With new graduate nurses starting in hospitals around Australia over the next few weeks, it’s a good time to think about how we give feedback that is both professionally delivered, and effectively received.
Feedback helps motivate the person to perform well and also clarifies any deviations between the preferred and the actual behaviour of the individual by giving the person information on their performance. Not only is it essential for professional growth, it provides direction and increases the confidence, motivation and self esteem of the individual (Matua et al. 2014; Rose & Best 2005).
New graduate nurses not only need constructive feedback, they also need positive feedback to know when and what they are doing well. By understanding how they are progressing they can then determine what new responsibilities they can take on and what further learning comes next. Quality feedback helps the individual to realistically rate their clinical practice and help minimise any poor practices (Chang & Daly 2012; Matua et al. 2014).
But, giving feedback can be difficult. You might be worried that they will take it the wrong way – they could become upset or even deny the behaviour occurred. So, with the possibility of one of those scenarios happening, often constructive feedback may not occur or – if it does – could be rushed and ineffective.
The incidence of feedback can be encouraged by the recipient nurse receiving it in a professional manner. This can then encourage and create a work environment where everyone gives and receives feedback. Nurses do need to take responsibility for their own behaviours and must be proactive in both seeking and offering feedback rather than feedback only being given in reaction to an event or performance (Chang & Daly 2012).
It should also be mentioned that within current nursing culture, positive feedback is often hard to find (Sodeify et al. 2013).
So with feedback only being given that focuses on areas of improvement without mentioning any areas where the learner is excelling, the learner can feel demotivated and devalued – especially in the case of new graduate nurses, questioning why they are in this profession (Duffy 2013).
There are many sources of feedback for graduate nurses. Sometimes it is being aware of these sources and knowing how to interpret specific situations as positive feedback.
For instance, there could be a patient who had a smooth transition home because the graduate nurse planned it well and kept the patient informed.
Colleagues of the graduate nurse can also be a source of feedback on how they are settling into the team and on their performance, however this information should be confirmed before constructive feedback is given to the graduate.
The use of several different sources of information will also add credibility to the feedback that is being given whether it is positive or negative (Chang & Daly 2012; Rose & Best 2005).
Graduate nurses should also be encouraged to reflect on their practices and behaviours to determine their strengths and weaknesses. This will help identify areas in which they need continuing education. It will give them insight into their practice and allow them to reach their full potential as a nurse (Chang & Daly 2012).
There are many different feedback models. This is fantastic, as what might work for one person doesn’t necessarily work for the next. Everyone is different and, different situations call for different types of feedback.
1. The Feedback Sandwich
This feedback tool consists of three components:
- Begin with the positive feedback
- Then introduce the constructive or negative feedback
- Close with specific that which builds up the learner’s trust and comfort
The Feedback Sandwich minimises any detrimental effect the negative feedback may have on the individual and ensures that the learner is not discouraged and remains motivated to learn (Matua et al 2014).
2. ‘Situation – Behaviour – Impact’ Feedback Tool
This tool allows the learner to reflect more on their actions whilst understanding precisely what you are commenting on and why, as well as think about what they need to change.
- Begin with defining the situation the feedback refers to
- Follow this by the specific behaviours you want to address
- The last step is describing how their behaviours affected you or others
From this, the learner then has the chance to reflect on the situation and their behaviour and discuss with you strategies for improvement (Mind 0Tools 2017).
3. Pendleton’s Model of Feedback
Pendleton’s model of feedback helps make the learning experience constructive by:
- Highlighting positive behaviours first
- Reinforcing these behaviours and including a discussion of skills to achieve them
- Followed by what they could have been done differently
Areas of improvement are first identified by the learner and then followed by discussion with the person giving the feedback about strategies to improve their performance (Chowdhury & Kalu 2004).
Characteristics of Effective Feedback
Although different feedback models can be used when giving feedback, effective feedback must display certain characteristics:
- Specific: It should contain specific information rather then generalisations
- Accurate: It should be factual and clear
- Objective: Feedback should be unbiased and unprejudiced
- Timely: It should be given as soon as possible after completion of a task (however, at times it might not be possible and may be delayed to a more appropriate time and place)
- Usable: Relate the feedback to goals and strategies so the individual can improve performance
- Desired by the receiver: Feedback can still be effective even in those who don’t actively seek it, however those who are seeking feedback will often be more motivated to improve performance
- Checked for understanding: Clarify understanding with the individual to ensure they are getting the most out of their feedback
(Matua et al 2014; Rose & Best 2005)
Effective feedback that is clear and focused and given regularly, even when it is negative in nature, often will still allow the individual to be comfortable with the person giving the feedback providing it displays these characteristics. The feedback should also mention specific strategies the individual can use to improve their learning and performance and should provide not only information on their performance but also a guide for their next steps (Matua et al 2014).
Timely and effective constructive feedback is especially essential in the case of a graduate or student nurse who is underperforming. It gives the learner a chance to rectify the situation which could potentially leave them failing if they are a student or causing harm and potential dismissal if they are a new nurse graduate (Duffy 2013).
Feedback can be difficult to hear at times but when receiving constructive feedback it is important to remember that the feedback is intended to assist you in your professional development. And with nursing culture generally being one where positive feedback tends to be neglected, let’s all give each other some positivity – especially our new nurse graduates – when they start on the wards.
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- Chang, E & Daly, J 2012, Transitions in Nursing: Preparing for Professional Practice, 3rd edn, Elsevier, Sydney.
- Chowdhury, RR & Kalu, G 2004, ‘Learning to give feedback in medical education’, The Obstetrician and Gynecologist, vol. 6, pp. 243-7.
- Duffy, K 2013, ‘Providing constructive feedback to students during mentoring’, Nursing Standard, vol. 27, no. 31, pp. 50-6.
- Matua, GE, Seshan, V, Akintola, AA & Thanka AN 2014, ‘Strategies for providing effective feedback during preceptorship: Perspectives from an Omani hospital’, Journal of Nursing Education and Practice, vol. 4, no. 10, pp. 24-31.
- Mind Tools 2017, The situation – behavior – impact feedback tool: Providing clear, specific feedback. Available from: https://www.mindtools.com/pages/article/situation-behavior-impact-feedback.htm
- Rose, M & Best, D (eds) 2005, Transforming Practice Through Clinical Education, Professional Supervision and Mentoring, Elsevier, Sydney.
- Sodeify, R, Vanaki, Z & Mohammadi, E 2013, ‘Nurses’ Experiences of Perceived Support and their Contributing Factors: A Qualitative Content Analysis’, Iranian Journal of Nursing and Midwifery Research, vol. 18, no. 3, pp. 191-7, viewed 16 February 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748536/
Sally is a Rehabilitation Clinical Nurse Specialist and Nurse Educator teaching the Diploma of Nursing. She is passionate about education in nursing so we can become the best nurses possible. Sally has experience in many nursing sectors including rehabilitation, medical, orthopaedic, neurosurgical, day surgery, oncology, emergency, aged care and general surgery. Sally's Blog.