On Negative Feedback

Negative feedback is something that we all encounter in our lives, both giving and receiving. Neither is easy and most kind people would rather give positive than negative feedback. There is value in learning to receive negative feedback in a postive way, no matter how clumsily it is delivered. Nurses Relations Article

There's being blunt, honest and plain spoken. There's saying what you mean and meaning what you say. There's giving it to you straight, not pulling punches and there's even being rude or brusque. But none of those things are mean, nasty or hateful. They're a communication style that not everyone is comfortable with receiving, but they're a legitimate communication style, and people who communicate in that manner probably are not out to get you. They're just being straightforward, not beating around the bush and not sugar coating anything. Not every interaction you find unpleasant is mean, nasty, hateful or (and I hate to even bring up the word) bullying.

Most of us would rather receive negative feedback, if we have to receive it at all, from someone who is very skilled at making us feel good while delivering the criticism. Unfortunately, there just aren't that many of us who are so skillful and capable at the art of delivering negative feedback. Some wrap it up in rainbows or sugar coat it until it's unrecognizable as criticism. Others are more direct.

There are definite advantages to working with someone who says what they mean and means what they say. If they're your preceptor, you don't ever have to worry about what they're thinking. You KNOW when you've screwed up, HOW you screwed up and what you need to do not to screw up next time. They're not the preceptor who is blowing fairy dust up your skirt while writing the memo to the manager about how you're just not catching on and probably are not going to fit in or work out.

They're the preceptor who tells you "You got the time management thing nailed, but you really should not have given the Coumadin to the man with the cherry red urine, the INR of 7 and the hemoglobin of 6. Your critical thinking needs work."

(Or, more likely, "Your critical thinking is showing improvement and you were right not to give that Coumadin, but your meds are still two hours behind and your charting is at least four hours late.")

Some folks would like all of their negative feedback wrapped in rainbows and sandwiched in between praise and compliments -- and some of those folks actually hear and process the negative feedback packaged that way. But all too many folks hear the praise and compliments which reinforce their opinion that they're doing just great and the negative feedback just whooshes over their heads.

Those are the people who sign the performance improvement tool, certain that it really isn't that big of a deal because didn't they just tell you that you're obviously very smart and trying very hard?

And then they're completely taken aback when someone calls them to a meeting to discuss their options -- quit, be fired or transfer to a "less acute area."

Most good people, nice people, kind people hate to give negative feedback, and some try so hard to give it in a positive manner that the negative gets entirely lost. Some folks sugar coat the criticism so much it could pass as candy rather than criticism. Some folks are so nervous about giving negative feedback that it comes out far harsher than they intended, or even than they realize.

Most of us can benefit from hearing negative feedback, whether we find the experience pleasant or not. And negative feedback that is given in a direct, straightforward fashion has more chance of being understood and processed than negative feedback that is disguised as fairy dust and rainbows.

Negative feedback is not usually mean, nasty or hateful. It is, if you make it so, a wonderful tool for learning and improving your practice, for making your patients safer and your unit a better place to work. And isn't that what we're all really after?

That is inappropriate and unprofessional in so many ways.

First, even if you don't like someone or think they're useless, you still need to work with them. Ignoring them and telling them to shove it makes it difficult to work with them.

Second, that person might be about to tell you that you've mixed up your dopamine and nitroglycerin drips when you spiked the tubing. He caught it, and he fixed it for you but he just wanted to let you know so you could be more careful in the future. If you listen respectfully, that's the end of it. If you ignore him and tell him to shove it, he not only writes you up, he sends a PSN report to the highest levels of management AND talks to the nurse manager telling her that you not only screwed up royally but that you're cavilier about it and don't seem to either "get it" or care about the mistake you made. (And he'd be absolutely right to do so.) Please don't tell me that you NEVER made a mistake that someone else caught.

And third, even people you don't like or don't respect have valuable knowledge that use can use to improve your practice and keep your patients safer.

Since we using numerical order.

First- Case in point that I do not care what folks like you have to say. I ignore it.

Second- as I said before, if you deserve respect you will get it. If the nurse had my back, why would I be rude? I would say THANK YOU and probably buy coffee for him. Duh? Where are you getting these third world examples from?

Third- I only learn and receive from folks who I respect. As I used in my initial response, my manager is tough and I learn everyday from him because I respect him. Not only does he tell me how it is, he always shows me by MODELING good practice. Now if he didn't have a great work ethic, why would I listen?

Its really not that hard to understand.

First- Case in point that I do not care what folks like you have to say. I ignore it.

Wellllllll, although you might not care what she has to say, you definitely didn't ignore it. You had quite a bit you wanted to talk about.

Wellllllll, although you might not care what she has to say, you definitely didn't ignore it. You had quite a bit you wanted to talk about.

Lol obviously. I answer to anyone that addresses me here.

Specializes in Pediatrics.

Interesting topic. Mind if I share a few bits?

The way we perceive language is affected by the culture we grew up with. Nursing especially for the developed countries tend to be multicultural and can get very tense due to language barrier and differences in communication style. Hofstede's model provides an insight on how people from different culture vary in their communication style. This is assuming that we accept that even though nurses practice in the same country and the same organizations, there will always be sub-cultures within the group. Power distance for example varies greatly from Asian perspective as against the Western culture. In my experience coming from the Philippine setting, we are a high context group. Our communication style is indirect and would require interpreting non-verbal cues such as gesture and posture as well as intonation. A colleague would tell me "It's OK" but with deep resentment. On my present environment though, people can really tell you off and sometimes quite brutally but that's the end of the story.

I find that handling criticism is difficult especially coming from a trusted colleague. It took me months to foster the mantra that these people have my best interest in mind. Once in a while though, you get criticized by people who are far less well, let's just say worth bothering with. My gold standard is, if the person was right, take it for what it is but if it was baseless and was just meant as a punch, brush it off.

Customer feedback, especially negative ones, we should try and hear them out. It maybe a chance to improve. But similarly, if it was meant as a punch, brush it off and take note of it. The more it keeps happening, the more likely it is a behavioral issue and the more it is documented, the more you can present as evidence to your manager on why that patient needs to go or be told off.

I have learned to be a bit more confrontational when I find that I am picked on, people may not be aware of their behavior and telling them usually fixes the problem. I find that if I keep getting personal attacks (from colleagues or patients), walking away and advising the other person that I will get my superior to deal with him works best... I am a nurse and if I get too much stress, I might take it out on innocent patients or get burned off which is of course, not safe; it is my responsibility to make sure I do not carry too much emotional baggage.

Specializes in Pediatrics, Emergency, Trauma.
I always say, if you want to hurt my feelings you have to hit me with a brick. Nothing short of that really gets through.

I don't interpret nuance and subtlety well. Sugar coating just leaves me scratching my head.

Therefore, bring on the plain speaking. Look me straight in the eye. No fidgeting, or smiling. Don't dress it up to make it look pretty, hoping I'll recognize it's not. If you smile at me while you're lowering the boom, the smile is what I'll cling to. I think most people do that.

Plain speaking leaves no room for guessing.

It makes my life easier.

THIS.

Being straight and too the point isn't "negative" per se; it may be jarring to someone who doesn't communicate that way, but it is no means "negative"; albeit it is subjective to the person at hand; unfortunately anything "jarring" to one's particular psyche is construed as unpleasant, therefore negative.

I've always expected and have requested from my preceptors plain spoken honesty; my objectivity allows me to interpret and analyze and adjust when necessary; as a preceptor, I've gotten the art down of making sure that I am clear on what is expected, and clear on the WHY for improvement; I give information and stress the reason and rationale in approaching best practice, and I've done that in an straightforward elevator speech manner because the communication can be lost if it's too wrapped up in "positive" wording.

I have witnessed peers give out a important message with "positive" words to the point that the person did not hear the message clearly and the individual continued the same behavior, instead of correcting their practice; that is until I had my elevator speech.... :whistling:

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
THIS.

Being straight and too the point isn't "negative" per se; it may be jarring to someone who doesn't communicate that way, but it is no means "negative"; albeit it is subjective to the person at hand; unfortunately anything "jarring" to one's particular psyche is construed as unpleasant, therefore negative.

I've always expected and have requested from my preceptors plain spoken honesty; my objectivity allows me to interpret and analyze and adjust when necessary; as a preceptor, I've gotten the art down of making sure that I am clear on what is expected, and clear on the WHY for improvement; I give information and stress the reason and rationale in approaching best practice, and I've done that in an straightforward elevator speech manner because the communication can be lost if it's too wrapped up in "positive" wording.

I have witnessed peers give out a important message with "positive" words to the point that the person did not hear the message clearly and the individual continued the same behavior, instead of correcting their practice; that is until I had my elevator speech.... :whistling:

I hate giving negative feedback to the point where I stress about it in advance if I know I need to give it. In the past, I've tried to give out feedback with positive words -- and was successful to the point where the person heard only the positives and didn't "get" the negatives. They continued with the behavior and we'd have the talk again. The third time, we met with my manager, and she just laid it right out there. The person "got" it that time, but really didn't believe it because "no one else ever said that to me. She doesn't work with me every day, she doesn't know. I'd trust your opinion before hers."

That orientee ended up losing her job because she never did believe that the problem was really hers, not the educator's, the manager's or her other preceptors'. I've always felt responsible for that job loss because I wasn't direct enough in the first place. I've had to swallow my distaste for giving negative feedback and give it as straight (and kindly) as I can. It's a difficult line to walk. Many others walk it better than me, but what I can say for myself is that I try really hard.

Specializes in OR, Nursing Professional Development.

I'm the type who wants to hear negative feedback when it is warranted. I can't fix something if I'm not told about it.

Specializes in Pediatrics, Emergency, Trauma.
I hate giving negative feedback to the point where I stress about it in advance if I know I need to give it. In the past, I've tried to give out feedback with positive words -- and was successful to the point where the person heard only the positives and didn't "get" the negatives. They continued with the behavior and we'd have the talk again. The third time, we met with my manager, and she just laid it right out there. The person "got" it that time, but really didn't believe it because "no one else ever said that to me. She doesn't work with me every day, she doesn't know. I'd trust your opinion before hers."

That orientee ended up losing her job because she never did believe that the problem was really hers, not the educator's, the manager's or her other preceptors'. I've always felt responsible for that job loss because I wasn't direct enough in the first place. I've had to swallow my distaste for giving negative feedback and give it as straight (and kindly) as I can. It's a difficult line to walk. Many others walk it better than me, but what I can say for myself is that I try really hard.

I think we all try hard to give that feedback that is "improvement" worthy; I guess the "positive" thing about it is our effort. ;)

Specializes in Med-Surg, NICU.

I prefer the term "constructive criticism" but I can appreciate what you are saying. The nursing student who gives Coumadin to a patient with THAT high of an INR probably should be pulled aside and given a strict talking to about patient safety and critical thinking (did that student want her patient to hemorrhage???). That being said, nursing students and new nurses are going to make mistakes and not know everything (as expected); that is why we need you seasoned nurses and your wealth of knowledge to guide us through the chaos that is nursing! :)

Think about how you would like to hear the negative feedback if it were you on the receiving end and stay true to that. It isn't as easy as it sounds.

Specializes in psychiatric.

Just throwing a thought out here, but if a new nurse has learned a skill or was exposed to some really good EBP, is their feedback listened too or even considered by experienced nurses? I am asking this because many of the posts are assuming only experienced nurses are the ones capable of teaching and providing feedback. Sometimes the "newbies" have valuable info and I hope they are listened to with the same respect the more experienced nurses are deserving of without their input being discounted out of hand.

Specializes in ER.

Great thread, Ruby Vee.