Transcript of Chats On Change Episode 14 - Annette Elliott Rose

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Hello and welcome to Chats on Change, a Nova Scotia Health podcast with your host, interim CEO Karen Oldfield. 

 

Hi everyone. Today we have a special guest. We have one of our newest employees at Nova Scotia Health. I've interviewed Dr. Annette Elliott Rose, who's been seconded to us from Iwk, and she's taking on the role of Nova Scotia Health Chief Nurse Exac and Vice President of Clinical Performance and Professional Practice.

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So she's all about nurses, and you can hear that from Annette herself. And you will after this short commercial. In Nova Scotia, there are many ways to access care. That's a good thing. But how do you know what care is right for your needs and where can you access it? How can you locate services, book, blood tests, X-rays and vaccines, or check emergency department wait times?

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The new Your Health N.S. mobile and web app provides more ways to manage your health, more health care faster your health. N.S. get it where you get your apps. Hi there. It's Karyn and I have a great guest here today that I'm anxious to speak with. This is Annette Elliott Rose, Dr. Annette Elliott Rose, Ph.D. And Annette has recently joined Nova Scotia Health, actually seconded from Iwk.

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And so welcome, Annette. How are you today? Doing great, Catherine. Thanks. Good, good. So you've come over recently. Let me just let me just share a little bit about your your background in your bio, and then I've got so many questions for you. Annette. So as I say, Dr. Annette Elliott Rose has just taken on the role of Nova Scotia health chief nurse, Executive and Vice President of Clinical Performance and Professional Practice.

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Dr. Elliott Rose was Vice President, clinical Care and Chief Nurse exec at the Iwk Health. Prior to being seconded first to the Department of Health and Wellness, leading the development and implementing action of the Provincial Health Workforce Strategy, which focused on nursing, advancing workforce and interprofessional practice and learning. And for those of you who do not know, and that she holds a master of nursing a Ph.D. in nursing from Dalhousie University and is an adjunct faculty member in Dalhousie University School of Nursing and that lives in Hammonds Plains with your with her partner Chris, and daughter Georgia.

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So all of these things were news to me, to Annette. I just knew you were a nurse. So, so recently as in two weeks, I think in moving over to nurse age. And I guess the first question is, you know, what attracted you to the role? Well, I think first and foremost, it's a chief nursing role. And of course, I, I had that role at the Iwk and had the good fortune of working with folks there.

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This is a different scope and breadth. There are thousands of nurses at Nova Scotia Health doing all kinds of fabulous work across the lifespan. So in many with many different populations and patients and families. And so this is an opportunity to dig in and again, with nurses, understand what's important to them, understand their ideas for innovation, understand what they see, what they need, what they're experiencing.

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And, you know, really in many ways get back to the meaning and purpose and joy of nursing. Like, you know, I'm a nurse forever. You're a nurse forever. I am a nurse. What kind of nursing did you do? So you so you're a nurse forever. What kind of nursing? What what were your nursing experiences and where did you.

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Where were you? A nurse? Yeah. So funny enough, I thought I would be a cardiology nurse for a long time in nursing school. And then my sister got pregnant and I thought, I think I kind of like that. So then I became a maternal newborn nurse. My first job was at the Iwk, and I was there for a few years, and then I went north.

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And it sounds odd when I say I went north. I became a community nurse, an outpost nurse in none of it. And worked in in a IT communities for about a year. And wow, does that open your mind like and it opens all the possibilities in nursing because you're it you're you're so back at. So where were you born?

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Were you from Nova Scotia? I am. Okay. So rural Nova Scotia just outside of Brooklyn Hants County. And and, you know, I was one of those kiddos in rural Nova Scotia who thought I got to get to the big city. So, you know, and there so many, many students around our province who want to get to Halifax and then some who want to go home.

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So none of it for a year. What took you to Nunavik? What took you to the north? Challenge and change and maybe a little bit of being naive and excited. Right. So I arrived on this little four seater plane in Pond Inlet, Nunavut, with my two Rubbermaid containers full of food. For the next few months. I signed up for three months and people said, What if you don't like it?

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And I said, It's three months. I can do anything for three months. And I loved it. I love the people. When you say you were at, you know, maybe give a sense of the kinds of things that you were doing as a nurse in Noona fit and why you say you were you were it so is a it's a it was at that time a 1200 person community with a five nurse community health center within her in charge and the other four doing care.

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So I'm just going to give you an idea of orientation. I am not recommending this for orientation, but I'm just saying. So I arrived. I plonked my suitcase down. The nurse in charge was this fabulous woman from Australia. She used to do their version of Doctors Without Borders in Australia and she said, okay, so this is how it works.

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This is the clinic. People are coming in, this is the pharmacy. We've reconstituted all of our own meds, like bottled it all up, labeled at the whole deal. This is our lab area where you can do some things and X-ray. We'll show you that later. And you said there's your office, There's people to see. And I left and I left.

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And now I am not recommending that. We have come a long way. That was 20 years ago. What was the technology in that? We had telehealth. you had tech? We had telehealth. So we would dial in to the folks in Ottawa and in Iqaluit and have a conversation about stuff. And we sent people out like that. It was a four hour plane ride out to Nunavut or to Iqaluit.

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So you learned a lot from your colleagues? I had there were some expert nurses there who had lived in the north for a long time, and they would hear my squeaky shoes coming down the hallway and they knew I had a question. Right. And and today, that's what we rely on. We rely on the relationships between nurses and the mentorship.

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So we look at the nurses who have lots of experience and so much to teach the new generation, the next generation. And I firmly believe in mentorship. I think it's it's the way to be. I still have mentors in my own career and I mentor, right? So yeah, So the North, beautiful people, strong, amazing people, learned a lot about clinical practice, learned a lot about everything.

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Nurses can do, and and then came home and got into a provincial program where I traveled all around the province, went to the smallest community hospital and did teaching around obstetrical emergencies and care for pregnant women, and then went off to the feds and did some work there with First Nations. And then you had health and and then to the Iwk and now here with Nova Scotia Health.

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How fabulous is that for a career and not done not done so along the way though you did do your master's and your Ph.D. So how did you fit all of that in with the work that you've just described? Balance, I guess I'll say that tongue in cheek. But at the time I didn't have a kiddo when I was doing my master's.

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And I don't know, I find as you get older, you learn to time management a little differently when you're working and going to school. yes, For both. For both, yeah. I think that's key because we have so many nurses and other staff members who are anxious to pursue ongoing education and take advantage of some lottering and etc..

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So, you know, as you think about how you were balancing that, do you have any any tricks that you would like to pass on? Find the people like build your network of people who are going to support you. That's family, friends and professionally, right. Again, the mentored. So find your mentors who are going to say it's okay, you're going to get through that.

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This is a little bit of a marathon, but you're going to get through it and it'll be done. I can remember having conversations with folks. Do I do a Ph.D.? Do I not? What's the value? You know, is it going to change how I can contribute to things? And someone said to me, Just dig in, dig in, get it started, and before you know it, you'll be done.

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And, you know, five years later, I was done. But but still, it's to seek out your people and they'll help you through that. And they'll help you through the practical stuff, too, like how to find some funding and you know, how to what was the what was your thesis and your that your work and your for your Ph.D. What was your.

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Well, I'll tell you, my master's first. My master's was on mentorship nurse to nurse mentorship, and my PhD was on a needs based health system and health human resources planning. Well, that's certainly come to the fore. Well, let's come to that. But on nurse to nurse mentoring, you know, what did you what did you research? What did you learn and where's that paper sitting these days.

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What's what's happened since you wrote that. A lot. So it was on informal mentorship. So that is how nurses connect with each other day to day. You know, we've often seen the engagement surveys from from staff and from nurses and what people say it's my team, my immediate team that I depend on. And it's true too. And things are, you know, moving along and things are busy.

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You're looking to your colleague next to you to be there for you and help you out and show you the way. I think Nova Scotia Health just in my short time here in the last few weeks, but also with some system work. There's some really cool stuff happening there, some some just in time kind of services that are underway.

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So the nurse out in a small community hospital can eventually dial in and get some help elsewhere. There's mentorship programs. I just saw presentation on that today where retired nurses are coming back and they're meeting with new nurses and helping them transition to practice not just clinical, which is important, but the how to be a nurse, how to grow as a nurse, how to go from novice to expert, you know, what's your career path, what's your passion?

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You know, where where do you want to go and how are you going to do your best right now in your clinical practice and get where where you want to be in five years or maybe ten years. So it was really that informal nurse donors mentorship. And what about your Ph.D.? What was your what new needs based planning?

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Yeah, So let's maybe jump there, because that's certainly something that you've spent the last, I don't know, two years, year and a half, fully immersed. And so what has your work been and what's the outcome been of of that research here in the province? So my thesis specifically looked at perinatal care, some pregnant women and newborns. But all of that can be extrapolated into the current system.

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So we know we have action for health, we have our six solutions. Several of those focus specifically on human resources and the health workforce and the talent we need to care for Nova Scotians. So part of the the work that I've been doing is to lead that group with others, lead with others looking at recruitment, looking at retention, looking at how we redesign our services so that we have the talent we need because there's a global health human resources crisis right now.

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We're competing globally, locally. And then how do we make sure people have the space supplies, equipment, technology, anything that they need to do, the practice that they need to do and that they can practice the way they were educated. So sometimes we have a gap between how people practice day to day and all the skills and knowledge that they have to practice.

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Example with a little bit of extra support, nurses can prescribe NPS can admit and discharge. You know, we just have to change our systems a little bit. And we are and we are. And so that was part of the work in the last little while. Recruitment, of course, increasing nursing seats, so education seats, internationally educated nurses coming in, lots of work happening around that.

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And then and then recruiting our new grads who are coming into the system and new nurses coming into the system. All of those efforts all at the same time, because that's what we need to make a difference. Now then you've you've been busy, I guess, over the past number of months, that's for sure. So I think, you know, what I'm hearing and what I what I'm happy I'm hearing, it's the connect between needs, recognizing that, you know, with a little extra education, nurses can prescribe with more education, they can admit and discharge.

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So you recognize the need. Then we figure out how do we do it and then we do it. And that's exactly what's happening. So brand new to this seat, what how are you going to take on the challenge of going from probably knowing many of the nurses at the Iwk to meeting, learning, understanding the challenges of, you know, all of the nurses we have at Nova Scotia Health all across Nova Scotia.

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Couple of strategies. One, I need to get on the road, so watch out because I'm coming in in a couple of weeks, hopefully to Cape Breton if that works out. And then we'll be working with folks around the province to organize some some meetings with nurses, and then I'll be asking them, okay, there are thousands of you and there's one of me.

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So how are we going to stay connected and what are the ways ongoing? Like, this isn't a one time road show. This is a how do we stay connected ongoing? How do I hear from you? How do I understand what's important to you? And what are the many ways that we can do that together? And of course, you know, there are managers and directors and clinical nurse educators and all kinds of fabulous people out there doing work.

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So this isn't a solo show. This is let's let's work on this together. Right. The experience that I would share, certainly in the past two and a half years, I have gone around the province now four times, I think to the entire province and, you know, people are always very generous with their time. They they like to see me come.

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They like to share their the good, the bad and the ugly. Not necessarily in that order. And and it's important for me to hear it because I can't troubleshoot. I can't solve the problems. I can't take advantage of the opportunities unless I'm hearing it in many cases firsthand. Because, you know, we do have layers now. And so there's there's there's a bit of distance between my office and and some of our frontline staff.

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So I do appreciate the opportunity of hearing it firsthand. And what I'm hearing you say is that you're looking forward to that as well. So that so I think one of the tricks is to make sure that people understand that their feedback has been heard and either and considered and you know, acted upon or not. And if if it has been, they need to know.

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And if it hasn't been, how come? So that is a big challenge that we have across the organization. And and I know that you know that. But I think getting some help to I mean, they I guess we could call it the feedback loop seems like a bit of jargon to me, but the feedback loop making sure that if somebody is good enough to share that we let them know what the outcome of their decision or problem or challenge or opportunity or what have you.

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So you got to be on the lookout for that one and that. Absolutely, I agree. And email is not the way to do that because it's just not manageable. So that'll be part of my, you know, my questions with nurses around the province will be how do we stay connected and how do I loop back with you? I firmly believe that the people living the work and doing the practice are often the ones with the best ideas.

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QUESTION You know, so absolutely no question. And so it's it's getting them and then translating that into the action. That's been my experience as well. And, you know, the more the more we can do it as a team, the better off it is. So, you know, we we often hear and certainly if you read media across the country, across the continent, you know, nurses are there's a lot of job stress.

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They're under enormous strain just given given staffing challenges and just the the manner in which many patients now present with multiple complications. And so if you, you know, in your visits with frontline nursing staff, what are you going to tell them about how you know, how you will work to improve their working conditions, improve their job as a nurse, make them want to you know, as you said at the outset, regain or retain their passion and their commitment and their motivation for this very important work.

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That's a big question. I think the key is getting out there and connecting with them and then hearing what's important to them, building some options. Because what's important for one nurse is not what's important to the next one. But we do know there are some things that are important to many flexibility. So how do we build some flexibility in how we staff in the opportunities for nurses career?

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I'll call it career development. So the professional development pieces in the here and now. So to do your work right now, but I think people need to see a possibility for a long term career in health in nursing in Nova Scotia. So what are those pathways? How do we how do we build some of those pathways? There's active work happening around wellness.

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There's more we need to do, but there's active work happening, some very concrete things again that we're trying to work on. And there's some pilots around the province, childcare, particularly for people who work shift work, right. And and needing that support. 20 47i can say that, you know, hopefully nurses are feeling this, that we had a successful round of negotiations with our union partners and that nurses in Nova Scotia are, you know, quite competitive with the rest of the country.

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So I think hopefully that that does help. And then the really the very real piece is we're trying to get some more people in the system because we want to attend to the vacancies, make sure people aren't working lots of overtime and short staffed, that they're able to get their vacations like that is the goal and it's there's no quick fix.

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We're going to keep at it and do all the things we need to do all at the same time to make that difference. And we will get there. We will get there now. And that we've talked about the role, as you know, Chief Nurse exact. But there are other aspects to this new position. You've taken clinical performance and professional practice.

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So maybe a comment or two around each of those segments, you know, what would you hope to accomplish under the heading of clinical performance, if you like? And then how are you looking at professional practice? So I've had a couple of good conversations with Dr. Butler and, you know, there's a lot of work and a lot more work to do around quality and safety and what I'll call best practice out there and digging in with teams to understand and what's working well, what's not working well, how we can get best evidence into practice, how we can provide people with all the things I talked about before, you know, around around learning the IPL team, the

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interprofessional practice learning team, I've had the good fortune of actually having a town hall with them this morning and they are rock stars. Like there is a lot happening in that team, so much more than I appreciated. And we had a couple of good presentations and there'll be more happening. I think there's an also an opportunity there as well to connect all that good work to the front line in a different way because I don't think people realize all that's on the go and the opportunities there for for, you know, improvements and for connection.

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So the clinical performance I need to dig into a little bit more. I think there are ways where we can standardize across the system in the ways that make sense and still have the flexibility that we need to be tailored to the local local population, to the local context, to the local talent of the teams there, to what's happening in communities.

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So it's that balance between the two. Yeah, it's really exciting work. Think and all of those things relate. Of course, nursing being our largest workforce, all the learning and professional practice pieces. I'm a firm believer in interprofessional collaboration, so teams make a difference. Well, you know, we can extrapolate because we could take that all the way to the to the collaborative practice, to the health home.

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It's it's all on the continuum. People want to be working in a team setting for various reasons. And so we have to be able to meet people where they are and and make sure that they're comfortable and happy and feel supported going forward. Like it's a it's a massive job that you've taken on. But, you know, I think it is exciting and I can tell from your voice that you're happy to your you've made the right choice.

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So, you know, I'm looking forward to seeing what you can do and to helping you and supporting you. Okay. What what message do you have for your teams? What message do you have for frontline nurses and what messages do you have for Nova Scotians? let's see. With teams, we can get through this together and we're going to work on it and we're not just going to get through.

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We're going to do some of the things that we've always wanted to do to change the system and services in new ways and all of it. The the the technology, the space, the the practice, all of it. People have been really chomping at the bit to to make some change. And there's right now we're at this sweet spot in Nova Scotia to do that.

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Like there we can move things ahead. And on the calls I was on earlier, there's such an energy. Like people are excited, They're excited to move things along. They're exciting, excited for change. And at the same time, change is the one constant, right? So it's challenging. And and so we have to be mindful of that. For for Nova Scotians, I would say there are a lot of amazing people working in health care to to make it better and to improve access and to improve services and they truly want to do that for you and they want to do it with you.

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Maybe that's the other key piece, right? We want to work with Nova Scotians to understand what they need, and we want to improve those services, continue to improve those services, and we will get there. And I firmly believe that collaboration partnership in Nova Scotia is our competitive advantage or small enough that we can do it. We can break down silos, we can get people around the table, we can figure it out and make it happen.

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And we're complex enough that we need to do a bit of that, right? We need to break some things down and and bring the right people around the table. But we will get there. Well, it's great to hear Annette. And I think, you know, as I say, I look forward to watching you do it and you have my full support and helping you.

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And I'm pleased that you've joined us. And, you know, I just look forward to letting you go. So thanks for coming today. I really appreciate it. I hope our professional staff, especially our frontline nurses, have heard enthusiasm and passion in your voice. And I'll just say you're going to be coming around. So get your questions and your challenges and your issues and all the rest of it ready and be prepared to share.

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So thanks. Thanks for coming today and up and look forward to working with you. Thanks so much.