Registered nurse peer evaluation in the perioperative setting

AORN Journal, Sept, 2006 by Melanie B. Gentry

Yearly performance evaluations can be frustrating and can create anxiety both for managers and employees. Managers frequently have several reviews to complete within a short period of time. The number varies depending on the overall number of staff members to be evaluated and, in some facilities, with the variation in employees' anniversary dates. A manager also may be unable to actually observe each individual's performance on a regular basis, especially if the facility has a large number of ORs. As a result, managers sometimes have to rely on anecdotal information to complete an employee's evaluation. The accuracy of this information can be questionable, and this may be a factor that contributes to the frustration and anxiety managers and employees experience in regard to reviews. To address this problem, a perioperative RN at CHRISTUS St Patrick Hospital, Lake Charles, La, proposed the possibility of conducting peer evaluations to the OR manager.

Webster's II New College Dictionary defines a peer as "a person who has equal standing with another, as in status, class, or age." (1) In the workplace environment, this equality generally applies to educational background; job description; and to a lesser degree, experience. For nurses, "peer evaluation is a method by which the nurse evaluates the work of a peer, according to set evaluation criteria." (2) At CHRISTUS St Patrick Hospital, facility administrators and the director of human resources (HR) gave permission for the development of a peer evaluation tool that would substitute for a portion of the yearly performance evaluation. The RN developer of the peer evaluation tool relied on her own experience as a senior OR staff nurse and as an instructor and preceptor of novice staff members to develop the evaluation tool.

LITERATURE REVIEW

Several recent medical articles describe peer evaluation as a valuable tool in assessing performance. Davis found that peer evaluation, in addition to resident evaluation, was beneficial to obstetrics and gynecology residents in training. (3) Bryan et al concluded that implementing peer and self-evaluations enhanced first-year medical students' assessment skills. (4) Rosenbaum et al surmised that using a method in which medical faculty members evaluated each other resulted in both objective and reliable measures of performance. (5) When Beckman et al compared peer evaluations with resident evaluations, they found that peer evaluation yielded higher interrater and internal reliability than did resident evaluation of medical students. (6)

Studies performed of nurse peer evaluations are not as recent. Welch, however, concluded that a nurse peer review was a valuable tool because it increased professionalism, enhanced teamwork in a noncompetitive environment, and improved individual practice and the quality of care provided. (7) Sheahan et al determined that peer review among nurse practitioners can reveal charting deficiencies and identify risk management problems and continuing education needs. (8) In a third study of nurses, Vuorinen et al concluded that peer evaluation promoted professional development in nurses and furthered collaborative learning with peers. (2)

PEER EVALUATION TOOL REQUIREMENTS

It was necessary for the perioperative RN developing the peer evaluation tool to consider several factors. First, removing the entire evaluation process from managers would be inappropriate. Managers have information regarding attendance, tardiness, yearly goals, and perioperative record documentation to which the average staff person would not have access. A manager or an educator also has information about continuing education credits completed by a nurse in accordance with hospital and departmental standards. The presence of clinical ladder criteria is an additional aspect that a manager needs to consider during a performance evaluation. At CHRISTUS St Patrick Hospital, the tool developer decided that the peer evaluation should comprise 60% of a person's total evaluation, with the remaining 40% of the evaluation to be completed by the employee's manager. This decision was subsequently approved by the director of HR.

A second consideration in the development of the program involved the format of the tool itself. To be acceptable to the HR department, certain portions of the evaluation, such as the scoring scale, had to be consistent with the evaluation system already in use. This was necessary because merit compensation is determined by the outcome of the performance evaluation. CHRISTUS St Patrick Hospital uses a Likert-type scale (ie, a numeric scale indicating the degree of agreement with a statement) in performance evaluations, and it was relatively easy to develop a peer evaluation tool that also uses this scale. Using a Likert-type scale, the perioperative RN developer was able to create a check-off evaluation sheet that significantly decreased the time needed to complete the review. The format used for the evaluation was that of a modified nursing process, with the addition of items specific to the perioperative environment.