ton of really good uh conversations because of it.

uh Jokes in the ER and a lot of the police paramedics fire were coming in with mustaches
and we all had high fives and stuff.

uh One of the young nurses was making fun of us and saying,

She didn't like the way we looked and we told her, well, this is November.

We're supposed to talk about this.

And she said, well, what do you mean?

And I said, well, one man dies every minute of suicide globally.

And she sat back, she's like, well, are you kidding?

So no, that's true.

Like one man dies every minute of suicide globally.

And I told her that I know seven of them.

And that was hard for her to comprehend.

bereavement in healthcare, think is like, whether it's loss of a person, loss of a role,
because you get burned out to the point where you have to pivot and step away from

something that you love or you got a lot of identity from is often, I think, misunderstood
and subsequently not treated properly.

I imagine when you make that transition where you take a step away and you become just
John again, you actually may embark on a phase of bereavement of your former self and the

self that disappeared for so long as it's about to come back to life.

Yeah.

So in your experience, what breaks caregivers first?

Is it the work they do or is it the systems they function in?

It's an excellent question.

It's obviously multifocal, but I think in my experience, personally and from what I've
seen in my closest colleagues, um it's been a failure, perceived failure to function how

they thought they could function.

When you're in school, you get into healthcare for all the right reasons.

People want to be, we're all humanitarian that are core typically, right?

Altruists.

Yeah, all through us.

And then you learn what the standards are, right?

Even just technical standards like door to doctor, door to balloon inflation, door to pain
control.

We have all these standards that we strive to achieve.

And then you start to practice and you realize there's no way you're going to achieve
these standards.

And then you're driving home from your ship and you realize the 75 year old cancer patient
who rang the call bell.

asked for pain control because they were in agony, you forgot to give them analogies
because you had such an interruption density in your day that you just forgot.

uh And then you feel guilty and you're morally wounded by that, what seems to be a small
thing, right?

But it uh has a major impact on people.

And then you compound that day over day.

And the, the moral injury that's associated with not being able to practice the way
thought you were going to be able to practice the way you want to be able to practice.

starts to create resentment.

creates a depression.

It creates, you know, it creates a lot of things.

And I see it manifest in my colleagues, you know, in a lot of different ways, a lot of,
uh, I didn't see it.

You know, as a man in nursing, was only 9 % of us that are men, 9, 10%.

I noticed gender nuance and a lot of my male colleagues are angry.

And a lot of my female colleagues are like, they exhibit, you know, despair.

It's like, this is just terrible.

My male colleagues are like, this is bullshit.

know, like they're really, they're really angry and neither one of those places is a great
place to dwell.

They're natural emotions and you need to experience them and sit with them.

But.

They become a bit of a prison when ah you stay there.

ah so uh that's where the joy starts to erode.

And I really, the word joy I think is really important to me.

That's one I've explored a lot.

And there's something about the collective joy, even on a shift that goes really well,
etc.

But once you don't feel the collective anymore and the joys eroded, it really puts you in
a different place.

And it's interesting that you touch on anger.

was just listening to some comments by Scott Galloway, who um was talking about how social
media these days, like the algorithms are just fueling the rage and the anger response.

And you could see where that's translating itself into uh

into the minds of young males.

And it's interesting that you brought that up just even in the context of the emergency
setting and reaction to the cumulative moral distress.

Because I really think the injury is the sum of multiple cuts.

And then that real injury imposes where it takes a big chunk out of you, probably more
than the sum of all the little nicks along the way.

It's interesting, you were talking about interruptions and how that potentially is a fuel
for moral distress because you forgot something, but there's some interesting work that's

been done on the number of interruptions that healthcare providers face while they're
engaging and trying to solve a problem in an emergency setting or in any setting.

Whether you're a nurse or a physician, like the cumulative interruption density is
actually mind boggling.

It's amazing that people can still keep focus, yet the expectation is that focus is kept.

But getting back to that sort of multifocal element, so we're not prepared.

We enter with open eyes and open hearts, open minds, and some people even open souls to
providing in the healthcare setting.

Yet that gets eroded, yet we don't get the boot camp training we should probably get with
some more advanced level thinking and approaches to training future healthcare personnel.

Even, you know, there's interesting analogies that we should be being taught the way that
Navy SEALs are taught.

Some of those resilient factors, some of those uh skill sets that go above and beyond
could be translated to a much newer curriculum preparing young healthcare providers of all

sorts for the next phase of their lives once they graduate.

What are your thoughts about that?

think you're right.

know, I have, like I said, I've lost a lot of people in my life to combat and suicide.

One of them was a nurse in the military as well that deployed to Afghanistan.

And I know a lot of, when I was in, I wore a lot of different hats in the military.

I was a reservist, medic, infantry soldier, and then a critical care nursing officer
towards the end of my 20 years.

And we, even in the military, we've evolved and learned a ton where alcohol was the
primary coping mechanism two decades ago or three decades ago.

You'd see a critic, didn't be involved in a critical incident and you would just get
drunk.

Right.

And that was the way, and you'd get drunk with your friends and you wouldn't really talk
about it.

just, you know, you get drunk and then engage in high risk behaviors and stuff that were
negative.

and limiting and ruin relationships and all that kind of ah Fast forward today and some of
the ah most seasoned war fighters I know, Canadian war fighters are some of the most ah

emotionally aware uh people that I know today, right?

So there's a bit of an irony there.

So I think that's because it's a massively trauma exposed profession, uh right?

that's like healthcare's trauma exposes different types of trauma.

Sometimes it's the same, but trauma is trauma, right?

So uh we definitely need to look across sectors.

I have a master's degree in quality improvement and um in that program and training, we
were encouraged to look outside of healthcare to find ways to improve health.

Aviation is a classic example where you look at the safety record of the airline industry
um and you take

You take certain things that, you know, pilots and air crews do to improve patient safety
and staff safety.

It's the same thing.

We need to look at how we evolve as humans emotionally and from a mental health capacity
and break down the barriers and the barriers that, you know, how we socialize.

big part of it.

How we talk about things is a big part of it.

And then look at the technical constraints as well, right?

Like alcohol use, that's a good example.

There's a lot more, there's a lot of focus on responsible drinking right now in the armed
forces.

uh And I just came from a staff party, an ER staff party last night, and there was lots of
alcohol going on.

There was lots of intoxication and

One of the things I don't do anymore is drink.

I didn't have a drinking problem, when I took my sabbatical and started looking inward a
lot, I was trying to eliminate things that weren't helping me.

And alcohol and substances are thieves.

They steal time, money, uh your health.

They're known carcinogens.

And for me, it was sleep, like I noticed.

I used to really enjoy.

the Scotch in the evening.

the thinking was, it would help me get to sleep.

And I'm sure it often did, but when the brakes come off, that ends that, when the brakes
come off that effect at 3 a.m., then your mind's racing, you can't get back to sleep.

And I had really broken sleep.

I had really broken sleep leading into my departure.

And I know that was a leading contributor for me, because I wasn't, you know, that was
just a snowball effect.

And it amplified everything.

So no cannabis, no alcohol.

is something that I live by right now.

And because I'm in a trauma exposed profession, and if I don't take that measure, if I
don't abstain from the things that don't help me, then I'm going to increase my

probability of uh injury again.

So we've established that we carry trauma because we work in health care as, depending to
different intensities though, potentially a traumatic environment.

And we're not necessarily well-prepared.

We bank on our best intentions starting off and then potential for amassing various
formative events which slowly decay and erode us.

And then at the same time, we're not really often facing an environment that's conducive,
whether we're just starting off, we don't have the mentorship we need, we have a lateral

violence among colleagues.

If you hear stories about individuals who are motivated and really good at their job, they
get sideswiped by others who are less motivated and maybe less talented or just are out to

lower the bar.

Lots of things can go wrong and without the ah resources to turn to or the knowledge of
which resources to turn to, as you so aptly pointed out, we often find ourselves just

plowing and keeping going.

When you were responsible as chief operating officer for thousands of people in different,
your decisions affected so many people during those critical times.

Was there moral tension that you carried that nobody outside of the system could even see,
but that because you were leading a big part of the system, you carried with you all the

time?

100%.

I'd love to know more about that.

Because I think that's something that's a little bit underappreciated and maybe
underestimated.

um When you function in a system that's like a zero sum game when it comes to money and
decisions and funding, it's always convenient to blame leadership for making decisions.

But the assumption is that there's probably some moral distress at higher level decision
making as well.

But it's a little bit underappreciated.

Yeah.

How, you know, first of all, what was it like?

And secondly, how were you prepared as you worked your way up the ladder?

Did you have mentorship and leadership?

I think that's a recurring theme that we're hearing more of is you don't just become a
leader overnight, or because there's a vacancy and you're the next most senior person in

line.

So boom, oh, by the way, guess what?

This is who you are today.

Good luck.

Yeah, I'm going to answer the second part of your question first.

uh There's zero preparation for leadership in healthcare.

So, especially on the nursing side of things.

So, um one of the key differences between physician leadership and non-physician
leadership in healthcare is that physicians are still allowed to practice as physicians

when they take leadership positions.

If it's their own private practice, they can do that.

In most cases, um I've very rarely seen a

100 % full-time uh leadership role outside of a chief medical officer.

uh So you see ratioed positions.

So a physician can be a leader and a physician at the same time.

They don't lose their identity as a physician.

Whereas nurse leadership, uh nursing is really a prerequisite for most clinical leadership
positions in health care, especially in the hospital context.

So a nurse manager, for instance,

And that's what I did.

My first leadership role um was a, well, that's not true.

It wasn't my first.

We have lots of different leadership roles within nursing from educator to uh clinical or
specialist and different things.

But if you want to get into governance, have to, you have, it's an all or nothing
transition.

You give away your uh seniority as an employee.

You give away your identity as a practicing clinician.

and you step in to a suit and tie in my case, and you are now, now you are a higher up and
you have no training.

So my very first, my very first manager role, gave me like a $12 million budget and 300
people.

I think it was a 500 bed hospital and I was in charge of the emergency department, which
included adults and pediatrics and mental health.

It was a referral center for a major part the province in Saskatchewan, in Saskatoon.

And I had no, I had no formal leadership training other than what I had experienced in the
military.

had formal leadership training in the military, I'm that's unique to the healthcare
system.

Didn't care about that.

They just were like, John's a great clinician.

He's outspoken about important topics.

So it makes sense that he'll be a good leader, which was not the case.

I didn't, I had to Google F what a full-time equivalent was on my first day.

I was looking at it, I didn't even know what an FTE was.

Yeah, so, and I had no supports.

Like it was, here's a phone, here's your laptop, good luck.

And then you get smacked in the face with the realities of scheduling and the science or
lack thereof, uh budgeting, commerce, communication and leadership.

There's no preparation.

So you learn by trial and error.

We set people up to fail.

most of the time because of that.

And then that goes into the first part of your question, which is uh people that have
never been in charge of human life uh don't appreciate the weight and uh moral strain that

it carries.

the examples, basic examples are performance management.

I've performance managed physicians and I've performance managed nurses and every other

allied health discipline.

You can think of um the egregious misstep is always the easiest to manage because it's
egregious and everyone can agree it's egregious.

you know, sexual harassment, assaulting a patient, that sounds like it would be, you know,
that does that actually happen in Canada?

Yes, it does.

um Humans are humans and we'll all make mistakes and behave poorly.

So,

That's why leadership is important to hold people accountable.

So those are the easy ones.

What's really difficult is managing the nuance in human relationship is knowing your
people and walking that line between a friend and uh a leader that needs to hold the

mirror up to people and say, this is how you're behaving.

And I know you've got a lot going on in your life, um but you can't, you

you can't do what you're doing.

You can pick an example in your mind about what that might be from being late to uh
behaving badly or oh even, you know, like I put nurses on and physicians on uh in

partnership with my physician diet partnerships, uh you know, remedial practice and
supervision because

they just weren't performing, they were dangerous at the bedside.

So, you know, it's morally stressful and the worst part of that moral distress is manifest
in the harm that you see.

Because as a leader, you see all the harm.

Every complaint from, had a, know, somebody spoke unprofessionally to me all the way up to
my child died because of a preventable error.

You're the one disclosing those errors to families across the table.

Like look, you know, face to face.

And there's nothing more life-changing than that in my experience.

Like as a leader, I had to do that several times in my career and it defined who I was as
a leader.

It was morally wounding.

um There's two that I can recall that were uh sentinel in my career and they were also
timed um close to the end of my uh departure.

So to your point earlier about, there's like, you have this culmination, your buckets full
over the years, and then you have one more um event that is serious and you just don't

have the capacity because your buckets full, it overflows uh with trauma.

ah It's heavy and holding people accountable for those uh situations, working through uh
case reviews um is difficult because nobody wants to do harm, but healthcare is one of the

most

dangerous places to be as a patient and a care provider in Canada right now.

It's about a 30 % error rate, depending on the source that you're citing.

many Canadians experience error causing harm.

And we know that as a worker, whether you're a physician or a non-physician clinician,
your chances of encountering violence in the workplace and injury

uh, do repetitive motion or whatever is, uh, also quite high.

So we're trauma exposed in a lot of different ways as leaders that is invisible to, the,
you know, the teams that you're leading who are focused on things that are important to

them from their, their schedule, their time off, uh, and at war to the equipment they have
or don't have or think they should have.

I learned a trick, um, probably too late.

had,

I used to put all my, I had a number of different whiteboards installed in one of my
offices at one of the hospitals I led.

And I had check-ins with all the medical directors of all of the portfolios that fell
under me.

at the time I had neurology, pediatrics, obstetrics, emergency services, trauma, and all
the physicians that led those specialties and rehab was another one of them.

I had standing meetings every month.

And every physician would come in to every meeting and say, okay, John, we've got a good
idea.

We're going to be able to reduce this metric or improve this metric um in a favorable way
for our patients.

We're going to be able to see more patients.

It's going to be safer.

And they would always have great ideas, right?

And I would say, okay.

And every single time their ideas would require resources.

And in every single meeting, I'm running a $10 million deficit.

So there's, so there's no money.

And uh that I use the term higher up earlier.

I became a higher up overnight.

um That's, that's when I was a higher up and I, that's when I was accused of not caring
about patients.

And that's when I was accused at not understanding their lived experience as a clinician,
even though I had been the very experienced season expert clinician prior my own

specialty.

And what I would do, I got angry.

I was always angry.

And some of the, some of the conversations didn't go, you know, as bad as well as they
could have, because I was, I was angry all the time because I was offended and my ego was

damaged in those interactions.

And what I would start to do differently is I would point to the wall.

would say, these are all of the issues I have on the go.

These are all my funding streams.

um I think your idea is great.

um Can we do it without any resources?

Is there, is there a no cost way of doing it?

The answer was no.

then I would ask them to help me select what we were gonna cut.

And that they would always sit back.

They'd first, they'd confused.

And then I would say like, and then I would tell them like, I have a $10 million deficit,
like there's no new money.

And in fact, I'm looking at, you know, I have a list of things that I'm considering
cutting, aspects of your portfolio.

Like we need to have a conversation about this.

Like how can, how can we reduce as well to live within our means?

And, uh

Those, that one question, that one approach generated empathy across the table from me,
right?

They asked it, oh, this is, I don't want your job.

it helped a lot.

And I took, and now I use that, I use that with patients now.

I use that approach to obviously not with the money and fiscal planning, but that type of
approach, like how to generate empathy with people and use empathy to mitigate.

misunderstanding and to uh generate alliances really helps you metabolize and help because
it's like putting rocks in a rucksack, right?

It's like eventually it gets too heavy.

need somebody to help you carry it.

And if you're always the person that people are pointing fingers at, it's just difficult.

You know, think people don't, our listeners, people everywhere don't really understand
these types of conversations, but it's very hard to cut ribbons and preach innovation and

excellence when you're running a zero sum game.

And as you aptly point out, you want to be innovative or are we going to cut from like,
there's no model in business.

don't think that can function where a business survives and, you know, stays,

stays atop its area for generations.

There's no MBA program that's going to teach that.

It's not going to happen yet.

It conveniently positions leadership like yourself that actually is engaged.

I must say, what I hear from your conversation is that you have been there to make the
tough decisions.

A lot of leadership that's

or positions that are created where there's no training, the last thing the leader wants
to do is deal with a difficult situation, which is really what leaders are called for.

But when unprepared, that becomes traumatic in itself.

m You know, and I can list off examples.

It's like uh your nurses who work for you that commit suicide, nurses or physicians that
are uh posting racist content online and then need to be let go because it's again, these

are the egregious things.

A patient dies due to an error because a nurse was sleep deprived and working in the 13th
overtime shift consecutive.

uh The list goes on, a nurse sexually assaults a patient and the system, because the
patient doesn't press charges and there's no criminal charge, then the organization is not

going to discipline the employee or let me fire them.

There's a lot of moral complexity in healthcare that's not acknowledged at the senior
leadership tables.

And then of course, it's just like the, we're looking every health authority in Canada
right now is cutting because we're cycling into a major and probably long-term austerity

phase, ah just like the 1990s, I think.

And people are losing their jobs and their livelihoods.

So non-clinical healthcare ah team members are being let go.

ah That's a big deal.

And when you're the leader making those calls, when you're the CEO or the vice president,

that is then directing your directors and then your directors, you're directing your
managers to uh deliver layoff news to hundreds of employees.

And you know that there is a family attached to each employee and how are they gonna pay
their bills?

What other sector are their skills transferable to?

The answer to that is almost zero in the private sector.

um So their transition is going to be radically diff, like they're going to have to make
radical change in their life, read from retraining to taking salary uh reductions that are

probably going to be difficult for a lot of people and using the word difficult, it's like
an understatement.

So, and the, so the moral weight of that just from uh is, uh is challenging and uh you see
it in body as well.

Since I've left, I still keep in touch with lot of the friends and uh colleagues that I
used to work with.

And when I see them now, I see the age.

People keep telling me how good I look and how I'm happy.

And, Johnny, you look so young.

I'm like, really?

What did I look like before?

And then I look at some of my colleagues that have just weathered the storm and they're
still going.

I have a lot of respect for that.

And I look at them and they're like, not happy.

or they appear to be not happy.

And I can see like they look older, like they look weathered.

Some of them have put on weight.

Some of them, you know, they just like the wrinkles and lines and their color.

As clinicians, we see those things in people, right?

they're like, oh, hope everything's all right.

But it does have a dramatic effect on your health, like as a, just from a physical point
of view as well.

John, we've been talking a lot about leadership and the different facets as we make our
way up the ladder of leadership and what responsibilities come with that rise up the

ladder of leadership.

But as a nurse and speaking to listeners now, what expectations should they have of
leadership?

Lots of things happen.

You speak of the trauma exposed nurses, the violence exposed nurses, their bills now being

tabled and said about violence towards health care providers.

Can you expand on that?

What should our expectations, what should our sons and daughters' expectations who are
starting off in the health care field be about violence directed towards them?

m I think the basic foundational expectation should be that they'll be protected, they'll
be safe, and if uh safety concerns arise, they'll be dealt with quickly, ah reasonably,

and transparently.

ah And unfortunately, that's not the case in most systems in Canada.

I have been exposed to violence.

as a clinician, I've managed violence as an incident commander, as a leader, including
shooting in an ER, one of the organizations I led, active threats, bomb threats.

like, you know, the most severe, the most serious cases that you can think of and all the
way down to managing lateral violence at the bedside.

But I stepped away, like the trajectory of my career and the chronology of events that
have

that I've lived, had 10 years of focused, um high fidelity clinical experience.

And then I had a decade or just over a decade of leadership and now I've come full circle
and back to clinical.

And I can tell you, the decade in between my two clinical phases are night and day from
the level of violence that I see in my day-to-day practice today.

And ah I've reflect on

There's one encounter I had with the chief of police ah in uh Victoria in one of the
facilities I led.

I met with them fairly regularly and we were talking about, I was just talking about the
things that we had, I was dealing with on a daily basis.

He was like, so how was your day going?

We were just making small talk before diving into an agenda.

And he said, you know, that's a crime, right?

Like we haven't, I haven't heard any of this.

And it struck me like his response was,

Yeah, we're dealing, we're not reporting crime as a sector.

We don't report violence ah very rarely, unless it is like very severe, very egregious.

We don't report it and we live with it.

And the nurses and the doctors come back to work the next day, like it never happened.

um So the expectation, we need an expectation from an assistance level that it will be
dealt with.

And that requires us to report it and like name it as

violence, name it as criminal behavior.

And um the concept, when we talk about violence in healthcare, I find it often gets bogged
down uh by a commitment to honor trauma-informed practice.

And trauma in my mind, in my experience, uh trauma-informed practice fails when it becomes
trauma-exposed practice for providers.

So I'm a huge proponent of harm reduction and trauma-informed care.

De-escalation, yep.

We need it.

Yeah, it's the right thing to do ethically and morally.

And I'm glad that we look at it.

um But when a patient punches me in the face, that's a crime.

And if we don't report it and treat it as a crime, then we're not supporting staff
members.

I've heard patients tell my female colleagues if they're going to quote, rape them.

And my female, my...

Yeah, no, I didn't mean to cut you off.

just, but this is, I'm just hearing this over and over again, that these things are
happening.

And I agree with you a hundred percent.

How do the people working in the Emerge, working in the ICU, wherever this is happening,
how come they don't feel backed up?

How come they don't feel supported?

And

It's not the COO who's going to be there to back them up.

There's going to be layers of management along the way.

How come they're not standing up for their young?

Politics is a big factor here.

It's an elephant in the room that we don't talk about.

I recently spoke to our Deputy Health Minister as just a frontline nurse.

She was in one of our facilities doing a leadership tour, which is fantastic to see, and
offered to chat with me offline at a later date.

And she was interested in some of my input and I provided that to her.

She was excited to tell me about things that were happening, which is great.

um All those things were like very macro level.

uh And my feedback to her was keep doing those things because structural change is
required.

um But that doesn't change the fact that today in one of your hospitals in British
Columbia is being assaulted, like as we speak.

That doesn't change that fact.

So we have to think about the macro and the micro.

The why is again, multifaceted, but uh we need to take accountability as providers to name
what's happening to us so that our leaders, our leaders, cause I see it on both sides

right now.

Today I'm a clinician.

There's something bad happens to me.

I've been, I've been guilty of not reporting violence uh formally.

I went home from work recently and my wife said, how was the day?

And I said, I had to fight a Nazi.

And that sounds ridiculous.

But it was a patient who came in topless, uh substance-affected and was treated with
Narcan.

He was unconscious when he arrived.

He was covered in white power tattoos and swastikas.

And the moment he got Narcan, the fight was on.

The brakes were off and he had other substances on board that were fueling aggression and
violence.

And he broke about $10,000 worth of equipment.

knocking it over, he jumped off the bed and started trashing the place.

A paramedic had to help restrain him.

Security, we have security in the units, but obviously there's a lead time on a leg to
hands on.

And I was close by and he was like inches away from 105 year old patient with pneumonia
and a six year old with a wrist fracture sitting on his mother's knee in a chair.

And they were witnessing this violence and at risk of being injured themselves because of
the commotion and the kerfuffle.

And I ended up holding this man down on the ground until uh the security arrived.

I didn't report that.

I let my manager know about it in an email, but I didn't follow the reporting process
after the fact because I had other work to do.

At that point in the day, I was triaging and I had a lineup of people that needed me.

patients that needed me and I carried on with my duties and instantly you talk about it,
distraction and density.

I'm making a lot of cases, I'm making life and death decisions at the trip and the triage
process.

I have to pivot, hold the man on the ground um who's violent and assaulting everyone and
breaking things, causing damage property and scaring and terrorizing people.

And then I have to go back to making life and death decisions.

At the end of my shift, I go home and I have to come back the next day.

So I go home and sleep, I come back the next day and I dive right back into a busy
clinical workflow.

and the reporting mechanism requires me to log on to a different system, fill out a
violence, like a report.

And that, I mean, that might take me 20, 30 minutes to do, or if I use the call center,
I'm put on hold, I talk to somebody who asked me, you know, it's good, it's, know, no

criticism for the people that support that process, but it's time intensive.

And if I encounter two or three of those events in a shift, which is reasonably expected
right now, uh

anywhere in Canada, ah you know, I'm just not, I don't have time for it and I'm not going
to do it.

And so I'm pointing the finger at me right now, because as a clinician, have a, I have a
responsibility to report those incidents and it's that the structural constraints I'm

working under don't allow me to do that.

Or I don't discipline myself enough to do that.

One or the other, then the system doesn't have the opportunity to respond.

So there's a reciprocal relationship between clinicians and the system.

The system needs to provide a reporting mechanism that is ah

convenient that they reduce the amount of friction that clinicians are up against when uh
they experience violence.

And then the last part of that is they actually have to do something with that
information.

we all clinicians, we all joke that it's those reports go into a black hole.

And of course they don't, they go into a repository that's, it becomes a data point.

uh And how that data is managed, we, as clinicians, we don't have that line of sight.

don't see it.

uh And so we make up a narrative in our head.

And the narrative most commonly is nobody cares, right?

And so that just compounds the moral injury that you have and the fear that you experience
and it creates hypervigilance and all the negative things that come with that.

Well, you see no signs of anybody caring though.

And I think I'm going to think of a different example.

mean, your training probably prepared you to subdue that violent individual and you're
probably more trained than the average person to deal with it.

But let's picture a young nurse getting punched in the face where they struggle to get
paperwork in, they're traumatized.

uh Or maybe examples recently heard of nurses uh entering the hospital getting assaulted.

uh

you know, someone trying to mug them, whatever.

But then not having a path of navigation, not having leadership check in with them, you
know, being asked a series of questions, which almost create cognitive dissonance and at

times even gaslighting, where individuals actually make the effort to report repeated
events and they're told, well, how come that happens to you so often and nobody else?

You know, there's a lot going on here and

You know, there are lot of voices, worried voices out there.

And, you know, at that point may just not be good enough.

That's true.

You know, leaders need to walk down the hall, right?

They need to go back into where they originated from and check in with the people they're
leading.

And I have no doubt from the experience I've heard from you that you are that kind of
leader.

um But at the same time,

There's so much variability out there that the assault and the swing and the punch or the
threats as you describe them may be carried despite reporting and there's silence.

How do we overcome that?

Well, I think you just touched on something I'd like to, that you said something that I
think is quite important.

You said um the reporting itself can be triggering.

Great.

And we think about the concept of trauma-informed care.

uh

most of our, like 90 % of our nursing workforce is female.

for I think over 40 approaching 50 % of our physician workforce is female.

Almost 100 % of the violence perpetrated against healthcare workers is male, in my
experience.

And I think there's lots of data to support that.

And so um when we talk about trauma in healthcare, like uh my female colleagues being
catcalled,

while they walk down the hallway by a patient or a visitor.

like I stated previously that, you I've heard patients threatened to sexually assault my
female colleagues and they just shrug it off.

They're like, oh yeah, you know, that's normal.

These women are also, they deal with that in their outside of work, in general, in life
because gender-based violence is a problem.

So when my female colleagues are experiencing violence in the workplace, having them
report it

is also, it can be problematic.

And I think it plays into why a lot of it isn't named as violence because it's accepted in
society and it's accepted.

And then the culture of healthcare doesn't name it as violence, doesn't name it as
criminal behavior.

I was reminded last night at the Christmas party by somebody who thanked me for supporting
them recently.

It was a young nurse, she's in her early 20s.

And she said, you remember?

This is gonna sound ridiculous.

But she said to me,

Do you remember those two men who were masturbating in the waiting room and we had to deal
with them and you went and did it.

So I didn't have to.

I said, yeah, I remember that.

And she just thanked me.

She's like, it, really meant a lot to me that I didn't have to do that.

Like I, that you went up to them and evicted them from, the ER and it turned into a big, a
big scene and they were dragged out kicking and screaming by, by our PSO, our protection

services officers or the security officers, but they do a great job.

I had a of respect for them.

It's a very difficult job to do.

But imagine that.

Imagine sitting down and these two individuals were sitting down in the corner of the
waiting room where there were children and toys.

They have toys so the kids can keep themselves busy while they're waiting to see a doctor.

But that wasn't reported as a crime.

Masturbation in public by two men.

And those two men

the response by the other colleagues that day were, oh yeah, like they're known to the
department by name because they have uh high needs, they're substance-affected

individuals, they may or may not be housed and so forth.

And so we take the concept of trauma-informed care and we try to empathize with these
people who are exhibiting criminal behavior and we let it go in the name of

trauma-informed care.

And um I think that we don't talk about that enough.

It's an elephant in the room and it makes a lot of people in my circle of uh influence
very uncomfortable when I talk about it.

I said, listen, is uh this person medically and legally competent?

Yes or no.

Are we forming them under the Mental Health Act because they're not responsible for this
behavior?

The answer is no, then they've just committed a crime.

Could they do that in an airport?

No.

Could they do that in a bank?

No.

how come they just did it in a hospital environment in front of 15 vulnerable people in a
waiting room and they get to walk out of the building?

It doesn't make any sense.

It's not reasonable when you zoom out and you look at it from a systems lens like that.

But those are daily occurrences in most hospitals in Canada, whether it's in the ER or uh
another area.

em Home care is one of the most, think, when I think about jobs that I don't want to do in
nursing,

I think home care would be one of them.

you walk into very uncontrolled environments.

You're going into people's homes with pets and firearms, ah kitchen knives.

You never know what's going to be behind the door when you open it.

um And like the stories that I, my home care colleagues have about their day to day are
fascinating to listen to or find some cases.

And of course they're beautiful in other ways because of the care they deliver and the

and gratitude they get.

I don't want to overstate the problem.

But yet it is a problem and we don't name it.

So I think that we need to really look at ourselves as members of a team.

We need to report.

And our leadership needs to find ways to prosecute these people.

Like to call the police and have them arrested and removed from the facility.

And there's no deterrence.

other thing with violence in healthcare I'm very passionate about speaking to right now is
a lack of deterrence.

We respond to violence, um but we don't deter it.

There's no metal detectors.

There's no body scanners.

There's no canine presence, like there is at an airport, let's say, right?

There's no, a uh lot of the hospitals in British Columbia, the security staff don't wear
uniforms.

They like to go wear a golf shirt and khaki pants or something because they want to be
trauma informed.

And they acknowledge that uniform presence can be triggering to people for various
reasons.

um

But then, you know, there's a contagion effect that happens with people because we're
human beings.

And, you know, whether it's a broken window theory or you just talk specifically about
contagion effect with uh either kindness or panic or violence, it's uh phenomenon that's

as old as time.

One person approaches the desk and is angry about something, the next person feels
empowered to do the same thing.

And we see it in the news, we see it in society right now around the world.

If you have a uniformed security personnel meeting you at the door, right away that sets
the tone.

And yes, it may not be trauma informed from, depending on what position you're looking at
the issue on, but it definitely demonstrates that there is protection.

If you're a staff member, you feel safer.

And if you are a patient, a substance-affected person, if you're contemplating violence,
you are looking at a potential consequence as soon as you walk in the door.

And that is prevention.

You know, it's prevention in the form of deterrence.

And right now, healthcare lacks any form of deterrence.

Every door to the hospital is unlocked.

can come in from any direction.

We really need to harden our, like we need to create a harder target.

for people right now, our staff and physicians are uh very, very vulnerable.

Do deterrence work?

What about deterrence from uh personnel?

uh Is leadership deterred these days by all of these things?

uh And are they deterred from acting uh in the best interests of their personnel?

Yeah, I think that would

You have your $10 million.

What if I came to you with, I needed a million dollars to put in metal detectors and
you're in a $10 million deficit.

Is there some override?

We need to pick opportunity costs.

Maybe we need a 10 % reassessment on every $100 million that leaves the country.

We need to say, well, that's nice.

We're going to take actually 10 of that and redirect it towards health care and tackle
some of these mandates.

before the money leaves the country.

You know, as it sort of was an afterthought, sort of reappropriation to key areas of our
society that need it.

But what if there's no money?

the medical, sorry, me, metal detectors never actually arrive.

Even if you're in a high event center.

reason metal detectors, 100%, the reason why metal detectors are not in Canadian hospitals
uh or scanners, because it's not just metal detectors.

There's scanners out there, some hospitals in Ontario that have used them uh very
successfully and get hundreds of prohibited items pulled out of the hospital per day by

visitors that are bringing them in, visitors and patients.

The reason is politics, it's optics.

So when I was in senior leadership, I asked every, like all the time,

shout it from the rooftops, I want a metal detector in my yard, I'll be the pilot site, we
can do it at my site.

And the answer from senior leadership, and when I spoke to government officials directly
about it, they said there was no political appetite for it.

This is like a nebulous statement, and we hear a lot in senior leadership roles at the
health authority level, we'll hear um the ministry won't like that.

oh

political appetite?

Does that trump a population's appetite?

That's a great question.

Yeah, that's an excellent question.

uh I guess what do I mean by political appetite?

I mean, the politics around trauma-informed care become more important than safety for
providers.

It's like this balance in this tightrope.

And so the government is, maybe people in government would disagree with me, but they walk
a very fine line of precedent setting and politics and

depending on what side of the aisle they are on politically, right, left, whatever, um
they have principles and values that they try to defend.

um put all that aside, like all partisanship aside, saying no as a leader, uh like I'm
talking about um operations leaders.

like the senior executive directors, vice presidents, CEOs of organizations,

saying no to a frontline operations director about a metal detector after there's been a
shooting in your hospital ah due to somebody coming in with a knife and threatening staff

and themselves.

It's reasonable to explore that as an option.

It's unreasonable to say, no, sorry, John, I understand you're emotional about this right
now because there's been a uh critical incident.

em But the ministry will say no, so we're not going to waste their time.

That is very common in any health authority I've ever worked in, and I've worked in many
health authorities.

I'm not throwing shade on any one organization right now.

There's a lot of talk about neuroplasticity these days and that sounds like something that
needs to be worked on.

That's like a bland monosynaptic reflex.

Yeah.

And that's where integrity and leadership comes in and it's why it's so difficult and why
leaders burn out so quickly and why we see such churn at the leadership level.

was uh at a clinical conference, it was a quality summit and we had a keynote speaker who
was a surgeon and somebody asked him on communication, how do you deal with your CEO when

you don't see eye to eye as a medical director?

It was like a very reasonable question.

And the initial answer he said,

He said, you just hold your nose long enough until your CEO leaves.

Cause they'll bet they're only there for a few years at a time.

And then when they leave, get a new one and you can start to formulate new trust and
bonds.

And everybody tipped their heads back.

was like, like a thousand people in the, in the conference center and everybody laughed
politely and then got on with their job.

And I was sitting there as a, as a senior leader and kind of looking around and it was a
fascinating, uh, example to me, you know, from a psychology point of view and group think

point of view where, um,

That's how we think about um leadership.

uh

We see that churn at the senior level um because if you don't toe the line politically,
you're gone.

If you do what's right, you'll get pushed out um because you're going to have to say no to
people uh who are going to rally against you.

um So it's a very lose lose scenario and it shouldn't be that way.

It's like people are banking on a culture of transience, which again, that doesn't really
afford longevity to a business model or a business.

I want to change gears a little bit.

In a lot of your postings and writings, you speak about how every nurse needs an exit
strategy.

Can you expand on that?

And you know, when we're talking about the worries we have about retention rates of new
graduates, I'm very worried when I hear exit strategy, but

Can you expand on what that means a little bit and how that sort of feeds forward into
what you've spoken about called cold lavender?

Yeah, it relates to the notion of uh how we metabolize trauma and how we process it.

uh So when I was an ER manager 15 years ago, learned quickly, I would hire a nurse and
they would quickly start to show signs of strain within six to nine months.

By 18 to 24 months, they were either reducing hours substantially, like going from full to
half time and

and working in different specialties to maintain sustainability, or they were just leaving
entirely and they would pivot to a different specialty that required retraining.

retraining, of course, as you pointed out, costs money.

um So to prevent that attrition and that very predictable pattern of behavior, I would sit
down with my nurses early and I would say, okay, um you're doing great.

um How can we keep you in a year's time?

And they would always kind of look at me say, what are you talking about?

Some of them got it right away.

They were like, yeah, that's a great question.

Like I'm really interested in forensic nursing or I'm really interested in uh a CLS or I'm
really interested in pediatrics.

And I would say, okay, I would like you to help us.

I'm going to pay you and take you off the floor.

I'm going to pay you a few days to help our educators put together.

you know, a training package or deliver care and get them passionate about an aspect of
care that took them away from the bedside for a short period of time and gave them the

passion and gave them purpose and drive and stimulated them outside.

And that would almost always increase their longevity because it created ownership in the,
in their role in the department.

um And it's difficult to do with everybody though.

That's the thing.

So my, by exit strategy, mean like, like I have an exit strategy.

uh, right now as, as a bedside nurse.

you know, I work well, I like physically it's a difficult job.

Like I'm 48 years old and some days I'm putting on over 10,000 steps in a shift.

I'm like holding people on the ground, like I just said, or doing CPR, lifting people out
of vehicles.

Uh, it's, it's, it's physically straining.

It's mentally straining.

And, I've already, I've been through cycles of, um, of, uh, injury in my physical end.

um

psychological in my career and I don't want to go back there.

So I'm giving myself permission to change lanes and switch gears so that I can maintain
joy and work.

fortunately, and it's a reality for that, system and our leadership needs to recognize is
in nursing, nurses have options.

can change specialties like in a blink of an eye.

It's like poof, you're a PACU nurse, poof, you're a med surgeon, it's like...

just like that because the, unionized environment award allows them to do that, which I
think is actually healthy in the context of a highly trauma exposed industry because it

allows them to stay in the industry and uh pivot and get away from noxious stimuli.

So for any ER nurses, some people really struggle with seeing wait times.

Like they're just morally affected by forcing

patients to wait and they own it.

think they're forcing patients to wait.

The system's forcing patients to wait and they're bearing witness to it.

Others are scared because of the violence and they just can't take being hyper, like as
you know, being so vigilant all the time and develop.

they can't do that.

Others are, it's the tempo, it's the physical component.

They just, they're, they're just so tired all the time.

They don't, they don't see the, they don't see it as a humane tempo and they get burned
out that way.

There's lots of different reasons.

And so what,

exit strategies are important for nurses to realize like when you start to lose the joy
and the spark that brought you into a profession, you really need, you know, my opinion to

think about ways to rekindle it, like to reinvent yourself, to find new beginning.

And uh that strategy doesn't have to be leave.

Like it doesn't have to be an exit per se.

um But it's, it's, it's a change in a new beginning and that takes, that takes ownership
and direction.

So are you approaching your leadership saying, I'm really burned out.

I'd like a change.

Is there anything I can help with?

Is there a project I can lead?

Is um it possible that I shadow in a different department?

Can I go learn about substance use uh with the street nurses and home care?

There's all sorts of different ways that leadership can create that flexibility so that we
uh don't just lose people.

Because if we don't do that, the other option is just leaving.

altogether and that attrition is serious problem for patients.

And how often will that be countered by, well, if you leave to do something else, everyone
else's patient nurse ratios are going to go up or we're already short staffed.

So nice try, but these are your options.

We know what the numbers are like.

We know what the situation is like in the community.

How often or how applicable are these approaches in and across all areas?

some fortunate scenarios where that flexibility exists or people in many places so
strapped that, well, that's a nice idea, it's just not able to be put into practice.

That's a fair question.

And I think the answer is it's not, it depends.

It's incumbent on our leaders to create that environment.

It's incumbent on them.

So you're right.

Different leaders are going to take a different approach.

I led with that approach.

it's why I'm leading.

It's obviously, it's why I'm bringing it up because I feel passionate about it for better
or worse.

oh I've seen other leaders uh completely say like, if you can't,

If you can't keep up, maybe this job's not for you.

And then the staff member doesn't feel supported.

They feel like a failure and they leave.

ah So there's like two ends of that spectrum.

we need to find, the system needs to empower leaders to create that flexibility across the
board because we all need a break.

Like these jobs are complicated.

uh

And I love the notion of, especially for leaders, going back to the all or nothing
structure and governance, it's just a stroke of a pen.

I think we should outlaw full-time leadership positions for nurses and nurse
administrators.

They should have to practice clinically.

I wanted to my entire career.

I loved clinical practice.

That's why I've come back to it.

um But I was banned from it.

um because of labor laws and union uh adversity.

So, uh you know, if we had nurses, if we had nurse leaders that were practicing 50%, even
just 25%, something where they were working a few shifts a month um and they felt the

pain.

Yeah, they felt the pain that their staff feel, because it's one thing to feel it, it's
one thing to empathize, but empathy and living, it...

in reality is a different thing.

And I think that wouldn't shape policy and it would shape the response.

Like if your manager has to work clinically and your manager's punched in the face and
threatened with sexual assault, the barriers to reporting should intuitively improve if

you're looking at it as uh at a macro level.

And I think that's where the disconnect between senior leadership and health care is right
now, where you say we need, where you have somebody at the front line saying we have a

problem with prohibited items entering our facility and causing harm to patients and
staff.

We need scanners at our entrances and we need to restrict access to the entrances that
don't have scanners.

This seems quite reasonable, right?

But when the response from senior leadership is no, then the ministry will say no to that
because of.

trauma and conformed care politics and uh ethos, then where are you?

You're going nowhere fast, you're spinning your wheels.

Is it truly trauma informed at that point?

It's almost like there's an element of blindness.

I can't quite off the cuff come up with a new descriptor, there's a lot of blinders here.

think we've lost the plot.

We've lost the plot when it comes to trauma-informed care.

And I think that is creating, it's setting the table for violence in our system.

What's the best operating definition of trauma-informed care for our listeners to really
take home so that they understand when they re-listen to these episodes or look at some of

the clips from today's discussion?

Because it's come up often.

I the definition for me is acknowledging that people, we all have a story.

uh There's a reason that we show up the way we show up, right?

ah And we need to acknowledge that.

We need to give people space and compassion and empathy.

uh If it's a patient who is substance-affected with multiple relapses and multiple
overdoses, we're acknowledging that their life is not easy.

uh as it is, obviously understating their situation.

They're probably coming from trauma.

the evidence suggests that, you know, they probably endured childhood trauma.

They probably enjoyed, endured poverty and are enduring homelessness in many cases.

So these are all things that are terrible.

And we need to give, we need to be compassionate in how we handle those people.

And I think that's correct.

um

When that patient's, when that concept allows that patient to punch me in the face and
walk out the door without any consequences, that's when it's failed.

that's when it's no longer trauma-informed care.

Now uh we're creating harm under the new.

Performed care.

Yeah.

Yeah.

And that's the, you know, that's the, uh, I've, I've heard security leaders in healthcare
and multiple health authorities say, uh, they've, they've said like, I don't think we

should have, we don't need a uniform presence at, at the door.

We, we shouldn't, you know, the first thing that patients should see as a friendly
clinician.

I don't disagree at its core.

That's a,

that's a good place to operate from.

um But when you're looking at rising violence, uh rising acuity and severity of violence,
like in the violence index, uh you have to start to think like, oh, and we're losing

nurses hand over fist.

Nurses are, think the average lifespan of an ER nurse is like 18 months.

And they've taken a $40,000, $50,000 training program.

through an accredited training institution and their salary was paid, they were paid for
two months to learn.

And then they they shadowed senior emerge nurses for weeks before they were allowed to
practice independently as an AR nurse.

That's wildly expensive.

And then their knowledge translation and the confidence they build over the years, they
get up to a intermediate expert level, then they leave to go to a different specialty

because they don't fit, because they're hypervigilant, they're scared.

em I've seen nurses choked against the wall since I've uh come back to the bedside by
patients and intervened and evicted the client as an RN.

But there's no system response that client leaves or the client comes back, the client
chokes the nurse and then they represent to the emergency department with a care plan that

says they're not allowed to be in the department.

and we don't evict them, like we don't enforce the care plan.

We don't call the police and say this patient is trespassing.

We don't call it trespassing.

We say they're here to see a doctor for X, but they're actually trespassing.

So we need to name it and...

stop thinking with the risk management lens, it's like, what kind of trouble will we get
in if we remove this patient with a history of violence or who's exhibiting violent

behavior or criminal behavior?

When you start thinking about this patient is breaking the law and harassing our staff and
we're not gonna tolerate it.

It's amazing how that's evolved and has such deep roots now as a modus operandi.

again, the parent in me uh is probably the best barometer, as it is most of our listeners.

uh Or if not parent, knowing someone you care about who's in the field and who is uh
facing such threats.

You know, your exit strategy really to me,

sounds like a repartitioning of parts of your self-strategy to ensure longevity.

And part of those exercises involves getting together after large events and making sure
there's collective healing.

And I imagine that's what Code Lavender is all about.

So I experienced code lavender when I um started my chief operating officer position in a
hospice.

This is one of the largest third largest hospice in the country.

had, it was a leadership role where I had first leadership role where I had no directs,
like I had no clinical acumen in that area.

I'd always been in the life and limb specialty, critical care, emergency flight, nursing,
mental military.

I heard about Coal Lavender.

I noticed that, you know, there were, there was always like a staff member, a physician or
a nurse or a social worker in tears on the unit.

And when I would reflect on seeing tears on the unit in the acute care context, it was
usually because something bad had happened or something went wrong or a staff was in

distress.

In this case, in a hospice environment, these were, these were seasoned pros.

Like these were nurses with decades of experience who were still there versus

the 24 year old, 25 year old ER nurse with an 18 month career expectancy in that
specialty.

I started to step back and go like, what is this code lavender about?

And what it is is the nurses who encountered trauma, like they'll say difficult dying or
traumatic, traumatic dying uh or difficult behaviors because of, because family and

visitors are bereaved.

They would call a code lavender.

It's a silent, it's a silent signal.

So they would put a, uh

a lavender magnet next to their name on the assignment board, or they would put a code
like a lavender button on, or a lavender dot on the patient's whiteboard outside their

room.

And that was a signal to everybody that they were struggling.

And then the team would silently rally around them and pull them aside and say, hey, what
can I do for you?

Can I take this assignment for you?

Should we switch assignments?

Do you need to go for a walk?

Would you like to go have a talk?

Like there was a department social worker and counselor that was available to staff and to
patients.

And I thought that was remarkable.

We had a social worker on the unit who was also available to staff in real time.

So if a staff member was cycling, they could step away and they could have a conversation.

You know, it was like a micro counseling session, sometimes not so micro in duration.

and I, I thought at first I thought to myself, like I had all this, it created some
dissonance for me because I thought like,

crying at work talking about this while the patients are here like, this professional?

Of course, the answer is yes.

And the reason why the answer is yes is because and why the nurses in that specialty had
decades like they were there, they started there and they were going to finish their

career there because they love it.

uh They, they dealt with their trauma in real time.

They didn't push it down.

didn't witness that.

They didn't witness the pediatric deaths and then stepped out of the room and be
threatened with violence.

And then

uh, be yelled at by somebody who was frustrated about a, uh, a 10 hour wait for a
non-critical event or non-critical injury.

They were, they were dealing with their emotions, uh, in real time and the, uh, the
culture, the workplace culture enabled, enabled and supported them to do so.

And it was a real strong lesson to me.

That was just, I left, uh, I left, started my sabbatical just after a year in that, in
that role.

And ah it taught me a big lesson, like probably too late in my career.

But of course there's nowhere to go but forward.

And that's one of the things I talk about now online.

And when I, when I practice myself, I try and emulate that.

try and be supportive and ask my team members if I'm, if they're okay.

And if I'm not okay, I name it.

People ask you, how are you doing?

And I was like, oh, you know, I'll tell them.

I'll name my emotions and feelings and sometimes it makes people really uncomfortable.

I've noticed and other times people like really surprised me in a wonderful way and
they're like, well, how can I help you?

And it's like, it's a good feeling.

um I wrote one post about how I got overwhelmed with emotion during it.

were, taking a report.

had a really difficult pediatric case.

And for me, pediatrics is I love pediatrics, but it's also as a parent and um

it, I find it difficult now the holder I get the harder I, is the harder it is for me to
see, um, children suffering.

And, uh, anyway, I was relating to the mother in that case.

And I was just like putting myself in this mother's shoes and I got, I got really upset
and, um I was, I cried and, uh, my, some of the staff were like, like they were like, no,

you can see like the, they didn't know what to do.

And there's a few other couple other team members.

were like, John, this is okay.

let's go get a glass of water.

They led me out.

took me like, didn't take me long.

I recovered from that in about, you know, three to five minutes.

I disagreed and came back on the unit and I was able to carry on, but I didn't feel, I
didn't feel stigmatized.

didn't feel, um I didn't feel like inept in any way.

And 20 years ago, I certainly would have, it would have been awkward.

People would have said, okay, just get out of here.

go do what you need to do and come back.

But nobody would have asked me after the fact, like, what did you need?

Or I probably wouldn't have talked about it.

would have been embarrassed.

And now I've given myself space and um I'm kinder to myself now and acknowledging that
trauma is trauma and the emotions that you feel when you're experiencing trauma are

natural and normal.

And ignoring them, yeah, you're human and ignoring is not healthy.

Yeah, that's what Code Lavender is all about.

And I think if we took a Code Lavender approach to emergency services and critical care
areas, acute care, we wouldn't, I think it would improve the conversation because it just

enhances the culture and it makes you honest with yourself and it allows you to be honest
with your colleagues.

And I would hope that it would help us name

The other things around us like criminal behavior and trespass and all the things that
I've just been talking about, like it's all really related.

It's about being honest and just naming what you're experiencing.

It sounds like a cold lavender comes from here and from here a culture grows.

I've never heard cold lavender being announced on the overhead.

It's not on the the list of codes, but it sounds like one that should be there, one that
we should learn as importantly about as others.

So as we come to the end of this amazing discussion, and I could only imagine hours more.

um to really explore things and maybe we'll get a chance someday to do that.

What habits and rituals allow you to care for yourself the best these days?

And for the caregiver who's listening today, feeling trapped, too tired to stay what
they're doing, uncertain about whether they should leave or not, what's one small step

they can take this week that'll sort of make them feel a bit more steady on their footing
as they navigate this period of time for them?

Yeah.

It's kind of a short answer.

uh When I was a clinical ops director, I used to tell my managers, no one's coming.

Let's not complain about the problem.

Let's stay solutions oriented.

uh It's up to us to create this, to look after our teams.

And I tell myself now that the same thing I say, like, John, no one's coming right now in
the context of the system.

There's lots of things stacked against you.

So if you want to stay here, which I do, um how can you, uh

maintain wellness and uh sustainability and maintain the joy that you have right now in
your work.

And for me, um it is no substances, so no cannabis, no alcohol, prioritizing sleep
ruthlessly.

I protect my sleep immensely because I am exposed to so much trauma.

There's lots of evidence and literature out there to suggest that sleep is
neuroprotective, especially immediately after traumatic event, you need to sleep.

So not being scared about using your benefits to call in sick after a critical incident if
you need to stay home.

Don't cope with it with alcohol.

Counseling is a big thing.

Talking about it, telling somebody your story is very therapeutic.

Journaling, I have a practice of journaling right now.

Where after I sit on my, it's not complicated.

I actually made the motion with a pen here, but.

Like I get a cup of coffee, sit in the chair in my kitchen and I look out the backyard and
I just kind of reflect on things and make notes on my phone.

Like it doesn't have to be complicated, but you need to develop a system that uh helps
you.

And the other thing is breathing.

I've done a lot of um personal exploration with, and I'm an advocate for veterans' health.

I've talked to my friends with PTSD.

have lots of friends with complex PTSD and breath work is an amazing tool.

And uh when I was a junior nurse in nursing school, used to hate all the things that I
talk about because they talked about journaling and we would get, we were encouraged to

journal and we could get graded on the quality of our journaling, which seemed a little
ludicrous to me at the time.

um

Now I realize the importance of that.

And I said earlier in this conversation that, you know, we don't learn anything.

I guess we do now that I just said it out loud.

There was a few things that we learned earlier on, but the emphasis wasn't applied and it
was easy to minimize and it wasn't carried on.

I didn't see it in practice and my manager never told me like, Hey, are you journaling?

Are you writing about your feelings?

Are you seeing a counselor?

Are you married?

Hey, good juice.

Are you in marriage counseling?

Cause that's going to help, you know, like the way.

curricular tick box, right?

Okay, we covered those things, but no one ever followed through, which is a big problem.

Yeah.

So finding a list of things that helps you.

For me, physical fitness is a big part of it.

uh I started clinical practice and I lost 20 pounds like a year and a half ago.

So uh that's helped me maintain.

I cycle to and from work.

uh I'm in a position in life and my kids are old enough that I can do that.

And I get it.

you're a young clinician and you've got a young family, you've got a lot going on.

So it's easy to neglect yourself.

But if you neglect yourself, it's a zero sum game race to the bottom.

uh focus on breath work, focus on writing, focus on counseling, uh focus on your benefits
and speak to your doctor.

I don't think we often do that.

We're the worst patients.

If you start to feel depressed or anxious, it might be something else going on that you
need to address.

And your doctor is like your biggest ally in that.

uh

and that so you know do the things that you would tell your patients to do and like really
honor it in yourself and accept the fact that you're human and that you need to do those

things as well.

And I think reaching out to the colleague next to you or close by who might be going
through the same meanderings but feeling alone, too often we think we're meant to be alone

in this.

But in fact, everyone's waiting to no longer feel alone.

And it's just collective reach out where suddenly that strength comes from community,
which I think is so important now in all of health care, no matter what field we're in.

You've witnessed so many different angles and you've shared so many different perspectives
today.

I wanted to take the time to thank you for joining us.

It's just been such an incredible conversation today.

So from the Caregivers podcast, we'd to thank you for joining us.

We'd like to thank everybody for listening today and welcome your comments.

Comments have been flooding in after recent episodes and I can't help but think that today
is going to be a very fertile ground for some interesting questions, interesting

discussions.

and we try to answer them as best we can.

And I look forward to seeing more of your work and your publications on LinkedIn, where
that's where we met.

And I was just really happy that we were able to sit and have this high level, but also
grassroots level conversation today.

I think these conversations are fuel and agents for change.

That concludes our episode of the Caregivers Podcast this week.

host, Dr.

Mark, we'll see you again next week.

And till we meet again.

Before we wrap up, I wanted to remind you of something important.

The conversations you hear on this podcast are here to inform, to support, to spark
reflection.

You're not a substitute for professional medical advice, care, therapy, or crisis
services.

Listening to this podcast does not create a doctor-patient or caregiver-client
relationship between us.

If you're facing a medical concern,

health challenge, a mental health challenge, or a caregiving situation that needs
guidance, I encourage you to reach out to a qualified professional who knows your story.

If you're ever in crisis, please don't wait.

Call your local emergency number or recognize Crisis Hotline right away.

You deserve real time help and support.

The views you hear on this show, whether from me or my guests, are our own.

They don't necessarily reflect any organizations we work with, are part of, or have worked
with or been part of in the past.

This podcast is an independent production.

It's not tied to any hospital, university, or healthcare system.

Thank you for being here, for listening, and most of all, for taking the time to care for
yourself while you continue to care for others.

I look forward to hearing from you.