Self-leadership in a hospital setting: A framework for addressing the demands of nurse managers

Nurse managers are tasked with tremendous responsibilities in high-stress clinical and hospital settings, where they manage budgets, supervise front-line personnel, and oversee patient care.

Yet, the challenges and demands inherent in health care environments often thwart their ability to deliver quality care while balancing expectations from administrators. And given that nurse managers are held accountable for patient outcomes, staff retention, and organizational success, it’s no surprise that 72 percent intend to leave their positions in the next five years due to burnout.

But what if nurse managers spent a little more time talking to themselves to sharpen their leadership skills and, consequently, alleviate the pressures and difficulties associated with their job profession?

Minding one’s self

That’s one of the strategies outlined by Associate Professor of Management and Entrepreneurship Chris Neck and his colleagues in their research paper titled, “Self-Leadership in a Hospital Setting: A Framework for Addressing the Demands of Nurse Managers,” which appears in the Journal of Leadership and Management.

In the paper, Neck and his co-authors outline how self-leadership practices can help nurse managers improve their management approach, specifically observing and using social cognitive tools like self-talk, mental imagery, and being aware of one’s beliefs and assumption to create a positive mindset and prosper in their roles.

Self-leadership is a framework based on social cognitive theory, which contends that people are influenced by the interaction of their thoughts, behavior, and environments. The process of self-leadership, Neck and his colleagues assert, can help nurse managers achieve a level of self-direction and self-motivation needed for optimal performance. And like other forms of leadership, self-leadership can be developed and taught.

“The idea is that people are responsible for and capable of shaping their ideas and behavior,” explains Neck, who teaches self-leadership in his courses at ASU, has authored many books on the subject, and consults with diverse organizations on using cognitive and behavioral techniques to improve self-leadership effectiveness.

I’m talking to you

A fundamental element of successful self-leadership is creating healthy internal dialogue, or self-talk — the things people covertly tell themselves. “We all talk to ourselves but we generally aren’t taught to examine our self-talk and do it effectively,” explains Neck.

He and his co-researchers suggest that if nurse managers become aware of and develop constructive self-talk it could help them better juggle multiple roles amid an increasing and ever-present level of change and dynamics in the workplace.

“Organizations are placing more demands on nurse managers and the employees that report to them in terms of work, hours, and responsibilities. More nurse managers are having to do more with less. The stress, lack of organizational support, and the culture mean they face great obstacles,” says Neck.

Rather than look for external fixes, we’re looking at internal solutions to enhance leadership.

By default, the nature of a nurse manager’s job doesn’t generate an atmosphere of powerful self-talk, but individuals still have to lead themselves within a team context. “If you don’t lead yourself and be the best you can individually the team will ultimately suffer. So adjusting self-talk to a more productive narrative is huge,” adds Neck.

For example, he suggests saying, “My job is to help nurses help patients and I’ll do what I can given the constraints,” instead of, “I have to do all of my workload today,“ which shifts a nurse manager’s perspective and the ability to self-lead while working toward the common goal of the staff and unit he or she supervises.

Neck points to the volumes of sports psychology literature to illustrate the role of self-talk in shaping advantageous leadership skills. “To be a self-leader, it requires discipline, practice, and taking responsibility. You see you this in basketball players who miss the shot but quickly forget about it and compartmentalize it because they understand they’ll sometimes miss the basket.”

The power of such opportunistic thinking gives nurse managers an important organizational performance edge. By becoming aware of their verbalization of the shortcomings present in their industry they begin to reframe negative emotions and self-statements and start to replace them with positive thoughts and tones, which leads to improved leadership behaviors.

Imagine the possibilities

Neck and his colleagues also recommend mental imagery as another cognitive technique for nurse managers to transform and foster productive self-leadership characteristics.

In much the same way a long-distance runner envisions crossing the finish line or a basketball player imagines draining the winning shot before the competition begins, nurse managers can construct positive results mentally before they ever set foot in their unit.

“Mental imagery is about learning how to be mentally present,” says Neck.

In the case of nurse managers, they can visualize a stressful performance review with an irate employee or having to deal with a family of a patient who is dying.

The key to using mental practice to mitigate work challenges, according to Neck, lies in what a person sees. “Are you watching yourself in the situation on a movie screen, so to speak, or in the mind’s eye, in your shoes, doing the task?” he asks. “What research has shown, including mine, is that you are more effective when you view yourself in your mind being an active participant and not a passive observer.”

Likewise, a nurse manager who considers a new quality control protocol could use positive mental imagery by picturing him or herself bringing the protocol to their unit and the positive response it would receive.

When nurse managers mentally conceive a favorable work outcome it can lead to better patient interaction, nursing supervision, and processes for improving unit operations, as well as cause an uptick in innovation, therapeutic care, and proactive behaviors among themselves.

Changing the internal message

Successful self-leadership also is contingent upon the ability of nurse managers to examine their beliefs and assumptions about the world.

“In my book, “Self-Leadership: The Definitive Guide to Personal Excellence ,” I describe a list of underlying beliefs and assumptions, which are usually related to dysfunctional self-talk. An example of this is when nurse managers lead based on all or nothing thinking and see things in black and white terms with no gray area,” says Neck.

Dialogue that includes, “I had 10 things to accomplish today but only finished nine” illustrates how beliefs about job failure — or success — can block a nurse manager’s self-leadership development.

Fortune telling, or believing you can predict the future, is another hard-held assumption that can sabotage healthy self-talk, according to Neck. “ ‘If I miss my meeting my boss is going to fire me’ is what I call the worry belief,” he adds. “Arbitrarily predicting things will turn out badly without concrete evidence.”

At the end of the day, self-leadership, whether it’s a nurse manager or a professional athlete, is a practice of training to achieve optimal performance. “The premise of self-leadership is how can you lead others if you can’t lead yourself?” says Neck. “The first step to being an effective leader is to be a self-leader.”