Communicating With Defensive Staff

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

I have heard multiple versions of a similar story from nurse managers in recent conversations:

I gave some constructive feedback to one of our new graduates today. It just involved some minor changes in how she prioritized her assignments. She became so defensive even though I was extremely gentle in my approach. She shut down and pushed back on what I had to say. She appears to have never received much constructive feedback and has challenges accepting it. How can I help her?

When leaders ask me this question, my first piece of advice is to look carefully at the behavior and ask the following questions:

1. Is this nurse defensive with everyone or just with me?  If it is just with you, she may not feel psychologically safe with you. You can work on this as a leader to build that level of safety.
2. Does this happen all the time or just once in a while?  If it only happens occasionally, the nurse may be exhausted and not at her best. All of us have bad days.
3. Is this nurse a perfectionist? Perfectionists have challenges with feedback because they may see it as being very black-and-white – I am either perfect or failing. They don’t see themselves on a journey.

Staff are defensive for many reasons. Some have had toxic experiences with feedback at work or home and have challenges seeing it as constructive. Some staff may feel unsafe in their work environment and worry about losing their job. The most formidable challenge is when defensiveness becomes a learned behavior to manipulate others by making it challenging to give feedback, thus avoiding it.

Most acute care units are now staffed with less seasoned nurses. Many young nurses don’t experience that awe when they watch a mentor intuitively grasp that the patient is crashing, even before any data exists. I remember how humbling it was for me to watch my preceptor quickly take action when I never even realized there was a problem. If you don’t see that level of expert practice, it is probably not surprising that many newer nurses think they are performing at a higher level than they may be.

Nurse managers can start by re-establishing a culture of professional feedback. All of us continually need feedback about our performance in the following three key areas:

1. Continue Doing – what are we doing as professionals contributing to excellent patient care, teamwork, or professional growth?
2. Stop Doing – what are we doing as professionals that do not meet expected standards of care, teamwork, or our professional growth and could derail us if we don’t change?
3. Start Doing – what areas we need to grow in our practice, build skills in working with others or raise our game in developing ourselves as professionals.

When interviewing new nurses, I recommend that you let them know they will receive professional feedback and why feedback is vital in their careers. If they later resist feedback, remind them you discussed this during their interview. When giving feedback to defensive staff, focus on the behavior and not the person.

As a leader, you must also open yourself up to feedback about your performance. Role modeling how feedback should be accepted is very powerful. Make it safe to give and receive feedback. It is impossible to be fully professionally socialized without feedback. We owe it to our younger staff to help them learn and grow even if they initially resist. You don’t want them to derail in their careers but rather become their best possible self.

© emergingrnleader.com 2023

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