Give the gift of feedback : Nursing Management

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Feature: Nurses Week Special

Give the gift of feedback

Cox, Sharon MSN, BSN

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Nursing Management (Springhouse) 47(5):p 44-48, May 2016. | DOI: 10.1097/01.NUMA.0000482528.92871.ea
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In Brief

The art of giving and receiving feedback is a skill too often neglected. Hone yours using the strategies in this insightful article.


Is feedback really a gift, or is it something you dread? A great deal hinges on your honest response to that question, so take a moment to notice if you smiled or sneered when you read the title of this article. Although we understand the importance of giving and receiving feedback, it's a skill set that's too often neglected. Our effectiveness in fostering teamwork, staff engagement, and even workplace accountability is enhanced or diminished by our feedback skills. As high-performing teams guru Patrick Lencioni has said, “When we fail to provide honest and constructive feedback, we're letting people down personally and also letting down our team.”1 In addition, our self-awareness and career development take a hit when we have difficulty with being on the receiving end of feedback. The good news is that this essential skill set can be honed by learning to value feedback and developing methods for more effectively giving feedback and being more responsive when receiving it.

The right tools

First, it's important to ask permission to give someone feedback, pick the right time and place, and be clear and caring with what you want to say. If you want the conversation to make a difference, take time to plan it. Feedback on the fly is seldom helpful. Consider your intention: Do you want to see a change in behavior or is this a behavior you want someone to sustain? (See Accentuate the positive.) These are the only two reasons for giving feedback.

As you plan the conversation, forget what you've been taught about the “sandwich” approach to feedback. This approach begins with good news, followed by bad news, which is then followed with more good news. Although this is common practice, in reality, it undermines your feedback and leaves you feeling disingenuous.2

Update your know-how with a much more effective method from feedback skills expert Shari Harley, who suggests an eight-step formula for giving feedback:

  1. Introduce what will be discussed and why it matters to bring clarity and focus to the discussion.
  2. Empathize to reflect sincerity and allow both parties to feel as comfortable as possible.
  3. Describe the problematic behavior as specifically as possible to lessen defensiveness.
  4. Share the impact of the behavior; in other words, indicate what happened as a result of the behavior.
  5. Engage in a dialogue by asking for the person's perceptions, intent, or questions; a two-way conversation is the key.
  6. Make suggestions or recommendations by discussing what you want to see done differently next time.
  7. Agree on next steps, such as what will be different going forward and what support is needed.
  8. Say thank you to show appreciation for the person's time and commitment to change.3

Remember to deal with only one or two issues at a time and keep in mind how you would want to be treated in the situation. Use “I” statements, such as “I've noticed...” or “I'm concerned about...” Most important, stay focused by separating the facts (what you observed) from your feelings or the opinions of others. It's about the behavior, not your assumptions about the other person's personality and his or her intent. Giving examples of the behavior in question increases the likelihood that your feedback will be taken seriously. If you don't have specific examples of the behavior under discussion, then you aren't prepared to give feedback. (See Common mistakes.)

Helping someone see the impact of his or her behavior is pivotal to the feedback process. Again, the need to be specific is essential. The more you gloss over the behavior or use “weasel” words (kind of, sort of, maybe), the more you're wasting an opportunity and losing credibility. Also, avoid generalizations. Instead of saying that a person is aggressive, describe the behavior as raising his or her voice in meetings and using foul language. Rather than stating that a person has a bad attitude, say that he or she challenges every decision or focuses on why something won't work. The more honest and specific you are, the more likely the conversation will have an impact.

Refer only to the behavior that the person can change, and listen to the person's perceptions and intentions because people are more likely to change if they feel heard. Consider the following phrases:

  • “If you had this to do over again, what would you do differently?”
  • “Walk me through your thinking in that situation.”
  • “What needs to happen if this goes unresolved?”
  • “We've talked about this, now tell me what you heard me say.”
  • “Part of my role is to have your back, and I would rather you hear this from me.”

When you're in the situation of having to deliver feedback about validated and impactful behavior that you haven't observed, you may encounter a challenge due to feelings of betrayal. Encourage the person to focus on what he or she can do differently and not on who said what. If the person argues with the feedback or denies that there's a problem, try the following: “Where there's smoke, there's fire, so regardless of the source, the feedback is food for thought and needs to be taken seriously.”

If the feedback fails to bring about a change in behavior, consider the consequences. All behavior has consequences unless we make excuses or rescue the person (“bless her heart”). Remember that people do what they do because it works; if you want to change what they do, just make sure that what they do no longer works. Reflecting on “What part of this is mine to own?” or “How are we helping this happen?” can shed light on enabling behaviors. Moving from blame to contribution can be very insightful and may even strengthen the feedback you're giving.4

Friendly or averse?

Our ability to learn from feedback is due in large part to whether we see ourselves as fixed and finished or always evolving and growing from experience.8 Assuming you're in the latter category, seek out feedback more often than your annual review or staff survey. To develop your skills in receiving feedback, ask trusted people who have your best interest at heart and whose insights you value. We all need friends and colleagues who'll tell us when we have broccoli in our teeth, so seek out these people in your inner circle and reflect on their insights. An easy frame for this conversation is, “What do I need to do more of, less of, or differently?”

You can also ask them to share your blind spots that may be problematic. If you respond in a way that encourages truth telling, such as, “I know this is a learning curve for me and your insights would be helpful,” the feedback becomes a gift. If the conversation is emotionally charged, ask for a follow-up conversation to give yourself time to process what you heard. This is especially true for introverts who process internally and need time to think over the input.

Always say thank you to anyone who gives you feedback. Know that you're likely to be defensive and let yourself feel that without acting on it. As you take in the comments, notice if you're hearing them as coaching or evaluation. The more you choose to hear feedback as coaching, the more you can learn from it and not feel judged. If the feedback was difficult, give yourself a grade on how well you handled it. You may not have scored well in the situation, but how you responded is of greater importance in the long run. The second score—how you handle the feedback—gives you something to work on that you can feel good about and reinforces your ability to learn from experience.8

Routinely ask for feedback from those with whom you work and you'll be modeling the value of this all-important skill set. For example:

  • Meet with new staff members at the 6-month and 1-year point and ask:
    • —What three things make you want to leave this unit?
    • —What one thing makes you want to stay?
    • —What would you do if you were in my role for 3 months?
  • As you routinely round on your staff members or talk with informal leaders, ask:
    • —What do I need to stop, start, or keep doing to improve this unit?
    • —Are you getting what you need from me? (Remember that taking notes helps your credibility.)
  • Reinforce progress being made on meaningful work and know that a visual depiction of the progress is better than relying solely on verbal communication. (The visual trumps the verbal.)
  • Talk with the person to whom you report about needed feedback and consider the value of a mentoring relationship.

A worthy priority

Think about the best feedback you ever received, and strongly consider honing your own ability to deliver it to others. The better we get with giving and receiving feedback, the more it can be a gift that keeps on giving.

Accentuate the positive

Research in neurobiology indicates that we're wired to hold on to negative thoughts while being resistant to positive ones.5 This means that we have to be intentional in noticing what's working well because feedback is often solely focused on problems or what isn't working. The ratio of positive to negative feedback needs to be 5:1. In top-performing teams, the ratio is 6:1.6 We need to frequently highlight the positives to foster energy and emphasize areas of progress for a more motivating workplace.

A research study involving several hundred employees and managers ranking the importance of incentives, clear goals, recognition, support, and progress on meaningful work found that employees ranked “making progress on meaningful work” as most important, whereas managers ranked this as last on their list of motivating factors. Think about that the next time you're preparing for a staff meeting.7

Common mistakes

Notice if you recognize any of these typical miscues when it comes to giving feedback, and team up with a colleague to be your accountability partner in making needed changes. These include:

  • waiting too can't change what you don't remember.
  • offering praise just to be polite with no substance or examples.
  • using voicemail or e-mail to avoid an actual conversation.
  • lacking follow through or not following up to recognize changes made.
  • delivering negative feedback in front of others; this includes negative body language.
  • giving advice before asking for insights, which creates a one-way monologue rather than a conversation.
  • bringing in the opinions of others rather than owning your own observations, which undermines trust.
  • going on vacation or being unavailable the day after giving feedback, which can be seen as avoiding follow up.
  • changing topics midway through the conversation and confusing the issue.
  • providing feedback only about what's going wrong.


1. Lencioni P. Overcoming the Five Dysfunctions of a Team. San Francisco, CA: Jossey Bass; 2005:64.
2. Schwarz R. The ‘sandwich approach’ undermines your feedback.
3. Harley S. How to Say Anything to Anyone. Austin, TX: Greenleaf Book Group; 2013:117.
4. Stone D, Patton B, Heen S. Difficult Conversations: How to Discuss What Matters Most. 2nd ed. New York, NY: Penguin Books; 2010:58.
5. Hanson R. Buddha's Brain: The Practical Neuroscience of Happiness, Love and Wisdom. Oakland, CA: New Harbinger Publications; 2009:41.
6. Zenger J, Folkman J. The ideal praise-to-criticism ratio.
7. Amabile T, Amabile S. The Progress Principle: Using Small Wins to Ignite Joy, Engagement and Creativity at Work. Boston, MA: Harvard Press; 2011:86–100.
8. Stone D, Heen S. Thanks for the Feedback: The Science and Art of Receiving Feedback Well Even When It is Off Base, Unfair, Poorly Delivered or You Are Not in the Mood. New York, NY: Penguin Books; 2014:183, 202.
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