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Giving Positive Feedback to Nurses

Nurses managers can empower staff to advocate for quality care.

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When Mildred Jones, RN, became the nurse manager on an acute psychiatric unit that had experienced a lack of leadership for many years, her goal was to raise the quality of patient care by advancing the staffs' knowledge and empowering them to advocate for themselves and their patients.

Each time Mildred walked through the unit her critical-thinking mind went into overdrive thinking about how much work needed to be done.

Occassionally, she pulled staff aside to alert them to the problems she noticed and shared with them the best practices for the current patient care situation. Her intent was to use point-in-time learning to raise awareness and provide guidance; however, some staff saw her actions as condemnation and ridicule.

What could Mildred do? She asked for help from a trusted colleague and set about developing ways to give positive feedback.

Many nurses are like Mildred. Nursing education emphasizes critical thinking. Nurses are taught to approach patient care situations with an eye for what is out of place or needs attention.

This makes us excellent observers and keen problem solvers. It becomes natural for us to enter a patient care situation and begin immediate analysis, often taking action and giving direction at the same time. Being able to do this is a great asset.

But like any asset it can also be a liability as Nurse Manager Jones found out. Her critical thinking mind, allowed to dominate, looked for and found problems and immediately began to problem solve. However, this had negative consequences on her relationships with others.

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Use Your Critical Eye to Find What Works

Giving positive feedback to others is crucial to any nurse's work success and collegial relationships with co-workers.

But many of us find that it does not comes naturally. Indeed, if we allow our critical thinking minds to take over, constantly seeking out problems, we often do not even see what is working well.

Giving positive feedback to others takes practice. When nurses become aware of an overactive critical thinking mind they can begin to practice redirecting themselves to look for what is going well in addition for looking for what needs attention.

So the road to giving positive feedback is to develop a more balanced approach to our work and relationships with co-workers. Allow your critical thinking mind to see what areas need to be addressed at the same time that you ask it to seek out what is going well and needs to be acknowledged and praised.

There are a variety of ways that you can balance your point of view at work and help your critical thinking mind to become a more appreciative mind. Four things to practice include:

1. Developing an attitude of gratitude.

2. Actively looking for what is going well.

3. Letting people know how much you appreciate them

4. Using a gentle positive approach when giving constructive criticism

Develop an Attitude of Gratitude

How do you develop an attitude of gratitude? It's simple - start by saying 'thank you'.

In a work situation you can start by noticing the little things that people do each day. A simple 'thank you' can mean a lot.

Go ahead - try it.

Thank the CNA for making up the bed, combing the patient's hair, changing the bed linens, or passing out the water for the patients.

Thank a colleague for giving out medications on time, talking with a distraught family member, or taking the time to answer a patient's question (even though it wasn't his patient).

At the end of the day, express thanks to your team members for making it a pleasant day. It is especially helpful to thank others when things haven't gone so well, "Thanks for holding your cool today when everything seemed to break loose at the same time."

When you do this you might see a smile creep across your colleague's face - that in itself is a simple reward for your efforts.

Of course, some might be suspicious of this new behavior. Reassure them by letting them know that you are trying to acknowledge what you have always noticed by kept to yourself.

When you begin to say 'thank you' you might find too that you begin to notice more and more things to be thankful for. And who knows - it might become contagious.

Actively Look for What is Going Well

When you walk into a patient's room remind your critical mind to look for what is going well not just for what is not. Do not passively wait for something to strike you as going well. Seek it out.

Some teams use a three-part evaluation for debriefing urgent work situations which can easily be applied to any work situation. The evaluation asks the group to answer these questions:

  • What went well?
  • What didn't go well?
  • What can we do differently next time?

This three-part evaluation helps give balance to the situation. By starting out with what went well we shift the emphasis to the positive and that gives us the opportunity to tell others know that we noticed their contributions.

Using this evaluation also models for others a way to give positive feedback. After a stressful staff meeting, the team leader asked the group to list what went well. Members were able to list that even though there were a lot of differing opinions they liked that everyone was given time to express themselves and others were polite enough to listen.

Let People Know How Much You Appreciate Them

How do you show your appreciation of others? Are you genuine in your approach to those you work with? How often do you express appreciation to your team leaders, your Nurse Manger, you nursing administrators for a job well done? A simple "thanks for representing our views" at a hospital wide meeting can go a long way in letting your supervisor know that you appreciate her effort.

Use a Gentle Approach to Constructive Criticism

We all know there are times when we need to offer constructive criticism to others. Following these guidelines suggested by Susan M. Heathfield in "How to Hold a Difficult Conversation" might help make it go smoother.

Seek permission to provide the feedback, saying for example: "May I offer a suggestion that might make that go easier for you?" Don't just dive right in. Let the person know that you need to provide feedback that is difficult but important to share.

Share what you've noticed in a kind way. Keep it centered on being helpful and on you and the other person. It's counterproductive to say something like, "Everyone is talking about it."

Keep it simple, e.g.: "I am talking with you about this concern because it impacts patient safety (goes against policy, seems to cause anxiety for the patient, causes confusion on the unit, etc.)."

Let the nurse know the positive impact her behavioral change will have on the situation. For instance, to a charge nurse staff complains is too aggressive, a nurse manager might say: "You understand the importance of staff working together in an efficient manner. But by lowering your voice and asking others for their opinions you can gain cooperation, reduce anxiety, and help us all get the job done faster".

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After applying some of these techniques to provide positive feedback Jones walks though the nursing unit with a better-tuned appreciative mind. Because she acknowledges the good she sees the staff are more receptive to her guidance because they now hear praise along with the instruction.

Resource
Heathfield, S.M. (No Date). How to Hold a Difficult Conversation. Providing Responsible Feedback Is Difficult. http://humanresources.about.com/od/interpersonalcommunicatio1/qt/feedback_com6.htm

Joan M. Lorenz is a Clinical Specialist in Psychiatric Mental Health Nursing, Adult and throughout her nursing career she has held a variety of clinical positions including Patient Safety Manager, Nurse Manager, Staff Development Educator, and Patient Education Coordinator. She currently provides consultation and workshops on a number of issues designed to empower work teams to make changes needed to put more joy in their work environments.


 


One way to be able to notice positive things to mention to staff is to look at what we nurses do with respect. I work with nursing students and I find it easy to notice good things in their attitudes even when they are still rather green, because of how much I admire students who care about our profession in a way that many seasoned nurses - often not much older - fail to do because of cynicism.

Thomas ,  clinical instructorDecember 13, 2012
MA




     

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