SARS in Toronto -- Nurses on the Front Lines

Susan Yox, RN, EdD

Disclosures

June 13, 2003

In This Article

Introduction

We thought that many of you might like to hear first-hand from a nurse who has been working in a hospital with patients with severe acute respiratory syndrome (SARS). Medscape interviewed Saverina Sanchez, RN, CNephC, of Toronto, Ontario, Canada, who told us how she and her colleagues have dealt with a very difficult work situation and a home quarantine.

Question: Saverina, please tell us a bit about yourself -- your nursing background (education, experience), where you work now, how long you have been with your current employer, and your interests.

Answer: I have been a registered nurse since 1985. I am married and have 4 daughters. I work full-time in Toronto, Canada, and I go to school full-time as well. I am almost finished with my BScN degree at Ryerson University.

I love working as a nurse. It has taken me to many wonderful work places. I have worked on medical floors, neonatal ICU, emergency, and now in a dialysis unit. Each area has been very rewarding. Nursing is the only job I know where you can work in so many different areas. This career has served me well.

My most recent mission is to become politically active. I have been very active with the Registered Nurses Association of Ontario (RNAO). I have been involved in many interviews, and I hope I have been able to bring some light to what nurses in Toronto have been through.

Question: How did you first learn that there was a SARS patient in your hospital? What happened next?

Answer: Well, the first clue that something was amiss was when the administrators locked the doors and would not let anyone out! A patient from another hospital had been transferred to our hospital before SARS was identified. The patient was not known to have SARS initially, simply because SARS was not in our vocabulary yet. Once we learned that there was a patient with confirmed SARS in our hospital, it took about 3 hours before it was decided that we could go home on a "work-home quarantine," with masks, thermometers, and instructions from public health about quarantine. Once the diagnosis was made, strict isolation techniques were instituted, and our hospital was able to keep the outbreak to a minimum. I do not know all the exact numbers, but I do know one of my nursing coworkers contracted SARS.

Question: Tell us about the situation in your unit and in the hospital at large when this outbreak was first confirmed. How did your workday and work situation change? For example, what protective gear did you wear? Did your hours or work assignment change?

Answer: Immediately after the outbreak was identified, the hospital instituted very strict precautions. The procedures were mandated from the Ontario Ministry of Health and a full "code orange," what we call our disaster code, was put into effect. The hospital closed all the doors. No one was allowed in or out. Everyone inside the hospital was given N95 masks, gowns, gloves, and goggles. There was an entrance designated for entry and one for exit.

Staff members were instructed to report to work regardless of feeling ill or well. If a staff person registered a fever, they were sent to the ER. There, those with symptoms were screened for SARS and treated accordingly.

Question: Tell us how the quarantine worked. What were your restrictions? Did you still go to work or did you take sick or vacation time? Could you travel freely between home and work? How were you able to care for patients if you were quarantined?

Answer: Being quarantined at home meant we were not to even set foot in a physician's office, grocery store, or any public place. The hospital employees were not to walk their children to school or even walk their pets outside. Masks were to be worn at all times, even at home. If you were in a room alone, only then could you remove your mask.

We had no choice about coming to work or not. We were told those who did not report to work would be dealt with when this was all over. No one was allowed to take vacation. That wasn't a big issue -- we were not allowed to go anywhere anyway, so why use vacation time?

In our hospital, all able people are to report to duty for a code orange when one is called. We could not travel freely to work. We had to wear a mask from home until we were inside the hospital. There, we would change into N95 masks (we wore lighter masks outside of the hospital) and don our protective apparel. [Editor's note: See Toronto Public Health's Fact Sheet on Work Quarantine for quarantine details.]

At work, it was business as usual. I work in a dialysis unit, so we could not turn away our patients. The patients were allowed in for treatment after being screened, and they were also gowned, gloved, and given N95 masks. So in a busy dialysis unit, we now had to work with protective equipment that made us extremely hot, almost to the point of being dehydrated and unable to breathe. The hours remained the same. We work 12-hour shifts, and a lot of nurses became ill with bronchitis, but we all pulled together to support each other.

In the mean time, the phone was ringing off the hook. Patients' family members were asking lots of questions. Reassurance was given to everyone. Patients were very grateful for the nursing care they received. Every day, they would say thank you to us. Sometimes I think the patients were more concerned about us than they were for themselves. They could see after the first 8 hours of work that nurses had no energy left, primarily because of the protective equipment we needed to wear. We were dizzy, nauseated, and generally feeling unwell. We could not lift our masks off to take a deep breath of air. We could not take our masks off to drink. In order to do any of those things, we needed to disrobe, change all our equipment into fresh gear, and then exit the department.

Many times, we would have to sit down and rest. When we got to the cafeteria, we had to sit 2 meters apart. The hospital hired a security guard to enforce this rule. You could imagine the tension within our hospital. Nurses were crying at the drop of a pin. Everyone had an issue, and all were valid ones. Some nurses lost their baby sitters. Some had no place to call home. The initial home quarantine lasted 10 days. It was an extremely difficult situation for everyone.

Question: You and your nurse colleagues must have been very worried -- about your own health and that of your family. How did this affect your personal and family life?

Answer: Most of the nurses were not afraid for themselves, but fear of the unknown was keeping us worried about our immediate families. A lot of nurses were told by their relatives to please stay away from home until the 10-day quarantine was up. Some were not allowed into their homes at all. I know a nurse who had to get a hotel room for 10 days. Then she had to sneak in and out for fear of being asked to leave if the found out she was under quarantine.

Spouses were to sleep in separate rooms. There was to be no physical contact for 10 days. That meant no hugs, no kisses, nothing! We could not touch or prepare food for the family. All cutlery and utensils were to be kept separate. Imagine the impact this had on me -- a mother of 4 children! And, as nurses, many of us are extremely careful about cleanliness in general. In this situation, those tendencies are magnified! I stocked up on disinfectant wipes, which I had to order from the Internet along with my groceries. I would walk around with disinfectant wipes in my hand and clean everything I touched all day long. I don't think I was worried about getting SARS as much as I was worried about the unknown. My coworker was still in hospital and recovering from SARS.

Question: Do you believe that the nurses are bearing the brunt of the SARS patient impact? Are the nurses supported as well as you think they should be? Are their working situations and compensation fair?

Answer: Yes, the nurses have carried the brunt of the SARS outbreak, and not only the nurses, but all healthcare workers. Nurses are working 24 hours/day, 7 days/week, while physicians and administrators go home at the end of the day.

Nurses are not supported as well as they should be. Initially we did not even have the right equipment. "You don't really need it," we were told. Supplies were on back order. Just yesterday, I found out that the gloves we are using in the dialysis unit are permeable. One vigilant nurse raised concern only because the rest of the hospital was using different gloves, and she was told dialysis nurses did not need the extra protection. Dialysis, could you imagine? We deal with blood and body fluids exclusively! Today we got the special gloves.

Question: What is the situation today? We have just learned that after 3 weeks without any new cases, SARS has emerged again in Toronto. How does that affect the hospitals and nursing staff?

Answer: The last week has been horrendous for nurses across Toronto. New cases are popping up everywhere. There was just a rally in Toronto, and I'm waiting to see what happened. It seems that only some nurses are getting double pay for working in the SARS-designated hospitals. I believe that every nurse who must wear all the protective equipment should be compensated. Fair is fair!

The new outbreak has the nurses fuming. We knew they were taking away the screening too soon. First, we were told we would be screening all summer. They hired students to man the stations. The next thing we knew, the masks disappeared and the tent came down. We could not believe it! But today everything is back.

We want nurses to be consulted at the bargaining table. There should be no bargaining when it comes to lives. Politicians are scrambling to get tourism back to Toronto. When the government is raising 10 million dollars for the Rolling Stones, how do you think the nurses lying in SARS beds fighting for their lives feel? Where is the justice in this? Does anyone even care? We know the public cares. The support from the general public has been great. Many letters of gratitude have been lining the local papers every day.

Question: As one of the first nurses to cope with the SARS outbreak, what recommendations do you have for other nurses who may need to deal with this situation in the future?

Answer: My first recommendation is to take care of yourself first. Take care of your mental, physical, and emotional well-being. Lock your door in your room and light a scented candle. Relax with whatever makes you happy -- a glass of wine or a box of chocolate. Surround yourself with people who understand you. We made sure we were supportive to our coworkers, especially those afflicted by SARS.

I found it therapeutic to get politically involved. Write those letters to the editor. Contact your professional organization, in our case RNAO. This same organization also set up a support group on the Internet where thoughts and worries could be exchanged anonymously. It was interesting to see we were all in the same boat. Get involved and be heard. Nurses will not be submissive any longer.

Thank you, Saverina, for telling us about the situation for nurses in Toronto.

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