Rebecca: It’s so powerful when you talk about self-love, especially I think in healthcare where it’s almost like seemingly an endless sort of ocean that needs to be shared with patients because it just doesn’t end. It goes way beyond what they show up for in terms of their clinical diagnosis. How do you mentor or speak to your teams about how to show up like that at the bedside?

Anita: We’ve been fortunate enough during this massive pandemic to have some retreats for my teams. Listening to the advisory board the other week, they were saying, “Healthcare does great in a crisis. We’re built for a crisis. We love crisis. Bring it on. But what do you do in the aftermath of the crisis? That’s where things can fall apart. I’m lucky enough at Cedar Sinai to really, working with spiritual care and organizational development to create some letting go ceremonies for our staff.

You can’t continue forward if you haven’t let go of what actually occurred and what happened to you. There was so much tragedy that had happened in people’s personal lives in conjunction with the pandemic, that they had lost loved ones, that they hadn’t shared with their colleagues because they didn’t want to burden their colleagues with one more thing. I was like, “How horrible to have lost your sister/your brother/your grandmother, and still have to show up to work every day.” So, we went through some physical practices, did some meditation and deep breathing. We did a bowl of dissolving ink so you could put your problem into the ink and let your problem float away and dissolve, with the support of everyone that was there, gathering with you in that small group. It was really beautiful and intentional, and that’s kind of where I took the Jean Watson Caring Science and carried it forward because those are all micro-practices that Jean talks about: Showing up for people is as simple as going from one perhaps upset patient and family, to going to wash your hands, taking a few deep breaths, stopping at the door before you go into the next patient’s room, and then be able to open the door with a fresh presence of yourself. I think that it needs to be intentional, and it can’t just be like, “show up better and be better;” You have to do some work around it.

I really believe in “tool kits and tool belts for leadership.” You have to provide some exact things that people can do to soothe themselves and make themselves feel better, or soothe their patients or soothe the world, whatever that is for them.

The mind/body connection is so real and especially in showing up. You used the word “clean” earlier, and we have to obviously wash our hands as we go from patient room to patient room. If you do that consciously with intention, there’s a real beauty that can come from that “washing of the hands and then walking into the next patient room,” almost like cleansing yourself of your previous experience and starting anew.

I think people always think it has to be some big act or we have to pray with people or be in some distinguished manner with them. Really, it’s the simplistic micro-practices of pulling up a chair next to the bedside, getting at eye level, using a soothing voice tone, connecting with your eyes…The human face is so beautiful! So yes, I think it’s all the small things, and in my own philosophy we pay too much attention to the big things. Those [big things] are all great and wonderful, but it’s the everyday, every moment things that really truly matter.

So many folks are talking about “the great attrition” and how they’re scared for the future in light of the shortages in nursing. Can you share “the secret sauce,” what you attribute to being able to retain and attract the most talented and experienced nurses?

I think it’s on the shoulders of giants. Dr. Linda Burns Bolton is such a powerhouse in nursing here at Cedars, and then also on the national stage And I think she established some really amazing patterns of tuition, reimbursement, and certification appreciation, and always raising the bar for degrees. We have a phenomenal Amount of masters prepared and doctorly prepared nurses still at the bedside, most importantly at the bedside. She built on that foundation, using the magnet model to really be able to drive structural empowerment. So that we have a great shared governance structure.

We bring 200 nurses together once a month and they solve the problems of the organization with and for us, putting all those serious structures and great community benefits in place. People come here not to just serve Cedar Sinai internally in the medical center, but also in community outreach. It’s a combination of a lot of little things that build teams, and then a lot of those teams that are really successful begin to flourish. We meet every single week to discuss best practices in the organization.

We have a lot of families that work here, too! I was just talking to somebody the other day and she’s marrying somebody from another unit, and his parents both work here! Then, one of my executive directors, Michelle Williams’ mother was a nurse here, and now Michelle’s daughter is a nurse here! It’s just so great to see.

That is outstanding! This podcast is called “Moments move us,” Anita, so when you talk about the micro-moments that add up and how that that’s at the basis of things, I hear you loud and clear. One of the things that you just mentioned was gathering together hundreds of nurses to solve critical issues. When people feel empowered to share their voice, and there is a responsibility on them from leadership to say, “This is a challenge we have. Can you help us?” That really shows the respect that you have for that group, and it empowers them in a very unique way. Can you share a little bit about that? I know across the industry, we’ve had challenges with nurses feeling heard and empowered to be part of the greater process within their health system.

They rebuilt their shared governance structure, and we turned it into a model of shared leadership, and they developed a Care Request Form. So, even if you’re working Saturday night at 11:00PM, you can still put in an electronic care request form via the internet. Some of those care request forms where as simple as, “The yellow PPE gowns, we’re running out of stock. We went to the cloth gowns and the cloth gallons had issues with snaps and laundering.” So, they put out a care request form. We were going to move back to the yellow gowns eventually too when stock got up, but in that instance, we were actually able to move that ahead in that particular journey. Even simple things like the cafeteria hours! I’m working on hiring more people so we can have our cafeteria open at longer hours from the night shift.

So all those small things that make a world of difference (for example, vending machines in the critical care tower that have healthy snacks); It’s all of those small things that can really make or break your everyday work environment, and letting them try to solve the problems with our support, all of the little things that you have to intentionally take time to sit down and talk about to be able to solve for, and they can usually be solved. And the ones that we can’t solve, we let the person who submitted the request know that there’s no budget for it this year, but we’ll consider it for the next fiscal year. I was closing the loop in communication, and we’re not perfect at that yet by any means, but we’re definitely on the journey to getting better at it.

How do you ensure that the amazing people that are on the front lines are feeling seen and recognized for the work that they’re doing on a regular basis?

I love formalized programs. We utilize the Daisy Foundation program here for recognition. Cedars is amazing, where there’s multiple forms of recognition.

There’s a President’s Award, where there are standing ovations! The team members are always nominating each other, which again, I think contributes to the whole beautiful ecosystem of recognition. But the Daisy Awards always bring me to tears. I can’t even go up to the unit and read the letters because they’re so beautiful, the nominations that our families and patients and colleagues make for each other.

One of the most recent nominations involved a patient that had passed away and the nurse drove the family Bible two hours to the family to get it back to them. The patient had passed, and they had left the Bible, and the nurse drove the Bible back to the family. It was incredible.

That really is incredible. What a story of caring for someone after they pass and for their extended family. My father suffers from a chronic illness, and we’ve had a lot of experiences with caregivers in my life. It always amazes me when the people taking care of him are almost equally concerned for my mom or me and trying to make sure that we’re comfortable. It makes a huge difference in an experience.

I had another time where a diabetes nurse was taking care of a pregnant mom. The mom got discharged from the hospital, but they didn’t have time to cover all of the diabetes education. The nurse drove out two hours there and two hours back to give the mom at-home diabetes education. She didn’t have to, by any means! She could have done it from an outpatient setting! I was said to her, “That is incredible from the goodness of your heart,” but she wanted to make sure the mom knew. The nurse wanted to make sure that the mom was safe and secure. It was so beautiful.

What an inspiration. That’s what it’s all about. That’s why we’re all here. It’s just stories like this that just make you feel so proud to be in this incredible industry, caring for people in a very expansive way.

Every moment of this discussion with Dr. Anita Girard is impactful, but here are a few standout quotes to entice you to listen to the full episode.

“I think people always think it has to be some big act or we have to pray with people or be in some distinguished manner with them. Really, it’s the simplistic micro-practices of pulling up a chair next to the bedside, getting at eye level, using a soothing voice tone, connecting with your eyes…The human face is so beautiful! So yes, I think it’s all the small things, and in my own philosophy we pay too much attention to the big things. Those [big things] are all great and wonderful, but it’s the everyday, every moment things that really truly matter.”

“When I pursued my doctorate in nursing practice, it changed everything. It really opened my eyes to the importance of 1: staying in the moment of where you are, and 2: not bearing the burden of everyone in your whole world, on your shoulder. The cleaner you can keep yourself and your own sanctity of mind and the stronger and more resilient you can make yourself with your daily practices, the more you’ll enjoy the moments that you’re in and then continue them forward.”

“The Director of Public Policy right now for the ANA, California, started a group of nurses that went out with their backpacks to the [George Floyd] demonstrations and did healthcare; scrapes, falls and blood pressure issues. They were able to triage people because there weren’t enough healthcare tents to be able to aid the victims of the protest. So, her team went out and they helped hundreds of different protests. They would work their shifts at the hospital, and then they went out at night when the protests were happening. It was just profound to see the care that they could give but they felt as nurses it was their moral obligation, which I thought was so profound. All of those little things that add up to be bigger things, that bubble up the issues and make people start to take notice and listen, are really powerful.”

“It’s really important that we stay hopeful and create new things. There’s just so much innovation! I think COVID, if anything, was the gift of innovation; and learning that we can innovate around anything. So, if we can do that, what else can we do when we don’t have a pandemic or we’ve eased the burden of the pandemic? I’m really looking forward to this next year. I think it’s going to be amazing. COVID has made us so much more nimble and flexible and innovative and creative, and I just hope that we can take all of that and package it and bundle it, love on it and build it into the new year.”