Intellectually, giving and receiving constructive feedback is simple, yet practicing it can be so hard that nurses often avoid it or find alternative ways to express concerns that may be very toxic to self or others. This is true for assertiveness and listening too and in reality, giving constructive feedback is a way to be assertive and receiving it a way to practice listening.
What are the alternative ways and why are they problematic?
- From a giving perspective, venting, gossiping, and/or humiliating are examples of poorly expressed feedback that destroy relationships, contribute to unsafe care and lead to poor patient experience.
- From a receiving perspective, over-internalizing feedback or defensiveness can chip away at confidence, minimize learning, and impact all of the above.
- It requires self-esteem, trust and abilities to reflect on one’s own behavior and honor others’ perspectives. These are attributes of emotional intelligence that often require practice, learning, forgiveness, and more practice. This can be tough in our day-to-day high stress, high stakes, fast-past clinical environments.
- Toxic cultures that promote blaming or tolerate disruptive behavior are big barriers to open and honest feedback. They threaten one’s psychological safety and job security. Sharing a concern about a colleague’s clinical technique may lead to overly scrutinized work. Since none of us are perfect, this could be a dangerous path to take.
- It may feel too risky to relationships, even when the relationships are unhealthy. Nurses have to depend on each other to get through the shift. These relationships may be full of alignments, horizontal violence, and/or co-dependence that MAY be good enough sometimes, but overall hazardous to everyone’s health. In other words, a staff nurse may not give feedback to a colleague if s/he is worried there will be resentment or retaliation. Not being available to cover a meal break or not sharing one piece of information can have a big impact on the next 8-12 hours.
- Staff may not feel like their input has been, is, or will be valued. Easier, sadly, to be quiet and get through the shift. In teaching and training for open and honest communication, organizational leaders must make sure there are realistic pathways for staff to healthily voice their concerns or share their ideas. If you are a leader and wondering why staff don’t speak up, there are two possible unmet needs, one to be safe and two to be heard. (Did you know that one of the most effective ways to promote assertiveness in nurses is by listening to them?)
Why focus on managers, preceptors, or teams?
Practicing giving and receiving constructive feedback involves a skill-set and a supportive culture. Nurse managers who get really good at the skills will be creating a culture among themselves and there will be a rippling effect throughout an organization. Nurse Preceptors who are really good at it will be impacting nurses at the beginning of their career or their position within an organization so not only will they learn all sorts of clinical skills and judgement, they will also become great at collaboration. Teams of nurses who may be transitioning from toxic to healthy cultures will undergo positive change as individuals and as part of a group. The group becomes more accepting of open and honest dialogue at the same time that individuals are developing the skills. Without this, the practice can be short-lived as there are insidious messages that don’t support it.
Ultimately giving and receiving constructive feedback is an integral part of creating healthy cultures and safe care. If you’d like to learn more about my interactive approach where I integrate experieential learning from medical improv and your staff’s input on problem areas, call or send me an email. 603-205-3509 – firstname.lastname@example.org