From nursing student to operations manager, Michelle found her niche in children's rehab
By Louise Kinross
Michelle Balkaran (above right) came to Holland Bloorview as a nursing student in January of 2007. After graduating that summer she was hired to work on our specialized orthopedic developmental rehab (SODR) unit, and she hasn't looked back. She worked as a frontline nurse, then clinical resource leader and today she is the operations manager for the unit. “Michelle has been very helpful and a very good listener," a parent wrote in a recent Spotlight recognition. “She goes the extra mile.” We spoke about how she came to be a nurse, the unique challenges of COVID-19 for inpatient families, and how she'd like to see better psychological services to support clients.
BLOOM: How did you get into this field?
Michelle Balkaran: I always wanted to work with children and I wanted to be a teacher. But I was part of the double cohort graduating, and there was a lot of competition. My mom said her friend's daughter had gone to teacher's college, but didn't get a job. Why not try nursing? So I went to nursing school with every intention of doing teacher's college after that. Then I got placed here, and I never wanted to leave.
I was exposed to the adult world in nursing school and I liked it, but being in pediatrics shows you the importance of family dynamics, and how the family contributes to the success of a client. That's really what drove me. I also met some amazing nurses here who have been doing this for years, and I saw their passion for what they do.
BLOOM: What is a typical day like now?
Michelle Balkaran: I plan for structure, but that's never the case. We huddle every morning with our hospital charge nurses at 8 and then with the clinical resource leaders and leadership team to get an oversight on what's happening within the organization and on the third floor. That means looking at our census, highlighting and problem-solving any issues that have surfaced overnight, and being proactive with the rest of our week. We hear about if there were any codes, any building service issues, and whether we need to follow up on anything, like COVID testing.
The rest of my day is spent in meetings. My calendar is always full. Right now it's our pandemic meetings, touching base with staff about any clinical issues, and how we can best support families, and thinking about how we can backfill nurses. Our staff have been getting their COVID vaccines and the second dose is making them a little ill. We're trying to plan, in the event that a certain amount of our clinicians are absent, how we will cover the clients and make sure the show does go on.
BLOOM: Does that mean using nurses from an agency?
Michelle Balkaran: We try our hardest not to do that. We're thinking differently about how we can use the skills of all of our clinicians. For example, I'm still a registered nurse. If six or seven of our nurses were absent, what are the tools I'd need in order to practice again and be pulled in to do client care?
BLOOM: What qualities do you need to be good in your job?
Michelle Balkaran: To be attentive, to be solution-focused, and a team player. The nurses and clinicians are the ones who are living it, so for me to sit there and dictate what they should do is not the right way to do things. I need to be open to ideas and suggestions from everyone. We need to figure out what's going to be beneficial for a client and then work alongside the clinicians and nurses to implement that. A lot of time our staff have great ideas, but they don't have the tools to execute them. Staying humble is very important to me. I take great pride in being a registered nurse and although I'm the operations manager, I still identify as an RN.
BLOOM: What's the greatest challenge of the job?
Michelle Balkaran: Right now, with COVID, I'd say supporting staff and clinicians with balancing work and life. I was reading Julia Hanigsberg's bulletin about how it's hard to feel like you're succeeding at anything now, whether it's work, being a parent or a good partner or family member. That resonated a lot with me.
When I applied for this job I was on maternity leave in October 2019. I had goals and ambitions and strategies I wanted to implement, especially on SODR because I've been part of that team since the beginning. But coming back in, COVID hit, and all of my plans were out the window. I had my own fears. I didn't know how to enter the building, the screening was different, everything was different. And having a small child who has somewhat of a medical history, I was very anxious coming in. Staff were amazing at comforting me so that I felt safe. So it's supporting other people who have the same fears and anxieties, helping them feel good about coming to work, and keeping them motivated and engaged.
We've had some challenges implementing COVID protocols with clients and families. At the beginning, leaves of absence, where families go home on the weekend, were not permitted. I found it really hard to tell a family that they couldn't go home on the weekend when I could go home to my family at the end of each day. That was a real struggle. Knowing families' backstories, and how difficult it was for them to be apart from other family members, was hard. But based on a lot of feedback and advocacy, we got the leave of absences implemented again.
BLOOM: What's the greatest joy?
Michelle Balkaran: Hearing our kids' goals. We always have our own therapy goals, but the kid will say 'I just want to see my dog.' It's so simple, but we can put all of the tools they need in place for them to go home for the weekend to see their dog. Or maybe they want to ride their bike again. It's seeing progress from day one to discharge day. Because I'm not so embedded in their care, I can see the changes a lot more than someone who works with them every day. Being a parent now, I see things differently. To trust a clinician to take care of your child is huge. And I see that our nurses and clinicians treat the children as if they were their own. That brings me joy. Over the years I've seen SODR evolve and progress. You give staff a problem and they say 'We'll figure it out.' They understand how to work together to overcome the challenges as a team.
BLOOM: What emotions come with the job?
Michelle Balkaran: There's a lot of joy, because I get to have that oversight. You get to know families on a personal level and you understand a bit more what they're going through, so sometimes there are frustrations with some of the constraints we work under, like when we have to implement COVID rules. It can be exhausting, but we just keep going. It's fulfilling, because you know you're making a difference in someone's life.
BLOOM: How do you deal with more challenging emotions?
Michelle Balkaran: At first it was hard to separate from work. But there's a sign by our pool that really helped me. It says to reflect on one thing you've done well, to reflect on something challenging, and then to turn your brain off. That sign really helps me disconnect from work. There's a quote that Kimberley Sui-Chuong gave me, about how you're only one person, and you're trying to help change the world, but you can't do it in one day.
Another thing I do is listen to music. When I'm in the car, that's my time, and I decompress from life. I listen to a lot of upbeat soca music and dancehall and reggae music. When I get home, I'm completely dedicated to my son. That is his time.
BLOOM: If you could change one thing about children's rehab, what would it be?
Michelle Balkaran: Post COVID, it would be to have inpatient families together again. That would mean opening up our accommodations again, making sure that siblings can visit, and supporting the family dynamic in other ways. To give you an example, right now I know a parent with a four-year-old here and a toddler at home, and it's very challenging that the two children can't be together. We had window visits in the summer, but they can't hold each other, they can't have meals together.
The hot topic on SODR now is getting the psychology supports that we lack. There are other programs in the facility that offer psychology services, but SODR unfortunately does not have as many resources. As a result, we've had to refuse some admissions, and some of our kids who really need those resources may not get the help they need. For example, someone who has sustained a traumatic spinal cord injury, this is a life-changing event. We can deal with all of the physical aspects of it, but the emotional and psychological components are where there are gaps, and our team is only equipped to do so much.
If we have to seek resources from external parties, that's not necessarily beneficial, because the specialist isn't integrated into our team. And it causes the family a burden to have to go to another facility to receive a session from a psychologist.
There's also an ethical dilemma for our staff, when they know a child or family needs counselling and emotional support that is out of our scope. We have social workers and physicians who are struggling to provide care and being pulled in all directions
We have an amazing working group that has put a proposal into senior management and we have high hopes for increasing those services in the future.
BLOOM: Is there anything you wish you'd learned earlier on in your career?
Michelle Balkaran: Stand your ground, and if you know what you're advocating for is right, continue to advocate for it. Pull others in earlier if you feel that will support positive decision-making. I used to hesitate because I didn't want to ruffle feathers by questioning things.
The other thing is if you don't understand something, don't hesitate to ask questions. It's okay to not know everything. It's still okay, now, that I don't know everything.
