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' perceptions of feedback to nursing teams on quality measurements: An embedded case study design.

BACKGROUND: Providing nursing teams with feedback on quality measurements is used as a quality improvement instrument in healthcare organizations worldwide. Previous research indicated contradictory results regarding the effect of such feedback on both nurses' well-being and performance. OBJECTIVES: Building on the Job Demands-Resources model this study explores: (1) whether and how nurses' perceptions of feedback on quality measurements (as a burdening job demand or rather as an intrinsically or extrinsically motivating job resource) are respectively related to nurses' well-being and performance; and (2) whether and how team reflection influences nurses' perceptions. DESIGN: An embedded case study. SETTINGS: Four surgical wards within three different acute teaching-hospital settings in the Netherlands. METHODS: During a period of four months, the nurses on each ward were provided with similar feedback on quality measurements. After this period, interviews with eight nurses and the ward manager for each ward were conducted. Additionally, observational data were collected from three oral feedback moments on each of the participating wards. RESULTS: The data revealed that individual nurses perceive the same feedback on quality measurements differently, leading to different effects on nurses' well-being and performance: 1) feedback can be perceived as a job demand that pressures nurses to improve the results on the quality measurements; 2) feedback can be perceived as an extrinsically motivating job resource, that is instrumental to improve the results on quality measurements; 3) feedback can be perceived as an intrinsically motivating job resource that stimulates nurses to improve the results on the quality measurements; and 4) feedback can be perceived neither as a job demand, nor as a job resource, and has no effect on nurses' well-being and performance. Additionally, this study indicates that team reflection after feedback seems to be very low in practice, while our data also provides evidence that nursing teams using the feedback to jointly reflect and analyse their performance and strategies will be able to better translate information about quality measurements into corrective behaviours, which may result in more positive perceptions of feedback on quality measurements among individual nurses. CONCLUSIONS: To better understand the impact of feedback to nursing teams on quality measurements, we should take nurses' individual perceptions of this feedback into account. Supporting nursing teams in team reflection after them having received feedback on quality measurements may help in eliciting positive perceptions among nurses, and therewith create positive effects of feedback on both their well-being and performance.

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.