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The cost & courage of caring - stories that spark resilience.
Over the last season of this
podcast, we've spoken with nurses
from across Canada.
Not administrators, not
spokespeople, but people at the
bedside.
And what surprised me wasn't just
exhaustion.
It was fear.
Fear of missing something
critical.
Fear of making a mistake that
could really hurt someone.
Fear of knowing exactly what good
care looks like and being unable
to give it.
We often call this burnout, but
burnout sounds personal.
And what nurses are describing is
really something else.
They're describing a system that
no longer protects patients or the
people caring for them.
Today's guest hears these stories
every day.
Linda Celes is the president of
the Canadian Federation of Nurses'
Unions,
representing more than a quarter
million nurses and nursing
students across the country.
I'm Dr.
Mark.
Welcome to this week's episode of
The Caregivers podcast.
Linda, are we as a society asking
young people entering the nursing
profession
to take on a job and a burden
that's fundamentally going to
break them
emotionally, mentally, and
physically for the rest of their
lives?
Interesting comment, Mark.
I would flip it.
I think as society, we have to
take a grips of what's happening
in our healthcare system.
You know, I represent nurses, but
I always say that healthcare is
the biggest team sport
we have because we all have to
work together.
And yes, the realities of today is
what you said.
It's breaking people physically.
We have the highest physical
injuries, but we also have
the highest mental health injuries
in any industry, and that is not
right.
So as society, we need to commit
to turn this around because we
have great nurses,
great personal care workers, great
doctors in the system that want to
continue for 40 years,
and right now they can't.
So how do we turn it around?
Fundamental question.
So you look back at 2025 and you
define it as
the year that was defined by your
fight.
For listeners tuning in today,
what's one story
that resonates with you and that
you just can't shake from your
head when you think back to that
fight and what you're fighting
for?
It's probably that nurse from
Newfoundland and Labrador.
I don't
want to specify where she worked,
but I was at a social reception
with her and she was kind of
high energy and kind of bubbly.
And I said, "Oh, did you work
hard?
Did you have a nice shift?"
Oh, she just went, "Excuse me, I
just finished my 30-hour shift and
I'm okay, but I just finished that
shift." And I looked at her and I
said, "Where do you work?" "Oh,
it's just intensive care."
But don't worry, I only got
confused around hour 20, and I'm
like mind boggling.
And that really
did a turnaround for our
organization.
We summoned two papers on the
fatigue, comparing nurses to
pilots, to bus drivers, on where
they have a limit of 13 hours a
day.
Why don't we have
that in nursing?
Why do we think that nurses and
healthcare workers can continue on
and on and on
and expect miracles?
So that turned it around.
And then it was that word
"burnout," and you mentioned
it in your introduction.
We talk a lot about burnout, but
what I'm hearing from our nurses,
they say, "Stop, Linda.
I'm not burned out.
It's not an injury.
It's not an illness.
I am morally
worried.
I'm morally injured of what's
going to happen.
It's that fear that's happening."
So we as an organization and
provincial nurses unions have been
trying to change the language
instead of burnout talking about
moral injury.
Instead of staying there for 24
hours after 13
hours, my dears, you should be
going home.
It's not worth the extra overtime
and it's not worth
the risk that you can give to
patients.
So it's again turning around that
ship that healthcare
workers are going to be there
regardless for their health, but
also the patient safety aspect.
Is it understood everywhere that
you can be told you can't go home,
even though you're exhausted?
And is there, is it an unwritten
rule or is it a written rule and
policy that you can be told,
be happy and need to stay, can't
go home?
Yeah, it's a fable.
It's a horror story.
In my days, when I practiced
nurses 30 years ago, you could
not.
And your codes of ethics would say
it.
And we've interpreted the code of
ethics of nursing of not
abandoning a patient.
And no,
you're not going to abandon a
patient.
But if you're beyond the point of
being able to safely
care for a patient, you need to
tell your supervisors, I'm beyond
that point.
I cannot
care safely for a patient and I
need to go home.
And it has to be in writing.
You have to protect
yourself and protect patients by
doing that.
So no one will say to a nurse that
is incapable
of working more than in today's
society, it's 12 hour shift or
eight hour shift, but usually 12
hour and we say around the 13 hour
mark where you will not work.
We have some collective agreement
that say up to 16, where that's
the limit the employer can give
them.
So our code of ethics
is clear.
We're there for our patient, we're
there to do no harm.
And we're not to abandon them,
but we're not to put them in
danger if we cannot function.
And that's advising our employers.
There's still some variability,
obviously, it's a big difference
in those last four hours between
12 and 16, where I could imagine
you would have a concentration of
errors, if anything.
Yeah.
And the evidence is clear, it's
after 12 hours that the incidents,
the errors,
medication errors and others start
happening.
And it makes sense, you know, I'm
sure you've
worked 12 hours in your career and
I still work 12 hours in my career
where it's like,
okay, you shake your head and you
have an extra cup of coffee and
think what's going on.
But
we need to be more supportive and
we need to make sure that we
protect the healthcare worker,
that we protect the patient in our
system that right now is in chaos.
And in those last four hours, it's
not like distractions and
interruptions go away,
everything keeps on at the same
pace.
And, you know, you mentioned that
you have to have a,
someone needs to speak up to say,
I'm incapable of doing the work
for this, I'm too tired,
I'm too exhausted, I don't want to
impart harm.
But is someone listening?
Is that voice actually
heard?
Or is it just muffled away through
administrative convenience?
I think it's muffled away with a
lot of prayers.
People are just wishing that
nothing's going to
happen.
But you, like I read the news,
there are patients that die in
emergency rooms because they
hadn't been seen or sent home when
they shouldn't have or stayed too
long on a stretcher without
being seen.
So we're hearing those stories
more and more.
And it is sad.
It is probably one of my
worst fears is that we're going to
have one of these cases that's
going to disrupt the whole
system with legal battles, when we
should be talking about safe
staffing, we should be talking
about work-life balance, we should
be talking about mentoring, we
should be talking about
more team works.
And yes, that might mean for a
while your surgery is going to be
delayed again.
But do you really want a surgery
when there's no qualified nurses
and the healthcare team to take
care of you when you're finished
the surgery?
The answer should be no.
So until we stabilize things,
there will be disruption, but it
is for patient safety.
So with that administrative
muffling of the voice and sort of,
as you said, the prayer that
hoping
that nothing bad happens, you
can't counter that when something
bad happens by asking the nurse,
well, what would you have done
differently?
And they were asking to do
something and they weren't
heard.
But let's switch to the stage that
you work on now from a national
vantage point.
What is it that political leaders
still misunderstand about the
day-to-day
reality of nursing work in 2026?
Again, it's that a politician
believes that they're in their
ivory
towers, either in Ottawa or
downtown Toronto or Fredericton,
New Brunswick.
And they're just in
these ivory towers and they make a
decision and they're really
disconnected from the reality at
that 2 a.m.
nurse.
And we need to bring them back to
the reality of think of that 2
a.m.
nurse.
Does
he or she have enough support?
Are they well-staffed?
Is that patient in the appropriate
environment?
Is the physician team well
equipped?
It's all connecting the dots and a
politician just sees it
often.
There are good ones out there, but
sees it as a dollar sign.
And right now we're working with
Jim Stanford, for example, a
famous Canadian economist, on
trying to convince these
politicians
that health care is an economic
investment.
So if we have a great health care
system,
that's good to bring business in
Canada.
That's good to bring business in
all the little regions
of our country.
So it's not all about cars and
buildings and pipelines.
It's about that public
health care system, that public
education system, those public
services that you need in a
community
to do it.
And we're focusing, of course, on
health care.
But it is important.
We're one of the largest
workforce in Canada, and
politicians still push it aside.
Still, it's not a money-making
thing,
but it is a life-saving engine,
and we need to get the politician
to wake up and listen to more
where
the money should be going.
Either that or have them in on
ward rounds more often.
Some have done that.
Ontario, many politicians have
went around the wards and do it.
But the reality is, you know,
when a politician comes around,
the manager makes sure that the
desk is clean, makes sure that,
you
know, people are buzzing in the
right direction.
So it's not like we're doing spots
visits.
And
that's what we have to look at, is
how do you bring that reality to a
politician?
And not that I wish
them any ill to enter our health
care system.
But there is a different reality
when you walk in as
Mr.
and Mrs.
Minister versus patient on a
gurney with a johnny shirt.
What I'm hearing here is just
about a question of for the sake
of the team, which knows no
borders
from the nurse at the bedside to
the manager, to the
administrators, to the policy, to
the leadership
at the health ministry.
It's all about leveling that field
of togetherness so we can all see
eye
to eye and move things forward.
When we spoke with the nurses in
Manitoba recently,
they didn't say I'm tired.
The resonant voice is I'm scared.
Scared of missing something,
scared of causing harm.
Is that a national fear now from
your
perspective across nursing?
That's what we were talking about
earlier.
The difference between
burnt out, medically burnt out,
the moral injury, or the
compassion fatigue.
You go into nursing,
you go into health care for
specific reason, and you have
specific great qualities to go
there.
Compassion is one of them.
Imagine you're trying to do your
job and you can't do your job to
your
best ability.
Every night you go home and did I
make a mistake, or did I provide
the right care,
or did I provide enough care?
That patient, that family is still
all alone and things are not going
fast enough, or whatever the
situation.
That compassion fatigue and moral
injuries are terms
that even pre-COVID, we weren't
using it.
We were using vacancies over time,
burnouts, high absenteeism,
and all that.
But today the language is changing
on compassion fatigue, moral
injury, and one of
the worst, I think, is they don't
want to work full-time positions.
They cannot handle a full-time
position.
They are telling us, "My union, I
cannot go work 37 hours a week in
that hospital, in that
long-term care.
Find a way to reduce my hours."
That, for the system, is
disastrous because it
just means the vacancies are more
and more and more because we need
more hours to fill.
Instead
of focusing, of making healthcare
jobs the best jobs in our
community.
That just sort of sets
the stage for the perfect storm.
But what I'm hearing from you is
that this fear is national.
And I would actually argue that
this fear knows no borders.
And from some of the comments
we've
received on the podcast, after
having spent time with nurses and
the Manitoba nurses and others,
is that we're getting answers from
all over the world and comments
from all over the world.
And
there's a unifying language here
that people are speaking.
And there's a unifying pain
that people are experiencing.
Yeah.
And Mark, when you look at big
institutions like the Canadian
Institute for Health Information,
CHI, as we know well, they are
also reporting on burnouts
over time.
But they're also matching it with
patient injury.
And the numbers are going up.
They're not going up fast, thank
God, but they're going up.
And one in 17 patients in a
hospital
bed will suffer from some kind of
injury, either medication error,
complication, fall,
because they're in that hospital.
And they're flagging this is a
trend going up, not going down.
They're also flagging that the
overtime, the vacancy rates, those
are all going up.
So we
have to work on, you know, put one
in one together.
What is happening is patients are
not getting the
appropriate care, and there's more
dangers for injuries and more
dangers for complication.
So it is not only nurses, nurses
unions talking about it, it is big
Canadian institutes
that are looking at data and
saying, okay, there's something
not jiving here.
Well, it sounds to me like a lot
more people need to hear about
this.
And the word needs to get out.
One in 17 doesn't sound like an
opportunity cost we can justify,
that's for sure.
If we think about what Canadians
need to hear, like if Canadians
could hear one
private conversation that nurses
are having with you right now as
their leader,
what truth do you think would
shock Canadians the most?
I think the truth would be the
tears that they're really
shedding.
And it goes back to that moral
distress or compassion fatigue,
where what they tell me is Linda,
I can never do enough.
Linda, I feel like I'm not worth
it.
I feel like management's not
listening.
Again, those are
the negative aspect we're hearing.
But then, though there are areas
of the country where we're
seeing, okay, my employer is
really trying, my government's
really trying.
So we as a national
organization, I need to bring both
of those together and boost it up.
But the tears are
probably what would surprise most,
because you hear through their
union, the anger.
You know,
that's our job as union is to
defend, to protect our members.
And when you look at 93% of your
members have signs of burnouts,
that brings anger into me.
But that member that comes to
knock at my door or on the phone,
her, him, it's the tears.
It's the fatigue.
I can't do this anymore.
I think coming with that as well
comes, and you alluded to it as
the guilt, but also the risk of
the shame where someone says,
"I'll never be good.
I'm not good enough.
I'm not good at this.
I'm no good." And then things take
on much more drastic proportions.
Yeah, exactly.
And that's an end to your job.
Is there one way that maybe even
the public unintentionally
contributes to the pressures
that the nurses are under these
days without even realizing it?
Yeah, it's the violence, Mark.
We're only seeing violence,
harassment, bullying,
really escalating.
In the late 1990s, early 2000s, we
were talking about that 30-minute
services, or it's free, attitude
of society.
You'd go quickly in an emergency
room or a doctor's
office or a nurse practitioner's
office, and you'd expect it to be
out of there in 30 minutes,
and everything would be all right.
Today, that's not happening
anywhere, but we're seeing more
and
more a violence episode.
We're seeing people bold enough to
enter with arms, guns, or knives,
or other types of arms in a
hospital.
We've never even heard of that.
And I never thought that in
2025, and it's going to continue
in 2026, that we would be lobbying
government to fund metal
detectors machines into a
hospital, and they'll be in
long-term care facilities soon,
because I see
that money should be going to the
caring budget.
And the caring budget is nursing's
personal care
workers' position, the whole team,
and all these millions have to be
placed into metal detectors
and more security, because we have
a legal responsibility.
Just like a politician needs
to be secure when they're working
in their legislative assembly, our
health care team needs
to be secure.
So that is a shock that I have a
hard time accepting.
I know we have to do it,
but that's where society is taking
their anger in the wrong place,
instead of buddying up with
nurses, with their unions, and
saying, "Okay, we're going to
support this campaign, and it's
not going
to be a thousand signatures sent
to the Premier.
It's going to be 50,000
signatures.
It is time to stop."
Absolutely.
And then there's the safety of our
patients who are using close
proximity to these
violent events and who potentially
can be collaterally injured.
Just this weekend on CBC,
there was a feature about metal
detectors that finally went up in
one of the provincial hospitals
in Canada, and the harvest of
objects they found is undeniable.
Yeah.
One of my presidents got the
government to put metal detectors
in certain of the hospitals.
Then the debate was, "Well, if I
find a gun or a knife, we have to
pay for the security boxes
for the patients to put it in so
they can get it back when they
leave."
And that blew out of the
proportion, because really, you're
not supposed to enter a public
institute with those arms.
They should be confiscated and
brought to the police and
let the police deal with it.
And that's one thing in
healthcare, we don't do enough.
We expect the nurse manager or the
nurse herself or himself, if
there's a violent issue,
you decide if the patient's going
to be charged.
Well, the last time I checked, I
am not a legal
authority, and neither is that
nurse manager.
Neither is the VP of the hospital,
honestly.
It should be an automatic that if
it happens, if a violent incident
happens, it goes to the
police and they decide who's going
to be charged and not charged, not
the individual nurse.
So it's a lot of discussions
happening around the violence
portfolio from metal detectors as
we just talked.
But then what happens if something
violent happens to these nurses?
Well, and that just can't be
branded as part of the job, right?
I don't think,
and the best barometer from my
perspective is always if I had a
child who was entering
the profession or was a young
professional nurse and was facing
these risks, how would
I feel as a parent?
And there's no way to rationalize
violence as just part of the job.
No.
No, but we're doing things to
change it, though.
Tell me about that.
The first campaign against
violence that I participated on
was in 1991.
So a lot of your
listeners are probably saying,
Lynn, that wasn't even born in
1991, or at least not practicing
nursing.
But back then, it was a poster.
No violence or violence is not
accepted here,
and that's about it.
Well, today, we were even able to
change the Criminal Act.
So now the Criminal Act says that
any physical assault or harassment
on a nurse or healthcare
workers will be an automatic
10-year charge, 10-year assault
charge.
I don't remember the
exact legal language.
But in normal lingo, you and I
know if a police officer stops you
for speeding
and you attack him or her, you
know you're going to be charged
automatically.
There's no ifs or
buts.
It's the same laws for healthcare
workers.
But the public doesn't understand.
Honestly,
the police don't understand it
yet.
So we have to do so much education
on the laws as change.
You protect a police officer.
You protect a nurse in the same
vein.
And how do we do it?
So much progress has happened in
30 years, but now it's the
education.
It's changing that culture
that nurses are there as angels of
mercies and they'll just accept
everything.
Nurses are very
strong, educated healthcare
professionals and are there to
work with a team and they're there
to be
respected in the same way.
And it's not punching bags because
you're frustrated.
The healthcare
system is not providing you what
you need.
So on that theme of education, I
mean there's
so much is getting messages out
and I've often heard you say that
the solution to many things
is also staffing and then staffing
and then staffing.
Can you help our listeners
understand
a little bit about what not having
enough nurses on duty looks like
from a patient's perspective?
Like lying in a hospital bed,
pressing the call button and no
one's coming.
It's not because
there's a choice being made to
ignore.
It's usually because people are
caught between distractions,
interruptions and concomitant
duties because they're just not
enough individuals to go around.
Walk us through that.
What does it feel like?
It's those near miss.
Those near miss are the
ones that make you sick to your
stomach.
That you realize that if at that
split second,
you wouldn't have caught the blood
pressure crashing or looking at
addressing and thinking,
oh, it's not the same color it was
two hours ago.
I need to go check it and then you
open it up and
everything blows.
It's all those near miss or it's
an absent of holding somebody's
hand
that you're so much in a rush and
they've just received a disastrous
diagnostic and you and the
physician just have to leave the
room and you know they're alone
and somebody should be there.
It's all of those situations where
it should not happen.
Regardless if it's a happy event
just like the birth of a baby,
that environment should be well
protected, well cocooned so the
family can enjoy it or at the
other spectrum where somebody
learns that their life is going
to end soon or it end it.
How do you protect that?
We forget that that's all part of
our
healthcare system.
It's not only the high energy,
high technique surgeries, the big
machineries,
you need an MRI, you need this and
that.
That's all important.
Don't get me wrong and we need to
get them on time but there's also
that supervision.
A surgeon cannot do your surgery
if there's not
the appropriate nursing staff to
go and monitor you either for 48
hours, for 72 hours, sometimes
for a week.
Then it's rehabilitation.
If you don't have your proper
rehabilitation, what happens?
Well
you stay longer in the hospital
then everything is slower.
It's all of those systems that we
just
think I need my surgery, I need my
surgery, I can't get my surgery.
Well it might not be a surgeon
shortage, it might just be that
there's not a bed shortage because
we have those.
It's the staff to take care of the
patient in the bed.
I can tell you that in my medical
career the
most memorable times of that
feeling of unity was when the team
of physicians and nurses were all
on the same page and we felt like
we were all looking towards the
same goal and I can tell you
last night I was in the ICU with a
gastrointestinal hemorrhage that I
needed to treat and I needed my
team there.
If I was there alone I couldn't
have done my job and collectively
we supported each
other through it and when it was
all done we looked at each other
and said we had a go team, we did
it.
Yeah I remember those in intensive
care too and it's true it's 30
years ago so the system was
different but it was this feeling
of it.
It was not success, it was that
taking this deep
breathe of relief and then looking
at the patient in the eyes and
feeling so great and still like
10-15 years after I lived in a
small town in New Brunswick I'd
see patients or family members
recognize me of being one of that
nurse part of that team and they
remembered the good story and
they remember the sad events too
but how can we make such a
difference together and it's
important
for me to understand as a nurse
what your qualifications are and
vice versa for you to
know what my qualification, my
experience is and build that trust
and as you would know it's not
like TV, we don't see our
healthcare system as what's
happening on TV.
And you hear lots of stories
from nurses, do they ever come to
you after a patient has spoken to
them about their despair
when they were calling for help
but no one could come when they
needed it just because of the
understaffing.
Do you hear those stories too?
Nurses coming and saying this
patient broke down
they were so upset and scared and
I just needed to listen to them.
Not to me directly if I'm honest
because being national president
there's a few steps in between
but when I go to annual meetings
those are the stories that we see
from the floor.
You know I'm
an ER nurse I can't take it
anymore these are my neighbors
that are coming through the doors
and have to order pizza because
they've waited so long.
I have to sleep on the floor I had
to give
a blanket for a husband to put
their sick wife on the floor or
their sick child.
Those are the
stories that that are coming out
and that's why you're seeing so
much frustration and anger coming
out of messages from unions is
because this is not okay this is
not okay for the community we're
trying to serve and it is not okay
for the workforce that should be
so cherished and protected and
respected.
We need to fight to get better so
it is how do we work with
governments.
Right now the big
project everywhere across the
country on safe staffing is nurse
patient ratios and some will
say oh it's too much of a blunt
tool.
Well how can you have 20-30 years
of academic reference
academic evidence that in med
surge so on a you know normal if I
can call it floor where you have
surgeries you have medical
patients you have a mixture of all
you should have one nurse for four
patients.
Some parts of our country we have
one nurse for eight patients 10
patients we know that's
not safe but we're still doing it
so how do you bring those numbers
in that will bring patient
safety but also will work on
retaining your nursing staff and
the rest of the team because you
know
it's like in a household I'm being
a bit bit sexist here but happy
wife happy home happy nurse happy
results in the healthcare system
and we have to really move towards
safe staffing and find the
right formula for every facilities
and that they're working across
Canada they're calling it all
different things so I'm thinking
you know let's do an interview in
two four years see where that
follows up and see where the
progress has been made and I'm
hoping that it will be made across
Canada.
I think there is some progress
being made I think there have been
some announcements
than certain provinces this is
really at the forefront if not law
already but British
Columbia on that note how are we
how's it going to be implemented
what's the formula to then
implement it because it involves
change and you know it involves
potentially silos actually having
to talk to each other one thing is
putting it in law how do you how
do you enforce that law
so putting in the logs only
Manitoba talking about putting in
in law right now and some of the
work
they have a committee that is
across the province from a union
academy employers governments on
where to start so you know there's
progress there and we were very
impressed when the minister
announced that we're going to have
legislated nurse patient ratios
that's a start British
Columbia is more ahead of the game
them it's about three years where
they've been working they've
implemented they're going to have
the first in the world of one to
four 24 hours a day
because the evidence has changed
as you know as a physician
nowadays a patient at 2 a.m it can
be
as critical and as needing medical
needs as at 2 p.m so how do you
make sure that 24 hours a day
your patients are taken care of so
they're in Nova Scotia established
a new system where Nova
Scotia is a lot more rural
different well is one to four for
example working for one area
of the province versus the urban
areas or the intensive care
emergency so a lot of discussions
what CFNU my organization has done
is we've just formed and are
funding a national council for
nurse patient ratio implementation
so we're bringing employers
government unions and researchers
all together and say let's not
talk about the evidence if it's
good or not we know that
but let's talk as different ways
on how can we implement that how
can we give the guarantee to
the nurses coming in at 7 a.m that
the staffing will be safe and
giving honestly the same
guarantee to patients that the
staffing will be safe and so we're
starting to work on that
our big workshop will be next fall
you mentioned good enough is the
evidence good enough i mean
that's subject to a lot of
interpretation but i guess the
real question is it's sufficient
and not just quantitative but
qualitative because i think the
stories speak for themselves and
that's
data also i look forward to maybe
having you back in a couple of
years and getting an update on
that topic because i think that's
huge and i think it's progress and
the scary thing is that it goes
beyond that i've heard stories of
one in 50 ratios in uh in other
institutional settings
or in private settings and you're
right with the level of complexity
of patients these days
you don't just get unstable or
sick at 2 p.m it's around the
clock because you've just got so
much
more complexity per patient that
the odds are something is going to
happen anytime
you know we touched on violence a
little bit earlier um and that
often includes sexual assault
what are what are nurses
experiencing these days in that
area and is that handled any
differently
after they report it
no i don't think it's handled any
differently than any other
violence incident and again it's a
cause and effect of our system our
surveys and we survey our nurses
on multitude of stuff every
year the last one came out last
march in march 25 and 18 percent
of nurses were saying to us that
they got sexually assaulted and
and those numbers are going up is
it that uh they're reporting more
just like in society in general
but it is still a big issue we
have to consider is it that we are
still at 91 92 female is it a
gender issue it is hard to
pinpoint why but it's also as
and i'd say as discussing when an
employer uh doesn't recognize it
uh you know we're past
the stage of what could you have
done differently uh we're in 2026
and if a
an employee tells you that they
were sexually assaulted or in a
violent situation or bullied
or harassed we need to believe
them and act appropriately and
we're still hearing uh nurses
telling us why would i go to my
employer they told my friend what
could you have done differently
or they told my friend just shake
it off and continue your shift
this has been normalized for so
long and not just like this type
of assault but other types but
who's benefiting from pretending
that it's inevitable like who's
benefiting is it because
leadership doesn't want to deal
with what leading has to do and
has to be to get someone through
such an event when they've
experienced assault it calls on
leadership to step in but what i'm
hearing is that it's just batted
back to the individual do we do we
need do we need more
leadership training do we need
more leadership criteria before
someone gets promoted to a leader
more than just seniority for
example yeah uh i think you hit it
right on the head mark it's
it's about training and resources
you cannot do interventions like
that on the side of your desk
you need the training and you need
the time to do it and that's
what's happening with a lot of
managers like i say all the time
there's great managers out there
and some of them are just
scared to do a mistake too so it's
easier just to shove it off and
make sure nobody talks about it
than dealing with it takes a long
time and a lot of energy to deal
with an issue like that
but if you respect your team and
you're there to enhance their work
life to protect them you need
to deal with them and then it's
higher up how do you provide the
support how do you provide the
training or is it that person that
should be dealing with it period
uh so it is all a thing
of staffing there is a research
paper done just before covid where
it talked about management in
the hospital and in health care
like on a nursing unit they manage
10 times the number of bodies of
individual of employees than you
would in the private sector for
example why is that why do we
again expect so much more in a
caring profession that we would
accept on a police force or do we
expect in another industry and uh
what when nurses finally decide i
can't do this anymore
and unfortunately too often now
it's sometimes within the first
two years of starting their
careers what usually truly pushes
them over that line nobody
listening to them uh we have about
one in four one in three depending
on the surveys of our early
careers is saying i'm not retiring
in nursing i'm not staying i'm
looking for the exit door and when
we ask them you know you expect to
hear the shortage the overtime the
scared uh of doing a mistake and
all of that but what makes them
tip is really not being listened
to not being respected and they
said why would i stay here
why would i work 12 hours night
when my colleague is you know
working eight hours and receiving
glories from her employer in a
different uh work environment so
it's really that listening and
that
respect question work environment
you mean the difference between
public and private or
what do you mean do you mean it's
just a different organization
different organization the the
problems we're living right now in
health care it's that caring
profession uh society employers
are expecting a lot more of
somebody like you that went into
medicine or somebody that went
into nursing or psychology and the
names are all there because of
that caring aspect saying
mark will do a little bit more
mark will do a little bit more
linda will do a little bit more
and there's always that attitude
of not respecting the individual
as a professional worker and that
i
tell to all my nurses say
regardless if you're a registered
nurse a nurse practitioner
licensed
practical nurse in ontario their
rpns or a site nurses remember you
are a professional worker
and as you as a physician also you
are a professional worker so you
have rights as workers
just like the bus driver the
police officer the construction
worker you know i'm sure you were
working during covid why did we
have to fight for ppe's because
they expected us as health care
workers to go and work and be on
and be always about that i will
not give up i will push the limits
which is all true but as a worker
you have rights to be protected
you have rights to have normal
working hours you have rights to
have proper staffing proper
equipment to protect yourself
if need be and training etc the
list goes on so it's that changing
of mentality of telling our
professional workers that you are
a professional workers and
employers for example there's
occupational health and safety
laws across the land and you are
obligated to protect those and
that goes from violence to
overwork to harassment to ppe's
personal protective equipment you
have a
legal obligation to follow that
and we need to push the limit on
those
well the hope there is that the
person behind the worker gets
recognized
and everyone's their own person
too and i've heard a lot of
comments about how there's a
person
hiding in there who's who brings
who shows up every day with their
own history and their own
their own person issues and
they're trying their best to get
their job done as a worker
we talked a little earlier about
nurse patient ratios and maybe for
some listeners that still
sounds a little bit abstract but
during a single shift what does a
safe ratio
actually change not only for the
nurse but for the patient
it's focused on safety it's
focused on expertise and what the
patient needs and that's when we
talk about nurse patient ratios it
doesn't mean the same thing on
every unit doesn't mean the same
thing for every nurse or every
patient's because let's be honest
if i'm a 20 year a graduate and
i've worked on that unit for 10 12
years my level of expertise is
different and higher than a new
grad that enters so you might need
two new grads for one experienced
nurses all depending on the
qualification and experience they
all have but what it means for the
patient it's a question of safety
it's a question of of caring
answering their needs on their
side also if the patient always
has a
member of the family attending
with them almost you know 24 hours
a day well there's care personal
care needs that might not be
needed by the health care team so
that's all factored into what we
call
ratios which is a simple formula
of on a unit it's either one nurse
for four patient one nurse for
six patient or in intensive care
er it's one nurse per two patients
i've seen two nurse for one
patient all depending on the needs
of the patient and then the
experience of that nursing team
and and i emphasize on the nursing
team because it is depend who's
around and what's needed
if the nurse through the
registered nurse doesn't have uh
anybody else to work with uh then
you you
need less patient loads of course
because you're doing everything um
so that in simple words that's
what we're talking about ratios
but it's really changing a focus
on the safety and the patient's
need uh of what during that shift
you spoke to me earlier about that
nurse in the icu had done a 30
hour shift what was their ratio
i'd only hope it goes one to one
can you imagine it being anything
more than that after 30 hours i
know i know it's uh it is hard to
hard to imagine how that went on
you know i'm from rural new
brenzewick or from new brenzewick
and i remember working intensive
care
where you know we couldn't go home
because there's a snowstorm uh but
there were areas where we could
take a break there was areas where
you know between units and we
talked about it earlier
too and your experience with the
teamwork okay you go sleep an hour
i'll close the door close
the light and then we'll switch
you know we're able to do that
today they're not able to do
that as much uh even in different
events but hopefully that nurse
had a one-to-one ratios
and one plus uh support of others
for sure so with the vision for
change
if we imagine a system that's
actually working and starting to
improve and meet
meet those goals what's the first
thing a young nerd young nurse is
going to notice that's telling
them this is safe this is
sustainable i can stay here the
first thing here she will notice
is that
they have an excellent mentoring
program uh that they're not drawn
to the wolves and that's one
thing we do too much in nursing
where you're starting and your
orientation is like everyone
else you know your seven days or
for one week of uh where's this
office where'd you call how do you
fill these forms but we forget
about the mentoring of the nursing
care on the unit and it changed
from unit to unit so it's not only
the new nurse coming in who
graduated in may it's about a
nurse
who worked 10 years in labor
delivery and is changing to go
work in intensive care or working
in orthopedics we need to surround
them well so they feel secure so
when a new grant or somebody
switching floors notice that okay
they're really going to surround
me with experience with mentoring
and i'm going to feel secure
that's when they're going to stay
a long career in that facility
um is you can't assign that
mentoring role to someone who's
burned out in dealing with a 10 to
nurse patient ratio because that's
setting the stage for failure and
mentorship because it's they
just won't be able to provide the
mentoring for that new trainee
who's just joining the team and
questions may be difficult to ask
and may be greeted with less than
receptive warmth
for sure partly part of that
spectrum of burnout and compassion
fatigue even compassion to the new
nurse who's joined the team who's
there to just ask a few questions
to help keep them on track
and when you think about it not
everyone is fit or wants to or
likes to be a mentor or preceptor
you know you have to get a bit of
training it's all about adult
education but you have
to enjoy it so sometimes it's
better to skip the next one you
know if a nurse manager hears from
ordinary team members i just hate
it it makes me nervous i'm worried
i thought well skip to the
next one you know uh that they are
people that just loves it and
that's what makes or break
a good nurse a good young nurse
yeah it's it's probably good to
fill those positions slowly
as opposed to as quickly as
possible when it comes to choosing
the individuals to take that
next level of leadership that goes
back to retention and also
returning where we're
finding a lot of our nurses are
leaving the workforce early before
you would see retirement
you know after 60 after 65 now
you're seeing it earlier well they
would most of them would love
to be called back and just do
mentoring you know why don't we
bring back that experience into
our
workplaces how do we convince our
nurses that work on a unit for
such a long time to bring
back their expertise to share and
and continue on building so we
have some facilities across the
country doing it and it's a big
success that's brilliant it really
is and we've got the clinical
nurse educators on different units
etc but the clinical mentorship
educator wow that would be
that would be next level for sure
do you really think that with
everything we've spoken about
today and people understand things
that much more from this
conversation that you will still
be
having to tell high level
ministerial people in health that
staffing saves lives like do we
still
have to prove that in 2026 or is
the data there and do we just need
to spread the word
the data's there uh the problem
right now it's the money
everything's attached to a dollar
uh
cent and uh you know i look at the
federal government currently it's
budget budget budget
it's how do we deal with the
economy so our job is really uh
bringing boat together and showing
that as i mentioned earlier that a
public health care system is an
investment in regards to the
staffing uh it's what we're asking
the federal government is to
create some kind of patient
safety guarantee patient safety
charter but for those canadians or
people living in canada that
are going in our health care
system our health care system is
not free we're paying it through
our taxes the regardless of the
level of taxes you pay but that's
what the guarantee we give to
canadian is you pay your taxes and
we will provide you an edge not an
education but a
an education too but a health care
uh services when you need it and
right now the number one
priority for canadian is primary
health care they can't get a
primary uh health care provider
regardless if there's a family doc
a nurse practitioner pharmacists
who others their list
is long they can't get mental
health services seniors care we
could do a whole show just on
senior scare and how do we move
away from long-term care to really
thinking of what do seniors need
that aspect but the federal
government because we're such a
small country should be able to
establish what are the guiding
lines what what are the hope what
are the guarantees
that we're giving everyone and
have the province and territories
uh be transparent on how they
qualify how they evaluate
themselves on it or have the
kai'ai the canadian institute of
health
information evaluate everyone on
those standards and primary health
care is number one it is not
acceptable that what between
depending on what you read four to
six million people do not have
a primary health care provider
that is scary because if you have
no one to call and you have
to go to the emergency and we know
the horror stories of waiting in
emergency and leaving
without being cared for or going
to a private clinic and then
there's no follow-up and that's
when you get in trouble in uh and
with your own personal help and
that's when you get frustrated
too so how do we how does the
federal government brings a higher
priority on what is our promise
as a nation to provide health care
services we have to focus on
patient safety and we always
want to champion innovation but
from the value perspective and
from the lens that you
look at things every day what
provides more value to canadians
innovation in illness care
or innovation in health care i
don't think they're the same yeah
i would say innovation
in health care but even innovation
uh is a big complex word uh it can
be as simple as having
enough time with your primary
health care provider or uh having
them being able to transfer you
immediately if you need mental
health services you know it's not
everyone is a mental health
expert but we need to be able to
refer we need to be able to
provide in a community if it's a
quick
diagnostic and it's within the
scope of practice well why can't
you go to your pharmacy and get
but all of that has to be well uh
secured under patient safety so i
think innovation in health
care is how do we give access to
health care health care needs of
our communities and it's
different in prince albert versus
downtown toronto very different
but it should be different and it
should be uh mobile and it should
be uh flexible again and then when
you need your emergencies when
you need your surgeries when you
need your hospitalization that's a
focus that is very
different than primary health care
it's a focus of that's where your
your different technologies
come in that's where your staffing
issues coming that's where your
different training comes in
you know it'd be hard to put a
nurse or a physician that only
worked in intensive care
put them in a community health
clinic i remember a story when i
worked in the emergent i worked in
intensive care and then emergency
and i went in labor delivery after
that and my first women that
fainted it i was about to call a
code 99 and the senior nurses
looked at me which is a cardiac
code
for our listeners but looked at me
she fainted lynda she just
delivered and for me it was i
just saw cardiac arrest cardiac
arrest so you know at the end it
was a funny story but it's
a nurse is not a nurse is not a
nurse you need different training
different environment
and goes the same thing when any
of our providers and that again
goes under the umbrella of patient
safety we hear about more money
going into health care attempts to
infuse more money into health
care yet nursing rotation nursing
retention is still failing what's
it gonna take in the year ahead
in the years to come it's safe
staffing safe staffing and respect
that's why we're putting
so much energy on nurse patient
ratios nurses are telling us that
if you give me the tools to do my
job properly and you respect me as
a professional worker i'm staying
i went into nursing for a reason
right now we're at the tip we're
just moving into it across the
province and across the country
and
some provinces are not even
touching it but that's how we're
going to save our nurses that's
what
happened in california where they
were the first to legislate nurse
patient ratios they don't talk
about retention in california and
it's not about the beaches and the
sun the nurses go work there
because they know that in the
majority of their big health
facilities there are specific
ratios
and they will be followed and and
uh then we're seeing in other
states uh other states in the u.s
we're seeing it in australia new
zealand ireland has a different
system so there are pockets
everywhere that nurse that the
employer and government are
respecting the professional work
of a nurse and giving them the
tools so that will fix retention
recruitment is still there
our schools of nursing are still
filling out the seats it's just
when they walk in the workplace
30 of them are saying i'm not
staying it's a shame you've
alluded to you know concerns about
relying
on for-profit nursing agencies but
just filling these spots with
nurses from for-profit agencies
change anything i mean it's it's
it's a fill but it it doesn't
change the dynamic it doesn't
change
the nursing experience like where
where does the concern lie and how
does it cause a problem
well on to aspect earlier in our
conversation mark we talked about
teamwork when some of these just
plucked in to fill in a shift
there's no teamwork there it is
very hard to build that team and
are
they going to be there tomorrow
are they not going to be there
tomorrow never see him again yeah
and
there's a whole there's no uh
engagement to the employer there's
no engagement to the team they're
there to do a job which is eight
hours or 12 hours on that unit and
then hopefully they'll come
tomorrow
so instead of investing into your
team into your community you're
plucking holes with agencies
and we're seeing employers across
canada spending millions uh and
we're seeing auditor generals
questioning it the first one was
in ontario newfern land labrador
pei novas kosha new brensway
and we're seeing other provinces
okay we need to start looking at
it manatobas one of them
where is that the right way to
spend our public dollars so that's
the first area the theme and
the other is really for the
individual um there's no guarantee
one day agency working and
manatobas the province where
they've done the most progress on
it agency work is going to finish
you
will not have a job you will not
have a pension plan when you hit
60 or 65 you it's very individual
so you're making a lot of money
today but there's no future and
how do we fix that again it's
about
working with the team it's working
to make sure that these employers
become the best employers
in their communities and invest in
your community and not in this
private sector company that open
and god only knows where well it's
it's hard to build collective
awareness and buy into a mission
whether it's on a nursing unit or
on a ward or in uh in any part of
a healthcare institution was that
that culture that team culture is
really important it can't be
nurtured with a culture of
transients
you're absolutely right yeah we
know that when a new nurse comes
on the floor and new employees
you know it's you have to build
them in the culture every unit is
different
i think 25 years ago that or 30
years ago it was a lot easier
because the nurse manager
often had was a career nurse
manager on that same ward they
stayed there and that was they
identified or that everybody
identified together and i when i
was a resident in montreal i
remember
that you knew the culture of each
ward you knew who the leaders were
and it was it it was palpable
you could you could just remember
it and i have very fond memories
of just the collective and
as residents you sort of you
joined in and you melded you
learned your your faux pas and
things
like that but if you really wanted
to experience the delivery of care
to the patients on your ward
you just melded with that culture
and it took skill there's no
question but it was very rewarding
that's one thing nurses ask us
also can you bring that old head
nurse type back you know we we
need
a head nurse that knows the unit
and will be there for the unit and
not for being at a meeting on the
second floor of administration so
your story about the head nurse is
very much appreciated
by frontline nurses those that are
at the bedside they need that
cheerleader that who knows what
they're doing for them well their
office was actually very often on
the ward right i remember
that distinctly and you knew where
to find them if you had five
minutes alone with the finance
minister who still believes that
you know private agencies provide
equal flexibility and you know
have something to offer um how
would you argue economically that
having permanent staff ensuring
permanent staff actually matters
more i think if i'd have five
minutes with a provincial finance
minister i'd bring an employer
there with me and they will show
how high cost an agency nurse is
and how high costs uh it is not
working for them i probably
wouldn't even have to talk about
it
because employers across the
country are telling us this is
bankrupting us this is putting
money
where we're not supposed to be
putting money in we want to invest
in better care better technology
and their list is long so that's
what i would do i'd bring an
employer and say tell them how
much
you just spend on agency nurses
why because you can't return your
nurses retain your nurses
and how do we fix it we work
together because we really have to
put the government the employer
and the unions the nurses unions
together to work on ratios nurse
patient ratios for example on
mentoring program we bring in the
students so it's more showing than
the dollars and cents you're
talking finance minister so it's
all about the evidence and then
what are your solution the
solutions in healthcare is really
bringing everyone at the table and
how do we find better solutions
and showcasing the value i think
the understanding of the value of
the success stories is probably
not always understood so for one
nurse who's listening tonight
somewhere in the world on
night shift or one family
caregiver who's listening right
now you talked earlier about
not five thousand signatures fifty
thousand signatures or more what's
one action that can
actually create pressure for
change how would you invite
caregivers nurses of course people
who care
in our society to create that
pressure for change well to create
almost the perfect storm of
pressure
for changes we have to
collectively agree on our message
and that is one of the downfall of
health
care there are so many needs out
there that we bombard politicians
with a thousand and one needs
for nurses we've tried to focus on
funding of health care so
depending on the level of
government
which should go directly to
staffing directly to patient care
other is enhancement of our
health care system such a national
pharma care program and i really
try to say let's say focus
on that uh and when we don't focus
uh politician pick and choose and
that that becomes the danger
of all of us what and we're
working better uh with national
organization and provincial
organization like the cma the
canadian medical association both
nationally and provincially
with the nurses and other health
care professionals to say okay how
do we give a common ask with
different messages because all our
messages are different but the ass
remains so where we really
focus commonly is on the financing
of health care and then telling
the politicians finance it
appropriately with great standard
and then let us do our job and
that works uh when we're able to
do
it you know it's so much goes into
that final product as you say and
it starts from identifying
the shared values and the shared
motivations and and the shared
targets and part of that it just
revolves around communication and
and that bigger inclusive
understanding of what it all takes
if we were to imagine a bedside
geriatric nurse here in canada or
a community practice nurse
in the uk or a pediatric nurse in
australia or an icu nurse down in
the states
or a family caregiver anywhere
listening right now
after our discussion today what's
the one truth you want them to
carry with them forward
from our conversation today
probably don't quit um we have to
have hope that decision makers are
going to see the light um and they
will i've been involved in nursing
for 40 years now and i've seen
the ups and downs of no jobs to
shortage no jobs to shortage and
it is you know there's always ups
and downs but at the end the
decision makers see the light and
right now we are at i don't want
to
say the worst because i think the
pandemic uh was the worst and the
best because everyone was focused
on a problem on a problem and we
were able to put resources to it
but now is organizations are
starting to see okay there are
solutions out there like the
security that we talked earlier
nobody would have thought that
we'd ever put metal detectors and
higher security in hospitals
but now we're seeing it okay how
do we move forward with nurse
patient ratios how do we
move forward with mentoring
program and we're talking nursing
now but it goes for the whole
health care team so how do we move
forward on this team approach for
primary health care
how do we guarantee everyone
living in canada will have access
to a primary health care
provider and they work as a team
in ottawa when i first moved in
ottawa in 2003 i had a
nurse practitioner they weren't
popular back then there was a
handful everywhere but she always
worked that happened it was always
a sheba always work with a family
doctor team so if they didn't
know what to prescribe or what
test to ask they'd walk across the
hall and the family doc was there
they'd work with a physiotherapist
etc uh the problem with them is
that there is no retention
uh programs at all so they were
all working part-time we're
working to change that to bring
more of
anichorilla equilibrium on it but
it is about don't quit and let's
as a team stay focused on
improving the fate of our health
care workforce which will improve
the fate of our community
and we've touched on so many
important topics today and your
answer don't quit really resonates
with me but i think the follow-up
to that is look around because
when you have a lot of people
thinking don't quit and they look
around and they see other people
saying don't quit you realize
you're not doing this alone yeah
i'd really like to thank you for
joining us today oh i thank you
this was an amazing discussion and
you're a champion and i look
forward to hearing
good news and we're seeing
progress and awareness being risen
every day and as we rise we'll see
the
changes thank you very much mark
and thank you for doing this on
your spare time but uh thank you
for
your career in health care it's
it's important to show that uh
there are hope up there out there
and that we're all working
together so our guru merci thank
you everybody this wraps up this
week's
episode of the caregivers podcast
until we meet again i'm dr mark
we'll see you next time
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
we're not a substitute for
professional medical advice care
therapy or crisis services this
evening 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 we 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 or 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 health care 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