ArticlesClinical NurseRegistered Nurse

Leading with Reflection

I was working as a hospice nurse and enjoying the freedom of being able to be out on the road seeing my patients in their homes. One day I had teamed up with one of the social workers, Sally, to do joint visits. My focus was on assessing symptoms, medication management and tasks I could do to make things better for the patient. Sally conversed quietly with the patient and family, while I worked and at times kept silent. I left each home feeling like I had accomplished something, even if it was as simple as filling a med box. After the second or third visit, I remember Sally turning to me and saying, “You know it’s okay to be silent.” She didn’t expand on that statement, and we went on to the next visit in silence. That one simple statement had a profound impact on my clinical practice and my leadership style. From that day forward I practiced the art of silence with intention everyday.

The first thing that I learned was that silence caused me to be more reflective on my work, how I interacted with those around me and the world at large. As the years passed and I worked with a variety of personalities, I realized that those who take time to reflect on the work they do were happier and more engaged as employees. When I moved into leadership, this became even more apparent. The higher the level of reflection in an employee, the more engaged that person was. These were the staff members who demonstrated passion about their work and a willingness to try new ideas. These were also the staff members who appeared more resilient and less likely to burn out. I decided to cultivate the skill of being reflective with the team as a way to help reduce stress and increase resiliency.

Team building activities often revolve around games and social events. I would like to propose that, as leaders, we take time to incorporate reflection into our team building. Here are a few ways you can encourage team members to become more reflective:

  • Practice the pause. As leaders, others look to us to solve problems; and there is a natural tendency to push for quick solutions and results. When approached with an issue, take a moment to consider the big picture before asking your team member what they think should be done. Silence can be uncomfortable and often the other person will start talking. Let them talk! Then ask: What insights are we missing? What question are we afraid to ask? This allows the other person time to explore solutions while you both reflect on the bigger picture.
  • Look for learning opportunities that encourage the passions of your employees. Learning opportunities are everywhere and do not need to be confined to conferences and classrooms. If a project arises that you know one of your nurses would be interested in, be willing to shuffle work assignments to assist with professional growth. Do this with all of your team as you are able. Not only will it build employee engagement, it will also allow front line staff to see how decisions are made and implemented throughout the organization.
  • Build reflection into meetings. Meetings are often about the sharing of information. Take time to also share reflections. Ask staff members to reflect on the time period since the last meeting and share new insights and ideas. This is a great time for being able to share stories that are unique to the work that nurses do.
  • As a leader, take time to share your reflections and awareness. Share insight you have gained and how you intend to apply that insight. This can be communicated in a variety of ways and models the reflective practice you would like to see your employees develop.





Working in hospice taught me the importance of reflection. As I prepared for my days working with the dying, I would reflect on how I could best serve my patients. As I drove home in the evenings, I would reflect on events of the day and allow myself to decompress. This has become such an integral part of my day that I refuse to not allow it to happen. As a leader, I have learned that the ability to look forward while reflecting on what has occurred in the past is vital to my success. It allows me to take time to make the best decisions possible and build a team that can do the same.

Christina Salm

Christina is a registered nurse who has practiced in a wide variety of settings from rural, critical access hospitals, to academic, acute care facilities, hospice, case management, and healthcare insurance operations. This diverse background has set Christina’s course as a leader in advancing positive change for clinicians. Her work has led to awards such as the MCG Doyle Award for Healthcare leadership and innovation. She is passionate about the role of nursing as patient advocates, health literacy and navigating the healthcare system. Her philosophy is that nurses have a unique role acting as translators to advance patient’s understanding of what they need to do to be well and clinicians understanding of what is most important to the patient and how that influences his/her health.

Leave a Reply

Your email address will not be published. Required fields are marked *