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Carefully read these directions and the grading rubric below.
Download the required template below under Template.
Rename that template as Your Last Name Professional Paper Worksheet.docx.  This must be saved as a Microsoft Word document (.docx). Save it to  your own computer or flash drive in a location where you will be able to  retrieve it later. Type your assignment directly on the saved document.  Save your work often..

5. This assignment must use the required article and sentences stated  in the announcement described above to complete the following items:

Reference for the assigned journal article,
Quotation with citation,
Paraphrased area with citation, and
Assigned article summary.

6. Each of required items above is clearly described on the  Professional Paper Worksheet Template. Page numbers for resources in the  current APA Manual are provided on the template for your use
7. The Assigned Article Summary that you write must be 175-200 words.  The Summary must contain the assigned sentence for quotation and  citation as noted in the announcement, the assigned sentence for the  paraphrased area with citation as noted in the announcement, several  additional paraphrased areas, and appropriately formatted citations. You  may also include one more short quotation if you wish.
8. When your Professional Paper Worksheet Assignment is completed, save  and close the completed template. Click the Submit button at the top of  this page to upload your completed assignment.

The required sentence for quotation and citation  is located on page 65 in the first full paragraph in the second column.  The sentence begins with the words: Nurse leaders are in a unique  position…
The required sentence for paraphrasing and citation  is also located on page 65 in the second column underneath the heading  Promote a Growth Mindset. The sentence begins with the words:  Constructive feedback that is taken and put into practice can lead to…
Follow the directions on the Graded Assignment pages to complete each  assignment. Contact your instructor with any questions. Thank you.


64 AJN ▼ September 2019 ▼ Vol. 119, No. 9

The Art of Giving Feedback
Regular feedback is a powerful tool for developing your team
and supporting their growth.

Giving constructive feedback is an essential lead-ership skill. It is only through feedback that nursing staff understands what they are doing
right or what they may need to do differently. The
best feedback is that which is immediate and action-
able. The annual performance evaluation alone does
not meet the needs of the contemporary workforce;
our millennial workforce actually has a desire for
frequent feedback from their leaders, according to a
2017 Gallup report.1 In 2014, Stone and Heen recom-
mended that leaders wishing to be effective engage in
three types of feedback conversations with their staff.2

The first type is appreciation feedback, which con-
veys gratitude for the employee’s contribution. Ac-
cording to Kouzes and Posner, giving appreciative
feedback is a means of “encouraging the heart,” one
of five exemplary practices of leadership.3 Positive
feedback has been shown to be extremely important
to maintaining team and individual motivation. This
type of input both builds a relationship and improves
the engagement of staff in their work.

The second type of feedback is coaching feedback,
which is designed to expand knowledge, sharpen
skills, and develop staff. Coaching staff to higher levels
of performance has become a vital part of the leader’s
role. When you coach, you can help your team mem-
bers build personal mastery, reach a higher level of
productivity, increase their professional competence,
manage conflict better, and reduce their stress. Your
goal in coaching is to create a practice setting that en-
sures quality, safety, cost-effectiveness, and joy and

Ideally, staff receive the coaching and appreciation
feedback throughout the year, in contrast to the third
type of feedback, the performance evaluation, which
typically occurs once a year (or more often) and in-
volves rating staff against a set of standards.

For most leaders, giving positive feedback comes
easily, but giving negative feedback is more challenging.
Leaders often choose to avoid discussions with staff

that they think will end in a confrontation. However,
when problematic behavior is not addressed, it lowers
the morale of the team and erodes trust in the leader.
A failure to address performance issues on your team
can have serious ramifications. When poor practices
are engaged in repeatedly and nothing is done about
them, staff begin to accept a lower standard of care,
and the behaviors can become normalized. Timely
and honest feedback—delivered respectfully—can
build the confidence of staff and create trust in the
leader. Regular feedback is a powerful tool for devel-
oping your team and supporting their career growth.
Feedback is like a muscle; it must be used frequently in
order to develop. The purpose of this article is to pro-
vide best-practice strategies for giving effective feed-
back—through building trust, promoting a growth
mindset, and developing the courage to tackle difficult
performance conversations.

It is often said that trust is the currency of leadership.
Leaders who are not trusted by staff experience chal-
lenges when giving feedback3, 4; However, trust is not
built overnight. In The Seven Habits of Highly Effec-
tive People, Covey uses the metaphor of an emotional
bank account to describe how trust is built.5 If, as a
leader, I make deposits with you in this emotional bank
account through confidentiality, courtesy, kindness,
honesty, and keeping my commitments, then I build
a reserve of trust. Your trust in me grows, and I can
call on that trust when I need it. When trust is high,
giving feedback is more comfortable, and it is more
openly received. If instead I show a lack of concern or
disrespect, if I fail to follow through on commitments
or overreact in situations, then my emotional bank ac-
count can quickly become overdrawn. You won’t trust
me when I give you feedback because you don’t feel
psychologically safe.

Psychological safety is crucial to creating an environ-
ment that fosters learning and a strong feedback loop.

For many leaders, giving positive feedback comes easily, but giving negative feedback can be more chal-
lenging. This article provides best-practice strategies for giving effective feedback—through building trust,
promoting a growth mindset, and developing the courage to tackle difficult performance conversations.

[email protected] AJN ▼ September 2019 ▼ Vol. 119, No. 9 65

By Rose O. Sherman, EdD, BSN, RN, NEA-BC, FAAN

Expectations regarding interpersonal consequences
in a work setting are formed by the level of psycho-
logical safety—and determine one’s behavior in that
setting. Amy Edmondson, an expert on psychologi-
cal safety in the workplace, describes it as “the belief
that the work environment is safe for interpersonal
risk taking.”6 An action that might be unthinkable in
one setting would be readily taken in another where
there is a culture of psychological safety. Feedback is
not as threatening in environments that are psycho-
logically safe because staff realize that it is given to
help them to grow professionally. In such an environ-
ment, staff can take it for granted that others will
respond positively when they put themselves on the
line by asking a question, seeking feedback, report-
ing a mistake, or introducing a new idea.

Consistency in how leaders approach delivering
feedback is critical to building trust. When the staff
expect to receive feedback on an ongoing basis, the
feedback feels safer. This expectation should be set
during the orientation process. A leader should have
regular check-ins with new staff members to both
give and receive feedback, which helps to build strong
relationships. It also reduces the anxiety a staff mem-
ber may feel when a leader asks to talk to her or him.
Performance feedback is especially essential for new
graduates, who often have difficulty gauging how
well they are doing in their role. One challenge with

some new graduates is that they may become stressed
and anxious and even demonstrate catastrophic think-
ing when suggestions are made to improve their per-
formance. Seligman believes that managers have the
capacity to help to decrease stress by using an active,
authentic, and constructive style.7 New graduates
need to be coached from the time of their job inter-
view that feedback is part of professional develop-
ment and that they should expect to receive it and
to act on suggestions that are made.

Nurse leaders are in a unique position to build
trust by modeling how to receive feedback. When
leaders see feedback given to them as a gift and
are not emotionally triggered by it, they set a pow-
erful example for staff. When leaders demonstrate
feedback-seeking behaviors, it results in greater job
satisfaction for staff, greater creativity on the team,
and lower turnover.2 DeLong suggests that leaders
can do this by asking the following three feedback-
seeking questions8:
1. What should I stop doing?
2. What should I keep doing?
3. What should I start doing?

Constructive feedback that is taken and put into prac-
tice can lead to significant improvements in perfor-
mance. The key is to be intentional in how it is given.














66 AJN ▼ September 2019 ▼ Vol. 119, No. 9


The goal of the leader when providing feedback should
be to promote a “growth mindset.” Carol Dweck is a
pioneer in the study of how adopting a growth mind-
set can transform how staff perceive feedback. A
mindset, according to Dweck, is perceptions or theo-
ries that people hold about themselves.9 Mindsets can
either be growth oriented or fixed. Individuals with a
growth mindset believe that their skills and abilities
can be developed through feedback about their per-
formance and hard work. Brains and talent are just
the starting point. This view of oneself creates a bet-
ter acceptance of feedback and a love of learning. In
contrast, staff members with a fixed mindset may
believe that they are doing the best they can and can
no longer grow professionally. Individuals with a
fixed mindset find feedback to be more threatening
because they lack confidence about their ability to

When a growth mindset is encouraged in staff,
negative feedback is easier to receive because they
have confidence in their ability to fix their perfor-
mance problems. To achieve a growth mindset, feed-
back on performance needs to be delivered in the
right way. Some suggestions from experts include
the following8, 10, 11:
• Keep it timely. Performance feedback on specific

problems should occur in a timely way, so the
problem or event is fresh in the staff member’s

• Keep it private. Performance feedback, if negative,
should be given in a secluded area where others
can’t hear what is being said.

• Keep the focus positive. Performance feedback
should address areas for improvement but also
include what is going well.

• Keep it inclusive. Performance-feedback conver-
sations should include the thoughts and ideas of
the staff member concerning the issues discussed.

• Keep it factual. Performance feedback should be
based on specific observations and facts, not on
opinions, gossip, or generalizations about behav-

• Keep it specific. Performance feedback should
address only one or two distinct areas in which
performance either was outstanding or needs im-

• Keep it goal oriented. Performance feedback
should include goals for the way forward and
when a follow-up conversation will take place.

Using an evidence-based framework for feedback
conversations can help leaders stay on track with
the feedback that they want to deliver and avoid the
drama that sometimes accompanies negative behav-

ioral feedback. The Center for Creative Leadership
has developed what it calls a situation–behavior–
impact (SBI) model that is easy to remember and ef-
fective when used.12 We can illustrate the model by
using the following case scenario often faced by new

Jackie Smith started in her nurse manager
role one month ago in an ED. She notices
that one of her nurses is repeatedly late for
her shift. The previous manager ignored the
behavior. Ms. Smith can see the impact that
the nurse’s lateness has on the rest of the team
and is determined to take action.

Without planning an intentional conversation,
this discussion could quickly deteriorate. The nurse
might tell the new manager that it has never been
an issue before and she is not the only staff member
who is late to work. This is avoided when the SBI
framework is used to frame the discussion:

Situation. The situation needs to be described
along with the details of what happened and when.
Ms. Smith might say, “Last Monday, you were 25
minutes late for your shift.”

Behavior. The specific conduct about which feed-
back is given should be fact based and judgment free.
Ms. Smith might say, “You didn’t notify the charge
nurse that you would be late, and she reported to me
that this was the second time this pay period that it
has happened.”

Impact. The effect that the behavior had, whether
positive or negative, is described. Ms. Smith might
say, “It may not have been your intent, but this be-
havior is affecting the work of the team. The night
charge nurse couldn’t leave on time. Both the patient
report and rounding were delayed as an outcome of
your lateness.”

Ms. Smith will want to seek the nurse’s reaction
to what is said. It can be helpful when giving feed-
back to have some guiding questions to use in the
conversation to gain clarification about the nurse’s
viewpoint.10 Here are some examples of what you
can ask:
• Is there more I need to know about this situation?
• How do you know your perceptions are accurate?
• What could you have done differently in this sit-

• How could you handle this situation differently

in the future?
• How might we fix this?

The next phase of the conversation is a discussion
about expectations. The manager would acknowledge
the value that the nurse brings to the team but also
convey that aspects of the professional behavior need

[email protected] AJN ▼ September 2019 ▼ Vol. 119, No. 9 67

to change. She or he could then work with the nurse
to establish a plan for moving forward that includes a
plan for ongoing feedback. It will be important that
when improvement is made, it is acknowledged and

It is easy to be a great nurse leader when things are
going well and everyone is performing at her or his
highest level. The real test for leaders is in how they
manage poor performance or complex behavioral is-
sues. Patrick Lencioni warns leaders that teams be-
come dysfunctional when conflict is avoided or there
is a lack of accountability among team members.13
These challenging conversations are sometimes la-
beled crucial discussions because there are opposing
viewpoints, the stakes are high, and emotions are in-
tense.14 Brené Brown writes about the need for leaders
to have the courage to provide feedback in difficult
situations. She reminds us that “clear is kind, unclear
is unkind.”15 Learning to manage tough conversations
is a vital nursing leadership skill.

Before you begin a crucial feedback situation, ask
yourself what you want to see as an outcome and
what is at stake.14 This allows you to begin with the
right motives. The conversation that you will have
if you want to help a staff member with performance
or behavior is very different from one in which you
plan to ask for a resignation or recommend a trans-
fer. The SBI framework outlined above is an excellent
way to stay on track regarding what you want to say.
It is important not to let the conversation enter into a
mode in which both parties become defensive and di-
alogue breaks down. Leaders should identify shared
points of agreement, and avoid creating a dynamic in
which there is an emotional reaction to the feedback
that is given.

Performance-feedback conversations are not “one
and done.” To successfully conclude the discussion,
you need to come to a consensus about what will
happen next. Document who will do what by when
and agree to have a follow-up meeting at a specific
time using whatever method is recommended by your
human resources department. The feedback loop is an
essential part of the process. Leaders must follow up
on any goals that were set. Achievements can be rein-
forced and recognized. There may be a need to revise
plans that do not work. If no progress is made, the
next step could be to begin a disciplinary action pro-
cess. The decision to act on feedback that has been
given is a choice and not one that all staff make.16

The key to success in giving uncomfortable feed-
back is advance planning. You should know how
the discussion will be conducted, who will be pres-
ent, what you intend to say, and what you hope the

outcome will be. Writing down your key points can
be helpful to keep you on track. New nurse leaders
may find that a rehearsal with a seasoned colleague
playing the part of a defensive staff member can be
useful. Conversations about tough issues can be very
challenging and sometimes personally painful. As
leaders gain skill, these discussions become easier and
help them grow as leaders.

Not all feedback sessions will have the outcomes

These situations can be very stressful. If not man-
aged well, these interactions not only increase our
stress levels but also
• rob us of our dignity because we may respond in

a very reactive way.
• destroy our confidence in our leadership.
• destroy our morale and that of the team.
• foster negativity in the environment.
• decrease the productivity of the team.

Until we reflect on situations, looking honestly at
our behavior and actions, we may not develop the
insights that will help us behave differently in the fu-
ture. The act of leadership reflection can help build
our resiliency. It offers us the opportunity to consider
changes we would make to how we deliver feedback
instead of ruminating on the outcomes of our ac-
tions. The act of writing down your ideas can help to
clarify your thinking. You will want to describe the
conversations you have as factually and objectively
as possible. You can then recall your reactions, your
thoughts, and your feelings. Most significantly, you
want to consider your responses to these discus-
sions and reflect on any lessons you have learned
from them:
• Do you see a pattern in your reactions?
• Do you easily become defensive when your lead-

ership skills are questioned?
• Are there opportunities to further develop your

emotional intelligence so future conversations
might have a different outcome?

Work culture has been described as the invisible ar-
chitecture of teams and in organizations.17 It is built
on shared core values, attitudes, and behaviors. Cul-
tures can be healthy and positive, but they can also
become toxic if problems are not discussed through
feedback. Becoming skilled in the art of giving both
positive and negative feedback is crucial to being an
effective leader. Like all skills, giving effective feed-
back takes practice and often courage. When it is
done well with the right intentions, feedback can
lead to remarkable changes in performance. ▼


Rose O. Sherman is an emeritus professor of nursing at Florida
Atlantic University and a current faculty member in the Marian K.
Shaughnessy Nurse Leadership Academy in the Frances Payne
Bolton School of Nursing at Case Western Reserve University,
Cleveland, OH. She also serves as editor-in-chief of Nurse Leader,
the official journal of the American Organization for Nursing
Leadership. Contact author: [email protected] The
author has disclosed no potential conflicts of interest, financial
or otherwise.

1. Gallup, Inc. State of the American workplace. Princeton, NJ;

2017. White paper;

2. Stone D, Heen S. Thanks for the feedback: the science and art
of receiving feedback well. New York, NY: Penguin Books;

3. Kouzes JM, Posner BZ. The leadership challenge: how to
make extraordinary things happen in organizations. Hobo-
ken, NJ: John Wiley and Sons; 2016.

4. Whitmore J. Coaching for performance: the principles and
practices of coaching and leadership. 5th ed. London, UK:
Nicholas Brealey Publishing; 2017.

5. Covey SR. The 7 habits of highly effective people: powerful
lessons in personal change (interactive edition). West Valley
City, UT: FranklinCovey Co.; 2016.

6. Edmondson AC. The fearless organization: creating psycho-
logical safety in the workplace for learning, innovation, and
growth. Hoboken, NJ: John Wiley and Sons, Inc.; 2018.

7. Seligman MEP. Building resilience. Harv Bus Rev 2011;89(4):

8. DeLong TJ. Three questions for effective feedback. Harv
Bus Rev 2011 Aug 4.

9. Dweck C. Mindset: changing the way you think to fulfill
your potential. New York: Little Brown Book Group Ltd;

10. Blatchley A. A nurse manager’s guide to giving effective
feedback. Nurse Lead 2017;15:331-4.

11. Kowalski K. Giving and receiving feedback: part II. J Contin
Educ Nurs 2017;48(10):445-6.

12. Gentry W. Be the boss everyone wants to work for: a guide
for new leaders. Oakland, CA: Berrett-Koehler Publishers;

13. Lencioni P. Overcoming the five dysfunctions of a team: a
field guide for leaders, managers, and facilitators. San Fran-
cisco: Jossey-Bass; 2005.

14. Patterson K, et al. Crucial conversations: tools for talking
when stakes are high. 2nd ed. New York: McGraw-Hill;

15. Brown B. Dare to lead: brave work, tough conversations,
whole hearts. New York: Random House; 2018.

16. Cox S. Give the gift of feedback. Nurs Manage 2016;47(5):

17. Tye J, Dent B. Building a culture of ownership in healthcare:
the invisible architecture of core values, attitude, and self-
empowerment. Indianapolis, IN: Sigma Theta Tau Interna-
tional; 2017.

Lippincott Williams & Wilkins

The Health Career Authority


mailto:[email protected]

NR351 Week 4 Professional Paper Worksheet Template 


1. See the NR351 Week 4 Professional Paper Worksheet Assignment page.  
2. Read the NR351 Announcement entitled IMPORTANT: Assigned Article for Weeks 4 & 6 Assignments:  

a. Download in PDF format the assigned article linked in that announcement; save it to your computer for future use.  
b. Locate the sentence required for quotation and citation.
c. Locate the sentence required for paraphrasing and citation.
3. Read the entire article. 
4. Carefully review the resources and page numbers below to help you with APA format in this assignment.  
5. Complete each item below. All lines should be double spaced.  
6. Submit the completed template on the assignment page.  

Complete each item below

1. Reference for Assigned Article:  
Create a reference for the assigned article (see announcement) using correct APA format including: author(s), year, article title, journal name, volume number, issue number, page numbers, italics, parentheses, punctuation, double line spacing, and hanging indent. Include DOI if available. 

[See pages 316-317 in APA 7th Edition Manual] 
Type the reference for the assigned article here beginning on the line below:  

2. Quotation and Citation:  
Type the assigned quotation from the assigned article (see announcement) using correct APA citation including quotation marks, names of author(s), year, page abbreviation, page number, and parentheses, and punctuation.  

[See pages 261-262, 266, and 270-272 in APA 7th Edition Manual] 

Type the assigned quotation and citation here beginning on the line below:  

3. Paraphrased Area and Citation:  
Type appropriately paraphrased version of the assigned sentence (see announcement) using correct APA citation including names of author(s), year, and parentheses, and punctuation.  

[See pages 261-262, 266, and 269 in APA 7th Edition Manual] 

Type an appropriate paraphrase and citation of the assigned sentence here beginning on the line below:  

4. Assigned Article Summary:  
Summarize the assigned article using 175-200 words. Include all of the main ideas from the assigned article. The Summary must contain the assigned sentence for quotation and citation as noted in the announcement, the assigned sentence for the paraphrased area with citation as noted in the announcement, several additional paraphrased areas, and appropriately formatted citations.  You may also include one more short quotation if you wish.

Type your 175-200 word summary of the assigned article here beginning on the next line:  

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