1. Burns, Margaret K. MS, BSN, RN-BC, CCRC

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IT WAS LATE FRIDAY afternoon. Mary was trying to tie up some loose ends before a planned weekend off work. A few minutes before Mary's shift ended, she received a high-priority e-mail from her nurse manager asking her to stop by the office before leaving to receive her annual performance evaluation. She knew her evaluation was due as she'd already completed her self-evaluation, in which she included many positive details about her work that year.

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In the self-evaluation, she listed her activities to align with unit goals and the facility's mission. Additionally, she suggested several new projects that would facilitate the unit's work flow. Having received certification in her specialty area, completed her assignments in a timely fashion, used few sick days, and published an article in a peer-reviewed journal during the previous 12 months, Mary felt good about her work performance.


Unfortunately, a poor review awaited Mary, and her manager's remarks took her by surprise. Mary received low performance ratings in multiple practice areas. The themes of "not working well with others," "rudeness to staff and patients," and "a messy desk" were repeated multiple times. Shock and disbelief were Mary's predominant feelings. Except for the "messy desk" comment, she'd never been counseled concerning her work. Her manager refused to discuss Mary's questions about the evaluation.


Performance evaluations are an important part of every healthcare professional's career. Continued employment, raises, promotions, and career changes hinge upon the substance of these evaluations.1 Employees may refuse to sign a disparaging evaluation, but this does nothing to change the content.


This article, although focused on Mary's evaluation, also depicts several management issues. Although the manager's conduct is beyond the scope of this article, nurse managers have a responsibility to address performance issues in a fair and professional manner. Nurse managers can consult the Nurse manager's checklist for managing negative evaluations. Here are steps an employee like Mary should take to remedy an unfairly negative performance evaluation (see Nurse's checklist for managing negative evaluations.)


Ask for a copy

The written evaluation provides the structure for any rebuttal. Each disputed point needs to be reviewed and a counterpoint developed in the nurse's defense. In the heat of the moment, the nurse may not be able to articulate a rational response. Verbal exchanges during the meeting are easily denied or misinterpreted.


Stay calm

If the manager won't engage in a professional and factual discussion about the content in the evaluation, calmly and quietly leave. Don't engage in arguments or threats. Be professional.


If the manager is willing to discuss the deficiencies, listen to the examples of the unprofessional behavior. Ask for clarification of parts that are unclear. With the manager, develop a performance improvement plan, targeting the areas of contention and listing concrete activities to rectify these problems.2



Mary's manager and possibly some coworkers don't have a high opinion of her work. She feels attacked, devalued, and humiliated. Sometimes anonymous peer input in an evaluation can be hateful and false, much like cruel social media responses.3


Prejudices based on culture, ethnicity, and/or age may be incorporated into an evaluation. Putting poor performance characterizations in writing doesn't make them true. On the other hand, consider the validity of the remarks. Visualize situations where actions could be interpreted as less than stellar.


Practice self-care

Especially during times of stress, Mary needs to eat nutritious meals, exercise, and sleep at least 8 hours per day. Avoid alcohol and other mind-altering drugs. She should imagine she's training for a big event and wants to be in top form both mentally and physically.4,5


Talk to a trusted friend

This isn't the time to air grievances on the unit. Although such verbalizations can attract an audience, Mary may not receive emotional support from all her colleagues. In fact, some of them may have contributed to her evaluation. A close trusted friend or relative can provide some insight into the validity of the negative evaluation themes. This same confidant may affirm the positive, professional behaviors that Mary demonstrates.5,6


Avoid minimizers

In an attempt to help, some friends may want to minimize the situation using this approach: "Well, nobody died!" Mary needs to feel the emotions created by the evaluation. Flee from the confidant who wishes to trivialize the situation or only wants to talk about his or her own problems.


Document the facts

Create a quick list of strengths and weaknesses cited in the evaluation. After this task is accomplished, put the list in a folder for 24 hours. Return to the list, and create a professional, typed document citing behaviors supporting the positives and negating the negatives. Also, include professional accomplishments during the past year.


Consider behaviors that may have contributed to this evaluation. For example, does Mary volunteer for difficult patients? Does she accept changes in patient assignments? Is she a team player? Can she cite examples to refute negative comments about her performance? If she determines that her nursing performance is less than exemplary, she should develop an action plan to remedy the behaviors.2,5,7


Request a follow-up meeting

Schedule the meeting on work time. Request that you be given no patient assignments or urgent tasks during the meeting time. Allot 30 minutes for the meeting in a private, quiet place.


Come prepared

Provide the manager and others in attendance, such as a human resources (HR) associate or union representative, with copies of the evaluation rebuttal. This document refutes each negative point and lists professional accomplishments for the past year. The 2014 American Nurses Association Position Statement on Professional Role Competence is a helpful reference.2


Also acknowledge incidents that demonstrate a lack of professional behavior. If you acknowledge deficiencies, show a plan to eliminate them. Ask the manager for help and direction to correct these flaws.7,8


Request a revised evaluation

This current evaluation could be detrimental to Mary's pay, promotion, transfer, and continued employment. Ask for a revised evaluation that objectively and accurately reflects professional performance during the last 12 months.2


Move to the next level

If Mary's manager refuses to meet, discuss, and/or change the current evaluation, Mary needs to follow the institutional policies and procedures for the rebuttal of an evaluation.9 In unionized settings, steps to refute a performance evaluation are clearly delineated. A union representative often attends each hearing on the matter. An HR representative may be involved as well. Come prepared with the same document, illustrating exemplary nursing care for the group of management assigned to the evaluation dispute. Dress professionally and state the problems in a calm and logical manner.


Continue exemplary nursing care

Many eyes are focusing on Mary's performance during the evaluation dispute period. She needs to continue to provide exemplary nursing care.10


She should avoid any disruption of the work schedule such as late arrivals or sick days, volunteer for less desirable assignments, and limit conversations to professional matters. Document the exemplary care at the end of each workday. This activity provides concrete examples of performance. Avoid any patient identifiers in the commentary.


Mary's self-worth and self-confidence were shattered by the evaluation. She began using these mantras: "I provide excellent nursing care"; "What would Florence Nightingale do?"; and "This problem makes me a stronger person." She worked at abolishing negative self-talk, such as, "Everybody hates me!" and "I'm not a good nurse." Ruminating on negative thoughts only gives them more power.11


Time for a change

Is the current job promoting Mary's physical and psychological well-being? Nursing offers many career paths. Jobs exist where truthfulness and professionalism reign. Remember that no job, no matter how good, lasts forever.12,13 Don't make an immediate or rash change in a career path, but be open to change. Use professional meetings to network with other professionals. Periodically scan the job boards.


Resolving Mary's conflict

When Mary's manager refused to meet with her, Mary visited the HR department and stated her case to an HR representative. She brought ample documentation of her excellent practice. Within 2 weeks, a revised evaluation appeared in her e-mail. The only negative comment that remained was the depiction of her "messy desk."


Although wounded by this experience, and a bit cautious in future dealings with her manager, she's still able to provide excellent patient care in her current position.


Nurse manager's checklist for managing negative evaluations


1. Remember that performance evaluations are important records that influence employees' raises, transfers, promotions, and/or firings.


2. Deal with poor performance immediately. Behavior depicted in an employee evaluation shouldn't come as a surprise to the employee.


3. Always incorporate information (time, date, and description of the incident) to accurately depict the professional and nonprofessional behavior.


4. Counsel the employee privately, verbally and in writing, concerning professional and nonprofessional behavior. Initiate counseling immediately after the observed behavior and continue counseling as needed. Feedback should be ongoing and timely.7


5. Don't use suspect or unsubstantiated peer input.3


6. Provide the employee with time to complete a self-evaluation during work.


7. Provide the employee with the written evaluation several workdays before the scheduled evaluation meeting.


8. Schedule the evaluation conference during the employee's shift with adequate time for discussion, in a quiet, private setting. No other responsibilities should be assigned to the employee during the conference time.


9. Follow institutional policies and procedures regarding employee evaluations.


10. Seek management counsel regarding questions and problems with employee evaluations.2,6,14


Nurse's checklist for managing negative evaluations


1. Ask for a copy of the evaluation.


2. Calmly leave.


3. Take time to grieve the loss of an ideal self.


4. Practice self-care.


5. Discuss the evaluation with only a trusted friend or relative.


6. Avoid minimizers.


7. Document the strengths and weaknesses in the evaluation.


8. Request a meeting to review the evaluation with the manager.


9. Come prepared.


10. Request a revised evaluation.


11. Move to the next level.


12. Continue exemplary nursing care.


13. Consider a change.




1. Zhong EH, Thomas MB. Association between job history and practice error: an analysis of disciplinary cases. J Nurs Regul. 2012;2(4):16-18. [Context Link]


2. American Nurses Association. American Nurses Association position statement on professional role competence. 2014. [Context Link]


3. American Nurses Association. American Nurses Association position statement on incivility, bullying, and workplace violence. 2015. [Context Link]


4. Kravits K, McAllister-Black R, Grant M, Kirk C. Self-care strategies for nurses: a psycho-educational intervention for stress reduction and the prevention of burnout. Appl Nurs Res. 2010;23(3):130-138. [Context Link]


5. Lambert VA, Lambert CE. Nurses' workplace stressors and coping strategies. Indian J Palliat Care. 2008;14(1):38-42. [Context Link]


6. Keegal T. Poor performance: managing the first informal stages. Prim Health Care. 2013;23(4):31-38. [Context Link]


7. Hilton L. A poor evaluation-now what. Nurs Spectrum. 2004;16(6):42. [Context Link]


8. Pearson A, FitzGerald M, Walsh K. Nurses' views on competency indicators for Australian nursing. Collegian. 2002;9(1):36-40. [Context Link]


9. Koparde S. Is your job on the line? Progressive discipline and just cause. Ohio Nurses Review. 2016;91(5,6). [Context Link]


10. Vandewaa EA, Turnipseed DL, Cain G. Panacea or placebo? An evaluation of the value of emotional intelligence in healthcare workers. J Health Hum Serv Adm. 2016;38(4):438-477. [Context Link]


11. Johnson J, Panagioti M, Bass J, Ramsey L, Harrison R. Resilience to emotional distress in response to failure, error or mistakes: a systematic review. Clin Psychol Rev. 2017;52:19-42. [Context Link]


12. Estes BC. Abusive supervision and nursing performance. Nurs Forum. 2013;48(1):3-16. [Context Link]


13. Rodwell J, Brunetto Y, Demir D, Shacklock K, Farr-Wharton R. Abusive supervision and links to nurse intentions to quit. J Nurs Scholarsh. 2014;46(5):357-365. [Context Link]


14. Tolhurst BG, Bonner A. Development of clinical assessment criteria for postgraduate nursing students. Collegian. 2000;7(2):20-25. [Context Link]