Abstract #209 Table 1

Themes of driving and restraining forces and representative quotes

ThemesDriving ForcesRestraining Forces
Fellow Characteristics
* extremes of behavior; pattern/repetitive behavior
* values feedback
‘if they go like above and beyond’
‘if somethings like stuck out’
‘just knowing that that’s helpful for them or that they would appreciate the critique…just sensing someone’s openness or reception to wanting to learn and improve in different ways impacts my willingness’
‘if you have a really positive experience or a really negative experience then you may think to fill it out’
‘I don’t think I’ve known that people want feedback necessarily’
‘most experiences are kind of like somewhere in the middle…doesn’t stick out to you in the same way’
‘what if they’re having a bad week, what if they’re having a bad service, what if they’re having a bad day’
NNP-Fellow Relationship
* continuity/exposure
* perceived hierarch
* fear of fellow reaction or repercussion
‘if I worked more closely with one of you, then I try to share’
‘your relationship with the fellow, whether or not you have the same communication skills’
‘I feel like there’s still a sense of hierarchy…it can feel like intimidating or strange to be critical of someone that you maybe see as your superior in some way or leader’
‘it’s very difficult to know where your boundaries are and where the line is in as far as giving negative feedback’
Evaluation Characteristics
* perceived feasibility
* confidentiality/anonymity
* type of feedback
* degree of specificity
* degree of timeliness
‘if you’re giving positive feedback…you hope that the person that you are writing about actually sees it because you want them to know that they’re appreciated’ ‘questions where it’s like give me an example…then I have to rack through my memory of the past month that you’ve been on service’
‘I would be hesitant to give that exact situation because then they would know who gave that feedback’
‘you’re thinking of one specific scenario but I don’t know where that fits in these like 3 questions that they ask about…it’s like you’re trying to fit your feedback into a mold that didn’t really go together’
‘you are given a random evaluation and you haven’t worked with that person in like a month’
NNP-Evaluation Relationship
* knowledge of evaluator role and value (to trainee and to program)
* knowledge of evaluation process and outcomes
* time constraints, interruptions, unprotected time
‘I just think that our feedback because we are in a different role is also invaluable because you will be working with other nurse practitioners in community hospitals, other nurses in community hospitals, rather than other attendings 24–7.’
‘it’s very important to have the bedside nurse and NNP…join in on that conversation because you’re not just communicating with consultants and you’re not just communicating with other attendings…you speak to an attending differently than how you speak to a NNP or bedside RN…so I feel like having a bedside RN and NNP weigh in on what you’re doing is important’
‘I guess I’ve never been explicitly…told about it or that we do have a role in that’
‘in the case of constructive criticism, it’s helpful if it’s very explicit in where it goes and who’s name is on what so you at least do that in full awareness of what maybe could be the implications of the criticism you are giving’
‘the simplest answer is no, I do not know the process for giving feedback’
‘we get bombarded with evaluations all the time’
‘we are inundated with a bunch of evaluations with absolutely everything we do’
‘everybody thinks like if I give this negative feedback, something bad is going to happen’
NNP Characteristics
* preferred evaluation and feedback strategies
* new to role, knowledge of own role, knowledge of culture/system
‘if it were simplified and we can just…have a place where there is eval forms…like ok I really have something to say about this person, I don’t want to wait for an evaluation to come out, I can go online and I can click on this tab and I can fill [it] out’
‘more years into the role, like I can see the differences in where a fellow stands and where they are in their career and how well they do their job’
‘I prefer to do it verbally, in person.’
‘I feel like verbal feedback is way easier, quicker, gets the point across.’
‘I…haven’t found a way to give…constructive criticism, partly because I am trying to figure things out myself’
‘it’s because I was a newer NNP…so I wasn’t comfortable, and didn’t really know the ropes, I guess, as far as what should be done…what should be expected’