The gift of feedback – beyond the box

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At a recent Schwartz Rounds session at my hospital, the moderators focused the discussion across the topic “The Gift of Feedback.” As I listened to the panelists share their experiences, I used to be reminded of two recent exchanges with colleagues with whom I actually have developed positive working relationships over time.

One was with a hard-working care partner (CP) who has been on our unit for about six years. The second exchange was with an attending physician who had been a respected leader in our NICU long before my 11 years on the job. I find them each very nice and really skilled.

Asking your care partner for feedback.

As one among the more experienced bedside nurses on our unit, I function a charge nurse about once every 4 to 6 weeks. I’ve done this over time enough that I feel quite comfortable within the role, but I do it so infrequently that I find yourself relearning certain facets of the role every time.

The charge nurse at all times sits at the identical station because the care partner who manages the reception desk. This person can get an up-close take a look at how different charge nurses handle this role. One day at the tip of a busy shift, I reached out to my care partner for feedback. Because he had the chance to find out about many various leadership styles and observe which approaches were more practical in managing communication and patient flow, I used to be inquisitive about his suggestions on how I could higher fulfill my role as a charge nurse.

Those who know me know that I’m a mild-mannered person. Even though I asked for this feedback in an open and non-threatening way, PK hesitated. After a couple of moments of silence, he told me that he was at all times reluctant to provide feedback because he didn’t know if what he said could be misunderstood. I attempted to guarantee him that I trusted his perspective and truly desired to learn from his observations, but he ultimately refused to share any of his thoughts.

Asking a physician for an opinion.

In my second exchange, I used to be a bedside nurse and worked with a nurse all day to stabilize a trauma patient who got here to us at night. It was not clear to all of us whether – based on the story provided by the caregiver – the patient had suffered a head injury because of this of falling from a table at home or was a victim of violence.

The caregiver was within the room attempting to insert an arterial tube into the patient. As the nurse was ending her work, the caregiver entered the room, very moved and distraught. She asked the doctor for an update on his medical information, and he provided a delicate, thoughtful explanation of the patient’s injuries and prognosis.

The caregiver needed to be especially careful to not suggest any immediate suspicions of abuse, while also making it clear that more people would want to check with her over the following few days to higher understand what had happened at the house. The caregiver cried, nodded in understanding, and left to rest within the automotive for some time.

Once she was gone, the nurse turned to me and the opposite nurse and asked, “Do you have any thoughts?”

It took me a moment to register that this very experienced attending physician desired to know what we thought concerning the way he conducted the interview. I used to be so surprised by his openness to our comments that I began looking for thoughts. And truthfully, I felt like he handled the conversation incredibly well and I did not have much constructive criticism to provide. I knew him as a really humble and gracious colleague, but somewhere in my subconscious there remained a hesitation – as “just a nurse at the bedside” – to provide him the required feedback, even when it was positive.

Things left unsaid.

Reflecting on my conversation with my caregiving partner, I needed I had found a technique to convey to him that his honest opinion would actually be a present. I desired to grow and improve as a charge nurse and was sad that I could not get any suggestions from him on how I could do that.

In that very same vein, I now realize that my hesitation in providing thoughtful feedback to our attending physician deprived him of that very same gift, regardless that I believed he did an amazing job managing his caregiver communication and I did not have much so as to add.

A hierarchical mentality can undermine openness.

These two encounters remind me that there’s a general mentality based on hierarchy. I imagine all of us still have a struggle in terms of giving one another feedback in our work. Even if the actual conversation in front of us is characterised by humility, openness, and trust, there still appears to be a mental battle to beat to acknowledge that I can safely give this person legitimate feedback, no matter our position.

These two meetings also jogged my memory how vital it’s for us to develop communication skills in order that we will express our thoughts clearly without stumbling. Looking ahead, I don’t need to provide up on this PK based on the thought, “Well, he felt uncomfortable and it didn’t work, so I’ll just not ask anymore.” I need to return and ask for his feedback again as I proceed to cultivate a secure and trusting skilled relationship with him.

I also need to be higher prepared to supply feedback to others once they ask for it.

We need practice, but we cannot at all times succeed – which makes it all of the more vital to cultivate a grace-filled environment through which we will practice while offering this priceless gift of feedback.