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Benefits of feedback for nurse leaders

Author(s): By Rose O. Sherman, EdD, RN, NEA-BC, FAAN, and Tanya M. Cohn, Ph.D., MEd, RN

Viewing feedback as a gift enhances career growth.

Takeaways:

  • Without feedback, beginning nurse leaders’ careers can be derailed
  • Constructive feedback can lead to significant performance improvements.
  • Individuals with a growth mindset believe they can improve their skills via feedback about their performance and hard work.

Chris* is an experienced charge nurse on a mother–baby unit. The unit practice council recently conducted a nursing staff work environment survey to uncover possible causes for high staff turnover. One of the open-ended questions asked about charge nurse support. Chris and her fellow charge nurses were surprised that most staff said they didn’t feel supported by the charge nurses. Specific complaints included staff assignment favoritism and tolerance for workplace gossip. The feedback initially hurt Chris, but she realized there was truth in it. She also had never actively sought feedback from the staff about her leadership skills.

Chris’s reaction to the work environment survey isn’t unusual. Most leaders in charge nurse roles rarely receive direct feedback from team members about their leadership. For Chris to improve her leadership, she needs to value and seek feedback about her performance. Rather than see the comments as hurtful, Chris must reframe her thinking and recognize feedback as a gift. Work culture forms the invisible architecture of teams and organizations. It can be healthy and positive, but it also can become toxic if problems such as gossip and favoritism aren’t exposed through performance feedback.

Without candid feedback, beginning nurse leaders’ careers can be derailed. The work environment survey results have provided Chris with some critical areas for reflection, and the honest responses indicate the staff has enough psychological safety to believe they’ll be acted on to make improvements. Chris can build on this foundation of trust if she uses the feedback to improve the team’s culture.

Seeing feedback as a gift

Constructive feedback can lead to significant performance improvements. It’s a gift, although Chris might not view it that way initially. By viewing feedback from this perspective, you adopt a growth mindset. Carol Dweck, PhD, is a pioneer in studying how a growth mindset can transform how a person perceives feedback. A mindset, according to Dweck, is “a self-perception or self-theory that people hold about themselves.” Mindsets can either be growth-oriented or fixed. With a growth mindset, individuals believe they can improve their skills via feedback about their performance and hard work.

With a growth mindset, Chris will view the feedback she received as an opportunity to become a better leader by improving her leadership skills. This view creates a better acceptance of feedback and a love of learning. In contrast, someone with a fixed mindset may believe that they’re doing the best they can and that they can’t grow professionally. Individuals with a fixed mindset find feedback threatening because they lack confidence in their ability to improve. One of the early actions Chris should take is to review the findings with her team and thank them for their candidness. She also should let them know that she’ll use the feedback to improve her leadership skills. Doing this will help Chris reinforce the idea that a culture of feedback is crucial not only for staff but also for leaders.

Building a feedback culture

Establishing a feedback culture begins with the leader modeling behavior that values input and minimizes defensive responses. Modeling is fundamental to how leaders earn, sustain, and build credibility. Sharing feedback can be interpersonally risky, and teams watch leaders for signals. If leaders become defensive and angry about feedback, staff learn that it’s not safe to tell the leader things they don’t want to hear. To increase the likelihood that staff will take that risk in the future, Chris must show them that their honesty won’t have negative repercussions.

When you earn a track record of accepting personal accountability by using the word “I,” staff will feel more comfortable giving you feedback. Our most significant growth comes from suggestions for improving our performance. Ask these three questions to elicit specific feedback:

  1. What should I keep doing as a leader because it supports the team and leads to good outcomes?
  2. What should I start doing to support team efforts and achieve better outcomes?
  3. What should I stop doing to better support the team and achieve better outcomes?

Evaluating leadership feedback

You’ll not always agree with the feedback you receive. At times, you may feel angry, confused, or even frustrated by it. Chris’s initial reaction of hurt isn’t surprising. She may perceive that she’s working hard and going above and beyond to help her team. Exploring her response to the feedback is essential. Instead of finding fault with the messenger, explore your reactions, especially if you’re defensive and angry. Some of the feedback may be true, but you’re having difficulty acknowledging it.

Chris took a crucial first step in evaluating the leadership feedback. She paused for a moment and reflected on the input with an open mind. This, coupled with the understanding that the comments are only part of the whole picture, allowed Chris to embrace the feedback, which is an essential next step. Reflective mindfulness enables leaders to see feedback as areas for improvement not as identified faults.

In some situations, you may need to let the person who provided the feedback know that they’re entitled to their opinions but that you disagree with their assumptions. But sometimes there’s truth in the observations. View the feedback as data you didn’t have before that will help you make more informed decisions in the future. This shift in perspective will enable you to imagine experiences from others’ viewpoints and reduce the tendency to rely only on how you believe things are working. It also enhances your self-efficacy and likelihood to continue to recognize the value in others’ feedback. In turn, this results in being open to receiving more feedback in the future.

Acting on feedback

Successful leadership and teams require leaders to act on feedback effectively. When leaders work on feedback they receive, they embrace a proactive personality that builds on these opportunities. Making a plan and taking action are crucial for learning and development, and also a signal to those who shared the comments that you’re serious about improving and you value their perspectives. Using the data that she received from the work environment survey, Chris might decide that the team’s gossip is a key priority area. (See Follow-up action plan.)

Follow-up action plan

In response to the work environment survey feedback, Chris and her fellow charge nurses develop a follow-up action plan to address team gossip and present it to the staff for discussion and input.

Goal

Create a team culture built on core values that promote dignity and respect and in which charge nurses and team members accept accountability to confront and stop gossip.

Action steps

  • Share survey comments about
  • Accept personal accountability for historic charge nurse behaviors that didn’t confront gossip. 
  • Review the evidence on how workplace gossip can reduce psychological safety and jeopardize patient safety. 
  • Commit to new team core values that promote respect and dignity. 
  • Develop a new set of charge nurse and staff behaviors about how to respond to gossip. 
  • Repeat the work environment survey in 6 months to assess progress in meeting team goals. 

Responsible team/person

  • Unit charge nurses
  • Unit nursing staff

Start date

Staff meeting May 2021

Although Chris didn’t solicit the initial feedback, moving forward, she can create a feedback process that supports check-ins with the nurses she leads. Within this process, leaders need to develop a clear and consistent strategy for soliciting input and a gracious approach to receiving it that encourages employees’ openness. Once the feedback is collected, the next step is to communicate the results. This creates transparency and opens the door to a team approach to feedback response, which is imperative to making effective positive change. When feasible action steps are collectively determined, leaders must take the next crucial step of creating and implementing change.

This actionable feedback process will result in professional growth, a listening culture, and motivated and engaged employees, which can help leaders roll out informal leadership opportunities for employees. This creates shared responsibility among the team and a willingness to hold each other accountable for a supportive work environment that results in better patient outcomes.

Learner leaders

The best nurse leaders are learners. They take the information they receive and use it to improve. The ability to do this could set Chris up to become a great charge nurse. Soliciting and learning from feedback isn’t always easy, but it’s necessary. It’s rare when professional colleagues offer us the kind of feedback we need to develop. We should receive it as a gift and be thankful. Acting on feedback allows us to build the skills we need to become more effective leaders. AN

*Name is fictitious.

Access references at myamericannurse.com/?p=77575.

Rose O. Sherman is adjunct professor at the Marian K. Shaughnessy Nurse Leadership Academy, Case Western Reserve University in Cleveland, Ohio, and author of The Nuts and Bolts of Nursing Leadership: Your Toolkit for Success and The Nurse Leader Coach: Become the Boss No One Wants to Leave. You can read her blog at emergingrnleader.com. Tanya M. Cohn is an associate professor of practice and a consulting nurse scientist at Simmons University in Boston, Massachusetts.

References

Tye J, Dent B. Building a Culture of Ownership in Health­care: The Invisible Architecture of Core Values, Attitude and Self-empowerment. 2nd ed. Indianapolis, IN: Sigma Theta Tau; 2020.

Dweck C. Mindset: Changing The Way You Think To Fulfil Your Potential. Boston, MA: Little, Brown and Company; 2017.

Kouzes JM, Posner BZ. The Leadership Challenge: How to Make Extraordinary Things Happen in Organizations. Hoboken, NJ: John Wiley & Sons; 2017.

Sherman RO. The art of giving feedback. Am J Nurs. 2019;119(9):64-8.

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