Brown delivered that message Thursday morning, during the opening keynote of the American Organization of Nurse Executives’ Annual Meeting, here in Baltimore. No act of leadership exists without the presence of vulnerability, according to Brown, and she believes all nurse leaders should embrace that feeling, rather than avoiding it for fear of appearing weak.

Health care is undergoing monumental change right now — Brown likens the nursing profession to being in “permanent whitewater” — and RN execs must give all of themselves to help lead the field through this uncertainty.

“Vulnerability is terrifying and it’s dangerous and it feels scary,” she told attendees. “But I do not think it’s as terrifying, dangerous and scary as getting to the end of our lives and having to ask, ‘what if I would have shown up? What if I would have said yes? What if I would have tried this.’

“The people I’ve interviewed who were at the end of their lives who never took the armor off had the most unbearable grief I’ve been around in my life. It’s not safe, but you’ll know you’re alive, and we need you because you really are going to need to lead this change for us and you’re going to have to do it with your whole hearts to work.”

Leadership challenges

Some of the biggest issues in leadership often tie back to that unwillingness to take risks and put yourself out there — conflict avoidance, stuck on past achievements, commitment to an unsustainable model were just a few that Brown listed. Too often, folks choose comfort over courage, and after 15 years of social science research, Brown said the only guarantee she can make is that leaders who put up a brave front end up getting wiped out.

Courage, she said, is comprised of four key skillsets — vulnerability of course, trust, clarity of values and rising skills (the ability to reset after a failure or setback).

“If you choose to show up and be a brave leader, you will go down,” she said. “You will get your ass kicked. You will be criticized. You’ll be made fun of, you’ll be put down. People will not understand you. Every day, you’ll have to make the decision: Do I choose comfort today or do I choose courage because you cannot have both, and in health care, you can’t even have a semblance of both.”

Of course, there are limits to this philosophy. No one is telling you to ugly-cry about your divorce in the middle of a board meeting. Rather, it’s admitting that you don’t understand something in a budget, or that you can’t undertake a big project without more support from the team. It’s about being vulnerable, but with boundaries, Brown said.

Generating leadership

Determining those boundaries can be tricky for leaders, too, she said, when you are managing a multi-generational workforce, with boomers who were raised to not wear their hearts on their sleeves, contrasted with share-all millennials who think they need to live blog every minor life event. “Define what is courageous vulnerability and what is not,” she said. “It is vulnerable to ask for help and it is brave. Live tweeting your bikini wax, not vulnerability.”

And of course, while Brown’s leadership philosophy is to embrace vulnerability and be willing to fail, that doesn’t mean you should go out willy-nilly taking big risks without any forethought. “When you fall, you have to know why you were in there and why you’re taking the hits. If your face is marred with dust and sweat and blood and you’re in the arena, and you’re not clear about what took you in there, you will not survive it. You will not get back up.”