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What does modern healthcare actually cost when we look past balance sheets and measure it in human lives, moral injury, and front-line burnout?
In this episode, New York Times bestselling author and Registered Nurse Theresa Brown joins the show to discuss her journey from English literature academic to bedside clinician and nationally recognized healthcare advocate. Drawing from her latest book, The Cost of Care, Theresa breaks down how profit motives and administrative overhead fragment the patient experience, the emotional weight of trauma and patient loss, and why nurses must claim their seat at policy and political tables.
From the transformative potential of Nurse Practitioners and Midwifery care to reframing elder care and combatting racial disparities in health outcomes, this conversation provides a clear-eyed analysis of the system's flaws—and a hopeful blueprint for sustainable, compassionate reform.
Key Takeaways & Core ThemesThe Human Expense of Profit-Driven Care: Financial metrics and administrative bottom lines often clash directly with bedside ethics, forcing clinicians to navigate systemic inefficiencies at the expense of patient outcomes.
Moral Injury & Patient Loss: Traditional clinical education leaves nurses unprepared for the emotional burden of patient death and secondary trauma. Storytelling serves as both a tool for personal healing and a weapon for systemic reform.
Expanding High-Impact Care Models: Independent Nurse Practitioner primary care and midwifery-led birth centers consistently deliver superior outcomes and human-centered care, yet face artificial regulatory and financial barriers.
Political & Economic Literacy as Advocacy: True healthcare reform requires front-line workers to move beyond bedside excellence into understanding health economics, legislative policy, and grassroots political engagement.
00:00 – Introduction: From Academia to the Bedside (Theresa Brown's Journey)
04:05 – The Invisible Weight: Emotional Toll, PTSD, and Writing as Clinical Healing
08:01 – Primary Care Evolution: Unleashing the Power of Nurse Practitioners
11:58 – Midwifery & Birth Centers: Evidence-Based Outcomes vs. Systemic Resistance
15:54 – The Profit Motive: Administrative Costs and Structural Inefficiencies
19:49 – End-of-Life & Aging: Confronting the Over-Medicalization of Death
22:00 – Equity at the Bedside: Social Determinants of Health and Racial Disparities
24:01 – Models That Work: Innovative Solutions for Sustainable Care
25:57 – Privatization Threats: Policy Battles Over Systemic Healthcare Access
28:10 – Nurses in Policy: Shifting from Bedside Caregiver to Systemic Advocate
29:59 – Health Economics 101: Why Front-Line Clinicians Must Understand the Money
32:08 – Humanizing the Data: Patient Stories Behind the Statistics
34:00 – Ethical Boundaries: Moral Responsibilities in Unkind Systems
36:02 – The Path Forward: Directives for Real Healthcare Reform
39:59 – Staffing & Safety: How Overwork Directly Impacts Patient Survival
41:49 – Lessons from History: How Healthcare Systems Have Shifted Before
43:59 – Public Options & Universal Access: Reimagining Care as a Human Right
46:02 – Call to Action: Using Your Voice, Story, and Vote for Reform
48:03 – Closing Remarks: Where to Find The Cost of Care & Connect with Theresa
Official Website: theresabrownrn.com
Substack Newsletter: theresabrown.substack.com
Order The Cost of Care:
Amazon: Amazon.ca Listing
Signed Copies: Pre-order signed/personalized copies locally via City of Asylum Bookstore
Social Media & Contact:
Email / Inquiries: https://www.theresabrownrn.com
X / Twitter: @TheresaBrown
Nursing students in Canada and the U.S. can rack up 800–1,400+ mandatory clinical hours before they graduate — and not one of them is paid.
In this episode, The Gritty Nurse Amie Archibald-Varley, traces that unpaid-labour model back to its actual origin: Florence Nightingale's 1860s training school and the 2,000+ hospital "training schools" that turned her vision into free ward staff within a generation. From there, Amie tracks how nursing education got professionalized, expensive, and gendered — comparing it to paid co-ops in engineering and the trades, unpacking why nursing training stayed unpaid while other fields didn't, and revisiting a piece of history most nurses have never heard of: a U.S. federal program that paid 85% of the country's nursing students to go to school, eighty years ago.
If you've ever wondered why nursing students foot the bill and do the labour, this is the episode that connects all of it — with the receipts.
Free Labour: The Real Cost of Becoming a Nurse
Why do nursing students do the labour of employees and pay like tourists — in both Canada and the United States? In this episode, we go back over 150 years to trace exactly how we got here.
In this episode:
* Listen on Apple Podcasts – : The Gritty Nurse Podcast on Apple Apple Podcasts
https://podcasts.apple.com/ca/podcast/the-gritty-nurse/id1493290782
* Watch on YouTube – https://www.youtube.com/@thegrittynursepodcast
Stay Connected:
Collaborations & Inquiries: For sponsorship opportunities or to book Amie for speaking engagements, visit: grittynurse.com/contact
REFERENCESThis week, grief was impossible to avoid — Hayden Panettiere, Dolly Parton, Tim Curry, and Peter Cullen all left us within days of each other, and the collective mourning was loud, public, and completely normal. But what happens when the person who dies isn't a celebrity — it's your patient, your coworker, or someone in your own family, and you're the healthcare provider who's supposed to hold it together anyway?
In this episode on The Gritty Nurse with Amie Archibald-Varley, I get personal about my own experience with grief, then break down exactly how nurses and healthcare providers are trained — from nursing school through clinicals to the bedside — to suppress it. I dig into why that training is maladaptive (with the research to back it up: burnout, complicated grief, even mortality risk), how it complicates our ability to grieve our own losses, and what "good grief" could actually look like if we stopped bottling it up — for our own health, and for our patients' care too.
It's time we stop teaching healthcare providers that big girls and big boys don't cry.
This episode explores the often overlooked topic of grief among healthcare providers, emphasizing how the current training and workplace culture suppress emotional expression and the profound impact this has on mental health and patient care.
keywords
healthcare, grief, burnout, emotional health, nursing, death, compassion, Schwartz rounds, mental health, professional culture
Listen on Apple Podcasts – : The Gritty Nurse Podcast on Apple Apple Podcasts
https://podcasts.apple.com/ca/podcast/the-gritty-nurse/id1493290782
* Watch on YouTube – https://www.youtube.com/@thegrittynursepodcast
Stay Connected:
Collaborations & Inquiries: For sponsorship opportunities or to book Amie for speaking engagements, visit: grittynurse.com/contact
Please LIKE, COMMENT and SUBSCRIBE!
Stay Gritty!
Would your hospital admit that staff get assaulted on the job — in public, with real numbers?
St. Joseph's Healthcare Hamilton just did. And it's exposing a crisis most hospitals would rather not talk about.
In this episode, I sit down with St. Joe's CEO Mike Heenan to unpack the numbers behind their decision to go public: at least 4 staff members verbally or physically assaulted every day — roughly 1,400 incidents a year, and that's just what gets reported. We dig into what it took to make transparency the policy, not the exception, and what other health systems are still avoiding.
We also look at what this means nationally, using the CFNU's 2025 National Nurses Survey:
Mike shares what it actually takes to build a safer hospital — leadership buy-in, community engagement, and the willingness to say "yes, this happens here." We also break down why I'm supporting Bill S-233, which would require courts to treat an assault against a healthcare worker as an aggravating factor at sentencing — meaning judges would have to weigh it as a more serious offence, not just business as usual.
If you're a nurse, a healthcare worker, or someone who's ever wondered why hospitals stay quiet about this — this episode is for you.
Fun fact I stumbled on while researching this: St. Joe's traces back to a group of Sisters of St. Joseph caring for cholera victims in railway sheds in the 1850s — that origin story alone would make a killer future episode.
About Mike Heenan Dr. Mike Heenan is President and CEO of St. Joseph's Health System and President of St. Joseph's Healthcare Hamilton. He joined St. Joe's in November 2023 and was named permanent President and CEO of the health system in June 2025. Before St. Joe's, he served as Ontario's Assistant Deputy Minister, Hospitals and Capital, during the COVID-19 pandemic, and has held executive leadership roles across various hospital settings. He holds a PhD in Business Administration/Health Policy Management from McMaster University.
Connect with Mike: LinkedIn
Careers at St. Joe's Interested in joining the team fighting for safer, more transparent healthcare workplaces? St. Joseph's Healthcare Hamilton is hiring. Browse open positions: joinstjoes.ca
In this new episode on The Gritty Nurse Podcast with Amie Archibald-Varley, we examine the case of Lindsay Clancy through the lens of postpartum psychosis and the catastrophic gaps in mental health care that allowed it to go unrecognized and untreated. I start with the question that should be asked before every postpartum antidepressant prescription: has this patient been screened for bipolar disorder? It's now considered the gold standard of care — and it only became standard practice because of this case. From there, we talk about what early screening should look like more broadly, what coordinated care between obstetric and psychiatric providers actually requires, and why compassion — not judgment — has to be the starting point if we want to prevent the next tragedy instead of just mourning it.
If you're here for sensationalism, this isn't the episode for you. These are real people, a real family, and real suffering. Our purpose is not to relitigate what happened, but to ask why it happened, and what needs to change so it doesn't happen again.
This is the conversation healthcare needs to be having — about postpartum psychosis, about the mothers falling through the cracks, and about the systemic changes required to catch them before it's too late.
keywords
postpartum psychosis, mental health, systemic failure, screening, care coordination, maternal health, psychiatric emergency, postpartum depression, bipolar disorder, healthcare gaps
key topics
Postpartum psychosis and its symptoms
System failures in mental health care and prescription practices
Importance of early screening for bipolar disorder and depression
Systematic gaps in postpartum care and follow-up
The Lindsay Clancy case and systemic accountability
Role of healthcare providers in recognizing red flags
Need for coordinated care among multiple prescribers
Impact of medication polypharmacy and withdrawal
Advocacy for improved postpartum mental health protocols
Community and systemic responsibility in preventing tragedies
* Listen on Apple Podcasts – : The Gritty Nurse Podcast on Apple Apple Podcasts
https://podcasts.apple.com/ca/podcast/the-gritty-nurse/id1493290782
* Watch on YouTube – https://www.youtube.com/@thegrittynursepodcast
Stay Connected:
Collaborations & Inquiries: For sponsorship opportunities or to book Amie for speaking engagements, visit: grittynurse.com/contact
Frontline pressures have reached a boiling point. In this swapcast episode, nurses Erica and Amie tackle the wave of nursing strikes across Massachusetts (MNA) and British Columbia (BCNU), exploring what these recent labor actions reveal about the true state of healthcare.
Together, they dive into the harsh realities nurses are standing up against—from unsafe staffing ratios and lack of workplace respect to burnout and corporate greed. Erica and Amie also address the elephant in the room: "scab nurses." They break down the ethical, emotional, and financial strain traveling replacement nurses place on striking staff, how hospital systems use high-paid temporary labor to undercut union power, and the complex reality of nursing ethics vs. corporate greed.
More importantly, they share actionable insights on how nurses can build genuine solidarity, mobilize for patient safety, and use their collective voice to drive real structural change. Whether you're on the floor or on the picket line, this is a conversation about standing tall for the profession.
🔗 Connect with Nurse Erica:
Podcast: Nurses Uncorked on Apple Podcasts & Spotify
Instagram & TikTok: @the.nurse.erica
Web: nurseerica.com
Listen on Apple Podcasts – : The Gritty Nurse Podcast on Apple Apple Podcasts
https://podcasts.apple.com/ca/podcast/the-gritty-nurse/id1493290782
* Watch on YouTube – https://www.youtube.com/@thegrittynursepodcast
Stay Connected:
Collaborations & Inquiries: For sponsorship opportunities or to book Amie for speaking engagements, visit: grittynurse.com/contact
How do we reclaim the narrative of modern nursing across generations?
In this episode of The Gritty Nurse Podcast, host Amie Archibald-Varley sits down with extraordinary nurses, advocates, and authors Tilda Shalof and Lisa Mochrie to discuss their powerful new book, The Handover: A Nurse's Last Shift.
Separated by a 40-year career gap, Tilda Shalof and Lisa Mochrie share their inspiring personal journeys through nursing to show that despite a lifetime of different experiences, we have far more in common than what divides us. At its heart, this episode is about the vital importance of nurses sharing their own stories—because when we write our own narratives, we reclaim our power.
Together, they deliver a masterclass in perseverance, nurse mentorship, and finding your voice. They dive deep into why authentic storytelling is the ultimate tool for bridging generational divides, healing the healer, and driving systemic advocacy in healthcare.
What We Discuss in This Episode:Why Nurses Must Share Their Stories: The critical importance of taking back our narrative, sharing our lived experiences, and refusing to let others define what it means to be a nurse.
Bridging the 40-Year Gap: How a veteran nurse and a newer generation nurse found common ground, proving that the core of the nursing experience transcends time.
The Power of Storytelling: Why sharing our raw, unfiltered experiences is crucial to changing the public perception of the nursing profession.
Navigating Systemic Challenges: Honest strategies for tackling burnout, staffing shortages, and institutional hurdles in healthcare today.
The Importance of Mentorship: How experienced chapters can uplift the next generation, and how new nurses can find the guidance they deserve.
The Handover Book: The inspiration behind their book and how it serves as a love letter—and a wake-up call—to the nursing world.
Career Longevity: Practical advice for protecting your mental health and thriving at every stage of your nursing career.
Tilda Shalof was a staff nurse in the Medical-Surgical Intensive Care Unit at Toronto General Hospital for thirty years. She is the best-selling author of several memoirs, including A Nurse's Story, and was awarded the King Charles III Coronation Medal in 2025 for her profound contributions to nursing education.
Lisa Mochrie is a Registered Nurse, Team Lead, and Nursing Educator based in Burlington, Ontario.Recognized for her compassionate clinical practice and dedication to mentoring, she was honored by her students with the Most Valuable Professor Award in 2025.
Grab your copy of The Handover: A Nurse's Last Shift: Available now through University of Toronto Press or your favorite local bookstore!
Connect with Tilda Shalof: IG- @nurse.tilda
Connect with Lisa Mochrie: IG- @lisa_mochrie
Website: www.grittynurse.com
Instagram: @GrittyNursePod
Twitter/X: @GrittyNurse
Support the Show: If you loved this episode, please leave us a 5-star review on Apple Podcasts—it helps other nurses find our community!
Content note: this episode discusses workplace violence, suicidal ideation and psychological harm in a clinical/workplace setting.
This week, almost seven years to the day since I walked out of a role where I once hid under my desk to escape a leader who ran her unit on fear, that same leader was walked out of hers.
This isn't a celebration episode. I don't take pleasure in anyone losing their income or their identity. But I can't stay quiet about what it means that it took seven years — seven years of turnover, burnout, and silence — for accountability to catch up.
In this solo episode, I break down five things we need to talk about: how healthcare culture protects powerful people who lead through fear, why "getting results" is not the same as good leadership, what real accountability structures should look like, and why we need to stop rewarding leaders who manage through intimidation instead of trust.
This one is personal. If you've ever made yourself small to survive a shift, this episode is for you.
With a growing mental health crisis and a system bogged down by waitlists and rigid silos, a powerful paradigm shift is happening across Canada: the rise of nurse-led psychotherapy. In this educational episode, we sit down with Sheena Howard (BScN, MA, RYT, RN), award-winning Nurse Psychotherapist and the founder of Acceptance Psychotherapy.
We dive deep into why Registered Nurses are uniquely positioned to transform mental healthcare. Grounded in a holistic nursing blueprint, nurse psychotherapists don't just treat symptoms in isolation; they integrate biological, psychological, and social factors—bridging the gap between the physical nervous system, medication management, and emotional trauma.
However, paving this independent path comes with major friction. Sheena pulls back the curtain on the institutional gatekeeping, regulatory ambiguities, and insurance barriers that independent nurse providers face daily. More importantly, she shares evidence-backed strategies on how to overcome these hurdles: by shifting focus from restrictive corporate insurance policies to strict provincial legislation, building multi-disciplinary alliances, and creating inclusive, trauma-informed clinical spaces. This conversation is a masterclass in healthcare advocacy and systemic disruption for any clinician ready to expand their scope and build a practice on their own terms.
Key Topics & Timestamps00:00 – Introduction to Nurse Psychotherapy in Canada
02:12 – Moving Beyond the Bedside: Sheena's Professional Journey
04:45 – The Holistic Edge: Merging Nursing Knowledge with Psychotherapy
06:48 – What the Data Says: Evidence-Based Outcomes of Nurse-Led Mental Health Care
09:07 – Overcoming Institutional Bias: Founding the Acceptance Clinic
11:59 – The Educational Pipeline & Advanced Clinical Competencies for RNs
14:54 – Dismantling Systemic Barriers, Sexism, and Gatekeeping in the Field
15:07 – Strategy Session: Navigating Insurance Red Tape & Regulatory Hurdles
20:15 – Intersectional Clinical Care: Harm Reduction & 2SLGBTQIA+ Affirmation
25:46 – Advocacy in Action: Changing Legislation to Expand Public Mental Health Access
Sheena Howard is an award-winning Nurse Psychotherapist, healthcare entrepreneur, and the founder of Acceptance Nurse Psychotherapy, a leading nurse-owned mental health practice. Registered with the College of Nurses of Ontario, Sheena holds a Bachelor of Science in Nursing and a Master of Arts. Over her 20+ year clinical career, she has dedicated herself to providing trauma-informed, intersectional, and harm-reduction-focused psychotherapy. Honoured with the provincial Nurse Innovation Award from the Registered Nurses' Foundation of Ontario in 2023, Sheena is a fierce advocate for nurse autonomy, health equity, and diverse mental health access.
Connect with Sheena:Website: Acceptance Clinic
Email: [email protected]
Instagram: @AcceptanceNursePsychotherapy
Community Advocacy: Join the Nurse Psychotherapists of Ontario network.
Clinical Practice: Acceptance Clinic Official Page
Professional Standards & Policy: Canadian Nurses Association (CNA)
Regulatory Context: College of Registered Psychotherapists of Ontario (CRPO)
Legislative Foundations: Regulated Health Professions Act (RHPA)
Equity Initiatives: CNA Reconciliation Framework
Clinical Practice: Acceptance Clinic Official Page
Regulatory & Practice Guidance: CNO: Psychotherapy and the Controlled Act Component
Listen on Apple Podcasts – : The Gritty Nurse Podcast on Apple Apple Podcasts
https://podcasts.apple.com/ca/podcast/the-gritty-nurse/id1493290782
* Watch on YouTube – https://www.youtube.com/@thegrittynursepodcast
Stay Connected:
Collaborations & Inquiries: For sponsorship opportunities or to book Amie for speaking engagements, visit: grittynurse.com/contact
Thank you to Hospital News for being a collaborative partner with the Gritty Nurse!
www.hospitalnews.com
How do we move from a healthcare system that only reacts to illness, to one that actively empowers patients?
In this episode of The Gritty Nurse Podcast, host Amie Archibald-Varley sits down with Mike Serbinis, the visionary CEO and founder of League, a leading digital health platform transforming the consumer healthcare experience. A seasoned tech innovator and entrepreneur, Mike has a storied history of disrupting industries—from working alongside Elon Musk on early jet propulsion designs to co-founding Kobo, which challenged the global e-reading market. Now, he's turning his sights toward fixing our fragmented healthcare system.
Amie and Mike dive deep into how cutting-edge technology, personalization, and AI can bridge the massive gaps in current healthcare delivery, alleviate provider burnout, and truly put the power back into the hands of patients and frontline workers.
What We Discuss in This Episode:The Journey to Disruption: How Mike transitioned from mainstream tech innovation to tackling the complex world of healthcare.
AI & Digital Platforms: The real-world applications of technology in streamlining care, improving patient outcomes, and modernizing the clinical experience.
Empowering the Individual: Shifting the paradigm toward proactive, patient-centered care and navigating the barriers to systemic change.
The Future of Care: What a fully integrated, tech-enabled healthcare ecosystem actually looks like for patients and providers on the ground.
Chapters
00:00 Introduction to Healthcare Transformation
02:25 Personal Journey into Healthcare Innovation
05:28 The Need for a Consumer-Centered Healthcare System
07:56 Aha Moments: Personal Experiences Driving Change
10:38 Shifting Power Dynamics in Healthcare
13:37 Leveraging Technology to Improve Healthcare Access
15:56 Case Study: Hello Pregnancy Initiative
18:53 AI in Healthcare: Balancing Innovation and Care
22:34 Empowering Clinicians Through Technology
27:31 Building Trust in Healthcare Innovation
31:42 The Digital Front Door to Healthcare
35:13 Preventative Care and the Infinite Care Team
39:45 Hope for the Future of Healthcare
Connect with Mike & League:LinkedIn: Michael Serbinis
Website: League.com
X (Twitter): @mserbinis
Listen on Apple Podcasts – : The Gritty Nurse Podcast on Apple Apple Podcasts
https://podcasts.apple.com/ca/podcast/the-gritty-nurse/id1493290782
* Watch on YouTube – https://www.youtube.com/@thegrittynursepodcast
Stay Connected:
Collaborations & Inquiries: For sponsorship opportunities or to book Amie for speaking engagements, visit: grittynurse.com/contact
Thank you to Hospital News for being a collaborative partner with the Gritty Nurse!
www.hospitalnews.com
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