On this episode of Nurses’ Voices, we’ll be talking with the nurse educator about what’s happening in nursing education. What we need to do to make sure Canada has the nurses we need for the future and what she wants to do to help achieve that goal.
Announcer: This is Nurses’ Voices, Nurses’ Voices is sponsored by Pfizer Canada.
It is supported by the Canadian Nurses Foundation and the Canadian Nurses Association.
Gail Donner: Welcome to Nurses’ Voices. I’m Gail Donner
Mary Wheeler: And I’m Mary Wheeler.
Gail Donner: We’re hearing a lot about nurses leaving their work and their profession. At the same time, we’re also hearing that the demand for nursing education is greater than the number of places for prospective students.
To help us understand what is happening in nursing education, why it’s happening and what needs to happen going forward, we’ll be talking to a nursing education Canadian leader.
Welcome to Nurses’ Voices. Rani Srivastava.
Roni is Dean of Nursing at Thompson Rivers University in Kamloops, BC.
And adjunct professor at both York University into Toronto and Dalhousie University in Halifax. She’s had a varied career in nursing and brings extensive and diverse experience to her current role.
So Rani, let’s get right into the issues of the day. We have a current critical nursing shortage, and we have increasing numbers of people who would like to be nurses.
We don’t seem to have the places for them in nursing education. And of course, even if they entered today, they’d still not be graduated for some years: Two at a minimum, and four in most cases. We have thousands of internationally trained, educated nurses in, in Canada who would love to be registered, or licensed. And, but that seems to be a work in progress.
So what’s going on? I think what we want to have today is a discussion about what’s happening in nursing education. Where does it fit into the whole scheme of things.
Rani Srivastava: What needs to happen in nursing education has, is very much tied to what’s happening in nursing practice.
I think the good news is that nursing continues to be a really sought after profession. People think it’s amazing. They want to come in and be nurses. Some of what we see currently in terms of the shortage in nursing is that it’s not just, at one end in terms of supply of nurses, it’s also keeping nurses in practice.
How do we keep them? Why don’t they stay? So, you know, you can spend four years graduating nurses. Well, what have we done if they leave two years later or three years later, or even four years later for that matter, that’s not serving us well, and yet that’s what’s happening. Right? So I think if we come back to nursing education that’s, as I said, good news, lots of people want to be nurses and we’re struggling in terms of how to provide really good quality education for as many nurses as we possibly can.
So for us, and I think at TRU, and I think it’s similar in other places, really the two biggest factors that seem to limit, I mean, other than funding from government, how many people we can take. Um, but right now government is funding. So right now it isn’t because the ministries in the various provinces aren’t willing to invest.
What we’re experiencing is we don’t have the educators to be able to have good quality education for our students coming in and really being able to offer them good practicum experiences and those clinical placements, both in terms of, you know, right now the health care system in itself, isn’t a bit of… call it, whatever you like. Some people have said it’s a crisis. It’s chaos. It’s challenged. All of the above in the COVID environment. It’s hard to have the same number of learners or large number of learners in smaller spaces with higher acuity of patients.
Gail Donner: So all I hear in this is, we need the educators and the institutions that employ nurses, to work together so that when you graduate nurses, they know what they’re getting into and there’s help for them so they don’t leave.
And also, so that the potential employers also do their best to provide quality clinical experience for students. But what kind of thinking are people about different way of doing what we’ve been doing? It seems to me with the exception of technology, we’re not doing it so much differently than we did it a lot of years ago.
Rani Srivastava: I think we’re trying to, but there’s always like a million other things that seem to get in the way. And I think part of what we need to do is prioritize this. I can tell you that, you know, this university across BC, we have a number of tables at every level where colleagues from the various sectors, so educators, the regulator, the provincial body, and certainly the ministry will come together and have conversations. So I think there’s stuff happening at the high policy level about the need to do some alignment. So we have some good tables. The conversations could be a tad more robust and maybe a tad, more efficient, I would say, but we’re there, we’re starting there.
Where some of the bigger challenges happen and where some opportunities are, is how do you take that higher level piece and bring it to sort of that mezzo and the micro level? I know this from my previous role as being a chief nurse in an organization is what the chief nurse and the director says may not be what the manager is saying, may not be what the preceptor’s saying.
And so I think it’s about those conversations that need to happen vertically, in each sector and across at every level. That’s where, when we do see success, that’s where we see success. So again, I’m fortunate now to be in Kamloops and TRU it’s a smaller town. We have one hospital, great relationships with the hospital, lots of relationships with, you know, managers. We have many of the, the nurses and the educators are also our faculty, many of our graduates. So having those relationships is really helping in terms of when we find those disconnects to help connect the dots sooner. We seem to put those things in place when there’s a shortage, and then it all becomes redundant when we’re fine.
All of these will work. If we. Invest in them and recognize that we have to be in it for the long haul, not the short haul. And do it in a way where it isn’t siloed, where there is greater ability and flexibility to work together.
Mary Wheeler: So many hospitals are putting out, amazing recruitment strategies for nurses. What is going on across Canada about recruiting faculty?
Rani Srivastava: We are trying to work very hard with both our respective unions, as well as the practice settings, because I think the models have to be more flexibility.
Mary Wheeler: Yep.
Rani Srivastava: We don’t have a lot of flexibility. So, you know, academic institutions have their rules around how you hire, how you work, what you can do et cetera.
And hospitals have their own rules. Nursing is a practice profession, and many nurses don’t want to give up their clinical and their practice world, but they do want to be in education and vice-a-versa. Many educators and in fact, some of us, would say they need to, right?
So we don’t have models of joint appointments. So you have to get creative, and say, okay, can we create secondments? Can we buy out time from this side to the other side? And if we do that, what does that mean for somebody’s ability to progress? Whether it is progress through the academic ranks or progressing in their career in a professional world, what does that do to their seniority or their benefits?
And how do we bring all of those together? It’s really on my mind right now, because we are in the process of trying to get a nurse practitioner program going. NPs needs to practice. So it’s pushing this whole conversation from a gee, maybe it’s a nice to do, to thou shalt, figure out a way to do it.
And it’s not a new conversation, but we’re struggling there as well. So again, it goes to show us where those blocks are. We need to think about how the funding needs to happen so that we can incentivize and create these kinds of appointments, where people do have a foot, a legitimate foot in both doors.
You both have known me for a long time and you know that I haven’t moved back and forth between academia and practice, practice, and academia. For those reasons, we’re trying to encourage people to go into graduate school. We’re trying to get more nurses prepared with education. But I think we’re always really mindful of, and again, being in a small town, every time we hire a sessional faculty member to teach, we know that that that’s taking away a nurse from the practice setting, or at least some nursing hours from the practice setting. And so we’re recognizing, and we’re saying yes, and both are necessary. So how can we work together and looking at that.
Gail Donner: It’s humorous to me, because of course, nursing nursing education began in healthcare settings, in hospitals mainly, but nevertheless, in the healthcare settings. And then we said, well, this isn’t working because the practice requirements, the needs of patients were subsuming any kind of opportunity for education for students. It was always, we need the people to provide care. We can’t let you go off and learn more. You just have to do.
So we separated that out. Now we’re seeing, we let two partners start working on their own agenda, start developing a atonamous organizations, and we gave something up. I became a nurse in that old system: I certainly don’t want go back and I wouldn’t want anybody I care about to go back there, but these are really tough time for care generally, for all the health professions, how do we get past this, these major barriers?
And I’m respectful of those barriers. We spent a lot of time providing quality work life for nurses through unions and other organizations. You know, we we’ve spent a lot of time regulating, working on scope of practice on standards of care. We don’t have to throw all that out. Do you ever think of any smaller ways to begin to make change rather than waiting for all the big partners to come together.
Rani Srivastava: I think it goes right back to having those conversations and building those relationships at every level. So there are the big partners coming together, and I think that is absolutely necessary. And maybe I’m an optimistic person by nature. So I hope this time. You know, we will get something that gets to be more sustainable.
And I think we’ve seen some good things happen in times of crisis. Right. And I think we just need to learn from them and work with them. So when COVID first happened and we were looking at what needed to be done. There was great collaboration between practice and education, whether it came to supplies, whether it came to people. Roni what if we need faculties to be in hospitals, giving care? Not a problem. We need, you know, patient care priorities will be there.
We need, you know, we packed up every, all of our labs and supplies and we said, okay, we’re not using them right now. We have all of this use them. So I think we’ve come together in crisis times. And I think we need to keep that up in non-crisis times. So let’s not wait for the next major crisis. This is enough of a crisis for us to think about how. So we do have those conversations about, you know, how can we support students?
How can we get them so that they are having good experiences? And I think practice settings are trying, they are really looking at recruitment. They’re working with our students, they’re saying, okay, let’s bring them in the, as I said, the, the summer employment programs or any of that, they’re looking at providing good orientations.
They’re working with their staff so that the students are valued. I was meeting with some students yesterday and asked them about, you know, we hear such doom and gloom about what’s happening in the hospital sector right now. And it is, it is true. I mean, there’s a lot of shortage, you know, surgeries that are canceled because staff are being floated.
Those are all realities. What the students said though, is that they were still really appreciating the learning that’s happening. So the good news is that the nurses that. Uh, we are recognizing that students aren’t a burden anymore, right? Uh, we are recognizing that we need the students and students are appreciating the strengths that the nursing workforce is under, but still taking the time to teach and guide them.
And I think then the other pieces, and I know I haven’t been doing it very much here, but I think this is where went in, in my old job, in the hospital, in the practice sector. We often seem to think about is, nurses are great employees. They’re great workers because they’re hard workers. They’re smart. I know I’m a little biased, but I think that they are, you know, they have a lot to offer and because they have a lot to offer, it’s very easy for nursing role to spread to many non-nursing things. Right?
Because nurses always there. So while you’re there, could you do A, B, C, D and E, which isn’t really nursing, but… we need to start thinking about nursing in ways that are perhaps a tad, more of a precious resource. And we get worried about the crisis, but we don’t think of nursing, nurses as a precious resource. And I think we need to! So be really thoughtful about if you have a nurse doing security checks. If you have a nurse doing, you know… where is it that that is taking away from nursing? So I know I often try to look at, does this require nursing knowledge, skill and judgment? And I know it’s not always easy, but that was sort of what we were trying to do is learn every task. And that’s one of, we’re trying to teach our students to be able to say, think about it in terms of, so often you’re right, we might do tasks that other people don’t see the nursing knowledge, skill and judgment, but can we see it? Can we articulate it? And most importantly, when people are designing nursing work, are those administrators recognizing what needs to be nursing? So, as I said earlier, I don’t think it’s any one thing, but I think we have to start recognizing, and I think our current environment has, once again identified the value of nurses.
The importance of nurses. And so I think it is time to start saying this is a precious resource that let’s not look at. So is there waste in the system? I think there is. And I think that would be another way to look at it as where are nurses doing non-nursing work.
Mary Wheeler: It’s the same as the conversation with, Gail Tomblin Murphy, in our first episode, it’s a very complex situation. And I think that’s what the public need to understand and nurses need to understand so that it isn’t going to come with a quick fix.
Rani Srivastava: So I think that’s the other piece is as acuity has shifted, as technology has come into support, I think nursing, you know, also needs to look at within themselves as to say, where are we putting up barriers to say only an RN can do that, only a practical nurse can do that and a healthcare assistant can’t do that.
And again, I recognize I don’t want to be overly simplistic cause I think there’s enough. You know, the more we keep adding layers to nursing, the harder it becomes for anybody, including the public to figure out what we’re doing and we’re adding more complexity into the system. But I think so I’m not for suggesting adding more complexity, but I think we can look within what we already have and see how can work better collaboratively.
So I think the last thing I will add to the conversation we’ve had is we could also look at some of our models of care and you don’t want to give up the accountability. You don’t want to give up the autonomy of practice or all of those, but a little bit more opportunity to work more collaboratively.
And this is what I always say that, and I’m saying that with a great deal of trepidation and hesitation, because you know what somebody comes up and and they say perfect. We’ll create a model where your one nurse and 10 healthcare assistants. That not, that’s not what I’m suggesting. Right. But we take it to the extremes as opposed to where’s that range, where we can do this creatively and safely, looking at the patient population and not just cheaply, like what’s the economic value to it because that’s where I think another thing that is then as that stops us from even exploring some of these things, there’s always the worry about, if this is going to work, all of a sudden it becomes a cost cutting exercise because, you know, if I have a healthcare assistant do this, that’s a lot cheaper than what an RN is doing. I have seen exquisite care given in many settings by healthcare assistants, but that that’s not the same as what an RN would do.
So again, it was mapping that, you know, the complexity of the care setting with what is needed and, and there are things that registered nurses can do and ought to be able to do. That I think we don’t always support. So that’s, I think it’s that whole other piece around the scope of practice.
Gail Donner: I want to switch gears though, for a minute. Who are the students coming into nursing now and what do they want?
Rani Srivastava: The students that I see is a huge diverse range. So we have students coming from high school and, you know, it used to be female dominated and it’s still a female dominated profession, but I’m seeing a lot of diversity. I’m seeing a lot of more men coming into nursing and even here in a small town, um, age; so they’re often people coming straight out of high school. There are people who are coming, who have tried different things in realize that’s not what they liked. They really like working with people, they like making a difference in terms of that, what I would call the helping profession. The, you know, when I talk to students about what brought them in, it really is about the working with people to being able to make the difference, the flexibility that the profession offers in terms of, I know I can get a job when I moved from Place A to Place B.
So all of those things, I think there’s such amazing things. And I think students see that. Right? Future practitioners, they see that. We’ve had students who are, you know, sort of, this is their second career. They’ve done a business, they run a business, they decided I’m done with that. I didn’t like it anymore and are coming back.
And I think that’s the challenge for educators. Our education system needs to build in more flexibility. And that is something we’re talking about. We’re not there yet. I’ve have our hands full with a few other things by that. Exactly. The kind of thing is how can we make it more nimble for people who are coming in with these experiences.
Um, and yet not compromise on the, the, the, the, the nursing knowledge, right? We want them skilled practitioners. So let’s not compromise on the knowledge piece, but do they really all need to go through exactly the same thing? So I think we could do a better job in nursing education. And th and there’s conversations, I think that are happening.
Uh, but like everything else, you know, when you’re the urgency is great and the bodies are few, then the conversations are great, but the, the thought to action takes a lot longer. And I think that’s where some of, of some of where we’re, we’re looking at. But I think that is certainly something that we will see more of in the future.
We’re already seeing that. Right. So I had, uh, when I was meeting with the students, one of them said: “So Roni,” cause I was talking to them about, you know, we’re talking about expansion. What do you guys think? What would that look like? What are your thoughts on that? And they said: “well, we were thinking about that. And so we have a four-year program. Well, what about a three-year program where you could get some credit for life experience on certain things?” Earlier, Gail, you were talking about the internationally educated nurses. And I think that is also another rich resource that we have not tapped into to its full potential.
And again, you know, why not have some models where people can actually, we make it very difficult for people to get licensure. Um, each province has its own and I’m learning that, you know, BC may be even harder than Ontario, why don’t you don’t didn’t think that was going to happen? Um, so we ha we have many of our students in our master’s program.
Uh, we’re graduating people with a master’s in nursing, but they can’t work as a registered nurse.
Mary Wheeler: Whoa!
Rani Srivastava: The urgency needs to be felt by each sector. Not just one sector. So I think sometimes the urgency’s being, obviously being felt by the practice sector: education is not very far behind. But then we think about the regulators and we know that there’s a job to do.
We understand, I, you know, I’m a member of the public and public protection and safety and all of that is absolutely critical . But we could do better. We could do faster. We could look at it. So I think those are the other things is to look at: Where are there resources? How do we make it easy in the education system for people who are in mid-career, who want to go back to school, but they have a family.
How is hard? So we’re looking at that in terms of, because again, being in a small town, you know, many of our potential students and actual students are coming back. Their high school was many years ago. So, how do we make sure we give them credit and let’s not put up 10 barriers about, you know, your, your biology 12 was five years ago, so we don’t count it and you got to take it over again.
Maybe we can do something different and we are, we are, we are looking at that. I mean, that’s one of the things that brought me to TRU is that whole notion of access to education is important and what can we do to make it easier? So I think we need to look at that access to education, including access to nursing education.
And looking at what are the fundamental supports that we need to put in for students to be successful? You know, for, for, for the mom who has been, you know, kind of doing other things or for the dad who has been doing other things. Um, but now sees this as an opportunity, but still has to juggle family responsibilities and all of these kinds of things. How do we bring them in and provide some, some supports for them to be able to be successful?
We don’t do a bad job on a one-off. I think when we find out faculty are really good, everybody goes out of their way. We’ll figure out stuff. So we do a good job on a one-off, but we don’t have it created where people can see: “I think I can do this. I’m going to apply and get in.”
So I think some of the other cool things that I think where we’re starting to see, we’ve been doing some work with some indigenous communities around health care assistants. And again, bite-sized chunks is where you begin. And so how do we take the education to them, work more closely, put it all in report. It is quite intensive. You know, if we can, and we are seeing the success, we get the successes. Those are students when they come back into nursing and I can guarantee you at least more than 50% will. And then our job becomes is how do we help fast-track them? So they don’t have to do everything. We’re not there yet, totally. But we can be.
So I think those are some of the solutions is to look at and say, looking at nursing education, and making it more flexible. RIght? People’s lives are much more complicated. We have more complex learners coming in. And I think if we were to do that, we would be able to support our int-internationally educated nurses, better because they will have some education needs that they can come in and meet as well.
Mary Wheeler: So you take your hat off in your role as leader at Thompson River. And really talk about Rani, the nurse. I’d be just curious why you went from Toronto, to Kamloops. And what’s the legacy you want to leave?
Rani Srivastava: I really wanted to come back to academia and some ways, you know, a lot of my nursing leadership career, I started off, um, being an educator. I think my first, first job at a university as a professor was 1985. I want to say. And then I moved back into practice and then back into academia and back into practice. So for me, this was nice to say, coming back, full circle to academia. I’m thinking about the future, right? Thinking about students, the future nurses, and what can I do with everything that I have and how can I make a contribution here?
So that’s sort of, what’s really exciting me. And I think my legacy, I hope will be to really look at strengthening that bridge between practice and academia. And I think, and I know we didn’t talk a lot about, because I think the other things that when I think about who else we haven’t tapped into and why many nurses leave, is that whole issue about, you know, are we creating a place for every nurse to succeed? Whether you are reflecting the mainstream, whether you are racialized, whether you are, you know, have a minority identity for any other reason, nursing should be the place where everybody should see themselves and thrive. And they don’t always. And so I know that either nurses burn out or leave and some of the racism and discrimination that they face within the profession is one more factor.
But I think coming back to what you were saying is what is my legacy? I hope it will be to say, how do we create a profession that really is valuing the expertise that nurses collectively and individually bring. And how do we really look at creating those opportunities for making an impact on the health and wellbeing of people?
You know, I look back on my career and I have nothing but gratitude every step of the way. Uh, I have been able to do lots of things. I have worked in many provinces across the country. I have done different roles and I just marvel at the potential for nursing.
Gail Donner: Well, I don’t know what to say, Roni, except that, uh, this has been a terrific conversation.
We’ve touched on a lot of different things, but what has been very gratifying, given I have known you for a long time, is to see your continued, uh, maybe over used word, but passion and commitment to looking ahead and to seeing what’s good and making sure that we keep that in the profession and build it for the future.
We hope you’ve enjoyed this second episode of season two Nurses’ Voices. We look forward to seeing you in future episodes. You can view and listen to Nurses’ Voiceson a variety of platforms, including YouTube and Apple Podcasts. And remember if you want to give us any feedback, please connect with us through nursesvoices.ca and remember to sign up to our e-newsletter
Announcer: Nurses’ voices is sponsored by Pfizer, Canada. It is created by donnerwheeler. It is produced by Cecktor Limited. It is supported by the Canadian Nurses Foundation and the Canadian Nurses Association.