By Giulia May/Unsplash

In a recent Schwartz Rounds session at my hospital, the facilitators centered the discussion around the theme, “The Gift of Feedback.” As I listened to the panelists share their experiences, I recalled two recent exchanges with colleagues I’ve developed positive working relationships with over the years.

One was with a hardworking care partner (CP) who has been in our unit for about six years. The other exchange was with an attending physician who had been a well-respected leader in our PICU long before my 11 years working there. I find both to be very kind and very professional.

Asking a care partner for feedback.

As one of the more experienced bedside nurses in our unit, about once every four to six weeks I fill the role of relief charge nurse. I’ve done it enough over the years to feel decently comfortable in the role, but I do it so infrequently that each time I find myself relearning aspects of the role.

The charge nurse always sits in the same station as the care partner who manages the front desk. This individual gets a close-up view of how all the different relief charge nurses handle the role. One day towards the end of a busy shift, I turned to the care partner to ask for feedback. Since he got to see many different styles of leadership and and observe which approaches were more effective for managing communication and patient flow, I was curious about any suggestions he might have about how I could do the relief charge nurse role better.

Those who know me know that I am a mild-mannered person. Although I asked for this feedback in an open, nonthreatening way, the CP hesitated. After a few moments of silence, he told me that he was always reluctant to give feedback because he didn’t know if what he said might be misunderstood. I tried to reassure him that I trusted his perspective and genuinely wanted to learn from his observations, but in the end he declined to offer any thoughts.

Being asked by a physician for feedback.

In the other exchange, I was the bedside nurse in a patient room, working along with our resource nurse for the day to stabilize a trauma patient who had come in overnight. It was unclear to all of us whether this patient had suffered a head injury after falling off a table at home, per the story given by the caregiver, or had been abused.

The attending was in the room, attempting to insert an arterial line into the patient. As the attending was finishing up, the caregiver arrived and entered the room, very emotional and distraught. She asked the attending for a medical update, and the attending provided a gentle, thoughtful explanation regarding the patient’s injuries and prognosis.

The attending had to walk the fine line of not suggesting any outright suspicion of abuse while also hinting that more people would need to talk to her in days ahead to better understand what happened at home. The caregiver wept, nodded her understanding, and left to rest in her car for awhile.

After she was gone, the attending turned to me and the other nurse and asked, “Do you have any thoughts?”

It took me a moment to register that this very experienced attending physician wanted to know how we felt about the way he handled the conversation. I was so taken aback by his openness to our feedback that I fumbled for thoughts. And in truth, I felt that he’d handled the conversation incredibly well and I didn’t have much constructive criticism to provide. I knew him as a very humble and gracious colleague, but somewhere in my subconscious remained a hesitation—as “just a bedside nurse”—to give him the requested feedback, even if it were positive.

Things left unsaid.

In reflecting on my conversation with the care partner, I wished I had found a way to communicate to him that his honest feedback truly would have been a gift. I wanted to grow and improve in the relief charge nurse role, and I felt sad that I couldn’t elicit his suggestions on how I could do so.

In the same vein, I realize now that my hesitancy in providing any thoughtful feedback to our attending physician deprived him of the same gift, even though I felt he did an excellent job navigating his communication with the caregiver and I didn’t have much to add.

A mentality of hierarchy can undermine openness.

These two encounters remind me that there is a general mentality of hierarchy I believe we all continue to battle when it comes to providing feedback to one another in our work. Even if the actual conversation before us is characterized by humility, openness, and trust, there still seems to be a mental struggle to overcome in recognizing that I can safely give legitimate feedback to this person, regardless of our positions.

The two encounters also remind me of how important it is for us to develop our communication skills so that we can clearly articulate our thoughts without tripping ourselves up. Looking ahead, I don’t want to give up on this CP based on the thought, “Well, he was uncomfortable and that didn’t produce results, so I just won’t ask anymore.” I want to go back and ask him again for feedback as I continue to cultivate a safe and trusted working relationship with him.

And I want to be better prepared to offer feedback to others when they ask.

We need practice and we won’t always get it just right—all the more reason to cultivate a grace-filled environment in which to practice offering this invaluable gift of feedback.