Towards a better understanding of the relationship between feedback and nurses' work engagement and burnout: A convergent mixed-methods study on nurses' attributions about the 'why' of feedback

BACKGROUND

Previous studies on the effects of providing feedback about quality improvement measures to nurses show mixed results and the factors explaining the variance in effects are not yet well-understood. One of the factors that could explain the variance in outcomes is how nurses perceive the feedback. It is not the feedback per se that influences nurses, and consequently their performance, but rather the way the feedback is perceived.

OBJECTIVES

This article aims to enhance our understanding of Human Resource attributions and employee engagement and burnout in a feedback environment. An in-depth study of nurses' attributions about the 'why' of feedback on quality measurements, and its relation to engagement and burnout, was performed.

DESIGN AND METHODS

A convergent mixed-methods, multiple case study design was used. Evidence was drawn from four comparable surgical wards within three teaching hospitals in the Netherlands that volunteered to participate in this study. Nurses on each ward were provided with oral and written feedback on quality measurements every two weeks, over a four month period. After this period, an online survey was distributed to all the nurses (n = 184) on the four participating wards. Data were collected from 91 nurses. Parallel to the survey, individual, semi-structured face-to-face interviews were conducted with eight nurses and their ward manager in each ward, resulting in interview data from 32 nurses and four ward managers.

RESULTS

Results show that nurses - both as a group and individually - make varying attributions about their managers' purpose in providing feedback on quality measurements. The feedback environment is associated to nurses' attributions and these attributions are related to nurses' burnout.

CONCLUSIONS

By showing that feedback on quality measurements can be attributed differently by nurses and that the feedback environment plays a role in this, the study provides an interesting mechanism for explaining how feedback is related to performance. Implications for theory, practice and future research are discussed.

Nurses' Perception of Feedback on Quality Measurements: Development and Validation of a Measure

Increasingly, hospitals use the data from their quality measurement activities, as feedback information for their nurses. It is argued that feedback on quality measurements can result in quality improvement at the expense of or for the benefit of nurses' well-being. The proposed relationship is assumed to be mediated by (1) nurses' attribution about management's purpose in providing feedback, and (2) nurses' perception of feedback as a job demand versus a job resource. This contribution describes the development and validation of an instrument to measure these constructs, based on research on HR attributions (Nishii et al., 2008) and the Job Demands-Resources model (Bakker & Demerouti, 2007). The measure has been discussed with several experts and practitioners, and pilot-tested among 55 nurses. Our pilot study reveals promising results regarding the content, construct and predictive validity of our measure.

Feedback provision, nurses' well-being and quality improvement: towards a conceptual framework

AIM

This contribution develops a conceptual framework that illustrates how feedback on quality measurements to nursing teams can be related to nurses' well-being and quality improvement.

BACKGROUND

It is assumed that providing nursing teams with feedback on quality measurements will lead to quality improvement. Research does not fully support this assumption. Additionally, previous empirical work shows that feedback on quality measurements may have alienating and demotivating effects on nurses.

EVALUATION

This article uniquely integrates scholarly literature on feedback provision and strategic human resource management.

KEY ISSUE

The relationship between feedback provision, nurses' well-being and quality improvement remains unclear from research until now.

CONCLUSION

Three perspectives are discussed that illustrate that feedback provision can result in quality improvement at the expense of or for the benefit of nurses' well-being. To better understand these contradictory effects, research should examine nurses' perceptions of feedback as mediating variables, while incorporating context factors as moderating variables.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing management can use feedback on quality measurements to nursing teams, as a tool for enhanced quality and as a motivating tool. However, nurses' perceptions and contextual variables are important for the actual success of feedback.