Inside a Thriving Nursing Unit with Vicky Sharma-Vermani and Kristen Vila

What we’re going to focus on is what makes a good patient care unit, a good working environment for nurses, and what can we learn that will help us improve both patient care and nursing work life, going forward.

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’d Mary Wheeler.

Gail Donner: We’re hearing a lot about nurses leaving their work and their profession. In our first two episodes of season two of Nurses’ Voices, we spoke about health human resource planning and what needs to happen to recruit and retain nurses and then about what needs to happen in nursing education to ensure we are recruiting and educating nurses for the current health environment and also for the future. Now it’s time to talk about what is happening on the ground.

And what does a good nursing unit look like? One that values nurses provides opportunities for them to grow and provide high quality patient and family care. What does a unit like that look like? For this, we’re going to hear the perspectives directly from a nurse manager and from a frontline nurse.

Welcome to Nurses’ Voices, Vicky and Kristen. Vicky Sharma-Vermani started her nursing career as a Registered Nurse 15 years ago, and is now the patient care manager on 2B medicine at Trillium Health Partners in Mississauga, Ontario. Kristen Vilas started her career as a Registered Nurse four years ago, working part-time at Trillium Health Partners and is currently a coordinating nurse on 2B, where Vicky is the manager.

So maybe before we get going with questions, Vicky, could I ask you just to tell our viewers and listeners a little bit about Mississauga, a little bit about Trillium Health Partners and a little bit about 2B medicine,

Vicky Sharma-Vermani: Trillium Health Partners is one of the largest hospitals within Ontario.

We have three main sites. There’s the Mississauga and Credit Valley and Queensway site. And we serve a very diverse population. We have many various programs. We have the cancer program, surgery, women’s and children, and then we’ve got medicine, which is where we fall under. 2B is one of the largest units in the hospital.

Gail Donner: Let’s talk about some of the issues and I’m going to start with you, Kristen. When I started asking colleagues for the name of a manager that was leading a unit that staff nurses want to work in, and that seems to be a good place providing good patient care, more than one, several people, mentioned Vicky and they mentioned 2B as a unit of choice.

So maybe you can say a little bit about how you came to be on 2B, why you are on 2B and then we’ll talk a little bit about what, what makes a good unit.

Kristen Vila: Uh, originally I started on 2B very early into my career. It was only on another unit for six months before I transitioned to 2B. At that time we had varying managers, but I really got along with the people that I worked with.

I stayed on my unit. I worked very hard as being a full-time RN on 2B. And shortly after the opportunity came about where, um, I had the chance to become what we call a coordinating nurse or a clinical leader, um, in other hospitals. And so I took the opportunity. Uh, within that time, uh, we had maybe three or four different interim managers, and so it became more of a kind of a team focus where we worked with each other because we didn’t have a constant manager. So the team became very strong. And as a nurse, I became self directed and kind of trying to mitigate the challenges that the managers had to deal with because they were also dealing with other units.

So I decided to stay, because it was a challenge. Now that Vicky’s there. It just amplifies the reason why I stayed, because I know I have that group support from my manager, from my educator, as well as from my staff. So I continue to be there. I’m growing. I’m still a junior nurse as they would call it.

Um, I love it there, I wouldn’t change anything about it.

Gail Donner: So, Vicky 2B had a variety of a nurse managers while it was figuring out what it wanted to be, I guess, when it grows up and the staff, when I listen to Kristen and the staff became quite a tight and self-directed kind of group. So tell us a little bit about how you came to be at, 2B, and as you, arrived, what were the challenges?

Vicky Sharma-Vermani: I had only heard about 2B, I was a student there once, and that was the last I heard of 2B. And I was like: “Ok, that’s it 2B’s done not looking back”. I was on a surgical unit at the other site and site. And then I came over to Credit Valley site as an educator and did like a few interim manager roles on other units.

And then only then, Shannon, my director, had approached me and said, you know, I think you’d do great on 2B. And so this is the biggest unit and I like Kristen, Kristen and I both know, 2B, did not have the greatest rep, for whatever reason, nobody was very specific. It was just that 2B, you don’t want to go to 2B.

And I was like, okay, I don’t want to go to, 2B. I don’t know why, but I don’t want to go to 2B Shannon, really, she was like, “no, Vicky, you can do it. You could do it” so I came to 2B. And it was seriously a walk in the park because ,we have three charge nurses, there’s Kristen, Andrea, and uh, Rebecca and these guys are just all so self-sufficient. I was there and like, okay, what am I doing for you? Because you guys have it all figured out. I didn’t know what the bad rep was about. I still can’t figure it out. In my eyes. I told these guys when I met them, like you are all shining superstars. I’m just here to take off the dust a little bit, so the rest of the organization can see it.

We went on to win awards. There’s recognitions. Um, we have, uh, uh, 905 leadership call where, um, 2B, has been highlighted a few times. And then all of a sudden I started getting all these applications from the prior units I was on and we got an influx of new hires and Becky transferred over.

Which is really nice. So some people started calling us the pied Piper because we had this following. My charge nurses especially, is that they have an issue, they solve it, they let me know afterwards just as a courtesy. And I, you know, I’m like, okay, but why didn’t you guys tell me before and they’re like “we weren’t going to bother you with that”.

So we know when they’ve come to me, I know they’ve exhausted everything else and um, but it rarely ever happens. So I really feel like I’m just there as a support. And in constant. When I first came, they said, you’re not going to go anywhere either. lIke, you know, they weren’t getting too attached to, because there’s so many managers that come in, like they came and they left, but I don’t see myself ever going anywhere else.

Like this is home now.

Gail Donner: So it’s fascinating. You, you’re saying, oh, um, what makes a good unit is having good staff and the fact that they work as a team makes your job easier, but I I’m assuming it also makes the quality of care better. If you don’t have to intervene very often, you must be pretty pleased with how they’re doing.

During the pandemic, it’s been a terrible situation for all acute care hospitals long-term care, public health. I mean, everybody and nurses have been in the spotlight a lot. And a lot of nurses have been complaining about being burnt out, and being tired and not being appreciated. So maybe you could follow up a little bit with what have you learned, about how to support nurses? What is the kind of support? And then Kristen, maybe you can talk about what, what it takes to help a manager, be a good manager.

Vicky Sharma-Vermani: For me, and it just is very simple. I read a book called “If Disney Ran Your Hospital: nine and a half things you would do differently”.

Just learning from that, it’s very simple. It’s just value people as humans and I’d put a great emphasis on relationship building and sustaining relationships. So when staff are sick, I’m not worried, “okay, we’re going to be short”. I’m more worried. How is that person doing? And so, you know, I actually reach out and let you know “if you need anything…”

We had a few staff that were off with COVID and genuinely, I think all of us, we reached out and said, if you need me to drop foods meds PPE, let me know. We will come and drop it off. We’ll Uber it to your door, whatever. Just that little thought, like people really, really appreciate it.

And I think that’s trickling down, like I said, from the senior leadership now, um, because I think once the pandemic hit, everybody came to a level playing field. There wasn’t this hierarchy anymore, and people were just texting back and forth and everyone was sharing the same feelings. So just having that relationship piece, I think is very important.

And once you build that relationship, having that trust, I feel like from my end, I’m obligated to uphold people’s trust. And in turn, I think on our staff reciprocates that, but that trust and also loyalty to an extent, because a lot of people don’t want to leave the unit, even though it is heavy: “Oh, Vicky, we don’t want to leave you”.

So, you know, the charge nurses are amazing. They’re so supportive. We have an amazing educator who’s there. Um, and just right at the bedside with staff and everyday at our huddle, we talk about respectful workplace. That’s something that we hold very high in our unit, um, to make sure everyone feels respected any new guests, any students, anybody that comes on to the unit, we’ll make sure we introduce them at huddle, uh right up to our PSRs, which is our cleaning staff. Um, we make sure everybody is acknowledged and everybody feels a part of the team.

Gail Donner: Kristen, what do you think about when you listen to Vicky?

Kristen Vila: I think everything Vicky said is, is exactly how we work.

It’s building that teamwork and those relationships within each other because being a nurse, sometimes you can’t do everything alone. And so, um, just having the good relationships with each other helps us go a long way within our day-to-day and our month to month and our year too. Um, that’s a lot of the reasons why I hear from my staff that they’ve stayed and they’re not going anywhere.

Our unit is very heavy and since the pandemic, I think it’s just gotten worse. Because we weren’t the designated COVID unit. We were a medicine unit and we weren’t getting the COVID patients, but we were getting a significant load of heavy patients that were severely ill, um, having each other and supporting each other through, um, really helped us a lot.

And also I think with Vicky it’s, it’s having the ability to go to her office and just say, Hey, I’m having a hard day today. And she was very open and, and say, how can I help you? What can we change? What can we make different? And it goes for myself to go through all this. We’re all needing a mental health day these days, because it’s just been, go, go, go, go, go.

And there hasn’t been much off time. Um, and so Vicki makes that happen where she encourages us to take that vacation and to take that time off and to focus on our mental health. Even though it’s not a vacation down south, it’s a mental health break from being there on the floor for five or four days a week.

Um, so she’s been very accommodating to the staff then giving them time off.

Mary Wheeler: How do we take what you’re doing? Like this is, and I, I’m not minimizing it, but this isn’t magic. This is talking about values. It’s talking about respect, it’s talking about relationships. So I’d really like to hear from the both of you, where are we missing out?

Why isn’t this happening in other places?

Vicky Sharma-Vermani: I really find that it’s not something we learn in school, you know, in school we learn a lot of theory. When we get to our jobs, we learn a lot of operational and I had a great mentor as well. Um, and you know, I did, uh, we did our Gallup strengths. The Gallup strengths is that, um, I was highly relational and so was he, so I really mimic a lot that I’ve learned from him.

So, and I know that, uh, Kristen right now is doing an invitation to leadership program and they see the relationships and they themselves say, you know, that it’s, it’s nice to be, not seen as a number, but as a person, I had a few nurses say that to me. So, you know, just hearing those things, they really resonate with me.

And you know, these are, I think I wouldn’t have known this early in my career. I’m still learning, but it seems to work. It seems to be the secret sauce that’s keeping people here and when they are transferring over. Um, Kristen knows as well as that they’re going maybe to the Emerg, or they’re going to renal or ICU.

So we know that they’re progressing, they’re progressing, they’re growing in their careers. So we feel good about that. I always tell everybody if you’re leaving me for another medicine unit, I need to know why. So we do our own little exit interview, but, uh, we haven’t had that happen.

Kristen Vila: So for me, um, having gone through like four different managers within the span of the year that I was a charge. You’ve had the different types of styles. And so every style of every manager has been different. And so I found myself like just getting used to one and then having to switch to another style at, for me was a little bit of a challenge. But that authoritative to kind of like, “you’re doing this my way, you can’t do this and you can’t do that”. Is something that did not work for our unit because they needed a more relational manager. So I think everybody is different in terms of how they will manage. But I think having that relational aspect where you can relate to the nurses, understand how they’re feeling and how heavy the workload is, and then giving them what they need, if they need some time off, allowing them to do that.

Because if you’re more like “you did this wrong, you need to go on a learning plan”. You like, there’s no room for growth. It’s more, “you did wrong; you need to learn better”. It’s not kind of like a working together type of relationship. And so I think our staff are thriving and because Vicky is excellent in saying to them, “let’s work on it; let’s work together. What can we do better?” Not just, “what can you do better?”, “What can we do better as a unit to help, um, amplify, uh, what’s going on and help, help learn from the mistake”. Of being approachable, being a manager that is present on the unit every morning, going around to say, good morning, how are you doing?

And that’s something Vicki is very adamant on doing is when she starts her day. She comes and says, hello, not only to me, but everybody that is working.

Gail Donner: What you’re describing is what we say we want, what high quality nursing care looks like. Establishing relationships, valuing the patient or the family for who they are not being judgmental.

How does all this fit with what the job is of the nurse and of the manager?

Kristen Vila: This is what I tell my staff all the time, because you’re going to have good days and you’re going to have bad days. And you’re going to have patients who complain and families who complain. But at the end of the day, it’s important to note that these people are in the hospital for a reason. And we came into nursing for a reason, is to care for our patients to help them heal. And so in the back of your mind, when you’re having that hard day, it’s just to remember that this patient is still a person they’re having a difficult time. You might be having a difficult time as well, but importantly enough that you’re going in there with no judgements.

You’re going in there with an open mind and not letting other things bother you. And then I always say it’s important to when you leave for that day, if you had a hard day, the patient gave you a hard time it’s to leave that at work, leave it there, go home and start fresh. Don’t don’t carry that on.

And that’s something it’s been extremely, extremely challenging. Like I said, not only the patients. They’re sicker because a lot of them haven’t came to seek help in a long time and, and followed up with their physicians. It’s now also these policies and the visitation rules that have been put into place, which have put big restraints on the patients and on the nurses, because not only do we have to provide that exceptional patient care, it’s also attending to the families and understanding that, if you were one of them, you would also need an update every single day about your loved one. So you need to take a step back, put yourself in their shoes and understand that every day is going to be different. You just have to take it as it is. And then if you are feeling that you are having that, no patience just take some time off, because I always say, if you feel like that, it means that you’re burnt out and you’re not going to be able to provide that exceptional care.

So take time off.

Gail Donner: What do you say to that Vicky?

Vicky Sharma-Vermani: So everything Kristen just said, she says that everyday at huddle. So she tickled everybody the same thing. Um, and I have other, um, other staff in the hospital that says: “oh, that charge nurse of yours, she’s a little firecracker. Like she is, she’s good!”

Like they want her. And I just said, Shoo them off and say, “no, stay away”. We’re not here just providing a service. We’re providing an experience for a lot of people. And for every single person that comes through our door, just making them feel welcome. And like Kristen said, and Kristen’s actually better than this than I am because I am highly relational.

So when I get yelled at, by a patient or a family, I hold onto it. And then I asked Kristen, I’m like, are you OK? And she says, oh, I’m fine, that was done long time ago. And I was like, okay, do you need to teach me, like, I don’t know how you do it. You know, I’m starting to talk to staff about is there’s like our, our judgment circle and then our learning circuit.

So, you know, when judgment, we’re listening to answer. And I think I’m guilty of this sometimes when, you know, I get calls from patients’ families, and listening, but I know what my answer is going to be. And then, so I’m moving a little bit more into the learning circuit to really learn about, okay, you know, what are they trying to tell me?

And it really, what can I do? Like, you know, so I tried it, there’s there visiting exceptions. There’s there’s black and white, but there is a bit of a gray area. So, you know, right now we have, um, where visitors can come in as an essential care partner. So you know, I asked them only what can you do so we can get you in here as an essential care partner, meaning providing hands-on care.

And so giving them some examples. I actually learned from Kristen about this one, because she is the one who is at the bedside. She’s mentoring the nurses, um, at all of our, all our, uh, care providers, uh, during rounds. How to deal with, you know, families and what approach to take, uh, Kristen knows best.

We’ve got a huge unit and she knows every single patient and a family member that’s associated, and she can tell you their whole story. Um, probably then their whole history. So I it’s Kristen, who know’s the answer. They’re going to for that.

Mary Wheeler: So I’d be interested in knowing what you’re doing on this unit? How was that making a shift in the organization?

Vicky Sharma-Vermani: I personally don’t think that I would’ve got this opportunity had the pandemic not happened. Um, you know, I think I, it would probably be a couple more years before I got into a permanent, I never thought of becoming a manager. Um, I thought I was going to retire as an educator and that was my thing. Um, so.

I think with the pandemic, everybody came on a level playing field and we really started looking at people’s strengths. Um, I can speak about the medicine program. Shannon was an external new director. She’s a nurse by background as well. She really sees people for who they are. And I’ve seen that even after myself, the people that she’s hired on really bring a different flare, like a different set of, and they’ve.

They really do value relationships and their employees and their staff. I see. As you’re saying, there is a paradigm shift. I do see an evolve when I look at the senior leadership, because I see it even beyond Shannon, like you’re able to joke with the VP. You weren’t able to do that before. Now, there’s more of a I would say a “board to ward” alignment. Like you see them coming to our huddles, you see them speaking to our staff. And meanwhile, when I was in staffer nurse, I thought the manager, my manager owned the whole hospital. I didn’t know that there was anybody beyond that. And she was great, now is that we’re seeing that, okay, the, you know, the senior leaders, they really do care about what’s going on at the bedside. We had like, I think three VPs come in one week coming to our huddles and they wanted to hear directly from the frontline staff what’s going on. So that’s something I haven’t seen before. And I think the pandemic really played a huge part in that.

Mary Wheeler: So if I was a staff nurse, or a manager who turned on Nurses’ Voices for this episode, and I’m thinking, boy, I’d love to be on a unit. Could you give me as the, as the viewer, as the listener, Kristen, could you give me as a staff nurse? What’s a couple of things I need to do to make it feel better.

Kristen Vila: I think it’s important, number one is to build relationship with your teammates and to have those good relationships. Not just a, kind of a work relationship, but really trying to get to know the person. Like, no, you don’t have to go into much depth, but knowing that they have children or having a cat or a dog that they enjoy what their hobbies are, like, stuff like that to really build that relationship with somebody.

Number one, number two, what we’ve been working on it as a team is also bringing joy to work. And I think it’s important to have a environment that fosters that joy. And so working with my staff, we’ve done things like spirit week as well, where, when it was Christmas time, we wore red and green and sparkles and just put that together.

So that way, when you come into work, you have something to look forward to. Um, and then we do things like decorating the unit as much as we can. Um, and just bringing that joy to the patients as well and making them feel like we’re at home.

For the third part, I should say is having that senior leadership be present. So not just seeing your staff members and your charge nurse, but having your educator and your manager present to help you with, to say good morning, and to lend you a hand, just showing that they are committed to you and making your day better, um, that goes a long way as well. And then having the tools and resources, you need to do your job and make your job easier would be my fourth and final.

We’ve been working a lot on this, uh, on 2B in making sure that the staff have things like a Hoyer lift, that you connect to the ceiling lip, so it makes it easier to weigh the patients, having vein finders and, um, things like that, where, the, the nurses don’t have to work as hard or take time out of their day to go and find something.

So…

Mary Wheeler: And Vicky I’m a manager watching this episode. What do I need to learn from your story?

Vicky Sharma-Vermani: I would say, you know, don’t be a dictator, just work with your team, trust your team. They know the unit best, and they can guide and tell you what’s gonna work and what’s not going to work with the team. So I, that’s what I would suggest and say, read the Disney book, “If Disney ran your hospital” that that one changed my life, you know.

Gail Donner: I’m just astounded at how passionate and positive and caring, you just comes across the screen, but what, where do you see yourselves 10 years from now?

Kristen Vila: I’ve been actually doing a lot of reflection and, uh, having done just my leadership to, uh, invitation, to leadership course and seeing exactly where I want to be in 10 years.

I think my goal is to go back to school, to get my master’s degree. And eventually I’d like to be where Vicky’s sitting. I’d like to be a nurse manager. Yeah, I think that’s, that would be my ultimate goal is to get there and, um, and then take it from there.

Gail Donner: What about you Vicky.

Vicky Sharma-Vermani: I am still in a surreal state, where I don’t, I don’t believe I am, um, right now, uh, just because a lot of these opportunities just kind of came my way, just very organically.

So I just kinda, I, I, my thing is that, just work hard and your work will speak for itself. And if something comes up, it’ll come up and I’ll probably say no at first, and then probably will get pushed into something but, right now I’m saying it that I’m probably going to retire as 2B manager.

Mary Wheeler: Ahh,

Gail Donner: That’s a great,that’s a great compliment.

Not just to, 2B, but to the work you do when you put it that way. Yeah. Well, I think our time is up. I’m I’m sad to say. I want to thank both of you very much. This has been just what we wanted in the sense of you’ve been your authentic selves, I think. And you’ve shared what makes you come to work every day, and you’ve shared to use your word, Kristen, you’ve shared how you bring joy and you certainly inspired me and made me more hopeful.

Uh, especially at this time, both about individual nurses, you, each of you, but also about the profession and also about the workplace. Things are possible.

We hope you’ve enjoyed this episode of season two of Nurses’ Voices, and we look forward to seeing you in future episodes, you can view and listen to Nurses’ Voices on a variety of platforms, including YouTube and Apple Podcasts.

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Announcer: Nurses’ Voices is sponsored by Pfizer Canada. It is created by donnerwheler. It is produced by Cector Limited. It is supported by the Canadian Nurses Foundation and the Canadian Nurses Association. .