Episode 2 | Heather Cooke
Care2Listen Podcast | Season 1 Episode 2
Dr. Heather Cooke has more than 20 years of experience working in dementia care in both a front-line and research capacity. Heather’s work is supported by the Alzheimer Society of Canada, the Michael Smith Foundation for Health Research, and WorkSafeBC. During this episode, Sean and Heather discuss the significance of the nature and impact of workplace incivility on staff well-being and care delivery.
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Civility Matters Toolkit | An Online Toolkit for Long-Term Care Staff
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Sean Burke: [00:00:00] Welcome to the Care2Listen podcast, where we interview frontline workers and healthcare experts who will share their stories and passions. This is a podcast to let you know that you’re not alone. The goal of this series is to reduce the mental health stigma in healthcare and provide accessible support for caregivers just like yourself.
Today’s episode is being broadcasted to you on the unceded and traditional territories of the Musqueam (xʷməθkʷəy̓əm), Squamish (Sḵwx̱wú7mesh Úxwumixw), and Tsleil-Waututh (səl̓ilw̓ətaʔɬ) Nations.
Sean Burke: Hello, everybody, and welcome back to another episode of the Care2Listen podcast. Today I am joined by an incredible guest, Heather Cooke. Welcome, Heather.
Heather Cooke: Thanks, Sean. Great to be here.
Sean Burke: We’re so fortunate. I mean, somebody who has more than 25 years of experience in dementia care. Both as a frontline worker and in your research capacity and part of the Alzheimer’s Society of BC. Could you share a little bit about who you are and what you do?[00:01:00]
Heather Cooke: Absolutely. So my current position is as Provincial Coordinator, Knowledge Mobilization for the Alzheimer’s Society of BC. What I do is make sure that everything we do at the society is underpinned by research. So our programs, our policies, our initiatives, are all supported by evidence-based research.
Heather Cooke: When I was an academic, we always want to make sure that the research that we do actually lands in the hands of those who can use it. I’ve always said that you know, my reason for being is to make a difference in the lives of those who live with dementia and those who care for them, be they folks in the community or in long-term care settings. And so I’ve been very fortunate to have had a career that has allowed me to do that.
Sean Burke: For you personally, was there a story or a mission behind this?
Heather Cooke: Many years ago, when I started as a home support worker, I would visit an older [00:02:00] couple. They were both in their nineties. The husband was visually impaired and his wife had dementia and they didn’t have children and were still living in community.
Heather Cooke: I went in two or three times a week, and I cooked them dinner. While I had learned about dementia as part of my undergraduate degree, which is in psychology, I hadn’t really experienced hands-on what that was like, what that looked like. And so Mrs. Brown, a lot of the things she would do, she would misplace things, she would put things perhaps in places they didn’t belong. I’d open the fridge. I’d find the iron in the fridge or mail in the fridge. So she and her husband were muddling along as best they could, but it really intrigued me. I was fascinated by it, and I started to work with a few more individuals in my role as a home support worker I absolutely loved the work.
Heather Cooke: [00:03:00] I think one of the things that individuals living with dementia can really teach us is about the power of living in the moment. And it’s always a lot easier as someone who’s working in long-term care. You really just see the person for who they are in the moment. You don’t have that history. You don’t necessarily see the losses.
Sean Burke: That’s something I know, Heather, that it shines through every time I talk with you and just the passion for the work that you’re doing. When we talk about workplace civility, help us situate what workplace civility is in the first place.
Heather Cooke: Workplace incivility is really one of the most pervasive forms of antisocial workplace behaviour, and yet its subtlety makes it really difficult to detect. Uncivil behaviour really is notably mundane. It’s things like rude behaviour, condescending behaviour, ostracizing or exclusionary behaviour that otherwise appears as everyday interaction. [00:04:00] But over time, our exposure to that incivility, witnessing that incivility, being the recipient of that incivility, just creates this downward spiral.
Heather Cooke: It results in an organizational climate of incivility. For those who are working in care, and particularly in long-term care in care homes these days, the work is difficult enough. And then when we layer incivility on top of that, it can make it really hard for folks actually to want to come to work. When we think about the health human resource shortage that we’re experiencing, we need to do everything we can to keep the staff we have. And so it really behooves us to find a way to support staff with this difficult work that they do, and part of that begins with creating a more civil workplace environment.
Sean Burke: Absolutely. I love hearing those [00:05:00] examples. I think, again, a lot of our listeners can relate. Whether they’re staff shortages, the rude behavior between, or just those small little passing comments, that slowly over time erode that trust, erode that connection and the ability to really build teamwork.
Sean Burke: So when you’re talking about system factors that create the incivility in the workplace, is there a gender lens? I know a lot of your research focused on some of those nuances, but I’m curious how does gender play a role in workplace incivility?
Heather Cooke: As many of your listeners, those who work in the field will recognize that long-term care is a very gendered work environment. It’s primarily women who are caring for women. So our residents in care homes are primarily women, and those who care for them are primarily women. Those who care for them are often racialized, they [00:06:00] come from ethnic minorities. They’re really seen as the low person on the workplace hierarchy.
Heather Cooke: When I started to interview staff, they would talk a lot about, “well, it’s just women being women.” I can think of one story that was relayed to me, a care aid was talking about how at a previous work site, one of the men had come in and had put a plate of chicken feet down on the table in front of them in the break room and said, “This is for you. You’re just a bunch of hens clucking about, and pecking at each other”, like pecking, just like hens do.
Heather Cooke: So, it’s not just women who necessarily perceive themselves that way, but it was their male colleagues who did as well. The challenge is that if we think that it’s just due to gender, then it[00:07:00] allows that bad behaviour to continue because it’s seen as an inherent trait. It’s just inherent to women, and it’s just something you have to put up with as part of your work environment. And so when we think in terms like that, then we might not necessarily take those steps to actually say, “Well, no, you know what? This shouldn’t be part and parcel of this working environment.” And we need to find a way to address this and to make it so that we’re working in a more collegial, positive environment, a more civil environment, if you will, as opposed to an uncivil one.
Heather Cooke: So in a situation, you then think about in a workplace setting where you don’t have much power, you’re not earning very much money. You likely come from an ethnic minority, so you have very little social power, and so how do you then, [00:08:00] try and gain power in that workplace setting? And often, that colours our interactions with others.
Heather Cooke:. It’s funny for me to think that maybe 25 years ago was the golden age of care, because, in many ways, there were many other aspects and challenges that we faced. Fast forward 25 years and because of the staffing shortages that the industry faces, if you call in sick, your teammates start to say “you weren’t here to help us, so when that individual comes back to work, we’re not helping you.” You create this sort of spiral, and yet these are circumstances that are sort of outside of the control. I mean, it’s not really that individual’s fault for taking a day off sick. It’s the fact that there are no staff to replace her.
Heather Cooke: Management at the same time are doing their best to fill those positions, so it just creates these environments that are just [00:09:00] ripe for incivility. And then of course there’s the whole piece around where someone might call in sick, but they wanted to attend a Canada Day parade or they wanted to go to a concert. They then post that on social media, and that gets seen by their colleagues. And of course then that just further exacerbates that incivility because then you’ve got someone going to management and saying, “did you know Josie was at a concert and she wasn’t at work?” It just becomes this really toxic environment.
Sean Burke: Today’s episode of this podcast is sponsored by SafeCare. SafeCare BC is an industry funded nonprofit association working to ensure injury free safe working conditions for continuing care workers in BC. SafeCare BC strives to be the industry leader in advancing injury prevention and safety training for long-term care and home support [00:10:00] workers through cost-effective training, educational services, and industry safety performance information.SafeCare BC also relays government health and safety legislation and policies which impact their members.
Sean Burke: How do you work with different managers? How do you work with those care homes to try to mitigate some of that incivility that is being created or conflict that’s being created?
Heather Cooke: Often incivility, or we might even call it, relational aggression because that’s what it is. It’s this relational aggression that’s occurring between workers. Is that it’s only readily visible to those who are immersed in it. If we have a manager who is dealing with their own issues in care these days, who might not be able to be on the units and might not have a presence on the unit as much as they perhaps should be, then they’re not picking up on these underlying tensions that are occurring, this relational aggression that’s occurring, between staff. [00:11:00] So thinking about, “okay, maybe management needs to have a bit more of a presence on the unit so that they’re fully aware of what is going on.”
Heather Cooke: And I think also acknowledging that everyone comes to work with a different level of baggage. So some of us, when we show up in the mornings at work, we come in and our baggage is neatly stowed in a purse and it’s tucked underneath our arm. And sometimes we come in and we are pulling our fully loaded suitcase, wheely bag in with us. And those can be for any number of reasons. We’ve got a toddler at home who’s been up half the night, or we’ve got a baby who’s teething, or we’ve had a fight with a spouse. All of those things. What we really need to do is think about how we create space for people to be honest, for people to be kind, for people to check in with one another, creating that culture of civility.
Heather Cooke: What we heard when we [00:12:00] did the research. We were very fortunate to have an advisory group, so we had representatives from SafeCare BC, industry partners, we had folks from the Occupational Health and Safety for BCGU, the BC Government Employees Union, from the Hospital Employees Union, from the BC Nurses Union. As we were sitting there talking, we thought, what we really need is some kind of toolkit. We need to equip people with the resources to be able to address this, because there are no resources. How do people go about addressing this? That was kind of the genesis of our Workplace Incivility Toolkit, which is launching this month, February.
Heather Cooke: It’ll be located on the SafeCare BC website, and it’s called Civility Matters. What we’ve tried to do is pull together resources, scenarios, [00:13:00] some kindness cards if you will. We’ve got templates on there so you can download little cards that you can leave for your colleagues to say, “Hey, thanks for being you,” “Thanks for doing this great work that you do,” “You’re awesome, keep it up.” It’s all about trying to infuse our workplaces with a bit more of that positive bent, and how do we create that civil environment.
Sean Burke: That’s so great and I think it’s so needed not only, in the healthcare industry, but also across this entire world, kindness. It’s such a simple thing to do, but sometimes can be very difficult.
Heather Cooke: Back to when we were doing the research and my own experiences working on the front lines is, at shift change, when you’ve got staff leaving, new staff coming in, and, and often there’s a report, so you’re sharing an update on the residents. And one of the first things that we talk about is [00:14:00] who’s had a bowel movement. We launch into that and we launch into the clinical care pieces. But sometimes I think it would be so helpful if we just took a step back for a moment and just during those first few minutes said, “just wanna check in with folks and see how you’re doing today.”
Heather Cooke: Getting a sense of, is your team member coming in today with that purse tucked under her arm, or are they trailing their wheelie bag behind them. That’s that opportunity to say, “I had a really rough night last night. I’m not on my A game today, so anything that you can do to help me, or know that if I leave wet towels in a resident’s room or I miss shaving Mr. Jones, it’s not intentional. I’m just not firing on all cylinders today.” I think if we create that environment where folks are able [00:15:00] to have those honest conversations and to say that, it’s not because someone’s being lazy, there’s a reason for that. And that just allows us to extend that little bit of compassion.
Sean Burke: Are there other moments where different people on shift might experience something that they carry with them the rest of their shift that, if they could just take a moment to themselves or just clear their mind that it might change the way they can continue on with the rest of their shift and how they ultimately support and provide great care?
Heather Cooke: We often talk about care work being unskilled. and it’s not. Anyone who’s ever had to toilet a two hundred and thirty five, two hundred fifty pound man with advanced dementia knows that there is skill to getting that individual into the toilet to be able to toilet them. It’s work that requires teamwork, a lot of teamwork, otherwise you’re putting [00:16:00] yourself at risk of injury. So we wanna do everything we can to help folks be able to draw on each other, to be able to support each other, rather than going it alone because that just makes the work that much more difficult and again, puts that individual at risk of injury.
Heather Cooke: I think one of the things we need to keep in mind when we’re talking about workplace incivility, is that the conditions of work are often the conditions of care. So we wanna make sure that we do all that we can to allow staff to bring their best selves to work. Because what that means is then that the residents are also getting great care, right? We’re creating those conditions that allow staff to flourish.
Heather Cooke: In terms of thinking about workplace incivility, giving folks access to the toolkit, it’s our way of being able to support their conditions of work to [00:17:00] improve those conditions of work that then are going to impact the conditions of care. So it’s a win-win for everybody. We end up with staff who are much more cohesive, who are able to work as part of a team and really enjoy coming to work. And the residents are the ones that also benefit from that.
Sean Burke: I’d love to talk a little bit about what that toolkit is, what’s involved, who it’s for, uh, let’s start with that. What is the toolkit? What’s in it?
Heather Cooke: So the toolkit has a couple of key sections to it. We’ve tried to set it up so that you don’t necessarily need to work through it in order. You can: The webpages flow in a certain order. But, we really wanted to recognize that often staff don’t have a whole lot of time in their day. We’ve talked about the time pressures. So, when you land on the homepage, we have two entry points, and one is for frontline [00:18:00] staff, so healthcare aids or dietary aids folks who are working on that hands-on. And then the other entry point is for management or administrators or for team leads.
Heather Cooke: Once you enter in through that by clicking on that button into the portal, the first place you land is a little bit of an explanation about what is workplace incivility and then some self-reflection about what have I actually witnessed as a staff member working in long-term care, and are there some behaviors that I might have done that are uncivil behaviors? Because all of us have bad days. There’s a lot of good people out there, but sometimes we don’t always act accordingly with how we should.
Heather Cooke: And then from there, as I alluded to earlier, we have these kindness card templates. So they say, [00:19:00] “thanks for being you. We appreciate the work that you’re doing.” They’re business sized cards and we’ve set up templates on the site so you can download them. You can either order them from a card site, like Vistaprint, or you can buy the paper that you slip in your printer from Staples. We’ve tried to make it really easy and accessible, and the idea being that you’re just spreading a little kindness around your work environment.
Heather Cooke: My colleague Ronda Croft came up with this idea a number of years ago and we did up the cards. We were doing a presentation at the Hearts and Hands Conference in October, last October with SafeCare, and folks were so excited to get their hands on them. We had a bunch made up, and took them with them.
Heather Cooke: We developed 11 scenarios that are based on some of the behaviors that we witnessed during the research and [00:20:00] then we pilot tested those. We’ve talked with healthcare aids and those working in long-term care with managers as well about, does this resonate with you? And that the scenarios seem to, so folks can click on which answer they think is right.
Heather Cooke: There’s a little bit of an explanation about, maybe that’s not the best way. Perhaps this might be a better approach to think about. So we have those. And then, to round out the toolkit, we have a whole slew of resources. We’ve included things like TED talks on how to have a difficult conversation, or we’ve got short articles about what is incivility or what are some steps to addressing incivility? What are things that you can do? And everything that we’ve put in those resources, we have put a time marker with them. [00:21:00] So if you’ve got five minutes, you could read this article. This article is a 10 minute read. This is a 10 minute TED Talk. This is a 30 minute podcast. So folks can kind of adjust accordingly depending on what their time looks like.
Sean Burke: Awesome. And I think that’s so important. I mean, we know that everybody’s super busy. We know that some of the challenge is that we have all this great content, great resources, but we just don’t have the time. So, to see that and to be able to have that as an indication of this is only gonna take a couple minutes. I think what’s great about this toolkit, at least my biggest takeaway from it, is that you’ve created ways for people to move forward as well. So it’s one thing to become aware of what’s happening, but it’s another thing to express and to help people with language, with simple language, with simple ways to connect through those kindness cards.
Sean Burke: Is there one main [00:22:00] takeaway that you’d want people to leave here today with?
Heather Cooke: This work is difficult and we need to find ways to come together to connect, to extend that kindness and compassion. Stop talking about, “it’s women being women,” right? About really not excusing that behavior or saying, “Oh, it’s just so-and-so’s personality” like those are immutable characteristics that we can’t change, and yet we can, we can change how we show up in the workplace. Our hope is that folks will use the toolkit to be able to change how they show up in the workplace to have a little bit of more awareness about how they’re showing up.
Sean Burke: We definitely applaud you in the work that you’ve done. The translation then into helping the frontline workers and ultimately, continuing to give back to this world. So thank you so much for coming today, Heather. We wish you all the best and we look forward to [00:23:00] releasing the toolkit and seeing everybody make use of all that great work. Thanks for coming today.
Heather Cooke: Wonderful. Thanks Sean. Thanks so much for the conversation.
Sean Burke: Thanks for listening to this episode. Be sure to visit the links in the show notes for more resources and supports for the CareforCaregivers program. If you’re interested in sharing your story on the Care2Listen podcast, please reach out to us at careforcaregivers.ca/podcast, and don’t forget to follow us on your favorite podcast platform to be notified when new episodes are released. Thanks again for joining us and see you next month.