24

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C H A P T E R

24

Performance Appraisal

An effective appraisal process rewards productive

employees and assists the professional growth and

development of inexperienced and unproductive

individuals.

—Mable H. Smith

An additional managerial controlling responsibility is determining how well employ-ees carry out the duties of their assigned jobs. This is done through performanceappraisals. In performance appraisals, actual performance, not intent, is evaluated.Performance appraisals let employees know the level of their job performance as wellas any expectations the organization may have of them. Performance appraisals alsogenerate information for salary adjustments, promotions, transfers, disciplinaryactions, and terminations.

None of the manager’s actions is as personal as appraising the work performanceof others. Because work is an important part of one’s identity, people are very sen-sitive to opinions about how they perform. For this reason, performance appraisalbecomes one of the greatest tools an organization has to develop and motivate staff.When used correctly, performance appraisal can motivate staff and increase reten-tion and productivity; in the hands of an inept or inexperienced manager, however,the appraisal process may discourage and demotivate staff.

A manager’s opinions and judgments must be determined in an objective, sys-tematic, and formalized manner because they are used for far-reaching decisionsregarding the employee’s work life Using a formal system of performance reviewalso reduces the appraisal’s subjectivity.

The more professional a group of employees is, the more complex and sensitivethe evaluation process becomes. The skilled leader–manager who uses a formalizedsystem appropriately builds a team approach to patient care.

This chapter focuses on the relationship between performance appraisal andmotivation and discusses how performance appraisals can be used to determinedevelopmental needs of staff. Emphasis is given to appropriate data gathering,proper implementation of management by objectives (MBO), and peer review. Theperformance appraisal interview also is explored. Performance management isintroduced as a new alternative to the traditional annual performance appraisal.The leadership roles and management functions inherent in performance appraisalare shown in Display 24.1.

USING THE PERFORMANCE APPRAISAL TO MOTIVATE EMPLOYEES

Although systematic employee appraisals have been used in management since the1920s, using the appraisal as a tool to promote employee growth did not begin untilthe 1950s. Most formal appraisals focus on the professional worker rather than thehourly paid worker, who is often guaranteed automatic pay raises if work meetsminimum acceptable criteria.

The evolution of performance appraisals is reflected in its changing terminology.At one time, the appraisal was called a merit rating and was tied fairly closely tosalary increases. More recently, it was termed performance evaluation, but becausethe term evaluation implies that personal values are being placed on the perform-ance review, that term is used infrequently. Some organizations continue to useboth of these terms or others, such as competency assessment, effectiveness report,or service rating. Most healthcare organizations, however, use the term performance

616 UNIT 7 � Roles and Functions in Controlling

appraisal because this term implies an appraisal of how well employees perform theduties of their job as delineated by the job description.

An important point to consider if the appraisal is to have a positive outcome ishow the employee views the appraisal. If employees believe the appraisal is basedon their job description rather than on whether the manager approves of them, theyare more likely to view the appraisal as relevant. Management research has shownthat the following factors influence whether the appraisal ultimately results inincreased motivation and productivity:

• The employee must believe that the appraisal is based on a standard towhich other employees in the same classification are held accountable. Thisstandard must be communicated clearly to employees at the time they arehired and may be a job description or an individual goal set by staff for thepurpose of performance appraisal.

• The employee should have some input into developing the standards orgoals on which his or her performance is judged. This is imperative for theprofessional employee.

• The employee must know in advance what happens if the expected perform-ance standards are not met.

617CHAPTER 24 � Performance Appraisal

Leadership Roles1. Uses the appraisal process to motivate employees and promote growth.2. Uses appropriate techniques to reduce the anxiety inherent in the appraisal process.3. Involves employees in all aspects of performance appraisal.4. Is self-aware of own biases and prejudices.5. Develops employee trust by being honest and fair when evaluating performance.6. Encourages the peer review process among professional staff.7. Uses appraisal interviews to facilitate two-way communication.8. Provides ongoing support to employees attempting to correct performance deficiencies.9. Uses coaching techniques that promote employee growth in work performance.

10. Individualizes performance goals and the appraisal interview as needed to meet theunique needs of a culturally diverse staff.

Management Functions1. Uses a formalized system of performance appraisal.2. Gathers data for performance appraisals that are fair and objective.3. Uses the appraisal process to determine staff education and training needs.4. Bases performance appraisal on documented standards.5. Is as objective as possible in performance appraisal.6. Maintains appropriate documentation of the appraisal process.7. Follows up on identified performance deficiencies.8. Conducts the appraisal interview in a manner that promotes a positive outcome.9. Provides frequent informal feedback on work performance.

Leadership Roles and Management FunctionsAssociated with Performance Appraisal

Display 24.1

• The employee needs to know how information will be obtained to deter-mine performance. The appraisal tends to be more accurate if varioussources and types of information are solicited. Sources could include peers, coworkers, nursing care plans, patients, and personal observation.Employees should be told which sources will be used and how such information will be weighted.

• The appraiser should be one of the employee’s direct supervisors. Forexample, the charge nurse who works directly with the staff nurse shouldbe involved in the appraisal process and interview. It is appropriate andadvisable in most instances for the head nurse and supervisor also to beinvolved. However, employees must believe that the person doing themajor portion of the review has actually observed their work.

• The performance appraisal is more likely to have a positive outcome if theappraiser is viewed with trust and professional respect. This increases thechance that the employee will view the appraisal as a fair and accurateassessment of work performance. Welford (2002) maintains that buildingtrust is a hallmark of transformational leadership and necessary for staffempowerment. A summary of the factors influencing effectiveness ofappraisals can be seen in Display 24.2.


Appraisal should be based on a standard.Employee should have input into development of the standard.Employee must know standard in advance.Employee must know sources of data gathered for the appraisal.Appraiser should be someone who has observed employee’s work.Appraiser should be someone the employee trusts and respects.

Factors Influencing Effective PerformanceAppraisal

Display 24.2

Writing About Performance AppraisalsDuring your lifetime, you probably have had many performanceappraisals. These may have been evaluations of your clinical performanceduring nursing school or as a paid employee. Reflect on these appraisals.How many of them encompassed the six recommendations listed in thechapter? How did the inclusion or exclusion of these recommendationsinfluence your acceptance of the results?Assignment: Select one of the above six recommendations about whichyou feel strongly. Write a three-paragraph essay on your personal experi-ence involving this recommendation.

Learning Exercise 24.1A

STRATEGIES TO ENSURE ACCURACY AND FAIRNESS IN THE PERFORMANCE APPRAISAL

A performance appraisal wastes time if it is merely an excuse to satisfy regulationsand the goal is not employee growth. If the employee views the appraisal as valu-able and valid, it can have many positive effects. Information obtained during theperformance appraisal can be used to develop the employee’s potential, to assist theemployee in overcoming difficulties he or she has in fulfilling the job’s role, to pointout strengths of which the employee may not be aware, and to aid the employee insetting goals. Because inaccurate and unfair appraisals are negative and demotivat-ing, it is critical that the manager use strategies that increase the likelihood of a fairand accurate appraisal. Although some subjectivity is inescapable, the followingwill assist the manager in arriving at a fairer and more accurate assessment.

The appraiser should develop an awareness of his or her own biases and prej-udices. This helps guard against subjective attitudes and values influencing theappraisal. The appraiser’s gender also may influence the accuracy of the perform-ance appraisal. Rudan (2003) states that women leaders view liking, trusting, andhelping others as more significant in the workplace than men do. Therefore,female managers are more apt to give a favorable evaluation during performanceappraisal than male managers are in an effort to meet affiliation needs. On theother hand, male managers tend to have lower affiliation needs and higherachievement needs; thus, they may be more willing to give constructive criticismeven if they expect the employee to be defensive (McMurray, 1993).

Consultation should be sought frequently. Another manager should be consultedwhen a question about personal bias exists and in many other situations. For exam-ple, it is very important that new managers solicit assistance and consultation whenthey complete their first performance appraisals. Even experienced managers mayneed to consult with others when an employee is having great difficulty fulfilling theduties of the job. Consultation also must be used when employees work several shiftsso information can be obtained from all the shift supervisors.

Data should be gathered appropriately. Not only should many different sources beused in gathering data about employee performance, but the data gathered also needto reflect the entire time period of the appraisal. Frequently, managers gather data andobserve an employee just before completing the appraisal, which gives an inaccuratepicture of performance. Because all employees have periods when they are less pro-ductive and motivated, data should be gathered systematically and regularly. Indeed,Fandray (2001) suggests that annual performance appraisals are falling out of favorwith human resource professionals. Instead, companies are turning to a process ofongoing assessment and feedback that emphasizes teamwork and shared leadership.

Accurate record keeping is another critical part of ensuring accuracy and fair-ness in the performance appraisal. Information about subordinate performance(both positive and negative) should be written down and not trusted to memory.The manager should make a habit of keeping notes about observations, others’comments, and his or her periodic review of charts and nursing care plans. Whenongoing anecdotal notes are not maintained throughout the evaluation period, theappraiser is more apt to experience the recency effect, in which the importance ofrecent issues outweighs past performance (Smith, 2003).


Collected assessments should contain positive examples of growth and achieve-ment and areas where development is needed. Nothing delights employees morethan discovering their immediate supervisor is aware of their growth and accom-plishments and can cite specific instances in which good clinical judgment was used.Too frequently, collected data concentrate on negative aspects of performance.

Some effort must be made to include the employee’s own appraisal of his or herwork. Self-appraisal may be performed in several appropriate ways. Employees canbe instructed to come to the appraisal interview with some informal thoughts abouttheir performance, or they can work with their managers in completing a jointassessment. One advantage of management by objectives (MBO)—the use of person-alized goals to measure individual performance—is the manner in which it involvesthe employee in assessing his or her work performance and in goal setting.

Lastly, the appraiser needs to guard against the three common pitfalls of assess-ment: the halo effect, the horns effect, and central tendency. The halo effect occurswhen the appraiser lets one or two positive aspects of the assessment or behaviorof the employee unduly influence all other aspects of the employee’s performance.The horns effect occurs when the appraiser allows some negative aspects of theemployee’s performance to influence the assessment to such an extent that otherlevels of job performance are not accurately recorded. The manager who falls intothe central tendency trap is hesitant to risk true assessment and therefore rates allemployees as average. These appraiser behaviors lead employees to discount the


Nothing delightsemployees more thandiscovering theirimmediate supervisor isaware of their growthand accomplishmentsand can cite specificinstances in which goodclinical judgment wasused.

Planning an Employee’s First Performance AppraisalMrs. Jones is a new LVN/LPN and has been working 3 P.M. to 11 P.M. on thelong-term care unit where you are the PM charge nurse. It is time for herthree-month performance appraisal. In your facility, each employee’s jobdescription is used as the standard of measure for performance appraisal.

Essentially, you believe Mrs. Jones is performing her job well but aresomewhat concerned because she still relies on the RNs for even minorpatient care decisions. Although you are glad that she does not act com-pletely on her own, you would like to see her become more independent.The patients have commented favorably to you on Mrs. Jones’ compassionand on her follow-through on all their requests and needs.

Mrs. Jones gets along well with the other LVNs/LPNs, and you some-times believe they take advantage of her hard-working and pleasantnature. On a few occasions, you believe they inappropriately delegatedsome of their work to her.

When preparing for Mrs. Jones’ upcoming evaluation, what can you doto make the appraisal as objective as possible? You want Mrs. Jones’ firstevaluation to be growth producing.Assignment: Plan how you will proceed. What positive forces arealready present in this scenario? What negative forces will you have toovercome? Support your plan with readings from the bibliography atthe end of this chapter.

Learning Exercise 24.2

entire assessment of their work. See Display 24.3 for a summary of performanceappraisal strategies.

PERFORMANCE APPRAISAL TOOLS

Since the 1920s, many appraisal tools have been developed. Certain types of toolsor review techniques have been popular at different times. Since the early 1990s,the Joint Commission on Accreditation of Healthcare Organizations ( JCAHO)has been advocating the use of an employee’s job description as the standard forperformance appraisal. Currently, JCAHO mandates that acute care hospitalsassess, measure, prove, track, and trend the age-specific competency of staff mem-bers with specific job titles (Krozek & Scoggins, 2001). In other words, employersmust be able to demonstrate that employees know how to plan, implement, andevaluate care specific to the ages of the patients they care for. This continual refine-ment of critical competencies for professional nursing practice has a tremendousimpact on the tools used in the appraisal process.

However, JCAHO makes it very clear that competence assessments are not thesame as performance evaluations. A competence assessment evaluates whether anindividual has the knowledge, education, skills, experience, and proficiency to per-form assigned responsibilities; a performance evaluation assesses how well an indi-vidual actually performs (Herringer, 2002).

The effectiveness of a performance appraisal system is only as good as the toolsused to create those assessments. An effective competence assessment tool shouldallow the manager to focus on priority measures of performance. The following is anoverview of some of the appraisal tools commonly used in healthcare organizations.

Trait Rating Scales

A rating scale is a method of rating a person against a set standard, which may be thejob description, desired behaviors, or personal traits. The rating scale is probably themost widely used of the many available appraisal methods.

Rating personal traits and behaviors is the oldest type of rating scale. Manyexperts argue, however, that the quality or quantity of the work performed is a more


Develop self-awareness regarding own biases and prejudices.Use appropriate consultation.Gather data adequately over period of time.Keep accurate anecdotal records for length of appraisal period.Collect positive data and areas where improvement is needed.Include employee’s own appraisal of their performance.Guard against halo effect, horns effect, and central tendency trap.

Strategies to Ensure Performance AppraisalAccuracy

Display 24.3

accurate performance appraisal method than the employee’s personal traits andthat trait evaluation invites subjectivity. Rating scales also are subject to centraltendency and halo- and horns-effect errors and thus are not used as often today asthey were in the past. Instead, many organizations use two other rating methods,namely the job dimension scale and the behaviorally anchored rating scale(BARS). Display 24.4 shows a portion of a trait rating scale with examples oftraits that might be expected in a registered nurse.

Job Dimension Scales

This technique requires that a rating scale be constructed for each job classifica-tion. The rating factors are taken from the context of the written job description.Although job dimension scales share some of the same weaknesses as trait scales,they do focus on job requirements rather than on ambiguous terms such as “quan-tity of work.’’ Display 24.5 shows an example of a job dimension scale for anindustrial nurse.

Behaviorally Anchored Rating Scales

BARS, sometimes called behavioral expectation scales, overcome some of the weak-nesses inherent in other rating systems. As in the job dimension method, theBARS technique requires that a separate rating form be developed for each jobclassification. Then, as in the job dimension rating scales, employees in specificpositions work with management to delineate key areas of responsibility. However,in BARS, many specific examples are defined for each area of responsibility; theseexamples are given various degrees of importance by ranking them from 1 to 9. If


Job KnowledgeSerious gaps Satisfactory Adequately Good knowledge Excellent

in essential knowledge informed on of all understandingknowledge of routine most phases phases of job of the job

1 2 3 4 5JudgmentDecisions are Makes some Good Sound and Makes good,

often wrong decision errors decisions logical thinker complexon issues decisions

1 2 3 4 5AttitudeResents Apathetic but Generally Openly Consistently

suggestions, cooperative cooperative cooperates and helpful andno enthusiasm and accepting of new ideas accepts new enthusiastic

ideas1 2 3 4 5

Sample Trait Rating ScaleDisplay 24.4

the highest-ranked example of a job dimension is being met, it is less importantthan a lower-ranked example that is not.

Appraisal tools firmly grounded in desired behaviors can be used to improveperformance and keep employees focused on the vision and mission of the organi-zation. However, because separate BARS are needed for each job, the greatest dis-advantage in using this tool with large numbers of employees is the time andexpense. BARS also are primarily applicable to physically observable skills ratherthan to conceptual skills. However, this is an effective tool because it focuses onspecific behaviors, allows employees to know exactly what is expected of them, andreduces rating errors.

Although all rating scales are prone to weaknesses and interpersonal bias, theydo have some advantages. Many may be purchased, and although they must beindividualized to the organization, there is little need for expensive worker hours todevelop them. Rating scales also force the rater to look at more than one dimensionof work performance, which eliminates some bias.

Checklists

There are several types of checklist appraisal tools. The weighted scale, the most fre-quently used checklist, is composed of many behavioral statements that representdesirable job behaviors. Each of these behavior statements has a weighted scoreattached to it. Employees receive an overall performance appraisal score based onbehaviors or attributes. Often merit raises are tied to the total point score (i.e., theemployee needs to reach a certain score to receive an increase in pay).

Another type of checklist, the forced checklist, requires that the supervisor selectan undesirable and a desirable behavior for each employee. Both desirable andundesirable behaviors have quantitative values, and the employee again ends upwith a total score on which certain employment decisions are made.

Another type of checklist is the simple checklist. The simple checklist is com-posed of numerous words or phrases describing various employee behaviors ortraits. These descriptors are often clustered to represent different aspects of one


Job Dimension 5 4 3 2 1Renders first aid and treats job-related injuries and illnessesHolds fitness classes for workersTeaches health and nutrition classesPerforms yearly physicals on workersKeeps equipment in good working order and maintains inventoryKeeps appropriate recordsDispenses medication and treatment for minor injuries(5 = Excellent; 4 = Good; 3 = Satisfactory; 2 = Fair; 1 = Poor)

Sample Job Dimension Rating Scale for an Industrial Nurse

Display 24.5

dimension of behavior, such as assertiveness or interpersonal skills. The rater isasked to check all those that describe the employee on each checklist.

A major weakness of all checklists is that there are no set performance stan-dards. In addition, specific components of behavior are not addressed. Checklistsdo, however, focus on a variety of job-related behaviors and avoid some of the biasinherent in the trait-rating scales.

Essays

The essay appraisal method is often referred to as the free-form review. The apprais-er describes in narrative form an employee’s strengths and areas where improve-ment or growth is needed. Although this method can be unstructured, it usuallycalls for certain items to be addressed. This technique has some strengths because itforces the appraiser to focus on positive aspects of the employee’s performance.However, a greater opportunity for personal bias undoubtedly exists.

Many organizations combine various types of appraisals to improve the qualityof their review processes. Because the essay method does not require exhaustivedevelopment, it can quickly be adapted as an adjunct to any type of structured for-mat. This gives the organization the ability to decrease bias and focus on employeestrengths.

Self-Appraisals

Employees are increasingly being asked to submit written summaries or portfolios oftheir work-related accomplishments and productivity as part of the self-appraisalprocess. Portfolios often provide examples of how the employee has implementedclinical guidelines and achieved patient outcomes, as well as including samplepatient care documentation (Taylor, 2000). The portfolio also generally includes theemployee’s goals and an action plan for accomplishing these goals.

There are advantages and disadvantages to using self-appraisal as a method ofperformance review. Although introspection and self-appraisal result in growthwhen the person is self-aware, even mature people require external feedback andperformance validation.

Some employees may look on their annual performance review as an opportuni-ty to receive positive feedback from their supervisor, especially if the employeereceives infrequent praise on a day-to-day basis. Asking these employees to per-form their own performance appraisal would probably be viewed negatively ratherthan positively.

In addition, some employees undervalue their accomplishments or may feeluncomfortable giving themselves high marks in many areas. In an effort to avoidthis potential influence on their rating, managers may wish to complete the per-formance appraisal tool before reading the employee’s self-analysis, or they shouldview the self-appraisal as only one of a number of sources of data that should becollected when evaluating worker performance. When self-appraisal is not con-gruent with other data available, the manager may wish to pursue the reasons forthis discrepancy during the appraisal conference. Such an exchange may provide


valuable insight regarding the worker’s self-awareness and ability to view himselfor herself objectively.

Management by Objectives (MBO)

MBO is an excellent tool for determining an individual employee’s progressbecause it incorporates the assessments of the employee and the organization. Thefocus in this chapter, however, is on how these concepts are used as an effectiveperformance appraisal method, rather than on their use as a planning technique.

Although it is not used frequently in health care, MBO is an excellent methodto appraise the performance of the registered nurse in a manner that promotes indi-vidual growth and excellence in nursing. The following steps delineate how MBOcan be used effectively in performance appraisal:

1. The employee and supervisor meet and agree on the principal duties andresponsibilities of the employee’s job. (The job description serves as a guideonly.) This is done as soon as possible after beginning employment.

2. The employee sets short-term goals and target dates in cooperation with thesupervisor or manager. The manager guides the process so it relates to theposition’s duties. In addition, the subordinate’s goals must not be in conflictwith the goals of the organization. In setting goals, it is important that themanager remember that one’s values and beliefs simply reflect a single set ofoptions among many; this is especially true in working with a multiculturalstaff (Taylor, 1998). Professional expectations and values can vary greatlyamong cultures, and the manager must be careful to resist judgmental reac-tions and allow for cultural differences in goal setting.

3. Both parties agree on the criteria that will be used for measuring andevaluating the accomplishment of goals. In addition, a time frame is setfor completing the objectives, which depends on the nature of the workbeing planned. Common time frames used in healthcare organizationsvary from one month to one year.

4. Regularly, but more than once a year, the employee and supervisor meet todiscuss progress. At these meetings, some modifications can be made to theoriginal goals if both parties agree. Major obstacles that block completion ofobjectives within the time frame are identified. In addition, the resourcesand support needed from others are identified.

5. The manager’s role is supportive, assisting the employee to reach goals bycoaching and counseling.

6. During the appraisal process, the manager determines whether theemployee has met the goals.

7. The entire process focuses on outcomes and results and not on personaltraits.

One of the many advantages of MBO is that the method creates a vestedinterest in the employee to accomplish goals because employees are able to settheir own goals. Additionally, defensive feelings are minimized, and a spirit ofteamwork prevails.


In management byobjectives, the focus is onthe controllable presentand future rather thanthe uncontrollable past.

MBO as a performance appraisal method has its disadvantages. Highly directiveand authoritarian managers find it difficult to lead employees in this manner. Also,the marginal employee frequently attempts to set easily attainable goals. However,research has shown that MBO, when used correctly, is a very effective method ofperformance appraisal.


Reviewing MBOs as a Part of Performance AppraisalIt is time for Nancy Irwin’s annual performance appraisal. She is an RNon a postsurgical unit, dealing with complex trauma patients requiringhigh-level nursing intensity. You are the evening charge nurse and haveworked with Ms. Irwin for the two years since she has graduated fromnursing school. Last year, in addition to the regular 1 to 5 rating scalefor job expectations, all the charge nurses added an MBO component tothe performance appraisal form. In collaboration with his or her chargenurse, each employee developed five goals that were supposed to havebeen carried out over a one-year period.

In reviewing Ms. Irwin’s performance, you use several sources, includingyour written notes and her charting, and your conclusion is that with herstrengths and weaknesses, overall she is a better-than-average nurse. How-ever, you believe she has not grown much as an employee over the past sixmonths. This observation is confirmed by a review of the following:Objective Result1. Conduct a mini-inservice or Met goal first two months.

patient care conference twice Last 10 months conducted only six monthly for the next 12 months. conferences.

2. Will attend five educational Attended one surgical nursing classes related to work area; wound conference in the city and at least one of these will be one in-house conference on TPN.given by an outside agency.

3. Will become an active member Has become an active member of of a nursing committee at the the Policies and Procedures hospital. Committee and regularly attends

meetings.4. Reduce the number of late First three months: not late. Second

arrivals at work three months: three late arrivals. by 50% (from 24 per year to 12). Third three months: six late arrivals.

Last three months: six late arrivals.5. Ensure that all patients Anecdotal notes show that Ms. Irwin

discharged have discharge still frequently forgets to document instructions documented in their these nursing actions.charts.

Assignment: As Ms. Irwin’s charge nurse, what can you do to ensure thatthe current appraisal results in greater growth for her? What went wrongwith last year’s MBO plan? Devise a plan for the performance appraisal.



Analysis: This case could have several different approaches, depending onwhether motivation or change theory or another rationale was being imple-mented to support the decisions. In reality, a manager may employ severaldifferent theories in order to increase productivity. However, this case will besolved using only performance appraisal techniques in order to demonstratethat they can also serve as an effective method to control productivity.

There are several aspects that seem to stand out in the information pre-sented in this case. First, it appears that Ms. Irwin is a person who needsto be reminded. She functions well in objective #3 because she receivedmonthly reminders of the meetings, and because she worked with agroup of people she was able to make a real contribution to this commit-tee. The similarities among the other four objectives are that (1) they allrequired Ms. Irwin to work alone to accomplish them and (2) there wereno built-in reminders.

Rather than viewing this performance appraisal critically, the chargenurse should expend her energy in developing a plan to help Ms. Irwinsucceed in the coming months. Nothing is as depressing or demotivatingto an employee as failure. The following plan concentrates only on theMBO portion of Ms. Irwin’s performance appraisal and does not center onthe rating scale of job performance.Prior to the Interview Rationale1. Ask Ms. Irwin to review her 1. Gives the employee opportunity

objectives from last year and to for individual problem solving come prepared to discuss them. and personal introspection.

2. Set a convenient time for you 2. Shows interest in and respect for and Ms. Irwin and allow the employee.adequate time and privacy.

At the Interview Rationale1. Begin by complimenting 1. Shows interest in and support of

Ms. Irwin on meeting objective employee.#3. Ask her about her work on the committee, what procedures she is working on, and so forth.

2. Review each of the other four 2. Allows the employee to make her objectives and ask for Ms. Irwin’s own judgments about her input. Withhold any evidence performance.or criticism at this point.

3. Ask Ms. Irwin if she sees a 3. Guide the employee into problem pattern. solving on her own.

4. Tell Ms. Irwin that MBO often 4. This is an offer to assist the works better if objectives are employee in achieving improved reviewed on a more timely basis performance and is not a punitive and ask how she feels about this. measure. It allows employee to

have input.5. Suggest that she keep her unmet 5. Employees should be encouraged

four objectives and add one to meet objectives unless they new one. were stated poorly or were

unrealistic.

Peer Review

When peers rather than supervisors carry out monitoring and assessing workperformance, it is referred to as peer review. Most likely, the manager’s review of theemployee is not complete unless some type of peer review data is gathered. Peer reviewprovides feedback that can promote growth. It also can provide learning opportunitiesfor the peer reviewers. Taylor (2000) suggests that peers who work together have alevel of insight into each other’s clinical practice, and that peer review providesemployees with an opportunity to receive better feedback about self-improvement.

The concept of collegial evaluation of nursing practice is closely related to main-taining professional standards. Peer review has the potential for increased profession-alism, performance, and professional accountability among practicing staff and isgaining popularity in the United States and internationally (Vuorinen, Tarkka, &Meretoja, 2000). Although the prevailing practice in most organizations is to havemanagers evaluate employee performance, there is much to be said for collegial review.

Peer review is widely used in medicine and by faculty in universities; however,healthcare organizations have been slow to adopt peer review for the following fivereasons:

1. Staff are poorly oriented to the peer review method. Peer review is viewed asvery threatening when inadequate time is spent orienting employees to theprocess and when necessary support is not provided throughout the process.

2. Peers feel uncomfortable sharing feedback with people with whom theywork closely, so they omit needed suggestions for improving the employee’sperformance. Thus, the review becomes more advocacy than evaluation.

3. Peer review is viewed by many as more time-consuming than traditionalsuperior–subordinate performance appraisals.

4. Because much socialization takes place in the workplace, friendships oftenresult in inflated evaluations, or interpersonal conflict may result in unfairappraisals.

5. Because peer review shifts the authority away from management, theinsecure manager may feel threatened.

Peer review has its shortcomings, as evidenced by some university teachers receiv-ing unjustified tenure or the failure of physicians to maintain adequate quality control


6. Work with Ms. Irwin in 6. Again, this is helping the employee developing a reminder or check to succeed. Do not simply point system that will assist tell employees that they should her in meeting her objectives. do better; help them identify how.

7. Do not sympathize or excuse her 7. The focus should remain on for not meeting objectives. growth and not on the status quo.

8. End on a note of encouragement 8. Employees often live up to theirand support: “I know that you manager’s expectations of them, are capable of meeting these and if those expectations are for objectives.’’ growth, then the chances are

greater that it will occur.

Peer review, whenimplemented properly,provides the employeewith valuable feedbackthat can promotegrowth.

among some individuals in their profession. Additionally, peer review involves muchrisk taking, is time-consuming, and requires a great deal of energy. However, nursingas a profession should be responsible for setting the standards and then monitoringits own performance. Because performance appraisal may be viewed as a type of qual-ity control, it seems reasonable to expect that nurses should have some input into theperformance evaluation process of their profession’s members.

Peer review can be carried out in several ways. The process may require thereviewers to share the results only with the person being reviewed, or the resultsmay be shared with the employee’s supervisor and the employee. The review wouldnever be shared only with the employee’s supervisor.

The results may or may not be used for personnel decisions. The number ofobservations, number of reviewers, qualification and classification of the peerreviewer, and procedure need to be developed for each organization. If peer reviewis to succeed, the organization must overcome its inherent difficulties by doing thefollowing before implementing a peer review program:

• Peer review appraisal tools must reflect standards to be measured, such as thejob description.

• Staff must receive a thorough orientation to the process before its implemen-tation. The role of the manager should be clearly defined.

• Ongoing support, resources, and information must be made available to thestaff during the process.

• Data for peer review need to be obtained from predetermined sources, suchas observations, charts, and patient care plans.

• A decision must be made about whether anonymous feedback will beallowed. This is controversial and needs to be addressed in the procedure.

• Decisions must be reached on whether the peer review will affect personneldecisions and, if so, in what manner.

Peer review has the potential to increase the accuracy of performance appraisal.It also can provide many opportunities for increased professionalism and learning.The use of peer review in nursing should continue to expand as nursing increasesits autonomy and professional status. See Display 24.6 for a summary of types ofperformance appraisal tools.


Trait rating scales: Rates an individual against some standard.Job dimension scales: Rates the performance on job requirements.Behaviorally anchored rating scales (BARS): Rates desired job expectations on a scale of

importance to the position.Checklists: Rates the performance against a set list of desirable job behaviors.Essays: A narrative appraisal of job performance.Self-appraisals: An appraisal of performance by the employee.Management by objectives: Employee and management agree upon goals of performance

to be reached.Peer review: Assessment of work performance carried out by peers.

Summary of Performance Appraisal ToolsDisplay 24.6

PLANNING THE APPRAISAL INTERVIEW

The most accurate and thorough appraisal will fail to produce growth in employees ifthe information gathered is not used appropriately. Many appraisal interviews havenegative outcomes because the manager views them as a time to instruct employeesonly on what they are doing wrong, rather than looking at strengths as well.

Managers often dislike the appraisal interview more than the actual data gath-ering. One of the reasons managers dislike the appraisal interview is because oftheir own negative experiences when they have been judged unfairly or criticizedpersonally. Both parties in the appraisal process tend to be anxious before theinterview; thus, the appraisal interview remains an emotionally charged event. Formany employees, past appraisals have been traumatizing. Although little can bedone to eliminate the often-negative emotions created by past experiences, theleader–manager can manage the interview in such a manner that people will notbe traumatized further.

OVERCOMING APPRAISAL INTERVIEW DIFFICULTIES

Feedback, perhaps the greatest tool a manager has for changing behavior, must begiven in an appropriate manner. There is a greater chance that the performance


Addressing Mary’s Change in BehaviorEven in organizations that have no formal peer review process, profes-sionals must take some responsibility for colleagues’ work performance,even if informally. The following scenario illustrates the need for peerinvolvement.

Since your graduation from nursing school, you have worked at Memorial Hospital. Your school room mate, Mary, also has worked atMemorial since her graduation. For the first year, you and Mary wereassigned to different units, but you both were transferred to the oncologyunit six months ago.

You both work 3 P.M. to 11 P.M., and it is the policy for the charge nurseduties to alternate among three RNs assigned to the unit on a full-timebasis. Both you and Mary are among the nurses assigned to rotate to thecharge position. You have noticed lately that when Mary is in charge, herpersonality seems to change; she barks orders and seems tense and anxious.

She is an excellent clinical nurse, and many of the staff seek her out inconsultation about patient care problems. You have, however, heard sev-eral of the staff grumbling about Mary’s behavior when she is in charge.As Mary’s good friend, you do not want to hurt her feelings, but as hercolleague you feel a need to be honest and open with her.Assignment: A very difficult situation occurs when personal and workingrelationships are combined. Describe what, if anything, you would do. Usethe readings from the Bibliography to assist you in making a plan.


The most accurate andthorough appraisal willfail to produce growth in employees if theinformation gathered isnot used appropriately.

appraisal will have a positive outcome if certain conditions are present before, during,and after the interview.

Before the Interview

• Make sure that the conditions mentioned previously have been met (e.g., theemployee knows the standard by which his or her work will be evaluated),and he or she has a copy of the appraisal form.

• Select an appropriate time for the appraisal conference. Do not choose atime when the employee has just had a traumatic personal event or is toobusy at work to take the time needed for a meaningful conference.

• Give the employee a two- to three-day advance notice of the scheduledappraisal conference so he or she can be prepared mentally and emotionallyfor the interview.

• Be personally prepared mentally and emotionally for the conference. Ifsomething should happen to interfere with your readiness for the interview,it should be canceled and rescheduled.

• Schedule uninterrupted interview time. Hold the interview in a private,quiet, and comfortable place. Forward your telephone calls to another lineand ask another manager to answer any pages you may have during theperformance appraisal.

• Plan a seating arrangement that reflects collegiality rather than power.Having the person seated across a large desk from the appraiser denotes apower–status position; placing the chairs side by side denotes collegiality.

During the Interview

• Greet the employee warmly, showing that the manager and the organizationhave a sincere interest in his or her growth.

• Begin the conference on a pleasant, informal note.• Ask the employee to comment on his or her progress since the last perform-

ance appraisal.• Avoid surprises in the appraisal conference. The effective leader coaches and

communicates informally with staff on a continual basis, so there should belittle new information at an appraisal conference. Cohen (2000) goes so faras to assert that if the employee first hears about a performance concernduring the appraisal, the manager has not been doing his or her job.

• Use coaching techniques throughout the conference.• When dealing with an employee who has several problems—either new or

long-standing—don’t overwhelm him or her at the conference. If there aretoo many problems to be addressed, select the major ones.

• Conduct the conference in a nondirective and participatory manner. Inputfrom the employee should be solicited throughout the interview; however, themanager must recognize that employees from some cultures may be hesitantto provide this type of input. In this situation, the manager must continuallyreassure the employee that such input is not only acceptable but desired.


• Focus on the employee’s performance and not on his or her personal characteristics.

• Avoid vague generalities, either positive or negative, such as “your skills needa little work’’ or “your performance is fine.’’ Be prepared with explicit per-formance examples. Be liberal in the positive examples of employee perform-ance; use examples of poor performance sparingly. Use several examples onlyif the employee has difficulty with self-awareness and requests specificinstances of a problem area.

• When delivering performance feedback, be straightforward and state con-cerns directly. Indirectness and ambiguity are more likely to inhibit commu-nication than enhance it, and the employee is left unsure about thesignificance of the message.

• Never threaten, intimidate, or use status in any manner. The appraiser mustmake sure that the person’s self-esteem is not threatened, because this willprevent the nurturing of a meaningful and constructive relationship betweenthe manager and employee.

• Let the employee know that the organization and the manager are aware of his or her uniqueness, special interests, and valuable contributions to the unit. Remember that all employees make some special contribution to the workplace.

• Make every effort to ensure that there are no interruptions during the conference.

• Use terms and language that are clearly understood and carry the samemeaning for both parties. Avoid words that have a negative connotation.Do not talk down to employees or use language that is inappropriate fortheir level of education.

• Mutually set goals for further growth or improvement in the employee’sperformance. Decide how goals will be accomplished and evaluated andwhat support is needed.

• Plan on being available for employees to return retrospectively to discuss theappraisal review further. There is frequently a need for the employee to returnfor elaboration if the conference did not go well or if the employee was givenunexpected new information. This is especially true for the new employee.

After the Interview

• Both the manager and employee need to sign the appraisal form to docu-ment that the conference was held and that the employee received theappraisal information. This does not mean that the employee is agreeing tothe information in the appraisal; it merely means the employee has read theappraisal. An example of such a form is shown in Display 24.7. Thereshould be a place for comments by both the manager and the employee.

• End the interview on a pleasant note.• Document the goals for further development that have been agreed on by both

parties. The documentation should include target dates for accomplishment,


support needed, and when goals are to be reviewed. This documentation isoften part of the appraisal form.

• If the interview reveals specific long-term coaching needs, the managershould develop a method of follow-up to ensure such coaching takes place.

PERFORMANCE MANAGEMENT

Some experts in human resource management have suggested that annual perform-ance appraisals should be replaced by ongoing performance management (Coens,Jenkins, & Block, 2000; Fandray, 2001). In performance management, appraisalsare eliminated. Instead, the manager places his or her efforts into ongoingcoaching, mutual goal setting, and the leadership training of subordinates. Thisfocus requires the manager to spend more regularly scheduled face-to-face timewith subordinates. “Thus, it is people who are managed, rather than paper flow’’(Fandray, 2001, p. 40).

In contrast to the annual performance review, which is usually associated withan employee’s hire date, the performance management calendar is generally linkedto the organization’s business calendar (Weizmann, as cited in Fandray, 2001). This


Performance appraisal for:Name: ______________________________________________________________Unit: _______________________________________________________________Prepared by: __________________________________________________________Reason: _____________________________________________________________(Merit, terminal, end of probation, general reviews)Date of evaluation conference: ____________________________________________Comments by employee:

Employee’s signature: ___________________________(Signature of employee denotes that the evaluation has been read. It does not signifyacceptance or agreement. Space is provided for any comments employee wishes to make.)Comments by evaluator:

(These comments are to be written at the time of the evaluation conference and in thepresence of the employee.)_______________________ _______________________Employee’s signature (Date) Evaluator’s signature (Date)

Performance Appraisal Documentation FormDisplay 24.7

way, performance planning is coordinated throughout the entire organization. Inthis manner, strategic goals for the year can be identified and subordinates’ roles toachieve those goals can be openly discussed and planned.

Weizmann also suggests that performance-managed organizations articulate a setof role-based competencies and let every employee know the five or six qualities thatdefine success for every member of the organization, regardless of job description.Then employees can determine how these qualities translate into performance inspecific jobs. Expectations, then, are not disputable; they are part of the agreed-uponroles assumed by subordinates (Fandray, 2001).

COACHING: A MECHANISM FOR INFORMAL PERFORMANCEAPPRAISAL

Effective managers and astute leaders are aware that day-to-day feedback regardingperformance is one of the best methods for improving work performance and build-ing a team approach. The word coaching has become a contemporary term to conveythe spirit of the manager’s role in informal day-to-day performance appraisals.Coaching techniques also should be used in the formal appraisal interview but areespecially effective for encouraging and correcting daily work performance. Perfor-mance coaching can help people through life transitions, can be instrumental in themature development of an individual’s basic values, can produce high performancein work or other aspects of people’s lives, can help people develop a vision and pur-pose for their endeavors, and can help with career and life planning (Detmer, 2002;Robinson-Walker, 2002). Coaching can guide others into increased competence,commitment, and confidence as well as helping them to anticipate options formaking vital connections between their present and future plans.

Manthey (2001) uses the terms reflective practice and clinical coaching to describe amanagement strategy that fuses both performance coaching and performance man-agement. In clinical coaching, the manager or mentor meets with an employee regu-larly to discuss aspects of his or her work. Both individuals determine the agendajointly with the goal of an environment of learning that can span the personal andprofessional aspects of the employee’s experience. During clinical coaching, employ-ees can discuss things that have made them feel angry or discouraged. They can alsoget new ideas and information about how to deal with situations from someone whooften has experienced the same problems and issues.This shared connection betweenthe manager and employee makes the employee feel validated and part of a largerteam. When coaching is combined with informal performance appraisal, the out-come is usually a positive modification of behavior. For this to occur, however, theleader must establish a climate in which there is a free exchange of ideas.

Robinson-Walker (2002) suggests that certain managerial skills are necessaryfor coaching to succeed and improve work performance. The following tactics willassist managers in becoming effective coaches:

• Be specific, not general, in describing behavior that needs improvement.• Be descriptive, not evaluative, when describing what was wrong with the

work performance.


• Be certain that the feedback is not self-serving but meets the needs of theemployee.

• Direct the feedback toward behavior that can be changed.• Use sensitivity in timing the feedback.• Make sure the employee has clearly understood the feedback and that the

employee’s communication also has been clearly heard.

When employees believe that their manager is interested in their performanceand personal growth, they will have less fear of the work performance appraisal.When that anxiety is reduced, the formal performance interview process can beused to set mutual performance goals.

INTEGRATING LEADERSHIP ROLES AND MANAGEMENT FUNCTIONS IN CONDUCTING PERFORMANCE APPRAISALS

Performance appraisal is a major responsibility in the controlling function of man-agement. The ability to conduct meaningful, effective performance appraisalsrequires an investment of time, effort, and practice on the part of the manager.Although performance appraisal is never easy, if used appropriately it producesgrowth in the employee and increases productivity in the organization.

To increase the likelihood of successful performance appraisal, managers shoulduse a formalized system of appraisal and gather data about employee performancein a systematic manner, using many sources. The manager also should attempt to beas objective as possible, using established standards for the appraisal. The result ofthe appraisal process should provide the manager with information for meetingtraining and educational needs of employees. By following up conscientiously onidentified performance deficiencies, employees’ work problems can be correctedbefore they become habits.

Integrating leadership into this part of the controlling phase of the managementprocess provides an opportunity for sharing, communicating, and growing. The inte-grated leader–manager is self-aware regarding his or her own biases and prejudices.This self-awareness leads to fairness and honesty in evaluating performance. This, inturn, increases trust in the manager and promotes a team spirit among employees.

The leader also uses day-to-day coaching techniques to improve work perform-ance and reduce the anxiety of performance appraisal. When anxiety is reducedduring the appraisal interview, the leader–manager is able to establish a relation-ship of mutual goal setting, which has a greater potential to result in increasedmotivation and corrected deficiencies. The result of the integration of leadershipand management is a performance appraisal that facilitates employee growth andincreases organizational productivity.

❊ Key Concepts

• The employee performance appraisal is a sensitive and important part of themanagement process, requiring much skill.

• When accurate and appropriate appraisal assessments are performed, theoutcomes can be very positive.


• Performance appraisals are used to determine how well employees are per-forming their job, using the job description as a standard of measurement.

• There are many different types of appraisal tools, and selection of the mostappropriate tool varies with the type of appraisal to be done and the criteriato be measured.

• The employee must be involved in the appraisal process and must view theappraisal as accurate and fair.

• Management by objectives (MBO) has proven to increase productivity andcommitment in employees.

• Peer review has great potential for developing professional accountability.• Unless the appraisal interview is carried out in an appropriate and effective

manner, the performance appraisal data will be useless.• Due to past experiences, performance appraisal interviews are highly

charged, emotional events for most employees.• Showing a genuine interest in the employee’s growth and seeking his or her

input at the interview will increase the likelihood of a positive outcomefrom the appraisal process.

• Performance appraisals should be signed to show that feedback was given tothe employee.

• Informal work performance appraisals are an important managementfunction.

• Leaders should routinely use appropriate coaching techniques to improvework performance on an informal basis.

• In performance management, appraisals are eliminated. Instead, the managerplaces his or her efforts into ongoing coaching, mutual goal setting, and theleadership training of subordinates.

More Learning Exercises and Applications


Requesting Feedback from EmployeesYou are the director of a home health agency. You have just returned froma management course and have been inspired by the idea of requestinginput from your subordinates about your performance as a manager.

You realize that there are some risks involved but believe the potentialbenefits from the feedback outweigh the risks. However, you want toprovide some structure for the evaluation, so you spend some timedesigning your appraisal tool and developing your plan.Assignment: What type of tool will you use? What is your overall goal?Will you share the results of the appraisal with anyone else? How will youuse the information obtained? Would you have the appraisal formssigned or anonymous? Who would you include in the group evaluatingyou? Be able to support your ideas with appropriate rationale.



Making Appraisal Interviews Less TraumaticYou are the new night-shift charge nurse in a large intensive care unit com-posed of an all-RN staff. When you were appointed to the position, yoursupervisor told you there had been some complaints regarding the mannerin which the previous charge nurse had handled evaluation sessions.

Not wanting to repeat the mistakes, you draw up a list of things youcould do to make the evaluation interviews less traumatic. Because theevaluation tool appears adequate, you believe the problems must lie withthe interview itself. You put at the top of your list that you will make sureeach employee has advance notice of the evaluation.Assignment: How much advance notice should you give? What additionalcriteria would you add to the list to help eliminate much of the traumathat frequently accompanies performance appraisal (even when theappraisal is very good)?

Add six to nine items to the list. Explain why you think each of thesewould assist in alleviating some of the anxiety associated with perform-ance appraisals. Do not just repeat the guidelines listed in this chapter.You may make the guidelines more specific or use the Bibliography forassistance in developing your own list.

Learning Exercise 24.6A

Helping a Seasoned Employee to GrowPatty Brown is an LVN/LPN who has been employed on your unit for 10 years. She is an older woman and is very sensitive to criticism. Her work isgenerally of high quality, but in reviewing her past performance appraisals,you notice that during the last 10 years, at least seven times she has beenrated unsatisfactory for not being on duty promptly and eight times for notattending staff development programs. Because you are the new chargenurse, you would like to help Patty grow in these two areas.

You have given Patty a copy of the evaluation tool and her job descrip-tion and have scheduled her appraisal conference for a time when theunit will be quiet. You can conduct the appraisal in the conference room.Assignment: How would you conduct this performance appraisal? Outlineyour plan. Include how you would begin. What innovative or creative waywould you attempt to provide direction or improvement in the areasmentioned? How would you terminate the session? Be able to give ration-ale for your decisions.



Could This Conflict Have Been Prevented?Mr. Jones, a 49-year-old automobile salesman, was admitted with severeback pain. As his primary care nurse, you have established a rapport withMr. Jones. He has a type A personality and has been very critical of muchof his hospitalization. He also was very upset by the quality and quantityof his pain following his laminectomy.

You agreed to ambulate him on your shift three times (at 4 P.M., 7 P.M.,and 10:30 P.M.) so he would need to be ambulated only once during theday shift. He does not care for many of the day staff and feels that youhelp ambulate him better than anyone else. You noted the ambulatingroutine on his nursing orders.

Yesterday, Joan Martin, a day nurse, believed his bowel sounds weresomewhat diminished. She urged him to ambulate more on the day shift,but he refused to do so. (The doctor had ordered ambulation q.i.d.) WhenMr. Jones’ physician visited, nurse Martin told him that Mr. Jones ambulat-ed only once on the shift. She did not elaborate further to the doctor. Thephysician proceeded to talk very sternly with Mr. Jones, telling him to getout of bed three times today. Nurse Martin did not mention this incidentto you in report.

By the time you arrived on duty and received report, Mr. Jones was veryangry. He threatened to sign himself out against medical advice. Youtalked with his doctor, got the order changed, and finally managed tocalm Mr. Jones down. You then wrote a nursing order that read, “nurseMartin is not to be assigned to Mr. Jones again.’’

When Joan Martin came on duty this morning, the night shift pointedout your notation. She was very angry and went to see the head nurse.Assignment: Should you have done anything differently? If so, what?Could the evaluation of clinical performance by you and nurse Martinhave been done in a manner that would not have resulted in conflict? Ifyou were nurse Martin, what could you have done to prevent the con-flict? Be able to discuss this case in relation to professional trust, peerreview, and assertive communication.


Web Links

Coaching the Caterpillar to Fly: A program for developmenthttp://www.squarewheels.com/coaching/coachcat.htmlInteractive “square wheels’’ exercise and butterfly metaphor that emphasize coaching as atechnique for creating trust and team building in organizations.

Guide to Performance Management:http://www-hr.ucsd.edu/~staffeducation/guide/Includes overview of performance management, standards of performance, observa-tion and feedback, the appraisal process, performance appraisal models forms, and abibliography.

Performance Appraisalhttp://www.performance-appraisal.com/intro.htmOutlines basic purposes, methods, benefits, reward issues, conflict and confrontation,common mistakes, and bias effects associated with performance appraisal.


Addressing Sally’s Errors in JudgmentYou are a senior baccalaureate nursing student. This is your sixth week of amedical–surgical advanced practicum. Your instructor assigns two studentsto work together caring for four to six patients. The students alternatefulfilling leader and follower roles and providing total patient care. This isthe second full day you have worked as a team with Sally Brown.

Last week, when you were assigned with Sally, she was the leader andmade numerous errors in judgment. She got a patient up who was onstrict bed rest. She made an intravenous medication error by giving amedication to the wrong patient. She gave morphine too soon becauseshe forgot to record the time in the medication record, and she frequentlydid not seem to know what was wrong with her patients.

Today, you have been the leader and have observed her contaminate adressing and forget to check armbands twice when she was giving medica-tions. When you asked her about checking placement of the nasogastrictube, she did not know how to perform this skill. You have heard some ofthe other students complain about Sally.Assignment: What is your obligation to your patients, your fellow stu-dents, the clinical agency, and your instructor? Outline what you woulddo. Give rationale for your decisions.


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