PERFORMANCE EVALUATION UNDER THE OPINION OF THE NURSING STAFF FROM A PUBLIC UNIVERSITY HOSPITAL

This study intended to know the opinion of the nursing staff of a public university hospital on the performance assessment process. Cross-sectional study with a quantitative approach, performed at a university hospital in the north of Paraná. The sample consisted of 70 participants, categorized as nursing assistants, nursing technicians and nurses from the inpatient units for adults and infectious diseases. For data collection it was used an adapted instrument. Data were analyzed using descriptive statistics. Most participants showed satisfaction with the performance evaluation, although, some subjects reported negative aspects, among them the moment of evaluation between pairs. It was concluded that the evaluation success is related to the meaning and satisfaction that the participant attributes to this process. When used properly, the performance appraisal provides benefits for both, for the institution and for the professional and personal development of employees.


INTRODUCTION
Hospital managers often face challenges to meet the demand of customers for standout services.When considering the quality of care as a result of human performance, management strategies are used, among them, the evaluation of worker performance, in order to promote their personal and professional growth and thereby increase the efficiency of the provided actions (1) .
In the international literature it appears that the performance evaluation system still faces challenges regarding the organizational context that, often does not provide a suitable working environment and can interfere with the performance of workers and in the implementation of methods to evaluate the professional globally, considering its specificities (2) .In Brazil, the difficulties are related to overcoming punitive, bureaucratic feature, characterized by repression and submission of the assessed individuals, particularly the nurses and their teams (3) .
In recent years it has been observed the efforts of institutions to reshape the performance evaluation in order to use it as a tool to stimulate professional and scientific improvement of the worker, relating to their identity and previous experience (3) .It is noted an educational and formative tendency, by which it seeks to empower the worker and seize this moment as an opportunity to reflect on the professional practice (4) .
Considering that the assessment does not represent the end of a process, but the means by which the manager may understand the strengths and weaknesses of the professionals who are part of their team, it is necessary to adapt the evaluation method to the reality of the institution in order to ensure their flexibility and ability to measure the performance of employees (4) .
The performance evaluation process subsidizes the diagnosis of training needs and Cienc Cuid Saude 2015 Out/Dez; 14(4):1403-1410 development of human resources besides personnel movement in the career plans of the institutions.It also contributes to the development of improvement strategies for quality of care, and to the organization and operation of nursing services (1) .
The results of the performance evaluation are used for admission, promotions, layoffs, relocation or staff transfer, training, warnings, personal and professional development, among others.Its use should be done with the utmost seriousness, competence and upon the use of objective criteria judgment in order to avoid subjectivity in the appraiser's decision-making (5)   .
It is noteworthy that the effectiveness of the performance evaluation is related to the experience lived by the employee during the evaluation process.The presence of an appraiser who values the participation of the assessed and establishes a relationship of dialogue favors the success of the evaluation (5) .
However, just so the evaluation systems become useful in promoting professional development, the institutions must implement a monitoring system and, above all, appreciate the discussion of the results between evaluator and evaluated, so that the employees identify their strengths and what need to be improved (6) .Getting to know the opinion of nursing staff on the evaluation process provides subsidies for managers to direct the usage of this management tool, and allows understanding the way professionals experience this process.
Thus, considering the importance of this theme for the management of human resources in health, particularly in the nursing field, this study aimed to know the opinion of the nursing staff from a public university hospital about the performance evaluation process.

METHODOLOGY
Cross-sectional survey with a quantitative approach, performed at a public university hospital in the north of Paraná state.
Sample calculation was carried out, with a 95% reliance interval and significance level of 5%, from a population of 100 nursing professionals working in the three shifts (morning, afternoon and nights), in the female and male adult infectious diseases inpatient units.These units were selected for being sectors with similar work processes, as well as its low staff rotating, which helps to analyze the review of the performance evaluation process.The sample should have been composed of 79 individuals, however, only 70 agreed to participate.Of these, 63 were nursing assistants and technicians, and seven were registered nurses; working in the morning, afternoon and night shift.
Inclusion criteria were: having statutory relationship with the institution, be working in the period of data collection and have participated in at least one performance evaluation since hiring.On the other hand, were excluded workers who were on leave and vacation while collecting data in addition to those that did not get back in touch to the researchers after three attempts.
In the institution under study, the performance evaluation occurs annually in three stages.The first involves the evaluation of the employee by the direct supervisor, being the only stage in which the participant personally meets the supervisor to fill out the evaluation form.The second, called in pairs, is done by employees belonging to the same section of work or playing activities in direct contact with the participant.The third stage comprises the moment of self-evaluation.The whole process is done through a computer system, being available for the participants a personal, nontransferable password, used for the participant to fill out the questionnaire and to have access to the received feedback (7) .
Data collection was done from September to December of 2011 through an adapted instrument by Brahm and Magellan (5) , designed to identify the opinion of nursing staff of adult inpatient units on the performance evaluation.It was chosen to use this instrument because, despite it not being validated, it is possible to achieve the objective of this study, besides it being intended for adult medical-surgical units, which were the surveyed services.
An adaptation of the original instrument was held, including six questions regarding age, participant sex, time being a nurse, daily workload performed at the time of data collection, number of jobs and the opinion on the Cienc Cuid Saude 2015 Out/Dez; 14(4):1403-1410 peer performance evaluation, amounting a total of 16 multiple choice questions.After the changes, it was performed a pilot test with nursing professionals workers from units/sectors not included in the survey in order to confirm the suitability of the questionnaire for the purpose of study.
The analysis variables included sociodemographic and occupational factors such as gender, age, professional category, time of performance in the profession and at the institution under study, number of jobs and daily work hours; besides the factors related to performance evaluation, comprehended by the interval since the last evaluation; review of performance evaluation process and review of the peer mode; on the conduction and attitudes of the appraiser during the interview, highlighted aspects during the evaluation, feeling during the evaluation process, assessment purpose and the level of professional motivation after the performance evaluation.Data were tabulated on an Excel ® spreadsheet and transcribed into the Statistical Package for Social Sciences (SPSS) ® version 20.0 for analysis of descriptive statistics, with the presentation of absolute and relative frequencies.
Survey participants were informed about the objectives of the study and those who agreed to participate signed the consent form to formalize the commitment.It should be noted that researchers and data collectors did not have any link with the study participants, and ensured there were no conflicts of interest.
The survey was conducted in order to ensure the compliance with the provisions of Resolution 466/2012 (8) on research involving human subjects, submitted to the Ethics Committee for Research Involving Human Subjects with a favorable opinion, as Certificate of Presentation for Ethical Consideration (CAAE) number 0130.0.268.000-11.
The daily number of work hours of more than half of workers (51.4%) was six hours/day.Beyond that (22.9%) participants had two jobs and two (2.9%) worked three jobs.
Regarding the time elapsed since the last performance evaluation, 39 (55.7%) workers reported having been evaluated in the last seven to 12 months and one (1.4%)employee who worked at the institution for over 21 years reported having participated of this process over 25 months or more.A large part (67.1%) expressed feeling satisfied with the assessment instruments used, however, dissatisfaction was indicated by two (2.9%) participants who had been working between one and 10 years, and one (1 4%) with 21 or more years of activity, as shown in Table 1.
Table 1.Frequency of performance evaluations and satisfaction of used instruments, according to the time of nursing staff activity in a public university hospital.Paraná, Brazil, in 2011.Performance evaluation should be done annually and continuously in order to allow monitoring professional performance, and to provide regular and constructive feedback to individuals and to encourage communication between evaluators and evaluated (6) .The absence of feedback practice can even trigger a suffering process for the individual, who longs for work recognition and looks for subsidies for his/her self-assessment (9) .

Time of activity
The long interval between the evaluations, as working time goes by, may be linked to the fact that, over time, the institution gets to know the characteristics, potentiality and weaknesses of the workers.Therefore, it tends to reduce the concern to carry out the performance evaluation process, making it less common (5) .
However, performance evaluation on a regular basis is crucial for the workers growth, as it can be used to plan their careers and it can be recognized as an important strategy to meet institutional goals.Thus, the absence of this practice can impair these professionals, in addition, the evaluation process provides formal subsidies for the institution on the work performed and its possible repercussions (10) .
It stands out that satisfaction about the used instruments may also be associated with the possibility of dialogue between the appraiser and the evaluated while the evaluation is being done by direct supervision, in which the contact with the supervisor can lead to improvements and advances both for the worker and for the institution.This factor stimulates greater participation of the individual in contrast to other models that restrict the participation of the evaluated (6) .
However, it is necessary to consider the fact that, over the years, workers tend to feel discouraged about the work organization so that it becomes a source of dissatisfaction as they get older (11) .In this sense, reviewing how to use the performance evaluation tools, according to the career time the employee has in the institution, constitutes an important strategy to reverse the negative concept associated with them (5) .
Most (72.9%) of the participants, at the evaluation time, considered their performance very participative.This result may be related to the way the appraiser conducts the evaluation, considering that the authoritarian posture can intimidate the worker, who tends not to actively participate of this moment (12) .
By adding the number of individuals little satisfied and dissatisfied with the peer evaluation, it was found that the majority, 42 (60%), fitted in this category.In this evaluation mode the worker may feel uncomfortable to be evaluated by a co-worker, or a member of the same professional category, who does not belong to their team.
Generally in society, and especially in the health field, interpersonal relationships are permeated by a dispute of powers, which occurs due to the accumulation of knowledge of the different professionals involved in providing assistance, influencing the behavior and individuality of workers (13) and it can be expressed through implicit competitions in the organizational context.In this sense, peer evaluation can exalt the relations of power present in teams, being necessary to seek strategies to manage the emotions resulting from this process and, above all, the dissatisfaction expressed by some workers.
It is noteworthy that, despite this dissatisfaction, the peer evaluation process constitutes an important management tool that allows full employee analysis from different views.The assessment carried out by members of the work team helps with accurate information about the way in which the worker has been developing his/her activities, and favors the sharing of best practices between workers in order to contribute to the professional growth of both parties (14)(15) .Thus, it is the role of managers to analyze the way this tool has been applied and seek for strategies to overcome the devaluation by the assessed individuals.
Regarding the conduction of the interview by the evaluator, adding the number of satisfied and fully satisfied individuals, it was identified that 53 (75.7%) fitted within that category, while 17 (24.3%)were least satisfied and dissatisfied.This reinforces the importance of the evaluator to adopt a flexible approach in order to allow and encourage the participation of the worker, as the evaluated feels insecure, unmotivated and cannot recognize the benefits of performance measurement when there is not an opening to discuss the measured points (6) .
It is emphasized that, in the evaluation process, the significance of the positive aspects constitutes an important tool to stimulate the performance of the individual in the institution.However, the negative aspects cannot be omitted because it is through them that are identified improvement points to be worked in the pursuit of professional development, which must be agreed jointly between evaluators and evaluated (5) .
In some cases, evaluators tend to make a positive evaluation of the worker not to be responsible for pointing and registering errors and deficiencies of the evaluated because this process is a formal record of the employee's performance.This practice can generate information that does not match to the actual performance, a fact that devalues the objectives of evaluations and undermines its purpose (16) .
The main feelings of the workers regarding the evaluation stage done by the direct supervisor were tranquility, reported by 45 (64.3%) participants; pressure, expressed by 14 (20%), and others, for example, the indifference and suffering described by six (8.5%) individuals.
It is emphasized that tranquility and dialogue are key elements throughout the evaluation process.Therefore, it is reinforced the importance of participatory assessments as a way to seek better results and to provide an exchange of experiences among the participants (12) .
However, despite occurring in a lesser extent, some workers reported feelings of pressure and suffering during the evaluation process by the direct supervisor.This reality needs to be analyzed by managers because it can directly affect and influence negatively the evaluation of worker performance, and the measures to be taken facing this process (6) .
It was found that 51 (72.9%) participants reported being motivated after attending the performance evaluation, among them 54.3% were women.However, for one (1.4%)female worker, this process caused discouragement, as shown in Table 2. Despite the educational trend and pursuit to overcome the punitive nature of performance assessments (4) , many workers still feel intimidated and strained facing this process, as stated in previous results.Therefore, it is noted that the negative imagery associated with the evaluation process is still present among these professionals and indicates the need to review the way it has been developed.
As the main goal of the performance evaluation 48 (68.6%) workers considered the professional performance; nine (12.9%) reported promoting; three (4.3%),corrective purpose, and only two (2.9%), the punitive character.This result shows how the evaluation process can benefit evaluated professionals and the institution, enabling organizational goals to be linked to individual interests of professionals (1,17)   .This way, it can be considered that the performance evaluation was incorporated as an instrument of the work process.The act of evaluating, inherent to human beings, has become a managerial resource capable of Cienc Cuid Saude 2015 Out/Dez; 14(4):1403-1410 promoting changes in the functioning of public institutions, used to identify weaknesses and provide professional development policies (17) .
Performance evaluation helps on the reflection of the organizing method of work and the skills and weaknesses of the employees who work at the institution (15) .Therefore, it must be based on organizational goals previously established as a way of promoting the performance and to overcome the bureaucratic and punitive character of the evaluation process (17) .
The data presented in this study indicated that most of workers recognize the performance evaluation as a positive practice, however, it should be considered that this process is complex because it involves financial costs, promotions, interpersonal relationships, beliefs, values and other factors.It is possible that employee satisfaction is also related to personal interests because of the possibility of financial and professional ascension (1.18) .

FINAL CONSIDERATIONS
The results of this study show that, despite most of the nursing staff feel satisfied with the performance evaluation, some of the assessed workers reported intimidation and negative feelings towards this process, in addition to being dissatisfied with the peer evaluation.The way of conducting the evaluator was also considered satisfactory for the participants, which reinforces the importance of the relationship between the parties for the success of the assessment process.
These results indicate the need to review the way in which this strategy has been applied in the institution in order to intervene in possible weaknesses.It should be noted that the performance evaluation is an important management tool for the diagnosis of worker performance from a perspective that differs from the power relationships between supervisor and assessed.In addition to that, when used appropriately it provides benefits, both for the institution as for professional and personal development of employees.
It is considered therefore that this study contributes to the advancement of scientific knowledge on the subject and the process of management of health services for providing information to managers, favoring the use of the performance evaluation as a management tool, combined with the institution's goals and development of the worker, in order to improve the quality of care.
It should be noted, as study limitations, inclusion of just the nursing team workers and one single hospital, which limits the comparison with other localities and to generalize the results.Therefore, it is suggested the conduction of further research involving a sample with different professional categories in order to extend the thinking on the topic and perspectives on the evaluation process theme.

Table 2 .
Motivation of the public university hospital nursing staff after the performance evaluation, according to sex.Paraná, Brazil, 2011.