Can leaders lead from peace of mind in the midst of chaos, asks coach and former nursing director Fiona Jacob, drawing on her experience of leading a 3,000-strong nursing team in the MERS CoV outbreak in Saudi Arabia

It was 3am when I got the phone call. Three patients had died in the last few hours in one of the cardiac surgical ICUs. I needed to get to the hospital immediately.

It was 2015 and I was working as the director of nursing in a large university hospital in Riyadh at the time of the first outbreak of the Middle East respiratory syndrome coronavirus (MERS CoV) outbreak in Saudi Arabia. I was the senior nurse director ‘on call’, leading a team of around 3,000 nurses.

On arrival at the hospital, I was greeted by 10 pairs of panicked, scared, exhausted, tear-filled eyes. In 20 years of leading hospital staff I’d never seen nurses and doctors so terrified of what had killed their patients, literally within hours. The unit was in chaos: surgical drapes on the floor, the defibrillator and crash carts at the bedsides, equipment everywhere. Three bodies in black bags were waiting to be moved to the morgue.

It soon became clear that the patients hadn’t died as a result of their surgeries but something else. Within hours another two patients in the ICU were deteriorating rapidly. Seemingly, modern medicine couldn’t save them. At that time none of us could imagine what was unfolding in our hospital and would continue to impact our lives for the coming nine weeks.

Confronted with this scene I momentarily panicked. This looked and felt very real and scary. But then I noticed that my thinking was fearful and panicked. In thinking scary thoughts, I was scaring myself! Suddenly I realised making decisions for the team from fearful thinking as if it were clear thinking wasn’t helpful and didn’t make sense.

Even within the chaos unfolding into places unknown, I realised it’s possible to be clear, focused, decisive and even peaceful. Within minutes I’d sorted out next steps for the patients, the team, and to find resources.

During the outbreak, just as now, we all experienced a ‘wild’ rollercoaster ride of emotions: frustrations, fear, courage, hope and love. I witnessed compassion, caring, courage and true professionalism. And death, suffering and tragedy, and tragedies turned into miracles when the sickest of the sick recovered.

What MERS CoV taught us

In 2015, MERS CoV had a death rate of 42%. Almost 1 in every 2 people with the virus died. The virus ripped through our hospital with over 220 patients infected in just days. At the peak of
the epidemic there were over 50 MERS-positive patients in our ICUs. It’s easy to understand the palpable fear and panic among frontline healthcare workers. The workload was unbelievable – despite all of us working 18-hour days, not everything got done.

At the end of a shift, our healthcare workers were physically drained and emotionally exhausted. Spending hours in Personal Protective Equipment (PPE) is insufferable and staff were dealing with the sickest of patients. Some days were horrific.

Naturally, I felt the pressure sometimes. They don’t train you for this at nursing school, nor on MBAs! How do you respond when you and your staff are faced with the possibility of dying? It’s not war, but yet it feels like one. How do you lead a team and keep them safe physically and emotionally, so they can take care of themselves, their colleagues and patients?

Safe space

This is what I found out about leadership in crisis:

• Find your inner quiet, calm resilient self: reach out for help and support if you need it
• Use your real-time responsive intelligence: there’s no such thing as a normal day in such a crisis – leaders need to ‘turn on a dime’ and be flexible, learning to rely on inner wisdom to guide you moment to moment
• Create a safety net for teams: you’ll get to witness great courage and selflessness as well as the human messiness of strong emotions, where people become easily distracted and unfocused. This is normal.
• Build a safe space and time for staff to share openly about work and families. Many will have pressures at home too. Listen as best you can without being judgmental – as a mentor of mine says, listen like a rock with ears! Be ‘OK’ with the personal distress of others in the moment and let them know it’s normal to experience different feelings in a crisis.

Our experience during the MERS crisis is that it was encouraging staff to speak openly and freely in a safe space that made the biggest difference. So many times I heard our nurses and doctors say… ‘I don’t know how to do this; I am afraid I may die; nobody really cares about me here; I can’t take any more’.

But I knew that if we just listened and cared for our staff with compassion and empathy, without judgement, this would dissolve some of the stronger negative emotions. We’d also point out that ‘fear’, although it feels real and scary in the moment, doesn’t protect you. Fear and common sense are at opposite ends of the scale. The best protection is to come back to that centred place within, fully present in the moment.

Time and time again we saw that after sharing their real feelings and what was going on for them, many would realise they were actually scaring themselves with their own thinking. Most would take a deep breath, sigh and say, ‘You know what, I really am OK’

• Provide clear timely communication, even if you don’t know something, say so and that as soon as you do, you’ll let people know. Even with bad news, it’s better staff hear it from you. And, when miracles happen – and they do – share them widely too.
• Be visible and take action: compassionate wise leaders walk the talk and are visible for their teams, creating more connection, respect, willingness and solidarity
• Small things matter: day ‘thank you’ a thousand times a day. From your heart. Send appreciation notes, emails of gratitude. It matters. People remember and appreciate it.

Be clear, be focused

As it turned out, this crisis became my biggest teacher. What I learned ‘in the trenches’ that really made a difference for myself and my teams was maintaining my own equanimity. As humans we’re beautifully made for responsiveness in the moment. When we’re present, we’re clear, focused and wise. We find that we know what to do, and what not to do.

But when we get caught up in our ‘scary’ thinking we easily lose our presence, clarity and balance. One of the gifts from that crisis was learning how to be comfortable with uncomfortable feelings and not to believe these feelings are necessarily telling us something real.

I also got to see and experience resilience in action in myself and the teams. Many authors describe resilience as something we need to ‘find’ or ‘get’ outside of ourselves, or an ability to ‘bounce back’, but with the inference that if we don’t, something needs to be fixed. However, the truth of human resilience revealed itself differently for me during that crisis. They were daunting times, where mostly everything felt like it was out of control. Days when I cried, got frustrated, angry, and my body was achingly exhausted. Yet moments later, I was back, settled, grounded, making a joke, in a freer mind, with clarity, resilience and hope.

I now see resilience as an innate capacity we all have (whether we know it or not). It comes from that unbounded part of us (soul, consciousness, spirit, a space, whatever your words are for this) that’s completely untouched by what’s happening or previously happened to us. We can simply allow our negative thoughts and feelings to dissolve in the moment. Instead we experience peace of mind, calm, ease, grace, humour and clarity. Our resilience is breathtakingly reliable and unshakable when we know where to look for it.

So, my message to leaders and coaches is this. It’s absolutely possible to have peace of mind and lead with clarity and wisdom in the midst of chaos. That’s what keeps us safe, focused, making the right decisions, and allows us to be with and for others with compassion and care.

I know this to be both an impersonal truth and a personal reality.

As humans we are optimised for the here and now. This is where we thrive. Right here. Right now. Lean in. Trust. You are built for this.  

• A version of this article first appeared in Surviving the Coronavirus & Social Isolation, a free downloadable ebook: https://bit.ly/2KPhjBD
• Jacob first spoke on her experience at three APECS webinars in March.

• Fiona Jacob is a certified transformative coach, coaching supervisor, consultant and CEO
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