Evaluating the Performance of Nurses: A Multidimensional Approach Patricia M. This article describes the development—including content, structure, validity, and rellabilly—of the Six-Dimension ‘Seale of Nursing Performance (Six-D Seale), which consists (of a series of 52 murse behaviors grouped ino sx perfor- mance subscales: leadership (S items), critial care (7 Items), teaching/ collaboration (11 items), planning/evalua- ton (7 items), interpersonal relations |ommunications (12 tems), and professional developmen (10 items). The sale ‘may be used 10 obtain self-apprasals of performance, employer appraisals of performance, or perceived adequacy ‘of nursing school preparation for performance. The case is ‘made fr the consiruct and pragmati validity ofthe Stx-D ‘Seale, and all sx subscales are chown tobe highly reliable The instrument was found to be suitable for performance evaluation az well af a useful research tool HE Six-Dimension Scale of Nursing Performance isa product of a contract research project, Prediction of Successful Nursing Performance, awarded by the Division of Nursing to The Ohio State University Research Foundation. The project began in October 1974 and termin- ‘ted in August 1977, The general goals ofthe project were to: review critically the Iterature of the past ten years rela- tive to academic and clinica nursing performance, obiain current iaformation fom basic professional schools of nurs- ing about predition criteria in use by them, and evaluate the telative merits ofthese predictors for subsequent on-the-job performance of the schools’ graduates Background of the Study ‘One ofthe mast crustal elements ina national study ofthis type was the identification and use of a valid, reliable tol that accurately operationalized the vari smance.” Therefore, the research related to the prediction of succesful nursing investigators (U.S. Division of Nursing, 1977) The research staff expected tata nursing performance measure would be ‘elfen con ng bal fam a a 2 See le ae ‘ro ovate ad pest 6 ci 3 | Seen een, | | ae 2 | Seitenoammaeme, | # | g | tebe eemereme wl ow 2 | SERRA tate a | =e | scepter ne rn pre some 2 | Sooo Ae 4 Maiti ih candids of ptforutoe om 2 | Serer, S| ee ct ere cane 5 | ESE Sire i EE "nts whe mee gle ns ee yee a fm toe anc BN NOVEMBER-DECEMBER 1978 VOL. 27, NO. 6‘The sx subscales tht were developed using this analysis roczdure are: 1) interpersonal retions/commasicatons {GPR/C)—12 items, 2) ledership—fve items, 3) eitcal care (CC)~seven items, 4) teaching/colboration (1/C)— 11 items, 5 planing /evaiation (P/E) acre items, and 6) professional development—ten items. “The content ofthe TPR/C subscale reas to the ars's ‘chavo inthe areas of nterpersonal elo and eommu- ications with clients and colleagues ia the healthcare setting. Hemsin the leadership subscale relate to activities hich an individual would engage in executing a eadership funtion regards of one's specif jo te. CC tems relate to nursing setts associated with th cae af ery cially 1 individuls—incuding the potential outcome of death T/C subscale items describe behaviors in which ares exch clients and fails a well s thse descriptive of ealabor- tive efforts involving patents files and other health professionals who contribute tothe cents’ well-being. The Ai subsale, simple bythe name, contains items which ‘eat to the behaviors ivlved in planing and evaluation of the nursing cre of clients. The items foreach perfomance subscale and the factor loadings fr cach item for bth grads utes and supervisors are shown in Table I. No factor loading values are asiged tothe ten items in the profesional development subse. These items wee rat incladed inthe factor analysis because they are cocepvally dierent from the other mrs bebavos, beng “good werk items which would apply (with appropriate changes in termincogy) to “good workers in almost any profession or employment sting. Moreover, the resp chozes that ‘ete appropriate forthe cer 66 nurse behaviors were not Appropriate forthe ten profesional development items, 04 Aifereat sto sponse choices was wed. Scale Reliability. The measure of reliability which was computed foreach of the Six-D subscales was Cronbach's alpha. Alpha, considered a fairly conservative index, has ‘roved to be bound to true reliability (Armor, 1974). Az a ‘general measure, it has been shown to subsume the Kuder- Richardson coefficients as well ax most ofthe split-alf rei ability coefficients. Under certain cond ‘the Spearman-Brown prophecy index. ‘The alpha coeficients, shown in Table 2, range in value {rom a low of 844 forthe leadership/emplayer subscale 10 978 for the profesional derclopment/self subscale. The ‘unifoclybigh liability values ofthe Six-D subscales attest ‘to thelr potential wily fr assessing nursing performance ‘Scoring. One methodologic problem arose in determining 2 functional method for calculating a meaningful, easly iter- pretable score for each of the six performance subscales. The sales are of different lengths (from five to 12 items); not ‘every respondent was evaluated on every item if the behavior ‘was not one which was asocated with the type of job she had. A person's scale score should not be lowered beco her job situation didnot require the performance ofall the behaviors in that scale. Rather, the goal was to calculate & subscale performance score that reflected the level of perfor- ‘mance of those sale behaviors on which the nurse graduate was evaluated either by herseif or by her supervisor. The scoring formula devised to generat fai, standardized sub- sealeseores was ‘Table Reta Ett sf DN Peformance Suse fom Cada Salappins tad lore Aras ecw relia! gman 0 ‘ur pent inant the ember of ema nec uae In the formula, X,...X, = the numerical ratings given to the nurse graduate on each behavior in the subsoae; n= the total numberof items in the subscale; m= the number of sin the subscale for which the graduate was given no havior rating. This was actually an average of ratings on behaviors which were rated: since iis standardized, subscale scores may be compared between subscales of different lengits. Structure and Use of the Six-D Seale of Nursing Porformance Self-Apprasal of Performance of Nurse Graduates. In the ‘conduct ofthis stud, it was desirable to obtain data from the ‘ew nurse graduates regarding the frequency with which they performed the specified nursing behaviors, thei assess- ‘ment ofthe quality ofthat performance, ad their evaluation ofthe adequacy of preparation for those behaviors. There- foe, each surse graduate respondent was asked to respond 10 cach ofthe fst 42 items using thre rating sales. To asess frequency, they were asked: How often do you perform these activities in your curent job? 1) not expected at my level of ‘experience, 2) not applicable in my job setting, 3) never or seldom, 4) occasionally, 5) frequently. To asets quality, fraduates were asked: For those activities that you do perform in your current jb, how well do you perform them? 1) not very well, 2) satisfactorily 3) well 4) very well. To sss perceived adequacy of preparation, graduates were asked: How well di your nursing school prepare you for this activity? 1) not at all, 2) not very well, 3) satisfactorily, 4) very well Supervisors! Appraisals of Nurse Graduate Performance. Supervisors were asked to report the frequency and quality of graduate’ performance onthe nurse behaviors using the following rating scales. To asses frequency, supervisors were asked: How often does this groduate perform thse activites in her currat job? 1) not expected at level of experience, 2) ‘not applicable to job setting, 3) never or seldom, 4) oceasion- ally, 5) frequestly. To assess quality of graduates pefor- ‘mance, supervisors were asked: For those activities that this graduate docs perform in her current job, how well docs Ine/she perform them? 1) not very well, 2) satisfactorily, 3) well, 4) very well, a Seal for Profesional Derelopment Scale Items. As noted earlier, the concepual content ofthe lst en items— the professional development sale—differs frm that of the other 42 items, requiring fore, the following directive and responses should be used with these ten items: Please indicate the number tha best Aeseribes the frequency with which you (or nurse graduate sellapprisl (this graduate [fr employer appraisal or nurse NURSING RESEARCH‘graduate engage()in the following behaviors. 1) seldom or never 2) occasionally, 3) frequently, 4) consistently. (Ordering the Six-D Seale lems. The 52 sale items were ‘ouped by subscale in Table | for the convenience of the reader. In actual use, however, the items should not be grouped by subscale (except forthe ten professional develop- rent items). The number atthe eft of each item indicates the aumerial order in which all 52 items shouldbe placed for random ordering when the Six-D Seale is used as 0 research a evaluation too. Discussion ‘The claim forthe vat of the instrument as an appropri- ate appraisal of the performance of nurses in thet job ‘soting was based onthe congruence of the factor structures, of items between the responses of nurse graduates and their ‘employers and on the fac thatthe performance subscales did differentiate between the performance of graduates who had ‘ben predicted 10 be “high performers” and those who had not been so identified. ‘The Sit-D Scale is flexible. It may be used to obtain: 1) selfapprasals of the frequency and/or quality of nursing performance, 2) employer appraisals ofthe frequency and/or ‘quality of nursing performance, and 3) nurse graduates’ perceptions ofthe adequacy oftheir nursing school prepara- tion for nursing precice. The Six-D Seale also is easy to prepare, administer, and score. It requires relatively litle r © to complete and produces scores on six nursing specific imensions of performance. Each of these sx subscales was showa tobe highly celible. ‘The Six-D Seale coud be used to: ‘+ emify the elatve importance ofeach dimension in the fective performance of nurses in various elient-care settings ‘Evaluate the quality of performance of graduates as one element of evaluating a nursing schools program. ‘ Longtudinally assess the developmental patterns of pet- formance improvement among newly graduated nurses over their fist one or two years of practice ‘Stuy structural factors associated with congruence/ incongruence of nursing graduates’ self-apprisals and those -iven by their supervisors. "The SiD Scale is a useful instrument forthe further evelopment of a substantive body of valid information tegarding the most effective means of preparing, organizing, and evaluating perfrmance of nurse graduates ia adminis tering the highest possible quality of nursing care. Wt etoronces mgr Ty tg ag chen an re Seis Or Gite care aS PSE ay ey hae ae i aca fea nlc econ ee NUN i cadens ee ere eS em UR cae regen a te ace alt Ici ded ee de att TRS Sel eee (cece ia at GENore tiresl Onh eha Researcher's Bookshelf ste A_ Biomedical troduction, By Byron We. Browe, Jr and jes Halla er Wey Seria Prob and Mahe. ‘asl Stats) 436 p New York, John Wey and Sons, 1977, 3139 Arai ut caer Revd Beta " 7 ties book. ade eter, Sat 4 a tet rt seater erent seater 2 arate eee seca etic, Dea See oe ae ee adeate tent in varios Bo: pines The bak present tat {ea eonepi in appliedate han there {ai terms no mathematical knowledge be Sond calege algebras sored "Fhe bon conan solos on topics comm monly covered in intoductery feats ietuaing probaiiy sampling, cane ene inter, tndypthes stig The il prt eager, {ets er proportions carlton, fepresion, Deven J. VouceR, PHD. an asec Ate profesor, Sebo of Nong, Boston Unters, Boston, Masachusets, NOVEMBER-DECEMBER 1978 VOL. 27, NO. 6 sg ga ain ae inde. Tse tents meal reach, Ivo cape oh nk dia an a ch teron analyte metodo etsoed dae atop, more compet Fee thn the average ited sas ‘Salita procures or darted in a ‘ursary ante. Difcalt con fenls hich are central oa tsi understand fap of sats, icludng potbliy dt: butions in genial, the normal Stanord dota condence Intern an ire rm engl byes re reed wth eet erpin eeneero derstand tha ideas eri: oeo of ths book ara text would requires pet de of ‘ippcmestaryprepton of lsum ma {seth tocapin the sr hcp sec vey ed onl hgound wal have tobe provided ee theta of depth of explana stati sal powers in the Riotedtiincstn weary Interesting problems The suthos hve a iid an etvene es of recent, hove ooking. 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