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What are the steps for creating a culture that drives great nurse performance?


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Organizations do not achieve outstanding results by accident— they take a powerful, common-sense approach that motivates all employees to consistently do their best. Exceptional organizations apply an approach that promotes outstanding individual performance, called the performance pyramid. At its core, "the power of the pyramid" is a human resource management tool.

The performance pyramid model is a common-sense approach to creating a nursing performance improvement culture. Here are the steps to achieve great nurse performances: visualize these steps starting from the bottom of the pyramid (the largest part of the pyramid that supports the whole structure) and moving up through the various layers that make up the whole:

  • Appoint excellent nurses: If you start by bringing nursing staff into the hospital who are well qualified and competent, you improve your ability to reach the level of excellence you desire. Carefully selecting nurses requires solid screening systems, so it is important to create and maintain the highest possible standard for nursing.
  • Set and communicate expectations: The nursing department should tell every nurse, in writing, what is expected of him or her to achieve excellence. This is your opportunity to establish expectations for the type of nursing culture you want.
  • Measure performance against expectations: Once a hospital has established expectations and communicated them to the nursing staff, it must measure each nurse's performance against those expectations. The foundation of any successful quality program is the basic premise that measuring something drives improvement.
  • Provide periodic feedback: Feedback should be frequent and targeted. Ongoing feedback to nurses on their performances is essential and reinforces the expectations established by the organization. When nurses receive feedback in a timely and easy-to-follow manner, they will use it for self-improvement.
  • Manage poor performance: Nursing managers should not wait until the annual review process to address performance issues. Discuss such issues with the appropriate nurse as soon as concerns arise. Use appropriate leaders and mentors to help motivate the nurse to change or eliminate unacceptable performance.
  • Take corrective action: Nursing leadership must act when all of the steps outlined have been taken but a nurse fails to self-improve and her or his poor performance threatens quality of patient care. Nursing leaders must consult human resources or the appropriate authority before corrective action is taken.

--Laura Cook Harrington, RN, MHA, CPHQ, CHCQM

(October 2009)