Every afternoon, the hospital enters a different rhythm.
As daytime care teams prepare to hand over to evening staff, conversations begin about patient volumes, available beds and the work still ahead. It is a moment of recalibration, when attention shifts from what has already happened to what is to come.
This is when Nafeesa Mussa begins her shift.
Mussa is a Clinical Manager, Evening and Weekends. Her role is focused on keeping the hospital moving after regular business hours. Much of her work happens behind the scenes.
She sees herself as an ambassador, advocating for patients and families and a steady leader for staff when challenges arise. Her goal is to help patients feel safe, ensure staff know they are supported and keeping the system moving.
Mussa is an occupational therapist by training and has been practicing for 18 years. She completed her Bachelor’s degree in Life Sciences at McMaster University and her Master of Science in Occupational Therapy at D’Youville University. Her experience as an occupational therapist has shaped how she approaches leadership – with a strong focus on function, collaboration and the patient’s overall journey through care. She spent years working closely with patients and families, including in discharge planning within the Emergency Department and Intensive Care Unit.
That experience informs how she shows up in her management role.
After hours, she oversees the hospital site as a whole. That includes staffing across units, responding to codes, supporting clinical teams and coordinating with evening and weekend clinical managers at other sites to ensure the broader system continues to function safely.
Unpredictability is part of the role.
Some evenings unfold quietly. Others bring challenges that require immediate coordination and clear judgment.
At the clinical manager level, Mussa is often called to respond when the hospital is facing its most significant operational issues.
One of those moments came when flooding affected the Niagara Falls site. A city water main break caused water to rush into parts of the hospital, impacting hallways and elevator access. Units had to be assessed quickly. Patient movement had to be re-planned in real time.
“There’s no option to close doors,” she says. “You have to figure it out.”
While large-scale disruptions are less common, pressure is a familiar part of Mussa’s work.
One of the areas where that pressure is felt most consistently is the Emergency Department.
She understands that when someone comes to the ED, they are often arriving on one of the hardest days of their life. Fear, pain, uncertainty and exhaustion all walk in with them.
“For many people, this is their worst day. We never lose sight of that.”
“For many people, this is their worst day,” Mussa says. “We never lose sight of that.”
Inside the Emergency Department, time does not move in a straight line. Care is guided by urgency. The sickest patients are seen first. Others wait, while care continues to shift around changing clinical needs.
“You’re not invisible,” Mussa says. “We see you. We know you’re there. And we will get to you.”
Emergency Departments care for more than the waiting room. Ambulances arrive throughout the day and night, often bringing patients who require immediate, life-saving interventions. Physicians may be pulled away at any moment to respond to a trauma or critical case, reshaping priorities across the department and affecting how quickly other patients can be seen. Some patients can be treated and return home. Others need to stay. When that happens, another layer of coordination begins.
“A patient can only move to an inpatient bed if there is a vacant bed,” Mussa explains. “And a bed only becomes vacant when another patient has been safely discharged.”
Discharge is never a single decision. Physicians, nurses, allied health professionals and discharge planners come together to review and plan. They talk through medications, at-home support, equipment, transportation and family involvement.
The focus is always on a safe transition home.
Like many healthcare leaders, Mussa recognizes that Emergency Departments have become a safety net for people who may not have access to primary care or who feel uncertain about where else to turn.
Over time, Emergency Departments have become a place people go when no other option feels clear. For some, it is the only door that feels open.
“Evening weekend managers keep our sites moving. They balance staffing, watch system capacity and make sure patients get to the right bed for the care they need,” says Lisa Hildebrand, Director of Access and Flow and the Regional Stroke Program. “Hospital operations can shift without warning, and they’re skilled at managing those moments. Their presence across our hospitals and units helps keep everything on track.”
What sustains Mussa through long evenings and high-pressure moments is the people around her.
She speaks often about the team she works alongside. Charge nurses who step in without hesitation. Physicians who communicate openly. Colleagues across sites who stay connected, checking in throughout the evening to ask what is needed and how they can help. Support is shared quietly and without expectation.
“There’s a lot of trust,” Mussa says. “People show up for each other.”
Mussa says moments of patience and understanding from patients and families are felt more than people might realize. Even small gestures can ease difficult moments and help everyone move through the evening with steadiness.
