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Tips for Improving Nurse Performance

Barbara Mayer, RN-BC, MS, PhD(c), for HealthLeaders Media, October 5, 2010

A nurse manager comes into your office and says, "Mary Lou just doesn't seem to get it. She makes mistakes and when I talk to her about it she gets really defensive. You need to provide some education for her." Is Mary Lou's performance issue really about lack of skills or knowledge? Or could it be something else entirely?

Staff development specialists (SDS) are often asked to provide education when nurse managers identify individuals or groups of employees who are not meeting performance expectations. Although lack of skill or knowledge can be the cause of under-performance, there are other causes that should be considered.

Because SDS' are neither staff nor management, they can engender trust among the staff and are in a unique position to investigate the root cause of performance gaps. This article provides SDS' with tools to:

  • Diagnose common causes of performance gaps
  • Formulate a plan to address specific performance problems
  • Identify metrics to evaluate the effectiveness of interventions

Don't all nurses want to do a great job? Of course! So, if they are not doing a great job they must need more education, right? Not necessarily, although education is often the "go to" tool in management's tool box. And when performance does not improve, SDS' are just asked to provide more education. This cycle can continue indefinitely if we don't step back and really look at the cause of the performance gap.

The Human Performance Technology model

Human Performance Technology (HPT) is "a systematic approach to improving productivity and competence, through a process of analysis, intervention selection and design, development, implementation, and evaluation designed to influence human behavior and accomplishment" (International Society for Performance Improvement, 2000). The goal is to identify and develop a set of interventions that solve or mitigate barriers to performance. HPT grew out of the instructional design field and is a valuable tool for SDS' in analyzing performance gaps and developing appropriate interventions.

Performance gaps

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