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For the past 20 months, UHN and hospitals across the country have been adjusting and recalculating their resources with each ebb and flow of the COVID-19 pandemic's waves in order to respond to its challenges.
These adjustments have been most pronounced among its most precious resource: the members of TeamUHN redeployed to support high-risk COVID areas such as the Intensive Care Units (ICUs), COVID-dedicated wards, Emergency Departments (ED) and Dialysis units.
Over the course of the pandemic's first three waves, UHN redeployed more than 1,000 staff, including to support long-term care, through a system organized by UHN's People and Culture.
As with anything built out of necessity, the system wasn't perfect. After Wave One, staff were surveyed to determine how the redeployment process could be improved to make an already stressful time a little easier.
"Though the hope is to never have to redeploy staff to that extent again, knowing what worked for them and what didn't helps us to improve an already difficult experience," says Dharsha Quintero, Director, People and Culture who managed the logistics of redistributing staff where they were needed through the Redeployment Centre.
"It's their experience of the process in real time that really helps provide insight on how to make it better."
A multi-disciplinary working group reviewed the survey results from Wave One, and made recommendations to affect change in the areas described which were incorporated in the redeployment process initiated to support Waves Two and Three. The changes made a difference.
"Although there were still some things identified as needing more work, overall, we found that the redeployment experience improved," says Dharsha. "Forty-three per cent of respondents said their experience in Wave Three was better than in Wave One."
According to feedback provided, "any education with a human" received the highest marks. This included: buddy shifts, mentorship, or unit specific sessions with an Advance Practice Nurse Educator (APNE) on the units where staff were redeployed.
"Support and orientation are the areas we focused most of our work to fine tune the redeployment process," Dharsha explains. "The goal was to provide longer assignments and more orientation to help staff be part of the team, and allow for some familiarity and routine."
Where the methods of redeployment were concerned, the survey made clear that the changes improved the experience from an operational standpoint. But it also revealed something else: the difficult emotional experience of redeployment.
Some feedback provided by staff in open-ended comments highlighted the positives of an incredibly difficult experience: redeployed respondents cited "excellent teamwork" on getting to work with new colleagues whom they described as "incredible, kind, caring," and that "they felt welcome and appreciated" on redeployed units.
Others spoke of the mixed emotions of the experience, that it was "overwhelming, stressful and rewarding." Some staff were even more open about the emotional toll, mentioning how "difficult [it was] seeing very sick patients" and that they "were not used to the increased mortality."
Mixed feelings from respondents who also expressed improvement of their overall experience isn't too surprising to Dr. Suze Berkhout, a clinician investigator with UHN's Centre for Mental Health.
"Even if you're able to find meaning in what you are doing during a very stressful time, it's normal to have conflicting feelings," she says. "Things experienced during a redeployment assignment, for instance, can be troubling and difficult and, if they weren't part of your regular day-to-day, can be hard to process.
"You don't have to have had a traumatic experience to be strongly impacted by things."
'A person needs to feel safe and comfortable in order to do emotional work'
Difficult experiences are also exacerbated when you find yourself in new and unfamiliar situations.
"Uncertainty breeds anxiety and everyone's tolerance for it is different," Dr. Berkhout explains. "Anyone who is redeployed is not only moving from an area where they are a complete expert in their field to a totally different environment, but also working under difficult circumstances imposed by the pandemic, such as a change in staffing ratios or caring for a large number of gravely ill patients.
"And this is on top of all the other uncertainties and challenges that COVID-19 has forced on everyone's lives."
So as the waves of the pandemic become smaller and, hopefully, recede, how do we move on? Or, at least, make sense of what we have been through? Processing our experiences, Dr. Berkhout points out, is a skill that needs to be developed.
There isn't one strategy that will work for everyone and it's likely a combination of things that can help ease any emotional burden.
"For some, being able to connect with others who've had the same experience is helpful," she says. "It can make the experience feel less isolating, help make sense of what someone is feeling, and put it into context."
Connecting back to your body through exercise, spending time in nature, getting adequate sleep, and eating well are also important as they help decrease uncertainty by providing a sense of routine.
But some may not be able to move on until the pandemic becomes less a part of every day life; which is okay.
"A person needs to feel safe and comfortable in order to do emotional work," Dr. Berkhout says. "So for some, it may not be until there is space from the pandemic and more routines grounded in normalcy that they can finally unpack the emotions from that experience."