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Cover Story: Sue Smith

Seeing the bright side of darker days: Nova Scotia’s Sue Smith leads the nursing regulator with a steady hand and positive outlook

By Anqi Shen | The Registrar

It would be tough to dispute that we live in an age of change, uncertainty, and even adversity. From the global pandemic to the rise of political extremism, and climate change to rising labour market instability, it’s unlikely to find someone who hasn’t been deeply and adversely affected by events of recent years.

Bedford, a neighbouring community of Halifax, is home to the Nova Scotia College of Nursing (NSCN). The regulatory body that oversees the profession of some 15,000 nurses has itself undergone a seismic shift since it was recently reborn after two colleges came together to become one nursing regulator.

A five-minute conversation with the CEO and registrar makes you temporarily forget about the world’s challenges, and become in awe of her passion, commitment, and positive outlook.

At its helm is Sue Smith, a nurse, who for more than forty years has had an impressive influence on health care in Nova Scotia and across Canada. Despite the trials and tribulations of today and yesteryear, a five-minute conversation with the CEO and registrar makes you temporarily forget about the world’s challenges, and become in awe of her passion, commitment, and positive outlook.

That infectious motivation is something you wouldn’t necessarily expect from the chief executive of a profession that around the world has been stretched to the limits of possibility and reality because of COVID-19.

Smith still remembers where she was when the world-changing pandemic was about to be declared in 2020. It was five minutes before a 10 a.m. leadership meeting about the new virus, which senior staff at NSCN had been following since the end of January 2020. She got a call from a provincial government official saying their chief medical officer and the premier were arranging a media event for noon. Ever nimble and adaptable, the leadership team leaped into action. Nobody knew at the time the pandemic would stretch out over the course of the next 19 months...and counting...

“We weren’t even quite one year old as an organization, but with all the work to create this new body, we’d worked so hard to build our business continuity plans,” an upbeat Smith says. “We already had plans in place for operational preparedness. Everybody prepared to take what they needed home, and officially March 17 we started at that point in time working offsite.”

Nova Scotia wasn’t considerably affected by the pandemic until the third wave. That’s when it experienced its highest number of hospitalizations and intensive care unit admissions, adding considerable strains on healthcare workers, Smith notes. Top of mind for her was to keep the public informed, support nurses, and ensure the safety of College staff throughout the pandemic. “One of the things that stood out first was how critical nurses were going to be to meeting this — being the largest health-care sector — they’re frontline. What’s so inspiring is nurses don’t just want to respond, but they respond knowing there are opportunities for innovation.”

The NSCN had many retired or not actively licensed but qualified nurses offer to return to service. “We quickly developed a rapid re-licensing process for nurses who were qualified but many of whom were retired,” recalls Smith. “Basically, within 24 to 48 hours, we were able to bring nurses that were qualified to come back to the system.”

The NSCN shared the rapid re-licensure process with nursing regulators of all national designations of nurses across the country, some of which had approached the NSCN to tap into their model.

The NSCN shared the rapid re-licensing process with nursing regulators of all national designations of nurses across the country, some of which had approached the NSCN to tap into their model. “Across the country, people asked, ‘Can we use your system?’ And we said, ‘Absolutely, you can copy and paste whatever is applicable to you,’” Smith says.

The new Nursing Act in 2019, which governs the regulation of nurses in Nova Scotia, helped the organization support nurses in a nimble way when the pandemic hit, Smith said. “Having this act has allowed us to respond quickly and allowed us that flexibility to respond with innovation during COVID-19,” she says. “We do benefit in achieving our consumer protection mandate by having very close and positive working relationships with government.”

The pandemic aside, Smith is no stranger to obstacles in her extensive experience in the regulatory sector. During her first week at what was the regulator for registered nurses (RNs) and nurse practitioners (NPs), the RNs had a new entry-to-practice exam introduced, the first change in many years. “There was certainly a range of reaction,” she says. “The one thing we kept constant is this, which is my motto as CEO: be open and transparent and collaborative. We met with our critics and stayed in conversation. That’s certainly been the approach we took whether we were one regulator or part of a different college.”

As an organization, the NSCN is the product of two regulators coming under the umbrella of one in June 2019. Discussions about whether the Nova Scotian public would be better served with a single nursing regulator began midway in 2016. Unlike the move to one college in British Columbia, which was government-driven, the merger in Nova Scotia was more governance-driven. “One of the things we’re so proud of was we have continually, for a small-to-medium province, we wanted to walk our talk and live our values of consultation and listen to our stakeholders. Over the course of three years, we had over 100,000 points of contact with our stakeholders — between surveys and focus groups.”

Equity, diversity, and inclusion has been at the core of the NSCN’s values since its inception, and Smith is intent on leading efforts to move it forward in her organization. “Nova Scotia is a diverse province. We recognized that we wanted to seek out more diverse staff, more diverse folks on the board, we needed to help educate ourselves — that’s why it was part of our first strategic plan as the NSCN.”

“The most important thing we did operationally was staff driven. No matter who you are, every one of us in our organization, including myself, have an objective on their performance plan on how you’re supporting and contributing to diversity and inclusion. We’ve taken an approach where we know we have a lot of educating to do internally. To be open and collaborative, we’ve invited experts who have lived experience and expertise in these many areas of diversity to have a conversation with us.”

Smith has been in the regulatory sector for going on 40 years now, starting with 32 years with Canadian Blood Services where she was executive director of plasma products and services and of the OneMatch Stem Cell and Marrow Network. She’s noticeably giddy talking about the ins and outs of governance and operations at the NSCN and has an optimistic outlook with an eye on the future.

“In my experience in nursing regulation, I’ve seen how rapidly external and internal environments change — and we have to adapt, be relevant, be nimble,” Smith says. An example she raises is the advent of a live chat on the NSCN’s website, which started as an eight-week pilot in December 2020.

Staff identified the core areas they thought the organization would be approached for and prepared responses. It was a highly effective tool, Smith says, for members of the public with questions about a complaint, or checking a nurse’s registration, or questions like how many nurses there are in Nova Scotia. “It’s helped free up time in areas such as registration and licensing because this live chat is able to answer questions where someone would previously call in, and a staff member would have to call back.”

“We’re not married to a certain process,” Smith says. “We’re always looking at, can we do it differently, or faster, can we streamline the process? This continues to improve our ability to look out for the public and serve all of our stakeholders.”

Since graduating with a Bachelor of Science in nursing from Dalhousie University and completing her RN exam, Smith has renewed her license every year. The reason is plain and simple: pride in her profession, and it’s evident. “I genuinely am so proud to be a nurse. If you look at surveys, nursing is the most trusted profession in North America and elsewhere in the world. I truly feel joy in nursing and the joy I have in this latter part of my career to work for the public and for registrants.”