1. Cox, Sharon MSN, BSN

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Q I just came from our nursing leadership meeting, and we're all feeling like gerbils on a wheel rather than leaders. How do we start getting a better handle on things so we aren't so reactive?

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Start by hitting the pause button. Leadership is both active and reflective; in our day-to-day busyness, we've lost the value of pausing both as a leadership team and on a personal level. In his book, The Pause Principle, executive coach Kevin Cashman reminds us that by stepping back and learning to pause, we can better lead.1 He refers to the ability to pause as a core competency for leaders and recommends that we be both intentional and consistent in reclaiming the value of pausing.


A leadership team in the Northeast decided to be consistent about hitting the pause button by scheduling a "pause and reflect day" every 4 months, with the intent of reflecting on "what's working, what isn't working, or what we need to do differently." They challenged the status quo, explored new ideas, brainstormed options, and put needed structure in place to fix the system rather than fix the blame. They also eliminated nonvalue-added work and made this a day of recognition for things that were going well. They prepared for these meetings by doing a "hassle audit"-3 days on all units for staff members to record on a flipchart the hassles they had in getting work done. The results were compiled so easy fixes of root-cause systems issues could be completed. These leaders confronted themselves with important questions to elevate their effectiveness.


As Cashman reminds us, "Managers speed up to increase efficiency, leaders slow down to connect to the meaningful, the important, and the innovative." Pausing to question allows you to break the cycle of reactivity and respond in more proactive ways. It's all about finding new possibilities and working smarter. Hitting the pause button allows you to:


* Notice patterns that hinder progress (problem processing, ready-fire-aim, or getting caught in "group think") and ways to counter these patterns.


* Ask "If we had this to do over, what would we do differently?" in a routine debriefing session after a system or process breakdown.


* Consider "What part of this is ours to own?" or "How are we helping this happen?" when problem-solving an issue.


* Inquire about how other organizations are dealing with an issue using listservs or phone networks rather than opting for a quick fix.



Slowing down to connect to what's meaningful and important is equally helpful personally. Consider how you can benefit from pausing to be more effective with your team and have a greater sense of job satisfaction. This is a good time of the year to reflect on what's working or not working for you. Perhaps you'll find value in pausing to:


* Ask those whose insight you value, "What do I need to do more of, less of, or differently?"


* Notice what you've started calling normal that doesn't reflect your values.


* Identify one thing you can do, that if you do it, would make you more productive.


* Be the last to respond so your team can discover their own, and often better, ideas.


* Notice what your intuitive sense is telling you about an issue.


* As you round on patients and staff, actively listen and be present and receptive. (One way to do this is to notice the eye color of the person you're talking with.)2



A nationally known children's hospital seeking to incorporate mindfulness in practice uses a small sign on every patient's door that reads "Pause to Care." This serves as a reminder for all staff members to be open to the moment, center themselves by taking a deep breath, and start fresh as they seek to be present with those in their care.3 This initiative has positively impacted self-care, resiliency, and safety.


It may sound counterintuitive, but we need to pause more, not do more, if we're going to meet the demands of a complex work environment. Thanks for pausing long enough to read this and noticing what resonates with you as you take a moment to reflect. It's time well spent.




1. Cashman K. The Pause Principle: Step Back to Lead Forward. San Francisco, CA: Barrett-Koehler; 2012: 23. [Context Link]


2. Cox S. Personal conversation with Judy Boerger, system chief nursing executive, Parkview Health, Fort Wayne, IN, February 24, 2017. [Context Link]


3. Cox S. Personal conversation with Christine Griffin, professional development specialist, Children's Hospital, Denver, CO, June 5, 2017. [Context Link]