Page 100 - Essentials of Nursing Leadership and Management, 5th Edition

CikguOnline
2208_Ch06_071-090.qxd 11/6/09 5:57 PM Page 87
chapter 6 | Getting People to Work Together 87 CikguOnline
experience. Without administrative support and
A Comprehensive Peer Review System guidance, however, the committee work can be
Peer review systems can simply be informal feed- frustrating when the group gets bogged down in
back regularly shared among colleagues, or they details and disagreements.
may be comprehensive systems that are fully inte- When the job descriptions and performance
grated into the formal evaluation structure of a standards for each level have been developed and
health-care organization. When a peer review sys- agreed on, a procedure for their use must also be
tem is fully integrated, the evaluative feedback from worked out. This can be done in several ways. In
peers is joined with the performance appraisals by some organizations, an evaluation form that lists
the nurse manager, and both are used to determine the performance standards can be completed by
pay raises and promotions for individual staff nurs- one or two colleagues selected by the individual
es. This is a far more collegial approach than the staff member. In some organizations, the informa-
hierarchical one typically used, in which employees tion from these forms is used along with the nurse
are evaluated only by their manager. manager’s evaluation to determine pay raises and
A comprehensive peer review system begins promotions. In others, the evaluation from one’s
with the development of job descriptions and peers is used for counseling purposes only and is
performance standards for each level within the not taken into consideration in determining pay
nursing staff. The job description is a very general raises or promotions. This second approach pro-
statement, whereas the standards are specific vides useful feedback but weakens the impact of
behaviors that can be observed and recorded. peer review.
In a participative environment, the standards are A different approach is the use of a professional
developed by committees having representatives practice committee. The committee, consisting of
from different units and from each staff level, from colleagues selected by the nursing staff, reviews the
the new staff nurse to top-level management. In peer evaluation forms and makes its recommenda-
some instances, they are very specific, quantifiable tions to the director of nursing or vice president
criteria, but others are likely to require professional for patient care services, who then makes the final
judgment as to the quality of the care provided decision regarding the appropriate rewards (raises,
(Chang et al., 2002). promotions, commendations) or penalties (demo-
In some organizations, the standards may be tion, transfer, termination of employment).
considered the minimal qualifications for each
level. In this case, additional activities and profes- Conclusion
sional development are expected before promotion
to the next level. The candidate for promotion to The responsibility for delivering and coordinat-
an advanced-level position prepares a promotion ing patient care is an important part of the role
portfolio for review (Schultz, 1993). The promo- of the professional nurse. To accomplish this,
tion portfolio may include a self-assessment, peer nurses need good communication skills. Being
reviews, patient surveys, a management perform- assertive without being aggressive and conduct-
ance appraisal, and evidence of professional ing interactions in a professional manner
growth. Such evidence can derive from participat- enhance the relationships that nurses develop
ing in the quality improvement program, evaluating with colleagues, physicians, and other members
a new product or procedure, serving as a translator of the interdisciplinary team.
or disaster volunteer, making post-discharge visits A major focus of the national safety goals is
to patients from the unit, or taking courses related improved communication among health-care pro-
to nursing. fessionals. In an effort to improve patient safety,
Writing useful job descriptions and measurable health-care institutions have moved toward imple-
standards of performance is an arduous but reward- menting a communication protocol referred to as
ing task. It requires clarification and explication of the SBAR method. SBAR sets a specific procedure
the work nurses actually do and goes beyond the that reminds nurses how to relay information
usual generalizations. Under effective group leader- quickly and effectively to the patient’s health-care
ship and with strong administrative support for this provider, which ultimately leads to improved
process, it can be a challenging and stimulating patient outcomes.