Why did you decide to become a nurse practitioner?
I became an NP so I could advocate more for the Indigenous communities I was serving. At the time, most of my nursing experience over two decades was in isolated remote and northern communities in Manitoba and Ontario. There is certainly a high need for holistic health management in these communities due to many health determinants that are not being addressed (e.g., overcrowded housing, residential school traumas). The lack of essential services such as CT scans, MRIs and specialist consultations delay what are often life-threatening diagnoses. These services would be readily available in an urban setting such as Winnipeg’s Health Sciences Centre.
I was doing my own X-rays at one point, when I was working for Health Canada, and delivering babies without physicians because of staffing shortage problems. Essential services still need more trained nurses in Ontario and Manitoba Indigenous communities. Nurses are retiring and new ones are needed that are trained to deal with today’s societal traumas, associated with the residential school years, and how to heal a spirit that was broken decades ago (their mothers and fathers)! The only time they had a physician was during the week; on the weekends there was no physician but of course there were critical things happening.
There is a lot of healing that needed to be done in Indigenous communities, and I had these experiences being Aboriginal myself. We have come a long way in health services, and it happened through a lot of advocacy and changes in the government to recognize the high needs of Indigenous populations and how health determinants are not meeting basic needs. Those indicators are yet to be identified by government leaders, such as non-insured health benefits, restrictions on basic needs (such as certain medications), and assistive living devices. There are also difficulties in finding culturally safe counsellors and healers for the three generations of Indigenous families that have been, and are still living with, the aftermath of the residential schools’ historical capture.
The importance of healing in my life came right from when I was a child. I was taught by my grandparents that healing was a big part of everyday prayer. I was raised to be a spiritual person, so being a healer is more than having an RN or NP designation — it’s knowing I am here to help people and here to learn from them.
How do you feel you help patients the most?
I feel I help patients the most by sitting with them and listening — I need to be with the person. In order to connect, you need a stillness first so they can share their experiences, whatever they may be. You need to be a good listener and have those essential listening skills. From there I gather information and advocate for whatever is needed to help with their health and wellness. I advocate on my patient’s behalf so that they are empowered to change their behaviour (e.g., smoking cessation) or reach out to other health services for their own benefit. People need to have information, and they need resources so that they can use their knowledge to help themselves. I do not like to keep a person boxed in. I do not like to enable my patients. For example, I’m working with women who are homeless, traumatized, and have been exploited. Some of these women are going onto third generation sexual exploitation, after their mothers were in residential schools. There’s so much trauma from residential schools. I help high-needs patients — most of whom are marginalized and Indigenous — and it’s challenging because so many are really consumed by their illness, very dependent on their drug use.
I have always served Indigenous populations. I have done a lot, learned a lot, through my patients. You come across a patient, you have to understand their language, history, support system and education to help them. People are like a puzzle, you need to put it all together, very complex. You need to know their coping abilities to help them move forward and use the resources that are there for them. It can be stressful. I have to be very up to date on global trends (for example, how to deal with patients who are transgendered) and I must know everything that is involved in patient treatment (such as surgery, hormones, etc.). There’s always new information. I have to keep learning, keep up with my education, because things are always changing and we want to keep our patients safe. We are privileged to be NPs and we must know our standards and guidelines for practice.
What is the most rewarding aspect of your job and what is the most challenging?
The most rewarding aspect is learning from my patients. For example, if my patient comes in and they are sick or lethargic because of taking too many drugs, I keep calm and listen to them. This teaches me how to be patient and to see clearly where these people are coming from. It is rewarding to be able to learn from this type of situation, as each is an opportunity to help the patient/client, and to be able to learn from that situation.
The most challenging aspect of my job watching a person deliberately destroy their spirit by poly-substance use or by experiencing pain, such as a cancer patient. When people suffer because of their pain, the spirit is suffering — this is difficult for me. The healing experience is one of “feeling,” whether it be happiness, sadness, frustration, hurt or fear. Those can be challenging for me, especially when you are experiencing it with your patient.
More about Angela
I am a giving person. I have a lot of love, patience, and I have learned a lot from my fellow humans. It is very rewarding because I learn so much from people. Some of my patients are so blocked by fear that it is challenging to help them heal (for example, women who are so sad because they are suffering from traumas in their life. They do not believe they are able to heal, they have no faith in themselves, and there is nothing you can do other than what you have already been doing. It is also challenging dealing with someone who is in a drug-induced psychosis, then the next day they come out of it and are quite aware of their surroundings. You cannot just form your opinion from that one encounter and put them in a hospital. You can only keep offering them services. But if they do not take it I feel such anguish watching them destroy and kill themselves).
People may know they have help available to them, but they don’t always take it and they continue to self-destruct. It’s very challenging because I am a helper. I have always been a helper. I pray every day when I come into work and pray every day as I leave. I am a very strong advocate for marginalized and homeless women, and I am privileged to be working among strong advocates for cultural safety, stopping the hatred and opening hearts. Peace, love, understanding, helping each other. There is a lot of work to be done to help the health of our communities.