We goofed up recently-I admit it. If you saw our September cover, you may have noticed it, too. AJN has a proud history of interesting and award-winning covers. Selecting them is a team effort that offers staff members the opportunity to get creative. Often there's a link between the cover and an article featured in that month's issue.
Our September original research article, "'Do I See Myself?' Exploring the Potential for Online Images to Attract a Diverse Nursing Workforce" by Johnson and colleagues, examined diversity in online photos depicting nurses and physicians, which seemed like a good issue to place front and center. We found a photo of a diverse group of nursing students from the Johns Hopkins School of Nursing in Baltimore, Maryland-a school renowned for its focus on diversity in the profession. In our enthusiasm to encourage diversity, equity, and inclusion (DEI) in nursing, we got caught up in the photo's aesthetics and lost sight of certain clinical details. As a result, some questionable infection control practices slipped through the cracks, namely a student wearing a mask under his chin and two students wearing their hair loose around their shoulders.
The photos are close-ups, with little background visible, so it's impossible to know the context in which they were taken. They might have been part of a photo shoot using props, in a clinical lab during class time, or in real clinical practice. Whatever the case may be, we would never want to send a message that perpetuated less than stellar nursing care. So, we would like to take this opportunity to renew our commitment to publishing high quality and clinically accurate photos in AJN.
This incident also made me think about feedback and how it's delivered and received. Feedback is an important tool used in educational and professional environments to foster growth and improvement and in health care to keep patients safe. To be effective, it's vital that feedback is given in a way that encourages learning and development for the recipient without causing unnecessary harm. When readers raise their concerns, there are different tones to the communications we receive. Some choose a straightforward comment or suggestion on social media or in a letter to the editor. We appreciate the opportunity to hear our readers' points of view. However, others use sarcastic or condescending admonishments that leave one with a bruised ego or worse. It makes me wonder how the latter group communicates negative feedback in their workplace.
There are many opportunities to give and receive feedback throughout our nursing careers, including peer to peer, educator to student, preceptor to new nurse, manager to employee, as well as during peer review of written manuscripts. In any of these situations, the unpleasant task of communicating negative feedback will inevitably present itself, and when it does, it must be handled with civility. Clark and colleagues (Nursing Outlook, 2022) wrote the operational definition of civility as "choosing to authentically engage in respectful, welcoming, and inclusive ways to foster equity, belonging, community, and connection, including instances when opposing views are expressed." It's the second half of that statement that can be challenging for many of us, but it's imperative that we do it. The American Nurses Association and the National League for Nursing have called on nurses and nursing faculty to foster civility in nursing and in health care.
One barrier to civility is implicit bias. As Therese Huston, author of Let's Talk: Make Effective Feedback Your Superpower, says, "Accept you're biased and be vigilant." Research has shown that unconscious or implicit bias can affect the type of feedback given based on the recipient's age, gender, or race. The authors of this month's Focus on DEI column recommend implicit bias training for all nurses, and note that "one fundamental action toward mitigating bias is recognizing one's own biases." Bias blinded me to the breech in infection control practices on our cover due to my focus on one aspect of the photos while missing others. Reader feedback helped me recognize that, and I hope we continue to receive feedback on our work. We just hope that in the effort to uphold clinical principles, civility doesn't fall away and that we can hold a space where people feel safe to share ideas and differing opinions.
As Hougaard and Carter state in their book Compassionate Leadership, "Regardless of what the person has done or how you have landed in this difficult conversation, it is imperative to see the other person as a human being."