291: The Hidden Driver of Burnout and How Leaders Can Regulate Under Pressure, with Vanessa McNeal

In this episode, Dr. Pelè speaks with Vanessa McNeal about what really drives burnout and performance under pressure.

They explore how leaders unknowingly operate in survival states like fight-or-flight and shutdown, and why this isn’t a motivation problem, but a nervous system and safety issue. Vanessa shares practical tools leaders can use in real moments, from simple awareness practices to quick physiological resets, along with mindset shifts that transform how leaders show up for their teams.

The conversation also highlights how emotional regulation shapes culture, spreads across teams, and directly impacts trust, decision-making, and patient outcomes in high-stakes environments.

If leadership is experienced in moments, this episode reveals what’s happening beneath the surface in those moments and how to change it.

Connect with Vanessa on LinkedIn: https://www.linkedin.com/in/vanessa-mcneal/

Transcript

Welcome And Why Regulation Matters

Dr. Pelè 0:07

Welcome to the human side of leadership in healthcare podcast. I'm Dr. Pele, and on this podcast, we explore how leadership shows up in real moments and how those moments shape trust, culture, and patient outcomes. Today we're talking about how leaders regulate themselves under pressure and how that shapes burnout, resilience, and performance. And it is truly my pleasure to welcome Vanessa McNeil. Vanessa is a keynote speaker and trauma-informed leadership coach who helps leaders understand how their internal state shapes how they show up in the moments that matter. Vanessa, I'm really glad you're here. How are you doing today?

Vanessa McNeal 0:49

I'm really good. Excited for our conversation today.

Dr. Pelè 0:53

And I know that you said you're in cold Iowa right now, Kyle.

Vanessa McNeal 0:56

I am in cold Iowa, yes.

Dr. Pelè 0:59

Hey, Vanessa, let's go ahead and just start with your story. I'm really impressed with your story. I've done a lot of research. I've followed you on LinkedIn and in other areas. And I know that you've worked uh deeply in trauma-informed care and nervous system regulation. What first led you into this work?

Fight Or Flight Versus Shutdown

Vanessa McNeal 1:16

Yeah, what first led me into this work is that I got my master's degree in social work and I specialized in trauma-informed care. And at that time, a lot of people in my cohort were going to become therapists. And I saw the importance of that, but I always had this drive to do more macro level change work. And that's why I became a speaker. And when I first became a speaker, I was speaking my own story of resilience and overcoming adversity and trauma until 2020, when I heard a quote that said, uh a quote by Mother Teresa that said, if you invite me to a war, an anti-war rally, I won't go. But if you invite me to a peace rally, I'm coming. And it offered me a different perspective into my work because at that time I was so anti-trauma. Let's get trauma out of the work, the world, the workplace and our lives. But I didn't realize that from that lens, I was really creating more of the energy that I didn't want in the world. So that's when I really reframed it. And I was like, how can I take people from these states of trauma or lower nervous system states and bring them into the world that they want to be in, which of course is more connection, more collaboration, innovation, uh compassion, performance. And so that's when my work really changed. And I became a coach soon thereafter and started to do the more uh deep inner work that it takes to unhook and unbind from a lot of these inner bottlenecks that we have. So that's the work that I'm bringing into the world.

Dr. Pelè 2:52

Oh my goodness, and what powerful work it is. You know, when you think about high performers in the general world, or maybe even healthcare workers uh who are stuck in, I think as you describe it, this kind of survival mode, like with the lower parts of their brain or something you mentioned earlier. What does that look like in real life? If if if someone were to say, hey, give me a tangible example or two of what that looks like or feels like, what would you say?

Vanessa McNeal 3:20

Great question. So there are two lower states that signal dysregulation. And most high performers and high achievers, especially in healthcare, are in what's called a sympathetic state. So that's the fight or flight state. So this is where you're feeling like this needs to get done and it needs to get done right now. And I'm probably talking a little bit faster, I'm probably walking a little bit faster because there's so much to do, and I have to get it done, and I have to get it done all right now, and I don't want to ask for help because no one can do it as good as I can. So, and we've all been there. And it's okay to like dip your toe in a nervous system state, but the problem becomes when you're chronically living in that fight or flight state, that's when burnout really happens. And and that's when the the body starts to shut down it on a cognitive level. It I mean, when you're running really fast all the time like that, you're not stopping to see what's around you. It's very much tunnel vision, you're not even tasting your food, you're not really hearing people, and so that's the first uh state is sympathetic that's on that lower realm. And then the second one is called dorsal, and that's when that like the circuits have now broken and you've completely shut down. And we see this in the wild with animals when there's a predator uh uh chasing prey, and the prey, you know, in its brilliance, is like, I'm gonna run from you because you're a threat to me, but it has to make a critical decision at a certain point when it feels like it can't run anymore, that it just decides to play dead. We do that in our jobs. So there are people in healthcare that are they're walking around and they're doing the bare minimum just to get by, but they're not feeling alive inside anymore. And so that's dorsal. That looks like checking your emails, and you're like, oh, I know I have to do this, but I can't. I know I really need to talk to this patient and explain, you know, all of the um uh discharge information, but I'm just gonna do like the bare minimum because I don't have the energy to go the extra mile. That's essentially what happens when you live in fight or flight, so long you shut down.

Dr. Pelè 5:41

Wow. And you know, as you were sharing, as you you shared all of these things, I was saying to myself, I bet you these leaders don't even know that this is happening. I mean, you know, you you're like, and and and correct me if I'm wrong, you know, more motivation or even more skill isn't really gonna help you fix what you don't know, correct?

Vanessa McNeal 6:02

Such a great point. It is not a motivation problem whatsoever. And I think that a lot of leaders, uh, I think it's easy for leaders to rely on that, just like they're not inspired enough. No, their nervous system is in a survival state and it's protecting them because it feels like there's a threat. So that's why they're what my work in organizations is to help them understand that what's needed in those lower two states is safety, psychological safety, um, in a workplace that doesn't feel like it's on fire.

Dr. Pelè 6:37

Wow. Now you've mentioned this word somewhere, either today or in one of the things I read about you, dysregulation. Yes, nervous nervous system dysregulation. I wonder if you could maybe tell us how that looks like in these moments and and maybe make it personal for people in high stress environments like healthcare.

Vanessa McNeal 6:58

Yeah. So dysregulation is when you drop into those lower two states that I talked about. Because an example in healthcare is maybe you started a new role and you are so excited about it when you first started. You it's something that brings you joy, it brings you meaning, you have a lot of good energy, you're regulated, right? And regulated means that you're grounded. It doesn't mean that everything is, you know, even perfect or close to perfect or going great. It just means that you have enough shock absorber in your system to be resilient through change and adversity. But when safety starts to erode or when burn burnout starts to happen, you're gonna drop into those states. So um when there's too much stress and not enough safety, your nervous system decides, okay, I'm gonna first, I'm gonna drop down into sympathetic and do the fight or flight because that's my best chance of survival. If I go really fast and if I do all the things, maybe I can outrun or outperform the threat. But if the system doesn't change and there's not more safety, that doesn't happen. And again, when you you're living and existing and sympathetic for so long, you will drop down the ladder even further until you completely shut down. So I hope that answers your question. But that's how dysregulation occurs.

Dr. Pelè 8:20

Yeah, and you know, as you as you talk about this in my mind, I'm thinking, wow, you you make analogies to animals and and our animal state. And you know, for anyone listening, you know, I I like to make things, you know, dead simple if possible. You know, can you guide us through why it's important for us to remember that we may not know it, but we still do have our biological animal-based systems working so that so that someone can go, you know what? So what she's telling me is that I may know who I am, but I might not know everything about it.

Noticing And The Physiological Sigh

Vanessa McNeal 8:57

Yes. Yeah, that's such a brilliant point because we are not taught this in schools. This is not, we were never formally educated about our states and how they work. And what ends up happening is that we drop into these states so automatically that we have no idea. So, what it takes is so much awareness and so much checking in with yourself in every moment to go, what sends me to the corners of myself? What changes in my day that sends me from a regulated state to I'm dropping down and I'm feeling the need to go into fight or flight? For me, it's uh picking my kids up from daycare. It's always stressful. Or the moment when my uh son gets home from school and like he has a lot of needs all at once. So I have to do a lot of work during that time period to ensure that I stay regulated through that stress. Another example would be right before I get on stages. So many nerves, the nervous system is in overdrive because I want to perform and do well. So I need to introduce safety through different strategies uh for myself to stay regulated, and that's what we all have to do.

Dr. Pelè 10:12

Yeah, no, I I love that. And I think I think we've talked about the problem enough. Let's go into solution mode, right? Yeah, that's okay. People should have a sense now of you know what that problem looks like, even if you're not fully aware of it. Let's talk about you mentioned shock absorbers earlier. This is part of your body of knowledge. I really love it, by the way. You talk about these shock absorbers. What are one or two simple practices or or best practices, if you will, that leaders can use in the middle of a stressful moment to either become aware or begin to get get out of it?

Vanessa McNeal 10:47

Yeah. The very first one, even before we go into a tool, is the just the practice of noticing. Most people are not even in their body to notice the signals of change, uh, to be able to be resilient through them. So that just means that what I imagine visually is that people have all of these invisible strings, thousands, millions of them going outside of themselves, they're thinking about work, performance, they're thinking about their kids, what's for dinner. But what we have to do if we want to stay grounded is to bring all those invisible lines back to ourselves to notice uh is my heart rate increasing right now? Do I feel like I'm in my body? Am I thinking uh creatively right now? If not, then why? So we have to first start by noticing. And it sounds so simple, but it takes so much energy and practice to actually live that way.

Dr. Pelè 11:45

Yeah.

Vanessa McNeal 11:45

Um, you know, people will meet me and they're like, Vanessa, you're so grounded, you're so calm. How do you get this way? And it's so much energy to be able to bring myself back to this moment. So that's the first thing is noticing. The second one, um, I mean, there's lots of grounding tools that people can do, but a physiological sigh is a quick and easy tool, and it's two breaths in through the nose, one exhale out the mouth.

Dr. Pelè 12:14

Okay, I just did that.

Vanessa McNeal 12:17

What that does, it lets it it's almost like uh the body's way of taking a deep breath, and it just lets the body know we're safe because 80% of the information about what your system processes, about what's safe or what's not, comes from the body. So if we can regulate the body, if we can introduce safety in the body, then the mind and everything else will follow. Because again, this is not a motivation problem, this is not even really a burnout problem, this is a lack of safety problem.

Core Questions That Drive Behavior

Dr. Pelè 12:49

Wow. Which which is not only psychological and you and is a blind spot, but it comes from our, frankly, our animal evolution and history. The things that make us biologically who we are. You know, uh for a healthcare leader who's got like 30 seconds before walking into the next patient room, everything's important, of course, and everything, you know. It sounds like even that example you just gave, the the breathing in twice and out once is a good way to reset. Um, I like to talk about habits because you know, one behavior is great, but you know, when you can burn that behavior again into your uh biological powerhouse, superpower, you know, it's even better as a habit. Could you give us some small daily habits that not just healthcare, but really any leader? You know, as you said, walking into a meeting or or into your next speech, what are some things that can help people shift out of survival mode?

Vanessa McNeal 13:49

Yeah, that's a really good question. Um, a different a different solution would be checking in about the questions that you're asking yourself. I talk a lot about that. Everyone has a core question that drives their behavior, and our behavior uh has so much to do with our nervous system and the states that we're in. So, really checking in with most people have um several core questions that they're asking, but a lot of the times um we're asking ourselves really uh disempowering questions like Am I good enough? Um do I matter? Does my work matter? And when you ask your brain a question, it's really tasked to give you an answer. And when you're asking low-level questions, you're gonna get low-level answers. So it's really reimagining the ways that you're speaking to yourself, because at the end of the day, we are a mirror for the relationships in our lives. So if we can be a model for uh higher states in ourselves, then we can be able to share that energy with people externally. So I say all of that to say, check in what is your core question, the question that you ask yourself more than anything else in the world, that you usually get the same answer for. Am I good enough? The brain's no.

Dr. Pelè 15:12

Oh, okay. So, first of all, thank you for like lobotomizing, probing into my brain and telling the whole world what I think about. No, seriously, I think what you shared, almost everyone goes through those uh questions. I wonder if we could maybe do the reverse of that. You know, what kinds of questions can we start asking that would lead us in a better direction for these high stress moments? Um, how do we get out of this negative loop, you know, and into the positive? What questions can we ask?

Vanessa McNeal 15:41

Yeah, the questions that you could ask, um, it reminds me of a coaching client that I had, and she was someone who was always the yes person. She's the uh executive on her team, and she's always the person that always just says yes. And her her first her core question was, Am I doing enough? She changed her question to, do I have the capacity for this? And right, and it changed the way that she shows up in the world and in her workplace by that simple core question shift. Other questions are like, what matters to me in this moment? Does this feel good to me right now? Um and just more positive, like who would I need to be in order to X, Y, and Z?

Dr. Pelè 16:28

Right?

Vanessa McNeal 16:29

So it's it's reframing and it's putting you uh into a different uh lens to find a better, higher quality answer.

Dr. Pelè 16:39

You know, one thing in in healthcare, but in leadership in general, is a tendency for us to focus on ourselves and where uh our knowledge base and our expertise makes us credible enough to to do XYZ and or say XYZ, and then we forget uh that it's not always about what we say, it's about how we're making the people in front of us feel. And so, like I'm wondering if what you're also saying is we need to ask questions that help with the emotional side of how we're impacting, making others feel versus just I'm the smartest person in the room.

Vanessa McNeal 17:16

You know, that's a big part of it.

Dr. Pelè 17:17

Yeah. Is that is that so that shift toward thinking about emotions, is that an area that's important in in this conversation?

When One Leader Burns Out A Team

Vanessa McNeal 17:26

Yeah, absolutely, because what is it emotions are energy in motion, and that our energy precedes us in all ways, and our as does our inner states. So if we can get to a place of more emotional regulation, more physical regulation, people feel that. People know what it what it feels like to walk into a room or an office setting or um uh a workplace and feel the energy of others and the emotions that they're carrying. So it it the illusion is that this stuff is fluffy. The illusion is that this is just you know touchy-feely, intangible stuff, and it's not. Yeah, it's really the work that shifts dynamics, it's the work that changes uh moods, and we know how those affect people and how they're collaborating, how they're showing up and voicing their opinions, their creative thoughts and solutions. So it's really a different way of looking at workplace dynamics and how to shift workplaces in a better direction.

Dr. Pelè 18:33

Um, I didn't ask you this earlier, Vanessa, but I'm gonna ask you now. Do you play any musical instrument? I don't. Oh, okay. Well, you can probably see the guitars and got pianos and everything everywhere. The reason I bring that up is you're making a point that reminds me of um, you know, like if there's a piano over there and there's a piano here, uh, there's science that proves that if I play a note here, there's a resonance that makes that piano play the same note. I'm wondering if if if burnout spreads like that, like culture, like you know, is that kind of how it's spread? It's almost magical. If I'm gonna be all burnt out now, everybody else is gonna be too, you know?

Simple Practices That Build Safety

Vanessa McNeal 19:10

Yes. Yeah, absolutely. When we talk about workplace culture, that certainly happens. And I'll give you an example of this. So I had a speaking engagement to a group of leaders all from different workplaces, and I asked them to drop into a regulation resource with me. It was essentially a guided meditation, and everyone was cooperative except for this one man in the front. He was shaking his leg and he didn't want to close his eyes. And so after the exercise was finished, I asked, How was that for everyone? He blurted out and excuse my language, but he said, I could think of a million other fucking things that I could do other than this. Oh Lord. And we every shock and horror. But I took a deep breath and I stayed regulated and I got curious instead of judgmental. And I said, Do you mind sharing where that's coming from in you? And he said, Well, I don't, you're you're asking us to be regulated and to get to a place of safety that doesn't feel safe for me to be calm. I don't want to be calm because when the shoe drops, how will I be ready and on my feet for that? And he was able to identify, because now this was a back and forth conversation. He was able to identify in in himself the resistance that he has to being regulated. And his team was there with him. And I asked his team members, how does it feel to work with someone who does not want to be regulated, who wants to be in this urgent fight or flight place because everything is a problem to him? And they're like, it's exhausting. We appreciate him as a leader, we really value him, but it makes us feel what he's feeling. It makes us feel like there's a fire because he's walking around with a fire within himself. And it it's it creates um separation, it creates a lack of trust, it makes us move urgently in places where we don't need to move urgently, which means that we're making more mistakes and showing up in ways that we don't need to. So that is really the impact that this lack of regulation has on a culture and a team.

Dr. Pelè 21:20

Sounds to me like there's some kind of a buzzword we could come out here, come out with maybe the regulated culture. Yeah, right, right, seriously. I I wonder if you have found or like any tools today. I mean, today's AI world, right? I'm sure there's tools to do everything, but um by the way, I happen to really appreciate AI for being a coaching companion, by the way. But have you come across any tools that can help build a regulated culture? So just not one person uh alone, but maybe a team and and and so on.

Vanessa McNeal 21:56

Yeah. Um what comes to mind just often Top of my head is doing round robins daily. And so these are quick daily check-ins of uh what's showing up for you today. Um, or like there's a team that has this exercise of like, what's the weirdest thing that happened to you this week? And then they all judge, and the person that has the weirdest thing gets to be the winner, and it's these like small but meaningful ways to connect that create safety. And again, that is what a culture of high performance, a culture of uh resilience, of care needs is that safety piece. And having the round robin allows everyone a voice, and that's also what's needed to have safety. So just even small but mighty things like that create healthy cultures. And um, in healthcare, another big one too is uh blameless error reporting, having that in a space where there's a system in place that allows employees to offer or to share um errors that were made in the system without blowback. And we know that hospitals and um healthcare systems that have blameless error reporting in place have less errors. It's like, whoa, how did that happen? There's so much safety for me to say to my leader, hey, I I typed in the wrong information here. I gave this patient uh uh the wrong medication or something, right? There's has to be a lot of uh safety in that culture to be able to know that I can make a mistake without being fired, without being ridiculed or shamed. And so those things are are necessary.

Dr. Pelè 23:48

Right there, you hit on a huge topic. I mean, the psychological safety, the idea. Imagine that, something went wrong, and I'm not blaming anybody. I mean, that's gotta be a skill that people need to spend some time learning. It's not easy to do. Um, if you could give every healthcare leader, um, or any leader whatsoever, frankly, because everyone has stress, one mindset shift about stress and performance, what would it be?

Vanessa McNeal 24:19

One mindset shift that I could give the more that you're investing in yourself, the better people around you will be. Because the illusion around uh what I hear a lot of people uh people in healthcare feel is like I have to give it all up in the name of helping other people and they're in the helping profession, and then they're burned out. But the more that you can sit with yourself, the more that you can have those regulation practices as a part of your life daily, the better that you can pour into people and you don't come last. You have to come first.

Dr. Pelè 24:56

Wow, that is so well said, Vanessa McNeil. Um, I I would love to know what's next for Vanessa McNeil. What projects are you excited about? What's coming up next that we can look forward to?

Vanessa McNeal 25:07

Really uh great question. So, what's next for me more keynotes nationally? Um, so speaking at conferences, association groups, um, I'm also doing organizational coaching as well. Um, so I work with employers who need additional support outside of the traditional support systems there. So that's really exciting for me too. And then I'm working on um a project at something that I do quarterly called Rewired Live, and that's where the community comes out and they get to ask me questions about the things that keep them up at night, and I coach them live in front of the audience. So I want to take that nationally. So that's another really exciting thing, but more talks, eventually a book in the future, but more of this work and more places.

Dr. Pelè 25:57

Well, I have to tell you, as I said, I've I've been following you, and I've even been following the people you follow, like actual uh Richards. Yeah, he's just awesome, and um, he's in the kindness speaking space. By the way, both of you are people that I I learned from because I'm also uh a professional speaker, um, and so I I just watch you do things like that. Um, so if you, you know, you're also, I just want to make sure I put this in there. You're one of the top 10 rising speakers. Oh my goodness. Uh tell us about that. I want to know more about that.

Vanessa McNeal 26:29

Yeah, so um there is a coach uh and uh a speaker who does amazing speaking all over the country. Um his name is Jacob Brown, and he offered uh I don't know if he does this every year, but at least this year he had a top 10 rising speaker lineup, and I just happened to be one of the speakers on it, which is such an honor. Um, and I do feel like there's tons of momentum around my work right now, and I'm just excited to watch it elevated.

Dr. Pelè 26:57

Yeah, well, you know, your work is at the core of success. It's it's in a blind spot category. And a lot of people are just living their lives and not seeing these things, but they're so important. And uh, I want to thank you so much for just sharing some time with me and with us. And do you have any last words, uh, any last point you'd like to make just to take us out?

Vanessa McNeal 27:19

Oh gosh, um the last point. Um yeah, I think if any of this resonated with the people that are listening or watching, I'd love to collaborate and work with you. There's there's so much here in what you just said around uh this is the work in the blind spot. This is really the shadow, this is shadow work. And we can't continue to do the same things and expect different results. And so this is a way forward um to help people in it uh organizations get out of a stuckness. So uh yeah, thanks for having me. And if you want to learn more about me, you can go to my website, Vanessa McDeal.com.

Dr. Pelè 27:57

And I'm gonna add your LinkedIn uh uh you know link as well, because that's a central place that I know you are are are are discoverable. Absolutely. All right, thank you, Vanessa. I really appreciate your time.

Vanessa McNeal 28:10

Yes, thank you.

Dr. Pelè 28:12

All right,