Performance Appraisal

 

Our thanks to Patricia M. Ritter, MSN, PNP for answering this question. She found herself in the same situation recently.

Question: I have begun a new job and have been told that I need to develop my own performance appraisal forms. There are forms for RNs and MDs, but none for PNPs. Can you give me some ideas as to what I can do?

Answer: "About a year ago, as I was nearing the end of my Master's Program, I could finally see the light at the end of the tunnel. I secured a position as a PNP in a Pediatric Hematology / Oncology practice where I had been a nurse for nearly 5 1/2 years. Setting up protocols to give to the practice and to the various governing bodies, such as State Board of Nursing and the Hospital where I hold Allied Health Privileges, was relatively easy. There was a plethora of material and assistance available via the Internet, as well as from some of the seasoned practitioners I had met along the way. However, when I asked my collaborating physician how he planned to evaluate my performance he stated, 'Write something up!'

After completing the mountainous paperwork required to provide everyone with my protocols, applying for my D.E.A. number and negotiating my new contract, I now had to develop my own evaluation form. I thought 'how hard could it be?' I recalled that I was once told by an instructor, 'Use your resources.'

Two months later, I started devising my own evaluation forms while waiting for a helpful response from my resources. I received one last e-mail that confirmed what all the others told me -- that no one had an evaluation tool specifically geared for a NP/PNP. Each response I had received stated that they used whatever 'standard evaluation was available' and tried to gear it toward their role in the setting in which they practiced. I concluded that if I didn't make the evaluation process specific to my role, I would be frustrated in my efforts to negotiate salary increases, time off and other benefits. I needed to develop a guide for my collaborating physician to assess my performance; document my continual improvement; and, more importantly, to demonstrate how valuable I was to the practice.

During the initial evaluation period, I was required to have all charts reviewed and co-signed by my collaborating physician for a period of four weeks, maintaining written documentation. Since patient records are part of the permanent record, keeping this documentation was not difficult. However, the requirement in my protocol for my collaborating physician to provide a written evaluation at the end of my first 90 days of employment was a bit more complicated.

Applying my experience with some creativity, I patterned this evaluation after the clinical forms used in our practice for patient evaluation. The patient evaluation included:

  1. Review of charts for initial visits (HPI/PMH/FMH).
  2. Review of systems
  3. Review of medications
  4. Review of physical exam
  5. Review of assessment and plan of care

 

By modeling my own evaluation after the patient evaluation, my collaborating physician was able to provide objective feedback in each area of patient care in which I was involved. I delineated additional areas of responsibility, but the above items provided a guide. Subsequently, informal evaluations during consultation and case reviews were ongoing.

Upon completion of the initial 90-day evaluation, on-going evaluations would continue on a monthly basis. A total of five charts would be pulled randomly to be reviewed by the physician and me and a written record was maintained. This form was simple and easy to complete. I listed the months and included a space for five separate patients that included diagnoses and a space for comments. As busy as our practice is, I wanted to keep it simple for both the physician and me.

Next came the performance review. This not only had to be precise, but designed so that my physician would be encouraged to take the time to evaluate me. I listed the following basics: quality of work; productivity; education, which included my ability to provide education to others; dependability; cooperation/interaction with staff; attitude; and punctuality. The physician would have to list my strengths, provide specific examples of major achievements during the review period and, of course, state how my performance could be improved. I designed this form to be used for any of the following type of reviews, Merit, six-month or yearly review. If the practitioner so desired, a merit review could be given at the six-month performance evaluation. This would depend on what both PNP and collaborating physician write into the initial contract.

Included in the yearly review was a 'Quality of Service' evaluation that required peer input. I devised a scale using the following grades: Highly effective, Effective and Improvement needed. Ten areas were covered, including professionalism -- from dress to patient care -- communication, accountability, promoting a healing environment and others.

The last tool in the evaluation process was a self-appraisal report. This gave me the opportunity to discuss my most and least successful job accomplishments, as well as key strengths or weak areas. I can also identify the actions that I will take to improve those weaker areas.

Once completed, the forms were reviewed by my collaborating physician and our nurse coordinator, who made some minor revisions. I now have in place an evaluation tool that specifically reflects my performance in my role as a PNP."

Note: Many thanks to Patricia for sharing all her efforts in this area with her NAPNAP colleagues.