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Communication skills are also part of evalua- and leadership of both staff members and manage-
tion. A comprehensive evaluation system can be an ment. Done well, feedback can provide many
effective mechanism for improving staff skills and opportunities for increased professionalism and
morale and for reducing costs by increasing staff learning as well as ensure appropriate rewards for
productivity. Constructive feedback demands high performance levels and professionalism on
objectivity and fairness in dealing with each other the job.

Study Questions
1. This is your first position as an RN, and you are working with an LPN who has been on the unit
for 20 years. On your first day she says to you, “The only difference between you and me is the
size of the paycheck.” Demonstrate how you would respond to this statement, using assertive
communication techniques.
2. A physician orders “Vit K 10 mg IV.” You realize that this is a dangerous order. How would you
approach the physician?
3. A patient is admitted to the same-day surgical center for a breast biopsy. She is accompanied by
her significant other, who has just had an altercation with an admissions secretary about their
insurance. The patient then has to wait 30 minutes after her designated arrival time. When the
nurse comes to call the patient, her significant other turns and says loudly, “What is wrong with
you people? Can’t you ever get anything straight? If you can’t get the insurance right, and you can’t
get the time right, how can we expect you to get the surgery right?” How would you defuse the
situation?
4. Why is feedback important? Who needs to receive feedback? Who should give feedback to
health-care providers?
5. Describe the difference between constructive (helpful) and destructive (unhelpful) feedback.
6. Describe an ideal version of a 3-month performance appraisal of a new staff nurse. Why do nurse
managers sometimes fail to meet this ideal when providing formal evaluative feedback? Can new
staff nurses do anything to improve these procedures in their place of employment?
7. What is peer review? How is it different from other types of evaluation? Why is it important?

Case Study to Promote Critical Reasoning

Tyrell Jones is a new unlicensed assistant who has been assigned to your acute rehabilitation unit.
Tyrell is a hard worker; he comes in early and often stays late to finish his work. But Tyrell is gruff
with the patients, especially with the male patients. If a patient is reluctant to get out of bed, Tyrell
often challenges him, saying, “C’mon, man. Don’t be such a wimp. Move your big butt.”Today, you
overheard Tyrell telling a female patient who said she did not feel well, “You’re just a phony. You
like being waited on, but that’s not why you’re here.”The woman started to cry.
1. You are the newest staff nurse on this unit. How would you handle this situation? What would
happen if you ignored it?
2. If you decided that you should not ignore it, with whom should you speak? Why? What would you
say?

3. Why do you think Tyrell speaks to patients this way?