I have the privilege of working with a team of 20 nurse leaders in a health care system that is undergoing change at all levels. In the past 18 months, they have experienced senior-level leadership transitions; new, high-profile community alliances; major service expansions; unpredictable census spikes; and the opening of a new hospital. They have also endured significant staff shifts and some reductions in force.
The leaders who remain have expanded scopes of responsibility and larger workloads. Some feel ill-prepared for the bigger roles they have been asked to assume. There has been no doubt that these leaders are stressed and exhausted. Yet consistently, their behavior demonstrates a fierce commitment to their organization and especially the patients they serve.
Although the team’s determination to excel in this environment is noteworthy, their culture of self-care is the focus of this article. When I first encountered this group a few months ago, they looked world-weary. Their fatigue was palpable, and it was seeping into their interactions with each other, and probably with their patients and families, too. If they hadn’t said they were worn out, I would have known anyway because the signs were so obvious.
Here’s what was happening:
- Many, if not most, were working long hours for long periods of time.
- Many, if not most, were not exercising regularly or sleeping well.
- Some had daunting responsibilities at home as well as at work. Their family challenges included illness, poor financial health, and difficult relationships. Others had professional challenges including charge nurses who were not prepared for their new roles, and/or staff who were also exhausted from the effects of so much change.
- Many were concerned that their staff would leave.
- Many, if not most, were discouraged by the amount and seemingly unending pace of major change. They were trying to do the right thing, but they were disheartened because they could not catch their breath.
Deeper patterns were evident, too, including the group’s frequently articulated intentions to “do better” with self-care. But when circumstances at work didn’t change, many abandoned those intentions. Then they felt worse.
Despite their CNO’s (chief nursing officer’s) interest in empowering the team to solve their own problems and to care for themselves, their capacity to manage their challenges was severely limited. They needed creative solutions, but their depleted states rendered them incapable of anything more than the basics. Their daily leadership choices were reactive rather than strategic and thoughtful.
This tableau may seem extreme, but the heavy weight of this team’s responsibilities is not unusual. But what is noteworthy is what Danielle, the CNO, did about it.
First, she made a commitment to a multipronged, multimonth customized leadership development initiative for these leaders. However, it’s not her commitment to “leadership development” that is column-worthy. What is worthy of our attention is the influence Danielle wielded when she stepped forward and spoke candidly about her own self-care demons.
In the team’s first retreat, Danielle took the floor. In less than 10 minutes, she talked about her lifelong habits of working too hard and making herself constantly available. She reflected on eating too much and exercising too little. She also shared what she was learning about herself. She told the team that when left unchecked, these behaviors were destructive to her and to those around her. She owned the fact that her ways of leading had contributed to a culture of overwork, excess stress, and ultimately, a less than fully productive workforce.
Danielle went on to candidly share what she was doing to reverse course, including working fewer hours, getting more exercise, improving her nutrition, and setting a better example for all who looked to her for leadership, including
those in the room.
Danielle concluded her brief talk by telling the team to get their work done and then take time away from their jobs. She explicitly gave them permission to “leave the building and go home.” She specifically said, “It’s not about being here all the time.”
These words may sound simple, but she meant them, and they were potent. When I returned to the system 5 weeks later, I learned that as many as half of the team left right after that offsite meeting. They covered their bases, but they didn’t return to the hospital until the next day—and the retreat ended at 1:00!
What followed was even more significant. Danielle didn’t just say these words once. In the months that followed, she modeled them. She demonstrated that her commitment to her own self-care was real. She had always worked long, long hours, but
she cut them back. She also stopped sending nonurgent e-mails on weekends and late at night.
Danielle has followed through on her personal commitment to better health, and as the months have gone by, the results of her new-found regimen are unmistakable. Her promise to support the team’s self-care for the long-haul is evident, too. She regularly asks the team how they were doing with their own self-care strategies. And here are just 2 of the outcomes:
- When a few of the team members made commitments to exercise more, work shorter hours, and eat properly, many others did the same thing. Danielle’s permission-giving and behavioral examples reverberated throughout the team. The leaders weren’t just following Danielle’s lead, they were following each other.
- What started as self-care in the literal sense grew into self-care in the broader sense. Most of the members of the team report that they are saying “no” more often. They are also speaking up frequently; getting organized and staying organized; and teaching partners and direct reports what they need to know and holding them accountable for doing it.
This did not begin as a formal study, so these results were not measured. But it is clear that these leaders and those around them are benefiting from the wonderful results this dedicated team has created. As they go forward, the team’s members are supporting themselves by helping each other stay on track and providing solace when they don’t.
As Danielle predicted, the rate and amount of change are not slowing for this health care organization. The environment in which these leaders operate is the same, but the team is not. Now, they create and implement strategies to live with and even excel when the demands are stressful.
Danielle’s efforts to inspire and the team’s commitments to better their self-care are not perfect. Their good intentions to leave earlier, eat well, and sleep enough are not always realized. But this team and their leader have been successful enough. When I work with them now, I am partnering with awake, engaged leaders who are eager to learn and practice new skills and behavior. Their “culture change” is real, not perfect, and their momentum is real, too. And, they show no signs of slowing down.
* This article was originally published in Nurse Leader