I am the manager of a 45-bed single-family room Neonatal Intensive Care Unit (NICU) (Figure 1) in Halifax, Nova Scotia, Canada. Before becoming the manager of our unit, I was the clinical lead for our redevelopment to single rooms and was hugely influenced by the care models in Sweden, Norway and Estonia and had visited several of their NICUs to inform our design. I believe in family-integrated care with everything I have. I believe that NICU babies will have better outcomes when their parents are full participants in the care. Being a part of building our new unit, I never expected to have this deeply engrained belief challenged in the way that it was during the first wave of the COVID-19 pandemic.
We first felt the impact just before March break 2020. We busily did everything we needed to do to prepare for adequate personal protective equipment (PPE). N95 mask fittings were a priority but there was a shortage of masks and only a fraction of the NICU staff was fit tested. We also went through a very distressing time where some of the PPE was going missing. This required additional oversight to ensure that we had everything that would be required to keep the healthcare workers safe. We ran simulations for donning and doffing. We collaborated with one other health authority in the province. We asked our colleagues at other health centres across the country and even internationally what they were doing when it came to PPE. In the end, we felt ready.
While we were figuring out our PPE requirements, we were also creating clinical pathways to outline the care requirements of patients that were suspected or confirmed for COVID-19. This was a lot of work and the workload remained heavy for months. Our medical director (a Neonatologist) spent countless hours to ensure that our clinical pathways were evidence-based. Once he would have a suggestion, we would book time with our Infection Prevention and Control (IPAC) colleagues to gain their input. We often had to collaborate with other teams, such as obstetrics, postpartum, and transport to make sure that our pathways did not conflict with theirs. To this day he and I are often the first call whenever there is a question about the clinical care of a suspected COVID-19 patient as everyone knows that we are the ones that know these pathways inside out.
As a manager I needed to also make sure that the unit had staff. Things worsened throughout the second half of March with a state of emergency called on March 22nd. A provincial lockdown was in place. Anyone with signs of illness couldn’t come to work. All schools and childcare facilities were closed, and nurses needed to have their schedules adjusted. The one bright side was that everyone wanted to cancel their vacations which certainly helped as nurses became unavailable! It was another thing to worry about for sure.
There was so much fear during this time. None of us knew what was going to happen. One senior nurse in our unit came to me with tears in her eyes. She said, “I am actually angry at myself, that I am a nurse. I cannot believe that I am about to put my husband, my children, all of them at risk, all because of what I do for a living”. It was heartbreaking to see. Also breeding that fear was the decision by the hospital to house the pediatric pandemic response unit in our NICU. Patients were being admitted that were suspected of COVID-19 and there were NICU babies only a couple of rooms over. Some of the NICU babies were displaced to an open-bay ward to accommodate this decision. There was a high level of uneasiness all around.
March 23rd. The absolute worst day of all. The hospital decided that pediatric patients could only have one support person. I was the one that delivered this message to the NICU families. Dads looked at me with tears streaming down their face. Begging to stay. Telling me that they would never leave if they could only be there for their partner and baby. One Mom was so angry, “You have told me that I should lean on “my person”. He is my person and now you are saying that he cannot be here”. It was awful. Especially because I am the one that I told you about in the beginning, the one that believes in families being with their children, about the positive impact that has. I never thought that I would ever see the day when families could not be families. I cannot talk about that day without tearing up. I think a lot about the trauma that was caused. I think a lot about the damage that we caused. The weight of that one day is like no other.
The best things that came from the pandemic were the advancements in technology. Everything happened so fast! Getting certain staff to work from home, getting things in place for families to have a virtual connection in the absence of physical connections. And our hospital fed all the support people which was tremendous!
It has been a long nine months since this all began, and yet, we are so very lucky. The rates in our province have been relatively low. There was the creation of the Atlantic bubble in the summer that helped our community bonds grow. The pediatric pandemic response unit moved out of the NICU. A second support person was able to come back into the NICU which was the biggest win of all!! I yearn for the day when we are fully ourselves again. When the unit is filled with families. When we see siblings holding their new little family member. When the stress of this pandemic is lifted, and we can all breathe again.