That nurses at all levels routinely use self appraisal performance review and peer evaluations

152 Pages·2012·14.57 MB·English

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EP 20: That nurses at all levels routinely use self appraisal performance review and peer
evaluations including goals setting, for the assurance of competence and professional
development.

The American Nurses Association Code of Ethics, Provision 5.2 states, “Competence affects
one’s self respect, self-esteem, professional status, and meaningfulness of work. In all nursing roles, evaluation of one’s
own performance, coupled with peer review, is a means by which nursing practice can be held to the highest standards.
Each nurse is responsible for participating in the development of criteria for evaluation and practice and for using those
criteria in peer and self assessment.” The Massachusetts General Hospital’s performance appraisal
process has incorporated self-reflection, peer feedback and goal-setting for nurses at all levels to
ensure competency.

Policy
As stated in the Massachusetts General Hospital Performance “Evaluation Policy”
(Attachment OOD 17.a), it is expected that the process of performance evaluation be an ongoing dialogue that
occurs informally on a day-to-day basis. The written performance evaluation is only one step in this process. It is
required that every employee receives this written evaluation of his/her work performance on at least an annual basis.
The evaluation shall be based on the employee’s work performance and on expectations/standards communicated to the
employee by management.
The MGH Human Resources Department revised the performance appraisal forms in 2010
using the Hospital’s Mission, Credo and Boundaries Statement as an organizer (attachment EP.20.a).
Copies of the forms for all role groups can be found in OOD 17. Please note that the Executive
Team (attachment OOD 17.j) and Nursing Directors (attachment OOD 17.i), utilize modified
versions of the Hospital’s performance appraisal forms that align with their work.
The Department of Nursing has a policy titled, “Annual Performance Evaluation Guideline”
(Attachment OOD 17.b) that describes the performance assessment process for licensed and
unlicensed staff who report to Nursing Directors. The guideline states, “Attaining and maintaining
performance expectations is the individual employee’s responsibility and is achieved through a combination of ongoing
assessment with leadership staff, peers or preceptor/mentors, educational activities, in-service programs and other
strategies developed in collaboration with the Nursing Director, Clinical Nurse Specialist, and others.”

Wage & Salary Program
Of note, every year the MGH articulates its Wage & Salary Program to employees across the
hospital (attachment EP 20.b). A completed performance appraisal is required before any salary
increase is processed.

Key Areas of Focus of PCS Performance Appraisal Process
One of the key Patient Care Services’ Guiding Principles is, “Learning is a lifelong process
essential to the growth and development of clinicians striving to deliver quality patient care” (OOD 1). Evaluating
practice (clinical or administrative) is a fundamental component of learning that occurs on an
ongoing basis throughout the year and it is formally integrated into the performance appraisal
process.

Self-evaluation
The performance appraisal tool for each nursing role group is designed specifically to
evaluate the practice of nurses in a way that supports the growth and development of the individual
nurses’ practice. Using the tool as a guide, the nurse has the opportunity to self-reflect on practice
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and is evaluated by a supervisor and peers to identify performance goals that focus on improving
practice. In addition, Staff Nurses utilize clinical narratives for self-reflection about their practice.

Peer Review
Peer evaluations and feedback are an additional method for assuring competence and
professional development. Inherent in the culture of the Massachusetts General Hospital is an
appreciation for peer feedback and collective learning. Peer evaluations are coupled with self-
reflection to more fully describe an individual’s practice. This process has formalized the means for
nursing to share feedback with their peers and has provided another means for nursing to reflect on
their individual competence and professional growth. Attachment EP 20.c presents an overview of
the role-specific peer review criteria. Role-specific peer review tools are found in OOD 17.

Required Training and Competency Assessment
Annual required training competencies are those knowledge, skills and attitudes that are
required for the delivery of safe, efficient and quality patient and family-centered care. These
activities are those that may fall into the "low frequency/high risk" category, but also are
components of care unique to a specific unit or patient population, such as Psychiatry, Pediatrics, or
Interventional Cardiology, to name a few. The required competencies that transcend the
organization are those matters which fall into regulatory, licensure or rules of participation. They
address general safety topics and form a common denominator of safety with the process to be
operationalized by the Norman Knight Nursing Center for Clinical & Professional Development
(Knight Center). Those topics which are required by the strategic plan or hospital policy, such as
ventricular assist devices retraining or procedural sedation retraining are operationalized by the
Knight Center in partnership with clinical experts and other subject matter experts, such as the
Clinical Nurse Specialists. For topics specific to a unit or patient population the responsibility for
these rests with the unit-based leadership. The unit based leadership conducts an assessment of their
area of accountability and working with the Clinical Nurse Specialist, design or select those activities
which will constitute unit-based competencies. The Knight Center’s model for required training and
competency assessment is in Attachment EP 20.d.

Mutual Goal Setting
The performance appraisal process bridges the nurse’s current reality as assessed through
self-reflection, peer review, and the Manager’s review, with the vision for the nurse’s practice.
Mutual goal setting between the nurse and Manager provides the road map to move toward attaining
one’s vision.

Illustrations of Performance Appraisal Process for Nursing at all Levels

Senior Vice President for Patient Care and Chief Nurse
When asked about the performance appraisal process and nursing practice, the Senior Vice
President for Patient Care and Chief Nurse (CNO) states, “It is all about the dialogue – an opportunity to
step back, to review what we set out to accomplish during the year to see how much progress was made, and to dialogue
about the future. We are evaluated on our progress toward attaining our shared strategic goals. By articulating and
setting mutual goals, it ensures that the work across the hospital is aligned with the strategic direction and priorities of
the hospital ensuring that our patients and families receive the best possible care.”
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The Senior Vice President for Patient Care and Chief Nurse (CNO) is often quoted as saying
that the Magnet Recognition process is her performance evaluation. She also views outcomes data
including quality, patient satisfaction and staffs satisfaction as her ongoing “report cards” (EP 3EO,
EP 32EO and EP 35EO).
For the CNO’s formal performance appraisal process, the President of the MGH asks each
member of his Senior Leadership team to identify organizational goals each year that they will
personally champion in their respective areas of accountability and that are aligned with the
Hospital’s strategic planning initiatives. During their performance review with the President, they
articulate (written and verbal) how they attained the goals. In concert with her executive team, the
CNO sets her performance goals based on the strategic planning goals of the Department and the
Hospital. The evidence provided in TL 1 and TL 3 speaks to how the CNO aligns the PCS strategic
plan with the Hospital’s plan.
In 2011, the CNO was evaluated on the strategic goals set by her PCS executive team
(attachment EP 20.e) and two organizational goals: to meet/exceed MGH targets for HCAHPs
indicators: nurse communication with patients and responsiveness. At her performance appraisal
with the MGH President, the CNO brought the following documents:
 Copy of PCS Strategic Goals and Tactics (Attachment EP 20.e)
 Performance Report for PCS Strategic Goals (Attachment EP 20.f)
 HCAHPs Indicator Summary for CY 2011 (Attachment EP 20.g)
 Additional Updates re: 2011 outcomes (Attachment EP 20.h)
 Peer Review letters from Physician Chiefs (Attachment EP 20.i)
 Peer Review forms completed by two CNOs from Partners HealthCare institutions
(Attachment EP 20.j and Attachment EP 20.k).
 In her dialogue with the MGH President, she demonstrated:
 Achievement of 11 out of 14 PCS 2011 Strategic Plan tactics (Attachment EP 20.f). (The
outcomes of the 2011 PCS strategic plan are fully-presented in TL 3EO). Next steps
regarding the three outstanding tactics are outlined in TL 3EO.
 Achievement of MGH targets for performance for HCAHPs measures: nurse
communication and responsiveness (Attachment EP 20.g).
 Achievement of additional outcomes for initiatives including:
 Advancement of Lunder-Dineen Health Education Alliance in Maine
 Restructuring of International Patient Center, Sports Physical Therapy Center,
Chaplaincy, Interpreters and Volunteer Departments
 Launch of Hospital-Wide Patient and Family Advisory Steering Committee
 Advancement of Center for Global Health initiatives
 Progress towards PCS/Nursing fundraising target
 Implementation of Direct Care Patient Affordability initiative through development
of Innovation Units
 Overcoming data collection issues regarding Infection Control measures such as
VAP and Cauti rates
 Research grant submissions that are in review process
 Successful international nursing conference re: professional practice
 Advancement of Excellence Every Day philosophy and initiates such as regulatory
readiness preparation and addressing identified scope of practice issues of concern
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In addition, she shared completed peer review documents prepared by her Physician Chief
peers and CNO peers. Here’s a sampling of feedback that speak to the CNO’s effectiveness
as a transformational leader.

“She personally knows every nurse in the hospital and has been dedicated to improving their work life and
performance, and it has shown in the outstanding quality of our nursing care as well as in the statistically
significant low number of nursing vacancies in a difficult market and the equally low turnover rate of nurses
at our institution.” Chief, Department of Surgery

“Together we have worked on several important strategic projects for the Institution: The development of an
Ambulatory Surgery Center at the MGH West, the creation of the Sports Medicine Center, and a recent
safety project in collaboration with the Physical Therapy Department on fall reduction on the Orthopeadic
Units. Her contributions to these projects have been visionary, collaborative, and in all aspects, patient-
focused.” Chief, Department of Orthopaedics

“I usually sit with the CNO every Wednesday at the General Executive Committee Meeting of the MGH.
The committee is composed of the Chiefs of Service, the President of the Hospital and the CNO. It is obvious
to anyone who observes this that she is held in the highest of esteem. She has been given tasks such as bed
deployment which could be a source of friction, but because everyone trusts her, it was carried out most
smoothly.” Chief, Vincent Obstetrics and Gynecology Service

“Notably when we asked to start a Nurse Practitioner program for the ICUs at MGH, the CNO was
extremely helpful in finding nurse educators to create the program. She ensured our success. A program has
now been initiated, with three NPs taking care of patients in our ICUs at MGH. We hope to hire many
more critical care NPs and the evaluation of this program documents that we have improved the overall care of
the patients.” Chief, Department of Anesthesia, Critical Care and Pain Medicine

“Her dedication to the hospital and to the clinical activities is unsurpassed and her leadership outstanding.
An example of her support for the staff was recently evident during one our major snowstorms; she was in our
main lobby early in the morning thanking the staff as they arrived.” Chief, Department of Urology

“After a recent tragic event at MGH which was publicized in the Boston Globe, the CNO made it clear
that she was assuming responsibility for the outcome as the Chief Nursing Executive. She shared her
experience with her peers and this provided all of us an opportunity to discuss how we see our roles as
“protectors” of the clinical practice of our Staff Nurses. Her ability to use this event as not only a learning
opportunity for herself, but for all of us, supported the environment of open collaboration and support. The
discussion of this event identified the need for all of us to assess the risks in our practice environment and
potentially saved additional lives.” Chief Nurse peer

“The CNO can be very bold when she feels strongly that current thinking should be challenged. She is
thoughtful and deliberate and understands the importance of developing a strong, compelling rationale for her
position. She is particularly skilled at anticipating the barriers and works to remove them in order to advance
change initiatives.” Chief Nurse peer

Looking ahead to 2012, the CNO shared the 2012-2103 PCS strategic goals (attachment EP
20.l) which were designed to be in alignment with the Hospital’s goals (TL 1 and TL 3) for 2012.
They also set mutually-identified Hospital-focused goals including:
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 Successful Joint Commission accreditation review
 Reduction in Total Medical Expenses (shared goal with rest of Senior Management
Team)
 Meet/Exceed HCAHPs Hospital targets for
 Nurse Communication
 Responsiveness
 Submission of Magnet Recognition evidence on October 1, 2012

Associate Chief Nurse
The Associate Chief Nurse’s performance appraisal process is directly linked to the
improvement of nursing practice through the strategic planning process. Every year, the goals of the
department and the strategic goals for the Hospital are shared with the CNO’s executive team. All
members of the team are required to develop their annual performance goals to support the strategic
goals for the department. The Hospital’s strategic goals requires the Associate Chief Nurse to work
across all disciplines and role groups and to understand and address issues in the larger healthcare
environment – health care reform, affordability and redesign initiatives – among them. Despite
those complex issues facing them, it is important to note that the CNO asks the Associate Chief
Nurses to begin their performance appraisal by asking them to reflect on the following question:
How would your employees evaluate you?
Utilizing the twelve questions found in Buckingham and Coffman’s book “First Break all the
Rules,” the Associate Chief Nurse is asked,
Would their employees agree that they:
 Know what is expected of them?
 Have the materials and equipment they need to do their work right?
 Have the opportunity at work, to do what they do best every day?
 Have received recognition or praise in the last seven days?
 Have you or someone else at work, who cares about them?
 Have someone at work that encourages their development?
 Have opinions that count?
 Know the organizational mission makes their work important?
 Have co-workers who are committed to doing quality work?
 Have a best friend at work?
 Have talked to someone, in the last six months about their progress?
 Have, in the last year, had opportunities to learn and grow?

The Associate Chief Nurse, whose performance appraisal serves as an example (Attachment
EP 20.m), thoughtfully reflected on these questions as described in her response below to the
question: Do my employees know what is expected of them?

“I believe they would say yes. We are fortunate to have in our Chief Nurse someone who is very much
committed to communication and sharing system-wide and institutional goals, and who from there works
collaboratively with our executive team in determining our priorities and goals. Those reporting to me benefit
from the information and stage setting they receive directly from the CNO as well as through me. I am told
that my communication style and expectation setting is clear and direct.”
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While we are comfortable in quantifying competency as related to a skill or task, the
challenge in evaluating competence in leadership practice requires agreement to what the leadership
competencies and behaviors are and how they are reflected in goal setting and achievement as well
as how others perceive the leader. Leadership, as noted in the performance appraisal, is an essential
component of all roles in Patient Care Services and is defined as “challenging the process, inspiring a
shared vision, enabling others to act, modeling the way and encouraging the heart.” (Kouzes and
Posner, 1995).
The leadership development competencies and behaviors that are a part of the performance
appraisal for all leadership in PCS to reflect on are:
 Enables and empowers others to act.
 Establishes collaborative relationships and promotes teamwork within and across
department/programs and areas.
 Transforms vision to action and strategy to reality.
 Recognizes, develops, implements and shares best practices.
 Inspires a shared vision and purpose.
 Thinks strategically.
 Seizes opportunities.
 Develops oneself.
 Acts with integrity and demonstrates ethical behaviors
 Communicates effectively.
Leadership demonstrates their competence in these skills through the following outcomes and
behaviors:
 A commitment to life-long learning.
 Fostering the release of human possibilities through education and life-long learning.
 Demonstration of courage when facing challenges.
 Fosters renewal to sustain and manage excellence.
 Demonstrates framing and re-framing skills to create possibilities.

The Associate Chief Nurse demonstrates her competence in collaboration, transformation of
a vision to reality and her ability think strategically, through her discussion on one of
her 2010-2011 goals: her work with the Department of Medicine Senior Vice President on
redesigning care in support of length-of-stay reductions. In addressing this goal she wrote:
“This has taken tremendous leadership and skill from me and from my team to help support this work.
Goals of 20% pre-noon discharges have been met and the Department of Medicine length-of-stay is the lowest
that it has been in spite of year (teaching program) and the fact that the CMI continues to go up. There is
much work yet to d; but, I am confident that with the pressure that Healthcare Reform exerts, we will
continue to make progress and that ultimately some of the lessons learned here will translate well across other
services as we look at organizational LOS.”

While the Associate Chief Nurse recognizes the success of the length-of-stay initiative, she
also recognizes that the work will continue and links this work to two of her goals for 2011-2012:
 Continue to provide leadership to the Department of Medicine length-of-stay and
capacity management initiatives to ultimately ensure compliance with DPH
regulations about ED occupancy.
 Co-lead broader institutional efforts to reduce length-of-stay and meet targets.
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As noted earlier, another way to evaluate competence in the performance appraisal is to ask
one’s peer to reflect on the same leadership competencies and share what their experience is
working with their colleague and identifying opportunities for improvement. The Associate Chief
Nurse asked a peer, who had recently joined the organization and had been mentored by the
Associate Chief Nurse, to address her leadership competence; the peer reviewer wrote on her
competence in “seizing opportunities”:
“She is a definite champion of new initiatives including recent projects such as reducing length-of-stay, reducing
readmissions and improving patient flow. She is a strong advocate for patients and staff during the daily
capacity meetings, challenges members of the group to review and revise current processes, and works with the
team to develop solutions to eliminate delays and overcome barriers. She recognized that the Code Help Policy
was an opportunity to facilitate improved patient throughput with the goal to improve quality, patient
satisfaction and access to care. She recently presented the Code Help Policy and implementation plan at the
Nursing Leadership meeting and did an excellent job communicating the goals, objectives and tactics to
prevent as well as respond to a Code Help situation.”

In addition to the above, the Associate Chief has included in her performance appraisal her
commitment to maintaining her leadership competence by attending educational sessions, serving as
a consultant as well as participating as a speaker at various forums addressing–health disparities,
ethics and physiological monitoring.
Of note, for the upcoming 2012 nurse executive performance appraisal cycle slated for
October 2012, the CNO has modified the performance appraisal form to align with the 2012
strategic plan (attachment EP 20.n).

Nursing Director
It would not be an understatement to say that the Nursing Director is the most influential
role in the hospital. They operationalize the CNO’s vision on their unit and they have 24-hour
accountability for practice, quality and safety on their unit and the professional development of the
Staff Nurses who care for our patients. As a member of leadership, the Nursing Director’s
performance appraisal addresses the key roles of leadership (Attachment OOD 17.i):
 Clinical practice
 Quality and safety
 Human Resource management
 Financial Management

As well as the key competencies of all leaders in PCS:
 Enable and empowers others to act.
 Establishes collaborative relationships and promotes teamwork within and across
department/programs and areas.
 Transforms vision to action and strategy to reality.
 Recognizes, develops, implements and shares best practices.
 Inspires a shared vision and purpose.
 Thinks strategically.
 Seizes opportunities.
 Develops oneself.
 Acts with integrity and demonstrates ethical behaviors
 Communicates effectively.
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In this section we will review the performance appraisal on two Nursing Directors including
their self–evaluation of their competence in the role, evaluation of their previous year’s goals, goal-
setting for the forthcoming year and the peer review.

Nursing Director A. Performance Appraisal

Nursing Director A.’s (attachment EP 20.o) unit moved to the new Lunder Building and her
response to that move demonstrates her competence in strategically thinking about what the move
will mean to the interdisciplinary rounds, which are critical to the teams’ ability to communicate. She
writes that:

“The interdisciplinary rounds continue to be successful. With the move to Lunder 9, this was a logistical
challenge. With support from the Teams we were able to implement “walking rounds.” This format of rounds
has been successful with our new environment. I have also been involved with the implementation of the MD
Rounder System. This has been successful for the unit and patients. It has increased MD/RN
communication and teamwork.”

She also recognizes that the Patient Care Associate (PCA) may not have always felt part of
the team and demonstrate competence in inspiring a shared vision and purpose by valuing their role
in patient care. She demonstrates this by reflecting on her work with them:

“I have identified that the role and practice of the PCA needs development. A unit-based PCA was
developed. With the move to Lunder 9, I was able to make changes to assignments and organization of
expectations and workflow. The PCA is a member of the team – they are part of team huddles.”

Nursing Director A. demonstrates competence in seizing the opportunity that the move to a
new location brought to build a better system to support collaboration between team members.
She is also reflective of areas where she wishes to improve her competence and develop
herself. In this instance it is in regards to financial management:

“I continue to learn the financial reports, budget and implications. I work closely with the Associate Chief
and colleagues in the Bigelow 10 Office to understand my FTEs and budget. The acuity and workload on Lunder 9
will be new data that I monitor closely. Balancing the staffing and budget is an ongoing process. I will seek to continue
to seek out resources as needed to manage and understand the financial responsibilities.”

Her competence in transforming the PCS Vision that “Patients are our primary focus, and the way
we deliver care reflects that focus every day” (OOD 1), is demonstrated in her commitment to creating a
safe and healing environment, as she states:

“Quality and Safety data including: NDNQI data, HCAHPS scores and hand hygiene rates, is a high
priority on the unit. These results are posted in the staff lounge and this data is reviewed and presented at staff
meetings. There has been ongoing education for the staff, fall huddles and self-learning packets. We are monitoring fall
rates and pressure ulcer rates closely. I am interested in having our data compared to other specialty oncology units.
Patient Safety rounds are an expectation for the unit. The RNs and PCAs are involved in this initiative.”

In reflecting on her past year goals, she evaluates her performance in another core leadership
competency “creating a shared vision and purpose.” As noted, she recognized that the move to the
new unit is a strategic opportunity for all staff to articulate the incorporation of the PCS and
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Hospital mission (OOD 1) as well as their own commitment to each other. She competently
achieved this goal by:

“Having two staff retreats this year; I hired an outside consultant to help facilitate the all day retreats. The
staff was able to discuss their vision and values for the unit. As a result, the vision and values statements
were set and they were a part of the unit. They discussed the value of teamwork and had honest conversations.
Setting my expectation, vision and wishes for the unit helped guide the staff, and understanding the staff’s
vision was also an important first step.”

Building on her previous year’s goals, Nursing Director A. looks to the future and her role in
creating a safe environment for patients and staff and the challenges of being an Innovation Unit.
These goals will continue to develop her competence as a leader as articulated in her goals:
 Continue to assess and positively impact the NDNQI scores and HCAHPS scores.
 Implement the Innovation Unit initiative.

Nursing Director A.’s competence in leading is evident in what her colleague writes as part
of her peer review. In the competency “transforming vision to action and strategy to realty” her
colleague writes:

“She has done incredible work in developing and implementing the inpatient NP program, which has been
highly successful. She was able to take an idea and execute the vision into practice. She worked with
administration and Physician staff to design the program; interviewed and hired competent NP staff;
developed an orientation program as some staff were not oncology focused; and, then guided the team through
the growing pains of implementation. As a result, this program is one that is recognized at a hospital level for
a decrease in length-of-stay and one that is patient focused.”

Her colleague, an experienced Nursing Director, knows the challenges that Nursing Director
A. faced and her skill and competence in bringing a vision of an NP service to reality. Her Associate
Chief Nurse, who has only worked with Nursing Director A. a short time, summarizes the
excellence of her administrative practice by writing:

“She is the new face of Nursing Leadership; she has a strong but gentle and approachable presence. You can
sense the camaraderie on her unit and that then translates to a partnership that her staff feel with their
patients and families.”

Nursing Director B. Performance Appraisal

Reflecting on the core leadership competencies allowed Nursing Director B. (attachment EP
20.p) to address her efforts to share best practice on quality and safety initiatives with her staff. She
reflects on her competence in this:

“I review with the staff the monthly safety reports. This is an opportunity for growth, to reflect on practice and
develop a blame-free environment. Staff Nurses have been encouraged to participate in walk-rounds at 6:30
am and interdisciplinary rounds at 9:30 and 10:00 am. Hourly patient rounds are a unit expectation. Unit
infection control and hand hygiene rates are shared with staff. I have been working closely with the Operations
Manager to improve the unit cleanliness and responsiveness which has been challenging. The majority of the
unit’s clinical quality dashboard clinical quality indicators are within target. I work closely with the CNS on
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these issues and meet monthly with the unit Medical Director to discuss issues. The unit-based practice
committee continues to meet monthly.”

She also reflects on her competence in identifying strategic opportunities to decrease
length-of-stay and advance care redesign for this patient population:

“I have been able to develop collaborative relationships with nurses, physicians, and other healthcare
professionals. The focus at present is how to decrease length-of-stay, but also ensure that quality patient care is
delivered, and readmission rates do not increase. The Surgeons, Nurses, NPs, Physician Assistants and I are
reviewing protocols and jointly developing standards that will encourage patient discharges by 10 am.”

In her peer review, her Nursing Director colleague writes on Nursing Director B’s competence in
inspiring a shared vision and purpose:
“Nursing Director B has done an outstanding job leading her staff through change. Over the past years there
has been a change in patient population to oncology and medical patients. This change in identity for staff can
be challenging and disruptive to practice. She has gracefully guided her staff through this change and has been
visible and supportive to them. She understands the need for the unit to change patient demographics again
with the move of the oncology patients to Lunder and she is communicating and assisting staff through this
next phase with strong leadership and vision.”

Reflecting on her goals for the next year, Nursing Director B. reflects back on the previous
year’s challenges: unit cleanliness and being over budget on the use of PCA sitters by identifying two
of her six goals to be:
 PCA observer budget will improve.
 Unit cleanliness and staff responsiveness will improve as evidenced by HCAHPS
scores.
Nursing Director B’s Associate Chief Nurse, in his evaluation, reflects on her competence as
a Nursing Director by writing:

“She takes her leadership role seriously and clearly communicates expectations in a positive, professional, and
collaborative manner. She promotes the mission and credo of the organization and focus on patient-centered
care.”

Clinical Nurse Specialist
The annual performance appraisal process for Clinical Nurse Specialist (CNS) combines a
self-evaluation process, peer review based on the three domains of the role, and goal-setting in
collaboration with the Nurse Director. CNSs evaluation form address eleven competencies
including job knowledge, quality of work, accomplishment of goals and objectives, interpersonal and
communication skills, teamwork and cooperation, analytical skills, consumer relations/hospitality,
initiative and creativity, cost effectiveness, problem identification and solving, and compliance.

CNSs are asked to seek feedback from a CNS colleague in one of three areas:
 Program Development including the work completed over the past year in developing
clinical programs at the unit, service, or organizational level.
 Clinical Expertise including building a foundation of research and evidence based practice,
facilitating excellence in patient care through providing direct patient care, teaching,
coaching and mentoring