Nursing leadership and management phần 66

18Jones Leadership(F)-ch 18 1/14/07 3:50 PM Page 303 Maximizing Employee Performance goals, there may also be some extrinsic reward as well Achieving one’s goals could result in a salary increase or a promotion This idea for setting one’s own goals is based on McGregor’s theory of management and is often referred to as MBO Many health-care organizations have included MBO as part of the performance appraisal process For the nursing staff, MBO offers an opportunity to a self-assessment and set goals that are realistic and meaningful to career aspirations Some details on developing goals as part of the MBO process follow: ■ ■ ■ ■ ■ ■ The staff should limit their goals to two or three Goals should be meaningful and realistic Strategies for achieving the goals should be included as well An in-service session on writing goals and strategies may be helpful when introducing the idea of MBO The nurse manager and nursing supervisor should review goals with staff members Before the goals are submitted, all parties should agree on them Working with the nursing supervisor and/or administrator, the performance appraisal process can become a meaningful and rewarding experience When one’s superior shows an interest in his or her career goals and aspirations, the employee may be motivated to reach his potential This is a win-win for both parties because the success of the administrator is often measured by the success of her subordinates The job description and standards of performance provide the starting point for assessing employees Performance appraisal, however, should make use of additional data sources depending on the requirements of the organization Standardized tools may be used to evaluate employees in some organizations, while others may opt for the use of tools developed in-house In any case, the responsibility for data collection rests with the nursing supervisor DATA COLLECTION The employees’ immediate supervisor usually carries out data collection for evaluations at various points during the review period The employee should be aware of the methods and have a copy of 303 the tool or tools that will be used to evaluate performance Data collection methods might include: (a) making notations on the tool based on observations, (b) keeping anecdotal notes, (c) reviewing charting, (d) interviewing patients, (e) attending staff meetings, (f) talking with the employee’s coworkers, and/or (g) reviewing the employee’s skills or competency evaluations Any or all of these may be used Performance Appraisal Tools Input from nurses working in different settings suggested that organizations are using a wide variety of tools Sophisticated, standardized tools are used in some organizations while others use simple checklists There seemed to be little consistency in the type of tool used from area to area Checklists, ratings, rankings, anecdotal records, peer reviews, and self-appraisals have their place in health-care organizations Several of these methods are described below in detail Peer Reviews Peer reviews are one means of evaluating staff, especially in a decentralized organization Peer review is a process of assessing, monitoring, and evaluating the quality of patient care provided Acceptable standards of practice are often used to determine the quality of care The process of peer review may vary from organization to organization Each institution should establish guidelines for conducting peer reviews These guidelines should describe who, what, when, how often, and under what circumstances A method that is commonly used in many institutions is critiquing patient records Generally, this involves a group of peer reviewers One or more of those individuals might randomly review patient records with attention to specific criteria The same criteria should be used when reviewing any patient records Because patient records are legal documents, certain criteria should apply from institution to institution, such as assessing the patient’s level of pain and documenting the patient’s response to any pain medication that may have been administered Other methods of peer review may require one or more of the peer reviewers to observe an employee giving patient care Here again, the criteria should be specified and the same for each person being observed Despite its increasing popularity, employees may see peer review as intimidating 18Jones Leadership(F)-ch 18 304 1/14/07 3:50 PM Page 304 Skills for Being an Effective Manager Parks and Lindstrom (1995) reported that the potential rewards for instituting unit-based peer review included increased trust, communication, and job satisfaction In the situation they described, performance appraisal was one of three reasons for instituting peer review Quality assurance and professional development were the other reasons given The peer review groups consisted of senior nurses who were experienced in mentoring and adept at group process skills Peer reviews can provide informal feedback to the nursing staff If used properly, peer evaluation can provide a powerful incentive for personal and professional development According to Marquis and Huston (2000, p 427), peer review has the potential to increase the accuracy of performance appraisal The idea of having colleagues or peers evaluate each other makes sense from the standpoint of similarity of experiences, knowledge, and familiarity with skill requirements This practice is becoming more widely accepted in health care and lends more credence to the overall performance evaluation of employees Although peer review offers some benefits, it cannot be entered into lightly, and it is unrealistic to think peers can be involved with evaluations without extensive training (Barnum & Kerfoot, 1995, p 256) Checklists Kelly-Heidenthal (2003, p 558) described checklists as the most commonly used type of performance evaluation tool Checklists are easy to use and only require the rater to determine whether the person being evaluated falls below the standards, meets the standards, or exceeds the standards of the organization The problem with checklists is that they often lead to rater errors, especially central tendency Central tendency occurs when the evaluator rates nearly everyone the same Most often this happens when the evaluator is not familiar with the persons she is evaluating or because she has not actually observed them in the performance of certain activities In organizations where this type of tool is used, employees often complain that they really have no idea of whether they are doing well or improving because their evaluations vary little year after year Rating Scales Rating scales are also used to evaluate performance The rater selects a number (usually between and 5) that best describes the individual’s perfor- mance (see Fig 18-2) While rating scales are only slightly more illuminating than a checklist, the rater does have more options from which to choose Although ratings and rankings are intended to be applied subjectively, any rating or ranking could reflect the rater’s bias (Houston, 1995) Ranking Employees Rankings are sometimes used to determine how an individual performs in relation to others in a similar situation Nursing administrators are sometimes required to rank subordinates based on a variety of criteria This method is one that is often used when decisions have to be made about promotion or merit raises Typically, ranking requires assigning numerical points rather than narrative descriptors when totaling data When ranking systems are used, the performance of individual employees is compared with those of other employees, usually those at the same level Rankings should not be used alone, however, because they not address the quality of the performance A ranking system is generally used in organizations where performance is used to determine merit increases or promotions For example, in a recent merger at Central Hospital, two staff nurses were being considered for a newly created position in pediatrics The nurse manager was unable to determine which nurse, Janet or Joyce, should be given the position Both of them had worked on the pediatric unit for years, and both of them had earned a bachelor’s degree in nursing Using the outcomes from the performance appraisal data, the supervisor was able to differentiate between the two individuals in terms of their overall performance for the past years On the 10 items listed on a rating scale similar to the one in Figure 18-2, Janet had scored 35, 43, and 45, respectively, for the past years Joyce, on the other hand, had scored 35, 40, and 40 during the past years Their scores on several other tools also reflected a similar pattern As a result, Janet received the job offer Anecdotal Records Anecdotal records are generally written records of observations If used to evaluate performance, criteria should be established for the evaluator For example, the evaluator might observe the individual’s behavior in a given situation to ascertain whether or not he has explained the side effects of 18Jones Leadership(F)-ch 18 1/14/07 3:50 PM Page 305 Maximizing Employee Performance a client’s medications When the behaviors to be observed are clearly defined, the evaluator knows what to look for, and the individual knows the criteria by which he is being evaluated Skill Testing Many organizations are now evaluating the skills of their employees Testing skills in working with specialized equipment or performing specific procedures is one way to evaluate the employee’s performance in areas that are unlikely to be observed in all situations Skill testing may be part of the orientation of new nurses in a given agency to bridge the gap between education and practice When skill testing is involved, nurses are often required to demonstrate expertise in such areas as cardiopulmonary-resuscitation, handling the crash cart, preparing and/or starting intravenous medications, isolation techniques, tracheostomy care, dressing changes, removing staples (sutures), and other skills as deemed necessary by the agency Some agencies have ongoing in-service programs whereby the staff are tested on a regular basis to maintain their expertise Brykczynski (1998) recommends identifying and describing levels of nursing skills into the performance evaluation Those demonstrating exemplary skills or the expert nurses could then serve as role models for the staff Patient Surveys Most health-care agencies use some form of patient survey Whereas supervisors often depend on patient surveys to evaluate the productivity and performance of the agency itself, they may also be used to assess patient satisfaction with care received Unfortunately, it is difficult to collect information about individual employees in an acute care setting using a patient survey form There are some rehabilitation centers and nursing care facilities that provide opportunities for the residents and family members to evaluate the staff In some cases, employees may be given a bonus for positive comments on these surveys Reviewing patient satisfaction data is part of the administrator’s responsibility Client care is the focus; when clients are dissatisfied, something is amiss Consumer satisfaction continues to be a major concern of health-care agencies Several tools have been used, most of which only describe the patient’s overall satisfaction or dissatisfaction with 305 the experience For example, patients may be asked if someone explained the treatments and medications they received and then how satisfied they were with the explanations they received Because most patients are not required to give their names, there may be no way of knowing who took care of them or perhaps even when they were hospitalized This kind of general information serves as a starting point, but the current thinking is that more relevant patient satisfaction measures should be used, based on patient outcomes or evidencebased practice EVALUATOR BIAS The more examples of behavior that the nursing administrator has to work with, the less biased the appraisal will be Performance appraisal is an interpersonal process containing an element of subjectivity (Huber, 2000, p 335) Regardless of the tool used, someone must evaluate the employee In most instances, the employee’s immediate supervisor is the person who does this To guard against subjective attitudes and values influencing the appraisal, the appraiser should develop an awareness of her own biases and prejudices, according to Marquis and Huston (2000) How can this be accomplished? The nurse manager could consult with other managers when questions of personal bias exist, gather data appropriately, and keep notes on observations, others’ comments, chart reviews, and care plans (p 417) Try as they might, raters are likely to be less objective than the ideal This could result in one or more evaluator rating errors (Nauright, 1987) Some of the most common rater errors include: (a) central tendency, (b) “halo effect,” and (c) “horn effect.” Central tendency occurs when the rater, unsure of how persons are performing, ends up rating them as good or average on most items listed The “halo effect” occurs when the employee has recently shown exceptional performance in one or more areas If this behavior is apparent to the rater during the last few observations, the rater may rate the employee as above average in most areas listed, regardless of the actual performance in some of those areas The “horn effect” is the opposite of the “halo effect.” In other words, an employee who has recently displayed less than satisfactory behavior in one or more performance areas may be rated as per- 18Jones Leadership(F)-ch 18 306 ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ 3:50 PM Page 306 Skills for Being an Effective Manager TABLE 18-1 ■ 1/14/07 Rater Errors Halo effect: Trait carryover; person whose performance is good in several known areas is assumed to be good in other perhaps unknown areas Recency effect: Recent events (good or bad) could bias the rater Horn effect/problem distortion: One poor performance may weigh heavier with the rater than many good performances Sunflower effect: Rater may grade all employees high if she thinks her team is great Central tendency: Rater may mark everyone as average, especially if she is unsure how certain people performed Rater temperament effect: Different raters will be stricter or more lenient than others Strict ratings: The rater may score the person lower than he deserves in an effort to motivate him Lenient ratings: The rater may score the person higher than he deserves so the person will think kindly of the rater Guessing error: “Guesstimates” by the rater about a particular performance she did not really observe Initial impression: Rater judges the person on appearance or some personal attribute and therefore assumes the person is doing a good job if she made a favorable impression, or perhaps the rater assumes the performance is less than satisfactory if the initial impression was less than favorable Status: Rater judges the person according to position, education, or other criteria rather than on actual performance Nauright, L (1987) Toward a comprehensive personnel system: Performance appraisal part IV Nursing Management, 18(8) 67–77 forming below average in many other areas This may not be a fair reflection of the individual’s usual behavior (Table 18-1) The Appraisal Meeting Once all the data are compiled, the nurse manager sets aside time on her calendar for employee appraisal meetings As a rule, these are conducted at about the same time each year for all employees The purpose of the meeting is to discuss the employee’s performance for the year At the conclusion of the meeting, both parties should reach an agreement as to the employee’s overall performance status, areas for improvement, and plans for maximizing performance THE ROLE OF THE EMPLOYEE In preparation for performance appraisals, employees should collect their own data They can begin by listing their strengths, especially contributions to the organization, as well as to patient safety and welfare In addition, they will want to identify any accomplishments since their last review that indicate progress toward their stated goals If little or no progress was made, they should be able to explain why In most organizations, employees would have been required to submit goals for the upcoming appraisal meeting well in advance, perhaps at the last meeting The employee should be prepared to address the goals they established at the time of their performance appraisal meeting Some of the long-term goals may be ongoing, while short-term goals may be completed or nearing completion by the time of the meeting Employees should identify any problems encountered with reaching their goals and ascertain why For example, an employee may have determined that she would have become a certified nurse midwife this year The employee might first look at the needed resources and/or strategies she identified in relation to the stated goal Next, the employee needs to ask herself a series of questions about failure to meet the goal Was it due to time constraints? Was it a matter of finances, or was it a lack of adequate experiences or preparation? Was there anything the organization or the supervisor could have done to assist the employee? The employee should be as honest as possible when identifying the reasons the goal was not accomplished Self-Appraisals Self-appraisals are commonly used to address whether or not employees have met established goals and if not, why not Self-appraisals can also be used in conjunction with any of the other tools as can anecdotal records In fact, self-appraisals should relate to performance of the job as defined by the job description, according to Swansburg and Swansburg (2002) When all parties are using like criteria or standards, there ought to be no surprises at the time of the appraisal interview The goals established by the employee should therefore have relevance to the goals and mission of the 18Jones Leadership(F)-ch 18 1/14/07 3:50 PM Page 307 Maximizing Employee Performance organizations as well as to her own career goals For example, a staff nurse who would someday like to be the team leader would need to determine what that job entails Her goals should be defined clearly with that idea in mind When meeting with her supervisor, the discussion should center on her career goals as well as on her capabilities as a staff nurse Before the performance appraisal meeting, the employee would be expected to submit self-appraisal materials to the nurse manager, including the goals developed for the coming year This information will be added to the data that have already been compiled by the nurse manager THE ROLE OF THE NURSE MANAGER Prior to meeting with her subordinates, the nurse manager should organize materials for the upcoming meeting This begins with reviewing the employee’s past performance and goals established for the past year Next, the manager would review data from tools, peer evaluations, self-evaluations, and any anecdotal records The benefits of prior planning cannot be overemphasized The manager should be in charge and prepared for all contingencies According to Rondeau (1992), successful performance appraisal sessions require a wellconceived and well-executed plan of action To evaluate subordinates better, the manager needs to know as much about the person being evaluated as possible For example, knowing the current position held by the employee and how long she has held that position could make a difference in terms of how the person is evaluated When looking at records of any critical incidents, the manager should remember that a single critical incident might not represent a true picture of the individual A date and time for the meeting should be established well in advance, and the manager should make certain the date and time for the meeting are satisfactory for both parties It is important that the meeting be free of interruptions The employee should believe that the manager considers this time to be important When employees are performing well, the meeting should go fairly smoothly for both parties The purpose of planning for the meeting is to review the employee’s job-related behaviors and the available evaluation materials The focus of the meeting is always on the performance level of the individual past and present and the progress she has made 307 toward the established goals The manager should also review and be prepared to discuss any positive comments from peers, patients, or the person’s immediate supervisor Anecdotal records can be discussed if needed, but the employee deserves an opportunity to discuss his self-analysis and career aspirations as well When evaluating others, the nurse manager engages in active listening and assertive communication Assertive communication means being open and honest but treating others fairly and with respect This means giving criticism when needed and handing out praise when deserved The focus of performance appraisal should be on the individual’s performance, not on personal characteristics or problems The manager needs to think through what he needs to discuss with the employee while making every effort to put the person at ease According to Ash (1984), there is a gender difference in responses to criticism Although many societal changes have occurred for working women in general, nursing has always consisted primarily of women In general, women are much more sensitive to criticism than men In other words, women take it much more personally and tend to react more negatively to criticism Difficult as it may be, the nurse manager must decide how to approach an employee who has demonstrated an unsatisfactory performance The nurse manager’s role is to encourage and motivate employees toward excellence in performance None of the manager’s roles is as personal as appraising the work performance of others (Marquis & Huston, 2000, p 414) This aspect of the process is considered extrinsic motivation Because most employees are sensitive to comments about their performance, good interpersonal skills are as important as good leadership and managerial skills At the beginning of this chapter was a quote from Ash (1984), “Sandwich every bit of criticism between two layers of praise.” In short, this means that managers should start by focusing on the person’s good points, then bring up the problems identified, and end by discussing how these can be resolved Rondeau (1992) advocates using criticism sparingly as it tends to build up individual resistance and shut down communication Leaming (1998) described several improvement pointers for academic leaders engaged in evaluation of their subordinates Many of these pointers would work well for the nursing administrator in any setting In general terms, it is important to: ... Checklists are easy to use and only require the rater to determine whether the person being evaluated falls below the standards, meets the standards, or exceeds the standards of the organization... mentoring and adept at group process skills Peer reviews can provide informal feedback to the nursing staff If used properly, peer evaluation can provide a powerful incentive for personal and professional... to the one in Figure 18-2, Janet had scored 35, 43, and 45, respectively, for the past years Joyce, on the other hand, had scored 35, 40, and 40 during the past years Their scores on several