Banishing the Organizational Shadow in Healthcare

(Please note: this article was first published in its entirety on my blog, Digital Doorway, on October 31, 2020.)

Carl Jung once identified the shadow (or shadow archteype) as the unconscious aspect of the personality that the conscious mind and ego don't especially care to recognize as an aspect of the self. Some may refer to the shadow as the entirety of the unconscious mind. In this light, can we also deduce that organizations themselves also have a shadow? 

The Shadow Lurks 

Jung stated, “Everyone carries a shadow, and the less it is embodied in the individual’s conscious life, the blacker and denser it is.” He also said, “One does not become enlightened by imaging figures of light, but my making the darkness conscious.” 

So what does it mean when an organization has an unacknowledged shadow? 

In an informative article published on Culture-Builder.com, author Matt Auron writes: 

“…..Something generally happens as companies grow. For start-ups, the change usually comes after the business model has been proven or their B round has funded. At this stage the executive team meets and discusses how to implement processes for sustained growth. This involves rapid hiring and expansion with individuals who mainly come from larger organizations. It’s a common experience in the growth stage of a company that most of us have seen. Less conscious decision-making results in unintended consequences. Leaders make decisions that are sometimes in direct opposition to the espoused values of the culture. People stop walking their talk. This, it seems, is the emergence of a collective and unconscious process called shadow.”

Torben Rick, a German organizational expert and consultant, states that organizations are actually shadows of their leaders. Rick opines that when a company’s leaders don’t walk the talk of the behaviors they purport to desire of those whom they employ, a lack of integrity results, and this reverberates throughout the organization. His examples of this dynamic include: 

• Increased teamwork and cross-organizational collaboration is preached, yet the senior team does not collaborate across divisional lines
• The organization is seen cutting back on expenses, yet the senior team doesn’t change any of its special perks
• People are asked to be accountable for results, while the senior team members continue to subtly blame one another for lack of results.

CEOs, COOs, and other healthcare executives can often be unseen, invisible to staff. It can feel like they’re locked away in their ivory towers counting their money and planning their next Caribbean vacation while the peons work in the hospital below, earning that money for them. Resentment towards the executive team can grow, and bad blood can infiltrate the emotional circulatory system of the organization. 

For their part, nurses frequently write to me with stories of bulling and incivility; PPE shortages in these times of the COVID-19 pandemic; dangerous staffing practices; potentially illegal anti-union actions by employers; heavy-handed leadership by authoritarian managers and supervisors seemingly devoid of leadership experience or training; and staff being treated as wholly expendable. 

There is a Path

On episode 291 of The Nurse Keith Show, I spoke with Dr. Jonathan Fisher, The Happy Heart MD, a clinical cardiologist and expert in mindfulness, kindness, and compassion in healthcare organizations. 

Dr. Fisher is employed by Novant Health, a multi-facility healthcare organization in the southeastern United States. He sits on the Organizational Resilience and Well-Being Team, the COVID-19 Burnout Prevention and Recovery Task Force, as well as the Empathic Communication Training Team. And according to Dr. Fisher, these are not simply organizational window-dressing; in fact, these teams are active, useful, and widely impactful. 

Even the presence of such teams at Novant Health can make us healthcare workers prick up our ears and pay attention, especially in light of the dearth of other organizations who would even deign to create such groups with a mission to address salient issues in relation to employee wellness.  

There may indeed be other organizations that are also addressing staff burnout and wellness at such a high level, and the naked truth is that we need hundreds more to also walk this path. 

My dear friend and colleague, Dr. Renee Thompson, is the CEO of The Healthy Workforce Institute, and her work with large healthcare facilities and systems focuses on the eradication of bullying and incivility in the interest of positive workplace culture. And we can all readily acknowledge that workplace culture can make or break an organization, and a supportive, healthy culture can lead to decreased signs of burnout, increased employee engagement and retention, healthier inter- and intra-team communication and cooperation, and, assuredly, improved patient outcomes. 

Creating a Healthy Workplace

To begin this crucial work, CEOs and other leaders can come down from their (perceived or actual) towers, meet personally with individuals and small groups of employees, and make their presence known. 

Enlightened leaders can don scrubs and gowns, walk the halls, speak with staff, observe, and almost literally walk in the shoes of, a nurse, a medical resident, an attending physician, an environmental services worker who cleans the rooms of COVID patients, as well as those who do the laundry, manage the HVAC system, cook meals, deliver meals, and those who provide workplace security. If a CEO has never followed and observed a nurse or environmental services worker for an entire shift, how can they know the slightest thing of that nurse’s day-to-day reality? They can’t, and they won’t until their boots are literally on the ground. 

Now more than ever, healthcare leaders must model positive behaviors. We need physicians, surgeons, Chief Nursing Officers, nurse supervisors, nurse managers, and even charge nurses to actively create and promote positive workplace culture. It is also crucial that nursing professors, preceptors, and others to not embody the kindness and compassion that set students up for success. Far too many nursing students are bullied by professors, belittled and beleaguered as a form of an old-fashioned, misguided hazing ritual that we no longer need to abide. The old days of hazing, ridicule, bullying, and harassment have no place in 21st-century healthcare and nursing. 

A single nurse can walk his or her talk by treating support staff with kindness and empathy. How many staff nurses know the names of the people who deliver the meals and clean the rooms? How many go out of their way to create relationships with those individuals who may generally be seen as faceless, nameless peons who scrub the floors and bring the food? 

We must reward intrapreneurship, creating funnels wherein employee intrapreneurs are supported in their efforts to improve the workplace around them. We must also create leadership funnels that groom, mentor, and nurture less seasoned employees for future organizational leadership. 

The bright minds of our Millennial and Gen Y staff members are ripe for more, and, whether we like it or not, Millennials are – thankfully, in my eyes – taking the reins of power as we older folk fade from the workplace. What gives me the most hope for workplace culture writ large are these up-and-coming generations who’ve been raised on the meat and potatoes of gay marriage, transgender equality, women’s empowerment, racial justice, and other social movements that for them are, by and large, a no-brainer. This can thus lead to more enlightened leadership. 

We should have a zero tolerance for aberrant behavior. No matter how much money a gifted surgeon brings in, if he or she is a bully, they’re put on notice, enrolled in a mandatory educational program, and if they don’t meet the requirements of behavior change, they are removed from the organization and replaced with someone who cares about being a good human being, not just a good surgeon. 

The organizational shadow must be addressed, and it needs to be addressed out loud. These changes and conversations shouldn’t happen behind closed doors around an oak table where regular staff aren’t seated. Everyone – and I mean everyone – should be at the table. 

For my part, an optimal organization embraces shared governance, but that shared governance should include not just surgeons, doctors, nurses and other clinicians, but food services, environmental services, and every department that exists. We cannot only change a culture from the top; we also need to change it from the grassroots, with both ends meeting collaboratively in the middle. Culture change must be holistic, all-encompassing, enforceable, replicable, and able to pivot and change with the times. 

The Pivot

If your organization has a shadow that’s staring you in the face, what can you do about it? Do you sit back and allow your silence to be seen as complicity with the current zeitgeist? 

We need organizations where speaking our truth about what we see doesn’t make us a pariah or get us reprimanded; rather, we should be thanked for caring and for having a vision of what could be improved. We don’t gossip and cry into our milk at breaktime; rather, we meet and discuss alternative visions of what we want and how to get there, choosing to work for organizations that provide us platforms from which we can present our ideas to the larger collective. 

Organizational culture change and the direct facing of the collective shadow should be a heartfelt pursuit, from the CEO to the person who collects the trash or fixes the HVAC or electrical systems. 

With due diligence and creative thinking and action, we can indeed run a 500-bed hospital on the engines of transparency and open dialogue among all players who have a stake in collective success – and that means everyone who receives a paycheck from that facility, as well as stakeholders in the community itself, including patients who are treated there and community organizations with which the healthcare facility interfaces. 

When we see our federal government’s shadow and the shadow of our country’s racism, sexism, homophobia, and xenophobia before our very eyes on every newscast, one way we can contribute to altering the dark path our nation appears to be on is to carpe diem – seize the day – and do the work of necessary change, beginning with where we live and where we work. And if our homes, neighborhoods, communities, cities, towns, and the organizations that are key players in those communities – like those who deliver healthcare to citizens – we’re on our way to addressing the shadows that hold us back, keep us small, and prevent us from having the world we know we -- and our children -- deserve. 

To hear the companion podcast to this blog post, please click here.

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Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is the host of The Nurse Keith Show, his solo podcast focused on career advice and inspiration for nurses. From 2012 until its sunset in 2017, Keith co-hosted RNFMRadio, a groundbreaking nursing podcast.

A widely published nurse writer, Keith is the author of Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century and Aspire to be Inspired: Creating a Nursing Career That Matters. He has contributed chapters to a number of books related to the nursing profession. Keith has written for Nurse.com, Nurse.org,, MultiBriefs News Service, LPNtoBSNOnline, StaffGarden, AUSMed, American Sentinel University, Black Doctor, Diabetes Lifestyle, the ANA blog, American Nurse Today, NursingCE.com, Working Nurse Magazine, and other online and print publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, keynote speaker, online nurse personality, social media influencer, podcaster, holistic career coach, writer, and well-known nurse entrepreneur. He lives in Santa Fe, New Mexico with his adorable and remarkably intelligent cat, George. (You can find George on Instagram by using the hashtag #georgethecatsantafe.)