18Jones Leadership(F)-ch 18 298 1/14/07 3:50 PM Page 298 Skills for Being an Effective Manager P roviding safe, high-quality patient care is the goal of health-care organizations To accomplish this goal, the organization depends on the teamwork of its personnel The nursing administrator is responsible for planning, organizing, directing, and coordinating the activities of the nursing personnel Team building is a critical part of this process The objective of team building is to develop a group that is committed to the work and each other (Creasia & Parker, 2001, p 171) Another important responsibility of the nurse manager and the focus of this chapter is monitoring and evaluating the performance of personnel, a function called controlling According to Creasia & Parker (2001), controlling includes personnel evaluation, discipline, and behavior modification For nurse managers, this function requires interactive contact with employees that is unlike any of their other responsibilities Successful nurse managers require knowledge and skill in interpersonal relationships to enhance the performance of employees This chapter will focus on the role of the nurse manager in motivating employees to achieve their professional performance goals within the organization Performance Appraisal Performance appraisal, as the term implies, is a formal evaluation of an employee’s performance The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires regular performance appraisals, and most health-care organizations offer them annually Regular oversight and evaluation of performance are the responsibilities of nursing administration, whether or not they are required annually The purpose of a performance appraisal is to provide opportunities for personal and professional growth and to ensure the quality of nursing care (Creasia & Parker, 2001, p 172) Generally, the process is intended to clarify how well the employee is performing the requirements of the job A job description often provides the baseline or minimal performance criteria Additional standards may be used to evaluate employees, depending on the setting For example, nurse educators in a university setting would be held to university standards for annual merit and/or promotion These standards generally include guidelines for perfor- mance in instruction or teaching; scholarly pursuits, such as research; and service activities to the community and the university In a clinical setting, the standards or benchmarks for job performance often include the American Nurses Association (ANA) clinical standards and the JCAHO patient safety guidelines Typically, upon hire, the individual will receive a copy of the appraisal tool and the criteria that will be used in the evaluation process The type of tool used will vary from organization to organization YoderWise (1999, p 273) described some of the most commonly used tools for performance assessment as either structured or flexible The most commonly used structured tools are the forced distribution scales and the rating scales The low and high values found on these types of scales may lead to problems in evaluation Forced distribution scales are one of several comparative methods that can be used alone or in conjunction with other tools to evaluate employees A common practice in many organizations requires the evaluator to place a certain percentage of employees into equally divided categories For example, each employee would be placed into one of three categories In a forced distribution scale, these three categories might be labeled: (a) above average, (b) average, and (c) below average To many employees this seems unfair as any comparative differences in their overall performance may be ever so slight When this method is used to determine merit raises, it frequently lowers the morale of employees who were found to be average or below (Fig 18-1) Most rating scales are constructed to evaluate the performance of employees They usually include a After reviewing the performance of the RN Staff on your unit, rank order them as follows: 10% (Excellent), 15% (Above Average), 50% (Average), 15% (Below AverageNeed Improvement), and 10% (Poor Performance-Need Assistance) On a unit with 40 employees, the result should be similar to the example below: 10% Excellent employees 15% Above Average employees 50% Average 15% Below Average employees 10% Poor Performance employees 20 employees FIGURE 18-1 Sample directions for a forced distribution scale 18Jones Leadership(F)-ch 18 1/14/07 3:50 PM Page 299 Maximizing Employee Performance 299 Directions: Complete this form by circling the number that most closely corresponds to your observations of the employee Do this on at least two different occasions Scale: 1=Poor 2=Below Average 3=Average 4=Above Average 5=Excellent Quality of Work: Knowledge of Job: Communication Skills: Interpersonal Skills: Concern for Patient Safety*: Concern for Patient Comfort**: Total: * e.g Observing universal precautions Washing hands between patients **e.g Administering pain medication as needed according to prescribed guidelines Date: _ Name of Employee: _ Supervisor’s Signature: FIGURE 18-2 Sample performance evaluation tool variety of measures that are common to nursing practice in general The biggest problem with these scales is that the behavior to be evaluated may not actually be observed by the evaluators, leaving them to make assumptions about the individual’s behavior For example, an item like “provides safe nursing care” is rather ambiguous and perhaps even circumstance-specific The individual may be rated low or high on that item depending on when she is evaluated and whether previous evaluations were low or high Figure 18-2 is an example of a rating scale Flexible tools like the behaviorally anchored rating scale (BARS), management by objectives (MBO), and peer review give a better picture of the individual’s performance and are less open to bias A variety of tools will be discussed later in this chapter For staff members, the performance appraisal process provides feedback about their progress toward career goals and changes in performance and provides an opportunity to review their last evaluation For the nursing administrator, the performance appraisal process provides opportunities to review the quality of patient care, identify those staff members with the potential for advancement, identify problem employees, and make decisions about the overall operation of various units within the facility For example, when a number of employees are not performing at optimum, this may indicate problems within the organization, such as high acuity rates and low staffing numbers If only one or two individuals are having problems, it could indicate a need for further training, coaching, or counseling In most organizations, individuals will be evaluated using both formal and informal procedures Formal evaluations may occur only once or twice a year (Tappen, 2001, p 273) In most cases, formal evaluation is required by accrediting agencies or is part of the organization’s policy With a formal evaluation, there is usually a written procedure or 18Jones Leadership(F)-ch 18 300 1/14/07 3:50 PM Page 300 Skills for Being an Effective Manager timetable to be followed Forms that must be completed by the nursing supervisor and/or administrator are also part of the typical process All employees should be aware of the procedure, the timetable, the tools, and their own role in the process According to Tappen (2001, p 274), informal evaluation is commonly thought of as individual feedback or information regarding one’s performance The organization may or may not have a procedure for conducting informal evaluations In most cases, the individual collects data from various sources to document her performance during the year The wise administrator and/or supervisor should being doing the same with each staff member For example, the supervisor should make a point of observing staff members in action and keep anecdotal records, noting the date, time, circumstances, and employee performance During these periods, feedback should be honest so that any employee who is not performing as expected can take corrective action Conversely, those employees who are doing well should be told so According to Barnum and Kerfoot (1995, p 256), feedback and correction should be ongoing, spontaneous, and to the point The employee should not be made to wait for an official evaluation date to receive this type of feedback Ongoing feedback can help motivate the employee toward outstanding performance BASELINES FOR PERFORMANCE APPRAISAL Federal guidelines have stipulated that performance appraisal of employees be based on a valid job analysis Because a job analysis is used for recruiting purposes as well as for evaluation and promotion guidelines, it should be current A job analysis generally describes the tasks, characteristics, skills, knowledge, and abilities required to perform a specific job As such, it serves as a basis for career development, in-service training, job forecasting, and performance appraisals In most cases, the job analysis helps determine the value of a job in terms of compensation while ensuring that pay equity is maintained A job analysis includes a job description and the job specifications Job specifications generally describe the qualities and characteristics of the person needed to perform the job A job description specifies the duties and responsibilities of a particular role The job analysis is often used by administration to determine recruitment needs and to make forecasting decisions for staffing within the organization Employees are generally given a job description when they are hired or promoted Job descriptions are not as comprehensive as a job analysis because they list only the basic requirements of the job (Fig 18-3) Job Description The employee’s job description details the basic skills and abilities needed to fulfill the job’s responsibilities; it serves as the starting point for a performance appraisal Ellis and Hartley (2004, p 461) defined job descriptions as written statements stipulating the duties and functions of various jobs within the organization and the scope of authority, responsibility, and accountability involved in each position Job descriptions should define minimum standards for effective job performance and employment and should not be too detailed (Swansburg & Swansburg, 2002, p 600) A comprehensive job description should describe what is to be done, not how to it For example, each nurse would be expected to use aseptic technique when doing a dressing change, but the dressing Nurse A applies may not look like the dressing Nurse B applies, even though both have maintained a sterile field while doing the procedure Most organizations have written job descriptions in their policy manuals As job responsibilities and performance requirements for employees are constantly changing, job descriptions should be reviewed and updated on a regular basis Employees should have an opportunity to provide input with regard to their job descriptions ANA Standards and Guidelines Contributing to job descriptions and to performance evaluation criteria for nurses are the standards of clinical practice established by the ANA and the guidelines for patient safety established by JCAHO The standards and guidelines proffer the measurements to be used by hospitals and a variety of healthcare agencies when evaluating their employees They can also provide additional information about job requirements for the nursing staff Nursing is guided by these ANA standards of practice and standards of professional performance (ANA, 2004, p 12) The ANA standards provide a framework for the evaluation and improvement of nursing practice 18Jones Leadership(F)-ch 18 1/14/07 3:50 PM Page 301 Maximizing Employee Performance 301 Position Type: Full Time Education: BSN preferred Experience: 2–5 years as a medical-surgical staff nurse, previous experience in an Emergency Department desirable, experience with telemetry monitoring desirable Other: RN licensure, ACLS certification Knowledge and Skills Required*: • Assessing patient status • Planning and implementing emergency care • Evaluating responses to care • Documenting nursing activities for individual clients • Operating a variety of technical equipment • Rapidly responding to trauma and disaster situations • Participating as a team member with other nurses and physicians • Coordinating activities related to the care of emergency and trauma patients • Communicating effectively with patients and family members • Educating the public as needed in the following areas: – Reducing preventable injuries – Promoting health and safety * The above list only covers basic responsibilities FIGURE 18-3 Sample job description; emergency department nurse It makes sense, therefore, to include these standards developed by the profession when evaluating the performance of the practicing nurse Most agencies will incorporate many or all of these standards as part of their performance appraisal process For instance, the first six standards articulated by the ANA are directly related to the practice of nursing These standards should be quite familiar to nurses and are more commonly known as the nursing process Beginning with the assessment of clients, the nurse is expected to proceed through a series of steps that include diagnosis, outcomes identification, planning, implementation, and evaluation The nursing process is based on a critical thinking process and provides the foundation for evidence-based nursing practice The standards of professional performance, on the other hand, reflect the commitment of nurses to the profession and the clientele they serve These standards include: ■ ■ Quality of practice Education ■ ■ ■ ■ ■ ■ Professional practice evaluation Collegiality Ethics Research Resource utilization Leadership These standards are also included as part of most performance appraisal tools Quality of practice typically means that the nurse engages in activities to improve nursing care and nursing practice This might include serving on committees to update or improve policies and procedures or documenting outcomes of practice Continuing education can be formal or informal Most state boards require periodic continuing education for relicensing Ideally, nurses will seek educational opportunities to enhance or improve the knowledge and skills needed for their practice area Lifelong learning is a professional commitment Professional practice evaluation is a process It implies that nurses should seek feedback actively on their performance as it relates to standards, 18Jones Leadership(F)-ch 18 302 1/14/07 3:50 PM Page 302 Skills for Being an Effective Manager guidelines, and job descriptions Feedback can come from a variety of sources such as patients, peers, and superiors Nurses have a responsibility to evaluate the care they give Soliciting input from others is one way to determine the effectiveness of care given For example, nurses understand the importance of checking the patient’s response to medications and treatments This can either be by observing the response of the patient or asking the patient how he is doing after receiving the said medication or treatment Today’s nurses must continually assess their strengths as well as areas needing improvement Peer evaluation, for example, is one means for ongoing self-assessment Peers generally have similar goals and experience New nurse graduates often seek advice from their superiors with experience when they take on new responsibilities Ongoing self-evaluation by nurses makes the performance appraisal process seem less threatening Periodic informal feedback should prepare nurses for the more formal process when it occurs Nurses constantly interact with other health team members Collegial relationships serve several purposes For one, they provide a learning forum for the nurse and enhance the outcome of the patient’s situation During the course of patient care, the nurse collaborates with patients, families, and colleagues Collaboration through communication and documentation is one way to ensure continuity of care for the patient Patients and their families have a right to expect nurses to engage in ethical practice, which is why it has become a component of performance evaluation Patients expect confidential handling of information about them and to be treated with dignity and respect Today’s nurse is also expected to participate in research at some level This may include helping to collect data, implementing new procedures based on research, sharing research findings, or serving on research committees This type of activity may be new to many nurses, but it can often be very rewarding Many of the practice guidelines that nurses take for granted are based on research findings The term “resource utilization” may be somewhat misleading but refers to keeping patients (as consumers) informed about their options Many nurses have been doing this for some time If there is a less costly but safer treatment available, nurses have usually discussed it with their clients For example, soap and water might work as well as an expensive hand cleanser An additional component here is delegation of patient care to unlicensed personnel Delegation requires finding the right person for the right job The five rights of delegation identified by the National Council of State Boards of Nursing are: ■ ■ ■ ■ ■ Right task Right circumstance Right person Right direction Right supervision In short, using nursing judgment and following these standards of delegation, nurses are able to assign tasks to other caregivers safely This is often difficult for new nurses, who may not be familiar with the job responsibilities of other health team members It is critical, however, that nurses use delegation appropriately to save themselves time and energy and to distribute the workload better Leadership implies that the nurse assumes a larger role in the community or outside of the practice setting This may mean, for instance, teaching first-graders about hand washing or spreading germs Nurses are expected to participate in committees within the practice setting either as a member or a leader They are also expected to take an active role in advancing their profession, usually by joining a professional organization One purpose of performance appraisal is to make good employees better According to Ash (1984), good employees are a company’s number one asset Management usually describes a good employee as one who is loyal to the organization and/or one with good work ethics Additionally, management has indicated that these individuals seem satisfied with their work and have low rates of absenteeism Ash believes that one way to make good employees better is for management to help them reach their potential MANAGEMENT BY OBJECTIVES Management by objectives (MBO) systems indicate a two-way communication process of evaluation (Houston, 1995) This implies that both management and employee establish goals to be discussed during the evaluation process Encouraging employees to set their own goals is often a good way to enhance performance and behavior Whereas there is a sense of self-satisfaction derived from achieving ... the nursing staff Nursing is guided by these ANA standards of practice and standards of professional performance (ANA, 2004, p 12) The ANA standards provide a framework for the evaluation and. .. descriptions ANA Standards and Guidelines Contributing to job descriptions and to performance evaluation criteria for nurses are the standards of clinical practice established by the ANA and the guidelines... the first six standards articulated by the ANA are directly related to the practice of nursing These standards should be quite familiar to nurses and are more commonly known as the nursing process