Karima Velji, bold and unleashed

September 2014   Comments

Karima Velji is many things. Visionary health-care executive. Wife, and mother to Alyshah and Alykhan. Dedicated global volunteer. And CNA’s 46th president. In this interview, she shares her vision for a revitalized association and her thoughts on a new way of thinking about nursing.

Karima Velji, bold and unleashed
Teckles Photography Inc.Karima Velji

You emigrated from Tanzania. What was coming to Canada like for you?
I came to Canada at the end of 1982. Tanzania is a tropical country, right on the shores of the Indian Ocean. The day I landed in Toronto, there might have been 40 centimetres of snow on the ground. I had never seen snow, and that was my first introduction to Canada. It’s been about 30 years. So, Canada now is truly my home.

What were your experiences with health care in Tanzania?
Every time we had to interact with health and health care in Tanzania, we had to first transact a sum of money. I remember being in emergency rooms in Dar es Salaam with my sister, who was not well. No one would actually attend to her needs until a sum of money was transacted.

But it goes back farther. When my dad died, I was only 10 years old. Observing the access — or lack of it — to different treatments etched in my mind that this was the area in which I wanted to make a difference. When you are vulnerable and sick and you are in need of help, your first interaction should not be a monetary transaction. Someone should just attend to your needs. My experiences with health care in Africa and other developing countries have shaped my support for a universal and publicly funded health system.

Were you interested in nursing early on?
At the time, my interest was health care. In Tanzania, nursing was not a highly respected profession. Families were very traditional, favouring narrow choices such as engineering, law or medicine. So, I thought if health care was my interest, medical school would be the way to go. Nursing was supposed to be a stepping stone into medical school.

But you made a different choice…
Rather than embarking on a general science degree, I chose nursing because of the work McMaster University was doing with the Aga Khan Development Network. And McMaster was a beautiful place to study nursing. They had the most innovative curriculum, and they introduced you to equity issues in health in such a big way. By my third year of nursing school, just as I was getting admitted into medical school, I made up my mind to stay in nursing. It had become an area of passion, and really a calling for me.

You do a lot of global volunteer work. Tell us about that.
I’ve been working with the Aga Khan Development Network for about 20 years. The work has taken me back to Africa, the Middle East and Central Asia. Of all the international work I’ve done, Afghanistan has really sparked me. The needs there are so great that everything you touch turns into gold. I’ve been involved in developing the credentialing program for nursing in Afghanistan; I have also led quality and safety reviews, and academic plans.

I think that more than what we take there is how much we bring back. Some of the most beautiful learnings for us in health care in Canada are found in developing countries because they do so much with so little. We need to learn from that because we have such a need to reform our health system. In our country, the lessons are up in the northern areas where some of the most beautiful ways of delivering nursing care and health care exist.

In your inaugural speech, you provided some insight into how you will define your presidency.
I used the phrase “unleash the power of registered nurses.” For me, this means three things. I said we need to shift to advocacy through action, and away from general messages. We need to put solutions on the table, to show we are the credible knowledge brokers. The second thing is to push the scope of practice, starting with RN prescribing, and really reimagine community-based care with nurses as the pivotal point. I also used the phrase “lead always.” We pass on a lot of our knowledge through narratives and stories. We need to build on that competency and use positive narratives and stories to showcase the best of nursing practice and our evidence-based solutions.

What should be the association’s major priorities during the next two years?

The first is the development of the new five-year strategic plan. For me, this strategic plan is about not only reimagining CNA but also reimagining nursing in Canada. The medical-surgical milieu and mindset influence perceptions of nursing, because of where we’ve been for the last 50 years: focused on institutions. We’re swimming in what I call a “red ocean” for us: so many professionals competing for the same territory and not allowing each other to work to full scope. When you think about our work in community-based practice, public health, primary care, school nursing, however…this is our space to own in a very big way. But I also want us to reimagine nursing in institutional settings, with expanded scopes of practice, nurse-led practice, navigation roles and complex populations.

And I would like to see the revitalization of CNA’s policy and advocacy arm and a change in direction, by turning the triangle upside down. What I mean is that a lot of our efforts have been focused on speaking to politicians in the hopes that they’ll support the ideas we are speaking to them about. I would like for us to seriously think about the fact that the best bang for the buck for our policy and advocacy efforts is to speak to the public more directly.

We are the most trusted health-care profession, so there is a unique opportunity to work with the public to co-design the messages and the asks. When a critical mass of people make solid demands, the elected officials have to listen. I think that voice is going to become more powerful than the voice of the associations alone. The better we understand the aspirations of our citizens, the more we can rally the public to be in front of us. To me, our next election platform will have to be about rallying the public’s voice on critical issues that confront health and health care.

You’ve said that perhaps it’s time for CNA to focus on fewer priorities. Why is this important?
Pinpointing two or three priorities makes our work more focused and allows the work to be deeper. And then it’s clear to the public and our own members what it is we stand for. The two or three things don’t have to be static. We need to focus on a number of priorities for some years, and then other priorities will emanate from there…and so on. Our work must be deep and have measurable impact, and it has to resonate with the nurses of Canada and the public.

For me, advocacy is not about picking a favorite topic, developing a set of key messages, pitching them on our lobby day on Parliament Hill and then walking away. Take seniors care, for example. We’ve done the day on the hill, we’ve pitched the messages about needing a seniors care strategy. We’ve done that at the Liberal roundtable; we’ve done it at the NDP roundtable. We’ll do it wherever there’s an opportunity to showcase a set of broad messages, but it’s not enough.

And seniors care is an issue you can really engage the public with.
Correct. So, in addition to all the broad messaging pieces we will continue to do, we can go to the public and ask them, “What is it that you are looking for as you age? What are your aspirations? What are your needs?” We can use those answers to create evidence-based interventions, package them and then the next time we are sitting with decision-makers, it’s not a broad ask. Not “we need a seniors care strategy.” Instead, it’s “we’ve engaged members of the public, and here is what they want. Nurses have conducted research that identifies the three most promising models of care for aging, and this is the best way to scale them up. And in order to scale them up, we need this from you.”

Otherwise, politicians get lost. They want to know “What do you mean by a strategy? Give me the stuff from underneath; tell me what’s in that strategy. What is the model you’re trying to advocate?”

This could mean a big change for CNA.
I think so. It’s the next generation CNA, the revitalized CNA of the future. And all the work does not have to be done by the staff at CNA House. They can spearhead it, they can coordinate it, they can bring it together, but I would say, let’s put our members to work. We have a network of nursing specialties. Why can’t we go to the Canadian Gerontological Nursing Association and ask them to identify the three most promising models of care and help us pitch them — and show that we have heard the voices of the public when we make the pitch. The models have to be based on evidence and co-designed with the citizens we are serving. That is a prerequisite.

What have the nurses you’ve met told you they want from their national association? Do they want to be put to work?
Absolutely. There are two underlying themes in what they say to me. The first is that having a card or pin that says they’re a member is not enough…they want to be able to see themselves in the national association. They need us to tackle priorities that are important to them. The second is that a majority of them want to be meaningfully involved. Nurses at the point of care have to be able to relate to our policy and advocacy efforts but also be engaged in them, too. So, it’s connecting the big-picture policy and advocacy agenda to what matters to their practice. I think that’s the sweet spot for CNA.

On health-care reform: “People are so afraid to raise critical questions about our health-care system. Fear that the system could be privatized really keeps us from examining it and finding creative solutions within the publicly funded space.”

On equitable access to care: “One of the principles (of the Canada Health Act) is accessibility. But that’s just on paper. We don’t have equitable access. You just have to go into our inner cities or northern communities or look at indigenous populations. This is Canada?”

On the relevance of CNA: “When we partner with our stakeholders, including our jurisdictional members and specialty network, and with civil society groups to lead on the issues that matter to the public and to nurses, then there can be no question about why a national association is needed.”

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