Self-leadership strategies for nurse managers

In Brief

Self-defeating thinking is a common challenge that stands in the way of nurse managers progressing their units toward desired objectives. This article offers approaches that can help you recognize and change dysfunctional thought patterns, paving the way for more constructive healthcare environments.

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Nurse managers work within challenging and continuously evolving environments. Operating between hospital administration and frontline nurses adds to the stress and complexity of the nurse manager role. Setting operational goals, scheduling, staffing, and allocating resources are just a few of the job requirements. Moreover, encouraging optimal staff behavior, managing time constraints, guiding patient safety, and ensuring quality of care have the potential of creating complex scenarios for the nurse manager. In an environment of greater nurse workloads, less supporting resources, and escalating patient acuity, burnout is cited as the most common reason for exit.¹

Although many external factors can create stress for a nurse manager, internal states of mind are within your control. Self-defeating thinking is a common challenge that stands in the way of nurse managers progressing the unit toward desired objectives. Fortunately, self-defeating thinking can be transformed into a positive state of mind and behavior with evidence-based self-leadership strategies. In this article, we offer self-leadership strategies that can help you recognize and change self-defeating thought patterns, paving the way for more constructive healthcare environments.

The theory of self-leadership

Nurse managers can utilize a wealth of techniques to enhance workplace performance. An often-overlooked strategy is self-leadership of thought processes. As stated in the seminal book on self-leadership, Self-Leadership: The Definitive Guide to Personal Excellence, “we usually have a choice regarding what we focus on and what we think about.”² This has significant implications for nurse managers working in challenging environments where there's an insistent potential for interpersonal conflict.

The theory of self-leadership stresses the importance of creating and maintaining constructive thought patterns.^3-6 Self-leadership's cognitive strategies place responsibility for these thought patterns on the individual. Just as we develop both functional and dysfunctional behaviors, we also develop functional and dysfunctional patterns of thinking. These mindsets impact our perceptions, the way we process information, and the choices we make in an almost automatic way.⁷

Two common and contrasting patterns of thinking are opportunity thinking and obstacle thinking.^3,8 A person who participates in opportunity thinking focuses on constructive ways of dealing with challenges. By contrast, a person who engages in obstacle thinking focuses on reasons to withdraw and retreat from problems.⁷ Opportunity thinkers develop what psychologist Carol Dweck calls a growth mindset.⁹ A person with a growth mindset believes that with effort and experience, he or she can learn new knowledge and develop useful skills for future pursuits. Ultimately, a person with a growth mindset believes his or her ability to do a job is developed with effort and persistence over time.

A person with a fixed mindset believes that ability is set at birth. Therefore, your odds of being successful in life are based on your genetic inheritance. Interestingly, people who think they're intelligent don't necessarily do better than others if they don't extend effort on projects. A key finding of Dweck's research is that people with a growth mindset outperformed those with a fixed mindset, regardless of IQ. Furthermore, research has shown that the opportunity thinker will extend more effort on the problem at hand.^2,5 Consider the following scenario.

An administrator asks two nurse managers to work on a challenging project improving frontline nurse turnover. They're to come up with initiatives to better keep nurses from exiting their units. One of these nurse managers (an opportunity thinker) uses this assignment as a chance to make a significant contribution to the hospital. The other (an obstacle thinker) perceives herself as being set up for failure in full view of the management and staff.

Self-leadership theory predicts that the obstacle thinker will have a harder time with the assignment than the opportunity thinker. Starting with an attitude of self-defeat lessens our commitment to taking the first step in a project, which then affects future steps. Psychologists agree that many life problems stem from dysfunctional thinking patterns, particularly cognitive distortions that can undermine personal effectiveness and even lead to forms of depression.⁶ (See Categories of dysfunctional thinking.)

You may be asking, “How can nurse managers learn to engage in less dysfunctional thinking and more opportunity thinking?” The answer lies in managing three things: self-talk (internal dialogue), visualization (mental images), and beliefs and assumptions.⁷

Self-talk

In the book Self-Leadership, Neck and colleagues suggest that our self-talk, or inner dialogue within ourselves, guides our behaviors, feelings, self-esteem, and even stress levels.² Much of this internal dialogue is based on where you place your attention. Many people agonize over matters that are out of their control. They worry about consequences that they can't exactly foresee and may not be able to prevent even if they did.

In The 7 Habits of Highly Effective People, management scholar Stephen Covey advises people that where they place their attention is critical to their professional success.¹⁰ He provides a mental tool called the circle of influence and the circle of concern. Imagine the circle of influence sitting inside the circle of concern. After all, there's a lot more in the world that we can worry about than we can ever actually influence. Covey then explains that everything a person thinks about falls into one of those two circles. If a person places his or her attention on things that can't be influenced or controlled, he or she is likely to experience anxiety and stress. However, if the person places his or her attention on matters that can be influenced, he or she gets results and feels better.

A major benefit of focusing on what you can actually influence and control is that results happen from forward movement on issues. And as you progress, your circle of influence grows, which enables you to address matters that at one time concerned you, but you had no influence to change. Good results and performance attract more resources, connections, and reputation that can be applied toward new concerns. This is Covey's formula for progress, which complements Dweck's emphasis on a growth mindset.⁹ Both mental skills can be developed with practice.

Now let's reconsider these principles in the hospital setting. Nurse managers who become aware of self-defeating self-talk and rethink and reverbalize these inner dialogues stand a good chance of improving performance. Consider the following scenario.

A new nurse manager is annoyed and confused when she learns that an administrator wants her to host a professor and nursing students for a clinical rotation on her unit. The new nurse manager knows that many of the staff members think the nursing students will be in their way, especially the employees who already feel overwhelmed by their responsibilities. In fact, she's talked with the staff members about their concerns, as well as spending time with them before and after the professor and nursing students complete their clinical day. Still, the nurse manager faces complaints about the students being there. She tells herself, “My unit already has a heavy workload, and this is just one more thing they have to deal with on the floor. Every day that this class comes to my floor is going to be an especially rough day.”

In this example, all-or-nothing thinking is occurring. A common dysfunctional belief has been activated by a potentially challenging situation. To alter this destructive belief and become more rational, the nurse manager must first identify the dysfunction and then change the thoughts that follow. She can challenge her belief that the class days won't go well on her unit, reversing her thoughts by telling herself something like: “I probably just need to communicate with the other nurses that the nursing students might need special attention at times, just like they did when they were in college. But if this doesn't work and my unit is still stressed about the class's presence, I must not take it personally. The fact is, I run an extremely busy, and often crowded, floor in the hospital. I'm sure the nurses believe there are other floors or even hospitals that have more capacity that could've hosted the class. Maybe I can explain to the nurses and staff that the class is on our floor because the hospital administrators believe we're a group these future nurses should emulate.”

The nurse manager also needs to pay attention to what she's telling herself about the students. Instead of saying, “Hey, this class causes problems. There's no way I'll be able to get the class and my staff to get along,” she can tell herself: “I'm going to do everything in my power to help this class be successful on my floor. By my unit spending time with the nursing students, maybe we can find some outstanding students to recruit to our team in the future. By concentrating on the potentially good opportunities of hosting the class, maybe I can also emphasize that we have eight extra people to help with patient care.”

A nurse manager who thinks and talks this way is exhibiting what psychologist Judith Glaser calls conversational intelligence.¹¹ She explains that people who think and speak from a position of fear, aggressiveness, defensiveness, or conflict activate cortisol and other negative neurochemicals in their brains and the brains of others around them. However, when people use what she calls aspirational language—or optimistic and positive statements about future events—they activate areas of the brain that generate trust, good decision-making, and optimism. A self-leader can become an effective opportunity thinker by maintaining positive thoughts and a growth mindset. Developing skills in conversational intelligence will enhance creative problem-solving, which can have a positive impact on the unit. Compare this leader with the one who sees everything as an obstacle destined to bring stress and failure and we can imagine two units that function very differently.

Visualization

After attempting positive self-talk a number of times, our nurse manager with visiting students on her unit will slowly internalize it and over time apply it more effectively in similar situations. Alternatively, she could use mental imagery (or visualization) before discussing the situation further with her unit. In that case, she would picture herself listening to the nurses' concerns, providing information, being supportive, and generating ideas and solutions. She may further imagine the nurses leaving the meeting with the feeling that they can handpick future colleagues who can help alleviate some of the staffing issues they've had for years. Of course, the nurse manager could use the same techniques negatively, picturing herself as failing to communicate the opportunities in the situation. The resulting lack of confidence may well lead to the very failure she imagines.

Beliefs and assumptions

Often, people lack confidence because they don't have enough knowledge about a situation. As a result, their minds can race to catastrophic possibilities. However, if a situation can be better understood and then reframed into one that's manageable and actionable, they can gain confidence going into the situation. Creativity expert Min Basadur believes that six questions can help a person better understand almost any situation.¹² If you're stuck or worried about a situation you're facing, ask yourself:

• What do you know or think you know about this situation?
• What do you not know about this situation but would like to find out?
• Why's this situation a problem for you?
• If this problem were solved, what would you have that you don't have now?
• What have you already thought of or tried to address this problem?
• What might you be assuming about this situation that may or may not be true?

Write down every answer you can think of. Then select a handful of answers that you think are most pertinent to the situation you're facing. Basadur then advises people to turn these facts into what he calls challenge statements in the form of “How might we...?” For example, consider a stressful situation where your unit felt overworked. If a key fact was, “We have a shorter number of recruits coming into our unit this year,” a challenge statement can be created that reads, “How might we recruit more nursing graduates into our unit?” You can now place your attention on this matter and search for more information about it. You can also examine the situation deeper by asking, “What's been stopping us from recruiting more nursing graduates into our unit?” A good first step in trying to get an answer to this challenge statement is to ask yourself, “Who else is struggling or has struggled with a similar problem and what can I learn from them?” Or, worded another way, “Who's really good at recruiting and what can we learn from their example?”¹³

Emotional intelligence and mentorship

This article has focused on self-leadership as a personal approach to improving performance and, by thinking and behaving in a more productive fashion, shaping environmental factors on the unit in a positive way as well. Two other skills can assist the nurse manager in developing even better self-leadership qualities: emotional intelligence and mentoring.

Emotions have a significant effect on our thinking, but most people aren't aware of that interaction when it's taking place. They're caught up in the moment and, as a result, emotional responses can lead to decisions or behavior that people may regret when they regain a cooler head. Fortunately, this phenomenon can be better understood and managed. Awareness of what emotions are, the different types of emotions, and how to handle those emotions when they arise can improve your thinking process—an important component of self-leadership.¹⁴ Research has also discovered a link between emotional intelligence and self-leadership, finding that people who have more awareness of emotional intelligence and practice self-leadership skills can significantly reduce stress in a situation and over time have a positive influence on those around them.⁸

Finding a mentor with strong self-leadership skills and emotional intelligence can also guide you to become the nurse manager you hope to be. The very process of engaging in conversations with an experienced advisor can improve your own conversational skills with others who are turning to you for direction. This practice also helps nurse managers attain a more flexible mindset toward situations, opening up to novel solutions that may not have been considered alone.¹⁵ If you're new to advising or coaching, three questions can be asked by a mentor to turn any event into a learning opportunity: “What went well for you or others in this situation?,” “What didn't go so well or could've gone better?,” and “What did you learn from addressing this situation that you didn't know before?”¹⁶

Space doesn't permit a more thorough discussion of these related topics, but nurse managers would be well served to explore emotional intelligence and mentoring in greater depth. The more calm, positive, and professional the nurse manager is, the better the unit is likely to perform. Observe the emotional factors that may be affecting your own and others' thinking and adjust your message to better influence the interpersonal dynamics in a positive way. In especially stressful times, turn to a trusted advisor or mentor who can help you consider perspectives you may have overlooked.

Putting it into practice

Following these five steps to self-leadership will enhance your own performance and improve your workplace:⁵

• Observe and record your existing beliefs and assumptions, your self-talk, and your mental imagery patterns.
• Analyze how functional and constructive these thoughts are.
• Identify and develop more functional and constructive thoughts to substitute for dysfunctional ones, perhaps writing them down.
• Try substituting more functional thinking when faced with a difficult situation that comes up often.
• Continue monitoring your beliefs, self-talk, and mental images and maintain the new more functional ones you've adopted.

In a hospital setting, this strategy may work as follows.

Kelly's unit has an important group meeting with an administrator to discuss new policies that require her staff members to undergo extra education and training based on new guidelines to meet Magnet^® standards. Kelly has heard through the grapevine that the new policies are complicated and require extensive workflow changes, including nursing documentation. She lacks confidence in fully understanding what she'll be told in the meeting. To prepare for the meeting, she begins by observing the assumptions, self-talk, and mental images she uses in different situations. She writes down some of these thoughts for a few particularly difficult challenges she encountered as she worked her way up the ranks of the hospital. She reminds herself that each position she held in the past required learning a new set of protocols and policies. This is just another one of those times, even if the new policies are going to make major changes to the way the hospital is run.

With insight gained, Kelly designs mental strategies appropriate for her current problem over the next few days. She uses constructive self-talk to bolster her confidence and ability to conduct a successful meeting with the administrator. She repeats phrases to herself such as, “I've learned new policies in the past and educated my staff on how to implement those changes” and “I can communicate to the administrator what parts of the policies are unclear to me and she can direct me to someone who can help me introduce it to my unit. That way I can ensure that my staff members are receiving accurate information about the changes and will be properly trained on the new policies.” She also repeatedly imagines the meeting and sees herself having a productive interaction. She reminds herself that she was put in this role because of her past mastery of previous positions and everyone is going to feel some discomfort with these new changes.

When the meeting takes place, the administrator goes through a long explanation of the new policies and why they're happening. Over the course of the conversation, Kelly takes notes to ask follow-up questions. Instead of nodding to everything the administrator says so she can appear competent, she asks the administrator to slow down when she needs extra time to process something unclear to her. The meeting goes a little longer than scheduled, and Kelly thanks the administrator for taking the time to clearly explain the policies and answer all of her questions. Kelly feels that she has valuable information for meeting expectations when the new policies take place. She knows that if she hadn't practiced her self-leadership skills, especially positive self-talk, the meeting may have been overwhelming for her.

Knowledge and awareness

Being a successful nurse manager requires preparation and persistence. Research has shown that effective self-leadership can give nurse managers the extra tools needed for optimal performance. In a field study, researchers compared two groups of employees: those who participated in self-leadership training and those who didn't. Results revealed that the performance, confidence, and mood of the training participants improved, whereas the nonparticipants remained the same.¹⁷ Not everyone gets the opportunity to receive this type of training. However, formal training isn't always necessary to see some improvement in personal and group performance.

Knowledge and awareness that your thoughts, behaviors, and environment are interrelated can help you shape the world around you. Be mindful of your thoughts. Avoid ruminating over negative stressors and find the upside in a situation. Replace a defeatist attitude by talking with others about potential benefits that can come out of a situation. Work together to find and implement solutions to the problems that are hindering your unit. Difficult times often turn out to be the best situations for developing your self-leadership skills in the long run. Soon you'll discover that not only are you approaching your work in a more positive manner, but your staff members are too. Practice and use the tools from this article on your own and with your unit and you should begin to see positive results.

Categories of dysfunctional thinking²

• All-or-nothing thinking. Observing situations in black-and-white terms; for example, if outcomes aren't perfect, it means complete failure.
• Overgeneralization. Generalizing a specific failure as having an unceasing pattern.
• Mental filtering. Focusing on a single negative detail, thus distorting all other aspects of reality.
• Disqualifying the positive. Writing off worthwhile experiences.
• Jumping to conclusions. Drawing negative assumptions about certain situations even when there isn't enough evidence to do so.
• Magnifying and minimizing. Amplifying the importance of negative factors and minimizing the importance of positive ones.
• Emotional reasoning. Interpreting reality through the lens of negative emotions.
• “Should” statements. Talking to oneself using terms like should, shouldn't, could, ought, and must to coerce or manipulate oneself into taking action.
• Labeling and mislabeling. Automatically using negative labels to describe oneself, others, or an event; for example, “I'm a failure,” “He's an imposter,” or “It will be a worthless meeting.”
• Personalization. Blaming oneself for negative events or outcomes that have other causes.