Giving Feedback When There is Pushback

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 tried to give some constructive feedback to one of our new graduates today. It just involved some very minor changes in the way she was prioritizing her assignments. She became so defensive. She thinks she is “doing great,” and I should be lucky to have someone as smart as her. I asked her to think about what we talked about. She returned later in the day and told me that she didn’t think this was the right place for her and planned to resign. Giving feedback today is so challenging in an environment where some nurses think they are performing at a level much higher than they are.

Psychologists have a term for what this leader was experiencing. It is called the Dunning-Krueger effect, built on a solid body of research that shows that people who are the least competent in a field often consistently rate their performance higher than it is because they don’t understand what being skilled in the field looks like. It is not surprising that we see more of this today. 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. As one manager recently observed, “we are giving good care but not great care, but there are few of us left in direct care who see the difference.”

So, where do we go from here? We need to re-establish a culture of professional feedback. All of us continually need feedback about our performance in the following three key areas:

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

I recommend that when interviewing new nurses, you let them know that they will receive professional feedback and the reasons why feedback is so vital in their career. If they later resist feedback, remind them that you discussed this with them during their interview.

As a leader, you also need to open yourself up to feedback about your own 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.

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