EP - Exemplary Professional Practice

EP20: Accountability, competence, and autonomy-Describe and demonstrate that nurses at all levels routinely use self-appraisal performance review and peer review, including annual goal-setting, for the assurance of competence and professional development.

One of the strategic goals for the Division of Nursing is the development of professionals in order to strengthen and/or expand their roles. This requires an annual performance appraisal process which reflects on growth for the past year and requires goal-setting moving forward. This process is used for all levels in the organization.

The current performance appraisal system used at Jersey CityMedicalCenter is the traditional competency based approach. Performance appraisals are continuous throughout the year, but are formalized annually. The tool utilized is organized by the elements of Magnet and is designed to portray the professional growth of the registered nurse. Issues addressed are professional education, specialty certification, level of organizational participation, mentorship and preceptorship activities, quality and safety involvement, as well as research and information technology. This format permits the Nurse Manager to grade the professional nurse in each category based on Benner’s model, From Novice to Expert, 1984. According to Benner, the nurse will progress through stages built upon experiences, how the nurse responds to these experiences stimulates professional growth. The rating scale includes: Novice, Advanced Beginner, Competent, Proficient and Expert. The staff nurses rate themselves in each of the performance standards. The Nurse Manager reviews the self-appraisal of the staff nurse prior to a discussion with the nurse. The nurse is requested, with the manager’s assistance, to formulate goals for the coming year. These goals assist the Nurse Manager in assessing educational requirements for the upcoming year. In addition to the formalized evaluation, the organizations behavioral standards are also addressed at this time. Competencies that are addressed include mandatory (regulatory agency determined), and unit specific or hospital-wide competencies. Clinical competencies are measured and are both generic (for all staff) as well as unit specific to the specialty setting. These competencies are resolved with either an examination, observation and/or a return demonstration.

Examples of competencies for medical-surgical staff nurses include, but are not limited to: Patient controlled analgesia, EKG rhythm strips, Tracheostomy care and suctioning, The Sharing Network and organ donation, Respiratory assessment on adults, and Procedural sedation/Time out. To review completed sample of competencies for medical-surgical nurses see (Reference EP20-A).

During the evaluation period, specific data is utilized to assist Nurse Managers to assess the strength and weaknesses of individual staff members. Data used for this process will include a number of patient outcome indicators, as well as data from other staff (peers) and self-appraisal from the employees themselves. Peer review is an important aspect of the appraisal process. The Nurse Manager distributes at least two (2) peer review tools to the colleagues of the nurse being evaluated. These peer review tools are formatted in accordance with the Values of the organization. Trust, Accountability, Communication, Excellence and Teamwork are all addressed. This information is instrumental in formulating the written evaluation document. It is essential that the evaluation be reflective of skill, knowledge and interpersonal relationships. Performance is frequently assessed by ongoing data collection from the medical record review , and patient outcomes that are reflective of the care received To see completed staff nurse evaluation review (Reference EP20-B).

The Nursing Directors are required to complete their own evaluations and submit them to the Senior Vice President. This self-evaluation process includes rating oneself on collaboration with a variety of disciplines, leadership abilities, organization and problem-solving capabilities. Goals are developed for the coming year and attached to the performance appraisal tool. A list of the year’s accomplishments is also attached and submitted. The CNO meets individually with each Director and reviews their goals and discusses issues from the previous year and areas for improvement. A Service Leader Peer Review is performed at the Director level as well. Two (2) peers are requested to complete this tool and evaluate this director. This Peer Review tool contains four aspects for the Director to be rated: Image of Nursing, Professional Development, Quality of Care, Quality Improvement, Interdisciplinary, Resource Identification and Utilization Review completed Director evaluation (Reference EP20-C).

Nurse Managers complete the designated performance appraisal tool which depicts particular leadership responsibilities. Areas include: Leadership, directs the provision of nursing care, develops staff and evaluates performance, collaborates with other health disciplines in the provision of care, improves organizational performance, professionalism and environment of care. This is organized via the Benner model as well. Each Nurse Manager performs the characteristics of a Service Leader peer review with at least two (2) of their peers. They then meet with their individual Nursing Directors, with a list of their annual accomplishments and their goals for the upcoming year and they discuss progress Review completed Nurse Manager evaluation (Reference EP20-D).

The Educators and the Clinical Nurse Leaders complete their respective evaluations which are designed specifically to incorporate the aspects of their practice. For example, the educational performance appraisal addresses teamwork, developing, teaching and coordination of educational programs for all levels of nurses, functioning as a liaison with outside agencies and schools and maintaining clinical expertise in specific areas of specialization. This group also completes a peer review (the characteristics of a Service Leader) and, along with their self-appraisal they submit annual goals. They meet with their immediate supervisor to discuss their goals Review completed CNL evaluation (Reference EP20-E).

Each Advanced Practice Nurse has an Addendum to their performance appraisal which applies directly to their specific practice. For example, the Palliative Care Nurse has specific duties and responsibilities particular to her specialty. For example, the Palliative Care and Pain Coordinator’s evaluation includes the oversight of pain/palliative care service’s budget, performance measures and the use of staff resources proportional to activity and patient care, and the provision of proactive leadership in the hospital interdepartmentally. It also incorporates the provision of services of end of life care. They also complete the characteristics of a service leader peer review. Review completed APN evaluation (Reference EP20-F).

Exemplar of Goal Setting

“Over a year ago, the Pediatric Unit was added to my existing area of a medical-Surgical Unit. The MedicalCenter at one point was a full-service pediatric center, but had downsized over the last few years. This was a difficult transition for the Pediatric Service, as well as for myself. The Pediatric census fluctuated and at times I would have to send staff home when the census dropped. I encouraged the staff to cross-train to the adult medical-surgical area so that they did not have to utilize flex time when the census dropped. I was met with some resistance. One night nurse in particular was particularly difficult. During the annual performance review, I discussed this issue in depth with the nurse. She said that she was just not comfortable with the adult patients. We developed a plan whereby she would be double-teamed with one of her peers that she worked well with until a comfort level was achieved. I also provided her with some articles taken from EBSCO on the care of the adult patient. She completed the competency package for the medical-surgical area and received remediation when needed. She was able, over the next few months to rotate comfortably to the medical-surgical areas. I felt that this process was a very productive one and that I assisted her with a growth process.”

(Submitted by Marilyn Sarnatora MSN, RN, BC, Nurse Manager 6E, 5E (Observation) and Pediatrics).