More than ever, it’s time to double down on commitment to profession
By Michael J. Villeneuve
May 9, 2022
Beyond the usual childhood visits to the family doctor, my earliest memories of health care were in the hands of my grandmother, Lydia “Lil” Kruger Daniels Villeneuve. Born in Boston in 1898, she was a 1914 graduate of the Montreal General Hospital nursing school, predating the registration of nurses. She would live the rest of her life in the Kilmar and Grenville areas of rural Quebec and spent most of her career at the Smith Clinic in Hawkesbury, Ontario, which, by 1960, was a respected, 50-bed hospital.
Lil was a force, in charge of nursing and food services. She was an amazing cook. When she walked the halls of the hospital in her starched white uniform, with my younger brother and I each holding one of her hands, staff stopped, backs against the wall, heads slightly down, and said, “Good morning, Mrs. Villeneuve.” I don’t recall her ever replying; she moved like a tank. Frankly, their behaviour was more from terror than respect, I imagine, because she was tightly wound and could be a piece of work. She was short, sturdy, ornery and fierce.
But she adored her grandsons and had a deeply loyal spirit and ethic of loving service for those around her. When student nurse Grace Hartley fell down the shaft of the elevator being constructed in the hospital and was rendered paraplegic, the hospital subsequently housed her in a home that shared a narrow driveway with the hospital. My grandmother took care of Grace for the rest of her life, providing care, sometimes cooking and spending time with her every day for decades.
My brother and I were visitors to be shown off. I can remember Lil kicking open operating room doors with her foot because her hands were holding ours. Operating rooms were in main corridors then. She would announce to Dr. Smith or Dr. Irwin, “These are my grandsons.” They would stop surgery to turn and greet us. Different times.
A career in nursing
Those early experiences are where I was first fascinated by the sights, smells (ether!) and intrigue regarding what was going on behind those swinging doors with all of those people in gowns and masks. The surgeons were, of course, men and the helpers, of course, women. I decided then and there that I was going to be a surgeon, in line with the gender role, and that was my career dream.
But in 1978, I made my way for the first time into health care when I was hired as an orderly at the Montfort Hospital in Ottawa. My first shift was in the emergency department (ED), and I was not there for more than a few hours, I’m sure, when I realized I was not very interested in what I saw the physicians doing. I was watching the nurses. They were like most ED nurses: smart, fast-thinking, sharp as a tack, vocal and decision-makers. It was another meaningful moment in my life because I never again seriously considered medicine and I never looked back.
I retired this spring and, reflecting on my life, I can say with pride and confidence that there is no career anywhere that’s more amazing than nursing. It is the most noble, intimate, loving act of service of all of the health sciences. It requires the most complex weaving of art and science, intelligence, courage, integrity and innovative thinking. To do it well demands a deep giving of oneself. I didn’t realize that my grandmother was showing me that DNA before I was five; she was smart, brave and tough as nails and had a heart of gold under all of that bravado.
My career took me from 3 a.m. hands-on care for vulnerable individual patients to exciting and influential work in administration, teaching, science and policy on national and global levels. And the icing on that cake? The public says, “We trust and respect you more than any other profession.” Who wouldn’t want to say that they enjoy that sort of power handed to them by the public year after year? That’s gold.
The health human resources crisis
These upbeat observations of nursing may seem to fly in the face of the health human resources crisis threatening to swamp health-care systems this spring. If I seem oblivious to the suffering of nurses all around us, I am not. Nurses have rarely been tested the way they are now. My own career has been cut short because of the physical, mental and emotional toll of the COVID-19 pandemic, and I am hardly at the sharp end the way nurses are in care delivery settings. But suffering is not a competition, and all of society is in pain in ways that I imagine will take years to unpack and understand. The toll on mental health alone is staggering, and millions of people in Canada are grieving the loss of a loved one, loss of their own health, loss of a job, loss of routine, loss of the normal social relationships that sustain us. Loss, loss, loss and grief, grief, grief. Everywhere.
But the suffering and even despair I see among so many nurses are not the profession. They are about the conditions in which the profession is practised, and, yes, they are particularly bad right now. But we have to separate the two, as tough as that may be. Why? Because the public needs us, and health systems collapse without us. It’s as simple and profound as that. People suffer health issues that require physician treatment in a hospital or other setting. But they stay there because they need nursing care. And whatever the setting, when care is not delivered by engaged, satisfied, safely staffed, professional nurses, people get sicker, they get hurt and too many of them die.
Holding the CEO role at CNA was never in my plans, but it has been the greatest honour of my life.
Nursing has been under a public microscope for the past two-plus years, unlike any time before. And the public sees our hard work and dedication. They also see the high price we have all paid — and so do employers and governments. That is part of the reason that groups such as the Canadian Nurses Association (CNA), working in partnership with the Canadian Medical Association, HealthCareCAN, the Canadian Federation of Nurses Unions and others, have been relentless in lobbying around the need to stop the bleeding in the health human resources crisis in this country. We have the attention of governments, they are prepared to buy their way toward stability and, finally, some of the retention strategies we have been pushing are being implemented.
Nurses are tired, but this is not the time to ease off; it is precisely the time to double-down and keep calling loud attention to shortfalls in transitions from student nursing to practice and in the regulation, deployment, employment and remuneration of nurses. Thousands of nurses across this country maintain their registration and licences, but are not practising in nursing. Why? Tens of thousands more work part time because they can’t tolerate the working conditions full time. Experienced, internationally educated nurses who want to work find it difficult to find their way into regulated practice. And across the country there are long waits to get into many nursing schools. We need more seats, more faculty and adequate clinical placements — admittedly, no small problems to fix. But these are all of the noise and conditions that surround nursing. They are not nursing itself.
Are we really short of nurses overall? There are 449,000 of us, and we are short of nursing care in many places right now. But with so much human capital drastically underused across nursing, and in the absence of any sort of pan-Canadian planning of health human resources, how do we really know? We don’t even know how many nurses we need or where they will be deployed by specialty or location. A plan to stabilize health human resources in the longer term is long overdue.
Although we are exhausted and many of us feel broken in our souls, guess what? Applications to schools of nursing are soaring in many jurisdictions. Just as I looked at those nurses back in 1978, the public is looking at us through that microscope of the COVID generation in 2022 and saying, “I want to do that.” They see the noble work that nursing is; they don’t really see or understand the practice conditions. They just want to be like us. That is magic when we look past the fog of the last two years. It is hard to imagine, but this time will pass, and the profession will still call tens of thousands of people in Canada every year.
A privilege and an honour
I worked hard over many years in policy roles pushing forward ideas and strategies to protect and strengthen the profession I love. The work has been hard, high-paced, intense and complex, and I never thought I would have the privilege to be able to take part in it all. Holding the CEO role at CNA was never in my plans, but it has been the greatest honour of my life.
Along the road I met some of the most amazing human beings — people full of ideas, energy and positive excitement about health care. Some were my brilliant students, some were senior nurses who mentored me, some were teammates at CNA and in other settings and some were role models I admired from afar. I know there is a huge energy around wanting to stabilize, support and advance nursing, and we need to muster the best of that right now.
We are in some very good hands. Although I will miss the amazing role as CEO, the timing of things happens as it should in life, and after an exciting career, I am happy to turn the baton to all of you. I have no regrets, and there is no other career I’d want to have had. After many years in the public eye, I will be happily cheering on this National Nursing Week from the sidelines. Now over to all of you: celebrate the profession well this week and then carry on, please!
Michael J. Villeneuve, MSc, RN, FAAN, is the former CEO of the Canadian Nurses Association. He retired in March 2022.