Health Care and Harmony

Canada’s Chief Nursing Officer balances nurses’ needs with patient care

Dr. Leigh Chapman’s reputation precedes her.

An RN for more than 20 years, Canada’s Chief Nursing Officer is a vocal advocate for social justice and harm-reduction issues, and has worked as a leader and direct care provider in various settings. Recently, she headed a new nursing program for people experiencing homelessness with COVID-19. But did you know she was once a CNO employee?

"My time at CNO was formative,” Dr. Chapman says about her role as an education consultant in the aughts. “I didn’t know much about regulation and I wasn’t really sure what the College was, other than a place I sent my money to for annual renewal. Working at CNO opened my eyes to seeing regulation as a common thread across the country. It took me from working at the bedside in critical care and teaching nurses in the classroom, to working with nurses across the province, as well as getting a pan-Canadian perspective of nursing practice. It left me with a lasting impression of the important role of regulation.”  

In May, during an online visit to CNO for Nursing Week, Dr. Chapman highlighted the critical importance of nursing regulation in Ontario. As the largest health profession regulator in Canada, CNO’s leadership is very important, she said. She called on CNO to use its influence in a number of ways, so other organizations across the country can follow suit.

The first order of influence is the way CNO regulates all nurses (Registered Nurses, Registered Practical Nurses and Nurse Practitioners) under one body. According to Dr. Chapman, having only one regulator for nursing in each province and territory would benefit Canada’s health care system, the providers who are part of it and the people it serves.

Most obviously, it would reduce costs. But she sees other advantages, too. For one, it would contribute to a stronger, more unified voice for nursing in Canada. In her cross-country travels, Dr. Chapman has noticed that multiple regulatory bodies in one jurisdiction often provide different perspectives on nursing, based on the category they represent. “This can be confusing. Not just for nurses but also for Canada, as there isn’t one perspective, yet we are one profession. We are united by our professional identity as nurses.”

Dr. Chapman says she is surprised that Canada has 25 regulators for 13 jurisdictions and, she admits, this also surprises representatives she meets from other countries. “I’m not sure how it serves nursing or the public, as the regulatory functions are similar no matter which category is represented. Optimally, Canada would have 13 nursing regulators. We have work to do in harmonizing regulatory processes across the country.”

Reducing the number of provincial regulatory bodies for nursing is one way to stabilize the nursing workforce, she believes. For starters it would help the government get an accurate count of the number of nurses in the country. “While we think there are 440,000 nurses in Canada, we also know some nurses are being counted twice. We need a better idea of the composition of the nursing workforce in Canada, with access to better data. We don’t know how many nurses we have and how many we are short.” She says more data is needed to support decision-making about health human resources, and organizations like CNO are doing their part.

Seeking recognition and unity for nurses

As Chief Nursing Officer of Canada, Dr. Chapman sees a need to recognize the importance of nurses at the national level. Now at the end of her first year in the role, she has taken that goal to every province and territory across Canada, meeting nurses and establishing a network. “We need to ensure we have the perspective of nurses in policy decision-making within the federal government. This is an opportunity to make the profession stronger, so Canadian nurses can be in the best position to provide safe care.”

CNA President Sylvain Brousseau, Prime Minister Justin Trudeau and Chief Nursing Officer Dr. Leigh Chapman in Montreal in July, 2023. Photo courtesy of Health Canada.

In speaking engagements across Canada, Dr. Chapman frequently uses words like unity and harmony. She knows how easy it is to divide nursing – by scope of practice, practice standards, gender and categories, to name a few. But in the face of dividing factors, she chooses to focus on unity. “There are lots of divisions in nursing. But overall, we are all Canadian nurses. It is important to highlight the unprofessional contribution of nurses. This unifying factor is really important to finding strength.”

Yet, while institutions and governments can get distracted by divisions, Dr. Chapman reminds them that for patients, it all comes down to one thing: seamless care. This is the approach on which she grounds her work. “So often we can get mired in the politics of health care in Canada, and the divisions between different sectors. But, it’s seamless for patients who go back and forth between them all. We need to centre patients in this. They are less concerned about politics – they just want care to be seamless and universally accessible.”

As a public servant, Dr. Chapman is aware of how it can sound to take politics out of a situation. But she feels it is her duty as a nurse and as the Chief Nursing Officer with both the experience and the national perspective to speak up about these issues.   

It comes from a personal place too.

Giving a voice to patient safety

Speaking up is nothing new for Dr. Chapman. In fact, hers is a voice you may already be familiar with from national radio. After the 2015 death of her brother Brad Chapman from an opioid overdose, a death she says could have been prevented, she set out to prevent it from happening to others.

In 2017, Dr. Chapman and fellow members of the Toronto Overdose Prevention Society opened an unsanctioned supervised injection site in tents in a park. During its 11-month existence there, the site produced numerous news headlines for its controversial and illegal presence. It also eventually led to changes in the province’s drug policy, and became a provincially approved site. 

“The goal was to save lives,” Dr. Chapman explains simply. “We were able to shape the course of provincial drug policy in Ontario. It was meaningful work. And, thankfully, we didn’t get arrested.”

Dr. Chapman at a Moss Park overdose memorial march and rally in Winter 2017 in Toronto, where she remembered her late brother.

It’s actions like these that, to some, made Dr. Chapman seem an unlikely choice for Chief Nursing Officer of Canada, when she was appointed in August 2022. While she was “delighted and honoured” to be chosen after a rigorous process and from among 70 fellow applicants, she acknowledges her background in activism and advocacy gave some people a surprise. “I think my experience lends itself well to this job. But, I admit I may push the envelope for what some people think of a Chief Nursing Officer.”

Even with her government role, Dr. Chapman continues to work at a consumption and treatment service in Toronto and stays connected to frontline needs. “There are still 20 deaths from overdose a day in Canada,” she reminds us. “There is a health human resource crisis and an overdose crisis happening at the same time. Having these dual health emergencies is an important lens I bring to the [Chief Nursing Officer] role.”

Her ability to toggle back and forth between disparate environments is stunning. Throughout her career, Canada’s Chief Nursing Officer has centred patients and providers in an array of settings, shifting between boundaries, going from resource-rich settings in hospital and community care to integrating health care and homelessness. She does this because she sees firsthand how health and health care is affected by different social factors. As an example, “Housing and health care are not separate issues – they are linked,” she says.

Most recently, during the pandemic, Dr. Chapman was the inaugural director of a homeless health care service in Toronto in a physician-services organization. The model of care quickly became interprofessional and nurse-led. In this role she created a team of more than 200 nurses who delivered care to unhoused people in 10 shelter and recovery hotels and in encampments set up in parks and ravines in the city. In the 19 days they had before opening their doors to patients, the team went full tilt organizing nurses, procuring equipment and retrofitting hotels to be clinical spaces. Since there wasn’t time to do full reference checks, they relied heavily on CNO’s online public Register, Find a Nurse, to ensure nurses were in good standing.

In spite of the obstacles, she and her team rose to the challenge. "They cracked the door open for nurses and we barged right in!” she exclaims. “Everything was new to these nurses: caring for people experiencing homelessness, providing care in hotels and of course, COVID. We had to deliver care in a way we had never done before.”

This meant actively solving problems on the job. For instance, nurses visited patients in their tents when they couldn’t risk having their possessions stolen to access care. Dr. Chapman says these kinds of initiatives were transformative in bringing people into trusting health care relationships – sometimes for the first time in their lives. In a steep learning curve that “got easier around the fifth or sixth wave,” Dr. Chapman highlights the flexibility and innovation of nurses with the program’s success.

“Nurses were unbelievable at developing the program of care. City staff and nurses worked collaboratively with people in the worst situation, people who were suffering from substance use and mental health issues, homelessness. If people needed isolation, we made sure it didn’t feel like they were ‘locked up’. Nurses approached it to make it the best experience of some people’s lives by ensuring they were well cared for during this difficult time.”

A focus on nurses

While nurses are busy improving the quality of their patients’ lives, Dr. Chapman spotlights their needs as well. With the expert skill of an acrobat, she balances patient care with the nurses who provide it. “In regulation, we’re always thinking about the public, but we also need to think about the nurse. This can be uncomfortable for regulators. Once nurses are registered, we need to ensure the practice environment is conducive to meeting the standards.”

Now with a global pandemic under their belts, Dr. Chapman believes Canada needs to focus on its nurses more than ever before. Referring to nurses as ‘heroes’ and banging on pots and pans is nice, but she wants to see more. “We asked nurses to pivot and do unprecedented things, like holding an iPad to a dying patient’s face so their family could say their goodbyes, when the nurse was actually the only other person in the room. Nurses are vulnerable, exhausted and hurting.”

Dr. Chapman wants to see less use of words like ‘resilience’ – which she says doesn’t acknowledge nurses’ pain and suffering – and more attention on creating resilient structures for nurses to work within. “Yes, we need a resilient workforce. But the language of resilience blames the individual and gaslights nurses’ experience during the pandemic. During an unrelenting three years during the pandemic, nurses were exposed to more deaths than ever before. They were not able to provide the compassionate care they are used to providing. We need the joy to return to practice before we begin to talk about resilience.”

Finding hope

As everyone knows, before joy comes hope, and Dr. Chapman is adamant about bringing hope to the Chief Nursing Officer role. “There are changes we need to see across the country, and we’re at a time when real change is possible – and inevitable.”

She positively notes the federal government’s record $2 billion investment in health care, to relieve immediate pressures on the system. She also wants to see racism and discrimination addressed. “We have a lot of work to do in this area,” she stresses. “There is a lot of racism and discrimination in health care, but we don’t collect race-based data, and nurses also have a key role to play in social determinants of health.”  

With increased access to care and more nursing-led initiatives, nurses will be able to provide better care. In the meantime, nursing will become, as Dr. Chapman puts it, “a career of choice” – a profession with good working conditions, that is enticing both to students questioning their career path and to nurses who may have left the profession and are considering coming back.

While it can be tricky to maintain the delicate balance between patients and care providers, it is one she does so well. All with the goal of making good decisions for Canada’s patients and nurses. “I always believe we make good decisions when we centre the patient and the provider.”