The giving and taking of constructive criticism are integral components of continuing professional development for Nursing and Midwifery Council (NMC) registrants. Petress (2000) defined constructive criticism as judgemental feedback given to help its receivers view their professional performance through the eyes of others.
The NMC's Code (2018) explains where constructive criticism fits in with the delivery of care expectations. Under ‘Prioritise people’, paragraph 1.2 stipulates that registrants must make sure that the fundamentals of care are delivered effectively, which links to using current evidence-based practice. Under ‘Practise effectively’, paragraph 8.4 states that registrants must ‘work with colleagues to evaluate the quality of your work and that of the team’ and 9.1 informs registrants that they should ‘provide honest, accurate and constructive feedback to colleagues’. Paragraph 9.2 advises registrants to gather and reflect on feedback from a variety of sources and to use this to improve practice and performance.
Knowing the theory of the perceived benefits of constructive criticism does not enhance the skilled understanding required in delivering it. The givers of constructive criticism need to reflect upon whether a criticism is required. If so, how should the message be packaged? Reflecting allows the givers to focus on their motivations in wishing to deliver constructive criticism. Reflection is particularly illuminating when emotional intelligence is used. Emotional intelligence promotes awareness of a person's underpinning emotions related to decision-making and action-taking. Use of emotional intelligence means that awareness is raised to a level where the perceptions of others, along with their likely accompanying emotions, are taken into account when planning how to initiate and then continue a particular conversation. Constructive criticism should be a two-way discussion, with the giver having identified the sensitive points of that conversation.
Petress (2000) highlighted that an important aspect of constructive criticism is to demonstrate that the feedback recognises the receiver's efforts are worthy of recognition. Ultimately, the purpose of constructive criticism is to give encouragement to the practitioner by being a confidence builder. It is for this reason that it is important to get the timing and the content of the constructive message right.
Fong et al (2018) emphasised that receiving constructive criticism should not become confused with failure. Fong et al (2018) developed a process model for the delivery and uptake of constructive criticism. For feedback to be considered constructive it needs to be embedded in perceptions of care delivery by a respected practitioner. The feedback message needs to be well-intentioned from the considered and reflected position of the giver, and from the perception of the receiver. The feedback needs to be targeted appropriately and should give clear guidance on how future work can be improved.
The uptake of the feedback is visible when the receiving practitioner displays a more skilled behavioural performance and/or attitude change. Fong et al (2018) emphasised that the required change is bound up with the receiver's emotions and perceptions, which is why the required change is not always evident. The giver of the constructive criticism needs to have skilled awareness of this and to plan and prepare for the constructive criticism discussion. The only deviation from this being in an emergency where directional instructions are given by an experienced practitioner to a novice.
Under ‘Promote professionalism and trust’, the NMC Code (2018) provides standards on how registrants in the privileged position of giving constructive criticism should behave. Paragraph 20.2 states that registrants are required ‘to act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment’. Paragraph 24.2 states ‘use all complaints as a form of feedback and an opportunity for reflection and learning to improve practice’. Paragraph 24.2 is also relevant to the giver should the receiver comment that the feedback is not constructive.
Regrettably, a bullying culture is perceived to be present in some healthcare organisations. This is not helping staff morale, or rectifying staff turnover and shortages. It is timely to re-think how constructive criticism is delivered within the culture of organisations to ensure its benefits prevail.