How to Give Constructive Feedback

Preceptors can dread giving constructive feedback. Here's a cheat sheet to follow to make it easy for both the preceptor and the preceptee.

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How to Give Constructive Feedback

Angela's preceptee, Lindsey, kept being late to work. Not terribly late, sometimes just 3-4 minutes. Other times, maybe 5-7 minutes. Typically Lindsay would rush in, all smiles and apologies. From the first, Angela was annoyed while she waited for Lindsay to put her backpack in her locker, her food in the fridge, and grab a report sheet, but it seemed petty to say anything. 

This morning, though, Angela was more than annoyed. It was a pattern. Why couldn't this new nurse just get to work on time? Weren't they taught in nursing school anymore to be ready to work at 0700, not to just show up at 0700ish? 

Angela liked precepting, so why was Lindsey forcing her into an uncomfortable position? Angela's friendly feelings towards Lindsey were fading fast. It was a little thing fast turning into a big thing.

Addressing performance discrepancies is part of the preceptor's role. Performance discrepancies are when the employee is doing something one way, but the organization expects him /her to do it differently. It's the preceptor's job to help close the gap-the performance gap. Avoidance is one way to deal with conflict, but there are better ways.

Here's how to give constructive feedback respectfully and effectively.

Step 1:  Open

Be respectful and ask for permission to meet and to talk. "We need to talk for a couple of minutes. Is this a good time?” Find a private space where no one can overhear. As the old saying goes, praise in public, criticize in private.

Don't beat around the bush and do get to the point, because your preceptee will be nervous. Start with "I have noticed", or "I have observed" and then describe the behavior. 

Give a couple of specific examples if possible. Just the facts, without judgement or opinion.

"Friday you clocked in at 0703, Saturday at 0705 and today at 0704".

note: What do you do if 2-3 credible colleagues have noticed the behavior and reported it to you, but you yourself have not seen it ? For example, maybe another nurse noticed Lindsey left the room to grab a catheter but left the bed in high position. As the preceptor, it's your job to address the performance discrepancy. In this case, start by saying "It's come to my attention" or "It's been reported to me". If the preceptee asks who said something about them, do not divulge any names-nothing good can come from that. 

Just re-focus the conversation back to the subject at hand- the preceptee's performance gap.

Step 2:  Clarify

You never know the other side of the story unless you ask. You really do want to understand the thinking behind the decision for the behavior.  "Can you tell me what's preventing you from getting to work on time?” and "Are you aware of the policy?” The preceptee may tell you that she heard there was a rounding time, and that getting to work up to 7 minutes before or after the start time was acceptable. Or she may sheepishly acknowledge that it's always been a challenge getting places on time, or she may present excuses.

The important thing is that you listen and strive for understanding.

Step 3:  State the Consequences 

In this step, you list the possible consequences if the performance discrepancy continues. "Getting here late delays the night shift from starting handoff report.”

Whenever possible, frame your concern as either a patient safety issue or a concern for the preceptee. "I would hate to see you get in trouble for being late" or "Leaving the bed in high position could result in a patient falling out of bed.” 

Let her know you're on her side and want her to succeed.

Step 4:  Close

As the preceptor, you need to do this final step, which is to bring closure. It may feel natural at this point to smile with relief and say "Good, then! Glad we had this talk!” but this last step is important.

Seek agreement, clarify the next step, and include actionable steps if appropriate.

Seek agreement. "So can we agree that you will be ready for work at 0700, meaning ready to get handoff report?”

Next step and action. "We'll check in next week to see how that's going"

Finally, close with an offer to help "Is there anything else I can do to help you?”

You will feel good about your communication skills once you try this! The great thing is, you can use aspects of this in your personal life as well. 

What tips do you have for giving constructive feedback?

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Nurse Beth

About Nurse Beth, MSN

Career Columnist / Author

Hi! Nice to meet you! I especially love helping new nurses. I am currently a nurse writer with a background in Staff Development, Telemetry and ICU.

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And to those who like to report simple things to preceptors so they can counsel the orientee about them: Don't. If at all possible, just very casually address the concern in real time; it isn't difficult. When you instead report to the preceptor unnecessarily that introduces a gossip-like quality to the situation. The preceptor is going to have a completely unnecessary "it has been brought to my attention..." talk, which makes the orientee feel like people are talking about their every move.

I like your tips.

I try to keep the day-to-day stuff as ultra low-key as possible; especially when it's about something very typical of brand new nurse. "Jane said you did awesome with the catheter-so good for you! Her only tip was to always remember to check that the bed is in the lowest position if you need to leave the room."

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I tend to disagree, sorry! 

After more than three or four times and after possibly two chats, I will decide no matter how excellent the excuses are, that this person is inconsiderate and therefore untrustworthy. 

The untrustworthy bit speaks volumes to me. This person will not update their education or seek appropriate ways to solutions or care enough to contribute. This further points to the excuses. What deliberate or unconscious excuses will surface when you need this person to perform? How will she compromise all of us when we really need her? 

And the inconsiderate points to selfishness and therefore she has to go. I view everything from the lens of my license and legal complications. This ensures that I am operating to a high enough standard to not compromise txs or people. I try to leave emotions at the door to ensure my objectivity! 

Patients are in a compromised state and deserve the best we could possibly give them! 

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Specializes in ER.

It's very difficult to get a lifelong non-punctual person to change their ways, just sayin'. Someone should have nipped that in the bud years ago like my mother and teachers did with me.

Definitely take a hard line with a new employee on that if it's vital to you. But, I have learned to accept it in some people who are otherwise  stellar and kind. It's a real inconsiderate trait in nursing when people have been there for 12 hours in anxious to get away. It's a big pet peeve of mine.

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37 minutes ago, Emergent said:

It's very difficult to get a lifelong non-punctual person to change their ways, just sayin'. Someone should have nipped that in the bud years ago like my mother and teachers did with me.

Definitely take a hard line with a new employee on that if it's vital to you. But, I have learned to accept it in some people who are otherwise  stellar and kind. It's a real inconsiderate trait in nursing when people have been there for 12 hours in anxious to get away. It's a big pet peeve of mine.

Add to the habit of always showing up late, the joy of passive-aggressive, non-veiled, hostility toward the coworker, and you can be certain that person will never come to work on time.

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