Leading Forward:

Embracing Feedback and Moving Toward

Authentic Positivity
Rhonda Collins, DNP, RN, FAAN

Nurse leaders are discovering a “new normal.” In other words, we have normalized
the discomfort we find ourselves in because of the pandemic and the disruptions it
has caused. Many of us are contemplating how we to lead going forward. How do
we inspire exhausted, frustrated, and overworked people? How do we lead with
authenticity when so many of our efforts seem to miss the mark or are rejected as
not actually solving the problem? This article offers a perspective on these ques-
tions and more, providing possible ways nurse leaders can embrace feedback and
turn toxic positivity into authentic positivity.

A
young nurse I know recently sent a photo to
me she had taken with her cellphone that got
me thinking about how good intentions can go
bad. The photo was of a pamphlet that had shown up
in her emergency department. It was placed there by
her obviously well-intentioned nurse leader, who had
distributed a wellness guide that included a sincere
encouragement essay urging nurses to stay in the
nursing profession. The young nurse’s comment to me
under the picture she’d taken was: “Here’s a book and
a bath bomb. Get your life together and be back at
7:00.” The young nurse told me she found the gesture
offensive. Why? Because, well-intended as it was, it
missed the mark as a response to the reality and
challenges of her work environment.
I have empathy for the perspective of the young
nurse, but also understand the perspective of the nurse
leader. I’ve been a nurse leader for several decades and
KEY POINTS
 Don’t respond to ongoing challenges with
toxic positivity.
 Let nurses be part of the solution. Simply
ask, “If we can’t hire more nurses, what do
you need to make your work easier?”
 Identify tasks to offload from nurses. My
mother, who has diabetes, has managed her
finger sticks for years. Yet, when she’s
admitted to the hospital, that task falls to a
nurse.
have lived the experience of leading exhausted and
overworked people.
Reactions like this young nurse had are a challenge
against the approach some nurse leaders may take to
respond to incomprehensively complex problems
through these troubled times. It’s beneficial for leaders
to be challenged by the people we lead. Being chal-
lenged can be uncomfortable, but our discomfort pre-
sents an opportunity to critically examine our response
and how we lead.
Most of us have found our “new normal.” In other
words, we have normalized the discomfort in which we
find ourselves because of the pandemic and the disrup-
tions it has caused. Many of us contemplate how we are
going to lead going forward. How do we inspire, moti-
vate, and encourage exhausted, angry, overworked peo-
ple? How do we lead with authenticity when so many of
our efforts seem to miss the point or are rejected as not
actually solving the problem? Feeling frustration is a very
human reaction to receiving negative feedback. But we
must accept feedback from the people we lead and find
truth when they express opposition or conflict so we can
lead through to authentic positivity.
BE MINDFUL OF RESPONDING TO NEGATIVE
EMOTIONS WITH TOXIC POSITIVITY
As the pandemic lumbered on, toxic positivity became
a widely covered topic in the media. A UW Medicine
blog captures the definition: “Toxic positivity involves
dismissing negative emotions and responding to
distress with false reassurances rather than empathy.”1
If the term negative emotions seems too general to be
meaningful, Brené Brown’s book Atlas of the Heart is

270 June 2022 www.nurseleader.com

helpful in navigating a spectrum of emotions and
putting a lexicon to what health care workers have
been feeling and expressing.2 For example:
- Places we go when things are uncertain or too much,
such as stress, anxiety, and fear
- Places we go when we compare, such as jealousy and
resentment
- Places we go when things don’t go as planned, such
as frustration
- Places we go when we feel wronged, such as anger
and dehumanization
Examples of toxic positivity include reassuring staff
members that all is well, telling them to think happy
thoughts, insisting that failure is not an option, or
suggesting that it could be worse and everyone should
just feel grateful.
Toxic positivity comes from feeling uncomfortable
with negative emotions. Although toxic positivity is
generally well-intentioned, it invalidates what nurses
are feeling and can cause alienation and disconnection.
The people you lead recognize false assurance for
what it is. You cannot demand positivity of people who
are standing in the burning wreckage of lived experi-
ence. Experts have suggested strategies for managing
toxic positivity when people are expressing difficult
emotions3:
- Create an open-communication environment where
an individual experiencing negative emotions can
say, “I’m not asking for a solution right now, I just
need to vent.” As leaders, we immediately jump to
addressing the problem at the root of an emotion.
When we do this, we might sound defensive to the
individual with the issue.
- Avoid delivering false reassurances. Let the individ-
ual expressing negative emotions know you want to
hear from them, and that you are listening. Even if
you feel discomfort, validate the person’s experience
by listening without interrupting.
- To mitigate the anger and anxiety that can build from a
lack of understanding, tell your staff exactly what you
are doing to solve the problems they are asking
about—without expressing defensiveness or frustration.
- If a nurse wants to be part of the solution, allow that
opportunity. Ask how you can work together to
resolve the issues causing the negative emotion.
GIVE NURSES THE OPPORTUNITY TO BE PART
OF THE SOLUTION
I frequently think of the Steve Jobs quote,4 “It doesn’t
make sense to hire smart people and tell them what to
do. We hire smart people so they can tell us what to
do.” Let nurses tell you what they need to do their jobs
more easily.
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If a nurse is overwhelmed or stressed, ask
questions like, “If there are not more nurses to
hire, what do you need to make your workload
lighter?” I’m hearing some amazing ideas from bedside
nurses who want to contribute to solving the enormous
staffing problem in nursing today. Here are some
examples:
- Mentoring: Many nurses entering the workforce
today have never touched a patient due to COVID-
19 restrictions limiting their access to hospitals.
Meanwhile, experienced nurses who can no longer
work a 12-hour shift are retiring, taking their wealth
of knowledge and experience with them. Consider
hiring retired nurses, who no longer can or want to
carry a patient load for a 12-hour shift, to work
alongside new, less-experienced nurses and transfer
their knowledge and mentor.
- Gig nurses: The gig economy is coming to
nursing. Imagine you need a wound care nurse for a
few hours to round and teach, but you don’t have
that expertise in-house at the moment. You use an
app to place a request, and wound care nurses
answer the request to provide the expertise. Hospi-
tals can create a roster of “gig” nurses with specific
expertise who are willing to work as their family and
life schedules allow. Think of it as pro re nata (PRN)
for the 21st century.
- Respite rotations: Many hospitals are creating
hospital-at-home care models and allowing nurses to
rotate through that less acute environment and
continue to work without the daily stress of
the critical intensive care unit environment. The
American Hospital Association anticipates that the
number of hospital at home providers will triple in
2022.5 This growth will provide ample opportunity
for flexible staffing models.
IDENTIFY TASKS TO OFFLOAD FROM THE
NURSE
My mother was diagnosed with diabetes decades ago.
She has performed her own finger sticks several times a
day for years. Yet, when she is admitted to the hospital,
that task is taken away from her and given it to
someone on the nursing team. Nurses or nurse ex-
tenders should not have to spend their valuable time
doing these things. Give patients an app on their
phone, a bedside tablet, or pencil and paper to allow
them to document their own input and output, blood
sugar, ambulation in the room, etc. Of course, the
patient must have the cognitive capabilities to perform
these functions, but the idea is to evaluate every task
and determine, “Is it necessary for only the nursing
team to do this?”
Two of the most time-consuming tasks a bedside
nurse has are admission assessment and discharge
June 2022 271
 teaching. Consider a virtual nurse on live video who can
teach interactively. One hospital I’ve worked with saved
up to 29 minutes per discharge for the nurse by using a
virtual nurse to engage with patients and provide
teaching. Imagine if a nurse has 4 to 6 patients and can
save 29 minutes per patient—that’s 2 to 4 hours given
back to the nurse to focus on other important tasks.
Hospitals are using this model with high patient and
nurse satisfaction. It also enables hearing-impaired
patients to read the lips of an unmasked nurse giving
them instructions, with closed captions or elevated
volume.
LOOK TO INDUSTRY PARTNERSHIPS FOR
SUPPORT AND EXPERTISE
Many of my colleagues in industry have an incredible
bench strength of expertise they will willingly share. As
an example, I have worked as a nurse leader in the
health care industry for 20 years with hospitals and
health care systems all over the world. I have
published on the topics including cognitive burden,
communication to drive team behavior, and nurse
acceptance of technology at the bedside. I work with a
team of clinicians, some of them former chief nursing
officers, with deep expertise in applying technology to
improve workflow. You may conduct 1 technology
go-live in 5 years, during which period we will do
thousands. You may struggle to implement new
methods and systems; we do this every day and are
here to guide you. Don’t hesitate to ask for support.
One hospital has asked me to serve on their nursing
innovation and research council, and this is a great
example of a hospital welcoming support from an
industry partner. We can and should leverage skills,
knowledge, and expertise to work across the profession
supporting each other.
Sometimes people seem to expect nurse leaders to
be experts in everything. We know that isn’t realistic, so
surround yourself with people who are experts in topics
that aren’t your forte. Be willing to step outside the
echo chamber of health care and look to business, in-
dustry, and education to find fresh answers to complex
challenges.
REST, RENEW, GO ON AGAIN
One of my favorite singer-songwriters, Patty Griffin,
lives in Austin, Texas, my home city. She wrote a song
in 2007 called “Up to the Mountain.”6
The song starts with this opening line:
272 June 2022
I went up to the mountain because you asked me to
.
The second verse goes:
Sometimes I feel like
I’ve never been nothing but tired
And I’ll be working
Till the day I expire
Sometimes I lay down
No more can I do
But then I go on again
Because you ask me to.
You are working during one of the most difficult
times in history for health care and nursing. You have a
long road ahead with constant changes and challenges.
But please know this, nursing needs you, and the
people in your communities need you.
Your ability to lead inspires and motivates all of us.
Ask for help. Be present as you climb your mountains.
Be with people who understand, who live this experi-
ence with you. Find rest and renewal in the moment,
but then go on again—because we are asking you to.
REFERENCES
1. Princing M. What you need to know about toxic positivity.
Right as Rain. UW Medicine. September 8, 2021. Available
at: https://rightasrain.uwmedicine.org/mind/well-being/toxic-
positivity#. Accessed April 1, 2022.
2. Brown B. Atlas of the Heart. New York, NY: Random House;
2021.
3. Razzetti G. The antidote to toxic positivity. Psychology Today.
July 13, 2021. Available at: https://www.psychologytoday.
com/us/blog/the-adaptive-mind/202107/the-antidote-toxic-
positivity#. Accessed April 1, 2022.
4. Goodreads. Quotable Quote. Available at: https://www.
goodreads.com/quotes/8586131-it-doesn-t-make-sense-to-
hire-smart-people-and-then. Accessed April 1, 2022.
5. Gliadkovskaya A. Healthcare industry will face higher
medication errors, declining patient trust in 2022: Forrester.
FIERCE Healthcare; November 10, 2021. Available at: https://
www.fiercehealthcare.com/digital-health/predictions-for-
healthcare-2022. Accessed April 1, 2022.
6. Griffin P. Up to the Mountain. RCA; 2007.
Rhonda Collins, DNP, RN, FAAN, is chief nursing officer at
Vocera, Communications, Inc. in San Jose, California, and
co-founder of the American Nurse Project. She can be
reached at rcollins@vocera.com.
1541-4612/2022/
Copyright 2022 The Authors. Published by Elsevier Inc. This is an
open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
https://doi.org/10.1016/j.mnl.2022.02.008
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