Nursing leadership and management phần 67

18Jones Leadership(F)-ch 18 308 ■ ■ ■ ■ ■ ■ ■ ■ 1/14/07 3:50 PM Page 308 Skills for Being an Effective Manager Keep channels of communication open Let people know they are appreciated for their contributions to the organization Involve your subordinates in departmental governance Be positive and encourage an attitude of cooperativeness Treat people fairly and with respect Spread the workload around Create a supportive culture in the workplace Tolerate differences among subordinates (pp 131–134) THE MEETING Once all the data are collected, the nursing manager or supervisor can begin to summarize the findings A good rule of thumb is to list the strengths first and then to list the areas in need of improvement If the employee submitted goals for the year and provided documentation, assess these as well Although the nursing manager can list a few strategies for improving performance, the employee should take the major responsibility for this According to Smith (2003), the appraisal meeting should be scheduled at a convenient time for the employee so the meeting can proceed uninterrupted for at least 45 minutes She also recommends that the environment be nonthreatening and relaxed and that managers be prepared for the meeting Lack of preparation is a time-waster and sets a poor example for subordinates It may also display a lack of concern or interest in the employee The meeting is a very personal, face-to-face interaction and should not be taken lightly by either party (Box 18-1) The focus of the meeting should be to review the employee’s performance and explore with him ideas for being successful within the organization The manager sets the tone for the meeting by first explaining the purpose for the evaluation, which may vary from organization to organization When merit raises or promotions are dependent on the outcome of the appraisal, the employees are likely to be somewhat nervous, so the manager should make every effort to put the employee at ease The nurse manager should initiate the evaluation process by reviewing with employees their goals for the year From there she should proceed to discuss her findings based on data collection Next, Box 18-1 Tips for a Successful Performance Appraisal Meeting ■ ■ ■ Conduct the meeting in a nonthreatening or neutral environment Allow 45–60 minutes per person Remember that information discussed during the meeting is confidential and should be shared only with committee members and the appropriate administrators According to Hecht, et al., (pp 109–110), the administrator should: ■ Maintain the focus of the meeting on the individual’s performance, not his personality ■ Give specific suggestions for improving performance ■ Establish a time frame for achieving the goals, and review progress at that time ■ Recognize and reward positive achievement following unsatisfactory performance If the employee has been unsatisfactory but has turned around, be sure to make note of improved behavior the manager can move on to the periodic observations or input from others, such as patients or peers Employees should have an opportunity to respond to these findings and to discuss their performance and accomplishments By the conclusion of the meeting, the manager and the employee should mutually agree on a plan of action for the professional or career development of the individual Both long-term and short-term goals should be addressed A preprinted form can be used for this purpose Such a form should include a space for a narrative summary and dated signatures of both the supervisor and employee This plan of action might also include the employee’s future goals with the organization FOLLOW-UP Implementing the plan of action may require longterm intervention by the supervisor, such as motivating, coaching, or counseling the employee If, at the conclusion of the meeting, the manager is convinced that none of those approaches would be beneficial to the employee, she may need to resort to disciplinary measures 18Jones Leadership(F)-ch 18 1/14/07 3:50 PM Page 309 Maximizing Employee Performance 309 Motivating The nursing manager/leader is in the best position to motivate employees to achieve their goals because managers set the tone for an environment that encourages productivity and success When the employees look good and perform well, the nursing manager/leader looks good and, in turn, the organization looks good A large part of motivation involves feelings related to self-worth and satisfaction According to Swansburg and Swansburg (2002), a motivating environment is one in which the nurse leader/manager: ■ ■ ■ ■ ■ ■ Establishes a career development program Helps employees to meet their career goals Communicates the organization’s goals and priorities Involves the staff in the development of department and organizational mission and goals Encourages teamwork Rewards teamwork, innovation, and creativity While the above list does not cover all aspects of motivation, the list specifies those environmental factors that would encourage excellence in employee performance Coaching In assisting employees to reach their goals and develop professionally, the nurse manager often assumes the role of a coach According to Donner, Wheeler, and Waddell (1997), coaching is an ongoing, face-to-face, collaborative process The purpose of coaching is to assist the employee in carrying out job responsibilities or gaining knowledge and skills required for the job The immediate supervisor often has ongoing contact with the employee and is in the best position to evaluate progress and identify areas for improvement Coaching might be likened to on-the-job training or teaching The employee on the receiving end of the coaching has the advantage of immediate application of learning in the real world This is a common practice in many organizations when new hires or individuals being considered for promotion have no educational experience related to the requisite knowledge or skills the job requires Loveridge and Cummings (1996, p 368) described coaching as informal counseling that can be used for the short term or over the chapter star: The Performance Appraisal Meeting July is staff appraisal time for Unit X Nurse Manger J (NMJ) has scheduled her 30 staff nurses over the first two weeks of July for performance review Some appointments will occur on the weekends for the weekend staff and at the beginning of the evening shift and end of the night shift to cover employees on those permanent rotations Thus, employees will not have to come in on an off day or offduty time All staff nurses set goals at last year’s appraisal meeting and have submitted their progress reports in advance of the meeting In addition to meeting standard staff nurse competencies, Staff Nurse A (SNA), who is scheduled for the first meeting, sets the following goals: Participation on one continuous quality improvement (CQI) project Attend a continuing education session on cardiac arrhythmias Develop skills in reading EKGs NMJ has approved SNA’s attendance at the cardiac arrhythmia workshop, noted that she participated in the CQI project concerning reduction of length of stay for cardiac pacemaker patients, and reviews her chart notes, which state that SNA included notation of rhythm strips on her assigned patients The performance appraisal meeting begins NMJ offers SNA a beverage of her choice While the secretary is bringing them, she inquires about SNA’s family to set a friendly, concerned tone for the meeting NMJ reviews all of the staff nurse competencies, which are rated “met” or “above or exceeds expectations.” She commends NMA on her performance Then she reviews her documentation on PRN pain medication and explains and coaches SNA on how she might improve her notation of the patient’s response by focusing on the following key factors, i.e., pain scale rating after receipt of medication, location of pain, and duration of pain, etc., at hours and hours after receiving the PRN medication Together they plan to include objectives for the next year to improve SNA’s documentation with milestones three, six, and nine months out SNA is informed that she will receive an “exceeds expectations” for her overall rating and therefore will receive a 3.5% pay raise The meeting concludes in 45 minutes SNA will forward her finalized goals for the next year within the next weeks 18Jones Leadership(F)-ch 18 310 1/14/07 3:50 PM Page 310 Skills for Being an Effective Manager long term Short-term coaching is generally spontaneous, brief, and open Long-term coaching can be used to correct performance deficiencies This type of coaching is usually planned and behavior-specific (Loveridge & Cummings, 1996, p 200) Coaching also might involve providing opportunities for the employee to attend workshops or conferences or serve on committees Counseling The nurse managers may also find themselves counseling employees According to Hecht, et al (1999, p 111), this process provides the nursing administrator with an opportunity to demonstrate genuine interest in subordinates Deciding if an employee would benefit from counseling requires interpersonal contact between the nurse manager and the employee Counseling is one of the most productive functions to improve employee performance (Loveridge & Cummings, 1996, p 368) Counseling generally occurs in a private session where the focus is on helping the employee solve a problem Generally, these are personal problems that may be interfering with the employee’s performance Frequent absenteeism is a good example While frequent absenteeism can be due to many other factors, it is a common symptom of substance abuse Other problems that require counseling might include disputes or conflicts with other employees In counseling sessions, the nurse manager should help employees get to the bottom of problems and adjust their attitude if necessary Sometimes this means separating the employees, putting them on different shifts or on different units If the problem is potentially life-threatening or requires therapeutic intervention, the employee should be directed where to seek help Because nurses are not always equipped or trained as therapists, the problem employee may need referral to another agency or a professional counselor for support Disciplining Managers may also be required to mete out discipline Although discipline is generally thought of as some form of punishment for negative behavior, Gillies (1994, p 557) stated that its purpose is to improve job performance According to Webster’s Dictionary (1995), disciplining can mean taking corrective action or bringing about self-control through instruction or training The definition also includes conformity to rules and regulations Marquis and Huston (2000, p 442) stated that when employees continue undesirable conduct, either in breaking rules or in not performing their job duties adequately, disciplinary action must be taken This approach may seem a little extreme, but in any organization there are standards and guiding principles Employees are expected to conform and perform accordingly In health-care systems, many of these standards exist to protect the patients and others One good example is universal precautions JCAHO (2005) published its list of disease-specific care national patient safety goals, one of which was to reduce the risk of health-care–associated infections One of the strategies listed was compliance with the Centers for Disease Control and Prevention (CDC) hand hygiene guidelines Nurses learn early on that aseptic technique is essential to preventing the spread of organisms from person to person But how often have nurses been observed rushing from one situation to another without taking the time to wash their hands between patients? Most health-care agencies have begun to post signs in plain sight in every patient room and anywhere that hand washing is considered essential Some nurses might view this as a form of discipline simply because somewhere, someone did not take the time to wash his hands When considered in a broader perspective, however, most nurses realize that this is a reminder for everyone who might transmit organisms: nursing staff members, physicians, other health-care workers, family members, and even the patients Few responsibilities of the nursing manager are as personal and time-consuming as performance appraisal The manager’s job includes a number of other personnel responsibilities, including working with new employees, probationary employees, and problem employees Although most healthcare organizations have personnel departments, the nursing manager is generally involved whenever the nursing staff is the focus of attention New Employees and Probationary Employees In this era of nursing shortages, new employees and probationary employees rarely have the luxury of a long orientation period Agencies should take care 18Jones Leadership(F)-ch 18 1/14/07 3:50 PM Page 311 Maximizing Employee Performance with new employees and develop an evaluation procedure for determining their ability to succeed When the organization shows an interest in the employee and is willing to spend time teaching him, he may be more likely to stay Metcalf (2001) stated that it is crucial for newly graduated nurses that the process of staff development begin at the commencement of and continue throughout their employment A collaborative environment is a motivating environment where the nursing administration provides ongoing support and encourages the professional development of each employee Conversely, any new or probationary employee who demonstrates problematic behavior in one department is likely to have difficulty on other units in the same facility Documenting behavior and evaluating abilities from the beginning of employment provides the agency with information about performance in general New hires and probationary employees who not measure up, especially with coaching and counseling efforts, may need to be terminated THE PROBLEM EMPLOYEE Once an employee is a part of the organization, the administration has a responsibility to assist that person A variety of personal difficulties can lead to poor performance in the workplace Most notable would be problems related to chemical impairment Chemical impairment refers to impairment due to drug or alcohol addiction (Marquis & Huston, 2000, p 459) Some common problems resulting from these impairments are excessive absenteeism, decreased quality of work, errors in judgment, work-related accidents, and high rates of turnover When evaluating employees, the manager should note when these problems occur with regularity Excessive absenteeism, tardiness, and sick leave can create a serious staffing deficiency unless guidelines or policies exist Most unionized settings address these problems, and nonunionized settings would well to address them as well (Box 18-2) In many states, nursing organizations or boards of nursing sponsor programs for the impaired nurse Many agencies and health insurance plans also cover the cost of such programs The nurse manager needs to be familiar with the policies existing in the organization and in the state For example, in Ohio, employers are required to report employees for con- 311 Box 18-2 Developing Organizational Policies for Absenteeism, Tardiness, and Sick Leave Recognize the existence of employee problems Take a proactive approach for dealing with the problem Review existing policies Solicit employee input Determine how many absences per year are considered excessive Determine how many successive sick days are permitted within a given period Decide what action should be taken for violations of the policy Develop a staffing protocol to be instituted when absenteeism and sick leaves occur Distribute policy to all employees, post policy on each unit, and add it to the policy manual duct requiring disciplinary action, such as a positive drug screen, even if that employee has been referred to an employee assistance program Ohio sponsors two programs for problem employees: a program for nurses with substance abuse problems and a program that requires nurses to obtain additional education to improve their practice skills Nurses in these programs are monitored by the state board of nursing and are able to remain employable with minimal threat to the public Other states as well as most professional organizations and many health-care organizations offer similar programs Although most organizations have a personnel department to deal with all kinds of issues that develop during corporate changes such as reorganization and downsizing, the nurse manager may find herself called upon for input when the nursing staff is involved Nurse managers may also be involved at the decision-making level when it comes to transferring or terminating nursing staff Transfers and Termination Transfers and termination within an organization can lead to increased productivity and success Good employees may be transferred to other areas within an organization as part of a promotion package or to make better use of their potential In some 18Jones Leadership(F)-ch 18 312 1/14/07 3:50 PM Page 312 Skills for Being an Effective Manager instances problem employees may be transferred to other areas where they may be more successful When an employee exhibits problem behavior that is unlikely to change and may be detrimental to the organization, she should be terminated Restructuring within an organization may result in the termination of employees, even those with good performance records Transfers Transfers are common in the corporate world; they often involve moving an employee to a new location, often with a promotion and an increase in salary In health-care organizations, this may not be the case Many employees, especially the nursing staff, are place-bound and unwilling or unable to move to another location When mergers or acquisitions occur in the health-care industry, it is often necessary to eliminate positions Mergers occur when two or more organizations join together to form a single new organization (Lancaster, 1999, p 99) When one organization buys another, the acquired organization no longer carries its original identity (Lancaster, 1999, p 99) In either of these situations, for example, there may be no need to have two evening supervisors for the intensive care unit (ICU) One of them could, if willing, be transferred to another unit as a supervisor, if they were unwilling to take a staff position in the ICU One type of transfer is the lateral transfer, meaning the individual would be moved to a position with a similar scope of responsibilities within the same organization (Marquis & Huston, 2000) Another type of transfer is the downward transfer, which occurs when someone takes a position within the organization that is below his or her previous level (p 539) If the transfer is unrelated to performance, the individual may be able to select a position that best relates to her career goals A person who eventually wants to be a nurse educator may opt to switch to the education department If this is not in her future, she may decide to take the open position as relief supervisor for the emergency department Downsizing refers to reducing the number of positions within an organization, normally done to reduce organizational costs and often accompanied by changes in job design to enhance the productivity of the remaining staff (Lancaster, 1999, p 93) Two personnel issues related to downsizing are transfers and termination of employees Usually, a transfer is no reflection on the employee’s performance because the person’s salary often remains the same With downsizing, this is becoming a fairly common practice Termination While termination is certainly possible with restructuring, the shortage of nurses makes it unlikely that nursing personnel would be let go More often, it is the unlicensed personnel whose jobs are in jeopardy Termination should be the final step in the performance appraisal process, when other measures have failed to bring about improvement of the employee’s performance As with other policies in the organization, it is critical that a well-defined procedure for termination be in place The guidelines should be followed strictly by the nursing administrator, after efforts at coaching, counseling, and disciplining have proved unsuccessful When an employee is a member of a collective bargaining unit, the contract delineates the steps leading to termination In many organizations, outplacement services are available for employees who have been terminated This might be a comprehensive program that helps individuals to prepare résumés and applications and work with counselors as they search for another job This type of program may also be instituted when an organization is going through a major transition, such as downsizing or closing When valued employees must be terminated, they may be recommended to other facilities within the corporate system All Good Things The purpose of performance appraisal is to improve the quality and productivity of the employee and enhance career aspirations The nursing administrator has the responsibility for overseeing the performance appraisal and motivating the employee toward excellence in practice When employees appear to need support or assistance in reaching goals, their supervisors may be able to work with them, coaching and counseling as needed Performance appraisal should be an ongoing process, which has both informal and formal components Employees should take an active role in the process by establishing meaningful career goals for themselves and working toward those goals The outcome of the process should be satisfied employees who realize their aspirations with the support of the nursing administration  ... there are standards and guiding principles Employees are expected to conform and perform accordingly In health-care systems, many of these standards exist to protect the patients and others One... organization’s goals and priorities Involves the staff in the development of department and organizational mission and goals Encourages teamwork Rewards teamwork, innovation, and creativity While... for an environment that encourages productivity and success When the employees look good and perform well, the nursing manager/leader looks good and, in turn, the organization looks good A large