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UNIVERSITY OF MICHIGAN HEALTH SYSTEM Performance Evaluation Process-Self evaluation with Peer Input 1. The nurse will select a minimum of 3 peers to perform peer review. Those selected must be educated in the peer review process. At least one peer must be an RN. Each nurse will be asked to evaluate the person on 1-2 different Framework domains, so that all five Framework domains are reviewed by peers. Clinical Skills and Knowledge domain must be completed by an RN whenever possible. 2. The nurse will submit the names of their chosen peers to the manager that will be completing their performance evaluation. The nurse distributes 1-2 domains of the peer feedback tool to selected peers. 3. The reviewers will use the current Development Framework Peer Input tool for their appraisal. They will complete their peer tool, sign it and return it to the nurse within 7 days. Peers should circle the appropriate behavioral level. Peer reviewers would be encouraged to support their views with concrete examples on the right hand side of the page. Each peer will comment on 1-2 different Framework domains. 4. The peer review forms are returned to the nurse, who shall review the content and summarizes the information on the performance review form. 5. The nurse will complete the level appropriate self-evaluation portion of the Staff Performance Planning and Evaluation form, with consideration of the input provided by the peer evaluation. 6. The nurse will submit their completed Staff Performance Planning and Evaluation form and their Peer Review forms to the manager. If materials are not submitted within two weeks of the established due date, then the managers may proceed with completing the evaluation process. 7. The manager will review the peer review form, peer summary and self-evaluation and then complete the manager section of the evaluation form. The manager will utilize peer and self evaluations as well as own knowledge of employee performance in determining ratings on the Performance Planning and Evaluation form. Rationale for rating other than “meets expectations,” must be provided in the evaluation summary section after each domain. The manager will arrange an appointment with the nurse for the performance review. 8. The Peer Review forms will be returned to the nurse following the performance evaluation process, and a copy of the completed Performance Plan/Evaluation will be given to the nurse. 9. Completed evaluations are given to the administrative assistant for processing. Final 4/16/04 Perry Revised 7/15/05, 9/15/06 Jordan-Sedgeman, Minerath Revised 3/13/07 Professional Development Framework Performance Evaluation Workgroup *Peers should circle appropriate level *Peer reviewers would be encouraged to support their views with concrete examples on right hand side of page *Return peer review form to the nurse DOMAIN: Clinical Skills and Knowledge A NURSING PROCESS Assessment B C Performs assessment & identifies appropriate nursing diagnosis and/or patient care standard with assistance. Performs focused assessment of unit standard patient for effective patient care with minimal assistance. Independently and completely performs focused assessment to provide most effective patient care for a given patient population. Recognizes specialty data. Nursing Diagnosis Recognizes data and Identifies key nursing identifies obvious diagnoses to address nursing diagnoses. physical and psychosocial/emotion al areas. Planning/Implementation/Evaluation D E Peer Input - Comments Independently and Exhibits highly developed assessment abilities that consistently performs exemplify a comprehensive understanding of the total goal-focused and patient/family situation. individualized assessment when caring for all patients, including those with complex pathophysiological and psychosocial needs. Prioritizes key Individualizes nursing Individualizes nursing diagnoses based on assessment nursing diagnoses to diagnoses based on data and integrates that with the diagnoses & priorities address physical and assessment data. of other disciplines in order to provide holistic care. psychosocial/emotion al areas. Practice is guided Uses evolving clinical Practice is driven by primarily by policies, experience as a theory and procedures, and guide for practice. experience. standards. Practice relies on previous experience for focused analysis of problems and solutions with individual patient modification in order to meet outcomes. Identifies expected With guidance Independently Accommodates outcomes and develops, develops, unplanned events nursing interventions implements, and implements, and and evaluates/ to meet identified evaluates plan of evaluates plan of responds diagnoses and care that recognizes care that recognizes appropriately with maintain standards of subtle changes in subtle changes in speed, efficiency, clinical practice. patient’s condition. patient’s condition flexibility, and Evaluates patients and adapts plan as confidence. based on basic needed. standards. DOMAIN: Clinical Skills and Knowledge (continued) A Technology Utilizes standard unit technology and with assistance uses advanced technology as appropriate. B C Utilizes standard unit technology. With guidance uses advanced technology as appropriate. Utilizes standard unit technology and uses advanced technology as appropriate. D Practice is driven by an intuitive base and is selfdirected, flexible, and innovative. Is consistently effective in providing holistic care that ensures positive change even in the most challenging patient care situations. E Peer Input - Comments Becomes expert and Takes a leadership role in evaluating technology and its resource for use of potential for use. standard unit technology and advanced technology as appropriate. Utilizes computer correctly for basic functions, including: - Groupwise - CareWeb- labs and radiology results reporting - Omnicell - Mandatory Program / Competencies - Policies and procedures Patient/Family Education With assistance, identifies basic patient/family learning needs. Initiates teaching using patient teaching protocols, patient care standards and critical paths. Utilizes computer for Utilizes computer for Becomes resource basic functions. basic functions as for use of computer. well as reference on patient conditions and treatment. Able to conduct literature search through library functions— CINAHL, Cochrane, Medline, PubMed. Identifies basic patient/family learning needs. Initiates and evaluates teaching using patient teaching protocols, patient care standards and critical paths. Anticipates patient/family learning needs and utilizes a variety of teaching strategies appropriate to the patient’s needs. Serves as expert resource and facilitates other staff in improving patient education. Collaborates with other disciplines to develop and/or implement patient / family teaching programs. Utilizes patient education resources on the unit. Accurately assesses patient/family’s readiness to learn, organizes and executes individualized teaching plan, evaluates patient’s understanding and modifies approach as necessary. Identifies learning needs of designated populations. Works collaboratively to develop strategies to meet these learning needs. Seeks out additional Revises and develops patient education patient education materials. resources beyond unit. Seeks out challenging patient/family education opportunities. Policy/Procedure/Pr otocols Identifies location of and utilizes hospital policies and unit procedures and protocols. Consistently utilizes hospital policies and unit procedures and protocols. Demonstrates ease in application of hospital policies and unit procedures and protocols. Teaches and Researches, revises, and develops hospital policies and functions as a unit procedures and protocols utilizing appropriate resources in the channels and resources. application of hospital policies, and unit procedures and protocols. DOMAIN: Clinical Skills and Knowledge (continued) A Promoting Culture of Safety Adheres to hospital policies related to medication safety: * Order writing conventions * Correct administration considerations * Double checks and other established policies and practices Familiar with and follows standards related to patient and staff safety. Documentation Admission assessment, flow sheets, MARs, and other applicable documentation forms are completed in a timely manner according to policy B C D Identifies and intervenes when there are concerns related to medication safety. Identifies and intervenes when there are concerns related to medication safety, providing feedback to staff members involved. Identifies concerns and intervenes related to patient and staff safety. Anticipates and Facilitates others related to patient and staff safety; actively works toward intervenes related to prevention of potential injury. patient and staff safety. Admission assessment, flow sheets, MARs, and other applicable documentation forms are completed in a timely manner according to policy. Consults documentation to identify trends in patient status and enhance continuity of assessment and ongoing nursing care. Unit expert and resource on medications applicable to their unit/clinical setting. E Peer Input - Comments Advocates for culture of safety through knowledge, problem solving, and system changes. Involved in ongoing Participates in the development of documentation tools, quality monitoring of standards, and/or policy. documentation of nursing care and patient outcome. with minimal guidance. Please describe a time when you saw me at my very best. What qualities did I display in this domain? Please provide your input regarding opportunites for my personal and/or professional growth. I have completed the Peer Feeback Class as required by the UMPNC 2004 contract, paragraph 28E, for participation in peer review process. Peer Signature & Date: *Peer should circle appropriate level. *Peer reviewers would be encouraged to support their views with concrete examples on right hand side of page *Return peer review form to the nurse DOMAIN: Therapeutic Relationships: An intentional interactive relationship with patients and families that is caring, clear, boundaried, positive and professional. It encompasses the philosophy of the institution, empowerment of the care givers and empowerment of the patient/family. A B C D E Peer Input - Comments Therapeutic Communication Recognizes how the Establishes Possesses clarity on Consistently role Intuitively uses expert therapeutic communication with nurse: patient/family patient/family:nurse ones own values and models individualized patient/family. relationship impacts relationship. Begins how they effect therapeutic the patient to identify how own interactions, communication experience. values impact the relationships and based on patient and patient/family:nurse boundary setting. family needs. relationship. Introduces self as a Registered Nurse and describes role. Wears identification. Individualizes communication based on assessment of the patients and families. Initiates consultation Shares and promotes collaborative approach to patient / leadership with the and family care. healthcare team to share and promote collaborative approach to patient and family care. Establishes open communication. Empowerment—Nurse, Patient, Family Recognizes the need Involves patients and Incorporates for patient and family families in care. patient/family in to participate in care. planning and implementing care. Invites patients and Maximizes patient/family participation in decisionfamilies to actively making and goal setting along the continuum of care. participate in plan of care to foster growth and competence. Seeks help as appropriate to assess readiness for participation in care. Compassion Actively listens to patient/family concerns in a respectful manner. Actively listens and responds to patient/family concerns. Demonstrates empathy in interactions with patients/families. Plans and provides Intuitive understanding of patient/family experience and nursing care that is proactive in providing creative approaches to optimize promotes intentional comfort and support. caring. Shows kindness and caring with patient/families. DOMAIN: Therapeutic Relationships (continued): An intentional interactive relationship with patients and families that is caring, clear, boundaried, positive and professional. It encompasses the philosophy of the institution, empowerment of the care givers and empowerment of the patient/family. A Advocacy and Ethics Recognizes, respects, and supports patient/family rights and maintains confidentiality. B Seeks resources in response to situations that have the potential to negatively impact patient/ family outcomes. Aware of UMHS patient rights and responsibility. Valuing of Diversity with Patients and Family C Mobilizes appropriate resources in response to situations that have the potential to negatively impact patient/ family outcomes. Recognizes ethical issues and seeks assistance in addressing them. D E Peer Input - Comments Challenges situations Challenges and adapts systems to maximize the and/or decisions that benefits for patient care. obstruct positive patient outcomes and works to reduce barriers. Anticipates patient/family needs. Aware of and values Demonstrates Seeks to learn about the diversity in openness to the and optimize the patient and families. uniqueness of others. unique contribution inherent in the diversity and culture of each individual. Demonstrates actions that incorporate the rich traditions, beliefs, and values of patients and families. Begins to incorporate Begins to explore one’s own biases and how they impact patient diversity care. considerations in patient care. Please describe a time when you saw me at my very best. What qualities did I display in this domain? Embraces visible and invisible diversity; seeks out perspectives from those of different backgrounds and cultures. Integrates understandings of populations into patient care. Please provide your input regarding opportunites for my personal and/or professional growth. I have completed the Peer Feeback Class as required by the UMPNC 2004 contract, paragraph 28E, for participation in peer review process. Peer Signature & Date: *Peers should circle appropriate level *Peer reviewers would be encouraged to support their views with concrete examples on right hand side of page *Return peer review form to the nurse DOMAIN: Professional Relationships: An intentional interactive relationship with the health care team that is marked by mutual regard, trust, and active engagement. A B C D Collaboration with the Health Care Team Recognizes role of Initiates collaborative Recognizes and Acts as resource to each member of the communication. values professional nursing and health health care team. collaborative care team. communication and the positive effect on patient outcomes. E Peer Input - Comments Through shared values and a clear professional identity, demonstrates and role models an interdisciplinary collaborative approach to patient care. Aware of importance Recognizes the of team collaboration impact of one’s and with guidance behavior on others. begins to initiate collaborative communication. Initiates referrals. Identifies and utilizes Is sought out by collaborative members of the resources. multi-disciplinary health care team. Monitors referrals. Participates and/or leads team care conference. Frequently initiates consults with health care team. Actively collaborates with other health professionals in delivering care. Recognizes need and calls for team conference. Valuing Teams/Teamwork Identifies self as Meets professional member of nursing commitments and health care consistently. teams. Begins to generate trust, respect, and compassion within the workgroup. Seeks assistance with resolving conflict. Takes responsibility for developing beginning team relationships. Functions as an independent and supportive team member. Fosters mutual Demonstrates team values that orient people to care regard, respect, and about performance and success of others. trust. Provides assistance to others. Demonstrates active Recognizes value of conflict in individual and engagement to organization learning and growth. enhance patient care and promote a positive workplace. Demonstrates flexibility. . Creates conditions and relationships that promote creative, innovative, and positive processes and outcomes. Demonstrates empathy and compassion in interactions with team members. Asks for and accepts help when needed. Approaches conflict Role models behaviors that demonstrate compassion and caring. . Acknowledges situations in a . Fosters other's when conflict exists. constructive manner. development of conflict resolution skills. DOMAIN: Professional Relationships (continued): An intentional interactive relationship with the health care team that is marked by mutual regard, trust, and active engagement. A Valuing of Diversity in Team Aware of and values diversity in all members of the health care team. B C Recognizes own biases and begins to demonstrate empathy as a member of the health care team. Seeks to learn about and optimize the unique contribution inherent in the diversity and culture of each individual on the health care team. Role models and Depends on diversity of workforce to enrich and build helps to establish great places to work. group norms that promote valuing of all health care team members. Readily able to delegate to UAP according to the 5 Rights of Delegation. Recognizes and values interdependent relationships. Adaptable, flexible, and consistently effective in delegation. Facilitates continuity of care and nursing work flow through nurse to nurse delegation. Recognizes strengths of other team members that would benefit the patient and the team—aligns skill sets of individual nurses/UAP to specific patients. Demonstrates foresight in anticipating and planning to meet patient and family concerns. Delegation Functions as part of Uses 5 Rights of nursing team; able to Delegation when describe and begin to delegating to UAP. use 5 Rights of Delegation when delegating to UAP: * Right task * Right circumstances * Right person * Right communication * Right supervision and evaluation D E Peer Input - Comments Recognizes value of nurse-to- nurse delegation. Successfully organizes and coordinates multiple activities, requests, and needs. Develops work process that maximize team work. Please describe a time when you saw me at my very best. What qualities did I display in this domain? Please provide your input regarding opportunites for my personal and/or professional growth. I have completed the Peer Feeback Class as required by the UMPNC 2004 contract, paragraph 28E, for participation in peer review process. Peer Signature & Date: *Peers should circle appropriate level *Peer reviewers would be encouraged to support their views with concrete examples on right hand side of page *Return peer review form to the nurse DOMAIN: Professional Development: Committed to the professional development of self and others. A Self Engages in self assessment related to orientation and initial learning needs and seeks out unit resources to assist in meeting needs. B Engages in self assessment related to ongoing learning needs. Completes mandatory / competency requirements during orientation and annually. C D E Peer Input - Comments Sets goals for knowledge/skill enhancement within the practice setting. Sets goals for knowledge/skill enhancement within and beyond the practice setting. Sets goals in self directed manner and actively seeks out opportunities for knowledge/skill enhancement within and beyond the practice setting. Seeks out additional learning experiences within practice area * Unit specific certifications * Consultation with experts * Inservices / rounds * Collaborating with multidisciplinary team Attends inservice(s)/CE’s within and beyond practice area. Evidence of advancing professional identity (at least one): * Certification in specialty (ACCN, ANCC Speciality Areas) * Active participation in professional organization - i.e.: Clinical specialty organizations, UMPNC, MNA, ANA, UAN * Active membership / leadership role in institutional groups r/t nursing DOMAIN: Professional Development: Committed to the professional development of self and others. A Contributions to Others B C D E Peer Input - Comments With guidance, provides respectful feedback to preceptors, peers, and Manager related to orientation and initial learning experience. Begins to participate Participate in peer in providing and feedback. accepting respectful feedback. Expands knowledge of the process: * Formal training authentic, accountable, respectful, relevant to clinical performance * Identifiable / attributable (not anonymous) Contributes to others knowledge and skill development in practice setting. Takes a leadership role in building and maintaining an environment where all team members thrive. Works to create and sustain a culture that is supportive and rewards and recognizes professionalism. Recognizes professional strengths in others and builds upon them. Mentors nurse colleagues in achievement of professional framework progression. Shares in/contributes Acts as a clinical resource/liaision beyond the unit to others setting * knowledge/skill Speciality resource development in * Other units practice setting, examples include: * Conducts inservices * Develops staff education tools * Acts as interdisciplinary clinical resource and informal mentor May act as preceptor of new and present staff when applicable. Utilizes own knowledge/skills to improve professional development environment on the unit. Please describe a time when you saw me at my very best. What qualities did I display in this domain? Please provide your input regarding opportunites for my personal and/or professional growth. I have completed the Peer Feeback Class as required by the UMPNC 2004 contract, paragraph 28E, for participation in peer review process. Peer Signature & Date: *Peers should circle appropriate level *Peer reviewers would be encouraged to support their views with concrete examples on right hand side of page *Return peer review form to the nurse DOMAIN Advancing Practice through Innovation and Research: Demonstrates ongoing innovation by reviewing, critiquing and applying existing evidence to practice. Continually improves practice by applying performance improvement methodologies. A B C D E Peer Input - Comments Research Reads clinical articles. Reads clinical articles. Demonstrates an Reads evidence awareness of current based articles related literature in area of to area of practice. practice, including journal club, inservices, etc. Implements change in practice for a population of patients based on the application of current research findings and evaluates effectiveness of practice changes. Participates in unit/area based Continuous Quality Improvement projects. Participates in unit/area based Continuous Quality Improvement projects. Identifies individual patient problems which require investigation. Makes recommendations for changes in practice based on findings. Participates in unit/area based research, as appropriate. Participates in and/or unit/area based/institutional Continuous Quality Improvement projects. Presents at unit based educational forums. Shares findings of Continuous Quality Improvement projects, such as: * Unit presentation * Rounds * Poster * Publishing Applies current literature/ research to problems in practice area. Innovation (creative solutions to everyday problems) Has knowledge of and supports established nursing improvement projects / endeavors in practice setting. Actively participates in established nursing improvement projects / endeavors in practice setting. Identifies areas for creative improvement in practice setting and seeks out resources and avenues to address them (unit practice council, content experts, etc.). Takes on leadership Independently seeks out opportunities to share role in relation to information and influence evidence based nursing innovations/ practice. improvements in practice setting. Evaluates effectiveness of innovation/practice changes. Please describe a time when you saw me at my very best. What qualities did I display in this domain? Please provide your input regarding opportunites for my personal and/or professional growth. I have completed the Peer Feeback Class as required by the UMPNC 2004 contract, paragraph 28E, for participation in peer review process. Peer Signature & Date: