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

Accepting the gift of feedback can lead to transformative change.

Key Takeaways
– Nurse retention is closely linked to the relationship staff have with managers.
– Avoiding career derailers is critical to leadership success.
– The most effective leaders are coachable and see feedback as a gift.

Kendra is director of a large critical care unit that’s experiencing high staff turnover. As her new chief nursing officer (CNO) interviews staff who have submitted resignations, they all mention Kendra’s command-and-control management style. The CNO meets with Kendra to share the feedback. She tells Kendra that although she’s achieving the business management expectations of her role, failure to improve her interpersonal relationship with staff will ultimately derail her career.

Nursing leadership is both an art and a science. The art comes in learning how to manage relationships with others. These soft skills, such as learning to manage conflict and communicating effectively with others, can be hard skills to learn. Kendra lacks self-awareness about how others view her leadership style and interpersonal interactions. This is a significant blind spot because it’s part of the emotional intelligence leaders are expected to demonstrate. She also hasn’t been attentive to the impact her behavior has on staff satisfaction and retention. Research from the Gallup corporation, conducted with thousands of employees globally, indicates that retention is closely tied to employees’ relationship with their supervisor. Nursing directors with high staff satisfaction ratings focus on ways to enhance nurse autonomy and take an authentic interest in their staff’s personal and professional lives.

Marshall Goldsmith, in his insightful book, What Got You Here Won’t Get You There, points out that while leaders like Kendra may work hard, some of their behaviors can prove ineffective or even destructive to their careers. Ironically, these behaviors may have helped move her to her current level but will now hold her back. In Kendra’s case, she’s likely an efficient and technically excellent critical care nurse manager, but she pays little attention to her relationships with others on her team. Much like when a speeding train derails, our careers can move off track if ineffective behaviors aren’t addressed. This can happen gradually or suddenly, but once it happens, repairing the damage can be difficult.

Avoiding derailment

In nursing leadership development, a great deal of time is spent focusing on the competencies, skills, and behaviors needed for success. Much less time is spent talking about what we should avoid doing or stop doing. The American Nurses Association (ANA) Leadership Institute has a competency model that includes derailment factors. (See Derailment factors.) Avoiding them is an integral part of the institute’s training for current and future nurse leaders.

Problems with interpersonal relationships is one of five key derailment competency clusters. It centers around difficulties in developing good working relationships with others. Some key problematic behaviors include being dictatorial, failing to share decision making, and leaving a trail of bruised staff. Kendra’s command-and-control style probably includes most of these behaviors.

Difficulty changing or adapting is sometimes seen with experienced nurse leaders. In a volatile and complex healthcare environment, failure to adapt to initiatives brought about by changing reimbursement or new technologies can lead to leadership failure. Likewise, leaders face high expectations today with respect to budget and performance goals. To be successful, nurse leaders must develop a business mindset and build their financial knowledge.

A failure to meet business objectives can quickly result in career derailment, as can having too narrow a functional orientation when contemporary nursing leadership requires higher-level systems thinking. Healthcare delivery models require strong teamwork, which involves resolving conflict and promoting close collaboration. Nurse leaders who have difficulty building and leading a team won’t achieve long-term success.

Career derailers aren’t limited to those included in the ANA competency clusters. Goldsmith notes these other derailing behaviors:

• needing to win at any cost
• insisting on contributing an opinion in every discussion
• passing judgment and imposing our values on others
• making needlessly sarcastic comments
• responding with “no” or “but” to send a message that we’re right and others are wrong
• telling the world how smart we are in every situation
• speaking when angry
• expressing negativity
• withholding information from others to maintain an advantage
• failing to give proper recognition or credit for work done
• clinging to the past
• playing favorites and failing to recognize when we’re not being fair
• refusing to accept blame or express regret
• failing to express gratitude.

Receiving feedback

Leaders like Kendra have a choice when presented with a potential career derailer. They can either ignore the guidance or choose to see it as a gift and develop an improvement plan to manage the behavior. David Brookmire, an executive coach, has found that great leaders know they have blind spots and seek to identify them. They also recognize that perception is reality, even if the reality may seem harsh or unkind.

Great leaders don’t wait for feedback but actively seek it out, using accountability partners if necessary. Getting honest feedback from staff can be challenging, but it’s possible if we open ourselves up to it. Here are some suggestions from experts in the leadership field:

1. Get out of the office and ask questions.

Kendra’s staff are more likely to give honest feedback if they’re in their territory versus being in her office. Ask questions like “What’s going well?” and “What could be improved?” Observe body language; if it appears that someone is holding back, ask about it.

2. Openly acknowledge mistakes you’ve made or contributed to.

When you have a track record of accepting personal accountability using the “I” word, staff will feel more comfortable giving you feedback. If you have a reputation of defensiveness or blaming others, you’ll be much less likely to get honest feedback.

3. Corroborate information with multiple sources.

Some staff will look to feed your ego with positivity while others may use their relationship with you to make destructive comments about other team members. Talk to people who may not agree with you.

4. Develop an improvement plan.

When you receive feedback about, for example, your lack of visibility on the unit, first assess what behaviors or actions might lead to improvement. This is where getting specifics becomes important in developing goals. To enhance your chances for success, find a coach or accountability partner to work with you on an improvement plan. Accountability to improve is critical. If you ask for honest feedback and then don’t use it, people will be less likely to give you feedback in the future.

5. View feedback as a gift. 

Stanford faculty member Carole Robin contends that we need to think about feedback differently. Rather than viewing it as criticism, think of it as a gift—data you didn’t have before that will help you make more informed choices in the future.

The most effective leaders are coachable. While positive feedback is wonderful, much of our growth will come when suggestions are made to improve our performance. The key to success in avoiding derailers is changing our behavior when we receive the feedback.

Changing behavior

Many behaviors in both our personal and work lives are a series of habits, both good and bad, that we develop over time. Kendra’s command-and-control style of management is a good example of a series of leadership habits that have probably become routine for her. Charles Duhigg has written about how habits are formed and what we can do to change them. He contends that habits make up 40% of our daily routines. Habits are the brain’s way of saving energy through a loop of cue-response-reward that becomes automatic. Replacing bad habits with good habits requires intentional action, whether it involves improving our relationships with staff or losing weight.

Breaking the habit cycle

When you look at changing habits, don’t just examine the habit from the perspective of the habit loop, also consider the context in which the habit occurs. In Kendra’s case, the cue for her behavior might be her sense of urgency about making unit decisions. Her response is that she doesn’t seek input from her staff. Her reward is that she’s crossed that task off her list and moved to the next one.

In response to the feedback she received from the CNO, Kendra decides to shift her style from authoritative decision-making to a shared decision-making model. Because she hasn’t built a culture of joint ownership where staff feel comfortable participating, she’ll need to start slowly by asking for input and showing appreciation when it’s given. This will be key to the process as she changes her own behavior. Although shared decision-making takes more time, Kendra will see a reward from the staff as she shifts to a leader-coach model. New habits require extensive practice, and to be successful in this habit change, Kendra needs to believe that change is necessary.

Duhigg makes the case that changing just a few key habits can make us more disciplined and increase our willpower. The same ideas can be applied at work. The character of a work unit or an individual is a collection of thoughts, values, and habits. Work habits developed over time offer a level of comfort but may not be constructive in the complex and changing healthcare environment and may even derail us in our leadership. Only through intentional evaluation of our habits are we able to change.

Get back on track

When we’re given an opportunity to change behaviors that could ultimately derail our careers, we can make transformations that change our career trajectory. This feedback is a gift and we should avoid becoming defensive. The key is to face the truth and develop a plan to change our behavior.

Rose O. Sherman is a professor of nursing and director of the Nursing Leadership Institute at the Christine E. Lynn College of Nursing in Florida Atlantic University in Boca Raton. You can read her blog at www.emergingrnleader.com. 

Selected references

American Nurses Association. ANA Leadership Institute™ Competency Model. 2013. Brookmire D. Avoid derailers: Seek more self-awareness. Leadership Excellence. 2012;29(5):16.

Duhigg C. The Power of Habit: Why We Do What We Do in Life and Business. New York: Random House; 2012.

Goldsmith M. What Got You Here Won’t Get You There: How Successful People Become Even More Successful. New York: Hyperion; 2007.

Peterson D. Carole Robin: Feedback is a gift: 7 tips for giving feedback to others. Insights by Stanford Business. November 27, 2013.

Avoid Career Derailers American Nurses Association Journal

> Further Reading

Building Trust in your Leadership

Nursing – Built on a Cornerstone of Leadership

Leadership and Women’s Health