Carol Farkas, the Director of Clinical Healthcare Services for Carecor

Carol is a seasoned nurse, an advocate for nursing and the Director of Clinical Healthcare Services for Carecor.

When did you get into nursing?
Carol: I began nursing in the early 80's.

What inspired you to become a nurse?
Carol: The nursing profession was always of real interest for me. Growing up, I remember my next door neighbor was a nurse and I always thought very highly of her. Within my family, I also had a relative who was in the healthcare profession. Although my relative was not a nurse, I remember hearing stories about what it was like to work in a hospital setting and it just really appealed to me. I always felt - and still feel - that as a nurse, you have a lot of options whether it be working in a hospital setting, teaching, public health or working in the community. Healthcare is a profession where there will always be a need for nurses.

What were your first experiences with nursing?
Carol: I remember doing some volunteer work during high school. The hospital had a volunteer program that gave you some training around what today would have been like a nurse's assistant. Although you weren't involved in providing personal care, you were there to help the nursing staff with the little things such as handing out food trays, talking with patients, feeding patients and just spending time with patients. Mostly, we helped with either the elderly patients or on the paediatric ward.  

Did you get opportunities to interact with patients as part of your training or was it all academic?
Carol: At the time when I entered the nursing program, you had two options: to attend the college program or attend a university program. The college program was always the program you entered if you wanted to work in a hospital setting. The focus was very much on patient bedside care. It was mandatory that we had a clinical hospital experience in each of the clinical specialties - surgery, medicine, paediatrics, obstetrics, mental health, community nursing - and you were able to choose an area as your final clinical. Mine was in the Emergency department. I really liked the aspect of the variety of patients who came in through the ER. There was a lot of stress, but the nurses were always the constant in the ER department. Many of the other healthcare specialties would be gone at 2 am, but in the ER, the nurses were always there for the patients. My role as a nursing student in the ER was primarily that of observer, but I was always really impressed by the skills of the ER nurse. Regardless of the urgency of the situation, the nurse always had time to talk with the patient and their family.  

Do you remember one of your first interactions with a patient and what it was like?
Carol: The first skill I remember ‘practicing' on patients was learning to do a blood pressure. I can remember trying to listen for the sounds the nursing instructor described we would hear and not quite ‘getting it' the first time. But like all the other technical skills you learn as a nurse, you become confident in what you are doing. I'm probably dating myself, but I also remember we had to learn how to make a ‘proper bed'. The nursing instructors were quite specific about having a perfect ‘mitred' corner to the bedsheets to ensure they stayed in place.

In the 1980s, were the nurses still made to be handmaidens to the doctors?
Carol: I remember we would have doctor's rounds. I remember as a new nurse, hearing stories from the older nurses that when the physicians would come in the nursing station, the nursing staff would be required to stand up. This is not anything I personally experienced. I think in the early 80s when I started, there was more of a formalized hierarchy between nurses and physicians. Nurses were seen as largely assisting the physician and playing a secondary role in patient care. The physicians I've worked with respected and valued the care that I and my fellow nurses provided to the patients. On occasion, I have worked with physicians who were not pleasant to deal with, but this is not the normal situation in most hospitals or healthcare settings where I have worked.

Today, I feel that the nursing education program is much more focused on working collaboratively with all the healthcare professions, physicians or other healthcare providers. The profile of the nurse today, despite some negative imaging, primarily shows the nurse as a valued member of the healthcare team, second to none.

The relationship between doctors and nurses - how has it evolved since you've been a nurse?
Carol: One of the key developments is the ability of nurses to work as Nurse Practitioners (NP). It wasn't that long ago when physicians opposed the idea of Nurse Practitioners and the practitioner programs were non-existent. Whereas now, that's completely changed. Now, there are Nurse Practitioners working in many aspects of healthcare, whether it's in a family practice unit along with physicians, working in a community health centre, or working as a NP in a hospital setting. NPs have a huge role to play in patient care.

Did you experience doctors resisting nurses acquiring more autonomy and more self respect?
Carol: In the early 80s, some physicians really either did not understand the role of what nurses could do or how they could contribute. I think there was resistance; certainly now, there is much more of a collegial relationship between all members of the healthcare team.

Do doctors as a group tend to completely respect the nurses' skill in assessing?
Carol: Overall, I believe that doctors trust the nurses' expertise in providing patient care, physical and emotional. As in any profession, there will always be the ‘bad apples', but the goal is to focus and promote the majority of nurses who really enjoy what they do.

Today when you look at the health care training of nurses and physicians, there is more focus and value placed on collaborating and valuing each profession's contributions. Physicians have a lot of responsibility and nurses have a lot of responsibility. One is not greater than the other. We both contribute to making the patient's experience a better one.

What's your philosophy of nursing in a nut shell?
Carol: I would say that as a nurse, you really have to enjoy what you do and you have to be passionate about wanting to help others. If that's not what motivates you, then you need to reconsider your choice of profession. Nursing is very stressful, it's challenging and constantly changing but at the same time, nursing is a gratifying profession. I can't think of many professions where you can really make a difference in someone's life on a daily basis. You have to be able to think on your feet, to make quick decisions and be able to implement and follow through. You have to be comfortable in the role of leader. You really have to want to be an advocate for the patient.

Where are Nurses as a profession at now?
Carol: Nursing is evolving and transitioning. The nursing program is now a four-year university based program as a minimum entry level to practice. Given the nursing shortage, the role of nursing has additional concerns related to adequate staffing ratios. I think the nursing shortage is the greatest challenge right now.

The general public values greatly the role of nurses. But again, I don't think they sometimes fully understand what we really do. There are still some stereotypical images out there that don't represent nursing in a positive manner, whether in the media, radio or television.

What was the hardest thing about being a nurse?
Carol: One of the hardest things for me was working shifts. I found at times that it was disruptive to my family life, particularly when I was working the night shift or weekends.

Nursing is also a physically demanding job when you are working at the bedside - constantly pushing and lifting or transferring patients. Many nurses frequently injure their back or experience muscle and joint pain related to the physical demands of their job. As well as physically demanding, nursing is also emotionally demanding as you are dealing on a daily basis with pain, death and discomfort. In addition to work, nurses have their own personal lives including family and children, or those nurses who are single moms and who are the primary bread winners.

In your opinion, what tends to be the most rewarding thing about nursing?
Carol: I think the most reward comes from the reaction you get from the patient and the family. Despite everything else that can happen, it is the thing that carries you from one day to the next. It can be a simple ‘thank-you.' When you see that somebody has pulled through a difficult situation and you just feel - Wow, I was able to help them on the road to recovery. In other instances, where you are involved with a patient who is dying, it is the reward of being able to have been there during this experience and to help in whatever way you can. It's just the feeling when you come out of your shift and you know that you've done a good job and have made a difference in someone's life.

Any extreme examples that disgusted you, inspired you, or scared the heck out of you? Carol: When I used to work as a community visiting nurse and care for patients in their homes, I recall my first experience working with an HIV patient. In the early 80s, HIV was very new and there was a lot of panic in the healthcare sector as well as with the general public, because not a lot was known about HIV. My patient was in the late stages of AIDS and wanted to die at home. I remember being very nervous about having to go into his home and being afraid that I would get AIDS just by being in the same room with him. As a member of a larger group of nurses who cared for this patient, I remember feeling a great sense of support from all the nurses as we each faced our fears in this situation. Nurses deal with their fear on a daily basis. We only need to look back to March 2003 when nurses faced the SARS outbreak. It's important that as nurses, we support each other in stressful situations such as this when our own personal safety may be at risk.

Do you see value in nurses getting together to talk with their peers?
Carol: The whole aspect of nurses being able to debrief or vent - I think that's something that we need to do more of. In a span of a day in a hospital setting, you are literally running from patient to patient helping people, with often little time to think about your own personal needs. That's a common thing that I hear from nurses; we'd like to be able to talk about our day - the need to vent, to get rid of some of the stuff that goes on and just be able to release it. I think that's important.

I like the idea of "nurse's stories" that would bring to light the common things that nurse's deal with on a daily basis. This may help to bring a realization among nurses that ‘I'm not alone because the thing that happened to me, also happened to someone else'. I'd like to see nurses being able to connect, not just in the traditional manner of a formal meeting, but by other means such media, the internet, via teleconferences or the written word in some form.

Is there anything you'd like to add - anything that you want to share with the world?
Carol: I'd like nurses to realize that they are a powerful group. They hold a lot of inherent power, not just through their numbers, but from the fact they are key to the success of the healthcare sector. Without nurses, healthcare facilities would not be able to function. Nurses need to use this power they have to enact change as a profession and in their workplace environments. Nurses need to find ways to come together and toss around ideas on how they can support each other. That's where the focus should be. I'm proud to be a nurse and want to work with my peers to continually evolve this profession.