We honor National Nurses Week by featuring an in-depth interview with Margo B. Minissian, PhD, ACNP-BC, NEA-BC, FAHA, FAAN, cardiac nurse practitioner and leader, Cedars-Sinai, Los Angeles. Dr. Minissian’s broad scope of work bridges bedside care and scientific research, and she is a passionate champion for a future where nurse-led innovation drives better outcomes for all.
Watch the video episode on our Nemours Children’s YouTube channel.
Guest:
Margo B. Minissian, PhD, ACNP-BC, NEA-BC, FAHA, FAAN, Executive Director, Geri & Richard Brawerman Nursing Institute, Simms/Mann Family Foundation Endowed Chair in Nurse Education, Innovation and Research, Assistant Professor, Cardiology, Cedars-Sinai
Host/Producer: Carol Vassar
TRANSCRIPT
Announcer:
Welcome to Well Beyond Medicine, the world’s top-ranked children’s health podcast produced by Nemours Children’s Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.
Carol Vassar, podcast host/producer:
Each week, we’ll be joined by innovators and experts from around the world exploring anything and everything related to the 85% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar, and now that you are here, let’s go.
Music.
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
Where there’s a nurse, there’s an idea.
Carol Vassar, podcast host/producer:
That’s the voice of today’s guest, Dr. Margo Minissian, and it’s a statement that captures not only the spirit of National Nurses Week, which is happening right now, but also the essence of the broad scope of work she does in the field as a nurse practitioner, a researcher, a scientist, a mentor, and a nurse leader. Dr. Minissian is chief executive of the Barbara Streisand Women’s Heart Center and holds the Simms/Mann Family Foundation chair in nursing at Cedars-Sinai Health System in Los Angeles.
She’s also Cedars-Sinai’s executive director for Nursing Innovation and Research, and we’re going to touch on all of those roles with Dr. Minissian in this podcast episode. Starting with her work in nursing innovation, where she and her colleagues are putting nurses at the center of creating the technology that they and their peers will use at the bedside. You might ask why it is important that nurses move front and center when it comes to technology development and research. That was my first question, too. Here’s what Dr. Minissian had to say.
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
That’s such an incredible question. I feel that I have the best job in the entire planet because I get to help incredible, brilliant nurses who innovate in and out of their day every day, create products, goods, and services that help benefit not only their role in providing the best care possible, which we do at Cedars-Sinai, but to help our patients find those solutions and answers to navigating a very difficult pathway when you’re sick.
And hospitals inherently have been known for the sick, we have turned that upside down, and we like to think of Cedars-Sinai as a place to go for wellness and for healing, and our nurses innovate in and out of that all day long. So helping them navigate the process on how to take their ideas and turn them into reality is what my team does within nursing innovation.
Carol Vassar, podcast host/producer:
Oftentimes, a nurse will be on the floor, they see something, they think it should go like this, and it’s your job, also a nurse, to make sure that it happens or at least research if it can happen. So, tell me about the innovation for the Nursing Transformation Center and the projects that you’re working on there that are really showing some promise.
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
If a nurse comes up with an idea, which they do all the time, Dr. David Marshall, who is our senior Vice President at Cedars-Sinai, he’s coined the phrase, where there’s a nurse, there’s an idea. And he’s so right, they have multiple ideas, number one, you have to be able to funnel and capture these ideas. One of our nurses had an idea on how to capture ideas. he created an ideation station, which is an innovative platform. He has filled out an invention disclosure form himself, he put himself through doctoral training at Yale Nursing Innovation, and he just graduated in June and is developing this platform.
So we’re using him as the case example on how a nurse will innovate with his platform. He’s paved the way for other nurses to put their ideas in. We now have about 25 ideas that have been submitted through his platform in the last month. We get about 25 new ideas a month.
Carol Vassar, podcast host/producer:
Tell me how that works, a nurse comes up with an idea, walks off the floor, goes over to their computer, and says, Here’s my idea?
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
There’s a QR code on the computer, on the workstation. They take a picture of it, they put in their information, a little brief synopsis of their thoughts around that idea, and then they can schedule an appointment to meet with one of us on the innovation team. Then we start to walk them through helping them develop that idea, we do the research behind, we work hand in hand with our innovation and on the health technology end, so we’re not reinventing processes that Cedars-Sinai is already very good at.
Our tech transfer team does an amazing job with helping with the environmental scanning, and then on the back end, I’m in PubMed searching it from a literature perspective, like, what is peer reviewed and published, if it is. Sometimes what they want it already is there, and I can wheel them and say, here it is, and this is the gold standard for doing this, and we can bring them that process or that idea to their units.
Carol Vassar, podcast host/producer:
It’s already fully formed?
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
It’s ready. It may be something that isn’t an aha moment, it may be something that is happening on the East Coast, or it’s happening in another country, and so it’s bringing it to them where they’re at, where they’re working. But many times their ideas are novel and new, like Greg’s platform, and so now Greg will be the owner, he’ll have 46% of all the revenues that will generate off that product once it’s fully developed. And so now you have nurses as inventors and being able to benefit from the revenues and the gravitas and everything else that comes with being novel with idea creation.
Carol Vassar, podcast host/producer:
From the moment an idea is submitted on this platform to the moment it goes live in practice, how long does that take?
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
It depends on the innovation, but typically, like most things, that needs to be tested, it goes quite quickly. It goes fast in the beginning, you get up to a certain stage. We’re actually quite quick, even with a patent process. Cedars is very good at this type of work, and they’re so supportive of our nurses. That piece even moves rather quickly when it’s done right, but then we have to pause, and then we need to validate. So we still have that research component, that test of change component that’s so important, so there are certain things that you can wield quickly, but then you need to make sure that the quality, the research and the data collection is there and then we let the data drive our decisions on, is this something we move forward with or not? It can take months, I would say, we’re trying to have it not take years.
Carol Vassar, podcast host/producer:
I want to change the subject a little bit, go to maybe another one of your jobs, and talk about the fact that there is currently a chronic, prolonged shortage of nurses in our nation. You’re a nurse leader at a large healthcare system. You practice half a day a week, which is nice to have your foot still in that role. What challenges do you face when recruiting the next generation of nurses?
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
There’s a paradigm shift in nursing. When I was a young nurse, I remember working a hundred shifts in a row, and coincidentally, this was 25 years ago, there was a nursing shortage then, too. I remember working in the ICU at UCLA and looking over, and the ICU director was taking patient assignments on the night shift next to me.
As a leader now, I’m in a position where I want to avoid having our teams find themselves in these tough places where staffing is a challenge or finding the right expertise is a challenge. So we really work very, very hard to make sure that our teams have everything that they need to take the best care of our patients. So number one, there’s some pros to some of this. We’re a little blessed because we’ve got great branding, we’re in Los Angeles, we have beautiful weather, we have terrible traffic, we have beautiful weather, it’s a desirable location.
I find that recruiting talent to the West Coast is not as challenging, but this generation, they’re not working a hundred shifts in a row; they work to live, they’re looking for balance in their lives. I think there’s a lot that we can learn from today’s bright, intelligent young nurse, where they are learning to balance their family, their own mental health and well-being, and translating that at the bedside and taking the best care of their patients.
We offer a multitude of different types of staffing opportunities that we didn’t used to do, you were either full-time or you weren’t. And those days are over, as leaders, we need to pivot and we need to adapt to our workforce and what is desirable for them. And so I find that all of those things have become very enticing. Plus a lot of nurses love this innovation space, and truly if you can dream it, you can come up with it and they know that’s the case and we listen. And I think that’s also very vital and important for a professional nurse today, they want leadership that listens to them and will make those pivots with them.
Carol Vassar, podcast host/producer:
I want to ask if with generative AI in particular, if that can potentially, certain platforms alleviate some of these shortages, maybe take some of the burden off the nurses who are in the field or coming into the field and make it just a little bit easier and less taxing?
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
The dream is that, but with innovation, usually early, we’ll add to a plate, so change management is key. There’s up to 40% of a nurse’s day that is what we call hunting and gathering activities. It does not take a master’s or a doctorate or years of experience to try and find the IV pump, or to try and find the right tubing, or to try and find the right Pyxis machine that is holding the controlled substance in it. Half of their day is spent trying to look for the right resources.
So we need to be better, and I feel that AI can be directed at helping to remove off their plates the things that are non-nursing focused and just problems that are non-nursing problems, but land on nurses’ laps because they’re the orchestra leader at the bedside.
Carol Vassar, podcast host/producer:
They are and they’re the most trusted profession, probably not only in healthcare, but across most professions.
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
That’s right, they are the most trusted profession.
Carol Vassar, podcast host/producer:
When you look at the profession of nursing and how it has become more technology-focused, especially with meaningful use coming in, electronic health records coming in, have we lost some of the art and the humanity, and how do we get that back into the picture for the patients?
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
It’s never lost nursing, nursing is all about patient caring, human-centered caring, and it is an art, and it is woven within our practice. With that, it’s important that patients and other healthcare providers and nurses understand that these technologies are here to augment our healthcare team, none of it is there to replace it, and so having screens between us or having monitors beeping at the bedside.
Still to this day, unless I’m in an ICU with, like, a fresh transplant patient, I can’t think of a reason why we need monitors beeping at us at the bedside. When I think of technology and innovation, I actually think of a peaceful quiet room that has plants in it and has wearables on the patient and the nurse and the healthcare team are carrying a tablet or a device, but that’s it, and it’s a place of healing, it doesn’t have to look sterile and cold and removed to be technically advanced, it’s almost like an Apple model.
Carol Vassar, podcast host/producer:
Interesting, expand on that.
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
The beauty behind Apple is the complexity that sits behind the simplicity, and that’s how I view and how I envision tomorrow’s nurse and our healthcare process going. It’s going to look less like the Jetsons and it’s going to look more like a room in your home, it may be the room in your home.
Carol Vassar, podcast host/producer:
It may be the room in your home. Well, talk about that, is there a move away from hospitals and toward home care?
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
It has been moving in that direction for the last 20 years. The patients that are on our floor are the patients that used to be in our ICUs. The patients that are in our ICUs used to be passed, and hospitals today are really reserved for people who are acutely ill. And so we really need to transcend healthcare into this wellness space and to keep people healthy and well, and to help empower people to be their own individuals empowered over their own care, and to keep that care at home as much as possible.
And through wearables and technologies and digital health and strategies, we now have tools as healthcare providers to deliver that care. I direct a postpartum heart health program, and I take care of young mothers who have postpartum hypertension, and they have little babies at home, and the last place that they need to be is coming into a medical center with a newborn for me to adjust a blood pressure medication. I love it when I have them do a virtual appointment with me, and they’re sitting under a tree in a park, and they’re watching their three-year-old dig in sand, and I’m adjusting their blood pressure medications.
Carol Vassar, podcast host/producer:
You are a cardiovascular health specialist-
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
I am.
Carol Vassar, podcast host/producer:
… Nurse practitioner, you’ve done some really groundbreaking research in that area, another one of your jobs apparently, especially during pregnancy as you noted. Give us some highlights of your latest work in that area.
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
Well, it’s interesting that with all of the technology, with all of the innovation that men and women worldwide still die of heart disease, which is a preventable disease, over 90% of individuals who have it. I started in heart-lung transplant and have worked my way into cardiovascular prevention, trying to get ahead of the disease. I love these young women because they have infants and small children, and they themselves, for the most part, they’re young enough that they haven’t hit anywhere where they’re in a disease profile yet. So we can teach them, we can mitigate, educate, and then they transcend that to their children and then they’re teaching their children healthy lifestyles and they’re cooking for their families, and they know about Mediterranean style nutrition, and it’s more than just fitting into your genes after you had your baby, it’s about your wellness inside.
Carol Vassar, podcast host/producer:
I also want to talk about nursing education, another of your many roles. In October 2023, you co-authored an article for Nursing World, and it was called Journey Toward Digital Transformation in the Age of COVID-19. Tell us more about this article and how digital transformation was used to create a better system of nursing education that, in and of itself, relieved some of the stress on nurse educators.
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
This was a super exciting space, very, very exciting, a little scary because when I was brought in as the executive director, they were doing everything in pen and paper at that point at Cedars-Sinai. I am a flower guest, early February, March of 2020, everything was pen and paper.
Carol Vassar, podcast host/producer:
And this is in the nurse education?
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
In nursing education, yes. All their competencies, all their assessments, all their testing, everything was all in pen and paper, and I thought, this team is going to hate me because I’m going to push them into digital, and COVID hits. And my first day on the job was April 13th, 2020.
Carol Vassar, podcast host/producer:
Pretty early.
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
And we had a week to get digital because we had to, and we had a new grad nursing cohort starting, and that first week on the job, I had to decide if nursing students were going to continue or not coming into the hospital. If new graduate RNs were going to be coming into the hospital or not, medical students stopped coming in, what were the nurses going to do? So we had to go digital.
What we did was, I grabbed what we had that was already available to us, and it was free and accessible, and it’s called REDCap, and it’s a research tool; every major medical center across the world uses REDCap, but in the research space, it has never been used in education. But in a matter of two weeks, the nurse educators loved it. It probably had 300 RNs trained on it, so it already transcended beyond just the educators; they started to train others on it, and so we used it as a primary platform until we could find a better digital strategy.
As we were looking at different platforms, depending on what the need was, we used REDCap as a general plug-and-play/repository. It has a lot of basic functionality to it. Then we did some change management strategies in there, we now have a consultant that is helping us with our digital health strategy, they started to look at all these different platforms, Smart Sheets on Teams, who knew Microsoft had Teams? Cedars-Sinai was paying for all of these resources; we weren’t optimizing the resources that we had. That was probably one of our biggest lessons learned during COVID: we were almost spoiled, if you will, and not having to optimize the resources that we already had at our fingertips. That was one of the most important, I would say.
Carol Vassar, podcast host/producer:
When it comes to COVID, do you think People are discouraged from going into the field of nursing or encouraged to go in?
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
It’s a U-shaped curve, both. They are, in my opinion, in many ways still exhausted; they’re still trying to just not feel exhausted. So when we now are really trying to pace our teams, which is very important for their health and well-being, so we do pulse surveys on our teams to make sure that they’re doing okay in this space around their own wellness, because COVID was such a suck on everybody’s physical and mental well-being.
But innovation emerged, I feel like we innovated 30 years in three, and that is very exciting and very energizing. And I see innovation being the paradigm shift that healthcare needs for us really to pull out of this traditional way that we’ve always cared for patients, which we know is financially non-sustainable.
Carol Vassar, podcast host/producer:
You are a healthcare leader at Cedars-Sinai. What advice do you have for aspiring nurses, aspiring nurse scientists, and young professionals who want to follow in your footsteps?
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
Be open-minded, go talk to other nurses, go talk to non-nurses, find some time to dream, if that’s your commute home. For me in LA, I just have this massive commute, and sometimes I’ll turn on some symphony music, or I’ll even just shut the radio off and just be alone with myself and allow myself to start to daydream. I think it’s an art that is being lost, and I’m hoping that more people gift themselves time for daydreaming.
Carol Vassar, podcast host/producer:
And in that daydreaming comes innovation.
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
It does.
Carol Vassar, podcast host/producer:
Anything else I haven’t asked you that you would like to share?
Margo B. Minissian, PhD, Executive Director, Geri & Richard Brawerman Nursing Institute, Cedars-Sinai, Los Angeles:
Number one, thank you for this platform, it’s absolutely wonderful. For those that are on the other end who are listening in, if this excites you, be open, learn something new. Every day I find that there’s something new to learn, and that’s what makes getting up in the morning and doing that commute, it makes it so much fun because I know that I’m going to learn something new that day and then we’re going to share and we’re going to gift it and pay it forward. Thank you so much for having me here, it’s such a delight.
Carol Vassar, podcast host/producer:
Dr. Margo Minissian is the Chief Executive of the Barbara Streisand Women’s Heart Center and holds the Sims/Mann Family Foundation chair in nursing at Cedars-Sinai Health System in Los Angeles. She’s also Cedars-Sinai’s executive director for Nursing Innovation and Research.
Music:
Well Beyond Medicine!
Carol Vassar, podcast host/producer:
Thanks so much to Dr. Minissian for taking time from her incredibly busy schedule to join us on the podcast. And thanks to you for also taking time from your incredibly busy schedule for listening.
Anytime, anywhere we look for what’s happening outside the doctor’s office that affects children’s health, and your ideas for the show are always welcome. Email us at [email protected] or leave us a voicemail on our website, nemourswellbeyond.org. That’s also the place to subscribe to our new monthly e-newsletter, where you can get a recap of recent episodes and a preview of what’s ahead. You can also go there to subscribe to the podcast if you haven’t already, and find all of our previous podcast episodes, which are also available on your favorite podcast app and on the Nemours YouTube channel.
Our production team for this week includes Cheryl Munn, Susan Massucci, Lauren Teta, Steve Savino, and Sebastian Riella. May is Mental Health Awareness Month, and the episodes for the remainder of this month focus on issues surrounding the mental health of children, teens, and young adults. Next time, when we talk with Dr. Anita Ravi, founder and CEO of the Purple Health Foundation, don’t miss it. I’m Carol Vassar, and until then, remember, we can change children’s health for good, well beyond medicine.
Music:
Well Beyond Medicine
