Saturday, March 20, 2021

Nursing Performance Evaluations


And furthermore, those black bobby pins securing 
your cap are most unprofessional. Use white pins!

Nothing exploits the fault lines of professional nursing quite like the annual performance evaluation. The assorted dynamics are varied, but always divisive; the young vs. the old,  BSN vs. diploma,  'Mericans vs. foreign born, neat fanatics vs. free spirits, and at the root of all conflict, the nurse office sitter academic/administrative complex vs. the lowly bedside nurse.  

The rigid, authoritarian nurse administrator doing the evaluation was once a member of the bedside nurse cohort but ascended the administrative ladder as a result of being totally unfit for direct patient care and also holding anyone who is good with patient care in contempt. Basically, it's a cabal of malcontented  busy bodies whose primary mission in the nursing world is proving their power and mettle at the expense of the lowly bedside nurse.

I love the optimism of  naive, young whippersnapperns who think it's possible to come out of performance  evaluations with an honest assessment of how they are  doing on the floor. Nurse Buff even has a blog post titled, " 8 Ways to Knock Your Performance Evaluation Out of The Park." Maybe things are different today, but in my experience, the nurse is far more likely to get knocked out of the park in this  nursing administration world of bureaucratic incompetence and legendary bullspin. It's a no win ballgame.

 The fur licking, scratching and hissing so common in nursing office settings is  like a magnet for administrative minded  folks. I once received an evaluation that noted I had zero potential for administrative advancement and considered that a high complement. Sitting in an office with these other worldly creatures  would have been like a prison sentence for me. Not everyone wants to climb the so called ladder of success when it involves joining the ranks of administrators.

One of the inherent problems with nursing evaluations is that good patient care is simply not narratable. Long time bedside practitioners develop a 6th sense based on pure instinct. I've worked with nurses who could smell impending death and could assess blood pressure without a syphgmomanometer by applying variable pressure to the radial artery. Long time neuro nurses can actually visualize that pre seizure aura and take appropriate action to nip the convulsion in the bud.  A good bedside nurse is indescribable, but you know one when you see one in action.

The philosophical bifurcation between administrative nurse and bedside care giver is enhanced by the use of lexicon hijacked from the business world. Office sitters have loads of time on their hands for the black art of word play.  In the age of corporate driven medicine the use of high minded sounding goobledegook has flourished. We have phrases like poor time management, customer service, inappropriate consolidation of resources, best practices, building consensus, core competency, paradigm shift, mission critical, or matrix structure. Wow, talk about a tower of Babel.

Here are few of my time proven strategies for dealing with nursing performance evaluations. The first rule is to simply avoid any specialty or area that has a high density of nursing offices. The operating room was a perfect refuge from office sitting navel gazers and misfits. There were no nursing offices in the OR suite and supervisors, like my long time nemesis, Alice, rarely sat down. Her evaluations carried supreme weight and her theory was "If  you don't hear from me, you are doing a great job."

 It's also good job security to excel technically so that your services are valued by the surgeons. That way you have an advocate from the top of the hospital food chain to back you up when the inevitable hits the fan. My favorite general surgeon, Dr. Slambow would body slam just about anyone giving me the business. I had earned his respect through our late night meetings over some gosh awful trauma that we usually  managed to turn the tide on.

Demeanor counts big when on the receiving end of evaluations, so  never, ever, back someone into a corner who is meaner than you, and that accounts for 95% of nurse administrators. Practice this one in front of a mirror. Your facial expression should assume a beacon of baptismal innocence when the dreaded document is being reviewed. Take some measure of control over the situation by signing the blasted thing and making a hasty exit with a broad smile plastered all over your countenance. This is a game you cannot win. Simply grin and bear it then rapidly forget all about it.

If nursing abomination administration genuinely wanted to improve patient care they would provide units with adequate staffing, pay nurses a livable wage, acknowledge circadian rhythms when scheduling, and maintain supplies of equipment to get the job done. Evaluations are small potatoes when striving for better direct patient care.

Although, I've tried to limit my tales of personal woe, there is one evaluation experience that will always haunt me. I was hospitalized with the mother of all Crohn's disease exacerbations and had not been able to eat for weeks. Thankfully,  hyperalimentation was initiated and as I was surrounded by beeping monitors and several infusion pumps a cheery, young nurse popped up at my bedside with news that there was a piece of mail for me.

How nice I thought, some kindly person from work was sending me get well wishes. Upon opening the envelope, I was dumbfounded, it was my annual nursing performance evaluation sent by Helene, my head nurse. I guess she figured that I was never going to recover and return to work so she might as well get it over with. Nursing can be a cold business and, yes, I did return to work just to spite her.


  1. "Zero potential for administrative advancement"is the best compliment I could think of for a nurse, OFRN!

    This post gave me the biggest laugh! Thanks mate, just love it when you really get cranky! Gorgeous. Cheers! Sue

  2. When I started this blog I promised myself there would be no belly aching (I love that term!) about personal health problems, but lately my joints have been driving me mad. I have Crohn's related polyarthropathy and I don't know which is worse the nastiness induced by unremitting pain or sheer lunacy induced by steroids!

    I'm so happy I was able to give you a good laugh. Sometimes laughter is the best medicine and in these times lots of things are indeed very funny.

    1. I feel your pain OF, I've been struck down with sciatica from a herniated disc for a couple of months now - agony! Chronic pain is the worst. One med gave me hallucinations. Am trying heat packs, mindfulness and distraction (I'm learning to play both guitar and folk harp - there are a lot of musical folk where I live now).

      I don't envy you the Crohn's - that's a horror.

      We have incredible floods here now - first the bush fires, then covid, now worst floods in a hundred years. I definitely needed that laugh!!! You take care of yourself, OK? Cheers! Sue

      PS: Oh, and we have a mouse plague here too. Something to do with the rain apparently. Horrendous! The cats here are very happy however!

    2. The Crohns was so much worse when I was a youngster with all the GI symptoms and problems. I abscessed several times after surgeries, but that part of the illness has been silent. It seems to have evolved to joint problems which is much easier to deal with than the intestinal manifestations. Sometimes aging has benefits in that you grow out of problems (at least that's what I keep telling myself!)

      Music is good therapy. I played trombone as a teen and it was a nice activity to distract myself from troubles.

      I hope your floods improve. We had a devil of a drought last Summer. It's too bad the weather can't even itself out. We could have used some of your rain.

      My neighbor actually had mice in her basement and treated them as pets-feeding them and taking care of them

    3. I draw the line at feeding mice in the basement OFRN! Ugh! Your neighbour should see the plagues of them not far from here - it's the stuff nightmares are made of! The floods are subsiding and everyone is hoping all the mice have been drowned...

      Trombone sounds like fun! And I don't envy you the joint pain.

      We have Brisbane in a three day lock down - we're not out of this yet! Have you all had your vaccinations there? Still waiting here! Sue

    4. We just received our 2nd Pfizer vaccination today. My wife has a bit of a sore arm, but I feel fine. The problem here is the spread of COVID variants and the unfounded relaxation of mask requirements. Some folks have the twisted idea that freedom means not caring if others get sick so they can unmask.

      Government officials are mandating masks for the same reason they restrict 10 year olds from driving-they are trying to save lives. What a sad state of affairs when personal freedom takes priority over the death of vulnerable people.

    5. We were fortunate here that we went into a hard lock down nation-wide very early on OFRN - and that, plus closing the borders, kept the covid numbers here very low, thankfully. We have one state back in mandatory mask wearing due to the UK variant appearing there - masks were mandatory nation wide during the lock down and pretty much everyone obliged, we didn't want to have here what we saw happening overseas.

      The vaccine roll out has been delayed due to a holdup obtaining it from Europe - I think people are slowly getting it done - the fortunate thing is how low covid numbers are here at all.

      I can imagine you are thankful to have the vaccine - I can't understand people objecting to wearing masks, it makes no sense at all! Cheers mate, and glad you and your wife have at least had your shots! Sue

    6. OFRN,
      It always seems as though when I speculated that you couldn’t raise the bar above past posts, you always do. Daughter is a cop, son a teacher. It would seem that many other industries miss the mark when evaluating the lowest on the organizational chart, those in the trenches.
      I am glad to hear that you and your wife have completed immunizations against the COVID19 pandemic. The unfounded relaxation of masking , as you so eloquently blogged, puzzles me as well.
      Back to your subject post, the divide between those that I would want at my family member’s bedside, and those nurses that have a nice office, grows larger every day.
      Reading your perspective helps me to keep rolling out of bed in the morning and show up to do the best I can. I don’t think I will ever be fluent in corporate speak, but you keep telling me that it’s okay. You have a gift.

  3. Thanks for your many kind words, Kathy. I read that evaluations post again and it sounds kinda on the cranky side. I must have been in one of my moods when I came up with it. Although it's true, it has a cynical tone which I should avoid in old age. It's best to remember the good stuff.

    Police officers have a very difficult row to hoe, Getting paid 70K a year to protect the interests of those who have so much more. On the face of it, it seems patently unfair, but life is like that. One of the ingrained mantras of diploma nursing schools was that life is not fair. We certainly had a front row seat to the proof of that.

    Thanks again for your uplifting comments!