EP15: Nurses at all levels engage in periodic formal performance reviews that include self-appraisal and peer feedback process for assurance of competence and continuous professional development.
Provide one example, with supporting evidence, of clinical nurses using periodic formal performance review that includes a self-appraisal and peer feedback process to enhance competence or professional development.
AND
Provide one example, with supporting evidence, of nurse leaders using periodic formal performance review that includes a self-appraisal and peer feedback process to enhance competence or professional development.
Note: The CNO and nurse educators are included in nurse leaders.
Example 1 - Clinical Nurses
NAME OF INITIATIVE
Clinical Nurse Periodic Performance Review Process
BACKGROUND AND PURPOSE
The Baptist Health South Florida Homestead Hospital’s performance evaluation process provides a means to document the employee’s work performance, review accomplishments, assess strengths, identify areas of improvement, and confirm competency. The annual evaluation process culminates with a determination of future goals and monetary compensation for overall performance as indicated.
In addition to informal discussions with employees, as well as the corrective action process, Baptist Health and Homestead Hospital utilizes a formal performance evaluation process, also known as performance management, in order to achieve the following results:
- To establish performance expectations and standards.
- To provide feedback on the employee's work performance; including praise and recognition for jobs well done.
- To reinforce and relate the individual's performance to that of his or her workgroup, team or department.
- To assist the employee in the training and development process for job mastery and potential promotion.
- To use job-related criteria for making merit pay increase decisions.
- To document discussions with the employee regarding deficiencies in job performance.
Performance evaluation provides an opportunity for the leader and the employee to establish a mutual understanding of the goals and objectives of the employee's position so the leader can facilitate the employee's development in order to achieve maximum results. For the process to be effective, it is essential that: (1) The employee must recognize the counseling and concerns of his/her immediate leader as that of an active partner in helping him/her, and (2) The leader must recognize and be concerned with the employee's personal aspiration, motivation, and growth needs.
METHODS AND APPROACH
Clinical Nurse Periodic Performance Review
Nurse leaders (CNO, Managers, Directors and Patient Care Supervisors) conduct a performance evaluation on each of their non-exempt employees annually. The annual performance evaluation will typically be scheduled during the anniversary month in which the employee completes one year of service following initial employment, promotion, or last annual salary/performance review. Leaders are expected to make every effort to complete evaluations in a timely manner. For newly hired employees, prior to the end of their 90-day introductory period, leaders are encouraged, but not required, to complete an informal written evaluation. Leaders may conduct formal performance evaluations more frequently in the event that the employee’s performance requires significant improvement or when an employee is promoted to another position.
For tracking and quality control purposes, an evaluation shall be considered completed when it has been reviewed with the employee either in person or by phone. In the infrequent instances when the performance interview cannot be scheduled in the appropriate time frame, the evaluation will be considered complete when signed by the leader and mailed to the employee. The latter method should only be used when the performance evaluation cannot be scheduled within the 30-day time frame. If presented in person, the employee will sign the evaluation to acknowledge receipt. In occasions when the evaluation is presented by mail or by phone, the leader will document the date and time of the presentation on the employee signature block of the evaluation. The original completed performance evaluation with a printed merit confirmation from Manager Self-Service will be forwarded to Human Resources for inclusion in the employee’s personnel file.
The annual performance review is based on their job description and the customer service standards. The nurse leader incorporates feedback into the evaluation by synthesizing, evaluating and incorporating several components. Suggestions for a fair and appropriate review process include:
- Looking for patterns and similarities within the feedback, and balance this against his/her own observations.
- Discarding isolated instances mentioned by only one individual if they cannot be verified. However, if two of the raters have similar observations, those observations could be incorporated into the performance review by describing the behavior observed and the impact of the behavior upon the organization and/or working relationships.
- Providing descriptions of observable, concrete behaviors and actions.
- Not associating specific feedback with particular sources.
- Reviewing the feedback from direct reports (if any) and incorporating a summary into either the job responsibilities section or into the appraiser's overall comments section.
Each job function and service standard is rated on a scale of one to four (1= does not meet expectations, 2= minimally meets expectations, 3= meets expectations, and 4=exceeds expectations). (EP15 01 Performance Evaluation) Any area in which the employee either exceeds or falls below meets expectations requires a special notation. In the event, the overall score is below a “3”, the supervisor initiates a performance improvement plan. Nurse leaders developed the tool, “RN Job Description - Clarifying Expectations” to provide some objective measures for each of the job functions listed on the job description for clinical nurses.
Enhancing Competence and Professional Development for Clinical Nurses
Approximately one to two months before the clinical nurse’s annual evaluation is due, the employee receives a notification from their nurse leader. It is recommended that the employee bring documentation to support any behaviors or job functions in which they feel they exceed a “3.” At this time, the clinical nurse is expected to complete the following:
- The BHSF Competency Model
- Complete StepOne ™
- Annual required education and competency
Each year, nurses are required to complete annual required education which is done by way of the intranet, that includes an overview of all regulatory requirements (i.e. fire, safety, infection control, quality, patient safety, risk management) and other topics specific to clinical areas (e.g. National Quality Measures). Additionally, Clinical Nurse Educators coordinate yearly competencies based on Donna Wright’s model. A portion of competencies include hospital-wide team training and the other part encompasses unit-based competencies. (EP15 02 RN Population-Specific Ongoing Competency Validation) - Licensure/ Certification verification
- Employee health screening
The Competency Model is a tool that was developed to assist nurses in their professional growth by outlining specific behaviors and competencies that are separated into five categories (Novice, Beginner, Proficient, Advanced, and Expert) according to Brenner’s model on which the Professional Nurse Advancement Program (PNAP) is based.
StepOne™ is an on-line relational database designed to provide demographic data for the American Nurses Credentialing Center (ANCC) Magnet Recognition Program® where nurses are expected to enter and update their demographic data about their education, certification(s), professional and community activities.
Leaders review nursing license and certifications [e.g. Basic Life Support (BLS)/ Advanced Cardiac Life Support (ACLS)] to ensure they are current.
Each employee is required to been seen in the Employee Health Office to complete annual health screening that includes N-95 Fit testing and Purified Protein Derivative (PPD) evaluation for pulmonary tuberculosis.
Once all of the documentation is complete, the nurse leader arranges a date and time with the clinical nurse to review the documents and discuss the performance review. The clinical nurse and the nurse leader may make changes based on any supporting documentation the clinical nurse may provide. Both parties then sign the document and the overall score is submitted electronically for a merit increase. The employee is advised what monetary rewards, if any, to expect. Some employees may have reached the maximum hourly salary and will receive a bonus, while others may receive a specified percent increase based on their score and salary quartile. Compensation department reflects the changes on their next paycheck.
The nurse is asked to complete the last section of the performance evaluation which is regarding their professional development. A conversation ensues about how the nurse leader can support them in achieving their goals. If needed, the employee meets with the Clinical Nurse Educator or the Employee Development Specialist in Human Resources to assist in meeting the identified goals. (EP15 03 Professional Development Form)
Self-appraisal and Peer Feedback for Clinical Nurses
Conducting a mid-year review allows both the leader and the employee to determine if the employee's performance is on track and to identify any changes necessary for the employee to reach their professional developmental objectives for the performance period. The mid-year review allows for course correction. It is considered a developmental and learning opportunity. It provides an occasion to discuss performance based on feedback from their peers and to identify support or resources that the employee may require from the leader.
At the time of the 6-month conversation, the clinical nurse completes a self- assessment and two peer RN assessments are distributed, one by the clinical nurse and the other by their direct supervisor, preferably to another clinical nurse that has had the opportunity to have direct interaction with the RN being evaluated.
- RN Self-Assessment: The self-assessment is based on the ANA Standards of Professional Practice and is in congruence with the ANCC Magnet framework. Each statement is ranked from 1-4 (1= does not meet expectations to 4= exceeds expectations). (EP15 04 RN Self-Assessment)
- Peer Feedback: The peer is asked to provide feedback using the same items in the RN Self-Assessment. (EP15 05 RN Peer Performance Assessment). The peers are asked to consider the performance of the individual, not the personality; focus on objectively evaluating and giving evidence on how well expectations were met; provide examples when possible on the quality of the working relationship; and to consider the entire performance of the individual, not just an isolated event or occurrence. The peer feedback provides the clinical nurse with additional insight on his/her performance as a professional nurse as viewed by the peers. This information together with the self-assessment and supervisor input can then be used to develop an action plan for enhancing competency or promoting professional development.
PARTICIPANTS
Clinical Nurses, Patient Care Supervisors, Patient Care Managers and/ or Nursing Directors, Clinical Nurse Educators, Employee Development Specialist
OUTCOMES FOR CLINICAL NURSES
As a result of ongoing discussions about performance and professional development, various methods and opportunities are available for clinical nurses, such as the Professional Nurse Advancement Program (PNAP), furthering their education, specialty programs, and promotions.
The table below shows data related to clinical nurses who took advantage of the available opportunities.
|
2012 |
2013 |
Percent who transferred to specialty area (ED, OR, ICU, PCU) |
8% |
7% |
Percent pursuing BSN |
21.16% |
23.29% |
Percent pursuing MSN or higher |
16.37% |
15.82% |
Percent participated in the PNAP |
4% |
6% |
Percent promoted to nurse leader position |
11% |
8% |
Summary of Attachments/Hyperlinks/Evidences:
EP15 01 Performance Evaluation
EP15 02 RN Population-Specific Ongoing Competency Validation
EP15 03 Professional Development Form
EP15 04 RN Self-Assessment
EP15 05 RN Peer Performance Assessment
Example 2 – Nurse Leaders
NAME OF INITIATIVE
Nurse Leader Periodic Performance Review Process
BACKGROUND AND PURPOSE
As required by regulatory standards and Baptist Health South Florida (BHSF) policy, Homestead Hospital has a formal evaluation process that includes the use of several tools and methods. The process allows for the evaluation of performance over the course of the year and provides an avenue to enhance performance, competence and professional development. Historically the annual evaluation was based on a self-evaluation of the nurse leader’s job description and an individualized Management by Strategic Objectives (MBSO) plan. In order to improve goal setting and alignment, Human Resources (HR) implemented a variety of tools such as the Leadership Evaluation Manager (LEM). LEM ensured leaders develop SMART (Specific-Measurable-Achievable-Relevant-Time-framed) goals aligned with the strategic direction of the organization. It also provided an opportunity to establish objectively a set of expectations for leaders’ performance.
LEM is a web-based system developed by The Studer Group that was customized to the needs of BHSF for all leaders who participate in the Leadership Incentive Manager (LIM), a performance-based incentive program. There are 2 components to the LEM. The first one includes goals that are based on the BHSF six pillars of performance (People-Service-Quality-Finance-Community-Growth), which accounts for 80% of the total LEM score. Performance goals are established and weighted with well-defined metrics. Because these goals are tied to the (BHSF) performance pillars, some of the LEM goals cascade down from the corporate level to the organizational, divisional and departmental level to ensure alignment. Additional individualized goals may be added based on a discussion between the nurse leader and their supervisor.
The second LEM component comprises leadership competencies and it accounts for the remaining 20% of the total LEM score. BHSF and Homestead Hospital adopted and customized 10 core competencies from the research-based and experience- tested work done by Lominger on leadership characteristics and talent management. The leadership competencies have been shown to improve job success and leader performance both individually and collectively. BHSF selected core competencies that reflected its core values and mission. The core competencies include: Developing Direct Reports, Building Effective Teams, Values & Trust, Organizational Agility, Customer Focus, Drive for Results, Priority Setting, Strategic Agility, Business Acumen, and Compassion. Through the use of leadership competencies in LEM, the organization is able to provide a tool for leaders that allowed them to take ownership of their own career development. Additionally, in order to add depth and perspective to the evaluation process, a more structured format for self-appraisal was added. In addition to the use of the nurse leader’s job description, a self-appraisal tool was developed that included these 10 core leadership competencies. This self-appraisal tool is used for peer-feedback and is used for the Individual Development Plan (IDP).
METHODS AND APPROACH
Nurse Leader Periodic Performance Review
Nurse leaders who utilize LEM goals include patient care supervisors, nurse managers, and nurse directors. LEM performance goals are established by nurse leaders with their supervisor and are given a weighted score based on its importance within the organization and the department. Leadership competencies are selected based on the individual needs of the nurse leader, which are based on past performance and feedback. The maximum number of performance goals is six, including some predetermined goals and weighting set at the organizational level, accounting for 80% of the total LEM score. The remaining performance goals can have a minimum weight of 10% and a maximum weight of 50%. The leadership competencies account for the remaining 20%. At least five of the 10 leadership competencies must be weighted, with a minimum weight of 2%. Each performance goal and competency is then rated and scored from 1 to 5 based on the established metrics. A 5 being a “Towering Strength”, 4 is “Talented,” 3 is considered “Skilled”, 2 is “Needs Improvement" and a 1 is a “Career Staller.”
Nurse leaders enter and update outcomes, metrics and competency scores into LEM throughout the year and review them regularly at “Monthly Report Card” meetings with their supervisor. At the end of the fiscal year, a final score is calculated based on the weighting and score of each item. (EP15 06 Director LEM Annual Evaluation) A minimum score of “3” is required to be eligible for the LIM, which encompasses the annual merit increase and Leadership Incentive Plan (annual bonus). Leaders who fail to meet the minimum score are required to develop a Personal Improvement Plan (PIP) in collaboration with HR.
Self-appraisal and Peer Feedback for Nurse Leaders
At the conclusion of each year, each leader submits to their supervisor the following:
- Self-appraisal based on established job description
Nurse leaders first go through a process of reflecting back over the past year, taking time to review the listed expectations and standards on their job description. In each category on the job description, achievements and outcomes are documented and rated on a scale of 1 to 4 (1= Does not meet expectations to 4= Exceeds expectations). An explanation is required for any category that is rated more than a 3 (Meets expectations). This acts as an important starting point for the appraisal discussion with their supervisor. The supervisor may make revisions or add additional comments where needed. For those areas in which a leader does not meet expectations, a plan is implemented and is reflected in their LEM goals and/ or in their IDP. (EP15 07 Director Job Description Self-Evaluation)
- Self-appraisal based on core leadership competencies
The 10 core leadership competencies described above in LEM is also utilized as part of the self-appraisal process. A score above 3 “Skilled” (in a scale of 1 to 5) requires a justification. (EP15 08 RN Leader-Director Self-Assessment)
- Metrics and core competencies as outlined in LEM
- Peer evaluations
Nurse leaders also have an opportunity to receive feedback from their peers through peer evaluations. The tool uses the same items in the RN Leader Self-Assessment tool. Each nurse leader submits at least two peer evaluations. Peers are asked to provide a justification for any score greater than a 3. (EP15 09 RN Leader-Director Peer Performance Assessment) Nurse leaders then compare the results of the peer feedback to their own self-appraisal.
Enhancing Competence and Professional Development
- IDP
Results from LEM, the self-appraisal of the job description and peer feedback are used to complete the individual development plans (IDP) and the goals for the upcoming year. IDP is used in order to provide opportunities for professional growth. It is developed in conjunction with the supervisor and input from the Organizational Development (OD) consultant. Plans are reviewed on a regular basis with the supervisor in order to provide guidance for both short and long term career opportunities. (EP15 10 Director Individual Development Plan) OD Consultant Aleister Avila is available to all leaders to assist in their professional growth and development. His role includes developing and facilitating formal classes such as classes on “Developing our Talent” and “Coaching for Success” and more informal classes, such as “IDP workshops.” He provides one-on-one consultations and coaching as well as team building activities.
- Annual required education
Nurse leaders provide a summary of education and professional activities for the year such as continuing education hours, current licensure, certification and conferences attended.
PARTICIPANTS
Nurse Directors, Clinical Nurse Managers, Patient Care Supervisors
CNO and VP Gail Gordon, MSN, RN, NEA-BC
Organizational Development Consultant Aleister Avila
OUTCOMES
Aligning performance goals and competencies to measurable outcomes has provided a more objective method of evaluating leader performance. FY 12 and FY 13 LEM scores for nurse leaders are shown below. More leaders scored between 3.51 to 4 in FY 13 as compared to FY 12 due to a better understanding of the rating scale which minimized the “halo” effect with the scores.
Score Category |
|
2012 |
2013 |
Less than 3.00 |
|
2% |
4% |
3.01-3.50 |
|
15% |
10% |
3.51-4.00 |
|
28% |
44% |
4.01-4.50 |
|
43% |
32% |
4.51-5.00 |
|
11% |
9% |
By having the ongoing discussion about leader’s performance, competence and professional development, Homestead Hospital has seen an increase in the number of nurse leaders who have furthered their education and/ or have obtained certification. The percent of nurse leaders who obtained degrees and/ or certifications are listed below:
% of Nurse Leaders |
2012 |
2013 |
with BSN |
55 |
53 |
with MSN or higher |
18 |
33 |
Certified |
55 |
58 |
Summary of Attachments/Hyperlinks/Evidences:
EP15 06 Director LEM Annual Evaluation
EP15 07 Director Job Description Self-Evaluation
EP15 08 RN Leader-Director Self-Assessment
EP15 09 RN Leader-Director Peer Performance Assessment
EP15 10 Director Individual Development Plan