When Reverend Hannah Rhiza steers her Spiritual Care Cart through Cedars-Sinai Marina del Rey Hospital, it's hard not to notice. The tiered trolley for staff overflows with neat stacks of flavored teas and self-care notecards nestled among a lollipop topiary and flickering electric tea lights.

"We're sowing a seed to build relationships and trust. Staff might not partake in anything on the cart at first, but they might come back to me later telling me about their kids, their personal life or their struggles," said Rhiza, the chaplain at Cedars-Sinai Marina del Rey Hospital. "We're not only here for our patients but our staff as well."

Since the beginning of the COVID-19 pandemic, Rhiza has played a central role in helping healthcare workers cope at this small community hospital, where staff regard each other as family. By bringing spiritual care to the staff, Rhiza’s goal is to meet them where they are and address the factors that lead to healthcare worker burnout.

"Burnout can sneak up on you and manifest in different ways. If we can help people identify it and normalize talking about it, the experience becomes less isolating," said Rhiza.

Preventing burnout is key to the future of healthcare, said Andy Ortiz, senior vice president of Human Resources at Cedars-Sinai. "Caring is at the heart of what we do at Cedars-Sinai, and this starts with caring for the wellbeing of our own people," he said.

During the pandemic, Cedars-Sinai offered a variety of supportive programs for employees, including free access to mental health counselors; reimbursements for child and elder care; hotel accommodations for frontline workers; pay protection and alternate assignments for employees whose normal work had been curtailed; paid leave for employees with COVID-19 symptoms; and mindful meditation sessions.

"What healthcare workers worldwide have experienced in responding to this pandemic has been overwhelming and at times traumatic," Ortiz said. "It remains more important than ever that we help our employees and staff in taking care of themselves as they continue saving lives and caring for others."

Healing the healers 

At Cedars-Sinai Medical Center, Chief Nursing Officer Anita Girard, DNP, RN, NEA-BC, said "Letting Go" ceremonies have helped nurses cope with daily challenges. Chaplains lead the ceremonies, during which nurses share their pandemic experiences.

"Nurses were coming into the hospital to deal with healthcare crises, but they also had loved ones of their own dying. Some had never told a co-worker that they'd lost a family member because they didn't want to burden them with their personal problems," Girard said. "These ceremonies helped people unburden themselves."

The Nursing Department brought in an expert to teach self-care practices that help cultivate resilience. "It could be a two-minute meditation while washing your hands, or learning to take a deep breath after leaving a patient's room so that you don't carry the past into the next room," Girard said. "You're protecting yourself while being available for others."

Cedars-Sinai also created Zen rooms on the units, where staff can take a 10-minute mental break. Staff repurposed space, such as an old linen closet, and decorated the room in their own way. Some have painted the walls and added massage chairs, a stereo for music or meditations, and soothing lighting.

Pebble in the shoe

Many physicians felt a renewed sense of purpose in the early months of the pandemic. "There was a feeling of, 'This is what I was trained for,'" said Alen Voskanian, MD, MBA, medical director of Cedars-Sinai Medical Group.

But that feeling faded, Voskanian said, and signs of burnout emerged during the summer of 2020. He said the pandemic has added a new layer of stress to an already overburdened profession. Physicians have grappled with isolation, financial stress, and concerns about the health and safety of their patients, their families and their own wellbeing. The "Great Resignation" intensified the pressure as some staff and clinicians left their jobs, increasing the workloads for the clinicians who remained.

"There have always been many root causes of burnout among physicians. It's death by a thousand papercuts. It's a pebble in our shoe that we initially ignore but after months and years leads to burnout," said Voskanian, who co-chairs the Cedars-Sinai Medical Network Physician Wellness Committee.

In response, Cedars-Sinai has provided financial stability to practices that saw patient volumes drop and shared mental health resources. Small in-person lunches that pre-pandemic helped physicians connect moved online, with meals delivered to participants when possible.

While virtual meetings have some benefits, Voskanian misses the ability to connect, bond and share meals with colleagues. With COVID-19 cases falling, he's hopeful they can meet face to face again in the spring.

"I do think we’re starting to see the light at the end of the tunnel in some ways," he said. "I'm very optimistic about the future."