Creating Change: Lessons, Skills and Advice



  • First and foremost, you can't think for one minute that you are going to please everyone you represent, because if you do, you're in for a real smack in the face.
  • Recognize the priorities, issues, and needs of the group for whom you are speaking.
  • Have faith that you're on the right path, but remember you must always be reviewing, going back to make sure that things haven't changed—because they can change very quickly.
  • You really must know your topic before you get out there, because if you don't, the media will make putty out of you. They can spot a phony, they can find the loophole—and then you've lost your whole persona and lost respect. So protect yourself with clear speaking notes and all the facts to support your arguments. Be prepared to address the worst question that could be put to you, and don't get carried away with expressive answers but be as brief and direct as you can.
  • It is important to have feedback from others so you know that you're on the right track and running in the right direction.
  • Interrogate your issue and local context before making any decisions. Study the past, Where were we then?—then look at the present, Where are we now?—and of course, Where do we want to go? Know where the support will come from and who can help bring about change.
  • Don't downplay or criticize the work of the past, but learn from it and go forward.


  • First, be a listener because to listen is to learn. That is the reputable knowledge that prepares you to speak out.
  • You also need to be able to listen to others if you're going to recognize who is with you, and who is your opponent.
  • Take an integrated view of society. From the nurses' perspective, you never know who is in that hospital room, nursing home bed, mental health clinic, or rehab clinic. So the more you know about all sectors of society in relation to the issues, the better. You must constantly survey the context, then ask how the different sectors in society may come together around an issue.
  • Cultivate these qualities:
    • Persistence,
    • Patience,
    • Empathy,
    • Open-mindedness,
    • Understanding of roles inside and outside your organization,
    • Good communications,
    • Team player skills.
  • Keep analysis and expectations realistic.


There aren't any of us who can do this on our own, but collectively we are a force to be reckoned with. So it can't just be around the coffee table or the lunch table. If there are issues, then we have to come together. So make sure that you've got the best working conditions you can possibly have, and that your future is secure with a pension plan.

Madeleine urges those who see the need for change to get involved and not wait for others to do all the work, remembering there is strength in numbers.

There are many ways you can be effective; it doesn't always have to be at the Board level. If you've got some skills, use them right at the grassroots. I love grassroots anyway, because that's where I came from.