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?

In my second job as a nurse, there was well-seasoned night nurse who I dreaded giving report to. She was blunt and direct. If there was something pertinent missing in report or something that should have been addressed, by golly you heard about it. New nurses called her "mean". In reality she was not. Assertive and even abrasive, yes, but never cruel or insulting.

She turned out to be an incredible mentor to me and taught me more ways to improve my practice in our limited interactions than the nurses on my own shift. Things may have turned out differently if I had internalized her criticism and gotten my feelings hurt.

Specializes in ED, Medicine, Case Management.
There are tangible rewards and intangible rewards for showing up and doing your job. Tangible rewards are things like your paycheck. Intangible rewards might include camaraderie, a sense of accomplishment, the opportunity for growth, etc.

Everybody makes mistakes. Everybody- not just new grads. When in a supervisory role, one of your responsibilities is to provide feedback.

The manner in which you choose to provide that feedback does matter.

One can approach the new grad and say "You're too slow. You need to learn better time management. Everybody else is taking six patients and you're only taking three. Everybody's talking about it. You need to up your game or you're never going to make it around here."

Or, one can ask the new grad how they think things are going. Ask about their time management. Try to find out what is at the root of the problem, then give some feedback such as "At this point in your orientation, you should be able to handle a full patient load. What can we do to help you achieve this?"- and then actively involve the new grad in making a plan.

One could say to the new grad regarding a med error "I can't believe you did that. What on earth were you thinking? If this happens again, I'm going to have to let you go and report you to the BON."

Or, one could say "Mistakes happen and I'm glad nobody was harmed. What have you learned from this and how will you try to assure that this doesn't happen in the future?".

I see no virtue in "telling it like it is". To me, this is like saying that I'm just going to say what I think regardless of how it might impact the other person. Conversely, being direct is sometimes required, but can be done with sensitivity toward the other person. I think that when in a leadership role, the latter is the more appropriate approach.

I do agree that as adults in the workplace, not only are we responsible for how we give feedback, but we are also responsible for how we *receive* it. Sometimes it's not pleasant to hear about how we need to improve our performance, but we must be open to hearing it. I simply disagree that "not sugar coating" is of any greater value than delivering the same feedback in a respectful and tactful manner. If you are a supervisor and you don't feel like you are skilled in the latter, then maybe taking a class in interpersonal communication at your local community college would be helpful.

I think there is a difference between "sugar coating" and tact/effective communication. You are demonstrating the latter and it is a skill. I do not see much value in sugar coating, especially when the message can so easily be misunderstood or lost. But I do see the value in supportive, effective communication in which one feels that they are in a safe environment conducive to learning and growth.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Sometimes, the art of diplomatically giving someone criticism is much like telling them to go to hell, while at the same time ensuring that they enjoy the trip.:yes:
I have a personal skill at this....I can tell you where to go and how to get there and you will thank me....LOL
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
The experience I had as a new grad was not 5:1 pos to neg, or 3:1. It was more like, 4:1- with 4 neutral interactions to 1 negative. By neutral i mean my preceptor would simply concur with my care, and when i messed up i would hear about it. Then every so often i would get a specific positive. But for the most part, no specific feedback was the positive.

I remember feeling desperate for positive words to counteract my own sensitivity to negatives, but i learned to adapt to this style, where negative was bad, neutral was good, and a positive here and there was great.

If it had been 4 negatives to one neutral and zero positives, then this would be a problem. Had a teacher like this in school and it was horrible.

So new grads really can benefit from exploring their own sensitivity, if they are prone to it. I am the better for it.

I think this is where I wish facilities still trained preceptors. I know amny years ago my facility sent us to some 8 week course to be effective teachers and mentors. I use those lessons to this very day.
Specializes in LTC Rehab Med/Surg.

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.

Specializes in ED, Cardiac-step down, tele, med surg.
for me its all about WHO is giving me the feedback. If your someone I dont respect or even like, you already know I'm either ignoring you(pretending I'm on the beach with drinks) or I'm gonna tell you to get out my face. My manager gives me hints on how I can do better; he doesn't give it to me in a sugary way but I wholeheartedly listen because I value him deeply. In fact I respect him so much that I DO try and do better. Now if your the dude that is useless or don't perform, I'm most definitely not going to be value your thoughts and I will let you know by ignoring you or tell you to shove it.

Just because someone is not liked, doesn't mean their opinion doesn't count. There are plenty of good nurses with solid skills that I don't particularly like, but if they were to point out something I'd listen. I think it's important to listen to all feedback and take in what makes sense and filter out what can be discarded. Ive learned a few things from the most unlikely sources.

I've had people I've trained in tell me what worked and what didn't for assisting their learning and never took it wrong. The point about constructive criticism and taking negative feedback is putting things in perspective and not getting defensive about it to use the experience in a beneficial way. I don't know if ignoring things is an effective way to gain insight.

Specializes in Pediatric Hematology/Oncology.
Anyone know the most effective ratio of positive to negative feedback?

ps: googling is cheating ;)

I remember being told it's 16:1. That's pretty far out there (and probably wrong) which is why I always remembered it. :woot:

This is such a great article. I have found that it is one of the hardest things as a preceptor is to teach someone and have to give them negative feedback. Finding the balance between being nice and yet still giving constructive criticism is one of the hardest things for me to do. I have always learned well from negative feedback. In the different areas I have worked, someone telling me how to do something different in this fashion has always been the best teaching method that I have encountered.

I totally agree with what you wrote: "Not every interaction you find unpleasant is mean, nasty, hateful or (and I hate to even bring up the word) bullying."

THAT. is the hardest thing for me to express to a new nurse. That when I offer constructive criticism or negative feedback, it is not to make you feel bad, but to try to help you adapt your way of thinking and to make your patient care safe.

Thanks for this article, a great encouragement. :)

Specializes in Psych ICU, addictions.
for me its all about WHO is giving me the feedback. If your someone I dont respect or even like, you already know I'm either ignoring you(pretending I'm on the beach with drinks) or I'm gonna tell you to get out my face. My manager gives me hints on how I can do better; he doesn't give it to me in a sugary way but I wholeheartedly listen because I value him deeply. In fact I respect him so much that I DO try and do better. Now if your the dude that is useless or don't perform, I'm most definitely not going to be value your thoughts and I will let you know by ignoring you or tell you to shove it.

The problem with that plan is is that the person you dislike/don't respect just might be the one with the crucial feedback that you need to hear.

IMO one would do far better to focus more on the message itself and less on the messenger delivering it.

The problem with that plan is is that the person you dislike/don't respect just might be the one with the crucial feedback that you need to hear.

IMO one would do far better to focus more on the message itself and less on the messenger delivering it.

That's true. However the way I am I don't take to heart what people I dont respect have to say. So its better left unsaid to me because I'm not listening. Emphasis on respect. I respect GOOD workers.

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

Can't think of a negative....

Does this mean I'm unbalanced?

:wacky:

Yes, but in a good way. :)

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Now if your the dude that is useless or don't perform, I'm most definitely not going to be value your thoughts and I will let you know by ignoring you or tell you to shove it.

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.