In the Spotlight

Lisa Merrill RN, MN

Lisa Merrill is a Clinical Nurse Specialist working in Health Sciences Center Women's Hospital. Currently, her role involves working with inner city mothers and babies. She is currently involved with the Partners in Inner-city Integrated Prenatal Care program, assisting inner-city pregnant women access prenatal care and other health care services. Lisa credits her interactions with inner city moms-to-be as one of the reasons she gets out of bed in the morning. She's been a nurse for over 20 years and acknowledges education with opening up new opportunities for her personally and professionally.

"Nurses are with patients 24/7. We have the most influence on the quality of patient care, healthcare outcomes and the experience of our patients. Nurses need to take ownership of this truth and their work."

Can you please talk about your nursing career?

I graduated in 1990 from St Boniface Hospital School of Nursing with an RN diploma. I had completed my senior practicum in the maternal/child program, working with sick babies in the neonatal intensive care unit. I loved working with the babies and helping their families during this difficult time. It was so rewarding to get to know the families and watch the babies improve and eventually go home. For others who didn't, it was a privilege to care for such fragile little lives and support their families during their time of loss.

That was my first job. It was terrifying to have that level of responsibility as a new nursing grad but at the time I graduated, nursing jobs were scarce. We had a great team, I had great mentors and  we all worked well together. It was this support network of nurses that was so important during this time.

I continued working at St. Boniface Hospital as I went back to school for my BN and then my Masters of Nursing .

What prompted you to pursue further education?

Like many nurses, 10 years had flown by. I was busy with my family and enjoyed my work. There were moments when I wondered how decisions in health care were made when as a bedside nurse, I felt that I could see simple changes that could have a direct impact on patient care and have potential cost savings but those weren't necessarily the changes being made. What I didn't understand was how to get that information into the hands of those making the decisions. So I tried reading journals and participating on committees to expand my knowledge and understanding but it just didn't feel like enough. There had to be more to it.

I had a manager who suggested I go "get educated" because that would broaden my understanding and help make me be in a stronger position to help make those changes. It was tough to hear and at first I was offended. After reflection, I could see she was right. That, combined with the fact that I observed that nursing was changing, and always moving forward . . . I wanted to be a part of that in a greater capacity so I went back to school.

How did you become interested in women's health from a health equity lens?

During my Master's Program, my program advisor offered me the opportunity to assist with one of her studies as a research nurse. I did data collection for the study, which explored barriers to prenatal care for inner city women in Winnipeg.

Substance use was one of the reasons why women did not come for prenatal care. As my years of working in the Neonatal Intensive Care Unit included caring for newborns that had been exposed to substances during pregnancy, having a greater understanding of this issue was of great importance to me. This led to my interest in exploring substance use during pregnancy and the basis for my thesis work.

The experience was very eye opening for me as I quickly realized that the issues behind the substance use were much more complex than I had originally realized. Substance use is only a symptom of the underlying problems. The interface of poverty, violence, trauma, racism, drug use and a lack of support for women is so evident but so overwhelming at the same time. It has become my goal to try and help improve equity for inner-city women and children by reducing barriers and stigma associated with substance use

What is a typical day like?

I'm at the beck and call of my pager. Days are unpredictable but it's important that I'm flexible and available to meet with the women when they are able to get here.

If a woman has a 9:00 am appointment, it's possible she might show between 9:00 am and 4:00 pm. I'm here. When a woman does show up, I like to meet with them face to face and make it easy for them to get the things they need. It's the personal connection that often makes the difference.

I am often contacted by adult emergency or obstetrical triage or from an inpatient unit from the general hospital to help a patient navigate the system and connect them with resources for prenatal care. Sometimes it's connecting them with a health care provider, a social worker or with a community partner for support. Collaboration with our community partners is very important. Mount Carmel Clinic (Sage House and Mothering Project), Street Connections, public health, midwifery services, mental health services, Addiction Foundation of Manitoba, Healthy Child Manitoba (Healthy Baby Programs), Child and Family Services, and probation are some of the programs we work closely with and access for support for women.

Sometimes a woman will come to me in crisis. More often than not, the emergency isn't directly related to her pregnancy - she may have been evicted, have no money or food, needs a winter coat, be upset about missing a doctor's appointment and worried about her baby's health, or have mental health concerns - but this is a safe place and she is looking for help. We will do our best to help her with whatever it is she needs and connect her to the places where she can continue to get the help she needs.

What is one key element of your work?

These are complex cases to work on and my goal is to make sure a woman is aware of supports than can help her. I work in an acute care facility, which doesn't have outreach capabilities. Women are only pregnant for a short period of time. Furthermore, there are great resources and support programs available  in the community. Relationships and partnerships with these community supports allow me to help prepare a mom so she can continue to be supported after her baby is born.

What is the biggest thing you've learned from the women you work with?

How resilient they are! When you hear their stories, it is amazing how adaptable the human spirit is. Every single day they encounter difficult situations, setbacks and barriers but they don't give up. They keep on going. I'm not sure what I would do if I were in their shoes . . . .how I would survive. I doubt I would last a day. They are amazing, resilient and adaptable women. Super survivors.

I've learned to be more mindful of my expectations of the women I work with and to pay attention to where they're at. The sad truth is that many have experienced being treated badly both in their personal lives and when they reach out for help. And so they often just expect to be treated badly. So, to try and approach the women with kindness and respect, it goes a long way in developing trust.

To be angry or closed makes sense if you've got a trauma history and haven't had great experiences with health care providers. That's why seeing small shifts - a woman lifting her hat, looking me in the eye or uncrossing her arms, for example - is so meaningful when I'm interacting with a woman.

To expect these women know what we think they should know isn't realistic. When I became a mom, I knew that it was important to smile and coo at my baby, but I was taught that and shown that. How would you know how to be a mom if your mom didn't know how to be a mom? I meet women who are second or third generation after residential schooling who are still impacted by that trauma: if you've never been parented, how do you know how to parent?

And how can you parent or live differently when everyone around you is doing the same? If your "normal" involves trauma after trauma after trauma and may include residential schools, colonization, poverty, homelessness, abuse or violence, the cycle often perpetuates. The question for us as service providers becomes how to help these women move forward given these generational legacies. Because I think it is possible to break free from generational cycles, and some do, but it's not easy and we need to focus on improving the determinants of health for women and families in order to make this a reality for more women and families.

What are your reflections on nursing?

Nursing is a great career. Although it can be tough work, and shiftwork can be difficult, it is more rewarding than I could have ever imagined. Nurses share the best and worst times in the lives of the patients and families, and have to be ready to deal with every possible scenario and outcome. But it's truly a privilege to be present and support patients and families through all of those times.

Going back to school introduced me to the potential power of nursing. It helped me to see the impact nurses have on health outcomes and patient care. Nurses are with patients 24/7. We have the most influence on the quality of patient care and the experience of our patients. Nurses need to take ownership of this truth and their work and keep pushing forward. I'm not sure why, but it feels like the nursing voice is often suppressed. The work we do is important to patient and health outcomes. It is time that nurses recognize this fact and take pride in their work.

What gets you out of bed in the morning?

My kids - they're 16, 15 and 10. Trying to get out of the house for the morning drop-off is never dull.

The interactions I have with the inner-city women I work with. They often have chaotic lives but they're so funny, so resourceful and so resilient, they give me hope. If they can get out of bed, so can I.

If I can help change the way they view health care or make their day better, that also makes me happy.

What's influenced your nursing practice?

Education. It sounds corny but it's opened up my perspective on everything, and changed me as a person. It has certainly changed the way I look at everything.

The other thing that's really influenced the way I practice is the awareness of the reality of people's lives. This was especially true of the women I encountered during my Master's degree work. Hearing people tell stories of their lives and how they got to be where they are today was completely life altering for me. It's created a different mindset for my practice where I look at how I can contribute to improving equity and reducing barriers. As health care providers, we often have agendas, and so do the people we care for but they are very different. I've learned to get better at asking questions like, "How are you today? What have you had to eat today? What's going on in your life right now? What do you need help with?", which help me get a clearer understanding of basic health determinants.