Real teams are the antidote to the chaos of modern medicine. “Real teams know each other, feel loyalty to one another, trust one another, and would not want to disappoint one another” (Tom Lee, NEJM Catalyst 2016). Practicing are conversations between real team members about why the work matters. Our goal is to preserve and share the stories of the teams at University of Utah Health.
Nursing director Cynthia McComber and recently retired infection prevention manager Cathy Gray met in the mid-1980s as staff nurses on 5 South, University of Utah Health’s pediatrics unit. When Cathy became the nurse manager, she promoted Cynthia into her first leadership role as assistant manager. Their careers grew from there — twisting and turning through many different parts of University of Utah Health. On the occasion of Cathy’s retirement last month, she and Cynthia sat down to talk about what they’ve taught each other and how they've developed as leaders.
Question 1. [Mari Ransco] What's your first memory of each other?
[Cathy Gray:] In March of 1984, 34 years ago, I was a student nurse at the University of Utah, and for my final quarter of school I was placed on the pediatric unit. I was intimidated when I first met Cynthia. She seemed to know everything. She was so good with the patients, and I was intimidated by taking care of patients at that point in time. We dealt with kids who were in pain. She had such an easy way with everything and didn't get flustered if parents were upset. She took it all in stride and was a great role model to me as a student nurse. She was always happy and made work fun. I hadn't thought of my experience in a work setting as something that might be fun. And it was — really fun.
[Cynthia McComber:] That's interesting Cathy brought up the student part because I've forgotten about her being a student. When she started to work on our unit, people naturally gravitated to her — she was a born leader. At the time, 5 South was in a lot of flex. It was a super busy 40-bed pediatric unit. The summers were crazy. We took care of chronically ill kids, and then we couldn't keep a manager. We all felt as a group that Cathy would make a great leader, so we rallied around her and supported her. In reality, if you look back on it, she was essentially a new grad put into this leadership role. I had confidence and faith in her, though, that she would rise up to the highest level. I started as a staff nurse the year before Cathy started, and I knew I would follow her.
Question 2. [Mari:] Cathy, how was Cynthia fun?
"I hadn't thought of my experience in a work setting as something that might be fun. And it was — really fun."
[Cathy:] She recognized that children weren't just little adults. She didn't just leave them languishing in their beds between medications; instead, she really engaged with them. She got to know them on a personal level — what they liked and didn't like. We played with the kids as part of work, which was really terrific for me. I really never intended to be a nurse and didn’t select the pediatric unit. Cynthia actually invited me to CF camp for all the children with cystic fibrosis. That summer was such a wonderful experience for me. They still had to do their treatments and get their medications, but it was really play. Even in the hospital setting, there was always time to play with the kids.
[Cynthia:] It wasn't just the children, either. We learned to develop relationships with their families. The things we went through on that unit with death and dying and the pain… that brought us together. We were like this work family. It was very tight-knit and emotional. It really was a good time.
[Cathy:] I liked to work the night shift, when we would play dirty word Scrabble with the older adolescent kids. They were not only sick; many of them were dying. Out at the nurse's station was a safe place for them to be who they were — not just a sick, dying kid in a hospital. They could hang out with their peers. I felt privileged to be included in that group. All the textbooks back then would have said, "Don't develop any kind of personal relationships with your patients. There's gotta be an us and them. You're the professional, they're the patient — those lines should never be blurred." Cynthia showed me that those lines indeed had to be blurred to be as successful as we were providing outstanding care to those kids, not only from a medical standpoint but from a personal standpoint as well.
Question 3. [Mari]: How did your time on 5 South influence how you think about teams, culture, and patient care?
[Cathy:] It was a huge influence. It established a really great base. Like I said, I never intended to be a nurse — I was just getting a nursing degree because I'd been in school for so long and didn't know what I was doing. I think of my career at the University of Utah as a series of being in the right place at the right time. I've been really fortunate to work here for 34 years — but I’ve had 11 different jobs.
That first job on the pediatric unit really set me up for success in understanding the importance of relationships with patients, families, staff members, physicians, and ancillary personnel. As part of our 5 South family, we included every member of the team. We had two terrific housekeepers that were part of our family. We had a dietitian, a school teacher, a child life therapist, a respiratory therapist, a physical therapist, physicians, and pharmacists. The whole team really came together and helped us provide outstanding care to that patient population. Every member of the team was so important to the outcomes of the patients that we cared for. I understood the importance of every single member of the team.
"You treat people as you want to be treated. Respect gets respect."
[Cynthia:] Cathy's leadership solidified so much for me. When I refer to my management style — how I approach my team and how I approach people — I always refer back to what Cathy taught me. You treat people as you want to be treated. Respect gets respect. Your team is so important. Those are the exact skills I learned from Cathy. She taught me how to carry myself.
Question 4. [Mari]: You’ve both used the word “family.” Tell me about that.
[Cathy:] I really got to know all the members of the team on a personal level. It wasn't just, "There's the housekeeper taking out the trash." The two I mentioned were a really important part of our team, and they learned how to work with the kids. It was different than working with adults. At our core, we understood the importance of relying on one another to fulfill each person’s role. That’s a family. You understand the role each member of the family plays. Within that family, you know who you rely on for what. You have an emotional connection. That’s different in a work environment.
[Cynthia:] In a family, if you can't deal with something, someone will step in and help you. That's exactly what happened on a daily basis on 5 South. If you were really getting burnt out, taking care of a family and a child that maybe was dying, we had each other’s support. It went hand in hand. We would take care of each other so we could take care of these kids. Because it was very intense work, you had the opportunity to step back and know that someone else equally qualified could step in and take care of that child that day.
[Cathy:] We attended funerals of patients together. That was one of the first impressions I have of Cynthia — her inviting me to attend Todd's funeral. He was one of the first patients who died while I was a student on the unit, and I was taken aback by it because there was this textbook separation: “What do you mean, go to a patient's funeral?” But I went to Todd's funeral with the 5 South family. It provided closure to the experience that I'd had with Todd as a patient, but more importantly as a person. That became an important part of what we did because so many of our patients died.
[Cynthia:] Even after these children would pass away, their parents would come back to see us. We were woven into their lives. Even our chronically ill patients that would be here for a doctor's visit down in kidney clinic would make a point to come up, say hello, and bring their child. We had the very first AIDS baby on our unit. We were all frightened by that. Then fast forward 10 years maybe, when we had another a baby with AIDS and a mom who was HIV positive. The entire staff wrapped their arms around this baby and the mom. We did it as a team. It was a family. We're still in touch with many of them today.
Question 5. [Mari:] What are you most proud of in your career?
[Cathy:] My role as a leader and the influence I had with so many other people who are now in leadership positions. It’s like a legacy. I helped people understand the importance of team and the importance of respect. That continues on even after I'm gone.
[Cynthia:] The proudest thing for me is taking those experiences and moving forward in my career. When I'm upset or dealing with difficult situations and difficult patients, I can fall back on that base that I brought with me from 5 South. That has helped me grow exponentially. I'm proud of what we accomplished on 5 South.
[Cathy:] I have to say, it's not only the people who have grown into leadership roles but all of the people I worked with over the years, whatever role they're in. I've worked with just about every department over the last 34 years, and I hope impressing upon them the importance of teamwork and respect has had a really positive outcome for patients.
Question 7. [Mari:] Cynthia, what is the one thing that you want to make sure Cathy knows?
[Cynthia:] How grateful I am for the opportunity she gave me. She had the trust and confidence in my abilities to put me in a leadership role. That started my journey. I always knew I was going to be a nurse. That's my first memory, taking care of my grandpa when I was 3 years old. But I never intended to ever be in a leadership role. I was always going to be a nurse. Because of Cathy — how she treated us, what she taught us — I started on that leadership journey. Cathy trusted that I could be her assistant.
[Mari:] Cathy, what's the one thing you want Cynthia to know?
[Cathy:] I would not be retiring after 34 years at University of Utah Hospital if it weren't for Cynthia. I would never have come to work here if it weren't for her. I didn’t intend to be a nurse — I was going wherever they put me. Cynthia included me as part of the 5 South family and made me want to be part of that team. I had that wonderful student experience and then really loved 95% of the last 34 years. It would not have happened if it weren’t for Cynthia.
Question 8. [Mari:] What advice would you give others who are looking to have a 35-year career at University of Utah Health?
[Cynthia:] When I became a nurse, I took a $2 cut in pay from my job as a checker at Albertson’s. I didn't even sign up for disability — that was for old people. I seriously had no plan. I knew I wanted to be a nurse and was given a list of areas to choose from and said, "Pediatrics sounds fun." It grew from there.
You have to have a love for what you do. The day that this is not fun or doesn't inspire me — the day that it is not a joy to accomplish things or motivate people — that would be the day I’d say, "I need to rethink this." You have to have a passion for what you're doing. If you don't, then you need to find it. That’s a good part of my role, and I've had lots of conversations about that with many people over the years. We work too many hours. Too much time of our lives is spent working. If you're not passionate about your job, I just can't imagine the drudgery of coming to work and hating to be here. That would be my message to people: you have to love what you do so that you can make a difference.
"The patient doesn’t care about the bureaucracy, the red tape, the changes in leadership, and the turmoil that happens behind the scenes. They care about their experience as a patient, wherever they are within our health care system."
[Cathy:] For me, it's always been about the patient. I have had 11 different jobs, and whatever role I've been in — at the bedside providing care to the patient and the family, or as an administrator in an office far away from the patients — the patient's always been my primary concern. That's my passion. You have to have an ideal that keeps you coming back, even when 5% of the time it's not so great being here.
I've always maintained my focus on what I can do to make sure that the patient gets the very best possible experience and outcome. I have always strived to make that better — that's what's kept me going. The patient doesn’t care about the bureaucracy, the red tape, the changes in leadership, and the turmoil that happens behind the scenes. They care about their experience as a patient, wherever they are within our health care system. We have to strive to improve and make sure that they're getting the best possible outcome.