How can we improve the health of our own?

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The healthcare literature is replete with articles that comment on and detail burnout. Read what Whittington et al. (2021) explain. Nurses often work in high-stress situations. The critical nature of patient care, particularly in intensive care settings where patients' stability fluctuates, significantly contributes to workplace strain and tension. Additionally, the interpersonal relationships that form within a multidisciplinary team of care providers can add to the challenges. Critical care units, surgical areas, and cardiac interventional units are among the highest stress-producing environments due to the demanding nature of the work. As such, scholars have identified three mental states linked to burnout, including psychological fatigue, professional detachment, and a low sense of professional fulfillment (Whittington et al., 2021). Can anxiety about work be related to burnout?

Let us examine a passage recorded by the Greek poet Lucretius, who lived from approximately 98 to 55 B.C., bearing in mind that mental health practitioners, including therapists and psychiatrists, now have a better understanding of what the ancient Greeks recognized over 2,000 years ago: the physical symptoms in the body that arise when experiencing anxiety or depression, which often occur together and can be a symptom of burnout as well.

But when the mind is excited by some more vehement apprehension, we see the whole soul feel in unison through all the limbs, sweats, and paleness spread over the whole body; the tongue falter, the voice die away, a mist cover the eyes, the ears ring, the limbs sink under one; in short we often see men drop down from terror of mind. (Adler, 1952, p. 32)

Terror of Mind

According to the DSM-5, the diagnostic manual for mental disorders, physical symptoms can manifest in response to anxiety. These symptoms include a feeling of restlessness or being unable to calm down, easily feeling tired out, difficulty focusing on essential tasks, experiencing mental blocks, and muscle tightness (Craske et al., 2022). In other words, the terror of the mind can be debilitating and is connected to the burnout sensation that nurses often experience in their daily patient care routines; this is what is known. In addition, studies have shown that a work environment that supports nurses' well-being and health is associated with positive patient outcomes and lower rates of burnout among nurses in the workplace (Adams et al., 2018). Anxious feelings, such as those described by the early Greeks as the syndrome of terror of the mind, are a poignant symbol of the experiences of nurses and healthcare workers today.

It is helpful to remember that when symptoms of anxiety arise, it is crucial to focus on managing concerns about real or imagined hazards. Healthcare workers are reminded and encouraged, especially registered nurses, to reach out for support when needed. As primary care providers, nurses can overlook the fact that they also face challenges in helping their patients manage illness. Resources are available, and safety networks are accessible for registered nurses. Additionally, excessive worrying and catastrophizing about potential or perceived events in the critical care setting can exacerbate anxious bodily reactions and often serve as preparatory stimuli to facilitate focus and attention. However, when they become unmanageable, they can be debilitating. Most organizations have assets, stakeholders, and services in place to support healthcare workers and should be utilized to the fullest extent when necessary, including their management and leadership teams.

To bring us back to how workplaces can counteract the "terror of mind" and the subsequent feelings of burnout syndrome in healthcare settings, scholars recommend getting to the job cheerfulness and good humor, creating a sense of shared professional allegiance and esprit de corps relationships and teamwork and creating a real sense of professional control over work through open discussing and speaking up (Whittington et al., 2021).

Bill of Rights

According to the American Nurses Association, specific guidelines and directives help nurses and nurse leaders create an environment, as recommended by other scholars, to minimize the symptoms of burnout among nurses. According to the Bill of Rights (ANA, 2022), Directive Number Five states that workplaces should provide support and make resources available, and that a psychologically safe environment should be in place. Whittington et al. (2021) also noted that when a sense of trusting relationships exists, cooperation among staff is present, a speak-up culture and sharing of ideas about the work among staff are prevalent, and staff feel a sense of belonging, workplace cultures can thrive and mitigate burnout syndrome.

References:

Adams, J. M., Zimmermann, D., Cipriano, P. F., Pappas, S., & Batcheller, J. (2018). Improving the work life of Health Care Workers: Building on nursing's experience. Medical Care, 56(1), 1–3. https://doi.org/10.1097/mlr.0000000000000839

Adler, Mortimer J. (1952). Lucretius: On the Nature of Things. In The Great Books of the Western World. (Vol. 12, pp. 1-97). Encyclopedia Britannica.

American Nurses Association. (2022). Nurses bill of rights. https://www.nursingworld.org

Craske, M. G., Manicavasagar, V., Schultz, S. K., Zbozinek, T. D., Wolitzky-Taylor, K., Ollendick, T. H., Muris, P., Mesri, B., LeBeau, R., Brown, L. A., Bogels, S., & Baum, K. B. (2022). Anxiety Disorders. In American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (5th ed., Ser. Text Revision, pp. 215–262). American Psychiatric Association.

Whittington, K. D., Shaw, T., McKinnies, R. C., & Collins, S. K. (2021). Emotional exhaustion as a predictor for burnout among nurses. Nursing Management, 52(1), 22–28. https://doi.org/10.1097/01.numa.0000724928.71008.47

What are counterproductive leadership methods?

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In the words of Epictetus, "If a man possesses any superiority, or thinks that he does, when he does not, such a man if he is uninstructed, will of necessity be puffed up through it" (Adler, 1952, p. 125). Scholars have noted that a leader's character is exposed when their position or security is challenged (Rooke & Torbert, 2005). Leadership lessons in the early stages of one's career often come too late or not at all. Usually, at times, early in one's career, the vocabulary is not present to describe the type of leadership style one has strengths in or an affinity for. For the writer of this essay, the only leadership tool available early in his career was military experience or an authoritarian style, which, if fitting, is often found in governmental hierarchies.

However, in healthcare work, some novice leaders tend to learn from challenging experiences or firsthand situations rather than through classroom instruction, books, or previous non-contextual methods. For example, as a healthcare department leader, ineffective methods became apparent through personal and professional involvement in former leadership roles held a decade ago. With more knowledge, insight, and wisdom now, a current position allows reflection on what could have been done better, even if viewed retrospectively. Additionally, to provide more context and framework for the following essay, past performance recollections and supervisory accounts will be set against and compared with scholarly insight from other business leaders to add value for the reader in this blog reflection.

Novice Leadership Experience

In the wake of the author of Palate and Pabulum's father's passing, a prior unorthodox leadership role dissolved. The previous year, an opportunity to move to this new role was seized with enthusiasm, albeit prematurely, which only became apparent recently. Challenges arise when transitioning to a new role, where the acquisition of subject matter expertise, which was sufficient to support the work ethic in a prior role, may not be enough for the next role. The venture was, in essence, sought after in the spirit of "to go at it blind."

Those firsthand, in-depth experiences, which provided painful, invaluable lessons learned at the expense of personal suffering, have brought great insight into the development and character building that characterizes the person today of the Palate and Pabulum blog. Technically speaking, all people go through growth and development, maturing and transforming, at least theoretically, and leaders often do the same. Scholars have written extensively about the transitions that leaders undergo. They are classified into seven types: the opportunity-seeking type, the ambassador type, the subject matter expert, the man or woman of action, the maverick, the tactician, and the wizard (Rooke & Torbert, 2005). Three transitions, as the author of this blog can identify with both personally and experientially, will be elaborated on in the next section.

Opportunity-Seeker Leader

Scholars such as Rooke and Torbert (2005) describe opportunity-seeking leaders as those who often operate with a top-down approach, prioritizing their interests solely. This leadership style can create a workplace environment of suspicion among staff members, foster leader egoism, and lead to insincere relationships. As the writer of this blog, as an opportunity-seeking leader, the lesson learned was that a positional authority offered some levels of control but denied the access needed to influence and empower others. As Stephen Covey highlights in his work, The Speed of Trust, without building trust in a new role with new relationships, what grows out of new direct report relationships is a feeling and a very raw sense of skepticism about the new leader from those in their employees (Covey & Merrill, 2018, p. 5). Where a suspicious attitude is present, direct reports will not trust the leader in the role.

Subject Matter Expert Leader

Rooke and Torbert (2005) articulate the concept of the SME leader. Those individuals who possess both expertise and skill are the type of people that most teams look to for problem-solving assistance. These individuals have the strengths to tackle challenging tasks and strive for results, embodying the standard for proficiency benchmarks that organizations seek. They are the kind of employees most organizations desire on their teams, especially in patient care. However, scholars note that these individuals can sometimes exhibit a "know-it-all" attitude and operate from a position of perfectionism.

When individuals with a superiority complex become managers or assume positions of authority, their leadership style is often met with disdain. An error and oversight made by the author of this blog was bringing an attitude of perfectionism to the new role, which was a shortsighted strategy. As often as others who practice the subject matter expert leader type style, individuals of this type tend to view themselves as better than others, believing that their opinions, ideas, and objectives are the only valid ones. Rooke & Torbert (2005) explain that this type of leader always thinks they are exact and precise, operating from absolutes. This mindset, which the blog author is cognizant of, makes it challenging for them to consider alternative perspectives, which can hinder their effectiveness as leaders. Examples of being overly critical of others, pointing out flaws, failing to recognize what is going well, and shifting blame to others for deficiencies created an insecure workplace environment in the author's prior role, a hard-learned lesson.

The Ambassador Type Leader

The ambassador-type leader, as the title suggests, focuses on diplomacy and aims to benefit those they lead. They manage their internal reactions to their work and strive to align with the principles and codes of their group and organization. However, they often avoid confrontational and argumentative relationships at all costs (Rooke & Torbert, 2005). While this leadership style is not inherently incorrect, it can lead to outcomes that create the impression of being overly involved, excessively hovering, and adopting a rescuing mentality, particularly in novice leaders. The ambassador-type leader style was, unfortunately, the default approach adopted by the author of this blog in their previous role.

As this blog concludes, a final look at the types of leadership styles that are most ineffective are as follows. The leadership styles that proved most ineffective were the ambassador, subject matter expert, and opportunity-seeking types. The outcomes associated with these styles were far from promising, primarily due to a lack of real-world healthcare leadership experience and insufficient development. As Warren Bennis, a notable business leader, author, and professor, emphasizes, the first tangible exposure to leadership often comes through a trial or an ordeal. It can be an excruciating and insufferable life lesson (Bennis, 2004).

With great humility, it is acknowledged that understanding what does not work is essential for growth. The experiences discussed here are designed to be both curative and therapeutic for individuals who aspire to leadership roles. For those currently in positions where growth and development are significant, the reader can find hope. For the seasoned leader, it is expected that the words are remembered to buffer pride and arrogance while providing counsel and support as they continue on their own personal and professional journeys. These insights are shared to serve and meet various needs as they may arise.

References:

Adler, Mortimer J. (1952). The Discourses of Epictetus. In The Great Books of the Western World. (Vol. 12, pp. 101-245). Encyclopedia Britannica.

Bennis, W. G. (2004). The Seven Ages of the Leader. Harvard Business Review, 82(1), 46–53.

Covey, S. M. R., & Merrill, R. R. (2018). The speed of trust: The One thing that changes everything. Free Press.

Rooke, D., & Torbert, W. R. (2005). Seven Transformations of Leadership. Harvard Business Review, 83(4), 66–76.

Is demeanor essential in management?

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According to Bennis & Thomas (2002), developing a sound mind and maintaining good health can help individuals cope with adversity, challenges, and problems rather than seeking a life free of difficulties. In reality, facing adversity is a common experience. Warren Bennis, a prominent author of many leadership articles and books on business administration and leadership theory, emphasizes that "the journey that turns any individual into a leader is a lonely one" (Bennis & Thomas, 2002, p. 96). Furthermore, we can draw wisdom from the ancient Stoic philosopher Epictetus, who suggested that "if it is true, it is possible to do everything both with caution and confidence" (Adler, 1952, p. 138). How do leaders find a balance between caution and confidence?

In his discourses, Epictetus discusses the concept of transforming from a person exhibiting insolent behavior to someone who leads a dignified life characterized by respectability, sincerity, and independence (Adler, 1952, p. 238). Often, leaders do not demonstrate noble, genuine attitudes or a willingness to help others. Instead, as noted by other scholars, many are opportunistic, using others to achieve their own goals (Rooke & Torbert, 2011).

The idea of training young men is highlighted in discussions about developing essential qualities, as demonstrated in the story of young men training in the wrestling arts. When they fail in a match, they are encouraged to stand up and try again, thereby exercising their will. A stoic approach emphasizes the importance of adhering to one's will and improving one's inner life to succeed in any task.

Epictetus discusses this concept (Adler, 1952, p. 238) by outlining how to eliminate insolent, arrogant, and audacious behavior. He suggests a method of self-talk, where individuals speak inwardly to themselves, denouncing such behavior. The person most capable of persuading oneself to change is oneself. One should engage in reflection and introspection while holding oneself accountable for one's actions and behaviors; it is valuable advice, but it can be challenging to put into practice.

References:

Adler, Mortimer J. (1952). The Discourses of Epictetus. In The Great Books of the Western World. (Vol. 12, pp. 101-245). Encyclopedia Britannica.

Bennis, W. G., & Thomas, R. J. (2002). Geeks & geezers: How era, values, and defining moments shape leaders. Harvard Business School Press.

Rooke, D., & Torbert, W. R. (2005). Seven Transformations of Leadership. Harvard Business Review, 83(4), 66–76.

Is building trust difficult for leaders?

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Healthcare management can be challenging. According to Bennis (1999), the personnel gap is the distance between the growing complex environment and the leaders' ability to deal with it. For instance, daily encounters with helping patients, working with doctors and nursing staff, and all the stakeholders in an acute care facility can be volatile, uncertain, complex, and ambiguous. This is also known as VUCA, which has been written about in other articles, see posts.

Leaders will always be faced with opportunities to learn, and as Bennis (1999) has written, mistakes are the teachers; if a class could be created for university students, the course title would be Leadership-101: You will make mistakes and How to Learn from them. Additionally, as Bennis (1999) reiterates, leaders can emphasize a culture of trust, where trust is present, team members and direct reports will more often than not be agreeable to the leader's viewpoints despite disagreeing with them. In contrast, if trust is absent, changing perspectives, visions, and initiatives will not be welcomed, no matter the buy-in. 

Reference:

Bennis, W. G. (1999). Managing people is like herding cats: Warren Bennis on leadership. Kogan Page Limited. Archive.org 

Are Leaders Fragmented?

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The anatomy of leadership is complex and ambiguous at times. Anyone in a leadership position or with influence at the organizational level can relate to the challenges faced in daily operations. One could stretch one's mind and imagine if the situation befits the analogy of a leader navigating the work environment like a dancer on stage or a wrestler in the ring.

In his Meditations, Marcus Aurelius is recorded for the reader today to remember that a person's character is revealed during times of challenge and for the reference and better analogy than was prefaced, especially applicable in today's environment of complexity in healthcare delivery, consider the wisdom of a renowned Greek Stoic. "The art of life is more like the wrestler's art than the dancer's, in respect of this, that it should stand ready and firm to meet onsets which are sudden and unexpected" (Adler, 1952, p. 283).

Leadership is like a dance, whereas a person skilled at moving across the stage, in tune with the rhythm of music, must remain flexible and agile to coordinate footing with the melodies of sound and action. Likewise, more often than not, and in many cases, leadership is tantamount to the wrestler in the ring, and those in leadership positions are ready to navigate and respond to situations, as mentioned by the late Stoic, that are sudden and unexpected. Suppose the reader keeps an open mind when they occur randomly and sometimes unpredictably. In that case, this concept of sudden and unforeseen events in the work environment can expose a leader's strengths and competencies or their weaknesses and deficiencies. However, that may not be a bad thing.

The Fragmented Leader

Scholars have studied in depth and navigated much theoretical practice in leadership types, strategies, and observations in organizational and business leadership and strategy, what is working and what is not in terms of managing operations, meeting the needs of company mission, vision, and values, and keeping an edge in competitive markets. Some scholars have identified, which is worth noting, that being fragmented, wanting, or lacking in a leadership role may have its benefits, as Ancona et al. (2007) describe.

From the great insights discovered in the journal Harvard Business Review, the person in a leadership role must remove the myth that they are at the helm of the organizational ship. However, an illustrious and tempting idea, though the idea that leadership is at the top and often romanticized, does not exist (Ancona et al., 2007). Instead, leadership scholars describe four elements of the role for best practices, such as the leader practicing daily deciphering and interpretation of current events, or in short, making sense of the daily environment, practicing authentic interpersonal relationships, having the power to see potential forecasts and outlooks and finally being a proponent of creating and developing new ideas to support growth in the organization (Ancona et al., 2007). In a nutshell, the real demands of a leader are to try and make sense of the work, identify with organizational constituents, cast a great vision, and use and implement new ideas. The reality and tough facts regarding actually implementing these four core elements can be daunting because, in actuality, no individual leader could perform all of these functions flawlessly. Without support, a leader feels inadequate, incompetent, or incomplete, as the authors highlight (Anconan et al., 2007).

Although those who engage in leadership perform such roles and do so often from a sense of duty or calling, it is mindful to remember, as Ancona et al. (2007) spearhead, that leaders should do their best to practice and work towards their strengths, which often come easily for them. At the same time, others in the organization can help offset the areas in which they are less developed and skilled, "Because no one person can possibly have all the answers, or indeed, know all the right questions to ask, its crucial that leaders be able to tap into a network of people who can fill in the gaps" (Ancona et al., 2007, pp. 96-97).

References:

Adler, Mortimer J. (1952). The Meditations of Marcus Aurelius. In The Great Books of the Western World. (Vol. 12, pp. 253–310). Encyclopedia Britannica.

Ancona, D., Malone, T. W., Orlikowski, W. J., & Senge, P. M. (2007). In Praise of the Incomplete Leader. Harvard Business Review, 85(2), 92–100.