Do you have questions regarding your professional life? Is there a conundrum at work that requires an outside perspective?

The Trainee Section and Women in Neurocritical Care (WINCC) Section have teamed up to publish a column in Currents to serve your professional advice needs. Submit questions to winccmentorship@gmail.com, and we will get them answered by a seasoned advisor. 

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Our most recent question is very relevant to the state of our country today. We want to remind everyone that NCS has a commitment to diversity and equitable patient care. Please reach out to us with any questions regarding our submissions and responses.

Dear Currents,

I am a nursing supervisor in a neurocritical care unit, and I have been training a nurse who is not making the cut. She has made mistakes that have endangered patient’s lives and does not recognize the gravity of her work. When I spoke to her about it, she asked if it had to do with her race. It does not. I want to be respectful about where she is coming from but also relay feedback about her performance honestly. How do I navigate this situation?

Sincerely,

Florence Nightingale

Dear Florence,

If there are legitimate concerns about a nurse's performance potentially endangering the lives of patients, this must be addressed. You were correct to approach this trainee and bring up your concerns. When doing so, it's important to be specific in your feedback and work with this trainee to develop an action plan for improvement.

The next step will require some reflection and finesse. Is there a reason why your trainee felt the negative feedback was related to her background? Have there been any interactions with physicians, other nurses or staff that have made her feel this way? Have you had any interactions with her that may lead her to conclude this? If you're not sure, this would be an opportunity to sit down and ask her these questions.

It's important that you create a safe space for this conversation so she feels free to share her perspective. If your trainee has had encounters in the workplace that she has perceived as discriminatory, you should take steps to create a more inclusive environment and provide feedback to individuals as needed.

Claiborne B. Childs, MD, MS
Medical Director of Hospital Medicine Service, Penn Presbyterian Medical Center
Associate Program Director for Diversity & Inclusion Initiatives, Internal Medicine Residency
Assistant Professor of Clinical Medicine, Department of Medicine, Section of Hospital Medicine 

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Florence,

This sounds like a very difficult situation.  Our goal as leaders in the ICU is to ensure the safety of our patients while promoting the growth and development of staff.  Providing specific feedback about her performance deficits can help reiterate your concerns. Be as specific as possible: “When you took care of Mr. Smith in room 2015 yesterday, I observed you doing XXX.” If this is a pattern, say that as well.  Keep notes about both the specific incidents and your conversations with her. 

What is her perspective? Could there be something happening in her life that is interfering with her ability to concentrate and practice safely?  Let her talk opening about what she’s feeling and how it may be affecting her performance.  If she has specific examples of bias or discrimination, listen openly and ask contextual questions.

Looping in your human resources partners is another important part of this process.  Because of the severity of her performance deficits, you will need to determine an action plan with specific goals and a timeline to meet them.  Your HR department can help with this language and framing the conversations.  They should also be notified of her concerns about discrimination.  While HR is a resource for managers, it is also there to support the staff and ensure all staff members are treated equally and without bias.

There are lots of great resources for leaders who are having difficult conversations and providing feedback.  While these conversations can be awkward at first, they do get easier with time and practice.  Talking through what you want to say and how you will say it with a trusted colleague is a great way to ease the anxiety that comes with providing difficult feedback.

I hope that this will be of help for you.

Jessica M. Fuller, MSN, RN, CCRN, NE-BC
Nurse manager
Hospital of The University of Pennsylvania NeuroICU 

Florence,

My advice would be to schedule a time with your nurse manager and possibly HR to discuss your concerns about the nurse you are training. Having their input to the situation may help to deescalate what could otherwise be a heated issue.

I have found that using concrete examples of behavior as well as evidence as to why the behavior does not meet standards can be helpful after taking the time to define a mutual purpose to the conversation.  An example of a mutual purpose for this conversation would be to help your trainee optimize their nursing practice and career while ensuring patient safety. Helping define what is at the core of what you are getting at can help remove some of the confrontation from a difficult conversation.

As mentioned before, I believe that it would be best to have a third party, such as nurse manager or human resources representative, be part of this conversation to serve as a mediator and for protection of all parties involved. Best of luck!

Kristen Gonzalez, RN, BSN
Adminstrative supervisor
SSM St Anthony Hospital, Oklahoma City