By Dr. Kevin Nourse

Leading healthcare organizations recognize the value of investing in developing high-potential future leaders in order to establish a pipeline of talent ready to step into future management roles. Proactively developing future leaders can make a big impact on reducing the likelihood of career derailment later in their careers.

Having designed and facilitated several leadership programs to develop high-potential talent in healthcare organizations and related professional associations, there are five common career traps experienced by participants in these programs.  In this article, I identify five common developmental challenges faced by emerging leaders in healthcare:

  • Perfectionism
  • Inability to delegate effectively
  • Excessively blunt communication
  • Failure to say no or set boundaries with others
  • Overly self-critical

The good news is that emerging leaders challenged by these traps can employ strategies to mitigate them before they negatively impact their careers.


Perfectionism often appears as an overriding need to avoid errors while preparing a work product such as a plan or report. Perfectionists often become fixated on some inconsequential detail and may lose sight of the big picture on a project or initiative. While perfectionism isn’t always a negative quality, for many leaders, it goes to the extreme and leads to analysis paralysis, procrastination, lost career opportunities, and career derailment.

Consider the case of Guadalupe, a new supervisor. She advanced her nursing career to the point of becoming a supervisor in one of her organization’s clinics. She always prided herself on high quality, error-free work. Because the scope of her role has grown substantially, she has a hard time staying on top of her work demands. Her manager has become frustrated with her inability to meet monthly deadlines for reports. Guadalupe struggles with completing these assignments, checking and rechecking her numbers, and report formatting.

What causes perfectionism? In a 2011 study, a team of social science researchers clarified a definition of perfectionism and developed the Measures of Constructs Underlying Perfectionism (M-CUP) instrument that identified nine key components. Of the nine constructs, there are five that frequently challenge my clients:

  • Perfectionism toward others, which appears as having excessively high expectations of others and may result in harshly evaluating others’ work.
  • Reactivity to mistakes in which an individual experiences stress to real or perceived errors.
  • Perceived pressure from others in the form of internal beliefs that others have high expectations or will be overly critical of their work products.
  • Dissatisfaction in which a person does not believe they or their work products are never good enough.
  • Black and white thinking is the tendency to think that the lack of perfection translates to failure.

If you struggle with perfectionism, there are some strategies you can use to reduce your perfectionistic tendencies:

  • Build awareness of situations that trigger you to become excessively perfectionistic
  • Assess the benefits and costs of perfectionism – are there situations when it is warranted or instances when the opportunity costs are too high?
  • Clarify both the time allowed to complete a work product and the need for perfection with your key stakeholders.
  • Ask for feedback from others including peers and subordinates about the level of achievement you expect.
  • Experiment on low-risk assignments by setting a time limit on the amount of checking and review you perform.


Inability to Delegate Effectively

One of the most significant barriers to the ability of emerging leaders to advance their leadership careers is the ability to delegate effectively. Symptoms of faulty delegation include:

  • Holding onto tasks for which others could complete more effectively.
  • Micromanaging subordinates when delegation occurs.
  • Miscommunicating expectations to subordinates.
  • Not willing to invest time in developing direct reports to be able to delegate downward.
  • Fear of having to share constructive negative feedback subordinates if their performance does not meet expectations.

The negative impacts of poor delegation can be substantial. Past participants in high-potential development programs describe how an inability to delegate leads to a sense of overwhelm, adverse effects on work-life balance, diminished growth of subordinates, inefficiency, and limited opportunities to work at the highest level of ones’ abilities.

In this book Leadership Agility: Five Levels of Mastery for Anticipating and Initiating Change, leadership experts Joiner and Josephs argue that one of the most critical shifts in the development of leaders in the evolution from heroic to post-heroic stages. Heroic leaders derive their power from their achievements and knowledge, not recognizing the need to leverage the skills other others. As a result, it is increasingly difficult for them to play a bigger game in their role since their skills and capacity constrain them. The ability to delegate is one critical skill associated with successful leader growth and evolution.

Susan, a new supervisor with three direct reports, was excited when she received her promotion but is quickly growing frustrated with her inability to focus on critical priorities. Susan initially believed that “if I want something done right, I do it myself.” In the last few months, she has tentatively attempted to delegate more. However, when she reviews the work products of her subordinates, they completely miss the mark. As a result, she feels compelled to rework their work products in addition to her tasks. Since she does not provide developmental feedback to her team, they never learn how to improve, and the pattern continues.

Strategies you can use to better delegate include:

  • Review your and prioritize them using this schema: (1) mission-critical tasks or projects that only I can complete, (2) essential tasks or projects that others have skills to achieve, and (3) tasks or projects that are not critical and others could complete.
  • Experiment with delegation by assigning two of the least essential tasks.
  • Interview a colleague that is skilled in delegation to find out their insights.
  • Interview your direct reports to understand better their interests and skills that you might consider in your efforts to delegate.
  • Ask one of your direct reports for feedback about your effectiveness as a delegator.

Excessively Blunt Communication

Authentic communication that is direct and unambiguous is an essential leadership competency. However, leaders that communicate with a harsh tone without consideration for others can seriously damage their reputation and relationships with others. Symptoms of excessively blunt communication include:

  • Questioning others competence in a group setting
  • Using an accusatory tone
  • Cutting people off in conversations
  • Harshly worded emails that are copied to multiple recipients
  • Using the same approach to communication regardless of the audience

Leaders that are excessively blunt when they communicate may be overusing a strength for task-oriented communication, talking when they are emotionally triggered and are unconscious of their behavior, or lacking empathy and awareness of others’ feelings. The impacts of this communication style include damaging relationships with others, destroying trust, and stifling creativity and innovation. A clinical supervisor in a high-potential development program I facilitated suggested, “the negative impact of my blunt communication style is a reduction or loss of credibility, respect, morale, and staff productivity…I could lose forward-progress or even my job.”

Consider the case of Steve. As a highly experienced healthcare finance manager, he prides himself on speaking truthfully and directly to others. However, Steve tends to overuse this skill or use it in inappropriate situations – both interpersonally and through email. During a recent meeting, he became defensive and used excessively harsh language with a new manager, putting him on the spot in a meeting with his peers. While he apologized afterward, he quickly developed a negative reputation as being easily triggered and lacking leadership presence.

There are several strategies to use if you struggle with your communication style:

  • Identify your patterns for being overly blunt – do you demonstrate this with specific individuals or situations?
  • Take three deep breaths when you are triggered to speak harshly.
  • Proactively build relationships with others, so you have established a trusting foundation as a way to counteract future episodes of harsh communication.
  • Communicate your expectations to others in advance, so you are not triggered if they don’t hit the mark.
  • Leverage the talents of others on your team to diplomatically communicate in sensitive situations.
  • Enlist others to support to review your tersely worded emails before you send them.

Failure to Say No or Set Boundaries with Others

Supporting others and going above and beyond the call can make a positive impression on others. However, emerging leaders who are unable to say no or set appropriate boundaries may find others taking advantage of their helpfulness. Symptoms of an inability to set proper boundaries and limits with others include:

  • Feeling taken advantage of by others
  • Unable to complete your core duties and tasks
  • Feeling stressed and overwhelmed
  • Afraid of the conflict that might result from saying no
  • People-pleasing tendencies

Leaders that are unwilling to set appropriate boundaries and limits may do so because they are overusing a strength of building relationships, don’t believe they have the power or authority to say no, or lack assertiveness skills. Others struggle with this because they inaccurately assume others know their limits. In essence, they teach others through their actions that they will continue to take on more and more. One participant described how she “feels a responsibility to do what I can when I can, even if that makes it personally challenging for me. I feel guilty if I say no to something I could have completed even if it would have overloaded me substantially.”

Barbara is a new manager who struggles with setting limits and boundaries. When asked by colleagues to take on specific tasks, she does so without hesitation. Barbara prides herself on having an open-door policy. As a result, colleagues and direct reports stop by to ask her “quick” questions that result in much more extended conversations. As a result, she works overtime on nights and weekends to catch-up creating negative impacts on her work-life balance. She is growing frustrated and angry. Because of her pattern, she has little time to proactively build relationships throughout her organization, including her boss – a strategic career mistake.

What can you do if you struggle with an inability to say no?

  • Before committing to taking on tasks from others, wait 30 minutes and reflect on the opportunity costs of taking on the additional work.
  • Proactively communicate to key stakeholders when you are not accessible except in emergencies.
  • Pay attention to your patterns associated with people-pleasing – do you do this with certain people or situations? Do you tend to say yes at the end of the day when you are exhausted?
  • Interview a colleague who is skilled at boundary setting to find out their approach.
  • Enlist your boss to help in setting boundaries on requests from peers or other departments.
  • Learn negotiation skills and the art of exchange – if you take on someone’s task, what are they willing to do in exchange.

Overly Self-Critical

Effective leaders pay attention to their performance and development, periodically critiquing their effectiveness to improve their skills. However, some leaders go to an extreme when critiquing themselves, resulting in several symptoms:

  • Unable to take action for fear of making mistakes.
  • Missed opportunities to contribute their ideas.
  • Catastrophizing and expecting the worst.
  • Lack of confidence.
  • Negative self-talk that focuses more on failures and mistakes versus successes.
  • Obsessed with a need to prove themselves to others.

Why are some leaders overly self-critical? In some cases, these leaders set excessively ambitious goals that are likely unattainable. Others experience an imposter syndrome anchored in a fundamental lack of self-regard, causing them to doubt themselves. Regardless of the cause, negative self-talk tends to persist unless leaders recognize the patterns of self-talk and unproductive rumination.

Carol is a supervisor who excelled as an individual contributor. With her promotion into her first management role, Carol’s boss expects her to speak about the performance of her team in leadership meetings. Before attending these meetings, Carol is obsessed with critiquing herself and consistently overprepares. When she shares her ideas in leadership meetings, she unconsciously apologizes to the group. As a result, many of her ideas get little traction with her supervisor and other stakeholders.

There are several strategies you can use to mitigate being excessively self-critical:

  • Evaluate the factors that trigger your tendency to become overly self-critical.
  • Create and periodically review a journal of accomplishments and accolades received from others.
  • Ask trusted colleagues for feedback on your strengths and weaknesses.
  • Practice mindfulness to build practical self-awareness skills for noticing negative self-talk.
  • Focus on self-care and wellness including adequate sleep, exercise, and diet.

Emerging leaders in healthcare may experience these five common challenges, including perfectionism, an inability to delegate, overly blunt communication, saying no, and being excessively self-critical. These challenges can limit your career progression. By building awareness, experimenting with new behavior, and enlisting the support of others, you can eliminate these potential career traps and prepare yourself for a successful leadership journey.

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Dr. Kevin Nourse is a member of HCE-SOCAL and has more than 25 years of experience developing resilient change leaders in healthcare. He is the founder of Nourse Leadership Strategies, a coaching and leadership development firm based in Palm Springs. For more information, contact Kevin at 310.715.8315 or