The Long-Term Care Crisis in Quebec and Canada with Natalie Stake-Doucet and Roya Kazempour
The Long-Term Care Crisis in Quebec and Canada with Natalie Stake-Doucet and Roya Kazempour
Watch and listen as Gail Donner and Mary Wheeler have an incredibly honest and passionate conversation with Natalie Stake-Doucet and Roya Kazempour, nurses in Quebec’s long-term care system.
Natalie and Roya take us behind-the-scenes as they describe the devastating impact and tragic loss during the COVID-19 pandemic, and how structural issues within long-term care can leave residents vulnerable. Natalie and Roya are passionate and hopeful, yet calls for change are necessary to improve the quality and conditions in long-term care. You don’t want to miss these remarkable stories.
I’ve been a nurse for just over a decade. It’s the best profession in the world, but also the one with the worst conditions for practice. I’ve worked in different hospitals and health institutions, and I’ve yet to find one that truly understands the value of nurses and nursing. This is why I’ve also been a nurse activist for a decade. Nursing is complex and highly political, yet is too often stuffed into a box that warps it into a seemingly apolitical and task-oriented job. Through my work as a doctoral researcher and as president of the QNA, I aim to contribute to creating environments where nurses can flourish and where they know their worth.
I started my career in a rural hospital, working on the float team. When I moved back to the city, I worked a couple years in a super-specialized forensic psychiatry institution, then became a ER nurse. What drives me and inspires me the most though, are nurses themselves. From the nurses’ union in Quebec blocking bridges last spring to historical giants like Emma Goldman or Mary Seacole, everytime I meet new colleagues, in person or through books, I learn something new. When we refuse to accept the “sacrificial” and “vocational” rhetoric that normalizes our abuse, we become an incredible force that can bring all of healthcare forward and make history.
Roya Kazempour, RN, BScN Jewish Eldercare Centre Montreal Jewish General Hospital
I am a nurse from Iran with 6 years of experience. I came to Canada in 2004 with my husband and our first child to raise my family and give my children the opportunity of having a better life and a better future. It took me several years to go back to work as a nurse, but I am grateful that despite the long wait, myself and others like me have the chance to continue working within their profession after having moved to Canada. I got my first job in 2014 and since 2015 I have been working at the Jewish Eldercare Centre in Montreal, Quebec; I consider it my second home. I started working as a team leader and I have had the opportunity to grow within the institution I am now an assistant head nurse. I also worked in cohort in our LTC facility during the pandemic’s first, second and third waves.
Quebec's Long-Term Care Crisis with Natalie Stake-Doucet and Roya Kazempour
[00:00:00] Gail Donner: We’re going to talk to two nurses who were in long-term care, during the worst of the pandemic.
[00:00:09] Announcer: This is Nurses’ Voices. Nurses’ Voices is supported by the Canadian Nurses Foundation and by the Canadian Nurses Association.
[00:00:20] Gail Donner: Welcome to Nurses’ voices. I’m Gail Donner
[00:00:23] Mary Wheeler: and I’m Mary Wheeler.
[00:00:25] Gail Donner: We’ll be talking to two nurses from Montreal.
Both women were at the bedside during the critical surge COVID cases in long-term care, they’re experience during that very sad time and their own careers and passions will give all of us a lot to think about it. Roya Kazempour is a nurse from Iran who’s been working as an RN in Canada since 2014 in the elder care unit at the Montreal Jewish general hospital. She also worked in the long-term care unit at that hospital during the three COVID waves.
Natalie Stake-Doucet is an RN currently working in a vaccination clinic. She’s been a nurse and activist for 10 years now and president of the Quebec Nurses’ Association, Natalie worked also in long-term care during the first wave of COVID in Montreal.
Natalie is also a PhD candidate at McGill university in Montreal.
So welcome Natalie and Roya. Both of you were in long-term care during probably the absolute worst of the pandemic. And Natalie I’d like to start with you if I could and ask you if maybe you can just introduce us to what that experience was like for you.
[00:01:55] Natalie Stake-Doucet: It’s still something, uh, I’m struggling to put into words. I ended up in one of the worst, uh, long-term care, uh, places at its worst time. So I was in a long-term care home called Yvon Brunet in April and we lost, the official number is 73 residents died in about two and a half months. Uh, yeah, it was, um, it’s really hard to put into words.
I mean, it’s something I never thought I would see in my life, in my career as a nurse in Canada, uh, in Montreal, it put everything in question and, uh, made me extremely angry. I’m still angry today at what we had to go through. Uh, all the staff, the residents, the family. And I’m really, in some ways I think holding onto that anger so I don’t fall into despair because it was a, it was a very, very difficult time. Um, and it was not something we should have gone through given the resources that do exist in 2020 in Canada, in Quebec. I think a lot of people died really, uh, terrible deaths when they shouldn’t have, that’s been driving me since then.
Basically it’s been over a year now. Um, but it’s not something you can. Move on from, uh, and you know, we don’t know, is there going to be more pandemics? Probably in our lifetime. I mean, it’s reasonable to think that, epidemiologists, speak a lot about, have been warning about pandemics for, for decades now.
And we know, uh, residents of long-term care homes are much more vulnerable, uh, not just because of their health, but now we know, because the healthcare system makes them vulnerable because the care homes themselves are in old dilapidated buildings with terrible ventilation, with one bathroom for two rooms with, so there’s, there’s a number of structural issues that make their vulnerability so much worse than it actually should be.
So I’m trying to focus on, on that and trying to act, uh, as much as I can with colleagues on, on changing that at least.
[00:04:07] Gail Donner: Yeah. It’s I think it’s impossible for people who don’t have the experience to actually feel like they must be feeling, but from the little that I know and what I’ve done in the past on long-term care.
I can imagine only the incredible stress that everybody was under, but maybe Roya, you could weigh in a little bit.
[00:04:31] Roya Kazempour: Everything started so fast and we like, started our cohort in April 2nd. So, uh, and uh, our first case was, uh, detected in March. And then they started to swab and do the COVID tests for all the residents.
And it was a very difficult experience because I, I know most of my residents when they are like family, you know, so it was difficult to see them. And this situation.
[00:05:05] Gail Donner: How did you manage to honestly to survive it?
[00:05:10] Roya Kazempour: Uh, the only thing at the beginning I was thinking about, I said, yeah, I signed for it. And I go, and they, these people, they need me need us. All of us. I kept me to go,
[00:05:24] Mary Wheeler: Roya, you were there on the unit. But Natalie, you weren’t working in long-term care yet?
[00:05:31] Natalie Stake-Doucet: Well, I’d been working in long-term care before both as an orderly and a nurse and in a March, I think it was March 13th or 14th that the prime minister here said, we’re going on pause. Um, and the next day they called for help.
They said, we need help in long-term care homes. Uh, there’s not enough people, half the staff is already sick. I knew I could do it. So I figured, you know, I, I can help. So I should.
[00:05:57] Gail Donner: What made you get up every day and go in?
[00:05:59] Natalie Stake-Doucet: At the beginning it’s definitely adrenaline, you know, it’s the fight or flight reflex that just kicks in and you’re just, you know, running on fumes basically.
Um, there’s just so much happening. There’s no time for you to think about anything else. You know, you’re just running around because we, they didn’t give us any more staff. Right. So we had less staff than usual, and we were, you know, everything takes much longer to do when you’re all dressed up. It’s not giving meds out to 10 patients.
It takes much longer during a pandemic than during regular time. So you’re constantly, there is not a second of your time that you’re not on your feet doing something. So I think it’s still something I’m trying to deal with and process like right now, I could not go back. Just thinking about it. I, you know, my breath sort of catches and it’s just, I don’t thinking about it.
Even walking in front of a long-term care home right now is very, very difficult. And I just see in my mind, these images all the time, so. In terms of coping. I don’t know if I’ve actually really coped with it. Um, so, you know, there’s, there’s stuff that you go through. It takes time to get through when you’ve seen so many people die, you know, in one day we lost 10 residents, you know, and, and I’d never seen it was, um, it’s just, it’s hard to.
It’s hard to fathom that something like that could happen on that scale. You know, that it could happen so much. I I’d seen death before, but never it never, ever, ever like this. I didn’t think that the volume and the, the quality of how of the deaths was just was devastating. We didn’t, we didn’t come out of it unscathed.
[00:07:47] Gail Donner: What what’s it like now for you and your colleagues? Roya?
[00:07:52] Roya Kazempour: We trying to go back to normal. I don’t know how it’s going to be your new normal, and uh, now our residents, uh, most of them I can say, uh, fully vaccinated. And we started to reopen visiting and coming. So that’s even see these things.
Encourage me to go again, you know, as Natalie said, even going back thinking about what happened before, it’s like, for me, it’s not easy anymore is whatever, what we saw and experienced. It was so difficult. We lost a lot of our precious residents, but this is a life. So we try to keep going. Most of my colleagues, they got sick at the beginning when we started.
Uh, like at the beginning I was alone because we didn’t have much resident five, six. So I had to orderlies and me. We could manage it and then started very fast to have more and more the resident getting sick and every time a colleague in coming to help me next day, I come in and don’t see them. And they say, yeah, they got sick too.
So, you know, it, it was so difficult and, uh, Understaffed, but because they, they got sick. Most of them, most of my colleagues, they got sick. So
[00:09:30] Mary Wheeler: Roya I’m interested in as an internationally educated nurse, you came from Iran, is long-term care where you wanted to work?
[00:09:41] Roya Kazempour: I, I loved it. I, at the beginning of when I came and because in my country, we, we didn’t have geriatric.
And so for me it was, it was something new and interesting. Yeah. So I loved it from the beginning.
[00:10:01] Gail Donner: But it took you a long time from the time you came to Canada to get registered. Is that right?
[00:10:07] Roya Kazempour: When I came after equivalency of my, uh, bachelor, they accepted and everything was good, but I didn’t know about the, uh, order.
They need us the documents and everything from my country. So if I was in Iran, I will do it. And prepare my document before coming could, uh, accelerate this process. But because I was here already, so took me several years. That was my fault, actually. But, uh, anyway, having young children also and learning lang… new languages took me also the time, but eh, after that, It was, uh, because when I came to Canada and to Quebec, uh, I, I love the French language very much.
So I started here to learn French first. And so I tried to go to French, uh, after I got the green light from order to go to college, get the integration program. Uh, unfortunately, uh, every time I was trying to go to this program, my French wasn’t good enough. So that also was, uh, that took me again several years.
I didn’t give up. I, um, so I had to change. The course, I go to English side. So I went, even my French was much better than my English. They accepted me there and yeah, I started my integration program there.
[00:12:03] Gail Donner: So a couple of
things, first of all, for, for the viewers and listeners who are watching the order is the regulatory body in Quebec.
So just like in every province, that’s the body that says, yay or nay about getting, uh, getting, uh, registered. But I have to say, I applaud your determination. You must be very committed to nursing because we know that internationally educated nurses have often a difficult time Quebec is not different from many other provinces.
I think in every, I think across the country, people are trying to fix it, but I know it’s very difficult. So I’m just impressed that for years, you just forged ahead and, and, um, I’m glad you’re doing what you’re, what you’re doing, but I saw you shaking your head, Natalie. And I wonder if from your, um, association experience, your advocacy experience, whether you hear a lot about, uh, I’ll say the plight or the difficulties or the opportunities for internationally educated nurses.
[00:13:11] Natalie Stake-Doucet: We need nurses. Um, and we should make it easier, uh, for them to get their licenses and to get to work. And I’m, I’m, I’m so glad Roya you’re here. Like we need you and I’m, I’m very happy that you’re here and I’m just sad that, you know, you weren’t able, even though your French was better than your English, you weren’t able to go into the French system.
Uh, that to me, Is mind-boggling. Um, and you know, it just doesn’t make sense. So that’s, there’s definitely many aspects of, of that that needs to be worked on. And we need, um, you know, the formal nursing leadership, both in universities, colleges, uh, and our, uh, in our regulatory body to be much more proactive on that, uh, in Quebec, especially we’ve talked about a nursing shortage for the past 25 years now. So it’d be nice if we actually do something about it rather than just, you know, lament well, oh, there’s nothing we can do about it. There’s a shortage. Uh, there is actually tons of things we can do. And especially in long-term care, that’s probably where we’ve been hit the hardest in terms of this shortage.
Uh, I’m not sure you can call it a shortage anymore. After 25 years. It remains, staffing remains an issue,
[00:14:26] Gail Donner: It’s not really a shortage, in an on and off again, kind of thing. It’s systemic, but you’re saying the things we should do. I’m wondering what both of you would, if you had a little magic wand and could make some things happen, what you, or what you would tell the people who have some authority to make things happen, what, what would you want to tell them to do in longterm?
[00:14:50] Natalie Stake-Doucet: We can do a whole thing just on that, but I think there’s, there’s this really amazing group of people called Canadians for longterm care standards that has started campaign across Canada to, uh, demand that the federal government work with the provinces to establish standards in longterm care. And that to me makes perfect sense.
If you go to an emergency room across Canada, you’re going to be triaged the exact same way. Whereas long-term care is kind of a free-for-all. One home has certain standards. Others there’s no ratios. There’s no, uh, there’s no standard for anybody. And that makes it difficult. Um, across the board for anybody who’s there for residents, family staff, um, everybody sort of does their own thing. And, you know, especially with the for-profit, uh, homes, you know, it’s, there can be a conflict of interest there when you don’t have any standards and you can just make money off of it. For me, that’s, that’s, that’s not something that’s healthy and that we should have in our healthcare system.
Um, obviously for me, probably the most important thing that come out of the pandemic is to have, uh, committees of that include residents and their families, uh, sort of a watchdog. Um, to prevent some of this stuff that we saw, you know, um, dying alone and families not, you know, that was the saddest thing I have ever seen in my life is seeing families in, in the window when it’s cold outside, just trying with their flashlight, you know, it’s still, it gives me goosebumps just thinking about it.
You know, they’re a little flashlight on their phones to see inside, um, that should never, ever, ever happen. Um, yeah. We don’t recognize the work that the families do, the caregivers, you know, when they were ripped out of long-term care, we lost all that labor people who were feeding, who were giving medications, who were helping us, uh, do, you know, baths and everything.
So that I always knew they did a lot of work, but to have it ripped away, the amount of work that they do is really incredible. And it needs to be recognized. I think it should be paid as well. Um, and obviously. You know, the most obvious part is work on developing strategies for attracting and retaining nurses in long-term care.
It seems so basic, but we treat nurses and staff and long-term care as if they are nothing, basically, they’re numbers. You can just move around, uh, without regards to their expertise and their knowledge and their experience. And that obviously makes it difficult to keep people in long-term care when you’re constantly adding to their workload without ever giving them anything in return, not even, you know, a basic recognition like a little pat on the back or anything like that, there’s nothing.
So of course you’re not going to keep people is going to be very, very difficult to attract and keep people. And that’s a basic management, uh, concept of retention. Why do we not apply it in healthcare? We know that we need it there desperately. And again, it’s, it’s, it’s something that, you know, our decision-makers at all level of government in our healthcare system have, have decided to just avoid for the past decade.
[00:17:59] Gail Donner: So, but here’s Roya who’s there and says she loves it. And it’s interesting. So. Roya, what would you tell a nurse who saying, well, I don’t know. Long-term care. Maybe I don’t want to go there. I’d rather go to critical care where the excitement is or, you know, Emerg or something like that, what would you say?
What, how would you recruit them?
[00:18:20] Roya Kazempour: Hm. Our LTC is one of the best and we are, they’re like a family. When you going to work, I don’t feel at all, I’m going to work. I’m going to my home. I love it. And I encourage people to come and work in elder care. And as I said, it’s not work. It’s just joy.
I love it.
[00:18:46] Natalie Stake-Doucet: Jewish elder care is renowned across the province for the quality of the care.
You know, it’s kind of like the one shining jewel.
[00:18:54] Mary Wheeler: I’d then be curious Roya. So a lot of our work is career work and, you know, individuals who might be interested in organization. So what makes this organization so unique? Like why is it like it is.
[00:19:10] Roya Kazempour: Actually we work together. There is no boss, no, you know, my, our nursing director always coming to us and discuss with us what we should do, even whatever we want to do.
Uh, in our units, we go to our orderlies, to our assistant nurses and everybody. “Okay. What do you think what we should do to improve it?” We work together. That’s the reason.
[00:19:38] Gail Donner: But somebody sets the tone, I guess. So maybe, maybe though that’s part of the answer to people is find a place with people like Natalie and Roya who liked what they do, love, what they do and, and work there.
I mean, we know when you ask nurses, “What makes a quality work environment?” One of the first things they say is the people I’m working with. My team, other people who want to do the work.
[00:20:06] Natalie Stake-Doucet: And I think Roya’s saying something really important too, you know, when you have a manager, a nurse educator, people that come see you and ask you, what do you think we should do instead of saying, this is what we’re going to do.
And that’s it. That definitely sets a tone in terms of, uh, how you feel accepted in a team and how, and so I think there’s definitely elements of, of how power or leadership is, is, uh, it is. Is exercised, I guess you would say that’s a français-ism. I’m sorry. Uh, but it’s important to have, it’s important to be heard.
And that’s also one thing that nurses across the board have always said, if I’m going to stay somewhere, I want to make sure that my voice is heard. Um, and so when you have a manager that says, okay, instead of having six patients today, are you going to have 12. And just leaves that’s that’s not a good work environment.
Uh, you know, a manager that says, well, you’re forced to stay at a whole other shift today. That’s not a good that’s. Those are the toxic work environments that have become so prevalent. Um, because we don’t have a lot. Um, a lot of places like Jewish, elder care, who really is, you know, the, the rose blooming in the pavement of a LTC.
And there are places that are better. Like it’s not across the board that it’s terrible. There are some teams, amazing people like Roya. Our system in Quebec is very heavy. Um, there’s been a lot of reforms to centralize everything. And now we don’t have managers, for example, in long-term care homes. Uh, we have like a head nurse, but there’s no manager that’s responsible for the long-term care home per se.
It’s, you know, managed by somebody who’s sometimes kilometers and kilometers and kilometers away. So that obviously makes it a lot more difficult for the higher ups to know what’s going on. And so the lack of channels of communication from the ground up, because we always hear what’s in what they want to tell us, but finding a way to talk to people who actually, uh, have the power to make stuff happen is, is very, very complicated.
And so that’s what make it made it very difficult when you know, one of the first things I asked when I got there was how do I get more vital signs machine? We had one vital sign machine for hot zones and cold zones. And obviously that didn’t make any sense. So I had to figure out who to call and I called so many people.
I emailed so many people just to figure out who knows how to get this, you know, and it’s ridiculous that as a nurse, I would have to spend so many hours just trying to figure out how to get a basic, basic, basic working tool that I needed, you know, and it was the same for trash cans, tables, you know, PPE.
I don’t want to even start. Where I worked until the first week of April nurses weren’t even allowed to wear a mask. It was prohibited. Even if people brought their own PPE from, from work from home, uh, people were threatened like, no, you’re going to get suspended. If you continue to wear a mask and stuff like that.
Whereas, you know, other places like the Chinese hospital here in Montreal, they had been wearing masks since January. And so they avoided a lot of that. The bomb I was talking about that went into these long-term care homes. So that was really a management that was completely disconnected from what was actually happening on the ground.
And that, you know, had tragic consequences.
[00:23:22] Mary Wheeler: The way you’ve both described the workplaces you’re in. And what I’m hearing from you Roya is that there is a different style of leadership that everybody pulls together and has a conversation and possibly where you were, Natalie. What I’m hearing is maybe more of a top down and is, is the success in how people manage through the pandemic back to leadership.
[00:23:44] Natalie Stake-Doucet: Roya is a big part of why it’s going so well at Jewish elder care. You know, so it’s important first of all, to study those places that are doing so well to figure out what are they doing differently than other places? Um, Second of all, there are some, there is data already out there in terms of how it’s important for teams to be allowed to be flexible.
So we need, you know, to have the, the possibility to be able to do exceptions without being afraid that we’re going to be sanctioned. For example, you know, I did that too, but I was not allowed to do that, you know, but I felt. I’ve been a nurse for 10 years in my clinical judgment. It is safe for this one person to come and see this one resident.
Um, and I think it’s okay to do that. And our capacities as nurses extend beyond just what we do between one nurse and one patient. It also extends to the conditions in which we practice. Uh, and so as a nurse for me, I, I strongly believe it’s okay for a nurse, any nurse to say, Hmm, eight patients might not be safe for me today and have a discussion with the manager about it, but that’s not the way the healthcare system is organized right now in Quebec.
So there are some shining examples like where Roya is, uh, but we need to study them more. And for that, we need. obviously access to data, which in Quebec is very, very, very difficult. Um, and collectively as a profession, I think we also need to reflect on, um, how we see management and what it means for a nurse to be a manager.
Is she a manager or is she a nurse? Um, is she a bit of both and what becomes the most important thing? So, yeah, so we need, we need to reflect on the importance that we give as a profession to nurses, um, bedside practice and, and recognize the leadership that exists there and recognize that nurses who work with patients are also allowed to question and to evaluate their conditions of practice and whether they are safe or not.
That’s not just a manager’s job. Uh, I think that’s something that we are able and should do on a much more regular basis.
[00:25:54] Gail Donner: You made a quick comment about a manager is a nurse and a, is she a nurse or he a nurse? Or they nurse, uh, all of our manager and Roya you’re an assistant head nurse What do you think about yourself as a manager or as a nurse what’s first for you?
[00:26:17] Roya Kazempour: Actually, I’m like a connection between the management and staff. I know staff very well. I worked with them with orderlies, with assistant nurses, with nurses, and now I’m in management side. So somehow I bring the issues from our job. To management. And when management asking me to do something I’m coming and discussing with my staff to see how we can do that.
So, um, I’m in between.
[00:26:55] Gail Donner: Thank you so much for first of all, for your honesty, your candor, but really for your passion.
[00:27:05] Mary Wheeler: Wow. Gail, like that went on longer than we generally do because they were both in their own way forces to be reckoned with, uh, Natalie. So passionate about how the system needs to change and Roya who was very, um, calm, um, but had so much just in her, her story.
She loves what she’s doing. This is again, she loves what she’s doing and she loves who she’s working with and their style of management and the way decisions are made, help them through, uh, the pandemic
[00:27:52] Gail Donner: Well, you know, I just kept… maybe I have a sort of stereotypical, uh, uh, view of passion, but I would say both of them were passionate.
Uh, I mean, I think, and, and she said, of course, Natalie is passionate for change and Roya is passionate about her work and her connection. And she, by her own story had a tough time to become registered. I mean, most people will just give it up. It’s not like this is the best paid job in the world. Um, so that I’m sure it’s that passion, you know, it’s that kind of I’m meant to do this.
So I’m just going to push ahead, and if they don’t want me in French, then they’ll have me in English. I was just blown away by that kind of passion from both of them. But also, I mean, I don’t think we can hear enough how horrible this, if this. I mean, we have to make a change in how long term care is done in Canada.
And, uh, you know, like Natalie said, there are examples of who’s doing it well, and we’ve seen that in, in, other interview with long-term care, but we need a lot of work to get from what that pandemic brought to what needs really to happen for some kind of quality, both work environment and home environment for residents.
[00:29:41] Mary Wheeler: This common theme across Canada, or even just, you know, is around how in long-term care are we going to recruit and retain, uh, uh, nurses? You listened to the two of them and I’m saying, well, who’s listening to the people on the front line. They do know the answers. They know what needs to happen.
[00:30:05] Gail Donner: These two women, they could be poster child for not just for long-term care, but for what is the essence of the profession? What do people do. They care. And they advocate. And they yell when they have to. And when they don’t have to, they connect, they, every interview episode we’ve done so far. People talk about their team.
[00:30:34] Mary Wheeler: So till next time
Here’s to Nurses Voices’.
[00:30:38] Gail Donner: Absolutely.
I would encourage you if you’d like to give us some feedback on this episode of Nurses’ voices to go to nursesvoices.ca also, please go to and join a podcast. Uh, through wherever you usually get your podcasts and look for us on YouTube as well. Thanks very much and see what the next Nurses’ voices
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Public Health Nursing with Janice Loe and Jane Skinner Public Health has always been at the core of communities across Canada. However, for many years the perception of public health has flown under the radar – it does great work, but without the attention that acute care often