Focus On: Clinical Nurse Specialist

Last month we headed out to Headwaters Health Care Centre, a hospital we work at frequently supporting our clients, and sat down with Clinical Nurse Specialist Lucy Gilmore and talked about her career, working in maternal health care, and in this community.

We would like to sincerely thank Lucy Gilmore for taking time out of her busy schedule to meet with us.  It was truly a pleasure to sit with her and learn more about the incredible team at Headwaters Health Care Centre.  Thank you Lucy for all you do for the families of the Headwaters Region.

What made you decide to become a nurse, how long have you been a nurse and what brought you to Headwaters?

My decision to become a nurse came in my last year of high school and quite by accident while looking through university programs.  I have never looked back, and would do it all again. I graduated in 1985 and I started at a larger hospital.  Within 3 years I finished my Masters Degree and a lot of people made an assumption that I would go into administration - but that was never my plan.  My Masters was clinically focused and upon completion, I went to  a small hospital where I was hired as a manager, but did a lot of clinical care.  From there, I went to a large organization. That role included a clinic practice in high risk obstetrics as a Clinical Nurse Specialist, and I have  been a Clinical Nurse Specialist ever since.  The Clinical Nurse Specialist role includes a mix of education, advanced practice, leadership, and consultation with others in the team, including physicians, midwives, and nurses, pharmacists and respiratory therapists
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​In 2010 Headwaters Health Care Centre was looking for someone to help develop the and grow the already strong program.  They were committed to high standards and advancing practice so decided to seek a Clinical Nurse Specialist for that role.  This was a perfect fit for me.

Image Courtesy of Headwaters Health Care Centre

Making Changes

​From there on, the Physicians, Midwives, Nurses and RTs have been a great team to work with.  Everyone has been very receptive to change - change was and is  generally welcomed, as everyone wanted Headwaters to continue on its path of being a top performing hospital and maternity unit.  So, although there were a lot of changes,  it wasn't hard because everyone was so patient and quality focused.  The entire organization, from the Senior Leadership to direct care providers is committed to excellent quality care and patient experience.  It is embedded in everything we do. So my journey at Headwaters started in 2010, and I've been here ever since!

What is a Clinical Nurse Specialist?

A Clinical Nurse Specialist is a title that is recognized by the Canadian Nurses Association.  It's not a protected title like an RN, but it is a recognized title.  To call yourself a Clinical Nurse Specialist, you have to have a Masters Degree in a Clinical Specialty, and you have to spend a significant amount of time in direct patient care with an advanced level of knowledge.  So the main roles are:  advanced practice, research,  education, leadership and consultation.

Headwaters:  A leader to look up to

I am proud to say the our maternity unit is a program that other hospitals look to model after.  I regularly receive questions and am asked advice on how we do things since our care is excellent and our patients and families rate us very highly.  I have had the opportunity to present our practices on provincial webinars about how we rolled out managing painful procedures for newborns, and increasing skin to skin time with mom and significant other, particularly in the operating room and recovery room.  Some hospitals were facing significant challenges doing skin to skin in the operating room, especially in smaller units.  Of the smaller hospitals, we were very early adopters of this.  We were also very early adopters of using specific strategies to manage pain in newborns undergoing painful procedures like blood sampling and IV starts.

Statistics To Be Proud Of

One of the provincial research projects I'm working on is Pain Management Strategies for Painful Newborn Procedures.  Currently, only 1.9% of our babies don't have some sort of pain management when they have a painful procedure done.  Sometimes that's timing, or it's an emergency.  According to the BORN database in the Province of Ontario, the average for hospitals our size is that 26% of babies  don't have pain management strategies.

Baby Camilla born here at Headwaters Health Care Centre (Image courtesy of HHCC)

Team Work

At our hospital, both the lab staff and nurses do the blood draws, so nurses and lab have to work closely to make sure all babies have an option to manage pain during a sample collection.  The lab staff may come to the ward for a blood draw and the baby may not be skin to skin or feeding at that time.  So, if the baby is in the bassinet, they won't just draw the blood, the lab staff take the time to get a nurse and confirm which pain  management strategy will be used, breastfeeding, skin to skin, or sucrose solution. THAT was a big change.  In the operating room, the team of physicians, nurses and respiratory therapist all come together, modify their usual work flow, so that the newborn can be skin to skin and breastfeeding in the operating and recovery room. So yes, managing newborn painful procedures, and the skin to skin in the operating room - I'm really proud of those, they are a true testament to the team work at Headwaters and the focus on patient experience and quality evidenced based care. Of course, the standard of care and providing excellent quality care is important, but the patient experience is so important!

What attracted you to maternal & infant care?

​I did a clinical placement just in postpartum my 2nd year of my nursing program many years ago and I enjoyed it.  It was the Nurse Manager who approached me and said "You're gonna be an OB nurse someday".  By my 4th year, I thought, yes, maybe I do want to be an OB nurse!  But in my final consolidation, I didn't get OB, I got Psychiatry –I enjoyed psychiatry but I knew I still wanted to do OB, so after I was done I applied for a position in Postpartum at Credit Valley Hospital in Mississauga (which wasn't even open yet) and I got it!

What do you love about your team of nurses here at Headwaters Health Care Centre?

OBS Staff Mary Jane & Donna (photo courtesy of HHCC)

We have fun, and we ARE patient centred.  The nurses are great advocates for their patients, which is really important, while collaborating well with all of the other care providers.  So, it's not a conflicting kind of advocacy. It's a real collaborative advocacy.

We support each other professionally as well as personally which is so important when we spend the amount of time we do together in a career that can be very demanding.

Tell us a bit about the team of Obstetricians at Headwaters Health Care Centre?

Well, we have the four best Obstetricians in the Province of Ontario!!  They collaborate well as a team, they are patient centred, and we work to really prioritize what the patient needs are together.

As a team they will help each other out to reorganize care, to make the best safety plan for when it's busy.  We collaborate around moving forward, using evidence based practice - it's continually evolving.

The Physicians are also very good to the staff, to the nurses - they are friendly, happy and enjoy their work, and they bring food when it's a busy shift!  They recognize the nurses whenever they can but particularly during Nurses Week and Christmas.  The Obstetricians and  Pediatricians are all very respectful of the nurses here and the feeling is mutual.   I think this type of culture then transfers to the  bedside, patients and families see us working as a team, including them as the main focus.

Evidence Based Practices

When the evidence is there, there is very little resistance to change.  People here are really receptive to what's best practice.  We love to be at the top whenever there are quality indicators that we can compare with other hospitals (I'm a tad competitive)!

If we have a metric where we can be top notch, we do strive to be at or above and we are proud of that.  We like to innovate as well here, so the group is not afraid to do things differently, to think outside the box - as long as the evidence is there.

What kind of advice do you have for a nurse just starting out?

If you want to get into Obstetrics it's important (because it's a specialty area) to be prepared to take the courses and the programs and do that advanced learning.  If you are in your 1st, 2nd or 3rd year and certainly your pre-grad, to get as much experience as you can in Obstetrics - because that's when you really "try it on".  You certainly need to have the specialties and take the courses.

What can families expect from their nurse when they arrive at Headwaters in labour?

When families arrive, we want patients to feel welcomed, we want them to know that we are glad that they are here.  We would hope that they always feel welcomed, and that they never feel like they are a burden - that's really important.  I think our nurses here are really good at that.  Patients can obviously tell when we're busy, but they never say "the nurses are too busy, I did not get good care".  What they say is "the nurses are so busy, you need more staff".   It is quite rewarding to see that patients and families feel so appreciative and connected with their nurses that they feel they have our back. They want to help, they recognize the team is working hard together, bring snacks and acknowledge the good care.  It is quite unique.
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Regardless of how busy it is, we want patients to feel like their needs are being met by the nurse, and that they can ask anything they want, and if the nurse doesn't have the answer, that they will find someone who does.  Also, if they have any special physical, clinical, or social needs that we may not be able to meet, but that we can help them get the support that they need.  You know, even though we can't deal with every clinical complication here, we can deal with emergencies here and we do it very well.  We work great as a team, and we also know, as a team when something is not within what we normally do on a day to day basis that needs to be referred out.

Our patients are going to get the right care,
in the right place, by the right care provider
​- the nurses are aware of this, and advocate for this!

What positive changes have you seen in Maternal & Infant Healthcare over the years?

I think my favourite changes are the increased emphasis on skin to skin care; the Baby Friendly Initiative as baby friendly feeding choices, whatever informed decision a family makes about feeding  is supported; the painful procedures; and I think overall, the focus on family choice, informed decision making and education.  Over the last 30+ years, there is much more collaboration with families around decision making :  information is shared and there is much less hierarchy between the families & the physician, the physician & the nurses, the nurses & the families. There have been hierarchies in the past and that shouldn't happen anymore, it is not good for safety, the patient, or staff experience.

Patient centredness,
family centredness,
and collaboration as opposed to hierarchy
​- those are the biggest changes over the last 30 years!

Are there any change you expect to see in the future?

There are so many important things that  are happening in our health care system.  We continually need to improve the multi-disciplinary approach to decision making at a systems level. I think we do this well at Headwaters.

If you could give one piece of advice to 1st time parents on how to prepare for birth, what would that be?

I would like to encourage new parents to think about what the time AFTER baby is born is going to look like as it can be pretty overwhelming.  There's a little person who's coming into your family and it is an intimate and personal time so make sure that they actually take that time.  You know there can be a lot of people around and it's easy to miss that time - with the partner and the baby.  Give yourself permission to have that intimate time, because sometimes it's hard, right?  I mean, the opposite is true as well, there are some families who are quite alone and for those people, they need to reach out where they might not otherwise (neighbour, friend, doula), and to use the resources they need.

Make sure that you think about
how your family is going to
have that intimate time
with your new baby,
because you will never get that back. 

​Those first few days are REALLY important!

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Lucy Gilmore RN MScN graduated in 1985 from McMaster University with a Bachelor of Science in Nursing and from the University of Toronto in 1990 with a Masters of Science in Nursing.
She worked as a manager at Georgetown Hospital for a number of years and then a Clinical Nurse Specialist at William Osler from 2002 to 2010 when she moved to Headwaters as a CNS.  The role of a CNS encompasses advanced practice, consultation, research, education, and leadership.

In addition to her role at Headwaters, she is the Canadian Association of Perinatal and Women’s Health Nurses (CAPWHN) representative on the College of Family Physicians of Canada Maternal Newborn Committee.  She is on the Provincial Quality Based Procedure (QBP) clinical expert panel for the Low Risk Birth QBP.  She is also working with a provincial research group on targeted parent education to improve practices for management of pain during blood work for newborns.
Lucy has been married for 30 plus years, has 4 children and too many  pets! In her leisure time she enjoys hiking with the dogs and running.   You will find her outdoors whenever possible, it is never too cold or too hot!

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Imagine Headwaters:
​Building our Hospital’s Future Together

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