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  1. Nurse Beth

    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 that was 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 may well 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? Articles You May Find Interesting Tips for New Grad Nurses 10 Essential Tips for New Grad Preceptors Reality Shock and New Grads. It's Real.
  2. TL;Dr: Nursing needs some help. What do you think will help improve the profession? Nursing as a profession is in definite need of improvement as we go forward into the future. Many additional tasks are thrown at us, sicker patients are assigned to us, and we’re always asked to do more with less and do it faster. There has been a palpable push toward tasks over people, a decidedly different path than historically and from what is taught as nursing in schools. Based on your experience, what would you change or do to improve the profession? I’m going to preempt some answers here and say go beyond better staffing/ratios, higher pay, ancillary staff, unionizing, etc. Think about the profession itself and how you think nursing fits within healthcare as a whole now and five years from now.