Holding space for a healthy work environment

FigureI TURN INTO Anarrow alley to access a public parking lot. On my left, another car is coming out of the lot, and on my right, there's a gas meter extending out from the adjacent building. The other car halts halfway into the alley, presumably waiting for me to proceed. To do so, without hitting the other car or the gas meter, I begin an alternating series of infinitesimal turns, reversing and edging forward. There's is room behind the other car, but the driver doesn't back up. I see the car's occupants exchange haughty looks. They can't see the gas meter, have no idea what I'm navigating around, and assume I'm just a crazy driver. HOLDING SPACE This story offers an analogy for an essential skill: holding space. A 2024 article in Forbes identifies holding space as the most important leadership skill of the year. Holding space is an approach that acknowledges an individual's emotional landscape, which is crucial, given high rates of anxiety, depression, and despair among working adults.1 Therapist Sarah Epstein describes holding space as centering another person's story, and offers four key elements: being present, creating a safe environment, effective listening, and empathizing.2 What this looks like, in practice, is a distraction-free focus on another person that respects their unique perspective of an experience. One temptation when listening to someone's story is to share a similar circumstance, and thus, build a connection. Equally tempting is to offer solutions to the challenges the story demonstrates. Examples of such responses to the scenario described in the introduction might be, “That's like yesterday, this car pulled right into the spot I was going to park in,” or “Why didn't you look for a space on the street?” Those replies are effective paths to conversations about bad driving experiences or inadequate parking, both fruitful topics. Such conversations are essential sources of interpersonal connection; however, holding space offers a different kind of value. Holding space for others is unique because, instead of jumping into a topic together, one person's experience remains central, whereas the other person refrains from offering advice, judgment, interpretation, or a story of their own.3 The one who holds space attends, actively listening not only to the words but also the emotions in the story. This attention serves to validate the speaker's perspective, and by extension affirms the speaker's value. HOLDING SPACE IS A DELIBERATE PROCESS Although empathizing is one element of holding space, the two processes are different. Empathizing involves a sharing of feelings. An empathetic listener often understands a story by tapping into a similar emotional experience or seeking to adopt the speaker's state of mind, sometimes referred to as “stepping into their shoes.”4 Unlike empathy, holding space is applicable even when the shared story is beyond the range of the listener's experience or imagination. In fact, the listener who holds space may not agree with all the views the speaker expresses when recounting their story, but the listener maintains their presence anyway. Empathy builds connection because the listener feels compassion for the speaker. Holding space builds trust because the listener values the speaker as a person. The term holding space can be misleading; space sounds weightless, so holding it ought to be easy. Holding space is more like holding a breath than lifting an empty vessel. There's a powerful instinct to decenter the other person's story, to stifle it with interpretations, judgments, or solutions. In fact, the experiences that offer the most insight may present the greatest challenge to a holding-space approach. The story that most needs to be told is the hardest to hear. In the book Thinking Fast and Slow, Nobel Prize awardee Daniel Kahneman describes the deliberate effort required to shift from instinctively responding to a set of stimuli—what he calls system 1 thinking—to consciously evaluating all available information, or system 2 thinking.5 Holding space is like the slow version of thinking, because it involves actively listening to all the details without drawing conclusions or deciding on a course of action. What initially feels like truth in the perception of another person's experience may reflect the listener's cognitive bias, not the speaker's perspective. Letting go of that bias requires conscious effort. Kahneman notes that stress increases reliance on fast thinking, a key consideration in the application of holding space to clinical work environments. FILL IN THE BLANK OR HOLD THE SPACE The story presented at the beginning of this article describes an interaction among strangers in cars that isn't likely to have a long-term impact. However, consider interactions among individuals in a clinical work environment. Relationships among healthcare team members profoundly impact patient care and the health of the work environment.6 Patient care is stressful, and that stress is compounded by regulatory requirements, burdensome documentation, resource limitations, and prognostic uncertainty. In addition, healthcare teams rely on fast thinking to ensure a prompt response to a sudden change in a patient's condition. However, extending the fast-thinking approach to conversations with colleagues causes communication to devolve into a fill-in-the-blank exercise. Rather than hearing the full story, the fast-thinking system gathers a few details, fills in the rest based on past experiences or assumptions, and arrives at a judgment as the foundation for further actions and decisions. Most of the time, the blanks are filled without the listener's awareness and certainly without the speaker's knowledge. Table 1 lists brief examples of clinical work environment interactions in which a nurse leader might select a holding-space approach. For comparison, the table lists responses consistent with a fast-thinking, fill-in-the-blank response as well as a slow-thinking, holding-space response. A key point is that the fast-thinking responses aren't wrong; in fact, all the responses in the table offer the speaker support. In addition, it's plausible that in the fast-thinking replies, the listener is correctly filling in the blanks of the briefly described situation. The fundamental difference between these two approaches is that the holding-space responses express a desire to listen and validate the speaker's unique perspective, whereas the fast-thinking responses indicate the listener has heard enough and is ready to move to resolution. TABLE 1: - Examples of how to hold space Situation Fill-in-the-blank response Holding-space response A family member is concerned that a loved one is being treated inappropriately by staff. Saying “I'll take care of this,” while thinking, “I bet it was that one day-shift charge nurse... I've noticed that she's burned out.” (making an assumption) “Your concern is important to me. Will you tell me what happened?” A nurse on orientation overhears their preceptor telling a colleague that the nurse who's being oriented “will never make it.” “Don't let it get to you. You need to be tough to work in an ICU. Your preceptor had a bad day; that happens! You've got this. I know you do!” (forming a judgment) “Can we talk about this? I need to know more because I want to support you.” A direct care nurse reports that the night-shift supervisor bullied him into accepting an admission that's not appropriate for the unit. “I know that supervisor. I'll follow up with her. It sounds like there was some kind of misunderstanding. We'll talk it through.” (leaping to a solution) “Please, walk me through what you heard from the supervisor.” A charge nurse cites repeated microaggressions by staff, who question her authority because of her racial identity. “I know it can be so hard. I feel like staff question my authority all the time, and it's so frustrating!” (joining the space) “I want to understand what you are experiencing. Can you tell me more?” HOLDING SPACE AND THE WORK ENVIRONMENT Clinical work environments are busy, dynamic, and sometimes chaotic. Nurses and leaders are likely to feel that there isn't time to slow down their thinking and hold space for their colleagues. In addition, this approach has limitations. Holding space won't bring disparate views into alignment, and it's not a simple solution to the many interpersonal issues that nurse leaders navigate. Furthermore, holding space is a skill that takes practice and that can be uncomfortable for leaders, especially when they feel accountable for a negative experience that the speaker describes.1 Giving time to a process that generates awareness of one's own limitations isn't nearly as productive as implementing an expedient solution. Holding space is a gift for the speaker, but for the listener, investing time and cognitive effort require appreciation for the long-term gains, because in the short term, restraining instinct and centering the speaker is incredibly challenging. One advantage of this approach is the opportunity to diffuse the emotions that pose a barrier to conflict resolution.2 When speakers feel heard, they're less likely to raise their voices, withdraw in despair, or assume the worst about their listeners. Effective solutions are more likely if the persons involved are calm and engaged. In addition, validating colleagues empowers them to reflect and identify the type of support or action they need. Repeated interactions in which colleagues shift from strong emotions to empowered reflection can change the work environment. Consider that unhealthy work environments are emblematic of a vicious cycle.7 Chaos and stress breed insufficient communication and a reliance on expedient solutions, generating further chaos and stress. Holding space could be part of a solution that reverses direction, creating a virtuous cycle. A team member who feels validated by a holding-space approach consequently may experience less stress and an increased capacity to hold space for others. In this way, the return on the time invested in holding space is realized. NEXT STEPS Because holding space is a skill, it requires preparation and practice. Consider the following ideas for nurse leaders who wish to develop and incorporate a holding-space approach into their roles. Attend to your own well-being. To effectively hold space for healthcare team members, nurse leaders need to be ready to manage their own emotions. Some strategies include journaling, enjoying nature, and walking or engaging in other exercise.8 Explore different leadership styles. Adopting and maintaining a style that guides interactions with others will demonstrate integrity.9 Build a script or practice responses that are consistent with a holding-space approach, such being curious about another person's experiences, asking them what support they'd find helpful, or restating the emotions that they describe.10 Be selective about the context that best suits a holding-space approach. It's imperative to have a private space that allows those engaged to focus. Given the continuous demands of patient care, talking to staff when they have clinical coverage for a patient assignment is a key consideration. STEP BACK AND CREATE SPACE In the story relayed previously, the other driver couldn't see all the obstacles in the narrow alley, and instead of stepping back (driving in reverse) to create space, the driver chose to stay in place, confident of their errant assumption. In closing, here's an example of effectively holding space in the healthcare environment. I'm about to leave the unit for a meeting when I see a nurse I've been meaning to speak to. She had a medication error last month, and she has arrived late to work twice. We scheduled time to speak about the med error, and she didn't show up, which made me feel frustrated. I tell her to come to my office, and I plan a 5-minute version of the stern speech that played in my head after she was a no-show for our scheduled meeting. But when she sits down, I see her expression and posture, hands clutched in her lap, and I realize that something is wrong. Rather than deliver my 5-minute speech, I say. “Can you tell me what's going on?” In a trembling voice, she tells me about a painful relationship in nursing school and a recent invitation to connect, through social media, with the person who hurt her. Since she received that message, she has been replaying the past, unable to concentrate, and sleeping poorly. I ask a few questions, and with her voice growing more confident, she answers. I withhold my strong opinion of social media, my relationship advice based on my own experience, and my assumptions about the other person. I even refrain from offering the number for the employee assistance program. I say simply, “I'm glad you told me this.” For a moment we're silent, maintaining eye contact before she replies, “I'm glad you gave me the chance.” It wasn't the 5 minutes I'd planned—more like 15 minutes—but it was worth every second.