The fear of speaking out is rooted in decades of devaluing the nursing profession, says Natalie Stake-Doucet, who teaches a course entitled Leading Change, Policy and Practice.

Myth-buster is not on Natalie Stake-Doucet’s CV, but perhaps it should be. A Faculty Lecturer at the Ingram School of Nursing (ISoN), Prof. Stake-Doucet believes that advocacy in nursing starts with identifying myths about nursing that are often internalized by nurses themselves – to their own detriment and that of the healthcare system. The most pervasive of these myths is the nurse as a self-effacing angel. “The healthcare system largely runs on nurses’ guilt. I teach my students to look at the larger system in which they operate because identifying, understanding and questioning the constraints and irritants imposed by the system is key to helping prevent burnout.”

“As nurses, we tend to individualize systemic problems and automatically assume we are at fault,” notes Prof. Stake-Doucet, who served as president and spokesperson for the Quebec Nurses Association (Association québécoise des infirmières et infirmiers) from 2018-2022. Early in her career, she was the sole nurse on the evening shift, responsible for 22 patients on an acute care floor at a psychiatric hospital where the units were far apart from each other. Her supervisor would regularly point out to her that she wasn’t fast enough and would advise her to improve her time management skills. At first, she felt guilty and inadequate, but after a few weeks, she finally discovered that while she was working solo, the other units had two nurses on shift at a time. There were no problems with her time management skills. For Stake-Doucet, this was a revelation. “I vowed not to let anyone else undermine my practice by making sure I had all the information at hand before assuming I was at fault.”

In her course entitled Leading Change, Policy and Practice, Prof. Stake-Doucet guides her students in an in-depth examination of how the broader societal context affects their patients, their practice and the care of specific populations. For example, data shows that pulse oximeters – machines used to determine patients’ oxygen saturation levels – were never tested on Black skin. As a result, during the COVID pandemic, thousands of Black patients did not receive timely care. This speaks to systemic forms of discrimination and racism that are all too prevalent in healthcare, even with tools used on a daily basis.

For their final assignment, students determine what their own advocacy will look like by researching an issue that is meaningful to them, proposing solutions, and preparing a policy brief that, crucially, is sent to whoever has the scope of influence to address the issue at hand. This ranges from hospital managers to CEOs to political decision-makers. Prof. Stake-Doucet notes that one shining example of advocacy directed at decision-makers is the op-ed by Sydney Wasserman, Enora Ledieu and Samantha Weisenfeld entitled This isn’t how to solve Quebec’s nursing shortage, addressed to the Quebec Minister of Health and Social Services and published in the Montreal Gazette and La Presse.

Advocacy is specific to each institution, unit and experience, and complicated by fear of speaking out. “It’s a fear rooted in decades of devaluing the nursing profession,” says Prof. Stake-Doucet. “I try to give students the knowledge and skills to be confident in their expertise and unapologetic about putting their ideas forward.”

Prof. Stake-Doucet is inspired by her students’ enthusiasm for the nursing profession and their desire to build stimulating and rewarding careers. Evidence shows nurses who have a modicum of control over their practice tend to stay in the profession longer. “Advocacy gives me energy, meaning and hope for the future,” she concludes.