When the Only Leader in the Room Is You
You’ve probably heard the stories—the ones about the first time you realize you’re the adult in the room. Whether it’s with your kids, at work, or just anywhere in the world, something happens, and you stop, look around, and expect someone else to step in. But suddenly, you realize that person isn’t coming. It’s you. Everyone is waiting for you to know what to do.
Funny thing is, that feeling never goes away. It may not always be about being the only adult in the room, but it shifts to different areas of your life and work. It’s being the only nurse in the room or the only leader in the room or the person who has to make a hard call you’re not used to making.
Let me take you back to my adolescent psych days for a moment. As you can imagine, the stories never end. Day after day, you’re waiting for a break, waiting for someone else to step in and take charge. But you realize that person isn’t coming, because it’s you.
By the time I’d been in my role for about three or four months, I was feeling pretty good. I had a solid handle on who to call in a crisis and how to handle a range of situations, from minor injuries to more significant mental health crises—exactly what you expect in this line of work. It was a typical weekend afternoon. We’d usually get intakes as soon as a bed opened up, and that’s exactly what happened that day. I was prepared, I knew who was coming, and what to expect. The intake process went smoothly, and everything settled down into a typical afternoon. Midday was recreation time, and I planned to catch up and prep for the evening.
Then, suddenly, the radio crackled. It was one of the male techs paging for me. I thought it was just a simple request—someone needing Tylenol or perhaps a bee sting. But no. The request was for me to come to the other campus quickly because there was an unconscious patient.
Well, in healthcare, you expect things to happen, but this wasn’t something I anticipated in adolescent psych. I grabbed my bag, stayed on the phone with the tech, and hopped in my car. I could get from point A to point B in about three minutes if necessary, and in this case, I was there in less than 90 seconds. I entered the room, handed my phone to the tech to call the doctor, and began assessing the situation.
Our new intake, a 15-year-old, was lying on the bed. My initial thought was that he was messing with us. He looked peaceful, calm, almost as if he were sleeping, but there was something off. His breathing was steady and non-labored, his skin color looked fine. As I prepared to take his vitals, I walked over and attempted to rouse him, saying his name as I listened to his pulse. I had my pulse oximeter on his finger and continued my assessment, but something still didn’t feel right. I became more concerned, my tone shifting as I moved on to sternal rubs—a technique used to check neurological function by applying pressure to the sternum. Still, no response. Nothing.
At this point, the tech came back into the room, and the doctor was on the phone. I instructed the second tech to call 911 and grab the emergency bag with Narcan while I continued briefing the doctor. We were not equipped to handle medical crises beyond a certain level within the facility.
As I assessed the situation, my immediate thought was overdose. The physician on call agreed, and as soon as the tech returned with the Narcan, it was administered. Within minutes, we could hear the ambulance arriving in the distance. But still, no response from the Narcan. I stayed on the phone with the doctor, keeping him updated, but nothing was changing. I prepared to administer a second dose, and just as I was getting ready, the EMTs arrived. They took over, and I stepped back, ushering the techs out of the room.
I moved to the hallway to debrief. Both techs were visibly shaken. One of them was trembling as we spoke.
The child eventually regained consciousness. It turns out, just prior to his arrival, he had consumed an outrageous amount of alcohol. We routinely drug test on intake, but alcohol wasn’t part of our standard screening. After this incident, breathalyzers became a mandatory part of every intake.
As I stood in the hallway with the techs, I radioed the rest of the team, letting them know that the patient was cleared and moving out to the other campus. I had every patient escorted out of view to minimize exposure to what had transpired. In this moment, I wasn’t an official leader—I hadn’t even notified my direct supervisor yet. My attention was needed elsewhere, on those who had been right there with me through the crisis.
I’ve always had a great relationship with the techs I worked with, but this moment was the one that truly bonded us. We stood there together in the hallway, and one of them said, “I’m so glad you were the nurse on this evening. There was no panic. It was calm, methodical—everything went smoothly without chaos.”
Internally, I could feel my heart racing as I came down from the adrenaline, but outwardly, I had remained calm. Despite the intensity of the situation, I had functioned on autopilot. In many ways, I wasn’t a leader in that moment, but I was still looked to for guidance, and I provided the calm presence they needed.
It was moments like these that taught me what being a leader really is. I learned skills in those intense situations—skills that I still carry with me today. While my work may look different now, whether in hospice leadership or other settings, the level of calm and clarity needed remains the same. Leadership isn’t just about having all the answers or being the one in charge—it’s about being present, grounded, and calm, especially when it matters most.
