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Meet the behind-the-scenes team that keeps SickKids ticking
14 minute read

Meet the behind-the-scenes team that keeps SickKids ticking


A team of 10 nurses is responsible for ensuring the hospital runs smoothly and safely after hours.

“It’s a well-kept secret. It’s one of the best jobs in the building,” says Barb Hoeve, whose job title of Clinical Programs and Services Administrator, hardly touches on the breadth and depth of the issues she and her fellow teammates get called for day and night. 

This team of 10, which is currently made up entirely of female nurses, uses its combined 325+ years of service at The Hospital for Sick Children (SickKids) to keep the hospital ticking at night, on the weekends and on holidays. Casually referred to as Child Health Services (CHS) Administrators, the team helps to ensure the building, and everyone inside it, is safe 24/7, 365 days per year. They represent on-site clinical and corporate leadership when many departments are on their off hours and operate with fewer staff in the hospital. 

It’s a responsibility felt deeply by all the CHS Administrators. “The accountability and responsibility are very, very heavy on an individual,” says Munira Nanji, who was a Nurse and Sr. Clinical Manager in the Division of Haematology/Oncology/Palliative Care Team for 25 years before she became a CHS Administrator. “I never feel alone. I always know the On-call team is there. Security is there, Housekeeping is there. But the way our decision-making is implemented, can be paramount to the safety of the patients, families, and staff. This leans very heavy on the Administrator.” 

Person stands in a lobby area, pointing and holding papers.
Munira Nanji, CHS Administrator, seen in the SickKids Atrium.

“The building is a big puzzle and staffing is a big puzzle” 

A key component of patient and staff safety is ensuring that all clinical areas of the hospital have appropriate staffing levels for their patient populations. As another CHS Administrator, Kristina Jovanovic, puts it, “Sometimes that’s beautiful and it’s easy. Sometimes it’s a little bit more difficult and you need to think outside of the box. But always it’ll be safe and always we try to make it nice for staff who have to move around.”

Two people in conversation, wearing masks.
Kristina Jovanovic, CHS Administrator, discusses staffing for an inpatient unit.

The CHS Administrators look at the entire hospital and help to balance risk by sharing resources between programs while ensuring redeployed staff are supported and working in areas that best match their unique skillsets. During the pandemic, when staff absences have been higher than usual due to COVID-19 or a COVID-19 exposure, this has been critically important.

“Really, the building’s a big puzzle and staffing is a big puzzle. All the pieces are things like the acuity of the patients, the number and experience level of staff on each unit, the Emergency Department and patients that need to be admitted. So, it’s one big puzzle and you just figure out how to make it fit,” says Hoeve, who spent 35 years at SickKids, initially as a Nurse in the Neonatal Intensive Care Unit (NICU) and then on the Critical Care Response Team (CCRT), before moving into her current role.

Person seated at a desk reviewing paperwork, wearing a mask.
Barb Hoeve, CHS Administrator, makes notes following her conversations with other nurses.

Keeping calm under pressure

Acting as hospital leadership after hours means being ready for a wide range of scenarios – and sometimes, disasters. In the event of a major emergency, such as an external incident that brings many patients to SickKids (also called a Code Orange) or a need to evacuate all or part of the hospital (Code Green), the CHS Administrator is often the first person to initiate the hospital’s emergency response.

“When something major happens to the hospital that could impact how we care for our patients or poses an imminent risk to people’s safety, we have to act quickly and decisively,” says Nanji. “We might decide to activate the hospital’s Command Centre so we can identify who’s going to take the lead and who do we need in the room – physically or virtually – to make and execute decisions.”

Person stands in front of Emergency department sign, wearing a mask and holding papers.
Munira Nanji, CHS Administrator, pictured outside of SickKids’ Emergency Department.

Depending on what’s happening, the CHS Administrators may take the lead of the Command Centre team, which is made up of representatives from across the organization. Alternatively, they might provide support by liaising with police, implementing measures that could impact clinical operations, or carrying out other tasks requested by the Command Centre.

“I’ve welcomed you as a guest into my house”

As with all hospitals, patients and their families are sometimes coming into SickKids during times of extreme stress. Despite everyone’s best efforts, conflicts can occur and potentially escalate to a point where a patient or family member becomes verbally or physically aggressive. In these situations, CHS Administrators are called in for their unique expertise and ability to de-escalate conflicts.

Jovanovic, who spent 20 years as a Nurse in the SickKids Emergency Department, describes her approach to managing conflict. “I’ll introduce myself and I’ll say, ‘This is my house. I’ve welcomed you as a guest at my house and I’m happy that you’re here. As a guest, I’ll offer you everything. But remember you’re at my house and I’d like for you to treat my family with respect.’ And usually people understand.”  

Person standing in front of a whiteboard with labels. The person is wearing a mask and holding a cell phone.
Kristina Jovanovic, CHS Administrator, pictured in the Cardiac Critical Care Unit (CCCU) at SickKids.

Hoeve, Jovanovic, Nanji and all the CHS Administrators take immense pride in making sure ‘the house’ is safe for patients, families and staff. Their respect and compassion for everyone who walks through SickKids’ doors is evident after just a few minutes of talking with them.

“I look at our patients and families and think to myself, ‘Wow, what incredible strength and spirit they have,’” says Nanji “And then I see the staff and how they are so dedicated and engaged, even during difficult times. I’m so proud to be with SickKids because of the people.”

Get a sneak peek into the role of CHS Administrators at SickKids


[SickKids logo appears on a white background]

[Barb Hoeve, CHS Administrator, sits at her computer desk]

[Murina Nanji, CHS Administrator, walks down the stairs toward the atrium at SickKids. She then stops walking and pulls out a ringing pager from her pocket]

Nanji: I will say this pager has not stopped!

[An employee walks down a hall at SickKids]

[Hoeve highlights documents while sitting at her desk]

[Hoeve sits at a conference table with a number of colleagues]

Text on screen: Barb Hoeve: CHS Administrator, SickKids

Hoeve: It was a real eye opener for me to have an understanding then of how many areas you get pulled into to help support the building. It's really a fantastic job for working with the collective. I mean, it's a well-kept secret, it's one of the best jobs in the building.

Text on screen: Murina Nanji: CHS Administrator, SickKids

We don't work through our office. It's an action driven role. And one of the things that we do is to make sure that we're building relationships; that we're making sure that we're there for the charge nurses, that they know we're there for them. We make difficult decisions, and sometimes we need to be very clear why we're making those decisions.

[Kristina Jovanovic, CHS Administrator, sits in an office alone.]

Text on screen: Kristina Jovanovic: CHS Administrator, SickKids

Jovanovic: So, the CHS administrator represents acting management after hours and on weekends. We try to ensure that we mitigate risk and that the hospital is operational and flowing smoothly.

[Nanji writes on a document at her desk]

Nanji: So just give me a few seconds. I just want to grab some information. So, one of the things that CHS's do that is imperative. First of all, it’s the safety of the patients, their families and the staff. Currently right now because of the acuity and the high volume of patients within the units, we're starting to see some gaps in some resources.

[Nanji sits at her computer.]

Nanji: So, I need to make sure that every area is number one, safe, to do safe, quality care for our patients.   And so, I have spent a good, probably an hour trying to navigate resources. As those things are happening, there's still calls coming in. So, my role right now is we’re going to head down to CCU. We're going to do a touch point, and we're going to check how they're doing.

[Nanji walks down the hall toward the critical care unit (CCU).]

[Nanji arrives at the CCU, and approaches a SickKids nurse sitting at his desk]

Nanji: I'm just going to ask you your opinion. In terms of going into tonight, [Nanji flips through a multi-page document] do you feel as a cluster that we are good with one, two, three? So, we've got a burn bed, a trauma bed, an adolescent med-bed and three beds. So, we have about six beds.

Person at Desk: Yeah.

Nanji: Okay. So, we're good with that?

Person at Desk: Yeah, that's about our average.

Nanji: Okay.

Person at Desk: Okay.

Nanji: So, thank you so much. And I will let CCU know.

Person at Desk: Okay.

Nanji: You're the best. You're a lifesaver.

Person at Desk: We try.

[Nanji walks away.]

[Hoeve sits at her computer desk.]

Hoeve: Really, the building's a big puzzle. And staffing is a big puzzle. And then you add in the acuity of the patients and the seniority of the staff, units that don't have charge nurses that usually do charge. The emerge kids that are being admitted. So, it's one big puzzle and you just figure out how to make it fit.

[The camera shifts to reveal three nurses in the room with Hoeve.]

[Hoeve turns to speak to a nurse sitting in the room with her.]

Hoeve: Four critical care status?

Nurse: *Nods their head*

Hoeve: Wow. Okay, so you are acute right now. Okay, COVIDs?

Nurse: No COVIDs.

Hoeve: No COVIDs. Okay.

[Nanji sits in an office with a nurse]

The nurses are compassionate, they're caring, they treat everybody like a big family, and they're always willing to help.

[Hoeve walks down a hospital hallway with a doctor while having an inaudible conversation.]

[Hoeve sits down at a desk with that same doctor]

[ SickKids employees interact on an inpatient unit.]

Nanji: So, every single hat that manages this hospital in terms of security, occupational health, managers, directors, even the component of financing you are responsible for...

[Nanji points at a white board with a colour coded chart]

Nanji: And so that to me, I think, is a heavy responsibility for an individual, but it is dynamic. You never stop learning.

[SickKids employees interact on an inpatient unit.]

Hoeve: You know, the people are fantastic, and we love being at SickKids for the families, for the children, for each other. We get to sit down and talk to staff. And it's not just always nursing, you know, it could be the RTs, or you know, a PSA. We're sitting down, we talk to them and we get to know one another.

[Hoeve sits in an office and checks her phone.]

Hoeve: Excuse me for a second. Oh. All right, so someone's asking to chat, so I think I'll go there. I will, I will come by.

[SickKids logo appears on a white background.]

[End of video]

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