Leadership Is an Inside Job - Why Healing Matters More Than Most Leaders Realize

Wounded.

Battle-worn.

Guarded.

Sometimes… jaded.

I’ve seen a lot of scars in leadership.

Working float pool gave me a strange privilege. I got to spend years stepping into almost every corner of the hospital. Every unit had its own personality. Its own culture. Its own rhythm. After a while, I found myself forming some pretty strong opinions—not just about the work, but about what that work seemed to do to people.

The ICU nurses? Mean girls… surprisingly often. Quite literally more attractive and more popular than average, with social confidence to match. Bullish. Brilliant. No one sits higher on the clinical food chain than the nurses down the hallway caring for one impossibly sick patient at a time. They live in the weeds. They sweat through baths and mouth care. They hold hands through codes. They carry far too much death.

The stepdown nurses would love the complexity of the ICU, but they still enjoy teaching, coaching, and engaging with patients. So instead they juggle four or five patients who are often nearly as sick, silently praying for a great CNA and hoping none of them decide to crash today. They become the kings and queens of the Rapid Response because no one wants a death here.

Med-surge nurses somehow manage six or seven patients whose acuity ranges from “ready for discharge” to “Why is this person not already in ICU?” They’re pulled in every direction at once. They worry about the patient headed south while simultaneously trying to satisfy the patient upset about the wrong flavor of Jell-O. They are probably the least likely nurses in the hospital to finish every required charting before the end of their shift.

Rehab nurses may not be considered the sharpest clinicians in the building, but that might not be accurate - they become masters of something else entirely. They understand schedules, therapy, family dynamics, motivation, and length of stay. They keep patients long enough to build relationships. They celebrate tiny victories. Their units somehow feel softer, homeier, and more hopeful than almost anywhere else.

Hospice nurses…

Hollywood—and Dr. Kevorkian—have done them no favors.

These beautiful nurses live in the strange, dark-yet-ethereally beautiful space between life and death. They balance their own hearts while carrying the hearts of others. They remind me less of grim reapers than of midwives, gently helping people through a different kind of birth. They deserve far more honor than they receive.

Behavioral health nurses – I encountered them later in my career, but I’d be amiss to forget them. These warrior-magicians come into a room full of chaos and angst and quickly cut to the heart of felt needs and fear. They balance the intensity of the World Wide Wrestling federation with the presence of an older brother or sister that a frightened patient leans against when they’re worn out, running from their own mind.

Operating room nurses are their own fascinating species. They possess the hospital’s most colorful vocabulary and often its strongest “allergy” to awake human beings. Fiercely loyal to their team, captivated by anatomy, precision, and process, they can be loud and intimidating one moment and quietly dependable the next.

Nurse leaders?

They may be the most exhausted creatures in the building.

They sprint from staffing crises to rounding, from coaching conversations to budget meetings, from patient complaints to employee conflicts, living every day on a roller coaster of praise and criticism, appreciation and blame.

And then there are the emergency nurses.

If you asked almost any hospital for one word to describe seasoned ER nurses, I suspect the answer would often be the same:

Jaded.

Not uncaring.

Not incompetent.

Jaded.

If the med-surg nurses are masters of multitasking, the rehab nurses patient teachers, the ICU nurses brilliant rescuers, the ER nurses are… crabs.

Hard on the outside.

Soft underneath.

They spend every day immersed in violence, addiction, manipulation, neglect, tragedy, trauma, and death. They develop remarkable tools that allow them to cut quickly to the heart of a crisis and save lives. Those same tools can also cut colleagues when they’re tired, frustrated, or carrying too much.

Our work shapes us.

Every specialty leaves fingerprints on the people inside it.

Leadership is no different.

Leadership wounds are inevitable. If you lead people long enough, you will be hurt. The question isn’t whether you’ll be wounded. The question is what those wounds will become.

Many of us assume hardship naturally produces wisdom. It doesn’t.

Pain changes us. Healing transforms us.

Time doesn’t heal every wound. Unexamined pain simply changes jobs. It stops being something that happened to us and quietly becomes something that leads us.

I’ve watched betrayed leaders assume malicious intent, powerless leaders become controlling, embarrassed leaders become defensive, and leaders who never felt valued chase titles instead of purpose. What often looks like a leadership problem is actually a healing problem.

There is a profound difference between leading from an open wound and leading from a scar. Open wounds react. Scars remember pain, but they no longer bleed.

That’s the heart of Kintsugi Leadership. The goal isn’t to avoid being broken. The goal is to heal so well that your broken places become sources of wisdom instead of collateral damage.

Because leadership is ultimately an inside job.

Pain is inevitable. Wisdom is intentional.

What experiences have shaped the way you lead? I’d love to hear what gold you’ve found in your own cracks.

🎧 Listen to the podcast: https://open.spotify.com/episode/3OOfwg1pAyRQsj9aoZ43JA?si=gzX1B6XoRNGIH7vaVEQRvA

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