Accountability

Tips for thinking like a nurse:

• Make sure that solid research/nursing science informs every aspect of your evidence-based practice.

• Always be prepared to answer the question "Why are you doing it this way?".

• Value being able to think strategically and creatively about the plan of care for patients with complex needs.

Tips for acting like a nurse:

• Demonstrate over and over again thar your primary concern is the patient, family, and community you serve.

• Prioritize patient safety and high-quality care.

• Inspire confidence and trust in your being a competent, compassionate, and responsible nurse.

• Learn how to advocate effectively for anyone not receiving optimal care or for colleagues being disrespected in the workplace.

• Create a culture that supports everyone doing the right thing simply because it's the right thing to do.

• Live a healthy life so that you can be energized for each day's practice.

Tips for feeling like a nurse:

• Renew your ability to empathize with patents, families, and communities in need and to respond compassionately; take a break when compassion fatigue or burnout threatens your care.

• Practice self-compassion when your best efforts fail to resolve patient problems or challenging practice situations.

• Recognize moral distress and seek help in responding.

• Value your growing resilience even in times of crisis.

What is the timeline of Shirley’s “Promise stage”?

The first 10 years of employment.

What are the defining features of Shirley’s “Promise stage”?

• Less experienced and tend to experience reality overload as a result.

• Making wise early career choices is critical in this phase.

What are expected milestones for Shirley’s “Promise Stage”?

Socialization to the nursing role (becoming an insider); building knowledge, skills, abilities, credentials, and an education base; gaining exposure to a variety of experiences; identifying strengths and building confidence; and positioning for the future.

What is the timeline of Shirley’s “Momentum stage”?

11-29 years of experience.

What are the defining features of Shirley’s “Momentum stage”?

• Nurses in this phase are experienced clinicians with expert knowledge, skills, abilities, credentials, and education base.

• Often achieves enough expertise to be a role model to others.

• One challenge is creating possibilities for career progression and avoiding stagnation.

• Must commit to lifelong learning and being willing to seize unexpected opportunities.

What are expected milestones for Shirley’s “Momentum Stage”?

Milestones include further building confidence in one’s competence; developing experience, gaining mastery, and establishing a professional track record; and finding a voice through aligning strengths with passion.

What is the timeline of Shirley’s “Harvest stage”?

30-40 years of employment.

What are the defining features of Shirley’s “Harvest stage”?

Value of these nurses my decline if they are not actively learning and adapting to changes.

What are expected milestones for Shirley’s “Harvest Stage”?

Milestones to be conquered include elevating their mastery to sage practice for advancing the profession, positioning as a professional statesperson, and establishing a legacy. 

Benner’s “Novice” stage of career development:

• Beginner with no experience

• Taught general rules to help perform tasks

• Rules are context free, independent of specific cases, and applied universally.

• However, rules cannot express which tasks are most relevant in real life or when exceptions are needed.

Benner’s “Advanced Beginner” stage of career development:

• Demonstrates acceptable performance  

• Has gained prior experience in actual situations to recognize recurring meaningful components  

• Principles, based on experiences, begin to be formulated to guide actions.  

Benner’s “Competent” stage of career development:

• Typically, 2 to 3 years’ work experience in the same area or in similar day-to-day situations  

• More aware of long-term goals  

• Gains perspective from planning own actions based on conscious, abstract, and analytical thinking and helps achieve greater efficiency and organization  

Benner’s “Proficient” stage of career development:

• Perceives and understands situations as whole parts  

• More holistic understanding improves decision making  

• Learns from experiences what to expect in certain situations and how to modify plans  

Benner’s “Expert” stage of career development:

• No longer relies on principles, rules, or guidelines to connect situations and determine actions  

• Much greater background of experience  

• Has intuitive grasp of clinical situations  

• Performance is now fluid, flexible, and highly proficient. 

What are some justifications for career development?

• Reduces employee attrition  

• Provides equal employment opportunity  

• Increases opportunities for employee growth  

• Improves the quality of work life  

• Improves competitiveness of the organization  

• Avoids obsolescence and builds new skills  

• Promotes evidence-based practice 

What two bodies should be involved with career development?

Organizational structures and proactive individual development.

How should career development begin?

It should begin with an assessment of self as well as work environment, job analysis, education, training, job search and acquisition, and work experience. 

What is included in career planning?

Evaluating one’s strengths and weaknesses, setting goals, examining career opportunities, preparing for potential opportunities, and using appropriate developmental activities.

What is a career path/advancement ladder?

These are organizational processes that outline potential job progression from entry level to higher levels of pay, skill, and responsibility.

Individual responsibilities that contribute to career development:

• Self-assess interests, skills, strengths, weaknesses, and values.  

• Determine goals.  

• Assess the organization for opportunities.  

• Assess opportunities outside the organization.  

• Develop strategies.  

• Implement plans.  

• Evaluate plans.  

• Reassess and make new plans as necessary, at least biannually. 

Organizational responsibilities that contribute to career development:

• Integrate individual employee needs and organizational needs.  

• Establish, design, communicate, and implement career paths.  

• Disseminate career information.  

• Post and communicate all job openings within the organization.  

• Assess employees’ career needs.  

• Provide work experiences to further employee development.  

• Give support and encouragement.  

• Develop new personnel policies as necessary, at least biannually.  

• Provide training and education. 

Career coaching:

Involves helping others identify professional goals and career options and then designing a career plan to achieve those goals. 

What are the three steps of career coaching?

Gathering data, asking what is possible, and conducting the coaching session.

What is included in the “gathering data” step of career coaching?

Managers should spend time observing employees, and collecting data such as past work performance, experience, education, credentials, and asking the employees themselves about their wants and needs.

What is included in the “asking what is possible” step of career coaching?

The manager should assess the department for possible changes in the future, openings or transfers, and potential challenges and opportunities.

• This type of managerial coaching may be effective in reducing role ambiguity among nurses.

What is included in the “conducting the coaching session” step of career coaching?

The goals of career coaching include helping employees increase their effectiveness; identifying potential opportunities in the organization; and advancing knowledge, skills, and experience.

• It is important not to intimidate employees when questioning them about their future and their goals.

Short-term career coaching:

the manager regularly asks the employees questions to develop and motivate them. 

Long-term career coaching:

is a planned management action that occurs over the duration of employment. 

How often should coaching sessions be conducted?

The effective manager should have at least one coaching session with each employee annually in addition to any coaching that may occur during the appraisal interview.

Why is group coaching also considered effective?

• More effective at challenging inequality and advancing social justice.

• It offers the potential to empower groups of learners to collectively challenge power imbalances and inequalities and in turn contribute to the ongoing development of social justice.

Management development (succession planning):

is a planned system of training and developing people so that they acquire the skills, insights, and attitudes needed to manage people and their work effectively within the organization. 

What is management development useful for?

• It provides new leader-managers their education/training.

• It teaches social learning theory and management theory.

• It offers social learning activities (case studies).

Promotions:

Are reassignments to positions of higher rank.

• Usually includes increased status, title changes, more authority, and greater responsibility; therefore, they can be used as significant motivational tools.

Before conducting a promotion, the following elements should be determined in advance:

• Whether recruitment will be internal or external. 

• What the promotion and selection criteria will be. 

• The pool of candidates that exists. 

• Handling rejected candidates. 

• How employee releases are to be handled. 

How can nurses update their knowledge and enhance competency?

By reading professional journals, attendance at conferences, and formal participation in educational activities organized by licensing authorities.

How are nurses expected to renew their RN license?

Most states in the United States require CE for RN license renewal, with requirements varying from a few hours to 30 hours, every 2 years

Professional specialty certification:

• An opportunity an employee can demonstrate advanced achievement of competencies.

• Certifications typically last 5 years.

How do professional specialty certifications benefit organizations?

Certification can improve processes of care, enhance work culture, improve job satisfaction and recruitment and retention, and advance the safety and quality of care. It can also reduce vacancy and turnover rates.

Examples of certified specialties:

• Certified Critical Care Nurse

• Certified Pediatric Nurse

Examples of Advanced Practice Nurse (APN):

• Certified Nurse Midwife

• Nurse Educator

• Nurse Anesthetist

• Nurse Practitioner

How can managers show their support for professional certification?

By giving employees paid time off to take the certification exam and by publicly recognizing employees who have achieved specialty certification.

Personal benefits of professional certification:

• Provides a sense of accomplishment and achievement. 

• Validation of specialty knowledge and competence to peers and patients.  

• Increased credibility.  

• Increased self-confidence.  

• Promotes greater autonomy of practice.  

• Provides for increased career opportunities and greater competitiveness in the job market.  

• May result in salary incentives.  

• Improved patient outcomes.  

• Increased levels of perceived empowerment creating more positive work cultures.  

• Demonstrates commitment to the profession.  

• Promotes lifelong learning and professional development. 

The Gibbs Reflective Cycle:

Is a theoretical model that provides a structured framework for experiential learning through a structured six-stage process of reflection.

This model emphasizes the importance of continuously revisiting experiences, looking at them from different angles, and using what has been learned to guide future decision making. 

Professional portfolio:

Is a collection of materials that document a nurse’s competencies and illustrate the expertise of the nurse.  

• Important to keep for random audits.

• Helpful when pursuing promotions, new positions, etc.

Content of a professional portfolio include:

Biographical information; educational background; certifications achieved; employment history; a résumé; a competence record or checklist; personal and professional goals; professional development experiences, presentations, consultations, and publications; professional and community activities; honors and awards; and letters of thanks from patients, families, peers, organizations, and others. 

What should new graduates seek when selecting their first employment?

• Seek work in a facility with a strong reputation for shared governance, positive work cultures, and a reputation for excellence in multiple arenas.

• Mentors and preceptors should also be available to support the new graduate nurse and role model. 

What responsibilities does the new graduate have for their first few years of employment?

• Becoming an expert in one or more areas of practice

• Gaining professional certifications

• Being well informed about professional nursing and healthcare issues.

• At what point continued formal education will be a part of their career ladder.

What are TPPs/residencies?

Curriculum/training provided by employers to new graduates to take the learning from nursing school and apply it in an expanded, intensive, and integrated clinical learning situation while providing direct patient care.

How long is the standard TPP/residency?

6 months to 1 year.

How should your resume be structured?

• Keep 1-2 pages long 

• Reverse chronologic is the most popular format. 

• Keep writing concise and clear. 

• Type it in a single-font format  

• Use bulleted points or sentences.  

What should be included in your resume?

• Add your LinkedIn address next to your name and contact information and make sure your LinkedIn profile is current and robust.  

• Include educational background, work history, awards or honors received, scholarly achievements such as publications and presentations, and community service activities.  

• Choose words carefully. Use keywords applicable to the job you’re applying for. 

• Include a cover letter addressed to a specific individual when possible to introduce yourself, briefly highlight key points of the résumé, and make a positive first impression. Objective statements are often replaced by a summary statement instead. If you include a résumé objective, it should be brief—no longer than two to four sentences. 

• Make sure to list only references who know you well. You should inform the references that you have listed them in your résumé so that when they are contacted, they are prepared to answer questions about you. 

What should be avoided when creating a resume?

• Do not include personal information such as marital status, age, whether you have children, ethnicity, or religious affiliations. Maximize your strong points and minimize your weaknesses. 

• Try to avoid overuse of “confidence-inspiring” words like “passionate,” “driven,” or “results-oriented” as these words have little meaning without context. Instead, keep your résumé direct and to the point and show, do not tell, how you accomplish things. 

Performance appraisals:

Let employees know the level of their job performance as well as any expectations that the organization may have of them. Performance appraisals also generate information for salary adjustments, promotions, transfers, disciplinary actions, and terminations.

How often are performance appraisals conducted?

Usually it is annually, but it is being replaced/supplemented by pulse surveys (short questions asked frequently and tracked over time) and other types of reviews throughout the year.

What strategies may assist the manager in providing fairer and more accurate performance appraisals?

• Appraisals should be based on objective standards, developed with employee input, and communicated to employees in advance of any appraisal.  

• Appraisal tools must objectively and accurately assess job performance.  

• Multiple sources should be consulted about employee performance, but employees need to know what sources of data will be gathered for the appraisal. This clarity of expectations is critical to the employee perceiving the appraisal as fair.  

• The appraiser should be someone who has directly observed the employee’s work and should be someone the employee trusts and respects.  

• Appraisers must be self-aware regarding their own biases and prejudices. Consultation should be sought if any concerns exist about bias or process. 

• Accurate anecdotal records with both positive and negative data and suggestions for improvement should be kept for the length of the appraisal period.  

• Employees should be encouraged to incorporate self-appraisal as part of the performance appraisal process.  

• Appraisers must guard against the halo effect, horns effect, central tendency trap, and Matthew effect.  

• Employees should feel supported by their appraiser and see the intent of the appraisal as personal and professional growth. 

Trait rating scales:

Is a method of rating a person against a set standard, which may be the job description, desired behaviors, or personal traits.

• Rating scales are subject to central tendency and halo and horns effect errors and thus are not used as often today as they were in the past.

Job dimension scales:

Require that a rating scale be constructed for each job classification. 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 focus on job requirements rather than on ambiguous terms such as “quantity of work.” 

Behaviorally Anchored Rating Scales (BARS)

Requires that a separate rating form be developed for each job classification. Then, as in the job dimension rating scales, employees in specific positions work with management to delineate key areas of responsibility.

• This is an effective tool because it focuses on specific behaviors, allows employees to know exactly what is expected of them, and reduces rating errors. 

What is a disadvantage of the BAR Scale?

The greatest disadvantage in using this tool with large numbers of employees is the time and expense. In addition, BARS is primarily applicable to physically observable skills rather than to conceptual skills. 

What are the types of checklists?

The weighted scale, the forced checklist, and the simple checklist.

Weighted scale checklist:

Is composed of many behavioral statements that represent desirable job behaviors. Each of these behavior statements has a weighted score attached to it. Employees receive an overall performance appraisal score based on behaviors or attributes.

The forced checklist:

Requires the supervisor to select an undesirable and a desirable behavior for each employee. Both desirable and undesirable behaviors have quantitative values, and the employee again ends up with a total score on which certain employment decisions are made.

The simple checklist:

Comprises numerous words or phrases describing various employee behaviors or traits. These descriptors are often clustered to represent different aspects of one dimension of behavior, such as assertiveness or interpersonal skills. The rater is asked to check all those that describe the employee on each checklist.

• A major weakness of all checklists is that there are no set performance standards.

Essay appraisal method (free-form review):

The appraiser describes in narrative form an employee’s strengths and areas in which improvement or growth is needed. Although this method can be unstructured, it usually calls for certain items to be addressed.

Self-appraisals:

Employees submit written summaries of their work-related accomplishments and productivity.

• The key is for employees to view self-appraisal as an opportunity to honestly showcase their accomplishments as well as identify areas of potential growth. 

• Self-assessment is also an important part of reflective practice. Reflection is a systematic, purposeful, mindful habit providing a way to learn from experience. 

Management by Objectives (MBO):

Is a strategic management approach where managers and employees collaboratively set specific, measurable, achievable, relevant, and time-bound (SMART) goals that align individual performance with organizational objectives.

The following steps delineate how MBO can be used effectively in performance appraisal: 

• The employee and supervisor meet and agree on the principal duties and responsibilities of the employee’s job. 

• The employee sets short-term goals and target dates in cooperation with the supervisor or manager. 

• It is important that the employee’s goals do not conflict with the goals of the organization. 

• Both parties agree on the criteria that will be used for measuring and evaluating the accomplishment of goals. In addition, a time frame is set for completing the objectives. Common time frames used in healthcare organizations vary from 1 month to 1 year. 

• Regularly, but more than once a year, the employee and supervisor meet to discuss progress. 

• Major obstacles that block completion of objectives within the stipulated time frame are identified. Some modifications can be made to the original goals if both parties agree. 

• The manager’s role is supportive, assisting the employee in reaching goals with coaching and counseling. 

Peer review:

When peers rather than supervisors carry out monitoring and assessing work performance.

• It has the potential to increase the accuracy of performance appraisal. It can also provide many opportunities for increased professionalism and learning.

Healthcare organizations have been slow to adopt peer review for the following reasons: 

• Staff are often poorly oriented to the peer-review method. 

• Peer review is viewed as threatening when inadequate time is spent orienting employees to the process. 

• Peers often feel uncomfortable sharing feedback with people with whom they work closely. 

• Peer review is viewed by many as more time-consuming than traditional superior–subordinate performance appraisals. 

• Interpersonal conflict may result in unfair appraisals. 

• Because peer review shifts the authority away from management, the insecure manager may feel threatened. 

If peer review is to succeed, the organization must overcome its inherent difficulties by doing the following before implementing a peer-review program: 

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

• Staff must receive a thorough orientation to the process before its implementation. 

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

• A decision must be made about whether anonymous feedback will be allowed. 

The 360-degree evaluation:

Includes an assessment by all individuals within the sphere of influence of the individual being appraised.

• Usually 8-12 people filling out an anonymous online feedback form.

• Recipients of feedback gain insight into how others perceive them and can become more self-aware. It also promotes accountability and ownership. 

Coaching:

Described as transfer of skills and knowledge from one person to another. 

• Can increase others competence, commitment, confidence, and ability to make connections. 

• Does not replace the need for self-motivation. 

How to become an effective coach:

• Be specific in describing behavior that needs improvement. 

• Be descriptive when explaining poor work performance. 

• Be certain that feedback meets the needs of the employee. 

• Use sensitivity in timing the feedback. 

• Make sure the employee understands the feedback and communicates. 

Upward appraisals:

Occurs when employees review their supervisors. 

• Allows managers to improve communication and relationships with their teams. 

• Uses the 360-degree evaluation process. 

• If focus groups are used, a experience-qualified employee relations specialist facilitates the discussion. 

• Employers may use surveys to determine job satisfaction. 

• Requires the leader-manager to trust their subordinates that their feedback is constructive.