Insights (Essays) November 2013

Let Compassion Be a Guide To Unleash Professional Potential

James Mastin

We are inspired by the theme cutting across all the conversations taking place on the “balcony of personal reflection.” No one is saying we cannot make this work. In fact, the opposite is being talked about: time for a mindset and behaviour shift. Making a shift from a registered nurse working in an ER to becoming a nurse practitioner in palliative care in a Community Care Access Centre (CCAC) has provided me with many insights. What has stood out most of all is the value and effectiveness of an organization that unleashes the potential of all its people. At Toronto Central CCAC, I’ve been empowered to work to the fullest scope of my practice, in a unique environment that ultimately improves patient care.

Out of nowhere, the Ghost of Healthcare Consciousness appears and says:

“When I look at overall healthcare service and delivery practices, I see a paternalistic system filled with good intentions. Unfortunately, good intentions only go so far, and the system continues to lack quality and efficiency. The real challenge is to create organizational environments that explore and exploit the potential of all healthcare providers.”

We believe that a large proportion of healthcare professionals still remain ignorant to the unique and specialized skills of different professional groups working within the system. Hierarchical practices remain and continue to squander some of the precious human resources in our healthcare system. This is an all too common occurrence in healthcare. Until we develop an environment that encourages full participation, allowing all individuals to yield their maximum contribution, the system will continue to stumble forward at a snail’s pace. It needs to be acknowledged that it is an organization’s culture that allows individuals to work to their full scope, in true interprofessional teams, and to be enabled by the organization to do what is necessary to deliver patient-centred care.

As a nurse practitioner, I (James) have experienced this disconnect first hand and many times over. Allow us to share a couple of personal experiences and observations: Practitioners now have open prescribing, but there are still barriers (e.g., writing prescriptions for controlled substances) that prevent us from using our entire skill set. The current dialogue between key decision-makers and these practitioners is a step in the right direction, but in the meantime, the current protocol can be detrimental to patient care, with squabbles over who is prescribing what. In palliative care, this can also lead to needless pain and suffering. Another example of our existing disconnect can be detected in a referral to a specialist. As it stands, referrals from nurse practitioners are often dismissed by specialists. The specialists’ dismissal is due to the level of remuneration received, which is determined by who makes the referral. In this case, the remuneration received by a physician’s referral is greater than a referral given by a nurse practitioner. In other circumstances, specialists insist on a physician’s signature on the referral form. So while a patient can be referred to a specialist by a nurse practitioner in theory, the practice is often very different. Again, we have a situation where organizations must empower all of their staff resources to the fullest.

It must be said that nurse practitioners themselves, and other healthcare professionals, can also be their own worst enemies. Whatever their discipline, many remain afraid to work within the full scope of their practice, perhaps because of the historical culture of the profession or that their training does not give them a solid enough foundation in practical experience. Confidence is built on experience, and the current system does not offer enough of it for emerging nurse practitioners. We all need mentoring in order to enter and grow in our respective fields whether it be in administration or clinical service delivery. With mentoring and support, we will be ready to make a full and meaningful contribution to healthcare.

Above, we shared with you two examples of where things can become disconnected within our current system, but we have also experienced the brilliance created when these barriers are lifted and individuals are given the ability to fully embrace and provide their entire skill set. Let us now share with you a story that depicts the greatness that can be realized when the system, and the relationships within it, are in tune: There was a palliative care patient who refused to accept the fact that she was dying. The patient had left the hospital and language barriers along with cultural differences were threatening to condemn her to a painful and lonely death. By taking an unconventional approach that recognized her unusual situation, she was provided with a dignified end of life experience at home, where she could be surrounded by her family.

Full participation in a collaborative model is vital for any healthcare system that hopes to achieve a new dynamic of wholeness. These necessary modifications are not limited to healthcare. Most industries must value and implement the ideas and suggestions of their workers. Nurse practitioners and other allied healthcare professionals have a lot to offer in terms of experience, knowledge, education and bold ideas. Our contributions and unique skill sets will only be embraced where there is an environment of open communication and knowledge acquisition. This will ultimately transform current beliefs and attitudes.

Three recommendations for your consideration:

  1. Education accreditation bodies adapt their requirements to include a central focus on quality and patient safety from the patient perspective.
  2. Health science program leaders commit to incorporating knowledge of quality and patient safety theory and practice into their core curricula, and programs emphasize inter-professional collaborative practice and teach quality, patient theory and practice from the perspective of teamwork and interdependency.
  3. Health science education programs require that practicum and apprenticeship sites be committed to a quality and patient safety improvement agenda and model behaviours consistent with a quality culture.

We close with a passage from the essay, “Asking, Listening, Talking”:

“It is almost cliché now to say that an organization’s people are its most valuable asset. The concept is touted by both private and public institutions who espouse values like respect, trust, diversity and openness. Too often, we must admit, the words are inscribed in invisible ink. The organization carries on with little commitment to the values and visions it once proudly proclaimed.

“But what if healthcare was committed to those values? How would we act? First, we’d be inclusive. We would invite opinion and involve people from all levels and walks of life in decision-making. We are asked, after all, to achieve sterling performance under conditions of extreme fiscal restraint and increasing service demand. We are forced to deal with factors outside our control, such as political agendas and their impacts on policy and funding. At any moment these factors can surge into an issue demanding immediate response, when wide inclusive involvement may not be possible, when a tough decision must be made with high-profile accountability on the basis of few facts.  But even in crisis we must fight the reflex to pull inward. We need to maintain open communication and decision-making.”

It is important to have a brief conversation about the factors that contribute to health. Join next week’s conversation titled:“Social Determinants – We Have Work To Do

See all essays in this series.

See essays from the second series.

About the Author

James Mastin … Nurse Practitioner, Colleague, Educator, Uncle, Brother, Friend and Lifelong Learner.
Hugh MacLeod, CEO Canadian Patient Safety Institute … Patient, Father, Husband, Brother, Grandparent … a Concerned Citizen.


MacLeod, H. and C. Power. 2013. “Asking, Listening, Talking.” Longwoods Ghost Busting Essays.




Robert Gordon wrote:

Posted 2013/11/26 at 11:14 AM EST

Article worth reading, but connection to its title?

Was "compassion" for "collaboration"?


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