As an RN and NP, Lhamo Dolkar has worked in group homes, long-term care, nursing homes, acute care, primary care and community health. She says her diverse experience in multiple sectors gives her the knowledge and confidence to represent nurses across the province as RNAO president. She feels she has a responsibility to be collaborative and balanced. Admitting she’s not a “conventional” president, Dolkar says her passion for quality health care and social justice is what she will draw on to inspire others as she takes on this leadership role.
RNJ: You were a homeopathic physician in your hometown of Mumbai, India before you came to Canada in 2009. Why did you want to become a nurse, and then a nurse practitioner?
Lhamo Dolkar (LD): I'm the first person who's gone to university in my family. Health care was always something that I was passionate about, and that’s never changed. For me, health needs to be looked at from a lens of equity, inclusion and class. These are barriers that society has to overcome in order to make health care accessible to all. I faced these challenges growing up, and I always wanted to work in health care to influence the policies that address these barriers. My philosophy has always been of harmonious balance and compassion (at the core of the Buddhist faith), and that drew me to medicine. However, I could not afford to go to a medical college when I came to Canada as a mature student. I researched a bit about nursing in Canada and I was amazed at the opportunities it offered to someone who loves medicine and social justice. It was the perfect opportunity and the best profession to be a part of, and I still stand by that. My self-resilience and confidence have always been there because as an immigrant you're a hustler. You want to make it because otherwise the system is going to break you. It was through education that was going to happen for me. Why did I become a nurse practitioner? I have a physician background. As a care provider and as an educator in India, I taught as an assistant professor in medicine at a homeopathic college. I think being a nurse practitioner was something that was the closest to what I did in India and closest to what I'm very passionate about: preventive health and primary care access. I’m not sure what the future holds for me; that is hard for anyone to predict. But I do know that I love nursing and my next step always depends on where I am today. That is the beauty of nursing.
RNJ: Tell us about your history with RNAO and what was most inspiring as you became more involved with the association.
LD: When I was a student at Ryerson University (now Toronto Metropolitan University), we had an RNAO student membership drive and I learned about RNAO’s advocacy and policy work on social determinants of health and health for all. It amazed and inspired me because the organization's values and mission were in complete alignment with my personal values. I have been involved in a lot of mobile and outreach clinics in India and in rural settings. Participating in mobile clinics during the tsunami in India opened my eyes to the importance of social and environment determinants of health and their impact. I joined the Pediatric Nurses Interest Group and Maternal Child Nurses’ Interest Group because that's what I thought I was interested in…not knowing I’d end up in geriatrics. And I think that's the beauty of nursing. You evolve. When I look back at every area of practice that I’ve worked in – and I’ve worked in several in the short 14 years of my Canadian experience – for me, it has always been about equitable health-care access. That is something RNAO has always been advocating. I have been an active member, and participating in the student board placement opened my eyes to governance. That's when I thought, wow, this is something that is needed because as a clinician, you are limited to providing individual care to a small subset of communities. But we need to understand governance and leadership to be able to influence more systemic changes on a larger scale. I realized that I need to do something that influences more people through governance and leadership.
RNJ: Why did you want to become president of RNAO?
LD: I've seen the power of advocacy and why it is important to voice our opinions and help in identifying the gaps in the system. For me, it is a great honour to be president of an organization like RNAO, and to represent an organization that is member driven and focused on policy making, advocacy and social justice. RNAO is a social movement that influences social change that is based on equity, diversity and inclusion. Being a clinician, I realize this is my once-in-a-lifetime opportunity to bring my experiences as a frontline health-care provider – in various areas of nursing practice – to this role on a leadership team that influences bigger social changes that affect health and equity. In addition to this, I think it is a very personal responsibility to continue to protect our publicly funded health-care system, which is what makes Canada one of the best places to live. Our society is always evolving and there are many challenges that we continue to face in order to ensure equitable, inclusive health-care access. We all have to do our part speaking out for nursing and for health. As nurses, we are by default politically engaged because we are the ones who understand health-care access and interact with our patients the most. If I don't do my part, I'm not part of the solution. I encourage all my colleagues to also understand that.
RNJ: As you know, the NP role is a very important focus of RNAO’s advocacy. Given your experience as an NP, how do you hope to draw more attention to this as president?
LD: I think RNAO is always doing a lot in terms of highlighting the contributions of nurse practitioners. I always want to reiterate that nurse practitioners are not here to replace physicians or anyone else. They are here to be a part of the wheel that runs the system. I think the skills, practices and responsibilities of nurse practitioners allow them to fill the gaps in the health-care system, especially the primary care access crisis that we are experiencing right now. NPs are effective, economical and provide quality patient care. I think we are caught in the bureaucratic processes. But we are not addressing the issues of inequitable access and the needs of Ontarians. More than 2.3 million Ontarians are without any primary care provider. This lack of access and unmanaged chronic illness will trickle down to emergency departments in the hospital setting, increasing burnout of health-care providers. RNAO has done great work on this, identifying the gaps in the system and continuing to advocate for long-term solutions in a very progressive and equitable manner. RNAO was pivotal in initiating the first NP-led clinic in Sudbury, and now we have 25 NP-led clinics across Ontario. RNAO continues to advocate for more as one of the solutions to address accessibility issues in primary care and to maximize utilization of NPs. I think the role of NPs should be leveraged more and not seen as a threat to (others’) jobs or their income.
RNJ: How do you hope to inspire your board colleagues and members more broadly?
LD: How can I inspire others when there are so many inspirational people around? We inspire each other, I think. We can be inspired and learn from people's lived experiences, which are varied based on their backgrounds and the history of their life experiences. I hope I can inspire others by my enthusiasm and my passion for health care and health equity. I will continue to do the work I'm doing and collaborate and engage with nurses across the province in all sectors. Together we will combine our knowledge and lived experiences – fueled by our passion – to build a better nursing workforce.
RNJ: You were open with RNJ in 2018 about your struggles with postpartum depression following the birth of your fourth son in 2017. How does your experience with that – and as a mother of four boys – translate to your role as president of RNAO?
LD: My lived experience during that transitional phase highlights the situation of many people who might never get that help because they never recognize that they have a problem. Talking about my experiences of postpartum depression was mainly to create more awareness about the issue. That’s key because we are afraid of the stigma that comes with mental health issues. This is a deterrent to express our emotions and seek help, and I think that's where we will struggle. The best practice guideline (BPG) on postpartum depression is a tool that will guide clinicians and aid in improving the quality of practice to support individuals experiencing postpartum depression. It was a great honour for me to talk about my experiences publicly (in RNJ and at the media conference to launch the BPG). I think this will translate into my role as president in two ways: first, to be empathetic; and second, to create an awareness and conversations about issues of mental health and accessibility of health services. We have to understand what people go through, and we can’t be judgmental. To be honest, being non judgmental is very difficult and requires constant reflective practice and contemplation of our own values. My experience has made me more reflective.
RNJ: Tell us about an influential person in your life.
LD: My mother. She came to India when she was two years old with her parents on horseback during the Chinese invasion of Tibet. She went to a Tibetan boarding school because her parents couldn't afford to take care of the 10 kids they had. They called it boarding school, led by the Tibetan government in exile. She met my dad when she was young and moved to Mumbai and married him. She tried to maintain her own, dignified life raising three girls. She started her own business. She created a noodle factory. She worked really hard to give us a good quality education in an academic school. When I came to Canada, people said: "You know English?" I wondered why that was surprising. I always spoke English, and I owe that to my mother. That's why I value education. That's the best gift you can give your child because education opens your mind and opens a whole new perspective. When I went to nursing school, my mother said: "You can do it." She sold off a little land to help pay for my school. After that, when I went for my master’s degree, she said: "You can do it. You should do it." She never said no to me. She was always there with that emotional support. If I had to rate people who really influenced me, I would put my mother first.
RNJ: You’re assuming the role of president at a time of great change and challenge within the profession. What are the top three health system issues that RNAO should continue focusing on over the next few years?
LD: The nursing workforce crisis is real. And it's an urgent one too. Just because you invest in beds, if you don't have the nursing workforce to take care of those patients in those beds, what use are those beds? We need appropriate investment in appropriate strategies to improve the nursing workforce and to keep nurses in the province. This is on the top of the priority list. We are bringing international nurses in, but we are not doing anything to sustain them. They are going to get burnt out very quickly because this is not what they signed up for…and then they're going to leave. We need strategies for organizations to take it upon themselves to grow a professional, no matter the stage they’re at on their nursing trajectory. There are ways to do this, so nurses stay with the organization. The third priority is further investment in primary care and public health. We cannot put that on the back burner. These are the three things that stand out to me. Workforce is an urgent priority. And we can start to address it by having the late career nurses program restarted. Bring back retired nurses, we need them to mentor. We need all-hands-on-deck to think strategically.
RNJ: What are your passions and pastimes outside of nursing?
LD: I like to spend time with my children so I can relive my childhood with them. Growing up in India was a bit of a struggle because of our economic status. I feel I'm privileged in that sense now because I have the education that has moved me up and I have secured a stable job that I love. This allows me to spend time with my children. My parents worked all their lives to give us a better life, and I think somewhere along the way, kids miss out. Whatever time I have, I like to balance with my children because they’re not going to be small forever. I am a workaholic - I will admit that. I love my work because I love to take care of my patients. But I want my kids to grow up with the memories. We like road trips and events.