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Accepting Criticism
SEPTEMBER 1989, VOL. 50, NO 3
AORN JOURNAL
Accepting Criticism A POSITIVE PROCESS Ruth E. Davidhizar, RN
0
ccasionally, a nurse receives criticism from patients, supervisors, and other individuals who cross his or her path during a workday. How he or she accepts criticism affects personal feelings of well-being and job satisfaction, and influences effectiveness in relating to others on the job. A nurse’s response to criticism from supervisors can affect his or her salary increases, chances for promotion, and recommendations to prospective employers.Thus, the nurse’s potential to achievepersonal and professionalgoals may correlate to issues surrounding criticism. This article addresses this significant interpersonal process by discussing the role of criticism in the workplace. In addition, guidelines for the nurse on the art of accepting criticism are provided.
Even though criticism can have positive objectives and consequences, it frequently has negative connotations. Criticism may produce a negative response if it is given prematurely, based on inaccurate data or false assumptions, unjustified, given inappropriately and dampens morale, timed poorly, thus losing its effectiveness, given in a public place causing the recipient embarrassment, or given in anger. Criticism may be exaggerated, and it may disregard or overshadow the positive efforts and
Criticism in the Workplace
F
or a nurse, criticism serves an important function as part of his or her performance evaluation. Criticism is given to improve future actions by the nurse; it also provides an important barometer of satisfaction from patients and their families, and it can be used to improve the quality of patient care. In addition to critiques of employee performance, hospital certification standards require ongoing evaluation of patient care services as part of quality assurance. Consumer evaluations are required as measures of patient satisfaction and hospital performance. In other words, criticism from patients may significantly affect accreditation and subsequent funding of the hospital.
Ruth E. Davidhizer, RN,DNSc, is the director of nursing, Logansport (Ind) State HospitaL She received her bachelor of science degree in nursing from Goshen (Ind) College, and both her m t e r of science degree in nursing and her doctor of nursing science degree in psychiatric nursingfrom Indiana University, Indianapolis.
AORN JOURNAL
SEPTEMBER 1989, VOL. 50, NO 3
When criticism is accepted in a positive manner, it can be used to improve both the individual’s performance and the quality of patient care. contributions of the employee. Even when criticism is justified, judiciously applied, and tactfully executed, it may be perceived as a threat to self-esteem.’ Rather than unleashing a negative reaction, the nurse can use criticism in the workplace as a cue that conflict exists and as an indicator that he or she needs to clarify and/or correct some action. When criticism is accepted in this manner, it can trigger actions aimed at conflict resolution and reestablishing harmony? Even though accepting criticism and reacting appropriately is not something that comes naturally to most people, the person who is being criticized can make criticism a positive process with insight and understanding.
Guidelinesfor Accepting Criticism
A
lthough nursing literature contains information on how to give criticism constructively, little is written about how to accept it. Giving and accepting criticism should be part of a positive interpersonal process. It is important that the person who accepts the criticism believes that he or she is part of that process. A supervisor must give criticism in a nonthreatening and genuine manner; a recipient must be open-minded and willing to receive the messages. When criticism is accepted in a positive manner, it can be used to improve both the individual’s performance and the quality of patient care. The recipient of criticism should consider seven guidelines that can make criticism a positive experience. Have a deliberate attitude. The recipient of criticism should take a deliberate approach to criticism rather than respond spontaneously and negatively. Poorly thought-out reactions can precipitate additional criticism. By deliberatingbefore responding, the nurse can 610
identify what action best fits the criticism received. In some cases, listening is an appropriate action. In other cases, corrective actions should be taken. For example, the person who is criticized may alter his or her performance or perceptions, or he or she may determine that an apology or a change in the way he or she relates to coworkers is appropriate. The nurse who assesses the situation carefully before reacting will be more effective in resolving problems and ~onflicts.~ If the criticism comes from someone other than the supervisor, the nurse may be wise to discuss the matter and review possible actions with his or her supervisorbefore responding. Criticism from a peer or person from another department may be handled better by a supervisor or between departmental supervisors. The supervisor should be advised of any significant conflicts that occur in the workplace. Listen carefully.Good listening techniques are essential to hearing what the person is saying. A good listener concentrates on what the person is saying rather than planning how to react. Active listening is communicated by giving the speaker your undivided attention, making eye contact, and responding to the feelings that underlie what is being said. Another important listening technique is to acknowledge points of agreement. For example, the nurse may say, “We both agree that the situation is frustrating. It is clear that we both want this process to change.” The nurse who listens to criticism may reduce the anxiety and frustration of the person giving the criticism. The feeling of being heard has a powerful impact, and it can facilitate a mood of reconciliation. Evaluate criticism objectively. Criticism commonly evokes an emotional response. It is important to carefully evaluate the criticism given and view it objectively rather than emotionally. If the nurse has made an error that requires
SEPTEMBER 1989, VOL. 50, NO 3
corrective action, that action should be taken quickly. The nurse should not take time to dispute or feel guilty about the mistake. By acknowledging a mistake, a person can frequently resolve the conflict. If the criticism is unjustified and it influences future interaction with the person who is criticizing, the nurse should attempt to discuss the criticism with that person. If that person lacks information, the nurse should provide it in a nonthreatening manner. When criticism is unjustified, a deliberate approach will tend to decelerate the conflict. Evaluate the criticizerand the situation.The nurse who is receiving criticism should evaluate the person who is offering the criticism and the dynamics of the situation. Criticism given by a person who is under stress (eg, a patient who is apprehensive about an impending surgery) may influence how the criticism should be received. The nurse must consider his or her relationship with the criticizer. If criticism is given by a supervisor and is meant to improve performance, the nurse must focus on what should be improved and indicate that corrective action will be taken. When criticism is from a supervisor who has unilateral power over the matter being criticized, negotiation may not be possible, and compliance without argument may be the best course of action. It may be necessary for the nurse to use an accommodating style of conflict resolution when the criticizer holds power in the in~titution.~ When criticism is accepted from a supervisor in a positive manner, the likelihood of a positive relationship in the future in increased. It may be unrealistic for the nurse to follow every arbitrary decision made by a supervisor in an attempt to please him or her. Even though the other extreme-open resistance-should be avoided, it is important for the nurse to distinguish between the issues that are important enough to fight for and issues that may be distasteful but do not adversely affect the nurse’s position. Avoid anger. Criticism is commonly seen as a personal attack. Consequently, anger is a common reaction. The nurse may display anger directly by a verbal retort, an angry telephone call, or a nasty memo. He or she may display
AORN JOURNAL
anger indirectly by walking away from the criticizer without speaking, avoiding the person, procrastinating in completing assignments, delaying appointments to discuss the criticism, sabotaging other projects, or talking about the criticizer behind his or her back. The nurse also may express anger passively by complaining of physical symptoms such as headache or stomachache. An angry approach that does not directly address the criticism usually prolongs the conflict. The unresolved conflict may surface later and add to the intensity of another conflict. The nurse who uses an angry, but direct approach to respond to unjustified criticism may promote a quick resolution to the conflict because his or her action will require prompt clarification and negotiation. The direct approach may facilitate discussion and clarify inaccuracies. Even though the deliberate approach is preferred, the direct approach may be warranted. Controlled anger is a powerful response, but it must be used sparingly to be effective. On the other hand, uncontrolled or irrational fury decreases the nurse’s personal stature and should be avoided. For maximum effect, anger must be used for issues that really count. Protect self-esteem. Each nurse has a basic need to feel worth and positive self-esteem. Selfesteem usually is bolstered by positive recognition. A nurse who is not praised and who is only told of incorrect actions may feel insecure. For the nurse who has a fragile self-esteem, criticism is painful and may result in anger, passive-aggressive actions, and attempts to justify and rationalize behavior. It is important for the nurse who relates criticism to self-worth to be aware of this association. Selfworth is not based on an individual error. Nurses learn from criticism; it serves as an important tool against making the same mistakes in the future. Human error is part of life and should be accepted without remorse. Criticism may have little to do with error, but it may be the subjective perception of the criticizer. The person being criticized must accept that he or she can not control the incorrect opinions or judgments of others. Use laughter. Laughing at oneself averts the possibility of taking oneself too seriously. A nurse 61 1
SEPTEMBER 1989, VOL. 50, NO 3
AORN JOURNAL
who can laugh at insignificant mistakes rather than find them demoralizing will enjoy life more. Humor offers a way to cope with a stressful situation; it is a way that people can cope with the incongruities and inconsistencies of life. It enables people in a stressful situation to distance themselves from the problem and to give them hope that the situation is not permanent.
Summary
C
riticism often has negative connotations, even when it is a planned supervisory technique and is part of a comprehensive approach aimed at improving employee behavior without damaging employee morale. The nurse may be the target of criticism from a variety of other people that he or she encounters in the health care setting. The nurse’s response to criticism is important to optimal conflict resolution and to maintaining relationships with integrity. The nurse’s actions and attitudes in response to criticism should be planned deliberately and directed at resolving the conflict. 0 Notes 1. N Metzger, The Health Care Supervisor’s Handbook, second ed (Rockville, M d Aspen Systems Corp, 1982) 38. 2. A Marriner, “How do you spell relief of conflict? F-I-e-x-i-b-i-1-i-t-y,” Nursing 87 17 (March 1987) 113114. 3. J Genovich-Richards,D C Carissimi, “Developing nurses’ managerial competence,” Nursing Management 17 (March 1986) 36-38. 4. Marriner, “How do you spell relief of conflict? F-I-e-x-i-b-i-1-i-t-y,” 113-114. Suggested reading Davidhizer, R,Bowen, M. “How to give criticism that gets results.” RN 51 (November 1988) 14-18. Henry, B M, Moody, L E. “Energize with laughter.” Nursing Success Today 2 no 1 (1985) 4-8.
612
Using Care Plans for Day Surgery Patients To efficiently and safely manage day surgery patients, Seton Medical Center, Austin, Tex, has developed care plans that are implemented during preadmission visits, according to the July 1989 issue of Same-Day Surgery. The care plan meets the Joint Commission on Accreditation of Healthcare Organizations’ standard: “Hospital-sponsored ambulatory care meets the same standards of quality that apply to inpatient care provided by the hospital.” The patient is scheduled for a preoperative visit several days before surgery. The patient completes the admission process, health assessment forms, and interviews with the anesthesiologists and RNs. During the preoperative visit, the nurses review the patients’ bodily systems and conduct complete nursing assessments, give preoperative and postoperative instructions regarding preparations for surgery, including what clothes patients should wear or bring to the facility, where they should park, and when they should arrive, have patients sign operative permits, and start a care plan addressing social, emotional, and physical elements of the patients. The care plan also draws attention to the patients’ special needs or circumstances such as the need for pastoral services, a wheelchair, or a quiet environment. Also, during the preadmission visit, the patients’ laboratory work, electrocardiograms, and chest x-rays are conducted to help decrease waiting time and turnaround time. The care plan, which encompasses preoperative and postoperative needs, is simple and quick for the nurses to complete; they only have to circle what is appropriate and comment briefly when needed. After the care plan is completed, it becomes part of the patients’ medical records.
AORN JOURNAL
Accepting Criticism A POSITIVE PROCESS Ruth E. Davidhizar, RN
0
ccasionally, a nurse receives criticism from patients, supervisors, and other individuals who cross his or her path during a workday. How he or she accepts criticism affects personal feelings of well-being and job satisfaction, and influences effectiveness in relating to others on the job. A nurse’s response to criticism from supervisors can affect his or her salary increases, chances for promotion, and recommendations to prospective employers.Thus, the nurse’s potential to achievepersonal and professionalgoals may correlate to issues surrounding criticism. This article addresses this significant interpersonal process by discussing the role of criticism in the workplace. In addition, guidelines for the nurse on the art of accepting criticism are provided.
Even though criticism can have positive objectives and consequences, it frequently has negative connotations. Criticism may produce a negative response if it is given prematurely, based on inaccurate data or false assumptions, unjustified, given inappropriately and dampens morale, timed poorly, thus losing its effectiveness, given in a public place causing the recipient embarrassment, or given in anger. Criticism may be exaggerated, and it may disregard or overshadow the positive efforts and
Criticism in the Workplace
F
or a nurse, criticism serves an important function as part of his or her performance evaluation. Criticism is given to improve future actions by the nurse; it also provides an important barometer of satisfaction from patients and their families, and it can be used to improve the quality of patient care. In addition to critiques of employee performance, hospital certification standards require ongoing evaluation of patient care services as part of quality assurance. Consumer evaluations are required as measures of patient satisfaction and hospital performance. In other words, criticism from patients may significantly affect accreditation and subsequent funding of the hospital.
Ruth E. Davidhizer, RN,DNSc, is the director of nursing, Logansport (Ind) State HospitaL She received her bachelor of science degree in nursing from Goshen (Ind) College, and both her m t e r of science degree in nursing and her doctor of nursing science degree in psychiatric nursingfrom Indiana University, Indianapolis.
AORN JOURNAL
SEPTEMBER 1989, VOL. 50, NO 3
When criticism is accepted in a positive manner, it can be used to improve both the individual’s performance and the quality of patient care. contributions of the employee. Even when criticism is justified, judiciously applied, and tactfully executed, it may be perceived as a threat to self-esteem.’ Rather than unleashing a negative reaction, the nurse can use criticism in the workplace as a cue that conflict exists and as an indicator that he or she needs to clarify and/or correct some action. When criticism is accepted in this manner, it can trigger actions aimed at conflict resolution and reestablishing harmony? Even though accepting criticism and reacting appropriately is not something that comes naturally to most people, the person who is being criticized can make criticism a positive process with insight and understanding.
Guidelinesfor Accepting Criticism
A
lthough nursing literature contains information on how to give criticism constructively, little is written about how to accept it. Giving and accepting criticism should be part of a positive interpersonal process. It is important that the person who accepts the criticism believes that he or she is part of that process. A supervisor must give criticism in a nonthreatening and genuine manner; a recipient must be open-minded and willing to receive the messages. When criticism is accepted in a positive manner, it can be used to improve both the individual’s performance and the quality of patient care. The recipient of criticism should consider seven guidelines that can make criticism a positive experience. Have a deliberate attitude. The recipient of criticism should take a deliberate approach to criticism rather than respond spontaneously and negatively. Poorly thought-out reactions can precipitate additional criticism. By deliberatingbefore responding, the nurse can 610
identify what action best fits the criticism received. In some cases, listening is an appropriate action. In other cases, corrective actions should be taken. For example, the person who is criticized may alter his or her performance or perceptions, or he or she may determine that an apology or a change in the way he or she relates to coworkers is appropriate. The nurse who assesses the situation carefully before reacting will be more effective in resolving problems and ~onflicts.~ If the criticism comes from someone other than the supervisor, the nurse may be wise to discuss the matter and review possible actions with his or her supervisorbefore responding. Criticism from a peer or person from another department may be handled better by a supervisor or between departmental supervisors. The supervisor should be advised of any significant conflicts that occur in the workplace. Listen carefully.Good listening techniques are essential to hearing what the person is saying. A good listener concentrates on what the person is saying rather than planning how to react. Active listening is communicated by giving the speaker your undivided attention, making eye contact, and responding to the feelings that underlie what is being said. Another important listening technique is to acknowledge points of agreement. For example, the nurse may say, “We both agree that the situation is frustrating. It is clear that we both want this process to change.” The nurse who listens to criticism may reduce the anxiety and frustration of the person giving the criticism. The feeling of being heard has a powerful impact, and it can facilitate a mood of reconciliation. Evaluate criticism objectively. Criticism commonly evokes an emotional response. It is important to carefully evaluate the criticism given and view it objectively rather than emotionally. If the nurse has made an error that requires
SEPTEMBER 1989, VOL. 50, NO 3
corrective action, that action should be taken quickly. The nurse should not take time to dispute or feel guilty about the mistake. By acknowledging a mistake, a person can frequently resolve the conflict. If the criticism is unjustified and it influences future interaction with the person who is criticizing, the nurse should attempt to discuss the criticism with that person. If that person lacks information, the nurse should provide it in a nonthreatening manner. When criticism is unjustified, a deliberate approach will tend to decelerate the conflict. Evaluate the criticizerand the situation.The nurse who is receiving criticism should evaluate the person who is offering the criticism and the dynamics of the situation. Criticism given by a person who is under stress (eg, a patient who is apprehensive about an impending surgery) may influence how the criticism should be received. The nurse must consider his or her relationship with the criticizer. If criticism is given by a supervisor and is meant to improve performance, the nurse must focus on what should be improved and indicate that corrective action will be taken. When criticism is from a supervisor who has unilateral power over the matter being criticized, negotiation may not be possible, and compliance without argument may be the best course of action. It may be necessary for the nurse to use an accommodating style of conflict resolution when the criticizer holds power in the in~titution.~ When criticism is accepted from a supervisor in a positive manner, the likelihood of a positive relationship in the future in increased. It may be unrealistic for the nurse to follow every arbitrary decision made by a supervisor in an attempt to please him or her. Even though the other extreme-open resistance-should be avoided, it is important for the nurse to distinguish between the issues that are important enough to fight for and issues that may be distasteful but do not adversely affect the nurse’s position. Avoid anger. Criticism is commonly seen as a personal attack. Consequently, anger is a common reaction. The nurse may display anger directly by a verbal retort, an angry telephone call, or a nasty memo. He or she may display
AORN JOURNAL
anger indirectly by walking away from the criticizer without speaking, avoiding the person, procrastinating in completing assignments, delaying appointments to discuss the criticism, sabotaging other projects, or talking about the criticizer behind his or her back. The nurse also may express anger passively by complaining of physical symptoms such as headache or stomachache. An angry approach that does not directly address the criticism usually prolongs the conflict. The unresolved conflict may surface later and add to the intensity of another conflict. The nurse who uses an angry, but direct approach to respond to unjustified criticism may promote a quick resolution to the conflict because his or her action will require prompt clarification and negotiation. The direct approach may facilitate discussion and clarify inaccuracies. Even though the deliberate approach is preferred, the direct approach may be warranted. Controlled anger is a powerful response, but it must be used sparingly to be effective. On the other hand, uncontrolled or irrational fury decreases the nurse’s personal stature and should be avoided. For maximum effect, anger must be used for issues that really count. Protect self-esteem. Each nurse has a basic need to feel worth and positive self-esteem. Selfesteem usually is bolstered by positive recognition. A nurse who is not praised and who is only told of incorrect actions may feel insecure. For the nurse who has a fragile self-esteem, criticism is painful and may result in anger, passive-aggressive actions, and attempts to justify and rationalize behavior. It is important for the nurse who relates criticism to self-worth to be aware of this association. Selfworth is not based on an individual error. Nurses learn from criticism; it serves as an important tool against making the same mistakes in the future. Human error is part of life and should be accepted without remorse. Criticism may have little to do with error, but it may be the subjective perception of the criticizer. The person being criticized must accept that he or she can not control the incorrect opinions or judgments of others. Use laughter. Laughing at oneself averts the possibility of taking oneself too seriously. A nurse 61 1
SEPTEMBER 1989, VOL. 50, NO 3
AORN JOURNAL
who can laugh at insignificant mistakes rather than find them demoralizing will enjoy life more. Humor offers a way to cope with a stressful situation; it is a way that people can cope with the incongruities and inconsistencies of life. It enables people in a stressful situation to distance themselves from the problem and to give them hope that the situation is not permanent.
Summary
C
riticism often has negative connotations, even when it is a planned supervisory technique and is part of a comprehensive approach aimed at improving employee behavior without damaging employee morale. The nurse may be the target of criticism from a variety of other people that he or she encounters in the health care setting. The nurse’s response to criticism is important to optimal conflict resolution and to maintaining relationships with integrity. The nurse’s actions and attitudes in response to criticism should be planned deliberately and directed at resolving the conflict. 0 Notes 1. N Metzger, The Health Care Supervisor’s Handbook, second ed (Rockville, M d Aspen Systems Corp, 1982) 38. 2. A Marriner, “How do you spell relief of conflict? F-I-e-x-i-b-i-1-i-t-y,” Nursing 87 17 (March 1987) 113114. 3. J Genovich-Richards,D C Carissimi, “Developing nurses’ managerial competence,” Nursing Management 17 (March 1986) 36-38. 4. Marriner, “How do you spell relief of conflict? F-I-e-x-i-b-i-1-i-t-y,” 113-114. Suggested reading Davidhizer, R,Bowen, M. “How to give criticism that gets results.” RN 51 (November 1988) 14-18. Henry, B M, Moody, L E. “Energize with laughter.” Nursing Success Today 2 no 1 (1985) 4-8.
612
Using Care Plans for Day Surgery Patients To efficiently and safely manage day surgery patients, Seton Medical Center, Austin, Tex, has developed care plans that are implemented during preadmission visits, according to the July 1989 issue of Same-Day Surgery. The care plan meets the Joint Commission on Accreditation of Healthcare Organizations’ standard: “Hospital-sponsored ambulatory care meets the same standards of quality that apply to inpatient care provided by the hospital.” The patient is scheduled for a preoperative visit several days before surgery. The patient completes the admission process, health assessment forms, and interviews with the anesthesiologists and RNs. During the preoperative visit, the nurses review the patients’ bodily systems and conduct complete nursing assessments, give preoperative and postoperative instructions regarding preparations for surgery, including what clothes patients should wear or bring to the facility, where they should park, and when they should arrive, have patients sign operative permits, and start a care plan addressing social, emotional, and physical elements of the patients. The care plan also draws attention to the patients’ special needs or circumstances such as the need for pastoral services, a wheelchair, or a quiet environment. Also, during the preadmission visit, the patients’ laboratory work, electrocardiograms, and chest x-rays are conducted to help decrease waiting time and turnaround time. The care plan, which encompasses preoperative and postoperative needs, is simple and quick for the nurses to complete; they only have to circle what is appropriate and comment briefly when needed. After the care plan is completed, it becomes part of the patients’ medical records.