Holding Space, Sitting with Tension, and Navigating the Digital Deluge in Australian Healthcare

naomi620
3 days ago
6 min read

"Negative Capability... is when a man is capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason" poet John Keats

Fault in ground between two environments - AI generated image

We are here to talk about the "Fault Line"—that precarious edge between bedside reality and boardroom accountability where the climate of our culture is determined.

As we navigate the corridors of our health services—from the bustling regional hubs of Alice Springs to the high-acuity metropolitan centers of Sydney and Melbourne—we see a recurring phenomenon. It is the exhausted exhale of a leader who has just spent twelve hours reacting to "pings," "pokes," and "pressures," only to realise that the deep work of the day—the strategic, soul-stirring work of holding a team together—has remained untouched. We are witnessing a transition that is as tectonic as it is taxing. Nurse leaders, often promoted for their ability to master a clinical crisis, are finding that the executive suite requires a different kind of bravery: the courage to be still in the center of the cyclone.

In two separate conversations with nurse executives interstate this week, current challenges were raised regarding nurse leaders' resilience and struggle in the role and a difference in the way we work over the last 8-10years. While both leaders framed the experience differently what they are seeing is the same - reactivity, leader distress leading to low team morale. I suggested this an inability to hold the tension of risk and not knowing,

This blog explores the fundamental shift from getting things done to holding space, the psychological weight of digital immediacy, and the evidence-based practices that allow a leader to sit with tension without being consumed by it.

Technology that promised to liberate us from the mundane has instead tethered us to a culture of constant responsiveness. We no longer have an hour to think; we have three minutes between a MS Teams ping, an urgent text from the Medical Director, and a dashboard alert signaling a breach in patient flow.

This Culture of Immediacy creates what is known as Hallucinated Urgency. We begin to believe that because a message arrives instantly, it must be answered instantly. This belief is a thief of time, robbing us of the clarity and focus required for the high-stakes decisions that define executive leadership.

icon showing impact of reactive approach

There are four thieves of time

Drive - the compulsion to do it all and never say no
Leads to a state of permanent overdrive and eventual burnout
Excellence - the pursuit of perfection in every minor task
Paralyses decision-making and stalls progress on larger strategic goals
Information - the hunger for just one more data point before action
Creates cognitive overload and the certainty syndrome where we fear the unknown
Activity - the addiction to motion- feeling busy as a proxy for productive
Fosters a culture of reactivity where we chase symptoms rather than causes

Embracing Negative Capability

Why is it so difficult to sit with tension? Why do we feel an irritable reaching for facts and reasons when faced with a gap in our knowledge? As clinical experts, we have been conditioned to solve problems. In the ICU, a dropping blood pressure demands a response. In the executive suite, a dropping culture might demand a pause.

The poet John Keats coined the term Negative Capability to describe the capacity to be in "uncertainties, mysteries, doubts, without any irritable reaching after fact and reason". In leadership, this is the ability to resist the urge for premature closure—to not jump to conclusions just to escape the anxiety of not knowing. Wilfred Bion, the psychoanalyst, suggested that we must "discard the future tense of our desire" and forget what we want the answer to be in order to leave space for a new, better idea to emerge.

When leaders lack negative capability, they fall into "Certainty Syndrome". They perform an elaborate display of openness while systematically dismissing any view that challenges their predetermined conclusion. This "Epistemic Rigidity" is a defense mechanism against the discomfort of ambiguity. It creates a "Predictive Compulsion"—the need to quantify and scenario-plan every element of existence, even those dimensions of human care that resist measurement

Ambiguity

A leader's tolerance for ambiguity is a predictor of their psychological well-being. Those with low tolerance for ambiguity perceive uncertain situations as a source of threat, leading to defensive behaviors, anger, or overconfident judgments that neglect reality.

In the rapidly changing world of Australian healthcare, flexibility is essential. By embracing uncertainty, we open ourselves to an "infinite number of ways" to tackle a problem. Strength, in this context, comes from humility—the ability to say "I don't know yet" and to listen for the purpose of understanding, not just responding.

Advocacy & Inquiry

To sit with tension, an executive needs a new set of linguistic tools. We often default to protecting ourselves, winning the argument, and avoiding discomfort. To move to mutual learning we must master the discipline of Advocacy and Inquiry.

Advocacy: "Here is what I am seeing. When I look at the staff survey results, I’m worried we are signaling that poor behavior has no consequence".

Inquiry: "What am I missing? Can you walk me through how you’re weighing these decisions?".

The power is in the combination. Articulating your reasoning makes your thinking testable rather than an edict.

Sometimes less is more

Nursing leaders must become warriors in the battle against busyness. This is not about working harder; it is about changing the tempo. Leaders should implement a strategic pause between activities—and protect 2-4 hours each week to work on the business rather than in it. This time should be used for strategic foresight, researching trends, and zooming out from the daily avalanche of email.

We must resist the pressure to be fast and decisive when faced with complex, ill-defined problems. By practicing Reflective Inaction—waiting, observing, and listening—leaders can create an intermediate space where genuine insight can emerge. This capability allows a leader to not jump to information that creates false certainty just to provide immediate relief for themselves and their stakeholders.

Leaders in the caring professions should use narrative medicine—the practice of interpreting and relating to diverse experiences of illness—to foster their negative capability. This practice helps a leader become divided: remaining fully attentive to the immediate distress of staff and patients while maintaining a reflective distance that prevents burnout. It is the key to determining what to give of oneself and what to hold back to survive the intensity of the role.

In healthcare, a Culture of Companionate Love—characterised by affection, warmth, and caring between colleagues—is linked to lower burnout and better patient quality of life. Conversely, a Culture of Anxiety buffers the benefits of clinical skill and leads to worse financial and patient outcomes. The executive's job is to lead the feelings, not just the figures.

Window with sheer white curtain pushed open by a breeze

Key takeaways for Team Leaders

The Emotional Culture is Non-Negotiable: If we don't lead the feelings, they will lead us. A culture of "Companionate Love" reduces burnout and saves lives. Our actions and requests need to reduce the anxiety or team feel rather than increase it.

Holding Space is High-Level Work: The role of the executive is to hold risk and absorb distress so that the team has the Change Space necessary to innovate and to do the work they do well.

Digital Immediacy is a Choice: Combat Hallucinated Urgency by categorising what truly needs to be known and what deserves your attention. Answer emails only at set times during the day. Turn off notifications. Turn your phone to silent during meetings - be in the meeting instead. The exception is if you are the executive on call.