2020-2025: Lessons in Leadership

Megan Hawk, DNP

My children were newborn, two, and four.

In February 2020, I had my youngest son, Noah, via C-section, just before the COVID-19 pandemic hit.

In June 2020, I returned to work as an outpatient psychiatric nurse practitioner during the pandemic.

Upon my return, I was putting in 24-32 hours at a community-based, outpatient mental health clinic. I immediately took on one psychiatric nurse practitioner student, which led to four more over the next two years. I bounced back and forth between two offices, one where I oversaw a substance use disorder treatment program and another where I supervised fellow nurses and psychiatric nurse practitioners.

I made it look easy.

At the same time, I was working part time as a nurse educator in an online graduate psychiatric nurse practitioner program. I was actively learning the ropes of the program director role at this job as I had intentions of eventually switching entirely to this career to better suit my family life.

At the same time, I was a stressed mom who didn’t know how to navigate the social and sensory differences my two oldest children were experiencing. I knew their experience seemed vastly different from what other moms described to me, though I struggled to put into words how. My oldest son struggled with social challenges and my middle son was nonverbal and getting tested for autism. This was a new world me, and there was an overwhelming amount of information to learn.

At the same time, I was volunteering for the Red Cross of Northeastern Ohio. I was insistent on "giving back" so I was providing disaster mental health counseling to individuals impacted by disasters in my area as a Red Cross volunteer. It was a challenging and rewarding experience that led to my involvement with the Sound the Alarm program by the Red Cross, installing free smoke alarms to communities in need. We specifically installed alarms in a small town impacted by a house fire that devastatingly claimed the lives of an entire family of five.

At the same time, my physical health was controlling my days, with head pain evolving into something beyond migraine. I took myself into work as long as I was functional to start the day off, though my ability to perform daily tasks gradually became more difficult as each day went on. Eventually, every afternoon, my head pain would hit a crescendo and tachycardia would become noticeable. My concentration wavered and my vision blurred most days. I could no longer think straight but didn’t know why. I was in a few near-accidents while driving.

Around this time, neurologic symptoms began. What is now described to me as small fiber polyneuropathy started as a wet sensation in my right foot and a water dripping sensation inside my head several years ago.

Before COVID and its vaccine, but after the birth of Noah.

Nerve pain shot through my face and stabbed through my eyes on severe days.

I struggled to plan into the next week, to plan the next day, to plan the same day.

I went through medication changes to target, at this point, both intractable migraines and idiopathic neuropathy.

I missed more and more work, and my absences became a topic of conversation.

The physical changes paired with work and life stress were causing me mental distress, so I was in psychotherapy as well.

I knew something needed to change. I started with cutting back hours at the clinic. I reached out to the managers at agency where I worked; they were verbally supportive of my request to carry out some administrative tasks from home, only putting my plans into action looked differently than I imagined.

I was still expected to see most of the patients on my schedule and thus have high productivity.

I was expected to have minimal administrative needs despite my increasing administrative duties and unchanging case load.

I was expected to run a substance use disorder treatment program without administrative time.

I was expected to maintain a full case load at two different locations.

I was expected to respond to the needs of the opposite office promptly (I was always with patients).

My job at the clinic was more difficult after I cut my hours, as though by intention.

I spent more time than reasonable justifying my time spent working from home to agency administrators. We had high turnover of our psychiatric medication prescribers, a challenge not unheard of for outpatient mental health agencies. At the time, the agency was building posh new offices at another location and expanding non-psychiatric services; meanwhile, psychiatric prescribers were dropping like flies. Disparities glared me in the face as a supervisor of the psychiatric setting that was not getting the attention it deserved. We lacked basic medical items like an all-in-one vital signs machine; our scale was unsafe for unsteady or immobile clients. I felt I was constantly reminded of the differences from one office to the next, but fought, and failed, to obtain the bare minimum.

Providers and staff in psychiatric services were struggling during COVID-19, too.

But the providers and staff at my office did not receive complementary massages.

I had a pelvic surgery in July 2021.

By this time of my career, I was so burnt out that I was in a nearly constant state of stress.

The surgery itself felt like a break.

I took three weeks off and returned to work, still in pain.

I returned to an email from my supervisor (also a nurse practitioner) vaguely yet condescendingly questioning my practices in the substance use disorder program I ran.

I was so taken aback by the messaging and the tone. and the fact that rather than a conversation, it was sent via email while I was on medical leave.

But when you work for a mental health agency

and your first day back from surgery is spent

crying in your office

while your supervisor walks around

In a Behavioral Health Hero sweatshirt.

Something's just not right.

I asked for specific examples so that I could review them. The three examples presented were clients who were all dismissed from the program for policy violations. They had been overheard speaking negatively about the program, which was reported to my supervisor and acted upon prior to her own investigation. I explained that everything had been done per policy and sent in my documentation (which was readily available anyway), yet a meeting was still called with two of my supervisors as though to further justify the unnecessary insult to my practice.

No mention was made about the tone of the email,

the fact that gossip was taken at face value,

or that the supervisor could have reviewed charts prior to reaching out.

Even better, an action plan was created that didn't solve the original issue.

In fact, the original problem was not even addressed.

They walked away from the meeting with a false sense of accomplishment.

But it was just one of many examples of poor leadership materialized.

It was 2022, and I was beyond burnt out.

I had committed myself to a final student through the Fall, then I planned to step away from practice. Two of my former students had come on to the agency to work, alleviating the gap in access to care made by a mass exodus of prescribers unhappy with the way the clinic was run.

My final two students and I were trying to get to the finish line.

The work I put into precepting PMHNP students went unnoticed until it was discovered that federal monies could be brought into the agency due the work I had already done.

A supervisor who had never introduced herself to my students (the same as above) became highly attentive to them so they would sign papers on behalf of a "precepting program" made possible by my hard work. I was not consulted on the creation of a precepting program.

Meanwhile, I received an email that the free soda at the agency was not meant for my students.

I fell behind at work.

I fell behind at home.

I became depressed.

Somewhere amongst all this, my mother in law died suddenly.

I started having panic attacks alone in my office.

Patients noticed.

“Your eyes look glassed over”

At one point, a patient asked me if I was okay over the phone.

I worked for a mental health agency.

.

.

.

I worked for a mental health agency.

I was pretty good at looking like I was doing fine, but those closest to me knew I was not.

I left that job in October 2022.

Management was difficult up until the day I left, a story some other past employees may find oddly familiar.

It's been nearly three years since I left clinical practice.

I still think of my clients often, and wish I had been able to give each of them a more lengthy, personalized farewell.

I simply was not in the head space for it.

I spent the past three years focusing on my family, mental health, and physical health.

It took a long time to feel recovered from the burnout of a toxic work environment.

I am respected as a member of the leadership team.

I am mentored by strong, transformative leaders every day.

I’ve learned the goal of a true leader is to inspire future leaders and help them grow.

Leadership is about accountability and ownership.

Leadership is saying, “You know what? I took gossip at face value and I shouldn’t have. That’s on me”.

Inability to recognize one's shortcomings stunts any future growth.

I dive into challenging conversations with my faculty – authentically and transparently. I owe that to them as their program director.

I have experienced so much growth as a leader, nurse educator, PMHNP, student, and human over the past three years since expanding my career beyond an agency that saw my productivity before my humanity.

Now I strive to be the leader for my team that I wish I had when I was struggling at work.

The most humanizing of all was experiencing all the above challenges at the same time and, years later, making my way out the other side stronger (and with a doctorate!).

Until next time,

Megan