In response to the unprecedented impact of COVID-19 on the healthcare system in the GTA, the team at The Salvation Army Toronto Grace Health Centre (TGHC) created a new unit specifically dedicated to treating COVID-19 patients, while continuing to provide quality health care to all their patients.

The TGHC believes that it is important to listen to their frontline health care workers and staff, and to encourage them to share their stories. Recently, I spoke with Harmeet Hans (HH), a registered nurse at the TGHC who worked on the COVID-19 unit in the spring of 2020. In this interview, she shares her personal involvement, as well as her experience working with her colleagues on the interprofessional health care team during the COVID-19 outbreak.

The pandemic was announced in March 2020, and three weeks later there was an outbreak on the TGHC’s fifth floor, Post Acute Care Rehabilitation (PACR) unit, where you work as a registered nurse. Can you describe what was happening at the time?

HH: After the pandemic announcement, everything seemed like it happened in the blink of an eye. Questions were flooding my mind: Will it happen? When will it happen? What if someone close gets infected? I never expected a COVID-19 outbreak on our patient care unit, but when one of our colleagues tested COVID-19 positive — right after that, we quickly realized it had spread to some of our patients and colleagues. It was completely overwhelming and a cause for great concern. Honestly, we became very nervous.

When the COVID-19 outbreak happened in April here at the TGHC, would you say that the senior management was effective in directing the facility through the outbreak?

HH: At the time our Patient Care Manager became ill and tested positive for COVID-19, she helped as much as she could. Our President and CEO, Jake Tran, our Chief Nursing Executive, Patricia Skol, and Director of Patient Care, Meredith Muscat came to us and asked what we needed — What could they do for us? Anything at all. They communicated immediately and understood exactly what was happening.

I assume that when your Patient Care Manager as well as your colleagues became ill you were short staffed. How did senior management help?

HH: Yes, we were very short staffed, and although senior management had their own responsibilities in running the hospital, each took time out of their schedule to do as much as they could — Jake would come up to the fifth floor and help with bedside care; Meredith, Patricia, and Diane Chyn, occupational health nurse, helped a lot as well. The demands of our patients had increased, they were experiencing diarrhea, vomiting, spiking fevers, as well as hallucinations. It was decided that to help with the shortage of nursing staff our floor would receive support from our allied health professionals. On our COVID-19 unit we had a physiotherapist (PT), an occupational therapist (OT), a rehab assistant, as well as a clinical dietitian. They were all reassigned from other patient care units to help with bedside care, and other duties that needed to be completed at that time.

You said, “on the COVID-19 unit.” Did the TGHC designate the fifth floor as the COVID-19 unit because that was where the outbreak began?

HH: Management made the decision that if other cases would arise or patients tested COVID-19 positive that they would be put on the fifth floor patient care unit. They understood that because of the outbreak we had gained some understanding of how to deal with the coronavirus and continue to provide patient care. So, our PACR unit was set up as a COVID-19 unit to look after the outbreak and the first wave that occurred throughout the GTA.

So, your floor had gained some knowledge and understanding in dealing with the COVID-19?

HH: The truth — it was frightening because it wasn’t just how overwhelming it became but that we needed to learn so much about the coronavirus and quickly. There was a lot of trial and error, and there were a lot of new regulations coming into place every day, or every few hours even. For example, [there was the question of] how much personal protective equipment (PPE) do you wear to keep ourselves and everyone safe? If we wanted to feel more protected, we would wear extra covering. We soon discovered wearing all that equipment added to the burnout and exhaustion as it became much harder to work because it became constricting and difficult to work with patients to provide the much needed care required. A lot of learning occurred in the early stages of the outbreak, and we continued to learn what worked and what didn’t. We are still learning day by day.

Harmeet, because allied health professionals do not have nursing backgrounds, during the outbreak did you feel that as a RN you took on a leadership as well as a teaching role? Could you elaborate?

HH: The workload and the patients’ expectations, as I said earlier, became more pressing, but we were fortunate that — our allied health professionals — were able to come to our floor to support us. In the beginning, it was difficult for all of us because while working together we were continuously learning about the coronavirus, and trying to establish a cohesive unit where we were all able to work efficiently and provide quality patient care. In a way, yes, my fellow nursing staff and I took on a leadership role to direct what needed to happen because at times we were feeling overwhelmed and quite frankly lost. Somebody needed to state what needed to be done…to successfully help patients get better so they could go home, or get better and transition to their next plan of care.

Teaching became a natural extension in helping to guide your allied health professionals?

HH: Allied health professionals volunteered to help, and because they did, I wanted to make them feel appreciated, part of the team, and not burned out or overburdened. Teaching became a vital role that all nurses played. Before I could delegate tasks, I needed to understand personality traits and assess the level of comfort these individuals would have with the particular tasks they were being assigned.

For example, I entrusted the PT with the responsibility of taking vital signs. [I taught] them how to use the machine, how to properly record and document the vital signs. I shared this knowledge with the PT [while examining] three or four patients until I was comfortable that they were ready to do it on their own. The other nursing staff and I were always available to provide support to them, and they essentially became the extra pair of hands we needed, prized, and very much valued.

Working on a COVID-19 unit must have made it difficult interacting with your family at home. Can you share what that was like?

HH: I’m a single mother with an eight-year-old boy. My son and I live with my parents and my grandmother. My mother is a cancer survivor, my grandmother goes to dialysis because she has end stage renal disease, and my father has coronary artery disease. So, all three are immunocompromised. I needed to keep my family safe, including my son, because my fear was that I would infect them.

What did you do?

HH: The Province of Ontario had temporarily banned short-term accommodation rentals. The day the outbreak was announced, I managed to get an apartment at Jane and Finch. The same day I found the apartment, I went home, gathered my necessities and everyday staple items, and quickly left to live in the apartment. I left my son in the care of my parents and grandmother.

How did you stay connected with your family?

HH: Facetime — every day, and whenever possible. I would connect with them and help my son do his homework and spend as much time together as we could. To physically see him, I would go to my house and stand at the end of the driveway and wave to him. Sometimes he would come out and ride his bike, both of us wearing masks and keeping our distance. I was very sad during that time; we’re very close to each other because it’s just the two of us. But you set the sadness aside because as a mother you put the greater good for your child over what you want, and will do that is in the best interest to keep your child safe. It wasn’t until the end of May 2020 that I could feel safe enough to hug him.

One of your colleagues described feeling isolated while working on the COVID-19 unit. She felt cut off from staff not working on the unit. Would you say that is true?

HH: I would agree with my colleague — I distinctly remember feeling very isolated because we were up on our patient care unit all the time, and not able to go anywhere else in the hospital; except to come and go from the hospital. Staff from elsewhere in the hospital would keep their distance from us; it was an alienating experience. I understand why. This was a necessary stage throughout the pandemic — look what I had to do to keep my family safe. You just never know who is immunocompromised or who may be carrying the virus. Fear is warranted and justified…however, understanding that doesn’t lessen the feeling of isolation.

Is there anything you would like to share?

HH: Yes, I feel because of what we went through with the coronavirus, which felt like a war, our team on the fifth floor enhanced our skill set, and as a tight-knit family we conquered the inevitable. We suffered and strived together, and I’m sure other frontline workers would understand what that truly means. This is, and was, a time and experience that holds true to our hearts and we endured this together. Through all of it, I think it made us an extraordinary group of people. That’s not to say or diminish the contributions of other health care professionals at the TGHC because we all played vital roles through this time.

Thank you Harmeet for sharing your story.

The TGHC Board of Trustees and Senior Management Team would like to acknowledge with thanks all the staff for their dedication and hard work with our patients, their families and their colleagues during these challenging days, and recognize and congratulate the team for bringing the April COVID-19 outbreak to a quick closure, as well as keeping the TGHC outbreak free during time since.  Kudos! 

By Gerry Condotta