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Déjà: Hi, and welcome to Big Ideas.I’m your host, and Mount Royal University journalism alum, Déjà Leonard.
Big Ideas explores the diverse perspectives, timely research, lived experiences, and hopeful aspirations of MRU alumni, faculty, and students as solutions-focused leaders addressing local challenges.
This season we’re digging deep into wellness in the 21st century. From aging to technology to our finances, how do the complexities of modern life impact our well-being - for better or for worse?
Let’s check out what we’re talking about in today's episode…
That's what we're seeing a lot of the time, you're coming into a situation where you have an unmanageable patient load and everyone needs something, and predominantly everyone needs someone to care for them. But you just can't provide that. It's, it's, you're asking nurses and a lot of other allied health professionals right now to do almost an impossible task.
Déjà: Meet Kent Soltys. He’s an MRU alum currently working as a Clinical Nurse Educator on Vancouver Island. Like many other nurses in Canada, Kent is seeing first hand the troubles that are impacting the world of healthcare.
According to the Canadian Nursing Association, between 37-57 percent of graduate nurses will leave the profession in their second year of practice.
Kent joined me remotely from his home in Campbell River to talk about some of the factors leading to this extraordinary attrition rate, and what he’s working on to try and solve it.
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Déjà: Thank you for joining. I'm super excited for this conversation and you know it's clear that you've seen the healthcare profession change [00:02:00] over time and I think that many people know that our healthcare system, you know, is facing a lot of challenges right now. I'm wondering what that looks like from your perspective?
Kent: Well to start, it kind of looks sad to me right now, but that's not to say I'm not optimistic of what it will look like. But what it looks like is a constant state of burnout. And right now, a lot of the joy and fun that I used to see in the faces of nurses and everyone else working in healthcare. It's not there, and I hope that we get back to it one day.
Déjà: Absolutely, you know, I think it's also apparent that a lot of nurses and, to be quite frank a lot of other healthcare professionals, end up leaving the profession after only a couple of years, um, you already spoke about burnout, but why is this happening?
Kent: I think there's a number of factors. Some are published, some are not, but from living it, working it and being in it, uh, you have a lot of individuals coming into the profession and they're preparing for an idealistic or a theoretical world that in reality isn't really there.
Um, I was lucky and I'll back up a bit. I was lucky to start about 14, 15 years ago, and I was surrounded by amazing, what we call senior nurses, people that have been in the profession for a period of time. They were there to support you, guide you, ah, call you out, uh, and really just facilitate your growth and development as a nurse and a strong practitioner and care provider. And, unfortunately when the pandemic hit and just before we had a massive, uh, kind of exodus of those senior nurses. So in addition to having a lot of nurses come out without that senior supporter or structure of support to guide them in their practice,
…we're really not prepared for what's happening in health care and the overburden of the health care system, to be honest with you.
The hospital system is packed. You hear about it every day about a shortage [00:04:00] of doctors, shortage of nurses, pharmacists, allied health professionals. And when you take that, the numbers of the care, of the people and the patients and the people we're trying to provide care for, when the numbers are increasing at a staggering rate due to various factors, and the supports aren't there for specifically nurses, we're talking about right now, but the supports aren't there to help them achieve their success it makes for a really challenging outcome, and I think that's one of the catalysts for a lot of people leaving the profession right now.
Déjà: That makes a lot of sense. You know, I certainly am not in, in the healthcare world but, I can’t imagine anything kinda more terrifying than stepping onto the floor and not really having folks there to guide you or the resources to help you through something like that. Especially when we compare to any other industry where you have usually very formal kind of mentorship tracks and, and things like that.
Um, so can we talk, I guess, a little bit about what this looks like in tangible terms? I mean, I think you went into it a little bit, but we're thinking about short staffing. Like, what does that mean when a nurse can't show up? Or what does that mean when someone has to do more in a typical shift than they should have to?
Kent: Yeah, uh, has someone who still works, I do work on the clinical side and, um and doing a lot of stuff there, but I still pick up on the floor because I like to, you know, one, I like to care and provide care. I like to be there for some of that support and senior leadership that is so desperately needed and the reality is that is a common occurrence. You have uh, nurses coming in to, ideally, uh, you know, they talk about a ratio of a one to four, uh, situation. So four patients per nurse, but routinely you'll come in and you have seven patients and they're not easy patients. They might be acutely ill. So you're having to make decisions, uh, this is where that moral distress thing comes in [00:06:00] you have to make decisions on in a shift who gets the care that you want to provide and who gets the care that has to be provided?
And what I mean by that is and and I see this and I've been there for those conversations and the end of the shift where the nurses are devastated or emotionally distraught because they had to make a decision on, they had someone that was acutely ill, and they had to provide care and that took an hour, two hours, sometimes of half of their 12 hour shift. And then that means that someone else didn't get that care, compassionate care that is so desperately needed for all, all individuals that we're caring for. So, that's what we're seeing a lot of the times. You're, you're coming into a situation where you have an unmanageable patient load and everyone needs something, and predominantly everyone needs someone to care for them. But you just can't provide that. It's, it's, you're asking nurses and a lot of other allied health professionals right now to do almost an impossible task and have to sometimes make decisions to relinquish care of someone over the acute necessary care of someone else. And you can imagine the toll that would take when we talk about attrition rate.
So you're going in there and I myself got into a caring profession cause I wanted to make a difference. I, I'm from a small community and I really wanted to give back. I wanted to help those that really couldn't help themselves and I think that's why fundamentally a lot of people get into the healthcare profession. They genuinely care about people and want to provide that care.
So I think that's one of the reasons we're seeing a tremendous attrition rate is just that you're having to make decisions that you're not taught to make when you're going through the post secondary education.
Ah, you're learning a theoretical perspective and then you get into the reality of it and nowhere in my university education, uh, when I was becoming a nurse, did we talk much about the situation that you have where you have to provide care for some people at the expense of not providing care to someone else. [00:08:00] So it's not touched on. And then the reality is from day one, you're jumping into a situation where you have to make those very challenging decisions to, to not provide care.
And for myself personally, when I have to make that decision, I feel when I can't provide that care, it just leaves a hole, right? It leaves a hole in your heart because you're, you're there for someone and you're not there for someone at the same time and that's just the reality of the situation right now.
Déjà: Wow. Yeah, I think especially for folks who, you know, in health care who are typically leading with empathy and like you said, wanting to give back that, that sounds super heartbreaking and like such a challenge. And, you know, one thing that you mentioned was, um. leadership, which I feel like is a really big piece to this puzzle.
Uhm, so, from what I'm understanding when we think about the pressure that the system is under, along with people leaving at alarming rates. There's also specific challenges in developing leaders. For example, people might find themselves thrust into a leadership position earlier than might likely be ideal. I know there's like a charge nurse position, for example. Could you chat about that a little bit?
Kent: Yeah, so. Typically… we'll just back up again. You'll see me regress a lot. You know, like we'll go back a few years. The charge nurse or your clinical coordinators or managers, typically, uh, were individuals with a lot of experience and maybe it was the last few years of their career or they're transitioning from the floor to a leadership position, whether that be a direct manager or a charge nurse. And a charge nurse used to be a role reserve for, uh, like I mentioned, those, those senior nurses or people with, which have seen a lot of things go sideways so that they know how to handle those when, when the time needs calm and cool and compassionate care.
But what we're seeing now with the lack of senior nurses, and if you look across Canada, the, the holes in [00:10:00] leadership positions so whether that be clinical coordinator positions or, or direct positions on the floor with leadership and. and leadership help on the floor. You're not having anyone, routinely you're having people fill those advanced leadership positions with minimal clinical, um, clinical time or floor time. Right now in some of the sites that I oversee or I'm working with, you have essentially new grads, so within their first year transitioning to direct leadership positions.
So they haven't lived those experiences yet where things have gone really bad and you still had to continue on that job. And then you can transition those skills to help someone else transition through a difficult time.
So you have individuals trying to do the best they can. And these are wonderful human beings. And you'll, you'll hear me repeat this.There are some wonderful, amazing human beings and I think that's where my work is going and where we need to see healthcare go. There's amazing people that are leaving the profession. And the more amazing people that leave, that had the potential to be true leaders, if we just allowed them that time to develop or nurture that, uh, that inherent leadership quality in a lot of these individuals, then I think over time that would really solve a lot of the issues we're seeing. Because could you imagine? You come on and it's kind of a game of who draws the short straw at times to see who the charge nurse is.
And what you're seeing when you see the charge nurse role is typically you're kind of managing that unit you're supposed to answer questions but more and more with the ratios we talked about and the distress we talked about so the nurses are now having a one to seven patient ratio so a tremendous amount of of a burden and then you're also having family members that are coming to ask questions about why that care is not being provided. Why is their loved one not being cared for?
And the people that have to field those questions a lot of the times are the charge nurse so you have individuals who are new to nursing holding these positions and then having to feel the tremendous burden of [00:12:00] trying to provide a rationale as to why a certain individual isn't getting the same care as someone else. And then they're still having to manage their patient load and they, those people in those leadership positions don't have anyone to lean on. So they're kind of the face of the floor at times as a charge nurse with no advanced training and they're just thrust out there.
And it's kind of a sink or swim mentality. And you'll hear that in healthcare a lot. Sink or swim, you know, sink or swim. And I think that's a, a really scary thing to use; sink or swim.
Déjà: Wow, no kidding. And, uh, perhaps not the most sustainable model. I think, you know, we've chatted in the past a little bit about also folks who kind of, I think they pursue their Master’s and it's really with the goal of, of, moving into some type of leadership position quickly as well, which I think then potentially leaves a gap between the leadership that's there and having that real world experience to relate to the folks that they are leading. Can you give me a bit of insight into that?
Kent: Totally. I’ll talk on the real world because that's something I'm super passionate about. When I started in the field of nursing, my whole dream, my whole goal was to become an emergency room nurse. And at the time to do that, you needed years. So you need two, three, four years of general experience, just. caring for people, um, dealing with, uh, situations where a patient might, uh, deteriorate so that when you move into those advanced positions, you, you have that background. And I think that can be said too about, um, advancing, into a Master's or a PhD without having that, uh, that little bit of a background working on the floor.
Not to say there isn't some amazing leaders I've encountered that have gone into the world of academia uh, and there's exceptions to every rule. But I think a lot of the times I think that if you start at the bedside [00:14:00] and you work your way up to the boardroom. So when I, what I mean by that is you, you start at the bedside, you understand, or you have that humbling experience of, uh, you know, dealing with all the situation of care and deterioration of patients and dealing with all that, that stress on the floor, and then you transition to, into the world of going for your Master's or academia or advanced leadership. I think if you can hold onto those skills you learned on the floor, I think, in theory, you'd have a more compassionate understanding of what's needed on the floor to continue to develop that cycle of leadership.
Déjà: Yeah, absolutely. That it makes a lot of sense. The challenge is really complex and layered, especially just in a time strapped and stressful environment. You kind of touched on this, but, you know, let's say I'm a leader in the health care system and I want to do something to make it at a healthier place, or I want to do something to, I only have a couple of minutes, but I want to find a way to connect with the people that I'm leading. Do you have some ideas around how they can do that considering the current environment?
Kent: Absolutely. And, uh, this and what I've seen is not necessarily just can, uh, you know, solely for health care, but it could be across multiple professions. But in health care, specifically, some of the best actions you want to see is the nurses in the frontline staff right now are just taxed or burdened and, and they're feeling like they can't make it through. But that uplift when you get a manager or a leader that has their own burden to bear with all of the stuff that's thrown at them trying to staff a building or trying to deal with other fires that are in the background. But when a leader or a manager or someone in an upper leadership position steps on the floor to answer a call bell, get someone a glass of water, talk to a family member even for a minute or two, or just walk the floor and put a hand on a shoulder and say you're doing a great job and show those little humanistic touches. [00:16:00] You have no idea for myself and the uplift that it gives everyone because I've seen far too often when, uh, you know, the, the definition of leader, and I've, I've heard this, or you might have someone to say, well, I'm just going to show my face on the floor and that's what I think leadership is. But honestly, in, in. all situations that I've seen in the last little bit actions speak louder than words,
What we do and what I've seen a lot of times is the kudos or the high five ends up being a pizza party from time or it's nurses week so we're celebrating nurses week this week and some people that you've never met or leaders that you never met come up to say what a great job you're doing and it makes you feel great, but they're just words. And they're not always words because sometimes it's nice to have a handshake and put a face and and there are leadership positions where they can't get out on the floor but you get out and show, you know, you see a General step on the battlefield, for lack of a better word. And for many instances right now, it is kind of a battlefield out there. But when you see the General step on the battlefield, and, and do any task out there, you're like, wow, that's someone I want to get behind.
And I know it might not seem like much because they can't fix the situation. But if they come up there and they just give an honest conversation and say, you know, we're really trying to do our best to staff the building or provide, uh, you know, the best ratios we can. At least we know that they're working on it in the background because the communication breakdown from frontline to leadership oftentimes is a real thing. We don't know what's going on there. Just like sometimes leadership doesn't know what's going on on the floor. Maybe it's a state of affairs with cellphones and where technology’s gone,
…but a human connection or that moment of honesty and empathy and support from your leadership literally can alter the course of that day and really helps to alter some of the culture on the floor.
Déjà: I love that. It kind of illustrates, [00:18:00] I think, also the power of small actions, right? Not all of these things take a ton of time, and it's not totally reorganizing the system or something that one individual can't take on.
Um, you've recently had some work published in the Canadian Journal of Nursing that focuses on MICRO goal setting. Can you tell me about this framework and how it came to be?
Kent: Yeah, absolutely. So MICRO itself is broken down into Manageable, Identifiable, Collaborative, Relevant, Realistic and Repeatable and Ongoing reflection and reevaluation. So just to double back on that further, the M in manageable, so can the goal set be achieved under the current constraints that are faced by the practitioner? So, is the goal they're setting something that they can manage with what they're dealing with in the current climate or situation they have of that day?
Two, is it an Identifiable goal? So is the identifiable goal realistic within the priority set and also is it within the scope of practice of the practitioner? So a lot of times with the constraints, nurses I found were really pushing the edge of where their scope of practice could go to meet the expectations of the patient. And we talked a little bit about moral distress, but practitioners are being put in a situation where they have to make a decision. And sometimes that decision walks a fine line between scope of practice and maintaining their practicing standards and providing the optimal care they know that patient needs. That's a really fine line.
And C, collaborative is something I'm huge with. Can you work with the team around you, the interdisciplinary team, whether that be nurses, doctors, care aides, janitorial staff, housekeeping, whatever it ends up being. Can you collaborate with someone else to make the burden of that goal or the burden of that work you have in the day manageable?
And R and relevant, realistic, repeatable. I'm a huge fan of developing [00:20:00] goals that are repeatable because once we do them once and use a skill or use something else, can it be repeated? So it's what the practitioner trying to set as a goal. Is it a relevant or a realistic goal? Can it be achieved under the current constraints they're facing and can they repeat it if they do have success with what they've tried to achieve?
And this is something again, I'm, I'm huge on is Ongoing reflective and reevaluation. So once the goal is reached, what was learned from that situation? So doubling back and just really reviewing and summarizing what was learned. Can we improve on what was done for the next shift, the next day, the next week or the next person?
And what can be tracked to ensure a positive progression in that goal set. So that's really what MICRO breaks down to. Where my work with MICRO goal setting came, um, was just, I wanted to set people up for a way to look at what they were doing in terms of tasks because nursing or a lot of health care is task. it's task orientated, focused with the undertone of providing empathetic, kind, compassionate care. Nurses are piling everything together and they have one big wheel of cheese and my idea was to break into small pieces of cheese.
So at the end of the day. They eat all the cheese, or at least eat a significant amount of the cheese, but they don't just start with one big block of cheese.
Ah, that's the best analogy I can do. It's a way of breaking down things into manageable bites, so that they can hopefully take away some of that burden of the day.
Déjà: I love the cheese reference. Who doesn’t love a couple small bits of cheese? That's excellent. Um, and you know, I definitely see how reframing, a heavy day with a heavy workload can really help kind of lower some of that anxiety and help nurses get through those extremely busy days.
So the next thing I want to get into is some of your, well, you have a new research project that you're doing with, uh, the University of Victoria. Is that correct?
Kent: I am, yeah, uh, it's something that, uh, I didn't think my career trajectory would take, research, but, [00:22:00] I really want to see in my practicing career and in my life, really, if we can do some really great things to try and help what's going on with healthcare in Canada. And through that, I realized that research might be a great way to do it. So I reached out, I, again, I collaborated and fortified some relationships with some very smart people, um, uh, at the University of Victoria. And together we just kind of brainstormed over the last couple of years. And we decided that a research project might be a great collaborative effort to try and see some of those changes through.
So, um, happy to say that we did just receive some grant funding and we've put together quite an amazing, uh, little team. And we're really going to dive into looking at the role of charge nurse. And then from there, our hope is that we can take that and turn it into some really great tools that we can then provide to, uh, you know, health authorities or the health authority on Vancouver Island or anywhere. Anyone that wants it, can take these tools and the hope would be to, these tools would help develop leaders on the floor.
Help with some identification of potential leaders and really provide that supportive, uh, network supportive tool set, to help build some capacity and really help to grow leaders so that healthcare can be transformed.
Déjà: Well, congratulations, uh, on the momentum on that project. And it sounds like there is some real potential there for impact, uh, you know, on our system.
And my last one for you, So we've, we've spent a lot of time talking about, you know, what's going on in hospitals, what's going on in our healthcare system and empathy and authenticity and, you know, when I think about society as a whole, so whether that's patients or just the rest of our community, you know, why is it important for us all to have this context, to understand the context that our healthcare system is operating under?
Kent: These are great questions. [00:24:00] So how I view it is, I think we're all partners in, in, society, and I think we're wherever we are across, we'll just use Canada, but we're one giant community, and we're one giant community of individuals who, collaboratively, have more ability to make change than we do individually. And while we can do individual things to try and alter it, um, our community of Canada, is really what's going to change health care.
Um, I myself as someone who accesses healthcare, I have three amazing, beautiful young kids that really they're sick all the time. They come home with their daycare illnesses. So I'm having to access this care. And I think that's one of the catalysts for me to want to make some changes because it's, it’s, extremely challenging right now to access care for myself, personal use, and that's anyone I speak to it's kind of the same situation.
So I think the vision or how I view health care in Canada is amazing care for all, anytime, and compassionate caregivers that have the time to provide compassionate and wonderful and beautiful care.
And right now we're not meeting those, but, it's not to say that we won't, but it's just the individuals that are trying to access care are getting stressed and that stress is then passed on to the practitioner and the practitioner then leaving the profession. So it's kind of this catalyst of the frustration by the general public is then transferred where they're going, whether it be physicians or primary care or emergency care, and that stress comes in, that stress is passed on to individuals who can only take so much stress because they're dealing with it. So, I think a message I would say is we all just have to have compassion and understanding and realize that we're in it together, and we all have a role to play in where the future of healthcare is going.
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Déjà:[00:26:00]That was a really eye-opening conversation with Kent.
As someone who has multiple family members who have worked in nursing, or still do, I feel like I have a much better understanding of the complexities they face.
There’s a lot that’s broken in our system right now and much of that is out of our control. But having a better understanding of the current situation can change our perspective, and help us show up with more patience and empathy when we or our loved ones are seeking care.
I think the Big Idea here is that meaningful leadership is grounded in authenticity. Supporting frontline staff to break their day into small tasks has the power to increase self-efficacy and create a healthier culture.
The Big Ideas podcast is produced by the Office of Alumni Relations at Mount Royal University.
A special thanks to MRU journalism and digital media alum, Gabrielle Pyska, for her savvy editing talents.
Until next time, I’m your host, Déjà Leonard and this is Big Ideas.
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