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How can one nurse make bring the change? What can happen when a team catches the vision? How can a team transition their culture from deep sedation and immobility to awake and walking? Nora tells us about igniting her team’s fire and the changes they are celebrating.

 

Episode Transcription

Kali Dayton 0:29
Hello, we’ve heard some pretty hard real talk in the last two episodes. Again, it is never meant to frustrate or depress anyone. But it is clear that change needs to happen. I have loved the discussions on feedback occurring on the podcasts, Instagram and Facebook. I recently saw a comment stating that nurses often chart a RASS of -1, but then sedate to at least a RASS of -2 or -3. When I surveyed my followers 91% agreed that this was a thing. I had to hit the brakes hard.

Listen, nurses are not malicious, and no one is doing this to cause harm. They’re also not innately dishonest. So what is going on? After further surveying, I found that 80% of the responders, and about 200 people responded, So 80% of those felt that the RASS scores were viewed as “objective or were misinterpreted”. 72% felt that there was not enough education about the reality and consequences of sedation. 90% reported emerging delirium during sedation vacations, and likely consequently, 81% have had difficulty implementing the A to F bundle on their unit. And 47% of those nurses report that they have more than two patients each.

So clearly, these mishaps in RASS goal compliance is not because anyone is evil or lazy. There is a huge knowledge deficit in our community. We cannot turn the ship around until every teammate can see the iceberg ahead of us. We have to support our teams and understanding the why. And then have the infrastructure to then address the how. So after all of this frustrating talk, it is definitely time to focus on the incredible good and changes that are occurring. My new friend Nora brings the light and the fire as she shares with us. Her team’s new victories. Nora, I’m so excited to have you on our show today. Introduce yourself and who and what you do.

Nora 2:56
Sure. So my name is Nora, I am a registered nurse at a hospital, a level one trauma center and the medical surgical intensive care unit. I’ve been working there for about two and a half years. It’s where I started my career. And yeah, I’m still working there now.

Kali Dayton 3:15
and up until now, what has been the culture and practices in your team?

Nora 3:21
Sure. So I would say I mean, I wouldn’t characterize us as an “Awake and Walking ICU” such as the one you described in your podcast. But I believe that we are starting to move towards that, in a sense. However, like many ICUs, the status quo has always really been, you know, the patient’s intubated, by default, usually had them on some type of sedation and, you know, analgesia confusion. So like I said, it seems like we’re starting to move in the right direction. She’s very exciting. But the culture that I was brought into as a new grad, wasn’t really this one of you know, “Let’s get the intubated patient out of bed. Let’s let the patient completely wake up after we give them the RSI drugs” It is kind of, you know, “intubate them, start the propofol”. And that’s kind of how how things were. But again, it is moving in the right direction, I think.

Kali Dayton 4:21
And it sounds like you’re kind of the one shaking things up. What changed your perspective? What made you open to changing things? What gave you the fire to get things moving?

Nora 4:31
Sure. So myself and my coworker, Abby, we had the opportunity to go to a conference in September of 2019. And it was our first year of nursing. So we’re still pretty new multiple nurses at this time, and it was all about the A to F bundle. And how to, you know, what it was how to feasibly implement it. And your hospital where, you know, maybe this wasn’t otherwise things were done this way. And it kind of in lined up and it opened our eyes because this wasn’t something that was taught to us when we first got to our hospital.

So we took what we learned. And we were presented with the opportunity to be involved in evidence based practice project where, you know, our sedation practices, I see liberation type things we’re going to be, you know, we’re going to review some literature and then try to implement some sort of change through this evidence that we would gather through literature review. So we wrote a letter of intent, basically talking about our experience at this conference. And, you know, what, what we believe based on what we learned at the conference, and what we had seen and some of the literature why we should try to have our project be approved for this grant, so that we could try to effectuate some change.

And we were able to make it onto the proposal piece of the evidence based practice project, we’ve got a whole proposal along with a pediatric nurse, and we were able to get approval. So from there, along with other hospitals within the system that our hospital was under, we did a robust literature review of 20 different articles related to the A to F bundle, and analgosedation, mobility in the ICU. And we came up with a protocol with the help from other stakeholders that we had recruited along the way for the project other physicians, pharmacists, respiratory therapists, and we created an evidence-based protocol for pain and sedation management in the ICU. So that’s where we’re at with it now. And at this point, we’re really just trying to roll it out and get people familiar with it. And then the hard part really trying to implement it. And that’s kind of how this all started.

Kali Dayton 6:52
And I love that you did the literature review, because I think that’s been what’s really been impactful to me, as well as talking to survivors. But I previously did my own research, I didn’t realize how much evidence there was out there on this. So what was impactful to you about what you found, as you started to read through the actual research that’s been done?

Nora 7:14
So the thing that was nice for us during this project is that, like you said, there is so much out there about how, you know, treating pain before sedating a patient is going to lead unless we to less ventilator days, which then leads to less days in ICU, less instance of delirium, better discharge disposition, and then that when you’re reducing the amount of sedation, then you’re able to mobilize the patient is awake, they’re not delirious, and it’s just this domino effect of positive, you know, outcomes.

So our issue wasn’t really finding the evidence, it was already there for us pretty much just painting a picture with that evidence and saying, “okay, everything that we have looked at, and this is just a tiny corner of that research, there’s so much more, how can we present this to our colleagues and say, ‘we need to, we need to make some changes.'”

Kali Dayton 8:18
And that’s where a lot of people are listening to the podcast. You’ve got lots of physical therapists, people that have maybe believed in this for a long time, or newly discovering this, they’ve got all this fire in their belly, and then they’re bringing it to their team, and they’re finding some obstacles. I mean, you alone cannot change the whole culture. So how did your team accept this when you presented it? What has changed their perspectives? Or how were you able to share this information with them?

Nora 8:48
So one of the things that because like I said, one of the biggest obstacles was just getting this buy in, was trying to figure out how we were going to spread awareness. So in the past, with any sort of, you know, qualitative initiative on a unit, a lot of times, there’s a bulletin board, there’s, you know, different modules online that you can do for education.

But when I found this podcast, things kind of clicked, like, because you can listen to a podcast while you’re on a walk, or you’re running while you’re cleaning your house in the car. And I think it’s something that strays people away from, you know, different unit initiatives or education. It’s just that I don’t want to sit there and read through this article. I don’t want to have to, you know, watch this video. It’s just not. I’m not really understanding why we’re making this change. I’m just doing it because you’re telling me to but with the podcast, we’re like, hey, just just listen to this podcast.

Like we gave a few key episodes to our stakeholders and nurses on our unit. So just listen to like these two or three. And then people were just giving us all this feedback like oh my goodness, I can’t believe that. I wasn’t thinking about this type of thing before. I can’t believe that this is what I see survivors go through. And that you can rock a patient on a ventilator with a piece of a team like it can be done. And not only can it be done, but it should be done because it’s leading to better outcomes.

And I think that having that unique and different ways presenting this information through the podcast, really helped get spark people’s interest and be like, “Okay, I’m excited about this, what’s going on, you know, with what we’re doing in our hospitals to make this change.” And then that’s kind of when we segwayed into the project like, “well, we’ve done this literature review, and this is a protocol we’ve created. And this is what we want to try to make standard practice within our hospitals.” So that was something that really helped just draw in more awareness, not just with nurses, but with doctors, pharmacists, physical therapists, occupational therapists, like it’s been, it’s been a great way to bring everybody in and try to effectuate that change.

Kali Dayton 10:57
Do you feel like you had an interdisciplinary or multidisciplinary approach prior to this, but was there strong collaboration between all the different disciplines? Or has this helped foster that as everyone comes together for this school?

Nora 11:09
I definitely think it’s helped foster it, because some of the barriers that we’re starting to realize now, as far as like interdisciplinary work goes is that a lot of times, we have orders that the doctor puts in, but they’re not really discussed in rounds, there’s not like this closed loop. So maybe the doctor thinks one thing is going on, but then in report, the nurse hears this one thing, like, “oh, we talked about in rounds, how we’re just gonna keep, we’re gonna keep the precedex on, or keep the propofol on, or for whatever reason.” And it’s not really communicated like in a closed loop.

So recently, we’ve been talking a lot about how the MAR, in our orders are going to help try to drive this change. And from talking to the doctors and other nurses, there’s just like this miscommunication, it seems. But I think the part of the problem is that there’s not a focus on, like, liberation in rounds. So we’re talking about the patient on our unit, the resident presents, and you’re talking about major events overnight, what’s going on why they’re in the ICU, like their past medical history, and then the plan for kind of treating each organ system. But we don’t really say we don’t really talk about, like, specifically, “okay, the patient’s on this sedation, why the patient’s on this? You know, what, why are they just on a sedative? And why are we not doing you know, an analgosedation?” We don’t really have that as a piece of our rounds.

Kali Dayton 12:46
You ever talk about delirium? Like, are they delirious? What can we do to clear it out? What are the exacerbating factors causing it?- Any of that discussion?

Nora 12:56
The only times I’ve noticed it discussed or if I bring it up. So if I say the patient is CAM positive, patients CAM negative. And a lot of times it ushers in this conversation between the attending physician and the residents. Because a lot of the residents don’t know what CAM assessment is. So they’re kind of like, “What is this?” Then it starts a conversation in rounds about “well, this is what the CAM ICU assessment is assessing, this is how you assess it. And this is what it means. And this is what we should do if it’s positive.” But again, that in my experience, we only really talk about it. If I bring it up. If I say, you know patient’s CAM positive, the patient’s CAMnegative.

Kali Dayton 13:38
Which Nora, you’re just reaffirming the power of nurses in all of this, right?

Nora 13:43
Yeah.

Kali Dayton 13:44
But we, we’ve talked about how we have lab results for all of our different organs that reflect an organ dysfunction. Yet, if we’re not talking about CAM, we are totally disregarding the brain. That is one of our only indicators that we have a brain injury.

Nora 13:58
Right. And another thing too, and I work with amazing nurses. And we, if we see a low blood pressure, we are in the room fixing it. If we see a high blood pressure in the room, we’re fixing it. If we see a low potassium high test, we’re fixing it right away as we see it. But we don’t have that same sense of urgency when we have a rapid negative for and it’s not indicated.

And I feel like if we did, you know, we would we would be seeing, you know, these outcomes that are bad. Right? And, again, I do I do think that there that awareness is building and I think that we’re moving in the right direction. But I kind of want to describe it in that way. Like if we are as ICU nurse we’re always assessing, we’re always, you know, thinking like proactively on what we need to do to keep the patient stable to get the patient better. We should be thinking about that with our RASS goals too.

Kali Dayton 15:01
I have seen, you know, as the nurse practitioner, I’m not in the room all the time of the patients anymore. And I’m so grateful for the approach that nurses have. They can smell delirium from a mile away once they know what they’re looking for. And they know why it’s so important. So I had nurses coming in saying, “Hey their handwriting’s got a little loopier,” , “hey, they’re not answering in full complete sentences. When they’re writing on the board.” Like they can sense the slightest little things even before their cam positive, they can see when something’s coming and we step back and like, “How do we improve their sleep? How do we get these certain medications off?” I mean, they are so good. And the nurses can say they’re the ones right there. And once they know what needs to happen, they’re gonna make it happen.

Nora 15:45
Right? It’s true.

Kali Dayton 15:48
So how, how did the team come together? And like we did the webinar? How was that received?

Nora 15:54
It was received really well. Yeah. So the webinar was kind of, once we got all this excitement about the podcast, we were able to make that work and get you to come to the webinar, which was wonderful. It sparked a lot of conversation, a lot of which was, “How can we do this? How can we get buy-in? How can we really make this work?”

And I get, I don’t think that we saw change right away, because it was kind of simultaneous with our next COVID surge. We had a lot of patients on neuromuscular blockade, which require deep sedation, and, you know, kind of back backtracking to like, “okay, our acuties are really high, and we’re just focused on what’s in front of us.” and kind of putting that in the back burner. Like, collectively, I guess,

Kali Dayton 16:43
Yet these are patients that are really important to apply this approach to.

Nora 16:46
Right.

Kali Dayton 16:46
Yet, when you’ve got a surge and things are really hot, it can be a lot harder to sell and bring in this huge change.

Nora 16:53
Sure.

Kali Dayton 16:53
So I totally get that.

Nora 16:55
But I still think that it was on people’s minds, because after that kind of, you know, settle down. I was noticing a lot more patients were dangling at the bedside on the ventilator. And I have to give a shout out to our physical therapists, occupational therapists who really, I mean, they, they’re our…. there’s a very small list of reasons why they won’t go in and try to get a patient up.

And I’ve noticed that even more with COVID, because in the beginning, when everybody was panicked, it’s like, “well, what do you mean? like, we’re not even going to talk about mobility right now!”- a lot of times they were reallocating the PTs and OTs to do different tasks. Because, at that time, it was like just this crisis sort of mentality, like, let’s just keep these people alive, pretty much.

But like we had a recent win with a COVID patient, I guess a month ago. And this patient was a larger man, he’s 450 pounds, and he was intubated, and he was COVID. Positive. And I did not take care of him until I think it was like his fourth or fifth day on the ventilator. But he had been up in walking every day since they intubated him, and when I got to him, I was like, obviously, so excited. Like this is great that we’re doing this with him.

Like I peeked in the room at seven in the morning. He’s like watching TV. And I’m pretty respectable vent settings. He wasn’t like ready to be extubated or anything like that. We were just being proactive and getting him up. And there were so many things that could have been used as excuses to get this particular patient up, like his size, like the fact that he was COVID Positive. The fact that his peep was, you know, higher than six or eight. But PT ot was in there every day.

And then I think that that got the nurses really engaged involved that were taking care of him. And the second day that I was there, we had him walked to the glass door, and he was playing tic tac toe with our residents and our other nurses on the other side. And he was standing there for like 10 minutes on the ventilator. And I remember from the episode with the physical therapist that I mentioned earlier, listening to…

Kali Dayton 19:15
Heidi.

Nora 19:16
Yeah, yeah, yeah, she are. We are maybe it was,…. I think it was with Tara because she had said that patient on the ventilator was a one assist.

Kali Dayton 19:23
Oh, yeah.

Nora 19:24
And it was really because she just had to make sure that his ET Tube stayed in place and his lines were okay. We had like probably three or four people in the room initially, just because we weren’t sure how it was going to go, he’s a bigger guy. But we were really just standing there because he had gotten up routinely every day, he had still had pretty good function, you know, that was closer to his baseline. And he ended up, I believe, one or two days later getting extubated and downgraded. Myself and the occupational therapist that I worked really closely with this patient We still talk about all the time, but we wanted to see him at the step down unit.

And we had like planned a time that we were gonna go, it was like gonna be at one o’clock at lunchtime, and we’re getting ready to go. He’s already discharged home.

Kali Dayton 20:14
Right home.

Nora 20:14
Yes. And we were kind of like, well, we were so happy. Of course, we’re also like, “oh my gosh, like, I wish that we could have seen him before he left.”- But he went home. And we hadn’t seen that with a COVID patient in a long time, an intubated COVID patient. So that, in that particular case, got a lot of attention on our unit. And then we started to see other patients walking in the room with a nasally intubated patient who was walking and up in the chair, which is another thing.

A lot of a lot of times, the reason for not getting a patient up would be over the airway is critical- it’s a nasal intubation. But no, we still got him up in the chair. And he did very well. And then I’m just noticing it becoming more part of the day. Like, in the thought process with nursing, like, even when I give report at nighttime, or from the night shift to day shift, like, they’ll talk about, “oh, like, we gave him melatonin to sleep. I think he slept okay through the night, not being on sedation, you know, PT ot worked with him, and the goal today, we’re going to try to stand up, or today, we’re going to try to walk” and it just seems like it’s like shifting more in that direction.

Because this patient, this COVID patient was a huge catalyst and showing people you know, we, we make these, all these reasons for why we can’t get the patient up. And a lot of it is because we’re trying to protect the patient. We think that doing this is going to result in a self extubation or fall or something. But when in reality, the longer we wait, the higher probability is out those things truly happening.

Kali Dayton 21:57
I mean, if that patient had sat in that bed for a week straight before ever be moved, how can you move a 400 plus pound patient? And especially during a surge and during COVID? There are so many factors that make it really hard to get that many people in there, get a lift going. It just it takes so much more time and people and resources and it’s so much more dangerous. I mean, if he fell to the ground, how are you going to get him up?

Nora 22:24
Right?

Kali Dayton 22:24
and yet that wasn’t even relevant because he was never sedated. So you guys just intubated him, let him wake up. And he kept his mind together.

Nora 22:36
I think that I can’t remember if he had to be paralyzed for a brief period of time. I think there was a point where he was on sedation. But then I think what started happening was he was on sedation, but like, his RASS was like -2, -1, he was following commands. So that I think the nurse was like, “Okay, well, let’s see what happens if we do less.” It was like, “okay, he’s like, just more awake doing the same thing. So why don’t we just turn it off?”

Like, I think that it started off in a normal way, like normal, you know, like, standard of the, you know, pushing the drugs, intubating, a patient trying to stabilize them. And then, you know, just like knee jerkingly starting these medications. But I guess the medication wasn’t started at such a rate that would make him an arousal or unable to interact. But when they noticed that he was like, calming following commands, like “okay, well, let’s trying weaning more.”- weaning it more, weaning it more and then all sudden, he’s off it. And then PT ot orders are and they come by, like, “How’s he doing?” “Oh, he’s fine. He’s like, following commands.”, “Alright, let’s go in there and see him.”

And they go in, and they talk to him, because he’s following commands. Let’s try sitting up. Sitting up and then standing up. And all of a sudden, a few days later, he’s playing tic tac toe! Taking steps! And I think that’s the most important thing with anybody that’s, you know, hearing these stories and thinking, “gosh, I want things to change, but I don’t know where to start. And I feel guilty, almost.” – like I kind of felt that way.

You know, learning about, like what happens to a patient when they’re on sedation, and for prolonged periods of time, and you know, how much better outcomes there are for patient is on less sedation, and how do I as one person, like, change this? And the answer is you don’t, but you have to celebrate the small wins. And then eventually, you’re going to see the culture change. If you just focus on little pieces instead of being like, “Okay, I just heard this horrible story about this patient who had this terrible experience and nightmare on sedation, and we can’t do this anymore. I just like, we have to change.”- and it doesn’t work that way.

And I’ve learned that because I have that mentality. Like, I want to like just figure out what to do about this right…

Kali Dayton 24:56
Turn all the the pumps off!

Nora 24:57
Yes! it’s like every room- everyone needs to be sedation. But like, obviously, that’s not going to work, especially when that’s not already the culture. So just start with this one patient, start with one patient, one nurse, one doctor, and then see where it goes. And people, you know, start to get curious. And then think, “well how about my patient? what reason do I have not to do this my patient?” you know, and then…

Kali Dayton 25:22
Especially with such a large patient, all these comorbidities, and you have these good outcomes. Now, how’s that not compelling or convincing?

Nora 25:29
Right!

Kali Dayton 25:30
And you started with the “why”. You started with educating your colleagues about why it should happen. And then you proved to them it could happen.

Nora 25:41
Right.

Kali Dayton 25:42
I think sometimes we push protocols without explaining the why. And it makes no sense. So I’m thinking of the modules, the read articles, just not real until you hear it from the survivors, or you see examples of case studies. And you get a whole picture of it, which is what compelled me to start the podcast. But it just reaffirms everything that I thought. That providers want to do the right thing, clinicians are there to get people better and get them back into their lives.

So if we just know why we shouldn’t do what we’ve been doing, and how to do something different, people are going to be excited about it. And your passion is totally contagious. Nora, you are a powerhouse. And I know there’s so many of you out there. I’ve had people reaching out asking me, How do I start? Where do I get started? This is like I get it, but I don’t even know where to start? What recommendations would you give to them?

Nora 26:35
I would recommend just starting with your own patient. So if you are hearing these stories, and you know you’re you’re fired up, you want to make you know, effectuate change, start with your own patient. And, you know, see where it goes talk about the cam assessment in rounds, say, “hey, the patient’s RASS goal is ordered as this, why is that? Or this patient, you know, like, why don’t we have PT and OT orders?”- and just like start with your own patient, and then see where it goes.

Because that’s what I’ve learned is the best thing to do. You start with your own patient, and it goes somewhere. And then you’re handing off to night shift, and you talk about what you did during that day. And then they’re hearing it, then it sort of clicks something in their head, and it has this sort of ripple effect. But I think that definitely just start with where you are and start with your own patient and then see where it goes, and then just keep talking about it. And report ask why your patient’s on sedation? You know, if they’re not paralyzed? “Why are they sedated? You know, were they agitated is their RASS zero to -2 on this?”

Kali Dayton 27:53
What’s causing the agitation? Right. Are they delirious? You know, are they in pain? Or do they need to have a zoom call with their family?

Nora 28:02
And a lot of times when you say, “Why are they sedated?” The answer is, “Well, they’re intubated.” And then there you go! there’s your segway! like, “Well, that doesn’t necessarily mean that they have to be on all the sedation.” Starting there, for me has been been key, I think, and then just not getting too overwhelmed with like, the prospect of this huge undertaking, and just celebrating the small wins, even if it starts off as just having your intubated patient off of sedation.

And then next time, having them dangle at the bedside with PTO to roll intubated, and then, you know, trying to get them up and walking. Because even though you’re starting off with this idea, if you’re in a culture where it’s not like completely embraced, it’s going to be hard for you to go from, you know, sedation clean line, like clean sheets, clean lines, everything looking pretty to let’s get this piece of 18 patient up and walking, like that’s just not possible. So just starting small, and then celebrating the small wins is my best advice.

Kali Dayton 29:11
I love it. I love it. And I think it is a skill set of working people through getting comfortable on the ventilator working through navigating the lines, feeling comfortable with that, and then assessing how they’re tolerating and going through a process. So it is such a learning curve. But when everyone understands the why what they’re working towards, and when you’ve seen successes like you have now that’s going to be a huge driving factor. And I think everyone’s going to be haunted about anyone that’s getting any kind of different treatment after that and they know that there’s a totally different route that they can send their their patients on.

Nora 29:50
Right

Kali Dayton 29:51
So, Nora, did you guys have to drastically change your staffing to make this happen?

Nora 29:55
I would say yes or no because recently our boss has done such a phenomenal job of making sure that we’re adequately staffed, especially since COVID started and we got hit with, you know, such high acuity and really needed all the help we can could get at the time, she created a shift for a resource nurse for 11 to 11. And having that has really kind of helped us trust in the fact that we have adequate staffing.

However, I don’t think that having more staff is what resulted in the successes that I described. Because we were able to do these interventions and liberate early on, so that the patient hadn’t deconditioned to such a point where they did need, you know, five, six people in the room to help, you know, either get up to the edge of the bed or help calm down as they emerge from sedation and in delirious state. Yeah, definitely.

Kali Dayton 31:03
How has this impacted your career and your fulfillment in your career, even during this crazy pandemic?

Nora 31:08
Yeah. So I feel lucky to have had this experience early on in my career. And I think that before, you know, you’re trying to figure out, you know, how just to navigate your unit as a new nurse? And is this what I want to be doing? Like? It’s, you’re asking yourself these questions. But when I learned about this, and I got involved in this project, I was like this, is it? Because I’m always wondering about the why.

And if there’s not an answer for the WHY, or a good one. Like, I want to figure out well, why is that like, like, let’s let’s dissect this more. And I think that, you know, having patients awake and mobilized and implementing, you know, I see liberation into our ICU nursing care, answers the why we’re here because we want to help people get better. And if this is going to help, and you know, time and time again, the evidence is proven, and the patient stories have proven that this is effective in getting people out, then, you know, that’s just it’s so fulfilling for me to say, I’m an ICU nurse with that premise in mind.

Kali Dayton 32:29
And you should be so proud of what you’re accomplishing. And your whole team, keep us posted. I want to hear more success stories. I want to hear all the stories we all do, because that is what is bring the change.

Nora 32:43
Yeah.

Kali Dayton 32:44
Anything else you would add?

Nora 32:48
I don’t, I don’t think so. I mean, just, I, I can definitely sympathize with someone who is listening to this. And, you know, wanting to change but not knowing where to start. And I just want to re emphasize, you know, you can do this, but it just starts with one person. And one little change, and then it has a ripple effect.

Kali Dayton 33:08
So I’m happy to do webinars with any teams that are interested in seeing videos here and a full explanation. I try to condense, you know, the 57 episodes into a 45 Minute Webinar.

Nora 33:19
and it is wonderful! I mean, that was such a, I think that was a big… having the webinar was a big turning point for us.

Kali Dayton 33:28
Everyone’s gonna have doubts.

Nora 33:30
Sure.

Kali Dayton 33:30
Even after the webinar, I’m sure there were some doubts, but almost having an objective third party come in, or some of that’s done it to say some of the hard things, to identify some of the problems and the culture, where sometimes when it comes from your colleague, it can kind of cause some tension. And no one wants to point fingers. But when someone comes in and says, “This is a problem”, and so they can get mad at me, but I don’t work there. So… I think everyone was really open and kind. And I’m glad that it was so effective. And I’m happy to talk to any team that’s interested in hearing and seeing all these stories.

Nora 34:02
Yeah.

Kali Dayton 34:03
Well, Nora, thank you so much. This has been incredibly powerful, and we’re excited to hear more from you later.

Nora 34:08
Yeah. Well, thank you for having me. I can’t believe I’m on your podcast.

Kali Dayton 34:13
You’re powerful. You’ve made the podcast. Thank you so much.

Nora 34:16
Thank you.

Transcribed by https://otter.ai

 

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