Good Practice Guide to Performance Management for Nurses and Midwives in Victorian Public Health Services

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1 Good Practice Guide to Performance Management for Nurses and Midwives in Victorian Public Health Services April 2013 Andrea Shaw Shaw Idea Pty Ltd And Associate Professor Verna Blewett New Horizon Consulting Pty Ltd

2 Contents Introduction... 1 Purpose... 1 Principal Audience... 1 Context... 1 Overview... 2 Background... 3 Dignity and respect at work... 3 Nursing and midwifery work in the health industry... 3 Managing poor performance of nurses and midwives... 3 Definitions... 4 What is performance management?... 4 What is bullying?... 4 The differences between performance management and bullying... 4 Principles that underpin an effective approach... 6 Regular and timely... 6 Improvement orientation... 6 Confidential... 6 Reasonable... 6 Fair... 6 Unbiased... 6 Open and transparent... 6 Courteous... 6 Equitable... 7 Leadership... 7 Natural justice... 7 The Code of Conduct for Victorian Public Sector Employees... 7 Practices that support effective performance management... 9 Skill development... 9 Clear system and standards... 9 Supportive policies, procedures and systems... 9 Communication... 9 Dealing with the influences on workplace performance Access to support Evaluation and monitoring Process for effective performance management Initiating disciplinary processes Capabilities Newly Registered Nurses and Midwives Experienced Registered Nurses and Midwives Associate Unit Managers Unit Managers Directors of Nursing/Midwifery References Attachment 1 - Do we apply the principles for effective performance management?.. 17 Attachment 2 - Do we use the practices for effective performance management? Attachment 3 Professional development needs assessment April 2013 Page ii

3 Introduction Purpose This guide provides a framework for best practice performance management for nurses and midwives in the Victorian health system. Using the guide will lead to more effective performance management in the Victorian health system and contribute to a systematic approach to preventing bullying. It complements existing guidance to public health services in Victoria on performance management, particularly the State Services Authority s Talking Performance material. This guide answers the following questions: What is the role of performance management in preventing bullying at work? How can I deal with poor workplace performance in an appropriate manner? How should I respond to negative behaviour in the workplace? What should nurses and midwives with different roles do to respond to poor performance and negative behaviour in the workplace? Principal Audience Context The primary audience for this guide is public health services in Victoria, including key managers and other stakeholders involved in performance management of nurses and midwives. This guide was commissioned as part of the Department of Health s approach to preventing violence and harassment of nurses and midwives across Victoria. The guide: establishes a framework for dealing promptly with negative behaviour at work, before it becomes entrenched or persistent; and ensures that performance management contributes to a workplace culture that treats nurses and midwives with dignity and respect. The guide is not a substitute for public health services own performance management systems and processes. These should be prepared by services to meet their own specific needs. Rather, this guide sets out the policy framework within which performance management should be undertaken in the health system when the performance of an individual nurse or midwife has not met expected standards. It does not address ongoing human resource management processes for performance appraisal, review and development, although the same principles are relevant. April 2013 Page 1

4 Overview Attachments The guide consists of the following sections: Background describing the links between performance management and bullying Definitions setting out the meanings of the key terms used Principles establishing the principles that underpin an effective approach Practices setting out the practices that an effective performance management approach must incorporate Process outlining the key steps of an effective performance management process Capabilities specifying the competencies that nurses and midwives in different roles need to have in order to achieve effective performance management. There are three attachments at the end of the guide. They provide practical tools to help you assess what your health service needs to do to meet the requirements of this guide: 1. Do we apply the principles for effective performance management? 2. Do we use the practices for effective performance management? 3. Professional development needs assessment. April 2013 Page 2

5 Background Dignity and respect at work Nursing and midwifery work in the health industry Managing poor performance of nurses and midwives Effective human resources structures, processes and skills are essential to creating an organisational culture that treats people with dignity and respect. Clear job requirements, systematic performance management processes and organisational norms that do not permit rude and aggressive behaviour from staff and clients are critical to preventing bullying. There is reliable evidence that anything goes management styles that fail to fulfil such basic management functions are both a direct and indirect cause of bullying (see Skogstad, Einarsen et al 2007). Equally, lack of processes and clarity about performance management can also lead to acceptable performance management actions being misinterpreted and responded to as if they were bullying. There are specific features of nursing and midwifery work in the health industry that create unique issues that must be addressed to prevent bullying. As well as the standard risk factors that may exist in any industry, issues more prominent in the health industry include: The emotional content of the work and the heightened emotions of patients and their families; Acceptance of aggression and negative behaviour as just part of the job ; A model of health dominated by medical approaches that can devalue other skills, such as those of nurses and midwives; Allegiance to professional norms requiring consistently high standards of performance; and Features of work organisation such as high demand and low control that, amongst other things, make it hard to achieve personal aspirations for performance and to withdraw from difficult situations. In this context, taking steps to manage poor workplace performance of nurses and midwives can be challenging. Rather than performance management being seen as a method for improving performance standards, in such an environment performance management can be taken as a criticism of the performance of individuals. When both the process of performance management and the skills of those managing the process are inadequate, this outcome becomes more likely. When a health service does not use a sound and consistent approach to performance management, actions to address poor performance may be conducted in a manner that constitutes bullying. The consequences can include workers compensation claims and industrial relations disputes. April 2013 Page 3

6 Definitions What is performance management? What is bullying? The differences between performance management and bullying Performance management is the process of assessing and addressing the difference between required performance and actual performance in the workplace. The gap can be positive when actual workplace performance exceeds required standards. In this case performance management aims to recognise and support outstanding performance. This guide addresses how to deal with a negative gap, when actual performance does not meet the required standards of workplace performance. Effective performance management is a continual process of monitoring, observing and communicating with nurses and midwives to give them constructive feedback about their workplace performance. When there is a negative gap, effective performance management puts in place agreed strategies to bridge the gap. WorkSafe Victoria defines workplace bullying as: persistent and repeated negative behaviour directed at an employee that creates a risk to health and safety (WorkSafe Victoria, 2012). Negative behaviour includes actions such as: yelling, ostracising, belittling, blaming, invading personal space, verbal abuse, excluding or isolating someone, or assigning meaningless tasks unrelated to the job. In other words, negative behaviour is behaviour that a reasonable person would anticipate would victimise, humiliate, undermine or threaten the other person. Bullying occurs when negative behaviour is persistent and repeated, not a one-off incident, although such incidents must be addressed. While performance management processes can be challenging for nurses and midwives, as WorkSafe Victoria states: At times people may feel that their working life is unpleasant and that they are being inappropriately treated, but feeling upset or undervalued at work does not mean an individual is being bullied at work (WorkSafe Victoria 2012, p. 1). Giving feedback and managing performance is not bullying if it is consistent with the principles and practices specified in this guide. On the contrary, using a sound performance management process that treats nurses and midwives with respect and courtesy consistent with this guide can model respectful behaviour and decrease the incidence of negative behaviour at work. It can also help to improve professionalism and good clinical practice. Performance management is also an important strategy for preventing bullying. Health services have an obligation to respond promptly to deal April 2013 Page 4

7 with episodes of negative behaviour in order to prevent repetition and the possibility that bullying might occur. This will often involve performance management actions. April 2013 Page 5

8 Principles that underpin an effective approach The following principles create a respectful organisational culture and support an effective approach to performance management: Regular and timely Improvement orientation Confidential Reasonable Fair Unbiased Open and transparent Courteous Performance management must be a regular aspect of people management in health services and actions should be timely in relation to performance issues. In particular, performance management processes must be able to respond immediately to negative workplace behaviour: behaviour ignored is behaviour condoned. Effective performance management aims to improve performance, not to catch someone out. Where there is a negative gap between expected and actual performance, the performance management processes must result in a fair and just approach to raising, discussing and bridging the gap. Nurses and midwives must be confident that the issues and processes involved will remain confidential and not discussed or known in unrelated contexts. The State Services Authority (SSA) defines reasonable as: exercising sound judgment and taking a sensible approach (SSA, 2006). A reasonable performance management system uses sound evidence. By ensuring that your performance management system is based on the practices described in the next section and that all nurses and midwives have the capabilities set out in this guide, you can be confident that performance management is reasonable. The SSA defines fair as being just and working within commonly accepted rules (SSA, 2006). This guide sets out the rules that the Department of Health accepts as appropriate for performance management of nurses and midwives. An effective approach to performance management will identify and address any possible sources of bias or unreasonable assumptions. Any real or perceived conflicts of interest must be avoided. The standards of workplace performance and behaviour must be clearly expressed so that everyone can identify when performance or behaviour does not meet expectations. The processes that will be used to address poor performance or behaviour must also be clearly stated and known. There should be no surprises in how the system operates. Performance management discussions and processes must treat all those involved with dignity and respect. April 2013 Page 6

9 Equitable Leadership Natural justice The Code of Conduct for Victorian Public Sector Employees Standards of behaviour must apply to everyone there should be no double standards because of seniority, expertise or personal relationships. At the same time, the different needs of different individuals must be allowed for, e.g. language or family responsibilities. Performance management should not be a one size fits all approach. Effective performance management requires leadership from across the health service, especially by executives. Executives should lead by example, demonstrating respectful and courteous behavior. They should work to create a positive workplace culture with clear performance standards and a constructive process for performance management based on this guide. Natural justice means that the identified performance gaps and the performance management process will be clearly explained to the nurse or midwife concerned. The nurse or midwife will have a genuine opportunity to respond to these gaps. They have the right to be accompanied by a support person or a representative at formal performance meetings. The nurse or midwife will be made aware of how the performance management process will proceed and the consequences if the required standards of work performance or behaviour are not achieved and maintained. They will receive timely notice of any meetings or formal activities and their purpose. These principles ensure that performance management processes are consistent with the Code of Conduct for Victorian Public Sector Employees. The following table sets out the link between the values required under the code and the principles that underpin an effective approach to performance management. Code of Conduct value Responsiveness Integrity Impartiality Accountability Respect Leadership Human Rights Principles for effective performance management Regular and timely Improvement orientation Confidential Reasonable Fair Unbiased Open and transparent Courteous Equitable Leadership Natural justice April 2013 Page 7

10 Use the Checklist in Attachment 1 to help you assess what your health service needs to do to apply the principles for effective performance management and meet the requirements of this guide. April 2013 Page 8

11 Practices that support effective performance management An effective performance management system for nurses and midwives must incorporate the following practices, which will help apply the principles described above: Skill development Clear system and standards Supportive policies, procedures and systems Effective communication Implementing effective performance management requires that individuals have the skills needed to implement the process and to apply them in a variety of settings. This is particularly important for managers, who will need to be able to conduct the performance management process with integrity and discretion. The final section of this guide details the capabilities that are required. The system for performance management should be clear, including: Clearly expressed standards of behaviour for nurses and midwives at different levels of the organisation. Use the National Competency Standards for Nurses and Midwives and the capabilities set out in this guide as the basis for these The steps that will be taken to ensure all nurses and midwives receive timely and constructive performance feedback, identifying any causes of concern How decision-making will occur, ensuring that sound evidence is used and that nurses and midwives are informed promptly. The triggers that will initiate formal disciplinary processes, which must be undertaken consistently with the principles and practices specified in this guide How nurses and midwives are able to comment on the operation of performance management processes Record-keeping procedures and standards. As well as policies and procedures that set out specific requirements for performance management, other workplace policies and procedures are critical to an effective performance management system, e.g. training, recruitment processes, job descriptions, rostering and equipment. For example, an unclear job description will lead to poor compliance with relevant procedures. Everyone in the workplace should have access to information about performance management which ensures that they are aware of the required standards of performance and behavior. They must have the information they need to respond appropriately when these standards are not met. A variety of communication methods should be adopted in languages that are used in the workplace. April 2013 Page 9

12 Dealing with the influences on workplace performance There are many influences on workplace performance the behaviour of individual nurses and midwives is the result of a range of workplace procedures and practices. An effective performance management system deals with the range of determinants of performance, including: Conditions of employment, such as wages, access to leave, nonwage benefits, rostering; Resources in the workplace, such as equipment and procedures; Clarity about the requirements of the role; Expectations of behaviour, both formal and informal; Ability to do the job and access to professional development opportunities; Recognition and feedback about performance. An effective performance management approach examines all of the factors that impact on performance at work. It starts with the assumption that employees are trying to do their best at work. It does not start with the assumption or jump to the conclusion that an individual nurse or midwife is deliberately underperforming or behaving in a negative way. Access to support Evaluation and monitoring Dealing with workplace performance and behaviour issues can be challenging, both for those conducting and those subject to the processes. An effective performance management system provides support to all involved. Those conducting the process should have access to skill development and advice to enable them to perform at a high level. Nurses and midwives whose performance is being managed should have access to personal support, e.g. through professional development or an employee assistance program. Nurses and midwives also have the right to be accompanied by a support person or a representative at formal performance meetings. A systematic approach to performance management entails evaluation and monitoring. Performance management is a process of evaluation and monitoring of workplace performance. The performance management system itself should also be monitored and evaluated. Monitoring ensures that the integrity of the approach can be maintained and any concerns addressed promptly. Evaluation provides the information that allows the effectiveness of the approach to performance management to be assessed and strengthened. Process and impact evaluation should be undertaken, assessing both what has been done and what has been achieved as a result of the performance management system. Use the Checklist in Attachment 2 to help you assess what your health service needs to do to use the practices for effective performance management and meet the requirements of this guide. April 2013 Page 10

13 Process for effective performance management Health services should develop their own performance management processes to meet their specific needs, incorporating the following basic steps: Talking Performance provides more detailed advice and tools for each stage of this process. Initiating disciplinary processes A formal disciplinary process should only be initiated when: Agreed standards are not being met after the agreed period; Agreed actions are not being completed; or Misconduct or criminal behaviour has or is alleged to have occurred. Formal disciplinary processes must operate in accordance with the principles and practices specified in this guide. April 2013 Page 11

14 Capabilities All nurses and midwives must be able to contribute to and participate in performance management processes in their health services. To do this, they require certain capabilities, consistent with their workplace roles and responsibilities. These will vary according to their different roles and jobs, e.g. what is expected of a newly registered nurse or midwife will be quite different to the expectations of a Director of Nursing (DoN). For all nurses and midwives, though, the capabilities needed for effective performance management are consistent with the National Competency Standards for Nurses and Midwives (Australian Nursing and Midwifery Council, 2006). The National Competency Standards set out the standards of performance required to register as a nurse or midwife in Australia. These Standards specify the competencies for effective performance as a nurse or midwife. These competencies also reflect the necessary capabilities for effective performance management. This section sets out in more detail what the National Competency Standards mean in the context of performance management. Attachment 3 provides a tool for assessing the professional development needs of nurses and midwives so that they can effectively use these capabilities. Newly Registered Nurses and Midwives Newly registered nurses and midwives must be able to: Report unsafe or unprofessional practice or negative workplace behaviour when they observe it. Intervene directly when they observe unsafe or unprofessional practice and negative workplace behavior, if they feel confident to do so. Take appropriate action if they are the target of negative workplace behaviour. Accept responsibility for their own practice, ensuring they personally maintain codes of conduct and ethics, and actively participate in performance improvement and management activities. Identify barriers that impede their workplace performance and report these to their immediate superior. Treat colleagues fairly and with respect, behaving in a reasonable and fair manner, establishing and maintaining effective, collaborative working relationships with other members of the health care team. April 2013 Page 12

15 Experienced Registered Nurses and Midwives Associate Unit Managers Experienced nurses and midwives can be ward staff, or clinical support staff, such as nursing educators, or quality and safety coordinators. In addition to the capabilities of newly registered nurses and midwives, experienced nurses and midwives must also be able to: Use professional standards to promote best practice within the health care team and act as a role model for other nurses, midwives and members of the health care team. Act to eliminate negative behaviour in the work place. Support other nurses, midwives or health care providers who report unsafe or unprofessional practice and negative workplace behaviour. Identify and address barriers that impede their own or their immediate colleagues workplace performance, directly (within their capacity) and by reporting to relevant managers. Provide on the job training or mentoring to meet any skills gaps causing unsafe or unprofessional practice. Provide constructive feedback to nurses and midwives in their work group about their clinical practice. In addition to the capabilities of experienced registered nurses and midwives, associate nursing/midwifery unit managers must also be able to: Provide leadership in the practice environment by maintaining and modeling professional behaviour and fair treatment. Establish and maintain constructive working relationships with the members of their nursing/midwifery unit, supporting and encouraging nurses and midwives in their work group to continuously improve their clinical practice. Implement the health service s performance management system, according to their role and responsibilities. Monitor workplace behaviour and provide useful and timely performance feedback to nurses and midwives. Contribute effectively as part of the management/leadership team for the unit, communicating regularly with the NUM and other ANUMs. Respond immediately to negative workplace behaviour. Investigate and address the causes of unsafe or unprofessional practice and negative workplace behaviour, in accordance with the performance management system. Identify and address the workplace constraints on good performance by nurses and midwives, e.g. arrange training, access improved equipment, strengthen recognition mechanisms. April 2013 Page 13

16 Contribute to implementing and monitoring appropriate performance management plans with under-performing nurses or midwives. Unit Managers Directors of Nursing/ Midwifery In addition to the capabilities of associate nursing/midwifery unit managers, nursing/midwifery unit managers must also be able to: Promote team structure by actively participating and encouraging team members, establishing an atmosphere free from negative workplace behaviour Collect and assess performance evidence, demonstrating sound judgment and exercising appropriate levels of discretion Test the validity of any assumptions they make about the performance of nurses and midwives Address poor workplace behaviour on the part of nurses and midwives through appropriate processes, such as discussion, establishing performance improvement plans, disciplinary procedures Respond appropriately, immediately and effectively to circumstances that could result or have resulted in incidents of workplace bullying or harassment Develop, implement and monitor appropriate performance improvement plans with under-performing nurses or midwives. In addition to the capabilities of nursing/midwifery unit managers, directors of nursing must also be able to: Provide leadership and create a positive workplace culture in the practice environment by maintaining and modeling professional behaviour and fair treatment Establish clear standards for acceptable behaviour and inform staff about how they are expected to behave Implement the health service s performance management system Ensure that all nurses and midwives understand the expected standards of behaviour Develop, implement and monitor a professional development program for nurses and midwives to enable effective performance and to support achievement of relevant performance standards Establish effective systems to ensure that poor workplace performance and negative workplace behaviour are addressed promptly and effectively, with the assistance of additional support if required Take action to prevent nurses and midwives from being victimised for raising issues about workplace performance Monitor and evaluate the implementation of actions to maintain positive workplace relationships April 2013 Page 14

17 Review and monitor the operation of the performance management system to identify any patterns or trends April 2013 Page 15

18 References Australian Nursing and Midwifery Council (2006), National Competency Standards for the Midwife, Melbourne: Nursing and Midwifery Board of Australia (available on-line at Statements/Codes-Guidelines.aspx#competencystandards) Australian Nursing and Midwifery Council (2006), National Competency Standards for the Registered Nurse, Melbourne: Nursing and Midwifery Board of Australia (available on-line at Statements/Codes-Guidelines.aspx#competencystandards) Skogstad, Anders, Einarsen, Ståle, Torsheim, Torbjørn, Schanke Aasland, Merethe and Hetland, Hilde (2007), The Destructiveness of Laissez-Faire Leadership Behavior, Journal of Occupational Health Psychology, Vol. 12, No. 1, State Services Authority (2006), Guidelines: Fair and Reasonable Treatment, Melbourne: State Government of Victoria. State Services Authority (2012), Talking Performance (Second edition), Melbourne: State Government of Victoria. (also available on-line at WorkSafe Victoria (2012), Your guide to Workplace bullying prevention and response, Melbourne: Victorian WorkCover Authority. April 2013 Page 16

19 Attachment 1 - Do we apply the principles for effective performance management? Use this Checklist to help you assess what your health service needs to do to apply the principles for effective performance management and meet the requirements of this guide. Is performance management: Principle Yes/No Action needed Completed Regular and timely? Oriented towards performance improvement? Confidential? Reasonable, i.e. sound evidence, sound judgement, sensible approach? Fair, i.e. just and within accepted rules? Unbiased? Open and transparent? Courteous? Equitable? Built on leadership? Based on natural justice? April 2013 Page 17

20 Attachment 2 - Do we use the practices for effective performance management? Use this Checklist to help you assess what your health service needs to do to use the practices for effective performance management and meet the requirements of this guide. Does our performance management system incorporate: Practice Yes/No Action needed Completed Skill development? A clear system and standards? Supportive policies, procedures and systems? Effective communication? Steps to identify and deal with the range of influences on workplace performance? Access to support? Monitoring and evaluation of the system? April 2013 Page 18

21 Attachment 3 Professional development needs assessment Use this tool to assess the professional development needs so that nurses and midwives can apply the capabilities for effective performance management. If any nurses or midwives find that they are not confident using any of the capabilities, they should contact their nursing/midwifery unit manager or nursing educator to help them establish a professional development strategy to develop the required capability. Newly registered nurses and midwives Report unsafe or unprofessional practice or negative workplace behaviour when you observe it. Intervene directly and appropriately when you observe unsafe or unprofessional practice and negative workplace behaviour. Take appropriate action if you are the target of negative workplace behaviour. Accept responsibility for your own practice, ensuring you personally maintain codes of conduct and ethics, and actively participate in performance improvement and management activities. Identify barriers that impede your workplace performance and report these to your immediate superior. Treat colleagues fairly and with respect, behaving in a reasonable and fair manner, establishing and maintaining effective, collaborative working relationships with other members of the health care team. I m not confident doing this I can do this already I can help others learn this April 2013 Page 19

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