Job Responsibilities I Performance Objectives. Comments REGISTERED STAFF NURSE PEER PERFORMANCE EVALUATION

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1 REGISTERED STAFF NURSE PEER PERFORMANCE EVALUATION Please rate each Job Responsibility or Performance Objective using the following scale: (N) =Not Meet Standards - Below expectations, sub-standard performance consistently demonstrated (M) =Meets Standards - Meets expectations, standard performance consistently demonstrated (E) =Exceeds Standards - Exceeds expectations, outstanding performance consistently demonstrated Comments must be written for any job responsibility which is rated Exceeds or Does Not Meet Standards Job Responsibilities I Performance Objectives %Value Rating N-M-E Comments Provides continuity of care through timely reassessments and updated treatment plan. (Patient Care Delivery; Outcomes Measurement) Scoring Criteria N = Reassessments not consistently completed and patient and family and other healthcare team members not updated on treatment plan. M = Consistently reassesses patient and updates treatment plan. Includes patient and family in the plan and communicates with other healthcare providers. E = Collaborates with the interdisciplinary team members to facilitate a change that results in an improved outcome. 5.00% Collects and communicates patient data for determination of interdisciplinary needs. (Patient Care Delivery) Scoring Criteria N = Consistently demonstrates lack of documentation of interdisciplinary needs. M = Consistently meets standards for documentation and handoff communication. E = Consistently exceeds standards and makes recommendations to improve documentation and patient handoff. 1

2 Prioritization of care consistent with desired outcomes. (Teamwork; Patient Care Delivery; Outcomes Measurement; Resource Driven Practice) Scoring Criteria N = Has difficulty prioritizing patient needs and shift work load. M = Consistently able to keep up with assignment and/or communicates to peers the need for team assistance. Helps other team members when requested. Asks and accepts help from peers when needed. E = During surges in unit intensity, proactively helps other team members and demonstrates flexibility in assignments. 5.00% Adheres to hospital and unit/department policies and safety standards. (Leadership; Professional Nursing Practice; Teamwork) Scoring Criteria N =Does not follow hospital policies consistently. M = Identifies and reports possible deviations from safety protocols/procedures. E Identifies and reports deviations from safety protocols/procedures and participates in offering an EBP solution to identified problems. Demonstrates ongoing individual accountability to ensure positive quality outcomes (Core Measures, NDNQI Indicators, etc.) (Teamwork; Outcomes Measurement) 15.00% Scoring Criteria N = Unable to verbalize or has minimal to no knowledge of quality measures. M = Awareness of unit and hospital performance measures and goals for quality indicators and makes suggestions for clinical improvement. E = Actively participates on unit or hospital based committees to improve quality. Addresses peers and hold peers and self accountable for compliance with quality measures. 2

3 Supports nursing based practice. Practice). research and evidence (Professional Nursing Scoring Criteria N = Does not support nursing research and EBP as evidenced by not participating in the collection of data, completion of surveys, equipment evaluations, or posing clinical questions to be evaluated through research or EBP. M = Participates in two research activities. Examples include but are not limited to: literature search, literature appraisal, data collection, serving as nurse research intern, completing surveys from nursing researchers or employee, RN, Safety Surveys for SHS, doing research, assisting with manuscript or protocol writing. E = Meets requirements for a "M" score and has an approved research topic or is the primary presenter at the local, state, or national level. Seeks and supports opportunities for professional growth and development, which may include but not limited to contact hours, in-services, certifications, degree attainment, etc. (Professional Nursing Practice) Scoring Criteria Attains educational offerings annually, Hours: N=<lO; M=I0-19; E=>19. Provides feedback to healthcare team members through formal and informal I realtime communication to provide positive input, as well as opportunities for improvement. (Professional Nursing Practice; Teamwork) 5.00% Scoring Criteria N = Does not hold self or others accountable for actions. Does not tum in completed peer and/or self evaluations or does not meet stated deadline. M = Consistently holds self and others accountable for their actions. Returns completed peer and/or self evaluations in by deadline with supporting documenation for any N and E. E = Meets standards of a "M" score and provides non-anonymus collaborative peer review documentation to manager for annual performance appraisal. Supports shared decision-making by attending and participating in staff meetings and /or reading minutes of unattended meetings to remain informed.(leadership; Professional Nursing Practice) Scoring Criteria Staff meetings attended: N = 26%; M = 26-49%; E = > 50% or reads unattended meeting minutes N = < 49%; M = 50-99%; E = 100%. 3

4 Supports shared decision-making by providing feedback and/or participating on unit-based teams and/or SHS committees/councils. (Leadership; Professional Nursing Practice) Scoring Criteria Councils/Committees/Unit-based Teams: N = 0; M =1-2; E = > 2 or provides documented feedback to council/committee members N =0; M=l-2; E=>2 By applying principles of caring and healing Meets the expectations of all customers. (Caring and Healing Environment; Professional Nursing Practice; Leadership) Scoring Criteria N = Displays behavior that is not consistent with the organizations values. Consistently demonstrates disrespectful and negative attitude towards customers. M = Consistently displays an open, courteous, non-complaining, positive attitude towards customers. E =Proactively anticipates customers needs. Answers questions and problem solves customers needs. Utilizes service recovery options. 100% The following two questions require a narrative statement bv the peer reviewer: Describe your experiences in following this nurse's work assignment. Describe your experience in being assigned to the same shift as this nurse? Additional Comments: ~ ~~~~~ ~-.- -~ -- -~---~--

5 ----.~~ Attachment OO17g Registered Staff Nurse Peer Performance Evaluation Blank Tool SECTION Ill. THE SHORE HEALTH SYSTEM CARE COMMITMENTS This section reviews the team member's adherence to our CARE Commitments. Shore Health is committed to providing our customers with service reflecting dedication to our community with a positive attitude, respect, and service excellence. Please use the drop down box to rate each CARE Commitment according to the following scale: (N) =Does not Meet Standards - Below expectations, sub-standard performance consistently demonstrated (M) =Meets Standards - Meets expectations, standard performance consistently demonstrated (E)=Exceeds Standards - Exceeds expectations, outstanding performance consistently demonstrated Comments should be written for each CARE Commitment. A times B Weighted Value Performance CARE COMMITMENTS Rating REVIEWER COMMENTS N-M-E Community-we always work together as a team % We realize we are part of a larger group of people that we call our community. Our community includes all of the people we interact with each day. We care about the effect our behavior has on others. Attitude-put the needs of patients and coworkers ahead of self % We maintain a positive outlook when being challenged to take on new tasks and meeting everyday obligations. We keep our emotions from interfering with our work. Respect- we show courtesy and compassion to our patients and each other % We listen and respond with empathy. We accept the differences in people. Excellence- we deliver Exceptional Care Everyday % We bring a spirit of accountability, honesty, and commitment to every task undertaken. We exceed our customer's expectations. We maintain a safe environment for ourselves, our colleagues and our patients. Weighted value must equal 100% % 5 ---~---..

6 SECTION V: COMMENTS, OVERALL RATING AND SIGNATURES This section enables the reviewer and the employee to comment on the overall job performance and to sign that the process was completed. Performance evaluations must be approved by the next higher level of management of the person drafting the review. Evaluations that have not been presented and signed by the employee within 30 days of the review date, must be signed by the Senior Vice President and Chief Operations Officer prior to presenting to the employee. Employee Comments: Reviewer Comments: Signatures: Employee Date: Reviewer Date:- Management Review Date: Chief Operations Officer Date: 6