Aug 19, 2021, By: Stephanie Gilbert
Editor’s note: this written interview from Stephanie Gilbert is part of the Canadian Nurse True North series , focusing on the stories and practice of nurses who work in northern Canada under some of the country’s most challenging conditions.
My name is Stephanie Gilbert. I am a registered nurse with a bachelor of science in nursing and I work in the Northwest Territories. I am an Inuk and grew up in Iqaluit, Nunavut. I have worked as a nurse in the Northwest Territories for 10 years in communities such as Fort Simpson, Wrigley, Jean Marie River, Nahanni Butte, Trout Lake, Lutsel K’e, Inuvik, Fort Smith and Yellowknife. I am also a certified remote nurse with special training to provide advanced practice nursing. My background has been primarily community health nursing, but I have also worked in acute care, emergency and public health.
What drew you to northern nursing?
It was a great fit for me right from the start. As an Inuk, I felt it was important to provide culturally competent care to other northerners. It’s fitting that nursing is about compassion, empathy, relationship-building, and shared responsibility — all of which overlap with the best and most beautiful aspects of the Inuit culture.
As an Inuk, building relationships with people and listening to their stories and lived experience is integral to understanding where someone is coming from. Inuit like to ground themselves in who they are to better connect to other people and understand where they are coming from. It’s about finding a common understanding between yourself and another to have an intentional and therapeutic relationship together.
Can you tell us your most memorable story from your practice?
The Inuit focus on building relationships is a useful asset when you are one of only two health-care providers for an entire community of people, especially one with an Indigenous population. Approaching my nursing role with an Inuit mindset has allowed me to form genuine connections with patients, no matter their lived experience.
My most memorable experiences come when this ability to connect makes me a better nurse. It’s especially important when I’m working with a patient who has experienced generational trauma or residential school trauma and has had their language and culture stripped away from them. Acknowledging and understanding what that was like for them as an individual — as well as part of a group with a shared identity — means that you are always reflecting about how to nurse them and care for them without repeating those same acts and atrocities that could trigger them or cause further harm.
I recall sitting one-on-one with a patient for over 16 hours during a mental health crisis. The first thing I did when the patient arrived was to assess his needs and provide medication to ensure he was comfortable and able to communicate. Afterwards, we spent the remainder of the time waiting for a medevac team to arrive and bring this patient to the nearest mental health facility. We were becoming very tired but, as a nurse, you get creative in how to pass the time effectively. We spent the evening and night talking through what brought this crisis on. We came up with a plan that on his return to the community, we would set up regular check-ins, both informal and formal, so that we could intervene sooner if necessary. This would avoid another traumatic experience of a medevac and transfer. That plan worked successfully for the rest of my time in that community and I look back on it as a success. A lack of facilities does not mean that there has to be a lack of care and response in the community.
We often hear that northern nurses work to their “full scope of practice.” What does that mean for you?
Being a community health nurse is considered advanced practice nursing. This means working in remote settings using clinical guidelines and a medication formulary. You provide medications, treatments, referrals, assessments, and ongoing screening and care. There are no other options in the communities.
Although it sounds a bit counterintuitive, my specialty is to be an excellent generalist. I must know a little bit about everything, and to know how to coordinate services and consultations to advocate for my patients. My hands-on assessments are critical to provide early intervention for my patients.
I must trust my instincts, listen closely to my patients, and be mindful of the risk associated with my assessment findings. Many of my patients do not want to travel to a city for care, so I have to be cautious and explain the risks if they stay in their community and make use of the treatment options that we can provide.
I must maintain a close relationship with the community leaders, stakeholders, social workers, teachers, Elders, RCMP, and so on. But most importantly, I must remain close to the people who have grown up in, and who are the future of, the community.
For those who want to consider this type of nursing, you must be an asset to the community and support what they feel is important. The community members you serve are ultimately the voice that you should listen to. They know their community best and they are forever invested in its growth and development. As a nurse, you should be part of that capacity building. Therefore, the partnership you build with your community members is an important part of your scope as a nurse.
How has COVID-19 affected your practice?
COVID-19 has become a huge part of my practice. I have set up an offsite swabbing clinic, been part of the team that planned how best to assess suspect cases in the health centre, worked to reduce risk to health-care staff and the community, and been on call 24/7 to ensure community members feel safe.
I have also travelled the North as team lead nurse for the Northwest Territories’ COVID-19 immunization response team, providing Moderna vaccines in a safe and organized manner to remote communities.
I have worked as the team lead for Yellowknife Public Health Clinic’s COVID response during the city’s first outbreak. This meant conducting numerous risk assessments and doing a lot of contact tracing and case management.
The part that hasn’t changed is continuing to use my client-focused approach to care. My aim is to make meaningful human-to-human connections to help people come through very difficult and trying times.
What do you like to do for fun?
I enjoy travelling with my family to different places, with an emphasis on giving them historical and cultural experiences. During the pandemic, we got more creative about what kinds of adventures we can have close to home. I also enjoy hands-on creative projects, including beading and sewing. I am fond of beading gifts for friends and family, and I am working on a pair of slippers for my cousin’s wedding this summer.